With Inadequate Staffing, ‘Nonessential’ Care Goes First–Then Patient Safety

A coworker of mine made a medication error a few weeks ago. It was a multifactorial error—the medication had been ordered wrong, labeled wrong, and administered wrong—and was investigated accordingly. That particular nurse was also “tripled,” with two ICU trauma patients and one critically ill medical resident patient. The nurse’s workload wasn’t factored into the documentation or investigation of the error, though, since the nurse manager didn’t consider it relevant. I heard her say, “An extra patient shouldn’t make any difference in the standard procedure for passing medications.”

2016-11-21T13:15:51-05:00September 8th, 2010|Ethics, nursing perspective, nursing research, safe staffing|7 Comments
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‘Go Home, Stay, Good Nurse’: Hospital Staffing Practices Suck the Life Out of Nurses

By Shawn Kennedy, AJN interim editor-in-chief

After I last wrote to you from the NTI (the American Association of Critical-Care Nurses’ annual National Teaching Institute and Critical Care Exposition), I headed back to the exhibit hall to check out the helicopter and the Army’s mobile operating tent. But I didn’t get to either one, because I met a young critical care nurse from a regional hospital in Missouri. We chatted about her workplace, and it was obvious that she was very proud of the work she and her colleagues did. When I asked her, “What’s your biggest issue?”, she said that it was probably staffing. I expected her to cite the shortage and the difficulty of finding qualified critical care nurses. But that wasn’t what she meant—rather she was talking about  bare-bones staffing because of tight budgets. Her hospital routinely switches between two tactics: it sends nurses home when the patient census is low (when this happens, the nurses are paid only $2 an hour to be on call, but must still use a vacation day to retain full-time benefits, a tactic that rapidly depletes their vacation time); or, when the patient census is higher, the hospital imposes mandatory overtime, creating havoc in nurses’ schedules, finances, and personal lives. And people wonder why there’s a nursing shortage! […]

2017-03-28T13:15:48-04:00May 20th, 2010|career, Nursing, nursing perspective, nursing research, safe staffing|33 Comments
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What’s It Gonna Take to Improve Nurse Staffing?

From otisarchives4, via Flickr

It’s easy to forget that nurses are the ones who will continue to provide most of the care in whatever health care system we end up with in the coming years. Unfortunately, two recent announcements about how nurses rated staffing and workloads gave me a nasty sense of déjà vu.

On July 6, the American Nurses Association (ANA) announced the results of an online survey it conducted for several months last year: 70% of the 10,000 plus respondents say staffing is insufficient; 52% said they are considering leaving their job (of these, 42% say it’s because of inadequate staffing). Slightly more than 35% say they “rarely or never” are able to take full meal breaks. Over half say the quality of care has declined and almost half (49.5%) are unsure if they’d want someone they care about treated in the facility in which they work. […]

2016-11-21T13:25:43-05:00July 10th, 2009|health care policy, nursing research, safe staffing|2 Comments
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Virtual Nurses in a Virtual ICU – Will Technology Trump Staffing?

Virtual Reality Headset Prototype (circa 1968). Photo by Pargon, via Flickr.

If you want to know what the ICU of the future will be like, think of an extremely ill patient connected to myriad tubes and monitors; watched by cameras; every sigh, snore, or change in breath sound picked up by an audio feed.

Then remove the patient, leaving just monitors, speakers, and video screens. […]

2016-11-21T13:27:49-05:00May 22nd, 2009|health care policy|2 Comments
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School Nurses, H1N1, Understaffing, and Public Safety

We’ve posted here, here, and here in recent days about the importance of school nurses during the H1N1 outbreak.

Now here’s strong testimony before the U.S. House Committee on Education and Labor from the California State Superintendent of Public Instruction on why school nurses were crucial during the H1N1 outbreak and why understaffing issues must be addressed for the sake of public health.

“At last count, there are approximately 2,844 nurses who serve California’s 6.3 million public school students. That translates to a ratio of 2,227 students to every one school nurse, the largest student-to-nurse ratio in the country. This in no way, shape or form provides effective healthcare for the increasing numbers of students with complex chronic and immediate health needs that require daily care on our school campuses. If we had more school nurses on our campuses, perhaps they could have played an even greater role in early detection and prevention efforts.”

2009-05-18T14:45:09-04:00May 8th, 2009|health care policy|2 Comments
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The Face of Burnout in Nursing: My Personal Story and Lessons Learned

Woman looking at ocean at sunset Photo by Artem Kovalev on Unsplash

Two-and-a-half years ago, I experienced severe burnout in my role as a night shift charge nurse in a cardiovascular ICU. This blog post shares my personal story, highlighting the common ingredients of burnout and the challenges I faced. Through this experience, I learned valuable lessons that can benefit both nurses and the health care industry as a whole.

Where it All Began

Transitioning from a clinical nurse educator to a night shift charge nurse in a new cardiovascular ICU was an exciting opportunity for me. However, it soon became overwhelming due to various factors. These included a surgeon I didn’t see eye-to-eye with, moral and ethical dilemmas in patient care, staffing challenges, and a hostile work environment created by lateral violence from coworkers.

