Nursing in Todays World :

Embracing Its Challenges

International Nursing Conference
The Search
forstyle
New Nursing Realities
Click to edit Master
subtitle

Dr. Rosnah Hadis

Director Selangor State Health
Department
10/19/09
13 October 2009

Things I would like to share

Introduction
Nursing Dimensions:

Facing the Challenges:

Nursing Fundamental : Environment

Outlook : Nursing perspective
Business not as usual
Back to the future
Curiosity & innovation: Evidence based practice :
Core business: leadership, soft skills & credentialing
Doing things differently: Nursing Informatics

Moving Forward

10/19/09

Introduction.
"So never lose an opportunity of urging a practical
beginning, however small, for it is wonderful how often in
such matters the mustard-seed germinates and roots
itself."
Nursing..exciting & rewarding
-- field,
Florence
yet
Nightingale

(inherent ) surrounded with challenges &

to use these challenges to focus on the new
realities

"Unless we are making progress in our nursing every year,

every month, every week, take my word for it we are going

back."
..Nursing Advocate

10/19/09

Environment as the x-factor in nursing

Nurses have the obligations to their clients ( patients)
to demand practice environment that have
organisational & human support allocations
necessary for safe, competent & ethical nursing care
..POSITION
STATEMENT
You heal sometimes. You relieve often. You
comfort always.
..Camus
10/19/09

Fundamental : The Nursing Theoryrole of

environment in human health
TODAYS
WORLD

Vigilance
environm
ent

Cultural
environm
ent

Responsi
ve
environm
ent

Foundation
set by F.N.
(1860)
Environment for
healing
- physical space
social
psychological

10/19/09

Outlook : from Nursing Perspective..

The Future of
Health Care
( Deloitte Survey
2005)

Where Art Thou,

Nurse?
Healthcare
Reform

57% of CEOs cite flexible work

arrangements as the most
effective strategy for
addressing the nursing
shortage
Quality and
safety
will be
while
43% highlights
the main
issue forof increased
effectiveness
providers.
Hospitals are being
salaries
attacked because we are
perceived as caring only

Still growing
of of
about
money,shortfall
not quality
nurses,
care. globally

Nursing exodus ( USA 2002 :

half a million RNs not
How will nursing be
employed
10/19/09
affected.
Nursing as a career..????

Business not as usual.

The
CEO
either
needs
hearing
aid or
grey
matter
transplan
t!
Bogs down on trivial & petty issues : chronic filtration
process of our distorted minds
Public understanding of nursing : not a crown jewel
Preoccupied with inadvertent & mishaps
The hallmark nurse as an angel, disappearing...
10/19/09

Long held stereotype image :

Enough is enough..
Shortage worldwide
Long working hours
Administrative tasks
TV shows/drama:
chauvinism facing nurses, nurses
roles being distorted ( ER, Grey
Anatomy,etc)
Reality : Almost all programs highly dependent on nurses
Bogs
What down
was notbetween
argued : career & family life

How much nurses influence patient outcomes

Study : reducing nurses patients ratio 1:4 to 1:8 increased

mortality 31%

10/19/09

Back to the Future

Significant of todays nursing :

.seen against backdrop of yesterday
19th century FN legacy : intangible aspects of a
persons needs i.e. Holism : to help a person
attain wholeness in every dimension of their
being
Some of her legacies :

Notes on Nursing, Notes on hospitals

Nursing Theory Statistics & data analysis ( unknown
to many)
Design & architecture, engineering, hygiene
10/19/09
Patient Diet

Click to edit Master subtitle style

Facing the Challenges

The optimist sees opportunity in every danger;
the pessimist sees danger in every opportunity.
-- Winston Churchill
10/19/09

10

Challenges

EBP : Initially, exploring the unchartered

territory.

