National Patient Safety Awareness Week (March 11 – 17) focuses attention squarely on one thing at the top of every nurse’s list – keeping patients safe.
Minority Nurse spoke with Patricia McGaffigan, RN, MS, CPPS, vice president, safety programs at the Institute for Healthcare Improvement (IHI) about the ongoing issues around patient safety and how nurses can continue to implement positive and productive change.
While nurses provide a majority of care in inpatient settings, McGaffigan says the issue of patient safety extends to a wider setting as interprofessional teams are responsible for so many levels of care.
Because of the nurse’s role, they are especially able to impact patient care. “Nurses represent the largest segment of the healthcare workforce, in roles that range from the bedside to the boardroom,” says McGaffigan. “One specific and relatively easy way that nurses can effect change is to become educated in foundational safety science.” Nurses who aren’t trained in safety science can obtain training, and many student nurses receive the training as part of the curriculum. “Nurses are perfectly positioned to be able to identify risks and hazards in their work environments that may be mitigated before harm occurs, and this daily commitment to mindfulness about preventing harm before it happens is vital.”
As nurses, ongoing education, and maintaining and obtaining appropriate certifications help nurses provide the optimal care when they are with patients. Consistency in providing care and following a standard of care plan help patient outcomes as well.
“Nurse-sensitive indicators that reflect structure, process, and outcome are of great importance to nurses.” she says. “As a profession, we want to ensure that we have appropriate numbers of skilled nursing professionals who are able to meet the unique needs of patients and families. Process measures are focused on ensuring that we deliver the right care in a consistent and reliable manner.”
Patient harm can result when there is a lack of guidance or an absent standard to follow, says McGaffigan. For instance, harm can result when patients aren’t regularly repositioned or when oral care in ventilated patients is neglected. Other areas of particular importance include medication errors, falls, hospital-acquired infections, or complications, and other injury.
To provide the best care, nurses must also be able to care for themselves. If they are overly fatigued, do not feel supported or able to thrive in their organizations or if they are working in an organization where a culture of safety is not emphasized, patients cannot receive optimal care and nurses themselves might be at greater risk.
“Nurses are increasingly and very appropriately focused on their own physical and emotional safety, as well as cultures of safety,” she says.
The interactions that build relationships between nurses and patients are key to keeping patients safe. “Nurses are often the profession that has the most interaction with patients and families,” says McGaffigan. “We can consistently strive to identify the needs and preferences of patients and families, and also ask patients and family members what matters to them, and what they might be worried about.” McGaffigan knows this first hand. “As a former pediatric critical care nurse, one of my greatest ‘early warning systems’ was when a parent might tell me that ‘something just doesn’t feel right about my child,’” she says.
When errors do happen, a transparent process to understand what went wrong, assess the cause, and prevent future harm is essential. “Punitive cultures exacerbate reluctance to report near-misses and errors,” says McGaffigan. “Nurses can become more familiar with Surveys of Patient Safety Culture, identify areas where unit and organizational performance is stronger or weaker, and play a key role as leaders and participants in initiatives to improve scores on their survey domains.”
Patient safety continues to evolve as new medical technologies are introduced and as patient care continues to become more complex and more challenging.
“Nurses, as well as our other colleagues in healthcare, have chosen our profession because we have a core value of ensuring that our care is not only technically sound and appropriate, but is safe,” says McGaffigan. “As nursing professionals, we come to work every day to ensure nothing less than safe care. Whether we are in traditional roles at the bedside or as nursing leaders, educating our next generation of nurses, sitting on boards of directors of health care organizations, serving in formal patient safety positions, contributing to progress in the medical device and pharmaceutical industries, or more, we individually and collectively embody safety as our core value.”
Those who enter the profession do so knowing they are often a patient’s greatest advocate and a crucial partner in receiving the best care. “We are committed to creating a world where patients are free from harm,” she says, “and we advocate and anchor our healthcare system to not simply regard safety as ‘one more thing that we do,’ but understand that ‘it is the one thing that must permeate and provide the foundation for all that we do.’”
