Changes….

As I sit in a class called Advanced Stroke Life Support and listen to all the new changes in stroke care, I reflect on how medicine continually changes. Practices that once were unheard of are now routine in today's nursing world. In the early 1970s I was taught by my mentors that a stroke was one of the worst death sentences to quality of life that could be delivered to a patient and his or her family. Their future was one of bedpans, bed baths, constant care, and a permanent loss of quality of life. In the year 2007, if caught early enough, one can see a patient's stroke dissolve before one's very eyes. I am amazed by medical advances and how frequently and rapidly practices change.

There has been a great deal of research and change in patient care during the past 35 years. Taking a trip down memory lane, I remember when we gave everyone D50W and thought it was the right thing to do for brain tissue! How about those MAST trousers? They were going to change the world of trauma and shock resuscitation. I remember one of our cardiologists in the early 1980s being called a radical physician and a “quack” by other physicians for suggesting the use of thrombolytics in the care of a patient with an acute myocardial infarction. Have we not changed a great deal over the years?

Change is difficult to accept and has been since the beginning of my nursing career. How many times have you said, “Why can't things just stay the same? Why do they have to change?” I have said those words myself as a staff nurse, educator, and manager. (Remember those American Heart Association changes to ACLS, BLS, and PALS every 4 years?) But then I think about all the lives that have been saved, the disability that has been avoided, and the good outcomes that we see for patients, families, and their loved ones. A single presentation of a “good” change seems to make the discomfort of change less difficult to accept.

In recent literature one can read about “change fatigue.” With the inception of the Internet, information is automatic and constant. With every new research study, we alter our practice to make improvements for our patients. With that constant change comes the discomfort of learning new policies, procedures, and practices to deliver better care. It seems as if every new program or initiative that someone reads about and wants to implement requires more change. Leaders of nursing are no different. We all want to be the best and deliver excellent care. This causes change, and thus discomfort or stress.

The management of change is critical to our patients. Good direction, good communication, and good governance are key to helping everyone understand and accept new practices in nursing. We all must embrace change and help each other communicate how the evidence shows it is best for our patients, their families, and our emergency nurses. I believe we can step back and ensure that we have all the steps in place so that change is made in the correct manner, with good communication and with proven good outcomes.

I am grateful that change helps patients. I am sad that nurses have to accept constant change and feel the accompanying frustration, but we have each other for support. We have each other for understanding. We have each other to see that change often is best for patient care.