km rn

I think what we can do about it is educate ourselves and others about the stagnation of wages issue in nursing. Yes the starting wage in many areas seems comparable...but a nurse's wage will quickly stagnate. My non-nursing friends were shocked to hear how much I made compared to a new nurse. They assumed if new nurses received such a good wage..it meant I must really be making big bucks. Although this may not be the biggest issue regarding retention of nurses...it is one factor that should be addressed. It is cheaper for hospitals to keep hiring new nurses and importing nurses than trying to keep existing nurses - Why? Health insurance costs vary significantly dependent on the ages of your employees as well as the costs of benefits for someone who has over 5 years of employment. I believe most hospitals see it as a cheaper alternative to keep hiring nurses (money on recruitment) rather than focus on retention. I have also found that most non-acute hospital employeers expect you to take significant wage cuts yet they want you to bring the experience and knowledge base earned by working in an acute care setting. They don't want to pay you for your experience and knowledge but mandate that you bring them.

Government statistics regarding nursing salaries. October 2002 Nursing salaries overall have remained STAGNANT in the past 10 years. Nurse's actual earnings have increased steadily from 1983 - 2002 BUT "real earnings" have been FLAT since 1991. (real earnings = money available after adjusting for inflation) Average Annual Salaries of RNs versus "Real Earnings" 1984 annual salary = 25, 064 Real Earnings = 22, 063 1990 annual salary = 29, 588 Real Earnings = 23,861 1995 annual salary = 35,146 Real Earnings = 23,711 2001 annual salary = 41, 060 Real Earnings = 23, 409. Futhermore....much of a nurse's wage growth takes place early and TAPERS off with time. New grad Nurse 5 years experience: makes 15 to 17% more than newgrad. Nurse 15 - 20 years experience: 16 to 20% more than new grad. Secretary Thompson points out that nurses' salaries are actually BEHIND those of another perceived low income group - elementary school teachers. Nurses' salaries are falling futher behind each survey period. 1984 Elementary school teacher = 25,000 1984 Nurse = 19,000 (4,400 less per year) 2001 Elementary school teacher = 54,800 2001 Nurse = 41,000 (13,800 less per year) Now please don't make this into a teachers versus nurse war - both groups have difficult jobs. However, I believe the teachers have done a much better job educating the public about their salary issues. Source: Government Statistics regarding Nursing Salaries October 2002 Contemporary Long Term Care In addition, the salary for a nurse varies significantly dependent on area of country and area of practice (hospital versus non-acute). I get very frustrated when I hear that nurse get very high wages - it needs to put into the right context.

It is not so much the starting wage in nursing that is horrible - it is the fact that your salary will stagnate and you will forever be making within 1000 - 3000 dollars more than a new graduate. The starting salary seems reasonable - I started at the same wage as many of my friends in non-nursing jobs...however now 19 years later - their wages are double to triple mine and their benefits have also increased. Any 1 - 2% pay raise I make is eaten up by my having to spend more money on my health insurance etc. During this last year, congress discussed the stagnation of nursing pay and compared it to teacher's pay. Both are predominately still female professions, yet the teachers did not have the same stagnation of salary issues. Teachers have received a lot of media attention towards their salary woes and it has done some good - less stagnation...yet neither teachers or nurses receive adequate compensation. I'll try to find the web link to the study...it was fascinating and helped educate me regarding stagnation of salary issues.

The information was in an article in Contemporary Long Term Care Magazine from 10/02. However, it was Secretary Thompson of HHS who made most of the comments and it might carry more clout if you could get it from the Congressional Record. I believe Secretary Thompson has testified re: nursing shortage and salary issues r/t it. Senator Cliniton has also shared the stagnation of nursing salaries as one problem with retainment of nurses. I can't remember the name of the article but I know it was Oct 2002 Contemporary Long Term Care - the article had to due with retention of nurses and the nursing shortage. Good luck with your negociations - I believe that we can more effectively educate the public about the salary stagnation!

