From the ANA SmartBrief-17

Study: Statins may increase the risk of type 2 diabetes
Data from three clinical trials found that one trial indicated high doses of atorvastatin slightly increased the risk of type 2 diabetes in adults, particularly those with risk factors, including hyperglycemia and excess weight. The researchers, in the Journal of the American College of Cardiology, said it remains unclear why statins such as Lipitor would contribute to diabetes and said the drugs' benefits outweigh potential risks for patients with heart disease or a history of stroke. Reuters (3/28)

Study looks at risk factors for atrial fibrillation
A study of about 14,600 people found almost 57% of 1,520 atrial fibrillation cases that developed during the 17-year follow-up were due to high blood pressure, diabetes and other heart disease risk factors. More than 80% of blacks had at least one risk factor compared with 60% of whites, according to the study in Circulation. The lead researcher said a heart-healthy lifestyle can help cut the risk for A-fib. U.S. News & World Report/HealthDay News (3/28)

Study: Marijuana use affects cognitive function in MS patients
A Canadian study of multiple sclerosis patients ages 18 to 65 found those who used marijuana had significantly poorer performance in cognitive measures, including tests on attention, thinking speed and executive function. The study in the journal Neurology also found marijuana users were twice as likely as nonusers to fail at least two of 11 tests, which qualifies them as globally cognitively impaired. HealthDay News (3/28)

Some interesting articles...NO comments from me today..Enjoy reading

From the ANA SmartBrief-16

Hospitals use palliative care to improve quality, reduce costs
More hospitals are offering palliative care programs and special teams of providers to improve quality of care and outcomes for seriously ill patients. Research has found palliative care programs can reduce hospitals costs and improve patients' quality of life, but insurers still might not cover services outside of physician visits and hospice care. The Washington Post/Kaiser Health News (3/28)

As you will see from many of my past posts on the care of the ageing, palliative care is so important to the future of healthcare. Comfort care is really a better name for it. Providing comfort and pain relief to those at the end stages of illnesses should be as primary a consideration as life-saving measures, even more so with the economy as it is. But an even bigger issue is educating patients and families in the choices they have, especially in the face of any limited hope of truly improving the life quality when a terminal situation exists.

It is no longer only cancer, every organ has its limits and end-of-life situations effect every one. Many integrative healthcare programs can provide the kind of comfort care that so many patients have earned and deserve. Palliative care therapies should consider aromatherapy, music therapy and massage/healing touch for patient with end stage illnesses...Just think how much nicer a chocolate chip cookie candle aroma and some Nat King Cole with a favorite blanket, pillow and maybe even a pet would be instead of Rib-cracking CPR, endotracheal tubes and the aroma of body fluids.

Patients and Families should KNOW all of their options and choices...

From the ANA SmartBrief-15--Another article on Safe Staffing

Nonsafety net hospitals have better outcomes with more nurses
A review of data from the University HealthSystem Consortium found more nurses and higher nurse staffing rates correlated with better patient outcomes, including fewer heart failure-related deaths and lower infection rates, at nonsafety net hospitals. Researchers found safety net hospitals had worse patient outcomes than other hospitals despite similar staffing levels. Nurse.com (3/25)

OH My...And again it is written that safe staffing makes a difference to patient outcomes..How many hammers do hospitals need to be hit with to realize that staffing ratios can not rely on just numbers, patient safety relies on staffing relating to patient acuity. On floors and in the ICU you should be prepared for any patient crisis. In the ER, especially if, you are a specialty center, i.e., stroke, cardiac, etc., you should have the staff to meet the needs of any patient/s that comes in.

DO hospitals really run like businesses, with acceptable risks and losses? Is collateral damage (sentinel events, poor patient outcomes) expected when executives make these staffing decisions? I understand that healthcare has become a great business, but bottom-line thinking does not work for nurses who expect proper staffing so that they can deliver not only acceptable but exceptional healthcare...The Right Way..

Maybe Joint Commission should consider SAFE STAFFING as one of their resolutions when they are handing out all of their other mandates....

An Article from the Nursing Center--Nurse Staffing and Inpatient Hospital Mortality

SPECIAL ARTICLE

Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., R.N., V. Shane Pankratz, Ph.D., Cynthia L. Leibson, Ph.D., Susanna R. Stevens, M.S., and Marcelline Harris, Ph.D., R.N.

