Nursing workarounds and what they mean for the future of healthcare.
Last evening, I spoke to a group of approximately 60 graduate nursing students at Northeastern University in Boston MA. I spoke on the topic of nurse entrepreneurship and intrapraneurship. The faculty members, Dr. Laura Mylott and Dr. Janet Rico wanted to show their students the different opportunities there are for nurses in the health care arena. Nurse entrepreneurship or intrapreneurship are two career options that we often don’t discuss in our formalized nursing education classes. However, I will tell you that they are very real career options and in many ways will be the only way in which we solve some of the day-to-day problems nurses are faced with at the bedside. The reason why nurses are the only individuals set up to solve these problems is because no one else knows they exist. No one is going to come knocking on the door with a solution to solve problems they don’t know exist.
I asked the class, “What is a workaround?”. It could have been that no one wanted to speak up but I didn’t get a volunteer to answer the question. So, I turned it around. “Ok. What is a problem you deal with every day and how to you get around it?” I had one student volunteer to tell the group that he works nights. At night, STAT labs are entered at midnight however the system goes down for 30 minutes every night at this time. It affects the timing in which labels are printed and subsequently when they can be drawn, resulted, and acted upon. So, instead of waiting and wasting time, he figured out a way to manually force print the labels. This is the workaround.
I then asked, “Ok, so you can get the labels but what is the impact of this effort?” He said, “time wasted”. That is exactly right. I then asked, “What does that mean (e.g. time wasted)?” The response from another student: “It means less time spent with the patient.” Exactly. It also means that you are forced to speed up other efforts to make up for the lost time. After that, the class was clear on workarounds. Whether getting linen from another unit because the cart was empty or using a syringe to pull out the air bubbles in the IV tubing to stop the ‘air in the line’ problem, they all had something that they fight with daily in an effort to get the patient the care he or she deserves.
Developing workarounds to existing problems at the individual level is the first step in understanding innovation. Innovation is a new product, service, or method created to benefit others. In many instances these workarounds affect all nurses. However, at the time in which they are being experienced, a short term solution is essential. We, as a profession, seem to struggle to bubble these workarounds up toward a long term solution.
For example, let’s go back to the linen cart. Every day that I worked as a bedside nurse, I strived to change the bed linens for each patient. However, despite the number of beds on the unit not changing, I always ran into the issue of an empty linen cart (whether for the pillow case, bed sheet, towel). I would then run to another unit and grab what I needed from another cart and proceed with my day. This took a few minutes to do each time and I always thought it was just me. Well, after using this example in recent talks, I have come to find out that I was not alone and actually everyone can relate to this problem.
As nurses, our short term solution is to run to another linen cart and solve the immediate need. It usually stops there. We have so many other things to manage over the course of the day that fighting the battle of a fully stocked linen cart doesn’t make it to the top of the list. Additionally, we don’t think of bringing it to someone who can help us solve it or champion the effort and move it forward with the support of others. Now, that example isn’t one that directly places patients at risk. However, it is an example of a problem that could be solved with some organizational support, data, communication, and revised processes across departments.
Nurses as intrapraneurs and entrepreneurs.
To tackle the linen cart example and solve it, would be an intrapreneurial act. Intrapreneurship is creating innovation within the walls of an established organization. Many organizations now have Chief Innovation Officers or Directors of Innovation to create new solutions. Any nurse could participate in these efforts and should explore these departments if they want to bring forward positive change that can impact not just themselves, but every other affected nurse, patient, family, doctor etc. This is where we can make change in healthcare that will help us for the future.
Entrepreneurship is the other place for innovation where nurses can get on board. Entrepreneurship is when an identified problem is solved through innovation (e.g., new product, service, method) and a business is created around it. Instead of within the health care organization, entrepreneurs create new businesses and organizations to address problems that affect large populations of people.
I created Know My Patient TM to address the pervasive issue of nurses relying on that report sheet that lives in their pockets and is used as a reference guide to support what nurses need to know about their patients on the go. However, that sheet is also a data collector now at the bedside and it is the most sophisticated of its kind in comparison to the alternatives. The alternatives are writing on paper towels, alcohol swabs, post it notes, tape on pants and even one’s own hands or glove. This happens every day. This is a workaround to a problem that hadn’t been solved… There is no reason why we cannot leverage the mobile technology that exists to replace the reliance on this workaround. The smart phone came along and changed how individuals access and use information. I saw the way nurses used the smart phone to their benefit instead of as a barrier and their actions sparked my action to take this on. I decided to go the entrepreneurial path and form a company, Nightingale Apps LLC, to help solve this problem that affects every nurse.
As nurses, we are trained to protect and promote the lives of our patients. At times, this also means that nurses are saving lives which is quite powerful. By taking the nursing process (e.g., assessing, planning, intervening and evaluating) and applying to existing problems, we as a profession can shift from individual workarounds to system-wide innovations that benefit the greater good of nurses, patients, families, health care professionals, and the industry at large.