THE NURSE LEADER AS KNOWLEDGE WORKER

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

The healthcare industry is continually growing, with innovations developed each day.

Nursing has transitioned from paper charting to electronic systems, with routine updates to

improve patient outcomes. At Boston Medical Center, the electronic health record (EHR) is used

for documentation of data and a collection of information that providers can reference. There is

an Early Warning Sign (EWS) alert system for nurses and providers to identify patients at high

risk of sepsis or immediate intervention in the EHR. The EWS will provide a score based on

temperature, heart rate, blood pressure, oxygen saturation, and white blood cell count.

The Scenario

Marcy is a night-shift nurse, and she is assigned the charge nurse’s role in the current

shift. She briefly looks at the unit management board to see which rooms are occupied and which

ones are clean. Marcy can also estimate the overall acuity of the unit based on the EWS scores of

each patient. She notices four patients marked yellow (with a score between 3 to 5) on the EWS

system. Upon further inspection, these patients are stable and showing improvement in vital

signs and lab work despite still being in the abnormal range. The primary nurses continue careful

monitoring. Marcy continues to look at the unit board and sees that two other patients are marked

red (score of 6 or higher) on the EWS system. Opening their charts, Marcy gets a pop-up alert

that requires her to notify the provider or on-call ICU nurse for immediate attention. After

confirming with the primary nurses of these patients that providers were notified, Marcy pages

the on-call ICU nurse and notifies him of two patients that may potentially become unstable.

Data Collection and Knowledge

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The EWS score was implemented by the informatics team of Boston Medical Center. The

score is determined by data that is populated in different areas of the patient chart. It allows

healthcare providers to have a quick summary of a patient’s acuity before looking further into the

information. However, the EWS only shows a snapshot of the patients’ most recent data input.

Mastrian and McGonigle (2018) emphasized the importance of timely use of data and that

accurate information used at the right time is imperative (pp. 24). Nurses and doctors can go into

the EHR and look closely at what triggered the EWS alert when assessing a patient. Was it due to

a high heart rate? What could have caused this issue? Data collection can also continue as

doctors can order more lab work or nurses repeating vital signs to ensure accuracy.

At this particular hospital, most patient records have converted electronically. Although

employees may have various formats of charting, the information is accessible as long as it is

relevant to the employee’s field of work and does not violate any privacy policies. Sweeney

(2018) mentions that with the reliance on EHRs, technology brings convenience but introduces

more areas where privacy can be breached. Because Marcy is the charge nurse, and it is her

responsibility to oversee patient safety, she does not violate the organization’s patient privacy

policies. She investigates the patients with high EWS scores and notices that one of the patients

has not had labs drawn in a few days. She communicates this information with the team, who

takes the opportunity to place new orders.

There have also been times where the EWS score may raise new information. Although

the intended use of the EWS is to prevent patients from developing sepsis, it is possible to trigger

the alerts without the involvement of infection. Nurses can view the data presented to them, but

the use of “integrating new knowledge and old knowledge… to enhance wisdom” can be

rewarding and challenging (Mastrian & McGonigle, 2018, pp. 27). For example, a patient can

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develop signs similar to sepsis if they have a history of hypotension and tachycardia but were not

receiving their usual medications. Nurses must be comfortable using technology as a tool but not

to heavily-rely on it without processing the bigger picture. Maintaining awareness on the

reasoning behind the data can help gain knowledge on steps to better patient outcomes, whether

that be maintaining updated data or recognizing that additional data is needed to care for an

unstable patient properly.

Clinical Judgement as a Nurse Leader

If the patients in the scenario are deemed safe to maintain on the current unit, Marcy must

keep this information in mind as a nurse leader. She can use the EWS system as a reference to

create safe nursing assignments for the following shift; however, she can use this experience as a

lesson that the EWS may not be an accurate representation of a patient’s condition. Although she

is not an informatics specialist, Marcy can still recognize that patient care can be complex, and

having fundamental skills in informatics makes a significant difference in her work. Kennedy

and Moen (2017) state that the responsibility of informatic knowledge is not solely on specialists

but should be an essential skill by nurse leaders (pp. 204). Marcy can use clinical reasoning in

making a fair assignment. She can also use her judgment by advocating for her patient if she

feels that there is too little data to determine them to be safely maintained on the unit. Using the

experience can help provide better care in the future and may push nurses like Marcy to

communicate this information to a specialist.

References

Mastrian, K. & McGonigle, D. (2018). Introduction to information, information science, and

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information systems. In D. McGonigle & K.G. Mastrian (Eds.), Nursing informatics and

the foundation of knowledge (4th ed., pp. 24-27). Jones and Bartlett Learning.

Kennedy, M. A., & Moen, A. (2017). Nurse leadership and informatics competencies: Shaping

transformation of professional practice. Studies in Health Technology and Informatics,

232, pp. 197–206.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

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