Nursing Wounds
When arrogant docs drive nurses away, patients suffer
Yet hospitals often seem reluctant to discipline wayward doctors. "They bring patients to the hospital, and that's a source of revenue," Rosenstein says. "Executives can be reluctant to confront them." Couple this with the stress of today's hospitals, where only the sickest patients requiring the most intensive care are admitted. Add to that mix a large group of older nurses who are retiring and young people who don't want to go into this profession, and you have all the ingredients for a shortage--and a shortfall in patient care.
Hospital administrators are waking up to the dimensions of the crisis. "We decided we have to change our culture," says Al Stubblefield, CEO of Baptist Hospital, a 480-bed facility in Pensacola, Fla. In the mid-1990s, Baptist ranked in the bottom fifth in national surveys of patient satisfation. "We knew we had a problem. There was a lot of finger-pointing." So Baptist started trying some new things. Physicians were told there would be no more abusive behavior. Nurses were given power to change the way their wards operated. One thing that changed was the ER, says Diane Wilbanks, vice president of patient care services. A triage nurse replaced a receptionist, reducing waiting times. Nurses also started voting for an outstanding physician each week, and doctors soon began competing for the designation by spending more time teaching nurses.
"When I first heard about this, I thought, `Yeah, yeah, sure,' " says Wilbanks. "But it's made a big difference." Patient satisfaction ratings shot up. Nurse turnover dropped from 24 percent annually to 14 percent. Rates of patient bedsores, blood and urinary tract infections, and other problems dropped as well.
UC-Davis has also reduced turnover. "We have more say at this hospital," says Smith. Nurses now go on patient rounds with physicians at Davis--a practice that is benefiting the bedridden. For example, nurses have been able to teach traditionbound doctors a new and more effective way to treat bedsores--an innovation that would never have occurred under the old system.
Happier nurses are not, of course, a panacea for all ills. At Davis, for instance, some infection rates have gone up. One possible explanation is that while the hospital staff was learning to get along, the hospital became a referral center for the region, treating much sicker patients sent from other facilities. But even these patients feel they are getting better care. Davis is one of about 50 "magnet" hospitals with high nursing standards identified by the American Nurses Association; research has shown these have better patient outcomes than nonmagnet hospitals. So when doctors and nurses mix it up, it's to share information, and it's the patients who benefit.
Happier nurses, healthier patients
A Case Study
Baptist Hospital in Pensacola, Fla., turned a corner in nursing care two years ago. Nurses were included in medical decisions, and abusive behavior by doctors was prohibited. These policies may not be the only factors, but key patient health indicators improved in short order.
MEDICAL PROBLEM 2000 2001
Medication errors 2.5 pct. 1.6 pct.
Blood infections 3.6 pct. 1.9 pct.
(cardiac patients)
Urinary tract infections 3.1 pct. 1.6 pct.
(cardiac patients)
Bedsores 4.2 pct. 3.8 pct.
Source: Baptist Health Care
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