The audio companion to the award winning Nursing Notes email newsletter

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The latest nursing news and information brought to you by the Johnson & Johnson Campaign for Nursing’s Future – This is Nursing Notes Live.

Nursing Notes Live is an audio extension of the national award-winning monthly e-newsletter, Nursing Notes – which offers the latest industry news, trends and updates in nursing. You can subscribe to the e-newsletter at www.discovernursing.com. Each month’s Nursing Notes issue will be accompanied by a couple of episodes of Nursing Notes Live, which will expand on the content and provide you greater insights into the topics presented in the e-newsletter. You can listen to previous podcasts on the Nursing Notes by Johnson & Johnson Facebook page or NursingNotesLive.com; or visit iTunes to subscribe to the podcast!

Student nurses – now you too can submit your photo to be included in the Campaign’s Portrait of Thanks Mosaic Project! For every photo uploaded by February 1, 2012, the Campaign will donate one dollar to the Foundation of the National Student Nurses Association to help fund nursing student scholarships. Submit your photo today at www.campaignfornursing.com/portraitofthanks. The Campaign also encourages you to check out the recently launched Short Takes: Narratives by Nurses video series! A group of nurses and one nursing student – people just like you – each filmed their very own videos, where they share their thoughts on their nursing careers. To watch the videos, visit the YouTube section of the Nursing Notes by Johnson & Johnson Facebook page or www.youtube.com/JNJHealth. And congratulations to the Campaign’s Amazing Nurses contest winner Lillian Shockney! Find out more about Lillian and the contest finalists at the Nursing Notes by Johnson & Johnson Facebook page.

I’m your host, Jamie Davis.

This month’s issue of Nursing Notes highlights nurses giving back to patients and their communities. I took this opportunity to look back at this year’s episodes to pull out some of the best statements on what nursing is and how we all can share our skills in a broader way with those around us in both the facilities in which we work and our community at large.

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Early in 2011 I chatted with a panel of Oncology nurses including Jackie Grandt, Program Director, Outpatient Oncology Services at Long Beach Memorial Medical Center in California. Jackie shared her personal experience of the importance of nurses sharing their skills not just with helping patients but also through mentorship and clinical education of new nurses and nursing students.

Jackie:  How I got into oncology nursing was during the final rotation in nursing school on an oncology unit. It was during that experience that I really identified an oncology nursing that there’s many challenges and there’s many rewards. That was what I was looking for in my nursing career. I wanted to be challenged and I wanted to feel that – every day I was learning something new and definitely with what I’ve seen over 30 years on oncology nursing that that’s been very true. For our new person, I agree with you having opportunity to spend some time and rotate in that area while you’re in training is absolutely an excellent way. Also identifying people who are already working in the field then asking to spend some time with them and learning from them how they got into it and what they do on a day-to-day basis and even developing maybe some opportunities for mentorship if you decide to go into that area and get the support because oncology nursing and oncology treatment can sometimes be really overwhelming.

Along with mentorship is the importance of advancing your education and practice level as a nurse. As there is more and more focus on advanced practice nurses and the opportunities they might offer to improve health care systems nationwide, what opportunity and value is there for the patient care team to have access to resources like clinical nurses specialists.  Susan Bruce, a clinical nurse specialist in oncology at Duke Raleigh Cancer Center in North Carolina shared her thoughts on why access to clinical nurse specialists is so important as “Change Agents” improving patient care and outcomes.

Susan:  There’s a lot of ambiguity with the clinical nurse specialist’s role in whatever setting you are in. In periods of time, they’ve done away with the clinical nurse specialist only to find out, five or ten years later, it’s that long, “Boy, we really need those people back.” We do offer a value, I think, to the institution. We are a change agent. We help to make change occur. With nurse practitioners, the world’s pretty clearly defined, the nurse practitioners of these patients in the clinic setting every day or whatever. The clinical nurse specialist, I think, just really adds so much more. Who is going to bring the evidence to the bedside if it’s not the clinical nurse specialist? Clinical nurse specialists look at systems as a whole. How do we implement this in the system? Whether I have an idea that I think would work good in the outpatient setting, is it something that could be incorporated in to the inpatient setting to help those people as well both nurses of those patients. It’s about the collaboration, I think – extending that information.

