patient safety Archives - Page 9 of 17

Drawing Attention to Lax Oversight of Problem Nurses, Plus One Caution

By Shawn Kennedy, AJN editor-in-chief

New York does not require applicants for nursing licenses to undergo simple background checks or submit fingerprints, tools that can identify those with criminal histories and flag subsequent legal problems. And it often takes years for New York to discipline nurses who provide inept care, steal drugs or physically abuse patients.

That’s from a recent ProPublica story on lax oversight of New York State nurses. Back in 2008, the same independent investigative journalism organization, in partnership with the Los Angeles Times, investigated lax policies of the California Board of Nursing that allowed nurses (both RNs and LPNs) with serious criminal convictions to continue to be licensed. (See our report on this and the editorial by then-editor-in-chief Diana Mason in the March 2009 issue.)

In this month’s story, ProPublica reporters Daniela Porat and colleagues turn their sights on New York State’s nurses. They detail the policy issues and systemic gaps that lead to poor oversight by the state education department’s Office of Health Professions, such as lack of background checks, relying on self-report of infractions, and no requirement for fingerprinting. Many other states have adopted more rigorous approaches. The report offers several compelling cases to drive home the point that investigations are often inadequate and disciplinary action often not taken, allowing many nurses who should not be practicing […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2017-07-12T18:22:28-04:00April 18th, 2016|career, Nursing|3 Comments

Hospital Shootings: Unacknowledged Job Hazard?

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Recently, while preparing for work, I received the following text from a coworker already at the hospital:

We’re on lockdown
Armed gunman
Stay home, they announced “active shooter now outside building”

Shocked, barely able to comprehend the message, I texted back:

WTF?
Are you safe?

She texted back that she and others were in lockdown in the cafeteria. Numbly, I switched on the TV, looking for more information, but found nothing. Not a single report of the event on any station. Turning to the Internet, I found a single tweet referring to an event in progress. Feeling helpless, I texted my husband and daughter and then called my mom, letting them know I was at home, safe, just in case they heard something. Then I waited.

Within an hour, the same coworker texted again:

All clear!

I stared at my phone, not knowing what to do. I went to work.

The resolution of the shooting situation was heartbreaking. However, no patients or hospital staff were harmed. The outcome could have been much worse.

That evening, local media coverage of the crisis remained scant to the point I nearly felt I’d imagined it. It was as though it never happened.

We were lucky. Our shooting occurred outside, on the hospital grounds—as do 41% of hospital shootings, according […]

Julianna Paradisi, RN, OCN2016-11-21T13:01:30-05:00February 3rd, 2016|career, Ethics, Nursing, nursing perspective|1 Comment

One Nursing Wish for the New Year

By Shawn Kennedy, AJN editor-in-chief

If there’s one universal complaint by nurses, it’s that there aren’t enough of them on a shift to provide the care their patients need. We have a lot of data linking nurse staffing to patient outcomes and revealing the deleterious effects of missed care because of insufficient staffing. Yet, according to many hospital nurses I’ve spoken with, they still find themselves stretched to the breaking point by high patient acuity, rapid patient turnover, and increasing documentation requirements.

These nurses see no end in sight to this situation as hospitals argue that they have insufficient reimbursements and revenues to increase staffing. Ironically, as hospitals invest in pricey, cutting-edge new technologies that haven’t been shown to improve patient outcomes, the evidence about nurse staffing continues to be ignored.

In November, the ANA released a white paper, “Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes.” The paper summarizes and updates the research on staffing and outcomes, linking staffing to Medicare initiatives to reduce costs, adverse events, and readmissions. The report notes:

“Existing nurse staffing systems are often antiquated and inflexible. Greater benefit can be derived from staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to account for unit and shift level factors. Factors that influence nurse staffing needs include: patient […]

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Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2016-11-21T13:01:37-05:00January 4th, 2016|career, Nursing, nursing perspective|1 Comment

Check my Conduct: Committing to a Better Way to Act with Colleagues

Christina Purpora, PhD, RN, is an assistant professor at the University of San Francisco School of Nursing and Health Professions. She has 30 years of hospital nursing experience.

by Steve Robbins/Flickr Creative Commons

I wonder whether any of my nurse colleagues can recall having said or done something less than kind to a peer at work. Looking back over 30 years of nursing, I am aware of times that I could have been kinder. Not too long ago, the way that Emily—a less experienced nurse who was new to our unit—conducted herself in response to my reaction to her request for help taught me that I ought to consider a better way to act.

Request for Help
I was walking out of a patient’s room when Emily greeted me by name, then said, “Ms. S has one of the new IV pumps and the alarm keeps going off. I can’t figure out what’s wrong. Can you please help me?”

I felt annoyed at her for making one more demand on my time when I could barely keep up with my current assignment. Rolling my eyes, I curtly replied, “Emily, I think you can handle it. You had the in-service like everybody else.”

Seemingly unrattled by my terse retort, Emily stood her ground. “Yes,” she told me, “I used the troubleshooting […]

Guest Author2016-11-21T13:01:47-05:00November 10th, 2015|career, narratives, Nursing, nursing perspective|2 Comments

Surveys Aside, One Crucial Precondition for Real Patient Satisfaction

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
1. Never
2. Sometimes
3. Usually
4. Always
5. I never pressed the call button

Everyone is talking about patient satisfaction these days. Purposeful rounding, responsiveness, and customer service are discussed in meetings, on blogs, and in conversations at work. An entire science has been created out of satisfaction, with whole journals devoted to patient experience and paid officers tracking scores and strategies. Since hospital reimbursement is linked to how happy patients are, we’ve suddenly gotten serious about satisfaction.

But behind the sterile questions on the HCAHPS survey, real stories about real people reside. I find myself often forgetting the flesh and blood that’s represented by each checked box, and am learning to realize that, while satisfaction is something to be striven for, dissatisfaction is something to be learned from.

In a series of posts, starting with this one, I’ll share stories of my own missteps—ones that may have caused my patients to answer never instead of always to questions about my care. The events described here helped me realize that, score or no score, responding to call bells actually matters at the human level: