< Previous18 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com stroke, convulsions, coma, renal osteodys- trophy, amenorrhea, and erectile dysfunc- tion. CKD also can advance to end-stage re- nal disease (ESRD). Patients with ESRD may die from complications of their disease, typ- ically from cardiovascular-related events. Nursing care goals Nurses care for adults with various stages of CKD in a variety of inpatient and outpatient settings. Regardless of CKD stage, the three main nursing care goals are: •prevent or slow disease progression •promote physical and psychosocial well- being •monitor disease and treatment complications. Prevent or slow disease progression Identifying and managing risk factors is the best way to prevent or slow CKD progres- sion. Collaborate with patients and providers to target modifiable risk factors, specifically focusing on diabetes and hypertension man- agement to keep glucose levels and blood pressure readings within appropriate target ranges. A combination of self-management techniques and medication therapies guide management of these chronic comorbidities. Promote physical and psychosocial well-being Provide patient-specific education to help patients take charge of their condition and promote well-being. Focus education on a broad overview of CKD, treatment, and self- management techniques. Specific education- al needs will depend on the patient’s base- line knowledge, CKD stage, and current and/ or future treatment plans. Conclude all edu- cation with an evaluation to gauge the pa- tient’s understanding. Be particularly sensi- tive to patients’ psychological needs. Overview. Your overview of CKD should include information about normal kidney function, common causes and risk factors, diagnostic testing, staging, symptoms, and complications. To identify specific areas of educational need, start with questions such as, “What do you know about your illness?” “What would you like to know about your illness?” and “What would you like to know about treating your illness?” Treatment. Early-stage CKD treatment includes medications, appointments, and many lifestyle changes. Late-stage treatment also may include renal replacement thera- pies (RRTs), which require a strong support system. Treatment education should occur regu- larly. In early-stage CKD, focus on engaging patients in self-management and care plans to slow progression. As CKD progresses, pa- tients will need education about RRTs—he- modialysis, peritoneal dialysis, or kidney transplant. Many choices exist within each therapy. For example, hemodialysis can be provided at home or at a dialysis center, at night or during the day. Peritoneal dialysis can be continuous or intermittent. Trans- plants can come from a living or deceased donor. Several considerations go into decid- ing which RRT is best for the patient, includ- ing patient preference, which best suits the patient’s daily life (including social, home, CKD staging Chronic kidney disease (CKD) staging is based on glomerular filtration rate (GFR). • GFR ≥ 90 mL/min/1.73m 2 • Kidney damage, normal or increased GFR • GFR 60-89 mL/min/1.73m 2 • Kidney damage, mildly decreased GFR • GFR 30-59 mL/min/1.73m 2 • Kidney damage, moderately decreased GFR • GFR 15-29 mL/min/1.73m 2 • Kidney damage, severely decreased GFR • GFR < 15 mL/min/1.73m 2 or need for renal replacement therapy • Kidney failure, end-stage renal disease 1 2 3 4 5MyAmericanNurse.com March 2020 American Nurse Journal 19 ards (for example, throw rugs and exposed power cords) from the home. Teach patients how to recognize signs and symptoms of in- fection and to report them to healthcare providers. Care plans developed collaboratively be- tween engaged patients and the care team can improve outcomes. Even if you’re not in- volved in treatment decisions, you can sup- port patients by sharing information to help them understand their treatment. Explain treatment options and what each involves (including benefits, adverse events, and how to manage complications); discuss how treatment may impact their daily lives; and provide information about treatment loca- tions in the area, transportation, and other support services. Talk to patients about the importance of adhering to medications and other prescribed treatments, and encourage them to ask questions and voice concerns. Assess patients’ self-management abilities before and after educational sessions. Ask questions, such as: “How is your physical and/or emotional health?” “What are your worries or what concerns you most?” “What’s important for you to achieve?” “What are your priorities?” “What