If We Know How to Prevent Falls, Why Are Our Patients Still Falling?

Falls: at least ‘theoretically preventable.’

Sometimes it can feel as though managing fall risk takes up a big part of the day. You do your regular risk assessments, put safety measures into place, and still—patients fall.

Considering the frailty of some patients, the many meds that contribute to falls, and the fact that even mild cognitive impairment can be made worse by a hospitalization, it’s a tribute to good nursing care that there aren’t more falls.

But because falls sometimes cause serious injury and are, at least theoretically, preventable, it always feels like we’ve failed when a patient ends up on the floor.

A checklist for high-risk patients.

Nurses at one hospital decided that they needed a new way to approach fall safety. In “Using a Fall Prevention Checklist to Reduce Hospital Falls,” authors Madeline Johnston and Morris Magnan describe their use of a 14-item change-of-shift checklist based on the hospital’s existing fall prevention protocol. For a patient known to be at high risk for falls, oncoming staff went through the checklist to be sure that all prevention interventions were in place before taking responsibility for the patient. […]

2019-03-01T11:40:56-05:00March 1st, 2019|Nursing, patient safety|2 Comments
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Protocol to Reduce Hospital-Acquired Pneumonia Improves Outcomes, Lowers Costs

Costs. Length of stay. Patient mortality. We know that the care we provide is central to good outcomes of every kind. But how often do we get to clearly demonstrate this for hospital administration? In “A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia” (free until March 1) in this month’s issue, authors Chastity Warren and colleagues describe a QI project that showcased how a simple nursing intervention decreased morbidity, mortality, and costs at their hospital.

A standardized oral care protocol.

Aware of the connection between poor oral care and hospital-acquired pneumonia, a group of nurses at their large Midwest hospital set out to devise a standardized oral care protocol for all adult patients. Patients were categorized as either ventilated, at-risk (for example, someone with a trach or with swallowing difficulties), or short-term care. The care kit and the frequency of oral care were different for each group.

Once the intervention was in place, the nurses tracked not only the incidence of hospital-acquired pneumonia in both ventilated and non-ventilated patients, but also (by creatively “triangulating” several sources of data) the adherence of staff on each unit to the protocols.

Protocol adherence.

Regarding protocol adherence—always a challenge with new protocols when multiple units and staff are involved—the authors noted that there’s still work to be […]

2019-02-06T09:10:07-05:00February 6th, 2019|Nursing, nursing research|0 Comments
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What’s a Preceptor’s Duty When a New Nurse Doesn’t Fit the Unit?

Challenges and joys.

square peg, round hole

Precepting new graduate nurses is challenging but also exhilarating. To guide a new nurse to a point of safe, confident, independent patient care requires a different level of critical thinking and relational skills. How do I delegate tasks and responsibility to my preceptee safely? How do I teach in a way that connects well with my preceptee’s learning style? How do I reassure the patient and family that they are safe in the care of these new hands under my watch?

Despite the challenges, it is inspiring to play an integral role in someone’s growth. I experience pride and joy watching my preceptees evolve from nervous trainees to skilled and compassionate novice nurses.

While I am always seeking to build up the new graduate nurse I’m precepting, the ultimate goal is always patient safety. There are rare times when new nurses have not not found the ‘right fit’ in our unit. We are a pediatric ICU unit in a level one trauma hospital. We care for very sick patients, are very fast-paced, and rarely have lulls in our census.

When a preceptee struggles.

I recently had a preceptee who struggled with the basics in caring for even our most stable patients. At […]

2019-01-09T12:17:49-05:00January 9th, 2019|Nursing|4 Comments
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Distracted Nursing: On Personal Cell Phone Use at Work

A new societal norm.

Kathleen Bartholomew

Most of us have seen the cars on the highway that suddenly slow down in the passing lane, blocking other cars while weaving dangerously across the dividing lines between lanes. We know the signs of distracted driving well enough by now. It resembles drunk driving. Or we’ve had to dodge the people staring down at their cell phones as they blindly approach us on the sidewalk.

Divided attention in the nursing workplace.

The examples of distraction because of cell phone use are endless; in fact, especially in certain places and age groups, this form of preoccupation has become the norm. The behavior carries over into many workplaces, and nursing is not exempt. The following excerpt is from this month’s Viewpoint essay by nurse educator and consultant Kathleen Bartholomew, “Not So Smart: Cell Phone Use Hurts Our Patients and Profession.”

It is 6:45 in the morning, and as I pass a patient in the ED, I see a nursing assistant watching a movie on her phone. She is supposed to be monitoring the 1:1 suicide risk, yet she appears so intrigued with the movie that I wonder if the patient is safe—or perhaps wants to talk.

Earlier that same day, a nurse tells me a story of calling the […]

2018-06-19T11:40:33-04:00June 19th, 2018|Nursing|7 Comments
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As a Long-Predicted Nursing Shortage Gets Real, Staffing and Retention Issues Get Urgent

Is the nursing shortage finally here?

In her June issue editorial, AJN editor-in-chief Shawn Kennedy notes that in her recent visit to the annual National Student Nurses’ Association (NSNA) conference, many of the senior students she spoke with already had jobs lined up.

She surveys some recent indicators pointing to the possible arrival at last of a long-predicted nursing shortage, and some of the possible implications this is having or may have in the coming years for patient care and the health of organizations. For example:

“A survey of 233 chief nursing officers conducted last July conducted last July by national staffing company AMN Healthcare found that 72% said their shortages were moderate to severe, and most expected shortages to worsen over the next five years. They also acknowledged that the shortage was having a negative effect on patient care, patient satisfaction, and staff morale.”

Bonuses for new hires.

She notes that, with hospitals in some regions paying signing bonuses to new nurses, the question of staff retention and development remains the elephant in the room.

The class of 2018, it seems, is entering a job seeker’s market. . . . Organizations that can invest in new nurses with programs that provide support and training will have a leg up in recruitment. But retaining […]

2018-06-04T12:21:33-04:00June 4th, 2018|Nursing|2 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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