Actually it wasn't meant to start a teacher/nursing war. Secretary Thompson was pointing out that most people are aware of the inequity of teacher's wages...however, very few people are aware that nurses are struggline also. I agree with should make comparisons with engineers, and other 4 year male wage professions. We have to make the public aware of the wage stagnation - most people I've run into think nurses are highly paid. I think it is vital that we become aware of what our wages/benefits are compared to other professions. It was an eye opener for my brothers to learn how my wages have basically plateaued (?sp) where their wages continue to increase as their experience increases. Both my brothers are engineers - civil and geological. My hope is that we will effectively be able to advocate for our profession.

The following are government statistics from October 2002 Contemporary Long Term Care. They represent average national salaries. Nursing salaries overall have remained stagnant in the past 10 years. Nurse's actual earnings have increased steadily from 1983 - 2002. However, "real" earnings have been flat since 1991. (Real earnings = money available after adjusting for inflation). Secretary Thompson points out that nurses' salaries are actually behind thos of another perceived low income group - elementary school teachers. In addition, nurses' salaries are falling further behind each survey period. 1984 Elementary school teacher average salary = 25,000. 1984 Nurse average salary = 19,000. Nurses averaged 4,400 less per year. 2002 Elementary teacher average salary = 54,800 2002 Nurse average salary = 41,000 Nurses averaged 13,800 less per year. Furthermore much of a nurses' wage growth takes place early and tapers off quickly. A nurse with 5 years experience makes about 15% more than a new graduate but only 1 - 3% less than a nurse with 15 - 20 years experience. 1984 -- annual salary for nurse = 25,064 1984 -- "real" salary for nurse = 22,063 1990 -- annual salary for nurse = 29,588 1990 -- "real salary for nurse = 23,861 1995 -- annual salary for a nurse = 35,146 1995 -- "real" salary for a nurse = 23,711 2001 -- annual salary for a nurse = 41,060 2001 -- "real" salary for anurse = 23,409. A lot of the public I run into believe that nurses are very high paid - they have no concept of the stagnation of salaries that we live with. Teachers have effectively educated the public regarding their low pay but as nurses we have been less effective. Notice how your "real" salary has been 23,000 since 1990. The stagnation of wages has a lot to do with retention of nurses. I always inform people considering nursing of the salary issues - I continue to be amazed how my friends in non-nursing have greatly surpassed my income - but they are in business, engineering and accounting ...mostly traditional male roles whereas nursing/teaching is still considered a female profession. Please comment - are you surprised by these numbers?

I've only refused to float to a specific unit once. Instead of forcing me to go to that unit - I was pulled to another. I was working SICU and they wanted to pull me to the Bone Marrow Transplant Unit where I would have a full patient assignment. I found out from one of the hospital's pool nurses that pool nurses couldn't float there until they had orientation to that unit so I refused based on that. At that same hospital I was floated to Neuro floors, ER, Rehab Unit, Cardiac Step down, Urology, etc... One of my friends got floated to Labor and Delivery. Unfortunately, where ever you went you were expected to take a full patient assignment and sometimes got the worst assignment because you were the ICU nurse and should be used to very sick people. We also never had anyone float to our unit but critical care float pool nurses and on a couple of occasions a Medical ICU nurse got pulled. We always gave those nurses the easiest patients and kept checking to see if things were okay. So...I would refuse to float to certain areas espicially if the expectation is you take a full patient load OR if you know float pool nurses in that hospital receive additional trainging before floating to that unit. Good luck! It usually can't be considered patient abdonment unless you have accepted the assignment.

Please check into why the catheter is being changed every month. We no longer change catheters every month - it increases the risk of infection. We change catheters if we need to get a urine culture, if the catheter feels granuley or it there are any concerns with blockage, etc. Frequently patients and families are taught to self-cath or catherize using a "clean" technique. Overall these patients seem to do quite well. There would be a different standard of care expected from a licensed professional than a lay person. Call the agency and discuss your concerns with the DON.