would im- prove your quality of life and well-being?” and “How are you and your loved ones han- dling your illness?” Based on the answers, provide education and resources to help pa- tients improve their self-management skills. Psychological needs. Keep in mind that patients with CKD are at risk for many psy- chosocial issues, such as anxiety, depres- CKD symptoms Early-stage chronic kidney disease (CKD) can be asymptomatic, but as the disease progresses it may affect many body systems with accompa- nying symptoms. Hematologic/ cardiovascular • Fatigue • Chest pain • Nosebleeds • Feet and ankle swelling • Headaches • Feeling cold • Dizziness • Weakness Respiratory • Shortness of breath • Pain with coughing • Productive cough GI/genitourinary • Vomiting • Nausea • Pain • Loss of appetite • Diarrhea • Changes in urinary output Neurologic • Lethargy • Confusion • Hand tremors • Sleep disturbances • Unusual behavior • Decreased mental sharpness Integumentary • Persistent itching • Rash • Bruising Reproductive • Decreased libido • Erectile dysfunction • Pain during intercourse Musculoskeletal • Joint pain • Muscle twitching and cramping20 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com sion, and stress. For example, Casey and col- leagues’ systematic review of patients begin- ning hemodialysis found that they felt vul- nerable because of their access site and related procedures, disfigured by their ther- apy access site, their body image was al- tered, and their life had been encroached on. They also felt anxious because they had to confront decisions they wanted to avoid. Patients who undergo transplants may feel guilty, especially if they received a de- ceased-donor transplant. The complex and lifelong nature of the CKD diagnosis will present many challenges and concerns. For example, many patients take several medications, conform to dietary and other restrictions, travel to appointments and treatments, experience employment ef- fects, may feel they’re a burden on their loved ones, and pay for expensive medica- tions and therapies. In addition, their self- image may be altered as a result of their dis- ease and treatments. Assess patients’ psychosocial status and coping mechanisms, and help them identify strategies, resources, and interventions to support their well-being. Patients receiving renal replacement therapy (RRT), whether it’s hemo - di aly sis, peritoneal dialysis, or a kid- ney transplant, will require education and support to manage access sites, adverse events, and psycho social issues. Access site management For patients receiving dialysis, provide education about access site protection: • Access sites should be used for dial- ysis only and are not for other pro- cedures (such as blood pressure readings, I.V. insertion, or lab draws). • Only trained professionals should enter the access site. • Patients should avoid strenuous ac- tivities, including carrying heavy objects, that might injure the ac- cess site. • Patients should keep the access site clean and dry to avoid infec- tion; some sites are covered with occlusive dressings that will need to be changed regularly, while oth- ers are left uncovered. In addition, instruct patients to promptly report the following adverse events to their providers: • increase or decrease in blood pressure • nausea • vomiting • chest and/or back pain • cramping • fever with or without chills. Transplant education Focus education for patients receiving a kidney transplant on preventing or- gan rejection. Emphasize that they should continue anti rejection therapy for the rest of their lives, even if they feel well. Therapies vary, but in gener- al they involve: • taking a combination of antirejection and other medications as prescribed • going to appointments and com- pleting laboratory tests • protecting against injury and infec- tion • promptly reporting any issues or con- cerns, such as illness, to providers. Common antirejection medications include: • azathioprine • cyclophosphamide • cyclosporine • mycophenolate mofetil • prednisone • sirolimus • tacrolimus. Encourage patients to take their med- ications as prescribed, including taking generic versus brand name versions of their medications. Some debate exists about whether switching from generic to brand name versions of medications (and vice versa) is appropriate. Ensure that pa- tients understand this and encourage them to speak up if a healthcare profes- sional other than their nephrologist at- tempts to make medication changes. Instruct patients to report signs and symptoms of acute organ rejection, which include: • flulike