Nursing Notes

February 26, 2010

Nurse Staffing Laws: Should You Worry?

Nurses At Work - ChangAn Hospital
Image by voxeros via Flickr

Here’s an interesting article about staffing laws.  As a member of my hospital’s Staffing Effectiveness Committee, I read this article with enthusiasm.  However, it quickly became evident that my experience with the state mandated committee was about par for the course.  It seems that as long as hospitals are not mandated to staff according to safety standards and acuity, they will continue to say that there is no problem with their staffing levels.

I have talked about my experiences working in California before and I have said that there are pros and cons to a legally mandated ratio system.  Now, working in Texas, I see very few pros and many cons with this states mandated staffing committees.  The only pro I can see is in allowing staff nurses to actually hear some of the issues around staffing from upper management; but the con to that is making nurses feel they have some power over the staffing when in reality they do not.

Please read the article below and comment on your take on this difficult topic.  I know I would love to hear from someone else about this.


By Terese Hudson Thrall
For hospitals, bills range from onerous to OK

Illinois legislators last year approved a bill mandating that hospitals form committees to create nurse staffing plans—and that 50 percent of committee members must be direct care nurses. The legislation was spearheaded by the Illinois Nurses Association and, to the surprise of some, was strongly supported by the Illinois Hospital Association.

“This bill was the result of many years of prescriptive ratio bills,” explains Cathy Grossi, IHA’s assistant vice president of health policy and regulation, “and a lot of criticism that nurses did not have a voice at their hospitals.”

The law requires the new committees to use a patient acuity model—which takes into account patient conditions and nurse experience—to guide adjustments to a hospital’s staffing ratio.

Illinois is not alone. Texas and Oregon already require hospitals to create staffing committees with half the members being direct care nurses. The Washington State Hospital Association expects similar legislation to pass in 2008 and the Ohio Hospital Association supports a bill introduced earlier this year.

It’s all part of a nationwide trend, says Stephanie Dodge, a labor and employment attorney and partner at Drinker, Biddle and Reath, Chicago. She’s busy these days, flying around the country to educate hospitals and hospital associations about state efforts to regulate how hospitals make decisions on nurse staffing. Legislation varies from state to state; some bills, like Illinois’, are intended to make sure nurses sit on staffing committees; some would require hospitals to make their staffing plans public or file them with state agencies; others, such as California’s controversial nurse ratio law, set staff-to-patient numbers; and some include a combination of mandates.

“I predict within five years, we’ll have staffing legislation at least introduced in all 50 states, with a significant number having passed some type of legislation involving staffing plans,” Dodge says.

To date, nine states have passed laws or adopted regulations addressing nurse staffing. In 2007, 16 states had some type of staffing legislation introduced. In the first two months of 2008, an additional four states saw legislation introduced. Bills in 13 states would mandate nurse-staffing ratios. (see map)


Leading Advocate

Nursing groups nearly always lead the legislative charge. Zenei Cortez, R.N., traces the efforts back to the 1990s when cash-crunched hospitals cut back their nurses and hired more unlicensed personnel. Nurses have been trying to gain more say on the staffing issue ever since, says Cortez, a member of the President’s Council created by the Oakland-based California Nurses Association and the National Nurse Organizing Committee.

On the other hand, Jean Moore, director of the Center for Health Workforce Studies at the State University of New York’s Albany School of Public Health, says pressure to improve quality of care, bolstered by reports from the Institute of Medicine and others that indicate a relationship between staffing and outcomes, has made staffing a priority with state legislatures. “When you cut to the chase, it’s about preserving quality and not putting nurses in a situation where they are likely to do harm,” she says.

The ongoing shortage of nurses also has focused attention on the staffing issue.

To Mandate Ratios or Not

The California Hospital Association disputes Cortez’s assertion that mandated ratios have brought nurses “back into nursing” by improving salaries and working conditions. “While the numbers of nurses in California have increased, many of those are traveler nurses,” says Jan Emerson, CHA vice president of external affairs.

The National Nurse Organizing Committee sent out a mass mailing to nurses in all 50 states earlier this year to drum up support for more ratio laws. Cortez says the group is now working for ratio laws in Arizona, Illinois, Maine, Massachusetts, Missouri, Ohio, Pennsylvania and Texas, with additional plans to target Kentucky and Nevada. In Minnesota and elsewhere, state unions have pressed for ratio bills.

The issue has been an effective one for organized labor, Dodge says, as unions target the 85 percent of the nation’s nurses who are not dues-paying members. “Here’s an opportunity for the unions to take the high road,” she says. “It’s a way to communicate to nurses, ‘We are interested in what you are interested in. You can trust us to do what is in your best interest.’ ”

But state nursing groups—even those that are unions—don’t uniformly embrace staffing ratios. Last year, the Oregon Nurses Association, an 11,000-member union, came out against a ratio bill backed by another state union. “We believe it is difficult to establish a single staffing standard for hospitals in Oregon or any other state because the great variable between hospitals,” says Susan King, ONA executive director. “The nurses at the facility are the experts on how staffing should be managed.”

The union had spearheaded legislation—strongly supported by the Oregon Association of Hospitals and Health Systems and passed in 2005—that created staffing committees whose members are evenly split between direct care nurses and nurse management.

“Our message to the legislature was ‘Give our plan a chance to work,’ ” King says. “We’d been working with the legislature since 1997 for nursing to have the authority at hospitals, and we had it. I didn’t see the advantage of abandoning our legislation.”

Gwen Dayton, the hospital association’s vice president and general counsel, notes that the union’s opposition to ratios “put them in a difficult position with other labor groups. It wasn’t easy for them, and we understand that.”

Attorney Dodge points out that staffing laws like those in Oregon and Illinois won’t preclude ratio bills from being considered; Illinois has seen one introduced during each of the last seven legislative sessions. However, ratios are much harder to pass when nurses and hospitals agree on another method.

Even with both the Oregon Nurses Association and Oregon Association of Hospitals and Health Systems committed to the 50-50 staffing committees, getting them up and running took a lot of work. The groups hashed out  guidelines to suggest ways the committees could operate, including how to select committee members, expectations for attendance, how to make decisions, and what to do when the committees reach an impasse. “It’s not always easy because it’s a new way of doing things,” Dayton says. “It might require a new hospital culture.”

