Patricia Cochrell, on systems implementation

By Bree LeMaire, MS, RN
August 12, 2002

How did you begin working with systems?

From the time I was 12 years old, I've known that I wanted to be a nurse. After working as a nurse manager, I saw that I wanted to communicate with the administrative side of health care and speak its language. Nursing needs a voice in the boardroom.

My MBA led me to look at systems theory and ways to conceptualize systems within hospitals. Ann Van Slyck, MSN, RN, FAAN, was one of those people [I admired]. She helped design a plan for managing patient care for a hospital in Phoenix and then started a consulting firm to share it. I saw her creation, which was a systems approach, as a method of promoting the professional practice of nursing.

Health care needs to embrace systems that don't ask a nurse to do more than integrate new systems into what they already do. Patient acuity, for example, is about the patient, so it should be part of the patient's medical record, not a separate system.

Nurses engage with our patients in many ways, and a systems approach best captures all that varied information. It can be used at the bedside as well as the boardroom.

How can a nurse use your systems?

I want to make what the nurse does more visible and recognize all available skills instead of just targeted tasks-to celebrate the things the nurse already is doing and document it.

We all bring a certain foundation to nursing practice. The technical aspects may differ but there are some things we all do.

Using the systems approach, I work with a core group of staff nurses and nurse leaders to look at the facility and define its patient population along a continuum. I want to reach and assist the nurse in the back hall, the nurse on the evening shift who may or may not get recognition for what he/she does.

Services need to be quantified and weighted for their importance with each patient. The nurse needs tools to highlight what's already being done. There are tools that a nurse can quickly use to document the teaching, interventions and professional services provided.

However, these services also might be exhibited in other ways, such as showing a lower acuity or capturing information about how quickly the patient has moved along the continuum of care.

Everyone's concerned about the nursing shortage. What's your take on it?

I'm very concerned. The average age of a nurse last year was 47. Aging baby boomers soon will need nurses and there's not a large enough workforce to take on the task.

The profession has expanded. Ten years ago, the hospital was the major employer. Today, nurses have moved far beyond the hospital into such directions as home care and insurance. Many more avenues are open to nurses. This diminishes the employment pool for hospitals.

Good leadership is the key. We have to listen to our staff nurses and be proactive so nurses can deliver good care, feel good about their work and respond to personal needs. Some of the recent legislation comes from unmanageable workloads and environments that are not nurse-friendly.

We need systems, for example, that help hospitals implement staffing by looking at patterns of high turnover, such as admissions and discharge, and implementing creative staffing, while being sensitive to nurses who have work schedule constraints.

What are some changes that you see in nursing?

What I'm seeing around the country is that nurses love what they do and they want enough time to provide everything their patients need. One ramification of the nursing shortage is that people are coming together to promote and articulate what nurses do. They also are becoming more vocal about the good parts of nursing. Nurses are getting in touch with what they value.

In his research, Peter Buerhaus, Ph.D., RN, FAAN, also has shown that there is a correlation between the number of hours of nursing care and better patient outcomes. We've got to retool our systems for that nurse at the bedside and celebrate doing what they do best. The professional nurse at the bedside is needed to provide quality care and my mission is to provide systems that support this precious resource.

Nurses do make a difference and we can celebrate that through the systems we embrace.