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Joined Mar 14, '04 - from 'California, USA'. herring_RN is a retired registered nurse. She has '>40 years' year(s) of experience and specializes in 'Critical care, tele, Medical-Surgical'. Posts: 16,461 (72% Liked) Likes: 31,746

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  • Jan 20

    Thanks for your reply.

    What are the ratios at NYU?
    What are the ratios at Monte?


  • Jan 20

    Thanks for you reply...

    It's been made clear that improving ratios improves patient outcomes.
    Mandatory ratios are a starting point, a ceiling not to be exceeded.
    If it were up to administrators they would have less nurses taking on more patients.
    They are constantly pushing on nursing staff to take on more to control costs, do more with less.
    Acuity should be the main consideration in giving patient assignments but is 'never' followed.
    The hospital is a factory/hotel, when a bed opens up it gets filled, 100% capacity is the goal and leaves no room unoccupied.

    The question is how can organizations afford the extra staff?
    It's starts by separating the nurse from the room charge as I have discussed in a previous post.
    This will enable us to give evidence to the care that's provided and eventually get paid for it.
    Medicare & Medicaid do not provide adequate reimbursements and need to be changed to cover the increased acuity of the population served.
    Organizations need to do a better job of capturing the costs that are incurred by patients. Every flush, every IV stick, every dressing change, every linen change... the list goes on.
    It costs less for someone to stay at a 5-star hotel than in a hospital and you get better service.
    If you don't like your room in a hotel the hotel doesn't charge you less do they? So then why should the hospital get paid less when they receive a negative survey?

    The idea here is to generate thoughts and ideas for our profession to start driving the bus.
    We have the numbers as a profession yet we are not utilizing this leverage with our legislators.


  • Jan 20

    Good Morning,

    I would like to bring your attention to the New York State Assembly Bill A08580 "Safe Staffing for Quality Care Act". It proposes a ratio of 1:3 for Step-Down & Telemetry.
    It does not differentiate between night & day staffing ratios.
    This bill was passed by the New York State Assembly June 14 2016.
    You can read the full bill here:
    New York State Assembly | Bill Search and Legislative Information

    The bill has been moved to the New York State Senate for input.

    It's unfortunate since the original justification for changing the ratios was recognized in 2003 by the Institute of Medicines report "Keeping Patients Safe: Transforming the Work Environment of Nurses " that we still don't have appropriate ratios that are supported by evidence based practice.

  • Jan 20

    If, as you said, you refused report, then it wasn't your patient. If you were unable to take over the patient due to a pregnancy and told them you could not, I believe its also an ADA issue. If it were me, I'd call my attorney to discuss approaches. I have a feeling you may need to speak with HR, but you need to be careful in your approach, because you don't want to burn bridges. Do you have a member, or attend professional or meetings with anyone you could discuss your situation with? I'd contact my Atty to discuss, as well as some of my mentors to bounce it off their heads.

  • Jan 20

    I'm a fairly new nurse. I've only been in practice for 1.5 years and am currently 6 months pregnant with my first child. I have only worked in my current unit, which is Trauma ICU, since graduation.

    Oftentimes, at our hospital, we have to float to the Medical ICU because of low staffing on their unit. My unit has been excellent at accommodating my pregnancy and being conscientious of my assignments, but about a week ago, I was floated to MICU. I got report on the first patient, and at the very end of report, the outgoing nurse said "Oh, I forgot to mention that the patient is on droplet precautions." I asked what they were on precautions for and she told me the flu. Which I immediately replied that I couldn't take that patient because I am pregnant and have been specifically advised by my Dr to not take flu patients. The charge nurse was standing behind us, so I immediately turned around and told her that I couldn't take the patient because of my pregnancy and her response was "It's ok, it's only for rule-out of the flu, they probably don't even have it." I told her I was not comfortable taking that patient and had been advised by my Dr not to, and would need to talk to my charge nurse. I thought that by telling her I could not accept the patient because of my pregnancy that I was not taking responsibility for the patient. I tried calling my charge nurse 3 times, but was unable to get ahold of him, so I ran over to my unit to explain to him what was going on. He told me he would send another nurse to MICU instead and I started getting report on my new patients. After getting report, my charge nurse calls me and says that the MICU charge said nobody was monitoring the flu patient (apparently the outgoing nurse left during this whole ordeal) and that she was wanting to write me up for patient abandonment. No harm came to the patient, and my charge had me go back to MICU to give report to the new nurse taking the flu patient.

