Patient Safety, My Old Friend

The other day I found myself in a meeting with hospital administration, negotiating for how the position of Break nurse would be implemented. We, the other union stewards/officers and I, wanted guarantees that the nurse wouldn't be pulled to patient care. Admin, of course, refused to make that guarantee or set criteria for a threshold that must be met before pulling the nurse from the role to which they had been hired. Because we have patient safety, they said, and we don't know what that looks like.

Well, we know it must not look like safe staffing despite the fact that research shows every patient added to a nurses load increases the risk for mortality for all of their patients by 7%-10%. We know it's it can't be efforts to retain nurses, despite the research that tells us it takes two to five years after graduation to even reach competency as a nurse. We know it's not in monetizing the care provided by nursing, thus creating an incentive for employers to keep us at the bedside, because CMS and insurers have bundled our care into the cost of the room. And considering that CMS recently made a decision that will result in private ensurers reducing their reimbursements by 4%, it's unlikely that we're likely to see any helpful changes from that direction. We know cannot possibly be protecting nurses from assault and the trauma that comes from working undersupplied and understaffed for years on end.

It must not look like anything that places the responsibility for patient safety at the feet of the employer, because I only ever hear it mentioned when administration is try to tell nurses why the must, once again, worker harder with less resources.

Nurses can, should, and do have a responsibility when it comes to patient safety. If anyone tries to argue otherwise they can join the rest of the mob that just doesn't understand what nurses do. But this responsibility cannot and should not rest with the nurse alone. The nurse is and should be accountable for their own decisions and how they effect the safety of those in their care. Yet, the nurse doesn't choose to work short staffed, doesn't choose to work without the proper equipment or supplies, doesn't choose the systems hospitals impose to improve their bottom line. We choose to show up to work despite these hindrances to the care we provide and the risks to our licenses. We choose to care for the people who need us despite the fact that we know the system will sacrifice us in a heartbeat to save itself.

We got our break nurse in the end. And they'll get pulled, because of course they will. Our hospital has recently made the decision to increase our nurse to patient ratios, making our once popular facility something to avoid. No nurse wants to work somewhere on PCU they're regularly taking 5 patients, where ICU nurses often find themselves trippled or given as many as four people to care for, or where a med/surge nurse can expect to take six patients on a good shift.

And when they pull the nurse to the floor, administration will tell us it's for patient safety. But why are we the only ones trying to make sure people are safe? What are we the only ones held accountable?

And what do we need to do to change that?