In Pakistan, the pandemic did little to raise the profile or status of the nursing profession. However, it does seem to be inspiring a movement among nurses and even physicians to reform the conditions that are hampering the work of nurses and the well-being of patients.
Back in April 2020, in an editorial in Pakistan’s Daily Times, Dr. Ghulam Nabi Kazi wrote, “In practice, nursing remains a neglected and least preferred line of work, despite the noble duty performed towards the treatment and quick recovery of patients, post-operative management or specialized interventions. Ninety (90) percent of nurses are females working in a highly misogynist culture, [who are] liable to sexual harassment and treated sub-optimally. They are often encumbered with long working hours, low wages, and poor career or promotion prospects or perks in comparison with officers with similar qualifications in other cadres.” Events and occasional editorials in Pakistani media sing the praises of Florence Nightingale, but in practice, low pay and lack of respect are driving a “brain drain” exodus of dedicated nurses to move to Kuwait or venture even further to find better treatment and higher salaries.
In this letter, Faryal Ghafoor, a Pakistani nurse and an MScN student at Aga Khan University School of Nursing and Midwifery outlines the key issues and the solutions nurses are pursuing to modernize the profession in Pakistan.
Despite our rigorous education and training, in developing nations like Pakistan, the respect for the nursing profession is little higher than it was in the West before the advent of Florence Nightingale.
Because in Pakistan the role of nurses is poorly defined, the general public has many misconceptions about the norms and values of the profession. The public views a nurse as a sort of servitor who dispenses medication on the orders of a doctor. Other roles of nurses are altogether ignored, and in the public sector, our ability to act as caregivers is often rigidly constrained by outdated mores and traditional practices. As a result, nurses are often unable to utilize their education to provide counseling, engage in advocacy or collaboration and remain restricted to the administration of medication.
A waste of an educated labor force
Many traditional and ongoing practices cause nurses to be overwhelmed with responsibilities that reduce the time they have to care for patients. In addition to performing inventory on supplies and managing staff, a nurse on a unit assists not only CNAs but ward attendants, Aya, and sanitary workers. The unavailability of service structure and monotony of tasks reduces the time they have to treat patients and—adding insult to injury, a nurse working in a Public sector job often ends up retiring on the same scale on which s/he was first appointed.
The perception of nursing as a profession designed to serve actual health care providers may correlate with the gendered nature of the profession in Pakistan. We are seeing more male nurses entering the profession but there remains substantial resistance and misconceptions about male nurses are almost as troubling as those about female nurses.
The impact of the commercial nurse education industry
Another significant issue that needs to be addressed is the burgeoning number of private nurse education programs. Despite the labor, long hours, and low pay, limited employment opportunities in Pakistan make nursing a highly attractive career option and as a result, private investors are cashing in by building new nursing schools to meet the demand. Unfortunately, their primary concerns revolve around profit and the bottom line, and the quality of education often seems to be an afterthought.
This is high time to bring reforms in Nursing Profession. There is a need to construct a positive image of nurses, without deconstructing the traditional image, the progressive image of nurses, and the quality of their services.
How can we improve conditions and keep nurses in the country?
Following are a few suggestions to reform the role of nurses, increase respect for the profession in Pakistan, and improve the conditions that are driving talented nurses to seek employment in other countries:
There must be a clear job description for nurses. There must be different domains of ward administration to look after the affairs of inventory, supplies and staffing. Nurses should be dedicated to patient care.
Nurses should use social media platforms to convey their values and concerns. By speaking out, they will help the public better understand the roles of nurses and the nursing profession.
There must be accredited courses of therapeutic communication in nursing to familiarize and encourage student nurses to communicate with patients. Thus, the gap between patients and nurses can be eliminated.
There must be specific tools to evaluate the care provided by nurses to patients. Nursing is a unique discipline. So, there must be a separate and unique audit system to assess and evaluate Nursing skills.
There must be criteria to include ongoing training programsspeak in every Nursing institution to meet the learning demands of nurses and to keep them updated about advances in knowledge.
Government lawmakers need to formulate service structure policies for the upgrowth of the nursing profession.
If you feel a special connection to your role as an advocate for your patients, perhaps you should consider adding the title “attorney” to your current title of “nurse.”
“Many nurses realize that they are advocates at their patient’s bedside and beyond from the beginning,” says Kimberly Cleveland, PHD(C), JD, MSN, RN, C-MBC, a nurse attorney, educator, and recording secretary of The American Association of Nurse Attorneys (TAANA). “That’s actually what I think draws most of the nurses who’d like to become attorneys into wanting to go to law school. They really believe and feel that their role is to create safe systems, to advocate for patient needs and ethics in healthcare.”
