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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. 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.
  2. 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.
  3. The #MeToo movement has empowered many targets of sexual harassment to address their harassers and report these situations to their employers and the authorities. The Equal Employment Opportunity Commission (EEOC) received more than 13,000 workplace sexual harassment complaints in 2018. They said that 15.9% of the charges were filed by male targets, which means that women remain the number one recipients of sexual harassment. More than $56 million was awarded to victims of sexual harassment through settlements before the cases ever went to trial. These statistics are appalling and should make each of us consider ways to keep ourselves and coworkers safe. What might be even more shocking than these statistics are stories where the perpetrator gets away with nothing more than a slap on the hand, like Dr. Moja, a physician in Virginia. Here is more about his story. Doctor with Multiple Allegations WTVR, Channel 6 shared the story of one nurse who remembers a conversation at a hospital elevator with Dr. Moja. The nurse, who has requested to remain anonymous, told reporter Melissa Hipolit, “Dr. Moja was talking to me, discussing some things, he had his hand on my shoulder. As he was removing his hand, he deliberately, with intent, came down across my breast -- slowly with intent.” The nurse described how she was shocked by his actions and waited for the physician to apologize or walk away. However, he didn’t. In fact, the nurse told the reporter, “He made the comment he just wanted to know if they were real or fake.” She remembered being in shock at first and then switching over to anger about the violation. She reported the incident to the hospital’s HR department that night but didn’t hear back from them for a few days. She reminisced that Dr. Moja tried to pull her off to the side to talk to her a few times after the incident, but she never allowed herself to be in that situation. She then spoke to the hospital’s director of nursing, who helped her to call the police department that same day. After Dr. Moja was charged with sexual battery, other women started discussing similar behaviors displayed by the doctor. He’s accused of asking one employee if she had ropes and handcuffs. He was also involved in similar situations at previous employers. All of this information was submitted to the Virginia Board of Medicine who convened to review it and decide the fate of Moja’s license to practice medicine. The Results The board stated that they were concerned by “Dr. Moja’s lengthy history of inappropriate actions and comments across multiple work settings with multiple professional workers, which span many years,” but they decided not to suspend his license. Dr. Moja was reprimanded and placed on probation indefinitely. Dr. Moja is still licensed to practice medicine in Virginia. His attorney told WTVR that they are appealing the disciplinary action given by the board and the conviction of the sexual battery charge. Understanding Sexual Harassment Inappropriate sexual advances in the workplace aren’t new. According to the Online Journal of Issues in Nursing, even Florence Nightingale had to control comments made by male physicians and surgeons in the 1800s. Since that time, there have been many cases of sexual harassment in just about every industry. With the powerful #MeToo Movement, professional organizations in healthcare have taken a stance on sexual harassment to prevent it from happening. The EEOC defines sexual harassment as unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature. It can also include offensive remarks about a person’s sex. Victims can be of any sex, and so can the harasser. However, there are a few factors that increase the risk of sexual harassment that might make it more likely to happen in healthcare settings: Isolated Victim Any workers who find themselves in secluded spaces tend to be at a higher than average risk of sexual harassment. Isolation can leave the target feeling alone since there may not be witnesses to the harassment. If you work in a small office, facility, or practice and find yourself alone with another worker, you could be at risk. Male-Dominated Work Women who work in male-dominated professions are at a higher than average risk of being a victim of sexual harassment. Nursing is female-dominated as a profession. However, medicine is not. Female nurses in male-dominated practices are one area of healthcare that could be a problem. Power Disparities Workplaces with unequal power between workers can set up an environment where sexual harassment may happen. Add in a possible harasser who is well-recognized or high-earning and the power imbalance and risk of harassment increases. Some people in positions of power feel that they don’t need to comply with laws and other rules and might even think they won’t be reprimanded for inappropriate actions. Changing the Trajectory of Sexual Harassment If you’ve ever been the victim of sexual harassment, you understand the level of violation that comes with the act. Victims don’t have to sit back and tolerate this type of abuse. If you or someone you know is being sexually harassed at work, you have rights. You can call the Equal Rights Advocates ' toll-free Advice and Counseling ling at 800-839-4372. You should also speak to your supervisor or human resources department. If you’ve been sexually assaulted, you can also call the National Sexual Assault Hotline at 800.656.HOPE. We Want Your Opinions How do you feel about Dr. Moja’s actions? Should he be allowed to continue to practice medicine? If you’ve been the target of sexual harassment or sexual assault in the workplace and are willing to share your story, we’d love to hear it. Tell us how you felt and what you did about it.
  4. Difficult conversations are part of healthcare. However, when the news is that a patient is terminal, it might be a bit harder of a conversation than others. One physician found himself on the receiving end of a difficult chat that spurred him to start mentoring other physicians about how to approach telling patients they’re dying. Dr. Ron Naito’s Story Dr. Naito is an internist with over 40 years of experience. When he saw the abnormal results of his blood test, he understood the prognosis. However, when he attended an appointment with his doctor, instead of learning of his formal diagnosis in a compassionate, dignified manner, he was met with attempts to dodge the results. “He simply didn’t want to tell me,” Natio said He told Indian Country Today that at one point, he overheard a specialist discussing the tumor biopsy results with a medical student outside of his exam room door. “They walk by one time, and I can hear [the doctor] say ‘5 centimeters,’” said Natio. “Then they walk the other way, and I can hear him say, ‘Very bad.’” Dr. Naito noted that the shock of this encounter still bothers him. He knew the diagnosis and prognosis because of his years as a physician. However, the lack of compassion, professionalism, and empathy in the way he found out is palpable. Dr. Naito has been using his time since his diagnosis to help educate medical students at Oregon Health & Science University how to speak to patients when the news isn’t good, which isn’t a skill many medical or nursing skills teach. How to Give Bad News Nurses aren’t often the ones who are providing dire test results and terminal diagnoses. However, once the severity of the news wears off and the patient and family has questions, it’s often a nurse who sits at the bedside providing answers, education, and support. If you find yourself in the midst of these conversations, here are a few strategies you can use to navigate through: Show Empathy Empathy, not sympathy, is one of the most powerful emotions you can offer. Being able to understand and share the feelings of the patient and their loved ones can put you in an excellent position to teach and support them through a difficult time. Be Honest These conversations are tough, but glossing over the details doesn’t help anyone. Patients deserve the full truth about their diagnosis, expected symptoms, and what the dying process might be like. One study found that only about five percent of cancer patients fully understand their prognosis. Without a thorough understanding of the disease process and what to expect, patients lack the ability to make informed decisions about their care. As a hospice nurse, I quickly learned how to navigate these difficult conversations with truth and compassion. It wasn’t always easy, but most patients appreciated the honesty. Be Open to their Questions You might not know the answer to some of the questions patients have. Sometimes, you may not even be the best person to give the answer. However, letting them ask the hard questions, and providing support is paramount to your relationship with them. If you don’t know the answer, tell them honestly that you’ll need to get back to them. Always follow through and get them the information they need. Don’t Use Cliches It can be very tempting to use phrases like, “just stay strong,” or “it will be okay.” When you are the one receiving devastating news, those words are worthless and even insensitive. Instead, use phrases like, “it’s okay to feel this way,” which supports the patient in their feelings. Show Support Patients want to know that they have a team of healthcare professionals around them who are there to help. Your job isn’t to tell them what to do or what treatment decisions to make, but rather to support them in the decisions that are best for them. Easy ways to show your support can come through your words, but often all you need to do is be present and use active listening skills so that they know you hear them. After the Bad News Dr. Naito is sharing his story in hopes of preventing other patients from having the same experience he had. He shared that difficult conversations can be a “heartfelt, deep experience.” We must always remember that our patients are human and have emotions and feelings about their life that we don’t understand, so being their support after the bad news is one of the most important places you can be for them. Have you ever found out a poor prognosis in a less than professional way? If so, tell us about it. Or, have you witnessed one of these conversations and had to navigate through it with the patient and their family? Let us know your thoughts about challenging conversations and how you get through them.
  5. Melissa Mills

    How Much was your First RN Paycheck?

