1. Nadler-Moodie, Marlene MSN, APRN, PMHCNS-BC

Article Content


Specialty adult-focused environment (SAFE) units offer a different and unique alternative to the use of constant observers, "sitters," for providing care for medical- surgical patients who require increased observation for a variety of safety concerns.



Ensuring safety for patients with increased safety needs, such as for agitation, high fall risk, delirium and confusion, vision or hearing impairments, and inability to follow commands to not pull at intervention "lines," poses a challenge for nursing staff on busy medical-surgical units. The use of "sitters" is widespread but quite costly. Maintaining safe clinical practices while minimizing costs is needed in today's healthcare environment.



The design of the SAFE units at Scripps Mercy Hospital in San Diego, CA, a 300-bed, inner-city, trauma 1 center hospital, has demonstrated success since the first unit opened in 2004. There are now 6 units operating, all of which have reduced their "sitter" use.



The basic premise includes cohorting "like" patients in close proximity to each other so that staff members are able to attend to them frequently. The environment is fashioned to include additional diversion equipment; all patients are seen by an occupational therapist and all nursing staff attend education sessions regarding the care of this patient population.



There was an approximate cost savings of more than $500,000 between fiscal year 2006/2007 and 2007/2008 in sitter reduction; this trend continues.



The initial vision that included creating a "sitter-free" environment, which promotes autonomy and dignity for patients and provides assurance for nursing staff that patients are cared for safely, has not only succeeded on the first unit but has also grown well beyond.


Implications for Practice:

The clinical nurse specialist has been instrumental in the development process, education and training for the staff, rounding on the units, and general nurturing of the growth of the concept. SAFE units are a practical and economical alternative approach for safe patient care and can be replicated in other facilities.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.