A look back at this year’s episodes, we pulled out some of the best statements about what nursing is and how we all can share our skills in a broader way with those around us, in both the facilities where we work, and our community at large.
MP3 Audio Podcast
Early in 2011 I chatted with a panel of Oncology nurses including Jackie Grandt, Program Director, Outpatient Oncology Services at Long Beach Memorial Medical Center in California. Jackie shared her personal experience of the importance of nurses sharing their skills not just with helping patients but also through mentorship and clinical education of new nurses and nursing students.
Jackie: How I got into oncology nursing was during the final rotation in nursing school on an oncology unit. It was during that experience that I really identified an oncology nursing that there’s many challenges and there’s many rewards. That was what I was looking for in my nursing career. I wanted to be challenged and I wanted to feel that – every day I was learning something new and definitely with what I’ve seen over 30 years on oncology nursing that that’s been very true. For our new person, I agree with you having opportunity to spend some time and rotate in that area while you’re in training is absolutely an excellent way. Also identifying people who are already working in the field then asking to spend some time with them and learning from them how they got into it and what they do on a day-to-day basis and even developing maybe some opportunities for mentorship if you decide to go into that area and get the support because oncology nursing and oncology treatment can sometimes be really overwhelming.
Along with mentorship is the importance of advancing your education and practice level as a nurse. As there is more and more focus on advanced practice nurses and the opportunities they might offer to improve health care systems nationwide, what opportunity and value is there for the patient care team to have access to resources like clinical nurses specialists. Susan Bruce, a clinical nurse specialist in oncology at Duke Raleigh Cancer Center in North Carolina shared her thoughts on why access to clinical nurse specialists is so important as “Change Agents” improving patient care and outcomes.
Susan: There’s a lot of ambiguity with the clinical nurse specialist’s role in whatever setting you are in. In periods of time, they’ve done away with the clinical nurse specialist only to find out, five or ten years later, it’s that long, “Boy, we really need those people back.” We do offer a value, I think, to the institution. We are a change agent. We help to make change occur. With nurse practitioners, the world’s pretty clearly defined, the nurse practitioners of these patients in the clinic setting every day or whatever. The clinical nurse specialist, I think, just really adds so much more. Who is going to bring the evidence to the bedside if it’s not the clinical nurse specialist? Clinical nurse specialists look at systems as a whole. How do we implement this in the system? Whether I have an idea that I think would work good in the outpatient setting, is it something that could be incorporated in to the inpatient setting to help those people as well both nurses of those patients. It’s about the collaboration, I think – extending that information.
But I really think we do have a very strong emphasis on keeping up with the evidence and ensuring that that gets into practice. I find that I’m doing that a lot in our setting, reviewing what standard of care is and how does that impact the way we practice. I see clinical nurse specialist is very essential in an organization be it large or small. I think other healthcare providers have a hard time seeing what we do because they don’t know what we do. They can’t articulate what we do and sometimes we can’t articulate totally what we do. But we’re good when you look at quality improvement processes. That’s one of our strengths, I think, is the ability to look at a process, see how it needs to be tweaked to being more effective. We know by taking care of population-based patients that we make a difference in health cost savings for the organization. Even though we can’t be like a nurse practitioner does in most cases, we do make an impact in cost-savings through those quality improvement processes and things of that nature. Who’s going to educate the nurses at the bedside, is the other thing. It won’t be the nurse practitioner that’s seeing patients in clinic because they don’t have time to do that. I think the CNS role is a great role to be in and I’ve embraced it and just looked at ways that I can make a difference within my own setting whether it’s through staff education or patient education and how that looks. I think we bring a lot to the role that other people don’t necessarily understand.
This was a recurring theme on the show as the expanded roles for nurses were discussed throughout the year. Nurse educators like Ann Mayo, Professor at the University of San Diego Hahn School of Nursing and Health Science are focusing on advanced nursing care as a key component in the future of how we care for patients. I asked Anne how she saw advanced practice nurses fulfilling the roles we had been discussing in a changed healthcare system.
Ann: Well, I think your question is just spot on. It is really critical that we get more advanced practice nurses out into the healthcare arena more than we’ve ever had before. We have an aging population. We have people coming into the United States who need healthcare. We see opportunities for advanced practice nurses in every setting, expanding their practice and taking on more in terms of being available for services to patients. We know that the advanced practice nurses in terms of nurse practitioners are looking at taking on more roles in primary care for example. How we see clinical nurse specialists coupled with that would be, as we get more nurse practitioners out in primary care, they will need some consultation in specialty areas around nursing care for patients. For example, patients who would be seeing in primary care and maybe diagnosed as a new diabetic patient, someone older who’s developed type 2 diabetes, the nurse practitioner is very capable in monitoring the care of such a patient but due to their broad focus and seeing many patients in a day in a primary care setting, may look to the clinical nurse specialist whose specialty area is diabetes to come in and assist with some of that management and definitely help with education and training of both the patient and the family members. As our population is expanding, adults were getting older, we see numerous roles for all the advanced practice nurses.
In fact, based on my conversations with other nurses this year, there are expanded roles and opportunities for nurses in almost every area of nursing care. Cyndy Krening, a perinatal nurse specialist at Littleton Adventist Hospital in Colorado shared some of her views on opportunities in her specialty when I asked her to speculate about the future of perinatal nursing.
Cyndy: Well, it is fun always to sort of dream and see what you think will happen. The wonderful thing about nursing is there is just so many opportunities to be in so many different kinds of roles. I’ve had an opportunity to be a flight nurse, an obstetrical flight nurse for high-risk patients that are being relocated from a rural or a level one facility to a higher level of care. I would see opportunities like that growing as our country try to regionalize health care and provide access to care for patients that are anywhere, rural or urban. There are also some roles popping up for high-risk perinatal nurse practitioners. There are a couple of nursing programs and units who have employed nurses who have received nurse practitioner educations specific to a care of the inpatient, the unstable pregnant woman in an inpatient setting. It’s a more of an acute care nurse practitioner role, which is also very exciting, just because we know it’s reformed that the advanced practice nurses are essential to our healthcare successes in outcomes. Those are a couple, definitely a couple of roles that are out there.
Even with all the expanded roles for nurses in every arena, the focus still remains on the patient centered care – a key value in nursing. Even in nursing specialties with a lot of technology to handle care, I was encouraged to hear the discussion continue to revolve back to making sure the patient was experiencing nursing care from every nurse they came in contact with. Nurse Anesthetists Terry Wicks, former President of the American Association of Nurse Anesthetists, and Nickie Damico, assistant professor and director of professional practice at the Virginia Commonwealth University Department of Nurse Anesthesia both talked about nurses not getting distracted by the technology and forgetting about the patient and their emotional needs in stressful and frightening situations.
Terry: Nickie, don’t you think that, as anesthesia professionals and have a nursing background, our focus is certainly on the technical aspects of what we’re doing. We’re plugged into blood pressures, and heart rates and EKG patterns and all that sort of thing, and fluid balance and all that. I was sort of taught early in my nursing career that we are advocates for the patients and that translates directly into the operating room. I feel like I’m plugged in mostly to those people from the moment I put my hand on them and shake their hand or touch their shoulder preoperatively. I engage them. I make it a point to do that. As healthcare has changed over the past several years and there’s more paperwork and more things to sign, and more checklists, it seems like the operating room nurses have been relegated to do that stuff. My focus still, from the time I meet the patient until the drugs start going to the IV, is to be plugged in to that patient emotionally, to reassure them, to educate them. That’s the most satisfying part of my job. Obviously, I love what I do in the OR and that’s very gratifying, as well, but when that patient wakes up and they see my face and they know that they’ve come through this comfortable and safe, that’s the rewarding part of that for me.
Nickie: Absolutely. I completely agree and I think that very often I describe my job as being very privileged. I’m privileged to have the role that I have in this process and to be interested by our patients to take care of them. To be able to be a part of that and to be there for them and very much to engage with them and help them through this very much with the technical things that we do and the interventions that we do in the operating room. But, absolutely, I think the most rewarding thing and the most valuable thing that we do for patients is to let them know that we care about them and that we’re there for them and that we will coach and help them through this whole process. Not just the other technical things that we do.
Nurses often feel privileged to be so connected to their patients throughout the continuum of their lives and this connection is an important reason for the expanded nurse’s role in helping patients and their families navigate the health challenges of their lives. In a health care system that doesn’t always prepare patients for all outcomes, nurses are among the most important agents for change in this system. Pamela Johnson, a certified Hospice and Palliative Care nurse and Director of Clinical Services at Odyssey Hospice in Pittsburgh explains how the system lost it’s patient care focus in favor of patient cure and how nurses are realigning that focus while preparing patients and families for end of life decisions.
Pamela: Well, I think in many ways we are to blame for this kind of system that we have created because what has happened over the last 50 years is the US health care system has focused on cure, on prevention of disease, on a belief that our medical system is infallible and it’s for every disease or problem that humans can have that there’s a solution to it. Therefore, we constantly see patients come in the hospital and families saying, “But, gee, grandma’s only 92 and everybody in our family lives to be 100.” Or the chronically ill person with heart disease comes to the ER and the family says that, “You always pull her through. The doctors are wonderful here. The nurses were great last time she was here.”
People have come to believe that death is avoidable, that every problem can be successfully treated and it’s a normal human response. We want to live. We want our loved ones to live and yet we now have gone full spectrum from early part of our history where people died of diseases early in life or most diseases were not treatable. That all that could be done was attention to their comfort. Then over 50 years we made this system where it seems like death is avoidable. With the current constraints on our health care we are having to realistically face the limits of what can be provided both in terms of when care that is aggressive and disease-focused no longer serves the patient well but also when it’s simply will be futile. These are very, very difficult things because everybody wants 92-year-old grandma to live a little longer and everyone wants to be cured of their liver failure or pancreatic disease, their end-stage heart disease. These are huge social issues but nurses play a vital role in helping patients and families understand treatment options. Nurses are vital in helping patients and families articulate their values and their needs. Nurses are translators. They take information that’s been delivered from a physician and others and make it understandable to patients and families so they can make best choices. But all of this is enormously complex and is really a reflection of society but fortunately nurses are in every system of care and are closest to patients and families.
Even systems of care outside of traditional health care facilities are impacted by the work nurses do each and every day. School nurses often provide the only consistent health care resource for many of our nation’s students. In addition to providing first aid and medication management, school nurses affect the long term health outlook not just for the kids they see each day but for their families and the surrounding community. I asked Sally Schoessler, Interim Executive Director for the National Association of School Nurses and Mary Ann Gapinski, President of the National Board for Certification of School Nurses how school nurses fit into the renewed focus on prevention before treatment in health care since healthier children in our schools become healthier adults in our communities.
Sally: Well, you really hit a nail on the head because so often when people are talking about health prevention strategies, they’re talking about things like colonoscopies for people over the age of 50 or when a woman should be having a mammogram. But we need to change the thinking back down to our children and our youth because when we can get the great health habits into our children, we’re not going to have to be worrying about the prevention strategies in middle or – let’s stick with middle age, I’m in that age group, I’d like to leave it at that age how – but the Department of Health and Human Services has just released a National Prevention Strategy and we just need to keep making sure that our voices are heard talking about the value of prevention for our children and youth.
Jamie: And Mary, you’re involved in public health in Massachusetts I believe but is there a real importance to have a more of a nursing representation in state and federal public health agencies to make sure that nursing focus is maintained there?
Mary Ann: Oh, I think it’s essential. You’re talking, as Sally said, with the future of our country when you talk about the children and the care. And primary prevention is going to become a major issue in our country when we try to begin to control healthcare costs. How does that begin but with education, children at the earliest ages? Who’s doing that in schools but school nurses? This is going to have a huge impact. We are already seeing this in again in Massachusetts from a public health point of view with our obesity initiative that our school nurses are involved with. We have already seen changes in BMI points coming down in these schools where school nurses have initiated programs for not only good nutrition but physical activity, doing parent and community education around these issues, working with the local pediatricians and other healthcare providers in the communities to look at this initiative. This is all primary prevention beginning at kindergarten and even earlier in those schools that have pre-school children that they work with. We’ve already seen it here in Massachusetts and the impact – and school nurses have been the leaders of that ever since we’ve begun these initiatives.
Nurses are giving back to their patients, the nursing profession, health care systems, and their communities in so many ways. It’s my goal here at Nursing Notes Live and in my other programs that I continue to draw attention to how nurses and other health care professionals are constantly working to improve so many parts of our lives. I invite you to continue to join us here at Nursing Notes Live throughout the next year as we continue to shine the light on the amazing care that nurses provide.
I think the best way to wrap up this episode is to share something Mary Anne Kenyon, Nursing Director for Orthopaedics at Brigham & Women’s Hospital in Boston said when I asked what being a nurse meant to her.
Mary Anne: Well, for me, I’ve done the whole journey. I started here as a staff nurse. I was a clinical educator and have done the director for several years. I think the most exciting thing for me is still the patient contact. I may be pulled away to meetings and things like that but I try to be on the floor for a significant portion of everyday. I try to see every patient every day. I will go back and admit patients. I will teach the pre-op joint class. I think, for me, it’s just staying connected to the – the reason why we do this is staying connected to the patients and their families.
Don’t forget to check out the entire December 2011 issue of Nursing Notes, featuring inspirational stories about nurses like you giving back to patients and their communities. You can read the entire issue online at www.discovernursing.com and don’t miss this month’s other Nursing Notes Live episode featuring an interview with the 2011 Amazing Nurses contest winner Lillian Shockney on her nursing career and the importance of giving back to your community. 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.