Nursing Notes

September 24, 2009

How many nurses on duty? Likely not enough |

Here is another article that discusses the impact on our patients when staffing is cut to the bone and one nurse is spread so thin that she can’t even stop to breathe.

We all need to pay attention to the nurses who are talking about why we are leaving this profession in large numbers.  The shortage is real.  We need to be looking for ways to keep our nurses, not run them off.

How many nurses on duty? Likely not enough
Staffing levels must be considered in investigations of medical failings.
Last update: September 23, 2009 – 11:00

Nurses have long warned about the negative impact of nurse staffing cuts on patient outcomes. The unfortunate incident at St. John’s Hospital in Maplewood (“Help came too late in the ER,” Sept. 18) illuminates our concerns.

Unlike the hospital administration, which has pledged to examine innocuous issues such as “staff training,” every colleague I have who reads the story about Raymond Newmaster, a stroke victim who waited nearly 90 minutes to be examined — and who ultimately died — is probably imagining the same scenario.

What other challenges faced the nurse in the ER that night in 2007? How many other patients was she attending? How sick were they? How many other nurses were on shift? How many other duties was she performing, like trying to get her documentation done, attempting to track down physicians, and answering numerous phone calls and requests from families and public safety personnel?

Staff training? Oh, if it were only that — it only scratches the surface.Hospitals continue to cut nurse staffing, adding responsibilities and workload to an already stressed nursing staff. And the consequences will continue to be dire. Patients will fall. Nurses will have no time to assess. No time to reassess. No time to treat. No time to teach. Perhaps staffing was stretched so thin that night, the nurse couldn’t even have had time to touch Newmaster’s wife’s shoulder and say, “I need to tend to a heart attack right now, but you can be my eyes and ears. Look for signs like this or this for me.”

Until inadequate RN staffing levels are considered integrally related to medical errors, we will not be able to truly address the 98,000 preventable annual deaths in U.S. hospitals. Until we commit to nurse staffing levels that meet the needs of the patient at the moment in time, we will continue to have adverse events such as this.

Linda Slattengren is president of the Minnesota Nurses Association.

How many nurses on duty? Likely not enough |

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September 23, 2009

What’s It Gonna Take to Improve Nurse Staffing? « Off the Charts

Filed under: Nursing — Shirley @ 11:44 pm
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Here is an article I found from AJN that addresses the lack of movement in making any improvements in staffing and nursing environments despite studies that show an increasing number of nurses who are unhappy with the status quo enough to think about leaving the profession. 

What do you think?  Please read the entire article and then visit the site on the link at the end.  There are several articles available there that you will find interesting and thought provoking.

If you are a nurse, or are thinking of becoming one, knowledge is power, so the more information you can gather about your profession, the better off you are in being prepared to make an intelligent argument against the status quo.

What’s It Gonna Take to Improve Nurse Staffing?

July 10, 2009

It’s easy to forget that nurses are the ones who will continue to provide most of the care in whatever health care system we end up with in the coming years. Unfortunately, two recent announcements about how nurses rated staffing and workloads gave me a nasty sense of déjà vu.

On July 6, the American Nurses Association (ANA) announced the results of an online survey it conducted for several months last year: 70% of the 10,000 plus respondents say staffing is insufficient; 52% said they are considering leaving their job (of these, 42% say it’s because of inadequate staffing). Slightly more than 35% say they “rarely or never” are able to take full meal breaks. Over half say the quality of care has declined and almost half (49.5%) are unsure if they’d want someone they care about treated in the facility in which they work.

And a survey of 2,203 nurses from 11 countries shows that nurses around the world have the same issues. On July 1, at its meeting in Durban, South Africa, the International Council of Nurses (ICN) released the results of a survey it conducted in collaboration with Pfizer. It found that 46% of nurses say that compared to five years ago, the workload today is worse. The conclusion? “’Staffing issues’ appear to be the most important problem facing nurses on a global basis.”

