I never thought I’d see the day, but there was ZERO spam in my box. Zero, the big “O,” the big empty hole with nothing in it.

Akismet has been working fabulously in screening out spam and making sure that it never even shows its ugly head in my comment box–awaiting moderation. But a few spams do get through, about 1% of what I used to get. But today, there is none.

Life is definitely looking up.

Sorry, but I couldn’t resist. But perhaps this can be filed under mental health–as in mental fog? Perhaps Sarah Palin is suffering from some sort of delusional ailment that allows her to believe that by virtue of osmosis, she has become an authority on the nation of Russia. Afterall, she can “see” Russia from some islands in Alaska.

I suppose that means I am qualified to negotiate treaties with Canada being that I live only 20 miles from the border….

Anyway, what is even more amazing is that she said this publicly. I was a little surprised by this interview, since I expected her to be a smooth talker, even if what came out of her mouth was pure ignorance and nonsense. But she bumbled and stumbled, and clearly, hadn’t a clue what she was talking about. I guess the all nighters with Karl Rove just aren’t working too well.

CBS News has just posted video of a chunk of Katie Couric’s interview with Sarah Palin that aired the other night. It’s difficult to describe.

COURIC: Well, explain to me why that enhances your foreign policy credentials?

PALIN: Well, it certainly does because our next door neighbors are foreign countries. they’re in the state that i am the executive of. And there in Russia –

COURIC: Have you ever been involved with any negotiations for example, with the Russians?

PALIN: We have trade missions back and forth. We do — it’s very important when you consider even national security issues with Russia — as Putin rears his head and comes into the airspace of the United States of America, where do they go? It’s Alaska, It’s right over the border. It is from Alaska, that we send those out to make sure an eye is being kept on this very powerful nation, Russia, because they are right there, they are right next to our state.

Does anyone actually know what she is talking about? Does she know what she is talking about? Is she saying that she is in charge of spying missions that are conducted from Alaska? Is Palin actually CIA, in disguise as a soccer Mom? Is this woman James Bond, or just suffering from massive delusions–that she has somehow, something to do with any covert activities being conducted by the US military that are related to Russia?

“Putin rears his head and comes into Alaska airspace…” Very poetic, but what the hell is she talking about? Does Putin make secret missions into Alaska airspace, to visit and negotiate with Palin? Just think, this woman can be the next VP of our country. And even the president, if John McCain suffers an early demise. Judging from the looks of him, and his totally erratic behavior, I wonder if he too, is suffering from mysterious mental ailment.

Now, what we need from Palin is the nursing interview. Not only what she thinks about the nursing crisis, but what are her views on repairing healthcare? She hasn’t said a peep about that, but then, maybe she doesn’t know there is one. About 18% of Alaskans are uninsured, and according to stats, tend to be young adults, males, and Alaska natives. In a state overflowing with oil money, has Palin even addressed that? Or thought about the health of her constituents?

Been there done that. Dealing with incompetent people who flaunt graduate degrees but not one iota of real experience.

For some careers, it doesn’t matter as much, as the advanced degree is the point where they can actually begin to work. But in nursing, an advanced degree without work experience makes you little more than a paper soldier. A cardboard cut-out, and certainly, not qualified to lead or teach.

But yet, it seems that some schools and spinning heads think that it a good alternative to pursue. From Nurse.com:

New nurses should start thinking about continuing their education much earlier than before. “We are finding it is in everyone’s best interests to identify promising people who want faculty careers and get them started more quickly,” says Raines.

One of the new educational trends is a direct route to a PhD for many nurses. “Many of our doctoral programs are admitting post-baccalaureate students directly into PhD programs, as other disciplines do,” says Raines.

This means doctoral students graduate from their terminal degree program, for example, at age 30, rather than 45, she says.

There’s nothing wrong with planning ahead and many nurses know exactly where they want to be in 5 years, and that they want a grad degree.  But still, going directly from baccalaureate into an advanced degree program without any experience is just idiotic. How can one teach, for example, if she’s never even worked on a unit? How can one be a manager if she knows nothing about work environments and situations?

Nursing programs give you the barest rudiments, and in many cases, clinical time is even being shaved down because of problems finding hospital sites.  And nursing is not like other disciplines because as I said earlier, in other disciplines, you need the degree before you can even get started.

