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I am an RN who returned to Neonatal ICU two years ago after 15 years apart from it and in Home Care. My husband and I are now in Lake Worth, but we are not tied to the West Palm Beach Region and we are looking all over Florida. I guess I'm lucky in that we have some breathing room. I would like some feedback on the best hospitals to work for, and i mean this query from a nursing perspective. I am looking all the way from Miami up to Jupitor, and am also interested in the Gulf Coast. Family is in West Palm and Ocala, but that is sort of irrelevant. Are there any NICU or Home Care nurses out there in the Florida forum who would be willing to pen pal with me? This is a big change, necessitated by the medical needs of a family member...although we are flexible on area we are commited to florida. Who out there might be willing to help me make the best choice in negotiating foreign territory and choosing and focusing on facility? I'll tell you this, i have applied with tenet in the West Palm and Boca region, and despite 21 years experience in nursing, I haven't heard back from them despite their posting positions. Doesn't bode well....I want a place that is responsive to nurses and nursing. I'm just hoping that's not too much to ask. thanks in advance

I apologize , and tried to edit this response. It is likely more than you wanted. I can not delete it, and so must leave it as I gave it. I recognize that your effort here is to seek nursing models. This diverges somewhat. Your first post indicated you were in the unique position involving a committee to reverse the autocracy of the hospital environment in which you work. The second indicated that you are currently considering magnet, primary and team. I have comments on primary, team, magnate and the role of the "consultant" you mention First, I'm confused. I know what team and primary nursing are, but magnet...[PLEASE tell me if I am wrong] this is a term I recognize as referring to "magnet hospital" status. Magnet hospital status is relatively new ...conferred by the ANA to hospitals more able to retain and recruit nurses in their local environments. Often, these hospitals include day care at their facility, self scheduling, response to nursing concerns, etc. The pay scale of magnets don't seem to be above those that aren't in their regional environments...what varies is the report among the nurses there employed, evidenced by a lack of recitivism, of the treatment of nurses by the hospital of employ. Magnet hospitals are mentioned much in legislation regarding nursing in regards to methodology in the nationwide effort to decrease the shortage. They are studied and referred to in regards to what hospitals with "magnate" status do that encourages a decreased local recitivism and vacancy rate , despite the reality in other regionally close hospitals with far greater recitivism and vacancy despite similar JACHO standing. So, for me [am i missing something here?] the consultant [as an aside I would be VERY interested in the degree and employment background of this key player on your committee- i think NURSES should run this committe and a "consultant" be the guest] mentioned primary and team nursing and then another thing entirely, magnet , the definition of which as I understand as given above. This means that i understand that your consultant is aware of magnet hospital standing and desires to gain it. I am going to ignore primary vs team and focus on magnet and what I think you are in the unique position to develop. Here's my imput. Bring to the group this discussion [ i have mentioned this in many other posts]. ALL surveys regarding the shortage and its roots, whether conducted by the ANA and allied groups or the AMA [American Hospital Association] and its allied groups, find TWO primary causes for nurse dissatisfaction leading to the current crisis shortage. The first has to do with inadequate response to market demand generally placed first in the NURSING evaluation of data of polls [that is: inadequate pay for work expected/performed-best stated as pay scale deficit]. The second are environmental factors more often put forth as primary on evaluation of the data by the hospital associations [who want very much to avoid increased pay] involving many complaints best described in aggregate as lack of voice [you can refer to my incomplete and ever expanding pages on the nursing shortage at http://www.cynthiaswope.com/ABedsideRNPerspective/TOC.html if you like where much discussion and documentation is presented]. Nurses often seek radical voice as a result of nursing's lack of voice, shamefully present for nurses throughout the health care system. Radical voice currently takes the form of unionization, where environmental and wage factors can be addressed through contract. Tired of being ignored, bedside nurses seek unions in order to have their voice heard. Hospital administration often seeks to undermine unionization efforts. YOUR MOST RADICAL and MOST INFLUENTIAL request of this committee, is for it to consider and demand the meaningful involvement of a bedside RN among the board of directors. THIS IS TRULY RADICAL. All hospital boards include an MD practicing in the hospital upon its board. WHY do not nurses, representing 70% plus of the labor resource pool of hospitals, NOT enjoy a similar position? Hospital boards that boast RNs [and those that do boast them loudly] have RNs long aligned to management and way removed from the bedside nurse. In my vision, this bedside RN on the board would be elected by the BEDSIDE nursing staff...would enjoy a year long appointment contingent on continued full time employment, and would absolutely NOT be in management. A vote for that member would have to be sought of the bedside nurses, who could be encouraged to choose that member much as we citizens choose our elected representatives in local, state and federal elections...that is , through evaluation of their stands, their vision, and through debate. I am glad for you having a committee to address these weighty problems. This is a very positive step. But I am wary that there is a "consultant" from whom you are, by her/his title seeking direction. In the worst case scenario, this person will get your committe to agree to a program nearly predetermined, the choices of which were already formed. It occurs to me you are in the possible position of providing, through your agreement to any "suggestions" [ whichever ones you choose, and dismiss without offering your own] provide a false sense of security regarding real change that could really initiate a change in your hospital. It is my feeling you should demand of this committee that it allow NURSING to present the options desired, and that much more than a commitee is needed. Real imput from the nursing staff is demanded, and only an elected voice in the position of leadership will suffice [hearkening back to the board of directors RN] If i were on this commitee, I would want to addressnursing voice, at the bedside {how nurses are treated, how their concerns are responded to, how they are interacted with, and their involvement in patient care decision making} , in the unit {what kind of nursing, team or primary is predominantly practised} and in the hospital tier {is there really an outlet for effective voice and someone in a position of authority and power able to address and respond to the ongoing concerns of the most vital portion of the hospital, its nurses. The the primary reason why patients are admitted to hospitals is the promise of nursing care.... in the ER, OR, Recovery, ICUs, floors, etc] . Remember this: patients are admitted to the hospital because of the promise of nursing care there. Make sure that this thought is presented. That's my two and twenty odd cents worth.

I was a public health nurse for many years. The worst abuse I received was from an EMT. While many appreciated my thoroughness [ i gave FAR more info than was demanded and far more than they get from family members] this one is the EMT I will remember. I had had to call 911 because of a patient's devastating condition on an intitial home care visit, and the lack of safety evident in her community environment. She had to be rehospitalized. I always waited for EMT to arrive before leaving, and always gave thorough reason for the 911 call, and the symptoms meriting it, the meds I had found, the interns and residents and their beeper numbers, the attending of record, the history I knew, etc. This particular EMT was beyond rude...he was abusive. He said all home care nurses are stupid. He grabbed my paper work from my hand, and refused to release it to me causing me to delay for 40 minutes as he painstakingly copied it down. He said home care nurses are lazy. When I asked him why he would say such a thing, he said "because its the truth". His name badge was not displayed, so I asked for his name, fully intent on writing up a complaint. He refused to give it to me [This was in NYC where the whole thing is very complex, with multiple providers of EMT transport]. He would not give me the name of his company. His buddy refused also to give his name. Luckily, the truck and license plate were clearly evident when I exited the apartment. So his identity was able to be found. There is a fracture between EMT and Home care. I don't know why. I guess they expect we are "not able to handle our patients" and some perceive themselves the beleaguered hero forced to answer our distress call and do the work for which they are hired. You are absolutely right in your perception. I encountered this belittling more than once.

I was a public health nurse for many years. The worst abuse I received was from an EMT. While many appreciated my thoroughness [ i gave FAR more info than was demanded and far more than they get from family members] this one is the EMT I will remember. I had had to call 911 because of a patient's devastating condition on an intitial home care visit, and the lack of safety evident in her community environment. She had to be rehospitalized. I always waited for EMT to arrive before leaving, and always gave thorough reason for the 911 call, and the symptoms meriting it, the meds I had found, the interns and residents and their beeper numbers, the attending of record, the history I knew, etc. This particular EMT was beyond rude...he was abusive. He said all home care nurses are stupid. He grabbed my paper work from my hand, and refused to release it to me causing me to delay for 40 minutes as he painstakingly copied it down. He said home care nurses are lazy. When I asked him why he would say such a thing, he said "because its the truth". His name badge was not displayed, so I asked for his name, fully intent on writing up a complaint. He refused to give it to me [This was in NYC where the whole thing is very complex, with multiple providers of EMT transport]. He would not give me the name of his company. His buddy refused also to give his name. Luckily, the truck and license plate were clearly evident when I exited the apartment. So his identity was able to be found. There is a fracture between EMT and Home care. I don't know why. I guess they expect we are "not able to handle our patients" and some perceive themselves the beleaguered hero forced to answer our distress call and do the work for which they are hired. You are absolutely right in your perception. I encountered this belittling more than once.

