Risk Management, what does it mean to you?

madwife2002, BSN, RN

To be a nurse we have to have a collection of strengths to stay in the profession. We have to be able to communicate effectively to people from all walks of life, to our co-workers and other members of the multidisciplinary team (MDT).

We have to be able to manage conflict, aggression, distress, pain, happiness and death all in the same hour.

We have to be transporters, house keepers, councilors, social workers, supporter, educators, mentors, assessors, experts, smilers and the list goes.

In fact we are expected to be 'the font of all knowledge' the oracle!

We have to know how to document, document and document, as though we were going to court every day of our lives

We have very high expectations of ourselves and our profession, yet we can be cruel, mean and unkind to those who don't meet our expectations.

Sometimes we are quick to throw others of our profession under the bus, we have a kind of dog eat dog mentality.

Often we don't tolerate mistakes, we gossip and talk about our co-workers when they are less than perfect. We can always and I mean always do better than 'her' or 'him, we often don't understand why the less than perfect becomes a nurse in the first place.

Not a lot of nurses support each other, we will scramble over the top of other nurses to be considered 'the cream of the crop'.

Even though we believe we do support each other, if we really look inside our hearts we know there is always room for improvement

Some of us smile inside knowing that the worse another nurse looks the better you will appear.

We don't share our own mistakes in fear that there will be retribution from the hierarchy.

This strikes the fear of God in our hearts.

We covert our knowledge, not sharing or educating others to make their life easier.

As soon as somebody messes up, the whisper around the floor is normally

'she should be written up"

'did she get written up"

Why? We should learn from mistakes, we don't want to make them; we want our care to be perfect even though no human being can be perfect all the time.

The new wave of thinking which has been around for 20 years plus in healthcare is 'Risk Management" we identify our mistakes, we learn from our mistakes and we teach others how to avoid.

Risk Management used effectively is a wonderful tool, yet I have only ever worked in one place where it was used as it should be used.

Although my current place of work is trying extremely hard to use this tool well.

The problem with 'Risk Management' is the people who use the tool, or should I say in the position to use it are often the ones who really believe that we should do numerous write ups, and get rid of the nurses who are less than perfect.

We do hear of those wonderful places where they are all team players and support each other through thick and thin.

This is a place where we would all want to work, if only we could only get an interview.

Retention is great, and recruitment not a problem.

Those places tend to have really good processes in place, really good education and support mechanisms. Often they have a very dynamic leader who is prepared to get their hands dirty and supports their staff.

Often when investigating a mistake, you find the process has broken down.

Normally there is a deficit of knowledge or experience and often education.

Nurses rarely go into a situation where they plan to make mistakes or hurt a patient, it is because their skill set may not be complete or their work load is to excess.

Sometimes the process is incomplete, something we have always done was missing a part and it is only when a patient is compromised or hurt do we realize that it is something we should have always done and had just been 'lucky' until now.

The investigator needs to look at all the pieces and see what was missing, so to do this they need all the facts. This means honesty from people involved, floors have to offer a safe environment for staff to report without fear of retaliation.

When looking for managers or leaders, we need to now ensure that our leaders buy into this mentality and are prepared to support their staff and investigate issues and problems effectively by not pointing fingers of blame.

We can ourselves when looking for employment ask about Risk Management in their facility, ask for examples of how mistakes and processes are managed.

Remember none of us are exempt from making a mistake, how it is handled is what we should focus on. It is not a mistake to ask the interviewer questions about what their management style is.

If they don't know then that is a problem, most managers these days should have a clear understanding of their skill set and style.

So until we learn how to work together as a team, support and educate, learn to share mistakes that we make, utilize the skills we have when we are looking after patients when interacting with our co-workers, and most of all stop pointing the finger of blame, then how can we stand strong together as professionals.

Even the most experienced nurse 'the oracle' is not complete until she can support good processes such as Risk Management.

Nursing doesn't just mean looking after patients, it means looking after each other as well.

CrufflerJJ, RN · Oct 31, 2012

I don't know anything about the official risk management process, or even know how it's implemented in my organization.

As an ICU nurse with a whole three years experience under my belt (wheeeee!), I attempt to remain aware of how I've made mistakes, and try to be willing to share those errors with the folks around me.

No, I've not admitted to all my errors. Boo on me.

Admission of errors requires a comfort level that in admitting fault, you won't be strung up by your reproductive organs (OUCH), poked with sharp sticks, reported to your State Board of Nursing, then fired.

It's taken a while to reach this comfort level.

As a preceptor, I always try to tell my favorite "Stupid CrufflerJJ" story to those I try to instruct. This story is somewhat painful, since it makes me repeatedly realize how I could have killed a patient had it not been for the attentiveness of others.

That being said, I feel obligated to share my faults with others since I was not crucified by my department's management as the result of a single error.

It's a careful balancing act, between being quick to find fault & severely punish the "guilty", and being lackadaisical (oh well....mistakes will happen....move on & hope that nobody else notices).

Errors WILL occur. To think otherwise is pure foolishness. Nobody is perfect.

I recently started doing a 1 hour presentation to the nurses going through the Critical Care Fellowship (ICU) training program at my hospital. My purpose in doing this was to try and let these folks know just how quickly an error can occur, and the life-altering impacts that these errors may have on our pts and the caregiver involved. I also want them to know that they WILL screw up. Guaranteed.

Mistakes happen. How we choose to deal with them reflects on us as individual caregivers, and also reflects on our employers.

madwife2002, BSN, RN · Oct 31, 2012

Crufflerjj Thank you for sharing I love your post, it sounds like you work at a great place

Risk Management, what does it mean to you?

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