How a Pilot Applies Aviation Safety Principles to Nursing

Rebecca Hendren, for HealthLeaders Media , March 22, 2011

"Let's face it, nurses can easily identify the impediments to safe care in their environment: Hierarchical leadership styles, poor nurse-physician communication, lack of psychological safety when communicating patient information to medical decision makers, and task loads that approach cognitive saturation," he says. "All of these issues can be addressed directly with CRM." 

Sculli set about implementing CRM on his own unit, and following his success, now trains others around the country. Key CRM concepts he brings to nursing include:

  • Team building behaviors for frontline clinical nurse leaders
  • Adopting appropriate leadership styles when leading nursing teams
  • Followership and assertive communication techniques to resolve clinical problems
  • Strategies to maintain situational awareness in the clinical environment
  • Managing threats to situational awareness and recognizing when the quality of patient care decisions may be at risk
  •  Methods to reduce distraction during critical phases of nursing practice
  • Briefings delivered by the RN to members of the nursing team
  • Developing and using checklists that support nurses as they practice and avoiding the tendency to create checklists that make work harder, not easier
  • Discussion of countermeasures to manage the effects of fatigue on performance

On his unit, Sculli applied CRM to the everyday responsibilities and challenges nurses face. One of his projects was to improve medication administration, an all-too-common source of errors that harm patients.

Nurses are subject to an incredible amount of distractions during their day—from patient and family requests to physicians arriving on the floor and needing information or supplies, to other staff members needing assistance. Then there is the ambient noise level on the unit created by televisions, loud hallway conversations, medical monitoring equipment, floor buffers, noisy carts, and nearby maintenance.

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