From the ANA SmartBrief

DNR orders are tied to worse surgery outcomes, study finds
Researchers found that almost 25% of patients with do-not-resuscitate orders died within a month of surgery -- a percentage almost three times higher compared with a control group -- although the outcomes varied based on surgery type. The study in the Archives of Surgery also found a higher number of complications, such as pneumonia and stroke, among those with DNR orders. Reuters (4/18)


Are all of these, not risks of surgery, even for the healthy?
Most DNR patients have this status for a reason, and these days, many more people are simply planning ahead. In any hospital, How many times a day are Advanced Directives addressed? Major surgery needs to be seriously evaluated with any patient who has major illnesses to begin with, and we all know they seldom have just one body system failing after a certain age.

Did U Ever Feel?

That nursing should have many more possibilities than currently available...Just to review..Here are some new and previously posted issues;
1) Yesterdays post about nurses being able to charge for individual services would set up a more professional standard than the current situation of just being part of the Hospital charge. We deserve our own place in healthcare.
2) A federally funded nursing retirement plan: This could not only improve the influx of people into the profession, but also be a great benefit to nurse retention, especially if it includes past service and years of experience. This could bring nurses back to the bedside; if they were assured of having a dedicated plan for the years of service (Nurses who have left the profession after i.e. 12 years of service come back for eight years and have a full retirement). AARP recently noted that less than 60% of nurses have retirement plans. This federal plan would be portable from job to job. Facilities could enhance retirement benefits or provide other inducements to the profession with the funds currently in use. IF railroad employees, teachers, firefighters, and police officers can have full retirement after 20 years, WHY have nurses been left out? The nurses I have presented this idea to most frequently ask me that question. WHY is this idea not already in practice?
3) Increased political awareness and interest for nurses. Facilities should have a dedicated position related to nursing politics. I have talked to many coworkers and they agree that knowing more about how their local, state, and federal politicians vote on issues regarding nursing would affect not only their voting participation but how and who they voted for. (i.e. IF you believe patients and families have a right to know what SAFE staffing ratios are and how those ratios affect patient safety and care, in addition to how the facility they are currently admitted to staffs their floors, then a politician votes against a bill that promotes these issues, Would you vote for that politician?? And another NOVEL Thought...
4) An agency that monitors the dangers and RISKS that nurses are often subjected to: to have written protocols and standards of what constitutes patient safety in relation to acuity and ratios. (i.e. What constitutes a 1:1 patient, a 2:1 patient, a 4:1 patient???). One that monitors how often those standards are not met and why. How to make it better to keep nurses at the bedside.

From the ANA SmartBrief

RN staffing levels can affect readmissions, study finds
Hospitals using more non-overtime registered nurses reduced the risk of patient readmissions because the RNs had more time to teach patients how to manage their health conditions after discharge, according to a study funded by the Robert Wood Johnson Foundation. The report in the journal Health Services Research also found hospitals that had higher levels of RN overtime had poorer discharge outcomes and more ED visits in the 30 days after discharge. Center for Advancing Health/Health Behavior News Service (4/26)


Another BIG surprise and OH My!, Another article on staffing and it's effect on patients...
What possible part does poor staffing play on nurses? Required overtime? Stress? Fatigue?
What possible part does poor staffing play on patients? Falls? Medication Errors, Pressure Ulcers?


Let's face it folks, there are only so many hours in a day and only so many jobs can be done in that time. Even the well-rested, not working overtime nurse can only complete so many tasks.


And guess what...Nursing satisfaction effects patient satisfaction...The two go hand in hand...
LOL..Like
Beaches and sunrises
Peanut Butter and Jelly,
Life and Death


And just like that Nursing Satisfaction effects the number of sentinel events that occur...Saving lives is intrinsic to nursing, but just like having equipment that works properly, the HEART machine that is Nursing Care, needs to be Right too...

Do you Care who ADVOCATES 4 U??? Is Nursing killing you?