As an educator, “I love sharing how nurses and healthcare providers can use what they know within the healthcare system to be able to provide for social justice and for equal access to healthcare for all,” Cleveland says. She notes that The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity2020-2030 calls on nurses to help ensure equitable care is extended to everyone.
“Attorneys have a special role in that because attorneys can also advocate for policy,” Cleveland notes. “One of the things that I find the most rewarding is that many times I’ve been called to weigh in on very large policy issues, and to help make sure that we’re considering all the stakeholders around the table when we’re coming up with our ideas about how to administer healthcare across the United States.”
“Nurses are positioned by the unique disciplinary preparation that they have to be outstanding advocates,” says Cleveland. “The critical thinking that nurses do at the bedside and within their roles as nurse leaders and clinicians really does help to prepare them to become outstanding lawyers. The key is really determining if that is where they want the focus of their practice to be, because as nurse attorneys we’re really advocates as well as problem solvers.”
Rigorous process
To become an attorney, you’ll need to go through the same process as every other individual who wants to practice law, notes Cleveland. “What I tell students is that law school is a very rigorous, iterative process. It is a profession that is full of details, of rigorous study, and of the ability to advocate and to write clearly.”
Although you’ll need to follow the same pathway as others, as a nurse you have unique attributes that can single you out. “Nurses have a wonderful opportunity to distinguish themselves from other people that want to be lawyers because they have such a broad experiential base,” says Diane Knoblauch, JD, MSN, RN, a nurse attorney and president of TAANA. “They come from so many different walks of life, and they have worked in so many different environments with so many different kinds of people and in so many different settings.”
Range of settings
As to where nurse attorneys practice, “There are as many roles for nurse attorneys as there are unique aspects of nursing,” according to Cleveland. “There are nurse attorneys working in family law because they have experience with being able to look at age appropriateness and communicate with children. There are nurses working in administrative law because very clearly, as nurse leaders, we are very keenly aware of the regulatory and administrative law aspects that impact health.”
“There are nurse attorneys,” says Cleveland, “that work on either the plaintiff or the defense end of medical malpractice because we understand the issues. There are nurse attorneys working in licensure for healthcare professionals, not just nurses but pharmacy and physicians and dentists. We see nurse attorneys actually working outside of the capacity of what you would consider a traditional nurse attorney in a courtroom, where they actually use their attorney skills as CEOs for hospitals, as CNOs in hospitals, or in quality areas, or even the vice president of legal counsel for a hospital.”
It’s not about the money
If you believe you’ll earn a high salary as a nurse attorney, you’ll need to rethink that assumption. Staff nurses, notes Knoblauch, make more annually than a nurse attorney, unless you graduate in the top 10 percent of your law class. In that case, you may be able to join a larger firm and make an income that would exceed a staff nurse’s salary. Knoblauch herself took a more than 50 percent cut in pay when she left her nurse practitioner position at the University of Michigan. What’s more, you’re likely to work at least 60 hours a week.
Analyzing complexity
With experience as a nurse, a nurse attorney can tease apart and analyze the complexity of today’s healthcare system. “Because many of us have worked in very complex systems, we’re also very adept at analyzing situations at a very high level to see how different sectors of healthcare administration come together to provide quality care,” Cleveland says.
“Because we are the patient-facing part of health care, we’re able to put together the complexity of the medical record, how patients come through the intake system, how patient handoff occurs, and how licensure and decisions about those types of things impact the ability to have privileges at a hospital.” Nurse attorneys, she notes, can also help analyze the system of care a patient is going to have, the quality that’s going to be delivered and what outcomes will be measured and reported.
“Healthcare is becoming increasingly complex and the issues that nurses and other healthcare providers are facing are almost overwhelming,” says Knoblauch. “More important than we could possibly imagine” says Knoblauch, are the critical thinking skills nurses are taught, “in being able to analyze all of those different elements and the components and what goes into putting a system together and making it work.”
“Nurse attorneys are well prepared, both from the nursing perspective and from the law perspective to be able to do that,” says Knoblauch “It’s pretty exciting to be on the frontlines at this point in time knowing all the opportunities that are out there.”
As a nurse, you play a critical role at the bedside, but you also can serve a vital function in the far different and potentially unfamiliar setting of the boardroom. In those spaces, you have the chance to influence healthcare standards, practices and policies.
