Nurses say they fear care in their own hospitals
Risk managers should be on alert for dangers
If you overheard two nurses talking about how they would not recommend their own facility to a family member because they don’t trust the care provided there, wouldn’t that ring all sorts of risk management alarm bells in your head?
The chances of overhearing that conversation in the hall may be slim, but a recent nursing survey found that a surprising number of nurses feel that way.
Two out of five nurses surveyed recently by the American Journal of Nursing reported that the quality of care at their facilities was either so bad they wouldn’t send their own family members there or unacceptably poor because of budget cuts, downsizing, and the increased use of unlicensed assistive personnel.1
The survey of the 7,500 nurses is a clear indication of how current changes in health care are affecting patient safety and a potential warning to hospital risk managers, says Beverly L. Malone, PhD, RN, FAAN, president of the American Nurses Association in Kansas City, MO.
Malone tells Healthcare Risk Management that the results were disturbing in the degree to which they show how current changes in health care are affecting patient safety.
"When RN staff is decreased in today’s hospitals, patient care suffers because there are either not enough nurses to deliver care or the few nurses who remain have such large patient loads care may be compromised," Malone says.
The increasing use of unlicensed assistive personnel was a particular concern for the nurses surveyed. More than 85% of them say the unlicensed workers, including nurses’ aides, nursing assistants, and patient aides, can threaten the safety of patients. They offer some anonymous examples, such as the time an aide disconnected an intravenous line to help a patient change gowns, not knowing that the patient would bleed from the line. The patient lost a great deal of blood before a licensed nurse arrived to clamp the line.
Nurses also complain of being required to take on more and more patients because fewer licensed nurses were left in the facility to handle the direct patient care that unlicensed personnel cannot do the labor trend known as "speed-up."
Warning signs of potential problems
Fifty-five percent of the respondents also report that their facilities provide less continuity of care, and the vast majority report having little time to provide aspects of nursing care that they consider important. Seventy-four percent say they have no time to comfort and talk to patients, 73% have no time to teach patients and families, and 68% say they do not even have enough time to provide basic nursing care.
Documenting the care they provide also is a problem that may concern risk managers, with 66% saying they do not have enough time to do it.
The survey findings are more a warning sign to risk managers than an absolute indicator of problems at every hospital, says Sam Bishop, ARM, director of risk management for Promina Northwest Health System in Atlanta. Some of those concerns have been around for decades, he says, but recent trends in health care have lowered morale among nurses.
"It’s true that it would be the absolute worst nightmare for a risk manager to hear that sort of talk from a nurse," Bishop says. "If you hear it, it’s a clear sign that you at least need to investigate and talk to those nurses to find out just how serious they are."
Bishop suspects that some comments about steering family members away from the facility are just exaggerations and the way some people blow off steam. That doesn’t mean the survey results, or actual complaints at your own hospital, should be dismissed, but Bishop suggests evaluating the results carefully.
"You have to hope that sort of comment is just a knee-jerk reaction, because it would be a sad state of affairs if your staff really doesn’t trust your hospital to care for their family members," he says.
Stay in contact with nurses, other staff
Knowing the difference between harmless grousing and a genuine, scare-the-pants-off-you comment requires being in touch with your staff on an ongoing basis. Risk managers should spend a lot of time circulating around the hospital, hanging out with staff members. Bishop suggests making a habit of joining nurses for lunch, for instance, so that managers can stay attuned to what’s going on and how people feel. If the staff are truly concerned that patient safety is in jeopardy, the risk manager will at least find out as soon as possible. And if the staff just need to vent, it is good to know that you don’t have a true crisis of patient safety.
Remember that staying in touch with the staff requires patience and is an everyday task. Suddenly showing up in the cafeteria to have lunch with a group of nurses is not going to yield any great insight that day. But if you do it often, and you make other frequent efforts to engage people in informal conversations, the eventual result will be a better understanding of how the front-line staff see situations that you might see only from the perspective of an administrator.
If it seems that there are legitimate, serious complaints arising from downsizing and other trends in health care, Bishop says you should act aggressively on them. He points to the complaint about not having enough time to document patient care and says that concern has been around for many years. Take that into consideration, he suggests, but also realize that recent trends could be aggravating the problem.
Bishop’s position is that documenting patient care is an integral part of providing patient care, so there is never an excuse not to do it. But if it seems that nurses are getting conflicting messages, it may be time for the risk manager to step in. Nurses may complain that they are being scheduled so tightly, for instance, that they are responsible for hands-on patient care right up to the shift change. And then the human resources department refuses to pay for overtime.
"In a situation like that, it pays to listen to how much the nurses have a legitimate complaint and act appropriately," Bishop says. "If this is just the age-old complaint that nobody has time for everything they’re asked to do, you might have to explain that they just have to find time. But if management is making it impossible, I might go to human resources and encourage them to pay overtime for documentation."
For more information, contact Beverly Malone, President, American Nurses Association, 600 Maryland Ave. SW, Suite 100 West, Washington, DC 20024-2571. Telephone: (800) 274-4262, Ext. 7011. Fax: (202) 651-7001. Or contact Sam Bishop, Director of Risk Management, Promina Northwest Health System, P.O. Box 725522, Atlanta, GA 31139. Telephone: (770) 956-6331.
Reference
1. Shindul-Rothschild J, Berry D, Long-Middleton E. Where have all the nurses gone? Final results of our patient care survey. AJN 1996; 96:25-39.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content