Barriers to Patient-Centered Care

Nurses seek solutions to concerns about the profession

“We’re hearing more and more there are barriers to practice.” Clareen Wiencek, RN, PhD, ACNP, ACHPN, president-elect of AACN said that to a group of nurses at the 2015 TRENDS in Critical Care Nursing conference. The assembled nurses were there for a round-table discussion on the barriers to patient-centered care. Together with Barbara Chamberlain, RN, PhD, APN, MBA, CCRN, the president of the SEPA chapter of AACN, she asked the audience to share their top concerns about the current state of nursing.

1. Financial Barriers
Financial troubles at some healthcare organization mean nurses who leave aren’t always replaced, causing a bigger workload for the remaining staff. At hospitals trying to achieve Magnet Status, nurses interested in the process need to attend many meetings. Those meetings are sometimes held outside nurses’ regular shifts and they aren’t always compensated for their time.

2. Less Respect from Institutions
“There’s nothing backing up the nurse,” said one participant. “There’s no support or level of professionalism.” Several nurses mentioned the lack of ancillary support at their institutions. Another told the story of a time she was reprimanded for not leaving on time, even though that meant she had to leave charting incomplete.

3. High Turnover
Both among nursing staff and patients, there is a high turnover rate. The nurses in the audience felt they have lost sight of the fact that the reason they are there is to take care of people. In terms of the patients, as one nurse said, “People leave quicker and sicker.”

4. Increased Documentation Demands
More and more, bed-side nurses are asked to document in real time. “I seem to be spending more time on my computer then touching my patients,” said one participant. Other nurses in the audience felt the pressure to document, document, document-or else have the fear of a lawsuit hanging over their heads.

5. Progressive Mobility-Is it Good for the Patient?
Getting patients up and of bed sooner is becoming a mandate in the ICU. But as the audience members asked, where is the support? One nurse explained how nurses in her unit are expected to mobilize all patients on ventilators, with only one physical therapist to help them. How can nurses get larger patients up and moving without lifts or manual support was another concern.

6. Negative Perceptions
One participant, who works to recruit students into the field, said they would ask her, “Why would I want to become a nurse? I’d get hurt.” Such negative perceptions by the general public are contributing to a nursing shortage.

7. Inconsistent Leadership
Nurses need support from hospital leadership. Several nurses talked about the correlation between lack of interest on behalf of the higher-ups and workplace morale. One nurse relayed the story of trying to implement lessons she learned at a nursing conference. She was dismissed and told, “That’s not how we do things here.”

8. Lack of Manager Engagement
Managers don’t want to engage,” said one nurse. A common perception is managers spend too much time in meetings and on committees and not enough time on the patient floor.

9. No Support for Education
Several participants bemoaned the lack of money for continuing education opportunities. Others mentioned they do not get adequate paid-time each year to complete their CE requirements. “It’s up to us to build up our own skills,” said one audience member.

10. Disconnect between Numbers and the Patient
The nurses took issue with the fact there is too much focus on metrics and patient-centered care is lost. “That’s why we went into nursing,” said one audience member.

Brainstorming a Better Future
With all these issues, a common resignation of nursing staff is to just “make do.” But what if that were not the case. Wiencek and Chamberlain encouraged the assembled nurses to think of how they could face some of these issues, and not wait for higher-level support.

One attendee said, “We have the responsibility to pull managers to be connected with us. We each drive our managers.”

Wiencek, who teaches at the University of Virginia School of Nursing, said she was impressed with the resiliency and mindfulness skills integrated into the curriculum. Teaching nurses the importance of caring for themselves is an important step to more fulfilled healthcare professionals.

Other audience members talked about their hospitals intern and extern programs. Those create a smoother transition from the classroom to the workplace and give early-career nurses an extra boost.

Another nurse in attendance said every afternoon, her unit pauses to take a breather. If anyone has any concerns at that time, they share them with the group. Everyone works together to think of solutions.

One nurse summed up the challenge facing all nurses. “We have to become excellent.” Challenges will always exist. When nursing staff takes ownership of their careers, they can begin to chip away at those barriers to patient-centered care.

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