“It’s so dangerous when there’s no one in charge.”

Our bosses over at the California Hospital Association say this stuff doesn’t happen.

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Nurses across California report that hospitals are cutting corners in increasingly brazen ways. For example, the critical role of Charge Nurse has been blurred and stretched to the point of being impossible to fulfill.

“Charge Nurses are extremely important in our units,” says Mary Miller, an ICU Nurse of 18 years in Riverside County. “They work to keep our floors staffed, ensure that RNs have assistance with invasive bedside procedures, bring supplies, directly assist the doctor, and—probably most importantly—provide constant backup and advice if an RN can’t put their finger on what’s going wrong with a patient.”

Mary used to serve as a Relief Charge Nurse. That was before it got so crazy. She doesn’t take those assignments anymore. She feels it’s unsafe. The hospital now makes Charge Nurses responsible for two separate units in two separate buildings.

“A Charge Nurse can have 40 patients in one building and 30 in another. In other words, they’re supposed to be in two completely different places at one time. How can they be available in an emergency? How can they provide necessary guidance for newer RNs? It’s obvious. They can’t. It’s so dangerous when there’s no one in charge,” says Mary.

Mary decided to become a Nurse when she was a girl. Her younger brother was forever suffering minor injuries riding his skateboard. She would care for him, clean his wounds. When she saw that she could help relieve his pain, it inspired her.

“I love being the one there to help people get better,” says Mary. “I comfort patients when they’re scared. I’ve also learned that I’m good at anticipating needs and helping younger RNs look ahead at steps B and C, not just step A; helping them figure out a whole course of action.”

At Mary’s hospital, Charge Nurses also do double-duty in “Rapid Response” situations when a patient is in crisis. Mary recently responded to two rapid response calls where the Charge Nurse wasn’t available. Her calm approach and insight make her an obvious choice for her colleagues to rely on when there’s an emergency.

“The Charge Nurse is supposed to provide guidance for the Nurse with the crashing patient,” says Mary. “But in this situation, the Charge was in another tower—nowhere near the RN who needed her support. I later spoke to that Charge. She was so upset that she wasn’t there for the RN and patient. The patient’s RN had no back-up. Luckily, the patient made it. Sometimes, we’re not so lucky.”

Mary also sees the effects of unsafe staffing levels in other areas of her hospital. During one recent shift, Mary’s patient had gastrointestinal surgery and needed an upper G.I. scan to ensure that the surgery went well. The patient was not permitted to eat or drink until after this scan, a crucial step to determine if the surgery was successful and ensure that there was no internal leaking around the surgical site. The patient hadn’t had food or drink for at least three days leading up to the scan, scheduled for 6 a.m. that morning. When Mary called to bring the patient over for the procedure, she was told to wait for the day shift to begin later that morning. They were understaffed and unable to perform the scan. Mary and her Charge Nurse together called a total of six times throughout the day, trying to bring the patient for the scan. Each time, the radiology secretary said they were short staffed and couldn’t do it yet. Finally, the furious surgeon and Mary together personally took the patient over to radiology at the end of the day where the surgeon insisted that the radiologist perform the scan.

“That scan was vitally important to rule out a leak, which brings enormous risk of peritonitis—a life-threatening condition which can degrade surrounding organs. That delay was dangerous!” says Mary.  “Even if there had been no leak, delaying the scan meant the patient would have had to go another day without food or water. That’s just unnecessary suffering.”

“There are simply too many ‘what if?’ situations when we’re understaffed. It’s like sitting around just waiting for a catastrophe. What if a crisis happens when the Charge Nurse is in another building? What if a postponed post-op scan means we miss a life-threatening danger? We—and our patients!—shouldn’t have to live with so many ‘what ifs.’”

 

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