Hospitals in Nurse Crisis; Dire Shortage Putting Many Patients in Peril [2004-05-09]

Susan Edelman [New York Post]


BURNED: photo [Loric Stothart seated in law office of his attorney Peter DeFilippis] shows off injuries he claims he received as a result of botched care from a harried and undermanned nursing staff. “The nurse is swamped trying to just keep up – and keep the patients alive for her tour,” said Lorna Samuels, a veteran registered nurse and chairwoman of the nurse-practice committee at Metropolitan Hospital in Manhattan.

Picture a 38-bed unit, if you will. This is a night in the life of a nurse. I walk on the unit at 6:45 p.m. for a 12-hour night shift to be the fourth nurse for 38 patients. I walk in to see the call bells lit up like a Christmas tree. Now, if you are a hopelessly compassionate nurse, like myself, you answer them.

For 20 minutes, heart patient Loric Stothart frantically pressed the nurse’s call button as a burning sting in his right foot intensified into what felt like a fire.

When a nurse at the Montefiore Medical Center in The Bronx finally arrived and tried to remove the electric heating boot wrapped around Stothart’s foot to aid circulation, his melted skin peeled off with his post-operative stocking.

The 70-year old grandfather nearly lost his burned foot. After skin grafts and a vein transplant, he now walks with a cane.

At SUNY Downstate Hospital Medical Center in Brooklyn, Gloria Thomas said her heart-patient husband was tied down last May by a nurse, who explained, “I didn’t have any help.” He later died of blood clots.

At NYU Medical Center in Midtown, Nicholle Ratto emerged from a three-month, $280,000 stay last summer with her derriere scarred with bumpy bedsores after repeatedly being left on urine-filled bedpans.

“I would press the nurse’s button every 15 minutes, and scream, ‘Please, somebody help me,’ ” the 37-year-old said. “It was like an insane asylum in there.”

At New York Presbyterian Hospital, a heart-surgery patient had his urethra ruptured when a “traveling” nurse – hired to plug a staffing gap – hurriedly jammed a catheter into him, rather than calling a urologist, he complained.

At hospitals across New York, patients are getting hurt at the hands of overworked, understaffed nursing teams, caught in the grip of a steadily worsening nursing shortage.

The New York State Nurses Association, which represents close to 7,000 nurses working for the city’s Health and Hospital Corporation, says the system of 11 hospitals and other clinics is currently short about 800 nurses – an 11.4 percent shortage.

Private hospitals are hurting, too.

The Greater New York Hospital Association, a trade group, reported last month that the vacancy rate at hospitals responding to its survey is 7.8 percent for registered nurses and 14.1 percent for licensed practice nurses. The RN vacancy rate in Manhattan is 10.1 percent – double the rate in 2001.

Many city hospitals today run units with nurse-patient ratios of 1 to 15 or higher – up from a “much safer” 1 to 8 more than a decade ago, said Donna Demarest, dean of the College of New Rochelle School of Nursing.

“If somebody I loved had to be admitted to a hospital, I would try very hard not to leave their side – because it’s unsafe,” she said.

Gloria Thomas of Brooklyn was disturbed last May when she found her husband Arthur “upset and nervous” after heart surgery at SUNY Downstate. He grabbed her hand and asked her not to leave, she said. When she asked why, he jotted a note: “They tied me down.”

When staff could find no doctor’s order authorizing restraints, Thomas said, she tracked down one of the nurses, who she said admitted defiantly, “Yes, I tied him down. I tied the left arm because there was no one to help me. Everyone was busy.”

Thomas’ lawyer, Alan Fuchsberg, said the nurse might have resorted to restraints to prevent the patient from yanking out a catheter, IV line or medication tube while performing a procedure.

Hospital spokesman Ron Najman said he was looking into the complaint. Thomas is suing the hospital for alleged malpractice in her husband’s death.

