Patient Harm And Patient Dissatisfaction

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

I would like to give you some insight as to the daily operation of a major Emergency Department in this city. Not unlike many other “ER’s” the nursing staff is tasked with the triage or assessment of patients in order to sort by priority. The nurse is then tasked with maintaining flow of the department and ensuring the timely care and physician evaluation of patients. This requires clinical nursing judgement and expertise which is tested constantly. To explain this plainly, nurses are faced with a meat grinder which cannot stop. There may be twenty patients in the lobby with ambulances lining up. The room nurses are trying to

When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

With so many cases of unfilled position in the hospital patients is not obtaining great services. Patient not receiving proper cares leads to closures, because of prolonged postponements that have led to deaths. Patient complaints at the emergency room have increased in recent years. Numerous patients that were admitted to the hospital’s emergency room are at high risk of dying. Six percent of emergency rooms in the U.S. have closed. These closings took place in the inner-city and low-income areas, but with an emergency room visit increasing by nearly 51%, the overwhelming amount of closures.

The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3

The source of these problems seems to be coming from two areas in Interwest Healthcare. The first area is the miscommunication that the hospital administrators are having with upper management. The hospital administrators and upper management are not only having miscommunication issues but they also do not share the same role expectations with each other which is creating tension. “The hospital people accused Singh of being a bureaucrat who did not care about patient services. Singh accused the hospital staffs of not understanding the importance of accurate reporting” (Brickley, Smith & Zimmerman 2009 p. 38). The

When someone is hospitalized, they are often in their most vulnerable state. Whether you are the fearful individual being hospitalized, a concerned loved one, or the compassionate care provider, ensuring the patient receives the best possible care throughout their stay is a substantial concern. When receiving care and trusting a facility with the health of the individual involved, wouldn’t it be assumed that the amount of attention and level of care received would be unwavering throughout the nation? Would it be surprising to you to find out that the patient’s outcome may be different depending on in which state they are being cared for? Depending on the state in which the care is being received, there may not be a limit to how many other patients your nurse is assigned to, thus, limiting time and energy that nurse has to spend with each individual. While this fact is a scary one, there is evidence that thousands of lives could be saved if hospitals across the nation would implement change and mandate nurse to patient staffing ratios.

Doctors are busy giving family members updates on their loved ones. Traumas are coming in with families in complete fear. Admitting staff trying to get information from the families to get patients registered while trying explain to patients why they must stay, and why some procedures aren’t covered by insurance. The thousands of questions the admitting staff get from patients about their stay all the while being invisible to majority of the staff. That is the Emergency room, that is what an ordinary person walking in does not see. The clicks and the social norms and the hierchy involved in hospital care. The disconnect of clinical staff from non-clinical staff. This same disconnect that contributes to low emergency room patient satisfaction scores, the reason why people leave the ER unhappy. People who work in the ER come in all shapes and sizes. Most of the nurses are females with just a few male nurses, all of which are between 20 to 60 years of age. Admitting staff is made up of males and females from different social backgrounds. The ER is a melting pot, which sometimes can be difficult to

However, data over the last decade reveals that it is not to the advantage of the nurse or the patient to continue in this fashion. This is an important issue, since patient outcomes and quality improvement are at the crux of every issue in health care. Increased medication errors, falls, inadequate discharge preparation and instructions and consequent early readmissions are all undesirable events in health care facilities and can affect reimbursement as well as hospital ratings. Risks to nurses are prevalent as well, including needlesticks, musculoskeletal injuries, and physical as well as psychological fatigue. Eventually this results in increased nurse burnout, lower retention rates by hospitals, and increasing shortages which perpetuates the overtime cycle.

The presence of Emergency Department (ED) crowding, and long boarding times, hinders its ability to provide the quality and efficient care (Weiss, Rogers, Maas, Ernst, & Nick, 2014). According to Mullins and Pines (2014), an average patient in the United States spends more than 4 hours in the ED before being admitted to an inpatient unit. ED crowding and increased boarding time have negatively impacted bed availability, increased staff workload, decreased productivity, and lessened patient satisfaction. Many healthcare organizations, including the Veterans Health Administration (VHA), have established an electronic bed board system (BMS) and InterQual Level of Care Criteria (IQLCC), which aim to enhance patient flow within organizations (United States, 2013).

I agree!! Somehow the priorities, patients and nurses being most important, have changed. Today, it is more about how fast can we get the patients to the admission bed, instead of what we can do to support their medial and physical condition that presented. A very sad, but true situation. While I understand that payment is an important part of the health care process, I become frustrated quickly about why I should be concerned with admission times, when nothing is being done about inappropriate staffing ratios. One would think that someone would see the issues that are created by low staffing, and do something to amend the situation. I have worked night shift my entire career, and never understood why night

Communication is key to the success of any facility. Being in the operating room at Baystate Noble I had many opportunities to attend different meetings. Before the start of the day, the OR staff gathers at the nurses station and has a brief meeting that the assistant manager or charger nurse will hold. At this meeting brief concerns are brought up and if anything was changed or added with the different cases of that day. I have also had the opportunity to attend a more formal meeting were the staff of the OR, PACU, and SCU gathered with the main manager. At this meeting the staff brought up concern about certain equipment that needs to be fixed, the need for better communication amongst the three units, how the units are doing, the changes

Consistent, open, honest, and transparent communication is invariably preferred, and would have best suited this situation, however, given the collective bargaining agreement requirements, this proved an impossibility. Furthermore, the rules governing the negotiation process and that planning occurred without the nurse’s knowledge indicated deception in their judgement. An already frustrated nursing staff became angry at what they perceived as a personal affront and severe injustice. Although the nurses’ could grasp the staffing insufficiencies, the severe changes required to remedy the unsafe staffing conditions evoked serious emotions and injured the trust between management and the nursing staff. Nevertheless, the medical center was obligated to follow the procedures dictated by the

The statistics were reviewed with the Charge Nurse team, the ED Director, and ED Medical Director and after much deliberation, the group concluded that a reorganization of the nursing staffing was the most judicious response. Realizing the restructure would impact the lives of every staff member employed in the ED, the decision was distressing. Nurses place great value on their shift, full time equivalent (FTE), and the pattern of their working days, however, the current staffing model conflicted with the operational needs of the ED, furthermore, the facility possesses an ethical responsibility to address safety issues when identified and the current status quo did not meet the safety requirements of the patients, nurses, or

Emergency departments are facing a shortage of trained nurses that are capable of functioning in the fast-paced environment such as an emergency department. The problem is the emergency room is not retaining nurses and faces a continuous influx of untrained, new nurses to fill the void. This unstable staffing situation leads to hazardous care environments for both patient and nurse. This is a perpetual the cycle that worsens with time and becomes a viscous cycle of departure. The nurses who stay become fatigued, overwhelmed and burned out, which causes more nurses to leave. The nurses who remain face short staffing, the burden of training new hires without help and no team to rely on for support.