So why the déjà vu? Back in 1996, AJN published the AJN Patient Care Survey. Author Judith Shindul-Rothschild noted, “Nurses across the nation, in every setting and specialty, report that they’re taking care of more patients, have been cross-trained to take on more nursing responsibilities, and have substantially less time to provide all aspects of nursing care.” Of the 7,560 respondents, 40% said they wouldn’t want a family member to be a patient in their facility.

Sound familiar? That was 13 years ago. I remember reading it and thinking, “Now we have data; now hospitals will take note.”

Then in 2001, the Agency for Healthcare Research and Quality (AHRQ) published Making Health Care Safer: A Critical Analysis of Patient Safety Practices. In the chapter on nurse staffing and models of care delivery, it noted that “richer nurse staffing is associated with better patient outcomes.” In 2002, Linda Aiken in JAMA and Jack Needleman in NEJM each published data linking inadequate staffing to complications and poor patient outcomes. In 2003, the Institutes of Medicine (IOM) published Keeping Patients Safe: Transforming the Work Environment of Nurses, which reaffirmed nurses’ pivotal role in safe patient care and put forth several recommendations to change workplace practices.

Well, I thought, now we’re cooking: when the IOM speaks, people listen.

How has it happened that we have made such little progress in seven years that the primary work environment for our profession still doesn’t allow us to do what we should be doing for our patients? How is it that even with hard data, nursing can’t make the case for nurse staffing as the key to not just safe but quality care? Why is it so much easier for hospitals to invest in technology that has not been proven to improve outcomes? While the literature suggests Magnet hospitals offer better staffing and a better work environment, nurses at many still have serious concerns about staffing. (In June, nurses in a Magnet facility in my northern New Jersey neighborhood struck over staffing issues.)

Next week, the IOM is embarking on another nursing initiative: the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine. I’m optimistic because the RWJF has a stellar track record in creating initiatives that work for nursing—its myriad nursing leadership programs and its Transforming Care at the Bedside initiative (a joint project with the Institute for Healthcare Improvement) are cases in point.

But meanwhile, I’d like to know: is there a hospital out there where the staff nurses wouldn’t echo the results of these recent surveys?Shawn Kennedy, MA, RN, AJN editorial director

What’s It Gonna Take to Improve Nurse Staffing? « Off the Charts

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September 20, 2009

Junkfood Science: Who will speak out for you?

Here is another take on the article I posted yesterday.  Please go to her blog and read this in full.  She has more facts and data than the already published article and you really need to know about this.  Currently, this concerns nursing and nurses, but this could become a global issue when “whistle-blowing” is involved.


Medical professionals, especially nurses who are generally lower on the food chain, so to speak, are increasingly reticent to speak out when they see unsound, unethical or corrupt things going on in healthcare. It is hard to do the right thing. They know and see the consequences of following their consciences and the Code of ethics. This is not an isolated incident. Three California nurses were suspended after they reported a doctor who later admitted giving a lethal injection to a child and another nurse was threatened with firing after refusing to follow a doctor’s verbal order to administer morphine until a patient stopped breathing. A California nurse was threatened with firing for reporting unsafe patient care practices. A registered nurse in San Antonio was fired when she voiced concerns about unsafe staffing at a dialysis center. A San Antonio hospital posted a notice to employees that anyone who went outside the hospital with a report of unsafe or unethical practices violated the state’s “Safe Harbor Law” and would face discipline and even termination. This “violates the basic premise of whistle-blower laws — to free up an individual from the internal politics of the workplace,” wrote Linda R. Srungaram, RN, an experienced emergency room nurse.

Ann and Vicky courageously did the right thing and had the expertise to understand how patients could be harmed. Yet, they only came up against the interests of a single doctor. What do you think happens to nurses who might dare to report something unethical or corrupt that affects entire institutions, comes up against well-funded drug companies or counters powerful political interests?

If nurses following their professional ethics and good consciences are prosecuted for speaking out on behalf of patients, how many nurses will avert their eyes and shut their mouths when they see unsafe, unsound or unethical patient care or corruption, for fear of being hauled off on criminal charges?All nurses and healthcare professionals will be watching what happens to these nurses in court next week.But so should each of us.

