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nataliadab

nataliadab MSN, RN

Pediatric Pulmonary and NICU
New New Educator Nurse
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nataliadab has 5 years experience as a MSN, RN and specializes in Pediatric Pulmonary and NICU.

nataliadab's Latest Activity

  1. Any disaster brings in an influx of patients at a higher rate and volume than most hospitals are staffed for even on a good day. In fact, one hospital I used to work for only ever hired for 78% capacity because they usually averaged this census. If it’s slower, some float, assignments are lighter, or people get called off. If it’s busier, the staff has heavier, potentially unsafe assignments, and some people kindly come in for overtime. Occasionally some institutions utilize mandatory emergency staffing, like another hospital I worked at. Systems Are Not Perfect Unfortunately, these systems aren’t perfect and work even less when disaster strikes. Sometimes, it’s not as bad because if it’s for a shorter time frame, such as after a shooting or explosion, people tighten the bootstraps or other hospitals come in to help. When the high demand is a little bit of a longer anticipated influx, such as during a natural disaster, people from all over can come help. You can get travel nurses or crisis personnel to come for a few weeks to that one affected area. But, what happens when the influx and crisis is all over? The way it is now during this global pandemic? Who is going to come save us and help us save our patients? Once a Nurse ... One thing states and other countries have been doing is calling on retired medical staff to come back into practice. Now, because we know the sayings, “Once a nurse, always a nurse,” and “A nurse isn’t a job, it’s who you are,” bravely many people stepped forward. Yet it still does not seem enough. And let’s not forget staffing continues to fall everywhere as staff becomes ill or exposed themselves. Relaxing the Rules So hospitals are also calling on anyone with a license. We have even lifted rules so that people can practice medicine in a state different from the one in which their license is held. But, how many people who are staffed in one area are really able to move across state lines to help another, when their own state is also in crisis? "Crisis Pay" My friends, colleagues, and I all keep receiving texts, calls, emails, and LinkedIn messages to come work for a few weeks or with essentially entire job offers on the table because of the high demand. Most recently, my friend received an email stating that nurses are urgently needed to help provide care during COVID-19 staffing shortages. The key I want to zone in on is the second part of that email: The compensation. Crisis pay. Up to $4,700 a week. This is more than most nurses make in an entire month, although I suppose it varies a little more depending on your state and cost of living. This offer is for 8-week assignments, 12-hour shifts with 3 or 4 shifts per week at $103/hr. Now, the Questions Why are we not making these offers to our own staff? On a unit level, a hospital level, or state level? This is what I asked my friend when she told me about this email. Because otherwise, the only people they are really appealing to are travelers and those who happen to be out of work at this time. I mean, it’s not like she or I can leave our current jobs and move over to the next state for the next 8 weeks while our own hospital needs more staff and likely wouldn’t accept us back afterward. Nursing Staff Deserve It I am not even saying that we need to suddenly increase base pay to “crisis pay” for everyone already working. I am sure there are those who would argue this and likely with some valid points. However, in the interest of being reasonable, I am arguing that staff deserves crisis pay or at least double pay for anything worked above their regularly scheduled hours. Why? Because there are many people who do not even want to work their regular hours at this time. This is mainly because they are scared to work in these conditions without proper PPE supply or because they are terrified of bringing the virus home to their families. They are also doing a lot more work than on a regular day and under more stressful conditions. However, they would be more willing to do this with fair compensation. Other Compensation Do you know why some healthcare professionals are asking for hazard pay or student loan forgiveness? It’s not because they feel above their work. It’s because they want some sort of compensation for doing at least double the work that should be required of any one person. It’s because they want to feel some sort of support for putting themselves at risk. It’s because they want to feel VALUED. There Are Staff Shortages Everywhere Right Now We can’t keep hoping that somehow people will come out of the woodwork to save our own hospitals because everyone is busy weathering their own storms. However, our own staff would likely be willing to help during these shortages with some incentive because in healthcare we always pull together as a team. I think this would also help hospitals from forcing staff to float to units or specialties they do not feel competent or safe working in. Back to that Email ... Hence, to circle back around to that email my friend got, my response to her was the realization that if our hospitals or even others within our own state did that and on more of “committed per diem basis” if you will, I would pick up a shift at least one day a week. She said the same. I think if we did a poll, a high percentage of healthcare professionals would also agree. Hospitals need to realize this and capitalize on it to create more of a win-win situation (as much as you can consider things a win under disaster). Now is Not a time for Penny-Pinching Our Dedicated Nursing Staff It’s no secret that adequate staffing is linked to better patient outcomes. You can easily search and find that good staffing equates to less falls, less pressure injuries, and even higher survival rates. The list goes on and on. So it is crucial for a time like this. A Win-Win Beyond that, in the long run, I do believe that if someone sat and crunched all the numbers, paying staff either hazard pay, double time for any time worked over their regular hours, or whatever incentive system thought of—this would still equate to a less overall cost loss for hospitals than not doing so. While it is likely many hospitals will suffer costs from workers falling sick, getting these travelers, or buying more equipment, we all know the high costs associated with negative outcomes and these are going to be higher than ever. And while I do not know for sure, I imagine insurance companies will not be cutting hospitals a break about their rule to not reimburse for hospital-acquired conditions. And, who is best at being able to prevent these conditions? It is the staff at the frontline with direct patient contact. So, Hospitals and States ... ... start placing more value and respect into your own loyal team. Rather than forcing your staff to work in other areas while offering astonishing packages to outsiders, give those benefits to your staff for picking up extra shifts or floating elsewhere. This Nursing staff delivers for your organization and community on a regular basis. They deserve the recognition. They deserve the profit. They deserve to receive a taste of what they are worth. This is not a time during which you will be able to pull more staff out of thin air, so it is time to start utilizing your own through those same measures. Loyalty goes both ways.
  2. nataliadab

