Lec 3: Role of the nurse + Pt. safety

Scope of practice refers to services a nurse is deemed..

• Competent to perform

• Permitted to undertake according to the terms of their professional nursing license

Nurse practice act is…

Legislation enacted by each state that defines requirements for licensure as well as the scope of nursing practice

The Joint Commission (TJC) is

A national organization that accredits health care organizations who demonstrate safe patient care

• Publishes yearly national patient safety goald

• Performs unannounced visits

Inner ring =

• Interpreting

• Noticing

• Responding

• Reflecting

Outer ring =

• Assessment

• Analysis

• Planning

• Implementation

• Evaluation

What are things we can never do as a nursing student?

• Administer blood / chemo

• Set up PCA pump

• Accept verbal / written orders from a HCP or enter orders into the computer

• Serve as “second” nurse to double check high risk meds

• Perform procedures or skills that require specialized knowledge/training

Primary care =

• Preventative

• Physician office, public health clinic, school nursing, community health nursing

Secondary care =

• Acute care

• Physician office, urgent care, hospital

Tertiary care =

• Long-term care

• Skilled nursing facilities (SNF), rehabilitation units, home care, hospice

List chain of command in order from highest - lowest

• Chief nursing officer

• Director of nursing

• Nurse manager

• Assistant nurse manager

• Charge nurse

• Nurse

• Unlicensed assistive personnel

Nursing interventions: Independent…

• Provided without an order or consultation of another member of the healthcare team

Nursing interventions: Dependent…

• Require an order placed by a provider before they can be performed

Nursing interventions: Collaborative…

• Carried out in consultation with other health team members

Droplet precaution (green)

• For infectious diseases spread over short distances through the air by droplets

  • Coughing, sneezing, talking

• Mask, Face shield, Goggles

• Ex) Influenza, rhinovirus

Contact precaution (yellow)

• For infectious agents spread by direct or indirect contact with the patient and or their environment

• Gown and gloves

  • Known contagious pathogen

  • Uncontrolled body secretions/draining wounds

• Ex) Vancomycin resistant enterococcus (VRE), Extended spectrum beta lactamase

• Dedicated equipment stays in room

Enteric Contact precaution (orange)

• For highly transmissible diarrheal illnesses

• Ex) C.diff, Hep A, Uncontrolled diarrhea

• Gown and gloves

• Dedicated equipment

• NO hand sanitizer, must wash with soap

• Must use bleach wipes to clean equipment

Enhanced droplet and contact precaution (purple)

• For infections spread by both contact and droplet routes

• Gloves, gown, N95 mask, goggles

• Ex) COVID-19

Airborne precaution (pink)

• For infections spread through aerosolized particles expelled from the respiratory system

• Ex) suspected / confirmed TB

• Negative air flow room

• N95 mask

• Door must remain closed at all times

Donning PPE steps in order

1. Hand hygiene

2. Gown

3. Mask

4. Eye protection

5. Gloves

Doffing PPE steps in order

1. Gown and gloves

2. Eye protection

3. Mask

4. Hand hygiene

What are the 2 fall risk assessment tools used at the OSUWMC

• Johns Hopkins Fall Risk Assessment Tool (JHFRAT)

• Fall predictive analytics

Orthostatic hypotension =

• Drop in BP with position change

• Positive if systolic BP drops by 20mmHg or more OR diastolic BP drops by 10mmHg or more

How often should you check a patient’s circulation/skin when in restraints?

Minimum every 2 hours