But I really think we do have a very strong emphasis on keeping up with the evidence and ensuring that that gets into practice. I find that I’m doing that a lot in our setting, reviewing what standard of care is and how does that impact the way we practice. I see clinical nurse specialist is very essential in an organization be it large or small. I think other healthcare providers have a hard time seeing what we do because they don’t know what we do. They can’t articulate what we do and sometimes we can’t articulate totally what we do. But we’re good when you look at quality improvement processes. That’s one of our strengths, I think, is the ability to look at a process, see how it needs to be tweaked to being more effective. We know by taking care of population-based patients that we make a difference in health cost savings for the organization. Even though we can’t be like a nurse practitioner does in most cases, we do make an impact in cost-savings through those quality improvement processes and things of that nature. Who’s going to educate the nurses at the bedside, is the other thing. It won’t be the nurse practitioner that’s seeing patients in clinic because they don’t have time to do that. I think the CNS role is a great role to be in and I’ve embraced it and just looked at ways that I can make a difference within my own setting whether it’s through staff education or patient education and how that looks. I think we bring a lot to the role that other people don’t necessarily understand.

This was a recurring theme on the show as the expanded roles for nurses were discussed throughout the year. Nurse educators like Ann Mayo, Professor at the University of San Diego Hahn School of Nursing and Health Science are focusing on advanced nursing care as a key component in the future of how we care for patients. I asked Anne how she saw advanced practice nurses fulfilling the roles we had been discussing in a changed healthcare system.

Ann: Well, I think your question is just spot on. It is really critical that we get more advanced practice nurses out into the healthcare arena more than we’ve ever had before. We have an aging population. We have people coming into the United States who need healthcare. We see opportunities for advanced practice nurses in every setting, expanding their practice and taking on more in terms of being available for services to patients. We know that the advanced practice nurses in terms of nurse practitioners are looking at taking on more roles in primary care for example. How we see clinical nurse specialists coupled with that would be, as we get more nurse practitioners out in primary care, they will need some consultation in specialty areas around nursing care for patients. For example, patients who would be seeing in primary care and maybe diagnosed as a new diabetic patient, someone older who’s developed type 2 diabetes, the nurse practitioner is very capable in monitoring the care of such a patient but due to their broad focus and seeing many patients in a day in a primary care setting, may look to the clinical nurse specialist whose specialty area is diabetes to come in and assist with some of that management and definitely help with education and training of both the patient and the family members. As our population is expanding, adults were getting older, we see numerous roles for all the advanced practice nurses.

In fact, based on my conversations with other nurses this year, there are expanded roles and opportunities for nurses in almost every area of nursing care. Cyndy Krening, a perinatal nurse specialist at Littleton Adventist Hospital in Colorado shared some of her views on opportunities in her specialty when I asked her to speculate about the future of perinatal nursing.

Cyndy:  Well, it is fun always to sort of dream and see what you think will happen. The wonderful thing about nursing is there is just so many opportunities to be in so many different kinds of roles. I’ve had an opportunity to be a flight nurse, an obstetrical flight nurse for high-risk patients that are being relocated from a rural or a level one facility to a higher level of care. I would see opportunities like that growing as our country try to regionalize health care and provide access to care for patients that are anywhere, rural or urban. There are also some roles popping up for high-risk perinatal nurse practitioners. There are a couple of nursing programs and units who have employed nurses who have received nurse practitioner educations specific to a care of the inpatient, the unstable pregnant woman in an inpatient setting. It’s a more of an acute care nurse practitioner role, which is also very exciting, just because we know it’s reformed that the advanced practice nurses are essential to our healthcare successes in outcomes. Those are a couple, definitely a couple of roles that are out there.

Even with all the expanded roles for nurses in every arena, the focus still remains on the patient centered care – a key value in nursing. Even in nursing specialties with a lot of technology to handle care, I was encouraged to hear the discussion continue to revolve back to making sure the patient was experiencing nursing care from every nurse they came in contact with. Nurse Anesthetists Terry Wicks, former President of the American Association of Nurse Anesthetists, and Nickie Damico, assistant professor and director of professional practice at the Virginia Commonwealth University Department of Nurse Anesthesia both talked about nurses not getting distracted by the technology and forgetting about the patient and their emotional needs in stressful and frightening situations.

