Nurse Blogs

I can't quite figure out why people/family think because my eyes are open, my neurons are synapsing in sequence and I'm fully cognizant.  Maybe because I used to have to be when I worked the OR and was on call all the time.  Some of you know the drill, the phone rings at 1am, your feet are on the floor and you're heading for the bathroom where you left your clothes as you're reaching for the phone.  Then you're running out the door, shrugging into your coat if it's winter or buttoning up an article of clothing or both at the same time.  Then you're in the car, dry brushing your teeth, because you keep a toothbrush and toothpaste in your car console and you spit out the window, (hopefully the wind is not blowing into the car and you remember to roll down the window) driving hell bent for leather to get to the hospital to set up an "emergency" case.  Maybe you'll even remember to run a brush through your hair, but often why bother, you put a bonnet on anyway.  However, this was me on call, this was and is not me off call.  It is no longer my life and I choose not to wake up quickly unless the house is burning down or some other crisis is looming.  I sleep like the dead.  I admit this.  There is something satisfying about waking up slowly and in my own time frame.

Anyway back to just because my eyes are open does not mean I'm cognizant.  Don't ask me important questions and expect me to give an intelligent answer or to remember what you've asked me.  I am not responsible and now refuse to take responsibility for anything until I'm actually awake.  I tell my great nephew this all the time, but being 12, he "disremembers" and takes advantage.  He came into my bedroom and asked me for a raise in his allowance to $20/wk a week ago (somewhere around 730am) and apparently I said sure.  Well Friday rolled around and he was disappointed when I handed him his weekly pay of $10. After 5 minutes of tears, ranting and more tears, (pre-pubescent hormonal angst) he did not get his raise.   I didn't remember nor was I going to honor it. 

I fixed his cute little tush yesterday morning.  He was still soundly asleep, I poked him, he rolled over and blankly stared at me and I said........ remember to, unload the dishwasher, clean the litter boxes,  pick up your room, brush your teeth and hair, before you fire up the xBox or no allowance this friday.  Did he remember?  Not a chance.  Then again, he doesn't remember 5 seconds after you tell him something when he's awake.  So when I confronted him he said, That's not fair!  I wasn't awake.  I just stared at him and  then the proverbial light bulb turned on over his mass of dark brown, curly, long unbrushed hair covering his head.  It was so bright, I'm surprized his mass of tangled curls didn't catch fire.  I, however, made my point.

So the entire point to this rant is this...........just because someone's eyes are open, doesn't mean they're awake.

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  Americans who buy their own health insurance have very little protection if companies want to deny coverage or raise their premiums when they get sick. A new report published by the consumer advocacy group Families USA says states should do more to protect consumers from insurance companies that will stop at nothing to avoid paying claims.

About 14.5 million Americans bought their own insurance on the individual market in 2006.  The Families USA survey of insurance commissioners across the country showed that all but five states allow insurance companies to deny coverage to sick or older patients. All but 15 states have no limits on how much companies can raise premiums if individual policy holders.

For those states that do offer some safeguards against insurance company abuses, the kinds of protections varied greatly.  Some states - such as Maryland, Illinois, and Idaho - let patients appeal when their individual coverage is revoked; other states - such as Ohio, Kansas, and Arizona - don't allow appeals. Most states guarantee that customers can review when companies deny individual claims. But in only a handful of states are those reviews free and conducted by an independent third party, the report says.

Overall, New York, Connecticut, New Hampshire, and California had among the most protections. States including Alaska, Arkansas, and Wisconsin had relatively few, according to the report.

Recently, some states have taken aggressive action against health insurance companies that abandoned policyholders when they became critically ill.  In April, the Los Angeles City Attorney sued Anthem Blue Cross for illegally dropping patients when they became sick.  The lawsuit claims Anthem maintained secret units in the company that looked for ways to drop the policies of sick patients.

Prior to the Anthem Blue Cross lawsuit, the Los Angeles City Attorney sued Health Net for the same type of abuse. That complaint alleges that the company illegally paid bonuses to employees for meeting policy cancellation targets. The incentive program led to the illegal cancellations.  For its part, Health Net has admitted that such a bonus policy was in effect at the company in 2002.

