The solution to nursing problems

teamrn · Oct 22, 2002

rncountry,

I was one of your original contacts, and I spread the word, and talked it up as far as I could. As I couldn't drive for a time, the work I did was all 'behind the scenes', and I know the change of approach to which you referred. I also agree with Youda, about the distance thing (major barrier); but I wonder about the committment of nurses in DC, Maryland, Delaware, VA area. Because of a lack of representation from RNs in these states, I'm now even wondering if marches on individual state capitals would be anymore successful.

I had one heck of a time organizing nurses in my state; we had a few committed, and the rest were complainers, so the efforts here fizzled.

I was unable to go because of illness:o , but would have gone, because in my mind, it was the right thing to do; regardless of the politics.

I still follow the media, write letters to editors, phone legisltators, talk to anyone who'll listen (within reason!), follow candidates, and have had non-form/personal letters returned from HHS, politicians. We can't change this overnight-as it took hundreds of years to come to where we are today-but we can each make our own contribution

teamrn

Bermuda · Oct 23, 2002

Mgt. can not force you to stay but they will say YOU WILL be staying until we get relief here..otherwise true it is abandonment... there has been more than once where there has been many call offs and no shows and we were told to stay until relief was able to get there...anytime from 2-4 hours...so... it has to be ALL and I for one do not feel that all nurses are really ready for that huge step...really...yet there has to be something that could be done to wake them up to the reality of the situation...

abrenrn · Oct 24, 2002

I appreciate all the information I get here. I thought a lot of RNs had given up, I know some who have. Reasons have been varied but usually boil down to - lack of recognition from patients, physicians or employers as to just how much we do and know. One nurse told me she left a CCU after she got tired of hearing patients say how brilliant the surgeon was and, gee, she was such a nice nurse. That, and a new plan by the hospital to, basically, screw the nurses.

I'm tired of trying to tell people what nurses can do, do all the time. They don't know, they won't believe me. Say, you know that press coverage about the doctor that ordered a med that killed a patient. How come they don't mention the nurse.

The response I get is, "what does the nurse have to do with it." Duh. They may not have mentioned in the paper but damn straight the nurse lost her license. In the meantime I hear nurses say, "Well we don't want people to know we can make mistakes." Great. They don't think we do anything.

The general public is getting the idea that they need nurses. They stll don't know why. Also, who's a nurse? The person in scrubs in the hospital, the "doctor's nurse" who's really an MA? I've brought that up with a couple of people who say, "well, why confuse the patient." Because this is what confuses patients!!!

How do we get it out? I have written "A Modest Proposal for a Solution to the Nursing Shortage" that I'm still making prettier. In an attempt at satire, I say the easiest solution is to eliminate Nursing, replace it with another profession called Wellness Engineering Professionals (WEPs). Same duties, different status. I end by saying Jonathan's Swift's original modest proposal - that the poverty and starvation in Ireland could be fixed by butchering and eating 1 year old children (incredibly good satire - read if you haven't) might work even better. After 20 years or so, nurses will be sold for the meals they can provide. Hospitals will realize that we'll taste better if we are treated well, even doctors will see the value in at least pretending to pay attention to us - our economic value will soar. So, it's a sacrifice but if we already eat our young, why not change the order of eating?

Think it's worth trying in a "regular" magazine? AJN turned it down, well written but just too confrontational they said, not the right tone.

Feedback would be appreciated. Above is but a brief summary.

betts · Oct 24, 2002

https://allnurses.com/forums/showthread.php?s=&threadid=16925

How many of the 'Healthcare' respondents to this thread got any answer to the dozens of letters sent out? I posted everything I received and still haven't received any replies from the networks contacted. I was successful with getting the Governor to act on affordable housing for nurses here with lower mortgage rates but not with the "Commitment To Excellence" I suggested.

The problem with writing government officials is that they're not the one's reading them but rather aids or assistants whom read,respond(read link above) and determine what's a priority.

The idea's set forth here are admirable but mostly unattainable simply because there is no UNITY among nurses.

Instead of a March again,how about every nurse, healthcare worker in the US place a sign in there front yard simply stating 'NURSES UNITE (UNITED,UNITY) NOW'! That's sure to get media and public attention and it's a start that doesn't coflict with all the obivious problems associated with a Walk.

Think about it.

