Why Nursing School Grades Don’t Matter

Why Nursing School Grades Don’t Matter

We all sat around in my living room, friends in the fight against those nursing school teachers who seemed hell-bent on making our lives miserable. There were about ten of us crammed into my small living room for this Saturday study group, and I was the de facto leader. I didn’t need to be there. I didn’t need much more than to glance through the notes to get good grades, but I wanted to help these on-the-bubble students pass. I taught what I knew. Everyone wanted to study with me because, well, test scores speak for themselves in nursing school.

Yes, I was one of those, and I always have been. Give me a book, and I can ace a test. It isn’t really genius. It’s just that I know how to take a test. Of course, I was immensely proud of my 4.0. I didn’t lord it over people, but I did feel rather smug I guess, rather superior. I felt this meant the nursing world was my oyster. I was cocky that I would breeze through orientation, but I certainly didn’t feel I knew it all. I also didn’t put my fellow students down. In fact, I enjoyed helping them, fighting the good fight to get them to pass.

One day, my teacher said something that made the bottom drop out of my stomach: “The best nurses are usually those in the middle of the pack. Those who score high tend to not do so well.”

Was she talking to me? She said it to the class, but was she talking to me?

Maybe I was paranoid, but it turns out that there was a kernel of truth in what she said.

When I interviewed out of nursing school, no one cared that I graduated at the top of my class, although I told them repeatedly. They were more interested in how I would handle a crisis and what sort of person I was and whether or not I would fit in with this culture. Despite my obvious hubris, I am actually someone who can work well with others, can care for patients, and can be a part of the team. The only thing is that my work in school didn’t matter a damn to them.

What really opened my eyes was orientation. I was lost. Everything I had learned was so much chaff. It came into play from time to time, but it really and truly did not matter.

I remember the first time I had four patients. It was a juggling act. The fact that I knew all the bones of the hand by heart was completely irrelevant. I needed to look at vital signs and know what they meant. I needed to know when to pass meds and when to chart. Most importantly, I needed to know when I didn’t know something, and I needed to ask for help.

Fortunately, questions have never been a problem for me, and I was able to become a safe nurse because of that. This 4.0 student spent more time with her preceptor or charge nurse than she did with her patients in the first year of nursing.

And still, all that book learning I had was merely peripheral. Sometimes, it came into play. I would know obscure things about electrolyte imbalances, for instance. I was also considered one of the go-to nurses with problems in my later years.

But my knowledge is not what makes me a good nurse.

I found that my personal sense of patient safety was the most important. My ability to handle more and more stress became the calling card of my practice. My life was about looking at a situation and making a decision. Do I call a doctor about this, or do I have the means to fix it myself? Do I delegate this responsibility, or do I do it myself? Should I ask for help, or do I know enough?

My mentors—my preceptor, my manager, the various charge nurses, and the more experienced nurses—made me into a nurse. It wasn’t that huge book I lugged around for so many years. It takes a village to raise a nurse. Not a textbook.

These are skills that are not measured by GPA. These are skills that I have but don’t come as easily to me as multiple-choice questions. The point is that if you are a 2.5 student, don’t worry. Your ability to pass tests and get good grades has nothing to do with real world nursing. Trust me. I’ve been there. I am a good nurse. I worked hard to become one, but it didn’t have anything to do with what I did in school. It was about a fabulous preceptor, a supportive group of experienced nurses, and hard work on my part.

Not graduating at the top of your class? You may just be the best nurse yet. If you are someone who can manage your time well, you will make a good nurse. If you are someone who can stare down a stressful situation and make decisions, you will be a good nurse.

Most importantly, if you can and will ask questions when you don’t know the answers—and accept that you know very few of the answers—you will be well on your way to becoming a fantastic nurse. If you just eked by in nursing school, don’t let it bother you. Take it from someone who has been there: It doesn’t matter at all.