It may well be that the response that you read was in reply to my "all hospital nurses" post. In it, I asked for a response to a question for a study I am doing, {and i'd very much like your own response to it!-I posted last night} and asked for the years experience, area of practice, and theory, if known, taught in their school of nursing. A respondent indicated that she couldn't remember the theorist utiilized in her nursing school. While I agree with you about theory, and that there is a fracture between schooling and practice that merits a whole 'nother thread, the truth is that the indoctrination of a nurse begins in school, and is fortified by the theory utilized, as it is cohesive to the entire program, and the philosophy of nursing taught. It presents an image of what nursing is or should be, in a way, and is part of the subconscious formation of the nurse. I think, far more important than the "science of nursing" a theory attempts to present, the nursing theory utilized helps form the nursing mind from incipience and so has great import in the subjective understanding each nurse has of the nurse role, and her job function within the general environment in which she works. Some theorists are more radical than others, believe it or not! It is not really expected that everyone will remember their theorist for my post...but it is possible that the answers I am seeking will have been given seed by the theorist of their school. I am seeking a correlation, in a way. If someone doesn't remember their theorist...i am not necessarily suprised. But as my particular theorist in my nursing school had a radical concept easily referred to for the response I am seeking...I asked for theorists as a way to cross correlate.

It may well be that the response that you read was in reply to my "all hospital nurses" post. In it, I asked for a response to a question for a study I am doing, {and i'd very much like your own response to it!-I posted last night} and asked for the years experience, area of practice, and theory, if known, taught in their school of nursing. A respondent indicated that she couldn't remember the theorist utiilized in her nursing school. While I agree with you about theory, and that there is a fracture between schooling and practice that merits a whole 'nother thread, the truth is that the indoctrination of a nurse begins in school, and is fortified by the theory utilized, as it is cohesive to the entire program, and the philosophy of nursing taught. It presents an image of what nursing is or should be, in a way, and is part of the subconscious formation of the nurse. I think, far more important than the "science of nursing" a theory attempts to present, the nursing theory utilized helps form the nursing mind from incipience and so has great import in the subjective understanding each nurse has of the nurse role, and her job function within the general environment in which she works. Some theorists are more radical than others, believe it or not! It is not really expected that everyone will remember their theorist for my post...but it is possible that the answers I am seeking will have been given seed by the theorist of their school. I am seeking a correlation, in a way. If someone doesn't remember their theorist...i am not necessarily suprised. But as my particular theorist in my nursing school had a radical concept easily referred to for the response I am seeking...I asked for theorists as a way to cross correlate.

the "House" should be reported for putting other patients at risk. Certainly in California, where patient ratios have recently been mandated, the removal of a staff member for such a request would never have been accomodated, placing the hospital at risk for abbrogation of patient ratio as established by law. No wonder you were PO'd. What a bunch of crap. I'm wondering if you can write a letter signed by the staff members present expressing what sort of pressure this placed on all staff as a result of the loss of one staff member during the period [including the MD who DIDN't Want this to occur] . the risk allowed via the changed patient ratio, and professional staff disappointment in, and concern for, the decisions made by "the house" as you call it, putting all professionals at jeapordy. If its a group letter, no one person has to stand out too strongly.

