Slim nursing staffing levels endanger patients
Some hospitals and facilities require one nurse to care for eight patients at a time
As a Houston medical malpractice lawyer handling cases all over Texas and throughout the country, I have handled a lot of cases involving hospitals, rehabilitation facilities, nursing homes and skilled nursing facilities. In practically every one of those cases, nursing communication contributed to harming or the death of a patient.
Of course, doctors are an important part of the health care provided to patients. But most patients and their families overlook the major role of nurses in ensuring patient safety.
You and I both know that most doctors are in a hurry when they see patients. They rush from patient to patient.
For instance, Travis Hird, M.D., the medical director at Reliant North Houston Rehabilitation Hospital, in Shenandoah, Texas, has up to 50 patients at a time under his care in that one facility. Other doctors see patients in multiple facilities, as well as in the office.
With physician time so crunched in shuttling among so many patients, nursing care is crucial.
Nurses are not mindless robots, but are a key part of the healthcare team. According to Texas Board of Nursing Rules 214.2(41), nurses are required to use a systematic approach to care for patients:
Systematic approach--the organized nursing process approach that provides individualized, goal-directed nursing care whereby the licensed vocational nurse role engages in:
(A) collecting data and performing focused nursing assessments of the health status of an individual;
(B) participating in the planning of the nursing care needs of an individual;
(C) participating in the development and modification of the nursing care plan;
(D) participating in health teaching and counseling to promote, attain, and maintain the optimum health level of an individual; and
(E) assisting in the evaluation of an individual’s response to a nursing intervention and the identification of an individual’s needs.
This means that nurses must take the time necessary to evaluate and assess their patients independent of the doctors. They cannot blindly follow orders, based on a doctor’s assessment of a patient that may have occurred hours or even a day or two earlier.
Nurses have to monitor their patients carefully and notify the doctor when something changes. They have been described as the “eyes and ears” of physicians—meaning that when nurses are not doing their job, the doctors are essentially blind and deaf, and terrible things can happen to patients.
When you or someone you care about is admitted to a hospital, rehabilitation facility, nursing home or skilled nursing facility, I recommend that you ask about nursing staffing levels. In other words, how many patients do the facility administrators assign to one nurse. This gives some information about how much time the nursing staff will have to spend caring for you and your loved one, and can be a big factor in patient safety.
Nurse staffing levels can vary from one facility to another, but facilities are required by law to provide an adequate number of nurses to safely care for all of their patients. At Reliant North Houston Rehabilitation Hospital, for example, the “optimum” ratio is one nurse for eight patients, and one nursing assistant for 10 patients.
When hospital or facility administrators do not provide an adequate number of nurses to safely care for all of their patients, there can be dire consequences.
Nurses may not have time to do proper assessments and then miss important changes in patient status that, in turn, are not communicated to the doctors.
When nurses are just too busy with too many patients, there can be delays in reporting important data like radiology reports and critical lab values to the doctors.
When doctors are kept in the dark, patients can be deprived of urgent care, and the results can be serious injuries or even death.
Safe patient care is a team effort, and nurses are an essential part of the team. A basketball coach would never choose to only put three players on the court, but sometimes hospital or facility administrators choose to shortchange their healthcare teams by inadequate nursing staffing.
If you have concern about the nursing care being provided to you or someone you care about, you should make a complaint to the nursing supervisor. Tell the nursing supervisor how the patient’s condition is changing and why you think it presents a dangerous situation.
Ask questions like how many patients are on the unit and how many nurses are responsible for those patients. If the nursing supervisor is not helpful, ask to speak immediately with the hospital or facility administrator who is on duty. It is important to be polite but firm when advocating for the proper care.
If you or someone that you care for has been injured or died as a result of poor nursing care, call the medical malpractice lawyers at Painter Law Firm who practice in Houston, and throughout Texas and the United States, for a free consultation.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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