[kinghill]

Just horrible. What is the solution to prevent this kind of stuff from happening?

http://www.sun-sentinel.com/news/loc...85,print.story

South Florida Sun-Sentinel.com
Lawsuit over man's death puts use of agency nurses in spotlight
Part-timer blamed in death

BY BOB LaMENDOLA
South Florida Sun-Sentinel
March 10, 2008

A patient's death after falling from his bed in a Plantation emergency room has raised questions about a common practice of hospitals hiring outside, fill-in nurses on a regular basis.

Critics of the practice, including nurses' groups and some industry officials, say medical care for patients may suffer when hospitals rely too heavily on short-term, temporary nurses who may not know a facility's system, patients, personnel or building as well as staff nurses.

[SharonH, RN]

Lowering the bed, putting up siderails and checking a patient with a diagnosis of seizures often is a common nursing intervention known as seizure precautions. Doctors need not order it and you do not need to have a long orientation to a hospital to know that you are supposed to do it on any patient with a diagnosis of seizure disorder. Additionally, the patient not being admitted to the ICU could not have been the fault of the agency nurse as bed placement is rarely under the control of the bedside nurse.

There was some negligence in this case but it was due to poor nursing care and not because the nurse was from an agency.

[Michigan RN]

Originally Posted by SharonH, RN

Lowering the bed, putting up siderails and checking a patient with a diagnosis of seizures often is a common nursing intervention known as seizure precautions. Doctors need not order it and you do not need to have a long orientation to a hospital to know that you are supposed to do it on any patient with a diagnosis of seizure disorder. Additionally, the patient not being admitted to the ICU could not have been the fault of the agency nurse as bed placement is rarely under the control of the bedside nurse.

There was some negligence in this case but it was due to poor nursing care and not because the nurse was from an agency.

I totally agree with you. Agency or not, this was poor nursing care. This didn't happen because the nurse was from an agency and not all agency nurses provide poor nursing care. There is too much of the blame-game going on.

[oramar]

Yeah, it sounds to me as if the accident has nothing to do with the nurse being from an agency. Ihave had patients take bad falls myself. Had nothing to do with my incompentence but everything to do with lack of help and the patients bull headed determination to do as the please. I mean seziure precations are nursing 101 but regular staff might have as many problems implimenting them as agency if theer is lack of help or equipment.

[kinghill]

Yeah I can definitely agree this one instance had some spin put on it about the fact that it was an "agency nurse". Like it says right in the article...

"Little research has been done comparing agency nurses and staff nurses on quality and errors."

It would be interesting to see some research done though. From the research I've done online, patients are pretty much in the dark as far as choosing a hospital in regards to quality of service. Lately I wonder how many other deaths occur from negligence and are never publicized. My aunt is an RN at a nearby hospital so I take her advice about the hospitals around here.

[RN1989]

Hospitals that utilize agency nurses routinely have system problems ocurring that have nothing to do with the competency of an agency nurse. There are good and bad agency nurses just as there are good and bad regular staff nurses. It just happened to be convenient to blame it on an agency nurse and to try to spread the damages around so that both the hospital and the agency gets hit up for money. Too bad everyone believes that agency nurses are the problem instead of overall poor working conditions that cause the need for agency nurses in the first place. Sure with I knew what to do to fix the problem.

[scattycarrot]

I am not excusing this particular nurses care, as it was lacking and theres no excuse for no putting up bedrails and lowering the bed. What I take issue with is this whole 'checking the patien often', which is all well and good when its written down but in practice, a patient who is having recurrent seizures and is awaiting an ICU bed doesn't need 'checking' often, they need someone there to observe him pretty much the whole time, which is one of the reasons he was going to ICU for 1:1 or at least, 1:2 care. It takes a split second for a patient be thrown onto the floor by a seizure and I have seen it done over the top of bed rails. Whenever something like this happens the cry of..'its the nurses fault' goes up in the air and no-one addresses the fact that staff shortages or lack of equipment are often at the root of the problem. In the ER, it can become swamped in a matter of minutes and a nurse can be expected to be caring for several high dependency patients at once as well as new admits/ a crash/a trauma and with very little support. Now, this goes hand in hand with the job but its the lack of staff and lack of patient to nurse ratios which make this dangerous. No matter how good you are as a nurse it is impossible to care well for patients under your care when you are snowed under with no support and no nurse as eyes in the back of their heads. Now, it takes 2 seconds to put up hand rails and as I said, I am not defending the nurse in question for not taking steps thatshould have been taken. I am, however, suggesting that there is more to this mans death than just 'poor nursing care' but thats all anyone ever focuses on. Hospitals which rely on agency care have staff retention issues for a reason!

