An invisible force

AORN Journal,  July, 2006  by Paula R. Graling

• E-mail
• Print
• Link

When I was in elementary school, I couldn't wait to become a member of my school's safety patrol. I stood tall in front of the assembly, took the pledge to keep my schoolmates safe, and was awarded my safety patrol belt. If you were a safety patrol, do you remember what color your patrol belt was? Was it a bright sunny yellow, or was it fluorescent orange? No matter the color, your belt was a symbol to those around you that you were there to keep them safe. The position of safety patrol earned you the respect of others, who followed your instructions or directions as needed.

Fast forward from elementary school to college.... When I graduated from nursing school, I took the modified Hippocratic Oath composed in 1893 by Lystra Gretter, RN. We all know it as the Florence Nightingale Pledge after the founder of modern nursing.

   I solemnly pledge myself before God
   and in the presence of this assembly,
   to pass my life in purity and to practice
   my profession faithfully. I will
   abstain from whatever is deleterious
   and mischievous and will not take or
   knowingly administer any harmful
   drug. I will do all in my power to
   maintain and elevate the standard of
   my profession and will hold in confidence
   all personal matters committed
   to my keeping and all family affairs
   coming to my knowledge in the practice
   of my calling. With loyalty will I
   endeavor to aid the physician in his
   work and devote myself to the welfare
   of those committed to my care. (1)

The pledge states that we will practice faithfully, uphold standards of professionalism, and do no harm to patients--in other words, we will keep patients safe. When I took this pledge, I was awarded my nursing pin--my "safety patrol belt," if you will--to signify my role as a nurse. I like to think of the RN circulator as the safety patrol of the OR, but what color belt is the nurse wearing to let others know about perioperative safety measures? When I am in scrubs, the public may not identify me as a symbol of safety, and I become part of an invisible force.

EXAMPLES OF INVISIBILITY

Two events occurred this spring that magnified for me our continued invisibility in the safety arena. On April 17, Robert Davis published an article in USA Today titled "'Wrong Site' Surgeries on the Rise." (2) In it, he states that an increasing number of health care facilities have reported wrong site, wrong side, or wrong patient surgeries. The article quotes Dennis O'Leary, MD, president of the Joint Commission on Accreditation of Healthcare Organizations, that the incidence of wrong site surgery is increasing and hospital reporting is inconsistent. A surgeon interviewed for the article says many surgeons often ignore safety protocols because they believe they could never make a stupid mistake like performing a wrong site surgery. The surgeon quoted is a supporter of standardized marking and is working on protocols for his own hospital. The article concludes with the story of a patient who underwent a wrong side ear surgery.

What is notable about the article to me is not so much what it contains as what it does not contain--a nurse's viewpoint and recognition of nurses as major players in the safety arena. Nurses are briefly mentioned in the role of calling for a time out and only then in the context that physicians may ignore the time out or may spar with the nurses because they think time outs are a waste of time.

One week after this article was published, The Today Show aired a segment called "Oops: Wrong site surgery." (3) The guests on the show were Atul Gawande, MD, MPH, one of the investigators in an Agency for Healthcare Research and Quality study that examined the rate of wrong site surgeries in 2.8 million surgeries during a 20-year period, and Doug McCoy, the gentleman with the ear tumor who underwent the wrong side surgery. A mobile interview was conducted with Dr O'Leary, and there were several segments of real time OR video, capturing the entire perioperative team.

"Ah!" I thought, "At last our chance to discuss the collaborative work on the Universal Protocol. Surely the reporter sees there are several team members in the room actively involved in caring for the patient." Again, however, there was not one comment from a nurse or any mention of the role of the nurse in the initiatives surrounding patient safety. The segment ended with a discussion about what patients must do to protect themselves when they have surgery. Katie Couric commented on how scary it must be for patients to have to take on this responsibility.

Two instances in one week? Is this coincidence? Is it that we are so anonymous in our success that patients, surgeons, and the public do not see our role in patient safety, or is it that we have not been in the right place at the right time to be seen or to have our say?

INCREASING VISIBILITY

How can we make ourselves more visible in 2006 and less anonymous to our perioperative patients? Our renewed focus on National "Time Out" Day is one such example. AORN Board members have heard during chapter visits and in Membertalk exchanges that implementation of the Universal Protocol is still problematic in some facilities. We want to continue to give you tools and resources that will help you in every area in which you practice.