Nursing Notes

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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March 21, 2011

Bill would squeeze nursing staffs

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

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

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

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CMHS authority: We’d have to hire more nurses

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

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

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October 26, 2010

Brother, Can You Spare an RN?

Filed under: Nursing — Shirley @ 8:02 pm
Tags: , , , ,

A friend recently sent me this article in an email.  I read it and I have to say I was appalled by the thought of this type of teaching for new nurses.  Nursing is all about touch and connection as well as knowledge.  What this type of training might turn out are simply nursing technicians–those capable of doing the tasks but without the underlying understanding and without the judgement factored in.  Please let me know what you think after reading this article.  Maybe I am just too old fashioned, but I want a nurse who knows all about me and what is best for me at that moment, not a nurse who is proficient in the tasks but hasn’t a clue how to deal with anything else.

This article is from Governing.com, which in and of itself is kind of creepy.

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There aren’t enough nurses to go around, and there’s no cure in sight.

Ellen Perlman | May 2004

 

Coming soon to the state of Colorado–if the Colorado Department of Labor and Employment has its way–is a computer simulator that will train nurses on virtual patients programmed to have emergent symptoms of a variety of conditions and diseases. With a shortage of clinical training sites and qualified nursing instructors throughout Colorado, the virtual teacher is one way the state plans to pitch in to help get more nurses trained.

Colorado is not the only jurisdiction that needs to take action to ease a nursing shortage. At the present time, at least 30 states are grappling with a shortage of registered nurses and that number is expected to grow to 44 states by 2020. The lack of nurses is felt in all sectors: private hospitals, nursing homes and doctor offices as well as facilities run by states and localities–clinics, public hospitals and the like.

While there are limits to how much an individual government can do to boost a profession’s ranks, several states and localities are trying to figure out how to solve the nursing riddle in their jurisdiction. And it is a complex riddle because the shortage problem is two-fold. There is a dearth of nursing teachers to teach the next generation of nurses, thereby cutting down on the number of people who, even if they want to become a nurse, can find an open slot in a nursing program. Beyond that, there are not enough young people being drawn to the profession to replace retiring nurses and meet escalating needs.

The current nursing shortage didn’t materialize overnight. It’s been happening, off and on, since the 1960s. Each time a crisis has arisen, it has taken a year or two to resolve it. The current shortage, however, breaks with the past: It began in 1998, and there’s no end in sight.

Lifestyle and demographics are part of the reason. In the early ’60s, nursing was one of the few careers open to women. Opportunities are, obviously, greater now, and the supply of students has gone down. As the nurse workforce ages, no baby boom of high schoolers is rising up to replace the old order. The employment growth in various age cohorts tells an alarming story. From 1994 to 2002, the number of employed nurses 50 years old or older grew by 60 percent; for those younger than 35, growth was inverse: -17 percent.

Given those numbers, it is not surprising that many nurses are likely to retire within the next 15 years. Unfortunately, those retirements will come just as the need for their services increases. “Demand,” as Peter Buerhaus, associate dean at Vanderbilt University School of Nursing, points out, “is going to accelerate with the wave of boomers turning 65.”

Throw state budget problems into the mix and the picture darkens further. Many state schools and community colleges that offer programs to train nurses have been devastated by funding cuts, and early retirement packages to reduce the workforce attracted a healthy share of nursing teachers. “We’re almost at a public health crisis on this issue,” says G. Rumay Alexander, a director at the School of Nursing, University of North Carolina at Chapel Hill. “Many of the schools don’t have the capacity to handle the numbers applying.”

A WEAK PULSE

Last fall, schools of nursing turned down at least 15,000 applicants. A big piece of the problem is the lack of nursing instructors. “The faculty shortage is the choke point right now,” says Jo Ann Webb, senior director of federal relations and policy for the American Organization of Nurse Executives. Clearly, without a sufficient number of nursing instructors, there’s no way to educate enough nurses to ease the shortage.

Low pay relative to nursing positions makes it difficult for schools to attract and keep teachers. “Why would I want to teach when I could be a nurse practitioner and make a heck of a lot more money,” asks Peggy Welch, a state representative from Indiana and a registered nurse in oncology. “We’re all scratching our heads over this. We know there’s a shortage. How do we address that?”

Colorado is trying. It is tapping public and private funds to develop an e-learning portal aimed at expanding classroom space and the availability of instructors. Simulation software will allow nursing students to take part of their clinical instruction in a virtual situation. Once in place, the portal could provide other curricula so students could complete some coursework over the Internet.

The state submitted a proposal for $250,000 in grant money from the U.S. Department of Labor and expects a public-private partnership to fund the rest of the $1.3 million to $2.2 million needed to design and launch a system and develop training modules. “We’ve all known the problem is there,” says Tom Looft, director of workforce development programs for Colorado’s labor and employment department. “It’s just gotten to the point where it’s become very critical.”

