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 some […]

2017-10-04T09:57:24-04:00October 4th, 2017|Nursing, nursing students, patient safety|2 Comments
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Nurse-Author Theresa Brown Reflects on Recent Book About Doctor-Patient Communication

Nurse and frequent contributor to the New York Times Theresa Brown writes a column for AJN called What I’m Reading, in which she reflects on a recent book about an aspect of health care. This month she examines What Patients Say, What Doctors Hear (Beacon Press, 2017), by physician Danielle Ofri.

The book is about communication with patients, about real listening and the kinds of listening that often substitute for it, sometimes to the real harm of patients. Brown also considers some differences between the ways physicans and nurses tend to talk to patients. Here’s a brief excerpt, but we recommend that you read the short article, which is currently free:

Can any of us, nurses or physicians, say that we always listen as well as we should, giving each patient’s story our full attention? Like physicians, nurses feel the unrelenting pressure of time constraints. Although I try very hard to listen well, I’m sure there are times when I fail. Ofri’s book reminds us that it is clinically important to listen to what our patients say. Ironically, such listening can save time in the long run. But the main reason for doing so is simple: in order to give patients the best care possible, we need to hear what they’re actually trying to tell us.

Brown’s column is not a book review; while she draws readers’ attention to books that are well worth reading, the column goes beyond this purpose, […]

2017-07-31T09:33:35-04:00July 31st, 2017|Nursing|0 Comments
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Connecting Emotional Intelligence, Team Communication, and Patient Safety

An Early-Career Nursing Memory

Photo by Barry Diomede/Albany Stock Photo.

Many years ago, fresh out of nursing school, I was in charge one night, with no other RNs on the unit. We had an “active GI bleeder” who needed hourly boluses of either ice water or iced milk through an NG tube. (Yes, the standard treatment at that time was gruesomely uncomfortable for the patient, and in later years determined to be counterproductive.) I had more than a dozen other patients to care for, but everyone got their meds and, miraculously, the bleeding man made it through the night.

When my supervisor made rounds at the end of the shift, I reported that all was well and that my critical patient had survived. Her only response: “Mrs. Todd! There is blood on your shoes!”

This senior nurse, standing there in her starched whites and impeccable shoes, didn’t recognize that I had feared I would be inadequate to the task, or even acknowledge my pride as a brand-new nurse in actually saving someone’s life. In retrospect, I can’t help wondering if her choice to focus on a superficial fact, irrelevant to the crisis, could be interpreted as an indication […]

2017-07-17T16:49:20-04:00July 17th, 2017|Nursing, patient safety|1 Comment
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Viewpoint: A Limitation of Preprocedure Checklists

I once worked at a hospital where some of the surgeons regarded safety checklists as an inconvenience. They saw them as bothersome intrusions by the nursing staff into the surgical suite. One OR nurse was even “counselled” by her supervisor (in the presence of the complaining surgeon) to avoid upsetting the doctors by using the preprocedure time-out.

How important are these tools? Are we using them well, or do we speed through them as rote exercises? Might we even expect too much of them? In AJN’s July Viewpoint, nurse Elizabeth Anne Crooks relates a frightening episode (she was the patient) that led her to think about time-outs in a different way.

Crooks was about to undergo a colonoscopy. The clinical team seemed relatively unconcerned about her bradycardia, which was a significant change from her normal heart rate. After completing the usual time-out protocol, sedation was initiated and the physician began the procedure. Suddenly, Crooks’ heart rate and blood pressure dropped precipitously.

I remember waking in distress and hearing the monitor alarming. The team was working rapidly to stabilize me with fluids and medications.

A routine procedure had suddenly become an emergency.

In reflecting upon her experience, Crooks wonders whether the preprocedure time-out may have given her clinical team a false sense of security—one that led them to downplay a clinically significant change. And yet, as we know, these time-outs focus on ensuring that the correct patient is receiving the correct procedure, and not on other safety […]

2017-06-28T09:19:40-04:00June 28th, 2017|Nursing, patient safety, Patients|3 Comments
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July Issue Highlights: Health and the Microbiome, Poststroke Depression, Need for Diverse Blood Donors, More

The July issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE Feature: Health and the Human Microbiome: A Primer for Nurses

The profound impact of the human microbiome on health makes it imperative that nurses understand the basic structures and functions of the various microbial communities. This article provides an overview of the current state of knowledge about the human microbiome—with a focus on the microbiota in the GI tract and the vagina, the two most commonly studied body sites—and discusses implications for nursing practice.

CE Feature: Early Intervention in Patients with Poststroke Depression

Nearly one-third of stroke survivors experience depression. Poststroke depression is associated with longer hospital stays, poor physical and cognitive recovery, poor quality of life, high caregiver distress, increased risk of recurrent stroke, and higher rates of morbidity and mortality. However, it often goes unrecognized and untreated. The authors of this article explain how poststroke depression often manifests, describe associated risk factors, and discuss the screening tools and therapeutic interventions nurses can use to identify and help manage depression in patients following stroke.

Clinical Feature: The Growing Need for Diverse Blood Donors

The chief nurse of the American Red Cross discusses how changing demographics […]

2017-07-27T11:21:04-04:00June 23rd, 2017|Nursing|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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