N Engl J Med 2011; 364:1037-1045March 17, 2011

Nurse Staffing and Inpatient Hospital Mortality

BACKGROUND

Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because they have not shown a direct link between the level of staffing and individual patient experiences and have not included sufficient statistical controls.

RESULTS

Staffing by RNs was within 8 hours of the target level for 84% of shifts, and patient turnover was within 1 SD of the day-shift mean for 93% of shifts. Overall mortality was 61% of the expected rate for similar patients on the basis of modified diagnosis-related groups. There was a significant association between increased mortality and increased exposure to unit shifts during which staffing by RNs was 8 hours or more below the target level (hazard ratio per shift 8 hours or more below target, 1.02; 95% confidence interval [CI], 1.01 to 1.03; P<0.001). The association between increased mortality and high patient turnover was also significant (hazard ratio per high-turnover shift, 1.04; 95% CI, 1.02 to 1.06; P<0.001).

CONCLUSIONS

In this retrospective observational study, staffing of RNs below target levels was associated with increased mortality, which reinforces the need to match staffing with patients' needs for nursing care. (Funded by the Agency for Healthcare Research and Quality.)

Is this a surprise for anyone? Really?

I have read many studies that show a correlation between proper staffing an many sentinel events, i.e., not only patient mortality, but, medical errors, patient falls, pressure ulcers, and increase in infections as well.

And, OOPS..by the way, these studies have also shown that proper staffing also improves nurse satisfaction and decreases turnover rates...

My oh My, what a revelation and a shame that such a study is needed.

Did U Ever Feel?--5

Just a thought,

That you just want to laugh out loud at all the people who come in the ER and say they are going to sue (i.e., you, the doctor, the hospital), somebody. More often than not it is the baker act who never takes drugs and only had two beers (odds on a positive urine drug screen), or the drug seeker who only dilaudid works for, or the entitled toothache , chronic back pain, or hangnail, who believes they are the most important person in the ER and should never have to wait.

One thing I have learned over the decades that I have been a nurse and the work I have done as a legal nurse consultant, is:

1) Damages have to occur for there to be a legal case

2) I have yet to see chronic pain or waiting actually kill anybody or cause damages (When I have to Yell clear in such a case, I may rethink the issue, at least after the 2nd time)

3) No one has ever had just two beers when they come into the ER, and only the truly psychotic, some diabetics or very critical head bleeds end up baker acted and have clean urine.

4) When the patient has an allergy list a mile long mostly consisting of pain medications except dilaudid, then they may really only need time and therapy.

5) When the lawyer on speed dial, bet even the lawyer doesn't answer that phone call...

The best and most true scenario of way too many ER Patients. Usually not even faking a seizure, but some complaint, to encourage the delivery of some narcotic or benzos...

http://www.youtube.com/watch?v=_m64cy1MMPg

Re post

Here's a question:

How many nurses believe that point-of-care testing should benefit the staff that draws the blood, runs the tests and trouble-shoots the machinery???

I vote for Nursing Revenue from POC testing.

From the ANA SmartBrief-14

Patients favor nurse help lines for communication, poll finds
A Capstrat-Public Policy Polling survey found patients favored using nurse help lines for communication, with 72% saying they would use it if offered and 55% expressing interest in online nurse advice. The survey also found that although 85% of responding patients said they wouldn't use social media to talk to their doctors, many said they are open to using the Internet to access their health data, pay bills or schedule appointments. Healthcare IT News (3/24)

We are told in the ER not to give medical advice on the phone, so we use a 1-800-Nurse line. The answers from them are generally to come to the ER, if the patients use it, but they frequently get very upset that we will not give them advice on the phone. And they repeatedly call back hoping to get a different answer from someone else.

I feel they are a great idea but not well utilized in that it seems for patients to actually call their own family doctor is not advised where sending them to the ER is...Are the answers standardized and pre-written?

Did U Ever Feel?--5

You are a nurse. You love your job; the love, the caring, the responsibility, the autonomy, the time to get to know your patients and to work to make them feel better and if everything goes well, the chance to see them go home and live healthy and happy lives. Many times you may have helped them through a harrowing and life-threatening experience, maybe you were able to help bring them back from the brink of death, or maybe, just maybe you were able to make their passage into the next life a peaceful and respected journey. Everyday you work, you help patients, families and doctors, and also your co-workers and managers; and everyday you come in you deal with their expectations and frustrations.