    In 1998, I was making $14 an hour.
  6. You might think that social media is only for personal use. If you've heard about social media from a professional perspective, it may have been in a negative context. There are stories about employers looking at social media to make decisions concerning hiring, discipline, and even termination. But, what if I told you there are positive ways to use social media in your nursing practice - both with patients and from a career perspective? Here are a few ways you can use social media in your nursing practice. Social Media For Your Health and Career Social media provides a connection, which we need with others to grow and thrive. Here are three ways you can use social media to meet your personal and professional goals. 1. Improve Your Personal Health I love the saying, "You can't pour from an empty cup." Nurses pour their heart and soul into patient care and their companies every day. This means, you have to fill up on positive, healthy habits, and social media can help. You can find Facebook groups and Instagram accounts to support you through healthy habits such as weight loss, life events, and healthy cooking. 2. Strengthen Your Professional Development No matter where you are on your nursing journey, social media can help your professional development. Nursing students can use social media to obtain knowledge and learn skills needed for clinical practice through Youtube channels made just for them. As a bedside clinician, you can connect with Facebook groups, Instagram accounts, and Youtube channels that provide continuing education on the latest research, technology, and evidence-based practices. You can also link to professional organizations and universities for continuing education opportunities and social networking. You have endless possibilities for career development when you search out the right connections on social networking sites. 3. Connect with Other Professionals Life isn't meant to be lived in a silo. Whether you are a new or tenured nurse, you need social and professional connections to continue to grow in your nursing practice. Connect with other nurses for professional help and support. Follow nurses or other healthcare professionals that inspire or motivate you, such as speakers or writers that you enjoy. Find them on Facebook, Instagram, Twitter, or LinkedIn for a continuous stream of inspiration. Social Media to Improve Patient Care Nurses shouldn't connect with patients through social media sites such as Facebook, LinkedIn, or Instagram. However, you can teach your patients how to social media to communicate with healthcare organizations and information. 4. Lead Patients to Trustworthy Information The National Institute of Health (NIH) reports that about one-third of American adults use social networking sites for health information. Here are a few tips from the NIH that you can teach your patients when they search for health information on social media sites such as Facebook or Twitter: Health information on social media sites can be brief. Teach patients to go to the sponsoring organization's website. On Facebook, look at the "About" section. On Twitter, teach your patient to look for a link to the site in the header. Instruct patients to make sure that the social media account is the official account of the sponsoring organization. Social media sites will verify official social media accounts. Teach patients how to look for this verification, or have your patient go to the organization and use the link of their website to find the official social media accounts to follow. 5. Improve Patient Behaviors Through Connection One of the best ways to teach your patients self-care behaviors is to meet them where they are on their health journey. You must match up your teaching method to the age and learning styles preferred by the patient. For elderly patients, written instructions might be best. For patients in their 20's and 30's - this might mean connecting them to social media outlets they use on a regular basis. One study demonstrated this theory well by using social marketing principles to decrease substance misuse and increase the sexual health behaviors of college students. The researchers found that pamphlets were not enough to attract study participants, but when they used social networking sites to increase education, health behaviors improved. It's important to mention that the researchers also noted that while social media connections can increase patient engagement in some populations, one-on-one contact is still the best approach to impact patient care. 6. Boost Self-Care Techniques If you have a patient that is looking to increase their physical activity, improve their sleep, or change their diet, suggesting that they connect to others through social media is helpful. Helping them do basic "hashtag" research to find a community for that advocates and supports others in their health journey. For example, if your patient is looking to lose weight, you might have them follow these hashtags for encouragement: #weightlossjourney, #weightloss, #weightlosstransformation. These tips can impact your nursing practice and patient care in positive ways. Challenge yourself to try one of these tips and see if it moves you closer to a professional goal or impacts your patient's care outcomes. Do you have any ways to use social media in your practice? Share below in the comments.
  7. Melissa Mills

    Nurse Donates Uterus to a Stranger

    Being involved in experimental care isn’t new territory for many nurses. However, donating spare body parts seems a bit rarer. For Heather Bankos, a neonatal nurse, donating her uterus came after she gave birth to three children of her own. Not only did she undergo the surgical procedure, but she also paid for her flight to Dallas, all with the hope that doctors can successfully transplant her uterus into another woman’s body for childbearing. Similar Procedures Uterine transplants have been successfully performed in Sweden. In 2014, a woman gave birth to a baby boy with the help of a donor uterus. The woman and her partner endured the transplant surgery, but also they had to go through other procedures, like in vitro fertilization (IVF). This process is standard for those who have difficulty getting pregnant and combines drugs and surgery to assist with fertilization and implantation. Past uterine transplants used donors genetically related to the recipient. However, the 2014 operation varied, because not only was the donor not related, but she was also over the age of 60 and had undergone menopause. The child was born a bit prematurely, at about 32 weeks gestation because of pre-eclampsia and an abnormal fetal heart rate. The father of the baby spoke with reporters shortly after the child’s birth in 2014 and stated, “He’s no different than any other child, but he will have a good story to tell.” Uterine Transplant Clinical Trial Bankos had the operation as part of a clinical trial at Baylor University in Dallas, Texas. The University started the study in 2016 and was quickly overwhelmed with women willing to donate. In fact, in just two weeks, they received over 200 inquiries about how to give. Today, the wait list includes hundreds of interested women from almost all 50 states across the country. The trial hasn’t only had a significant amount of interest, and there’s been success, too. Two babies were born at Baylor, which is part of Baylor Scott & White to uterine transplant recipients. The first mother, who had zero chance of having a baby without this trial, shared her story and stated, “Our main incentive was for the science, and to think about the 16-year old girl who gets this diagnosis, and she doesn’t have to hear what I heard when I was 16. She’s going to have options, no matter what happens.” These live births prove that the procedure can be replicated and is a viable fertility option for other women. The surgery that Bankos had removed the uterus robotically, which decreases recovery and minimizes the length of the incision. However, the procedure itself took about nine hours, which is almost twice as long as the conventional method. Dr. Johannesson, a medical director, and gynecologic surgeon at Baylor, explained that the uterus is an excellent organ to give away because once you’re done with it, you don’t need it anymore. Understanding the Ethics As with every social issue, there are a few ethical challenges to consider around uterine transplants. Getting a uterus isn’t life-saving. At this time, it’s only done during clinical trials but will likely come with a hefty bill once it’s officially approved. Of course, whether or not insurance companies will cover the cost of the surgery is yet to be seen. There are alternatives, such as adoption and surrogacy, but anyone who’s carried a biological child to term can probably relate that there are some differences. Currently, there are no documented risks for children born after a uterine transplant. Those who donate can be educated on all known risks of hysterectomy. So, it does seem that the majority of the considerations have to do with time, cost, and the fact that it’s not a life-saving procedure. What do you think about uterine transplants? Would you be willing to give yours to someone who couldn’t have children? Do you feel that other options, like adoption and surrogacy, should be used first? Tell us your thoughts below.
  8. Melissa Mills

