Why is meeting the "minimum standard of care" good enough?

[stevierae]

Guys, I posted this on another section of the board, with only a couple of responses--I am really interested in any and all opinions, here, as I am passionate about this issue--so am posting it in this area, where I think people are more outspoken about their beliefs, and just as passionate--

This is something that has always bothered me--both in clinical practice, and in doing case reviews as a legal nurse consultant--

Why is meeting "the minimum standard of care" good enough for some nurses and nurse managers?

When did nurses become so complacent that to perform to anyone's "minimum" standards is acceptable?

I think we all set higher standards for ourselves, or we should--these are human lives, and they deserve better than the minimum mandated by--who? Who was it that came up with the "minimum standard of care?" Various state nursing boards?

I see so many cases of what I--personally, as a nurse-- would consider nursing negligence that, legally, do not meet the criteria--because the nurse in question met the "minimal" standard of care. As a legal nurse consultant, I know that a charge of negligence won't fly, and the nurse will be back in practice--doing little more than what she has always done--"the minimum."

I have worked in operating rooms where some people could only meet "the minimimum" requirements that allowed them to be there--what do you think this did to the morale of the people that set much higher standards for themselves, and as a result had to do all the really difficult and challenging cases--while the folks who performed to "the minimum"--with the blessing of management--got the easy, kick-back no-brainer cases day after day, so that they couldn't hurt anybody--come to think of it, maybe they were smarter than we were--they got paid the same, but didn't have to work very hard, or THINK...

I would really like to hear input on this--but please, let's not bring up the old "AA vs. BSN" argument here---it's been done to death, and entry level practice nursing errors are not what I am referring to--I am referring to errors, complacency and incompetence made by seasoned RNs who should know better--

At deposition, one cannot ask a nurse whose care appears to have been negligent if said care would be "good enough" if the patient in question was one of her own family-- sometimes I think it should be allowed--because we all know that, if she is honest, she would have to admit that it was not acceptable, whether it met the "minimum standard" or not--and the case would be over then and there--settled in favor of the plaintiff-because a jury that heard this admission from a nurse would be outraged, and rightfully so.

What say you all?

[Gldngrl]

There are persons I know who perform at the "minimum standards of care" who simply do so because that is their intent. There are others I believe, that operate at this level because they are overwhelmed with too many high acuity patients and a lack of resources and they have no choice, but to do or leave. A facility that does not encourage the staff to provide optimal care is probably one that also does not value it's staff, does not provide enough nurses, does not provide ancillary staffing so nurses do not have to perform outside tasks,etc etc.

I worked at a hospital where one management person stated that it is cheaper to pay a settlement on a wrongful death than it is to hire more nurses. I think the "minimum" mentality can be shared by a multitude of entities and the trickle down effect is what you're seeing as an LNC.

Nursing and medicine are not the only professions that share the "minimum standards of care", I've seen it and discussed it in law as well- some clients lose their "life" so to speak when their attorney fails to represent their interests and they are left financially ruined or in prison, without a hope of appeal. I consider professions dealing with persons (whether it's nursing,medicine, law, etc) in the same manner, that they not only have a legal, but an ethical duty to their patient/client.

My suggestions for improvement would be to increase the professional responsibility courses or the equivalent of what is covered in any program and discuss daily stresses, the practical realities of a profession and how one deals with them without compromising the care or case of their patient or client. I also would like to see hospitals becoming accountable:roll for conditions that lead to staff being able to provide anything, but minimal care and promote opportunities for staff to avoid conditions such as burnout, which can contribute to this issue.

But if someone wants to provide minimum care and they are not violating any disciplinary rule, statutory reg, hospital policy, etc. then there's not a lot that can be done. It's like the saying "You can't legislate morality", although here we're discussing ethics: one can't force another to conform to his/her way of thinking.

[Hellllllo Nurse, BSN, RN]

Great post, Gldngrl!

[Gldngrl]

Thank you...

Stevierae posed thoughtful questions to a very complex issue, but unfortunately, there's neither a simple answer nor even one easy answer to the problem. It would be a good classroom question to discuss, wouldn't it?

