Текст книги "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital"

Автор книги: Alexandra Robbins

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Текущая страница: 31 (всего у книги 33 страниц)

Burnout can lead to . . . heavy-heartedness. See, for example, Meredith Mealer et al.

“Compassion fatigue does not” Debra Wood, “The Personal Cost of Caring Can Be High,” Oncology Nursing News, October 6, 2009.

“are associated with a sense . . .” D. Boyle.

“Doctors are demanding . . .” Interview. Experts say that if a nurse doesn’t treat compassion fatigue early, the condition can permanently affect the way she/he cares for patients (see D. Boyle). Yet compassion fatigue, arguably a major occupational health and safety hazard, is still relatively little known among healthcare providers.

social workers, counselors . . . See, for example, Caitlin Crawshaw, “Caring Workers Pay the Price; Mind and Body Compassion Fatigue Flies Under the Radar,” The Telegraph-Journal (New Brunswick), June 20, 2009.

“They often enter the lives . . .” D. Boyle.

Simpson calculated that . . . D. Wood, “The Personal Cost . . .”

some types of personalities . . . See, for example, G. C. Keide, “Burnout and Compassion Fatigue Among Hospice Caregivers,” American Journal of Hospice and Palliative Care (May–June 2002).

Also note, according to a 2014 study, nurses who are motivated primarily to help other people may be the most likely to burn out. Jeanette Dill, Rebecca Erickson, and Jim Diefendorff, “Motivation and Care Dimensions in Caring Labor: Implications for Nurses’ Well-Being and Employment Outcomes,” unpublished paper in progress, provided to the author in August 2014.

already highly empathizing people Author correspondence with Oakland University School of Nursing professor Barbara Penprase regarding a study in progress.

“We are programmed to . . .” Interview.

demands of managed care . . . Nadine Najjar et al, “A Review of the Research to Date and Relevance to Cancer-Care Providers,” Journal of Health Psychology (March 2009).

eight to ten percent . . . terminally ill patients. See Meredith Mealer et al. “The Prevalence and Impact . . .”

Other events that could lead . . . Meredith Mealer et al., “Prevalence of Post-traumatic Stress Disorder Symptoms in Critical Care Nurses,” American Journal of Respiratory and Critical Care Medicine, 175, no. 7 (2007).

similar to female Vietnam veterans. Interestingly, the ICU nurses most likely to exhibit these symptoms were night-shift nurses who were not the charge nurse. See Meredith Mealer et al., “Prevalence of Post-traumatic Stress . . .”

Twenty-four to 29 percent . . . general nurses. Ibid.

Outpatient nurses Meredith Mealer et al., “The Prevalence and Impact . . .”

“intense fear, helplessness” See Darlene Welsh, “Predictors of Depressive Symptoms in Female Medical-Surgical Hospital Nurses,” Issues in Mental Health Nursing 30 (2009).

“Often, I feel it’s an impossible job” Interview.

In 2010, Kimberly Hiatt . . . 140-milligram dose. JoNel Aleccia, “Nurse’s Suicide Highlights Twin Tragedies of Medical Errors,” msnbc.com, June 27, 2011.

A ten-fold overdose . . . not necessarily be fatal. Interview with a neonatologist at another hospital.

hospital personnel escorted Hiatt See, for example, JoNel Aleccia. “Nurse’s Suicide Highlights . . .”

(who had heart problems) See, for example, Theresa Brown, “High Price of Mistakes Sits Heavily on Nurses,” The New York Times, The Virginian-Pilot Edition, July 17, 2011.

Hiatt, who told staff . . . careful in the future.” Ibid.

Hiatt was stunned . . . her entire career. JoNel Aleccia, “Nurse’s Suicide Highlights . . .”

Administrators had given her . . .“leading performer.” Ibid.

The state nursing board required . . . See, for example, “Too Many Abandon the ‘Second Victims’ of Medical Errors,” ISMP Medication Safety Alert, July 14, 2011.

