Registered Nurses Leading Innovative Changes

As innovators, all registered nurses (RNs) act as agents of change to drive processes and policy and leverage technology to prove better, more affordable care for individuals and the community. The authors consider examples of RNs leading innovative ideas and practices to create new knowledge; develop healthcare policies and practices; improve the quality of care; and advance health information technology. This article describes a number of key innovation goals identified by the American Nurses Association Professional Issues Panel, Barriers to RN Scope of Practice, discusses relevant literature related to overcoming barriers to innovation, and identifies recommendations for leading innovative change to achieve innovation goals.

Registered Nurses as Interprofessional Collaborative Partners: Creating Value-Based Outcomes

State-specific nurse practice acts, a defined registered nurse (RN) scope of practice, and nurse-led initiatives prepare nurses to lead in a meaningful and ethical way within the professional practice setting. However, barriers still exist that challenge the full RN scope of practice. One of these barriers is insufficient interprofessional collaboration among healthcare providers from multiple disciplines. We will briefly discuss the RN scope of practice and describe several evidence-based transition to practice programs and activities that are effectively helping to minimize these barriers. The article will also consider opportunities for interprofessional collaboration for RNs to implement evidence-based programs to support transition to practice, create interprofessional collaborative environments, and care for patients in a culturally competent way to minimize healthcare disparities. We conclude by offering recommendations to enhance interprofessional collaboration.

Registered Nurses as Professionals, Advocates, Innovators, and Collaborative Leaders: Executive Summary

This article concludes a series that described work completed by the American Nurses Association (ANA) Barriers to RN Scope of Practice Professional Issues Panel (Panel). The Panel has summarized the roles of the registered nurse (RN) as professional, advocate, innovator, and collaborative leader. As professionals, RNs are accountable for their own educational development, growth of their own practice, and execution of their own professional role. As advocates, RNs provide direct and indirect care focused on the achievement of optimal health. As innovators, RNs act as agents of change in driving processes and policy and leveraging technology. As collaborative leaders, RNs lead within the professional practice setting with state-specific nurse practice acts, a defined scope of practice, and nurse-led initiatives. In this article, Panel members describe their methodology, offer role definitions and recommendations, and provide individual recommendations for RNs to remove barriers and practice to the full extent of their scope of practice. We conclude with some future considerations.

Crisis Management of Hypotension in the OR.

Perioperative nurses play a pivotal role in coordinating care during crises, employing their nursing skills to foster a positive outcome and collaborating with their colleagues and peers to achieve the desired resolution. Whether caring for a patient during a liver transplantation or one undergoing removal of a cyst, perioperative nurses know that a drop in the blood pressure may signal a momentary phenomenon or a critical event that can become a crisis. It is important for nurses to understand how the color of the patient's tissue, the strength of a pulse, or the downward trending of blood pressure readings can affect how well blood is distributed throughout the body and eventually adversely affect cellular viability with prolonged hypotension. Integrating the patient's objective data (ie, blood pressure readings, pulse oximetry) and subjective cues (ie, skin color) are important perioperative nursing skills that demonstrate clinical patient advocacy and judgment and are crucial for the successful treatment of hypotension.

Crisis management of air embolism in the or.

An air embolism in the OR is a life-threatening emergency that demands prompt coordinated interventions by all perioperative team members. Specific applications of protocols and guidelines, such as the flowchart provided in this article, provide key components of traditional and effective responses to surgical crises. Successful management of an air embolism event requires critical skills of perioperative nurses who must consider both the risks for VAE or AAE and preventive actions, be aware of the resources available during an air embolism in the OR, and collaborate with their team members through precise and accurate communication.

Crisis management of fire in the OR.

Fire in the OR is a life-threatening emergency that demands prompt, coordinated, and effective interventions. Specific applications of fire protocols and guidelines for perioperative nurses and their interprofessional colleagues may take several approaches. The perioperative nurse's role is one that can frequently prevent or ameliorate the damaging thermal effects of a fire. For example, to some degree, the nurse can control all three components of the fire triangle: the ignition sources used during surgery (eg, fiberoptic lights, ESU devices), the oxidizers (eg, room air, supplemental oxygen administered during procedures under straight local anesthesia), and the fuel sources (eg, alcohol-based prep solutions). Although all members of the surgical team play an important role, the ability of and the opportunity for the nurse to minimize the risks of fire are important patient safety attributes of the nurse. Team training, rehearsing appropriate actions, and reacting effectively are essential to preparing health care providers to respond in emergent situations and be able to deliver optimal care. In most jurisdictions, any fired--regardless of size--must be reported to the local fire department. Personnel, managers, and administrators should be prepared also for the possibility of participating in postcrisis evaluations by the fire marshal, The Joint Commission, the Occupational Safety and Health Administration, Centers for Medicare & Medicaid Services, and possibly other fire safety-related organizations. Additionally, supplemental information related to investigating a fire is available through the ECRI Institute.28 The ECRI Institute serves as a third-party investigator and can facilitate root-cause analyses, identify whether the crisis ought to be reported and to whom, and assist in restoring clinical operations.

Implementing AORN recommended practices for transfer of patient care information.

The Joint Commission estimates that 80% of serious medical errors are associated with miscommunication during patient transfers. Patient transfers may occur between a wide array of settings: between physicians' offices or preoperative areas and traditional ORs or ambulatory settings, between emergency departments or interventional suites and the OR, and between other areas where the exchange of patient information occurs. AORN's "Recommended practices for transfer of patient care information" serves as a guide for establishing achievable practices that promote a safe level of care during perioperative patient transfers. Strategies for the successful implementation of the recommended practices include promoting teamwork, including with the patient and the patient's family members; developing effective communication skills; documenting processes; creating and adhering to policies and procedures; and establishing quality management programs.