Are we experiencing mass burnout in healthcare? Are we experiencing mass burnout in healthcare? - pg.4 | allnurses

Are we experiencing mass burnout in healthcare? - page 4

This was written in response to a thread where a nurse experienced lateral violence at the hands of her preceptor. I thought it would be an appropriate discussion to start in this area. Thoughts? ... Read More

  1. Visit  tewdles profile page
    #39 1
    There are quite a number of physician owned surgi-centers, hospitals, etc. Recent studies have shown that the cost of healthcare is significantly increased in those areas where the docs have a direct financial benefit for services ordered and provided. There was a thread on ALLNURSES which discussed this recently. The more economical health delivery seems to occur in systems where the docs are employees of the larger provider...as in Mayo Clinics practice.
  2. Visit  Katie5 profile page
    #40 1
    I think it's a sad state of affairs too, especially when patients threaten state on any slightest thing and if you haven't got a good manager looking out for you, then you're stuck.
  3. Visit  herring_RN profile page
    #41 2
    Quote from sheatab
    please consider taking a look at s. 1031 and h.r. 2273. both of these bills seek to enact mandatory minimum nurse-to-patient ratios. i'd be interested in hearing the thoughts of bedside nurses with regard to these measures.

    best!
    i think most of us can support the national nursing shortage reform and patient advocacy act.
    i'm thinking that now is a time to become familiar with it and discuss it with our colleagues.
    after the health insurance debate we can start working it.

    official summary - http://www.govtrack.us/congress/bill.xpd?bill=s111-1031&tab=summary
    text - http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s1031is.t xt.pdf


    the bill would:
    • establish specific nurse-to-patient ratios that will not only save lives and improve the quality of care, but also encourage more nurses to enter and stay in the workforce, which could help ease the nursing shortage. the ratios begin on page three.
    • provide whistleblower protections to protect the right of nurses to advocate for the safety of patients and report violations of minimum standards of care.
    • create a standard for helping nurses to lift patients to prevent on-the-job injuries and promote better quality patient care.

    the bill also creates a registered nurse workforce initiative within the health resources and services administration that invests in the education of nurses and nursing faculty. the initiative provides grants for:
    • nursing educational assistance and living stipends for nursing students who agree to work for at least 3 years for a safety-net health care provider.
    • graduate educational assistance for registered nurses who commit to serve as nurse educators for at least 5 years at an accredited nursing program.
    • training and mentorship demonstration projects.
  4. Visit  herring_RN profile page
    #42 3
    of course we will need extensive discussion.

    for example h.r 2273 includes, states that, at least 2 years prior to the date of the enactment of this title, have enacted minimum direct care nurse-to-patient ratios that allow the use of licensed practical nurses to meet state-imposed minimum direct care nurse-to-patient ratios may continue to make such allowance, and such allowance shall be considered to satisfy requirements imposed under this subsection, so long as the particular licensed practical nurse is employed in the same or a comparable position.”

    text of h.r. 2273 - http://frwebgate.access.gpo.gov/cgi-...2273ih.txt.pdf

    i think s. 1031 addresses the issue better. from page five, ‘‘ prohibition against imposition of lay-offs.—a hospital shall not impose lay offs of licensed vocational or practical nurses, licensed psychiatric technicians, certified nursing assistants, or other ancillary staff to meet the hospital unit direct care registered nurse-to patient ratios required under this subsection.”

    text of s. 1031 - http://www.calnurses.org/nursing-pra.../pdf/s1031.pdf
  5. Visit  nursemike profile page
    #43 5
    When I was in school, we were more or less bludgeoned into a field trip to our state capital for Nurses' Day, where we wore our uniforms and looked bored while a bunch of troublemakers--er, nursing leaders--made speeches and lobbied for laws against mandatory overtime. The law passed, and I've never had to work an hour of mandatory overtime. So I have made a difference. Well, okay, I showed up and watched others make a difference. But, clearly, legislative action is one recourse. Unions may be another, but my prior position at my current facility was unionized, and about the best that union did for me was let me do someone else's work along with my own. Indeed, members of the union were key participants in all but gutting my old position. By that time, I was a nurse, so I wasn't directly affected, but it still irks me to see what was a useful and interesting job reduced to menial labor. Frankly, if my fellow nurses were to vote to join that union, I'd have to look for a new job. Nor am I enthusiastic about the ANA, which seems to have as little to do with bedside nursing as management does. The last I heard, the ANA didn't recognize my LPN colleagues as nurses, nor did they think I, an ASN RN, should be.