As nurses, we have been taught to be care-givers, listeners, organizers, nurturers, decision-makers, and to be so many other ideals. It is part of being a nurse to give care and consideration to the many people we are consistently responsible to and for, the kind of care they expect and have a right to.

The nursing shortage and recent staffing ratios instituted by many facilities has made giving the right kind of care next to impossible. There is no longer time for all we have to do, more often than not; we are leaving patients in unsafe situations.

This article compares various researchers and their findings on the effects of nurse staffing and the outcomes, difficulties and dangers patients have faced and still face today. “The parallel is astounding. In the late 1990s, modern nursing was under attack from the consulting firms that promoted radically ‘restructured’ care modalities to reduce the costs of patient care. For example, Byron Erwin, President of the APM Consulting Firm, insisted that there should be no nurse above the level of head nurse in any facility (Erwin, 1994)” Curtin (2003). Florence Nightingale was similarly persecuted by Parliament when they tried to blame her for the increase in deaths at Scutari hospital; she was able to exonerate herself by proving the unsanitary conditions in the hospital caused the deaths, Curtin (2003 pg.1). “…Seago (1999) demonstrated that utilizing lower paid nursing assistants to give care actually increased costs. Sovie and Jawad (2001) studied 28 university hospitals that had undergone restructuring and reengineering and found that patient falls increased as nurse/patient ratios increased, while patient satisfaction with pain control decreased as nurse/patient ratios increased” Curtin (2003 pg. 2). In the last five years several studies have been done and they have clearly indicated that there are more patient complications and poor outcomes when nurses are staffed with increasing patient numbers, especially in intensive care units with 1:3 or 1:4 nurse-patient ratios. In another study that included financial risk, these ratios have also been shown to increase hospital costs.

“Dimick and colleagues linked hospital discharge data to a prospective survey of organizational characteristics in the intensive care unit-an indicator that some environments are predictably therapeutic, while others are just as predictably toxic” Curtin (2003 pg. 3). Part of being therapeutic means having nurses with greater autonomy, more nurse control of the unit budgets and resources, and positive communication and collaboration with doctors and the rest of the team providing care for the patients. Studies show that therapeutic environments encourage patient outcomes and toxic ones slow the healing process and increase mortality. “…A higher proportion of hours of care provided by registered nurses was also was associated with lower rates of pneumonia, shock or cardiac arrest, and ‘failure to rescue,’ which was defined as death from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep vein thrombosis” Curtin (2003 pg. 5). Study after study shows that a higher nurse/patient ratio (i.e. 1:2 in ICU and 1:4-6 on the floor) significantly reduces the risk to patients and the adverse affects of their stay. “Results demonstrated that the odds of patient mortality increased by 7 percent for every additional patient (over 4) in the average nurses workload. The same increase in odds was evident with respect to the failure to rescue rate” Curtin (2003 pg. 6).

Several other studies found that staffing and nurse turnover are heavily related to the outcomes, length of stay, and increased hospital costs. Institutions that provide better ratios have less nurse turnover and experience less undesirable patient outcomes/sentinel events, thereby decreasing hospital costs. Just the costs of orienting new nurses would decrease with fewer turnovers.

Nurses’ education has also proven to affect the number of poor patient outcomes. “A 10 percent increase in the proportion of RN’s across all hospital types was associated with five fewer deaths for every 1000 discharged patients” Curtin (2003 pg. 7). Another study showed that “A 10 percent increase in the proportion of nurses holding a bachelor’s degree was associated with a 5 percent decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue” Curtin (2003 pg. 7).

“Only nurses can nurse, but administrators create the environment and circumstances within which care is given. If the environment is toxic, nurses will leave, patients will suffer, and in the end, hospitals will lose the money they are trying to save” Curtin (2003 pg. 8).

In conclusion, many nurses feel that most administrations care more about the bottom line than the nurses, and therefore, the patients’ well-being. This would be a result of the non-nursing administrators operating the institutions around this country. With better staffing ratios, patients will receive the care they expect and deserve. Nurses will be able to, if not prevent, at least delay sentinel events, leading to improved patient outcomes. Increasing nurse/patient ratios, encouraging autonomy and allowing nurses more control of their environment and responsibility of its operation will decrease nurse turnovers. It will make them more concerned in maintaining good relationships with doctors and various other co-workers involved in the patients care. With such autonomy and accountability, more nurses will seek higher levels of education and professionalism, and the result will be better patient outcomes, lower hospital costs, and a decrease in continuing nurse shortages.

