Nursing Notes

October 17, 2011

EDs seeing more children for psychiatric care

Here is an article from that presents the findings of a study showing that mentally ill patients, and in particular, mentally ill children are being forced by cutbacks in mental healthcare to utilize the emergency rooms more and more in order to get the help they need.

Emergency rooms are already overcrowded and when you add in mentally ill patients that come to the ER because they cannot get seen in any outpatient clinic, you have a disaster.  People believe that the ER is the magic answer to their health problems when in reality this system is stretched so far that real emergencies have trouble getting care sometimes.

We all know that going to the emergency room with a non-life-threatening problem means a very, very long wait.  Triage will put you to the end of the line and let the life-threatening problems have first opening.  That is really the way it is supposed to work.  However, it seems that with a population woefully under or non-insured, the ER becomes the place of last resort.  There has to be a solution to this problem.  There just has to be.  ER nurses are burning out at record numbers.

Please visit the site and read other articles similar to this one and be sure to leave them a comment.


Pediatric patients, primarily those who are underinsured, are increasingly receiving psychiatric care in EDs, according to an abstract presented Oct. 14 at the American Academy of Pediatrics National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status and type of care received, from the National Hospital Ambulatory Medical Care Survey between 1999 and 2007. They found during eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8% were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4% in 1999 to 3% in 2007. The underinsured group — patients without insurance or who are on Medicaid — initially accounted for 46% of pediatric ED visits in 1999 and grew to 54% in 2007.

The data show, as anticipated, psychiatric visits by children to EDs continue to increase in number and as a percentage of all patients being seen in EDs, said lead study author Zachary Pittsenbarger, MD, of Children’s Hospital Boston.

“A second, and more novel finding, is that one group in particular is increasing beyond any other sociodemographic group, and that is the publicly insured,” he said. “It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized. This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”

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April 25, 2011

Nurses fear even more ER assaults as programs cut

Here is an article that is a bit old, but still imparts useful information. The violence against nurses is escalating.   When you go to your work prepared to do whatever it takes to help people survive and improve, the last thing you expect is to be attacked or killed.  It seems that violence against nurses is becoming  the norm not the exception.  What really bothers me is that we seem to have become used to hearing about this violence and no longer react with appropriate dismay.

One of the factors that contribute to this violence may be the actual staffing ratios that hospitals use to staff.  When a very few staff are expected to do all, you set the stage for frustration and violence.  We see evidence of this everywhere today.  Simple frustration regularly erupts into full blown violence.

Please read this article and tell me your thoughts on the topic, won’t you?  This article is from the San Diego Union-Tribune.   You can visit the site to read comments and leave your own.


By JULIE CARR SMYTH, Associated Press Writer

Tuesday, August 10, 2010 at 11 a.m.

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

// / AP//

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio. A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press. Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

U.S. map and chart show expected state mental health budget cuts;

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

In this July 29, 2010 photo, emergency room nurse Jeaux Rinehart sits in a treatment room at Virginia Mason Hospital in Seattle. Rinehart was accustomed to fielding kicks, spits, scratches and flying punches from his patients there, but one day in 2007 he didn’t move quickly enough. An erratic intravenous drug user who had entered the ER in search of a fix, grabbed a club, came up from behind and, as Rinehart turned, smashed it into his face. Bones broken, Rinehart sucked meals from a straw for weeks. (AP Photo/Elaine Thompson)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

COLUMBUS, Ohio — Emergency room nurse Erin Riley suffered bruises, scratches and a chipped tooth last year from trying to pull the clamped jaws of a psychotic patient off the hand of a doctor at a suburban Cleveland hospital.

A second assault just months later was even more upsetting: She had just finished cutting the shirt off a drunken patient and was helping him into his hospital gown when he groped her.

“The patients always come first – and I don’t think anybody has a question about that – but I don’t think it has to be an either-or situation,” said Riley, a registered nurse for five years.

Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.

Nurses have responded, in part, by seeking tougher criminal penalties for assaults against health care workers.

“It’s come to the point where nurses are saying, `Enough is enough. The slapping, screaming and groping are not part of the job,'” said Joseph Bellino, president of the International Association for Healthcare Security and Safety, which represents professionals who manage security at hospitals.

Visits to ERs for drug- and alcohol-related incidents climbed from about 1.6 million in 2005 to nearly 2 million in 2008, according to the federal Substance Abuse and Mental Health Services Administration. From 2006 to 2008, the number of those visits resulting in violence jumped from 16,277 to 21,406, the agency said.

Nurses and experts in mental health and addiction say the problem has only been getting worse since then because of the downturn in the economy, as cash-strapped states close state hospitals, cut mental health jobs, eliminate addiction programs and curtail other services.

After her second attack in a year, Riley began pushing her hospital to put uniformed police on duty.

The American College of Emergency Physicians has recommended other safety measures, including 24-hour security guards, coded ID badges, bulletproof glass and “panic buttons” for medical staff to push. Detroit’s Henry Ford Hospital is among hospitals that have had success with metal detectors, confiscating 33 handguns, 1,324 knives, and 97 Mace sprays in the first six months of the program.