When the Rubber Meets the Road

That’s just what Ruby Jason, R.N., found when she started to work on her organization’s new staffing committee. Jason is division director of pediatrics at Oregon Health & Sciences University, Portland. The 500-bed medical center had a history of rocky relations between management and the more than 2,000 nurses who work there. Heavily unionized by the Oregon Nurses Association, the nurses went on a 56-day strike six years ago.

“When the state law came out with provision for equal representation, a lot of nurses thought it was a labor-management committee,” Jason says, “but the union doesn’t have a place at the table.”

The eight committee members spent two months working with an outside consultant to set aside their hospital roles and change their frames of reference. “We had to learn that staff nurses weren’t responsible to the union and the nurse managers weren’t responsible to the administration,” Jason explains, “that we were all responsible for making sure that this law was equitably applied to nursing staff.”

Eventually, the committee found common ground. “We realized we are all nurses and every one of us wanted to be safe,” Jason says. “We wanted patients to receive safe care, and we wanted the organization to stay safe.”

When the committee started work 18 months ago, it met twice a week, all day, going through the law line by line, agreeing on what the provisions meant. The staffing plan took eight months to devise, but Jason says it was worth it. One big payoff: More nurses strongly support the staffing plan.

The committee has granted direct care nurses more information and insight about the budget. “When you work on staffing it isn’t always about the money, but sometimes it has to be,” Jason says. “We all want to get paid and have benefits, and we all want to get new equipment.”

She has been surprised by the reaction of staff nurses on the committee when confronting certain problems. For instance, the committee found that one medical center unit was sometimes understaffed because the nurses were setting their own schedules. One day the unit would have 17 nurses, the next day only 11. “That was a hard sell to that unit,” Jason recalls. “We had to say, ‘We are not going to hire more nurses just so you can have the schedule you want,’ and the staff nurses on the committee agreed.”

Susan Campbell, R.N., chief nursing officer at OSF Saint Francis Medical Center, Peoria, Ill., says she’s had a similar experience with her 12-member committee, which is just getting started. “I have found very few nurses want an unreasonable thing; they are pretty comfortable with normal staffing levels, 1-to-5 for med-surg and 1-to-2 or 1-to-1 for intensive care,” she says. “What they want is more guidance when it’s not an average day.”

State laws vary on how strictly hospital executives must follow whatever proposals come out of the staffing committee.

For instance, Illinois’ law does not require hospitals to act on a committee’s recommendations but says only that the recommendations must be given “significant regard and weight.” To Campbell, that means a hospital’s administration would need a strong reason, backed up with data, to show why it rejected the committee’s advice.

Dodge urges her Illinois clients to take that part of the law very seriously. “You want to show these nurses they had an impact. The worst thing that can happen is that the nurses do this work and hospitals turn up their noses at it.”

Oregon, on the other hand, requires hospitals to act on committee recommendations, although the administration can ask for changes. Theoretically, nurses could hold up the staffing plan if they can’t get some provision they want, although Dayton has not heard of any such instance so far.

Next Steps

Even in states with no staffing legislation in the works, Dodge urges hospitals to pay attention to the trend. She recommends that all hospitals start staffing plan committees with nurse input. “Staffing committees are a great opportunity for hospitals to engage their nurses. Get them involved in the process and the solution on individual units,” Dodge says. “You’ll make your nurses happy, remain competitive, be better able to recruit nurses. And a union is not likely to come knocking if your nurses are touting your hospital.”

At Ohio Health & Sciences University, Jason says the hard work of setting up staffing committees could bear even more fruit. Committee members might next consider reengineering bedside care to improve nurse performance. “What is making the nurses so busy? Is it how they interact with doctors? The documentation they prepare?” she asks.

Like Dodge, Jason recommends hospitals set up the committees simply for the good of the nurses and the hospitals. “The nurses really drive the business,” she says. “For a long time, hospitals have focused on doctors and patients they admit, but beds don’t take care of patients, nurses do.” And if hospitals don’t proactively involve nurses in workplace decisions, she warns, “they will find themselves with mandated ratios.”

Here’s the link to the original article.

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February 23, 2010

New York, New Jersey Educators Debate Bsn In 10 Bills

Visiting nurse
Image by Ed Yourdon via Flickr

In this article, you get a picture of the disagreement brewing in the profession.  This situation is as old as nursing, I think.  Nurses themselves have disagreements daily on the ability of one nurse to do the work of another nurse.  But is it based on licensure or is it really about experience?

While I feel pretty neutral on this subject, I will say that there are questions arising daily in nursing practice on the floors, but we all sit for the exact same NCLEX exam and we all get the exact same license issued.  So where is the difference and why all the big deal?

I understand the attempt to make a standard and I also understand the need to have nursing considered as a professional occupation by the general population.  But, again, what really is the big deal?


It’s no secret that there are three points of entry into practice as a registered nurse: a four-year baccalaureate program, a two- to three-year community or junior college program, or a diploma program that typically lasts three years. Regardless of the length of study and amount of money spent, candidates from all three programs sit for the same licensure exam.

Even so, Bills S4051/A2079B in New York and S620 (nee S2529)/A3768 in New Jersey are seeking to ensure that the baccalaureate of science in nursing becomes the standard for continued RN licensure in those states. The bills would require all RNs to obtain their BSNs within 10 years of initial licensure. Essentially, if you want to remain an RN in either of those states and are a graduate of an associate degree or diploma program, you would have to go back to school.

What Does It All Mean?

According to 2007 National League for Nursing statistics, there are still far more AD programs than BSN and diploma programs in the U.S. New York has 65 AD programs, 55 BSN programs and just one diploma program. According to the New Jersey Hospital Association, New Jersey is home to 18 schools that offer an AD in nursing, and 19 offering the BSN. It does, however, have 11 hospital-based diploma programs — the largest number of such programs in the U.S. after Pennsylvania.

Passage of the legislation in either state could have serious implications for AD and diploma programs, both positive and negative. For example, enrollment in two- and three-year programs could suffer, as potential candidates opt for the four-year program that would ultimately be required to continue to practice. On the other hand, if they become law, the bills would ensure the BSN becomes the minimal standard for RN licensure within 10 years of practice, a step that already has been implemented in other countries.

Some schools of nursing have begun to prepare for those implications, noting the requirement would benefit nursing as a whole. “We have been very proactive in this regard and well-positioned for the BSN in 10 proposition,” says Mary Lebreck Kelley, RN, MSN, MEd, CNE, dean of the Trinitas School of Nursing and director of education at Trinitas Regional Medical Center. The Elizabeth, N.J., school offers a diploma program in nursing that gives students the option of going on for an AD from Union County College in Cranford.