References

Curtin, L. L. (2003, September 30). An integrated analysis of nurse staffing and related variables: effects on patient outcomes. Retrieved May 8, 2005, from Online Journal of Issues in Nursing Web Site: http://www.ana.org/ojin/topic22/tpc22_5.htm

NP clinic is part of city's plan to cut health costs
Federal officials and residents in Camden, N.J., celebrated the opening of a nurse practitioner-staffed clinic at the Northgate II subsidized residential complex for elderly and disabled people. The clinic is part of a citywide initiative to reduce health care costs. The Examiner/The Associated Press (3/22)

This is the way of the future for many nurse practitioners and the many nurses pursuing this field. Fewer and fewer college students are choosing medical school as their future while many colleges are promoting the doctoral pathway for nurse practitioners.

A program that may enable nurses to hang their own shingle and provide care to the great number of patients expected in the future. The current baby-boomers are expected to be the greatest population of the elderly and sick. Nurse practitioners are one answer to this coming epidemic.

Another issue to be addressed is the fact that many colleges have limited resources and spaces for nurses who have already obtained a MSN degree to pursue the Nurse Practitioner certificate. There should be fast track options for this pathway, for nurses who have paid there dues and have many experiences.

Though the trend seems to push (fast track) nurses out into the profession with no dues and little experience. There seems to be an abundance of offers to promote fast education for those with little knowledge, and those who really should experience some nursing practice before expanding...

Consider offering opportunities to nurses with experience without penalty for already having experience.

Fast track MSN's to the Nurse Practitioner Certificate Programs

From the ANA SmartBrief-13

Study underscores need for nurses to speak up on safety issues
A 6,500-participant study found 58% of nurses who had encountered a patient safety warning did not report the problem. With regard to events that almost or actually harmed patients, only 17% of nurses who had seen a dangerous shortcut and 11% of those who had encountered an incompetent colleague reported the case, according to the study. The researchers said the culture of silence is many hospitals can undermine the effectiveness of medical error prevention efforts. U.S. News & World Report/HealthDay News (3/22)

A symptom of this is the way many new and returning nurses are being pushed out into the profession...So many advertisements today show how fast you can become a nurse or increase your education in less time...Where does the experience come in, the chance to even get the baseline gut feelings most older nurses have that SAVES lives..Too many nurses today do a lot of things because someone else told them that's the way to do it, with very little explanation for why it needs to be done and the theory behind it....

I always train new nurses to NEVER do anything without KNOWING WHY they are doing it...And Always Ask!!!

Another symptom of this problem is that many older nurses are still in the mindset, that it is better to deal with situations internally and are still afraid of the disciplinary process...Yes many facilities have tried to make it kinder and friendlier but too many nurses burned in the past will hardly trust the new system and newer nurses still see the process as accusatory and unsupported to making real changer to make practice safe...

From the ANA Government Affairs

The big day is finally here, Health Care Reform is one year old!

Exactly one year ago today President Obama signed the historic Affordable Care Act (ACA) into law, paving the way to desperately needed insurance coverage for over 30 million uninsured people across the country.

Thanks to the ACA, insurers cannot drop or deny coverage because of pre-existing conditions, children up to the age of 26 are now allowed to stay on their parent’s insurance plans, and Seniors are protected from the Medicare “Donut Hole” that threatened so many of our most vulnerable citizens. These are just some of the initial life-changing benefits that are cause for celebration today.....

Things that make you go Hmmmmm...Yet his plan is also to take benefits away from seniors WHO HAVE ACTUALLY EARNED through years of working and paying taxes their deserved Medicare...So yes lets take from them and increase their deductibles and prescription costs to provide for all of those who have never worked a day in their lives...

Here's a CLUE, don't increase my costs to pay for others...

Consider this..Lets pave the way for the uninsured by having insurance companies take a small portion of their earnings (say 1%) and yes even their upper management wages lowered t provide for the uninsured..There is a thought not many have proposed, and insurance companies having the best lobbyists in the world, OBVIOUSLY, because no one suggests their aid in this matter...It always seems to be aimed at the already paying too much for insurance consumer...

