Ignorance May Be Bliss — But It’s Certainly Not Professional

By Christine Moffa, MS, RN, AJN clinical editor

A few weeks ago I attended an orientation provided by the New York City Department of Health for a school-based H1N1 vaccination program. Years ago I worked as a school nurse here in New York and I thought participating in the program would be a great way to keep up some clinical skills and spend time with patients. A physician from the bureau of immunization gave an informative lecture reviewing the epidemiology, signs and symptoms, prevention, and treatment of influenza.

There were about 100 nurses in attendance, many of them new graduates who were unable to find full-time work. During a break one of the new grads said to me, “why do we have to sit through this irrelevant lecture?” I couldn’t believe it. If you’re administering a medication, I told her, of course you’d want to understand how it works and why you’re giving it. In addition you need to be able to explain it to the patient or their parent. She rolled her eyes and walked away. And I thought, once again: this is why nurses are not taken seriously as professionals.

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If You Think ‘Evidence-Based Practice’ Is Just Another Buzzword, Think Again

Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes. In many hospital EDs across the country, children with asthma are treated with albuterol delivered with a nebulizer, even though substantial evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. Nurses even disrupt patients’ sleep, which is important for restorative healing, to document blood pressure and pulse rate because it’s hospital policy to take vital signs every two or four hours, even though no evidence supports that doing so improves the identification of potential complications.

That’s from the start of an article in the November issue of AJN, the first in a new series we are running to highlight the way’s evidence-based practice (EBP) changes what nurses do at the bedside—and saves lives. The authors point out that every day nurses perform dozens of actions and procedures without ever really asking whether the way they are doing them is the best way, or whether or not they are even helping patients by performing these actions.

While […]

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About Nurses Write, Right?:

“If 1 percent of the three million nurses in the USA would write about what they do, we could take over health care.”
–Dr. Teena McGuinness

About Saving SimBaby-Teaching Nurses to Speak Up, a post about using simulation technology for training nurses:

“I used to dread simulation situations (like ACLS years ago when it was much more stressful). Now I think they are the best way to learn and to teach some situations. Reproducing a certain degree of anxiety helps young nurses, and more experienced nurses, learn how to keep anxiety and stress from becoming fear. Being forced to repetitively face those anxieties diminishes the likelihood that a nurse will be overwhelmed by them in a […]

Mammography Screening: Change Isn’t Easy

Exactly what is the evidence supporting annual mammography screening and breast self-examination for women over the age of 40? Napoli pointed out that the available evidence from large international studies didn’t support the belief that early detection of breast cancer actually resulted in lower mortality rates and that the high number of false positive tests resulted in unnecessary anxiety and treatment. At the time, there was even some evidence that premenopausal women who are diagnosed with breast cancer through mammography may actually die earlier than women who are not screened.

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