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Brenda F. Johnson BSN

Gastrointestinal Nursing
Member Member Writer Expert Nurse
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Brenda F. Johnson has 27 years experience as a BSN and specializes in Gastrointestinal Nursing.

After three years on a Med/Surg floor, I transferred to an outpatient setting. I was interested in a normal schedule, but little did I know I would find my niche in GI nursing. I love GI nursing because every day is a learning experience. My passion for writing led me back to school to get my degree in creative writing. Most of my writing prior to allnurses was creative non-fiction and poetry. Writing for the online magazine is great, allowing me to combine my love of nursing and writing. It is a dream come true!

Brenda F. Johnson's Latest Activity

  1. Brenda F. Johnson

    Setting the Precedent: Nurses Fired for Being Sick

    I have not personally been fired for being sick, but I have witnessed other nurses suffering that fate. I felt bad for them and I can’t imagine what they must have gone through. We want things to be fair and just, and to be able to trust the company that we work for to do the right thing. However, employers aren’t always fair. I’m sure many of you reading this will be able to relate to the story highlighted in this article. A nurse from Nolensville, Tennessee, Chrissy Ballard was fired this summer after being off from work to begin treatment for her stage 2 hormone-receptor negative (can’t be treated with hormones because it doesn’t have hormone receptors), and HER2+ breast cancer (tests positive for the protein human epidermal growth factor receptor 2 which encourages the growth of cancer cells). Chrissy worked with dying patients in Hospice care for a company called Caris Healthcare. This past March, Chrissy was diagnosed with the terrifying diagnosis of breast cancer. She must now face her own truth of mortality, after helping patients do the very same thing. Caris Healthcare fired her in the middle of her cancer treatment. Her termination letter states that the reason for her firing was due to “health reasons”, but that she was eligible for rehire. Caris Healthcare’s mission statement is to “Hospice with Compassion and Hospice with Grace”. Their actions towards Chrissy does not line up with their mission statement. Not one person on earth is immune to being diagnosed with cancer, or some other diagnosis that threatens our life and well being. If the day comes that we need to take time off from work for an illness, we hope to be able to take the needed time off to have surgery and other treatments without retribution from our employer. The Family and Medical Leave Act of 1993 (FMLA) that was initiated by President Bill Clinton, allows employees to take 12 unpaid weeks off from work for qualified reasons while their jobs remain secure. The employee must have been at the institution for 12 months in order to qualify and have worked 1250 hours during that time. Chrissy was fired just before the 12-month deadline. While Chrissy’s case is being fought in the legal arena, Chrissy and her husband say that they regret not putting her request in writing. Lawyers suggest that when you are going to be out for qualified reasons, put it in writing as to why you are asking for time off. After reading about Chrissy’s situation, I pulled up the policy for attendance at my facility. The policy stated that an “Absence”, in which the employee must take an unscheduled absence over 4 days be referred to FMLA with a written note from a physician. Under the “organizational rights” in the policy, it tells us that the business has the right to authorize or refuse the request to be off, and are able to investigate absences to determine whether the reason is justifiable. In the employee handbook at my place of employment, it gives the following reasons an employee can use FMLA for pregnancy-related issues such as complications, birth, and care after birth or adoption, care of a family member with a serious illness, and a serious health condition that inhibits the employee from doing their job. FMLA is also granted for military reasons including allowing the employee to take off 26 weeks for a special leave related to care for a covered service member. FMLA allows the employee to come back to work to an original or equivalent position, same pay and benefits. In a perfect world, we would be able to take off the amount of time that we need and be able to keep the same job. However, employers have to protect themselves as well. Some employers engage in shady practices that put their employees in jeopardy. It is our job to know the law and our employers’ policies regarding time away from work. We should never assume anything. When applying for a job, make sure to check into whether they provide short term disability, long term disability, insurance, and that they fit the qualifiers to provide FMLA. Chrissy’s surgery was successful, and now she is in the middle of her radiation treatments. The Equal Employment Opportunity Commission is investigating her case for improper firing. Her case can and will set a precedent for nurses in the United States. Like I stated earlier, I’m sure there are nurses reading this who have experienced good and bad issues regarding their employer when faced with a life-changing event. Share your experience if you wish, or give advice to those who may be facing this in their lives right now. Below is the link to the article about Chrissy Ballard if you would like to read more about her. A Hospice Nurse Started Chemo. Then Her Employer Fired Her.
  2. Brenda F. Johnson

    Workplace Violence in Healthcare: Nurses, What is Being Done to Protect Us?

