Unapologetically a Nurse

Here is an essay I found on the Huffington Post headed “Unapologetically a Nurse”, and I am so glad I found it and glad I read it.  Nurses everywhere need to read this.  She defines nursing in such a profound way, with unadulterated truth and honesty.  Nurses are just people.  However, they are very special people who have been called to minister to others.  I know, that sounds corny in today’s world, but corny or not, it is the truth.  You can run away and try to evade it, but if nursing is calling you, nursing will get you.

I was tearfully moved by one statement she makes in her essay, ” And yet those who are in on the secret, or at least are suspicious of it, understand that it was no miracle that saved your loved one. Rather, it was the intent and vigilant care of a critically thinking, intuitive, and fiercely devoted nurse. Our secret is that we save more lives than we are willing to admit; we catch more errors than we hope to share; and we can sense subtle nuances that prevent a turn for the worse. ”  This is so true.  I can speak as a nurse but I can also speak as a parent.

When my youngest daughter was bleeding to death in ICU after her liver/kidney transplant, it was her 7p-7a nurse that saved her life that night.  She worked tirelessly and she hung bag after bag of blood, platelets, albumin, and IV fluids to keep my daughter alive.  She took orders from the nurse practitioners on the floor that night as well as three different doctors calling orders in to her from home.  She went with my daughter off the floor, bringing all those bags of life saving fluids with her for a procedure to try to find and stop the bleed.

As far as I am concerned, that night I witnessed a miracle and was in the presence of a real Angel.  I cannot ever thank her enough for all she did and the worst part of it all is that I don’t even know her name–just Liz.  When my daughter stabilized and her shift was over, she hugged me and told me to go home and get some sleep, then she left and I never saw her again.  But believe me, she is in every prayer I utter every day.

Please read this essay.  You will be a better person for it and you will understand your nurse better for it.

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Unapologetically a Nurse

I’m No Angel
 
 

I sit here starting at a blank computer screen, filled with quiet concern. It’s simply that I have so many things to say to about the nineteen million and counting nurses across the planet, and not enough time in the world to say it. They are my team. They are my posse. They are my family — an utterly dysfunctional one, but family at that. I believe that few professions exist where colleagues can be grossly irritated by each other one moment, and cracking jokes in the next. It has been mentioned before that what we do every day makes us akin to the “Navy Seals” of the healthcare profession. That statement alone suggests that nurses work in some of the most stressful environments while enduring more intense circumstances daily than many face in a lifetime. What we do, every single day, is a labor of love. But we are all in on the real secret: nurses are not angels placed on earth to serve and lift. We are not diminutive and submissive and gentle souls that kiss boo-boos. We are not the starched white caps and perfectly polished shoes that history books portray. Nor are we fishnet stockings and naughty rendezvous in dark corners. We have been glamorized and fetishized and placed on a pedestal unlike any other profession, and yet the definition of what we are is only surpassed by the list of what we are not.

Please read the rest of this short essay here.  I promise you it is well worth your time.

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The Patient Satisfaction Survey Score

 Here is an article that addresses a common issue found in today’s healthcare setting.  The Patient Satisfaction Score, although a great idea, has become an albatross around the necks of all healthcare workers.  It is one thing to practice a patient-centered nursing, which is good; but it is another thing to turn nurses into maids and servants who are desperate to please.  Sometimes what the patient wants is not what the patient needs to improve his health and denial of his wants can be reflected in the patient satisfaction score.

There is not a nurse alive who goes to work and says, “I am going to make my patients very unhappy today by denying them all their requests.”  To think there is such a nurse is just plain stupidity.  Nurses are there to administer care while a patient is unable to do so for himself and while his condition warrants close monitoring.  All nurses want their patients to be happy and healthy, but there is also a reason why the patient is in the hospital to begin with.  Nurses have to walk that fine line between wants and needs all day long.

Please read this article and see if you agree or disagree that Patient Satisfaction Scores are becoming a real problem in the healthcare arena.

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The Problem With Satisfied Patients

A misguided attempt to improve healthcare has led some hospitals to focus on making people happy, rather than making them well.

patient satisfaction
Philippe Wojazer/Reuters
When healthcare is at its best, hospitals are four-star hotels, and nurses, personal butlers at the ready—at least, that’s how many hospitals seem to interpret a government mandate.When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The Centers for Medicare and Medicaid Services (CMS) officials wrote, rather reasonably, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” They probably had no idea that their methods could end up indirectly harming patients.

Beginning in October 2012, the Affordable Care Act implemented a policy withholding 1 percent of total Medicare reimbursements—approximately $850 million—from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and the top performers will receive bonus money from the pool.

Patient-satisfaction surveys have their place. But the potential cost of the subjective scores are leading hospitals to steer focus away from patient health, messing with the highest stakes possible: people’s lives.
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Remembrance of Days Gone By

Today is All Soul’s Day and I think it would be appropriate to reminisce about nursing in the past.  Remembrance of days gone by is always challenging because reflection brings strong emotions to bear sometimes.

I was leaving my exercise class this morning at the clinic and I spied this picture up on the wall in the entryway.  I was mesmerized by this photo.  It made me stop and think about all the nurses who went before me, all the nurses who blazed trails for the modern day nurse.  I fear that most or all of the nurses in this picture may be deceased by now, but posting the photo here is my way of saying, “Thank you very much for your service.”

It also helps me to remember that as a nurse myself, I am part of a long line of selfless, caring people who wanted to make the world a better place one patient at a time.

Let’s use this opportunity to remember nurses past.

remembrance of days gone by

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Nurses: Why Are We Letting Them Burn Out?

Burn out is real and a danger to all of us–both nurses and patients.  When your nurse is burned out, you get only part of the care that nurse is capable of.  When the nurse is burned out, the interactions on the unit become strained and difficult so communication among and between care teams is at risk.

As a nurse for 25 years, I can attest to the statistics floated in this article.  I cannot remember a single shift I worked where one of the other nurses would not complain about the state of nursing and vow to quit.  Not one shift.  That is terrible.  Nurses want to give good, competent care.  Nurses want to make patients better–improve their lives if possible.  But the truth of the matter is that they are overworked and with the advent of computerized charting must spend time away from their patients to chart.  Together these two things are driving nurses out of nursing in large numbers.

Please read this entire Huffington Post article and see if you don’t agree that there may be a significant problem on our horizon that no one seems to be interested in attending to.

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We Need Nurses More Than Ever. Why Are We Letting Them Burn Out?

The combination of an exodus of RNs and an influx of aging patients could create a health care crisis.

JOHN TLUMACKI/THE BOSTON GLOBE VIA GETTY IMAGES
Tufts Medical Center nurses picket in Boston on July 13 after being locked out after a 24-hour strike. One of the sources of stress nurses report is not being included in the decision-making process at health facilities.

About 10 years ago, Elizabeth Scala was a young RN, working on a psychiatric floor of a busy Maryland hospital. She’d been in the role for two or three years, and she’d risen to a position of authority, coordinating her colleagues’ activities as a charge nurse on the unit. From the outside, it looked like she had everything together, but inside she was so stressed out she was nearly falling apart.

“It was like Jekyll and Hyde,” Scala said.

When she got off work, she said, she would go home and pick vicious fights with her boyfriend. She wasn’t sleeping or eating well. She was constantly furious with her co-workers and supervisors. She remembers throwing a temper tantrum one night, flailing around on her bed like a 4-year-old.

Then the situation began affecting her ability to do her job.

“Eventually I just started to really resent going into work — dreaded going in — and actually didn’t want to talk much with the patients,” she said.

Scala finally left the job, shifting to a career in which she could use her nursing skills in administrative and research. She also wrote Stop Nurse Burnout, a guidebook for nurses who feel like she once did.

And that’s a lot of nurses. A survey earlier this year by travel nursing company RNnetwork found that almost half of the nurses they asked were considering leaving the profession. About a quarter said they felt overworked, 46 percent said their workloads had risen and 41 percent said they’d been harassed or bullied by managers or administrators. Making matters worse, with the aging of the baby boom generation, demand for health care is rising at the same time that large numbers of experienced nurses are retiring. That could lead to the worst nursing shortage in generations within the next decade.

Read the rest of this article here.

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Mean Girls of the ER: The Alarming Nurse Culture of Bullying and Hazing

This article surprised me in that it comes from Marie Claire magazine.  Although written in 2015, the article still remains pertinent and applicable to today’s nursing.  There is the nurse culture of bullying and hazing and it is one of nursing’s secrets, even today.

When you think of nurses, you probably think of calm, competent men and women who try to do whatever they can do to help a person recover from an injury or illness.  This is an accurate picture, but underlying that calm, helpful image is a bizarre negative.

Nurses can be angels sent from heaven and usually are, but they can also be hateful, deceitful, vengeful, people–usually toward other nurses.  If you ask nurses about the nurse culture of bullying and hazing, you will be met with a blank stare and a confused expression.

But if you ask “why do nurses eat their young?”, every nurse will understand what you are asking and will probably have their own personal story to illustrate this concept.  It is not that nurses intend to be mean to each other; rather it is the stress of the job, the expectations of the patients and families, and the limit of time that contributes to nurses not being as nice to each other as they could be.

