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Melissa Mills BSN

Nurse Case Manager, Professor, Freelance Writer

Hi there! I'm Melissa and I'm a skilled writer, editor, and content manager and I would love to help you with your next project. I specialize in healthcare and women's content

Content by Melissa Mills

  1. Elder abuse comes in many forms. However, most people believe that patients are safe at the hands of their nurse. This might be why the story out of Pennsylvania feels so jarring. Ashley Ann Smith, a 30-year-old licensed practical nurse, has been accused of taking photos of at least 17 of her elderly nursing home patients. Some of the images show the residents in various states of undress and in need of immediate private care. One video found on her phone showed a patient undergoing a medical procedure while nude. The complaint filed against Smith states, “The images are explicit and private, and some have the sole purpose to humiliate the patients.” Not only did she take the photos, but she’s also charged with sending 20 pictures to a former co-worker, who also happens to be the father of her child. This man, Ron Whittaker, turned Smith into hospital leadership sometime last week. At this time, Whittaker hasn’t been charged with any crimes. If all of this isn’t enough to cause outrage, police also found two pictures of a 2-year-old girl on Smith’s phone that have been called pornographic. So, along with the 30 crimes of invasion of privacy and abuse of care, she’s also facing child pornography charges. Smith was immediately suspended from Kane McKeesport Community Living Center without pay once the photos were discovered. Then, on May 1st, Smith was terminated when local law enforcement notified the long-term care center that the allegations were founded. In a Pittsburgh Post-Gazette article, Lori Rushe, the daughter of one of the alleged victims stated, “You’re taking advantage of people who don’t know their name, where they’re at or anything” about her father, a 90-year-old man with dementia. Lori told the paper that she noted a new sign on the elevator a couple of weeks ago stating that taking unauthorized pictures of residents was prohibited. She went on to say that she wished the staff had told her the seriousness of the allegations. Understanding Elder Abuse While this case seems pretty clear that what happened to the residents at Kane McKeesport Community Living Center is abuse, let’s just review the definition. The National Institute of Aging notes that there five types of abuse: Emotional Abuse, also called psychological abuse, happens when a caregiver or other person yells, threatens, or repeatedly ignores an older person. Neglect happens when the older person’s needs aren’t met. Physical abuse occurs when someone causes bodily harm to the person, such as hitting, pushing, or slapping them. Abandonment is when an elderly person is left alone without having their needs or care planned or met. Sexual abuse happens when a caregiver forces an elderly person to be part of any sexual act. Signs of Abuse We often think that signs of abuse are only physical and usually visible. However, it’s critical to know that some seniors won’t be able to tell you about the abuse, such as what’s allegedly happened to those at Kane McKeesport. Here are a few things to monitor for if you think there’s been any sort of abuse: Withdrawn Stops taking part in activities they enjoy Has unexplained burns, bruises, or other injuries Has trouble sleeping Seems depressed Weight loss with no explanation Rocks back and forth, or shows other signs of trauma Acts violent or agitated How Would You Feel? It’s probably safe to say that if you had a loved one living in this facility, you would be outraged. But, what about if you worked there? Maybe you were even friends with the nurse who’s been charged and didn’t recognize any signs of this heinous crime? How would you feel? What do you think should happen to Smith? Should she lose her job along with any criminal sentence she receives? Post your comments below. We would love to get your take on the situation.
  2. "You're Fired!" Those words might make you queasy at the thought of hearing them directed at you. Many nurses get fired every day for reasons that range from legitimate to downright ridiculous. And sometimes, you don't have to do anything wrong to be fired. Your actions might be a simple misunderstanding that places your employer at a risk you didn't even consider. Here are a few reasons nurses get fired and how to keep yourself off the chopping block. Breach of Ethics Nursing is a serious profession. Besides making life or death decisions daily, you are held to moral and ethical standards that are much higher than those held by other occupations. Unfortunately, some nurses engage in some of these behaviors anyway, such as lying, not working to the expected level of professionalism, HIPAA violations, or even patient abandonment. How to protect yourself: You may think that following morals or ethics is common sense. But, we all can think of a time or two where the "right" thing might not have made as much sense as other possible actions. Make sure you are familiar with the American Nurses Association Code of Ethics, which consists of nine provisions and interpretative standards. It's a good idea to familiarize yourself with your state's nurse practice act too. On a local level, understand all human resources and ethics policies for your facility. These policies will guide you to your employer's expectations while on the job. Misrepresentation of Your Work You know that if you didn't chart it, it didn't happen. But, what if you chart something that didn't happen? Falsifying documentation is a serious offense. There are many cases of nurses documenting care they didn't provide and most of the time, these cases end with the nurse being caught, disciplined, fired, or even charged with criminal offenses. Take a look at one such story here. How to protect yourself: It's relatively easy to protect yourself from this offense. Do your work. Document accurately, honestly, and thoroughly. Causing Harm to Patients Mistakes happen, but acting recklessly is not accepted in most professions, and nursing is no exception. According to American Nurse Today, malpractice is negligence, misconduct, or breach of duty by a professional that results in damage or injury to the patient. In many cases, the care provided didn't meet the standard of care expected to be delivered by a "reasonably prudent" nurse. How to protect yourself: Communicate appropriately with colleagues, physicians, and other members of the healthcare team. Follow all standards of care. Assess and monitor your patients according to standard practice protocols. Delegate properly and document according to your facility's policy. Diversion Unfortunately, you've seen stories of nurses diverting medications in the news. Controlled substance abuse and addiction affect nurses like anyone else. Many nurses get caught each year for diverting drugs away from their patients and into their own pockets. Diversion can ruin your reputation and put your employer at significant risk. If caught, you can be criminally prosecuted and might suffer civil consequences as well. You might lose your job, your license, and be subjected to monitoring, detox, rehab, and other programs. How to protect yourself: Never start this behavior. You should know the signs of drug diversion, just in case you would notice them in a colleague. Common symptoms of diversion include: Change in behaviors or job performance Multiple absences Long and excessive breaks Withdrawing from colleagues, friends, and family Excessive medication errors Change in mental alertness or confusion Mood changes Incorrect narcotic counts Large amount of narcotic waste Reports of ineffective pain relief from patients Offering to medicate co-workers patients Changing verbal orders False Credentials or Work History No matter how badly you might want a job, never falsify your work history or credentials. You might think that telling someone you have a Master's degree will get you the interview or even the job, but if you don't have these credentials, don't pretend you do. Another licensing issue that can get nurses into a bind with their employment is forgetting to renew on time. You probably don't enjoy completing the required continuing education courses or paying your state to renew your license, but it is a professional expectation and requirement to keep your job. How to protect yourself: Never lie on job applications, resumes, social media profiles such as LinkedIn, or verbally about your credentials or degrees. Be sure to renew your licenses and other certifications on time. Set reminders on your calendar or on your phone to make sure you never miss a deadline. Have you been fired? What lessons did you learn?
  3. Melissa Mills

    Nursing Home Resident Taunted by CNAs

    Leaving your mother or grandmother in a long-term care facility is challenging. For one Illinois family, it turned into a nightmare. A video taken in December of 2018 showed two certified nursing assistants taunting resident, Margaret Collins with a hospital gown. Jamie Montesa and Brayan Cortez posted a video to Snapchat that showed them repeatedly throwing a hospital gown on top of Collins with the caption, “Margaret hates gowns.” Collins, who has dementia, waved the gown away each time. Resident’s Rights If you’ve been around healthcare for any length of time, you know that individuals living in skilled or long-term care facilities have many rights. The scenario above clearly violated several of Collins’ fundamental rights as a resident of a long-term care facility. Right to participate in care Collins not only had the right to participate in her care, but she also had the right to refuse it. She clearly did not want the hospital gown. One could argue that she was agitated at the time. Even if this were true, she didn’t have to wear the gown and could have been dressed in her own attire. Right to privacy and confidentiality Collins had the right to keep the details of her care private. Having a video of herself posted on Snapshot without her or her designee’s explicit consent is a direct violation of this right. Right to dignity and respect Treating any human in the manner that Montesa and Cortez treated Collins greatly lacks both dignity and respect. She also has the right to be free of mental and physical abuse and to determine what activities she wants to participate in during her care. Both of the nursing assistants disrespected Collins in this case. Right to make independent choices Residents living in healthcare facilities have the explicit right to make decisions about what they want to wear or eat and how they want to spend their free time. Their choices should be accommodated and respected by all caregivers. Legal Implications and Disciplinary Action The two nursing assistants were initially given a six-day suspension. After further investigation into the incident, the facility determined that they violated internal policies and standards. Montesa also admitted to previously recording a video of Collins while she was in a wheelchair. When the investigation concluded, the two workers were terminated. In a statement, a representative from the facility said, “The privacy and dignity of our residents are of the utmost concern.” The family of Margaret Collins is reportedly suing the Abington for $1 million in damages. The parent company of the facility and the two nursing assistants are also named in the suit. Collins has been moved from the facility. The family reported that she suffered from anxiety related to the incident. Is Termination Enough? Most people will agree that Montesa and Cortez received what they deserved when they were terminated. However, is it enough? During a search of the Illinois health care worker registry, it appears that both Montesa and Cortez remain certified in the state of Illinois. No administrative filings are on record for either worker. Of course, it can take months or even years for cases like these to come before the regulatory boards. These gaps in time could leave other vulnerable individuals in similar situations. The incident with Collins leaves me wondering how difficult it would be to formally suspend a healthcare worker who is terminated for abuse or neglect. Could this be done? And, if it's done in error, what are the repercussions to the worker? Cases like this may become more common as more people live longer with debilitating conditions such as Alzheimer’s disease or dementia. At some point changes, need to be made by the facilities, training programs, or states who certify and license people who care for the elderly. What are Your Thoughts? What do you think? Did Montesa and Cortez get what they deserved? Should they be allowed to care for others in the future? And, how would you respond if this were your mother or grandmother? Add your thoughts in the comments below. We would love to hear what you’re thinking about this despicable act.
