Nursing Notes

October 31, 2009

What does a nurse really do?

Filed under: Nursing — Shirley @ 10:05 am
A nurse working in a nursing home.
Image via Wikipedia

 

I found this question online and was struck with how brief the answer was:

What does a nurse do for the people?

Answer

A nurse gives: medicine, shots, hangs iv drugs, gives baths, checks orders, double checks medicines and doses, alerts doctors to mistakes, checks tests, checks results, assesses patient, keeps patient comfortable, starts iv’s, draws blood, monitors patients condition, notifies doctor of changes, evaluates what is and isn’t an emergency, answers patients questions, problem solves, deals with families, cleans up vomit, and feces, and assists patient in everyway.

I don’t think this even begins to cover the subject.  Nurses do all those things, yes; but what do they really do?

Nursing is about caring–sounds trite, but nonetheless it is true.  A nurse cares for her patients and does everything she/he can do to improve the health and well-being for each patient.  However, how do you quantify all of the other things that nurses do instinctively for patients?  We hold hands, we listen, we laugh at jokes, we talk with families, we educate, we advocate, we stand up for those who cannot stand up.  We worry about patients after we go home, we help with tasks no longer easy or painless, we give encouragement, we watch for signs of problems so we can head them off, we quite simply care.

Nursing is not so much in the tasks we do, but more in the way we do them.  Nursing is alot more than just going through the motions.  Nurses are present in the moment with the patient; nurses are connected to our patients in a way that no one else cares to be; nurses accept both the good and the bad and try to find common ground.  So, I don’t think the answer above is quite all there is.

Here is an excerpt from an article on the website of The Center for Nursing Advocacy:

What does a nurse really do?

This is a note, reproduced largely verbatim, left recently at a nurse’s station at a rehabilitation unit in Detroit by a difficult patient upon his discharge from the unit.

Dear [Nurse],

I wanted to thank you personally for teaching this old dog new tricks. I always thought that nurses were basically the doctor’s handmaidens. I thought that the sexy little stereotype portrayed on television with the nurse doing sex in the linen closet with whoever was correct. I looked upon your profession badly, and I sincerely apologize.

What I have found during my stay in your care, is a completely different story (and I won’t say [you’re] not sexy, [because] you are, but you made it clear you don’t date patients, but just in case I am leaving my number at the end here). Anyway this is what I want to say, and I think each patient should be given a copy of this part on admission to any nursing facility and hospitals should be known as nursing care providers, because a patient enters the hospital for nursing care. I found this out during my stay. I had nurses 24 hours a day every day I was hospitalized, I had maybe 10 minutes a day with the doctor. So here goes my opinion of what every patient needs to know.

1. You have been placed in the hospital for nursing care.

2. The provider of that care is an educated individual who unselfishly dedicates themselves to your health and well-being. And even though you may not like being told what things are good for you and what are not, the nurse telling you does so to give you a chance to redeem your health and well-being.

3. That provider is proud to be a nurse.

4. That nurse does more than you know. She plans your care around your medical condition, emotional state, abilities to do for yourself (sorry, [nurse], I think you said “self care” in your rant), that nurse provides support to you and your family, she/he is the link between you and the doctor, [and] the everything in the facility.

5. That nurse does your bedside care, she knows what medicine you need when, and how to give it. She knows what all the tubes and stuff are and what they are used for and what to look at them for.

6. That nurse can hang an IV or hold your hand and reassure you.

7. That nurse watches over you and reads monitors and knows when [you’re] sleeping and when [you’re] awake and pulls strings to get you that cup of tea at 3 a.m.

8. That nurse is your lifeline, she can call a whole team of professionals together with her calm voice and make them work their [butts] off for your life with the flash of her/his eyes.

9. That nurse will wish you luck and give you all the instructions you need when you leave her competent care even if you were the biggest pain in the ass she ever met.

10. The nurse is why you are in the hospital and why you will go onward, be it home, perpetual care, or the morgue, she will insure that you do so with your dignity and rights intact. Why? Because it is what a nurse does.

/signed/ ……………..

This one comes just a little closer to the truth, but in my opinion still leaves out something.  What do you think? Won’t you leave me a comment telling me what you think a nurse does?


 

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October 30, 2009

Student nurses should not underestimate the value of delivering hands-on, personal care | Practice | Nursing Times

Here is another article from the UK but one that addresses a basic and undervalued skill for nurses.  After reading this, I was able to articulate why I like to do personal care when my patients need help.

I have many times sat in the bathroom helping my patient to bathe or shower.  As I work with psychiatric patients, I rarely give bed baths, but I have done a few for medically compromised psychiatric patients in my time.  It has been during these times that I have received pertinent information that directly affected the care given.  Once a patient relaxes and let’s down those barriers, you can explore just about any topic with them. 

