Comment NOW on the Future of Nursing

Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

This is an opportunity for well written professional commentary to be submitted not vent your spleen pieces. Links to prior meetings and discussion at bottom of webpage.

Archived Webcast of the September 14, 2009 Meeting is available

See: Fulfilling the Potential of the Nursing Workforce

Ann Hendrich, Ascension Health

Improving healthcare delivery--Realizing the potential of nursing


Improving healthcare delivery (handout)

Leaders at Ascension Health and Kaiser Permanente conducted the Time
& Motion Study, a comprehensive, multisite study to identify how nurses in
hospitals spend their time, in an effort to find more time for nurses to provide
patient care at the bedside.

Only 7.2% of nursing practice time
is spent on patient assessment
17.2% of nursing practice time is spent
on medication administration
27.5% of all reported nursing practice
time is spent on documentation
Nurses spend 30.8% of their time in the patient rooms
and 38.6% of their time at the nurse station
A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their
Time? The Permanente Journal, Summer 2008, Vol. 12, No. 3, pp 25-34.

Proclamation for Hospital Change
In order to transform the hospital patient care environment and
improve the delivery of safe, high-quality, patient-centered care,
healthcare leaders must focus on:
Patient-centered design. Hospital and technology design should be
organized around patient needs – helping patients and their families
feel engaged in the caregiving process.
Systemwide, integrated technology. Architects and technology
vendors should work closely with nurses, physicians and other
caregiving departments in designing workspace and technologies in
order to ensure a systemwide approach to meeting patient needs.
Seamless workplace environments. The physical design of
medical-surgical units should be completely integrated with
caregiver work processes and the technologies they use, so
caregivers always have the right medication, materials and
information, in the right place, at the right time.
Vendor partnerships. The design and operation of technology
devices should be intuitive, error-free and part of interoperable
systems – so that healthcare providers can access information in
hospital or outpatient settings and not waste time serving as human
bridges that link multiple technology devices in different locations.
A Proclamation for Change - Transforming the Hospital Patient Care Environment, The Journal of Nursing
Administration, Volume 39, Number 6, pp 266-275.

What if the need for workarounds were eliminated
and nurses could spend the majority of their time
on patient care? Imagine the impact on cost,
quality and access

I wish there was something more nurse-friendly in the initiative! That need never changes, other than becoming more apparent when it's missing. No mention of continuing education means that "by-the-seat-of-the-pants" learning is meant to continue, as well as "intuition".

"Overcoming challenges" so health care reform will be successfully implemented, is the job of administrators, rather than staff nurses, although nurses' input must be considered and utilized, or the needs of patients' care will suffer. Nurses have become inbued with "critical thinking" for the last few decades (emphasis on critical), yet communication skills still have a backseat to other more mechanical skills.

Most human mistakes happen when communication is lacking. Have you noticed the way computerized menus talk? Without emotion. Yet humans are full of those, and the overlap all aspects of nurses' lives. Reading just a few threads at this website illustrate that. Positive approaches to problem solving require the skills of angels, and the tact of God. Muttering "the glass is half full", helps.
That's when humor enters the patient care arena.

I like to think of the above as the frame of a painting of the perfect nurse. Starting as one would when doing any assessment, the future perfect nurse would still be hatless, yet his/her hair really should stay on his/her head, without being in danger of contaminating any field, especially his/her shoulders.