  4. Let's talk dress code. I am certain that everyone has an opinion on this topic. We can discuss nursing whites versus colors or clogs versus gym shoes, but that is just too mundane! Let's dig deeper. Let's talk tattoos! Or, how about unnatural hair color? Oh, and piercings! That's right, let's talk about some controversial dress code topics. The Stats While it is difficult to find statistics on hair color, piercing and tattoo statistics for the general population is quite easy to find. It is estimated that 42% of all adults in the U.S. have at least one tattoo. 83% of all adults have had their earlobes pierced, 72% of which are female. There is an additional 14% of the U.S. population who have a body piercing other than their earlobes. What does this mean? Well, quite simply - it means there are a lot of people who believe that self-expression through body art is acceptable. It means that people, regardless of education, socioeconomic status or occupation, have tattoos and piercings. Nurses are no different. Many nurses, doctors, and other healthcare personnel have tattoos, body piercings and colorful hair. But, should they? Historical Perspective Long gone are the days of white uniform skirts, nursing caps, hose and plain shoes. The idea was that uniformity made nurses easy to identify. Hospitals and other healthcare facilities also used the all-white nurse dress code to reflect a certain image. After all, nurses were and still are the most trusted professionals around. However, over the years, colorful scrubs in a variety of patterns have replaced the traditional white nurse uniform. Now, in a society that supports self-expression and individuality, we are still questioning the role of the uniform for nursing professionals. Patients' Opinions While the research is limited, one study done in 2012 looked at how patients' perceived patient care providers with tattoos and or body piercings. In this study, patients were shown images of male and female patient care providers in uniform with and without tattoos and/or non-earlobe body piercings. The results? Patients perceived the patient care providers with visible tattoos and/or body piercings as less caring, confident, reliable, attentive, cooperative, professional, efficient and approachable. Patients perceived females with tattoos to be less professional than male patient care providers with similar tattoos. Patients also felt that female patient care providers with visible non-earlobe piercings were less confident, professional, efficient and approachable than females with no body piercings. Did the patients get it right? Most of us can think of at least one tatted-up nurse who can run circles around their non-tattooed counterpart, so is there any validity in this thinking? Is this where we are today? A New Era Some people may feel that we are on the verge of a new era when it comes to tattoos, hair color and piercing policies for hospital staff. According to Becker Hospital Review, as of January 1, 2018, Mayo Clinic has instituted a new dress code. Becker Hospital Review reports that under this new rule, tattoos "may be visible if the images or words do not convey violence, discrimination, profanity or sexually explicit content. Tattoos containing such messages must be covered with bandages, clothing or cosmetics. Mayo Clinic reserves the right to judge the appearance of visible tattoos". Mayo Clinic has long been known for its professional appearance and conduct of employees. The hospital continues to stress that all employees are expected to project a professional appearance and demeanor. Mayo Clinic is not the first or the last healthcare facility that will change their dress code policy. Industries outside of healthcare have been feeling this shift for many years. There are simply many people in healthcare that feel that allowing these forms of self-expression will make patients feel uncomfortable or less trusting of the staff in general. How Do You Feel? Do you have tattoos? If so, have you ever felt judged by administration, other healthcare professionals or patients because of your tattoos or piercings? Do you believe that nurses and other healthcare professionals should not have visible tattoos or piercings or keep them covered? I would love to hear how you feel.
  5. Going to work should not be dreadful. However, for many nurses, the stress, burnout, and culture can sometimes make it downright painful to get dressed and head to work. After days, weeks, months, or even years of these types of feelings, you might lose the love you once felt for the profession. If you’re going through this, you must remember that you are not alone and that these feelings are normal. If they hang around for a few days or a month, it’s probably not too concerning. But, any longer than that and you may need to start looking at strategies to help you bounce back and reignite the passion you once felt for your career. Here are a few of my favorite things you can do to get back on track. Take Time Off Americans let 768 million vacation days go unused in 2018. This equals billions of dollars in lost benefits and often means that workers aren’t getting the rest, relaxation, and restoration they need. Unfortunately feeling like you’ve lost your passion for your work can sometimes be a double-edged sword. You feel burnout, so you keep working with the hopes of finding something that will reignite the passion you once felt. Unfortunately, it often makes the situation worse. If you’re feeling disconnected from work, talk to your manager or supervisor about scheduling in a few “mental health” days. Don’t plan any major events on these days, instead book time doing something you love. Or, you may want to make an appointment to get a massage, pedicure, or other restorative treatment. Treat Symptoms of Burnout Burnout is a challenging condition. If you start feeling like every day is a bad day or you’re exhausted all the time, you might be dealing with burnout. Other symptoms to watch for include: Feeling worthless or hopeless Feeling bored or overwhelmed Feeling under-appreciated Exhaustion Frequent illness Headaches or muscle pain Change in sleep patterns Change in appetite If you are experiencing any of these symptoms of burnout, you need to get the treatment you need. Talk to those around you about how you are feeling. If you have a workplace mentor or a boss you trust, start there. They may have noticed these changes, too and can offer invaluable feedback. You should also try to increase your connection with your coworkers, but avoid interactions with negative individuals. You might also need to look for activities outside of work that can increase your feelings of meaningfulness and purpose. Look for a New Specialty Sometimes feeling overwhelmed and unhappy can be a sign that it’s time for a change. If you work in a specialty like hospice, oncology, or other high-acuity areas, you may need to consider looking for a new area of nursing to try. Not only can a change decrease your level of stress, but it can also help you find your passion through learning about new areas you never thought about before. Work With a Coach or Mentor Reaching out to another nurse who has maybe experienced these same feelings can be helpful. If you have a mentor, start there. If not, it might be a good idea to hire a career coach who is also a nurse. You can discuss your feelings with them and also ask them for ideas of other areas of nursing that could be a good fit with your background. Take Care of Yourself It seems that self-care, getting plenty of rest, and eating a well-balanced diet is a good answer to just about any problems we have in life. And, feeling burnout and drained at work isn’t any different. Carve out time to get at least 30 minutes of moderate-level activity each day. Find a diet that is low in carbohydrates, junk food, and sugary foods. You might want to consider one that is plant-based or at least has high amounts of fruits and vegetables. Finally, make sure you are getting eight hours of sleep every night. Getting Back on Track Remembering your passion for nursing can be challenging when you are in the midst of burnout and other feelings of disconnection from your work. You can use these ideas, but there are also many other ways to reconnect with your passion for the art of nursing, it just takes a little work and time. Have you ever experienced burnout or “fell out of love” with nursing? What helped you get back on track? Share your ideas with us by posting in the comments below. We would love to hear them.
  6. Over 56,000 qualified nursing school applicants were turned away in 2017. You read that right - 56,000. This is happening while hospitals and clinics continue to report a nursing shortage. According to Becker's Hospital Review, some of these qualified applicants are graduating high school with a 3.5 GPA or higher. These are candidates that will likely be successful nursing students. You may be wondering why this is happening in the middle of a nursing shortage. Let's discuss the statistics, reasons for the problem, and a few solutions. The Statistics Here are a few concerning statistics about the number of aspiring nurses being turned away each year by nursing programs: The National League of Nurses reported that up to 45% of ADN applicants and 36% of BSN applicants were turned away in 2014 Cabrillo College in Aptos, California reported having hundreds on their wait list for a 60-seat nursing program Many schools are saying that applicants will be on wait-lists for up to six years and some schools are discontinuing wait lists altogether The Reasons To fix the problem, you need to understand why thousands of students are turned down each year by nursing schools across the country. Not Enough Instructors Nursing faculty positions go unfilled year and year. In fact, the American Association of Colleges of Nursing reported in their Special Survey on Vacant Faculty positions that the United States has an annual national nursing faculty vacancy rate of slightly over 7%. This equates to about two teachers for every nursing program out there. And, over 90% of these vacancies require or prefer the nurse filling the position to have a doctoral degree. The survey went on to break down the vacancies by region. The most substantial number of vacancies can be found in the Midwest, with nearly 10% of all faculty positions remaining unfilled. Just behind that region was the South (9.7%), North Atlantic (9.5%), and finally the West (9%). If you look at the issue by type of institution - 9.6% of all vacancies are found at public colleges. And, one more break down tells us that the largest number of vacancies are in Baccalaureate programs (14.6%). Do Nurses Want to Be Instructors? Being a nursing instructor may be of interest to many nurses until they begin doing their homework about the position and salaries. Up to 18% of all faculty positions do not have a tenure system at the institution, and another 32.6% of the jobs just don't qualify. The amount of education required for these vacant positions appears to be another barrier. Over 22% of all vacant positions required a doctoral degree. The special report by the AACN also reports that many schools have insufficient funds to hire new faculty. And, in some schools, the administration doesn't support the additional faculty positions, even though they are turning away potential students. Clinical Space Shortage All programs require a significant amount of hands-on experience in a clinical setting. Finding nursing units available for clinicals can be a challenge for nursing programs. If we had enough faculty, would they receive the training they needed? The answer is probably, no. Many schools are reporting that there are a limited number of clinical spaces for students to get this experience. And, finding preceptors in specialty areas can be another barrier. This has further compounded the need to turn away qualified nursing school applicants. Higher Clinical Nurse Salaries As clinical nursing salaries continue to grow, nursing faculty salaries have not been able to compete. Up to 33.9% of schools with faculty vacancies reported that noncompetitive wages were to blame for the inability to fill the position. In fact, the AACN reported in March 2016 that a masters-prepared faculty member made an average of $77,022 per year. Compare this to a masters-prepared nurse practitioner salary of $87,000, and you can easily see why these positions are difficult to fill. The Answers Identifying the problem is only half the bottle. Let's explore a few solutions to this nursing dilemma. Bridge Programs Many nurses choose nursing as a second career. Or, they start out as an LPN or ADN and move up to a master's or doctoral prepared nurse later on in their career. Professionals can make these transitions with the use of bridge programs. These programs allow qualified candidates to continue their education when it's convenient for them. These programs have adopted an online format over the past several years, making it even easier for nurses to continue to work and advance their education. With the help of bridge programs, some of these faculty positions could be filled. Think Outside the Box for Clinical Sites As our healthcare environment moves away from extended hospital stays, nursing programs need to consider new locations for clinicals. Instructors are now turning to rehab centers and nursing facilities to gain exposure to patients who were once kept after surgeries and other procedures. Nursing jobs are changing too. Looking for preceptors in-home care, hospice, and other community-based settings is crucial for the future of nursing education. And, it gives students exposure to non-hospital nursing career options. Create a Competitive Salary Structure Teaching is such an essential career, yet, teachers across all industries seem to have lower paying salaries. There is undoubtedly a demand for more nursing instructors, so this needs to be rectified. If you are interested in pursuing a career as a nurse faculty member - you can increase your earning potential based on the location and type of school. You may also look at roles, such as nurse education director, to improve your salary. What are your thoughts about nursing schools turning away qualified applicants? Have you experienced a long wait-list or other issue related to starting your nursing education? We would love to hear your thoughts and experiences.
