Discussion Response : Analyzing Patient Risk

Respond to the discussion below using the following approach:

Offer and support an additional strategy a colleague might use to integrate the principle of stacking into his or her specialty of interest.

Expand on your colleagues' postings by providing additional insights or contrasting perspectives based on readings and evidence.

Ask a probing question, substantiated with additional background information, evidence, or research.

Discussion

As the acuity level of our patient's health status increased, the complexity of our roles increases also. Attempting to manage multiple patients with complex health statuses requires the nurse to develop a care giving rubric that allows for this complex decision making process to occur seamlessly, with no harm coming to our patients. As novice nurses this task can seem daunting and overwhelming at times, but as we process through our career, the clinical decision making matrix becomes much easier to perform. One of those decision-making matrixes is stacking.

Stacking is an RN cognitive process involving decision-making about workflow priorities (Shirey, Ebright, & McDaniel, 2013). Stacking as an important strategy used by experienced RNs for management of the complexity surrounding nursing care which involves complex reasoning and clinical decision making.

My clinical setting for my example is the Operating Room (OR) of a large hospital. As OR nurses, it can be overwhelming even for a seasoned OR nurse to understand, and prioritize this complex, multifaceted environment. Being a high pressure environment, the OR can be a very fast-paced, stressful place. Surgeons' tempers can run high, and that can trickle down to the staff, placing more emphasis on creating smooth running process, by the OR RN. Eskola et al. (2016) noted that the OR can be a stressful practice environment, where nurses might have either job stress or job satisfaction based on their competence.

In my clinical example, the building was built in the early 1900's with many, many additions over the years. In the Operating Rooms suites, their locations were scattered on 3 different wings of the hospital, and on 2 different floors. In addition, the Central Supply, which sterilized and stored the surgical instruments and disposable supplies, was located in the basement of the original building, requiring multiple elevators trips to gather supplies. Also, the elevators were not dedicated to the OR's, but were general use elevators, which made timely delivery of supplies problematic.

In this environment, the OR nurse needed to be very skilled in stacking, as regards to equipment and supply prioritization and optimization of use. In today's hospital culture of, "just in time" supply delivery, many hospital items are not stocked in large quantities and so amassing of large quantities of possibly needed equipment and supplies was frowned upon. The prioritization skills of the novice nurse would have been taxed as even the more experienced nurses found the ability to have the correct supplies, in the correct quantities, in addition to planning for the unforeseen issues, daunting in the best of circumstances, and overwhelming in the worst of situations. Yildiz Findik, Ozbas, Cavdar, Yildizeli Topcu, & Onler (2015), remarked that the nursing students generally employed a helpless/self-accusatory approach among passive patterns as their clinical stress levels increased, and those who had never been to an operating room previously used a submissive approach among passive patterns.

In this environment, emphasis must be placed on the prioritization decisions in preparing and stocking supplies, and in the relationship management with the physicians. For example, in cultivating a high relationship management technique with the operating the physicians, the OR nurse was better able to anticipate needs and have the correct items available, when they were needed. Patterson, Ebright, & Saleem (2011) said that in particular, being proactive on certain tasks was believed to reduce the overall amount of time spent on them. Being proactive in the OR environment requires a certain level of self confidence in the ability to communicate information quickly, concisely and accurately.

References

Eskola, S., Roos, M., McCormack, B., Slater, P., Hahtela, N., & Suominen, T. (2016). Workplace culture among operating room nurses. Journal of Nursing Management, 24(6), 725-734. doi:10.1111/jonm.12376

Patterson, E. S., Ebright, P. R., & Saleem, J. J. (2011). Investigating stacking: How do registered nurses prioritize their activities in real-time? International Journal of Industrial Ergonomics, 41(4), 389-393. doi:10.1016/j.ergon.2011.01.012

Shirey, m. r., Ebright, p. r., & McDaniel, a. m. (2013). Nurse manager cognitive decision-making amidst stress and work complexity. Journal of Nursing Management, 21(1), 17-30. doi:10.1111/j.1365-2834.2012.01380.x

Yildiz Findik, U., Ozbas, A., Cavdar, I., Yildizeli Topcu, S., & Onler, E. (2015). Assessment of nursing students' stress levels and coping strategies in operating room practice. Nurse Education in Practice, 15(3), 192-195. doi:10.1016/j.nepr.2014.11.008

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