Terry:   Nickie, don’t you think that, as anesthesia professionals and have a nursing background, our focus is certainly on the technical aspects of what we’re doing. We’re plugged into blood pressures, and heart rates and EKG patterns and all that sort of thing, and fluid balance and all that. I was sort of taught early in my nursing career that we are advocates for the patients and that translates directly into the operating room. I feel like I’m plugged in mostly to those people from the moment I put my hand on them and shake their hand or touch their shoulder preoperatively. I engage them. I make it a point to do that. As healthcare has changed over the past several years and there’s more paperwork and more things to sign, and more checklists, it seems like the operating room nurses have been relegated to do that stuff. My focus still, from the time I meet the patient until the drugs start going to the IV, is to be plugged in to that patient emotionally, to reassure them, to educate them. That’s the most satisfying part of my job. Obviously, I love what I do in the OR and that’s very gratifying, as well, but when that patient wakes up and they see my face and they know that they’ve come through this comfortable and safe, that’s the rewarding part of that for me.

Nickie:   Absolutely. I completely agree and I think that very often I describe my job as being very privileged. I’m privileged to have the role that I have in this process and to be interested by our patients to take care of them. To be able to be a part of that and to be there for them and very much to engage with them and help them through this very much with the technical things that we do and the interventions that we do in the operating room. But, absolutely, I think the most rewarding thing and the most valuable thing that we do for patients is to let them know that we care about them and that we’re there for them and that we will coach and help them through this whole process. Not just the other technical things that we do.

Nurses often feel privileged to be so connected to their patients throughout the continuum of their lives and this connection is an important reason for the expanded nurse’s role in helping patients and their families navigate the health challenges of their lives. In a health care system that doesn’t always prepare patients for all outcomes, nurses are among the most important agents for change in this system. Pamela Johnson, a certified Hospice and Palliative Care nurse and Director of Clinical Services at Odyssey Hospice in Pittsburgh explains how the system lost it’s patient care focus in favor of patient cure and how nurses are realigning that focus while preparing patients and families for end of life decisions.

Pamela:  Well, I think in many ways we are to blame for this kind of system that we have created because what has happened over the last 50 years is the US health care system has focused on cure, on prevention of disease, on a belief that our medical system is infallible and it’s for every disease or problem that humans can have that there’s a solution to it. Therefore, we constantly see patients come in the hospital and families saying, “But, gee, grandma’s only 92 and everybody in our family lives to be 100.” Or the chronically ill person with heart disease comes to the ER and the family says that, “You always pull her through. The doctors are wonderful here. The nurses were great last time she was here.”

People have come to believe that death is avoidable, that every problem can be successfully treated and it’s a normal human response. We want to live. We want our loved ones to live and yet we now have gone full spectrum from early part of our history where people died of diseases early in life or most diseases were not treatable. That all that could be done was attention to their comfort. Then over 50 years we made this system where it seems like death is avoidable. With the current constraints on our health care we are having to realistically face the limits of what can be provided both in terms of when care that is aggressive and disease-focused no longer serves the patient well but also when it’s simply will be futile. These are very, very difficult things because everybody wants 92-year-old grandma to live a little longer and everyone wants to be cured of their liver failure or pancreatic disease, their end-stage heart disease. These are huge social issues but nurses play a vital role in helping patients and families understand treatment options. Nurses are vital in helping patients and families articulate their values and their needs. Nurses are translators. They take information that’s been delivered from a physician and others and make it understandable to patients and families so they can make best choices. But all of this is enormously complex and is really a reflection of society but fortunately nurses are in every system of care and are closest to patients and families.

Even systems of care outside of traditional health care facilities are impacted by the work nurses do each and every day. School nurses often provide the only consistent health care resource for many of our nation’s students. In addition to providing first aid and medication management, school nurses affect the long term health outlook not just for the kids they see each day but for their families and the surrounding community. I asked Sally Schoessler, Interim Executive Director for the National Association of School Nurses and Mary Ann Gapinski, President of the National Board for Certification of School Nurses how school nurses fit into the renewed focus on prevention before treatment in health care since healthier children in our schools become healthier adults in our communities.

Sally:    Well, you really hit a nail on the head because so often when people are talking about health prevention strategies, they’re talking about things like colonoscopies for people over the age of 50 or when a woman should be having a mammogram. But we need to change the thinking back down to our children and our youth because when we can get the great health habits into our children, we’re not going to have to be worrying about the prevention strategies in middle or – let’s stick with middle age, I’m in that age group, I’d like to leave it at that age how  – but the Department of Health and Human Services has just released a National Prevention Strategy and we just need to keep making sure that our voices are heard talking about the value of prevention for our children and youth.

