Besides making sure that patients have everything they need to heal, nurses also have to ensure that their patients are safe. Sharon Roth Maguire, MS, RN, GNP-BC, Chief Clinical Quality Officer at BrightStar Care, has an extensive health care background with more than 15 years of experience in the health care field. Maguire works closely with nurses—in addition to having worked as one herself—and she knows how important patient safety is.
Maguire agreed to answer our questions on patient safety in honor of Patient Safety Awareness Week. What follows is an edited version of our interview.
What are some of the most important tips that nurses need to know regarding patient safety?
Nurses are uniquely poised to think of patient safety in a very broad way—emotionally, physically, socially, and environmentally—while simultaneously narrowing it down to the specific care situation. We need to think of our patients comprehensively, especially within in the home. We at BrightStar Care follow the national patient safety goals of the Joint Commission as accredited home care agencies.
Home safety evaluations are essential. What within their home environment could put the client at risk for falling? We need to evaluate adequate lighting, plumbing, furniture that is hazardous as a way of support, throw rugs, etc. Clients who are on oxygen in the home are at a significant risk for potential fire outbreaks. It’s important that the nurse educate clients and their family members on oxygen safety in the home.
Medication safety is a Joint Commission national patient safety goal. BrightStar Care nurses collect information about what medications clients are taking (prescribed and over-the-counter as well as home remedies) and are aware of potential hazards of the actual medication as well as how it interacts with other medications, diet, alcohol, etc. We advise clients and their family care partners about the risks we’ve identified. These interventions are critical to safe medication practices in the home setting.
What should nurses do if they make a mistake that results in possible patient harm/injury?
Nurses are skilled at following policies, process, and procedures, but despite their best efforts, a mistake can be made occasionally. Nurses are taught and held to a standard of high integrity including the importance of reporting any sort of mistake. The worst thing to do would be to hide a mistake. The quicker the mistake is reported and acted on, the quicker the potential negative outcome can be reduced.
What are the most common tips that new nurses should know so that they can keep their patients safe? What about keeping themselves safe?
When in doubt, ask questions. Even though nurses may have gone to school for many years, they might have never had the chance to practice a particular skill. Never hesitate to ask for help. If you’re unsure, don’t think you know something—instead just ask a more experienced nurse. Have a more experienced nurse mentor be your partner when you’re doing something for the first time.
Some patients tend to get scared in the hospital, rehab center, or any place they would be treated by nurses. What can nurses do to alleviate their fears?
Most patients really just want someone that they can trust and feel safe and confide in. Nurses should be reassuring and empathizing while explaining things simply to patients. It’s also important to listen to our patients and understand their concerns. Be kind and be patient.
Don’t let the schedule dictate your response. At the end of the day, your patient is your primary focus and although tasks need to be done, that shouldn’t be at the expense of your patient. Patient safety, comfort, and peace of mind are top priorities.
Is there any other important information regarding patient safety awareness that nurses should know?
Safety is so extremely important. Nurses should slow down, take time to understand what is required to be safe—whether that’s when performing a procedure, giving a medication, or reading physician orders. Safety is paramount in the world of a nurse especially in the nurse-patient relationship.
Many physicians’ offices, hospitals, and urgent care clinics often have nurse practitioners (NPs) working in them. Although it’s usually the patients who aren’t sure what this kind of nurse does, we know that some of our readers may not know as well—at least not all the minutia involved with this kind of job and career path. Considering that more nurses are choosing to become NPs, knowing this information is important—especially in helping you decide if this is where you want to go next.
We interviewed Joyce Knestrick, PhD, APRN, C-FNP, FAANP, a family nurse practitioner and president of the American Association of Nurse Practitioners (AANP), to learn more about what exactly a nurse practitioner is and does. An edited version of our interview follows.
What is a nurse practitioner and what type of work does s/he do? What additional duties and responsibilities are they able to do because of their additional education?
The first thing to know is that NPs provide primary, acute, and specialty health care to patients of all ages and walks of life. We operate in all types of care settings from hospitals to home care, and urgent care clinics to the VA. NPs conducted over a billion patient visits in the last year alone. Many of your readers have probably seen an NP at some point, and we have developed a solid reputation of being close to our patients. The profession’s track record of patient-centered health care and outstanding outcomes have been well established over 50 years of research. NPs assess patients, order and interpret diagnostic tests, make diagnoses, and initiate and manage treatment plans—including prescribing medications.
NPs complete a master’s and/or a doctoral degree program, along with having completed advanced clinical training beyond their initial professional RN preparation. If an NP wants to go on to specialize in an area of care, it requires additional education and training.
With over 234,000 NPs across America, each having to undergo rigorous national certification, periodic peer reviews, clinical outcome evaluations, as well as adherence to a code for ethical practices, we’ve quickly become the primary care provider of choice for millions of Americans from rural areas to dense urban ones. About 16% of the profession works in communities of less than 10,000 and over 36% work in communities with a population less than 50,000.
Are there currently any barriers to practicing as a nurse practitioner? If so, what are they?