  7. You’ve probably felt the effects of workplace burnout at least once in your nursing career. As of this week, burnout has officially been recognized by the World Health Organization (WHO) as a formal occupational phenomenon. Clinicians of all types have been living with the effects of short staffing, stress, and other patient barriers that seem to zap their energy and ability to provide the best care. Burnout is now defined as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It’s characterized by reduced professional efficacy, feelings of exhaustion, and increased mental distance or negative feelings about your work environment. Nurses and Burnout The concept of burnout has been around since the 1970s when psychologist Herbert Freudenberger coined the term. When you’re under high levels of stress for an extended period, it’s common to start to feel tired and unhappy. However, the phenomenon doesn’t only make you want to sleep. It can create psychosomatic issues like anxiety, depression, and insomnia, too. Nurses in burns units, critical care, pediatrics, and emergency departments are at a greater risk of developing the condition. The high levels of care and increased uncertainty of outcomes in these areas can take their toll on the mental and physical faculties of any nurse. Other causes of burnout include inadequate staffing and caring for those who are nearing death or actively dying. You might also struggle with burnout if you’re a newer nurse or have continued conflicts at work that challenge your values. How Can You Prevent Burnout Many people think that burnout is driven by the way each nurse deals with stress. However, some experts believe that burnout is a consequence of administrative processes. This means that preventative measures must be initiated on a global level if you want to see changes in the level of burnout nurses experience. Here are a few ways administrators can help to minimize the number of nurses affected by burnout. Improving Communication Methods The concept of interoperability isn’t limited to the patient’s medical record. If you must access multiple platforms to gather information and then manually synthesize the data to make care decisions, this could be adding to your level of burnout. Another factor in communication involves having to search for policies and procedures, rather than having these types of resources in one central location. Think About Scheduling Whether you work 3-12 hour shifts or 5-8 hours shifts, nursing is challenging. Many nursing units have rigid scheduling policies that make it challenging to take a day off at the last minute for “mental health” needs or family events. You might also not get your schedule more than a week or so in advance, so scheduling life outside of work can be difficult. Facilities need to learn ways to adopt flexible scheduling policies so that nurses get the time off they need. This might mean hiring more staff, so that weekend rotations are decreased or using “prn” staff to fill in during times of high acuity. Some units use self-scheduling as a way to increase satisfaction with schedules Consider Nurse-to-Patient Ratios A 2018 study conducted at Marshall University concluded that nurse-to-patient ratios are directly related to nurse productivity and overall health, including mental, emotional, and psychological factors. Not only did the researchers find that the health of the nurse was in jeopardy during times of inadequate staffing, but they also suffered from job dissatisfaction. In California, nurse-to-patient ratios are mandated, but the rest of the country is left to the individual policies of healthcare facilities. More nurses are advocating for set staffing ratios and working with lawmakers to initiate legislation. However, this can take years for it to become the norm across the nation. Does the New Recognition from WHO Help? Do you feel that recognizing burnout out as a workplace phenomenon will help support issues such as staffing ratios, long hours, and job stress? Will employers finally look for new methods to fix the problems that plague nursing units? What do you think? Share your thoughts in the comments below.
  8. Have you ever seen a double-pan balance scale? It’s a scale that has two pans that are balanced against one another. As you put weights on one side, you must counter it with weight on the other to maintain balance. If you read about these scales, you will find that you must put weight on them in very small increments to maintain equilibrium. You must also take into account the weight of the container that you use to help balance the two sides. The idea of nurse work-life balance works the same. For everything you do at work, you need to offset it with something at home to keep balance. And if you take time for yourself at home, you would need to ramp up work to meet the weight of what you just did for yourself at home. This concept would keep work and home life equal in function, value, and amount. The more you think about this notion, the more you may consider that this is not a safe or healthy life for nurses. Maintaining a complete balance between work and home will likely lead to burnout, fatigue, and career unhappiness. Let’s take a look at the dangers of work-life balance in nursing. Work Doesn’t End When You Clock Out In today’s world of technological advancements, walking away from work is challenging. Even when you aren’t within the confines of the hospital or long-term care facility, you are probably connected. You may receive emails on your phone or text messages from coworkers letting you know that Mrs. Johnson took a turn for the worse. You might even carry a laptop home with you that seems to call your name each time you sit down to take some time for yourself. It’s easy to think, “I’ll just check on a few things. It will only take 10-15 minutes,” and before you know it, it’s been three hours and you are knee-deep in work that you shouldn’t be doing until tomorrow or the day after. This can further tip the scales of nurse work-life balance towards unbalance. Challenge of “Leaving Home at the Door” Have you ever had a supervisor tell you that you need to leave your home life and any problems at the door when you come to work? In theory, this is a good concept. However, it isn’t always practical. If you have an ill child, parent, partner, or another family member, you might have to answer questions or check in on them at work. And, sometimes life gets messy in ways that you just can’t “turn-off” because you are at work. Trying to block out home life when you’re working can tip the scales in a way that could lead to an unhealthy home life. Balance Can Be Dangerous Trying to keep balance in life could be dangerous. Think about it, your body is rarely in perfect balance. When you walk, you need a little imbalance to keep moving. When you are perfectly balanced, you are standing still, not moving forward or achieving any goals. The same could be true with the idea of work-life balance. If work and home are equal, you are likely not moving forward in either place. It’s important to allow the scale to shift from time to time. Maybe this month you are doing continuing education and a conference that requires work to be a little on the heavy side. But, next month you have plans to take a few days off and will be resting and having fun with friends and family. This is a healthy mix of imbalance that can help you move forward in both areas of your life. What Are a Few Strategies to Be a Healthy, Imbalanced Nurse? Call in When Needed Raise your hand if you’ve ever called in and felt extremely guilty about it. Okay, a sea of nurses' hands just went up! Nursing is a challenging career. If you or a loved one are sick, you may need to stay home. Heck, sometimes you just need to spend more time at home, even if no one is ill. You might need a “mental health” day or need to spend time with a child who is having a hard time at school. While it might feel that you are letting your coworkers down, it’s critical to remember that your sick days are “yours” and you get to use them as you see fit. Your employer provides these days to give you time to address family needs, so use them! Make Work Your Focus When you are at work, be present. We all need to check in on kids every now and then, but it’s essential to have a structure at home that can handle the nuances of life when you are at work. This means hiring a babysitter, putting a little more responsibility onto your partner on days you work or asking for help from family and friends. Plan Professional Development You became a nurse to help others. To do this, you have to invest in your continuous improvement and education. One of the best ways to do this is to join professional nursing organizations and get involved. Go to the annual conference and participate in education and self-improvement activities. Be sure to structure home life in a way that allows you to fully engage with your educational opportunities. Plan a Vacation Going on vacation might seem like a luxury that you can’t afford. However, it’s vitally important to give your family a good dose of imbalance at least once a year. Plan a trip or cruise and completely disconnect from work. Let coworkers know that you are off and need to not be contacted about work. This doesn’t mean your work-bestie can’t text you, it just means that they need to not tell you about the issues at work, but can check in to see how you and the family are doing. An imbalance is good. How do you keep a little imbalance in your life to stay healthy? Leave a comment below to get the conversation started.
  9. On Saturday, June 8th nurses, doctors, and medical students stood side-by-side to protest the American Medical Association’s (AMA) annual meeting in Chicago. The AMA, which was founded in 1847, is a large, powerful, and wealthy lobbying group. However, it seems that many young physicians and medical students don’t agree with the work done by the group. In fact, in 2016, it was reported that the AMA only represented about 25 percent of practicing physicians. This decrease was a significant change from just a few decades ago when nearly 75 percent of all physicians were members. #AMAGetOutTheWay If you perform a quick social media search for #AMAGetOutTheWay, you will find support from many healthcare professionals fighting for Medicare for all. Experts believe that adopting a Medicare for all system in the United States would allow us to join the ranks of the rest of the industrialized world where health coverage is universal. They also feel that this would save money and improve health outcomes. Protesters feel that the AMA isn’t fighting for the right initiatives. Adam Gaffney, President for Physicians for a National Health Program and an instructor at the Harvard Medical School, made his feelings known at the rally. “The AMA is not fighting for their patients, they’re not fighting for the uninsured, and they’re not fighting for the underinsured. We’re here today because the AMA is again on the wrong side of history.” Other groups well-represented at the rally included Students for a National Health Program (SNaHP), National Nurses United, People’s Action, and The Center for Popular Democracy. SNaHP published on their website that showing up at the rally showed support by “taking a stand AGAINST corporate greed, misleading advertising, and the profit motive of health care.” National Nurses United is the largest union and professional association for registered nurses and supports Medicare for All. What is HR 1384? Medicare for all isn’t just a catchy slogan used by Democrats like Bernie Sanders. It’s a legislative proposal, HR 1384, that would create a nationwide health insurance program for all U.S residents. A single-payer system such as this would replace the current mixed healthcare system which includes private and public health programs. It also has a provision to allow people to purchase public coverage during a transitional period to this new system. Who Would Be Covered? HR 1384 aims to provide coverage to all U.S. residents, documented immigrants, and even undocumented people. The program would prohibit anyone from being excluded because of citizenship status. How Would it be Funded? This single-payer system would not require premiums to be paid. However, it would require new federal taxes for both businesses and individuals. What Would Be Covered? All medical care would be covered under this system. Those who support HR 1384 proudly boast that it would also cover reproductive health services. This would include maternity and newborn care. The Power of Unity Regardless of your opinions about HR 1384, the rally in Chicago is an example of what could happen when healthcare workers come together. It’s estimated that there over one million physicians and nearly three million nurses in the U.S. Imagine how workplace problems and care deficiencies could be approached with this type of unity. Would we be able to solve some of the top problems that plague healthcare? Just think for a minute how discussions about safe staffing, workplace violence, and long working hours might change if these two “strong-in-number” groups stormed the offices of administration and lawmakers across the nation. Where Do You Stand? There are so many different conversations that could come from this one event. Do you support a Medicare for all system? And, what do you think about the unity that was displayed at this protest? Oh, and what other issues do you think a unified front could impact? Let’s start there for now. Tell us what you think!