Youda · Oct 24, 2002

Unfortunately, betts, your experience is all too common (not to minimize how terrible this was for you). Admins frequently blame the nurse for their own stupidity and incompetence. Someone want to start a thread about experiences with being blamed by admin when admin does the stupid thing? I have a few stories . . .

-jt · Oct 24, 2002

2- Many ANA leaders are in education, research and management, often disconnected from the clinical practitioners, causing many problems: in short, they do not know what lies behind the nursing shortage - they got away from bedside nursing as fast as they could.>>

My state nurses assoc has an affiliation with the states student nurse assoc. Many nursing school programs in my state REQUIRE their students to participate in the state nurses assoc lobby day events & other workshops as part of their course work. The state nurses assoc peer assistance program goes to nursing schools throughout the state to educate students on nurse addictions & the help that is available thru our organization. Student nurses are invited to state nurses assoc events, are encouraged to be members at a student discount, etc etc etc. I dont know about your state, but my state assoc does go to the students - many of the educators are members too - especially now that staff RNs are being recruited to teach clinicals & the majority of our state assoc is staff RNs - students in my state graduate already knowing about the state nurses assoc & many are already members by then.

As far as the ANA, there are STAFF RNs in leadership positions on the ANA Board of Directors, the ANA PAC, and most other committees there. And there are other RNs in leadership positions who remember what it is to provide direct care to the pts. The leadership is ELECTED by the members - and the majority of the members are STAFF RNs. I disagree with your statement because I am in there & I see both great Staff RNs & great pro-staff RNs in leadership positions in that organization these past few years & they are making a difference.

All these nurses posting here seem to have so much interest in taking action, its amazing. If everybody put that energy & effort into backing their professional assoc & making the voice for nurses stronger in their state & this country, just think what could happen.

You have your professional organizations right there waiting for your help in getting our message out & getting the changes we need, but youre all sitting here getting frustrated because you want to get involved in doing something pro-active & cant figure out how. The answer is right in front of you but

"here we go round in circles............"

abrenrn · Oct 26, 2002

As I've said, my professional organizations seem to miss most of the issues that drive me from nursing: not a single entity seems aware that nurses are professionals with licenses that we are responsible for (unless it's a hospital with a "No forced overtime" statement, but hey nurse, you're abandoning your patient.

Nobody even knows why they need nurses.

I'm tired of being expected to always be diplomatic - with everyone. Look at the thread re Oct Nursing - that's what the profession wants us to be.

I've talked. I'm done. No point here. I am on permanent sabbatical. Maybe there is a profession or job that wants intelligence, self direction, personal accountability. I haven't found it in nursing yet.

abrenrn · Oct 26, 2002

Another thing

Gosh, I missed all those mailings, facts, etc. Sure hasn't been in my mail box, my office. I'm licensed in two states, shouldn't be hard to find.

Oh, that's my fault - I'm a nurse, what isn't? - I'm supposed to hunt them down, even if I don't know they are there.

No problems with organized nursing whatsoever. Don't know what's wrong with me.

Disgruntled enough.

Hey, know what a PT, fellow nurses, hospital administrators,... told me? I'm supposed to help nurses aids and I have a problem cause I thought it was the other way around.

Y'all have fun helping nursing aides while you try to find support from your professional journals, organizations, etc. Hey, dare to care - just care, don't bother thinking, learning, knowing.

Youda · Oct 26, 2002

Anne has a very valid point. There is a huge difference between working in a unionize area vs. a right-to-work area.

-jt · Oct 28, 2002

>

I disagree. I hear & read our professional assocs saying quite a bit that says exactly that & much more that makes a lot of sense & I see them not only supporting the RN at the beside, but also fighting for state & national laws that will obtain the changes that staff RNs need in the workplace. A lot more info everyday is posted on the professional assocs website than could ever be mailed to 2.7 million nurses homes . If a nurse is interested, all she has to do is click her mouse to that site & read - she wont miss anything.

Anyway, it seems to me that the professional assocs are hitting the nail on the head:

From the ANA:

ANA, UAN, AAN Representatives Testify Before IOM Committee on Nurses' Work Environment, Patient Safety Concerns

9/26/02

"Nurses should never be threatened with patient abandonment and potential loss of license when they are afraid that working additional hours will endanger patient safety," ANA President Barbara Blakeney, MS, APRN,BC, ANP, told the Institute of Medicine (IOM) Committee on Work Environment for Nurses and Patient Safety with regard to the unsafe practice of mandatory overtime. Testifying on behalf of the United American Nurses (UAN) was UAN Secretary Treasurer Jeanne Surdo, RN, BSN, MA; testifying on behalf of the American Academy of Nursing (AAN) was AAN Secretary Linda Burnes Bolton, DrPH, RN, FAAN.....

