Unique Training for Student Nurses
Director of NCPS' Clinical Team Training Program, Gary Sculli, M.S.N., A.T.P., lectures nursing students at the University of Michigan School of Nursing.
Aspects of the NCPS Clinical Team Training (CTT) program are being presented to nursing students at the University of Michigan School of Nursing to promote a fundamental aspect of patient safety: clear communication.
“Improving communication is one of the cornerstones of developing a culture of safety,” said Gary Sculli, M.S.N., A.T.P., the director of the CTT program at NCPS. “It’s been a privilege over the last few years to introduce a number of important communication techniques to nursing students, things they can use every day as they enter the health care arena.”
The CTT program creates an opportunity to improve patient safety and reduce the risk of patient harm by facilitating clear and timely communication through collaborative teamwork in the clinical workplace. The program introduces the principles of aviation’s Crew Resource Management (CRM) that have been developed in a clinical context to model specific applications in health care.
CRM was implemented by the airline industry in the early 1980s after a series of highly publicized accidents resulted from poor communication and team decision making, not from mechanical malfunctions. Today, the airlines enjoy an exemplary safety record, due in large part to the implementation and sustainment of CRM methodologies.
Dana Tschannen, Ph.D., R.N., clinical associate professor, University of Michigan School of Nursing, and Gary Sculli, M.S.N, A.T.P., director of NCPS' Clinical Team Training Program.
“In review of medical errors occurring in hospitals, it’s very clear that a root cause of many of these incidents is communication-related,” said Dana Tschannen, Ph.D., R.N., clinical associate professor, University of Michigan School of Nursing. “The training Gary provides offers some very specific, practical tools that are easy to understand and implement in the patient care setting. They can be used to ensure that correct clinical information is being passed along by nurses, physicians and others involved in patient care. This improves team situational awareness and ultimately decision making."
Gary has worked collaboratively with Dr. Tschannen for the past several years, providing a CRM workshop for B.S.N. students at the senior-level “Leadership and Management” course at the School of Nursing.
“Insufficient communication” was the most frequently cited root cause of the nearly 3,000 sentinel events reported to the Joint Commission between 1995 and 2004. Joint Commission statistics (2004-2013) also indicate that more than 60 percent of the time communication failures continue to be cited as a major root cause in reported sentinel events.
Of the wide range of topics Sculli presents to the students is the idea of “effective followership,” which means taking an active role that requires an ability to directly and promptly communicate concerns about patient safety.
Effective followers practice “assertive inquiry,” questioning patient care decisions when there are concerns about the appropriateness of that decision, and “assertive advocacy,” promoting the best course of action for safe patient care, regardless of team or organizational hierarchy.
“Taking action is a bold step and followership is not for the faint of heart,” Sculli said. “You take responsibility for team decisions and preserve operational safety. You have to speak up when necessary.”
“Others on the team may be just as concerned, but don’t have the courage to speak up at that moment,” he continued. “If you do, you are demonstrating effective followership. In fact, speaking up with concerns serves not to degrade, but strengthen a team leader’s ability to make appropriate and safe decisions when managing clinical problems.”
Sculli provides students with practical ways to intervene in a difficult situation through using communication tools like the “3Ws”:
- Say what you see
- Say what you are concerned about
- Say what you want to happen
His approach using specific tools to improve communication, with real-world examples of how they have been used, has been well received by previous students.
“I spoke with a student who had graduated from our program. She ranked the topics covered in CRM as among the top five experiences that prepared her for nursing. The importance of having easy and effective communication tools cannot be overstated. We, as health care professionals, must effectively communicate with one another in order to provide optimal patient care,” concluded Dr. Tschannen.
Learn more
- CTT
- Topics in Patient Safety (Dec/Nov 2013)
- Topics in Patient Safety (May/June 2013)
- University of Michigan School of Nursing
References that provide more detailed information
Aebersold, M. Tschannen, D. & Sculli, G. (2013). Improving nursing student’s communication skills through utilization of crew resource management strategies, Journal of Nursing Education, 52(3),125-130.
Sculli, G.L., Fore, A.M., West, P., Neily, J., Mills, P.D., & Paull, D. E. (2013). Nursing Crew Resource Management: A Follow-up Report From the Veterans Health Administration. Journal of Nursing Administration, 43(3), 122-126.
Sculli, G.L., Fore, A.M., Neily, J., Mills, P.D., & McKnight, S.C. (2011) The case for training VA front-line nurses in Crew Resource Management (CRM). Journal of Nursing Administration, 41(12), 524-530.