    Nurse Beaten by Patient Denied Request for Unpaid Time Off and Fired

    Worker's Compensation is administered differently in every state. I'm not familiar with Iowa laws. It's also critical to point out that just because you file a worker's compensation claim does not mean that you can get benefits. Employers and the state can fight the claim, including compensation and medical coverage. When you have unions involved, things tend to get a tad bit trickier, too.
  9. As 2019 begins, the healthcare industry is faced with challenges. Everything from cybersecurity to payment models is listed as possible issues. As a nurse, you likely ponder longer on problems of patient care and experience than any other potential challenge. Patients are demanding better service as out-of-pocket contributions, and cost-sharing percentages continue to rise. This means that nurses must look at ways to improve their practice and increase the credibility and skill they bring to the bedside. The American Board of Nursing Specialties reports that there are almost 750,000 certified registered nurses worldwide in a variety of settings. To publish a complete list of common nursing certifications takes quite a bit of space. Nurses can be certified in critical care, case management, urology, or wounds, just to name a few. Certification can be time-consuming and difficult. However, the benefits for employers, patients, and the nurse are many. Adding Value to Your Employer Nursing requires ongoing learning and mastery of skills. Many employers value nursing certifications in various specialties to demonstrate experience and knowledge in complex areas. Nurses are only required to pass the NCLEX once (thank goodness!) but do have to complete a set number of continuing education courses each year by their state board of nursing. Certification in a specialty provides ongoing validation of experience, skills, and knowledge in your certification specialty. Some employers will support certification through continuing education courses, reimbursement of costs associated with certification, and annual memberships to accrediting bodies. Hospitals and other facilities often publish data on the number of certified nurses to increase the public’s confidence in the nursing care provided within the walls of their organization. Employers who embrace certification might be better positioned to thrive in today’s competitive healthcare marketplace. Increasing Confidence of Patients Patients are sicker today than ever before. As life expectancy increases, more people are living longer with chronic illness and acute exacerbations. The public wants to be assured that nurses are competent and highly skilled in their specialty area before they become patients. A 2002 Harris Poll found that 78% of consumers were aware that nurses could be certified. Awareness of nurse certification was slightly higher for nurses than other professions such as doctors, teachers, and accountants. Many consumers prefer hospitals that employ certified nurses to provide care. Being certified in a specialty brings credibility to your practice and marks your work with a sense of excellence. Boosting Job Satisfaction Certification doesn’t only benefit your employer and patients. It validates your knowledge and skilled judgment in a specialty area. Karen S. Kesten, DNP, RN, APRN, CCRN-K, CCNA, CNE and associate professor at George Washington University School of Nursing spoke with Mary Watts, Community Director of AllNurses in 2018 about the path to certification. As the past chair of the national board of directors for the AACN Certification Corporation, Karen understands the benefits of certification. She encouraged nurses to obtain certifications and emphasized that nursing is a lifelong learning pattern and with certification, you have more options. She advocates for nurses to have a louder voice to advocate for the patients, and one to obtain this voice is through specialty certification. When you become certified, you are the “expert” in your specialty and on your unit. You must meet eligibility requirements in your specialty that demonstrates you’ve been working in the field for a specified period. Once you meet the eligibility requirements, the real fun of studying and learning what you need to know to pass the exam begins. Once certified, you will need to maintain your certification through continuing education courses that meet the requirements set by the accrediting body. All of this ensured continued growth your knowledge and skill of your specialty area. Certification can open up job opportunities. Nurses who are certified possess the knowledge and skill to give employers confidence that you will be a high-performer. A certified nurse might pass up other nurses with the same amount of practical knowledge solely because of the extra initials they write behind their name. Weighing in on Certification Are you certified in a specialty? If so, what has certification done for your credibility with other professionals and patients? Has certification helped boost your confidence in your skill level or opened job opportunities? If you’re not currently certified but are considering becoming certified in a specialty, what do you hope to achieve through certification? Do you have questions about certification that other nurses on AllNurses can help to answer? As a certified nurse case manager, I can help along with so many of the other nurses here on the site. Let us know what excites you about the idea of certification and if there is anything that terrifies you about beginning the journey to certification.
  10. Health Commission meetings are generally not too exciting. However, a session held at the Zuckerberg San Francisco General Hospital on May 28th was full of energy when nearly 150 nurses strode in to make their concerns known. The commission is in current contract negotiations with the close to 2,100 unionized nurses across the city. Without an agreement, a possible strike is on the horizon, set for July 1st. The commission believed they have met the nurses’ needs and felt satisfied with an offer they placed on the table during a May 24th meeting. However, the description provided by The Mission Local, about the May 28th meeting left us thinking of many words other than satisfied to describe the nurses. Aaron Cramer, a cardiac catheterization lab nurse, shouted, “We are chronically understaffed” in the meeting. He made the only public comment during the meeting, which he followed by telling the commission that he held a petition of no confidence with the Department of Public Health with over 1,300 nurses’ signatures. Cramer then began reading the list of signatures as other nurses chanted, “safe staffing now.” The cardiac cath nurse was about 15 minutes into reading the names on the petition when the health commissioners picked up their belongings and left the room. The nurses were attempting to provide a clear picture to the commission of what an actual strike would look like if a mutually agreed upon contract isn’t found soon. Zuckerberg San Francisco General Hospital isn’t new to being in the press. Earlier this month, several current and former nurses protested the Zuckerberg name change that happened in 2015 after a $75 million donation from Mark Zuckerberg and his wife. The name change was approved by the Board of Supervisors shortly after the donation was made. However, some nurses feel that the 147-year-old hospital shouldn’t be named after Zuckerberg due to privacy issues that faced Mark’s company, Facebook. Today, the hospital is under scrutiny related to a chronic state of understaffing. While the commissioners report that the nurse staffing levels of the hospital are safe and in compliance with codes, they failed to comment further on the issue. This claim is that 40 percent of all nursing hours are assigned and completed by per diem staff. The Mission Local tracked down the financials and were able to confirm that since 2016, the Department of Public Health has far surpassed their budgeted dollars for per diem nurses. For the fiscal year 2016-17, the department paid out $58.4 million in wages for per diem nursing staff. This far outreached the budget for the same year of $16.9 million. The following year, 2017-18 was a similar story with $17.3 million budgeted and $62.3 million spent. For the current fiscal year 2018-19, the department has spent near twice the amount they budgeted for per diem staff nurses for the entire year while they are only seven months into the period. They have spent $34.3 million to date. As tempers rise, the idea of a striking seems to be looming on the horizon. The unionized workers allege that hospital administration won’t add more full-time positions, but in the light of the numbers above, it might seem that the commission isn’t making fiscally sound decisions regarding the issue. How do you feel? Should the nurses strike? Does the Department of Public Health have it all wrong and should shift their budgeted dollars from per diem nurses to full-time staff? And, if they do, who would want to work in a facility with this current reputation? Would you? Let us know by commenting below.
  11. Nurses across the state of Illinois are demanding change. While Illinois House Bill 2064 aims to deliver nurse staffing ratios, nurses speak out to raise awareness of a variety of patient and staff safety concerns. Channel 5 Chicago aired an interview with five nurses who had a lot to say and as the anchor pointed out, “a lot to fight for.” The union nurses interviewed work in Chicago’s intensive care units, emergency rooms, psychiatric units, and beyond. One nurse stated, “there is no margin for error in nursing, it can be life or death.” But, what happens when the life being threatened is the one that put on their scrubs with the sole purpose of helping? They discussed patients who came to the hospital needing care for critical issues like gunshot wounds and drug and alcohol ingestion. As they discussed their typical high acuity assignments, the anchor asked them to raise their hand if they’ve ever felt threatened while at work. It’s probably not surprising to know that all five arms went up in the air. Whether it was a knife, a verbal threat, or having phones and other devices thrown at them, these nurses all shared one thing in common - violence at the hands of those they care for each and every day. One of the nurses reported that she’s even had to press charges against a patient. Chicago hospitals have been the site of horrific crimes, like the one that played out in November of 2018 when a gunman killed a doctor, pharmacist, and police officer at Mercy Hospital on the south side of town. In 2017, an unshackled inmate took a nurse hostage at the Delnor Hospital. While a correctional officer slept, the inmate obtained the officer’s gun, took two nurses hostage and then raped and tortured one. When officers shot and killed the inmate, one was also shot. As the interview shifted from violence to nurse-patient ratios, both the men and women reported seeing nurses with up to nine patients at a time. They’re fighting for set nursing-to-patient ratios similar to the ones seen in California. The Illinois Hospital Association believes this request is a “one-size-fits-all” remedy that won’t keep the nurses or their patients safer. They think it will actually increase costs and limit the number of services available. Every single nurse said that striking is something they will do to get the changes they need, but also adamantly stated that they can’t see themselves doing anything else. When they spoke of patient successes, their faces lit up, and their expressions showed a sense of pride and accomplishment. What Will it Take? Nurses across the country are fighting for safe work environments that allow them to provide the care they feel their patients deserve. As more hospital violence happens and patients are put at a higher than usual risk of adverse outcomes, many nurses are wondering just what it will take to get the changes needed. If the governments aren’t willing to step in and mandate change, will it ever happen? What do you think? For a news video of this story go to Nurses Tell All.
  12. Melissa Mills

