Nursing Notes

December 22, 2011

Group says El Paso’s nurse-patient ratios inadequate

Here’s an article from the El Paso Times that discusses the differing viewpoints of what is adequate and safe staffing.  When you have sick patients that are totally at your mercy for safety, how can you skimp on the number of nurses assigned to care for them?  It is a shame that this article will get little to no attention because the topic is being put forward by the nursing union and today everyone hates unions, it seems.

This is a timely and interesting article that I hope you will read to the end and leave your thoughts about.  When nurses strike or threaten to strike it most surely will be because of patient care adequacy or patient safety.  Rarely will you find a nurse who says she/he does not make enough money.

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Posted: 12/22/2011 12:00:00 AM MST

El Paso nurses alleged Wednesday that hospitals are jeopardizing patient safety by having inadequate nurse-to-patient ratios.

This is happening with greater frequency, and it has nothing to do with nurse shortages, said members of the National Nurse Organizing Committee (NNOC)-Texas/National Nurses United (NNU).

A group of registered nurses who belong to the organization had a news conference Wednesday across the street from Del Sol Medical Center to bring attention to patient, staffing and pay issues.

The NNOC/NNU said in a statement that nurses have filed 334 formal complaints known as ADOs against Del Sol and Las Palmas Medical Center.

“ADOs (assignments despite objections) are lodged when nurses are given assignments that, in their professional judgment, could affect patient care standards,” the statement said.

El Paso NNOC/NNU members Gloria Givens and Amy Peña said they also are seeking better pay for nurses at Del Sol and Las Palmas, which together employ about 800 registered nurses.

Guidelines for the ideal nurse-patient ratios vary, depending on the level of care required for patients.

The NNOC/NNU members said California is the only state that has codified nurse-patient ratios. Although national guidelines exist, each hospital in the rest of the states sets its own policies and procedures.

“Patient care is our first and absolute priority every day at both Las Palmas and Del Sol Medical Centers,” said Carla Sierra, spokeswoman for the two hospitals.

The allegations made by the National Nurses Organizing Committee (NNOC) about staffing issues at both hospitals are not true. We have been bargaining with the NNOC in good faith, and we will continue to do so in an attempt to reach agreement on a contract.”

At Las Palmas, nurses have complained about inadequate staffing and the treatment of nurses.

“For example, in the neo-natal intensive care unit — where the most critically ill babies are cared for — staffing standards are not consistent with either the hospital’s policy or national guidelines,” the NNOC/NNU statement said. “In the telemetry unit, where adult patients are monitored and cared for — a similar situation exists, where staffing ratios are below standards.”

At Del Sol, NNOC/NNU members said, nurses also have raised concerns with management, at the bargaining table and in individual units, including medicalÐsurgical, cardiac ICU, and telemetry units, about the hospital’s nurses staffing in these units required by the hospital’s own patient classification system.

“The nurses are in negotiations with their respective hospitals, owned by Nashville-based Hospital Corporation of America,” the NNOC/NNU statement said, and added that Hospital Corporation of America continues to rank at the top of the nation’s most profitable hospitals.

Peña said, “This is the time for hospital management to focus on a host of issues related to RN staffing. We have laid out these with detail and towards the goal of a comprehensive policy to ensure patient care standards.”

NNOC/NNU members said they are encouraged by the fact that registered nurses recently concluded a collective-bargaining agreement with an HCA-affiliated hospital in Las Vegas, which incorporates enhanced professional and economic standards.

“The gains we made makes me excited to continue my career in a facility that will really value skilled, experienced nurses,” said Liz Bickle, a registered nurse in the Las Vegas hospital’s progressive care unit.

The HCA Mountainview-Las Vegas contract creates a staffing committee to examine the hospital’s staffing levels. Registered nurses will also receive pay raises of 9 to 19 percent during the contract’s three-year period.

Diana Washington Valdez may be reached at dvaldez@elpasotimes.com; 546-6140.

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December 18, 2011

Top 10 Nursing Stories of 2011

Filed under: Nursing — Shirley @ 10:51 am
Tags: ,
An oil lamp, the symbol of nursing in many cou...

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Here’s a round-up of the top 10 nursing stories this year that I found at HealthLeadersMedia.com.  I only posted the first page here, so be sure to click over to see the remaining 2 pages.  I reread all the stories and each one is important and timely, so be sure to click on them too.

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Rebecca Hendren, for HealthLeaders Media, December 13, 2011

2011 has been a tumultuous year as healthcare organizations come to grips with value-based purchasing, rules for ACOs, meaningful use, and financial upheaval. Nursing has dealt with continued cost cutting while also being expected to lead care delivery transformation, improve patient satisfaction, and reduce healthcare-associated infections.

