NEW YORK NURSE: July/August 2009
Q.: I recently faced discipline measures from my facility for pre-signing medications. I don’t think it was entirely my fault. Staffing was inadequate, and I was called away for a number of serious patient issues. I was told I might be reported. What can I do?
A.: If you are represented by NYSNA for collective bargaining, you have resources available to help protect your rights. If you believe understaffing could cause a significant problem with patient care, fill out a Protest of Assignment form (remember to keep a copy whether it is signed or not) and contact your nursing representative. It is your responsibility to provide safe care to your patients – but you are not alone in this responsibility.
Let’s examine the root of the problem: punitive versus educational environments. Healthcare environments are often punitive, even though the majority of accreditation agencies recommend an educational environment. Healthcare personnel are more likely to break rules or hide errors if they know they will be disciplined and punished. This makes it more difficult to correct the root causes behind the errors.
The majority of medication errors are related to problems in systems or processes. The Institute for Safe Medication Practices has defined ten key elements of the medication administration system. The last element states:
The way to prevent errors is to redesign the systems and processes that lead to errors rather than focus on correcting the individuals who make errors. Effective strategies for reducing errors include making it difficult for staff to make an error and promoting the detection and correction of errors before they reach a patient and cause harm (Institute for Safe Medication Practices, 2009.)
Registered nurses are obligated to follow standards of care to protect the public from preventable errors. To ensure that the right patient has received the right medication and the right dose via the right route at the right time, the right documentation must follow administration. If any portion of this process is skipped, the opportunities for errors increase.
Facilities are responsible, however, for protecting patients by adhering to the state Public Health Law. Although the law isn’t specific about the number of RNs on each unit, it does require adequate staffing for safe patient care. Multiple studies have provided evidence that an increase in the number of RNs available for patient care reduces medication errors and improves staff and patient satisfaction.
The recent passage of legislation requiring the reporting and disclosure of staffing levels in hospitals will help in identifying areas where inadequate staffing is making it difficult, if not impossible, for nurses to follow accepted standards of care. Send a message to Gov. Paterson and tell him to sign the bill!
This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA Nursing Representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800-724-NYRN, ext. 282.