But there are practical and philosophical obstacles to locking down an ER. Bellino and others say safety begins with training health care workers to recognize signs of impending violence and defuse volatile situations with their tone of voice, their body language, even the time-outs parents use with children.

He said nurses, doctors, administrators and security guards should have a plan for working together when violence erupts. “In my opinion, every place we’ve put teamwork in, we’ve been able to de-escalate the violence and keep the staff safer,” he said.

Also, he and others said it is important to combat the notion among police, prosecutors, courts – and, at times, nurses themselves, who are often reluctant to press charges – that violence is just part of the job.

“There’s a real acceptance of violence. We’re still dealing with that really intensely,” said Donna Graves, a University of Cincinnati professor who is helping the federal government study solutions.

Robert Glover, executive director of the National Association of State Mental Health Program Directors, said economic hard times are the worst time for cuts to mental health programs because anxieties about job loss and lack of insurance increase drug and alcohol use and family fights.

“Most of them, if it’s a crisis, will end up in emergency rooms,” he said.

Vermont nurse David DeRosia, who has been attacked at work, said patients want McDonald’s-like fast service even when they visit busy emergency rooms. When they don’t get it, some lash out.

“They want to be able to pop in and get what they need immediately, when the emergency department has to see the sickest patients first,” he said. “There are many people who have unrealistic expectations they can get whatever they want immediately, and it isn’t a reality.”

What has heightened fears among nurses and other health professionals is that attacks have become more violent, Graves said. “What’s bringing attention to it now is the type of violence: the increase in guns, in weapons coming in, in drugs, the many psychiatric patients, the alcohol, the people with dementia,” she said.

Twenty-six states apply tougher penalties for assaults against on-the-job health care workers. A renewed push to stiffen punishment began the Emergency Nurses Association reported last year that more than half of 3,465 emergency nurses who participated in an anonymous, online survey had been assaulted at work.

“It came as news to me that they are one of the most assaulted professions out there,” said state Rep. Denise Driehaus, who is pushing tougher nurse-assault penalties in Ohio.

Yet bills making an assault on a nurse a felony instead of a misdemeanor failed in North Carolina and Vermont during sessions that just ended, and Virginia shunted its proposal to a state crime commission.

Rita Anderson, a former emergency nurse who pioneered efforts in New York in 1996 to make it a felony to assault a nurse, said resistance is often strong – among both nurses and law enforcement officials.

In 1999, after her jaw was dislocated by a 250-pound teenager, Anderson pursued charges under the state law she had worked hard to pass. She said police were surprised a nurse would press charges against a patient, and prosecutors were skeptical of the case.

“It doesn’t matter if you’re drunk or you’re on drugs or you’re in pain,” she said. “That doesn’t give you the right to hit another person.”

Seattle ER nurse Jeaux Rinehart had learned to get outside fast to avoid kicks, spit, scratches and punches on the job at Virginia Mason Hospital. Then one day in 2007 Rinehart didn’t move quickly enough and a junkie who had entered the ER in search of a fix smashed him in the face with a billy club. Bones broken, Rinehart sucked meals from a straw for weeks.

“A thing like that sticks in your mind to the point where it’s always there, it’s always present,” Rinehart said. “I’m on heightened alert a hundred percent of the time.”

Rinehart was attacked again in July. An intoxicated patient punched and spit on him, then threatened to come back with a gun and kill him. He is pursuing felony charges.

Please go to the original site to read this and others like it:


Emergency Nurses Association:

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March 18, 2011

Fun Friday Video

Filed under: Nursing — Shirley @ 9:30 pm
Tags: , , , ,

Let’s have just a little humor today, okay?  This video is funny but true.  Let me know if you enjoy it as much as I do.


November 18, 2010

Increasingly, nurses facing violence on the job

Here is another article that lies out the problem with violence that nurses and nursing staff are dealing with.  This is a good, but long, article and I hope you will click over to read the entire thing.  Nurses should not have to wonder if going to work will mean a loss of livelihood or worse, a loss of life.

This article is from The Philadelphia Inquirer.  Please do go to the site and read the next page.


By Jane M. Von Bergen

Inquirer Staff Writer


Amber Knierim, 20, wanted to be a nurse when she grew up, her MySpace profile says.

Instead, she’s in jail for beating one up – a Temple University Hospital emergency-room nurse who was attacked when she tried to keep Knierim from grabbing needles from an empty examination room on June 21.

“She picked the wrong person to mess with,” said Joan Meissler, 53, of Northeast Philadelphia, now working on light duty until she heals from the beating that wrecked her finances and left her in permanent pain, angry, and disheartened.

On Wednesday, 180 nurses and other health-care workers will convene in a ballroom at the Philadelphia Airport Hilton for a booked-to-capacity session on workplace violence for health-care workers, sponsored by the Pennsylvania Association of Staff Nurses and Allied Professionals, a union.

