A statistical death

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I'm sure that the healthcare system that employs the nurses in my hospital, and the others in the system, has plenty of data to back up the staffing model that leaves most of our general inpatient floor nurses with 6 patients on days and evenings and 7-8 on nights. They have determined that we have the necessary staffing to provide "statistically" safe care. They can probably show somewhere that there aren't enough inpatient adverse events or deaths to warrant the extra expense of hiring nurses to lower that ratio. However, a couple nights ago we had a patient code who has since died, and I am 100% convinced that the patient's death could have been avoided if that night staff were not the bare bones allowable.

The whole night was a mess and the patient coded on a floor where there was a rapid response less than 3 hours earlier, and those nurses were all stretched thin to begin with, so I am not in any way placing blame on my coworkers and hope it does not come to litigation against any of them. However, I was with the patient and family in the ICU for much of the day yesterday and I doubt they think that the loss of their loved one is in any way an acceptable risk for the hospital to take in favor of saving some money. It was one of the most heartbreaking days I have had in nursing and I know I'll get over it, but right now I'm sad for that family and mad for all of us that want to provide the best care, because in some cases we're set up to fail.

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Specializes in Travel, Home Health, Med-Surg.

I have seen and heard of situations just like this. It is hard for family and staff. Very sad but I don't see it changing anytime soon. The last hospital I worked in had so many forms, checklists etc in order to avoid these situations that they in fact were the cause of some of them by taking nurses away from their patients. I don't work in the hospital setting anymore but from what I see it is happening across the board. (Most) administrations either don't care or have no power to change the environment. It is very difficult to keep working in a situation where you are unable to provide the good care that you (the nurse) want, and that patients deserve. Just sad all the way around!

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Specializes in school nurse.
13 hours ago, Daisy4RN said:

I have seen and heard of situations just like this. It is hard for family and staff. Very sad but I don't see it changing anytime soon. The last hospital I worked in had so many forms, checklists etc in order to avoid these situations that they in fact were the cause of some of them by taking nurses away from their patients. I don't work in the hospital setting anymore but from what I see it is happening across the board. (Most) administrations either don't care or have no power to change the environment. It is very difficult to keep working in a situation where you are unable to provide the good care that you (the nurse) want, and that patients deserve. Just sad all the way around!

Paperwork should serve the needs of the healthcare provider (and facilitate them giving good care), but quite often the provider "serves" the paperwork...

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Specializes in ICU/community health/school nursing.
18 hours ago, JBMmom said:

I'm sure that the healthcare system that employs the nurses in my hospital, and the others in the system, has plenty of data to back up the staffing model that leaves most of our general inpatient floor nurses with 6 patients on days and evenings and 7-8 on nights. They have determined that we have the necessary staffing to provide "statistically" safe care. They can probably show somewhere that there aren't enough inpatient adverse events or deaths to warrant the extra expense of hiring nurses to lower that ratio. However, a couple nights ago we had a patient code who has since died, and I am 100% convinced that the patient's death could have been avoided if that night staff were not the bare bones allowable.

The whole night was a mess and the patient coded on a floor where there was a rapid response less than 3 hours earlier, and those nurses were all stretched thin to begin with, so I am not in any way placing blame on my coworkers and hope it does not come to litigation against any of them. However, I was with the patient and family in the ICU for much of the day yesterday and I doubt they think that the loss of their loved one is in any way an acceptable risk for the hospital to take in favor of saving some money. It was one of the most heartbreaking days I have had in nursing and I know I'll get over it, but right now I'm sad for that family and mad for all of us that want to provide the best care, because in some cases we're set up to fail.

Your post is painfully eloquent, and it speaks so well of your commitment to the profession and to that family, Hang in there.

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Specializes in Varied.
19 hours ago, JBMmom said:

I'm sure that the healthcare system that employs the nurses in my hospital, and the others in the system, has plenty of data to back up the staffing model that leaves most of our general inpatient floor nurses with 6 patients on days and evenings and 7-8 on nights. They have determined that we have the necessary staffing to provide "statistically" safe care. They can probably show somewhere that there aren't enough inpatient adverse events or deaths to warrant the extra expense of hiring nurses to lower that ratio. However, a couple nights ago we had a patient code who has since died, and I am 100% convinced that the patient's death could have been avoided if that night staff were not the bare bones allowable.

The whole night was a mess and the patient coded on a floor where there was a rapid response less than 3 hours earlier, and those nurses were all stretched thin to begin with, so I am not in any way placing blame on my coworkers and hope it does not come to litigation against any of them. However, I was with the patient and family in the ICU for much of the day yesterday and I doubt they think that the loss of their loved one is in any way an acceptable risk for the hospital to take in favor of saving some money. It was one of the most heartbreaking days I have had in nursing and I know I'll get over it, but right now I'm sad for that family and mad for all of us that want to provide the best care, because in some cases we're set up to fail.

What is most difficult, I believe, is that we need a better understanding of "safe" nursing ratios. Acuity should always be considered when looking at "safe" staffing ratios. As you mentioned, "statistically safe" isn't good enough for our staff or our patients.

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Sounds like it's time to find a new employer. Most places are going with bare bones staffing, but some places are worse than others.

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Specializes in oncology, MS/tele/stepdown.

I've seen this in small community hospitals and in big teaching hospitals. All we can do is advocate for our patients and vote with our feet if we can find safer pastures.

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Specializes in Critical care, tele, Medical-Surgical.

Although numerous studies have statistically shown that the hospital nurse staffing ratios mandated in California are cost effective and associated with lower mortality too many refuse to provide sufficient nurses to ensure that patients receive needed nursing care.

Quote

Implications of the California Nurse Staffing Mandate for Other States

California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908200/

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Specializes in ER.

Research states that for every patient above 4:1 there is a 7%greater risk of death for each patient. I'll go hunting for the reference when I have a minute, but 6:1 is not ideal.

https://jamanetwork.com/journals/jama/fullarticle/195438?version=meter at null&module=meter-Links&pgtype=article&contentId=&mediaId=&referrer=&priority=true&action=click&contentCollection=meter-links-click

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