Advice on Expressing Patient Safety Concerns

Nurses Safety

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I worked three years as a pediatric registered nurse at a facility. I left due to patient care concerns. I returned to work PRN after three months off to find the situation unchanged and, though I wish to leave again for the same reasons as before, I find that my conscience stings in leaving such care practices still in place.

The facility is a 20+ bed dedicated pediatric unit. As far as equipment they lack many 'routine' elements of acute care such as wall suction and replace it with one or two working portables for the unit. The cribs, though in working order, are older, rusting in places such as the handles, and difficult to work at times.

Communication is also lacking. I returned to find the defibrillator missing. I assumed it was being repaired and the full-time nurses I was working with also did not know where it was at the time. I returned to work PRN two weeks later and again commented on the still missing defibrillator. The full-time staff, again, did not know where it was. It was discovered with communication to the on-coming shift of its absence that the old defibrillator was removed from the unit and the unit now shares a defibrillator with the adult floor on the same level of the hospital. This new defibrillator is kept behind a locked door on the adjacent adult floor to which none of the pediatric staff immediately know the code.

As far as staffing, it was one of the major reasons I left full-time there. During the winter it was not uncommon to have six to seven pediatric patients per nurse without the assistance of a tech for assistance. The nurse to patient ratio by the book at that time was three nurses at nine patients. Keep in mind this is a 20+ bed unit and rarely more than three nurses were ever scheduled per shift. Acuity is never truly factored in. It is always based on numbers.

Another issue was the location of the pediatric IV room which is located behind the nurses desk through a play room. As it takes two nurses to start a pediatric IV in most cases, that often left no one at the desk or within access to the other patients at the time of IV starts - particularly at night.

Prior to my leaving, I wrote the hospital two letters on patient care concerns which were mailed to them return-receipt requested addressing the concerns of staffing, acuity, and patient safety. The response was basically "Thank you for bringing this to our attention. We are working to correct this." I returned PRN to find that the nurse to patient ratio for the allowance of three nurses had risen to three nurses at 10 patients - including on day shift where most of the admissions and discharges occur. The recommended nurse to patient ration for stable acute pediatrics is one to four. The unit does not have any assisting staff such as techs or secretaries.

New graduate RNs are also often left in charge of the floor with LPNs or are given patients who were critical earlier in the day without the guidance of a more experienced nurse being present.

Furthermore, I recently was spoken to by a charge nurse for setting up the portable suction to suction the airway of a month old baby with RSV. Granted I had to gather equipment from two different floors to even set up the suction equipment and had to use a small feeding tube (taped to create a seal) to suction the nose as the hospital does not carry specific equipment for the suctioning of small noses such as little suckers/neosuckers. I do not need a physician's order to clear an airway. I was informed by the charge nurse that "had I been the manager, I would have made you come back in and take it down." Upon bringing up the existence of such equipment as little suckers to help with suctioning over two months ago to the manager, I was informed that she had samples in her office but had never felt the need to order - even after I recommended the product to assist in oro-nasal suctioning on infants where bulb syringes failed to work well enough. "We've never had a death from lack of suctioning."

As I have written letters in the past to the management expressing my concerns without result and am increasingly concerned over the issues encountered, I am seeking any advice on how to proceed. I am concerned for the safety and welfare of the patients and wish to help improve the situation for them.

Wow. The defibrillator thing has me so concerned. All you can do is nice up the chain of command one link at a time. Keep records of everything. If you see something not up to code call them on it. Where I worked before there was a hazardous situation that was not up to code. A quick anonymous call to the Fire Marshall got that situation fixed.

Specializes in Critical care, tele, Medical-Surgical.


Most hospitals have a Risk Management department that would be very interested in what you have to say.

When it concerns matters of financial liability and potential litigation they're all ears.

I spoke with Risk Management before I left full-time. They had started floating pediatric nurses to the medical-surgical floors to take 5-7 adult patients without orientation. This included nurses who have never worked anything other than pediatrics. It ended with our being given an "orientation book" that included the layout of the unit, where supplies were kept, and the codes to the locked doors at that time. They have since changed. There was no information on unit policy and information collected from the staff varied with who you asked and what you were asking. When concern was expressed that the drugs were different, pharmacy brought up a list of names for the most commonly used medical surgical drugs which not everyone even received - only the two people who brought that to attention got a copy. Anything further was completely brushed aside by the facility and Risk Management never responded.

One of the nurses who had been floated to take patients, had 7 patients - including two on heparin drips, had never worked med-surg, and was unfamiliar with most of the drugs (we don't routinely give them in the pediatric population). When she stated she was uncomfortable taking the patients but was willing to help the unit, she was told that if she refused to take them she would be written up for patient abandonment. I consulted an attorney after that for clarification and was told the hospital could legally do that if someone had clocked in. The whole reason the pediatric staff was being floated to these floors during our summer slow months was because the hospital had lost 5-9 nurses in a two-three month window because they refused to take 7-11 patients routinely. They filled the spots with travelers for a while and then starting using the full-time staff as a float pool regardless of their experience or area of expertise.

One reason I'm so frustrated is because I've exhausted the resources there without change. It's almost as if it's not going to be an issue until something happens. That's not proactive at all. What about the person it happens to when it could have been prevented? =/

If you have clocked in to work peds and then get floated to another unit where you are unable to accept an unsafe assignment, that is not abandonment. Suggest you contact a TAANA nurse attorney for that opinion.

However, hospitals routinely use that "written up for abandonment" threat. Just because they write you up for it does not mean that the board of nursing will give them the time of day, especially if you have preempted their report with one of your own describing what you have here. Won't they be surprised!

Also, you must have your own -- if not, get it NOW -- and you can call and speak to a lawyer there for free, and if needed, they will represent you as part of your coverage, no extra charge. So now you have backup, and you can let them know if they threaten you again.

Thank you.

Specializes in Critical care, tele, Medical-Surgical.

typo

  • Even if your state has no whistleblower protection you CAN report to a licensing and regularory agency to protect future patients.
    Of course we do all we can to care for patients the unsafe conditions described are not legal. It needs to stop before a preventable tragic event occurs.

PLEASE!

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