This month’s featured “Get to Know Nurse” is Kelly Hyde, a certified med-surg nurse at Oregon Health and Science University medical center. I got the chance recently to chat with Kelly about how she got started in her nursing career.
MP3 Audio Podcast
Jamie: Kelly, welcome to Nursing Notes Live. First off, I’d like to ask our Get-to-Know nurses what drew them to nursing. Why did you become a nurse, Kelly?
Kelly: Well, I was a civil engineer for about twelve years and really enjoyed that profession as I was kind of engineering storm water and drinking water systems to promote public health. But I really wanted to kind of pull back from that and do something that it was a lot more personable, working more closely with people and their lives and their individual stories. So I decided to go into nursing to kind of implement my critical thinking skills and those sorts of things with a more tangible effect, really, one-on-one.
Jamie: So you really were doing something that was really a public health role but not necessarily a healthcare role but just something that was affecting public health. That’s interesting. Had you known someone else that was a nurse or was this just something that just intrigued you when you moved into it?
Kelly: Actually, I kind of grew up in a healthcare-related family. My mom and my grandmother are both nurses. My father is a hospital administrator. So I kind of grew up hearing about healthcare around the dinner table kind of thing. It was something I was always exposed to growing up. Yes.
Jamie: Kind of the insider’s view you have with the administrator and everything else. That’s interesting. What drew you into Med-Surg nursing? A lot of nurses traditionally start in Med-Surg and then move into other specialties. But Med-Surg is a specialty unto itself, what kept you there?
Kelly: As a student nurse, actually, I did most of my clinical nursing in Med-Surg and I guess I just got lucky as I enjoyed my clinical placement so much that I decided to go with that as my specialty. I work on a surgical specialty floor for gastrointestinal surgeries and I’ve always been fascinated with the GI system and wound care. The unit that I landed on happened to be really doing some interesting in-depth kind of on the front end of things work with wound care and GI specialties. I just really enjoyed. I thought it was fascinating and decided to stay there. So that’s where I’ve been ever since I was a student.
Jamie: I hear that time and again from nurses who say there was a section or a segment of their clinical rotations in nursing school that resonated with them and that’s what got them into a specific specialty. I use that as a way to say, “Look, keep your mind open because you just know what area of your clinical might click with you.” Certainly, it seems like Med-Surg and, specifically, surgical and GI seemed to really click with you. What is it about wound care? Certainly we’re seeing a lot of more wound care issues with a lot of patients. Is there something in particular that you really enjoy?
Kelly: Well, I think there’s a lot of dynamics behind and around the wound care that are fascinating about how the wound came to be and how you get it to heal in terms of looking not just the wound itself but other things that are going on with the patient. Whether it’s pain or whether it’s diabetes like blood sugar control or nutrition or just kind of a multi-dynamic system that goes into healing wounds. There’s also a lot of technology involved. You have your basic dressing changes but you’ve also got Wound Vac therapy as well. So there’s a lot of different ways to treat and manage wound. I think it’s just the on-going and ever-evolving kind of subspecialty of Med-Surg nursing.
Jamie: What do you see the future in that role for nurses? I just read an article recently that talked about nurses fulfilling more and more roles as there are gaps in where physicians are covering parts of healthcare. Do you see nurses having a more active role in wound care as a primary care resource for that?
Kelly: I think so. I think not only in wound care but a lot of different elements within the healthcare field. I think that the notion like the definition of what it means to be a med-surg nurse is expanding because of budget cuts, because of nurses taking over almost more of practitioner roles. So you’re looking at more issues about like chronic illness, diabetes, pain management, even psych issues, and all of those come up so frequently in our med-surg patients that maybe prior in history may have been a little bit less complex. So there’s a lot more factors weighing in to how you practice nursing on a day-to-day basis.
Jamie: You have that civil engineering background. Do you bring some of that to your nursing practice? Is there something that you – as you look in how you practice nursing, you say, “Wow, this is a skill I picked up as a civil engineer that I’m transferring into nursing care.”
Kelly: Yes. Actually, I do. It’s funny because, as a civil engineer, I did a lot of project management, a lot of multi-tasking and managing various projects that varied in complexity. Each project have their own unique issues and I kind of mirror that, reflect that over to having a certain patient load and having to critically think for patients and advocate for them and work with their families just as I would have worked with contractors or other consultants kind of thing. So there are some parallels – sort of a stretch but in my mind it was sort of a good phase as I go lead in to nursing for me, so, yes.
Jamie: It makes perfect sense to me. There are many stakeholders in any public works project and there are certainly many stakeholders in the care of patients both from the healthcare side of things with our collaborative care approach that we’re seeing more and more but also in the patient themselves – their patients, their family members, the caregivers, the visitors, and just the dynamics of sending someone home. We were sending sicker patients home than we did ten or fifteen years ago because they don’t stay in the hospital as long. So you need to involve so many more people.
