I had planned on posting later about the link to allnurses.com, in which the nurse discusses being fired for eyebrow raising reasons. However, something far more important convened. It’s not quite about nursing, but…

Apple iTunes made a major blooper. Like really major. Like so major, that I’m surprised it isn’t plastered all over Stargate fan sites.

To backtrack, I don’t watch television and don’t have cable–out of choice. The last time my television was turned on was 9/11, to see the news. Four days later it went off again, and has remained dormant expect for movies. Somehow, I have inadvertently gotten addicted to Stargate. With Netflix, that is easy to happen. I started backwards with Stargate Atlantis, and then went back to SG1, even watching the original Stargate movie again.

At any rate, tonight we re-watched the season cliffhanger of Stargate Atlantis, which ended Season 3. And then, lo and behold a big surprise, we were able to get the first show in Season 4 through iTunes. It’s regular broadcast was yesterday, and since I don’t have the SciFi channel (remember, no cable) I would have had to wait until it became available by Netflix. And really, who can possibly wait that long?

Welcome iTunes. What a wonderful invention from Apple. Episode 1, Adrift, was available for $1.99. Ah, the convenience. And I was so ready to watch it.

Well, after making a tea and getting some nice dessert, we settled in to see what happens to the Lost City, which is now lost in space and running out of power. Dr. Weir is seriously injured, Rodney can’t decide what to do and no one is stoking his ego, and basically, the outlook is not promising.

But as soon as it goes on, we realize that something is veddy veddy wrong. Instead of a frantic crew, trapped in the Lost City of Atlantis which is now doubly lost since they are drifting in space and running out of power, we see the famous foursome hacking their way through a jungle. Shepherd, Ronon, Teyla and Rodney. They don’t seem extremely upset, they are on land, and not even discussing any of the event from the season cliffhanger.

Hmmm….

Shepherd has a little adventure with a strange crystal, and then they decide to head back to Atlantis.

Double hmmm…

And then we see Atlantis, all lit up, sitting nicely on some planet. Plenty of power, safe and sound. Not moving, not flying, just sitting in one spot as any city should be.

The opening credits go on, and then the name of the episode comes on. Doppelganger. No, this is supposed to be called Adrift. The episode we downloaded clearly said Adrift. But as you can see, it is called Doppelganger.

Well, I quickly went to investigate and saw that Doppelganger is actually the 4th episode of Season 4. What this means is that it hasn’t yet been shown on television, and iTunes screwed up major league. They apparently mixed up episodes, and sent us the wrong one. I’m sure the SciFi channel is going to be thrilled, as I can’t imagine that we are the only ones who got the wrong show.

Major league blooper, Apple. Seems like someones computer is suffering growing pains, or someone is sleeping on the job. And worst of all, I can’t see Adrift. Wah!!!

Anyway, for those of you thinking of downloading Season 4 from iTunes, you better check what’s coming over the cyberwaves.

Do you believe all the hype about a nursing shortage? If so, check out this link on allnurses.com. It really shows just how “desperate” employers are to hire and retain nurses. Especially retain them.

I’ll be back with my wonderful thoughts on the subject later today. Right now, it’s off to the Farmer’s market, even though it looks like the end of the earth outside…

I was pleasantly surprised to find that my comment box was not inundated with hate mail, in response to my less than sympathetic view of the doctor-to-be who sued to get more break time to pump her breasts. This type of incident does not benefit women, I’m sorry to say, even though that is so politically incorrect of me to say so.

As I mentioned in my post yesterday, the Board has already bent over backwards for her, by giving her an extra day to take the test, and supplying her with a private room and a breast pump, so she can pump while taking the test. Yes, you can do two things at a time. I know writers who conduct telephone interviews while they’re nursing their babies, and having worked in the NICU, have seen thousands of women pump. Some read while pumping, others talk on the phone or to their spouse/family member–one mom worked on her taxes. So please, this woman could have easily attached her boob to the pump and continued working on her exam.

Nursing moms have now become the new cause celebre. And while I certainly hope that we can stop the prudishness and gasping at the thought of a woman nursing a baby in public, I think that we also have to keep from going overboard on it. I remember a story that came out a number of years ago, about a new mother who was suing her employer. It may have been Microsoft, I’m not sure. At any rate, she had held some fancy position prior to giving birth, and was suing because she felt that she was being discriminated against.

There were two issues; one, she claimed that they refused to accommodate her need to pump her breasts, and two, she had been demoted from her fancy job.

Terrible, right? Poor woman. Well, on closer look….she had been given a place to pump but she didn’t like it. I guess the decor wasn’t fancy or plush enough for her. However, the company had very limited available space, and they had made over a small room for her. I suppose she felt that the CEO should have been booted out of the office to make way for her to pump…but after reading the details, it did seem like they had made every effort to find her a private and comfortable place.

On the second issue, she seemed to think that now that she was a parent, she could redefine her job description. Her former job was a high power one, and required a lot of time and effort. You know the score–weekends, evenings, and a lot of travel. Well, she said that now that she had a baby, she couldn’t travel anymore and wasn’t going to do weekends or evenings, or anything beyond 9-5. Hello???

If the job no longer suited her new lifestyle, then she should have quietly asked for a transfer or resigned. This is her choice. She does not have the option, however, to dump her own responsibilities on other people (who may also have families) or to refuse to perform the duties required of a person in her position.

The company refused to give in and so Ms. New Breast feeding mom sued. I don’t remember what happened, but I doubt that she had a leg to stand on. I think this kind of stuff only makes it worse for women, and I think in the long run, may make it more difficult.

For example, New Mexico passed a law recently that requires both public and private employers to create a clean place for breast pumping near a mother’s work station but not inside a bathroom. Well that sounds all nice and good, it could be a tremendous hardship for a small business, or outright impossible. What if there are no spare rooms that can be used?

