Health care as an industry is changing in Canada and the US. Budget concerns seem paramount and are apparently the stimulus for these changes. It must be remembered though that fiscal responsibility should not compromise patient care. Already in my nursing practice, I see incidents that lead to unsafe situations for patients and staff. Professional responsibility forms are being filled out at an alarming rate as staff try to stop the tide of unsafe health care sweeping Canada.
This past weekend, the CEO of Alberta Health Services was quoted as saying that just because a unit had a registered nurse running it in the 1990s does not mean it needs to be run by one now. He states that things must change not stay the same. Dr. Duckett could not be more wrong! I shudder to think of the professional liability of health care workers who make mistakes because they are not trained to see the entire medical picture. And let’s not forget the human price of those mistakes—the patient, the family and the staff all pay a high emotional and psychological price for a negative impact on a poorly managed case.
A registered nurse has always been in charge of a hospital unit. Not because of her special status in the hierarchy but because of her experience, skills and education. To have the head of Alberta Health Services not comprehend (or appreciate) the importance of this role is shocking. It also means that negligence and malpractice is about to become a common theme in Alberta trial law.
I wonder if Dr. Duckett has budgeted for increased insurance , settlements and claims?
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Monday, August 17, 2009
Wednesday, August 12, 2009
Can there be a budget during a pandemic?
It is well established that we are about to face a flu season that will take a heavy toll on health care workers as well as the general public. Meetings are held to provide information and plans on how to cope, but there are also phrases like “we still have stay within budget” from administration. This sets a dangerous environment where the cost of caring for the ill and dying takes precedent over the actual care needed. Can there be a budget during a pandemic? Bureaucrats and politicians think so. Front line health care providers do not. Managers are pressured to keep their budgets under control under all circumstances.
As a nurse, I have to question just how safe patient care will be during this crisis. Increased staff shortages will be a certainty with health care workers ill themselves or caring for family members. Paying overtime for replacement staff is already discouraged so how do units replace badly needed staff to care for the ill in the hospitals? There will be a lack of equipment as unit budgets are stretched to pay for supplies. There are already reports of defective protective equipment from poor quality sources and from being stored under the wrong conditions.
The fallout from the H1N1 pandemic will resound for years. No doubt it will also find its way into lawyers’ offices and court rooms. Perhaps there the question of how much a pandemic will cost will be answered.
As a nurse, I have to question just how safe patient care will be during this crisis. Increased staff shortages will be a certainty with health care workers ill themselves or caring for family members. Paying overtime for replacement staff is already discouraged so how do units replace badly needed staff to care for the ill in the hospitals? There will be a lack of equipment as unit budgets are stretched to pay for supplies. There are already reports of defective protective equipment from poor quality sources and from being stored under the wrong conditions.
The fallout from the H1N1 pandemic will resound for years. No doubt it will also find its way into lawyers’ offices and court rooms. Perhaps there the question of how much a pandemic will cost will be answered.
Thursday, July 2, 2009
Specialized training program too expensive?
In the North American world of obstetrics, there is a specialized program that is considered a “gold standard” of maternity care. It provides information and training sessions for the care of women during pregnancy and delivery. It is a valuable tool for teaching health care providers of all levels from obstetricians, family physicians, registered nurses, and midwives on the multitude of skills necessary for the modern practice of obstetrics. Lawyers who work on maternity cases will often ask if this program was in place to train the staff to an expected standard of care.
However, in the current environment of budget reviews and the “business” of health care that is an emerging trend in Canada, this program is about to disappear. Deemed “too expensive” by administrators, the program is expected to be gone by the end of 2009.
It takes at least two years of full-time work for a nurse new to the area to begin to feel comfortable with anything that can be thrown at her during labour and delivery. We don’t have that kind of time anymore and the training program helped fill that need of skill building because we are losing experienced care providers to retirement. They will not be there to provide the support and hands on training for a bevy of young nurses just starting to get their skills established in this very specialized area which relies very heavily on the expertise of the RN to identify and apply interventions necessary for the well-being of the mom and her baby.
Too expensive to train health care providers? How much are the two lives of mom and babe worth? How much value is there in traumatized staff who only wanted to provide the best care?
However, in the current environment of budget reviews and the “business” of health care that is an emerging trend in Canada, this program is about to disappear. Deemed “too expensive” by administrators, the program is expected to be gone by the end of 2009.
