forrester

If you go to My Florida News website, follow the link to Florida Roundtable, and then scroll thru the podcasts on the Florida Roundtable, you can hear Dr. John Silver (RN) talk about these issues. He is the author of "just a union...of nurses". Boring intro but good discussions. We need more nurses speaking up!

Not to mention the impact on nurse retention and getting nurses who simply refuse to work in these conditions backinto the work force. SInce it costs the hospitals around $50,000 to replace an RN, it makes sense that these costs would go down. Once, in a discussion with a CEO about the need for sane staffing on my 3 telemetry floors, I brought up the issue of improved patient safety. His response to me was, "That's why we pay insurance." What a callous prig. Interesting how when they or one of THEIR loved ones comes in, it's private rooms and private duty nursing. Evidently what's good enough for the goose is not good enough for the golden calf.

There are 2 obsenities associated with this= 1) CEO and administrative salaries have risen 725% over the past 2 decades. I know my salary hasn't performed as well. 2) Administrative costs are now around 24% of healthcare expenditures, up from 12% 3 decades ago. Don't worry though, we can simply cut services. Mandated ratios are the ONLY thing these people will understand, and California has led the way on this. A new book just out, "just a union...of nurses" goes into this in some detail as it traces the history of the CNA and how they managed to get a nurse pateint ratio law and whistleblower protection law passed. Fascinating read that shows we are not powerless to protect our patients and our domain of practice, in spite of our current "leadership".

ANd, since we are supposed to be advocates for our patients, communities, and country, exactly what are we as nurses doing about this?

With the exception of ARNP's of course. That said, I strongly agree. There is a lack of "nursing" in primary care, and an ounce of prevention, as they say, is worth a pound of cure. I read an article recently that said that many primary care physicians had stopped talking to their patients openly and frankly about obesity because patients would simply go to another PCP who didn't.

This is ridiculous. We should legalize pot now. Throwing people in jail or prohibitting terminally ill people from using it is the real crime. I've spent over 40 years in healthcare, more often than not on the front line, ER/critical care units/trauma/burn etc. The number of pot related cases I've had to deal with are exactly 2- and they were minor. We're either a free country or we're not a free country, and if we pass laws resrtricting this freedom, or depriving someone of their freedom, needs to be evidence based. This is BS and reasonable people understand this.

You know, we keep debating unique cases but are missing a bigger point. Most of what we spend on healthcare now is due to preventable diseases. 65% on obesity related issues. If we could just go back to 1980 obesity levels, we would save 1 trillion dollars in healthcare. Medicare problem solved! How much education on obesity do you do with your patients? How are you doing?

Well, the evidence and studies do not support you in this . great radio show on this My Florida News- Follow the Florida Roundtable link- Podcast with John Silver Sound arguments are presented based on the evidence. 8 states now allow unrestricted practice------no bad results 48 states allow prescriptive authority for NP's to their scope of practice (not Florida or Alabama) Over 40 years of studies documenting outcomes, compliance, and/or prescribing patterns (even in NEJM and JAMA) Federal government allows for DEA numbers for NP's (not PA's or anyone else commonly disparaged as "physician extenders). Federal Government allows direct billing to Medicare Both of the federal laws were passed in 1997! Plummeting numbers of GP's and a horrible distribution of both medical resources and specialists. The Florida medical association has 3 essential arguments: 1) No NP is qualified to prescribe drugs listed as schedule 2 drugsd. Obviously not true based on, you know, facts. 2) We already have a major prescriptive drug abuse problem in Florida. Essentially saying = I speed so you can't drive. Again, absolutely no evidence to support this. 3) It will decrease the quality of care to Floriidians. Here we go again, in fact the evidence directly contradicts this. SO, we either believe the evidence and start moving healthcare into the 21st century, or we keep going with basically guild laws from the 1800's. It's important to understand, however, given the topic of this blog, that the STATES regulate medical and nursing practice. There is no national regulation even though all of us take national exams. There is not even a way to track these practitioners from state to state. It is relatively easy to quack your way around the country.

Hi Herring_RN, long time no talk

"I was educated on becoming a part of the political process in my PN and my BSN program." QUOTE Not really- re-read your books. They either show the ANA as the solution or provide information about addressing foot ulcer problems by appealing to legislators. The REAL political world is not to be found in nursing textbooks...until now. In FLorida, for example, the FHA has 20 full-time lobbyists. The FMA has 18 lobbyists. The FNA has 2 (it used to have 1) APN's have 1.

Critical care IS somewhat protected...and isolated, but I am hearing more and more of 3 patient assignments in Florida for ICU nurses. California has a law about staffing ICU's that actually dates back to 1975. When I worked there, I never had more than 2 patients, 1 if need be. When I cam back to Florida, I started seeing 3 pt. assignments regularly in the ICU's starting around 1997. Administrations will push the envelope as far as they can, as they have on the "floors". It seems the only thing they do respect is state laws that punish violations. The hospital associations and their nursing puppets (the AONE) will not do this on their own. The ANA, for whatever reason, will not get off the fence on staffing ratios. When I brought this up at an FNA meeting on staffing issues, I was told they will not talk about ratios. We can change this dynamic...but it will take some work from all of us. "just a union...of nurses" provides a blueprint for nursing action. We've had nothing but rhetoric for 40 years now. Read the nursing surveys for the last 40 years- nurses have been speaking up on this issue but nobody seems to be listening.

I'll be very interested to see how your poll works out.

I hope you do buy the book and read it. Every nurse should. It talks about political empowerment, how we are not alone, and how we can do something about it. It uses a concrete example of bedside nurses who DID rise up and change their world. No, we can't do it alone, but there are 3 million of us, and we should all have an obligation to work together. The book also presents WHY we are having such difficulties. Knowledge is power.

Go tell your nurse manager that the staff has decided to only take 5 patients on their med-surg floor due to the risk associated with each additional patient. Staffing ratios are the number one complaint from nurses around the country, and the statistics on retention in the first 2 years of practice are atrocious. We rank 37th in healthcare !00,000 Americans die each year from avoidable errors, with another 100,000 dying further downstream. Almost 1/3 of nurses are trying to find other employment than bedside care. The current non-system rewards medical task completion, not nursing. NP prescriptive authority is up for the 20th straight year in Florida. Np's have independent practice in only 8 states. The ANA cancelled its "health care summit" in New Orleans in 2009 (you know, when the country was in the midst of a national discussion about healthcare) due to lack of attendance. So much for the White Paper! Our leadership is more affiliated with the AHA than with actual bedside nursing practice. I'm glad you feel empowered...most don't.

It also talks about providing for the general welfare. Public health affects us all, whether in terms of communicable diseases or in terms of an epidemic of obesity which is driving the cost of healthcare over 17% of GDP. We would save 1 trillion dollars a year if we could just go back to 1980 obesity levels. There, no more health care crisis.