I have thought all day about your dilemna on how to present why it is that nurses in the not for profit sector should not be allowed to unionize, despite all your intuition [and my own] that this endeavor runs against core sentiment and stronger arguable reality response and outcome. I must tell you, my mind draws a near blank, because I am a bedside RN deeply commited to the right to unionize. But when I try to put myself in the mindset of a manager, seeking to make this argument, a few ideas DO occur. They will not, however, make your argument stronger for this project, i fear...for they are too weak to bear out. To make these points I must put aside the idea of not for profit vs for profit for a moment, and consider nursing as a whole [again, the primary labour pool of any hospital for profit or not for profit, representing 70% plus of their entire labour resource pool]. I am sorry I can not help you without doing it in this way; But I am at a loss to do otherwise , although not for profits will figure more strongly in some of the arguments given below. Again, I do not agree with any of these arguements, and so , i am not a good source for arguments you seek. I will provide my few weak positions in response to your task, and provide why I think them weak. 1. Nursing is an essential labour resource upon which the entire population depends. It is an entirely necessary profession and so subject to rules and laws defining it as essential. The general society at large can not function without nurses in times of peace or harmony, and more so in times of distress and chaos, and so, the right of nurses to unionize must be curtailed. This is a result of the understanding that unionization carries with it the right to strike, and so, the right of the nurse to remove herself from the essential labor she provides. As a result, and because nursing is an essential labour resource, unionization can not be encouraged. a. if nursing IS an essential labour resource, why do not more nurses state they feel essential to the entities in which they are employed, and why is it this sentiment held by nurses transcends periods of nursing abundance or shortage thus creating an environment in which nurses seek radical voice [ie, unions] ? 2. Nursing is an essential service profession, and those seeking employment within it understand it as such upon consideration, education, indoctrination, and service to that employ. As an essential service , all nurses understand through the vehicles above mentioned that their own desires are subjugated to the needs of the population they serve. It is a giving profession, and must adhere without fail to the provision of their service. Therefore, unionization must be curtailed, as a result of nursing's responsability as an essential service profession, and the underlying understanding that ALL nurses share in, and will adhere to this understanding. a. This is a misguided understanding of why nurses, and potential nurses, seek employment as RNs. While desiring to be needed and seeking the 'secondary gains' of a service professional, these professionals seek out nursing as a legitimate, socially conscientious, respected, and adequately compensated service profession...they seek nursing as a reasonable outlet for their socially responsible imperative. Socially responsible imperative does NOT translate to service as a professional no matter what the conditions demanded by the employer. 3. As the majority of funding for hospitals comes from the government in the form of medicare and medicaid, the hospital has the right to curtail nursing unionization and the threat of loss of income that unionization entails. Government, as the primary source of payment for nurse labour pool, must be held accountable to encourage the viability of nursing, without allowing the threat of loss of income by hospitals that unionization provides. a. way off. hospitals receive income and choose where to spend and argue the right of that income source. Pharmaceuticals claim far more of the hospital coffer than nurses do, and pharmaceuticals are not limited by the right to strike, not being labour intensive segments of the hospital expense sectors, yet they recieve a large portion of the hospital coffer as a result of their "essential service" and significant lobbying arms. 4. The people, the same people mentioned in the constitution , need and depend on nurses. The people and their well being supercedes the advantage to nursing that unionization allows. a. do i need to tell why this is wrong? i think you and i agree in general, and will not expound. 5. Not for profits are volunteer organizations not seeking or demanding profit orientation. Their potential in the free market system is curtailed. As a result, those working within their entities must adhere to rules apart from those adhered to in the uncurtailed free market system a. my first post addressed this. Not for profits are strongly aligned with, and subject to the mandates of , for profit entities. No real difference exists between them. Does this help at all?

well, since we are in a crisis nursing shortage part of a longstanding nursing shortage evident since post WW II, it is clear that nurses are not paid in terms of market demand. If market demand were met, there would not be a shortage. As for me, in the urban areas in which I have worked, 50$ /hour is what I think is needed to assure lack of recitivism and continued new labour resource pool. Screw the "if I have certification" or "if I work nights" or "if i'm a cardiac specialist" My answer for urban areas: basic rate, 50$, the certs, nights, specialties to follow up from there.

