Activism??? Nursing responsibilities increasing dramatically

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Tell me why I have to get clarification on approximately 45% of all the doctor's orders I recieve? Sometimes the doctor will be right there and can not tell you what they just wrote! Plus they do not follow the proper medication administration rules when writing orders. I feel there is so much asked of the nurse and no one is standing up and saying "Hello I have increasing number of patients to care for, treatments, decreasing amount of certified nursing assistants, increasing number of rounds per patient per hour, increasing acquity of patients, increasing documentation, increasing responsibility to interact with nutrition, respiratory, lab, social worker, physicians, transportation to name a few. Plus awareness of the facilities policy and procedure to insure your in compliance with all your tasks. But here you can do this too! Where is the ANA in all of this? Why isn't someone speaking up and saying enough is enough! I have heard many people say "nursing is a calling". So does this mean because your called they can dump on you and you will be the trouper and carry that burden like an ox? Or is it because physicians were primarily male and nurses were primarily female and had to be submissive and take on responsibilities they dictated. Whatever! It's time to stop the crazy train and hold other health care personnel responsible for their actions and not just say "Your the nurse, the patient advocate, patient safety is your number one concern, and you should have known." Currently in a nursing class in the textbook it states that healthcare providers will be legally responsitble for the informed consent teaching for self-care, and discerning appropriate learning materials for that patient.

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Specializes in PICU, Pediatrics, Trauma.

I hear you! I feel the same. Currently not sure where to begin. Letters to ANA? Letters to Congress? How about we gather nationally and start a complaint with the National Nurses Organization? We have to gather in numbers. It's not just a state by state issue.....just look at all the posts here. Nurses are angry and some are just plain afraid.

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Specializes in Critical care, tele, Medical-Surgical.

You have excellently described what is wrong in all too many hospitals and healthcare facilities.

As rapid changes are implemented in health care settings, RNs are often witnesses to unsafe or compromised patient care conditions.

An important part of quality patient care is ensuring adequate hospital staffing to avoid putting patients at risk.

It is difficult for one nurse to improve policies and staffing.

To start perhaps your colleagues can work with you to bring up your issues at a staff meeting or make an appointment with nursing management.

It is important to be factual, give an example, and ask for something concrete.

Presenting as a group makes it clear you and not just a disorganized or unhappy nurse.

As an individual nurse if, in your professional judgment, you believe a patient care assignment is unsafe, or potentially unsafe, you have an obligation to notify your

employer so the problem can be corrected and injury or harm to a patient can be

averted.

If your employer cannot or will not correct the situation I suggest keeping a diary of every shift. Some shifts you may just write, "Went OK."

But when you tell a manager or supervisor why your assignment is unsafe their response needs to be documented in order to protect yourself in the event of

adverse outcomes for the patients or other staff.

Write, "Told ***** my assignment is unsafe for the acuity of assigned patients and the excessive time it takes to ensure the physicians orders are written correctly In my professional judgment today's assignment places my patients at risk."

Make sure the date, unit, time, and a direct quote of what was said is included.

The most common answer in my experience was, "Do the best you can."

Ideally along with the journal you would write out a dated letter to your manager describing the unsafe assignment or assignments. All staff who agree would sign it, make two copies and hand it to your manager.

The above works well with some managers in some facilities.

Stick to facts. Always be calm and polite.

Know that the only reason a person is admitted to the hospital is for Nursing Care so that hospital is required to staff appropriately.

I hope others will have suggestions too.

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Specializes in Critical care, tele, Medical-Surgical.
I feel there is so much asked of the nurse and no one is standing up and saying "Hello I have increasing number of patients to care for, treatments, decreasing amount of certified nursing assistants, increasing number of rounds per patient per hour, increasing acuity of patients, increasing documentation, increasing responsibility to interact with nutrition, respiratory, lab, social worker, physicians, transportation to name a few. Plus awareness of the facilities policy and procedure to insure your in compliance with all your tasks. But here you can do this too!...

