Sleep Deprivation of Nurses: Poor Health Care Practice
Submitted by Bettye Cobbins BSHA, MBA/HCM, DHA
Corley and Goren (1998) reported few nurses have committed serious medical errors and crimes but that nurses may be guilty of providing inadequate care. Wolf (2012) reviewed literature on nursing practice breakdowns, which have been defined as the absence or disruption of any aspects of good nursing practice. Not all breakdowns are intentional, but they can have negative results. Intentional acts in particular can negatively affect patient outcomes, ranging from the patient feeling demeaned to the patient dying (Wolf, 2012). Wolf also found nurses’ actions not only affect patients but also the patients’ families. When nurses are unsympathetic, patients’ families may feel slighted (Wolf, 2012).
Many patients reported nurses fail to demonstrate compassion (Riemen, 1986; Wolf, 2012). Halldorsdottir (1991) found many patients perceive nurses as uncaring. Uncaring nurses are described as being in a rush, rude to patients, and not adhering to the rules and code of ethics at the health care organization (Wolf, 2012). Uncaring characteristics are part of what is called the dark side of nursing (Jameton, 1993). Other traits considered part of the dark side of nursing include dominating, antagonistic, and aggressive behavior, which can eventually diminish the nurse’s relationships with his or her patients (Wolf, 2012). Corley and Goren (1998) suggested other inappropriate behaviors include abuse, controlling behavior, and interpersonal distance. The dark side of nursing is also evident when nurses disregard policies and regulations and act carelessly, placing patients in harm’s way. Such undesirable traits can lead to negligence and medical errors (Wolf, 2012). Because of the potential dire consequences of the dark side of nursing, members of the Joint Commission took measures to address the issue (Rosenstein & O’Daniel, 2008).
Clark and Springer (2007) and Wolf (2012) asserted when nurses fail to provide high-quality care, other nurses must take action and report the inadequate care. Stevens (1998) concurred, stating nurses must report patient abuse and neglect demonstrated by other nurses. Halldorsdottir (1991) posited nurses and other health care personnel are afraid to report inadequate care provided by other nurses. Wolf noted just as employees in other industries are expected to report reckless behavior, nurses must also report such behavior in their work environments. Employees who disclose reckless behavior are known as whistleblowers and legislation was passed to protect whistleblowers from retaliation (Wolf, 2012).
Longest & Darr (2008) acknowledged the difficulties most health care leaders experience while providing quality medical care and measuring the quality of the interpersonal relationship between physician and patient—a process important in the delivery of quality health care (p. 462). One tool the health care organization makes good use of is medical audits, leadership in health care delivery and quality improvement within the health care industry came together to collect data to exchange throughout the industry and address ways to improving the quality of health care (Longest & Darr, 2008).
Medical audits enable health care organizations measure quality care to evolve in the health care industry. The medical audits will include the appropriate use of services, standards, and peer review. The medical audit did not always strongly analyze the quality of care, but the quality of care continues to evolve. In 1970, according to (AHRQ, 2010), the Joint Commission required quality assessment activities; a variation on medical audits (p. 1). In the 1980, the Joint Commission set the standards of the medical audits to set the standard evolving around finding and describing problems to become proactive in the delivering of quality care. Longest and Darr (2008) stated the improvement of quality of care is now the umbrella concept of Joint Commission standards involving quality care (p. 462).
The medical audit was the Enactment of Medicare and Codman’s contribution to developing the standards and establishing the standards within the Joint Commission (Longest & Darr, 2008). Quality care is important in health care organization, therefore, management must consult with the risk management team to ensure the analysis of the medical audits are among the training of the staff to improve quality care. “Risk management and performance improvement are examples of structures and programmatic control methods within the standards of quality care” (Longest & Darr, 2008, p. 466).
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