The Elephant In The Room and Evidenced Based Practice

[Tweety]

Our directors are very fond of saying "evidenced based practice" when telling us what to do..like hourly rounding, bedside report, safety huddles, etc. etc. I usually have no problem with any of this. I'm a "go with the flow" type of person.

Next up is a mandatory report sheet we have to use to give bedside report, in the SBAR format. Again, I'll go with the flow and I helped create one for our floor and sent it for approval (but they lost it and it's not saved..doh). A director was talking to our unit about it, siting "we're modeling ourselves after the airline industry that greatly improved safety over the years. Hospitals have the worst safety record of all industries. Evidences shows lack of communication is one of the things that cause mistakes and evidence shows this SBAR report will help with that."

Me: "I have one word to say: ratios. Evidence based practice over and over shows this improves safety and outcomes".

They want it all...safety, great customer service scores, high profit, but don't address the one elephant in the room.

[tinarob]

Whoa.I wasn't going to the point of making demands, reusing assignments, etc. Sounds like YOU have.. in your mind. I was also not saying you are part of the problem.

You have addressed the elephant. It's a very good start, the elephant is a monster. As for me, I am no longer in the hospital setting. However, I am working with Michigan Nurses Association towards their goal of passing a state law mandating safe patient ratios.

I get the irony.

Thank you for advocating for Michigan nurses. I recently read the "The Nurses" by Alexandra Robbins. In her book, Robbins exposes the many frustrations of nursing including the topic of this (original) post. I live in Northern Michigan and the saying here is "the view of the bay is half your pay"...other than lower than average pay, nurses are treated well. Day and afternoon shift in non-critical care areas are 1:4 and night shift is 1:6. For the sake of all patients and nurses, I hope to see a law passed regulating patient ratios.

[Brandidrn]

You nailed it! May I say I also think we need to remember to look at the patient not the numbers at times cause no two people are the same and some people don't fit the "mold" but are a part of the topic.

[NurseDiane]

As long as evidence-based practice doesn't involve spending any money, they're all for it. As soon as something is suggested (like increasing nursing staff) that would take money from the pockets of the administrators, all of sudden evidence-based practice doesn't apply to that. They love to have "committees", where nurses sit around, drinking coffee while coming up with new "ideas" for improved patient safety that don't involve increasing nursing staff. The reason there was no growth or improvement in areas & you lost Magnet status is because nurses have enough to do without drumming up ways to improve patient safety that the managers will pass on to administration (as their own ideas) so they can circle-jerk to it and make it look like they're doing something. Everybody, in every hospital, in every town, in every state, knows that more clinical floor nurses is what REALLY improves patient safety--not more committees, not more managers, not more paperwork, not more policies. When a nurse has too many patients to watch out for is when safety flies right out the window.

[betbrennan]

We used to call them "code Pink"when a doctor was acting out. I have recently read several publications where hospitals have used patient acuity scores to help determine staffing. In our profession, many of our days are unpredictable and a patient can become very ill quickly. I have also read where nurses were given staffing ratios only to have ancillary staff such as secretarial, kitchen and housekeeping cut!

[Jules A, MSN]

They love to have "committees", where nurses sit around, drinking coffee while coming up with new "ideas" for improved patient safety that don't involve increasing nursing staff.

Adding: on their own time and how bout those snazzy poster projects? lol I'm surprised the Kool Aid hasn't lost its luster.

[lellisrn]

After 15 yrs, I hear more complaints about nurse to patient ratio than ever and the ratio has improved. I'm not sure what my peers are truly expecting. I started my career on a med/surg unit with a day ratio of 1:8 and night ratio of 1:10 unless I was doing charge or precepting, then the ratio was 1:6. I spent 7 yrs as a travel nurse on med/surg units and worked with 1:6 up to 1:8 as the norm. Now I'm in acute care rehabilitation and nurses are expecting a 1:5-6 ratio on days and 1:7-8 on nights even if they only have 1 tech. I'd be great with that if my peers believed they owned responsibility for answering call bells and helping the techs.

When management has lowered the nurse to patient ratio, I see nurses sitting around the desk socializing. They have all the opportunity to do the best patient care possible. They have time to do teaching so patient's and families will be able to do care when they go home. They have time to do amazing documentation. Time to ensure medications are on time. Instead... they show their "appreciation" to management by ignoring patients, slacking on documentation, being late with medications and no completing education that is mandatory. I'm a nurse, I love my career. I love helping patients and seeing positive results.

I truly have issues with the whining about ratios when there is no initiative to improve patient care when accommodation is provided