By E’Louise Ondash, RN, contributor
May 12, 2010 - From May 6-12 every year, nurses across the nation are honored and celebrated during National Nurses Week. As you partake in the celebrations and say “thank you” to your fellow nursing colleagues, read on to learn more about these inspiring nurses who have made major contributions to the profession. Each story provides a look at how much difference one nurse can make.
Mary Viney, RN, MSN, NEA-BC, CPHQ
Keep your patients close and care is better, hospitals are safer and nurses stay on the job longer.
That’s what Mary Viney, RN, MSN, NEA-BC, CPHQ, found when she became one of the first to test the Transforming Care at the Bedside initiative, which she headed at Seaton Northwest Hospital in Austin, Texas, in 2003. It was an opportunity and experience worth emulating, she believes.
“We were all very excited about the new process and the improvement tools we learned over time,” Viney said.
The initiative and “experiment” was spurred by the 2000 Institute of Medicine report which found that medical errors in this country cause harm annually to an estimated 1.5 million people and generate nearly $3.5 billion in unnecessary hospital costs. Combine these facts with an impending nursing shortage, said the investigators, and you have a recipe for disaster in hospitals.
Viney, then a vice president with Seton Healthcare Network, and her superiors decided something had to be done quickly in their hospital. Their objectives: enhance the quality of patient care and service; create more effective care teams; improve patient and staff satisfaction; and improve staff retention.
Their method for making changes, though, was going to be different than in previous experiments. The changes would be implemented quickly, avoiding the lengthy process of reports, meetings and more reports. The process also would involve “front-line” staff immediately, and if something didn’t work, they would try something else – immediately.
“Hospitals can’t meet the current challenges on medical and surgical units by fine-tuning the status quo or exhorting staff to work more diligently,” Viney wrote. “They must establish new models of care.”
And that they did.
“We started testing and implementing changes on the second day,” Viney said. “We have since spread the concept and the tools to 10 different hospitals and over 20 different departments.”
Here are a few examples of what they accomplished:
• Standardized postoperative order sets – Before: every gynecology surgeon admitted post-op patients to the unit using a different, sometimes illegible handwritten order form. After: Surgeons use a standardized form that incorporates common elements of best practices. This allowed the pharmacy to create a standard computerized record and eliminated the need for nurses to transcribe information. Orthopedic surgeons also adopted the model for total-knee and total-hip replacements.
• Nurse status boards – Before: A scheduler was in charge of bed assignments for the 15 to 20 admissions daily. Nurses had to be called every two hours to ask if they could accept new patients. After: Magnetic boards with color-coded magnetic dots indicated nurses’ workloads, allowing staff to assist each other during busy periods, resulting in more balanced workloads and timelier care.
• Supply reorganization and waste reduction – Before: Nurses roamed the unit looking for or ordering basic supplies from central supply. After: Central supply and housekeeping now stock frequently used supplies in each room, saving nurses’ time.
“The opportunities to study and improve work processes at the unit level…were energizing,” Viney said.
The changes have had a positive effect on morale, too.
“Whenever a person can exert some influence or control directly impacting their work, they become more engaged and more likely to create new solutions or accept new ideas coming their way,” Viney explained. “The opportunities really keep nurses closer to their patients, and when that happens, care is safer, quality increases and both the nurse and the patients are more satisfied.”
Patricia A. Grady, Ph.D., RN, FAAN
Public Law 99-158 authorized the establishment of the National Center for Nursing Research (NINR) at the National Institutes of Health (NIH) in 1985, and it finally became a reality in 1993. Its mission is to “promote and improve the health of individuals, families, communities and populations…through the funding of nursing research and research training.”
Patricia A. Grady, Ph.D., RN, FAAN, has been NINR’s director since 1995.
Prior to her appointment, Grady earned a doctorate in physiology from University of Maryland School of Medicine. As a researcher, she focused on arterial stenosis and cerebral ischemia. Grady is a member of many medical and nursing organizations, and helped establish the first long-range research agenda for medical rehabilitation research.
Grady’s faculty appointments include University of Maryland School of Medicine and School of Nursing. She has authored many articles on stroke-related problems and is on the board of major stroke journals. Her honors are numerous, and she speaks frequently on the future direction of nursing research and research opportunities.
Despite the NINR’s $140 million annual budget, the institute still must dole out the research grants carefully.
“When the center started in 1985, the budget was $14 million,” Grady said. Today’s budget is 10 times that, “so we’re supporting that level of research, but we could support more. Competition is stiff to get funding from our institute.”
Still, researchers aren’t just born. The NINR spends 8 percent of its budget on training nurses to be researchers. Another chunk of the budget focuses on symptom management research – much needed in light of current and future demographics.
“People are living longer and developing chronic illnesses – sometimes more than one,” she said. “We spend majority of our funds on this.”
Getting out the message that nurses are among the top researchers in health and medicine and that their research is patient-centered is not always easy.
“Our research addresses quality of life,” Grady explained. “The profession as a whole doesn’t look at administering drugs as the approach to use first. For example, we have studies working with teens with diabetes to introduce coping skills so they can better manage their illness so hopefully they won’t be suffering long-term consequences.”
Another example of NINR-sponsored research comes from the University of Pennsylvania on a transitional care model. A nurse-led team follows patients from the hospital into the home. With close monitoring, instruction and follow-up, fewer re-hospitalizations occur. And even with additional personnel, this ends up saving money, Grady pointed out.
