Student Spotlight: Nursing Is A Unique Profession That Allows Rebecca Donahue to Move & Do What She Loves

Student Spotlight: Nursing Is A Unique Profession That Allows Rebecca Donahue to Move & Do What She Loves

DUSON Student Spotlight highlights the diverse background of our nursing students and their personal stories of dedication, leadership, perseverance and academic or community achievements.

DUSON shines a spotlight on DNP student Rebecca Donahue from Midland, TX. Donahue will graduate in May 2016.

Q: What would people be surprised to know about you?

A: I am a military spouse, so I move every 2-4 years, which makes advancing my education and career difficult. But it has been a wonderful lifestyle that has forced me to be outgoing, adventurous, and flexible. In the 10 years I have been an RN I have worked in Texas, Florida, California, and Arizona. I have a two year old son who was 3 months old when I started my doctoral program.

Q: What is a cause you're passionate about?

A: I am very passionate about patient centered care and empowering individuals to understand their own health and take an active role in healthcare decision-making. I am passionate about promoting quality of life, multimodal pain management, and a holistic approach to wellness.

Q: Tell us about a project, service group or organization that you are involved with at DUSON, Duke University or in the community.

A: My Capstone project for the DNP program is the development and implementation of an educational video and pain regimen for patients undergoing elective knee replacement surgery in a community, non-profit hospital. The regimen is based off published research and clinical guidelines and similar regimens that are utilized in other hospitals around the country. For knee replacement surgery, the key to successful rehabilitation is early mobilization. This regimen has been designed to allow patients to begin physical therapy including ambulation, on the same day of surgery. This can be tricky, because traditional anesthesia and analgesia techniques such as femoral nerve blocks, can limit early mobilization because it impairs quadriceps strength. Also, opioid based regimens with patient controlled analgesia (PCA) can result in nausea, vomiting, dizziness, and drowsiness which can interfere with therapy.  The goal is to balance adequate pain relief while still promoting early mobilization.

Many of the stakeholders were skeptical at first that these goals could be achieved. The development and preparation for implementation took a year and a half to achieve consensus from all the stakeholders. I have had to collaborate with the orthopedic surgeons, anesthesiologists, administration, Departments of Surgery, Quality, Physical Therapy, Pharmacy, and Nursing. I provided educational training to the 150 nurses, physical therapists, and occupational therapists providing care to these patients. The regimen was implemented starting in September 2015 and the pilot period is almost complete. I have followed each patient through the continuum of care from the outpatient clinical evaluation for surgery until discharge. Preliminary results have shown that opioid use has been cut in half for patients who have received the regimen compared with those prior to implementation. Patients are able to mobilize sooner, they are experiencing less nausea and vomiting, and length of stay has been reduced. Once the data has been analyzed, it will be presented to the stakeholders and they will determine if the regimen will become standard practice and potentially expand it to other orthopedic surgeries.

Q: What have you learned (or are learning) that's made a difference to you?

A: We have all heard that research often takes 17 years to be utilized in clinical practice.  I always thought that sounded absurd but this project has shown me how that statement is actually true and has highlighted the barriers to evidence-based practice. Although the literature supporting this regimen has been published over the past 15 years, it is not common practice in this setting. Many non-teaching hospitals do not have the same resources that large academic hospitals have.

The success of this evidence-based quality improvement project has been dependent on a thorough literature review and synthesis, fulltime efforts for coordination of patient-care, and hours of communication and collaboration between different departments. Unless hospitals invest in positions and personnel who can support these efforts, the implementation of new innovations will not be done until governmental and regulatory agencies mandate change. I truly believe that this is a key role for Advanced Practice Nurses to fill.

Throughout the DNP program I have learned skills to critique and analyze research, lead change initiatives, make a business case for quality improvement, and collaborate with multidisciplinary teams.

Q: How does your nursing degree fit into your life's plans?

A: As I have mentioned, I am a military spouse and we are told where we will be stationed only 3-months prior to moving. We may stay in one location for 2 to 4 years. Nursing has been a unique profession in that I have always been able to move and find work that I love.

I hold dual certification as an Adult-Geriatric acute care nurse practitioner and as an Adult-Geriatric Clinical Nurse Specialist. Military life is difficult because there are so many things that you have no control over, but I have control over my professional development and education. I believe that achieving my Doctor of Nursing Practice will help prepare me for the variety of opportunities that will come my way in the future.  

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