It takes at least two years of full-time work for a nurse new to the area to begin to feel comfortable with anything that can be thrown at her during labour and delivery. We don’t have that kind of time anymore and the training program helped fill that need of skill building because we are losing experienced care providers to retirement. They will not be there to provide the support and hands on training for a bevy of young nurses just starting to get their skills established in this very specialized area which relies very heavily on the expertise of the RN to identify and apply interventions necessary for the well-being of the mom and her baby.
Too expensive to train health care providers? How much are the two lives of mom and babe worth? How much value is there in traumatized staff who only wanted to provide the best care?
Wednesday, July 1, 2009
Can H1N1 be contained in hospitals?
The last few months have seen the outbreak of the H1N1 virus. It has been appearing all over the world and varies from mild to severe, sometimes resulting in death.
People present to the hospital for various reasons. Some are staff. Some are visitors. Some are injured. Some are booked surgeries and diagnostic tests. Some are very ill. When word of an outbreak occurs, everyone assumes that doctors, nurses and other hospital staff will take every precaution to protect themselves and others so that the infection cannot be spread within the hospital itself.
But is this true?
Sadly, it is not. The worst culprits are often doctors. Doctors who make dangerous assumptions. They discount the need for isolation precaution procedures already in place. They ignore nurses who tell them of the risk and precautions necessary before, during and after patient contact. They don't wash or sanitize their hands before and after seeing a patient. They contaminate the charts and the desk area where others work.
Often it is only after they receive as positive lab result (sometimes days later) that they acknowledge what they have done... and only to themselves.
Patients who develop complications after a hospital visit-- no matter what they were doing there-- need to have a thorough examination of the timeline. There is a very good chance it is a case of "white coat" contamination. Questions that need answers include: were isolation procedures implemented, reinforced and carried out at all times? Was any caregiver diagnosed with the same illness or treated with anti-flu drugs due to an unprotected exposure? Detective work by someone who knows how a hospital works behind the scenes can provide the answers.
People present to the hospital for various reasons. Some are staff. Some are visitors. Some are injured. Some are booked surgeries and diagnostic tests. Some are very ill. When word of an outbreak occurs, everyone assumes that doctors, nurses and other hospital staff will take every precaution to protect themselves and others so that the infection cannot be spread within the hospital itself.
But is this true?
Sadly, it is not. The worst culprits are often doctors. Doctors who make dangerous assumptions. They discount the need for isolation precaution procedures already in place. They ignore nurses who tell them of the risk and precautions necessary before, during and after patient contact. They don't wash or sanitize their hands before and after seeing a patient. They contaminate the charts and the desk area where others work.
Often it is only after they receive as positive lab result (sometimes days later) that they acknowledge what they have done... and only to themselves.
Patients who develop complications after a hospital visit-- no matter what they were doing there-- need to have a thorough examination of the timeline. There is a very good chance it is a case of "white coat" contamination. Questions that need answers include: were isolation procedures implemented, reinforced and carried out at all times? Was any caregiver diagnosed with the same illness or treated with anti-flu drugs due to an unprotected exposure? Detective work by someone who knows how a hospital works behind the scenes can provide the answers.
Friday, June 5, 2009
Economy and healthcare changes bring business to lawyers
This week saw glimmers of recovery in the Canadian economy. Mortgage rates, always tied to the bond market, have started to rise and this is a sign that the slump is beginning to come to an end.
However, the healthcare industry is not going to follow that trend. Layoffs and budget cuts have begun in major hospitals at a time of increasing patient loads. Nursing shortages that were the focus of news articles as recently as two weeks ago are suddenly announced "over" by politicians seeking to justify radical changes to the voting public. Clinical educators are slated for layoffs as well which directly impacts the continuing education for nurses and other professionals.
This has been good news for nursing and other health professional recruitment firms from other countries; they have begun actively seeking to recruit our experienced, well-educated registered nurses and they are succeeding. Offers are for positions with great wages and benefits in prime locations.
How does all this bring business to lawyers?
Patient care is coming under direct duress in the current work environment and this leads to mistakes.
Management is being shifted so that managers are in charge of units in which they have no clinical experience. Management of units is being consolidated under the supervision of one manager.
Education and training programs are being cut so staff will not maintain their skill levels at current standards. New staff, already coming in without the background of a registered nurse, will not receive a consistent orientation program so their care may not reflect policies and procedures.