    Should Hospitals Set Workloads for Nurses?

    In a recent Chicago Sun-Times Letter to the Editor, nurse Mary Nnene Okeiyi responds to the need for safe workloads in Illinois hospitals and current legislation that lawmakers are reviewing. Illinois House Bill 2604 Illinois House Bill 2604 provides the maximum number of patients that can be given to a registered nurse in specific situations. Under the bill, hospitals will be able to assign the nurse with fewer patients during their shifts, but never more. The legislation also limits the ability of facilities to pull nurses to units they haven’t previously received training to ensure the nurse has the essentials needed to provide care to this specific type of patient. One Administrator’s Point of View Mary wrote her letter following a letter from A.J. Wilhelmi, President and CEO of the Illinois Health and Hospital Association. In Wilhelmi’s letter, he states that “While supporters of ratios say it (mandatory nurse staffing ratios) will help patients, it will do the opposite.” He contends that the state of Illinois doesn’t have enough nurses as it is, quoting a 21,000 nurse shortage with another one-third of RNs planning to retire within five years. He went on to say that the ratio legislation will only deepen the shortage of nurses in the state and create safety issues for patients. Wilhelmi’s solution? Leave staffing in the hands of hospital administration, not lawmakers. One Nurse’s Point of View Let’s go back to Okeiyi’s letter for just a moment to gather an understanding of her perspective. She says that she went into nursing for a career that “inspires, educates, and advocates for others.” She went on to say that unfortunately, she is often expected to assume the care of an unsafe number of patients. Mary contends that the ‘big business’ mentality of hospitals is more about money than safe patient care and that administrators are often more worried about their bottom line. She closed her letter with a simple, yet powerful statement, ”What we cannot trust hospitals to do on their own, we ask politicians to do by passing HB 2604.” Breaking Down the Issue Illinois won’t be the first or the last state to consider and possibly pass nurse staffing ratios. Let’s take a look at a few nursing staff ratio laws in states across the nation. There are currently fourteen states with official staffing regulations. Another seven states require hospitals to have staffing committees for nurse-driven ratios and staffing policies. California is the only state that provides a minimum nurse to patient ratio. Massachusetts passed a law specific only to the staffing ratios in the ICU. Minnesota requires that a CNO or designee develop a staffing plan for ratios, and the state of New Mexico has given powers to specific stakeholder groups to recommend staffing standards. Staffing issues have long been a source of contention between nurses and administration. This is why many have turned to lawmakers to take the role of mediator to create policies that must be followed. While a federal regulation (42CFR 482.23(b) has been in effect for some time, without a law backing it up, there isn’t a way to hold hospitals and other facilities to the rule. The dangers of not having enough nurses, like medication errors, patient mortality, and hospital readmissions, should be enough to make any administrator consider their staffing ratios. However, it seems that it just isn’t enough. Who Should Decide? So we come down to one simple question - who is in the best position to decide how many patients any one nurse should be assigned to care for during their shift? As nurses, we know the dangers of having too many patients, but can we be objective and offer this information for the good of all involved? Or, should this be up to administrators or even lawmakers? Tell us how you feel about Mary’s letter and who you think should be in charge of making nurse staffing ratio policies.
  13. Have you ever considered that nursing excellence allows physicians to provide compassionate, patient-centered care? A recent study conducted by Press Ganey revealed that comprehensive nursing practice in high-performing hospitals creates high patient satisfaction rates for both nursing and physician delivered services. What is the professional practice environment really like? It's free of disrespectful, rude, and disruptive behaviors between staff. Professional relationships don't focus on power or the abuse of it. This allows the work being done to center around the patient, and not on how one group is defending itself against the other. A healthy workforce also consists of effective communication, collaboration, and mutual respect. Understanding the Nurse-Physician Connection Ask any nurse, and frankly, any physician and they are likely to tell you that the relationships between nurses and physicians matter. Knowledge of the professional practice environment is critical to not only to collaboration but also to nurses’ recruitment and retention rates. The professional practice environment is where medical and nursing care happens. Depending on how the nurses and doctors feel about the workplace and their collaborative roles with one another impacts quality. So is the professional practice environment really like? It’s free of disrespectful, rude, and disruptive behaviors between staff. There is no abuse of power or relationships between nurses and physicians and allows for work satisfaction for both professionals and quality patient care. It’s filled with communication, collaboration, and mutual respect. Nursing Excellence Initiatives The American Nurses Credentialing Center developed the Magnet Recognition Program for hospitals. It started in 1983 when they conducted a research study and identified 14 characteristics that made some organizations more able to recruit and retain nurses. Not only does the program require excellence, but it needs to be guided by a visionary nursing leader who supports, advocates, and practices nursing excellence. The 14 characteristics of nursing excellence, according to the American Nurse Credentialing Center include: Quality of Nursing Leadership Organizational Structure Management Style Personnel Policies and Programs Professional Models of Care Quality of Care Quality Improvement Consultation and Resources Autonomy Community and the Healthcare Organization Nurses as Teachers Image of Nursing Interdisciplinary Relationships Professional Development Nursing Excellence, Hospital Scores, and Physicians Press Ganey's study explored the relationship between Magnet status and National Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. This standardized publicly reported survey looks at the patient's perspective on hospital care, including the environment and how well physicians, and nurses communicated with them during their care experience. The Press Ganey survey found a connection between Magnet Status, which indicates nursing excellence, and higher patient ratings of their doctor’s skill, responsiveness, and bedside manner. While the difference appeared subtle in number, there was a meaningful difference in the patient’s perceptions. Out of 123 Press Ganey client hospitals, the survey found that 45 percent of those in the top quartile for engagement of physicians were also Magnet hospitals. Compare this to the 16 percent of bottom quartile facilities who also shared the Magnet designation, and you can see how nursing and physician care must be intertwined to deliver care that is perceived by the patient as having them in the center and being of the highest quality. Improving Nurse-Physician Relationships Considering that only about 8 percent of all hospital in the US achieve Magnet designation, we must find ways to enhance the nurse-physician relationship outside of this prestigious designation. Here are a few ways you can work on your relationship with the physicians in your facility to increase collaboration and positively impact patient outcomes. Practice as a Team While nurses spend far more time at the bedside than doctors, it’s critical that we remember that we each have a unique role in patient care. Share in the responsibility of patient outcomes with all staff members and work collaboratively. Uphold Professionalism When nurses uphold professionalism, the workplace runs smoothly. This includes simple things like getting to work on time, avoiding negativity, and working both autonomously and collaboratively. Develop a Strong Sense of Advocacy One of the pillars of nursing practice is to