Please read this article and decide what you think about this culture of bullying and hazing.

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Mean Girls of the ER: The Alarming Nurse Culture of Bullying and Hazing

It’s not only threatening the profession, it’s putting patients’ lives at risk.

Everett

Over the course of four years, I interviewed hundreds of nurses for a book (The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital), examining a subculture the public knows little about. The nursing profession demands a lot from its ranks: 12-to 14-hour shifts coping with traumas, managing grotesqueries, soothing distraught family members. And they do it with a calm and grace that belie just how complicated their jobs really are. The women and men I spoke with exuded the compassion and selflessness we’ve come to expect from nurses, traits that make it easy to understand why the country’s 3.5 million nurses have topped Gallup’s annual poll of Honesty and Ethical Standards in Professions for 13 straight years.

Which makes the profession’s silent secret all the more surprising: rampant hazing, bullying, and sabotage so destructive that patients can suffer and, in a few cases, have died. Nurses told me about numerous daunting behavioral patterns: colleagues withholding crucial information or help, spreading rumors, name-calling, playing favorites, and intimidating or berating nurses until they quit.

“Nurses eat their young.”

Nurse bullying is so pervasive that it has its own expression. In 1986, nursing professor Judith Meissner coined the phrase “Nurses eat their young” as a call to action for nurses to stop ripping apart inexperienced coworkers. Nearly 30 years later, the bullying seems to be getting worse, says Gary Namie, Ph.D., director of the Workplace Bullying Institute in Bellingham, Washington, which receives more calls from nurses than from workers in any other field (36 percent vs. 25 percent from educators, the next-most-frequent callers). “The profession’s on the brink of some sort of transition,” Namie says. “Nurses uniformly seem to accept nurse-on-nurse violence as just part of the job. But they’re losing nurses by the drove.”

Read the rest of this article here.

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Nurses Endure Violence On The Job

This incident was an eye-opening event for some about the shocking amount of violence nurses face on the job.  There is not a nurse anywhere who has not personally been abused at work or who has not seen abuse of nurses at work.  It is our dirty little secret.

I know that when this incident happened, I was appalled.  I absolutely could not believe my own eyes.  This nurse was following the law.  She was protecting an unconscious person in her care.  She refused to do something illegal to aid in prosecution.  And she was thrown into the back of a police vehicle and booked into jail.  WOW!

This incident was discussed on every news channel, in print, on the web, on YouTube.  My question is “What does it take to protect nurses from assault at work?”  Has anything changed?  Not that I can see.  Has anyone proposed legislation to protect nurses at the work place?  If there has been proposed legislation at the federal level, we are not privy to that information.

The end of this story has a happy ending in that she was released, got an apology from the Chief of Police and the Mayor, and now we find out that the police officer in question has been fired.  Yea, or is it?  It seems like a knee-jerk reaction to this situation with no attempt at resolving the issue.

I am sure that this nurse did not want the police officer to lose his livelyhood, but she may have wanted him chastised, maybe fined, and sent back for more intensive training in the laws of this country.  All in all, I feel that this has been a no-win situation all the way around.

Nurses everywhere continue to be assaulted, abused, and injured doing the job they love to do–helping others.  Am I the only person who sees this as a significant problem?

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Nurses Endure A Shocking Amount Of Violence On The Job

Usually, though, it’s not at the hands of police officers.

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Rules About Violence Against Health Workers

Here is an article from Kaiser Health News that addresses rules about violence against health workers and states that California’a rules may become the model for such rules around the entire country.

As a psychiatric nurse, I can definitely tell you that violence against health workers occurs pretty regularly, especially for nurses.  In my 25 years of work, I have had teeth kicked out, my face and nose broken, and I have torn my rotator cuff, as well as having my knee injured in a fall while at work.  That is just my injuries.  Many nurses can list more and more serious injuries sustained while trying to help patients heal.

ER nurses, psychiatric nurses, ICU nurses are all at extreme risk due to the population they care for; but no nurse or doctor is immune.  Violence in the workplace has taken on a whole new meaning when you are talking about healthcare.

Please read this article and see what your thoughts are about dealing with this problem.  We need to address this issue before we find ourselves with no nurses to care for patients.

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California Rules About Violence Against Health Workers Could Become A Model

violence against health workers

California rules would require site-specific assessments to identify violence risks for health care workers and plans to mitigate them.

Dana Neely/Getty Images

Workers in California’s hospitals and doctors’ offices may be less likely to get hit, kicked, bitten or grabbed under workplace standards adopted by a state workplace safety board.

