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January 01 2017
Medical Professional or Just Interested in Medical Information
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January 01 2017
How Nursing Has Evolved Through the Years
Nursing has evolved throughout the years thank goodness to a different level of respect. Although I do believe that some doctors and even nurses still carry the old way of practicing where the doctor is the lead and nothing else matters. This is I believe even differs from the North to the South. I remember graduating from nursing school and working with the doctors in labor and delivery who are now looking at me not as the kid in school, but as the professional on their team. The doctors would say call me Mike, or John when we were not around the patients and it was a comfortable working relationship (not to the extent of the TV show dramas, that is not realistic!) making everyone’s job easier, especially for a new grad that had questions.
When I moved to Florida I noticed that the nurses and staff would say Dr. Smith or Dr. Jones and he would say whatever it is he needed and the nurse would say yes sir, is there anything else that I can do for you. It was the politeness of the South or the servant of the South one or the other. I thought to myself, okay this is certainly going to take some getting used to if I am going to live in Florida. In no time at all, I had to conform since I wanted to be gainfully employed.
When I think of being on an interprofessional team, I think of the team that I was in up North, where it was a comfortable open ended relationship between nurses and doctors to discuss what was happening with the patient and come up with a plan. When I think of being on the interprofessioal team in Florida when I first moved here, that to me was not a team. It was a nurse and a doctor, with the doctor stating what needed to be done, the nurse saying yes sir and doing what she was asked. It should be a partnership collaborating together (Sommerfeldt, 2013).
Many years have evolved since I first moved to Florida and I have seen the change happen where nurses can have a more involved relationship with doctors as a team player and include nutritionists, therapists and discharge planners. There are still some rigid single minded doctors out there that will not work on an interprofessional team; however our job is not to change them. We can spend a long time trying to make changes and getting our point of views heard, but if we can make an impact with what we can control in our scope of practice, this will go a long way to improving healthcare.
Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014
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January 01 2017
The Nurse Leader of a Healthcare Team
A nurse can play three different roles as part of an interprofessional team. The three roles consist of a nurse, nurse leader and nurse educator. The interprofessionalism team consists of other healthcare workers as well, not just nurses (Sommerfeldt, 2013). However as nurses the roles can be at different levels depending on the patient’s condition. At my previous job, I worked as a complex case manager. The team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers and nutritionists. The nurse case manager managed the patient, however if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs. If the member had psychological issue or other financial issues that required the need of a social worker or behavioral health specialist this referral would be added as well. There was collaboration on the plan of care and all participated because we all were looking at the patient as a whole, not just as the part that each discipline took care of. If the member cannot pay his light bill or water bill due to financial difficulties, until we take care of those needs through resources, any teaching that the nurse would do would be in vain. A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance the nurse is playing the role of the nurse leader.
When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration and other treatments. The nurse’s role in the interprofessional team that may consist of the doctor, physical therapist and dietician, would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially. The patient is on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietician can help the patient understand the diet and the nurse can reinforce the teaching.
The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting. This type of setting also has multiple specialties that can follow the patient. In this instance the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar or blood pressure. The nurse educator measures the members learning based on return demonstration through development of a plan of care.
All three roles bring value to the scenario that they are in, because the nurse is the one that will be around the patient most of the time. In each role the nurses is responsible for all aspects of the patient’s care. In reading through the assigned readings for this week, I am able to see that although you have one nurse, that one nurse can play one of three roles depending on what scenario the nurse is in. Regardless of which role the nurse is playing, working on an interprofessional teams is a style of partnership that allows decision making to be collaborative (Sommerfeldt, 2013). It takes many people to work together in getting a patient discharged to his home.
References
Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014
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January 01 2017
The Future of Nursing Your Workplace
I was recently speaking to a nurse about her current work place and some of the changes that she sees coming. She was concerned for the safety of her patients with many changes that will take place putting more work on the nurses and not for any greater pay or benefit. I explained to this nurse about a previous place that I was employed at and how I had to break away because I was not using my full potential as a nurse.
In my previous work environment, my position was a manager of long-term care case managers. The Institute of Medicine(IOM) report was not shaping our scope of practice at my previous location. The organization was very top-heavy and there did not seem to be enough people to do the jobs that directly affects the population that we serviced, which was the Medicaid and Medicare population. The training that was provided to the staff was more on how to complete reports and paperwork that was required by the state of Florida in order to be in compliance with AHCA.
The issue with this was that the members were not being followed up with properly. Nurses and social workers were going through the motions of case managing their files, with basic monthly telephonic questions asking a member living in the home how things were going, have they received their supplies was there anything new that they should be aware of. A monthly contact should involve so much more, but yet it didn’t because the case managers did not have enough time to fulfill the job in eight hours and they would work for 12-15 hours daily some of them, to get documentation done in order to avoid a reprimand by upper management.
In the IOM report there are six aims that healthcare providers should follow and one of them is patient centered healthcare (Rubenfeld & Schaeffer, 2014, p. 82). The goal of the health plan was to have patient centered care and have policies in place for it. The case managers did everything in their power to obtain services for the members and get them started as soon as possible and formulate a care plan with goals. The challenge that they were running in to was that the case managers were out in the field 4-5 days per week, they didn’t have time to complete the documentation of their assessments while they were in the member’s home, therefore creating more after hours documentation for the case managers, dissatisfaction with the job and more report concerns rather than focusing the time speaking with the member to really understand what the member’s needs are.
The nurses and social workers were not able to apply quality improvement plans because there was little collaboration as an interdisciplinary team. Nurses and social workers both did the same assessments and did not have the ability to collaborate on a case as if they were both co-managing the case.
The nurse I was speaking to was amazed that this happened in the work place that I used to work in. I explained to this nurse that the IOM report would not shape my career as a doctorate of nurse practice (DNP) at my former job because the region that I was in did not support critical thinking or any type of evidenced based nursing. The rigid structure would remain and no changes unless implemented or suggested by upper management would be considered in our department.
Now as a DNP on the outside of this organization, the ultimate goal is to consult with nurses, doctors. therapists, nutritionists and specialist to get the right people involved in carin for a patient whether at home or in a facility. It is good to have a future goal with a plan in place to reach that goal.
Rubenfeld, M. G., & Schaeffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. http://dx.doi.org/
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