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Maurene Harvey: First Nurse to Head SCCM

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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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