Hiatt had difficulty finding . . . committed suicide. Ibid; Carol M. Ostrom, “Nurse’s Suicide Follows Tragedy,” Seattle Times, April 20, 2011.

Hiatt reportedly suffered . . . often be neglected.” See “Too Many Abandon . . .”

surgeons who thought they made . . . See, for example, JoNel Aleccia, “Nurse’s Suicide Highlights. . . .”

92 percent of doctors surveyed . . .” Ibid.

“If we fire every person . . .” F. Norman Hamilton, “Suicide of Nurse after Tragic Event,” Letters to the Editor, Seattle Times, April 22, 2011.

second victims usually require . . . “time of greatest need.” “Too Many Abandon . . .”

“Of course, we will also . . .” Tom Hansen, “Children’s Hospital CEO Responds to Infant Overdose,” kirotv.com, September 28, 2010.

half of nurse respondents believed . . . Thank you to Judy Huntington, the executive director of the Washington State Nursing Association, for providing the author with survey data.

After terminating Hiatt . . . “Patient Safety Day Strengthens Seattle Children’s Efforts to Improve Medication Safety,” Seattlechildrens.org, October 30, 2010.

In 2003 and 2009 . . . See, for example, “Death Was Third Fatal Medication Error At Children’s,” kirotv.com, September 28, 2010.

“This was not the fault . . .” See, for example, Q13 FOX News Web Reporter, on chicagotribune.com, October 1, 2009.

“If my mom got an insulin . . .” JoNel Aleccia, “Nurse’s Suicide Highlights. . .”

Ohio nurse Beth Jasper CNN Wire, “Lawsuit: Nurse Who Died in Car Wreck was ‘Worked to Death,’” KVDR.com, November 13, 2013.

The case was dismissed . . . Dismissal order, James Jasper vs. Jewish Hospital, Court of Common Pleas, Hamilton County, Ohio, entered April 10, 2014.

In Massachusetts, after a newborn . . . Scott Allen, “The ‘Second Victims’ of Medical Tragedies,” Boston Globe, November 30, 2004.

“have a little cry.” Interview.

even when their hospitals . . . Interviews.

if an average hospital RN salary . . . T. M. Dall, “The Economic Value of Professional Nursing,” Medical Care 47, no. 1 (2009).

staffing for hospitals is not . . . Interview, Peter McMenamin. The author is grateful to McMenamin for spending a significant amount of time explaining the economics of nursing.

A strong nursing staff . . . P. Miller, “Nurses Drive Hospital Revenue Too,” HCPRO, Inc. (March 2009).

nurses could do a better . . . Interviews; also see, for example, B. Lombardo and C. Eyre, “Care for Caregiver to Avoid Low Morale and Burnout,” Hospice Management Advisor, August 1, 2009.

“People will just about kill . . .” Donna Gray, “Care Providers Get Compassion Fatigue: Burnout Common Among Healthcare Professionals,” Calgary Herald (Alberta), February 2, 2006.

nurses take self-care measures . . . their feelings. See, for example, Patrick Meadors, “Compassion Fatigue and Secondary Traumatization: Provider Self Care on Intensive Care Units for Children,” Journal of Pediatric Healthcare (January 2008); “Self-Care of Physicians: Strategies for Care,” Hospice Management Advisor, August 1, 2009; “Female Nurses Reduce Burnout in ICU Teams,” Nursing Times, August 30, 2011.

“permitting ourselves to seek support” Interview.

Some hospitals do have programs . . . Interviews.

Barnes-Jewish Hospital in St. Louis recently . . . staff retreats. Interview, Patricia Potter, director of research for patient-care services. See also Laura Landro, “When Nurses Catch . . .”

with experience . . . prepare themselves accordingly. Interview.

registered nurses younger than thirty . . . the profession’s demands. R. Erickson and W. Grove, “Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses,” Online Journal of Issues in Nursing, October 29, 2007.

