Question: Examining Mortality Rates You have been the nursing coordinator of cardiac services at a medium-sized urban hospital for the last 6 months. Among the hospital's cardiac services are open-heart surgery, invasive and noninvasive diagnostic testing, and a comprehensive rehabilitation program. The open-heart surgery program was implemented a little over a year 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 medical director with your findings. He becomes defensive and states 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 question him about examining 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."

ASSIGNMENT: Outline your plan. Identify areas in your data gathering that may have been misleading or that may have skewed your findings. If you believe 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?