Here’s a rundown of the most popular nursing stories we covered in 2011 in case you missed them or just want to have another look.

1. Five Reasons Nurses Want to Leave Your Hospital
Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? Mandatory overtime and ignored bad behavior are two issues that have nurses eyeing the exits.

2. Suicide After Medical Error Highlights Importance of Support for Clinicians
A tragic story about the death of a child from a medical error turned even sadder in the spring after the nurse who administered the medication took her own life. The incident served as a grim wake-up call for hospitals and how to deal with clinicians after errors.

3. 5 Ways to Retain New Graduate Nurses
New nurses have a difficult time bridging the gap from nursing school to practice and often don’t stay with their first job for the long term. Hospitals can recognize this transition and help new graduate nurses through the transition with these five strategies that ensure they are engaged, long-term employees.

4. Does Mandating Nurse-Patient Ratios Improve Care?
The debate intensified as more than a dozen states considered laws to establish hospital nurse-to-patient ratios. This article examined whether patients get better care, experience fewer adverse events, and have shorter lengths of stay and lower mortality with ratios…[read more]

 

 

 

 

 

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December 15, 2011

New Facebook Fan Page Created

Filed under: Uncategorized — Shirley @ 6:49 am
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Česky: Logo Facebooku English: Facebook logo E...

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I have just learned how to make a fan page on Facebook.  It was really quite easy and you can do quite a bit more with a page than with your personal profile.  I hope you will check it out and like it if you do.  Right now, there’s not much on it, but I intend to change that soon.  I’m working on autoposting from this blog and from another to that page, but I am still learning how to do that.  I hope you will try this for yourself.  Making Fan Pages is really fun!

Here’s the link:  https://www.facebook.com/#!/pages/Nursing-Notes/290893507619413

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December 10, 2011

A growing number of registered nurses in California, U.S.

Filed under: Nursing — Shirley @ 8:17 pm
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Here’s an article from the Los Angeles Times that I found very interesting.  At first I read this thinking, “Great, a good article about nursing for a change.”  Then I reread the article and had a change of heart.  It seems that California, a state with a legally mandated nurse-to-patient ratio, is seeing more growth in the nursing field than any other state.  Imagine that–hmmm, I wonder why that might be?

Then the Rand Corporation goes public to announce THE END OF THE NURSING SHORTAGE is at hand!  But not until 2030.  Isn’t next year 2012?  Sounds like a lengthy shortage to me.

Then, this article talks about a Cardiac nurse, a Nurse Practitioner, and a Research nurse who wants to be a Nurse Practitioner.  Where are the lowly bedside nurses?  Why are we never consulted or included in these events?

I think I must be extremely biased, but you read the article and make your own conclusions.  Let me know what you think of this article, won’t you?  Maybe I am way off track, but I don’t think so.

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If the trend continues, say researchers at the Rand Corp., there may be enough nurses by 2030 to meet the projected needs of aging baby boomers and the expansion of the healthcare system.

By Anna Gorman, Los Angeles TimesDecember 6, 2011

Lauren Mills’ counselor in college pushed her to consider nursing. She heeded the advice, graduated from Cal State Long Beach in 2007 and now works with cardiac patients at an Orange County hospital. It’s proved a challenging and gratifying choice, said Mills, now 27.

“You are using your brain and in a way you are using your heart too,” she said. “You feel good when you go home. You feel you made a difference.”

Increasing numbers of women like Mills are helping swell the ranks of registered nurses, easing chronic shortages in both California and the nation, according to a study released Monday by the Rand Corp.

Nationwide, the number of registered nurses ages 23 to 26 grew from 102,000 in 2002 to 165,000 in 2009, according to the study. The current cohort of young nurses is expected to be the largest ever, the study said.

If the trend continues, there may be enough nurses by 2030 to meet the projected needs of aging baby boomers and the expansion of the healthcare system, researchers said.

“Compared to where nursing supply was just a few years ago, the change is incredible,” said David Auerbach, lead author of the study. “If it keeps going, it turns everything on its head and it’s a major revolution.”

California has seen an even more dramatic rise in the number of new nurses, said Joanne Spetz, a professor at the Institute for Health Policy Studies at UC San Francisco. “We are seeing a lot of young people entering the field, which is fabulous. These are the people we need to be moving into the nursing workforce.”

More than 11,500 people graduated from California nursing schools in 2010, up from 5,300 in 2002, according to a report Spetz did for the California Board of Registered Nursing. Much of that is due to a concerted effort by hospitals, foundations and policymakers to expand nursing school slots, she said.