    I thought for sure that nothing would come of this because 1) I declined taking the patient both to the outgoing nurse and to the charge nurse and 2) I have a legitimate medical reason to not take the patient. Well my manager called me into the office today and said that since I technically received the entire report on the patient, even though I told the nurse and charge that I couldn't take the patient, that I had legally taken care over the patient and she would need to give me a written warning for patient abandonment. She said I was still responsible for making sure someone watched over that patient while I went to go talk to my charge nurse. She didn't have the paperwork together yet, and said she would have everything put together by next Thursday, so I have until next Thursday to explore my options of fighting this. I told her that I would not sign the paperwork because I feel that I did everything that I thought was right to not take responsibility for that patient. I even had my doctor give me a note stating that I could not care for influenza patients or patients suspected of having influenza and brought it in with me today to give to my manager.

    Does anyone have any advice on what I should do or experience with dealing with this type of situation? We have a brand new Director who was just appointed a couple days ago, so I'm not sure if I should go to him, or if there is something else I should do. Thank you guys so much for your help.

  • Jan 19

    First, Let’s Review The Different Types Of Fat

    Beginning with the good fats, because we all need some good in our lives, they are liquid at room temperature. There are the two extensive categories of good fats, monounsaturated and polyunsaturated fats.

    Monounsaturated fats: peanut oil, avocados, nuts, sunflower oil, canola oil, and olive oil.

    Polyunsaturated fats: salmon, mackerel, sardines, flaxseeds, walnuts, unhydrogenated soybean oil

    Saturated fats are solid at room temperature, and are considered in between the good and bad fats. Milk, red meat, and coconut oil are examples of saturated fats.

    The worst is saved for last - trans fat. These fats are marketed as partially hydrogenated oil found in solid margarine and vegetable oils.

    Trans fats can be found in many commercial pastries, cookies and fast foods.

    *Fat is a needed by the body to absorb needed minerals and vitamins as well as energy.

    Current Contrasting Conclusions

    According to the article, “Saturated fat may not increase heart disease after all” by Hannah Nichols, the following are the conflicting recommendations:

    Academy of Nutrition and Dietetics - recommend de-emphasizing the role of saturated fat in developing heart disease, due to the lack of evidence connecting the two
    American Heart Association - agree with government warnings and echo that the consumption of saturated fat can lead to levels of bad cholesterol in the blood that may raise the risk of heart disease
    For more than 50 years it has been taught that saturated fat is bad to have in our diets, however, a new study published by The American Journal of Clinical Nutrition that challenges this body of thought.

    New Research
    Professor Simon Nitter Dankel along with his colleagues put the philosophy that foods containing saturated fat such as meat, butter, and cheese should be limited in our diets to the test. Their research included 38 men with abdominal obesity broke into two groups with one group following a low fat, high carbohydrate diet and the other followed a high fat, low carbohydrate diet. Fat mass was measured in the abdomen, heart, and liver along with risk factors for heart disease.

    Their diets contained limited sugar and intake was similar between the two groups with protein, energy, and polyunsaturated fats. After twelve weeks, Ottar Nygard, contributor, professor and cardiologist tells us, “The very high intake of total and saturated fat did not increase the calculated risk of cardiovascular diseases.”

    In fact, they found that the participants who were on the high fat diets were found to have improved blood pressure, blood lipids, better blood sugars. “Our findings indicate that the overriding principles of a healthy diet is not the quantity of fat or carbohydrates but the quality of foods we eat,” Johnny Laupsa-Borge PhD tells us.

    Furthermore, it was established that the high fat diet resulted in a higher LDL. The outcome of the study shows that the health risks related to fat in our diets that have been the standard for many years have been excessive guidelines. The focus should be to reduce processed foods, flour based and sugar added products.

    Now For The Piece De Resistance

    In the past few years ( for those paying attention) we have become acutely aware of fake news. False information changed the diet recommendations over 50 years ago. Academic researchers from the University of California uncovered documents from the 1950s derived by the Sugar Research Foundation about dietary concerns and heart disease at that time.
    Thousands of pages of “correspondence and documents at Harvard and other academic libraries that showed leading sugar industry officials devising a plan by the mid 1960s to shift the nutrition heart disease debate away from the sugar and toward fat through a combination of research, lobbying and public relations efforts.”

