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'm a staff nurse on med-surg and our ratios go from 5:1 to 7:1. If you're asking have I personally addressed the elephant by making demands, refusing assignments and organizing staff protest, no I haven't. I'm an introvert and not the activist type. I suppose as is suggested in a prior post, I'm part of the problem because I put up with it and have not right to complain. Others don't and hit the road, but it seems to be the standard in this area.
In many meetings, many times I've addressed the issue with managers and directors.
My post is the irony of people promoting evidenced based practice and moving towards that direction in pretty much every area but one.
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.
It's really all about priorities. My employer just finished re doing the hospital lobby and announced construction is about to begin on a new parking garage for the doctors. Meanwhile my department has 7 unfilled nursing positions.
Cannot TELL you how many facilities I have worked in with a BEAUTIFUL lobby. One had a baby grand piano and waterfalls. My first day on the job ( as a traveler), I had to bathe my patient for the first time in a week and take the trash out of her room.
I just did some rudimentary math and came up with a figure of approx. $300,000 (plus or minus a bit) that a facility/hospital may save per year by not adding one staff to any given unit per shift. Say it's a fairly small hospital and they are saving that per unit for a few units.....that adds up.
'The call lights really should never go off if you're doing your job properly'. That's insane. What are we supposed to be, mind readers? (And before someone says it, yes, if we do our job well, the *number* of call lights should be reduced, but to say they should never go off is ... crazy).
So, PCT/CNAs aren't doing their jobs right, either?? Yes, crazy indeed.
We had Magnet status, but lost it because we showed no growth or improvement in areas. I love where I work, and I think we provide high quality care to best of our ability with what we have. But we can do better with better ratios. In my opinion.
I'm glad to see that you've had that culture at some point in time in your hospital, because there may very well be a lingering framework for Quality Improvement.
Hear me out: Nothing, ( and I know you will agree with me ) nothing speaks louder than Numbers to the bean counters that ration nursing FTE's per bed units.
The best way to go forward is to show the C suite suits how much money they can save by equating number of nursing FTE's to (Insert the biggest cost savings issue that your unit has at this moment). What keeps you up at night regarding your unit r/t staffing issues? (for example)
Narrow it down to one problem that can be focused on.
Do your research on that issue, get about 5 to 7 critically appraised peer-reviewed, higher level research articles about your issue together.
Perhaps you would like to get a journal club together and get whoever else on the unit together to brainstorm with you. Keep it to a handful of people to make it workable.
Figure out how the best way to run the project (for example- - - say you want to tie nursing FTE's to decreased incidences of UTI's). How many UTI's have you had in the last quarter of 2015. Each UTI costs the unit X amount of money per incidence. Find out how much that is (Talk to Performance Improvement, or Quality Assurance, Or Quality Improvement, or whatever the data people are called in your facility). They'll be able to tell you, because THEY KNOW.
Look at the staffing patterns in your unit. See if there is any way you can correlate staffing patterns to UTI's. (This is very, very simplified, but I'm using it for the sake of simplicity in the general picture).
I realize that correlation does not always mean causation, but if you can show a strong p value to support your numbers, you've got a running start.
I'd love to hear how things go. I hope that what I've shared makes a difference. That's all we really want in the end: to make a difference.
Specializes in Med-Surg, OB, ICU, Public Health Nursing.
I get so tired of the new "nurse speak."
I understand that every nurse is not an activist. However, if changes are being based on "evidence," one could certainly ask, have you read the Aiken Study?
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I'm glad to see that you've had that culture at some point in time in your hospital, because there may very well be a lingering framework for Quality Improvement.
Hear me out: Nothing, ( and I know you will agree with me ) nothing speaks louder than Numbers to the bean counters that ration nursing FTE's per bed units.
The best way to go forward is to show the C suite suits how much money they can save by equating number of nursing FTE's to (Insert the biggest cost savings issue that your unit has at this moment). What keeps you up at night regarding your unit r/t staffing issues? (for example)
Narrow it down to one problem that can be focused on.
Do your research on that issue, get about 5 to 7 critically appraised peer-reviewed, higher level research articles about your issue together.
Perhaps you would like to get a journal club together and get whoever else on the unit together to brainstorm with you. Keep it to a handful of people to make it workable.
Figure out how the best way to run the project (for example- - - say you want to tie nursing FTE's to decreased incidences of UTI's). How many UTI's have you had in the last quarter of 2015. Each UTI costs the unit X amount of money per incidence. Find out how much that is (Talk to Performance Improvement, or Quality Assurance, Or Quality Improvement, or whatever the data people are called in your facility). They'll be able to tell you, because THEY KNOW.
Look at the staffing patterns in your unit. See if there is any way you can correlate staffing patterns to UTI's. (This is very, very simplified, but I'm using it for the sake of simplicity in the general picture).
I realize that correlation does not always mean causation, but if you can show a strong p value to support your numbers, you've got a running start.
I'd love to hear how things go. I hope that what I've shared makes a difference. That's all we really want in the end: to make a difference.
Take care
Are you kidding? When is all this supposed to happen? On whose personal time? And the numbers are already out there; the studies have been done, the results published and the bean counters firmly in "ignore" mode.
Now nursing journals and seminar companies are on the staffing bandwagon. They're preaching to the choir. I personally fought the good fight for many years. My experience can only be described as Orwellian.
Are you kidding? When is all this supposed to happen? On whose personal time? And the numbers are already out there; the studies have been done, the results published and the bean counters firmly in "ignore" mode.
Now nursing journals and seminar companies are on the staffing bandwagon. They're preaching to the choir. I personally fought the good fight for many years. My experience can only be described as Orwellian.
How's that working for you at where You work? Don't even go there for me - I practice what I preach, and I'm a bedside nurse. Albeit, I am a Masters prepared Clinical Nurse Leader.
This does Not take as much time as what my impression of time that you're thinking of.
Been there,done that, ASN, RN
7,241 Posts
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.