THE RACE TO RECRUIT

If the teaching shortage were solved, that would still leave states with the problem of attracting people to the nursing profession, and particularly to areas of health care where the shortages are most acute. In fiscal year 2001, when state budgets were flush, many legislatures passed measures creating nursing scholarships or loan- forgiveness programs for nursing students who agreed to serve in health professions that faced nursing shortages. The next year, as budgets shrank, legislatures focused on setting up nursing workforce commissions and data centers to analyze statistics on the nursing situation.

Some big states have persevered in efforts to bring more people into the profession. New York passed a health care reform act in 2002 that provides $1.8 billion over a three-and-a-half-year period for health care workforce recruitment, training and retention in hospitals, nursing homes and home health care settings. That same year, California announced a $60 million, three-year nurse workforce initiative to recruit, train and retain nurses for employment in hospitals and other health facilities. About $36 million of that money had been allocated by the time Governor Gray Davis was recalled.

Still, there are problems. There is a waiting list of one to two years to get into nursing schools. “The California pipeline for nurses is not big enough,” says Joanne Spetz, assistant professor at the University of California at San Francisco. “And it’s a leaky pipeline.” Anywhere from 10 percent to 50 percent of nursing students don’t complete their schooling. An average of 20 percent to 35 percent of students either don’t graduate or don’t pass the board exam.

Other states are rounding up public and private organizations to attract and train nurses. In Georgia a $4.5 million initiative pairs the state university and health care providers in an effort to turn out 500 new nurses, pharmacists and medical technologists within two years. The state pays $2 million for instruction and expenses. Health care providers contribute money and also donate equipment, staff time and lab space.

Agencies in neighboring Florida have teamed up with private partners to provide eligible nurses with affordable home mortgages, including up to 100 percent financing. The partners also offer low-interest student loans to those who work full time in health care after graduating from Florida colleges and universities.

The Colorado Department of Labor and Employment teamed up with representatives from federal and state agencies, community colleges and private health care groups to develop scholarships for nursing students. Small projects around the state have community colleges working with workforce investment boards and hospitals to increase capacity for nursing students in select community colleges and to speed up the training track.

Some legislators are studying working conditions to see how they can be improved to attract more people to nursing. In particular, they have looked at minimum nurse-to-patient ratios so nurses aren’t overburdened. California passed a law, sponsored by the California Nurses Association, that calls for clearly defined nurse-to-patient ratios. There must be, for instance, at least one nurse for every four patients in the emergency room and one for every six on medical- surgical wards.

Hospitals are not happy with the law, particularly since it doesn’t provide money to pay nurses or to train them. “Hospitals,” says Jan Emerson, spokeswoman for the California Healthcare Association, “are in a bind.”

Some hospitals have been trying to staff up by hiring nurses through traveler agencies–companies that get nurses from out of state. But Emerson says that’s just stealing nurses who are needed in other states, and it doubles a hospital’s nursing costs. “You can’t pass a law mandating new nurses when the nurses don’t exist. That requirement is posing serious problems.”

Emerson says the association has been doing a weekly survey of 450 acute-care hospitals and the responses from nine out of 10 of them is that they cannot comply with the state law. Their options, they say, are to break the law and continue to provide care or comply and shut down beds, make people wait longer in the emergency room and delay surgeries.

Meanwhile, hospitals have taken steps to increase the base of nurses available. Sutter Health, a not-for-profit community-based hospital system, is underwriting a program that enables Sacramento Community College to hire more faculty members and expand space to admit more nursing students. “It’s wonderful that hospitals are stepping up to the plate and partnering, but it’s not the solution,” says Emerson. “We need a statewide policy solution.”

The problems caused by a nursing shortage are repeated all over the country. The annual need for nurses is at least three times above and beyond normal levels of enrollment, says Vanderbilt’s Buerhaus. If schools don’t produce the required number of nurses, “the alternative is watching health care facilities turn off their lights. Access will go down, quality will go down. States will have to deal with the issue in a different way.”

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October 22, 2010

FL nursing shortage will grow | Jacksonville Business Journal

Filed under: Nursing — Shirley @ 8:38 am
Tags: , , , , , ,

This is one of the few articles I have found about the nursing shortage that actually includes the economic slowdown as well as the impending changes from the new health care bill.  Although many states say they “have no nursing shortage”, my opinion is that either they are unaware of the projected needs of the state or their nurses are so overworked that they don’t have a second to voice an opinion.

In Austin, I am frequently told that there is no nursing shortage here.  Great!  Explain to me then why I work with more than 5 acutely psychotic patients at a time.  There are some hospitals that staff 12:1 on some shifts, even.  I guess there is no shortage if the nurses working now are able to do more and more for less and less.

Don’t get me wrong, I work hard and make a decent living.  I don’t want to be anything except a nurse.  What I do want to be, however, is a nurse with a voice and some control over my workplace/workload.  I want to be a nurse that gives excellent nursing care and takes great care of my clients.  What I find is I am struggling just to get the minimum done each shift.  I don’t like this.

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New projections from the Florida Center for Nursing show that the implementation of health care reform, along with a slowly recovering economy, may cause the nursing shortage to grow.