Still, experience always helps.  Wouldn’t someone who wants to be an archaeologist benefit from working at a museum, going on digs even as a volunteer, or working in some capacity with an expert before/during their pursuit of an advanced degree? Medical schools are now looking at experience–but people who have a little bit of life experience, or who have worked in healthcare–even if its just as a medical assistant or an aide. They have real life, hands on knowledge of patients, workplace politics, even Medicare/Medicaid if they had some type of admin job. All of this enriches the experience.

There’s nothing wrong with a nurse moving straight through the academic ranks as long as there’s work experience in there. In fact, a certain amount of cumulative work experience as a nurse should be required before an advanced degree is issued. No one without at least 2 years working experience in that specialty should be allowed to teach, for example.  A clinical nurse specialist flaunting her triple PhD and month long internship is going to be laughed off the floor by the experienced nurses–I mean, who is going to take this person seriously?

But this little anecdote, that I pulled off of Nurse.com, seems to be another one of those bright-eyed solutions to the great nursing shortage. In this case, scrambling to produce more faculty members. So this brilliant idea is to weed out the “promising” nursing students and shove them through academics. Give them a PhD, and put them out to teach. Wow, what an inspiration. They can throw outdated rhetoric and theory at their students, and God help them if they are asked a mundane question that requires on the job know-how.

Never a dull moment in nursing.

I know, I know, I know. I don’t want to get sucked into slicing and dicing Sarah Palin because this is not a political blog. But since this is a health related issue, and one that has been making the rounds across the media, I decided that I would mention it.

Sarah Palin and rape. The woman does not believe rape victims should be allow to abort the fetus of their attacker, and now it seems that she actually cut funding for services to rape victims. Under Sarah Palin’s administration, Wasilla cut funds that had previously paid for the medical exams and began charging victims or their health insurers the $500 to $1200 fees. Now is that a compassionate Christian woman or what? Or I suppose that Palin is of the mold who thinks that women who get raped are promiscuous, or that they somehow “deserved” what they got. But whatever the reason, Palin’s action is cruel and unjustified, particularly in a state that is flush with oil billions, and has gold pouring from its coffers.

Palin’s handlers have denied that she had anything directly to do with this action. But according to an article at the Huffington Post, that’s not quite the story:

The Palin rape kit billing controversy has made its way from OfftheBus all the way to CNN. In her story on the controversy, Jessica Yellin claimed to have found no evidence in city records that Sarah Palin was aware that sexual assault victims were being billed for forensic testing. However, recently released budget documents show that Sarah Palin directly shifted the cost of the rape kits from the police department to the victim in her budget for fiscal year 2000. Given that the CNN article quotes a former city council member as saying “Palin would review each department’s budget line by line,” even if an underling wrote up the actual budget, she knew about the funding shift, and still signed off on the budget.

The article is interesting and gives exact data which connects Palin to this action. Not just heresay or rumors. And of course, the McCain/Palin handlers have not responded and refused to comment.

As a nurse, female, and human being, I find this act beyond heinous. Considering that Alaska has the highest rate of rape in the nation, and that despite the oil bubbling in the ground, many Alaskans live below the poverty level, do not have health insurance, and paying $1200 for a rape kit is beyond their means. For the life of me, I can’t imagine how any woman in the country could vote for Sarah Palin. Or any nurse, especially those of us who have dealt with rape victims.

It really makes me cringe to think that Palin considers herself a Christian, but then, I guess her brand of Christianity is similar to the one that George Bush believes in.

Salary. The faux pas of nursing. The purists believe that nurses are angels of mercy and shouldn’t be concerned with anything so mundane as money. Those with an iota of common sense believe that nursing is a stressful job, one that requires a great deal of skill and responsibility, and that you should be making more money than the 17 year old checking your groceries at Whole Foods.

But what do nurses really earn? It is so hard to tell, since every survey comes up with remarkably different results, and the results often differ from the “real world” experiences reported anecdotally by nurses.

This came into my in-box today, courtesy of Nursing Spectrum/Nurseweek. Now, this particular publication tends to skew a bit, meaning that it always tries to present the rosy side of nursing, and never the dismal realities.  Even when they’re discussing a serious and morbid subject, such as workplace violence, they somehow manage to spin sunshine into it.

There’s nothing wrong with optimism, but I find that their articles don’t do much to present a balanced portrayal of nursing. For example, I’ve never seen them tackle the subject of nurses being cancelled due to low census. Or being forcibly floated to work on units where they have no skills or just don’t want to work there. Why not?