Jamie:    And Mary, you’re involved in public health in Massachusetts I believe but is there a real importance to have a more of a nursing representation in state and federal public health agencies to make sure that nursing focus is maintained there?

Mary Ann:    Oh, I think it’s essential. You’re talking, as Sally said, with the future of our country when you talk about the children and the care. And primary prevention is going to become a major issue in our country when we try to begin to control healthcare costs. How does that begin but with education, children at the earliest ages? Who’s doing that in schools but school nurses? This is going to have a huge impact. We are already seeing this in again in Massachusetts from a public health point of view with our obesity initiative that our school nurses are involved with. We have already seen changes in BMI points coming down in these schools where school nurses have initiated programs for not only good nutrition but physical activity, doing parent and community education around these issues, working with the local pediatricians and other healthcare providers in the communities to look at this initiative. This is all primary prevention beginning at kindergarten and even earlier in those schools that have pre-school children that they work with. We’ve already seen it here in Massachusetts and the impact – and school nurses have been the leaders of that ever since we’ve begun these initiatives.

Nurses are giving back to their patients, the nursing profession, health care systems, and their communities in so many ways. It’s my goal here at Nursing Notes Live and in my other programs that I continue to draw attention to how nurses and other health care professionals are constantly working to improve so many parts of our lives. I invite you to continue to join us here at Nursing Notes Live throughout the next year as we continue to shine the light on the amazing care that nurses provide.

I think the best way to wrap up this episode is to share something Mary Anne Kenyon, Nursing Director for Orthopaedics at Brigham & Women’s Hospital in Boston said when I asked what being a nurse meant to her.

Mary Anne:   Well, for me, I’ve done the whole journey. I started here as a staff nurse. I was a clinical educator and have done the director for several years. I think the most exciting thing for me is still the patient contact. I may be pulled away to meetings and things like that but I try to be on the floor for a significant portion of everyday. I try to see every patient every day. I will go back and admit patients. I will teach the pre-op joint class. I think, for me, it’s just staying connected to the – the reason why we do this is staying connected to the patients and their families.

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Don’t forget to check out the entire December 2011 issue of Nursing Notes, featuring inspirational stories about nurses like you giving back to patients and their communities.  You can read the entire issue online at www.discovernursing.com and don’t miss this month’s other Nursing Notes Live episode featuring an interview with the 2011 Amazing Nurses contest winner Lillian Shockney on her nursing career and the importance of giving back to your community. You’ll find this and other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.

Podcast: Play in new window | Download

The latest nursing news and information brought to you by the Johnson & Johnson Campaign for Nursing’s Future – This is Nursing Notes Live.

Nursing Notes Live is an audio extension of the national award-winning monthly e-newsletter, Nursing Notes – which offers the latest industry news, trends and updates in nursing. You can subscribe to the e-newsletter at www.discovernursing.com. Each month’s Nursing Notes issue will be accompanied by a couple of episodes of Nursing Notes Live, which will expand on the content and provide you greater insights into the topics presented in the e-newsletter. You can listen to previous podcasts on the Nursing Notes by Johnson & Johnson Facebook page or NursingNotesLive.com; or visit iTunes to subscribe to the podcast! The Campaign encourages you to check out its Portrait of Thanks Mosaic Project which invites nurses from around the world to submit a photo online to be part of a historical image of nursing. For every photo of a nurse uploaded between now and February 1, 2012, the Campaign will donate one dollar to the Foundation of the National Student Nurses Association to help fund nursing student scholarships. Submit your photo today at www.campaignfornursing.com/portraitofthanks. And check out the five finalists of the Amazing Nurses Contest at the Nursing Notes by Johnson & Johnson Facebook page!  The Grand Prize Winner will be announced on December 11.

I’m your host, Jamie Davis.

This month marks the one year anniversary of Nursing Notes Live! In this month’s episode, Nursing Notes Live takes a look at the world of orthopaedic nursing. This month’s featured “Get to Know Nurse” is Mary Anne Kenyon, Nursing Director for Orthopaedics at Brigham & Women’s Hospital in Boston, Massachusetts. I asked Mary Anne how she became a nurse and arrived at an orthopaedic nursing career.

Interview Transcript:

Jamie:                         Mary Anne, it’s great to have you as a guest on Nursing Notes Live. We always try to start off these Get-to-Know-Nurse segments with just asking you, what led you to become a nurse to begin with?

