Off to surgery

Then Travel nursing when healed...Plan to Blog about Nursing across the country....
We'll see what it's all about...

On the road to surgery.....

Postings will be limited due plans to have surgery for a torn rotator cuff tear.
Everybody enjoy their summer....

Re-Post Make Nurses Part of the Change Process

More forums need to be in place to allow front-line nurses the chance to help make some changes. This gives the nurses at the bedside the opportunity to voice concerns and if they are wise, they will come with ideas for changes needed, not just the issues themselves but a way to make it better. In addition to the changing views that many facilities are embracing, there needs to be changing views among the nursing-at-the-bedside staff. With professionalism encouraged at every level in facilities, it should no longer be the directors versus those at the bedside; it should be us (being every one of us) for them (being the patients and families that come through the hospitals doors). 

Through increased education, taking pride in being autonomous, improving the collaborative way in which we practice, taking command of our professionalism, and working hand-in-hand everyday for the betterment of our nursing culture, will we be able to improve nursing satisfaction. With these measures, we can ensure patient safety and satisfaction and decrease patient mortality and morbidity.

One other issue to be considered in the face of this looming crisis is that nurse’s work in alphabet soup. JACHO, OSHA, and AHCA are just a few of the alphabet telling us how to do our job and often how wrong we are doing it at varying levels. Where is the alphabet that helps us not work in jeopardy, with unsafe staffing ratio? Where is the alphabet soup FOR nurses?

Re-Post

The ANA supports safe staffing....

Read and follow:
http://www.healthleadersmedia.com/content/NRS-304933/ANA-Backs-Federal-Nurse-Staffing-Bil

Copy and paste the above in your browser for the article...

Legislative Policy & Regulatory News

Senate bill would require reporting of nurse staffing plans
A bill sponsored by Sen. Jeff Merkley, D-Ore., would require public reporting of unit-by-unit nurse staffing plans. The measure would require hospital committees that include nurses to set unit-by-unit staffing ratios. "What works in a rural hospital in my hometown [in North Dakota] may not be the same thing in an urban trauma center. It allows flexibility and it also allows buy-in," said Jerome Mayer, ANA's associate director of government affairs. HealthLeaders Media (5/27)

Here's a sample:

A Senate bill calls for unit-by-unit staffing plans and publicly reporting those staffing plans, but stops short of dictating mandated nurse-patient ratios.

Federal requirements for unit-by-unit staffing plans and publicly reporting those staffing plans are at the heart of the newly introduced Registered Nurse Safe Staffing Act of 2014 (S. 2353), which stops short of dictating across-the-board, mandated, nurse-patient ratios.

Crafted with input from the ANA, the legislation is sponsored by Sen. Jeff Merkley (D-OR) and is companion legislation to a House bill introduced a year ago, the Registered Nurse Safe Staffing Act of 2013 (H.R. 1821).

WHAT Nursing Can Mean

These are only a few of the pressing issues that need to be improved and examined to waylay the oncoming shortage and the danger this presents to the increasingly sick population coming into facilities around the country. Staffing is an issue unto itself and needs extreme measures and policies implemented to ensure patient safety, satisfaction and the care they deserve. Tied to this is nursing satisfaction. Patient safety and satisfaction decrease with decreased nursing satisfaction. Research has noted that patient mortality and morbidity, that is their deaths, increases with nurses unhappy in their situation. Safe staffing ratios can be found throughout nursing studies; many have shown that a nurse with more than two patients in a critical care area compromises patient safety and care, and the nurses on the floor should have no more than four patients to care for and ensure their safety. Some states have even mandated that hospital units advertise their staffing ratios so patients and families know what they are walking into.

Attitudes are changing; hospitals across the nation are adopting more nurturing and less punitive reactions. Nevertheless, they seem to have missed the realization that as the nursing shortage continues; the value of a skilled and professional nursing staff that feels appreciated is paramount to the stability of any facility. The attitudes unfotunately are still Like it or leave. And Big Clue Here...Guess what is happening?? NURSES will continues to leave this wonderful profession for the same reasons that they have left for the last many decades. NEW NURSES will LEAVE for the same reasons because the issues are not being repaired; the problems with this profession are not being fixed. These newly educated nurses are walking into seriously compromised staffing situations and viewed with many of this younger generation’s work ethic, they will not stay as long as the nurses currently in place. THE DEATH OF THE BEDSIDE NURSE IS WHAT IS HAPPENING... For any who care...

Respond....follow and comment please...

Re-Post with additions

Lots of ideas...Need a new computer...Need ideas from my friends and colleagues...

What are your ideas??? (1)

What exactly is short staffing? Is it the new MTO (Oh and suck it up-like it or not)/not necessarily when needed) staffing?

A) Like when JCAHO or OSHA or AHCA visit? (Like does safe staffing really matter any other time)

B) Like when the budget says so? (But hey lets not look for ways to actually encourage money-making ideas for the workplace) Just cut the staff short instead.

C) NURSING SATISFACTION STAFFING???? OH my those are the wrong words to use, because nurse satisfaction is so often the first consideration.... (I can dream)

D) Study after study shows that safe staffing improves not only nursing satisfaction, longevity, security, etc., but actually promotes patient and family satisfaction, promotes better patient outcomes, patient safety and less sentinel events, and reduces medication errors. OH so many ANDS for nurses and patients...and SO many buts fro those that really should care but too often

consider the bottom line and NOT the bottoms of their nurses and patients....

Again, I really do not place patients after nurses, I just really consider the Patients and families have the WHOLE freakin alphabet advocating for them...Nurses do not even have the ABC's (another day for my BLOG on the one organization that really does care, just a quick hint...FNA)

Re-Post

Re-Post because the situations have not changed in my decades of nursing and It NEEDS Nursing involvement and caring

Political Possibilities

POLITICAL POSSIBILITIES

Everyday in the practice of Nursing, I see RISKS. Nurses across the country work in precarious situations, not only a danger to patient safety, but to their licenses and livelihood. These situations occur due to staffing issues and patient acuity. The population is aging and health is deteriorating for many of these individuals. The responsibilities of nurses are increasing everyday and the higher acuities make it worse and more dangerous for nurses to provide even adequate care.

The nursing shortage is already at dangerous levels and is only going to increase. The changes are not occurring rapidly enough and they are rarely directed in the right paths.

I propose and hope to see in my lifetime these changes and I am HOPING that you will HELP me.

1) 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?

2) 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??).

3) 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.

4) National Nursing Licensure

5) Better Health Care Coverage—since we provide so much of it, it should be a reward.

So much more, these are only a few of the issues I would like to see instituted and implemented and truly believe it will affect the future of nursing. So many agencies and groups protect patient safety and there are no real protectors of nurses and their work conditions. Such an agency will only enhance patient safety. The CAN (Center for American Nurses, part of the ANA) is a start, but so far, no one is really affecting change in workforce conditions, thus the NURSING SHORTAGE.

Just because it keeps going on...

Who Cares?

Who cares really?

Do those you work for really care?

I just want you nurses and those that claim to care to really CARE...

Those days that you are working to yet again save the life of your patient, whether they be the loving grandmother of soooo many children or the DOC lifer who may also be a child molester...Who's will is it to beg the difference???? My OH my...who's to decide who deserves better care?

But while you are working so hard to keep this person alive...PLEASE manage to discharge one patient and get to the bathroom another patient... and PLEASE...also get to all of the other computer work and paper work...LOLLLLLLLL. Is there new time on the clock? Has some magical power added a new day?

REALLY???

Make me a promise you can keep OH great administrator.....

Repost

Right in time for Nurses Week

http://www.aacn.org/wd/practice/content/nurse-staffing-ratio.pcms?menu=practice

Nurse-to-Patient Ratios

ANA Applauds Federal Legislation to Mandate Safe Nurse-to-Patient Ratios

Sen. Inouye introduces bill to protect patients, hold hospitals accountable for RN staffing.

Washington, D.C. — The American Nurses Association (ANA) today applauded the introduction of the Registered Nurse Safe Staffing Act of 2003, federal legislation that aims to ensure that patients receive safe, quality nursing care in hospitals and other health care institutions. The legislation mandates the development of staffing systems that require the input of direct-care registered nurses (RNs) and provides whistle-blower protections for RNs who speak out about patient care issues.

The bill, S.991, was introduced by Sen. Daniel Inouye (D-HI) yesterday. Today marks the start of National Nurses Week, which is celebrated May 6-12 each year.

ANA, which worked closely with Sen. Inouye's office on the bill, lobbied for this legislation to protect patients and registered nurses, given the absence of enforceable standards for nurse staffing in hospitals and the widespread practice of healthcare facilities stretching their nursing staff with unsafe patient loads, mandatory overtime, "floating" to specialty units without training and orientation and other practices that undermine the delivery of safe, quality care.

"Inappropriate nurse staffing is the number one concern of nurses today," said ANA President Barbara Blakeney, MS, APRN, BC, ANP. "More than a decade of research has shown that RNs make the quality difference in patient care and that when RN care is insufficient, patient safety is compromised and the risk of death is increased."

"We applaud Sen. Inouye for his leadership on this issue and for his commitment to protecting patients and nurses from practices that are dangerous," said Blakeney. "Furthermore, this legislation is needed to improve the work environment for nurses, to enhance retention of practicing nurses and recruitment into the profession."

In July 2002, the Department of Health and Human Services released data confirming that a nursing shortage already exists in the United States and that it is expected to grow. According to the HHS study, in 2000, there was a shortage of 110,000 nurses (6 percent).

Without changes in the system, the HHS study predicts that shortage will grow to 12 percent by the year 2010, 20 percent by 2015 and 29 percent by 2020.

The RN Safe Staffing Act amends the conditions of participation in the Medicare program and establishes a requirement for minimum staffing ratios. Rather than establishing a specific numeric ratio, the act requires the establishment of a staffing system that "ensures a number of registered nurses on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care."

Specifically, the staffing system must:

• Be created with input from direct-care RNs.
• Be based on the number of patients and level and intensity of care to be provided, with consideration given to admissions, discharges and transfers that nurses must handle each shift.
• Account for architecture and geography of the environment and available technology.
• Reflect the level of preparation and experience of those providing care.
• Reflect staffing levels recommended by specialty nursing organizations.
• Provide that a RN not be assigned to work in a particular unit without first having established the ability to provide professional care in such a unit.

In addition, the act requires public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs.

In addition, the act provides whistle-blower protections for RNs and others who may file a complaint regarding staffing. The RN Safe Staffing Act incorporates ANA's Principles of Nurse Staffing. Rather than recommending specific numeric ratios, ANA developed the principles in 1999 as a tool for nurses to better gauge appropriate staffing.

The principles not only take into account the number of patients, but also look at other important staffing considerations, such as the experience level of nurses on the unit, the severity of patients' conditions and the availability of support services and resources.

"ANA has long been supportive of establishing nurse-to-patient ratios," said Blakeney. "However, ANA has not supported the approach of legislating specific numeric ratios, because that approach fails to take into consideration the multiple variables that affect nurse staffing at the unit level. Staffing systems can only be effective if the direct care nurses who work on a specific unit have input into the system. This legislation provides a comprehensive solution to the complex and urgent problem of insufficient nurse staffing."

