Boise VA Medical Center

Boise VAMC nurses were among few to be selected for pilot training program designed to improve patient safety. Nursing Crew Resource Management is aimed at changing the way professionals in the healthcare system communicate and function, starting with the front line nurses.

Communication and situational awareness in the workplace environment can be the cornerstones to success or failure. Mistakes due to miscommunication cost time, money and are one of the easiest and most preventable problems to correct. Lack of effective communication may lead to misunderstandings, deficiency of information, a decrease in employees' performance, and an increase in a company's turnover. In healthcare, miscommunication can cost someone bodily harm or even their life. Losing situational awareness can also lead to grave mistakes. When presented with a problem, people often focus only on the problem and forget the bottom line safety measures required. In healthcare, the minimum functions that must be done to maintain safety are thought to be identification and assessment. The staffs in the Boise VAMC Intensive Care and Telemetry (Step Down) Units are changing their culture and the way they communicate, educate, and document to ensure that loss of situational awareness and communication errors are at a minimum or non-existent.

Working in a teaching facility such as the Boise VA Medical Center proves to be a challenge for all areas of operation and disciplines involved. Not only is the facility taking care of critical patients, but it is responsible for the teaching and development of new professionals. The Intensive Care Unit (ICU) nursing staff has been chosen as pioneers in the effort to change the health care culture concerning patient safety. The National Center for Patient Safety selected 10 units across the nation, based on written applications, to participate in a pilot study to improve patient safety. The Boise VA ICU was the only ICU chosen in the nation. They will be combining efforts with the Step Down Unit to participate in an intense training. The goal is to change the way professionals in the healthcare system communicate and function, starting with the front line nurses. This will be a project that will be followed for the next several years to evaluate improvement in teamwork, communication in dynamic situations, management of human factors on operational safety, process changes implemented, and overall satisfaction.

Along with the Nursing Crew Resource Management, the Boise VA is piloting a shared leadership program. Many of our nurses are strong leaders and vested in the safety and healing of their patients. However, there is has been no official method or model to bring those leadership skills together in the interest of holistic patient care. This is why Nursing Service has taken on the Shared Governance Leadership program described by the American Nurses Association. This model allows the point of care nurse to use evidence-based research to direct their practices. This creates empowerment and ownership of their professional practice which will improve the quality of patient care delivery. The nurses are in charge of researching, writing, and presenting policies and protocols that reflect the most current and safest practices. They will then present these to the appropriate committees for approval.

The nursing staff at the Boise VA is very proud of the progressive steps they are taking to ensure the best and safest quality of care is provided to our veterans. They are grabbing hold and taking charge of their profession in an effort to change how care is provided and reaching towards ensuring no preventable mistakes are made.