Angry Nurse

mustangsheba · Nov 22, 2000

This is such a hard nut to crack. At the moment we are dealing with a specific problem on the floor is not the time to give detailed or negative explanations to patients. Explaining that an emergency arose that required immediate attention is sufficient. When time allows (little joke here), we may return and reassure patients that we would not have left them hanging if circumstances hadn't dictated that we must. Depending upon the patient, I have pointed out after one of these incidents that had they had their own emergency, I would have dropped a bedpan and been right at their side. I validate their feelings and apologize for the inconvenience, but I do not apologize for prioritizing appropriately. I recommend patients contact the hospital administration for any complaints or recommendations they may have and encourage them strongly to follow through, reminding them that they are the consumers and are the ones with the power. This does not mean I don't advocate strongly for my patients while they are in the hospital. I would have been in my supervisors office about the wet bed. I do believe patients need to be reminded that they are paying the bills and need to demand adequate MEDICAL care. Unfortunately, it will be a while before the insurance companies are put in their place. Which is not in control of medical care.

OC_An Khe · Nov 22, 2000

If the nurses don't expose the lack of appropriate staffing on the hospital units who will? Maybe the hospitals financial officer will?

teamrn · Nov 23, 2000

I believe that most RNs think that the patients should be told the 'why's, but the grey area is HOW to tell them and HOW MUCH and WHEN. Do you try to stop at the time of the 'emergency' and explain, do you wait and hope that you'll have the opportunity to discuss w/ them at a later time that your priorities shifted(like mustangsheba said), or do you hope that they'll take the time to answer those patient satisfaction surveys,(and then if they do, be honest!)? Lots to think about here, but I agree that the financial officer's NOT going to address this, and if we REALLY want to advocate for our patients, we need to figure a way to get to the meat of the issue.

Mijourney · Nov 23, 2000

Originally posted by teamrn:
No, I don't think we need to give complete DETAILS re: why[there are problems], but I think its wrong to completely disavow knowledge of them. We need to find a way to indicate to patients that we are aware of their concerns, and are working to find solutions, w/out making patients feel unsafe and afraid that their care may suffer. Its been my experience that patients are already aware that something is 'amiss', so an indication to the contrary would be deceptive. Finding the necessary balance (telling some vs. telling all) is a juggling act in itself, so that needs to be OUR challenge. The American public is very savvy and intelligent, and does NOT enjoy hearing of a deceit perpetrated on itself. If given the facts and the opportunity, I believe they would be a valuable asset in helping to find a solution to a problem that affects THEM as well as us. Isn't that what we want? The majority don't want to see us coming to work with the negative attitudes that can result from unsafe conditions, poor compensation, mandatory OT, etc. They don't prevent it because they're not AWARE that it exists. I see no need or reason to alienate such a powerful group, and I see that exclusionist attitudes can and will do just that. Aren't we all really on the same 'side'?

[This message has been edited by teamrn (edited November 19, 2000).]

Hi teamrn. I like your thoughts. What do you think about the concept of filling out and making copies of incident reports and submitting them to risk management? I think that staff shortages coupled with patient complaints is a risk management problem. I wonder what the pros and cons would be? Two cons do come to mind: 1-If incident reports have to go through someone in administration,(which they would) would the forms reach risk management? 2-Would the nurse feel confident enough about his/her care to fill out one when faced with patient complaints/demands and excessive nurse-patient ratios? The first question would easily be solved if nurses have access to a computer database with direct email access to risk management. The second I don't know. I agree problems with patient demands/needs and nurse access/availability need air time.

What do you think about using incident reports in this area? Anyone else? Bad idea?

Another nurse posted perhaps under another topic that he/she used the facility mission, values, and goals to hold the hospital accountable for providing adequate staff for patient care.

