February 5, 2013

By:

How long has it been going on?

Nancy J. Brent, MS, JD, RN

My husband, our Miniature Poodle Sunny, and I are very fortunate to live on a quiet street with friendly neighbors. The age-group of the families who live here is varied—some young couples have children living with them, and other families have children who have moved away and had children of their own. A few families are “older,” with family members retired or thinking of retiring. Indeed, it’s a nice neighborhood.

In the past few months, however, several of our neighbors have had health crises, two of which resulted in the passing of those individuals. Two others had the misfortune of falling, one due to a stroke with a subsequent broken hip that required a hospital admission; the other required a hospital admission for a period of observation. Both, of course, were admitted to a nearby hospital. The hospital enjoys a “good” reputation.

What became apparent, however, was that the nursing care provided these two neighbors was far from “good,” both in the hospital itself and in the nursing home/rehabilitation facilities to which they were transferred, albeit at different times and for different reasons.

Our neighbor with the stroke and broken hip developed pneumonia and a large decubitus ulcer, the ulcer present after being in the hospital for a matter of days. His wife stated time and time again that few nurses were in to check on him or turn him as needed. The mattress for his bed to prevent further decubitus ulcers remained in the hallway outside his room for days even after she asked when it would be placed on the bed and being constantly assured it would be placed on the bed “soon.” After much frustration, she raised this issue, and other care issues, with the physicians, nursing staff, and the director of nursing. The wife also contacted her attorney. The mattress finally made it onto his bed.

After a bout with pneumonia, which he contracted in the hospital, my neighbor was medically stable enough for the hip surgery he needed. The surgery was performed, and off he went to a nursing home/rehabilitation facility, where he still is today. His decubitus ulcer “became” infected while there, he is still medically fragile, and the nursing care at the nursing home also leaves much to be desired, according to his wife.

By the way, the wife literally lived at the hospital and is now doing the same at the nursing home because she feels a need to protect him from potential future harm.

Our second neighbor was a little more fortunate. She didn’t break any bones when she fell, but because of a bad knee, needed extensive physical therapy before she could return to her home. As with our other neighbor, both homes have steps, inside and outside, which need conquering. Although those steps are still not overcome, this neighbor is home and living on the first floor, with care being given by personal care givers.

The care in the hospital and nursing home for this neighbor was no great shakes, either. One of the family members and/or a hired health aide was with our neighbor at all times during her stay at the nursing home because a family member said she couldn’t be sure her mother was getting the observation and care that she needed while there. One important plan of care was that the patient be turned regularly during the night and checked for incontinence of any kind, and that she sit up in a chair for no longer than 2 hours at a time. This simple nursing care didn’t occur and decubitus ulcers resulted in a longer stay, since the patient wasn’t able to be discharged home due to the extensive, consistent observation and treatment the ulcers required.

Let me be clear about one thing before I go into my spiel. I love nursing and always have. I’m proud to be a nurse. When I decided to go to law school, I hoped to somehow combine my law degree with my nursing degrees. As it turned out, after a while I was able to concentrate my practice in representing nurses in employment matters and professional discipline matters, and in consulting with and educating nurses about the law and nursing practice. I even call myself a nurse attorney (as many of us do with our dual backgrounds) rather than “just” an attorney.

So when I hear about poor nursing care, about nurses who don’t advocate for their patients (however slight the advocacy may be), and about nurses who don’t establish interpersonal relationships with their patients and their families, I’m shocked.

What is even more disturbing is that my neighbors didn’t need extensive one-to-one care, didn’t require the skill and expertise of an ICU nurse or a CCU nurse, and hi-tech equipment wasn’t in the picture. All that was in the picture was basic nursing care—observation, turning a patient as ordered, attention to complaints and concerns of family members and the patient himself or herself, adherence to proper hand-washing requirements, proper medication administration, and a caring attitude towards the patient.

Maybe the few examples of my neighbors’ poor nursing care discussed here (there were many more but I think you get the point) are isolated incidents. I apologize for making this much noise about only two situations in which poor care was given if these are isolated incidents. But, these individuals are my elderly neighbors, they are human beings, and they, like all patients, need good nursing care so they can hopefully return to their homes as soon as possible. Both of them clearly deserved better basic nursing care than what they received.

What really bothers me, though, is this: Is the kind of nursing care described by my neighbors common? If so, what has happened to nursing? If this kind of care is provided in “good” hospitals and “good” nursing home/rehabilitation facilities, what goes on in lesser-rated institutions?

