Why Do We Continue to Harm Patients?

Ratios! Overloaded nurses are more likely to make mistakes.

Better staffing

Top-notch incentives and benefits for senior, experienced nurses to stay at the bedside. We need their knowledge and expertise to help keep our patients safe.

I have two comments already about staffing - and you are SO RIGHT - the next question is - so what are we going to do about it? Would you be willing to share strategies you are using to advocate for better staffing ratios?

From the ANA:

"States with Staffing Laws

14 states currently addressed nurse staffing in hospitals in law / regulations: CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA.

7 states require hospitals to have staffing committees responsible for plans (nurse-driven ratios) and staffing policy – CT, IL, NV, OH, OR, TX, WA.

CA is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. MA passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient.

MN requires a CNO or designee develop a core staffing plan with input from others. The requirements are similar to Joint Commission standards.

5 states require some form of disclosure and / or public reporting – IL, NJ, NY, RI, VT"

Please consider joining the ANA (if you haven't already) and support PAC funding to lobby our legislators to pass The Registered Nurse Staffing Act.

Would love to hear more about your efforts in your state.

Top-notch incentives and benefits for senior, experienced nurses to stay at the bedside. We need their knowledge and expertise to help keep our patients safe.

I agree BeccaznRN - and I have another question - how can we go about making this happen? It seems like nurses know what needs to happen for safer care, yet "nothing ever changes" - please share strategies you have used to get these sorts of incentives implemented.

Kristi,

This is not directed at you personally, but at the whole "safety" bubble: Some of this is getting exceedingly disingenuous at this point.

I understand why frontline staff must be involved in solutions, and we want to be, but you know as well as I do that the first 30 "holes in the swiss cheese" are things that bedside RNs can't fix, and what's worse, we are very likely to be vilified for caring too much about them or calling any attention whatsoever to them. So then, all of this becomes a bit of a game where we're playing by ourselves.

These nearly 20-yr-old reports and terrible (actually awful) analogies about how many people we're killing have ceased to be useful in this conversation except as attempts to make those with the least power in our organizations suffer with ongoing guilt - while those who shouldn't be able to sleep at night continue to shirk responsibility.

"We" are not sociopaths out killing jet planes full of people.

If you want to help patients (and nurses), the only way is to get real. Nurses and Safety teams have been coming up with mostly asinine (and some good) suggestions the whole time our profession has been being taken over by business people and their hired cheerleaders, who make up whatever facts are needed to suit their cause. And as far as I can see, the "cause" is to appear to be doing something about safety. It's very useful for the public to believe that uncaring, undereducated, poorly-prioritizing RNs and callous, money-hungry jerkwad physicians are the cause of safety issues. Well, we have made a ton of strides and now it is time for others to step up to the plate.

Sorry. I know your work is important but this conversation needs to change in a big way.

What am I going to do about it???? > Spread the word about this damaging, devaluing and demoralizing farce.

Kristi,

This is not directed at you personally, but at the whole "safety" bubble: Some of this is getting exceedingly disingenuous at this point.

I understand why frontline staff must be involved in solutions, and we want to be, but you know as well as I do that the first 30 "holes in the swiss cheese" are things that bedside RNs can't fix, and what's worse, we are very likely to be vilified for caring too much about them or calling any attention whatsoever to them. So then, all of this becomes a bit of a game where we're playing by ourselves.

These nearly 20-yr-old reports and terrible (actually awful) analogies about how many people we're killing have ceased to be useful in this conversation except as attempts to make those with the least power in our organizations suffer with ongoing guilt - while those who shouldn't be able to sleep at night continue to shirk responsibility.

"We" are not sociopaths out killing jet planes full of people.

If you want to help patients (and nurses), the only way is to get real. Nurses and Safety teams have been coming up with mostly asinine (and some good) suggestions the whole time our profession has been being taken over by business people and their hired cheerleaders, who make up whatever facts are needed to suit their cause. And as far as I can see, the "cause" is to appear to be doing something about safety. It's very useful for the public to believe that uncaring, undereducated, poorly-prioritizing RNs and callous, money-hungry jerkwad physicians are the cause of safety issues. Well, we have made a ton of strides and now it is time for others to step up to the plate.

Sorry. I know your work is important but this conversation needs to change in a big way.

What am I going to do about it???? > Spread the word about this damaging, devaluing and demoralizing farce.

I think what you are trying to say is - stay away from the histrionics - the alarming stories cause more harm than good. It also sounds like we have a difference of opinion as to how to go about improving the safety of our patients.

My goal is to incite action, and in that I believe we are unified. Thank you for spreading the word about empty promises and weak actions being taken by healthcare facilities. I will continue to spread the word about how nurses can empower themselves to make positive changes through political action and voting with our feet, while fully realizing these aren't options for all nurses, I hope to inspire some nurses to do more. Only 3% of us are active - I would argue that if nurses increase our voice (since we continue to be the most trusted providers in healthcare), we might perhaps cause some positive change.

Sincere thanks for your input and feedback.

I have worked at three hospitals, 2 being magnet hospitals using Epic and the new one that is still using paper charting and no barcode system for meds. This causes so many mistakes. I overheard a charge nurse say she almost makes a mistake once or twice a week. That is unacceptable. At this point, all hospitals need scanning systems.

There's no magic to better staffing ratios. It's more money for nurses. Unfortunately every trend I see is the opposite. When hospitals became a business we nurses became an expense to be minimalized. How do we combat this? Join a strong union. Become politically active. Educate your neighbors.... It would take all the above but first nurses need to form a united front on these issues & I've seen no evidence of that at all

There's no magic to better staffing ratios. It's more money for nurses. Unfortunately every trend I see is the opposite. When hospitals became a business we nurses became an expense to be minimalized. How do we combat this? Join a strong union. Become politically active. Educate your neighbors.... It would take all the above but first nurses need to form a united front on these issues & I've seen no evidence of that at all

Now that's what I am talking about! If we joined together - just think what we could do? I appreciate the positivity of your statement - we CAN do this - we have to CHOOSE to do it.

I have worked at three hospitals, 2 being magnet hospitals using Epic and the new one that is still using paper charting and no barcode system for meds. This causes so many mistakes. I overheard a charge nurse say she almost makes a mistake once or twice a week. That is unacceptable. At this point, all hospitals need scanning systems.

I hear you, and yet I also find it interesting that depending on the study you read, CPOE or barcode admin can cause an increase in error. I think it has to be more than just tech - it has to be a change in culture. Healthcare has to stop blaming individuals and open up to the idea that we are absolutely going to make mistakes - there is no shame in making mistakes. Let's just get that out of the way, admit it, stop firing nurses for doing their jobs, and begin to value the folks who work at the bedside with better hours, higher pay and some respect.