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  1. allnurses

    We Did Not Sign Up For This

    This article was written by someone who wishes to remain anonymous. Due to the topic and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system. COVID-19 is here and it is terrifying. People are scared. People are panicking. I have seen posts that criticize nurses who choose not to work right now because they are afraid. “This is what YOU signed up for!” people say. That is not true. This is NOT what we signed up for. NOBODY has signed up for this. Unlike what you might have seen on TV, there are many different types of nurses and we all have different skills. We specialize in our own fields. The Renal nurse knows how to educate patients who are in renal failure about fluid and dietary restrictions, so they do no overload their systems. She understands shunts and dialysis equipment. For the patient in renal failure, she is an expert. The Cardiac nurse knows how to take care of patients who have just had open-heart surgery. She can read an EKG expertly. She may not know how to connect a patient to a dialysis machine, but for cardiac patients, she is an expert. The Labor and Delivery nurse can check your cervix to tell when it’s time to push. She can read fetal monitoring strips to make sure your baby is not in distress during labor. She may not be an expert at reading EKGs, but for a laboring mom, she is an expert. The ICU nurse takes care of the most fragile patients. She understands ventilator settings, arterial pressure readings, blood gas readings. Drugs that most wards will never see – like Levophed are used here. She cannot check your cervix, but for a critical patient, she is a lifesaver. Each of these nurses (and oh so many more different types of nurses!) are experts in their fields. They “signed up” to care for those patients. They have trained and educated themselves to care for their specific patients. That is why if you are in labor, you want a labor nurse, not a renal nurse, at your bedside. Right now, ALL NURSES, regardless of specialty, are being called to care for COVID patients. Please bear in mind that not ALL nurses have been trained to deal with highly infectious patients who have the potential to go into acute respiratory distress quickly. We are NOT being offered additional training. This is part of the reason nurses are terrified. This is why some nurses are leaving nursing right now. This is definitely NOT what they “signed up for.” For the most part, nurses take care of people who are ill or injured with non-communicable illnesses or injuries like cancer, heart disease, strokes, car accidents, etc. This means we can help without the risk of catching our patient’s illness or injury. We do take care of patients with infectious illnesses as well – the flu, pneumonia, etc. Because these patients do not take up a large part of our hospital normally, we have the appropriate respirators, reverse-air flow rooms, and PPE we need to take care of these patients. These patients are usually on appropriate wards with nurses who have been trained to care for them. Although there is a risk when we take care of these patients, there are also vaccines and known treatments to help us fight if we get infected. COVID-19 IS DIFFERENT. IT IS A HIGHLY INFECTIOUS, POTENTIALLY FATAL VIRUS WITH NO KNOWN CURE OR TREATMENT. Because it is a PANDEMIC, many people are sick at the same time. Hospitals are overwhelmed. Patients are being sent to wards where nurses do not have the correct expertise to care for them. Hospitals do not have the appropriate equipment to help keep their nurses SAFE while we are caring for patients. There are not enough masks. Nurses are being asked to wear bandanas or sew their own masks at home! Would YOU walk into a potentially infected person’s room and care for them with a bandana? So please. STOP. STOP saying “Nurses signed up for this.” We did not. We did not sign up to sacrifice ourselves because hospitals won’t provide us with the proper equipment and training we need. We did not sign up to die of an infectious disease just because “it’s your job!” Do you want a labor nurse trying her best to ‘figure out’ how to operate a ventilator for your child? Do you want a cardiac nurse delivering your daughter’s baby? Do you want a wound care nurse to try and figure out your dialysis settings? No. I promise - you don’t. We understand you need us, but our families need us too. If we are scared right now, it’s because we have every damned reason to be terrified. If some nurses choose to stay home and protect their families, that is their priority. They have a right to protect their own life. No JOB is worth anyone’s life
  2. allnurses

    COVID-19 Health & Safety Tips

    COVID-19 is here and it is not going away anytime soon. As this story continues to unfold, the media coverage is permeating our lives. As nurses who are on the front line, we need to take care of ourselves. But the buck doesn’t stop with nurses and healthcare providers. Everyone has an obligation to do their part to help flatten the curve of what is yet to come. There has been much information out there, but as this is constantly evolving, you need to keep up to date with information, recommendations, and mandates from reputable sources. We have created this simple visual to answer the question: WHAT CAN I DO? allnurses.com covid-19 health and safety tips.pdf
  3. The 2018 Marguerite Rodgers Kinney Award for a Distinguished Career was awarded to Beth Tamplet Ulrich, EdD, RN, FACHE, FAAN at the 2018 American Association of Critical Care - National Teaching Institute annual conference. While at the NTI conference, Mary Watts, BSN, RN, allnurses.com Community Director interviewed Dr. Ulrich and discussed her career and some of her accomplishments. Dr. Ulrich received her bachelor’s degree from the Medical University of South Carolina, her master’s degree from the University of Texas Health Science Center at Houston, and her doctorate from the University of Houston in a collaborative program with Baylor College of Medicine. When she moved to El Paso, Texas; due to her husband’s job, she started in dialysis and learned from the ground up as dialysis was in infancy. She worked to set standards of care and is a past president of the American Nephrology Nurses Association (ANNA). While earning her doctorate, she worked in hospital administration developing nursing simulations and nurse residency programs. She became