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State of Nursing 2011
A Q&A with Local Nursing Directors
PUBLISHED: JULY/AUGUST 2011
READ PAGE FLIP or READ PDF
Healthcare Journal of Baton Rouge: What are the characteristics
of an effective nurse manager?
Jennifer Johnson, RN, MSHSA, Chief Nursing Officer,
Lane Regional Medical Center: The nurse manager today
must not only manage, but lead. They must have vision for the
future and the ability to influence others to follow the vision.
They must have excellent communication skills, a positive attitude,
self directed sense of ownership, and initiative.
Anna Cazes, DNS, RN, Vice President, Patient Care
Services, Baton Rouge General Medical Center: Number
one, you have to come in with some good clinical background
in the area you need to cover. You have to have autonomy on
the floor and be able to stand up for your decisions. Nurse
managers need to be able to critically think because of different
scenarios, whether it be staffing, patient care, or communication
with physicians. One of the newer things that we have
asked of nurse managers is to really learn how to be business
savvy. Healthcare really has a business component to it so
you want to make sure you have managers that understand
both the clinical and business side of it. They also have to
have very good, open communication with the staff.
Patricia Johnson, RN, MN, Chief Nursing Executive,
Senior Vice President, Woman’s Hospital: I’ve found that
the most effective nurse managers have strong clinical and
organizational skills along with a strong sense of flexibility,
which is crucial in the ever-changing climate of healthcare.
Strong interpersonal and communication skills are also an
essential trait in managing a diverse clinical team and effectively
addressing the challenges and demands of staffing and
providing quality care.
Dawn Pevey-Mauk, RN, BSN, Chief Nursing Officer,
Ochsner Medical Center: The characteristics of an effective
nurse manager include loyalty to the staff and organization,
compassion, caring attitude, fairness to all employees, and a
nonjudgmental attitude. They should have the ability to gain
trust and respect as well as showing competency in the area
with continuing education. Key components include being ethical,
honest, candid, but respectful, confident, knowledgeable,
reliable, and open-minded. They should also demonstrate
integrity, fairness, decisiveness, and persistence and they
should be a motivator. They need to be able to hold people
accountable and still motivate them. Other characteristics
include transparency, good communication, consistency with
expectations, hard work, openness to feedback, follow
through, and follow-up.
Debbie Ford, RN, MSN, VP of Patient Care Services, Chief
Nursing Officer, Our Lady of the Lake Regional Medical
Center: The characteristics of an effective nurse manager
include: listening; being a change agent; vision; pacing—it’s
up to you—you cannot trust the river as it is permanent white
water rafting; resolve—holding fast to standards; and fun.
Sonya Leteff Willis, RN, BSN, Director of Nursing, Earl K.
Long Medical Center: An effective manager must be knowledgeable,
flexible, goal-oriented, have clear communication
skills, and be a leader who is an advocate for his/her patients.
Leslie S. Norman, PhD, RN, CPHRM, NEA-BC, VP, Patient
Care Services/CNO, St. Elizabeth Hospital: Believe and
live your core values—you must demonstrate this and be a
role model. You must be highly visible and accessible by the
team and share decision-making with the team—no one likes
a dictator. Listen intently, demonstrate that you care about
what they have to offer, do what you can do to meet their
needs, then close the loop by communicating back—we call it,
“You Asked, We Listened.” Have an open door policy—you
may be “too busy,” but don’t let the team know that—it will be
perceived that you don’t have time for them. Don’t tolerate
negativity or bad behavior—one can spoil the whole bunch—
you must be consistent and fair—if you let one do it, you won’t
have a leg to stand on for the next one. Share problem solving—
don’t solve all the world’s problems for your team; be a
coach and mentor to teach others how to come to the table
with solutions.
Paula Hymel, RN, Senior Vice President/Patient Services
& Outreach, North Oaks Health System: An effective nurse
manager anticipates the complexities that may arise in health
care delivery and provides the nursing professionals on
his/her team with the skills, resources and inspiration needed
to provide care successfully to the patient. Effective nurse
managers drive the constant improvement of the care delivered
by their team. They take the time to listen to their staff
and patients and are open to suggestions.
HJBR: What will the increased implementation of evidence-
based practice mean for nurses and the work they
perform?
Anna Cazes: Evidence-based practice, especially for registered
nurses, is significant. When treatment is based on scientific
information, when you have that rigid research, whether it
is gathered from outside facilities or at your own, it will
increase good outcomes for the patient. Recently we implemented
Lean/Six Sigma at this hospital and with that we have
to go through very rigorous ways of studying processes. It
brings the process to the next level and helps us to understand
each piece that affects our organization and which are
statistically significant. I know that if you want to have good
outcomes for patients you need to make sure you are using
evidence-based practices.
Jennifer Johnson: The effect of evidence-based practice on
the bedside nurse today gives them the avenue to bring their
interests and observations to the research arena in order to
facilitate the best outcomes in patient care using proven nursing
interventions. This should increase efficiency and nursing
job satisfaction.
