Beyond the Checklist ... What Else Health Care Can Learn From Aviation Teamwork and Safety, Suzanne Gordon, Patrick Mendenhall, and Bonnie Blair O'Connor, 2013. Ithaca, NY, and London, England: ILR Press, an in-print of Cornell University Press. Softcover, 264 pages, $69.95 cloth, $19.95 paper.
Suzanne Gordon is well known to nursing. As a journalist, she conveys the stories of nurses caring directly for patients as a voice that needs to be heard and reaches many outside nursing. In this book, along with her coauthors, she tackles a challenge all in health care face: Safety. In his foreword, Captain Chesley "Sully" Sullenberger makes the connection between aviation and health care. Captain Sully was the pilot who successfully landed Airways flight 1549 in the Hudson River, January 15, 2009. He credited crew resource management (CRM) training that enabled his crew to help him safely land the plane. In his foreword, he states:
Because of CRM's sea change in our workplace culture, flying-which is inherently dangerous-has become remarkably safe. Travel through the world of high-tech medicine, which can be hazardous for individual patients, is now being made safer wherever hospitals truly embrace similar methods of interprofessional teamwork and training.
This is a book about teamwork in a highly stressful industry. Teams learn concepts such as cross-monitoring, mature leadership, assertive followership, briefings and debriefings, situational awareness, being aware of the danger of assumptions, task saturation, fatigue, and distributed cognition (p. 210). CRM requires team intelligence.
"Team intelligence is the active capacity of individual members of a team to learn, teach, communicate, reason, and think together, irrespective of position in any hierarchy, in the service of realizing shared goals and a shared mission" (p. 10).
If you believe as I do, moving from a hospital-based system to a population-based one does not make these challenges go away. Behaviors such as physicians ignoring nurses or nurses afraid to speak up would not be tolerated in a CRM culture. In population management, a team member may be a competitor, making this approach to team even more important. There is much more detail about CRM in the book. There are 11 chapters supplemented with an Appendix, Glossary, Notes, and Index.
As we move the center of health care outside the hospital walls, it is ever more important to implement this kind of thinking. Crew resource management is not the only method to create intelligent teams but as your organization finds its way in the new system, this is one approach to consider. Not because we will be rewarded for value and not volume but because fatal errors are no longer acceptable even in a complex, high stress, high volume industry. The authors acknowledge the current challenges to both industries such as mergers, consolidations outsourcing, "work intensification" (the attempt to get more out of workers with fewer resources) (p. 207). Just as we learned in our quality journey, it is a journey that is continuous and able to respond to change. Crew resource management cannot be learned in a 4-minute video or an online course. Very powerful stories and anecdotes about both aviation and health care are dispersed throughout the book. The authors do an excellent job of making the case for teamwork and safety. Even if you have started another methodology to create a culture of safety, the book will be a good check and balance as to whether you have addressed all issues.
-Elizabeth (Betty) Falter, MS, RN, NEA-BC
Note: The following review was invited by me. Sigma Theta Tau sent a book I thought pertinent to our upcoming retiring nurses. Hospitals have always had volunteer departments. I cannot imagine delivering population health without volunteers, especially experienced nurses. I worked as a head start nurse for 3 years. I cared for my kids and their families with the support of public health nurses, nurses in doctor offices, and the many volunteers who helped bring education and health care to this community. Lucy Read is a great resource both to the community of Tucson and the University of Arizona, College of Nursing. Thus, she is an invited reviewer.
Volunteering at Home and Abroad: The Essential Guide for Nurses, Jeanne Leffers and Julia Plotnick, with input from 40 global contributors, 2011. Indianapolis, IN: Sigma Theta Tau International. Softcover, 308 pages, $24.95.
Both authors have records of distinguished nursing careers, organizational leadership, and extensive volunteer service. They encourage various types of volunteer experiences for nurses because they truly recognize the value of volunteer work for themselves and for others-a boost in self-regard, an added depth to resumes, new skills, life meaning and satisfaction, physical and emotional well-being, greater social connectedness, and a global perspective of health and nursing care. From their combined voice of experience, the authors are able to offer a comprehensive guide to nurse volunteering at home and abroad.
There is concise and practical information about matching personal passions and motivation for volunteer service with actual volunteer opportunities. As respectful, empathetic and compassionate persons, nurses are frequently thought to make valuable volunteers in community and/or global positions. Self-assessment checklists in this book assist readers in identifying personal needs and characteristics along with professional skills. An honest and thorough assessment will aid volunteers in any of the following nursing roles: direct service, education, research, administration, health promotion, policy making, collaboration, board involvement, advocacy, or consultation.
Equal time is given to the process of finding international volunteer opportunities through online resources, churches, colleges, professional publications, nonprofit organizations, and guidebooks. The authors suggest completing a review of organizations and program opportunities and then incorporating that information into the self-assessment profile. This is a way to avoid a poor fit for the overall experience. For example, living with a large Spanish-speaking family without a separate room/comfortable bed, hot shower, or morning cup of coffee while caring for critically ill patients 12 hours per day might not be the best placement for an experienced nurse volunteer who does not speak any Spanish and who needs her own space and creature comforts.
Preparing for an experience abroad requires close attention to details and logistics: determining the time commitment, making travel arrangements, developing realistic expectations and goals, learning about endemic health problems, developing a sense of cultural and political awareness, managing the costs of the assignment, getting immunizations, knowing what to take, language study, and licensure. While detailing the topic of required licensure at home and abroad, this book omits a discussion about the difficulty in maintaining licensure when full-time employment ends. Consider the waste of professional expertise, knowledge, and skills when retired nurses-many of whom now have time and desire to volunteer-are excluded from volunteering altogether. Perhaps state boards of nursing should consider a new category of "nurse volunteer" for retired nurses who have been licensed to practice for many years. In several areas of the world, nonnurse community health workers (called "promotoras," in Mexico) educate the public on health, safety, and hygiene issues. Many retired nurse volunteers could make valuable contributions to various health care initiatives during their encore years. See http://www.hciproject.org for more information on the USAID Healthcare Improvement Project.
Serving as a volunteer means working for little or no pay. In fact, volunteers often must make a significant financial contribution to cover travel, administrative costs, host country transportation, plus food and housing associated with the experience. Nurse volunteers need to know that expenses vary among different organizations and in different locations of the world. Faculty exchanges, experiential learning programs for student nurses, and disaster volunteering are not exempt from this financial commitment.
Returning home from a global volunteer experience requires introspection, debriefing, and adjustment. Sharing experiences with others is helpful and may be a catalyst to propel nurse volunteers forward in facing new challenges. Volunteering at home or abroad is physically and emotionally demanding. It is not without risk for personal health, safety, or well-being but certainly has great rewards in terms of personal or professional growth and job satisfaction.
Nurses going through transitions in their own personal lives or professional careers as well as baby boomer nurses contemplating next step scenarios will benefit significantly from reading this book. As you read this comprehensive guide, you may want to listen carefully to your own "inner coach" about taking on an exciting nurse volunteer role either at home or abroad.
-Lucy Read, MA, RN (Retired)