Inside the cranium, it would be best if a good 8 hour stretch of frequent, long REM cycles have ocurred recently allowing clear thinking and accurate deductions. Food intake of nurses needs to be of the highest nutritional quality, free of chemical preservatives, specific allergens and loaded with roughage and fluids. Plans for each patient's care is evaluated and ammended if necessary to be easily accomplished within the time period given, with breaks worked in by assigning another staff nurse for that time. Delegated tasks and equipment checked as early as possible, and coworkers given positive reinforcement for work done well. All team members text information as needed, to each other.
New doctors' orders checked as transcribed to nursing care plan; and medications and/or equipment ordered by unit clerk. Dressing changes reviewed with LPN/LVNs for observed improvements or untoward changes. Monitoring devices for manifestations of pain and/or anxiety are checked hourly with interpretation slips placed in charts with recording of interventions and resultant relief or not, faxed to patients' physicians.
Surely there's something newer than that! Oh yes, when unexpected surgery is indicated, the necessary orders, chart pages, lab, X-ray, and oral intake and output records are entered automatically into the patient's O.R. specific virtual record which is transmitted along with all necessary preop procedures checked as indicated. Patient is placed on guerney securely by N.A.s who check ID bands, for transportation along moving corridor, to O.R. anteroom where acupuncturists will provide treatment for anxiety and best outcome through strengthening Xi. Patient is scanned for possible melanomas which can be removed during the surgery. Then informed consent can be signed by patient or their medical POA, utilizing signing apparatus so signature can be verified.
Following the surgery, PT will assure that optimal physiological adaptation occurs; and a chiropracter will check vertebral alignment for well being. Monitoring of pain reaction, wound temperature via sensor, with appropriate release of IV analgesia will be noted with vitals automatically. If there is a malfunction, IT will be notified by apparatus. Nurse will check lungs and listen for heart abnormalities, adjusting musical selections patient requested upon admission according to reactions observed.
Televised report on each patient with input by all members of patient care team along with current written care plan for the next shift is given next caregiving team. Adjustment to assignment of patients, utilizing time estimater will be done accordingly, before report is given; and new nurses given their assignments.
Nurses will be encouraged to describe any problems encountered, to persons who can make necessary adjustments for better communication/care.

Anticipatory specific patient care will ward off complications, thus reducing costs by averting complications. Checking wound temperature alerts staff nurse to possible infection; and he/she will take culture and sensitivity swab accordingly without necessity of doctor's order, before antibiotic is ordered.
Ah, one can dream......

Please share how you see staff nurses' decisions being "brought to the table". Which table? Where?

What I meant when I posted that, is that staff nurses need to make their voices heard to administrative nurses, who in turn need to present their nurses' input to non nurse administrators. We are closer to patients who have put off their medical care, thereby allowing their illness to worsen, requiring hospitalization without insurance, which requires the public's taxes to pay for much more expensive treatment. That's what most people who say they don't want to pay for others' health care, don't get! They are paying more now, than preventive care would cost.

Privately we can join action groups, go to town hall meetings about health care, etc. to inform the public about the increasing number of patients having advanced in their illnesses (of course taking care not to divulge information about patients that would identify them), due to lack of preventive care and monitoring of their disease.

An example of that is the diabetic who didn't think following a diet was that important, and now they've lost their foot, leg, etc. They can't work in the field they did previously, become depressed and often stay on disability (not because they're lazy, but because they haven't been able to see a future for themselves without their missing appendage). That is very costly!!! They're using tax dollars and not working to replace them. That information is something that will bring realization of the need for health care reform with a public plan.

Sounds like another coroprate, capitalist wax job if I ever heard one. Not one note along the line of, "improving salary or addressing specific working conditions that decrease the ability of the very people who make acute care work..."

This is a plan to make money by selling crap to hospitals. And like our computerized charting systems that are absolutely useless, ridculous, and impossible to navigate without countless hours of training, we are about to receive more "state of the art" garbage that only makes money for non-medical people.

Well, let's assume the metaphor was already well understood.

Ahem...

I'm also curious regarding how specifically this group intends to encompass or be 'involved with' or 'focused on' the issues that surround the staff nurse workforce. I do appreciate this OP. Good to know there are so many other healthcare disciplines actively involved in charting the future course of nursing.
Were the plain 'ole acute care RN's invited to sit on this panel provided the same anticipatory cautions about refraining from whine-a-logs, grammatical tragedies and other violations of accepted business decorum?
Oh, wait, there weren't any practicing bedside RN's invited.
My bad
Still can't wait to learn about our collective future, though.
Thanks again!

I hate to sound cynical, but these people do not want the opinions of actual nurses or their input. If they did, they would have included nurses in the panel. Thanks, but no thanks. I think writing a proposal that no one on that panel is going to read is a complete waste of my time and energy.