Would You Report a Medical Error?

October 5, 2011 at 8:37 pm

As someone in the medical field, the last thing a patient wants to hear from you is “oops!” (Trust me, I’ve been on the receiving end of the “oops” and it was not fun. I even changed doctors over it, but I digress…) If you saw a fellow nurse making a mistake or even if you yourself made a mistake, how likely are you to report it?

Just because you have your online BSN degree doesn’t mean that you are mistake free. Can you imagine any other job outside of the medical field where you have to be perfect all of the time? Maybe airplane pilots and lion tamers, but rarely do other occupations carry such a high risk on a daily basis. Johns Hopkins Medicine recently released a report about why so many doctors and nurses do not report mistakes that they see or have committed.

“Investigators e-mailed an anonymous survey to physicians, nurses, radiation physicists and other radiation specialists at Johns Hopkins, North Shore- Long Island Jewish Health System in New York, Washington University in St. Louis, Missouri, and the University of Miami, with questions about their reporting near-misses and errors in delivering radiotherapy. Each of the four centers tracks near-misses and errors through online, intradepartmental systems. Some 274 providers returned completed surveys.

“According to the survey, few nurses and physicians reported routinely submitting online reports, in contrast to physicists, dosimetrists and radiation therapists who reported the most use of error and near-miss reporting systems. Nearly all respondents agreed that error reporting is their responsibility. Getting colleagues into trouble, liability and embarrassment in front of colleagues were reported most often by physicians and residents,” explains the report.

I was surprised to read that 90% of the people surveyed saw “near misses” and didn’t report them because no patient harm was done. Of those surveyed, they mentioned that time management or a complicated online report system were not to blame for not recording the incidences.

“‘A national system that collects pooled data about near-misses and errors, which are thankfully rare, may help us identify common trends and implement safety interventions to improve care,’”commented Johns Hopkins radiation oncology resident Kendra Harris, M.D., who presented an abstract of the data on Oct. 2 at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Honestly, this seems like yet another moral dilemma that those in a RN to BSN bridge program have to face. When you were a kid, you hated being called a “tattle tale.” As an adult, does this stigma still apply?

To read the complete article mentioned in this post, please visit:
http://www.hopkinsmedicine.org/news/media/releases/survey_reveals_reasons_doctors_avoid_online_error_reporting_tools

Good Nurse Bad Nurse

July 28, 2011 at 7:32 am

If you’re in a BSN program, LVN course or simply considering nursing as a career, there are several things you have to seriously think about before entering the field. One of these sounds simple enough, but needs to be investigated fully: do you really want to help people? Most people will say yes, but some students in BSN programs and LVN courses may be fooling themselves. Convinced that nursing is a stable and lucrative profession, they don’t take the time to really consider their ability to commit a lifetime to helping others.

While many nurses are constantly playing heroic roles, helping and saving lives even when they don’t have to, some are doing just the opposite. Today’s post is about two incredible stories on opposite sides of the moral spectrum.

Last week, nurses aids at Prentiss Center Nursing Home in Cleveland were caught abusing a 78 year old patient. The patient’s son, suspecting abuse, set up a hidden camera in his mother’s nursing home room and was shocked to see that his worst suspicions were real. Cleveland-based news station, 19 Action News, is currently investigating this story and reports that the video reveals nurses aids tossing his mother around “like a rag doll.” At one point a nurses aid throw a gown onto the patient’s face and pulling bed sheets out while she is still inside them. The nurses aids are also caught screaming and hitting the patient. One of the nurses aids has been charged with felony assault.

While the Metro Health System has issued a statement addressing and apologizing for the crime committed by their employees, their words do little to console. A helpless patient has been harmed and her son struggles to regain trust for nursing facilities meant to care for their patients.

On the other hand, some nurses never let themselves off duty.

