A nurse can exert leadership without occupying a formal leadership position by taking a leadership stance. In the course, Becoming a Leader in Health Care, it describes leadership as an attitude and not just a position (Reinertsen, 2009, p. 2). Leaders take responsibility for problems and look for ways to solve them. The nurse on an interdisciplinary team serves as a leader by acting as a patient advocate and by coordinating with the other team members to work towards a common goal for the patient. The nurse is instrumental in directing the care and communicating the essential issues in the patient’s care to the whole team. Communication is an essential part to the healthcare team.
The nurse communicates with all the members of the team the vital information and ensures follow up care is received. This coordination of care and effective communication leads to positive patient outcomes and increased patient satisfaction. Another way the nurse serves as a leader on the interdisciplinary team is by bringing forth process problems and asking for the teams input on how to solve a particular problem. For example, the nurse may identify a problem with a decrease in hand hygiene compliance. The nurse can solicit ideas on how to solve the problem. The nurse may also bring forward some of his or her own ideas to solve the problem like more dispensers outside of each room and visual reminders to staff to do hand hygiene that are not following the procedure to increase hand hygiene compliance. By doing this nurse is acting as a leader by taking responsibility for a problem. The leadership stance is a lets solve it attitude towards problem resolution. (Reinersten, 2009, p. 2).
C. Active Involvement
It is important for a nurse to be actively involved in the interdisciplinary team because teamwork is essential in effective patient care. One of the first ways a nurse plays a contributing role on the interdisciplinary team is by communication of relevant information. A structured communication tool called SBAR (Situation, Background, Assessment, and Recommendation) is used to relay relevant information between caregivers. An example would be a nurse communicating to a doctor regarding a patient with chest pain. Situation: “Mr. Clark is complaining of chest pain radiating down both arm.”
Background: “He has a history of cardiovascular disease and has taken 3 sublingual Nitroglycerin without relief.” Assessment: “He is short of breath and diaphoretic.” Recommendation: “Can we institute the Acute Coronary Syndrome Orders until you get here? How long will it be till you arrive?” A second example of the way a nurse contributes to the interdisciplinary team is through the coordination of care. If the patient needs a bedside procedure such as a bronchoscopy the nurse needs to coordinate with the physician to provide informed consent and the equipment technician to set-up the equipment for the procedure. The nurse must coordinate with the pharmacist to obtain medications that will be needed for the procedure and the respiratory therapist to assist with the procedure. Lastly, the nurse must coordinate with the lab and radiology to do any post-procedure labs and x-rays. C1. Contributing Position
The nurse can take an active contributing role with an interdisciplinary team by working with the other disciplines. The nurse collects data for the dietician such as height and weight, monitors fluid intake and output and diet intake. The nurse does a thorough assessment of the gastrointestinal system and monitors bowel movements. This information enables the dietician to better plan the nutritional needs of the patient. This collaboration leads to improved outcomes for the patient. A second way that the nurse can take a contributing role is by making sure core measures are done for specific diagnoses. These evidenced based measures guide the care and contribute to better outcomes for the patient. D. Culture of Safety
The Institute of Healthcare Improvement defines the four characteristics of a culture of safety as psychological safety, active leadership, transparency and fairness (“Culture of Safety”, 2011). Psychological safety pertains to a safe environment where people feel comfortable in speaking up about a concern. For example, if site verification is done on an impending surgery and one member of the team feels there might be an error the person can feel safe to speak up and question without fear of being penalized or berated for speaking up. This promotes an environment where learning is increased and the risk of future harm to patients is decreased.
Active leadership in a culture of safety is using effective leadership. Effective leaders set a positive tone in the environment, share information and invite others to share, call people by their names to create familiarity, and are approachable. An example of this would be surgeon who is about to perform surgery, he speaks to the team members using their first names, explains the case to the them, and asks the team to speak up if there is questions during the case. The surgeon maintains a positive attitude and the team feels that they can approach him with concerns. Transparency is the willingness of an organization to investigate errors that have occurred and share the information so that others can learn from the mistake. If transparency does not exist it can allow errors to continue to occur and risk patient safety. An example would be a wrong site surgery, if an important check was omitted and not reported the error could occur again.
Transparency allows the organization to fix process problems that may have precipitated the error and help find solutions to prevent future errors. Lastly, fairness is another component to the culture of safety. Fairness relates to the fact that people are responsible for their behavior but the important distinction is the fact that some errors are made due to flawed systems and some errors are made due to poor decision-making. The three concepts of human behavior that need to be determined before accountability can be decided are human error where the nurse just inadvertently made a slip or lapse by forgetting to turn back on the tube feeding after giving medication. When the nurse creates a shortcut in a policy, such as running potassium faster than the recommended 10 meq/hr, is considered at risk behavior. Reckless behavior would be a nurse taking narcotic medication prescribed for a patient while on duty (“Culture of Safety”, 2011). Culture of safety is an important aspect to making patient care safer.
Reinertsen, J. (2009). Becoming a leader in health care. Retrieved from http://www.ihi.org/offerings/IHIOpenSchool/Courses/Pages/default.aspx PS
106: Introduction to the Culture of Safety. (2011). Retrieved from www.ihi.org/offerings/IHIOpenSchool/Courses/Pages/default.aspx