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  1. Nurse Beth

    Male Nurse Disgusted by Female Nurses

    Hi Beth: I believe you submitted a recent article about Safe Patient/Nurse Ratios in this country. I have been a nurse for about one year and a half and I am appalled by what I have observed with the untenable and unsafe patient/nurse ratios healthcare employers are demanding nurses work with, BUT, I am even more FRUSTRATED and DISGUSTED with the TOTAL LACK OF UNITY among nurses when it comes to speaking in one voice to employers about this. They would rather run to the bathroom and cry or ***** and moan in private never having the guts to unite and square off with themanagements responsible for creating unsafe conditions for the sake of profit. I am a male nurse....you ladies always tout this spirit of "Teamwork" on the floors yet I have never in my life witnessed the amount of undermining and backstabbing that exists among nurses. Before we can begin to force change on healthcare employers we have to take ownership of our failure to unite.Ladies. please stop all the petty politics among yourselves! Let's all come together as one body and push our legislators for change!! We are in the millions and we are in demand!! That is power!! Dear Male Nurse Disgusted with Female Nurses, The female experience is very different from the male experience, my friend. You are operating in the largely female world of nursing, and it probably feels very foreign to you. But as women, this is our world and we know it well. You believe we are petty and fight among ourselves rather than uniting and speaking up to management. Uniting and speaking up to management as one is male behavior. Female behavior is more divisive and it has kept us down as a profession. You're right, the nursing profession is really not built on strength or unification. But there's a reason for this behavior. As a male, you would not know this as a lived experience. Female Conditioning Females are conditioned to envy each other, not to trust each other, and to compete with each other. Females compare themselves to other females all their lives. Girls compare themselves to Barbie, to the pretty girls, to the girls boys like best, to the cheerleaders. To every other girl. Women are taught to be helpless when they're not, act stupid when they're smart, not be hungry when they're starving, and to remain passive they're angry. Females are called the "b" word for being assertive and considered to be more feminine when they are "sweet". It's a dichotomy of expectations. The dichotomy is everywhere. Look at popular movies about mean girls. Being direct and straightforward is not how women are brought up to communicate whatsoever. Saying what we need is less important than meeting other's needs. Meanwhile, boys are taught to stick together, in the army, on the football team. You rarely hear doctors criticize other doctors. Even when a patient goes to see a doctor with a condition that was mishandled by another provider, the response is more along the lines of "Well, let's move forward from here". By contrast, nurses are hard on each other. Nurses can be quick to blame other nurses. As females, we expect perfection from ourselves...and each other. State boards of nursing, made up of nurses, are notoriously hard on nurses as compared to doctors' governing boards. There's another reason for your observations about female behavior. Men Rule It's still largely a male-dominated world. Men have the power. Look at the recent "Time's Up" issue. Even in liberal Hollywood, men have the power. Hospital boards are largely male. Hospital CEOs are largely male while CNOs are largely female. It's a tough but true reality. Even in nursing, a traditionally female occupation, when men become nurses they are often viewed as more qualified. It's no secret that men in nursing make more than women. Self-Value But we women have very special qualities. Intuition, compassion. Empathy. We are nurturers. When we focus on those unique gifts and collaborate together, instead of competing with each other, we are our most powerful selves. No Excuses This is not to say these explanations are excuses. Excuses are for people who don't take responsibility. We are a force to be reckoned with once we take responsibility and come together. There are over 3 million nurses in the United States. We act as if we only have a rake when we actually have a bulldozer in the garage. We have enormous ability to bring about change. How do we rally the masses? I don't know. Nurses do unite in outrage, as in Show Me Your Stethoscope. But there is an apathy around bringing about political change. The nursing profession itself is not unified by the American Nurse's Association (ANA). Some would say the ANA is beholden to the American Hospital Association (AHA). The AHA is a powerful lobby. For whatever reason, it is time to stand up, stand together, and speak up. There is a grassroots movement that is dedicated to legislating nurse-patient ratios. It's the Nurses Take DC organization. If every nurse reading this would make a call to their legislator, or write an email- it will make a difference! Easily find out who your legislators are and make a call. Write a letter to support H.R. 2392 and S. 1063 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 legislative bills. Legislators respond to topics based on the number of phone calls and mail from their constituents. Please read Mandated Nurse-Patient Ratios and share it and this article on social media. Use hashtags #NursesTakeDC and #allnursesSTRONG
  2. 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
