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« Chlorine Road | Main | Fighting fear with fear »

May 03, 2012


My reading of the original article suggests that it was spot on, didn't really need substitution of 'management' for all the 'nursing' references. It's a systemic as well as nurse training and competency issue, in my opinion. Imagine having a nurse who is unaware of how the telemetry monitoring system in the CCU works and doesn't know why a lead is improperly placed. Would you like to have her monitor you when you are recovering in hospital from a cardiac event?


Thanks for taking the time to read and comment.

My intent, here, is the same as when I write about the ultimate responsibility of officers for the soldiers in their command. The VA Eastern Colorado Hospital has an executive in charge of Education and Training. Assuming she was there when the substandard competencies were uncovered, I wonder why she still has a job in that facility. Nurse training and competence is not a nurse issue, it's a management issue. Nursing student ignorance is not a student issue, it is a faculty problem. Having nurses in my family, having known nursing faculty over the years, and my own experience, it is virtually axiomatic that nurses are the first ones to get thrown under the bus when the tort monster rears its ugly head.

You and I read the original article, and we both both understand that there is a lapse in the management system, as well as in nursing competence. I would go so far as to say that most readers of AB have no problem in reaching the same understanding. However, Tracy Weber and Charles Ornstein did not write about the scrutiny of management. They wrote about the scrutiny of nurses. They did not write about the incompetence and poor skills of management. They wrote about incompetence and poor skills of nurses.

Another way of looking at it is to pose the question of how you arrive at a long lasting solution for providing excellent nursing care. Do you fire the nurses and hire new ones? Or, do you fire the supervisors and managers and hire new ones who will take responsibility for the competence and performance of the nurses in their charge? The philosophy of supervisory management can be summed up very nicely. It is doing everything possible to make sure that the people in your charge are successful in their jobs.

Norm has the better argument here. The authors focus on the link between patient and nurse, eliding the link up the hierarchy to administration. There's a vague reference to the IG's finding of "lack of oversight." Bureaucracy parcels out the division of responsibility, hence the inspectors' entirely appropriate review of samples of files, rather than their stepping in for management to do their work. (What do they do all day, after all?)

The departmental investigations linked to in the original, this, for instance show a slow but careful inquiry into the sequence of events leading to demises of patients. That does focus on both the systemic problems (inadequate or improper protocols) as well as nurse competence.
The ProPublica article comes from a couple of writers (Ornstein and Weber) whose 2010 article on abuse perpetrated by rogue nurses brought them a Pulitzer nomination, so it's possible that it would have colored their current article and made them weight it towards 'Blame the nurse'. (Kind of like, school administrators who 'Blame the teacher, not the student' for students failing to learn from a teacher who is battling uphill with trying to impart education to a child who has little home support and reinforcement.)
Axes to grind, anybody?


That was exactly what I was thinking before I did my re-edit. However, I didn't want to make a point of it. I wanted the nurse v. manager criticism to stand on it's own. I sent my re-edit parody and this link to Weber and Ornstein. I hope they might weigh-in on the discussion.

Considering that the management would have also consisted of several who were regular nurses before moving up the career ladder, I guess that using the generic 'nurses' instead of 'management' may not have been totally off the mark.

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