Shortly after beginning her chemotherapy infusion, Susan began to feel “funny.” She experienced difficulty in breathing. The attending RN immediately recognized the change in patient status and initiated a rapid response alert. The patient was promptly assessed, the chemotherapy infusion was interrupted, stat IV medications were administered, and the patient was closely monitored, which resulted in the improvement of her breathing and reaction to the chemotherapeutic agent.
Another RN on the same nursing unit interpreted the lab results of a recently admitted patient, recognized the severe neutropenia, and immediately placed the patient in a private room on neutropenic precautions, while she made a telephone call to the MD for further orders. The prompt action by the RN provided this immunosuppressed patient a stable environment.
The above situations illustrate the power that individual nurses have to keep their patients safe. The importance of continuing education, partnering with physicians, workplace planning and redesign, and information infrastructure are key factors in providing a secure environment.
The Institute of Medicine (IOM) report "The Future of Nursing: Leading Change, Advancing Health" includes key recommendations:
- Nurses must practice to the fullest extent of their education and training
- Nurses should achieve higher levels of education through an improved education system that promotes academic progression
- Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare
- Workplace planning to improve data collection and information infrastructure
How can we implement these recommendations?
Does the unit culture encourage questioning and assertiveness by the RN? Is the RN supported by the manager or clinical specialist in clinical situations? Is mentoring a strategy used to develop RN competency?
As a staff RN, are you “increasing the skills in your toolbox” by attending in-service and continuing education programs offered in your organization? The newly acquired knowledge and skills may make you appealing for your next position.
As a manager, are you supporting your staff’s development through attractive time schedules that respect the staff’s attempt to attend or return to school? Do you encourage incorporating evidence-based research into practice? Is staff invited to present journal articles at staff meetings? Is specialty certification encouraged and celebrated?
Has the organization considered partnering with academic centers to provide on-site classes for progression in nursing education?
As a staff RN, can you identify processes that need to be improved? Are you prepared to participate in quality improvement teams to address quality and safety patient issues?
As a manager, will you seek staff input and consider their recommendations?
Are nurses participating in user groups for the development and evaluation of information systems? RNs are the most knowledgeable of patient processes and documentation requirements. They can streamline what very often is a cumbersome system.
We agree that it is difficult to be a nurse in today’s complex healthcare environment, which includes high patient acuity, advanced technology, and ever-changing institutional and healthcare policies. The stress that nurses face on the frontline is incredible. The actions demonstrated by the nurses in the beginning scenario of this article can be described as watchful, intelligent, and assertive.
Stevenson (2010) suggests that watchfulness in frontline nurses is characterized by monitoring, role modeling, and mentoring. The IOM report has focused on the nursing profession and its potential for playing an important role in providing safe, quality patient care. Let us focus on what nursing can do. We can join together to ensure that nursing accepts this challenge to be watchful, intelligent, and assertive, as we provide a safe patient environment.
- Institute of Medicine (2010). "The Future of Nursing: Leading Change, Advancing Health." Retrieved from http://books.nap.edu/openbook.php?record id=12956
- Stevenson, K.C. (2010). "Focused and Intuitive Watchfulness: Registered Nurses Working With Students in Clinical Practice." (Doctoral dissertation.) Retrieved from University
of Calgary. ISBN: 978-049-1347347
- Sorrell. J. (2012). "Ethics: Creating a Culture of Ethical Watchfulness." OJIN: The Online
Journal of Issues in Nursing. Vol.17 No.3