Sunday, May 22, 2016

Back to Basics

The Association of periOperative Nurses (AORN) started adopting a back-to-basics approach to continuing education and in journal articles. These articles inspired me to adopt this approach to continuing education for the experienced staff nurses that I work with at the medical center. Let me be clear, this is not because of lack of skill or knowledge on their parts, it was to encourage a focus on the basics of what it means to be a safe practitioner in the operating room. In the operating room, the technology that the nurse is responsible for being able to prepare, operate, and troubleshoot is truly amazing. It can be easy for the nurse to get very task focused and to get the basics so engrained in muscle memory that the technology can take center stage. This approach looks to refocus the staff nurses on the basics of what is done and the why behind it, which is patient safety.

Technology, while attempting to improve patient safety, has taken a lot of the art out of nursing. Regulations, policies, and procedures, while attempting to protect patients who are very vulnerable, have taken some of the essence of nursing away from the registered nurse. I see it in a variety of settings, where the nurse talks to the computer instead of engaging the patient or where the nurse responds to a computer alert or monitor sound instead of the patient in the bed. This is where a back-to-basics approach can begin to help, to refocus nurses on the basics of patient care. The nurses at the medical center are amazing and truly do provide excellent care. I hope to be able to help them rediscover the art of nursing since they seem to have the science of nursing down so well.

Friday, May 6, 2016

Change is good...

     I am one month into my new nurse educator position. In meetings with the operating room director, who has been in her position for two months, one area of focus for change was the preoperative holding area. The nurses in that area do an amazing job getting patients ready for surgery and keeping the flow of patients going for the operating room. However, in observation, those pre-op nurses take many extra steps that take them away from the bedside and providing an optimal patient experience. These nurses are hampered by interruptions from staff trying to find their patient, incomplete or unsigned orders, incomplete patient charts, and lab tests that remain undone. This all leads to a less than stellar patient experience right at the beginning of their surgical journey.

     In an ideal world, or as I like to say my world of rainbows and unicorns, pre-op holding is to be the warmest, fuzziest place in the hospital outside of the pediatric unit. It is supposed to be friendlier than Disneyland with a lot less anxiety.  This, unfortunately, is not the environment hat has been created by the current state of practice in the unit because of interruptions to the nurses trying to be at the bedside.

     I did approach the change meeting with the nurses on the unit with some trepidation. These three nurses have been practicing for a combined 55 years in this unit. I was expecting extreme resistance to change form my proposals.  I went in wearing my educator as evidence-based change agent hat and was ready for anything. Much to my surprise, these nurses were hungry for a better way to provide a great patient experience. Many of the suggestions they have either lobbied for themselves with previous directors and educators or had been doing in the past until the practice was changed without their input.  These nurses wanted to re-energize their practice and be change agents. I was elated.

     Now experience has taught me that talking about change and actually implementing it are two very different things. Sometimes the biggest cheerleaders during the meeting phase become the biggest naysayers during implementation. I am hoping that this is not the case on this unit. In an effort to continue to tell my story, I will bring updates to this blog about the changes taking place in this unit and other units in surgical services and the ups and downs of being a change agent through the educator role.

Sunday, May 1, 2016

An Amazing Discourse

     I am now a Master's prepared nurse with a specialization in nursing education. Through perseverance and timing, I am now the nurse educator at a local hospital for surgical services. Brought together by the director of education and informatics, the educators at the hospital I work at had the most amazing conversation.

     Let me start by setting the scene. Currently, there is a push for hospitals to have nurses take more responsibility and autonomy in their practice. This usually involves some sort of shared governance model, in which front line nurses form a committee and decide on practice and projects for the department. Until recently, educators have been left out of this loop, serving mainly in an advisory role to these unit-based councils.  The educators had fallen into the trap of having the departments or the councils decide the practice of the nurse educators. More over, the nurse educators allowed it to happen.

     This discussion started to change that practice. The director came in and said, what services do we offer to the departments that we feel should be owned by education, and which ones are better left to the departmental leadership. The educators of NICU, Med/Surg, Critical Care, Nurse Residency, and myself were involved. We talked about what we should be involved in and which tasks were to revert back to the departments. essentially coming up with a menu of services that we can offer that are of value to the hospital and use us to the best of our abilities. In, essence, we took control of our practice and it was very freeing. My fellow educators and I challenged the status quo, challenged each other and our ingrained notions, and came up with the beginning of a model for nursing education practice at the hospital. This is what empowerment looks like and feels like, and it is intoxicating.

     Why am I writing this? I have long encouraged my nurses to tell their stories and I came to the realization recently that I have not been telling mine. I want to empower nurses through sharing of stories and ideas to enrich their lives and take control of their practice. I hope to continue to tel my stories, past and current, to accomplish this goal.