interested in the healthy work environment and began her work with the American Association of Critical Care Nurses (AACN). She assisted with development of the first Healthy Work Standards survey in 2005. Dr. Ulrich stated that AACN brought together “an expert panel to create the standards.” In 2006, it was decided to “obtain opinions from those nurses with boots on the ground; the staff nurses who do the doing every day.” She further explained that AACN is “absolutely committed” to obtaining information to help the bedside nurse work in the safest environment possible. The 2005 survey was a snapshot. By the 2008 survey, AACN began to assemble comparisons of data which expanded when the 2013 survey data was added and AACN was able to took at trends. Now in 2018, AACN has received over 8000 responses to their current survey. Every time the survey is done, there are more and more nurses responding. Mary stated, “nurses see the value in these surveys because they want changes” via the published results. Dr. Ulrich continued, “When we first looked at this, we were looking for a baseline. In 2013, we saw the down turn of the economy: nurses were returning to work, they were changing from part time to full time, or for those who were working full time, they were looking for overtime.” In this scenario where the economy dictated how much you needed to work, there were not a lot of changes in the work environment regarding safety as income was the number one reason to work. Mary asked, “What contributes to an unhealthy work environment?” Dr. Ulrich answered that inappropriate staffing - results showed that 39% of the respondents reported they had appropriate staffing. Another more concerning result was that 32% stated that <50% of the time, they had adequate staffing. “This is pretty scary for the patients and the nurses". Dr. Ulrich pointed out that "staffing isn't just about the patients; it's about the nurses too, because when staffing isn't adequate, nurses don’t practice at the top of their license. They get done what they have to get done. They don't get to do the things only nurses can do - the critical thinking things, the discharge planning, comforting, teaching patients and families. They have to do tasks and then nurses aren’t satisfied with their jobs.” This results in decreased job satisfaction. Staffing is more than just about enough nurses to take care of the patients. It reflects on everything in the work environment. “I was surprised at the high number of incidents of discrimination with the 2018 survey.” This included verbal and physical abuse experiences. “We capped it at 200 incidents in the survey.” Nurses aren’t leaving nursing, they are leaving the hospitals - they have many options. They aren’t limited to work in the hospitals. “Once a nurse, always a nurse,” stated both Mary and Dr. Ulrich in unison. The survey results are published in Critical Care Nurse, AACN's clinical practice journal. Link to study Allnurses.com extends their gratitude to Dr. Ulrich and AACN for continued support in disseminating vital information for nurses.
  4. As nurses move into new positions, there are many choices and aspects to consider before saying yes to the job. Mary Watts, BSN, RN and Maureen Bishop, MSN, CNS discussed ICU orientation and how to be a successful ICU nurse. They met at the 2018 NTI Conference in Boston, Massachusetts. They talked about the changing face of nursing employment. Nurses on the Move A recent study found that millennials will change jobs an average of four times in their first decade out of college, compared to about two job changes by Gen Xers their first ten years out of college. Ms. Bishop explained that the expectation of employment at her institution is two years. Essentials of Critical Care Orientation (ECCO) Ms. Bishop has been hiring new grads into the ICU for the past 10 years. "Mostly we look for passion. We do what is called a blended orientation concept. They do online modules, classroom time where they learn basic critical thinking skills and they take an 8-week arrhythmia course." In addition, they are required to take and pass ACLS and "of course the most important part is to spend time bedside." Ms. Bishop attributes her facility's orientation success to utilizing AACN's ICU Essentials of Critical Care Orientation (ECCO). According to the AACN, "ECCO's up-to-date, interactive evidence-based education easily blends into your existing orientation plans. AACN's 24/7 customer support, comprehensive reports, and progress tracking tools make implementation straightforward." The ECCO program has earned accolades for its content: "American Association of Critical-Care Nurses (AACN), a leader in providing standard-setting education and expertise that nurses and healthcare organizations can trust, recently won two prestigious Brandon Hall Group silver awards for excellence in the Best Learning Team and Best Advance in Custom Content categories." Even after the 4-6 month official orientation, there is a mentorship program too; where new grads and seasoned have added support for an extended period of time. They also have follow up with Ms. Bishop as well as the unit manager. Mary asked about whether orientation is customized for the experienced nurse and Ms. Bishop assured her that the orientation must be flexible in order to meet the needs of everyone. Customized orientation is also important to AACN and their ECCO program. Ms. Bishop also emphasized that they welcome nurses who apply from out of state, both new grads and experienced nurses. Evaluation Evaluating the end product of orientation is extremely important. Ms. Bishop states that the criteria she uses to evaluate orientees consists of their ability to grasp the concepts of ECCO and put them into practice. She also emphasizes the need to utilize solid critical thinking skills when confronting complex patient care. Other important aspects of a successful new ICU nurse are that they are able to coordinate all the aspects of care including physical assessment into a solid plan of care. This includes understanding lab results, medications and how they affect the overall care of the patient. She concludes, "so for me, it's really how they are doing on the job. Are they putting that knowledge into practice?" Nurses want to be successful in their chosen career. There are many barriers to a successful orientation but using a known product to facilitate this process will increase the odds of retaining ICU nurses.