Critical Thinking: A Vital Trait for Nurses

Critical Thinking: A Vital Trait for Nurses

One of the most commonly heard phrases right from day one of nursing school is “critical thinking.” The common consensus is that everyone has to develop sound critical thinking in order to be a safe and effective, registered nurse (RN). This necessity is magnified when it comes to critical care areas where one decision by the RN can change the patient’s outcome. Nursing has changed from a simple caregiving job to a complex and highly responsible profession. Hence, the role of nurses has changed from being task-oriented to a team-based, patient-centered approach with an emphasis on positive outcomes. Strong critical thinking skills will have the greatest impact on patient outcomes.

So, what is critical thinking and how do we develop this? A precise definition was proposed in a statement by Michael Scriven and Richard Paul at the Eighth Annual International Conference on Critical Thinking and Education Reform during the summer of 1987. “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness,” reads the document.

Simply put, critical thinking in nursing is a purposeful, logical process which results in powerful patient outcomes. “Critical thinking involves interpretation and analysis of the problem, reasoning to find a solution, applying, and finally evaluation of the outcomes,” according to a 2010 study published in the Journal of Nursing Education. This definition essentially covers the nursing process and reiterates that critical thinking builds upon a solid foundation of sound clinical knowledge. Critical thinking is the result of a combination of innate curiosity; a strong foundation of theoretical knowledge of human anatomy and physiology, disease processes, and normal and abnormal lab values; and an orientation for thinking on your feet. Combining this with a strong passion for patient care will produce positive patient outcomes. The critical thinking nurse has an open mind and draws heavily upon evidence-based research and past clinical experiences to solve patient problems.

How does one develop critical thinking skills? A good start is to develop an inquisitive mind, which leads to questioning, and a quest for knowledge and understanding of the complex nature of the human body and its functioning. A vital step in developing critical thinking for new nurses is to learn from those with a strong base of practical experience in the form of preceptors/colleagues. An open-minded nurse can learn valuable lessons from others’ critical thinking ability and will be able to practice for the good of their patients.

Critical thinking is self-guided and self-disciplined. Nursing interventions can be reasonably explained through evidence-based research studies and work experience. A strong sense of focus and discipline is also important for critical thinking to work. If thinking is unchecked, nurses can be easily misguided and deliver flawed patient care. A constant comparison of practice with best practices in the industry will help guide a nurse to think critically and improve care. This makes it easier to form habits which continue to have a positive impact on patients and colleagues. Every decision a critical thinking nurse makes affects not only the patient but also his or her families, coworkers, and self.

In summary, the take-home message for nurses is that critical thinking alone can’t ensure great patient care. A combination of open-mindedness, a solid foundational knowledge of disease processes, and continuous learning, coupled with a compassionate heart and great clinical preceptors, can ensure that every new nurse will be a critical thinker positively affecting outcomes at the bedside.

Be More Efficient During the Holidays

Be More Efficient During the Holidays

During the holidays, one of the biggest things most people lack is time. With so much extra squeezed into these weeks at the end of the year, it’s hard to finish up all the tasks on your list let alone find time to enjoy yourself.

But all that holiday hectic rush can seep into your work day making you feel like you are on a hamster wheel. At work you worry about everything you have left undone on the home front, and at home you worry about all the things you need to finish up at work.

How can you calm this cycle and make your work day more efficient? Here are a few tips to keep you on track.

State Your Intention

As you transition from work to home or home to work, make a conscious choice to refocus your energy. It might sound silly, but stating your intentions for the day out loud can help you shut out all the nagging details of one area of your life to focus on the details at hand.

As you walk into work, you can say, “Today I am going to focus on being the best nurse I can. I especially want to _______ (fill in the blank with your intentions—comfort my patients who are melancholy because of the season, nail my big presentation, mentor the student nurse who will be on the floor).

