The legislation would also account for acuity. We weren't rallying for numbers, yes sometimes 2 patients on a med/surg unit can be impossible, and sometimes 5 can be easy... we want a happy medium; set ratios, but also consideration of each individual patient on the floor at a given time.
agreed. Also, I am opposed to ratios as they do not allow flexibility. Sometimes ONE patient is too many and sometimes 5 are ok. Texas passed a law about staffing that requires hospitals to have a staffing committee with at least 60% direct patient-care nurses.
Re. flexibility , their is the same degree of flexibility using ratio's as a staffing guide , as their is with anyother staffing matrix , Ratio's simply set a maximum number of patients to nurses , wheras most hospital commitee based staffing matrixs try to cram the maximum number of patients into the care of the minimumnumber of bedside nurses .
As an example of the shinnanagans I know of , re staffing set by a hospital committee , an infant whose bottle feeds take greater than 30 minutes , whilst an infant whose tube feed is greater than 30 minutes are grasped at different levels , even though it is our policy and good practice to with either baby throughout the whole feed .So the bootle fed infant can go in amaximum of a 1:3 assignment , but the tube fed infant can go in a 1:4 assignment , that is an example of how a commitee without bedside nurses can creat poor staffing , which leads to an overworked nurse being unable to provide optimum patient care .
Obviously some area care for patients of a higher aciuity ,hence the different ratios for different areas , but in your example of the need for 1:1 versus 1:5 , if this is on the same floor then it is an example of either the rapid deterioration of a patient who should be transferred to a higher level floor ASAP, or poor management who are not assigning patients by the acuity tool .
Thanks for sharing the article. It was indeed sad to read. The tone of the discourse demonstrates the caliber of misinformation the public has about nurses. Unfortunately, some of it is correct. We don't always show our best side to the camera. Some of our peers are not on point when they come to work. I'd like to think that most of us are, most of the time. And yet, we are as a group relatively uninformed and apathetic about the public's perception of us and about our role as healthcare providers. We can be short-sighted in our ability to see our virtue as a force for good. Consider our role in nurse-patient ratios: how many nurses actually understand that by reducing the ratio, we increase the positive outcomes for our patients and can actually reduce the "burden" on the healthcare system by increasing health? How many care enough to write a letter or make a call to their congressman(woman) to express their concerns/support/information?
Perhaps it is time for a change. Perhaps we need to consider ourselves as the source of that change, and come together and create the changes needed. I'm a nurse, at the bedside, by choice. I love what I do. I want to do it better, not just for me, for my patients.
When my left knee began to ache ferociously a few months ago, I thought it was just a remnant of an old injury that I'd sustained back in my early 40s. I'm on my feet a lot, and being neither young nor thin, I suppose I had it coming. Then the ache became a roar, and finally it was so bad that I had to see a doctor to find out why it wasn't healing. He promptly informed me that I had a torn meniscus and probably some major osteoarthritis that would have to be dealt with surgically; the MRI I had a few days later confirmed it. In the meantime, I was to wear an immobilizer, take pain pills, use the RICE protocol, and stay off it as much as possible.
So in order to continue working, I've been using a wheelchair for at least part of the shift for the past several weeks. I'm not happy about it, but when I get tired from dragging this bad leg around or need to go a long way down another hall, it's been invaluable. With a husband who's only working 20 hours a week for minimum wage, I MUST stay employed---I don't have the luxury of taking time off while I wait for my surgery date (scheduled for the 23rd of this month). And until a couple of days ago, I thought I was doing well.
There are times in every nurse's life when s/he questions whether or not continuing in this career is worth the heartache, the emotional stress, and the wear and tear on the body. That moment arrived for me when my DON sat down at the nurses' station with me and informed me that the administrator was "uncomfortable" with my using the wheelchair at work. Seems that it didn't look right to some VIP who was visiting the place......and since I didn't have a doctor's note stating exactly what was wrong with me, I shouldn't be using it---or any other visible form of support, such as a walker---during my shift. Not even AFTER my operation.
My initial response: "Huh??"
My secondary response: confusion. What on earth did using a wheelchair for part of the shift have to do with the amount of work I was producing? Wasn't I getting everything done as usual? If I hadn't been, I could've understood the concern, but being able to scoot along whenever I had to go to the other end of the building made the difference between completing my work in my usual timely fashion or being in so much pain that I couldn't even think straight, let alone finish everything I had to do.
And it wasn't like I was always in the chair, either; I only used it when I absolutely had to. But because I didn't bring in a copy of my medical record for this purpose---like the immobilizer and a pronounced limp weren't evidence enough of my problems---I wouldn't be allowed to work if I couldn't do it unassisted. I would have to take FMLA leave (unpaid, of course) until I was cleared for normal duty.......no matter if that was a week or a month. In the meantime, my hours were being changed anyway due to budget cuts, meaning I could work as few as 20 hours per week (and lose my health insurance), or maybe as many as 48, which is about 16 more than I can handle even when I'm at 100%.
My third response was indignation. I've broken my backside for this organization, I care about my residents and staff, and I've saved the facility not one but TWO lawsuits, thanks to my diplomatic skills and a willingness to spend some 'quality time' with the more, um, intense families. If that's the thanks I get.........besides, as I said to myself, my condition is NONE of their business, and I wasn't going to waste my time or the doctor's time getting "permission" to use some form of support so I could get through each day a little easier. So when I went to work yesterday, I was determined to make it without any help whatsoever......they weren't going to put ME out to pasture if I could help it.
This attitude lasted exactly one shift...........and this morning, after spending the night flopping around in pain like a beached fish despite two Vicodin and an Ativan (and nearly falling because the knee had the nerve to lock up on me when I got out of bed), my inner activist roared to the surface and screamed in my ear, "Are you SERIOUS? You are a professional nurse---you don't work for an Alabama textile mill, and you aren't Norma Rae. How dare they treat you like this!"
As a matter of fact, I am serious. And I'm done feeling hurt and disappointed in my employer; now, I'm royally ticked off. I've loved this job, and this place, more than any other in my entire career; but I have only this one body, and I'm not going to let ANYBODY tell me I'm not allowed to take care of myself just because they don't like "how it looks". Heck, if I were a visitor to the building and saw a nurse going about her duties in a wheelchair or with a walker, I would think it an honorable thing to keep her working despite her disability (and mine is only temporary, for crying out loud!). But I guess that's just me.
What I'm going to do from here on out, I don't know; but I don't see myself continuing much longer in this position with the prevailing attitudes and the uncertainty regarding my hours, even after I recuperate from the arthroscopy. I'm a fifty-something nurse with years of experience and I will NOT let myself be abused again---not here, not anywhere.
Is there ANY nursing facility, hospital, clinic, or other healthcare setting that doesn't treat nurses like dirt? Inquiring minds want to know!
Compassion fatigue syndrome (CFS) can be a serious problem for trauma workers, whether they're employed in emergency rooms, as relief workers, or counseling rape victims. For caregivers, whose work is often emotionally wrenching, a lessening of the compassion that brought them to that work can be a problem both for themselves and the people they are trying to help. It used to be called burnout, but now it's recognized as a serious syndrome.
the job of a nurse is so, so serious. i just hope that people going into nursing realize that someone could DIE at that blink of an eye if you are not careful. even after all these years i triple check everything especially on kids. my heart goes out to the family..
I was thinking something like lomotil or Immodium. I don't know. I seriously wonder if this is related to fatigue, inexperience, or what. It's unfortunate for everyone involved.
Alicia Coleman was born relatively healthy, her mother said, even though she was three months' premature and weighed little more than 2 pounds at birth.
Things grew worse when Alicia came down with a bowel infection at 12 days old. The infection quickly spread through her intestinal tract and wreaked havoc on her tiny body.
Alicia's doctors initially gave her a 5 percent chance of survival, said her mother, Dominique Coleman.
Yet Alicia fought through 15 surgical procedures and the battery of medications that marked the first year of her life. She improved to the point where doctors wanted to wean her off her medications. She was learning how to walk.
"We were very optimistic," said Coleman, 26, of Omaha.
The 19-month-old child suddenly died Saturday while in the care of Children's Home Healthcare's World, a pediatric care center at 7815 Farnam Drive.
Coleman and hospital authorities said medical staff erroneously injected some of Alicia's medication into a catheter connected to her jugular vein.
Unfortunately, the article is rather vague about the tragic medication error. From other news sources, the best I can piece together is that Alicia was to receive a "medication to slow her bowels" (Zantac? Paregoric?) It was to be given po/ng, but was admnistered into her central line instead.
Apparently, the child usually had homecare services, but they were unavailable on Saturday, so her mother took her to the respite facility instead while she went to work. This facility is a part of Children's Hospital, which has an impeccible reputation. How terribly sad. Thisis the second deadly medication error involving a young child in our city in just the last few months. Another child died at the University of Nebraska Medical Center recently following an apparent heparin overdose.
It is truly tragic that our health care leaders have been ineffective in preventing these errors. I believe in my heart that a large part of the problem is the lack of highly experienced nurses at the bedside.
Just read the paper and read through some of the contract proposals. Go MNA nurses!
