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Recent rapid responses
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Displaying 1-4 out of 4 published
12 November 2012
We were pleased to see the issue of nurse leadership emphasised in the editorial on nurse leadership and patient safety (BMJ 2012;345:e4589).
Leadership and professionalism are essential to improve patient safety. However, there was no reference to team working and the role of other professionals in ensuring patient safety through distributed leadership, in particular nurses working with consultants on the ward.
There is currently a lack of communication between ward nurses and consultants on the wards – in a recent survey by the RCN and RCP, it was reported that consultants and nurses failed to both be present on 70% of wards rounds . The clinical review of patients is therefore inherently disjointed and ineffectively coordinated. This situation must change. Medical staff and nursing staff must both take ownership of the holistic safe care of patients. Our recent publication on ward rounds gave examples of and guidance on good practice where communication has been enhanced  .
Some teams have introduced safety checklists on ward rounds to ensure that issues of hydration, pressure areas, falls and continence amongst others are regularly reviewed, whilst empowering active nurse participation and leadership in the ward round setting. The Royal College of Physicians has also called for a named consultant to be designated to work with the ward manager to keep patient safety and the holistic care of patients under review.
It is only by working better together, beyond the traditional professional barriers, that we can ensure patients receive high quality joined-up care.
 Royal College of Physicians, Royal College of Nursing. Survey of nurse participation on ward rounds. London: RCP, 2011.
 Royal College of Physicians, Royal College of Nursing. Ward rounds in medicine: principles for best practice. London:
 Editorial. Ward rounds: what goes around comes around. The Lancet 2012 380: p1281.
Competing interests: Both authors were lead authors on a recent report from the RCP and RCN entitled 'Ward rounds in medicine: principles for best practice'.
Royal College of Physicians, 11 St Andrews Place, Regent's Park, NW1 4LE
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27 August 2012
Nurses can serve as agents of change in the drive towards better working practice. A model for change to evidence-based practice, systemically asks a clinical question, searches the relevant literature, critically evaluates the evidence, and applies the results to the practice setting was described (Rosswurm & Larrabee, 1999). Many times communication appears to be a simple concept within health care. A lack of quality communication limits the quality of service that can be provided to the patient. Some of these issues are rooted within health care system design, while others are the result of inappropriate services provided to patients (Wanzer, Booth-Butterfiled, & Gruber, 2004; Strawderman & Koubek, 2006). Communication limitations often make the patients’ visits frustrating and unpleasant but since the products of health care systems are services, measuring health care quality must extend beyond clinical measures to also incorporate patient perceptions and experiences (Wanzer, Booth-Butterfiled, & Gruber, 2004; Strawderman & Koubek, 2006).
Patient safety is dependent on practicing nurses, nurse educators, leaders, researchers, and other healthcare professionals to contributions to the health of patients, nursing education and practice, by discovering and evaluating new strategies for improving healthcare quality for patients and communities can find great value in the new insights and innovations. Knowledge of how to develop, implements, and continuously improve patient safety is currently limited and not accessible to most health care organizations. Health care organizational strategies for electronic health records safety which either affects patient safety directly or indirectly are; care-process transformation (thoroughgoing redesign of health care processes to achieve significant improvements in clinical outcomes, service levels, and costs), patient safety (consistent, organization-wide efforts to improve care quality and patient outcomes), human-factors engineering (fitting technologies to organizational, team, and individual needs), project management (the application of explicit management practices to a project to maximize benefits and minimize costs, including risks) software safety (the application of systems engineering methods to reducing the risks associated with software design and use), continuous improvement (unceasing, systematic efforts to improve processes and outcomes (Brown et al., 2007; Carayon, 2007; Ebright, 2010; Kohn et al., 1999; Walker, 2005). Leadership models can offer increasing knowledge for stability that may be ideal for health organizations to focus control and management of resources, manpower and assets, efficiently. However, a hierarchical form of leadership is not congruent with our current knowledge era marked by the need to build intellectual capital and facilitate knowledge flows, adaptability and learning.
