DiversityNursing Blog

Quality Patient and Nurse Safety

Posted by Erica Bettencourt

Mon, Oct 30, 2017 @ 03:43 PM

nurse-safety.jpgNurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team but, physicians may spend only 30 to 45 minutes a day with even a critically ill hospitalized patient. This means Nurses have the critical role in ensuring a patient's safety.

Nurses ensure their patient's safety by monitoring them for clinical deterioration, detecting errors, understanding care processes, and performing countless other tasks. There are many ways to help you achieve quality safety for yourself and your patients. Here are a few...

Nurse-to-patient ratios

According to Agency for Healthcare Research and Quality, assigning increasing numbers of patients eventually compromises a Nurses' ability to provide safe care. Several seminal studies have demonstrated the link between Nurse staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity, and even mortality as the number of patients per Nurse increases. The strength of these data has led several states, beginning with California in 2004, to establish legislatively mandated minimum Nurse-to-patient ratios; in California, acute medical–surgical inpatient units may assign no more than five patients to each registered Nurse.

Safe and healthy workplace

OSHA, which enforces the Occupational and Safety Health Act of 1970, ensures employers are providing a safe and healthy workplace for workers and comply with OSHA’s regulations. Some of the obligations include:

• Complying with your employer’s policies and procedures based on its obligations under OSHA;

• Using personal protective equipment, including masks, when indicated;

• Informing your Nurse manager and others designated in the facility policy of workplace violence (e.g., bullying, intimidation, verbal abuse);

• Using proper body mechanics when lifting, pushing wheelchairs or otherwise working with patients;

• Reducing risks for slips, trips or falls by removing obstacles, wiping up wet walking surfaces and wearing shoes that support your feet and your walking;

• Speaking with your Nurse manager and CNO when policies and procedures governing safety are not being followed.

Overtime and long shifts

It is common for hospitals and clinics to request that their Nursing staff work overtime. While working overtime can be an effective solution to a Nursing shortage, it also can present a number of problems. Nurses risk becoming burned out, tired and/or stressed if they take on too much overtime.

 A study conducted by the Pennsylvania Patient Safety Reporting System showed working a 12-hour shift or working overtime was related to having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The most common medication errors identified in the study due to Nurse fatigue were wrong doses, dose omission and extra doses.

Communication

Health care teams that communicate effectively and work togehter reduce the potential for error, resulting in an improved clinical performance. According to the American Hospital Association,  A key aspect in improving teamwork and communication in health care is engaging patients and families. Increasingly, research shows a correlation between increased patient and family engagement and fewer adverse events. Determining how patients and families want to be involved in their care and then engaging them in designing their plan of care increases their understanding of tests, procedures, and anticipated care outcomes, including a successful discharge.

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Topics: patient safety, nurse safety

10 Warning Signs You Are Working with the Wrong Nurse Leader

Posted by Erica Bettencourt

Wed, Jan 14, 2015 @ 01:01 PM

By Cynthia Howard RN, CNC, Phd

10 Warning Signs You Are Working with the Wrong Nurse Leader resized 600

Finding the right nursing job includes finding a manager that will help you grow, develop, and support your career goals.

There is a saying that people leave their managers and not their jobs and to have success in your career may mean you want to circulate your resume in order to find the best fit for you. This means you have to know what you want and need in the area of support.

Here are 10 warning signs you may be working with the wrong manager:

  1. You never hear from your manager prior to your performance reviews. Over 75% of performance problems can be improved with proper feedback and less than 33% of the time, feedback is provided.
     
  2. You have no idea what they want.  This can be worse than not having feedback at all. When a manager says, “I do not like how you did that,” you really have no way of knowing what they really mean. Make sure to ask for clarification. Review your job description and ask for your manager to specify what parts of your job responsibilities are most important to them. It could be they are focused on patient safety and you have an interest in health literacy. Knowing what they want gives you the advantage of focusing your efforts for the greatest gain.
     
  3. It is their way or the highway.  This is a problem for many nurses. Job satisfaction comes with autonomy and the opportunity to solve your own problems as they show up on the job. When a manager consistently tells you what and how to do something, employees quickly turn off their own creativity; more than likely, with an increase in mistakes.

    A nurse who is practicing for 7 years shared a story about his experience on a new unit. His Clinical Specialist was a micro-manager. She told him to give this medication immediately because of incoming admissions. She had poured the med. This went against his better judgment but because he knew she would have a fit, he gave it, to the wrong patient. She was extremely apologetic however the “error” was on him. Do not compromise your judgment for the sake of status quo.
     
  4. Your manager wants you to figure it out.  The opposite of micro-managing is to not manage at all and letting everyone figure it out for themselves. This happens quite a bit leaving the power position to go to the most domineering individuals on the unit. Everyone needs to know the manager is in charge and when needed will make those tough decisions.
     
  5. You could not recognize them if your life depended on it.  If your manager hides behind email or a closed door, having a relationship with your manager will be impossible. Communication and trust is the foundation of a great working relationship.  