“It’s a national problem,” said union president Patricia Eakin, adding that she did not want to single out Temple. Eakin, a nurse, an emergency room colleague of Meissler’s, was on duty the day Meissler was attacked.

Meissler wants Temple to erect a billboard in the neighborhood with two pictures on it – hers and Knierim’s. “Temple needs to send a message to the community,” said Meissler: ” ‘Lay a hand on one of our staff members and you’ll spend the next five years in jail.’ ”

The U.S. Department of Labor Tuesday released 2009 statistics that ranked paramedics and nursing aides as being the workers most likely to miss work because of injuries. While most of the injuries come from overexertion caused by lifting, there are 38 incidents of violent assaults per 10,000 nurses aides.

The only occupations that face a greater likelihood for assault on the job are police and correctional officers.

Between 8 percent and 13 percent of emergency-room nurses are victims of physical violence every week, according to a survey released in September by the Emergency Nurses Association, a professional group in Illinois.

Why is the work so dangerous? Nurses and experts point to a number of factors.

First is proximity. “We as nurses are hands on – to touch and be touched,” said nurse Christine Pontus, occupational health and safety director for the Massachusetts Nurses Association and one of the national leaders addressing the issue. “The boundaries are not as clear.”

Pressed to reduce expenses, hospitals have been cutting back on nursing and security staff at a time when the number of uninsured using emergency rooms is growing. Those same budget constraints are limiting options for treatment and care of the mentally ill and addicted.

Unemployment and the economy has exacerbated stress among the general population, with that tension manifesting itself in hospitals, where frustrated patients and their families waiting longer for treatment tend to lash out at staff members.

Most of the violence is by patients or their families against nurses and other staff, according to the Emergency Nurses’ survey.

Many hospitals don’t have complete safety plans that include adequate staffing, consistent and frequent use of security wands and metal detectors, training in violence de-escalation, safety committees with worker representation, emergency-drill sessions, and analysis of unsafe conditions.

Meanwhile, there is some sense that nurses and others should accept violence as part of the job, Pontus said. She is the lead speaker at Wednesday’s event. District attorneys from Philadelphia and Delaware County are scheduled to attend.

“A lot of times the victims are traumatized and afraid to speak,” especially if the organizational culture doesn’t support them, Pontus said.

“There is a stigma of victimization, embarrassment, fear of being blamed for provoking the assault, fear of job loss,” she said. “The patients abuse us and we abuse each other. We’re all post-traumatic out there.”

Two weeks ago, a California nurse working in the intake area of the Contra Costa County jail died when a new inmate faked a seizure. When the nurse bent over him to help, he grabbed a lamp and smashed her over the head. She died on Oct. 28, three days later.

A psychiatric technician at Napa State Hospital in California was strangled on Oct. 23 by a patient, one of a majority committed there for crimes related to their mental illnesses. Local news reports described a chaotic facility where security had become lax.

Those are the headline cases, but the reality is more like what emergency room nurse Sean Poole, 33, experienced at Crozer-Chester Medical Center on Friday night.

Poole and a fellow nurse were trying to get blood work from an intoxicated and delusional patient when the patient bit his coworker, drawing blood. “It was pretty bad,” said Poole, who lives in the tiny borough of Parkside in Delaware County.

Poole has been punched and bitten, but has never pressed charges. “It’s hard to get anything to stick,” he said. “If they are intoxicated, it won’t hold up because they were intoxicated. If they are mentally ill, it won’t hold up because they aren’t in their right mind.”

In the spring of 2009, Crozer-Chester nurse Aimuel Elder walked into a patient’s room to find family members fighting and using pepper spray. He got sprayed as well.

“I tried to settle things down,” he said. “The police were called and so were our own security. The police arrived before our security.”  …[Read more]

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October 15, 2010

Hospital launches new telemedicine program for stroke and child trauma Neurologists and child trauma experts can now view patients at suburban Seton Hospitals through a webcam.

HELP Telemedicine clinic 1
Image via Wikipedia

Here’s an article in the Austin American Statesman that shows the benefit of developing technology for better patient outcomes.  At Seton Hospitals here in Austin and the surrounding areas, this one technological change is saving lives.

Telehealth is a trend that will not only continue but will expand as the need for services outgrows the available service providers in any given area.  Hospitals that cannot or will not expand their use of technology will not be able to compete with those who do.

Won’t you tell me how your hospital is meeting this challenge?


By Claire Osborn
Friday, September 04, 2009

ROUND ROCK — A woman lying in a hospital bed at Seton Medical Center Williamson in Round Rock on Thursday was listening to a series of questions Thursday from an Austin doctor on a 27-inch LCD television monitor.

“Can you open your eyes please and face the camera?” said Dr. Darryl Camp, medical director of neurology for the Seton Brain and Spine Institute in Austin.

“Elevate your right leg and then elevate your left leg. Can you say your name?” Camp said.

