Strategies for Nursing Success: Part 1 of 3 | Identifying Practice Issues

As nurses, we are held accountable and responsible for making complex decisions that are consistent with safe, competent, compassionate and ethical nursing practice. We are also faced with diverse and challenging issues that can impact the delivery of patient care. This three-part series will help you to identify, communicate and resolve complex nursing practice issues that you may experience within your nursing career.

Strategies for Nursing Success: Part 1 of 3 | Identifying Practice Issues

Since nurses are expected to be self-regulated professionals, we are legally and ethically obligated to identify and make a valid attempt to resolve all practice issues as they arise as a means to minimize potential negative impacts they may have on patients, our fellow colleagues, and daily operations. In part one of this three part series, we will focus on how to identify practice issues and how they may negatively affect our patients, as well as our ability to perform and function at an optimal level.

Let’s take a look at two strategies we can implement to gain a better understanding of what’s going on, so we can find the best way to resolve a practice issue:

Identifying a Practice Issue

A practice issue can be defined as any issue or situation that either compromises patient care or services by placing a client at risk for harm, or one that affects a nurse’s ability to provide patient care or services that are consistent with current standards of practice.

The first step in addressing a practice issue is being able to identify one. In order to determine if your issue is indeed a practice issue, one must ask the following questions:

  • Does the issue present a risk to patients?
  • Does the issue make it difficult to function according to current standards of practice?
  • Does the issue conflict with your institution’s standards, guidelines, or policies?

If you answered “yes” to any of the above questions, then you may have a practice issue that needs to be resolved. If you answered “no”, your issue is not likely a practice issue but still needs to be explored further and resolved if possible.

Here are some examples of practice issues:

  • Inappropriate use of social media such as discussing your patient on Facebook.
  • A nurse from a telemetry unit being floated to the intensive care unit and is assigned a ventilated patient without appropriate support.
  • Withholding critical information about a patient from a member of the healthcare team.
  • Consistently working short staffed with unsafe nurse to patient ratios.
  • Chronic workplace bullying and lateral violence.

Once you have been able to properly identify a practice issue, you must then explore the issue to determine the severity of the issue so that you may prioritize resolution accordingly.

Fully Exploring a Practice Issue

Taking the time to fully explore a practice issue will help you to gain additional insight and develop a shared understanding among colleagues and other members of the healthcare team. A better understanding will also help to prevent a quick response that may be influenced by incomplete information, emotions, or assumptions surround the issue. Reflecting on a practice issue before reacting is a great way to look at the situation more objectively and can help you to quickly identify potential causes. Gaining your team's perspective can also provide further clarity about the issue and supports a team approach to resolving the issue.

The following questions can assist you in reflecting on and exploring a practice issue in greater detail:

  • How does this issue place patients at risk?
  • How does this issue affect your ability to provide patient care according to current standards of care?
  • Does this issue go against the Nursing Code of Ethics?
  • Does this issue put a strain on your nursing oath to do not harm?
  • How does this issue prevent you from following agency policies and procedures?
  • Do you have the knowledge and skill to address the practice issue?
  • Who is affected by the practice issue and what are their perspectives?
  • Does your organizational policies, procedures, or guidelines contribute to this issue?
  • Is this a recurring practice issue? And if so, why is it recurring?
  • What are some of the anticipated outcomes if the issue goes unresolved?

Develop a Description

Once you have explored the practice issue in full, you will need to develop a description of the issue, making sure to be as objective as possible. You’ll want to include the date, time, place, people involved and full account of how the issue affects the client, your nursing practice and/or the healthcare team. Be sure to outline all contributing factors. Having this detailed description will be helpful when communicating the issue with your nursing leadership. In many cases, common contributing factors for practice issues include, but are not limited to:

  • Inadequate Skill Mix
  • Lack of Accountability
  • Decreased Resources
  • Lack of Responsibility
  • Ineffective Communication
  • Breaks in Standards of Practice
  • Outdated Policies and Procedures
  • Challenging Legal and Ethical Issues
  • Workplace Bullying and Lateral Violence

As you can see, the first two steps in resolving practice issues involve identifying the practice issue, then fully exploring the issue and the anticipated outcomes on the quality of patient care and delivery of high-quality nursing practice. Once you have completed the first two steps, you will move into utilizing available resources and taking action to find resolution.

Stay tuned for part two - where we will discuss two more strategies in resolving practice issues for nursing success!

Best,

Damion

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Damion Jenkins

About Damion Jenkins, MSN, RN

NCLEX Columnist

Damion Jenkins, RN, MSN is an NCLEX Prep Expert and CEO of The Nurse Speak - a Nursing Education and Consulting Business. Named the "NCLEX Whisperer" in an article by Nurse Beth, Damion provides individualized tutoring and mentoring services for nursing students, new graduate nurses and professional nurses alike. For more information about Damion and the services he provides, check out www.thenursespeak.com

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Specializes in Faith Community Nurse (FCN).

"As you can see, the first two steps in resolving practice issues involve identifying the practice issue, then fully exploring the issue and the anticipated outcomes on the quality of patient care and delivery of high-quality nursing practice." Thanks for this discussion. It is well stated.

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