dlatimer

Sorry I wasn't clear. To summarized: Bad staffing conditions result in poor patient outcome. Who regulates that staffing levels are adequate? Nurses risk their jobs when they demand/stand up for better staffing. JCAHO is paid by the hospitals. Is this similar to the financial meltdown? The financial institutions were paying S&P, Moodys for favorable ratings on their products.

Nursing Shortage resources: http://www.aacn.nche.edu/media/FactSheets/NursingShortage.htm The statements below are from AACN Nursing Shortage Fact Sheet, April 2011. According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 RNs to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%. The report, titled The 2007 State of America's Hospitals - Taking the Pulse, also found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005. In July 2010, the Tri-Council for Nursing released a joint statement on Recent Registered Nurse Supply and Demand Projections, which cautioned stakeholders about declaring an end to the nursing shortage. The downturn in the economy has lead to an easing of the shortage in many parts of the country, a recent development most analysts believe to be temporary. In the joint statement, the Tri-Council raises serious concerns about slowing the production of RNs given the projected demand for nursing services, particularly in light of healthcare reform. See http://www.aacn.nche.edu/Media/NewsReleases/2010/tricouncil.html The American Association of Colleges of Nursing (AACN) is concerned about the shortage of Registered Nurses (RNs) and is working with schools, policy makers, kindred organizations, and the media to bring attention to this health care crisis. AACN is working to enact legislation, identify strategies, and form collaborations to address the nursing shortage. To keep stakeholders abreast of current statistics related to the shortage, this fact sheet has been developed along with a companion Web resource. I agree that it the employers who don't hire needed nurses. More on that later.

Purpose of State Boards: Protect the Public or Organizations? I was recently introduced to a problem a nurse had with their State Board of Nursing and their employer, a hospital. The nurse was placed on probation after self-reporting they had sought and received treatment for alcohol addiction. Since then this nurse has been unable to find work. The conditions of probation exclude many places to work and limited to hospitals, doctor's offices and nursing homes. In several instances the hospital was interested in employing this nurse, but had a policy to not hire nurses on probation. The nurse informed the Nursing Board of this situation and was told 'We don't have any control over the hospitals.' After pondering the situation, I wondered if that was true. Hospitals are the main source of complaints to the Nursing Boards. Therefore they must have some relationship with them. To reinforce that concern an article in the February, March, April issue of the Nursing Board's Newsletter entitled Reporting Final Disciplinary Actions. Two things caught my attention when reading this article. 1) Hospitals and ambulatory surgical centers were mandated to report. Wouldn't that constitute a working relationship? 2) A list of types of incidents that don't require a report to the board. That list is: Rudeness Tardiness Absenteeism No call no show Personality Conflicts Employees not being a good fit for the organization based on personal beliefs and values. Time card violations The stated purpose of the article was to inform the newer mandated reporters and limit the unnecessary complaints. I don't mean to read too much into this, but does this imply these were 'incidents' that are no longer investigated by the board? Especially personality conflicts and employees not being a good fit for the organization based on personal beliefs and values. I only mention these because it is well known that many health care institutions are 'for-profit' and their goals are to increase shareholder value which may not be shared by the nurse committed to more humanistic values. Such as 'what is best for the patient' which may not coincide with 'what is best for the organization'. Recent nurse polls have indicated a majority of nurses are dissatisfied with working conditions. That said, they may not be performing at peak performance. I don't know about you, but when I or my loved one is under the care of a nurse - I would like that nurse to be at peak performance. Pride in workmanship is universally recognized as a good indicator of job performance. If a nurse can have pride in their work, then they do a better job. As the nursing shortage continues in most parts of the country does this effect the number of nurses who leave nursing? The Nursing Board is mandated in most states to be the public protector. Are they relying too much on organizations for their disciplinary reporting that may not have the public good in mind? If so that would explain why the US health system is ranked lower in quality and higher in cost than many other world health systems. Maybe it is time Nursing Boards review their disciplinary procedures so there is no conflict of interest regarding their stated purpose.

I would think twice and cover all your bases. I self reported and since then have been unemployed for over 2 years. Story: When I began my nursing career if I did what was the best for the patient, and I didn't step on the doctor's toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained 'not a good fit for our organization'. Then they can fire me 'for negligence or incompetence' as they were the ones deciding the definitions. The healthcare organizations can also 'weed out' the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can't find a job. There seems to be a disconnect. I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse's notes, which could explain why the value wasn't entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn't include the physician's assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father's condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient's heart condition indicated it was more than probable. The treatment was the same regardless. No one died. What the accusations didn't mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn't able to deliver quality care in this ICU. My patients and their families always come first and if I can't perform by own principles and morals; it is time for me to leave. I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn't something I would make up. I was under oath. To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years' probation. I didn't complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can't get a job anywhere (one business hired me, I was in orientation, then told I couldn't be hired without an explanation when I asked.) even McDonald's. I will soon be living on whatever social aid I can get and become a burden on society. This doesn't have any logic. If I am such an incompetent nurse: why didn't it come up before 30 years? Why didn't it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn't they contest my unemployment compensation? These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.

When I was a patient at the same hospital I had been working at, I was ignored and heavily medicated after surgery. I only had my vital signs taken a dozen times and the day after I had my chest tube removed (right lung decortication) they discharged me. I certainly didn't rate any favoritism and was expected to do for myself, although it was very painful. It certainly changed my attitude toward any patient. People are there for help, not because they want to be. It made my whole concept of compassion change.

I understand, absolutely. I have been there and was appalled.