Link to ANA President Blakeney's full testimony: http://www.ana.org/pressrel/2002/iom924.htm

from the UAN - national RN labor union arm of the ANA:

FOR IMMEDIATE RELEASE

September 24, 2002

Statement on Behalf of the United American Nurses, AFL-CIO

to The Institute of Medicine Committee on Work Environment for Nurses and Patient Safety

regarding The Working Conditions of Registered Nurses and Their Relation to Patient Safety

September 24, 2002

"Good afternoon, Madame Chair and members of the Committee. My name is Jeanne Surdo. I am a registered nurse and secretary-treasurer of the United American Nurses, AFL-CIO, the collective bargaining arm of the American Nurses Association. The UAN through its 26 constituent members (state nurses associations) represents approximately 100,000 registered nurses for collective bargaining throughout the United States. Our members include staff nurses working in a variety of health care settings. I myself have more than 30 years experience as a staff nurse and currently work in the pediatric cardiology/genetics unit of Children's Hospitals and Clinics in St. Paul, Minnesota.

In addition to my work at the national level, I am first vice president of the Minnesota Nurses Association. In that capacity I represent the concerns and voices of staff nurses at both the state and local levels. The United American Nurses (UAN) appreciates the opportunity to present its views to the Institute of Medicine (IOM)committee on the working conditions of registered nurses and their impact on patient safety.

Background:

Today, health care institutions across the nation are experiencing a crisis in nurse staffing, and we are standing on the brink of an unprecedented nursing shortage. Without doubt, the current staffing crisis and the emerging national shortage of RNs pose a real threat to the nation's health care system. As the single largest group of health care professionals, registered nurses are the backbone of the U.S. health care system. With more than 1.3 million registered nurses working in hospitals throughout the country, we underpin the entire health care delivery system. Having a sufficient number of nurses is critical to the nation's health. In the wake of disastrous experiments in health care restructuring, downsizing and displacement of RNs by unlicensed staff in the mid-1990s, registered nurses have been and continue to sound the alarm about patient safety.

RNs across the country tell us there are too few nurses taking care of too many patients. Nurses report they have less time to care for their patients who are increasingly ill, and they are deeply concerned that the quality of care they deliver is deteriorating. And, as shown in survey after survey, more and more registered nurses are voicing dissatisfaction with their high-risk, high-stress working conditions, some even voting with their feet and leaving their profession entirely.

IOM Committee Questions:

The IOM Committee on Work Environment and Patient Safety, at the request of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, identified two areas that are the focus of its study:

key aspects of the work environment for nurses that likely have an impact on patient safety; and potential improvements in health care working conditions that would likely increase patient safety.

Key Aspects of the Work Environment:

The UAN believes there are several major areas of the registered nurse's work environment that must be addressed in a comprehensive manner in order to improve working conditions and thus enhance patient safety. These include:

* Staffing

* Health and Safety

* Decision-making

* Respect

* Compensation

Potential Improvements:

1. Staffing

Staffing is the single most important issue UAN members are addressing in our collective bargaining negotiations. The UAN believes that the safety and quality of care provided in the nation's health care facilities is directly related to the number and mix of direct care nursing staff. More than a decade of research shows that nurse staffing levels and skill mix make a difference in the outcomes of patients.

The recent study of nurse staffing levels and the quality of care in America's hospitals, which concludes that "a higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients," confirms the UAN's long-held belief that more care by RNs means better care for patients in hospitals. (Needleman, Jack., et al. Nurse-Staffing Levels and the Quality of Care in Hospitals," N Eng J Med, Vol. 346, No. 22 (May 30, 2002), pp. 1715-1722)

UAN members have bargained contract language that calls for a written hospital-wide patient staffing system, based upon acuity classification, for determining and measuring the effectiveness of nurse staffing. The required nursing care is based on patients' aggregate and individual needs and is the primary consideration in determining the number and categories of nursing personnel needed. The staffing system provides for minimum numbers of RNs per unit and shift, and is regularly evaluated using patient outcome indicators and data from staffing request documentation forms.

