Myrna B. Schnur, MSN, RN
Clinical Editor, Lippincott NursingCenter.com

Innovation is a word used almost excessively in our society where technology permeates every aspect of our lives. Nowhere is this more evident than in the field of healthcare which has benefited from centuries of new discoveries. Medical innovations such as novel drug therapies that have eradicated diseases, emerging device technologies that have extended lives, electronic medical record systems that have enhanced communication, and advances in process, service delivery, and education that have improved the overall quality of patient care. I have had the privilege of working and experiencing many innovations throughout my 25-year nursing career.

Chapter 1
Beginning in the cardio-thoracic intensive care unit (CT-SICU), I was immediately drawn to the challenging environment where a multitude of technological advances were utilized daily. Each open-heart surgery patient typically arrived to us from the operating room intubated, along with intravenous lines, an arterial line, pulmonary artery (PA) catheter, one or more mediastinal chest tubes, pacing wires with or without an external pacemaker, and a foley catheter. The immediate post-operative period was a delicate balancing act that required careful titration of vasoactive medications and administration of precise amounts of fluid to allow the heart to pump without disrupting fragile coronary grafts. For patients who suffered from complications, additional devices were utilized. We frequently encountered the use of nitric oxide, intra-aortic balloon counter-pulsation, left-ventricular assist devices, bi-ventricular assist devices, extra-corporeal membrane oxygenation (ECMO), and continuous hemofiltration and dialysis. Surrounded by cutting-edge technology was overwhelming at times, and I often felt like a technician managing the machines, desperate to keep each fragile patient alive. It was far from boring, and I grew immensely as a clinician during those years.

Chapter 2
While attending graduate school, I had an opportunity to participate in a team hired to implement a new electronic medical record (EMR) system throughout the university hospital. For most of us working at the bedside, this change in process appeared only as an added bureaucratic burden to our routine. I had no idea at the time how important this technology was and how EMRs would shape healthcare today. The Task Force consisted of nurses from a variety of medical specialties. We assisted health care providers in entering patient orders and educated each staff member to accurately document the medications that were administered as well as each procedure performed. In the intensive care unit, we piloted a program that continuously captured vital signs. We added inputs for physical assessments, titration of vasoactive medications, and changes in ventilator settings. We conducted audits, collected clinician feedback and played an important role in providing input on flow and design to the information technology department. The new system would transform communication among the multidisciplinary team and emerge as a driver in data collection, reimbursement, patient safety, and quality improvement.

Chapter 3
After graduate school, I thought I would pursue a career in EMR systems implementation. The experience proved to be extremely rewarding and the field was swiftly expanding. However, another opportunity presented itself. Instead, I would land in the world of pharmaceutical research working on the early human papilloma virus (HPV) vaccine phase II clinical trials. In terms of innovation, this vaccine would be the first to prevent HPV infection that is responsible for cervical, vaginal, and several other cancers. Again, I was one of several clinical nurses on the team responsible for coordinating the study and ensuring the integrity of the data. The path that a new therapeutic agent moves along on its journey to product approval can be rigorous and long; however, the ultimate public health impact is profound.

Chapter 4
A new stage in my life brought me out west where I made the riskiest career move, or so it seemed at the time. Enamored with the world of high-tech, I interviewed with a start-up company whose goal was to bring simulation technology to the forefront of medicine. Founded on the principles of haptic, or “touch” feedback, the company developed simulations based on endovascular procedures such as coronary angiography, angioplasty and stenting. Working with talented computer engineers, the clinical team developed complex simulations for a variety of medical devices. To expand our reach beyond the cardiac catheterization lab, we created simulations focused on quality improvement initiatives such as sepsis, stroke, heart failure, and ventilator-associated pneumonia to name a few. Each simulated scenario began with a patient history, diagnostic studies and relevant laboratory results. The clinician would use this information to formulate a procedural or treatment strategy. This was followed by a fully immersive experience requiring the practitioner to walk through the scenario, perform the procedure, monitor vital signs, administer medications and manage the patient status. The human patient simulator was pre-programmed to respond appropriately to each action and treatment choice. A debrief was conducted to review both the individual and team performance.

Simulation training is an innovative methodology that has evolved over the last two decades to provide practitioners with an opportunity to learn how to use new devices, to manage complex patient diseases and to experience rare complications in a safe, risk-free environment. It also promotes collaboration and improves communication among health care teams. The National League of Nursing (2015) has advocated simulation as a teaching method to prepare nurses for practice and supports the study conducted by the National Council of State Boards of Nursing which concluded that high-quality simulation experiences could be substituted for up to 50% of traditional clinical hours across the prelicensure nursing curriculum (Alexander, et al., 2015).

I had not thought much about innovation in my career until I was asked to write about it for National Nurses Week. I realized that innovation had been interwoven into several chapters of my life and career as a nurse. And conversely, nurses have played an integral role in every area of health care innovation, not limited to those discussed here. Nurses possess an exceptional skill set allowing them to adapt quickly to novel therapeutics, to translate clinical information into technology requirements, to work in a variety of settings including research, and to create high-tech educational platforms that would alter the delivery of training for future generations to come. Nurses are uniquely positioned to influence change, to take on leadership positions to bridge the gap between technology and clinical practice. We, as a profession, are reminded that we have a responsibility to positively guide the impact of innovation to improve safety and the quality of patient care.

References
Alexander, M., Durham, C.F., Hooper, J.I., Jeffries, P.R., Goldman, N., Kardong-Edgren, S… Tillman, C. (2015). NCSBN Simulation Guidelines for Prelicensure Nursing Programs. Journal of Nursing Regulation. 6(3), 39-42. DOI: https://doi.org/10.1016/S2155-8256(15)30783-3

National League for Nursing (2015). NLN Vision: A Vision for Teaching with Simulation. Retrieved from http://www.nln.org/docs/default-source/about/nln-vision-series-(position-statements)/vision-statement-a-vision-for-teaching-with-simulation.pdf?sfvrsn=2