What a pain in the abstract

Like all hospitals, GVMH has nurses that function in roles away from the patient bedside.  Over the next couple days we are going look at how the roles of these nurses contribute to better care for our patients.  Today’s blog is by Nancy Engeman and Nancy’s job is to abstract information for our ORYX submission and recommend process changes to improve patient care.  ORYX is a big deal to hospitals as the process helps hospitals identify and work towards best practices and the federal government provides millions of dollars to our hospital to comply.  Here’s Nancy’s story.

 “…there’s some good in this world, Mr. Frodo… and it is worth fight”                      Sam, Lord of the Rings

At Craig’s request, I’m going to try my authors’ pen! I have been asked to provide insight as to why my career has moved from the patient bedside to the current position I hold. Do you ever really know how you get to where you are in life?

My career started as a candy striper. (I hope I spelled that right!) I loved my interactions with patients – and the uniforms were so cute! When I started nursing school, I started working in the float pool at Research Medical Center as a Patient Care Technician. During nursing school, my favorite class was Nursing Research. It really impacted me how some of the simplest acts of care could have the greatest impact on patient outcomes. After graduation I worked on the Cardiac Telemetry Unit. The group of physicians and surgeons I worked with frequently referred to research studies. Discussions on the appropriate application of research to our patient population were common. Employees were expected to participate in a unit committee mine was Quality Improvement.

Once my husband and I had children involved in activities, I found working 12 hour shifts difficult. My first career change was management – but that was like working 5 twelve-hour shifts! After 6 years, I took a low impact position of abstracting charts for cardiovascular procedures. Thus began my next career phase of working behind the scenes. After working with staff for 12 years, I knew the mistakes I was seeing were not from people who did not care, rather there were so many reasons why specific therapy was delayed in getting started. I knew they understood the rationale behind treatments. But the reasons for delays involved other departments, their staff, use of preprinted orders, and even the order in which things were listed on orders impacted patient outcomes. I began working as a Cardiovascular Nurse Clinician. My primary role was to look at processes and how they impact care provided to the patient. I have to say, I have never done anything harder, met more resistance across the board, than when you try to streamline a process. No matter what your approach is, people naturally react as though they are being criticized.

My greatest achievement has been the process revision in the care of a patient who presents to the ER with a specific type of heart attack called a STEMI or ST Elevated Myocardial Infarction. These are the kind we are most familiar with on TV where the patient arrives and actors can tell by the look on your face you are having a heart attack and people start making things happen. Our door to balloon time was on average 210 minutes from arrival (the standard was 90 minutes). That means that half of the patients that presented with heart attacks had times longer than 3 hours to get appropriate treatment. The thorough review and break down of processes to identify how to streamline your approach to care has become the challenge I enjoy. After 12 months of networking with physicians, ER staff and cath lab staff we had some of the best door to balloon times in Kansas City, 56 minutes!

So here I am, working closer to home, providing a different level of care at Golden Valley as a Quality Outcomes Coordinator. I never set out with a plan for my career to lead me here to this point; in fact I can barely describe what I do in ten words or less! At GVMH I review patients who present with the most common diagnoses: heart failure, heart attack, pneumonia, and surgery. My goal is to see that every patient receives the best care possible without the error of poor processes or poor planning impacting their outcomes. Sometimes it is simply rethinking how we complete a task, making sure supplies are where they need to be, and other times it is becoming educated on new information (things have changed in the 20 years I’ve been nursing!)

It is very rewarding to look at outcomes that reflect exceptional care. It is worth fighting for changes that will impact the kind of care we receive at the hospital in our own back yard. After all, the battle I fight for is not only for your loved ones but mine as well, and it is worth it.

About Craig Thompson

I am a young professional with two great sons, and I work in the healthcare setting. I am employed in hospital administration and serve as Chief Executive Officer at Golden Valley Memorial Healthcare in Clinton, Missouri. At GVMH we care for our families, friends and neighbors. We're committed to providing the safest, friendliest and most compassionate care to all we serve.
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