Posts Tagged nurse

I’m Sorry — difficult for doctors

sorrybearSaying “sorry” is the human thing to do.  Doctors and nurses should say it when they feel it.

Saying “sorry” seems to have two meanings:  1) something bad happened and I understand your emotions  2) something bad happened and I had some connection with the event for which I feel partly responsible.  Bad things do happen in health care but “sorry” is a very uncommon utterance for health care providers.

Dr. Abigail Zuger writing in the New York Times 7/14/14 “Saying Sorry, but for What?” compared how she felt about a plumber who broke a valve in her house with medical personnel who broke other things —  neither said “sorry.”  Sorry truly does not fix anything;  but, the absence of “sorry” is infuriating.

The problem is ego.  Ego infuses some health care providers with the notion bad things are an act of God but good things are an act of ME.   Absence of “sorry” is a sure sign of defense (a defense of self).  Perhaps the health care provider was spanked as a child or yelled at by teachers.  Who knows … ego has gone wild.

Quality health care depends on people believing errors are due to system failures.  When providers fail to embrace that philosophy they fail to correct problems.  No failure, no correction.

A fall in the hospital can be deadly.  Recently, a family member fell in a room while no nurse was present and they died.  The nurse did not say “sorry.”  There was no acknowledgement of responsibility.   No acknowledgement the system was at fault, no realization there was a better way, and no reason to prevent future deaths.  The simple statement “sorry, I wish I had been there to stop the fall, we will investigate this to help others” would be the right thing to say, and believe.

Lawyers are not the cause of excessive health care ego.  However, lawyers with the threat of suit are a convenient excuse.  When bad things happen honesty and caring are much more likely to assuage the displeasure of a family than stonewalling.

 

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Nursing Quality — paperwork problems

nurseWhen Quasimodo answers your call light instead of the the nurse you know something is wrong.  It probably has to do with all that paperwork — one third of a nurse’s time is spent doing clerical work either on paper or on the computer.

Laura Landro of the Wall Street Journal reported 7/21/14:  “Nurses Shift, Aiming for More Time With Patients”.  Ms. Landro highlights one hospital where nurses are getting more help from LPNs and CNAs so they can spend more time at the bedside.

More low-level helpers — where does that lead?  Probably not to more Florence Nightingales at the bedside but rather fewer RNs who will mainly serve as supervisors.  Nurses are getting expensive so the trend will save money for hospitals.

Nurses are hit from many directions.  Shift-work is hard on family life and the educational requirements have increased.   Highly motivated nurses often escape the shift work by training to become outpatient nurse practitioners — why try to climb the corporate ladder?  Nurses aspire to be more like doctors at a time when doctors as hospitalists become more like nursing supervisors.  And, hospitals don’t see much value to experience —  they fire a 50 year old nurse so they can hire 2 twenty something nurses to save money.

Nurses are criticized for quality issues as well:

  • Poor shift to shift communication — who knows what the guy at the end of the hall has?
  • Collection of information that has no value 24 hours later — a huge waste of time.  Unfortunately, the nursing model is focused on filling out forms or online queries.   Always made worse by legal concerns.
  • Training that inhibits drawing a conclusion.  For example,  if a nurse finds a patient is on the floor bleeding from a cut on the head … the conclusion is “deficit of patient comfort”  rather than “scalp laceration and possible brain injury”.  That’s the doctor’s job — too bad the doctor is not always there.

It’s almost a perfect storm.  A general shortage of nurses, a background of quality problems, hospitals anxious to find lower cost employees, and nurses obtaining more training to command higher salaries.  Nursing is not going away but the RN job will be different in the future.

 

 

 

 

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