The document discusses nursing skill levels, quality and safety standards, and nurse accountability. It describes the stages of nursing skill levels from novice to expert. It outlines various organizations and their roles in establishing safety and quality standards. Finally, it discusses how nurses maintain professional accountability through adhering to standards of practice, continuing education, and managing errors, complaints, and quality of care measures.

1. Care and Safety Standards,
Competence, and Nurse
Accountability
Chapter 9
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.

2.  Novice
 Beginner, has beginning skills; lacks experience
 Does exactly as told
 Advanced beginner
 Gains experience in the field and demonstrates a solid
performance
 Level most graduates are in
 Competent nurse
 Usually 2 or 3 years in the new role
 Develops safe organizational skills to get through the day’s
tasks efficiently
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
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Classification of Nursing
Skill Level

3.  Proficient nurse
 Has much experience
 Has beginning ability to recognize patterns and think
both holistically and critically
 Expert nurse
 Has had a great deal of experience
 Is flexible and adaptable, responds to changes with ease
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
3
Classification of Nursing
Skill Level (Cont'd)

4.  Reduce errors
 Agency for Healthcare Research and Quality (AHRQ)
 Culture of safety, or a commitment on both individual and
organizational levels to accept accountability to attain
excellence in performance by directing resources toward the
problems
 National Quality Forum (NQF) created a list of never events
categorized into six areas
 Surgical events, product or device events, patient protection
events, care management events, environmental events, and
criminal events
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
4
Educational and Professional
Standards

5.  Quality and Safety Education for Nurses (QSEN)
 Ensures that all nurses develop knowledge, skills, and
attitudes (KSAs) for continuous quality and safety
improvement
 Primary competencies
 Patient-centered care
 Teamwork and collaboration
 Evidence-based practice
 Quality improvement
 Safety
 Informatics
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
5
Educational and Professional
Standards (Cont'd)

6.  Professional accountability
 Being answerable for the actions or interventions one
performs as a nurse
 Taking responsibility for professional growth
 Being accountable to the patient, society, profession
 Benchmarks for judging nursing care
 Standards of practice
 Individual state boards of nursing define the scope of practice and
licensure requirements.
 Standards of care
 State and national nursing organizations and specialty
organizations establish policies and provide position statements.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
6
Educational and Professional
Standards (Cont'd)

7.  Personal accountability
 RN should maintain current level of expertise
 Continued education and competency updates
 New graduate should make honest assessment of
weaknesses and strengths related to the chosen work
area and carry out a plan to address them
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
7
Educational and Professional
Standards (Cont'd)

8.  Professional practice standards and standards of care
 RNs use the nursing process to plan care.
 Professional and specialty organizations set policies and
practice standards
 Identify what the prudent RN should do.
 Accountability and autonomy are practice standards.
 Clinical judgment shows accountability.
 Collaborate with the health care team.
 The ANA Code of Ethics
 This is the fundamental ethical standard for nursing
practice.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
8
Educational and Professional
Standards (Cont'd)

9. Which organization/agency is responsible for defining
the standards of practice?
1. National Quality Forum
2. Quality and Safety Education for Nurses
3. Individual state boards of nursing
4. Agency for Healthcare Research and Quality
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
9
Educational and Professional
Standards Question 1

10.  3. Individual state boards of nursing. Individual state boards of
nursing define the scope of practice and licensure requirements for
RNs and LPN/LVNs, or the standards of practice.
 1. The National Quality Forum (NQF) created and has since expanded
and revised a list of never events that are categorized into six areas.
 2. The goal of QSEN is to ensure that all nurses develop the
knowledge, skills, and attitudes (KSAs) to be pivotal in the quest for
continuous quality and safety improvement.
 4. The Agency for Healthcare Research and Quality (AHRQ) called for
the creation of a culture of safety, or a commitment on both
individual and organizational levels to accept accountability to attain
excellence in performance by directing resources toward the
problems.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
10
Answer

11.  Situations
 A health care team member may defer or avoid asking for
assistance from a supervisor to resolve a problem or to report
an error, for fear it will hurt his or her professional reputation.
 The RN must act judiciously and prudently in the delivery of
care.
 By not going to the supervisor when a mistake is made and
failing to demonstrate accountability for contributing to the
mistake, the RN risks not only harm to the patient but also
potential legal and ethical consequences.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
11
Managing Care Aberrances

12.  Occurrence reports
 RN directly involved in the error or who discovers the
error completes the occurrence report
 Document errors in omission or commission and
measures taken to safeguard the patient
 Positive step to improve quality care
 Root-cause analysis
 Identifies the underlying causes
 Designed to seek errors of process, rather than lay
blame on individuals or groups
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
12
Managing Care Aberrances (Cont'd)

13.  Involving management in decision-making
 Accountability also extends to times when the nurse
must involve supervisors, department managers, or the
nursing or hospital administrators in the decision-
making process.
 There will be times when management is needed to
facilitate care or to assist in operational decisions.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
13
Managing Care Aberrances (Cont'd)

14.  Patient and family complaints
 Determine whether assistance is needed to address the
problem.
 Make referrals when needed.
 Chain of command
 This resolves problems by beginning with the immediate
supervisor and, if necessary, working up the chain of
command to higher levels of authority, even to the
agency board, if needed.
 Question physician’s orders, if necessary.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
14
Managing Care Aberrances (Cont'd)

15.  Quality of care measurement
 Gauge patient satisfaction, cost of care, and
effectiveness of care.
 Patient satisfaction increases with nurses’ listening,
empathy, and understanding.
 Patient satisfaction decreases when nurses are detached,
all-business, or seemingly uncaring.
 RNs must pay attention to quality care ratings.
 RNs are accountable to ensure that patients and families
are satisfied with the care they receive.
Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier
Inc.
15
Managing Care Aberrances (Cont'd)