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.
Hi, this is my first reply to something, and I've been reading quite a few of these letters/notes. I'm totally suprised that most of the mail on here is about how we can give more, and how we can do better....what about the hospitals.........I'm beginning to feel that the "Gods that be" in the hospitals are sitting around, spending money and trying to come up with more paperwork, more for us to do at work,etc. I feel like we don't get enough time to do some of the nicities:crying2: I wish I had the time. Please don't tell me I need a break, that's not the answer, we need to get involved....try to get something going that will give us time to do these things. I feel that the big companies, don't care anymore about the patients wellbeing, they just worry whether you've crossed you t's and dotted your i's. :angryfire I got into nursing because I love people, and I want to take care of them, but not the way the companies want me to take care of them. I've been a nurse for 13 years, a hospital nurse, and it's always been stressful, but lately it's getting dangerous. Why is it that we nurses (as a group) won't help ourselves? We'll die trying to help others, but when it comes to taking care of ourselves we fail...............I don't mean to drag anyone down, I just don't understand why most of the messages on here aren't about the shortage, the danger, the abuse we get, and how we can help each other........tilii stands for "tells it like it is".
I ALMOST CRIED READING YOUR POST!!! I AGREE I AGREE I AGREE!!!
Actually, I HAVE gotten involved, and I encourage all nurses to do the same. I wrote an article entitled "How Can Nurses Advocate for Patients, When We Can't Even Advocate for Themselves?" addressing how nurses--and patients, as consumers--can be more proactive in holding the powers that be--hospitals and their various levels of management--accountable for situations that lead to unacceptable treatment of nurses and unacceptable patient care. I have sent it to various nursing and consumer watchdog groups. It appears below. All comments welcomed.
Fellow RNs: This is an op-ed article I submitted to our local newspaper and to various journals and consumer advocate magazinnes in response to various other articles addressing the nursing shortage.
I have suggested some ways that both nurses AND CONSUMERS can, and must, empower themselves to confront this national crisis head on, and demand accountability from those who caused and perpetuate it.
Consumers are all potential patients who have the right to demand an excellent product in return for their investment--in this case, the product is nursing care. Why should they settle for am mediocre product, simply because some manager or insurance company is trying to cut costs? Would that administrator or insurance company executive settle for less than a quality product if he or his family member were on the receiving end? He absolutely would not!
I encourage all nurses to write similar articles or letters and send them to your local newspapers and magazines such as AARP, Family Circle, Working Mother --any publication that will be read by non-nursing consumers and get them thinking about how they can advocate for nurses, as well as for themselves and their family members. We MUST get the word out about how our adverse working conditions affect the quality of patient care we deliver.
When potential patients add their voices to ours, safe staffing levels will become law everywhere, and we can deliver the level of nursing care we are currently being prevented from delivering--the quality of nursing care that we would want for ourselves and our own families--excellent care by which standards are set. Less than that is simply not good enough. We are dealing with human lives.
Subject: "How Can Nurses Advocate for Patients, When They Can't Even Advocate for Themselves?"
Nurses need to assert their right to "just say no" to mandatory overtime. What is so difficult about simply saying "No, I cannot stay overtime?" No apologies or excuses are needed. By accepting it, they are delaying what needs to be done: the passage of a staffing law, that will hold managers accountable; this will ensure a safe ratio of nurses to patients, rather than compromising patient care.
This is the real reason for the nursing shortage: nurses are tired of being forced by management to deliver substandard and, at times, downright dangerous patient care. They see too many incident and occurrence reports documenting mistakes, and witness plenty of "near misses" that weren't documented. Every nurse has witnessed an error made by a colleague who was either overtired or was denied the proper resources to carry out a job safely, due to understaffing, and has had the same thought: "There, but for the grace of God, go I."
"Mandatory overtime" is a contradiction in terms. It is an unfair labor practice, and is illegal. Management knows this; the nursing unions know this. Too many nurses, even union nurses, however, are afraid to "make waves," or be thought of as troublemakers, so the practice continues.
Indeed, why should the nurses themselves HAVE to make waves? This is what they pay union dues for, so that they can concentrate on patient care, and rest secure in the knowledge that their union is protecting them from unfair labor practices. Why are the unions falling short? Staffing is a management dilemma. Management may like to use a lot of guilt inducing catch phrases to try to force nurses to stay overtime; these phrases include "Health care is changing everywhere. We all have to pull together to work with less resources; it's the same all over the country," (Untrue!) or "How can you leave? How would you feel if that was YOUR mother in there?" or, my personal favorite, "If you don't stay over, you will be disciplined for patient abandonment!"
Mandatory overtime is a ploy used by management as a way to avoid hiring and benefiting the proper number of employees to do a job. There are other options available to ensure safe levels of staffing, such as using traveling or registry nurses to augment hospital staff, but some nursing managers simply refuse to use them.
Nurses need to learn to advocate for themselves. If they can't, how can a patient trust them to advocate for him or her? No hospitalized patient should have to advocate for himself or herself. That is a role traditionally played by nurses, who have those skills. Potential patients or family members can learn some self-advocacy skills before they even enter a hospital. Health care is a commodity for which they pay handsomely; they have every right to demand the best care, and to hold people involved in that care accountable.
I suggest every patient, or designated family member, ask the following questions of his nurse when he is hospitalized, and any others that might help ensure quality care and his peace of mind:
Are you my primary nurse?
What is your name?
