In AJN’s very first issue, 117 years ago this month, a nurse, M. Riddle, wrote, “The nurse has a very important duty to perform. She is the picket-guard. On her care and watchfulness the well-being of the patient very largely depends.” It seems fitting, then, that we return to the issue of safety this month, with several articles that address creating safe environments for patients.
The 1999 landmark Institute of Medicine report, To Err Is Human: Building a Safer Health System, revealed what those of us in health care had long known—hospitals are rife with errors. It also put forth new thinking about how to address such errors and make systems safer. It supported transparency and creating a “fair and just culture,” in which the focus is on fixing the system rather than placing blame on the individual. Initiatives spurred by that report have led to changes in health organizations that encourage error reporting and systems analysis toward preventing future errors. And because errors can be examined, systems can be fixed, and individuals can learn from their mistakes, patients will be safer.
However, nursing schools seem to be lagging behind the health care organizations in which their students learn, as shown in this month's original research CE article, “Exploring How Nursing Schools Handle Student Errors and Near Misses.” In the article, Joanne Disch and colleagues examine how nursing schools track, report, and follow up on clinical errors made by nursing students. The authors’ findings revealed that more than half of the 494 responding schools didn't have a tool for reporting clinical errors, over 80% didn't have a process for tracking error trends, and about half had no consistent process for following up with students. Student follow-up likewise varied and many responses seemed to harken back to days of a more punitive approach. One wonders if this could make students hesitant to report errors when they transition to practice, thus undermining efforts of agencies to be more open in examining and correcting them. (Next month, the second article in this two-part series will offer strategies for schools to create a more fair and just culture.)
The clinical CE article, “Assessing Patients During Septic Shock Resuscitation,” focuses on one of the most fundamental roles of nurses—assessing and monitoring patients, and being the watchful sentinel that guards them from harm. Perhaps no clinical syndrome is as devastating as septic shock. As author Elizabeth Bridges notes, the Centers for Disease Control and Prevention has made early recognition and treatment of sepsis a national priority. This article focuses on correctly measuring and interpreting two important components of the sepsis bundle—capillary refill time and skin mottling score. Correct interpretation of these parameters will help guide resuscitation to a successful outcome.
In our Question of Practice column, ethicist Nancy Berlinger examines nurses’ age-old practice of creating workarounds to address what we see as dysfunctional or time-wasting processes. However, while workarounds may provide a quick fix, they can lead to unsafe conditions and even patient harm if communication isn't forthcoming or practices aren't fully transparent.
And finally, our Profiles column describes how one nurse's vision to keep older adults at home safely led to a new model of care. As an NP performing home visits, Sarah L. Szanton realized that home repairs were often a major factor in whether seniors could safely manage on their own. She developed CAPABLE (Community Aging in Place, Advancing Better Living for Elders), a program in which the home health care team includes a nurse, an occupational therapist, and a handyman. The program, which first launched in 2009, is now in 13 cities in eight states.
The common thread weaving through these articles is nurses’ commitment to creating safe environments for patients. M. Riddle's words from 1900 are as true today as they were 117 years ago.