Managers: Don't fail to train staff

'Incompetency' might be lack of education

While "incompentence" showed up as a primary patient safety issue in the recent study "The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives," this problem is not specific to any one setting, says Jan Davidson, MSN, RN, perioperative education specialist at the Association of periOperative Registered Nurses (AORN). AORN sponsored the study, along with the American Association of Critical-Care Nurses (AACN) and VitalSmarts, a corporate training company in Provo, UT.

For example, "it should never be assumed by anyone that working in an outpatient setting is somehow an easier job and that the nurses that work in such a setting are somehow not as skilled as the nurse that works in another perioperative setting," Davidson says. "That is far from the truth."

However, outpatient surgery staff often work with limited resources, she adds. "Managers need to hear them when they say, 'help us to be better by allowing us time for regular and ongoing education.'"

Nurses and other clinicians in outpatient surgery wear many hats. "We fail them when we don't provide them with the necessary tools and/or training they need to also assume the role and responsibility for something they have never had to do before, such as the facility radiation safety officer or the infection prevention specialist," Davidson says. "We also fail them when we don't provide them regular and consistent time allotted for continuing education and in-services."

Managers need to provide tools and/or training to refine staff members' critical thinking skills and/or their critical care skills such as with advanced cardiac life support (ACLS) and pediatric advanced life support (PALS), she says. In "The Silent Treatment" study, 82% of respondents said that 10% or more of their colleagues are missing basic skills and, as a result, 19% say they have seen harm come to patients. Only 11% have spoken to the incompetent colleague.

Stephen Trosty, JD, MHA, CPHRM, ARM, president of Risk Management Consulting Corp., in Haslett, MI, says, "The question is, are you making sure your personnel have adequate training in CPR, if patients have heart-related problem, and that you not only know how to respond, but you have adequate equipment to respond and stabilize them before 911 or emergency personnel can get there?"

Have an emergency plan, Trosty advises. "There should be an early indication of basic skills and understanding, to help prevent potential harm to a patient, should one of these potentially negative events occur," he says.