He was demonstrating new technology that will allow doctors at Seton hospitals in Round Rock, Burnet and Kyle to more quickly consult with neurologists in Austin about stroke patients and pediatric trauma patients.

The $250,000 program, based at Dell Children’s Medical Center in Austin, starts this week.

Instead of having to describe symptoms over the phone to neurologists, physicians can wheel their patients in front of a television monitor with a camera that allows a specialist to see the patients.

The program also allows the Austin neurologists to read CT scans on their laptops. Seton hospitals have handled 1,200 stroke cases in the past year and hope to double that number with the new technology, Camp said.

Time is precious when a person suffers a stroke because brain cells can die by the minute, Camp said. He is one of seven stroke specialists who will participate in the program.

Neurologists can advise doctors whether clot-busting drugs are needed immediately or whether a patient should simply be observed, said Dr. Brian Aldred, medical director for the emergency department at Seton Medical Center Williamson.

Neurologists can also catch subtleties in a CT scan that other physicians might miss, he said.

Children with traumatic injuries will also benefit from telemedicine, said Dr. Pat Crocker, emergency department medical director for Dell Children’s Medical Center of Central Texas.

A neurologist in Austin might need to tell a doctor in another county whether a child who comes into a hospital with a chest injury and a collapsed lung needs to be intubated before being transferred to Dell Children’s Medical Center of Central Texas, Crocker said.

Fifty-four pediatric specialists from Dell Children’s will participate in the child trauma part of the telemedicine program, said Emily Schmitz, a spokeswoman for the Seton Brain and Spine Institute.

The five Seton facilities that will be using the technology include University Medical Center Brackenridge, Dell Children’s, Seton Highland Lakes Hospital and Seton Medical Center Hays, which is scheduled to open in October in Kyle.; 445-3871

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April 2, 2010

Uptick in violence spurs effort to protect health care workers

Here is another article that talks about the daily violence that occurs in our hospitals and ER’s.  As a psych nurse, I have seen my fair share of violence–both directed at others and directed at me.
In 20 years, I have had my teeth kicked out, my back injured, my rotator cuff torn during a violent restraint;  I’ve had family come to the hospital with a gun, I’ve seen my fellow nurses stalked in the parking lot after work,  and I have even had my coworker killed on the job.  None of that should be considered part of the job.  Not now; not ever.  It is about time that nurses receive some protection under the law.
By Kyle Cheney/Statehouse News Service
GateHouse News Service
Posted Mar 30, 2010 @ 06:05 PM

Nurses have been punched and kicked over the years but their attackers have faced little in the way of repercussions, advocates for nurses say, on the eve of an expected House vote on a bill to toughen penalties for anyone who assaults on-duty health care workers.

The bill (H 1696), which has languished for years in the Legislature, would punish individuals who assault nurses, nurse psychologists, occupational therapists and physical therapists with jail sentences between 90 days and 2.5 years or fines up to $5,000.

Current law punishes assaults on emergency responders, ambulance operators and ambulance attendants.

The Massachusetts Nurses Association, citing a worsening situation, hopes recent high-profile attacks on health care workers will tip the scales in their favor.

“There’s been a number of highly publicized cases in Massachusetts of this issue coming to the forefront. The Legislature’s becoming more aware of it,” said David Schildmeier, spokesman for the MNA. “We have an epidemic of violence. Nurses are getting punched, kicked, attacked on a too-frequent basis.”

Schildmeier pointed to increasingly crowded emergency rooms, where patients and family members, frustrated with long waits, are “striking out at the first person they see.”

“We have a much more violent society,” he said.

The association cites a decade-old Occupational Safety and Health Administration report that found that health care workers are assaulted 12 times as often as workers in other private sector industries. In that report, OSHA officials say health care-related assaults are likely underreported because of a perception that they are part of the job.

The MNA also points to a 2004 survey showing half of Massachusetts nurses reported they had been punched within the last two years, and more than 25 percent reported being regularly pinched, scratched, spit on or having their wrist twisted. More than 1,000 calls to 911 were made from inside Brockton Hospital between May 2006 and May 2007, according to the group.

The Massachusetts Hospital Association supports added protection for nurses, but a spokeswoman said the organization would prefer the legislation be expanded to protect “the entire care team.”

“We just thought it was somewhat limited,” said the spokeswoman, Christine Baratta, who said MHA has urged lawmakers to “broaden the umbrella.” Baratta said she was unsure if the organization would support an amendment to that effect during the House’s Wednesday debate.

Rep. Michael Rodrigues, the bill’s sponsor, was not available for comment. The Massachusetts Medical Society did not respond to a request for comment.

Here’s the link to the original article

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March 8, 2010

Overworked and understaffed

Here’s an article I found that is an opinion of Dennis Kosuth.   Although I am usually not rabid in my push for improved nurse staffing, I do find myself looking around and thinking, “There has to be a better way to do this.”

