Thousands of hospitalized patients die every year and the cause is directly attributed to nurses and their “failure to rescue” the patients within their care. We’ve all heard about that one patient that came in with one issue and died of another. Those of us who have reviewed charts for malpractice cases refer to it as the “snowball effect”—reading the progress notes of a patient who died due to failure to rescue will make you cringe at the glaring errors.
Patients may have one clinical issue, however minor, that if overlooked by the nurse, cascades into a huge mess of concurrent errors and oversights that often leads to the injury or needless death of a patient. Did you ever wonder why this occurs? Short staffing? Maybe. Nurse burnout? Could be. The main contributing factor, though, is that unfortunately there are many nurses who don’t think creatively or innovatively. They don’t act on their assessment findings nor do they follow up on a change in patient condition. They fail to act as advocates for their patient. Nurses who fail to rescue use “traditional thinking” rather than critical thinking.
Failure to rescue always includes four key elements: (1) Omission of care; (2) a failure to recognize a change in patient condition; (3) a failure to communicate a change in patient condition to medical or other staff; and (4) poor or lack of clinical decision making.
Preceptors and nursing instructors, no matter the level of nursing taught (RN, BSN, MSN, NP, or DNP), should review the below list. It contains elements of traditional thinking. Promoting traditional thinking stifles critical thinking.
who don’t think critically:
- Don’t learn from their mistakes or the
mistakes of other nurses.
- Demand that nothing changes and have a
“but we’ve always done it this way” attitude.
- Treat each patient interaction in
- Fail to “connect the dots” from one
interaction to another.
- Fail to learn about cause and effect.
- Do not connect new events with prior
- Do not see what is possible in the future.
- Solve problems in isolation.
- Demand that all things be done their way
and not any other.
- Allow personal dislikes and prejudices to
- Lack self-confidence.
- Have poor verbal and written communication
skills and do not interact well with others.
- Do not further their education or promote education
- Force others to make decisions quickly or
set time limits on when decisions can be made.
The behavior and clinical actions of nursing preceptors and instructors affect a student or new nurse long after their clinical rotation or orientation has ended. In fact, the actions of a preceptor or instructor will influence the new nurse far into their nursing careers.
The following statements, said by a preceptor or any nurse to another nurse, will stifle critical thinking:
- “That’s a dumb idea.”
- “I can’t believe your school didn’t teach
- “Your idea is good, but it won’t work here.”
- “It’s too complicated so I’ll just do it
and you can watch.”
- “You spend too much time talking with your
- “We tried that here on our unit and it
How do you teach critical thinking to your preceptees and students? Let us know in the comments!
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The United States is facing a critical shortage in all health care professions. With the nation’s baby boomer population approaching retirement age, the issue is twofold: the aging population requires more care, and the nation’s physicians, nurses, and other health professionals are retiring.
Too Many Students, Not Enough Options
The solution to filling this gap is replacing the departing health care professionals with nursing graduates of all academic levels. However, many higher education institutions are turning away suitable candidates in droves. In 2016, nursing degree programs in the U.S. rejected 64,067 qualified applicants from baccalaureate and graduate nursing programs alike citing a lack of budget, faculty, clinical sites and preceptors, and classroom space.
Currently, there is a serious shortage of physicians, which continues to grow. By 2025, there will be a projected deficit of nearly 35,600 primary care doctors alone. Nursing schools are facing the struggle and strain to increase the capacity of existing nursing programs, and explore other avenues like online courses and accreditation.
Higher Education Means Higher Pay
Enrollment is increasing in nursing masters and doctoral programs across the country, and it’s no wonder that nurses are applying to graduate schools en masse. RNs realize there are significant perks to training and becoming an advanced practice registered nurse. Evidence shows that the quality of care by an advanced practice nurse is comparable to physicians, while often more affordable.
The full-time annual salary for a Nurse Practitioner (NP) averages $105,546. The high pay range of the NP may be partly to blame for the faculty shortage—higher compensation in the clinical setting is luring potential educators away from teaching.
Most vacant faculty positions require a terminal nursing degree. If more nurses pursue a doctoral degree, the faculty shortage will be alleviated. What will the outcomes of the nursing shortage be? Only time will tell.
