"Getting Good Care in the Hospital requires Vigilance"

Nurses General Nursing

Published

From the Pittsburgh Post Gazette

http://www.post-gazette.com/healthscience/20030114hwise4.asp

Getting good care in the hospital requires vigilance

Healthwise

Tuesday, January 14, 2003

By Virginia Linn, Post-Gazette Staff Writer

In recent weeks, I've received more complaints than I can remember from exasperated family members trying to ensure good medical care for their loved ones. Not while they were at home, but in the hospital.

Virginia Linn

For many, it required 24/7 vigilance and repeated visits to the nursing stations to seek basic assistance such as janitorial services, water cups or a change of dirty linens that had been soiled for hours.

Here were some of the complaints:

A 90-year-old Squirrel Hill woman with a swallowing problem was given a "Nothing by mouth" order from her doctor, meaning she was to receive no liquids or food by mouth. But several times, cafeteria aides left food trays at her bedside. The practice continued despite complaints from her daughter.

One morning at 3, the daughter got a call at home from a hospital nurse with news her mother wasn't doing well. The nurse had been feeding her ice cream.

An 84-year-old woman on a fluctuating dose of the blood thinner Coumadin was admitted to the hospital with other medical problems. Her son said the nurses failed to follow her strict drug regimen and after she was released, she experienced related complications that landed her back in the hospital. While there, she went hours without water, despite repeated requests to the nurses, and often was left without for a bedpan.

The daughter of a 96-year-old Munhall patient was horrified at the condition of her mother's hospital room during a lengthy stay: On one day she found dirty latex gloves, toilet tissue and bloody bandage wrap on the floor and an overflowing garbage can. There were no paper towels in the room for more than two days and the bathroom often lacked hand soap (How was the medical staff washing their hands?). Staff administering drugs often failed to read medical charts, and had to be corrected by the daughter about the proper drugs and doses.

When her mother was in a critical care step-down unit, her care was entrusted to unsupervised nursing students for extended periods.

The daughter ultimately took her complaints to the Pennsylvania Department of Health, which conducted an unannounced investigation. In a letter to her, the health department said the investigators found no violations.

These are just a handful of complaints I've recently heard involving respected hospitals throughout the city. These complaints would take weeks of investigation and interviews to confirm, but the pattern of these concerns shows that something is not right. Are families just becoming more proactive or critical in their assessments of hospital care? Or is care deteriorating before our eyes?

Most hospitals have patient representatives who handle complaints, but families often find them ineffective.

Charles Inlander, president of the People's Medical Society, a consumer advocate group based in Allentown, Lehigh County, is not surprised about these complaints.

"When we started the organization in 1983, the No. 1 issue was hospital-related problems," he said. That hasn't changed. "The hospital is the most unsafe place you can be when you're sick. If you have to be there, you have to be assertive -- not obnoxious -- but assertive."

There are many things families can do to ensure the best care, he said. First, enter with the right attitude.

"You're not in custody, you are the patient. You are the customer. You have the right to have your questions answered, you have the right to prompt service, the right to information not easily made available, the right to complain and the right to ask for a different nurse or a different staff member. The law supports this in every case."

There's more:

If possible, have someone with your loved one 24 hours a day. Patients often are too sick or intimidated to push for what they need.

As soon as you get to the hospital, make it clear that you'll be keeping a close watch on your loved one. Write down everything that happens -- the name of every person who comes in the room, what he or she does, the condition of the room, etc.

If a nurse doesn't answer a page promptly, call the hospital switchboard and ask to be connected to that floor's nurses station. They'll be sure to pick up that phone.

If your problems are not being addressed, call the hospital administrator. If a secretary tries to refer you to the patient representative, say "no", and insist on talking to the administrator.

"That gets you very quick action," Inlander said. "The hospital does everything it can do so you won't complain. It doesn't want problems."

But there's a flip side. The complaining relative becomes a pariah among hospital staff, said one daughter. "You're public enemy No. 1."

After her experience tending to her mother in the hospital, she said "you feel like you've been through a war."

You can find other strategies in the People's Medical Society book, "Take this Book to the Hospital With You: A Consumer Guide to Surviving Your Hospital Stay" by Inlander and Ed Weiner. It's available at local bookstores or Amazon.com for $5.99.

As some Amazon reviewers learned, simply displaying the book on their hospital bedside table prompted staff to be more attentive.

Upon a patient's discharge, many hospitals distribute surveys so the patient can evaluate the stay. Take full advantage of this.

Bill Lieber, a travel agent who lives in Squirrel Hill, was admitted to a local hospital in late November for pneumonia.

After a five-hour wait in the emergency room, he was taken to his hospital room where there were two uncovered wastebaskets filled with Kleenex and dirty paper towels. They were never emptied during his three-day stay.

He needs a special breathing machine to sleep because of apnea, but staff didn't install it until after midnight -- hours after he normally would have been asleep.

And two requested urine samples went uncollected, each sitting by his bedside until the next day, and became too old to be tested.