“The greatest common risk” Tara Parker-Pope, “A Doctor’s View of Medical Mistakes,” nytimes.com, March 26, 2008.

Burnout and compassion fatigue have been linked . . . See, for example, B. Lombardo and C. Eyre; Nadine Najjar et al.

correlated with higher patient mortality rates . . . See, for example, Lara Landro, “Informed Patient: Helping Nurses Cope . . .”; Patricia Potter et al.; D. Boyle.

prone to make mistakes. See, for example, Brittany Hoover, “Compassion Fatigue May Cripple Health Workers, Expert Says,” Lubbock Avalanche-Journal, March 30, 2012.

fatigue alone can cause . . . ISMP Medication Safety Alert, “Nurse Advise–ERR,” December 2005.

nurse burnout is linked to . . . $69 million a year. Jeannie P. Cimiotti et al., “Nurse Staffing, Burnout, and Healthcare Associated Infection.” American Journal of Infection Control (September 2012).

Michigan Health and Hospital Association implemented . . . See, for example, Tina Rosenberg, “Speaking Up for Patient Safety, and Survival,” The New York Times, Opinionator, April 28, 2011.

for every 10 percent . . . “Study: Nurse Safety, Patient Safety Linked,” United Press International, November 8, 2011.

a national emergency. See, for example, Meredith Mealer, “The prevalence and impact . . .”

99.9 percent of the nurses surveyed . . . R. Erickson and W. Grove.

“I work where kids die” Interview.

As Georgia nurse Brittney Wilson . . . Wilson gave the author permission to attribute the quote. Wilson posted this comment at: Kevin Pho, “Should nurses be fired for fatal medication errors?” KevinMD.com, May 2, 2011.

all but three circumstances . . . See, for example, R. T. Penson, “Laughter: The Best Medicine?” The Oncologist (September 2005). Globally, the use of humor in hospitals varies by the culture. In Taiwan, for example, nursing school professors teach therapeutic humor more than U.S. faculty, but use that humor less often in clinical settings because of a reverence for illness. See Lenny Chiang-Hanisko, Kathleen Adamle, and Ling-Chun Chiang, “Cultural Differences in Therapeutic Humor in Nursing Education,” Journal of Nursing Research 17, no. 1 (2009).

humor can help patients . . . their treatments. Ibid.

nurses use humor with patients . . . See, for example, Howard J. Bennett, “Humor in Medicine,” Southern Medical Journal (December 2003); R. T. Penson et al.

staging pranks . . . bejeezus out of her. Interviews.

hidden under a sheet . . . shrieking down the hallway. Jim deMaine, “Gallows Humor is Only a Temporary Release from a Traumatic Situation,” KevinMD.com, November 13, 2011.

A California nurse has sprayed . . . Interview.

Nurses have awakened night shift . . . Interview.

“I am not the only nurse . . .” Interviews.

When a young Southern nurse asked . . . Interview.

“I’d been punk’d.” Interview.

“It tastes infected . . .” Interview.

urologists tend to have a lewd . . . Interviews.

“We get very naughty . . . like you mean it.” Interview.

A Texas nurse remembered . . . Interview.

“gallows humor. . .” tragedy or death. See, for example, Howard J. Bennett; J. Sayre, “The Use of Aberrant Medical Humor by Psychiatric Unit Staff,” Issues in Mental Health Nursing 22 (2001); Karyn Buxman.

when a doctor calls out . . . die in one night. http://themountainsarecalling.blogspot.com/2010/06/thoughts-on-death.html. Used with the nurse blogger’s permission.

“circling the drain” . . .“Eternal Care Unit.” Karyn Buxman.

“donor-cycles.” Ibid.

“the departure lounge.” “Gallows Humour in Hospitals Can Help Doctors and Patients Feel Better,” Daily Mail, September 27, 2011.

Gunshot wound . . . Celestial transfer. “Tragedy, Black Humor, and Coping,” Health Beat, November 1, 2012.