As Black History Month closes, Minority Nurse interviewed Martha Dawson, DNP, RN, FACHE, and assistant professor in the Nursing and Health Systems Administration at the University of Alabama at Birmingham School of Nursing (UABSON). Dawson is also director for the Nursing Health Systems Leadership (NHSL) Division at UAB. The NHSL division includes nursing administration, clinical nurse leaders (CNL), and nursing informatics students. She is also the historian for the National Black Nurses Association.
Dawson, who knew early on that nursing was her path, earned her doctoral degree in nursing after many of her colleagues encouraged and prodded her to advance her studies. The challenges she faced, the experiences she had and her determination will resonate with many minority nurses.
“As I would mentor younger nurses and encouraged them to continue their education to the doctorate level many would say, ‘But, you don’t have a doctorate,’” says Dawson. “I knew then that I had to be the role model and earn a doctorate so I would not become a barrier to young nurses seeking higher education. I have always enjoyed learning and sharing my knowledge.”
The following is our Q&A with Dawson.
Why did you choose to become a nurse?
Becoming a nurse was just something I wanted do from a very young age because I could help people from birth to end-of-life. I can recall telling my father that I wanted to be a nurse. When he asked me repeatedly what type of nurse, I kept replying an RN—I had no idea about the vast career options at such a young age.
I can recall begging my mom one Christmas for a doll that had a medical kit including syringe, stethoscope, bandages, clutches, and arm and leg casts. Nursing provides me with so many career options from providing hands-on care, teaching, mentoring, research, and leadership, and most importantly paying it forward to help others become nurses. Then, there were the times when I took care of my grandmother when she broke her knee and my father when he burned his back. I can also recall when my brother dislocated his leg and I my big toe—mom reset or aligned them using wood splints without us going to a doctor. I was impressed and hooked on being a nurse.
How did you choose your path?
For me this a limiting question because nursing offers pathways, not just a path. Currently, I guess one would say that I am an educator.
I am a planner and strong believer in career mapping and progression. My current educator role is the result of taking a systematic approach to my nursing career by setting short- and long-term goals. I decided early in my nursing career that I wanted to teach, but only after I acquired the expertise to share both lived experiences and book knowledge—in short, I wanted to walk in the shoes of those I would be educating. Therefore, my nursing career started as a BSN nurse in a cardiovascular open-heart intensive care unit where I provided direct care and worked as relief charge nurse and then charge nurse.
Then, like many nurses, after transferring to a pre- and post-cardiovascular unit, I was asked to step into the nurse manager role with no preparation. Management and leadership came naturally to me, but I knew that I needed business and organization skills and knowledge. Therefore, I completed a dual master’s as a cardiovascular clinical nurse specialist (CNS) and in nursing administration that required completion of a 10-month hospital residency certificate program.
By the time I started the nursing administration studies, I had become hooked on leading and influencing change, plus being a voice for nursing both internal and external to the organization. Nursing administration became my passion, and I committed myself to learning as much as I could. I have held positions at the director level, associate chief operating positions, chief nurse, and executive VP level in practice setting, mostly academic medical centers. These roles provided me with the experience to teach the next generation of nurse leaders. I am still growing and determining the next chapters in my career.
I am a life-long leader and forever a student of our great profession.
What kinds of challenges did you face in your career and how did you overcome them?
My challenges would fill a book. There were very few minority students in my school, and it was rarely that more than two of us would be assigned to the same clinical group. In addition, there were very few African American faculty. During my BSN and MSN studies, I did not have a faculty member of color from any ethnicity. Most of the time, I felt the grading was fair, but then I had experiences where I would receive a B on a paper with no correction or remarks only the letter grade. Yes, I did follow up with the faculty and administration as needed.
My advice, and what helped me, is that challenges are there to overcome and to be used as stepping stones. When someone said that I could not do something or advance my career, I felt that it was my God-given right to prove the person wrong. My faith has made and kept me strong. I really try to set my goals and pathways in life and not allow others to determine my destiny. I know and respect that this approach and mental model will not work for everyone. Therefore, I try to help others find their voice.
