Admonished for missed billing charges while chronic patient safety issues fall on deaf ears

RNs Mobilize for Healthcare District Meeting Tuesday
 

Marin General Hospital registered nurses will present a patient care report outlining their patient safety concerns to the Marin Healthcare District Board Tuesday evening. The nurses have compiled an extensive list detailing specific incidents of unsafe patient care conditions throughout the hospital over the last 14 months that remain unaddressed by both the hospital board of directors and management.

Top nurse management were well aware of the patient safety concerns of the nurses who have documented through assignment despite objection forms (ADOs) every major incident where care was compromised. ADOs are an independent documentation system that provides direct-care RNs a means to object to an unsafe or potentially unsafe patient care and are delivered to management. The number of ADOs filed has doubled over the last year from 15 to 30 per month.

“We have tried to get our managers who reject ADOs and view them as personal attacks to see them instead as important useful information from bedside RNs that highlight problem areas with an eye toward solutions,” said Barb Ryan, an RN who works at the hospital.  “We strive to work at a hospital we can proudly say provides quality care. That is not the case at this point in time."

RN patient safety concerns unaddressed

Instead of addressing patient care issues, RNs were shocked when 44 surgery RNs received an email in early February from a nursing administrator admonishing them for missed hospital charges, naming each RN with exact amounts, and that there would be a training to correct the problem.

When hospital board members were notified of RN concerns with summaries of the ADO patient care problems in early February, they were admonished by Chairperson Paul Kirincic who replied:   “I disagree with your portrayal of the situation. There are management systems in place to respond to safety and quality issues. Please remove me from any further email communications.”

A petition signed by a majority of Marin General RNs outlines the following patient safety areas (partial list):
 

Computerized records and charting system malfunctions

• Check the box system and pull-down menus limit RNs ability to provide individualized patient care
• System is dropping orders and is slow
• Insufficient training with frequent upgrade and fixes that staff can't keep up.
• Doctors are entering orders inaccurately

 Inappropriate placement of cardiac monitor patients in units with less staffing in violation of state law:

• Heart patients are monitored remotely, not at the bedside, which results in delayed response time. 
• Nurses without adequate training are assigned cardiac patients on monitors
• Nurses responsible for remotely monitored cardiac patients are being assigned more patients than they can safely care for. State law mandates no more than four patients.

Problems with staffing in critical care units on a regular basis:

• Administration limits support staff, such as technicians, to assist nurses.
• Patients moved prematurely to units with lower levels of care.
• Excessive use of temporary, “travel” RNs who are used to fill positions instead of hiring regular local nurses. Travel RNs are not being given proper orientation.
• Intensive care RNs sent to care for critical patients in the emergency and recovery room with insufficient equipment and supplies. 

Emergency department holding patients in the hallways causes safety problems and potential HIPAA violations

• Patients in hallways six to 12 hours.
• Emergency department RNs caring for “hold” patients when critical care specialty units have insufficient staff to float to the ED to care for these patients.