  5. This past May allnurses.com caught up with Danielle LeVeck, DNP CVICU NP/CNS more commonly known by her Instagram name "Nurse Abnormalities," at the 2018 NTI AACN Critical Care Conference in Boston. Danielle is an acute care nurse practitioner and has been a cardiovascular surgical ICU nurse for seven years. She began her first blog in 2015 after the controversial media coverage on "The View" of Kelly Johnson, Miss America candidate, who wore a stethoscope as she presented a monologue on nurses. She's grown her Instagram to more than 85,000 followers and is regarded as a top nurse influencer. In the following interview, Danielle talks to us about the ups and downs of nursing and how to navigate the cross section of nursing and social media. She shares some of the tips she has learned about how to build an effective social media presence. Keep your vibes positive as much as you can Be very real and willing to be positive Never post a picture of a patient Be careful about what you post in the hospital. Be honest with your employers about your social media presence. n=https%3A%2F%2Fallnurses.com&widgetid=1
  6. The opioid epidemic is a hot topic in today's headlines affecting more than 1 million people across the United States. As part of the multidisciplinary healthcare team, the nurse plays an important role in providing safe pain management using a multimodal approach. Catherine Ewing, BSN, RN shares strategies for optimal outcomes for pain control including safe prescribing and follow-ups as needed. At NTI 2018, allnurses.com's Community Director Mary Watts interviewed Catherine Ewing, BSN, RN who addressed the nurses' role in the opioid epidemic. She discussed the recent changes to the Centers for Disease Control and Prevention's recommendations. She stated, "The purpose of these guidelines is not to deny people pain medications but to prescribe safely and have prescribers practice follow-up." Catherine Ewing holds a BSN from the College of Saint Teresa in Winona, Minnesota. She works in the Department of Anesthesia Inpatient Pain Service at the Mayo Clinic, Rochester. As a member of this consult service, she triages and manages epidural and peripheral nerve catheters for both inpatient and outpatient populations. Catherine and Mary discussed the importance of individual pain assessment relative to several factors: Type of pain Reason for pain - is it due to recent surgery or trauma? Patient's previous experience with narcotics Does the patient have a history of addiction? Patients who have addiction issues need pain control also. The American Pain Society has guidelines to help clinicians provide adequate pain relief for those patients who have opioid addiction issues. Some of the points include: Use of methadone, dosing, initiation and titration Conduct a thorough pre-op pain medication assessment in a non-judgemental manner Use a validated pain management tool Provide close monitoring of respiratory status Surgeons should consider local blocks during surgery utilizing long-acting analgesia Catherine went on to state, Consistent nursing assessment and documentation is key to successful pain management. Nurses should also consider nonpharmacological means of pain management too, for instance, ice, elevation, guided imagery, and massage. This is a national problem and one many nurses face each shift they work. Pain Management and the Opioid Crisis - Conversation with Catherine Ewing Catherine's session was very popular and widely attended. One of the comments from the audience, "this is such an important topic given the current state of our healthcare system! I find this particularly relevant to the Cardiothoracic Surgery patients I typically encounter - in the facility in which I work a major issue is that generalized "pain management" policies do not take in to account the nature of the operation itself and the importance of pain control in preventing complications and improving outcomes. Pulmonary hygiene and early mobilization are paramount, however often difficult to achieve without adequate pain control. Unfortunately, it seems the corporate-minded aspect of many healthcare institutions is becoming a barrier to optimizing patient outcomes. I believe wholeheartedly that bedside critical-care nurses should be included by administrators in the development of methods to manage pain in postoperative recovery given the concerns of the opioid crisis. Great topic, glad to see it being discussed!" Pain control is an important element of patient care and one that deserves all nurses' attention. What is your hospital doing to ensure patients have adequate pain control? Reference: American Pain Society, Guidelines on the Management of Post-Op Pain
  7. AllNurses.com's Content and Community Director, Mary Watts recently interviewed Karen Kesten, DNP, APRN at NTI 2018 on the subject of nursing certification. Dr. Kesten is the past chair of the national board of directors for the AACN Certification Corporation, as well as an associate professor George Washington University School of Nursing. Many nursing certifications are available from AACN Certification Corp. for both RNs and APRNs. Dr. Kesten recommends certification for all nurses as a "mark of excellence and distinction." She went on to state that this proves credibility of knowledge and leads to higher patient and nurse satisfaction. New Certifications Two new certifications; CCRN-K and PCCN-K are now available. These certifications are for nurses who do not currently deliver direct bedside care but who indirectly affect patient care thru management, instruction or staff development. The "K" stands for "knowledge." This is a way for nurses to continue to use their knowledge even though they are no longer bedside. Other new certifications include palliative care, and forensics nursing. These specialties show patients and colleagues that the nurse has attained a level of expertise in their specialty. Dr Kesten foresees possible future certifications for nurse navigators and nurses who are involved in transitions of care. APRNs and the Consensus Model Advanced Practice Registered Nurses (APRNs) also need to consider the Consensus Model when choosing their educational pathway. The APRN roles are: Nurse Practitioner Clinical Nurse Specialist Certified Nurse Midwife Certified Registered Nurse Anesthetist "To help take APRN practice to the next level, AACN collaborated with over 40 nursing organizations to address the inconsistency in APRN regulatory requirements throughout the United States. The result was the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (LACE)." The Consensus Model sought to improve patient access to APRNs, support nurses to work more easily across different states, and enhance the certification process by preserving the highest standards of nursing excellence. Through consistency and clarity of APRN Consensus Model criteria, APRNs were empowered to work together to improve health care for all." LACE also determines what patient population and focus the APRN certifications cover. This is an effort to delineate out each APRN specialty and to develop more consistency. Dr. Kesten encourages nurses to consider a primary care APRN role as nurse practitioners are in great demand especially in underserved and more rural communities. With the current physician shortage, nurse practitioners are filling many provider roles. More and more nurse practitioners are seeking roles in specialty care, which extends the availability of providers. Why Certification is Needed Dr. Kesten encourages nurses to obtain certifications. She emphasized that nurses are in a life-long learning pattern and with certification, they have more options. There are many faces of nurses so there are many certifications and she expects that nurses will have many more opportunities in the future. Dr. Kesten advocates for nurses having a louder voice in order to advocate for their patients. Overall there are many more opportunities available for certified nurses. Consider certification! References: AACN Certification Corporation APRN Consensus Model
