Spine Program Nursing, Stephanie Johnstone, Casa Colina

I educate the staff, including new nurse graduates, and I work with all of the units (including PACU, preop, med-surg, and ICU) on spine patient care to make certain that each patient has a comprehensive individualized discharge plan.

I continue to follow spine surgery patients for a year, so I am available if they have questions or need support, and I report outcomes to the care team and leadership.

Are there any cases you can share to illustrate how your program works?

We had a patient of advanced age who had never had any type of surgery whatsoever and was very frightened about the prospect. She was independent and lived alone, but had lumbar issues that were causing difficulty with walking, so something clearly had to be done.

When she met with the surgeon, the staff gave her a brochure about our program, and she called me. I encouraged her to take our presurgical class so that she could make an educated decision. The reassurance the class provided led her to go through with the surgery.

She went home a day and a half after surgery and was ambulating without her walker two weeks later. Six weeks postoperatively, she was back to normal — pain-free, independent, and not using any assistive devices.

We also had a 28-year-old patient with a large benign spinal tumor who had never been under anesthesia. She was also very frightened before surgery, and was too scared postoperatively to get up from a supine position.

I worked with her fear, encouraged her, and established a therapeutic relationship built on trust. In coordination with the physical therapist, we got her up and moving. She continued to build confidence in ambulation and was nearly independent before discharge. I spoke with her sometime later, and she was doing well at home.

What do you see as the future of integrating tech and IT with nursing and the delivery of patient care?

There’s new technology constantly coming into play in neuro, cardiac, oncology, and many other areas of patient care. We now have networking capabilities in the OR, as well as advances in robotics, implantable devices, and other technological developments. Even things like bladder scanners are more advanced now.

We need to increase nurses’ comfort with technology. Issues around digital security and privacy are increasingly important, as is making sure that staff are up to date on how to keep data safe.

Technology is changing education too. We currently have a series of animated videos available on our website for patient education, but I look forward to the day when we can leverage virtual, mixed, and augmented reality to take patient education to the next level.

What will it take to become Joint Commission certified?

The Joint Commission looks closely at the flow and continuum of care beyond surgery. They require that we track at least 200 patients through the entire continuum, with standardized delivery of care.

Because our surgeons use a different EMR system than the hospital does for clinic visits, I’ve been working on creative ways to bridge the two systems to satisfy Joint Commission requirements.

Another challenge is that our patients come from all over California, and sometimes from out of state. Linking their continuum of care over the course of treatment and recovery can be challenging, and requires a great deal of coordination, data collection, and reporting. I am working diligently on putting the appropriate processes in place to meet the rigorous requirements for certification.

What do you foresee in the future for yourself, professionally speaking?

I love education, but I currently have one daughter finishing her master’s, and another to get through nursing school. Maybe after both of my daughters are finished, I’ll go back to school myself.

What I do know for certain is that, no matter what I study or what I do, I’ll always find ways to work in a clinical setting, because I love working with patients and healthcare workers.

KEITH CARLSON, RN, BSN, NC-BC, has worked as a nurse since 1996 and offers expert professional coaching at www.nursekeith.com.

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