Navy nurses attending class, 1940s. Image courtesy US Navy
Credit: US Navy, Bureau of Medicine and Surgery

A recent meeting of nurses highlighted the need to integrate more evidence into what nurses do and toss out “the way we’ve always done it.”

By Rose Hoban

As recently as a decade ago, health care workers in intensive care units assumed that some patients would get life-threatening bloodstream infections from the centrally inserted intravenous lines that delivered their lifesaving medications. A report from the U.S. Institute of Medicine published in 2000 cited infections in these IVs – that feed directly into the body’s largest vessels – as contributing to the deaths of thousands of Americans annually.

But in the past five or six years, new guidelines on caring for those IV lines have reduced infection rates around the country and decreased deaths and injuries caused by the infections, as workers in many ICUs started heeding evidence on how to prevent the infections.

That need to embrace evidence-based practices in health care is what was behind a symposium for several hundred nurses earlier this month at the Koury Convention Center in Greensboro.

Bernadette Melnyk. Image courtesy National Institute of Nursing Research
Bernadette Melnyk. Image courtesy National Institute of Nursing Research

The meeting was the first daylong symposium in the state aimed at getting working nurses to start questioning whether what they’ve been taught to do is based on evidence.

“Only about 55 percent of health care practices are evidence-based,” said Bernadette Melnyk, who taught the first half of the workshop. Melnyk is a dean in the nursing school at the Ohio State University and researches how health care workers integrate evidence into the way they practice.

“Up to 200,000 individuals in the U.S. die annually from medical errors, many of which could have been prevented with evidence-based practice,” Melnyk told the group.

The U.S. Institute of Medicine estimates that another 15 million people are injured by medical mistakes each year, mistakes that also cost billions in extra health care costs.

“Most of those errors are caused by competent, well-trained people trying to get to the right outcome in a poorly designed system,” Melnyk said. “We need to make data-driven decisions.”

Melnyk told the group that she frequently wears a button that reads, “That’s the way we do it here,” with a slash through it.

“I don’t want to hear it,” she said.

Shaking things up

“We’re trying to get people excited about the possibilities in nursing with evidence-based practice,” said Theresa Brodrick, chief nursing officer for the Moses Cone Health System, based in Greensboro. Broderick was instrumental in organizing the symposium.

Brodrick said she takes evidence seriously. For instance, Moses Cone has implemented a policy that forbids clinical staff from wearing nail polish at work. Research has shown microscopic cracks in nail enamel can harbor bacteria that can contribute to patient infections.

CAPT. Patsy J. McCondless, a registered nurse, comforts a patient who is in traction at Womack Army Hospital, 07/15/1976
Nursing practice has changed dramatically in the past few decades because of new evidence. This Army nurse cares for a patient in traction, a technique no longer used to set broken bones. Image courtesy US Army, via National Archives. Credit: US National Archives

Moses Cone has seen central-line infections drop to below the national average in the past few years, according to one national quality survey.

Brodrick has also moved Moses Cone to emphasize hiring more bachelor’s-prepared nurses. Now a nurse with an associate degree in nursing is required to complete a bachelor’s degree within four years of being hired. Nurses prepared in bachelor’s programs complete research classes, while nurses who attend community colleges and receive associate degrees do not study how to conduct research.

“We’re shaking up the state a little bit by doing this,” said Brodrick, who admitted there’s been some pushback from the nursing community. “But we can’t get to this level of evidence-based practice until we get nurses educated to this level.”

The push for basing nursing care on data is not just about saving money or reducing infections, Brodrick said. An emphasis on evidence is written into the federal Affordable Care Act, and hospitals that don’t meet quality benchmarks will face penalties.

“According to a Institute of Medicine roundtable report on evidence-based medicine, by 2020, 90 percent of health care decisions will be evidence-based,” Melnyk said.

She said it’s preferable to embrace the changes now rather than be forced into them later.

Staff nurses getting on board

At lunch break of the symposium, over salads, seven nurses from High Point Regional Hospital bandied around ideas for changing the way they do things on the job.

One emergency-department nurse talked about a journal article she recently brought in to share with co-workers. There was a lively back-and-forth about whether data supported refrigerating vials of insulin after they’re opened.

“We’re all members of the Evidence Based Practice and Research Council at the hospital,” said Elizabeth Newton, nursing director for several units at High Point.

“If [staff nurses] read something in a journal, they bring the journal article in for their peers to read, and we gather ideas from them,” Newton said. “These are the kinds of ideas to improve practice hospital-wide.”

Newton’s co-worker Sherry Watson said High Point recently switched to a practice called “hourly rounding with purpose,” whereby nurses check on each patient at least once an hour, without waiting to be called.

“We’re seeing a decrease in our falls rate and hopefully it will also impact our [bedsore] rates,” Watson said. “The evidence supports that if we meet their basic needs, there will be an increase in patient satisfaction.”

Newton described one patient who, after the hourly rounds were explained to him, told his family to go home.

“He said, ‘Don’t worry about staying with me tonight, they’re gonna be checking on me all the time,’” Newton said. “So patients recognize that it’s positive, and they like it.”

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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