Caitlin Goodwin MSN, RN, CNM is a Board Certified Nurse-Midwife and freelance writer. She has ten years of nursing experience and graduated with a MSN from Frontier Nursing University.
When the first nurse practitioner residency programs began, the term “residency” left many in the nursing community unsettled.
“One of the concerns of residency programs and that terminology is the suggestion that nurse practitioners are not prepared upon graduation, which is not accurate at all,” Kitty Werner, MPA, executive director for the National Organization of Nurse Practitioner Faculties (NONPF), told MedPage Today.
In considering the language debate, Werner said, “[I]f people look at them [residencies or fellowships] closely they see how they are specific to their practice site, it’s much more like an intensive on-boarding experience for new graduates. Or it might be for existing nurse practitioners who transition to that particular practice environment, but they don’t replace formal educational preparation.”
The NONPF, as part of a broader statement on post-graduate education, declared that the term “residency” is “not an optimal description for NP post-graduate support” because it may be confused with medical residencies which are required for physicians to gain licensure. Four other major nursing groups signed the statement, which was later endorsed by the largest, the American Nurses Association.
“The residency in medicine fulfills the required clinical focus of a particular specialty. In NP preparation that clinical focus is embedded in the NP educational program centering on the population focus that is the center of NP practice emphasis (e.g., family, pediatrics, women’s health, etc.),” the statement read.
Even more confusing, some nursing programs use “residency” specifically for the clinical hours already included in their programs. The statement urged post-graduate support programs to keep things simple and call themselves “fellowships” instead.
Britney Broyhill, DNP, ACNP-BC, the director of the nurse practitioner program at Carolinas Healthcare in Charlotte, N.C., said she prefers the term “fellowship” since the programs are voluntary and offer advanced practice clinicians a chance “to go above and beyond their formal education and training in a subspecialty.”
But there are dissenters, among them Margaret Flinter, PhD, APRN, senior vice president and clinical director of the Community Health Center in Middletown, Conn., who founded the first nurse practitioner residency program and still prefers that name.
“My feeling is still — though I’m always open to the conversation — that this kind of broad-based, very intensive clinical training across the full gamut of primary care is best described as residency.”
She noted that the Department of Veterans Affairs also uses the term “residency.”
This story was originally posted on MedPage Today.
The Ohio University College of Health Sciences and Professions’ School of Nursing is putting virtual reality to use in the classroom. Assistant professor Sherleena Buchman helped create a Narcan simulation during the 2018 spring semester. Since then, the initial video simulation has been transformed into a virtual reality simulation.
A 360-degree video was made from cameras surrounding the Narcan simulation, which features two college students discovering a friend experiencing an opioid overdose. Throughout the scene, the students call 911 and work together to help their friend by administering Narcan.
“Using virtual reality goggles, the person can turn around and see everything. It’s really amazing,” Buchman shared with the CHSP Newsroom. “When you look down, you can see them going through the bag looking for Narcan. If you hear a noise, you can turn your head to look in that direction to see what’s going on. It’s just like you were physically in the room.”
Buchman believes that as the simulation becomes more realistic, the students will learn even more than they could in a traditional nursing education setting. Currently, this simulation is only available in the university’s GRID Lab, but Buchman is working to have the simulation eventually available on all smartphones. The simulation will help students learn not only about Narcan and how to administer it, but how to view and think about addiction without a stigma.
“It leaves you with a feeling of ‘Wow, I just watched someone overdose and watched them come back,’” said Buchman. “The reactions viewers gave were interesting and emotional. They showed compassion as we sometimes don’t consider the side of the actual person who overdosed and the feelings of those that found them.”
Currently this simulation is only available for laymen, but Buchman is working on another version specifically for Ohio University’s nursing students that can be used as a teaching tool. She feels excited and grateful about her success with the simulations so far.
“It’s been a pretty amazing journey. I love technology, simulation and education and the students today have grown up with technology in their hands. This is a way we can impact them that’s familiar,” Buchman said. “It’s amazing to think that we can help create something that will help patients and help our community by impacting this generation of students and community members who see this and will be able to carry out these actions on their own.”