AACN News—April 2008—Opinions

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Vol. 25, No. 4, APRIL 2008

President’s Note
Reclaiming Our Priorities

You? Me? Us? Them? Yes.

AACN’s founders and their physician colleagues challenged traditional care because of unsafe situations arising in the new critical care units of their day. I’m not sure whether to be appalled or reassured that safety is still a concern nearly 40 years after AACN was founded. But then, Florence Nightingale was also concerned about patient safety. And that was 150 years ago. She was concerned with pure air, pure water, drainage, cleanliness and light. She also took on nutrition and noise. Where do you think Nightingale might focus in order to ensure patient safety today?

Surely those words ring familiar. Safety is one of three core values we identified nearly a year ago when we accepted the challenge of reclaiming our priorities. With the 1999 release of the landmark Institute of Medicine report, “To Err Is Human: Building a Safer Health System,” the fabled words of Hippocrates, “First, do no harm,” have become the cornerstone of a movement. Tragic, isn’t it, that we now require a movement to ensure a fundamental premise of healthcare. Such are the times in which we live.

As we did last month, let’s do some free-range thinking about safety. Once again, a caution: Our thinking may not proceed in a straight line.

National Quality Forum. Dozens, perhaps hundreds, of organizations have answered the clear, resounding call for safety. Among them, the National Quality Forum (www.qualityforum.org) has become a gathering place for organizations committed to ensuring safety in healthcare by pledging to set national priorities and goals for performance improvement, supporting education and outreach programs to achieve those goals, and endorsing consensus standards for measuring and publicly reporting on performance. The beauty of NQF is how it welcomes all stakeholders as members. Professional organizations such as AACN can join. So can healthcare providers, accrediting bodies and many others. Is your employer an NQF member? (www.qualityforum.org/about/membership)

Who Is Ultimately Accountable? You? Me? Us? Them?
The obvious answer: Yes. When all is said and done, we are all accountable for ensuring safety and we cannot do it separately. It’s that simple and also that complicated. Delivering healthcare today presents us with a paradox. Healthcare has become so complex that neither individuals nor systems can go it alone anymore. Everyone and everything affecting patient care have become cogs in an immense system that must be 100% safe.

Focus on Outcomes. Here’s a start. Trend data from The Joint Commission continues to single out communication as a root cause of six in 10 sentinel events. What if communication were eliminated as a root cause just like many ICUs have eliminated ventilator-associated pneumonia? What if communication—and other healthy work environment measures—were publicly reported like VAP rates? What if hospitals openly used their success in creating a healthy work environment as one way of recruiting new nurses?

Talking With New Nurses. I recently had an invigorating conversation with some senior BSN nursing students. They were passionate about their plans to work in high acuity or critical care. They were clear about our need as nurses to own nursing’s work. “There are no multiple choices where taking ownership of nursing work and practice is concerned,” one student affirmed. “Why wouldn’t we want to own it? If we don’t own it, someone else will.” I was reassured by their wisdom and insight, at least until we talked about ensuring quality and safety. After some gentle inquiring they came up with tasks like, “Make sure the patient’s call button is within reach” and “Keep the patient’s bed in the low position.” My experience with new nurses suggests this task orientation without evidence of critical thinking and problem solving isn’t unusual among new graduates. As I reflect back on my own experience as a nursing student and novice nurse, I was probably similar in my own orientation to quality and safety.

Teach to the Test. I’m not referring to the NCLEX or certification exam. I mean the minute by minute test of every patient and family interaction. It’s a test each nurse must pass 100% of the time. Translated to the bedside, it means that every acute and critical care nurse, experienced or new, can communicate skillfully, truly collaborate in a multidisciplinary team, proactively address conflict, willingly participate in rapid quality improvement strategies, commit to evidence-based practice care delivery and solidly understand how to address broken or dysfunctional processes and systems.

QSEN—A Good Place to Start. If we’re to share accountability for ensuring safety, each of us must become safety experts. We can call upon individuals and resources whose primary focus is safety. We just can’t offload our ultimate accountability to them. A good place for educators and clinicians to start is QSEN—Quality & Safety Education for Nurses (www.qsen.org). This comprehensive national program funded by the Robert Wood Johnson Foundation offers myriad resources and tools to embed quality and safety in our professional identity as nurses by embracing the Institute of Medicine competencies of patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. AACN leaders including Joanne Disch, Jane Barnsteiner, Lisa Day and Deborah Ward helped develop it.

How do we ensure quality and safety 100% of the time? What gets in the way? Who is accountable? You? Me? Us? Them? I invite you to share your perspectives by writing to me at priorities@aacn.org.

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