Yes, there are several barriers to practice for NPs all across the country. Currently, 22 states, plus the District of Columbia, allow NPs to practice to the full extent of their education, training, and licensure. While that may be over 40% of the country, AANP believes every state should enact laws enabling what we call “full practice authority.”
Every state is unique with its own set of public policy and political challenges, but we are committed to removing the barriers between NPs and their patients by drawing on the expertise of NPs who serve at the intersection of health care policy and patient care with the goal of achieving better health and improved access to care, at a lower cost.
We’ve identified several states as priorities this year. Any of you readers who are interested in helping to reduce barriers to practice for NPs should visit AANP.org and look for our state policy guide.
To make it easier for people to understand many of the nuances surrounding the FPA issue, we’ve assigned each state a color (see our map here).
Green states, which we’ve already mentioned, allow NPs to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications and controlled substances—under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and National Council of State Boards of Nursing.
Yellow states are called “reduced practice states,” and they reduce the ability of an NP to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care or limits the setting of one or more elements of NP practice.
Red states are called “restricted practice states,” and they restrict the ability of an NP to engage in at least one element of NP practice. State law requires career-long supervision, delegation, or team-management by another health provider in order for the NP to provide patient care.
There are many reasons why states fail to modernize regulations to enable NPs to practice to the full scope of their education and clinical training, not the least of which is pressure from organized medicine. That’s not to say that there aren’t similarities between yellow and red states’ barriers, but each state requires its own approach, and we actively identify legislation, support state-level NP organizations’ policy initiatives, and develop policy resources that cultivate strong NP leaders and sound health policy in every state.
What states are the best to work in as a nurse practitioner? Why?
Of course, any state colored green on our map will be more favorable to NPs than ones colored yellow or red. As the map demonstrates, western and northeastern states have chosen to enable NPs to practice to the fullest extent of their clinical training and licensure.
Why is it important for NPs to be able to practice fully? What do they bring to the health care table, so to speak, that benefits the health care system as a whole?
As clinicians, NPs blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. We bring a comprehensive perspective to health care.
When patients need to be moved from one location to another, and they’re in critical condition, every second counts. The transport team caring for them during these moves provide crucial care that can sometimes mean the difference between life and death. Today we celebrate them in honor of Critical Care Transport Nurses Day, held annually on February 18th.
Kristen Ponichtera, BSN, RN, CFRN, CTRN, CCRN, is a Critical Care/Emergency Nurse at University of North Carolina at Chapel Hill Medical Center. She knows firsthand the importance of being a critical care transport nurse. “As a transport nurse, no two days are the same. The job entails a lot of planning and preparation, as well as constant maintenance of didactic and clinical proficiencies. The ability to perform at a high level at a moment’s notice is a key element of the field because, for majority of the patient population, minutes matter,” Ponichtera explains.
After she spent years working in critical care and emergency medicine, Ponichtera became a critical care transport nurse because she says, “I was ready to expand my scope of practice and test my knowledge and skills to the fullest. Critical care transport nursing was the appropriate step. I then fell in love with the specialty.”
Like every health care position, critical care transport nursing has both challenges as well as rewards. “The biggest challenge of the job, which doubles as the most exciting, is to expect the unexpected. Every patient assumed under your care during transport is remarkably different from the last, and it is the responsibility of the transport nurse to be able to anticipate the needs of each individual patient,” says Ponichtera.
As for the best parts of the job? “The greatest reward of being a transport nurse is being able to give a patient and their family peace of mind by providing care marked by precision and exactitude when they are in their most vulnerable state,” Ponichtera says. “Practicing with autonomy and earning collegial respect is an additional reward in being a transport nurse. Finally, recognizing the impact made each day on the lives of patients and their families adds value to the career.”
If you are interested in looking into becoming a critical care transport nurse, Ponichtera says that “This is one of the greatest jobs in the field of nursing. Confidence coupled with humility are characteristics every transport nurse must possess, as our patients demand the best in care. But we also must recognize there is always more to learn. Luck is where preparation meets opportunity. Getting the right experience, asking the right questions, and never giving up are the ways I was lucky enough to get into this field, and I suggest you do the same.”
“Although small, the transport nurse community is always willing to lend a hand to those looking to break into the field,” says Ponichtera. “Seek us out and we will be happy to assist our fellow nurses in any way we can.”
When patients need surgery or any other procedures that require anesthesia, they need a good health care team working with them to ensure their safety. Perianesthesia nurses are a crucial part of this team. And in honor of PeriAnesthesia Nurse Awareness Week, Regina Hoefner-Notz, MS, RN, CPAN, CPN, answers our questions about working as a perianesthesia nurse.
Hoefner-Notz is the Clinical Manager for Phase I & II PACUs (Post-Anesthesia Care Units) at Children’s Hospital Colorado as well as the Vice President/President-Elect for the American Society of PeriAnesthesia Nurses (ASPAN). An edited version of the interview follows.
As a perianesthesia nurse, what does the job entail on a daily basis?
Perianesthesia nursing encompasses all the care an individual might need around (Peri from the Greek for “around”) the administration of anesthesia—hence the practice name perianesthesia. Most people think in terms of recovery rooms and surgery, but this practice has evolved into so much more.
