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Bridgid Joseph BSN, MSN, APRN, CNS

Surgery,Critical Care,Transplant,Neuro
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Bridgid Joseph is a BSN, MSN, APRN, CNS and specializes in Surgery,Critical Care,Transplant,Neuro.

I am a CNS for Emergency Cardiovascular Care, I have been a SICU/Trauma SICU RN for 10 years prior to this role, and have a lot of experience with Neuro and Solid Organ Transplant patients.

Bridgid Joseph's Latest Activity

  1. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    Acessible means that people have access to care when they need it, without two day waits in the ED waiting room, to a hospital not hours from their home. I am not incorrect, I have posted the site that I obtained the statistics from numerous times. It has nothing to do with money; MA self insures more residents than most states, we always have been on the forefront of universal access to healthcare. I am in no way worried that my hospital will close....
  2. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    Daisy- once it passes there is little room for change; what most people don't understand is the fact that there have been a multitude of options for improvement of the bill sent to the ANA who is pushing this bill, and they refuse to change some of the biggest issues: 37 days to become compliant is absurd. Since you live in CA, you know that they had up to 5 years to become compliant. There is no wiggle room in cases of emergencies: the ANA does not consider the Marathon bombing a state of emergency warranting that we may be off with staffing despite it being an unexpected (understatement) state of emergency for the city of Boston. The language needs to be cleaned up and some sticking points need to be clarified for it to be approved; just like anything else, once it is approved, you cannot un-approve. The issues are not the staffing ratios, it is the language and time frame surrounding it.
  3. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    I'm a single mother of two young women. I work long, hard, clinical hours. I have never received a bonus as a nurse, ever, and I don't make personal attacks on people through a fake name on the internet. I have my opinion, and at least I am willing to put my name behind it. You don't have to agree with me, but you do need to be respectful.
  4. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    Well, you're right and wrong. I'm not a "paper Pusher" I do have clinical responsibilities....at the bedside...but I'm not a med surg nurse. I also don't appreciate personal attacks and judgements against me for educating the general public and other nurses as to the rigidity of the bill I appreciate your read!
  5. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    That's nice that you think I have a marketing team and am a professional writer :) just a nurse for 16 years with a passion for not only our profession but educating the general public on all things related to healthcare.
  6. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    That is also my alma mater, and she is running straight staffing numbers and not taking into account overhead of hospitals- they need money for outlier services (linens, IS support, etc.) as well as building maintenance, equipment replacement, bed replacements, etc. You can't run a hospital "even" especially considering the delay of insurance and medicare/medicaid reimbursements because just like in your own life, bills need to get paid, no matter when you are given money owed. AS well, she isn't taking in account the need (and cost) for travel RNs that will most likely fill the gaps while hospitals are up staffing and on boarding new hires. CEOs at most of the major hospitals don't get bonuses and it is all publicly reported....I haven't been able to find these salaries and bonuses folks keep referring to? The bottom line: Everyone wants safe and affordable care to the residents of MA, I am not sure that this should lie in the hands of lay people, considering that all nurses don't even agree on most parts of the proposed bill.
  7. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    So you think that we should decrease access to healthcare, and despite our #5 ranking nationally in MA for quality/cost/access to healthcare, and beef up staffing in certain areas, without increasing beds, and hope that care is improved, despite no literature to support this measure? And actually literature supports having BSN educated nurses, and that BSN only staff have decreased morbidity & mortality rates, however due to the quick need to increase RN numbers, MA hospitals (which many are BSN only) will have to throw that out the window, to possibly improve patient care? The ratios made absolutely n change in M&Ms for ICU patients.
  8. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    They actually can't. Even large teaching hospitals cant afford it.
  9. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    Most for profit hospitals will close- it won't make financial sense to stay open...
  10. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    Only until you are compliant with the nursing staffing, then all support staff can be downsized
  11. Bridgid Joseph

    Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA

    You are correct- the law says you ot need to keep support staff until you are compliant with the law, then jobs are on the line for support staff
  12. The ballot question 1 in Massachusetts (Nurse Patient Assignments Limit Initiative) which will be voted upon November 2018 was designed to establish patient assignment limits for registered nurses working in hospitals, with limits determined by the type of unit or patient with whom a nurse is working, and the maximum numbers of patients assigned would apply at all times. Massachusetts is a hub for medical advancement. In Boston specifically, there are 6 major medical centers within a few feet of one another. Most are teaching hospitals of Harvard University, so staffing, technology, and innovation to support patients and safety are at the forefront of care. Despite that, there has been a push by the Massachusetts Nurses Association (a union) to enact a similar law for over 20 years. It was brought as a ballot question in 2014 but tabled after allowing for a change in ICU staffing ratios (which showed no change in patient mortality or complications, in a study from Beth Israel Deaconess Medical Center). Now it's more stringent and on the ballot for November 2018. Why does this ballot question face so much opposition? It seems like more nurses is a good thing, right? No one disagrees that nurses are good, and its beneficial for us to take care of our patients. That being said, attached to this proposed bill is not only tighter staffing ratios than California, a 37-day window to comply (to which California had five years), but there is also a $25,000 fine for each time there is not that exact nursing ratio on the unit. The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay. What about leaving the unit for a lunch break, or getting coffee? Not if it means the nursing ratio will be off for any period of time. Shared governance or interdisciplinary meetings? Sorry, you will have to schedule those on your days off. Because of the quick turnaround time to become compliant, and the few numbers of nurses in MA, any resource staff, unit based educators, and/or clinical nurse specialists will be pulled into staffing. There will not be anyone extra to help and "cover" a patient for a quick break. In California, the law allowed for Licensed Practicing Nurses (LPNs) to be hired to assist with upstaffing, but not in MA; RNs only. Differences also include that MA law has higher RN numbers to start and the bill in MA has a prohibition against reducing levels of other healthcare workers (CA did not). MA does not allow any exemptions, whereas in CA 25 hospitals sought and obtained an exemption from the law. These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city. Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services. Currently, according to the 2017's Best & Worst States for Healthcare Massachusetts is ranked #9 overall for Best hospitals (#1 being the best), with California ranked at #25, despite these ratio laws being fully compliant since 2009. Furthermore, Massachusetts has a current ranking of #3 for access to care, meaning access to healthcare is readily available throughout the state. California is ranked #48, meaning the public has less access to healthcare. It's pretty telling that despite making nursing ratios legally required, the state of California has not improved the patients access to care and their overall satisfaction with care. On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day. If I have 4 patients, 3 of which are ready for discharge, I cannot take a new PACU admission to help out the unit. A nurse who may have three heavy patients, one requiring a Rapid Response and eventual transfer to the unit, may have to take that patient, or it negatively impacts throughput and the patient has to sit and back up the PACU waiting until someone can admit them. That scenario may seem extreme, but it is something staff face every day, and if I am willing to take that extra patient to support my colleagues and support patient care, my hospital can be fined $25,000? That makes no sense. However, it is the reality of this bill. 4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up. The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole. This is not to say lay people don't understand good care, they are our customers and they deserve the safest and best care possible and their input is invaluable. However, they do not know how to run a hospital, how it is budgeted, how we currently run staffing matrix, and what this bill means not only to their care but the state of Massachusetts. It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible). It is an estimated $900million annually to maintain these new staffing ratios, without any revenue to the state, and more headaches and difficulty for the public to access care. No other field asks laypeople to make a decision on how they guide their business/care (think Medicine). It is bad policy-making for nurses to do the same; we all believe that highly trained nurses at the bedside, with an appropriate number of patients, benefits not only patients but the work/life balance of our staff. This bill is not the way to do it. We don't want hospitals to close, and patients to have to search for care. We want the best care possible for all of the residents of Massachusetts, and eventually, all patients in all states, as this will set a precedence for mandated ratios in all states in the future!
  13. Bridgid Joseph

    Our Current Reality: Are You Going to Work Scared?

