NURS 8302 Quality and Safety in Healthcare and Nursing Practice
NURS 8302 Quality and Safety in Healthcare and Nursing Practice
Previous Experience with Quality and Safety
Quality and safety in nursing play a vital role in the care provided to patients and their outcomes. Preventable errors have caused adverse patient outcomes; however, the staff has been facing increased stress, burnout (BO), and compassion fatigue (CF) in the past few years since the COVID pandemic. The rapid spread of the COVID – 19 took the medical professionals by surprise, causing emotional and physical strain, decreased physical and mental health well-being, and decreased performance. During March 2020 and April 2020, the American Nurse Association surveyed nurses’ concerns and experiences, and there was a concern of 74% lack of proper personal equipment, 64% were concerned about family and friends, and around 85% expressed actual fear of going to the workplace (Judith et al., 2020). As an emergency room nurse in a level two trauma center, we recently found ourselves with an increase in staffing shortage due to illness, lack of support/resources, increased CF, BO, and the COVID Mandate.
Unfortunately, the lack of staffing has impacted the quality of care provided to the patients and imposed a safety issue for the patients. With staff shortages, the risk of adverse events occurring is high. Unfortunately, healthcare safety remains an issue despite the patient safety movements for the past years (Barkell & Snyder, 2021). There have been several preventable medication errors, one which clearly should have been prevented. Nurses did not pay adequate attention to drug and administration orders because they were distracted by the effects of the staffing shortage, lack of pay, and exhaustion. One of the staff gave the wrong patient the medication intended for another patient. Fortunately, a non-lethal dose was given, and no adverse events occurred; however, this could have been a much different outcome. The nurse felt horrible about the medication error and is aware of the potential poor outcome. Still, unfortunately, as she says, she is burning the candle at both ends (M. Levy, personal communication, November 25, 2021). Common errors occur, policies and procedures to prevent these events are essential to be established.
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Role as A DNP-Prepared Nurses
As a well-prepared graduate of a DNP-FNP program, as mentioned in the Walden Handbook (2017), my advanced education can improve the community, professional, and personal life outcomes. Increased knowledge, problem-solving skills, effective communication, and leadership focus on older policies and procedures, updating current healthcare directives and needs while keeping up with the continuous healthcare changes. I can impact the stakeholders within and outside the community, establishing methods and processes to improve patient care and cultural diversity while maintaining respect, integrity, compassion, understanding, and professionalism towards all stakeholders. Giardino & Hickey (2020) mentioned that the advanced education and structure would provide the tools needed to provide positive changes and outcomes. With the tools learned, one can make positive changes in healthcare, improving patient outcomes and staff satisfaction.
Barkell, N. P., & Snyder, S. S. (2021). Just culture in healthcare: An integrative review. Nurs Forum, 56(1), 103-111. https://doi.org/10.1111/nuf.12525
Giardino, E. R., & Hickey, J. V. (2020). Doctor of nursing practice students’
perceptions of professional change through the DNP program. Journal of
Professional Nursing, 36(6), 595–603. https://doi-10.1016/j.profnurs.2020.08.012
Judith, E. A., Courtney, M. G., Bengt, B. A., & Eamonn, A. (2020). Nurse reports of stressful situations during the COVID-19 pandemic: Qualitative analysis of survey responses. International Journal of Environmental Research and Public Health, 17(8126), 8126-8126. https://doi.org/10.3390/ijerph17218126
Kohn, L.T., Corrigan, J.M, & Donaldson, M.S. (Eds). (200). To err is human: Building a safer health system. National Academies Press.
Walden University. (2017). 2016-2017 Walden University student
Experience with Quality and Safety
Quality and safety are the driving force behind delivering and promoting optimal care (Stalter & Mota, 2018). My primary role as a clinical nurse is to provide high-quality, patient-centered care using evidence-based practice. Before giving any care or medication dispensing, I include EBP into the routine. In my current role, I noticed that my colleagues rely on post-education, and I feel that approach is integrated at the wrong time, which is usually after an incident or error has occurred. I strongly believe in pre-education and promoting evidence-based practice in nursing.
I work on a 23-bed Med-Surg unit, and Friday mornings are the busiest surgical days. On this morning, a nurse administered a patient scheduled for Coronary Artery Bypass Graft (CABG) 20 units of Aspart and 15 units of Regular for a blood sugar of 206. Unfortunately, the patient had been NPO after midnight before the day of surgery. In the meantime, as we continued to make rounds and administer morning medications on the unit, the nurse received a call from the telemetry unit that the patient heart rhythm converted from normal sinus rhythm to ventricular tachycardia. The staff quickly went to the bedside and noted the patient to be diaphoretic, lethargic with a heart rate sustaining in the 130-150’s.
Immediately we had to call the rapid response team for further assistance. After the team arrived and was given a full report on the patient, the team administered IV antiarrhythmic medication to aid with the heart rate and a bolus of IV fluids for the blood pressure. Then, of course, the surgery was postponed, and the patient was transported to the ICU for closer observation. At shift change, the nurses had to report on what happened and how the patient received such a high insulin dose. Any high-alert medications must have two verifiers; only one nurse verified and administered the drug, which led to the error above. After further investigation, it was a computer error because it did not prompt the alert box for an additional signer. In addition, the nurse who administered the medication was new to the unit. I’m not making any excuses; however, the nurse should have verified the insulin order with the charge nurse or the ordering provider. Also, the ordering provider should have discontinued the order before surgery, which could have prevented the error. Therefore, thorough education and the implementation of evidence-based practice are imperative in nursing.
Role as a DNP-Prepared Nurse
As a DNP-Prepared nurse, I intend to integrate evidence-based practice by developing our organizational culture that supports best practice and promotes opportunities for staff to enhance their clinical skills and knowledge. With the healthcare system being so complex, as a DNP-prepared nurse, promoting a healthy work environment is an effective solution to promoting quality improvement and being proactive in preventing errors or glitches before they occur (Abdul, Jarrar & Don, 2015). In addition, I would advocate for the implementation of evidence-based practice throughout the nursing unit and organization by educating nurses on skills, such as critical appraisal and translation of research findings into practice (Tu & Wang, 2011). Furthermore, in my role as a DNP-prepared nurse, I can use error prevention strategies by continuously monitoring outcomes and completing root cause analysis when errors occur, including the input from clinical staff and the leadership team.
Abdul, R.H., Jarrar, M., & Don, M.S. (2015). Nurse level of education, quality of care and
patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-
sectional study. Global Journal of Health Sciences.7(6):331-337. doi: 10.5539/gjhs.v7n6p33.
Stalter, A., & Mota, A. (2018). Using systems thinking to envision quality and safety
in healthcare, Nursing Management. Volume 49(2): doi:
Tu, Y.C., & Wang, R.H. (2011). High-quality nursing health care environment: The patient safety perspective. Hu Li Za Zhi 58(3): 93-8. https://pubmed.ncbi.nlm.nih.gov/21678259