There’s a lot of talk these days about healthcare reform. Many change-weary nurses are bracing themselves as they ponder the future. What new rules will now dictate patient care? How much new documentation will be required? Most importantly, who will replace us at our patients’ bedsides while we implement these new requirements?

In some facilities, nurses may also wonder, “Did anyone ask for my opinion?”

While we all recognize the value of evidence-based practice and new technology, it can be difficult for the bedside nurse to find time or energy to keep pace with ever-changing policies and procedures. In order for nurses to buy into new guidelines, we need to believe that the changes are meaningful. Of course, some changes would be welcomed by any nurse. For instance, who doesn’t crave lower patient-nurse ratios, more support staff, and a steady stream of supplies?

Nursing is an evolving art, based on new knowledge, emerging technology and solid scientific evidence. Yet, it can be hard to face the idea of change when we are elbow-deep in bedside care. The bedside nurse’s immediate focus is, rightly, on the task at hand. We cannot afford to be distracted from our daily duties, whether we are adjusting bedpans or intravenous drips. Our undivided attention is vital to safe and effective patient care. This is why nurses need to be given structured time, away from the bedside, to engage in healthcare planning.

It is at the bedside where we often see, first-hand, the need for change. We also see the direct effect of new policies on our patient care and our workload. Bedside nurses literally have our fingers on the pulse of this country’s health. We are, therefore, instrumental to maintaining any meaningful change. Our ideas must be included in any sensible healthcare reform measures. But, how can administrators realistically include bedside nurses in policy-making and administrative decisions?

At the same time, how can bedside nurses reasonably challenge the status quo, or establish new traditions, when we are so busy with patient care? Upon learning of a proposed administrative change in bedside documentation, I once heard a staff nurse laughingly ask, “Can I have my own nurse to complete my daily loads of documentation? Then, maybe I’ll have time to go about the business of providing nursing care to my patients.”

Unfortunately, no bedside nurse has the luxury of a personal secretary or an administrative assistant. Everyone laughed at his joke, but this nurse’s question begs another. How many administrators have recently worked at the bedside and truly understand the impact of new policies on the nature of today’s bedside care? Then again, how many bedside nurses honestly grasp the facility-wide impact and global implications of many of their daily activities?

I believe it is possible for us to have a meeting of the minds.

For bedside nurses, it ultimately seems to come down to us. Our patient. Our tasks. Our interruptions. Our documentation. Our personal liabilities. It can be hard to fit administrative concerns into this picture. But, it is vital that we do just that. We need to be kept abreast of global implications of our decisions. We are all in this together. The team concept is both lateral and horizontal.

Nurses are more likely to embrace change when we can see the implications of our actions. We need frequent glimpses of the “big picture.” This can occur through informal meetings or computerized presentations. It can also happen through mentoring. Administrators can help broaden nurses’ viewpoints by including them in policy-making decisions and providing professional growth opportunities, away from the bedside.

This would allow nurses to see, firsthand, the effects of our daily decisions on overall healthcare.

Tasks performed at the bedside directly relate to broader realities. Take, for instance, the improvement in “patient fall” statistics which can be brought about by merely engaging in hourly rounds. Consider the ability to lower nosocomial infection rates by providing regular oral hygiene to the ventilated patient. Such statistics should be routinely shared with the bedside nurse.

It only takes a moment to grasp the positive impact of our care by viewing a simple graph, correlating a drop in patient fall rates with hourly rounding. What better way to promote new evidence-based practices?

If you could change just one thing in your nursing experience, what would it be? I look forward to hearing from you.