"I sent it to everybody," he said about the hospital survey. "This was the worst experience I've ever had."

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What can I say to people except we nurses warned you. We warned you 5 years ago, 4 years ago, 3 years ago and 2. We said that lack of nursing staff and overwork was going to produce dangerous conditions. Not only dangerous condtions for patients but the nurses are in danger also. My dear old dad would have said, "it's time to pay the piper". Myself and many other nurses who tried to sound a warning were accused of being whiners and chronic complainers. Indeed, some of us were literally run out of the professions by cost cutting management that wanted whistle blowers silenced. These same people who produced these unsafe conditions have now exited the healthcare business with pockets bulging. Thus leaving nurse and patient alike to reap the whrilwind.

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Originally posted by oramar

What can I say to people except we nurses warned you. We warned you 5 years ago, 4 years ago, 3 years ago and 2. We said that lack of nursing staff and overwork was going to produce dangerous conditions. Not only dangerous condtions for patients but the nurses are in danger also. My dear old dad would have said, "it's time to pay the piper". Myself and many other nurses who tried to sound a warning were accused of being whiners and chronic complainers. Indeed, some of us were literally run out of the professions by cost cutting management that wanted whistle blowers silenced. These same people who produced these unsafe conditions have now exited the healthcare business with pockets bulging. Thus leaving nurse and patient alike to reap the whrilwind.

can i hear a "woot!"?

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And then the suggested course of action, according to this article, is to treat staff in a hostile manner. Yeah, that'll work.

Did this writer, or any of the complainants for that matter, stop to think that there's a reason this is happening? That if a nurse doesn't answer your call bell promptly, it may be because she is trying to promptly answer the 8 other call bells that are ringing.

They don't get it, they never will get it, and what's more, they don't want to get it.

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Originally posted by fab4fan

Did this writer, or any of the complainants for that matter, stop to think that there's a reason this is happening?

That's kind of what I asked her in the email I sent asking if she would please cover the whole story and not just one side. I worded much better than that of course. I'm a letter to the editor type of person. I write to the media ALL the time.

You all should ask her to do the same:

Virginia Linn

http://[email protected]

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f4f, I agree with you - that's the first thing *I* thought. How about you? I know *I* work so much better when I feel threatened and under a microscope. Sheeesh I used to recommend that people keep paper and pencil with them in order to write down questions so they'd remember them in the 20 second amount of time that the doc visits, but what's suggested here is just dumb.

I do agree with the author that it's best to have someone with the patient 24 hours a day. With hospital care being what it is now, and given that you have to be at death's door to be in hospital at all, it's stupid to leave your family alone at all.

Love

Dennie

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I wrote,

Dear Ms. Linn,

I find it absolutely incredible that nurses are blamed for these conditions. Nurses are patient advocates. They have been warning the public about increasingly dangerous patient loads at hospitals for years; the public has largely been silent, the media unresponsive. The fact is, hospital management has caused the conditions you describe, trying to cut costs by cutting nursing staff, by understaffing units, by using unlicensed staff to do nursing tasks, and by failing to retain experienced nurses.

The result is that thousands of licensed nurses have left the bedside, and management cries, "We have a nursing shortage!"

No kidding, really?

And is the management which caused these problems planning to retain nurses by paying them a decent wage, by hiring and staffing in sufficient numbers to promote patient safety, or encouraging retention of experienced bedside nurses? Oh no. Now they're going to recruit nurses from overseas. They're going to lower the standards for licensing for them, so that they'll be able to work in the US, and they're going to pay them less.

So now you can add to your list of complaints the fact that patients will additionally have to deal with cultural differences and language barriers. Staffing ratios will stay the same. Conditions won't change.

The media needs to realize that the nurse is not the bad guy here; management caused these problems. Only a public outcry and media coverage will prompt management to change it.

PS It would also be a big help if you folks in the media would not call Patient Care Techs, Unit Secretaries, Respiratory Therapists, housekeepers, and other such ancillary staff, "Nurse." Because they aren't. And chances are that most of the patients in the scenarios you describe weren't dealing with RNs or LPNs. (A couple of your scenarios were not even nursing issues, by the way, they were housekeeping issues. Again, root cause is poor management, not bad nurses.) Why do we all look alike? So patients will think that they have a large staff of nurses caring for them. Management just loves that.

Please take the time to get educated about who the nurse is and what the nurse does. Nursing is hard enough without having to take the fall for everyone else's mistakes.

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I don't even care that it's not a writing masterpiece; what's important is that the media gets inundated enough to realize that there's more to the story than they're getting.

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Sleepyeyes, you are a hero! I would be just too awesome if this woman was inudated with replies to her article. THAT'S at step in the right direction for change.

~Sally :cool:

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Here's my letter...left out some personal stuff but this is it pretty much in whole. Please don't flame me on the "thank you" part...it's part of the letter writing game!!

Dear Ms. Linn,

Your article "Getting good care in the hospital requires vigilance" from Janurary 14, 2003 was posted on a message board that was created for and frequented by nurses all over the world. The website is http://www.allnurses.com. I am a Registered Nurse in the state of California. I would like to say thank you for writing such a story but I would also like to think (or hope) that the story is also told from the other side. The article makes it sound as though the "nurse" is all that is wrong in hospital care. You know, there's always two sides to any story. By requesting attention to the other side of the story I'm not trying to minimize or challenge the facts in your report. They are all very real and we nurses know that--first hand.

What I would like to see talked about is just how did that hospital(s) get to be in the terrible shape it's in now? Nurses have been crying foul for years and have been trying to voice our concern that something exactly like you describe in your article was going to happen. Well now it's happening!

I have never read any of your articles, so I don't know if you have covered the nursing crisis in this country. Let's be fair here and talk about that--after all, in your article the nurse is blamed for everything. Let's talk about the lack of Registered Nurses willing to put their professional license and their patients lives on the line due to the lack of safe work environments including nurse to patient staffing ratios. Let's talk about mandatory overtime and the fact that taking a lunch break is discouraged in nursing. Let's talk about the lack of recognition by society and fellow professionals of nursing's monetary, experiential, and essential contributory value to healthcare. Nurses ARE the backbone of healthcare in this country. These are the REAL reasons for the nursing crisis, hence the hospital crises. There is NOT a shortage of nurses. There are plenty of us, but not enough of us to tolerate the pathetic wages and dangerous working conditions that we are expected to provide "quality care" in! Watch out, one day there will be a NATIONAL nurses strike and those thousands of RN's who keep their license current but choose not to practice nursing will be walking right along side us for change and desiring to come back to deliver safe and decently compensated care.

Now and over the last several years the sickeningly money hungry healthcare business has their management replacing strong experienced nurses in part with international nurses who are willing to work in these conditions--leaving their homelands more desperate in already desperate situations. This is wrong and does not solve anything. Money is thrown our way to educate potential new nurses which is useful, but again, does not solve anything.

You're not doing the public any favors by recommending a book for them to bring along on a hospital stay. You would better service your readers by exposing the problem as a whole. I'm lucky, my path in nursing in CA has led me to a reputable hospital that serves it's professional employees and patients well. That's the way it should be, but it's not, and so those fat-cat's pockets get fatter...the nurse and the patient suffer.

A nurse is the last and sometimes only line of defense in patient advocacy. We know what's happening because it's happening to us. Why don't you (the media) let us speak or hear our voice? For the future of healthcare in this country, please, talk about it!

Regards,

blah blah blah

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l put my .02 as usual...here it is:

Ms. Lynn, What ever happened to unbiased and fair journalism? As an RN l find your article "Getting good care in the hospital requires vigilance" reprehensable in placing the blame on nurses. Surely as an informed reporter you have heard of the nursing shortage. In your article you suggest family members approach nursing staff in a defensive and near hostile manner. Writing down names of everyone who comes in the room...puleeeez! Nurses are responsible for life and death issues such as treatments, medications and ever vigilent assessments of critical patients looking for subtle clues that a patient's condition is slipping. It is an ignorant myth that nurses function in the same capacity as airline attendents...thanks largely to moronic medical shows like ER and Strong Medicine etc. Pillows, maintenence, and yes, even hygein take a back seat to more critical life matters. Perhaps the nurse is busy answering call lights of 7 other patients. Also, the ancillary help has been cut to the bone,much fewer nursing assistants and lab techs, housekeeping. I could go on. Nurses work under deplorable conditions, and deal with difficult families like you have encouraged and they do so working 12+hr shifts many times without breaks on units that are severely short staffed.....hence...the nursing shortage. Thanks to ignorant advice like you provided, the situation will only get worse. I would refuse an assingment to care for a patient with family members such as you encourage....Yes, hostility makes me work better for sure!

If you were really interested in improving health care for people, you would expose the vulgar high salaries of hospital CEO's, look into all the "improvements" and building funds going on in hospitals and then ask the question that BEGS to be asked...."You can't afford nurses?" Nurses are front line defense in the ultimate outcomes of patients and are probably the #1 deciding factor in the quality of these outcomes. Doesen't make a whole lot of difference if you had a talented surgeon if the nurse does not deliver the appropriate follow up care. If she has too many high acuity patients to care for, the patient's care will suffer. Believe me, nurses do not like this either! We are put in a dire predicament, so many of us leave the bedside to persue friendlier fields of nursing. Also, l might add...when expierienced nurses leave the bedside, who takes over?...Inexperienced young nurses, also working in deplorable conditions...even more unsafe.

Ms. Lynn, your blame is sorely misplaced and does a huge diservice to pantients AND nurses. I hope you will re think this and retract, You are wrong!

Sincerely,

L,.R. RN

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Wow this was awesome, I felt every breath of all of the replies. I have to remember, Me, the RN, at the patients bedside, I am the lifeline to that patient's care. THE NURSE AND THE PATIENT ARE ON THE SAME SIDE!!!!!!!! Too bad the rest of the health care industry isn't. What happened?????????

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