Respond to the discussion #2 below using the following approach:
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- Offer and support an additional strategy a colleague might use to integrate the principle of stacking into his or her specialty of interest.
- Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
- Ask a probing question, substantiated with additional background information, evidence, or research.
It has been more than 11 years that I have been working as a registered nurse, and yet, I can still remember exactly how I felt after the first time I got pulled to another unit. I had been on my own about a month when I got pulled to the busiest med/surge unit in the hospital. There is no schooling that prepares you for being pulled out of your element, and thrown into an environment where you feel clueless, helpless, intimidated, and scared. I think I cried about 4 times that night, in between round-the-clock pain meds, Q 4 hours antibiotics, and numerous admissions. I remember leaving the hospital the next morning, 2 hours late, and was faced with the aftermath of a blizzard. As I left the building, up to my knees in snow, I headed to my car which I had parked on the street. Physically getting to my car was no easy feat due to the snow. Once I did get to the car and cleaned it off- I couldn’t get the car out of the spot and had to wait to be picked up. Even though I could not wait to get home, and shut my mind off for a little while, none of what happened with the snow mattered. In that time after leaving the hospital- nothing compared to the misery I had felt working that night. It was a horrible, stressful, miserable experience that made me question my career choice over and over again. I still remember to this day the overwhelming relief I felt as soon as I walked out of the hospital doors that morning.
The principle of stacking is the cognitive process, or mental to-do list that a nurse creates to promote good decision making and clinical judgments in order to provide and deliver safe, effective, and quality care to patients (Laureate Education, 2013). Effective ‘stacking’ and the ability to apply it to practice is a concept that is developed through clinical experience and actual provision of care (Ebright, 2010). In my personal experience, the quality of care I delivered that night, as well as the safety of the patients could have been improved by stacking, or cognitively organizing and prioritizing what needed to get done. As an advanced beginner, I mentally listed all of the tasks I had to do throughout my shift, constantly referencing my kardex as Dr. Ebright (2013) said I may. Looking back, at the situation, a proficient or expert nurse would have been able to differentiate between what needed to get done, and what tasks were unnecessary- making the experience less stressful than it was.
A stacking strategy I feel may be helpful in managing the complexity of nursing practice in the ED would be routinization. Developing a routine while delivering care to patients can promote effective time management skills as the “repeated and integrated approach to routine situations” is successfully implemented (Kohtz, Gowda, & Guede, 2017, p. 18). The advanced practice nurse in the ED setting could utilize routinization as a guide to deliver care in the fast-paced environment, while having the clinical experience and foundation of knowledge necessary to revise the routine if necessary. Having clinical experience in the specialty field of ED nursing, as well as in the environment where care is being delivered is important in promoting positive patient outcomes.
Ebright, P. R. (2010). The complex work of RNs: Implications for healthy work environments. The Online Journal of Issues in Nursing, 15(1)
Laureate Education (Producer). (2013). Addressing complexity of nursing practice [Video file]. Retrieved from https://class.waldenu.edu.
Kohtz, C., Gowda, C., Guede, P. (2017). Cognitive stacking: Strategies for the busy RN. Nursing 2016, 47(1). Retrieved from: http://journals.lww.com/nursing/Citation/2017/01000/Cognitive_stacking_Strategies_for_the_busy_RN.7.aspx
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