Kelly: Yes. [It’s] becoming a very multi-disciplinary approach to patient care – a lot of different players in the hospital that are involved in getting a patient ready to go home or on to their next level of care so, yes.
Jamie: What do you see as one of the biggest challenges facing medical-surgical nurses? I know there are sub-specialties in there but it is, I think, one of the largest areas of nursing care as a whole. What most people that are not around the healthcare setting all the time think of, when they think of nurses in the hospital, they think of med-surg nurse. So there’s a lot of history and maybe a lot of stereotypes that go along with that. There’s a bright future here. Certainly, it’s going to be a very busy field but are there some specific challenges that you’re looking at that may be coming down the road that you are paying attention to?
Kelly: I think there are a couple of issues that come to my mind. (1) You sort of touched on that, is that sort of the image of nursing. I think it’s something that a challenge and something that’s exciting at the same time. I think that nurses are kind of redefining themselves in their profession and their practice. They are becoming more leadership-oriented, more science-based than I think that they were in the past and so that they’re redefining what it means to be a professional nurse and defining their practice. So I think that’s kind of something that’s starting to evolve and it is becoming bigger, which is very exciting. And I also see issues coming down the road with healthcare reform and affecting a lot of what we do at the bedside in terms of promoting public health and nutrition and trying to get people off on the right foot so that they can be advocates for themselves out there in the world where healthcare and exposures to healthcare is limited. And I also see technology will have a big impact on nurses in the future too. Technology is always constantly changing with medical records, imaging, and even some kind of point-of-care bedside technology that’s coming up on the forefront. So you have to keep up with stuff all the time. [Laughter] So not only for med-surg nurses but I think all nursing specialties have to face all these issues.
Jamie: There’s a lot of things going on that have to do with, like you said, healthcare reform and the fact that the way that reimbursement occurs for patient care especially in things like med-surg where you are sending patients home and they can’t be readmitted for the same problem or the reimbursement for hospital-acquired problems. Certainly it’s going to change our focus and we’ve always – I think, nurses have always been at the forefront of improving patient conditions and stopping healthcare infections. That’s the basis of Florence Nightingale’s early work. There’s a problem there as well because I see a lot of nurses having less and less bedside time with their patients or at least saying they’re having less and less bedside time with their patients and we want to send these patients with more information and yet we’re also asking them to spend – the nurses to spend more time with them to do that and yet they don’t have the time to spend is what I’m trying to say. Do you see that as well or do you think that this is something that will get resolved through technology or through other educational resources?
Kelly: I would love to think that technology would make it easier but sometimes I think it adds more time than taking away from patients unfortunately. But there’s – it’s kind of an interesting question because I’m involved in a leadership project where I work here at OSHU. It’s based off the National Health Service out of the UK. It’s a product called “Productive Ward: Releasing Time To Care.” It’s a program that’s the staff-led initiative within a hospital to enable the nurse to spend more time at the bedside with patients and the program allows you to do that by streamlining workflow processes and reducing steps that it takes to get from A to B, streamlining procedures and equipment rooms and those kind of things. So I see those kind of initiatives sort of trickling into hospitals perhaps to try to meet that gap between healthcare reform and still wanting to provide good safe patient care to get us back to the bedside where we all want be truly.
Jamie: What about mobile devices? I really – of course, I’m a technology guy, it’s based upon what kind of work I do in nursing but I see a lot of possibilities from mobile devices like tablets – like the iPad – or the mobile phones and devices. I have to think – and this, of course, is something that I didn’t get the chance to do when I was in nursing school a few years back. But it seems to me that there’s an opportunity for the nurse to carry every chart in their pocket and not necessarily have to go back out to the station and do your charting like we do now or like I did in the past. Do you see that? I could see that being a really great tool to enable the nurse to spend more time in the room with the patient, just having that one-on-one time.
Kelly: I absolutely agree. I think that would be great. I think that, in that respect, technology has something to perhaps offer us to get us back to the bedside. Yes, definitely. Something more integrated so that you’re not having to waste time, like you said, going back to the nursing station to log in to the computer, checking on something that you can sort of have the information that you need at your fingertips to use it immediately when you need it. Yes, that will be great.
Jamie: Yes. We’ll have to just keep pushing for that. I think med-surg nurses really uniquely – because there are just so many med-surg nurses that seemed to be the one of the primary nursing specialties in numbers. I could see those nurses really being at the forefront of saying, “This innovation is needed.” Hopefully, that will continue to change.
Kelly: Yes, I agree.
Jamie: Talking about public health earlier and some of the things you were looking at in your engineering career. But certainly there’s a need to really focus on public health ever more as a nurse now. We’re sending these patients home faster. We need to really bring that holistic nursing view that we are supposed to have all the time. But I think we’re really focusing in on all of these different aspects because there’s so many things about patients now, all the co-morbid factors, that we are sending patients home that have all these chronic illnesses and they also have surgical problems, wounds that are still in the mode healing, so they are at risk for infection because of decreased blood flow from diabetes or obesity or whatever. The med-surg nurses pay attention to all of that.
