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Nurse Empowerment On the CUSP: Stop BSI
Story of cardiac surgeon not doing doing check list.
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Learning Objectives To understand the importance of nurse empowerment
To consider the regulatory and accreditation mandates for nursing leadership To learn strategies to help empower nurses
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CUSP/CLABSI: What We Know
Change involves technical challenges Evidence Measurement Analysis Change involves adaptive challenges How to engage nurses, physicians, executives Competing priorities Organization hierarchies How to hardwire practice changes Gettysburg strategic operational and tactical Union had strategy and commanders intent. (review)
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Improve Patient Safety Culture: Create Trust
Caring Keep patients as your North Star Commit that preventable harm is not tenable Tell your own Josie Story Competent Learn from mistakes Implement teamwork tools (CUSP)
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Ensure Patients Reliably
Receive Evidence Senior Team Staff leaders Engage How does this make the world a better place? Educate What do we need to do? Execute What keeps me from doing it? How can we do it with my resources and culture? Evaluate How do we know we improved safety? This is the model we used for learning change. It recognizes the technical (science) part and the adaptive (emotional attitudes part. Engaging people is adaptive work done locally by telling stories and showing current evidence of harm Educate is technical. What is the evidence Execute is adaptive and local. Given my resources, how do I ensure all patients reliably receive the evidence Evaluate is technical. We have to measure in a scientifically sound way Pronovost: Health Services Research 2006
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Nurse Empowerment Keep Patient as North Star – Harm is not tenable
Decision to speak up Must feel competent Must feel it is safe Must feel it will work Transparency when harm occurs At patient level At provider level At organization level
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Strategies for Nurse Empowerment
Policy Level Code of conduct Require nurses to assist with central line placement Make certain supportive structures are in place Require adherence to insertion checklist Policy to deal with disruptive behavior Require that bedside nurse attend rounds Managers need to support best practice; hold nurses accountable and respond to poor practice
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Strategies for Nurse Empowerment
Practice Level Licensure Nurse Practice Act Magnet Nursing Collaborative Practice Models Infection Preventionists Attending Physicians
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Strategies for Nurse Empowerment
Performance Level Orientation/Skill Building Annual Competency Assessment Clinical ladder – leadership recognition
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Strategies for Nurse Empowerment
Use tools to practice nurse empowerment in safe space Nurses participate in staff safety assessment Nurses participate in HSOPS (culture survey) Daily Goals with nurse read back Learn from Defects Participate in M&M Address disruptive behavior quickly
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Strategies for Nurse Empowerment
In conflict, keep focus on patient as North Star Remind staff that teams make wise decisions with diverse and independent input Do not play person down
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Action Plan Project leaders meet with CUSP/CLABSI team
Discuss what policies can be put in place to enhance nurse empowerment Create strategy to involve beside nurses in this project: use the 4Es Discuss what tools you can use to enhance nurse empowerment
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