  10. Your job title probably means a lot to you.It might even be as important to you as your birth-given name. You went to school so that you could write specific letters behind your name, such as LPN, RN, or FNP. However, if you decided that it was easier to tell your patients that you were a caregiver, caretaker, or health assistant, would it matter? What if your preferred title was one that other professionals feel is reserved only for them? For one advanced practice registered nurse, it mattered quite a bit. In fact, it was important enough for him to be able to call himself an anesthesiologist that he fought for this right in front of the Florida Board of Nursing. Nurse Anesthetist vs. Anesthesiologist John McDonough has identified himself to his patients as a nurse anesthesiologist for years. After recently appearing before the Florida Board of Nursing, McDonough can legally use this title. However, the Florida Society of Anesthesiologists doesn’t agree with the decision. Chris Nuland, an attorney, and lobbyist for the organization told The News Service of Florida, “The FSA firmly believes that, although this declaratory statement only applies to this one individual, this sets a dangerous precedent that could confuse patients.” McDonough didn’t mince words regarding how he feels about his right to call himself an anesthesiologist. He was quoted in an article on nwfdailynews.com saying, “I’m not a technician. I am not a physician extender. I am not a mid-level provider. I am, in fact, a scientific expert on the art and science of anesthesia. So I think anesthesiologist is a perfectly acceptable term, especially since the term anesthetist has been hijacked from my profession.” He goes on to offer similar examples to his situation like dentists who identify as physician anesthesiologists. Florida's Board of Nursing seems to make several statements about the role of advanced practice nurses these days. They are also deciding if advanced practice nurses can practice independently from physicians. Other nursing boards across the country are making critical decisions about the expansion of advanced practice nurses to work with greater autonomy. Given the continued expense of healthcare and the increased need due to an aging population, it only seems logical to allow these nurses more ability to work with less oversight. Understanding the Role of the APN It’s essential to know that the term APN refers to several different types of nursing professionals. These various roles perform tasks such as diagnosing illnesses, performing head-to-toe physical exams, providing specialized exam such as functional and developmental testing, ordering lab tests, performing a variety of testing, and dispensing medications. APN includes the following Certified Nurse Practitioner Certified Registered Nurse Anesthetist Certified Nurse Midwife Clinical Nurse Specialist Advanced practice nurses have various levels of autonomy across the country. Some states allow APNs to operate clinics or offices independently. Other states require physician collaboration or supervision at all times. Because each type of APN has a different job description and role, the settings in which they practice and how they practice varies too. For example, a family nurse practitioner may work in an office with one or two MD’s and only consult on cases as needed. For roles like a nurse anesthetist, the setting is likely larger, and they usually work with doctors and surgeons while performing their job functions. What Do You Think? So, what’s in a name? Does it matter if you call yourself a nurse or caregiver? Should nurse anesthetists be limited to this term or should they be allowed to call themselves an anesthesiologist since this is the specialty for which they are certified? Let us know your thoughts by leaving a comment below.
  11. You probably know happiness when you feel it. As a nurse, you may feel those positive emotions that come with a deeper purpose when an acutely ill patient turns the corner toward better outcomes or a patient living with cancer finds out they are in remission. You also feel happiness in everyday life when you reach goals, spend time with loved ones, or enjoy a nice dinner with friends. However, happiness isn’t something that comes easy for everyone. According to the World Happiness Report, the United States ranks nineteenth in the most satisfied countries in the world, with Finland, Denmark, and Iceland ranking in the top five. American adults have been experiencing a decrease in happiness since 2000 and reporting more thoughts of suicide, depression, and acts of self-harm since 2010. These statistics are scary. Nurses can experience high levels of stress-related to work environments, short-staffing, and the emotional aspects of working with ill and injured individuals each day. Combine your work with the statistics about happiness in the U.S., and you can see why it’s critical to take your happiness serious and plan out ways to increase your happiness quotient daily. Here are ten ways you can increase your happiness today. Create Happiness Goals Ok, you might think this sounds silly, but we live in a country where happiness is dying. So, having a goal to meet up with friends once a week for happy hour or planning a date with your partner is good practice. Find a Hobby Finding a hobby can be challenging. If you are looking for a hobby, think about what you loved to do as a child. Did you enjoy painting or crafts? If so, this might be an excellent place to start. If getting started on your own feels like a daunting task, find a class to take that can get you started with the basics. Use Your Vacation Time A recent report revealed that a record 768 million vacation days went unused in the U.S. in 2018. This is an increase of 9% from 2017 and adds up to billions of dollars lost in benefits. Dedicated nurses can sometimes feel guilty about taking vacation days and leaving their coworkers short-staffed. However, your vacation time is critical to your health and ability to refuel so that you can continue caring for others. Stay Healthy Nurses are skilled in educating patients on ways to stay healthy. You teach about diet, exercise, and chronic disease management. But how well do you keep you with your own wellness? Make your health your number one priority. Get plenty of sleep each night, eat a well-balanced diet, and get at least 30-minutes of activity daily. Practice Gratitude Each of us has many blessings in life. Expressing our gratitude can boost your mood and remind you of reasons to be thankful. Try telling the most important people in your life how you feel about them. Or, keep a gratitude journal to jot down two to three things you are thankful for each day. Ask for Help When You Need It Whether you need a little assistance with an admission or a patient who needs a PRN medication, asking for help can make your day run a little smoother. You should also ask for help outside of work when you need it too. If you feel that your happiness tank is getting dangerously low and you are struggling with symptoms of depression or suicidal thoughts, make an appointment to talk to a counselor or psychologist. Take a Walk Getting outside can boost your spirits. Feeling the sun on your skin and the wind in your hair is an excellent way to inject a little bit of happiness in the middle of a busy day. If you’re having a stressful day, take a 15-minute break to get outside and get a little sunshine. Volunteer Your Time Nothing can boost your mood quite like giving freely of your time and gifts. Find a charity organization that aligns with your purpose in life and spend some time working with others who may be less fortunate than yourself. Have a Good Laugh Did you know that laughing releases endorphins, the feel-good chemical, into your bloodstream? Laughing also relaxes muscles and can relieve built-up tension and stress. So, the next time you are looking for ways to boost your happiness, catch a comedy show, hang with your bestie who knows just how to make you laugh, or play a fun game with your family. Practice Mindfulness Life is busy. Whether you’ve received your fourth admission for the day or you’re trying to balance work and family life, taking time to connect to the present is critical to your happiness. The good news about mindfulness is that you can practice it pretty much anywhere. Find a quiet place like the breakroom at work or your bedroom at home and sit down in a comfortable position. Then, close your eyes and take ten deep breaths. As you breathe in, silently and slowly count to four, then hold your breath for a count of four, followed by a long exhale for a count of six. Do this for at least one cycle, but preferably two to three times. Happiness is a much-needed emotion. If you don’t plan ways to increase your happiness in your everyday life, you can start feeling sad, depressed, or disconnected from those around you. What other ways do you increase your happiness? Comment below to let us know what activities bring a smile to your face.
