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Practice Tip of the Week: Risks to Nursing Practice and Mitigation Strategies

Tuesday, November 27, 2018   (0 Comments)
Posted by: Kanaka Sathasivan
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By: Ellen Martin, PhD, RN, CPHQ 
Director of Practice, Texas Nurses Association

As a new partner of NSO, TNA was invited to participate in the NSO Annual Summit. We received valuable information on practice risks for nurses, from disciplinary risks, including delegated acts, to the opioid epidemic to workplace violence from guns and preparedness for mass shooting events and risks from predatory publishers and conferences. A consistent theme throughout the conference was the importance of continuing competency so nurses can align their practice with current standards and nursing regulation.

Opioid epidemic

The opioid epidemic is a public health crisis encountered by nurses in every practice setting. Nurses who avoid judgment and stereotyping are in the best position to facilitate positive patient outcomes through patient engagement. Patients with complex pain management situations such as opioid use disorder with surgical pain or acute pain syndromes benefit most from person-centered, team-based interprofessional care. 

Nurses can mitigate risks through continuing competency in pain management. A generous grant from Johnson & Johnson has made 15 contact hours of continuing nursing education on pain management available for free online until Dec. 31, 2018. Topics include evidence-based pain management, motivational interviewing techniques for collaborative care planning and health literacy.

Even though nurses don’t prescribe opioids for chronic pain, it is helpful to understand guidelines and position statements.

Gun Violence

The FBI defines a mass shooting event as four or more people shot or killed in a single incident, excluding the shooter. According to Shooting Tracker, Texas has had 16 mass shootings so far in 2018. Joan Widmer, executive director of the New Hampshire Nurses Association, talked about the distinctions between standard of care vs. sufficient care, routine care vs. crisis care. Mass casualty events were described as events that overwhelm usual capacity, are often chaotic and needs exceed available resources. The goal in these events is to provide sufficient care.

Multiple casualty events are situations where the patients are successfully managed by mobilizing resources and are controlled events where the standard of care is expected.

Widmer emphasized the importance of regular drills to support “recognition-primed” decision-making in which clinicians can act quickly because they have “seen this before and know how to act.” Learning lessons from event debriefings is critical. The speaker noted that in the Las Vegas shooting, police roadblocks delayed staff from getting in to the hospital to help. Nurses can learn what to expect by reviewing the lessons learned and considering them during facility drills.

She also discussed the importance of staff support after a mass casualty event noting that in the year after Hurricane Katrina many first responders experienced post-traumatic stress and over 50 died by suicide. TNA and the Texas Organization of Nurse Executives, with support from the Johnson & Johnson Foundation developed Care for the Caregiver to help nurses before, during and after disasters.

Nurses are in a position to save lives by learning about the Stop the Bleed Campaign and the Hartford Consensus to improve survival after active shooter events.

Read more about TNA’s plan to address workplace violence in the upcoming Legislative Session.

Next week’s Practice Tip will address additional topics from this informative Summit.


Texas Nurses Association

Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Austin TX

800.862.2022 | 512.452.0645 | tna@texasnurses.org