Get the chance to sit down and chat with our Get to Know Nurse this month, Barbara Edwards. Barbara is a clinical nurse leader at St. Lucie Medical Center in Florida. Here’s that segment with Barbara.
MP3 Audio Podcast
Jamie Davis: Barbara, I just want to take a moment to welcome you, first of all, to Nursing Notes Live. It’s great to have you here on the show.
Barbara Edwards: Great. I’m excited to be a part of it.
Jamie Davis: I always try to ask the nurses that we have on the show to talk to us a little bit about their background in nursing: why they wanted to become a nurse and some of the path that they went through that led them to where they are today.
Barbara: I thought a lot about why did I become a nurse and I don’t know at any one point, I’m not one of those people who grew up and said, “I always wanted to be a nurse.” Actually, when I started my education, I was looking towards a couple of other things. Then I was in my early 20s and my younger sister actually was in a nursing program. I started talking to her and she would tell me about some of the experiences she had, some of the opportunities she had to really be able to make a difference for patients and to make a difference for the families that she was caring for. It made me become interested in nursing. I got a little bit of information. I did start my nursing career in an ADN program. So my first nursing degree was an associate degree.
Jamie Davis: What was your progression? Did you start out on a Med-Surg unit or were you specializing in other areas first?
Barbara: I actually started on a General Med-Surg unit and, from there, I went and worked in an Orthopedic and Neuro unit. I really enjoyed working in orthopedics. We did a lot of total knee replacements, total hip replacements and some back surgeries. I did that for about six years. At that point, I was looking for ways to continue my education, to continue grow in my nursing knowledge and there was a position available as a charge nurse on a Med-Surg unit and I actually opted to go back to Med-Surg and take that position as a charge nurse and I did that for a years. I did that for a good five or six years also. I really was at a point where I wanted to do more. I wanted more education. But I enjoyed taking care of patients. I enjoyed being at the bedside. I enjoyed my role as a charge nurse where I was supporting the nurses in the nursing care that was being provided. So I went ahead and I did go back and I did get a Bachelor’s degree in Nursing. But again I didn’t have that desire for an advanced practice role because, at that time, I looked at a lot of advanced practice roles, and not all, but a lot of them as leaving that bedside care and I really enjoyed that and working with some of the newer nurses. And it happened to be – I suppose it was probably somewhere around 2005 – the American Association of Colleges of Nursing had just put out a new white paper on a new role in nursing. It is the first new role to be added to nursing since the nurse practitioner and that was for the clinical nurse leader. And that really got my attention because a clinical nurse leader is an advanced generalist. So you have to go back to school and get your Master’s degree in Nursing. But what it did is it really focused on the tools that you needed to be able to provide and to oversee professional nursing care that was being provided in a lot of different arenas not necessarily only at an acute care facility. There’s clinical nurse leaders in home health, in the school systems, in clinics and offices, but really to focus on the provision of patient care.
Interviewer: I heard you say earlier that you were struck by your sister’s description of how she was helping families. I think that’s important because there’s so many ways that we impact the patient beyond just direct bedside care for their acute problem but we really are involved in helping them to become healthier in many ways and helping to interact with their families and the rest of their healthcare environment. Why do you think that’s so important for nurses to focus on that?
Barbara: I think that so many times, when you look at the healthcare profession in general and you look at the way we provide healthcare in the United States, we really focus on incident or disease management. So somebody has a problem and we treat that problem. What I really saw in a lot of the conversations that my sister was having with the families and the patients she was caring for was that she was helping them to see beyond this one incident, helping them to be able to look to the future: how were they going to plan care, how were they going to manage their health beyond just that episode that they were presented with at the moment? That probably interested me more with how can I make a difference for them not just today but as they go through life and as they progress through whether it would be a disease process or an illness.
Interviewer: So how does your role as a clinical nurse leader take that bedside nursing focus and translate it into a leadership role?
Barbara: The clinical nurse leader is a very unique role. I started in that role in 2006. So I was one of the first practicing clinical nurse leaders in south Florida and we are all across the United States and growing very rapidly. But as a clinical nurse leader, there’s actually two of us on my Med-Surg unit, we’re not a part of management. So we don’t do finance or budget or scheduling or any of those things but what we primarily do is we oversee the nursing care being provided to a cohort of patients. Sometimes it’s by diagnosis and sometimes it’s just by geography. But we really look at nursing from a microsystem approach and what do we need to be successful on this unit? And a lot of times, there’s new initiatives that come out. There’s new research that say, “This is the best practice” and we know that it takes so long from the time a best practice is identified until it becomes incorporated into the way we do things every day. And what a clinical nurse leader does is really look at being a change agent. What are those best practices and what are the barriers that get in the way of my staff when they try to implement those best practices? And then help them to work through that. We do a lot of one on one education with all of the patients and the families. We don’t do discharge planning per se as in a utilization standpoint. I’m not the person who sets up their home health or their skilled nursing facility but we do a lot of the conversation with the patient and the family and help them make the decision that’s going to be the safest and provide them the highest quality of life.
Jamie Davis: That just sounds very rewarding and the fact that you get to impact so many more patients in this role. It must be something that you find very gratifying.