symptoms, such as a fever • pain at the transplant site • sudden weight gain, swelling, or changes in blood pressure or heart rate • feeling generally unwell. RRT patient education tipsMyAmericanNurse.com March 2020 American Nurse Journal 21 Monitor disease and treatment complications CKD can result in several complications (such as fluid overload, electrolyte imbalances, and anemia) that will require treatment. In collab- oration with patients and pro viders, nurses help deliver treatment by assessing, planning, implementing, and evaluating care plans. For example, if your patient is experiencing fluid overload, you may need to carry out provider orders that include applying fluid restrictions and/or administering diuretic medications. Electrolyte imbalances may require dietary changes and/or medication administration. Use the nursing process when performing these treatments, and frequently and prompt- ly com municate with patients and providers to help improve outcomes. Your accurate and thorough nursing assessment data will help in revising treatment plans to ensure that pa- tients meet goals. These data should include vital signs, including pain and pulse oximetry levels, intake and output, weight, mental sta- tus, energy level, reflexes, skin color and integrity, presence of blood in sputum and stools, heart and lung sounds, psychologi- cal status and needs, and the patient’s ability to accomplish activities of daily living. For patients with late-stage CKD who are receiving hemodialysis or peritoneal dialysis, assess access sites for any issues (for exam- ple, signs and symptoms of occlusion and/or infection), keep sites clean and dry to pre- vent infection, and promptly report concerns to providers. Place an identification band on the access extremity so other healthcare professionals know not to use it for any oth- er procedures. Promptly report signs and symptoms (changes in blood pressure, nausea, vom- iting, chest pain, back pain, cramping, and fever with or without chills) of RRT adverse events and infection to providers. Signs and symptoms of local infection at the access site include redness, warmth, tenderness, puru- lent drainage, sores, and swelling. Signs and symptoms of systemic infection include fever, chills, blood pressure changes, nau- sea, and vomiting. If a patient has a he- modialysis arteriovenous graft or fistula, as- sess for patency and signs that the access site may fail by palpating for a thrill (vibra- tion); auscultating for a bruit (swishing); and assessing capillary refill time, pulses, and for alterations in sensation, color, temperature, and shape (abnormalities such as blebs, bal- looning, and bulging). For patients who have undergone trans- plantation, report any signs of acute organ rejection (for example, flulike symptoms, pain at the transplant site, sudden weight gain or swelling, feeling generally unwell). Work with the transplant team to meet pa- tients’ care and educational needs. Patients always have the right to refuse treatment or choose palliative care. Help pa- tients make the best choice for themselves and respect their wishes. Collaborate with and involve providers in these discussions and decisions. (See Resources.) Build confidence, improve care Nurses encounter adults with CKD in all set- tings and at all stages of the disease. When you can identify the risk factors for CKD, un- derstand how to prevent or slow disease progression, and are skilled at providing pa- tient education and monitoring the disease and its treatment, your confidence in caring for these patients will increase. With that confidence and knowledge, you can pro- mote patient physical and psychosocial well- being to help ensure quality of life. AN Visit myamericannurse.com/?p=64618 to view a list of references. Jennifer Chicca is a PhD candidate and graduate assistant at the In- diana University of Pennsylvania in Indiana. Many chronic kidney disease (CKD) resources are available for nurses and patients. Several local and national organizations provide free re- sources, including answers to frequently asked questions, informa- tion booklets and brochures, trained professionals who provide on- site and remote assistance, and support groups for patients with CKD or end-stage renal disease who are receiving renal replacement ther- apies. Visit these organizations’ websites to gather resources, learn more, and refer patients as needed. • American Kidney Fund kidneyfund.org • American Nephrology Nurses Association annanurse.org • Living Legacy Foundation of Maryland thellf.org • National Kidney Foundation kidney.org • Standardised Outcomes in Nephrology songinitiative.org • United Network for Organ Sharing unos.org Resources 22 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com Please mark the correct answer online. 