Nurses who understand the emerging science of complexity will be better prepared to creatively face these issues and improve health in broad and lasting new ways for improved safe patient care, from the start of nursing education programs providing advanced leadership theory content in academic curricula or respective organizational/system leader development programs, and then applying these areas learnt to practice. A survey revealed that healthcare leaders intuitively support principles of complexity science, because, leaders that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes (Burns, 2001). Leadership functions will be need to thrive in complexity, the challenge facing organizations by identifying new ideas, interacting with others to generate novel solutions, and building relationships and networks. Policy-making initiatives will be vital for these successes, and for providing seamless, affordable, quality care that is accessible to all, with improved health outcomes. The impacts and organizational/ national changes that can occur from policy creation can become extremely beneficial for the healthcare population. As leaders, nurses can work with all groups, agencies, organizations and communities to foster and develop the transformation that is necessary for the 21st century.
Brown, M., Grimm, N. & Shaw, N. (2007). The relationship between electronic health records and patient safety: a joint report on future directions for Canada Toronto, ON: Canada Health Info way; 1-31.
Burns, J. (2001). Complexity Science and Leadership in Healthcare. Journal of Nursing Administration, 31(10), 474-482.
Carayon, P., Kosseff, A., Borgsdorf, A., & Jacobsen, K. (2007). Collaborative initiatives for patient safety In: Carayon P, editor. Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. Hillsdale, NJ: Lawrence Erlbaum.
Ebright, P. (2010). "The Complex Work of RNs: Implications for Healthy Work Environments" OJIN: The Online Journal of Issues in Nursing, 15 (1), 4. DOI: 10.3912/OJIN.Vol15No01Man04
Kohn L, Corrigan J, & Donaldson M. (1999). To Err Is Human: Building a Safer Health, System Washington, DC: National Academy Press; 1999.
Rosswurm, M.A. & Larrabee, J.H. (1999). A model for change to evidence-based practice. Image, The Journal of Nursing Scholarship, 31(4), 317-322.
Strawderman L, & Koubek R. (2006). “Quality and Usability in a Student Health Clinic”. International Journal of Health Care Quality Assurance. 19, 225-236
Walker, J. M., Richards, F. & Bieber, E. (2005). Implementing an Electronic Health Record System. New York: Springer.
Wanzer, M. B., Booth-Butterfiled, M., & Gruber, K. (2004). “Perceptions of Health Care Providers’ Communication: Relationships between Patient-Centered Communication and Satisfaction”. Health Communication, 16(3), 363-384.
Competing interests: None declared
Northern Caribbean University, Mandevile, Manchester, Jamaica W.I.
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14 August 2012
Let’s also not forget the valuable role nurses play in managing and teaching medical and nursing students. As a medical student myself, I have found nurses to be an incredible resource. For example, when unable to locate a doctor to help or advice, or when given a task by a doctor you have no idea how to fulfil!
Nurses based on a ward often have a more specialised knowledge of in particular patients. They are highly skilled in the tasks junior doctors need to be able to do, some may argue more so than teaching consultants. The majority are also very approachable, and can sometimes explain things in a more absorbable format than may be offered by a doctor.
With nurses roles increasing, and more demands on their time becoming ever apparent, then something has to give, and this unfortunately appears to be the need for nurses to work longer hours, or for a higher proportion of ‘nursing assistants’ to be employed.
Whilst ‘nursing assistants’ provide an important role, the reason nurses are in such high demand is because of the way they have been trained to manage, appease, teach and more importantly care for patients. It is therefore of upmost importance we do not lose these crucial nursing qualities.
Competing interests: None declared
Cardiff University, c/o 5th floor, Cochrane building, UHW, Cardiff
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10 August 2012
Research in the US and UK shows that higher ratios of Registered Nurses (RNs) to patients is crucial in improving patient outcomes. These ratios have been reduced severely in recent years, increasing numbers of untrained 'healthcare assistants' (HCAs)being used as substitutes for registered nurses. This also means that RN numbers are inadequate for proper supervision of HCAs.
The increasing trend towards 12-hour shifts for nursing staff has also been shown in research to be detrimental to standards of care.
Leadership is important, but it is not the only consideration in relation to patient outcomes.
Competing interests: None declared
none, The Heath Lodge, BS9 1PY
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