Is your nursing job killing you? Many would say slowly, and surely...
Is it the hours? The always safe (NOT) staffing? The increasingly entitled and demanding patients? Along with the patients who are truly sick and do need to come not only into the ER but need to be admitted? The increasing demands with little to no compensation?
You can always expect to have more work and more often than not, No increased staffing or reduction in responsibilities when new ones are added...:-) what could I be thinking.
An article I read recently suggested that Yoga could be the answer for the stressed out nurse, again I laugh at this answer, just thinking about it...
I do truly believe that to have a massage or yoga session that can reduce stress is a Great idea, but nevertheless, it will never fix the problem. 
One part of the article notes that nurses are afraid to have a voice, afraid to lose the job that could very well be leading to their own demise... 
What I say?? Does it take to get nurses involved in their own advocacy???
The standard answer I hear is that they (hospitals, administrations, etc.) Will NEVER change..
Well it is time to be your own voice and change them...There is not enough lubricant in the world to just keep bending over and taking IT...
Nursing shoulders are huge, but We ARE NOT ATLAS, and should not keep being expected to add more and more changes and procedures and lack of staffing without having a voice in the decisions made that effect our work and safe practice. We cannot carry the weight of the world on our shoulders. We need to be the MAIN ingredient in the change process for Healthcare.


NO One has paid my mortgage or bought me a car, yet more and more taxes are coming out of my paycheck. And more and more responsibilities are added, sometimes on a monthly if not weekly basis in my work situation.


Here is a NOVEL concept, if doctors and other care providers can charge for each procedure, Why are nurses not charging for every level of their care? Why are we still just part of the HOSPITAL Cost? We do more and more, from bedpans, to Swan-Ganz catheter and drip management. And so many more life-saving and death preventing measures that are intrinsic to nursing. Let's change the way we are not only treated but change the way we deliver care.


We are professionals that deserve the proper compensation..How much autonomy and ownership of our practice could this idea provide????


See one of my first Blogs for the nursing retirement proposal.

From the ANA SmartBrief

AHRQ reports 52% rise in drug-related adverse events
The Agency for Healthcare Research and Quality reported that the number of drug-related hospitalizations in the U.S. increased from 1.2 million to 1.9 million from 2004 to 2008, with patients age 65 and older accounting for 53% of such hospitalizations. Unspecified medicines and painkillers led the way for the most cases of emergency department visits while corticosteroids made up the biggest share of hospital admissions for drug-related side-effects and injuries, the report found. Nurse.com (4/18)


Any one surprised here??? Can you say Dilaudid?
But Steroids???Hmmmmm
Here is my personal favorite and why is it still on the market? Lisinopril??? Too many other options to keep one around that has such adverse reactions...Wonder where this one is on the list???

From the ANA--NSTAT--Interesting stuff

Should exposure to harmful chemicals be a part of your daily job as a nurse?  Should you need a Ph.D. in Chemistry to know what products are safe for you and your family? 

ANA doesn’t think so.  If you agree, we need your help! Ask your Senators to co-sponsor legislation to put common-sense limits on toxic chemicals today.

The Toxic Substances Control Act (TSCA) was enacted in 1976 to regulate the use of chemicals based on their risk to human health or the environment.  Unfortunately, it’s failed to protect us from toxic chemicals almost from the start.  In the 35 years since TSCA took effect, the Environmental Protection Agency (EPA) has been able to require testing on just 200 of the more than 80,000 new chemicals produced and used in the U.S., and to date just five chemicals have been regulated under this law.  Five.

Studies continue to demonstrate the links between these toxic chemicals and serious illnesses that threaten public health, and because of the many chemicals nurses and other health care workers are exposed to in the workplace, they are at even higher risk.
In response, Senator Frank Lautenberg (D-NJ) introduced S. 847 "The Safe Chemicals Act of 2011." This landmark legislation would overhaul the way the federal government protects the public from toxic chemicals.
We need you to ask your Senators to co-sponsor this important piece of legislation. By co-sponsoring the bill, they can show their commitment to protecting workers and the public from toxics. 
Please take a minute to ask your Senator to become a co-sponsor of the Safe Chemicals Act.


