Patient Safety Dilemma

[aehart]

First off I want to set up the scenario I have been working with lately (sorry it's so long and involved):

I work as a student nursing technician on a very busy med-surg/trauma/neuro/stroke unit. Recently, we have been severely understaffed due to other aides getting injured/sick. That leaves us with two part-time aides, three full-time aides (one for days, one for evenings, and one for nights), and about ten techs who are per diem. On the weekends we usually have six or seven RNs, two LPNs, and anywhere from one to three aides/techs.

Because of the nature of the patient population I would venture to guess ninety percent are considered high fall risks. About half of our patients will have bed checks/alarms and it is not uncommon for someone to be in restraints.

Yesterday I was working the 3 - 11 shift with two other girls. One was leaving at seven when another tech would come in. We have a large amount of sitter cases right now. It was my turn to sit so I was assigned to a motorcycle accident with CHI and multiple abrasions. He also happened to be detoxing. The night before he had gotten very violent and had to be put in restraints. When I was sitting with him he was unhooked from his restraints because he was sleeping (2 mg of Ativan will do that to you). As I was sitting there was a woman who they also wanted to make "sitter cases." That now left us with six patients who needed sitters/companions. Two of the patients happened to be husband and wife and they were roomed together (NOTE:***This is not the nature of my question, BUT I found this to be extremely unsafe because of their extremely similar first and last names, but I digress).

The patient I was sitting with was deemed safe (because he had been knocked out all day) and his sitter/companion case was cancelled. I was then assigned to the husband and wife who really just needed reoriented every once in awhile and told not to get out of bed.

One of the other techs had to sit, leaving one aide on the floor. The girl who was supposed to come in at seven called off.

As the night went on I kept hearing call lights from in my room. Apparently the other aide sitting in a different had a family emergency and had to leave taking our only other aide off the floor. The call lights went on and on and on and on and on. I even had mine on for over twenty minutes. The nurses would NOT answer the call lights. We have a computer that tells us how long call lights have been ringing. I stepped out of the room while the nurse was in passing meds and I looked at the computer. One call light had been going off for about seven minutes, another for fifteen, another for seventeen, and mine for twenty-three.

My question is should I, as a student tech, say something to my manager? I find this to be VERY VERY UNSAFE for patients. twenty-three minutes! Someone could die in that time. W have had a huge increase in our falls and I blame it on the RNs and LPNs who refuse to answer call lights. I don't know if it is because they feel like it isn't THEIR job or what. I think that answering call lights should be everyone's job, not just unlicensed personnel. Should I say something? And, if so, how should I say it. I don't want to be a compainer or a whiner or anything. I just want the patients to be safe. I don't want to compromise my ability to get a job when I graduate in May, but I feel like if something doesn't get said, nothing will change until the worst thing possible happens. Any input would be extremely helpful. I'm sorry this was so long!

I should probably also note this is usually only a problem on the weekends as we have different weekend night/day staff from week day night/day staff.

[himilayaneyes]

Understaffing a problem in every facility. However, your situation seems to be very unsafe. Having a sitter case means you can't leave the room...so those nurses should have answered the call lights. I would bring it up to management w/o naming anyone in particular...b/c this is just a tough situation. Tell them the situation in a polite/respectful manner and verbalize your concerns.

[chloecatrn]

I would mention your case in your room. Explain that you were in a room sitting, and you had a call light on for over 20 minutes without being answered. Share that you were concerned that other patients might have had to wait for a similar amount of time without a staff member present in their room with them. If it's all about your experience, there's not any problem in bringing it up. Good luck, and kudos to you for wanting to enhance your patients' experience.

[DogWmn]

Big understaffing issue, the RN's and LPN's have a job to do to and they are just as pressed as you are. When I worked LTC just getting my meds,treatments and charting done was about all I could get done. If I was passing by a room and a CNA needed help to boost someone up I'd do it, but anything that got me off my schedule was out.

You have several options, quit, suck it up, complain to the Charge (could cost you your job), or continue to just do your best.

[nyrn5125]

patient safety is everyone's responsibility. we constantly get interrupted during med passes to place pt' on bedpan, boost in the bed, talk to family, answer bathroom lights/bed alarms, answer phones, it's constant interruption and it is ridiculous how some aids cannot function independantly without asking the nurse for help. But, it's the nurses job as well as the aids to make sure the pt is ok. The best thing to do is chain of command and suggest an in service on everyone pitching in without blaming. I see both sides of it all the time and i know how overwhelmed the RN LPN are, but I would rather be 10 minutes late for a medpass than to have a pt on heparin fall

[michiganurse]

Another example of hospitals trying to save a buck, and IT WILL COME BACK AND COST THEM PLENTY. They never learn. As far as nurses not answering lights? AMEN. Where I work, we have NO AIDES--no one but us nurses (all RN staff) and we get our lights--some faster than others, but even THIS IS UNSAFE, b/c, as i said, no aides--they short us secretaries, phones ring off the hook, we do our baths, feeds, cover the sitter for 1:1 sit so they can go to lunch, even tho we don't get one half the time, telem alarms sound, vents, pumps--we HUSTLE. on the rare occasion they loan us a nurse from another floor, they SIT ON THEIR AX next to the call box showing THEIR light is on, and they continue to sit, and sit--until we say GO GET YOUR LIGHT PLEASE--b/c they're USED TO SITTING AND HAVING THE AIDES GET THE LIGHTS. well usually the aides have plenty more to do. one sat and listened to her vent alarm (not on my floor) like what would the aide do for this? the patient bradied down and coded b/c he had popped off his trach. so nurses, aides or NO aides, get off your butts. and yeah, i'd say something to the manager--more than likely this has been going on longer than you have been there, and the nurses are probably burned out on it--i'd mention to the manager how this is going to cost WAYYY more in an injury or death lawsuit somewhere down the line, and KNOWING you're staffing the unit that way, that just might be criminal conduct. and yeah, that manager just might have her hands tied, unable to hire any more staff, and the ones she has calling in prob due also to burn out! this is why sometimes you have to teach the jerks who hold the purse strings a lesson and report the hospital to cems and osha for unsafe staffing. write your legislators to PASS the nursing staffing bill!

[systoly]

What's wrong with asking the nurses why the lights are not being answered? If the answer is unsatisfactory go up the ladder.