Mikayla is a bedside nurse on a same-day surgery unit. Mikayla noticed that when she discharges a patient the physician does not consistently order a postoperative office visit. Often, the patient is discharged home without a scheduled postoperative visit with the surgeon. Mikayla discusses the problem of postoperative patients not having a follow-up appointment with the surgeon at the next monthly unit meeting. The unit manager assumed all patients received a follow-up office visit appointment, as she assumed it was part of the postoperative protocol and no one raised this problem previously. The unit manager listens to Mikayla’s concerns and decides the post-operative discharge protocol needs to be updated. The unit manager assembles an interprofessional team to address the problem.

Because Mikayla provides direct patient care to this population of patients, she is able to identify a problem and call attention to her concerns about the quality of patient care processes. In this example, Mikayla identified a situation that could detrimentally affect patient care outcomes. Mikayla recognizes her role in QI and felt supported in voicing her concerns. The unit manager has created an environment of openness and encourages her staff to discuss patient-safety concerns. Because direct care nurses have a unique perspective on patient care, they can identify problems in providing quality patient care. Nurses have an obligation to question current nursing practices when a process does not meet the expected outcomes.

1.

Why are bedside nurses in a good position to discover clinical problems?

2.

How did the unit manager’s attitude toward QI encourage Mikayla to speak up about a clinical problem?

3.

If the unit manager displayed a negative attitude toward QI, what other avenues could Mikayla pursue to resolve the clinical problem?