When you head for home, review your day and then bring your home life to the front. State your intention with a simple, “I am going to give my home life my attention now. I will use my time tonight to ________ (reconnect with myself or my family, enjoy time with friends, focus on my classwork, finish my holiday shopping).

Make a List

Leaving one place behind to focus on the other is a lot easier if you feel like you aren’t forgetting something vital. Keep a list of what you want to accomplish each day, each week, and even each month if that’s possible. At the end of your day, review your list and cross off what you managed to get done. Break it down into an order that works for you. You can accomplish one big task (finishing the unit’s schedule) and five small tasks (booking a conference room for a meeting, checking your vacation balance, remembering to tell a patient a funny story) or you can choose two big tasks. Maybe your day needs to be filled with lots of tiny details that need to get done, but understand that a big task will be impossible to fit in. List even the small tasks like booking a dentist appointment or the long-range ones like thinking about your upcoming annual review. Those are the details that get lost in the shuffle and can cause you to feel less in control.

Use a Timer and a Calendar

Being realistic about what you can accomplish means being able to manage your time efficiently and effectively. It’s unrealistic to devote 30 minutes to shopping for presents and visiting a friend. At work, you can’t expect to write a thorough report in a four-hour block if you have two meetings in the same time frame.

For a while, time how long you spend on a task so you can more accurately plan your time. Have no judgment or expectations about being faster or doing more. Just knowing how you work can make your life easier.

When you have that down, start using your calendar to plan blocks of time when you can realistically get things done. Book specific time to accomplish the smaller things and use your calendar to remind you.

Staying on track and on top of all you have to do at work and away from work can be overwhelming. But there are plenty of ways you can take control and make your life easier. See what works best for you and stick with it.

 

Surviving the First Year as a Nurse: I Got My First Job as a RN, Now What?

Surviving the First Year as a Nurse: I Got My First Job as a RN, Now What?

Here come brand-new nurses with their brand-new scrubs, clipboards, nursing shoes, and stethoscopes, eager to start the adventure as a nurse in the real world of nursing. Securing the very first job as a registered nurse is one of the most exciting—but also terrifying—events that any new graduate nurse experiences. No more simulation labs and clinicals, but real lives (and your license) are at stake. A recent report suggests that nearly 30% of new graduate nurses leave their job within the first year. You had been asking yourself if you would survive the nursing school. Now, you have to ask yourself this question: Am I going to survive the first year as a nurse? Here are some real-life tips from one new graduate nurse who just survived the first year working as a bedside nurse to another.

Cherish Your Orientation Period

New graduate nurse residency programs, such as Transition to Practice programs, are excellent opportunities to receive extended orientation periods, labs, and classes. It is true that often you may feel like you are back in school again with extended orientation time. However, it is critical for new graduate nurses to take this opportunity to learn, practice, and experience as much as they can during this period because once the orientation is over, you will be on your own without preceptors to back you up. After the first couple of shifts on your own, you may miss the orientation days.

When in Doubt, Ask!

The biggest mistake that a new graduate nurse can make is to assume things. “There is no such thing as a stupid question. We are not worried about new nurses asking endless questions regardless of the content, but we will be worried if a new graduate nurse has no questions,” says Jo Burney, who has more than 20 years of bedside nursing experience and frequently mentors and precepts new graduate nurses. Asking questions doesn’t make you look like an incompetent nurse at all. Providing inadequate, or unsafe, care because you weren’t sure what to do but didn’t ask questions about it will make you not only incompetent but also a reckless nurse.

Find Out the Good, the Bad, and the Ugly

Nurses are only human. There are experienced nurses who are excellent teachers and mentors to new nurses professionally and personally. However, there are also experienced nurses who have nothing to offer to you, meaning that they don’t want to teach you and you probably don’t want to learn anything from them either. New graduate nurses should be able spot these different types of nurses. If you haven’t figured it out on your own, ask your preceptor at the end of your orientation for a list of nurses who can be great resources around the unit.

