DNP-Educated Nurse Leaders Developing Situational Awareness

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Situational awareness (SA), or the ability to anticipate and act on needs based on the surrounding events, began as a foundational theory for sound decision-making in military planning, law enforcement and aviation. SA has since been adopted in nursing to promote effective leadership and healthy patient outcomes.

For nurse leaders, situational awareness in healthcare means understanding how to be prepared in any situation and to remove obstacles for better delivery of care.

“Healthcare leaders must understand the critical link between situational awareness and clinical decision-making,” Gary Sculli and Douglas E. Paull, the authors of “Building a High-Reliability Organization: A Toolkit for Success,” said in an excerpt.  “SA depends on teamwork and communication. A culture that facilitates communication leads to improved SA, better decision-making and better outcomes for patients.”

The authors said leaders are responsible for creating a culture of communication and respect, which can help to develop situational awareness in healthcare. For registered nurses (RNs) who are pursuing higher levels of education, including through an online DNP program, learning about being an effective nurse manager is one way to improve SA in healthcare.

Understanding Situational Awareness

Situational awareness has its roots in industries that require split-second decisions in life-and-death situations – such as military exercises, law enforcement operations and aviation emergencies. In healthcare, situational awareness links understanding a patient’s current and future needs to clinical decision-making.

In 1995, Mica Endsley, Ph.D., a former U.S. Air Force chief scientist and situational awareness theorist, defined three levels of situational awareness. The three steps to SA are still considered relevant today.

Level 1—Perception

Clinicians gather patient information through physical exams, reading medical charts, reviewing data and speaking with other team members.

Level 2 ­—Comprehension

Clinicians analyze and examine the information gathered and use the results to form a decision.

Level 3 ­—Projection

With information and decisions from the first and second levels, clinicians can predict events that may occur, which supports short-term planning.

“Within healthcare organizations, these three levels are critical to being proactive, rather than reactive, when unexpected events or emergencies occur in the clinical setting,” the medical technology company Amplion said in its white paper, “How Real-Time Situational Awareness Improves Patient Outcomes.”

Because SA plays an integral role in nursing, nurse leaders must understand how to apply the tenants of SA to their practice, Kirsten Drake, DNP, said in “How to hone situational awareness.”

Refining Situational Awareness Skills in Nurse Leadership

Drake, in the journal Nursing Management, said being an effective nurse manager who uses SA begins with being self-aware.

“Evaluating your strengths, challenges (weaknesses) and natural leadership tendencies will help you understand how you tend to respond to situations. Leaders with high emotional intelligence who can recognize their own and others’ emotions exhibit stronger situational awareness,” Drake said.

Drake also said that a critical component of SA is observation. Nurse leaders must watch routine and uncommon events alike to learn how the staff reacts. Being present in the moment allows nurse leaders to understand and assess the situation.

When reviewing the circumstances of a situation, nurse leaders should consider an after-action review, Drake said, which should focus the actual outcome instead of the intended results.

“This practice is frequently a team activity that can provide you with insightful information about how your team works and help you learn from being transparent about your actions, as well as those of your team members,” Drake said.

Drake also said nurse leaders must remember that all actions and decisions have consequences and that a failure to act is an action as well. She said the best leaders involve staff members in decision-making for a better level of overall accountability.

Benefits of Situational Awareness for Nurse Leaders

In its white paper, Amplion also said situational awareness provides key advantages in healthcare scenarios, including:

  1. Better patient outcomes
  2. Improved patient satisfaction
  3. Fewer patient safety errors
  4. Increased nurse retention.

Frank Grant, president and CEO of Amplion, said SA helps clinicians become more proactive rather than reactive.

“Clinicians are constantly faced with situations that require on-the-spot thinking and response,” Grant said. “Achieving situational awareness takes practice.”

For nurse leaders, SA proficiency also comes as a result of a well-rounded education. Registered nurses (RNs) seeking a doctor of nursing practice (DNP) degree learn advanced proficiencies to lead healthcare teams. At Duquesne University, students enrolled in the online DNP program learn work in an academic environment that encourages situational awareness and critical-thinking skills.

About Duquesne University’s Online DNP Program

Duquesne University’s online DNP program prepares RNs to become leaders who use situational awareness for positive patient outcomes. The terminal nursing education prepares students with a focus on one of three areas of study: Transcultural Nursing, Forensic Nursing or Nursing Education.

Duquesne University has been repeatedly recognized as a leader in nursing education, most recently as a “Best Online Graduate Nursing Programs” by U.S. News & World Report. The university’s online DNP program provides one-on-one faculty mentorships and a 100 percent online curriculum. For more information, contact Duquesne University now.



Situational Awareness is an Important Part of High Reliability: PSQH

How Real-Time Situational Awareness Improves Patient Outcomes: Amplion

How to hone situational awareness: Nursing Management

4 Benefits of Leveraging Real-Time Situational Awareness in Healthcare: HIT Consultant