Is it Silence that Kills or is Silence a Symptom of Much Deeper Problems?

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This morning’s “Hospital Impact” has a disturbing article by Dr. John Burroughs about a preventable brush with death that his mother-in-law had recently.   She resides in a corporate LTC facility on an Alzheimer care unit and became seriously ill on an antibiotic despite signs and reasoning that the antibiotic was contraindicated. He’s right, doctors, nurses, and staff should hold each other accountable.  And yes, “Silence can kill”, but this is an old mantra at this point.  I want to challenge us to dive deeper and see how silence is not the problem, but rather a symptom of unresponsive management, toxic cultures, and  insufficient/ inappropriate staffing all of which are exacerbated by limited resources and a failure to understand the complexity of the work that nurses do.

Ironically, nurses and other experts all over the country have been speaking up about these issues for years.

But who is listening?  And what do you do when you are chronically ignored, dismissed, or invalidated? You either talk louder, shut-up and do your best while exhaling at the end of every shift, or get out!  In some cultures, talking louder is likely to get you a warning or worse, fired.  (I recently left my per diem RN position in part b/c of these issues. I’d say a quick prayer at the end of my shift that the narcotics count would be right b/c I knew how easy it would have been to make a mistake!)

It is like 120px-Yellowstone_Wolvesthe opposite of  ‘the boy who cried wolf’ in that we’ve been shouting and shouting but no one seems to pay attention.  Now the camp is surrounded by wolves.  Even my initial comment which linked to many posts that help explain the problem was censored on “Hospital Impact”!  (Many are posted below.)

Seasoned nurses have lots of expertise that helps to prevent acute clinical issues or detect them early so that treatment is initiated and suffering minimized.  But this expertise is invisible and maybe even discouraged in a company that sees no financial gain from preventing ED visits or minimizing suffering.

Maybe part the answer is to build on Dr. Burroughs plea for accountability and include organizational leaders’ accountability for staffing, positive cultures, and resources to do the work.  I know solving the problem about patient safety is not simple, but I also believe it can be done. IF, IF, IF we are willing to do the deeper work of creating positive workplaces, providing adequate staffing, and listening to people on the frontline.  When senior leaders and direct care staff are listening to each other and have the same priority, a lot can happen.  And I’m afraid that until they do, we will continue with our shameful record of >1000 preventable deaths/day in U.S. Hospitals with who only knows how many occur in LTC!

Here are some additional posts by a variety of experts that help explain the importance of staffing, creating positive cultures, and understanding complexity of nursing work.

censor no talking quiet Silence…?



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What are your thoughts?