Nurses Join Choosing Wisely

On May 1, the ABIM Foundation announced the expansion of the Choosing Wisely® campaign to include organizations representing non-physician members of the health care team. The first three groups – the American Academy of Nursing, the American Dental Association and the American Physical Therapy Association – will publish lists of tests, procedures and practices in their field they say are overused and should be discussed with patients later in 2014.

Leaders at the American Academy of Nursing (Academy) began thinking about the role of nurses in Choosing Wisely not long after the campaign launched in 2012.

“We’re trusted, and I think it’s because we’re with people at often the most vulnerable point of their lives. We’re invited in, and we’re dealing with emotions. We’re at a place where we sometimes have more time and opportunity to talk with a patient and can be sensitive to when those conversations happen,” said Karen Cox, PhD, RN, FAAN, Secretary of the American Academy of Nursing.

The Academy convened leaders from a variety of subspecialties at its annual meeting in fall 2013 to determine their fellows’ interest in joining the effort and to explore what nursing practices might be included in a list. That led to the formation of an interest group that generated a list of 25 to 30 items relevant to nursing practice in an inpatient setting. The Academy plans to release its final list at its annual policy conference in Washington, DC, in October 2014.

“Immediately after Choosing Wisely came out, we saw this work and thought, this is something that’s going to have an impact and make a difference in the practice of medicine,” said Dr. Cox. “Nursing has a lot of things that we do that are tradition-based, or more about a routine and a procedure than it is about evidence-based practice.”

The Choosing Wisely lists have always been intended to start a conversation between clinicians and patients about what care is truly best for them. The critical function and ubiquity of nurses ensures their involvement in nearly every patient encounter—there are more than 3.3 million registered nurses in the U.S. alone. The list from the Academy will help reinforce to its members what practices they should be aware of and talk with patients about.

“In nursing, we see the waste, we see the unnecessary care being given all the time, and I think too often nurses feel they don’t have the authority to say we shouldn’t be doing this,” said Diana Mason, PhD, RN, FAAN, President, American Academy of Nursing. “And I think this movement, and nursing’s contribution to Choosing Wisely, can help us to provide that authoritative voice so that nurses on the front lines can say, ‘Wait a minute, this is part of Choosing Wisely and we shouldn’t be doing this.’”