Posts Tagged Patient safety

Smokers Have Other Problems Besides, Well, Smoking

If you work in the North, you’re familiar with the scene: patients in gowns, riding wheelchairs and trailing IV pumps scrambling over snow banks and icy walkways and braving frostbite-inducing winds to get off hospital property to have a smoke. I suppose for most of my readers, the image will induce a great big “Meh.” But a new article in the Canadian Medical Association Journal suggests otherwise, and that smokers who need to exit the hospital to smoke face special risks and little support in managing their addiction. Money quote:

Study findings affirm evidence that tobacco dependence treatment is inconsistently offered in hospitals and heath providers were uninformed about tobacco dependence treatment, despite availability of nicotine-replacement therapy at study sites. This treatment gap is perplexing, especially as within Canada there exists an evidence-based hospital tobacco dependence treatment program. Unintended patient safety consequences of smoke-free property necessitate effective tobacco dependence treatment during a stay in hospital simply as a risk-management action. Moreover, a health-promoting policy that causes patients to face diverse safety concerns (treatment disruption, infectious disease contact, exposure to adverse weather and possible violence) projects a contradictory health message.

Not helping, of course, are the usual (and sometimes, let it be said, judgemental) opinions of heath care professionals who view smokers adversely and see them as the authors of their own problems.* They tend to take the somewhat cavalier position that if smokers want to go outside for a cigarette, well, that’s their lookout. Elderly woman who falls on ice and fractures a hip while out for a puff? Hell, she brought it on herself by smoking! But is it actually humane to send sick people to the curb in the winter to tend to their addiction? Is it consistent with good nursing practice? And what about the liability and duty-to-care?

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*I will never forget the physician who told a young, pain-wracked lung cancer patient that she was responsible for her suffering, and that she should go home and “deal with it.” But some HCPs like to play the blame game in general and especially with patients with addictive behaviours.

 

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The Most Useless Form on the Planet

Imagine this: you’ve had the shift from hell, no beds, every other patient is moments away from seeing Jesus/Allah/Buddha and to top it off, the department is down three nurses, another nurse is transporting the multisystem trauma downtown, and you feel really think working conditions were unsafe for both you and more importantly, your patients. So you go to your unit union rep — in the case of most Ontario nurses, from the Ontario Nurses Association — and she says, No problem. Just fill out this document, the Professional Responsibility Workload Form, in either Official Language, in quadruplicate, and all will be well.

Oh, I forgot. Here’s page 2:

So it’s 0730, you’re coming off nights from the shift in which you thought you might finally go postal, and you’re union rep is telling you to fill out this form. The chance of it getting completed? Is zero too high an estimate? Here’s a hint: there’s a four-page guide on how to effectively fill out the form.* And if the form is actually filled out? The union (I think) is supposed to meet with  management to discuss the (completed) form, but in truth I have never heard of any outcome of such a meeting, or if in fact such meetings exist. One suspects when the union raises workload issues with management — encompassing such items as competency, patient safety, you know, important things — management says, “It is what it is,” and with a nod and a wink the union goes off to collect its membership dues. In short, we’ve filled out these forms for as long as I’ve been a nurse, and nothing has ever changed as a result.

It seems, to me anyway, that the Professional Responsibility Workload Form is a classic example of appearing to address an issue, while in fact doing absolutely nothing. Doing so lets both the union and managers off the hook for the deteriorating quality of nursing work life. I don’t think I am being unduly harsh. There is a distinct lack of accountability and transparency around these forms, and it’s symptomatic of a general complacency within ONA’s leadership about issues affecting front line nurse. Given that ONAs 57,000 members each pay nearly a thousand dollars annually in dues, you think someone would come up with a better process to watch workload issues.

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*The statement on the top of the guide made me laugh out loud:

“ONA members indicate it is important and worth the work to complete Professional Responsibility Workload (PRW) Report forms.”

I am not very clear which ONA members the union leadership was speaking to. Not anyone, I’m guessing, from an emerg.

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