Mary Anne:                Well, thanks for having me. I had sort of a different path to becoming a nurse. I was at a small all-girls school. This was back in the ‘70s. They really were empowering us to study math and science. It was just really starting to be accepted that women, girls went into engineering and some of the high-tech fields that were just starting. Originally, I wanted to be a civil engineer. I wasn’t even thinking nursing. My father was a civil engineer. I wanted to do that. Through some guidance – through my father and one of the sisters at the school that I was attending – they looked at my aptitude and thought I would be better suited in nursing. So it was something that I came to slowly. I wasn’t really sure that’s where I was going to start. I think my father’s exact words were: “Give it a month. Try it. Just give it a month.” I had to tell you that after the first – even just month of college I was really intrigued. We had a variety of courses – science-based. We had a very beginning nursing course that you just really – I think all you can do was talk to a patient. I had a good feeling about it. I like that it felt comfortable. It felt like I was doing something. Everyday was different. It just sort of grew from there. It grew quietly from there. Years later, I’m very happy that that’s the course I chose. I would never have chosen anything else but it was a quieter start.

Jamie:                         It’s interesting you talked about the push that helped girls becoming more interested in going into the hard sciences. Yet, traditional female career path, like nursing, is certainly very science-focused. It’s all about the science and science-based care and research-based care. I wonder if that’s just – if people were missing the point there.

Mary Anne:                I think we did. I think when I started school – I graduate high school in the late ‘70s – and back then nursing wasn’t a baccalaureate program required at the time. It was still a three-year hospital course. I think from a young girl who was in an all-girl school so we were very empowered. To look at nursing, it might have felt a little soft for me. They were in hospitals. They were not handmaidens but that idea was certainly still out there. I thought I wanted to be more. I wanted to have a voice. So if I was going to make a difference, I want to make a difference. I think when I went to college – and actually the college I went to had a three-year associate degree program – and it was just moving towards all five-year students. The five-year was the baccalaureate. I went into the five-year program and it felt academic based. It felt like it had all those hard sciences. I think we took nine science courses in our first two years and we were taking them alongside the physical therapy students and the pharmacy students. Right out of the gate, you felt that collaboration with the healthcare team or what the healthcare team is going to become. So when I got there, it definitely met my expectations. But when I first started I wasn’t really sure what it was going to look like.

Jamie:                         Yes. I never met anybody that said nursing school was easy. [Laughter]

Mary Anne:                I won’t say that either.

Jamie:                         I don’t put down anybody’s major in college but I would hold up the rigors of any nursing program, even our Associate’s Degree nursing programs that are out there, are certainly more rigorous than any of the other programs or as rigorous as any other program in their schools.

Mary Anne:                Oh, sure. I just wanted to be in the college environment. I didn’t want to start my career right out of high school in nursing hospital-based program probably because it was predominantly women at the time and I was coming from a four-year all-girls school.

Jamie:                         I completely understand. You needed to get out there into the broader,  well, civilian marketplace.

Mary Anne:                Exactly.

Jamie:                         What about orthopedic nursing? Did you start out right out of school as an orthopedic nurse or did you move into that after doing some med-surg or emergency or something else?

Mary Anne:                I didn’t. I’ve always been in Boston or predominantly on the East Coast. When I graduated from nursing school, you could not buy a job. It was very similar to the flavor of nursing right now. It was tough to get into a hospital. I graduated from college in June and I started grad school in August because the jobs were not that plentiful. So I went right on and got my Master’s and worked part-time and I worked on a floor. It was very unique. It was ten beds. Five of them were rehab and five of them were dermatology – just a very eclectic group of patients.

Jamie:                         That’s interesting.

Mary Anne:                It was at Yale-New Haven Hospital and it was very eclectic. I loved the rehab end of it. The derm was nice but it offset the hard work that the rehab patients were going through. The derm patients were having tar put on them to soften up the plaques on their skin. I liked the rehab end of it. When I graduated from grad school, I moved back to Boston and applied to the hospital where I currently work, still. The floor that was open at the time was orthopedics. I think I was just open to anything. I was (1) happy to have a job and (2) I had only been working part-time since I graduated from nursing school, again, concentrating on my master’s degree and so wasn’t committed one way or the other and started in ortho. At that time, ortho was even different than my orthopedic unit right now. It was orthopedics with a heavy concentration of rheumatology. I just thought that I think for me I liked the fact that the patients came in not feeling so well. They came in with debilitating arthritis. They stayed for about ten days to fourteen days and when they left, they still weren’t fully mobile. They weren’t independent but they were getting there. They were getting better. I think that’s the part that really attracted me and still attracted to orthopedics. You see an immediate improvement in someone’s life and it’s an improvement that’s going to carry them forward. It’s only going to continue to make their life better. Immediately after surgery when you see them walking, they’re only going to get better. They’re going to lose the walker. They’re going to lose the crutches. They’re going to be independent. They’re going to be back to their life in six weeks. I’m not sure there’s another field that really has that high of an impact on patients.

