Top tips from Tanis

Published: 27 February 2012

The RCN’s Adviser for HCA and AP members gives advice on how to manage risk and help keep people safe in places of care

We are focusing on each of the RCN’s Principles of Nursing Practice in our eNewsletters as they are such a fundamental part of good nursing care. Whether you’re a health care assistant (HCA) or assistant practitioner (AP), and whether you work in acute care, mental health, the independent sector or indeed anywhere, the Principles will apply to you and your colleagues.

The Principles make clear exactly what quality nursing care looks like. They can be used by nursing staff, colleagues, patients, or the families or carers of patients.

Principle C

Nurses and nursing staff manage risk, are vigilant about risk, and help to keep everyone safe in the places they receive health care.

So, Principle C is about the safety of all people (patients, visitors and staff), the environment, organisational health and safety, management of risk, and clinical safety. I will use a very simple and practical example to help illustrate what it might mean for you.

I used to work in general practice and ran the diabetes clinic in a small treatment room with a couch, a desk, a chair for the patients and a bookcase. Every day I would assist patients up from the chair onto the couch so that I could examine their feet. If they were unsteady there was a risk of the patient falling as they climbed on or off the couch. There was also a risk to me as I "assisted" them as carefully as I could. If they were unable to climb onto the couch I had to crouch down and perform the foot examination on my knees – not good practice in any shape or form.

So, with a little bit of thought, we moved a phlebotomy chair into the room, which could be laid back and raised or lowered. It was also wider and therefore more appropriate for some of the larger patients. I could safely perform the foot examinations at a good height without risk to the patient or myself. This was a very small amount of effort, and a minimal cost to reduce a series of risks in a practical way.

HCAs and APs are vitally important to this agenda. Imagine a typical day wherever you work, and ask yourself what the key risks are to staff, patients and visitors. Choose one of these groups and then ask yourself if there is anything that could be done to reduce the risk. It could be as simple as attending a training session, but small changes often make a world of difference. See if you can implement something to make you and your colleagues, or patients and visitors safer and let us know your success stories at hca.ap.newsletter@rcn.org.uk

Saying ‘no’ can also reduce risk

All the Principles link together and shouldn’t be used in isolation. Think back to Principle B which is all about responsibility and accountability. Have you ever been asked to perform a task that you aren’t competent to perform? Is there any aspect of your role that you do not feel comfortable doing, perhaps because you feel that you need a better understanding or greater knowledge, or possibly more supervised practice before doing it on your own?

If there is, saying “no”, and explaining why would have a huge impact on your patient/client’s safety and also yours too. Remember that you should always speak with your supervisor first, and you will definitely benefit from discussing issues so you don’t feel that you’re putting yourself or others at risk.

What if you witness poor practice?

Do you have the confidence to speak up about it? There is advice about raising concerns on the RCN website and we have a whistleblowing hotline so you can confidentially express your worries if local reporting processes have failed. Call 0345 772 6300 if this applies to you. Read more (PDF 536KB) [see how to access PDF files].