and a Culture of Safety
June 20, 2012
The Role of the Nurse
Historically the role of the nurse has been as a patient advocate. Nurses’ have advanced from being seen as low cost labor to an autonomous practioner. Prior to Florence Nightingale the nurse was a member of a religious order or under the direction of the military. Florence Nightingale established the first nursing schools and was responsible for their own practice. In the early 1900’s nursing education was taken over by hospitals and the licensing of nurses began. In the 1990’s nurse practioners, (under the license of a physician), began prescribing medications, ordering lab and radiology test, and referring patients to other health care providers (Nursing: history of nursing, 2012).
(Nursing: history of nursing, 2012) (Nurse at work photos, 2008)
Today, nurses perform assessments of patients, develop an individualized plan of care for the patient, administer prescribed treatments, and evaluate effects of these treatments. In order for the nurse to develop a workable plan, the patient has to be the center of that plan. Historically, the patient ad a physician and a bedside nurse that performed physical therapy, wound care, social services, occupational therapy, psychological counseling, spiritual counseling, discharge planning and education. Today there are multiple physician specialties, physical therapists, occupational therapists, wound care nurses, psychiatric nurse specialists, spiritual counselors, discharge planners, and dieticians.
Imagine how overwhelming, frustrating and exhausting this is for a patient. This is where the nurse must be the patient advocate and a liaison within the interdisciplinary team. The nurse is with the patient longer than any other specialty and she is the liaison between the patient and all other specialties. The bedside nurse knows the patients daily routine, when they are tired, their treatment times, when their families are available, the best way they learn, the medications they take and their interactions.
One night in the emergency room where I worked, Mrs. M. returned for the second time in a week (her previous visit was for hypertension). Her blood pressure was sixty eight over thirty three and she was lethargic. After stabilizing the patient, I was reviewing her medications with her daughter and realized that the patient was taking a dose of hydrochlorothiazide for high blood pressure prescribed by her primary care physician and a second larger dose that was prescribed by the previous ED physician. As a liaison and advocate for this patient, I informed the ED physician of the events and asked that a social worker see the patient to set up a home health visit to follow up with the patient and her medication understanding. I educated the patient and her daughter on how blood pressure medicines work and also performed medicine reconciliation so this would not happen again.
A Nurses Leadership Role in the Interdisciplinary Team
You might ask, “how can a staff nurse be a leader in the interdisciplinary team when the physicians are in charge?” By communication and knowledge of the patient. The bedside nurse has been with the patient for an eight to twelve hour shift, they perform assessments, evaluate treatments, and interact with the patients’ family. An important leadership quality of the nurse is to communicate these assessments to the interdisciplinary team. “Effective communication depends on our realization of the diversity of the staff and their perception of the world, and uses this knowledge to direct our interaction with others. Effective communication permits nurse leaders to accomplish mutual understanding, guide the circulation of information, assist the staff to surmount impediments to frank discussions, motivate...