Study

Nursing school may be over, but the education continues. It is highly encouraged to study about the specialty of nursing that you are in, such as the common patient populations, diagnoses, medications, pathophysiologies, protocols, and policies. You may even consider opening the textbook that you said you would never open again after nursing school is over! Do so when you have downtime at work if you can’t make time outside of your work. Having the knowledge behind the nursing tasks you do will increase your ability to critically think and analyze the cases.

Be Personable, but Stay Away From the Drama

You don’t have to be best friends with your coworkers, but it doesn’t hurt to leave a good impression and to get along with them. Introduce yourself to the other nurses and nursing assistants and remember their names. Smile and greet! Simple and small courteous actions will make a difference. If it seems appropriate, you can also share personal things such as family and pets. You want to treat each nurse as an individual rather than just another nurse who happens to be working the same shift as you. However, never gossip or badmouth other nurses even if everyone else is talking and gossiping about a certain person in front of you.

It’s All About Listening

Listen to your patients and their family members. Listen to other nurses, nursing assistants, secretaries, providers, social workers, and other interdisciplinary team members. You can always learn something from anybody, whether it is how to transfer phone calls or how to program an IV pump, as long as you keep your ears and minds wide open for all the million things that you have to remember as a new graduate nurse.

The first year as a new graduate nurse will pass in the blink of an eye, and you will become a novice nurse who is somewhat comfortable but is still a little nervous with unfamiliar cases and emergent situations. You will be so very proud with that one year of bedside nursing experience under your belt, but the journey to become an experienced nurse will always continue.

Challenges Facing Nursing Students Today

Challenges Facing Nursing Students Today

There have always been challenges facing nursing students. What are the biggest ones today, and how can students deal with and overcome them? Some experts weigh in.

Frederick Richardson, a BSN student and the Breakthrough to Nursing director for the National Student Nurses’ Association, had no doubt about how much of his time would be taken up when he began attending nursing school. Yet, he says, this seems to be one of the toughest aspects of attending nursing school that students struggle with.

“One of the biggest issues that nursing students face is time—making time for everything,” explains Richardson. “Nursing school is very demanding, and when you add in the coursework, reading for homework, and the clinical work, there usually isn’t time for anything else.”

Richardson says that he was fortunate enough to learn about this before choosing to attend nursing school. His older brother had attended nursing school, and Richardson saw firsthand how often he didn’t see his brother during that time. “He would be at the library studying, at class, or at clinicals,” recalls Richardson. “When I’d see him, it would be late at night. And he would be out of the door first thing in the morning. At the time, I recognized that when I would get to nursing school, I would probably have a similar schedule, and sure enough, it’s been exactly the same way.”

To overcome this, Richardson says that students need to have perspective and be realistic regarding what they can accomplish in their lives while attending such vigorous programs. “Our schedules can get really hectic. But I think that when you get into nursing school, you have to recognize that you’re going to devote the majority of your time to your nursing program. A lot of students don’t realize that,” he says.

Students need to set their priorities straight and decide how they are going to organize their time. Richardson, for example, says that he had to learn how to plan his time, organize his life and tasks on a calendar, and then follow that calendar every single day. From his perspective, quite a lot of students expect to attend nursing school and still have an active social life and do everything they did before, like watch all their favorite television shows.

“I think that the trouble students run into is they believe they can have everything—do well in nursing school, have an active social life, et cetera. If they go in with that kind of view, I don’t think they’re going to survive nursing school,” says Richardson. “They’re going to have to sacrifice a lot of that time, but once you get into it, it gets a bit easier.”

Martha A. Dawson, DNP, MSN, FACHE, assistant professor and coordinator of Nursing and Health Systems Administration at the University of Alabama at Birmingham School of Nursing, as well as the current historian for the National Black Nurses Association, agrees that having enough time can be an issue for nursing students. Traditional nursing students still face challenges that relate to study time, finances, and part-time work. In addition to the challenges of traditional students, however, second degree nursing students, such as those in a BSN to MSN bridge or other accelerated degree program, may also have immediate family obligations, explains Dawson. For instance, some may be primary caregivers for older parents. “Many students in these new and emerging programs are older, and these added life demands can lead to both high stress and exhaustion,” she adds.