    I do think one of the major problems is with reimbursement. My facility is not for profit, but still bound by some of the constraints of a for-profit facility, in that they can't lose money indefinitely. Our patient population is about 60% Medicare/Medicaid. These agencies, in effect, are pretty well able to dictate what we can charge. Of course, as a taxpayer, I benefit from their efforts to prevent waste and fraud, but too much pressure can cut into the "muscle" we need to provide adequate care.

    I feel less equivocal about insurance companies. Pirates would be embarrassed by many of their practices. At one meeting, I was told that Blue Cross routinely rejects half of the bills we send them, so they can hold on to that money another month while we resubmit. Health insurance today is not much more than a Ponzi scheme. I am not a socialist, I favor a free market, but a free market does not mean freedom to run amuck as the insurance and banking industries have lately done, at considerable cost to all of us. (Granted, I don't think health insurance had a great deal to do with the recent economic crisis, but it is largely run by the same conglomerates, and I think it has a great deal to do with the problems with healthcare.)

    I've said I'm not a socialist, and I'm truly not, but I am a liberal Democrat, and I firmly believe this is one area where government action--including a public option for health insurance--can help correct the practices of corporations that have shown themselves to lack the ethical discipline to control themselves.
  6. Visit  SheaTab profile page
    #44 3
    Hi NurseMike,

    This is an insightful post. I am right there with you on health insurance reform. It isn't a republican, democrat, liberal, conservative, or socialist issue; in my estimation, it's a human rights issue.

    I agree also that according to their scope and practice, nurses of all educational preparation bring infinite value to the profession. I have wondered on occasion if "the powers that be" will further dilute the role of the RN by assigning what used to be RN roles out to LPNs and CNAs. I am hoping that this is not the wave of the future or else we all may be looking for jobs. In this respect, I do advocate for keeping RN roles, RN roles or else we may be challenged to justify our continued existence in certain practice areas. Take dialysis for example. There are many clinics that use dialysis techs for the most part and provide minimal nursing oversight. Dialysis is not a benign procedure and it certainly requires vigilance on the part of the nurse to interpret lab values and make nursing decisions based upon assessment of the patient. This is one small example of how RNs are being replaced by unlicensed assistive personnel. Don't be surprised to see licensing/certification programs crop up in the near future for all sorts of nursing related duties. Another example is the practice of CNAs delivering medications in some LTC environments. We have to protect the scope and practice of an RN because it is the right thing to do for the patient.

    Would you mind elaborating on the duties that were added to your load as a result of union intervention? I am interested in hearing more about your experiences.

    Profit or Not-for-Profit, the motivation appears to be the same and that is, PROFIT! The revenues are just distributed differently.

    Medical insurance providers are definitely earning a pretty penny and our patients are paying the price! The same is true of medical malpractice insurance companies. What a mess! They are price-gouging docs who have no choice but to participate in the monopolies. What about tort-reform? Mercy! While many lawsuits are frivolous, tort reform has resulted in the inability to receive any justice with regard to acts of harm committed against them. Take Texas for example. Doctors are flocking there in droves to set up shop as a result of the extensive tort reform in the state. It has become unprofitable for attorneys to take on most med malpractice cases and as such, the patients are left without a legal advocate when they are harmed.

    Thanks for your thoughts!