1. Which of the following cause about 70% of chronic kidney disease (CKD) cases? a. Hypertension and glomerulonephritis b. Diabetes and hypertension c. Diabetes d. Glomerulonephritis 2. CKD is primarily diagnosed based on which of the following tests? a. Renal ultrasound b. Creatinine c. Glomerular filtration rate (GFR) d. Uric acid 3. All of the following are risk factors for CKD except a. antineoplastic therapy. b. sickle cell disease. c. urinary infections. d. age 70 or older. 4. Signs and symptoms of CKD include a. feeling warm. b. feet and ankle edema. c. increased appetite. d. occasional itching. 5. By the time patients experience overt symptoms of CKD, how much of their kid- ney function has typically been destroyed? a. 10% to 20% b. 30% to 40% c. 50% to 60% d. 80% to 90% 6. You are caring for Mr. Johnson*, who has been diagnosed with CKD. His most re- cent GFR is 20 mL/min/1.73m2, indicating what stage of CKD? a. 2 b. 3 c. 4 d. 5 7. General dietary instructions for Mr. Johnson include eating a variety of foods that are a. low sugar. b. high fat. c. frozen. d. high carbohydrate. 8. You learn that Mr. Johnson will require hemodialysis. Patient education related to the access site includes: a. Access sites should be used for dialysis only. b. Access sites can be used for dialysis and blood draws. c. Carrying heavy objects over moderate distances is permitted. d. The occlusive dressing doesn’t need to be regularly changed. 9. Mr. Johnson reports fever, chills, and nausea. You suspect a. electrolyte imbalance. b. localized infection. c. systemic infection. d. poor oxygenation. 10. Ultimately, Mr. Johnson requires a kid- ney transplant. Patient education should include which of the following? a. Signs of acute organ rejection include decrease in temperature. b. Signs of acute organ rejection include sudden weight loss. c. Generics can be substituted for brand name medications. d. Antirejection medications, such as cy- clophosphamide, should be taken as prescribed. *Name is fictitious. POST-TEST • Adults with chronic kidney disease: Overview and nursing care goals Provider accreditation The American Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Provider Number 0023. Contact hours: 1.36 ANA is approved by the California Board of Registered Nursing, Provider Number CEP17219. Post-test passing score is 80%. Expiration: 3/1/23 ANA Center for Continuing Education and Professional Devel- opment’s accredited provider status refers only to CNE activities and does not imply that there is real or implied endorsement of any product, service, or company referred to in this activity nor of any company subsidizing costs related to the activity. The author and planners of this CNE activity have disclosed no rele- vant financial relationships with any commercial companies pertaining to this CNE. See the banner at the top of this page to learn how to earn CNE credit. CNE: 1.36 contact hours CNEMyAmericanNurse.com March 2020 American Nurse Journal 23 D URING your rounds as a rapid response nurse, nurse Kyle Austin* tells you he’s con- cerned about Anne Jones, age 81, who was ad- mitted to the medical-surgical unit for fever and pneumonia. Her medical history includes hypertension and coronary artery disease. She’s restless, short of breath, and tachycardic. History and assessment You assess Ms. Jones with Kyle. The patient’s vital signs are temperature 100.4° F (38° C), HR 164 bpm, RR 32 breaths per minute, BP 108/74 mmHg, and Sp O 2 91% on 3 L/minute of oxy- gen. Ms. Jones is anxious and dizzy and her heart is racing. She denies chest pain. Taking action As you place Ms. Jones on the ECG monitor, Kyle activates the rapid response team (RRT). The patient is in narrow-complex supraventricu- lar tachycardia (SVT), with a regular rhythm at a rate of 176 bpm. When additional members of the RRT arrive, Kyle shares his assessment find- ings: Ms. Jones was admitted with pneumonia, the provider ordered I.V. antibiotics, and the pa- tient is hypoxic. You increase the flow of oxy- gen to 6 L/minute to obtain an Sp O 2 > 96%. Anticipating that the provider may order adeno- sine, you connect the pacing pads to the moni- tor, obtain a 12-lead ECG, verify patent I.V. ac- cess, and instruct Kyle to prepare a bag of normal saline (NS). The provider attempts vagal maneuvers, first by having the patient bear down as if she were having a bowel movement and then having her blow