A cubicle can be screened off, providing that the new mom is okay with that and doesn’t go and file a lawsuit because her employer isn’t renting her a room at the Ritz. A space can be cleared in a supply closet, and a sign put up on the door when the mother is using it. But if you get people like the woman who sued to get an extra 60 minute break to pump, then its going to be messy. Several other states already have these statutes, and I wonder if it has led to young women being discriminated against when applying for a job? And especially, if a woman is pregnant.

What it boils down to is how much accommodation the employer is expected to supply. If it’s a store, or a restaurant, then space is going to be at a premium and they are not going to be able to set up a sanctuary for breast pumping. I think the law would be more coherent if it spelled out expectations, and divided it up by company size and type. While I think that most women will be happy as long as they can sit down, plug in their pump, and have some privacy, there are others who will squeal and cite that the “law requires a breast feeding room that is near my work station.” A room used to stock office supplies isn’t good enough for them, even though it’s the only real choice. Plus, it takes more than 10 steps from their desk to get there. And some degenerate lawyer will take the case, no doubt. Which is why I cringed over the case of the woman taking the medical boards. It can definitely stick ideas into the heads of those who are lawsuit prone and think the universe revolves around them.

Also, another issue that may eventually come into play is how much accommodation do we give to one specific subpopulation? And this is a rhetorical question, but it is already happening. I’ve read about situations where employees with families think its okay for single people to work overtime but not them. They have to leave early for soccer practice, but hey, John is single and certainly won’t mind finishing up my work. They can’t go on a business trip because Saturday is Maddy’s ballet recital–oh, you mean it’s part of my job? Well can’t John go? Single people have nothing to do.

I was amazed by some of these attitudes when I was working as a nurse. There were a few of my coworkers who really thought that because I wasn’t married with kids, that all I did in my spare time was walk around malls and talk on the phone. That there was nothing of value or interest in my life, and that I was available to come into work at any time. Two coworkers didn’t even think that single people should have the option of having Christmas off. In their minds, first dibs went to nurses with kids. It never occurred to them that a single person, or even a married one without kids, could possibly have anything to do on Christmas, or had any right to enjoy and celebrate the holiday.

Again, back to accommodation, and some questions:

Should a breast feeding mom be allowed to have a flexible schedule at work, even though that flexibility is not extended to other workers? And I should add, workers who would like some flexibility?

When I worked in the NICU, we used to refer to the obsessive lactation consultants as “Nipple Nazis.” You know, the ones who are basically telling new moms that their baby will die without breast milk, and think that NICU nurses are being cruel by not permitting mom to nurse a 1 pound premie hooked up to a ventilator.

So it is in the realm of the nipple Nazi that I write this note. And I’m sure that breast feeding aficionados are rejoicing over this story, and will find my comments nothing less than sacrilegious. However, I find this story rather disturbing.

Which story? Well, it concerns the Harvard student who is taking her medical boards so that she can become a physician. The woman, 33 year old Sophie Currier, demanded that she be given extra break time during the exam so that she could pump her breasts. The allocated 45 minutes wasn’t enough for her, despite the fact that she had been provided with a breast pump and a private room in which to pump. But I guess pumping on her break was too demeaning, or maybe she’s got extra gigantic boobs that take more than 45 minutes to pump? Or maybe she should be allowed to bring her baby to the test, and let it nurse while she filling in the boxes.

From the Boston Globe:

The woman, Sophie Currier of Brookline, argued that it would be uncomfortable and possibly pose a health problem if she took only the allowed breaks.

The National Board of Medical Examiners offered to let her pump while she took the test, but she said that would put her at a disadvantage during the exam, which she must pass to graduate and begin her residency at Massachusetts General Hospital.

“I now feel that I am able to take this test without putting my health or my child’s health at risk,” said Currier. “I hope this decision encourages moms to breast-feed and employers of moms to accommodate their needs.”

Yes, I’m certain that her health and that of her daughter are going to be jeopardized by her being restricted to a 45 minute break. And here’s a great line from the anonymous breast feeding specialists…”Lactating women can experience pain and risk developing infection of their breasts if they don’t express milk at least once every three hours.” Uh, maybe when you’ve got a newborn who’s eating every 2-3 hours, but at four months, a lot of kids are sleeping through the night. I don’t know of any breast feeding moms who set their alarm clock to wake up every 3 hours to either pump or force milk on a sleeping baby.

But let’s back track. Now not only is Currier demanding extra break time, but she has already been given an extra day to take the test! Duh, doesn’t that help with the breast feeding schedule? She has dyslexia and attention deficit disorder, so while everyone else has to take the test in one day, she gets two. And she doesn’t think that she is being fairly accommodated?

Now let’s take a look at this more closely. The test is 9 hours, and most students do it in one day. Since Currier has two days, that gives her 4.5 hours each day. So how many times does she actually need to pump her breast in a 4.5 hour period? She can pump or nurse her baby before the test, and pump or nurse afterwards. But she gets a 45 minute break in there, so that isn’t sufficient? Why on earth does she need an extra hour? Something is very wrong with this picture.

A lot of articles are yapping about how this is such a great step forward for mankind (the Medical Board is going to appeal the ruling, by the way), but to me, this woman seems just overindulgent and wants everything her way. While I think accommodations should be made for people who need them (and it seems that the Board has bent over backwards for her), I think this chick is really pushing it. Sorry, but having a baby does put some restrictions on you. There are inconveniences, and sacrifice, but it is a choice that she has made.

Pray tell, what is she going to do when she starts her residency? Demand that she get less on-call time than everyone else, get more breaks, gets off Christmas and New Year’s, and doesn’t have to work on weekends–all because she has children and is breastfeeding? Residencies can be brutal, especially the first year, and it seems that she can’t even cope with taking the Medical Boards, let alone a residency.

What will she do if it’s time to pump but a patient is crashing? Tell everyone to wait so she can empty her breasts? Is she going to demand a “light” residency schedule so she doesn’t have to be away from her children so much?

She also had the option of delaying the test, which is given several times a year. I have a friend who took off a semester from dental school when she had a baby, so that she could relax and take care of him during his first few months. Would it be so dreadful for Currier to take the test a few months from now, when her daughter is older and maybe nibbling on rice cereal?

