Safe Nursing

HomeBound · Dec 10, 2018

I do agree with you. The conversation needs to be had, and thoroughly. The previous post devolved into medical issues in particular with that particular patient. Not the point of her original thought, which was...what the heck is going on with how patients are being treated?

But I think it is not a "why aren't healthcare workers not providing safe care" I believe it may be more global than that.

There are unsafe RNs (see versed vs. vecuronium) and there are unsafe conditions (see 10:1 ratios for a NewGradChargeNursePreceptorandNoCNAWithThreeDaysOfOrientation) and there are unsafe policies/procedures at facilities.

I think OP did want to discuss the current state of medical care---but she was also on the warpath about how her Mom was treated at this particular ER--and I, for one, being an ExED RN (is that a thing?)--was a little....confused as to what she was getting at.

When it's a family member, things get skewed. I've seen the best MDs and RNs get totally ridiculous when it comes to their kids or parents or spouses. I had a hard time believing that Mom was roomed and never seen or evaluated for 8 hours. Maybe it happened. Maybe this is the Worst Run ED In The Country. I don't know.

What I do see though--is there is plenty of "blame" to go around for the current state of things.

Administration squeezing every ounce of lifeblood from staff---understaffing, under resourcing, mandatory overtime, low pay, poor working conditions.

RNs and staffers who are not...how shall I say it....coming to work to do the job? Poorly trained or entitled attitude, harassers and bullies, laziness. "Senioritis" staffers who have X days until....graduating from NP and life's gonna be skittles and unicorn farts or retirement or new job...and they check out. Frustration, fear, over work, underpaid, disrespected, no voice, violence in the workplace, long hours, schedulers jerking you around, no vacation granted, understaffing, out of control "education" and "charting" requirements.

This list can go on. Not any ONE of these things can be blamed. It's the system as a whole that is broken.

I cannot provide what OP may have deemed "quality care" when I am getting the literal **** kicked out of me out there when I showed up for a shift in a Level 1 ED, two RNs called out, no techs, I am assigned 10 acute and 2 critical patients...and RN Mgr throws over his shoulder on the way out..."RNs called out! Divide the beds! Have a great night!" Blood admin on one, resp distress in another, needy jerko in that bed there, golf club to the head on the drunk guy---and a resident asking ME what she needs to order

And you believe that your Mom should be my priority.

It's my fault for putting up with it and not walking sooner. It's RN Mgr's fault for putting me in that position. It's admin's fault for putting RN Mgr in that position. It's the jerko guy who just wants to be high's fault, pressing the call light and pulling me from YOUR MOM repeatedly.

I don't have the staff to do what is being asked of me, safely. RN Mgr "supposedly" doesn't have the money to hire those new nurses or pay for overtime...or he's just a crappy manager being paid off to squeeze the staff. The hospital doesn't have the money to build that new addition onto the ED, staff it with doctors, nurses, support staff and resource it.

See where this goes? The system is broken. I think that the only thing we can do, as clinicians, is the best we know how to do---don't be the entitled, poorly trained, inattentive RN who just does this for a paycheck and who doesn't give a rat's rump....if you decide to stay bedside.

Personally...I am leaving. That's a decision to improve healthcare too. My attitude was sinking fast and I don't want to be in a place that I can't give these people what (some) came to me for in the first place.

What I can't believe is that anyone, and I mean ANYONE would accept being placed in a hallway bed like this is some third world country. People are being desensitized by these facilities that this action is somehow "normal" and acceptable. In this day and age of you or I getting termination papers for a HIPAA violation. UM......oxymoron much?

The discussion needs to happen, but as long as healthcare is traded as a commodity--everything from the band aid and glucostrips you use to the drugs you administer to the beds and monitors you rely on---have companies/shareholders that want their stock prices to go up up up up, insurers that want their claims to go down down down down---you have capitalistic healthcare. The momentum is making money, not taking care of patients.

Susie2310 · Dec 10, 2018

My guess is that the subject of quality of care is one that a number of people are reluctant to discuss. Often, it is not until we, ourselves, or our family members, are affected/harmed by receiving substandard care, that a conversation takes place which includes what we can do to rectify the situation at a political level.

Trauma Columnist · Dec 11, 2018

Staff reminder: per the terms of service allnurses.com does not provide medical or legal advice. When the issue discusses personal experience and then others comment on the care, that is medical advice. General discussions of perceived care is fine.

Thanks.

JKL33 · Dec 12, 2018

My guess is that the subject of quality of care is one that a number of people are reluctant to discuss. Often, it is not until we, ourselves, or our family members, are affected/harmed by receiving substandard care, that a conversation takes place which includes what we can do to rectify the situation at a political level.

Reluctance - yes, but only because trust is broken and many IRL safety discussions start out on a trajectory that is going nowhere - - way too many poor analyses of problems and way too many stipulations on the discussion. They go exactly where they are intended to go, which is nowhere.

The majority of the time, skewering individual RNs is not helpful. When nurses rant (here or IRL) about another nurse's care from a very limited point of view, frankly it infuriates me because it is so seldom that whatever went wrong can be attributed solely to one person. RNs should know that better than anyone, but it makes people feel superior to criticize peers. It's hen-pecking at some point.

If there's no system-view in most of these instances then these freaking complaints solely about what RN Susie did are perpetuating the problem of whole staffs being hobbled in their work before they even touch a single patient, and then blamed the instant they can't/don't provide excellent care.

And when I say "system-view" I don't mean that in a "we need some more policies and initiatives to prevent this" kind of way. I'm referring to the bird's-eye view of the problem of RNs' high responsibility and low authority. And the frank disregard of our position and work.

I'm just over it. That is the reluctance to "discuss safety issues."

I only have one suggestion, and that is to hire people who can be entrusted with patient care, then invest in them and treat them appropriately.

I don't see that as being likely.

If it isn't going to happen then there is no legitimate safety discussion.

unknownjulie · Dec 12, 2018

When a person weighs the positives and negatives of speaking out, and the system is set up in such a way as to almost guarantee no positive outcome, then why would anyone speak up? Personal ethics come to mind, but you can't eat personal ethics or pay the rent with it either. Plus, conflict is stressful.

I think about this often. Is my personal involvement as an employee in a nationally corrupt system (for profit healthcare) mean that I am making an unethical decision each time I show up for a shift?

Daisy4RN · Dec 12, 2018

When a person weighs the positives and negatives of speaking out, and the system is set up in such a way as to almost guarantee no positive outcome, then why would anyone speak up? Personal ethics come to mind, but you can't eat personal ethics or pay the rent with it either. Plus, conflict is stressful.
I think about this often. Is my personal involvement as an employee in a nationally corrupt system (for profit healthcare) mean that I am making an unethical decision each time I show up for a shift?

I don't think you are making an unethical decision by just showing up. Hospitals force RN's to work with very little resources and that is not on you! It usually doesn't do any good to speak up because your NM already knows but either cant, or wont do anything about it. If you do try to speak up you will be labeled a trouble maker and they will try to get rid of you. IMO, your best choice is to not say anything and just do the best job you can with what they give you to work with.