Staffing by Acuity makes Ratios SAFE

Just a few proofs that better staffing provides better outcomes:

http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.html

• Lower levels of hospital nurse staffing are associated with more adverse outcomes.


• Patients have higher acuity, yet the skill levels of the nursing staff have declined.
• Higher acuity patients and added responsibilities increase nurse workload.
• Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
• Hiring more RNs does not decrease profits.
• Higher levels of nurse staffing could have positive impact on both quality of care and nurse satisfaction.

Additional Studies and websites:

Saint Joseph’s is part of the Resurrection Health Care system, which assembled committees across the system to develop standards and assign weights to different patient types.

Mary Anne Harper, clinical manager of maternal child services, explains that before launching the program, her department discussed the amount of time nurses spend on the various patient types in maternal-child nursing, e.g., a normal newborn. The weights assigned were reviewed and agreed upon by the entire system.

Once the program was implemented, she says it was fairly easy to roll out to nurses. Two hours before the end of their shift, nurses enter information about their patients into the computer system. They select attributes for patients from lists already entered, such as whether patients are receiving blood transfusions or have total care needs, whether they are in isolation, and so on. The program assigns a weight to each patient that indicates the acuity needs.

“The charge nurse on each shift will review after everyone has entered,” says Harper. “They run a report to determine needs. How many people are level 1 acuity, how many people are level 2, etc. The charge nurse looks at the numbers and determines her staffing needs.”

Harper says the charge nurse may find the unit has a lot of patients with high acuity, which may mean they need more nurses. Sometimes they may have low acuity—for example, if a lot of patients are simply waiting to go home—and may need fewer nurses.

Just another clue that staffing SHOULD be based on patient needs/acuity

Acuity Systems Dialogue and Patient Classification System Essentials
"Aiken and colleagues found that when nurse-to-patient ratios go from 1:6 to 1:4, patient death rates decreased by 2.3 per 1000 patients. Cho et al found lower rates of urinary tract infections, pneumonia, upper gastrointestinal bleeding, and shorter hospital stays"

http://www.ena.org/practice-research/Documents/StaffingGuideline/Harper_2007.pdf

This is just from floor staffing, THINK of how many sentinel events can be averted in an ICU with proper staffing and acuity levels.

The Association of Registered Nurse Staffing Levels and Patient Outcomes

http://www.ona.org.3pdns.korax.net/documents/File/pdf/KaneRNStaffingPatientOutcomesMedCare.pdf

Again...Fight for your rights...To Party or just be respected...

Specialty Nursing Certification--Benefits you if you work in the right place

Organizations and articles show that specialty nursing certification benefits nurses through improved continuing education and benefits patients in this way also. As one of the most trusted professions, certification provides a sense of stability and comfort to patients in the advanced knowledge these nurses attain. Employers also benefit from the respect and security felt by patients who are cared for by certified nurses and can feel secure themselves with highly trained staff.
These sites offer more information:

http://www.aacn.org/wd/certifications/content/benefitstoptempnrs.pcms?menu=certification

http://www.medscape.com/viewarticle/717805

The Medscape article claims that a 2006 survey showed certified nurses made $7300/year more for said specialty certification.

http://www.nursingcertification.org/pdf/white_paper_final_12_12_06.pdf (2006 survey)

This survey shows that close to 2500 surveyed offer NO Incentives. It also cites lack of institutional incentive and support as barriers to certification. May be a CLUE... or do they just need the board game.

Do you know where?

I plan to look, because many places in my state don't seem to offer such incentives. Yet they seem to think the certification which often requires many more CEU's to renew is okay to expect and/or mandate that you do. Incentives and salary differentials seem like a better plan. I suspect one day such certification may be mandatory in some workplaces, as well as higher levels of education, which few facilities reward. This is especially true for experienced nurses who have reached the cap of the payroll limit for their years of service (Yet again, another topic for another day). Here is the CLUE, for all of the places who find incentives beneath them. Make it....WORTHWHILE, it costs time and money, continuously.

These issues are again an ISSUE...

CCRN-CEN??? DO they make it worth it?

NOT just in the monetary sense, that is a topic for another day. BUT, just FYI, there are actual facilities and states that pay $/hour for being certified in your training specialty.

Today, consider the critical patients you care for on a daily basis and how safe or unsafe you feel in your practice. Especially when they are handing you the responsibility of even another patient when you can barely get out of the room of the current TTD (trying-to-die) patient.

DOES the place you work have formal guidelines for what constitutes a 1:1 patient? It is more than just treating a patient with an IABP or running CRRT or ECMO, or initiating a hypothermia, TPA, or sepsis protocol. These are the DUH factor, but how many other patients get paired or more? Every area with any standards should have policies that protect the patient with such guidelines. And safe staffing should be maintained.

Many organizations have statements and standards relating to what constitutes 1:1 care and 1:2 care and so on. They provide guidelines for what protects your practice and constitutes safe care delivery.

As your director or manager encourages you to be certified in your specialty by such entities (i.e. AACN or ENA), think about whether or not they honor the standards recommended by these organizations.

Give thought...should you have time, when the next shift you have the crazy busy night and you know you are just lucky if the patients all survive, much less get the care they deserve and the care you chose this profession to give. The night you are thankful to grab a sip of some refreshing beverage, maybe from the sink in the room (YUCK) if you are allowed, and again very happy to actually make it to the bathroom, some times that day or night. These are the times to just give it a thought. Is the certification worth it, if they cannot even HONOR standards for those TTD's?