Apparently, she has already failed the test once. And rather than review her options (of which there are numerous), and make some sane choices that might better suit where she is right now, she chooses to file a lawsuit. Great going.

Her lawyer was quoted as saying, “As a society we should be supporting her efforts to become a doctor, not put roadblocks up for her.” That has to be about the most bogus statement I’ve ever heard. They’ve basically paved her path with gold, and jumped through hoops to accommodate this woman. I guess if she flunks again, she’ll blame it on not having sufficient time to pump (maybe they should allow her a break every hour and then give her a week to complete the test), or blame it on the “mental stress” of her traumatic ordeal.

Personally, I feel a little sorry for any of her future patients.

This is an interesting article that appears in today’s NY Times, about the usual suspects–greed and the deterioration of services in nursing homes. So what’s new about this? Same old story–a chain of nursing homes gets bought up by a private corporation, whose only goal is to make money. So the end result isn’t pretty, not for staff or patients.

From the NY Times

Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.

The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.

That alone should make your flesh crawl. Nursing homes are generally poorly staffed, with a serious lack of RNs. So this brilliant suit decided that halving the number of nurses was a great move. Oooo, the profit.

And this happened in Florida, one of those lovely right-to-work states, so the nurses weren’t unionized and couldn’t really fight back.

The investors and operators were soon earning millions of dollars a year from their 49 homes.

Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.

“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.

So why didn’t the regulators shut the place down? Why didn’t they start fining the company about $1 million a day until the problems were fixed? I think that strong action needs to be taken, if this type of travesty is going to be addressed in a meaningful way.

Just a few more notes on the importance of nurses…

Nurses are often residents’ primary medical providers. In 2002, the Department of Health and Human Services said most nursing home residents needed at least 1.3 hours of care a day from a registered or licensed practical nurse. The average home was close to meeting that standard last year, according to data.

But homes owned by large investment companies typically provided only one hour of care a day, according to The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services.

For the most highly trained nurses, staffing was particularly low: Homes owned by large private investment firms provided one clinical registered nurse for every 20 residents, 35 percent below the national average, the analysis showed.

Regulators with state and federal health care agencies have cited those staffing deficiencies alongside some cases where residents died from accidental suffocations, injuries or other medical emergencies.

And I also blame the nurses who stayed on there, and who didn’t keep reporting infractions. They should have leaked it to the press if need be, if they weren’t getting any response. There are plenty of jobs in Florida, and by working in a place like this, they are actively contributing to the abuse of the residents. No, they are not helping the patients. They are helping the CEOs, president, VPS, etc, make a fortune.

The article also explains how the corporations make it very difficult to get sued, and very expensive for the lawyers, because of the way the holdings are divided up among investors. Which goes to show, this system is very broken and no one is held liable. Oh, maybe they can sue the nurse who neglected the patient….never mind that she was the only one on duty.

The article points out that people are making huge profits at these homes, at the expense of the patients, and no one seems to be accountable. Aren’t there state laws? What’s the point of having the places inspected if nothing of note is going to be done?

I do think that nurses should be held responsible for medical errors, especially ones that are made out of stupidity or ignorance. And on the subject of ignorance, this flows into my favorite peeve–forcibly floating nurses to work in areas where they have no experience, are uncomfortable, and can’t function as they should. That is inviting disaster, and nurses should refuse to do it. There’s a nursing shortage, right? Well, no better time than now to stand up for yourself.

But back to errors…most are unintentional, and are an endpoint of a system that is badly damaged. Too many patients, overwork, not enough help, and not enough time to doublecheck everything that comes from pharmacy. Plus, there may be nothing wrong with the drug or dose, but someone (and not necessarily the nurse) failed to note that the patient is allergic to the drug. Or the drug dose is correct for someone with normal kidney function, but this patient is going into renal failure–only the physician failed to take note of that, the pharmacist didn’t know, and it’s hardly expected that the nurse to going to read the physician’s notes and study lab values from the previous day before giving an ordinary drug.

There is an interesting on Nurse.com discussing the rise in criminal charges against nurses who make unintentional errors. Considering that most physicians are never charged with criminal intent, even if they amputate the wrong leg or remove the brain by mistake, it seems a little excessive to charge your average nurse. True, killing someone because of a medical error is tragic–but then, most drunk drivers who kill people tend to go free or with a piddly sentence. People who have been involved in traffic accidents because they were text messaging while driving don’t seem to be charged with criminal offense either. So why nurses?

In late 2006, the Wisconsin Department of Justice charged obstetric nurse Julie Thao with a felony for making a medical error that caused the death of a patient.

Although Thao pled no contest to two lesser misdemeanor counts for the role she played in the death of a patient at St. Mary’s Hospital in Madison, Wis., the direction society is moving by prosecuting nurses who err unintentionally is scary indeed, says Gina Dennik-Champion RN, MSN, MSHA, executive director of the Wisconsin Nurses Association.

There are nurses who are criminally negligent, and who should not be practicing. But as this article points out, many of the errors that nurses make are part of the larger broken system, as I mentioned earlier.

“It has become commonplace and accepted among administrators and their peers to mandate that nurses work overtime,” says Stephanie Bloomingdale, director of public policy for the Wisconsin Federation of Nurses and Health Professionals. “The way we see it is that currently we have employers out there who are absolutely irresponsible in forcing nurses to work mandatory overtime.

“When nurses work prolonged hours and are forced to work beyond the end of a shift, they are often fatigued —- and we know that fatigued nurses are more likely to make mistakes,” Bloomingdale says.

The nurse in this article, who had criminal charges filed against her, made her lethal error while working a shift separated by only seven hours from a double 16-hour shift the day before, according to published reports. Hospitals have to realize that they can’t work their staff to death and escape lawsuits; nurses have to stand up for themselves (and their patients) and just say no to mandatory overtime; and while many nurses like the overtime pay, they have to realize their limits.