Researchers previously predicted that the U.S. could be short as many as 400,000 registered nurses by 2020. In California, experts believed that the state could see a shortage of about 89,000 by 2030…[read more]

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December 2, 2011

More on Grief and Loss

Filed under: Uncategorized — Shirley @ 9:08 pm

As I am personally experiencing some of both, I found this article to be helpful.  I hope to get another guest posting but the author after the holiday season is over, but for now I will post this article she sent me.  I recommend her book and hope you will visit her website for more information about her.

I would like to invite other nurses to guest post here on this blog.  I try to make this blog a place to come and find viable and current information that reflects on the nursing profession as a whole, but most importantly, on the nurse at the bedside.  Any information that I can produce to empower that nurse, to educate that nurse, to give that nurse a voice is what I aim for here on this blog.  If your writings fall into that catagory, I would love to have you guest post.

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   LOSS, GRIEF AND THE WORK-0F-GRIEF: A DIFFERENT PERSPECTIVE

                                                                              By A. Barbara Coyne, Ph.D, MSN

 

Loss: Ever-Present in Living

 

“The hour that gives us life begins to take it away”…Seneca, first century philosopher

In the unfolding spiral of living, loss is inevitable and universal. If we heed the wisdom of Seneca, we know that we experience loss from the moment of birth until our own death. And throughout the subsequent twenty centuries, we have known that grief is the natural companion of all loss. Although much of what we know about grief is rooted in post-death grief, we also know that we experience other losses: we are connected to people, animals and things and when any of those connections break, we grieve and mourn. Some of these “other losses” include but are not limited to: loss of a job or home, friends who move away or choose to no longer be our friends, chronic but not life-threatening health conditions, divorce, separation and, of course, death (of people or beloved animals).

 

Every loss leaves an indelible print on the very core of one’s being and each becomes an integral aspect of the unfolding biography that makes you uniquely you. It is this uniqueness of each grief story that renders meaningless the well-intentioned cliché: “I know just how you feel because I’ve been there”. No one experiences your grief in your way. While there are identifiable commonalities in how grief shows itself, each individual’s experience of grief is unique in light of the meaning, context, and current circumstances in which the loss is embedded. Every loss, then, becomes a part of the historical context in which a loss in the present is experienced and expressed. It is in this sense that grief is over…but it’s never over: it changes over time as we learn the lessons that grief, our internal healer, teaches.

 

Grief: The Internal Healer

 

 Look well into thyself, there is a source of strength which will always spring up if thou wilt always look there.”…Marcus Aurelius, Stoic Philosopher and Emperor of Rome (161-180 A.D.)   

     Grief, the natural response to all loss, is a fundamental aspect of our humanness. It represents a vital energy within the healing life force, the creative power in all of us that propels our on-going shifting, changing growth. We can think about this vital energy as the “wisdom of the body”—a very old concept having to do with the body’s power to heal itself. This idea has changed over time, stretching from the ancient temples of Asclepius, god of healing, to the modern versions of “stress theory” in the medical model. But it is in the ancient sense of a healing life force of the whole person—not the modern construction of “body-mind-spirit” or “bio-psycho-social parts”—that grief can be recognized as our internal healer.

 

In this perspective of grief as internal healer, we recognize that grief is not a sickness from which we “recover” in a prescribed timeframe through the well-known five stages: it is the very essence of the human condition in whose wake we learn to live. The learning surfaces as we willingly, albeit reluctantly, engage the difficult process of the work-of-grief…not to be confused with the psychoanalytic concept of “working through issues”.  It is a process that sends us deep inside to wander through the depths of our pain, honor the truth of what we find as we seek the “strength which will always spring up if thou wilt always look there”.

 

The Process of the Work-of-Grief: Discovering and Creating New Meanings

        The Essence and the Elements of the Process

v    The Essence:

           “Adopt the pace of nature—her secret is patience”….Ralph Waldo Emerson

 

The very essence of the work-of-grief has to do with using energy to heal the pain of loss as we struggle to discover and create different meanings in a world that seems suddenly chaotic and meaningless. All life processes require energy: from the fundamental basics of cellular function to the increasingly complex human engagement with living, we use vital energy and constantly revitalize it in a variety of ways. Since all losses are embedded within the on-going process of living, when we experience a loss, grief—that internal healer—alerts us that we are now using even more of that vital energy. It explains why one of the “identifiable commonalities” in the experience of grief is an unremitting and overwhelming fatigue. It is this further depletion of vital energy that can contribute to making us sick. Respect this “wisdom of the body”: it is telling us to gentle down, slow our pace, attend to the myriad messages coming from within, nurture our patience and carefully nourish our “self” as we embrace the difficult process of the work-of-grief. It is a time to “adopt the pace of nature”, whose secret is “patience”—to help us tolerate the pain of loss as we inexorably move toward relinquishing our grief through actively embracing the elements of the work-of-grief.

