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Expanding Patient Advocacy with Leadership, Creativity, and Vision

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Expanding Patient Advocacy with Leadership, Creativity, and Vision The New Face of Nursing: Expanding Patient Advocacy with Leadership, Creativity, and Vision he image of the traditional bedside nurse of the last century—white stockings, crisply ironed skirt, and starched cap—is now a distant memory. But the core tradition of care and compassion remains, along with a continued commitment to serve as patient advocates in an increasingly complex medical system. These days, nurses are taking this core tenet of Tadvocacy and coupling it with their drive for improvement, creativity in solving problems, and vision for the field of nursing. The result? New opportunities, more intriguing career paths, and emerging leadership roles. There is no question that today’s nurses face a more complex and chal- lenging working environment than their predecessors. Patients are more seriously ill as hospitals now primarily serve people with emergency or catastrophic health issues. The amount of administrative work required of nurses has skyrocketed. And technological advances have completely changed how nurses perform many basic tasks. However, in the midst of these paradigm changes, Hopkins nurses have not only adapted, they have thrived. In fact, nurses are taking a stronger stance on behalf of patients than ever before, leading interdisciplinary initiatives to ensure that patients receive care that is the safest, highest quality, and most ethically sound as possible. Nurses at the Johns Hopkins University School of Nursing (JHUSON) and the Johns Hopkins hospitals are applying their expansive knowledge of patient care to broaden their responsibilities as clinicians. And they have gone to great lengths to ensure that they are able to perform their jobs to their fullest potential, even taking the lead to By Elizabeth Heubeck reform state laws. Illustrations by Robert Neubecker The articles that follow share a few examples of the leadership, creativity, and vision of Hopkins nurses—all of whom are contributing to the expansion of the profession. 28 J OHN S H OPKIN S N UR S ING Training Leaders for Nursing’s Future “To be an effective leader, one must have passion, a vision, and the appropriate tools. Hopkins helps define, determine, and develop these essential elements,” says doctor of nursing practice student Cheryl Bridges, MS, MBA, ACNP, who works at the Johns Hopkins Hospital as a nurse practitioner. “The profession of nursing, unlike medicine, public health, or pharmacology, has a unique position in the health care arena in that it approaches the patient from the perspective of the ‘whole’ system. We therefore have a duty to be our patients’ advocates.” Other JHUSON graduates echo that mantra. “It’s a Hopkins tradition for nurses to always question the process and try to make it better. People there who do, end up rising through leadership roles,” says Deborah Baker, BS, MSN. She should know. Having earned her baccalaureate degree from JHUSON in 1992, Baker returned to the school to obtain her MSN in 1997, then a Business of Nursing Certificate in 2001. S PRING 2008 29 Now, she is Director of Nursing Achieving Competence Today (ACT), Surgery at Johns Hopkins Hospital a program funded by the Robert and president of the Johns Hopkins Wood Johnson Foundation. As part Nurses’ Alumni Association. of a multi-site national pilot, Hopkins The school’s faculty assembled teams of graduate nursing, acknowledge their emphasis on medical, and health administration nurse leadership and autonomy. students to participate in the planning “Sometimes, in the culture of of quality improvement projects. In medicine, the nurses’ perspective this interdisciplinary setting, nursing is dismissed. I want my students students demonstrate the unique to embrace the knowledge and perspective they bring to the table— perspective that they bring and not and learn how theirs fits in with other apologize for it,” says associate health care disciplines. professor Cynda Rushton, “It’s not often enough that we sit DSNc, RN, FAAN. down together and think about how At Hopkins, professors do we can provide better care as a team. If more than talk the leadership we can establish more communication talk. They give students among physicians, nurses, and real-life opportunities to administrators, then I believe the walk the leadership walk. quality of health care will improve by One such example is leaps and bounds,” says Peter Cornell “If we can establish Prepare to Care: New Nurses, Aging Patients more communication among physicians, Geriatrics offers surprises to those for nursing students to learn about who associate it exclusively with this population is the need to nurses, and nursing homes. Today, except collaborate with multiple disciplines. administrators, then for maternity and pediatrics, “Most patients don’t have just one approximately 50 percent of hospital illness; they have multiple complex I believe the quality patients are 60 or older. As a