    Yes, she was known by her attacker. I didn't put much about him. He worked as a parking valet at the garage and had recently been fired.
  3. I don’t remember hearing anything about Carlie’s murder last January, but her community of nurses did. On January 25, 2019, in the parking garage of a Wisconsin hospital, Carlie was kicked in the head over 40 times and then left to die under a car in the early hours of the morning on January 25, 2019 (O’Reilly, 2019). It was so cold that her skin froze to the concrete (Harris, 2019). She left work at 1:00am, was found at 3:43am by a snow plow driver, and tragically died at 4:21am. Carlie died a slow, torturous death - Alone (O’Reilly, 2019). As I read Carlie’s story, and how she died, it weighed heavy on my heart. I pictured someone I know falling victim to such a brutal death and my stomach squeezed so hard that it hurt. Was Carlie conscience, did she lie there thinking about her husband and family. How much pain did she suffer while her tears went unheard. With any act of violence, we try to rationalize it - we try to make sense of it. But the circle of thoughts that we continually play in our minds about something irrational cannot be rationalized. Nurses often are on the receiving end of abuse, and those feelings and memories stick with us forever. Not to mention our individual histories and personal experiences with abuse that we bring with us everyday. The ones that have shaped us and have developed how we respond to abuse. Any abuse - verbal, sexual, physical, or mental is immensely personal, it touches and shapes our souls. The abuser tries to steal our joy and our sense of safety, but it’s time we as nurses stop putting up with workplace violence. According to Bankole K. Fasanya and Emmanuel A. Dada, in their article, “Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses’ Perspectives”, that on a daily basis, two people are killed as a result of workplace violence, and 87 are injured (2016). This statistic covers any field of work, however, the healthcare field takes credit for a large majority of those numbers. In fact, in the article, “Educational and Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study”, it tells that we as healthcare workers are victim of almost 74% of the abuse inflicted in the workplace (Hemati-Esmaeili, Heshmati-Nabavi, Pouresmail, Mazlom, & Reihani, 2018). Workplace violence can be verbal, emotional, sexual, or physical and most nurses have experienced one or more forms in the span of their career. Abuse can come from a peer, superior, doctor, patient, or family. Certain fields of nursing suffer higher incidents of abuse such as the Emergency Department, Long Term Care, and the Psychiatric wards. A large percentage of these events are not reported. The reason may be that there is a feeling that nothing can or will be done, or that there will be retribution for reporting. How can we, as nurses advocate for ourselves? We need to empower ourselves and our fellow nurses and learn what our choices are and what is being done about workplace violence. A bill was introduced February 19 this year by Representative Joe Courtney. He represents Connecticut in the House of Representatives since 2007. This bill - H.R. 1309 will require the Department of Labor to look into violence in the healthcare field. It is asking that requirements be set to educate healthcare workers on how to de-escalate violent situations, and recognize the signs of impending violence. Also, it asks that each incident be investigated as soon as possible in order to get the most accurate information. Nurses often do not feel comfortable or safe reporting incidents of workplace violence. They fear retribution, prejudice, or even losing their jobs. This bill will allow them to report concerns and events privately and without punishment. What can we do? Contact your state Representatives and Congressmen/women and ask them to support this bill. Tell them that is is essential that something be done to protect us. If this becomes mandatory, turnover will decrease, morale will increase, and the culture of the healthcare field will greatly improve. The perception that nurses are expected to endure a certain amount of violence needs to be eliminated (Fasanya, 2016). Thank goodness the majority of workplace violence cases are nonfatal. But one fatal incident is too many. Share your stories with the allnurses community. References Fasanya, B., & Dada, E. (2016). Workplace Violence and Safety Issues in Long Term Medical Care Facilities: Nurses’ Perspectives. Safety and Health at Work, 7(2), 97-101. doi: 10.1016/j.shaw.2015.11.002 Harris, C. (2019). Dying Wisconsin Nurse Found Frozen to Ground was Allegedly Targeted by Former Parking Valet. People. Retrieved from https://people.com/crime/slain-wisconsin-nurse-was-allegedly-targeted-by-valet/ Hemati-Esmaeili, F., Heshmati-Nabavi, F., Pouresmail, Z., Mazlom, S., & Reihani, H. (2018). Educational ad Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study. Iranian Journal of Nursing and Midwifery Research, 23(6), 478-485. doi: 10.4103/ijnmr.IJMNR_77_17 O’Reilly, M. (2019). Murder and Me. Medscape Nurses. Retrieved from https://www.medscape.com/viewarticle/917203
  4. Brenda F. Johnson

    Gender Bias in Health Care

    This has been going on for decades. About 10 years ago, I asked an Anesthesiologist why on their pre-surgical orders have different guidelines for men than women in regards to EKG. She told me that is is just how it is. The criteria was different regarding ages for routine EKGs preop. Men got one at a younger age than women. Made no sense to me. Very good article, thank you!
  5. Brenda F. Johnson

