This article discusses the importance of emotional intelligence and assertiveness for nurses and the relevance that self-care has to patient safety.
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In this compelling Ted Talk, Leilani Schweitzer, tells us about the death of her little boy, Gabriel after a series of medical mistakes. He was 20 months old when his heart stopped while hospitalized.
All of the alarms that he was hooked up to had been turned off by a nurse with devastating results. Although this happened more than 10 years ago, much can be learned from this. (If you can, please find 15 minutes to listen to her TED Talk.)
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Leilani is articulate and despite unimaginable emotional pain does not blame the nurse. She understands, at least to some extent that this was a systems failure and has a compelling message about the importance of three components of medicine:
Transparency
Compassion
Truth
In this case, all three were utilized in one of the two hospitals involved in Gabriel's death and contributed to quality improvements in the alarm design and some healing for this Mom. I also see a fourth and somewhat elusive component: the need for emotional intelligence (EQ) for nurses. Not only so that nurses will speak-up as patient advocates, but for themselves and their colleagues too!
In this case, how does a highly trained professional get to the point where she would do something that appears so egregious? Part of the answer lies in having the self-awareness and self-respect to say:
I'm having a hard time thinking with all of these alarms and interruptions.
I'm too tired to work overtime.
I need help. and ultimately: We need help.
Or to have a colleague say:
You look exhausted!
It is hard for me to concentrate with all these interruptions too!
What can I do to help?
Or to have a manager say:
[to staff] Let's see what we can do to address the frequency of alarms on the unit.
[to senior leaders] We need to consider technical and staffing solutions to address the frequency of alarms distracting our frontline staff.
All of these arise out of a respect for 'self'' and 'others' that is critical for patient safety and for sustaining long-term rewarding careers. Nurses must be able to set healthy limits, to have these limits respected, and to work in cultures where respect is the norm.
It would be easy to be aghast at the nurse's action. Who could justify turning off an alarm, not just at the bedside, but the nurses' station too? She shouldn't have. That's obvious. But seeking to understand the individual and organizational factors that contributed. Did she have alarm fatigue? Was there a history of false alarms with this and other patients. That shift? That day? That unit? Was understaffing contributing to excessive interruptions and distractions? Was this nurse on chronic 'overload'?
Understanding how unnecessary interruptions, such as false alarms or alarms that are in place as a substitution for adequate staffing is hard to quantify yet there effect can have a profound impact on our ability to concentrate.
Over the last decade there has been an increased focus on training nurses in assertiveness. Yet available models such as TEAMSTEPS, SBAR or ISBAR focus on speaking up to physicians and others for patients. This is only part of building true assertiveness and I advocate for a deeper process that involves emotional intelligence. A process that medical improv is perfectly suited for and where nurses develop self-awareness self-respect, and respect for others, including colleagues. I don't think we can optimize safe care build safe cultures, or sustain longterm, rewarding careers without it. What do you think?
