Why is meeting the "minimum standard of care" good enough?

Specialties Operating Room

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Guys, I posted this on another section of the board, but I am posting it here as well, because I value input from my own O.R. nurse colleagues who might not visit the other sections of the board-

This is something that has always bothered me--both in clinical practice, and in doing case reviews as a legal nurse consultant--

Why is meeting "the minimum standard of care" good enough for some nurses and nurse managers?

When did nurses become so complacent that to perform to anyone's "minimum" standards is acceptable?

I think we all set higher standards for ourselves, or we should--these are human lives, and they deserve better than the minimum mandated by--who? Who was it that came up with the "minimum standard of care?" Various state nursing boards?

I see so many cases of what I--personally, as a nurse-- would consider nursing negligence that, legally, do not meet the criteria--because the nurse in question met the "minimal" standard of care. As a legal nurse consultant, I know that a charge of negligence won't fly, and the nurse will be back in practice--doing little more than what she has always done-- "the minimum."

I have worked in operating rooms where some people could only meet "the minimimum" requirements that allowed them to be there--what do you think this did to the morale of the people that set much higher standards for themselves, and as a result had to do all the really difficult and challenging cases--while the folks who performed to "the minimum"--with the blessing of management-- got the easy, kick-back no-brainer cases day after day, so that they couldn't hurt anybody--come to think of it, maybe they were smarter than we were--they got paid the same, but didn't have to work very hard, or THINK...

I would really like to hear input on this--but please, let's not bring up the old "AA vs. BSN" argument here---it's been done to death, and entry level practice nursing errors are not what I am referring to--I am referring to errors, complacency and incompetence made by seasoned RNs who should know better--

At deposition, one cannot ask a nurse whose care appears to have been negligent if said care would be "good enough" if the patient in question was one of her own family-- sometimes I think it should be allowed--because we all know that, if she is honest, she would have to admit that it was not acceptable, whether it met the "minimum standard" or not--and the case would be over then and there--settled in favor of the plaintiff-because a jury that heard this admission from a nurse would be outraged, and rightfully so.

What say you all?

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Specializes in O.R., ED, M/S.

I think there is a very fine line between "minimum" and "below minimum" I see people everyday doing just the "minmum" to get by and it makes you wonder why they do this. The ambition doesn't seem to be there at times and they "skate" day after day. How are they ever going to better themselves without having the initiative to go that extra mile to see what's over the next hill. The profession asks that each and everyday, "go ahead do it, see what it is like to try something new. It seems the go-getters are the ones people look up to. I know that sometimes other people sit back and ask, "what the hell do they think they are doing?" Minimum care has always been like kissing your sister, you can do it, even do it well, but does it get you anywhere. you become very stagnant in your every day care of your patients and never learn anything new. I think if you go through this whole nursing board and look at the threads that deal with unhappiness, I think you will find people who are doing their job at the minmum level. They are either to afraid to try something new and exciting or they are just lazy and don't want to further their continuing education of nursing. Everyday is a learning experience in nursing and I have always said that you really don't experience nursing until you are out of school. reall ywhen you think of nursing school are they, the students, learning at a "minmum level"? I don't think any professor of nursing would allow their students to do this. Maybe once we get out of school the pressure is off and we can slow down and waltz through work day after day. I don't know if I am making sense but I see it all the time with fellow workers in my unit, the OR, and from other units around the house. A lot of them are just "putting in the time". Minmum standard of care, to a lot of them it is clocking in and clocking out! Sorry, Mike

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I have been asking myself the same question. I have worked in the OR for 13 years and I have seen the standard go down!!!! what once would have been unacceptable is now standard. It is a scary place to be. I have read the posts here for a few years and I have to agree totally with shodobe and stevieray on their many posts. Where I work, it has become standard to allow 2 techs to count while the RN is gone to get the patient. But as the RN, I am responsable for making sure the counts are correct. Several times the techs have forgotten to count bovie tips and other things we are required to count and be accountable for. The management goes by AORN standards only when they are convienant for them. They don't want the circulator to rock the boat by being the patient advocate. I love being an OR nurse!!! But I have lately been questioning myself for staying in this position. I don't want to leave the profession that I have worked so hard for. I occasionally work midnights in the OR. On the weekends I am the only person there!!!! that scares the Heck out of me!!! When an emergency comes in I have to book the case, run the preference card, start picking the case and call the tech and the attendant in!!!! I feel this is less than minimum care!!!!