During bathing, I have been told “secrets” that these patients had been carrying around for years.  In one case, the secret dealt with sexual abuse and ended with prosecution.  Another time, the secret was revealed by the presence of new wounds on breasts and abdomen.

I agree that this is a wonderful time to do a full head-to-toe assessment.  Your patient is relaxed and comfortable.  You are there to help and support them.
For me in psych, it is a wonderful time to observe for side effects of psychotropic medications or to assess for over-medication.  Since our patients are all encouraged to be independent and ambulatory, this is a perfect time to assess the patients ability to fulfill these functions.

Never, ever, miss an opportunity to provide personal, professional care for a patient.  If you do, you and your patient lose out on an opportunity for growth and sharing.


30 October, 2009

Even though HCAs now deliver most bedside care, student nurses must realise the value of developing skills in essential care, says Ben Bowers Recently a very experienced community colleague retold a student nurse’s disappointment that she had spent a six-month placement working in a residential home. This experience was particularly unsatisfactory for the student because she felt she had not learnt anything from washing people which will aid her practice when she qualifies.

Being a holistic practitioner, my colleague challenged this view. However, as we come to increasingly rely on healthcare assistants to deliver personal care, are tomorrow’s nurses perceiving washing patients as a role separate from being a qualified nurse?

The harsh reality of modern healthcare is that there are relatively few qualified nurses while there are increasingly more patients. As practitioners we often manage this by overseeing HCAs who deliver the bulk of hands-on, personal care.

But like any delegated task, we need to know what care we are asking others to deliver and the outcomes of such interventions. For qualified practitioners, this means being willing to help patients with their personal hygiene and advocating the high standards of respect and dignity we expect of the whole team. For example, my colleagues and I are busy community nurses but when the opportunity arises we welcome the chance to help a patient wash.

Helping patients with personal hygiene gives nurses the opportunity to use all their assessment, observational and communication skills. You discover how well they can coordinate their actions, mentally process what is being said and express themselves. It is a great opportunity to learn how to assess patients’ skin integrity, bodily functions and their variations in physical stamina. Most importantly, it is the best way to learn the telltale signs of clinical problems and when someone is not coping physically.

Nurses often have to assess patient needs quickly and efficiently. Other members of the team may deliver much of the personal care for patients but nurses need the knowledge and skills to oversee that the care meets each patient’s needs. This is particularly important for patients at a higher risk of conditions such as pressure ulcers, skin infections or fluid retention.

Without the hands-on experience of delivering personal care and seeing how situations present, nurses are ill equipped to prevent potential problems. Developing such nursing skills can be compared to learning to read. Before we learn to read, all the pages in a book appear just as important. Once you have experience of reading you develop the knowledge to cut straight to the main text, avoiding the publisher’s information and uninteresting forewords.

Student nurses often hear all these reasonings in college lectures and from their clinical mentors. I remember sitting through just such a lecture thinking, “Well, this may be true but the qualified nurses I see in practice hardly wash patients.”

In reality, no matter how busy things get, most nurses will make time to help patients wash when they believe they have complex needs, or if they need extra support or end-of-life care. The reason for this is simple: helping people to wash shows them you have time for them. It helps build up trust and aids the nurse-patient therapeutic relationship far more than countless drug rounds or other clinical interventions.

Helping patients with personal hygiene is one of the most fundamental and crucial relationship-building skills available to nurses, regardless of their seniority and clinical experience. My advice to student nurses is to embrace these opportunities while you do not have other time pressures and reflect on your experiences. These skills will prove invaluable in delivering, overseeing and evaluating meaningful, holistic care.

BEN BOWERS is community charge nurse, Cambridge Community Services and Queen’s Nurse, Cambridge

Student nurses should not underestimate the value of delivering hands-on, personal care | Practice | Nursing Times

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October 29, 2009

We must tackle unsafe hospital discharge for homeless patients   | Practice | Nursing Times

Filed under: Nursing — Shirley @ 2:09 pm
Tags: , ,

This article is really about nursing in the UK but, I think it applies to all nurses around the world.  Homelessness knows no boundaries.  The number of poor patients grows exponentially.  We, as nurses, are in a position to try to show compassion and give care when no other person will.

Through empathy, we should be able to see what these patients go through and determine their unique needs so care planning can be patient-centered.
Granted, this population is not a favorite in any medical setting, but these are real people with real needs and untreated health care issues.

As a society, we need to look at our own attitudes about treating mentally ill or homeless patients.  When you become a nurse your aim should be to treat all patients with dignity and respect and to provide the best care you can.  Are we really doing this?


We must tackle unsafe hospital discharge for homeless patients
9 October, 2009

Nurses need to resist the pressure to discharge homeless patients inappropriately, and must act to ensure better outcomes for them, says Samantha Dorney-Smith

Homeless people experience more health problems and have poorer access to healthcare compared with the general population. They also have a higher rate of attendance and admission to hospital, and once there, problems continue.

