Why can’t we quantify nursing care?

Bedpans to outcomes: Why can’t we quantify nursing care? KevinMD |Amanda Anderson, RN | Conditions | September 5, 2016

Thanks to Hollywood, most people equate nursing to following doctor’s orders, making patients comfortable, and giving medications and bedpans. The word “assessment,” which is the bulk of a nurses’ responsibility, falls foreign.

This disconnect between stereotype and understanding, is, I believe, largely our own professional fault, and until nurses deliberately explain their complex work of care, our professional battles for workplace and workforce improvement and, in direct connection, the quality of care we provide, will continue to remain buried in the graveyard of bad bedpan jokes and unsolved professional problems.

Wow, that’s a long sentence!  

Perhaps this lack of nurse-led visibility has to do with our inability to quantify the complex nature of our primary skill: the science of care.

Physicians, with the central function to diagnose, might have an easy advantage. Diagnostics are largely quantifiable — the skill can be easily translated and replicable in research, data, and even conversation.

In contrast, care, which is the primary nursing skill, equally complex and patient-specific, remains difficult to quantify.

Although it has been studied for decades, nursing care’s complexities can often slip between quantifiable parameters, and thus, out of public dialogue.

This is exactly the same problem we have with pain “care”:
there is no way to quantify the experience of pain or its relief.

One patient, deemed ready for transfer to the less acute observation floor, gave her pause. His heart rate was a touch too high, and his blood pressure equally too low, albeit both in the normal range. His blood counts had dropped some over the past day, but not abnormally, considering his recent surgery.

He looked — on paper, and in person — OK to transfer.

Again, we see the curse of “invisible illness”. As humans, we prioritize and put our trust into what we physically see far too highly.

But there was a nagging alarm in my friend’s gut, and she told the surgeon, who trusted her intuition and immediately took the patient back to the OR, trumping another surgeon’s schedule.

It seems almost impossible to believe such a rarity: a surgeon who trusts a nurse enough to take drastic action. This surgeon is a hero for bucking the long-standing conter-productive social norm of doctors not listening to their troops.

He found three liters of blood in the patient’s chest. The timing of the lab draws had masked a slow bleed from one of his stitches, and if undetected, the patient would have decompensated quickly, making intervention impossible.

Instead, because of his nurse’s hunch, he was saved.

I asked my friend what made her act on this feeling she had. Why did she trump logic for intuition? What if she had been wrong and the patient was re-opened for nothing? She couldn’t say. She couldn’t quantify the care that she gave, even though she knew that her patient needed further intervention, without knowing how to describe why.

Nurse researcher Patricia Benner, in her seminal book, From Novice to Expert, describes my friend’s care as expert-level, the pinnacle of nursing experience, while acknowledging it’s near-impossibility to quantify,

“… a deep understanding of the total situation; the chess master, for instance, when asked why he or she made a particularly masterful move, will just say: ‘Because it felt right.’”

It is this inability to explain our most complex, expert-level work that trips us up in the public eye, but it is also this complexity that demands reform of healthcare systems and nursing requirements of care.

A nurse with ten patients cannot learn to think beyond the face-value assessments that she whizzes through.

A nurse with fifteen ER patients can’t listen for the subtle signs of danger when the bells of half of them are ringing for emesis basins or pain medicine.

A nurse without a strong foundation of education can’t determine when to think past tasks and into the realm of deep intuition.

So, the next time you think of telling a nurse a bedpan joke instead of asking about the details of nursing care, think again.

Author: Amanda Anderson is a nurse with a background in intensive care who currently works in health care administration.  

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