Doey, BSN, RN · Nov 23, 2000

I had a situation not too long ago where we had 9 pts. in ICU, five which were vented with myself and two other RNs one of which was just recently off orientation and new secretary/CMO. In PCU 11 pts. with two RNs one of which was an agency nurse, and CCU with 6 pts. and two RNs, no secretray/CMO. Because of this no one from these units was able to help out like they normally would. Needless to say it was one of the worst nights of my life. The supe., who would have normally piched in to help was stuck up on the floors almost the whole night trying to fix things (med errors, orders not noted etc, etc...) from the last shift which had been staffed with new nurses. None of our pts. was able to complain, but I did for them. The next day when I was calmer, I wrote a letter to risk management with copies to the nurse manager and VP of nursing. (I hand delivered that one). That entire w/e there must have been at least 6 letters/incident reports made out to risk management. The VP also spoke with me for 2hrs. at the time I gave her my letter. (signed by all who worked that night). I told her about the whole night and she was understanding and we went over each problem I addressed in the letter. She then asked me for my input on things including recruitment/retention etc. I did learn that her hands are tied too as to what she is able to do. She said that she would bring some of my suggestions to the executive committee. (always a committee of some kind). Anyway, it didn't happen right away, and maybe it had little to do with our meeting, but we got a raise in Oct. with another one scheduled for Feb. and a critical care and med-surg educator obtained through a grant that the VP of nursing and HR worked on. She had also told me that if this type of situation were to happen again that we could call her/nurse manager in to help out. We also have specific pt. complaint forms that we fill out when pt./family member has an issue/complaint that we give to our nurse manager and she follows through with it. I have to say that up to this point she has followed through on them. So for me thus far, incident reports and pt. complaint forms have helped. (after this we also started seeing more agency nurses to fill the holes)

pickledpepperRN · Nov 23, 2000

There is no logic in making nurses accountable for the nursing care without the means to provide that care. Nursing administrators as the heads of the most important department in the hospital should have the authority and budget to provide the staffing and equipment it takes to ensure quality care. They are accountable to the patient as nurses, but to the bottom line as management. VERY wrong!

Most if not all states require the nursing department to be headed by an RN. They need to organize as a professional group and insist they be given what is needed to de the job they are hired to do.

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OC_An Khe · Nov 23, 2000

First, Happy thanksgiving to all the posters on these boards. You have all provided interesting lines of thought. In most hospitals even the VP of nursing have their hands tied by the bean counters. Until the bean counters realize that there are taking enormous financial risks by not providing adequate resources for nursing nothing will change. Nothing destroys the reputation of a hospital faster then the patients perception of inadequate nursing care. Additionally that hospital becomes the employer of last resort among the RN's. The hospital has fewer RN's and can't recruit enough RN's to meet patient needs. Eventually patient go elsewhere. Risk managers can help but its the CEO and the Board of Directors that really need to know our concerns. If they are not responsive (and a lot aren't) then the public neds to be made aware.

JenAZ · Nov 25, 2000

Something interesting happened recently in Kansas. The family of a patient sued a hospital for "understaffing." The patient began to have respiratory difficulty, the family tried to find a nurse and couldn't. The patient ended up having a stroke and suffered significant brain damage. The family discovered how understaffed the unit was, and won the lawsuit. I think it is one of the first lawsuits over staffing initiated by a patient.

Anyway, I disagree with the poster who said lawsuits against the hospital can lead to even worse understaffing, or loss of jobs. Just the opposite!! This particular hospital is a "for-profit" institution, and since the lawsuit, has increased the base pay for nursing staff by $2!! It is also aggressively recruiting new nurses by offering bonuses. These hospitals can afford to shell out for the first lawsuit, but certainly don't want to open the door to more by cutting staff further!!

As for the ethical implications of telling patients about staffing problems, I don't know. I have been asked by patients and their families how many patients I have, and I have always told them, but I don't know if that means anything to someone who doesn't know exactly what the job entails. Instead of saying "We're understaffed," we say things like "we're REALLY busy tonight," or "we have ALOT of patients on the unit tonight."

I think it will take many more lawsuits by families and patients directly related to staffing issues before any change will happen. The public does need to be educated about the problem, perhaps through the media. I'm sick of hospitals crying "Nursing Shortage" as if there are NO nurses. The only shortage there is is a shortage of smart people willing to work in a situation where their license is on the line everyday, and where they can't do what they have trained for years to do (help people heal) because they're too busy with paperwork and trying to make sure that everybody ELSE is doing their job! Until hospitals change their ways, they can expect to lose staff and get sued on a regular basis! Ahhh, I could go on FOREVER on this subject, so I better shut up now!! Good luck to everybody!

Jenny

[This message has been edited by JenAZ (edited November 25, 2000).]