The Orlando-based Florida Center for Nursing, which studies the state’s nurse workforce needs, said the shortage will grow to more than 50,300 full-time registered nurses by the year 2025.

The center said it expects an increase in retirements and a reduction in the workforce participation of nurses — which is at historic highs due to the recession. Combined with a lack of faculty and clinical space, the result will be very slow growth in the number of working nurses.

“We have been urging stakeholders all along not to be lulled into complacency by the temporary reduction in the nursing shortage,” said Mary Lou Brunell, the center’s executive director. “With these new forecasts, we’re now able to put a timeline on the reemergence of the nursing shortage and quantify its severity.”

The center projects a continuing tight labor market for RNs over the next three years, owing to a sluggish economy. Once the major provisions expanding coverage within health care reform are enacted in 2014, the shortage is expected to increase rapidly. By 2015, the shortage may top 11,000 nurses, and by 2020 it may reach more than 37,500.

Read more: Report: FL nursing shortage will grow | Jacksonville Business Journal

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August 9, 2010

Nursing shortage: 1 in 5 quits within first year, study says

Filed under: Nursing — Shirley @ 5:41 am
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Here’s an article from 2009 that I found in USA Today.  This is interesting in that today I don’t think there is any difference in the statistics.  My hospital has a Versant program and we frequently work with Versant nurses.  But, even with a residency program, we still loose some of our Versant nurses.

Enjoy the article below and see if you think there has been much improvement since February of 2009.  I really don’t see improvement; actually I think nursing is loosing ground rapidly.  Maybe it’s time for a complete overhaul of the way we nurse and the way we train nurses.  Maybe we need someone to do some oversight of the CEO’s of all the major hospitals and compare their salaries and bonuses to the nurse-to-patient ratios and the actual staffing of their hospitals.  I really don’t care where the problem is attacked, I just know that we have to do something before nursing looses out.

This article is from here.

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Yaima Milian, center, who is in a nursing residency program, examines Carmen Perez, left, as more experienced nurse Marvin Rosete looks at Baptist Health of South Florida in Miami on Feb. 6. More hospitals are investing in longer, more thorough residencies, which can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who burned out is about $50,000, experts estimate.
Enlarge image Enlarge By Wilfredo Lee, AP
Yaima Milian, center, who is in a nursing residency program, examines Carmen Perez, left, as more experienced nurse Marvin Rosete looks at Baptist Health of South Florida in Miami on Feb. 6. More hospitals are investing in longer, more thorough residencies, which can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who burned out is about $50,000, experts estimate.

By Rasha Madkour, Associated Press
MIAMI — Newly minted nurse Katie O’Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

She lasted nine months. The stress of trying to keep her patients from getting much worse as they waited, sometimes for 12 hours, in an overwhelmed Dallas emergency room was just too much. The breaking point came after paramedics brought in a child who’d had seizures. She was told he was stable and to check him in a few minutes, but O’Bryan decided not to wait. She found he had stopped breathing and was turning blue.

“If I hadn’t gone right away, he probably would have died,” O’Bryan said. “I couldn’t do it anymore.”

Many novice nurses like O’Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

That turnover rate is a major contributor to the nation’s growing shortage of nurses. But there are expanding efforts to give new nursing grads better support. Many hospitals are trying to create safety nets with residency training programs.

“It really was, ‘Throw them out there and let them learn,”‘ said University of Portland nursing professor Diane Vines. The university now helps run a year-long program for new nurses.

“This time around, we’re a little more humane in our treatment of first-year grads, knowing they might not stay if we don’t do better,” she said.

The national nursing shortage could reach 500,000 by 2025, as many nurses retire and the demand for nurses balloons with the aging of baby boomers, according to Peter Buerhaus of Vanderbilt University Medical Center. The nursing professor is author of a book about the future of the nursing work force.

Nursing schools have been unable to churn out graduates fast enough to keep up with the demand, which is why hospitals are trying harder to retain them.

Medical school grads get on-the-job training during formal residencies ranging from three to seven years. Many newly licensed nurses do not have a similar protected period as they build their skills and get used to a demanding environment.

Some hospitals have set up their own programs to help new nurses make the transition. Often, they assign novices to more experienced nurses, whom they shadow for a few weeks or months while they learn the ropes. That’s what O’Bryan’s hospital did, but for her, it wasn’t enough.

So more hospitals are investing in longer, more thorough residencies. These can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who washed out is about $50,000, personnel experts estimate.

One national program is the Versant RN Residency, which was developed at Childrens Hospital Los Angeles and since 2004 has spread to 70 other hospitals nationwide. One of those, Baptist Health of South Florida in the Miami area, reports cutting its turnover rate from 22% to 10% in the 18 months since it started its program.

The Versant plan pairs new nurses with more experienced nurses and they share patients. At first, the veterans do the bulk of the work as the rookies watch; by the end of the 18-week training program, those roles are reversed.

The new nurses must complete a 60-item checklist. They must learn how to put in an IV line and urinary catheter; interpret different heart rhythms and know how to treat them; monitor patients on suicide watch and do hourly checkups on very critically ill patients; know how to do a head-to-toe physical assessment on a patient, as well as how to inform families about the condition of their loved one.