I would love suggestions that I could take to the managers on changing this dangerous practice!

thanks

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I must say the "minimum" standard of care has always seemed to me to be a level I should strive to surpass. However I guess there has to be an attainable base level against which all levels can be measured.

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G'day All,

I'd have to agree with Carsha, The minimum standards are a baseline for everyone to surpass, and it is the no-brainer's that stay there, while anyone who has any real wish to be a nurse, let alone an affective nurse, should and do surpass that. The ANCI competencies are designed for a nurse just out of Uni, and competent nurses are expected to consireably surpass these, for instance.

Adiau, Jason

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What say you all? [/b]

Excellent posts;

I agree that nurses and techs exhibit a complacency about their practice in the OR coupled with a lack of willingness to extend themselves beyond providing a minimum standard of care.

As a perioperative nurse of 27 years this is my take:

1) The generational difference between myself and younger staffers. My role as an advocate for this patient means I provide 100% of my knowledge and expertise towards ensuring a positive surgical outcome. This means I serve the surgeon so he can do his job. I don't mean this is a disrespectful subserviant relationship.. I've received far more respect from the surgeons I work with because they understand I am there for my patients, as well as for them. I do not see this level of passion for providing nursing care in nursses a generation younger than myself (48)

2) The attitudinal differences. I am a nurse and an OR nurse because I love my work. I am passionate about what I do. My attitude about how I feel about my work shows in the care I provide. The attitude of the nurse/tech who is at work simply to make a paycheck or because he/she mistakingly thought working in an OR relieved them of not having to work eves, nights, weekends and holidays is appalling. So many of my co-workers are there just for the paycheck. I agree that this really impacts the morale of hard working staff.

3) Lack of professionalism in the workplace. What ever happened to speaking to co-workers and surgeons in a respectful manner using the title they earned? I don't mean referring to all surgeons by "doctor so-and-so' while the patient is asleep duing surgery. This lack of professionalism extends to the catty criticisms of staff who, for 1 reason or another complain about every little thing in the department. Ask them to step up, devise and enact a plan to improve the issue they are complaining about and they back off because they don't wish to get involved or couldn't be bothered with doing more than the minimum. (Mind you, they continue to complain)

This lack of professionalism also extends to the lack of professional accountability. Many of my co-workers attend the minimum amount of continuing hour education programs to meet their lisensure requirements. Few are members of their professional organizations and seldom to do they attend it's meetings. How can they keep up with trends, stay current and feel inspired to want to provide the very best care?

4) Inspiration, or lack of it. If management doesn't set that bar and inspire their team to want to give 100% by showing that they, themselves are giving 100%, how can they expect it from the staff?

After many years of staff nursing, several of them frustrated by a lack of inspiration and direction from my management, I am in the postion of trying to lead a staff of 25 each day. It is indeed a challenge to attempt to inspire someone to want to give 100%, 100% of the time.

JMHO,

Paula

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POPRN - The first thing I would ask management is to have pre-picked emergency carts always available. I can't imagine having to pick my own carts, this is certainly a standard of care (substandard, it doesn't even meet the threshold of miniumum care) issue especially in emergency situations.

Secondly, and please don't beat me up. Having been in another profession before nursing I can tell you that doing the miniumum is what many employees are all about. I know some nurses many times hold themselves to a different standard than just "anyone", but human nature being what it is, I think it's logical that you are going to get those who do the miniumum and no more. If we throw out these folks we've just cut our staffing by 50% or more. This attitude comes directly from management as well. When you get put upon more and more by a management that doesn't really care, the human response is "fine, I don't care either". I'm not saying it's right, I'm saying it's just fact, albeit an ugly one.