“It is the responsibility of nurses to seek out and serve in roles where they can shape strategies and policies, because through their work in clinical, academic and community settings, they see the implications of decisions,” says Laurie Benson, BSN, executive director, Nurses on Boards Coalition (NOBC). “They’re ideally and uniquely suited to serve on boards that make decisions about policies.” In general, she notes, boards exhibit great receptivity to including nurses and the nursing perspective.
NOBC declares that its mission is to improve the health of communities through the service of nurses on boards and other bodies. Created in 2014 in direct response to the IOM’s 2010 The Future of Nursing: Leading Change, Advancing Health report, NOBC can point to the noteworthy success of having achieved the founders’ key strategy of 10,000 board seats filled by nurses.
Making a difference
Nurses who serve on boards can have a significant impact. A qualitative research study completed by the NOBC Impact of Nurses on Boards Research Work Group and published in The Journal of Nursing Administration concluded that “nurses bring expert healthcare knowledge, expertise, and wisdom along with the values of caring and collaboration to impact board decisions, which may, in turn, influence governance effectiveness and organizational performance. Nurses promote effective board governance by ensuring that the perspectives and needs of all stakeholders are well represented in board discussions, deliberations, and decision-making. Given the high stakes of healthcare, board leaders of health-related organizations cannot afford to miss the opportunity to appoint nurses as decision-making members of governing boards.”
How to start
In deciding to join a board, start with what interests and excites you. “It’s important to get involved in an area that you’re passionate about,” notes Benson. “It’s so important to think about what you care most deeply about, because it does take time to serve. It does take time to get involved and work alongside other key stakeholders to really be in a position to start to make meaningful change.”
You might, for instance, serve on a school board. Or, notes Benson, you could pursue a board seat with an organization that affects health equity, access to care, housing, transportation, or food shortages.
Self-assessment
You’ll want to conduct a self-assessment to determine the competencies you have acquired and can offer. “The wonderful thing is that the skills, experience and competencies that nurses build in their careers translate very naturally into a governing, policy-setting environment,” Benson says.
To conduct your self-assessment of competencies, you can start with resources on the NOBC website. Specifically, NOBC offers three models: NOBC Board Competencies Model; NOBC Board Readiness Model; and NOBC Support Roles for Board Success Model.
The Board Competencies Model outlines competencies in three domains: self-leadership; organizational leadership; and civic/professional leadership. These competencies, according to Benson, were identified by conducting over 100 interviews with nurses who serve on boards.
The Board Readiness Model, based on the Benner Novice to Expert paradigm, maps the Board Readiness competencies against different types of boards. The Support Roles for Board Success identifies the different types of support roles that a board member might need, such as a preceptor, mentor, sponsor or coach.
Being bold
Having joined a board, get to know your board colleagues, says Benson. “Certainly in the first six months, make a concerted effort to reach out to your board colleagues to get to know them and learn from them.”
And while you want to be a good listener, “I also think you need to be bold,” Benson says. “Nurses are humble by our nature. At the same time we need to be bold and taking action that is relevant and meaningful for all those we serve. I wouldn’t sit back. Make your comments succinctly. As nurses do so well, make sure they’re evidence-based and research-driven so that others have good information as they’re considering what path to take forward.”
Seizing the moment
In deciding whether to join a board, Benson recommends that you “don’t wait until it’s convenient for you to serve in these roles.” Certainly, she admits, there are times when you’re required to be with family and home.
“But don’t wait until you feel like you have mastered all the competencies. Don’t wait until it’s a perfect time where your schedule opens up. Say yes when you have an opportunity to serve on a board. It doesn’t have to be perfect, and you don’t have to be either, but take a step forward to raising your leadership voice to make a difference and help achieve equity for all.”
How often – and how well – do nursing programs teach lessons about the impact that climate exerts on health? And as more of us are exposed to and sickened by toxins, polluted air, unsafe drinking water, and a lack of access to basic health care – not to mention the economic, geographic and social effects of rising tides, stronger storms and predictably unpredictable weather – should climate lessons be mandatory for clinicians?
“In public and environmental health,” University of VirginiaMSN student Amelia Kirby, BSN, RN explained, “that Venn diagram, that overlay, is really close.”
