One of my favorite professional qualities and traditions of registered nurses is nursing advocacy. Advocacy requires nurses to exercise critical thinking to identify situations that are unsafe for patients and to speak up to get action.
When we discuss nursing advocacy, it’s typically in the context of a medical malpractice lawsuit, when nurses didn’t do what they should have done.
For example, just today I was working with an emergency nursing expert witness in a case where the absence of nursing advocacy contributed to a tragic outcome for our client. Let’s call him Mike.
Throughout the registered nurse’s care of Mike in a Dallas area hospital emergency room, Mike had abnormal vital signs including tachycardia (an abnormally high heart rate) and tachypnea (an abnormally high respiratory rate), despite being on 10 L/minute supplemental oxygen by Venturi face mask (the maximum setting).
The registered nurse noted that Mike’s oxygen saturation continued to decrease below 90%. This is a significant number because it reflects hypoxemia or abnormally low levels of oxygen in the blood for most patients. At deposition, the nurse explained that with Mike’s level of oxygen saturation he would be hypoxemic and she would expect his body to start shunting blood flow and oxygen to keep his vital organs functioning.
Yet, despite actual awareness of these ominous signs for Mike’s status and safety, the nurse didn’t tell anyone. Not the emergency physician. Not the nurse practitioner covering the intensive care unit (ICU). No one. No advocacy whatsoever.
Our nursing expert described the patient’s status as in extremis. By that, she meant that Mike’s clinical status was so clear that he could have respiratory decompensation in a code event at any moment. In fact, that’s exactly what happened and Mike developed a permanent brain injury before he was resuscitated.
That’s the bad side of nursing advocacy—when it’s absent. But in today’s news, there’s the story of another side of nursing advocacy.
According to Becker’s Hospital Review, several nurses were escorted out of an Ascension hospital after they advocated against the nursing shortage in the hospital’s emergency department. The nurses were concerned about patient safety because hospital guidelines called for staffing of 10 nurses in the emergency room, but there were only 4 nurses on duty to handle 46 patients.
That’s over 11 patients per nurse—in an emergency room setting!
In the best of circumstances, nurses work hard to juggle the responsibilities of patient care, documentation, and other tasks that hospitals require. In times of short staffing, nurses may pick up extra shifts or work longer hours.
But then there are situations like this one where conditions seem objectively unsafe. The emergency room nurses felt that there was a danger to patient safety to continue to accept more patients with gross understaffing. That’s why they urged the hospital administration to move the hospital to bypass or diversion status. This is a designation that informs emergency medical services (EMS) that the hospital is saturated or overcapacity, such that it cannot safely provide care to additional patients.
While, as a former hospital administrator, I’m disappointed in the actions of this hospital’s leadership, I’m proud of these emergency nurses for speaking up for patient safety.
Based on information and documents that I’ve seen from numerous medical negligence cases, some hospitals and nursing facilities are chronically understaffed. While we can discover this through litigation, it’s too late to prevent harm to those patients who are already injured. That’s why the role of nursing advocacy is so important.
If you’ve been seriously injured because of poor nursing or hospital care in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.
