Reclaiming Our Priorities - The Power of One
Following are excerpts from the keynote address delivered by AACN President Dave Hanson, RN, MSN, CCRN, CNS, at the opening session of the 2008 National Teaching Institute & Critical Care Exposition in Chicago, Ill. The full text with references is available online at www.aacn.org > NTI.
If you’re like me, listening to someone talk about numbers makes your eyes glaze over, but I want to talk about numbers that inspire. Numbers that inform. Numbers that remind us of our awesome responsibility and power.
Let’s start with the number one. If we reclaimed one priority today, we could prevent more than 675,000 medication errors by the time we gather next year for NTI 2009 in New Orleans. Imagine, 675,000 medication errors! And that’s possible counting only those of us here at NTI today. Each one of us, individually, could prevent 75 medication errors in that same time frame.
Conservatively, on average, we are each responsible for more than 300 patient days per year. One nurse. 300 patient days per year. On average, one drug error per patient day, 25% of which are preventable. There are more than 9,000 of us at NTI 2008. If our reclaimed priority is to end medication errors, we have the potential to avert 675,000 errors over the next year.
In our work as nurses, we have tremendous power to influence the outcomes of our patients, to put their care first, above all else.
There are only 9,000 nurses here at NTI today. Imagine if we added the other half million nurses who are currently caring for acutely and critically ill patients in the United States. Our impact would grow exponentially, raising the number of medication errors we could avert to more than 37 million.
The numbers, and the implications, are staggering. The responsibility; profound.
The number one is pivotal. As the old proverb says, a journey of a thousand miles begins with one step. So what if, we, you, I concentrate on the power of one?
One focus. One time. One person. Let me explain.
By one focus, I mean we must focus on doing what only nurses can do. We cannot continue to divert our nursing focus by regularly doing non-nursing tasks. We’ve all grown up to embrace the ability to multitask. I’d like to challenge that thinking. Every shift, there are many times when we should and must be wholly focused on one task. For example, when we are obtaining or administering medications.
Now I’d like to explain what I mean by “one time” by sharing a quote by James Reason that has stayed with me ever since I read it.
“Unsafe acts are like mosquitoes. You can try to swat them one at a time, but there will always be others to take their place. The only effective remedy is to drain the swamps in which they breed.”
We can choose to drain the swamp one time, or we can swat mosquitoes all day, every shift, all year long. Don’t you think there are some swamps that need to be drained in our organizations?
Quality improvement research identifies two types of approaches. One approach is a short-term remedy called patching. The other approach focuses on fixing the actual root cause, so we can prevent future occurrences. As nurses, we are so busy patching to ensure that patients get the care they need, we have little energy left to fix the root cause that ultimately frees us from having to repeatedly face the same challenge.
There’s a quote I admire from author and spiritual pioneer Mary Mannin Morrissey that says, “Don’t wait for something big to occur. Start where you are, with what you have, and that will always lead you into something greater.”
I think defining moments also come from the first small steps one person takes to turn around deeply entrenched system dysfunctions or harmful traditions.
Each of us must articulate the priorities that we demand be reclaimed. We do not have the luxury to sit back and hope that others will do it for us. Individually and in community, we must assert with conviction that we hold the solutions to many of healthcare’s most pressing problems. As the largest group of healthcare professionals, we must use our numbers to influence change so that we can confidently provide safe, quality care in healthy work environments.
Be Bold and Innovative
If ever there were a time for boldness and innovation, it is now.
If you believe we cannot become what we need to be, by remaining what we are, then we must use this time together at NTI 2008 to prepare ourselves for creating our futures.
I know we can do it. I am absolutely confident that we can. Are you with me?
Are you ready?
Let’s reclaim some priorities!
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