It may be more important than ever that states take greater steps to protect consumers from such abuse, as more and more people are forced to buy private health insurance.  In fact, the number of people buying their own individual policies could explode if Sen. John McCain (R-Arizona) is elected to the White House.  Health insurance reform touted by the Senator would replace existing tax breaks for employer-sponsored coverage with tax credits individuals could use to buy coverage on the individual market. The change would likely shift millions of workers onto individual coverage, where they would be vulnerable to insurance companies' cost-saving tactics.

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The new trend in hospital satisfaction is called "scripting." Hospitals seemed to have paid some company to do a survey on patient satisfaction and it seems that people have stated that they feel that the nurse doesn't have time for them. The answer to the problem? Nurses are now mandated to script to patients with the last sentence being "Is there anything else I can do for you? I have the time." They are also using this and hourly rounding as a way to "prevent falls" when the real reason for falls is that staff is simply too busy. Hospitals have become competitive within the realm of "customer service" and actual patient care is a vintage act. Instead of focusing on safe patient care, they are more concerned with images.

Patients and families are fully aware that nurses spend very little time at the bedside doing patient care. Some people are under the impression that it is because of the new wave of computer technology. They see nurses at the computers charting and they believe that is what is taking them away from time with the patient. Other people may be convinced that their nurse is lazy and is off reading a magazine somewhere. While every job classification may have the "magazine reader," this is not the problem.

The truth behind this scene is that patient care has become more complex and the resources have decreased equally if not more for nurses. Hospital settings have become a revolving door for employment with a new concept revolving called "Magnet Status" which means that employees are happy so the care will be better. Basically, this is another administrative forced expectation that encourages employees to vote to help their hospital receive this "Magnet Status" when in all reality there are still underlying issues within employment and job satisfaction.

Nurses have a wide multitude of expected tasks throughout an eight or twelve hour shift. They are expected to exchange report on their patients, check patient's orders, medications and labs, sometimes immediately start their shift following up on a task that was passed on to them by the previous shift. They are supposed to start their shift off by checking on, meeting and assessing their patients. If everything is going well, they begin to pass medications which requires applying experience, skills and training because specific laboratory results or patient conditions may require a change in any given medication. Throughout the day there will be expected and scheduled treatments which include dressing changes or repetitive assessments to keep a patient stable. The reality of nursing is that on a "medical/surgical" unit with a nurse being responsible for 5 patients, her tasks alone can easily consume an eight or twelve hour shift. Now add interruptions with phone calls, water, blankets, bed changes, assisting patients to the bathroom and even waiting on families and visitors who seem to think that nurse is another word for "waitress." In a regular eight to twelve hour day the nurse finds herself behind on the important tasks of patient care trying to maintain "customer satisfaction" with a smile while addressing interruptions. Using the words; "I do not have the time right now" can send the nurse right to the unemployment line with absolutely no reference for any time spent on the job.

Another dilemma that nurses face is the concept behind "assistive personnel." The actual job that the nurse has to perform is increased due to the fact that they are supplied with various levels of "assistive personnel." One of the common problems with this is that the "assistive personnel" may be extremely busy or rebellious towards the nurse resulting in the nurse taking on more of the interruptions and other tasks that takes the nurse away from her expected duties and patient care. Often times, there is a great imbalance within the "assistive personnel" where there might be one reliable tech to every unreliable tech. This not only increases the demands on the tech but the nurse as well. Another imbalance is the experience of staff where there is a mixture of inexperienced new nurses and new techs due to the "revolving door" effect from either job dissatisfaction or movement within the field. This is an on-going event in facilities. Some facilities will have the techs responsible for 10 to 20 patients while nurses care for 5 - 8 or even 10 patients. In all reality, with a patient load that heavy a nurse can easily spend her whole shift practically just trying to pass medications. Add the interruptions and...well...customer satisfaction goes down and the facility administrators come up with more "tasks" to improve the "customer satisfaction" but not the quality of care.

Over the years, expectations, tasks and documentation have increased along with the number of patients a nurse will manage. The mix of the expectations, tasks and documentation is more than an eight or twelve-hour shift can handle. Safe nurse to patient ratios have been mentioned for years as the "nursing shortage" increases and nothing is being done to actually address "safe patient care." There are hundreds of thousands of licensed inactive nurses that are not working with over 50% specifically stating that it is because of the unsafe conditions. There isn't much data to report the number of nurses that are actively working in patient care but are unhappy with the unsafe conditions. This is partly due to the repercussions of administration - if you get caught speaking up, you will find yourself one of many nurses looking for employment without a reference.