I Love Nursing...I want Nurses to Want More...

What Nursing can Mean Part III

As noted previously, nursing is one of the most compassionate, rewarding and enjoyable professions in this world. It is also demanding of knowledge, experience, and the ability to make life-altering rapid-fire decisions and all of the stress that that can entail. Nursing often requires more than adequate amounts of time, the time to assess patients’ thoroughly and accurately. In this way, nurses are more likely to note a deteriorating condition before it becomes life threatening as well as perhaps having the time to interview patients more carefully, thereby, determining issues that may present problems while they are caring for them.

More and more what a patient deserves is going to be in the manner that they are going to be lucky to get only what they need the most. Numbers show that in 10-20 years there will be a shortage of at least 800,000-1.2 million nurses in this country alone. Nurses continue to leave the profession or are moving into areas away from the bedside, sometimes through increasing education or taking jobs in other, often, less critical areas, or moving out of the profession altogether. Many facilities seem to be pinning their hopes on graduating nurses who have no experience or gut feelings that can prevent patient events. The fact of the matter is that without experienced and satisfied nurses the mortality and morbidity of patients will only escalate. Admittedly, more nurses graduating and getting experience will help with some of the increasing shortage, but working to keep and satisfy nurses who have been loyal and committed to a workplace should also be a high-level goal. Due to past business crises, many hospitals have decreased or eliminated the benefits that nurses received in the past and may be looking to decrease them further. This is the time to improve benefits and tuition reimbursement if these facilities want the better-educated nurses at the bedside. Better retirement packages should be implemented, whether on a hospital-to-hospital level or at the state and national levels. Increasing the salaries would also be of benefit. There should be no salary cap for nurses who continue to be educated. On not only a yearly basis but also many are back in college, obtaining higher levels of degrees and certification. Facilities should be just as concerned at rewarding their loyal and experienced nurses as well as encouraging new nurses. There should be no limit on how many years a nurse can earn a raise; they have only continued learning throughout their career. The fact that many new nurses are paid very close to the same salary as a nurse with 20 years of experience says a great deal about who hospitals and other facilities value.

 

Re-Post

I do Love this Profession and Always Want More for every Nurse

What Nursing can Mean Part II

Many nurses find themselves in this situation today. Patients are increasingly sicker when they come into the hospital, with greater demands in regards to their care and needs. Their potential to arrest or just begin the often agonizingly slow spiral towards the light is when they need nurses with the time to assess and re-assess their situation. Time that can make the difference with an experienced and astute nurse caring for this patient, this nurse can maybe delay or prevent a sentinel event from occurring. This nurse uses years of learning to know the signs that indicate a significant occurrence is heading towards this patient. Often it may just be a gut reaction, but the chance to head off disaster is in the hands of this nurse who knows the warning signs and what to do to keep the pending arrest at bay and turn the tide when provided the time to care for this patient in a safe and uncompromised manner. This is the time that many nurses rarely have in an age where staffing ratios have not changed for the better in well over a decade. Most facilities’ ratios are built on the budget and the decreasing number of nurses, not the increased acuity of the worsening patients’ health characteristics. Standards need to be set based on the patients’ level of illness and the increased workload that illness places on the nursing staff to give them the care they need and deserve.

Re-post and still True

I Love Nursing and Will Always Want More...

What Nursing can Mean

Nursing is many things to many people. It is often a profession, a career, a calling and to some, just a job. To love this job is to learn early on that when the rewards do not outweigh the negatives it may be time to re-evaluate. In the current nursing shortage/crisis, whatever some may call it, many are re-evaluating what this profession means to them. Every day they drive to work, often wondering, what the day may bring. Each day is often very different.

Will you have those few patients that make it all worthwhile, the 2-year-old that, once her fever has broken, follows you around holding your hand? She lets you know with her innocent trust, that you helped her feel better and that she has just made your shift a brighter piece of time, this is the one, that while you may not really have the time to play, you decide it’s a good time to make time. Is it the older woman with multiple organ disease and a loving family, who just wants her to be able to go gently into the night? Her family understands her desires and needs for a peaceful end; so, you soothe her with cool cloths and keep her as comfortable as possible, leaving the family the chance to share her final moments in time. While this may not be a physically busy patient, the emotional investments it generates, play a different havoc with your coping mechanisms on a busy shift. On the other hand, will it be that man, that, though seemingly sailing along on the road to recovery, the inexplicable occurrence happens. You find yourself and many others on the medical team, fighting to save this man from the circling four horsemen, whose dogs are nipping at his heels. When you pull him back from the breach, will you have the staff to cover his increased level of need? Will it have been another day of coming in only to find that there are not enough nurses on the floor and that the intensive care unit is currently full, but they are trying to find a bed?

Re-Post

Political Possibilities -- Still the same issues today

POLITICAL POSSIBILITIES

Everyday in the practice of Nursing, I see RISKS. Nurses across the country work in precarious situations, not only a danger to patient safety, but to their licenses and livelihood. These situations occur due to staffing issues and patient acuity. The population is aging and health is deteriorating for many of these individuals. The responsibilities of nurses are increasing everyday and the higher acuities make it worse and more dangerous for nurses to provide even adequate care.

The nursing shortage is already at dangerous levels and is only going to increase. The changes are not occurring rapidly enough and they are rarely directed in the right paths.

I propose and hope to see in my lifetime these changes and I am HOPING that you will HELP me.

1) 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?

2) 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??).

3) 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.

4) National Nursing Licensure

5) Better Health Care Coverage—since we provide so much of it, it should be a reward.

