Sara E.
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The nursing profession has to learn to work smarter and create innovative technology to decrease time-consuming, burdensome tasks. The increasingly hectic pace of stress and workload decreases professional nurse satisfaction. Also, the entry into nursing has also been inconsistent and schools are faced with a shortage of professors to lead the way. Below is a fictional story of how technology can improve nursing education and care, and consequently alleviate the issues contributing to the nursing shortage. A Perfect Morning I walked into the lavender-infused breakroom and poured myself a coffee from the automatic gourmet coffee dispenser. I just had to touch ‘Sara’s Java’ on the screen, and the perfect brew poured out into my favorite mug. I sat down on a comfy couch in the sunny and bright break room to peruse my 4-patient medical surgical assignment before greeting the night nurse for a report. I look at the interactive screen and see our charge nurse just clocked in, and I touch the screen to send a big smiley face emoji to all the staff on shift today. I log into my nursing tablet (only once for the whole shift!) to carry with me to document assessments, medication administration, and communications with the healthcare team. I schedule my lunch break on the device, where my device will be locked, and scheduled tasks equally divided among the other nurses online so I can have an uninterrupted lunch. I then order my meal on the device to be delivered right before my scheduled time. I am ready to start the day. Julie greets me with her infectious smile and says those magic words every nurse wants to hear: “This is a great group, everyone is alert and oriented!” She then details the plan of care for each patient at the bedside. Luckily, I have only one discharge today. I bid Julie good day, as she closes out her device, which automatically clocks her out for the shift. Morning Tasks Redefined I start my morning rounds. Each patient is wearing the new Vitality Patch, which is a hypo-allergenic patch applied to each patient when during admission to our unit. The patch wirelessly transmits vital signs and telemetry information into the chart. The vital sign information is color-coded on my device: green for vitals within normal limits, yellow for slight variations in vitals, and red for serious changes needing intervention. Next, as I perform physical assessments on each patient, I explain each assessment to the patient. This interaction is captured by voice-recognized software, and the assessment is entered into the appropriate sections of the EMR. All I need to do is to verify the information and validate it to ensure complete and accurate charting. The doctor has signed the discharge order for my patient, Mrs. Giggles, and I am notified by a buzzing on my device. The provider has already sent the prescriptions, which have been delivered via drone to the bedside. The patient’s interactive screen will review the discharge instructions, and I just have to verbally confirm that the patient understands the instructions. If not, I will provide additional education. Our electronic tram will pick her up to take her to her husband, who is waiting in the car outside. I wave to Ms. Giggles as she steps into the tram and enthusiastically thank all the staff who cared for her. Our hospital was the prototype for driverless trams, which are powered from medical waste, for patient transportation. Safety measures with cameras and voice-activated interventions are included. This reduced our need for people to transport the patients. The displaced transportation staff members have been trained and promoted to ancillary staff positions such as CNAs, surgical technicians, and respiratory technicians. The system has a 100% safety record, even with critically ill patients. I then start my morning medication pass. I notice Mrs. Friendly has an Intra-Body antibiotic ordered, as she was admitted with a foot infection. She does not have the access device in place, so I start the procedure. Intra-Body devices are a new invention that replaces intravenous applications. The device connects to the patient with a small prick and has a special infusion pressure that spreads the medication evenly, producing a better effect than the old-fashioned IV. The patient experiences much less pain than during the IV placement, and there is no chance for infiltration or extravasation. Ms. Friendly also has a host of labs to be monitored. I take a small vial of blood from her fingertip with the new Universal Pipette Tube (where a few drops of blood is all that is needed for all labs), and send the sample to the lab. I make sure the medication is infusing, and head to the next room. Next, I enter Mr. Congenial’s room and he states his usual pain medication does not seem to be working. I ask a few more questions, then query if he would like to try some new interventions. He is up for a change, so I begin some healing touch maneuvers on his lower back. I explain his positioning and decreased exercise may be the cause of this unusual pain, but I would let the doctor know as well. I further explain to him that our unit closed for a week, and our entire unit went on a Cruise to learn acupressure, reiki therapy, and therapeutic massage. We obtained a special certification to practice these alternative therapies. As a result, by applying the techniques to our patients, we reduced narcotic pain medication by over 75%. Mr. Congenial says he feels much better and does not have the groggy feeling he usually experiences with his pain medication. I shoot the provider a quick text about the pain, interventions, and patient response. My device rings, and I see the notification that Mr. Nice has a CT scan ordered. I hear the tram coming to pick him up, and I walk to his room to let him know the plan. However, his interactive screen in the room has already alerted him to the ordered test and played a quick review of the procedure. He stated he hit the green checkmark after watching the video indicating he understood and did not have any further questions for me. This, in turn, was documented in the patient education record with the care plan updated. A Fresh Look At Nursing School My CNA, Joe, has reviewed and validated all the vital signs from the Vital Patch system for the morning and completed his other tasks. We sit down for a minute to review his Nurse Master Plan work. Joe is in the universal nursing program and I am a mentor, so I can check off skills on his Nurse Master Plan. “The Plan,” as all the nursing students call it, is the new way nurses obtain licensure and degrees. Mentors check off skills, which can be done as a paid CNA. Students write papers, complete assignments, and take tests during their days off from work. Artificial Intelligence software adjusts the learning plan in real-time for the students going through the comprehensive program. Joe had difficulty grasping the concepts with the Intra-Body Device and had to spend a few extra days before he was able to move forward with the program. Student nurses can finish school at their own pace and gain intentional clinical experiences based on their specific needs. The professors and others going through the program meet weekly for reviews and discussions. When the program is completed, the student has a Bachelor of Science in Nursing. The NCLEX test is built into the program with the AI software, so that is the final step of completion when the program is finished. This new system solved the issue of the shortage of nursing professors. It also created a systematic and universal path of entry into the field of nursing. Gosh! It was a pretty busy morning, and I can see my lunch has been delivered. My device grows dim, and the breakroom is calling me for a refreshing repast. I will be able to return to my patients after having an interruption-free break, knowing my patients are being cared for during that time. This is a fictional account of how a technological shift can change the future of nursing practice. Comment with your innovative ideas! References Nurses' Experiences of Busyness in Their Daily Work Nursing Faculty Shortage in the U.S.: Has a pandemic compounded an existing problem?