    These documents were published showing that the sugar industry whitewashed the link between sugar and heart disease. In 1965 the Sugar Association published research that blamed fat for heart disease while downplaying the effects of sugar on heart disease. Present day federal diet guidelines are based on this very data. The article can be found here.

    In response to this information, the present Sugar Research Foundation states that there is no proven link between heart disease and sugar. They admit that there should have been more transparency regarding the research from the 1960s and that that research didn’t require peer review.


    Disregarding research, it has been true for over 50 years that America has been told to eat low fat. Unfortunately, due to the accepted dietary guidelines, there are many people that feel it is good to eat low fat and high sugar.

    Personally, as a diabetic, when I eat low carbohydrate my sugars are much lower which translates into less insulin use. Also, my cholesterol levels are fantastic and I have hyperlipidemia. Yes, I take medications for the hyperlipidemia, which keeps it controlled, but a low sugar, low carb diet takes it to a different level.

    What has been your experience?


    Nesbit, Jeff. “Fat Might Not Be Bad for You After All.” 12 Sept. 2106. USNews.Com. 12 Dec. 2106. Web.

    Nichols, Hannah. “Saturated Fat May Not Increase Heart Disease Risk After All.” 27 Dec. 2016, Tuesday. MedicalNewsToday. 28 Dec. 2016. Web.

    “The Truth About Fats: The Good, The Bad, and The In-Between”. Feb. 2015, ud. 7 Aug. 2015. Harvard Health Publications, Harvard Medical School. 28 Dec. 2106. Web.

  • Jan 14

    I completely can relate to this, and I am not even a nurse...yet. I have been a teacher for almost 7 years now and have been through most of the challenges described in the article. On average I have had 37 students to be responsible for, with never-ending assessments, tracking progress, lesson planning, PDs etc. I was expected to do more, more, and more every time my principal stepped her foot into my classroom. I would also eat through lunch, holding a lunch sandwich in my left hand while grading papers with my right one. Using the bathroom? Forget it! I would have to hold it for hours in a row, while allowing the students to use their bathroom every 5 minutes, hearing their constant complaints how bad it felt for them that they could no longer hold it! I can go on, and on about the nonsense that is abound in the teaching profession. But like other poster has noted, such nonsense exists pretty much in every profession. We need more unions, and laws across the country that will allow for safe assignments and reasonable nurse-to-patient ratios.

  • Dec 31 '16

    98% nurses voted FOR contract.

    Einstein nurses ratify 3-year pact; here's what they got

    Philadelphia Business Journal
    Dec 27, 2016, 7:50am EST
    John George

    ...As part of the new contract, according to PASNAP, Einstein has agreed to hire additional nurses and maintain improved staffing levels. The hospital will put in place new plans to handle spikes in volume and will work with a nurse-led committee to address staffing issues.

    Einstein has also agreed to limit the pulling and reassignment of nurses to specific areas for which they are appropriately trained. Over the course of the three-year contract, the hospital will reduce or eliminate the direct patient assignments of charge nurses.

    In addition, according to PASNAP, the contract calls for undisclosed wage increases and a transparent wage scale based on years of experience. PASNAP said the hospital also agreed to improve the nurses’ health insurance, providing more coverage for nurses and family members who are treated outside of Einstein....

  • Dec 24 '16

    Can't "like" this article and thread enough. When will we stop considering it a badge of honour to accept disrespect and poor working conditions? Even in this century, we're still buying into the myth that we're somehow more noble beings than the rest of the populace and have to live up to that. That belonging to a union is somehow "unprofessional". That requiring appropriate compensation and working conditions is "undedicated".

  • Dec 24 '16

    Great article Missing breaks is not a badge of honor, it is a violation of labor laws. Accepting abuse is not a virtue, it's a weakness. And unsafe patient assignments abound when neither nurses nor states have input into safe staffing levels.

  • Dec 20 '16

    We all know someone that we consider to be "entitled." They believe, and in many cases demand, special privileges that they have not worked to earn. Working with these people is a total drag.


    What if there are instances in which being "entitled" is actually a good thing? What if, dare I say it, nurses should feel entitled to some things? What might these things be?

