Low staffing
at Carlisle Regional Medical Center might have contributed to 2 recent
deaths, Department of Health says
August 2011
by David
Wenner, Patriot-News
Carlisle
Regional
Medical
Center
has been persistently and dangerously understaffed, and low staffing might
have contributed to two patient deaths in June, according to the
Pennsylvania Department of Health.
A report compiled by the Health
Department details an assortment of alleged incidents discovered after a
complaint led to an unannounced inspection and investigation in June.
The
results can be read at the health department’s website.
Many of
the incidents involve low staffing levels of registered nurses in parts of
the hospital. For example, the department concluded there were 233 unfilled
shifts in the emergency department’s RN schedule from June 27 to July 23.
The report
further cites excessively long waits for admitted patients to move from the
emergency room to a regular bed or to the intensive care unit. It also said
short staffing in the ER contributed to the two patient deaths.
From May
22 to June 8, the Health Department said, the hospital used emergency room
beds as inpatient beds for more than 200 patients. Some spent as much as 18
hours in the ER. The emergency room isn’t equipped to serve as an inpatient
unit, the department noted.
The department also quoted
several employees who said an ER manager was fired for pressing management
about low staffing levels and that nurses who complained about staffing were
considered “troublemakers.”
"We all fear for our jobs because corporate will fire at will,” an employee
told the department.
No fines
or penalties have been levied against Carlisle Regional. The facility will
have to provide a plan of correction within days, and the Health Department
will continue to monitor the situation, a department spokeswoman said.
Carlisle
Regional CEO John Kristel declined a request for an interview for this
story.
Health
Management Associates, Carlisle Regional’s Florida-based parent, issued this
statement: “Carlisle Regional
Medical
Center
takes these findings seriously. We are very committed to patient care and
the safety of our patients is our utmost concern.
“We uphold
high standards in regards to nurse-to-patient ratios and continuously
increase or flex staff to meet patient census demands.
Carlisle
Regional
Medical
Center has a long history
of providing quality patient care and will continue to do so for the
community we serve.”
The Health
Department report details the cases of two patients who died at the hospital
in June. In those cases, the hospital failed to ensure that emergency room
services “were provided to meet the needs of patients in accordance with
acceptable standards of practice,” the report said.
In one of
the deaths, the patient was sent for a scan without a nurse because the four
nurses on duty were occupied by a full ER and full waiting room. The patient
stopped breathing during the scan, was brought back to the ER and died
there, the department said.
The other
case involved a patient with chest pain. A cardiologist indicated the
patient should be transferred to Harrisburg Hospital for valve-replacement surgery.
But the patient was never transferred and died in the ER while waiting for
an inpatient bed, the Health Department said.
The report
said the death occurred more than seven hours after the cardiologist
recommended the transfer.
The
department said both cases qualify as “serious events” which, by law, must
be reported to the Pennsylvania Patient Safety Authority. Carlisle Regional
failed to report the events, the department said.
Carlisle
Regional further failed to divert patients from its emergency room or offer
transfers to another hospital for patients facing long waits during the
times covered in the report, the department said.
The
department also said patients were billed as if they were in the inpatient
unit even as they endured long waits in the ER.
One
Carlisle Regional employee told the Health Department, “Management is aware
of the serious staff shortage throughout the hospital and management told
the ER nurses to be more creative.”
According
to the Health Department, some emergency room patients who received initial
or primary assessments walked out without receiving further treatment. The
department cited 76 “elopements” from May 22 to June 8.
It further
said Carlisle Regional failed to report the incidents to the Health
Department as required.
The report
details daily struggles to deal with low nurse staffing during 11 days
beginning May 24.
Many of
the details come from logs kept by the nursing supervisor.
On May 28,
for example, the nursing supervisor wrote: “Ratios high. (Medical surgical)
floor with 1:7 (nurse-to-patient ratio). Patients holding in (emergency
department) ... Several hours spent making staffing phone calls ...
Absolutely no headway made with regard to staffing. This weekend will be a
challenge. Staffing inadequate for days, Sunday, on both (medical surgical)
units despite hours of call being placed earlier ...”
The report also recounted alleged statements from hospital
employees that staffing was insufficient to allow monitoring of heart
monitors and trauma beds and referring to heart monitors that didn’t work.
They also described temporary doctors who didn’t know how to use the
computer system and thus required help from nurses who were struggling to
care for patients.
Post Note from a Maryland State ENA RN:
I know you are busy but
please read this article about the ED nurse manager that was fired for
advocating for staff and patients by refusing to cut staffing ratios. It was
published in the Patriot News a local paper in Harrisburg Pennsylvania.
Comments may be posted on the site of the article at this link
http://www.pennlive.com/midstate/index.ssf/2011/08/low_staffing_at_carlisle_regio.html
Additional comments may be sent
to your senator and congressmen to educate and inform concerning current
clinical conditions.
