Healthcare workers know that hand washing helps keep them safe and helps prevent the spread of germs in the patient population. “Every episode of hand hygiene can interrupt the spread of germs between patients, between patients and healthcare personnel, and between the contaminated environment and patients,” says Sickbert-Bennett. “Healthcare personnel need to wash their hands dozens of times throughout their workday as they have complex interactions with very sick patients.”
Despite knowing how effective simple soap and water (or alcohol-based hand sanitizer) is at preventing the spread of germs, the study found that complete hand washing guidance isn’t always followed. In an intense and rushed environment, it’s not simply forgetfulness or a lack of intent that sometimes prevents proper hand hygiene. “The biggest factor is likely time – which impacts our ability to do hand hygiene often enough and thoroughly enough,” says Sickbert-Bennett. “An important way to mitigate this is to make sure that hand hygiene supplies are easily accessible in areas where patient care is occurring.”
And education about the proper techniques for keeping hands clean is essential, particularly considering that the report cites research that shows only 7% of healthcare personnel effectively clean the entire surface of their hands with thumbs and fingertips being the most frequently missed. The report also notes the potential for bacteria being difficult to remove if providers have certain fingernail polish or applications such as acrylic nails. Guidance around the need for proper cleaning practices, even if gloves are also worn, is also noted.
“Hand hygiene programs that use reminders to reinforce the habit of hand washing at the right times have been shown to be effective,” she says. “Nurses can play an important role in hand hygiene and patient safety by reminding their colleagues to clean their hands throughout the day as they take care of patients.”
Commitment from the top levels of organizations will also move the needle in the right direction. The report notes that nurses and healthcare personnel need easy access to hand-cleaning supplies and also moisturizing lotions that are in compliance with hygiene safety standards. All that hand washing takes a toll on the skin and cracks can also lead to infection. That means plenty of access to soap and water and also wall mounted pumps containing alcohol-based hand sanitizer instead of nurses carrying hand sanitizer in bottles in their pockets.
As healthcare providers, nurses can care for themselves and their patients with increased attention to an essential tool–their hands.
RaDonda Vaught, RN, was not the first nurse to be prosecuted for making a mistake, but the circumstances and her trial were the most public.
Nurses from around the country watched and spoke out, supported her, and shared similar issues about the environment of care that she worked in, the failure of organizations to support nurses after self-disclosure, and the lack of trust in non-punitive response to error.
We learned that organizational system issues were present and acknowledged, yet RaDonda was held individually accountable, prosecuted, and convicted. (Department of Health and Human Services, 2018) This punitive response to the error is the biggest reason for the lack of trust in just culture. It can cause nurses to suppress patient safety information as they attempt to protect themselves, their licenses, and their livelihood.
Healthcare Environment Can be a Chaotic Place for a Nurse
The healthcare environment is an ever-changing, distraction-ridden, and often chaotic place nurses work. Nurses have learned to develop workarounds of procedures to care for patients within systems riddled with roadblocks and a lack of staff. They drift from ideal practice interventions and are forced to multi-task most of their day. These behaviors are often mistaken for autonomy rather than the root cause until that mistake is grave or deadly. This environment of care is ripe for error and unsafe patient care outcomes.
When direct care nurses and nurse leaders fully understand how the environment impacts patient safety, they can develop a better awareness of the behavioral choices nurses make when providing care and build ways to decrease the likelihood of error. The first and most crucial part of arming yourself with knowledge about why mistakes happen is understanding the difference in behaviors.
Human error is unintentional and not considered a behavior at all. It is an outcome of the fallibility of being human. Risky behaviors occur when we drift away from policy and procedure and develop habits that we think are safe because we don’t appreciate the risk of injury. Reckless behavior is a conscious disregard for a known risk, understood by the person, and the action is taken anyway. It is intentional. (Institute for Safe Medical Practices, 2022)
Healthcare is not perfect, and mistakes will be made no matter how careful a person’s actions and behaviors are. It is a mistake to expect no mistakes! Organizations should strive to be reliable, not perfect, and provide an atmosphere that includes and promotes systems that catch mistakes before they reach the patient. (Rodziewicz, Houseman, and Hipskind, 2022)
What Every Nurse Can Do
Direct care nurses can improve the environment of care and decrease the possibility of making mistakes by:
Speaking out and sharing concerns about the culture of safety with your leaders. Nurses are the most vital source of error identification in all organizations and all circumstances.
Insist on duplication and validation processes for high-risk injury interventions. Embrace teamwork by helping each other to ensure that clinical practice is correct.
Become active members of shared governance committees and assist in developing policies driven by real practice, not ideal environments. The best policies have multiple decision trees to the desired outcome, for example, “if this occurs, then do that .”Policies can then incorporate the known workarounds so that leaders understand the multiple avenues nurses may need to take to provide efficient and effective care.
Learn about the incident management and investigation processes in your organization. Volunteer as “subject matter experts” so investigators understand how nursing care is provided, and the incident analysis is fair.
Nurse leaders ensure that the care environment is safe. Actions they take can include:
Create real fixes when systemic or other issues are raised and praise those nurses who are brave enough to raise their voices.