    Considering Quitting my Job

    I'm a little late-- but have you talked to your child's doctor? For some of my asthma patients and cystic fibrosis patients, we have gotten calls from parents who work in different areas--including Navy, nurse on an adult pulm floor, and pharmacy--and because they are worried about their child we wrote a letter to their employers to figure out alternate ways for them to work or to not work at all and stay home because of the risk to their children. We use a letter template provided by Compass (a CF organization) that states this, then states it is in the interest of the child, and references a paragraph on these patients being protected under law. Actually...let me see if I can show you here: Re: Letter requesting accommodations for remote or work alternatives Patient: DOB: To Whom It May Concern: On behalf of my patient, [ X ], I am requesting that [his/her] [mother/father] be given the opportunity to work remotely or be provided alternative accommodations to distance [him/herself] from others. My patient has cystic fibrosis (CF), a progressive lung disease which may put [him/her] at greater risk of developing serious illness from COVID-19. The CDC has issued guidelines for people who are at higher risk -- including avoiding large gatherings, such as the work place and staying home as much as possible as extra precautions to put distance between themselves and other people. Individuals with chronic illness, like CF, are considered a protected class under the Americans with Disabilities Act (ADA). Considering the current state of risk for exposure to COVID-19, all possible accommodations should be made out of consideration for [X’s] medical condition. Thank you for considering this request. Please feel free to contact me with any additional questions or concerns you may have at ( ). Sincerely, I use this template and fit it to patient and his/her medical conditions whether asthma or PCD or what have you. You should ask your child's doctor.
  3. By Natalia Dabrowska, MSN-CNL, RN Change for the Future In all the craziness in the midst of COVID-19, it is easy to only focus on the present, but we cannot forget to elicit change for the future as well. If we don’t do it now, it may never be done. No more pushing it off or putting it on the back burner with, “Well this is how it’s always been.” That clearly does not work. Shortages of Staff and Equipment I am currently working across three different hospitals navigating this pandemic. Like everywhere else in the country, there is a shortage of masks, equipment, PPE, possibly ventilators and beds. There is also already a shortage of nurses and staff on a GOOD day, without these huge spikes of hospitalizations flooding in. Well here’s some news that nurses have always known: There is not actually a shortage of nurses—There is a shortage of nurses willing to work UNDER THESE CONDITIONS. Case and point: While we are being called to the front lines without proper gear, being rationed protective equipment, we ourselves are not being rationed. For instance, my main job is as a pediatric pulmonary nurse coordinator. I have two other nurses who share this same role with me. Usually one of us is in the office, one of us is with patients, and the third may work on the Cystic Fibrosis registry and research. In an effort to reduce exposure to patients, we cancelled all non-urgent appointments, testing, research, etc. This put all THREE of us coordinators in the office the same day. One of our doctors was fuming. She said each of our chances of contracting COVID-19 is OVER 50% and if one falls down we ALL fall down. Still, administration and management did not budge. They continue to lead “updates” via zoom meetings, where they sit on camera in sweatshirts from the comfort of their own homes while we put ourselves at risk. A Time for Change This is the first sign that it is time for change. There is no room in healthcare for people who choose to sit at home rather than jump into the trenches when patients and entire communities need us. The reason our Healthcare System so often fails us is because there is NO room for it to be business-driven and for-profit for a small group of individuals ready to cash it all in. Why Weren't We Ready? THAT is why we were not ready for something like this. We should have been ready. There is no excuse. Yet we weren’t because we have non-medical people making decisions along with medical people who somehow never even put hands on a patient. These are the people we let run the show and it is shown time and time again that this FAILS. We are one of the most developed first world countries on this planet and we continue to have one of the