Nursing Notes

March 21, 2011

Bill would squeeze nursing staffs

Here’s an article I found in the Citrus County Chronicle Online.  I found this interesting and, although talking about Florida politics and Florida healthcare issues, I think it can be extrapolated out to the entire nation.  We are in a crisis in our country and no one seems to understand that.  Not only can people not afford healthcare in this country, when they can afford it, they may not be getting quality care because of short staffing in our hospitals.

This is not a problem that is going to go away anytime soon.  The shortage of nursing is real and growing.  Maybe if nursing was not so physically and emotionally draining; maybe if nurses could actually give the care they want to give–then there would be no shortage.  I am only one nurse and I certainly don’t have the answer to this looming national problem, but I do work regularly and see and hear the comments of my peers.  I know what I think and how I feel about my nursing career.  Someone out there should be talking to the nurses.

Please click over and read the rest of this article.  I think you will find it both interesting and stimulating.  We need to go back to the drawing boards and draft our own solution to this problem.  Maybe if nursing care was not grouped in with the cost of the bed, but billed separately, then we would have more of a voice.






CMHS authority: We’d have to hire more nurses

By Chris Van Ormer
Saturday, March 19, 2011 at 9:27 pm

If the Florida Legislature passes a bill to mandate a higher ratio of nurses to patients, Citrus Memorial hospital would need another 35 nurses.  The proposed staffing level also comes at a time when the United States as a whole needs 300,000 nurses.  Linda McCarthy, chief nursing officer at Citrus Memorial Health System in Inverness, discussed the bill Monday with the Citrus County Hospital Board. McCarthy advised the trustees about the ways the bill would affect nursing care at CMHS, and got right to the bottom line: “I would need to find 35 nurses.”
Florida Hospital Patient Protection Act is sponsored by Rep. Cynthia Stafford, D-Miami.
“It’s a pretty extensive bill,” McCarthy said. “It’s not the first time it’s hit the floor. It’s a little different each time.”
The bill calls for more registered nurses rather than licensed nurses.  “It defines a direct patient care provider as a registered nurse,” McCarthy said. “Previously, it could be a licensed nurse, it could have been any of those support people but this is a direct care provider. They have not stipulated yet in this document the level of education required.”
As chief nursing officer, McCarthy would need to use a staffing plan based on the severity of the patients’ conditions. This is known as the acuity system of the patients’ needs.  Another difference in practices would be that minimum staffing levels would be mandated at all times, including meal times and other breaks.
“It has a mention of prohibition of mandatory overtime and it uses the nursing process inclusive of assessment, diagnosis, planning, intervention and evaluation that only a registered nurse can do at this point,” McCarthy said. “It also asks that the nurse look at the assessment of orders. She must check for appropriateness, whether it’s licensed by a licensed practitioner and whether the order itself is within the nursing scope of practice.” The registered nurse may decide if the order is inappropriate.  “She has the ability to refuse to implement this order without ramifications, so she needs to be able to accurately assess the order that the physician writes and make sure it’s appropriate,” McCarthy said. “If she disagrees with it or a patient disagrees with it, she is acting as the patient’s advocate and must speak on behalf of the patient.”
McCarthy described some of the issues with the bill.  “The nursing shortage itself is huge and they project it will be more than 300,000 by the year 2015,” McCarthy said. “We are seeing a slight decrease of the nursing shortage because of the economic times we are living in. Many of the nurses who are currently at retirement age have decided to hang on a little longer to build up funds.”  When the economy turns around, it could increase the shortage of nurses as more decide they can afford to retire. McCarthy did not have numbers for the nurse shortage in Florida, but she said the “opening rate” or potential vacant positions across the state stood at 23 percent.
With so many nurses not retiring, the average age of nurses has increased.  “We’re also looking at the aging population,” McCarthy said, “not just of the patients, but that of the nurses. The average age of a nurse right now at Citrus Memorial is 49.6 years old and I have at least 65 nurses who are at or are eligible for some type of retirement program at this time. Should the economy turn around, those could be immediate losses.”
Adding to the crisis of the nurse shortage is the lack of nurse educators.  “The problem most immediate with nurse education is that there are no nurse educators,” McCarthy said. “There is a minimum qualification that you must be master’s prepared to be a nursing instructor, so there are a minimum number of nursing instructors. Even if there were people wanting to take nursing programs, there are very limited supplies of educators.”
Nursing today competes with many other career choices for women.  “At one time, nursing was considered a woman’s profession and she could do very well there,” McCarthy said. “Now we have many opportunities. We can all go to be an astronaut. We can be engineers; we can do all those things. So we have minimized the people who are even getting exposure to the nursing profession.”
If the bill becomes law, CMHS has to have a plan to comply with it.“We need to implement an automated patient acuity system,” McCarthy said. “We currently have an acuity system that is based on each one of the nursing floors and the type of patient that they care for. We have a number system we apply to each patient based on the number of IVs and the number of medications and the type of treatments they need. Most of the more intellectual processes involve adding the data out of an electronic document which loads immediately in and calculates an acuity score for the patient. That would be one of the first things we would be looking at.”
Another option would be primary care nursing, McCarthy said. It is a method of nursing practice…[read the rest of the article here]

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