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dzadzey MSN, RN

Dialysis, Hospice, Critical care
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  1. dzadzey

    Why Do Nurses Eat Their Own?

    All cliches aside, there is an element here which goes unrecognized, and that is the inability, or unwillingness of too many nurses to stand up for themselves. Hospital administrators expect the nurses at bedside to do more...with less. And, in large part, nurses quietly do so. They grumble amongst themselves, the frustrations spill over, resulting in cliques and a general unwillingness to look beyond what is immediately before us...The patients. If we can't see beyond what is in front of us, desperately important though it is, we won't be able to provide our patients the care they deserve. We must take care of ourselves by demanding as much from hospital administration as they demand from us. And we can't do this if we fall victim to the cliquishness and back-stabbing we see...all to often...among our co-workers. To paraphrase another cliche, we must hang together or hospital administrations will cheerfully hag us separately.
  2. dzadzey

    The Nursing Shortage: A self-inflicted wound?

    "Self-inflicted" as in letting management and administration run roughshod over us as professionals.
  3. Much is being made of the nursing shortage, but the sad fact of the matter is that much of this shortage is a self-inflicted wound. "30%-50% of all new RN's elect either to change positions or leave nursing completely within the first three years of clinical practice" (MacKusik & Minick, 2010, p. 335). The reasons are many and varied, but a 2010 qualitative study by Carol MacKusik and Ptlene Minick examine these issues and find three major themes, an unfriendly workplace, emotional distress related to patient care and, fatigue and exhaustion (MacKusik & Minick, 2010). An unfriendly workplace can be one in which the new nurse is simply thrown to the wolves, expected to "toughen up" by more experienced coworkers, women experiencing sexual harassment from male coworkers and physicians, and lack of support from management and/or administration in addressing these issues. The emotional distress we as nurses experience is, all too often, related to cases of futility of care. This is where, regardless of how many life support systems the patient has attached to them, the result will be the same...the patient will die. The only question being how much suffering they experience as they do so. This occurs at both the beginning of life in neo-natal ICU's to the end one's years in ICU. In either case, physicians may not be entirely honest with patient families, thus giving them false hope regarding the prognosis. The other side of the coin is families, for whatever reason, cling to the hope that their loved one will somehow arise from the bed and leave hale, whole and healthy. This is often due as much to family dynamics involving guilt as it to unrealistic and unreasoning religious views. The toll this takes on the nurses involved in the direct care of these patients is huge. Fatigue and exhaustion come into play when, for whatever reasons, management and/or administration are more concerned with filling beds than whether or not the staff is available to safely care for these patients. Nurses are asked, then expected, to "flex up" and take more patients it is safe for them to care for, thus putting patient safety and nurses licenses at risk. This creates a fundamental conflict between the core values and terms of licensure for nurses and the values of the organization. Add to that overtime and calls to work on their days off, and the physical and emotional exhaustion simply becomes too much to bear. So the projected nursing shortage...some 500,000 nurses by 2025 (MacKusik & Minick, 2010)...seems to be as much a result of nurses fleeing the acute care setting as it is with the lack of sufficient new grad nurses to take up the slack. References MacKusik, C. I., & Minick, P. (2010). Why Are Nurses Leaving? Findings From an Initial Qualitative Study on Nursing Attrition. MEDSURG Nursing, 19(6), 335-340.
  4. dzadzey

    Why do we do this?

    Forget I asked.
  5. dzadzey

    I hate what's happening to nursing...