    How the U.S. Cadet Corps Changed Nursing History

    That is so cool!
  6. Brenda F. Johnson

    How the U.S. Cadet Corps Changed Nursing History

    The second World War drained the hospitals, health agencies, and schools of nurses by about 30% according to Liz Eberlain in her article, “Making a Difference: The U.S. Cadet Nurse Corps”. This created a nursing shortage that threatened the future of the country as well as the war. After the war was over, nurses would be needed for the continued treatment of the soldiers and their families. Labor - Federal Security Appropriations Act, 1942 The House of Representatives and Congress put together a Code, addressing the labor and other needs of the United States due to World War II called “Labor - Federal Security Appropriations Act, 1942”. Among this Code was a law that communicated how federal money would be used to recruit nurses. The demand for nurses had become critical and the medical community would have collapsed under the great need for nurses during and after the war. This code also dropped discriminatory practices by allowing any race, color, or creed to apply (An Act Making Appropriations for the Department of Labor the Federal Security, 1942). The code focused on High School graduates between the ages of 17 and 35. These students could be trainees, student nurses, or post-graduate nurses; it even offered refresher courses for nurses who had not been working due to retirement or having children. Recruitment Recruitment efforts were widespread using leaflets, posters, newspapers, parades, even Hollywood made short films and advertisements to encourage enlistment. (Below is a link to one of these short films) High schools hung the posters in their hallways to encourage new graduates to enlist, and parents were promised that their daughters would be safe and taken care of. These young women would receive a monthly stipend along with free tuition to nursing school. The nursing program was pushed from 36 months to 30 months in order to expedite their graduation (Eberlein, 2019). However, the $5 million allocated to get the program going was not enough. The forward thinking congresswoman, Frances P. Bolton initiated the bill called the “Bolton Act” that asked for the establishment of a governmental program that would give grants to nursing schools to enable the training of nurses (Eberlein, 2019). Her bill passed on July 1, 1943, giving $65 million in the first year to nursing schools across the country (Eberlein, 2019). Several things happened that year to further the nursing profession. One was that the cadet program was put under the Public Health Services who answered to the Surgeon General (Eberlein, 2019). The Surgeon General at that time was Tomas Parran who appointed Lucille Petry, RN over the new Division of Nurse Education (Eberlein, 2019). The birth of return demonstration teaching began during this time, changing how nurses are taught forever. Altogether, the U.S. Cadet Nurse Corps recruited 124.000 women. Recognition The reason that The United States Cadet Nurse Corps has made it back into the public eye recently, is because they are asking for more “formal recognition” for the women who served in the corps, according to the article, “Recognition ‘Now or Never’ For U.S. Cadet Nurse Corps of World War II”, by Jill Kaufman (2019). Many of these nurses have now passed away, but the lobbying for the government to acknowledge the nurse corps is still going on. These nurses began working towards receiving full veteran’s benefits in the 70s, but have not been successful. More recently, Barbara Poremba, a nursing teacher has initiated a bill called “Honorary Veterans” that would offer the member of the nursing corps burial benefits (Kaufman, 2019). The U.S. Cadet Nurse Corps Service Recognition Act would recognize the women who served by giving them honorable discharges, the above-mentioned burial services, and ribbon and medal privileges (Scheible, 2019). These women went overseas, some were even captured by the Japanese, others worked in the states, and they all served our country. They worked under the conditions of war, and continued to serve after the war was over. They deserve at least the proposed privileges. A couple of those women, now in their 90s are Elizabeth “Betty” Beecher of Weymouth, who is now 95, and Emily Schacht from Waterford, Connecticut and is 92 years old. We honor them among our nurses’ community. Have you known a nurse who served in the corps, or know a story about it, please share with the allnurses community. To see a recruitment film, click on the link below: The CriticalPast: The need for cadet nurses and young girls to volunteer for military nursing service during World War II. References An Act Making Appropriations for the Department of Labor the Federal Security. (1942). Labor-Federal Security Appropriations Act, 1942. Retrieved from: Library of Congress Eberlein, L. (2019). Making a Difference: The U.S. Cadet Nurse Corps. National Women’s History Museum: Making a Difference: The U.S. Cadet Nurse Corps Kaufman, J. (2019). Recognition ‘Now or Never’ for U.S. Cadet Nurse Corps of World War II. New England Public Radio. Retrieved from: Recognition 'Now Or Never' For U.S. Cadet Nurse Corps Of World War II Scheible, S. (2019). Military.com. Retrieved from: Lawmakers Renew Bid to Honor US Cadet Nurses
  7. Brenda F. Johnson

