Nurses spend more time with patients than most other types of providers and have unique insight into patient care and the the healthcare system.

Workarounds May Work, But They Perpetuate Dysfunction

Photo © Associated Press

A couple of months ago, we posted a query on Facebook asking visitors to the page if they had ever used workarounds—the improvised shortcuts that may not be the standard practice or the policy, but may allow for more efficient work processes. We were amazed at the uniformity of the responses. No one saw a problem with workarounds, and most responded along the lines of “I love my workarounds—couldn’t do my job without them” and “I’ll never tell—keep hands off my workarounds.”

Nothing new.

Workarounds have probably been around since Florence Nightingale’s day—I can imagine one of her nurses at Scutari hiding lamp oil so she’d have enough to make rounds at night. In my early nursing days, we hid sheets so we’d have some in case we needed an extra bed change for a patient. When I worked in the ER of a busy city hospital, we kept a pretty large supply of IV fluids and medications on hand in a closet. It became a well-known secret that the ER had its own stockpile—in fact, there were occasions when the pharmacy would come to us for meds!

Today, the workarounds I hear about tend to revolve around dealing with the electronic health record and scanning medication bar codes.

Some cautions.

In […]

2017-10-18T09:59:23-04:00October 18th, 2017|Ethics, Nursing, nursing perspective|1 Comment
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The CAPABLE Program: Supporting Aging in Place

Determining what matters to homebound elders.

Sarah Szanton

This month, AJN profiles Sarah Szanton, who created a program known as CAPABLE—Community Aging in Place, Advancing Better Living for Elders—that helps low-income seniors to remain at home with the aid of a unique home care team.

Szanton, an NP who has provided care for homebound elders, notes that “[b]eing in someone’s home gives you the opportunity to see what matters to them.”

The “person–environment fit.”

Szanton’s keen interest in the “person–environment fit” of her frail elderly patients led her to a different perspective on managing illness—one focused less on the “medical model” and more on “function and being able to do what they would like to do.”

In 2008, after the NIH requested proposals for projects to help the newly unemployed, Szanton wondered whether people with home-building skills could be paired with elders to improve their independence and quality of life. And the idea for CAPABLE began to form.

A unique home care team: nurse, occupational therapist, handyman.

CAPABLE’s home care teams are made up of a nurse, an occupational therapist, and a handyman. The patient identifies functional goals such as “to be able to stand long enough to prepare a meal,” and the team devises a plan based on these goals. […]

2017-10-13T10:10:47-04:00October 13th, 2017|Nursing, nursing perspective, patient engagement, Patients|2 Comments
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Designing Nurses: Make Your Ideas Reality

“At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher…”

Earlier this month, the New York Times published an article, “Design Thinking for Doctors and Nurses.” In it, the author describes a simple solution designed by a nurse to identify who was in charge of a resuscitation team: whoever was wearing the orange vest was the leader.

As a former ED nurse who participated in many codes and trauma emergencies, I could easily picture the chaotic scene that led to this innovative solution. In a large urban teaching hospital, cardiac arrests and trauma calls draw many physicians and medical students, respiratory therapists, and of course, at least two to three nurses. It wasn’t unusual to have conflicting orders shouted out by physicians, residents chiming in with questions and suggestions, and the medication nurse making the decision as to which order she/he would process. At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher—only the physician in charge and resuscitation team were allowed inside the box. All other onlookers (mostly medical students and residents) had to stay outside the box and be silent. It did wonders for instilling a quiet, organized atmosphere into a highly charged event.

Left out of a wide range of decisions critical to care delivery

Those […]

2017-08-16T09:22:11-04:00August 16th, 2017|Nursing, nursing perspective|0 Comments
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When Brokenness Transforms Nursing

photo by Karen Roush/all rights reserved

I’ve had opportunities to sit in peer interview panels for new grad nurses looking to start their career in our unit, an experience which prompted me to consider what it takes to be a good nurse.

The obvious qualities were, well, obvious: critical thinking skills, strong communication, compassion, teachable, team player. But I’ve had a sense for a while that we nurses have been missing something when we consider what it takes to be a good nurse. While this something is strongly tied to empathy, it’s still a bit different. I tend to think of it as the nurse’s recognition and embrace of his/her own brokenness, even as the nurse looks to take care of others who are in some manner broken.

By brokenness, if the term is unfamiliar, I simply mean the awareness that we all know what it is to suffer, to struggle, to feel lost or wounded or weak. So in speaking of brokenness, I don’t mean it as a condescending lens through which we view everyone as objects to be fixed. I use the term brokenness to acknowledge the humbling reality that every person will crack a bit under enough pressure; every person who has been tossed around enough by […]

2018-01-18T10:03:17-05:00August 9th, 2017|Nursing, nursing perspective|4 Comments
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AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday

We loved readers’ contributions to AJN’s celebration of Nurses Week.  For those who missed our Nurses Week Questions of the Day on Facebook, here are some highlighted responses to some of the questions:

What nurse has most influenced your nursing career?

There were many shout-outs to mentors by name, lauded for their grace, commitment, integrity, vast knowledge, and patience, or described as nurses who “role-modeled intelligence, compassion, and professionalism.”

Moms, grandmothers, and wives were often mentioned, as were instructors in both RN and LPN schools, and charge nurses. One nurse described being mentored by a paramedic, who “showed me how to remain caring in a system that so many times does not have time for the small things.” Another cited “every nurse I’ve ever worked beside” as a mentor, because other nurses model both the best and worst of nursing practice.

What do you think the general public doesn’t understand about nurses and nursing?

The number one frustration expressed in these answers was that we are often thought of as caring but not intelligent—that “we don’t know what to do until a doctor tells us.” But as one nurse succinctly put it, “We know what’s going on with you before you or the doctors […]

2017-05-31T15:49:58-04:00May 31st, 2017|Nursing, nursing perspective|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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