  8. As a nurse, you speak with the public daily. You educate patients, support families, and provide information to community resources to get your patients the care they need. When our country experiences disasters, nurses are at the bedsides, providing care, and advocating for their patients. But, when a journalist covers a story about the latest flu epidemic, acute flaccid myelitis, or another violent attack, who do they interview? Do they look for the nurse at the bedside who cared for these patients, or the doctor overseeing the care? We're quite sure you just said "doctor" in your head, right? But, do you know why? A recent study conducted by Diana Mason and Barbara Glickstein replicated the original Woodhull Study that was done in 1997 to explore how often nurses were identified or interviewed in the media for general healthcare stories. The study was reproduced to determine if there have been any advancements of nurses in the media. At a recent AACN-NTI Conference, we sat down with Diana, who is the Senior Policy Service Professor for the Center for Health Policy and Media Engagement at George Washington University School of Nursing during the American Association of Critical Care Nurses meeting. She provided an overview of the original findings, new data, and the future of nurses in the media. You can watch/listen to the full intervew below. The Original Woodhull Study In 1997, the "Woodhull Study on Nursing and Media" was published, and was the first of it's kind to explore the representation of nurses in the media as sources of health-related stories. Dianna explained that the original study found that nurses were sources in quotes less than 4% of the time in newspapers, and about 1% of the time in newsweeklies. During the interview, she explored the notion that even when nurses were at the heart of the story, such as with HIV/AIDS care in the mid-90's, they were nowhere to be found in print publications. Even rarer was to find nurses being interviewed about nursing policy or actually photographed for news stories. Following the release of the original findings, Sigma Theta Tau raised awareness of the need for nurses in the news. Then in 2010, the Institute of Medicine (IOM) released the Future of Nursing Report in which the Robert Wood Johnson Foundation and the IOM conducted a two-year initiative to assess and transform the profession of nursing. The study concluded that nurses played a vital role in the advancements of the healthcare industry, but that barriers existed that prevented them from being well-positioned to lead change and advance health. Have We Progressed? According to the preliminary results released by The George Washington University, the new study examined 365 randomly sampled health news stories published in September 2017. They looked at the type and subject of the article, the profession, and gender of the speakers, and how many times nurses were references without being quoted. The researchers found that nurses were identified as sources in just 2% of the health news coverage and mentioned in 13% of health news coverage overall. While this is a decrease in the representation, Dianna explained that it's not statistically significant, so the conclusion has been made that nothing has changed. She acknowledged that this might not be accurate because nurses might be cited in stories, but not recognized for their role. It's normal to see stories where Dr. Smith is quoted, even if he or she isn't in a hands-on provider. However, when a nurse holds an executive level position, their credentials aren't always given. Other findings included that females are less represented that males in the media, even though the profession is predominately made up of women. There were also preconceptions in the news media about positions of authority and journalists admitted that they weren't sure what nurses do and when nurses would add to a story unless it was explicitly about nursing. How Do We Make Change? Nurses provide more hands-on care than any other healthcare professional. Yet, they aren't equally represented in the media. Is this because nurses are not comfortable with being in the spotlight? Could it be that when journalists request an interview for a story nurses are not the ones provided by healthcare systems? Or, maybe journalists aren't even sure how to access nurses for stories. Actually, all of these were found to be true. So, how do we ensure that this won't be the same 20 years from today? Here are a few things you can do to help progress nursing representation in the media: Support movements like Show Me Your Stethoscope (SMYS) that advocate for positive cultural changes within the nursing profession and the healthcare community. They strive to provide a united voice for nurses on issues facing our communities. SMYS was founded in response to a public attack on the nursing profession and has ultimately led to the #NursesUnite concept. Talk about your credentials. Diana points out that you don't need to include all 7 of the certifications you hold, but identifying yourself as a nurse with a hard-earned degree and license is paramount to the required changes in media. Improve media competence by training journalists and offering media training to nurses. If you want to be a presence in your local community, seek out the media relations department at your facility and request to be trained on how to speak to the media. This training can teach you how to talk with journalists, stay on your message, and just be yourself. Anticipate healthcare happenings and identify nurses who should be at the forefront of stories. This should be accomplished on a local, state, and national level by healthcare facilities, organizations, universities, and government agencies. Our time with Diana was eye-opening and empowering. Have you been in the media as a nurse? Were you well-represented in print? Or, maybe you have ideas on how to empower nurses to be in the press? Whatever your thoughts are about this study, we want to know. Comment below and get the conversation started.