    The Future of Nursing Retention

    The cost of nursing staff turnover is immense for hospitals according to the 2019 National Health Care Retention & RN Staffing Report (NSI, 2019). The NSI reports that on average to replace a bedside nursing job it can cost up to $52,100. Last year, it is estimated that a hospital paid out up to $5.7 million just in recruiting, educating, and training new hires (NSI, 2019). This is a huge amount of money to keep a hospital staffed. The top reasons nurses leave jobs vary - such as personal reasons, relocation, or career advancement. Other reasons that nurses leave jobs is because of salary, schedule, commute, management, retirement, and staff/patient ratios (NSI, 2019). Nurses have the luxury of being able to change jobs if they are not happy. There are so many choices for us, that if we aren’t happy, we can leave or transfer. If a facility does not value the nurses’ needs or care about retention, then they will have a large turnover rate. There is one hospital system that has created a program that is like no other. The Allegheny Health Network has developed a RetuRN to Practice program that offers nurses shorter shifts, flexible shifts, refresher courses, and a support network. This information can be found at the following link: https://www.ahn.org/education/ahn-return-to-practice-program The Allegheny Health Network purposes to lure nurses that have left nursing to raise children, or are retired, to return to the bedside. Allegheny has created a system that fits the modern nurses’ lifestyle, and as a result, decreases the workload for the current staff. According to the article, “Bring Nurses Back to the Bedside”, by Jennifer Thew, “participants must offer managers availability in a minimum of three-hour blocks at any time on a day, evening, or night shift, or on a weekend or holiday”. The agreement allows the nurse to self-schedule but requires a minimum availability. They don’t take assignments necessarily but relieve for breaks or when the nurse has to be off the unit for a period of time. They can do admissions and discharges as well, or patient teaching, the things that take a chunk of time. The hospital provides refresher courses for the RetuRN nurses to take that will help them get their license re-activated. Shadowing is also available to help the returning nurse update clinical skills. They also offer a concierge program that helps the returning nurses navigate the process of getting hired and activating their licenses. When the RetuRN nurse comes onto the unit, it is then that they get their assignment, which requires flexibility. It does create scheduling adjustments for the manager, who has to fit the RetuRN nurse with a three-hour block of time into the day’s schedule. What the program has come to find is that once these nurses are on the units, the units fight to keep them, finding them very valuable. Because this is a new program, they are constantly re-evaluating and getting feedback from all the key stakeholders. The first wave of the program hired 22 nurses, all of whom still work there. The RetuRN nurse does not have to twelve-hour shifts or work the weekends, some of the deterrents that kept them away. They can self-schedule in order to fit the job to their life schedule, creating a balanced work to life ratio. Being that the most recent percentage for staff turnover in hospitals is 19.1, this program recognizes that number and is forward thinking enough to try and decrease it. Bedside nursing turnover rate is 17.2% in 2018, compared to 16.8% turnover rate of 2017 (NSI, 2019). The numbers continue to increase each year, reflecting the satisfaction of the staff. In just five years, the average hospital has “turned over 87.8%” of their staff (NSI, 2019). This is a huge number that should get hospitals attention, not only for the money involved to recruit and train new employees but keeping staff once they hire them. The RetuRN program will be one to watch. It already has given us a lot of information. In a couple years, the program will be larger and will have even more data to backup their claims. It will be interesting to see what it becomes and how many other hospitals will begin to use the program, or create something just as effective. The nurses who take advantage of the program have a lot of experience and skills to share that will benefit their fellow nurses and the patients. In return, the nurse gets to work a schedule that they choose and keep skills current. References 2019 National Health Care Retention & Staffing Report. (2019). Nursing Solutions, Inc. Retrieved from: www.nsinnursingsolutions.com Thew, J. (2019). Bring Nurses Back to the Bedside. HealthLeaders Analysis. Retrieved from: https://www.healthleadersmedia.com/nursing/bring-nurses-back-bedside
  8. Download allnurses Magazine The evolution of nurses day or nurses week took many years to become official. The first official attempt was in 1953 when Dorothy Sutherland of the U.S. Department of Health, Education and Welfare proposed a “Nurses Day” to President Eisenhower. She wanted it to reflect the 100th Anniversary of Florence Nightingale's mission to Crimea, but it did not get done. However, the following year in 1954, a National Nurses Week was celebrated from October 11-16 (Gillies, 2003). In 1955, a bill was introduced to declare a National Nurses Week, but it did not pass. Ten years later, the International Council of Nurses started celebrating “International Nurses Day”. President Nixon is asked in 1972 to acknowledge a “National Registered Nurse Day”, but it did not happen. However, two years later, Nixon proclaims “National Nurses Week”. The same year, the International Council of Nurses proclaims May 12 as “International Nurse Day” (Gillies, 2003). There are several milestones in the years that followed, and in 1982 the ANA recognized May 6 as “National Recognition Day for Nurses”. That same year, Congress also made a resolution for May 6 to be “National Recognition Day for Nurses”, and then President Ronald Reagan signed a proclamation on March 25 declaring the same (Gillies, 2003). The ANA made nurses week (May 6-12) official in 1990 (Gillies). May 12 is Florence Nightingale's birthday, so it is fitting that we end the week of celebration - celebrating her. After attending nursing