Anyway, it doesn’t mean that their survey is inaccurate, but I just have to wonder who exactly, they surveyed. And there is no real explanation of the results. Are these staff nurses, or per diems (who generally earn more per hour)? How many years experience do the nurses have, do these figures include overtime, shift and weekend differentials, etc. What kind of facility are these nurses working in–makes a big difference much of the time.

Also, note that they combined nurses in all different types of jobs to come out with their “average” salary of $$62,618. Managers, administrators and APNs can earn a great deal more than a staff nurse, and thus give this average quite a boost, even though they are in the minority. All in all, I think this survey would be more useful if they would break it down more carefully, and tell us exactly what a staff RN with XX years of experience makes per hour in any one of these locations. For example, RNs working at an academic medical center in Southern California, with 5 years experience, average $XX/per hour as their base pay. That kind of information is useful, not this hodgepodge mixed together. But then, as I said, this publication strives for the rosy picture, and its nice to make nursing salaries look as high and attractive as possible.

So here they are:

A reader profile study of Nursing Spectrum/NurseWeek nurse readers released in 2007 provides a mixture of results, influenced by specialty, setting, and experience. Of the 2,598 total respondents, 1,910 answered a study question about their approximate annual incomes and 1,720 answered a question about their hourly wages for a regularly scheduled shift.
How does your salary rate compare with the Nursing Spectrum/NurseWeek readers who responded to this Harvey Research Inc. questionnaire? Do you rank with the more than 14% of RNs who earn between $60,000 and $69,000 per year?

Nurses’ salaries, of course, depend on level of education, years of experience, type of work, and specialty area. They also vary from from location to location. The majority of survey respondents from across the U.S. are BSN grads (39.3%) with 21 to 30 years of experience (33.2%), who work full time in hospitals (49.7%) in a med/surg primary specialty (13.9%). About 60% are not certified in their nursing specialty or subspecialty area.

Of the almost 75% who responded to the question on salary, the average salary was $62,618. This group included nurses who provide direct patient care (46.3%); managers (9%); educators/staff developers (5.5%); APNs/CNSs (5.4%); and administrators (2.6%).

Notable Findings in Nurses’ Earnings by Region

Southeast
Average Annual Salary: $57,261
Average Hourly Wage: $29.60

Florida
Average Annual Salary: $59,204
Average Hourly Wage: $30.00

IL/Chicago
Average Annual Salary: $58,810
Average Hourly Wage: $32.00

Midwest
Average Annual Salary: $53,759
Average Hourly Wage: $29.10

New England
Average Annual Salary: $61,707
Average Hourly Wage: $36.10

NY/NJ
Average Annual Salary: $73,630
Average Hourly Wage: $37.30

Philadelphia
Average Annual Salary: $61,719
Average Hourly Wage: $33.40

DC/MD/VA
Average Annual Salary: $63,920
Average Hourly Wage: $34.50

South Central
Average Annual Salary: $59,288
Average Hourly Wage: $28.80

Northwest
Average Annual Salary: $59,562
Average Hourly Wage: $32.90

California
Average Annual Salary: $74,950
Average Hourly Wage: $41.60

Heartland
Average Annual Salary: $52,771
Average Hourly Wage: $28.80

Southwest
Average Annual Salary: $59,562
Average Hourly Wage: $32.90

Other Data

Now, keeping the limitations of ths survey in mind, I found data from 2005. Unfortunately, the link to the whole article is no longer valid. But still, there was quite a difference from 2005 to 2008. It’s barely 3 years, and things have not changed all that much.

If you live in a metro area of California or New York, for example, you stand to have a higher paycheck than your cousin in rural North Carolina. Our results show 70 percent of California RNs and 72 percent of New York RNs making $55,000 or more. These figures are comparable to BLS statistics, which say the top five highest annual mean wages for nurses are in California ($65,100), Maryland ($63,070), Massachusetts ($59,890), New York ($59,370) and Hawaii ($59,570).

On the other hand, only 31-34 percent of RNs in rural New England, Indiana, North Carolina, Tennessee and Alabama make that much.

Florida

I am especially leery of their salary rates for Florida, which is generally cited by nurses as being very low paying, considering the cost of living. In 2007, a nurse wrote that “A nurse with 10 yrs experience can make $27.00/hr full time with benefits. Cert pay for ACLS and PALS add another $1.50 and speciality certs like CEN, CCRN etc adds another $1.50. ” This was for Brevard County.

