Nursing Voices

Tuesday, February 05, 2008

Who's Running the Asylum?

Meet Nurse Kit Jessop. She’s young and energetic, and she loves her job. Notice how she smiles as she walks the halls of her unit. She is holding her head up high because she has confidence in her nursing skills, and in her ability to make patient care decisions. Everyone, including the doctors and the hospital administrators, respect her as a health care professional. This book was written during a time when nurses were truly in charge of their units. We told hospital administrators what we needed to do our job, and it was the administrator’s job to meet our needs. Patient care was nurse driven, and the patients’ needs came before anything else.

Nurse Jessop wouldn’t be smiling today because, sadly, those days are gone forever. Nurses are marginalized, and are frequently ignored when they advocate for their patients’ needs. I admitted a patient last weekend that made me cringe. Due to HIPAA regulations, I can’t tell you the details, but let’s just say I wouldn’t want this individual hanging around a playground. I placed the patient on our highest observation level, and called in additional staff to watch the new patient’s every move. I was very concerned for the safety of the minors on our unit, so I called our medical director to tell him what was going on. Here’s a little bit of our conversation:

Doctor: (Yelling) Why did you place this patient on one-to-one observation? He hasn’t done anything while he has been on the unit. Take him off one-to-one observation.

Me: The best predictor of future behavior is past behavior, and we have children on the unit.

Doctor: (Shrieking): Give me one good reason why we should keep the patient on one-to-one.

Me: So we don’t get sued.

That comment turned the tide. Screw patient safety, it costs too much to bring in an additional staff member to ensure the safety of the other patients, but god forbid we get sued. This is crazy. Hospitals are turning into asylums because nurses aren’t in charge anymore.

Did I mention that I’m still looking for my dream job? I’ll keep you posted.


Blogger may said...

sad. if i had the guts, i would have told him: "if you want to see why, please come and join him for at least 30 minutes, maybe then YOU'LL put him on one to one observation.

but i'm a wimp, and i would have been speechless. you hit the nail in the head when you told him about being sued. at least that woke him up. a lawsuit is everybody's main concern. it used to be the patients. not anymore. sad.

12:44 PM  
Anonymous Anonymous said...

Your so right. Nurses cannot be nurses any more. We have lost all respect. Even doctor's don't have the respect they used to have. Administration has taken over. It's all about the money now.

1:13 PM  
Blogger Lynn said...

I am going to nominate you to the Office of National Nurse. As if the powers that be would allow nominations from a lowly bedside RN.
****heavy sigh****
If only our voices could be heard by the masses.

3:50 PM  
Blogger FetchingGal said...

Why don't ya come to the OR? We knock most of the patients out and they cannot hurt others when anesthetized ;) Besides, we have lots of cool, shiny tools!

5:18 PM  
Blogger Rollernurse said...

Great job, you were advocating for the safety of everyone on the unit. I am impressed with how you handled that physician.

8:24 PM  
Blogger Doreen Orion said...

My husband and I are both psychiatrists. I wish I could post some commiserating stories, but this blog does not allow anonymous comments!

Unfortunately, I'm not at all surprised by the medical director's reaction. I do mainly insurance review work these days and the vast majority of it is pointing out egregious quality of care concerns. If I had a dollar for every doc who explained away crappy care with, "I'm just covering," or the lack of ANY family contact (even for adolescents, and even for adolescents whose reason for admit was a suicide attempt due to argument with family) with, "the social worker does that," (and then of course, "we have don't have enough social workers" to explain why even the social worker didn't do it) I'd be looooong retired.

I recently try scare a doc who never contacted family by asking, "Even if you don't think it's necessary to talk to the family, in this case, if god forbid, this patient successfully suicides after discharge and you never talked to his wife, how can that be justified medical-legally during the lawsuit?" He actually replied that since the expert psychiatric witness would have to testify on the local standard of care, and in that community, standard of care was that the MDs didn't talk to family, he didn't have to worry!

Those are the standards - ie, none. I really don't remember it being like this when I started out 20 years ago.

12:06 AM  
Blogger The Curmudgeon said...

VERY good use of the 's' word.

10:26 AM  
Blogger Anne said...

Um. Because minors who are already in the mental health care system (and therefore almost by definition have some sort of abuse history) really need the opportunity to be retraumatized in a place that's supposed to be helping them. Riiiight. Normally I try to make some smartass remark at the end of a comment, but this is so unfunny I have nothing to say, nothing at all. Rock on, Mother Jones!

10:59 AM  
Blogger Jean-Luc Picard said...

Sadly, Nurse Jessop has retired, or has quit now.

8:44 AM  
Blogger moplans said...

My daughter spent three months in the hospital this year and it made me ill to see the nurses who spent time with patients having little input into their care.
There was one doctors note I will never forget that indicated the baby's breastfeeding was improving yet I had never met the doctor.

10:32 PM  
Blogger The two weeks on a trolley team said...

So, your biggest concern was not getting sued? As opposed to the safety of the kids?

Dr. Thunder

8:54 PM  
Blogger How to Cope with Pain said...

I don't think it's the MD in front of this guy's name which is the problem. Doctors usually do value patient care very highly. It's the fact that he's an administrator - they often have, unfortunately, different priorities. When anyone goes into an administrative position, leaving patient care, they can forget what's important and what's needed to care for our patients.

Perhaps, like some schools do for new medical students, have him be an inpatient for a day - hey, maybe in your patient's room - and his views may change.

8:47 AM  
Blogger Unknown said...

Dr. Thunder: The only way she could get her level of concern for the patients through the head doctor's skull was to mention a lawsuit. It's clear that she was very much worried about the patients.

1:02 PM  

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