  12. In 2018, TIna Suckow, a 49-year old nurse, was brutally beaten by a patient at a state mental facility in Iowa. Suckow had been employed there for over 4 years when the incident occurred. A “code red” alert was issued, and multiple staff members responded, one of whom was Suckow. A patient, who is said to have been in a manic episode, was throwing furniture and threatening physical violence. Staff members brought in a “turtle shield,” an assault-protection device the facility had recently purchased, but not yet trained staff to use. Shortly after this device was brought out, Suckow became trapped between the shield and the patient. She was then beaten unconscious and hospitalized with injuries to her shoulder, knee, and head. She has undergone several surgeries and continues to need medical treatment today. Share Your Thoughts via Video During the incident, officials at the facility didn't call law enforcement to investigate the situation, which has left Suckow feeling like a target. “I’m not the criminal here,” said Suckow, “I didn’t do anything wrong.” The Nursing Director at the facility, Georgeanne Cassidy-Westcott sent an email two days after the incident informing staff about the opportunity to use the “turtle shield” and stated that while they had not trained on the use of the device, it was “fairly effective” when used in this situation. Suckow contends that during her time off, she was not treated fairly. She reports that other staff who were off for medical reasons were allowed to send in paperwork electronically. However, Suckow was required to make a two-hour round-trip drive to deliver her paperwork in person. After her federally mandated time-off ended, Suckow made two requests. First, she requested catastrophic leave, which would allow other employees to donate sick time so that Suckow could extend her time on payroll. This was denied. Her second request was for time off without pay. However, the state rejected this request as well and is protected to do so under a 2017 state law that limits government employee unions to negotiate on the employees’ behalf for anything except pay. According to a ucomm blog article, the union reports that terminations and forced resignations have tripled since the 2017 law went into effect. Some people in Iowa believe this number is low because it doesn’t account for state workers who have been forced to resign and others who like Suckow, have been injured on the job. In fact, Suckow’s state employment record doesn’t even list her as being terminated. Another result of this legislation is that hospitals are now struggling more with being understaffed, which places patients and workers at risk of more safety concerns. Danny Homan, president of the American Federation of State, County, and Municipal Employees Iowa Council 16 told the Des Moines Register, “Any reasonable human being should have concern because if it’s OK for the state of Iowa to treat workers this way, then Casey’s can do it, Ruan can do it, any employers in the state of Iowa can do it.” Even in light of this horrific situation that Suckow has endured, lawmakers still support the 2017 law. State Rep Steven Holt, helped to get the bill passed. He believes the changes have created a fairer balance between workers’ rights and government operations. He told the Des Moines Register, “There are plenty of horror stories to go around in the old system as well.” Holt also believes that a connection between unfair treatment by managers can’t be tied to the law. Should lawmakers and citizens of Iowa accept the 2017 law because it’s not “worse” than the previous law? Or, should the union and the employee have more rights in this situation? What do you think? Share Your Thoughts via Video
  13. Ah….fall! That time of year where we start to prepare for winter. Autumn brings leaves, pumpkins, and warm sweaters. Everyone heads outside for bonfires, football games, and trick-or-treating. Yet, lingering right around the corner is flu season. This isn’t a season that brings joy and happiness. The flu is a dangerous and even deadly virus that is preventable. Here are the essentials you need to know about the Influenza vaccination recommendations from the CDC for 2019-2020. What is the Flu? Influenza, commonly called the flu, is a respiratory infection. The flu can cause serious complications in those who are compromised for any reason, such as older adults, young children, or individuals living with conditions that decrease their ability to fight off infection. Vaccines are not 100% effective. However, they are the best way to prevent the flu and possible complications. How are flu vaccines created? Flu viruses are constantly changing. Each year, researchers across the country, study the current strains, and review the composition of vaccines. Updates to the vaccines are needed to match the viruses that are seen the most. There was a delay in selecting the viruses for the 2019-2020 season due to frequent changes in some of the common viruses. Flu shots protect individuals against three or four viruses that are expected to be most common during the season. Four vaccines will be available to the public this year. Medication Rights: Right Patient, Right Time Annual flu vaccination is recommended for everyone over the age of six months unless contraindications exist. Getting vaccinated is of utmost importance for a few specific populations, including women who are pregnant, young children, and older adults. Young children may need up to two doses of the vaccine to be fully protected. Other populations that are at high risk of complications from the flu include individuals living with obesity, liver or kidney disease, diabetes, HIV/AIDS, asthma, cancer, COPD, or cystic fibrosis. Will there be Enough Vaccine this Year? The amount of vaccine available each year depends on manufacturers. The projection for the 2019-2020 season is between 162 million and 169 million doses for the U.S. alone. These numbers may change depending on how the season progresses. Arguing for Mandatory Flu Shots If you work around people with the flu, your chances of contracting the virus are increased. Getting the vaccine not only protects you, but can also help to protect your family, friends, and patients. Individual’s with the flu are contagious one day before symptoms show up and up to seven days after becoming sick, which means that many people can pass the flu on to others without even knowing it. The CDC recommends that all U.S Healthcare workers get vaccinated against the viral infection. More than 78% of all healthcare workers received the vaccine during the 2017-2018 season. Doctors and pharmacists were the most vaccinated at 96.1% and 92.2% respectively. Nurses came in at 90.5% and nurse practitioners at 87.8%. Healthcare workers in long-term care settings were the least likely to get the vaccine, and those in hospitals were the highest. Some healthcare settings mandate flu vaccines for all clinical and non-clinical staff. These clinical setting had the highest rate of coverage at 94.8%. Arguing Against Mandatory Flu Shots While the CDC recommends getting vaccinated, not everyone wants to get a flu shot. Hospitals report that making flu vaccines mandatory is to protect patients. However, what about the rights of the healthcare worker? Researchers report that vaccinating healthcare providers will help with patient safety, increase the effectiveness of the vaccine, and protect those staff who are at an increased risk of complications from the virus. Those who oppose the vaccine report factors like side effects of the drug, setting a precedent to require healthcare professionals to comply with other medical treatments, or just feeling like a shot isn’t needed as their reasoning for opposing the requirement. Many nurses feel that following standard and transmission-based precautions such as hand washing, wearing masks, and even keeping people in isolation should be enough to minimize the spread of the infection. How Do You Feel? Vaccines can elicit much debate these days. And, requiring professionals to take a medication that they don’t want could cause some tempers to flare. So, where do you stand on the issue? Take our poll so that we get an idea of how many of you only take the vaccine because it’s required at work. And, comment below to let us know how you really feel about the topic.
  14. Have you ever been faced with a situation where you had to make a life or death decision knowing that it could jam up your license or even cause you to lose them? Jennifer Jacobs, a Registered Nurse, working in a public school made a challenging decision last year when a seventh-grade student who had diabetes came to her office during lunch with low blood sugar. When the student entered the school nurse's office, she was greeted by Heather Wengler, LPN who jumped to action. Jacobs was at lunch at the time, but returned and began assisting within a few minutes. The two nurses gave the student food and glucose tabs only for her blood sugar to continue to drop. At one point, the student fell to the floor and went unconscious. Jacobs told the Tri States Public Radio, "[She] wasn't seizing but was tremoring, and her eyes were rolling back in her head….." Jacobs gave a dose of glucose gel. However, because the student was drooling, it ran right out of her mouth. This is when the two nurses conferred with one another and decided to make a difficult decision. They knew the student needed a dose of glucagon, but this particular student didn't have the drug in her supplies. However, another student did. And, in the state of Illinois, glucagon isn't a drug that schools keep in stock for nurses to give following a standing protocol. Jacobs told the news channel that she knew giving the drug might mean losing her license and placing the school district at huge liability risk. She also knew that the other option was to do nothing and risk the student slipping further into the hypoglycemic episode, seizures, breathing difficulty, and ultimately death. She made the split-second decision that was confirmed by Wengler to take the glucagon from the other student's supply and administer it to the student in distress. Paramedics arrived and delivered a second glucagon dose on the way to the hospital. The student made a full recovery, and the school replaced the dose of glucagon to the student for which it was ordered. You might think this story ends here. However, Jacobs knew that she needed to do something about this law that left her placing herself in jeopardy to do the right thing for the student. She contacted her state representative, Michael Halpin of Rock Island to discuss the possibility of changing the law to add glucagon to a list of other drugs that can be given per a standing protocol. These drugs include an EpiPen for allergic reactions, Narcan for opioid overdoses, and an inhaler for asthmatic episodes. Halpin agreed to help with the legislation which has now cleared the house and will soon be heard in the Senate. So far, the proposed law has been met with unanimous approval. The most impressive part of this story isn't that Jacobs gave the medication. It's that she recognized a barrier to care, took the risk, and then refused to sit back and allow this to be another Illinois school nurse's dilemma in the future. She acted with quick and just decision making to see what more she could do. Have you ever been faced with a similar care issue where you had to decide between "right" and "legal"? If so, we would love for you to leave a comment and let us know about the situation, how it turned out, and if you would do it again. If you have never been in a similar situation, share your thoughts on Jacobs' and Wengler's actions. Would you have done the same or do you think they should have acted in another way?
  15. If you watch the news or TV shows, you might be led to believe that there is a high risk of firearm homicide. Researchers from Northeastern University, University of Washington, and Harvard University conducted a study into the perceptions of gun violence and the leading cause of death in the United States. They found that the presence of a firearm in a home increases the risk for suicide, which is more common than firearm homicide. So, what's behind our misconception about gun violence and how do you educate the community about the real dangers? Looking at the Numbers According to the Brady Campaign, the oldest organization in the gun violence prevention movement, 96 people die every day in the United States from gun violence. Of these 96, 34 are murdered, and 59 die from suicide. That means nearly twice as many people die from firearm suicide compared to firearm homicide. There are also 246 people shot daily who survive - 183 are injured in an attack, 49 are shot unintentionally, 4 are shot in a legal intervention, and 11 survive a suicide attempt. A 2014 study published in the Annals of Internal Medicine reported that access to firearms in the home increases your risk of violent death by suicide, homicide, or unintentional injury. There was a direct correlation to the risk of suicide among people who had access to firearms compared to those without access. The study also reported that the US has one of the highest rates of access to firearms in the world. Could impulsivity and the ease of access to a gun place some people at a higher risk of committing suicide or homicide? The study suggests that it's possible. Yet, there are no hard data to support the claim. States with the highest rates of firearms, also have a higher percentage of firearm violence compared to non-firearm violence. Is it a Public Health Issue? According to the American Public Health Association (APHA), gun violence is an issue that is deeply rooted in our culture and must be addressed through a public health approach. Violence research should be conducted to ensure that guns don't fall into the wrong hands. APHA also believes that access to mental health services must be expanded to those who need it most to decrease the number of suicides by firearms. Do Nurses Have a Role In the Firearms Debate? Every day nurses in Emergency Rooms across the country come face-to-face with the gun violence issue. They might deal with victims of homicide, suicide, and unintentional shootings. Nurses who work in schools have become far too familiar with the issue over the past few years. The National Association of School Nurses released a Position Brief in which they state that school shootings in the US are an urgent public health crisis. The NASN advocates for safe school environments for all children and recognizes the emotional and physical effects that gun violence has on our students. This doesn't account for nurses in the ICU, rehabilitation units, and many other settings that might care for gunshot victims. Unfortunately, healthcare workers can fall victim to gun violence, too. Recent research has highlighted the prevalence of suicide among nurses. And, gun violence in hospitals and other healthcare facilities seems to happen at an alarming rate. In fact, just a few weeks ago, a young doctor was killed in the parking lot of Mercy Hospital in Chicago at the hands of her former fiancee. What Can You Do To Help? Gun violence is a hot political debate these days. No matter which side of the aisle you stand on, as a nurse there are a few things you can do to help keep patients safe: Educate patients about the risks inherent in having a gun in their home. It's particularly important to speak to parents of young children about safe storage of all firearms. Connect patients with mental health concerns to services as quickly as possible. Many patients have mental health needs that if left unattended can quickly lead to violence towards themselves or others. Participate in violence prevention and intervention programs at your hospital or facility. None of us want to discuss or consider that a shooting could happen at our workplace, but unfortunately, the risk is real. Write to your elected officials to make your viewpoints on the issues known. Advocate for more research to be done to increase our understanding of homicide, suicide, and those who commit both. What are your thoughts on the firearm statistics? Do you feel that nurses have a place in the firearm debate? Let us know your thoughts in the comments below.
