About Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)

Editor-in-chief, (emerita), AJN

Workarounds May Work, But They Perpetuate Dysfunction

Photo © Associated Press

A couple of months ago, we posted a query on Facebook asking visitors to the page if they had ever used workarounds—the improvised shortcuts that may not be the standard practice or the policy, but may allow for more efficient work processes. We were amazed at the uniformity of the responses. No one saw a problem with workarounds, and most responded along the lines of “I love my workarounds—couldn’t do my job without them” and “I’ll never tell—keep hands off my workarounds.”

Nothing new.

Workarounds have probably been around since Florence Nightingale’s day—I can imagine one of her nurses at Scutari hiding lamp oil so she’d have enough to make rounds at night. In my early nursing days, we hid sheets so we’d have some in case we needed an extra bed change for a patient. When I worked in the ER of a busy city hospital, we kept a pretty large supply of IV fluids and medications on hand in a closet. It became a well-known secret that the ER had its own stockpile—in fact, there were occasions when the pharmacy would come to us for meds!

Today, the workarounds I hear about tend to revolve around dealing with the electronic health record and scanning medication bar codes.

Some cautions.

In […]

2017-10-18T09:59:23-04:00October 18th, 2017|Ethics, Nursing, nursing perspective|1 Comment
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Thinking About Las Vegas

This latest mass shooting, in which 59 people were killed and 500 wounded in Las Vegas, is distressing—and it won’t be the last. Again we find it incredible that this can be allowed to happen.

And again we are reminded of the unique position of the United States compared to most other countries, our astronomically higher numbers of gunshot deaths and the financial and emotional costs they exact. As I wrote in my February 2016 editorial on gun violence, “firearms accounted for 417,583 deaths—253,638 suicides and 163,945 homicides between 2003–2013.”

There’s more information about gun violence and the dismaying number of injuries and deaths among children in our report in the September issue. And a study just published in Health Affairs puts the annual cost of emergency and inpatient care for firearm injuries at $2.8 billion.

The numbers of deaths and injuries we can measure. The sense of helplessness and frustration, and the creeping sense of anxiety we experience as we go into public spaces, are more invidious. […]

2017-10-07T08:35:43-04:00October 6th, 2017|Nursing, Public health|3 Comments
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Student Errors in the Clinical Setting: Time for Transparency

Mistakes happen.

When I was working as an ED nurse, we often had nursing students assigned to the area. One day we had an elderly man with asthma in one of the treatment rooms. The physician ordered aminophylline suppositories. After reviewing the “5 rights”—right patient, right medication, right dose, right time, right route—I directed the student to administer the suppositories. All seemed well.

Imagine my surprise when the student proceeded to insert the suppository into the man’s nose! She explained that since it was a breathing problem, she naturally thought they would be inserted nasally. It never occurred to her that these were rectal suppositories and it never occurred to me to ask if she knew what to do with them. We all had a good laugh and that was that.

Undocumented errors.

Another day, another patient, another faux pas: a physician said to “cut the IV,” which everyone knew (that is, we assumed everyone knew) meant to discontinue the patient’s IV. One of my colleagues intervened when she saw a determined-looking student, with bandage scissors in hand, approach the patient’s room, ready to “cut the IV.” We again marveled at the student’s interpretation of the phrasing, and that was that.

And that’s the problem—that was that. There was no documentation of these as “near-miss” errors, and while […]

2017-10-04T09:57:24-04:00October 4th, 2017|Nursing, nursing students, patient safety|2 Comments
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Safety vs. Independence: When Is a Person Too Old to Drive?

I’d venture that many of us have had family discussions about whether it’s safe for a grandparent or elderly aunt or uncle to be driving. Driving is often the last vestige of independence and one that is fiercely held onto.

I had an aunt and uncle who worked out a unique and very shaky scheme so they could still get around independently: he couldn’t drive because of severely diminished eyesight, but he would direct his wife, my aunt, who had early Alzheimer’s, as she drove. Between the two of them, they could get to grocery stores, church, medical appointments, and bingo.

And one colleague, to prevent her father from driving after multiple accidents, told him she needed the car to get to work; in reality, she just drove it a few blocks from the house and parked it.

While author Loren Staplin and his colleagues note in ”Can Your Older Patients Drive Safely?” that “decline in driving abilities is related to functional status, not chronological age,” they also observe that the “greater risk associated with driving at age 75 and older is . . . evident in these drivers’ greater level of involvement in fatal motor vehicle accidents relative to their representation in the licensed driver population.” […]

2017-09-13T09:26:54-04:00September 13th, 2017|Public health|1 Comment
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Designing Nurses: Make Your Ideas Reality

“At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher…”

Earlier this month, the New York Times published an article, “Design Thinking for Doctors and Nurses.” In it, the author describes a simple solution designed by a nurse to identify who was in charge of a resuscitation team: whoever was wearing the orange vest was the leader.

As a former ED nurse who participated in many codes and trauma emergencies, I could easily picture the chaotic scene that led to this innovative solution. In a large urban teaching hospital, cardiac arrests and trauma calls draw many physicians and medical students, respiratory therapists, and of course, at least two to three nurses. It wasn’t unusual to have conflicting orders shouted out by physicians, residents chiming in with questions and suggestions, and the medication nurse making the decision as to which order she/he would process. At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher—only the physician in charge and resuscitation team were allowed inside the box. All other onlookers (mostly medical students and residents) had to stay outside the box and be silent. It did wonders for instilling a quiet, organized atmosphere into a highly charged event.

Left out of a wide range of decisions critical to care delivery

Those […]

2017-08-16T09:22:11-04:00August 16th, 2017|Nursing, nursing perspective|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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