UNLV Nursing alumna Catherine Prato-Lefkowitz didn’t set out to invent something for nursing. But thanks to a conversation with a pharmacy executive, she now oversees a new brand she hopes will ease a nursing student’s education.
Three years ago, Prato-Lefkowitz conceptualized a digital program that would alleviate student anxiety. This program would store all necessary and relevant information for students building care plans for patients into one centralized space.
NurseMuse launched officially Spring 2022 with the twin goals of simplifying both nurse notetaking and erasing any ambiguity about what a care plan is.
The Business of Nursing
Prato-Lefkowitz came up with NurseMuse as a graduate student at UNLV, but despite earning three nursing degrees, it actually started in a non-health care field. She explains the idea started while studying for her Executive MBA at UNLV. She was brainstorming ideas for a thesis in her entrepreneurship class. It was during a conversation with other business leaders she realized what that could be.
She recalls, “When I was talking to CVS, their CEO said, ‘I don't know how nurses keep track of all those notes, writing all this stuff down throughout the day. That must be cumbersome.’ I said, ‘Yes, it's called the nursing brain board. We just take a piece of paper and all of our patients [are] written down. That's when it clicked that I could incorporate this into nursing education and help students understand the ‘why.’”
But the idea evolved further from just notetaking. Prato-Lefkowitz realized she could build something that emphasized the purpose of what students were trying to achieve. “The nursing faculty would tell students, ‘At the end, it's going to come together.’ When I was a student, I was like, ‘I don't know what is supposed to come together,’” Prato-Lefkowitz says. “So, you're a new nurse, stuck in the hospital. You have patients with diagnoses, and you don't know what the diagnoses are. Then you're told you have to write a care plan based on your nursing and medical diagnoses. That's very overwhelming.
“I can make it easier for our students to see the whole package upfront and then try to peel back the layers.”
Prato-Lefkowitz made sure to always keep the “why” at the top of her priority list. When she asks her students why they perform a task, she wants a well-thought out response. “I need an evidence-based rationale answer instead of, ‘We have a doctor's order,'" she says. "We don't do that anymore. [Nursing] is all evidence-based practice.”
Building the Muse
Although Prato-Lefkowitz has extensive nursing experience, transferring her knowledge into a program wasn’t easy. For her, it was like being a freshman student. “I feel I went through nursing school again after putting it together,” she admits. “I probably have 250-300 diagnoses in the care plan right now you can link, but I hand wrote all those. I used my evidence and textbooks. I had to research.”
Then she found a programmer to help with the actual software building. When NurseMuse was ready to test, she shared the program with UNLV students to get their take on what works and what could be improved.
“I'd say, ‘Tell me what's missing.’ They say, ‘It would be great if we could pull up normal vital signs for a baby versus an elderly patient,’ or ‘It would be great to look up a normal lab value.’ It started evolving from there, getting feedback from nursing students,” Prato-Lefkowitz says. The more responses she received, the more comprehensive the care plans became.
NurseMuse was built during the height of COVID-19, when Prato-Lefkowitz was also working as a nurse. The pandemic helped her focus more on the program and, she notes, it can assist with learning should a future shutdown that limit clinical resources for students.
“A lot of students never entered a hospital [during the pandemic]. Now, they're graduating nurses, and they've never touched a patient,” she says. “I think with this program, we can use it with simulation or case study, or integrate it into our curriculum so our students get more of that understanding, which is important for how these concepts connect with one another. Then, if they don't get to touch a patient, at least they're going to understand that ‘why.’”
The NurseMuse interface divides its resources into useful tabs for either a nursing student or a registered nurse. Information accessible include medical and nursing diagnoses; vital sign ranges, medical terminology; labs; and more, all evidence-based and referenced. “There are a ton of resources there,” Prato-Lefkowitz says. “If I'm a nursing student, and I forgot what the normal value of hemoglobin is, I can look it up on NurseMuse. I can also document everything for my patient that day. I can create the care plan, print it out and turn it in to my professor. It's very HIPAA-compliant; only I can access my patients I've put in.”
One of the distinctions in NurseMuse is between nursing approaches and medical diagnoses. Prato-Lefkowitz explains nurses cannot solely use a medical diagnosis because of the different areas of practice and different objectives between physicians and nurses. A patient may have medical problems and nursing problems, requiring different interventions for each.
“We don't treat hypertension; we treat decreased cardiac output," she says, for example. "Because we're nurses and we have to have a special language. We aren't treating the medical diagnosis, which is challenging for our nursing students to understand. I have a patient who has hypertension. They have high blood pressure, but we aren't treating the high blood pressure. Our physician is treating the high blood pressure by ordering these medications. We're going to give them medications, but we as nurses have to understand how those medications work in our system and look for any adverse effects or any positive or negative outcomes.”
Additional technological resources in nursing (or health care, in general) is a commonality these days, and Prato-Lefkowitz wants to stick to the modern trend to keep up with our future nurses. “I think our students these days are used to growing up with their computer. When I was in nursing school, we would be at home with our textbooks, finding nursing diagnoses. But now, our students are used to opening a link and having everything at their fingertips, which I think is important because that's how it's going to be when they graduate and become practicing nurses.”
However, she says there can always be a risk to relying too heavily on technology. “When we teach how to take blood pressure, we teach [students] how to manually take blood pressure with the stethoscope and [cuff],” she says. “Our students say, ‘I don't know why [we’re doing manual], because we have automatic [machines] in the hospitals.’ What if your automatic one isn't working, or what if there's an emergency or what if your provider asks for a manual on both sides?” She adds, “You have to understand our foundation.
With NurseMuse, I'm trying to teach them that foundation. It's great if they use it. But if it's not working correctly, hopefully from their prior history of using it, they should already know what they’re looking for with the patient. If they can't access it, it should not be the end of the world.”
NurseMuse launched three months ago, and Prato-Lefkowitz is spreading more awareness about her program. Her goal is to implement the program in nursing schools across the country. She also wants to expand NurseMuse for certified nursing assistants and nurse practitioners.
She acknowledges there is much to learn about the business side of introducing a new product, specifically marketing. “I believe with any new system, you just have to hear it: ‘NurseMuse, NurseMuse,’ and eventually somebody will say, ‘Maybe I should check it out.’ We're in that phase of just trying to get it out there. It's grassroots right now, but I'm going to keep promoting it.”
One particular review convinced Prato-Lefkowitz she was heading in the right direction. “I showed this to a nurse at Henderson Hospital. He's an ICU nurse, ex-military, going to med school. He said, ‘This is the most awesome thing I've ever seen. This could be huge.’ I thought, ‘He's a smart dude. He used to do IVs in a helicopter, and I have his blessing. At least I'm not wasting my time.’”