Questioning Current Standards of Care: Nurses Speak Up!

For the first time, a nursing association has collaborated in a set of recommendations for the Choosing Wisely® initiative – a national campaign designed to spark conversations about medical tests and treatments that may not be necessary or appropriate. Read on to find out why this is a huge step forward for the nursing profession!

New recommendations represent an interdisciplinary collaboration between nursing and key medical societies.

The American Association of Critical-Care Nurses (AACN) participated, as part of the Critical Care Societies Collaborative (CCSC), in a project that identified five routine critical care practices that clinicians and caregivers should question. These practices are often unnecessary and in some cases may even be harmful.

In case you’re not familiar with the Choosing Wisely initiative, its goal is to foster dialogue between physicians, consumers, and other industry stakeholders. To start the conversation, medical specialty societies have created lists of tests and treatments that are not necessarily evidence-based. They are asking physicians and patients alike to question whether these practices are appropriate to a specific care regimen at a specific point in time. Consumer Reports has also been active in the initiative, and has helped develop materials that may help patients engage their caregivers in discussion.

Here are the five recommendations the AACN helped to develop:

  • Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.
  • Don’t transfuse red blood cells in hemodynamically stable, non-bleeding critically ill patients with a hemoglobin concentration greater than 7 mg/dL.
  • Don’t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of a stay in an intensive care unit.
  • Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.
  • Don’t continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.
  • The list is also available online, with detailed explanations for each item and supporting references.

    So let’s say you don’t even work in critical care – how does this list affect you?
    These recommendations represent an interdisciplinary collaboration between nursing and key medical societies. This is a huge step forward for our profession, in terms of empowerment, credibility, and recognition by other members of the care team.

    Why? Because nursing’s voice has been heard, and nursing’s opinions have been considered when it comes to evaluating current standards of care. It is a clear sign that the industry is moving away from the idea that nurses are task-workers who simply carry out physicians’ orders without questioning it.

    Consider this: As you go about your daily duties, numerous opportunities exist for you to question the validity of current nursing practices in your hospital, and to use evidence to make the care you provide more effective. As a nurse, you should continually ask the question, What is the evidence that this intervention is the best possible practice? For a dynamic example of how this process can work, take a look at our report on Chris Kowal, a full-time nurse and American Sentinel student who observed that the tool being used to assess pain in his ICU patients was outdated – so he combed through the research literature to identify a more suitable tool and then successfully implemented it.

    As frontline care providers, nurses have the most direct knowledge of the practices that enhance patient safety and high-quality care. They need to be able to articulate these insights to other caregivers. As basic as it sounds, this transfer of knowledge between members of the multi-disciplinary team is often the first step toward bringing a new practice or technology into consistent use within a clinical setting.

    In order to help develop evidence-based practices, nurses have to understand the concept of research and know how to find and evaluate existing research studies – no easy feat sometimes. Fortunately, these skills are taught in modern RN-to-BSN programs.

    The ability to facilitate change is also an important leadership skill, and you can learn more about developing it by downloading American Sentinel’s popular white paper, Powerlessness is Bad Practice: Any Nurse Can Be a Facilitator of Change.

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