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Technology tells two tales of nursing’s past

Liz Engel Clark
Monday, Jun 4, 2012

Linda Crawford.

It’s hard to imagine that technology has touched an industry more than the ever-changing medical care field – there’s the paperless records, da Vinci robots and always-evolving imaging improvements. All are advances at work right now in the Upper Cumberland.

But tech’s great effect is particularly evident in one the most recently completed capital projects at Cookeville Regional Medical Center – a series of six new operating rooms. The rooms, with 250-square-feet more wiggle room than before, can more safely house state-of-the-art equipment and allow for more complicated procedures. The project, hospital officials say, will prepare them for technological advances five to 10 years down the road, which, for two long-time nurses, Darla Cline, RN, OR manager, and Linda Crawford, chief clinical officer at CRMC, that means the sky’s the limit.

“The integration in the new OR’s is better or equal to any other in the state,” Cline said. “It’s patient-centric. The information and connectivity is really a great part of that – we can pull up the X-rays, any of the patient information we need, and put it on a screen. You don’t really have to have a hard (X-ray) film.”

Cline, a graduate of East Tennessee State University (ETSU), started her OR career back in 1975, a time when pay for nurses, she said, was around $3 an hour. She initially worked on the medical-surgical floor but liked the operating room better, partly because it had more gadgets. She’s been at Cookeville Regional for nearly five years.

“Even with the old technology, there were more buttons to push and more monitors (to check). I just liked it,” she said. “(Nursing) is my calling and what I really wanted to do.”

Crawford, meanwhile, wanted to be a nurse for as long as she can remember. She started out as an LPN, then received her RN degree as well as her master’s in nursing. She also attended ETSU. She’s worked in a variety of positions over the years – at a doctor’s office, as an instructor at Tennessee Tech, as a staff nurse in the hospital. Now, she’s in administration; ironically, management was never the long-term goal.

“I didn’t aggressively go out and pursue that,” she said. “It wasn’t, actually ever, in my plans. But I kept being put in leadership positions, so here I am.”
She says the da Vinci robot, which allows surgeons to perform more minimally-invasive procedures, is one of the biggest technology changes, particularly in the OR, in recent years, but even more basic shifts, like improved IV pumps, have changed the game completely.

“For me, because everybody had to learn to give IVs as a nurse, that’s a total change,” Crawford said. “When I started, you actually had a glass bottle of IV fluid and a watch. You’d hang up that glass bottle and count to make sure enough drops were dropping per minute to get the patient what they needed. Look at where we are now. You have smart pumps that you can program, and it knows the maximum dose allowable, (etc). These are being used everyday and on practically every hospitalized patient in America.”

The hospital, Crawford says, is all the time treating patients who are sicker, meaning technology must keep pace.

“We know for a fact that hospitalized patients are sicker than in the past, and we know because of the acuity level that gets assigned when they come in (to the emergency room),” Crawford said. “Patients that used to be placed in ICU (the intensive care unit), are now placed in step down units. Patients that are in ICU are extremely sick. Everything’s much more complex, and that’s why you have people in the hospital now like clinical pharmacists, because there’s many more medications.”

Currently, the operating room expansion project is in its second phase of construction, which means the remaining old OR’s will receive a facelift and more patient recovery rooms will be added, Cline said. That process should be complete by November. And while there’s other improvements inked in the future, particularly an emergency room renovation – “like any business,” Cline says, “you have to have a five- or 10-year plan” – the hospital must maintain its personal touch, the core of all patient care, regardless of what new technology comes down the pipe.

That can often be the toughest challenge when constantly surrounded by computer-based electronic medical record systems (EMRs), online libraries, electronic imaging and non-verbal cues like texting and email.

“I’ve always trusted my gut,” Crawford said. “Sometimes what you’re seeing from a machine and what you’re seeing with your own eyes is just not jiving. As a health care provider you have to say, ‘something’s wrong here.’ Sometimes you can’t even pinpoint it, the patient looks different than he or she did an hour ago, and maybe it’s not manifested itself yet and the changes aren’t (apparent) on the monitor.

“You can’t ever get away from that human touch,” she said, “that human intuition. That’s something we must maintain.”

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