National Nurses United

C A L I F O R N I A N U R S E J U N E 2 0 0 5 15 Introduction T his two-hour continuing educa- tion home study describes the RN as the enforcer of patient advoca- cy and highlights how this was achieved through education, indi- vidual, and action-oriented collective patient advocacy activities. One of the key shapers of the RN patient advocacy duty is the California Board of Registered Nursing (BRN). Before 1985, California RNs had an ethical obli- gation and duty to act in any instance where their patients might be placed in danger. Since then, the BRN promulgated regulations mandating that California RNs have a legal obligation to act as patient advocate [California Code of Regulations, Title 16, Section 1443.5 (6), Standards of Competent Performance]. This means that RNs have a high duty of care to pro- tect their patients and to keep them safe from harm. California is the only state where the RN's condition of licensure is to act as patient advocate. Today, accord- ing to the BRN, the RN has a duty and a right to be a patient advocate. (See California Nurse, "Advancing RN Patient Advocacy Through Collective Bargain- ing," March 2005 edition: mandatory reading) S E C T I O N I . Enforcing Means Recognizing and Eliminating Any Barriers to Patient Advocacy Long Beach Memorial: "As RNs we have a duty to learn all there is to know about our rights, responsibilities, and authority." So does DeAnn McEwen, Chair of the Joint Nursing Practice Commission, eloquent- ly describe the value of education in her article entitled "Nursing Solidarity in the Hospital Matrix" (See California Nurse, October 2004 edition: mandatory read- ing). This feature story describes how ICU RNs at Long Beach Memorial defeated a plan to replace them with LVNs during breaks. She wrote, "Since we organized with CNA, we've become better educated, more discerning, and more assertive." City of Hope: In a distinct case involv- ing the use of medication infusion tech- nology, City of Hope RNs recognized early on that the newly purchased FluidSense IV pump s had inherent problems which could result in patient harm. They imme- diately implemented a concerted patient advocacy drive to stop this unsafe under- taking. The scenario started as follows: City of Hope RNs were asked to come to work one hour early to attend an orientation on the hospital's new FluidSense IV pumps. These RNs were required to leave after one hour even though the in-service was not complete. When the RNs began assess- ment of their patients, they found that the patients were already physically attached to these new pumps. This FluidSense IV pump was touted as a great innovation. Not only did it pre- vent the free flow of fluids to the patient, it did not need to be plugged in and was lightweight. This would make it easier for patients to ambulate without securing electric cords. The reality was something else. The pumps ran on hearing aid-type batteries that—although touted to last 96 hours— actually lasted an average of only four hours. When they ran down the pump would alarm loudly. They had sensors that set off alarms for air bubbles too small to be seen. The tubing connectors came apart, leaking and letting air into the tubing both above and below the pump. Blood sometimes backed up due to a loose connection. Batteries were stored in the Pyxis, requiring RNs to access the machine for each battery. Nurses were not to carry bat- teries in their pocket. Oncology patients often have four, five, and six or more IVs. Even antibiotics were to be administered using the pump, whether or not the physi- cian thought it was necessary. With so many pumps, alarms were sounding almost all the time. Patients complained the alarms startled them awake. Often a patient would suffer nausea and vomiting when awakened so suddenly. There were multiple problems with air bubbles, requiring the discard of up to 20 percent of the medication; very awk- ward flushing procedures causing a high risk of violating sterility; and constant beeping of at least one pump. When an alarm began sounding when an RN was with a patient, the nurse had to remove isolation garb, wash hands, get a battery from the Pyxis, wash hands, put on isolation garb, and finally change the battery. The easily loosened tubing caused expensive and toxic chemotherapy med- ication to leak onto the floor. Even worse, no one could be certain how much had infused into the patient. Each RN had a small key attached to the name badge to program the pumps. This caused many concerns with both reverse isolation and isolation for infec- tious disease. Nurses began keeping a sup- ply of small plastic bags to cover their badges. The majority of call lights were to tell the nurse that the pump was alarming. One nurse went into a room with an alarming pump and began troubleshoot- ing the pump. The patient vomited on the floor because the nurse did not notice the patient gesturing for an emesis basin. Nurses complained that they spent their time nursing the pumps instead of nurs- ing their patients. These pumps beamed a record of each access with the "key" to a location in Kentucky. Hospital management could access which nurse changed the rate on CE | Home Study Course RNs: The Enforcers of Patient Advocacy Submitted by the Joint Nursing Practice Commission and Hedy Dumpel, RN, JD Special contributions provided by Bonnie Martin, RN and Laurie Hoagland, RN

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