Hiring freezes mean no replacements for maternity leaves of up to one year, no replacements for the retiring nurses, no replacements for nurses injured on the job and no coverage for absent staff. Nurses already have the highest absentee rate in Canada and this will only increase as staff become more overworked and stressed.
Less staff on the floor means current standard nurse-patient ratios will come under pressure to change. Areas where levels of care now dictate 1:1 nursing for the optimum patient outcome may see nurses caring for 2 or 3 patients and important information on the patient's condition will be missed or delayed in being seen resulting in compromised outcomes. Even layoffs in the clerical sector impacts patient care when nobody is at the desk to answer calls from the rooms while the nurses are busy with patient care in other areas of the unit.
There are implications for the mental health of all hospital staff during this period. Rumours and awareness of the impact of these changes have created an environment of high stress, lack of concentration and decreasing commitment to an employer who cuts jobs. Stressed hospital staff simply cannot perform at optimum levels.
Legal nurse consultants have the experience of hospital nursing to know the implications for patients and families during times of high stress and staff cutbacks. They can tell the legal team what to look for to see if the employer is at fault for the care that was or was not received during a hospital stay. Legal nurse consultants can pick up the subtle wording of other nurses that provides clues about the unit activity that affected your client. They can also give advice on questions for interviews that will demonstrate the environment during the event and its impact on your client.
Legal cases involving hospitals in Canada will see an increase as acuity, activity and populations rise while staff and budget levels decrease. Are you ready with your full legal team that will best represent your client?
However, the healthcare industry is not going to follow that trend. Layoffs and budget cuts have begun in major hospitals at a time of increasing patient loads. Nursing shortages that were the focus of news articles as recently as two weeks ago are suddenly announced "over" by politicians seeking to justify radical changes to the voting public. Clinical educators are slated for layoffs as well which directly impacts the continuing education for nurses and other professionals.
This has been good news for nursing and other health professional recruitment firms from other countries; they have begun actively seeking to recruit our experienced, well-educated registered nurses and they are succeeding. Offers are for positions with great wages and benefits in prime locations.
How does all this bring business to lawyers?
Patient care is coming under direct duress in the current work environment and this leads to mistakes.
Management is being shifted so that managers are in charge of units in which they have no clinical experience. Management of units is being consolidated under the supervision of one manager.
Education and training programs are being cut so staff will not maintain their skill levels at current standards. New staff, already coming in without the background of a registered nurse, will not receive a consistent orientation program so their care may not reflect policies and procedures.
Hiring freezes mean no replacements for maternity leaves of up to one year, no replacements for the retiring nurses, no replacements for nurses injured on the job and no coverage for absent staff. Nurses already have the highest absentee rate in Canada and this will only increase as staff become more overworked and stressed.
Less staff on the floor means current standard nurse-patient ratios will come under pressure to change. Areas where levels of care now dictate 1:1 nursing for the optimum patient outcome may see nurses caring for 2 or 3 patients and important information on the patient's condition will be missed or delayed in being seen resulting in compromised outcomes. Even layoffs in the clerical sector impacts patient care when nobody is at the desk to answer calls from the rooms while the nurses are busy with patient care in other areas of the unit.
There are implications for the mental health of all hospital staff during this period. Rumours and awareness of the impact of these changes have created an environment of high stress, lack of concentration and decreasing commitment to an employer who cuts jobs. Stressed hospital staff simply cannot perform at optimum levels.
Legal nurse consultants have the experience of hospital nursing to know the implications for patients and families during times of high stress and staff cutbacks. They can tell the legal team what to look for to see if the employer is at fault for the care that was or was not received during a hospital stay. Legal nurse consultants can pick up the subtle wording of other nurses that provides clues about the unit activity that affected your client. They can also give advice on questions for interviews that will demonstrate the environment during the event and its impact on your client.
Legal cases involving hospitals in Canada will see an increase as acuity, activity and populations rise while staff and budget levels decrease. Are you ready with your full legal team that will best represent your client?
Saturday, May 30, 2009
What happens when entire health care portfolios are gone?
Recent administrative changes to Alberta Health Services are bringing changes to the organization. Within the Calgary area, for example, Women’s Health Services no longer exist. And the word is that this may be slated to happen province-wide.
The immediate effects are seen in the absence of top level management positions to advocate for health care services geared toward women’s health care. At a time of record numbers of maternity cases, maternity units in dire need of renovation and updating and increasing demand for gynecology services, there is no leadership with a specific interest in this specialty. There has also been a hiring freeze placed on nursing staff and support staff in these areas despite clear indications that there are understaffing issues and pending retirements.
