Two steps forward, one back: Consequences of our actions.
Nursing plays an integral role in the overall care of any patient whether it is in an acute care setting or sub-acute facility. There are several interventions that are coordinated and implemented by nurses based on the clinical needs of a patient. Oral hygiene for intubated patients, elevating the head of a patient’s bed, and repositioning a patient to help thwart off the development of pressure sores are basic routine interventions. These seemingly rudimentary interventions as most nurses know are vitally important in improving the health of a patient and more importantly reducing the likelihood of an iatrogenic complication from occurring.
Unfortunately some of these instituted interventions increase the risk of other sequela occurring. A thought provoking editorial in the April 2008 American Journal of Nursing discusses several interventions that nurses do such as raising the head of the bed of intubated patients to prevent ventilator acquired pneumonia (VAP) that actually have shown to increase the prevalence of pressure sore development.
The article is written by Dianna Mason, PhD, RN, FAAN in which she goes over some of her views regarding nursing interventions and data collection that is utilized for quality care indicator analysis. She discusses what some nurses are doing and not doing to make the “numbers” look good. One particular example describes how nurses are leaving patients in bed that are at high risk for falling. Staffing shortfalls prevent them from moving these patients safely so they stay in bed. This type of intervention may prevent patients from falling and injuring themselves but it opens them up to iatrogenic complications such a deep vein thrombosis and pulmonary embolism. Mason calls these “unintended consequences”.
Mason also brings to light that some of today’s routine interventions are actual recommendations that have been made by large clinical organizations such as the Institute for Healthcare Improvement (IHI). She poses questions which are quite apropos when she asks why nurses need to be told to do some of these basic and seemly obvious interventions. Why are nurses not taking responsibility for these interventions themselves? Additionally why are some nurses not providing the care that these patients need?
One of the more debasing aspects I have seen in healthcare is when a physician provider orders routine interventions such and intake and output under a heading of “Nursing”. Nurses should be the ones dictating what nursing orders need to be carried out for each patient. Additionally these interventions should be discussed collaboratively. A nurse that is waiting to be told what to do for a patient is nothing short of appalling. It is professionally embarrassing to see this happen.
Healthcare is under the gun these days with hospitals vying for market share, struggling with lower reimbursement rates, and a general outcry from the public for faster, higher quality, and more responsive medical care. Nursing is more than capable of dictating the care and interventions that are required for each patient that impact the aforementioned issues. Nursing provides a valuable service in today’s healthcare arena, we should not let other factions of healthcare dictate our practice so routinely. Nursing needs to utilize the critical intellectual skills that nurses have in developing custom plans of care for patients and follow through with those plans.
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
