Here's the scenario

[lpncal]

You have been a staff nurse on a cardiac unit at a medium size hospital (300) beds in an urban

community for the last 6 months. Among the hospital's cardiac services are open‐heart

surgery, invasive and non‐invasive diagnostic testing, and a comprehensive rehabilitation

program. The open‐heart surgery program was implemented 14 months ago. During the last 3

months, you have begun to feel uneasy about the mortality rate of postoperative cardiac

patients at your facility. An audit of medical records shows a unit mortality rate that is

approximately 30% above national norms.

You approach the unit nursing and medical directors with your findings. They become

defensive and state that there have been a few freakish situations to skew the results but that

the open‐heart program is one of the best in the state. When you ask the medical director to

examine the statistics further, he becomes very angry and turns to leave the room. At the door,

he stops and says, "Remember that these patients are leaving the operating room alive. They

are dying on your unit. If you stir up trouble, you are going to be sorry."

My question is, what is our responsibility as a nurse to do in this situation? Is this an issue for JCAHO to look into or what?

Is this something I am supposed to be aware of as a future RN or is this someone else's responsibility to deal with?

[KyBreed]

I suppose the exact cause of death would be what a person needs to look at. If the reason for death had nothing to do with direct nursing care, then there's nothing for you to do. Are they operating on people that are too far gone and have very little hope of survival anyway or are patients being ignored because of high nurse:patient ratios? Discovering what went wrong and who was responsible has to be examined before this question can be answered, in my opinion.