    I've already told my unit director, on more than one occasion, that if she wants customer service, hire some chirpy, empty headed 18 year old. If she wants quality patient care, stop bothering me with this tripe and let me get back to work. But the corporate, for profit mentality is driving even the non-profits. We are told we have to make "sacrifices" in terms of pay and benefits while the CEO takes home a seven figure salary. Please, don't poor mouth me when the CEO takes home more in one year than my wife and I make together in fifteen years.
  6. Choice makes all the difference in the world. But all too often the patient has no choice in the matter.
  7. Yeah...saw that once when I worked hospice.
  8. This time of year, we get them. Patients so gravely ill that they must be placed on life support. Ventilator, pressors, art lines, central lines, Swans, trans venous pacing, CVVH. And when all of these have failed, or are failing, the families want to keep their loved ones 'alive' until the holidays are over. I'm talking about patients for whom the term "futility of care" was created. And I just don't know which is worse...The families who want their loved ones to maintain a heartbeat until the holidays are over or the physicians who acquiesce to their demands. Have we, as a society, become so reality averse that the thought of a family member passing during the holiday season is simply unbearable? Which would people have as a last memory of their loved ones? Passing peacefully at home on hospice...? Or tied to multiple life support systems as their systems shut down, they weep from every extremity and their skin sloughs off to the touch? Too many families faced with this insist on 'everything' being done for their loved ones with no real comprehension of just how much and how far 'everything' can go. And the healthcare community won't stop and educate them as to just what 'everything' entails. It's a sad fact at this time of year, and it will continue so long as physicians fail to make the situation crystal clear to families with a loved one at the end of their days. Such cases not only use up valuable resources and critical care beds, they deny access to those who would benefit most from them. Never mind the emotional toll such patients take on the staff assigned to care for them, as they watch their efforts go for naught. And all because people fear their own, and their loved ones, mortality. Fear begins when you suspect your mortality and ends when you accept it.
  9. dzadzey

    Part of Health Care Law Ruled Unconstitutional

    The judges decision was the result of political shopping by Virginia's Attorney General. A decision which likely won't stand on appeal given the judge's blatant conflict of interest in the case. As for health care insurance rates going up, that's more a case of health insurance companies trying to maximize their profits before the legislations effects are actually felt in the insurance markets.
  10. If any group of workers are in need of a strong union, it is health-care workers...Nurses, techs, support staff. Unfortunately there really isn't a union out there that is worth the match it would take to burn the contract with. This is partly due to the marginalization of unions over the last 40 years by Republican Presidents and GOP dominated Congresses. But it is also due to the unions cutting each others throats to unionize where they can, the workers be damned to yellow-dog contracts.
  11. dzadzey

    I should be grateful to have a job,but

    I work for a large healthcare organization run by grossly overpaid executives, and our more of the costs of our health insurance has been shifted onto staff. They are eliminating incentive and crisis pay. I would be more willing to believe the poor mouthing of the system's administration if the CEO wasn't pulling down a seven figure salary.
  12. dzadzey

    Increase of super morbidly obese patients?

    It's becoming more and more common. just his weekend as many as 7 of our 24 patients were over 350lbs, with 4 of them at over 400lbs. Yet we don;t get any more staff to meet their needs. A study in the Southern Online Journal of Nursing Research has shown that the morbidly and super-morbidly obese patients can take two times, or more, the number of staff and care time than non-obese patients. And given the economy and changes to Medicare, it's hard to see where the funding to provide the necessary equipment and staff to adequately care for this population is going to come from. But do patient care providers have to face the daily choice between avoiding injury or providing care to their patients? Because that is the choice many of us face...personal and potentially debilitating injury...Or simply giving up and not providing the level of care these patients need. It's a choice none of us should have to make.
  13. dzadzey

    Turning Patients

    Does anyone know of a study addressing the issue of proper stafing ratios for caring for morbidly obese patients in an ICU setting?
  14. dzadzey

    Executive compensation

    Just an addendum to my reply to CRNA2007...The President of the United States recieves an annual salary of $400,000. He also receives $100,000 non-taxable travel expenses, a $50,000 expense account and $19,000 for entertainment. Tell me, please, do the responsibilities of the CEO of health care systems, or any corporation in general rival those of the POTUS? I think not. Consider yourself pwned.
  15. dzadzey

    Executive compensation

    http://www.managementhelp.org/chf_exec/ed_defn.htm Now that the veil of ignorance you assume we are all blinded with has been lifted, do the responsibilities outlined in the above link justify a seven figure salary? In a word, no. Until recently, it was common practice for overseas corporations, and some socially conscious corporations here in the states, to limit the the pay of CEO's to the equivalent of 7 to 10 time the pay of the lowest paid member of a company. That that may be insufficient says more about how poorly the lowest paid staff members are than about the demands placed on a CEO. Secondly, your argument regarding the taxes paid by these highly compensated individuals is a canard. These individuals pay a lower marginal tax rate that they have at any time since the Clinton administration. Unless, of course, they want to go back to the 30%, 40% or 50% tax rates paid by the wealthy during the Eisenhower administration. These individuals also, because of their wealth, have access to tax shelters and methods of hiding income unavailable to the average wage earner. In short, your point is meaningless. In closing, your attitude is condescending and an insult to the intelligence of those who read and post here.
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