“In 2004, we formed a partnership with the College of Saint Elizabeth to bring a BSN program on-site to our Elizabeth campus, and in 2007, CSE brought their MSN program on-site, also,” Kelley says.

Kelley believes that the legislation, should it pass, would be more benefit than hazard to Trinitas’ program.

“The BSN in 10 proposition will serve to encourage graduates from our program to take advantage of what we already have in place for them on-site,” she says. “I see it as a win-win situation.”

Other schools have taken a similar position.

“I believe that the impact overall will be very positive,” says Joanna Scalabrini RN, MS, MA, dean of the Hopfer School of Nursing at Sound Shore Health System and professor Emeritus at Westchester Community College.

Scalabrini doesn’t think the legislation would have any impact at all on New York’s lone diploma program, and believes the bills will only serve to make the AD more valuable, as it can be seen as a steppingstone. “This path will allow the candidate to obtain a solid nursing education with emphasis on direct patient care, prior to their BSN completion program,” she says. “This 2-plus-2 plan can save a candidate thousands of dollars in education loans.”

Hopfer’s faculty is in full support of the proposal, notes Scalabrini, as are most of the students who attend. “I ask our incoming students at their orientation to present a written argument for or against the BSN in 10,” she says. “I have been doing this since the Board of Nursing first unveiled the idea. No less than 80% of each and every class fully supports this plan.”

Jennifer A. Ort, RNC, MS, chairwoman of the department of nursing at Monroe College in The Bronx (N.Y) also sees the proposal as a chance for nursing to step up its game and be viewed as other healthcare professions are, while not undervaluing AD or diploma programs. “Master’s degrees and even doctorates are entry-level educational expectations for many other healthcare professions,” she says. “BSN in 10 is a wonderful way to allow those who want to be nurses to continue at the associate or diploma level before continuing for their BS.”

Ort says she is most concerned about what the legislation would mean for practical nurses. “… Our nursing program is a one-plus-one LPN-to-RN program,” she says. “What will happen to LPN education when BSN in 10 passes?”

Bumpy Transition

Although some believe the proposals would provide instant credibility to nursing in New York and New Jersey, others, such as Susan Neville, RN, PhD, chairwoman of the department of nursing at the New York Institute of Technology in Westbury, N.Y., and Maria Elena Pina-Fonti, RN, MA, associate professor at York College in Queens and adjunct professor at Molloy College in Rockville Centre, N.Y., believe it’s not that simple. If the proposals pass, they say, more work would be necessary.

“The issues are complex and will require a collective effort by all levels of nursing education to prepare for and sustain this requirement,” Neville says. “For example, seamless educational level articulation models, strategic faculty system/regional assignments, academic and service partnerships, clinical education models and the increased use of technology in educational pedagogy.”

Taking the notion one step further, Pina Fonti believes eliminating AD and diploma programs altogether will help nursing get the same respect as other healthcare professions that required a baccalaureate degree as a minimal requirement.

“The myopic view of subdividing our professional educational process into three distinct levels (two-, three- and four-year programs) catapults us to underpin our fundamental structure and compromises our educational product (the nursing graduate) and our nursing profession in the societal realm,” she says.

“I believe that the structural reframing that is necessary must be implemented in a partnership or consortium approach in which initially the AD program is partnered with an existing baccalaureate program to aid in the transition of the student and with a central focus of phasing out the AD program,” she says.

Although the complex process would be fraught with “growing pains,” Pina-Fonti believes the resulting educational infrastructure would define a new era in the history of nursing. “Ultimately, the partnership created would provide opportunities for growth [both for the student and faculty body] that would far outnumber the challenges created in the implementation of the new program.”

Neville agrees the proposals are imperative to nursing. “These initiatives become pivotal to the profession, as nurses move forward in preparing to meet the increasingly complex, multicultural care needs of patients in a fast-paced technological society.”

Neville and Pina-Fonti are not alone in their line of thinking. In its description of nurse training and qualifications, the Bureau of Labor Statistics offers the following advice: “Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher.”

Baccalaureate degree programs offer more clinical experiences in non-hospital settings as well, notes the BLS, and with the complexity of today’s patients, that benefit could make the task of initially choosing a BSN over an AD or diploma program much easier and the passing of the proposals more appealing.

Tracey Boyd is a regional reporter. Send letters to the editor to or comment below.

Here’s the link to the original article.

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February 22, 2010

Survey: Older nurses sticking around

This is an interesting article that supports what I see daily at my job.  Older nurses across the board are talking about staying active in the field of nursing .  I rarely hear any talk about retiring anymore.  Mostly what I hear is, “I will die here at work!”  While I’m not sure if that is such a good thing, it makes perfect sense.  Today is not the time to be planning to cut back your income so drastically and nursing is needing good, experienced nurses on the floors so it seems to be a win-win type of situation.
It was interesting to also notice that the nurses in this article don’t care for large numbers of patients at a time.
Maybe if our hospitals really listened to us about staffing problems in this field, the nursing shortage would diminish.
Who knows?  All I know is that I am fast approaching the age bracketed by this article and I know I have no intentions of retiring from nursing.  I won’t be able to afford to.
Katie Ripley, 29, listens to Marjorie Shibler, 73, on Thursday, Feb. 18, 2010 at Chesapeake General Hospital. Shibler, a nurse from Virginia Beach, works often with nursing students like Ripley to help them learn how to be a nurse. (Ross Taylor | The Virginian-Pilot)
By Amy Jeter
The Virginian-Pilot
© February 21, 2010

Marjorie J. Shibler has a mortgage.

Juliette Crichton wants to continue a lifestyle of monthly pedicures and workouts with a personal trainer.

Luzviminda Jusayan hopes to avoid the boredom and weight  gain of staying at home.

They’re all registered nurses who are old enough to be on Medicare  but have no plans to retire.

“There’s always going to be a need – forever – because there’s always going to be ill patients,” said Shibler, 73, a medical-surgical nurse at Chesapeake General Hospital . “My future plan is to work at the hospital until I can’t work anymore.”

Though older nurses are hardly a staple in Virginia health care, a surprising number of those still around intend to stay.

