Failure to rescue: A potential measure of school nursing practice

Vigilance has been central to nursing practice since Florence Nightingale, but measuring vigilance has become increasingly significant in our outcomes driven health care delivery system. “Failure to rescue” (FTR) has emerged as an outcomes measure that is sensitive to the measuring nursing vigilance in acute care settings. Interest in this concept has result in its evolution to other practice settings. Critical components of vigilance (anticipation of impending problems; knowing when immediate action is necessary; mounting an effective response) have been identified in the literature. This project analyzed anecdotal stories and media accounts to identify critical components of vigilance in school nursing practice and to describe the relationship of school nurse vigilance to school deaths and school rescues. These findings provided an initial description of concept of vigilance unique to school nursing practice and provided evidence for the critical role that school nurses play in determining the outcome (life or death) when a catastrophic event happens at school. Accurate definitions of the FTR term and sound evidence into predictors of FTR may provide the data to demonstrate that school nurses are a reasonable and cost-effective investment for meeting the obligations of schools and communities to keep children safe in school. The results of this work indicate that there is potential to use FTR in areas of nursing practice outside of acute care. Future studies are needed to explore the concept of vigilance and the FTR measure in other public health nursing specialties.