NR 351 Nursing Roles in Quality Improvement

NR 351 Nursing Roles in Quality Improvement

NR 351 Nursing Roles in Quality Improvement

Each of us strives to provide quality patient care with the best outcomes. The Institute of Medicine (Hayes & Gordon, 2015) stated that quality care includes providing health services to improve outcomes while including patient-centered care, good communication, and collaboration. Hayes and Gordon (2015) claimed that quality improvement is a systems-based concern.

As we learn more about the nursing core competencies of safety and quality improvement this week, we must also examine our own processes. By considering potential changes, you will show leadership in your professional nursing practice. I want to hear about what you are doing at your facilities that promote safety.

Always remember to return to the assigned discussion topic and questions (above the first post) and make sure you thoroughly address each area.

Reference

Hayes, K., & Gordon, D. B. (2015). Delivering quality pain management: The challenge for nurses. AORN Journal, 101(3), 327-337.

“Professional nurses bring a unique perspective and offer valuable skills to enhance health care quality. All health team members must be invested in developing and maintaining a culture of safety and QI” (Hood). Nurses play a vital role in all aspects of care, nurses are the frontline and with that comes huge responsibility. Nursing is probably one of the most stressful occupations and with stress comes the potential for mistakes. No one is without fault but what makes the difference is how that fault is handled, whether it is punitive response or an opportunity to learn. “An important feature of a safe organization is the creation of a “just culture.” A just culture allows frontline employees or personnel to feel comfortable disclosing errors, even one’s own error” (Fondahn, Lane, Vannucci). Even mistakes or near misses should be treated as an opportunity to reflect and learn. We are all imperfect and working in a punitive environment  creates stress and the potential for increased errors. Nurses must feel empowered to take responsibility for mistakes and not feel that they will be punished. At my hospital we embrace a “just culture” and use every opportunity to huddle and review what happened, what could have happened, and what could have been done differently.

I feel that my hospital has the tools in  place to create a non-punitive environment. The improvement I would like to see is something in place to help nurses work through the pressure and guilt of needing to be perfect. Any time I have ever made a mistake the guilt I feel and the “beating myself up” is more punitive then any one could impose.

 

Hood, L. J. (2018). Leddy & Pepper’s professional nursing ninth edition. Philadelphia: Wolters Kluwer.

Fondahn, E; Lane, M; Vannucci, A (2016). The Washington Manual of Patient Safety and Quality Improvement. Philadelphia: Wolters Kluwer.

I would think most nurses feel responsible after making an error especially if harm was caused to a patient. I like how you stated that is ok to make a mistake, however, one needs to be held accountable.  Also, I believe it is what you learn and take away from the mistake that matters.  The more experienced nurses should always make an effort to make the new nurses feel comfortable asking questions; as you stated, this is how one learns.  One way you can exhibit leadership in your unit is to encourage others to embrace the newer nurses. I would also like to hear about a safety improvement process at your facility.

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In your citations, you always need to include the year along with the author’s name. Example: (Hood, 2018). In your references, the name of the book should be in italics. Great effort.

I agree with you that nursing is one of the most stressful jobs and with increased stress comes a higher risk for

NR 351 Nursing Roles in Quality Improvement
NR 351 Nursing Roles in Quality Improvement

potential mistakes. An environment that is non-punitive and uses mistakes and errors as a learning opportunity for everyone is a much better environment to work in. With that being said, certain mistakes can not go without punishment, however, it should not be the primary focus. At the hospital I work at, we started a “Good Catch” award. It is to allow nurses to speak up and report a near-miss or an error that was made without being punished. It is meant to help educate staff and do a root analysis to find out how the mistake happened and what can be done to fix the problem and make it safe.  Those nurses that made a “good catch” report are recognized in the monthly newsletter. It has helped nurses take responsibility to speak up about near-misses or errors made and not having to worry about being punished.

As nurses, we promote safety and improve quality by constantly “analyzing errors and designing system improvements” (Massachusetts Department Of Higher Education Nursing Core Competencies, Revised 2016). My floor is now the COVID-19 quarantine unit of the hospital and we are continually collaborating to improve upon processes aimed to prevent contaminating ourselves, patients who might not actually be infected, or anything outside of our unit. Preventing the contamination of patients involves constantly changing PPE and keeping the unit as clean as possible. Moving people, supplies, and waste, and eating, drinking, and going to the bathroom takes more thought, though. Our donning and doffing area is like a gradient of cleanliness with a tent at the end. On the other side of the tent lies the outside world. I feel like we live on an island where practically everything has to be delivered. But it’s not a Southern Caribbean island where people are happy to bring things and might even stay for lunch, it’s more of a Northern Atlantic island, in the middle of winter, where people do not want to come, usually leave supplies on the coast, and rush home. This is good though, because we want as few people as possible coming ashore.

Then there is the conservation of supplies issue. We are now confronted with the choice of conserving and waiting, or depleting PPE, to leave the area to drink, eat, and use the bathroom. Supplies are already low and according to Palmer (2020) “preparing for a worldwide pandemic, especially when you don’t know how fast it will spread or how serious its consequences will be, is one of the hardest things that healthcare workers do.” But we are really learning how to better cluster care and align the time between patients, when we already have to change PPE, with short breaks. I feel like we are going to come out of this being some of the most efficient nurses ever.

And in addition to improving the effectiveness of our unit, we exemplify adequate training with regard to the provided technology to ensure safety to both healthcare provider and receiver (Massachusetts Department Of Higher Education Nursing Core Competencies, Revised 2016). We have become very skilled at working in airborne precautions and although all hospital staff involved in direct patient care have been extensively trained in it, those who don’t frequently visit our unit need special instruction with our process of moving into and out of the quarantine area. Our solution is to always have a “specialist” appointed to the area to both assist those in need and ensure the area is adequately cleaned and stocked.

In response to the second question, I believe my workplace, promotes a very non-punitive culture of safety, where the cause of the error is more significant than the one who caused it (Barnsteiner, 2011). Earlier in my career, I once started a fentanyl drip too fast and realized it a few hours later. The rate was within the titration parameters, and although the patient was not harmed, it was still a medication error. That evening I reflected upon what had caused the error, identified how I could prevent repeating it, discussed it with my manager, and documented it on our error tracking system. Since I was very open and honest about my mistake, and I do not have a reputation for medication errors, my manager was very understanding and I was not punished because there is a balance in my workplace “between not blaming individuals for errors and not tolerating egregious behavior” Barnsteiner (2011).

References

Barnsteiner, J. (2011). Teaching the culture of safety. Online Journal of Issues in Nursing, 16(3). doi:10.3912/OJIN.Vol16No03Man05

Massachusetts Department of Higher Education Nursing Initiative. (2010). Massachusetts Nurse of the Future Nursing Core Competencies© Registered Nurse. Retrieved from http://www.mass.edu/nahi/documents/NOFRNCompetencies_updated_March2016.pdfLinks to an external site.

Palmer, J. (2020). Coronavirus and preparing for the worst. Medical Environment Update, 30(4), 1-4. Retrieved from https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=10&sid=97796d22-d348-4e3f-ae9b-322226ab0e2a%40sessionmgr4007