    Suggestion for managers: Time is an important commodity and getting around to all your staff can be time consuming. Why not use technology and set up a short video. Most iPhones take excellent video. Take 2-3 minutes every week and share what is going on. You may also want to share something personal about yourself; if you just started juicing, kickboxing, celebrated an anniversary or a milestone with your children. Interview them, show images along your morning run, and share something of yourself in order to make the connection with your staff.

    Suggestion for staff: Make a short video on your unit of a new initiative, gratitude board in the break room, more efficient way to give report, a snippet of rounds, and just a friendly hello from everyone on the unit. You may even want to say thanks and express appreciation; managers are people too!
     
  6. The way out the door is faster than up. If you have a manager that makes any attempt for you to advance your skills difficult, it will be hard to boost your resume. Managers can feel threatened by qualified staff members who want to move up the ladder and may indirectly thwart your efforts to move forward. This is really short sighted on the manager’s part because any manager that turns our qualified leaders actually looks really good to their higher ups given the ongoing need for good talent in any organization.
     
  7. Lack of training.  Being able to do a job well requires the right training. Often it takes the manager to assess the need for training based on performance and outcomes. This relates to the lack of feedback. While every employee really should do their own assessment of what they need to do well and then make the request of their manager, the manager should also be on the lookout for staff that need training and set up opportunities to make this happen.
     
  8. When the manager has obvious “favorites.”  Everyone has preferences in personality style, but when the manager consistently selects one particular individual for all the initiatives, opportunities for advancement, or other assignments that provide variety, the manager is sending a message to others they do not care about your skills or your future.
     
  9. When your manager routinely says, “I’ll think about it.”  Obviously considering all sides of the problem/ situation is important however some managers hide behind this and never make a decision about what is the ideal way to go.  Quickly, this can be frustrating if you are looking for a course of action to solve a problem.
     
  10. When your manager over reacts or criticizes you in front of others.  This is a toxic behavior and is an indication you want to find a new place to work. Quickly this will diminish your self-esteem, leading to resentment and stagnation.

    Knowing what you want in the way of workplace is key and will help you avoid a poor manager. What type of opportunities are you looking for in the workplace? What are your career goals? Evaluate the workplace, ask questions, find out the management style, review a performance appraisal, ask about turnover, and see if you can build a relationship with your new manager.  

Enjoy the opportunity to find a place that truly supports and honors you! 

Source: www.nursetogether.com

Topics: hospital, job, RN, work, medicine, patient safety, practice, nurse, nurses, nursing, resume, career, jobs, medical, shift, manager, LPN, performance, clinical specialist

RN Safe Staffing Bill Introduced in Congress

Posted by Alycia Sullivan

Mon, May 20, 2013 @ 10:41 AM

The American Nurses Association (ANA) this week applauded the introduction of federal legislation that empowers registered nurses (RNs) to drive staffing decisions in hospitals and, consequently, protect patients and improve the quality of care. The Registered Nurse Safe Staffing Act of 2013 (H.R. 1821), crafted with input from ANA, has sponsors from both political parties who co-chair the House Nursing Caucus—Reps. David Joyce (R-OH) and Lois Capps (D-CA), a nurse.

"Nurse staffing has a direct impact on patient safety," said ANA president Karen Daley, PhD, RN, FAAN.  "We know that when there are appropriate nurse staffing levels, patient outcomes improve. Determining the appropriate number and mix of nursing staff is critical to the delivery of quality patient care. Federal legislation is necessary to increase protections for patients and ensure fair working conditions for nurses."

Research has shown that higher staffing levels by experienced RNs are linked to lower rates of patient falls, infections, medication errors, and even death, ANA reported. And when unanticipated events happen in a hospital resulting in patient death, injury, or permanent loss of function, inadequate nurse staffing often is cited as a contributing factor.

The bill would require hospitals to establish committees that would create unit-by-unit nurse staffing plans based on multiple factors, such as the number of patients on the unit, severity of the patients’ conditions, experience and skill level of the RNs, availability of support staff, and technological resources.

The safe staffing bill also would require hospitals that participate in Medicare to publicly report nurse staffing plans for each unit. It would place limits on the practice of "floating" nurses by ensuring that RNs are not forced to work on units if they lack the education and experience in that specialty. It also would hold hospitals accountable for safe nurse staffing by requiring the development of procedures for receiving and investigating complaints; allowing imposition of civil monetary penalties for knowing violations; and providing whistle-blower protections for those who file a complaint about staffing.

ANA backed a similar staffing bill in the last Congress. This version includes requirements that a hospital’s staffing committee be comprised of at least 55 percent direct care nurses or their representatives, and that the staffing plans must establish adjustable minimum nurse-to-patient ratios.

Additionally, ANA has advocated for safe staffing conditions for the nation’s RNs through the development and updating of ANA’s Principles for Nurse Staffing, and implementation of a national nursing quality database program that correlates staffing to patient outcomes. 

To date, seven states have passed nurse safe staffing legislation that closely resembles ANA’s recommended approach to ensure safe staffing, utilizing a hospital-wide staffing committee in which direct care nurses have a voice in creating the appropriate staffing levels. Those states are Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington.

Source: EndoNurse

Topics: RN, nurse staffing, safe, Congress, bill, patient safety

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