For Yaima Milian, who’s currently in the program at Baptist, this is markedly different from the preparation she got at her first hospital in New Jersey. She left after a six-week orientation because she didn’t feel ready to work solo.

While Milian was paired with a more experienced nurse at the New Jersey hospital, they didn’t see patients together; they split the workload. Her first week on the job, Milian was charged with caring for several patients with complicated issues — those on ventilators and with chest tubes — and she felt thoroughly unprepared.

“It just didn’t feel right, it felt very unsafe,” Milian said.

Besides the residency’s professional guidance, which includes classroom instruction, new nurses also get personal support from mentors — people they can call after a bad day or to get career advice. The new nurses also gather with their peers for regular debriefing, or “venting” sessions.

“Here you have this group that is pretty much experiencing the same things you’re experiencing,” Milian said, “and it makes you feel better.”

To be sure, not all the nurses who leave do so because of a rocky transition. But for nurses who do leave because of stress, these programs seem to help.

The American Association of Colleges of Nursing and the University HealthSystem Consortium teamed up in 2002 to create a residency primarily for hospitals affiliated with universities. Fifty-two sites now participate in that year-long program and the average turnover rate for new nurses was about 6% in 2007.

“We believe all new graduates should be given this kind of support system,” said Polly Bednash, the nursing association’s executive director. “We are facing downstream a horrendous nursing shortage as a large number of nurses retire from the field… So you need to keep the people you get and keep them supported.”

The federal government has jumped on the bandwagon. Since 2003, it has awarded $17 million in grants for 75 hospitals to start first-year training programs.

The National Council of State Boards of Nursing is considering a standardized transition program. It cited a study showing a link between residencies and fewer medical errors, but also pointed to the inconsistency among current efforts.

That’s something O’Bryan, the Dallas nurse, knows about. Her hospital — which she declined to identify because she didn’t want to be seen as complaining about a former employer — had a three-month program, in which she attended weekly classes and was assigned a nurse to shadow. After that period was over, though, O’Bryan was abruptly alone, even as she continued to face new situations that she wasn’t sure how to handle.

“When things are going good and I’m not overwhelmed and I’m able to help people, I love it,” she said, recalling the gratification of seeing a bedridden patient finally manage to take a few steps.

“There are always those moments,” she said, “but they’re interrupted pretty quickly.”

The 27-year-old is currently looking for a new job. She’s not sure it will be in nursing.

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March 24, 2010

DC/Maryland/Virginia Letters To The Editor

Here are two letters to the editors of Nurse.com that address the issue of staffing and safe patient to nurse ratios.  I found them to be quite interesting, even though they come from two different perspectives.  Please read these and then go to the original article to read it.  Let me know what you think, won’t you?

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Staffing Ratios Need Everyone’s Attention
I was pleased to see your article (“The Sum of Staffing,” Feb. 8 issue) on nurse-to-patient ratios. As an RN for 34 years and an ER nurse at Temple University Hospital in Philadelphia for 11 years, I can attest to the need for such ratios in Pennsylvania.

Many days, I have gone home from work exhausted and frustrated with the knowledge that I often was unable to give the most appropriate, and, at times, safe care.

As the president of the Pennsylvania Association of Staff Nurses & Allied Professionals, I have worked with many nurses across the state who have expressed the same concern about unsafe conditions and the need for ratios.

Bedside nurses know from experience that minimum ratios are the best guarantee for patient safety.

We have ratios in our day care facilities and our prisons, so why not in our hospitals where it is a matter of life and death? As nurses, we should be able to work under the conditions that enable us to apply our clinical skills, not simply juggle impossible patient loads.

We have therefore introduced a bill in the state Senate that would mandate safe, minimum ratios in hospital units, similar to California.

The chief sponsor of this bill, called the Pennsylvania Hospital Patient Protection Act, is Sen. Daylin Leach, and the bill number is Senate Bill 742. Similar legislation is in the house as House Bill 147.

We plan to have hearings and rallies and conduct a public campaign to achieve passage of this important legislation. Pennsylvania nurses and patients deserve a safe working environment.

— Patricia Eakin, RN
President, Pennsylvania Association of Staff Nurses & Allied Professionals Philadelphia

‘Sum of Staffing’ Equals Misinformation for RNs
To say I am disappointed with the article “The Sum of Staffing” (Feb. 8 issue) would be a major understatement. It does not present an unbiased picture of the staffing-ratio issue for nurses to consider and merely fosters misinformation that is favorable to the industry.

We all understand that having the appropriate number of nurses on the unit is critical to safe care and the skills mix. The issue boils down to whether we, as nurses, and the public, as patients, can trust the facilities to do the right thing when it comes to staffing.

It is not an issue of occasionally shifting into high gear to handle an overload, but rather the chronic need to shift gears.

Some of the article is true. Ratios improve patient satisfaction and patient care. There is strong evidence to support improved patient outcomes, and the work by Linda Aiken appears well done.