Kelly: Yes. You’re absolutely [true]. There are so many factors that you have to look at before you send the patient out the door and along with that is assessing their level of education and their understanding of how much – you can teach them but you have to really assess how much they’re actually absorbing and that they have the resources to implement when they do go home. And it might, I guess, cause a resurgence in home health too to also bridge that gap to give patients a lot more support when they go home. So it seems like we kind of send people out the door and expect the best and then we seemed to be surprise when they are coming back through our doors as well – “We told you what to do. Why didn’t you do it?” So I think there are a lot of strides to gain in patient education and follow through when people go home and how to give them more support when they’re in their home environment.
Jamie: I see a lot of studies that I’ve seen over the last few years looking at this tele-nursing aspect of discharge patient care. The research that seems to point to the fact that just having a phone call a day or so after discharge and talking with the patient and the caregivers has a great positive effect on outcomes and on readmissions. Because, first of all, I think, we forget we’ve all been patients or had family members that have been patients before too and we all know how hard it is to pay attention to all those details and all those instructions right before you’re thinking about – “All right, I got to go get the car in the parking lot. I got to have money because I got to pay the parking garage.” All these little details that are going through your brain and the nurses talking to you about, “When you get home, do this. You need to go to the pharmacy and do this.” It’s no wonder that more patients still come back.
Kelly: Right. It’s just overwhelming. Definitely.
Jamie: It’s great to hear that you are proactive about assessing your patient’s understanding of things. That’s one of my pet peeves when I look at nurses in handling discharge and I know everyone’s busy but we’ve all seen that situation where – “Here’s your discharge instructions. It’s all written down write here. Sign here and we’ll get you on your way. I’m going to call transport.” And that’s discharge. [Laughter]
Kelly: Right. That’s not quite discharge.
Jamie: Well, that’s what passes for discharge in some places and it’s so frustrating because it doesn’t take that long to just take a few extra minutes and make sure the patient education is there.
Kelly: And so many patients are going home with a new list of medications they’ve never seen before. They don’t know what they’re for. They don’t know what side-effects are going to happen. They don’t know how to take them safely. There’s so much education to go home not only for self-care but for medication education as well.
Jamie: It sounds like you’ve been doing the right things. Now OHSU stands for?
Kelly: Oregon Health and Science University.
Jamie: Yes. It looks like a great program. I was checking out their website here before we got on the call and they seem like that’s a great program. You got your BSN there and you continue to work there. It’s fascinating to see all these great organizations for healthcare around the country and some of the initiatives they’re involved with. I love the project you’re working on that’s trying to model some of the things that the NHS is doing over in the UK.
Kelly: Yes. It’s fascinating to be part of that project. I believe that Oregon is one of the first state to implement that project and hopefully if it’s successful it will spread throughout the country. It would be a good avenue for increasing the patient care and increasing the job satisfaction that nurses have in general. It will be great.
Jamie: Kelly, I want to thank you for taking a moment to catch up with us. I know we kind of put this interview together on-the-fly in just a few days and I really appreciate you’re clearing up sometime to speak with the Nursing Notes Live audience and to share with them. Could you just maybe leave us with a final thought for that nursing student or that person thinking about a nursing career that is saying, “I might be interested in the nursing career as a med-surg nurse.” Would you like to share some thoughts on what they might want to pay attention to or things they might want to think about as they go through school?
Kelly: Yes, absolutely. I would encourage nursing students out there to at least do one clinical rotation in med-surg nursing even if it’s something you think you might not want to do because you may be surprised by what you come across. I think it’s a great arena to not only learn a lot of great bedside skills and to learn how to work in a multi-disciplinary setting but you are – I think you get a unique opportunity to become a really strong patient advocate that you might not get in another setting because of all of the on-going multi-sectorial issues that are going on with your patients. I would just really highly recommend someone to just check it out because I think there’s a lot under the surface that might not be immediately apparent that can offer a lot of opportunities for growth and leadership and experience and just be a great growth opportunity for anyone interested. I guess it kind of an honor to be a med-surg bedside nurse and be such a strong advocate for your patients and just see people go through their experience in the hospital and walk to that experience with them, be their advocate, be their educator, be a listener, just to encourage them and see their progress and kind of hopefully send them out the door with a new start on life and to have watched that patient go through that journey is humbling and inspiring and I think that a lot of people should just try to see if that’s a good fit for them especially when they’re in the nursing school.
Don’t forget to check out the entire November 2011 issue of Nursing Notes, featuring med-surg nursing careers. This month’s Nursing Notes newsletter highlights the growing recognition of the med-surg specialty, the necessary skills of a med-surg nurse and provides information on nursing scholarship opportunities. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month featuring a panel of med-surg nurse leaders and their insights into this nursing specialty. You’ll find this and other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.