How nurse initiated protocols can change healthcare

Stories - CaduceusNurses are on the front line of healthcare, and it is only obvious to those who actually work as nurses. Most of the management and administrators are tasked with making policy changes and affecting the way patients are cared for.

Here’s a radical idea: why not ask staff nurses for their opinions on patient care and create protocols based on that? It isn’t such a stretch, but the idea still has not taken hold in the minds of healthcare policy makers.

Fortunately, a new group called the Clinical Scene Investigator Academy is mobilizing a group of regular nurses to help make policy changes. Much to the surprise of everyone but nurses, it is working, and here are a few of the areas where the nurse directed changes are making an impact.

Fall Prevention

Falls are a huge problem in hospitals and long-term care facilities, but the way to prevent them has left the big wigs scratching their heads. Nurses, however, know the ins and outs of falls and are better equipped to evaluate how to prevent them.

In fact, when nurse initiated protocols were used, the amount of falls decreased by a large percentage. These protocols were only initiated in certain hospitals, but a database was created to help hospitals not included in the studies to apply the techniques learned.

Even in hospitals that were not part of the study, the nurse initiated directives resulted in fewer falls. This was the result of several protocols that worked together to achieve the decrease in this phenomenon, including a no fall zone for patients.

Decreasing Pressure Ulcers

Again, pressure ulcers are the domain of nurses, and it is often our responsibility to find them prevent them, and treat them. Who else knows pressure ulcers as well as a nurse on the front lines?

One of the strategies put forward by the study suggested a full body scan for pressure ulcers whenever a patient is admitted into a facility. This allows the nurse and doctor to know if there are any possible places were a pressure ulcer is likely to occur.

It seems like common sense, and some of it is. No one in the higher echelons of the hospital would realize this, though, because they are not as tuned into the patient, not as expert in the warning signs of pressure ulcers, and not aware that traditional methods usually don’t work.

Early Ambulation

Another issue researched by the CSI group was early ambulation in patient outcomes. There are many reasons for early ambulation, such as the decrease of blood clots, decrease in likelihood of pneumonia, and a decrease in muscle deterioration.

Nurses know that patients need ambulation, particularly after surgery, but most hospitals don’t have this simple measure in their policies and procedure manuals. Unfortunately, the lack of ambulation can lead to a whole host of problems and poorer outcomes for nurses.

Although the focus on nurse initiated policies and procedures is encouraging, it doesn’t go nearly far enough. We should be asked about the computer systems, the ease of delivering medications, and the workflow. Hopefully, in time, we will see this practice become common.


Skip to toolbar