  16. The need for patients to be well-informed, and even a bit tech-savvy in today’s healthcare market is critical. Those living diabetes with or without comorbidities must be well-versed in disease management strategies like how to recognize the symptoms of high or low blood sugar and when to give insulin. According to the Centers for Disease Control and Prevention, there were more than 100 million adults in the U.S. living with pre-diabetes or diabetes in 2017. The American Diabetes Association reports that the total cost for those living with diabetes in 2017 was more than $300 billion. This makes diabetes 2.3 times more expensive to those living with it compared to people who have no diabetes diagnosis. All of this data illustrates the importance of patient engagement and self-care for those with diabetes. A recent study conducted by researchers in China reports that the motivation some patients are missing to participate in self-care may be simpler to provide than ever before. The study found that sending a series of motivational text messages can improve the control of blood sugar in patients with diabetes and comorbidity of coronary heart disease. Overview of the Study Study participants included patients with a dual diagnosis of cardiovascular disease and diabetes. Patients were told that the study would help them better care for their bodies, given the serious nature of both conditions. Knowing that lifestyle changes are pivotal to the success of managing the symptoms of both diseases, made these researchers curious about the use of text messaging. The study followed 502 patients in 34 different hospitals throughout China. Each patient received standard care for both conditions. Study participants were divided into two groups. The first group received six autogenerated or pre-programmed texts every week for the duration of the study. The messages focused on controlling blood pressure and glucose readings, providing advice on healthy lifestyles, and educating on the importance of following their medication regimen. An example of a message study participants received includes, “Afraid of testing blood glucose because it hurts? Try to test on the sides of your fingertips or rotate your fingers, which can help to minimize pain.” The second group of study participants received two messages each month. These messages did not offer education or encouragement but instead thanked each patient for their participation. Patients in the motivational text messaging group experienced lower blood sugar levels after about six months. They also had a 0.2% decrease in their overall HbA1c levels compared to an increase of 0.1% of those patients in the control group. More than 69% of the motivational text messaging study participants reached the target value of HbA1c levels below 7%. Even though messaging targeted both diabetes and cardiovascular disease, there was no difference in blood pressure, cholesterol, or body mass index results of the two groups. Could this Strategy Work for Other Conditions? The results of this study are encouraging. If a few text messages can decrease overall sugar levels and increase disease control, just imagine what other conditions could be managed. This isn’t the first study to look at the use of mobile technology to help with chronic conditions. A 2018 study published in the British Medical Journal looked at the use of two-way digital text and voice messaging on the overall control of chronic diseases. The researchers reviewed four studies that provided patient observation, motivation, supportive communication, reminders, praise, and encouragement to those living with long-term illness. These studies also looked at the efficacy of using mHealth technologies with low literacy patients and those who may live in areas with minimal resources. Overall, this study found that increasing communication between patients with chronic conditions and their healthcare providers can improve health outcomes. Moving Forward in a High-Tech Industry Patients turn to technology for everything from logging workouts to tracking symptoms to attending visits with a provider. The more the healthcare community embraces the use of tech in healthcare treatments, monitoring, and overall management, the sooner we may see long term lifestyle changes that can impact overall health outcomes. Do you have any experience, either in practice or first-hand, using communication tools like text or voice messaging for disease management? If you have a story or even a thought about this practice, drop a message in the comments below to get the conversation started.
  17. Mobile Health According to Statista, during the second quarter of 2019, there were nearly 50,000 health apps available in the iOS app store. By 2020, the mobile health market is expected to be worth 21 million dollars globally. Many consumers turn to mobile health (mHealth) for overall health and wellness. You can do things like track your meals, log chronic symptoms, keep detailed records of the amount of water intake, or keep track of your workouts. More healthcare companies and practitioners are turning to mobile health to reach patients, and some are using chatbots to increase how quickly they can connect. Health insurer Anthem is taking a shot at a new digital service where patients can pay for a text chat with a physician to review symptoms and receive treatment. However, their first interaction is with artificial intelligence (A.I.) chatbot that asks about symptoms and suggests diagnoses. The patient is then connected to a physician for follow-up that happens at the patient’s convenience for an agreed-upon fee. As more people turn to mHealth for disease management, we need to get a clear picture of the pros and cons. Kevin Campbell, MD, took an in-depth look into the good and bad of mobile health and why he thinks patients will like it and physicians won’t. Here is a look at the good and bad around using mHealth and A.I. for medical care. Understanding the Benefits Most medical care and treatments come with pros. Here is a look at the positives of using AI-based apps for healthcare treatment. Price Transparency Most care happens with little or no conversations about what it might cost the patient. However, in our current healthcare market, more patients want to know what their out-of-pocket contribution will be before they sign on the line consenting for treatment. Anthem understands this desire of patients and is meeting them halfway by giving them the cost of their chatbot visit and MD appointment upfront. Not only do patients know the cost of the visit, but they also get an appointment that fits into their schedule from the comfort of their home, office, or breakroom. Of course, price transparency doesn’t only come from apps. The Affordable Care Act requires hospitals to publish a master list of costs so that consumers can shop around for the best price. This rule was enforced on January 1 of this year but has become nothing more than a long list of expenses that mean little to most consumers. With the Anthem app, prices are clearly communicated to the patient before care so that an informed decision can be made. Increased Patient Engagement As nurses, we know that a highly engaged patient typically sees better outcomes. When dealing with complex medical issues like cardiovascular disease or diabetes, being well-versed in their symptoms, medications, and any possible side effects can keep patients healthy. App visits can also provide a level of anonymity that may allow some individuals to ask questions that they may not feel comfortable asking during a face-to-face visit. Understanding the Possible Drawbacks Just like all medical treatments, there are potential cons to using A.I. and mHealth. Here are a few of the potential dangers of chatbot visits. Legal Implications for ChatBots As Dr. Campbell points out, artificial intelligence is an excellent tool for healthcare professionals. However, seeing your physician or nurse practitioner and their office staff will always be the gold-standard for medical diagnoses and treatment. If a doctor does not have the ability to see the patient and do a physical exam, the risk of misdiagnosing the condition is significant. One question that is concerning for some experts is who would be responsible if an incorrect diagnosis is given to a patient during the chatbot conversation. Chatbots can’t be sued, but physicians, nurse practitioners, and other care providers can be held responsible for misdiagnosing a patient’s condition. Physician Burnout Could healthcare systems start expecting physicians to see patients all day and then go home and be connected to their phones? More doctors are talking about symptoms of burnout they feel from their day jobs. The American Academy of Family Physicians called burnout an epidemic in 2015, with about 46 percent of physicians reporting symptoms of the condition. Burnout can lead to low job satisfaction, anxiety, depression, and lower quality of patient care. Quick Fixes Aren’t Always a Good Thing Our society likes a good quick fix. You can find a hack for almost anything these days. However, when it comes to your health, choosing the quick fix may not be the best answer. Dr. Campbell worries that patients may chat with the bot, get a few possible diagnoses and then end the visit before ever-texting an actual human. This could lead to poor outcomes and misdiagnosis because the patient didn’t take the time to speak with the physician. The Future of MHealth and A.I. Healthcare was slow on the uptake of technology. Today, the industry has caught up and is even leading the charge in many areas of technology. So, what do you think about mHealth and chatbots? Would you use this service for yourself, and would you recommend it to your patients? Share your thoughts in the comments below.
  18. On May 29th, a Montgomery, Alabama judge sentenced former Nurse Practitioner, Lillian Akwuba to 10 years in federal prison. Akwuba was found guilty on 23 counts of healthcare fraud and drug distribution. However, she wasn’t alone in her acts that caused Judge Sharon Blackburn to tell Akwuba that she was a “ highly educated drug dealer” who wrecked the lives of patients and families to make money. The Story Dr. Gilberto Sanchez, who owned Family Practice in Montgomery, was arrested in 2017 for allegedly running a pill mill. He was indicted along with other staff members from his office, including Akwuba. They were charged with prescribing unnecessary controlled substances, such as hydrocodone, oxycodone, fentanyl, and methadone. Not only did they give these dangerous drugs for no reason, but they also had patients return to their office every month to get their prescriptions. These visits were considered unnecessary and a form of healthcare fraud. According to AL.com Akwuba left Sanchez’ practice in 2016 and opened her own practice, Mercy Family Health Care in Montgomery. She continued to overprescribe the same controlled substances. However, since she was legally required to collaborate with a physician, she broke the law in new ways. Prosecutors reported that she began forging signatures of physicians and faking the collaboration required under Alabama state law. A WSFA News 12 article , reported that Akwuba pleaded for mercy at her trial and stated that her family depends on her for support. She said that she was remorseful. However, the judge pointed out that at no point during her hearing did Akwuba ever comment about the people that she prescribed dangerous drugs to and probably turned into addicts. Blackburn even replied that she didn’t feel that the former nurse practitioner understood the extent of her conduct and just how criminal her actions were. An Assistant United States Attorney, Jonathan Ross was also present for the trial. He told WSFA that Akwuba showed “complete and utter disrespect to her patients and the court by lying under oath during the trial, and disrespect to the doctors who tried to work with her and curb her prescribing habits.” Ross also called Akwuba a “drug dealer.” Ross feels that Akwuba is at higher levels of blame compared to Sanchez, who pleaded guilty to five counts and was sentenced to serve more than 12 years in prison. Akwuba remains detained until her family produces her passport, at which time she could be released on bond before heading to serve her sentence. The Dilemma There are so many issues in this story. Did Akwuba understand her prescribing actions? How was she able to go for such a long time forging the names of physicians? The state of Alabama only gives nurse practitioners limited authority to prescribe, which means they must have physician collaboration. Did pharmacists in the area not recognize the forgery? Stories such as these can be used as ammunition to support the notion that nurse practitioners should not be given autonomy to prescribe without physician oversight and work independently. However, these stories are few and probably shouldn’t be used to set precedence for future laws. But, we all know what one bad apple can do to an entire bag, right? What do you think should happen to Akwuba, and where did this situation go wrong? Share your thoughts below.