That comes to about $56,000 a year. However, some report that new grads start out at $18/hour or lower, which certainly pulls the salary down quite a bit. Brevard County is also on the mid-Atlantic coast, and the location of the Space Center. Salaries in less affluent parts of Florida are lower, and higher in areas like Miami and Ft. Lauderdale. A nurse just reported that starting pay in Tampa/St. Pete area is about $20/hour.

The website from the Florida Nurses Association states even more dismal stats:

Salaries vary depending on locale. However, the average starting salary for a new nurse in Florida in acute care ranges from an average of about $15.00/hr or $31,200/year. Salaries increase with experience. The salary range of an ARNP can range from $45,000 to over $90,000 generally. Salaries of nurse administrators are comparable to the ARNP salaries.

Wow, $15 an hour.  That’s about what I made working per diem/registry in Florida 25 years ago.  But look at the ranges they’re giving. No wonder the Nurseweek survey is so vague.  If you just take the poor nurse making $31,000 a year, and combine her with the ARNP making $90,000 a year, you get an average of $60,000. Hardly an accurate figure to throw out and say, “This is what the average nurse makes in Florida.”

Beware surveys. Do your own homework. Ask employers upfront, ask other nurses what they really make. Don’t get sideswiped by “feel good” surveys.

So what happens when a medical error causes a musician to lose part of her arm? She sues, right? Is she justified? Was it a real unavoidable accident or real negligence, or done maliciously?

Well, she is justified, as far as I can tell, and I would call it negligent. The musician, a woman named Diana Levine, received a relatively benign drug that was delivered in a manner that has the potential of causing great harm. The story is in the New York Times, if you want to have a look.

It seems pretty straightforward–at first.  The patient sued Wyeth, the drug manufacturer, because she said it failed to provide adequate warning about a drug. She was awarded $6 million. Okay, nobody sheds too many tears when a drug company has to shell out, because we always assume they are wrong and we are right. But now the woman is back in court, battling over whether she can keep the money.

When I read the first few paragraphs, I thought the usual–that the drug company had blundered and was now trying to cover its tracks and using all sorts of legal jargon and new fangled and obscure laws to get out of paying her. But then, I read on…

In the spring of 2000, suffering from a migraine, Ms. Levine visited a clinic near here for a treatment she had received many times: Demerol for the pain and Wyeth’s drug Phenergan for nausea.

“Nothing wrong with either drug,” Ms. Levine said. “They’re both safe when given the right way.”

But if Phenergan is exposed to arterial blood, it causes swift and irreversible gangrene. For that reason, it is typically administered by intramuscular injection. According to Ms. Levine’s lawyers, using an intravenous drip is almost entirely safe as well.

This time, though, a physician’s assistant used a third method. She injected the drug into what she thought was a vein, a method known as “IV push.” But the assistant apparently missed.

In the following weeks, Ms. Levine’s hand and forearm turned purple and then black, and they were amputated in two stages.

Uh, excuse me, but this case has nothing whatsoever to do with Wyeth. The drug is clearly labeled, and the fault lies solely with the physician’s assistant who administered it, as well as the clinic in general, for having a policy that permits the non-emergent use of IV push phenergren.  Nausea sucks big time, I grant you that, but there is no excuse for giving this drug as an IV push, rather than IM or a slower IV drip, to an ambulatory outpatient who has a migraine! Please.

Nurses, physicians, physician’s assistants–would you ever give this as IV push to a patient with a migraine? And let’s take that a step further–whoever injects a drug straight into a vessel like that without first flushing it through to make sure that you are indeed, in a vein? Since this wasn’t any sort of emergency, the PA could have quickly started an IV infusion, and then slowly gave the drug IV push into the line. And checked before hand if it was a vein or artery?  The only time you would stick a needle directly into a vessel, and not bothering to assess if you were in a vein or artery, if it is a life threatening situation where every second counts.

The Human Stain

This whole situation reeks of total negligence, on the part of Ms. Levine’s clinic. But yet, the article barely touches on it. It says that Ms. Levine settled with the clinic and then moved on to attack Wyeth because she thinks it needs a stronger warning.

“All they had to do,” Ms. Levine said, “was change the label and say, ‘Don’t give it this way.’ ”

But Ms. Levine, the warning clearly states that this drug should never be given into an artery. How much clearer does it need to be?  This is a case of pure negligence on the part of the clinic and the PA who administered it.