Money, Money, Money

Richardson and Dawson agree that financial issues can also be a big challenge for nursing students. Dawson says that with the varying nursing programs and the older student population in them, these students may have greater financial obligations besides school, like a mortgage. “The current economic climate is making it more difficult for students to gain access to scholarships, trainee grants, and other forms of funding without going further into debt,” says Dawson.

In addition to taking out loans to attend nursing school, Richardson says that there are a number of scholarships available for students. Believe it or not, though, not a lot of students are applying for them. “There are a good number of scholarships available,” says Richardson. “After speaking with some people who have scholarships or who fund scholarships for students, I’ve discovered that they’re not getting a lot of applications. One reason is because of the time. A lot of students don’t know that the scholarships exist, and a lot who know they exist feel like they don’t have the time to fill out the applications because of the high demand of nursing school.”

The reality, Richardson says, is that studying takes up so much of the students’ days that many don’t think they could take the time to do what some scholarships may require in their applications—like get a letter of recommendation, write three essays, get transcripts, and the like.

Recently, Richardson had a heart-to-heart talk with a student who was frustrated because of going to school, clinicals, and a part-time job. “I said, ‘If you took about three hours applying for a scholarship, you would get more money to help you out with your school fees,’” says Richardson. He continued to explain to the student that he was working twice as hard and putting in twice as many hours at his part-time job to make the same amount of money that he could get if he applied for a scholarship—which would ultimately free up more of his time. “It would help the student more in the long run,” says Richardson.

Family Support

Along with not getting enough financial support, some nursing students don’t have as much family support, says Rebecca Harris-Smith, EdD, MSN, BA, dean of Nursing and Allied Health at South Louisiana Community College. “Nursing classrooms across the nation are filled with an intergenerational, multicultural group of students that range from millennials to baby boomers,” explains Harris-Smith. “This nontraditional classroom of students has many that are parents who frequently do not have siblings, parents, or other relatives to assist them with child care. The expense of child care, transportation, and after-hours coverage often impacts the nursing student’s classroom, clinical, and study time.”

Richardson says that family support and encouragement is often needed, but not every student has it. “I noticed immediately that I needed a lot of support,” says Richardson.

Communication

“In my personal experience, soft skills as they relate to interpersonal people skills have become an issue for nursing students. The ability to communicate both verbally and in writing appears to be a challenge,” says Harris-Smith. She says that because Gen Xers and millennials have grown up with a lot of technology, they have spent a lot of their early years communicating that way.

“Basic socialization has changed in that the younger generations would prefer to text over having a verbal conversation. The lack of appropriate communication skills has an impact on the students’ ability to work collaboratively with physicians, fellow nurses, and other members of the health care team,” explains Harris-Smith.

“Effective communication is essential due to the intra- and interprofessional team collaboration essential in the health care arena,” Harris-Smith explains. “Additionally, nursing students must learn flexibility, professionalism, and a strong work ethic—which are essential to the development of the new nurse graduate. Being able to adapt to an ever-changing environment is important as health care facilities have staffing issues often requiring nurses to work beyond their shifts.”

Challenges for Minority Students

Although the challenges for nursing students are often the same for students of color and those who aren’t, “students from underrepresented groups in the nursing profession and in society . . . have them on a much larger scale,” says Dawson. “There are barriers and biases that these students experience such as academic skills, perceived perceptions about their abilities, lack of faculty role models, limited peer support, and major financial issues that ‘majority’ students do not have to deal with on a daily basis. Many minority students also struggle with the very basics of housing and food.”

