In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of security plans in order to:

  • Use clinical decision making/critical thinking in situations related to security planning
  • Apply principles of triage and evacuation procedures/protocols
  • Participate in institution security plan (e.g., newborn nursery security, bomb threats)

Using Clinical Decision Making/Critical Thinking in Situations Related to Security Planning

Clinical decision making and critical thinking skills are utilized by the registered nurse who participates in security plans, the execution of security drills, and the evaluation of the successes, or the lack thereof, associated with security plans and responses to security threats and breaches.

Safety and security are closely aligned. Health care facilities have security plans, as mandated, similar to the necessity for emergency preparedness plans. Security plans are consistent with the regulations and recommendations of the Joint Commission On the Accreditation of Health care Organizations, The Centers for Medicare and Medicaid and the International Association for Health care Security and Safety.

Some of the most commonly occurring security risks in health care facilities include infant abduction, client elopement, the entry of dangerous and violent people into the health care setting, computer hacking and information/data theft.

Although health care facilities can vary somewhat in terms of their security and security plans, some of the commonly used security measures that are used in health care facilities include:

  • Security alert systems to alert staff to a security breach such as code pink when an infant abduction has occurred
  • The use of staff identification badges and visitor identification badges that identify people who are authorized to be in a facility
  • Closed circuit monitoring and alarm systems in high risk areas such as the emergency care area
  • Security doors
  • Special assignments and training for a group of people so that this specially trained group can act when a security breach occurs. For example, a psychological crisis team may be trained and assigned to act when a psychologically impaired person is violent towards other clients, staff or visitors
  • Electronic methods and devices, such as an electronic wristband, for the newborn and the mother to prevent successful infant abductions
  • Procedures to follow in the event of a security threat such as a bomb threat or an active shooting event that may lead to the evacuation of clients and others

Nurses must be fully knowledgeable about security plans and their assigned responses to security threats so that they can act rapidly and with delay.

Even though preventive security measures, such as secured and alarmed doors and staff identification badges, are routinely used, there are times that these serious and dangerous events occur.

Similar to emergency preparedness plans, all nurses must be prepared to act with security threats and security breaches. One way to prepare is to review the policies and procedures relating to your role on a regular basis and another way to prepare is by participating in mock drills and practices within the organization.

Applying the Principles of Triage and Evacuation Procedures/Protocols

In descending order of priority from the most severe to the least severe type of client, the following clients should be selected for discharge and relocation. The need for this may occur, for example, when a shooter is loose in the building and on a rampage.

  • Medical unstable and unpredictable critical care patients are the most severe of all patients. They are not candidates for discharge and relocation except under highly severe and threatening intra facility crises.
  • Stable clients who need assistance are the second priority and, therefore, not discharged until the lowest priority clients are discharged
  • Ambulatory clients who need no assistance are the first clients to be safely discharged and relocated.

Participating in the Institution's Security Plans

Similar to emergency preparedness plans, all nurses must be prepared to act with security threats and security breaches. One way to prepare is to review the policies and procedures relating to your role on a regular basis and another way to prepare is by participating in mock drills and practices within the organization.

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Alene Burke

Alene Burke

Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.
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