Absolutely not. Before I anser your question, this paragraph. I do not think the term non profits is accurate in what you describe...its is Not for Profit that is the term that fits here. All hospitals work for profit, in order to remain viable. As you no doubt know from your research, the not for profit hospitals are constrained by a non distributive constraint, meaning profits may not be distributed to owners in the form of annual dividends or other earnings-conditioned payments, unlike their for profit counterparts. But the management styles and business practices of both for profit and not for profit hospitals does not vary with any truly perceptible degree, and the educational background of the CFOs/CEOs/Managerial tier is in no way different. While once not for profits were "volunteer" hospitals depending on philanthropy, this is long in the past. The seperation of for profit and not for profit hospitals is solely dependant on the non distributive restraint. Despite that restraint, in the 80s and 90s through to the new millenium, little managerial difference is experienced between the two entities in general and certainly in regards to the nursing labor pool upon which ALL hospitals depend and without which any hospital absolutely can not function. Where " once the voluntary hospital had been small, basic, and locally controlled, the not-for-profit of the 1980s was large and complex....By the 1990s, the not for profits were more likely to be part of a large corporate system, often with distant ownership or control and strong contractual ties to managed care or other (sometimes for-profit) insurers." See Health Policy Analysis Program Webiste [HPAP]. Community Benefits and Not For Profit Health Care, Policy Issues and Perspectives: November 1995. The Catholic Health Association. Madden, Katz et al Now in answer. The "patient abandonment" argument has been manipulated and over manipulated throughout the history of nurse primary employment in hospitals occuring since the 1930s stock market crash, both with detriment to the nurse providing the labor required of the hospitals dependant on her and the hospital itself, which inevitably faces an inconsistent labour resource pool as a result of lack of vision in regards to their longstanding problem in assuring consistent labor pool. Before the 1930s, nurses were primarily employed outside the hospital arena. Since the nursing shortage has existed since the post WW II era, with periods of spikes and inadequate market adjustment calming a crisis, but laying groundwork for the next inevitable crisis shortage [of which our current Crisis Nursing Shortage is merely a part], one can argue that ALL forms of [constantly recycled and never insightful] attempts to address the shortage have been inadequate, and shortsighted, and, in fact, evidence of conscientious mismanagement in general. Unionization is not sought for the right to STRIKE [the cruxt of the 'patient abandonment' manipulation]. Unionization is sought for the right to VOICE. NO strike includes patient abandonment. There are too many failsafes and safe gaurds. Patients are moved out, surgeries cancelled, intake diminished, and ER visits curtailed through many months preceeding the actual strike which by law must be announced as "intent to strike" far in advance of a strikes occurence. What hospitals experience, and the real stregnth of the union, is diminished profit as a result of potential temporary loss of labor resource pool, causing them to pay attention, listen better than usual, and address market demand in addition. Unionization is a right, a hard gained right, and to mess with that right is well, shortsighted and certainly adversarial. One might even be tempted to call it unamerican. No nursing strikes occurs spuriously; the groundwork for strike strongly protects all patients currently or during the period of percieved strike, reliant on the hospital. It can be easily argued that management is responsible for creating an environment unable to assure its labor resource pool and that in abbrogation of their weighty responsibility they create the episodes of patient abandonment possibility, the responsibility for which they then foist on the labour pool upon which they are dependant, while ignoring their own role in its formation. My answer for your "no it should NOT be illegal" [beyond the implications of what it means to suppress this current right]: According to all polls, whether conducted by the American Nurses Association or closely aligned groups, or the American Hospital Association and any closely alligned Management Lobbying arms, nurses complain PRIMARILY of two things. The first is easily born out in our free market economy. They feel they are underpaid. Borne out by free market economy reality, The wage/benefit ratio for work expected/performed is not adequate to meet market imperative. The second reason, though, is masked in many terms, but is one best described as "lack of voice" [you can refer to my ever expanding and as yet incomplete webpages at http://www.cynthiaswope.com/ABedsideRNPerspective/TOC.html if you wish]. Nurses throughout the country experience a lack of voice...and Nurses UNIONIZE as a result. Lack of voice involves both how the employer preceives and pays the nurse and his/ her work, AND how the general hospital hegemony disregards or ignores the concerns of nurses and nursing. If you make the argument that nurse unionization SHOULD be illegal, be prepared to answer to the many bedside nurses NOT present in your managerial class, why it is there is no voice for the nurse in hospital management. Look at hospital boards of directors, and consider that there is no representation there for the 70%+ on hands nurses on which that hospital is dependent. While there is always a practising Medical staff member on the board, there is NEVER a practising bedside RN on the board. Any hospital board boasting an RN has one who is long aligned to management, and far removed from the bedside and the very population which you currently address. In short, to suppress the right to unionize will NOT address the lack of nursing voice, it will be perceived as, and in fact will, diminish the ONLY vehicle currently present to express bedside nursing voice, thus contributing to the shortage, while also proving the managers inept and bullying. It will not encourage new members to the profession, neither will it assure the continuity of the nurses currently employed. It will be the bite your nose to spite your face movement which could be the death of the non profits, for it leaves the for profits competitor the only entity with that vehicle currently the only form of adequate nursing voice. Rather than suppress the right to voice, which is how nurses percieve the choice of unionization when that difficult choice is made, your class should discuss how it is you will create voice, and thus not have to argue for or against unions at all.

