Wow! We had a huge week at work and SH had so much for us to do after 3 PM.
Peer Review is moving along. It was amazing to hear about things many of us would consider minor that can really make a big impact when you don't take care of them. One Nurse will be reported to the Board for changing her documetation for only one patient because she didn't come and talk to the review board personally and take responsibility for her mistake. Since she refuses to discuss the small problem, the review committee feels she could falsify other documents to cover other mistakes instead of learning and moving on!
Why did she change her documentation? Because she misread a feeding order and fed a patient q3 instead of q4 hours.
Oh, the Horror! Geez! A simple phone call to the doctor, explaining the error, and all could've been well after a short butt-chewing. Ummm, the next feeding could've been skipped to satisfy a tight fluid restriction, or whatever was needed, but to be disciplined and possibly lose your license over something so small?
The real issue is her need to Cover it up! to not respond to any of the inquiries on the local level! to not take responsibility for her actions! Because of these bigger issues, she is Dangerous!
We also discussed the composition of the local peer review board. It is made up of experienced, veteran nurses from many different areas and floors of the hospital. Each unit uses different technology and has slightly different floor specific policies. Members of different units may not have the full picture without the discussion by the nurses familiar with these policies. They all rely on each other to decide which peers are within the appropriate scope of their practice and which ones are out of line. It is terrific that a group reviews these issues, instead of one individual. If the nurse under review handles it with the review board, it usually doesn't go any further. The nurse is given suggestions, information, and tips on how to handle the situation in the future to make her actions fit the situation properly, and how to make her documentation clear so there isn't any question that she did the right thing, etc. If the nurse is deemed dangerous, the board is consulted.
We discussed H.C.A.P.S. in detail comparing our hospital with our main competitors on the national level based on the new standards. We are highly rated for a facility our size, but there are always areas that we can improve. I wish we could narrow our competition to hospitals our size that handle the multitude of complicated cases we handle. Our rating would be on top, I'm sure! Unfortunately, we are compared to outpatient facilities, ambulatory surgical centers, problem-focused clinics and smaller hospitals that don't have our acuity. It must be easier to score high when you only handle one type of client that isn't deathly ill to begin with! It would be easy to standardize care, navigate through the facility, and keep your patients and doctors happy.
SH also invited me to attend the N.T.O.N.E. meeting. This is the North Texas Organization for Nurse Executives meeting. It was held at Medical City on Thursday. We had 2 powerful Nurse Speakers. They delivered the 2 most front-line nursing focused seminars I can remember hearing. I was expecting to hear executive nurses telling other executive nurses how to be executive nurses. I was thrilled to hear these presenters focused on the front line nurses on the floor.
The first focused on actual care givers at the bedside and how the executives are losing touch with them. Data in this area is hard to find because there is no standard collection tool that everyone uses. There is a lot of raw data that needs to be interpreted, but since it isn't standardized, the interpretation can be questioned. Bottom line was, the bedside nurses don't feel in touch with the system. They feel like they are doing all of the work, more and more mandates are being handed down by the upper echelon, and they are spending all of their time charting and very little time actually providing patient care. She encouraged everyone present keep the front-line nurses involved in the system changes so they will feel empowered by the changes, use the changes, and feel supported, instead of feeling more pressure to perform more "meaningless" tasks.
The second focused on Medication Administration and how interruptions caused mistakes. Several hospitals have implemented a "medication interruption free zone" and use vests or sashes while preparing/delivering medications. Medication errors have been reduced by 80% in several facilities because everyone works to not interrupt the nurses wearing their sashes. They only wear them for med. administration, but the difference is great! New technology doesn't have to be expensive, a simple SASH worn during medication administration can be extremely cost effective when compared to the cost of an ERROR!
I was so interested to see and hear these presentations. Our Leadership team is trying so hard to keep our best interests in mind while they implement new mandates set down by JCAHO and the BNE, but as one of the front-line nurses, it's easy to think they are clueless to our needs.
I witnessed in person the focus of our executives. I heard their questions and discussions and I know they are not clueless, they are simply trying to compromise so many issues into working solutions that the bedside nurses can't realize all of the effort that has gone into each new decision.
Subscribe to:
Post Comments (Atom)
While maybe not the case at this institution, the healthcare industry in general seems to foster a culture of blame, which leads to nurses covering up their errors instead of reporting and growing from them. I certainly agree that it was a bad decision, but nurses learn this behavior somewhere. I wonder how we can move beyond it...
ReplyDeleteThe interesting thing is, if this nurse had come to the council, taken responsibility for her error, and acted remorseful, the matter would've ended. The Peer Review Council is made of experienced nurses.
ReplyDeleteEvery nurse had made a medication error, or read a doctor's orders wrong, or missed a treatment of some type. No one is perfect and we can all learn from each other's mistakes. The council would've spoken with her and given her advice on how to handle the problem more effectively next time. Perhaps they would've given her an assignment about error reconciliation that she would've turned in at another meeting, but the matter would've been handled locally, without BNE involvement.
Blame is an unfortunate side effect of everyone not wanting to be part of a bad situation. We all want to stay unblemished, so we point fingers. If we are such caring, nurturing individuals that come into healthcare to help others, it would be nice if we could start by nurturing our peers...
That would indeed be nice. :)
ReplyDeleteWendy--most of the hospitals I have worked staff at (and there have been many, especially counting part-time agency work I did when I had a full-time job too) don't have a way for a nurse to tell administration about their perception of what is happening on their level. It always seems to be something administrators don't actively seek out. I have been an RN since 1977, without a break, and mostly full-time patient care, and there has always been a fear of nursing administration at almost all of the facilities I have been in. It definitely impacts nursing care in an unsafe way when a nurse feels they can't voice practice concerns without having to find a new job, but that is usually how it goes.
ReplyDeleteAlso, Dr. Tera Pape is one of our professors at TWU now. Her research developed the Sash for medication delivery! She is on the frontlines for trying to help nurses practice safer in the hospital environment.