Demand
for registered nurses to continue well past 2011
August 7, 2011
Las Vegas Review-Journal
It may seem surprising that registered nursing, already the largest health
care occupation with 2.6 million jobs according to the Bureau of Labor
Statistics, could possibly grow more.
And yet, employment of registered nurses is expected to increase by an
above-average 22 percent from now until 2018. It's a U.S. News and World
Report "hot job for 2011," in addition to several other rankings as one of
the best career choices this year.
Experts attribute the growth, in part, to a growing emphasis on wellness and
preventive care -- including addressing poor lifestyle choices like bad diet
or smoking, which nurses are adept at doing -- in addition to a growing
elderly population that's living longer now than in decades past.
And then there's the small fact that the new health care bill will bring
roughly 30 million adults, children and elderly into the system, according
to Kathy McCauley, Ph.D., a professor of cardiovascular nursing and the
associate dean for academic programs at the
University
of Pennsylvania.
"People's health care needs are huge right now," she said.
The school has gotten a surge of applicants recently for both the
undergraduate and graduate programs, and the quality of the application pool
has also increased, McCauley said, reflecting an interest in nursing from
"the best and brightest in the country." There's also a strong population of
people who are getting their second degrees and taking advantage of the
school's program that accepts liberal arts credits from their original
degree and puts them through nursing school in a year and a half, helping to
keep up with the rapidly growing need for RNs.
Job possibilities and specialties for RNs are virtually endless, from
geriatric nurses to transplant nurses to nurses who focus on a particular
disease or condition. There are also four types of advanced practice nurses
who earn masters degrees: clinical nurse specialists, nurse anesthetists,
nurse-midwives and nurse practitioners.
Nurse practitioner will be one of the most in-demand specialties, McCauley
said, because nurse practitioners can function as primary care doctors
helping to accommodate those 30 million people new to the health care
system, able to make diagnoses and write prescriptions.
"Nurse practitioners can (provide primary care) in a cost-efficient way and
can be just as effective as physicians," McCauley said.
Despite prospective growth in the field, landing a job in nursing requires
the same commitment to career building as any other job search, and it
starts in college. McCauley recommends finding a faculty mentor and taking
every opportunity to help with research or visit the faculty member's
practice -- anything that provides hands-on experience and helps the student
narrow down his or her interests within the nursing field.
Perhaps even more critical in nursing than other fields, McCauley said, is
loving your job.
"The common thing is that you want to make a difference and you want to help
people," she said. "You cannot be really, truly fabulous if you don't have
that as a foundation."
She also notes that you have to be a lifelong learner and adapt to changing
research. Fifteen years ago, McCauley wouldn't have dreamed of teaching some
of the treatments she teaches today. Or take Jamie Joy, a registered nurse
at St. Luke's Hospital in St. Louis,
whose mother is also an RN and, until recently, charted everything on paper
instead of using a computer.
Joy specializes in cardiovascular and pulmonary care and is getting her
master's degree to become a nurse practitioner. She said the best part of
her job is talking to patients, getting to know them and then seeing them
get to go home.
But there are many aspects of her career that are just like a regular desk
job. Networking is critical, as is getting your foot in the door as an aid
or care tech early on.
And Joy has a task list and a schedule to keep, just like the rest of us.
"It's a lot of time management and organizational skills," Joy said. "If you
don't stay organized, you're staying late and your patients aren't getting
good care."
Both she and Katie Brewer, M.S.N., R.N., senior policy analyst for the
American Nurses Association, pointed out that nursing as a profession isn't
likely to go anywhere, because people will always get sick and will want a
person, not a computer or robot, to take care of them. And with an
increasing emphasis on wellness and prevention, the role of RNs seems even
more secure.
"It's a perennial profession," Brewer said. "We're always going to have
people with health care needs, and now nurses aren't just caring for sick
people, but well people too."
IOM's
Long Road to Reform Nursing Begins
December 14, 2010
HealthLeaders Media
Rebecca Hendren
In October, the Institute of Medicine released its landmark report,
sponsored by the Robert Wood Johnson Foundation, The Future of Nursing:
Leading Change, Advancing Health. The report outlines how nurses are crucial
to meeting the country's healthcare needs and says that to handle the
increasing complexity of care and greater responsibilities, nurses will need
higher levels of education and training.
The report calls for 80% of RNs to have BSNs by 2020 and for the number of
nurses with doctorate degrees to have doubled in the same timeframe.
Recently, the IOM took the first step in outlining how to make this happen.
The National Summit on Advancing Health through Nursing, held November 30 —
December 1, in Washington, DC, brought decision makers and thought
leaders—including Don Berwick—together to discuss how to implement the
report's recommendations.
