www.nursingmattersonline.com
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June • 2015
June-July 2015 • Volume 26, Number 6
Nursingmatters www.nursingmattersonline.com
INSIDE: Population is your patient
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2014 Wisconsin RN Survey Report
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The Finish Line
PAID
MADISON WI PERMIT NO. 1723
PRST STD US POSTAGE
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Evidence: The Ultimate Game Changer
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he nursing profession is comprised of the largest group of clinicians participating in the delivery of healthcare in this country. Numbering more than 3 million, nurses are the largest sector of the health professions. Nursing is practiced in virtually every setting in which healthcare is delivered, from the home, to hospitals, clinics, nursing homes and hospices, to name a number of the most common. Though nursing care has been, or will be, experienced by everyone at some stage of life, it is ironic that the work of the profession is poorly understood by those who are recipients of its services, colleagues in other clinical disciplines and those who administer healthcare organizations. Nursing has not clearly communicated the nature of its work to its publics. It has also been less effective than it must be in assuming ownership of all of the accountabilities that comprise any clinical profession including defining practice, managing quality, assuring competence, generating and validating the knowledge base of the discipline and managing the resources essential to the work. The result has been detrimental to the care of patients across the country in many settings, but nowhere more acutely than in hospitals. Since the early 1980s, the pressure of declining reimbursement to hospitals has resulted in decisions related to nurse staffing that have at times created unworkable and even unsafe, practice environments. The Institute of Medicine Report on the Future of Nursing identifies that high turnover rates among new nurses continues to be a concern. Nurses, disenchanted with practice environments that do not support excellence, and may even pose risks to patient safety, have left those settings. Nurses are knowledge workers. While much of what nurses do in the form of tasks is observable, such as administering medication, teaching a patient, or changing a dressing on a wound, the essence of nursing practice is not. Nurses, in caring for patients, are engaged in a continuous process of interpreting a broad array of objective and subjective information. The information is gathered through a variety of means including observation,
JOAN ELLIS BEGLINGER MSN, RN, MBA, FACHE, FAAN physical examination, conversing with the patient and/or family and review of diagnostic test results. Nurses interpret and assign meaning to the information by drawing on a vast knowledge base from the physical and social sciences, liberal arts, practice wisdom and intuition. They make judgments about the significance of the information and decisions concerning appropriate intervention. Continuous evaluation of practice interventions for desired outcomes rounds out what has come to be known as “nursing process.” Effective nursing practice is dependent upon the nurse’s ability to know the patient’s “story,” including pertinent history, co-morbidities, present illness, culture/beliefs, family support, education and any compounding variables that might impact his/her interpretation of the patient situation. Subtle changes in a patient, which may precede a significant change in condition, can only be noted if the nurse has the opportunity to remain in adequate contact with the patient. Research has demonstrated that the expert nurse can often intuitively detect deterioration in a patient’s condition before there are any objective findings to support that conclusion. Further, studies have shown that an assignment of too great a number of patients to a nurse may result in “failure to rescue”, that is, impending signs of patient deterioration are missed because of inadequate opportunity to observe the patient first hand. Research continues to contribute to the growing, and irrefutable, body
Effective nursing practice is dependent upon the nurse’s ability to know the patient’s “story,” including pertinent history, co-morbidities, present illness, culture/beliefs, family support, education and any compounding variables that might impact his/her interpretation of the patient situation. of evidence that patient outcomes are improved with increased RN staffing, positive practice environments and greater percentages of BSN prepared nurses. The Principles and Elements of a Healthful Practice/Work Environment, developed by the American Organization of Nurse Executives in 2004, supports the presence of adequate numbers of qualified nurses as important to the provision of quality care to meet the patient’s needs. In the absence of research-based evidence to guide us, decisions about “adequate numbers of qualified nurses” have historically been largely opinion-based. As we move forward, these methods must be replaced by decisions based on best available evidence. In 2005, the Wisconsin Organization of Nurse Executives published its first evidence-based position paper on nurse staffing entitled Guiding Principles in Determining Appropriate Nurse Staffing: Standards of Practice for Acute Care in the State of Wisconsin. The Standards were developed to reflect the best available evidence and the process involved eliciting input on the draft document from all Wisconsin Organization of Nurse Executives members, as well as support from the Wisconsin Nurses Association. SEE EVIDENCE, Page 3