So much more, these are only a few of the issues I would like to see instituted and implemented and truly believe it will affect the future of nursing. So many agencies and groups protect patient safety and there are no real protectors of nurses and their work conditions. Such an agency will only enhance patient safety. The CAN (Center for American Nurses, part of the ANA) is a start, but so far, no one is really affecting change in workforce conditions, thus the NURSING SHORTAGE.

 

Re-post from 2011

Another issue that just won't change...

Laws that NEED to be Enacted in FLA

Do you ever wonder why the Southeast often seems behind in nursing practice issues.

Florida is the last state to STILL refuse to pass the LAW that allows ARNP's to write all levels of narcotic prescriptions...

How do you spell Ludicrous?? FLA??? ;-)

Come on and make the change FLA, time too loosen the strangleholds of the AMA and the AHA,

Join the rest of the country and let ARNPs, BE all that they can be...

Think about where many Nurse Practitioner's Practice, Have a Clue??? In Nursing Homes and special needs facilities, including long term care...WHERE PEOPLE NEED all levels of pain relief and pain management...

Not only does NOT Passing this law limit the care nurse practitioner's can provide, it makes pain relief more slowly provided than necessary to patient's, NOT RIGHT...

Law Maker's In FLA--Get over the delay and PASS the BILL...

Please folk's write the Senators and Congress of FLA, Let them know what you think of such backward progress...

http://dlis.dos.state.fl.us/fgils/government.html

 

This is another issue spoken about recently and this is a repost from 2011 that won't change without better support from the nurses it affects.

Laws that are still waiting for support from the Nurses they are meant to aid

Laws that NEED to be Enacted in FLA

Did you know???

There are many bills in the FLA Legislature that can promote the improvement of nurses workforce situations, that can protect the health and well-being of nurses, and that can promote nursing autonomy.

Many bills just never get the support they need to be passed into law.

In the recent past there have been bills that make it very important to include the staff nurse (aka: nurse at the bedside) in the decision making process regarding changes and new procedures and protocols in the workplace.

WOW, What a novel concept to include the one doing the work and providing the care (24/7) in the decision making process. It could be great progress to include these nurses in the process of changes rather than just expecting them to add something new (without their input) to already stressful workloads. And how much safer could it be? For patients and staff????

Things that make you go HMMMMMMMM.....

 

ANA Government Affairs @ http://www.rnaction.org/takeaction can get you where you need to see issues and contact your representatives..

 

This is a Re-post from 2011 and these issues are still in need of support, because work situations and the support of your management are not the way it should be...

 

Please Get Involved in Making your Practice the Best it can be...Should Already BE!!!!

 

RN Retirements—Tsunami warning!--Follow the link below and get involved...

An e-mail I received is below and I followed easy directions to POINT-AND-CLICK and reach my representatives about these Oh so serious situations our profession is in:

Dear Theresa,

A health economist at the American Nurses Association sounded a warning in his recent blog post:

RN Retirements—Tsunami warning!

The Department of Labor Bureau of Labor Statistics updated its Employment Projections for 2012-2022. It is predicted that 555,100 RNs and APRNs will retire or leave the workforce by 2022—a tsunami of retirements. And that’s not all. In addition to retirements, we will need an additional 574,400 new nursing jobs to keep up with the aging population. These are staggering numbers to digest.

As a current or soon-to-be RN, it’s our job to make the profession safe and appealing to those considering this career. ANA works on your behalf to keep the health care environment safe for you and your patients.

Safe staffing. Safe Patient Handling & Mobility. Home Health. Durable Medical EquipmentIf this passed today, it would help shape the profession tomorrow.

Together let's make nursing the best it can be.

Today and tomorrow,
Your Government Affairs Team

This is exactly what I have been saying and it is NOT getting fixed...

Get Involved to protect yourself and Nursing's Future...

PLEASE...

The Death of the Bedside Nurse...

There is a nursing shortage and a greater one looming as the experienced nurses working today will be the ones to retire tomorrow.

The world needs bedside nurses and the nursing situations many nurses currently find themselves working in too frequently involves unsafe staffing with little or NO ancillary staff to ease the burden. This, along with perpetual increases in responsibilities and expectations in our practice put the bedside nurse in a less than enviable position too many nights in a row. Patient care suffers when there is not enough staff. Patient satisfaction dwindles in relation to increased nursing pressures and decreased nursing satisfaction. Study after study has shown this.

The nurses graduating so easily and frequently in what is supposed to be a solution to the nursing shortage are not staying at the bedside. So, when the nurses you work with today retire and the new nurses move on to the very many opportunities now available, who will be the bedside nurse?

Older nurses have weathered and tolerated the "nurses are easily replaceable and of little value" attitudes of those in power many times over the decades. Each time nursing schools mass produce new nurses, managers actually do all they can to devalue their experienced nurses, thinking that all the new nurses will be the replacements. However, time after time, the experienced nurses have stayed and the new ones have left for often easier and greener pastures. Now they don't even have to leave the profession but obtain higher education that only gets easier and easier. When they "Don't Like it" today they very easily leave. WHO will be the bedside nurse?

WHO will be the Bedside Nurse?

PASSION for Nursing...And all that it can be...

I am so passionate about this being one of the best professions in the world...Everyday, just the care I give, the patient I help keep alive and the ones I give comfort and relief to, makes me proud to be the nurse that I am. Giving excellent care is the reason I go in everyday. I LOVE what I do at the bedside. I HATE the lack of support of those who should be making my job easier.

