By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Many leaders today report to me that they feel like they are the device police on their units. When they attempt to raise concerns with staff about the importance of remaining situationally aware today, they often receive blank stares or shrugs of disinterest. Consider the following story from a nurse manager:
I discussed the problems associated with using personal devices, such as cell phones, AirPods, and Meta glasses, as a patient safety issue during my staff meeting today. However, my warnings seemed to fall on deaf ears. I tried to explain that aside from being rude and looking inattentive, using these devices makes us less situationally aware. We often overlook our colleagues and patients who need assistance. When patients or families begin escalating, we don’t see the telltale signs that can quickly de-escalate into violence. There is legal liability when you are not situationally aware and fail to hear alarms or detect a patient falling.
Some of my staff members discussed their need to shut down and withdraw to effectively do their work, and the role of these devices in helping them achieve that. I acknowledged that our work environment was stressful, but shutting ourselves off from it was not the professional solution. It isn’t an option – you’ll need to remain situationally aware, I explained. I will keep saying this, but it shocked me how hard this was to explain to my younger staff – they didn’t get it.
This nurse manager is not alone in her struggle. Conversations like this occur daily on units across the country. The recognition of the need for situational awareness has become cloudy with the rise of personal devices. Situational awareness is the ability to perceive, understand, and interpret information about your environment and the factors affecting it. It involves being aware of what is happening around you, recognizing potential threats or opportunities, and making informed decisions based on that understanding. Many automobile accidents and fatalities are an outcome of the loss of situational awareness by one or more of the drivers. You take your eyes off the road to read a text message – and a fellow driver makes an sudden turn or stop that you did not anticipate or see.
Teams perform more effectively when their members are alert and aware of what is happening with other team members. When situationally aware, teams can provide backup support, make assignment adjustments, and more effectively manage team emotions. Situational awareness is essential in clinical areas like emergency departments, where conditions can change rapidly. Teams with high situational awareness pay attention to the following areas:
- How are others on the team doing?
- Does anyone need my help to catch up with their assignment?
- Are there patients who seem to be high risk that were not identified as such in report?
- What is happening in the environment such as an increase in admissions and transfers that could impact the team?
- Are there angry patients or family members who seem to be escalating?
- Are there people walking around our unit or department that don’t belong here?
Here are some key ways to teach situational awareness skills:
- Ask the staff member to scan a patient’s room and identify at 3 three potential safety hazards.
- Debrief on situations where a violent incident has occurred – ask the staff to pick out three things that indicated the possibility of a violent threat.
- Present a clinical case situation and then ask for 2-3 things we need to anticipate could change and indicate decompensation.
- Choose a patient on the unit who is high risk for falls and then round with the team in the room to assess for fall hazards.
Some team members are naturally situationally aware, but others need to be taught and are more inwardly focused. You will need to be more explicit about what to keep an eye on in the environment.
© emergingrnleader.com 2025
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