Bringing the ‘nursing lens’ to health care and education

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A conversation with UMSN’s 2017 Distinguished Alumni Award recipient, Joanne Disch

Joanne Disch (UMSN Ph.D., 1985) is the inaugural winner of the University of Michigan School of Nursing’s (UMSN) Distinguished Alumni Award. Receiving her Ph.D. in nursing from UMSN in 1985, with a focus on healthcare economics, Disch has gone on to a career dedicated to safety in health care and person and family centered care. She will receive her award on Friday, October 27 at the Homecoming Reunion.

Disch has been a powerful voice for nurses and the critical roles they play, especially in venues where nurses have not historically been represented. She has worked to implement systems for reducing clinical errors, developed clinical learning environments to teach safe practices for new clinicians, and modeled ways in which to make the individual and his or her family a full partner in care.

UMSN’s Kate Wright recently spoke with Disch and asked her to look backwards and forwards, to see where the nursing profession has come from and where it needs to go to meet the challenges of the future.

Kate Wright (KW): Your nomination for Distinguished Alumni Award states: “A distinct contribution is Joanne’s work on non-nursing boards and committees, which articulates the power of a nursing presence in decision-making circles.”

Can you give an example of the “power of a nursing presence”?

Joanne Disch (JD): I’ve long talked of ‘the nursing lens’ which is the perspective that nurses have when looking at health care or, actually, the world. It’s holistic, relationship-based, system-oriented, pragmatic and individualized to what the person or the family needs. Bringing this lens to any situation offers a useful approach for reframing issues and solving problems.

An example of this holistic, system-oriented view is one occasion when a health system, on which board I served, was planning to introduce electronic health records (EHR). The plan was to move one group at a time to EHR, first nurses, then physicians. I pointed out the unintended consequences of this idea. How would they share assessments of a patient? Would nurses enter physicians’ orders? This would create incredible interprofessional conflict. The board changed the plan to bring everybody on board at the same time. 

KW: Do you feel that nurses are now included enough in national health care leadership?

JD: No, but it’s getting better slowly. The public – and organizational leaders – understand and greatly appreciate the role of the nurse as the backbone of providing excellent care. But understanding the strategic and logistical insights that nurses bring is not as well understood.

KW: You started as a staff nurse in 1968. Can you reflect on how nurses’ roles have changed in hospitals and health care centers since then?

JD: Nurses have always been the cornerstone of care in hospitals. One thing that’s different now is that nurses are practicing in so many settings and roles that didn’t exist earlier.  Nurses, nurse practitioners, and clinical nurse specialists are in various roles in ambulatory care facilities, pharmaceutical and medical device companies, and in large corporations such as Target and CVS. Given our expertise in understanding systems and finding pragmatic solutions, it’s no surprise nurses are moving into leadership roles in all sectors.

KW: You have emphasized safety in hospitals and nurse education for safer health care. What inspired you to focus on that? What work are you most proud of in the area of safety?

JD: Nurses are often called ‘the safety net of health care.’ In every setting, we are the health care professionals at the point of care and able to intervene to prevent errors and near-misses.  But care has become so complex today, and the time frame has shrunk dramatically. When I began practicing in the cardiovascular surgical intensive care unit (ICU) in the late 1960s, we would have patients with us for four to six weeks.

Today, for comparable care, patients would be in the hospital for three to four days. The number of drugs, tests and treatments has also risen exponentially, so what nurses have to remember is extraordinary. The chance for error has grown accordingly and vigilance is not enough. What is needed are information systems that integrate needed data, access to the latest evidence, and greater attention to teamwork and collaboration.

In the safety arena, I’m proudest of the work that I’ve done with the Quality and Safety Education for Nurses (QSEN) initiative. With the other members of the leadership team, we developed quality and safety competencies for safe nursing practice and then helped faculty learn how to teach them. Students now graduate with better preparation to practice safely in today’s complex health care environment. 

KW: You have also led the emphasis on person and family centered care. Can you explain why person and family center care is important?

JD: As a nurse, the focus is always to improve the quality and safety of patient care. Over the years, however, many health care providers forgot that while we might be the experts in a particular condition or disease, the patient and family are experts in the individual’s history, background and preferences. We need to be partners with them. This is a big change from how health care had been delivered.

We needed to recognize that the caregiver-receiver relationship extends beyond the hospital, and that many of the people with whom we interact in a care relationship aren’t actually patients. This includes children in schools, residents of community centers, or former patients. Hence, I have become an active proponent of ‘person and family-centered care,’ and co-authored a book with Jane H. Barnsteiner and Mary K. Walton on it.

(Ed. note: Person and Family Centered Care by Barnsteiner, Disch and Walton received the first place award in the 2014 American Journal of Nursing Book of the Year award, in the Nursing Management/Leadership category.)   

KW: If you could change three things about the health care system in this country, what would they be?

JD: First, move toward a single payer system. Second, direct more resources toward social determinants of health. This means adequate housing and food, good schools, safe neighborhoods, and meaningful work. Third, remove needless barriers to practice so that all health care providers can practice to the full extent of their preparation, licensure and certification.