Walking in a nurse’s shoes

National Nurse Week begins tomorrow. I’m fresh off a 4-hour shift shadowing a nurse on a busy inpatient unit with cardiac surgery patients. I was taking part in the “Walk in My Shoes” program at Stony Brook Sue in scrubs cropped (2)Medicine where I currently serve as interim CIO.

All the executives were asked to block out 4 hours this week to shadow a nurse. I looked forward to my shift despite the other work on my desk. And as I told the nurse I shadowed, spending time on their unit was more fun than some of the problems I deal with as a CIO.

But I wasn’t there to have fun. I was there to understand what a nurse’s day is like and find ways that administration can help. And as the CIO, I wanted to understand how they use the systems we support and to find opportunities to improve them.

I donned a pair of scrubs, the universal hospital uniform and a fashion neutralizer. It’s amazing how different it feels to be on a nursing unit in scrubs compared to being a “suit” who periodically does rounds with a bunch of other “suits”. The staff seemed more willing to just tell it like it is when I encouraged them to be candid with me.

As soon as got to the unit a nurse realized I was from IT. His first thought was that I was there about a system problem that had been reported in the patient safety system. I introduced myself and my role as interim CIO. I told him that while I was there to shadow another nurse, I wanted to hear about their IT issues.  This was my “gemba” walk with a group of nurses.

We expect a lot of nurses. They need to be clinically sharp while being compassionate and caring. They must master all the medical technology and information systems we put in front of them. They need to be able to focus on clinical details and their next set of tasks while blocking out the noise around them.

Watching them carefully review the meds they are about to give a patient with activity and noise all around them, I vowed to myself that I’ll never complain about too much noise outside my office when I’m trying to compose an email on a difficult subject. Nurses juggle many tasks at once but seem to never forget everything they must do. If I don’t write down my “to do’s” they don’t get done.

I shadowed Ginny who has been a nurse for over 20 years. I interacted with her colleagues – other nurses, nurse practitioners, physicians, clinical nurse specialists and unit clerks. The sense of team on a nursing unit is unique. They work closely together for 8 or 12 hour shifts in shared space and are in and out of patient rooms. They are in a very different environment than my IT management experience in an office and cubicle environment with staff.

I watched Ginny administer medications for very sick and somewhat confused elderly patients who don’t want to take them or have trouble swallowing big pills. She did it all with grace, warmth and patience. She made each patient feel as though there was no one else around who may need her though she had other patients to care for.

I watched Ginny coordinate with transport staff to prepare two of her patients to leave the floor for procedures. She ensured all clinical prep was complete and the “trip slip” was filled out and affixed to the paper chart that went with the patient.

As she documented online I saw firsthand some of the extra steps and barriers to efficient documentation we need to address. Together we looked at the new electronic whiteboard and ways to improve it. As they reminded me more than once, technology should make it easier, not harder to do their jobs.

Nursing is a team effort in many ways. They learn new systems together and teach one another. They back each other up during breaks. They review together and co-sign when smart pumps need to be changed to ensure there are no errors that could harm the patient.

I heard that they think training is inadequate for some of the new tools they are expected to use, especially the ones they use infrequently.

We looked through the paper chart. It’s organized into standard sections, most of which are empty since it’s almost all online. The few sections with paper included consents, patient property list, and an insurance form needed at discharge; these are either not yet electronic or will never be.

I had a list of follow-up items for my IT team when I finished my time on the unit. I reviewed the ones the CNIO needed to know that afternoon. By the next day she had initiated follow-up on all of them. My CTO also did a shift this week and has yet another list of opportunities. We need to compare notes yet. And I look forward to debriefing with our CNO on the overall experience as part of hospital administration.

Whether you work in health care or not, we all know a nurse or may even be fortunate to have one in our family. Be sure to thank the nurses you know for what they do every day and don’t just do it this week! And if you work in health IT, don’t just thank them, keep finding ways to make their jobs easier.

Related posts:

A salute to the nurses among us

Nurses got talent

 

12 thoughts on “Walking in a nurse’s shoes

  1. Cindy Arnold MSN RN-BC Informatics on said:

    Excellent article Sue. It is so important to spend that time with the staff using our IT products to understand the intended and unintended consequences of our build, implementation, and electronic systems we ask them to use daily. As a Clinical Informatics Specialist, I see this overlooked and there is much information to be gained by “walking a mile in their shoes”.

  2. Michael Watson on said:

    An insightful post, Sue. As a healthcare IT project manager I believe my job is to contribute to patient care and patient safety, as I believe that’s everyone’s job in the the entire enterprise. The only way I can advocate for the patient is to advocate for the clinician. This is done by observing and asking about their process, maintaining continuing dialog, and providing the right devices and systems, of the right type and quantities, at the right locations in their workflow. During this process I meet some of the finest, smartest, and most compassionate people in the world, working in challenging circumstances.

    • Sue Schade on said:

      Michael, very well said! I always tell my IT team that we’re part of the extended care team; we don’t touch the patients but the people who do depend on the systems we provide and support.

  3. Bruce on said:

    Yes, our Clinical staff push the bus uphill on a daily basis with compassion, skill and patience. Great experience for you and them. It is not often that a ‘suit’ dons scrubs and goes elbow to elbow for such an extended time. Thank you.

    • Sue Schade on said:

      Bruce, know you and your team get it. You should know that all the execs were asked to participate this week. Look forward to hearing what other execs have to say.

  4. Kathy on said:

    Sue I have to say you looked like a natural in those scrubs. The nurses were really glad you spent time with them. We roll out solutions with collaborated and defined workflows however it is the real events of the shift that test us all. The importance of optimization and re-evaluation cannot be stressed enough. Healthcare is ever changing and keeping our systems current, relevant and intuitive should be something we all strive for. Having a clinical team as we do helps in Translating the needs of clinicians. Thanks again for the great feedback we are on it!

  5. Carolyn on said:

    Sue, on behalf of the nurses at SBUH, we deeply appreciate your taking the time to participate in the experience of walking a nurses shoes. There is no better way to recognize a nurse than to walk beside them, see, listen – and then take that experience and incorporate lessons learned into your own practice. Exactly what you have done , and we are already seeing those changes! Loved the post!

    • Sue Schade on said:

      Carolyn, my pleasure. Thanks for the kind words. As our CNO, your leadership is much appreciated – “Walk in my Shoes” is a great program that I hope other hospitals model.

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