The University of Texas said "no" to Janet Gilmore's proposal for research into how postoperative patients can better manage pain. "We didn't get the funding, but we're reinventing that and we're going to ask for some money from another group," she said.

That is so Gilmore. Solving problems, and the critical thinking inherent in that, is her forte. "I think the tougher they are, the more I get out of it, and we certainly are dealing with problems all day in health care," she said.

She's a former critical care nurse and, as director of perioperative services, oversees four units in which pre-anesthesia patients are assessed before surgery, prepped with IV lines or blocks and are in recovery.

Many of the solutions she's engineered have made RNs happier with their work environment, which in turn is reflected in the quality of patient care. "I'm a firm believer that people who are satisfied in their jobs do a good job," Gilmore said. "I don't think that we have anybody who doesn't want to do a good job. It's just a matter of giving them the tools."

The first tool Gilmore provides is a voice. "I don't make decisions in an ivory tower; I incorporate the people who are involved to come up with solutions," she said.

Staffing the recovery unit for emergencies, weekends, nights and holidays was at one time a sore spot with nurses. With multiple units signing up for the same call, no one was happy with a rotation that occasionally gave nurses access to choice assignments, but more often than not put them far behind others in covering shifts.

Gilmore computerized the call, moving it to the hospital's intranet. That gave all nurses equal access at a designated time, with software documenting who signed up and when.

"It made the call system so fair, now our problem is the opposite," Gilmore said. "There are people who feel like they're not getting enough call. And we were having to pay premium pay to get people to take call before."

Besides saving the hospital money, computerization made the call almost self-governing for managers because nurses can view schedules and take into account the levels of experience scheduled for the unit at any time.

Nursing students also benefit from Gilmore's innovation. Last summer, students attending Houston Baptist University, where she serves on the clinical faculty, were able to earn college credit while learning perioperative nursing in the first such program in the Houston area. "You certainly don't get a whole big portion of this in nursing school," Gilmore said.

She said she will continue to look at patient outcomes and encourage nurses to "think in directions that they've never thought of before."

New thinking is at the root of the pain research proposal.

"Typically, we find that a surgeon will do things the way he's done them since the day he got out of medical school, and one size fits all. You see the same medications given to all the procedures going home," Gilmore said. "There needs to be a methodology in determining what the patients' needs are before you send them home."