The politics and managerial decisions frequently being made around me are the things that drive me crazy. Nurses need the support of their leaders, not derisive and apathetic leadership styles. The "LIKE it or LEAVE it"  attitude of so many so-called leaders are the epitome of ridiculous. Not only do they NOT care about their nurses, they are actually driving nurses away from the bedside. One manager recently told a group of nurses that if they do not like the way things are going, they should REFLECT if this is a good fit. This is in situations that are supporting unsafe staffing ratios with plans to make it even worse with no support staff and no relief if more critical situations develop within a shift. These less than adequate leaders should REFLECT on why they have such a poor level of respect for the nurses who care so much for the sick and injured.

And guess what? The new nurses that they keep heaping responsibilities on with minimal training and education; all of these nurses are the ones that are already in the process of moving on as quickly as possible away from the bedside. This type of management is driving nurses away and this will continue if nursing satisfaction is not made a priority...The nursing shortage is only going to get worse by these ATTITUDES...LIKE IT OR LEAVE IT management is KILLING the BEDSIDE NURSE!!!!!!!!!!!!!!!!!!!!!!

This Bill is again being discussed...

Did U Know?...

The American Nursing Association has issued an opinion about the potential effects of federal budget proposals on the nursing work force.

Republicans in the House of Representatives have proposed significant spending cuts as part of a budget that would cover the rest of the 2011 fiscal year. Among the affected programs, according to the ANA, are Title VII Health Professions Programs and Title VIII Nursing Workforce Development Programs.

Title VIII provides funding for nursing education programs and recruiting, including in critical shortage areas, while Title VII covers healthcare practitioners in general.

According to the ANA, the budget proposal currently under consideration would cut funding to these programs by 29% compared with 2010.

“At a time when the nursing shortage threatens to impact the quality of care, we need to continue to invest in nursing programs,” said ANA President Karen Daley, RN, PhD, MPH, FAAN.

“Our patients are our first priority, and without an adequate supply of nurses to provide care, and adequate funding to implement the reforms of the Affordable Care Act, our healthcare system will not be able to meet its growing demands.”

While the budget for the rest of fiscal year 2011 remains to be determined, President Obama also has proposed a budget for 2012.

Although Obama’s budget features an array of spending cuts, the ANA was happy that it included a 28% increase for Title VIII programs. As with the 2011 budget, Obama’s budget is subject to change after congressional debate and negotiations.

“It’s heartening to see the Obama administration continues to recognize the invaluable contribution that nurses make to the delivery of care,” Daley said. “This proposed budget represents a substantial commitment to addressing the nursing shortage and ensuring access to care for all. Increased funding for Title VIII programs is vital to reducing avoidable complications associated with the nursing shortage — saving lives and reducing healthcare costs.”

THE ANA FOLLOWS MANY OF OBAMA'S PLAN'S BUT ARE THEY REALLY GOOD FOR NURSING...

DOES IT REALLY PROMOTE THOSE AT THE BEDSIDE..THOSE TAKING CARE OF PATIENTS???

WHAT DO YOU THAT ACTUALLY TAKE CARE OF PATIENTS THINK?????????????????????????????

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What are your ideas???

What exactly is short staffing? Is it the too frequent standard of some matrix that only those that manage the staff know about? Too often just having a patient care tech to relieve some of the ringing phones, calling patients, or watching the monitors can make a difference.

Just last week I had to tell a patient who needed help going to the bathroom that I would send in his nurse as soon as I could instead of going into help him myself. I truly felt really bad about it, but my 1:1 patient was losing his blood pressure and I was starting yet another vasopressor and hanging fluids. And AGAIN there was no other help to be had. Short staffing is NOT safe for Patients

A) Like when JCAHO or OSHA or AHCA visit? (Like does safe staffing really matter any other time). Funny how much staff is available when the alphabet soups are expected. How about they show up and see staffing as it really can be. Maybe staffing ratios could be a NATIONAL PATIENT SAFETY GOAL. It truly is, but never gets treated as such.

B) Like when the budget says so? (But hey lets not look for ways to actually encourage money-making ideas for the workplace) Just cut the staff short instead.

 

C) NURSING SATISFACTION STAFFING???? OH my those are the wrong words to use, because nurse satisfaction is so often the first consideration.... (I can dream)

 

D) Study after study shows that safe staffing improves not only nursing satisfaction, longevity, security, etc., but actually promotes patient and family satisfaction, promotes better patient outcomes, patient safety and less sentinel events, and reduces medication errors, falls, and pressure ulcers. OH so many issues for nurses and patients...and SO many OH NO's from those that really should care but too often consider the bottom line and NOT the bottoms of their nurses and patients....

 

Again, I really do not place patients after nurses, I just really consider the Patients and families have the WHOLE freakin alphabet advocating for them...Nurses do not even have the ABC's (another day for my BLOG on the one organization that really does care, just a quick hint...FNA)

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What Will IT Take to get Nurses Involved in Protecting their OWN Practice?

It truly is a point and click world and you can be involved and actually keep in contact with your local and state representatives. Many of your state nursing associations can provide the issues and the means of contact. However, it can also be done independently. So many Bills, so little time.

Do not leave how you practice up to the medical associations and hospitals. Do NOT let them be the only ones to decide your nurse to patient ratios. Truly caring about your practice, your license, and bottom-line...your patients...means taking matters into your own hands and having a voice in such decisions.

So many states have actual laws regarding staffing ratios, that protect patient care and your license. Yet, here in Florida the state has yet to allow nurse practitioners full controlled substance prescribing abilities. In addition, it is the last state to maintain this decision. And who other than ARNP's  primarily care for patients in long term care facilities and patients with critical and painful end-of-life illnesses?

Also, many nurses here in Florida just keep taking the nights and days of providing care with budget minimizing staffing with little complaint. Where there are seldom written standards for what constitutes 1:1 acuity. AND NO LUBRICATION for the pleasure of having that severely critical patient paired with another patient.