In the middle of the night . . . they ate the pizza.” Katie Watson, “Gallows Humor in Medicine,” The Hastings Center Report, September–October 2011.

nearly 90 percent used it . . . exercising (30 percent). Anne Villeneuve, “Why Paramedics Go for the Punch(line),” Dartmouth Medicine, Spring 2005.

In 2014, a Virginia patient . . . up a rectum. See, for example, Evan Bleier, “Colonoscopy Patient Sues Doctors for Making Fun of Him While He Was Unconscious,” Upi.com, April 22, 2014.

more than $5 million in damages Elizabeth Waibel, “Patient Says Bethesda Practitioners Mocked Him During Colonoscopy,” Gazette.net, May 13, 2014.

derogatory humor, in which . . . Delese Wear et al., “Derogatory and Cynical Humour Directed Towards Patients: Views of Residents and Attending Doctors,” Medical Education, January 2009.

make fun of patients’ names . . . locker. Interviews.

“Status Dramaticus” . . .“into the Hilton.” Interview.

hummed the Jaws theme. Interview.

“only one joke per patient.” J. Sayre.

targeted more than others . . . were removing. R. H. Coombs, S. Chopra, D. R. Schenk, and E. Yutan, “Medical Slang and Its Functions,” Social Science and Medicine (April 1993).

trade anecdotes . . . hospital urban legends.” Ibid.

“whose illnesses and health problems . . .” Delese Wear et al., “Making Fun of Patients: Medical Students’ Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings.”

“difficult” patients . . . “us all look good.” See R. H. Coombs et al.

they usually intend . . . A lot. Interviews.

“There’s nothing potentially funny . . .” Ibid.

some ERs keep an orifice box . . . Interviews.

glass perfume bottles . . . an entire apple Interviews.

After Indiana nurses pulled a . . . Interview.

he had swallowed “something . . .” Interview.

required surgery to remove. Interview.

phone pictures of amusing X-rays. Interviews.

in meetings See, for example, Delese Wear et al. “Derogatory . . .”

“difference between whistling” Ibid.

humor helps medical professionals Ibid.

“Sometimes when something happens” Interview.

“find the bright side . . .” Interview.

shown to improve doctors’ . . . See, for example, Howard J. Bennett.

It allows them to express See, for example, R. T. Penson et al.

“having a common sense . . .” R. H. Coombs.

“How does it feel to be . . .” R. T. Penson et al.

“stray bullet effect”. . . type of patient. See, for example, Delese Wear et al. “Derogatory . . .”

“Critics of backstage gallows . . .” See Katie Watson.

medical students use derogatory . . . See, for example, R. H. Coombs.

“a safety valve for ‘letting off steam.’” These arguments are more persuasive than the idea that people who need to fill long stretches of silence in the Operating Room resort to gossip and jokes. (One medical student reasoned, “What else are you going to do? Oh yeah, that’s a nice tibia . . . ? You have to say something.” See Delese Wear et al. “Making Fun of Patients . . .”).

“It’s almost more depressing . . .” Interview.

“scandalous” . . . Interview.

can empower healthcare workers . . . locate joy or playfulness See, for example, Linda Caputi. “Humor in the Healthcare Workplace: A Cure for Stress.” Presented at the Healthcare Educators’ Conference, June 22, 2012; Karyn Buxman.

“Nurses need to blow off . . .” Interview.

nursing school educators who used humor . . . to combat burnout. See, for example, M. McCreaddie and S. Wiggins, “The Purpose and Function of Humour in Health, Heath Care, and Nursing: A Narrative Review,” Journal of Advanced Nursing 61, no. 6 (2007).

“Start a collection . . .” Karyn Buxman.

“When is behind-the-scenes . . . death won.” Katie Watson.

Chapter 6

“The nurse promotes . . .” The American Nurses Association’s Code of Ethics For Nurses: http://nursingworld.org.