© 2009 Sandy Szwarc

Junkfood Science: Who will speak out for you?

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September 19, 2009

Report a bad doctor to the authorities, go to jail? : Respectful Insolence

Here is a blog article that I found that discusses an incident I had intended to put here on my own blog.  However, after reading this article, along with the author’s asides and explanations, as well as the comments; I felt this was the most appropriate way to bring you this information.  Please follow the link at the end and read all of the comments, too.  This situation is untenable and should not be allowed to happen!

Posted on: September 18, 2009 6:00 AM, by OracI just found out via one of the mailing lists I’m on of a very disturbing case in Kermit, Texas.

Two nurses who were dismayed and disturbed by a physician peddling all manner of herbal supplements reported him to the authorities. Now, they are facing jail: In a stunning display of good ol’ boy idiocy and abuse of prosecutorial discretion, two West Texas nurses have been fired from their jobs and indicted with a third-degree felony carrying potential penalties of two-to-ten years’ imprisonment and a maximum fine of $10,000. Why? Because they exercised a basic tenet of the nurse’s Code of Ethics — the duty to advocate for the health and safety of their patients.

The nurses, in their 50s and both members of the American Nurses Association/Texas Nurses Association, reported concerns about a doctor practicing at Winkler County Memorial Hospital in Kermit. They were unamused by his improperly encouraging patients in the hospital emergency department and in the rural health clinic to buy his own herbal “medicines,” and they thought it improper for him to take hospital supplies to perform a procedure at a patient’s home rather than in the hospital. (The doctor did not succeed, as reportedly he was stopped by the hospital chief of staff.)

How can this be? This is how: The nurses Vicki Galle, RN, and Anne Mitchell, RN, say they were just trying to protect patients when they anonymously reported their concerns April 7 to the Texas Medical Board (TMB). The RNs believed a physician wasn’t living up to ethical practice standards at the 15-bed county hospital where they worked. The report indicated Rolando Arafiles, MD, one of three physicians on contract with the hospital, improperly encouraged patients at the Winkler County Memorial Hospital emergency department and the county’s rural health clinic to buy herbal supplements from him. However, because the two nurses worked for a county hospital – and included medical record numbers of the patients in their letter to the TMB in April – the county attorney’s office indicted them on “misuse of official information” – a third-degree felony that carries potential penalties of 2-10 years’ imprisonment and a maximum fine of $10,000. Additionally, the prosecution asserts the nurses used patient records as part of the evidence they offered to the TMB to “harass or annoy” Arafiles.

Part of what’s so disturbing about this is that complaints to the medical board are supposed to be confidential. Indeed, this sort of retaliation is exactly why such complaints are confidential. Why do I say “retaliation”? Well, certainly there is the suspicious timing of how they were arrested: Mitchell and Galle, both long-time nurses at the facility, were fired from their positions and were subsequently arrested June 12, just 5 days past the 60-day window that could have been part of the defense to prove retaliation. The two nurses are free on bond of $5,000 each.

Gee, you don’t think that timing was intentional, do you? If that’s not enough, take a look at this account: The nurses went up their chain of command with their complaints. They got nowhere with their 25-bed rural hospital. So they anonymously turned the doctor into the Texas Medical Board using six medical record numbers of the involved hospital patients . When the medical board notified the physician that he was under investigation for mistreatment and poor quality of care, he filed a harassment complaint with the Winkler County Sheriff’s Department. To find out who made the anonymous complaint, the sheriff left no stone unturned. He interviewed all of the patients whose medical record case numbers were listed in the report and asked the hospital to identify who would have had access to the patient records in question. At some point, the sheriff obtained a copy of the anonymous complaint and used the description of a “female over 50” to narrow the potential complainants to the two nurses. He then got a search warrant to seize their work computers and found a copy of the letter to the medical board on one of them.