Kirby began her professional life working in nonprofits before heading to nursing school in spring 2020, just as COVID struck. Two years later, Kirby – who on May 22 earns a master’s in nursing through the UVA’s Clinical Nurse Leader program – says it couldn’t have happened any other way. And the environmental causes she embraced since childhood continue to flavor her nursing and determination to do good for both the planet and its human residents.
“I thought entering health care would be the end [of my environmentalism], but it’s turned out to be quite the opposite,” Kirby said. “There are a lot of people in nursing and medicine who care really deeply about the planet, and they’re motivated to change things. It’s very buoying to see how many people are interested in this.”
A climate and health conference in early 2021 first brought Kirby into contact with UVA nursing professors Tracy Kelly, Emma Mitchell and Kathryn Reid, champions of the Nurses’ Climate Challenge, which offers tools, resources and support for faculty committed to teaching climate and health lessons in their courses.
As Kirby’s environmentally minded connections multiplied, so did her ideas and determination to act. Over the last year, she led in developing a Planetary Health Report Card tool for measuring nursing schools’ planetary awareness. The work has presented speaking opportunities at conferences, and landed a national award and other applause from national nursing and environmental groups.
The first Planetary Health Report Card tool was created in 2019 by a group of University of California, San Francisco medical students to assess across five metrics about the climate consciousness of medical programs.
Following a similar model, Kirby, fellow clinical nurse leader student Alyssa Dimatulac, and a team of nursing students from the University of Minnesota, the University of Brighton, the University of Lancaster, and Germany’s Esslinger Science and Health College compiled their own tool to assess nursing programs’ environmental mindedness across curricula (how well and how often nursing courses embed topics of climate’s impact on health), day-to-day sustainability practices, student support, community impacts and interdisciplinary research. She hopes the tool ultimately becomes a commonplace way for prospective students to assess programs that align with their personal values.
During the 13-month fellowship, students work to improve the health and well-being of under-resourced populations throughout the state of Alabama.
“As vulnerable populations in our communities face significant obstacles to health and improved quality of life, it is encouraging to see more students rise to the challenge of tackling these issues head-on,” said Executive Director of ASF of Alabama Kristin Boggs. “We are excited to come alongside these students, along with our academic and community site partners, to channel their ideals and grow their commitment to using their knowledge to affect change for under-resourced communities.”
Dorner was inspired to apply for this fellowship following clinical experience at The Foundry’s Changed Lives Mobile Clinic, which serves men at the Changed Lives Christian Center in North Birmingham, a faith-based organization that offers transitional housing in order to break the cycle of homelessness. Through this clinic, CLCC residents can access primary care and resources that aid in overcoming substance misuse.
During his clinical experience, Dorner worked closely with UAB School of Nursing instructors Deborah Bowers, DNP, DMin, MDiv, CRNP, FNP-C and Emily Patton, MSN, CRNP, FNP-C. Bowers will serve as a mentor during this fellowship, and Patton will play an important role through her work at the clinic, Dorner said.
“My decision to apply for this fellowship ties into the passion that Dr. Bowers had in my undergrad classes and community classes,” Dorner said. “I think a lot of students can focus on critical care experience, which is incredible, but it can be easy to overlook community. Those classes spoke to me, however, and provided an opportunity to do a lot of simulations with low-resourced clinics. That really spurred my interest in working with under-resourced populations.”
During the fellowship, Dorner is collaborating with UAB Heersink School of Medicine student Eric Mussell to encourage medication adherence. They will work with residents at CLCC, developing a system to track medication adherence and providing resources between primary care visits. They also will identify barriers and develop interventions that encourage patients to remain diligent while taking medication.
“We want to focus on medications that treat hypertension in order to help improve the health of this patient population,” Dorner said. “Sometimes at the clinic we see patients who have not kept up with their medications and have very high blood pressure. Our goal is to provide an intermittent meeting between primary care appointments in order to encourage medication adherence and hopefully avoid the need for an urgent care visit.”
Dorner and Mussell hope to set up this project so that it will continue with one nursing student and one medical student each year to facilitate that connection. Patients also benefit from this interdisciplinary partnership, Dorner said, as he and Mussell are able to learn from each other and offer a balance of perspectives.
“Eric and I are both volunteers at the clinic, and we chose to enter our project as a team in order to bridge the gap between professions and provide the benefit of interdisciplinary care,” Dorner said. “Due to the COVID pandemic, we did not get as much physician/nurse interaction as students, and I think facilitating a project that can continue a bond between our two schools and benefit the community is so important.”
The project is still in its early stages, Dorner said, and they are compiling resources needed to best support patients.
