Webster's Dictionary defines complacency in a way that we, as a people, can all understand. As nurses and caregivers, we know deep down that complacency is taken to an entirely different level within our scope. It is a weighted situation that causes a slew of issues of which safety takes precedence over all. Let me reel you in a little deeper...
As a nursing student, I followed a wound care nurse that was performing a monthly study on the prevalence of wound progression while in the hospital. We rounded on a patient's room and whipped off their socks. In an instant, we were stunned to find a blackened foot that had completely lost perfusion-- when? No one knew. The report from the nurse, "I just didn't think of taking off their socks when checking pulses." When inquired as to why, 'I... I guess I just got lazy.' This patient lost their foot.
Once again, as a nursing student in the GI suite watching colonoscopy after colonoscopy, a woman came in for a study due to an extensive family history of colon cancer. As the probe was removed and she was slightly stirring from her twilight sleep, someone made an inappropriate joke at her expense. The entire room started laughing. The patient then looked up at me with tears in her eyes, "They are laughing at me, aren't they?" I lied in order to save face. Uncool my friends. Uncool.
A nurse I was working with a fellow comrade who felt too proud to ask for help with a blood infusion on a cardiac step-down unit. As I'm sure you can assume, this patient suffered from pulmonary hypertension as well as a very poor ejection fraction with apparent symptoms of heart failure exacerbation. They ran the blood too fast, didn't inquire to the MD about Lasix in conjunction with the infusion. Here comes massive fluid overload and a rapid response call. Avoidable? Indeed.
Taking a step away from nurses, call into question a physician who flits in and out of the hospital who thinks that a ticking time bomb of a case (pulmonary hypertension, hypertension, kidney failure without dialysis and COPD) isn't worth abrupt addressing. I walk in and find the patient talking one minute, unresponsive the next. After bedside intubation and a run down the hallway to the ICU, the patient almost died (bless vasopressors). When the physician rounded on the floor they peeked into the room-- "Oh, they are gone, I'm assuming to the ICU? [shoulder shrug] Okay." May I mention not answering pages (most of them stat) and the fact that physical compensation wore out and almost killed this man. The physician had no shame.
One last example... A CNA rounded on a patient in my unit. This individual was extremely confused, was assisted to the bathroom, then helped back to bed. Great right? Wrong. The bed alarm wasn't set nor were the bed rails up. I was running down the hall when I saw the patient literally roll out of bed and smash their head on the floor. It was a sound I would love to forget.
I am sure that many of you will look at these cases and think words like: negligence, ethical issues, etc. You are right for sure. But what I can also bring to the table about all of these stories is that each of the individuals involved had been approaching their jobs with a complacent attitude. All differing levels, but it was present, and it was absolutely affecting their care.
Complacency is a filthy animal. It makes Facebook at work more important than hourly rounding. It makes that extra long break of greater importance than double checking those pulses post cardiac cath. It means blowing off education and cheating on hospital required testing and skills check-offs because "we just don't have time."
We all know that our jobs hold immense importance and are very high risk, to us as well as those we see on a daily basis. If you think about it, the decisions we make on a daily basis can stop or even restart a heart. I don't know about you, but to me, this will always be an immensely frightening aspect of our careers.
What I ask of you is if you feel yourself sliding, none of us are above it mind you, take a step back. It is of utmost importance for us to draw the line when it needs to be marked (WITH BLINDING SIGNS). We need to understand our limits as caregivers. In order to save ourselves as well as our patients and our teams we have got to have to courage to state when our threshold has been met. I can recall in the last two weeks when I had to draw the line and ask for help because I couldn't take another [insert touchy situation here], or I would just break.
IT'S OKAY! YOU ARE HUMAN! We are fallible and at times inflexible. Let that crazy super-nurse idea in your head relax and take a reprieve.
I will never forget what an amazingly talented ICU doctor and anesthesiologist told me that day I left the GI suite with the laughing matter. The doctor grabbed me by the arm and reminded me in all seriousness, "It is our job to protect and do no harm. Every day this is our goal. As soon as you see yourself sliding, it's time to stop before you hurt someone."
So use those days off. Ask for help. Take a mental health day.
Because when we allow for complacency to take over and rule our care, that is the day that a nurse did more harm than good.
Florence expects the best, our patients expect the best, their families, the doctors, even you.
So let's provide the best care we can. In doing this we need to know our limits and be willing to draw those lines.
