National Nurses United

Patient Safety? An inconvenient problem? For whom? Do less harm? Than what? It would be easy to overlook this volume while browsing the shelves in search of a good read on the factors associated with increased morbidity and mortality of hospitalized patients. Its cover does not do a good job of hinting at the important issues inside. But if readers press on, they will be confronted by essays contrasting the market gospel of blind faith in healthcare information technology and the realities of its use. For direct-care RNs caught in the cross fire between the competing and conflicting interests encroaching on the profession of nursing, the subject matter will surely provoke a visceral reaction. Read it and weep, but don���t say I didn���t warn you. After all, it was Florence Nightingale who said, ���It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do no harm.��� Trust me, I���m a nurse. Patient safety is an imperative, not an inconvenience. There are harmful barriers to achieving it, but working to identify and remove the barriers to safe, therapeutic, and effective patient care is and has been job one for the generations of direct-care RNs who���ve followed in Nightingale���s footsteps. Be that as it may, the authors have rightly observed, ���patient safety becomes a casualty of the drive to cut health care costs and the accompanying failure to understand that ensuring safety is���in and of itself���a costsaving activity.��� The stated aim of this book is to identify some of the gaps in the so-called patient safety movement, gaps that persist despite decades of hard work and billions of dollars spent. As Ross Koppel and his colleagues point out, ���sales pitches for new equipment and information systems rarely include much discussion about the impacts on the work of caregivers or larger impacts on systems of care. There is a vast gap between the use of HIT and its promised outcome.��� Despite an excellent identification and analysis of why HIT problems are not addressed, ���from corporate marketing to clinician���s workarounds,��� the authors��� fallback position on fixing the ���gaps��� and assertions of why HIT adoption fails and/or increases the risk of adverse events (sometimes catastrophically) is that these failures could be mitigated by labor-management partnerships and involving frontline staff and labor unions in the adoption of new technologies early on in the process. But according to David Schildmeier of the Massachusetts Nurses Association, ���We have participated on various quality and safety committees, but our suggested J U LY | A U G U S T 2 0 1 2 solutions don���t get implemented. Many times managers keep us at a distance; they don���t value our input.��� Koppel and Gordon have contributed to and assembled a wellreferenced collection of essays from noted researchers on nurse staffing, workload, and patient outcomes: a health information business and technology consultant, a patient, and a nurse. However, the book was ultimately disappointing in the concluding chapter entitled, ���Twenty-seven Paradoxes, Ironies, and Challenges of Patient Safety.��� Subheading #25 of that chapter is titled: ���Patient Safety is Helped by Coherent Regulation.��� I was surprised, to say the least, that the authors in this section failed to discuss, highlight, or even give honorable mention to the most important and well-documented safety initiative ever implemented into law: California���s historic RN-to-patient ratio law. The law establishes strict, numerical minimums (a floor, not a ceiling), and hospitals are still required to provide additional staffing beyond the minimums, using a valid patient classification tool. The healthcare industry has become big business in the United States. Nurses across the country have consistently spoken out about unsafe workplace policies, unsafe staffing, and unsafe working conditions that place their patients at risk of preventable injury and harm. When initiatives that are undertaken or imposed to improve patient safety or care quality also increase workload, the results can be other than intended, as noted by the authors. If other options already well supported by the evidence, such as increased RN staffing ratios were pursued first, the complications suffered by patients and negative impacts on nurse and patient outcomes that the CPOE/HIT systems were supposed to treat may very well be prevented. As others have observed, health IT is still largely a social experiment, and hospitals are a highly risky environment for implementing it. Ross Koppel, Ph.D. is a faculty member of the University of Pennsylvania���s Department of Sociology and the principal investigator on UPenn���s study on hospital workplace culture and medication errors. Suzanne Gordon is a prominent journalist, author, and coeditor of the Culture and Politics of Health Care Work series for Cornell University Press. She was designated as a project leader on a communication and safety grant for nurse managers, funded by the Robert Wood Johnson Foundation. ���DeAnn McEwen, RN Hipwrecked: My Health Insurance Sucked so I Went to India for Surgery By Phyllis Katz; Idiolect Press, 2009 I n this quick and easy read, Phyllis Katz, a writer, actor, and improv teacher from Los Angeles, details in the first person her saga of discovering that she needs a double hip replacement, realizing that there was no way she could pay the almost $100,000 it would cost despite her insurance coverage, and then taking the plunge into medical tourism to have her hip surgery in India. The total cost for the trip and procedure in India? $18,990. W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 19

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