Inexperienced RNs... too much.. too soon

  1. I recently attended a seminar where the following lawsuit was discussed in regards to hospitals using unsafe staffing..

    In California, a hospital was sued because a mother's unborn child was deprived of much needed oxygen for 10-15 minutes before it was picked up by the RNs. As a result, the child was born with all the anoxic complications you would assume would be there.. ie cerebral palsy etc.. (i'm not a L&D RN so forgive me if i get some of this incorrect <grin>)

    The plantiffs sued the hospital based on their hiring process.. the evening this horrible event occurred there were 4 RNs on the floor... the TOTAL number of years of experience of these 4 RNs was SIX.. SIX YEARS BETWEEN ALL 4 RNS... the lawyers were able to show conclusively that the hospital created a hostile environment for the more experienced, highly paid RNs to work and as attrition occured they replaced them with much less experienced RNs at a much lower wage.. mmmmmmm.. to compound the already unsafe situation, they did not have adequate initial orientation NOR did they have adequate ONGOING education.. which the lawyers proved was exactly why they were unable to pick up the life threatening situation BEFORE irreversable damage was done..

    how sad... and yet i see the same thing in my ICU.. as experienced staff quits due to burnout.. frustration.. etc.. they are replaced with brand new nurses... not there is not a place for new nurses.. there is .. but what we see historically is that during times of a RN glut new nurses are not hired to some areas.. but when a shortage rolls back around they're everywhere... manager must keep the overall picture in mind... there needs to be a good mix of the most experienced down to the least experienced.. so that as the more experienced nurses move on there will be nurses already in place to fill their leadership roles..

    I have only been an ICU nurse for 15 months.. yet I already do charge.. and there have been MANY 3-11 shifts when i could add up the years of experience of 6 nurses and not come up with a number greater than 8 years!!! again, we lucked out.. but how long can the luck be sustained???

    Share your experiences with an inappropriate staff mix and how it affected your patient care...

    by the way, the nurses WERE charged as liable in this lawsuit from what i understand.. i'm still trying to locate the suit so i can read it myself...
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  2. 20 Comments

  3. by   barton
    Hi LRichardson,

    THANK YOU SO MUCH for this information!!
    It just goes to prove our point again, doesn't it?

    Please note that the "Reply to Barton" topic's thread has been closed by the Administrator, bshort, and that he has created THIS FORUM to bring that discussion over here and make it more focused. If you note the previous posts, you will see that bshort is highlighting our discussions in the next issue of NURSE-ZINE (19,000 subscribers!) and that one of our writers, Canrckid, has posted the name, e-mail, etc. for Sylvia Johnson (with her permission) from

    -----------ABC's 20/20!!!!!--------------

    As I believe you are aware, we are writing/e-mailing, etc. the ANA, legislators, AARP, state nursing associations, etc. re: nurse/patient ratios and LICENSED nurses at the bedside.

    PLEASE HELP continue our efforts at reform!!

    As I've said before, if we just send a brief spate of messages, and then give up, how can we accomplish anything?

    I believe that we MUST PERSIST in writing at regular and polite intervals, so that the "powers that be" KNOW that we ARE NOT GIVING UP!!!

    I urge you to report what you have told us today to Sylvia Johnson at ABC's 20/20. Will you?

    THANKS AGAIN FOR YOUR VERY INFORMATIVE POST!
    I have asked everyone to post what they have written, to whom, and any responses they have received.

    LOOK AT HOW MUCH WE HAVE ACCOMPLISHED IN THIS BRIEF PERIOD OF TIME!!!

    LET'S NOT GIVE UP!!!

    THANKS ALL!!!!

    barton

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  4. by   bluesboyj
    I have been in the same boat. The last facility floated nurses to our ICU/CCU with less than 6 months TOTAL NURSING EXPERIENCE who had to take vents at invasive lines sometimes because the experienced nurses had to take the CABGs, IABPs, and those on vasopressors. Thankfully, where I work now has a long orientation for new graduates. And here at the University of Texas has a critical care summer elective that is popular and that's where we get our new grads.

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    Blues Forever
  5. by   Sophie
    Barton and Bluesboy, Hello again! I like having the posted topics broken down , but no more than this . It would get too scattered I think and yes, you would probably loose the people that we want to have come in and observe our postings. Kepp up the good work! Sophie
  6. by   barton
    Sophie,

    DITTO, DITTO AND DITTO!!!

    I could not agree more. Let's not get "scattered" and let's stay focused folks, OK?

    barton

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  7. by   TessaG
    Boy it sure is nice to know that I can finally relate to someone the fears that our nurses at our small rural facility have felt.We too have almost a whole staff of very new nurses who dont get enough orientation and are thrown into charge positions quickly.In example one evening shift a respiratory pt. went a whole shift with no nurse because she wasnt assigned one!!!!!! that is just one of many easily made mistakes when you have inexperienced nurses who arent properly trained and administration that doesnt advocate for their nurses.. When will this stop??????????
  8. by   Sophie
    Teresa, Good to hear some some newcomers to the site! Document,document your incidents as the one you described. Valid documentation is the only way to provide substantial proof to our administrators of the reality that exists -DANGEROUS STAFFING!! Documentation is objective. The emotion is removed from the descriptions of the incidents. Administrations love to think we are emotional, hysterical, and only capable of working with issues on a superficial, girlish way. Objective documentation that is witnessed and recorded in some manor, conveys a seriousness with it that administrations can't criticize. Keep up the interest!! Sophie
    Sophie
  9. by   barton
    Tessa G,

    I welcome you also! Please get involved in what we are doing: writing/e-mailing, etc. our legislators, the ANA, your state nursing association, etc..!!!I hope that you have read ALL of the posts in this forum--there's a lot of HOPE here!!