Homeless patients suffer a higher rate of inadequate inpatient management, and frequently experience unsafe hospital discharge, such as self-discharge, inappropriately early discharge, and/or discharge to inappropriate accommodation.

Hospital admission is often the only time a homeless person is free of substance misuse, well cared for, and in a position to talk coherently with healthcare professionals. It is also a time when there is potential for reflection, and life changes can be made. However, this opportunity is often missed.

A common reason for self-discharge relates to substance misuse treatment. Recently, an ambulance crew, when collecting a patient from one of our hostels, drove the patient to the pharmacist for his daily methadone dose, on the way to A&E.

This was an example of excellent, patient-centred practice, and demonstrated a clear understanding of that patient’s needs. A client drinking 15L of cider a day, or injecting £100 of heroin a day, will not stay long in hospital without the addiction problem being treated.

Failed discharges are common. Once in hospital, hostel dwellers often recognise that their hostel accommodation is unsafe, and decide they do not want to return. However, because they are perceived as having a “home”, their concerns are not heard.

In fact, homeless hostels can be extremely unsafe. Although the voluntary organisations that run them do an excellent job, these hostels are full of clients actively engaged in substance misuse, with a variety of mental health disorders. Health outcomes are often appalling. In one hostel last year there were seven deaths, at an average age of 38 years.

Clients requesting not to return to their hostel should always be referred immediately to a social worker, and need strong advocacy to fight their case.

Another common situation is where hostel clients are admitted to hospital, and are unable to articulate clear opinions about their future. For example, many homeless patients have cognitive deficits (secondary to alcohol misuse), or are severely depressed, and have mental capacity issues. These patients may not be able to conceptualise the risks of being placed in a hostel. Expert psychiatric opinion might be needed and a working knowledge of the Mental Capacity Act is required by all professionals involved in discharging homeless patients.

”Some clients have not been “verified” as homeless, and may need to be discharged to a homeless persons’ unit. In these cases patient hotels and/or intermediate care settings should be considered. A welfare rights/benefits worker should also be involved.

Wherever homeless patients are discharged to, every effort should be made to ensure adequate follow up. Check whether they have a GP, and if not, try to register them. Refer them to the nearest homeless health team, and check they know how to access these services. Ensure you have active addresses for clients for any outpatient appointments.

There is often pressure to discharge homeless patients, and a feeling they will quickly become “bed blockers”. There is even sometimes a perception that other patients may be more “deserving” of these beds. Although evidence does suggest that homeless people stay in hospital twice as long as others, it also indicates they are generally twice as sick. There is no evidence they become “bed blockers” any more than the general population. However, if safer discharges do mean that clients end up staying in a bed longer, the trade off will be less readmission and much better outcomes for the most vulnerable patients.

So now I encourage you to ask yourself – are you discharging your homeless patients safely?

AUTHOR Samantha Dorney-Smith is nurse practitioner, Three Boroughs Homeless Team, south London, and co-chair, London Standing Conference on Nursing and Midwifery (Homelessness Group).

We must tackle unsafe hospital discharge for homeless patients   | Practice | Nursing Times

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October 28, 2009

Prescription for success: Don’t bother nurses

When I read the following article, I sat and thought to myself, “How obvious!”  It amazes me that we never take the time to step back and observe the entire process that we go through daily in taking care of our patients. 

I can tell you that in my current practice, I am bombarded constantly for prn medications, and my patients are all up and out of bed, so they can come and find you.  There are days when I literally have full sheets of prn MARs for each patient and I usually have a patient load of 8 or 9.

Passing meds is the most critical time for a nurse.  There are so many factors to take into account.  We have to not only check our own processes, but we also have to recheck the last shift’s administration processes to ensure safe administration. 

I was shocked to see how much medication errors cost each year, but I am mortified to know that each error involved a real, live person. 

Please read this article and let me know what you think.


Victoria Colliver, Chronicle Staff Writer
Wednesday, October 28, 2009

For nurses, constant interruptions while tending to a patient are part of the job. But a distraction that happens while they’re giving medications could have deadly results.

UCSF program to improve accuracy in administering drugs – with particular emphasis on reducing interruptions that often lead to mistakes – resulted in a nearly 88 percent drop in errors over 36 months at the nine Bay Area hospitals, according to results being released today.

“Medication errors make up the largest slice of the medical error pie,” said Julie Kliger, director of UCSF’s Integrated Nurse Leadership Program, which developed the medication errors program. “Improving these numbers is a huge benefit to patient safety and, secondarily, it reduces costs.

“Errors in administering medication cause about 400,000 preventable injuries in hospitals and about $3.5 billion in extra medical costs a year, according to the Institute of Medicine.

