Hospital Profits Over Patient Safety: The reasons you should not be a nurse

[KalipsoRed21]

I saw this and it just spoke to me in a thousand ways. I want hospitals to be profitable enough to be stable, and to expand services, but the goals for profit are FAR beyond those meager goals. Your healthcare sucks because of capitalism. And the reason you shouldn’t be a nurse: capitalism = nurse abuse and poor patient outcomes. 

[Jedrnurse, BSN, RN]

8 hours ago, macawake said:

Our manager will remind us at staff meetings if there haven’t been many reports recently and encourage us to write more of them.

It’s a non-punitive system designed to safeguard patient safety and improve/protect our work environment. I probably write two or three every week. 

What are some of the issues that have been positively impacted/improved due to the reports being submitted?

[macawake, MSN]

12 hours ago, SunDazed said:

Our hospital administration is trying to improve their reputation as it relates to surveys and hospital certifications. Do they actually do anything when we write things up? Doesn't seem like it.

They are completely out of touch with the experience of those of us on the patient care front. They encourage us to write things up, because it makes the hospital LOOK better.

Seriously... I used to write things up when we had a manager that would actually follow up and ask questions about the submitted reports. When no one asks a single question about what you submit in a report? Well, you know they are not reading them or don't intend to do anything. 

I can completely understand why you wouldn’t write things up if nothing ever comes of it. It sounds as if your organization might be more hierarchical than mine. Mine is rather flat.

What first happens when I submit a report is that I get an automated email seconds after, confirming that my report has been received. The report is then received by my manager who has to figure out what area or specialty the report concerns. If I for example wrote that I think that many ER doctors weren’t proficient in CPR and I’d witnessed their subpar performance and that I now recommend that they get additional training (that’s obviously not the case and I haven’t written that report), then my manager would forward that to the Chief of Staff/ER. Then I get another email saying that my manager logged the report and has now designated the boss over at the ER as the person responsible for getting to the bottom of this. 

When the Chief of Staff submits their findings and recommended course of action and a timeline for the implementation of any necessary actions, I get another email describing the outcome. If all is well, the case is closed. So I always know what happens to my reports. 

In our department we have monthly meetings where we track all incident reports that have been written and have been assessed as needing further action, and follow up to make sure that none are missed. It’s a group of managers (first-line) and their boss, as well as one representative of every profession. 

[JKL33]

7 minutes ago, macawake said:

I can completely understand why you wouldn’t write things up if nothing ever comes of it. It sounds as if your organization might be more hierarchical than mine. Mine is rather flat.

I am judicious with incident reports. I have neither the time nor the internal motivation to write them for anything less than a serious patient safety issue. The last one I wrote involved something so convoluted I won't write it because it would be recognized.

I never heard anything back.

I have worked in at least one place where if the incident meant that admins would need to change something they didn't want to change, or if it was not a situation where they could easily just blame and chastise employees, no one ever heard about it again. For all we know the reports get lost in an intranet black hole, or previously when on paper may have been delivered straight to the shredder unless it was something juicy like a report about Mean Doctor.

[macawake, MSN]

5 hours ago, Jedrnurse said:

What are some of the issues that have been positively impacted/improved due to the reports being submitted?

Lots of things really, big and small. We write reports on many different areas. Patient safety, staff working conditions and even environmental issues. I wrote one that made the department switch to a more environmentallly friendly dishwasing liquid. Several years ago I wrote one regarding greenhouse gas emissions from volatile/inhalation anasthetics, suggesting the department look into using Sevoflurane more often over other gases that are even more potent greenhouse  (Or using TIVA when appropriate). 

I’ve gotten an emergency exit re-classified to a staff entrance. They had to install one of those keycard thingies, and now we can pop out for some fresh air and a short break much more easily. This door is on our floor and earlier we had to trek through half the hospital in order to get some fresh air.

Years ago, there was a nursing job where I worked at the time that was only staffed by a single nurse. It didn’t involve caring for a lot of patients and most nights the job could be easily handled by a lone nurse. It’s just that when **** did hit the proverbial fan, things would escalate quickly, and then you really needed to be two. So I wrote a series of reports outlining the risks and in the end, that position was permanently manned by two nurses. 

I’ve also written a series of reports that lead to another department creating two new permanent physician postions and rearranging the order some things were done. That department was providing a service to the department I worked in and the things we needed done, were often late. I actually talked to several of the docs, telling them that I would write reports. These were great physicians, they simply had too much one their plate. 

