Well stated and provocative. See this video

[Doctors of Nursing Practice, Inc.]

Click Here to see this YouTube video. This looks to be a great DNP project if the stakeholders would support this effort to test for improved outcomes.

[Francis Tesoriere]

This is a really interesting video and speaks to a number of items acting as barriers to nurses delivering high quality care. Such a radical, yet worthwhile idea with a potential to impact patient outcomes by relieving some of the longtime clerical stress placed on nurses working at the bedside. I agree and feel this would make for an interesting DNP project should it gather enough momentum and interest.

[Patricia Boyle]

What a thought-provoking video. I often imagine being a nurse back in Florence Nightingale‘s day where there was little to no documentation. What would nursing look like if we spent 100% of our time with the patient. The importance of notating care proves very useful to other practitioners taking care of the patient but what a novel idea to have a secretary or more secretaries than we currently have to assist nurses with the monotonous paperwork. David hit it on the head when he said that secretaries need not be nurses. There are sufficient helpers that can help with secretarial duties such as nursing students and volunteers. Similarly, how medical providers have scribes why can’t nurses too have scribes of their own?

[Prerna Wilson-Pauliah]

This is a very interesting video. I currently work in labor and delivery and definitely see the need for this especially when we get really busy. I have also worked in a Surgical ICU and can see this being of great help in that setting. However, I would be interested to know how this would impact the patient and healthcare facilities financially. Further, how would this be implemented? If each nurse were to have their own scribe, that would double the number of personnel on a unit. How would that impact space? Also, to pay for the cost of hiring nurse-scribes, would that mean that each nurse will have a greater patient-to-nurse ratio? How will that impact nursing care?

[Savannah Sharp]

I enjoyed listening and thinking about the perspectives offered in this video. As a new nurse (1 year of experience), I had quite a shock when I started working and saw just how much responsibility the nurse has for the well being of multiple patients. Most people think that it is the MD’s that do all of the patient care but it could not be any more opposite. The nurse is the one who spends 12 hour shifts at the bedside with the patient actually delivering patient care! With that being said, there have been many instances when time could have and should have been better spent at the bedside with patients instead of completing administrative duties. I think that it would be extremely helpful to have an administrative assistant in order to help ease the burden on nurses and allow them to have more time to spend performing hands on patient care. Due to nurses being so busy and always short staffed, shortcuts are being taken and that is how mistakes happen. Even though I find the idea of assistants to be phenomenal, I sadly do not ever see it happening in the near future. I think it would cost the employer too much money and I think that is unfortunately what has the final word.

I also enjoyed gaining a new perspective on how to eliminate the nursing shortages that COVID-19 has caused. The video offered the idea of bringing retired nurses back to the bedside, accelerating graduation of senior nursing students, and hiring international nurses. The video mentioned that hiring international nurses should be avoided because that means that other countries are losing much needed nurses. I never saw this as an issue when thinking about this solution before but it is true! Nurses are needed in every country. Bringing retired nurses back to the bedside and using senior nursing students might not be the best solutions either. Retired nurses might have forgotten some of their skills or not be aware of up to date practices. Senior nursing students haven’t even begun to start actually practicing their skills in a live workplace and doing so under the stress of a national pandemic might be difficult, especially with the level of patient care that COVID-19 patients require. I feel like these options might actually put patients at risk instead of benefit them. However, these individuals and medical assistants alike can help with administrative duties and allow the nurse to spend more time at the bedside. I also found it interesting that this idea has been implemented before by Lydia Hall in the 1960’s. It shows that nurses have been feeling like they need additional support in order to accurately complete their nursing duties for a while now.

The last issue that sparked my interest in this video was the issue of TV shows stereotyping the work of a nurse. TV shows like Grey’s Anatomy do tend to depict nurses as helpers that only do work in the background. This is quite irritating because nurses are just so amazing and do such amazing work for their patients every shift. The author of the video did mention that there are shows out there that do pay tribute to the work of a nurse such as Call the Midwife. I have personally seen this show and it is amazing. I highly recommend it! Thanks for reading. I enjoyed this forum.

[Joseline]

This video is eye-opening for nurses not working at the bedside. It should be even more eye-opening for people not related to healthcare. Knowing that nurses feel overworked and many of them were already overworked prior to the pandemic should mean a lot to our society. To trained nurses at the bedside, especially in critical care takes time. The video is full of thoughtful ideas about how the healthcare system can continue to provide care, ensuring that every patient gets a trained nurse capable of providing the care the patients need and ensuring that nurses do not feel overwhelmed or under stress while providing the appropriate care. Reinventing the workflow in hospitals can ease the burden on nurses. The approach of bringing nurses from other countries is not ethical because it worsens the nursing shortage in other countries. The principle of valuing nurses as one of the most valuable resources across the world should be a priority in all healthcare facilities and reflected in their mission, vision, principles, and daily workflow. Reinventing the workflow and having medical assistants record assessments, send labs, bring specimens to labs could improve the amount of time nurses spend at the bedside. This could decrease the burden of nurses, their burnout, and the daily stress of nurses. Thinking about nurses as assistants in the healthcare setting is wrong. Nurses are professionals who deserve to be at the center of care provided in hospitals. Patients spend more time with a nurse than any other healthcare provider in the hospital. By providing one medical assistant and changing the workflow in hospitals many lives can be saved as nurses can spend more time in providing clinical care.