The UCSF program, which was funded by the Gordon and Betty Moore Foundation, involved UCSF Medical Center, Kaiser hospitals in Hayward and Fremont, San Francisco General Hospital, St. Rose Hospital in Hayward, Contra Costa County Medical Center, Stanford Hospital in Palo Alto, San Mateo Medical Center and Sequoia Hospital in Redwood City.

Low-tech solutions

Striving to reduce interruptions that lead to mistakes, teams of nurses at the different hospitals came up with a variety of methods – often surprisingly low tech – to alert others they were administering medications. The strategies included everything from wearing brightly colored vests or sashes to establishing “quiet zones” or making announcements at key points in the day when medications are being administered.

At San Francisco General, for example, nurses found they were constantly being interrupted in the medication room because their colleagues could see them through the windows. So they covered the windows.

The solutions “have to be low tech because we, as staff nurses, don’t have the money or ability to make high-tech changes,” said Celeste Arbis, a registered nurse in the medical-surgical unit there. “Something as simple as changing the process just a little bit can make a big difference.

“Some hospitals, such as Kaiser, have high-tech methods to reduce medication errors. Kaiser hospitals use bar-coded patient identification bands, which allow nurses to scan the bar code on the medication against the patient’s wristband to make sure they match.

Such advances may reduce mistakes by decreasing the risk of giving the wrong medicines, but they don’t stop interruptions or eliminate all mistakes, said Joanne Mette, chief nursing officer at Kaiser Permanente in Hayward and Fremont.

Mette said nurses can be interrupted five to 10 times in the course of giving one medication. Kaiser nurses opted to use fluorescent sashes to signal they were in the middle of giving a patient medications and conducting necessary safety checks.

Airline comparison

“We wear the sash because you can get interrupted doing the bar coding,” Mette said, adding that a medication error isn’t limited to giving the wrong medication, but includes even a minor delay in delivery. “We liken it to flying a 747. They never give up their safety checks and we don’t give up ours.

“The flight comparison is particularly apt, given that the program borrowed its techniques from the airline industry. The Federal Aviation Administration established the “sterile cockpit” rule, which means pilots must refrain from all nonessential activities during critical phases of the flight, typically under 10,000 feet.

“Distraction for them is anything under 10,000 feet,” said Kliger, of the nurse leadership program. “In the nurses’ world, it’s when giving medications.

“Aside from reducing interruptions, the program established other safety techniques, including requiring nurses to check two forms of patient identification before giving medications, explaining the drug to the patient and keeping it in the package until they’re at the bedside.

Nurses attributed much of the program’s success to allowing those on the front lines to develop and tailor their own solutions. What worked in one hospital sometimes didn’t work in another. Success also varied from unit to unit within each hospital.

At St. Rose Hospital in Hayward, for example, nurses in the maternity wards found the sashes too flimsy and opted instead to use bright green vests. In the large medical-surgical units, nurses rejected the vests and sashes in favor of carrying yellow folders. In the hospital’s intensive care unit, nurses put a border on the floor around the electronic medication dispensing machine along with an overhead sign.

Linda Aug, nursing supervisor in the medical-surgical unit, said St. Rose nurses were a bit apprehensive at first because they didn’t realize they were distracted or making mistakes. But the techniques reduced the hospital’s interruption rate from 53 percent of the time in 2006 to 32 percent in 2007 and 2008. The rate for the first nine months of this year has been just 12 percent. The program did not reveal individual hospital error rates.

“It’s been a whole hospital-wide awakening,” she said. “We learned that it wasn’t something to be afraid or threatened by. It’s for the patient.

“Reducing errors

A 36-month program involving nine Bay Area hospitals found:

— Accuracy in administering medications improved from an average of 83.8 percent at the start of the program in 2006 to 93 percent after 18 months and 98 percent after 36 months.

— Between September 2006 and September 2009, medication errors at the hospitals dropped by an average of 87.7 percent.

— The adherence to a series of “best practice” principles, which included such techniques as checking two forms of patient identification before administering drugs and explaining each medication to the patient, increased from 79.5 percent at the start of the program to 96 percent after 36 months.

Source: Integrated Nurse Leadership Program

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

Prescription for success: Don’t bother nurses

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Why Nurse Stereotypes Are Bad for Health – Well Blog – NYTimes.com

Filed under: Nursing — Shirley @ 3:36 am
Tags: , , ,

I’ve been wanting to write about this topic for a while now, but held back because #1 my opinion is just that and #2 television and movies are a personal choice.  When I found this article, I decided to go ahead and post it.  The author touches on many of the objections I have to the way nurses are portrayed in the media.

It was encouraging to find another nurse who felt similar to me.  I can hardly watch medical shows on television anymore.  I have tried to watch the new batch of Nurse shows but turned them off after only a few minutes.

