Northwest Health | WINTER 2008 By Ginny Smith

Most people no longer think of nurses as the early-era physicians' helper in starched white uniform and cap. But few realize just how important and far reaching the role of nursing has become in health care today. With more education, specialization, and responsibility than ever, nurses are often pivotal to the wellness of a broad mix of patients.

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When it comes to your ongoing care, coaching, and troubleshooting, nurses will likely be your first line of support. Let's say you've just been diagnosed with diabetes and are trying to figure out what to eat and how to monitor your blood sugar. A nurse will help you develop a plan and set goals for managing your condition. Planning a trip to Zimbabwe and don't know what medications to take? Ask the nurse at Group Health's Travel Advisory Service. Just been put on warfarin, a blood thinner? You'll need careful monitoring, which, again, nurses will oversee.

"It used to be that patients' access to care was primarily through their personal physician," says Group Health's Barbara Trehearne, RN, PhD, executive director of Nursing Operations. "Now, physicians diagnose health problems and lay out a treatment plan. Nurses coordinate much of the care after that. They spend a lot of time with patients on the phone, assessing concerns, triaging problems, and determining who needs to be seen by a physician. Group Health also relies heavily on nurses for consulting nurse services, case management, and home care." The organization has about 900 registered nurses, 340 licensed practical nurses, and 280 medical assistants.

Added Responsibilities
Here are a few of the areas where nurses have taken on added responsibility in recent years:

Chronic wound care. "People with chronic conditions like diabetes or vascular problems often develop skin ulcers or sores that must be managed on an ongoing basis," says Karen Wulff, RN, director, Nursing Operations. "Nurses receive special training in the latest wound care techniques and products and are able to either support the patient in healing their wounds or minimize the severity of these wounds. It's a very successful program."

Anticoagulation management. If medications, diet, exercise, or other factors aren't in perfect balance, patients taking the blood thinner warfarin (Coumadin) can bleed or develop blood clots.

"By working closely with patients, nurses can make speedy lifesaving adjustments," says Priscilla Di Carlo, RN, manager of the Anticoagulation Management Service. "We manage the care of about 5,800 patients, and our track record for keeping patients' blood levels within targeted ranges is phenomenal."

Complex case management. "Nurses are critical in managing the care of patients who have three or more chronic illnesses, several care providers, and are on multiple prescription medications," says Jeanne Mock, RN, clinical nurse specialist for Complex Case Management. "We help patients identify their health care goals, such as caring for themselves at home and staying out of the emergency room and hospital. Then we work with them one-on-one to achieve those goals. We also stay in close contact with the patient's primary care team and specialists throughout the process."

"Complex, chronically ill patients represent 1 percent of our patient population, but about 80 percent of the care Group Health provides," says Trehearne. "These patients are really sick and need intensive resources for a limited time until their condition is improved or they get into a better care setting. Intensive monitoring by nurses helps them keep from getting sicker and learn to take better care of themselves."

Member Karen Jake remembers the help she got from the care management liaison nurses when her mother broke her hip and needed a long-term care facility. "The nurses worked long hours, calling facilities not only here but in another county, and gave me suggestions and tips when I was stressed and overwhelmed."

Better Care
An increasing body of research shows that care provided by nurses consistently results in better health for patients — no doubt from nursing's combination of science, touch, and compassion. Over the years, the Group Health nursing staff has been instrumental in innovations such as nurse telephone triage, emergency room observation units, group visits, and infection control procedures. They've also endeared themselves to countless patients.

"We have long-term relationships with our patients and develop a level of trust and teaching that influences healthy behaviors and a sense of well being over time," says Tricia Hamill, RN, administrator at Silverdale Medical Center.

Countless testimonials from Group Health patients attest to the special care nurses provide. Here's one about Mary Benton, RN, a 2007 KIRO-TV Salute to Nursing honoree:

"Mary has been my nurse in the pulmonary clinic for years. She's calm, professional, empathetic, and has the energy of several people and a megawatt smile. I don't think the clinic could run without her, but then that's true of most Group Health nurses I've encountered."