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ADVANCE Perspective: Nurses

Defining Quality

Published January 30, 2013 2:12 PM by Guest Blogger
By Diane Goodman, APRN, BC, MSN-C, CCRN, CNRN

Recently, I was discussing "retirement" with a friend. Unfortunately, with global economic changes, many of us in healthcare may work years longer than originally intended. During the retirement discussion, my friend had several pointed questions I found difficult to answer. The most difficult was to define "quality" time, meaning what would I choose to do to provide quality in the time between cessation of work and onset of senility and/or death? Several days have passed since our conversation, and the word "quality" has remained foremost in my thoughts, nagging at me, and begging to be described and clarified.

What is quality time? Has quality become one of those words utilized so often in healthcare that it defies meaning? We have standards of care, evidence-based practice protocols and quality of life indicators for patients, yet for nurses and healthcare providers, could we require an alternate definition? Do we remember to add quality to our lives, or are we at the bottom of Maslow's hierarchy so habitually that we have forgotten what it is?

For many of us, work itself has become a measure of validation, with the next goal being seen as a gauge of success and time well-spent, no matter how much stress or sacrifice was involved. We cannot get through an appraisal of work without having measureable goals and checkpoints. If asked to slow down long enough to define quality time, how many of us would pass the test?

As I pondered the question of what would bring me joy and a sense of peace, I realized for me it is often seeing a patient previously in pain begin to relax, or a new nurse struggling with the fears/anticipation of her first years providing bedside care. It is the face of comprehension, when nursing associates understand blood gas analysis for the first time, or are provided with an arsenal of tools to care for difficult or challenging cases. It is not about watching Top Chef, Investigation ID or an Academy Award nominated movie. I love all these things, but I'm not yet ready to define them as "quality." They amuse, but do not excite.

If we are truly honest as nurses, we have a tougher time than most leaving work at work. We drag our gallows humor to almost every party we attend, and dinners out to socialize usually become another opportunity to vent work frustrations or revisit "the good old days" when doctors smoked at the nursing station before advising patients to quit. We became nurses and caregivers because it is in our blood, and like an ongoing infection, it may be difficult to treat.

Nursing has consistently been voted the most trusted profession; however it is also one of the most stressful. Drop-out rates within the first year of employment (for new nursing graduates) have remained elevated, with attrition percentages varying from 10-40% within nursing schools. As described by a recent article in the Los Angeles Times, what we've witnessed is more of a nursing crash than a nursing shortage.

Think about the concept of quality in your life. How do you define what gives back and centers you? Does the word have meaning ... or is it still in the formative stage? Think about what you would enjoy doing most in the years between work and the end of life. Does the word have definitive parameters, involving family time and hobbies, or is it blurry and lacking substance?

I am ashamed to admit I have yet to figure out what the word means for me. I do know that for myself, as for many nurses working in healthcare, applying our knowledge, skills and compassion on a daily basis provides a concept of quality for those who come within our sphere of influence. The inverse is also true; the less one sees a nurse, the poorer the potential outcome.

It's when nurses get in the car and head home that those same definitions become indistinct. If we are incredibly, impossibly lucky, we have those at home who need us to provide care and nurturing, good care, perhaps even quality care.  If our luck prevails, we won't have to answer tough questions about how we will thrive once that is gone.

 

4 comments

First of all…. nurses go to Nursing School NOT Medical SchoolNursing School = NursesMed School = Doctors/Physicians/Surgeons/ect.—————————————————————–1) What was the worst smell from a piteant youexperienced?ex. full fledged diabetic necrosis via gangrene from foot to knee2) Do you find doctors to be easy to deal with? What makes doctors better to deal with?(I’m currently in my Senior year of College and my goal is to be a good doctor that gets along with nurses (you have to respect those who do the dirty work (constant monitoring, change catheters, clean people, ect.).)3) What type of Nurse are you?Depending on where you're at in the hospital I'm not sure I'd classify RN's as the ones who necessarily do the dirty work unless you're lumping dirty work in with piteant interaction.  I've actually been frustrated (once again depends to an extent on the unit) because even as an RN I tend to work far less with the piteants than I'd like.  I suppose it's admirable that your goal is to get along with everyone but seeing as how you aren't even in college yet let alone med school it's a bit worrisome to hear that you're worried about being able to get along with your co-workers/underlings.  Respecting and working well as a unit/team with your co-workers is fundamental to any job and this is of paramount importance in healthcare.  In addition, because of advanced nursing degrees (NP, CRNA) and the ability to have advanced knowledge at your fingertips (whether it's a computer program or an app), the power differentials that used to exist in the hospital are starting to become a thing of the past.  It's more than possible to walk in and treat everyone like garbage and get away with it, but pickings are going to be scarce when you're up against a rock and hard place and looking for someone who has your back.  The communication issues that arise surrounding Physicians and RN's tend to originate from them being grossly overworked and sharing a large portion of the responsibility for any given piteant's health, yet their main tool for obtaining information surrounding a piteant is often the RN and it's not usually the same RN so it can be difficult to precisely gauge an accurate baseline on how someone is functioning.  There's also a monumental knowledge gap between RN's and MD's.  It's embarrassing being one of the least educated individuals in the hospital healthcare system.  IMO the RN programs need to be more streamlined and require more in depth material.  The RN residency programs however do seem to do a great job at preparing fledgling nurses (usually an additional 3-9 months of additional focused schooling that varies based on the unit).  The only downside is that residencies aren't mandatory everywhere yet.  If you don't have family members who work in the hospital I'd recommend interviewing and job shadowing various medical positions before you set your mind on one or the other.  It isn't any easier to get into med school versus nursing school (at least on the west coast) so it's extremely important to figure out what you want to do in order to have a slim chance at getting into school.  Dino

Tayyar Tayyar, mktAzZshzOiOz - vvlTXhVyBrXJWw, VUACLjHWPWmLQmsC March 4, 2013 11:13 AM
tZaiGBtSRUUcFy MI

Nursing is a part of who I am, can't help it. My mother, an RN, is 86 yrs old, and says that you are always a nurse, your whole life.

Because nrsg is the most trusted profession, our opinions are  often taken as gospel by lay people. For that reason, it is important that nurses are life-time learners not only about their profession, but about what is going on politically in health care --and not only what the ANA puts out, but also what the AMA puts out and the hospital associations today say.---

kathryn, RN, BSN February 10, 2013 1:07 PM
sumter SC

How true this is.  I am finding RN and LVN high in their 60s and into their 70s. The oldest have been twin sisters at 79 working in long term care and caring for aging parents.  From that era of nurses the work ethic was for long hard hours and deep dedication to the profession in any area of the profession.  It continues to be hard to balance family and patient's/company needs.

Beverly Pearson, Education - RN BSN MBA, Infusion Therapy February 10, 2013 10:33 AM
Arlington/Midlothian TX

I really identified with your observations Diane!  Just this week I related my story of "docs used to smoke at the nurses' station" to a class of novice critical care nurses.  We DO love our stories!

Pat , APN, CCRN, CCNS January 31, 2013 1:53 PM
Oak Brook IL

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