into an occluded straw for 15 seconds. With no result, the provider orders 6 mg of adenosine I.V. followed by a 20 mL NS flush. You explain to Ms. Jones that adenosine may make her feel as if she’s passing out, but that the feeling won’t last long. When the first dose of adenosine has no effect, you administer a second dose of 12 mg. After a brief run of sinus brady- cardia, Ms. Jones goes into normal sinus rhythm at 84 bpm. Because tachycardia is a symptom of an underlying cause such as dehydration, fever, pain, bleeding, hypoxia, or electrolyte imbal- ances, the provider orders a complete blood count, troponin test, and a basic metabolic panel. Ms. Jones reports that her dizziness has subsided. Her vital signs are HR 86 bpm, BP 112/68 mmHg, RR 22 breaths/minute, Sp O 2 97% on 6 L/minute of oxygen via nasal cannu- la. You transfer Ms. Jones to the medical telemetry unit. Outcome Ms. Jones continues her pneumonia treatment and responds to the I.V. antibiotics. Follow-up chest X-ray shows that her pneumonia is im- proving and her oxygen is weaned to room air. Ms. Jones is discharged 2 days later. Education and follow-up SVT is a broad term describing a fast regular rhythm originating above the atrioventricular (AV) node. The narrow complex and regular rhythm of Ms. Jones’ SVT suggests AV nodal reentrant tachycardia or AV reciprocating tachy - cardia; an irregular rhythm would more likely indicate atrial fibrillation or atrial flutter. Maneu- vers that increase vagal tone can help reduce the heart rate, but when that’s unsuccessful, adeno- sine is typically administered. With a half-life of < 10 seconds, adenosine slows conduction in the AV nodal pathways and interrupts reentry path- ways, restoring the heart to its normal rhythm. It’s not effective in atrial fibrillation or flutter, but it will slow the rate, aiding in diagnosis. Pneumonia may lead to hypoxia, causing cardiac arrhythmias, such as SVT. You com- mend Kyle for recognizing the change in Ms. Jones’ clinical status. AN To view a list of references, visit myamericannurse.com/ ?p=65084. * Names are fictitious. The authors are rapid response nurses at Thomas Jefferson Universi- ty Hospital in Philadelphia, Pennsylvania. Supraventricular tachycardia A quick response ensures good outcome. By Elizabeth Avis, RN, MSN, CCRN, and Lois Grant, RN, ASN STRICTLY CLINICAL Rapid Response24 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com The perils of perfectionism in nursing Don’t let perfectionism derail your leadership career. By Rose O. Sherman, EdD, RN, NEA-BC, FAAN J ACKIE * is a director of quality management at her organization. She prides herself on being a perfectionist in every aspect of her life, so she’s surprised when feedback on a recent 360-de- gree evaluation indicates that her direct re- ports and peers find her difficult to work with. Their observations include “She edits all writ- ten work done by others (often with comments that don’t add value)” and “She rarely fully delegates projects to her staff without a signifi- cant amount of micromanagement.” Jackie also has been tagged as indecisive; she believes her deliberative decision-making approach avoids errors. Jackie’s supervisor asks her to re- view the evaluation and develop an action plan to dial down some of the perfectionist ten- dencies that are impeding her effectiveness. Jackie’s challenges aren’t unusual for those who pride themselves on being perfectionists. Perfectionists usually can’t see that a threshold exists to adding value to conversations, proj- ects, or written work. Beyond a certain point, their ideas aren’t value-added and their be- havior becomes frustrating to others who are trying to complete a task. Ultimately, perfec- tionism can derail a leader’s success. Jackie’s exacting standards make it hard for her to let others do their job. She frequently decides to do the work herself so that it will be “done right.” The outcome is that she’s overloaded with work, and her team members aren’t growing in their roles. Perfectionists like Jackie have the mistaken belief that every job or project has a perfect out- come. They set an unrealistically high bar for themselves and others. No matter how much work has been done on a project, they may feel that it’s not good enough and continue revising their work and that of others. In a chaotic and rapidly changing healthcare environment, main- taining this level of control is an illusion. By their nature, perfectionists want to make the very best decision and frequently believe that even better alternatives exist. Failing to act in a timely manner may mean