Category Archives: Workflow
Efforts to expand the role of nurse practitioners (NPs) to help address the country’s shortage of primary care providers have been bolstered by legislation in several states. But laws expanding scope of practice may not do all they could to relieve the nation’s primary care crisis, according to a new study by researchers at the Columbia University School of Nursing, which suggests that the culture in health care settings can impede full utilization of NPs.
The study, published in the Journal of Professional Nursing, was conducted in Massachusetts, where state health reform increased demand for primary care and legislation recognized NPs as primary care providers. Researchers found that gains made by government can be neutralized by formal and informal practices at health care organizations. For example, the study cited instances where NPs were not allowed to conduct physical assessments or see new patients.
“Organizational policies can often trump governmental policies, keeping the contribution of the nurse practitioner unrecognized and preventing them from making the fullest contribution possible to effective patient care,” lead researcher Lusine Poghosyan, PhD, RN, an assistant professor of nursing at Columbia and a Robert Wood Johnson Foundation Nurse Faculty Scholar, said in a news release.
Researchers at Loyola University Medical Center have conducted the first study of moral distress among nurses in an intensive care unit for burn patients, starting to address “a significant gap” in knowledge about responding to the painful feelings that arise in situations where people can’t act according to their ethical ideals, due to barriers such as lack of time and supervisory support, and policy and legal constraints.
Moral distress has been studied in various populations of health care providers, including neonatal ICU nurses, pediatric ICU nurses, genetic professionals, surgical residents, and medical residents. The Loyola study, published in the September/October issue of the Journal of Burn Care & Research, points out that the impact of moral distress on nurses during the provision of care, particularly in critical care settings, is well documented and can result in a wide variety of reactions, including depression, anxiety, emotional withdrawal, frustration, anger, and a variety of physical symptoms.
In 2003, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation launched Transforming Care at the Bedside (TCAB), a nationwide, nurse-focused effort to improve health care delivery. TCAB recognized that nurses often hold the key to making hospital care more effective, patient-centered and efficient. David Harrington, RN, BSN, CMSRN, has been a nurse at Providence St. Vincent Medical Center since 2006 and a TCAB leader there for two years. Erin Hochstein, RN, BSN, PCCN has been a staff nurse at Providence since 2010 and a TCAB leader for two years. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
As nurses, we are with our patients and their families during some of the most pivotal moments in their lives, which is a true honor. Yet, with the ever-increasing demands of health care, the responsibilities of nurses have become greater, pulling us away from the bedside. To curb this trend we were given the opportunity, at Providence St. Vincent Medical Center, to adopt Transforming Care at the Bedside (TCAB), a program that gives bedside staff the chance to streamline care and improve patient outcomes.
By allowing us direct input on our workflow, we have the opportunity to develop rapid tests of change that we implement over the course of one shift. This adjustment in practice empowers frontline nurses to be catalysts of change for patient care, permitting us creative liberty in finding solutions to practice and system issues we face on a daily basis.
The Providence St. Vincent TCAB team began its journey in 2010 by visiting Prairie Lakes Hospital in Watertown, South Dakota, one of the original TCAB pilot sites, as part of an innovation grant provided by Providence Health & Services. Nurse representatives from three medical-surgical units along with hospital leaders were introduced to TCAB in action. As newly appointed TCAB leaders, we returned from the trip feeling motivated, inspired, and ready for change.