COLUMNS

REFLECTIONS ON PRACTICE

Are we really listening?

Karen S. Hill

by Karen S. Hill

Nursing and hospital environments are stressful. As nurses, we have always known hospitals are a source of stress for patients. The hospital environment is also stressful for bedside nurses—today more than ever.

As a longtime nurse executive, I continue to be amazed by the dedication and compassion of our nursing staff, and I am gratified to see these qualities continue to be displayed in the practice of nurses who have been in clinical roles for many years. I am also encouraged to see this spirit in nursing students as they rotate through our hospital for clinical learning, anticipating a rewarding career.

Stress in a hospital comes from many sources. Regulations and accreditation standards are not new to nursing. For many years, nurses have had to document information on a medical record—not because the information is a prioritized issue of relevance for a particular patient, but because a regulating body has established a safety guideline or requirement for the entire patient population. Today, more than ever, the pace of patient flow on nursing units is fast, the acuity of patients is often high, and the public’s expectations for compassionate care are also high. The technical expertise required of nurses can also be daunting.

Our hospital is an acute-care facility dedicated to providing the highest quality care possible. We ask nurses—in addition to their other clinical and assessment responsibilities—to take the lead in medication reconciliation, assist in monitoring physician practices related to national core measures and incorporate a growing list of national patient safety goals into daily practice. Meanwhile, care delivery models are being redesigned and physical workload solutions are being tested and will continue to be studied for years to come.

In light of these and other ongoing initiatives, a reflective review of the professional nurse’s role in an acute-care environment, a review that includes perspectives of practicing staff nurses, is indicated.

As a nurse leader, I want to advocate for nurses and patients—to be able to continue the kind of care and caring that is valued as the essence of nursing practice, to meet expectations for customer service, and to remove barriers and unnecessary frustrations from any system that impacts nurses and, ultimately, their patients.

In addressing these concerns and reviewing role expectations of bedside nurses, it is important that we continue to invite practicing nurses to the table for their input. Before adding further regulations, we must solicit input from practicing nurses to assist in balancing time demands with practice requests and available resources, thus avoiding unnecessary frustration and optimizing patient outcomes.

As patient expectations evolve in today’s environment, nursing practice must also evolve. Staff nurses know some of the solutions and, as nurse leaders, educators and regulators, we need to listen.

To help promote active listening by me and nurses in similar administrative roles, I will co-author future installments of this column with various staff nurses here at Central Baptist Hospital, soliciting their perspectives on issues relevant to hospital practice. I’m looking forward to writing this column and expect to learn something in the process.

I’d like your input, also. If you have insights you would like to share in regard to perspectives expressed in this column, or topics you would like to see addressed, please contact me at khill@bhsi.com.

— Karen S. Hill, RN, MSN, CNAA, FACHE, is vice president of nursing at Central Baptist Hospital in Lexington, Kentucky, USA.