Authors

  1. Pettit, Elizabeth L. MSN, RN

Article Content

How do nurse educators teach patient advocacy? Nursing faculty in our community college addressed this issue by incorporating TeamSTEPPS strategies in simulations. Students were taught to express safety concerns using the TeamSTEPPS CUS technique and 2-challenge rule. CUS is an acronym for I'm Concerned, I'm Uncomfortable, this is a Safety issue. The 2-challenge rule states a team member has the responsibility to assertively voice a concern at least 2 times. Twenty-three LPN-EMT bridge-to-RN students answered survey questions on years of work experience, comfort level on questioning orders, and frequency of addressing patient safety concerns. Most of these health care workers had 6 to 10 years of experience and were comfortable expressing safety concerns with physicians and supervisors but did it less than once a month. The students first viewed TeamSTEPPS videos and then participated in a simulation where a physician ordered lactated Ringer's intravenous (IV) fluid for a patient with liver failure. Even though the students had discussed contraindications to using lactated Ringer's in their laboratory experiences, 2 of 6 simulation groups did not question the IV order in the simulation. During debriefing, the facilitator and students addressed basic IV fluid concepts and explored complex issues involving nursing role, hierarchy, effective communication strategies, and advocacy. From these conversations, it was evident that students need more simulations to practice their communication skills. The nurse educator should use debriefing for reflection on behavior and guide students into becoming strong patient advocates.