Mentoring is important for any nurse, but especially for minority nurses. Did you have any kind of mentoring relationship?
I really did not have a mentor(s) early in my career, as I progressed in my career there were leaders that I would say have served as good coaches for me. During my doctorate education, I had my first African American nursing faculty—31 years after becoming a nurse.
Do you mentor young (or new-to-nursing) nurses now?
I mentor everyone that will allow me, from elementary school to doctorate level students. Giving back and investing in others is a personal charge that I have accepted to afford others a smoother path. I mentor nurses, other healthcare professionals and those who aren’t nurses/healthcare professionals. Mentorship is a bidirectional relationship.
However, as a mentor it has to be about the mentee and their career goals. For me as a mentor, the relationship keep me current with professional and society issues, and it improves my listening skills so I can hear and support the mentee. It is key that mentees come to the relationship with a desire to focus and put in the time. Too often, I believe the mentees fail to appreciate the work that will be required of them. However, a good mentor will help mentees step outside of their comfort zones and encourage them to excel beyond the level of the mentor.
True mentorship must include self-assessment, self-reflection, and the willingness to change and reinvent oneself if necessary. It is a learning and growing process that never ends. I encourage my mentees to outgrow me and seek advice from others. In addition, I tell them that if I can only get them to my level of performance, accomplishment, or achievement, then I have failed them because it is not about me, but them. I should help them do more, give more, achieve more, and go further. The mentees help and allow me to sow into their success and support them as I transition into a different phase of my career.
In short, each mentee is a part of my succession plan to ensure that the profession and world are in good hands with the next generations of nurses, nurse leaders, and teachers.
What is the most beneficial outcome of increasing the diversity of the current nursing workforce?
I believe the greatest benefit of having a diverse nursing workforce is the role model and mentoring that can be provided to students of different races and ethnicities to help them enter, matriculate, and graduate from nursing programs. Next, if the profession truly wants to improve population health, then we must have nurses that have lived experiences of the populations we are trying to help.
In the same manner, if we want to create a culture of health, it is important that the owners of culture are engaged on the front end and that the engagers look like them and understand them. There is also a business and economic case to be made that we rarely read about in the literature; nursing is a great profession and one of the few occupations that can continue to earn a livable wage during an economic recession. Nursing as a career can help improve the economic status of families and improve the long-term health outcomes of whole communities for generations. I appreciate diversity at all levels. However, we have to be careful of the global approach to diversity, i.e., where we are counting everything to avoid addressing the real issues of race and ethnicity.
We need more men in nursing but not to just increase the “diversity count.” In other words, I still want to know the breakdown of male nurses by age, race, and ethnicity. Then, we have to address the issue of diversity and inclusivity. Diversity without inclusivity is just a pen, paper, and number game. My motto is that diversity is the quilt that creates a beauty pattern, but inclusivity is like tapestry, many different colors of threads creating a picture. Therefore, an organization has to ask, “Is our vision of diversity a pattern or a picture of interconnectivity?”
What are the biggest barriers for young students of color to become nurses and how can that be changed?
After serving as the principal investigator for two HRSA workforce grants, I am convinced that if we want to increase diversity in nursing and the medical field, we have to start with pre-K through 7th grade.
Nursing is a science-based discipline, and students must be introduced to the profession with the understanding that they have to take the STEM-related courses. The lack of preparation in math and science is the biggest problem facing our students. Prerequisite courses derail many of our pre-nursing students of color. Therefore, they cannot wait to take chemistry, advanced math, anatomy, and physiology, and other related science courses. These courses are needed prior to college entry.
The second major problem is related to high school and freshman counselors. Top performing high school students are receiving information on nursing as a career option. Then many students of color, even some with the GPA, are being mis-counseled and advised against nursing because of the rigor of the program. In addition, many schools of nursing that are concerned about their NCLEX pass rates are growing and holding more and more seats for their “honor programs” thus making it more difficult for that pre-nursing student with an ACT of 20 and GPA of 3.5 to even be considered for the nursing program.