Read the article below and then let me know what you think about how we are portrayed in the media.


By Theresa Brown, R.N.

My husband was working recently on a New York Times crossword puzzle when he called me over. “Hey, look at this one.

”The clue was “White-cap wearer” and the answer was . . . Nurse.

What?! There may be nurses in the hinterlands who still wear white caps, but no nurse I trained with or work with would be caught on the floor in a “nurse’s cap.” The outdated suggestion of wearing a cap raises the hackles of every nurse I know.

In the new book “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” co-authors Sandy Summers and Harry Jacobs Summers explore the dated and false images of nursing that still persist in the media, ranging from popular television shows to the crossword puzzle. They cited a February 2007 Times puzzle that listed “I.C.U. helpers” as a clue. (The answer was RNs.)

“Helpers?” the writers asked with exasperated italics. That one word encapsulates their critique of how nurses are typically portrayed on entertainment television, in movies and in most journalism.

Nurses are not “helpers,” the authors argue. Nurses work with medical doctors, but not for them. Hospital nurses are hired and fired by other nurses, answer to a unit manager who is a nurse, and follow the protocols set by more senior nursing officers. Health care works best when doctors and nurses communicate, but the authors note that nursing is an autonomous profession and the formal management structure of most hospitals keeps M.D.’s and R.N.’s separate and independent.

Maintaining a nurse’s independent status is about saving lives, note the authors. “One of nurses’ most important professional roles is to act as an independent check on physician care plans to protect patients and ensure good care,” they write.

In nursing school, we hear over and over that keeping patients safe is a crucial part of the job, but we rarely see that role of nurses portrayed in the media. It’s not that doctors constantly make mistakes — they don’t. But in the ordered chaos of the modern hospital it’s good to have the person who spends the most time with the patient — the nurse — keeping a watchful eye on his or her patient’s care, and nurses feel that obligation heavily.

Sandy Summers was an emergency department and intensive care nurse herself for many years and now runs a nonprofit advocacy organization called The Truth About Nursing. Her co-author, Harry Jacobs Summers, is a lawyer and senior adviser for the group.

“Saving Lives” is an important book because it so clearly delineates how ubiquitous negative portrayals of nursing are in today’s media, particularly three common stereotypes of nurses — the “Naughty Nurse,” the “Angel” and the “Battle Axe.” They argue that these images of nursing degrade the profession by portraying nurses as either vixens, saints or harridans, not college-educated health care workers with life and death responsibilities.

The popular medical television shows “ER,” “House,” “Grey’s Anatomy,” “Private Practice” and “Scrubs” receive the bulk of the authors complaints. They list numerous examples of nurses acting as “helpers” in these TV programs rather than autonomous and knowledgeable professionals. The writers also contend that these shows go out of their way to denigrate nurses and insult nursing as a profession. In one episode of “Grey’s Anatomy,” for instance, a male doctor insults a female doctor by calling her a nurse.

Another problem is that popular television shows often show doctors doing nurse’s jobs: giving medications, checking I.V.’s, educating patients about treatment, and providing ongoing emotional support from shift to shift. Of course, the focus of the storyline is often on the physician, so it may simply be easier to write and follow if the doctors do all the work. A notable, but still controversial, exception is the new Showtime program “Nurse Jackie,” which features Edie Falco as a capable and assertive nurse, although she’s also highly troubled and hardly a role model.

The problem with how nurses are portrayed in the media is that it has the potential to devalue the way we view nurses in the real world. The result is less support for important policy issues like short staffing and nurse burnout.

I certainly never expected my beloved New York Times crossword to reinforce an outdated nursing stereotype. White-cap wearer, indeed! Nurses don’t need headgear to show the world what we do. It’s what’s inside of our heads that counts.

Theresa Brown is an oncology nurse and a regular contributor to the Well blog.

Why Nurse Stereotypes Are Bad for Health – Well Blog – NYTimes.com

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October 27, 2009

Seeking RN expertise at LPN prices | StarTribune.com

Below is an article I read with some dismay.  I find it untenable that the general population does not even understand what a nurse does and what a nurse is held legally accountable for.

In today’s economy, we frequently hear of cost cutting, or streamlining budgets.  Nursing is really not an area where it is cost effective to cut costs.  You really do get what you pay for.

I love working with LPNs, and I love working with my team.  However, I frequently find myself in the role of teacher with my peers.  I see, quite distinctly, the differences in education as it pertains to patient care.  I also see the lack of understanding for legality and civil rights issues.

I think this article points out some of the potential problems to be faced if LPNs are allowed to do the work of RNs.  Please do not think I am anti-LPNs because I am not.  I really am trying to be an advocate for my fellow nurses who would then be put in a dangerous position if the legal system ever were to become involved.


