I knew it was going to be a busy shift. After all, it was Wednesday—that meant elective surgery admissions from PACU [postanesthesia care unit], direct admissions from the clinic, and anything else the emergency room sent us. Each of us already had five patients apiece, some of them needing a lot of nursing care. There was no secretary available to put charts together and the nurse manager had already said that there was “no nurse in the system” to send to help us.
When the ER called to report on my second admission for the shift, I asked if they could please hold the patient until I finished a blood transfusion on one patient and completed the admission on the patient I had gotten from the recovery room. The nurse from the ER told me the patient would be up in five minutes and before I could say another word, she hung up the phone. I called my supervisor and explained that we were overwhelmed with all of the activity on the unit and asked if she could send another nurse to help us get settled or assign the admission to another unit. She told me that she would “look around” but that she had no one she could send right away. I asked her if she could delay the admission for a while until I could stabilize my other patients. She responded that the ER was “backed up” and that I had to take the patient right now or she would have to “write me up.”
When the patient came, I had to leave a new mastectomy patient who was crying each time she looked at her surgical dressing and whose PCA [patient-controlled analgesia] pump was alarming. I left her with a promise to get back as soon as I could and went to check the ER admission. The shift ended and I never got back to her except to check her IV fluid totals for the shift.
It was only after I got home that I remembered that I had not put the allergy band for seafood and penicillin on the ER admission. I called back to the unit just as the patient was being sent down to the operating room and asked them to put the allergy band on the patient and note on the front of the chart.
I could not rest. Every time I closed my eyes I thought about the fact that she could have been prepped using an iodine scrub and/or that they might have given her penicillin as a peri-operative antibiotic. A reaction from either of them could have been fatal.
The number of nursing staff available to provide in-patient nursing care is linked to patient safety by a substantial and growing number of research studies. Although there have been no experimental controlled studies of interventions that increased or decreased nurse staffing levels and measured the subsequent effect on patients, substantial evidence on the relationship between nurse staffing levels and patient outcomes has been produced by observational studies. This research has been conducted separately for acute care hospital and nursing home care.