school in Germany, Florence went back to London and became superintendent of a hospital for “gentlewomen” (The History, 2016). Her work in public health and during the Crimean War set new standards for healthcare. She decreased mortality by improving sanitary conditions. Not only that, she kept records of the people who died, and how they died. This allowed her to make the connection between sanitation and disease. Florence actually had some of the first evidence-based research in healthcare. Looking back at how many changes (or not) have taken place in nursing and the medical field, it seems overwhelming. Even so, the nurse's mission has remained steady throughout this medical metamorphosis. This is evidenced in a book published in 1930, , F.A.C.P. In the preface, he tells us what his perspective of what a nurse is. “The function of the nurse in medical diseases is to observe symptoms accurately, to recognize early signs of complications and to carry out the physician’s orders intelligently” (1930). This description applies today just as much as it did in 1930. Although we have made great strides in chemistry, biology, and electronics, our basic purpose remains as it always has been - to provide care to our patients to the best of our ability without doing any harm. I love my old medical and nursing books. I enjoy reading them and seeing the nursing students’ signatures written crookedly inside the front cover and maybe some scribbled notes of something they thought was important. These books are precious, connecting the past with the present. One of the books in my collection was written in 1917 by George M. Price, M.D. called, Hygiene and Sanitation A Text-Book for Nurses. When I flipped to the dedication page, it read, “To Lillian D. Wald - The pioneer of Public Health Nursing in the United States and the foremost advocate for the extension of the scope of the nurses’ work. This book is dedicated in appreciation and respect” (Price, 1917). Wow. Makes me wonder if he knew her or just knew of her. This is the perfect segue into talking about Lillian D. Wald and her contributions to the world of sanitation, education, and the improvement of conditions for children in that day and time. Lillian Wald is known for her work in reforming public health. Not only did she open a “settlement house” (opened in poor urban areas in an attempt to bring the rich and the poor together in proximity and socially) in 1893 called the Henry Street Settlement, she moved into the house along with her friend and fellow nurse Mary Brewster (Lillian, n.d.). There in the house, she provided nursing care for the poor. Eventually, there were many nurses who would come and volunteer their time. Soon, the settlement was able to open playgrounds, afterschool programs, kindergarten, mother’s groups and more. Lillian was able to discern what the community needed and then make sure it happened. Together, she and other well-known women’s rights activist such as Lavinia Dock and Florence Kelley helped to write textbooks, aiding to the progression of the professional nurse. New York City school children benefited from the many people living in that settlement who helped to improve conditions in the schools. Special educations classes were created, and a program for school nurses was started, along with a lunch program for the students. Lillian’s activism and hard work in her community were boundless, including her work in the political arena to end child labor. Her story is a good example of how one nurse changed a country (Lillian, n.d). Getting back to the book, I thought you would enjoy what Dr. Price had to say in his preface. “The last decade has seen a wonderful expansion of the function of the trained nurse and a great broadening of the scope of her usefulness. No longer are her duties limited to the simple care of the sick. The nurse has become a priestess of prophylaxis. Her work in preventative medicine has become invaluable. She has become an important factor in social, in municipal, and in public health work” (Lillian, n.d). **To all the wonderful male nurses out there, know that we appreciate you and you are the “princes of prophylaxis”. ** While documenting in charts has become obsolete, we now see our faces in the reflections of all of the electronic devices we use. We get lab, and other results in real time and can treat patients sooner. Communication has become easier and faster, decreasing the incidents of delay of care and improving patient outcomes. While all of this is great, let’s not forget to look up and make eye contact with our patients; they need it, and so do we. Just from looking at them we can tell so much. We can see if they are pale, in pain, or nervous, and most of all, it begins the process of building a rapport. Nurses Week is to celebrate you. All the times you ignore your back pain and keep going, or brush off the bladder that is about to burst in order to care for your patient. As you bring them their lunch while yours is getting cold, this week is for you. When a doctor yells at you for something that is no fault of yours, this week is for you. As you walk to your car on feet that are so tired they can’t take any more steps, we celebrate you. The connection we have as nurses over the past decades to now binds us in our journey of serving. The best things about the healthcare system have been created by nurses just like you. Do some creating of your own and don’t forget to get a massage to reward yourself. You never know, decades from now, nurses may be reading about you and all the wonderful things that you were able to accomplish. Tell us about some things you would like to pioneer. References Blumgarten, A. (1930). A Textbook of Medicine for Students in Schools of Nursing. New York: The MacMillan Company. Filiacia, A. Lillian Wald - Public Health Progressive. (n.d.). Wordpress. Retrieved from www.lillianwald.com Gillies, H. Florence Nightingale The History of Nurses Week. (2003). CountryJoe. Retrieved from www.countryjoe.com/nightengale/nursesweek.htm. Price, G. (1917). Hygiene and Sanitation A Textbook for Nurses. Philadelphia and New York: Lea & Febiger. The History of Nurses Week. (2016). Ashford University. Retrieved from https://www.ashford.edu/online-degrees/health-care/the-history-of-nurses-week
  9. Brenda F. Johnson