Registered nurses (and subsequently patients) are threatened by cost-cutting.
By EILEEN WEBER
Last update: October 18, 2009 – 5:18 PM

 

Twenty-five years ago, Twin Cities registered nurses made history with the nation’s largest strike. Over 6,000 RNs stayed out for six weeks, without a strike fund, against a coalition of most Twin Cities-area hospitals.

Many of these highly trained professionals used food shelves and borrowed money to survive. They went on strike for numerous reasons, including respect for seniority when laying off staff instead of cutting the most experienced nurses first.

The strike highlighted the worrisome new hospital practice of sending patients home “quicker and sicker” in order to avoid losing money. Medicare’s new Diagnosis Related Group program reimbursed hospitals for the expected stay of patients with certain diagnoses, instead of paying for the actual stay. This threatened revenue if patients stayed longer than their DRG called for.

Similar to private managed care, the policy implicitly encouraged hospitals to send patients home when their time was up, not when they were ready. Concerns that people too sick to go home would end up right back in the hospital were well-founded.Payers now want to save money by reducing the expensive inefficiency of rapid rehospitalization. Nurses then and now say, “Duh.” When it comes to the big picture of meeting health care needs, cutting corners rarely cuts costs.

Registered nurses, whom the law calls “professional nurses,” won the seniority battle, keeping more wisdom at the bedside. They now face a new corner-cutting threat to their professionalism. The Minnesota Board of Nursing, charged with licensing all levels of nurses, seeing that they meet state educational requirements and protecting the public from unsafe care, is under pressure to allow less-educated licensed practical nurses (LPNs) to do what RNs do now. The chair of the subcommittee drafting the board’s proposal is himself an LPN.

Only legislators may define nursing practice, but instead of taking this issue to them, the board is putting a new spin on the law to appease those who would benefit if organizations that deliver health care can get an RN at an LPN price.

Vulnerable populations, especially in rural communities with fewer resources, are often the canary in the mine of health care corner-cutting. If LPNs do more than the job they are educated for, the effects will be suffered by patients who are least likely to understand what’s missing, who are not inclined to complain, and who are found where LPNs usually work: in home and institutional long-term care.

If there’s anyplace that needs an RN’s better-trained ability to assess what is going wrong in a person with multiple problems, to decide what is needed, to connect that patient with the right problem-solver and to judge if the solution is working, it’s exactly where corner-cutters would like to replace RNs with less-expensive caregivers.

The differences among the rungs of the nursing career ladder all come down to education. Certified nursing assistants (CNAs) take a basic technical course, are the backbone of basic nursing care and have the aching backs to prove it. They report to RNs and LPNs. LPNs have more education than CNAs, can give some medications if trained to do so, and know more of what problems to look for. They report to an RN. RNs have college degrees, more in-depth education in the science, specialties and basic law of health care, ethics and care management. When they can’t independently solve a problem, they call on doctors or advanced practice nurses. Advanced practice nurses, like nurse practitioners, are RNs who get at least master’s degrees to specialize in areas like pediatrics, midwifery, geriatrics and more.

Additional education brings additional independence, accountability and pay. The answer to someone on the nursing ladder who wants to do more has always been to go back to school.

Instead of cutting corners to get around this safeguard of quality care, the Board of Nursing should be pressuring the Legislature and nursing schools to do what is necessary to produce more of all the kinds of nurses needed to assure excellent care of a growing, aging, diverse population with increasing acute and chronic health care needs.

Eileen Weber is a nurse attorney serving on the board of directors of the Fourth District Minnesota Nurses Association. She lives in Washington County.

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Seeking RN expertise at LPN prices | StarTribune.com

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October 22, 2009

Similar healthcare issues abroad?

Filed under: Nursing — Shirley @ 5:35 pm
Tags: , , , ,

I’m always fascinated when I find articles that present the outlook of nurses in other countries.  What I discern is that nurses, no matter where they practice, are facing the same problems everywhere.  True, some are having more trouble than others, but basically the same problems surface–not enough time in the day to provide consistent, safe, quality care for patients, administration placing higher demands on nurses to “take up the slack” for other disciplines, sicker and more demanding patient loads, older nurses carrying the burden of the work. 

If these problems are the same in England, in Germany, in the USA then what should we be doing to solve them?

The article below is not only interesting, but specifically points out some of the problems facing our sister nurses in the UK.  Please take a minute to visit the site and read the entire article, then come back and tell me what you think.


BBC NEWS | Health | Nurses calling for safer staffing

Four out of 10 nurses say staff shortages compromise patient care at least once a week, according to the Royal College of Nurses.
An RCN manifesto to all the political parties says NHS employers must assure themselves they have safe staff levels.
The RCN, whose survey covers the views of 9,000 nurses, is warning against job cuts due to possible reduced funding.
NHS trusts said managers were increasingly examining their workforces to best use the skills of their staff.