About 30 percent of the state’s registered nurses between ages 66 and 70 said they planned to work at least another five years, according to a recent survey by the Virginia Department of Health Professions. More than 40 percent of the state’s licensed practical nurses in that age group said they would stay on the job another 10 years or more.

The trend is helping to temporarily relieve the state’s nursing shortage.

Those results also mirror other polls showing that older workers are delaying retirement to bolster financial security during tough economic times.

Elaine Griffiths, Chesapeake Regional Medical Center’s chief nursing officer, thinks there’s more to it than that. As life expectancy increases, she said, people are accomplishing more in later years.

“Our whole notion of older people’s capabilities and wisdom in their profession is being modified,” she said.

On Chesapeake General’s fifth floor, Shibler tends to five or six patients a day.

She assesses them from head to toe, administers medication  and fulfills doctors’ orders. When needed, she starts IVs and performs a particular type of dialysis through the abdomen. She also is trained to handle skin wounds sustained by patients during long hours in bed.

Shibler became a nurse in 1981 after a divorce forced her to find an income.

“I thought, ‘What could I do forever?’” said the  grandmother of two.

She keeps working to pay the bills – and because she likes the experiences and autonomy that go along with a full-time job.

Her colleagues see her as “old  school”  because of the time she devotes to talking with patients – and perhaps for her occasional struggles with computers.

Shibler is not afraid to ask for help with “texting, computer stuff,  hi-fi and hi-wi  and all the crap  that I don’t know anything about.”

Years of experience in a profession that demands problem  solving sets  Shibler apart, said Margaret Summers, a nurse manager at Chesapeake General.

“The new ones,” she said, “they just don’t have that yet.”

Patients who find out how old these nurses are often respond the same way: “Wow.”

Some older patients prefer talking to a caregiver closer to their own age.

“We can talk about things the younger nurses wouldn’t know anything about,” said John Horn, 74, who works as a licensed practical nurse  at Sentara Heart Hospital. Like the Korean War, he said. Like “what it was like before we had television all the time.”

Juliette Crichton , who turned 71 on Saturday , is often mistaken for someone years younger. Despite a hip replacement a little more than year ago, she works out twice a week with a trainer who is a former Olympian in handball.

Like Shibler, Crichton specializes in preventing and treating skin wounds. She has worked at Sentara Virginia Beach General Hospital  since 1981.

“They’ll say to me, ‘Honey, when you’re my age …’” Crichton said. “I’ll think, ‘I’m not going to tell them.’”

She trained in the 1960s when nurses were taught to help patients look pretty and give them back rubs.

Today, people who are hospitalized typically suffer from numerous and more serious ailments  and nurses don’t have time for such niceties, she said.

“Nursing was always hard, but the patients are so much more complicated,” Crichton said.

Her colleague Linda Neely points to advances that have made the job easier and medical care better, such as magnetic resonance imaging.

Even the fax machine helped, she said, remembering occasions in the past when she would  go to doctor’s offices to retrieve records. Neely, who turned 67 on Friday , is the lone nurse in the radiation oncology department of Virginia Beach General. She prepares cancer patients for treatment and makes sure they fully understand the procedures.

Colleagues covet her job for its regular weekday shifts and its specialized focus. Some keep tabs on her retirement plans, but Neely brushes them off.

“I’m looking at 75, but I’m not committing to anything,” she said.

That might have been different if she’d kept her position in a medical-surgical unit, where nurses are responsible for several patients in different rooms and are on their feet all day. After back surgery two years ago, Neely stopped doing heavy lifting.

Most problems that come with aging – such as diminished eyesight – can be easily corrected in the nursing workplace, said Griffiths, the chief nursing officer with Chesapeake Regional.

Nurses, like other hospital employees, must be able to demonstrate competence in their field every year for the organization to maintain accreditation from The Joint Commission, a nationally  recognized group.

If older caregivers meet those requirements, Griffiths  said, she does n’t worry about their capabilities.

Equipment and co-workers can help with some of the physical issues, such as lifting. At Children’s Hospital of The King’s Daughters, managers have considered scheduling older nurses differently, so their three 12-hour shifts are not on consecutive days, said Penny Hatfield, a nurse manager.

Luzviminda Jusayan  started tending to babies after she injured her back lifting adult patients. Now, she works in CHKD’s neonatal intensive care unit with infants sometimes smaller than 1 pound.

At 66, she’s one of the oldest of 150 registered nurses in her unit, and she knows tricks to keep her body from tiring too easily. She wears support panty hose  and Easy Spirit slip-on shoes  and sits down to do paperwork when she can, twirling her ankles to restore circulation.

Friends who retired advised her against it, saying there was nothing to do but watch television and eat.

Jusayan’s job gives her purpose. The babies she cares for inhabit her thoughts and dreams, even when she’s away from the hospital. “It’s in your head,” she said. “Maybe you can say it’s in your blood.”

Amy Jeter, (757) 446-2730,

Here’s the link to the original article be sure to visit and read any comments at the site.

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February 20, 2010

Florida Nurses Unite Feb. 17 In Tallahassee To Demand Lifesaving Patient Safety Improvements

The old Florida Capitol Building with the new ...

Image via Wikipedia

This article just shows that this subject is not going to go away anytime soon.  I like the way this march was framed.  Instead of addressing nursing needs for ratios, this article approaches from the point of patient safety. Ratios have been shown to improve patient safety measures as well as improve patient outcomes altogether.

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


17 Feb 2010


Hundreds of registered nurses from across Florida will travel to Tallahassee this Feb. 16 and 17 to march, rally, and advocate for the new Florida Hospital Patient Protection Act of 2010, introduced by Rep. Oscar Braynon (D-Miami Gardens) and Sen. Tony Hill (D- Jacksonville). The Patient Protection Act will:

– Guarantee a safe ratio of RNs to patients on every unit in every hospital in Florida. Research has identified unsafe nurse staffing as a key factor for sentinel events in units throughout hospitals.
– Establish whistle-blower protections for RNs who expose unsafe conditions
– Assure RNs the legal guarantee to serve as patient advocates


The RNs are members of NNOC-Florida, a professional association and union for RNs. NNOC-Florida is the state chapter of the National Nurses Organizing Committee (NNOC) and is affiliated with National Nurses United, the new national union of RNs, founded in December 2009 and composed of 150,000 nurses from every state in the country, which has won accolades for its “Send a Nurse” to Haiti program. They will be joined by colleagues from SEIU Healthcare Florida and SEIU 1991, a professional association and union for RNs and healthcare workers, and the Florida Nurses Association.