 

v    The Elements: (three simultaneously unfolding elements)

               “The only way out of the desert is through it”……An African aphorism      

 

  • DISCONNECTING-CONNECTING which has to do with disconnecting from the familiar rhythm lived with the person/thing lost and at the same time, connecting with the unfamiliar pattern your life is now taking. This creates a profound struggle as you try to “understand” and “make sense” of your loss—as you

 

  • NARROW THE KNOWING-BELIEVING GAP . “Understanding” has to do with knowing and believing, two different ways of interpreting our world: knowing has to do with “facts” before us; believing has to do with coming to know these facts from our inner experience of them. There is often a wide gap between these two ways: it’s why a common expression following a loss is some variation of “I can’t believe it”—even though you know it: you saw him in the casket, touched him and knew he didn’t feel alive; you hold the divorce  papers in your hands; your friend has moved across the country so you don’t see her every day, your beloved cat does not greet you at the door—so yes, you know it, but you do not believe it: yet! And no, this is not the psychiatric mechanism of the stage of “denial”. It is the “wisdom of the body” offering you a slowing of the process as you come eventually to narrow the gap between what you know and what you believe. You come to this understanding in myriad ways as you live the reality of your changing pattern of living.  FOR EXAMPLE, EACH TIME YOU:

 

  • reach for the telephone to call your mother for your “daily 3:00 call…..
  • wander through your “empty house’ in the after shock of your spouse’s “moving out”….
  • see the dog’s empty dishes…
  • wonder why and how this could have happened….
  • question how or what you could or should have done better/different/sooner/not at all……….you are narrowing the gap!

Many similarities cross the spectrum of loss—whether related to death, divorce or separation; whether from person, animal or thing. But there is at least one significant difference: for those grieving a loss through death, the reality becomes more concrete in light of the absolute finality of death; for separations or divorce, the person is still “out there” and while communication may be changed or non existent, thoughts of “what if” persist over time. It is important to let all this confusion and disorientation tumble through you as you grieve and mourn your loss…..inexorably you

 

  • RESOLVE THE WORK-OF-GRIEF which has to do with becoming more familiar with your changed living pattern. Grief, your internal healer, has guided you through this very painful process, to a higher order of wholeness as you integrated new awareness, explored  some difficult truths about connections, relationships and ways you participated in the rhythm of their unfolding. You tolerated the discomfort of engaging the truth presented in your questions and doubts.  In search of peace and perhaps serenity, some choose not to engage their truths because the risk of “seeing” may be greater than the risk of “not seeing” and yet, profound growth surfaces in our willingness to honor our truths, no matter how painful or incongruous. The theologian, Reinhold Niebuhr said it this way: “The final wisdom of life requires not the annulment of incongruity but the achievement of serenity within and above it.” You have lived the incongruity and found your way “out of the desert of your grief”.

 

     And finally…grief always offers us the opportunity to grow in light of the many losses throughout living. We embrace this growth when we acknowledge the transitory nature of life, hold firm our beliefs and values, honor the truth of our participation in the world and focus on the gifts we have to give. With Hemingway, who tells us (A Farewell to Arms) that “the world breaks everyone, and afterward many are strong at the broken places”, we embrace the strength at our broken places—and we create different ways to be happy.

 

This perspective can be further explored in my recently published book: You Don’t Have to Like It, But You Do Have to Live It (Visit me at www.barbaracoyne.com )

 

November 29, 2011

Helping Nurses deal with death and dying

Filed under: Nursing — Shirley @ 7:02 am
Tags: , , , , , ,

I recently was contacted about running a story here on an interesting situation.  This is a topic that all nurses must deal with at one time or another.  We don’t talk much about it, and maybe we feel uncomfortable about dealing with it.  However, death and dying are part of living and we, as nurses, are usually there to help the family deal with this trauma.

It’s seems really nice that a mortuary would be willing to help nurses learn about and learn to deal with this situation.  Because of my past experiences and the experiences of many of my sister nurses, I am posting his article here for your education.  Let me know what you think about this topic and if you want me to continue to offer guest postings here.

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When a death occurs at a hospital or in hospice and people have questions about what happens and what they should do, who do they ask? Usually the first person of authority they see: a nurse.

 A difficult yet inevitable conversation, what can nurses do to prepare for these questions? O’Connor Mortuary, serving Southern California’s families since 1898, offers CE credits for a tour entitled “Unmasking the Mysteries.” The tour consists of an informative visit to the mortuary and an in-depth presentation on the processes that go on behind closed doors. Dealing with mortuaries is often intimidating for families and nurses alike, but this tour, along with other workshops offered by the mortuary, opens the line of communication and gives nurses a chance to ask questions and fully understand what goes on to better answer the questions of their patients and patients’ families.

