One of the things I have learned in my 20+ years of handling medical malpractice cases in New York and Pennsylvania is that it is absolutely critical that patients (and their families) must be active advocates for their own care. What I mean be this is you can NOT safely assume that your doctors/nurses are necessarily providing appropriate care or that they are fully familar with your medical history. But please don’t get me wrong– I truly respect doctors/nurses/medical providers– most (sadly not all) are intelligent, hard-working people who truly want to provide good medical care. The problem is that all too often the medical “system” dooms these people to failure because they are over-worked, under-staffed and sometimes poorly trained.
Below is a great article from Bottom Line’s Daily Health News that got me to thinking about this issue. My thanks to the quoted source for the article, Tom Sharon, for emailing it to me as part of his weekly email discussions of health care issues. Tom, who is a Registered Nurse himself, gives many great tips for protecting yourself and your loved ones from sub-standard medical care. This really should be required reading for all of us who care about getting the best medical treatment possible.
Nursing Shortage Impacts Hospital Stay
Ever ring the call buzzer in the hospital to get a nurse’s attention? And then waited? And then waited some more? The consequences of waiting a while for attention in the hospital can prove serious indeed, even life-threatening.
SUPPLY DOWN, DEMAND UP
It’s no news that there has been a serious nursing shortage in the US for some time. The dilemma, however, is that as baby boomers reach their 60s and beyond, the demand for nurses grows. Fewer new nurses are entering the profession, and the average age of RNs is climbing. This is not exactly reassuring at a time when more than 100,000 people a year die in hospitals from preventable accidents and complications from medical mistakes, many of which are due to substandard nursing care.
It’s frustrating to consider and it might seem there is little a person can do individually about a national shortage of nursing… except hope for good health. But there are, in fact, measures that patients and family members can take to make sure their loved ones in the hospital get the high-quality nursing care they need. I spoke with Thomas A. Sharon, RN, MPH, author of Protect Yourself in the Hospital: Insider Tips for Avoiding Hospital Mistakes for Yourself or Someone You Love (Contemporary Books/McGraw-Hill). Noting that the quality of nursing is just as important to health outcomes as physician care, he had plenty of advice on how to shield yourself and your loved ones during a hospital stay.
FEWER NURSES = POORER CARE
In a recent survey, one in three people reported experiencing personally or having a family member who had been the victim of a medical error. It’s likely this high figure is related to the nursing shortage, since nurses play a critical role in preventing medical errors. Their role in hospital safety cannot be overestimated, stresses Sharon. Research backs up his observation. Investigators at the University of Pennsylvania found that people who undergo surgical procedures in hospitals with fewer nurses — i.e., high patient-to-nurse ratios — faced a 31% increased risk of dying. For every additional patient in a nurse’s workload, the risk of death in surgical patients jumped by 7%.
Sharon says he’s seen this personally in his 30-year career as a nurse: “When one nurse is assigned to care for 20 patients, some will have to wait and this delay has an impact on health.” He says that in his experience, falls are one of the most common — and most tragic — results of higher-than-optimal patient-to-nurse ratios. Whether bedrails are in place or not, when ill or elderly patients need to use the bathroom or accidentally soil themselves, they’ll do nearly anything to climb out of bed if their call for assistance isn’t responded to within a few minutes. “It’s a tragedy waiting to happen,” he warns.
WHAT YOU CAN DO
It’s not that nurses don’t want to help, stresses Sharon. Given the current shortage, many nurses are simply overwhelmed by what’s being required of them. He offered this advice on how to work cooperatively with nurses to get the best possible care during a hospital stay:
Organize a supportive rotation of family members and friends. This is especially important at night, since a smaller staff is on duty and accidents are more likely to happen. Sharon urges family members to be diplomatic, starting with a visit to the nursing supervisor on duty. Let him/her know who will be staying with the patient and stress that the goal is to help out with simple tasks such as calming your loved one, keeping fresh water available and helping with visits to the bathroom. This removes some of the burden from nurses’ shoulders while also enabling you to keep a close eye on matters.
Ask questions. Make sure you understand what’s going on, urges Sharon. He suggests requesting an explanation of the IVs and other confusing — and often frightening — tubes and wires. What’s the purpose of each? What potential problems can you help keep watch for? For example, Sharon notes that when patients are on respirators it is important to be alert to certain warning signs — such as mucous in the tube or a gurgling sound. These are red-alert emergencies that require the nurse to come immediately to clear the patient’s airway. Bring a list of all medications currently taken (both prescription and over-the-counter, as well as any dietary supplements) to the hospital.
Be familiar with all pills/medications being given. Errors in medication dispensing are far too common. Ask the doctor what medicine is being prescribed, the dosing for each and its purpose — and then ask the nurse giving the meds what they are and in what doses before taking them. This is to be sure the right doses of the right medicines are being dispensed. If anything is different — the size or shape of the pill, for instance — ask about it, immediately. There may be a simple explanation — say, that an equivalent generic is being substituted for a brand name drug… or it may be that you are preventing a potentially life-threatening error.
If there’s a problem, speak up. Don’t hesitate to report any issues of concern, such as unresponsive, distracted or rude nurses, emphasizes Sharon. The proper channels to go through: First, speak with the nursing supervisor… next to the hospital ombudsman… and, finally, if you remain unsatisfied go right to a hospital administrator’s office. There is always an administrator on call and nursing supervisors have access to the pager number for after-hour, weekend and holiday problems. These measures are usually effective, but, if not, every health department in every state has a complaint division, and in the current climate — when news of medical errors regularly blares from the headlines — regulators are acutely sensitive to issues of patient safety. Information is available on-line on your state government Web site or call information for the State Health Department number. They will investigate, says Sharon.
Filing a complaint when appropriate is what’s best for you and your loved one and other patients, who will benefit from your actions, too.
Thomas A. Sharon, RN, MPH, author of Protect Yourself in the Hospital: Insider Tips for Avoiding Hospital Mistakes for Yourself or Someone You Love (Contemporary Books/McGraw-Hill).