    And.......I recommend you LISTEN CAREFULLY to what Sophie just told you----she's doing some "GREAT THINGS"!!

    Thanks,
    barton

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  10. by   bluesboyj
    Hi Sophie, Glad to get your mail about our old stompin' grounds. Sophie, I think you'll agree with the following observations. I believe one of the biggest problems with the way admin. does things is becaue his/her boss is the Board of Trustees. Who makes up these boards? MDs, lawyers, people with money. Yet the vast majority of our patients are middle to lower middle income people. The people of the community we serve most are the ones who should sit on the board. There would be far fewer paper shufflers at the top and more nurses doing what we do best with the time and the staff to do it right. Of course morale would be high, nurses would stay on for the long term because there would be more money for patient care (because admin. wouldn't be sending doctors and their wives on trips), there would be solid education/orientation for new grads to new areas of work for experienced RNs, more patients would come in because of the quality of care and we wouldn't be living in this dark, damp, smelly, dump called managed care. Otherwise known as trading lives for increased profits.

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    Blues Forever
  11. by   barb o
    Interesting lawsuit. Also interesting to me, a nurse with 20 years in the ICU who can fully appreciate the value of experience in preventing problems, that hospitals are once again starting to pay hiring bonuses to new staff but don't give the ones who stay anything. Except maybe more aggravation and lousy, if any, salary increases.
  12. by   SandyP
    This is my first posting to this board.(somebody came over to the nursing spectrum board and left a message about this one) Know what happens when you make a xerox..of a xerox.....of a xerox? Every copy of the copy of the copy gets more blurred and less like the crisp original. When "newbies" less than one year out of school and only a few months out of orientation are assigned to precept other new orientees this also happens. Case in point: I come into an OR for 3-11 shift and take report on a CABG in progress from a "newbie" recently off of orientation (2-3mo). When we're rewarming the patient we need to defibrillate the heart. After the second attempt to charge the defibrillator I realise that the "newbie" has incorrectly attached the internal defibrillator paddles to the defibrillator! Probably the patient suffered no harm(we were on bypass and well oxygenated) but the scarey part to me is; what if that "newbie" had still been in the room, circulating alone? Would anyone else in that OR have picked up what was wrong and quickly corrected it? I went to OR management and was told I was being an alarmist. Next week I couldn't find an A/V pacing box when asked for one(had to run over to SICU to get one). Surgeon was pissed and I again went to OR management("newbie" I got report from had not checked to see if Pacing box was in cabinet). I was reprimanded for not checking myself at the time I got report! Couple of weeks later I found the liquid nitrogen tank for the cryopreserved veins alarming on a sunday night when I got to work-come to find out it had been alarming since FRIDAY but nothing was done(newbies on duty knew they were supposed to check it but not what to do if it was alarmin). Again, my report was ignored. The final straw was when I had an incident involving no cardioversion cable from the monitor to the defibrillator. I got a non-nurse (boimedical engineer) to verify with me that the cable was not there, then was told by the manager that the CV teamleader said I had overlooked it. The CV team was critically understaffed and had taken 4 new nurses(2 were new to OR and 2 were new grads!) I quit. When I called the Human Resources office to request an exit interview, I was told that "we have discontinued doing exit interviews because we have found that employees mostly don't change their minds and leave anyway". Yes, we have critical shortages-but could we safely train our new staff for a decent period to time before cutting them loose to "sink or swim"?
  13. by   LAS
    As a profession we are very hard on the youth of our profession. I truely feel very sympathetic to any nurse that comes into our facility, especially new grads or nurses with little experience. How can we expect a new nurse to function in an assignment when veteran nurses feel overwhelmed and frustrated. We owe it to our profession and our patients to work to bring about change. Inexperienced and overwhelmed nurses put in high risk situations with high risk patients adds up to bring trouble. Please continue t post and get involved.
  14. by   JLN
    I graduated from nursing school 2 years ago, and I just transferred to the maternity floor in my hospital. I have to say that it certainly is difficult to be new, and that some of the more experienced RNs seem to go out of their way to be downright hostile to new people. It is quite difficult to try to learn what is expected in a new position when one is constantly looking over one's shoulder and receiving cryptic notes and email messages about minor mistakes and overhearing the other people discuss one in a very derogatory manner. It has been my experience that a lot of senior people scrutinize the work of newer nurses just looking for things to run to the manager and complain about instead of trying to help the newer nurse learn to do her job better or make suggestions for improvement. I certainly didn't go into nursing to kill anybody or do a lousy job, and I do try to learn what is expected and I just can't understand why some more experienced people(not all of them) get so much enjoyment out of being mean and sarcastic. I have to work third shift tonight and I have had heartburn all day thinking about it.

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