The other day I was hiking with a friend, another former nurse, and she told me about an acquaintance who is trying to get into a community college nursing program. She’s been accepted, but without financial aid, can’t attend. I guess community college tuition has gone up, and the program is geared so that working adults will have supreme difficulty in attending.

Anyway, that’s another story in and of itself (hello, what happened to the nursing shortage and the desperate attempts to get students pushed through at maximum speed), but just out of curiosity, I looked up the school that she is currently taking her prereqs at. I wanted to see the tuition, but got another surprise instead, when I looked at the particulars of their nursing program.

Yes, times have changed. I’m not going to name the school, but this really borders on the ludicrous, especially their first sentence.

Clinical placements, employment, and licensure in a healthcare field often require a background and drug check. XXX school will conduct a XX State Patrol background check on applicants to the Nursing Program. Students need to pay the $10 fee for background checks to the business office, obtain a receipt, and attach that receipt to their application. Results of the background check will be given to the Nursing Program Coordinator.

Excuse me, but since when does getting hired as a nurse require a background check? Drug screens are becoming more common, but considering that there is no national database to keep track of licensed personnel, this seems a bit excessive. And totally unnecessary. The person is entering a nursing program, not applying to the CIA. I can honestly say that no one ever did a background check on me for a nursing job–not for full time, per diem, or with a registry. And I don’t know any other nurse who has ever had one done either.

But that’s just to apply to the program. Now if you’re lucky enough to be accepted….

Students accepted into the Nursing Program will need to complete a more extensive background and drug check as required by the local hospital for clinical placement. Cost for the extensive checks varies between $50 and $110 depending upon the number of states the student has lived in. Results of the background checks will be sent to the Nursing Program Director.

Have these people gone off the deep end? A more extensive background check, just to be a nursing student. Like anyone is going to hand over the narc keys to a student, unsupervised. Are they going to call the FBI, and have a spook go and talk to your former neighbors, your priest, and your parole officer?

Now, how on earth do they know which states the student lived in? They have to go by what the student tells them. So if a student did have a shady past in one state, it could be very easy to omit it.

Now they also want you to have a negative TB test or chest x-ray, Immunization record: recent diphtheria-tetanus vaccination; Positive Titer (German Measles) or measles, mumps and rubella vaccination; varicella; Hepatitis B vaccination series.

That’s something that hospitals do when you’re hired, at their expense. That was never needed just for school. So in addition to tuition, this place is really milking students dry for background checks, drug screens, getting blood titers if you don’t happen to have your little babyhood shot card handy, and you have to get a Hep B vaccine.

Cool. I wish they had done background checks and drug screens when I was first applying. And tried to force me to pay for titers and shots…uh no, sorry. School was expensive enough. And just the thought of it–a background check to apply, and then another one when accepted? I may as well join the military, or the CIA! But if that had been the case, I never would have gone to nursing school. I would have switched to another program, and been a lot happier. As it was, I spent most of my nursing career trying to get out of it.

But maybe this is just one of the school’s tactics for weeding people out. If they are willing to put up with all this crap and expense, then they must truly want to go to nursing school. Those unwilling to submit to unreasonable bureaucracy aren’t wanted or needed. Besides, they would never survive in today’s healthcare system!

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.

Imagine that–there are nursing schools with no waiting list. This certainly flies in the face of the stories about how “if only there were more nursing schools, the nursing shortage would be solved.” And how “tens of thousands of students are turned away every year” because schools have no room.

Well here it is. Here is a list of nursing schools that have no waiting list. And this is undoubtedly a partial list, because the schools have submitted their names voluntarily so it is quite likely that there are many other schools that have zero wait for anyone wishing to enter a nursing program.

This list of schools can be found on discovernursing.com, the sweet sugar coated website of nursing put together by Johnson & Johnson. But nevertheless, while the website paints an overall picture of nursing minus any of the gore, blood, issues, problems or gives any indication of what a nurse actually does all day–this list is an interesting twist.

It debunks the myth that the nursing shortage is caused solely by lack of schools, space, and teachers. It shows that all nursing schools aren’t filled to the brim, and that many, indeed, have space for anyone interested. And what are these schools?

Well, you can look at the list for yourself, but it includes private and state schools, as well as community colleges. And no, they are not all located in Podunk, USA, or institutions hanging by a thread to their accreditation.