“Hospitals tend to focus . . .” Interview.

base 30 percent of hospitals’ Medicare HCAHPS Fact Sheet (CAHPS Hospital Survey), May 2012.

“Delivery of high-quality . . .” Department of Health and Human Services. Federal Register, Vol. 76, No. 160, August 18, 2011.

Beginning in October 2012 . . . See, for example, Jordan Rau, “Patients to Affect Hospital Bonuses,” Kaiser Health News, in partnership with the Washington Post, April 28, 2011.

percentage will double in 2017 See, for example, Laura Landro, “The Informed Patient: A Financial Incentive for Better Bedside Manner,” The Wall Street Journal, November 8, 2011.

Blue Cross Blue Shield See, for example, Liz Kowalczyk, “Nurses Balk at Bid to Guide Dealings with Patients,” The Boston Globe, March 21, 2012.

Hospital Value-Based Purchasing Program “Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs,” Healthcare.gov, April 29, 2011.

thirty-two-question survey . . . improved the patient’s medical issue. See HCAHPS Survey: http://www.hcahpsonline.org, March 2014.

“my roommate was dying” See “Scrubs Contributor,” Scrubsmag.com, July 4, 2012.

“This somehow became the fault . . .” Interview.

“Many patients have unrealistic . . .” Interview.

Medicare calculates scores . . . Not an average rating. “Always.” Confirmed with a CMS spokesman; See also, for example, Cheryl Clark, “Top 12 Healthcare Quality Concerns in 2011,” HealthLeaders Media, January 4, 2012.

Medicare awards bonuses . . . See, for example, “Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs,” Healthcare.gov, April 29, 2011: “Hospitals will be scored based on their performance on each measure relative to other hospitals.”

Washington, DC, and New York patients . . . lower ratings. See, for example, Jordan Rau, “Patients to Affect Hospital Bonuses.”

either call or mail . . . See, for example, Jordan Rau, “Test for Hospital Budgets: Are the Patients Pleased?” The New York Times, November 7, 2011.

a patient asked Molly . . . Interview.

patients who reported being most . . . J. Fenton, A. Jerant, K. Bertakis, and P. Franks, “The Cost of Satisfaction: A National Study of Patient Satisfaction, Healthcare Utilization, Expenditures, and Mortality.” Archives of Internal Medicine, March 2012.

results could reflect that doctors . . . Ibid.; see also “Patient Satisfaction Linked to Higher Healthcare Expenses and Mortality,” UC Davis Health System Press Release, February 13, 2012. In an email to the author, Fenton clarified, “Most of our work on satisfaction pertains to outpatients, although some have generalized it to hospital care.”

“Focusing on what patients want . . .” Theresa Brown, “Hospitals Aren’t Hotels,” The New York Times, March 14, 2012.

hospitals that perform worse . . . “definitely recommend the hospital.” This is a conservative tally. I did not include hospitals that scored better than the national average on any one category, even if they had multiple categories in which they scored worse than average, because of the low but still possible likelihood that patients responding to the surveys fell into the “better” categories. I also excluded hospitals that did not have enough data in any one category for Medicare to rank them, in case highly satisfied patients filling out the surveys could have fallen into those categories.

“Patients can be very . . .” Interview.

In 2012, when a white father . . . JoNel Aleccia, “Hospital Granted Dad’s Request: No Black Nurses, Lawsuit Says,” NBCNews.com, February 23, 2013.

Hurley settled. . . $41,250 apiece. Gary Ridley, “Hurley Paid Nearly $200,000 to Settle No-Black-Nurses Lawsuit, Records Show,” MichiganLive.com, March 20, 2013.

more than 61 percent of patients . . . in the bottom half. See Saket Girotra, Peter Cram, and Ioana Popescu, “Patient Satisfaction at America’s Lowest Performing Hospitals,” Circulation: Cardiovascular Quality and Outcomes (May 2012). Some caveats: The 61 percent who would recommend low-performing hospitals is compared to 66 percent of patients at hospitals with high scores, Girotra noted in correspondence with the author. He added, “Although the difference between low and high performing HF hospitals was statistically significant, it was small. . . . Lastly, it is important to remember that the patient satisfaction ratings were provided by a sample of all patients discharged from the hospital and not just heart failure patients.” In addition, Girotra said that on average, patients treated at consistently low-performing heart failure hospitals were less likely to give high marks to those hospitals compared to patients treated at high-performing hospitals.

