D455 Task 1 Interdisciplinary Leadership Paper Example

Measured, Not Estimated: What Three Clinical Teams Taught Me About the Nursing Role and Leading Change

Student Name

Leavitt School of Health, Western Governors University

D455: Professional Nursing Role Transition, Task 1

Course Instructor

Month Day, Year

Measured, Not Estimated: What Three Clinical Teams Taught Me About the Nursing Role and Leading Change

Introduction

Across my clinical rotations I have worked beside physicians, pharmacists, therapists, social workers, dietitians and many others, but until this course I rarely stopped to ask what made some of those teams work and others stall. This paper summarizes three interdisciplinary experiences from my rotations, describes the roles the team members played, explains why the nursing role was central in each, and then looks at the factors that drive change in clinical settings and why nurses are well placed to lead it. All three experiences are described without names, dates or facility details, and patient information has been changed so that no one can be identified.

Summary of Interdisciplinary Experiences

The first experience took place on a postpartum unit. About forty minutes after a vaginal birth, the nurse I was working with weighed the patient's underpads during a routine check, as the unit's protocol required, and found a cumulative blood loss that had passed the unit's alert threshold, although the patient's heart rate and blood pressure were still normal and she said she felt fine. The nurse called for help using the unit's hemorrhage protocol. Within minutes the obstetrician, an anesthesia provider, a second nurse and the charge nurse were at the bedside, the blood bank had been notified, and a uterotonic medication had been given. The bleeding was controlled without transfusion. What struck me most was that the alarm was raised by a number the nurse had measured, not by a change in vital signs, which would have come later.

The second experience was a weekly treatment team meeting on an adult inpatient psychiatric unit. The psychiatrist, a psychiatric nurse practitioner, the unit's registered nurses, a social worker, an occupational therapist and a peer support specialist met to review each patient's progress and plan for discharge. For one patient, the psychiatrist was ready to discharge based on improved mood in brief daily interviews. The night nurse's notes, read aloud by the charge nurse, described the patient pacing and not sleeping for two nights, and the occupational therapist reported that the patient had not been able to complete a simple budgeting task. The discharge was delayed, a medication adjustment was made and the social worker arranged a partial hospitalization program. The team reached a better decision because each member had seen a different part of the patient's day.

The third experience was on an orthopedic unit, where a patient recovering from hip surgery developed a stage 2 pressure injury on the sacrum. The nurse I followed consulted the wound care nurse, who changed the dressing plan and recommended a pressure-redistributing mattress. The dietitian found that the patient had been eating less than half of each meal and started a protein supplement, and the physical therapist added a second daily session to get the patient out of bed. The team met briefly at the bedside, and the nurse wrote a turning and mobility schedule that tied each discipline's plan to specific times of day. The injury was healing when my rotation ended.

Roles of the Team Members

In the postpartum emergency, roles were defined in advance by the hemorrhage protocol. The primary nurse measured blood loss, recognized the threshold and activated the response. The obstetrician examined the patient, identified uterine atony and directed treatment. The anesthesia provider assessed the airway and prepared for sedation if a procedure was needed, and the second nurse started a second intravenous line and gave medications. The charge nurse called the blood bank and kept a running record of times and doses so the team could see what had been done. Because each person knew their part, no time was spent deciding who would do what.

The psychiatric treatment team worked differently, because it was a planned meeting rather than an emergency. The psychiatrist led decisions about diagnosis and medication, the nurse practitioner managed physical health problems and some prescribing, the social worker handled housing, benefits and aftercare, the occupational therapist assessed daily living skills and the peer support specialist spoke from lived experience about what patients were likely to need after discharge. The registered nurses brought something none of the others had: a continuous account of the patient across twenty-four hours.

On the orthopedic unit, roles were organized around consultation. The wound care nurse and the dietitian each assessed the patient and made recommendations within their expertise, and the physical therapist set mobility goals. None of them, however, was present at the bedside for more than a short time each day. Interprofessional practice depends on each member understanding the roles and responsibilities of the others and using that knowledge to meet the patient's needs (Interprofessional Education Collaborative [IPEC], 2023), and in this case the nurse turned three separate sets of recommendations into one plan the patient could follow.