Jamie:                         Mobility is so important to who we are. That independent movement of – even being to be able to walk across the room to pick up something you want to have is so central to just being a person and your general health that it is such an impact.

Mary Anne:                Absolutely. I think that’s one of the things that we hear from our patients. We do have the luxury of seeing them preoperatively. In a class, we teach them to get them ready for – “Do you really know what you’re signing up for this?” Majority of it is elective surgery – “Do you know what you’re setting yourself up? Do you know what your needs are going to be?” You can make all kinds of provisions before you get here. So you have a smooth transition and less worry when you’re here. One of the things patients frequently say is “I’m so frustrated right now.” Either they’re unable to participate in a sport or an activity that they enjoy. The same thing, if it’s a hip, they can’t bend over the way they could before. They can’t sit for as long as they used to. Just being able to get them back to their lives is so gratifying.

Jamie:                         I was looking at some of the things about orthopedic nursing recently and one of the terms that really leapt out at me was – not an official medical healthcare term – but “boomeritis.” This aging population coming in with existing sports injury problems and they’re aging. So they got arthritis. They’ve got the normal challenges that go along with an aging population or an aging individual and then they had a very active life up to a certain point and they want to maintain that activity. What do you say to those patients?

Mary Anne:                Well, we welcome them here. We’re glad they made this first step. We are seeing exactly what you just said. We are seeing the weekend warriors. We’re seeing the early mid-fortyish population that was very active through college and high school and just wear-and-tear on their joints. We’re seeing older patients who are really so active and vital already and are starting to get limited. That makes them feel old and they don’t want to feel old. They want to stay active and busy. Most of our patients we do encourage them to stay as active as possible before they have their surgery. Then we try to give them the mindset that you’re not sick, unlike some patients who might come to a hospital. You’re not sick. You’re electing to come and make your life better. So don’t get into sick mode. When you’re here, participate in your physical therapy. Get out of bed as much as you can. Participate in your exercises and have that plan for when you go home that you’re going to continue to just get more and more independent.

Jamie:                         We so often talk about educating our patients as an important part of the nursing process but I think a lot of people often think about that as discharge instructions and there’s really a lot more to it.

Mary Anne:                There’s definitely a lot more to it. Our class has been perfected over the last several years. It’s co-taught by a physical therapist, a nurse, and a care coordination nurse. We each have very separate roles but very supportive roles of each other. Our physical therapist will instruct the patients on what they can expect through the [months]. That’s usually a big question for them – “I play golf. When can I go back to golf? I ride a bike. When can I do that?” They want to know that they’re progressing on a normal scale. Our physical therapist is able to set some short-term goals with them and really give them some hopeful encouragement that this is definitely the right thing to do in their lives. They walk them through some exercises. They demonstrate them with the things that they should start doing before they get here. The nurse is able to come in and really talk about her supporting role in pain management and cryotherapy and making sure that the patients are on their baseline medications and their dressing and all those things that will make them feel confident that they can go home independently and help them to participate in their physical therapy to the maximum while they’re here and get close to the independence. Then the care coordination nurse, she’s sort of pulls up the backend and make sure that they know that we’re not just going to let them out the door. That we are going to continue to follow them when they leave. Setting them up with VNA at home and making sure that they have physical therapy support when they leave until they see their surgeon again and sometimes even beyond that. But the class has been great. It’s an opportunity for them to ask questions. As most people in orthopedics know patients who have a knee replacement or hip replacement often have a second joint replacement as well. So in the room when you have a group of patients and their loved ones, their supports in the room, the conversation is so rich they – patients will turn around and talk to the people sitting near them and say, “Oh, this happened the last time I was here.” They’ll give them helpful hints and tell them what to do. It just becomes a very exciting exchange between people and often people linger long after class just having conversations. We’re just going to start looking at – “How do we get our class or a class to everybody?” Because we’re a large academic medical center not all of our patients are from Massachusetts. Some of them are going to choose to have surgery here but they’re not from here so we’re looking at things like podcasts and YouTube videos and what kind of up-to-date brochures we can send them that have the right information so they’re not googling things and making themselves nervous and then making sure that they have human contact. We usually follow up our joint class with – patients have my card and we tell them, “If you have any kind of questions, when you go home, don’t sit at home and worry, call.” People will call. They’ll get home and they’ll start thinking about they heard in class, what they learned, and trying to make complete sense of it so that they’re totally prepared when they get here and they do. We have been able to demonstrate that patients who come to class and participate do so much better and they’re usually out post-op day 2 in the afternoon and they’re going home.

