Monday, June 4, 2007, three Registered Nurses’ employment by Health Management Associates at Dallas Regional Medical Center in Mesquite was terminated. Why?
They complained that their nurse to patient ratio was being raised critically high, so as to possibly endanger patients.
Normally, the nurse to patient ration in an Intensive Care Unit (ICU) would be 1:2. They were being ordered to increase that ratio to 1:5. Patients in ICU are in critical peril, and increasing the ratio only means that each critical patient will get less necessary attention.
Michael B. Rothburg, M.D., MPH, assistant professor of medicine at Tufts University and a physician at Baystate Medical Center, Springfield, Massachusetts, conducted a cost effectiveness study that seems to apply to the Mesquite case.
Dr. Rothburg found that the standard of an average ratio of 1:4 patients throughout the whole of the facility was maximum effective. Such a ratio could save 72,000 lives annually, and could result in fewer patient complications that increase patient stays by three to four days, “at a cost of $4,000 and $5,000 per day.” [“Study Finds Nurse-to-Patient Ratios Cost-Effective” by Christina Orlovsky, NurseZone, Wednesday, June 6, 2007]
Considering the health of the patients and even the cost efficiency, the three Registered Nurses took the correct position to complain to their Supervisor. However, they were terminated.
All Nurses take an Oath --
The Florence Nightingale Pledge
I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.
Obviously, the choice of these Nurses was a morally difficult one if they knew their employment might be jeopardized. They decided to uphold their own Oath, and now they will pay the price to Administrators who fail to understand that both patient care and bottom line economics share one decision. The three Nurses were right.
People who stand by their morals, even when risk is real, are Heroes.
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