‘Heavy workload’

THE RCN MANIFESTO
# Stand up for staff who speak out
# Safer staffing levels
# Give nurses time to train
# Regulate the drinks industry
# Improve care for long-term conditions
# Current levels of health spending should be maintained

The RCN has issued its 2009 Employment Survey which covers the views of 9,000 nurses.
It shows that more than half (55%) say they are too busy to provide the level of care they would like
.Almost two thirds (67%) consider their workload is too heavy.
And nurses say they are looking after more patients on the wards.
Dr Peter Carter, head of the RCN, said staff were concerned that they were delivering the basics but were unable to provide the full range of quality care they would like.
He said: “Nurses and healthcare assistants feel up against it, worn down and exhausted by the pressure to make efficiencies and frustrated by being prevented from delivering the quality of care they want to be providing.

“‘Shortfall

‘The RCN are also warning of a shortfall in the number of nurses in coming years.
The RCN’s Labour Market Review said about 200,000 nurses are expected to retire in the next 10 years, there will be fewer newly qualified nurses and fewer nurses moving to the UK because of restrictions on migration.
The RCN says the impact of growing retirements from the profession will be felt first in the community sector where most of the nurses tend to be older.

To read the entire article click the link below:

BBC NEWS | Health | Nurses calling for safer staffing

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October 15, 2009

Study: Hospitals must retain experienced nurses as nursing shortage looms

Here is an article from Healthcare Finance News that addresses one part of the ongoing struggle to solve the nursing shortage–the retention of the experienced nurse.  After reading this article, I felt vindicated because I have always thought that retention would go a long way to helping hospitals and clinics resolve their staffing problems.

The flip side is that retention is not an “easy fix” and can prove just as costly as a new hire.  Nurses understand that they are in demand, yes they do.  They also understand that their profession deals daily with life and death issues and their skills are necessary.  What they have been saying over and over is not that they don’t want to do bedside nursing or that they don’t want to do whatever is required to give their patient’s a successful outcome but rather that they cannot do the job they want to do based on time constraints, unbearable expectations of administration, and short staffing.

Something has to give in this situation and I hope it is not safe, responsible care.


July 29, 2009
Richard Pizzi, Editor

WASHINGTON – Hospitals, medical centers and other healthcare organizations must implement strategies that help to keep more veteran nurses at patient bedsides, according to a new study.

The study, “Wisdom at Work: Retaining Experienced Nurses,” finds that a number of healthcare organizations lowered turnover rates among experienced nurses by making a concerted effort to improve nurse morale and productivity.

Supported by the Robert Wood Johnson Foundation and coordinated by The Lewin Group, the study reveals that successful strategies included innovative approaches to staffing; employee health and wellness programs; and training and development opportunities for veteran nurses.

Ergonomic initiatives, such as teams and equipment to help nurses lift patients and other heavy items, did not contribute to an overall drop in turnover among experienced nurses; however, they did improve morale and cut expenses associated with work-related injuries, the study found.

“We know that there is no quick fix to the crisis in healthcare,” said Susan B. Hassmiller, RWJF’s senior adviser for nursing. “But the approaches explored in our ‘Wisdom at Work’ initiative are pieces of a larger puzzle that will help healthcare organizations keep experienced nurses from walking out the door – and taking their expertise with them – just when we need them most.

“The new study includes seven in-depth case studies examining strategies used by healthcare and non-healthcare institutions that have received recognition for their success in retaining experienced workers, as well as findings from 13 separate research projects conducted from January 2007 to December 2008 to explore the impact of interventions aimed at retaining experienced nurses in hospitals.

It is a follow-up to the white paper, “Wisdom at Work: The Importance of the Older and Experienced Nurses in the Workplace,” commissioned by RWJF in 2006.The new “Wisdom at Work” report finds that companies that have successfully retained older workers cite the following reasons for their success: sustained commitments by corporate leadership; corporate cultures that value aging; and compensation packages that cater to older workers, offering benefits such as phased retirement options and flexible work arrangements.

“The evaluations demonstrate that there are ways to retain experienced nurses that ultimately are cost-effective,” Hassmiller said. “With our nation’s population aging and healthcare needs growing, we need to encourage more veteran nurses to stay in their jobs so we can benefit from the knowledge and wisdom they have gained over the years.

“The average direct cost to replace a full-time registered nurse at the 13 hospitals in the study totaled $36,567, a sum reflecting expenses associated with termination payouts, filling temporary vacancies, additional overtime costs, and hiring and training new staff. The loss of experienced nurses is especially costly.

Study: Hospitals must retain experienced nurses as nursing shortage looms | Healthcare Finance News

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October 13, 2009

Florida facing shortage of nurses

Here is another article that describes the current nursing shortage as being very complex.  This article discusses the shortage from the dwindling number of nursing instructors and the effect these lower numbers are having on the overall shortage.