I can also say that sometimes as a circulator I am so darned busy trying to get together a case that was posted wrong or has a bunch of "oh, by the way"s attached to it, that my care is not always what I want it to be. That is not intentional, when all three surgeons pagers are going off, they are demanding the calls returned, they are asking for additional things that they didn't post for, the front desk is calling in to get a finish time, I'm hunting for trays that I socked away but someone else stole from my cart, equipment has quit working (I'm a mechanic too, did I tell ya that?), oh, and I also have to charge for all the items used and it must be perfect (I'm an accountant) or I'm called to CS to explain why something wasn't returned from the previous case based on my charges (I also moonlight as a stock clerk, aint' that sexy) and well, I'm also protecting the sterile field from the medical student or student nurse who hovers too closely to the back table, and oh yeah, anesthesia forgot to bring some of their drugs to the case they need and of course those can only be fetched by an RN.

You get the picture? Oh, it would be lovely to be the perfect nurse whose standards are always way above the minimum but somedays I just don't get there no matter how hard I try. :o

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POPRN - I can also say that sometimes as a circulator I am so darned busy trying to get together a case that was posted wrong or has a bunch of "oh, by the way"s attached to it, that my care is not always what I want it to be. That is not intentional, when all three surgeons pagers are going off, they are demanding the calls returned, they are asking for additional things that they didn't post for, the front desk is calling in to get a finish time, I'm hunting for trays that I socked away but someone else stole from my cart, equipment has quit working (I'm a mechanic too, did I tell ya that?), oh, and I also have to charge for all the items used and it must be perfect (I'm an accountant) or I'm called to CS to explain why something wasn't returned from the previous case based on my charges (I also moonlight as a stock clerk, aint' that sexy) and well, I'm also protecting the sterile field from the medical student or student nurse who hovers too closely to the back table, and oh yeah, anesthesia forgot to bring some of their drugs to the case they need and of course those can only be fetched by an RN.

We've all been there. You have just described the typical case for the typical circulating nurse--none of this is at all unusual. It comes with the territory.

I, personally, do not answer pagers. I will if I happen to have time and IF I happen to feel like it, but any doctor in my room knows, as a general rule, to leave his pager at the front desk.

I tell them all--not being bi**chy, not being aggressive, just being truthful, "My attention needs to be devoted 100% to this patient. If there is no one available to whom you can delegate the care of your patients on the floors while you are scrubbed, then maybe you shouldn't be scrubbed."

(Most attendings do not expect the circulator to answer their pagers--they have delegated their duties appropriately before they scrubbed in, and they respect us as fellow professionals.)

The people that expect secretarial service from the circulator are generally residents. You just have to set them straight as soon as they come onto the rotation.

Being busy doing one's job is no excuse for just "doing the minimum."

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You're lucky you can set them straight. At my hospital, pagers in the OR are standard and expected, don't agree with it, can't help it, have to answer the calls, especially when they are carrying the trauma red and trauma blue pagers. Yes, I did describe what sometimes happens in the OR, thankfully it's not every day. I'm glad for you that you are always on top of everthing so much that your care never sinks to the depths of miniumum standards. I am always amazed at those who are nearly perfect all the time every day. Then there are the rest of us. :chuckle

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You're lucky you can set them straight. At my hospital, pagers in the OR are standard and expected, don't agree with it, can't help it, have to answer the calls, especially when they are carrying the trauma red and trauma blue pagers. Yes, I did describe what sometimes happens in the OR, thankfully it's not every day. I'm glad for you that you are always on top of everthing so much that your care never sinks to the depths of miniumum standards. I am always amazed at those who are nearly perfect all the time every day. Then there are the rest of us. :chuckle

Well--it comes with experience. Maybe you'll get there someday--it's something to strive for.

Bottom line: YOU are the circulator. YOU are in charge of your room. TAKE CHARGE.

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