If interested in interviewing Neil or if you’d like information about upcoming “Unmasking the Mysteries” tours, please let me know.

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Helping a family that has suffered the loss of loved one can be incredibly complicated. Many family members, in their hour of need, may ask a number of very difficult questions as they attempt to deal with both the emotional and logistical challenges of a death in the family. Neil O’Connor, CEO of O’Connor Mortuary in Laguna Hills, Calif., has worked with many nurses to steer these families in the right direction as they deal with the myriad questions that come following a death in the family. Here are some common questions you may encounter, along with some straightforward answers.

 My loved one has passed away. What do I do now?

 If the patient has preplanned their funeral, you should simply instruct the family to call the mortuary to notify them of the passing. Sometimes the family assumes the hospital will notify the mortuary, but for safe measure, you should urge a family member to take that first step.

If the patient has not preplanned their funeral, you should ask them if they’ve selected a mortuary. Most hospitals have a list of local mortuaries they can provide. Families are often overwhelmed and don’t know where to begin, but choosing the right provider is an important step in planning a funeral. Hospitals typically give families 1-2 days to choose a funeral home and transfer the care of their loved one from hospital to mortuary, so encourage them to take their time and ask questions about the care they’ll be receiving.

Once the mortuary is engaged to bring someone into their care, it will transport the person to the facility. A written release from the family granting the mortuary permission to do so may be required depending on the hospital.

How soon should I plan a funeral or memorial service?

It is recommended that the funeral occur within 4-6 days of the death, but at O’Connor, we encourage anywhere from 5-10 days. This event will commemorate the life of the loved one, and we don’t want anyone to rush through the planning of this one-time ceremony. We encourage people to take their time and get the details in order to ensure that service will accurately reflect the loved one’s life and provide the best opportunity for remembrance to family and friends.

What is the best way for me to inform friends and family of my loved one’s passing?

In addition to your many responsibilities as a nurse, you are often looked to for emotional support as well. When we hear this question, we advise families to personally call those closest members of their family circle, and then to create a “phone tree” to inform extended friends and family. Enlisting the help of friends and family will help alleviate some of the stress.

Is embalming required by law?

Embalming is not required by law unless they select arrangements that require the body to be embalmed, such as public or private viewing or shipping to another state or country via a common carrier. There are also some occasions when the Coroner’s or Medical Examiner’s office will embalm a body for investigative reasons.

 What if There is not a chosen a mortuary?

 My best advice is not to select a mortuary from the internet or the yellow pages at 3:00 a.m. It is very difficult to make sense out of anything when you are working through a crisis. Even if you have not selected a mortuary and a death has occurred, you still have time to find the right provider for you and your family. Remember, even if you select a mortuary and your loved one is taken into their care, you can still select another company if you change your mind. You do not have to stay with your first choice if you don’t feel comfortable with them.

 What questions should I ask to ensure the funeral home is looking out for my best interests?

 Here are four key questions to ask over the phone or in person.

1. How will you take care of me?

2. Why should I trust you?

3. What makes you different?

4. Will you guarantee your services & memorial products 100% or money back?

If they cannot answer these questions off the tip of their head, they probably are not living these core values.

Do you have questions you’d like to have answered by Neil O’Connor? Ask in the comments section and we’ll get them answered!

 

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October 27, 2011

Engage Nurses to Raise Your Patient Safety Scores

Filed under: Nursing — Shirley @ 1:13 pm
Tags: , , , , ,

Here is an article about patient safety and who owns the indices.  This article is good, in that it talks about how top-down changes never stick and that you have to involve and empower the hands-on staff if you want to make lasting changes.  That I like.  What I was not too keen on, and I could be way off target here, is it also felt that nurses not taking ownership because of administrations policy and ways of dealing with the problem, was somehow to blame for there still being a problem.

After reading the article, I felt “there’s just another thing to throw on the nurse’s plate” when nurses everywhere are already struggling to stay current and afloat with all the healthcare changes that are in the works.  Nurses just want to nurse.  Period.  Let them do what they became nurses to do and maybe some of these problelms would disappear.  However, you would have to have enough nurses first so that each nurse could actually do the nursing she/he went to school to do.  What a concept!  I’m being sarcastic, in case that does not translate well in print.

Here’s the article from HealthLeadersMedia.com so you can read it and decide for yourself how it makes you think and feel.  Let me know, won’t you?

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Rebecca Hendren, for HealthLeaders Media , October 25, 2011

Who owns the quality measure and patient outcome scores in your hospital? Most hospitals have quality, safety, and infection prevention professionals devoted solely to these statistics and ways to improve them.