I search out and find numerous articles about staffing ratios, staffing laws, etc.  I read them all.  What stands out in my mind is the fact that hospitals are a business and will continue to act just like every other business in the world.  The bottom line is God.  Hospitals, so far, have escaped the notice of the public–who still view hospitals as a haven of safety and help.  When will the public realize that patients and patient care are not that important to the hospitals except in the way they affect the bottom line?

Please read this article and then come back and let’s talk.  I sometimes feel that I am out her alone, but I know that can’t be right, can it?


Dennis Kosuth, an ER nurse in Chicago and member of the National Nurses Organizing Committee, makes the case for laws mandating nurse-to-patient ratios.

March 8, 2010

AMONG NURSES who work in the emergency room, there’s an understandable fear that when you go to check on one of your patients, they may have stopped breathing. Because many people come in with undiagnosed conditions, it’s sometimes impossible to predict the direction they’re headed before it is too late.

In a public hospital, this concern is compounded by a waiting room bursting at the seams, where sick patients with nowhere else to turn sometimes sit for 18 hours before being seen by a doctor. While waiting for tests or a bed upstairs, patients are routinely wheeled into the hallway to make room for the next one, so the pressure building out front can be relieved.

Depending on the day, this can result in one nurse having seven or eight patients, and when their covering nurse goes on lunch, the number doubles. All this endangers the patients that nurses are responsible for–not to mention straining nurses to their physical limits.

Every day, in hospitals across the country, this ticking time bomb is wound up, and everyone crosses their fingers, hoping that nothing bad happens to themselves or their loved ones. According to an investigative feature in the San Francisco Chronicle, “[A]ll of the available research indicates that the death toll from preventable medical injuries approaches 200,000 per year in the United States.”

The profit-driven health care system has no interest in getting to the bottom of these numbers, mainly because it would involve investigating itself. It simply stands to reason that an overworked nurse with too many patients is not an accident waiting to happen, but a guarantee that accidents will happen.

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ON A Friday evening in February in Chicago, almost 50 registered nurses gathered at a forum sponsored by the National Nurses Organizing Committee (NNOC) to discuss the need for safe nurse-to-patient ratios in the state of Illinois.

Bills (known as SB0224 and HB5033) have been introduced in each chamber of the Illinois legislature to establish a maximum number of patients per nurse, depending on the level of care. In the ER, for example, the legislation would mandate a maximum of four patients per registered nurse (RN), and this ratio would have to be maintained during breaks as well.

The Illinois bills are modeled after California, the only state to have such regulations. In 1999, Governor Gov. Davis signed the legislation, which mandated compliance by 2004. It was twelve years between the legislation first being introduced to a law going into effect.

Throughout the process, significant resistance was organized by the hospital industry, aided by their friends in state government. Even after the bill was signed into law, Davis’ successor, Arnold Schwarzenegger, was particularly obstructive, helping to wage a legal battle against the new law. So the California Nurses Association (CNA) protested him wherever he went, inside the state and out.

The Illinois Hospital Association (IHA) is vehemently opposed to nurse-patient-ratio legislation. One complaint is that in California, the new law raised health care costs by more than $1 million per hospital, “with 23 percent attributable to increase in nurse wages,” the IHA claimed in a statement.

But the hospital owners don’t say is that having more nurses will actually save medical costs by reducing errors and recovery time–not to mention other insignificant questions like saving some of the 200,000 lives lost to medical error every year. The focus on profits blinds the IHA to measures that would actually improve patient care.

Another excuse for opposing the new legislation is that Illinois already has the “Nurse Staffing by Patient Acuity Act,” which took effect in January 2008 and was supported by the IHA, as well as the Illinois Nurses Association (INA), a professional organization that also represents some Illinois nurses through collective bargaining agreements.

But this existing law only requires hospitals to have a written plan for nurse-to-patient ratios, which is designed by a committee made up of at least 50 percent nurses. There is nothing about monitoring, regulation or enforcement of the wishes of bedside nurses. This is a toothless bill that leaves ratios in the hands of management.

There are currently 136,000 RNs in the state of Illinois, making for a definite nursing shortage. This leads to another IHA claim–that mandating nurse-to-patient ratios would further exacerbate the shortage.

The fact is, however, that many nurses don’t stay in the field because working conditions are so stressful.

According to one study in 2007, for example, the average voluntary turnover rate for first-year nurses was 27.1 percent. The federal government’s quadrennial survey found that only 83 percent of people with a license to work as an RN chose to do so in 2004. With the total number of RNs at 2.9 million, that means there were almost 490,000 nurses nationwide who didn’t work in the field.

Ratio laws can actually turn these trends around. In the short time since ratios went into effect in California, the state has seen an increase in the number of nurses being retained, an influx of nurses to California and a greater interest in nursing as a job. Once conditions were improved, nurses went back to work at the bedside, started moving to California from out of state, and more people have enrolled in nursing school.

