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Guest Editorial: Changing Nursing Roles, Enduring Commitment to Our Patients
Guest Editorial: Changing Nursing Roles, Enduring Commitment to Our Patients j Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN
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rom the hospital to the battlefield, in our homes, schools, and communities, nurses’ roles have evolved from comforting and healing the sick and injured, to handling complex technology, to studying the effect of interventions on patient outcomes, and to advancing Pamela F. Cipriano policy for a better health care sysPhD, RN, NEA-BC, FAAN tem. The National Academy of Medicine’s Progress Report on the Future of Nursing reinforced the need to maximize the impact of nurses and ensure that all nurses practice to the full extent of their education and training (National Academies of Sciences, Engineering and Medicine, 2015). Nurses have embraced these ideas and are expanding their scope of practice and influence. But much of what nurses do today remains unknown or misunderstood. Across the continuum of acute, home/community, and chronic care, nurses’ clinical roles have evolved to prepare patients and their families for myriad tests and treatments, coordinate services and plans of care, and ease pain and suffering across the life span. Nurses are the human interface between complex technologies and the scared or vulnerable patient. They manage administration of toxic medications, stand ready to rescue a patient in
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, President, American Nurses Association, Silver Spring, MD. Corresponding author: Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, President, American Nurses Association, 8515 Georgia Avenue, Suite 400, Silver Spring, MD 20910. E-mail: pam.cipriano@ ana.org J Radiol Nurs 2016;35:1e2 1546-0843/$36.00 Copyright Ó 2016 by the Association for Radiologic & Imaging Nursing. http://dx.doi.org/10.1016/j.jradnu.2016.01.006
VOLUME 35 ISSUE 1
demise, and are leading partners in team-based care. They are helping their organizations make the shift from volume- to value-based care and achieve appropriate cost savings. A review of pioneer accountable care organizations found that nurses are more often filling formal roles as care coordinators to guide hospital transitions, providing direct care in primary care settings, monitoring patients via telehealth, and leading home care teams (Pittman & Forrest, 2015). Advances in health care such as breakthrough diagnostic and invasive technologies, electronic health records, and new pharmaceuticals have created or expanded roles for nurses, yet these very advances have also introduced unintended consequences that if not addressed, become threats to safety. Provision 3 of the Code of Ethics for Nurses With Interpretive Statements (ANA, 2015, p. 9) lays out the expectation that each nurse “promotes, advocates for, and protects the rights, health, and safety of the patient.” This provision also includes the responsibility to promote a culture of safety, which includes establishing and following policies that protect patients from harm, promote health, reduce errors and waste, and maintain a culture that promotes safety for patients and staff. This concept is not new to nurses in radiology and imaging services who are minimizing risks and keeping patients safe by ensuring procedural time-outs, minimizing sedation, reducing patients’ stress and anxiety, and being vigilant before, during, and after diagnostic and therapeutic procedures. Imaging has become the norm in medical diagnostics, but a new specialty for nursing was required to meet the demands of this environment. Few colleagues venture behind the lead walls to appreciate the complexity of nursing care in an interventional radiology suite or the challenges of imaging a frail elderly patient. In a single patient episode, a radiology and imaging nurse may use a range of skills from assessment to critical care, to perioperative and postrecovery, to pain relief and patient education.
www.radiologynursing.org
1
Cipriano
JOURNAL OF RADIOLOGY NURSING
Tight knit teamwork results in safe care that looks effortless to the patient and family. The American Nurses Association (ANA) recognizes the pivotal role nurses play in keeping patients safe and has launched a new program for 2016, Safety 360, Taking Responsibility Together, to help nurses and their organizations promote, establish, or enhance a culture of safety. Nurses have always sought to keep patients from harm and have been responsible for significant reductions in hospital-acquired conditions. They are leading conversations to ensure ethical and healthy work environments support a culture of openness and trust that eliminates blame when addressing safety concerns and solutions. ANA (2013, p. 39) defines a culture of safety as “core values and behaviors resulting from a collective and sustained commitment by organizational leadership, mangers and health care workers to emphasize safety over competing goals.” Nurses recognize that safety is a fundamental element of quality. They also recognize that a healthy and ethical practice environment includes safe staffing levels and skill mix, zero tolerance for bullying, violence, and incivility, using technology to improve safety and reduce errors, avoiding fatigue, and eliminating manual patient handling. These initiatives are all part of ANA’s vision for a culture of safety. In addition, we support the use of quality measures to improve patient outcomes, working with leadership to make changes to improve safety, and linking individual, team, and organizational safety. We are also committed to ensuring the health and wellness of nurses in all settings and support the emergence of the quadruple aim of health care, which adds care of the provider along with better care, better health, and lower costs. When solving safety concerns becomes a way of life, everyone benefits.