    Tabitha
  7. Visit  SheaTab profile page
    #45 2
    Quote from herring_rn
    of course we will need extensive discussion.

    for example h.r 2273 includes, "states that, at least 2 years prior to the date of the enactment of this title, have enacted minimum direct care nurse-to-patient ratios that allow the use of licensed practical nurses to meet state-imposed minimum direct care nurse-to-patient ratios may continue to make such allowance, and such allowance shall be considered to satisfy requirements imposed under this subsection, so long as the particular licensed practical nurse is employed in the same or a comparable position."

    text of h.r. 2273 - http://frwebgate.access.gpo.gov/cgi-...2273ih.txt.pdf

    i think s. 1031 addresses the issue better. from page five, '' prohibition against imposition of lay-offs.--a hospital shall not impose lay offs of licensed vocational or practical nurses, licensed psychiatric technicians, certified nursing assistants, or other ancillary staff to meet the hospital unit direct care registered nurse-to patient ratios required under this subsection."

    text of s. 1031 - http://www.calnurses.org/nursing-pra.../pdf/s1031.pdf
    herring ... thank you for bringing this important issue to light. i'm afraid that i will have to admit that i spoke to soon about h.r. 2273 since i obviously did not read the bill close enough. wow, i am not in favor at all of any legislation that would support an "rn or lpn/lvn." i feel that both r's and l's bring a tremendous amount of value to the table; however, rn's have their scope and lpns/lvns have theirs.

    thanks again for informing me,

    tabitha
  8. Visit  SheaTab profile page
    #46 2
    love it! i'm standing ready and can't wait to discuss this further after the insurance debate. thanks for all you do on this forum to support nurses advocating for their profession!

    on lifting, i don't know if this is a trend throughout the u.s.; however, there is at least one large system in my state that has a new policy that they will no longer provide compensation and/or worker's comp to staff who sustain an injury from lifting a patient if the assistive devices provided were not used. i have a few thoughts around this. first, kudos for providing the assistive devices; however, some of the devices take more time to find and use than what small amount of time is available. i think lifting devices with insufficient numbers of staff are almost as useless as no lifting devices at all--which is beautifully addressed in s. 1031. minimum nurse-to-patient ratios. thanks again, senator barbara boxer.

    i plan to return to school next year for my phd, thanks yet again, senator boxer!

    i can imagine a world without nurses, we are disappearing in droves, both physically and emotionally. s. 1031 is what appears to be a major catalyst in our journey toward advancing the profession and practice of nursing.

    warm regards,

    tabitha


    Quote from herring_rn
    i think most of us can support the national nursing shortage reform and patient advocacy act.
    i'm thinking that now is a time to become familiar with it and discuss it with our colleagues.
    after the health insurance debate we can start working it.

    official summary - http://www.govtrack.us/congress/bill.xpd?bill=s111-1031&tab=summary
    text - http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s1031is.t xt.pdf


    the bill would:
    • establish specific nurse-to-patient ratios that will not only save lives and improve the quality of care, but also encourage more nurses to enter and stay in the workforce, which could help ease the nursing shortage. the ratios begin on page three.
    • provide whistleblower protections to protect the right of nurses to advocate for the safety of patients and report violations of minimum standards of care.
    • create a standard for helping nurses to lift patients to prevent on-the-job injuries and promote better quality patient care.

    the bill also creates a registered nurse workforce initiative within the health resources and services administration that invests in the education of nurses and nursing faculty. the initiative provides grants for:
    • nursing educational assistance and living stipends for nursing students who agree to work for at least 3 years for a safety-net health care provider.
    • graduate educational assistance for registered nurses who commit to serve as nurse educators for at least 5 years at an accredited nursing program.
    • training and mentorship demonstration projects.
  9. Visit  SheaTab profile page
    #47 2
    Quote from Katie5
    I think it's a sad state of affairs too, especially when patients threaten state on any slightest thing and if you haven't got a good manager looking out for you, then you're stuck.
    Hi Katie,

    You're right in that we have a sad state of affairs in our present system. The most distressing is that a patient would have anything to complain about at all in terms of their Nursing care. My goal as a Nurse is to be there for my patient in whatever way they need me to be and to always seek to take a holistic approach in the delivery of my care. However; it has become increasingly difficult to provide holistic care, let alone care that is based on sound nursing judgement and assessment.