The intangible benefit may be that nurses stay in the workforce longer, burn out less and are safer practitioners. Given a recent poll that shows 30% of nurses are considering changing career paths, this becomes critical when we consider the looming nursing shortage.

The recent emphasis on a staff nurse component of the decision-making team is a farce, and once again we will be at the mercy of an industry that already has demonstrated its reluctance to institute rational staffing. Which staff nurses are to be included? Who decides which nurses sit on these committees?

I hear it from my friends. I hear it from my students, and I read about it on blogs.

The loads are just too heavy, the acuities too high.

It’s time we stop pretending there is no problem and start acting to protect ourselves and our patients. We need to become the patient advocates we think we are.

— John Silver, RN PhDc
Assistant Professor of Nursing
Nova Southeastern University
Fort Lauderdale, Fla.

Letters to the editor may be edited for content, length and clarity. Letter writers must be identified by name and location, although names may be withheld upon request at the discretion of the editor. E-mail letters to editorDC@nursingspectrum.com or post your comment online.

Here’s the link to the original article

Here’s the link to the original letters to the editors


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March 19, 2010

Spotlight on the Best and Worst Media Portrayals of Nurses

Grey’s Anatomy - Thumb
Image by LA100RRA 3logs via Flickr

And this brings to a close our three-part series found on Medscape.  I hope you will visit the original and read all the additional articles to be found there.  I was totally unaware of these resources but you can bet that I will be browsing them regularly in the future.

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It’s award season in Hollywood, so it’s timely that the Truth About Nursing organization (“the Truth”) has just released both its end-of-decade (Tables 1 and 2) and annual (Table 3) awards for images of nurses in the media. From their press release:

The Truth About Nursing announces its list of the best and worst media portrayals of nurses it saw between 2000 and 2009. The Truth’s Decade Awards highlight media from a decade in which the world has faced a deadly nursing shortage fueled in significant part by poor public understanding of the profession.[7]

In a promising turn of events, several nurse-focused television dramas (a rarity in Hollywood) premiered in 2009, and these shows made the “Best List.” The smart and skilled nurses on Showtime’s Nurse Jackie, TNT’s HawthoRNe, and NBC’s Mercy, rather than retreating into the background, are front and center, fighting for patients, not for attention.

The Truth gave honorable mention to newspaper columns written by Ronnie Polaneczky, reporting by Integrated Regional Information Networks, the documentary Nurses on the Discovery Health Channel, and the HBO film Wit starring Emma Thompson. “Most Improved” awards were given to the television drama ER for better depictions of nurses during the show’s final 4 years, and the “Take a Loved One for a Checkup Day” campaign for changing its name from “Take a Loved One to the Doctor Day,” which ignored the significant role of nurse practitioners in providing primary care to the campaign’s target population.

Table 1. Ten Best Media Portrayals of Nurses of the Decade, 2000-2009

1 Nurse Jackie New York ED nurse Jackie Peyton is tough but talented, and finds creative ways to help patients lead better lives or find lasting peace
2 Mercy Veronica Callahan is an Iraq war veteran with PTSD who leads a crew of smart and committed nurses.
3 Critical Care: The Making of an ICU Nurse Boston Globe article chronicled the 8-month training of a new ICU nurse showing the high level of skill required to care for these complex patients
4 The Rookies Episode 1 of Lifeline: the Nursing Diaries shows nurses engaged in routine nursing functions, such as life-saving interventions and patient education
5 Angels in America Nurses at the center of AIDS care, balancing skill, determination, humor, and caring
6 Media by Diana Mason Weekly radio show Healthstyles with nurse experts; garnered mainstream press for nursing research
7 HawthoRNe Chief nursing officer Christina Hawthorne is a strong and skilled expert nurse in Richmond, Virginia.
8 Media by Theresa Brown Blog for New York Times about nurses, giving nursing perspective on key policy issues
9 Media by Suzanne Gordon Wrote the book Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and Patient Care (2005)
10 California and Massachusetts Nursing Associations. Advocated for nursing through mass media campaigns explaining the value of nursing and presenting nurses as articulate, holistic advocates of public health

Adapted from The Truth About Nursing Decade Awards[7]

Table 2. Ten Worst Media Portrayals of Nurses of the Decade 2000-2009

1 Grey’s Anatomy Nurses are insignificant, as physicians perform real-life nursing work. Nurses are portrayed as bitter or fawning losers.
2 House Ignores nurses completely or treats them as annoying fools who are there to clean up the mess.
3 Private Practice Mocks clueless nurse character who works as a receptionist.
4 The Naughty Nurse Many appearances throughout the decade, including ads by Virgin Mobile, Gzhelka Vodka, the Lung Cancer Alliance, the Heart Attack Grill; and in degrading comments made by Kelly Ripa and “Dr. Phil” McGraw on TV.
5 The Today Show For attacks on advanced practice nurses, including nurse midwives and nurse practitioners.
6 ER (2000-2005) Portrayed nurses as physician handmaidens whose highest aspirations are to go to medical school.
7 Passions An orangutan named Precious serves as a private-duty nurse, suggesting that apes can do nurses’ jobs.
8 Hopkins 24/7 & Hopkins Repeatedly suggested that physicians perform all important care; virtually ignored the thousands of highly skilled nurses who work there.
9 Media by the American Medical Association Comments in major news media questioning the competence and qualifications of nurse practitioners, in spite of evidence of their effectiveness.
10 The robot nurse Doesn’t exist, but makes appearances in the media as “robo-nurse,” “virtual nurse,” “nurse robot,” electronic nurse,” etc., reinforcing the view that a “nurse” is anyone or anything that acts as an assistive caregiver.

