Hill’s Side

For this issue of Johns Hopkins Nursing, with its focus on the Hopkins Nursing “brand” and on 2006 Homecoming events, it seems appropriate to share my column with a very special Hopkins Nurse, Barbara Donaho ’56, RN, MA, FAAN. Barbara, a former Johns Hopkins University Trustee, who in 1991 was named one of the University’s Distinguished Alumni, has been a nurse leader throughout her career and is recognized nationwide as an expert on hospital nursing.

At this year’s homecoming meeting, we heard her speak on “Strengthening Hospital Nursing.” Following is an excerpted version of the speech. It may be viewed in its entirety at /alumni.

Martha N. Hill, PhD, RN ’64, FAAN

“I have been asked to speak about nursing today and in the near future.  Let me try to place before you a few characteristics…

“First—technology is the most critical change in the hospital environment and in all practice settings. Whether it is taking vital signs, recording information, doing diagnostic work, or a means of communication—we are in a high-tech era and it is only going to become more so…

“This tech explosion has changed the entire face of a hospital—and for patients and families it has created more anxiety and at the same time some comfort if they believe the staff know what to do with all the funny lines and the vast array of numbers on the screen.

“Second—the time allotted for staff to know the patient and family is so reduced it is almost impossible to do more than deal with the crisis of the moment. I am sure we all remember the detailed care plans we produced … plans today are short term and relate to prevention of crisis, and maybe some information the patient and family need at discharge…

“Third—the era of quality assurance has arrived. There is an effort to change the systems that support care, which studies have shown are more often than not the cause of serious mishaps that harm patients. When mortality data became public…serious efforts were undertaken to reduce these errors and the potential for serious harm to the patient.

“Fourth—the nursing shortage is key to the quality of health care in the country. The imbalance of baccalaureate education compared to other forms of nursing preparation leaves a huge shortage of leadership on the patient care units and within the institution itself. Great pressure is and will continue to be placed on the shoulders of the professionally prepared nurse to safeguard the quality of care within the institutional setting…

“Now to the challenges nurses and the profession will face.

“First—keeping pace with the knowledge explosion and what to do with the amazing amount of information the technology surrounding the patient has made available. Because many of the other professionals spend even less time with the patient and family, it is the professional nurse’s obligation to keep abreast of the data, translate it into meaningful information, and get it to the appropriate colleague so that correct and responsive action is taken…the success of recovery is dependent on communication between the primary physicians or to the staff in other care settings—ICU, step down units, rehab units, nursing homes, assisted living facilities, or home with the family. Navigating the continuum of care unfortunately continues to fall to the patient and the patient’s family.…Home-going information is critical.

“Second—the professional nurse leader must be just that: the leader. We have come full cycle in the past 50 years. Remember when Eleanor Lambertsen came to Hopkins to introduce Team Nursing? Her day has come again. The team is back—only today it is an interdisciplinary team and it crosses the many and various settings of care.

“Third—the most critical issue hospitals and other care settings face—the lack of prepared leadership … not only for directing or coordinating care, but also for providing care. It cannot be accomplished without strong, educated leadership. Both clinical and managerial skill sets are needed…

“The educated nursing professional must be willing to speak up and challenge what they know to be wrong and what must change. That is a great risk in today’s environment, but one that must be taken by the true professional nurse if care is to improve and be safe for patients…

“Nursing has the opportunity to take a major role in improving the way care is delivered in this country—and I am confident that our Johns Hopkins University School of Nursing graduates, with the heritage of which we are so proud, will meet the challenge…”

—Barbara Donaho ’56

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