NURSES:
More Hazards for working nurses...and Again who is Caring about Nurses?...It is time to make your law makers and politicians part of the solution and not continue to let them be part of the problem

Did U Ever Feel?

That Nursing is just fun? That the puzzle pieces of figuring out what is wrong with someone and using what you know to make them better is stimulating and just enjoyable? Powerful too, when you are right and what you do makes a difference.

Now there are those times where you may feel like you are beating up little old people who do not have the proper advocates. Here is a clue for those who may read this and are not in the medical field:

CPR is NOT Painless...CPR is PAINFUL--to Anyone feeling Anything!!!!

CPR and the majority of life saving measures are Really NOT fun for those who have multiple illnesses or chronic diseases that are killing them..It may simply be old age or a life of fun and extravagance that has riddled their body, but making plans for the future when your body starts to fail you is REALITY in todays world.

All life-saving measures are invasive, often  painful and have the possibility of severe RISKS. Consider how much you want done if you have little hope of not only being cured, but living any kind of LIFE the way you want.

The way your Life ENDS should be your choice ALSO. Nice aromatherapy candles and music, and even massages would be a better way to go then Someone breaking your ribs trying to keep you alive When it is your time. Be aware of your options and plan ahead... 

From the ANA SmartBrief

Joint Commission makes alarm fatigue a top priority
The Joint Commission is making alarm fatigue in hospitals a priority issue this year because of increasing reports that nurses do not hear or might ignore or turn off monitors that indicate patients are having problems. The commission said it will meet with FDA officials, who already are working with industry groups on ways to address the problem. The Boston Globe (free registration) (4/18)


How much you want to bet that this will come to haunt nurses???


Not the fact that most of the alarms are inaccurate and unreliable. The monitor companies need much better designs and settings to recognize all of the static situation versus real life-threatening arrhythmias; this should include the fact that most pulse oximetry monitors are very skin sensitive and movement sensitive. THE Majority of this responsibility should be laid on the shoulders of companies like Seimens, HP, GE and such businesses that provide monitoring equipment.


Now nurses that actually turn off monitors ARE liable and just STUPID...Over time you get to know what sounds are artifact and less important versus the alarm sounds that indicate life-threatening rhythms. You can look at a monitor when it alarms and know when there is a difference just by the sound of the alarm. They need to stay on and be adjusted to get the best possible reading.


Alarms should never be turned off and nurses should always be trained in proper monitoring.


But the machines themselves need better sensitivity and recognition software.

From the ANA SmartBrief

ICUs take simple steps to reduce patient delirium
Hospitals use several strategies, such as limiting sedation, reducing noise and opening window blinds to let in the sun, to reduce ICU delirium among critically ill patients. Arthur St. Andre, director of surgical critical care at Washington Hospital Center, said creating a natural environment, even through music or soothing murals on the ceiling, is important. The Washington Post (4/11)


Administering comfort care measures for all patients with bodies that can no longer provide them with a significant quality of life will support the mission of health care. Instituting such therapies in the ICU’s will not only decrease the costs of hospital stays, but will limit the number of invasive procedures and the amount of pain to patients with limited possibilities of a cure. Palliative care is a program every intensive care unit should incorporate to make the ICU stay a truly gentle treatment.