It seems to be a growing trend, however, that criminal charges are being filed against healthcare workers. This is all the more reason for nurses to take stock of a situation and know that they could end up in prison for making a lethal medical error. And like most things, it is always so easy to blame only the nurse, when in fact, the medical error may have likely been the result of a chain of events that begins at the top–like the facility refusing to staff adequately.

At the same time, whenever a medical error occurs, the roles of other healthcare providers need to be evaluated.

“If the supervisor, the director of nursing, or the hospital CEO breached his or her responsibilities and could be charged with a criminal action and was not, well, shame on the state’s attorney,” Brent says. “It’s not fair if a nurse gets charged with a crime and others do not.”

I haven’t complained about spam lately, and I am thankful that it has been lessening. It does seem to come in waves, along with the type of junk that spammers are trying to cram into my comments. For a stretch of time, I’ll get endless porn stuff. Then it’ll switch to hot deals for cialis and Xanax. Then it goes over to Texas Hold ‘em and other gambling sites. Then there are some that I just can’t figure out, and really don’t want to know what they are.

Now it seems, we are back to porn. Here was a cute morsel that I found this morning:

drunk blowjobs jade

So does this mean that the blowjob itself is drunk, or that the person performing the blowjob is drunk and also named Jade? Or that the blowjobber is wearing jade jewelry, perhaps drunk jade jewelry?

What a great way of procrastinating–trying to figure out the deep meaning of porn.

Yesterday, of course, was the 6th anniversary of the destruction of the World Trade Center in NY. I have to say, I was surprised that it was completely ignored on some of the websites and forums that I visit. And the reason I am surprised is because last year, it was an entirely different story. In 2006, a lot of people were saying how they were glued to their TV sets watching all the footage, the memorial ceremonies, and what not; some were saying how distressed they were over it and unable to work; others were saying that they found it difficult to get anything done because their mind was on 9/11. One writer actually said that she thought that it was “disrespectful” for anyone to query editors on this day, and that she couldn’t possibly understand how anyone could do something that mundane on 9/11. The conversations went on and on, so that it why I was surprised to see nary a peep. Even the Google News had very few stories about ceremonies or a rehash of events, etc.

I guess that’s what happens once we start reaching multiples of 5 and 10 year anniversaries. There was much media press and discussion for anniversaries 1-4. Then last year, the 5th anniversary, was a biggie. This year is #6, which now is just an ordinary year, falling between 5 and 10 year anniversaries. And things have changed. Construction is now going on at the site, the focus is getting out of Iraq–which has killed more Americans than who died in the WTC (and not to forget tens of thousands of Iraqis). About 27,000 American soliders have been wounded, many seriously so. Many are suffering from severe psychological problems. Millions of Iraqis are now refugees, and Osama bin Laden is still at large.

So there are many other things to think about it. The destruction of the WTC and the attack on the Pentagon were tragic events, but they are being relegated to history, as the focus is now on resolving the cause of the carnage which is now taking place on a daily basis.

Anyway, it was just interesting to see the shift from last year to this year.

And now, back to our regularly scheduled blogging….

I just love this history site I found. It is terrific for a history buff like me, as it contains first person accounts dating back several hundred years ago. I’ve been looking at entries related to health and nursing, but they cover all kinds of topics.

This is an interesting audio interview with a nurse named Bruce Priebe who became infected with HIV and subsequently became an AIDS activist in the 1980s.

PRIEBE: I was a nurse for eight years before I found out that I was HIV+. And I like to think that I was delivering healthcare in a caring, compassionate way and a way that did not bring any harm to anyone. And I didn’t have a personality change after I found out I was HIV+. I still feel that way. There are a lot of healthcare workers that are HIV+, including physicians. But we do not allow them to tell us that because when they do we hit them over the head with a hammer. So I can understand why people chose not to do it. Unfortunately, because again, that creates the illusion that there aren’t, that there’s just this isolated little group.

I don’t really consider myself a political activist, but you’d be amazed at how active you can become when this is happening to you and to your friends and your family. I think it’s called a lot of us into a type of activism that we might not have imagined seeing ourselves doing. We formed a civil disobedience group called the Forget-Me-Nots and we had t-shirts with pictures of people close to us who had died with their names and the dates of their birth and death. And we went to the Supreme Court and were arrested. And when we were at the FDA in 1988, we were chanting 40,000 died and I remember thinking, what a horrendous number of people — 40,000 people. And yesterday I read there were 153,000 people and God only knows how many thousands of people will have died by the time this film is seen.

Unfortunately, the audio or transcript doesn’t say if Priebe became infected in the workplace via a needlestick, or if he was a gay male who picked it up sexually, or so on. I think that information is important to the interview, as it would demonstrate that healthcare workers were very much at risk, especially in the early days of the epidemic.

For nurses working during those good old times, it probably didn’t seem that way. If nurses think that working conditions are bad now, please take a look at this except from the autobiography of Mary Roberts Rinehart, who trained as a nurse in 1893.

That first night duty was simply plain hell. Nowadays, when I have occasion to employ a nurse, she talks of eight-hour shifts, of a dozen things I do not understand. That hospital of one hundred and fifty beds, and with emergency operations day and night, was staffed with thirty nurses, all student nurses. We ran the wards, the private rooms, the operating rooms—two of them—the general dispensary, and the eye and ear clinic. Such a thing as a graduate nurse coming in to care for a private patient was unknown. Instead, during the second year of training, a small number of seniors was sent out on private duty. What was paid for them went to the hospital, not to them.

The nowadays that Mary is talking about is circa 1930, as her memoir was published in 1931. A lot had changed in the 40 years since her first night of training. Eight hour shifts–how novel. I highlighted what she said about graduate nurses coming in to care for a sick patient–hospitals back then were staffed with student nurses, give or take a few head nurses. It was your basic slave labor, and many hospitals eagerly opened nursing schools (some quite dubious) in order to get free labor that they could work as hard as they wanted, and without any restrictions on job description or hours worked. By 1930, however, it seemed that the free ride was coming to an end, and a number of labor laws had been passed.