    Yes, I've tricked you. This article is not going to be about annoying coworkers who think they are better than everyone else. It's going to be about nurses and what they are entitled to as working professionals. This article is going to challenge the "martyr" persona that nurses are expected to project. Here we go:

    1. You Are Entitled to Your Lunch Break

    Yes! Believe it or not, much like other people, your body requires food in order to produce energy so that you can be effective in your job. Not only do you deserve to eat, but you also deserve to eat sitting down in a place that is specifically designed for eating. Things get busy, and if you do not get to take your lunch break, you should be compensated for working through it.

    I once had a co-worker who never notified the department of working through lunch. She believed that if she could at least scarf down a granola bar in some back corner of the unit then she did not need to be paid for the other 28 minutes of break that she missed. She let others know that she was not asking to be compensated for those minutes. This resulted in tension between nurses throughout the department. Why? Because some felt that they were expected to give up lunch breaks without pay. Others felt that they were made to look less "dedicated" by expecting to take a full break.

    2. You Are Entitled to a Safe Assignment

    I had a mentor that worked in an ICU setting. One day they were severely understaffed and, as a result, she was assigned four patients. This is not okay. She was expected to take care of double the expected patient load in an intensive care area. This very competent, capable nurse was near her breaking point by the end of that shift. When she wasn't doing patient care, she was praying that two (or three...or four...) of her patients didn't go south at the same time.

    Look, we all get assignments that we don't like. Sometimes we get busy assignments (hey, that's life!). That is not the issue. The problem arises when the assignment is unsafe, or the ratio is a serious danger to the patients. As a nurse, you are putting your license on the line when you accept a dangerous assignment. You are entitled to a safe assignment. Workplaces need to be prepared to deal with understaffing. Remember, they take on the same obligation to keep patients safe. That should not depend on you turning into superman to make the impossible happen. They have a responsibility.

    3. You Are Entitled to Respect

    One time I observed a physician throw a piece of equipment across the room because she was upset with the nurse. Nurses experience disrespect from all directions. A frustrated physician, an angry family member, an unhappy patient, fellow nurses--you name it, a nurse has experienced it.

    When someone disrespects you, your response should be professional and dignified, but that doesn't mean that you should have to accept such behavior regularly. Respond appropriately, but understand that you are entitled to work in an environment where objects will not be thrown, shouting will not tolerated, and other acts of disrespect will be dealt with by management. A workplace that allows nurses to be disrespected by their colleagues and patients is not treating them right. You are entitled to respect, just like everyone else.

    All of this seems like common sense, so why do nurses sometimes tolerate these things? The problem lies with the "martyr" mentality that nurses are expected to live by. You are expected to be selfless, kind, and giving, but you will be criticized if you demand appropriate working conditions or compensation.

    It's time that we challenge that idea. Nurses have families to provide for. Difficult assignments to navigate. Emotionally taxing work that must be done. You are a nurse and you are entitled to the basic things that are afforded to other working professionals.

    Do you think there are some things that nurses are entitled to? Share your thoughts!

  • Dec 14 '16

    I fail to see how this is "new". It's an enduring myth arising from the idea of nursing as a vocation & promulgated by an industry that has refused to institute the same basic safety measures that protect truck drivers and airline staff.

  • Dec 13 '16

    I think we're still our own worst enemies. Missing breaks and not billing for the time, charting off the clock, etc. are some ways we continue to do this to ourselves. Not speaking up in staff meetings (or keeping silent while one vocal person goes out on a limb), coming in on one's own time to complete "mandatory" education modules. Not belonging to the union.

    I used to encourage my coworkers to be better advocates for themselves; one martyr hurts all of us. It used to show up on my evaluations that some people didn't like my "conversations".

    We can publish all the studies we want. Most of us don't need studies because we already know how we are affected. Most administrators don't care. We're seen as overhead, not profit. Until we're ready to step up and speak up, nothing will change. Patients will have poorer outcomes and we'll get admonished for not smiling enough. The public sees us as angels, not professionals. Advocating for ourselves is seen as unacceptably mercenary. We have a long way to go, baby.

  • Dec 10 '16

    I know a DeElegance (m), and Patience (f). They are adults now.

  • Dec 10 '16

    The first baby I cared for in maternal/newborn clinical was named Dequavius.

    I also met a new mom who thought the hospital named her new daughter. That little girl's name was Female (rhymes with tamale).