Regulators within the California Division of Occupational Safety and Health approved a rule last Thursday that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process. The standard now will be reviewed by the Office of Administrative Law, which proponents expect will approve the new rules. The earliest they could take effect would be January 2017.

“This is a landmark day for the entire country,” said Bonnie Castillo, a registered nurse who is director of health and safety for the California Nurses Association/National Nurses United, which represents 185,000 registered nurses across the U.S.

There are no federal rules specifically protecting workers from violence, but some states, including California, New York, Illinois and New Jersey require public employers to take preventive measures, according to the American Nurses Association.

The Cal/OSHA rules apply to private health care facilities in the state and are more robust than existing workplace protection rules, union officials say. Site-specific assessments will be done to identify violence risks, and the resulting plans to prevent injuries will address concerns identified by workers. 

“California has now set the bar with the strongest workplace violence regulation in the nation,” wrote Castillo in a statement.

Read the rest of this article here.

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Nurse! What’s Taking So Long?

This is an interesting article from WebMD.com that tries to help patients and families understand why response to alarms could be taking longer than it should.  I know as a family member of a seriously ill patient, the time for response can seem forever when in fact is is mere minutes.

As a nurse, I can also tell you that response time can be affected by the number of patients the nurse cares for, the patient’s current status, and the time in the shift.  It is true that as it gets closer to the end of a long shift, nurses may opt to let the next shift deal with the issue unless it is life-threatening.  Nurses on the floor know which patients are critical and respond to those patients first.

I think this article is good and I think parents need to understand what the criteria is for response, but that said it is difficult to stand and wait when it is your loved one in need.  We nurses understand that and do not wish to make the hospital stay worse than it already is.

Unfortunately, nurses are just people who are doing the very best they can, and who have no control over how many patients they are assigned each shift.  It is difficult to be everywhere at the same time.  Nurses have to prioritize their responses so that they can help the most patients during their shift.

Please read this article and see if you agree with me, or if you think response to alarms should be immediate no matter what.

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Nurse! What’s Taking So Long?

Study at a children’s hospital evaluates response time to bedside alarms

By Randy Dotinga

HealthDay Reporter

TUESDAY, April 11, 2017 (HealthDay News) — When a bedside alarm goes off in a child’s hospital room, anxious parents expect nurses to respond pronto.

That rarely happens, however, and a new study helps explain why.

Researchers found that nurses are usually quick to react when alarms are urgent. But, they’re slower to respond at the end of the workday or when they suffer from “chronic alarm fatigue.”

Also, having parents present doubled the response time on average, the study found.

But, delayed response time didn’t threaten any of the 100 patients evaluated in the study, the researchers said. And just half of 1 percent of more than 11,000 alarms analyzed were deemed “actionable,” or crucial.

“The nurses were overall doing a great job predicting which alarms were going to be important,” said study lead author Dr. Christopher Bonafide, an assistant professor of pediatrics with the Children’s Hospital of Philadelphia. “Their intuition was correct.”

The high number of false alarms in U.S. hospitals has led to “alarm fatigue” among nurses. As a result, the Joint Commission — the organization that accredits American hospitals — issued new guidelines for managing alarm monitors.

The beeps and buzzes alert staff to medical problems facing patients such as high heart rates, dips in oxygen levels in the blood and dangerous heartbeat patterns, Bonafide said.

But, many false alarms are caused simply by babies moving around and disrupting sensors, he said.

“When an alarm goes off and the nurse is already in the patient’s room, they can immediately look up, check on the patient, and make sure everything is OK,” Bonafide said. “When a nurse isn’t in the room, some hospitals like ours have the ability to send them a text message to the phone that they are carrying.”

For this study, researchers analyzed video of 38 nurses caring for 100 patients at Children’s Hospital of Philadelphia from 2014-2015.

Almost all of the 11,745 beeps and buzzes that sounded were valid. And 50 were deemed critical, “the important ones we would not want anyone to miss,” Bonafide said. Nurses responded in about a minute, on average, to these alarms.

Read the entire article here. 

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Safe Nurse Staffing: 4 Key Points You and Hospital Admins Must Know

Here is an interesting article from NurseLabs.  I often post articles that pertain to nurse staffing, so of course this article caught my attention.  As a nurse for 25 years, I have often complained about staffing ratios in the hospitals I worked in.  It isn’t rocket science to connect the dots between patient outcomes and nurse to patient ratios.

This article gives you a chance to read not only the ideas about why nurse staffing levels are important, but also gives you the research that was used to make the argument.  It also gives suggestions for what you can do to make a change.

