If you have been at your nursing job for a while, you’ve probably almost forgotten.
Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give care.
At one point you probably did. I was not around during this age of nursing. The age when we had autonomy. Freedom to practice. Freedom to be innovative.
Today, I am somewhat saddened by the current state of the nursing profession. Don’t get me wrong: I LOVE what I do. I am so thankful for the opportunities set before me.
But whatever happened to “nursing judgment”? Or “nursing decision”?
I can’t tell you how much recently I’ve heard the phrase, “It is hospital policy that…” “You can’t do that, it is protocol that…”
I understand the need for protocols. They help us in the case that something goes wrong and the hospital gets sued. Did the nurse adhere to the protocol? If not, they will be subject to disciplinary action and take the fall. If something goes wrong and there is no protocol, the hospital can say in its defense: “There is now a protocol in place.”
Maybe a less cynical need for protocols: promote and regulate evidenced-based practice among nurses. Evidenced-based practice was developed for a reason: it brings good outcomes and protects the patients.
Even so, to me it seems we are being protocoled to extinction.
Recently, I got to shake hands with and also have lunch with doctor-writer extraordinaire Atul Gawande! He was nearly everything I had made him out to be. He wore a snappy blue blazer, a jumble of ID tags, and round specs befitting a prominent Harvard academic doc … only he wore them in a manner that suggested a man of action. Am I gushing? Sorry. I’ll stop … except to say that he had the chicken salad on white, which sat largely untouched as he drove through the conversation.
One of the greatest storytellers in the history of health care, Atul has discovered something very important about the way we deliver complex procedures … a series of checklists that bring down costs and improve outcomes … and yet adoption of his findings is incredibly low! He is seriously considering raising money to fund—NOT to continue his research and writing—but to literally fund a team of Maoist-like activists to cajole the ranks of docs and hospitals into adopting these bloody checklists!! These checklists are real bluebirds. Nobody loses their job from the adoption of these things. Except for a few embarrassing ‘re-operations to fix terrible mistakes, nobody loses any money either. So what gives?
Atul told me the story of penicillin adoption … I was stunned at how long it took for this miracle drug to be mainstreamed. I remember from my OB-GYN days the number of docs who were still doing continuous fetal monitoring during labor, twenty years and five studies after it was shown to be counter-indicated … and episiotomies, and circumcisions (ouch)!
These are good people. I have met literally tens of thousands of docs and can count the truly questionable people on one hand. So what is it?
There is no market mechanism for the solution. That’s what.
If a payer came to me and gave me Atul’s checklist and said they’d pay even 5% more for a surgery done according to his checklist, I’d build it into an EMR and flick it in within a week! It’s a no-brainer for me and it’s good money for the doc! Ya know what that would be an example of? That would be MEANINGFUL use of an EMR.
God Bless you, Atul. I’m in for a donation … but not for the Maoists. You go find the truth and we’ll go make a market for it.
PS … Atul signed my copy of his book!
Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.