Advanced Nursing Practice Patient Safety Concern, Essay Example

Nursing education focuses on a mixture of content knowledge learning and hands-on practice at a variety of degree levels. However, it is necessary for new nurses to demonstrate their application of this knowledge prior to beginning their career in the field. All nurses are required to gain a broad knowledge of different nursing specialties in order to provide multifaceted patient support. However, this broad focus often indicates that many new nurses did not receive thorough training in each field. Therefore, it would be beneficial to incorporate additional internships or residencies into nursing programs to enable the development of specialized skills before new cohorts enter practice.

Studies have shown that it is beneficial to provide newly graduated nurses coming to the labor and delivery unit to have a more extensive formalized training in the operating room (Phipps et al., 2012). While many of these individuals typically acquire operating room expertise as a part of their work experience following graduation, hospitals would benefit more greatly by hiring new nurses that are already fully trained in these capacities. Since quality control and nurse staffing are issues that are frequently encountered in health care, hiring pre-trained nurses would alleviate these problems because less resources will be needed to provide these individuals with the necessary training and they will therefore be able to start in their expected roles immediately.

Traditionally, many health care organizations have attempted to resolve this problem by incorporating a larger degree of simulations in the training of new nurses (Arriaga et al., 2014). However, these simulations do not always provide nurses in training with the sensation of what working in the real life operating room is like. Thus, it would be preferable to provide labor and delivery nurses with an internship experience that will allow them to become trained in the necessary operating room skills before being allowed to work with patients independently.

Description of Selected Change Model for Quality Improvement Proposal

To provide reasonable operating room knowledge to new nursing students, it would be valuable to incorporate Lewin’s change model into their training. This model incorporates three steps that allow students and professionals to incorporate new knowledge into their practices. The first step is called “unfreezing” which provides students with the ability to incorporate new and modified nursing practices. Typically, a major hindrance to learning occurs when individuals believe that the way they implement their trade is the best and that there is no need for improvement. Many young, intelligent, and motivated individuals fall into this mindset and it is necessary to make them recognize that they still have room for growth. Therefore, new nursing students need to unfreeze to be adequately prepared to accept the new nursing practices that they will be taught during training. To ensure maximum success of this phase, it is necessary for both the trainers and trainees to recognize that there is a need for change, which will make this step of the change model a collaborative process (van den Heuvel et al., 2013). An example of this phase of the change theory would be teaching students a new surgical method that differs from one they learned during their undergraduate training. To ensure that they unfreeze, it is necessary for them to demonstrate that they are willing to use the new technique in place of or in addition to the one they were taught. This indicates that the students have become open minded with regards to learning.

The second step of Lewin’s change model is called “implementing change”. This follows the unfreezing stage and indicates that the students are ready to begin to incorporate their new knowledge into practice. This step involves the trainers providing these individuals with information pertaining to new techniques and standards. On the other end, the students will remember this information through repeated observation or study of these practices so that they are able to incorporate them into the skill set that they will regularly use when working with patients (van den Heuvel et al., 2013). An additional concern for new nurses may be that they need to effectively transition from their role as student to their role as practitioner. This is made possible by the implementing change step of this model. An example of this is that nurses could be made familiar with institutional standards and be expected to incorporate these rules into the standards that have already been established by the American Nurses Association.

The third and last step of Lewin’s change model is the “refreezing stage” in which students make the knowledge they acquired during the implementing change phase more permanent. This step of the change model must be carefully monitored by the trainers to ensure that the knowledge was incorporated in the correct manner. If this is not the case, there will be a need facilitate the entering of the unfreezing and implementing change stages once again. If the change was implemented correctly, the trainer will need to reinforce the concepts that they presented to the students to refreeze them. This will require them watching the new technique repeatedly in addition to practicing it many times as well. In some cases, this will also require a thorough understanding of when and why the technique should be used. On the student’s end, it is necessary to continue to study the information and begin implementing the technique independently when relevant. An example of this would be when a nurse that was trained using this method continues to apply this knowledge in his or her practice as an independent nurse (van den Heuvel et al., 2013).

Presentation of Selected Change Model for Quality Improvement Analysis

The final goal that is anticipate from providing new labor and delivery unit nurses with more extensive formalized training in the operating room is that this will improve the quality of patient care delivered within the institution. Typically, new graduates go to a generic peri-operation training session but spend less time than operating room specific nurse graduates completing this training. Furthermore, when these new nurses return to the unit to practice what they have learned they are uncomfortable in the operating room and unsure of the step by step processes that they should follow in this unit. As a consequence, it is hypothesized that new labor and delivery nurses would feel more comfortable and work more effectively in the operating room if they were provided with specialized training before being required to work independently.

