Pub Date : 2019-11-01DOI: 10.1097/01.NUMA.0000602804.57560.9c
Heidi L. McNeely, Sasha Jacobs-Lowry
M edical tubing misconnections have been reported for years. Although the problem still exists, the events are likely underreported.1 Misconnections have resulted in death or major harm to patients and have the potential for causing secondary trauma for the nurses who make the error.2-5 The ability for misconnections to occur continues to point to the need for a redesign of current connectors.6 An alert from The Joint Commission was issued to notify healthcare facilities about the risk of smallbore tubing (less than 8.5 mm inner diameter) misconnections and encourage facilities to put plans in place to limit the risk of misconnections and transition to new standards.7 A group of clinicians, manufacturers, and regulators collaborated with the International Organization for Standardization (ISO) and the Association for the Advancement of Medical Instrumentation to develop ISO 80369 standards for small-bore tubing connections.8 Nutrition Safety Solutions
{"title":"Enteral tubing connection changes: A failure modes and effects analysis.","authors":"Heidi L. McNeely, Sasha Jacobs-Lowry","doi":"10.1097/01.NUMA.0000602804.57560.9c","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000602804.57560.9c","url":null,"abstract":"M edical tubing misconnections have been reported for years. Although the problem still exists, the events are likely underreported.1 Misconnections have resulted in death or major harm to patients and have the potential for causing secondary trauma for the nurses who make the error.2-5 The ability for misconnections to occur continues to point to the need for a redesign of current connectors.6 An alert from The Joint Commission was issued to notify healthcare facilities about the risk of smallbore tubing (less than 8.5 mm inner diameter) misconnections and encourage facilities to put plans in place to limit the risk of misconnections and transition to new standards.7 A group of clinicians, manufacturers, and regulators collaborated with the International Organization for Standardization (ISO) and the Association for the Advancement of Medical Instrumentation to develop ISO 80369 standards for small-bore tubing connections.8 Nutrition Safety Solutions","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116430150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1097/01.NUMA.0000602836.74593.96
Jeffrey N. Doucette
This is an area in which many organizations are struggling, and the approaches to improving reporting are as unique as the organizations themselves. Creating a culture of safety requires a multifaceted approach. In my experience, increased reporting is one of the last indicators that you’ve achieved a strong safety culture on your team. When reporting goes up, it’s an indicator that there’s a significant amount of trust and respect—the foundational elements of a safe, team-oriented, and highly reliable practice environment. Building trust on your team begins with you. As a leader, it’s imperative to foster a culture of open, honest, direct, and transparent communication and role model these behaviors. Trust also requires a substantial investment in acknowledging the positive attributes of your employees in at least a 5:1 ratio to the negative. In other words, you should be telling staff members what they’re doing right five times more than pointing out what they’re doing wrong. Trust can be complex and mean different things to different people, but the key features are competence, integrity, honesty, and reliability. In general, this includes possessing the right skill set, having each other’s backs, and always doing the right thing, especially when no one is looking. Establishing psychological safety is another main component of increasing event reporting. Harvard Business School professor Amy Edmondson describes a psychologically safe workplace culture as “one where people are not full of fear, and not trying to cover their tracks to avoid being embarrassed or pushed.” This is a particularly poignant definition when you consider the complex and ever-evolving environment in which care takes place. Interventions to enhance psychological safety include having leaders who admit to and own their own mistakes, as well as forgive team members’ mistakes. Although this isn’t always easy to do, it’s essential for a team focused on safe and reliable practices. Encouraging questions and responding favorably to even the most seemingly impossible suggestions and ideas also helps inspire psychological safety. When staff members feel like their voices are heard, they’re far more likely to speak up in the spirit of safe patient care. Implementing highly reliable processes also contributes to an environment that supports reporting. When processes are reliable, they’re consistent, well understood, enculturated, and executed consistently regardless of who’s performing the task. This makes it easier to identify deviations from accepted practices, as well as hold employees accountable for performance expectations. Although it’s important to focus on processes, you must also balance this with a significant focus on people. Leaders and organizations who try to divorce the two are almost certain to never achieve positive safety outcomes. When people and/or processes fail, using a just culture framework to evaluate the root cause of problems and to take appropriate corr