Palm Beach Community College and Seminole Community College are on the list, and Florida has one of the worst nursing shortages in the country. Not only can’t they get nurses to work there, but they can’t even get students to go to school there!

Surprisingly, prestigious schools like Columbia University and University of Michigan, Ann Arbor, are on the list. U of M is also a state school, so the price tag is lower. The Medical College of South Carolina is also on the list.

And as I said, these are only schools which have been submitted to Discover Nursing. I would guess that the actual number of schools without waiting lists is much higher.

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.

Is Pharma a dirty word? Do nurses who “defect” and go off to work for pharmaceutical companies sell out their souls and become defiled?

Or is working in the pharm industry simply another option for nurses, and should I add, one that pays well and doesn’t include wiping up puke in the job description?

The reason I bring this up is that I came across a posting by a nurse who seemed absolutely horrified that her coworker would leave the marvelous land of hospital nursing and go off to work at a pharm company. The nerve. And to think that her pay check would double, she would be off on weekends and holidays, and the company actually offered her a pension plan.

Granted, pharmaceutical companies do not have the best reputation, but some of it is media hype. And certainly, some of the problems within the pharm industry are reflections of the healthcare system as a whole.

But this posting reminded me of an essay I had read a number of years in a nursing magazine, one of those first person pieces penned by a nurse who had defected from the hospital but was now “seeing the light.” This particular nurse had worked in ICU, gotten fed up with the usual abuse, poor working hours, low pay, etc., and had left hospital nursing. Now working as a pharm rep, with a job that gave her a huge boost in pay, a company car, an opportunity for travel, and more regular hours, this nurse suddenly felt “dirty.” Like the job was stealing her soul and tainting her with pleasures of the flesh.

So what does the good nurse do? She returned to the hospital, and now felt that she had been “cleansed.” In fact, she now said that she felt “clean.” And here she was, back on night shift, running up and down hallways and would no doubt soon be complaining about her aching back and varicose veins, but at least she was clean.

The essay, as you might be able to tell, left me feeling ill. I think we can look at this from 2 different angles. The first goes back to the ancient concept that nurses are supposed to be poor, work out of love, and should expect to be manhandled and abused. Afterall, they are angels of mercy which is just a step above being a martyr. Any self-respecting nurse who gets to wear a suit to work, and not have a dinner tray thrown at her by an irate patient (with the hospital talking heads warning her to just “forget the incident or else”) should feel defiled. If you’re not suffering, then you’re not a real nurse.

The other take on this is that working for big Pharma is dirty. Period. You touch their brochures, bottles, and cash a check, and you’re dirty. It’s a big bad industry, and only the corrupted Satan worshipers go and work there.

So let’s see. Well, this particularly nurse, from what I can recall, didn’t really have any complaints about the company she was working for. She didn’t say that she was being forced to lie and cheat and adjust clinical trial data so that a big potential blockbuster could come on the market. Nothing of the kind. And for those nurses who think that working for a pharm company is bad just because, well, consider that the next time your patient needs a drug. Do you refuse to administer the prescribed drugs because you think pharma is bad? Do you tell the patient that–sorry, I refuse to give you this insulin because pharma is bad bad bad, and I am defiling myself by having anything to do with them.

Yes, have nurses who think that working for pharma is dirty ever considered that aspect? They develop the drugs but you’re the one who gives them. Touche.

However, I tend to think that my first rendition of this rings truer. It’s the guilt complex, the martyr complex, the idea that nursing is a calling and you shouldn’t even be paid for the privilege of getting stuck with a contaminated needle or berated by a pinhead wearing a manager’s cap.

After reading less than stimulating articles on the nursing shortage, and listening the mantra of “train more, train more,” or shorten the training time period for nurses so we can push them into unsafe working conditions sooner and make it even more likely that they’ll get fed up that much faster–it’s always refreshing to find articles that show a little depth and honesty of the situation.

This is from a website about getting a nursing degree online, and this is an excerpt from an article about the wisdom of importing foreign nurses:

I know this much - the domestic workforce doesn’t seem to share the same excitement about the profession as staffing agencies. Nurses’ unions disagree with the premise that nurses from abroad will help solve the problem. Nursing organizations are voicing a deep concern that foreign nurses are not being incorporated into the unions upon entering the workforce. And this means hospitals and the like can hire foreign workers far cheaper than domestic nurses plus they don’t complain about working conditions, because it’s better than their home country. The result is a national deterioration of the nursing wage, which affects all nurses.