OC_An Khe · Nov 25, 2000

There is a belief that there isn't a RN shortage. Many believe this, especially admin types. They believe there are plenty of RN's out there but that they do not want to work. Gee I wonder why they don't want to work in a field where they get little respect ,virtually no recognition and as to rewards....

CHPN1680 · Nov 26, 2000

As nursing professionals, it is our duty to put the patient's well-being first. I can't see any benefit to the patient in telling them that you are short staffed. It just creates more anxiety and concern. The correct and professional way to deal with the situation is the apologize for the delay stating that you had an urgent matter to take care of for another patient. If the patient/family is not satisfied, you can cetainly direct them to the appropriate supervisory person who can handle it from there. Then, you just have to let it go. There will always be difficult families and patients. It comes with the territory.

The stress involved in being a nurse is tremendous these days. It is the reason that more people are leaving the profession than are entering it. This is scary as more people are needing care and there are less of us to give it.

I hear repeated themes of blame on "Administration" for staffing problems. I think that we all need to realize that the causes of the nursing shortage reach far beyond our local "Administrations". They are only a part of the problem.

The staff shortage in nursing is now affecting most parts of the country. It is not new and it is not going away anytime soon. What I have not been hearing from nurses are possible solutions to solve the staffing problems. We can complain all we want, but what about being proactive? Have you written any letters to your local, state and federal political representatives lately?

Have you been involved in any nursing organizations that are advocating for our profession?

We all need a place to vent our frustrations and discuss the problems arising from this crisis. Let us also be part of a process that can lead to solutions.

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BOBL

OC_An Khe · Nov 26, 2000

Originally posted by BobL:
As nursing professionals, it is our duty to put the patient's well-being first. I can't see any benefit to the patient in telling them that you are short staffed. It just creates more anxiety and concern. The correct and professional way to deal with the situation is the apologize for the delay stating that you had an urgent matter to take care of for another patient. If the patient/family is not satisfied, you can cetainly direct them to the appropriate supervisory person who can handle it from there. Then, you just have to let it go. There will always be difficult families and patients. It comes with the territory.

The stress involved in being a nurse is tremendous these days. It is the reason that more people are leaving the profession than are entering it. This is scary as more people are needing care and there are less of us to give it.

I hear repeated themes of blame on "Administration" for staffing problems. I think that we all need to realize that the causes of the nursing shortage reach far beyond our local "Administrations". They are only a part of the problem.
The staff shortage in nursing is now affecting most parts of the country. It is not new and it is not going away anytime soon. What I have not been hearing from nurses are possible solutions to solve the staffing problems. We can complain all we want, but what about being proactive? Have you written any letters to your local, state and federal political representatives lately?
Have you been involved in any nursing organizations that are advocating for our profession?
We all need a place to vent our frustrations and discuss the problems arising from this crisis. Let us also be part of a process that can lead to solutions.

I agree with most of whatyou said in the above post. Particularly about being involved and active in the solution.

Yes the local facility is pressurred by managed care et. al but that dosn't mean that they have no responsibility. The local administrators (all, not just nursing) set priorities on how the institution will spend and invest it capital. Nursing and patient care seem always to be at the bottom of the list. It's a cost center you know and doesn't generate any revenue. If I can have one nurse take care of 10 patients instead of 6 I have just increased my profit on that group of patients by 40%, and the Nurse isn't going to get any of it. Not even a thank you. So much for rewardand recognition, as to respect well...

[This message has been edited by ocankhe (edited November 26, 2000).]

041975 · Nov 26, 2000

Originally posted by goldilocksrn:
I am wondering if this has happened to any of you.... I got "talked to" by my Assistant Nurse Manager (charge nurse) because of an incident with a patient. My patient asked for some water, and I went to get it, but on the way to the kitchen, got stopped by another family member stating my one of my other patients had CP. After 30 minutes, I took my patient her water, only to find out her son called community relations saying that his mother was ignored. I apologized, saying that we were short staffed that day, that I had an emergency to attend to. He said there was no excuse for his mother not getting water. Anyway, I got "talked to" because I was not supposed to tell patients and family members that we are short staffed. What am I supposed to tell them, that I a retard? Why do they think that nurses should take all the blame? What do you think?