work as a patient advocate. You must learn to speak up for the patient and let the physician know your observations and thoughts about the patient’s condition. This can be difficult, depending on the type of relationship you have with the physician and other clinicians in the healthcare setting. Practice Effective Communication The ability to communicate with coworkers, including doctors, is critical to positive patient outcomes. You must learn to organize your thoughts before you pick up the phone. If you find yourself struggling to communicate concisely, check out a few different communication tools that can help you standardize your reports to the physicians and fellow nurses. Having a clear report can help the receiving clinician understand the patient’s needs better so that a comprehensive plan that addresses the most critical areas can be developed. How do you feel about your relationship with the physicians in your facility? Do you think that you have a good relationship, built on mutual respect? We would also love to hear from nurses who work in magnet hospitals to learn how you feel about your ability to support physicians and how the two groups work together. Let us know what you think by commenting below. Reference: How Great Nursing Improves Doctors' Performance
  14. It is flu season. Turn on any news station and you will hear statistics about how this year's flu has spread faster than anything. But, there is one thing I can think of that spreads faster than flu and does not have a limited "season" - that's right Gossip! Gossip is a pathogen, infecting workplace morale, productivity and the mental and physical health of those around it. Gossip happens at the nurse's station, in patient rooms, in the elevator and even through text or email. One study found that gossip is expected to occur in stressful work environments where people work closely as a team. Nursing certainly fits this criteria. What is Gossip? Dictionary.com defines gossip as idle talk or rumors about the personal affairs of others. According to Renee Thompson, DNP, RN, CMSRN, gossip can be an attack on another person's character or personal attributes. It betrays trust, damages relationships and breaks confidence. In some situations, it can even be considered a form of bullying. Gossip comes in many forms. Here are the most common ways it shows up in nursing departments: Rumors - repeating information that is not entirely true Judgements - forming an opinion about an issue or person without adequate information Tattletales - telling on someone or revealing information about another person's actions Betraying Confidentiality - sharing information you were told in confidence by another person without their permission The Controversy Let's be clear about one thing: gossip can be good. It can relieve emotionally charged situations. It can spread information more quickly than a flyer on the back of the bathroom stall and it can decrease stress and create bonds. The negative effects are certainly stronger and greater in number than any positive effects. Gossip must be regulated and at times, resisted. Why Do We Gossip? Gossip can be fun. It may make you feel like you belong to the "in" crowd. It builds social bonds between yourself and the other gossipers. And, you can even use it as a way to feel better about yourself. Negative talk about others, makes us feel superior. Tips for Staying Out of the Dirt Redirect the Conversation - If you are given information that is a rumor or gossip, simply redirect the person who is sharing this information with you. Try to gently change the subject by asking a question that is far from the gossip or share something else that can easily grab their attention. Reflect on the Feelings or the Sharer - Instead of engaging about how Susie left a mess in Room 4 for Greg to clean up, reflect on Greg's feelings. Use a statement such, "Greg, it sounds like your shift started out rough. What can I do to help?" This removes Susie and her actions from the conversation and allows you to let Greg know you hear him and are there to help him with this difficult situation. Gossiping about Susie will not get Room 4 cleaned up, but your help and willingness to listen to Greg will. Remove Yourself From the Conversation - If reflection and redirection do not work, it may be time to simply walk away. By removing yourself from the conversation, you are making a clear statement that you do not want to be part of the gossip. Actions Speak Louder Than Words Don't Repeat - If you hear gossip. Simply tuck it away and leave it where it should be, in the past. If you would not be comfortable saying it to the person's face, don't repeat it behind their back. No matter how juicy it may be. Set High Professional Standards - We can each set high professional standards for ourselves. Standards that gossip simply does not fit into. If you are a nurse manager or leader, set high professional standards for your staff. Model the behaviors you want to see in your nursing department. Don't tolerate gossip. Confront those who are habitual gossipers and set clear expectations. Hold everyone accountable for keeping gossip to a minimum. Most nurses chose this profession with helping others in mind. Yet, our treatment of colleagues may not always be helpful. Use these tips to stay out of the dirt on your nursing unit. Have you ever been the subject of nurse gossip? Did you confront those talking about you? Have you ever stopped gossipers in their tracks? Share your stories with us.
  15. House Bill 793 passed in the state of Virginia in 2018 and went into effect in January of this year. The legislation allows nurse practitioners (NP) in specialty practices to open a private practice and work without the oversight of a medical doctor. Since nearly half of the states across the country have similar legislation, this appears to be a win, but also possibly just part of the natural progression for NPs. Marsha Stonehill, a psychiatric NP recently opened her own practice, Melt the Ice. Her doors opened in March, just a few months after the bill went into effect. She described her practice and why she decided to go out on her own in a recent Fredericksburg.com article. Stonehill has previously worked in large health systems that required her to see many patients in a day and even cut sessions short. Today, she truly is a one-woman show who answers her own phone and emails and even set her times directly with her clients. She leaves extra time between patients in case there are emergencies or care issues that need further discussion beyond the scheduled appointment limits. She has chosen to be a private pay practice to avoid some of the limitations set by health insurance plans. While Stonehill is enjoying the freedoms of her practice, not everyone in Virginia or even across the nation agrees that nurse practitioners should be allowed to practice alone. The Debate Virginia’s law requires NPs to have a minimum of five years of full-time clinical practice. They must submit documentation from a physician who can attest that there was collaboration between the two during that time. If an NP wants to go out on their own but doesn’t meet this qualification, they must provide a plan to the state detailing how they will refer complex cases and emergencies to a doctor or other provider. Some doctors, like Dr. Davis Liu, who practices in California and runs a start-up called Lemonaid Health doesn’t feel that nurse practitioners should be allowed to practice on their own. He was quoted saying, “It boils down to training. Primary care is a cognitively challenging specialty. The amount of training doctors receive is far greater than that of nurse practitioners.” However, Lui might be in the minority for a few reasons. And, it’s not just nurses who question if his opinions are correct. Understanding the State Practice Environment According to the American Association of Nurse Practitioners, across the U.S., there are three categories of practice that governs the care provided by NPs. Full practice states allow the clinician to evaluate, diagnose, order and interpret diagnostic tests and start and manage treatments. They can also prescribe medications, including controlled substances under their license. This model of care is supported by the National Academy of Medicine and the National Council of State Boards of Nursing. States in this category include Washington, Hawaii, and Iowa. Reduced practice states include Ohio, Utah, and New Jersey. NPs in these states have a reduced ability to engage in at least one element of the NP practice. They must have career-long collaboration with a provider under a set agreement. The final category is restricted practice in which the NP have a restricted ability to engage in at least one element of the NP practice. They also must maintain career-long supervision, delegation, or team management by another provider. States who continue to restrict NP practice to the fullest include California, Texas, and North Carolina. What’s Next? Using NPs as an integral part of the healthcare team has been proven successful many times over the years. They’re a cost-effective solution to the shortage of physicians, and many patients prefer the care they provide. As more states adopt similar laws to Virginia will the naysayers finally believe in the value of NPs at work? What’s your opinion?
