Institutes are addressing barriers to safe nursing practice

"The progressive world is necessarily divided into two classes - those who take the best of what there is and enjoy it - those who wish for something better and try to create it."  ~  Florence Nightingale.

"Our lives begin to end the day we become silent about things that matter."  ~  Martin Luther King 

Nurses undergoing state board discipline should not feel dis-empowered to reach out to State Representatives and MPs to discuss their case.  Please ask your local politician to connect with Rep. Tony Shipley (R-TN) to gain more understanding about the issues that a nurse faces when investigated/disciplined by the SBRN.

Also send a copy of your resume; any outstanding achievements academically or in the work place; as well as a copy of your college course curriculum (pre-requisites and core requirements for your nursing program). All clinical placements and research you have been involved in so that you portray your level of education, experience and expertise.

Highlight the need to support legislature that requires a 5:1 nurse/patient ratio.

Some of the information you can give to your local politician in the US are as follows:

www.nursetogether.com Catherine Garner writes that the Institute of Medicine (IOM) has identified barriers to effective practice that nurses are challenged by in the health care system and recommendation for 4 key changes: 

1. Nurses should be able to practice to the full extent of their education and training; encourages higher levels of training and education; full partners with MD's and other health professionals in redesigning health care in the US.

2. Barriers to effective practice are: regulatory and policy barriers; fragmentation of the health care system; high rates of turnover; difficulty transitioning from school to practice; aging workforce and other demographics. 

Scope of practice is determined by each state's legislature and can vary.  The IOM sees this as a political decision and not related to safety or nurses ability or training.  Restricting a nurse from practicing to his/her full potential according to the level of education and work experience preparedness is viewed by The Federal Trade Commission (FTC) as anti-competitive conduct and seeks to provide reforms related to the "widest choice of competent cost effective health care providers."

The American Association of Critical Care Nurses (AACN) has published six standards for establishing and sustaining healthy work environments.

1. skilled communication

2. true collaboration

3. effective decision making

4. appropriate staffing 

5. meaningful recognition

6. authentic leadership

The (IOM) says there exists an "historical lack of inter-professional co-operation and cultural barriers to patient safety.  The Nurse-MD collaboration is the strongest predictor of psychological empowerment for nurses.

Linking the inter-professional components of communication, true collaboration and effective decision making it is sad to say that 8% of MD's recognize nurses as part of the decision making team.

I recollect asking a lawyer on the Board of a hospital where I worked what he thought were the main reasons for medical mistakes and he told me it was due to communication barriers.  

Appropriate staffing:

Studies reflect negative patient outcomes when nurses have too heavy a workload and that the maximum number of patients a nurse should be assigned in the acute care setting is 1:5.  Dr. Aiken's research at the University of Pennsylvania can be accessed at www.nursing.upenn.edu.  Duke University are the quintessential source of data on nurse:patient ratios that I refer to and can be downloaded  ttps://faculty.fuqua.duke.edu/~fdv1/bio/ratios3.pdf

Medical mistakes kill 250,00 people in the US and costs $30 billion each year.  Nurses intercept 86% of all medication errors made by other health care providers.  On average, Peter Pronovost MD, Johns Hopkins Hospital, reports a "patient receives a little more than half of the therapies they are supposed to."

I hope politicians are taking stock of the barriers that nurses face in the work as health care providers and some insights into why nurses encounter difficulties with their practice in the workplace.  The one person I believe whose head has been put on a plate for practicing to the level of her education and experience and should be supported by nursing associations and indeed the AZ state board of nursing is Amanda Trujillo.  When a nurse neglects to listen to his/her patient's wishes before of fear of having a full blown investigation and put in jeopardy of loosing the license that has been earned through long hours of study and dedication to patient care, its a sad day for all nurses.  We need to stand behind nurses and stand up one by one to show support.  Too often people are afraid of being caught in the radar and perhaps fear retaliation; act as judge and jury in their own minds; or just don't care because it isn't their ordeal.  Just think about the situation as one which might be the one you will face one day and how you would like others to respond.

Thinking of those nurses undergoing state board discipline and sending positive thoughts and well-wishes your way today.  Rita.