MYTH BUSTING

To clarify a few misconceptions around NPR, the panel participated in a myth-busting exercise:

MYTH: Everybody that goes to NPR gets reported to the Board.

FACT: Only nurses who have engaged in bad-faith reporting or conduct subject to mandatory reporting are required to be reported.

SOLUTION: Organizations can adjust messaging to nurses and remove all punitive language and stigma related to the process.

MYTH: Only major errors get sent to peer review.

FACT: Leaders should not wait to send their nurses to peer review if there is a pattern, trend or significant gap in practice.

SOLUTION: Nursing is a self-regulated profession, and nurses must be held accountable for their practice. Effectively tracking and trending minor incidents can alert nurse leaders to intervene before a minor incident becomes a major incident.

MYTH: Only direct-care nurses go to peer review.

FACT: All nurses regardless of role can utilize both safe harbor and incident-based NPR as long as their organization qualifies under the law.

SOLUTION: CNOs are required to ensure policies are in place and need to ensure nurses are educated about the policy and procedure for NPR.

Documentation and trending events are often perceived as punitive. The reality is, trending incidents are essential to early identification and action to offer nurses the opportunity to remediate before a minor incident becomes major. It is essential for nurses and leaders to be involved in the process. Amber Ulate, M.S.N., M.H.A., RN, NE-BC, CSSGB, emphasized that, while CNOs have a key role in the implementation of NPR, “Every nurse is responsible for their own education as part of their own accountability and their own license.” Every nurse is required to know the requirements of NPR. Nurses need to continue to seek out knowledge about this process.

Post-Pandemic NPR

Now that nursing is re-establishing a new-normal functionality post-pandemic, it is a great time for organizations to invest in revitalizing, modernizing and bringing NPR back to life, the way it was intended.

WORKPLACE VIOLENCE PREVENTION

In the 88th legislative session, nurses across Texas celebrated the monumental victory of the WPV bills that passed in the legislature with overwhelming support. Since then, organizations have invested time and resources into nurse-led strategies to prevent violence and ensure a safer workplace. While many organizations and health systems across Texas lead efforts to prevent violence, one organization describes the adoption of multiple strategies with an emphasis on prevention.

Leah Blackwell, MSN, MBA, RN, NEA-BC, FAONL, serves as Vice President and Chief Nursing Officer in a large hospital in Texas, where she supports the organization in implementing strategies to prevent and respond to workplace violence incidents. According to Blackwell, workplace violence can be physical, verbal, sexual, and/or psychological abuse, and directly impacts nurse burnout. According to OSHA, 73% of incidences of violence happen in healthcare settings. Strategies used to facilitate work around WPV prevention included, but were not limited to:

1) Creating a steering committee and launching a clinical and security subcommittee workgroup.

2) Developing a WPV Prevention plan, including policies and procedures and ensuring every staff member was aware of a zero-tolerance culture.

3) Developing a plan for scenarios for aggressive versus active shooter situations and mock drills of each so teams feel ready to respond in these critical situations.

4) Deploying media campaigns emphasizing that healthcare workers are human just like the patients served.

5) Hardwiring de-escalation training across hospitals.

6) Setting boundaries with the team by defining roles and responsibilities when patient behavior impedes care.

7) Implementing weapons detection systems to prevent individuals from entering the hospital with weapons.

These strategies are only a few among many available options for organizations to use in the prevention of and response to WPV incidents. For further reference, The Texas Nurses Association, in collaboration with the Texas Hospital Association, developed a toolkit for hospitals to use on their journey to compliance and to a culture of workplace safety for all.

THE TEXAS NURSE STAFFING STATUTE

The Texas Nurse Staffing Statute was first enacted in 2009, yet many nurses lack understanding of what the statue includes and how it positively impacts nursing practice. Since the COVID-19 pandemic, organizations are re-strategizing to ensure all required laws, rules, and regulations are being implemented in their facilities. While many organizations are tackling the statute in a variety of ways, some individual nurses are stepping up in their workplace to lead the effort in forming nurse staffing committees.

Dollye Martinez, RN, CMSRN, was recently appointed to serve as the chair of the Nurse Staffing Advisory Council (NSAC) in her hospital and was immediately challenged when revamping a safe transfer policy from the Emergency Department (ED) to the Medical Surgical division. It was clear there was a lack of engagement to get nurses to recognize the importance of their participation.

As required by the staffing statute, the staffing committee is required to present a staffing plan and data to the hospital board of directors. In describing her experience, Dollye stated that her facility has seen “improvements in the hospital with three different nurse quality indicators: falls, hospital acquired pressure injuries, and nurse responsiveness.” To accomplish the improvements, Dollye credits having subcommittees on the staffing committee who focus on individual metrics and reporting. One practice the organization committed to was ensuring each subcommittee collected data and reported back each month to the full committee, making any necessary changes to the staffing plan in real time. Dollye highlights several recommendations which served as the best practice in her organization:

1) Communicate in real time through transparent and assertive communication

2) Ensure appropriate staffing is available considering the inconsistencies with admissions and discharges or unpredictability of staffing patterns in some units

3) Celebrate teams and encourage consistent use of best practices

Engagement was a barrier only until nurses began developing expectations around shared advocacy and accountability. Once nurses recognize the impact of their participation and voice, decisions were made to better support nurses in all areas of practice. All nurses have a duty to understand how laws and rules impact nursing practice. They also have a collective imperative to work together to implement solutions for a better work environment. TN