Nursing Staff Spotlight: The “A” Team
For Amber Harkey and Andrea Safford, quality work is not something that happens behind the scenes. It is woven into the care they provide every day at the bedside. Known affectionately as the “A” Team on 5 Main, these two nurses balance direct patient care with unit quality leadership, helping translate best practices into meaningful improvements for patients, families, and fellow nurses. Their story illustrates how frontline nurses can drive change, strengthen safety, and make quality work feel less like an extra task and more like an essential part of exceptional patient care.
1. What inspired you to become a nurse, and what has kept you passionate about bedside nursing?
Andrea: I was that person who had no real medical knowledge until I had to learn on the fly. My twins endured a lengthy 6 month NICU stay, my oldest daughter has lifelong disability needs, my son had brain cancer at 4, my middle daughter developed psoriatic arthritis at 4, and my youngest son dx with asthma at 2 after 2 hospital stays. Needless to say I learned so much from these experiences they don't teach in text books. I knew I needed to do something more with all this knowledge and decided to go back to school for nursing. The connections made with patients and their families, knowing our Quality work helps keep these kids safe and the team we work with keep me passionate about bedside nursing.
Amber: I feel like I have a typical answer, that I knew from a very young age that God put on my heart that I wanted to help people in some form or fashion. One of my older cousins is a L&D nurse and would come to my grandmas when we would all get together and tell stories of her work. Hearing her stories and the difference she made and her passion for it is what first made me interested. In high school, I got my CNA and learned how it really felt to care for a population that was vulnerable and needed love and healing, but so sweet. I was given the opportunity to shadow a nurse here at Cook while in high school and that solidified that pediatrics was where my heart was. What keeps me passionate about nursing are the kids and their families we care for. We have the unique chance to see some families on their worst, scariest day and it is very rewarding to comfort them then, care for the child in the middle, and see them get to go home happy and healthy. Quality work too has brought a whole new light to how to care for these patients while they are here and the "behind the scenes" work that goes on.
2. How did you become involved in quality work, and what does that role look like alongside your clinical responsibilities?
Andrea: I joined the CLABSI Champions in 2022 and really enjoyed the audit process. I would work audits into being a helper for dressing and cap changes and that helped reduce the stress of "being watched" for our staff RN's. I applied for the 5 Main Quality Nurse because prior to nursing I had a lot of experience with data collection while I was a paralegal. When asked how I would feel about sharing the role with another 5 Main nurse I really like that idea. Two heads are better than one! It has been such a great experience having a partner in crime to collaborate with all while improving our 5 Main processes! I am able to apply what we are finding works with our Quality endeavors to my bedside nursing every time I'm on the floor. I like being a resource for our team to ask questions and seeing changes make a difference in real time.
Amber: I first became involved with quality work on my unit about 5 years ago when I joined the PIVIE champions. I would audit my fellow coworker on PIVs. When the position became available to become the quality nurse, I was so thankful it was split into two roles and Andrea and I were both able to do this work together. There we coined our quality name, The "A" Team, which we sign all our quality emails with. There is so much that is done in quality that I never saw working bedside. There are studies and bigger audits that are done hospital and nation-wide that explain the "why" behind all that we do. It is a fun experience to learn the "why" and then get to turn around and share it with my friends. Learning and understanding this, I feel has helped me become a better bedside nurse. It has helped me be able to educate my friends, patients and their families on the reasons for these best practices and to have more resources available when they have questions too. I have come to realize these steps while bedside are sometimes very small and slight adjustments that are made and they can make the biggest impact on ensuring a smooth and safe stay for our patients. Like taking the extra moment to remove an armboard from an IV to assess it or taking the extra moment when removing an item from a baby's crib to give the parents the "why" behind that are the quick small adjustments and they have a big impact.
3. Can you share a quality-improvement project or practice change that has been especially meaningful to you?
We have several, and they go together. We enjoy reducing the fear of the stigma of being audited with our coworkers. We are not here to get anyone "in trouble" and our friends on the floor really understand that now.
We recently had a patient that was on our unit for a very long extended stay, and she unfortunately was our first CLABSI in over 6 years. We all took this very personal because we had grown very close to this patient and were all very involved in her care. This event helped change our process that we had with central lines and the care of them. We have evolved the way we do handoff regarding lines, orders for the care for lines (hygiene, dressing changes, etc) and helped us initiate a CLABSI cart to keep all the supplies in one place. Additionally, this provides a specific place for a sterile field with everything we could need.
4. What is one way quality work can support, not add to, the work of bedside nurses?
We are both in the unique role that we still get to do bedside shifts. We get to see and feel both sides of nursing, both hands on and in the quality role. We feel like we get to really see what works and what doesn't in real time as far as education, implementation, and experience the roll-outs for different quality requirements. Additionally, because we are in this role and bedside nurses, we get to experience firsthand if the changes we are trying to make will work or not or if it needs to be changed in any way. In this, we get to augment them in real time to fit what is realistic on our unit and workflow. The quality role for our unit is there to support bedside nursing while ensuring bedside safety and best practices by simplifying the quality processes for bedside nurses by integrating the requirements into daily practice. For example, checking for ID bands and Fall Risk bands at the same time. Another example is at shift change, we have created a Shift Change Challenge for bedside nursing to continue to give report bedside, but also in that, reassess pain, perform an IV check, double check bands. This also provides us the chance to audit and make sure handoff is done bedside and the opportunity for our PIVIE champions to audit the off-coming shift.
5. If you could add a button to every computer on wheels in patient rooms, what would the button do?
This button would pull up a check list of things that each of us need to do everyday when we work bedside in patient care. Did we do all the quality things required for our central lines, are all the bands on, pain reassessed, intake and output updated, did the patient change positions, was oral care complete and the right bath/hygiene done? Are there any audits that need to be charted? This would be a hard stop to exit Epic and leave the room. And once all of that is done, this button would give the nurse their favorite candy as a job well done.