Adapted from The Truth About Nursing Decade Awards

Annual awards for the year 2009 are found in Table 3.

Table 3. Best and Worst Portrayals of Nurses in the Media, 2009

Best Worst
1 Nurse Jackie 1 Grey’s Anatomy
2 Mercy 2 House
3 HawthoRNe 3 Private Practice
4 Theresa Brown 4 The Today Show
5 Pauline Chen, New York Times 5 Minette Marrin, Sunday Times (UK)
6 Nurses advocating in the media 6 New York Times damaging portrayals
7 Reports on nurse innovators 7 “Naughty nurse” advertisements
8 Zara Nicholson, Cape Argus (S. Africa) 8 Three Rivers
9 Erin Thompson, USA Today 9 Mental
10 Reports on school nurses 10 The robot nurse

Adapted from The Truth About Nursing Annual Awards, 2009.
Available at: http://truthaboutnursing.org/press/awards/2009/awd.html.
Used with permission

For some perspective on this, I contacted Truth About Nursing’s Executive Director, Sandy Summers. The Truth is an organization that seeks to increase public understanding of the central, front-line role that nurses play in modern healthcare. I asked Ms. Summers how the Truth comes up with the “best” and “worst” awards.

“We analyze depictions of nurses in the news, the lay media, television, radio, music, films, billboards, plays, magazine articles – all sorts of media – and tell readers how good a job they are doing in portraying nurses,” responded Summers. “Sometimes, it’s good; sometimes it’s bad. When a show is doing something right, we ask our readers to send letters to thank the media for doing a good job. When we find a negative or stereotypical depiction of nursing, we encourage our readers to send letters asking the media to improve its product. We set up form letters to help facilitate this and clearly, the more letters the media receives, the more likely they are to respond favorably (though the AMA appears to be an exception.)”

And the Truth has made some headway. When the Lung Cancer Alliance (LCA) used a rap-style video called “Waitin’ Room Service” that included nurses dancing suggestively and making sexual overtures to “Dr. Lunglove,” the Truth started a letter writing campaign to ask the LCA to remove the video from its Website. “They were admirably trying to educate people about lung cancer,” explained Summers, “but they didn’t need to use a naughty nurse to do that. The LCA did finally listen to all our letters and phone calls, and took the offensive video off its Website — but with much resistance.”

I asked Summers if stereotypical depiction of nurses was a global problem, to which she gave an unqualified “yes,” and continued, “The whole world has this problem, not just the United States. It’s even worse in some areas where nurses are viewed as the equivalent of prostitutes, and have trouble finding husbands because their jobs bring them such disrepute. But the media stereotypes are the same, largely propagated by Hollywood shows which are spread throughout the world. The US is the world’s biggest purveyor of negative images of nursing.

“Trying to get messages about the value of nursing across to the media is a monumental task,” explained Summers. “The media don’t actually speak to nurses — they don’t think they need to. They ‘learn’ about nursing by watching other media depictions so they think they know what nurses do without asking about it themselves. They think, ‘nurses just get stuff for physicians.’ That’s what goes on inside their heads, so we have to change that, shake them up with the truth about what nurses really do. It’s very difficult when nurses themselves are reluctant to speak with the media — these are 2 groups of people who need to communicate, but neither one wants to talk to the other.”

Nurses will have to be stronger, louder, and more direct in their messages to all media — not just Hollywood dramas but television and radio news programs, newspapers, and others who degrade the image of nursing — but how? The Truth has answers. On their “Take Action” Web page, they describe “what you can do to shape a better image of nursing.” You will find hundreds of ideas, such as writing letters to television programs such as Grey’s Anatomy, House, or Private Practice (addresses provided), submitting your own nurse story ideas, using nurse-friendly language, or learning how to interact more effectively with the media. If you are interested in finding out more about how media portrayals of nursing affect the nursing profession, read Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk, by Sandy Summers and Harry Jacobs Summers (2009).

What Is at Stake

For a long time I just turned off the television when anything offensive came on. I avoided hospital or medical shows entirely, knowing that I would be disgusted by them. Lately I’ve realized that not much has changed since I was in nursing school, and there is much more at stake here than hurt feelings. As Summers said, “We cannot solve the global nursing shortage without resources for nursing clinical practice, education, research and residencies. And we cannot get this needed funding if decision-makers think we are unskilled losers. If you were in charge of a billion dollars and had to decide how to divide it, would you give it to the lifesavers or their flunkies? This is why nurses get half of 1% of the National Institute of Health budget and nursing residencies get $1 for every $375 that physician residencies receive. If nurses are not valued by the public, we will not be funded, and the global nursing shortage will continue to further spiral out of control.”