worst healthcare systems. We have high rates of maternal mortality, infant death, and others. There is NO excuse for this. We work short-staffed or with unsafe assignments while “higher up” people don’t care. What they care about is apologizing to the patient who had a meltdown because the cafeteria put orange juice on their lunch tray instead of apple juice by mistake. They don’t support the patient’s nurse who gets blamed for this even though she kept a very sick patient alive that day while juggling 5 others for 12 or 16 hours. It is too often a thankless job. And yet, the nurse who does this day in and day out is the one who does NOT get listened to about making changes and improving workflow, patient care, and safety. Who Cares About Employees' Health? We give all of ourselves for a system that does not even realize it would collapse without us. This is even better shown with this example during this pandemic: One of our CRNA’s worked side-by-side a doctor during a five-hour surgery. This doctor later became symptomatic and tested positive for COVID-19. The hospital told the CRNA that he was exposed but could not get tested and that he should self-monitor—but come to work still. This group of CRNA’s later bought their own respirators because the hospital could not provide them with enough. Instead of applauding this, the hospital told them they cannot wear them because IT MIGHT MAKE PATIENTS AND VISITORS NERVOUS. So, who cares about our employees’ health as long as we minimize any concern for everyone else (who is in even more danger if our exposed employees are walking around unprotected)? We are at war during this time with COVID-19. We are at war and we are not properly equipping our soldiers. We are at war and our generals are sitting at home hoping that not all of us fall while fighting their battle for them. We are at war and having to sacrifice ourselves. Make no mistake- medicine is built off of the sacrifices of our soldiers. We give up bathroom breaks, lunch breaks, holidays with families, weekends, sleep, and more. We even risk ourselves when we know we shouldn’t. I once ripped my gloves off at a micro-preemie delivery when it was believed mom had an unknown infection. We had finally gotten the tiny endotracheal tube in the right spot, about 6cm at the lip, and I had to tape it in place, with what you can imagine was a tiny, tiny piece of tape. This is always a rush to ensure we do not lose the tube and get the baby stable as soon as possible. The tape kept sticking my gloves and I couldn’t peel it off, so I finally ripped off the gloves and thereby exposed myself to this baby covered in maternal fluid. I did this and do things like this, because we all do at some point in our careers, because in this game of life and death we try to win at life as much as possible. We do this because when we have a really hard shift or a death, part of what heals us is being able to look back on the situation and say, “I did everything I could have possibly done. I gave it my all. We all did our best.” My fear is that we may not be able to say this when we look back at COVID-19. We are already at a loss and drowning. We don’t have the equipment to do our best and we may get knocked out in the process. So we while we continue to try the best we can with what we have, we cannot forget that when this war is over, our war on the healthcare system is just beginning. Enough is Enough We have to continue to come together and rise. We finally have to say enough is enough and not back down anymore. We have to storm the streets and government buildings the way we are storming the hospitals to fight this thing. We have to demand safe staffing ratios. We have to demand appropriate compensation. We have to demand a complete reform of the structure. We have to demand putting selfless, medically competent people in charge to pioneer our hospitals—those who come into the trenches with us when we need leadership and all hands on deck. We need to make our healthcare system something better than using drowning nurses as pillars and Press Ganey scores as the entire foundation while our “leaders” sit on top in the ivory tower. Now More Than Ever The time is now. No, actually, the time was yesterday, was years ago, but the next best time is now. We owe it to ourselves and we owe it to our patients. We owe it to our communities and to all those who will be joining this humbling workforce after us. These burdens we have been carrying on our backs can be eased with a paradigm shift. It is time to rebuild. This war may be our hardest and most challenging one yet, but it is the most necessary, now more than ever.
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