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Guest Editorial: Working Smarter, Not Harder
In October 2009, the Robert Wood Johnson Foundation and the Institute of Medicine1 hosted a public forum on the future of nursing, targeting nursing in the acute care setting. The timing could not have been more fortuitous, given recent legislation aimed at reforming the healthcare system. The point of the forum was to present best practices and successes in innovative nursing care projects as well as to collect data about the status quo (the “dark side”). Although the direction of the forum’s outcomes is still unclear, the message is that acute care, in many ways, is “broken.”
The forum focused on three crucial topics within the acute care context: safety, technology, and interdisciplinary collaboration (or lack of same in all three). Many innovations across the country have generated major advances, but barriers to their dissemination prevent wider adoption. One participant remarked, “The future is here, it just isn’t everywhere.”
The current crisis state of acute care nursing (and essentially acute care in general because it is intimately linked to nurses’ functioning) is startling. The forum targeted the fact that recent research reported that less than one fifth of nurses’ daily time is spent on direct patient care — nurses manage a plethora of activities such as patient monitoring, medication administration, and care coordination. While “hunting and gathering” missing equipment, scarce supplies, and the like, nurses (and other clinicians) have become “masters of work-arounds” for dysfunctional health systems. Not surprisingly, in many instances unsafe care has resulted. This situation is occurring just as a tsunami of elders is beginning to further stress healthcare resources.
Publication of the IOM Report provides a great opportunity for personal reflection, especially regarding its implications for quality wound care. What safety challenges, technological deficits, or negative interdisciplinary confrontations did you encounter today? What are the primary factors hindering you from delivering safe, efficient care? What circumstances are driving you out of clinical practice? Is your healthcare system or setting trying to innovate or is it stuck in “neutral?” Conversely, what makes you, the frontline clinician, feel personally satisfied at day’s end?
Whether or not you are a nurse, the report on the future of acute care nursing is worth reading. Physicians, allied health professionals, and patients should read about system deficiencies linked to poor and/or unsafe care and how little time nurses actually can interact with their patients. Read about the insightful suggestions provided by nurse experts providing testimony. Ponder the implications of delay in attacking the issues for both patients and clinicians.
Frontline nurses have the best perspective on the deficiencies of acute care and can offer crucial advice on how to improve patient outcomes and the work environment. Because they are the single greatest discipline in acute care, frontline nurses are “the face of healthcare today.” They (and other acute care clinicians) want to work smarter, not harder.
So ask yourself: what would help you do your job better? Faster? Safer? What technology would you like to have to make these good outcomes happen? Would you like technology such as voice-recognition computer data entry in a handheld device instead of typing at a computer terminal? How about a handheld device that photographs wounds you are assessing, measures them, and enters the data automatically into the patient record and into a spreadsheet tracking your patients? How about instant digital access to patients’ medical records or online references for best practices at the bedside? How about a wound team in the truest sense of the phrase?
Long-term improvement and healthcare reform depend on empowering nurses and clinicians to deliver evidence-based care through improved safety mechanisms, better technology, and positive interdisciplinary collaboration. My challenge to you: What would you like to see happen to improve acute care, especially wound care? Please write to us (www.o-wm.com) and let us know.
This article was not subject to the Ostomy Wound Management peer-review process.
1. Institute of Medicine. A Summary of the October 2009 Forum on the Future of Nursing: Acute Care. Washington, DC: The National Academies Press;2010.