More than four years ago, Tennessee nurse RaDonda Vaught typed two letters into a hospital’s computerized medication cabinet, selected the wrong drug from the search results, and gave a patient a fatal dose.
Vaught was prosecuted this year in an extremely rare criminal trial for a medical mistake, but the drug mix-up at the center of her case is anything but rare. Computerized cabinets have become nearly ubiquitous in modern health care, and the technological vulnerability that made Vaught’s error possible persists in many U.S. hospitals.
Since Vaught’s arrest in 2019, there have been at least seven other incidents of hospital staffers searching medication cabinets with three or fewer letters and then administering or nearly administering the wrong drug, according to a KHN review of reports provided by the Institute for Safe Medication Practices, or ISMP. Hospitals are not required to report most drug mix-ups, so the seven incidents are undoubtedly a small sampling of a much larger total.
Safety advocates say errors like these could be prevented by requiring nurses to type in at least five letters of a drug’s name when searching hospital cabinets. The two biggest cabinet companies, Omnicell and BD, agreed to update their machines in line with these recommendations, but the only safeguard that has taken effect so far is turned off by default.
“One letter, two letters, or three letters is just not enough,” said Michael Cohen, the president emeritus of ISMP, a nonprofit that collects error reports directly from medical professionals.
“For example, M-E-T. Is that metronidazole? Or metformin?” Cohen added. “One is an antibiotic. The other is a drug for diabetes. That’s a pretty big mix-up. But when you see M-E-T on the screen, it’s easy to select the wrong drug.”
A Five-Letter Fix: Making It Stick
Omnicell added a five-letter search with a software update in 2020. But customers must opt in to the feature, so it is likely unused in many hospitals. BD, which makes Pyxis cabinets, said it intends to make five-letter searches standard on Pyxis machines through a software update later this year — more than 2½ years after it first told safety advocates the upgrade was coming.
That update will be felt in thousands of hospitals: It will be much more difficult to withdraw the wrong drug from Pyxis cabinets but also slightly more difficult to pull the right one. Nurses will need to correctly spell perplexing drug names, sometimes in chaotic medical emergencies.
Robert Wells, a Detroit emergency room nurse, said the hospital system in which he works activated the safeguard on its Omnicell cabinets about a year ago and now requires at least five letters. Wells struggled to spell some drug names at first, but that challenge is fading over time. “For me, it’s become a bigger hassle to pull drugs, but I understand why they went there,” Wells said. “It seems inherently safer.”
Computerized medication cabinets, also known as automated dispensing cabinets, are the way almost every U.S. hospital manages, tracks, and distributes dozens to hundreds of drugs. Pyxis and Omnicell account for almost all the cabinet industry, so once the Pyxis update is rolled out later this year, a five-letter search feature should be within reach of most hospitals in the nation. The feature may not be available on older cabinets that are not compatible with new software or if hospitals don’t regularly update their cabinet software.
Hospital medication cabinets are primarily accessed by nurses, who can search them in two ways. One is by patient name, at which point the cabinet presents a menu of available prescriptions to be filled or renewed. In more urgent situations, nurses can search cabinets for a specific drug, even if a prescription hasn’t been filed yet. With each additional letter typed into the search bar, the cabinet refines the search results, reducing the chance the user will select the wrong drug.
The seven drug mix-ups identified by KHN, each of which involved hospital staff members who withdrew the wrong drug after typing in three or fewer letters, were confidentially reported by front-line health care workers to ISMP, which has crowdsourced error reports since the 1990s.
Cohen allowed KHN to review error reports after redacting information that identified the hospitals involved. Those reports revealed mix-ups of anesthetics, antibiotics, blood pressure medicine, hormones, muscle relaxers, and a drug used to reverse the effects of sedatives.
In a 2019 mix-up, a patient had to be treated for bleeding after being given ketorolac, a pain reliever that can cause blood thinning and intestinal bleeding, instead of ketamine, a drug used in anesthesia. A nurse withdrew the wrong drug from a cabinet after typing in just three letters. The error would not have occurred if she had been required to search with four.
In another error, reported mere weeks after Vaught’s arrest, a hospital employee mixed up the same drugs as Vaught did — Versed, a sedative, and vecuronium, a dangerous paralytic.
Cohen said ISMP research suggests requiring five letters will almost entirely eliminate such errors because few cabinets contain two or more drugs with the same first five letters.