An additional burden that minority students face, says Harris-Smith, is that of access and equity in education. “A selective admission process is used by schools of nursing across the nation, and this very process can serve as a barrier for students of color. Academic profiling of students ensures admission of the most academically prepared students that rank highest among their peers, but students from underrepresented populations are often the first-generation college students that struggle with the issues of being the first in the family to attend college. This situation places a heavy burden on the student because s/he may be dealing with the pressure of being the ‘savior’ for the family. These students are generally not savvy enough to apply for multiple college programs, have difficulty completing financial aid forms, and generally come to college with limited resources,” says Harris-Smith.

“Nursing programs tend to address diversity in their mission statements but fail to explain how this is accomplished. Merely placing the statement in the mission statement does not explain how the school of nursing addresses the issue. To ensure transparency, each school of nursing could better address this issue by providing information on the way in which this mission is accomplished,” says Harris-Smith. For example, she says, schools could use a statement that’s more explanatory: This school of nursing addresses diversity via academic profiling of students but is careful to admit a diverse student body that resembles the demographics of the community in which we live.

“There is a need for schools of nursing to restructure their admission process to address the lack of the underrepresented students in attendance at their colleges and universities,” Harris-Smith adds.

Richardson says that’s why he is a part of the Breakthrough to Nursing committee because its goal is to increase diversity in the nursing profession. Another challenge he’s seen is that some minority students don’t last in nursing school because they have different ways of learning. “Culturally, students from different backgrounds learn differently. I’m a kinesthetic learner. If you show me how to start an IV, I will know how to start an IV more efficiently than reading three chapters about how to start an IV,” Richardson explains. “A lot of nursing school is geared toward your textbook. But a lot of students are visual, auditory, and kinesthetic learners.”

He says that there are also students from various cultural backgrounds who don’t know how to study. “For students who come from the other side of the world to America to learn, their views are different from yours, and when you have a different perspective, you’re able to become more aware. You’re able to see a different view. It actually makes us stronger and allows us to become smarter to look at the way that other people do things,” suggests Richardson.

“With diversity, we need to recognize and communicate to understand what the other person’s thinking is and allow them to realize that though their culture is different, it’s not a bad thing,” says Richardson. “It’s just a different view and perspective for them.”

Nurse Practitioners and Today’s Professional Liability Risks

Nurse Practitioners and Today’s Professional Liability Risks

According to the American Association of Nurse Practitioners, there are more than 234,000 nurse practitioners (NPs) licensed in the U.S. today. As health care delivery has continued to evolve, many Americans are using NPs for much of their health care needs, making nurse practitioners a critical component of the modern system. This growth in demand and responsibility has also increased and evolved the many risks NPs face in their work environments. The new Nurse Practitioner Claim Report: 4th Edition from CNA and Nurses Service Organization (NSO) took a deeper look at those risks by analyzing 287 closed professional liability claims against nurse practitioners (claims that resulted in an indemnity payment of $10,000 or greater) over a 5-year period. Study results found the average total incurred payment per claim was $240,471, and indicated that while the number of nurse practitioner claims have been relatively stable over the past five years (2012-2016), the average indemnity payment has increased at least 2% annually since 2012.

Current Liability Patterns and Trends

Nurse Practitioner Claim Report insights show that the majority of claims against NPs developed from a failure involving core competencies, such as diagnosis, medication prescribing, or treatment and care management. Allegations related to failure to diagnose and improper prescribing/managing of controlled drugs were found most frequently.

These claims demonstrate that nurse practitioners are responsible for reviewing, following up on, and documenting the results of appropriate tests and consultations in a timely manner, as well as properly evaluating each patient prior to prescribing medications.

