An Innovative Approach to Excellence in Nurse-Sensitive Outcomes:

Purpose:
Positively influence nurse-sensitive outcomes and mindful organizing through a structured conversation examining hazards during risk resilience conversations.

Significance:
Safety occurs when nurses recognize, adapt to and absorb changes and disruptions falling outside the set of disturbances the nurse is designed to handle. Adaptation, situational awareness and pre-designed defenses are components of risk resilience conversations influencing nurse-sensitive outcomes.

Strategy and Implementation:
The risk resilience conversation strategy is derived from mindful organizing, illustrating hazard recognition and hazard containment. The structured conversation triggers a preoccupation with failure, sensitivity to operations and reluctance to simplify interpretations. This strategy influences identification of pre-designed defenses, adaptations and escalations, allowing adaptation to constant threats in the nursing work environment. Risk resilience conversations are a structured exercise that walks the team through steps following an event that include identification and strengths and weaknesses of the following: pre-designed defenses, adaptations, escalations and assumption. Hazards related to the identified assumption are identified by team engagement around action steps to eliminate or mitigate hazards in the future. Implementation of risk resilience conversations have occurred within the interdisciplinary nurse-sensitive teams as well as during rounds and safety huddles.

Evaluation:
Measured effectiveness includes but is not limited to demonstrated improvement in nurse-sensitive indicators and outcomes including fall, pressure ulcer and hospital-acquired infections.

Implications for Practice:
Implications for practice are remarkable. The identification of factors predictive of hazards and situational awareness among nurses influences the design and implementation of interventions aimed at eliminating unnecessary hazards negatively influencing nurse-sensitive outcomes.