Consider this scenario: A 55-year-old woman arrives at the emergency department with pain in her arms and neck and shortness of breath. At the time of her admission, an assessment that included several diagnostic tests and a 12-lead electrocardiogram (ECG) showed normal ranges. But because the woman was at risk of a cardiac event, she was admitted to the observation unit. Soon afterward, the woman’s symptoms worsened.
A nurse practitioner on the unit looked at the previous ECG, observed the patient’s clear discomfort, and felt something had been missed. She quickly instructed a staff nurse to repeat the ECG and at the same time consulted an online evidence-based, point-of-care procedural reference on performing a 12-lead ECG, which highlighted chest lead placement.
During a review of the patient’s tests, the ward nurse noticed that the chest markers from the ECG done on the patient in the emergency department were not in alignment with proper placement. The ECG was therefore redone and showed the patient was having a heart attack. The nurse practitioner notified the cardiologist, who immediately ordered the patient to the cardiac catheterization laboratory for an intervention that resulted in saving her life.
Let’s compare that example with another case at a different hospital. Again, a middle-aged woman arrives at an emergency department with symptoms similar to those in the first example, and after initial assessment, shows nothing abnormal. This time, however, no one picked up on the problem with misplacement of the ECG leads, which led to a different outcome: the patient had to experience a more complicated and prolonged recovery.
So, just how did those two patients with similar symptoms end up with two different courses of care?
Consistency of care is key
The differences between these examples underscore the critical importance of nurse education and knowledge at the point of care. Today, from one large health system to the next there are dramatic differences in the ways nurses practice—across hospitals and even across units. When such care variation exists, hospitals become challenged to meet their quality measures and thereby provide the right level of care in each situation, each time.
The informed clinical instincts of practicing nurses who care for patients can be the difference between life and death. When expertise combines with standardized procedures and ongoing professional development, hospitals can expect better-quality care and better patient outcomes.
To complicate matters, the growing shortage of nurses—as experienced baby boomer nurses start retiring—is having an effect. Hospitals recently reported that the nursing shortage is the worst it’s ever been, and the US Bureau of Labor Statistics estimates that by 2024, more than one million registered nurses will be needed to replace the many nurses reaching retirement and to support an aging population.