It is LUDICROUS any time that patient acuity is based on a budget or staffing. By definition Patient Acuity MEANS Patient situation and level of care. And who should decide that but the nurse at the bedside. FINAL ANSWER.

What do you want from NURSES of the FUTURE?

I Want:

Nurses that care about being nurses, that are PROUD of what they do and what they can manage with all of the limits placed on them...

 

Nurses that automatically place what is best for their patient's 1st!!!. For me that should be the ultimate in basics for nursing....I have always thought that it is UHHHMMMM...Ludicrous that all of these alphabets are needed and SAD, because caring for your patient is why you are here, WHY you exist, that care, comfort, and life-saving elements ARE the basis of Nursing... I DO NOT NEED

Alphabet Soup (JCAHO, OSHA, ACHA, etc., ad nauseum) to tell me what is right for my patient's...

 

I Want...

 

Nurses that Care...I always start with the idea that I am going to treat this patient the way someone I care about should be treated. With caring and respect and my best effort to make them comfortable... Now, on another note..I would not tolerate any of my family members being an ASS and acting entitled, or that I owe them a particular type of care just because they came in today. Be a DECENT HUMAN and treat people with common courtesy (Esp your Nurse, they want to help you)..When a patient or family drops that ball, I will kick it back at them...Stress, pain, etc..DOES NOT MAKE it OKAY to be a JERK...

 

I Want...
 

Nurses that are NOT Here Just for a Paycheck, the bottom line is...that it is great to make money...but LIVES are at stake here..

My #1 Rule is..Know why you are doing whatever you may be doing for a patient, Never do anything just because you may have seen someone else do it...If you do not know ask...

 

Just a few thoughts about what I want from all of these nurses..that schools are pushing out way too fast...KNOW the reasons you are treating a patient...It will save your butt and always ensure the care of your patient.

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It is a Point and Click World...

Did U Know?

That in the Florida House there has been a bill related to the safe lifting of patients...
It is a great idea and aimed at protecting not only patients but nurses backs...Wow, an issues that promotes the health of nurses??? (A shame that nurses need such bills)
But even in some bariatric facilities nurses cannot get the proper tools and lifting equipment needed. Forget the normal sized patients that may be immobile, just double or triple that and the need for many nurses needed for the lifts and turns. (So we do need bills passed into laws)

Really novel...and need I say, Finally??? But it has not been passed.

Not enough nurses were made part of this process nor have they been involved or encouraged to be involved in even knowing that bills are proposed and voted on regularly. Bills DIE in the limbo of government officials. Those who are most affected are the least involved in the process--Patients and NURSES.

Many of these bills never see the light of day because it does not suit the purpose of the AMA or the Hospital Associations, and not near enough nurses get involved or are even aware.

It could make such a difference...What a Voice nurses could have if we just get involved...In my city alone there are more than 14,000 RN's that is power...That could be one of the greatest voices senators and congressmen have ever heard...

Think about the changes that could happen........

 

IT IS a Point and Click World. Nurses can easily get involved by being a part of organizations that work to influence the government and lobby for changes that protect nurses and their practice and work situations. And from being in touch with your representative to voting on bills you find worthy, it can all be done from home. Of course, more involvement is always encouraged and available, but you can be involved from the comfort of your home on the few days you are not working overtime or just dealing with life.

 

GET INVOLVED TO PROTECT YOUR PRACTICE

 

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Love Nursing?

WOW...So many things to Love about this profession...Just a few

1) Making someone feel better is often its own reward, most especially when that patient improves enough to know you have truly helped them..Often that help is in the form of medication, sometimes even education...

 

2) There is something powerful about saving lives and making a difference..Many of us make a joke of it, but when you know you have the knowledge and the ability with one or two actions to pull a patient from the cliff of death...It feels great when it works and sometimes even when it does not and you just know that you have done all that you can

 

3) Satisfaction is another factor for nurses and patients...It just feels good to know that you have comforted and bathed and pampered a patient, to know that if that was your mother, father or child, this is how you would want them cared for...

A Wonderful Life

It is a wonderful time for nursing. There are so many opportunities for everyone who chooses this profession. From Nurse Anesthetists, Practitioners, and Educators; the choices are endless. As more and more nurses join the workforce, we need to also protect the bedside nurse. Very many nurses are jumping into going back to school and the new nurses are doing faster than ever before.

SO, what does this do for the nursing shortage,? It certainly does not fix the coming situation.

The new nurses are much less resilient and very much less tolerant of current workplace conditions. They seldom work to fix it, they just see the greener pastures of furthering their education and work towards leaving the bedside. The massive push to quickly graduate new nurses that was aimed to replace retiring nurses, certainly looks to be back-firing. As it gets easier and easier for nurses to choose other pathways, we have to find a way to also encourage and make it beneficial for nurses to stay at the bedside. Do what you can to make changes in the workplace that make it intolerable to stay at the bedside while you are there.

I still love what I do at the bedside, and love giving excellent care. All of the peripherals, politics, and management leaves me cold; because, I seldom truly feel supported to make the workplace a better place to be. Short staffing is never going to improve if the bedside nurses keep leaving. Again, the managers who feel that nurses are so easily replaceable should maybe just shoot themselves in the foot. Because they are not realistic and they drive nurses away from patient care. They keep increasing patient care loads and not for patient safety or staff satisfaction. Making the nursing shortage a continuous cycle. AND...

Many nurses are getting very close to retirement age, these are the nurses that have stayed at the bedside for decades and longer. They are weathering the past storms and they will not be there for the future hurricane coming.