Avoid quick responses and decisions to occurrences and let the investigation take its course.
Stand by staff when human errors or risky behaviors happen. Console nurses who make mistakes and avoid causing them more harm from the punitive response.
Promote transparency of the investigative process and promote legal support for nurses who may be held individually accountable.
Promote teamwork and consider alternative nursing delivery methods that can be flexed as acuity increases and decreases
Develop on-site resources for self-care and staffing schedules that enable nurses to take advantage of them. Stress, lack of sleep, poor nutrition, and lack of exercise can create cognitive changes that cause a lack of appreciation of risky decisions that direct care nurses can make. (Okpala, 2020)
Finally, all nurses need to become politically active. By participating in local and state governments, nurses can educate elected officials who may need help understanding the healthcare environment and expect perfection in care. In addition, nurses must help to create or support legislation that protects healthcare workers from legal prosecution. A culture of safety in healthcare takes a village!
Institute for Safe Medical Practices. Criminalization of human error and a guilty verdict: A travesty of justice that threatens patient safety. ISMP Medication Safety Alert 27(7). Published April 7, 2022. Accessed September 25, 2022 https://www.ismp.org/sites/default/files/attachments/2022-04/20220407_0.pdf
Okpala P. Nurses’ perspectives on the impact of management approaches on the blame culture in health-care organizations. Int J Healthcare Manage. 2020; 13(S1): 199–205. doi: 10.1080/20479700.2018.1492771
Rodziewicz TL, Houseman B, and Hipskind JE. Medical Error Reduction and Prevention. Updated May 1, 2022. StatPearls. Treasure Island, FL: StatPearls Publishing; 2022: 42-44. Accessed August 2, 2022 https://www.ncbi.nlm.nih.gov/books/NBK499956/#_NBK499956_pubdet_
As the Delta variant of COVID-19 spreads and numbers of those infected and being in treated in ICUs across the country keeps getting worse, it’s important for those not vaccinated to do so.
The American Nurses Association (ANA) recently spoke out and took a stand—stating that nurses should get vaccinated.
ANA President Ernest J. Grant, PhD, RN, FAAN, took the time to answer out questions about this and why it’s so important.
Why did the ANA feel the need to come out in favor of nurses getting the vaccine for COVID-19?
ANA has a longstanding history and commitment of supporting immunizations to protect nurses, health care professionals, and the public from highly communicable and deadly diseases—and COVID-19 is no different. For our nation to recover, heal, and return to a semblance of normalcy, enough individuals, nurses, and health care professionals must get vaccinated against COVID-19.
The swift development of COVID-19 vaccines and the execution of mass vaccination efforts is a significant public health victory and a scientifically proven strategy to slow the spread of COVID-19 and prevent the loss of more American lives. ANA continues to implore all health care professionals and the public to follow the science, adhere to the latest guidance of public health officials, and get vaccinated against COVID-19.
As we’ve seen, there are nurses and other health care workers willing to lose their jobs when they are required to get the vaccine. Why is this problematic?
It is very disheartening to hear reports of nurses who are willing to quit their jobs rather than get the COVID-19 vaccine. There is significant clinical evidence on the safety and effectiveness of the authorized COVID-19 vaccines being administered under the Food and Drug Administration’s (FDA) Emergency Use Authorization (EUA). To those who are apprehensive about taking a COVID-19 vaccine, I say trust the science and evidence. What is more, the pillars of patient-centered care and the nursing’s own professional standards ethically obligate nurses to model the same prevention measures that nurses recommend to their patients.
Nurses play a critical role in the monumental recovery efforts currently underway to end the COVID-19 pandemic. Our nation will only be successful in recovery efforts with a robust nursing workforce at peak health and wellness, providing safe patient care, administering COVID-19 vaccines, educating communities, and setting an example for millions of Americans.
There are nurses who don’t believe the vaccine works. What can other nurses say to them to help them understand?
It is paramount for nurses to remain knowledgeable and up-to-date on the science behind the vaccines, and the ongoing clinical studies that prove its efficacy. ANA has developed key principles to guide nurses and other health care professionals’ consideration for COVID-19 vaccines. These principles provide recommendations for access, transparency, equity, efficacy, and safety of COVID-19 vaccines. Additionally, ANA’s comprehensive COVID-19 vaccine resource page stays up-to-date on the latest clinical information and news. ANA has also created a focused video education series on COVID-19 topics, covering different aspects of this crisis and providing information that nurses can apply immediately when caring for COVID-19 patients. ANA’s COVID-19 videos are FREE for all nurses.
Has the ANA received any backlash from nurses about this stance?
We are seeing more and more nurses getting vaccinated. And based on what we’re hearing from our state associations, organizational affiliates across the country, and our most recent survey, nurses are in favor of the vaccine mandates and trust the COVID-19 safety and effectiveness of COVID-19 vaccines.
Tell us about the support that the ANA has received from this stance.
Nurses working across all areas of the health care system are disseminating culturally relevant information on the COVID-19 vaccines to the communities and patients that they serve. Nurses are connecting with their patients every day to have meaningful conversations and answer questions about COVID-19 vaccines. ANA applauds those nurses who are getting vaccinated against COVID-19 and proactively setting an example for their patients and the public.
