Celebrating All Who Say "I'm Possible"

With only two years of experience as a nurse and entirely new to the ED, Sara had just begun her evening shift. One of her patients, a seemingly physically fit male in his early 30’s, came to the ED complaining of chest pains that radiated to his back. He had been working in the hot sun all day and potentially had been exposed to solvents. He had no history of heart issues--or any health issues. His skin was cool, yet damp, but he was “joking and talkative” with everyone. “You can’t take symptoms at face value. You have to hit all the bases,” Sara said. “You can’t disregard anything."

Sara was the first to recognize that an ECG was mission-critical. She saw her patient starting to turn gray. “I immediately engaged a safety measure we have in our protocol that allows us to call for a 12-lead ECG without a doctor’s orders,” Sara said. She briefed her team and her actions ultimately led to the conclusion that the patient was on the verge of a catastrophic cardiac event. “I had a near-identical simulation as part of my training before transitioning to the ED. I left prepared to assert myself in a situation like this and manage the stress that can come with it.”

“When I worked in Med-surg, I worked in an environment where I mostly worked independently. In the ED, I was working as part of a team. It’s completely different. When we realized that the patient was on his way to a massive code, suddenly our entire team was engaged. A paramedic connecting the ECG, a nurse ordering blood work, another establishing an IV. It happened just as I experienced in our simulations, everyone performing their assigned roles.” The ER physician came in and ordered that the patient be transferred to the cath lab. The patient was in the ER for no more than 30 minutes.

“I knew every moment was critical,” Sara said. “But I’m amazed at how calm I was. I just kept repeating to myself, ‘Time is brain. Time is muscle. Get to the next level of care ASAP.’ I was the new nurse on the team. And, I’m probably a little shy. But, my simulation training taught me how and when to be assertive for the benefit of the patient and the team. It also taught me how to manage stress. I wasn’t quite satisfied with my first day of simulation, so I asked to go back for more. I left feeling over the moon at how confident I was after”

Sara’s story illustrates how simulation is being used in healthcare today to instill patient safety as a mindset. Historically, providers were confined to learning by treating real patients. The National Council of State Boards of Nursing (NCSBN) now recommends that simulation can be used to replace up to 50% of required clinical hours. Across healthcare, simulation is being used not only to teach clinical skills, but to teach critical thinking, leadership, and teamwork skills—the very skills exhibited by Sara to save her patient. “See one, do one” in healthcare is making room for “Simulate twice, act once.”

We would like to thank Sara and the simulation staff at Florida Hospital System for their mutual contribution to achieving the goal of zero preventable harm. It was because of their combined dedication and efforts—nurses, educators, and leadership alike—that Sara’s case that evening was not her first like it. If it were not for Sara’s simulation experience, she may not have been able to think as clearly and act as decisively as she did. You are examples to all of us in the simulation and patient safety community of what it means to say, “I’m possible.”