Currently, the public doesn’t really get the connection between nurses, research and saving health care dollars, “because we don’t have ambassadors out there to spread this, but they are starting to get the message.”
Grady has seen many changes in nursing during her career. For instance, the single, college-aged woman is no longer the typical nursing student.
“Nursing is attracting people from other fields,” Grady said. “We have a large number coming from other fields – people who already have other degrees.”
But the biggest change, she said, is that “the role of the nurse has expanded and there are so many more opportunities. It’s also a challenge to prepare nurses to handle all these opportunities. One of new frontiers now is genetics. It is one way to measure risk factors for disease and nurses are especially good at assessing risk factors.”
Technology has also changed nursing—as well as nursing research.
“Many things that are being developed are being tested clinically by nurses,” Grady said. “It is also important to say that nurses at every level can be part of a research team to try to improve practice. A really important role is to make clinical care better in our society.”
Claire Murray, RN, MS
Claire Murray, RN, MS, can’t remember a time when she wasn’t involved with Nurses House, a New York-based national organization that offers financial aid to nurses in crisis.
“I started as a contributor through the New York State Nurses Association,” she said. “At some point I was asked to serve as treasurer, then a board member and vice president, and now president of the board.”
Murray’s 40-year-plus nursing career is replete with personal, professional and volunteer accomplishments, but she considers working with Nurses House as one of the most important. This unique organization runs solely on donations from nurses and members of the nursing community, like associations and businesses that cater to nurses.
Last year, Nurses House gave nearly $168,000 to 150 nurses in need, according to spokeswoman Stephanie Dague. The grants typically ranged between $1,000 and $2,000, but could be more or less, depending on funds available and the needs of the applicants. The past couple of years have been a challenge financially because of the economy, with donations down approximately 20 percent last year. The level of need was not reduced, however, and some nurses are in dire need, according to Murray, “having lost everything due to serious illness or injury.”
The history of Nurses House goes back to 1922, when a Long Island mansion donated by Emily Bourne was offered to nurses as a place to rest and recuperate. Times and needs changed, so the property was eventually sold and Nurses House became a national service program.
Emergencies can happen to anyone, Murray emphasized. For instance, there was an increase in need after the Sept. 1, 2001 terrorist attacks in New York City because nurses’ family members lost jobs and many resources were no longer available.
“You can very quickly get into financial problems,” she said. “Most often they are precipitated by illness. When I served on the board of the American Nurses Association (more than 30 years ago), a fellow board member had been the recipient of a Nurses House grant. She was a single parent, had a serious chronic illness and financial difficulties. We helped her get back on her feet.”
Today’s grant recipients are decided by a group of nine volunteer nurses who review anonymous applications and make recommendations.
Although raising money for Nurses House has been more difficult lately, Murray stays at it and feels a great sense of satisfaction “knowing that I’ve done something for my colleagues, because bad things can happen to any of us. We need to be there for each other.”
Barbara Dossey Ph.D., RN, AHN-BC, FAAN
Barbara M. Dossey, PhD, RN, AHN-BC, FAAN, entered nursing not because of a passion to care for the sick, but because she thought white starched uniforms and blue capes held a dramatic
flare.
“I had three cousins who were nurses and 10-plus years older than I, and I was always fascinated by their stories and their blue capes and white starched uniforms,” confessed Dossey, known to the healing world as the Mother of Holistic Nursing and for her work in the compassionate care of the dying.
Today’s nurses no longer wear capes, but they have discovered and studied the holistic philosophy, thanks to Dossey’s passion which she developed after graduating more than four decades ago. Thanks to her dedication, holistic nursing is a recognized specialty of the American Nurses Association.
“Holistic nursing is based on a philosophical foundation that can be practiced at anytime and anywhere,” said Dossey from her office in Santa Fe, N.M., where she is director of Holistic Nursing Consultants. “Holistic nursing is a science and art that can be used in traditional settings – even the ICU. The finest contemporary nurses use an integrative approach using the latest technologies (as well as) addressing the person's mind and spirit.”
The biggest challenge for today’s nurses is “how to use this integrative approach when we still have a health care system driven by a disease-based model that functions as a disease-management industry,” Dossey said. “The challenge is to bring our intuition, compassion and presence into all corners of health care, even when technology tends to nudge them out. We must recognize that patient care also requires ‘being with’ rather than always ‘doing to.’”
Dossey wants nurses to know that the holistic philosophy also includes a “personal awareness.” To be an effective “instrument of healing,” they must take care of themselves.
Dossey was a leader in organizing the Florence Nightingale centennial commemorative service on April 25. More than 3,000 nurses, friends and family assembled in the National Cathedral in Washington, D.C., to pay tribute to the world’s 15 million nurses and mark the 2010 International Year of the Nurse. She also co-founded the Nightingale Initiative for Global Health, whose mission is to inform and empower nurses and other health care workers and educators to become “21st century Nightingales,” working in the local, national and global community to build a healthy world.
In 2003, Dossey and her husband, Larry, received the Archon Award from Sigma Theta Tau International, honoring their contributions to promoting global health.
A Nightingale scholar, Dossey also has written or co-authored 23 books on the nursing pioneer, and she continues today with her consulting work. She teaches and writes about the integration of the five core values of holistic nursing: philosophy and education; ethics, theories and research; nurse self-care; communication, therapeutic environment and cultural competence; and the caring process.
“I’m assisting people to identify their belief systems, their inner world of images, Dossey said, “and to find their own pathways to wellness with personal rituals. This continues to be a healing journey for me and a source of immense joy.”
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