Jamie:                         I think we’ve over trained our patients to have this expectation that they can’t get their questions answered over the phone and yet there’s such an important aspect of the ability of telenursing – of that ability to answer these questions over the phone from a trained nurse – that really helps alleviate a lot of the patient’s problems and deals with issues before they become a problem. It sounds like you all have really met that challenge head on.

Mary Anne:                We tried. I think we have learned over several years – I’ve been doing this about 27 years now – that patients will start to get a level of anxiety if they don’t have their questions answered. Because they’ll just fill in the gap of “You know, I think I heard this” or “My friend who have their joints 35 years ago told me this.” That’s a message we are very clear in class is “Don’t sit at home and worry;” “Don’t google” – googling is fine but – “If you need answers or you have a question, here’s the person – this is a direct line. You’re not going to get put on hold. You’re not going to sort of go in to a queue and no one’s going to answer your question. There’s a live voice on the other end – usually me – and we are here to help.” Nursing is so central. You see your orthopedic patients. They’re going to see a doctor. They’re going to see physical therapist. They’re going to see care coordination. Yet it’s nursing who chose to own this piece of it. I can ask a question to a physical therapist if I have to then I can take that back to that patient and really interpret it in a way that they can understand it. One of our patients, she was having a struggle with – she had a dental problem. She had heard in class that if you have joint surgery you might need to take an antibiotic dose afterwards. She was very confused. She went to her dentist and her dentist said, “Don’t have any dental work done before you have your joint surgery.” We, of course, tell them, “If you have the opportunity, have your dental surgery before you have a new joint replacement just to protect your joint.” She agonized over it. I think she called me every day for a week. I was able to talk her down. “This is okay. Go to the dentist. You’re going to be fine.” When she got here she said, “I want to see your face. I want to make a connection.” It was really great. She was able to express that just knowing that someone was listening to her and sort of holding her hands with the whole thing made her much less anxious and she did fabulous. She had a great experience.

Jamie:                         That point really shows that distance nursing or telenursing or even answering text questions and things like that are good ways to connect to patients and create that caring nursing relationship even though it is at a distance. It’s clearly evident by the fact that she wanted to meet you because she had formed that relationship.

Mary Anne:                Exactly. It’s all good for me too because I invested in this patient and I wanted to – I try to deliver on what I said. She did great. It’s a really good experience.

Jamie:                         What about for a person considering a move into orthopedic nursing? What would you say to that new nurse that is interested in orthopedics or perhaps an existing nurse who’s thinking of changing career paths?

Mary Anne:                For me, orthopedics has been my passion. I started fulltime in that field and I have just never left it. I’m fortunate to have a group of nurses who work with me who have been here through the whole journey with me. In this day and age, everyone wants the glamor – they want the ICU, the want the NICU, they want the emergency room – those areas are so specialized. It’s hard for a new nurse to always break into them. I tend to hire a lot of brand new nurses right out of school. We call them “newly-licensed nurses” (NLN). I would say I probably hire about fifteen a year. Many of them, I have to believe, showed up at my office because it was a job. As I sit and talk to them I really try to tell them about orthopedics and it’s so much more than a job. But taking care of an orthopedic patient is probably one of the best foundations any new nurse could have because the patients (1) they’re not chronically ill, they’re not even acutely ill. So you got a patient who is going to be able to partner with you and go through the journey together – and still better – and know that they’re going to leave here in a better state. The orthopedic surgery itself – surgery is a great place to work. The patients – they have a surgical wound. You’ve got all those post-op things that you have to look for – their vital signs, bleeding, there’s a fair amount of tubes and drains and IVs, pain management – you get a smattering of all that. But what I sometimes think really helps the new nurses, all the orthopedics come with their own co-morbidities. You might parade in ten people who’ve had their total knee and their knees all may look the same but the patient doesn’t look the same. Some have diabetes. Some have heart disease. Some are status post transplants. It’s all that other stuff that you really get to touch on. I think it gives you such a broad picture of what a patient can be, what healthcare is. You interface with just about every surface. We have orthopedic oncology. We have orthopedic patients who come with metabolic issues. We have orthopedic patients who have cardiac or transplant medicine issues. They’re not just hips and knees. They are this total patient who everyone looks different. The nurses that usually come to my unit, they’ll stay three, four years and then they are really ready to transition to just about any other field of nursing there is. They have just an exposure to so much. I think sometimes we lose sight of that. We think of orthopedic surgery – there’s traction and it’s heavy and the patients can’t walk – but it’s so much more than that. I think it’s a great place to start your nursing career.