What kind of nursing care is given, and what kind of care do you give, in the facility in which you work? Are you focused on the patients and their families during your tours of duty? What are the families and neighbors of these patients saying about your care and your facility?

Are you proud of the care you and your colleagues provide? If so, that’s great. Keep it up. Please tell me about it.

And, do me another favor. If the poor care that was experienced by my neighbors is the norm, can you tell me why, and how long, it has been going on?

Nancy J. Brent received her Juris Doctor Degree from Loyola University Chicago School of Law. Ms. Brent concentrates her solo law practice in education, consultation, and the defense of healthcare providers (mainly nurses) before the Illinois Department of Financial and Professional Regulation. She has published and lectured extensively in the area of law and nursing practice. The information in this article is for educational purposes only and does not constitute legal advice.

 

9 thoughts on “How long has it been going on?”

  1. RN says:

    Sad to say, this is NOT uncommon. I agree with a previous post that some people are in nursing for the money now, not because they really care. It’s sad. I think a lot of people want to blame it on staffing, but why is it that 30 years ago when nurses had twice the pt’s we have now was nursing ten times better?

  2. Joyce says:

    There is an article in the Western Journal of Nursing Research published online on April 29, 2014 by Beatrice Kalisch and Boquin Xie titled, “Errors of Omission: Missed Nursing Care.
    The article discusses results from studies with nurses and also asking patients about missed care. Many of the things missed fall under the category of basic care. As a nurse for 50 years and in nursing education for much of that time, it is sad that so many patients are not getting basic and safe care.

  3. Lynn says:

    Graduated with my BSN in 1980. I knew before school I had to go to school. I went into nursing because I cared about people, wanted to be of service to people and wanted to provide quality service. I was innately a nurse, then went to school. Today people go into nursing for the wrong reasons – for the money, they are tired of computer work or accounting, etc. I am in the hospital often and what I hate the most about it is 90% of the ignorant, rude, unaware,self interested nurses!

  4. Dorothy says:

    Sad to say what you describe is common. Why are nurses not providing basic nursing care? Decrease staff is not an excuse. Why is providing basic personal care not seen as part of nursing care? Why is it not a focus in Nursing schools today? You do not have to be a nurse to give medicine, Nursing is more than that.

  5. Anonymous says:

    Not uncommon! Nurses sitting at computers documenting, only going in patient rooms to give meds, not thinking to medicate post-op patients prior to getting them out of bed. My mother recently had major surgery and she thought she had a “med nurse” because that was the only time she saw the RN. The LNA did everything else. She went home with a temporary colostomy and not the faintest idea how to care for it, after 12 days in the hospital. “Home health will show you!”

  6. Melissa B. says:

    Sadly, I think what you describe is occuring all too often. My husband and I are both nurses. I was a patient several years ago – and had several nurses that were excellent – and some that were horrible and didn’t provide even minimal ‘basic’ nursing care. One nurse ignored my huge surgery and decided I was drug seeking – so took away my call light and gave only minimal pain drugs – my level was never below 8. Horrible experience. Basic care? I don’t think so!

  7. Anonymous says:

    I do agree with mmiller, HOWEVER, the organization for which I work also is cutting costs and keeping our staff at the minimum needed to operate successfully. I absolutely refuse to: 1)work for free, 2)spend 1 minute less with each patient because I have a jammed caseload, and 3)Both advocate for my patients and nursing/myself! We can do it: provide quality basic nursing care to our patients AND beat this “cost-cutting” that is ever present in healthcare.
    Geni M.

  8. last of a dying breed says:

    No, maám. Your observations are in line with today’s nurses who havén’t been taught what “nursing” is. My article in Oct 08 AJN questioned the “fundamentals”of patient care. Faculty don’t spend time teaching basics and today’s nurses feel like they have to do something, like giving meds to “be a nurse.”Without us RN’s with knowledge and history of bedside nursing to guide new nurses, and lack of RN charge nurses to implement, this is the result. Repeated over and over-toothbrush? not likely

  9. mmiller says:

    Unfortunately, the scenarios Ms. Brent describes occur too often to ignore. In my area, I attribute such incidents to cost cutting and lack of high quality staff. Medical facilities keep down costs by not hiring enough staff at all levels, and by not hiring nurses even with BSN’s. This occurs especially in long term care facilities.

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