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An Insult to Nurses!
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Jon Landis, RN, CCRN Portland, Oregon
Send letter to journal:
kuma13{at}comcast.net Jon Landis
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Yet another article that degrades our profession. This study by Malesker and colleagues was written by 4 pharmacists, 1 physician, and ONE token nurse. It examines the suboptimal delivery of tight glycemic control in the inpatient setting. Methods used were time-motion analysis, chart review, and a survey. Just prior to the conclusion and recommendations of the article, the authors state that "[b]ecause the times for blood glucose determinations were outside the accepted range of +/- 15 minutes more than 75% of the time, perhaps the nurses simply did not appreciate the importance of the TGCP." This statement is insulting at best, professional slander at worst. Critical care nurses are highly intelligent, highly motivated, highly educated professionals. At my institution we adopted TGCP several years ago. Although I have not personally conducted a time-motion study or a survey, I can say from personal experience and observation that when the protocol is not followed it is not because my coworkers or I don't appreciate the need for tight glycemic control. Our protocol mandates glucose checks every hour. When you have 2 patients, both of whom are on an intensive insulin protocol, you are very busy just shuttling back and forth between the two rooms trying to adhere to the protocol. Very little time is left to do all the "other" things required in intensive care, such as care planning, patient advocacy, teaching, and patient/family emotional support. Despite the critical nature of tight glycemic control, our institution does not recognize the higher acuity of this activity. Obtaining one to one staffing is rare. Critical care nurses prioritize care. The study noted elapses of time (from meter pickup to intervention) and rarely noted the reason for the time lapse. It is likely due to patient care with that patient or with another patient. I, for one, rarely enjoy a regular lunch break. Instead of assuming that nurses "simply did not appreciate the importance" of this protocol, perhaps the authors and the American Journal of Critical Care could advocate for increased staffing. Give nurses the tools to do well and they will do well. FINANCIAL DISCLOSURES
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