Danielle Orr, of the Gazette, reports that on June 17, two off-duty nurses were lounging by the pool when they heard pleas for help. A four-year old boy had been rescued by a lifeguard but was blue and unconscious when the two nurses arrived at the scene. They sprang into rescue mode and began CPR. The boy began to cry just as the ambulance arrived to take him to a nearby hospital.

What we have here are two stories that exemplify the best and worst kinds of nurses. On the one hand we have nurses who truly fulfill their commitment to caring for those in need, and on the other we have nurses who demonstrate some of the worst kind of behavior that goes on in healthcare facilities. Unfortunately, cases such as the latter do happen and need to be combated.

What could possibly motivate healthcare workers to mistreat and abuse their patients is beyond my capacity to reason and understand. Students in BSN programs, LVN colleges, and those merely considering nursing, if caring for people isn’t something you enjoy or feel compelled to do, don’t bother becoming a nurse. Nursing takes a level of commitment that most jobs don’t. To be a nurse you must always cater to the needs of your parents, no matter how difficult it may be.

To read more on the stories mentioned above, visit: the Gazette and 19 Action News.

A Letter to Nurses

June 29, 2011 at 1:22 pm

My baby is having surgery tomorrow morning so I thought I’d write this post today. I’m sure there are several things on the nursing news forefront, but right now the most important news in my life is the care of my child and I wish to share it with you. You deal with people like me everyday, but we don’t always get to share all of our feelings and thoughts with you. I thought I’d do it now. Hopefully it strengthens your resolve continue with your RN to BSN program because we need you… I need you.

Dear Nurse,

Tomorrow I am putting my daughter in your capable hands. Even though she is having minor surgery, I am still terrified. As a mom we want to do everything in the world to prevent our children from experiencing pain. The pain she faces now will eliminate greater pain that she may face in the future. My head knows that, but my heart still aches.

Please be patient with my questions and my irrational fears. You know so much more than I do on this subject and my nerves can get in the way of clearly thinking. In this age of technology I also may know too much of the wrong things: extreme cases and false horror stories. Your patience and confidence will go far in alleviating my irrationality.

Please see me as a mom and not as a random face walking through the door. You deal with this stress on a daily basis. This is a major event in my life and in my child’s life. Your smile, compliments and gentleness will help me to put my trust in you.

For the nurses who have called and that I’ve met with at the pre-op, thank you. You’ve told me what to expect, calmed my fears, answered my questions thoroughly, treated me with respect and greeted me with a smile. I know that you are doing a job that you love and are doing the best you can. Releasing my baby into your hands is going to be difficult, but I know that you care about her, too. We may only see you for a day, but the impact that you are going to have on the quality of her life and her confidence cannot be measured.

With Sincerity and Gratitude,
Lanie’s Mom

Hostility between Nurses and Doctors

June 2, 2011 at 3:46 am

This is a follow-up to my first post on interactions between doctors and nurses, where I cite Nurse Theresa Brown’s (now infamous) article on the doctor-nurse relationship.  I previously warned nursing students about the hostility that can occur between nurses and doctors because of the status hierarchy in hospitals.  Doctors are on top, and some of them feel that their status gives them the license to belittle nurses.  This, of course, results in problems such as passive aggression and distraction from work.  It’s a problem that does occur, has been documented, and should thus be addressed by hospital superiors.

Today I want to share an article that offers a deeper analysis of the relationships between nurses and doctors also based off Nurse Brown’s commentary.

Doctor Rahul K. Parikh, health columnist for Salon.com, brings attention to the doctor-nurse relationship which he states is “fraught with class and gender issues.”  In his article, he interviews Nurse Brown and together they also shed light on how nursing education has changed.  It’s worth a read.

Doctor Parikh writes:

In one sense, nurses have spent the last half-century fighting to overcome the stereotype that they are defanged doctors.  It’s a division rooted in education, income, and gender.  Doctors – men, affluent, with a professional education – reigned supreme in the hospital.  Nurses – female, working-class, with a trade school-level education – were their handmaidens.