I could go on all day, but I doubt anyone is all that interested. My point is I feel that the time I spend writing these reports, do pay off. 

[macawake, MSN]

27 minutes ago, JKL33 said:

I am judicious with incident reports. I have neither the time nor the internal motivation to write them for anything less than a serious patient safety issue. The last one I wrote involved something so convoluted I won't write it because it would be recognized.

I never heard anything back.

I have worked in at least one place where if the incident meant that admins would need to change something they didn't want to change, or if it was not a situation where they could easily just blame and chastise employees, no one ever heard about it again. For all we know the reports get lost in an intranet black hole, or previously when on paper may have been delivered straight to the shredder unless it was something juicy like a report about Mean Doctor.

That’s horrible. As a nurse I have a legal obligation to notify my employer if I witness something that poses a serious threat to patients; illness, injury or death. My employer then has a legal obligation to make a report to an agency that is responsible for oversight of patient safety, as soon as they are informed about the incident.

I think it’s scary that things appear to be swept under the rug like you describe. I’ve never noticed you being prone to using hyperbole, so when you describe the incident the way you just did, I’m assuming it was something serious.  

[SunDazed, BSN, RN]

1 hour ago, macawake said:

 

In our department we have monthly meetings where we track all incident reports that have been written and have been assessed as needing further action, and follow up to make sure that none are missed. It’s a group of managers (first-line) and their boss, as well as one representative of every profession. 

That sounds like a useful system.

[JKL33]

6 minutes ago, macawake said:

I think it’s scary that things appear to be swept under the rug like you describe. I’ve never noticed you being prone to using hyperbole, so when you describe the incident the way you just did, I’m assuming it was something serious. 

It was serious; I should be clear that no one died. It was a completely unnecessary scenario that did involve the need for resuscitation and higher level care.

[Guest 1152923]

1 hour ago, JKL33 said:

For all we know the reports get lost in an intranet black hole, or previously when on paper may have been delivered straight to the shredder unless it was something juicy like a report about Mean Doctor.

          Somehow, these reports especially, alway seem to mysteriously disappear.  This is even more true when the doctor is an absolute tyrant, mean SOB but a high revenue generator for the hospital..."incident report, what incident report?'

1 hour ago, morelostthanfound said:

          Somehow, these reports especially, alway seem to mysteriously disappear.  This is even more true when the doctor is an absolute tyrant, mean SOB but a high revenue generator for the hospital..."incident report, what incident report?'

Maintain your own copy of the incident report. 

[KalipsoRed21, BSN, RN]

On 1/29/2022 at 12:42 PM, Ashlee59 said:

I'm glad I'm in home health.  Hospital just seems full of drama

Home health is not without theirs. No way I’d go back to the pissant pay of “salaried” home health or per visit home care. The charting is dramatic and the drive miles on my personal vehicle inordinate compared to the compensation. The one good home care company I worked for at least paid me hourly and gave me a car and a gas card. But they still wanted me to drive 150-200 miles, see 6-7 patients and chart all that. Sorry dudes, I need a life or I need to get paid. Apparently having both in nursing is not possible.

 

[JKL33]

3 hours ago, morelostthanfound said:

Somehow, these reports especially, alway seem to mysteriously disappear.  This is even more true when the doctor is an absolute tyrant, mean SOB but a high revenue generator for the hospital..."incident report, what incident report?'

Not in my last place. Special rounds were made periodically specifically to solicit reports about doctors whose words did not fall perfectly upon the particular listener's ears. All part of the game. I noticed that all those efforts didn't elevate nurses' status with employers; it had nothing to do with helping us, it was about lowering physicians' status below that of MBAs'. Just another thing I would say doesn't seem to be going too well.

[nursel56]

3 hours ago, KalipsoRed21 said:

Home health is not without theirs. No way I’d go back to the pissant pay of “salaried” home health or per visit home care. The charting is dramatic and the drive miles on my personal vehicle inordinate compared to the compensation. The one good home care company I worked for at least paid me hourly and gave me a car and a gas card. But they still wanted me to drive 150-200 miles, see 6-7 patients and chart all that. Sorry dudes, I need a life or I need to get paid. Apparently having both in nursing is not possible.

 

I agree with you.  I would not characterize home health nursing as drama-free.  

It is true that you have only one patient in private duty, but in my experience there is plenty of drama.  It's just a different kind of drama compared to hospital staffing drama.