“The nurse is swamped trying to just keep up – and keep the patients alive for her tour,” said Lorna Samuels, a veteran registered nurse and chairwoman of the nurse-practice committee at Metropolitan Hospital in Manhattan.

The Greater New York Hospital Association survey found the most vacancies on night shifts.

Ratto, who had emergency colon surgery at NYU Medical Center last summer, told The Post, “I would dread nights. That was when the nurses wouldn’t come or do anything for me.”

When she pressed the nurse’s call button, she said, the light was either ignored or a nurse would answer and say help was on the way. But Ratto, a magazine publisher, had to call again and again before a nurse came, she said.

She said she waited up to two hours for pain medication. Her backside is scarred from blistery bedsores caused by sitting in urine.

Her husband, Matthew, learned where the supplies were kept, changed his wife’s dirty sheets, and stood at the nurse’s station until she got her medication.

“I became her nurse,” he said.

The GNYHA survey found hospitals plugging nursing holes with costly Band-Aid solutions – skyrocketing overtime, and increased use of temporary or “traveling” nurses lured by expense-paid stints in the Big Apple.

Demarest said heavy use of traveling nurses, supplied by agencies, “impacts very negatively on the quality of care . . . They are not vested in the hospital or the community. They just come for a while, and then move on.”

This was the frustrating experience of the heart patient at New York Presbyterian Hospital, who has filed a legal suit claiming a traveling nurse botched a procedure in which a catheter was to be inserted to help him urinate.

Insisting on doing it herself rather than calling a urologist, the nurse “proceeded to jam and force” the device into the patient, causing bleeding when it ruptured his urethra.

But when the patient tried to sue the nurse, identified as Susan Smith, the hospital told his lawyer, “She doesn’t work here,” and refused to give any information about her.

A Supreme Court judge later ordered the hospital to reveal the name of the company that supplied her, American Mobile Healthcare, based in San Diego.

Myrna Manners, a spokeswoman for New York Presbyterian, said, “We don’t let anyone touch our patients until we are satisfied they have met our criteria with regard to experience, training, qualifications and licensure.”

Experts blame a vicious cycle of harried working conditions driving nurses out of the profession for exacerbating the shortage.

“We don’t have a shortage of nurses – we have a shortage of attractive jobs,” said Mary Mundinger, dean of Columbia University School of Nursing.

Surveys show about 65,000 licensed New York nurses do not work in nursing, and the average age of nurses has increased to 48 – meaning younger nurses are abandoning the calling, Mounding said.

Neither the state Health Department, which oversees hospitals, nor the state Education Department, which oversees nurses, could provide data to The Post detailing the city’s nursing shortage.

One nurse’s tale

The following account of a recent night shift at a Staten Island hospital was written by a nurse in her mid-20s with just two years’ experience. The Post is withholding her name and the hospital’s name to protect her identity.

Picture a 38-bed unit, if you will. This is a night in the life of a nurse. I walk on the unit at 6:45 p.m. for a 12-hour night shift to be the fourth nurse for 38 patients. I walk in to see the call bells lit up like a Christmas tree. Now, if you are a hopelessly compassionate nurse, like myself, you answer them.

Before I can take a report, I have already spoken to two family members who have been waiting to speak to a doctor since 4 p.m. I look at my watch, 7:40 p.m. – “How can this be?” I think to myself.

I shake my head and vow to see what I can do. Then I tend two patients who need bedpans.

“Where are the nurse’s aides?” you ask. There were two aides staffed for the shift, but one of them has been pulled off to another unit, and the other is on her dinner break.

Quickly, I tend to one patient and rush to the other. The second patient, however, is in need of more time and several more towels.

When journeying to the linen cart, I am outraged to see that, once again, we are out of towels.

Other staff members inform me, to my disbelief, that the washing machine is broken and we are to use the linen sparingly. Again, I shake my head and improvise with a fitted sheet.