    I'd like to tell you a story if I may. I once met with a patient (we'll refer to her as Kathy) in a long-term acute care facility. Kathy was vent dependent and had recently been fully weaned. Her trach tube was removed and she was set to be discharged in the next few days. Now, this mid-30's patient in particular was a paralyzed from the waist down from an injury sustained in her early 20's. Each time I met with Kathy, her mother sat diligently at the bedside, ever-watchful and supportive of the plan of care. I once gently asked her mom how she managed her own life since she was ever-present in the hospital. Sh responded that she didn't feel that she had a choice. She told me a story that left me speechless and with an even greater urge to advocate on behalf of our profession and patients. She shared with me that just two weeks ago, Kathy was laying in bed and had a "coughing spell." During that time, Kathy began to vomit and as soon as this happened, she hit the call-bell for assistance. She did her best to remove the vomitus from Kathy's mouth herself, however, it just wasn't enough. The nursing staff never came to her assistance and ultimately, she had to run to the desk to get some help. Kathy had to be reintubated and treated for aspiration pneumonia. She said that she was afraid that the one time she left Kathy's side, would be the one time that Kathy would die as a result of inadequate staffing and long-response times. It is really no surprise that many families won't leave their beloved alone and this is an injustice that I'd like to work with you and our peers to change. Our patients should expect that we will provide them with the very best care available each and every time they access the system. The sad truth is that we regularly fall short of doing this. Patients don't care, nor should they, that our staffing is inadequate except that it would be great if they would stand with us to support legislation for change. A patient should never have to concern themselves with their personal safety and yet not doing so can and does result in harm. I can't even begin to tell you the number of times I had to remind nursing and ancillary staff to cleanse their hands before touching my mother during her last inpatient admission. This is indeed a sad state of affairs.

    Katie, many times facilities will allow blame for their personal shortcomings to fall on the shoulders of staff as opposed to placing it where it belongs. I feel your pain.

    Keep the faith & be the change!

    Advocate for your right to deliver the stellar nursing care you want to give. Both you and your patients deserve it.

    Best!

    Tabitha
  10. Visit  Onekidneynurse profile page
    #48 1
    Quote from nursemike
    When I was in school, we were more or less bludgeoned into a field trip to our state capital for Nurses' Day, where we wore our uniforms and looked bored while a bunch of troublemakers--er, nursing leaders--made speeches and lobbied for laws against mandatory overtime. The law passed, and I've never had to work an hour of mandatory overtime. So I have made a difference. Well, okay, I showed up and watched others make a difference. But, clearly, legislative action is one recourse. Unions may be another, but my prior position at my current facility was unionized, and about the best that union did for me was let me do someone else's work along with my own. Indeed, members of the union were key participants in all but gutting my old position. By that time, I was a nurse, so I wasn't directly affected, but it still irks me to see what was a useful and interesting job reduced to menial labor. Frankly, if my fellow nurses were to vote to join that union, I'd have to look for a new job. Nor am I enthusiastic about the ANA, which seems to have as little to do with bedside nursing as management does. The last I heard, the ANA didn't recognize my LPN colleagues as nurses, nor did they think I, an ASN RN, should be.

    I do think one of the major problems is with reimbursement. My facility is not for profit, but still bound by some of the constraints of a for-profit facility, in that they can't lose money indefinitely. Our patient population is about 60% Medicare/Medicaid. These agencies, in effect, are pretty well able to dictate what we can charge. Of course, as a taxpayer, I benefit from their efforts to prevent waste and fraud, but too much pressure can cut into the "muscle" we need to provide adequate care.

