ainz

Good questions psychrn03. I am no longer doing direct patient care. I am now in hospital administration and am looking at this thing from a hospitalwide perspective. I am a chief operating officer for a hospital in California. Part of my job includes reviewing the patient and employee satisfaction surveys, handling incoming comments from the medical staff (both positive and negative), seeing all of the financial data, and reviewing the quality data. The theory of fewer patients for nurses to care for would tend to make one think it is a good thing. I think it is a good thing but there are so many more factors to consider besides just the number of patients assigned to one nurse. It is early in the game with all of this and I think we should really take an objective view and do an thorough risk/benefit analysis. The ratios will help only if other things are addressed as well. With the current situation in healthcare and the shortages of various disciplines, this has the potential to have a disasterous effect. Closing beds and reducing services is just about the only alternative a hospital has if they can't find the nurses or the hospital could face the consequences of violating the law. Our hospital has already budgeted about a million more dollars for salary expense in order to meet the ratio. The nurses are just not there to pay at this time. We are already having to turn patients away because we do not have the staff and I am not willing to sacrifice quality just to keep the census up either. This law is taking an already difficult situation to manage and making it worse. There needed to be some other basic issues addressed along with the ratio. If the ratio laws fail, and there is a good chance they will (what I mean by fail is being repealed) then the CNA and nursing in general will have a serious credibility issue and this will be seen as validation that nurses really have no concept of financial management and managing a huge complex business in general. It could really be bad for nursing if this thing blows up. Just my thoughts. By the way, I am very PRO-NURSING, always have been, always will be, and I work very hard to advance our profession. I just want to see us do it right and be taken seriously and be heard.

The staffing ratio laws will bring to light some things that I don't think the CNA really thought through, or perhaps didn't care to, not sure. Why does there have to be such an "us versus them" mentality about all of this. Like a war between administration and nursing. My current hospital began staffing according to the new laws back in the summer in order to prepare and see the finanical effect it would have. The care hasn't improved, the nurses still complain and whine about being too busy, nothing has changed. What was CNA thinking when this thing was pushed through? Kind of like saying, well let's see, there is already a nursing shortage so let's just make it worse and force the hospitals to hire even more nurses they can't find. The end result will be closing beds and cutting back services. Again, who loses in the end----the PATIENT.

Nurses and doctors are really hung up about giving pain medication. My wife was recently in the hospital and asked for her pain medication as soon as the time came around, because she was in some serious pain. The nurses acted like she was drug-seeking and abusing the pain meds. Perhaps they are afraid a person will turn into a raging drug addict from a 3 day stay in the hospital. Talk about overeacting. Or maybe it is the added inconvenience and subsequent irritation when the RN has to stop what they are doing to administer a prn medication. Don't nurses and doctors realize their attitude is quite apparent to the patients and families? I guess to realize that you would have to give a damn to start with.

Being a RN, hospital administrator, and relatively healthy, it has been quite some time since I experienced being in the hospital as a family member where no one knew me or what I did. What an eye-opener!! I just spent 3 days with my wife while she was a patient. I sat back and observed and was the "family member." I could go on and on but will make some general statements about this experience. It started with the nurse who was starting my wife's IV and dropped the sterile IV site dressing on the floor, she picked it up and proceeded to place it on my wife's IV site. When I kindly and gently asked her not to do that her reply was "well we do clean our floors." I thought she was joking but she was not. Generally, the nursing staff was rude. All but 2 of the nursing staff that worked with us behaved in a way that communicated to us that we were an irritant and a bother. I was appalled and disappointed in my chosen profession. Everything was about the nurse, how busy they were, how overworked they were, how short staffed they were, how they insisted we must follow the hospital policies that no one bothered to explain, etc. etc. During the few explanation of procedures that we received, when we attempted to ask a question the nurses would talk over us and seemed annoyed that we had interrupted their lesson to us. They talked down to us. I could go on and on. Nurses--it is not about us, it is about the patient. It costs nothing to smile, have a good attitude, and focus on your PATIENT'S needs and not your OWN while you are at work. What is going on with healthcare in this country?

Nursing is a great career. I have never really done anything else other than the jobs I had to do to work my way through nursing school and a couple of tours in the army as a medic. After 24 years and hindsight, I would probably do the same thing again. As I am sure you are aware, having some sense of balance is key to most anything. These days, just in my opinion, nursing (collectively speaking) has become somewhat unbalanced because nurses seem so focused on themselves and less on their patients. Great career, great choice, much flexibility in schedules, area of practice, setting of practice, and much opportunity for advancement. You are really only limited by your imagination and desire. Good luck. We can always use another mature, professional person to join us.

I believe some state boards vary a little concerning how they go about handling these things but I believe there are also many commonalities. Don't know how long you would have to wait before you heard anything, can be a while. Not sure if there is some sort of statute of limitations or not, might have your lawyer check into that. The record will not show any action against your license until official action has been decided on and that should not occur without a hearing. You should be notified in writing of the charges the board is bringing against you. These charges should be very specific and reference the particular provisions of the nurse practice act in your state. You should also receive notice of your hearing date at that time as well. That is if they decide to have one. Good luck with it. Narcotic errors are serious business, especially if someone reports your error to the board. My experiences have been this usually does not occur unless there is suspicion of diversion. My experiences are also that state boards of nursing do not play around with this kind of thing and many have a representative from the state attorney general's office present during the hearing to see if there is anything there to warrant criminal charges from the state as well. It can get pretty ugly. Good thing to have an attorney present and representing you. Again, good luck. If you have been diverting drugs, seek treatment immediately for your own good, license or not.