So let’s get this straight. Two nurses, alarmed that a physician was inappropriately peddling herbal remedies that he sells to patients in the emergency room of a small rural hospital in the middle of Bufu, Texas, try to report him through the chain of command. From here on out, I’m going to try to read between the lines a bit, but I bet my speculation is not too far from the truth. My guess is that Dr. Arafiles is probably either popular or desperately needed in Kermit–or both–and that he’s well-connected in the town.

Well, actually, that last part is almost certainly true, as apparently Dr. Arafiles is buddies with the Sheriff (Robert Roberts) and–who knows?–probably Winkler County Attorney Scott Tidwell as well for all we know. The Sheriff, tipped off by his buddy that someone at the hospital was complaining about his questionable choice of venue to peddle his herbal woo, went after Mitchell and Galle as though they had gone on a four county shooting spree and and then, after he figured out who they were, threw the book at them, even though they had no justification in doing so.

The Texas Medical Board sent a letter to the attorneys stating that it is improper to criminally prosecute people for raising complaints with the board; that the complaints were confidential and not subject to subpoena; that the board is exempt from federal HIPAA law; and that, on the contrary, the board depends on reporting from health care professionals to carry out its duty of protecting the public from improper practitioners.Excerpts from this letter include: * Information provided by an individual to the board… is information used by the Board in its governmental capacity as a state agency…Information provided triggering a complaint or furthering and investigation by the Board is information provided for a governmental purpose – the regulation of the practice of medicine. * …under federal law, the TMB is exempt from the [HIPAA] requirements; therefore, the provision of medical documentation with patient names on them to the Board is not a violation of [HIPAA].

And it’s true. In order to encourage whistleblowing and minimize the chances of retaliation, HIPAA rules don’t apply to complaints to state medical boards. Regardless of the merit of Mitchell and Galle’s complaint, they were well within their rights to report Dr Arafiles to the Texas Medical Board. It doesn’t matter whether they had first gone through the chain of command or not, regardless of what hospital flunkies or apologists for the sheriff say.

This case is bad. Real bad. Nurses and other health care professionals are reluctant enough as it is to report a bad doctor or a doctor peddling dubious therapies as it is. What makes this case particularly outrageous is not only because it appears to be a horrible abuse of power by Sheriff Roberts, but, even worse, it sends the clear and unmistakable message to nurses in Texas: Don’t get out of line or the medical powers that be will make you pay. They will find out who you are, no matter what it takes to do so, and then they will do everything in their power to retaliate. They’ll even try to throw you in jail if they can figure out a rationale to do so, legal or not. It’s hard enough to go against a doctor as it is, particularly in small towns, where doctors are often considered pillars of the community, making it hard enough to risk the disapproval that would be likely to be directed at any whistleblower. Without legal protections against prosecution for reporting a doctor to the board, confidentiality means nothing if there is someone in a position of power who is determined enough to shred the confidentiality of the complaint (like a county sheriff) and apparently ready to abuse his power to retaliate against the nurses making the complaints.

Even though I’m a bit late to the game, it disgusted me to read about this case. If we are to protect the public from physician misconduct, be it quackery, breaches of ethics, inappropriate sexual behavior, fraud, or whatever, there must be protections for the complainants against retaliation by hospitals or whomever. Quite correctly, the Texas Nurse’s Association is fully backing Mitchell and Galle, and Mitchell and Galle are also filing a civil lawsuit in federal court against the hospital (Winkler County Memorial Hospital), the county attorney, and the sheriff. The complaint alleges: Specifically, Winkler County had a policy to prohibit any adverse report without first getting the approval of the Board of Control of Winkler County Memorial Hospital and the Medical Staff. This discouraged employees from publicly reporting matters of public concern regarding patient safety and patients’ health and welfare as to how they were being treated that would cast Winkler County or Winkler County Memorial Hospital or Rolando G. Arafiles, Jr. in a negative light.

This sort of miscarriage of justice should not be allowed to stand. The Texas Nurses Association has set up a legal defense fund for these nurses, and I urger you all to contribute. I have. I also encourage you to write polite letters of protest to the Winkler County District Attorney’s Office. It is a travesty that this retaliation against nurses just trying to do their duty for their patients has been allowed to continue this long and this far. We should do whatever we can to make sure that this pure power play to put a couple of uppity nurses back in their place does not stand.

