Lessons Learned from NTI

As a newbie to AACN’s NTI (American Association of Critical Care Nurses, National Teaching Institute) I did not know what to expect; I certainly did not know how ‘big’ and overwhelming the conference was going to be. And inspiring. I cannot possibly list all the incredible sessions I attended, interesting, intelligent people I met, and information I learned. But I can tell you that being in a room with over 7,000 nurses aspiring to provide the best, safest, quality, evidenced-based care they can was exciting. Sharing success and challenges, heart-wrenching stories and uplifting accomplishments was both invigorating and frustrating. This is what healthcare is supposed to be – nurses committed to caring, compassion and excellence; living it, everyday. Isn’t this why we got into nursing in the first place? Because we care and desire to nurture and heal those who are ill or in need?

One of the highlights of the conference is the AACN president’s message. The current president inspired us and shared how we have “Act[ed] with Intention” as she passed the reigns to the incoming president who unveiled her theme for 2010: “Stand Tall.” So the question is what does it mean to “stand tall” as a nurse and how will I accomplish it? I challenge others as well to think about standing tall: doing the right thing, going the extra mile and striving for excellence. No matter how small the act or the intention, we as individuals can make a difference in each patient’s experience and that alone is cause for standing tall.

Building better care

Another interesting article (Physicians must become team players) on providing primary care and the steps it will take to ensure patients are cared for and each provider type fills their niche. And although cliche' it really is about teamwork and working collaboratively and complimentary of one another towards the same goal...quality & cost-effecient patient care.

Celebrate a nurse

Recently there has been a lot of discussion in the mainstream and healthcare media regarding ‘turf and title wars” between healthcare providers, namely physicians and nurses that has resulted in nurses being painted in a negative light. (Fox News Health Blog) Nurses have been characterized to be less intelligent than physicians, only going to nursing school because they were unable to get into medical school, that physicians are the only providers saving the lives of patients and nurses are merely task-masters and have no role in the recovery and outcomes of patients.

During this time of uncertainty within the healthcare delivery system, I find it incredibly demeaning and inappropriate that instead of looking toward common goals (patient care) that we are bickering about who is smarter, who has more education and who can provide care or perform what skill. Interestingly, the myriad of medical-drama television programs portray physicians frequently performing nursing roles with a disproportionately higher number of physicians to nurses.

There is no doubt that nurses are not content with the current system –an increasingly growing number of sicker patients in the acute care setting with less resources resulting in poor patient outcomes. Impending Medicare cuts (for both primary care and hospitals), an ever changing and evolving healthcare landscape and decreasing numbers of all levels and types of providers; this includes physical therapists, pharmacists and respiratory therapists just to name a few. Shouldn’t we be focusing on the current resources and collaborative practice?

Maybe the discussion we should be having is how can physicians, nurses, advanced practice nurses and all other care services provide safe, efficient, and competent care together?

With so many unknowns related to the healthcare reform bill, it is time to seriously look that the global impact that the changes are going to have on all providers and patients. We are all professionals and deserve to be treated with respect no matter education level or title we have.

It is time for nurses to let their voices be heard and re-educate others about the important role they play in providing safe, quality healthcare.

Happy Nurses Week to the 2 million strong and intelligent nurses across the country.

And remember to say thank you - they might just save your life one day!

Would you like fries with that?

I recently overheard a conversation in which a patient was berating the nurse for the temperature of the food on his tray and that he could not see outside his room from where he was sitting.

Disclaimer: I am huge patient advocate and in most cases will look at a situation from the patient’s point of view as they are most vulnerable and it is our responsibility as nurses to provide competent care, ensure their safety and preserve their dignity and rights in the process…however in this particular case, the patient was treating the nurse more like a waitress than a professional. The part of the conversation I encountered upon was only a small part of the patient-nurse dynamic that had been transpiring. The tone of voice and demanding attitude towards the nurse were inappropriate and belittling. She felt that everything she did was not good enough and was spending an inordinate amount of time trying to please him, meanwhile getting behind in her medications and patient assessments. This nurse handled herself with great poise and patience, yet he continued to be demanding.

Nurses are not waitresses. Nor are they babysitters or activity directors. Yet, much of a nurse’s shift is spent making sure the patients are happy instead of cared for. I understand that the role of the nurse is multifaceted and must care for the whole patient, however there comes a point when fluffing pillows and entertaining patients interferes with real nurses work – taking care of patients. The quest for patient satisfaction has perhaps swung the pendulum too far. I am sure some would argue that is part of a nurse’s job. I would however challenge that if nursing has truly become no more than providing hospitality services, then why do we expect nurses to be educated, make critical decisions, provide complex care and so much more around the clock?

I think this situation is a symptom of a bigger problem…entitlement. Everywhere people go, the customer is always right, the service must be outstanding, the product must be perfect and if not the right to complain about it is theirs. Healthcare is different and hospitals are not hotels. There is no room for social admissions anymore; beds are tight and resources are short. If you are well enough to notice the food is cold and want to see into the hallway to people watch you are most likely too well to be in the hospital (this a perfect example of healthcare waste) and would be better off going to Burger King where you can have your way.

It's a new day

and I am back...or at least I hope to be. I cannot believe it has been nearly a year since I last posted to my blog. So much has changed in these past 11 months, but wasn't hasn't changed are my passions: nursing/patient care and coastal living.

Stay tuned as I find my way back to the blogging world!

the right words

The five rights of patient medication safety include: the right person, the right drug, the right dose, the right route and the right time. It seems pretty simple enough. The last piece critical to medication safety is the right/write documentation. Not just because of the fact that if it is not documented it is not done, but if it is not documented what is stopping someone from giving the medication again.

I am continually amazed when doing case reviews at the lack of documentation. Besides the obvious legal peril that not documenting may leave someone in, the safety implications are often overlooked. And don’t forget the issue of payment and reimbursement. How can you bill for services that there is no record of? More than once I have I seen charges written off because after reviewing a medical record the “patient’s story” is not clear – there are pieces missing and the care that was provided, however appropriate and safe is brought into question because the proof is not there.

This does not just apply to nurses….physicians, respiratory and physical therapists, social workers, paramedics, and anyone who provides care to patients. A hospital defense attorney’s worse nightmare is to have to defend a hospital or provider using a chart that is missing notes and documentation. Documentation is just as important as performing the five rights.

Connect the dots. Close the loop. Write it down. Take credit for the care or treatment that was provided.

Of course, make sure what is written is both legible and spelled correctly.

Happy Birthday

May 12th, 1820 - August 13th, 1910

Nursing and healthcare have certainly changed through the years, but what hasn't changed is the impact of examing practice to improve clinical outcomes. Florence Nightingale was on to something all those years ago using science and statistics to effect patient outcomes; she positively impacted the face of nursing.

Thank you Florence.