Advocating for patient safety: patient safety is ensured when nurses have the competence, the resources and the autonomy to evaluate their patients' needs and changing conditions.

Nurses play a vital role in advocating for patient safety. They are responsible for the needs of the patients in their care and are closely Linked to the issues facing patients. Through careful monitoring, assessment and evaluating patients, nurses can make sure care is delivered in a timely manner and is safe. A recent committee in the United States looking at the work environment for nurses and patient safety states: "a primary activity performed by nursing staff in all hospitals, long-term care facilities, and ambulatory settings is ongoing patient surveillance (or referred to as assessment, evaluation or monitoring)--on important mechanism for the detection of errors and the prevention of adverse events." (1) Therefore, monitoring a patient's condition and acting on the signs and symptoms that present is crucial to patient safety and fundamental to nursing practice.

Nurses who fail to monitor a patient's condition or act upon the consequences of a patient's deterioration could find their practice being scrutinised by the Health and Disability Commissioner (HDC), Accident Compensation Corporation (ACC), Nursing Council or the Health Practitioners' Disciplinary Tribunal established under the Health Practitioners' Competence Assurance Act 2003.

Competency requirements in nursing practice are fundamental to all aspects of patient care. This includes the provision of staff who are well trained and who have access to professional development as an essential component of their employment. This development should not be rationed or restricted. It is imperative that health practitioners maintain their competency when practising. Under the HPCA Act, all health practitioners are required to demonstrate their competency to the regulatory bodies. Health practitioners who pose a risk of serious harm to the public will be investigated and their competency scrutinised under this legislation.

Right 4 of the Code of Health and Disability Services Consumers' Rights stipulates the rights of consumers. (2) (See table below.) This has been used in many HDC investigations where health practitioners have breached the code by not providing services of an appropriate standard. Many adverse patient events investigated by the Commissioner have, in part, been due to the failure of nurses to monitor patients successfully and to take action to prevent harm to patients. The Commissioner's opinions can be found on the HDC website, www.hdc.org.nz. Accessing these opinions is valuable to all health practitioners in order to learn from the events and to prevent similar incidents from occurring.

Nurses are the essential link to quality initiatives and improvement programmes regarding patient safety. Quality initiatives are not successful without the valued input of nursing knowledge and experience. Nurses have a lead role in patient safety and have campaigned for the resources needed to ensure care is delivered to the appropriate standards.

The restructuring of health services over the last two decades has had a significant impact on patients' care and the delivery of effective nursing care. A number of organisations are rebuilding existing services or developing new ways of providing care within limited financial resources. When services are renamed or reconfigured, nurses need to understand all future implications for their practice. Nurses' contribution in these processes is fundamental, so these changes must include the know-ledge nurses have about patient care and safety.

The participation of nurses is essential when organisations are making decisions that influence patient care. The recognition and empowerment of nurses within the health workforce is crucial for continuing safe patient care. Nurses need to be active and aware of changes. Nurses behave professionally and ethically when they highlight system or resource deficits that may lead to adverse patient outcomes. What can individual nurses do to ensure patient safety? They need to monitor a patient's condition and act early to detect and prevent potential problems which may cause complications. They need to document their assessment and the subsequent actions taken. If they are unable to maintain adequate standards of care because of workloads, lack of resources or high patient acuity, they should fill out incident forms and submit these to their employer for further examination.

NZNO and its members are committed to patient safety. Many of NZNO's initiatives, campaigns and publications are designed to help members articulate issues and problems that compromise patient safety. These are outlined on NZNO's website www.nzno.org.nz. NZNO members, regional council delegates and colleges and sections are all advocate for improved conditions to ensure patient care and nursing care is effective and safe.

Code of Health and Disability Services Consumers' Rights, Right 4

1) Every consumer has the right to have services provided with reasonable care and skill.

2) Every consumer has the right to have services provided that comply with legal, professional, ethical and other relevant standards.

3) Every consumer has the right to have services provided in a manner consistent with his or her needs.

4) Every consumer has the right to have services provided in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.

5) Every consumer has the right to co-operation among providers to ensure quality and continuity of services.

References

(1) Page, A. (ed) (2004) Keeping Patients Safe: Transforming the Work Environment of Nurses. The Institute of Medicine of National Academies--Committee on the Work Environment for Nurses and Patient Safety. Washington, DC: The National Academies Press.

(2) Health and Disability Commissioner. (1996) The Code of Health and Disability Services Consumers' Rights, Health and Disability Commissioner Regulations. Wellington.