1. Zibell, Elizabeth MSN, RN

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I thought you wanted to be a nurse." This is the response I usually get when I tell people of my most recent career move. Along with three other RNs and a multitude of programmers and "techies," I'm part of a team responsible for implementing a computerized physician order entry (CPOE) system in our hospital.


My friends and family are having a hard time understanding why I'm not at the bedside anymore. I explain to them that my role as a business system analyst has just as much impact on patient care as bedside nursing; installation of the CPOE system in our hospital is intended to increase patient safety in the hospital. A polite "oh" is all they muster in response. They're still attached to an image of a nurse in white cap and uniform, happily administering the contents of a gigantic syringe at the bedside. Perhaps they believe there's something suspect about a nurse without patients. After all, aren't patients the reason people become nurses?


A desire to work with patients and help make their health care experience as positive as possible did prompt me to enter the field. But I've discovered since obtaining my RN license that nursing care isn't necessarily done just at the bedside.


During a year spent with a local public health department, I found myself teaching day care providers about infection control and then driving to the home of an 88-year-old, his inhaler and Camels in his lap, to debate the ills of smoking. Such home visits helped me to hone my ability to read a map, leap over three-foot stacks of newspapers, and manage my time efficiently. Eight years of service in a neonatal ICU (NICU) taught me how to lull a tiny 28-week infant to sleep while keeping one eye trained on a cardiac monitor and the other on an overeager sibling. My teaching skills and patience level increased as a result of my experiences in both the NICU and the clinic. As a study coordinator working in a National Institutes of Health-supported clinical research center, I was able to see medicine move from laboratory bench to bedside. My nursing knowledge and skills grew and deepened as a result of the personal stories that research patients were willing to share about their struggles with illnesses. (I should also mention that I can now peruse a research article and actually appreciate it.)


Now, although I sit at a computer and wear heels instead of clogs, my work is more patient focused than ever. As a nursing analyst, I am responsible for the Herculean task of translating what nurses do for programmers. While sometimes this is as simple as explaining what a complete blood count is, at other times it can involve helping to incorporate new Joint Commission on Accreditation of Healthcare Organizations standards into ordering language. The CPOE system, once we "go live" with it, will provide all physician orders electronically and will interface directly with our pharmacy, radiology department, and laboratory. Nurses and physicians will use the system to record patients' allergies, track vital medical history, and document care.


In a time when nurses so often feel weighed down by the challenges and problems facing the profession, I'm encouraged by the wide array of available opportunities. Sure, I have days that I think will never end, but when I consider the skills and knowledge that I've accumulated in my career, the moments of insight during patient assessment, the gratefulness of patients and their families, and the collaboration with colleagues on how to improve care, I feel both proud and satisfied. Maybe it's because I'm a Gemini, but I have loved all the changes and turns in my nursing career. Each new role-whether responding to the immediate needs of patients or stepping back to gain a more "global" perspective on the workings of an acute care teaching hospital-has only enhanced my skills and helped me grow. Care may be delivered at the bedside, over the phone, in a class, in a patient's living room, or at a computer, but it's all nursing. Yes, I always wanted to be a nurse, and I am.