Actually it sounds like you are doing well - we usually have 1 nurse for 24 residents and 3 aides. So you are carrying a heavier load then we are.

We need to get the stagnation of pay issues out to the forefront of the nursing shortage issue. It is not unusual or surprising to find nurses who have worked at a facility for years to be making slightly more or the same wage of a newly hired, inexperienced nurse.

1400 every 2 weeks, I am an RN working in a nursing facility as a QI Nurse/Nurse Manager. I have been a nurse for 18 years. Believe me - you pay stagnates the longer you've been a nurse and the longer you've been out of the hospital. Wage stagnation coupled with not retirement fund like police officers and fire fighters are two additional reason to not become a nurse.

Our staffing is as follows: Days: 2 nurses and 6 CNAs for 48 residents PMs: 2 nurses and 6 CNAs for 48 residents Nights: 1 nurse and 2 CNAs for 48 residents.

How about looking at the 6am meds and weeding out the ones that should be given at a later time. I agree that it is very hard to get resident awake and in proper positioning for swallowing pills. So....I would ask that everyone focus on getting rid of some of the 6am meds, discontinuing some, etc. Good luck.

Thanks for your kind replies! Our state survey agency believes that every regulation demands perfection. As such, they cite anything they see regardless of what you can show them from a QI perspective. They say that although you will be cited, the severity will be low, hence...you shouldn't care. However, they narrow the population to increase the scope of the problem whenever they can. It is frustrating to live in a border city and know that the facility 5 miles away in another state would not be cited for the same issues. Our state believes that they are doing everything correct and the other states are under-citing.

I agree Hepatitis presents a bigger threat than AIDS, etc. However, also look at disability issues - neck, back, shoulder, etc. injuries disable many nurses every year. Recognize the risks and do what you can to protect yourself - standard precautions, pre-shift stretching exercises, etc.

We had our annual Medicare/Medicaid Certification Survey last week. The survey team cited 278 - Accuracy of assessments because 4 items were coded incorrectly. 3 residents were involved. ERROR #1: Resident A used full side rails but it wasn't coded under the restraint section P4a instead was coded correctly under G6b. ERROR #2: This same resident had P1o checked since she was a hospice patient but staff neglected to check J5c. ERROR #3: Resident B had P1o checked since he was a hospice patient but staff neglected to check J5c. ERROR #4: Resident C used a chair that prevented rising on 2 occasions during his assessment period, but staff failed to code this under P4e. I am upset - the survey team expects perfection in MDS coding - they could not identify any outcome related to this miscoding, but stated the regulations demand 100% perfection. My calculations were that 7500 boxes needed to be completed for residents A, B, C, D and E during the last 3 quarters. The survey team found 4 items miscoded out of 7500 - an error rate of 0.5%....less than 1%! Our facility completed 354,048 MDS boxes during this period - it is inconceivable to me that the survey team expects perfection in this area! Have your survey teams taken this hard core stance? PLEASE let me know if this seems reasonable to you or if you have experienced a similiar problem with the survey team. HELP>>>HELP!

I work in a 192 bed facility. However, there are 4 units in our facility On day shift and pm shift, each 48 bed unit is fully staffed with the following direct care staff: 2 charge nurses, 6 CNAs, 1 Transport Aide (transports residents, makes beds, passes water, etc.) and 2 nurses. When we are critically staffed - the CNA number drops to 5. Most units split up so 3 staff work on the north side and 3 on the south side. Of that group of three - one person usually completes the residents who need one CNA for the majority of their cares, the other two CNAs work as a team to complete residents who are more heavy care in nature. When we have 5 CNAs - the 5th CNA floats to both sides and helps with the residents who need one person assist or are lighter in care. We used to assign CNAs to a group of residents, but have found that this modified team approach work well - the CNAs feel comfortable working with different residents rather than being fixated on working with 1 group of 8 residents only. Luckily, we only have 3 CNA openings right now. We are struggling with filling nurse positions (4 open positions) - a third major hospital opened in our area, plus the VA, psych hospital, etc. drain the nurse pool.