    I feel less equivocal about insurance companies. Pirates would be embarrassed by many of their practices. At one meeting, I was told that Blue Cross routinely rejects half of the bills we send them, so they can hold on to that money another month while we resubmit. Health insurance today is not much more than a Ponzi scheme. I am not a socialist, I favor a free market, but a free market does not mean freedom to run amuck as the insurance and banking industries have lately done, at considerable cost to all of us. (Granted, I don't think health insurance had a great deal to do with the recent economic crisis, but it is largely run by the same conglomerates, and I think it has a great deal to do with the problems with healthcare.)

    I've said I'm not a socialist, and I'm truly not, but I am a liberal Democrat, and I firmly believe this is one area where government action--including a public option for health insurance--can help correct the practices of corporations that have shown themselves to lack the ethical discipline to control themselves.
    Medicare rejects just about every bill that is submitted. We submitt scripts for meds every three months and Medicare rejects them in January, April, July, and Oct every time. Same med, same chronic illness, same patient.
  11. Visit  nursemike profile page
    #49 1
    Quote from Onekidneynurse
    Medicare rejects just about every bill that is submitted. We submitt scripts for meds every three months and Medicare rejects them in January, April, July, and Oct every time. Same med, same chronic illness, same patient.
    Wow. That's a side of Medicare abuse you don't hear much about.
  12. Visit  Laney123 profile page
    #50 1
    I think there are so many things wrong with nursing that I don't know where to start. I think unfortunately many people see nursing as a stable entity and enter the profession for the wrong reasons. It is not an easy career and one must absolutlely LOVE it for to be successful. Those that enter for the wrong reasons are the ones who are LAZY and yes, there are many of them. I bust my butt every shift, doing extra, taking care of the patients to the best of my abiility. I work overtime to finish everything and try not to leave things for the next shift to do. I also find lateral violence in my workplace. Its so tiring to have nurses attack each other. There seem to be those that are never happy, that are always attacking others and I for one am downright sick of it. I think we all work hard and need to bond as a group rather than to implode from within.
    I also agree the problem is bigger than nursing. I know the mandates come down from management, but I for one signed onto this career to take care of my patients, to be a patient advocate and nobody will take that from me. I am a nurse who cares for her patients and for her coworkers. I think there are more of us than not and we need to start becoming advocates for ourselves just as much as we are advocates for our patients.
    I also say, if you dont love the profession and you are not in it for ALL the RIGHT reasons then, step aside and let those of us who want to care for patients do just that.
  13. Visit  nursemike profile page
    #51 0
    Quote from SheaTab
    Hi NurseMike,

    This is an insightful post. I am right there with you on health insurance reform. It isn't a republican, democrat, liberal, conservative, or socialist issue; in my estimation, it's a human rights issue.

    I agree also that according to their scope and practice, nurses of all educational preparation bring infinite value to the profession. I have wondered on occasion if "the powers that be" will further dilute the role of the RN by assigning what used to be RN roles out to LPNs and CNAs. I am hoping that this is not the wave of the future or else we all may be looking for jobs. In this respect, I do advocate for keeping RN roles, RN roles or else we may be challenged to justify our continued existence in certain practice areas. Take dialysis for example. There are many clinics that use dialysis techs for the most part and provide minimal nursing oversight. Dialysis is not a benign procedure and it certainly requires vigilance on the part of the nurse to interpret lab values and make nursing decisions based upon assessment of the patient. This is one small example of how RNs are being replaced by unlicensed assistive personnel. Don't be surprised to see licensing/certification programs crop up in the near future for all sorts of nursing related duties. Another example is the practice of CNAs delivering medications in some LTC environments. We have to protect the scope and practice of an RN because it is the right thing to do for the patient.

    Would you mind elaborating on the duties that were added to your load as a result of union intervention? I am interested in hearing more about your experiences.

    Profit or Not-for-Profit, the motivation appears to be the same and that is, PROFIT! The revenues are just distributed differently.

    Medical insurance providers are definitely earning a pretty penny and our patients are paying the price! The same is true of medical malpractice insurance companies. What a mess! They are price-gouging docs who have no choice but to participate in the monopolies. What about tort-reform? Mercy! While many lawsuits are frivolous, tort reform has resulted in the inability to receive any justice with regard to acts of harm committed against them. Take Texas for example. Doctors are flocking there in droves to set up shop as a result of the extensive tort reform in the state. It has become unprofitable for attorneys to take on most med malpractice cases and as such, the patients are left without a legal advocate when they are harmed.