  9. Unsafe nurse staffing is a problem that occurs in hospitals across the United States. Decades of research shows that when nurses have too many patients, outcomes are worse and mortality is higher.[1] Some states have staffing legislation in place requiring hospitals to staff their units according to a staffing plan developed by a committee made up of at least 50% direct care staff nurses. States with this legislation include Texas, Ohio, Illinois, Oregon, Washington, Nevada, and Connecticut. Other states have regulations that address nurse staffing in some other manner; these include California, Massachusetts, Minnesota, New Jersey, Rhode Island, Vermont, and New York. Many states have no legislation or guidelines on nurse staffing.[2] Some hospitals use staffing committees or acuity systems. Others use nurse-to-patient ratios for different units, with limits on the number of patients any nurse can have. Some hospitals use a combination of staffing methods. You can help us find out what type, if any, of staffing methods or plans exist in the nation's hospitals. As to date there is no research that shows the effectiveness or compliance of staffing by acuity plans in hospitals. Despite that factor, professional organizations only recommend this approach to staffing. We are doing a survey of nurses to determine what bedside nurses are experiencing in their hospitals and to see whether nurses feel that staffing is safe where they work. Please help us by completing this short survey to help us collect data that will help indicate compliance, effectiveness and safeness of the working conditions that you the bedside nurse experience. SURVEY LINK: If you are a direct care staff nurse who holds an active RN license, work in the U.S. and wish to participate in the survey, click the following link to help determine How is your staffing determined and do you feel it is safe? Participate In Our Survey Please share your stories in the comments below as we look forward to hearing what you the working bedside nurse have to say. References 1. Curtin LL. A conversation about the ethics of staffing. 2016;11. Accessed August 29, 2018. 2. Buppert C. What's being done about nurse staffing? Accessed August 29, 2018.
  10. The #1 digital stethoscope for nurses. 40x sound amplification Reduced ambient noise 7 volume levels for listening comfort Adult & pediatric diaphragms Rechargeable battery with 9 hour life with continuous use Bluetooth connectivity to free mobile app Connecting the CORE to the free Eko App gives clinicians the ability to visualize, record, save, and share heart sounds. These functions are useful for hearing low grade heart murmurs, getting a second opinion on irregular sounds, education, and telemedicine. The Eko CORE is available in two models. $299, the Eko CORE Digital Stethoscope is a complete stethoscope $199, the Eko CORE Digital Attachment can digitize a traditional stethoscope from manufacturers such as 3M Littman, ADC, and Medline Who uses Eko Stethoscopes? The Eko CORE is used by over 10,000 clinicians at 1,000 institutions around the world. The sound amplification and bluetooth connectivity are helpful for clinicians with hearing loss or patients that are difficult to auscultate. Medical and nursing schools are adopting Eko as an intuitive learning tool. Finally, Eko is expanding telemedicine programs with cardiology-grade live streaming of heart and lung sounds. FLASH SALE This special 30% off offer - only available to allnurses.com readers - expires September 30th, 2018. Use the promo code allnurses to get 30% off your order today! Click Here to Purchase
  11. Disposable gloves have long been a mainstay of required equipment for the protection of healthcare workers and patients. In many perioperative areas, surgical tasks require the use of double-gloving. Ansell developed the GAMMEX® PI Glove-in-Glove System™, the world's first pre-donned double-gloving system featuring pre-donned outer and inner gloves allowing quick and easy double gloving with a single don. Features and benefits include: Semi-transparent outer glove over a green under glove allows quick and easy breach detection Ability to don 2 pairs of gloves with one don in half the time of the traditional double gloving with 2 dons Non-latex Saves time Cuts down on waste For more information see the GAMMEX® PI Glove-in-Glove System™ Product Overview in the allnurses Product Directory. If you have used this product, please leave a review in the Directory.
  12. Pam Robbins graduated in 1978 from the St. Joseph School of Nursing. She went on to work at Provena St. Joseph Hospital from 1979 until 2002 when she was unlawfully terminated from her position there. Pam, who states that she has always been interested in nursing policy and political activism, was elected as co-chair and then chair of the Illinois Nurses Association and served as the collective bargaining unit, developing contract language, for registered nurses at the Medical Center. During that time, Pam utilized her opportunity to complain about inadequate staffing numbers which lead to delayed treatment of patients. She asked fellow nurses to record staffing shortages and delay in treatment as well. During the investigation process, Pam helped to organize nurses and their stories in discussions with Administration at the Medical Center, The Illinois Nurses Association union, and legal personnel. As a direct result, the Medical Center terminated several nurses including Pam herself. She filed a lawsuit against the Medical Center in violation of the anti-retaliation provision of the False Claims Act. Pam won this lawsuit and then began to follow a different career path which allowed her to focus on her passion. Pam Robbins has made it her mission to educate and encourage nurses to become politically active as "nurse constituents advising their legislators on how to vote regarding healthcare policy". In following this mission Pam remained active in her local and state Nurses Association. She has been lobbying legislation in support of nurses for decades. She was elected President of the Illinois State Nurses Association. She was hired by the Illinois Nurses Association as Practice Director and Lobbyist. She went on to obtain her Master's Degree in Nursing in 2013 from the University of St. Francis in Joliet, Illinois. She works as adjunct faculty for Millikin University educating graduate nurse anesthetist students on Healthcare Policy and Politics. Pam has a passion for nurse political advocacy and notes that nurses are not educated until the Master's Degree level on this. She believes it should be taught at a much earlier stage in our education. She has been a consummate force to educate nurses about safe staffing and creation of protocols to maintain staff and patient safety. Pam encourages nurses to become political advocates using 3 steps. 1. Know this Issue at hand. Educate yourself on safe staffing ratios, if that is the problem in your state or hospital. Know what the laws say and dictate. Know what hospital policy and the Board of Nursing in your state dictates. 2. Know your state legislator. Find out who your state legislator or running official is. 3. Know how to educate your state legislator through sharing what happens during your workday. Educate regarding problems and perceived threats to the safety of nurses or patients. Understand that legislators do not know what we know. They are not at the bedside and do not provide the care of patients. We are responsible to educate others about our profession and its gaps. In promoting this, Pam has partnered with the Show Me Your Stethoscope Foundation in supporting several rallies for safe staffing and nurse safety. She was an active organizer and Keynote speaker in the NursesTakeDC 2018 Rally in Washington DC and has teamed up with several nursing "forces" to empower nurses to put their "white caps" in the political advocacy arena. So, how does one voice become the strength and voice for so many of us? Educate yourself and others! Spread the word! Be heard! Be strong in supporting what is right for ourselves and our patients! Know that nurses matter! Thank you, Pam, for all that you have done for our profession over the past 3 decades! The allnurses team was very happy to meet and talk with you at the 2018 NursesTakeDC Rally. Thank you for sharing your experiences and knowledge at the Legislative Educational Session you led to help empower nurses to become political advocates and take action that will promote changes for the betterment of the nursing profession. Thank you for your driving force...thank you for your passion and perseverance! Pam used this as part of her session... [video=youtube_share;RWzl2goKo8c]