  16. Shortly after 4pm on Monday, May 6th, nurses, physical therapists, and paramedics at Mercy Health St. Vincent Medical Center in Toledo, Ohio went on strike. The group of workers, represented by the United Auto Workers Union was unable to reach an agreement with hospital management concerning health care costs, on-call regulations, and overtime policies. WCPO in Cincinnati reported that president of the health center, Jeff Dempsey, declined to discuss the plan to replace those on strike. He did, however, report that the facility was prepared to handle the walkout. The hospital said last week that they felt the contract they presented to the workers was generous and included increases to staff’s wages. A Family-Member's Perspective Have you ever wondered what happens to patient care during a strike? Shirley Parrott- Copus, a family member of a Mercy Health St. Vincent Medical Center patient, was interviewed by 13abc about the changes in the care she observed. Shirley said that services had dropped since the strike began. She went on to describe the nurses before the strike as “wonderful.” She stated that the morning after the strike started, she was woken by a nurse who asked her where her dad was because she didn’t know. Shirley was alarmed by this event and worried that they had lost her father. Of course, there are many different reasons for the possible missing patient, but to a family member, a statement like that can impact their ability to trust employees. Parrott-Copus is a nurse herself and stated, Who Cares for the Patients? When facility administrators can see a strike on the horizon, they prepare by calling in non-union travel and agency nurses to fill in for staff. The nurses who step up to work don’t have any connection to the hospital, but probably understand the issues at hand. They usually won’t cross the picket line and try to keep a low profile on the job. Travel agencies warn their nurses that tempers can flare at any time during a strike. They advise staff to travel in pairs, remove their name badge and scrubs in public, and to avoid engaging in conversations about the strike with patients, family members, or hospital staff. During a strike, the work is hard and the hours are long. Many nurses work up to six 12-hour shifts each week. Many agencies require staff to sign a contract agreeing to work up to 72 hours a week if needed. Because the hospital is desperate, they need all hands on deck, but what do these long hours do to patient care? The Impact to Quality Care One study conducted in the state of New York found that patient care suffers during nursing strikes. The effects of strikes between 1984 and 2004 revealed that in-hospital mortality increased nearly twenty percent and readmissions went up by 6.5 percent for those patients who came to the hospital during the strike. The study also estimated that 138 more people died because of the strikes. While patient care continues and nurses from agencies fill in, it’s just not the same as having nurses who are comfortable with the inner workings of the hospital, unit, and even politics of the facility. Other issues such as a sense of ownership might be at play for those who are just there to “fill in” until an agreement is made. What’s the Answer? You might be wondering if there is a better solution. Is it better for nurses to continue working in unsafe and conditions, so that patient care remains at a higher level or should they strike and potentially place their patients at an increased risk for adverse outcomes? We’re not sure if there is a right or wrong answer in this situation. What do you think?
  17. Nurses in Texas are turning to lawmakers for relief from workplace violence. Kimberly Curtin, remembers being punched in the head as a young nurse in the ER. Not only was the event terrifying, but what a fellow nurse said to her may have been worse, when they simply stated, “Welcome to ER.” Is this the truth of nursing? Have we just gotten to the point that violence at the hand of patients is expected and even tolerated? Nurses in Texas are hopeful that they can see the beginning of the end in their state. The Texas Legislature is working on laws that would set expectations for employers. Health care systems would be mandated to provide violence training. They would also be held to expectations for investigation and reporting of any incidents of violence perpetrated against their employees. Even though rules and expectations might be necessary to get the ball rolling, it is enough? Let’s look at the numbers. What is Workplace Violence? The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as an act or threat of violence, ranging from verbal abuse to physical assaults directed to a person while they are on duty at their place of work. NIOSH goes on to say that fatal workplace violence is highest among those in protective services, sales, and transportation. However, those in healthcare and social work face higher than average nonfatal violence leaves them missing work due to physical and mental injury. To show the impact of workplace violence in healthcare, NIOSH has even created a free CE course for nurses on violence prevention. Violence in Healthcare by the Numbers In 2016, nearly 17,000 workers in private industries suffered nonfatal workplace abuse according to the Bureau of Labor Statistics. The people who suffered violence on the job were predominantly female (70%) and ranged in age from 25 - 54 (67%). You might be wondering where they worked. You guessed it, 70 percent of the workers who experienced nonfatal violence in the workplace were healthcare and social work employees. Because nursing and social work jobs are held by more women than men, this is likely the reason that most victims were female. Regulatory bodies are taking note of the issue too. The Joint Commission reported in a 2018 Sentinel Event Alert that healthcare workers are at a 20 percent higher risk of being a victim of violence on the job. They also said that in eight-years there were 68 incidents of rape, assault, or homicide against hospital staff. The idea that going to work to help others put you at a higher rate of these violent and life-altering crimes is outrageous! Why are Nurses at Risk? Nurses care for people who are ill, injured, and dying. They give up time with their families to work beyond the end of their shift when faced with issues like short staffing, high acuity, and emergencies. Most nurses go into the field with a sincere desire to help others. So, if they are there to help, why are they suffering at the hands of those in their care? There are a few things that place nurses at risk. Here is a list of factors associated with workplace violence in healthcare: Understaffing Patients with mental health conditions such as dementia Patients and families who act out during stressful situations Gang activity Poor facility conditions such as low-lighting in hallways and parking lots Unrestricted, public access to care areas Lack of community mental health care Finding a Solution Nurses in Texas are turning to lawmakers to institute policies that require employers to recognize and prevent these violent incidents from happening. However, this might leave you with questions about enforcement and consequences for those who injure nurses on the job. Because nurses are often not given a seat at the table when discussing critical topics like this, we invite you to pull up a chair. If you were in charge of violence prevention at your place of work, what would you do? Do we need laws, more policies, or some sort of consequence for those who commit crimes of violence in the healthcare setting? Let us know your thoughts.
  18. Melissa Mills