2
Guest Editorial
The Association for Radiologic & Imaging Nursing (ARIN) is a valued organizational affiliate of ANA, and we share a commitment to protect patients and promote their health. I encourage you to join ANA in addition to ARIN as we advance the profession for all nurses. Throughout the year, I hope you will follow our work on culture of safety through monthly Navigate Nursing webinars and two special four-part Safety 360 webinars. Culture of Safety is also the theme for 2016 National Nurses Week (May 6e12) (http:// nursingworld.org/MainMenuCategories/ThePractice ofProfessionalNursing/2016-Culture-of-Safety). This is a great opportunity to educate our friends, families, and coworkers about the evolving roles of nurses in the highly complex world of health care. We want them to know how nurses leverage knowledge, compassion, and critical thinking skills to ensure an unwavering commitment to their safekeeping. References American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org. Retrieved from, www.Nursebooks.org. Accessed January 17, 2016. American Nurses Association (2013). Safe patient handling and mobility: Interprofessional national standards. Silver Spring, MD: Nursebooks.org. National Academies of Sciences, Engineering and Medicine (2015). Assessing progress on the Institute of Medicine report The future of nursing. Washington, DC: The National Academies Press. Retrieved from, http://www.nap.edu/catalog/ 21838/assessing-progress-on-the-institute-of-medicine-reportthe-future-of-nursing. Accessed January 17, 2016. Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in pioneer accountable care organizations. Nursing Outlook, 73, 5554-5565. http://dx.doi.org/10.1016/j. outlook.2015.05.008.
www.radiologynursing.org
MARCH 2016
F
rom the hospital to the battlefield, in our homes, schools, and communities, nurses’ roles have evolved from comforting and healing the sick and injured, to handling complex technology, to studying the effect of interventions on patient outcomes, and to advancing Pamela F. Cipriano policy for a better health care sysPhD, RN, NEA-BC, FAAN tem. The National Academy of Medicine’s Progress Report on the Future of Nursing reinforced the need to maximize the impact of nurses and ensure that all nurses practice to the full extent of their education and training (National Academies of Sciences, Engineering and Medicine, 2015). Nurses have embraced these ideas and are expanding their scope of practice and influence. But much of what nurses do today remains unknown or misunderstood. Across the continuum of acute, home/community, and chronic care, nurses’ clinical roles have evolved to prepare patients and their families for myriad tests and treatments, coordinate services and plans of care, and ease pain and suffering across the life span. Nurses are the human interface between complex technologies and the scared or vulnerable patient. They manage administration of toxic medications, stand ready to rescue a patient in
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, President, American Nurses Association, Silver Spring, MD. Corresponding author: Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, President, American Nurses Association, 8515 Georgia Avenue, Suite 400, Silver Spring, MD 20910. E-mail: pam.cipriano@ ana.org J Radiol Nurs 2016;35:1e2 1546-0843/$36.00 Copyright Ó 2016 by the Association for Radiologic & Imaging Nursing. http://dx.doi.org/10.1016/j.jradnu.2016.01.006
VOLUME 35 ISSUE 1
demise, and are leading partners in team-based care. They are helping their organizations make the shift from volume- to value-based care and achieve appropriate cost savings. A review of pioneer accountable care organizations found that nurses are more often filling formal roles as care coordinators to guide hospital transitions, providing direct care in primary care settings, monitoring patients via telehealth, and leading home care teams (Pittman & Forrest, 2015). Advances in health care such as breakthrough diagnostic and invasive technologies, electronic health records, and new pharmaceuticals have created or expanded roles for nurses, yet these very advances have also introduced unintended consequences that if not addressed, become threats to safety. Provision 3 of the Code of Ethics for Nurses With Interpretive Statements (ANA, 2015, p. 9) lays out the expectation that each nurse “promotes, advocates for, and protects the rights, health, and safety of the patient.” This provision also includes the responsibility to promote a culture of safety, which includes establishing and following policies that protect patients from harm, promote health, reduce errors and waste, and maintain a culture that promotes safety for patients and staff. This concept is not new to nurses in radiology and imaging services who are minimizing risks and keeping patients safe by ensuring procedural time-outs, minimizing sedation, reducing patients’ stress and anxiety, and being vigilant before, during, and after diagnostic and therapeutic procedures. Imaging has become the norm in medical diagnostics, but a new specialty for nursing was required to meet the demands of this environment. Few colleagues venture behind the lead walls to appreciate the complexity of nursing care in an interventional radiology suite or the challenges of imaging a frail elderly patient. In a single patient episode, a radiology and imaging nurse may use a range of skills from assessment to critical care, to perioperative and postrecovery, to pain relief and patient education.