CONSIDER new clues to this matter...

Did U Ever Feel?--4

That the whole idea of there even being a work ethic is non-existent

I am seeing this today not just in my profession but in the 20-30's age groups.

Too many of the entitled seem to think that when you are hired for a job, they really are not expecting you to work, do your job, oh by the way, actually show up and on time...Oh MY, they can't mean that...Really???

These are the same people that take life for granted, and that every mistake or mess-up, MUST be someone else's fault.

YOU really don't have to be loyal to your workplace..These days so many places do not encourage your loyalty as they continue to place you in unsafe practice conditions and seldom consider your true worth and needs, but you should be loyal to your co-workers...

Personal Responsibility should be the key words for out future generations, including the personal responsibility for healthcare choices...THEY need to pull themselves up by their bootstraps and do the right thing...Maybe give them some boot straps instead of welfare THEN norplant and vasectomies for the rest....

Just a thought, but, Has ANYONE gotten their mortgage paid or a new car since the last major election???

Things that make

From the ANA SmartBrief-12

Hospitals try ways to reduce nurse interruptions
The Virginia Mason Medical Center in Seattle uses signs, red tape and other visual cues to help reduce the number of nurse interruptions, particularly during medication administration, and increase the time they spend at the bedside. Hospitals participating in the Transforming Care at the Bedside project are also working to reduce such interruptions by encouraging patients to take a "quiet time" that allows nurses to chart and advising family members to call at certain hours to reduce the number of pages throughout the day. NurseZone.com

Reducing interruptions is a fine thought for practicing safely... now maintaining safe staffing can also limit reduction of things that slow the flow of patient care. And maybe, just maybe nursing satisfaction will rise when nurses are allowed the time and opportunities to provide the kind of care that so many nurses go into this profession to give.

From the ANA SmartBrief-11

Nurses can help prevent falls, infection and medication errors
Nonprofit Innosight Institute's Dr. Jason Hwang says nurses can play a significant role in helping patients avoid three adverse events in particular: infection, falling and drug administration errors. Because nurses spend a lot of time with patients, "they have the biggest opportunity to impact patient safety," said Children's Healthcare of Atlanta's infection prevention manager J. Renee Watson. NurseZone.com (3/17)

Another consideration that requires safe staffing ratios and better yet nurse satisfaction...Wonders never cease when it requires maintaining actual standards for your nursing staff.

Many studies have shown that simply providing safe staffing ratios drastically limits the above incidents as well as many sentinel events. Another time for the CLUE Game...

Nurses need to Take Care of Nurses-6 cont.

Here are a few ideas;

1. Pay nurses commensurate with the years of experience they have and for the advanced skills they may have, making them the competent nurse, that all patients want at their bedside, i.e. balloon pumps, intracranial lines and other invasive monitoring, life-saving drips, just to name a few.
2. Instead of reprimanding nurses for using sick time, frequently after working many hours of overtime. When an amount of overtime is put in by a nurse, give them a free sick day, that won’t count against the often ridiculous limits set by many institutions (you’re only allowed to be sick 3-4 times a year in many settings).
3. Free meals for those working overtime and may have been to busy catching up on sleep to make a meal or get to the ATM.
4. If you want one color for uniforms in an institution, let that institution provide the scrubs, etc. Just think how many viruses, etc. may not be taken out into the community.
5. Very few nurses take all of their vacation time, if they take it at all. Work with your community to get some good deals for your staff, i.e. vacation plans, dinner certificates, etc.

These are just a few ideas; there are so many things that can be done to make nursing better for nurses, and therefore only making it better for patients. If there were more advocates making nursing a better place to be there would be less need for patient advocates. That is a nurse’s primary role and should be at the forefront of any decision made, not something that over time has been made more and more difficult to achieve due to the shortage and the stresses that have ensued.

Nursing doesn’t have to be Disney World (the Happiest Place on Earth), nor is it expected, but everyone should be able to look forward to coming to work, not wondering how bad it is going to be and how much you probably won’t get done.