In the past, nursing schools were based in hospitals, which put students directly under doctors’ influence. While that no doubt perpetuated the doctor-nurse game, at least it exposed both groups to each other. But over the past 40 or so years, nursing schools have become university-based. “Nursing school was now independent of doctors,” Brown explained. “Yes, we are taught to be patient advocates, but we are also taught to be a check on the doctor. The problem with that is we’re only taught to see docs as adversaries,” she told me.

As a result, Brown admitted that nurses “never get a good understanding of the stresses and strains of what it’s like to be a physician.” I told her that medical school provides next to nothing in terms of how nurses approach patients either.

What do nurses want from doctors? I asked. “Respect, a willingness to listen even when we’re bringing up something stupid, a sense that we’re on the same team,” Brown replied.

Can doctors and nurses hold one another accountable without picking the scabs off old emotional wounds? Her suggestion was that if there’s conflict or a mistake made, debrief together. “Be honest, say what happened, work together to solve a problem.” One way doctors do this is by having regular “morbidity and mortality meetings,” where individual cases are discussed and the physicians involved are asked to explain why a patient was hurt or another bad outcome occurred. Nurses are not part of that process, and the tendency among them is to “just say something bad happened, not talk about it again.”

“If we really want parity and respect we also need to be held accountable,” she said.

To read the entire article, please visit: http://www.salon.com/life/poprx/index.html?story=/mwt/feature/2011/05/30/doctors_and_nurses_poprx

In order to break these cycles of hostility in the hospital environment, it’s important for BSN students and all future nurses first to be aware of the issue, and second enter the workplace with a willingness to engage in honest dialogue.

Nurses Under Fire for Standing by Patient Care

May 19, 2011 at 6:41 am

People become nurses for different reasons.  BSN students, you know this.  But we all know that the main reason people become nurses: to help people.  And perhaps the biggest perk of all is connected to this altruistic goal – having a sense of purpose and fulfillment.  But sometimes, the demands at work actually make it difficult to meet the goal of providing people with the best care possible.

The story below describes the battle that a group of nurses in Texas are fighting in order to ensure that their patients receive proper care:

A group of Intensive Care nurses say they’ve been suspended, three of them were even fired for being vocal about under staffing at Valley Regional Medical Center.

Linda Valdez, a Registered Nurse says she was suspended for refusing to be assigned the role of “charge nurse.”

It’s a position she says takes away from the assigned patient load she already has in the ICU.

“If something does happen, in the unit, outside of the unit, or in another unit, patient gets sick to the point where they’re calling for a rapid response or a patient is coding, they call for an ICU nuse that has to respond. When we respond to those patients that need us because they’re basically on the brink and may be in their last moments and we have to respond, we’re having to leave our patients, our critically ill patients to other nurses that are already overwhelmed,” she says.

Cleo Vasquez faced the same problem. Being terminated for her job for not wanting to assume the duty of a charge nurse.

“As far as being a charge nurse and stepping away from the unit to respond to other issues going on at the hospital, it is to me a very unsafe assignments and that is what we are advocating, patient safety first,” says Vasquez.

Being a nurse often means making tough calls.  These calls you have to make are sometimes the different between doing what’s best for your career or what’s best for your patients.  This group of nurses has chosen to stay true to their purpose and stand by their patients.

To read the entire article, please visit: http://www.krgv.com/news/local/story/Registered-Nurses-Claim-Patients-Not-Getting/8AAA778iZES5h68Cb-OWdw.cspx

 

The Role of Nurses in Healthcare Quality

May 17, 2011 at 12:44 am

BSN students and current nurses know that their work is what makes healthcare possible.  However, with more and more demands placed on the healthcare system, including quality improvement, the role of nurses is more critical than ever.

According to the Center for Studying Health Care System Change, gaining a more in-depth understanding of the role that nurses play in quality improvement and the challenges nurses face can provide important insights about how hospitals can optimize resources to improve patient care quality.

