By Jennifer Larson,
feature writer
Maurene Harvey, RN, CCRN, is
the first nurse to be elected president of the Society of Critical Care
Medicine.
That’s especially unusual,
considering the organization is predominantly composed of physicians, but it’s
appropriate, given Harvey’s belief that nurses and doctors should work
together.
Harvey believes that the best
critical care is provided by a cohort of qualified experts, including both
doctors and nurses.
“We really believe the way
to give good care is to have a high quality team,” Harvey said, calling such
an approach “something I’ve always believed in.”
Harvey recently spoke about
this very topic to members of the Society of Critical Care Medicine during the
organization’s 31st Critical Care Congress, held in San Diego,
California, Jan. 25-30. She will serve as president of the society for the
2002-2003 term.
According to Harvey, critical
care nurses play an important role in providing patient care. But it’s the
collaboration with others that makes it possible.
“It’s like an orchestra,
with every instrument finely tuned,” she said.
But Harvey also believes the
orchestra needs a conductor. The conductor should be a physician trained in
critical care medicine, an intensivist who received extra training in critical
care beyond training in surgery, pediatrics, or other specialties.
Harvey, who received her
diploma from the California Hospital School of Nursing and a master’s degree
in public health from California State University at Northridge, worked as a
critical care nurse in a hospital with a critical care fellowship program
directed by one of the SCCM founders, Dr. Max Harry Weil.
That experience convinced her
of the benefits of a patient-centered, intensivist-led team in the critical care
setting.
Now Harvey, who has been a
member of the SCCM for many years and a member of the executive committee, is a
consultant in critical care and nursing education. She calls herself “a
vagabond gypsy instructor” who visits many ICUs each year. Those visits
strengthen her conviction of the need for an intensivist-led model in critical
care medicine.
The 24-hour presence of a
specially-trained physician can mean a big difference in patient morbidity and
mortality rates, she said, but only about 5 percent of critical care units in
the U.S. have intensivist-led teams.
“I was immediately and am
continually astounded by how few have intensivist-directed multi-disciplinary
teams, and how this negatively affects patients and their families,” Harvey
said in a presidential address at the recent SCCM meeting.
“In this country, unlike
most developed nations, the medical care of a patient is often left to critical
care nurses,” she added. “The medical care of our most vulnerable patients
is being managed by nurses.”
But that’s not what nurses
should be doing, according to Harvey.
“Thankfully, critical care
nurses are highly trained and committed to their patients,” she said during
her keynote address. “But why doesn’t this cause all nurses to clamor for
intensivists?”
“Nurses are a precious,
precious commodity. Nurses shouldn’t be wasting their time organizing the
medical care,” Harvey said. “We need to be freed up to take care of
patients.”
Harvey acknowledged that hers
may be a controversial point among nurses but maintained that nurses need to
have the time to perform their own job duties, not taking care of the
responsibilities of physicians.
But many nurses have never
worked in an intensivist-led team, given the small percentage of such programs.
Given the lack of experience with a properly trained intensivist, nurses likely
could not imagine the benefits of a critical care setting with an increased
physician presence.
“They picture increased
confusion and interference,” Harvey said. “They cannot conceive of how much
more organized and less fragmented the delivery of care would be.”
“They cannot dream of the
day when a fully-trained ICU physician would be available whenever needed,”
she said, adding that the physicians will be able to prevent conflicting medical
orders and inappropriate admissions and ensure appropriate bed utilization.
Harvey wants to convince
nurses of the benefits of intensivist-led critical care teams for both patients
and themselves.
Physicians with special ICU
training can “take responsibility for the medical management of the ICU
patient so that nurses have more time for giving high quality nursing care,”
she said. “Nurses can practice nursing.”
Plus, she added, freeing up
nurses to do their own jobs will ensure increased patient safety. It will even
save millions of dollars over the years by decreasing patient lengths of stay
and expensive complications.
“The better [nurses] are,
the better patients do,” she said.
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