Finally, we still have the issue of lack of diversity among SON faculty. Nursing must become more committed to developing a diverse academic workforce. A great starting point would be to increase faculty diversity to be 10% higher than the state demographic profile because we have a lot of catching up to do.
I still love nursing and think it was the best choice for me. I am not sure what I will be when I grow up, but it will have something to do with nursing. Oh, not grow up, but when I retire.
If you ever need a reason to feel proud of the lifesaving treatment and the compassionate caregiving, you offer every day in your nursing career, the launch of Nursing Now on February 27 is a big one.
In an effort to raise the profile of nursing as a career and as a worldwide factor in improving health, the International Council of Nurses and the World Health Organization are launching Nursing Now across the globe.
Nursing Now is organized by the Burdett Trust for Nursing, a UK-based charitable trust. As nurses’ status increases, their influence will be felt in policy, reputation, and the status of the professional nurse. Nurses themselves can begin to tackle some of the biggest challenges that are facing humanity in the next century.
No matter what location nurses practice, they face similar challenges. They want the best opportunity and training to offer their patients top-notch care so they can lead better and healthier lives on their own and within their communities. Nursing Now will push for those changes, but nurses will see them happen slowly in their own communities and then on a broader national level before becoming a worldwide trend.
The launch is the first step in an initiative that runs through 2020. Nursing Now will support other programs around the world and hep nurses become more able to influence the ways in which they work and effect change with patient and community health.
The initiative has five stated goals:
1. Greater investment in improving education, professional development, standards, regulation and employment conditions for nurses.
2. Increased and improved dissemination of effective and innovative practice in nursing.
3. Greater influence for nurses and midwives on global and national health policy, as part of broader efforts to ensure health workforces are more involved in decision-making.
4. More nurses in leadership positions and more opportunities for development at all levels.
5. More evidence for policy and decision makers about: where nursing can have the greatest impact, what is stopping nurses from reaching their full potential and how to address these obstacles.
Nursing Now recognizes that global change begins as people work together in each and every community. As nurses band together for change, the momentum will grow and impact greater people and reach into higher changes.
The University of North Carolina Chapel Hill School of Nursing will host with United States launch event, and nurses will be able to check the main website throughout the day to learn about other events worldwide.
On February 27, check out Nursing Now and envision and even stronger and more influential nursing future.
Are you thinking it’s time to test the water on a job search? Is your career feeling stagnant and you think it’s time to move to a new organization or even a new branch of nursing?
What can help you with your decision if you’re not ready for a full-fledged job search?
Testing out whether it’s time for a job switch takes some thought and a little bit of work. Here are a few ways nurses can gather information without jumping into a full search.
Sit in on Seminars
Find some seminars or classes that will help you decide if you want to move from emergency nursing to travel nursing or from infusion nursing to cardiac care. Get some experience, talk to a professor or class leader, and chat with others in the room (even in online classes) to get a point of reference in your job change decision.
Become a Visible Networker
Networking isn’t all about finding a new job, but it is about becoming noticed in your profession. And if you have an active and extensive network when you are looking for a job, you’ll have a valuable resource. Find association meetings, nursing groups, or even a few general business groups and regularly attend meetings. Meet new people and offer your help as well.
Go to a Career Fair
Find a healthcare career fair and take some time walking around. Come prepared with resumes just in case you find an excellent opportunity, but make gathering information your primary goal. Investigate what jobs are out there and see how your qualifications measure up.
Whether you take on more responsibility in your current role or gain skills on a team to learn new skills (volunteering for your town’s emergency response team, for instance), know you need to learn more. Start the process for a new certification or volunteer to learn the new software at work – just make sure your skills are current, cutting-edge, and marketable.
If you decide a career move is your next step, you’ll be ready with a solid understanding of the available opportunities and how your skills will meet the market needs.
Nurses provide top quality care in all settings, but critical care transport nurses have a slightly different typical treatment space. They could administer life-saving care in an ambulance moving at top speed or in flight thousands of feet in the air.
Every February 18, the Air & Surface Transport Nurses Association (ASTNA) sponsors Critical Care Transport Nurses Day to recognize the work in this distinctive branch of nursing.