I had three wards, C, D, and E, on that night duty. Also I had the emergency ward—E, however, was a convalescent ward, and gave no trouble. But D was a nightmare. It was the men’s medical ward, and to it came the delirious typhoid cases, an occasional delirium tremens, any sick man who needed help. Not only was typhoid still raging in the city that year, but the aftermath of the panic of ‘93 which had ruined my father had filled the wards. Disease was fostered by ill-nourished bodies, and unemployment was still rife. That winter the bread lines wound for blocks around the city streets and men lay at night for shelter on the bare floors of the station houses. When they were brought in, injured or sick, they were ragged and filthy, their bodies gaunt. Sometimes they tried to kill themselves and we got them, dazed with drugs, writhing with poison, wet from the river.

The drug cases were very bad. If the drug had been a narcotic they had to be kept awake, roused from coma; they had, as soon as possible, to be walked about. One interne had a heroic method. He knotted towels, dipped them in ice water, and beat them to keep them awake. Then, an orderly on one side, himself on the other, he walked them up and down, up and down. They would stagger, go to sleep on their feet. More ice water, more walking. When they reached the walking stage they lived.

The training was the worst of it, as the vast majority of student nurses went into private duty after graduation. A few worked for the emerging public health service, and a few must have stayed on in the hospital as a head nurse or instructor, but hospital work was primarily unpaid labor for students. Mary Roberts barely survived her training, and married a physician soon after she graduated, and never worked as a nurse. She went on to have an extremely successful career as a writer.

Come to Florida, and find yourself in the land of unique opportunities…..so reads an advertisement that found its way into my in box. The ad is featured in Nursing Spectrum, and while I realize that they must run advertisements (however inane) to support the publication, and they don’t really care what the ads say as long as they don’t feature child porn or headless nurses–nevertheless, I have to wonder why intelligence is so frequently absent from advertising.

The PR spin wizards who created this tribute to the state of Florida must truly believe that nurses are just a bunch of dim-witted cretins with a single digit IQ. The ad makes it sound that Florida is indeed, paradise found, and a haven for nurses seeking refuge from the mean, cruel world. Which of course, begs the question–if Florida is such a fabulous place to work, then why is there such an acute shortage of nurses in that state? And no, it’s not solely because of the geezer population filling beds to capacity with bed sores, heart attacks, and arthritis.

Florida is also one of the prime destinations for travelers, and yet, most are not tempted to remain and go on staff. They travel in and out, and back and forth, but are apparently not interested in working permanently in such a glorious place as Florida.

Granted, the state isn’t that bad, and has pluses and minuses like anywhere else. It also depends on where in Florida you live, as the geographic regions vary dramatically as far as politics, type of people, etc. But overall, I hardly find it a great place for nurses. And one thing that the ad never mentions is salary. Dig through all of the glitz and double talk, and there is not one mention of pay. Why not? Well Florida is one of the lowest paying states, as far as nursing goes. The pay is not in line with the cost of living, and it really is awful.

The ad is from the Florida Hospital Association (that should already arouse suspicion, that you can’t believe a word of it), and begins with the following:

A fabulous place to live. Florida has more theme parks, entertainment and cultural centers, resorts, sports venues and tourist destinations than any other area in the country. It boasts more than 7,500 lakes and rivers, everglades, rich, deep forests in the north and gorgeous beaches all along its 1,100 miles of coastline. In fact, no part of Florida is more than 60 miles from its famous beaches. All of this, along with a subtropical climate of mild winters and quite warm summers, makes Florida the premiere attraction state in the US.

Yes, there are many interesting things to see in Florida, and I do love the beaches there. But what exactly do they mean by “cultural centers?” Is that referring to culture, such as museums, opera, theater, art galleries, book stores, etc? Or do they simply mean “Florida is the home of Epcot?”

And I love their newspeak, and the cute way they define the climate in Florida. A land of “mild winters and quite warm summers.” What is a “quite warm summer?” Is that like a summer that is warm but not hot? Warm like a piece of toast right from the toaster?

This is PR ninny speak at its best, and in fact, sounds a lot like realtor speak, when they describe a house as having “newer carpet,” or a “charming” kitchen. Translation; the carpet needs to be replaced and the kitchen hasn’t been renovated since 1860. But getting back to the climate, I guess they couldn’t say anything that might tarnish the perfect image they are portraying. Florida has horrendously hot and steamy summers. They are unbearable for the most part, unless you like being steamed alive, and last from about April thru October. Summer nights are hot and sticky, and filled with mosquitoes galore. And on the subject of bugs, I notice that’s not mentioned anywhere in the ad; that any nurse with with even the slightest phobia of insects should stay clear of here. Unless one truly loves to play with 2-3 inch flying cockroaches (affectionately named palmettos).

They also neglected to mention that hurricane season lasts for 5 months, and yes, Florida is the state most likely to be hit by storms. Florida is blessed with two coastlines opposite each other, so if a storm missed the Atlantic coast, chances are, it will hit the Gulf coast. Or both, as has happened in the past.

Here’s another precious line…”makes Florida the premiere attraction state in the US.” Really? By whose statistics? And what is a “premiere attraction state?” More roller coasters than any other state? More jumbo swimming pools? More pictures of Mickey Mouse?

Where do PR people learn to talk like this? And do they think that anyone believes them, or that a nurse is going to come and work in Florida because she can get to meet Donald Duck?

Right to Work

As in most nonsensical ads that try to sell snake oil, they usually begin by trying to sell you on the location rather the job. I’ve seen countless ads for nurses that show people climbing mountains, prancing through forests, sitting at cafes and giggling, or watching sunsets. Nothing about healthcare, or even images of people who look like they might work in a hospital, as though the ad wants to make you believe that if you do come and work at hospital X, most of your time will be spent sky diving and flirting with gorgeous men.

In this ad, the photos along the side look like an ad for the Florida Tourist Bureau. There’s a picture of someone playing golf, the space center, a sunset, a sailboat–like anyone trying to survive on the salaries they pay is going to be able to afford a boat! There’s no indication from the photos, that this has anything to do with nursing.

