Why I Can’t Say Enough about the Im

Why I Can’t Say Enough about the Importance of Nursing

October 15th, 2012|Middle East,Patient Care|By Steve Thompsonby STEVE THOMPSON on OCTOBER 15, 2012Share on emailShare on twitterShare on facebookMore Sharing ServicesMoreI’ve mentioned in a previous post the importance that we at Johns Hopkins Medicine International attach to nursing in our work with our colleagues around the world. But it’s such a critical element of what we do that I’d be remiss to not devote an entire post to it. (Not that one post could be enough.)To put it as simply and clearly as possible, nursing is as important as any other component of the projects we undertake in helping colleagues around the world improve the capacity, quality, efficiency and safety of health care. Helping our colleagues develop top-notch nurses is as big a priority to us as ensuring there are top-notch physicians and administrators.One reason is fairly obvious: nurses tend to spend more time in direct contact with patients than physicians do, and so the patient experience is highly influenced by what goes on with nursing. As we continue to move full speed into the era of patient-centered medicine, the ability of nurses to affect the perceived quality of care is becoming more significant.But there are other reasons we emphasize nursing, and one that really stands out is how big an impact nursing has on a hospital’s culture. If the nursing leadership at a hospital or clinic is dedicated to caring and professionalism, then chances are good the rest of the staff is on board as well. Nothing would set off bigger alarm bells for us than a lack of these qualities on the part of the nursing leadership and staff.That’s why we believe we can’t help our international colleagues reach full success if we don’t tackle nursing up front and do it well. As Jane Shivnan, our executive director of clinical quality and nursing, likes to point out, one of the first things we do when we embark with an international affiliate on a new project is assess the status of the nursing staff if there’s an existing facility or start working on plans to build a strong nursing staff if it’s a greenfield project.We always include highly experienced nurse leaders on our core team during the critical assessment and planning phases, and not just to focus on nursing. We want nurses to have a hand in every aspect of the project. For example, leading-edge hospital design now emphasizes patient-room areas that facilitate nurse-patient interaction. And patient safety is largely a question of how closely nurses and physicians work together on it.Another typical initial step in our projects is to ensure that effective nurse leadership is in place. Thus, when we supported our colleagues in Turkey in the building of the world-class Anadolu Medical Center outside of Istanbul, the very first new employee we helped place in the project was the vice president of nursing. When we were beginning thePerdana University Graduate School of Medicine project in Malaysia—in collaboration with the Malaysian government, we are seeing the development of the country’s first complete academic medical center—we fielded a visit from a dozen nurses from the Malaysian nursing board in Baltimore to our nursing school and some of our hospitals. Sonia Ruiz, our managing director for Latin America, estimates that fully half the focus of the team working with our Colombian partners at Fundación Santa Fe de Bogotá is placed squarely on nursing.Nursing training programs are virtually universal in our projects. That can run the gamut from full-fledged schools of nursing, like the one anticipated for Perdana University, to less formal but still intense programs built around visiting lecturers and practitioners from Baltimore, as well as teleconferences. Training covers everything from best practices in routine care to intensive care to patient safety, and all sorts of specialty care. In Singapore, for example, our affiliate there has helped develop oncology nursing as a specialty practice in the country, and much the same has happened with our colleagues in Trinidad and Tobago with regard to cardiovascular and diabetes care.Another key training tool: bringing nurses to Baltimore to round alongside our nurses here, not only in our main hospital but also in our community hospitals and clinics. In some cases, these bear a closer resemblance to the sorts of facilities our international colleagues want to operate. We also increasingly emphasize mentorship, having highly experienced nurses work one-on-one alongside their international counterparts at the local facility.One of our newest relationships, with the Kuwait Ministry of Health, is an extensive project built almost entirely on the mentorship model, and nursing is a huge part of it. And when we bring various leaders, administrators and practitioners from all our overseas affiliates together once a year for our Partners Forum, nursing tracks always represent a major part of the sessions, and the forum that just took place here in Baltimore is no exception. (I’ll have more to say about that conference in an upcoming post.)In my blog post on role modeling, to which I referred above, I addressed the issue of helping to empower nurses so that they feel comfortable providing input when physicians are making patient care decisions. It’s critical that nurses feel comfortable speaking up when they think a mistake is being made that might affect a patient’s health and safety. Our nurses in Baltimore don’t hesitate to interrupt a complex surgical procedure if they notice that a checklist item has been skipped, and we want nurses at all our international affiliate locations to begin to feel they’re in a position to do it, too.Often one of our biggest challenges in a project is simply identifying the required number of qualified nurses. We can always recruit internationally, of course, but if there’s a shortage of good nurses in a region we also take pains to work with our colleagues to help raise local levels of nursing availability, excellence and leadership. We’ve already made some good strides in that direction with the United Arab Emirates, for example.Nursing is going to become even more important in the coming years. That’s because health care systems throughout the world are gradually shifting attention toward models that do more to prevent and manage cardiovascular disease, diabetes and other chronic diseases that are best dealt with in patients before they require hospitalization. Nurses will play an enormous role in these lower-cost, higher-touch, prevent-and-manage models, because the emphasis will be on more frequent but less intense levels of care that call for coaching, outreach and simple patient self-measurements like blood pressure—routines that often don’t require much physician involvement. And as nursing continues to grow higher-level, more specialized branches, the way that physician practice has, nurses will increasingly take over many diagnostic and treatment tasks.It’s just one more reason to assign nursing such a high priority. I am proud to say that we’ve yet to work with an international counterpart that didn’t end up sharing that point of view