Dawn Pevey-Mauk: Evidence-based practice (EBP) will
ensure quality care. In addition, this will help grow the profession
of nursing. Nurses will continue to have a role in care
delivery by having their voices heard through EBP.
Implementation of EBP will mean a more rounded plan of care
not only for the patient, but it will mean the nurses will start
caring for themselves and their co-workers. Implementation
will yield consistency in quality outcomes that will raise the
level of excellence and allow us to hold each other more
accountable in daily practice. It will ensure a higher quality of
care for our patients. I believe communication between nurses,
physicians, and other departments is essential to providing
the best quality care and most efficient care. It will “drive”
quality and propel the nurse to a new level of excellence and
awareness concerning patient care. Medicine has been evidence-
based for years so it is time for care. This will help
explain why we do what we do.
Paula Hymel: Evidence-based practice implementation will
provide a degree of standardization that will enhance nursing
care delivery and lead us to excellence as a profession
through the elimination of deviation in practices.
Patricia Johnson: Evidence-based practices are integration
of the best research evidence, clinical expertise, and patient's
experience, and by incorporating EBP into nursing, we are
able to provide the highest quality of care and experience for
patients and families. In order to provide this level of service
and remain current on the latest EBP, nurses must embrace
change-management skills; gain a better understanding of
various levels of research and knowledge, and understand
measurement of outcomes.
Debbie Ford: Increased implementation of evidence-based
practice will mean:
•Better quality care for our patients/improved outcomes
•More autonomy for our profession—confidence
•Efficiency in processes
•Creativity—increased risk taking
Leslie S. Norman: We will be practicing using data and science
as a proven, solid backdrop to guide our work. It means
that we will not have to “always reinvent the wheel” to develop
new processes or care. By doing this, we will be creating
an environment to help speed healing and length of stay
through more efficient work processes.
Sonya Leteff Willis: Evidence-based practice will validate
current nursing practices and allow elimination of practices
that are not evidence-based or value-based.
HJBR: Is there a need for increased interdisciplinary education
and communication between nurses and other
providers?
Debbie Ford: Yes. I always say it takes a village. Each discipline
brings great benefit to the patient. This will lead to
improved collaboration and thus trust. Interdisciplinary communication
and teamwork are vital as they promote mutual
respect and role clarity.
Sonya Leteff Willis: There is a need for increased interdisciplinary
education and communication between all healthcare
providers. If communication and education are increased it
allows nurses as well as other providers to better understand
patient care as a totality. Knowledge is power and understanding
other professional roles in healthcare contributes to better
patient care.
Leslie S. Norman: I feel there is always opportunity to foster
effective interdisciplinary education and communication.
Traditionally in the past, we have all been functioning in minisilos,
but it is time that we all come together to share ideas,
review, and implement evidence-based practice, because in
order to facilitate effective care in the new healthcare world,
we all play a part just like a symphony. All parts have to be in
harmony to sound good.
Jennifer Johnson: Definitely. Patient care delivery and the
quest for excellent outcomes cannot be done in isolation and
total independence. It is a holistic approach and involves all
disciplines communicating and working together for the common
goal of excellent patient outcomes.
Dawn Pevey-Mauk: Yes. Caregivers will know where other
caregivers are going with their plan of care and this will
enhance the patient’s care. We have not reached the level of
mutual trust and respect that is needed to obtain the best
patient outcomes. The success of the entire team is hinged
upon this concept. Nurse managers and medical directors
should be in constant communication of what is expected from
each and agree on the unit’s goals.
Anna Cazes: Oh definitely. Our meetings include all of the
service lines we have. All the managers and directors are part
of those committees and we always bring in the frontline staff.
When they are in nursing school they feel intimidated. We
don’t want those students to be isolated on one side and not
know what’s going on in the hospital. We have made sure we
tap into all resources. For example, it sticks better sometimes
to have a physician help teach from a physician’s standpoint,
share what they are expecting, so we had an orthopedic surgeon
teach that class at the nursing school. I have a steady
line of physicians that will teach classes. Other specialties
have come in to teach; for example, for anesthesia, we had a
respiratory therapist.
Paula Hymel: Yes, ongoing interdisciplinary education and
communication between nurses and other providers is key to
the delivery of quality patient care. For example, here at North
Oaks Medical Center, we place a pharmacist on our nursing
units that care for our most complex patients. Not only does
this heighten communication between nursing and pharmacy,
but it also facilitates our pharmacist’s interaction with physicians
and the patients to enhance their care.
Patricia Johnson: Most often it’s the nurse who coordinates
the care of the patient in the hospital; therefore, they are the
ones who communicate directly with departments such as
social services, respiratory, home health, lab, and radiology.
By improving interdisciplinary education and communication,
nurses and other clinicians can gain a better understanding of
everyone’s role and result in improved collaboration, which
will ultimately produce better patient outcomes.