What does this mean for medical liability attorneys? It means there are going to be cases emerging as a direct result of insufficient resources to provide the standard of care expected in Canadian hospitals. The staff will not available to maintain the current standard of nurse-patient ratios. Less qualified and experienced staff will be hired as a cost-cutting bridging measure which puts patients at risk. The equipment necessary to monitor patients for their safety and best outcome will either not be available or will be outdated and not meet current standards. The physical environment of the hospital patient will deteriorate—even to the point of being dangerous from an infectious disease standpoint with such things as cracks in the floors under delivery beds and beds unable to be cleaned to acceptable standards because they are need of replacement after years of use and breakdowns.
Nurses are aware of the shortfalls of working within a hospital environment during times of economic downturns while patient populations and acuity rise. Having that experience and perspective will assist you in evaluating and building your next case involving women’s health gone wrong.
The immediate effects are seen in the absence of top level management positions to advocate for health care services geared toward women’s health care. At a time of record numbers of maternity cases, maternity units in dire need of renovation and updating and increasing demand for gynecology services, there is no leadership with a specific interest in this specialty. There has also been a hiring freeze placed on nursing staff and support staff in these areas despite clear indications that there are understaffing issues and pending retirements.
What does this mean for medical liability attorneys? It means there are going to be cases emerging as a direct result of insufficient resources to provide the standard of care expected in Canadian hospitals. The staff will not available to maintain the current standard of nurse-patient ratios. Less qualified and experienced staff will be hired as a cost-cutting bridging measure which puts patients at risk. The equipment necessary to monitor patients for their safety and best outcome will either not be available or will be outdated and not meet current standards. The physical environment of the hospital patient will deteriorate—even to the point of being dangerous from an infectious disease standpoint with such things as cracks in the floors under delivery beds and beds unable to be cleaned to acceptable standards because they are need of replacement after years of use and breakdowns.
Nurses are aware of the shortfalls of working within a hospital environment during times of economic downturns while patient populations and acuity rise. Having that experience and perspective will assist you in evaluating and building your next case involving women’s health gone wrong.
Tuesday, May 26, 2009
What role could a nurse have in a law firm?
Canadian nurses have discovered a new area of specialty-- legal nurse consulting. It can be the best of both worlds for an experienced RN. She can use her established knowledge and skills in a whole new way. She can explore employment options outside of shiftwork. She can remain an important member of a professional team that can make a difference.
Here is how a nurse works within the team:
*Strategizes with the legal professional for successful resolutions between parties involved in health care-related litigation or other medical-legal or health care-legal matters;
*Educate attorneys and/or others involved in the legal process regarding the healthcare facts and issues of a case or claim;
*Research and integrate healthcare and nursing literature as it relates to the healthcare facts and issues of a case or a claim:
*Review, summarize, and analyze medical records and other pertinent healthcare and legal documents and comparing and correlating them to the allegations;
*Assess issues of damages and causation relative to liability within the legal process;
*Identify, locate, evaluate, and confer with expert witnesses;
*Interview witnesses and parties pertinent to the healthcare issues in collaboration with legal professionals;
*Draft legal documents in medically related cases under the supervision of an attorney;
*Develop collaborative case strategies with those practicing within the legal system;
*Provide support during discovery, depositions, trial, and other legal proceedings;
*Support the process of adjudication of legal claims.
Source: AALNC
Here is how a nurse works within the team:
*Strategizes with the legal professional for successful resolutions between parties involved in health care-related litigation or other medical-legal or health care-legal matters;
*Educate attorneys and/or others involved in the legal process regarding the healthcare facts and issues of a case or claim;
*Research and integrate healthcare and nursing literature as it relates to the healthcare facts and issues of a case or a claim:
*Review, summarize, and analyze medical records and other pertinent healthcare and legal documents and comparing and correlating them to the allegations;
*Assess issues of damages and causation relative to liability within the legal process;
*Identify, locate, evaluate, and confer with expert witnesses;
*Interview witnesses and parties pertinent to the healthcare issues in collaboration with legal professionals;
*Draft legal documents in medically related cases under the supervision of an attorney;
*Develop collaborative case strategies with those practicing within the legal system;
*Provide support during discovery, depositions, trial, and other legal proceedings;
*Support the process of adjudication of legal claims.
