Are you "just a nurse"?

Suzanne C. Beyea

In the December Patient Safety First column, I listed six patient safety goals for perioperative nurses. This month's column discusses the second goal: Don't be "just a nurse."

Perioperative nurses often serve in the role of patient advocate for patients undergoing surgery, anesthesia, or sedation. A nurse must speak for patients when they are unable to speak for themselves. Patient advocacy is one of the most important roles of a professional nurse. AORN's Perioperative Nursing Data Set I includes the nursing intervention,

   acts as a patient advocate by protecting
   the patient from incompetent,
   unethical, or illegal practice. (1(p112))

Acting in the role of patient advocate, nurses often contribute to patient safety. Many nurses can relate situations in which their advocacy for a specific patient resulted in a positive patient outcome or avoidance of a medical error. A nurse may be the one who communicates a medication allergy or the patient's wishes when the patient is unable to do so. The role of advocate may be as straightforward as sharing information unknown to other members of the health care team, or it might involve delaying surgery to ensure that a time out is conducted according to the organization's policy and that the procedure is conducted on the correct site.

In certain situations, however, a nurse may hesitate to take action. For example, recently, I overheard a nursing colleague tell a patient, "I simply can't help you with your questions, I am just the nurse." Later, she told me how frustrated she was that other members of the health care team had not addressed the patient's questions or problems. She further complained about a recent situation in which she believed that a physician colleague had not listened to her about a change that she noticed in a patient's condition. This nurse experienced a sense of powerlessness in her efforts to bring the patient's worsening condition to the physician's attention. "The doctor would not listen," she said. "Sometimes when you are the nurse, there simply is nothing you can do."

Perhaps you also can describe a situation in which a nurse in a clinical setting did not take action or speak up, believing that he or she was "just the nurse." This perspective is self-defeating for a professional nurse. Further, it may result in the nurse being unable or unwilling to intervene to protect a patient from harm. Professional nurses play a critical role in maintaining patient safety, and often nurses are in the best position to serve as a barrier between a patient and a significant adverse event. This protection can only occur when a nurse places the patient's safety first. To intervene on behalf of the patient and patient safety, however, requires that the nurse does not think of himself or herself as "just a nurse."

NURSING AUTHORITY AND RESPONSIBILITIES

In each state, nurses are granted authority to practice as RNs by the state's Nurse Practice Act. State boards of nursing ultimately exist to protect the public and ensure that nurses act in the public interest. The Nurse Practice Act explicates the roles and responsibilities of the nurse with the ultimate goal of protecting the citizens of each state from unnecessary harm.

The American Nurses Association's Code of Ethics for Nurses (2) provides an ethical analysis and decision-making framework for nursing practice. This document states that "the nurse's primary commitment is to the patient, whether an individual, family, group, or community." (2(p9)) Furthermore, professional nursing organizations provide standards of practice for nurses in specific specialty settings. One such resource is AORN's Perioperative Standards and Recommended Practices. (3) Embedded in these types of resources is a commitment to patients with the intent to ensure patient safety.

Specific responsibilities and roles are associated with each member of the health care team. As integral members of that team, nurses must clearly understand and proudly fulfill their roles. Being "just a nurse" simply is not an option for a professional nurse who is committed to high-quality patient care. Professional nurses have the legal authority to practice nursing, and that authority implies that nurses have a significant responsibility to act in the best interests of the patients in their care.

THE IMPORTANCE OF TAKING ACTION

One reason that some nurses hesitate to take action may be the belief that other members of the team have more experience or expertise. Additionally, a nurse may not believe that he or she has the assertiveness to take a position, especially when there are other members of the health care team who have an opposing view. Another factor that may prevent a nurse from speaking up is that he or she may not feel that it is safe to express an opinion in the culture of a particular clinical setting. The importance of speaking up or taking action, however, never should be underestimated.

BEING A PATIENT ADVOCATE

Recently, a nurse in the postanesthesia care unit (PACU) was caring for a patient with an inordinate amount of pain after surgery. She did not know what was wrong with the patient, but she knew that the patient's level of pain was not typical of recovery from this type of procedure. She contacted the surgeon, who prescribed more pain medication.

The nurse consulted with the charge nurse and then called the surgeon again, asking him to come and examine the patient. The surgeon stated, "I'm busy and will be there by the time the patient is transferred to the inpatient unit." The nurse firmly insisted that the surgeon come to see the patient; the surgeon came to the PACU and determined that the patient had an active intra-abdominal hemorrhage and indeed needed immediate surgery. That single act of nurse advocacy and assertion saved the patient's life. This would not have occurred if the clinical environment did not support open communication or if the nurse lacked skills of assertion and advocacy.

Learning how to be assertive is crucial to serving as a patient advocate. Each nurse needs to develop his or her skills to become an effective communicator. Leonard et al (4) suggested that health care teams should develop effective and appropriate assertion techniques through education and training. They also recommended the use of structured communication, briefings, and the SBAR technique--a technique in which clinicians clearly communicate the situation, background, assessment, and recommendation--as potential strategies to develop a culture that supports teamwork and communication.

These skills and techniques are essential to members of the health care team in their efforts to participate in effective, nonhierarchical communications. Of greatest importance is a commitment to patient care, excellence, and never being "just a nurse" when providing care. Every nurse should be proud to be a nurse, committed to patient safety and excellence in his or her role. If you have ever felt like you are "just a nurse," take action to learn more about assertion and advocacy. Remember, as a nurse, each of us plays an essential role in advocating for patients and protecting them from harm.

Editor's note: If there are additional patient safety goals that readers would like to recommend for this series, please share them with the column's author by sending an e-mail to AORN at PSFcolumn@aorn.org.

REFERENCES

(1.) Petersen C, ed. Perioperative Nursing Data Set. Rev 2nd ed. Denver, CO: AORN, Inc; 2007.

(2.) American Nurses Association. Code of Ethics for Nurses With Interpretive Statements. Washington, DC: American Nurses Association; 2001.

(3.) Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008.

(4.) Leonard MS, Graham S, Taggart B. The human factor: effective teamwork and communication in patient strategy. In: Leonard MS, Frankel A, Simmonds T, Vega KB, eds. Achieving Safe and Reliable Healthcare: Strategies and Solutions. Chicago, IL: Health Administration Press; 2004:37-64.

SUZANNE C. BEYEA

PHD, RN, FAAN

DIRECTOR OF NURSING RESEARCH

DARTMOUTN-HITCNCOCK MEDICAL CENTER

LEBANON, NH

COPYRIGHT 2008 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale, Cengage Learning