Guest Author - Katie Thomas
There are serious risks involved in hospitalization, especially for pediatric patients who cannot articulate specifics about how they feel, and how those feelings are changing. Each year, more patients die of hospital-caused infections, medication errors, and other adverse events than from any other cause. One of the most critical reasons for this is the worldwide shortage of qualified nurses. Many patients’ deaths or injuries can be traced directly to the problem of short staffing.
When a hospital is short-staffed, RNs usually have to care for more patients than they really should have assigned to them. They are working twice as hard for many more patients, and they have to prioritize the nursing care they give, so the most urgent tasks are done for every patient, and frequently even those most urgent tasks are skimped. They are stressed and in a hurry. This situation can add to nursing care errors.
Another factor is that because of health care expenses, insurance costs, and job loss, the patient acuity level is generally much higher than staffing ratios were originally designed to handle. Acuity means the degree of illness and related difficulty of the care provided; the higher the acuity, the more nursing hours [actual time] must be provided to adequately care for the patient.
Because of the shortage, many hospitals must float RNs from their customary clinical area to another that is less well staffed, so the RNs may not be adequately trained or experienced enough in that area to provide best care. Another result of the shortage of RNs is that sometimes the RN taking care of your child is not only inadequately trained for pediatrics, but is also working an overtime shift. She or he may be tired. Tired people make errors. Some hospitals require their staff RNs to rotate all three shifts, many times working two different shifts in one pay period. Research shows that people who rotate tend to make more errors than those who work straight shifts.
Because of the nursing shortage, many hospitals are also forced to use PRN nurses. These RNs and LVNs may be at the hospital for only one shift. There is no continuity of care such as occurs when the same nurses work the same units and acquire knowledge of particular patients and the changes they undergo. Also, there is no continuity of nursing supervision that would weed out poor practitioners.
PRN nurses are usually employees of the agency who provides them, and the hospital has no independent verification of their skills, ability, or experience. Some years ago, JCAHO, the organization that accredits hospitals, started charging substantial fees to accredit supplementary staffing agencies, thus fostering the implication that such accredited agencies were adequate providers and that they provided superior nurses, with policies and procedures in place to assure that temporary nurses met hospitals’ high standards. Unfortunately, this assumption is invalid. JCAHO notifies the agency when they are due for inspection, and inspects paperwork for compliance. There is no ongoing inspection which ensures that agencies are doing what they are certified to do, and there are strong indications that they are not all performing as certified. Further, because JCAHO expects hospitals to use only their certified agencies, this discourages the kind of open competition that would keep providers “honest.” A still greater problem is that nurses are licensed and governed by each state’s Board of Nursing, under law, and the intrusion of JCAHO into this relationship dilutes the Board’s authority. The attitude of many hospitals’ legal staff also contributes to the continued presence in the workforce of a number of nurses who are clinically insufficient. In order to avoid employer labor suits, legal frequently sets guidelines that include failing to report nurses to the Board, as required by law, for errors, and the “dates of hire only” reference procedure which allows a poor nurse to move from one hospital to another.
However, most RNs are deeply concerned that they and their peers do their jobs right. An injury or death of a patient is usually devastating to the nurses providing care, even thought they know that the lack of adequate nursing staff is not their fault. However, once you as a parent are aware of the reasons for most hospital errors, you can take action to minimize the risk for your child. See the related articles “Preventable Pediatric Medication Errors” and “Risk Management for Pediatric Patients” for additional information on this problem, and for some ways you can prevent such errors and minimize your child’s risks.