  13. Meet Theresa Puckett If you do a Google search for "nurse fired for being sick" you will be inundated with articles about Theresa Puckett, PhD, RN, CRCP, CNE, a nurse from Northeast Ohio who found herself terminated after a legitimate bout of the Flu during one of the worst Flu seasons our country has seen. According to an article in Becker's Hospital Review, Theresa worked as a PRN Nurse at University Hospitals, based in Cleveland. She called in sick one day at the end of December 2017 with flu symptoms. Theresa visited a physician and tested positive for the flu virus. She was treated with Tamiflu and ended up missing two days of work. Her physician provided a note excusing her from work for these days. She returned to work a few days later and was instructed by a supervisor to leave early due to continued illness. The next day, she saw a Nurse Practitioner who diagnosed her with a sinus infection and provided her with another note stating she should not return to work for a few more days. However, returning to work was never an option for Nurse Puckett because she was terminated. You may be thinking - How does that happen? According to the University Hospitals statement to Becker's Hospital Review, they allow six unscheduled absences for full and part-time staff within a 12 month period, and nine absences may result in termination. For "as needed" or PRN staff, two occurrences of unscheduled absences within a 60-day period may result in termination. Because Theresa returned to work for one shift in between her two absences, this counted as two occurrences and qualified her for termination. Presentism versus Absenteeism If you have ever gone to work sick, raise your hand. As hands of nurses around the world are raised high, let's discuss the reasons we've all done it. To really understand both sides of the issue, you need to understand the difference between absenteeism and presenteeism. Absenteeism is the practice of staying home from work or school when you are ill. Of course, there are other reasons people call off, but for this article, we are only exploring this issue concerning illness. So, what's the opposite of absenteeism? Presenteeism - the act of going to work when you are ill. Nurses have high standards for themselves and the care they provide to patients, even when they are ill. A 2000 study by Aronsson, et al. reported that rates of presenteeism were highest among nurses and teachers. But, we know that presenteeism may result in adverse patient outcomes, poor nurse health, and cost consequences. So, why is it so difficult to take a sick day? Let's consider a few of the most important factors when deciding which side of the issue you support. The Team Needs You Your throat is on fire, your head feels like a giant elephant is jumping on it and crawling back into bed sounds like the best possible plan - but, you know your teammates need you. You don't want to let others down. Staffing on many units is kept to a minimum so even one call off could cause your co-workers to take on larger assignments, be in unsafe situations, or be upset with you for calling off. A February 2018 article by News 5 Cleveland quoted one nurse as saying "Nurses are often commended for coming into work sick, so they don't put their comrades at a disservice for being understaffed." It seems the issues of teamwork, loyalty, and service is a double-edged sword on nursing units. Patients Need You Nurses spend more time with patients than any other healthcare professional. You recognize minor changes in assessments and notify physicians. Yes, the doctors diagnose and order new treatments, but it's the nurses who carry out these orders that are often life-saving treatments. A 2015 study published in JAMA Pediatrics explored the reasons physicians and advanced practice nurses work while ill. While 95% of the respondents believed working while sick put patients at risk, 83% reported working at least one time in the prior year while sick, and 9% reported working while ill at least 5 times. Symptoms reported in this study included fever, diarrhea and acute onset of respiratory symptoms. 92.5% of these clinicians cited not wanting to let patients down as one of the reasons they headed to work with these signs of illness. So, as you lie in bed contemplating calling in - that's what runs through your mind, right? Without you - who will care for your patients? And, what if you are not the only one with this dreaded illness? So, off to work you go. Sick Time Policies Are sick time policies created to protect or punish you? This is a hard question to answer. And, it often leaves nurses faced with difficult decisions that end in absenteeism or presenteeism. Let's explore a few sick time policy practices. Forfeiting Pay Some call-off policies will withhold pay from nurses if you call off at specific times. This might mean that calling off the day before a holiday will result in forfeiture of holiday pay. Or, if you call off on your last scheduled day before a planned vacation or on your first scheduled day after a planned vacation - you forfeit vacation pay. In a world where many people live paycheck to paycheck, this policy might result in nurses putting themselves and their patients at risk to keep pay that many would argue is rightfully yours. You can't plan illness, so if you are sick around these specific time points, what are you to do? Unexcused Absences Most policies give a number of 'unexcused" absences allowed over a period of time, such as 12 months. Typically after missing this number of days, you will be reprimanded. You may also be given a specific amount of time, such as the remainder of the year or 90 days, in which you must not miss any more work. Of course, if you end up legitimately ill during this time, you are probably going to go to work or risk disciplinary action. No Sick Pay Nurses who work a limited number of hours per week or prn often have no sick time. This leaves you making financial decisions in the face of illness. Or, your policy may require you to use vacation time before using sick pay. This may seem counterintuitive given the fact that nurse burnout and fatigue runs rampant on many nursing units and days off are necessary. Physician Notes Some sick policies require a physician's note for any unplanned absences. Others might state that no MD note is necessary because all unscheduled absences are unapproved. Or, you may also find policies that require a doctor's note after a certain number of days, which may be due to the Family Medical Leave Act. No matter what your policy reads in regards to doctors notes, you need to understand it before you need to use it. Be sure to get notes when they are required to remain compliant with your facilities policies. Termination Almost all sick policies will lead to termination as an end result. And, when such procedures are executed the same across the board, most nurses find these policies to be acceptable. However, when these policies are not carried out consistently, you may feel that they are being used against you or other staff on your unit to force your hand at finding a new job. Some of the allnurses team met Theresa at the NursesTakeDC rally earlier this year. Nurse Beth was able to interview Theresa and learn more about her ordeal. Thank you for sharing with us, Theresa. What are Your Thoughts? So, where does all of this leave you? Do you stay home when ill or head to work in an attempt to avoid discipline, even when you know it is not best for you or your patients? Now it's time for you to decide. Tell us your thoughts and experiences with nurse absenteeism, presenteeism, and termination.