But in the second section, comes their feeble attempt to show that Florida really is a worker’s paradise. It’s hysterical and pathetic at the same time, and again, how stupid do they think that nurses are?

A great place to make a living. Florida, with a workforce of more than 8 million people, is a right-to-work state. And Florida has no personal state income tax. Best of all, you’ll work with some of the nation’s premier healthcare organizations, with state-of-the-art advances in medical care, and a focus on healthy and productive work environments for RNs. In fact, Florida leads the Southeast with 17 Magnet-designated hospitals!

The most important factor here is right-to-work, and this ad highlights this facet about Florida as though it is a plus. Do any of the PR spinners even know what right-to-work is? The Florida Hospital Association certainly does, and I have to say, it really does take major cajones to try to pawn it off as being beneficial to nurses.

Right-to-work sound so nice, so working man, so Bruce Springsteen. It even sounds Marxist, as it conjures up pictures of workers marchers with their fists raised. Does right to work mean that everyone living in a state has the inalienable right to a job, and that one will be provided because of this law? Well, far from it. Right-to-work is merely a damaging piece of legislation that is heavily supported by industry, with the sole purpose of preventing and/or weakening labor unions.

What it says is that it prohibits trade unions from making membership or payment of dues or “fees” a condition of employment. Mandatory union membership is really necessary to offset the power of big business in a market economy. If employees are not required to join the union, then it severely weakens the union, which is precisely what employers want. The Right to Work laws give some employees a free ride, by enjoying the benefits of unionization where they work without paying the costs associated with maintaining their employment rights and benefits.

So is the Florida Hospital Association that brain dead as to tout right to work as a benefit in being employed in Florida? Apparently so, but then again, they can’t figure out why nurses aren’t flocking to their facilities.

Since the 1940s, 22 states (and Guam) have enacted Right to Work laws. They are: Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Iowa, Kansas, Louisiana, Mississippi, Nebraska, Nevada, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming. It is interesting that half of these states are in the south, where salaries are lower than elsewhere. True, cost of living is lower, but these states also don’t seem to do well in other areas. In 2001, for example, schools in the southern states ranked lowest:

In fact, it might do well to look at how the rest of the states that formed the old Confederacy did in the report. None of those 11 states finished in the top 25. The highest was Virginia, ranked No. 27. Then came Texas at 35, Florida at 38, North Carolina at 40, Arkansas at 42 and then Nos. 45 through 49 were Tennessee, Alabama, Georgia, South Carolina and Louisiana, respectively.

Salaries also tend to be lower in right-to-work states. An analysis which looked at the effect of right to work on wages reported the following:

To determine the effect of right-to-work laws on wages we estimate log wage equations using the Bureau of Labor Statistic’s current population survey-outgoing rotation group (CPS-ORG) data for 2000. The sample consists of 152,576 prime age workers, ages 18-64, who earn wages or salaries. Average hourly wages for the sample were $15.54, and median hourly wages were $12.25. Median wages for workers living in right-to-work states were $11.45, while wages for those living in non-RTW states were $13.00, indicating that wages were 11.9% lower in RTW states.

Many of the right-work-states also do poorly as far as healthcare. As of June 2007, Texas had more than 30% of its adults under age 65 without health insurance in 2004 to 2005. The Commonwealth Fund reported that Hawaii, Iowa, New Hampshire, Vermont and Maine had the best healthcare systems (all non-RTW states), while Oklahoma, Mississippi, Texas, Arkansas and Nevada as the worst (all of them are RTW states).

So while just being a RTW state doesn’t mean that the place is a mess, a certain pattern does emerge. These states certainly don’t shine, for the most part, in providing basic services for their residents. Conversely, many of them often advertise as being “friendly to business,” when they try to attract industry to their states. In other words, you won’t have to deal with pesky unions, and you have leeway in how badly you can treat your employees.

There is an interesting rundown from the Center for Policy Alternatives on how Right-to-Work laws only serve to make life more miserable for employees. Here are a few highlights:

Right-to-Work laws inhibit the right to organize.

Right-to-Work laws do not guarantee any rights. Right-to-Work statutes prohibit employers and unions from voluntarily negotiating a union security agreement. A union security agreement requires employees who benefit from the union’s representation to pay dues that cover the costs of union negotiations, contract administration, and other union-provided job services.

Right-to-Work laws decrease wages for everyone.

Because workers’ organizing rights are diminished in states with Right-to-Work laws, an average worker earns about $7,131 a year less than workers in free bargaining states ($30,656 versus $37,787).1 Across the nation, union members earn $9,308 a year more than nonunion members ($41,652 versus $32,344).2 Clearly these laws only provide a right to work for less.

Right-to-Work states have more poverty, higher infant mortality rates and poorer schools (as I’ve already touched upon).

Right-to-Work states have a poverty rate of 13.5 percent, compared with 12.2 percent in free bargaining states. The infant mortality rate is 7.94 percent higher and the uninsured population rate is 15 percent higher on average in Right-to-Work states. And Right-to-Work states spend on average $1,680 less per pupil in elementary and secondary school. The lack of spending results in lower teacher salaries and student test scores—average teacher salaries are $6,943 lower and composite ACT scores are 3.55 percent lower in Right-to-Work states.

And yet, the Florida Hospital Association is highlighting and showcasing this as a plus. Come work in Florida, where you will never be protected by a union, where you will be paid less, where your kids can attend substandard schools, and where healthcare is worse. Come to the land where the employer sits upon the throne and you will be treated as peon and tossed to the dogs if you dare complain.

Salary

Finally, this goofy adds highlights all the wonderful “perks” that are offered by many members of the Florida Hospital Association, but never once do they mention competitive pay. Or anything about salary. The ad does give vague terms like “Defined Clinical Ladder” and “Flexible Scheduling.” But what do those terms really mean? Does it mean that you get a raise of 5 cents an hour (generous by Florida standards) when you move from step 1 to step 2? How long does it take to move up? Does flexi scheduling mean that you get to choose between working Christmas or New Year’s–provided no one beat you to it?

