As mentioned in the last issue of ASPSNews (Summer, p. 6), various organizations ask ASPSN to endorse initiatives concerning healthcare, health policy, patient safety, and other related issues. ASPSN has joined forces with the Americans for Nursing Shortage Relief (ANSR) Alliance. ANSR has submitted numerous letters to policy makers in Washington asking them to support Title VIII: Nurse Workforce Development Programs at the Health Resources and Services Administration, by increasing the proposed funding for this program. Title VIII is aimed at helping relieve the critical nursing shortage facing America today. In FY 2006, a total of $149,000 was appropriated. For FY 2007, President Bush has asked for an increase of $1,000,000. ANSR is requesting that policy makers increase the FY 2007 proposed budget to $175,000,000.
Why is ASPSN supporting ANSR's initiative? Studies have demonstrated that a shortage of qualified nurses has a direct impact on patient safety. A report issued in May 2002 by The New England Journal of Medicine found that America's nursing shortage directly affected patient care by correlating to longer lengths of stay and increased incidence of urinary tract infections, upper gastrointestinal bleeding, pneumonia, shock, and cardiac arrest (ANSR, 2006a). Supporting this research is an August 2002 report issued by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that stated that America's nursing shortage contributed to nearly a quarter of all unexpected incidents that adversely affected hospital patients (ANSR, 2006b).
The American Association of Colleges of Nursing believes that the current faculty shortage is exacerbating this shortage. According to the American Association of Colleges of Nursing, who conducted a survey of 423 nursing schools, 32,617 qualified applicants to entry-level baccalaureate programs were turned away in 2005 (ANSR, 2006c). When looking at all nursing programs, the National League for Nursing estimates that number to be close to 147,000 (Fiscal Year 2007 Appropriations, 2006). Wait lists of two to three years are causing many to seek other educational opportunities. Currently, there are fewer than 20,000 full-time faculty in a system that needs approximately 40,000 to fill the gap, and the shortage is expected only to worsen as faculty age continues to climb.1 A portion of the increased funds requested through ANSR would go toward reducing this shortage.
With an estimated 2.9 million licensed registered and advanced practice nurses, nurses represent the largest occupation of healthcare workers and play a critical role in the nation's healthcare system (Fiscal Year 2007 Appropriations, 2006). Nurses are often the first line of defense, using detailed assessment skills to detect early signs of a developing complication. This skill set often puts the nurse in a direct path to affect morbidity and mortality rates. However, for nurses to stay in tune with patients, they must have time to spend observing them. Maintaining a realistic nurse-to-patient ratio is critical to maintaining the quality of care that every patient deserves.
PATIENTS TRUST NURSES
More than highly trained medical professionals, nurses are the ultimate patient advocate as they address safety in all aspects of care. Using a holistic approach, nurses care for patients during the most vulnerable period of their lives and in doing so, must concern themselves with the patient's physical, emotional, and social safety and well-being. I believe this is one of the reasons that nurses consistently rank number one in the annual Gallup poll's survey to determine the profession considered most honest and ethical.
A NATION IS EDUCATED
Although nurses have acted as patient advocates for centuries, a national movement toward increasing patient safety gained recognition after a landmark 1999 study, To Err is Human: Building a Better Healthcare System, conducted by the Institute of Medicine, reported that as many as 98,000 people die annually from preventable medical errors (Institute of Medicine, 1999). In an attempt to increase patient safety, the American Nurses Association, in collaboration with the Institute for Healthcare Improvement, has instituted a campaign called Saving 100,000 Lives. The campaign aims to educate nurses and others on ways to enhance patient safety in hospital settings (Nursing World, n.d.). Although this campaign is a step in the right direction, many patients are seen outside the traditional hospital setting, and this program should be expanded to involve patients in all patient care areas.
MEDICATION ERRORS
To err may be human, but to report imperative. Although nurses are credited as being a critical link in preventing medication errors, studies show that medication errors occur at every step of the medication process. Errors occur in prescribing, transcribing, dispensing, and administration of ordered medications (Agency for Healthcare Research and Quality, 2000). The five Rs have consistently proven themselves to be the single most important step to decreasing these potentially serious/deadly errors. The Institute for Healthcare Improvement reports that patients who experience what they call an "adverse drug event" are twice as likely to die as those without an adverse drug event (Nursing World, n.d). A retrospective look at death certificates between 1983 and 1993 showed that medication deaths rose from 2,867 to 7,391 (Institute for Healthcare Improvement, n.d.). Reports indicate that these numbers have steadily increased since that report.
Why do medication errors occur? This may just be the $64 million question. Although medication errors are often blamed on a lack of knowledge, one study of 1,000 drug administrations suggested that failure to follow correct procedures accounts for only a small percentage of errors. Other factors such as workload, shift patterns, look-alike drugs, time of day, pressure from coworkers, relying on the accuracy of automated dispensing systems, environmental factors, and incomplete charting of patient allergies also contribute to these errors (Nursing World, n.d). Thankfully, most medication errors do not cause significant harm to the patient although it is important to report all errors and document the incident for follow-up. The best way to improve patient safety outcomes is to capture, analyze, and review the data collected at each institution and on a national level. National reporting procedures have been put in place by President Bush to collect this type of data without fear of retribution for doing so.
NATIONAL TIME OUT DAY
Another patient safety initiative that was developed by the JCAHO is aimed at reducing Wrong Site, Wrong Procedure, and Wrong Person Surgery by using a universal protocol to prevent such problems. These universal precautions charge the surgical team to properly mark the operative site and mandate that the team take a "time out" immediately prior to starting the procedure. The Association of Perioperative Registered Nurses has named June 21st as National Time Out Day. Yet even with these initiatives, we still read reports of wrong site, wrong procedure, and wrong patient surgeries. Is your facility following JCAHO's universal protocol? If not, why not?
PATIENT SAFETY: EVERYONE'S CONCERN
Whether nurses work independently or as part of a team, they know that communication across disciplines is essential to coordinated, timely, and safe patient care. Ultimately, every member of the healthcare team must accept responsibility for the patient's safety. We must be willing to use or develop systems that create checks and balances aimed at limiting the number of human errors made by a human healthcare professional. We must continue to learn and seek out new information to guide our practice; we already know that using an evidence-based practice model is instrumental to successful patient outcomes. ASPSN and the Plastic Surgical Nursing Certification Board take patient safety seriously, as do all our members. ASPSN supports Plastic Surgical Nursing Certification Board's decision to approve the patient safety component that requires three patient safety credits for certification renewal. ASPSN also supports patient safety education by publishing this year's PSN "focus issue" on Patient Safety. This issue is specifically designed to focus on the need to remain current, for we know that facilities with "the best" nursing care have patients who do better. ASPSN desires to help every plastic surgical nurse give "the best" nursing care and to provide patients with the ultimate patient experience: safety and satisfaction.
REFERENCES