  14. Julie Godby Murray, RN has over 40 years in healthcare and is currently an OR nurse in Michigan. She has been instrumental in developing the Nurse Honor Guard. This is a ceremony that takes place to honor a nurse's service to her patients, community, family and friends. As Ms Murray states, "It's so healing for the families. Families know what we go through. The families are very touched." She further explains that the Honor Guard wears a white dress, cap, cape, and they carry a white rose that is placed on the casket to symbolize the caring that a nurse does during her lifetime. This is a ceremony that takes place to honor a nurse's service to her patients, community, family and friends. As Ms Murray states, " Its so healing for the families. Families know what we go through. The families are very touched." She further explains that the Honor Guard wears a white dress, cap, cape, and they carry a white rose that is placed on the casket to symbolize the caring that a nurse does during her lifetime. Here is an example of a Nurse Honor Guard ceremony. Taking their cue from military honor guards with a tradition of honoring fallen military comrades via a ceremonial tribute, the Nursing Honor Guard provides this tribute for nurses who have died. Julie, who is also the union steward for over 500 nurses in a Michigan hospital system provided some more information about what a Nurse Honor Guard does: Attend all services wearing the traditional white uniforms with cap and cape Stand guard at the nurse's casket or simply provide a presence at the visitation. Recite "A Nurse's Prayer" at the funeral or during a special service Present the Florence Nightingale lamp to the family. Place a white rose on the nurse's casket at the end of the service, which signifies the nurse's devotion to his or her profession. Julie has been a driving force in the further development and spread of the Nurse Honor Guard. From the east coast all the way to the Kenai Peninsula in Alaska, you will find Nurse Honor Guards ready and willing to pay tribute to their fellow nurses. Julie is willing to help and has assembled many tips on her organization's FaceBook page; OPEIU Nurses Honor Guard. Julie was also one of the invited speakers at the 2018 Nurses Take DC. She encourages nurses to legislate for adequate nurse-patient ratios. She stated, "Our hospital has the same staffing ratios that California has and our ancillary personnel are figured into this. We need them too!" She went on, "We have the power, lets do this together." She closed her discussion with this quote from Alice Walker, "The most common way people give up their power is by believing they don't have any." [video=youtube_share;22nbfekuGCE] References: Alice Walker, Author of the Color Purple
  15. Who Knew Wearing a "Doctor's Stethoscope" Could be the Start of Something BIG? Little did Janie Harvey Garner know at the time that the Miss America Pageant in 2015 would change her life forever. A nurse by profession, Miss Colorado, Kelley Johnson got on stage during the Miss America Pageant that year and gave an engaging and touching monologue about a particular nursing experience. She wore scrubs and a stethoscope during that monologue. By the next morning, Kelly Johnson was in all the news getting lambasted over her monologue while wearing a "doctors stethoscope"...as if there is such a thing as a doctors stethoscope. Janie Harvey Garner, an emergency room nurse at the time, had had enough. Personal Story Before we get into what Janie did with the frustration over the lack of understanding of what nurses do, let's discuss her personal story. Janie received her Associates Degree of Applied Science in Nursing from St. Louis Community College. She is a former United States Navy Hospital Corpsman. Janie has practiced nursing in the Intensive Care Unit, Emergency Room, Cardiac Catheterization lab, SANE, and Cardiac Electrophysiology lab (where she continues to work today). While working in the Emergency Room in 2011, her life took a tragic turn when Janie and her husband Paul lost their oldest son in an unfortunate accident. She was so grief-stricken that she felt she had to leave bedside nursing (in particular Emergency Room nursing) and move to a desk job. At one point during her grieving process, Janie found herself sitting in her car with a syringe full of insulin, ready to end her life. She remembers thinking that her son would not have wanted this for her. He would not have wanted her working behind a desk, he would want her to continue helping others as a nurse. So she put the syringe down and joined the nursing profession bedside yet again. SMYS - The Beginning Fast forward to Janie working again in the ER, catching an episode of "The View" where Miss Colorado was being raked over the coals so to speak for her monologue about a special time in her career as a nurse. Janie decided after seeing the media's negative response to Miss. Colorado's "talent" of nursing, that she would create a Facebook page showing support for Kelly Johnson and the nursing profession as a whole. Being from Missouri, the "Show me" state, she named her page "Show Me Your Stethoscope". She invited her colleagues to post pictures of themselves showing off their stethoscopes. Janie thought she would have maybe 50 or so of her ER colleagues joining in but by bedtime over 50,000 appeared with over 100,000 by the next morning and an additional 20,000 more during her morning commute. Just a week after forming Show Me Your Stethoscope, Janie had over 800,000 followers and the site has been successful ever since. We've Come a Long Way Janie Harvey Garner is now the Executive Director of Show Me Your Stethoscope (SMYS), the nonprofit online facebook "platform of solidarity for