Monday December 18th 2017

Partnering to promote safety in the nursing profession

More than ever, RNs are providing care for patients with complex needs, delivering high-risk treatments, and attending to diverse psychosocial needs. Safety risks are ever-present, and nurses must be competent in recognizing and reporting them. When individual nurses and nursing units adopt a culture of safety, a team that is highly committed to optimizing safe care is created. The nursing staff become advocates for safety with a shared goal of preventing and minimizing events that may cause harm. Together, an environment is cultivated that encourages safety reporting without fear, responds to safety issues promptly and effectively, and constantly works to improve the safety and quality of care.

Nurses often seek education and guidance on safety issues from professional associations. In turn, nurse associations help by validating safety concerns and providing evidence-based approaches to address them. The Oncology Nursing Society is an organization that has integrated patient and nurse safety in many aspects of its work, and recognizes safety as a basic yet significant component of quality cancer care. Throughout 2016, ONS has embraced and supported the American Nurses Association’s “Safety 360: Taking Responsibility Together” campaign with a complementary #SpotlightonSafety initiative.

Discussions with, and inquiries from, ONS members truly highlight the need for nurse empowerment when recognizing and reporting safety concerns. As a result, the ONS initiative includes educational opportunities and collaborative recommendations that prioritize, promote, cultivate and champion safety in any care setting. But, the ONS initiative also recognizes that empowering nurses to possess a personal dedication to safety is not enough, and overcoming safety-related challenges necessitates both individual and team-based considerations.

At the individual level, nurses can reflect on their sense of willingness and ability to address safety concerns. For instance, developing moral courage may help a nurse to overcome fear and stand up for personal values and professional obligations.

Collaboratively, care teams and nursing units can explore factors that contribute to safety risks, and the ONS initiative supports building a team that prioritizes safety above all else. Suggestions include taking steps to better manage task interruptions for improved vigilant risk assessment. Another tactic is to revisit care flow processes to be sure they include proactive error recognition and allow time to think through the steps of a procedure before a care task is performed. And, should an error or near-miss event occur, evidence suggests the need for responsive error reporting policies and procedures that outline a non-punitive investigative process aimed at reducing the chance for repetitive events.

Essentially, the ONS #SpotlightonSafety project is aimed at supporting nurses as core champions of safety and nurturers of a safe and just culture in the workplace. This initiative has sought to explore what oncology nurses know, what safety issues are of highest concern, and what learning needs exist. The project has engaged the organization’s members through use of the #SpotlightonSafety and #SafetySunday hashtags in social media postings, Twitter chats, highlighted articles in weekly mailings, journal editorials, newsletter blogs and interactive conference sessions. A “virtual safety wall” is available for members to submit their safety experiences and stories (both good and bad), and local chapters have been challenged to integrate safety topics into meetings and newsletters with the chance to win prizes for their participation. Oncology nurses have also contributed to the development of two safety-related continuing education offerings that are free to members. The #SpotlightonSafety initiative has flourished with ONS departmental champion collaboration, support from the executive team and board of directors, and great interest from ONS members.

Suggested personal safety priorities and goals

  • Know the current standards that guide care and apply to specific patient populations.
  • Follow policies and procedures, but speak up and recommend changes if a step is missing or needs revision to assure higher levels of safety.
  • Be a role model for safe care behaviors when performing high-risk care interventions.
  • Report staffing, environmental, and organizational issues that present obstacles affecting the safe delivery of care.
  • Educate patients about how they can maintain safety.
  • Report any observed or suspected at-risk patient and staff behaviors.
  • Communicate effectively during handoffs and care transitions.
  • Take ownership of errors, report them as required, and follow up as needed.
  • Use mistakes as opportunities for change to prevent similar events from happening again.
  • Ask for assistance, training or mentoring if faced with a task or care issue that is unfamiliar or its safety seems questionable.
  • Remember that safe care is holistic, addressing the physical, psychosocial and emotional safety of patients.
  • Don’t forget self-assessment and reflection to assure personal physical, psychosocial and emotional safety.

— Tracy Wyant is an oncology clinical specialist at the Oncology Nursing Society, an ANA organizational affiliate. Tracy has led the organization-wide ONS 2016 Culture of Safety initiative. She is enrolled in her final year of the DNP-Clinical Expert program at The Ohio State University

Resources

Finding the balance for a culture of safety
http://journals.lww.com/nursing/Fulltext/2015/12000/Finding_the_balance_for_a_culture_of_safety.19.aspx

Highly Reliable Health Care in the Context of Oncology Nursing: Part I
https://cjon.ons.org/cjon/18/2/highly-reliable-health-care-context-oncology-nursing-part-i

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