It is important to speak up! I think a major issue is probably unsafe staffing.

Keep records as in my previous post. if you write every shift you work it will hold up in court or the Board of Nursing (BON) if something happens.

Take it slow trying to work with fellow nurses, write and/or meet with management, or seek help.

Your hospital may be violating federal and state statutes and regulations. Learn all you can about safe patient care.

Centers for Medicare and Medicaid Services regulates all hospitals that admit Medicare patients. I'm providing a link with a quote from the pertinent section on pages 13 & 14:

§482.23(b) Standard: Staffing and Delivery of Care

There must be a RN physically present on the premises and on duty at all times.

Every inpatient unit/department/location within the hospital-wide nursing service must have adequate numbers of RNs physically present at each location to ensure the immediate availability of a RN for the bedside care of any patient.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

Here is a site for research showing that safe staffing is cost effective and saves lives:

http://www.ninr.nih.gov/sites/www.ninr.nih.gov/files/10-landmark-nursing-research-studies.pdf

More to read:

Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk | Jun

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Specializes in Vascular Access.

If your employer cannot or will not correct the situation I suggest keeping a diary of every shift.

I completely agree. Remember to keep things professional and keep the emotion out. Stay cool and calm and report the facts.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

"Where's the ANA in all this"?

NOWHERE where they help the average staff nurse. Which is why I won't be a member. They have a political agenda; they definitely are not there to help the nurses they purport to represent.

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Specializes in Critical care, tele, Medical-Surgical.

Here is an example of a hospital cited with a Statement of Deficiency for unsafe nurse staffing. The nurse was assigned four patients with one critically ill requiring 1:1 care.

There is no Plan of Correction yet:

http://media.bizj.us/view/img/10081835/u-of-l-hospital-report.pdf

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Specializes in PICU, Pediatrics, Trauma.
Here is an example of a hospital cited with a Statement of Deficiency for unsafe nurse staffing. The nurse was assigned four patients with one critically ill requiring 1:1 care.

There is no Plan of Correction yet:

http://media.bizj.us/view/img/10081835/u-of-l-hospital-report.pdf

The responses so far are "technically" good, but read this and you will see that voicing concerns and documenting is not "practically" effective. Over a period of several months a year? (Difficult to pin down, because there were so many voiced concerns), this hospital did nothing to rectify their short-staffing isses. In fact, it appeared that they caused the problem related to "changes" in administration. In this instance, high level physicians even complained and nothing was done. It is a good example though, of how keeping records can help in the long run when/if the hospital is investigated. This report shows how many voiced concern over a period of time and I am sure helped the case in the end.

So, what I am saying here is, do voice concerns, and do document. Just saying don't expect things to change quickly. And, if enough staff do the same, it may prevent those who do complain from being targeted as having a bad attitude or some such other crap as there is power in numbers.

What concerns me, is how many other situations occured that were not documented, and why did it have to get so bad in this hospital before anything was done?

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Specializes in PICU, Pediatrics, Trauma.

I just have to give an example that happened at a hospital I worked for, because it is a great example of how administrations keep piling on responsibilities to Nurses.

Apparently, there had been so many errors made in the dietary department, the nurses were told we had to check each tray and snack delivered, and sign a form stating that each and every item on the tray was appropriate for the patient's ordered diet. Can you believe this? Instead of doing better training, re-training or whatever else was needed, they just made the nurses check the work. The point is that it appears "no one else" is held accountable to their work alone. As Nurses we are now also held accountable to every other departments' work in addition to our own. We can't trust that the doctors write orders correctly/dose correctly. We have to check that the pharmacy sends the correct med, dose, form of delivery, diluent in the appropriate dilution ratio and call them for missing meds on a regular basis. We have to call and bug PT/OT regularly to come evaluate and treat the patients. Frequently, we have to call anyone and everyone to come do their job or ask for clarification on their job such as Lab results not entered after sufficient time, and the list goes on and on....I have never heard of any other profession (although they may exist), where one role is expected and held accountable to ensure another role is done correctly. That is called Supervising. We are supervising everyone else's work in addition to our own.