这是许多组织都在努力的领域，改进报告的方法和组织本身一样独特。创建安全文化需要采取多方面的方法。根据我的经验，增加报告是您在团队中实现强大安全文化的最后指标之一。当报告上升时，这表明有大量的信任和尊重——安全、团队导向和高度可靠的实践环境的基本要素。在团队中建立信任从你自己开始。作为领导者，必须培养开放、诚实、直接和透明的沟通文化，并以这些行为为榜样。信任还需要投入大量资金，以至少5:1的比例认可员工的积极品质和消极品质。换句话说，你应该告诉员工他们做对了什么，而不是指出他们做错了什么。信任可以很复杂，对不同的人意味着不同的东西，但关键的特征是能力、正直、诚实和可靠。一般来说，这包括拥有正确的技能，互相支持，总是做正确的事情，尤其是在没有人注意的时候。建立心理安全是增加事件报告的另一个主要组成部分。哈佛商学院(Harvard Business School)教授艾米·埃德蒙森(Amy Edmondson)将心理安全的职场文化描述为“人们不会充满恐惧，也不会试图掩盖自己的行为，以避免尴尬或被逼。”当你考虑到发生护理的复杂和不断变化的环境时，这是一个特别尖锐的定义。提高心理安全感的干预措施包括让领导者承认并承担自己的错误，以及原谅团队成员的错误。虽然这并不总是容易做到，但对于专注于安全和可靠实践的团队来说，这是必不可少的。鼓励别人提出问题，并积极回应看似最不可能的建议和想法，也有助于激发心理安全感。当工作人员感到他们的声音被听到时，他们更有可能本着安全的病人护理精神大声疾呼。实现高度可靠的流程还有助于创建支持报告的环境。当过程是可靠的时，它们是一致的、被很好地理解的、适应的，并且无论谁执行任务都一致地执行。这样可以更容易地识别与公认实践的偏差，并让员工对绩效期望负责。尽管关注过程很重要，但您也必须将其与对人员的重要关注相平衡。试图将两者分离的领导者和组织几乎肯定不会取得积极的安全成果。当人员和/或过程失败时，使用公正的文化框架来评估问题的根本原因并采取适当的纠正措施是最合适的方法。最后，庆祝鼓励报告和识别潜在流程故障点的机会和想法。一个强有力的“好机会”计划提供了一个论坛，让人们产生想法，报告事件，并表彰提出这些问题的员工。例如，我目前的组织有一个委员会，负责审查每月提交的文件，并选择“最佳捕获”，在每月的领导团队会议上奖励员工和/或团队，颁发证书，并在面向员工的沟通中撰写一篇文章。增加事件报告在很多层面上都是一个挑战。创建促进报告的文化可以增强流程的可靠性，并减少与错误相关的风险。在一天结束的时候，一个强大的报告程序最重要的部分是你作为领导者的责任，跟进与你分享的事件和想法。纳米
{"title":"Creating a safety culture.","authors":"Jeffrey N. Doucette","doi":"10.1097/01.NUMA.0000602836.74593.96","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000602836.74593.96","url":null,"abstract":"This is an area in which many organizations are struggling, and the approaches to improving reporting are as unique as the organizations themselves. Creating a culture of safety requires a multifaceted approach. In my experience, increased reporting is one of the last indicators that you’ve achieved a strong safety culture on your team. When reporting goes up, it’s an indicator that there’s a significant amount of trust and respect—the foundational elements of a safe, team-oriented, and highly reliable practice environment. Building trust on your team begins with you. As a leader, it’s imperative to foster a culture of open, honest, direct, and transparent communication and role model these behaviors. Trust also requires a substantial investment in acknowledging the positive attributes of your employees in at least a 5:1 ratio to the negative. In other words, you should be telling staff members what they’re doing right five times more than pointing out what they’re doing wrong. Trust can be complex and mean different things to different people, but the key features are competence, integrity, honesty, and reliability. In general, this includes possessing the right skill set, having each other’s backs, and always doing the right thing, especially when no one is looking. Establishing psychological safety is another main component of increasing event reporting. Harvard Business School professor Amy Edmondson describes a psychologically safe workplace culture as “one where people are not full of fear, and not trying to cover their tracks to avoid being embarrassed or pushed.” This is a particularly poignant definition when you consider the complex and ever-evolving environment in which care takes place. Interventions to enhance psychological safety include having leaders who admit to and own their own mistakes, as well as forgive team members’ mistakes. Although this isn’t always easy to do, it’s essential for a team focused on safe and reliable practices. Encouraging questions and responding favorably to even the most seemingly impossible suggestions and ideas also helps inspire psychological safety. When staff members feel like their voices are heard, they’re far more likely to speak up in the spirit of safe patient care. Implementing highly reliable processes also contributes to an environment that supports reporting. When processes are reliable, they’re consistent, well understood, enculturated, and executed consistently regardless of who’s performing the task. This makes it easier to identify deviations from accepted practices, as well as hold employees accountable for performance expectations. Although it’s important to focus on processes, you must also balance this with a significant focus on people. Leaders and organizations who try to divorce the two are almost certain to never achieve positive safety outcomes. When people and/or processes fail, using a just culture framework to evaluate the root cause of problems and to take appropriate corr","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126167234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.1097/01.NUMA.0000580624.53251.29
Maricon Dans, Vicki Lundmark
“R etention is now a critical issue...as we risk losing nurses faster than we can train them.” This startling statement was made by Howard Catton, CEO of the International Council of Nurses (ICN), at the ICN International Workforce Forum in March 2019.1 Discussion at the ICN Forum recognized that the nursing shortage spans continents, necessitating an urgent global response. In the US, the nursing shortage continues to worsen, with a 17.2% turnover rate for RNs in 2018, tying with the 2015 rate as the highest in the last decade.2 Increasing RN job satisfaction and improving retention have become high-ranking strategic priorities for healthcare organizations everywhere.
