Q&A: Now and then in nursing

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Over the past 25 years, nursing has seen numerous changes — from technology to research to education to changes in healthcare policies. In this, our first issue of 2013, we ask nurses in the New York/New Jersey Metro region about the advancements that have most changed their nursing practice. We kick off the 25th anniversary celebration of Nurse.com with this Q&A feature.

In celebration of the 25th anniversary of this magazine, we asked local nurses what are the biggest changes in their practice in the past 25 years. This is what they said.

Rosanne Greenan, RN, CEN
Stroke Coordinator, Northern Westchester Hospital, Mount Kisco, N.Y.

Nurses no longer are seen as the caretakers to the healthcare team, carrying out tasks ordered by physicians. Now, we are leaders of the team as well as patient advocates and educators, ensuring patients and families have the information and tools they need to make the right decisions about their care. In the ED where I work, nurses are the first to assess patients and often establish the goals for their hospital stay. Physicians view us as colleagues who make concrete observations and offer valuable suggestions. Our knowledge base has grown as the demands of our professional responsibilities have increased. The use of evidence-based practice and the acceptance of credentialing in our specialty have raised the bar for nurses everywhere. As much as nursing practice has changed, our primary goal remains to take care of our patients in the best way we know how.

Ruth Atienza, RN, MSN, APN-BC
Staff Nurse, PACU, Saint Clare’s Health System, Denville, N.J.

As a nurse for more than 25 years, I am a living witness to the changes and advancements made in medicine and nursing. When I started my career on a med/surg unit, patients had invasive surgeries requiring many drains and tubes. Today, patients are able to return home faster, some even the same day, as a result of minimally invasive surgeries. Advancements in technology have changed nursing documentation. The electronic medical record — with drug-to-drug interactions and electronic signing of medications after scanning a patient’s identification bar code bracelet — increases efficiency and safety for our patients. Continuing education allows nurses to advance the care provided to patients as well as to grow in their own nursing career. As a former ED staff nurse, I returned to school for my adult nurse practitioner degree and apply what I learned every day. In addition to a signficant increase in the number of nurses who are becoming certified in various specialties, there is a gradual shift toward nurses seeking higher education, which includes bachelor’s, master’s and doctoral degrees.

Paula Augustyniak, RN, ED
Staff nurse, Somerset Medical Center, Somerville, N.J.

Although documentation remains a priority in good nursing care, it has evolved to a level I don’t think anyone could have imagined. Technology has changed so much in the last 25 years, and even more so in the last 10 years with the coming of age of the electronic medical record. Many nurses who were not familiar with computers have had to add these new skills to their repertoire, and just when they mastered one, a new program is rolled out or the computer system changes. The long-standing principle of nurses adjusting their method of practice to meet the needs of patients and ensure quality care has never changed. During National Nurses Week, many of us seasoned RNs look back and remember when we would walk the unit with physicians as they rounded on their patients, and we reminisce about the days of metal bed pans, hoppers and “S and A’s,” the old sugar and acetone, which came about before the days of the glucometers. In many ways, technology has vastly improved patient care and resulted in better patient outcomes. Yet when I think back on the days of making rounds with physicians and carrying the patients’ charts and taking notes for them, I realize the most important way nursing has changed is the communication and respect between physicians and nurses. In the ED where I work, it is clearly evident our opinions are not only valued but also sought after when caring for patients. We function independently and collaboratively in achieving the highest standards of care and the best outcomes for our patients.

Edna Cadmus, RN, PhD, NEA-BC, FAAN
Clinical Professor, Specialty Director-Leadership Tracks, Rutgers University, College of Nursing, Newark, N.J.

