Nursing
orders
October 14, 2018 --
Doctors order things all the time -- diagnostics, medications,
treatments -- and so do nurses, within their scope of practice, of
course. But we don't call them nurses' orders, observes nationally
recognized Electronic Health Records expert and industry thought
leader Ann Farrell, BSN. Instead, we call them care plans.
This is a problem. For one thing, hospitals cannot charge for them,
weakening nursing's political and organizational influence. Also,
nursing care plans are not tracked well -- though nursing care is
essential to value based pricing (VBP) which ties revenue and
penalties to outcomes. And of course outcomes are dependent on, more
than anything else, nursing care.
Ms. Farrell writes [personal communication]:
Do we REALLY know which are key OBSERVATIONS (we forget this when
replacing RNs with lesser educated and experienced staff) and
interventions RNs do that impacts outcomes? Hospitals want the
cheapest staff possible which makes nursing vulnerable.
A set of MD's orders is an "order set", and a set of RN (and
therapist) orders is a "care plan". Together, they provide an
"integrated plan of care" which brings together the entire care
team, and should increase stature of nursing role.
Alas, nurses are considered "task masters" -- following MD orders.
People don't understand the role nursing has in CREATING part of
the plan of care.
People think of RNs "passing meds" as if there were not a critical
thinking process. The MD order may be perfect when it's written
but patient status changes from moment to moment. EVERY TIME an RN
administers a med they evaluate its appropriateness. People think
it's just an assembly line from drug cart to patient, RN role
"transport". NO ONE has been able to explain what nurses DO!
[We also] lack a common "framework" or terminology to guide
profession and industry... it's painful to reflect on the damage
to nursing due to lack of data (and leadership) to support what
value [we] bring.
The words we use to describe nursing's contribution denigrate it. By
continuing to undervalue the role of nursing, we deliver health care
that's not as good as it could be.
What's needed, says Farrell, is deeper thinking by our nurse leaders
and less simplification of complex issues. Nurses must participate
more fully in technology design and deployment decisions. We nurses
have largely abdicated those responsibilities. For our jobs and our
patients, this must change.
In a time of tremendous economic pressures and disruptive
technologies, Farrell's is a rare voice of reason.
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