An ideal training program would be to require labor and delivery nurses to spend a minimum of eight weeks in the main operating room shadowing an operating nurse in all her cases, not just those specific to labor and delivery. This will allow the new nurse to get a better feel of the operating room environment in both fast paced as well as slow paced cases. Furthermore, quality improvement initiatives will be able to be maintained because this practice will not jeopardize the sterility of the case and the setup. This would allow new nurses to be ready for emergencies in the operating room prior to their work as an independent nurse. The efficacy of this program could be measured by examining operating room success rates among new nurses prior to and following the implementation of the eight week long operating room shadowing program.

The professional nurses that are shadowed during the training program will facilitate the unfreezing of the new nurses by providing them with an engaging experience. They will then facilitate the implementation of change by demonstrating a variety of operating room practices over time. These will include practices that are not typically observed by a labor and delivery nurse so that they are adequately prepared for what to expect in different settings in the operating room. Last, the refreezing stage will occur when the new nurse observes repeated operations and begins to implement what was learned during these observations in his or her independent practice.

This plan would be approved by administration because it addresses patient safety concerns. Ultimately, it is expected that this plan will be accepted by the nurse executive council. Infection control and surgical site infections (SSI’s) are a major safety concern that could be prevented by educating new nurses about national and local safety standards. Furthermore, time is often a factor in successful surgical practices and the training provided to these new nurses will allow these surgeries to be completed in a timelier manner, reducing the risk of contamination of the surgical sites (Shaw et al., 2012).

While the training for this eight week long program will be requested to be covered under the nursing administration budget, the didactic portions costs are covered by the nursing administration.  Furthermore, it is expected that specific units will pay from their cost centers for the clinical portion when the new graduates are paired up with an experience nurse preceptor on their home unit. It is expected that this expense will operate as an investment and save the hospital money over time. Having well-trained and efficiently functioning nurses will allow for a greater number of patients to be seen in a smaller amount of time after these individuals have completed their supplementary education program. While the program does take eight weeks of work experience away from these individuals, the work that is done once they begin to work independently is more effective. Ultimately, the benefit of this program is worth the time and monetary investment because only eight weeks of training can result in a career’s worth of efficacy. This will also save the hospital money by reducing the likelihood of medical error, as nurses will have a comprehensive understanding of safety standards and techniques that can be used in both labor and delivery and in the operating room.

Conclusion

In conclusion, it is necessary to provide nurses labor and delivery with training that will allow them to gain a greater understanding of operating room functions. When new nurses enter the operating room setting, they often feel lost and confused which is an indicator of the lack of specialized training they received during their nursing education. However, this problem can be resolved by implementing an eight week long internship program that will allow labor and delivery nurses to shadow an experienced operating room nurse before being required to work independently. As a consequence, these nurses will have a better understanding of what is expected from them in the operating room and they will have already learned the quality and safety standards that must be met in addition to a wealth of techniques that can be used.

Students will benefit from an incorporate of Lewin’s change model into their training. While it is likely that many new nurses already learned basic operating room techniques during their broad training, they will be required to be open minded about learning new ideas in addition to how they should be applied. Furthermore, they will be required to pay close attention to the nurse they are shadowing in able to obtain new information that could then be used by them in their independently practice. Lastly, they will reinforce these new skills by watching them be performed repeatedly by professionals and then by incorporating them into their own practice.

This is an ideal training program because it supports the goals of the administration. While the initial investment for the training program will be costly, it will help the institution over the long-term in terms of providing nurse efficacy that will allow less individuals to see a greater number of patients in a shorter period of time and decreasing the rate of medical errors made. As a consequence, this will save the hospital money over time and contribute to the professional development of more confident nurses, which will boost patient satisfaction as well.

References

Arriaga AF, Gawande AA, Raemer DB, Jones DB, Smink DS, Weinstock P, Dwyer K, Lipsitz SR, Peyre S, Pawlowski JB, Muret-Wagstaff S, Gee D, Gordon JA, Cooper JB, Berry WR. (2014). Pilot Testing of a Model for Insurer-Driven, Large-Scale Multicenter Simulation Training for Operating Room Teams. Annals of Surgery, 259(3): 403-410.

Phipps MG, Lindquist DG, McConaughey E, O’Brien JA, Raker CA, Paglia MJ. (2012). Outcomes from a labor and delivery team training program with simulation component. American Journal of Obestrics & Gynecology, 206(1): 3-9.

Shaw TJ, Pernar LI, Peyre SE, Helfrick JF, Vogelgesang KR, Graydon-Baker R, Chretien Y, Brown EJ, Nicholson JC, Heit JJ, Patrick JT, Gandhi T. (2012). Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial. BMJ Qual Saf, 21:819-825.

van den Heuvela M, Demeroutib E, Bakkerc AB, Schaufelia WB. (2013). Adapting to change: The value of change information and meaning-making. Journal of Vocational Behavior, 83(1): 11-21.