The fact that nurses are often excluded from healthcare policy decisions reflects the general belief that nurses’ opinions don’t matter, a belief that is reinforced by media depictions of nurses. This is what we must change. The image of nursing would benefit from having a visible, highly respected nurse leader, such as the proposed Office of the National Nurse.[8]

If all 3 million of us (15 million worldwide) were to join forces and attack this issue head-on by speaking back to the media, and advocating for the nursing profession, I am convinced we could fix the image of nursing and nurses, and the snowball effect could change the direction of the nursing shortage and the future of healthcare.

Here’s the link to the original article

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March 10, 2010

Focus Returns to Nurse Retention in 2010

Here’s a look at what the nursing executives are reading now.  Retention is just now being brought to the forefront?

It cost less to keep a nurse than it does to hire and train a new nurse to your facility. I wonder why that is so hard to figure out.  I agree that turnover is unavoidable in any profession, but the rate can be controlled somewhat by the administration if there is genuine respect and concern for their employees.  I fail to see how trinkets and freebies are the way to keep your nurses.  What I do know is that treating people with respect and giving value to their efforts goes a long way in keeping them satisfied and in place.

I understand that administration has hard decisions to make and must watch the bottom line as well as try to improve the profit level of the business.  That should not be difficult for anyone to agree with.  However, there is no need to totally discount the needs of the employees–without whom there would be no profit margin.

This article is interesting and I hope you enjoy it.

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Rebecca Hendren, for HealthLeaders Media, December 29, 2009

What New Year resolutions are nurse executives making this year? Savvy ones are vowing to pay attention to nurse retention once again.

The recession saw an easing of RN shortages and turnover rates around the country, allowing many facilities to put nurse retention initiatives on the back burner. Budgets for recognition and reward initiatives were slashed as belts were tightened everywhere.

But with many economists predicting the green shoots of recovery will flourish into leaves in 2010, the effects will be felt in nurse employment. The recession and high unemployment caused a drop in RN vacancy rates nationwide. As spouses lost their jobs or feared layoffs (70% of RNs are married), nurses picked up extra shifts or went from part-time to full-time. Some returned to the workforce and many who had been considering retiring delayed their plans.

Organizations saw their turnover plummet and their vacancy rates look healthier than they had in years, so they eased up on recruitment and retention efforts. But 2010 looks set to bring back the twin issues that have plagued nursing for the last few years: RN shortages and turnover.

Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies in the Institute for Medicine and Public Health at Vanderbilt University Medical Center, predicts that as the economy recovers, nurses who returned to the workforce or who took on more hours to make ends meet will leave the workforce again. Those who delayed retirement will start considering their exit strategies, although they may still have to work a little longer to rebuild retirement incomes that were devastated by stock market declines.

Of course, many economists are predicting unemployment will remain high in 2010, which could delay the return of the shortage, but that doesn’t help organizations that want to begin expansion work in 2010, who will need additional nurses to staff the new construction.

So it’s worth taking a look at your workplace development strategies and examining what might be in store in the next year. Your RN demographics will show you what percentage of your staff is likely eyeing retirement and you can also examine turnover and vacancy statistics to consider historical trends.

It’s also a good idea to conduct an RN satisfaction survey if you haven’t done one in a while. If your organization has suffered through layoffs, you may think the last thing you want to do is ask nurses how unhappy they are. But surveying them now could elicit interesting findings. If you find out what your nurses’ priorities are, you may be surprised that many, if not all, do not involve money.

There are many ways to improve the nurse working environment without significant financial expenditure, and savvy organizations are looking at:

  • Restructuring care delivery systems to match the needs of key patient populations
  • Redesigning nursing roles, including cross-training staff for increased flexibility
  • Paying attention to the needs of older employees and offering options such as shorter shifts
  • Focusing on succession planning and starting career development pathways so that nurses possess the skills needed to fill key positions as they become available
  • Offering recently retired employees options to return to work in some capacity, such as specialized roles mentoring or training new nurses or tackling committee work

It’s also worth noting that the long-term nursing shortage is not going anywhere. Buerhaus says the shortfall in the number of nurses needed is expected to grow to 260,000 by the year 2025. To increase the nurses in your pipeline, there are long-term strategies to focus on now that can increase the supply of staff for your organization:

  • Partner with schools of nursing to provide adjunct faculty and increase opportunities for clinical placements where nursing students can gain experience
  • See whether local colleges and universities will agree to tuition reduction for staff interested in continuing education
  • Partner with public schools to offer job shadows, career exploration programs, and summer internship programs

Putting nurse retention on your list of resolutions now will ensure your plans are in place for whatever 2010 brings.


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


Rebecca Hendren is an editor with HealthLeaders Media. She can be reached at rhendren@hcpro.com.