HJBR: Are recruitment and retention an issue and what
can be or is being done to address the problem?
Leslie S. Norman: Currently, I am not experiencing recruitment
issues; in fact, I have a waiting list of applicants. Many
seasoned nurses who are at or near retirement are staying in
the workplace. I think this is common across Louisiana.
However, the predictions from current research supports that
within the next 5-10 years, we will experience a shortage
again. In order to stay ahead of the curve, we will have to
assure we have qualified nursing faculty to accept all of the
applicants. As the economy improves, we will see nurses
again choose retirement or other options, thus creating a
vacancy issue.
Anna Cazes: Right now we are in good shape in our area. I
think this is true of almost all hospitals. We don’t have as
many positions. Right now, we have probably fewer than ten
openings. We haven’t been in a position where there is a
shortage, but I think all of this will change in the next few
years. For retention we use talent management. It’s a way to
try to objectively rate nursing staff within the unit as to where
they are in their performance. About 70 percent of the workforce
is highly ranked. They are well versed in what they need
to do and are big contributors to the hospital. Twenty percent
of the staff are top talent. Top talent staff go way beyond what
regular clocking in, clocking out staff do; they are really making
a difference. Then there are about 10 percent that are less
effective, they are really not doing what they need to do, they
have issues. We rate the staff every quarter so they know if
they are in the bubble and they have another quarter to take
care of the problem. If it goes on, the less effective can be terminated.
We’ve had this process for over two years and I think
it is really helping.
In the recruitment part I had a lot of issues with what I thought
to be the problems occurring on the floor. A lot of them were
basic nursing skills. I went to the school of nursing and HR
and I increased the screening regimen in Human Resources.
They have skills class testing, behavioral testing, and critical
thinking testing before being forwarded for an interview. You
have to push the nursing programs to produce better graduates
that are ready for the workforce.
Paula Hymel: Within the past year, we have not had a problem
recruiting registered nurses to fill our vacancies.
However, we have placed emphasis on recruiting qualified
nurse practitioners to help meet the needs of the communities
we serve.
Patricia Johnson: Woman’s Hospital was identified in a
1973 study as a “magnet” hospital – a hospital that attracted
nurses. Woman’s was officially designated in 2006 by the
American Nurses Credentialing Center as a Magnet hospital.
Magnet hospitals are recognized for their excellence in patient
care and professional model of nursing. To date, Woman’s
has not experienced any recruitment or retention issues; in
fact, we often have a waiting list of nurses who would like to
join the organization.
Dawn Pevey-Mauk: There has been great difficulty in filling
positions with experienced nursing staff. It is believed that
people are scared to make a move with the instability of the
economy. People doing the recruiting need to take a closer
look at the people they are trying to recruit. They need to be
sure to ask the question, “Will this person be a good fit for our
team?” I would like to see them give a more realistic view of
our system. Also they need to explain what is expected of
them when they work for the Ochsner system. The younger
nurses do not seem to have the type of need to stay at a
place and make something lasting. There has been
improvement over the past year, but it is still challenging.
We are doing a good job of reaching out to the various
schools–nursing, allied health, etc. However, we are not
doing enough to pull in experienced people.
As for retention – unit practice councils are beginning to
realize that they can make change happen. Retention is
managed by great recruiting and hiring practices. The
directors need to be more involved in the “recruiting”
aspect. This was not a must in the past. Retention is currently
a problem because of forced turnover. Nurses who
are not meeting the expectations are moving on. We have
implemented a very strong orientation and on-boarding
program which I believe is working well.
Sonya Leteff Willis: Recruitment and retention are currently
an issue at our hospital. As a public hospital that is
set to close in 2013, many of our nursing staff are leaving
to find a more secure position at other facilities. We currently
are trying to recruit nurses who have just graduated
out of nursing schools and have been here at EKL to perform
their clinical. As a teaching hospital this is very inviting
to build the foundations for many new graduates.
Debbie Ford: Both are integral to a role where professionals
participate in caring for people and saving lives. We
should always be re-recruiting our stars and creating an
environment of “we.” When we retain our experienced
stars, we ensure patient safety.
Jennifer Johnson: Having the right mix of competent staff
is always in the forefront of any effort of a successful
organization. It is imperative to know and understand the
needs and desires of the available employment seeking
professional – both the novice and the expert – and to drive
efforts to meet those needs. Evidence-based practice is an
example of how this can be accomplished by giving nurses
a voice in their practice on an ongoing basis.
HJBR: Are nurses being adequately and appropriately
educated for the workplace? Do you support transition-
to-practice residencies for new nurses?
Dawn Pevey-Mauk: I feel there could be more education
in the workplace for all healthcare workers. The younger
nurses do not seem to have the same basic nursing fundamental
educational requirements that the older nurses
have. The interns we have had in the past turned out to be
a more knowledgeable group than those we did not work
with as interns. They are getting the theory they need, but
not enough practical application. Residency programs
would dramatically improve the transition from the “ideal
state” of reality. I believe that in general, nurses are adequately
educated, but individual drive and in-depth specific education
is very important. I support a nurse residency program.
