There are two things that I have often thought to be consistent with modern day nursing program’s focus of emphasis: teaching students how to write state boards and preparing students how not to “kill” or injure someone when they first begin nursing practice. I’ve often reminded nurses of this because not only does it merit some truth, but also partly to solicit a laugh to certain truths that applies to most of our nursing experiences. Nevertheless, the reality for most professional nurses throughout our careers is that everything we’ve ever learned about nursing practice and taking care of patients was actually learned by showing up for work every day.
As I reflect on my earlier days as a nurse, not only was I nervous during those days, but recently it occurred to me that there was one other point of emphasis particularly stressful about learning how to take care of patients. It involved learning to time-manage. Being able to manage tasks so that all patients are cared for responsibly and timely require not only learning the task or the skill at hand, but also executing the steps within the process efficiently. As I gave this idea additional thought, I concluded that the skills we learned as beginners, we spend the rest of our careers perfecting those skills until it is woven into the fabrics of our professional beings. Additionally, the longer we practice to perfect those skills, the more we tend to cling to our processes because they are reflective of the labor and effort that went into learning the very practices which we consider to have made us prudent professionals.
We emphasize perfection of our practice primarily because most of us have been determined to get it right since we were beginners. Being that most of us after gaining work experience believe we are competent in our practice, we also are usually the least bit interested in modifying the very things that have consistently worked for us in creating positive patient outcomes. The rhythm in which we work represents those time efficient processes which defines who we are as professionals; best of luck to anyone with enough courage to attempt to change old practice habits.
Old practice habits die hard
Working in rhythm or managing time is a fundamental nursing principle that represents the foundation from which many bedside nurses build their practice. Though it is intrinsic to professional nursing, it rarely is given any attention until unsolicited attempts to change the way things have always been done threatens to hinder our perceptions of workflow and rhythm. The resistance that often accompanies the threat of change can sometimes appear insurmountable for many nurses will not allow nor trust outside influences or competing ideas to potentially jeopardize their professional credibility. Even if not to this extent, some of us are justifiably stubborn and rebel in the name of familiarity regardless of whether new process suggestions are more practical in the form of how we go about doing our jobs.
I intentionally created this analogy for the purposes of explaining two thoughts as it relates to changing patient-lift processes. The first thought explains some of the reasoning for why it is difficult for nurses to change practice routines. The second thought is to suggest that meticulous change management skills are necessary if the overall objective is to influence nurses to change or reconsider old practices habits that work.
Patient-lifting as a practice process
Patient-lifting is a nursing practice process that many nurses are unwilling to change. Regardless of the injury risks to both themselves and their patients, patient-lifting is one of those processes that we were taught as beginners and though a difficult skill, we feel a responsibility towards perfecting it. Encouraging bedside nurses to reconsider this process may be a “tall order” depending on your approach. Nevertheless, it is possible under the right provisions to influence nurses to change.
To generate the motivation nurses need to reconsider manual patient-lift practices, there are two things that I would suggest to put you on a path towards success. First, take into consideration the staff nurse to whom you are speaking. This is important because it specifically establishes a communication route that may very well resonate while invoking thoughts of change. For example, has the nurse ever had a lifting injury or knows someone who has? Is the nurse older or younger in their careers? Is the nurse someone who places value on life outside of work? Is the nurse primarily responsible for the more physical or manually intensive parts to patient care? Taking into consideration the listening audience should influence how information is communicated with the intent to create a cause for the nurse to pause and rethink.
Secondly, ensure that any changes you attempt to implement does not add steps to any nurses’ processes, but instead transitions fluently into their daily workflow and work routines. The easiest way to quickly lose a nurse’s attention is to leave the impression that newly suggested recommendations create additional work. Depending on the nursing unit, it is important to understand the unit’s working algorithm for taking care of patients. For example, do nurses have to ask for keys to access bed linen from the clean utility closet? Are nursing supplies maintained and made readily available or accessible for use? Do outside departments such as escort services assist patients when needing to be transported on and off the unit? Does the organization employ a team designated to perform patient lifts? Understanding daily work routines allows a Safe Patient Handling Coordinator to align process recommendations consistent with daily work activities.
In closing, I understand the fixation on developing the skills that are taught as beginners to professional nursing practice. However, have we ever considered traditional lifting techniques to be the standard because there is no other available alternative? There is no disputing that nursing practice comes with more than its fair share of liabilities. The question to be answered is, should your personal health be one of them?
Roric P. Hawkins is the founder and president of The RP Hawkins Group and is the safe patient handling coordinator at Michael E. DeBakey VAMC in Houston, Texas. The views expressed here are his own.