Challenges in nursing includes: scarcity of nursing resources; difficulty engaging nurses at all levels—from bedside to management; growing demands to participate in more, often duplicative, quality improvement activities; the burdensome nature of data collection and reporting; and shortcomings of traditional nursing education in preparing nurses for their evolving role in today’s contemporary hospital setting. Since nurses are the key caregivers in hospitals, they can significantly influence the quality of care provided and, ultimately, treatment and patient outcomes. Consequently, hospitals’ pursuit of high-quality patient care is dependent, at least in part, on their ability to engage and use nursing resources effectively, which will likely become more challenging as these resources become increasingly limited.

Here are some salient points from HSC’s study that further explain the consequences of some of these challenges:

The scarcity of nurses is a major challenge for hospitals because it impacts not only their ability to provide nursing coverage for patient care, but also to provide adequate nursing resources for other key activities, such as quality improvement. Hospital respondents in two communities—Memphis and Seattle—reported being significantly affected by a nursing shortage, which some believed would only worsen, particularly as more nurses age out of the workforce and demand continues to exceed supply.

Respondents noted that there is a limit to how much work, including quality improvement, can be added to nurses who are already short staffed. As one quality improvement director stated, “Our shortage of staffing means that we’d rather leave the nurse in the care role vs. the process change role.” Hospital respondents in the two communities that did not report a current nursing shortage said that if such a shortage were to emerge, the tendency would be to take nurses “away from the table and onto the floor,” making it hard to keep quality improvement efforts on track.

When hospitals are unable to employ an adequate number of nurses for patient care, they often are forced to use agency or temporary nurses. A hospital CNO said that with heavy reliance on agency or temporary staff, “you will have a hard time making people available to participate in quality improvement activities and you will have a hard time seeing improvement because you aren’t going to have the consistency that you need.”

One way to deal with these challenges is to identify and promote nurses and physicians to champion quality improvement.  These efforts reportedly help empower staff to engage in and move quality improvement initiatives forward. One hospital CEO found nursing champions particularly important—that even though the academic facility is very involved in quality, when nurses champion a project, they are able to achieve “real, sustained improvement.”

These challenges within the healthcare system that particularly pertain to nurse should not deter you from following your passion and becoming a nurse.  Going into the profession with knowledge of such problems will help you to better handle with them once in the workplace.

To learn more about how nurses can help improve healthcare quality amidst the challenges, please visit: http://www.hschange.org/CONTENT/972/

 

Nurse Interactions: Nice or Nasty?

April 27, 2011 at 6:59 am

If you’re a BSN student, hostility in the workplace is something you need to be aware of before entering a sometimes not-so-hospitable environment.  If you’re a working nurse, you may be all too familiar with nasty nurse interactions.

Grif Alspach, RN, MSN, EdD of Critical Care Nurses explains the issue of lateral hostility in the workplace: “lateral (or horizontal) hostility refers to a variety of unkind, discourteous, antagonistic interactions that occur between persons at the same organizational hierarchy level and are commonly described as divisive, infighting, backbiting, and off-putting… the issue is characterized as “bullying” and is considered both a serious and pervasive problem throughout each country’s national healthcare system.”

Between nurse hostility is actually becoming an international phenomenon as nurses in the U.S., Canada, and Hong Kong calling out this problem. Last year, a nursing journal website asked visitors if they had witnessed any nurse treating another nurse inappropriately in the last six months and 55% of the respondents replied yes.

Why are nurses being so nasty toward each other?  It’s not a secret that stress plays a huge factor in the lives of nurses, affecting their emotions and daily interactions with one another.  However, experts believe that the real source of horizontal hostility trickles down vertically from the new corporate structure of managed healthcare that changed the very function of nursing nearly 30 years ago.

Kathleen Bartholomew, MN, RN attributes the hostility to change healthcare’s value system, “Our virtues are killing us. The facts that we adapt incredibly, work so hard and never complain are no longer compatible with the healthcare system,” she says. “The values have changed. Healthcare now is a business. We’re the only country in the world that uses the word ‘industry’ in conjunction with taking care of people. The implications of that are profit, loss, productivity, business and technology; all the things that, at their core, have nothing to do with nursing.”

