You have been a staff nurse on a cardiac unit at a medium size hospital (300) beds in an urban community for the last 6 months. Among the hospital's cardiac services are open-heart surgery, invasive and non-invasive diagnostic testing, and a comprehensive rehabilitation program. The open-heart surgery program was implemented 14 months ago. During the last 3 months, you have begun to feel uneasy about the mortality rate of postoperative cardiac patients at your facility. An audit of medical records shows a unit mortality rate that is approximately 30% above national norms.
You approach the unit nursing and medical directors with your findings. They become defensive and state that there have been a few freakish situations to skew the results but that the open-heart program is one of the best in the state. When you ask the medical director to examine the statistics further, he becomes very angry and turns to leave the room. At the door, he stops and says, "Remember that these patients are leaving the operating room alive. They are dying on your unit. If you stir up trouble, you are going to be sorry."
Briefly discuss the quality of care issues and ways to measure the effectiveness of patient care on your unit.
Identify areas in your data gathering which may have been misleading or that may have skewed your findings.
If you feel action is still warranted, what are the personal and professional risks involved?
How well developed is your power base to undertake these risks?
To whom do you have the greatest responsibility?
How might you address your concerns in a productive manner?
1. Are quality of care issues clearly delineated?
2. Are the measures of effectiveness of care clear, measurable and time related?
3. Is there a clear discussion of concerns related to data collection and how data may be misleading?
4. Are personal and professional risks identified?
5. Is there evidence that personal and professional risks have been considered and used to plan further actions?
6. Is there an understanding of power and influence in a work group?
7. Is there clear discussion about professional responsibility?