By Megan M. Krischke, contributor
March 18, 2010 - “Safety is every patient’s right and everyone’s responsibility,” began Kathleen Nelson, RN, MPH, CPHRM, national leader of patient safety and risk management for Kaiser Permanente. “Nurses have a preoccupation with patient safety and they try to provide the most compassionate and safest care for every patient every time.”
While most nurses are patient safety specialists in their own right, a career path focused on patient safety can provide a variety of experiences and can be extraordinarily satisfying.
“I loved having that kind of daily impact one patient at a time, but I started wondering how I could impact more patients,” Nelson continued. “I started serving on committees on patient safety and got to help create performance improvements that applied to whole units and whole hospitals. Now I have the privilege to affect patients nationwide. This work really called to me.”
Debora Simmons, RN, MSN, CCRN, CCNS, a researcher at Texas A&M, also serves as the associate director of the Patient Safety Education Project.
“When I would see clinicians who seemed very competent, educated, and at the top of their game, responsible for errors, I would just reel,” said Debora Simmons, RN, MSN, CCRN, CCNS, research scientist at Texas A&M University, who works as a patient safety educator, researcher and advocate. “We are trying to make patients well and when harm comes to them it is so hard.”
“When the first Institute of Medicine reports came out about a decade ago, it provided answers to a puzzle I’d been trying to put together for years,” said Simmons. “The report clarified why errors were happening in the critical care environment and sent me down the path of patient safety.”
Mei Kong, RN, MSN, senior director, patient safety at New York City Health and Hospitals Corporation (NYC HHC), stated, “Working in patient safety, everything I do contributes to improving patient outcomes and when patient outcomes are better, what more can you ask? Keeping patients free from harm is a great job.”
Mei Kong, RN, MSN, senior director, patient safety for NYC HHC, was drawn to her current position due in part to the broad scope of the work.
According to Kong, specializing in patient safety not only requires strong clinical skills, but a value for teamwork and collaboration and the ability to lead and to influence a wide variety of people.
“It is no longer just nursing. It is a lot more than nursing; you are working with every discipline from pharmacists to administrators to housekeeping staff,” she explained.
There are a number of different areas in which a nurse can work and contribute to patient safety: performance improvement, risk management and patient safety, clinical education, running a simulation training, educating clinicians on human factors, and infection control, to name a few.
There are also positions available at a variety of levels. Kaiser Permanente, for example, has a director of quality and patient safety at each local medical center and at the regional and national levels.
“With healthcare reform and the continued emphasis on quality and comparative effectiveness, there are many career opportunities for specialists,” remarked Simmons. “Additionally, as Medicare and Medicaid, along with more and more private insurers, are refusing to cover the costs of fixing medical errors, the insurers need people who can audit claims and hospitals are more motivated to avoid errors. That trend is opening up areas where nurses can make a huge contribution and pursue careers around patient safety and quality.”
As part of her work in patient safety, Simmons evaluates products and medications for risk.
“We take what we know about safety and apply it to a particular product or process. We see what we can do to make it error-proof or put a safety net around it so it doesn’t cause errors when introduced to the clinical environment,” she explained.
For those looking to specialize in patient safety, Nelson and Kong recommend the Institute for Healthcare Improvement’s (IHI) Patient Safety Executive Development Program. According to IHI’s Web site, it is “an intensive, seven-day program designed to prepare those responsible for safety to be leaders of strong, effective patient safety programs.”
Additionally, the American Society for Healthcare Risk Management offers a certification program in healthcare risk management.
“To be effective in patient safety one thing is critical and absolutely necessary. You have to have an understanding of human factors,” emphasized Simmons. “It is a science that looks at how humans interact with their environment and from that understanding, designs systems where humans can be effective and not make errors. It is a blend of cognitive psychology and systems analysis.”
All three experts emphasize that every nurse can work to improve safety in his or her current environment.
“Again, I think the most important thing a nurse can do is to have a complete preoccupation with patient safety; look for what could go wrong and catch it before it does. The easiest and best way for this to happen is for everyone on the team to work toward great communication and thorough information exchange and to help each other spot errors before they occur,” Nelson advised.
Kong exhorts nurses to speak up, “Nurses are sometimes too timid and don’t communicate their concerns to the doctor when they see the potential for an error.”
Simmons concurs, “Nurses have a mentality of putting up with and finding ways of working around unsafe situations. They need to stop and say, ‘This is unsafe and we need to fix it before someone makes a terrible error.’”
Simmons offered this final word of advice, “If you are going to focus on patient safety you need to develop a real sense of mission and purpose because you are going to have to say things that some people aren’t going to want to hear. Sometimes your only reward is knowing you did the right thing.”
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