It is often said that attitude is everything. I submit to you that this statement must be qualified to say that the proper attitude is everything. This seems to be a particularly important characteristic of a good nurse. In these times of increased awareness for patient safety, I see plenty of people with attitude but the safety level appears to have been level for the past few years.
Having lived most of my hospital life in and around operating rooms, there is no shortage of nurses who are willing to show you their attitude. This is particularly true when any new safety item trickles down from the ivory towers of academia, accreditation or outside organizations. I listen to people tell me why this procedure or that process won’t work in their operating room. Apparently, operating rooms are like snowflakes in that no two are alike. What works at Johns Hopkins will never work in any other OR in the world, or so many people would have you believe. When I ask what method will work, I am either met with a blank stare or a comment about how that problem has never happened at their hospital. The big question is how can that attitude be changed?
We probably need to first look at how the negative attitude set up shop to begin with. Was it something that they brought with them from childhood or from sometime later? Have they been nurturing a bad attitude since they started their healthcare training? If we can identify any common ground, then we should be able to perform some attitude readjustment before people start to work with patients. Lacking that information, we still need to change the prevailing attitude that prevents us from making progress in patient safety. I think that the only way you will be able to grab someone’s attention to start changing attitude is to make it such an overwhelming event that there will not be any doubt about the hospital’s intent.
But how can you make such a grand statement? What about having everyone (nurses, surgeons, anesthesia, techs) show up for work one day and not have any patients? A full day involving everyone in getting on board the same train and taking the same trip. When everyone has the same destination in mind, projects like patient safety are much easier to accomplish. But wait, I can hear the attitude from many people already! You can’t close the OR on a weekday and have everyone but the patients show up. What about the lost revenue, the surgeons lost time, administrators not attending meetings, and so on? If you want a comparison to show people why this is necessary, just add up the cost to do this for one day. Next to that figure add up the cost of a wrong site or wrong patient surgery. Don’t forget to add in the legal cost, rise in liability insurance cost, the hospital’s share of the patient’s bill that will not be reimbursed because it was preventable and loss of patient revenue when the public hears (and they will) about the mistake. Actually, the cost for one down day in the OR isn’t all that too much after all.
This is the type of demonstration that administration needs to show the OR staff for them to know that the hospital leadership is serious about effecting change. This will reinforce the fact that everyone’s attitude must change to embrace proven procedures that have been worked out and shown to enhance patient care and safety.
The Latin proverb — extremis malis extrema remedia — ‘extreme remedies for extreme ills’ holds quite true for this subject. We must take the extreme measures necessary to keep from needlessly causing harm to others. While patient safety statistics are often quoted as occurring to “one patient in” whatever denominator you like, the fact remains that if you are that “one person” then it occurred one time too many. This is the true path to becoming a good nurse.