Wednesday, February 17 – 9:00 a.m. march, 10:00 a.m. rally


The rally will be held across from the State Capitol at Kleman Plaza, 306 S Duval Street, Tallahassee. Hundreds of RNs will march there from the Doubletree Tallahassee (101 S. Adams) via Park, Monroe, Jefferson, and Duval streets before ending at Kleman Plaza. Nurses will then go to the Capitol to speak to legislators.


“When patients are denied access to a medically-appropriate level of nursing care, their outcomes suffer. It’s that simple, and it is totally preventable. Many hospitals under-staff their units, denying access to RNs, and undermining patient safety in the name of hospital profits. The Florida Patient Protection Act will extent to my patients the level of care they deserve, and that’s why I’m marching on Tallahassee and demanding the passage of this life-and-death bill,” said Barbra Rivera, an RN from St. Petersburg.

Background on the Florida Hospital Patient Protection Act of 2010

Reflecting the hopes and dreams of nurses and patients–and the best scientific evidence-the Florida Hospital Patient Protection Act of 2010 will improve patient outcomes and draw nurses back to bedside by allowing them to practice their profession safely. The act will:

– Guarantee a safe ratio of RNs to patients on every unit in every hospital in Florida. Research has identified unsafe nurse staffing as the cause of many sentinel events for hospitals patients today.

– Assure RNs the legal guarantee to serve as patient advocates

– Establish real whistle-blower protections for RNs who expose unsafe conditions

The benefits of safe nurse-to-patient ratios for Florida hospitals:

Nurse-to-patient staffing in Florida hospitals is in crisis, with RNs juggling up to nine extremely ill patients at a time.

– Studies show that each additional patient an RN is assigned increases the risk of patient death by seven percent – Agency for Healthcare Research and Quality, May, 2007.

– Increasing the number of full-time RNs on staff per day by one, there were nine percent fewer hospital-related deaths in intensive care units, 16 percent fewer in surgical patients, and six percent fewer in medical patients – Healthcare Risk Management, February 2008.

– Cutting RN-to-patient ratios to 1:4 nationally could save as many as 72,000 lives annually, and is less costly than many other basic safety interventions common in hospitals, including clot-busting medications for heart attack and PAP tests for cervical cancer – Medical Care, Journal of the American Public Health Association, August 2005.

– There has been a 60 percent increase in state RN applications since a similar law was signed in 1999, suggesting its appeal to RNs – California Board of Registered Nursing

– A study published in the Journal of the American Medical Association in October 2002 linked higher patient loads with a 15 percent increase in nurses’ dissatisfaction with their jobs.

– Cancer surgery patients are safer in hospitals with better RN-to-patient ratios. A study of 1,300 Texas patients undergoing a common surgery for bladder cancer documented a cut in patient mortality rates of more than 50 percent – Cancer Journal of the American Cancer Society.

Safe nurse to patient ratios are working across the country.

“I work in a medical unit where a majority of our patients are diabetic and require lots of teaching and monitoring. Our night-shift RNs used to have nine to 12 patients before the ratios were in effect. We could never keep a core nursing staff on nights. As a result of the ratio law we don’t have more than five patients, which gives us the time we need to do patient teaching and has dramatically improved patient outcomes and nurse retention. Before the ratios, with too many patients to safely care for, many nurses left the profession,” said Mary Bailey, RN, Medical Unit, Long Beach Memorial Hospital.

California Nurses Association

Here’s the link to the original article.

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February 19, 2010

Nurse Leaders’ Role in Promoting Autonomy and Accountability

Nursing Magnet Application Send-Off
Image by Christiana Care via Flickr

Autonomy and accountability go hand-in-hand.  The problem in nursing is that administration tries to tell you that you are autonomous and accountable, but then they tell you exactly how you have to do your job; no one ever listens to the floor nurse, but everyone has ideas on how to do our job better, quicker, and with fewer people.

Accountability is something nurses everywhere understand.  We are held accountable by a multitude of agencies, and organizations besides our hospital.  We know accountability every time we look into the eyes of our patients or their families. We feel responsible for good patient care with good patient outcomes.

When nurses work in an environment of blame and threat, there is not going to be anyone who will step up and assume accountability.  We need leadership that is willing to support and educate nurses.  We need to know that someone, somewhere is in our corner when things get really tough.  We need to feel respected and we need to feel safe if we are going to continue to do this job.

Let me know what you think about this article, won’t you?


Rebecca Hendren, for HealthLeaders Media, February 16, 2010

Nursing issues have been in the news in the last week and not all of them have been good. First, AMN Healthcare released a survey that found nearly half of the nurses who responded want to make a career change in the next three years, and more than a third said they were dissatisfied with their job.

Then there was a piece in The New York Times‘ “Well” blog by Theresa Brown, RN, about the disturbing prevalence of bullying in nursing. And finally—some good news—Texas whistleblower Anne Mitchell, RN, (whose case I wrote about last week) was acquitted of all changes.

A thread runs through these stories: the lack of autonomy in nursing.

Brown quotes nurse researchers Cheryl Woelfle and Ruth McCaffrey’s article “Nurse on Nurse” to speculate why nurses attack their own. “Nurses often lack autonomy, accountability, and control over their profession,” they write. “This can often result in displaced and self-destructive aggression within the oppressed group.”

More than 40% of the nurses in the AMN Healthcare survey were not satisfied in their positions, which may be due to a lack of control over the things that matter to them in their jobs. Mitchell lacked autonomy in her hospital to do something about a physician she perceived as unsafe, so she went to the Texas Medical Board as her only option.

Employees are happier where they have a degree of autonomy over their jobs. Successful organizations work to give their nurses as much autonomy as possible.

Eileen Dohman, vice president of nursing at Mary Washington Hospital in Fredericksburg, VA, says nurse leaders’ must create an environment where nurses have autonomy—and are held accountable—for their behavior and practice.

“My responsibility is the environment that nurses practice in,” says Dohmann. “That’s my job: To create, reinforce, and ensure that nurses have the environment they need to safely practice.”

Dohmann is accountable for all the patient care that happens in the building but she doesn’t provide any of that care. She sees her role as being an advocate for the nurses and to provide an environment where nurses are in control of what happens to them. That doesn’t mean nurses always get what they want. Dohmann cites the example of productivity. Mary Washington Hospital has emphasized nurse-to-patient ratios and productivity targets. Dohmann has created an environment where nurses understand their parameters and what they have to work with to provide care.