result, problems and may be taking a dozen of health care will according to Johns Hopkins University different medications. Tanner adds, School of Nursing Assistant Professor “A myocardial infarction does not improve by leaps Elizabeth (Ibby) Tanner, PhD, RN, manifest the same in a 50 year old and bounds.” “every nurse should be prepared as it does in an 85 year old.” To to care for older adults in hospital differentiate, nurses must develop —Peter Cornell ’03, CRNP ’06 settings.” Unfortunately, most a high level of problem solving, providers, including nurses, have not communication and assessment been trained to do so, but skills in addition to old-fashioned that’s changing. compassion, and then offer solutions “Issues in Aging” is now a that fit the patient’s social, physical required first semester course at and economic resources. That’s a JHUSON. “We’re pioneers in this tall order. field,” said Tanner, who is also A mitigating factor: “The goal is teaching a multidisciplinary seminar not necessarily to resolve all of the on the care of the complex older geriatric patient’s medical problems,” adult, another first for the school. Tanner said. “An important goal is to She notes that what’s paramount improve quality of life while focusing 30 J OHN S H OPKIN S N UR S ING ’03, CRNP ’06, who participated in the ACT program in 2005 when he was an acute care nurse practitioner student at JHUSON. Reaching Beyond the Call of Duty Time and time again, graduates from JHUSON programs demonstrate how far they can go professionally when their natural leadership qualities are cultivated in an educational atmosphere that not only accepts, but rewards, these traits. Consider Brenda Blunt, who graduated in 2006 from the school’s IRK K baccalaureate program. After less than ILL W two years as a registered nurse at Johns In addition to her duties as a nurse in the Neonatal Intensive Care Unit, Brenda Blunt serves Hopkins Bayview Medical Center’s as chairperson of an interdisciplinary Perinatal Bereavement Committee at the Johns Hopkins Neonatal Intensive Care Unit, Blunt Bayview Medical Center. your attention on each individual’s are expected to visit seniors in their on Aging and Retirement Education social and emotional well being, as homes and share a meal. (CARE). Most of the patients she well as the physical care.” Among the A solid foundation in the care works with now have dementia. “I many satisfactions that come from of older adults also has practical knew what to expect,” Tyler said. caring for older adults: “We can learn advantages. “Nurses who are “That makes it easier clinically. so much from them.” prepared for this work are highly Professor Tanner is a great mentor.” Kitty Poon ’06, who is pursuing her sought after in a myriad of settings, Tanner, along with Dean Martha N. graduate degree in nursing, agreed. including acute care, emergency Hill, PhD, RN, FAAN, has been publicly “I’m amazed by their resilience,” she room, psychiatry, oncology, etc.,” recognized by the John A. Hartford said. Since 2004, Poon has been a Tanner said. Foundation Institute for Geriatric volunteer in the Service Awareness Megan Tyler ‘07 is a good Nursing for her work in content through Geriatric Education (SAGE), example. She credits her nursing mapping and including strategies for a community service program which school leadership experience with the teaching the core competencies of matches students from the Schools of JHU-wide multidisciplinary Geriatric geriatric nursing. She is also the first Medicine, Public Health and Nursing Interest Group organized by Tanner as nursing faculty to be affiliated with with seniors living independently. instrumental in being selected for her the Johns Hopkins Center on Aging The goals are to reduce elder job as a staff nurse in the special care and Health, which now includes loneliness by fostering friendships unit at Anne Arundel Medical Center. faculty from the Schools of Medicine, between the generations and to As a student, she also participated Public Health, and Nursing, all broaden the students’ perspective in Grand Rounds at Bayview Medical working together on the forefront of of older adults outside of a medical Center and one of her clinical aging research. setting. Volunteers, usually in teams experiences was with the Baltimore —Susan Middaugh of two and from different schools, City Health Department’s Commission S PRING 2008 3 has added to her nursing responsibilities One of the current goals of the the role of chairperson on the unit’s bereavement committee is to support interdisciplinary Perinatal Bereavement grieving families according to their Committee. Blunt did not seek to carve preferences and values. Under Blunt’s out a leadership role for herself in the direction, the committee has closely NICU. But after just a short stint on examined how specific populations cope the unit, she was prepared to lead this with loss. “We’re looking at different important initiative. cultures and how they grieve, so we “I’ve always been a caretaker,” Blunt don’t impose our practices and ideas on says.
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