President’s Column: Learning to Shift

Oct 01, 2018

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I love the fall and October in particular. There are a number of reasons for this — and one big reason is it’s time for the World Series. As a self-proclaimed sports enthusiast, I love baseball!

I basically lived at a baseball field watching my son play for the better part of 18 years. In all those years of sitting in the bleachers, I learned that much of the strategy is based on statistics. Statistics about the batter, pitcher, catcher, fielder and any of those positions in combination. Not sure what I mean? Let me share an example.

A batter comes up to bat, and you notice the opposing team in the field “shift.” The players on the field have all shifted to one side of the field, say the right side. This leaves the left side of the field open without a fielder. Statistics about where the batter hits the ball are kept for each at-bat, and this informs the fielders about where to position themselves to maximize the likelihood of catching the ball when it’s hit. In this case, the likelihood is high the batter will hit the ball to the right side.

To me, this example is very similar to the strategies nurses implement every day to increase the likelihood that patients will have positive outcomes. Take the practice of passive leg raising to determine if a patient will be responsive to fluid administration. Statistics indicate that only about 50 percent of patients in shock respond to a fluid bolus with an increase in stroke volume. So, in a way, it’s a coin flip to determine if it will work. Additional research tells us that passive leg raising in specific situations will aid in predicting which patients will realize an increase in stroke volume with a fluid bolus.

So why don’t all healthcare providers — especially nurses — use passive leg raising to inform their practice?

Barriers to implementing research into practice include lack of time, lack of organizational support and inability to develop evidence- based guidelines. But another key barrier is clinician behavior. For change to happen, current behavior has to be unlearned, and new behavior learned and then adopted. The process of unlearning can be difficult. I must admit that, like many of my colleagues, throughout my career what I have known to be good science and valid research has been tested by what I’ll call the “n of one phenomenon” — being swayed negatively by one patient outcome contrary to the evidence.

But our voice is stronger when we use objective evidence to support our practice. Our Voice, Our Strength comes from a united voice supported by our nursing body of knowledge.

Let’s go back to our baseball example of “shifting.” Does the shifting strategy ever fail? Of course! But that is what makes watching the game exciting … waiting, hoping, cheering that the batter beats the odds and hits the ball to the open part of the field for a hit. It’s all part of the Old Ballgame.

Let me know how you use objective evidence to support your practice at at