Other UAN contacts provide for RN-to-patient staffing guidelines based on patient acuity levels and the number of RNs and non-RN personnel available to staff the unit, enforceable through arbitration. UAN members have also won agreements that require the hospital employer to involve the union in proposed changes to nurse-to-patient ratios or staffing skill mix changes before changes are made. Changes made unilaterally by the hospital are subject to the grievance process.

The Minnesota Nurses Association is setting the pace in patient care initiatives. In a recently concluded collective bargaining agreement, registered nurses won the right to temporarily close a unit to new patients when too few RN staff are available to care for more patients. This contract innovation has helped our nurses cope with excessive workloads. We secured this language only after our nurses put their lives on hold and went on strike last summer to fight for quality nursing care for their patients and better working conditions for themselves and other nurses around the nation.

Mandatory Overtime:

The UAN believes that mandatory overtime must be abolished.

Our concerns about the use of mandatory overtime are directly related to patient safety. Nurses report that fatigue can contribute to medical errors and other consequences that compromise patient safety, and that mandatory overtime is driving nurses away from the bedside.

The UAN supports enactment of national legislation (the "Safe Nursing and Patient Care Act of 2001") that prohibits the use of mandatory overtime for nurses except in the case of a declared state of emergency. Mandatory overtime would be a requirement that a nurse work in excess of any of the following:

the scheduled work shift or duty period of the nurse;

12 hours in a 24-hour period;

80 hours in a consecutive 14-day period, and which, if refused by the nurse, may result in an adverse employment consequence to her or him.

The UAN supports enactment of state mandatory overtime legislation. The Minnesota Nurses Association led the successful fight for passage of the "Mandatory Overtime Protection Act" which the Governor Jesse Ventura signed into law on March 25, 2002. The legislation prohibits certain healthcare facilities from taking action against a nurse who refuses to work overtime when in the nurse's judgment doing so may jeopardize patient safety.

The law makes clear that the nurse, not the employer, must make this judgment call. To date, UAN member states that have enacted mandatory overtime laws include New Jersey, Minnesota, Oregon and Washington.

2. Health and Safety

The UAN believes that when nurses are protected from health and safety hazards, patient safety is likewise enhanced. When nurses can work in an environment of care that is free from unnecessary safety and health risks, patients benefit because nurses can then do what nurses do best: advocate on behalf of their patients and provide them their first line of support.

In today's presentation, I want to focus on one health and safety issue vital to nurse and patient safety: ergonomics. The UAN is committed to the goal of pursuing a strong Occupational Safety and Health Administration (OSHA) ergonomics standard which will prevent disabling back injuries and other musculoskeletal disorders among registered nurses.

Over the past two years, UAN and ANA elected leaders and injured nurses have testified in support of such a standard at OSHA public hearings and at Department of Labor ergonomic forums. The UAN believes that scientific evidence strongly supports the relationship between worker exposure to biomechanical risk factors and the resulting musculoskeletal pain and injuries. Comprehensive ergonomics programs can greatly reduce employee risks and prevent injuries. Every day nurses are exposed to disabling, career-ending and life-altering injuries when taking care of patients.

The U.S. Bureau of Labor Statistics reported that nursing personnel had the second highest rate of days away from work due to musculoskeletal disorders of all occupations. "Registered nurse" as an occupation ranked sixth among U.S. occupations at risk for strains and sprains, outranking construction workers and stock handlers. Of these disorders, the back is the body part most frequently injured, and patient lifting and transfers are the major sources of the injury. What ergonomics really means for nurses is encouraging safe ways to lift, move, reposition and provide essential and safe care - safe for the patient and safe for the nurse.

Well-designed patient lifting and transfer devices pay for themselves by preventing back injuries. Additional measures like job hazard analysis, lift teams and employee training can reduce injury risks even further. The UAN supports a strict, enforceable ergonomics standard that requires employers to protect their nurses from preventable injuries. Nurses need a federal ergonomics mandate because, although effective control measures exist to reduce these risks, few health care employers have voluntarily implemented them. Without a federal mandate, there will always be higher priorities in health care than preserving the health and safety of workers.

The voluntary ergonomics guidelines issued in April 2002 by the Bush administration's Department of Labor for the OSHA fall far short of what is needed. The UAN further believes that the absence of enforceable ergonomics regulations is a contributing factor in the decision of many nurses to leave the profession. In an ANA health and safety survey conducted last year, 60% of nurses surveyed cited a disabling back injury as ranking among their top three health and safety concerns. Additionally, nurse respondents stated that more than half the facilities in which they worked did not have lifting and transfer devices readily available for moving patients.