I hate this topic - I know how hard it is to get away for a decent break and how easy it is to run...run....run...and need water to help you function better. Unfortunately, OSHA has taken a very rigid stance on this issue in my state. It sounds like from other posts that JCAHO, infection control issues also prohibit this. I have avoided dealing with this issue at our facility - I feel we have bigger issues to focus on right now - so we have mentioned OSHA's standard to staff but have taken no definitive action. good luck!

Yikes...what an awfull way to spend your work days - afraid of the spy. I also work in long term care - I am the QI Coordinator for 192 bed facility. It is too bad your administrator has become sucked into this "spy nurse's web". What does your DON say - does she also beleive spy nurse? Another option rather than leaving is perhaps filing a grievance with your Human Resource Dept/person. Your facility should have an internal procedure to follow for grievances. Clearly the nurses falsly accused can find supportive documentation/witnesses to clear them. It sound like this "spy nurse" is causing a "Hostile work environment" - look in your personnel policy manual to see if this meets your facility's requirements. I am worried that you are being asked to work triple shifts - that is not safe for your, residents or your facility. Your DON should never ask you work a triple. We occasionaly have a nurse who works 16 when the next shift's nurse calls in sick and we can't find a replacement but usually can split the shift into a 12 hour shift. We also look at finding a replacement for the nurse so they don't have to work days/pm then work days the next day. Will the other nurses/CNAs join you in filing a grievance or hostile work environment report? Have all the nurses gone to the DON and requested a meeting with spy nurse to discuss the issues? I am baffled that your administrator and DON would encourage this type of behavior by spy nurse. Encourage the nurses that feel spy nurse has lied to file grievances - in our facility Human Resources would have to investigate the situation. The hostile work environment and grievance option both entail hard work, stress and risk on your part - I don't know if it will pay off for you or not. I hate to think that you will become spy nurses' next target, yet I understand how hard it is to leave your residents. However, leaving might be the best option. Yikes - if you decide grievance, hostile work environment and they don't work, you can consider sending letters to your facility's board of directors. However, it is far easier to walk away. Good luck - none of your options look wonderful!

My biggest problem with nursing is stagnation of your salary. I started nursing in 1984 at $12.00 per hour. I thought this was a fair wage - it seemed midline between what my nursing and non-nursing bachelor degree friends made. Now in 2001, I make $19.00 per hour. 17 years of experience is worth little more than inflationary increases. My non-nursing bachelor degree friends have doubled or tripled my current salary. So, my expectation would be to have experience recognized and rewarded. How many excecutive director/CEOs would take this - they demand adequate compensation for the ?work they do. 50% raise would be ideal. 35% would be minimal. Thanks for the interesting topic.

Thanks for your replies - any additional replies, responces would be appreciated. The terry cloth like coverups we use work well BUT it looks and feels so institutionalized. Even residents who eat independently and never spill want to wear them - because if John Doe has one ...I need one too. It becomes part of the culture. What kind of things are you doing to make dining less institutional and more home-like in your facility? Do any of you serve the formed pureed food - or do you serve mounds of brown, mounds of tan and mounds of orange purred food on a plate? Please respond! We are also looking at changing our meal times. Most of our new residents want to sleep in - they are getting up at 7:30, 8:00 or 9:00am. Are you also seeing a trend of residents wanting to sleep in and wanting a lighter breakfast - toast/coffee?

Parkinsons, COPD, CVA, Arthritis, CAD, Osteoporosis, Orthostatic Hypotension, Anxiety Disorders, Quadriplegia, Depression, Bi-polar Disease, Depression, Asthma, Macular Degeneration, Glaucoma, Pneumonia. I hope you enjoy your long term care experience - long term care lets you use not only physical assessment skills but also leadership skills. Enjoy and Best Wishes!