"The Foundation is committed to using the IOM Future of Nursing report as it
is intended to be used, as a roadmap for future direction and action," said
Risa Lavizzo-Mourey, president and CEO of RWJF said in a statement."We are
doing this by convening leaders from all sectors, both public and private to
join us as partners in this national movement to make these recommendations
a reality."
The Future of Nursing: Campaign for Action, is working on five main areas:
• Preparing and enabling nurses to lead change
• Improving nursing education
• Removing barriers to practice
• Creating an infrastructure for interprofessional healthcare workforce data
collection
• Fostering interprofessional collaboration
To begin with, the campaign has enlisted five states to work on developing
best practices and programs that can be replicated elsewhere. These Future
of Nursing Regional Action Coalitions (RACs) are located in New Jersey, New
York, Michigan, Mississippi, and California. They have been tasked with
capturing best practices, determining research needs, tracking lessons
learned, identifying replicable models, connecting with the other RAC
programs, and monitoring progress.
The stewards of the IOM report have a huge task on their hands. Some of
their recommendations seem positively Herculean, such as the call for 80% of
the country's RNs to have baccalaureate degrees by 2020. As I wrote in the
summer, this issue has been argued about in nursing for decades and no topic
has the capacity to divide the rank and file of the profession quite like
this one.
Yet evidence shows that higher-educated nurses produce better patient
outcomes. We also know that to fulfill the recommendations of the committee,
and meet the future healthcare needs of the country, we need a
well-educated, well-trained nursing workforce.
Another Herculean battle to overcome is the recommendation that scope of
practice barriers be removed. The state-by-state differences in the
regulations regarding advanced practice nurse practitioners are absurd. That
one state considers nurse practitioners competent to see patients and
prescribe medications independently while another requires physician
oversight to do the same is ludicrous.
Meeting the needs of our aging population is going to require multitudes of
healthcare providers of varying levels and specialties, and it only makes
sense to use our limited resources to the extent of their capabilities and
to find ways for everyone to work together for the good of patients.
It will be interesting to follow what happens as the real work begins.
Count ER Nurses among True Heroes
October 20, 2007
Chicago Daily Herald
Every day we read about our heroes and their amazing feats of courage and
strength. Today's culture emulates entertainers, and athletes even, with the
daily reports of their indiscretions. The sports pages are filled with
"clutch catches" and "walk-off home runs." My heroes are different. They can
be found in hospitals across America. They are emergency nurses, and they
have no agents or entourages.
Who's Your Hero ?
In the ACEP News
September 2006 issue, Dr. David Baehren wrote a Guest Editorial about
emergency nurses being a "hero" and 'societal role model'. He describes some
emergency nursing "challenge patients" who tax our physical and emotional
limits. He remarks that we are the "lock stitch in the fabric of our health
care safety net". He recognizes our intellectual and professional
contributions and the "productivity that expands gracefully to accommodate
the endless flow of patients while the rest of the hospital 'can't take
report'". He relates stories about our "good humor", "great strength of
character", "stamina", "discipline", "tenderness" and "patience of a saint"
qualities.
He knows that
"when emergency nurses go to heaven, they get in the fast lane, flash their
hospital ID, and get the thumbs-up at the gate."
How refreshing it
is that he gets us !!!!! Many thanks to him for that glowing rendition of
our work and passion.
Click here to read
the complete article
http://www.acep.org/webportal/membercenter/periodicals/an/2006/sep/hero.htm
He lives in Ottawa
Hills, Ohio and practices emergency medicine. He is the author of "Roads to
Hilton Head Island". He welcomes
your feedback at
DFBaehren@Ameritech.net
ICE - In Case of Emergency
A campaign encouraging people to enter an emergency contact
number in their mobile phone's memory under the heading ICE (In Case of
Emergency), has rapidly spread throughout the world as a particular
consequence of last week's terrorist attacks in London.
Originally established as a nation-wide campaign in the UK, ICE allows
paramedics or police to be able to contact a designated relative /
next-of-kin in an emergency situation.
The idea is the brainchild of East Anglian Ambulance Service paramedic Bob
Brotchie and was launched in May this year. Bob, 41, who has been a
paramedic for 13 years, said: "I was reflecting on some of the calls I've
attended at the roadside where I had to look through the mobile phone
contacts struggling for information on a shocked or injured person. Almost
everyone carries a mobile phone now, and with ICE we'd know immediately who
to contact and what number to ring. The person may even know of their
medical history."
By adopting the ICE advice, your mobile will help the rescue services
quickly contact a friend or relative - which could be vital in a life or
death situation. It only takes a few seconds to do, and it could easily help
save your life. Why not put ICE in your phone now? Simply select your person
to contact in case of emergency, enter them under the word 'ICE' and the
telephone number of the person you wish to be contacted.
Please will you also email this to everybody in your address book, it
won't take too many 'forwards' before everybody will know about this.
It really could save your life, or put a loved one's mind at rest. For more
than one contact name ICE1, ICE2, ICE3 etc.
