You would think that most folks in the medical profession do this without question and most do, yes Karen even when they say it will only hurt a bit, and it ends up hurting like hell.  We all have different Ideas of pain, get over it.  This is not the do no harm I am talking about; it is, of course, intentional harm the patient by a provider. The cases are rare, and they do happen. Take this case:

The women allege that Dr. Keith Ablow, an author who was a contributor to Fox News network until 2017, abused his position while treating them for acute depression, leaving them unable to trust authority figures and plagued with feelings of shame and self-recrimination.

The malpractice lawsuits, two of them filed on Thursday in Essex Superior Court and a third filed last year, paint a picture of a therapist who encouraged women to trust and rely on him, then coaxed them into humiliating sexual activities, often during treatment sessions for which they were charged. When the New York woman had trouble paying her therapy bills, she said, Ablow advised her to work as an escort or stripper because the work was lucrative.

Yes, this is an example of what we think of when we think of harming. This therapist set out with a clear goal in mind. Regardless of what the outcome of this particular individual’s trial is, it is a perfect example of harming that I’m pretty sure no one can argue against this being a bad thing.

Okay, let’s talk about some subtle harm that happens much more frequently that is subtler but just as intentional. What I’m talking about is the nurse to patient ratio on an inpatient unit. As the evidence continues to show, there is no magical thing happening to make nurses any more efficient that would allow that ratio to increase. The evidence shows just the opposite. Current evidence by the AHRQ which is the Agency for Healthcare Research and Quality, shows that ideally on a medical-surgical unit that number is four patients to one nurse. It also allows in situations where a there are patients of lower acuity that that number can be 5:1. Now granted there are a lot of factors with these ratios; however, in general, a safe number is between 4:1 and 5:1. Why do you care, as long as you’re getting hospital care? Well you should care the greatest number of mistakes occur in situations where a nurse is overwhelmed by their patient load. A lot of buzz goes around this topic, and a lot of conversation like, “they can ask for help,” or other uninformed statements.

Floor nursing is a tricky duck, in that it can be sane 1 minute and completely crazy the next. By overwhelming a staff nurse from the beginning, you are setting them up to fail when things do become crazy. What is found in the situation is an increase in medication errors, an increase in patient safety events such as falls, and a decrease in quality of care? So why is this done?

The answer is pretty simple, greed.

Hospital corporations need to make money to stay in business; there are a lot of factors that affect the bottom line, but upfront and foremost is staffing; it costs a lot of money to hire a registered nurse. So, we try to cheese in as many patients as we can to avoid hiring that one more nurse. The bottom line is that overwhelmed nurse is likely to make more serious errors.

I know it’s shocking to think that nurses make errors and it’s also kind of humorous in a macabre sort of way that hospitals are also willing to throw a nurse under the bus to help reduce their liability. Nice, huh?

Then again this is typical in corporate America where we push the worker until they make a mistake and then blame the worker for not being smart enough to overcome the mistake. So, what am I talking about here? Recently a nurse at Vanderbilt University made a very tragic medication error that ended up in the death of a patient. I’m pretty sure she didn’t mean to give this patient a particular drug but in the middle of a busy floor and her being in a hurry she pulled the wrong drug out of the Pyxis machine (this is a machine that holds medications securely). When she was getting a drug called Versed which causes sedation and light amnesia, she pulled the drug vecuronium which is used to paralyze the body for surgery.  Without someone to assist that patient with breathing, she died while having an MRI because of suffocation.  Now instead of working through the incident with the nurse and risk management, the hospital has suggested that criminal action (negligent homicide) charges be filed. Why? (we have asked that a lot today) To save the hospital from liability and throw it all on the nurse.  Yep, the nurse.  The one that may have made a mistake, but was forced to work in a situation with six patients and very little professional support on a unit that had a paralytic drug in its medication dispenser.  Let that sink in, vecuronium is only used in a surgical setting why is it in a floor Pyxis machine?

Okay I am quite sure there is more to this situation, and I am oversimplifying it, but truthfully that’s how large hospitals operate. They operate on the idea of overstuffing the building in an attempt to get the maximum revenue possible.  Hospitals’ do not care about your wellness. It is the patient care teams that do.  I think you would be hard-pressed to find patient care teams that do not care.  That may explain why providers are curt with you because they are trying to provide a high level of care to all of their patients.  Nurses are the same, while they are answering your call light, there are 2 others holding that they need to take care of.

Recently before I left floor nursing, we were told that the magic patient to nurse ratio was going to be raised to 6:1. This was suggested by a chief nurse that probably hadn’t worked with a patient load since before Nursie Poo became a Nursie Poo. All as the culture has shifted from a culture of solving problems through education to a punitive culture where mistakes generate write-ups.

Now before you are afraid to set foot at a provider’s office, realize that your provider cares.  They are doing their absolute best to provide quality care. Mistakes are infrequent and not nearly as serious as the drug mix-up above.  You are safe with your provider. Remember to work with them and ask questions.

Well, the bats and the hellhounds are calling for a brunch date.  Be well my pretties