By Glenna Murdock, RN, contributor
July 1, 2010 - Under the umbrella of direct nursing care, nurses have always worn a number of occupational caps. While we no longer need to function as housekeepers and laundresses like our predecessors in the early twentieth century, today’s nurses continue to juggle a number of roles—some of which were not on the horizon even two or three decades ago.
Many of these “jobs within a job” have evolved due to rapid advances in medicine and technology and the changing culture of health care.
A nurse for 25 years, Craig Luzinski, MSN, RN, chief nursing officer at Poudre Valley Hospital (PVH) in Ft. Collins, Col., said nursing is dramatically different now.
“While today there are vast opportunities for nurses to be involved in all aspects of health care leadership and operation, that was not the case when I began my nursing career,” Luzinski stated. “When I started, nurses were primarily direct care providers and managers.”
Pat Village, BSN, RN, director of surgical oncology, orthopedics and the ambulatory infusion center at McKee Medical Center in Loveland, Col., has worked in nursing for 30 years and agrees with Luzinski.
“Hospitals today are a completely different environment,” Village said. “Thirty years ago nurses were at the bedside, patients were in the hospital longer, staffing was usually not an issue and hospitals were rich with resources. Today, with the increase in health care costs and the decrease in reimbursement, hospitals are struggling financially, patients are sicker than we’ve seen before but have shorter hospitalizations and the complexity of care has increased four-fold. The challenge is how to administer excellent care for the patient within stringent financial limitations.”
The jobs they neglected to tell you about in nursing school
In addition to traditional roles like healer, teacher, mediator, counselor, and leader, there are a number of facets to a hospital nurse’s job. In identifying these, Village borrows from the book, From Silence to Voice, by Gordon and Buresh, while Luzinski draws from the Career Tree directive for advancement used by his hospital.
Here are some of the key roles that they see direct care nurses filling today:
Sentry - “The nurse is the guardian for the patient,” Village said, “and is consistently watching over, protecting, assessing and intervening to ensure good outcomes.”
Risk Manager - “With a more intense focus on the financial aspect of health care, managing risk is an essential aspect of keeping costs down,” Luzinski said. “Implementation at the unit level can only be achieved when nurses are knowledgeable and good leaders for their team.”
Guide/Interpreter - “A guide helps another through unfamiliar circumstances,” Village stated. “It is important that the nurse make rounds with physicians to hear what the doctor says to the patient. The patient will hear only a small portion of that and the nurse must fill in the blanks and translate medical terms for the patient and the family.”
Hospitality Ambassador - Village explained that enhancing the patient’s hospital experience by making hourly rounds helps the patient feel safe and watched over and gives the family peace of mind. And as the only clinicians that have 24-hour contact with patients, nurses have a tremendous impact on patients’ overall satisfaction with a facility.
Informatics Expert - “One thing certainly not in the picture 25 years ago is the nationwide trend toward electronic hospital records,” Luzinski pointed out. “Nurses have no choice but to learn this system of documentation and communication. At PVH we have on our units ‘super users,’ nurses who have a greater interest in and a passion for computers and this form of documentation. They teach and assist other nurses and can contribute to system design that enhances workflow and access to information for direct care providers.”
Village reports that McKee Medical Center is now fully electronic, including physician order entry, and this was accomplished through intense training and support of the nursing staff who chart exclusively on the computer.
Collaborator - “Patient care isn’t provided in isolation,” Village stated. “It takes a team of nurses to coordinate and execute a plan of care.”
Communication Specialist - The results of the seminal study released by the Institute of Medicine in 1999, “To Err is Human,” revealed that 100,000 patients in the United States die annually due to medical errors, identifying lack of communication as a key factor in those deaths. Village stated that nurse leaders must create a work environment of clear communication that ensures all members of the health care team have a voice. “The complexity of medical care and the high acuity of so many patients make effective communication imperative,” she said.
Admission Prevention Officer - “The future of health care will be the promotion of good health rather than focusing on illness,” Luzinski believes. “We need to be sure we are adequately educating our patients, especially those with chronic illnesses such as diabetes and hypertension, to reduce or prevent readmissions. PVH has six nurses who will make home visits to support patients and families by reinforcing important care information and providing other services.”
Village concurs, adding that nurses at McKee make phone calls to patients within 24 hours of discharge to see how they are doing and to ensure that they understand their discharge instructions, thus reducing the likelihood of another admission.
Most nurses will recognize that this list still isn’t complete, and that, as the field continues to change, we can only wonder what roles await nurses in the future.
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