Aphorisms and epigrams are common to almost every aspect of our personal and professional lives. "The squeaky wheel gets the grease." "If it wasn't charted, it wasn't done." For the newly minted registered nurse (RN) who just got an earful from an annoyed physician, we console, "It's better to give too much information than too little." Although it is certainly possible to share our wisdom and learn through these pithy statements, there can be a downside. Precisely because aphorisms and epigrams are easily recognized and repeated, they have the potential to be detrimental to our profession.
Recently, there has been an increased use of the phrase "it wasn't ordered." This is often uttered as justification for the absence of some specific task or assessment. In the United States, the nursing scope of practice is guided by the State Boards of Nursing. Whether you are an RN or an advanced practice provider, you have a defined scope of practice. There are actions, interventions, and assessments that RNs are license to perform independently, and there are actions, interventions, and assessments that advanced practice providers are licensed to perform independently.
Living in Texas, I found that the Registered Nurse Scope of Practice1 identifies that professional nursing involves "[horizontal ellipsis]the observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes." On that same page are instructions that the RN, "[horizontal ellipsis]may engage in independent nursing practice without supervision by another health care provider." Why then is the quip "It wasn't ordered?" invading our practice?
As neuroscience nurses, assessment is perhaps one of our most important skills. We assess constantly; it is part of our professional nature. Admit it! You have all been in a mall or an airport quickly determining the deficit, diagnosis, and rehabilitation plans for a sizeable portion of the people you pass in the hallway! Nobody had to order you to assess the man who has a clumsy grasp on his suitcase. You did not need a physician's order to implement falls precautions on the pleasant lady who obviously had a right anterior cerebral artery stroke and is walking with slight limp. Without a physician's order, you quickly decide that you will just happen to end up next to her so she has a steady arm going down the jet bridge.
In June of 2017, Madden et al2 reported on progress by our own association toward meeting the goals set forth by the Institute of Medicine. One of those goals focused on ensuring that nurses have the ability to practice to the fullest extent of their licensure. Not only do we not need orders for every task and assessment-we do not want them. Nursing is a profession. Nurses own the profession of nursing. By extension, neuroscience nurses own the profession of neuroscience nursing.
I know from my travels, visits, friends, and social media that nurses are, in fact, owning our profession. With that in mind, the Journal of Neuroscience Nursing (JNN) is seeking evidence to support the statement that "neuroscience nurses own the profession of neuroscience nursing." Submit a reflections article to JNN, and share your research results, your success stories, and professional practice pearls. Help JNN build the body evidence to reject the null hypothesis that "it wasn't ordered."
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