Source: AALNC
Tuesday, May 12, 2009
Nursing shortage is important to lawyers
A report issued by the Canadian Nurses Association shows that the shortage of registered nurses is expected to grow to 60 000 by 2022. The current absentee rate for RNs is twice as high as any other profession with an average of 14 days per year. Workload, short-staffed units, lack of basic equipment and large numbers of less qualified and less experienced staff are taking a huge toll on the skilled work force in Canadian hospitals.
"It gets to a point where you have nurses so tired that when one of their colleagues calls in sick, they just say: 'Give me a warm body' - regardless if he or she has the education." Personal care workers are heavily relied on in some regions. "We need (them), don't get me wrong," Linda Silas, President of the Canadian Federation of Nurses Unions said. "But for patient safety and quality care, you need the nurses around and we shouldn't jeopardize this because of the shortage."
There is also a noticeable shortage of doctors, pharmacists, and physiotherapists.
Why should this matter to a lawyer? Because when your client comes to you with their story of what happened to them in the healthcare system, you need to be aware of the dynamics of the environment in which the event(s) took place. What were the staffing levels at that moment? What were the qualifications and experience of the direct care givers as well as their supervisors? Was the care being given by a worker outside of their scope of practice? Was fatigue or illness a factor in the level of care being provided at that moment?
Legal nurse consultants are registered nurses who have hands-on experience with the healthcare environment. They know first hand how the level of care is affected by the dynamics of the unit and the people in it. Let their expertise and insight bring to light nuances of the case that could so easily be missed.
"It gets to a point where you have nurses so tired that when one of their colleagues calls in sick, they just say: 'Give me a warm body' - regardless if he or she has the education." Personal care workers are heavily relied on in some regions. "We need (them), don't get me wrong," Linda Silas, President of the Canadian Federation of Nurses Unions said. "But for patient safety and quality care, you need the nurses around and we shouldn't jeopardize this because of the shortage."
There is also a noticeable shortage of doctors, pharmacists, and physiotherapists.
Why should this matter to a lawyer? Because when your client comes to you with their story of what happened to them in the healthcare system, you need to be aware of the dynamics of the environment in which the event(s) took place. What were the staffing levels at that moment? What were the qualifications and experience of the direct care givers as well as their supervisors? Was the care being given by a worker outside of their scope of practice? Was fatigue or illness a factor in the level of care being provided at that moment?
Legal nurse consultants are registered nurses who have hands-on experience with the healthcare environment. They know first hand how the level of care is affected by the dynamics of the unit and the people in it. Let their expertise and insight bring to light nuances of the case that could so easily be missed.
Wednesday, May 6, 2009
What is a legal nurse consultant?
The legal nurse consultant is a licensed registered nurse who performs a critical
analysis of healthcare facts and issues and their outcomes for the legal profession,
healthcare profession, and others, as appropriate. With a strong educational and
experiential background, the legal nurse consultant is qualified to assess adherence to standards of healthcare practice as it applies to the nursing and healthcare professions.
There is a diversity of practice settings and services performed by legal nurse
consultants nationwide.
The legal nurse consultant practices the art and science of this nursing
specialty in a variety of settings, including law firms, government offices, insurance
companies, hospital risk management departments, and as self-employed practitioners.
The legal nurse consultant is a liaison between the legal and healthcare communities and
provides consultation and education to legal, healthcare, and appropriate other
professionals in areas such as personal injury, product liability, medical malpractice,
workers’ compensation, toxic torts, risk management, medical professional licensure
investigation, and criminal law.
analysis of healthcare facts and issues and their outcomes for the legal profession,
healthcare profession, and others, as appropriate. With a strong educational and
experiential background, the legal nurse consultant is qualified to assess adherence to standards of healthcare practice as it applies to the nursing and healthcare professions.
There is a diversity of practice settings and services performed by legal nurse
consultants nationwide.
The legal nurse consultant practices the art and science of this nursing
specialty in a variety of settings, including law firms, government offices, insurance
companies, hospital risk management departments, and as self-employed practitioners.
The legal nurse consultant is a liaison between the legal and healthcare communities and
provides consultation and education to legal, healthcare, and appropriate other
professionals in areas such as personal injury, product liability, medical malpractice,
workers’ compensation, toxic torts, risk management, medical professional licensure
investigation, and criminal law.
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