Over the years I have seen many changes in the education of
nurses. They are not taught the basics anymore. When students
come to the floor there is no sense of pride or “fearful”
respect. They aren’t motivated to learn everything they can
when they are here.
Jennifer Johnson: Yes. Other disciplines have done this
effectively for years. I see the need for it in the new graduate
nurses today. There is now a need for extended and extensive
new nurse preceptor and orientation programs in order to fill in
the gap between education and reality of practice needs.
Paula Hymel: Yes, nurses are appropriately educated for the
workplace. Nurses who are new to North Oaks Health System
are provided with transition-to-practice through their pairing
with a nurse preceptor who has received training in orientation
education. The new nurse remains in this partnership for many
weeks until he/she feels confident in their new role.
Anna Cazes: All nursing programs have a lot of clinical hours.
The quality of clinical hours can differ. So by raising the standard
and improvement of the staff, the supplier of the nurses
will raise up and say, “We will produce the best nurses.” In the
scenario hospitals are in right now where there’s not that much
need, I have one position with 20 to 30 applicants. That was
not true of nursing for years. Before, you would have a job
before you graduated. Now I can really screen and take the
cream of the crop. You want to have someone who is really
dedicated to what you do. We do have internships, but they
are a cost to us. We have to pay them while we are getting
them ready and a lot of this preparation can be done in a nursing
school. If they are trained properly it should not take me
more than six weeks of orientation. With an internship, where
they spend 3 months in the ICU, six months in the operating
room, if I have a problematic candidate it costs the hospital a
lot of money. We are sitting in a very good position right now,
but in five years I think we will see a change in the workforce
numbers again as nurses meet retirement age. These are
experienced staff members and when you hire new people
they won’t have as much experience. We need to make sure
we have a plan to prepare really strong nurses for the workforce.
Patricia Johnson: The ideal program would provide transition-
to-practice residencies because when nurses graduate
they have the basic knowledge, but they still require an indepth,
comprehensive, formal orientation. One of the best
methods to help a new nurse become more competent in complex
clinical skills is through mentoring with experienced nurse
preceptors, which we do at Woman’s Hospital.
Sonya Leteff Willis: Most nursing students are adequately
book wise when they come out of nursing school, but sometimes
lack the fundamental skills/knowledge that are needed
at the bedside. Nursing students need more hands-on experience
with the practical side built in. Without more clinical experience
they have a very hard time integrating from the book
world of nursing into the practical world of nursing. I do support
transition-to-practice residencies for new nurses. This
would allow more hands-on at the bedside. It also allows the
nurse, as well as the nurse manager, to see if the employee is
a good fit for the role they are going to be taking on.
Leslie S. Norman: I think our schools of nursing do a wonderful
job, but healthcare has changed dramatically over the
last 25 years and those of us in the acute/hospital world need
to partner with the educational systems to further enhance the
required skill set and competencies needed of our new graduates.
Competencies such as: customer relations and satisfaction,
ethics and compliance in healthcare, quality and performance
excellence, and current regulatory issues are needed.
These are necessary skills that need to be garnered through
the transition-to-practice residency programs.
Debbie Ford: The educational programs are meant to be
comprehensive but not exhaustive. The student is exposed to
activities, but the main focus is on critical thinking and planning
which are important as the world of healthcare is everchanging
and new evidence everyday has to be assimilated.
Nursing education is tough. I remember watching my colleagues in other disciplines having downtime, when my nursing
colleagues and I were preparing patient plans of care,
studying drug cards to ensure a safe experience for our
patients the next day.
Yes, I support transition-to-practice residences for new nurses.
The goal of the education system is to prepare a nurse for
minimum competence. This is appropriate. We then take them
and put them in an internship where this competency is
enhanced and built upon. The work of nursing is experiential…
the caring and the science…is a building block.
HJBR: Are there challenges for nursing from the scope of
practice barriers for nurses in LA?
Patricia Johnson: Scope of practice for the registered nurse
is well-defined by the Nurse Practice Act. However, as healthcare
continuously changes and new technologies are introduced,
we must constantly reassess how we work and practice
in order to provide patients with the best care possible.
Anna Cazes: For bedside nursing right now the biggest challenge
is preparation of nurses when you have variation in
nursing preparation, whether ASN, BSN, or a diploma program.
The scope of practice for these three levels are almost
the same the majority of the time. In the advanced practice
role most nurse practitioners are allowed to write prescriptions.
I think that was one of the biggest barriers for advance
practice nurses, but that’s kind of gone away. If they are willing
to go back and retest for the prescription privileges they
can do that. I think overall the advanced practice nurses in
Louisiana perform very well and there is nothing pressing that
they have voiced to me.
