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March 30, 2003
Dear Nurse Nancy,
I have worked in a critical care unit for many years,
and have thought about transferring to the Emergency
Department. I keep reading about Violence in the Workplace,
and have some concern about my personal safety. I don't
live in an urban city area, but I am still worried.
Is it safe to work in the ED?
MB
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Dear MB,
Well certainly there is a lot in the press about violence
in the workplace, and certainly this involves nurses.
I think of those professors in Arizona who were murdered
by a disgruntled student in the classroom - who would
think a classroom would be the sight of a murder?
The National Institute for Occupational Safety and Health
(NIOSH) defines workplace violence as any physical assault,
threatening behavior, or verbal abuse occurring in the
work setting. Certainly ED nurses are on the front line
for all kinds of workplace violence, caring for people
with both mental and physical illnesses, as well as
social problems and behavioral issues.
The Emergency Nurses Association (ENA) has an excellent
position statement on this topic, which they wrote in
1991, and has been updated over the years. They have
some great practical advice for safety of all personnel
who work in the Emergency Department. The link to get
there is:
http://www.ena.org/about/position/violence.asp
I would recommend you go and speak to some ED nurses
in your area, and see what their experience has been.
Ask what education on personal safety and defusing a
difficult situation with a patient (or another staff
member, for that matter) would be given to you prior
to transfer. I think you need that information prior
to transfer.
I wish you the best.
Sincerely,
Nurse Nancy
March 26, 2003
Dear Nurse Nancy,
I have worked on a medical surgical unit for five
years, and I feel like this is a specialty. How come
there is no organization for nurses who choose not to
specialize, like in the ICU or OR? Don't you think we
deserve our own organization?
SS
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Dear SS,
Yes, I agree that Medical Surgical nurses have a specialty.
You are generalists, and are knowledgeable about so
many things! And, I think as nurses we have not always
valued our medsurg colleagues….for some reason,
the higher tech kind of specialties have more attention.
You will be happy to know, though, that there is an
organization for Med Surg nurses, the Academy of Medical
Surgical Nurses who represents nurses practicing in
adult health/medical surgical nursing. I encourage you
to take a look at their web site - www.medsurgnurse.org
They have a newsletter, a journal, annual convention
- all the things that the other specialty nurses groups
have.
Thanks for the question.
Nurse Nancy
March 25, 2003
Dear
Nurse Nancy,
I was in a staff meeting the other day, and my nurse
manager is encouraging us to fill out an occurrence
record if we make a medication error, and promised it
won’t be used against us. I am not sure about
this – can’t they use that kind of information
to get rid of us? Sometimes errors don’t hurt
the patient – so why report them?
–—SY
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Dear SY,
Your nurse manager is correct; we all need to report
medication errors. There are a few reasons for this.
First of all, it is part of quality improvement to track
errors – if everyone is having the same problem,
there must be something in the system that needs to
be changed. An extreme example of this is potassium
chloride. Errors were being made when we had the small
bottles on the units, and some of these errors were
fatal. In the spirit of patient safety, you no longer
can find a multiple dose vial or bottle of KCl on a
hospital unit. Only the pharmacy can dispense KCl, and
that limits the possibility of reaching for a bottle
of saline or sterile water, and getting KCl instead.
If it is not on the unit, it can’t happen.
Another reason is that regulatory agencies (like JCAHO)
expect us to report our medication errors and adverse
drug reactions. This is not just for nurses; physicians,
nurse practitioners and pharmacists can also make an
error and report this. The whole point of this is to
improve practice.
Sincerely,
Nurse Nancy |