Erin Sparnon, an expert on medical device failures at ECRI, a nonprofit focused on improving health care, said that although many hospital drug errors are unrelated to medication cabinets, a five-letter search would lead to an “exponential increase in safety” when pulling drugs from cabinets.
“The goal is to add as many layers of safety as possible,” Sparnon said. “I’ve seen it called the Swiss cheese model: You line up enough pieces of cheese and eventually you can’t see a hole through it.”
And the five-letter search, she said, “is a darn good piece of cheese.”
Vaught, a former nurse at Vanderbilt University Medical Center in Nashville, was arrested in 2019 and convicted of criminally negligent homicide and gross neglect of an impaired adult during a controversial trial in March. She could serve as much as eight years in prison. Her sentencing May 13 is expected to draw hundreds of protesters who feel her medical error should not have been prosecuted as a crime.
At trial, prosecutors argued Vaught made numerous mistakes and overlooked obvious warning signs while administering vecuronium instead of Versed. But Vaught’s first and foundational error, which made all other errors possible, was inadvertently withdrawing the vecuronium from a cabinet after typing just V-E. If the cabinet had required three letters, Vaught probably would not have pulled the wrong drug.
“Ultimately, I can’t change what happened,” Vaught said, describing the mix-up to investigators in a recorded interview that was played at her trial. “The best I can hope for is that something will come of this so a mistake like that can’t be made again.”
After the details of Vaught’s case became public, ISMP renewed its calls for safer searches and then held “multiple calls” with BD and Omnicell, Cohen said. ISMP said that, within a year, both companies confirmed plans to tweak their cabinets based on its guidance.
BD raised the default on Pyxis cabinets to a three-letter minimum in 2019 and intends to raise it to five in a software update expected “by the end of summer,” spokesperson Trey Hollern said. Cabinet owners will be able to turn off this feature because it’s “ultimately up to the health care system to configure safety settings,” Hollern said.
Omnicell added a “recommended” five-letter search through a software update in 2020 but left the feature deactivated, so its cabinets allow searches with a single letter by default, according to a company news release.
Perilous Typos: M-O-R-F-I-N-E
At least some hospitals must have activated the Omnicell safety feature because they’ve begun to alert ISMP to workflow problems — spelling errors or typos — made worse by requiring more letters. Omnicell declined to comment for this story.
Ballad Health, a chain of 21 hospitals in Tennessee and Virginia, activated the five-letter search while installing new Omnicell cabinets this year.
CEO Alan Levine said it was an easy choice to engage the safety feature after the Vaught case but that the transition has laid bare an unflattering truth: Lots of people, even highly trained professionals, are bad spellers. “We have people that try to spell morphine as M-O-R-F-I-N-E,” Levine said.
Ballad Health officials said one of the most common issues arose in emergency rooms and operating rooms where patients need tranexamic acid, a drug used to promote blood clotting. So many nurses were delayed at cabinets by misspelling the drug by adding an S or a Z that Ballad posted reminders of the proper spelling.
Even so, Levine said Ballad would not deactivate the five-letter search. Because of the pandemic and widespread staffing shortages, nurses are “stretched” and more likely to make a mistake, so the feature is needed more than ever, he said.
“I think, given what happened to the nurse at Vanderbilt, a lot of [nurses] have a better appreciation of why we are doing it,” Levine said. “Because we’re trying to protect them as we are the patient.”
Some nurses remain unconvinced.
Michelle Lehner, a nurse at a suburban Atlanta hospital that activated the five-letter search last year, said she believed hospitals would be better served by isolating dangerous medications like vecuronium, instead of complicating the search for all other drugs. Five-letter search, while well-intentioned, might slow nurses down so much that it causes more harm than good, she said.
As an example, Lehner said that about three months ago, she went to retrieve an anti-inflammatory drug, Solu-Medrol, from a cabinet with the safety feature. Lehner typed in the first five letters of the drug name but couldn’t find it. She searched for the generic name, methylprednisolone, but still couldn’t find it. She called the hospital pharmacy for help, but it couldn’t find the medication either, she said.
After almost 20 minutes, Lehner abandoned the dispensing cabinet and pulled the drug from a non-powered, “old school” medication cart the hospital normally reserves for power outages.
Then she realized her mistake: She forgot the hyphen.
“If this had been a situation where we needed to give the drug emergently,” Lehner said, “that would have been unacceptable.”
As an educator, “I love sharing how nurses and healthcare providers can use what they know within the healthcare system to be able to provide for social justice and for equal access to healthcare for all,” Cleveland says. She notes that 