The cost of living in Florida has risen considerably, and car insurance, homeowners insurance, property tax, and sales tax in Florida are quite high. Even if there is no state income tax, these things offset the advantage. Real estate has gone through the roof, and food is quite expensive as well. Plus, with all the recent hurricanes, you are lucky if you can even get insurance on a new home, especially if it is close to the coast. The salaries have not risen in Florida to match the rising cost of living.

But none of these things matter, according to the Florida Hospital Association. Florida gives you the right-to-work, the right to a poor salary and poor treatment.

Getting ready to pack your bags?

I’m not sure who wrote this or what this website even is, but thought it was worth repeating, just to make some nurses queasy:

During the early days of nursing, there was no uniform for nursing. They only gained popularity when Florence Nightingale, one of the first women pioneers in the medical field, established the importance of wearing nursing uniforms during the Crimean war. The first nursing uniforms were dark-gray, full-length dresses covered by white aprons. Today, nurse uniforms take on many styles and functions for seeing to the safety and security of patients.

Over the years, nursing uniforms evolved. White dresses and hose were the standard garb, but when many complained because these were impractical and difficult to work in, white tunics and pants came about. These were more comfortable to wear and nurses could actually move around easily. Nowadays, most nurses wear colored uniforms and nurse scrubs. The colored uniforms and scrubs are more convenient, since dirt or stains can’t easily be detected.

However, according to many critics, more patients are confused with colored uniforms and nurses can’t be easily picked out from the rest of the hospital staff. That is why, many hospitals reinstated white nursing uniforms with a designer flair for style and comfort. These uniforms not only give patients a sense of security, but also give nurses a level of comfort and style that they expect in their day-to-day attire.

Nursing uniforms are indeed an effective way for patients to easily recognize the nurses who take care of them. Not only that, nursing uniforms give a sense of pride to the nurses who wear them, since they are just one symbol of their love and dedication to their profession.

Everyone is entitled to their opinion, but this sweet little tribute to the “woman in white” is not only riddled with errors, it is downright silly.

The earliest uniforms were those wore by nurses who were part of religious orders, and that included both men and women. So if we want to get technical, those can be considered the first nursing outfits, and later on, secular nurses in some nations did wear uniforms based on that, ie, the veils worn by nurses in the UK and Australia (along with the term “sister” utilized).

Florence Nightingale had absolutely nothing to do with wearing uniforms, and she established no such protocol during her stint in the Crimea. At the time Nightingale took her troopers to care for the soldiers in the Crimea, she wanted to draw a strict line between nurses and hookers (yes, you read right). Her women were coming to nurse men, not to screw them, and she established strict protocols of behavior so that they would be taken seriously. At this time in England, secular nurses had a very bad reputation, and there was good reason for it.

Her nurses did not wear uniforms, and the idea never crossed Nightingale’s mind. The women wore ordinary dresses that one might wear for doing housework, and covered them with an apron, to keep them clean. And even in the first nursing programs–including the one Nightingale started in 1860–the students did not wear uniforms. In fact, the idea of wearing a uniform was repugnant, since it was something that they equated with being a maid.

The first real nursing uniform appeared in the 1880s, at Bellevue in NY. Up until this point, nursing schools and nurses did not wear uniforms. Euphemia Van Rensselaer is given credit for the introduction of the blue and white striped uniform, with the white cap and white apron, that was adopted by the school. However, the style of the dress was left to the discretion of the individual student. . By 1900 the style of the uniform was standardized, along with a distinctive cap.

The white uniform, certainly the most impractical color that could have possibly been chosen, was not always an “integral” part of nursing, regardless of those who moan and groan that it is nothing short of a threat to national security if nurses wear anything else. Up until the 1920s, the standard nursing uniform was generally a single color or striped dress, worn with a white cap and white apron. No white uniforms. And since most graduate nurses worked either as private duty nurses or for the public health system, it really didn’t matter that much what they wore. Hospitals were staffed for the most part by slave…oops..I mean student labor.

That is why, many hospitals reinstated white nursing uniforms with a designer flair for style and comfort. These uniforms not only give patients a sense of security, but also give nurses a level of comfort and style that they expect in their day-to-day attire.

It would be interesting to hear how wearing a white uniform gives a nurse a “level of comfort and style…” Blood stains really show up nicely on white, and it gets gray or yellow tinged after many rounds in the washing machine. Is wearing white really more “comfortable” than other colors? Most people also do not look particularly good in white, and I doubt there’s a great sense of comfort in knowing that every speck of dust, spill, and splatter is going to show up on your uniform. I personally find the white uniform distasteful in that it reeks of the “angel” image of nurse, one of purity and selflessness. The angel of mercy, the angel in white. Somehow, you are less angelic in scrubs.

Hospitals that are forcing nurses to wear white again have faced resistance, and the only reason that they are doing so is that they see it as some sort of PR scam. You know, that they are going to draw a larger share of patients who will flock to the hospital because their nurses are professional and wear white. Or some misguided ninny in PR thinks that forcing nurses to wear white is going to do wonders for recruitment and retention. Believe me, the return to whites is not because the nursing staff requested it.

Finally, the idea that nurses should wear white so patients can recognize them is a little outdated. Would we return to horse and buggy, simply because a lot of people used to recognize that as the means for traveling long distances? The color white is merely a blimp in the evolution of nursing dress. That’s all it is. Nurses in the US wore white for about 50 years before the dress code began to evolve. Caps mercifully vanished, and scrubs became more common. Many older patients, or those who grew up on General Hospital, still associated white with nurses, but I doubt that is true for the majority of patients. The people who diligently tune into House, ER, and Scrubs do not see nurses in pearly whites. They do not see nurses with caps on their heads. The association with white is disappearing.

Some people also think that anyone wearing a suit or a nice dress is also a doctor. Should we tell executives, QA people, social workers, pharm reps, etc., that they too, must wear a uniform so as not to confuse the patient?