Who will be in charge of my care when you are on breaks or at meals?
Will you actually be making rounds on me at intervals, or just talking to me via intercom when I ring my call bell?
What is the reason you have to stay at the desk, rather than making rounds? Does it have to do with understaffing? --Is there a safe nurse to patient staffing ratio on this floor today?
Will there be unlicensed personnel doing procedures on me that, in your opinion, should be done by a Registered Nurse?
Are you forced to be here today on mandatory overtime?
To your knowledge, are there policies and procedures on this floor that were implemented after an incident report was generated that documented a mistake that occurred because of unsafe staffing levels? (If your nurse seems uncomfortable answering that last question, ask to speak to the nurse manager, and direct the same question to her. In fact, move right on up the chain of command--nursing administration, medical administration, hospital administration--put THOSE powers that be "on the spot.")
To whom can I address a letter of complaint regarding the unsafe patient care and adverse working conditions I noticed while I was a patient here?
To whom can I address my immediate verbal concerns?
Let's hope it doesn't take a death or tragedy to force Oregon (and other states) to implement a safe nursing staffing law. Assertive RNs and proactive potential patients can pull a lot of weight when it comes to enacting a safe staffing law. I know; I saw it happen in California, where I still choose to practice hospital nursing, even though I live here. Even before California had a safe staffing law in place, I can honestly say that every manager I ever worked for there did her utmost to ensure that we had all the resources we needed to ensure outstanding patient care.
If someone called in sick, she was replaced by registry; if staff were out on vacation, travelers were contracted to take their place in the interim. Overtime was something you were ASKED to do, and for it, you were compensated generously, and thanked.
If you could not do it, you did not need to fumble for excuses as to why you could not and you were not made to feel guilty. Management had too much respect for our intelligence to try to implement unfair labor practices; plus, we had, and still have, an incredible union. God bless CNA!
By the way, physicians are under some of the same pressures we are: to get more done, in less time, with fewer resources, particularly in HMO affiliated and teaching hospitals. There are many questions patients or designated advocates can and should be asking their physicians, as well, as a way of being pro-active in their own treatment plans. That, however, is the subject for another op-ed article or letter!
HELLO,
I LIKE THIS!! WOULD YOU MIND PLEASE EMAILING ME A COPY OF THIS? I THINK I WOULD LIKE TO HAVE IT TO HAND OUT IN THE COMMUNTITY. IF NURSES WON'T STAND UP FOR THEMSELVES MAYBE THE PATIENTS WILL. MAYBE THEY WILL OR CAN INITIATE THE CHANGE SINCE WE ARE NOT. I GET SOOOO FRUSTRATED ON THE QUOTES I GET:
IT WILL NEVER CHANGE.
WE'LL CODE THEM WHEN THEY DID THEN THE DOCTOR WILL ORDER THE RIGHT THING.
CHOOSE YOUR BATTLES.
YOUR JUST A NURSE.
PERSONALLY I MAY BE JUST A NURSE BUT I AM A NURSE WHO CARES AND WHO WILL STAND UP AND SAY NO MORE. I HAVE DONE IT AND I HAVE INTIATED CHANGE. WAS IT HELL? YES BUT IT WAS SO WORTH IT! TO SAY TO ME CHOOSE YOUR BATTLES WHEN IT COMES TO A PATIENT IS LIKE SAYING LET THEM DIE THEY YOU CAN ARGUE. ANY SUBTANDARD CARE IS A BATTLE TO ME. ANY NEGLET OR HATEFULNESS TO A PATIENT IS A BATTLE TO ME. IF YOU INFLICT PAIN YOU GIVE PAIN MEDICATION. DO NOT IGNORE MY PATIENTS. I DO GET TIRED OF FIGHTING BECAUSE WE SHOULDN'T HAVE TO FIGHT TO GIVE ADEQUATE HIGH STANDARD CARE. I SHOULD NOT HAVE TO LOOK AT MY WATCH WHEN MY PATIENT NEEDS A HAND TO HOLD BECAUSE I HAVE TO MANY OTHER PATIENTS TO CARE FOR. WHAT IS WRONG WITH US WHY DO WE ACCEPT THIS???
I HAVE PEOPLE MAKE FUN OF ME BECAUSE I AM IN A ROOM TO LONG OR BECAUSE I GO A MANICURE, WASH AND BRAID SOMEONE'S HAIR, GIVE PEDICURES OR WHAT EVER ELSE I FEEL LIKE DOING. THEY SAY I DO TO MUCH AND GIVE TO MUCH AND SHOULD NOT DO THAT IT MAKES EVERYONE ELSE LOOK BAD WELL THIS IS WHAT I HAVE TO SAY TO THAT TOUGH S**T! THEY CAN LOOK BAD BECAUSE ALL THESE PEOPLE ARE MY GRANDMOTHER TO ME AND MY GRANDMOTHER IS ALWAYS GOING TO GET GREAT CARE!!!! PERIOD!!! END OF STORY!!! IF PEOPLE ARE WORRIED ABOUT LOOKING BAD THEN MAYBE THEY SHOULD EXAMINE THEMSELVES.
THIS TOPIC IS TOO HOT FOR ME. I CAN GET MYSELF IN TROUBLE ON THIS BOARD WITH THIS. I HAVE FEIRCE STRONG FEELINGS ABOUT THIS.
vibe9
17 Posts
I ALMOST CRIED READING YOUR POST!!! I AGREE I AGREE I AGREE!!!