What's tested on the NCLEX: Safe and Effective Care Environment

First, and foremost, it’s important to be an advocate for the patient. The RN is the health care professional spending a majority of time with the patient. Thus, it’s also the person who knows the patient best among the healthcare team.
In advocating for the patient and managing their care effectively, it is the RN’s responsibility to make sure informed consent is obtained before procedures. That does not just mean signing the paper the doctor hands you after explaining a procedure to a patient. Rather, it is the RN’s responsibility, as well as her/his right, to confirm and ask the patient if they understand what is going to happen to them. Thus, look to see if the patient looks confused, or ask if they have any questions before signing consent as a witness.

Confidentiality is an important part of a safe and effective care environment. This includes asking a patient if he/she is comfortable answering questions and talking about their health care with family members in the room. Note, just because a patient’s spouse is in the room doesn’t give the spouse the right to be a part of the patient’s health care decisions.
Alternatively, also consider that a patient may want someone they trust in the room to have a second pair of ears when they are receiving information. Given how overwhelming the health care setting can be, perhaps the patient would even like to delegate a health care proxy and or living will to aide in decision making. As RNs, we can provide the information to the patient on these advanced directives.
Reporting information over the phone is another component of confidentiality. All too often, we receive calls from family members wanting updates on patients. However, because we are never able to 100% confirm the caller’s true identity, limited information should be given over the phone.

In nursing school, we are taught that from the moment a patient is admitted to the hospital, a discharging planning should begin. With this planning comes anticipating the needs of the patient at home. Will this patient need oxygen? Will they require visiting nurse services? While these are tasks for case management to coordinate, it is the primary RN’s role to ensure that work behind the scenes is happening so that the patient can discharge home safely.
Delegation of tasks and prioritization of care are key components for the RN that will make the tasks, such as the one previously mentioned, more doable. Look at the tasks ahead of you and decide what you can ask your nursing assistant for assistance with. Be sure the tasks you are delegating are within the professional’s scope of practice though. In other words, a patient care technician should not be passing out medications. Also, assess who is most critical and should be seen first. For example, the patient with the trach collar should be seen before the patient with cellulitis.

Safety is our second subcategory and of huge concern in the hospital setting. Proper medication administration includes giving the right patient, the right dose, the right drug, through the right route, at the right time. Two patient identifiers, name and date of birth, will aid in confirming the right patient. Checking medications at the bedside and signing them off in the electronic medication record will also prevent errors.
Another way to provide patient safety is through hand hygiene, especially when working with a patient’s IV line. Be sure to wash your hands, wear gloves, and scrub the hub for 15 seconds prior to connecting tubing to prevent central line associated bloodstream infection.
Hospital falls are another safety concern. All patients should be assessed once a shift for any cognitive changes or changes in medications that may increase their risk of falls. Patient falls can be detrimental to the patient, and while sometimes unavoidable, there are many interventions that can be implemented to prevent them: yellow socks, hourly rounding, frequent toileting, a reachable call bell, and a side table with the patient’s personal belongings. Always make sure you are reassessing your patients’ fall risks.
Further, to protect yourself, your patient and other patients, always maintain the appropriate standard precautions. Does your patient have the flu? Droplet precautions should be maintained, meaning you are wearing a gown, gloves, and mask upon entering a room. Is your patient neutropenic? Have they been educated on hand washing, avoiding fresh fruits and flowers, as well as other individuals who are sick?