“There is no shortage of nurses in Massachusetts,” says David Schildmeier, spokesperson for the Massachusetts Nurses Association. “There is a shortage of nurses willing to work in hospitals under current conditions, assigned to too many patients, that is why people are leaving.”

Well of course staffing agencies support importing nurses–the poorer the home country the better. They make a bundle from the hospital and in fact, an entire industry has developed around recruiting nurses and passing them around the globe.

And what Schildmeier says is so true. I’ve been saying it for years. And isn’t it odd, that despite all the endless hoopla about the nursing shortage, that very few facilities have stepped up to the plate and made real progress in improving their work environment. It’s as if they want nurses to quit, so that they can keep replacing them with new grads (read cheaper) and foreign help.

I came across this website while just doing a little browsing for any new insights into the nursing shortage–you know, hoping to find an article about how a facility has discontinued canceling nursing shifts when patient census is down, or how they are stocking their place with state of the art technology that will make the lives of nurses easier, or have adopted realistic nurse-patient ratios –you know, stuff that will help keep nurses on the job.

Instead, I found this odd website devoted to the nursing shortage. The title of the website is “Nursing Shortage” and then it has a nice little set of buttons down the side which are supposed to tell you all that you ever wanted to know about the nurse scarcity gripping the nation.

There is no mention of who owns this site, who runs it, or anything–just a half-baked generic email address. And if you actually click on the buttons and read the content…well, with each click, it looks suspiciously more and more like PR double talk.

“Reasons behind the nursing shortage” makes no mention of burn-out or experienced nurses leaving the profession. It only gives the usual, tired, let’s get out the violins excuse of how schools can’t mass produce enough little nurses on the assembly line. And yes, it also squeezes in about the boomers getting old, decrepit, and sickly, and how they will need nurses to change their catheters and bedpans…

And yet, the usual schtick about nurses retiring…

Are we in Kansas yet?

The other sections are no more enlightening. This is from their section on “addressing the shortage:”

When the factors behind the nursing shortage are thoroughly analyzed, it becomes apparent that in order to begin to fix the problem, one of the factors in this cycle needs to be stopped. The cycle is such that there are fewer nurses because many older nurses are retiring. However, there are fewer nursing graduates entering the field because of a lack of funding to nursing schools and programs. How can these younger nurses be expected to enter the field if their educational needs cannot be met? The most important way in which the nursing shortage can be addressed is through this avenue. In order for the shortage to begin to be alleviated, the lack of funding and space in these nursing programs needs to be evaluated. Because of these constraining factors, not enough applicants can be accepted and therefore graduate ready to enter the field –and the shortage continues to grow.

The rest of the section is just as silly. Nothing about improving working conditions, retention of nurses, and so on. The section called “World of Nursing” does mention burn-out, but its entire focus is on long hours–12 hours shifts which many nurses actually prefer working–and on unsafe patient loads. But the way they put it:

Nursing shortages and turnover rates have been reported to be the highest in critical care facilities, in which nurses are worked for long hours and have to care for more patients then they feel they can safely care for.

Uh, what about other areas of the hospital? Unsafe patient loads are not mentioned, like the med/surg nurse assigned 10 patients–6 with IV meds, 4 who can’t get out of bed, 5 with colostomies, 3 with NG tubes, 2 on oxygen…you get the idea.

They also make no mention of mandatory overtime, which is one of the reasons why nurses are working such long hours. Or of the general disrespect that nurses get on the job, or verbal/physical abuse, or hospital PR weenies screaming that the “customer is always right” even if the patient slugs the nurse in the face….and so on.

It’s hard to figure out who put together this brilliant little piece of information. There’s a lot in it about agency nursing and travel nursing, so I’m assuming that a temp agency put it together. If anyone thinks that putting out nonsense like this is “helping” the nursing shortage, they are sadly mistaken. It merely just helps to fuel the myth that hospitals are desperate and willing to do anything to hire and keep their nurses, that workplace abuse just doesn’t exist, and that the primary reason for the shortage is a lack of new nurses.

This is like, getting so old…

And here I thought I was up on everything to do with nursing. Apparently, there is a movement to create an Office of the National Nurse–and have it be on the same par as the Surgeon General. According to the supporters, this is what the Office of National Nurse would be/would do:

* Elevate the Chief Nurse Officer (CNO) of the US Public Health Service to full time status within the Office of the Surgeon General to become the National Nurse to enhance prevention efforts in all communities.
* Complement the work of the US Surgeon General.
* Promote involvement in the Medical Reserve Corps to improve the health and safety of the community.
* Incorporate proven evidence-based public health education when delivering prevention.

HR 4903 was introduced into the 109th Congress, to make this a reality.

Laura Stokowski MSN, RN testified before the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, on the behalf of creating the Office of the National Nurse. She closed her statement with this:

We believe that creating an Office of the National Nurse is a way to bring attention to nursing, to instill pride and to recruit new nurses. But most importantly, it is a way to achieve better health for the citizens of this country by effectively utilizing nurses to improve health outcomes.”

I really haven’t thought too much about this issue, and don’t really have an opinion on it. But realistically, is the ONN really going to make that much of a difference in the health of Americans? That is, is the ONN really going to go to bat and fight the huge agribusinesses that promote junk food, factory farming, and the mass industrial complex that producing food has become? The industrial complex that doesn’t want to hear about the detrimental effects that its products are having not only on health, but on the environment and the degradation of prime farmland?

Is the ONN going to work on exposing the shenanigans that go on behind the scenes, between the FDA and big pharma? Or how the FDA is still working hard to undermine the alternative health community, the availability of supplements, or allowing any sort of health information (notice the word information, not claims to cure diseases) of some of these products?

Is the ONN going to help people get health insurance–for a price they can afford and that provides decent coverage?

Is the ONN going to stop Congress from cutting Medicaid and Medicare payments to practitioners–and this includes advance nurse practitioners as well? Hint–lower payments to clinicians means that fewer and fewer are going to accept patients on Medicaid and Medicare.

Is creating an ONN really going to help nurse recruit? What about nurse retention? Is the ONN really going to do anything about working environments, pay, schedules, abuse, and all the other negatives that nurses in hospitals have to deal with it?

These are issues to think about it, before making sweeping statements about what this position is going to do. Many of the surgeon generals find their hands tied, and do little to nothing by the time their tenure is over. And if a president doesn’t like them, they get the boot.

C. Everett Koop was perhaps the Surgeon General who made the greatest impact, in that he bucked the Reagan administration and attacked the AIDS epidemic head-on. I think Reagan was torn between staying the darling of conservatives and his Hollywood friends dying of AIDS–so closing his eyes and allowing Koop to take the heat was a nice compromise. But aside from Koop, I think most Americans would have a hard time recalling the name of any of the Surgeon Generals, or tying their names with a major inroad in the health of our nation.

Anyway, if you want to read more about the National Nurse:

http://nationalnurse.org/

It seems that our neighbors north of the border are also having a little crisis in healthcare. Canada’s healthcare system is remarkably different from ours, but it seems that they are plagued with the same problems when it comes to staffing shortages. And according to this article from the National Post, it seems that they are taking the same dumb-assed approach to solving a physician shortage (which was artificially created in the first place) that we are taking to solve the nursing shortage here (also artificially created).

The country [Canada] has approximately 15,000 too few doctors, a figure roughly double the total number of students in all years of study at our 17 medical schools combined. At a doctor-patient ratio of just 2.3 per 1,000 population, we are 24th on the list of 28 industrialized countries. Approximately 1.5 million Canadians cannot find a family physician as a result.

No, it isn’t the climate that is causing the shortage in Canada. The problem is multifaceted and complex, just like the nursing shortage here. It was created artificially, and the brilliant idea to solve it is to shorten medical training.

Yep, you heard right. Shave off a year of medical school, from 4 years to 3. And voila, all the issues that caused the shortage in the first place will disappear. Surely, whoever dreamed up this idiocy must have been receiving intel from the same idiot who decided that shortening nursing education in the US was the key to solving the shortage. Some brilliant minds at work no doubt. Just mass produce them puppies, and all troubles will melt like lemon drops.

The writer of this editorial agrees with me, and thinks that the idea is insane. Just like putting a bandaid on a head injury where your brains are oozing out of the skull.

If this scarcity can be alleviated, even in part, by shortening the duration of doctor training, it might be worth a look, provided Canadians can also be reassured the change will not dull the skill of the country’s new doctors. However, it doesn’t go to the twin hearts of the problem: socialized medicine and centralized planning of health care. Graduating more doctors sooner won’t cure the underlying condition. Rather, it is more like treating a wound on the left hand by suturing the right one.

The doctor shortage began in the mid-1980s — not coincidentally, at the same time the last Trudeau government passed the Canada Health Act, which forbade user fees, balanced billing by doctors and private clinics and hospitals. Immediately, doctors began moving to the United States by the hundreds every year. The effects of this exodus were compounded in the early 1990s when provincial health ministers consciously decided to limit enrolments in their medical schools. Doctors, they reasoned, were the enemies of health budgets; limit the number of doctors and there would be fewer tests ordered, fewer hospital beds filled, fewer surgeries performed and lower costs to their department’s budget. (By this thinking, eliminating doctors altogether would really bring provincial cost into line.)

And here I thought that the Canadians had more sense when it came to healthcare. Guess I was wrong.

Now how could I have possibly missed National Nurses Week. I mean, why wasn’t it highlighted on my calendar in dayglo green, or why didn’t I have some sort of alarm system chiming…”We are now entering National Nurses Week, please put a smile on your face.”

National Nurses Week is one of those things, something that some dweeb thought up to “honor” nurses. It runs from May 6-May 12, this year, to coincide with the birthday of the grand-dam of nursing herself, Florence Nightingale. It would be one thing if it was a sort of May Day type thing, where nurses all over the country dropped their bedpans and took to the streets. It would be one thing if facilities thought to actually honor nurses during this sacred week, by doing something that shows that nurses are respected and considered an important member of the team, instead of something they figure that they can work to death, and toss out the door if they think they need to make cuts somewhere.

This is from the American Nurses Association:

As we celebrate National Nurses Week 2008 (NNW) May 6 - 12, the American Nurses Association (ANA) and its constituent member associations (CMAs) salute nurses across the country with the theme Nurses: Making a Difference Every Day. Nursing is often described as both an art and a science; this year’s theme reflects the commitment nurses make every day for their patients and the compassion and quality of care they provide for their community.

Today’s nurses must have the strength to care for patients during times of disaster and crisis; the commitment to remain involved in continuing education throughout their careers; and the compassion to provide hands-on patient care at the bedside – as they have done throughout the centuries. Moreover, at 2.9 million strong, nurses represent the largest group of health care workers in America, and we have the power to achieve much-needed reform in nursing and in health care. That is why it is important to take time out during National Nurses Week to thank nurses for what they do and to remind the public just how vital our nation’s nurses are to patients, their families and society.

It shows you just how out of touch with reality they are. Nurses don’t want to be thanked, they want to be treated as professionals, respected, and paid what they are worth. Of course, far too many nurses still believe that it’s okay to be abused on the job, okay if a patient hits them or a physician smacks them around….hospitals tend to think so as well. It would be really nice if the ANA was an organization akin to the American Medical Association, and had real clout and a real vision.

But less than 10% of all nurses belong to the ANA, and it’s not hard to understand why. They do nothing, have no vision except to throw around fancy rhetoric, and tend to skim over real issues. Like last week, which was supposed to honor nurses. How about getting a little more militant, and striving to motivate nurses to stand up for themselves, to organize and fight abuse?

I guess that would go against the spirit of National Nurses Week, though. Nurses are supposed to be sweet and compassionate. They should be thankful that their employers don’t kick them in the ass more than once a day. Right?

Come one, come all….if you’re interested in a nursing job in the greater Seattle area, you can come to the free job fair (like anyone should have to pay to go to one of these) that will be held in May. It will be held May 15, 2008.

Washington State Convention & Trade Center
Hall 6E
800 Convention Place
Seattle, WA 98101

8:30am-4:00pm (CE Seminars)
10:00am-2:30pm (Exhibit Hall)
Doors open at 8am

EXHIBITORS

Auburn Regional Medical Center
Cascade Valley Hospital & Clinics
Children’s Hospital & Regional Medical Center
Columbia Basin Health Associates
Evergreen Healthcare
Franciscan Health System
Good Samaritan Emergency Dept
Group Health
Harborview Medical Center
Harrison Medical Center
Healthways
Maniilaq Health Center
MultiCare Health System
Northwest Hospital & Medical Center
Phoenix Children’s Hospital
Public Health Seattle & King County
Puget Sound Blood Center
Seattle Pacific University
Seattle University College of Nursing
State of Alaska, Dept of Health & Social Services
Stevens Hospital
Supplemental Health Care
The College Network
The Regional Hospital
University of Washington
US Army Healthcare Recruiting Team
VA Medical Center
Valley Medical Center
Virginia Mason Medical Center
Walgreens - Option Care
Washington State Department of Corrections
Washington State Department of Social and Health Services
Western Governors University
Yuma Regional Medical Center

Of course, I have heard stories from many nurses that their resumes are ignored, the recruiters never call them back, and basically, it just seems for show. Or that despite the whining and bitching about no nurses, they really don’t want to hire anyone who has one iota of experience. That translates to having to pay them more, they will probably use more benefits (after all those years on the job, undoubtedly there is a back injury brewing), and may be less malleable than a fresh new grad who thinks that she’s going to save the world.

Under Seige

If you are a nurse esthetician, watch out. Apparently, your right to practice medical esthetics without direct supervision by an MD is being challenged in California. This is just off the press from the Association of Medical Esthetic Nurses.

ALL MEDICAL ESTHETIC PROFESSIONALS CALIFORNIA UNDER ATTACK AGAIN!!

All Medical Professionals in California your right to practice medical esthetics as you now know it under attack. Again, these moves are instigated by a subspecialty group of physicians to gain statutory protection and protect their financial cash cows by limiting competition. Meanwhile they are tying up our legislatures and incurring debt on the taxpayers with their unjustified and nonsensical personal agendas.

California Assembly Bill 2398 would require a physician or surgeon who delegates the performance or administration of any cosmetic medical procedure or treatment to directly supervise the delegate. The bill defines cosmetic medical procedure or treatment as “a medical procedure that is performed to alter or reshape normal structures of the body solely in order to improve appearance.” We are uncertain as to whether the scope of this bill is intended to include light-based cosmetic procedures, however we believe it will. A hearing regarding this bill has been scheduled for April 9.

We must fight back, we did in it Wisconsin, GA, AZ, CO, MASS, other states, WE CAN WIN, but we must be united and each do our part. Look over this amendment and contact (email and call) your respective congress persons to voice your strong opposition to this proposed amendment. Also please email the Assemblyman that are responsible for this bill:

Assemblyman Alan Nakanishi’s email is: assemblymember.nakanishi@asm.ca.gov

Assemblyman Ross Warren’s email is: ross.warren@asm.ca.gov

Other Committee Members can be found at:
http://www.assembly.ca.gov/acs/newcomframset.asp?committee=129

I looked up the bill, and it states that (among other techno-talk):

This bill would require a physician and surgeon who delegates the performance or administration of any cosmetic medical procedure or treatment, as defined, to provide immediate supervision of that procedure or treatment, as specified. The bill would provide that a violation of that provision may subject the person or entity that has committed the violation to either a fine of up to $25,000 per occurrence pursuant to a citation issued by the board or a civil penalty of $25,000 per occurrence.

So I’m not really sure what this means, to be quite honest, or how the system is working right now. Does it mean that an MD must be physically present when a nurse performs the procedure, as in breathing down her neck and watching as her fingers inject Botox? In that case, the physician may as well do it himself. Or does it mean that there just needs to be an MD present somewhere in the facility? The MD could be doing his or her own procedures at the same time the nurses are doing theirs?

I do know that nurses perform many of these procedures, and in fact, I’ve seen them advertised on the windows of salons in Seattle. Perhaps a doc is available by phone, and then there’s always the ER, but I’m certain that salons do not have a physician physically on the premises.

I would appreciate more feedback on this from nurse estheticians, who are not nurse practitioners or who have an advanced degree.

This website may seem a little morbid to some, and challenging to the sensibilities. In essence, a German photographer photographed 22 dying individuals right before they died, and when they were deceased. Yes, a photograph of a dead face.

The photos are beautiful and sensitive, and when I looked at some of them, I wondered what the person was thinking, as all knew that they were close to death when the portraits were made.

When I was in nursing school, death was mentioned but as sort of a side remark. Patients weren’t supposed to know, and we weren’t supposed to know that some of them died. Our patient assignments during our clinical roations were carefully selected, in that none of the patients were too ill. End of life was mentioned briefly in textbooks, mostly as it related to pain relief.

I’m hoping that programs have gotten a little more 21st century, and acknowledged that as a nurse working in acute or long term care, patients are going to die. Get used to it. These photos symbolize, at least to me, that transition–when one is aware that the end is near, and the camera has captured that awareness in their eyes and facial expression. And then afterwards, when their soul has been freed and the body is at peace.