In the past 25 years, there were major milestones where nurses became more visible and demonstrated leadership abilities. In 1993, the American Nurses Credentialing Center began to offer certification for hospitals to become Magnet facilities. These standards have evolved from structure and process standards to empirical outcomes. In 1999, the IOM report called Crossing the Quality Chasm was released, which identified issues around quality and safety in hospitals. The focus continues today and is even more intense where nursing is responsible and accountable for outcomes now linked to payment. The 2010 IOM report called The Future of Nursing: Leading Change and Advancing Health has set into motion a galvanizing direction for nurses. I believe history will show how nurses led this effort and changed healthcare.

Muriel M. Shore, RN, EDd, NEA-BC
Dean and Professor, Felician College School of Nursing, Lodi, N.J.

Advancements in the educational preparation for nursing practice have been dramatic over the past 25 years. This has led to the expansion of nursing science and evidence-based practice, all of which improves the quality and effectiveness of healthcare. The emergence of doctoral programs, especially the DNP, has elevated the education of advanced practice to the level of other health professions, an important societal consideration. The concerted effort for unity and collaboration among nurse educators, scientists, researchers, practitioners and executive leaders with professional organizations to improve healthcare worldwide is achieving results in the area of new public policy and access to healthcare services for all. These advancements are monumental and challenge academic leaders to look to the next 25 years and ask who will be the new nurse learner, how will educational programs change based on emerging healthcare demands, how will technology enhance learning, and how will interdisciplinary education be planned? At Felician, we are always examining these critical questions so we position ourselves for this new future.

Maureen Schneider, RN, PhD(c), MSN, MBA, NEA-BC, CPHQ, FACHE
Senior Vice President Clinical Program Development and CNO, Somerset Medical Center, Somerville, N.J.

The last 25 years demonstrated extensive transformation in healthcare and nursing practice. Examples include the introduction of the electronic health record and technological advances in medicine. One area continuing to move forward is nursing research. More than ever, nurses are increasingly becoming skilled in conducting research and changing nursing practice based on research outcomes. As healthcare technology advances, our nurses are well positioned to pursue newly designed clinical practices and new ideas that provide extensive opportunities to create and move forward progressive nursing practice. As nurses showcase meaningful outcomes, patients benefit from their care and nurses are recognized in their professional practice. In fact, the new healthcare dynamic is requiring and seeking nursing research inquiry for new methods to deliver care.

Debora Riccardi, RN, DNP, CPNP
Director of Community Health Nursing, Cohen Children’s Medical Center, North Shore-LIJ Health System, New Hyde Park, N.Y.

I have been a pediatric nurse for 25 years, and one of the greatest changes in that time is the advancement in education and the opportunities to further our education. It is also exciting to see the advancements nurses have had with respect to research. These two components — education and research — have and will continue to strengthen our profession. I continue to observe nurses pursue higher education and have an understanding that an advanced degree can provide them more opportunities toward employment and new challenges while giving them the ability to make a positive impact on patient care and the healthcare system. I also have witnessed the growth of administrators supporting these endeavors. Time gives way to new technological advancements, but those things pale in comparison to knowledge.

Liz Hirschhorn, RN
Staff Nurse, Inpatient Behavioral Health, Lutheran Medical Center, Brooklyn, N.Y.

Fresh out of nursing school, I began working at Lutheran in 1979. My expected role was to make the best hospital corners possible and work diligently to assist the doctor. Over the years, the profession has transformed from the role of solely carrying out orders to becoming part of the healthcare conversation. Today, I have more independence when providing healthcare. The expectations and standards of care for nurses have increased dramatically. As an example, PICC lines, which were performed mainly by doctors in the 1980s, became a responsibility of mine on the IV team after acquiring advanced training. The certifications a nurse could gain grew, and many of us have broader skill sets. Today’s nursing practices have created a culture of excellence that I am proud to be a part of.

Olivia Babol-Ibe, RN,C, MSN
Director of Nursing, Schervier Nursing Care Center, Bronx, N.Y.