nurses", as the website states. Janie has stated that she believes "the biggest problem we have as nurses is a lack of unity in health care; division equals strife and unrest" The website is all encompassing of nurses, from students to the most seasoned veterans, all degree types, genders, areas of practice etc. are welcome. The Show Me Your Stethoscope Foundation, a 501 © 3, was formed to "globally empower nurses and healthcare workers to educate the public of their rolls." SMYS now, among many services, supports medical missions in a number of countries through service and donations (including donated stethoscopes). Giving Nurses a Voice As nurses, we need to take note of the impact that one voice can make. In 2015, Miss Colorado, Kelley Johnson's monologue inspired Janie Harvey Garner to find her voice in creating one of the largest nurse-run online communities. The number of nurses reached and empowered to find their voice though Show Me Your Stethoscope is further proof of the power of each voice. Janie's vision has grown into the desire to educate, support, and give back to the world. Whose voice will Janie's inspire.......? Some of the allnurses team met and talked with Janie when we traveled to Washington DC to participate in the Nurses Take DC Rally in April. It was a very busy time in DC, however, Nurse Beth was able to grab Janie for a short interview that was conducted just outside the networking exhibit hall as part of the rally. [video=youtube_share;_KmjqYx0mCw]
  16. NursesTakeDC had one purpose: to support the Federal Legislation for National Nurse-to-Patient Ratios S.1063 & H.R.2392 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. These bills support mandated nurse to patient ratios. Doris Carroll, BSN, RN-BC, CCRC is one of the faces and organizers of NursesTakeDC. She is also the Vice President of the Illinois Nurses Association and she is an administrative nurse at the University of Illinois Hospital and Health Sciences System. At the recent NursesTakeDC rally in April, where nurses gathered in the Nations' Capitol to advocate for safe nurse-patient ratios, Nurse Beth from allnurses. com talked with Doris Carroll who stated, "It's time we do something. We need to take charge of our profession. Some of our nurses have 3 and 4 patients in the ICU... Nurses need to understand that we are so powerful at almost 4 million strong across the country, yet we can't seem to unify around the most dangerous part of our jobs which is unsafe staffing. What we want to do is empower nurses. This movement is comprised of both non-union and union nurses. It doesn't matter where you come from or what kind of nurse you are. What matters is that you do and say something to change things. is not just about nurses, it's about our patients. We must let the public and legislators know that patient acuity ratios affect patient outcomes." Nurse Beth, who is from California stated, "Some of these ICU nurses have 3-4 patients. This is unheard of in California where we've had nurse ratios for 14 years. What would you advise nurses to do?" Doris responded, "Find out who your senators are - talk to them about acuity-based nursing ratios in language they can understand. Relate it to their family - I might not be able to get to their Mother or Father in a timely manner when they need help; when they cry out for pain medication or if they fall on the floor. Encourage your legislators to co-sponsor nurse ratios laws." She went on, "It doesn't matter whether you are union or non-union, we want our patients to be safe. Educate other nurses that acuity-based ratio staffing will help the nurses to remain at the bedside caring for patients." Currently 14 states have staffing ratios: 7 states require hospitals to have staffing committees responsible for plans (nurse-driven ratios) and staffing policy - CT, IL, NV, OH, OR, TX, WA. CA is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. MA passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient. MN requires a CNO or designee develop a core staffing plan with input from others. The requirements are similar to Joint Commission standards. 5 states require some form of disclosure and / or public reporting - IL, NJ, NY, RI, VT Nurse-patient ratios are an extremely important issue for nurses as well as patients. Improving safety and reducing errors as well as improving job satisfaction are all tenets of nurse-patient ratios. In 2014, the Robert Wood Johnson Foundation cited a statistic that almost one out of five new nurses leave their first job within the first year of gaining licensure as a nurse. If that is not worrisome enough, one out of three leaves the profession within two years of beginning their nursing career. Medical errors are the third leading cause of death in the US. Patient safety is the most important reason to improve and mandate nurse-patient ratios. In order to reduce patient errors, there needs to be more nurses at the bedside. One study found that for every one additional patient added to a hospital staff nurse's workload is associated with a seven percent increase in hospital mortality. A study published in 2014 in the Lancet showed, "An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%." Doris Carroll concluded, "We are educated and professional and we care about our patients." Thanks to Doris Carroll and Nurse Beth for their informative interview. Now...we all are being tasked to talk to the public and our legislators. [video=youtube_share;5H2LCDSuEPY] References: ANA - Nurse Staffing Nearly One in Five New Nurses Leaves First Job in One Year Nurses Take DC Position Paper Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study Third Leading Cause of Death Doctors
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