All their efforts are meaningless unless nurses and other clinical staff are engaged in the process. Too often, they are not. Most staff nurses don’t know what value-based purchasing is or why they should care about it. All they know is that when Administration or “Quality” has a new scheme it will take nurses more time to do their jobs.

Nurses may fully support the changes because they will benefit patients, but they don’t own them and they don’t own those scores.

As the people who actually touch patients, all members of the nursing staff need to feel directly responsible for patient safety. Quality improvement becomes one more meaningless directive from “above” unless nurses feel engaged in the process, involved in the plans, and accountable for the results.

“Culture eats strategy for lunch,” says Mary J. Voutt-Goos, MSN, RN, CCRN, director, Patient Safety Initiatives and Clinical Care Design at Henry Ford Health System in Detroit. “If frontline staff aren’t in agreement and actively engaged in the process, it won’t happen. Top-down approaches to culture change are typically unsuccessful.”

This is one reason why scores can start creeping downward after a successful quality improvement effort has come and gone. If nurses aren’t engaged in the process, they have less inclination to remain on a directed path.

“All frontline staff, not just nurses, should be engaged, as well as empowered to act, if we really want to see a change in our culture of safety,” says Voutt-Goos.

One way to build a feeling of accountability in nurses is to empower them to solve the problems themselves—in conjunction with quality and patient safety professionals, of course. New procedures or processes are more likely to be met with acceptance and to become part of everyday practice when the caregivers themselves are involved in the design.

At Henry Ford Health System, the organization studied aviation industry principles of safety cultures and safety climate literature and identified global indicators of safety culture.

“We use these global indicators as a guiding framework for our culture of safety efforts,” said  Voutt-Goos. “One of the global indicators is employee empowerment.”

Empowering employees involves giving them a level of responsibility and knowledge, which sometimes they may not want, but is vital to achieving an end result of quality patient care in a financially healthy organization.

One common practice to reduce outcomes-related to issues such as patient falls or CAUTIs is to pit units against each other in competition and reward the winner with a pizza or ice cream. While it’s appropriate to celebrate success and recognize hard work, I think it’s a mistake to rely too heavily on competition.

Rewarding the unit that most improves its customer satisfaction scores or reduces patient falls by the greatest percentage is great at building enthusiasm and recognizing hard work, but it’s not an effective long-term strategy. Nurses should be treated like adults and involved in the imperatives behind process improvement, both those related to patient care and those related to the organization’s bottom line.

Just as the hospital should treat nurses as adults, nursing staff should be more interested in quality outcomes. They must seek out and embrace their level of ownership in these metrics. In today’s financial reality, it is no longer acceptable to not take an active role in quality improvement efforts. Organizations should engage nurses in frank and honest communication.

The financial imperative is such that hospitals can’t afford…[read more]

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October 25, 2011

The Truth about Nursing

Filed under: Uncategorized — Shirley @ 8:28 pm

Here is a video about nursing that is really hillarious until you realize it is too sad because it is true.

The public’s view of who a nurse is and what a nurse does has not changed since the inception of the profession, despite our best efforts to give the public correct information.  It is sad that most people still view nurses as sexually loose women or as doctor’s handmaidens–there is no room for any other stereotype in their collective minds.

As a nurse, I am appalled when my profession is maligned in the media.  I hope you feel the same way.

Here is a video to articulate this issue:

October 21, 2011

Vitamin Studies Spell Confusion for Patients

Filed under: Uncategorized — Shirley @ 6:43 am

As a proponent for taking multiple vitamins daily, I am always upset when there is an article or new story about how dangerous and unhealthy it is to take them.  I am always suspect of any and all articles that say “vitamins will cure you”  or “vitamins will kill you”.  This is the type of news reporting that seems to be in favor right now and with most of the public relying on news for their information, I think this is a shame.

The article below, presented by ABC News,and found on MedPage Today is just one of a myriad of articles that say, in effect, don’t take vitamins because you don’t need them.  But, the healthcare system has just recently begun to even check to see if patients show any vitamin deficiency with lab draws.

We all were taught in school that there are several diseases that can be prevented with a simple vitamin.  Is that not still true?  We are told that all we have to do is eat correctly and we will get all that we need.  Who do you know right this minute who eats correctly 100% of the time–that eats 6 servings a day of fruits and vegetables, moderate meat, moderate starch, low fat?  I have to say that I don’t know anyone to fit that description, including me.

What I would hope is happening, but the title to this article seems to think not, is that people are doing their own research and making informed decisions about whether or not they need to supplement their daily intake.  With the crisis in healthcare today, it seems we would be trying to encourage self-care and healthy lifestyles with supplementation of vitamins being only a part of that picture.