Nurses in perianesthesia guide and care for individuals through some of the most traumatic times of their lives. Surgery and procedures are nerve-racking for everyone. Anytime a patient receives anesthesia, there are nurses who prepare them, educate them and their family members, vigilantly assess and intervene as they recover from anesthesia, as well as continuing to prepare them for returning home safely. These nurses are specially educated and knowledgeable about many aspects of care, and various surgeries and procedures.
When I discuss this with nurses with whom I work, I acknowledge that they accomplish in 1-2 hours what it may take other nurses an entire shift to figure out. Perianesthesia nurses deal with multiple patients throughout a shift, each requiring care compassion and spot-on assessments.
I have the great fortune of managing our Phase I and II postanesthesia care areas. These nurses specialize in the immediate needs of their patients as well as collaborate with our anesthesia colleagues to determine when a patient is well enough and safe enough to leave the hospital after his surgery or procedure.
Why did you choose this field of nursing?
I was searching for a new nursing venue after 20 years in pediatric critical care. I had heard of the PACU as a great place to work and, in 2000, I took the leap to try this practice area. It has been one of the best career decisions I have ever made. After orienting and learning new skills, I remember thinking, “This is why I went into nursing, to see the whole picture.” It is extremely gratifying to be able to see a patient and family come into a hospital, successfully have surgery, reunite with loved ones, and be comfortable enough to go home to continue their recuperation in familiar surroundings. I love it!
What are the biggest challenges of your job?
My challenges are a little different right now as a nursing manager and leader. I want every nurse to see this as an amazing practice area and to reach their greatest potentials through education and participation. I try to encourage ongoing professional education and involvement. It has been extremely rewarding to see nurses reach professional places they never thought possible, knowing I have a small hand in some of that. Other challenges evolve around the changing face of health care and trying to determine how we continue to give exceptional care to our patients, while always being mindful and good stewards of our financial resources.
What are the greatest rewards?
I have been a pediatric nurse for 37 years. The greatest reward of this job is to see families breathe that sigh of relief as we reunite children with their parents after surgery. The reward is seeing a child well cared for, and not as afraid as they might have been if they had not been in a pediatric hospital with perianesthesia nurses providing very specific care for them. My practice area combines two great loves—perianesthesia nursing and pediatrics.
What would you say to someone considering this type of nursing work?
This is an incredible practice area with something for everyone. Some nurses want to be front and center, always part of the action, and there is a place for them in PACU. Some nurses want to educate patients and spend meaningful time making sure everyone knows what to expect and what to do—there is a place for them in the pre-op areas and Phase II discharging areas. Some nurses want a little bit of everything, and they can do that too. Perianesthesia nursing can be found in hospital settings, surgery centers, outpatient centers, GI clinics, dental clinics, and anywhere there is a need for anesthesia and excellent nursing care.
Is there anything I haven’t asked you about being a perianesthesia nurse that is important for people to know?
Perianesthesia nursing is so privileged to have a professional organization exclusively dedicated to this practice area. ASPAN is the organization whose core purpose is to “Advance and promote the unique specialty of perianesthesia nursing.” ASPAN sets standards of care by promoting evidence-based practice for all nurses practicing in this area. This organization encourages networking, as well as professional growth and development, for all its members and I am a perfect example of someone who has been able to expand my professional horizons by being actively engaged in ASPAN. I would encourage every nurse to seek out his or her specialty organization and get involved.
Whenever we finish an experience, we tend to look back on it for many reasons. For example, we may look back after graduating from college to remember what classes we liked or friends we made. We revisit childhood in our minds to think of the really good times we had and what it was like growing up. And, when we retire, we will probably think back to what we learned, loved, and liked about our careers.
At Friendship Village Tempe, a retirement community in Arizona, there are forty-five retired nurses. They took some time to tell us what they would love for everyone—from new nurses to experienced ones—to know.
“Everyone today must acquire knowledge regarding their own health in order to make wise decisions.”
—Mary Lou Adler, RN, BSN
“Being a nurse uses all the knowledge and skills that you have. Deciding to be a nurse means you have not decided anything yet, because there are so many opportunities in the field.”
—Nancy Dolphin, PhD, BSN
“Problem solving skills can be transferred from bedside care to international leadership in addressing and advocating for health and human rights.”
—Joan A. Newth, RN, BSN
“Nurses can be advocates for family and friends when they are hospitalized to ensure safe, appropriate, compassionate, and ethical care.”
—Rosemary Kessler, RN, BSN, MED
“Since Florence Nightingale established the foundation for nursing, our profession has continued and continues to evolve as an art and a science.”
—Joan A. Newth, RN, BSN
“The number one thing that I would want you to know is that laughter is the best medicine. The number two thing is—that laughter is the best medicine!”
—Marilyn Lehwalder, RN, BSN
The following are from retired nurses who preferred to be anonymous:
“It will never get well if you pick it.”
“Marry a doctor.”
“Old nurses never die, they just lose their—patients—patience.”
What advice would you share with your nursing colleagues? Let us know in the comments!