Dawn Pevey-Mauk: Yes, there are lots of challenges with the
scope of practice barriers. I would like to see a younger age
group in the State Board positions. I would like to see a group
that has current experience with hands-on nursing.
Debbie Ford: As healthcare evolves and new evidence is discovered,
the role of the professional nurse changes naturally
and thus may impinge on the scope of other practitioners.
That is not a bad thing. As healthcare becomes more complex,
all healthcare providers, physicians, nurses, and others must
rise to meet the patient needs. For example, such rigid practices
as requiring an Advance Practice Nurse to have a collaborative
practice agreement with a physician may have once
served a purpose, but may now be more of an impediment to
patient care due to the nature of having to refine, get signatures,
be limited by type and number of physician signatures.
The collaborative relationship that the boards of nursing and
medicine have cultivated over the years is a positive force for
Louisiana.
Sonya Leteff Willis: Over the past 10 years practice barriers
for nursing have diminished, but some still remain. I believe
with the knowledge and leadership of nursing these barriers
will continue to diminish.
Leslie S. Norman: In particular, in order to keep up with the
future demands of healthcare in the reform era, we will have
to address the scope of practice limitations of nurse practitioners
in Louisiana. Currently, the regulations restrict NP’s in our
state to have strict oversight by a physician for skills and competencies
they were educated and trained for such as prescribing
medication and diagnosing conditions. These will
have to be dealt with through legislation.
Jennifer Johnson: The Board of Nursing addresses issues
as presented to them. There are always challenges regarding
scope of practice issues. It is important that we all work
together for the benefit of the nursing profession.
Paula Hymel: As the role of the professional nurse continues
to expand, the scope of nursing practice will, likewise, expand.
The Louisiana State Board of Nursing is very active in assisting
North Oaks Health System in clarifying any nursing questions.
HJBR: Should more be done to train and encourage nurses
to pursue leadership roles?
Leslie S. Norman: Yes. I have experienced great difficulty
with enticing staff nurses to entertain leadership roles
because: 1) there are no extra perks or benefits to move into
management; 2) most are working 3 days a week full-time and
leadership usually requires 5 days a week; 3) they see leaders
working overtime without monetary compensation; 4) they
frankly don’t want the decision-making authority; 5) they don’t
feel adequately prepared to assume these roles. I think we
need to be more aggressive in succession planning and identifying
hidden talent so as current leaders, we can groom and
prepare team members to assume future leadership roles.
There are many Master’s and Doctorate programs now
appearing that also provide more intensive leadership/management
preparation.
Sonya Leteff Willis: More training and encouragement of
nurses to pursue leadership roles is vital to our future and the
future of health care. Nursing is an ever-changing career with
many opportunities. I also believe that if you build training of
leadership into your nursing staff they will become better care
givers, even if they decide leadership is not the route they want
to take.
Anna Cazes: Oh definitely. The majority of CEOs or CFOs
have a Masters in Business Administration. They all have
some background in leadership. The majority of nurse managers
got that position for being good clinicians, but not all
good clinicians translate to good leaders and that is the biggest
hurdle in nursing. The majority of nurses in Louisiana are still
prepared at the associate degree level. Even at the BSN level,
they may only have one class on leadership, one in management.
And if you look at the curriculum, the majority of that is
trying to learn how to be a charge nurse or how to manage six
patients. That’s what they are being taught. Not to become a
CNO, not to become directors. So when we put them in a leadership
role they struggle. When they struggle I have to have a
strong framework to help these people out. I have to get tools
for them. Get them to think not only what is best for the patient
but what is also best financially. The oil that makes the hospital
move is based on reimbursement, but there is no nursing
program that teaches finance. They have the other half of the
pie. They are really good nurses, really good clinicians. I have
to turn it around and get them to understand the other side.
Patricia Johnson: I believe that all nurses are leaders in
healthcare as they are leaders for other nurses, for patients
and their families, and for their communities. Leadership development
should be encouraged throughout a nurse’s career
because this gives individuals the ability to be more effective in
their roles, and gives them more flexibility to pursue a management
role.
Paula Hymel: Nurses at North Oaks are offered ample annual
educational opportunities to develop leadership skills.
Debbie Ford: The importance of nurse leadership has long
been recognized in the nursing profession and succession
planning is incorporated into many employment types. There
are informal and formal programs, which may include executive
coaches, mentors, and other forms of training. The importance
of mentorship should not be overlooked and generally is
highly encouraged.
Dawn Pevey-Mauk: At OMC, there are many avenues for
nurses to advance in leadership. I think the schools could do
more about encouraging future leaders. I think in nursing as a
whole we need to train the younger nurses to be leaders. In the
past, leaders were chosen and then their training was hit or
miss at best. Too many nurses come out of school expecting
to step into bedside. I think it is very important for every nurse
to experience bedside care before being allowed to lead in
nursing. Without that experience, they can never really relate
to the staff nurse. Recognition of strong leadership characteristics
is key. A person simply showing interest does not mean
he/she is capable of being a strong leader. I really appreciate
Ochsner’s succession plan where leaders recognize those
who may one day replace them. We need more educators. It
is becoming more and more apparent that nursing seems to be
moving away from the bedside and almost to the point that
nurses feel somewhat inadequate if you’re happy at being a
bedside nurse and not some type of leadership or advanced
practice.
