Dr. Hamilton, the principal investigator for our research, recently spoke at a Faculty Forum at Midwestern State University. Not only did the local media outlet pick up the story but also the National American Nurses Association. Please find the article below.
Dean researching off-peak hour hospital death rate
By Ann Work
Thursday, April 9, 2009
Hamilton, a registered nurse and dean of graduate studies at Midwestern State University, learned from interviews with 30 nurses that it’s best for patients to always bring a family member with them as an advocate for their care.
“One nurse in a critical care area said, ‘I’m so glad when families are in the room. Then I know I can’t ignore them,’ ” Hamilton said Tuesday when she presented her initial research findings at MSU’s University Faculty Forum. “So take somebody with you.”
Hamilton is in the beginning stages of a $300,000 study investigating why 23 of the 100 leading causes of death in hospitals happen most often during nights and weekends.
“We’re sure it’s so. Why it’s so is still unknown,” Hamilton said. With a grant from the Robert Wood Johnson Foundation, Hamilton has conducted interviews with nurses for the past four months at two Texas hospitals.
Initial research shows that nurses who work off-peak hours are often the most inexperienced. They also report difficulty with on-call doctors who refuse to answer nighttime phone calls or to respond as asked, which requires nurses to take on duties beyond their ability levels.
Problems in hospitals in their off-peak hours aren’t new. But when Hamilton saw that magazine editors were including survival tips for hospital stays alongside tips for escaping plane crashes or bear attacks, she decided it was time to find out more.
After studying a neonatal unit, she learned that the “weekend effect” is greatest at hospitals of moderate size — not at the very biggest hospitals and not at the smallest.
The largest hospitals have large, competent staffs; small hospitals are quick to transfer difficult cases. It’s the medium-sized hospitals that may keep a patient who is having problems, thinking its staff can handle it.
“We’re not sure, but it worries us,” Hamilton said.
Nurses also reported serious communication problems with physicians and other nurses. The problems continued, even after the nurses were given a half-day training session to help them.
Often, nurses denied having problems if they worked evenings or weekends, but if given space on a survey at the end, would scrawl out horror stories. “We couldn’t explain this,” Hamilton said.
Interviews with nurses in stressful intensive care units showed that the younger, less experienced nurses are often scheduled to work the off-peak hours. When an emergency arose, they asked themselves, “Who can I wake up? Who will be nicer to me?” During the day, doctors were readily available; at night, doctors often couldn’t be awakened or wouldn’t come in to help.
Hamilton also learned that teamwork was difficult for nurses when they had to work with nurses who came from different ethnic groups, spoke English with different types of phrasing, or had different training. Supplies often ran out during the night shift or on weekends, requiring nurses to drive across town to replenish.
Nurses cited difficulties with 12-hour shifts, particularly during the hours from 3 a.m. to 5 a.m. Because of family responsibilities, it was typical that many nurses reported for work with only two to four hours of sleep before putting in a long day.
“I am astounded at what they are able to do with what they have,” Hamilton said.
Interviews will continue through Aug. 31, 2010; results will be disseminated quickly and broadly, she said.
Education reporter Ann Work can be reached at (940)763-7538 or by e-mail at worka(at)TimesRecord News.com.
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