Critical care transport nurses provide on-scene nursing care in instances when patients need to be transported from one location to another. It could be an ambulance or a medflight taking patients from one institution to another or from an accident scene to a medical facility.
Transport nurses generally work as part of an emergency response team or as part of a transport team in non-emergency situations. They will provide assessments of a patient’s condition, injuries, vital signs, and will remain with the patient during transport to make sure the patient is kept stabilized.
Transport nurses often work within constantly shifting teams. Being able to adapt to and work within different frameworks will help you focus on your patient while fulfilling your role on the team.
If you are thinking this type of nursing would be a good choice for you, there are a couple of things to keep in mind. You must attain registered nurse credentials, several life support training credentials (adult/pediatric), and then gain at least two years of nursing experience in a critical care environment (like an emergency room). You’ll want experience in a general environment of critical care so you can be exposed to many different situations as that will mirror what you’ll see as a critical care transport nurse.
Because of the nature of working in an environment that is literally moving, you must be able to provide treatment in constantly changing environments. You’ll need to be able to lift and move patients with assistance, and be able to work electronically with team members at a medical care facility.
Transport nurses gain certification through the Board of Certification for Emergency Nursing in joint partnership with ASTNA. After you pass the certification exam, your certification will either be as a certified flight registered nurse (CFRN) if you typically operate in flight or as a certified transport registered nurse (CTRN) if your practice is generally in ground transport. If you practice on the ground and in flight, you can either choose the most pertinent certification or you may earn both certifications.
Critical care transport nursing will call on you to use every nursing skill you have and your situations will all be varied. On February 18, honor the critical care nurses in your organization!
February 5 through 11 is a national observance of National PeriAnesthesia Nurse Awareness Week, sponsored by the American Society of PeriAnesthesia Nurses (ASPAN). Nurses who help transition patients pre- and post-procedure are there to offer intensive medical care and equally essential caregiving. They especially want patients to know they are there for them. They are their advocates throughout the process.
If you are interested in a career as a perianesthesia nurse, you’ll find the challenges of the position range from using your advanced nursing skills in urgent situations to incorporating the most basic hands-on comfort skills. Charged with caring for patients at critical pre- and post-procedure points, perianesthesia nurses must be able to multitask, to identify and respond to patient conditions immediately, and to do this all with a calm demeanor to help keep patient stress at bay.
Perianesthesia nurses especially enjoy their work caring for patients before and after procedures that require any anesthesia. Before a procedure, they are the nurses who are there to find out any information that could have an impact on the anesthesia care. With more and more patients appearing with several health conditions, they have to factor in variables like medications, physical condition and limitations, and emotional stability in their patient assessment. While they are assessing and gathering information, they are also providing a calm and unwavering support to help nervous patients know they are in trusted hands.
Perianesthesia nurses are also there when patients come out of anesthesia and are sometimes confused, uncomfortable, or even nauseated or vomiting. Post-procedure, nurses are once again continually monitoring a patient, assessing vital signs, reassessing existing health conditions, and at the same time, offering that hands-on caregiving that helps patients feel safe. Perianesthesia nurses then help determine how a patient can safely move to their next place whether that is to home, another hospital, or another care facility.
Many perianesthesia nurses say they have perfected a way to develop a rapport with patients that can build the trust necessary for completing such a long task list in a short time and under pressure. Once a nurse has identified a topic that helps the patient relax, they can begin conversations about family, pets, schooling, movies, or books that are both informative for nurses and distracting for patients. Many nurses also say they use those nuggets in the conversation to help bring a patient out of a drowsy and sometimes confused anesthesia.
For those considering this branch of nursing, ASPAN offers many resources and is an excellent reference to find out information about certification (through the American Board of Perianesthesia Nursing Certification, Inc.) that must be renewed every three years, scholarships for education, career resources, mentoring opportunities, conferences, and up-to-date anesthesia information.
This week, recognize and appreciate the perianesthesia nurses on your team. Their skills often help the entire procedure proceed smoothly and safely.