Lessons about patient safety from Jean Reeder - Patient Safety First

AORN Journal, August, 2002 by Suzanne C. Beyea, Aileen R. Killen, Jackie L. Berlandi

Jean M. Reeder, RN, PhD, FAAN, was an AORN past President. Her contributions to the nursing profession and AORN were many. She was a nurse researcher, author, lecturer, educator, mentor, and nationally recognized authority on perioperative nursing and patient safety. Jean taught her colleagues many lessons about patient safety and the ethical dilemmas in nursing practice. She wrote and talked about patient safety long before it became a buzzword, and she was one of the first to thoughtfully consider how health care professionals cope with making a medical error. Jean's work has and will continue to direct AORN on the path to ensuring that surgical patients receive safe, competent, ethical care.

BEGINNINGS

Jean's lessons to nurses about patient safety spanned her entire career. Many recognized her as a patient advocate in her various roles during her distinguished military and professional career. Her earliest published articles focus on helping patients achieve their highest level of independence and a variety of ethical issues in nursing practice. (1) She was one of the first to write about the specific nature of the types of dilemmas perioperative nurses face on a regular basis. Areas of concern that Jean addressed include informed consent and truth-telling; allocation of resources; the care of patients who are HIV positive; advocacy for intraoperative patients; infection control; and balancing multiple, competing clinical demands. (2)

Jean's concern for the protection of human rights and her writings from the late 1980s and early 1990s reflect her strong commitment to ensuring patient safety. In 1989, she wrote,

   Perioperative nurses must be permitted to establish safe levels of patient
   care in terms of nursing capabilities and institutional staffing
   limitations. They must be able to withstand outside pressure to compromise
   the quality of care given to patients in surgery in order to get the job
   done. (3)

She was among the first to recognize the importance of maintaining patient safety in a high-risk environment while placing the patient's preferences and desires first. Her dedication to this premise later led to the formation of AORN's Special Committee on Ethics. (4)

AN AORN LEADER

Jean's focus on patient safety became even more apparent during her AORN presidency. Her monthly "President's Message" columns are evidence of her belief that nurses should be involved in health care improvement activities. She was instrumental in moving forward AORN's goal to "participate in effectiveness and outcome of health care initiatives." (5) During her leadership years at AORN, Jean supported activities that helped develop a blueprint for action related to effectiveness initiatives. This blueprint continues to serve AORN. Her support of these types of activities led to the work that evolved into what now is known as the Perioperative Nursing Data Set. These efforts and others promote the understanding of the relationship between nursing contributions and patient outcomes in perioperative settings.

In 1992, just before AORN's annual Congress, Jean wrote,

   When will it change? Images that people have about individuals involved
   with health care in our country--nurses, physicians, administrators, health
   care regulators, insurers, attorneys, and anyone else remotely connected
   with "the system"--continue to be dismal. (6)

Those of us who knew her recognize the writing in this "President's Message" as Jean's distressed reaction to the information presented in The Great White Lie: How America's Hospitals Betray our Trust and Endanger our Lives. (7) How anguishing this book must have been to an individual so committed to protecting patients. In this message, she also wrote about the terrible tragedies related to medication errors, equipment malfunctions, overworked nurses, incompetent surgeons, and poorly trained staff members. Rereading this "President's Message" 10 years later, one is forced to question whether anything has changed in our health care system.

Jean's reaction to this book must have precipitated her renewed commitment to patient safety and her work in subsequent years. She wrote,

   I believe that fidelity, the commitment, begins with each of us. Attaining
   and maintaining competence is one of the primary responsibilities that we
   have as professional nurses. (8)

She continued to explain.

   It means having the courage to say that they [nurses in clinical settings]
   have not used a particular piece of equipment before and need some
   instruction before they can competently participate in the procedure.
   Nurses protect patients from harm and injury by following recommended
   practices and reporting unsafe occurrences. (9)

A SENTINEL EVENT

Jean's career after leaving the military led her to a position as chief of nursing. In this role, she advocated for ethical nursing practice. She also served as an active member of numerous nursing organizations and as a consultant. During this time, she made presentations to groups such as the American College of Surgeons' committee on operating room environment and the World Congress of Operating Room Nursing. Jean was one of those unique professionals who could not only "talk the talk" but "walk the walk" in every aspect of her professional career.