    Nursing: The Most Trusted Profession

    Download allnurses Magazine Think of one patient who changed your nursing career. Was it a baby who fought their way into this world or an elderly person at the end of life? Maybe it was a child who fought during a battle with cancer or the young mother and father who sat next to their bed night after night. We each have a story of someone who changed our professional lives for the better. However, many people around the globe would argue that the more important part of this story is how your actions made the patient and their family feel. When they left the hospital or clinic, or you discharged them the agency, they likely never forgot your name or what you looked like. Your compassion and care created a bond in the center of your professional relationship. This bond is known as trust. For the 17th consecutive year, nursing was named the most trusted profession by the annual Gallup poll. More than 4 of every 5 Americans rated the honesty and ethical standards of nurses as “very high” or “high.” Nursing was added to the poll in 1999 and has been at the top of the list every year except 2001 when firefighters won the vote just after the 9/11 terrorist attacks. While it might be easy for you to understand why your profession is number one year after year, it’s essential we take a deep dive into the reasons you and your colleagues are thought of so highly by the public. Understanding the Meaning of Trust We can’t discuss the reasons nursing has outpaced all other professions unless we know what being trusted means. Trust is a belief in the truth, strength, and ability of others. It is formed during a relationship between two people. You can’t demand or expect it from the other person. It is created by your actions and words. It bubbles up when you tell someone that you will be there, take care of them, educate them, or support them and then follow through on that promise. Ethics and honesty are pivotal factors in trust. Why are Nurses the Most Trusted? As nursing continues to be at the top of the list on the annual poll, experts are starting to wonder why. There are several theories. Here are a few of the reasons why nurses are trusted by people across the country. Level of Intimacy in the Relationship Patients stand before their nurses naked (literally and figuratively) day after day. You help with elimination problems, care for them after surgeries or injuries, and listen as they tell you about their fears, failures, and battles. Your empathetic heart gives patients the confidence to tell you things they may have never shared with friends or family before. According to a 2007 study on clinical intimacy in nursing practice, the connectedness in the nurse-patient relationship must be achieved practically and predictably way within the difficult constraints of the practice environment. It must be distinct from empathy in both concept and practice. The therapeutic nurse-patient relationship must be built on mutual trust, have shared meaning, and a strong sense of understanding. Female-dominated A 2010 study published in Time reported that people perceived women to lie less than men. They also think of the type of lies told by the two sexes differently. The interesting thing is that men and women both admit to not telling the truth about 20-35 percent of the time during social interactions. Even though people may feel that women are more honest, there isn’t likely any real statistical significance. You might be wondering why any of this matters. Nursing is a female-dominated profession. In fact, less than 10 percent of all nurses are men. This means that when individuals answered the poll about the jobs they trusted, they were thinking primarily of women. Some experts have argued that this could be one reason the profession tops the charts year after year. While the fact that nursing is a predominantly female profession, it’s essential to point out a few things. First, male nurses are trustworthy. My personal experience has been that most of the men I’ve worked with throughout my career were trustworthy, and when the “you-know-what” hit the fan, I was happy they were by my side. The other thing to consider is that the specialties men choose might not be where patients remember the care they provided. Our 2018 Nursing Salary Survey collected information about specialty and found that most men who work as nurses can be found in emergency rooms, med-surg units, and on specialized cardiac care floors. Often patients are very ill when they are on these units and might not remember those who provided life-saving treatment when they are completing a survey months later. Code of Ethics You learned many things in nursing school, from how to do an assessment to inserting IVs to how to teach patients about their diagnoses. However, one critical thing you learned that is probably ingrained into your daily practice is your code of ethics. The American Nurses Association created nine provisions that help nurses conduct their actions by the code. These provisions include practicing with compassion, being committed to the patient, and promoting, advocating for, and protecting the rights and safety of the patient at all times. When a nurse’s actions align with these provisions, it creates a therapeutic relationship in which trust can grow. Patients and their families can see the nurse acting and working with their best interest at heart and know that their nurse selflessly and tirelessly provides the care they need to restore health. These heartfelt and sincere actions build a trusting relationship that creates the basis for all other care. Will Nurses Remain the Most Trusted Profession? There are many reasons that nurses have outpaced any other profession as the “most trusted.” While it’s hard to tell just how long they can hold onto the honors, the trade as a whole has certainly earned it each year. If you had to choose the most trusted profession would you choose nursing or would another job take the top honor?
  19. Nurses Celebrate Nurses across the state of Washington celebrated last week when House Bill 1155 passed, creating new break and overtime laws for nurses and other healthcare professionals across the state. You probably first heard about the bill when video clips of Senator Maureen Walsh hit the internet that showed her opposing the legislation by making a comment that some nurses “probably play cards for a considerable amount of the day.” While her comment received tons of publicity and backlash from many nurses and nursing organizations, it wasn't enough to stop the bill from being passed. Understanding House Bill 1155 The bill passed on April 24, 2019, and should go into effect on January 1, 2020. It currently sits with the governor, who will sign it for final approval. This legislation will implement new restrictions on hospital staffing. It removes a mandatory eight-hour cap on nurse shifts and also offers provisions that nurse’s breaks can’t be interrupted to address patient care needs. This means that nurses will receive uninterrupted meal and rest breaks, with the only exception being patient care emergencies. SHB 1155 also provides changes to the use of mandatory on-call for regularly schedule shifts and excludes pre-schedule on-call nurses from being used to cover staffing needs for reasons like census or high acuity. Finally, the bill protects nurses and other healthcare workers from not receiving rest breaks between consecutive shifts that will put them into overtime hours. While the initial changes will affect nursing staff, other healthcare workers will be included in these rules beginning in July 2021. The list of workers that will join in on the provisions of SHB 11155 includes radiology technicians, cardiovascular invasive specialists, certified nursing assistants, surgical technologists, and respiratory care practitioners. While everyone knows Senator Walsh made a statement that was insensitive to the long hours and hard work nurses do each day, other lawmakers and hospital associations in the state agree that this bill could be detrimental to critical access hospitals. The fear is that these small, rural hospitals, who have less than 25 beds, might have difficulty complying with the newly passed regulations because of staffing constraints. However, critical access hospitals have been given additional time to comply and won’t join the law until July 1, 2021. Washington Nurse Speaks Out in Support The Spokesman-Review interviewed ICU nurse, Sara Rice just after the passing of the bill. Sara reported that in her 10 years as a nurse she has never worked a full week where she was able to take her allotted breaks. She went on to explain that it wasn’t a knock at her employer, but rather a cultural issue that’s prevalent to both nursing and hospitals. Rice feels that the bill is a “big win for nurses” even though lawmakers and the hospital industry remain in opposition. Rice went on to say in the interview that, “We just want patients to get quality, safe care. In a perfect world, we wouldn’t need laws for that.” Could More States Follow? While Senator Walsh shuffles through the more than 1,700 decks of cards she received in the past week, you might be wondering how the passing of SHB 1155 could affect other states. You may have even considered how your current laws about breaks and lunches work and if your employer could meet the standards of rules like this. If this would happen in your state, how would you feel? Do you agree that SHB 1125 a win for Washington nurses? Or could it even be a win for nurses across the country? Let us know how you feel about the passing of this law below.
  20. Nurses care for vulnerable populations each day. Patients might be considered vulnerable because of economic, social, or political standings or because of an illness or disability. Regardless of the reason for the patient's vulnerability, it’s the nurse’s role to care for these patients with sensitivity, skill, and above all us - protection. Breaking Headlines If you’ve watched television in the past week or so, you probably saw a story about a nursing home patient who gave birth to a baby at the end of December. When this story first circulated, there were questions about the patient’s mental capacity and who might be the father. A few days after the initial coverage, a nurse, Nathan Sutherland, was arrested and charged with assault and abuse of a vulnerable adult. Sutherland cared for this patient in the nursing home and willingly took a DNA sample, which is allegedly a match with to the patient’s newborn baby boy. As this story unfolded, questions flooded the minds of people across the country. How does this happen in a facility where care providers are working around the clock? What systems failed to protect this patient? And, how can a patient in a long-term care facility deliver a full-term baby, but no one seems to know that she was even pregnant? The answers to these questions aren’t available yet. However, as nurses, it’s our duty to learn from these situations and consider what patients, family members, or loved ones might be susceptible to the same or similar behaviors at the hand of healthcare providers. Vulnerable Patients 101 Our healthcare culture might have us more concerned about reimbursement models, readmission rates, and patients with comorbid conditions over those who can’t speak up in the face of abuse, neglect, and general misconduct. Definitions of vulnerable patients vary based on organizations, locations, and use of the system. One population might be considered vulnerable in one setting, but doesn’t meet the definition in another. A few populations that are generally considered to be vulnerable include: People 60 years or older with physical, mental, or functional limitations in their ability to care for themselves Adults 18 years of age who: Are unable to make medical decisions and might have a guardian Live in a nursing facility, rehabilitation center, group home, or other facility licensed by a state Have developmental disabilities Receive in-home services such as hospice, home care, or individual providers Children under the age of 18 Making Sense of the Dichotomy At the end of 2018, nursing was selected as the most trusted profession again for the seventeenth consecutive year. Nursing has earned this designation because this is how the general public views nurses - trusted. Why are we so trusted? Nursing staff help bring babies into the world. Often nurses are there when the aged, ill, and injured take their last breaths. Imagine any significant life event in the middle of birth and death, and there is probably a nurse supporting, caring for, or educating patients, family, and other caregivers. Nurses speak up when patients have no voice. They fight for the wounded and underprivileged. Yet, this incident happened in a facility filled with nurses. How does this dichotomy live on the spectrum of nursing? I must admit - this story has been hard to understand. And, while it’s essential we remember that Mr. Sutherland hasn’t been found guilty at this time, this situation can make you lose a little faith in humanity. However, being an optimist (most of the time), I feel that this is an excellent time to review ways to keep vulnerable patients safe. Safeguarding Against Abuse and Neglect There are a few things all nurses caring for patients can do to ensure you’re keeping those entrusted into your care safe at all times. Learn the signs of abuse The symptoms of abuse are different depending on what’s happening. Having stellar assessment skills is one of the best ways to protect against any form of abuse. If you notice new bruises, injuries, burns, or a change in the patient’s reaction to care, this might be a sign that something out of the ordinary is happening. If patients are being neglected, you might notice weight loss or gain, poor dental and physical hygiene, and the presences of new pressure sores. When neglect is happening, patients may wear the same clothes for days at a time, even when they are torn or visibly soiled. You might also notice changes around food, such as begging or scarfing down food as though they haven’t eaten in quite some time. Speak Up If you suspect neglect or abuse of a patient, it’s your responsibility to speak up right away. If you’re in a facility, bring your concerns to your manager or the Director of Nursing. When caring for patients in the community, know your employer’s policies and when you should contact the police or other agencies such as adult protective services or children services. If you’ve ever had to file a report of suspected abuse or neglect, let us know about the situation in the comments below. Do you have other ways nurses can protect vulnerable patients from dangerous situations?
  21. Melissa Mills