Is the ANA’s hope that other health care associations will follow their example? Why would this be important?
We strongly encourage other health care organizations and health systems to support of mandatory vaccinations against COVID-19 for all health care professionals including nurses.
Most importantly, we urge everyone to follow the evidence and science, so our nation can continue making progress in recovering from this pandemic to restore our health care systems and communities.
March 14 kicks off Patient Safety Awareness Week, an annual recognition of the essential need to improve safety in all settings.
For nurses, awareness about patient safety impacts every aspect of their work. From medication prescriptions and delivery, to diagnoses and follow up, to ambulatory safety and safety of those who are bedridden, to the treatment of conditions and issues that affect virtually every area of the body, nurses place safety at the very top of the list of what they do.
No matter how careful healthcare workers are and how much they prioritize patient safety, there’s always room for improvement. And the numbers are alarming when it comes to the widespread impact errors have. According to the World Health Organization, as many as 4 in 10 patients are harmed in primary and outpatient healthcare situations across the globe. Of the harm done, more than three-quarters of the cases are preventable and the most harmful errors fall under medication use, prescriptions, and medical diagnosis. Even treatment in some of the highest income nations with excellent healthcare isn’t entirely protective. One in 10 patients suffers harm in a hospital setting in these countries and almost half of those errors are preventable.
Organizations including the Center for Patient Safety and the Institute for Healthcare Improvement (IHI) advocate for attention to common ways where patients are harmed during healthcare treatment. Resources such as the Patient Safety Essentials Toolkit from the IHI can help nurses and nursing teams assess their typical workflow and make changes that can have a big impact on outcomes. From the SBAR (Situation-Background-Assessment-Recommendation) technique to better communication, even small adjustments in the way a unit operates can improve patient outcomes and safety for both patients and staff.
The opportunity for improvement is extensive. According to the WHO, patient harm occurs on many levels and in varied settings. From medication error to infection prevention practices to radiation errors or unsafe injection practices, the potential for mistakes occurs across the spectrum of care. It can also include harm such as falls and other unintentional injury.
Nurse leaders and healthcare management can also promote a culture of safety for all, because a workforce that feels protected will likely have the resources and culture in place necessary to promote safety for patients as well. In one study Does Employee Safety Matter for Patients Too? Employee Safety Climate and Patient Safety Culture in Health Care, the authors found that increased focus on employee safety had a positive correlation to safety for patients and better outcomes.
As a nurse, educating yourself about the latest evidence-based safety practices is always good professional development, as is learning new skills. Take courses, read journals, and investigate what other healthcare settings are doing successfully. Promote safety practices on your unit and advocate for opportunities to learn more about protecting your patients at work, whether that’s through speakers, seminars, or with hands-on education and projects.
What is one thing you can do to elevate your own practice this week?
With COVID-19 making a rapid advance across the globe, this week’s recognition of Patient Safety Awareness Week draws attention to a critical subject.
Sponsored by the Institute for Healthcare Improvement (IHI), nurses can use the week to learn new standards and practices, especially in light of COVID-19, and can also educate patients and their caregivers on how to protect themselves across the healthcare spectrum.
The numbers are especially alarming when patients and healthcare workers realize those numbers are attributed to preventable events and mistakes. As a nurse, you know lives depend on you paying attention to everything you do. Your patients and colleagues depend on your high-quality care and top-notch performance every single day you’re at work. With those kinds of standards, nurses know patient safety is a top priority.
Patient safety has a clear spillover impact into other areas of healthcare—workplace safety in particular. When patient safety is compromised, nurses’ safety is compromised. And it doesn’t take much to create unsafe situations.
Think of these examples:
Moving a patient without proper equipment or sufficient staff. As a result, the patient is exposed to a risk of falling and the nurse is now more likely to have a physical injury from trying to move the patient in unsafe circumstances.
Sharps or equipment being improperly stored or disposed of exposes patients and nurses to disease and injury
Medication errors because there is no established process for reducing error
Infections due to lack of proper hygiene
As a nurse, you can take steps every day to ensure and promote patient safety.
If you notice a process that could become or already is creating a safety concern, address it with your supervisor.
Make sure your attention to safety never wavers and notice when you feel distracted.
Ask for continual professional development opportunities around patient safety.
Propose a process or standard plan around high-risk activities so that it becomes a standard care plan in your organization.
Take care of yourself by getting enough sleep, staying hydrated, eating nutritious foods, and managing your stress.
Practice immaculate personal hygiene and encourage it in your colleagues and in your patients and their caregivers. Thorough hand washing protects everyone.
Lobby for patient and healthcare worker safety in local and national government and in organizations. Even a simple letter to a representative or supporting a professional organization that works for these issues can help.
Becoming an advocate for patient safety is part of any nurse’s focus. In your daily work, spread the word and educate anyone who will listen. Talk about patient safety to peers, colleagues, patients, family members, and other caregivers. Raising awareness with simple and continual discussion can make a significant impact—in the lives of your patients and in your own life.
