This issue represents the beginning of this journal's 10th year. How time flies! 2008 promises to be an interesting time in healthcare, with an increased focus on the problems plaguing our healthcare system and various thoughts on how to fix them. From my viewpoint, the time has come for all nurses to engage in the national debate over these issues.
As a healthcare attorney, I have seen the same types of problems repeatedly over the course of my career, all of which ultimately result in nurses and hospitals being sued and/or nurses being disciplined by the state licensing authority. Despite the "advances" in the healthcare system over the last 12 years, the same problems persist: poor communication between healthcare providers, inadequate documentation, poor communication between providers and patients/families, and providers assuming responsibility for tasks beyond their training and experience. Every day I see coming across my desk the end product of the nursing shortage and the siege mentality that has taken over many healthcare facilities in today's market.
So what can be done to fix this mess? I propose that although the answer to this question is quite complicated, an essential beginning is that each nurse make a commitment to become involved at some level this year in addressing the problems that plague the system. The situation in which we now find ourselves in healthcare has come about in large part, I believe, because of the fact that the voice of the bedside nurse has not been heard. It has not been heard by the legislator who is debating how to vote on a law that impacts the practice of nursing. It has not been heard by the health system executive who is worried about meeting a budget despite reduced insurance revenues. It has not been heard by the insurance company employee who is deciding whether to grant or deny coverage for a procedure. It has not been heard by the physician who is deciding how to respond to a request to come to the hospital to evaluate a patient.
As nurse executives and nurse managers, you are in a unique position to increase the chance that the voices of the bedside nurses working for you are heard by those who have the decision-making power in healthcare today. One of the most important things you can do is seek your staff's input and make their thoughts known up the corporate ladder. Second, you can seek out and take opportunities to let other decision makers know the impact on nursing and on patient care of proposed changes to the national system. Many stakeholders are lining up to have a say in this debate. Let us make sure that nurses are heard.
In this issue, our CEU feature discusses the psychiatric advance directive and its implications for nursing care. Our NCSBN column discusses the licensure of advanced practice nurses. Conversations in Ethics for this issue focuses on no-code designations for patients with disability undergoing surgery. Lastly, we are pleased to bring you an article on family presence during codes. As always, your feedback is greatly appreciated. E-mail me at [email protected] with your thoughts and comments. Happy New Year.