    Have you had your Colonoscopy? March is Colon Cancer Awareness Month

    Praying for good results!
  10. Brenda F. Johnson

    Congratulations! You're a New Nurse Leader…Now What?

    Thank you for this article, I can relate to the information because I am in a new role of leadership after many years. The biggest change for me is the information that I learn, I also want to share, but cannot. Before, I didn't really have to have a filter, now I have to check myself before sharing certain things. Doing the little things for my unit and staff goes a long way for unity and satisfaction.
  11. In our country, and specifically in healthcare, we are leadership deprived. It is difficult to lure good leaders into management positions due to the increased stress that they will have to deal with. Adding to that, younger nurses don’t want it either. There are other fields of nursing that they can invest education and experience in that will yield them more money. Some nurse managers are promoted out of convenience or because they are great nurses. However, Good clinicians don’t always make effective managers because they may not have any leadership skills. Over 70% of nurse staff turnover is because of bad managers (Roussal, 2016). When a nurse leaves a position, it can cost around $75,000 to replace that person (Roussal, 2016). This includes the recruitment of the new staff person, replacement, and possibly temporary staff until the position is filled. Included in that number is the overtime paid to the present staff and the orientation of the new person. When there is a high turnover, the core staff become burned out and unhappy leading to the potential of additional turnover. Personally, I have had some fantastic nurse managers, and some not so fantastic. But my recent experience tops the not so fantastic scale by epic proportions. I kept waiting for the lies to catch up to this person, or the emotional bullying to escalate until someone finally reported the problem. For years, I had begged for help from the manager’s superior, but to no avail. Nothing happened. I felt trapped, frustrated, and angry. Was there no one who cared that the whole department was stressed and unhappy? A part of my frustration was that my co-workers would not stand up for themselves and report the manager. A culture of co-dependency and toxic circumstances had festered for so many years, that I guess they accepted it as status quo. Recently, my manager did something that was so egregious that this person is now forced to step down from their position. What I have realized from this experience is that some of my co-workers who would not have reported this incident. The manager would have gotten by with it, and gone on to commit other intentional errors. Now that there is some exposure to the bad management, my co-workers are more willing to speak up. The people who were brave enough to speak up in the first place did so with much consideration and purpose. There are incidents that are reportable, that must be reported by those with knowledge of what happened. Of course, there are incidents that aren’t harmful but still need to be reported. This allows for a review of the system and root cause analysis that improves how we do things and prevent future incidents. There are a few leadership qualities that lead to failure; lack of vision is one of them. Leaders must be able to articulate their vision so that the staff can relate and understand. This will help staff know that they are a vital part of fulfilling that vision. If a leader has no connection to the larger picture, the staff feel disconnected and unimportant. When a manager has no empathy, the staff don’t feel cared for. Part of having empathy is being able to listen and hear them when they have concerns. No motivation can kill a department’s ability to thrive. Having an environment that helps to create energy and purpose will allow the staff to enjoy their workplace. Also, when a leader has no eye on the future, the staff feel stifled and are unable to learn and grow. Good leaders create trust between themselves and the staff. If the staff has trust, then they will feel comfortable bringing to you issues that they have. They will also know that the manager has their back in difficult situations. A nurturing environment will grow empowerment amongst the staff. A good leader accepts responsibility for things that are their responsibility. They don’t deflect blame onto the staff, or elsewhere but instead are mature enough to self evaluate and use situations to improve their leadership skills. Being an advocate and liaison between the staff and upper management, other departments, and ancillary is an important part of being a good manager. Being open and approachable will go a long way in human relationships. Having a good emotional IQ helps as well. Communication is extremely vital in maintaining any relationship, and especially important with management. Being able to effectively communicate and have crucial conversations will make all the difference in how staff respond to changes. Not every good leader can be excellent in all aspects, but they can continue to try and learn. As for those bad leaders. . . I have no idea! Tell us about your good leader, or bad one. Give us the reasons they are either good or bad.
  12. Brenda F. Johnson

    Injection Gone Wrong: Part 1

    Your story is much like the woman's I wrote about. She is still on workman's comp though. She actually just came back to work after another surgery. It's a shame that this is common. It shouldn't be.
  13. Brenda F. Johnson

    One Stop Shopping: The Trend of Retail Healthcare

    Thank you for your insight. I think what worries me most is what you talked about in 1 and 2, lack of follow up and missing an important diagnosis because they are not looking at the whole patient like the primary caregivers.
  14. Brenda F. Johnson