Who funds these studies?  My experience, after I dig and dig, is that most of them are funded by Big Pharmacy.  The supplement industry is large and that money is getting away from them because they cannot patent a natural substance.  What is showing up now are called “nutraceuticals”, which are a blending of vitamins and herbs with known prescription drugs.  These can be patented and sold at exorbitant prices to the unwitting public.

Please let me know what your thoughts are on this hot topic, won’t you?

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By Kristina Fiore, Staff Writer, MedPage Today
Published: October 14, 2011

 

If it’s Monday, it must be bad news about multivitamin day — or was that Wednesday? No, Wednesday was good news about vitamin D, not so good news about vitamin E — if you’re confused, join the club.

The alphabet soup of vitamin studies making headlines in the last few weeks has left more than one head spinning, and most clinicians scrambling for answers.

As the dust begins to settle, physicians interviewed by MedPage Today and ABC News agreed on a bit of simple wisdom — a healthy diet is more important than a fistful of supplements.

“I had already asked my patients to stop their vitamin supplements four to five years ago, with the exception of those with a deficiency of vitamin D, … pregnant patients [who should get] folate and prenatal multivitamins, or those with cognitive impairment, when I would recommend a vitamin B complex,” Albert Levy, MD, a primary care physician in New York, said in an email to MedPage Today and ABC News.

Whether patients heed the advice is another question, as recent research has shown that more take supplements now than ever before. More than half of Americans report taking a multivitamin or other dietary supplement, up from 40% just two decades ago.

And there’s sure to be pushback from the largely unregulated dietary supplements market — estimated to be a $20 billion industry — which has already launched multiple critiques of the latest evidence.

The Deluge

Here’s a sample of the supplement headlines over recent weeks: B12 deficiency leads to cognitive decline, vitamin D helps fight off tuberculosis, vitamin E ups the risk of prostate cancer, calcium won’t improve outcomes for Mom or baby.

The one that garnered particular attention reported an increased risk of death in postmenopausal women taking multivitamins, as well as vitamin B6, folic acid, iron, magnesium, zinc, and copper.

Though multivitamins carried only a slightly increased mortality risk, many clinicians say they’ve written off the supplement for good.

That’s because multivitamins were never recommended on the basis of strong evidence anyway, David Katz, MD, of Yale’s prevention research center, told MedPage Today.

“What we had was a notion that this was an insurance policy,” he said in an interview. “Many people don’t eat the way they ought to, so they’re not getting the optimal doses of nutrients from food. Instead, we can rely on a pill that ought to do you some good, and certainly couldn’t do you harm. That was the thinking.”

But more studies have suggested that the health outcomes in patients taking multivitamins appear to be slightly worse, Katz said.

Still, he cautions that the present study is merely observational and can’t prove cause and effect. For instance, some patients may take supplements as a result of being diagnosed with a condition, or they take them because they have a family history of chronic disease and are trying to prevent it, he said.

And clinicians certainly are not concerned that taking multivitamins will kill their patients. It’s just that there is no longer a dearth of evidence that they won’t confer any harm at all, Katz said.

“Considering the weak basis for recommending multivitamins in the first place,” he said, “when you combine that with evidence that maybe it could hurt, the rationale for making routine use of multivitamins goes away.”

Which Supplements Are Supported?

That’s not to say supplements shouldn’t be used at all, Katz said. He recommends omega-3 fatty acids and vitamin D for most of his patients, plus calcium for women. Prenatal vitamins and folic acid supplementation are also on that list.

There’s evidence behind those supplements, he said. The GISSI trial found cardiovascular benefits for omega-3s. Study after study has shown that the majority of Americans are deficient in vitamin D, and the supplement study flood included more positive findings for folic acid supplementation around the time of conception.

As for the rest of the supplement lot — give them only in the face of deficiencies, Katz said.

It’s long established, for instance, that B12 deficiency plays a role in dementia and other neurological disorders, and supplementation can stave that off.

As well, certain vitamins are established treatments for a host of diseases, from vitamin C in scurvy to B12 in pernicious anemia.

Who Is Deficient?

But how can clinicians be sure that their patients actually need specific nutrients, especially since there are usually no obvious symptoms?

Katz said, in most cases, doctors should ask about their patients’ diets and about what vitamins they currently take, though he makes the exception for children who are meeting growth milestones or for adults with good muscle tone.

The majority of clinicians reporting in a MedPage Today poll — 70% — said they supported annual screening of specific vitamin levels to treat deficiencies.

They may simply be following recommendations — in June, the Endocrine Society recommended screening for vitamin D deficiency in at-risk patients, setting various levels of treatment for different risk populations, to keep at bay rickets and bone complications.