Yesterday's vote came through.... 84% voted for an open ended strike.
Wish us luck that the hospitals will come to the table finally and talk before we walk!!!!
BRAVO!!!!
Wonderful commentary. THANK YOU SO MUCH BRAVE NURSE for saying what I know to be true in my daily practice!!!
On behalf of my patients, I thank you for your STRENGTH AND COURAGE! Keep it up Minnesota!!!!!
The legislation would also account for acuity. We weren't rallying for numbers, yes sometimes 2 patients on a med/surg unit can be impossible, and sometimes 5 can be easy... we want a happy medium; set ratios, but also consideration of each individual patient on the floor at a given time.
Patients aren't all created equal!
As an example of the shinnanagans I know of , re staffing set by a hospital committee , an infant whose bottle feeds take greater than 30 minutes , whilst an infant whose tube feed is greater than 30 minutes are grasped at different levels , even though it is our policy and good practice to with either baby throughout the whole feed .So the bootle fed infant can go in amaximum of a 1:3 assignment , but the tube fed infant can go in a 1:4 assignment , that is an example of how a commitee without bedside nurses can creat poor staffing , which leads to an overworked nurse being unable to provide optimum patient care .
Obviously some area care for patients of a higher aciuity ,hence the different ratios for different areas , but in your example of the need for 1:1 versus 1:5 , if this is on the same floor then it is an example of either the rapid deterioration of a patient who should be transferred to a higher level floor ASAP, or poor management who are not assigning patients by the acuity tool .
herring_RN,
Thanks for sharing the article. It was indeed sad to read. The tone of the discourse demonstrates the caliber of misinformation the public has about nurses. Unfortunately, some of it is correct. We don't always show our best side to the camera. Some of our peers are not on point when they come to work. I'd like to think that most of us are, most of the time. And yet, we are as a group relatively uninformed and apathetic about the public's perception of us and about our role as healthcare providers. We can be short-sighted in our ability to see our virtue as a force for good. Consider our role in nurse-patient ratios: how many nurses actually understand that by reducing the ratio, we increase the positive outcomes for our patients and can actually reduce the "burden" on the healthcare system by increasing health? How many care enough to write a letter or make a call to their congressman(woman) to express their concerns/support/information?
Perhaps it is time for a change. Perhaps we need to consider ourselves as the source of that change, and come together and create the changes needed. I'm a nurse, at the bedside, by choice. I love what I do. I want to do it better, not just for me, for my patients.
I never thought it would come to this.
When my left knee began to ache ferociously a few months ago, I thought it was just a remnant of an old injury that I'd sustained back in my early 40s. I'm on my feet a lot, and being neither young nor thin, I suppose I had it coming. Then the ache became a roar, and finally it was so bad that I had to see a doctor to find out why it wasn't healing. He promptly informed me that I had a torn meniscus and probably some major osteoarthritis that would have to be dealt with surgically; the MRI I had a few days later confirmed it. In the meantime, I was to wear an immobilizer, take pain pills, use the RICE protocol, and stay off it as much as possible.
So in order to continue working, I've been using a wheelchair for at least part of the shift for the past several weeks. I'm not happy about it, but when I get tired from dragging this bad leg around or need to go a long way down another hall, it's been invaluable. With a husband who's only working 20 hours a week for minimum wage, I MUST stay employed---I don't have the luxury of taking time off while I wait for my surgery date (scheduled for the 23rd of this month). And until a couple of days ago, I thought I was doing well.
There are times in every nurse's life when s/he questions whether or not continuing in this career is worth the heartache, the emotional stress, and the wear and tear on the body. That moment arrived for me when my DON sat down at the nurses' station with me and informed me that the administrator was "uncomfortable" with my using the wheelchair at work. Seems that it didn't look right to some VIP who was visiting the place......and since I didn't have a doctor's note stating exactly what was wrong with me, I shouldn't be using it---or any other visible form of support, such as a walker---during my shift. Not even AFTER my operation.
My initial response: "Huh??"
My secondary response: confusion. What on earth did using a wheelchair for part of the shift have to do with the amount of work I was producing? Wasn't I getting everything done as usual? If I hadn't been, I could've understood the concern, but being able to scoot along whenever I had to go to the other end of the building made the difference between completing my work in my usual timely fashion or being in so much pain that I couldn't even think straight, let alone finish everything I had to do.