Past, Present and Future--Re-Post with Additions

Did U Ever Feel?

Like your voice is never heard?

I recently heard from a co-worker that spoke up at a meeting that she was really trying to be a voice for the staff...Yet again a Novel idea... And she felt like she was not heard and made little difference...

Sad thing is that this happens way too frequently in the face of administrative and bureaucratic managing (another bit of BS to me)

When patients and safe practice are the issue, the bottom line needs wiggle room and the SUPPORT of OUR SO-CALLED leaders...

I would love to hear how many NURSES

DO?

or

DO NOT?

Feel like they are supported in autonomy and safe practice for their patients?????

 

Is you voice heard by your administrators or leaders???

 

WOW...For me this is Workplace Bullying and Harassment--to not be allowed a Voice that is Heard...

 

Do you actually speak up when everything about your night screamed UNSAFE in how you were able to provide care for your patients? Was your 1:1 patient paired with yet another critical patient?

Did you actually get to sit down to chart or rest or eat, or even speed to the bathroom to do whatever you need to do??? What a concept... 

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Nursing Intervention in their own Practice

Nurses need more of a voice in their own practice and to take ownership of how their working situations develop and are maintained. Lemming nurses are not needed in today's economy or workplace. Just accepting all mandates and decisions by management is ludicrous. Whenever changes are proposed consider you workplace situation and how that will effect your practice, question or have alternate ideas ready to make you own situation safe.

 

Laws that NEED to be Enacted in FLA--3

Another recent bill that has yet to see the light of day: Is the bill to make it mandatory for bedside/staff nurses to be part of decision and change processes....

WOW...another NOVEL concept...to actually involve the nurses that provide the comfort and care to the patients--24/7. This often includes life-saving measures...BTW..those that make these decisions...ON A DAILY BASIS....

Really what a shame that lawmakers need to promote what should be obvious...

BUT ya wanna guess who would be the MOST against this bill being passed...

???? Hospital Associations will be against being made to do something that should already be a standard....AGAIN...one of my faves...LUDICROUS....

 

Come on nurses...get involved....YOU can make the difference..BE a VOICE for your own advocacy...

 

Your state nursing associations are one of the best ways to aid such bills to be passed. The Florida Nursing Association has their own lobbyist and they are always promoting issues for the betterment of your nursing practice. Look into it, students can join at a discount, and I know very many nurses who are back in school. Find out how to better serve your practice and your patients.

Re-Post with Additions--So True still today

Nurses need to Take Care of Nurses

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”. That and too many managers seem to feel that all nurses are easily replaceable. 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.

This attitude is ever-present and seems to be getting worse with the shortage.

Standards to be a priority and the acuity system should ONLY be based on the patient's dire circumstances NOT staffing or a budget. Great nursing comes from caring and experience, not the new nurses who too often want to jump into situations they do not comprehend. It takes time to learn and develop gut reactions. I will say again...ALWAYS Question and demand respect for what you do.

Re-Post--watch the ER seizure link...So true and so funny

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--Is there a NURSE ADVOCATE somewhere???

WHO Advocates for Nurses?

Just another day that makes you go HMMMMMMMMM.......

You go to work and think, today will be Good. Things will go just fine...

Then you find a patient slumped over and realize that syncope may be real...

SO much for that telemetry floor she was going to, as you fight to keep her breathing and not intubate her.... Oh so glad she wakes up and is only a little confused...LOL..

Another life preserved...

Calling for help sometimes is another thing that makes you go HMMMMMM....

Do you take the time or just do what you need to do...And GOD help you if the intercom once again does not work and you have just wasted valuable time...

With Brains and Hearts...Time IS Muscle....

Anyway......
LMAO

HMMMMMMMMMMMMM.....

So who helps you make it all go the right way...Your charge nurse if you are lucky, then maybe your director, if they are one of the ones who actually will come in and aid the effort to fight off death and the destructive process that many patients suffer from...Is your manager one who will fight the good fight or do they push papers and crunch numbers, not for the betterment of patient safety and standards of care but for the ALMIGHTY BUDGET...

Takes more than sheep to keep death at bay safely...

Re-Post for New Followers and for continuing situations...As a nurse...Do you stand up for yourself?

Nursing Appreciation...

Really? Who does? Many studies find that we are the most trusted profession, but that never stops the impatient patients and families and those that NEVER SEE all we are doing to help them...

ENOUGH

Enough entitled of the entitled society that never says thank you and thinks that we owe them their healthcare and why aren't we handing them the doggie bag of meds while we are at it...Please include the Dilaudid and Phenergan...

Does administration really appreciate nurses? Hey you...Nurse...Work another shift of overtime, but you better not be late or take a sick day...and by the way...your socks are WRONG...go home and change and work another 12-hour shift...LMAO...LUDICROUS...

And do NOT....however your night or day may go, say anything that may digress from the status quo...Do not voice your complaints or worries with the poor staffing or lack of standards in your practice.. i.e. criteria for 1:1 patient-nurse staffing ratios

Too many directors and managers Want Sheep...People who keep on taking whatever situation they are placed in and never voice a complaint...They may be frazzled and muttering throughout their shift, they are actually frequently DROWNING...But here comes the BOSS (though I have never truly believed I have one, because you know what??? I was taught very early in nursing school, when dinosaurs roamed the Earth...That you Protect your license by Knowing that you can refuse any ordered action that you believe will endanger your patients...and that includes unsafe staffing ratios) and when the Boss shows up all is sunshine and rainbows and there was never a problem all night...When there was not enough staff for the so very sick patients....And the trends continue...

DO NOT BE SHEEP!