All Entries Tagged With: "nursing accountability"
One of your nurses will make an error today. Will she report it?
Be prepared for errors and develop a culture where near misses are reported—and learned from—with the best practices presented in the 90-minute audio conference Learn From Errors and Near Misses with a Just Culture: Stop Punishing Nurses for Mistakes. Experts Cole Edmonson, DNP, RN, FACHE, NEA-BC, and Lucy Bird, RN, ONC, live the Just Culture experience every day and will demonstrate what to do when the worst happens to support clinicians, learn from mistakes, and build a culture of accountability and high-reliability.
Find answers to all your questions about improving patient safety and increasing nurse satisfaction by building a Just Culture in your facility.
For more information or to order, call 800/650-6787 and mention Source Code EZINEADp1 or visit the HCPro Healthcare Marketplace.
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!
Schwarzenegger replaces most of California’s State Nursing Board
On Monday, July 13, Californian Gov. Arnold Schwarzenegger replaced most of the members of the state’s Board of Registered Nursing after reports of potentially dangerous nurses continuing to work even after being accused of egregious misconduct.
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Ask effective questions to ensure meetings are productive
In a meeting, you want participants to process information in a useful way that adds value. Each person in the room is running on a processing question. They are asking themselves a question and continually answering it. By setting that question for them, you can make the meeting much more productive. [more]
Setting expectations for accountability with staff
Nurse managers are in one of the most difficult roles in any organization. They must manage nursing units while supervising, leading, and mentoring nursing staff.
To be effective managers and to promote the organization’s goals of patient safety, patient satisfaction, and high-quality care, nurse managers rely on staff nurses to provide excellent patient care and to follow the organization’s policies and procedures. [more]
Three goals for instituting a shared decision-making model
The fundamental belief behind shared governance is that nurses at every level should govern their practice and be included in all decisions that affect their practice. This belief requires a redistribution of influence among managers and staff from one in which all decisions are made by administrators from the “top down” to one in which decisions are agreed upon collaboratively from the “bottom up.”
A shared decision-making model’s success is dependent on active involvement of nurses at all levels from the bedside to nursing leadership and must be supported at all levels.
The three main goals for instituting a shared decision-making model are:
Achieve accountability when working with physicians
We have many opportunities to work with physicians. It may be in caring for a specific patient or group of patients, or we may work with them on a project or team. Working with physicians to achieve accountability is no different from working with anyone else. We want to get physicians to do what they say they are going to do. We want them to make commitments and keep their commitments, as explained in the video below.
We can use the same tools used in all accountability situations, and one which is to frame the conversation.
Framing an accountability conversation is how you “set the stage” for what is expected. Often, you don’t achieve the results you desire because the expectations were not clear or each party had different expectations. Framing allows you to define what you expect.
Framing is when you ask the physician to listen and process in a positive way. It creates the listening opportunity for you to speak into. It creates one common mindset in the conversation and enables participants to do the correct work.
You can easily fix the random mindset in a conversation or meeting by asking people to be a certain way, to do a specific kind of work, and to be open to the possibility of accountability. In a group, framing sounds like this:
- I ask us to focus on our vision of improving our patient satisfaction scores by five percentage points in six months
- I ask us to listen to the presentation for opportunities we can pursue to make progress on our goal
- Please be prepared to make commitments at the end
You can do the same thing in a one-on-one conversation with a physician. For example, let’s say you are caring for a patient in pain. You contact the physician and use the SBAR technique (situation background assessment recommendation) to communicate the patient’s condition. You confer with the physician about how reasonable pain control can be achieved, and the physician gives you an order for pain medicine. You commit to the physician that you will give the medication as ordered and you will call the physician in three hours if the patient’s pain has not improved (pain level < 5) for further orders. The physician agrees with the plan.
Everyone wants to do the right work and to contribute. All we have to do is ask!
What methods have you used to gain commitments from physicians at your facility?