“My job is to help them understand; it’s not necessarily my job to help them like it,” says Dohmann. “But my job is to help them understand and then give them the autonomy. I say to my nurses all the time, ‘keep it legal and keep it safe. Those are the rules. So figure it out.’ Nurses at the bedside in our hospital don’t want me making decisions about how they practice nursing at the bedside. I don’t do it. They do it. I see my job is letting them know what the confines are that they have to live within, and the rest of my job is making sure that I get any barriers out of the way so they can do what they need to do.”

Nurses treating one another poorly is nothing new. Dohmann says nurse leaders play a huge role in creating the environment that does not allow bullying. Leaders have to set expectations and hold people to those expectations.

“When you talk about behaviors and how people feel and accountability and autonomy, you have to give people permission to be accountable and autonomous,” Dohmann says. “People don’t feel autonomous unless you create an environment and give them permission to feel that way.”

Nursing leaders must cultivate an environment where nurses can tell them what is working and what is not.

“I want people to tell me what’s not going well. I can’t advocate for you if you don’t tell me what’s going on,” says Dohmann. “We have to be willing to listen and we have to be willing to hear. More importantly, we have to be willing to do something about what we hear.”

Note: You can sign up to receive HealthLeaders Media NursingLeaders, a free weekly e-newsletter that offers concise updates on the top nursing leadership headlines of the week from top news sources.

Here’s the link to the original article.

Rebecca Hendren is an editor with HealthLeaders Media. She can be reached at

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February 18, 2010

Ohio Nurses Association Supports Bill to Prevent Violence Against Nurses

The Ohio Statehouse in Columbus
Image via Wikipedia

After yesterday’s article, I couldn’t help myself.  I just had to post this article.  Here is a bill that I can see a real need for.  Violence in any guise should not be allowed to occur against nurses and other health care personnel.

I have reviewed several articles in the past that describe violence in the workplace from nursing perspective.  It is a fact that nurses see more violence than other professions; nurses usually see people who are not at their best.  The problem is that somehow, we nurses have become convinced that violence is a part of the job and we just put up with it.  Studies have shown that nurses as a group under-report the incidents of violence and aggression against them.

So, let’s look into passing more of these bills…one in each state legislature would be nice.


COLUMBUS, Ohio, Feb 16, 2010 /PRNewswire via COMTEX/ —- The Ohio Nurses Association applauds the introduction of House Bill 450 (HB 450) on February 11, 2010, sponsored by State Representatives Denise Driehaus (D-Columbus) and Linda S. Bolon (D-Columbiana). The bill will increase the penalty for assault when the victim is a registered nurse or a licensed practical nurse engaged in the performance of official duties whom the offender knows or has reasonable cause to believe is a registered nurse or a licensed practical nurse.

HB 450 recognizes that violent acts against nurses in the workplace occur more frequently than in any other profession. ONA is pleased that Reps. Driehaus and Bolon recognize that an assault on a nurse should be treated the same as an assault on school employees, police, fire and EMS workers, which under Ohio Revised Code 2903.13 is a fourth degree felony with a mandatory twelve-month prison sentence.

“I recognize and appreciate the integral role nurses fill in our health care system,” said Rep. Driehaus. “I want to do everything in my power to not only protect these hard-working men and women as they do their jobs but also to aid this vital profession in its efforts to recruit the next generation of nurses.”

“ONA has long advocated for legislation to protect nurses from violence in the workplace, and we are proud to support House Bill 450 as a key part of ONA’s overall workplace violence prevention initiative,” said Elise Geig, ONA Director of Health Policy.

The bill has received bipartisan support from across the state, including the following legislators:

   John Domenick, District 95, Smithfield
   Kenny Yuko, District 7, Richmond Heights
   Nancy Garland, District 20, Gahanna
   Matt Patten, District 18, Strongsville
   Kathleen Chandler, District 68, Kent
   Roland Winburn, District 40, Dayton
   Tom Letson, District 64, Warren
   Scott Oelslager, District 51, North Canton
   Randy Gardner, District 6, Bowling Green

About the Ohio Nurses Association

The Ohio Nurses Association is a member-driven, full-service professional association and is the premier professional organization for Ohio’s registered nurses. Organized in 1904 to secure a Nurse Practice Act to protect the citizens of Ohio, it has been promoting and protecting nurses, the nursing profession and those who receive nursing care for over one hundred years.

SOURCE Ohio Nurses Association

Here’s the link to the original article

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February 17, 2010

Poor planning results in busy nurses

ER Nurses
Image by Todd Ehlers via Flickr

This is an interesting article that I found on a blog at Respiratory Therapy Cave and I thought was worthy of a repost here.  Let me know what you think of this article, won’t you?


She was an RN. Her boss sat next to her as she was finishing her charting and asked her if she would work tonight. The RN said she was unable. The boss lectured her that “we are all in this together, and part of being a team means we all need to do our part.”

The RN said, “I am doing my part. I work my one day a week and that’s all I want to work. If I wanted to work more I would schedule myself for more.”

The boss was dumbfounded. She picked her ear with one hand, and with the back of her other hand wiped away the drool swirling around the corner of her lower lip as it dropped almost to her jaw.

I thought for a moment she might cry. I, for a brief moment, felt empathy for this boss. Finally she said, “We need you. We’re in a crisis here and we really need you.”

“Look, I don’t mean to be disrespectful,” the RN said, “But poor planning on your part doesn’t constitute an emergency on mine.”

That ended the discussion. I won’t go on about how it ended. I won’t explain how I so happened to be there to hear the discussion, for neither of those facts matter.

Tonight I was sitting in the ER. I noticed that the charge nurse was sitting at the unit secretaries desk putting in all the orders. From time to time she’d get up, run to a patients room, do some chore there, and return to finish typing away, and flitting through sheets of paper.

“Why are you doing all this work?” I asked, knowing she didn’t have time to talk with me.

She leaned back in her chair and smiled, “The unit secretary went home at 2:00 in the morning. The rest of the night we have to go without her and without any nurses assistants or techs to help us out. Plus Janet is going home at 3:00 and so is Jim. So basically it will be just me and Susan.”

“So basically the powers that be want you guys to work at unsafe levels.”

