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Preceptor perspectives: Reporting a near miss event

by Julie Harris, RN, MSN

Who likes to get in trouble? I know that I sure don’t! Yet, reporting a near miss event sometimes feels like that. Let’s look at a scenario that demonstrates this feeling:

One night Mason noticed a medication error from the pharmacy. They sent up the wrong dose of medication for his patient. After sending the medication back to the pharmacy, Mason filled out an occurrence form and placed it in his manager’s box. Several days later, the manager called him into a meeting with the pharmacy and other managers. They wanted him to explain the near miss event. He did and then was excused from the remainder of the meeting. Mason left feeling like he received a slap on the hand for reporting the near miss. He wondered if he should bother reporting any other near misses in the future.

This scenario is common throughout hospitals and healthcare facilities. Mason felt like he was in trouble for reporting the near miss event.

Many nurses, like Mason, do not see the “big picture” when it comes to reporting a near miss. And many times, this is due to a lack of just culture training from the hospital. Nurses are told they have to report near miss events. But, they are not told why to report such events or the outcomes of their report.

Preceptors can help solve this problem by training orientees and other staff members on the “big picture” of near miss reporting. This training should include:

  • The importance of reporting a near miss event
  • What qualifies as a near miss event
  • How to report a near miss event (i.e. how to fill out the form)
  • Where the report goes after it leaves the nurse
  • Who to contact for follow up
  • Examples of near miss events and their outcomes involving process change, patient safety, etc.

High-quality, safe patient care is the goal for all hospitals and healthcare facilities. Reporting near miss events is one avenue for nurses, especially preceptors, to take in order to achieve this goal!

The importance of succession planning and training nurse managers

By Betty Noyes, RN, MA

The management gap in healthcare is a real and increasing issue of concern. We do not seem to have enough talented managers to meet the goals of our organizations.

Without sufficient skills, first-line managers do not benefit an organization. The first step to increase the number and education of managers is to provide effective training designed to specifically improve organizational performance.

Currently, healthcare costs are high. When all elements of healthcare reform are implemented, higher costs may ensue. There will be a demand for more change and greater resilience from our management teams. Unless we have managers who are resourceful in their management skills, we will not achieve new and improved ways to succeed in the goals of safe, high-quality care at a reasonable cost.


Study: Board of directors missing nurses

In 2009, the University of Iowa conducted a study reviewing 201 health systems with a total of 2,046 voting board members and discovered that only 2.4% were nurses. This number comes as a bit of a surprise, as the study also found that 22% of the voting board members were physicians.

To add to the data, Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Foundation senior adviser for nursing and director of the RWJF Initiative on the Future of Nursing at the Institute of Medicine conducted a study of her own. She looked at the top 10 organizations that oversee quality, the top 10 hospitals and health systems, and the top 10 peer-reviewed non-nursing journals, and counted how many nurses were on the board of directors.

To Hassmiller’s dismay, she only found 2% to 4% of board spots held by nurses. [more]

Legislative lessons from school

Many of you have been following my intermittent posts on my journey, at the age of 54, to pursue my MSN degree. In just a few weeks, I will have completed course No. 4 on healthcare delivery systems. One of our assignments was to interview a person in a legislative position and discuss the many facets of his or her role as it relates to how healthcare is delivered to his or her constituents. The legislator I selected happened to also be a family practice doctor. I just couldn’t resist. Oh sure, I could have picked a female legislator, or one whose name has been in a headline more often than deserved, but not me. I went straight for the jugular-a doctor who is my state rep, which brought me to an interview that was more of one as a constituent that that of a master’s level student.

The interview was a grand opportunity to better understand not only how the state process works, but how and why many decisions are made regarding healthcare bills. In the state of Tennessee, our legislature had been handed a bill that would make it optional for adults to wear helmets on motorcycles. Being an ED nurse, I am sure you can guess what my vote would have been on this! This motorcycle-riding physician, father, and state legislature felt otherwise. He strongly felt his job was to represent all of his constituents who wanted the helmet option. We agreed to disagree on this issue and I left the interview feeling our county/district was in good hands.

As we look to the last quarter of this year, by the end of December, I will be halfway through the program. I feel like my brain is packed with so much information, I will have to upload more GB to store any new lessons for 2009!

Are you still wrestling with whether or not you should go back to school? Are you having an argument with yourself over what to specialize in?

Rev up your resume

by Phyllis Quinlan, RNC, MS, CLNC, CEN, CCRN

I am frequently asked about the best way to revise a resume. Many nurses find it challenging to identify and present their accomplishments. Here are some suggestions for getting started:

  • Begin to revise your resume today even if you are not planning a career move. This will allow you time to truly consider your strengths and accomplishments without the pressure of submitting something by a specific date.
  • If you have practiced in a clinical setting for many years, outline your abilities in a manner that shows some range. For example, instead of documenting 10 years of experience in pediatrics, consider stating your experience in terms of “neonate to seventeen.” This offers the reader more information about where you may fit into a potential position and is especially helpful when you are applying for a position outside of the traditional settings.
  • Develop the strongest generic resume you can and use a cover letter to outline your qualifications for a specific position.
  • Your cover letter can also help to clarify your experience. Recruiters in acute care may not fully realize that your long-term care (LTC) experience is relevant to what they are presently seeking. A few sentences discussing the co-morbidity and clinical complexity of your LTC residents drives home the point that your skill set is more evenly matched with acute care then they may have realized.
  • Be sure to present your experience in precepting new staff members, participating on committees, and unit-based special projects in the best light. If you have not been involved in these areas to date, get involved.
  • If you were is a position that was not a good fit for six months or less, there is no rule that states you must note it on your resume.

Revising your resume today also gives you the opportunity to identify any skills that you should develop in the future. Is it time to attend some computer classes and work on those PowerPoint and Excel skills? Has it been awhile since you attended any continuing education? Are you prepared to claim 10 years of experience in a specialty and answer questions about why you are not certified in that specialty? Act now. Be proactive. You will be amazed at how empowered you can feel.

What’s the first step you take when updating your resume?

For more information about professional life coaching email Phyllis Quinlan at

Essential business skills for nurse managers

By Denise Danna, DNS, RN, CNAA-BC, FACHE

For a nurse manager to be successful in today’s healthcare environment, mastery of basic business skills is essential. No longer are nurse managers expected to be clinical experts but, instead, must be equipped and skillful in “running their business.” Each nursing unit is a component of a larger organization that depends on qualified nurses to manage the business and to understand the “big” picture. Nurse managers are the change agents and leaders in improving the work environment where nurses practice, so it is essential that they have the required skills.

What are the essential business skills?

As you think about business skills, the first thing that probably comes to mind is the budget or the finances, but business skills include so much more. Business skills frequently include human resources, strategic planning, and systems thinking, to name a few.

The following three categories identify several of the business skills that are essential for nurse managers:

  • Financial management
  • Human resources
  • Strategic management

For more of Denise’s article, visit our Reading Room.