    I think it's great that so many of us are not impacted by mass casualties. For those of us who have been impacted (for me it was the Boston Marathon bombing and one of our MDs shot in a clinic by an enraged family member at an adjacent hospital and I've had family members and loved ones that have barely escaped) that may have a different perspective. I am fearful sometimes that this will happen again in my city,and I might not get home to my family, or that some of my close friends and colleagues may be injured. Tragedies happen every day in different ways and mass casualties is just one of them, and it's reassuring to know that maybe it's only the folks who have had a mass casualty in their city, and responded to them, are the ones that may be feeling PTSD. And, it's important to support our colleagues and loved ones who may need help.
  14. Every time there is some horrible mass casualty that happens anywhere in the world, we see immediate and intense video, usually raw footage, streamed live to our computers, TVs, and smartphones. All at once we are not only processing that something horrible has happened/is happening, but we are also visualizing the hysteria, loss, and destruction simultaneously. As nurses, we are not only seeing these things happen, but as soon as we realize it's either happening (or not) in our town, many of us are wanting to go right out and help. How often have you seen something horrible happen, like the Las Vegas shooting, Texas church massacre, or any other mass tragedy, and thought "It's not in my city, but what if it was?" According to the National Institute of Mental Health, 7 or 8 out of every 100 people will experience Post Traumatic Stress Disorder (PTSD), which can be brought on after surviving a dangerous event, having a friend or loved one involved in a dangerous event, or after the unexpected loss of life of a loved one. Less than half of these people will seek help for treatment of their PTSD. The VA National Center for PTSD reports rates of PTSD after bombings around 34% and mass shootings 28%, which are high numbers, considering the volumes of people impacted by each event. With all of these mass casualties happening annually and all of the visualizations of these acts of terror, I wonder if these numbers might start to jump even higher with the increase of mass casualty events, especially with healthcare workers? There are some people that are now afraid to fly after 9/11, afraid to go to concerts after the Manchester bombing and the Las Vegas shooting, afraid to send their kids to school after the Columbine and Sandy Hook shootings...need I go on? There are a lot of regular activities that people of all ages are afraid for their lives to do, because of possible bombings, shootings, etc. And then there are nurses and other healthcare workers that leave their homes every single day to go take care of other people, and when these mass casualties happen, we are expected to perform at the top of our abilities...and somehow not be focused on what might be going on with our families, letting them know we are OK, are they? What about the staff that suffers PTSD and have to go to work every day? Do you feel that way or know any colleagues that do? At most, if not all, hospitals, there are Employee Assistance Programs (EAPs) that can help anyone who may be suffering from PTSD related to these mass casualties. I think that as much as our job is to care for our patients, we also owe it to each other to look for these signs in our colleagues and either speak to them personally to try to get them some help, or talk to their manager to make sure that they speak to them and offer assistance. I had to do this just last week, and I really wasn't sure how the conversation would be received by a colleagues manager, but they had actually seen some changes in their employee's behavior and appreciated my feedback and the employee got the help they needed. According to the National Institute of Mental Health, the signs and symptoms of PTSD are: Flashbacks (reliving recent trauma) Frightening thoughts Avoiding talking about the event(s) that caused trauma Easily startled On edge/tense/short-tempered Difficulty sleeping Angry outbursts Negative thoughts about oneself or the world Distorted feelings of guilt or blame Loss of interest in normally enjoyable activities Displaying even one or two of these signs can mean that you/your colleague may have PTSD. You don't have to have every single sign for a diagnosis, so if you notice these changes, especially noticing a change in temper or other behaviors, please speak up. Talk to your manager, a friend, a colleague, if you notice any of these symptoms in yourself, and get the help you need to get back to feeling yourself! We are on the frontline of saving people's lives when these are mass casualties, so let's make sure that we are all looking out for one another, taking into account our own mental health and our colleagues as we navigate through these scary times.
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