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THE REAL reason the hospital industry opposes the Illinois ratio proposals and similar national legislation is profit, flexibility and speedups. A recent article in Becker’s Hospital Review listing “10 Best Practices for Increasing Hospital Profitability” starts with “reducing staffing costs” through flexible scheduling and reducing benefits for full-time employees.

While health care was one industry that created jobs during the recession, this hasn’t lessened the corporations appetite to improve their bottom lines. Profits returned at large community hospitals in the first quarter of 2009, partly due to an improved stock market, but also from a decrease in hospital labor costs. Many employers were able to gain significant concessions from workers by playing on their economic fears.

For example, Mount Sinai Medical Center, a large Chicago hospital that serves the poor, has not only gotten away with wage freezes for the past couple years, but has also been on a campaign to get employees to make donations to the hospital. This is the same “not-for-profit” institution that spent significant resources to successfully fight off a unionization drive by nurses three years ago.

On the federal level, Sen. Barbara Boxer of California recently introduced legislation to institute nurse-to-patient ratios nationally. This national bill and other state legislation could produce important improvements in patient care and working conditions.

But this isn’t the only path to ratios. Union nurses at Saint Mary’s Regional Medical Center in Reno, Nev., recently won contract language that mandates the same nurse-to-patient ratios as exist in California.

The introduction of these bills is a good first step, but it’s only the beginning. If the mammoth resistance to even the tepid measures promoted by Barack Obama and the Democrats in their “reform” legislation is any indication, the health care industry will stop at nothing to fight mandating ratios.

As one public health nurse said at the Chicago forum last month, “I’ve been to Springfield, written letters and called my representatives. We need to start thinking about protest actions that are just on the other side of the law if we’re going to get the change we need.”

Ratios themselves won’t solve the ongoing health care crisis in this country, but organizing around this issue can bring nurses together with patients and others to address one of the more glaring aspects of it–and force the issue of the present nursing shortage higher on the agenda.

Here’s the link to the original article

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March 4, 2010

ED Shooting Shows Why Confronting Hospital Violence Must Be A Priority

There is no excuse for any person to come into a hospital, church, or school and start shooting.  This is an occurrence that we are becoming way to familiar with.  This article caused me quite a bit of concern because I had not read anything about this incident before.  How is that possible?

Why was this incident not played up in the national news?  Is it deemed normal for someone to shoot up an Emergency Room?  This is scary and I hope you will also feel threatened when you read this article.  I go to my job to help others and I never for a minute expect that someone will take shots at me for doing my job.  Maybe I need to rethink my position.


John Commins, for HealthLeaders Media, March 1, 2010

The Feb. 15 early morning shooting inside the emergency department of Scotland Memorial Hospital in Laurinburg, NC, provides an unwelcomed, frightening, and extreme example of the violence that healthcare professionals too often confront. If you want to read the details of the report, here’s a local news link. Bottom line: some jerk allegedly brought a gun into a hospital and started shooting people. I really don’t care what his motive was, although I was gratified—but not surprised—to read that the healthcare professionals on duty acted heroically to secure the safety of their patients. When the attack was over, one patient at the hospital had suffered multiple critical gunshot wounds to the chest, his alleged attacker was in police custody, the hospital was in lockdown, and a number of healthcare professionals and their patients—though not physically injured-were badly shaken. The story got little play nationally and not that much play around North Carolina—a couple of news cycles and then nothing. That left me wondering if hospital violence has become so commonplace that it no longer warrants extensive news coverage. Had a similar shooting occurred in a school, for example, it likely would have generated much more media coverage. Is this a sign that we are becoming inured to the idea of violence in the ED? Let’s hope not. From everything I’ve heard and read so far, it appears that Scotland Memorial CEO/President Greg Wood and his staff did a good job responding to the shooting, and then keeping the public informed. SMH issued two press releases in the hours immediately after the shooting—doing their best to explain the convoluted chain of events and the hospital’s response, even as the police investigation was still underway. “We have never experienced anything like this in our hospital before,” Wood said in a media release. “The safety of our patients, visitors, and staff is of paramount importance to us, and we have extensive security measures in place to minimize the likelihood of such a horrific incident as this.” Wood understands the importance of keeping the public informed on this critical issue. He could have simply referred inquiries to the local police. You’d be amazed at how many hospitals do. SMH is still assessing its reaction to the shooting, what worked, what could be improved upon, etc. I hope to speak with Wood when that review is complete. When will hospital violence get the attention it deserves? This is not a new phenomenon. HealthLeaders Media and other healthcare media have reported on it, but you don’t see it talked about much anywhere else. An Emergency Nurses Association survey last year found that more than half of emergency nurses say they’ve been “spit on,” “hit,” “pushed or shoved,” “scratched,” and “kicked” while on the job. One in four of the 3,465 emergency nurses surveyed for Violence Against Nurses Working in U.S. Emergency Departments say they’ve been assaulted more than 20 times in the past three years, and one in five nurses have been verbally abused more than 200 times during the same period. A report from the National Advisory Council on Nurse Education and Practice also found “considerable evidence that workers in the healthcare sector are at greater risk of violence than workers in any other sector.” The report cites Bureau of Labor Statistics data which show that 48% of all non-fatal injuries from occupational assaults and violent acts occurred in healthcare and social services settings. BLS data also show that 9.3 in 10,000 employees in the health services sector suffer injuries that require time off from work, compared with two in every 10,000 workers overall in the private sector. There are cost big factors at work here too. How much are hospitals paying in workers’ compensation claims, or litigation for unsafe work environments, or for missed work, or for overtime or hiring temps to cover those missed shifts? How will a shooting in your emergency department affect recruiting and retention? These are grave questions that deserve immediate attention. First and foremost, however, this is a human resources issue. This is about providing dedicated healing professionals with a safe working environment. They have enough stress in their work already. They shouldn’t have to worry about getting shot, or stabbed, or kicked, or slapped, or scratched, or punched, or spit upon, or pushed, or cursed at, or intimidated. That sort of abusive conduct is not tolerated almost anywhere else. Why are hospitals the exception? Note: You can sign up to receive HealthLeaders Media HR, a free weekly e-newsletter that provides up-to-date information on effective HR strategies, recruitment and compensation, physician staffing, and ongoing organizational development.

