Nursing Process Revisited: Damn the care plan! Damn the care plan!
Although it feels like most of my time in my new role as an NP has been devoted to reading everything I can about state law in reference to prescriptive authority, collaborative agreements and the like, a clinical focus has emerged.
An old crusty CNS I will refer to as M.M. cornered me during my first week.
â€œHeidi, (she couldnâ€™t keep my name straight) you need to focus on four things: Pee, Poop, Pain and Skin. Those Ortho guys donâ€™t do any of these things well. You need to be an expert at all of them.â€
If that wasnâ€™t foreshadowingâ€¦
M.M. was referring to the basics. Getting bowels moving, pulling catheters/preventing UTIs, preventing hospital acquired pressure sores (what is the PC term for bed sores these days?), and controlling pain. All hospitalized patients have these issues, but I am quickly finding out that the orthopaedic population is a group unto its own.
I realize that there are volumes written about these subject areas. I know that they have been hashed and rehashed in all of my different levels of education. How different it is to observe them in a practice setting in which I have the opportunity to change the way care is delivered on a much larger scale possible than anything presenting itself during my time as an RN. Wow. This realization has been materializing over the past 5 months and is changing from a misty apparition into a more solid, concrete form. Wow.
The next question? Where do I freekinâ€™ start?
I guess we begin at the beginning. Yup, you guessed it, back to the nursing process:
Whoâ€™d a thunk it. I can just see the looks of gratification on the faces of my Associate Degree Nursing Instructors as I write this. (damn the care plan! damn the care plan!)
So, over the past week, my trusty partner (there are two of us ortho-trauma NPs, but that is a story for another day) and I have brainstormed plans, problems, and more problems which my boss, the nursing director, refers to as, â€˜opportunities.â€™
The past week culminated in us deciding to tackle a few big-win clinical practice â€˜opportunities.â€™ These include, in no special order, DVT/PE prophylaxis compliance, skin, and pain. The first two are going through the nursing process cycle as issues which will make an almost immediate difference. We have three weeks to have a concrete assessment, diagnosis, outcome identification and plan prepared to present to our boss. This is going to be an interesting few weeks.
So, as M.M. looks on as a mentor, who I am beyond grateful for, I will tackle the above with what has been pounded into me over the past 4 years of education. We will see if a Nurse Practitioner is what this hospital and more specifically, floor/patient population needed.