Report a bad doctor to the authorities, go to jail? : Respectful Insolence

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September 18, 2009

Online Nursing Education Blog –

Here is another article I found that describes the highest paying nursing jobs and what you have to do to get one.  Read the excerpt below, but then please follow the link to read the entire article.  I think you will find the information both informative and useful.  I know I did.

How to Become a Nursing Superstar: The Highest Paying Nursing Jobs and Their Educational Requirements

Every field has its superstars, and nursing is no exception. The 3 most highly paid jobs to which a clinically practicing nurse can aspire are Certified Registered Nurse Anesthetist (CRNA), Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS). Advanced practice nurses who work in these roles are among the most highly educated in their profession, and enjoy the highest amount of industry demand. If you have a passion for any of these areas and would enjoy an elevated salary and strong job security, it may be easier than you think to achieve your goals.

Enrolling in an online nursing degree program can be the first step to becoming a CRNA, an NP, or a CNS.#1 Highest Paid Nursing Job: Certified Registered Nurse Anesthetist (CRNA)CRNAs provide anesthesia care to over 22 million surgical, obstetrical and trauma patients every year in the USA. They are qualified to dispense all kinds of anesthetics, work in all types of practice setting, and provide care for all sorts of procedures, from open heart surgery to pain management programs.

Pursuing further education so you can become a CRNA is an ideal option for an RN who is interested in surgery, has good technical skills, or is less interested in ongoing patient interaction.

Online Nursing Education Blog –

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September 8, 2009

National Nursing News | N.Y. and N.J. Consider BSN Requirement

Filed under: Nursing — Shirley @ 3:47 pm
Tags: , , , , ,

Here is an article from the Nursing Spectrum that makes no sense on the first hand–don’t we have a critical nursing shortage?–but then makes some sense on the second hand–better educated may make better quality decisions in dealing with sicker patients.  After reading this entire article, I am still left pondering whether the timing of this is right. 

I have been a BSN RN for 19 years and this topic was hot when I was in school.  At that time, we had a nursing shortage so I believe the issue was tabled.  Now, when we have a shortage of massive proportions,  do we really want to open this Pandora’s Box again?  Might this legislation dissuade some from entering the field when we need good people to join us?

Please visit the site and read the article in its entirety.  There are some very interesting statistics on the page also.  Make your own mind up after reading.

For several decades, the education standards for entry into nursing practice have generated spirited discussion among nurses and legislators alike. That discussion is sure to heat up once again with BSN in 10 bills on the floor in both the New York and New Jersey state legislatures. The bills would require all newly licensed RNs to obtain a BSN within 10 years of initial licensure.

If signed into law, the proposals will have a lasting impact on the nursing profession. There are a number of concerns about what the passage of the two bills would mean for the schools of nursing in New York and New Jersey, that, like the rest of the country, already are turning potential candidates away because of faculty shortages.

Concern over the fate of ADN and diploma programs also is a major issue, as is the potential monetary burden that could be placed upon nurses to fulfill the BSN education requirement.On the other side, some argue the new requirement would be worth it to ensure nurses in New York and New Jersey are equipped to handle the ever-increasing complexity of patient care. In addition, they say nursing needs to step up its game to remain viable and equally competitive in the healthcare arena by making the baccalaureate degree the minimal requirement to maintain licensure.

“All nurses need to know the facts regarding BSN in 10 S620 introduced by [N.J.] Sen. Joseph Vitale (D-19th), the chairman of the Senate Health Committee,” says Bonnie Michaels, RN, MA, NEA-BC, vice president and CNO at Mountainside Hospital in Montclair, N.J., and a member of Nursing Spectrum’s Regional Advisory Board.New York State’s Bill S4051/A2079B (The Educational Advancement for the Nursing Profession) and S620 (nee S2529)/A3768 in New Jersey — most commonly referred to as the BSN in 10 proposals — include the same general points. Both pieces of legislation would require new graduates of associate degree and diploma programs to obtain their baccalaureate degrees in nursing within 10 years of the date of initial licensure. If passed, the New York law would take effect immediately, while New Jersey’s would take effect after 90 days.

