Critical care units at St. Joseph’s Hospital Health Center in Syracuse, New York, were faced with a formidable task. They had applied to receive the Beacon Award for Critical Care Excellence – a distinction given only to the top intensive care units in the United States. One of the components on which they would be judged was how they assessed patients’ pain levels in a critical care environment, and that’s where they hit a snag.
“The staff and I were measuring it using a tool that was outdated and not suited to ICU work,” said Chris Kowal, who, in addition to being a full-time staff nurse, was pursuing a Master of Science Nursing Education degree at American Sentinel University.
Using change management skills he’d gained from his studies, Chris was able to identify a more appropriate pain assessment tool and design a pilot program to study its effectiveness. The results were remarkable. “I was able to better manage patients’ pain and get them out of the ICU more quickly,” Chris said. “And the new tool improved productivity at the same time.”
Navigating the change management process
In the critical care unit, Chris and the other nurses routinely had to assess pain levels in patients who weren’t able to talk. They had been using an observational scale known as PAINAD – for pain assessment in adults with dementia. Although the tool was definitely designed for patients who couldn’t speak for themselves, Chris questioned if it was really appropriate for the critical care population. Most of these were lucid adults who were temporarily rendered non-verbal because they were intubated and on ventilators. Was there a tool that better fit the guidelines of evidence-based practice?
Using several medical databases, Chris did a literature search to find out. He discovered three or more pain scales that seemed better suited for his post-surgical patients, and the nurses settled on the CPOT (critical-care pain observation tool).
“But we found it was not an easy fix, although as nurses we assumed it would be,” said Chris. “We had to go through the hospital’s critical standards committee to get a pilot program approved, even though the tool was already backed by research and statistically valid.”
Fortunately, Chris was familiar with the process of managing change from his coursework at American Sentinel University. “I definitely had the background, from my education, to do this,” he affirmed. The nurses reached out to surgeons and anesthesiologists to get their input and buy-in. “We had never collaborated across disciplines before, and the MDs were impressed that we were so invested in wanting to improve our practice,” said Chris.
The pilot program lasted six months. Chris evaluated the results through a retrospective chart review – comparing patient charts from the pilot period with charts from a prior six-month period. The findings were significant – because the nurses could assess pain more accurately using CPOT, they could control pain more effectively. As a result, patients felt better and were able to come off ventilators sooner. “If a patient has pain, they are unable to participate in their rehabilitation process to the maximum potential,” explained Chris. And because patients were spending less time on ventilators, the rates of ventilator-associated pneumonia dropped drastically in the critical care unit.
A staff nurse distinguishes himself as a leader in his hospital
Thanks in part to Chris’s help, the ICU unit at his hospital earned the coveted Beacon Award in 2009. Chris even wrote an article, published in 2010 in the Journal of the New York State Nurses Association documenting his success with the program.
“The work I did empowered our nursing staff to identify needs and test new practice methods,” he said. “Now we can have discussions about change in practice. After everyone saw the results of the pain assessment pilot, which took a year to implement, they saw the benefit of the process.”
“Now I show nurses how to write proposals and implement changes,” he said. “The next person shouldn’t have to be as frustrated as I sometimes was. They should be empowered to move the process for change along further.”
Crediting online education for know-how and confidence
Chris has two master’s degrees from American Sentinel – a Master of Nursing Education and a Master of Nursing Management and Organizational Leadership – both of which he earned while working as a full-time, bedside nurse. A self-described “clinical leader without borders,” Chris recently began studying in American Sentinel’s Doctor of Nursing Practice (DNP) program in executive leadership.
“That’s how it can be done,” he said, referring to the university’s flexible online platform. “American Sentinel is the perfect example of what’s right in distance education. They have teachers known for excellence on a national level, and I can study under them even if we’re on opposite sides of the country. That’s awesome.”
In the DNP program, Chris is learning to apply leadership to everyday practice, something he said was once only taught to “people who were going to sit in an office.”
“The bonus is that our instructors recognize each student’s unique potential,” he added. “My long term goal is to keep one foot at the bedside, working on practice improvement, and place the other in the administrative arena. Having the proper education to do both is paramount to success.”
The new methods Chris helped pioneer while studying for a master’s degree had a profound impact on the nursing staff at his hospital. Playing an instrumental role in a process that brought about much needed procedural changes gave him a taste of what it means to be a nurse leader.
“My greatest love is empowering nurses to be leaders at all levels of practice,” Chris said. “Leadership starts from within. Bedside nurses need to harness leadership potential and use it to benefit patients.”