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.

[I.C.UNurse]

Exactly right, the elephant is in the room because nobody wants to do anything about it. Safety will increase with better and APPROPRIATE ratios (Ex. ICU RN's have 2 patients, but do not give me the two sickest patients, both on life support with pressures in the crapper while on multiple pressors, family issues, etc., which giving the other nurse 1 ICU patient who is on no pressors or life support and being downgraded in an hour) I recently improved our safety in our unit by not scheduling people for mandatory overtime anymore. Management breathing down my neck because we did not have enough staff on the unit and I bargained with people to work overtime in exchange for future time off and the schedule they wanted. Well that went on for about 6 months and they still hadn't even hired anybody or interviewed! I stopped doing the overtime and people of course were not coming in when staffing calling about extra shifts because of burn out or wanting personal time off. We had to start turning patients away because of not enough staff. Well, guess what there went $$ out of the door and sure enough, new staff members hired the next week. You must acknowledge the elephant yourself and do something about it!

[Chisca, RN]

What is there to address? CDC links staffing ratios to nosocomial infections, management ignores evidence, patients continue to be placed at risk because profit margin is more important than evidence based medicine.

Georgetown University Journal of Health Sciences | Linking Nurse Staffing to Nosocomial Infections: A Potential Patient Safety Threat

[CBlover, BSN, RN]

My manager and I were meeting one day regarding bedside report and its evidenced based practice and I just point blank said, "I don't care what evidenced based practice says...I don't like it and I don't think it works well." Boy did I get the nasty look.

[NursesRmofun, ASN, RN]

I hadn't even finished your post without having thought : STAFFING!!!

Why is it so obvious to us, but not them?!? Maybe selective 'elephant blindness'?

IMO, they know the answer is better staffing/ratios, but it's more about the $$$$ they don't want to spend.

[twozer0, NP]

The moment that healthcare started referring to patients as "clients" is to understand how modern healthcare is evolving. Its about dollars and how quickly you can get them in and out the door. Look at bundled payments that rolled out for CMS. You get a set amount that covers X surgery and stay. Typically total joints stayed around 2 days, now they are pushing for them to be done as outpatients with

[Julius Seizure]

Not everybody has the skills to organize protests. What can a shy, introverted nurse do to help? If you are staff-level, not management....its easy to feel like you cant do anything.

[djh123]

It's the old situation where the people who come up with what they think are good ideas don't really work on the grunt level - because those people don't work on the grunt level, and don't 'get it'.

[Farawyn]

It's the old situation where the people who come up with what they think are good ideas don't really work on the grunt level - because those people don't work on the grunt level, and don't 'get it'.

But that is when charge nurses like Tweety can speak up- because they are charge and "grunt" as well. Like the "Head Nurse" of old.

[Tweety, BSN, RN]

But that is when charge nurses like Tweety can speak up- because they are charge and "grunt" as well. Like the "Head Nurse" of old.

As was stated in my original post, I did speak up. I'm introverted but I speak up all the time at the appropriate time and place. So does the manager. I have to say our manager advocates for a better staffing budget all the time.

It's a vicious cycle staff come and go so quickly it's hard to make even established ratios our bosses give us, never mind the evidenced based practice safe levels that aren't budgeted.

[Horseshoe, BSN, RN]

I'm not sure what you mean by saying I didn't address it because I did bring it up.

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

I was ignored because they said they weren't talking about that topic, but the new hand off report.

Will I organize a protest, refuse assignments, quit for a better job, contact labor unions, march to the capital. No.

I do understand I'm part of the problem by whining about it and putting up with it.

That was my bad. For some reason I read your remark as more of an internal dialogue vs. what you actually said.

[djh123]

I at least partly agree, Farawyn, but I was mostly talking about people higher - sometimes far higher - than a charge nurse - like some idiot in the corporate office who comes up with yet another form or procedure that doesn't help anything, but instead just wastes more of our time. And where I work, sometimes even long-time nurses who are now long-time administrators have been off the floor too long and don't get what some of us are dealing with.

[Tweety, BSN, RN]

I at least partly agree, Farawyn, but I was mostly talking about people higher - sometimes far higher - than a charge nurse - like some idiot in the corporate office who comes up with yet another form or procedure that doesn't help anything, but instead just wastes more of our time. And where I work, sometimes even long-time nurses who are now long-time administrators have been off the floor too long and don't get what some of us are dealing with.

Yes this. My job as a floor staff/charge nurse is definitely grunt level.

The same person, a director whose been off the floor for many years, said "the call lights really should never go off if you're doing your job properly".

Clueless. Again I say one thing: ratios