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A few days each month, I work at an inpatient hospice. My work there is a labor of love. Besides hands-on patient care, one of the greatest rewards is my ability to work independently. I rely on standard protocols that outline key medications and treatments to manage pain, secretions, constipation, anxiety, shortness of breath, and other end-of-life symptoms. When someone's condition changes, I can intervene quickly, adapting his plan of care without making numerous phone calls for orders.
Having worked in acute care for years, I know how tedious and time-consuming getting solutions to patient problems can be. But if you have strong protocols and a thorough understanding of the indicated treatments, you can cut the red tape to quickly deliver excellent care.
Although some acute care facilities use evidence-based protocols for anticoagulant therapy or weaning patients from ventilators, others use none at all. Most acute care facilities could benefit from nurses taking the lead to develop practical protocols based on current, evidence-based practice.
Greater use of nursing protocols can be a win-win situation for patients and health care providers alike. When I performed a Web search on nurses using these tools, I found an article titled "Advancing Nurse Autonomy" on the American College of Surgeons site. Citing the nursing literature, the authors acknowledge a direct correlation between nurses' job satisfaction and their degree of autonomy. And physicians benefit from nurse autonomy too: Handling fewer pages about routine matters, resident physicians can more easily limit their hours on duty as required by the Accreditation Council for Graduate Medical Education.
Which nursing tasks frequently require you to contact a health care provider before delivering patient care? Could a standardized protocol safely and efficiently eliminate many of these calls? If so, consider working with prescribers and colleagues from appropriate disciplines to develop protocols that will streamline those tasks. Not only will patients benefit, but you'll also find yourself happier with your practice.
My greatest satisfaction as a nurse is taking positive action to help patients, which I can readily do with tools that offer solutions. Going home knowing I've made a big difference in a patient's care is the greatest feeling in the world.
Cheryl L. Mee, RN, BC, CMSRN, MSN
Wayne JD, DaRosa DA. Advancing nurse autonomy. American College of Surgeons, Residency assist page. http://www.facs.org/education/rap/darosa.html. Accessed October 11, 2006.
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