{"title":"The effects of positive practice environments: Leadership must-knows.","authors":"Maricon Dans, Vicki Lundmark","doi":"10.1097/01.NUMA.0000580624.53251.29","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000580624.53251.29","url":null,"abstract":"“R etention is now a critical issue...as we risk losing nurses faster than we can train them.” This startling statement was made by Howard Catton, CEO of the International Council of Nurses (ICN), at the ICN International Workforce Forum in March 2019.1 Discussion at the ICN Forum recognized that the nursing shortage spans continents, necessitating an urgent global response. In the US, the nursing shortage continues to worsen, with a 17.2% turnover rate for RNs in 2018, tying with the 2015 rate as the highest in the last decade.2 Increasing RN job satisfaction and improving retention have become high-ranking strategic priorities for healthcare organizations everywhere.","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121462004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.1097/01.NUMA.0000580604.15133.77
Christie Muza, K. Flinn, Lori Ann Parrott, Crista Schronk
The following articles represent the first-place and runner-up winnersfrom the NMCongress2018 poster contest. Both posters were presented and recognized at last year's conference. Congratulations to our winners!
{"title":"Congress2018 poster winners.","authors":"Christie Muza, K. Flinn, Lori Ann Parrott, Crista Schronk","doi":"10.1097/01.NUMA.0000580604.15133.77","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000580604.15133.77","url":null,"abstract":"The following articles represent the first-place and runner-up winnersfrom the NMCongress2018 poster contest. Both posters were presented and recognized at last year's conference. Congratulations to our winners!","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123566834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.1097/01.NUMA.0000580620.45628.cd
L. L. Littleton, L. Fennimore, C. S. Fernald, J. Z. Gonzalez
H ealthcare organizations have been challenged to create and sustain an exceptional care experience that promotes patient engagement and optimal outcomes. Patient experience has become a critical differentiator, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. This is far more than just an attempt to “satisfy.” Building relationships and communicating well with our patients and families are vital approaches.1 In today’s complex healthcare environment, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.2 Although the literature shows that nurse leader rounds correlate with increased patient satisfaction and associated financial incentives, specific rounding practices aren’t differentiated and there are no evidence-based studies reflective of the number of rounds necessary to generate a change in overall patient satisfaction.3,4 With ever-changing national benchmarks and competing demands on unit leadership, more strategies are needed to determine the quantity of time and resources required for nurse leader rounding to truly enhance patient satisfaction.2 This quality improvement (QI) project explored the relationship between the percentage of patients on the unit who were rounded on by a nurse leader and the results of a discharge survey reflective of patient satisfaction
{"title":"Effective nurse leader rounding improves the patient experience.","authors":"L. L. Littleton, L. Fennimore, C. S. Fernald, J. Z. Gonzalez","doi":"10.1097/01.NUMA.0000580620.45628.cd","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000580620.45628.cd","url":null,"abstract":"H ealthcare organizations have been challenged to create and sustain an exceptional care experience that promotes patient engagement and optimal outcomes. Patient experience has become a critical differentiator, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. This is far more than just an attempt to “satisfy.” Building relationships and communicating well with our patients and families are vital approaches.1 In today’s complex healthcare environment, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.2 Although the literature shows that nurse leader rounds correlate with increased patient satisfaction and associated financial incentives, specific rounding practices aren’t differentiated and there are no evidence-based studies reflective of the number of rounds necessary to generate a change in overall patient satisfaction.3,4 With ever-changing national benchmarks and competing demands on unit leadership, more strategies are needed to determine the quantity of time and resources required for nurse leader rounding to truly enhance patient satisfaction.2 This quality improvement (QI) project explored the relationship between the percentage of patients on the unit who were rounded on by a nurse leader and the results of a discharge survey reflective of patient satisfaction","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127240429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.1097/01.NUMA.0000579032.78599.b2