forgoing critical strategic opportunities and can result in turnover of frustrated staff. Jackie’s supervi- sor is wise to push her to examine the perils of her behavior and to dial down her perfec- tionism. But behavior change will be chal- lenging because perfectionism may be deeply rooted in feelings of anxiety and insecurity. Perfectionist behaviors Researcher Brené Brown, PhD, LMSW, has noted that shame is the birthplace of perfec- tionism. Perfectionism is a mistaken belief that if we live a perfect life, act perfect, and look perfect, we can minimize the pain of blame, judgment, and shame. Perfectionism can begin in childhood as a pattern of behavior devel- oped to earn the approval and acceptance of parents and other adults. Most of us have some perfectionism traits, but others, like Jack- ie, are on the far end of the continuum. When taken to an extreme, perfectionism can be- LEADING THE WAYMyAmericanNurse.com March 2020 American Nurse Journal 25 come self-destructive because it’s an unattain- able goal. And it doesn’t happen in a vacuum. Jackie’s perfectionism affects everyone around her because she’s setting impossibly high stan- dards not only for herself, but also for her staff. Jackie should begin her path to reducing perfectionism with a reflective look at some of her behaviors. (See Are you a perfectionist?) Dialing down perfectionism Because perfectionist leaders don’t empower their staff and don’t practice transformational leadership, they’re rarely confronted about the impact their behavior has on others. Instead, they try to maximize results by using a pace- setter management style. This approach is characterized by impatience, lack of empathy, negative stretch (stretching people well be- yond their comfort zone with insufficient or no support), and harsh judgments about oth- ers’ performance and capabilities. When staff fail to meet expectations, the leader is disap- pointed and staff feel micromanaged. Like many perfectionists, Jackie may justify her behavior by contending that her standards are just higher than others’; she wants excel- lence. But striving for excellence isn’t the same as perfection. For staff, excellence is at- tainable and allows them to appreciate their accomplishments. Perfection can be crippling because enough is never enough. A perfec- tionist approach can cause even the best and brightest people to feel unmotivated, deval- ued, dependent, disempowered, frustrated, and ultimately disengaged. When the leader’s behavior is left unchecked, staff may feel they have no safe way to push back on the leader’s perfectionism, so they leave. Dialing down her perfectionism will require a radical change from Jackie. She’ll need to carefully evaluate her current work habits and move to change destructive behaviors. To travel the road to reform, Jackie should em- brace these five steps: 1. Recognize perfectionism is a weak- ness masquerading as a strength. To suc- cessfully conquer perfectionism, Jackie must recognize that it doesn’t drive her success; in- stead, it’s a barrier. She’s achieved her career goals because she’s capable and motivated despite her issues with perfectionism. She won’t be able to change her perfectionist ways without accepting they’ve become a lia- bility that could derail her. This recognition will require Jackie to practice self-compassion and reframe how she thinks about herself. 2. Identify key problematic perfection- ist behaviors and triggers. After Jackie rec- ognizes that her perfectionism is problematic, she’ll need to identify the key behaviors to change as well as what triggers her criticism and nagging. This will require reflection and a willingness to embrace her imperfections. Jackie’s lack of decisiveness is a good exam- ple. She needs to pay attention to when she doesn’t make timely decisions but instead keeps exploring options, hoping for some- thing better. Jackie must recognize that this is flawed thinking. 3. Differentiate excellence from perfec- tion. Setting high standards for excellence is the right approach in leadership, but Jackie will need to differentiate excellence from per- fection. She should consider the risks of something being imperfect and that at some point “done” is better than perfect. 