  3. New Jersey, along with fourteen other states and the District of Columbia have legislation or regulations that address nurse staffing. Registered nurses that are faced with a higher nurse to patient ratios are faced with a higher rate of burnout and job dissatisfaction. Patient-to-staff ratio s have potentially grave effects on the patients being served. These staffing ratios can have a negative effect on patient safety and ultimately patient mortality. Many health Care facilities are being affected by the growing need for more Registered Nurses on staff related to the increase in higher acuity of patients and the demand for shorter hospital stays. The New Jersey Legislature found that changes in the health care delivery system now had higher acuity levels. Recent studies have shown that this can result in medical errors, patient infections and increased injuries to both patients and caregivers. New Jersey's Assembly, No. 2548, introduced February 21, 2012, regulates the minimum nursing to patient ratio that would be provided in hospitals, ambulatory surgery facilities and certain Department of Human Services facilities. At minimum, there would be one registered nurse for: 1) Every six medical/surgical patients (during the first year after the regulations are adopted) 2) Every five medical/surgical patients (following the first year of the adoption of the regulations) 3) Every four patients in a step-down unit 4) Every four patients in a telemetry unit 5) Every four patients in an intermediate care unit 6) Every four patients in an emergency department 7) Every two patients in a critical care service of an emergency department Every patient in a trauma unit 9) Every six patients in a behavioral health or psychiatric unit 10) Every two patients in a critical care unit 11) Every two patients in an intensive care unit 12) Every two patients in a neonatal unit 13) Every two patients in a burn unit 14) Every two post-anesthesia patients in a recovery or post-anesthesia care unit 15) Every two patients in a labor and delivery unit 16) Every four patients in a postpartum unit (where the mother and infant share the same room) 17) Every six patients in a mothers-only unit 18) Every four patients in a pediatric or intermediate care nursery unit 19) Every six well-baby nursery patients (State of New Jersey, 2012). The bill also provides additional requirements including maintaining a float pool of qualified nurses to accommodate nursing needs and nurses assigned to a unit are to receive prior orientation and have demonstrated competency for that unit. The staffing system must meet the approval of the majority of the nurses in that unit or the nurses' bargaining unit. Furthermore, it establishes a system for nurses to file a complaint for violations (State of New Jersey, 2012). New Jersey does not require hospitals to establish nursing staff committees to meet patient needs and establish staffing policies (ANA, 2011). Four states also require that their staffing committee consists of at least fifty percent of nurses who provide direct care to patients. Two states take it one step further and provide evidence-based guidelines (ANA, 2011). The American Nurses Association advocates "a legislative model in which nurses are empowered to create staffing plans specific to each unit" (ANA, 2011) allowing for flexibility to allow for accountability of charges, the intensity of needs during the shift and the level of nursing experience of nursing staff (ANA, 2011). The state of Washington had proposed a bill that would require safe staffing plans as opposed to specific nursing to patient ratios (Welton, 2007). Staffing ratios in the workplace affect the nursing staff, the patients, and the organization as a whole. "Researchers are examining the critical issues of how staffing, fatigue, stress, sleep deprivation, organizational culture, shifts work and other factors can lead to errors" (AHRQ, 2010). According to the Agency for Healthcare Research and Quality, having more patients per nurse puts the patient at risk for nursing care related adverse outcomes. These outcomes include UTIs, pneumonia, longer hospital stay, and even an increased mortality rate. As the ratio increases, the nurses' workload increases making them less able to attend to details or care for more critical patients in the amount of time they may require. Nurses surveyed by the AHRQ that had a nurse to patient ratio higher than recommended indicated job dissatisfaction in 40% of the nurses. These studies also found that only 33% of the nurses thought that there was enough staff on a daily basis to handle the workload they were presented with. One study by the AHRQ found that adding just one additional patient to each nurse on a surgical floor increased their likelihood of mortality by 7%. Increased staffing ratios impacts the nurse both physically and mentally. They are faced with more job dissatisfaction and increased risk of burnout. When a patient is admitted into the hospital, they are there to receive medical and holistic care. According to a study of acute care hospitals in New Jersey, Pennsylvania, Florida and California, "There was a ten-percentage-point difference in the mean percentage of patients who would recommend the hospital between those cared for in hospitals with better nurse work environments (69.9%) than those cared for in hospitals with poor environments (59.6%)" (Kutney-Lee et al., 2009). Patient-to-staff ratios affect not only the nurses, who get over-worked and burnt out and thus their job performance suffers; it effects patients who are being cared for by these burnt out nurses, nurses who are not giving their 100% because they have too many patients, and too little time. Patient satisfaction is one of the most important factors to keeping a hospital running and by improving staffing levels, "may ultimately save hospitals money by preventing adverse events" (Kutney-Lee et al., 2009). By improving patient-to-staff ratios, it may cost more money, but will improve nurse and patient satisfaction. By adjusting the patient-to-staff ratio by just one patient, would impact the care received by the patient and thus would increase the likelihood of that patient receiving care from that hospital again. The nurses are not the only ones who feel that burn out, they are not the only ones affected. Hospitals must remember that they are in place to care for patients; at the end of the day the patient is the most important factor in a hospital. The impact of total nursing staff to patient ratio in the hospital is significantly related to patient safety outcomes and in-hospital mortality. "Some private payers have followed the lead of the Centers for Medicare and Medicaid Services in no longer paying hospitals for the costs associated with certain nursing-sensitive, hospital-acquired "never" events, such as pressure ulcers and catheter-associated infections" (Buerhaus, Harris, Leibson, Needleman, Pankratz & Stevens, 2011). When nurses have a heavy workload the risks to patient's increase, as a nurses attention toward her patients becomes distracted and clouded by other mounting tasks. This situation is more likely to occur when there is inadequate staff per patient ratios, leaving less time for nurses to spend at the bedside performing direct patient care nursing assessments and interventions. According to Buerhaus, et al. (2011), better patient outcomes could be achieved by offering payment incentives as well as additional ongoing supportive resources for organizations that comply with suggested nurse to patient staffing ratios. A relationship has emerged between the level of in-hospital staffing by registered nurses and patient mortality, adverse patient outcomes and other quality measures. This evidence, proven in multiple studies cannot go unnoticed. Studies have been conducted proving that patient safety is directly related to the quantity and experience of Registered Nurse on staff. These findings are the reason some states have proposed that there be mandatory minimum nurse-to-patient staffing ratio be enacted. These mandates are intended to address a growing concern that patients are being harmed by inadequate staffing related to increasing acuity and complexity of care (Welton 2007). Although these mandates may be beneficial to the patient there are some negative impacts on the facilities affected by them. The cost increases associated with need to higher more Registered Nurses to meet the minimum requirements for staffing ratios will not be offset by additional payments to the hospital, which will evidently result in mandates that are unfunded. In response to this problem hospitals are decreasing other staff, ultimately leading to the extra burden on the Registered Nurse to perform non-nursing duties. "The American Hospital Association (AHA), along with its individual member associations, have universally opposed laws mandating any specific nurse-to-patient staffing ratio. The AHA has argued that nurse-to-patient staffing ratios reduce scheduling and staffing flexibility. The American Organization of Nurse Executives also opposes mandatory ratios and has called for a more balanced approach through increased monitoring of nurse staffing, improved recruitment and retention approaches, and development of undergraduate nursing education" (Welton 2007). The lack of additional funding for increased Registered Nurse's on staff is the main reason why many health care facilities remain resistant and are fighting against proposed mandates to increase nurse-to-staff ratio's. An alternative to implementing a minimum nursing to patient ratio is to change nursing from being a cost center to being a revenue center. Presently, nursing costs are designated to either routine floor care or intensive care cost centers. With being a revenue center, specific care and supplies would be billed to the patient. This would allow for reimbursement for the increased number of registered nurses needed to care for the patients. Medicare and other payers would reimburse the facilities for the actual care given rather than nursing being included at a set cost in the room and board (Welton, 2007). Billing for the actual hours of nursing care would also allow for a collection of data that could be used for a comparison of nursing care and trends and provide a consensus on safe working acuities. Additionally, the data could help set health care policies, assist in establishing rates for services and assist in implementing healthcare services research (Welton, 2007). There are steps that nurses can take to help change this issue in their facility. Nurses can join their Union or facility committees that address the United States Congress, State legislation and their facility's policy making. Alternative options include forming committees to address or modify time consuming tasks such as the admission process of new patients (Buerhaus, 2009), or issues such as missing or delayed arrival of equipment and inconsistencies in communication. Orientation for new nurse graduates could provide strong critical thinking skills and strengthen complex decision making with rationale through mentoring by experienced registered nurses (Ebright, 2010). Nursing can encourage brain-storming at Unit meeting for supplemental ideas such as RN stacking. This skill develops with experience while remaining continuously informed of the surroundings. " Stacking is the invisible, decision-making work of RNs about the what, how, and when of delivering nursing care to an assigned group of patients" (Ebright 2010).