And it wasn't like I was always in the chair, either; I only used it when I absolutely had to. But because I didn't bring in a copy of my medical record for this purpose---like the immobilizer and a pronounced limp weren't evidence enough of my problems---I wouldn't be allowed to work if I couldn't do it unassisted. I would have to take FMLA leave (unpaid, of course) until I was cleared for normal duty.......no matter if that was a week or a month. In the meantime, my hours were being changed anyway due to budget cuts, meaning I could work as few as 20 hours per week (and lose my health insurance), or maybe as many as 48, which is about 16 more than I can handle even when I'm at 100%.
My third response was indignation. I've broken my backside for this organization, I care about my residents and staff, and I've saved the facility not one but TWO lawsuits, thanks to my diplomatic skills and a willingness to spend some 'quality time' with the more, um, intense families. If that's the thanks I get.........besides, as I said to myself, my condition is NONE of their business, and I wasn't going to waste my time or the doctor's time getting "permission" to use some form of support so I could get through each day a little easier. So when I went to work yesterday, I was determined to make it without any help whatsoever......they weren't going to put ME out to pasture if I could help it.
This attitude lasted exactly one shift...........and this morning, after spending the night flopping around in pain like a beached fish despite two Vicodin and an Ativan (and nearly falling because the knee had the nerve to lock up on me when I got out of bed), my inner activist roared to the surface and screamed in my ear, "Are you SERIOUS? You are a professional nurse---you don't work for an Alabama textile mill, and you aren't Norma Rae. How dare they treat you like this!"
As a matter of fact, I am serious. And I'm done feeling hurt and disappointed in my employer; now, I'm royally ticked off. I've loved this job, and this place, more than any other in my entire career; but I have only this one body, and I'm not going to let ANYBODY tell me I'm not allowed to take care of myself just because they don't like "how it looks". Heck, if I were a visitor to the building and saw a nurse going about her duties in a wheelchair or with a walker, I would think it an honorable thing to keep her working despite her disability (and mine is only temporary, for crying out loud!). But I guess that's just me.
What I'm going to do from here on out, I don't know; but I don't see myself continuing much longer in this position with the prevailing attitudes and the uncertainty regarding my hours, even after I recuperate from the arthroscopy. I'm a fifty-something nurse with years of experience and I will NOT let myself be abused again---not here, not anywhere.
Is there ANY nursing facility, hospital, clinic, or other healthcare setting that doesn't treat nurses like dirt? Inquiring minds want to know!
Oh this is so sad.........
Five rights... five rights, checked three times....
every nurse should never get to the point where they stop checking the five rights.... three times....
the job of a nurse is so, so serious. i just hope that people going into nursing realize that someone could DIE at that blink of an eye if you are not careful. even after all these years i triple check everything especially on kids. my heart goes out to the family..
Sadly everyone makes mistakes.. If the weatherman is wrong he can get up the next day - no harm no foul. If we mess up someone could die.
How sad...
I was thinking something like lomotil or Immodium. I don't know. I seriously wonder if this is related to fatigue, inexperience, or what. It's unfortunate for everyone involved.
Alicia Coleman was born relatively healthy, her mother said, even though she was three months' premature and weighed little more than 2 pounds at birth.
Things grew worse when Alicia came down with a bowel infection at 12 days old. The infection quickly spread through her intestinal tract and wreaked havoc on her tiny body.
Alicia's doctors initially gave her a 5 percent chance of survival, said her mother, Dominique Coleman.
Yet Alicia fought through 15 surgical procedures and the battery of medications that marked the first year of her life. She improved to the point where doctors wanted to wean her off her medications. She was learning how to walk.
"We were very optimistic," said Coleman, 26, of Omaha.
The 19-month-old child suddenly died Saturday while in the care of Children's Home Healthcare's World, a pediatric care center at 7815 Farnam Drive.
Coleman and hospital authorities said medical staff erroneously injected some of Alicia's medication into a catheter connected to her jugular vein.
full article: Girl dies after medication error - Omaha.com
Unfortunately, the article is rather vague about the tragic medication error. From other news sources, the best I can piece together is that Alicia was to receive a "medication to slow her bowels" (Zantac? Paregoric?) It was to be given po/ng, but was admnistered into her central line instead.
Apparently, the child usually had homecare services, but they were unavailable on Saturday, so her mother took her to the respite facility instead while she went to work. This facility is a part of Children's Hospital, which has an impeccible reputation. How terribly sad. Thisis the second deadly medication error involving a young child in our city in just the last few months. Another child died at the University of Nebraska Medical Center recently following an apparent heparin overdose.
It is truly tragic that our health care leaders have been ineffective in preventing these errors. I believe in my heart that a large part of the problem is the lack of highly experienced nurses at the bedside.
Finally a REAL article about what is happening in nursing. Hopefully more people are catching on that nursing isn't immune to the recession.
Nursing Job a Sure Bet? Think Again - ABC News