Barbara: It is. I tell my peers – and, you know, part of what I do as a clinical nurse leader in my unit as well, is to promote the role of the professional nurse and to encourage my staff to go back to school and to continue that education. We have a very strong state college, Indian River State College is a local state college for us, so we get a lot of Associate Degree nurses from that program. I really encourage them to go back to school to – what can I do to support you in obtaining that Bachelor’s degree or that Advanced Practice degree, find where it is that you enjoy and then a way to pursue nursing down that avenue. But I tell them all the time I have the best job in nursing. I get to do all the fun things. I get to talk to the patients, talk to the families, educate the staff, look at the quality outcomes, things like that.
Jamie Davis: I noticed in some of the information that I looked up about you preparing for this interview, that you received an award this year from the American Association of Colleges of Nursing, the Clinical Nurse Leader Vanguard Award for 2013. Congratulations first of all on receiving that award. What is it about awards like this? Why is it important for us as nurses to recognize each other formally in these types of awards and these types of situations to encourage us to continue to strive to do better?
Barbara: Definitely, thank you for the recognition and I was very humbled by the award, the CNL Vanguard Award. The American Association of Colleges of Nursing works in coordination with the Nurse Certification with the CNL. And, really, what they were looking for and what we’re hoping to get out of the role in general is some innovation in the way nursing care is provided. Looking for those nurses, those CNLs that really advocate for the role of nursing. As we move forward with the Institute of Medicine and our roadmap to the future, I think that there’s a lot of opportunities for nurses in this type of role. As a CNL, the clinical nurse leader, I really focus on helping to coach not only the patients but to coach my staff in ways of doing things better. Sometimes I get myself in a little bit of trouble because I call it a “positive deviance” but I really look for different ways for us to do things that give us a better outcome or that enhanced nurse workflow. When you identify somebody who has these abilities through things like a Vanguard Award, it gives you a little extra drive to know that you are making a difference. People are watching the work that you’re doing and that it’s taking the profession in the right direction.
Jamie Davis: Barbara, a lot of times we get questions from people, students and other nurses, that listen to the show, about how they can advance their practice. I’m just curious, what your thoughts are about the types of skills that someone should try and develop or the types of events they should put in place in their career path to advance toward becoming a Clinical Nurse Leader.
Barbara: I would have to say that anyone who’s interested in the role of the Clinical Nurse Leader could do a little bit of research. Like I had said, there are clinical nurse leaders in several different areas. We are not just in acute care. There are clinical nurse leaders in the home health area. There’s clinical nurse leaders in office, clinic, some of the school systems, some of the public health departments are starting to employ clinical nurse leaders. But really you need to be somebody who wants to make a difference. Somebody who can look at the way you’re doing things today and say, “I think it would be better if….” Definitely someone who is interested in maintaining the professional role of a nurse. In saying that, sometimes you wonder, “What does that mean the professional role of a nurse?” But I think that it’s important that we always look at nursing as what is our body of knowledge and what is it that we provide for the patient as an independent profession. And it’s one of the things that I try and stress with the nurses is there’s a lot of times when you are presented with an issue and the first thing you want to do is call a physician or bring it to somebody else’s attention and ask for a solution. And I really encourage the staff here to go out there and look for the research: who is doing it or who can show us how to do this better and what can we bring. Rather than go in and identifying a problem, what can we bring to the show and say, “We did this research. There’s nurses who are doing this. We are interested in trying something better.”
Jamie Davis: I hear you talking about the way you encourage your staff to go out and find the answers for themselves and seek best practices based upon what other nurses are doing in other facilities, in other parts of the country. It really seems like what you’re doing is a mentoring role. I think that’s something that we as nurses need to do more of, what do you see as the role of all nurses to become mentors for new nurses and student nurses coming in to the profession?
Barbara: Well, I think that healthcare is becoming more complex. Patients are coming into our system with multiple co-morbidities. They’re not coming in with one problem or you can focus your attention on that one problem. You’re having to manage the whole person. As we move further and further into the age of the baby boomers, I think that we’re going to continue to see those numbers increase, in addition to how complex the patients are and their co-morbidities, the patients and families themselves have access to so much information. A lot of times they’re coming in to the hospital, they have their laptop open. They’re already telling you what they think the issue is. Part of what we do as a nurse, and that’s any nurse who’s interacting with them, is help them to understand the information and to understand that reading one article or watching one television show is not an appropriate diagnosis and also to give them comfort into their team. That it’s okay to have that information. It’s okay to have that access and help them to go to sites that provide true medical information and not a sales website or something along those lines. As far as the clinical nurse leaders, I think that, in addition to the patients and families, our role is also in helping the multi-disciplinary team by being able to aid in communication, facilitating that care in order to make sure that we’re providing the most appropriate care but also the most cost-effective care for the person, for the individual, for the facility and looking at our country, as a whole, how can we spend those healthcare dollars where we’re getting the most out of it?
Make sure you check out the entire November, 2013 issue of Nursing Notes, where we examine the role of clinical nurse leaders around the country. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month bringing you a panel discussion on clinical nurse leaders and clinical nurse specialists with Nina Swan, a Clinical Nurse Leader at Iredell Memorial Hospital in North Carolina, Cathy Coleman, clinical nurse leader and adjunct professor at University of San Francisco School of Nursing and Health Professionals, and Peggy Barksdale, a clinical nurse specialist and vice president of the National Association of Clinical Nurse Specialists. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.