Jennifer Johnson: Yes. In our hospital, we provide leadership training to nurses new to the leadership role as well as to
those who have been in the role for a while. However, our bedside
nurses as a whole in nursing across the state and country
are typically not taught leadership and management skills.
Hopefully, with the advent of Shared Governance Councils
and increased awareness, this will improve.
HJBR: Do nurses have a strong enough voice in health
transformation and reform?
Debbie Ford: Yes. We can argue that we can always improve
our voice. The American Nurses Association has done an
excellent job in keeping their members informed of key activities
related to healthcare. Nurses taking advantage of these
benefits are able to participate fully. There are several ways
nurses may be involved. For example, The Nurse Intern in
Washington program sponsors a program that trains nurses
and then arms them with information to take to the Hill and
takes them there. Local nursing associations also encourage
and provide avenues for nurses to be informed/to participate.
Here at OLOL, we expose bedside nurses through research
days, evidence-based practice, journal clubs, and a newsletter
called “Fast Facts.”
Jennifer Johnson: As healthcare reform progresses in the
country, it will be imperative for nursing to be actively and intimately
involved in order to preserve quality patient care.
Nursing is the heart of healthcare. We represent the patient as
a person and our presence has a direct impact on the patient
in a way that is unique to us.
Paula Hymel: At North Oaks, our nurses are very engaged
and informed when it comes to health care transformation and
reform. In fact, North Oaks was recently recognized by the
American Hospital Association as the “Grassroots Champion”
for the state of Louisiana for exceptional leadership in generating
grassroots and community activity in support of our mission.
Patricia Johnson: Nurses should become more involved in
advocacy and, as healthcare reform continues to evolve,
make sure that they are knowledgeable and active in the
health policy process.
Dawn Pevey-Mauk: Nurses who do are the ones who fight to
have their voices heard. Nurses do not have a strong enough
voice in healthcare transformation and reform. We have very
little voice in how the politicians make the laws that govern our
healthcare. I feel nurses need to take a more active role in
these areas. Each specialty has its own initiatives and without
oversight from a common organization we will never gain the
voice we need to seriously impact healthcare reform.
Leslie S. Norman: Currently in Louisiana, I do not feel our
voices are heard to the extent that they need to be. Nurses will
be the key drivers and players in the new healthcare era. The
Institute of Medicine report, “The Future of Nursing: Leading
Change, Advancing Health,” which was created through the
Robert Woods Johnson Foundation has given us a strong
platform to begin building the infrastructure. In Louisiana, we
are privileged to be chosen as a Regional Action Coalition with
the Louisiana Center for Nursing in partnership with AARP.
This will allow us to take an active role in developing and educating
healthcare providers on these future needs and roles
around our state and region.
Sonya Leteff Willis: Health transformation and reform, I
believe, will be a platform for nurses to use their voices. I
believe that we have a very strong voice in this arena, but we
need to be stronger. As we continue to push forward our goals
of leaders will gain more recognition as to the transformation
of health care reform.
Anna Cazes: Well if you look at the participation in the local
nursing associations the number of nurses is extremely poor.
We don’t have a good number of nurses who think about
those things and understand what’s going on. Membership is
way too low for the number of nurses in the state. I think they
are going to know about reform, but are they there now? I
think there are people trying, but I’m not sure we have enough
people going to make sure their voice is heard.
HJBR: Do you anticipate nurses playing a more
enhanced role in healthcare with reform?
Paula Hymel: Yes. In our region, the number of people
requiring primary health care services will increase as a result
of reform. In anticipation of a true shortage of primary care
physicians, the nursing profession will be challenged to
address this need with Advanced Practice Registered Nurses
or APRNs. We currently employ many APRNs and offer a
stipend program to help our employed RNs pursue advanced
practice to meet present and future demands.
Jennifer Johnson: Yes. Quality of care results are paramount
for the welfare of the patient, the providers and healthcare
institutions. Nurses have a profound and direct impact on
quality.
Patricia Johnson: I do anticipate nursing playing a larger
role in healthcare reform because nurses are experts at care
coordination and patient education. Additionally, advance
practice nurses, such as nurse practitioners, nurse anesthetists,
nurse midwives, and clinical nurse specialists, can
play a stronger role in helping to provide quality, primary care
services.
Dawn Pevey-Mauk: I’m not sure. This would take nurses getting
empowered to join their national and local organizations
to have their voices heard. I can see the nurse’s role going
either way. If the nurses get more involved I can see them
having a more enhanced and defined role. I can also see that
if nurses do not step up and become more involved it will be
delegated to who and what the politicians want.