“Wow! That words it about right.”

That was the end of that discussion.

A few years ago another nurse named Peggy was sitting in the nurses report room about 40 minutes after her shift was supposed to start. I said, “Why are you sitting in here when all the nurses out there appear to be overworked.”

She said, “I’m refusing to take report because they want me to take 14 patients, and I think that is unsafe. I’m not going to put my license on the line because of their poor planning on their part.” She was referring to the RN boss.

Due to her persistence another nurse arrived a half hour later and Peggy finally took report on seven patients, a load that she said was safe.

With respect to hospital bosses it is not possible to know when business is going to be swarming and when it’s going to be slow. But still, poor planning on their part does not constitute an emergency on the part of the nurse.

RT Cave Rule #41: Poor planning on the part of administrators, bosses and supervisors does not constitute an emergency on the part of the staff.

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February 16, 2010

Wash. House approves nurse rest break requirement

Filed under: Nursing — Shirley @ 4:43 pm
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Before reading this little article, I erroneously operated under the assumption that nurses were covered by the State and Federal laws pertaining to breaks and lunches.  Obviously, I have been wrong all this time.  Now, it seems, nurses need a special law to protect them and allow “rest breaks”.  How quaint.  I wonder why I didn’t think of this?

Since this is from the Seattle Times, I wonder if it is just nurses in Washington state that need this special dispensation?  I found this information at the US Dept. of Labor website:

Washington ½ hour, if work period is more than 5 consecutive hours, to be given not less than 2 hours nor more than 5 hours from beginning of shift. Counted as worktime if employee is required to remain on duty on premises or at a prescribed worksite. Additional ½ hour, before or during overtime, for employees working 3 or more hours beyond regular workday. Administrative regulation Excludes newspaper vendor or carrier, domestic or casual labor around private residence, sheltered workshop, and agricultural labor. 2/

Rules for construction trade employees may be superseded by a collective bargaining agreement covering such employees if the terms of the agreement specifically require meal periods and prescribe requirements concerning them.

Director of Labor and Industries may grant variance for good cause, upon employer application.
Washington Paid 10-minute rest period for each 4-hour work period, scheduled as near as possible to midpoint of each work period. Employee may not be required to work more than 3 hours without a rest period. Administrative regulation Excludes newspaper vendor or carrier, domestic or casual labor around private residence, sheltered workshop, and agricultural labor. 3/

Rules for construction trade employees may be superseded by a collective bargaining agreement covering such employees if the terms of the agreement specifically require rest periods and prescribe requirements concerning them.

Scheduled rest periods not required where nature of work allows employee to take intermittent rest periods equivalent to required standard.
Director of Labor and Industries may grant variance from basic standard for good cause, upon employer application.

The state House has endorsed mandatory meal and rest breaks for hospital nurses.

The bill would require uninterrupted half-hour meal breaks and 10-minute rest breaks for every four hours worked.

There would be exceptions in emergencies, and in times when nurses with specific skills are needed to prevent harm to patients.

Supporters say the change is needed to make sure that overworked nurses are giving patients the best care possible. Opponents argue that nurses and hospitals should bargain for rest breaks, rather than have the state impose a mandate.

The bill was approved on a 63-34 vote and now heads to the state Senate for consideration.

The nurse rest bill is House Bill 3024.

Here’s the link to the original post

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February 14, 2010

Costs on rise, nurses protest staffing changes

I am a staunch supporter of some type of national nurse-to-patient ratio to be enacted.  I feel this way because I know what it is like to work a shift with too many patients and not leave at the end of your shift.  I know what it is like to wake up from a dead sleep to call the unit to make sure I did (or did not) do some task because I was so busy during my shift.

That said, I have to now say that the following article does not surprise me in the least.  I read articles each and every day that describe the effects on health care of all the budget cutting going on.  I know that hospitals really are a business and are always looking for ways to save money (read increase profits).  I knew it would not be long before “nursing costs” were under scrutiny and new and novel means developed to decrease those costs.

Granted, these nurses have been working with fewer patients than the norm.  Granted, these nurses are well paid.  However, it sets a really dangerous precedent for this hospital to increase nurse-to-patient ratios as a cost-cutting tactic.  What do you suppose will happen to that same hospital when it cannot find or keep nurses at the bedside?  Hospitals cannot operate without nurses, period.

Is there no other way to save money and increase profits besides increasing patient loads?  Surely there are some intelligent and creative people out there with better solutions to this problem.


Nerrissa Shurtluff and others gathered outside Tufts Medical Center in Boston. Nurses from Tufts and Boston Medical Center protested what they say are dangerous changes to staffing.
Nerrissa Shurtluff and others gathered outside Tufts Medical Center in Boston. Nurses from Tufts and Boston Medical Center protested what they say are dangerous changes to staffing. (Wendy Maeda/Globe Staff)

By Liz Kowalczyk Globe Staff / February 12, 2010
Tufts Medical Center says it has found a way to trim the high cost of nursing while improving care, but the plan prompted a protest yesterday outside the Boston hospital by nurses, who say it is an example of the intense cost-cutting pressure on hospitals statewide.

But they said cost was not the primary reason for the change, adding that they want to improve care and working conditions for nurses. The hospital is bringing on 35 technicians to free up nurses from unskilled jobs like transporting patients to imaging tests and tracking down missing meals, so they can focus on monitoring vital signs, giving medications, and providing essential patient care.

“Our nurses will be working smarter,’’ said Nancy Shendell-Falik, Tufts’ chief nursing officer, who said she believes patients could get more, not less, attention from their nurses. She said a consultant hired by the hospital found that nurses at Tufts – and, by extension, other Boston teaching hospitals – care for fewer patients than is typical for similar hospitals elsewhere in the country.

But many nurses are upset by the changes. They say that requiring nurses on the hospital’s medical and surgical floors to each care for five patients, most of whom are extremely ill, is dangerous. Tufts nurses have traditionally cared for three or four patients on regular floors. In intensive care units, Tufts is assigning two patients to each nurse in most cases, up from one, but can increase the number of nurses if patients are especially ill.

“Nurses are overwhelmed,’’ said Barbara Tiller, a nurse at Tufts for more than 20 years. “They are behind their entire shift. Patients slowly deteriorate now, and no one picks it up until they’re in a crisis mode.’’