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I was wrapping up all the loose ends of the day as my shift was winding down. I always like to present my reports about assigned patients to the oncoming nurse, like a package with a bow on top. On this particular day, I had a patient return to the floor late following a procedure, and I walked to their room to administer the subcutaneous heparin shot that was overdue. As I was giving the medication, my phone was both ringing for a call and buzzing with a telemetry alert. The patient’s IV pump started alarming “air-in-line.” The patient was asking for a soda, ice, and pain medication. My mind jumped with the interruptions, and so did my hand after I gave the shot while pushing the retractable safety device. It did not work, the needle instead went through my glove and stuck into my finger. Immediately I felt panicked. All of the alarms and voices went into blurry background noise, and I thought of what I urgently had to do. From the recesses of my brain, I remembered: “squeeze blood from the site, wash immediately” as I quickly and quietly performed these tasks. I sat down and collected myself taking deep breaths. I knew it was just a small poke, but it was an exposure to a patient’s blood and body fluids just the same. At that time of the evening, the charge nurse and the nurse managers had left for the day. I called the nursing supervisor, who directed me to complete the proper forms on our facility’s intranet. The reporting process was seamless, and luckily the patient was agreeable to having the recommended blood levels checked on my behalf. Then, as directed by the occupational health nurse, I waited for the results and silently prayed my patient did not have any communicable diseases. The Facts Instead of worrying, I decided to keep my mind busy by researching facts about needle stick injuries. The Occupational Safety and Health Administration (OSHA) estimates about 600,000 to 800,000 injuries per year occur to health care workers from skin puncture injuries. Nurses are the most likely healthcare professionals to obtain an inadvertent needle stick. The risks of transmission from a bloodborne pathogen are actually very low. If a patient is positive for the hepatitis C virus (HCV), the risk is 1-2% for contracting the disease, Hepatitis B virus (HBV) is 6-30%, and human immunodeficiency virus (HIV) is 0.3%. However, if the nurse has the vaccine for hepatitis B updated, the risk drops to below 0.1%. The risks are much lower if the injury was just a stick versus a full-blown cut. My initial research calmed my fears, understanding that the risks were minimal. The Law In 2000, Congress passed the Needlestick Safety and Prevention Act, which is a regulation that prescribes safeguards to protect workers from the hazards of sharp injuries. Additional regulations from this Act are outlined in the OSHA Bloodborne Pathogens Standard, which gives provisions for employers to maintain the prevention and care of exposure to body fluids. All healthcare agencies are required to have a plan in place for mitigating, reporting, and treating needlestick exposures. Each nurse should review their facility's policies and procedures around an exposure, so if it ever does occur, the process is already familiar and can be activated quickly. Generally, the reporting includes the time and date that the incident occurred, the circumstances, and the parties involved. The employer is required to test the blood of the exposed worker if desired, as well as the patient. The employer is obligated to make a confidential medical exam and follow-up guidance, which is mandated to be at no cost to the employee. Ten ways to prevent injuries Pay attention to the task at hand! Distraction was the reason I was injured. Never recap a needle. This is actually against the law! Dispose of needles in a sharps container, but make sure it is not overfilled as you risk getting injured by an inadvertent stick. Always use the safety devices. They are required by law to be provided by employers. Enlist another colleague to help subdue patients who may make sudden movements while using a needle. Use needleless systems whenever possible. Participate in bloodborne pathogen training. Ensure vaccination status for Hepatitis B is up-to-date, including a positive titer. Report the issue immediately if it occurs. Follow up with the occupational nurses if an exposure occurs for proper treatment. The Results My story had a happy ending. The patient’s blood test indicated they did not have HBV, HCV, or HIV. I continue to be thankful that I did not suffer a negative outcome from this potential exposure. Good health is the best present nurses can give themselves! References/Resources OSHA: Bloodborne Pathogens and Needlestick Prevention American Nurses Association (ANA): Needlestick Factsheet ISIPS: Needlesticks Overview
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Hi All! Currently, our system does not allow bedside nurses to have home/remote access to email. If a nurse is in Shared Governance, they can be approved, but not other nurses. Would you mind answering a few questions? Do you have access to work email outside of work? What are the stipulations (if any)? How many beds are in your hospital/or are you part of a large system? What state are you in? Pros and cons of getting email (in your opinion). We are required to read our email, and most don't have time during their shift. It is the most commonly thing asked for by our bedside nurses. I am chair of a corporate bedside nurse shared governance committee next year, and I'm going to bat to get the nurses email....thanks in advance for your help.