    Staffing and Unions: Beaumont Hospital in Royal Oak

    Thanks for your comment! I agree that there are pros and cons to unionizing. I have no experience with nurse unions, however, my experience with non-professional unions (my husband's company) isn't positive. We need more open, honest conversations about these types of issues to know how to handle these issues though.
  22. Melissa Mills

    Should Hospitals Set Workloads for Nurses?

    Very interesting comment. Other industries have so many regulations, yet when it comes to safe staffing - we do leave it up to people who have often never been in the middle of patient care, much less a code or other emergent situation. Thanks for the input on this convo!
  23. Melissa Mills

    Should Hospitals Set Workloads for Nurses?

    I agree!!!
  24. Melissa Mills

    Washington Nurses Celebrate House Bill 1155

    I agree with tnbutterfly - nothing goes into depth on how it will be enforced. I assume that is up to the state. Melissa
  25. Download allnurses Magazine A sick patient enters the emergency department. Feeling faint, he looks for a nurse. As he scans the room, he notices men and women in colored scrubs. He looks again, trying to find a female in head-to-toe-white. This is his image of nursing. Many years ago, this might have been a logical place to begin when looking for a nursing professional. However, today you might find nurses in solid or patterned scrubs, street clothes, or in a lab coat that looks more like the traditional physician attire. Nursing uniforms don't end with clothing. It used to be understood that nurses had no visible tattoos, piercings only in their ears and that naturally colored hair would be pulled back or kept short. Hospitals have become more lenient on the clothing nurses wear and these other aspects of their attire, too. Have you ever wondered how we made it to this point? Whether you feel that your body is not your resume or that the way you dress as a nurse is linked to professionalism, here is a historical view of nursing uniforms from the past to the present. Florence Nightingale Had a Vision Uniforms from the 1800s looked similar to a nun's habit, consisting of floor-length dresses in drab colors with white aprons over the front. Many of the first people to care for the ill were nuns, which is why the uniforms were similar. In the 19th century, Florence Nightingale revolutionized nursing. She entered the profession against her family's wishes because nursing was not seen as a worthy career choice at that time. Florence is known for molding nursing into a respected discipline, writing multiple books, and establishing the Nightingale Training School at St. Thomas Hospital. Florence had a vision for herself and those she trained. She understood the importance of creating a professional image that also served a purpose. She created uniforms to separate nurses from those still in nursing school, and that protected them from illness, weather elements, and the advances of male patients. The first recognizable nursing uniform included a long dress, apron, and frilly cap. War-Time Changes During World War I the nursing uniform underwent some of the first changes. Working on battlefields become difficult in long dresses. Nurses needed to be efficient and move quickly to assist the wounded. The aprons disappeared, and hemlines shortened. Tippets - short, cape-like garments - were added to the war uniforms. Nurses began displaying badges on their tippets to show rank. Uniform Changes with Popularity As nursing became a popular career choice in the 1950s, attire needed to be easier to clean and produced in large quantities. Skirts and caps remained a staple of the standard dress code. But, the need for more flexibility caused hemlines and shirt sleeve length to shorten. Many nurses wore starched white dresses with white hose and shoes as the standard hospital uniform. Capping it Off It's possible that the most recognizable part of a nurses uniform was the crisp white cap that was worn up until the late twentieth century. An article on Medscape Nurses reports that this change brought about changes from patients who said they could no longer tell the nurse from other hospital staff. Caps were worn to show dignity and pride in the nursing profession. Many nursing schools ended with capping ceremonies to celebrate the induction of new nurses into the trade. However, lacking practicality was likely the main reason for the demise of the nursing cap, which was no longer required by most hospitals by the 1970s. Emergence of Scrubs Scrubs began in the operating room. In the 1940s physicians started wearing white uniforms rather than their own clothing. By the 1960's surgical scrubs changed to the traditional green that you see today to lessen eye strain experienced by surgical staff from white uniforms and bright operating room lights. As nurses became responsible for the cost and care of their uniforms, they also started to request more comfortable options from manufacturers. This prompted the modern day scrub. By the 1980s and 90s, the traditional nursing uniform was replaced with scrubs in most healthcare facilities across the U.S. Scrubs are easy-to-care-for, come in a variety of styles and colors, and offer nurses comfort and mobility during long workdays. You can choose styles with multiple pockets, elastic waistbands, drawstrings, and other options and still meet most hospital policies. Some facilities might require nurses to wear a specific color or pattern to help distinguish them from other clinicians. Other employers such as home care, hospice, or other community health providers may wear a combination of scrubs and street clothes to care for patients in their homes. Men in Uniforms Not only has the appearance of the nursing uniform changed over the years, but the look of the workforce has changed, too. Finding images of men in traditional nursing uniforms is difficult. Many nursing schools provided men with a shirt made of the same dense fabric that women wore, and no caps were required. Some hospitals required men to wear uniforms worn by physicians or dentists because there wasn't a standard male attire. As scrubs became acceptable, men followed suit, choosing scrubs in multiple colors and patterns. Hair Color, Piercings, and Tattoos For years, many nurses have covered tattoos and refrained from coloring their hair in unnatural colors to conform with facility policies across the U.S. A 2015 article in Minority Nurse even reported hospitals and nursing schools banning all nail polish colors, unusual hairstyles, and earlobe gauges. In recent years, many facilities have started to change their policies on nursing dress codes. Indiana University Health, the state's largest health system adopted a relaxed policy on tattoos and hair color in 2018. The hospital reported that the changes were made to reflect "authenticity" of their staff. A Becker's Hospital Review article from December 15, 2017, stated that the Mayo Clinic changed their policy on showing tattoos for both nurses and doctors in January 2018. This came just three years after the hospital ended a rule that required female employees to wear pantyhose. These rules, lodged in societal norms, continue to change and evolve. However, some feel that the uniform is more than just functional attire. It's part of the nurse's expression of self, and it's also one component of the patient experience. Function versus Expression The nursing uniform has long been positioned as a way to keep nurses safe. The functionality of the first long-sleeved and floor-length frocks met the safety standards of the day. As the need to become more mobile emerged, changes began to happen that made the uniform more functional. With the emergence of infection control practices, other equipment was added to the attire that is now considered standard, such as gloves, masks, and even isolation gowns, when needed. As nursing gained popularity, nurses found their voice and demanded respect in many forms. The choice of wearing a uniform, changing their hair color and even showing their ink is a part of self-expression and acceptance that many nurses have welcomed with open arms. The Future of Nursing Uniforms Where do we go from here? Will nurses one day be roaming the halls of hospitals in street clothes while they care for patients? Or, will nursing "whites" come back into style either on their own or at the requirements of employers? It's hard to tell what's next for nursing uniforms. We have come a long way indeed. How do you feel about your current nursing uniform policy? Do you want more leniency or do you think that we've gone too far?
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