Practice What We Preach
National Nurses United’s Joint Nursing Practice Commission is on a mission to ensure nurses can practice nursing the way they know they should
Ever stop for a moment and consider what makes a nurse a nurse? Why is what registered nurses do called nursing practice? What are the ramifications to nursing if a nurse in Ohio cares remotely for a patient in Oregon? What does it mean for nursing if family members and unlicensed staff are trained to perform certain functions nurses do? For the 20 RN members of National Nurses United’s Joint Nursing Practice Commission, these are questions they ponder and debate daily. Their job within the organization is to monitor and think critically about the work nurses do and the forces shaping their practice, and furthermore to safeguard nurses’ ability and right to provide safe, therapeutic, and effective care for their patients.
“They say that healthcare has changed more in the last 30 years than in the last 300 years,” said Bernadine “Bunny” Engeldorf, a Minnesota Nurses Association RN member of the JNPC who has worked at Allina Health’s United Hospital in St. Paul, Minn. for more than 26 years. And she’s not just talking about the actual drugs, treatments, and procedures. Engeldorf noted that health information technology and the rise of corporate healthcare, under which profits are prioritized above patients, both pose dramatic challenges to how nurses have learned to practice nursing and the way in which they would like and know they ought to practice.
“I don’t think most nurses have much time to think about their practice. Management keeps us too tired and busy,” said Dahlia Tayag, an RN at University of California San Diego Medical Center and chair of the JNPC. “We go to work, get paid, and we go home.”
The commission is determined to change all that and is on a campaign to involve all RN members in working collectively through their union to improve and protect nursing practice, whether it’s using assignment despite objection forms (ADOs) as a unit, floor, or entire facility to demand appropriate staffing levels or going to their state capitals to testify against bills that would allow paramedics or respiratory therapists to replace licensed RNs. They take their representative role very seriously and encourage all nurses to contact them with questions about what their supervisors and facilities are asking them to do. Members are also planning to help teach continuing education courses, attend professional practice committee meetings in their regions, and reach out to nursing students to better prepare them for the realities of nursing in a 21st century corporate healthcare setting. The JNPC also researches and issues position statements meant to guide nurses on how to interpret current developments in nursing or healthcare.
“We need to put the fire back in the hearts of our nurses,” said Cokie Giles, an RN at Eastern Maine Medical Center and a CNA/NNOC copresident who acts as the board liaison to the JNPC.
NNU’s nursing practice and patient advocacy work can be broadly categorized as falling into five major categories: nursing practice research, analysis, and resolution; patient advocacy; continuing education; competency; and safe patient care. The JNPC is responsible for providing overall direction, promotion, and oversight of this program.
At the top of the JNPC’s priority list is simply preserving and enforcing what nursing practice laws, regulations, and standards nurses around the country currently have in the face of a presidential administration and corporate deregulation movement that is aggressively seeking to eliminate or reduce all kinds of rules and government bodies that keep individual patients safe. At the same time, corporate forces are aiming to make registered nurses interchangeable and, ultimately, replaceable either by promoting multi-state nurse licensure compacts that permit nurses to work in any participating state (making strike breaking much easier), developing technology to make nurses obsolete, or by using lesser-skilled or unlicensed staff to usurp nursing duties and functions.
“In nursing, there are always new developments; it’s always changing,” said Lisa Oliver, a pediatric and adult ICU RN at Eastern Maine Medical Center who recently joined the JNPC. “They’re always trying to take the nurses away from the bedside and replace us with technology. They don’t want to spend the money. But I want to be the one to take care of my patients. That’s why I became a nurse. I want to be the one to give my patient a bath, because while you’re giving a bath, you are also assessing and teaching your patient about their disease process.”
One of the most basic ways nurses can protect their practice is by ensuring that their workplaces, whether it’s a clinic or a dialysis center or a floor of a hospital, are appropriately and safely staffed, so the struggle to win and enforce safe RN-to-patient staffing ratios is a centerpiece of the JNPC’s work. “If staffing is not at an adequate level, you are not able to practice nursing the way you know you should be,” said Audricia Brooks, a 24-year nurse practitioner at the Cincinnati VA Medical Center and a JNPC member. “Staffing levels influence how you do your job.”
Besides advocating for ratios laws at the national level and in states that do not have them, the commission reviews and updates the assignment despite objection (ADO) forms which are an essential tool in protesting and documenting unsafe assignments that could jeopardize patients’ health and nurses’ licenses. Oliver said that filling out ADOs works when used collectively; she recalls one instance where her hospital’s professional practice committee (PPC) observed 10 ADOs coming from one surgical floor. They used the documentation to call a meeting with management to get the staffing issues resolved. “You need to be an advocate for your practice,” said Oliver. “If they’re asking you to do more with less, there are avenues you can take. One is to fill out ADOs and bring issues to the PPC. You must protect your patients, protect yourself, and protect your coworkers. When you fill out an ADO, everyone signs it.”
Not surprisingly, the vast majority of nurses on the commission are 20-year, 30-year (and upwards) veterans of nursing, and another reason they all have for serving is to preserve and improve nursing practice for future generations of nurses. In recent years, they have noticed how student nurses who enter their hospitals for their clinical rotations seem less prepared than in previous years, have had less experience with patients in real-life situations versus simulation labs, and are less supported by their instructors. This state of affairs has them extremely concerned. “I want to fight for these young nurses to have the opportunity to care for patients themselves,” said Oliver.
Oliver, who normally works nights, remembers she once worked a day shift where student nurses were supposed to be gaining hands-on learning experience, but there was no apparent preceptor or instructor to be found. She took it upon herself to teach. “I said, ‘Come on in, kids. Let’s learn,’” she said. “When you have an intubated baby, what’s the first thing you look for when you walk into the room? Where’s my med cart?”
Brooks gave similar examples. “In the last five years, I’ve found the NP students are not nearly as well prepared,” she said of the nurses she precepts. “I find I am doing more remedial work; they haven’t learned the material well enough. For example, cranial nerves. It’s one thing to learn about them, but they don’t know enough about them: how to test for it, when to test for it.” The JNPC hopes to develop a more robust outreach program to nursing schools and student groups in the coming years.
“What excites me about the JNPC is that I can more clearly see the benefits of nurses defining nursing practice, not legislators or corporations,” said Brooks, “If we’re not careful, we will allow others to make us practice in a way that is not safe for patients and will increase our own liability.”
For more information about the JNPC, please visit http://nnumagazine.uberflip.com/i/924503-nursingpractice-informational-booklet-2017