Literature demonstrates: only 15% of the

nursing workforce consistently practices
EBP framework
Engagement of evidence-based practice :
ensuring quality & patient safety
Outcome & impact : the corner 10/19/09
stone

11

Challenges

Nurse leaders : Nothing but perseverance

Unwavering Commitment : It
separates doers & dreamers
Business strategic initiatives : avoid
business as usual
KPI : do big with small, set
expectation from outset
Search for the cracks : pain point!
Creative, tenacity, innovative, risk
taker : ability to multitask, prioritise &
Nursing
is a marathon, not a sprint; you have to
self direct
pace
yourself &planning
know that: coaching
youre in it&for the long haul
Succession
10/19/09
mentoring, exploiting potentials.

12

Challenges : Non clinical aspects

of care..

By virtue : Nursing; we interact with people

Leninger: Caring is the essence of nursing
The leading root cause of medical error
(65%) : communication failure ( Joint
Commission)
What matters : relationship, connection,
communication & interpersonal skill
Insight into non-clinical aspects of care :
social & emotional issues : with compassion
I dont care what you know; I want to know you care
Constant
reporting : Patient
satisfaction
score
Source : Improving
practice
Nursing

with Schwartz rounds,

10/19/09

13

Credentialing in
Nursing

ICN uses the following

broad definition of
credentialing:
Credentialing is a term
applied to processes
used to designate that an
individual, programme,
institution or product have
met established
standards set by an
agent (governmental or
non-governmental)
recognised as qualified to
carry out this task.
Credentials may be
periodically renewed as a
means of assuring
continued quality and
they may be withdrawn
when standards of
competence or behaviour
are no longer met. (Styles
and Affara, 1997)

10/19/09

14

and another. leadership credentialing

as a pivotal role in nursing

Talking about mentoring & advocating, too much

enthusiasm
dont take for granted.
Looking for the traits
with distinguished characteristics &
qualities

10/19/09

15

Nursing Informatics - How

IT makes a difference
Information technology (IT)
is not a panacea, and will
not fulfill its promise unless
it is harnessed in support of
foundational values. That is
why every nurse cannot
afford to be unconnected to
this transformation, but
must take an active role in
ensuring that IT is used in
service to our profession's
values. After all, we are
knowledge workers.

McBride,2
10/19/09
005,

16

Challenges :

Adopting IT to support nursing

practices & care delivery : incorporating EBP
Key areas of opportunity : optimising IT
Evaluate process (error prone process) &
implications, alignment & leverage best
practice: new way of doing things
Daunting task: naming convention,
standardizing nursing nomenclatures &
taxonomies
10/19/09
Access to real time patient information

17

Key Results :

Informatics nurse professionals play crucial role

across a wide
variety of IT areas

scores of 6.29 ( scale 1 to 7) : the value

informatics nurses bring
to the IT systems implementation processes

Nursing informatics Impact in 3 key areas :

workflow, user
acceptance & screen flow

10/19/09

18

Deploying ICT : Meeting Business Requirements

Components

Business

Information

Activities Involved

Patient

Managing Patient

Patient Profile

Register, Ap & Sch., Admit, Bill

Transfer, Discharge, Report

Managing
Illness &
Conditions

Clinical Information Take history: Chart, note

Observe : Chart, progress
Order : prescribe, etc
Task: procedure , test, dispense
Make Report /Summary

No film handling

Gone are the days..

Nursing task : tracing
lab results & x-ray
films
1919

Click to edit Master subtitle style

Way Forward

10/19/09

20

The pursue : revitalising FN legacy &

revolutionized nursing:

A nurse does not only seek to alleviate

physical pain or render physical care
she ministers the whole person. The
existence of suffering, whether
physical, mental or spiritual is the
proper concern of the nurse
Nurse Travelbee,
To Revisit.
1971
Nursing is discipline distinct from medicine
focusing
on patients reparative process rather than on their
Nursing
education belongs in the hands of nurses!
diseases!
10/19/09

21

Another message, Nursing

Charter.. ..on image &
profession

Hard look : state of nursing today &

where we see the profession going ( from
its tradition, nurses are subservient).
Huge workforce (25% of KKM staff) : how
assertive in changing the landscape of our
healthcare setting
Working condition: staff shortage ( guilty
to say no)- need respectful
communication

10/19/09

22

Patient Centred Service.with honour & respect

But not this
way..

.we hold them at

ransom!!!!!

Thank You.

drrosnah@moh.gov.my

10/19/09

23