As a registered nurse for more than 30 years, I have experienced the numerous ways recent advancements in technology have drastically changed — and continue to change — healthcare. Over the years, my role has expanded greatly, training has been enhanced and converted to be primarily online, filing cabinets have transitioned to electronic medical records for secured confidentiality and a quicker transportation, and new programs and services have been developed. These advancements are all due to the influence of technology, which continues to revolutionize the methods and techniques we use to care for our patients, the quality of care we are able to provide and even the ways our environments are structured and regulated. The implementation of the Affordable Care Act has helped increase patient engagement, and the centers of Medicaid/Medicare create regulations that greatly impact care of our residents.

Mary Wagner, RN
Vice President of Clinical Practice, MJHS Home Care, Brooklyn, N.Y.

Looking back, I’m struck by the shift in emphasis from process to outcomes. Of equal note is the development of technologies that facilitate evidence-based practice and outcomes-based evaluation of practice. In the late 1980s, the focus was on nurses’ performance of tasks and activities — on doing for the patient. Today, the focus is on teaching and supporting patient self-management skills, fostering independence and achieving improvement in patient outcomes. Wireless home telemonitoring has moved care feedback into the 21st century. Today, unobtrusive units provide feedback to patients and their nurses about the effectiveness of self-management practices. Point-of-care technologies and electronic medical records have essentially replaced manual documentation and paper records. These advances permit communication and clinical information sharing and support evidence-based practice and the collection of data.

Jeanne DeMarzo, RN
Director of Nursing, Weiler Hospital, Montefiore Medical Center, Bronx, N.Y.

The complexity of nursing is multifaceted — increased demands for services, financial pressures, cost containment, the economic climate, increased consumer demand for transparency in quality and nursing outcomes, access to services, HCAHPS, new technology, education, training, cultural diversity/sensitivity, ACOs, emphasis on wellness and prevention, the nursing shortage, educational standards for entry level RNs, RN-patient ratios, clinical excellence and competence, advanced practice, nursing research, informatics, advocacy, patient safety, emergency preparedness, regulatory requirements — and therefore, the changes impacting my practice as a clinician and leader during the past 25 years have been multifaceted. I have to be able to adapt quickly, think on my feet and be able to communicate and interact with different disciplines. Also, I’m finding that I am managing and leading nurses from four different generations, and I have to communicate with each of them differently.

Diane Cooper, RN
Public Health Nurse, Congregate Care, Visiting Nurse Service of New York, Bronx, N.Y.

I studied community health at Hunter College Bellevue School of Nursing in New York City. It was during my last year of nursing school in 1980 that I found my calling. After two years of working in a hospital, I joined VNSNY. Back then, my caseload was a mix of mothers and babies, children, teens, adults and the elderly. A big challenge was finding a working pay phone to call the office. Highlights of my VNSNY nursing career over the years have included getting a VNSNY beeper, a phone and a pen-based tablet computer, along with celebrating the 100th anniversary of our organization in 1993 at Tavern on the Green. Along the way, I have earned a master’s degree as a nurse educator and became certified as a geriatric NP. My commitment to VNSNY is grounded in our commitment to meet the challenges of an evolving healthcare system, changing economic conditions, shorter hospital stays and greater longevity of patients’ life expectancies.

Lois Iavarone, RN
Staff Nurse, Labor and Delivery, South Nassau Communities Hospital, Oceanside, N.Y.

An important change I’ve noticed in my nursing practice over the past 25 years is patients verbalize a much better remembered birth experience. They are awake for the baby’s birth and involved in its delivery. I see nurses as playing an important role in this evolution of care. As a result of our shared governance model, South Nassau has begun the Baby-Friendly initiative where we minimize the separation of the mother and infant. This further promotes mother-baby attachment behaviors with skin-to-skin contact. On the whole, nurses have made strides in increasing their knowledge and education and by gaining professional certifications. There is considerable respect for the depth of their knowledge in their specialty areas.

Tracey Boyd is a regional reporter, and Janice Petrella Lynch, RN, is a regional nurse executive.


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