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Specializes in Critical care, tele, Medical-Surgical.
I just have to give an example that happened at a hospital I worked for, because it is a great example of how administrations keep piling on responsibilities to Nurses.

Apparently, there had been so many errors made in the dietary department, the nurses were told we had to check each tray and snack delivered, and sign a form stating that each and every item on the tray was appropriate for the patient's ordered diet. Can you believe this? Instead of doing better training, re-training or whatever else was needed, they just made the nurses check the work.

The point is that it appears "no one else" is held accountable to their work alone.

As Nurses we are now also held accountable to every other departments' work in addition to our own.

We can't trust that the doctors write orders correctly/dose correctly.

We have to check that the pharmacy sends the correct med, dose, form of delivery, diluent in the appropriate dilution ratio and call them for missing meds on a regular basis. We have to call and bug PT/OT regularly to come evaluate and treat the patients.

Frequently, we have to call anyone and everyone to come do their job or ask for clarification on their job such as Lab results not entered after sufficient time, and the list goes on and on....I have never heard of any other profession (although they may exist), where one role is expected and held accountable to ensure another role is done correctly.

That is called Supervising. We are supervising everyone else's work in addition to our own.

THANK YOU!

I would file an incident report each and every time dietary, pharmacy, or another department makes an error, doesn't send needed food or medication, or does not show to do their job. I would make sure it goes to the hospital attorney, not just a manager.

I too am in California. Check the title of the person responsible for ensuring the department performs it's required functions. Most are accountable to Medical Staff and Administration.

What do you think of calling Administration when these departments make an error or fail do do their jobs?

Here are the regulations for some hospital departments in our state:

Dietary:View Document - California Code of Regulations

Pharmacy: View Document - California Code of Regulations

Laboratory: View Document - California Code of Regulations

Radiology: View Document - California Code of Regulations

Occupational Therapy: View Document - California Code of Regulations

Physical Therapy: https://govt.westlaw.com/calregs/Document/I05849A10D4BC11DE8879F88E8B0DAAAE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

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Specializes in PICU, Pediatrics, Trauma.
THANK YOU!

I would file an incident report each and every time dietary, pharmacy, or another department makes an error, doesn't send needed food or medication, or does not show to do their job. I would make sure it goes to the hospital attorney, not just a manager.

I too am in California. Check the title of the person responsible for ensuring the department performs it's required functions. Most are accountable to Medical Staff and Administration.

What do you think of calling Administration when these departments make an error or fail do do their jobs?

Here are the regulations for some hospital departments in our state:

Dietary:View Document - California Code of Regulations

Pharmacy: View Document - California Code of Regulations

Laboratory: View Document - California Code of Regulations

Radiology: View Document - California Code of Regulations

Occupational Therapy: View Document - California Code of Regulations

Physical Therapy:https://govt.westlaw.com/calregs/Document/I05849A10D4BC11DE8879F88E8B0DAAAE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

Thank you for the info. I would do reports on errors. But then that would have to be OT, no doubt, as Incould barely get my work/charting done on time. Also been criticized by one manager saying.."every time I turn around there is another report.from you.". Can't win...

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Specializes in Critical care, tele, Medical-Surgical.
Thank you for the info. I would do reports on errors. But then that would have to be OT, no doubt, as Incould barely get my work/charting done on time. Also been criticized by one manager saying.."every time I turn around there is another report.from you.". Can't win...
It is too difficult when you are the only one.

I know it worked on one unit where everyone, RN, LVN, CNA, and unit secretary filled them out.

The hospital attorney came to a staff meeting. He said that if there was a malpractice suit the hospital could be liable.

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