John Commins is an editor with HealthLeaders Media. He can be reached at

Here’s the link to the original article

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February 6, 2010

Are West Texas nurses criminals or health advocates?

Remember a while back I posted about two West Texas nurses who were being prosecuted for advocating for their patients?  Well, that case is still advancing, much to the dismay of the nurses; but support is building and people and other nurses are aligning themselves with these two nurses.


Toni Inglis, Regular Contributor

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Published: 7:10 p.m. Friday, Jan. 29, 2010

Remember the two West Texas nurses who were not only fired from their jobs but also indicted on third-degree felony charges for doing what they thought was right?

To me, there appears to be so much wrong here — arrogance, vindictiveness, downright good-ol’-boy idiocy — that it’s hard to know where to begin.

Last April, Vickilyn Galle and Anne Mitchell complained to the Texas Medical Board that Dr. Rolando Arafiles improperly encouraged patients in the hospital emergency department and in the rural health clinic to buy his own herbal “medicines.”

The nurses, who practiced at Winkler County Memorial Hospital in Kermit, also thought it improper for him to attempt to take hospital supplies to perform a procedure at a patient’s home. (The hospital chief of staff stopped him.)

Galle and Mitchell, both in their 50s and longtime members of the American Nurses Association/Texas Nurses Association, went up the chain of command at the 25-bed hospital and got nowhere with their complaints. So they anonymously turned the doctor into the Texas Medical Board, using the medical record numbers of six hospital patients, not their names.

When the medical board notified the physician that he was under investigation for mistreatment and poor quality of care, he filed a harassment complaint with the Winkler County Sheriff’s Department.

To find out who made the anonymous complaint, the sheriff industriously interviewed all patients whose medical record case numbers were listed in the report and asked the hospital to identify who would have had access to the patient records in question. The sheriff narrowed the potential complainants to the two nurses. He got a search warrant to seize their work computers and found a copy of the letter to the medical board on one of them.

The nurses were fired by the hospitals and charged by the district attorney’s office with “misuse of official information,” a third-degree felony that carries a potential of two to 10 years’ imprisonment and a maximum fine of $10,000.

Their lawyers unsuccessfully sought to have the charges dismissed at a pretrial hearing in August. A second pretrial hearing in October resulted in a change of venue from Kermit (population 7,000) to Andrews (population 13,000), the county seat of adjacent Andrews County.

Meanwhile, in August, the nurses filed a civil lawsuit in federal district court against the hospital administrator, sheriff, county and district attorneys and physician (all males) as well as the hospital and the county. They charged violation of their constitutional right to free speech and due process, conspiring to intimidate and threaten the plaintiffs from filing any civil action and for violating the Texas whistleblower law.

The federal court ordered mediation, which took place in December and failed. The nurses’ criminal trial begins Feb. 8.

In a third pretrial hearing last month, the court denied a request by prosecutors to try the nurses separately and reminded the state of its unfulfilled obligation to turn over contact information of its witnesses. Interestingly, a New York Times reporter and photographer were present.

The public outrage needle jerked into the red zone as the nurses got media coverage and widespread support. The Texas Nurses Association created a legal defense fund for the Winkler County nurses (accessible on its Web site), and the first donation was from a staff nurse practicing in New York who wrote out a check for $500 from her personal account.

Since August, more than $40,000 has been donated by 450 individual nurses from 35 states and 25 nurse organizations from eight states.

Galle and Mitchell exercised a basic tenet of the professional nurses’ code of ethics — the duty to advocate for the health and safety of their patients. On Feb. 8, state as well as national attention will be focused on the squat, Depression-era Andrews County courthouse where the nurses will learn their fate.

Inglis is an editor and neonatal intensive care staff nurse at the Seton Family of Hospitals.