Back to the night at hand. I finally sit down with the day nurse to take reports on my 12 patients – two are on ventilators and two are on chest tubes, while six of them are on tube feedings. Only two patients can walk without assistance.

Eight are diabetics needing fingersticks, and seven dressing changes are needed.

I get a hold of myself and get to work.

Now, I must mix all of my own medications and do so quickly. Our pharmacy closes at 11 p.m., and then it’s every nurse for herself. I rush through all my meds – stopping for occasional bedpan calls, linen changes, garbage dumping and admission.

Unfortunately, many patients are neglected, waiting too long for the bedpan, resulting in soiled linen – which, as I mentioned before, is on a strictly “need to use” supply.

Doctors are overworked, which means you never see them. Nurses are forced to make life-or-death decisions several times a night in fear that the doctor may not get there in time. We are forced to become the “MacGyvers” of nursing.

By “MacGyvers,” I mean that we make do with what we have. We were the pioneers of the blackout of 2003. We have incubated patients by flashlight. We have bathed patients in bottled water. We have shredded pillowcases to make towels. And we have journeyed to the four corners of the hospital to find medications. We have done it all for the welfare of our patients.

Back to the night at hand. All of their setbacks and inexcusable conditions might be made bearable except for what happens next: It is 11 p.m. – shift change for some, crunch time for others.

The phone rings. One RN must be pulled to staff another unit. Everything comes to a screeching halt. We all plead our cases and someone has to go.

Thankfully, it’s not me. I had been pulled the night before. Now I must pick up two more patients, making the magic number 14.

The night goes on. Doctors are paged. Some answer and some don’t. I do what I can with my own two hands. It never feels like enough. I must do the best I can for my patients. I take most of my orders over the phone, the doctors trusting me.

Thank God most of us are competent nurses. We are constantly pushed, tested, challenged and undermined, and we are tired and drained. How much can one person do?

It is sad, as a nurse, when I have to turn my shoulder away from a crying patient to tend to something like cleaning urine off the floor because there is only one housekeeper in the hospital on duty.

It is heart-wrenching when I have to tell patients they must wait for anticipated bloodwork results, because there is no lab technician on staff that night.

How embarrassing to explain to a patient that I am transporting them from the ER to the floor because there is no transporter.

So the night goes on. You laugh, you cry, you yell and you get frustrated but you make it through another night. The morning is here – the phone rings. One nurse and one aide call in sick. Another nurse must be mandated to work overtime to staff the day shift. More cases are pleaded; I have to stay. That will make a 16-hour shift! Hey, it happens every other day, what can you do?

Well, someone has to do something. No “hospital” should be allowed to exist in these conditions. It is a threat to the quality of patient care. Doctors, nurses, aides, technicians, housekeepers and janitors are all understaffed and overworked. This takes its toll on all aspects of a patient’s stay.

Thankfully, there are the few and the bold who have managed to take on this mess. We will not abandon our patients. Every day we stay in spite of the lack of staff, supplies and respect. We pray every day that it won’t get worse. How bad can it get before something is done? Then the phone rings again. It’s radiology. They inform you that your patient who has just fallen must wait for her CT scan of the head because the one machine is broken. I shake my head again. Hey, it happens every day, what can you do?

– UNDER SIEGE: NURSES ARE ‘SWAMPED’: Lorna Samuels says nurses are swamped from the moment they start. (Linda Obuchoska) – PATIENT IN PAIN: HOURS ON BED PAN: [Nicholle Ratto], with husband [Matthew] and daughter Riley, says it was “like an asylum” in the understaffed hospital she is suing. (Michael Sofronski) – BURNING ANGER:LEGS WERE BURNED: [Loric Stothart] shows off injuries he claims he received as a result of botched care from a harried and undermanned nursing staff. (Michael Sofronski) – ONE NURSE’S TALE: Too much work and not enough hospital staff have this Staten Island nurse wondering when something is going to be done. (NY Post: [Susan Smith] May Tell)

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