    Thanks for your thoughts!

    Tabitha
    As far as scope of practice, two things have really surprised me since I've been a nurse. One, not a huge surprise, is how good many LPNs are. In school, we were taught the differences between professional nurses and practical nurses, and it all sounded very logical. I was not surprised that experienced LPNs knew more than I did as a brand new RN, but I soon noticed that many could teach things to experienced RNs. For example, our "wound care champion" is an LPN, and RNs go to her with questions about dressing changes. But, in retrospect, I shouldn't really be so shocked, nor should I attribute it to a more "boot camp" mentality in LPN school. Rather, with our work loads, the simple fact is that we're all doing practical nursing, with precious little time to do a lot of deep thinking.
    My other surprise, and it still amazes me, is that even very smart, very dedicated aides are often severely lacking in critical thinking. One example I've sited elsewhere is a patient with exaccerbated CHF and +3 edema in both legs, so we've got to get those legs elevated to get the swelling down. Well, that's a knowledge deficit, and when you explain why it isn't a good idea, most get it. But there have been other instances when I've had to butt heads a little bit over something that seemed to me like simple common sense, but maybe wasn't so simple before I went to nursing school. One example comes to mind was a walkie-talkie pt with serious psych issues whose family had complained because he hadn't had a bath in three days. I wasn't out of school, yet, but I was assigned as a sitter when an aide came in and laid down the law that he was getting a bath, or else. He did not get the bath, and I was still calming him down an hour after the aide had moved on. I don't guess that's a great example, because I wasn't yet a nurse, but I had covered therapeutic communication, so I was using nursing skills the aide evidently lacked and thinking about our priorities. There have been enough other examples that don't come to mind at the moment to persuade me that an aide is not a nurse, so I'm right with you on not delegating tasks that really need a nurse. And as much as I will always respect LPNs, as I get better at some of the practical tasks of bedside nursing, I do sometimes get to use some of that professional training. Just not always as much as I'd like to.

    My own unlicensed position was a notch down the pay scale from an aide. I usually say "orderly," but it was a bit more complicated. When I started, we did patient transports, but also passed meal trays and did the housekeeping in the patient rooms. Daily cleans--dusting, mopping, stocking supplies--and terminal cleans after the patient was discharged. It was hard work, but you spent a lot of time with patients, and that had a lot to do with my becoming a nurse. We were under nursing services and assigned to particular units, so you got to know the patients and the nurses pretty well. We were CPR certified, but I never had to use it. Still, sense I was in each room several times a shift, there were times when I did see something that needed a nurse's immediate attention and get help that avoided a more serious problem.

    Over time, some of these tasks got removed. The job got easier, but seemed less meaningful. Now it's strictly transport. Housekeepers clean the rooms--but now nurses or aides have to remove all the linens and hazardous wastes after a discharge, because, you know, we have so much extra time on our hands. Dietary workers pass trays, but they don't take time to open containers for patients who can't, so food sits until an aide or nurse notices it's there. Transporters pick people up and drop them off, but have no idea who's been puking his guts out all morning and needs a gentle ride. And it just doesn't look to me that a lot of them feel like they have anything to take pride in. However, the union was run by housekeepers who didn't like that we made a quarter an hour more than they did, and after ten years they managed to get that job classification changed. And, to me, that's one of the risks of any union, that decisions are made by union officers and any members militant enough to show up to all the meetings and scream about their personal peeves. As much as my fellow nurses hate coming in for mandatory, paid staff meeting, I just don't think many are going to make it to optional, unpaid union meetings.

    But we need to do something. I just wish my critical-thinking skills were up to figuring out what.

    ETA: I do notice that I can usually manage five patients better than six. I even have time to stop and chat with them a bit.
    Last edit by nursemike on Nov 26, '09

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