Nicole Dragoon, Michelle L. Nadeau, Susan Toolin, M. Gagne, Kate Fitzpatrick
W hen the University of Vermont (UVM) Medical Center redesigned its CNO role in 2015, the new CNO’s top priority was establishing a governance system that engaged clinical nursing staff in organizational decisions relevant to professional practice. The UVM Medical Center is a 500-bed academic medical center in Burlington, Vt., with a staff of approximately 1,800 nurses across the care continuum. A limited shared governance structure was in place at the time, which consisted of nonstandardized departmental councils and a global nurse practice council. In a survey of nurses, only 35% felt included in organizational decision-making, with 66% attributing role satisfaction to their ability to effect change. Under this structure, clinical nurses were inconsistently involved in project proposals and implementation. Additionally, a review of council productivity and outcomes revealed opportunities for improvement and greater alignment with organizational strategic priorities. This article describes the organization’s journey to establishing professional governance with an innovative, patientand familycentered structure that leverages collaboration between the CNO, point-of-care staff, and organizational partners. A new approach The existing governance structure at the UVM Medical Center was a leader-driven, top-down approach, in which staff members were consulted on practice changes versus recommending and leading efforts. The new nursing professional governance (NPG) design requires active engagement of clinical nursing staff in shared decision-making. The structure evolved from leaderdriven to nurse-driven, with
{"title":"Nursing professional governance: Patient- and family-centered design.","authors":"Nicole Dragoon, Michelle L. Nadeau, Susan Toolin, M. Gagne, Kate Fitzpatrick","doi":"10.1097/01.NUMA.0000579032.78599.b2","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000579032.78599.b2","url":null,"abstract":"W hen the University of Vermont (UVM) Medical Center redesigned its CNO role in 2015, the new CNO’s top priority was establishing a governance system that engaged clinical nursing staff in organizational decisions relevant to professional practice. The UVM Medical Center is a 500-bed academic medical center in Burlington, Vt., with a staff of approximately 1,800 nurses across the care continuum. A limited shared governance structure was in place at the time, which consisted of nonstandardized departmental councils and a global nurse practice council. In a survey of nurses, only 35% felt included in organizational decision-making, with 66% attributing role satisfaction to their ability to effect change. Under this structure, clinical nurses were inconsistently involved in project proposals and implementation. Additionally, a review of council productivity and outcomes revealed opportunities for improvement and greater alignment with organizational strategic priorities. This article describes the organization’s journey to establishing professional governance with an innovative, patientand familycentered structure that leverages collaboration between the CNO, point-of-care staff, and organizational partners. A new approach The existing governance structure at the UVM Medical Center was a leader-driven, top-down approach, in which staff members were consulted on practice changes versus recommending and leading efforts. The new nursing professional governance (NPG) design requires active engagement of clinical nursing staff in shared decision-making. The structure evolved from leaderdriven to nurse-driven, with","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114945916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.1097/01.NUMA.0000580612.60875.e9
S. Cox
{"title":"Moving out of autopilot.","authors":"S. Cox","doi":"10.1097/01.NUMA.0000580612.60875.e9","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000580612.60875.e9","url":null,"abstract":"","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123147856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.1097/01.NUMA.0000580608.22757.c5
Send us up to 1,000 words on how being a mentor or mentee shaped your practice.
给我们发送至多1000字的信息，说明作为导师或学员如何影响你的实践。
{"title":"Share your story with us: When mentorship mattered.","authors":"","doi":"10.1097/01.NUMA.0000580608.22757.c5","DOIUrl":"https://doi.org/10.1097/01.NUMA.0000580608.22757.c5","url":null,"abstract":"Send us up to 1,000 words on how being a mentor or mentee shaped your practice.","PeriodicalId":358194,"journal":{"name":"Nursing Management (springhouse)","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121652166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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