From the ANA SmartBrief-10

Hospital culture influences heart care performance, study says
Yale researchers learned that hospitals in the top 5% and bottom 5% of heart care didn't have many differences in treatment protocols but had gaps in "strong organizational culture" and approaches to quality improvement. Top-performing hospitals had lower nurse turnover rates, used mistakes as a learning experience, and valued the opinions of nurses and other staff, according to the study in the Annals of Internal Medicine. The Wall Street Journal/Health Blog (3/15), Nurse.com (3/15)

Oh My!! What a surprise that a hospital that values their nurses and their opinions AND has low turnovers in staff, actually is a TOP-performing hospital. Nursing satisfaction is important...May be one day these places that under-value their staff will not need the Game CLUE to actually get one...

Nurses need to Take Care of Nurses-6 cont.

True retention programs need to be instituted, that reward experience and learning. In doing research on the internet and reading professional magazines, there doesn’t seem to be a retention program that is working.

It was not too many years ago, that it seemed to be a trend to weed out experienced nurses for newer “less expensive nurses” and that has only increased the shortage and not made the situation any better.

Now graduate nurses are making only a few dollars less than nurses with many years of experience. That is not only insulting it is ludicrous. That someone with no experience is more highly valued than well-experienced and learned nurses. It is understood that the field of nursing needs to be made more attractive to welcome people into the field, there also needs to be a higher value placed on the nurses who have stayed in the field through good times and bad, continued to learn new skills and maintain previously learned skills, and tolerated years of callous and often seemingly uncaring management. There need to be programs to bring back older nurses, who can more likely than not renew old skills and learn new ones, than the new nurses coming in. The way nursing staffing and other issues are now, will only drive them back out of the field, and if you look at the way it is going, it will drive out the new nurses too.

“Reality Shock” is just as prevalent as it has always been in this field, as the short-staffing, challenges and responsibilities continue to grow, disproportionate to “joys of nursing” not to mention the wages and benefits of this profession.

So many institutions of caring have long seemed to feel that nurses are easily replaceable, “a dime a dozen”. This attitude is one of the biggest factors in creating the shortage nursing now faces. They have persisted in stretching staffing to the point of unsafe work situations; they rarely have true standards in place to protect the nurse-patient ratio to the patient’s best interest. Usually it is in the interest of the institutions budget, not the patients’ right to receive the care they come in for and deserve.

Nurses need to Take Care of Nurses-6

A Nurses View of the Shortage…

As a nurse of over 20 years, there have been many changes.

Nursing continues to be a fulfilling and rewarding profession and one that’s easy to love after all of this time. Taking care of my patients and their families, making them feel better and helping them through the illnesses and life threatening diseases that often bring them to the hospital makes coming into work every day worth it. Their care often includes making snap-decisions that will help save their lives and being proficient in medications and life-saving equipment is only part of why experienced nurses are important. Sometimes the care also includes helping them on their journey to a better place, to “go gently into the night”. There are so many parts of what it takes to make the caring, supportive and knowledgeable nurse.

The decades have continually increased nursing responsibilities, experience and education. Along with this there has been very little compensation, respect or appreciation in a profession that is facing a severe shortage. Understaffing continues to be looked as a “just deal with it” issue, and when concerns arise that patient safety is compromised, many are told, “if you don’t like it you can leave”. More and more responsibility and patient load is added to nurses’ shoulders, and they can barely manage the care they have to give, much less the care they want to give. That extra TLC that can be given when time allows, often when the nurse may not have even had a chance to grab something to eat or drink, or make it to the bathroom, when all shift you have been wishing for a leg bag, is often put on hold for the next crisis taking precedence.

Well, nurses have been leaving for years, and can now leave easier than ever.

From the ANA SmartBrief-8

Study examines how nurse staffing affects patient mortality
Data from about 200,000 admissions and 177,000 nursing shifts found that patient mortality risks climbed 2% in units with inadequate nursing staff and 4% when high patient turnovers increased nurses' workloads. "Hospitals need to know what their nursing needs are for their patients, and they need to bring staffing into line," said Jack Needleman, senior author of the study published in the New England Journal of Medicine. HealthDay News (3/16)

As a nurse of over 20 years, there have been many changes.

Nursing continues to be a fulfilling and rewarding profession and one that’s easy to love after all of this time. Taking care of my patients and their families, making them feel better and helping them through the illnesses and life threatening diseases that often bring them to the hospital makes coming into work every day worth it. Their care often includes making snap-decisions that will help save their lives and being proficient in medications and life-saving equipment is only part of why experienced nurses are important. Sometimes the care also includes helping them on their journey to a better place, to “go gently into the night”. There are so many parts of what it takes to make the caring, supportive and knowledgeable nurse.

Nurses need to Take Care of Nurses-5

Nurse accountability is integral to professional nursing. Every nurse should know that with every decision and action made she/he is the one who is ultimately responsible for the patient outcomes related to those decisions and actions. Patient safety and well-being; optimization of their health and enabling the patients return to a normal functioning status should be inherent to any plans or procedures performed. Autonomy requires exercising informed judgment and competence that generally only comes with experience and time. A part of that use of autonomy is knowing when to call for help and/or call the doctor, especially, if the avenues of choices from standard orders have been exhausted. So many decisions and actions that every nurse performs on a daily if not hourly basis. Each time the patient's welfare is being considered.

This is just another reason that NURSES NEED their own ADVOCATES...

Patient's have the whole alphabet in advocates and they BEGIN with Nurses...

Nurses should be advocating for themselves as well and be involved in all decisions regarding how they practice. Whether it is in their workplace and more importantly in the political arena...Get Involved...

Health Care for the Future of the Aging Population-4

A plan for adding alternative therapies to the comfort measures in place for patients in EOL situations will provide greater options in providing care. The complementary treatments such as music therapy, aromatherapy, massage, and healing touch provide significant levels of comfort. The therapies soothe patients in terminal care conditions, stimulating fond memories through scents and music and promoting pain relief via massage and healing touch. A strength is that both aromatherapy and music therapy can be provided for minimal cost expenditures. Providing both of these touch therapies could be accomplished for low to moderate financial requirements. Healing touch can be an option for patients during any bathing, turning, or moving procedures. Aromatherapy and music can be supplied to the patients at regular intervals around the clock. Massage therapy can be incorporated into the physical therapy regime for EOL patients and healing touch can be taught to the nursing care providers at all levels. An additional strength is that none of the treatments have significant risks nor will the therapies interfere with intensive care unit functions, care provision, or equipment, the staff may also benefit from the comfort provided.

Some weaknesses of the plan will include resistance and opposition by staff members to an increase in the workload if the plan does not incorporate the time required by the touch therapies. Aromatherapy and music therapy should not increase work requirements as long as the supplies are available. Another weakness may be in the lack of understanding by patients, families, and staff of the benefits of these treatments. Seeing them as giving up or encouraging death will be some views of the therapies and palliative care that will need to be addressed. Educational programs will be one of the significant costs to implementing the plan.

Opportunities of the strategic plan to implement complementary therapy into palliative care programs of ICU’s include the chance to educate the healthcare providers, public, insurance providers, and the community as a whole. The education should include not only responsible decision making for EOL health conditions but being able to choose the comfort measures desired when a terminal situation arises. Preparedness is a better measure for the increasingly sick population that will be seen in the coming years. Implementing these simple and noninvasive alternative measures into the comfort care of the dying will open the doors to integrating other complementary therapies into more healthcare situations. Here will be a chance to educate administrators and upper management about alternative treatments that often are paid for out of pocket by clients and that patients seeking these therapies will provide revenue to the facility.

From the ANA SmartBrief-8

Nurses are key players in the field of health research
Nurse researchers have made big contributions in investigating the causes of diseases, pain management and quality of life during end-of-life care through evidence-based studies ranging from animal tests to the use of assessment tools. "There are lots of funding opportunities and needs for more research to better guide care," said researcher Deborah McGuire. NurseZone.com (3/11)

The populations of every community are aging and becoming progressively more ill. Personal responsibility for healthcare choices in addition to having more options available will be issues for the aging and ailing baby boomers. This population will flood healthcare facilities a tremendous number of patients with end-stage organ diseases. End-of-life (EOL) preparedness and choices need to be part of the plan for many diagnosed conditions. Comfort care “refers to care that is designed to provide comfort and dignity when curative therapy is no longer appropriate. It includes the process of relieving pain and suffering, and controlling debilitating symptoms, while not preventing the patient from dying”. More research and education of the public is needed to promote the right to die with comfort and dignity.

