25. A risk worth taking?
Older People's Forum
(R) That this meeting of RCN Congress supports the need for clear guidance for nurses who facilitate a positive risk taking culture when planning and delivering care
Result
The resolution was passed.
For: 97.11% (369)
Against: 2.89% (11)
Abstain: (18)
Debate report
Sue Edwards from the Older People’s Forum proposed the final debate of Congress 2013 on the challenging issue of risk.
The concept of risk assessment in care should be a simple one, but all practitioners are different which can result in bias and differences of interpretation. We can strive to reduce risk but it is inevitable that things will sometimes go wrong. We need to support staff to maintain a good patient relationship while also maintaining high levels of patient care.
Congress heard that practitioners need to decide what an acceptable level of risk is while also allowing patients to make their own risk decisions – which is a challenge in itself. The issue of risk is cultural, it is not simply about nursing.
People need to be given the tools to ensure they have the capacity to judge risk. However, Stephen Walton of the RCN Students Committee pointed out that as risk is fluid, it will be a challenge to provide a set of guidelines that can be used in every situation.
Harvey Morgan of County Durham and Darlington stressed that the College needs to change the culture of risk in organisations from the top down – in practice as well as in policy.
Background
In our daily lives we all take risks every day. We do so as part of life; exercising choices, making decisions, being in charge of our actions. These risks and choices can be miniscule, or huge, but they all theoretically pose risk. Broadly speaking, risk may be thought of as: the likelihood of an event happening with potentially beneficial or harmful outcomes for self and others.
Nursing vulnerable patients often poses the challenge of when and how to manage risks which may present themselves.
Risk is often perceived to have only negative connotations, it is coupled with the ideas of danger, damage and injury. However, in some circumstances within health care, accepting and managing risk and developing risk tolerance, can lead to valuable learning and life experience for the patient. Risk is a commonplace part of health care but often perception of risk is driven more by a fear of getting things wrong.
It may be challenging to tread the line between being overprotective (attempting to eliminate risk altogether) while respecting individual freedom and allowing patients to develop or maintain their independence through risk management.
A positive risk taking culture looks beyond the potential physical effects of risk, such as falling over or of getting lost, to consider the mental aspects of risk, such as the effects on wellbeing or self-identity if a person is unable to do something that is important to them.
Those involved in caring for vulnerable people may feel that they fundamentally have to do everything they can to avoid risk, to protect the individual from harm, and they may be entirely justified in doing so. Positive risk-taking is not negligence or ignorance of the potential risks. It is a balancing act between risk and gain.
Risk assessment is a common phrase in many clinical settings although there is evidence that a lack of training and support can lead many practitioners to see risk management through a very narrow lens; believing that all risks need to be minimised or eliminated and therefore missing any benefits there may be in taking calculated risk in the patients’ interest. Risks and benefits of any given situation need to be considered together and outcomes may be different for each individual patient.
The media often rely on sensational reporting of health care failures to drive public debate on services. As such nurses may be discouraged from taking risks with innovative approaches to service delivery, fearing public criticism or condemnation. A target culture and need to be seen to make constant progress and improvement can also drive out innovation as risk taking can be slower, and more expensive in the short run.
References and further reading
Department of Health (2010) ‘Nothing ventured, nothing gained’: risk guidance for people with dementia, London: DH. Available at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_121493.pdf (accessed 14/03/13) (Web).
Morgan S (2004) Positive risk-taking: an idea whose time has come, Health Care Risk Report, 10(10), pp.18-
19 [online]. Available at: http://practicebasedevidence.squarespace.com/storage/pdfs/OpenMind-PositiveRiskTaking.pdf (accessed 14/03/13) (Web).
Nursing and Midwifery Council (no date) Guidance for the care of older people, London: NMC. Available at: www.nmc-uk.org/Documents/NMC-Publications/NMC-Guidance-for-the-care-of-older-people.pdf (accessed 14/03/13) (Web).
