“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 at the point of care are often left out of decisions critical to care delivery—whether the decision involves designing a process, systems, or equipment uses in care settings, or even the setting itself. Nurses see the consequences of this omission many times in the course of a career. One of those “oh no!” moments happened in the ED where I worked, after administration purchased an autotransfusion machine for use in major trauma cases. The trauma chief was itching to try it out, and the opportunity finally came when we received a patient with a gunshot wound to the abdomen. Everyone descended on the ED to see this new machine in action, only to be disappointed—the new, expensive autotransfuser didn’t fit through the door!
When nursing experience informs better design
That was in the 1970s. Since then, many nurses have become involved in designing equipment, hospitals, and systems. In April 2011, we profiled (free until August 30) the work of Denise Choiniere, MS, RN, the sustainability manager at the University of Maryland Medical Center in Baltimore and responsible for instituting environmentally friendly design and products in the hospital. Many nurses sit on product evaluation committees and recommend purchases of equipment. In 2013, the Robert Wood Johnson Foundation funded an initiative called Maker Nurse, which supports nurses to pursue developing their creative ideas for products. (We covered this in “Attention DIY Nurses: Workarounds Wanted,” an article in the September 2014 issue of AJN.)
We’d love to hear about and from nurses who’ve designed products and processes that make providing care easier and better—send us your story.