National Nursing News | N.Y. and N.J. Consider BSN Requirement

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September 5, 2009

Nursing Students Check Their Biases | RNBuilder Nursing Blog

Filed under: Nursing — Shirley @ 12:58 am
Tags: , , , ,

This is an interesting blog I found.  I read several of the postings and really felt that this was good information about becoming a nurse.  I hope, after reading the post below, you will visit the link and read all of the good posts you can find there.  I know I will be back again to see what they post new.

Nursing school is an excellent time for self-reflection and awareness of your beliefs, fears, prejudices and any other thoughts or behaviors that you may not be aware of now, but have a good chance of rearing their ugly head later in your career when you least expect it.I know that all nursing students believe they are fair, just, open-minded, nurturing, unbiased, politically correct beacons of humanity. Yet somewhere between graduation day and years into their career, something happens and, in some nurses (not all), the cynicism switch is turned on.Whether the cause is career burnout, a cutting sense of humor that helps them survive their shift, or they’re just “going along with the crowd,” the once fresh faced, innocent nurse finds herself saying things that would have horrified her in nursing school. She finds herself labeling patients as “frequent flyers,” “drug seeking,” or sometimes worse depending on what she (or he) has heard from her colleagues.

One of the most common biases in health care is toward the elderly. An article in the Journal of the American Medical Association (JAMA)* stated that “Some studies have indicated that medical students perceive older people as being dull, disagreeable, inactive, and economically burdensome.” Potentially damaging preconceived notions about elderly patients or patients from any specific age group, ethnicity or other demographic, are not confined to medical schools either.Nurses and nursing students need to examine their own beliefs and notions for potential warning signs. This is even more true of nurses, since they spend by far the most amount of time in direct contact with patients and also experience a great deal of stress related to heavy workloads. Times of stress have a way of acting like wine, in the sense that “in wine there is truth.”

It is far better to be honest with yourself now and prevent an embarrassing and potentially career threatening situation later.*

“Ageism in the Preclinical Years”; Catherine Caruthers McCray; University of Kansas School of Medicine; JAMA. 1998

Nursing Students Check Their Biases | RNBuilder Nursing Blog

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September 2, 2009

Three Nurse Groups Merge to Create Super Union –

Filed under: Nursing — Shirley @ 4:55 pm
Tags: , , , , ,

Here is an article I found that talks about the formation of a nurses’ “Super Union”.  I’m not sure how I feel about this move.  I can see pros and con to such a formation.  Although I do understand that to make any changes in our profession we need to be political, I still don’t want to lose the actual reason I became a nurse–patient contact.

This move may actually, at some time in the future, help our profession.  However, I am in need of some help in the “here and now” and so are my patients.  I am seeing my patients being charged more and more and receiving less and less care.  This has to stop.

Anyway, read this excerpt below, and if interested please click through to the entire article.

Three Nurse Groups Merge to Create Super Union

Sarah Kearns, for HealthLeaders Media, September 2, 2009

The three major nurses’ organizations in the country have come together to form the largest registered nurses union and professional association in U.S. history: National Nurses United. Members of the California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association make up the 150,000 member national organization.

After meeting last month in Minneapolis, the leaders of the National Nurses United announced that they will be holding a convention December 7–8 in Scottsdale, AZ. From now until December, each organization will have its own national convention to approve the pending union with the purpose of creating a stronger national movement of direct-care RNs.

National Nurse United also plans to put emphasis on the protection and expansion of patient rights and RN professional practice. To accomplish such goals, National Nurse United hopes to promote Senate bill, S. 1031, the National Nursing Shortage Reform and Patient Advocacy Act. The new merge will also focus to strengthen nurses’ voice in the national healthcare debate.

Three Nurse Groups Merge to Create Super Union –

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