“is part of an ongoing national effort” Sample Initial Cover Letter for the HCAHPS Survey, March 2013.

valet parking See, for example, Nina Bernstein, “Hospitals Aren’t Waiting for Verdict on Healthcare Law,” The New York Times, June 10, 2012.

live music See, for example, Laura Landro, “The Informed Patient: A Financial Incentive . . .”

custom-order room-service . . . televisions. See, for example, Melissa Burden, “Stakes High for Hospital Service,” Detroit News, March 19, 2012.

“. . . loyalty programs.” Ibid.

spent approximately $50 million . . . executive chef. Todd Sloane, “The University of Patient Satisfaction,” Partners, January–February 2012.

Beaumont Hospital spent half a million . . . score.” Ibid.

scripting nurses’ patient interactions. See, for example, Nina Bernstein, “Hospitals Aren’t Waiting . . .”; Nina Bernstein, “Walkouts by Nurses Loom as Hospitals Seek to Cut Costs,” The New York Times, December 15, 2011; Liz Kowalczyk; Todd Sloane.

use particular phrases . . . See, for example, Jordan Rau, “Test for Hospital Budgets . . .”

Posters hang in break rooms Interviews.

cue cards in their pockets See, for example, Todd Sloane.

wear laminated cards . . . “in your room.’’ Liz Kowalczyk.

at least three times per shift. Ibid.

more than 800 healthcare organizations See, for example, https://www.studergroup.com/what-we-do/institutes/upcoming-institutes/hcahps-summit/hcahps-nashville-tn/post-event-page/.

“coaching” https://www.studergroup.com/what-we-do/coaching/.

A.I.D.E.T. stands for Acknowledge . . . Competency Assessment. Accessed through the Studer Group tools page. Used also in The Nurse Leader Handbook. www.firestarterpublishing.com/NurseLeaderHandbook.

have to undergo “remediation” See, for example, Bridget Ward, “Dumbing Down Disrespects Nurses,” Letter to the Editor, Berkshire Eagle (Pittsfield, MA), June 7, 2011.

“improvement plan.” Competency Assessment.

assessed by “A.I.D.E.T. auditors.” “Tool 9: Aidet Interaction Assessment,” Taking You and Your Organization to the Next Level, Studer Group Tools, 2009.

health systems are now using . . . bonuses. Interviews; See also, for example, “Better Bedside Manners; Customer Service Comes to Healthcare.” Indianapolis Business Journal, March 21, 2011; Franklin Michota, “Adviser’s Viewpoint Patient Satisfaction Is No Simple Thing,” Hospitalist News, April 2012.

auditioned and hired professional actors . . . See, for example, “Hospitals Hire Actors to Improve Patient Satisfaction, Communication,” FierceHealthcare.com, August 30, 2012.

“an open-book test . . .” “Quick-E! Pro Scripting: A Guide for Nurses,” HCPro.com, 2009.

. . . do not approve of these tactics. “Hospitals are not permitted to attempt to influence or encourage patients to respond in a particular way,’’ Ellen B. Griffith, a spokeswoman for the Centers for Medicare and Medicaid Services, emailed Boston Globe’s Liz Kowalczyk.

“hospitals must not use . . .” CAHPS Hospital Survey (HCAHPS) Quality Assurance Guidelines, Version 9.0, March 2014.

“Stepford nurse” Liz Kowalczyk.

ten-page laminated guide . . . “Uh-huh.” “Better Bedside Manners: Customer Service Comes to Healthcare,” Indianapolis Business Journal, March 21, 2011.