  19. Okay, so maybe it’s not time to toss out your N-95. However, a recent update from the Centers for Disease Control and Prevention and the National Tuberculosis Controllers Association shows an overall decline of TB cases. The organizations also report that TB cases following occupational exposure have dropped, too. This new information has created a few updated recommendations All healthcare personnel should get a baseline TB risk assessment, screening for symptoms, and TB skin or blood test upon hire Annual testing is not recommended for healthcare personnel unless there is a known exposure or ongoing transmission in your facility Personnel with an untreated latent TB infection should be screened each year for symptoms and treatment is highly-encouraged All staff should receive yearly TB education, which includes information about risk factors, TB infection control policies and procedures, and a list of signs and symptoms Personnel with a positive TB skin or blood test should be evaluated for symptoms and have a chest x-ray performed to rule out the disease Understanding Your Risk Tuberculosis is an infectious disease that mainly affects your lungs. TB is spread through tiny droplets that are released into the air following sneezing and coughing. Once it’s in the air, the droplets can be breathed in by others, and they can become infected. The disease was once thought to be rare in developed countries. However with the increase of HIV, it gained momentum in the mid-1980s. The disease is difficult to treat because many drugs have become resistant. Treatment can take several months, and the patient will need to be separated from others until they are no longer actively contagious. Symptoms Active TB creates severed illness. It can make you sick shortly after you contract the condition, or it can make you sick years later. The main signs and symptoms include: Coughing up blood Persistent cough (lasting three or more weeks) Chest pain Fatigue Unintentional weight loss Fever Night sweats Loss of appetite Chills TB can also remain in your body in an inactive or latent state. This means that you have the bacteria in your body. However, the disease doesn't make you ill. Latent TB can become active, so it’s important for people who have latent TB to receive treatment to decrease the spread of the illness. What Are The High-Risk Populations? You may be at an increased risk of contracting TB if you work with high-risk populations. Here are a few populations you need to consider: Patients with Weakened Immune Systems Your immune system helps to keep you safe from TB and other infections. If you have a weakened immune system, you may be at an increased risk of contracting the condition. Pediatric or geriatric populations A few diseases that can put you and your patients at a higher risk include: HIV/AIDS Malnutrition Diabetes Severe kidney disease Drugs used to treat RA, Psoriasis, or Crohn’s Chemotherapy drugs Certain cancers Drugs used to prevent rejection of transplanted organs Traveling to Foreign Areas TB runs rampant in some under-developed areas. If you or your patient has been to one of these areas, you may need to consider the possibility of TB: Latin America Russia Africa Asia Caribbean Islands Other Populations There are a few situations that can also place patients at an increased risk of contracting TB. Those individuals with poor overall health and medical care, those with substance abuse issues or those who use tobacco are more vulnerable to TB.
  20. An elderly couple near Ferndale, Washington may have given into the stressors of financial struggles from looming healthcare bills. An article published on wtap, an NBC affiliate, reported that dispatchers received a call on the morning of August 7th from 77-year-old Brian Jones. He told the dispatcher, “I am going to shoot myself.’ The dispatcher tried to keep the man on the phone while he activated emergency services. However, Jones told the dispatcher, “We will be in the front bedroom.” When the police arrived, they tried to contact anyone inside the home without success. After an hour, they sent in a robot-mounted camera and found the man dead from an apparent self-inflicted gunshot wound. He was lying next to his 76-year old wife, Patricia Whitney-Jones, who was also dead from a gunshot wound that investigators believed was caused by Jones. Detectives are calling this a likely murder-suicide and report that they found several notes citing ongoing medical problems for Jones’ wife that the couple could not afford. America’s Elderly Healthcare Financial Crisis Did you know that the U.S. spends twice as much on healthcare than any other developed nation around the world? It’s estimated that 18 percent of our gross domestic product each year goes to support our healthcare system. Many older adults incur higher than average medical costs related to chronic health conditions. One study estimated that a couple who retired in 2017 at the age of 65 needed $280,000 in savings to cover future healthcare costs such as premiums for doctors and medications. If these elderly individuals also required additional services such as long-term care or assisted living, they would need additional funds to cover these costs. As a nurse, you know that individuals with chronic illness spend more money and time in the healthcare system. The Kaiser Family Foundation reports that half of the population accounts for 97 percent of US health spending. Many people struggle to keep up with drug costs as well. A whopping 30 percent of people age 50-64 have difficulty paying for prescription drugs. For many people, not having their medication leads to exacerbations of their conditions, and ultimately, they land back in the hospital, where care is even more expensive. In a recent New York Times article, Paula Span reported even more details about the future of healthcare for America’s aged population. By 2029, middle-income older adults will need between $25,000 to $74,000 to pay for just one year of long-term care services. While most older adults will need at least some increased level of care, the majority won’t be able to afford it. With the increase in the elderly population, we aren’t talking about a small number of people. In fact, it’s estimated that this group of adults will almost double in the next decade, and will consist of approximately 14.4 million people. While many will want to age-in-place at home, some will require care that simply can’t be delivered outside of the confines of a nursing facility. This will leave them searching for ways to afford the level of care they require. When Financial Stress is Too Much As you think about the future forecast of healthcare costs in America, what comes to mind? Do you feel that we may see more stories like Jones and his wife? Most of us were raised to respect our elders. Some of us even went into nursing to make a difference for people just like this couple. The thought of older adults seeing their healthcare needs as a burden that they can’t handle saddens me in so many ways. What Do You Think? Tell us what you think about this devastating story. What do you think the future of healthcare holds for older adults? Do you have any thoughts on how the healthcare community can impact our future in a positive way for our elders? Share your thoughts below.
  21. Melissa Mills

    4 Reasons Nurses Need Mentors

    I remember my first nursing mentor like it was yesterday. Her name was Della. She was my preceptor during my preceptorship at the end of nursing school. She was smart, sassy, and offered so much practical knowledge that nursing school didn’t provide. After I graduated, I went to work alongside Della and others that I knew from clinicals. As my career progressed, I found other nurse mentors, like Lisa in the NICU and Paula in hospice. Even after 20+ years as a nurse, I still need a mentor. When I changed my specialty from leadership to writing, I found a coach and later connected to a few different writing groups and networks. Nurse mentorship is a collaborative relationship. Sometimes we choose our mentors, and other times, they choose us. Mentors are role models who teach us not only about nursing care, but about customer service, teamwork, and our career potential. Many hospitals and nursing facilities have mentorship programs where they partner new nurses with tenured staff. However, some of the greatest mentoring relationships come from reaching out in times of need for support, guidance, or education. Why Do I Need a Mentor? 1 - Burnout is Real The stress of direct patient care can be significant. Nurse burnout is a mental, emotional, and physical state created by long-term overwork. Burnout continues because of a lack of support and job fulfillment. Mentors can help fill this void. Common signs of nurse burnout include: Lack of personal and professional accomplishment Physical and emotional exhaustion Job-related skepticism or cynicism Mentors can recognize the signs of burnout in their mentees. They can offer suggestions of ways to combat nurse burnout and help you create healthy coping mechanisms. 2 - Confidence is Needed Whether you’re a new grad or just new to a unit, having someone to turn to for help and guidance can help with your overall career success. A mentor will have your back at all times. They can help you hone your skills and lend a hand when it’s needed. Having someone in your corner helps to boost your confidence levels so that you can be successful in your career. 3 - Everyone Grows Mentorship isn’t a one-way street. Nurses who mentor others will learn from experiences and grow in their professional development. Many nurse mentors discover their love of education or leadership as they help guide and coach others. While mentees learn much from the collaborative mentor relationship, mentors also grow in their confidence and skills. 4 - Career Growth Mentors can help when you’re looking for a new job or researching a unique nursing specialty. Connecting with other healthcare professionals on Linked-In or even through social media platforms such as Facebook or YouTube can help provide a glimpse into various nursing specialties that you may have never considered. If you’re looking for a new job, reach out to others in the role who may be able to offer guidance and strategies for finding your first job in the new niche. Finding the Right Mentor for You Not everyone is lucky enough to find a Della, Lisa, or Paula. Sometimes, you have to search for a mentor who is willing to give you the time, feedback, and support that you need. Formal nurse mentorship programs aren’t as standard as they should be in most nursing settings. So, you may need to get creative when looking for a nurse mentor. Here are a few ways you can find the collaborative relationship you’re looking for and need for career success. Participate in a Formal Mentorship Program If your facility offers a mentorship program - sign up! You may be given a chance to select a mentor you’re comfortable with, or you may be assigned a mentor that the program administrator thinks will be a good fit. Formal programs often have contracts that both the mentee and mentor sign. You may also be asked to create goals of your mentorship relationship to ensure that you stay on track during the program as a team or partnership. Connect with a Colleague If your facility doesn’t have a formal program, look around while you’re at work for a mentor. Is there a coworker who you look up to or someone that already gives you support? If so, ask them if they would be your mentor. Once they agree, set up times to meet to discuss your progress on the unit and review your career goals. Find a Mentor On-line You can search for nurses on Facebook or Linked-In. Many professional organizations offer membership networking benefits like mentorship programs. Search for someone who has similar interests and professional goals. You can also hire a nurse coach to help you along the way. Professional nurse coaches may offer group and one-on-one sessions, resume help, and specialty programs like how to makeover your LinkedIn profile. Tell Us About Your Mentor Do you have any great stories about your nurse mentors? We would love to hear them. Leave a comment below with stories about nurses who have either formally or informally mentored you throughout your career.
  22. According to Lively’s Wellness & Wealth report, only 54% of adults see their doctor for preventive care. Another 28 percent only head to the MD when sick, and a whopping 18 percent only see a provider when they consider their health-related problem to be catastrophic. The study also revealed that as people age, they do seem to go to the doctor more. However, could the increase in visits be related to the lack of preventative care during their younger years? Another portion of Lively’s study looked annual income to be a reliable indicator of the likelihood to engage in preventative healthcare. It’s probably not surprising to learn that wealthier adults are more likely to go to the doctor compared to those in lower-income brackets. About 60 percent of people who make over $50K a year attend preventative appointments. While less than half of people making salaries below $50K each year participate in regular doctor appointments. Healthcare Costs and Bankruptcy Not going to the doctor when you’re younger could set you up for more than just poor health as you age. A CNBC article published in February reported that two-thirds (530,000 families) of all people who file bankruptcy report that medical issues were a key contributor. Individuals who filed bankruptcy cited both the direct healthcare costs and lost wages from time off of work as reasons that they had to file for bankruptcy. Many experts and lawmakers hoped that implementing the Affordable Care Act (ACA) would improve the issue of financial problems related to healthcare costs. However, it doesn’t seem like it has. The ACA increased the number of Americans who had health insurance. However, the number of people who said that medical expenses were a reason for their bankruptcy increased from 65.5 percent to 67.7 percent in the three years following the adoption of the ACA. Can Preventive Care Help Save Your Health and Money? Young people in America today need to learn a valuable lesson from older adults. Avoiding health-related concerns may mean that you have to spend a few dollars on a copay or prescription medication. But, allowing health problems to linger and exacerbate can be a pricey mistake. To illustrate the issue, let’s consider the symptoms of a nagging cough. If you head to the doctor, you may pay $25-$40 dollars in a copay and another $10 to $50 for a prescription. However, if you wait until the cough turns into pneumonia, you could spend thousands of dollars on an emergency room visit, labs, medications, and radiology fees. 3 Ways Nurses Can Increase Preventive Care Nurses play a crucial role in care strategies and implementation. We often think of ourselves as caring for people when they’re ill. However, arming your patients with the information they need to be healthy today may keep them in a state of wellness for years to come. Here are a few ways nurses can help increase the use of preventive care services. 1 - Teach Self-Care Strategies Chronic illnesses are challenging, but patients need to understand the importance of going to the doctor before they get sick. You should also be asking patients about their immunization status and reviewing records each time you see them in the hospital or clinic. Vaccines are an excellent strategy to keep patients well and increase care outcomes. 2 - Identify At-Risk Patients We screen patients all the time for multiple conditions, but what happens to that information? If you complete an admission and identify a patient that is high risk for cardiovascular problems or that they have a higher than average risk of developing diabetes, communicate this to them and their providers. Empower patients to seek preventive care for chronic conditions they are at risk of developing. 3 - Educate the Community Many organizations offer free or reduced-rate screenings, immunizations, and clinics. Be sure to share these events in your facility and your Facebook or Twitter accounts to increase the event’s reach. You can also volunteer at Health Fairs or other activities that raise awareness of specific conditions and provide education on healthy lifestyles. Keeping Your Patients Healthy What preventive health strategies do you use with your patients that other nurses could use in their practice? Share your ideas below to create a healthier America.
