|Our bosses over at the California Hospital Association are telling lawmakers we don’t need SB 227, our “Stop Repeat Offender Hospitals” bill.|
Jennifer Sanchez has been a Nurse for four years. She decided to become a Nurse when she was a teenager.
“If you’d asked me when I was younger, I would have told you I wanted to be a brain surgeon,” says Jennifer. “But I noticed how little time the doctors spent with their patients. It was the Nurse who spent more time, who related to the patient on a more personal level. I wanted that. I wanted to be the one who could gently guide the patient and make it all OK. I knew I was meant to be a nurse.”
Jennifer is an Emergency Room RN at a hospital in Riverside. There are 37 beds in addition to several waiting areas. One recent day in March of 2019, there were 137 patients in the E.R. in beds, in hallways, in various waiting areas on chairs. That’s 100 additional patients, many with very critical medical conditions.
For the most critical patients without beds, the hospital created an area they simply call “chairs” where they assign one “Chairs Nurse” to monitor and medicate as many as 50 of the most ill patients for whom they don’t have sufficient beds, Doctors or Nurses.
“These are all the patients who really should be in beds,” says Jennifer. “They can have G.I. bleeds, elevated cardiac enzymes…you name it. Serious health crises.”
Hospitals get paid for the number of patients they service and/or admit. Recently, a couple Doctors tried to refuse to accept any additional transfers to the E.R. Hospital administrators told them to accept all transfers or lose their jobs.
“It’s getting worse. Where the chairs area used to have 15 to 20 patients and two RNs monitoring them, now it’s almost always at least 30 to 40 and with only one RN,” says Jennifer. “And patients are paying the price. A couple months ago, we had an 86-year-old who’d finally been taken to an exam room after spending almost three hours in the chairs area. She was left there alone. I happened to have patients nearby and saw that she was anxious and short of breath. She needed to use the restroom, so I took her. She became more distressed and even more short of breath. I knew something was terribly wrong. I took her back to the exam room. I noticed that her oxygen tank was empty—and for who knows how long? We were short staffed and there was no one there to monitor her. I took the cardiac monitor off one of my patients and sure enough she was AFib with RVR—a super rapid heartbeat. And I had no idea how long she’d been like that. She needed medication immediately. I alerted our Charge Nurse and the Doctor, as well as the Chairs Nurse. That poor patient—remember, she’s 86!—had to be taken back to the chairs area, still hooked up to my other patient’s monitor. There, the Chair Nurse gave her a very strong antiarrhythmic drug to lower her heart rate. This entire time I had four other patients and the Chairs Nurse had 30 or 40 other patients.”
Not long ago, Jennifer heard a former E.R. administrator say that their hospital prefers to hire new grads since the more experienced Nurses will not stick around due to the unsafe situations they’re placed in. This administrator said it was because the new Nurses are less likely to protest. They simply don’t know any better and want to keep their jobs. Jennifer also found out recently that during the new-hire interview process, one of the questions asked is, “If your supervisor told you there were no other resources available, would you go out of ratio?”
“I know this firsthand,” says Jennifer. “We all felt the same way when we first started here. We thought that it must be normal to work in conditions like this and that we needed to try to be OK with this environment. And since then, it’s gotten much worse. We never saw the number of holding patients we’re seeing now. When you have a room packed with seriously ill patients and one RN, their vitals aren’t taken again for another four to five hours—not to mention tons of delayed medications.”
Jennifer has account after account of how understaffed and overcrowded it’s been in the E.R. lately. Certain patients really stand out, though. Close calls like the teenage diabetic whose parents brought him to the E.R. He was in the “chairs” area without a monitor for at least a couple hours before the Nurse Manager on duty got word that he was in diabetic ketoacidosis, a severe, life-threatening complication. She brought him to a reclining chair in a corner behind RNs’ station, got meds started and alerted the Charge Nurse. At this point, he was identified as an Intensive Care patient. He was finally moved to a bed in a hallway in E.R., but he still didn’t have a monitor. The nurse-to-patient ratio for ICU is no more than two patients per RN. When Jennifer saw the poor ER Nurse caring for him—who still had three other patients—she looked like she was ready to fall apart.
Then there was the man who Jennifer heard would have died of a fatal arrhythmia if the Chairs Nurse hadn’t jumped into action with the crash cart while the patient was still on the EKG gurney. He was looking pretty bad. There were no beds, so the Chairs Nurse along with the MD recognized the imminently fatal arrhythmia and needed to shock his heart. There was nowhere to do it accept in a little alcove right there by the chairs. It was so unsafe, not to mention incredibly alarming for the other waiting patients, who had no one attending to them while the Chairs Nurse was focused on this patient.
“I’m not even sure that RN had any hands-on experience for defib,” says Jennifer. “And what if they had to intubate and hook up to ventilators?”
Jennifer’s worst memory in the E.R. was maybe not as life-threatening as these other incidents, but it’s the time that broke her heart.
“A couple years ago I was the Chairs Nurse. I had maybe 20 patients. One young woman there with her husband was actively miscarrying. She was bleeding a lot,” says Jennifer. “We couldn’t monitor her. We did the best we could without a bed. Then she called us in distress from the bathroom, where she’d basically delivered and the fetus was still attached. We had to transport her in a wheelchair sitting on a bed pan to a room where a Doctor could examine her. Then we had to move her again to a room where the actual procedure to cut the cord could be performed. A full hour passed before we could cut the baby from her. It was horrible. I asked the woman and her husband if they wanted to see their baby. I wrapped the little girl in a washcloth and they were able to hold their baby. I’ll never forget the sadness of that moment. Even worse was that I had to keep leaving because I still had 20 additional patients to take care of. Another hour passed before I could return. They were alone. I saw that they’d gently laid the baby by the sink. It was awful. They were still in so much shock. There wasn’t even a call light in that room.”
Jennifer notes that in a well-staffed hospital, there would have been an RN with the couple the entire time, able to provide care and comfort, and who could take the baby from them when they were ready.
“I was devastated. It shouldn’t be that way. I became a Nurse to be with people in their worst moments—to make them feel safe and let them know they’re not alone,” says Jennifer. “What a moral dilemma!”
Nurses like Jennifer used their strength in numbers this year to introduce legislation designed to strengthen enforcement of California’s nurse-to-patient ratio regulations. Read more about California Senate Bill 227 here.