Unfortunately, the public seems to be fairly educated about the conditions for nurses but in their attempts to speak up, more demands fall upon the nurses to hush the public and hide the problem within the facilities.

"Magnet Status" seems to be ironic with many facilities trying to obtain the status while being staffed in large numbers by "supplemental staffing." If the facility were such a great place to work, you would think they would have adequate staff to cover their needs without the need to utilize outside agencies or even internal supplemental staff to fill the holes.

While many nursing unions or groups have mentioned safe nurse to patient ratios, nothing seems to be happening to make the change towards what we consider "safe patient care." Instead, we will continue to "shop" for medical care with the hospitals competing against each other with bigger flat screen televisions and nurses waiting on unimportant demands from the "customers" while struggling to provide safe care to their patients. The data to support the fact that the more patients the nurse manages increases the likelihood of mistakes and poor patient outcomes seems to mean nothing in the competitive world of health care. Numerous articles and statistics have reiterated this problem for years but nothing is changing except for the number of tasks and patients that the nurse is responsible for and that number keeps getting bigger and bigger.

Seems the only thing we can do as customers within this outrageous scenario is to stay educated, keep yourself healthy, try to avoid hospital stays and keep a very close eye on your care.

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When nursing began it was about the promotion of health, prevention of illness and care of the ill, disabled and dying. Nurses became advocates in the promotion of health care and a safe environment. Nurses participated in research as well as the shaping of health policies and systems management within the patient and health business. They developed education for patients, families and other health care providers.

Since the beginning of nationally regulated nurses in New Zealand in the year 1901, nursing has taken on many challenges as well as facelifts. Education for nurses is predominately geared towards the promotion of care and patient advocacy but the real world of nursing exposes nurses and their patients to something very different. Over the years medical care has become more financially profitable for investors than it's original cause, which was about treating and educating the ill. Profits are obtained by "selling" both health care and education to the ill and their families. Nurses are now severely limited in utilizing their training or desire to practice their professional skills and knowledge as our "Lady with the Lamp," Florence Nightingale, envisioned. Nursing has evolved into "employment for profits." Gone are the days of promoting health, prevention of illness and patient advocacy unless there are profits to be made by selling such "merchandise.'' Acting as a nurse as history established has now created a "nursing shortage."

With health care "merchandise" resulting quickly and easily in the exchange of 5, 6 and 7 figure charges for a single visit to the hospital, other licensed professionals are now forced to utilize their specialized training and talents in informing you that your insurance is about to run out and there will be no more funds for you to receive their "merchandise." You will be professionally assisted in reviewing your options to discontinue receiving their "services" and receive "services" from another corporation for a limited period of time or find a way to now take care of yourself at home. While the corporation is carefully working with your insurance company to justify their actions to receive these 5,6 and 7 figures you will probably be convinced that their services and commitment to you are their number one priority. You and your care are very important to them. When they can no longer justify receiving these profits you are professionally informed that you are going to have to find another way to receive the care that you need and that they can no longer extend their wonderful treatment to you. They are, however, very "sorry about your luck."

Now where do these profits go? While these corporations insist that there is no money in their budget for your direct care such as nursing, they have many other "services" or merchandise to offer you in exchange for profits. They will go so far as to put up new buildings with new décor, new televisions and offer you more treatment options and diagnostic services to get your business. Over the years, the area of direct personal care such as nurses, case managers, social workers, assistive personnel and other departments are working with limited resources including the number of employees needed to assure that you receive the skilled and specialized care that will actually promote a better recovery. They insist that the funds are not available for this "merchandise."

Statistics have proven that medical errors result in an average of countless thousands of deaths with many of the errors not being reported and that number being hard to determine. It is also proven that the new terminology referred to as "short staffing" has a direct relation to this number of fatal events.

THE TRUTH BEHIND "SHORT STAFFING" AND THE "NURSING SHORTAGE:"

Short staffing is a term used in the field of direct patient care that is deceiving. It leads the public on into believing that corporations are not able to find the correct number of staff to provide one of the most important parts of care that you should receive as a "customer" of their services. That is not the case. Their "staffing models" are set up for profits with your care and safety being at risk. Nurse to patient ratios are at unsafe levels while corporations are raking in the profits for salaries and more "merchandise" to lure you in. Professionals that speak up for your welfare and better working conditions are faced with being slandered and tarnished as "bad employees." Not only do these corporations have the money to decorate, build and purchase, they have the money to employ large legal firms to protect their actions in proving that these employees were released for justifiable reasons as stories are developed or twisted and supplied within their personal files. The fear of such actions keeps professional caregivers under control to participate in the vicious circle of profits for health care while trying to feed their families and pay their bills.

