The Pulse | Thursday, June 4, 2020

GI Nursing: Become Your Own Advocate

Muriel Moyo, MS BSN RN CCRN-K NE-BC, shares her thoughts on the importance of advocacy in GI nursing. Moyo outlines the unique nature of GI patient care settings, mandatory ratios in procedural areas and how you can become an advocate for yourself and your specialty.  

Why is advocating for GI nurses so important?

GI nursing is a specialty area in nursing. GI nurses possess a unique skill set which hovers between ambulatory, emergency and critical care nursing. We need to rapidly assess, triage and fast-flow patients. At the same time, we must manage high acuity patients (such as acute GI bleeds) and have the ability to sedate patients or care for patients under anesthesia.

GI nurses spend a significant amount of time coordinating patient care, including pre- and post-op phone calls, setting up and turning over their procedure rooms and even handling audits. These are non-direct care actives which are intangible and do not reflect on actual productivity metrics (i.e., patient volumes divided by hours worked). While that may be the case, all these activities are imperative for optimal patient outcomes and overall performance of the department. The outlined differences and unique nature of the GI patient care setting makes it crucial to advocate for GI nurses.

What are your thoughts on mandating staffing in regard to inpatient nurse-to-patient staffing ratios?

I think there is value in mandatory ratios, especially in this era of value-based care. It is imperative that nurses have a manageable number of patients. This allows for focused care, which in turn optimizes outcomes and drives key performance metrics. There is a downside to mandatory ratios — for example, when patient acuity does not match the mandated ratios. A nurse may have lower acuity patients, but that nurse cannot be assigned more than what is outlined for the department per mandatory ratio.  

I do, however, feel there is a need for mandatory ratios in procedural areas such as GI departments, especially as it relates to moderate sedation care in the GI department. Some GI departments only have one registered nurse (RN) sedating the patient and taking care of all other tasks that otherwise, a second circulating could complete. One has to ask how a nurse can safely administer sedation medication and monitor airway and vital signs, while also assisting with other tasks in the procedure room. I believe this lack of mandatory staffing for two nurses in all moderate sedation cases in GI settings compromises patient safety.

How can someone become an advocate for their area?

“Charity begins at home.” I say this because I believe GI nurses need to become their own advocates within their organizations first. This means being visible to the organization, participate in safety or patient-flow huddles and other nursing related meetings, even if those meetings are inpatient focused. GI nurses need to be vocal about the unique needs of their departments. There is a desperate need for GI nurse leaders with strong business acumen that are able to write business cases for additional staffing, write equipment return on investments (ROIs) or justification for capital funds requested. GI nurses can be involved in policy making at state or national level, partnering with lobbyists to address the needs of GI nurses. This does take external motivation and time outside of regular patient care work.

Do you have any advice for nurses just getting started? What’s a good way to make your voice heard?

Every GI nurse needs to know and understand their organization’s mission, vision and goals. By doing so, GI nurses can then understand their overall contribution for organizational success, i.e., gaining a sense of purpose. “Just speak up,” but with that, always explain why in a way that leaders and administrators understand. For example, when GI nurses asking for new endoscopes, what is the “why?” Patient volumes are increasing, so more endoscopes will ensure efficient care and faster patient turnover. More efficiency plus more patient volumes means increased revenue and ROI, increasing organizational success.