Nursing Process Revisited: Damn the care plan! Damn the care plan!

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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.

“Heidi, (she couldn’t keep my name straight) you need to focus on four things: Pee, Poop, Pain and Skin. Those Ortho guys don’t do any of these things well. You need to be an expert at all of them.”

If that wasn’t foreshadowing…

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 freekin’ start?

I guess we begin at the beginning. Yup, you guessed it, back to the nursing process:
-Outcome Identification

Who’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, ‘opportunities.’

The past week culminated in us deciding to tackle a few big-win clinical practice ‘opportunities.’ 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.