The terms "short staffing" and "nursing shortage" are used as generic "titles" for this dilemma but in all reality neither of those terms are appropriate because "short staffing" implies that they are actually missing the number of nurses needed to completely staff a unit in order for the appropriate care to be provided and "nursing shortage" implies that we actually have a shortage of nurses in the field. In all reality, "short staffing" is a term that nurses have began using in their every day life of explaining why they have more patients they can handle. The truth of the matter is that the hospitals "staffing model" is typically set up for the nurses to struggle with a set number of patients per shift and that set number is well known throughout the industry to be "too many." If they work with fewer nurses that number goes up on each assignment. As far as the "nursing shortage" is concerned, there are hundreds of thousands of nurses that are licensed and inactive in practice. Many of those nurses have stated that poor working conditions were the reason for leaving and there are many more that have been unable to find employment because they spoke up about conditions and were terminated and falsely accused of misconduct or inappropriate behavior that has interfered with their ability to find employment.

At the present time it appears as if the average age of leaving nursing tends to be people in their 40's. Many of those nurses have suffered physical damage due to the heavy lifting and harsh physical demands. Others have been forced out for either speaking up about unsafe conditions or just simply replaced by younger cheaper nurses. Look around and you will notice more young and new nurses as the primary population on many hospital units. You will also see these young and new nurses training newer nurses when they have had minimal experience in the field. Nursing is a profession that requires actual experiences to perform tasks with skill. New and inexperienced nurses are at risk for inaccurately dosing medications they are not familiar with, not having the experience to handle a code situation in order to save a life and many other things that come from "exposure." Yet these nurses are now training the new graduates in the field. Experienced and seasoned nurses are found in smaller and smaller numbers throughout hospitals. There is a surprising number of nurses that would either return to the field to work if the conditions were more manageable or if previous employers were controlled from tarnishing their personnel files with slanderous allegations of misconduct after speaking up about conditions. This, alone, would resolve retention issues as well as make the field more desirable to qualified people who have avoided nursing as a career because they are fully aware of the conditions.

The sad truth is that the administrators within the corporations are fully aware of all of these facts but deny their validity to the public as well as those around them. Many nurses within management have either NEVER experienced actual floor nursing or have spent very little time as a floor nurse. It is not uncommon to find a nurse in a supervisor position who either never worked as a floor nurse or couldn't handle the demands of floor nursing. In order to secure their position and salary they are more than willing to enforce "staffing models" otherwise known as "short staffing" where nurses are forced to work under unsafe conditions. Unlike history's role models Ellen Dougherty and Florence Nightingale, these managers have lost the vision of "advocates in the promotion of health care and a safe environment" and are more concerned with budget restraints and their own income. Often times the staff employed under their management are dissatisfied with them but are afraid to speak up for fear of losing their jobs.

SO WHAT DOES ALL THIS MEAN?

I ask you... what is the value of human life? What is the value of your life and the lives of your loved ones? Do you turn the other cheek when your care is barely managed by a nurse with 8 patients and she is too busy to see that you are not able to breath and too weak to call for help? Or do you throw such a fuss that the care you receive is adequate but the other 7 patients are now neglected? People have begun to recognize this problem and speak up and so far the only changes that have been made is that the corporations and accrediting organizations have come up with more work for the nurses to cover up this problem. They have been given more documentation and more tasks to address the fact that people are stating that they see that nurses do not have time to spend with patients. They still have more patients than they can safely handle but now they have documentation and tasks to prove to their employer and the public that they CAN handle the assignments. Obviously, speaking up has not cured this problem.

So what do we do?

For one, there are many (too many to be exact) organizations that are promoting changes in the medical field to address the "short staffing" problem as well as "whistle blowing" which is unreasonable reprimand or consequences for speaking up. These organizations have already put together petitions and are working to change the problems that exist. You can sign their petitions, join as members, assist them with their mission and even make cash donations to support them.

So, what can we do while we are waiting for things to change?