    One Stop Shopping: The Trend of Retail Healthcare

    Americans thrive on being able to access things quickly. Drive-thrus give us our coffee, hamburger, or prescription through our car window. We are busy people, and this allows us to multitask without dragging the kids or dog out of the car. We can't see a doctor or nurse practitioner through our car window, but we can stop at our convenience at a clinic on the corner or in the grocery store for our UTI. That is retail healthcare. As Jeannette Y. Wick RPh, MBA tells us in the article, "Retail Health Care: Where It's Been, Where It's Going", there has been a shift in the recent years away from the emergency room for those non-emergency healthcare problems such as bronchitis or that rash on your belly. The cost is less for the patient, and valuable resources are not held up when an urgent care clinic is visited instead of a hospital emergency room that is trying to help a person in a real crisis. Retail healthcare is attractive to the consumer, but for the investor, it is even more so. "What's Behind the Surge in Retail Healthcare Deals?" written by Nirad Jain, Jeremy Martin and Kara Murphy explain that, "From 2012 to 2017, the number of deals involving retail health companies-those that operate freestanding health-related outlets like dental clinics or urgent care facilities-has soared, increasing at a compound annual rate of 34%" That is a large number, and for investors it means a good return. The owners examine it from the patient's side as well as a business side to find the best solution for both parties, their competition is the patient's (consumer's) reward. The investing companies are dependent on the consumer and the consumer has a choice whether to use them or not. This makes the company look at patient proximity, specialization of care, cost, and last but not least customer satisfaction. Patients are becoming self-advocates. One out of three patients look online for a diagnosis and 41% say that a medical professional confirm their diagnosis according to the article by Gary Druckermiller, "What Can the healthcare Industry Borrow From Retail Marketing?". We've already seen the upside to this form of healthcare: a variety of health care services, close proximity to patients, less cost to the patient, less wait times, profit for the owners, and standardized protocols. There are some issues that have to be taken into consideration regarding retail healthcare. No company can provide everything to everyone, so they have to cater to the "most valuable" according to Jain. Knowing the patient's needs coupled with the business side of knowing the regional market is a must for their success. Another issue for the corner clinics is keeping doctors and nurse practitioners. Recruitment for this type of job is not easy and not having the proper number of clinicians can back up the patient load and eventually, the consumer will go somewhere else. There is a fine balancing act by the investing companies that goes into these clinics. Reimbursement looms as an ever-changing factor for these clinics, making the owners concerned. As reimbursement changes, especially if it increases, will roll down to the customer and possibly increase the rates. Continuity of care for the patient is very important. Guiding a patient over time and making sure they receive the proper care can get lost if the primary physician is not informed. For example, it a patient visits a clinic for a UTI, the primary doctor doesn't necessarily get notified. One time is fine, but if the patient is having frequent UTIs and goes to more than one clinic, a diagnosis could get missed. The patient could potentially have other issues going on that require more intense studies. A breakdown in the patient to primary relationship will happen if the patient solely relies on the clinics therefore, the continuity of care will be fractured. In a study cited by Jeannette Y. Wick in her article, "Retail Healthcare: Where It's Been, Where It's Going," she tells us that between 2008 and 2015, 21 million uninsured people made 52 million visits to urgent care clinics. The use of urgent care has increased greatly and will continue to do so. In fact, they have increased by 93% With the multiple advantages of retail healthcare, there can be a downside. With all the conveniences, patients may go long periods of time not seeing the primary and miss doing essential exams, or fall through the cracks on a diagnosis. Have you seen it effect your patients? References Druckenmiller,Gary. "What Can the Healthcare Industry Borrow From the Retail Marketing?" Evariant. 14 January, 2016. 29 August, 2018. Web. Jain, Nirad., Martin, Jeremy., and Murphy, Kara. "What's Behind the Surge in Retail Healthcare Deals? Bain & Company. 9 May, 2018. 28 August, 2018. Web. Wade, Evan. "Investigating the Rise of Retail Clinics." HealthCare News. 11 April, 2018. 28 August, 2018. Web. Wick, Jeannette Y RPh, MBA. "Retail Health Care: Where It's Been, Where It's Going". Contemporary Clinic Pharmacy Times. N.d. 29 August, 2018. Web.
  15. Brenda F. Johnson

    Has Medication Advertising Affected Drug Intake?

    Haha, I will have to pay attention to that!
  16. Brenda F. Johnson

    Has Medication Advertising Affected Drug Intake?