[SMK1]

Originally Posted by kinghill

Just horrible. What is the solution to prevent this kind of stuff from happening?

http://www.sun-sentinel.com/news/loc...85,print.story

South Florida Sun-Sentinel.com
Lawsuit over man's death puts use of agency nurses in spotlight
Part-timer blamed in death

BY BOB LaMENDOLA
South Florida Sun-Sentinel
March 10, 2008

A patient's death after falling from his bed in a Plantation emergency room has raised questions about a common practice of hospitals hiring outside, fill-in nurses on a regular basis.

Critics of the practice, including nurses' groups and some industry officials, say medical care for patients may suffer when hospitals rely too heavily on short-term, temporary nurses who may not know a facility's system, patients, personnel or building as well as staff nurses.

I don't understand how this has anything to do with the nurse being an agency nurse. Sounds like she just didn't take falling precautions, or maybe she did but the precautions didn't work....

[banditrn]

I worked PRN at our hospital for three of the years I worked there. During that time, I watched them using some agency nurses. The ones we had were good, but I knew from talking to them that the hospital was paying a lot of money to get them.

So, I went to our unit director and told her I'd sign a 3 or 6 month contract with them - during that contract period, I'd work the same amount of hours that I did before I went PRN, and they wouldn't have to pay me for 'low-census' like they did with the agency nurses. All I wanted was $2 and hour more than I was making then. They'd have saved a LOT of money doing that. The unit director was excited about it, so she went straight to the Dept. Head, who came right down to talk to me about it - she liked it all, except she said they couldn't possibly pay me more money - even tho they were paying the agency a whole lot more.

So I told them to forget it, I'd just stay PRN.

[Miss Mab]

Originally Posted by scattycarrot

What I take issue with is this whole 'checking the patien often', which is all well and good when its written down but in practice, a patient who is having recurrent seizures and is awaiting an ICU bed doesn't need 'checking' often, they need someone there to observe him pretty much the whole time,!

Oh my, can i just say that this is probably the one issue I have the most difficulty with at work and the one that makes me physically ill when I see how this card is played?

OK, A, terribly sad about the pt. I wonder if the family had known how horrendously long ER holds can go, perhaps they would have stayed? How would a layperson know that the time between 'yep, he'll be admitted to ICU----have no fear dear family' and actually making it up there can be, forget hours, but sometimes DAYS. Seriously, who would believe it? It's certainly not the family's fault in any way but I do know they must feel terrible guilt as well. Just sad all around.

Personally, I am SO over all of our clear cut policies and procedures that we keep typed up smartly in an offical looking binder that dictate 'hospital enforced' safe nursing practice in these types of situations that we all know aren't terribly unusual on any given shift.The 1-1 situation/pt. like this, the mulitple critical drips or the vented down the hall, and all the myriad situaitons where a pt. needs (and deserves) our sole attention.

Yes, you can inform the charge and notify the supe and on and on and document/try to CYA etc...... I know what you're supposed to do. But when you are ignored and help never arrives or heck, bad things can happen to any of those above mentioned patients while you're actively following the chain and doing the right thing and trying to get more bodies where they're needed and you're on the phone doing so and........blah blah.

My entirely too long winded and disgusted point is.....AFTER all of that and your documentation and your frenetic attempts to somehow simultaneously be at the 1-1 BS while at the same time titrating whatever pressor is infusing into the pt. in the room down the other side of the unit, what absolutely gets me.......is when the whoosit hits the fan, as it sadly did down in FL, well then there again are all of these prettily perfect P & P's that get pulled out that detail each of these exact individual situations you are dealing with and which clearly describe what any 'prudent nurse' would do and voila, hospital is halfway to absolved because ------well look right there, the nurse very blatantly CHOSE not to follow the established policy and procedure.

ARGH!

We want to do the right thing----at least i think we do-----we sometimes physically can not. Or at least I couldn't, anyway. I could get by, oh sure, never 'got in trouble', but my conscience couldn't take it. Split personality I may cop to sometimes but I have yet to figure out how to split my physical being into 4 and then be in 9 places at once to do the job I know I should and desperately want to be doing. The deservedly correct and safe way all the time.

Please pardon my head exploding just now. I've just seen this BS and the stress and guilt it heaves on the fellow well--intentioned entirely too often in my still fairly fresh 'career'.

But I guess that's also why I'm taking me a little break. I finally just had to up and used my words.....

Be safe all...