4. Accept that a goal can be achieved in multiple ways. Perfectionists often see their Perfectionistic traits that might derail your leadership career include: • a continuous drive to do more, be more, and prove yourself • a strong need for control • setting impossibly high standards for yourself and others • fear of failure • excessive rumination and overthinking when things don’t go well • checking and redoing others’ work • the inability to delegate work to others • an orientation to detail versus the bigger picture • a focus on flaws and mistakes made by others • a strong association of self-worth with career accomplishments • a preoccupation with your appearance and status in others’ eyes • frequent criticism of others when they don’t meet your expectations • excessive need for cleanliness and order • a need to present an external picture of the “perfect life” to others • thinking in terms of absolutes and an inability to live with ambiguity • a belief that only one best way exists to goal achievement • a focus on individual weaknesses versus strengths • the inability to be decisive if the “perfect” decision isn’t evident • a need to add value even when it’s not necessary • a high stress level during setbacks. Source: Martin 2019 Are you a perfectionist? (continued on page 46)26 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com T HE YEAR 2020 , designated by the World Health Organization as the Year of the Nurse and the Midwife, is pivotal for our profes- sion and for engaging nurses to reshape healthcare through their innovations. The ANA Enterprise is recognizing this momen- tous occasion by highlighting and magnifying the work of in- novative nurses across various practices and fields of expertise. We’ll be celebrating nurses as trusted change agents who are leading and innovating through out healthcare. Nursing has a rich history of creativity and inventing solu- tions to meet the needs of peo- ple and communities. Have you ever imagined how healthcare could be different if just a few (or a lot of) things changed? If you answered yes, these mus- ings were a new design for the future of healthcare. Whenever you improve upon something ex - isting or create something new, you’re innovating. Some innova- tions are simple everyday hacks, some change processes, and still others lead to new products, devices, or technologies. We can all think of innovations that have changed the world. My sincere belief is that nurses can create solutions to some of the greatest challenges of our time. As a nurse, how are you already innovating? In my role as vice president of nursing in- novation at the ANA Enterprise, I look for- ward to collaborating with nurses and nurs- ing leaders around the country to develop a strategic national framework for innovation. These efforts involve building an inclusive and transparent space to ensure nurses’ abil- ity to lead at all levels of society so they can transform practice and individuals’ health across the continuum of care. Like many of you, I pursued nursing to positively impact people’s lives. On my first day of nursing school, the World Trade Cen- ter towers collapsed. This was an immediate reminder that things we believe to be con- stants can and do change rapidly. The events on September 11, 2001, led to my desire to prepare for, manage, anticipate, and ultimate- ly create the solutions for workflows, processes, and systems to improve nursing practice, operations, and the communities we serve. Because of this, I began my journey to immerse myself in the work being done across the innovation ecosystem and to un- derstand the possibilities for our profession. My goal at the ANA Enterprise is to vali- date and develop the courageous spirit that exists within every nurse. The innovation led by nurses today will empower and educate the next generation of nurse innovators. To this end, the ANA Enterprise has created sev- eral opportunities to recognize nurse inno- vators, including our Innovation Awards, powered by BD, and HIMSS NursePitch™ events. Our hope is to partner with even more organizations that lead in the design and innovation space to expand the possibil- ities for nurse engagement and education. Nursing and nursing innovation can no longer be invisible. The current healthcare system and paradigm need innovation at every level of practice, which requires cre- ativity, original thinking, diversity, inclusion, and interprofessional partnerships. The world needs nurses and health professionals to bring their amazing ideas forward to transform health, our profession, and health- care. My 2020 charge to all nurses is to tap into the innovator within you. AN Oriana Beaudet is vice president of innovation for the ANA Enter- prise, which is composed of the American Nurses Association, the American Nurses Credentialing Center, and the American Nurses Foundation. LEADING THE WAY Year of the Nurse 2020 Advancing professional innovation By Oriana Beaudet, DNP, RN, PHNNext >