Strained to the Breaking Point

As my anxiety grew, I struggled to meet expectations each night. While prioritizing patient care and my night shift team, I feared for our patients’ well-being. Frequently, we were overloaded with acute post-cardiothoracic surgery patients. Despite my efforts to manage admissions responsibly, I faced constant pressure. Doubts crept in, and I lost trust in myself and my ability to provide safe care.

The emotional toll […]

2023-07-13T11:32:42-04:00July 13th, 2023|career, Nursing, nursing career, nursing stories, patient safety|3 Comments
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Pediatric Mental Health Tops ECRI’s 2023 Top 10 Patient Safety Concerns

Photo by Eric Ward on Unsplash

Each year, the ECRI Institute creates a list of top 10 patient safety concerns along with actionable recommendations for institutions to reduce these risks.

Some years, the list includes repeat offenders such as medication errors and concerns surrounding staffing. In the past few years, the list has reflected the reality of living during a global pandemic, with 2022’s top 10 concerns including clinician’s mental health, supply chain disruptions, and vaccine coverage gaps. This year’s list moves away from the pandemic somewhat, but still includes some fallout from COVID-19, with the number one concern reflecting a crisis among our youth: pediatric mental health.

According to the report:

“Concern for pediatric mental health was already high during the 2010s due to the growing use of social media, limited access to pediatric behavioral health providers, drug and alcohol use, gun violence, and socioeconomic impact, among other stressors. However, pediatric mental health issues have been exacerbated by the COVID-19 pandemic, with a 29% increase in children age 3 to 17 experiencing anxiety and a 27% increase in depression in 2020 compared with 2016.”

The report lists some recommendations to confront this issue, including securing leadership support and resources to evaluate the organization’s pediatric […]

2023-04-05T12:25:54-04:00April 5th, 2023|patient safety|0 Comments
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Tuning in to Humor in Nursing

1. Nurses Don’t Have to Make This Stuff Up

Photo by Kah Lok Leong on Unsplash

During a fire drill the nurse, Kathryn, was closing doors to patients’ rooms. An 86-year-old patient was talking on the phone to her daughter when Kathryn reached her room. As Kathryn started to shut the patient’s door, the woman asked, “What’s that ringing noise?”

“Don’t worry,” Kathryn said. “We’re just having a little fire drill.”

As she was leaving, Kathryn heard the woman tell her daughter, “No, everything’s just fine, dear. The hospital’s on fire but a nice little nurse just came to lock me in my room.”

Having worked as a nurse, as well as having interviewed hundreds of nurses over the years, I can attest that you don’t have to make this stuff up. Yet nurses from coast to coast right now are telling me, “There’s nothing funny happening in my life.”

Having studied the brain and humor for decades, I can tell you that if that is your belief, that will also be your reality. Telling yourself there’s nothing funny around you will wire your reticular activating system to show you just that—nothing funny.

Even during times of chaos—overwhelming patient census, lack of resources, staffing shortages—humorous material […]

2023-03-07T13:20:16-05:00March 7th, 2023|Nursing, nursing perspective, nursing stories|2 Comments
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ER Nurse Who Called 911 for Backup: ‘What Are We Afraid Of?’

Making the call.

As I got home this morning after a hectic 12-hour shift as charge RN in a 50-bed ER, I sat in my silent car for a moment to ponder how much has changed in the last three weeks.

Three weeks ago, overwhelmed by walk-in patients and ambulance traffic and severely short-staffed, I called the emergency services non-emergent line and asked for help in our crowded lobby. I wasn’t thinking about the repercussions, about the uproar or the giant target I sometimes feel I’ve installed on my back with my outspokenness. I was thinking about my coworkers, spread too thin, exhausted and afraid for their licenses, and the patients that I knew had been sitting in the lobby for hours, sick and in pain and mostly unmonitored. I had no idea of the attention that call would receive.

Did speaking out change anything?

Someone recently asked, “What changes have you seen in the month since you made that call?”

For myself, I’ve been learning to navigate in a more public arena, […]

2022-12-01T09:51:43-05:00December 1st, 2022|Ethics, Nursing, nursing perspective, patient safety, safe staffing|5 Comments
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Improving the Discovery and Care of Pressure Injuries in the Emergency Department

Jonathan Nover, MBA, RN

The problem.

Hospital-acquired conditions, particularly pressure injuries (PIs), increased at alarming rates during the COVID-19 pandemic. Hospital isolation precautions and infection prevention practices limited clinician time at the bedside. How does a nurse regularly turn and position a patient if they are unable to enter the room as often as they did prior to the pandemic? In addition, hospitals often operated with high percentages of their workforce out sick.

While Covid may be less of a threat by now, the number of patients admitted to EDs continues to increase while nurse staffing shortages intensify the pressure on nurses to maintain patient safety standards. With patient boarding in EDs becoming more common, the risk of hospital-acquired PIs grows as well, even in the ED. Traditional ED care focuses on rapid screening, assessment, and stabilization, followed by discharge or admission. But the reality is that medical–surgical inpatient care has become more necessary in the ED.

A central element of nursing care is the identification of PIs upon entry to the hospital, PI prevention, and care of existing PIs. Patients who are boarded in the ED, particularly older patient populations with underlying diseases and long length of stays, are at especially high risk for pressure ulcers […]

2022-10-27T11:03:41-04:00October 27th, 2022|Nursing, patient safety|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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