Monday, July 14, 2008

Then AFTER the sentinel event....

A patient COR'ed under... well... a horrible set of unfortunate circumstances two months ago. I'd been involved with the case and had blogged about it, but I've since removed that post. Seemed like a good idea, what with all The State Inspectors coming through and forcing some policy changes.

Steps were taken fairly immediately to change some staff roles. The State told us to do it, and for once, a governmental body stepped in and said the right things. The changes were good steps, to the RNs view. Essentially, we added staff in ancillary roles to increase patient monitoring. Yay for the patients! Yay for us!

In the short term, nurses filled those roles. Nurses were more than willing to accept the inconvenience for patient safety. The state inspectors were apparently satisfied with our change. We were glad for the role change/addition. We were thinking that more ancillary staff would be hired to fill the ancillary roles, and then we could get back to the bedside.

Exit state inspectors.

Then, we hear that there are more changes under discussion. First, the number of patients for each ancillary staff to monitor doubled. Then the ancillary roles were physically moved away from one of the units. Then discussion was underway on whether to add more patients from two entirely different floors for the staff to watch.

I had a hissy fit.

I sent a scalding email to my manager and the CNO. I talked about the patient that died. I mentioned her name, I talked about her family, and the tone of my email implied that SOME of us had forgotten and we didn't care that she was dead.

I talked about the logistics of the proposed changes being dangerous. I talked about what is GOOD on our unit, what WORKS on our unit, and the difficulty of these proposed changes being feasible. I hammered at how unsafe these changes appeared to be for patients, and how unsafe I would feel leaving my license to this system.

I was pretty hot.

So my manager pulled me into her office days later. She was upset and hurt. Why did I write an email criticizing instead of coming up with positive solutions? Because it sounds like the decision's done, and you never solicited suggestions at any point.

How can you suggest I didn't lose sleep over that woman's death? I'm sorry, I was angry and honestly, this looks like a decision made with a bottom line in mind, not patient safety....Of course you lost sleep over it....everyone involved in the case lost sleep over it. However, I said, I don't like this decision. I don't think it's safe for patients. I'm sorry you are hurt by my tone, but I feel very strongly about this one.

Hopefully, the meeting at least allowed her to get what she needed to off her chest. I apologized for implying she didn't care. I didn't apologize for finding the new policy changes flawed and dangerous.

I was requested to meet with my manager's boss, Director. (This woman reports to the CNO, so technically I guess I went over her head.) So I went. The director doesn't like my way of communicating. O....kay. (And?)

I broke chain of command. Yes. I've known CNO for a long time and feel comfortable going to her....I just met you two months ago....CNO has always said she has an open door. Director said, Of course CNO has an open door, she's a very caring person, but if you have issues with this unit, you can come to me before you go running to CNO. (Direct quote, that one.)

I told her I didn't like the proposed policy changes. She said the state made her do it. I said: I liked the changes that happened after the state went's this new stuff I don't like. She asked if I'd worked in other ICUs, where things worked differently. I haven't and she knows that. Director said that in her x number of years of experience that she'd never seen nurses be so lazy and rely so much on ancillary staff.

Wow. ....I was struck so stupid by that I don't remember if I even responded to it.

She outlined her ultimate plan for the unit, and parts of this plan do appear to have some positive things about it. I still don't like the fact that the ancillary staff will be monitoring 40 patients apiece, including both ICU pods, and a new ER chest pain center.

She said I could come to the meetings "with concerned staff members" and take part and be "part of the solution." The qualifying factor is that I was chair of ICU's nurse practice council, and was part of the hospital's unit practice council for 18 months....being "part of the solution". I quit two months ago because nothing had changed in that 18 months.

I'm also wondering how she concluded from my angry email that I was promoting RN laziness by asking for adequate ancillary staff. (This picture of yet another lazy RN to the right.)

I promised her I wouldn't go "over her head" again. I will keep my promise.


I called another company the very next day and left the message that, You know, I'd told your recruiter I was only interested in prn at this time...and I think I've changed my mind and I'd like to talk about a full time position. Could you have her call me back please?


murse c said...

And they wonder why nurses are leaving in droves... Job opportunity for newbies like me but it makes me walk on eggshells approaching employers because you never see this from the recruitment side until you have been sucked in.

RehabNurse said...

Go for it!

If they can't handle you looking out for the patients, and your license, go right on to the next unit.

Then if you come back, you can tell x manager that you have seen what can happen at other units, because you've been there.

Best of luck!

gorochan said...

my manager is cool and physically hid extra tele monitoring boxes when told, "oh we can't afford the extra tele monitor tech that we said we'd have with the new satellite tele. So we'll just have the one for 40 possible beds." There's literature somewhere that says 29 or so is the number one can reasonably expect a monitor tech to keep track of safely. I would find it and stick it to her face before quitting.
Tele RN

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