Nurses need to Take Care of Nurses-4

To improve political activism in nursing workforce conditions and practice issues, nurses need to be involved and aware. All levels of nursing should be involved in this process; student nurses, licensed practical nurses, registered nurses and advanced practitioners. From contact with the department of health, just in the Jacksonville area alone, the number of nurses, totals over 14,700 nursing professionals. This could be a powerful tool for improving working conditions and protecting professional practice if even a portion of these nurses become more involved and today much of this can be done through the point-and-click method.

When politicians make decisions about how nurses practice and the situations they work in, the time is now to be more aware and involved in the politics of nursing. Politicians should be educated by nurses about nursing issues.

The main feeling that many government representatives have about nurses, is that they are not organized, and that being organized is the best way to get your interests heard.

Many legislators have regular delegation meetings that often address issues and particular groups; this is one option for nurse involvement.

Helping legislators with their campaign is a good way to stimulate interest in sensitive and important nursing issues and does not require money. Congressional representative Patterson said “sweat equity” is as much or more valuable. Walking neighborhoods for a representative that is willing to listen and possibly help nurses with an issue important to you, time allowing, is an easy chore. Other options include steps as simple as stuffing envelopes or putting a sign in the yard, which he said, is often hard to get people to do.

Have well-spoken representatives (Nurses) are needed to speak in committee hearings in Tallahassee

Summertime is the key time to present issues of concern to legislators; they have recently completed the sessions for the year and are back in their home districts. This is the time to present new issues.

Know your legislators; their past successes and failures in healthcare issues, the issues they have supported or been against in the past, and know when key committee hearings are taking place.

From the ANA SmartBrief-7

Experts outline how to reduce health care work-related violence
Nursing experts suggest that hospitals should work to identify risk factors of patient violence and create a culture of safety, including a post-incident response and support net. Nurses should also work in pairs or groups and be trained "to recognize when the situation is escalating and how to keep themselves safe," says Nancy L. Hughes of the ANA. NurseZone.com (3/4)

Does your facility keep you safe?

Do they support you by prosecuting those who threaten you?

Things that make you go HMMMMMMMMM...

From the ANA SmartBrief-6

Workplace violence continues to be a risk for nurses
Although hospitals have implemented more safety rules and states have toughened assault laws, nurses and other health care professionals are still more likely than most other workers to experience violence at work. The National Institute for Occupational Safety and Health is working on a best-practices course, which will be accessible in 2012 through the ANA and the NIOSH websites, to educate health care providers about workplace violence prevention. The Atlanta Journal-Constitution (2/22)

Does anybody actually have a facility that will prosecute the patient's and families that feel they are entitled to threaten nurses, or be verbally and physically abusive towards them?

We have big signs saying it is a Felony to threaten or assault the nursing staff, but when it happens, they refuse to actually do anything and the police do not even want to take a statement.

Why is it okay for these people to get away with this? I understand the emotional strain of being in the hospital...But it is not NOW or EVER OKAY to act this way unless truly demented or psychotic...Just being an impatient rude jerk is intolerable, and even the alcoholics and drug users know how they are behaving and who they are threatening..these people are just not right... and it should not be tolerated, especially when you are trying to help them.

Really...I know the facility I work at did not send them an invitation to come there, nor were they promised drive through medicine or narcotics, and this place is not named The Marriot or McDonalds...

What can nursing do to care for themselves and their own?

The nursing shortage is a danger to healthcare on multiple levels; to the future of safe patient care delivery and professional practice, in addition to nursing workforce issues. The numbers vary weekly, but have been noted to be over one million nurses short to provide care in the next one to two decades. Aging baby boomers increase the risk and the numbers. States across the country are bringing more politicians into the nursing practice with laws created that decide practice issues. These laws cover multiple workforce situations that are being decided by politicians, from safe patient handling to the publics right to know, and various other issues effecting our practice, including staffing ratios. Now, one thing that lead me to this path is a firm belief that the bedside nurses, who GIVE their hearts and souls 24/7 providing skillful and knowledgeable care comfort and compassion SHOULD NOT have to worry about what kind of situation they are driving into, when coming to work. The legislators deciding these issues are often basing their decisions on very limited knowledge of nurses and how they practice or experiences they have had in the past with nurses, or worse yet, what they know about nurses is based on stereotypes (like TV shows like Scrubs and ER) and very little reality. Not being involved in the politics of nursing can leave the decisions of how we practice up to people with little knowledge of nursing issues and the situations surrounding the workforce today.