Other findings from the report revealed:

  • The three specialties with the highest average paid indemnities were neonatal, women’s health (obstetrics), and emergency medicine.
  • The highest percentage of closed claims occurred in the adult medical/primary care, family practice, behavioral health, and gerontology specialties.
  • The health care delivery settings that experienced the greatest number of claims were physician office practices, nurse practitioner office practices, and aging service facility, skilled nursing.
  • Both the frequency and severity of nurse practitioner office practice setting closed claims have increased significantly. In 2012, this setting accounted for 7.0% of the closed claims, with an average paid indemnity of $45,750. In 2017, this setting accounts for 16.4% of the closed claims, with an average paid indemnity of $158,611- three times greater than in the 2012 report.
  • Five allegation categories accounted for 95.0% of all the closed claims in the analysis: diagnosis, medication prescribing, treatment and care management, assessment, and scope of practice. Diagnosis-related claims had the highest percentage of closed claims, accounting for 32.8% of all closed claims and with an average paid indemnity of $283,263 per claim.
Current License Protection Patterns and Trends

Different from a professional liability claim, an action taken against a nurse practitioner’s license to practice may or may not involve allegations related to patient care and treatment provided by the nurse practitioner. The Nurse Practitioner Claim Report also evaluated this particular risk area, analyzing 404 reported license protection claims affecting CNA/NSO-insured NPs.

Of the closed claims, 240 resulted in a license defense cost in which legal counsel defended nurse practitioners against allegations that could potentially have led to license revocation. The allegation classes with the highest percentage of license protection defense paid claims were medication prescribing/management (27.1%), scope of practice (22.1%), treatment and care management (13.3%), and professional conduct (8.8%). The average payment – comprising legal expenses, associated travel costs, and wage loss reimbursable under the policy – was $5,987. License defense paid claims involved both medical and non-medical regulatory board complaints against nurse practitioners.

Risk Control Recommendations

While rare events may be difficult to prevent, nurse practitioners can glean lessens from the experiences of their colleagues to help enhance their own clinical practices. The following selection of basic risk control recommendations can serve as a starting point for nurse practitioners seeking to evaluate and enhance their patient safety and risk management practices.

  • Remain current regarding clinical practice, medications, biologics, and equipment utilized for the diagnosis and treatment of acute and chronic illnesses and conditions related to one’s specialty and obtain regular continuing education.
  • Document all phases of medical treatment, including the care plan, laboratory and diagnostic testing, procedures performed, and medication provided in a timely and objective manner. The substance of all electronic communication related to patient care, including diagnostic test-related communications – whether by telephone, text, email, or instant messaging – should be documented in the patient health care record.
  • The informed consent discussion represents the first step in managing patient expectations. Discuss (and document) the nature of proposed treatment, alternatives to the treatment, and foreseeable risks and benefits of the treatment options.
  • Also engage in an informed consent discussion with patients when prescribing medications. Educate the patient about the need for follow-up, and signs and symptoms that should prompt a call to the doctor or a trip to the emergency department.

A self-assessment checklist also is available in the full report to inspire nurse practitioners nationwide to examine their practices carefully.

In Summary

This analysis reveals that, while there have certainly been advances in clinical practice and patient safety, many claims continue to develop. It demonstrates that nurse practitioners are expected to diligently screen, test for, monitor, and/or treat diseases known to have high morbidity and mortality rates and are responsible for obtaining appropriate tests, consultations, and referrals to meet the patient’s medical needs. The report findings also reinforce the responsibility that nurse practitioners must prescribe the right drug, for the right patient, in the right dose, by the right route, at the right times, for the right duration and for the right indications.

Armed with this insight, nurse practitioners can apply key risk control recommendations and resources to focus their efforts on areas of statistically demonstrated error and loss.


Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management, or legal advice. It is not intended to be a substitute for any professional standards, guidelines, or workplace policies related to the subject matter.

This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.

Just Published!

The Minority Nurse Winter 2017-2018 issue is now available. Read the latest issue of Minority Nurse today.

Challenges Facing Nursing Students Today

Selecting the Right Nursing School

Why Nursing School Grades Don’t Matter

Surviving the First Year as a Nurse

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