Friday, July 27, 2007

Medical Mistakes Happen

This newspaper in Wisconsin details some of the medical mistakes healthcare providers make. Here is another link to a web site for journalists covering healthcare:

I regularly receive the ISMP newsletter (offers free CEUs twice a year!) and have been amazed at some of the errors RNs have made. As nurses, we are instructed to use the "6 rights" of medication administration:

  1. Right patient

  2. Right medication

  3. Right dose

  4. Right route

  5. Right time

  6. Right indication

However, using these 6 rights does not guarantee patient safety. Critical thinking skills are essential and even then they can fail the best nurse, especially in Hour 10 or 11 of a 12-hour shift on the third day of a string of 12-hour shifts.

Patients must take responsibility and ask questions about the medications that are being administered to them. I frequently encounter patients who have no idea what medications they are taking or what they're used for.

Here is a link to an online medication form that patients can use to fill out and carry with them at all times. The Institute for Healthcare Improvement (IHI) provides extensive information from hospitals nationwide who have implemented safer healthcare delivery practices. The site requires free registration to access information and I have found it to be a wonderful resource.

As an RN, I tell my patients they should always ask who the person is who is administering the medication (are they an RN? a CNA? a crazed patient from room 210 who is offering you his stashed medicines?). Patients should also ask what the medication is, the dosage, and what the medication is used for. The RN should also instruct the patient on the common side effects and what the patient should do if he or she experiences one of them. However, this would happen consistently in the ideal world and that's not where we live.

Thursday, July 19, 2007

Dinosaur Nursing

We were critically short-staffed before and now one of our nurses left on emergency leave this morning. You can't run a schedule with five nurses. In the meantime, I've been moved out of the MSU to General Surgery. They chose another nurse to cover both her clinic and the MSU which doesn't make sense. I still had to manage a physical readiness issue for one of the sailors and I am writing three end-of-tour awards for staff detaching in the next couple of months. I also have to turn over with the Division Officer who will be taking my place.

The other nurse covering the ward chose to have nurses work 8-hour shifts in addition to their regularly scheduled 12-hour shifts so a new graduate nurse was not left on his own on the night shift. I argued that the 8-hour shifts would actually be longer because things happen and staff would be reluctant to leave, even when their shift was over. She responded, "When I was a nurse at their level of experience, I had to work seven shifts to get four off!"

I replied, "Dinosaur nursing doesn't work nowadays."

She retorted, "These nurses are just BABIES! They need to suck it up."

Quietly, I said, "These nurses are not babies. They are adults who have different priorities." But she had already turned and walked away.

It's times like this that I have to apply the 5-year rule: Will this really matter in 5 years? And my response is no. And I am sick and tired of the phrase, "Suck it up."

Slow Leadership says this:

"...organizations rely on people's feelings of loyalty. Not loyalty to the business, mostly, but loyalty to colleagues, who will be forced to take up any slack if someone refuses to give up vacation time or work a 60 or 70-hour week." The best workers vote with their feet: "Those with the most courage, the highest levels of self-confidence, the greatest commitment to ethical principles, and the strongest personal values leave."

Slow Leadership continues: "One of the differences between high levels of stress and actual burnout is the presence of depression. Someone suffering burnout has given up. He or she no longer has the power to fight, nor the self-esteem to put the blame on the organization, where it belongs. The burnout victim was, typically, an ambitious high-flier, a good team player who gave and gave until
there was nothing left to give."

Finally, Slow Leadership says, "Work is part of life, not the other way around."

What I should have asked this senior nurse is, "Don't you remember how angry, how powerless you felt when you were given these demands? Didn't you vow then to never become that kind of nurse or leader?"

Thursday, July 12, 2007

Managing Across the Generations

One of the blogs I frequently read is Penelope Trunk. She posted a report published by Deloitte & Touche on managing across the generations. You can download the report here:

I also recently read a report in Training Magazine that despite beliefs generational differences exist, all generations share core values which include an emphasis on family.

My husband has told me I can "stay Navy" or I can stay married. The biggest change in regarding the Navy as employer of choice is the massive number of hours I work at the expense of time with my family. At this point, I am working over 50 hours a week. There have been times in the past few months where I have worked six 12-hour shifts in the space of seven days. Unfortunately, I am not the only one in this situation. This will have increasingly chilling aspects for Navy recruiting as it attempts to do more with less.