Re Post...From the early days

Nursing Revolution Survey for nurses interested in a federally funded retirement planis being considered. Those interested please post... The purpose of the study, and how the results will be used. This will be a quantitative study using survey research. The purpose of this study is to discover if a federally funded nursing retirement (a program that will guarantee 50% of retirement income after 20 years of service, and an additional 25% for every ten years of service, up to 100%. This will be pro-rated as decided later.) could help to bridge the gap in the nursing shortage for Northeast Florida. Would it promote nursing retention, longevity, and security for nurses currently working as well as prompting nurses to return to the profession? The results will be used to seek the aid of local, state, and federal politicians in organizing and instituting a nursing retirement plan. As one of the largest workforces in the country that provides caring and professional services to all communities, we deserve a retirement plan. We work long and strenuous hours with tremendous responsibilities and stressors and are justified in seeking this plan.

From the ANA SmartBrief--A few interesting articles

HealthGrades lists top 10 cities for ED care
A HealthGrades quality report released Tuesday ranked Cincinnati first on a "Top 10 Cities for Emergency Medicine" list, followed by Phoenix, Milwaukee and Dayton, Ohio. The cities on the list had the lowest mortality rates for Medicare patients admitted through emergency departments, and the report said patients treated at hospitals in those cities have a 40% lower risk of death than those at other facilities. The Kentucky Post (Covington) (4/12)


Data find heart-healthy benefits of apples in women
Women who consumed one serving of dried apples every day for a year experienced a 14% reduction in total cholesterol, a 23% drop in LDL cholesterol and about a one-third decrease in levels of lipid hydroperoxide and C-reactive protein, while those who ate prunes daily had a relatively smaller reductions in such heart markers, according to a study. The researchers also found that women in the apple group lost about 3 pounds over the course of the year. WebMD (4/12)


HHS launches $1 billion patient-safety initiative
The HHS is allocating as much as $1 billion in federal funds to support its Partnership for Patients program, which aims to save 60,000 lives in three years by cutting rates of adverse events and medical errors. HHS Secretary Kathleen Sebelius said health IT will be key to meeting the goals of the program, which so far has received support from at least 500 health groups. Government Health IT online (4/12) 

Medicare releases report on preventable errors at hospitals
Medicare has released data on eight serious and preventable medical errors that occurred at more than 4,700 U.S. hospitals, based on billing reports for Medicare patients from 2008 to 2010. Falls were the most common preventable error at hospitals, occurring at a rate of one for every 2,000 patient stays, followed by severe bedsores or skin ulcers, according to the report. St. Louis Post-Dispatch (4/7)


Time and time again, report after report, shows that minimizing sentinel events and just providing proper patient care relies on proper nursing care. But in there lies the rub, proper staffing better ensures proper nursing care and the nurses ability to monitor and protect their patients. AND protecting patients is one of the most basic of nursing, it is inherent in any meaning to being a nurse. But you must have the staff to be able to limit medication errors, prevent ulcer development and minimize patient fall risks.


The Game CLUE is not just for children anymore..Anyone affecting these events needs to make staffing a FACTOR. 

Did U Ever Feel?--6

That the kinder gentler/politically correct/BIG Business way of running healthcare is seriously lacking in REALITY. We are supposed to never let a patient think they are less important than anyone else...
Really, because the patient coming in AGAIN for the same cold, toothache, back pain, even headaches and abdominal pain, HAS to be as important as the HMMMMMMM...Acute STEMI, Severe Shortness of Breath, and OOPS, the not so important CARDIAC ARREST....Again, REALLY, and did any of these OH so terrible emergencies fill any other prescriptions other than the narcotics, or follow up with the Recommended specialists.
The answer is 99-out-of -100 times IS a resounding NO.

The Reality is that I tell these people when I am dealing with a critical patient and that I will get their care provided as soon as possible, but that the TRUTH is that the critical and dying come first.
Usually they are understanding and more patient from that time on, and will be treated soon, but, the few who are not, well they may have to wait. These are the ones who are able to stand outside the door and tap their feet, they may even occasionally tap their watch...OH they know how to get things done fast...Right?