Debbie Ford: Nurses are pivotal to healthcare reform. The
pay for performance measures—Hospital Assessment of
Healthcare Provider Services, CMS Core Measures, and
Hospital Acquired Never Events—are just a few of the programs
that highlight the enhanced role of nursing. Nursing
sensitive indicators are the key drivers, such as prevention of
pressure ulcers, patient falls, and providing quality are all key
components of the healthcare reform.
Sonya Leteff Willis: I believe nurses will play a greater role
in healthcare with reform. There will be greater autonomy with
advanced practice nurses through evidence-based practices.
Anna Cazes: To me, if I was a practicing nurse at the bedside,
I probably am so detached from what’s happening in the
whole world. The concern is just the daily work at the bedside.
They don’t have time to focus on healthcare reform. I am hoping
it will get to the next level. You get comfortable doing the
same things for years and this is changing the way we practice.
I wonder how we will translate all these changes to the
staff, implement all the changes, because nurses are not
trained that way in school. That’s shaking everybody. I think
priorities will change and the way of thinking of nursing will
have to change. It is part of my role to make sure I get them
to the next level. Some know what they read in the newspaper
or on the internet, but it doesn’t hit home really.
Leslie S. Norman: Absolutely! We must be at the table as
redesign decisions are made because nurses will be key players.
It is anticipated that new roles will be developed in the outpatient
world and nurses will have more options than ever,
such as: transitional care nurses, clinical nurse leaders,
health coaches, and telemedicine nurses. If everything goes
according to predictions, we will see a shift away from needs
of traditional inpatient roles to more outpatient driven, health
promotion delivery models.
HJBR: How have you seen the nursing profession
change over the past 20 years?
Patricia Johnson: Everything has changed! Through the use
of technology and advances in medicine the role of nurses has
become more prominent, yet also more efficient. Computers
now allow nurses ready access to patient information, which
results in more responsibility and the ability to respond to
patient needs faster. Also, patients’ length of stay has shortened
due to advances in medicine – for example, the
laparoscopy or robotic surgery only typically keeps a patient in
the hospital one night, so nurses are experiencing more
patients with a variety of conditions in shorter periods of time.
This demonstrates a strong need for interpersonal skills, flexibility,
and continued clinical education. However, the role of
the nurse as a patient advocate has not changed.
Debbie Ford: Changes include:
•Expansion of nursing articulation programs for improved transition
from one nursing degree to the next, e.g., Associate
Degree to Bachelor or Master’s degrees
•Enhanced collaboration between the boards of nursing
(LSBN) and medicine (LSBME).
•Expanded roles and scope of nurses to include the changes
in the nurse practice act to allow Advance Practice Nurses
more autonomy
•Increasing complexity and acuity of patients have forced
nurses to become increased consumers of evidence-based
practice
•The image of the nurse has greatly improved, especially in
media
•Salaries and compensation packages have improved.
Sonya Leteff Willis: The autonomy of nurses is greater and
nursing has become a more respected profession.
Leslie S. Norman: I have been a nurse for 25 years and have
seen tremendous cycles of change. We have moved from a
paper-based, manual documentation system to the electronic
medical record. We have extensive clearing houses with data
and information pertaining to best practices instead of the old
“trial and error” methods of long ago. I have seen nurses operate
from a holistic framework where tremendous time was
spent with each patient, to one that is primarily task driven. We
are all trying to bring the time at the bedside back to care as
we speak. The professional image has changed, from wearing
the crisp, white uniforms to scrubs in a variety of colors.
Jennifer Johnson: Nurses of today are required to have a
broader base of knowledge than in the past. We are more of
an assistant and extension of the physician than ever before.
We not only are required to provide compassionate and competent
care, but we are required to do it more efficiently than
ever before.
Dawn Pevey-Mauk: One area that has changed the profession
is the electronic medical record. This takes away time that
was used at the bedside. In addition, many advancements
have been made due to the availability of the records. Over
the last 20 years nurses have gone from a handmaiden who
did the undesirable jobs to an active part of the healthcare
team. Nurses and doctors have a better working relationship.
The most significant change is in the severity of illness of the
patients that are cared for on medical units. This has created
the necessity for nurses to have a strong ability to multi-task
and do critical thinking. However, technology has robbed
many nurses of their ability to do critical thinking. Economic
issues have taken the staffing grids to levels that do not allow
nurses to spend enough time with their patients. I have noticed
nurses now have less autonomy. Also, the responsibilities of
the nurses continue to increase leaving less time for nurses to
be at the bedside. It is so much more than bedside care of a
person. It is the responsibility to offer every client and his or
her family a truly meaningful and positive experience. We are
not task performers but critical thinkers; not servants but here
to serve. Nursing is so multifaceted now you can be anything
you want to be.
