Jennifer Mensik, RN
When I speak about nurse staffing issues at conferences, one question consistently comes up. Nurses ask, “If I am not scheduled to work, and work calls, what responsibility do I have to come in?” While there is no legal requirement in this situation, it does present a moral dilemma. Nurses want to help their colleagues, and know that better staffing equals better patient outcomes. Yet, nurses also need to balance their personal lives and family needs. This dilemma can lead to nurses experiencing moral distress.
Several studies, including one published in 2002 by Linda Aiken, PhD, RN, FAAN, FRCN, and another published in 2007 by Robert L. Kane, MD and colleagues, have demonstrated that better staffing does improve patient care. Research also shows that fatigue can impact patient outcomes. For instance, one study by Marianne E. Weiss, DNSC, RN, and colleagues noted that in units with higher RN nonovertime staffing, the odds of patient readmission were lower compared with units that included RNs working overtime. RN overtime was positively associated with post-discharge utilization, which means when RN overtime staffing was higher, the odds of ED use also were higher, resulting in 1.7 times higher odds of an ED visit.
What is the answer to this dilemma? While working on my private pilot’s license, I have learned many useful mnemonics. One example is the IMSAFE checklist. As noted in the Federal Aviation Regulations Aeronautical Information Manual, Chapter 8-1-1, commercial and private pilots should use a checklist to assess their ability to fly safely. To prevent human injury or loss of life, the Federal Aviation Administration expects pilots to identify, assess and satisfactorily mitigate risk through a safety-risk management process, which includes using checklists.
The IMSAFE checklist is very easy to apply as an objective measure of your ability to work an additional shift if you’re asked.
I — Illness — Are you suffering from any illness or symptom of an illness that might affect ability/performance?
M — Medication — Are you currently taking any prescription or over-the-counter drugs?
S — Stress — Are you overly worried about other factors in your life? Psychological, environmental and physiological stress can be a powerful distraction and affect ability.
A — Alcohol — Legal limits vary. State boards of nursing have position statements on this subject.
F — Fatigue — Have you had sufficient sleep and adequate nutrition?
E — Emotion — Have you fully recovered from any extremely upsetting events?
While nurses are not flying a plane, we are taking care of lives. As such, we can routinely look to the safety record of aviation and ask what we can apply to make healthcare safer. There is no single answer for the question, “Should I go into work on a day off?” However, understanding the research, noting valuable risk management lessons from aviation, and performing a self-assessment can help you decide.
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Ever other profession that is responsible for the safety of others including aviation, architects, construction teams… They all use checklists. but medicine is too complicated and sophisticated to be bothered with checklists. And what do we have to show for it? Being admitted to the hospital is public hazard #8 and the 3rd leading cause of death in the US behind cancer and heart disease. 250,000 patients a year die because we can’t communicate properly, we don’t seem to believe in infection control measures and we are too important to be tied to a silly checklist.
250k people is like 2 jumbo jets crashing every single day. Would you fly if you knew 2 planes a day would crash and kill everyone on board? Where is the outrage over safety in the hospital?
The aviation industry turned itself around with a simple checklist. buildings don’t fall down because of checklists. Imagine what a simple checklist could do for 250k patients who don’t have to die this year.
I teach nurses about the care of central lines and I absolutely stress using a checklist when changing andressing in order to avoid missing any crucial steps and risk contamination through improper handling of the line.
I show a little clip of a video that’s talks about airline safety checklists and how if they can take the time to pull out a checklist when a plane is crashing then we can most certainly take time to do so while changing a dressing.
I know that’s just one aspect of what a nurse does on a daily basis but we really need to start somewhere by getting nurses more education. We literally have someone’s life in our hands and every single day there a a thousand things we could be more mindful of.
We need a culture change out in the medical field period. Any death we can prevent is a start!
A great idea that fails in practice because other variables, such as keeping food on the table, take precedence. I have to work two jobs, and sometimes I know it is dangerous, but I have no choice. If they can’t pay me a living wage, then there is no choice. Besides, how do you abandon your coworkers when the ship is sinking? Each other is all we have.
What a great ‘self assessment’ tool. I feel that what would make this most beneficial, is that, although it is ‘subjective’ it provides ‘objective’ evidence for the nurse who is being asked to come in to work on his/her scheduled time off. Last I knew, unless you are “on call”, no one has to go in to work on their day off. Unfortunately, a lot of nurses feel ‘obligated’ to go in in order to help their fellow colleagues. That isn’t necessarily the best action. Perhaps having a checklist like this one would help the nurse who has difficulty saying no, to understand and appreciate the need that he/she must say “no”. It’s all about safety. Health and safety, for all.