Facts are facts and most people understand that the Emergency Room is just that and that Critical  patients are Emergent and so far they are appreciative that I would be providing the same life-saving measures if they or a family member were in the same condition, and they appreciate being made aware of why there is and has been a delay...

Another issue is we are often told not to judge someone else's pain...BUT, I will write down what they say and I will note their behavior...I.E.: the excruciating (#10) abdominal pain who is sitting in the bed, laughing on the phone, and drinking a soda or maybe even eating some fried chicken. What is not to judge in this instance?
I still wonder where some of these ideas come form...Ludicrous is only the icing on top of a very deep cake that is filled with UNREALITY, all in the name if Business and certainly NOT Healthcare...

Did U Ever Feel?--6

That nurses are one of the hardest groups to organize or get them to join forces to better their own situations. We often baulk at the thought of unions. Joining a picket line and not caring for our patients goes against almost every reason we became nurses. Then again, many nurses are working 48++ hours a week, often are single parents or caregivers to elderly parents, and many other reasons getting involved is prohibited. Never the less, since no one is truly advocating for nurses. Now is the time to get involved, politically or any other way that ensures the voice of the bedside nurse.

Nurses need to find a way to advocate for themselves and todays point and click world has made it much easier.
Today you can join organizations that are politically involved and that keep you aware of lawmakers that support nursing issues or help to write bills that promote better nursing workforce conditions. Here in Florida, the Florida Nurses Association has its own lobbyist and stays ahead of the game in trying to make the situations of nurses better.
AND...It can all be done with POINTING and CLICKING...But ALL NURSES Need to get INVOLVED.

From the ANA SmartBrief-19

Survey looks at variations in nurse salaries
The Advance for Nurses 2011 Salary Survey found that California nurses had the highest income and Nebraska nurses the lowest. Data also found some states had higher pay for nurses in academia, while many others paid those in outpatient and inpatient settings more. Job experience, advance degrees and certification were tied to higher nurse salaries, the survey found. NurseZone.com (4/1)


Now if only more employers truly cared about advanced degrees, more nurses would pursue them. But unless nurses are planning to leave the bedside for higher degrees, it is rarely worth the effort to seek higher levels of education, because too many facilities may value it for the prestige, but they do not pay extra for the more educated nurses. If you are in a state that does, you are lucky.
Very few places truly value their nurses to the point that they advocate for their nurses over and above the bureaucracies, agencies or even the physicians...Has anyone even seen such a position posted in any facility. I have worked in a few dozen places over the span of my career and have yet to see it. Would love to hear if anyone has...

WHO Advocates for Nurses?

Does anybody? Really?

Most every NURSE who works, especially in facilities with charge nurses, and directors and such, expects to be able to trust these supposed leaders. Yet, seldom do they truly advocate for the very people they hire and are responsible for. They CLAIM to be advocates; They CLAIM to care. However, that is rarely the case. They follow the bottom line with little regard for the added responsibilities and pressures placed on their staff. Even when they are seriously jeopardizing patient care, they always say just handle it. Or my ever faithful favorite, "Just deal with it or Leave". That really is advocation in motion, caring about patient safety fits right in there too.

This is WRONG, nurses deserve to expect support and caring from their so called leaders and directors. Change processes, protocols and procedures should be decided by those that it affects, at the very least, they should be involved when decisions are being made. But those that make the decisions do not even consider how much stress and added pressures are applied with each new change.

The bottom line does NOT fit in with delivering the kind of patient care that Patients and Families Deserve. Staffing should always fit the levels of patient acuity, and the number of patients that may be treated in a given time.

From the ANA Capital Update-They need YOUR Help And Support

RN Safe Staffing Act Reintroduced in U.S. House of Representatives

ANA-supported Safe Staffing legislation was reintroduced in the House of Representatives on March 2nd. Representatives Lois Capps (D-CA) and Steven LaTourette (R-OH) dropped the Registered Nurse Safe Staffing Act (H.R. 876), which would hold hospitals accountable for the development of valid, reliable unit-by-unit nurse staffing plans. These plans would be established by direct care registered nurses (RNs) in coordination with nursing leadership and based on each unit’s unique characteristics and needs. ANA needs your help to educate members of Congress and build support for this important legislation!

