I'm hoping to increase nsg awareness on the topic of defensive nursing.
Most of you are aware of defensive charting practices. The practice of stating facts--not opinions.
However, many nurses seem to throw caution to the wind when they accept nursing assingments.
I have observed many nurses trying to handle dangerous heavy pt loads. Loads that are so high and unsafe that pt care is compromise. One example is nurse Jane Doe or John Doe comes into work and is assigned a dangerous asignment of 12 patients instead of his normal 8. Being a kind and thoughful person, he naturally decides not to let his co-workers down and accepts the assignment.
However, his kindness can not effectively manage to do his job in a manner that is deemed safe. As a matter of fact, many of his patients do not receive prn meds in a timely manner; treatments are delayed; and numerous Now and Stat orders are on his charts wating to be noted. Furthermore, he is so swamped that he is not able to CHART AS THE SHIFT progresses; therefore, he forgets to chart defensively and accurately.
As the shift progresses, the nurse is constantly besieged by his patients to come to their aid when they use the call light. As a result of this nurse being swamped, he cannot pass schd meds on time and is often very late passing prn pain meds. His patients are frustrated because they are not being waited on in a timely manner. And as a result, complaints are filed against this nurse. And to top it all off, he has a patient code which later died. He also had a confused patient crawl out of bed and as a result of confusion and overall general weakness, this patient is transferred to ICU for head trauma.
As a consequence to the fall that one patient received, that patients family decides to sue nurse John Doe and the hospital that he was working at.
Another family is also pursuing a claim of negligence d/t their beloved family member not receiving prn pain meds until a hour after requesting them.
Keep in mind that John Doe is a excellent nurse but has bit off more than he can chew by accepting this assignment of 12 patients who are all over 65, have high co-morbidity factors, are all bedfast and need constant one on one supervision while they are using the restroom, who need patient teaching, need f/u on schd insulin, etc.
John has been informed that he is named in a suit for negligence, For the patient who fell and later went to ICU and died.
He is also named in another negligence suit d/t not giving prn meds w/in a resonable amount of time. The suit states that the patient suffered severe emotional distress as a direct result of not being medicated in a timely manner.
John, was not trying to give less than quality care. As a matter of fact he is known for delivering exceptional nursing care. However, on this fateful shift, John was overwhelmed w/ stat and now orders. He also had to start IV's on several patients and was also monitoring a pt receiving 2 units of PRBC's. He was also overwhelemed by having to answer call light after call light.
John had one aid and that aide had 16 pts to care for. John was unable to get assistance from his coworker, for they were overwhelmed as well.
Johns charge nurse could rarely offer John any help for she was tied up with her duties.
So to make a long story short, John did the best that he could with what he had. However, his best was not good enough for John could not keep pace with the problems that arose.
QUESTION:
Could John loose his license as a result of the events that transpired on his shift?
Yes!
Even though John did every thing that he could to keep pace w/ the mounting problems, he invariably was unable to monitor his patients--to access for changes in status--on a regular basis. Except for the quick focal assesment that he gave everyone on arrival to the floor, he was unable to give head to to assessments.
Remeber John was responding to now and stat orders. And also monitoring blood, as well as answer call lights, etc.
Do you think that John could possibly loose his license?
Do you think that John could face criminal charges?
Yes, to both above.
No matter how kind and compassinate John is. John made the fateful error of accepting a pt load that he could not handle. Therefor, as a cosequence, a patient died, and another did not receive prn meds on time.
Attorney's have won their settlement, John's
nursing insurance paid the claim. However, the nursing board in John's state found him liable for negligence and providing inadequate nursing care and has revoked his license and to make matters worse criminal charges are pending for negligence.
Is this fair?
No.
John should have made his charge nurse aware that he could not handle that many patients. But out of fear from termination and out of fear for letting his co-workers down and out of pity for his patients, John accepted the assignment.
Accepting the assignment was John's undoing. He placed fear from termination and fear from not being their for his coworkers above the safety of his patients. And now John is facing jail time, and lost his license to practice.
But John being naive, accepted the unacceptable. Afterall, he has seen countless other nurses do the same thing. And on several other occassions, John accepted more pts than he normally gets--and not once did anything major happen.
But see that's the problem: no one comes to work ready and prepared for the worst case scenario.
But nurses, I don't know about your state, but the state of Texas sends out quarterly newsbriefs on LVN nursing and in these briefs there are countless pages of people who have lost their license by putting themselves in a jam.
I have seen instances where nurses lost their license d/t not giving a prn med on time or d/t a pt falling resulting in death.
Your license is everything. You worked hard for it. Don't make the mistake that John did. He tried to be SUPERNURSE.
Everyday hospitals are constantly asking nurses to accept higher and higher loads and nurses give in; however, it can be to their own undoing.
This story is not a real story. Howver, it could very well happen. And I'm sure that countless nurses have lost their license by being suckered into accepting assignments that are too dangerous.
It is your license...Think about it.
