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The Health of the Staff Is as Important as the Health of the People We Serve
Consider This. . . The Health of the Staff Is as Important as the Health of the People We Serve
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hese are momentous times in U.S. mental health care. A wave of mental health consumerism has the attention of the American public and has generated a number of legislated reforms that impact directly on the image and practice of psychiatric nursing, particularly regarding the use of seclusion and restraint (S/ R). One of the initial forces behind the current reform was a newspaper expose´ (Weiss, 1998) that alleged abuse, coercion, staff violence, and trauma-inflicting practices are unregulated norms in psychiatric settings and that staff routinely cause patient deaths through the misuse of medication and restraint. Terms like bsanctuary harmQ and bpsychiatric survivorQ are now accepted as part of our vernacular. Akin to the Institute of Medicine’s discovery of the shockingly high error rates in hospitals (Kohn, Corrigan, & Donaldson, 1999), this public outcry has deeply troubling implications for nursing. Mental health reform is sorely needed, and this movement has many laudable aspects. Our concerns are not with the intent but with the manner in which political tactics are overriding science and safety. To date, most published S/R programs fail to address injuries, staffing, and the heterogeneity of psychiatric dangerousness, particularly in our public sector institutions. Nursing staff injuries from violence have traditionally been and are continued to be treated as a sustainable cost of doing business. For example, the Pennsylvania S/R reduction project states that while they did not monitor staff injuries during the first 8 years of their 10-year policy-driven initiative, bit is valuable to consider this measure because it is common for health care workers to be concerned about staff injury when [S/R] is reducedQ (Smith et al., 2005, p. 1117). Reform efforts must include nursing staffing, nursing competencies, and strategies with proven effectiveness. Research using nurse-sensitive indicators consistently finds that the proportion of RNs to other nursing staff increases quality and safety. We must speak out about political tactics, occupational health hazards, and system failures that tarnish our image, infantilize us, and leave our patients and our colleagues at-risk in policy-driven environments. The health of our staff is as important as the health of the individuals we serve. We must be partners with our patients, not their adversaries. What we need now is fewer emotionally charged testimonials about how we, as professionals, have abused, traumatized, and violated those whom we have devoted our careers to care for and more emphasis on interventions that actually keep people safe—all people in the hospital community.—Colleen Carney Love, DNSc, RN, FAAN is the Director of the Clinical Safety Project at Atascadero State Hospital in California. Kris A. McLoughlin, DNP, APRN, BC, CSAC is an Associate Professor (Clinical) at The University of Utah, College of Nursing. Kohn L. T., Corrigan J. M., & Donaldson M. S. (Eds.). (1999). To err is human: Building a safer health system. Committee on Quality of Health Care in America. Institute of Medicine. Washington, DC7 National Academy Press. Smith, G., Davis, R. H., Bixler, E. O., Lin, H., Altenor, A., et al. (2005). Pennsylvania state hospital system’s seclusion and restraint reduction program. Psychiatric Services, 56(9), 1115 – 1122. Weiss, E. M. (1998, October 11). Deadly restraint: A Hartford Courant investigative report. Hartford Courant, 1998, October 11,15.
Kris A. McLoughlin, DNP, APRN, BC, CSAC, and Catherine Kane, PhD, RN, FAAN, are the editors of the bConsider This. . .Q column, a forum for addressing current topics affecting psychiatric nursing. We encourage your commentaries, opinions, and ideas on professional, policy, and practice issues. Responses to this column in the form of letters to the editor are welcomed and encouraged. The opinions presented in this column are solely the views of the author(s). Submissions to bConsider This. . .Q are welcome and should be no longer than 450 words. References used should be no more than three and will be included in the 450-word limit. Please refer to bInformation for AuthorsQ for submission address.
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Archives of Psychiatric Nursing, Vol. 21, No. 3 (June), 2007: p 176
T
hese are momentous times in U.S. mental health care. A wave of mental health consumerism has the attention of the American public and has generated a number of legislated reforms that impact directly on the image and practice of psychiatric nursing, particularly regarding the use of seclusion and restraint (S/ R). One of the initial forces behind the current reform was a newspaper expose´ (Weiss, 1998) that alleged abuse, coercion, staff violence, and trauma-inflicting practices are unregulated norms in psychiatric settings and that staff routinely cause patient deaths through the misuse of medication and restraint. Terms like bsanctuary harmQ and bpsychiatric survivorQ are now accepted as part of our vernacular. Akin to the Institute of Medicine’s discovery of the shockingly high error rates in hospitals (Kohn, Corrigan, & Donaldson, 1999), this public outcry has deeply troubling implications for nursing. Mental health reform is sorely needed, and this movement has many laudable aspects. Our concerns are not with the intent but with the manner in which political tactics are overriding science and safety. To date, most published S/R programs fail to address injuries, staffing, and the heterogeneity of psychiatric dangerousness, particularly in our public sector institutions. Nursing staff injuries from violence have traditionally been and are continued to be treated as a sustainable cost of doing business. For example, the Pennsylvania S/R reduction project states that while they did not monitor staff injuries during the first 8 years of their 10-year policy-driven initiative, bit is valuable to consider this measure because it is common for health care workers to be concerned about staff injury when [S/R] is reducedQ (Smith et al., 2005, p. 1117). Reform efforts must include nursing staffing, nursing competencies, and strategies with proven effectiveness. Research using nurse-sensitive indicators consistently finds that the proportion of RNs to other nursing staff increases quality and safety. We must speak out about political tactics, occupational health hazards, and system failures that tarnish our image, infantilize us, and leave our patients and our colleagues at-risk in policy-driven environments. The health of our staff is as important as the health of the individuals we serve. We must be partners with our patients, not their adversaries. What we need now is fewer emotionally charged testimonials about how we, as professionals, have abused, traumatized, and violated those whom we have devoted our careers to care for and more emphasis on interventions that actually keep people safe—all people in the hospital community.—Colleen Carney Love, DNSc, RN, FAAN is the Director of the Clinical Safety Project at Atascadero State Hospital in California. Kris A. McLoughlin, DNP, APRN, BC, CSAC is an Associate Professor (Clinical) at The University of Utah, College of Nursing. Kohn L. T., Corrigan J. M., & Donaldson M. S. (Eds.). (1999). To err is human: Building a safer health system. Committee on Quality of Health Care in America. Institute of Medicine. Washington, DC7 National Academy Press. Smith, G., Davis, R. H., Bixler, E. O., Lin, H., Altenor, A., et al. (2005). Pennsylvania state hospital system’s seclusion and restraint reduction program. Psychiatric Services, 56(9), 1115 – 1122. Weiss, E. M. (1998, October 11). Deadly restraint: A Hartford Courant investigative report. Hartford Courant, 1998, October 11,15.
Kris A. McLoughlin, DNP, APRN, BC, CSAC, and Catherine Kane, PhD, RN, FAAN, are the editors of the bConsider This. . .Q column, a forum for addressing current topics affecting psychiatric nursing. We encourage your commentaries, opinions, and ideas on professional, policy, and practice issues. Responses to this column in the form of letters to the editor are welcomed and encouraged. The opinions presented in this column are solely the views of the author(s). Submissions to bConsider This. . .Q are welcome and should be no longer than 450 words. References used should be no more than three and will be included in the 450-word limit. Please refer to bInformation for AuthorsQ for submission address.
176
Archives of Psychiatric Nursing, Vol. 21, No. 3 (June), 2007: p 176