- Email: [email protected]
Just Do the Best You Can
LETTERS
Unsolicited Letters With News, Notes, and Comments From Our Readers Always Welcomed All letters must be typed double-spaced and should be sent on disk to Karen Halm, PO Box 489, Downers Grove, IL 60515 or via E-mail to: [email protected].
Just Do the Best You Can
J Emerg Nurs 2003;29:95-7. Copyright © 2003 by the Emergency Nurses Association. 0099-1767/2003 $30.00 + 0
Dear Editor: I would like to commend you on your recent editorial, “Just Do the Best You Can,” in the December issue.1 Because I work in the risk management field, I have, unfortunately, been reviewing more cases involving poor patient outcomes related to inadequate nurse staffing. I concur with your statement that “courts of law and state boards of nursing don’t make decisions based on extenuating circumstances.” Patients and their families depend on competent, quality nursing care, not just when we are adequately staffed, but all of the time. Nursing is a profession and we are expected to be professional. As the staffing shortage intensifies, it is imperative nurses understand their mandate to inform management of the situation, each and every time. This can be documented through an incident report, which can alert the risk management department to potential problems. You can also keep a separate journal of incidents, including your action and the response of others (be aware that if a lawsuit is filed, this journal may be “discoverable”). Competency is another issue raised in your editorial. Any nurse “floating” to another unit needs to have documented, current competencies to work in that area. Many hospitals are cross-training nurses to assure competencies in the event that staffing requires “floating.” However, if you do not think you are competent—and you are the best judge of that—it is your responsibility to state this and refuse the assignment. We are professionals. That requires us to understand our state’s nurse practice act and also to alert the administration to potential and actual issues related to staffing. It is your nursing license and your patient’s health that are at risk; don’t take that responsibility lightly.
April 2003 29:2
JOURNAL OF EMERGENCY NURSING
Just Do the Best You Can
More on the Experience of Rural Nurses Transferring Out Trauma Patients
Reply
Tissue Plasminogen Activator for Ischemic Stroke: Unintended Consequences
95
LETTERS
This is a big issue, and it is only going to get worse.— Jacqueline Ross, BSN, RN, CPAN, Chagrin Falls, Ohio; E-mail: [email protected] REFERENCE 1. Lenehan GP. “Just do the best you can.” J Emerg Nurs 2002;28: 481-2. doi:10.1067/men.2003.71
More on the Experience of Rural Nurses Transferring Out Trauma Patients
Dear Editor: I was saddened to read the research article on rural nurses and trauma stress in the December issue of the Journal.1 One aspect that was especially disheartening to read was the lack of teambuilding between the rural nurses and the flight nurses who did the transport. I practice in a rural setting and work daily with our local air ambulance service, Northwest MedStar, who have bases in Spokane, Moses Lake, and within the near future, a third base in the south of Washington State. I think that one reason we have such a good rapport with them is that they are actively involved in teaching advanced skills to rural medical facility staff. They offer classes on a monthly basis to all the rural facilities. In addition, there is an open channel atmosphere promoted by the staff, encouraging rural staff to ask questions and seek advice. Medstar gives us feedback on our patients’ conditions whenever confidentiality rules allow. This is, I think, very important as the transfer of patients to a hospital that is maybe ten times the size of your facility can be daunting, to say the least. I hope that somehow our Canadian colleagues can find a better way to interact with their air evacuation crews and relieve some small aspect of the stress they are feeling.— Ruth N. Pechin, RN, EMT, Colville Wash; E-mail: pechinrj@ starband.net REFERENCE 1. Moszczynski AB, Haney CJ. Stress and coping of Canadian rural nurses caring for trauma patients who are transferred out. J Emerg Nurs 2002;28:496-504. doi:10.1067/men.2003.72
96
Reply: We appreciate the feedback. As mentioned in our article, there are very few studies that examine stress and coping in rural nurses. The purpose of this research was to hear the voices of rural nurses who work specifically with transfer trauma patients. Our results vividly describe how the nurses in our study experience stress and how they cope with it. We do not know if our study represents the “Canadian scene” and cannot speak to the experience of all rural Canadian nurses any more than Ms Pechin can speak for all rural US nurses. Our study does begin a dialogue, but there is much more to do. Further research is necessary to determine how prevalent professional discord is between transport teams and nurses in Canada and in the United States and how best to address the root issues.—Colleen J. Haney, PhD, Vancouver, BC Canada; E-mail: [email protected] doi:10.1067/men.2003.74
Tissue Plasminogen Activator for Ischemic Stroke: Unintended Consequences
Dear Editor: Intravenous tissue plasminogen activator (t-PA) has been heralded as a breakthrough treatment for some patients with acute ischemic stroke. But, despite its promise, health care workers must recognize the inherent and sometimes unpredictable dangers that accompany its use. A 65-year-old woman presented at my emergency department with significant, acute, neurological deficits. A non-contrast computed tomography scan of her brain revealed no acute changes—consistent with an acute ischemic stroke. The attending ED physician carefully reviewed her medical history and determined that she met inclusion criteria, and did not have any exclusion criteria for receiving intravenous t-PA, according to the National Institute of Neurological Disorders and Stroke (NINDS) guidelines. The drug was administered according to standard protocols. Within 24 hours, the patient suffered a significant intracerebral hemorrhage and became unresponsive. She was transferred to a tertiary center for further evaluation and care. During the next few days, a team of doctors and nurses at my hospital reviewed this patient’s case. Our combined efforts failed to reveal any identifiable risk factors for
JOURNAL OF EMERGENCY NURSING
29:2 April 2003
Unsolicited Letters With News, Notes, and Comments From Our Readers Always Welcomed All letters must be typed double-spaced and should be sent on disk to Karen Halm, PO Box 489, Downers Grove, IL 60515 or via E-mail to: [email protected].