Here’s the link t0 the original article

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March 9, 2010

Nurse to patient ratios: lies, damned lies, and statistics.(Legislative Updates)

This is an old article, but I want to publish it here just to show that this problem has been going on for quite some time and still is no further along towards any resolution.  I am sure that if the hospital administrators had to work the floors as nurses, there would be a fast action, but since that will never happen I expect little to no headway to be made along the lines of mandated nurse-to-patient ratios.

Nurses will just continue to get frustrated and burned out and drop out of nursing altogether and we will continue to hear about the “horrible” nursing shortage.  If the nurses who currently hold RN licenses were to all come back to the profession right now due to better staffing and nurse to patient ratios, would we even still have a “nursing shortage”?

This article just lets you know that we have been fighting this battle for a long, long time.

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By Lillian Gonzalez | August, 2007

The data is in. The fewer patients assigned to nurses, the better the patient outcomes. So why does Nevada, particularly Southern Nevada, have high nurse-to-patient ratios?

Some argue that it’s all about the money. After all, it is logical that fewer nurses caring for more patients could yield higher revenue for hospitals. It can also ensure a cycle of repeat business by way of “frequent flyers.” For example, a male patient is hospitalized to get a knee replacement. Because his nurse has ten other patients, the nurse is unable to adequately protect him from acquiring an infection. Thus, the patient must stay an extra few days for antibiotic therapy. He is rushed out of the hospital because of the HMO factor and receives little to no discharge teaching because the nurse is putting out fires for the other nine patients. The patient returns a week later with a bowel obstruction because he didn’t understand that the pain killers he took home could cause constipation. So much agony could have been avoided if a nurse had had the time to adequately address his needs during his first admission.

So are high nurse-to-patient ratios about the money? Or is it unavoidable because of the highly publicized nursing shortage? Let’s get right down to the stats.

The American Hospital Association (AHA) reported in April 2006 a national registered nurse deficit of 118,000 RNs “to fill vacant positions nationwide.” (1) In the December 2003 issue of Health Affairs, distinguished nurse researcher, Peter Buerhaus, published interesting statistics supporting our nation’s increased dependence on “foreign born” nurses. (2) However, this same data appeared to indicate a surplus of 600,000 registered nurses in the U.S., not working as nurses. A surplus of 600,000 nurses could well eliminate the AHA’s reported 118,000 deficit.

When questioned by email about this surplus, Buerhaus responded, “There are roughly 500,000 individuals who are licensed to practice as an RN in the U.S. today, but who are not currently working.” He then speculated that perhaps many of these nurses are retired, too old to work, independently wealthy, or have chosen to stay home with children. But nurses working in the hospital trenches of Nevada, where some of the highest ratios in the country exist, need not speculate why Nevada has the worst shortage of nurses in the country. To them the reason is: burnout.

Another argument challenging ratio enforcement is the hypothesis that ratios would be impossible to meet and would therefore cause hospitals to shut down. But according to Deborah Burger, President of the California Nurses Association, where mandatory ratios are in full force, “After many dire predictions about closing hospitals and wards by the California Hospital Association, there were in fact NO hospital closures let alone unit closures in California due to the ratios law. It is not just my wishful thinking but actual facts reported to the Department of Health Services.”

Did California have an abundance of nurses to support mandated ratios? Before ratios were imposed, California ranked last in numbers of nurses per capita and Nevada ranked second to last. Today, California has increased its numbers of nurses per capita, now leaving Nevada in last place.

The California Nurses Association has embraced nurses is Texas and other States to help them achieve mandated ratios as well. In a report by The Texas Observer, “Even Schwarzenegger’s office has acknowledged that California’s law has produced some benefits. For one thing, it’s lured thousands of nurses back to work, easing that state’s shortage.” (3)

How did the California Nurses Association manage to beat the odds and attain ratio legislation? Ms. Burger reports, “Since we left the ANA [American Nurses Association], we have accomplished more in the last 12 years than in the previous 50 years with ANA. Since then we have put forward safe staffing legislation (ratios and whistle blower protections) in Illinois, Maine and Texas. In all states, ANA has opposed the bill, but we are moving forward because nurses (just ask any traveler who has worked in California recently) know this will make a difference.”

California has set the standard for hospital nursing care. There, medical-surgical nurses are assigned a maximum of five patients, while here in Nevada it is customary for nurses to have twice as many.

So the next time someone offers statistics supporting a particular view, recall what Mark Twain said, “There are three kinds of lies: lies, damned lies, and statistics.”

(1) http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm

(2) http://content.healthaffairs.org/cgi/content/abstract/22/6/191

(3) http://www.texasobserver.org/article.php?aid=2495

Lillian Gonzalez, BSN, RN

Las Vegas Agency Nurse

NurseLily@AnAmericanRN.com

Here’s the link to the original article

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February 22, 2010

Survey: Older nurses sticking around

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

Marjorie J. Shibler has a mortgage.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Amy Jeter, (757) 446-2730, amy.jeter@pilotonline.com

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

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