Patient Safety / Quality

Letters to the Editor – June 2007

Float or be fired?
The February article “Protecting yourself from malpractice claims” states, “Don’t accept assignments if you’re not sure you’re competent to perform them.” How does a nurse refuse assignments without getting fired? At my hospital, nurses who’ve left adult medicine for pediatrics and the nursery are required to float to adult units. Some have been away from adult units for years; I question whether they remember the indications, dosages, and adverse effects of drugs given to adults. Also, unless we have at least weekly exposure to changes in policies, procedures, and equipment, we can’t keep up with these. Yet we risk disciplinary action if we refuse to float. Are we legally responsible for staying up-to-date on procedures, policies, equipment, and drugs that don’t pertain to our home unit? It’s hard enough to keep up with the unit in which we choose to work, let alone those to which we’re required to float.
-Name withheld upon request

Author’s response:
A facility that “floats” its nurses involuntarily must ensure they have appropriate competencies to provide safe care—or make provisions for missing competencies. Voice your concerns to your immediate supervisor in a way that promotes joint problem solving.

Explain that you’re willing to float but may need additional time and resources to assure your patients receive appropriate care. Avoid terms that could inflame or that imply management isn’t sensitive to the situation. Propose a floating approach that promotes safe care, such as having float nurses care for lower-acuity patients and giving them access to pharmacists and nurses with expertise in the drugs they’re likely to give on their float units.

For a longer-term solution, work with administrators to come up with innovative solutions. For instance, your facility might create a group float pool, with several med-surg units floating their nurses among each other; educators on these units should develop competency seminars, skill sets, and key updates to help staff stay on top of trends outside their primary specialties. Perhaps the facility could make additional resources available, such as expert nurses you could reach by pager or phone to help you through your floating experience.

I’m always disturbed to hear that a nurse fears being fired if he or she speaks up about potentially unsafe care practices. If you believe your practice environment is unsafe and is forcing you to abandon the standard of care or violate your nurse practice act, you’re obligated to report this. Check with your state attorney general’s office about anonymous reporting avenues and find out if “whistleblower” protection is available. If your situation is intolerable and you think you’d be fired for internal reporting of questionable practices, consider seeking a position elsewhere.
Deanna L. Reising, PhD, APRN-BC

Additional information could help us ace our ABGs
Your April article “Are you an ABG ace?” was enlightening. But it would have been even more informative had the author listed some of the medical problems that can cause each type of acid-base imbalance. This would help nurses (especially those who don’t always ace their ABGs) to identify such problems early—and that could improve patient care and help decrease illness and death.
Joycelyn Burke, RN
Brooklyn, NY


Accolades for the April issue
The April issue of American Nurse Today is the best all-around issue of a nursing journal I’ve ever subscribed to. The ambulatory surgery facility where I work is undergoing large staff shortages and I think online shift bidding (“Staffing through Web-based open-shift bidding”) would work well for us. I plan to show that article to our Director of Nursing to discuss the idea. Keep up the terrific work. From here on out, I’ll be an avid reader of your journal.
John V. Mills, MSN, RN
Shreveport, La.

Baccalaureate requirement would boost nursing’s image
I enjoyed the interview with Pamela Cipriano (“On the record with Pamela Cipriano, Editor-in-Chief”) in your April issue. She was right on target in recommending a baccalaureate as the entry-level educational requirement for nurses. A few days after I read that article, I was surprised to see that Parade magazine’s annual “What People Earn” story included RNs in a section called “The Hottest Jobs (No College Degree Required)”—along with legal secretaries, auto technicians, athletic trainers, insurance adjusters, transportation workers, and sales representatives. I’m angry that Parade misrepresented nurses. Requiring a bachelor’s degree for all RNs would leave no doubt about the professional status of nursing—both within our profession and in the eyes of the public.
Lynn Rogers, MS, RN
Kemmerer, Wyo.

Another perspective on our February cover
I disagree with the reader who criticized your Feb­ruary cover as sexist and “provocative” because it showed a nude woman clutching her chest. I found the cover thought-provoking, relevant, and important—but certainly not provocative in a titillating sense. I hope the cover and accompanying article help wake people up to the fact that heart disease is indeed the #1 killer of women in this country and has been underresearched, undertreated, and misdiagnosed for far too long. In this country, we’ve sexualized the female body—particularly the breasts—and we must get beyond this. I hope your journal continues to run stories that highlight the need for the healthcare industry to address the health issues of women, minorities, and other underrepresented groups with the same detailed care, attention, funding, and study that other groups have received.
Barbara Orsi, BA, RN
Eugene, Ore.

Correction
In the April issue, the box at the bottom of page 13 incorrectly identified several drugs as selective serotonin reuptake inhibitors. Bupropion is an aminoketone unrelated to other antidepressants. Mirtazapine is a tetracyclic antidepressant; venlafaxine is a selective serotonin and norepinephrine reuptake inhibitor.

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com by clicking on the “Letters to the Editor” link on the top menu. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HealthCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

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