Bartholomew believes that the first step nurses should take in regaining control over the situation is by reclaiming their voice. “She must speak her truth at all times,” she says, “Particularly to the person she’s experiencing the hostility from.” This may sound like a step on confrontation but repressed feelings only lead to passive aggression which is how the trouble often starts. Healthy release of hurt feelings keeps them from brewing into anger.

“It helps to describe what she’s experiencing, explain why it offends her,” Bartholomew says, “State what she wants to change and make clear what the consequences are if it doesn’t.”

Here are more of Bartholomew’s suggestions for preventing work hostility elevating the nursing profession to its rightful place:

1.       Assertiveness training for all nurses.

2.       Be aware of cliques, incident reports constantly filled out by the same nurse and absenteeism as symptoms of department hostility.

3.       Stand up for absent co-workers.  Silent witnesses are accomplices to horizontal hostility.

4.       Adopt a zero tolerance policy in the workplace.

5.        ”RN” when introducing yourself to rebuild the professional nursing image.

6.       Educate patients about the nurse’s specific role in their plan of care.

7.       Don’t apologize when calling a physician.

“Nurses need to start demanding the respect they deserve, beginning with other nurses,” Bartholomew stated. “It’s time to stand up and say, ‘No, I’m not coming to work and being treated like this. The work I do is too important.”

For more information on nurse hostility and how to deal, please visit the articles referenced in this post: http://ccn.aacnjournals.org/content/27/3/10.full
http://nursing.advanceweb.com/Article/Odd-Nurse-Out.aspx

Electronically Tracking Nurses

April 21, 2011 at 1:57 am

If you’re a BSN student or a working nurse, here’s something you may find interesting: a new, potentially controversial electronic devise has recently come out and will be put to use by Sentara Princess Ann Hospital in Virginia Beach when it opens in August.  The electronic devise will track nursing activity in an effort to see how much time caregivers spend with their patients.

Some nurses may take this as an insult to their abilities and their pledged commitment to their patients.  Nursing students and current RNs, what do you think about this new device?

HamptonRoads reports that hospital staffers will be issued badges with tags that are scanned when they enter and leave a patient’s room. Different tags will be assigned to different workers, and colored lights outside the room will indicate who is inside, for example: blue for a physician or green for a nurse.

The information will be stored on a computer, so workers can better monitor the frequency and duration of the visits.

Equipment, such as portable X-ray machines, can also be tagged and tracked through the system.  This is a product of Rauland-Borg, a Chicago communications technology company.

Stephen Porter, president of the Sentara Princess Anne campus in Virginia Beach, said this and other new technology at the hospital will help ensure that patients are getting enough attention. The system also will alert more hospital workers if a patient’s call bell remains unanswered for a certain amount of time.

In an age where technological communication can take the place of human contact [think of the tracking devise doing the job of the supervisor who oversees task completion], it seems like a practical move to employ these devises in an effort to improve patient care.  After all, supervisors can only keep track of so much.

The concept behind the devise is obviously pro-patient, which is good, but the practice of tracking nurses while they work is nonetheless intrusive.

“It’s not so much that we’re trying to be Big Brother,” Porter said. “We’re going to be able to provide an environment that allows our staff to be at the bedside more.”

We’ll have to see how nurses take the idea of being tracking while working, and if the practice is actually effective in improving patient care.

To read the full news story visit: http://hamptonroads.com/2011/04/virginia-beach-hospital-have-hightech-tracking

When Nurses Have to Decide What’s Right

April 5, 2011 at 4:47 am

Eventually, all nurses struggle down the slippery slope of ethics.  Making tough decisions, such choosing to stick to your convictions even if it costs you your job, is something that isn’t always discussed in nursing school.

