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TwitThisDangerously Overworked
Cheryl Johnson, a registered nurse at the University of Michigan Hospital in Ann Arbor, remembers driving home after a 12-hour shift, wondering why a patient suffering an allergic reaction to a bee sting had such a worrisome response to the epinephrine she gave him. Suddenly it hit her. She'd given him a larger dose than ordered."It had been in my 11th hour on duty," Johnson says. "I was tired."
Once home, she phoned the hospital to report her error. The patient escaped serious harm, but an overdose of the stimulant could have triggered life-threatening heart arrhythmias.
Medication errors clearly become more frequent when nurses are too rushed or too tired from long hours on the job. In the 2001 survey by the SEIU Nurse Alliance, 34 percent of the nurses reported that missed or delayed medication administration occurred at least once a week on their shifts, and another 8 percent reported that patients were given the wrong medication or dosage at least once a week.
To the risks from overwork and fatigue, add this problem: Even as managed care has thinned the ranks of RNs, it has cut costs by pushing patients out of the hospital as quickly as possible, leaving only the sickest behind. So not only are fewer RNs spending longer hours caring for patients, these patients are more critically ill than in the past.
When 43-year-old Gary Stephens* was working in neonatal care in a Washington, D.C., area hospital, he believed his unit was becoming dangerously short-staffed. One Saturday he and his nurse partner were told to care for three-day-old Baby Kevin,* who suffered from a life-threatening bacterial infection. At the same time, Stephens and his partner were assigned care of two-day-old Baby Anna,* born three-and-a-half months premature and clinging to life.
Baby Kevin's only hope for survival had been a machine called ECMO (extracorporeal membrane oxygenation), which would take over for his failing heart and lungs and buy the infant time to heal.
Because ECMO babies can deteriorate rapidly, Stephens's unit had always assigned two specially trained nurses for each infant on the ECMO machine. One would constantly watch the baby's vital signs while the other monitored the ECMO for potentially lethal bubbles or clots in the tubes that are circulating the baby's blood. All the while, they both had to continually fine-tune the medications.
Baby Anna needed the same kind of constant monitoring, however, and taking care of these two critically ill babies at the same time was "an impossible assignment," Stephens says.
Within a day, Baby Anna developed a severe intestinal infection that forced surgeons to remove a section of her bowel. This was followed by a long period of antibiotic therapy and additional months in the hospital. (Both babies ultimately survived.)
"I believe if we had been able to watch Baby Anna more closely, we'd have caught the first subtle signs of her infection," Stephens says. "We might have headed off the worst of it."
Stephens protested the shortage of nurses to hospital management and never felt he got a satisfactory reply. About six months later, he was laid off in a round of nursing cutbacks.
The single most unnerving scenario for nurses is encapsulated in an opaque hospital euphemism: "sentinel event." In layman's terms, a sentinel event refers to an unanticipated death, injury or permanent loss of function while under hospital care.
In August 2002, the JCAHO tied the shortage of RNs to one-quarter of the 1,600 sentinel events reported by hospitals between January 1996 and March 2000. (Experts think sentinel events are underreported and that the actual number is significantly higher.)
*Names changed to protect privacy.
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