Effie, RN

re: FMLA, it applies to illness or providing care for an immediate family member and sister/brother in law would qualify. There are some conditions, i.e.: FT employment for one year, but after that it's pretty open and if you've qualified you have 12 weeks to take in any increments you need to...one day at a time or weeks at a time. For an employer not to offer this option to an employee in this situation is not just immoral it is against federal law and prosecutable!

Re: Case Manager 1 getting fired: This situation is why FMLA exists...it is illegal for them to do this, you just have to go about it the right way!

the key here is knowing the knowledge level of the practitioners and everyone working as a team! it's not supposed to be about egos or letters after your name, it's about using everything you know and everything everyone else knows to make sure the patient gets the appropriate level of care.

i have never thought this was a good idea. in missouri we have certified medication technicians who can also get insulin certified so they not only do the fingersticks but give the insulin too, all with training that is measured in hours not months or years. in the same vein, i am totally opposed to "patient care techs" removing indwelling urinary catheters and iv lines. who in the world came up with these moronic ideas???

i'm also one of those baby boomer nurses. been doing this for 32 years and have seen the job gluts come and go but the need for nurses does not change. i personally do not plan to continue working until i'm in my dotage and want to be sure that there will be some younger yet experienced nurses there to take care of me when i need it. i agree that there may be less facility based care for us but believe that the home-base care will sky-rocket for economic and comfort reasons. having worked as a vna nurse, i know that this kind of care requires experienced rns because you are out there on your own so please students...study hard, work in acute care to get that great experience, and be there when we all need you. (and can we all play nicely together?)

been a nurse for 32 years, seen the ease of getting a job ebb and flow but one thing is for sure there will always be a need. every estimate i have seen in the literature says that unless there is some major miracle there is likely to be a shortage of nurses in 2020 of up to 1 million!!! from your posts, it sounds like you are going about it the right way and for the right reasons. good luck!

all the more reason for you to get involved!

until we all realize that the politics of nursing is important then nothing is going to change. the docs, the hospitals, the insurance companies have each had a powerful lobby in dc and the state capitols for years speaking for them and getting the public to see things their way. we nurses on the other hand have been at the bedside providing care, working our tails off, and then complaining about how no one gets it. if we don't all speak with one voice through our professional organizations no one ever will get it. only very recently have nurses gotten "a place at the table." ajn is just one professional journal, one of several that i personally subscribe to from one of several professional organizations general and specific that i belong to. every one of us has the professional responsibility to stand up and be heard through our professional organizations to make things better for our patients and for all of us too!

it makes me very afraid when a bedside nurse is not interested in finding out about research based nursing care. this is evidence based practice in action. if you don't think it is pertinent, you should contribute something that is.

for anyone who cares to read it there is a very timely article in the current issue of ajn on this very topic. i would encourage anyone who has strong feelings to read it. i would also refer all nurses to the standards and scope of practice for nurses and the code of ethics for nurses with interpretive statements. these two documents, which were originally begun many years ago and have been revised and honed many times, are the basis by which we all should practice. upon those, i rest my case.

i do understand. but things were no better "way back when", just different. we had more patients jammed into smaller spaces plus family members camped out in chairs. we were trying to manage iv pumps and any other equipment we could squeeze in behind all that. when i was first out of school, i worked on a primary care neuro floor. that meant we nurses each had 6 patients for whom we did absolutely everything. if we were lucky there was a na or an orderly who could help us lift or do a bath but that was 1 for the entire floor not 1 per nurse. we didn't have computers, we did everything on paper which meant of course trying to read a dozen or more different different mds hand- written notes and orders. there was no pyxis, meds had to be brought up from the pharmacy individually when needed. we mixed most of our own ivs and antibiotic drips. getting the picture? so yes, i understand. and staffing issues with administration has always been an issue. back then the difference was that most hospital administrators were business people or mds. no chance that a "mere nurse" would ever reach that pinacle of success so it was pretty rare to have anyone topside who had ever had boots on the ground no matter how long ago. the more things change, the more they stay the same. the only way that anything will improve is if we can all just believe that we all have hard jobs but no matter what the patient comes first...that is, the person patient, not the patient as dysfunctional medical machine.

this is not a personal criticism of you but my own experience with nurses on all shifts, all days in the hospital i was in. thankfully i did not personally need a cardizem drip. what i did desperately need and did not receive was adequate pain control after major abdominal surgery. i also needed my lungs assessed and appropriate intervention taken but that didn't happen without strenuous intervention on the part of me and my family. i am quite sure that we were all labeled as difficult by the nurses who were not doing their jobs and that doesn't hurt my feelings one little bit. a patient should not have to threaten to call the jcaho in order to get an individualized pain control plan, rather than being told "it's not in our policy" when there is a physician order in the chart to give a medication immediately post-op. these same "professionals" also told me a great deal of hipaa protected information about my roommate. what frightens me is that there are many patients every day who do not have the benefit of many years of experience in the heathcare environment, do not know their rights or what should be happening and so do not know how to protect or advocate for themselves as i did for myself and my family did for me. this is why family members want to stay in the hospital, because they have heard the same horror stories on 48 hours and 60 minutes that we have. what truely saddens me is that there seem to be so many nurses who resent these family members who are only trying to care for their loved ones the best way that they know how. a big part of our job as nurses has always been and continues to be to advocate for the patient and their support system. florence nightengale wrote about this in her book "notes on nursing" which, by the way, is still very pertinent in 2009 if you read past the part about chamberpots!

in fact it is what my family members did, in addition to monitoring my medications, my respiratory status, my pain status, and making sure my iv didn't run dry. oh wait, isn't that all what my nurses were supposed to be doing?

wow. i guess i am just some kind of dinosaur or something. i too remember doing pm care and giving backrubs but i remember it a bit differently. i remember how much all of my patients appreciated it. i remember how much more relaxed they were, how much better they seemed to sleep, how much better their pain meds worked. no, i'm not a massage therapist, i'm a nurse. on my license it says that i am a "registered professional nurse" and that's how i see myself. that includes doing whatever kind of personal care will help my patients get better...not just the high tech stuff though that is certainly important. i'll share something else too: when i was a patient last summer i would have loved having one, just one, nurse who care enough about my wellbeing to even offer to do something simple like give me a backrub. unfortunately, the nurses who "cared" for me were much too busy looking after my iv pumps, etc. so busy in fact that they failed to ever assess my lungs adequately. they also managed to make several major medication errors and did not control my post-op pain. btw, this was in a hospital that is "one of the top 5 in the us" according to recent news reports.

catherine- brava, well said. i've been where you've been (na to rn, started as an na in '71) and you are right on! it is all about professionalism, something that seems to be in very short supply these days in many professions, nursing included. customer service, to our patients, families, and outside providers (external customers) and to our coworkers (internal customers) is not a new concept, just new language to nursing. formerly it was called common courtesy and respect for others. we would all benefit from more of it.