Guilty by omission?

If you haven't already picked up a theme among my blog entries, you soon will. I want us (every nurse possible) to work together. Now, when I say "work together" I am speaking in terms far beyond a shift or two...I mean really pull together as a profession and become a unified voice. There is no reason we cannot nor should not do this. Work in a rural area? A small clinic? A large university medical center? It doesn't matter. Neither our employer, our specific job description, nor or geographic location defines or limits our ability to interact with one another. Ever attend a national conference? If not, you should...at least once in your career...it is a wonderful opportunity.

Anyway, back to the topic of "omission". You can be guilty of not doing something just as easy as doing something. You can not give a medication or not perform an important procedure or intervention just as easily as you could actually do them. Being negligent due to omission can be a very important concept to consider in your practice. Do you pull up the blood administration policy every time you administer blood products? Sure, you may have administered it hundreds of times...but it only takes one incident to create a catastrophe. Don't get to comfortable in your routine...don't incorporate too many "workarounds", or shortcuts. There may be a time and place for them in some of your tasks, but when it comes to patient care and adhering to the 5 patient rights, there are no workarounds. You are busy...you have 10 things going on at once...you have 2 phone calls, 3 call lights, and a patient who wants to leave NOW. I get that. But the five minutes you save may be the most crucial five minutes of your shift...and you can't get those minutes back. Forget to raise a patient's head after restarting tube feeding because you are "busy"...the patient aspirates and quickly progresses into respiratory failure....then cardiac arrest...now you have a much larger problem on your hands. Maybe I am looking at this as "worst case scenario". Maybe. This is just an example, and this can happen to any one of us...and maybe something similar has. We have all been in similar situations...and if you haven't, more chances are you will at some point in your career. You can't get those minutes...those seconds...back. Just be careful.

Well, now that I have scared several of you from ever returning to work, let’s move on to another issue of "omission"....

Once again, lets "Google Earth" this topic out quite a bit, and gain a much broader view. In the recent issue of AACN Bold Voices (3(5), p. 22), AACN president Kristine Peterson speaks about our responsibility to seek out one another, use our available resources, and communicate with our policy makers (local and national), in order to ensure nursing's voice is heard at the table. Her article, "Will we let someone else answer?", is a great example of taking the initiative to pull our ranks together and do something. There is a wonderful quote by Goethe in this issue:

    

 Knowing is not enough; we must apply. Willing is not enough; we must do.

True. Very true. And this is what I mean by "guilty of omission": allowing policy to shape our practice instead of the other way around. We need to guide how policy is made. We need to be there when non-nurses and non-health-care-providers are at the table deciding what we can do, where we can do it, how we can do it, or even if we can do it. In the latest report from the Institute of Medicine, "The future of nursing: leading change, advancing health", released this past October, the IOM had four very direct recommendations:

• Nurses should practice to the full extent of their education, training, and licensure.
• Nurses should achieve higher levels of education and training. (Academic and other lifelong learning activities)
• Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the US.
• Effective healthcare workforce planning and policy making require better data collection and an improved information infrastructure, particularly as it relates to nursing's contribution to care.

These were restated from Peterson's article, and I would strongly encourage you to take a look at this report for yourself. (If you don't feel like reading hundreds of pages, you can read the Executive Summary, which provides a nice overview. The IOM speaks to the nation, saying, "let nurses do what they are trained to do...help them achieve higher standards of excellence in their training...hear their voices...let them be involved in health care decisions"...in my opinion, anyway. But the IOM is saying this to nurses as well. We need to be proactive in our approach to policy and procedure formation. We need to make sure we are present at the table when these decisions are made...we cannot afford to let someone else dictate our practice. We have an incredibly rich and diverse body of knowledge within our profession. We have nursing scientists that work very hard to encourage improvements and innovations. It would be a shame if we did nothing, and let it all go to waste. It would be a shame if we were guilty of omission.

Take pride in what you are. Take responsibility for your practice, and for those who follow in your footsteps. Leave it better than you found it. Nurses are not generally a quite bunch, so I think this should not be as difficult as it sounds. The only barriers we have are those we place on ourselves.

Thank you.

Steve