Nursing today more high-tech, patient-centricWritten by Sarah Ottney | Managing Editor | firstname.lastname@example.org
With a career in nursing spanning more than 30 years, Gladeen Roberts has watched new mindsets and technological advancements transform the way patient care is provided.
As president of Nursing Excellence at ProMedica, Roberts is charged with integrating nursing practices at all ProMedica facilities to ensure a uniform standard of care. She spearheads collaboration internally among facilities as well as externally with area nursing colleges. The position, created last year, is one of only a handful of similar jobs nationwide.
“I always thought I just wanted to take care of people and I am still, but different kinds of people, not always people in beds,” Roberts said.
One of the biggest evolutions for the nursing field has been technology, Roberts said.
“In the past, processes took a little longer, but in some ways that was nice because you were hanging an IV or doing a tube feeding and you had to sit there and you talked to the patient at the bedside,” Roberts said. “Now everything’s automated so you go to the machine.”
Telemonitors allow nurses to monitor daily blood pressure, weight, blood sugar and cholesterol levels without the patient leaving home.
“It transmits over so we can call the patient and say ‘You forgot to weigh yourself today’ and when he does, we can see if it’s a critical value or not and we can call his doctor,” Roberts said.
Adopting a more patient-centered focus has been another major shift, Roberts said.
“In the ’70s, a lot of what we did was based on what physicians wanted. If they wanted daily weights done before they came in, we’d wake the patient at 5:30 in the morning,” Roberts said. “Now we’re about what’s best for that patient, not what’s best for the nurse or the doctor. That’s a different thought process than we’ve had in the past.”
Patients are more complex today, said Judy Didion, dean of nursing at Lourdes College.
“When I went to nursing school, patients were not as sick as they are today. Now there’s more technology to keep people alive longer and improve their quality of life,” Didion said.
“The kind of patients we may have cared for in a hospital are now in skilled care or home care. Hospitals are for the very critically ill, so everything is more complex.”
Today’s nurses specialize in areas like cardiology or orthopedics and their insight is valuable, Roberts said.
“We’re relying a lot more on the nurse at the bedside to identify the problems and improve the care than we ever did in the past,” Roberts said. “They’re closest to the patient, they make the biggest difference, so let’s empower them.”
Nurses are no longer found in just hospitals but in a variety of settings, such as hospice, insurance offices and physician’s offices.
The face of nursing has also changed.
There are more male nurses and more women in leadership roles than ever before, Roberts said.
Because of delayed retirements, nurses are also more diverse in age, Didion said. It can be tricky to help a multigenerational staff appreciate each other’s strengths — experienced nurses tend to be more intuitive, while recent graduates are typically better with technology — while also managing their differing expectations, she said.
One way health systems, including ProMedica and Mercy, are addressing the increasing complexity of health care is by developing navigator programs.
Navigators — like Lisa Helminski at Toledo Hospital — are nurses who work closely with patients to guide them through the system. Navigators can answer questions about procedures, medication and next steps, remind patients to set up appointments, advocate on their behalf and much more.
“It’s a wonderful model. We’re looking at the whole picture as a puzzle and putting all the pieces together,” Helminski said. “We work with bedside nurses, physicians and social workers right beside them. It’s a huge team approach. We’re very much an advocate for the patient and family. We have time to go in and talk to patients more than the bedside nurses do. I think it’s just an awesome program, I really do.”
Not all patients are assigned navigators. Candidates include those with chronic diseases, those whose condition requires many specialists or those without family.
Helminski recalled a patient who had a chronic condition and was told his insurance would no longer cover his specialist, so the man quit going to the doctor, visiting emergency rooms instead.
“When he came here I saw that was a problem for him and worked with his insurance case manager to find a physician that would take him and also set up home care for when he went home,” Helminski said. “He was very grateful and we ended up hugging at the end.
That was someone who could have fallen through the cracks before because it took a lot of work to put it all together.”
ProMedica has 30 care navigators in its hospital system, including outpatient facilities. Mercy’s five navigators work with breast issues in the women’s centers at St. Vincent, St. Anne and St. Charles as well as with cancer patients at St. Anne and St. Charles.
With the average age of Ohio nurses at 47, and 40 percent indicating in surveys they plan to retire, demand for nurses will be greater than ever in the next 10 years, Roberts said. Nationally, a shortage of between 300,000 and 1 million nurses is predicted in the next decade — with even the low figure three times higher than any U.S. nursing shortage in the past 50 years, Roberts said.
The nonprofit Institute of Medicine, which conducts research and offers health care policy advice, is calling for greater percentages of nurses to hold bachelor’s and doctorate degrees by 2020.
“Patients are becoming more diverse and you really have to have the education and critical thinking to be able to deliver the right care to the right patient at the right time,” Roberts said.
However, although the profession has changed, the cornerstone of nursing has remained the same, Roberts said.
“The essential reason we exist is to give the safest and best possible care to our patients and that has been true ever since I started working in nursing,” she said.