  23. Melissa Mills

    Put Your N-95 Respirators Away: TB Exposure is on the Decline

    Thanks for your comment, Nursej22. It was supposed to be a bit of tongue-and-cheek humor. Of course, no one can put their N-95 masks away. However, the decline of TB cases in the U.S. is encouraging. Hi Pepper The Cat! Of course they won't and nor should they. The title was a bit of tongue-in-cheek humor. Thanks for your comment!
  24. It seems talks about staffing ratios are taking the nation by storm. One group of nurses at Beaumont Hospital in Royal Oak, Michigan is taking matters into their own hands. BeaumontNurses.org is a 100 nurse-strong group which has launched a drive to unionize the hospital with the Michigan Nurses Association. The push to unionize is to achieve safer nurse-to-patient ratios, but the question remains if the group fully represents all nursing staff. The hospital employs about 3,000 nurses. This is the fourth union drive at the facility in the last 24 years. Susan Grant, RN, executive vice president, and CNO was interviewed in a recent article and reports that she doesn’t believe the group advocating for a union represents the majority of nurses at the facility. Grant cited a recent satisfaction survey in which 80 percent of the nursing staff reported feeling “engaged” with their work. However, the question at hand is this, “Can you feel engaged but also feel that having a union to represent the majority of the nurses across the hospital is a good thing?” Why They Want a Union Not only have these 100 nurses organized themselves, created a website, and publicly listed their names to express their support, but they are openly sharing their reasons for the desire to unionize. Here are a few: Philomena Kerobo, RN of 18.5 years in quoted stating, “Beaumont used to be a best place to work.” She went on to say that around 2007/2008 things changed at the hospital and today, she fears seeing her provider or having a procedure done because of the out of pocket expenses that she will have to pay for month or years to come. She wants the union so that she can have a “voice in what affects our patients and us (nurses).” Irina Schmidt, RN who has been a nurse in the Emergency Center at Beaumont for five years stated, “I want to form a union to advocate for safe staffing levels for nurses, transparency from our administration, and the pay and benefits necessary to recruit and retain quality RNs.” Christe Buck RN for 19 years at the facility reports that having a union will create a voice in decision making and allow for safer staffing. She ended her statement on the site with, “I’m proud to be Union Strong!” Where does the Michigan Nurses Association Stand? You might be wondering where the Michigan Nurses Association stands in all of this since the request to unionize was sent to the organization. The Michigan Nurses Association recently launched the Safe Patient Care Act in a 2019-2020 legislative session, in which they advocate for safe limits on patient assignments across the state. The act also calls for limitations on forced overtime for Michigan nursing staff and will require transparency of all facilities to report RN-to-patient ratios publicly. The MNA supports nurses efforts to obtain statewide legislation as well as facility-wide provisions that set staffing ratios, even if that means unionizing. Along with these goals, the legislation calls to create committees made up of 50 percent direct-care RNs to help monitor staffing levels and use to national evidence-based standards to set nurse-to-patient ratios. A few of the proposed ratios include: Emergency Room - 1:3 plus one ER nurse for triage Medical-Surgical - 1:4 Intensive Care, including ER, neonatal, and pediatric - 1:1 First stages of labor - 1:2 Hearing the Voice of Nurses Across the Nation It seems that the collective voice of nurses across the country is being listened to about staffing ratios. Whether it means that more facilities unionize or that states pass and enforce mandatory nurse staffing minimums is still to be seen. No matter what the answer is, we could be moving in a direction that’s much closer to patient safety, job satisfaction, and protection for nurses than we’ve ever been. You might even say that some of these nurses are working hard to put the “care” back into healthcare. What are your thoughts? Would you join a union if it meant having a seat at the table on critical issues like staffing? Do you agree with the provisions presented in the Safe Patient Care Act that Michigan lawmakers have been given? Let us know your thoughts.
  25. On June 4, 2019, a former nurse at Roswell Park Comprehensive Cancer Center in Buffalo, New York was charged with stealing pain medication from cancer patients. Kelsey Mulvey, of Grand Island, was charged with illegally obtaining controlled substances by fraud, tampering, and violation of the Health Insurance Portability and Accountability Act (HIPAA). She is accused of diverting powerful painkillers like Dilaudid, oxycodone, methadone, and lorazepam. She was also allegedly administering water to the patients who legitimately needed those drugs. These charges could find Mulvey in prison for 10 years and fined up to $250,000. Details of Mulvey’s Crimes In 2018, administrators at Roswell Park Comprehensive Center suspected that a staff member was diverting pain medication from the Pyxis. Between February and June of 2018, it’s alleged that Mulvey failed to administer medication to 81 patients, instead of giving them water, that at times was contaminated and resulted in infection. Administration became suspicious after finding a large number of transactions in the Pyxis that were “canceled removed,” indicating that the drawer was accessed, but the operation was never completed. The complaint filed last week states that she removed and replaced controlled substances with water during these canceled transactions. Mulvey accessed the Pyxis on units she wasn’t assigned and even on her days off, including vacations. When the facility started investigating the issue and Mulvey in 2018, she resigned. As of June 16, 2019, there are two Kelsey (Anne) Mulvey’s listed in Buffalo, New York on the license verification site. However, both list that the license to practice nursing is inactive. Nurses and Addiction Caring for others is a challenging business. Nurses watch as patients endure horrific medical battles. Many times, nurses and other healthcare professionals internalize or suppress their feelings to get by and cope with the stress. However, sometimes, nurses bend under pressure and turn to misuse and abuse of substances they possess or even some they divert from patients who need the medication for pain, anxiety, and other symptoms or conditions. The American Nurses Association estimates that one of every 10 nurses abuse drugs or alcohol. So, at the next staff meeting you attend, look around and do the math. For every nine nurses, you are sitting with, you or someone else in that small group is or will abuse a substance. Maybe even at the detriment of a patient. Scary, right? Many of us can’t fathom being that one in 10. However, when you think about the reasons nurses abuse drugs and alcohol, the picture starts to become a bit clearer. Let’s discuss a few of the reasons experts believe nurses struggle with issues of addiction: Stress Levels Run High Results from a study of 120 nurses in the Midwest revealed that more than 90 percent of respondents had moderate, high, or very high levels of work-related stress. To combat work-place stress, 79% of the study participants talked with friends and loved ones, 46% listened to music, 43% watched TV, and 43% used prayer and meditation. Unfortunately, 13% reported that drinking alcohol was a coping mechanism they used to deal with their stress levels. Nurses with the most stress also experienced poor health outcomes and high-risk behaviors. Stress can make you do things you wouldn’t usually do. It can also impact your overall health and well-being. However, when stress gets to the point that deadening the feelings with substances sounds like a good idea, it’s time to reach out for help. Easily Accessed If you work in a hospital or other care facility, you likely hold the key to some powerful medications. This alone can be problematic for nurses with chemical dependency issues and those who are under more stress than usual. Psychology Today reports that behaviors that should make you question what’s going on with colleagues include volunteering for shifts on holidays, weekends, and overnight because there is less oversight by administration during those shifts. You might also wonder what’s up if a coworker constantly has incorrect narcotic counts, reports wasting medications without a witness because no one was around, or they look for opportunities to be alone with pulling narcotics from the dispensing system. It’s critical to point out that doing one of these actions or having it happen occasionally isn’t reason enough to schedule a meeting with the unit manager to discuss your concerns. However, if you notice a coworker doing these actions consistently or if you have that “nurses intuition,” it might be best to discuss your observations with the manager privately. High Levels of Fatigue We’re not talking about being tired after a day out and about with family and friends. The fatigue nurses feel is often caused by inadequate staffing, high acuity assignments, and increased clinical responsibilities. Fatigue can cloud a nurse’s judgment, placing their patients in danger. The American Nurses Association reports that fatigue is costly because it can increase healthcare needs and worker’s compensation costs, disability, recruitment and training efforts, and legal fees. The remedy to fatigue sounds quite simple - sleep. However, sleep eludes an estimated 1 in 3 people. Older individuals are at a higher than average risk of experiencing insomnia. Women are twice as likely to struggle with sleep than men. And, shift workers have a higher than average risk, too. Since nursing is made up of primarily female workers and sick people don’t miraculously get better at night, nurses are prone to experience fatigue. Resolving the Issue of Addiction in Nurses Each state and local jurisdiction handles drug-addicted nurses differently. Some walk away with a criminal record, but no jail time and others are fined and locked up. And, of course, there are those who are never charged and walk away completely unscathed. These are simply the criminal ramifications that nurses might face and doesn’t address the variations of what might happen to the nurse’s license to practice and make a living. How do you feel about nurses who struggle with addiction and get caught diverting? Do you support programs to help them with the problem and keep their nursing license? Have you or a colleague ever struggled with addiction? Share your thoughts below, we would love to hear what you think about Kelsey Mulvey and other nurses who struggle with addiction.

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