Ms. Levine and her lawyers apparently turned to Wyeth because the pockets are deeper than the clinics. That’s my guess.  Their assertion that they are entitled to a payout because the label needs a broad warning to cover all human errors, and for failing to say “do not administer using the IV push method just in case you hit an artery”, is beyond pathetic.

Perhaps the drug should also have a warning that it should not be administered directly into the eyes, or inhaled, or used intra-rectally or intra-vaginally.  Perhaps it should also read not to apply directly to an open wound, or do not swallow.

It is the responsibility of the healthcare provider to administer the drug in the prescribed fashion, and not use an alternative method not specifically mentioned on the label. If the label says administer intra-muscularly or intravenously, why administer it using the IV push method? And putting it into an artery is a blatant error.

So while I do feel sorry for Ms. Levine, that she lost part of her arm due to a medical error, that sympathy is tempered by her greed in trying to make the manufacturer responsible. Sorry, but I’ve had my fill of hearing about these bogus lawsuits. This is about as bad as the smoker who sues the cigarette companies–you know, the one who started smoking after warning labels appeared on cigarette packs that they could be harmful to your health.  And this same person, who never even tried to quit until after he was diagnosed with lung cancer. And now, its time to sue the manufacturer because he failed to adhere to warnings.

The Saga of Polyvisol

A little anecdote to make my point….when I was working in Florida many moons ago, a nurse working in the NICU failed to make use of her brain. This unit was small and sort of weird, and she was trained on the job–sort of. She used to walk around saying, “I just do what they tell me to.” I told her that no, you need to understand why you are doing something.

Well, she definitely wasn’t the sharpest knife in the drawer, because one day, she went to give a baby Poly-vi-sol. For those of you unfamiliar with this delectable item, it is an oral vitamin supplement. She drew some up in a syringe, and then proceeded to stick the needle into the infant’s IV line. A nurse standing nearby fortunately saw it as well, and grabbed her arm before she could push the syringe. The oral formulation, nice and greasy, could have killed that baby.

So should Poly-vi-sol be labeled–”DO not give IV?” “Do not give IV push?” Is the word “oral” on the label sufficient? Shouldn’t a healthcare practitioner be able to read and understand that 4-letter word? And if that nurse had gone ahead and given that dose, and the baby died or suffered from other damage, would the parents have been justified in suing the manufacturer of Poly-vi-sol?

Absurd, you may think, but it is an identical story to the one of the Vermont woman. Different drug, different circumstances, but it all boils down to one thing—gross human error.

The blog has been empty of posts due to my very recent trip to Sweden. I was attending the annual meeting of the European Society of Medical Oncology, and fun as they are, meetings are tiring. Lots of work, squeezing in play time and some nice dinners….I’ve been to Stockholm before but quite a while ago, and it is a lovely old city. A lot of beautiful architecture, and best of all, survived WW II completely unscathed since Sweden was neutral, so no rebuilding was necessary.

I actually did try to blog, but in updating the Word Press and other stuff on the blog, the password was changed and I forgot to bring it with me. So I was unable to enter my site from my laptop.

But I’m back, and I see things are cooking all over the place.  I guess with all the financial woes going on, and Sarah Palin screaming that she’s not a pig with lipstick (what an insult to pigs, anyway), no one has said much about healthcare. But even if they did, what good are promises unless you can keep them?

Interesting question. Someone on allnurses.com started a thread about this, wanting to know if universal healthcare would negatively affect the income of RNs. There are a lot of responses, but one thing is apparent–no one has really defined what universal healthcare is. And there is no one definition. It basically means that all people will have access to healthcare, and that one never needs to worry about going bankrupt or losing their home in order to pay for medical care.  But beyond that, universal care comes in many different forms. It varies from systems like in the UK, where it is government sponsored and nurses/physicians are employed primarily by the government, to situations like Switzerland, where everyone is covered by insurance.  In both cases, no one falls through the cracks–and if they do, there is a net to catch them.

So will salaries go down if we managed to install some sort of universal healthcare in this country? Probably not, would be my guess.  We already have wide fluctuations in salaries, depending on where you live, and it would be very hard to keep nurses working in NY, for example, if salaries were cut. It would also be very difficult to standardize healthcare and salaries across the nation, as exists in some countries, due to the enormous differences in cost of living, populations, and the huge differences in lifestyle. Compare living in a tiny town in South Dakota to Los Angeles, for example. The healthcare needs of the populations are different, as are the type of healthcare facilities needed.