Anyway, this article was just one of those silly diatribes, riddled with inaccurate information, that is trying to glorify the good old days of white–those days, I may add, when nurses were paid less than factory workers, had to stand when a male doctor walked into the room, and mopped floors as part of her duties. Thanks but no thanks.

This is actually an interesting document, published by the California HealthCare Foundation and First Consulting Group. It’s entitled: The Nursing Shortage: Can Technology Help?

It’s not brand new, but the issues discussed in this analysis still have not been addressed, remedied, or seem close to it. What this document focuses on is that aside from obviously stocking hospitals with more nurses, technology should be instituted that makes nurses more efficient, lessens their workload, and provides a safer environment for the patient. As an example, they mention one hospital that gave its nurses wireless phones, enabling them to make and receive calls anywhere on the unit, while eliminating noisy paging systems and time-consuming trips to the nurses’ station. Now how easy is that to do?

The full report can be downloaded and read for free at this website. Enjoy!

Did anyone know that the real cause of the nursing shortage in the U.S. is legalized abortion? Yep, according to the former golden boy of the Republican Party Tom Delay (isn’t that guy in prison yet?). At a talk he gave to recent national convention of College Republicans, a 250,000-member organization that promotes GOP policies and candidates, this was his Biblical pronouncement:

I contend [abortion] affects you in immigration. If we had those 40 million children that were killed over the last 30 years, we wouldn’t need the illegal immigrants to fill the jobs that they are doing today. Think about it.

Yes, he really said it. And to think, this man was just two heartbeats away from being president. Well, to his credit, at least he wasn’t arrested in a public toilet, unlike some of his cronies.

But according to maestro Delay, the U.S. is suffering from an acute labor shortage, thanks to legalized abortion. And that’s the reason why poor Mexicans are streaming across our border. You see, if all of those fetuses hadn’t been aborted, Mexico would be able to support their entire population in luxury. The government wouldn’t have any corruption, there would be no inequality, and they wouldn’t feel the need to cross the border in the dead of night, or swim the Rio Grande.

Does it make sense to you? I didn’t think so. Makes no sense to me, but then, we’re talking about Tom Delay.

But according to Delay, what if? What if all them li’l old fetuses had been allowed to grow the full nine months and been born….

According to Tom, most of those little un-aborted babies would grow up and willingly rush out to the fields picking strawberries, cotton, peaches…they could clean houses, pluck chickens, work in factories….yup, all the things the poor illegals do now. And these un-aborted people would be more than willing to do the work for below minimum wage.

Well, surely at least some of them would have become nurses. Right? The ones who didn’t see a future in breathing in pesticides and baking in the hot fields. Or grilling burgers in greasy diner or washing dishes. The ones who didn’t want to scrub toilets and polish silver for the missus…

Leave it to Tom Delay to come up with the answer to the nursing shortage. You figure out of 40 million abortions, maybe we could have squeezed about 5 million nurses out of it.

Now, I really don’t want to get into the politics of abortion–this post was only to highlight one of the dumbest quotes I’ve yet to read in my lifetime, and to point how this explains the nursing shortage.

But just in case anyone has forgotten how truly sleazy this man is, and what a disgrace he was (and still is) to our country, we should be reminded of how he really feels about abortion. This is from Snagwire, in reference to this infamous quote:

Of course, you know quite a bit about unfair labor, Mr. DeLay. Your rich lawyer friend, Mr. Jack Abramoff, represented a sweat shop in the North Mariana Islands that forced it’s pregnant female workers to get abortions (the islands are US Territory, but not subject to US labor laws). When a bill was introduced to make this practice illegal, you made sure it never made the Congressional schedule. After that, the Senate passed a worker-reform bill to extend US labor laws to people on the islands. You stopped the House from bringing it into consideration. Then when Representative Peter Hoekstra (R-MI), a fellow Republican, planned a fact-finding mission to the islands, you threatened to strip him of his subcommittee chairmanship. Mr. DeLay, you may not be very smart on the subject of illegal immigration, but you clearly care quite a bit about labor.

This is a website that is certain to put a number of people of the nurse persuasion into a tizzy–especially those suffering from the supernurse syndrome, who think that physicians are worthless and should be ground up in a Vita-Mix and used for compost.

Kevin Perez, MD, appears to be the owner of this website, and he very bravely tackled the subject of nurse/doctor relationships by posting segments of emails that he received from nurses who returned to school to become MDs–yes, how sacrilegious. According to the nurse police, that never happens. Anyway, these emails are very interesting, and I think quite true, based on my own experience.

This is one of them:

I was a nurse for ten years before I became a doctor. While I was a nurse, I often thought I knew just as much as the doctors, and so did many of the nurses I worked with. Then I went to medical school. Let me tell you, it was hard . . . REALLY hard. If I’d known as much as I thought I did, I guess it wouldn’t have been such a challenge, right? Having been both a nurse and a doc, I know what nurses know, and I know what doctors know — and I know there’s a world of difference between them. So, Pez, I have to say I agree with you that doctors do know more. In retrospect, it’s amazing that anyone would doubt something so obvious. This probably won’t set too well with your readers who are nurses, but I have one thing to say to them: go to medical school, and THEN tell me you really think nurses know as much as docs.

In some instances, I really do think that the nurse may know more about a particular patient than the physician. Nurses spend more time with the patient, especially if it is someone in a long term care facility or a home health patient. The physician may become alarmed, for instance, if he thinks a patient (who he has never seen before) is breathing too hard. However, the nurse who has been caring for this patient for the past 2 months can point out that this is a dramatic improvement (you shoulda seen the guy last month!).

But some nurses I’ve seen “know” what is wrong with the patient, they “know” what the patient needs–even if they haven’t a clue. I’ve seen both very bad doctors, who would do well to spend the rest of their careers planting potatoes in the middle of Siberia, and some very bad nurses who would do well to spend the rest of their careers nursing fruit flies in biology labs.

Anyway, Doc Kevin looks like he has an interesting website. I’ll have to check it out more thoroughly one of these days.