I have always felt that this problem is multi-focused.  First, you have nurses leaving after a long term commitment to the profession.  The population is aging and so are the nurses.  Second, you have many younger people wanting to become nurses and alleviate the shortage, but they are being turned away from nursing schools because there are not enough instructors to allow for larger numbers to be accepted.  Third, you have middle-aged nurses getting burned out due to over work and understaffing.  These nurses are leaving in large numbers to take early retirement, or to just simplify their lives.  Then, you have the younger nurses who leave to care for new and very young families when it becomes apparent that this job takes a bigger toll on your personal life than expected.

I really don’t have an answer to this problem, and apparently no one else does either.  I wonder what we will all do when no one can get any care when they are truly ill?


Posted: Oct 09, 2009 3:07 PM CDT
Updated: Oct 09, 2009 5:22 PM CDT

LEE COUNTY: A statewide nursing shortage is expected to get even worse. Nursing schools are now turning away many well-qualified applicants, because there are not enough teachers to run the classrooms.

In the next 10 years, Florida is expected to be short 52,000 nurses.

“The United States does have a shortage of nursing. Florida does have a shortage of nursing. But in Fort Myers, Naples, Charlotte County – we’re not really having a shortage of nursing,” said Dr. Mary Lewis, Edison State College Associate Dean of Nursing.

At least, that is not the case just yet.

As more instructors retire, Edison State College is a perfect example of luck running out. Nursing schools are becoming desperate for masters level nurses to teach. But it’s tough to entice a teacher with no money.

“We’re offering them a different salary, much lower salary, sometimes one-third or one-half of what they can get using their nurse practitioner or their administrative licenses abilities so we need the educators but education just doesn’t pay,” said Lewis.

Fewer teachers will mean fewer nurses.

While Lee Memorial Health System isn’t feeling the pinch yet, it is having trouble recruiting people from out of the area.

“Depending on what their spouse or significant other’s career or employment type might be, with our high unemployment rate here in Lee County it can be challenging,” said Kristy Rigot of Lee Memorial Health System Human Resources.

In a down economy, the nursing shortage isn’t getting any better. In fact just in the next year, the state will be down about 18,000.By Christina Mora

Florida facing shortage of nurses – NBC-2.com WBBH News for Fort Myers, Cape Coral & Naples, Florida

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County program having difficult time attracting, retaining nurses –

Filed under: Nursing — Shirley @ 4:28 am
Tags: , , ,

Here is an example of nursing positions that go unfilled.  Though the salary is not competitive with large hospitals, these are jobs that can give you a good start and leave you with experience on your resume.

In searching for your first nursing job, don’t overlook county, city, and state postings for entry-level nurses.  Great experience is available out there.


Little Falls, NY – The Evening Times
Mon Oct 12, 2009, 05:19 PM EDT

Facing an inability to fill nursing positions, county officials are looking to make a decision on the future of a Public Health Department program that provides home health aides.

County Administrator James Wallace said the nursing shortage is a result of county salaries not being competitive with the private sector, making it difficult to attract or retain certified nurses.But since the Certified Home Health Agency program requires registered nurses to oversee health aides, the county’s ability to continue providing the service is endangered.

Wallace said the county is looking at maintaining the program at current levels, attempting to hire more nurses to assist with the program, selling the license to a private provider or moving the home aides to another program.Wallace referred requests for further details on the matter to Dr. Gregory O’Keefe, Public Health director.O’Keefe did not return multiple calls.

The program currently employs 18 aides that provide in-home care to county residents, said JoAnne LeClair, president of the Civil Service Employees Association local unit representing county employees.In order for the program — which is not mandated like other public health programs — to operate, there needs to be at least one registered nurse overseeing the health aides. But as the number of nurses continues to drop, the ratio of nurses to aides in the program has caused difficulties.LeClair feels the registered nurse will be kept if the program is cut, but was less sure of the home aides’ future.

“If the program doesn’t exist, it’s a great concern of what happens to the home aides and the residents,” she said.County officials have said the home aides could be retained and moved to another program, such as long-term care, according to LeClair.

“They’re hopeful that no one has to lose a job,” she said, “but the information is still sketchy.”Union representatives believe the CHHA program issue is tied to the county entertaining proposals from Valley Health Services Inc., an affiliate of Bassett Healthcare, to take over Country Manor Adult Care, a county-run facility.

“We see this as all related, Country Manor and the CHHA [program] are in this position because of mismanagement and neglect by the county,” LeClair said.The Public Health Department is down to eight full-time nurses, from a high of at least 40 in the early 1990s, according to LeClair.“The [officials] have known for a long time the county needs more nurses,” she added.

County program having difficult time attracting, retaining nurses – Little Falls, NY – The Evening Times

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