Just Do the Best You Can
J Emerg Nurs 2003;29:95-7. Copyright © 2003 by the Emergency Nurses Association. 0099-1767/2003 $30.00 + 0
Dear Editor: I would like to commend you on your recent editorial, “Just Do the Best You Can,” in the December issue.1 Because I work in the risk management field, I have, unfortunately, been reviewing more cases involving poor patient outcomes related to inadequate nurse staffing. I concur with your statement that “courts of law and state boards of nursing don’t make decisions based on extenuating circumstances.” Patients and their families depend on competent, quality nursing care, not just when we are adequately staffed, but all of the time. Nursing is a profession and we are expected to be professional. As the staffing shortage intensifies, it is imperative nurses understand their mandate to inform management of the situation, each and every time. This can be documented through an incident report, which can alert the risk management department to potential problems. You can also keep a separate journal of incidents, including your action and the response of others (be aware that if a lawsuit is filed, this journal may be “discoverable”). Competency is another issue raised in your editorial. Any nurse “floating” to another unit needs to have documented, current competencies to work in that area. Many hospitals are cross-training nurses to assure competencies in the event that staffing requires “floating.” However, if you do not think you are competent—and you are the best judge of that—it is your responsibility to state this and refuse the assignment. We are professionals. That requires us to understand our state’s nurse practice act and also to alert the administration to potential and actual issues related to staffing. It is your nursing license and your patient’s health that are at risk; don’t take that responsibility lightly.
April 2003 29:2
JOURNAL OF EMERGENCY NURSING
Just Do the Best You Can
More on the Experience of Rural Nurses Transferring Out Trauma Patients
Reply
Tissue Plasminogen Activator for Ischemic Stroke: Unintended Consequences
95
LETTERS
This is a big issue, and it is only going to get worse.— Jacqueline Ross, BSN, RN, CPAN, Chagrin Falls, Ohio; E-mail: [email protected] REFERENCE 1. Lenehan GP. “Just do the best you can.” J Emerg Nurs 2002;28: 481-2. doi:10.1067/men.2003.71
More on the Experience of Rural Nurses Transferring Out Trauma Patients
Dear Editor: I was saddened to read the research article on rural nurses and trauma stress in the December issue of the Journal.1 One aspect that was especially disheartening to read was the lack of teambuilding between the rural nurses and the flight nurses who did the transport. I practice in a rural setting and work daily with our local air ambulance service, Northwest MedStar, who have bases in Spokane, Moses Lake, and within the near future, a third base in the south of Washington State. I think that one reason we have such a good rapport with them is that they are actively involved in teaching advanced skills to rural medical facility staff. They offer classes on a monthly basis to all the rural facilities. In addition, there is an open channel atmosphere promoted by the staff, encouraging rural staff to ask questions and seek advice. Medstar gives us feedback on our patients’ conditions whenever confidentiality rules allow. This is, I think, very important as the transfer of patients to a hospital that is maybe ten times the size of your facility can be daunting, to say the least. I hope that somehow our Canadian colleagues can find a better way to interact with their air evacuation crews and relieve some small aspect of the stress they are feeling.— Ruth N. Pechin, RN, EMT, Colville Wash; E-mail: pechinrj@ starband.net REFERENCE 1. Moszczynski AB, Haney CJ. Stress and coping of Canadian rural nurses caring for trauma patients who are transferred out. J Emerg Nurs 2002;28:496-504. doi:10.1067/men.2003.72
96
Reply: We appreciate the feedback. As mentioned in our article, there are very few studies that examine stress and coping in rural nurses. The purpose of this research was to hear the voices of rural nurses who work specifically with transfer trauma patients. Our results vividly describe how the nurses in our study experience stress and how they cope with it. We do not know if our study represents the “Canadian scene” and cannot speak to the experience of all rural Canadian nurses any more than Ms Pechin can speak for all rural US nurses. Our study does begin a dialogue, but there is much more to do. Further research is necessary to determine how prevalent professional discord is between transport teams and nurses in Canada and in the United States and how best to address the root issues.—Colleen J. Haney, PhD, Vancouver, BC Canada; E-mail: [email protected] doi:10.1067/men.2003.74
Tissue Plasminogen Activator for Ischemic Stroke: Unintended Consequences
Dear Editor: Intravenous tissue plasminogen activator (t-PA) has been heralded as a breakthrough treatment for some patients with acute ischemic stroke. But, despite its promise, health care workers must recognize the inherent and sometimes unpredictable dangers that accompany its use. A 65-year-old woman presented at my emergency department with significant, acute, neurological deficits. A non-contrast computed tomography scan of her brain revealed no acute changes—consistent with an acute ischemic stroke. The attending ED physician carefully reviewed her medical history and determined that she met inclusion criteria, and did not have any exclusion criteria for receiving intravenous t-PA, according to the National Institute of Neurological Disorders and Stroke (NINDS) guidelines. The drug was administered according to standard protocols. Within 24 hours, the patient suffered a significant intracerebral hemorrhage and became unresponsive. She was transferred to a tertiary center for further evaluation and care. During the next few days, a team of doctors and nurses at my hospital reviewed this patient’s case. Our combined efforts failed to reveal any identifiable risk factors for
JOURNAL OF EMERGENCY NURSING
29:2 April 2003