[BSNDec06]

Originally Posted by elkpark

More and more facilities are instituting Rapid Response Teams. However, again, they can only help if the bedside nurse is able to recognize that the client is getting into trouble and calls for them.

Agreed. I heard of a patient who went septic in my hospital, and his nurse failed to report an episode of apnea to the physician preceding the kid's transfer to the ICU. These things happen when you have a bunch of new nurses with heavy loads and little support. This nurse had only recently gotten off of orientation.

[santhony44]

Originally Posted by oramar

I don't know where these researchers get their ideas sometimes.

Probably not at the bedside.

[DaveMac]

Originally Posted by rjflyn

Sadly most often they only way places see the light of day is for the "right " person to die of have a error occur to them due to these issues. Then the crappola hits the fan.
Rj

What you said is so true. I have seen nurses and I have spoke about what could be a problem. It seems to fall on deaf ears until the "right" person is involved, either they die or are critical. It seems the upper level of the hospital don't want to spend a little to save a lot. As the saying goes - an ounce of prevention...

[earle58]

failure to rescue??

what about failure to retain experienced nurses?
or failure to respect nsg w/latitude and gratitude?
failure to acknowledge the depth of responsibilities we bestow?
failure to advocate for our inherent worth and contributions?

once the aformentioned issues are addressed, i'm sure failure to rescue will seldom be an issue.

leslie

[rjflyn]

Originally Posted by earle58

failure to rescue??

what about failure to retain experienced nurses?
or failure to respect nsg w/latitude and gratitude?
failure to acknowledge the depth of responsibilities we bestow?
failure to advocate for our inherent worth and contributions?

once the aformentioned issues are addressed, i'm sure failure to rescue will seldom be an issue.

leslie

Kind of what I said but with the $$ angle. Hospitals all this other fluff and stuff to retain us but bottom line if you don't spend $$ were still pardon the pun they are hemorrhaging nurses.


Rj

[DeLana_RN]

Not long ago, such a sad case occurred in my acute dialysis unit. We were overwhelmed with pts, and the charge nurse kept calling for more pts (first mistake). Then she accepted a pt who had just had a dialysis catheter inserted in the interventional radiology unit and had "some trouble breathing" (second mistake. A pt in respiratory distress not related to dialysis - i.e., pulmonary edema due to fluid overload - should have never been sent to us!)

Next, she was in a big hurry to get the pt hooked up to the dialysis machine because she was in "pulmonary edema" (third mistake. She didn't have the typical assessment findings). Of course, none of us were able to assist - nor did the charge nurse request help - because of all the other pts. Finally, with the pt increasingly SOB (with normal SPO2, however) she decided against notifiying the rapid response team and had RT called instead (fourth mistake). A few minutes later the code was announced.

The pt, just 48 with young kids, did not make it. No autopsy was done, but the likely cause of death was pulmonary embolus.

Could this death have been prevented? Maybe not, PE is a serious - and often deadly - complication of any surgical procedure. But the pt should have been immediately transferred to ICU and never been brought to us; at the very least, the rapid response team should have been called in promptly.

The charge nurse in this case, BTW, has some 20 years experience and is certainly no new grad.

So, yes, I'm sure this is a serious problem in all hospitals.

DeLana

[Emmanuel Goldstein]

Many a shift I've worked on the edge, praying that nothing like this happens. And I can't count the number of times I've had a patient going bad, with not enough staff to cover their own patients much less the rest of mine who I pray remain *ok* until I get through the current crisis.

Kinda sad to think that far too often I consider it a 'good night' if everyone is breathing when I leave...

[pinoy_guy]

Originally Posted by DeLana_RN

We were overwhelmed with pts, and the charge nurse kept calling for more pts (first mistake).

lordy.

this is how it is in my hospital too.

the current trend is for the charge nurse to have here own patient load...and through a devious "game plan" of assigning "partners" the hospital is getting away with understaffing.

each nurse is partnered with another nurse, and labelled as "teamwork" and "encouraged to ask for help from your partner."

problem is, all the nurses on the floor have full plates, and it's very hard to ask for help from your "partner" as he/she has a full plate too.

this made me realize the precariousness of the nurses' position.

admin is covering its behind with nice-sounding phrases like "but they had a partner! he/she did not know when to ask for help!"

fact is, if a patient goes south, even if you recognize it early, sometimes there's very little you can do, especially if your other patients are always on the call light, or if their relatives are constantly hounding you to give pain medication (even if the patient is obtunded with pain medications).

this is why I'm advocating laws that require these admin people to work the floors 6 months of each year, so they cannot continue to ignore the problem.

as things stand, the hospitals are winning large by betting/playing with the nurses' licenses.

if the admin people have to risk their licenses too, I doubt they'll be instituting these lopsided policies.

Originally Posted by Emmanuel Goldstein

Many a shift I've worked on the edge, praying that nothing like this happens. And I can't count the number of times I've had a patient going bad, with not enough staff to cover their own patients much less the rest of mine who I pray remain *ok* until I get through the current crisis.

Kinda sad to think that far too often I consider it a 'good night' if everyone is breathing when I leave...

this is how I feel too.

sad.

[Ruffles 1]

I feel that nurses are at the bottom of the list. Admin, managers, director of nurses have lost reality with what goes on, during a typical day, evening or night shift. I had a supervisor tell me that I had to take an admission right now, when I had a patient who was diabetic going bad. I told her she could admit that patient, you know what happened??? That patient sat in the room for over an hour before I could see the patient and do an assessment. We are sure taking the patients money but not providing the care....

[CraigB-RN]

All have good points, and s nurses we are overwhmed with high acuity patients.

However I have to keep somethings in perspective. I've been doing this a long time,and have seen many "failure to rescue patients" show up in my ICU over the years. The difference between then and now is the 24 hour national news that brings these things to out attention now were not many yearsa go this would barely be local news.

We blame administrators, the government, ands everyone else, but don't take any of the blame on ourselves. If we keep waiting on someone else to fix the problem, it's never going to go away.

In each place i've worked over the past 3 decades, the places that had the most failure to rescue patients were places that didn't work as a team. Everyone was out to just service their own little piece of the world for the next 12 hours. We and I include myself in this, watched a co worker get called into a room every 5 min, but didn't do anything to help them with the other patients they had to take care of. The new grads didn't call for help because they were afraid they were going to be put down, and in some cases we did put them down.

The best places, were were we all worked as a team. If we noticed something, we stepped in and helped, the new grads KNEW that we EXPECTED them to scream for help and that when they did, they were going to learn something. We supported each other when someone was having a bad night. You know the shifts ere you just can't seem to get organized or get your act together.

All this because it was the culture we expected and we implemented. Now some policy or program from above, not because someone threw more $$$ at a problem. We set a standard and everyone worked their tail off to meet that standard.

We and I mean We, myself included spend way to much time pointing the finger at administration, but tolerate behavior in our coworkers and ourselves that is at best not making hte problem better and at worse is as much the cause as anything else.