3. Decision-Making

The UAN believes that staff nurses must be fully involved in all decision-making related to nursing practice and patient safety. Staff nurses must participate fully, for example, in establishing staffing effectiveness standards at their facility. They must participate in implementing these standards, in collecting and analyzing nursing-sensitive outcome data, and in measuring and evaluating their effectiveness. Staff nurses should also be involved in assessing and purchasing patient-focused technology as well as the efficacy of proposed capital improvements and cost-containment decisions. As the frontline professionals caring daily for patients, staff nurses are uniquely positioned to understand the issues surrounding patient safety. Their voices need to be heard and their authority recognized when decisions are made in any area related to nursing practice.

4. Respect

The UAN believes that hospitals and other health care facilities must create and maintain a supportive workplace culture that values registered nurses. This is key to patient safety. Respect at the workplace is a standard that staff nurses deserve. Unfortunately, all too often the reality staff nurses experience does not reflect that standard. Disrespect in the forms of verbal abuse or other disruptive behaviors has a negative affect on nurse satisfaction levels and morale. Nurses must be recognized for their competence and valued for their experience.

Respect also includes having the necessary assistance and resources that allow staff nurses to spend more time delivering direct patient care. Hospitals must not reduce the number of support personnel needed for safe care delivery and then expect the registered nurse to perform those added responsibilities. As the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) recently reported, the high cost of high RN turnover is not only higher patient costs and lower profitability but greater patient mortality.

5. Compensation

As the leading union OF registered nurses FOR registered nurses, the UAN believes that RN compensation must reflect the important role nurses play in the nation's health care system. Appropriate RN compensation is essential to patient safety in that it would help ensure the nation of an adequate supply of registered nurses to meet the demand for health care services. Findings from the 2000 National Sample Survey of Registered Nurses indicate that staff nurses need to continue their struggle for appropriate pay and benefits.

According to the survey, average annual earnings of registered nurses employed full time as "staff or general duty" nurses was $42,133. Adjusted for inflation, RN wages for much of the 1990s have been essentially flat, barely keeping pace with the rising cost of living. The UAN also believes that significant improvements must be made in non-wage compensation, particularly in the areas of health insurance and pension benefits. Employers are pressing nurses to shoulder an increasingly larger part of their health insurance premiums as they try to shift the costs of care. And more and more employers are moving away from defined benefit pension plans toward financially riskier defined contribution plans.

The UAN is in the forefront of negotiating non-wage compensation issues and educating nurses about the need for career-long financial planning. Appropriate compensation is also essential to a viable recruitment and retention strategy. If nursing is to attract new women and men into the profession and retain its experienced staff nurses, it must offer a level of compensation that can compete with other professional occupations.

Conclusion

The UAN maintains that the current staffing crisis - and the danger to patient safety that goes with it - will remain and likely worsen if changes in the workplace are not addressed immediately. The profession of nursing will be unable to compete with other career opportunities available today unless we improve RN working conditions. Registered nurses, hospital administrators, other health care providers, health system planners and consumers must come together to create a system that supports quality patient care and the nurses who provide that care. We must begin by improving the environment for nurses.

Madame Chair, members of the subcommittee, the UAN looks forward to working with you to make the current health care environment more conducive to high quality nursing care. Improvements in the environment of nursing care, combined with recruitment and retention efforts, will help ensure a stable nurse workforce and promote better health care for all Americans. Thank you." # # #

http://nursingworld.org/uan/pressrel/2002/surdo.htm

The United American Nurses, AFL-CIO, the labor arm of the American Nurses Association, is the nation's largest RN union with 100,000 nurses and is made up of state nurses associations or collective bargaining programs from 24 states, the District of Columbia and the U.S. Virgin Islands.

Comments may be addressed to:

Suzanne Martin

202-651-7133

http://www.UANnurse.org

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jtfreel · Jun 3, 2004

I applaud your objectives but disagree with the plan.

Nursing, as a profession, needs to unify before taking such drastic steps. How many support the ANA? How many are politically (at least to the point of expressing their opinion and voting)? What issues are severe enough that it would result in nursing care being withheld from patients? How have these issues been addressed at this facility in the past?

A unified profession has power. A unified, powerless group of people needing protection, to me, is a union. Just my 2 cents.

DZcarrie · Jul 28, 2004

that'd be effective....

yet, i'd sure the heck hope i wasn't in the hospital on that day!!!!!!

:eek: