With the financial crisis having reached its peak (hoepfully), and a bail out (if that’s what you want to call it) getting the finishing touches, it seems that both Obama and McCain have shifted back to the “regular” stuff. Not that the financial arena is safe and secure, but everything else has been thrown to the wind, and people still want to know about other issues.

So healthcare is back. Today their battle over the big H is splashed all over Google news.

Some good articles on CNN, and Newsweek.

While neither candidate is offering a universal system of health care, it does seem that Obama is closer to the mark. McCain’s plan sounds like Bush’s idea of privatizing Social Security–give people tax credits and let them choose. Sounds all well and good, that people should have a choice, but in reality, how much of a choice does one actually have?

Regulation of the health insurance industry is pathetic, and I fear that a McCain led government would make it even more “free market.” In other words, continuing to pander to the wealthiest corporations.

A regular nurse, maybe even a hokey mom or a pitt bull with lipstick (but one who sounds a lot more coherent that Caribou Barbie, who is in dire need of lessons in English language syntax) penned a nice opinion piece about the healthcare positions of the two candidates.

The gap between the rich and the poor is widening. This gap and current structure of our health care system has affected the health of all Americans. If we do have insurance, we are paying higher deductibles and in some cases, have to get permission from our insurance company to access the care we need. Our employers are unable to provide raises and invest in expansions due to the rising cost of insurance premiums.

Here are a few examples of the annual compension packages paid to CEOs of some of the major insurers: United Healthcare $8.3 million, WellPoint, Inc. $5.2 million, Cigna $4.7 million (Atlantic Information Services, April 24, 2006). Can you see where I am going with this?

So the next time you get an insurance raise, and they give you the usual corporate “bleeding heart” whine about growing medical costs, ask them about their CEO’s compensation package.  Should $8.3 million of your insurance premiums really be going to line this guy’s pocket, especially when after paying your exhorbitant premiums, they still demand a copay of 25%?

Do either of our candidates have a plan to streamline insurers and force them to be accountable? Or to force them to insure everyone who wants it, even if they had their tonsils removed 25 years ago? Or were treated for acne in 1962?

Despite the shortcomings of both candidates, this nurse feels that Obama has more of grip on reality, and on a plan that is more workable.

Studies by the Tax Policy Center say the Obama plan would reduce the number of uninsured Americans by 18 million in 2009 and McCain’s plan would only reduce the number of uninsured by 1 million in 2009. In my opinion, the McCain plan falls short of most Americans’ expectations. The United States is the only industrialized nation that does not have a universal healthcare system.

Healthcare has fallen a bit by the wayside, in lieu of the more urgent financial crisis.  But it is still important, and it is a chronic issue that is going to be waiting for us after the dust clears.

I was going to blog about something entirely different, until I looked at Google news and saw that today ushers in a month of pink.

Pinky this and pinky that, all in the same of curing breast cancer.To be quite honest, this whole campaign makes me a little queasy. One, because the “pinkettes” have somehow turned a dreadful disease such as breast cancer into a trendy and feminine and celebrity ridden “event.” We run for the cure, do dances for the cure, buy pink colored nonsense because a company is going to give some undefined proceeds to curing the world of breast cancer…while the real issues remain silent.

Real issues like why has the rate of breast cancer–that is, the number of women who get the disease, showed such a dramatic increase over the past few decades? The pink brigade tends to be silent on that, and instead, the whole movement is focused on the elusive cure. A world without breast cancer, they say. Well, that world isn’t going to happen until we take a serious look at the causes (and many are known but its safer just to ignore them) and address it.

The safe causes, which are often cited by rote, are the increased used of mammography, more women delaying childbearing, rising obesity rates and perhaps the popularity of hormones to treat symptoms of menopause. I will agree, these factors could have added to it, but do not show the whole picture. Take for example, this chart, from 2004.

Note: numbers are per 100,000.Source: J. Ferlay, F. Bray, P. Pisani and D.M. Parkin. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version 2.0. IARCPress, Lyon, 2004.

Note the position of the U.S. on the chart. The highest incidence of breast cancer. Not the highest death rate, but certainly, these numbers should give one pause. Why is the incidence of breast cancer so high in this country? Certainly other industrialized nations are grappling with the usual suspects, ie, delayed childbearing, increased use of mammography, rising obesity rates, and hormone use. So what is it about the U.S. that gives us the distinction of almost being the breast cancer capitol of the world?

But hey, we’ve got pink ribbons and bon bons. And women with breast cancer can even get pink teddy bears and all sorts of cutesy items.

There is a really good commentary in the Guardian about pink month, and her disappointment in the lack of real discussion about breast cancer.

October is breast cancer awareness month, and the breast cancer industry is in overdrive. You can buy a plastic duck with swirling eyelashes from Cancer Research UK, exclusively designed by Twiggy. Or you might purchase a pink product from Next, which will donate 10% of proceeds to Breast Cancer Care. Breast cancer is indeed the darling disease of the corporate world. And it has lodged itself in the national consciousness in a way that HIV/Aids once did, but this time without the icky wrong-sort-of-sex connotations.

Imagine that, a duck with swirling eyelashes, all in the name of breast cancer. I have a better idea–instead of wasting money on pink objects you don’t want, have no use for, or paying 10 times the amount of what they’re worth–why not just donate money to the breast cancer charity of your choice? It’s a better bet for your buck.

In her excoriating essay Cancerland, the American writer Barbara Ehrenreich describes induction into the pink and perky world of breast cancer, following her own diagnosis in 2001. “In the mainstream breast cancer culture, one finds very little anger, no mention of possible environmental causes, few complaints about the fact that, in all but the more advanced, metastasised cases, it is the treatments, not the disease, that cause illness and pain.” She begs: “Let me die of anything but suffocation by the pink sticky sentiment embodied in that [ribbon-branded] teddy bear.”

Infantilising merchandise aside, Ehrenreich correctly identifies the unspoken in the breast cancer discourse. Disease rates have increased by more than 50% over the past 20 years in industrialised countries. From the preservatives in our lipsticks to the flame retardants on our sofas, little is said about the possible link between everyday chemicals and breast cancer. The majority of money raised goes to treatment rather than prevention. And, meanwhile, car and cosmetics manufacturers continue to appropriate the (untrademarked) pink ribbon to boost their image with consumers as they boost their bottom line.

I couldn’t say it better myself. So while finding effective treatments for breast cancer is certainly a priority, and we have done a very good job in prolonging life and curing the disease, the unspoken needs to become the spoken.

Pink somehow washes the disease, making it seem less ominous. Pink is a sweet color. So should we all be good girls and not question the powers that be, and just dutifully wear our pastel bracelets and run for the cure? And tiptoe around the unspoken causes, because someone’s feelings (and profits) might get hurt?

Photo courtesy of Stock.xchng.com

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.

No, I don’t mean blocking nurses. I’m talking about nurses as a voting block. And no again, I don’t think nurses vote as a block. Not even remotely.

It is silly to think that certain groups of people are similar, simply because they work in the same profession.  In my experience as a nurse, for example, I worked with nurses who were male, female, gay, straight, fat, skinny, short, tall, and who came from all walks of life.  Some were born in other countries, some born in poverty, some well to do, and their life experiences before, during and after becoming a nurse varied dramatically.

In this same vein of thought, some nurses I met were racist, bigots, narrow minded, ignorant, just plain stupid, mean, malicious, psychotic, and substance abusers. Others were kind, thoughtful, honest, hard working, open minded, brilliant, sweet, loving, and mentally healthy.

On the political front, and politics were rarely a topic of conversation for obvious reasons in the workplace (just like religion–best to leave it alone), I do know that nurses selected their candidates much the same way other Americans do. There was no “standard” nurse vote. No nurse voting block.

The reason I bring this up is because healthcare is such a big issue on the ballot. It is an issue for everyone really, because at some point, everyone is going to use the healthcare system in one form or another. But just because one is a nurse doesn’t mean that healthcare is the most important or pressing issue on the agenda, or the issue that raises the most concern. Just being a nurse doesn’t mean that the vote will go to the candidate with the best healthcare agenda. Other factors may be more important, such as the candidate’s position on what to do with the Iraq mess, environmental concerns, schools, and so on. A nurse who has a relative dying from ALS might be very keen on what the candidate’s think of stem cell research and who is going to support it, for example.

Anyway, I started thinking about this–how certain groups of people are often placed into arbitrary clusters as if they were generic and of one mind. What brought it on was the memory of what some guy once said to me in LA, when I was sitting outside reading. He lived in my apt building, and I had never spoken to him before. He struck up a conversation, and when I remarked that I worked as a nurse, he nodded his head.

“I like nurses,” he said. “They’re good people.”

The generic nurse. Even the nurse who kills patients or who falsifies patient charts is “good people.” If I said I was a mortician, do you think he would have made such a stupid comment? Or if I said I was a dentist? Does anyone ever say, “I like dentists. They’re good people.”

How do our 2 presidential candidates feel about nursing issues? The ANA decided to find out, and sent each candidate a questionnaire–about nursing and related healthcare issues.  Only Barack Obama responded, and you can read his responses here–this is a transcript containing Senator Barack Obama’s remarks to the American Nurses Association’s 2008 House of Delegates on June 27, 2008.

Unfortunately, I can’t offer a link to John McCain’s remarks/responses because he hasn’t yet responded.  Maybe he will eventually, but healthcare is an important issue and nursing is part of that. Surely the man can’t be blind to all the media hoopla about the nursing shortage. If he wants to get brownie points, it would be worth his while to have one of his speech writers draft some nice prose and fill in the blanks, and at least show nurses that he’s interested.

Surely there had to be a nurse assigned to this patient at some point? An RN, LPN, or an aide? Surely this is not just a warehouse to toss living bodies into and watch them die…

From CNN:

A mental patient died after workers at a North Carolina hospital left him in a chair for 22 hours without feeding him or helping him use the bathroom, said federal officials who have threatened to cut off the facility’s funding.

The state sent a team Tuesday to help Cherry Hospital in Goldsboro draft new procedures to ensure patients receive proper care.

An investigator’s report released Monday found that 50-year-old Steven Sabock died in April after he choked on medication and was left sitting in a chair for close to a day at the facility about 50 miles southeast of Raleigh. Surveillance video showed hospital staff watching television and playing cards a few feet away.

The scene of the crime is Cherry Hospital, which is supposedly a JACHO accredited institution. Accreditation is supposed to mean that they meet a certain standard of care.

How can this happen, you may be wondering. Me too. I’ve worked in some pretty bad hospitals, but I couldn’t imagine anyone sitting a patient in a chair and then leaving him there for 22 hours.  Four shifts came and went, and still this man sat in his chair without food or being able to use the bathroom. I mean, what did nurses say at report?  Mr. Sabock is sitting in his chair and has been for the past 10 hours, and oh, I don’t think he’s hungry. Or has to go pee-pee.

And didn’t anyone stay with him when they gave him his medication, especially considering that he was a mental patient? You know, to make sure he took it? Or if they left it, to check back that he did take it instead of leaving him to choke on it?

Department of Health and Human Services spokesman Tom Lawrence said the state team also may investigate what, if any, disciplinary action should be taken after Sabock’s death.

Surely they jest? Are they questioning if any disciplinary action should be taking, or is this just a poor joke? Anyone related to this patient’s care should be fired, and have their license (if they have one) permanently terminated. And criminal negligence charges should be brought among the most guilty, like the nurse who dispensed the medication, or the workers who sat watching TV and playing cards while this poor man sat in a chair without food, and probably peeing and pooping in his pants.

The message has to be sent that no, this is not okay. And the hospital should get a stiff fine, and be investigated as to how it trains its workers. Surely there must have been a nursing supervisor walking around. Did she not say anything to the workers watching TV, like, “have you checked on all of your patients?”

Were there any nurses’ notes on this patient? Did anyone chart on him?

Did he call for help, I wonder?

Sorry, but I don’t think the hospital can blame this one on the nursing shortage.

Don’t these newspapers ever get tired of printing the same story over and over and over and over and over again? I mean, really. The nursing shortage news in most outlets seems to be simply a cut and paste of previous stories, with names, dates and locations changed. That’s it. Nothing that shows that the reporter crept outside the box, or even bothered to find out what an RN even is.

Take this masterpiece from the Dowagiac Daily News. I’m not really sure where it is, but I’m assuming that it’s in Michigan, since it refers to the great shortage of nurses in that state.

Did you know that Michigan is expected to have a shortage of about 7,000 Registered Nurses by 2010 and a shortage of 18,000 RNs by 2015?

No, I didn’t. Please tell me about it. See what I mean about just changing numbers and locations?

There is a growing nursing shortage in Michigan – and the United States. Michigan’s nursing education programs are bottlenecked in their ability to admit, educate and graduate all qualified applicants.

At the same time, our population is aging and will need much more health care in the future.

Still awake? Now how many times has this same tired argument been repeated. Not too long ago, I posted about a website which lists schools that do not have waiting lists. And I clearly recall that when I was looking to get into a nursing program, state schools also had waiting lists. That was in the 1980s, when interest in nursing was pretty low. The reason was the same as now. State schools are cheaper, and nursing programs can only hold xxx amount of students, due to nature of the program. Clinical rotation groups have to be small, and even lecture groups have to be limited in size. And schools are all competing for clinical space at hospitals.

This article goes on to talk about some initiative that will provide tuition and stipends to allow graduate-level nursing students to enroll in full-time programs and graduate as future faculty. In return, they have to teach in a Michigan nursing program for 5 years.

Its’ about time that someone thought of something intelligent to lure nurses into teaching, but even so, this idea still may not do the trick–unless the individual really wants to teach. Is it full tuition, and is the stipend enough to allow the nurse to live on, so he/she doesn’t have to work? How intense is the program? Can a nurse still pull a few shifts if the stipend just doesn’t cut it, ie, the need to eat still exists?

Second, the 5 year obligation. It really may not be worth the nurse’s while in the long run. Paying for grad school is expensive, but working as a teacher for 5 years, at the median pay scales for instructors (and I’m assuming that they’re talking master’s trained, in which the pay would be less than PhD) may not even it out. Other types of jobs for graduate trained nurses pay far more, and they will probably be far ahead, moneywise, if they pay for their own schooling and then get a more lucrative job at the end of the five years.

Plus, if they want tenure, they will have to go on to get a doctoral.

Put it this way, the only way that anyone is going to beef up the instructor market is to pay market wages. A teacher is just going to have to earn more money than the average nurse working on a med/surg floor, which at the moment, they don’t.

So nice try, but no cigar.

For whatever reason, whether it be a school project, scientific dissertation, a book, curiosity, or just time on your hands–I found the perfect spot to hunt down nursing websites.

Yes, websites that are related to nursing in one way or another. It’s run by the Health Sciences Library at the University of Buffalo, the State University of New York. Not to get off track, but when I was applying to colleges, the state university system of New York was as follows:

State University of New York at Buffalo or SUNY at Buffalo. Ditto for SUNY Stony Brook, SUNY Albany, and so on. I don’t know, do they think calling it the University of Buffalo sounds more sophisticated? More classy? You don’t see the UC system in California changing anytime soon. I highly doubt that UCLA is going to become “the University of Los Angeles” any time soon.

But back to the subject at hand (it’s so easy to get distracted), this website is really a nice listing of nursing organizations, nurse practitioners websites, nursing history, nursing informatics, nursing research, and so on. Even nursing theorists, whatever that may be. If its anything like the nursing theories that they tried to enamor us with in nursing school, then I’ll pass on that one.

From Time.com:

On July 17, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, scrapped plans for a large clinical trial of the government’s most advanced HIV vaccine candidate to date. The vaccine, a two-shot injection, was designed to fight HIV infection a new way — by activating the body’s cell-based immune responses rather than by relying on antibodies to HIV.

It’s not a complete surprise, as a similar vaccine failed to live up to expectations last year. Very disappointing, and there’s not much else on the immediate horizon.

Early on in the AIDS epidemic, the experts were very confident that there would be a vaccine within a few years. Once the virus was identified, it was only a matter of putting the components together and coming out with the magic potion. But as the years passed, and vaccine attempt after vaccine attempt failed, the outlook was less rosy.

While I don’t think that efforts to find a vaccine should be abandoned, I do think that the emphasis should be on preventing and treating the disease. We know how its spread, we know how to stop it. Which is why it is so devastating to see the U.S. throwing away funding to meet political and idealogical goals, rather than the needs of the population being served. See my post from July 18.

Like, does it make sense to ignore sex workers? Are they going to disappear if they are ignored, go uneducated about AIDS, and untreated? Are they not going to infect anyone if we refuse to acknowledge that they exist? And do the wealthy politicians in the US have any inkling that sex work is the only job for many of these young girls (and boys)?

Or the idea that needle exchange is going to encourage people to be drug addicts. Please, that philosophy reeks of the “just say no” attitude. Drug addicts don’t live in a vacuum. If they share dirty needles, they spread infectious diseases. It’s as simple as that. And then not only will they become ill (and become a burden on society if you want to look at it monetarily), but they will spread it around.

Anyway, in lieu of the elusive vaccine, we need to work with the information and tools that we have right now.

Well, they didn’t exactly throw it away, but just missed a golden opportunity to make better use of funding. To channel funds where they are needed, and to use the money wisely, and get the most for the buck, so to speak.

The Center for Health and Gender Equity (CHANGE), in partnership with Advocates for Youth, the International Women’s Health Coalition, American Jewish World Service, the Sexuality Information and Education Council of the United States, and the National Council of Jewish Women is issuing the following press statement in response to the recently passed Senate bill (S. 2731) to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR). The organizations emphasize the Senate’s politicization of public health and failure to rectify serious flaws regarding PEPFAR’s prevention policies that will have harmful implications for the health and rights of women and girls worldwide. Please contact CHANGE if you have any questions.

It’s Broke, But They Won’t Fix It:
The Senate Authorizes a Global AIDS Relief Package that Comes Up Short

Washington, D.C.–On Wednesday, the Senate voted 80 to 16 to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $48 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.

The Senate missed a golden opportunity to epitomize the generosity of the American people by making U.S. global HIV/AIDS relief more effective, compassionate and fiscally responsible. As a result, millions of people are at greater risk of HIV infection.

Under pressure to act quickly, policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic. Much has been learned since PEPFAR was enacted in 2003. However, rather than heeding to the evidence collected by our own government agencies, the bill passed by the Senate compromises sound public health practice for ideology and political expediency.

* One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding.

This provision was left in the bill despite a 2007 report from The Institute of Medicine, which recommended the removal of PEPFAR’s then-requirement that one-third of prevention funds be spent on abstinence-only-until-marriage programs. The Senate’s decision to leave these de facto restrictions in the bill means that those fighting the HIV epidemic on the front lines will be deprived of the vital discretion they need in determining how funds are best spent.

* The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services. However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.

* The 2003 PEPFAR legislation contains a provision that enables organizations receiving U.S. funding to pick and choose the prevention and treatment services they wish to provide. Millions of dollars go to organizations to provide prevention services, even though they refuse to discuss the potential of condoms or other contraceptives in preventing the spread of HIV. As abstinence and partner reduction programs have outpaced programs that enable individuals to have all the information they need to prevent HIV, the law stands in the way of the effective use of resources.

The Senate has taken this bad policy and made it worse by extending the so-called “conscience clause”, or refusal clause, to organizations that provide care and support to people living with HIV/AIDS, their families and their communities. This provision paves the way for taxpayer-funded discrimination based on “moral” and religious grounds, allowing PEPFAR funding recipients to refuse to provide care for someone based on their religion, how they got infected or any other basis. The refusal clause is yet another damaging provision that flies in the face of good public health practice.

* Lastly, the Senate upheld the requirement that groups fighting HIV/AIDS overseas publicly pledge their opposition to prostitution and sex trafficking before receiving U.S. money. Prevention programs that have reached sex workers, a group that is marginalized and exceedingly vulnerable to HIV infection, have yielded dramatic reductions in HIV transmission. According to numerous reports, the pledge has led to further alienation and discrimination of already-stigmatized groups. This policy drives sex workers underground and away from the non-governmental organizations and health workers best poised to provide them with services they need to protect themselves from infection.

It is our moral obligation and fiscal responsibility to use PEPFAR funding to prevent as many infections as possible. However, large sums of money, spent unwisely, will not save lives and will require an ever growing need for increased resources in the future. The bill fell short exactly where more was needed: full and flexible funding of prevention programs that would enable us to make a difference in the lives of millions.

What is wrong with these people? The purpose of the funding is to prevent and treat infectious diseases, and not spread the moral viewpoints of a few wealthy Americans who can’t even begin to fathom what life must be life for people that the funding is supposed to help. I’m so glad that Brazil refused U.S., because it would compromise the great inroads that they made in treating HIV infection. But unfortunately, other countries don’t have that option–they need the money. So the most vulnerable people will continue to fall through the cracks, organizations that are given funding will have the option to pick and choose patients based on “morality,” and a full third of the funding will be tossed out on the abstinence until marriage programs which have failed miserably.

Sad, sad, sad. A great opportunity has been lost. And we can’t just blame Bush for this, because obviously, this was a bipartisan vote.

Heart surgeon and medical pioneer Michael DeBakey died, at the age of 99. Actually, he was less than 2 months shy of his 100th birthday.

I remember hearing about DeBakey and his contemporary, Christian Barnard, the famed South African cardiac surgeon, in the late 1960s. Heart transplants, artificial hearts–all very distant and vague to a child, but yet the names stuck in my head. Both names would make the medical news over and over again.

DeBakey, as it turns out, was a lot more than just your average long-lived cardiac surgeon. I really knew little about him, other than that he was famous for pioneering a number of surgical techniques, performing the first human heart transplant in the U.S., and helping to develop the artificial heart, as well as implanting the first one into a live patient.

Reading about him now, just after his death, makes me breathless. And at the same time I am inspired and discouraged, because I look at all he accomplished and think of how little I’ve done in my own life. What am I waiting for? The other interesting thing is that DeBakey has shown that old age does not mean internment in a nursing home with a million debilitating illnesses. Yes, the man did look old and wrinkled at age 99, but his mind was razor sharp, and aside from a torn aorta that he experienced at age 97 (and survived surgery to repair it and was back at work after a month in intensive care) his health was excellent. Right up until he died, DeBakey was still active, still consulting and mentoring, and keep up a hectic schedule of writing and travel.

There are a number of really good in-depth articles about his life, his accomplishments, and personal achievements. But here’s a run down from the LA Times:

In his highly influential career, DeBakey performed the first coronary artery bypass surgery and the first carotid endarterectomy to prevent strokes. He developed the pump that is the key component of the heart-and-lung machines routinely used on patients during heart surgery and an artificial heart now used to keep patients alive while they wait for their own heart to improve.

He also developed the concept of the mobile army surgical hospital — immortalized in the film “M*A*S*H.” He also played a key role in the creation of the National Library of Medicine and transformed the Baylor College of Medicine and its Texas Medical Center from a third-rate hospital into a nationally recognized center of excellence for heart care.

I had no idea that he had anything to do with MASH units. Another article I read said that he was influential in convincing President Johnson, who was one of his patients, to sign the bill that established Medicare. He also spoke French, German and Arabic, and in 1939, published the first scientific paper linking cigarette smoking to lung cancer.

His ideas were far reaching, and have really become the standard of care. And of course, he was challenged by the status quo who wanted to keep the mediocre status quo. Instead, in-between caring for patients and inventing new surgical techniques, and publishing medical papers, he also dived into reforming Baylor College of Medicine from some backwater school into the world class and world renowned center that it is today.

Later that year, the Baylor University School of Medicine, as it was then known, tried to get DeBakey to join its faculty, but he turned down the offer twice. “They didn’t have any clinical service. They had no hospital. They had no residents, no training program in surgery,” he told the Houston Chronicle.

He ultimately accepted when the university promised him a 20-bed surgical service at Hermann Hospital and a free hand as chief of surgery. He quickly became unpopular.

One of his first controversies involved a rule he announced stating that physicians with no training in surgery could not operate at Baylor-affiliated hospitals. “No one who is unqualified to do good operations should be allowed to operate,” he said.

He was also unpopular with the Harris County Medical Society in Houston because of his new ideas — including the creation of intensive care units at Baylor, establishing new training guidelines for surgeons and admitting black patients — and his frequent appearances in the local newspapers, something that was then against the society’s rules. When the society tried to eject him, he hired attorney Leon Jaworski, who stopped the proceedings with a single letter.

After 20 years as chief of surgery, he became the school’s chief executive at a time when it was near bankruptcy. One of his first actions was to sever it from Baylor so that it could accept federal funds for research.

He also spearheaded a campaign that raised $30 million to eliminate the school’s debt. A foundation he created still contributes $2 million a year to the school.

About the same time, he played a key role in the formation of a new Houston high school designed to attract youths, particularly ethnic and racial minorities, into medical professions. The school is now known as the Michael E. DeBakey High School for Health Professions.

If you’re not exhausted yet from reading about this man, here’s one last tidbit…

He also advocated specialized medical and surgical follow-up systems for military veterans, a program that eventually became the Veterans Affairs healthcare system.”

Thank you, Dr. DeBakey. And now, I am going to get off my ass and do something. Even if it’s just cleaning up my office and getting the last boxes unpacked.

For those who think that computerized order entry and bar coding is second only to the Garden of Eden, think again. Technology is not perfect. While the aforementioned items can certainly help reduce medication errors, technology needs to also fit into the hectic day of people who will actually be using it. And if it doesn’t work properly, they are going to find a way around it, thus defeating its original purpose.

Does this sound like a tongue twister? Well, maybe. A study in the July/August issue of the Journal of the American Medical Informatics Association (JAMIA) found that that the design and implementation of the technology, which is often relied upon as a “cure-all” for medication administration errors, is flawed, and can increase the probabilities of certain errors.

Equally surprising is that the urgencies of care and the ingenuity of nurses to cope with these shortcomings have the unintended consequences of creating other medication errors.

This is the abstract to the study. The entire paper is available online for free.

The authors develop a typology of clinicians’ workarounds when using barcoded medication administration (BCMA) systems. Authors then identify the causes and possible consequences of each workaround. The BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic medication administration records. Ideally, BCMAs help confirm the five “rights” of medication administration: right patient, drug, dose, route, and time.

While BCMAs are reported to reduce medication administration errors—the least likely medication error to be intercepted— these claims have not been clearly demonstrated. The authors studied BCMA use at five hospitals by: (1) observing and shadowing nurses using BCMAs at two hospitals, (2) interviewing staff and hospital leaders at five hospitals, (3) participating in BCMA staff meetings, (4) participating in one hospital’s failure-mode-and-effects analyses, (5) analyzing BCMA override log data. The authors identified 15 types of workarounds, including, for example, affixing patient identification barcodes to computer carts, scanners, doorjambs, or nurses’ belt rings; carrying several patients’ prescanned medications on carts.

The authors identified 31 types of causes of workarounds, such as unreadable medication barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient identification wristbands (chewed, soaked, missing); nonbarcoded medications; failing batteries; uncertain wireless connectivity; emergencies. The authors found nurses overrode BCMA alerts for 4.2% of patients charted and for 10.3% of medications charted. Possible consequences of the workarounds include wrong administration of medications, wrong doses, wrong times, and wrong formulations.

Shortcomings in BCMAs’ design, implementation, and workflow integration encourage workarounds. Integrating BCMAs within real-world clinical workflows requires attention to in situ use to ensure safety features’ correct use.

A lot of news about more babies getting hit with heparin overdoses. But as much of the news in the popular media, the information is incomplete and vague. I’m assuming that since it’s for a general audience, they assume that the public is too stupid to understand anything more detailed.

From the Wall Street Journal:

This time, it’s more infant overdoses: 17 babies at a Texas hospital got too much of the blood thinner; one has died, though hospital officials told CNN that it remains unclear whether the heparin contributed. Nurses keeping IV lines clear apparently used 10,000 units of heparin instead of 10, and the error wasn’t caught until two days later.

What kind of IV lines are they talking about? No one routinely flushes an IV line with heparin, unless it’s an arterial line. And even then, a tiny amount of heparin is mixed in with the IV solution, and that is normally done by the pharmacy. So what kind of lines are they flushing? Hep locks? That would only take a minute amount of fluid to flush through.

It would be nice if they actually explained what happened. Did the nurses add the heparin to the IV solution that was running through an arterial line and make an error–like use the wrong concentration? Was the vial mislabeled?

But of course, everyone has an answer for cutting down on medical errors, while ignoring the obvious.

The quality gurus at the Leapfrog Group, a consortium of employers aiming to improve health quality, said the problems underscored safety issues at hospitals across the country.

“Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take,” said Leapfrog CEO Leah Binder in a statement. Studies cited by Leapfrog suggest that computerized systems could cut drug error by 50% to 100%.

They’re not wrong of course, but I got into a “discussion” with a physician at a conference who also thought that computerized systems were the answer to all our prayers. Perhaps the WSJ article might also have told us about the staffing at these hospitals where the errors took place. How many patients did each nurse have? How sick were they? How many hours of mandatory overtime were they working?

Most medical errors are generally caused by a cascade of events that happen that lead up to the error–and since the nurse is at the end of the food chain, she often gets the full blame. Which isn’t to say that nurses shouldn’t pay attention to what they’re doing, but the current working conditions actually encourage errors of all kinds, and no amount of computerized systems is going to make up for lack of staff.

But again, nurses should not be working in unsafe conditions. ICU nurses should not be taking 3 patients (I hear complaining about it, but still the good nurse takes the assignment for the “sake of the patient”), and nurses should refuse mandatory overtime. They should take the time to read the labels of the meds they are giving, and if they get behind in their work, then they need to speak up. If they have to stay over to finish, then demand overtime. I met a nurse once who kept talking about how she could never finish her work on time, and generally had to stay over at least an hour every day to finish charting, but never asked for overtime. Even though her workload made it impossible to leave on time. What a dream nurse she was–every CEO’s dream.

Anyway, these hospital error stories, particularly the ones about heparin, are really getting tiring. How about we hear a story about a hospital that has actually done something about it? Like increased their staffing, makes sure pharmacy double checks what gets stocked on units (especially NICUs), gives nurses safe assignment and “stocks” the units with ancillary staff like clerks, respiratory therapists, aides, etc. Uses a computerized system that is user friendly and that actually makes the nurse’s life easier rather than more difficult? Are there any stories like that around?

Now how scary is this. Isn’t being a nurse hard enough without having to worry about being attacked by your wonderful patients or their loving family members?

The NY Times printed a wonderful story about dangers in the hospital. Finally, something other than the usual whining about the nursing shortage and how we have to step up recruitment and sanitize nursing so that students and potential students don’t know what they’re getting themselves in for. Just visit www.discovernursing.com if you want to see the greatest con job ever told.

But getting back to workplace violence–of course, hospitals say that its not their fault.

Richard Wade, a spokesman for the American Hospital Association, said health care facilities should not necessarily be blamed for patient violence. “These things don’t happen because of breaches of security,” he said, “but because something happens that you can’t predict, and nurses are on the front lines.”

But Mr. Wade added that hospitals were very much aware of the issue and were addressing safety concerns in a variety of ways, among them increasing camera surveillance, expanding the security staff and training employees to deal with potentially violent situations.

“You want to have good security, but you don’t want it to feel like going through an airport screening or like a place in lockdown,” he said. “Hospitals are by their very nature supposed to be open, caring places where patients and families feel safe and don’t feel imprisoned.”

Hmmm…does that sound like PR spintalk or what?

Maybe they can’t predict violent episodes, but they can certainly be better equipped to handle them. Like what about having an emergency button in every room, that a nurse can press if a patient or visiting even shows signs of hostility. And the response to the call button is 2 minutes or less. Is that possible? Of course it is, but most hospitals don’t really care if their nurses get beat up. They don’t want to invest money in their protection. In fact, many nurses say that they are discouraged from writing up incident reports. Nursing schools still fail to teach that nurses are not punching bags, and there should be zero tolerance of abuse from anyone. Hospitals are more interested in customer service, and in not antagonize the patient or family, even they push the nurse out the window.

There should be security in the emergency rooms at all times. Security should be patrolling round the clock. But despite Mr. Wade’s cheery spin, most facilities are woefully lacking in trained security, and response time is dismal. And yes, hospitals are places where patients and families should feel safe, but then, so should staff. And having extra security also protects patients.

The article goes on to say that according to the federal Bureau of Labor Statistics, half of all nonfatal injuries resulting from workplace assaults occur in health care and social service settings. While some areas of healthcare are intrinsically more dangerous than the average office, ie, a psychiatric setting, that is still no excuse. There should be extra security. Nurses should never have to be in a vulnerable position in a ward or facility where violence occurs on a regular basis. Nursing homes have some of the poorest staffing, yet they are prime for violence because of the mental disturbances of many of the residents. Yes, that little old lady can pack a punch.

This is the most frightening of all:

The level of violence may well be higher, since the government figures include only the most serious incidents. A booklet published by the Occupational Safety and Health Administration in 2004 noted that violence in health facilities was “likely to be underreported, perhaps due in part to the persistent perception within the health care industry that assaults are part of the job.”

I rest my case. This perception didn’t come out of nowhere. The lack of protection for staff, the idea that nurses aren’t supposed to complain–even if a patient is crashing a chair over their heads, and the failure of hospitals to stand up for their staff. It’s the ER, these things happen. A gunshot isn’t so bad, you’ll get over it. so what if the patient bit your head off–there’s worse things in life…

But you know, this all goes back to nurses and other staff taking a stand. Nurses have to stand up for themselves, they need to file incident report and press charges (horror of horrors) and need to refuse to work if conditions are unsafe.