www.radiologynursing.org
1
Cipriano
JOURNAL OF RADIOLOGY NURSING
Tight knit teamwork results in safe care that looks effortless to the patient and family. The American Nurses Association (ANA) recognizes the pivotal role nurses play in keeping patients safe and has launched a new program for 2016, Safety 360, Taking Responsibility Together, to help nurses and their organizations promote, establish, or enhance a culture of safety. Nurses have always sought to keep patients from harm and have been responsible for significant reductions in hospital-acquired conditions. They are leading conversations to ensure ethical and healthy work environments support a culture of openness and trust that eliminates blame when addressing safety concerns and solutions. ANA (2013, p. 39) defines a culture of safety as “core values and behaviors resulting from a collective and sustained commitment by organizational leadership, mangers and health care workers to emphasize safety over competing goals.” Nurses recognize that safety is a fundamental element of quality. They also recognize that a healthy and ethical practice environment includes safe staffing levels and skill mix, zero tolerance for bullying, violence, and incivility, using technology to improve safety and reduce errors, avoiding fatigue, and eliminating manual patient handling. These initiatives are all part of ANA’s vision for a culture of safety. In addition, we support the use of quality measures to improve patient outcomes, working with leadership to make changes to improve safety, and linking individual, team, and organizational safety. We are also committed to ensuring the health and wellness of nurses in all settings and support the emergence of the quadruple aim of health care, which adds care of the provider along with better care, better health, and lower costs. When solving safety concerns becomes a way of life, everyone benefits.
2
Guest Editorial
The Association for Radiologic & Imaging Nursing (ARIN) is a valued organizational affiliate of ANA, and we share a commitment to protect patients and promote their health. I encourage you to join ANA in addition to ARIN as we advance the profession for all nurses. Throughout the year, I hope you will follow our work on culture of safety through monthly Navigate Nursing webinars and two special four-part Safety 360 webinars. Culture of Safety is also the theme for 2016 National Nurses Week (May 6e12) (http:// nursingworld.org/MainMenuCategories/ThePractice ofProfessionalNursing/2016-Culture-of-Safety). This is a great opportunity to educate our friends, families, and coworkers about the evolving roles of nurses in the highly complex world of health care. We want them to know how nurses leverage knowledge, compassion, and critical thinking skills to ensure an unwavering commitment to their safekeeping. References American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org. Retrieved from, www.Nursebooks.org. Accessed January 17, 2016. American Nurses Association (2013). Safe patient handling and mobility: Interprofessional national standards. Silver Spring, MD: Nursebooks.org. National Academies of Sciences, Engineering and Medicine (2015). Assessing progress on the Institute of Medicine report The future of nursing. Washington, DC: The National Academies Press. Retrieved from, http://www.nap.edu/catalog/ 21838/assessing-progress-on-the-institute-of-medicine-reportthe-future-of-nursing. Accessed January 17, 2016. Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in pioneer accountable care organizations. Nursing Outlook, 73, 5554-5565. http://dx.doi.org/10.1016/j. outlook.2015.05.008.
www.radiologynursing.org
MARCH 2016