[Tweety, BSN, RN]

I think there has to be a minimum standard that is acceptable in order to have a definition of what is acceptable and what is not.

I also think that some of us who have high standards and go above and beyond are shot down by those around us. I know my coworkers like working with me because I'm a hard worker, but sometimes I get comments like "Oh, Tweety's on guess we'll be moving patients around and taking lots of admits" "Why did you tell the supervisor we had an empty bed, the other charge nurse told her it was blocked", I even had a manager say "The other charge nurses are complaining you are making them look bad by taking patients." The manager and coworkers have actually tried to drag me down.

It's demoralizing and frustrating to have high standards. It's easier to perform at the minimum level, get the paycheck, whine and complain and go home.

[Hellllllo Nurse, BSN, RN]

Originally posted by 3rdShiftGuy

..........I also think that some of us who have high standards and go above and beyond are shot down by those around us. I know my coworkers like working with me because I'm a hard worker, but sometimes I get comments like "Oh, Tweety's on guess we'll be moving patients around and taking lots of admits" "Why did you tell the supervisor we had an empty bed, the other charge nurse told her it was blocked", I even had a manager say "The other charge nurses are complaining you are making them look bad by taking patients." The manager and coworkers have actually tried to drag me down.

It's demoralizing and frustrating to have high standards. It's easier to perform at the minimum level, get the paycheck, whine and complain and go home.

I can identify, Tweety!

When helping out on a short-staffed unit, I've been told "Don't do that, the oncoming shift will start expecting it."

I replied "They can expect it when I'm working."

I've also been told that I'm too "slow" with my work. The actuality is that I'm more complete in my work, which takes more time. I'm busy the whole time I'm on duty. I don't have time to stand around and bs like some others.

[fergus51]

I think part of it is human nature. You do the least you have to in order to meet your own needs. It's just the level of what is acceptable that varies.

[pickledpepperRN]

Seems many barriers to quality care versus minimal care are level of competence, understaffing, and attitude.

I was told the same when bathing patients on the night shift. "Don't do it when it's quiet or they will expect it every night."

I have worked with nurses who had worked understaffed so long that when staffing improved they used the extra time to gossip instead of doing more for their patients like offering a back rub.

Nurses new to a specialty need more time to give basic care

[stevierae]

Thank you for all your very insightful replies! I, too, have been called into management while working in the O.R. and heard, in a very stern tone of voice, as this was a VERY serious reprimand: "The other nurses are complaining that you go above and beyond on Dr.s (X, Y, Z's) cases, and they resent it, because now he expects the same from them."

Helloooo?? Since when is doing what you are paid to do--and doing it the way it should have been being done in the first place--something to complain about?

When I voiced this, the supervisor replied, "Just because you set higher standards for yourself does not mean that he can expect others to perform to those standards. As long as people here can perform to a minimum standard of care, that is all I expect, and that is all he should expect."

Oh--when I told the surgeon about it, and he confronted her--she told him the same exact thing--essentially reprimanding him for expecting quality care for his patients.

So sad--I wonder how patients would feel, or families of those patients would feel, knowing that they will be the recipient of "minimal standard of care?"

[stevierae]

Originally posted by Gldngrl

I worked at a hospital where one management person stated that it is cheaper to pay a settlement on a wrongful death than it is to hire more nurses.

Oh. My. God. Is this person still in management?

Awesome post, Gldngrl.

[Gldngrl]

Don't know, this was about 7 years ago, it was (is) a Tenet facility though:eek:

[Nurse Ratched, RN]

Originally posted by stevierae

Oh--when I told the surgeon about it, and he confronted her--she told him the same exact thing--essentially reprimanding him for expecting quality care for his patients.

Heaven forbid we give 100% during our workday. I've gotten the resentment thing when I insist that our bedbound elderly patients get turned q...2...h (No, it's *not* enough to change them once right before evening shift gets here so they are dry for the oncoming shift. Sheesh.)

I stock and neaten if I get time after meds, care and charting, all the while seeing others sitting on their tushes reading magazines. As long as meds get passed and charting is done, they think they've done their hitch.

Anyway, my point is, no, you're not wrong to think that minimum standard is just that - a minimum - and we should strive to go above it when possible.