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Original Articles

Always a Nurse

The Supply Chain Director

Aliberto, Alexander MBA, RN

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Nursing Administration Quarterly: January/March 2020 - Volume 44 - Issue 1 - p 33-35
doi: 10.1097/NAQ.0000000000000386
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TRAUMA TEAM 1 is paged over the hospital intercom. Your training kicks in, as you and your team prepare for the patient to arrive. You look around the room and see that all critical members of the team are accounted for, as are all essential equipment and supplies. Any deviation in the execution of these defined trauma management processes could potentially be detrimental. This includes not having the right equipment and supplies readily available to treat the unknown needs of the incoming trauma patient.

Quality patient care depends on competent caregivers, team member communication, policies and procedures, and workflows that comprise evidence-based practices. It also relies on a dependable supply chain. When nurses and other clinicians are caring for their patients, they need to be assured that they have quick and reliable access to the resources they need.

As a nurse who has worked in various roles from acute to post–acute care, I understand how critically vital it is for caregivers to have supplies available for patient care. As a current Director of Supply Chain in one of the largest not-for-profit organizations in the United States, I support my direct care colleagues (and contribute to the care of patients) by working to make sure that they do. I have been in health care supply chain for 6 years, managing an amazing team that oversees the purchase of products, supplies, and services that range from nursing commodities and surgical implants to services such as food and locum tenens nursing.

As I reflect upon the years when I was providing bedside nursing, I clearly remember numerous times I would take excessive amounts of supplies into the patient's room. I remember justifying my actions by believing I was actually being considerate to the oncoming shift by stockpiling supplies. While we never actually ran out of supplies, we always behaved as if we were in survival mode when it came to patient supplies.

While working as a WOCN certified wound nurse, I would “horde” products that I felt were superior to the products that were at hand. I did not know then that those products had been reviewed by a team of practicing wound care nurses and clinicians. Their review included evaluation of products as to both their qualitative and quantitative efficacy.

I did not plan on having a career in supply chain. The path I intended to take when I entered nursing was supposed to lead to me practicing patient care as a DNP. As it turned out, leaving bedside nursing to transition into the unknowns of supply chain management has been one of the most rewarding journeys of my career. Sometimes, life, and nursing, takes you places you had not planned.

My story as a nurse was not one of typical stories shared in a commercial that pulls on the “heartstrings.” It could be considered as happenstance. My full-time career, prior to nursing, was working as a sign language interpreter and as an at-risk career counselor, which I thoroughly enjoyed. However, my career options within this vocation were limited.

One night, I was at an automotive drag race and struck a casual conversation with a random individual about his car, work, etc. He informed me he was an emergency department nurse at a local level 1 facility. He shared some of his nursing stories (without divulging confidential, personal information, of course). He also spoke about the unlimited career paths available to a nurse. The very next day I decided to start on my prerequisites, so I could enroll into nursing school.

During the last 2 blocks of school, I had the opportunity to be one of 2 selected applicants to start as an “extern” and begin my nursing career at a level I trauma center. I eventually left trauma and worked in a variety of settings that included the post–acute care sector. I also had a stint as a consultant. Eventually, like many of my nursing colleagues, I felt the bug to go back to school. I determined I wanted to specialize in wound and ostomy and to venture back into acute care. I decided to pursue a certificate as a wound and ostomy nurse through Emory University.

After a few years of working as a wound care nurse, I began contemplating pursuit of my DNP. However, after reading a few health care books, I decided I needed to go into the business side of health care. I felt the missing link in health care was the limited number of clinicians making decisions within the business operations.

I decided to challenge myself and took on an ambitious goal of getting my master of business administration (MBA) degree while supporting my family as a full-time wound care nurse. While pursing my MBA, I did not consider a career in supply chain. I am not even sure I quite understood what that department was. I envisioned myself using my nursing background as a foundation for business operations in areas such as mergers and acquisitions or the next big “innovative start-up.” Supply chain was neither my first nor second thought when contemplating my “big” career shift/change. However, I knew one thing: I wanted to make a large-scale impact as a nurse with bedside experience who could help drive the change we need to see in health care. I was seeking to “find my calling.”

In my last semester of business school, I started to reach out to various leaders. I interviewed them to gain firsthand insight into what they do and what drives them. During that time, I was invited with a few colleagues to be a wound care representative for our Integrated Delivery Network.

I quickly learned that supply chain in health care is more complex than what the 2 chapters covered in my graduate studies. At a presentation provided by the SVP of Supply Chain, I learned that supply chain is the first place looked at when trying to reduce spend while avoiding impacting (cutting) full-time equivalents. He also spoke about the power of supply chain to help reduce variation, decrease the environmental footprints, and control costs in order to make health care affordable. What he said hit home. I understood the continuously rising cost of health care and its increasing percentage of the nation's gross domestic product. As a nurse, I felt (and still feel) an accountability to individuals and communities. I have a deep sense of responsibility to reduce the cost of supplies and services because that translates to decreasing the net impact of health care costs to our patients and the amazing communities we serve. When I was in wound care, I shared that “patients will remember and leave with the emotional perception of care provided, the healing wound, and the bill.” If I can reduce the impact of that bill, I am confident that patients and families will remember the care and focus on healing. In addition, reducing our environmental footprint through careful decision-making about what we use to provide care is extending care to future generations.

I sought out nurses who were directly engaged in managing various service lines in supply chain. They were dialed into quality metrics. They were engaged with various nursing and physician councils. They talked not only about “widgets” and cost but also about “why” we consider and evaluate products with evidence, data, and a shared understanding that “we” are all here to serve our community.

From insights gained, I decided I wanted to transition my nursing career to supply chain. I wanted to focus on moving the conversation from strictly cost to making decisions based on evidence.

Shortly toward the tail end of my MBA, I was fortunate enough to be selected as a product specialist in supply chain. The timing was opportune, as they asked me to lead the advanced wound care category.

I learned something I did not know when I was “hoarding” my favorite supplies: spending more on patient care material does not necessarily yield better patient care results. I learned more about supply chain processes and met with subject matter experts. Together, we were able to conduct multiple evaluations on products, review their usage, and “spend.” We talked through appropriate utilization during an average length of stay. There were ample data and evidence that showed higher spend did not equate to lower quality metrics. My colleagues and I have been able to standardize products based on average length of stay. We have decreased waste, achieved savings, and decreased product variation by 60%. That is good for our organization, our caregivers, and our patients. Nursing has brought me opportunities I never thought of. My education and training as a direct caregiver have galvanized my perspective on how and why there is a need for passionate, clinically trained experts to find a home in supply chain and other areas of health care operations. We have not “left” nursing—we have brought our experience and skills into positions that support evidence-based, appropriately provisioned care. We understand the cultural nuances and “sacred cows” in health care. We have the understanding to talk through processes and the “why” in order to make clinically responsible decisions when it comes to products and services in health care. We want to lead change that offsets the financial burden of the organization. We understand that part of “caring” is ensuring that “care” is affordable.

It was not that long ago when I was caring for a necrotizing fasciitis wound or doing neuro checks on trauma patients. My experience as one of the direct caregivers has deepened my ability to be their advocate in supply chain. I know firsthand why products are being used, how waste happens, and how that impacts the over financial health of the organization (and could very well be financially detrimental to a patient, a community, or a country).

In meetings, I introduce myself as a nurse. This will always be a point of pride for me. I once “ran codes,” and now I am running a large segment of supply chain. I still make a big difference in the well-being of others. I am truly grateful for being a nurse and the opportunity the profession has afforded me.

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