    Before the FDA gained control of how networks can air medication commercials, several doctors did some research and wrote if their findings in, "Television Advertising and Drug Use", by Barry Peterson, Ph.D., et al. They take the stance that advertisements of over the counter drugs contributes to public misconceptions and encourage drug use. "In promoting OTC drugs for the relief of everyday symptoms such as pain, nervousness, or lethargy, drug companies may deceive the public into thinking that drugs are an easy way out of everyday discomfort". That was 42 years ago, but the same concern is echoed by doctors in 2001. In the article, "Ban TV ads For Prescription Drugs?" it tells us that the American Medical Association would advocate for banning prescription drugs ads from television, newspapers, and magazines. They feel that the misinformation is causing problems with the patient population. They also say that these ads undermine their credibility. Doctors find themselves in a quandary when patients demand a medication they saw advertised, but the doctor feels another medication would better fit the patient's problem. Dr. Angelo Agro, an ear, nose, and throat doctor says this about medication ads, "Ads by their nature are biased and compressed and are driven more by drug companies' financial concern than by concern for the patients' best interest". Although there were doctors meeting to lobby against the drug companies advertising, there were also doctors who felt that a ban would violate free speech. The latter group of doctors that felt the ban was unnecessary and made it known to the committee that they saw medication advertisements as a positive because they may encourage patients to see their doctor, even those who wouldn't normally seek medical treatment. They also felt that these ads help to take the stigma out of certain conditions such as depression. Present day research is related in the article written in 2018, "Coverage By The Media Of The Benefits And Risks Of Medications", by Roy Moynihan B.A. et. al. They discuss how news stories need to cover adverse effects as well as benefits, and often research is focused on the results to favor the company. They found that out of the 207 newspapers and television stories they looked at exhibited shortcomings in their reporting. Moynihan reported that only 15 percent of the media outlets presented relative and absolute benefits; 83 percent gave information in relative terms only which can be misleading. Declaring only absolute or relative benefits does not tell the full story. 53 percent did not talk about potential harms, and 70 percent did not mention cost. Cost can be a deciding factor for many patients in whether they will choose a particular medication. Disclosure was an issue also. Scientific literature underreports the ties between research results and industry. They conclude that the news media should "focus" more. They suggest an educational program for journalists that would help them to focus on the reporting and interpretation of clinical findings. The FDA states on their website under the title "Background on Drug Advertising", the following: The FDA oversees the approval and marketing of prescription drugs through the law, "Federal Food, Drug, and Cosmetic Act". We have a lot of regulation in regards to getting medications on the market compared to other countries. The mid-80s saw more involvement of the media in direct to consumer advertising instead of only to doctors and pharmacists. You have probably noticed that there are some commercials that are really vague, and others that go into great detail. There are several classifications of drug ads: Product Claim Advertisements - These are the only ads that state the benefits and risks of a drug Reminder Advertisements - These ads give the name of the drug, but not the drug's uses. Help-Seeking Advertisements - These describe a disease or condition but do not suggest a specific drug. Ex. are ads for allergies, asthma, or erectile dysfunction. I have noticed an increase in advertisements for medications, especially on television and in magazines. Ever since the FDA approved advertising for medications years ago, the number per commercial break has skyrocketed. According to the article, "Think You're Seeing More Drug Ads on TV? You Are, and Here's Why" by Joanne Kaufman, 771,368 medication ads were shown in 2016. She states that it is "an increase of almost 65 percent over 2012". Not only has the number increased for medical advertising, but the class of drugs as well. Years ago, we saw ads for allergy medication or reflux, but now we see chemo drugs, cardiology drugs, and insulin. The marketing is towards those who are older (and still watching TV), rather than the younger generations. The professional opinions are varied in regards to advertising of drugs, some have reasons they are for them, and those opposed have their thoughts. Research shows that the average consumer can be misled by these advertisements. This misinformation can cause issues between the caregiver and the patient. The doctor may have several reasons why a particular medication may not be right for their patient but the patient feels that it is the best choice for them. Cost is another factor, especially with new medications. Insurance may not pay for a new drug, and the patient is left with a large bill or having to go back and ask the doctor for another alternative. Some patients are more pill driven than life-changing driven in regards to treatment and end up on a long list of medications. Should drug companies be allowed to advertise at all? Should the government be involved? It's difficult to turn back federal regulation, and advertising is money driven. What would you like to see happen regarding the advertising of medications? References "Background on Drug Advertising". www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising. 20 July, 2018. Web. "Ban TV Ads For Prescription Drugs?". CBS News. 18 June, 2001. 20 July, 2018. Web. "Basics of Drug Ads". www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising. 20 July, 2018. Web. Bell, Robert A. Phd, Kravitz, Richard L. MD MSPH, Wilkes, Michael S. MD PHD. "Direct to Consumer Prescription Drug Advertising and the Public". 14(11)651-657. Journal of General Internal Medicine. 14 Nov, 1999. 20 July, 2018. Web. Kaufman, Joanne. "Think You Seeing More Drug Ads on TV? You Are, and Here's Why." The New York Times. 24 Dec. 2017. 20 July, 2018. Web. Moynihan, Ray B.A. et al. "Coverage By The News Media Of The Benefits And Risks Of Medication". The New England Journal Of Medicine. Vol. 342 Nu. 22, 11 July, 2018. 20 July, 2018. Web.