The author uses humor to address serious issues but make no mistake, this is no laughing matter.  Lives depend on the outcome of this issue.

Please read the entire article and make up your own mind about this issue.

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Safe Nurse Staffing: 4 Key Points You and Hospital Admins Must Know

Safe Nurse Staffing: 4 Key Points You and Hospital Admins Must Know

Worldwide, nurse staffing levels are impacted by the shortage of nurses, budget cuts, greater public demand for health care and aging populations. Safe nurse staffing has become a major issue in the nursing profession leading to extensive research studies, protests, as well as advocacy for appropriate legislation by major nursing organizations.

In June 2016 the New York State Assembly overwhelmingly passed the Safe Staffing for Quality Care Act, but this Act still has to be approved by the Senate. “The issues of chronic understaffing and low nurse-to-patient ratios are alarming and real. Ignoring nurses’ concerns for the wellbeing of their patients is both egregious and ill advised” said Barry Kaufman, the President of the New York State Alliance for Retired Americans at a press conference afterwards. “Retired Americans know that passing this legislation is literally a life and death matter for many of our members.”

“THE ISSUES OF CHRONIC UNDERSTAFFING AND LOW NURSE-TO-PATIENT RATIOS ARE ALARMING AND REAL.”

Safe staffing levels allows for quality patient care, higher job satisfaction and retention of nurses and better overall outcomes for organizations. The following points about nurse staffing levels are supported by mounting research evidence in published studies across the world.

1. Staffing levels impact on patient morbidity and mortality

Nurses are the ones who care for hospitalized patients 24 hours of the day and the nurse’s name on the patient’s chart means that she has full responsibility for the patient’s welfare and safety. But what happens when the nurse is caring for too many patients and stretched so thin that it becomes impossible to see everything she needs to see and be everywhere she needs to be? This not only places patients seriously at risk but also the nurse’s license.

Numerous studies (1234) have correlated higher levels of nurse staffing with positive patient outcomes, decreases in the length of stay of patients, a lower rate of readmission and reduced patient mortality. This means that besides improving patient satisfaction, safe staffing levels also cut patient care costs.

“BESIDES IMPROVING PATIENT SATISFACTION, SAFE STAFFING LEVELS ALSO CUT PATIENT CARE COSTS.”

For us as nurses it also comes as no surprise that research links low staffing levels with a…

Read the rest of the article here.

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Nurses Named #1 Most Trustworthy Profession for 15th Year by Gallup Poll

Here is a little article I found that gave me pause.

First, this is printed on Chamberlain University’s webpage.  To me it seems that maybe the source is touting its own horn here.

Second, there constantly are “polls” telling us about who is #1 at this or that, who is the top of some list, etc.  I am quite skeptical of such “polls”.  Who was polled?  Whose information is included in the numbers?

Lastly, as a retired nurse myself, I can say that I love nursing and believe in my heart that nurses are trustworthy and professional.  However, I have worked with many who might fall short of those qualities.

Nurses are just people.  Granted they are people who care about others; however they are still just people.  You get good people and bad people in every profession.  I do know that nurses are held to a very high standard and are constantly reviewed by the nursing boards when they make errors.

But the bottom line is that all nurses have the potential to make errors and unfortunately, these errors have the ability to cause harm to an already compromised individual.  Now all that having been said, I do believe that nursing is professional, that nurses want to do what is best for their patients, that nurses never intentionally make errors (except maybe in the event of drug diversion), and nurses are really good people.

So read this little article, click over to see the poll results even.  It is nice for nursing as a profession to be acknowledged, but maybe the accolades need to come from somewhere outside of nursing to be taken seriously.

In 25 years, I have worked with wonderful nurses.  I have loved working with them all.  In the last 2 years while my daughter has been critically ill, I have been in the company of many wonderful nurses who worked tirelessly to save her life.  I have no complaint about the quality and trustworthiness of nurses in general.  I love all nurses.

Please click over and look at this article at its source and be sure to check out the poll.

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Nurses Named #1 Most Trustworthy Profession for 15th Year by Gallup Poll

  • by Molly Mattison
  • Dec 20, 2016

No surprises here! Nursing has been ranked #1 for honesty and ethical standards by an annual Gallup poll released this week. This is the 15th straight year that nurses have topped the list.

For the poll, Gallup interviewed a sample of Americans living in all 50 states and the District of Columbia to rate the ethical standards of nurses, as well as 21 other professions.

Of those surveyed, 84% rated nurses “high” or “very high” for honesty and ethical standards. This is a full 17 percentage points higher than pharmacists, who nabbed the #2 spot…(read the rest of this article here)

 

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