Jamie:                         I used to have the impression that orthopedic nursing when I was going to nursing school was like the construction zone of the hospital. If you like tools and – but, really, just doing the research for this even opened my eyes even more. The patients are not just surgical candidates all the time. There are patients that have joint issues that don’t require surgery but do require some thoughtful and critical thinking from a nurse to help them find the solution that may help them manage whatever their issue is.

Mary Anne:                Absolutely. I think orthopedics is just an amazing field. The technology and the techniques of this, I started here a long time ago, and our patients came – I think our hips and knees respectively stayed ten and fourteen days. They come with their luggage. They’d come with everything they own because they were staying. Our patients now – same surgeries, same idea of surgery – they’re in and out 48 hours post-op. If you had told me that back in the ‘80s I would have said, “You’re crazy. There’s no way. Their pain can’t even be managed in that short of a time.” I’m very fortunate to work with a fabulous multi-disciplinary group of physicians and physical therapists and nurses and we have been marching into the future with these patients. I think sometimes we have to stand back and say, “It’s amazing! This is an amazing work that these patients are having major surgery on a joint and they’re [up] the day of surgery. They’re walking a day after surgery. They’re on crutches on day two and they’re back to their lives. I just think it’s amazing. It’s almost like bionic. The “Bionic Woman,” I grew up with that TV show. It almost feels like that. You’re rebuilding this people. They’re happy. You can see them. They’re walking on the floor. They’re not dragging IV poles and sitting in johnnies. They’ve got their gym shorts on and their sneakers and they’re tracking around the floor and they’re ready to go. They’re happy. It’s changed their life.

Jamie:                         It sounds like you’re empowering these patients. That’s such a different way of looking at healthcare. It is really exciting to have talked with you. What’s one of the things that you take away from this as a nurse?

Mary Anne:                Well, for me, I’ve done the whole journey. I started here as a staff nurse. I was a clinical educator and have done the director for several years. I think the most exciting thing for me is still the patient contact. I may be pulled away to meetings and things like that but I try to be on the floor for a significant portion of everyday. I try to see every patient every day. I will go back and admit patients. I will teach the pre-op joint class. I think, for me, it’s just staying connected to the – the reason why we do this is staying connected to the patients and their families. I have a little bit of a luxury of being able to sit with the patient’s family and talk to them – “How has this changed you? What are your plans? You got a brand new knee now, what are your plans? What is the first thing you want to do?” It’s really interesting to listen to the patients. We had one woman who said, “I’m going to Italy. I have been wanting to go to Italy forever and my knees bother me and I just didn’t know how I’m going to get there and my friends have been there.” As soon as she got the green light from her surgeon, she was going to fly over to Italy and get to fulfill her dream. I think that the patient contact is what keeps me coming to work every day and the fact that our patients do so well. They do well. You ask them. You engage them in conversation and they say, “I don’t know why I didn’t do this before. I don’t know why I was so nervous.” It’s just amazing.

End of Interview Transcript –

Don’t forget to check out the entire October 2011 issue of Nursing Notes, digging into the world of the orthopaedic nurse. This month’s Nursing Notes newsletter reveals the origins of orthopaedic nursing, injuries that lead to “Boomeritis” and gives a look at the upcoming National League for Nursing’s technology conference. You can read the entire issue online at www.discovernursing.com and don’t forget to catch the other Nursing Notes Live episode this month featuring a panel of orthopaedic nurse leaders and their thoughts on the future of this field of nursing. You’ll find this and other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.