Anna Cazes: You now have to think about the cost of an RN
and what can they do, what can you get? Right now I am seeing
most hospitals go to all RNs. But as the transition occurs
you will see that nurses will need to think more in a leadership
role. We’re very focused on acute care but that’s going to
change. We will want to prevent patients coming to the hospital
by providing a lot of services outside. We are now seeing
nursing transitioning into leaders providing that kind of service
in the community. The hospital will also have to change their
philosophy of how they run the business and we will have to
prepare our nurses in that direction. The development of a
diploma program is one change. We love our diploma nurses
because they train here at our own hospital. When they come
out they pretty much can run. Twenty years ago it was easier–
you could have 10 or 12 patients for each nurse. They could
do it. It was okay because the patients did not leave in a day
or two. The length of stay was longer and you got to know
them and their routines. LOS now is two to three days. When
you see patients like that it’s really hard to be on the floor.
There is so much paperwork to do, so many regulations
regarding admission and discharge. The push for decreased
length of stay truly changed the process on the floor. You have
to be efficient in case management. Many processes that
were taken care of in the hospital can now be taken care of
through home health. Nurses need to know how to coordinate
that. The changes are occurring back to back to back. We
need to push and change the education as fast as the government
is changing the rules. You have to be able to match
what’s happening out there in the community.
Paula Hymel: Like all health care fields, the nursing profession
has become much more complex. For today’s nurses,
critical thinking is essential as they are challenged like never
before by new technologies coming online, the complexities of
medication delivery, and the requirements of regulatory and
accrediting agencies.
HJBR: What would you have to say to someone considering
a career in nursing?
Sonya Leteff Willis: Nursing is a passion, not just a career.
You have to have a want and a need to do this job. It is a love
for something greater then yourself and you have to make
sure you are up for the challenge.
Dawn Pevey-Mauk: I would tell the individual that this profession,
although there are many stressors and difficult times, is
the most rewarding job. As a nurse, you treat a patient holistically.
Not only do you address all medical issues, you are
trained to also address spiritual, social, and many other
important factors. This enables you to really reach a patient.
When you leave work daily–you’ve really made a true difference
in someone’s life. I would make sure that the person who
was asking knew that nursing isn’t something you go into just
for the paycheck. I’d make sure they know that this is a career.
It is extremely rewarding but a very challenging career that
requires you to put forth your best even when you don’t feel
like it. You must love people and have a generous spirit and
unwavering commitment to quality. So look inside first—our
patients, which include your family and mine, deserve only the
best. I would tell them the great thing about nursing is there
are so many opportunities and paths you can take.
Anna Cazes: Nursing to me is still the most trusted, the most
satisfying job that anybody could have. It is a hard job, but
when you go home, there’s something to say if you are a
nurse. You touch a lot of lives in that eight or twelve hours
you’ve worked, whether you are in leadership, management,
or a staff nurse. There is not one other profession that you can
touch this many people in a given year and make a difference.
It’s not an easy job. I always told my students when I was
teaching, “Don’t come to nursing if you want to be a nurse
physician or CNA. I want you to know what nursing is about
first.” To stay in nursing you have to like what nursing is about.
You have to love what you are coming here for. If you don’t
have a passion for nursing you are definitely in the wrong profession.
If you are only in the nursing program because you
read in the newspaper that you can make a certain amount of
money, then you are really in the wrong place. It’s a tough job,
but a very rewarding job. If you are one of those who want to
make a difference in someone else’s life, then nursing is the
right profession for you.
Patricia Johnson: It gives a person the opportunity to really
make a difference in people’s lives every day while providing
a flexible lifestyle. Nurses are not restricted to a certain city or
state – they can choose to live anywhere. They can also
choose how much they want to work, the type of work, and
have the ease of moving in and out of different roles, such as
management. The education opportunities in nursing are also
continuing to grow; advanced practice nurses, such as nurse
practitioners, nurse anesthetists, nurse midwives, and clinical
nurse specialists, are now playing a stronger role in providing
quality, primary care. Nursing has been a great career for me,
and I highly recommend it!
Debbie Ford: It is a profession of heart and science. You
must have an interest in keeping people healthy as well as
treating them when they are not. It is a rewarding
career…after all, where else do you get to both care for and
care about people while saving lives?
Leslie S. Norman: I would tell them that to be a nurse is not
a right, but a privilege that we have in making a difference in
someone’s life.
Paula Hymel: Nursing is a truly challenging profession in
terms of the knowledge and skill required, as well as the physical,
emotional and spiritual aspects of the job. Not everyone
can be a nurse, but for the true nurse…the nurse who is
always kind and listens to his/her patients to better provide
care and comfort…it will be the best experience of his or her
life. I know it has been for me.
Jennifer Johnson: It is one of the most satisfying and rewarding
careers anyone can hope to have. We have an opportunity
like none other to directly impact the lives of people. We are in
a position to be directly impacted and changed ourselves as a
person by our contact with humanity in all of its forms.
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