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A Wake-Up Call.

The Chicago Tribune headlines were powerful and painful. They read as follows: "Nursing mistakes kill, injure thousands," "Cost-cutting exacts toll on patients, hospital staffs," "Nursing accidents unleash silent killer," "Problem nurses escape punishment, training often takes a back seat," "Oversight panels don't see all facts of medical mistakes cases" (Berens, 2000). The panels are not the only ones missing the facts. In the case of nursing errors, as reported in one newspaper, but widely publicized across the country, the series' author and the public are poorly informed as to the nature, extent, and consequences of nursing errors. The nursing profession, up in arms over perceived press maltreatment, has no one to blame but itself. The Chicago Tribune series serves as a wake-up call that nursing's professional reputation and status have slipped, and that we all need to do something about it.

According to reporter Berens, at least 1,720 hospital patients have been accidentally killed and 9,584 others have been injured due to the actions or inaction of registered nurses around the country since 1995. The reporter and his colleagues analyzed three million records in state and federal data bases to reach this conclusion and noted that this figure is incomplete and a serious underestimate of the actual problem. Among the errors cited were the following: medication mistakes and overdoses, failure to monitor patients and intervene appropriately when problems were identified, lax or faulty recordkeeping (including the falsification of medical records), nurses working while impaired by alcohol and other drugs, theft of patients' belongings, and patient battery.

The series, in particular the first article on errors, freely acknowledges and discusses the effects of a decades worth of cost-cutting on supervisor roles and continuing education. In focusing on hospitals, the author describes the rampant shortage of adequate staffing and the increasing acuity levels of patients. Through several vignettes, he illustrates how errors such as failing to monitor patients postoperatively for blood loss and the sounding of warning alarms on medication infusion pumps can have dire and even deadly consequences. However, what the author does not describe in detail is the context in which nurses work and how their work is critical to hospitals' abilities to safely and effectively care for patients. Perhaps nurses should be glad he did not.

Communication Breakdown

The day-to-day responsibilities of nurses, let alone the essence of nursing practice, were never discussed in the Tribune series. Lacking this perspective, the public is left with the impression that even though there is blame on managed care organizations and hospital belt-tightening, the problem is really with the nurses. And that's the big problem.

What we have here is the classic failure to communicate. We, as nurses, have failed to communicate exactly what it is that we do and why it is that we are so important. We have not conveyed our message to patients and their families, as well as the general public, that taking care of them in the way we know we should is a huge, thankless job. The support, tangible and intangible, for this job has been so eroded that an entire generation of nurses is demoralized, and we are having trouble recruiting and retaining their successors. The next health care crisis looming is one of quality and quantity -- not enough nurses, let alone good ones.

Nursing as a profession has failed in its mission to care because we stood by and watched (and enabled) the system to unravel and patient care to deteriorate. We are mired in our own petty squabbling about decades-old arguments and unable to come together for the better good despite incomplete consensus on all issues. As a result, we have allowed ourselves to be defined and depicted as far less than what we used to be. In essence, we have, de facto, given up and given in. The once proud and dominant image of the fierce and vigilant nurse watching over her flock of patients and keeping them from harm's way is largely gone. Everyone's a loser, because patient care has suffered and nurses are so demoralized that rebuilding hospital, home health, and nursing home systems to even minimal levels of quality is going to be a gargantuan task.

This summer, I spent many hours in hospitals and health care facilities. My 84-year-old mother-in-law developed acute cardiac problems on top of existing chronic health problems and underwent five major cardiovascular procedures in 3 weeks. She is recovering, for which we are most grateful. However, as a nurse, I became painfully aware of our profession's enormous problems when countless friends said, "Well, thank goodness you're a nurse. You don't dare go into the hospital these days without bringing someone to look out after you." This commonly held belief is not only sad, it is a travesty.

Reporter Berens was right on target when he labeled nurses "the primary sentinels of patient care." We are there to help those too sick to help themselves. We are the early warning system, and the system's final safety check. Patient care is only as good as a patient's weakest nurse, and we all know it. Unfortunately, the public does not know the whole story. That is where we have failed.

Take Back the Beds

Wake up adult health nurses. Let your unit and hospital managers know that we will not tolerate system failures being dumped on our backs. We are taking back the beds and the corridors. We are letting patients know the facts in the most concrete terms. When patient care is jeopardized or unsafe due to inadequate staffing, when nurses have not received the proper training to use equipment safely, and when poorly trained assistants, temps, and travelers are substituted for the experienced nurses they should have, we are going to tell patients and their families. We are going to let patients know what kind of care they should expect, and when they do not get it, why. How to complain about poor care is going to be another part of the message. Protecting the perpetrator never solves the problem, and it has not worked for health care.

Most of all, nurses need to wake up. As professionals, they need to act like it. Part of being a professional is accountability for one's own actions and destiny. Not one nursing organization or leader was cited in the Tribune series. Was this an accident or deliberate slight? It was probably neither. The profession's lack of visibility and voice is its own fault. We can all blame someone else for our problems and lack of cohesive leadership. But the reality is, all nurses must own the problem of nursing's failing voice for patients. Change will never happen unless each and every one of us decides to change something. What will your choice be? How will you be a force for change on your unit and in your institution? I do not know about you, but I did not enter nursing to be second rate.

Reference

Berens, M.J. (2000, September 10, 11, 12). Nursing mistakes. Three part series. The Chicago Tribune. [On-line]. Available: www.news/nationworld/article; http://www.chicagotribune.com.
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Title Annotation:nursing profession standards
Author:Fetter, Marilyn S.
Publication:MedSurg Nursing
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Feb 1, 2001
Words:1186
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