KNOW YOUR MEDICAL PROVIDER! Ask hospital administrators how many patients that their nurses are responsible for on each shift. Ask them how they handle "short staffing" concerns. Tell them that you know that 8 - 10 or more patients is unsafe. Tell them that you do not agree with their staffing model and that you are aware that the risk of medical errors goes up with the number of patients there staff is responsible for. Tell them that you refuse to believe when staff is forced to tell you that they have the time to take care of you and that you don't approve of them covering things up with lies. Tell them that you don't agree with risking patients' lives by refusing to staff with numbers that allow for safe patient handling and care.

Another deceiving concept is something called "Magnet Status." With this "title" hospitals strive to convince the public that their employees are happy to work there and that safe conditions exist. Again, take a look around. How many experienced seasoned nurses do you see? If the majority of the population is young and new graduates, then why has there been such a turn around in employees? How many supplemental staff are on the floor? Chances are many seasoned nurses were pushed out, fired or chased off. The present staff is encouraged to prove their loyalty by acting out in a way to help the hospital obtain "Magnet Status." As far as I am concerned, Magnet Status would be the hospitals with the least amount of turnover, the least amount of terminated employees and the least amount of employees that have left due to dissatisfaction. There isn't anything in the process of achieving "Magnet Status" that addresses that. Achieving "Magnet Status" comes from current employees who may not have even been there long and all they have to do is fill out surveys. I believe "Magnet Status" should be a concept that tells the public that they reviewed their "human resources" files and they publicly post....

1) The number of employees terminated for negative reasons,
2) The number of employees that left voluntarily for negative reasons,
3) The number of employees that left satisfied but to pursue other options,
4) The number of patients that nurses are responsible for on each unit and each shift.

Those are the facts that speak for themselves.

Read more about Magnet Status:
http://www.nursingadvocacy.org/faq/magnet.html

See the actual survey for nurses:
http://nursecredentialing.inquisiteasp.com/cgi-bin/qwebcorporate.dll?WSEVF5
Fill in the information with something and go read the survey for yourself.

The questions in the survey do not address the most important issues that result in SAFE PATIENT CARE.

BE INFORMED!
SPEAK UP!

Don't waste your breath telling them that you felt the nurses were too busy and didn't have time. Tell them what you know. Tell them that you know 8 patients and more is unsafe. Tell them that forcing employees to repeat scripts telling you that they have time is an insult to your intelligence. It's your life and your health.... what is it worth to you to turn the other cheek until some medical error causes a tragedy in YOUR family.

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After being a nurse for twelve years and never working in a hospital (yes, it is possible!), I have never had a job where I was required to wear scrubs or a uniform. For all of my twelve years, I've worn street clothes---"business casual", as they call it---and while I often complained about having to iron my cotton pants and shirts every week, I never considered the fact that scrubs were a possible fashion choice. Still, in a community health center setting a few years ago, I was indeed on occasion known to wear a (grey) lab coat when the manager was around (only to slip it off as soon as she was gone). 

Interestingly, even as a visiting nurse about nine years ago, I refused to wear scrubs of any kind, and often stained my clothes with Betadyne and other fluids as I dressed wounds and tended to patients. For some reason, I felt that wearing street clothes would make me seem more accessible, less clinical. I considered whether patients would feel more comfortable if I did indeed look more clinical, but I had high approval ratings and how I dressed seemed of little consequence at the time.

Now that I'm working for a visiting nurse/hospice agency, I note that all of my new colleagues wear some sort of scrubs to work. In hospice, we're often dealing with leaky catheters, PCA pumps, enemas, disimpactions, and wounds, thus the idea of wearing scrubs that never need ironing is truly a revelation to me. Having just completed eight years as a Nurse Care Manager where I wore relatively nice clothes to work (lots of ironing, as usual), I am now somewhat thrilled to simply throw on some scrubs and head out the door in the morning. Be that as it may, I'm a firm believer in not wearing scrubs in public once one has been in contact with patients and their body fluids, thus I have a practice of changing clothes before I leave for home at the end of the day. I also notice that I don't necessarily want my profession to be so easily identifiable as I walk down the street or go to the store. My anonymity is still important to me. 

If I worked forty hours a week as a hospice nurse, the scrub thing might sometimes get a little stale, but as a per diem worker, the novetly of wearing those wash-and-wear utilitarian garments is truly that---a novelty whose time has come.

 

 

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