Parkinsons, COPD, CVA, Arthritis, CAD, Osteoporosis, Orthostatic Hypotension, Anxiety Disorders, Quadriplegia, Depression, Bi-polar Disease, Depression, Asthma, Macular Degeneration, Glaucoma, Pneumonia. I hope you enjoy your long term care experience - long term care lets you use no only physical assessment skills but also leadership skills. Enjoy and Best Wishes!

JCAHO is a voluntary accredidation agency - hospitals etc. pay money for the luxury of being surveyed by JCAHO. I agree with the others - it is very easy for focus on paperwork compliance - it is far more tidy, there is less chance of identifying any substantial issues, and the paperwork is far easier to manipulate that what a person actually observes. I spent 7 years working in a SICU - when JCAHO came around ...only the managers lived in fear. We saw very little of JCAHO - they were too busy with paperwork to explore life in the trenches. That was wrong - they choose to stick with the paperwork because if they explored the trenches, they would discover problems. My next job was working for my state's Health Department. Although I was hired to survey hospitals and nursing homes, the regulations are set so that hospitals are very infrequently surveyed. The nursing home survey focused on observations of care, interviews with residents and families, observation of medication passes etc. During my 2 years of employment, we surveyed hospitals only twice - both times the focus was soley on Policy/Procedure Manuals and an environmental tour. The state is mandated to survey a certain percent of JCAHO hospitals to ensure JCAHO is conducting honest evaluations and not being swayed by money, perks, etc. But hey - the focus of both is on paperwork compliance. So frankly, I don't think JCAHO will care if they get complaints re: staffing from nurses, etc. Their response will be to have each hospital develop a staffing protocol for their hospital - you can imagine how management's version of how many staff are needed compares with how staff see the minimum number of staff. In one of the hospitals I worked we had "acuity based staffing" - the only time managment used it was to pull nurses from the SICU to the floor - "Acuity staffing states you have 5 more nurses than you need - send them to these floors". When the acuity staffing indicated that we needed six nurses to provide safe care - we heard " We can send you 1 nurse that is the best we can do". Sorry for the cynical point of view. But how long do you think that hospitals would continue to utilize JCAHO accredidation if JCAHO started to explore actual patient care, the impact of inadeqate staffing, etc. JCAHO knows who pays their fees - the hospitals.

JCAHO is a voluntary accredidation agency - hospitals etc. pay money for the luxury of being surveyed by JCAHO. I agree with the others - it is very easy for focus on paperwork compliance - it is far more tidy, there is less chance of identifying any substantial issues, and the paperwork is far easier to manipulate that what a person actually observes. I spent 7 years working in a SICU - when JCAHO came around ...only the managers lived in fear. We saw very little of JCAHO - they were too busy with paperwork to explore life in the trenches. That was wrong - they choose to stick with the paperwork because if they explored the trenches, they would discover problems. My next job was working for my state's Health Department. Although I was hired to survey hospitals and nursing homes, the regulations are set so that hospitals are very infrequently surveyed. The nursing home survey focused on observations of care, interviews with residents and families, observation of medication passes etc. During my 2 years of employment, we surveyed hospitals only twice - both times the focus was soley on Policy/Procedure Manuals and an environmental tour. The state is mandated to survey a certain percent of JCAHO hospitals to ensure JCAHO is conducting honest evaluations and not being swayed by money, perks, etc. But hey - the focus of both is on paperwork compliance. So frankly, I don't think JCAHO will care if they get complaints re: staffing from nurses, etc. Their response will be to have each hospital develop a staffing protocol for their hospital - you can imagine how management's version of how many staff are needed compares with how staff see the minimum number of staff. In one of the hospitals I worked we had "acuity based staffing" - the only time managment used it was to pull nurses from the SICU to the floor - "Acuity staffing states you have 5 more nurses than you need - send them to these floors". When the acuity staffing indicated that we needed six nurses to provide safe care - we heard " We can send you 1 nurse that is the best we can do". Sorry for the cynical point of view.