Insufficient nurse staffing is among the top concerns for nurses today. Accordingly, securing appropriate staffing to protect nurses and patients remains a lead priority for ANA. ANA supports the establishment of nurse-patient ratios to address the current crisis, but feels strongly that these ratios must be set, not by legislators, but in the workplace, in direct coordination with nurses themselves, and based on unit-by-unit circumstances and needs. This approach, based on ANA’s Principles for Nurse Staffing, treats direct-care nurses as more than just a number in a ratio. The RN Safe Staffing Act recognizes nurses as professionals and requires that they play an integral part of staffing plan development and decision-making by giving them a say in the care that they provide.

The Registered Nurse Safe Staffing Act would require Medicare participating hospitals, through a committee comprised of at least 55% direct care nurses or their representatives, establish and publicly report unit-by-unit staffing plans. These plans must:

• establish adjustable minimum numbers of RNs;
• include input from direct care RNs or their exclusive representatives;
• be based upon patient numbers and the variable intensity of care needed;
• take into account the level of education, training and experience of the RNs providing care;
• take into account the staffing levels and services provided by other health care personnel associated with nursing care;
• consider staffing levels recommended by specialty nursing organizations;
• take into account unit and facility level staffing, quality and patient outcome data and national comparisons as available;
• take into account other factors impacting the delivery of care, including unit geography and available technology;
• ensure that RNs are not forced to work in units where they are not trained or experienced.

While ANA respects all attempts to address staffing, we have real concerns about the establishment and legislation of fixed nurse to patient ratio numbers in federal or state legislation. Such legislated numerical ratios seem to offer a concrete solution, and may appear to be a good fit for some workplaces, however, so many other variables—factors including intensity of patient care needed, level of experience of nursing staff, layout of the unit, level of ancillary support—are key to establishing the “right” nurse-patient ratio for any one unit.

Regardless of the approach taken, no staffing system or ratio can protect patients and nurses without transparency and enforcement. The RN Safe Staffing Act requires public reporting of staffing information–hospitals would be required to post daily the number of licensed and unlicensed staff providing direct patient care on each unit and each shift, while specifically noting the number of RNs, and data must also be reported the Secretary of Health and Human Services (HHS) for publication on the Department’s Hospital Compare Website. The bill also requires collection and public reporting of quality data related to nursing services.

The bill affords whistle-blower protections for RNs and others who may file a complaint regarding staffing, allowing for refusal of assignment and establishing procedures for receiving and investigating complaints. Hospitals would be held accountable under the RN Safe Staffing Act through enforcement mechanisms including civil monetary penalties that can be imposed by the Secretary of Health and Human Services for each knowing staffing violation, as well as penalties for failure to collect and publicly report staffing and nursing-sensitive indicator data.

We need your help to build support for the RN Safe Staffing Act! Get more staffing information on ANA’s safe staffing website,http://www.safestaffingsaveslives.org/ or jump straight into action by writing your members of Congress or sharing your story through our Take Action page.

Michelle Artz and Rachel Conant

From the ANA SmartBrief-18

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 (3/18)

What a good idea...SO many interruptions during the shift, these only serve to open the door for medical errors and other events. Hopefully this will be a trend that catches on. It is great to be the kinder, gentler healthcare system (Yawn), but the great reality is that healthcare is not just a business. It is still a system that is about saving lives and making decisions that are not always politically correct. All of this, "No Wait ER", "Open Visiting", and such decisions, have the possibility of only putting more pressures on staff and sometimes patients. Considerations should include the bedside nurse and how they can incorporate changes with little interruption to their often already heavy workload. The 24/7 staff nurse needs a voice in all change.