Risk is a way of life that every hospital employee must encounter on a daily basis. When the goal is to improve quality of life, the stakes are enormous when outcomes are less that expected. Risk managers encounter obligated concerns for patient safety, employee safety, incident management, federal regulations, existing organizational policies, medical errors and insurance claims. With all the factors and variables that encompass the daily routines of a hospital, nurse managers can directly impact the risk team's success.
I learned long ago that many patient safety events that result in injury are mitigated in an effort to reduce the overall seriousness. I often wonder, why not just say we are sorry for the event, own up to it, look forward for opportunities of improvement and allow those grieving the event to be a part of the new change. Sounds great, right? Unfortunately the country has the expectation that nothing should ever go wrong in a hospital. I must say, I agree! Before we ever get to making this statement true, we have much work to do.
One of the greatest joys of being a nurse manager is the impact your ideas can have on multiple people. While the clinical nurse helps the patients they are assigned, the nurse manager impacts hundreds. So, how do I, the nurse manager, keep the risk team happy? To answer this, I am going to pose two different scenarios dealing with patient falls. You, the reader tell me what hospital you favor.
Scenario 1: The confused, 98 year old patient suffering from dementia is admitted to the busy medical floor. The nursing team identifies risk by performing an accurate assessment. Next, the team implements a series of interventions such as a bed alarm, yellow socks and blanket, door markers, a fall contract with the family, hourly safety rounds and leadership safety rounds. Despite all these initiatives, the patient continues to attempt to get out of bed and has a near miss fall. This is identified by the management team after an event report is created as a near miss. The decision is made to place a video monitor in the room for additional safety. The increased awareness keeps the patient safe until she is discharged to her home with around the clock nursing care.
Scenario 2: The patient does well at home until the day she trips while walking to the bathroom. She is brought to a neighboring hospital by the rescue squad and is admitted to a medical floor for evaluation. The nurse greets her, settles her into her bed, ensures the family the patient will be alright and moves on to her next function. The nurse aide caring for the patient watches as she attempts to climb out of bed. After a few repetitive times of telling the patient she cannot get out of bed, the nurse aide leaves the room. Hours later a loud thud is heard. Staff find the patient on the floor with blood seeping from her head.
These are two very different scenarios with two very different outcomes. Investing in systems, hardwired procedures, a culture of safety and management support reduces the overall risk of injury to the patient. I am often baffled when I hear from other healthcare professionals at how risk is managed. Administration must buy into evidence-based practice and forfeit the initial costs they impose in order to reduce the costs that can incur.
Risk managers must work with nursing managers to improve processes and avoid the overall mitigation process due to negative outcomes. As the family member of a loved one who fell in the hospital and broke a hip, I felt much less about sueing when systems were in place than if hospital administration chose to turn their heads on baisc interventions. Our family did not sue, we accepted the hospital’s apology, understood the processes in place and that not all falls can be prevented.
So as parting words, I say, "keep the risk team happy!" Happy endings are far more pleasant than court room drama and wishing you did something different after-the-fact. Been there, done that.
John Green, RN, MSNJohn H. Green is a Masters-prepared, registered nurse who has worked in healthcare for 20 years. He currently works as a nurse manager for a 46-bed medical unit in upstate New York.
John was born in Bennington, Vermont. He graduated from Vermont Technical College with an Associates of Science degree in Nursing. Prior to this, John attended medic training for the U.S. Army. Beginning in long term care, he worked as a supervisor for a 150-bed sub-acute facility in southern Vermont. After five years, he entered into a critical care fellowship at a level one hospital in northern Vermont.
In 2010, he obtained his Bachelors of Science in Nursing (BSN) degree. Up to this point he worked in many organizations as a clinical nurse and charge nurse. Experiences included emergency rooms, intensive care units, pediatric intensive care, surgical recovery, medical, surgical and neurology.
John entered clinical management after accepting a clinical coordinator role. For seven years, he supported the director of nursing by providing real-time leadership to four units which included evaluations, daily staffing, hiring and assistance in counseling.
He accepted a manager position in 2015 at which time he obtained his Masters in Nursing (MSN) at Kaplan University, graduating with a 4.0 grade point average. This position has opened many leadership opportunities, including the chair of the Nursing Leadership Council for the past year.
John is sought after for his expertise in the field of nursing and has presented at prestigious organizations such as the American Nurses Association (ANA) staffing conference in New Orleans where he explained throughput initiatives that reduced the admission time from the emergency room to the hospital unit.
Residing in upstate New York, John enjoys playing guitar, working on his property, spending time with his three children and growing old with his high school sweetheart.
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