“If you haven’t found a way . . .” Rebecca Hendren, “Top 5 Challenges Facing Nursing in 2012,” HealthLeaders Media, November 15, 2011.

Oh, they get it. See, for example, “A Message from ‘Rank and File, RN,’” from Emergiblog.com, November 16, 2011.

“In our staff meetings . . .” Interview.

“good customer service skills . . .” Amy Bozeman, “Wanted: Good Customer Service Skills,” Scrubsmag.com, July 6, 2011.

evaluates staff members on “customer satisfaction.” Todd Sloane.

“Now we are told . . .” Amy Bozeman.

representatives give warm blankets . . . marks to the nurses. Ibid.

at a hospital that switched its “A Message From ‘Rank and File, RN.’”

The University of Toledo Medical Center . . . “true belief.” Todd Sloane.

“patients are more satisfied . . .” Liz Kowalczyk.

UTMC is among the worst performers . . . At the time of this writing, UTMC scored worse than the national average on five categories of Hospital Readmissions, Complications and Deaths Data. See Data.Medicare.gov for current data.

UTMC made headlines . . . See, for example, Susan Donaldson James, “Toledo Hospital Threw Out Donor Kidney, Now Denies Negligence,” ABCNews.com via Good Morning America, August 29, 2013.

study comparing patient satisfaction . . . patient per nurse. Ann Kutney-Lee, et al. “Nursing: A Key to Patient Satisfaction.” Health Affairs, July/August 2009. The study authors caution: “A limitation of the research is the cross-sectional design, which does not inform us about causation.”

good work environments . . . “throughout the world.” Linda H. Aiken et al., “Importance of Work Environments on Hospital Outcomes in Nine Countries,” International Journal for Quality in Healthcare (August 2011).

Higher staffing of registered nurses . . . assigned eight. Linda H. Aiken et al., “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction,” Journal of the American Medical Association (2002).

failure-to-rescue rates drop . . . to die See, for example, Arminee Kazanjian et al., “Effect of the Hospital Nursing Environment on Patient Mortality: A Systematic Review,” Journal of Health Services Research and Policy (April 2005); Linda H. Aiken, “Investments in Nursing Save Lives,” Center for Health Outcomes and Policy Research. A PowerPoint presentation supported by National Institute of Nursing Research; Ann Kutney-Lee et al.

readmitted to the hospital. See, for example, Jonathan Gruber and Samuel L. Kleiner, “Do Strikes Kill? Evidence from New York State,” National Bureau Of Economic Research Working Paper Series (March 2010).

stay is shorter . . . error is lower. See, for example, Rebecca Hendren, “Nurse Staffing Costs Must Be Weighed Against Cost of Errors,” HealthLeaders Media, August 30, 2011.

the fewer the nurses, the higher . . . Jeannette Rogowski et al., “Nurse Staffing and NICU Infection Rates,” JAMA Pediatrics (May 2013).

hospitals could earn . . . and fewer tests. See, for example, Linda H. Aiken, “Investments in Nursing . . .”

in poor nurse working environments . . . saved every year. Linda H. Aiken, “Investments in Nursing . . .” In correspondence with the author, Aiken, a leading nurse researcher, clarified that “frequently” is defined as “once a month or more often.”

“the single most critical . . .” “HCAHPS: Hardwiring Your Hospital for Pay-for-Performance Success,” Studer Group webinar, 2011.

check in with patients every hour Ibid.

“The Most Bang for Your Buck” Ibid.

“to promote higher quality . . .” Federal Register, Department of Health and Human Services 76, no. 160, August 18, 2011.

“building a culture of healthcare excellence” Disneyinstitute.com.

Chapter 7

“I will abstain . . .” Florence Nightingale Pledge at the American Nurses Association: http://nursingworld.org.

“It’s insanely easy . . .” Interview.

“one of the most devastating . . .” See, for example, T. Monroe, “Addressing Substance Abuse Among Nursing Students: Development of a Prototype Alternative-to-Dismissal Policy,” Journal of Nursing Education (May 2009).