[Jorge Mesa]

The video provides a great argument for finding solutions to solve the nursing shortage and reduce nursing overwork. The nurse’s role is always changing, and more and more tasks and responsibilities are placed upon the nurses. Throughout the years, a significant amount of administrative, such as audits, reviews, and evaluations, have been given to the nurse to be implemented as part of their daily routine. The COVID 19 pandemic revealed some of the areas for improvement and new practices that can be implemented. The idea of given the nurse a secretary is not far-fetched. However, revising and reevaluating some of the policies, practices, regulations, and requirements can help reduce nursing overwork, reduce turnover, and retain experienced nurses. Documentation was one of the reviewed tasks, and leaders implemented alternatives to manage the surge of patients. Before assigning this task to another healthcare team member, revision of the documentation requirement, revision of workflows, and maximizing the use of technological tools can give the best gift, the gift of time. Unfortunately, many organizations have not maximized the use of technological tools to perform tasks such as audits and tracers.
Some of the alternatives presented in the video to manage the ever-growing nursing shortage, preventing nurse turnover, could effectively decrease the nursing shortage. The incorporation of internship during the academic preparation of the nurse can be beneficial in reducing the post-graduation training, helping the nurses’ growth in their careers as clinicians.
The nurse’s role has evolved and continues to evolve, requiring new solutions to the unique problems of the profession.

[Steven Watson]

This is called team nursing, or at least a version of it. I enjoyed listening to this video, the presenter brought out many good points. One of the most clinically significant points is the decreased risk for cross-infection by fewer persons crossing the infection barrier. The presenter mentioned a moral objection to the use of international nurses where this would leave one country with fewer nurses. As an international nurse, I can say this topic is much more complex than presented. Mass recruitment from other countries doesn’t deal with the issue of the clerical burden being presented.

The clerical burden on nurses is a combination of low perception of nurses by the public (and other health professionals) and the sense of self-worth of nurses. As mentioned in the video others may view nursing as an entry-level position and therefore not necessitating a secretary. Nurses, on the other hand, are trained to be highly sensitive to minute details which should be considered holistically, as such we are reluctant to give up any aspect of our role.

There is only so much we can do/control, especially in crisis situations. Team nursing is an idea borrowed from other disciplines where it has been successfully implemented. Henry Ford famously streamlined car production by introducing the production line where individuals sequentially performed tasks repetitively resulting in high quality and efficiency. This task-focused model of team nursing traditionally has not been executed well. When various assessment tasks are divided it results in the inability to easily consider the patient’s whole situation.

Team nursing can work well when duties are well allocated, like the proposal given by the presenter. This assessor/documenter form of team nursing works well in given situations, like isolated patients, recovery, and precepting new nurses for example. This form uses the TeamSTEPPS closed-loop communication tool by the assessor calling out (or dictating) assessments and the second person reading back (documenting) what is called out completing the closed-loop. The proposal in the video suggests that this second person does not need to be a highly trained RN. This process reduces the number of times a nurse goes between the patient and the recording station, improving efficiency and reducing cross-contamination.

This form of team nursing is not ideal in all situations but could definitely be expanded beyond the situations I mentioned above. The interesting part for DNP’s and Ph.D.’s will be defining the cost-benefit tipping point for this model and obtaining buy-in from nurses and administrators alike. Of course, we should also deal with the other part of the clinical burden equation by promoting the perceptions of nursing among the public and other professionals.

PS. Please don’t connect more than one patient to a ventilator, it will end up under-inflating the person with stiffer lungs and hyperinflating and potentially injuring the other.

[Rania Qaqish]

There has always been a shortage of nurses, this pandemic definitely made that problem even worse. Yes, we were running out of space and ventilators, but the shortage of nurses is nothing new. But this video was right, we cannot fix that problem with ventilators. I used to work in the medical ICU and I can tell you first hand that a lot goes into taking care of critical patients. I did not work in the ICU during COVID, but I commend the nurses that did. I am definitely open to the idea of using medical assistants as efficiently as possible. I also definitely agree physicians should be more familiar with nursing tasks, most physicians don’t know how to start an IV or even prime and connect a bolus to that IV. No one should be above any type of work, we need to foster a relationship and teamwork with healthcare professionals. These times are hard for everyone in the medical field, I do feel like nurses deserve more recognition for all that they do.

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