Here’s the link to the original post in the Austin American Statesman


Then, I found another snippet about these two nurses and I felt I should add it here so you can see this play out in its entirety.

There is really something really wrong here.  Why is it that nurses are the easy target?  Doesn’t make me want to stay a nurse and probably doesn’t encourage others to want to be one either.


At the request of the prosecutor, a Texas judge dropped the case against one of two nurses scheduled to stand trial next week on charges that they misused government information by reporting concerns about a physician (Print subscription required.) to the Texas Medical Board.

The nurses, Vickilyn Galle and Anne Mitchell, worked for Winkler County Memorial Hospital, a county-owned hospital in Kermit, Texas, and were indicted after a sheriff’s investigation determined they were the source of an anonymous complaint to the medical board. County Attorney Scott Tidwell argues that the complaint was made in “bad faith” to carry out a personal vendetta against the doctor.

Tidwell filed a motion to dismiss the case against Galle, but the trial is on track to proceed with Mitchell as the lone defendant. The nurses, meanwhile, have filed a civil lawsuit in federal court alleging that their rights to free speech and due process, as well as various whistle-blower protections, were violated by the doctor, the hospital, the sheriff and prosecutors.

Mitchell’s attorney, John Cook, said he believes Tidwell is too invested in the case now to drop it completely. The only reason given on the motion to dismiss Galle was “prosecutorial discretion,” Cook said. — Gregg Blesch

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February 5, 2010

RN’s: Victims or Bad Asses

As a psychiatric nurse, I have always dealt with aggressive and/or assaultive patients.  People seem to think that is “just part of the package” but I disagree.  Nurses, no matter where they work, should not be targets for abuse.  These are people who do what they do because they only want to be helpful to others.  Nurses usually describe their choice as a “calling”, much as a nun will describe the need to give her life to God as a “calling”.  Nurses, by and large, want to help others to heal, to restore to health, to learn to live with chronic conditions, to be able to laugh and enjoy life.  Nurses work with the patient, but they also work with the families of that patient in a way that gives them relief and support.

There have been times when working at a psychiatric emergency room that police brought in handcuffed and pepper-sprayed individuals who were actively psychotic and aggressive.  These 3 or 4 policemen would uncuff the person and leave.  I worked the night shift and we routinely had a nurse and two techs available at any given time.  Do you think we were better equipped to deal with this person than those police?  We frequently were assaulted and injured.

There needs to be some protection in the law for the nursing staff of any hospital–that they should not have to fear injury or death because they show up for work.

By Sheryl McCollum

The ER is open 24/7.  It provides unrestricted access to the public.  Nurses and doctors are trained to help all in need of medical attention.   However, the staff  is exposed constantly to an un-screened and potentially high-risk population for violent behavior.
I have two sisters that are emergency room nurses.  They have both dealt with violent patients.  Both have been hit, kicked and threatened.  One of my sisters was even seriously injured by an inmate that was receiving care.  Unfortunately, most people are not aware of the dangers for nurses in the ER.

ER nurses can deal with individuals that are suicidal, schizophrenic, drug addictive, and/or violent criminals all in a shift.

When dealing with a violent offender, the police can call for back-up.  They have a variety of weapons to defend themselves with such as: OC Spray, ASP batons, and a gun.  Additionally, a police officer also has the authority to place the offender  in a holding cell.  Once the fight is over, the criminal is transported to the hospital for care.  The criminal arrives at the hospital.  The ER reality — nurses deal with the same violent criminals without the back-up, weapons, or authority to place in a cell.

I have had people tell me that the nurse can strap the violent patient to the bed and call security.  Yes, they can; however,  how will they get straps on a strung out, violent criminal who attempted to harm the police?   Nurses are not trained in self defense or take down procedures.

If a person potentially overdosing PCP is transported to the ER, the ER nurses are dealing with the same violent, strong, crazed individual that the police would.  If a criminal is injured, the police take them to the hospital.  These criminals may have raped, burned or killed innocent people.  Again, nurses do not have the same defense training as a police officer.

What about the mental ill patient that has not committed a crime but is in need of medical treatment?  These patients also pose a tremendous risk for the people that give them care.  These patients often do not come into the hospital with the police.  The nurses may never see any security with these individuals, but this situation can still be very dangerous for all who care for this patient.

According to the Bureau of Labor Statistics (BLS), in 2000, the injury rate for nurses is among the highest, and 25 of every 10,000 full-time nurses were injured in workplace assaults. This rate is much higher than private-sector industries, which is 2 per 10,000.

The reality is cops, correctional officers and nurses all deal with the same people.  Nurses are the only ones that have had no training on how to deal with hand-to-hand combat, have no radio, no weapons, and no real lifeline to call for back-up.

I admire the work that they do and the heroic conditions that they perform under each and every shift!

Victim or Bad Ass??? – I say both!

Sheryl McCollum, MS
Cold Case Investigative Research Institute

Here’s the link to the blog, Time’s UP and this post

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