The Massachusetts Nurses Association, a large union, also organized a protest at Boston Medical Center yesterday, which plans to increase the number of patients assigned to some nurses from two to three. Hospital administrators said that they are assigning patients who are not as ill to those nurses and that they hired the same consultants as Tufts, who said nurses in intermediate care units nationally usually care for three patients.

“Of course, cost is included in our decision, but we have to be responsible about patient safety first,’’ said Lisa O’Connor, vice president of nursing at BMC.

The union also bought newspaper advertisements yesterday criticizing the changes at the hospitals.

“We understand that everyone is in a budget crisis,’’ said Lisa Sawtelle, a nurse at Boston Medical center. “We will not complain about the money we bring home. But they’re making it more and more difficult for us to do our job at the bedside.’’

Soaring hospital costs statewide are under increasing scrutiny. Medical costs in Massachusetts are growing more than 7 percent annually, driving up insurance premiums and threatening to bankrupt businesses. Last month, the attorney general’s office found that the increases are largely driven by higher prices charged by hospitals and doctors, and Governor Deval Patrick proposed legislation Wednesday that would allow the administration to review and reject medical provider rates.

At the same time, some hospitals, including Tufts, have been at a financial disadvantage because they get lower reimbursement rates than their larger competitors with more market clout. Boston Medical Center, too, is struggling with cutbacks in state funding and has sued the state over the issue.

Nursing always has been a huge expense for hospitals. Administrators who testified at hearings held by the Division of Insurance last month said labor accounts for up to 70 percent of their costs, of which nurses are the largest component.

Massachusetts nurses have enjoyed some of the highest salaries in the United States, which is typical of states with strong nurses unions. The average salary for a nurse in Massachusetts was $79,000 in 2008, up from $57,000 in 2003, and second only to California, said Judith Shindul-Rothschild, a nurse and professor at Boston College. Massachusetts nurses also enjoy some of the best working conditions in the country and are among the most highly educated, she said.

The Advisory Board Co., the Washington, D.C.based consultants hired by Tufts, found that Tufts nurses have lighter workloads than average. Tufts nurses typically have cared for 3.7 patients each on regular medical and surgical floors, while the national average is 4.5 for teaching hospitals and 5.7 for all hospitals. The company, however, also found the hospital had lower than average numbers of support staff.

It is unclear whether the new Tufts plan or the consultant’s findings will lead other hospitals to assign more patients to their nurses.

Karen Nelson, a nurse and senior vice president of clinical affairs for the Massachusetts Hospital Association, said the deciding factor will be whether the hospital is able to maintain good results for patients.

Shindul-Rothschild cautioned against comparing nurse-to-patient ratios in Massachusetts with national averages, because they may not account for differences in patients and because they do not indicate if the state’s higher concentration of nurses leads to better care.

“Yes, maybe we have higher ratios,’’ she said. “But you can’t look at those in isolation of patient outcomes.’’

Here’s the link to the original article.

February 13, 2010

Nursing Certification Has Many Rewards

I have been a nurse for 20 years and all that time I have worked in the same specialty.  It has just recently become a goal of mine to obtain certification in my specialty.  I will get no pay increase for it, I will get no additional pat on the back, but I will feel more professional.

With the current dialogue going on about what should be the “entry level” requirement for educational status in nursing; whether BSN should be required to sit the NCLEX or not, certification could easily fall through the cracks while the fight ensues.  My thought is that certification is something you do for yourself and in doing so, you do something for your patients and their outcomes.  Not everything we do as nurses is about compensation, or at least I hope it’s not.  Sometimes we do something simply because it is the right thing to do.  Certification is the right thing to do.


There are a myriad of advantages to becoming certified in your field of nursing.  I am a Certified Occupational Health Nurse Specialist (COHN-S) and find that certification has many rewards!  Here are a few reasons to consider:

BENEFITS YOUR PATIENTS: According to the American Association of Critical-Care Nurses (AACN), nursing certification has been linked to better patient outcomes.  Certification is credited with a reduction in medical errors, among other benefits.  If I listed no other reasons to become certified, this one should be enough!

ACCOMPLISHMENT: Becoming certified in your field is both a professional and a personal accomplishment.  Most certifications require extensive studying and experience to initially attain the certification.  Once earned, you carry with you a keen sense of accomplishment as a certified nurse. You are seen by uncertified peers and management as a level above.

CAREER ADVANCEMENT/PART 1: Earning your certification advances your career, and creates opportunities that otherwise may not be available to you.  For example, with my COHN-S certification, I am eligible to apply for case management positions.  Although I have never done case management, one requirement (just to be considered) is either a Case Management or Occupational Health certification.  Nurses certified in specialty areas earn an average of $9,000 more per year than their non-certified peers (Mee, CL. Nursing 2006 salary survey. Nursing. 2006, Oct; 36(10):46-51).  Mee also reports that certification increases confidence and job satisfaction.

CAREER ADVANCEMENT/PART 2: With current job market challenges, certification places you ahead of the competition when applying in a new organization or for promotional opportunities in your current workplace.  Hiring authorities view certifications as a mark of excellence and a sign of commitment to your field.  Additionally, hiring personnel understand you have gone the extra mile to earn your certification. Don’t believe me?

“Nurse Managers surveyed by the American Board of Nursing Specialties (ABNS) overwhelmingly prefer to hire certified nurses because certification attests to an individual’s proven knowledge base and documented experience in a given specialty. In fact, 90% said they clearly prefer to hire certified nurses.” –

SKILL AND KNOWLEDGE: Even though you may have practiced in your field for years, there are aspects of your professional area you may not be familiar with.  For example, when studying for the COHN-S, I learned all about OSHA chemical reporting programs that I have never worked with.  Studying for certification can familiarize you with other paths in your own specialty area that you never knew existed.

KEEPING ABREAST OF THE LATEST CHANGES: Nursing certifications require a lot of continuing education to maintain the certification.  This consistent education validates knowledge, keeps a nurse abreast of the latest changes in his/her field, and enhances patient care.

To participate in discussions regarding continuing education programs and certificates, go to our  Continuing Education forum.

About the Author: Sue Heacock, RN, MBA, COHN-S and author of the recently published book – Inspiring the Inspirational: Words of Hope From Nurses to Nurses.  Sue is a Certified Occupational Health Nurse Specialist and has worked in a variety of areas of nursing including pediatrics and research. Before entering the nursing profession, Sue worked in human resources and equal employment opportunity.

Click here to read more on Sue Heacock.

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