I agree with many of comments because I have worked at a SNF. But, will you lose your license? It depends on the relationship with your institution and the Board of Nursing. My story illustrates. When I began my nursing career if I did what was the best for the patient, and I didn't step on the doctor's toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained 'not a good fit for our organization'. Then they can fire me 'for negligence or incompetence' as they were the ones deciding the definitions. The healthcare organizations can also 'weed out' the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can't find a job. There seems to be a disconnect. I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse's notes, which could explain why the value wasn't entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn't include the physician's assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father's condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient's heart condition indicated it was more than probable. The treatment was the same regardless. No one died. What the accusations didn't mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn't able to deliver quality care in this ICU. My patients and their families always come first and if I can't perform by own principles and morals; it is time for me to leave. I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn't something I would make up. I was under oath. To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years' probation. I didn't complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can't get a job anywhere (one business hired me, I was in orientation, then told I couldn't be hired without an explanation when I asked.) even McDonald's. I will soon be living on whatever social aid I can get and become a burden on society. This doesn't have any logic. If I am such an incompetent nurse: why didn't it come up before 30 years? Why didn't it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn't they contest my unemployment compensation? These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.

These are some great replies. I wonder if the bottom line isn't the incentive behind the VP's comments? Return on investment. I had an incident that is related. When I began my nursing career if I did what was the best for the patient, and I didn’t step on the doctor’s toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained ‘not a good fit for our organization’. Then they can fire me ‘for negligence or incompetence’ as they were the ones deciding the definitions. The healthcare organizations can also ‘weed out’ the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can’t find a job. There seems to be a disconnect. I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse’s notes, which could explain why the value wasn’t entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn’t include the physician’s assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father’s condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient’s heart condition indicated it was more than probable. The treatment was the same regardless. No one died. What the accusations didn’t mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn’t able to deliver quality care in this ICU. My patients and their families always come first and if I can’t perform by own principles and morals; it is time for me to leave. I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn’t something I would make up. I was under oath. To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years’ probation. I didn’t complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can’t get a job anywhere (one business hired me, I was in orientation, then told I couldn’t be hired without an explanation when I asked.) even McDonald’s. I will soon be living on whatever social aid I can get and become a burden on society. This doesn’t have any logic. If I am such an incompetent nurse: why didn’t it come up before 30 years? Why didn’t it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn’t they contest my unemployment compensation? These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.

Favoritism is probably always going to be present. This story is related. When I began my nursing career if I did what was the best for the patient, and I didn’t step on the doctor’s toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained ‘not a good fit for our organization’. Then they can fire me ‘for negligence or incompetence’ as they were the ones deciding the definitions. The healthcare organizations can also ‘weed out’ the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can’t find a job. There seems to be a disconnect. I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse’s notes, which could explain why the value wasn’t entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn’t include the physician’s assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father’s condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient’s heart condition indicated it was more than probable. The treatment was the same regardless. No one died. What the accusations didn’t mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn’t able to deliver quality care in this ICU. My patients and their families always come first and if I can’t perform by own principles and morals; it is time for me to leave. I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn’t something I would make up. I was under oath. To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years’ probation. I didn’t complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can’t get a job anywhere (one business hired me, I was in orientation, then told I couldn’t be hired without an explanation when I asked.) even McDonald’s. I will soon be living on whatever social aid I can get and become a burden on society. This doesn’t have any logic. If I am such an incompetent nurse: why didn’t it come up before 30 years? Why didn’t it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn’t they contest my unemployment compensation? These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.

I have had a couple of good managers over the years, but find they are just like people: some good, some not so good. It seems the managers attitudes have changed over the years. Here is my story one manager. When I began my nursing career if I did what was the best for the patient, and I didn’t step on the doctor’s toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained ‘not a good fit for our organization’. Then they can fire me ‘for negligence or incompetence’ as they were the ones deciding the definitions. The healthcare organizations can also ‘weed out’ the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can’t find a job. There seems to be a disconnect. I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse’s notes, which could explain why the value wasn’t entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn’t include the physician’s assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father’s condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient’s heart condition indicated it was more than probable. The treatment was the same regardless. No one died. What the accusations didn’t mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn’t able to deliver quality care in this ICU. My patients and their families always come first and if I can’t perform by own principles and morals; it is time for me to leave. I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn’t something I would make up. I was under oath. To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years’ probation. I didn’t complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can’t get a job anywhere (one business hired me, I was in orientation, then told I couldn’t be hired without an explanation when I asked.) even McDonald’s. I will soon be living on whatever social aid I can get and become a burden on society. This doesn’t have any logic. If I am such an incompetent nurse: why didn’t it come up before 30 years? Why didn’t it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn’t they contest my unemployment compensation? These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.

Kudos to you bree* for being honest, I hope.

So, there is a price on life? (But, I may be quietly smiling while tripping you up.) Do you agree that men, as well as women, can be stereotyped?

After reading most of these posts it is obvious that there are different perspectives. I find it interesting that compassion is a 'requirement' for being a good nurse, but I have trouble finding it in some of these posts. No doubt there is an educational, learning and attitude deficit, but on which end? Practicing mindfulness, compassion and willingness is sometimes difficult. It is sometimes difficult to remember nursing is a team effort. Communication is essential to good care. Is this an example that nurses eat their young?

To me, it's all about trust. If you don't trust your employees, then how can they trust you? Adults should be expected to act as such. Scowling and threatening are methods used in grade school. I appreciate tough attitudes when warranted and a healthy respect of rules is just a responsible adult characteristic. I would watch my back. If someone would stoop to those tactics...what else would they do?

kdc, It's only a job. It's not your life. You get to decide. Start looking elsewhere now. I would rather work for less money and be happy than sacrifice my children and marriage. Everyone has tough choices to make. Please think about possibilities. There is a way out. Know yourself and love yourself - then you can know and love others. Yes, everything has consequences. Life is a risk. It is too short to be so unhappy. You are not alone. Joe