Ditto. I got the CARN and a cert. in psych nursing. Don't need any particular degree, just the RN, some experience, the money to pay the fee to take the tests, and pass the thing and you are there!!

It used to be said, "They'll never replace the horse."

Ditto. I think it is an opportunity for them to lay eyes on you and see if you can articulate in an effective way. Not really that big of a deal but don't underestimate it.

Zantac and Prozac work well.

There are many many male OB doctors. They have never given birth, they examine young, modest women who are delivering their first child. What's the difference in a male doctor and a male nurse in L&D???? OB was my favorite rotation in nursing school. I inquired about employment in L&D at that hospital (a Baptist hospital). They told me they did not hire men into the L&D department. That is discriminatory. If I were applying today for a job in L&D and was told that I believe I would file a gender discrimination suit and challenge it in court.

Need a little more specific info on the disciplinary action before I can comment, or anyone else for that matter.

It can be done but is very demanding. First, you must learn to function on 4 hours of sleep or less. Use paper plates, plastic ware, paper cups, hire a maid to do the essential cleaning, find ways to shave off a few minutes here and there to decrease your workload at home. I had to find all kinds of odd jobs from delivering pizzas to washing cars to working for the city park service doing things from picking up trash in the parks to waxing gym floors in the public school system. Went back to school after becoming an RN and found a weekend (Baylor) program, worked for 3 agencies and did evening and weekend work. It all added up to fulltime work with much flexibility. It was hard and I will never do it again!!!! Good luck and just never give up.

Customer service is not just another way to tell the staff to shut up and take it. What a narrow-minded statement to make (sorry if anyone is offended but come on!!). Nursing staff that are asked to engage in effective (key word here) customer service or service excellence techniques are not being thrown to the wolves. It is capitalism, free-market economy where supply and demand and competition rule!! WE even have laws that preserve our ability to compete--antitrust laws. The advent of the 3rd party payor system (worst thing that ever happend to healthcare in the USA) generated some expectations that have brought us where we are today concerning customer service. Healthcare staff expected the patient to follow orders, do what they were told, and fit into the way the hospital does things. The money to pay for the care was not coming out of the patient's pocket so they did it without question. Now that consumers are more educated, healthcare insurance is super expensive, consumers are waking up and saying wait a minute, I am paying alot for this so I am going to go where people treat me right with good service, as with any other business. You would not go to a shop or restaurant where the staff were rude to you!! So we are having to deliver a quality product with a smile just like everyone else in a competition based economy. As for patients, or customers as they should rightly be called, abusing staff, it should not be tolerated. I am a RN who has been in administration now for 7 years or so, and I do not tolerate this. I recently banned a family member from the facility for abusing the nurses. Did and will call the police and press charges against them again. So come on guys. The attitude of the poor down-trodden, unappreciated, unrecognized, oppressed nursing staff is tired and old. Stand up and realize the power you have and use it. If we don't have satisfied patients/customers they will go somewhere else for their care. Where do you think that paycheck you get regularly comes from anyway?!?!

For a previous post: administration listens to doctors because they bring in the money, has nothing to do with a union. That is private physicians who admit patients and send patients for outpatient tests/treatment. Physicians that work for hospitals say as a hospitalist, pathologist, or other "house-based" work also can have administration's ear because of their network of other doctor friends and colleagues who admint patients and generate revenue (make money) for the hospital. Nurses now have a window of opportunity to really get some things changed. Don't know if the union is the way to go or even necessary. Nurses truly are generators of revenue, they make money for the hospital. Problem is, most nurses I talk to about this kind of thing do not understand enough about our complicated and fragmented healthcare financing system to realize this. Administration sees them as expenses, or rather continue to tell the nurses they are expenses so as not to "awaken the sleeping giant." Nurses truly are generators of revenue for the hospital. How? The need for nursing care is the only justification for an acute care hospital stay!! Without the nurses the hospital could not keep patients in the hospital, not just from a care delivery point of view but from a getting paid point of view as well. When nurses realize this they will understand the power that nurses truly have. It trumps the physician's power as well. Perhaps a union is good only as a vehicle to rally nurses together but it is unnecessary to deal with administration. I am in California and I can tell you the hospital administrations are scrambling around in a panic over the staffing ration laws. Nurses are hard to find. When you can find them you pay dearly. Nurses are at a distinct advantage at this point in time. NOW is the time for some real gains that will last. It's not just about staffing, it's about all issues that face nursing. However, we must temper the demands. For instance, the staffing rations are putting some burdens on the health system that I think have been unanticipated and can be disasterous for everyone so in this way it is a bit extreme. However, on the other hand administrations have been screwing over nurses for some time now. NOW nurses have the needed leverage (in California anyway) to make some real gains by sort of coming with an olive branch and saying to administration, "are you ready to sit down and be reasonable about some things?" Don't know that you need a union for that.