Last week, Roosevelt Hospital in New York City refused to treat a homeless man who had taken a fatal drug overdose – and then fired a nurse who tried to expose the mistake.  The suit was filed by former Roosevelt Hospital nurse Danna Novak.

NY Daily News reports that the homeless patient, Daniel Iverson, was well-known to the emergency room staff. He would wheel himself into the hospital, his prosthetic left leg lying across his lap, to complain about back pain or to persuade someone to let him sleep off his latest bender, court papers say.

When he came into the ER, he told Novak, the triage nurse, he was sick of living and had consumed 700 milligrams of morphine. She took his vitals, recorded a racing heart and low blood pressure, marked him “emergent” and rolled him to the resuscitation room. There, another nurse declared Iverson was faking it, the suit says. A second nurse berated Novak for being naive and said Iverson would have to wait for a doctor. After listening to the exchange, Iverson turned his wheelchair around and rolled out of the emergency room, Novak claims.

The next morning, a hot dog vendor found Iverson in his wheelchair outside the hospital, cold and gray. He was taken to the ER, where he was pronounced dead.

Novak declined to comment, but her suit alleges that the hospital tried to force her to quit and then fired her, claiming she left patients unattended. A hospital spokesman said Novak’s firing was not related to Iverson’s death.

Read more: http://www.nydailynews.com/ny_local/2011/03/28/2011-03-28_nurse_lawsuit_fired_for_exposing_hospital.html#ixzz1IcPhITbB

Unfortunately, there’s little room for big hearts in a rigid healthcare business model.  Still, nurses like Novak are sticking to their convictions and performing their duties, giving patients the care they deserve. After all, nurses enter the profession because they want to help people. It’s easy to grow cynical in the healthcare profession, to be callous toward problem patients, but the real challenge is seeing beyond the hang-ups and staying true to the ultimate obligation of saving, not dumping, human lives.

Nurses Accused of Thievery in Oakland

March 25, 2011 at 8:38 pm

          Nurses have a lot on their plates: helping sick patients, adjusting to budget cuts, constantly learning new skills and procedures and trying to figure out how health care changes will affect the medical field. Now the nurses in Oakland have another issue to juggle: proving their integrity as professionals beyond their skills as certified nurses. This is not something you learn in a RN to BSN college.
          Yesterday in the Contra Costa Times, reporter Sandy Kleffman addressed the story of how a group of nurses at Doctors Medical Center in San Pablo were accused of stealing heart monitoring devices after the devices were found missing. “The incident began when an emergency room doctor sought to admit a patient to the telemetry unit but was told that although there were enough beds and nurses, there were no more telemetry boxes available and thus the patient could not be transferred,” registered nurse Bobby Roberts explained. “Hospital managers discovered that four telemetry boxes were missing from the unit. The boxes sometimes end up on other floors because they remain on patients who were transferred or some are sent to another area of the hospital for repair.”
          It’s bad enough that the nurses on staff were accused of stealing the equipment worth several thousand dollars, but the way the incident was handled is where a major issue lies. These nurses were detained, questioned by police and were “grilled in hallways where patients could overhear.”
          The devices that were reported missing were found later elsewhere in the hospital, but what I want to know is who would want to steal these devices in the first place? I suppose you could sell them for parts, but is there really a black market out there for partial medical devices? Maybe I’m really naïve, but I would be more concerned about office supplies missing or medications disappearing.
          Now the nurses are claiming that they are too stressed to return to work. “Since the incident, Roberts and several of the other nurses have been off work, saying they are too stressed to return. They have contacted an attorney to discuss their options,” Kleffman reports. Seriously!? Okay, I’ll admit that the incident stinks, but call a spade a spade and say “I’m too ticked to go back to work” or “I want time off to think this over.” I can understand not wanting to use vacation time for this, but come on…
          So basically this whole event has been handled poorly. It’s just one more incident in the complex world of nursing….some things you just don’t think you need to learn in a RN to BSN program

For more information, please go to:
http://www.insidebayarea.com/oaklandtribune/localnews/ci_17220357