  4. I've been busy lately, as I'm sure many of you have been, as well. I'm also finishing up an online leadership class, and my focus area is staffing/scheduling. I've been interested in this area since nursing school and, sadly, I can't see that much has changed. I'm particularly concerned that in the area of staffing/scheduling/workload, nurses don't take the advice of the much heralded Evidence Based Research we are all so frequently reminded to implement. In a nutshell, much of the EBR demonstrates that 12hr shifts are problematic, at best, dangerous, at worst. Yet, since the 1980s, when 12hr shifts went into effect, nurses, nursing organizations, and medical facilities have not budged much on the 12hr shift/schedule. I know the research also shows that for every nurse that doesn't like the 12hr shift, another nurse does, so, nurses themselves are mixed on the decisions. Nursing organizations and governing bodies have largely been silent, or at least, lax, with the exception of California's statutory legislation mandating nurse-patient ratios. I believe there is, or has to be a better way. One proposal that I've thought about is in the realm of more nurse autonomy in scheduling, which also flies in direct opposition to management/administration/hospital executive policies and practices. I believe flexible scheduling could achieve cost-cutting goals, patient safety goals, and boost nurse morale, as well. I also think that nurses have to decide what they really want! I'm not doubting that nurses want to do right by their patients. I'm not doubting that nurses are professionals and deserve to be treated as the most trusted & honorable profession in the United States. I think many nurses experience intra-personal conflict and don't know how to work out the personal and professional ethical dilemmas going on within some of us. On the other hand, I believe management is content with the status quo, as it is in their best financial and personnel costs to leave things as they are, despite the evidence-based research. But, I don't think either of us can have it both ways, at least not forever. So, I ask, what do we really want? If we push EBR as the standard, why don't we use the standard when it comes to scheduling/staffing? Or, are millions of annual medical errors totally unrelated to anything having to do with staffing, scheduling, and workload? And, why aren't our membership-based organizations doing more on our behalf in this area? And, what about the research that consistently demonstrates the low morale, abbreviated family time, sleep deprivation, high attrition, and other cons of the scheduling/staffing/workload mix? What about the much touted "work-life balance" and "holistic" living for nurses? Do we ignore the parts of EBR that we just don't like? Does management ignore the research that demonstrates that nurses want more flexibility, financial incentives, more time off, and more standardized/mandated workloads & nurse to patient ratios? Does management take into account any of the reasons why nurses are leaving the profession or at least leaving the floor, in droves? Is either side ready to take a seat at the table and work out the hard spots, always with the idea that there has to be a win-win? Both sides want the best for patients, but, is that same spirit given to both sides in the debate? My fear is that things won't change until something devastating happens that will exceed the risk management/liability limits set aside by any medical institution. In other words, when it costs more to pay out medical claims than it does to hire nurses for 12hours shifts, then we will see the need for paradigmatic changes in our profession.
  5. In this second of a series of Facebook Live Events about nurse staffing, Beth Hawkes and Keith Carlson talk more about bills that are in the House and Senate calling for mandated nurse-patient ratios and how you can be an advocate for safer staffing ratios and quality patient care. The ratios under discussion are similar to what is already in effect in California. Patient acuity is a consideration, however, there is a minimum nurse-patient ratio to ensure safer patient care. Beth and Keith provide more information about: The Bills HR 2392 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 Sponsor: Rep. Schakowsky, Janice D. (Introduced in House 05/04/2017) S 1063 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 Sponsor: Sen. Brown, Sherrod (Introduced in Senate 05/04/2017) Bill Summary These bills in the House and the Senate state that "nurses have a duty and a right to act based on their professional judgment and provide care in the exclusive interests of patients. Nurses may object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing their nurse's license. Hospitals may not: (1) take specified actions against a nurse based on the nurse's refusal to accept an assignment for such a reason; or (2) discriminate against individuals for good faith complaints relating to the care, services, or conditions of the hospital or related facilities. HHS must publish the names of hospitals penalized for violating the requirements in this bill." Ways to Influence Your Legislators - How to Advocate Call your legislators - before or after the rally Face-to-face meeting with your legislators at the rally or at local state office Write a letter Send an email Sign a petition Please add your comments and questions below. We want to hear from you. Beth and Keith will try to answer your questions here or in an upcoming Facebook live event. There are many readers who are very knowledgeable about the issues. Hopefully, they will post here as well. Are you planning to attend the rally? Please let us know. We (Beth, Keith, and the allnurses team) would love to meet you. [video=youtube_share;QL2daRJySN8]

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