Importance of the Nursing Role

In all three experiences the nurse was the member of the team who was present the longest and saw the most of the patient's day, and that presence made the nurse essential in three ways. The first is surveillance. The postpartum nurse detected hemorrhage before vital signs changed, and the psychiatric night nurse recorded the pacing and sleeplessness that the brief daytime interviews had missed. Other team members see the patient in snapshots; the nurse sees the film.

The second is coordination. On the orthopedic unit, the wound nurse, dietitian and physical therapist each gave good advice, but it was the bedside nurse who fit their recommendations into a schedule of turns, meals and walks that could actually happen on a busy unit. Research on healthcare teams has found that teamwork depends heavily on shared understanding of the plan and on clear communication about who is doing what (Rosen et al., 2018). In these experiences, the nurse was usually the person holding that shared understanding.

The third is advocacy. In the treatment team meeting, reading the night nurse's notes aloud changed the decision, because it put the patient's actual behavior in front of the people making the choice. A nurse who stays silent in a meeting, or who assumes that the physician already knows, removes that safeguard. I saw that advocacy is often less about disagreeing than about making sure the right information reaches the table.

Factors That Drive Change in Clinical Settings

Change in the settings I saw was driven by several identifiable factors. The first is evidence. The postpartum unit's use of measured blood loss is a recent change in many hospitals, prompted by evidence that visual estimation is inaccurate and often underestimates hemorrhage; national obstetric guidance now recommends quantitative measurement of blood loss after every birth (American College of Obstetricians and Gynecologists [ACOG], 2019). The second is safety events. Nurses on that unit told me the protocol was adopted after a hemorrhage in which the patient's blood loss was recognized late. The third is regulation and accreditation, which set expectations that units must meet. The fourth is staffing and workload: on the orthopedic unit, pressure injury prevention competed with admissions and discharges, and the unit's charge nurse said the turning schedule had to be simple or it would not survive a short-staffed shift. The fifth is technology, such as electronic prompts that remind nurses to document blood loss or reassess skin at set intervals. The last is the patients themselves. The psychiatric unit had begun including peer support specialists after patients and families asked for them, a change driven by people receiving care rather than by staff.

Why Nurses Are Instrumental in Leading Change

Nurses are positioned to lead change for reasons that follow from their role. They are the largest group of health professionals and are present in almost every setting at every hour, so they see which processes fail and how often. They carry out most of the steps in patient care processes, so a change that does not work for nurses will not work at all. They work across disciplines every day, so they understand what each profession needs from a new process. The National Academies, looking ahead to 2030, called for nurses to be fully engaged in leadership and decision-making if health systems are to improve care and advance health equity (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021), a call that assumes nurses are ready to lead.

The postpartum unit's move from estimated to measured blood loss is a clear example. According to the nurses who worked there, the change was led by a staff nurse on the unit's practice council. After the late-recognized hemorrhage, that nurse brought published guidance to the council, persuaded the physicians to adopt a shared protocol, arranged for scales and pre-weighed pads to be stocked in every room, taught the method to her colleagues and tracked how often measured blood loss was documented until it became routine. The change worked because it was designed by someone who knew exactly where a nurse would stand, what that nurse would be holding and how many minutes she would have. Watching the protocol work on the day I was there, I understood that a nurse's leadership does not depend on a title. It depends on seeing a problem clearly and being willing to take the first step toward fixing it.

Conclusion

These three experiences showed me teams working in different ways, in an emergency, in a planned meeting and through consultation, and in each the nurse's continuous presence at the bedside supplied information and coordination that no other discipline could. They also showed me that change in clinical practice comes from evidence, safety events, regulation, staffing, technology and patients, and that nurses are often best placed to turn those pressures into practical new routines. As I move into practice as a new graduate nurse, I intend to speak up in team settings with specific observations, to learn how my unit's practice council works and to look for the small, measurable changes that a staff nurse can lead.

References

American College of Obstetricians and Gynecologists. (2019). Quantitative blood loss in obstetric hemorrhage (ACOG Committee Opinion No. 794). Obstetrics & Gynecology, 134(6), e150-e156. https://doi.org/10.1097/AOG.0000000000003564

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433-450. https://doi.org/10.1037/amp0000298