Rise and Fall

Just as vitamin E was recently found to be unable to prevent prostate cancer — it was actually associated with an increased risk of developing the cancer, albeit a “marginally significant” one — several other nutrients once touted for their preventive benefits flopped in trials.

“We fell in love with vitamin C in middle of the century, but trials didn’t confirm the benefits of preventing colds or cancer,” Katz said.

Similarly, B-complex vitamins promised to lower heart disease risk, he said. While they did lower homocysteine, trials turned up no clinical cardiovascular benefits.

The carotenoid antioxidants beta-carotene and lycopene also proved to be a bust, with both having no benefit in prostate cancer and the former no use in eye disease nor heart disease.

“We have a long litany of barking up the wrong tree,” Katz said.

Why Don’t They Work?

It’s not clear why these vitamins don’t do what they’re expected to do, and researchers are actively looking into why.

The latest theory is that vitamin isolates don’t work quite as well on their own. The vitamin E isolate used in the prostate cancer trial was alpha-tocopherol, which is only one in the family of E-complex vitamins, Katz said.

Rather, it may take the full blend of antioxidants and phytochemicals found within the context of a whole food in order to deliver any potential benefits.

That appears to concur with clinician consensus on the majority of supplements, particularly in healthy patients: they’re not needed. Eat a healthy diet instead.

“[Patients] should stop trying to look for health in a pill,” Lee Green, MD, of the University of Michigan, said in an email. “Health is not found in pills. It’s found in good food and regular exercise. There’s something in our psyche that makes us want to believe in magic, and that desire to believe has focused on vitamins.”

This article was developed in collaboration with ABC News.

October 19, 2011

Nurses Worried About Retirement Prospects

Filed under: Uncategorized — Shirley @ 6:28 am

As nurses, we rarely take the time to take care of ourselves.  We go into nursing to care for others, so being outwardly focused is inevitable.  However, the truth is that we must first take care of ourselves in order to be able to care for others.    This article is a prime example of a way that nurses need to be taking care of themselves.

Please click over to the original site at Nurse Zone and read the rest of this enlightening article.  Be sure to leave them a comment about it and let me know if you found it interesting.

 

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By Jennifer Larson, contributor

October 14, 2011 – A recent survey found that most practicing nurses feel secure about their current jobs, but they don’t feel nearly as secure about their retirement prospects.

The 2011 Fidelity Investments Nurses Study surveyed 408 nurses and found that 7 out of 10 don’t feel prepared for retirement. The 71 percent who feel they’re not saving enough for retirement is a significant increase over the 57 percent who reported that sentiment during a similar Fidelity study in 2007.

They’re worried about how the economic climate, including possible future changes to programs like Medicare, is affecting their retirement prospects.  They’re worried about not being able to save enough money. And some of them even fret that they may never be able to retire.

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Cindy Hounsell, president of Women’s Institute for a Secure Retirement, said, “The longer you can put off using that nest egg, the better off you are.”

Those responses, which were collected in August by Versta Research, were not unexpected by Cindy Hounsell, president of Women’s Institute for a Secure Retirement (WISER).

“I’m not surprised, with this economy and this nursing population that’s older, that more people are unprepared,” she said.

The results were similar to those found in a study conducted a few years ago by WISER in conjunction with the Center for American Nurses, Hounsell said. That study also found that many nurses had not prepared adequately for retirement.

Robert Henderson, president of Lansdowne Wealth Management, LLC, in Mystic, Conn., said there doesn’t seem to have been enough emphasis on personal financial planning in the nursing profession.

“I believe that much of it stems from the fact that the field is predominantly women, many of which have working spouses who are the primary breadwinners,” he said.

Start here, start saving

Nurses should start by sitting down and figuring out where they currently stand financially and how much money they will realistically need for retirement, said Cassandra Chandler, MBA, a certified financial planner and author of The Retirement Game for Nurses. Then, they should account for family members that may need care and financial support.

If you haven’t started a retirement account, contact your employer to get information on signing up for your employer-sponsored plan. According to the Fidelity study, 81 percent of the nurses said they do participate in their workplace savings plan. Experts say that’s a very important way to make sure you’re saving for retirement.

If you work for a for-profit facility, you can start a 401(k) plan, or if you work for a not-for-profit, you can open a 403(b) plan. These are accounts that allow you to save pre-tax dollars. Because the funds accrue over time, experts always recommend getting started as soon as possible.

“Sooner is better than later, and later is better than never,” Chandler said.

However, it’s not enough to just sign up for your employer-sponsored retirement plan, Hounsell cautioned. You have to work long enough to become vested in order to be entitled to the matching funds provided by your employer. And not every plan has the same requirements…[read more]

 

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