After I wrote my post I happened on this site. Go to Salary and Benefits at this page, and click on link...information you requested will be there. The NY Hospitals have "rounds of negotiation" and what happens in other hospitals happens in the others based upon it. The current "Round" was started by Colombia Presby in 2002. This Lennox Hill benefits scenario reflects the trend at most NY hospitals as a result. Differences occur. Like I said, the individual contracts will reveal. But go to http://www.lenoxhillhospital.org/nursing/Nursing_Benefits_2004.pdf

In NY city, differentials for cert, BSN, etc have been in the contracts since at least the early 80s. New York has a longer history of contracts than other regions in the US, and each contract, as you know, builds on the one previous. It may be helpful and enlightening for you to get a hand on the contract of some NYC hospitals. This is not hard to do. All hospitals in Manhattan are unionized, minus one [New York Hospital which to be viable must adhere to the general pay scales established by the other, union hospitals and so follows their suit] and a copy of the contract is gladly sent with any request for employment there. In it, you can see all these diffs, and also the base salaries, as well as other aspects of contracts ever stregnthened by negotiations and new contract language including issues like floating and rotation, nocturnal parking priviledges, etc, etc etc. Write to the recruitors of St Lukes/ Roosevelt, Mt Sinai, St Vincents, Colombia Presbyterian, Harlem Hospital, etc, etc, and request a contract with application material, and you will get one from each. [links to New York hospitals are found at http://www.noah-health.org/english/hospitals/nyhosp2.html#Manhattan] This may be the sort of thing that will REALLY help your negotiation team. GOOD LUCK and keep up the good work.

Since 1999 the "Gallup Poll for Honesty and Ethics" has included nursing [it previously did not] in the list of professions ranked for perception of those qualities. In 1999 , the first year for nursing's inclusion, nurses ranked top of the list. In 1999 and each year since, [minus 2001, when firefighters ranked first and nurses second -a reflection of the events of 911] , nurses have ranked first among respondents as holding High or Very High standards of honesty and ethics. While this poll reveals a high esteem for our profession and its members among the respondents to the poll, many nurses feel that they are not esteemed. What, in your opinion, causes the fracture between the perception of nursing as a highly regarded profession held in high esteem evidenced by the poll, and the work experience of the nurse contributing to the profession's shortage and so, demise?

Since 1999 the "Gallup Poll for Honesty and Ethics" has included nursing [it previously did not] in the list of professions ranked for perception of those qualities. In 1999 , the first year for nursing's inclusion, nurses ranked top of the list. In 1999 and each year since, [minus 2001, when firefighters ranked first and nurses second -a reflection of the events of 911] , nurses have ranked first among respondents as holding High or Very High standards of honesty and ethics. While this poll reveals a high esteem for our profession and its members among the respondents to the poll, many nurses feel that they are not esteemed. What, in your opinion, causes the fracture between the perception of nursing as a highly regarded profession held in high esteem evidenced by the poll, and the work experience of the nurse contributing to the professions shortage and so, demise?

Never set your own standard for an eval higher than that which will be given you "Safe enough to work, needs work in a few areas". You'll be constantly disappointed. Nursing evals NEVER will say exceptional, but they will never say "Bad" [so why didn't you fire em? is implied]. As long as at the eval you are told you are not fired [which of course you won't be during an annual eval] then be satisfied. The managers position is not justified if not constantly looking for areas of improvement in those she manages...its a catch 22. Those of us in nursing any real amount of time have come to expect an "average" sounding eval. In the response portion of the eval [your hospital does do this right?] be sure to write, these are the letters of appreciation I've recieved, these are the times when I go our of the way [for me, since I speak spanish, i get pulled to translate alot while noone does my tasks but some does 'watch my patients'] , and this is why I am an exceptional nurse [see above]