Kathleen Singleton, RN, MSN, CNS, CMSRN, a clinical nurse specialist for med/surg nursing at Fairview Hospital in Cleveland, remembers treating a patient who had been transferred from the ICU to the med/surg unit after suffering from a massive gastrointestinal bleed. To further complicate the case, the man had residual effects from a stroke three years earlier. He was one of five patients she was caring for that day.
Singleton has witnessed the trend that patients in today?s med/surg units typically have more complex medical issues than a decade ago. Nurses are working in a world in which patients have more co-morbidities and chronic illnesses, use more medications and have shorter hospital stays. All of these factors contribute to the increased demands on nurses, says Singleton, who also is president of the Academy of Medical-Surgical Nurses.
To understand how to best support the modern med/surg nurse, the AMSN conducted a survey of its members, for which it had 674 respondents, and conducted member interviews. The academy then conducted an in-depth analysis of members? feedback.
?It came across in the data from the survey that it was important to have a healthy workplace to be able to deliver best practices and manage patients well in today?s complex care setting,? Singleton says.
Using survey results, the academy?s leaders created a strategic plan that focuses on five goals aimed at helping nurses survive and thrive in the ever-changing world of healthcare.
More Patients, More Prescriptions
The first goal is aimed at giving nurses tools to manage rapidly escalating demands on med/surg nurses.
Singleton says, for example, it is not uncommon for each patient to need 10 to 12 medications a day. The number of prescriptions purchased in the U.S. jumped 71% between 1994 and 2005, compared to a U.S. population growth of only 9% during that same time period, according to data from the Kaiser Family Foundation. The average number of prescriptions per capita also increased from 7.9 to 12.3 during those years, according to the report.
?People who have chronic illnesses are also living longer, and this increases the complexity of caring for these patients,? Singleton says. ?And we are taking care of more acutely ill patients.?
Singleton predicts med/surg nurses also will feel the impact of the additional 30 million Americans who are expected to gain health insurance because of healthcare reforms. People who did not have resources in the past to seek regular medical care can be discovered to be more compromised in their health when they start pursuing care, she says.
The challenges are mounting, but best practices are continuing to develop at different institutions, so the AMSN is developing a resource toolkit that will give RNs a chance to learn from hospitals that are maintaining healthy work environments in spite of the increasing demand by highlighting best practices. Nurses from different institutions also will be able to use the AMSN?s website to network with one another.
?Sometimes we work in an unhealthy environment, but we don?t know it is unhealthy because we are used to it,? Singleton says. ?This online toolkit will give nurses an outside perspective.?
Well Read = Well Prepared
The AMSN?s second goal is designed to support nurses in a healthcare environment that is increasingly placing value on evidence-based practice.
?It is important for nurses to be aware of research about outcomes that can be reported and benchmarked,? Singleton says. ?In the future, reimbursement will be based more on quality patient outcomes. It has that element now, but it will increase in the future.?
She encourages nurses to stay current with practices by reading nursing journals and visiting the AMSN?s website, which offers a resource library with access to presentations, articles and convention information. The organization also established the Cecelia G. Grindel Evidence-Based Practice Award last year to support nurses who are doing research.
The AMSN?s third strategic goal encourages nurses to pursue professional development as a way to thrive in today?s demanding workplace. As of April, more than 12,600 nurses had earned certification through the Medical-Surgical Nursing Certification Board.
Human Resources
The fourth goal aims to use the AMSN?s network to help nurses become leaders in their profession. By collaborating with other organizations and one another, nurses will have greater influence, Singleton says. AMSN, for example, works with other nursing organizations to solve problems and discuss the future of nursing on a large scale.
Singleton has personally experienced the power of collaboration when she was working in a hospital in which specimens were sometimes mislabeled. Singleton networked with nurses from AMSN about the problem. As a result, she developed a policy for specimen labeling and incorporated the policy into the hospital?s systemwide nurse orientation program.
The fifth goal focuses on refining and promoting the organization?s identity.
?There is a misconception that med/surg nursing is not a specialty,? says Singleton. ?We take care of diverse patient populations. Patients can be people who just had a major surgery for the first time or others who have a chronic illness who we?ve known for the last 10 years. Patients are stable but have the potential for complications.?
Med/surg nurses comprise more than 50% of nurses working in hospitals, and more than 30% of nursing in all healthcare settings, according to the AMSN.
More Work, But Better Tools
Although the evolution of healthcare is placing more and more demands on nurses, Singleton believes that AMSN?s goals have the potential to help nurses take advantage of the benefits of modern healthcare rather than feel overwhelmed by change.
?We have technology and pharmacology that we?ve never had before, and the potential to provide even better care is enormous,? she says. ?In other nursing units patients may be too ill, under the effects of medications or anesthetized and unable to participate. I love being a med/surg nurse because you work with many patients who have the ability to determine their care now and in the future. The fact that they can make decisions about their care creates a great opportunity to be a part of someone?s life.?
Heather Stringer is a freelance writer.