“code of silence” Interviews; see also, for example, Debra Dunn, “Home Study Program: Substance Abuse Among Nurses—Defining the Issue.” AORN Journal (October 2005).

“don’t talk rule” Debra Dunn,

“bend rules or . . . can be difficult.” Ibid.

nurses worry that . . . Ibid.

quick to stigmatize . . . Ibid. See also “Substance Use Disorder in Nursing,” National Council of State Boards of Nursing, 2011.

“Society, in general . . . grandmother’s pain pills.” Ibid.

army medical center nurse . . . hepatitis C. Darren Meritz, “Former Nurse at Beaumont Army Medical Center Given 3½ Years,” El Paso Times, December 2, 2009.

Nurses across the world have stolen narcotics See, for example, Clair Weaver, “Nurse Stole Pills off Elderly,” Sunday Telegraph (Australia), August 10, 2008; Myra Philp, “Missing Drugs: 6 Nurses Axed; Staff Suspended in Morphine ‘Theft’ Probe,” Sun, August 17, 2009.

replaced or diluted it . . . during surgery See, for example, “Fentanyl Replaced With Saline Solution During Surgical Procedures,” US Fed News, November 29, 2006; Pat Grossmith, “Indictment: Nurse Diluted Drugs,” Union Leader (Manchester, NH), July 18, 2008; Roxanna Hegeman, “Kansas Nurse Gets 3 Years in Drug Tampering Case,” Capital-Journal, February 3, 2012; “Nurse gets 3 years for drug tampering,” Capital-Journal, February 25, 2012; “Woman Sentenced to Probation for Stealing Painkillers,” August 6, 2005; “Pain Medication Thefts: Nurse’s Drug Problem Was Recorded,” Daily Camera (Boulder, CO), July 9, 2009.

nurse at a nursing home . . . for her migraines. “Former care home worker is struck off nursing register,” Wells Journal, April 28, 2011. She was accused of killing other patients, but was cleared. See “Nurse accused of murdering two of the elderly residents she was stealing drugs from.” Wells Journal, January 28, 2010.

6 to 8 percent of nurses Author correspondence with an ANA representative. Also see, for example, Cynthia Clark and Judy Farnsworth,“Program for Recovering Nurses: An Evaluation,” Medsurg Nursing (August 2006). See also Patricia Welch Dittman, “Male Nurses and Chemical Dependency: Masterminding the Nursing Environment,” Nursing Administration Quarterly (October–December 2008); Madeline Naegle, “Nurses and Matters of Substance,” NSNA Imprint (November–December 2006).

same rate as the general population See, for example, Thomas Zambito, “High Anxiety in Hospitals: Nurses in Drugs, Drink Crisis,” Daily News (NY), March 14, 2004; “What To Do When Confronting an Impaired Colleague,” Medical Ethics Advisor, June 1, 2005.

between five and 100 times greater. T. Monroe, “Addressing Substance Abuse Among Nursing Students: Development of a Prototype Alternative-to-Dismissal Policy,” Journal of Nursing Education, May 2009.

skilled, achieving, respected See, for example, Matthew F. Shaw et al., “Physicians and Nurses with Substance Use Disorders,” Journal of Advanced Nursing 47, no. 5; Jane Hedrick; Debra Dunn.

67 percent of nurse anesthesia students . . . the bottom third. Jane Hedrick and Stephanie Luck, “The Alarming Trend of Substance Abuse in Anesthesia Providers,” Journal of PeriAnesthesia Nursing (October 2004).

“intelligent, calm”. . . from their supervisors. Patricia Welch Dittman.

“believe they have the knowledge” Jane Hedrick and Stephanie Luck.

are much more likely . . . downward spirals in time. See, for example, Debra Dunn.

ER, OR, PACU . . . cope with these traumas. Ibid. See also “Substance Use Disorder in Nursing.”