is tomorrow. It is almost 30 years since the first published document about AIDS appeared in MMWR in 1981, a short little article about 5 gay men with strange problems afflicting their immune system. Of course, it was not the first time this strange syndrome had appeared, but the first time it appeared in the scientific literature. Thus, June 1981 has been marked as the beginning of the AIDS epidemic.

According to UNAIDS estimates, there are now 33.2 million people living with HIV, including 2.5 million children. During 2007 some 2.5 million people became newly infected with the virus. Around half of all people who become infected with HIV do so before they are 25 and are killed by AIDS before they are 35.

But as we get ready to mark World AIDS day, some experts are saying that the epidemic is overblown

Interesting article and some points to consider. The different viewpoints are all valid, but it all adds up to the same thing--money. How should we best be using scarce resources?

One good use of money would be to increase salaries of nurses and physicians in developing nations so that these people have some incentive to stay and work in their homelands. While brain drain is talked about, nothing seems to be done about it.

According to a new Gallup poll, nurses are the bastion of respect and honesty. Those babes in white are to trusted above anyone else.

PRINCETON, NJ — For the seventh straight year, nurses enjoy top public accolades in Gallup’s annual Honesty and Ethics of professions survey. Eighty-four percent of Americans call their honesty and ethical standards either “high” or “very high.”

This year’s results are based on a Nov. 7-9 USA Today/Gallup poll rating the honesty and ethics of workers in 21 different professions.

Nurses have topped Gallup’s Honesty and Ethics ranking every year but one since they were added to the list in 1999. The exception is 2001, when firefighters were included on the list on a one-time basis, shortly after the Sept. 11 terrorist attacks. (Firefighters earned a record-high 90% honesty and ethics rating in that survey.

It is nice to be so trusted, but where does trust get you? Trust without respect is meaningless, particularly in the workplace. Patients often treat nurses like they are the “hired help,” like the nurse was their private servant.  And they treat nurses like they are the upper class and nurses are lowly working class drudge.  And of course, some nurses reinforce that image by not sticking up for themselves, and demonstrate to the patient that they are nothing more than servant labor–by grabbing a mop instead of calling housekeeping, or washing down the shower!

Administration also has little respect for nurses–I don’t know how many nurses talk about punching a time clock. Gee, we’re supposed to be professionals and instead, playing Laverne and Shirley? At least factory workers tend to be union members, which is more than I can say for nurses.

But in the words of Aretha Franklin:

R-E-S-P-E-C-T

Find out what it means to me.

R-E-S-P-E-C-T

Nurses need to add that word to their vocabulary, and demand it.

With all of the excitement over the election, and my usually hectic schedule (I finally sent my last two change of address cards–never mind that I moved 11 months ago), this entry sort of got pushed to the back of the pile. But a reader contacted me and asked me to read an article she had written, and to comment on it. And if I liked it, to please mention it on my blog.

Well, I do. It is a great article about those little details of nursing that most of the “experts” like to omit. It zooms right in on what the problems are in nursing, the real problems. And in looking at these real problems, it is impossible to just shrug the shoulders and say, “Well, we can solve the nursing crisis if only we offer more scholarships.” Or “Let’s try to get more minorities/men/three headed elves into nursing.” Or “We just need to turn out new nurses faster, and once we mass produce them, we’ll glue them into place on the job.”

You can read her whole article at Right Here! But here’s the first paragraph–and you can see why I like it so much…

Why Are Nurses Still so Underpaid?

The Mission-Critical Sticky Factors in Nursing

The nursing shortage is a veneer for other nursing-specific problems that really go under-reported. We tend not to hear about them because they lay bare a few disappointing truths about nursing often only known by insiders.

• First, nursing salaries stink—period.
• Second, nurses as a whole are uninspired when it comes to furthering their education or moving up the “healthcare ladder.” The rest of the world thinks it’s a novel idea, but nurses think little about it.
• Third, the nursing shortage doesn’t get any better when you try and put new nurses into the pipeline simply because it’s an open-ended model—as fast as you drop some new into the stack a slew of very experienced – the real valuable human resources – go tumbling merrily out the back side, relieved to be free and onto OTHER CAREERS, OTHER upward ladders.

These are huge factors in the nursing profession in one way or another and each poses a real world “sticky” problem.

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.

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.

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.

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.

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/

Yes it’s true, nurses are packing it in and moving on. Moving on from hospitals, that is. As working conditions within hospitals continue to deteriorate, and opportunities outside the hospital continue to proliferate, what do you think the outcome will be? Will nurses remain angels of mercy or martyrs, or will they get out of Dodge while they’re still in one piece?

From Modern Healthcare:

If hospital administrators think they face a nursing shortage now, they have more than another thing coming.

That’s because the looming problem has many parts to it, experts say. First, there continues to be great demand for Nursing care outside the hospital setting, a need that will persist as the baby boomer generation ages and seeks care at home, in skilled-nursing facilities, and in outpatient clinics. At the same time, the average age of nurses who work outside hospitals is older than the age of those who work in acute-care settings. So as they retire, these other facilities will look to hospitals to replenish their workforce. And data from the National League for Nursing just compound the problem. The league estimates that 3,500 nursing faculty will retire in 2009, with that number growing steadily to 11,500 in 2013 and just under 28,000 in 2023.

“We are not replacing the nurses in retirement as fast as they are aging,” says Mary Jean Schumann, director of nursing practice and policy at the American Nurses Association. “And the ones that we are putting out are not your 19- to 22-year-old nurses; they’re older. It’s a problem that self-perpetuates.”

Peter Buerhaus is the director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tenn. He notes that 73% of registered nurses worked in hospitals and 27% served in other settings in 1983, compared with 60% of nurses who worked in hospitals and 40% who worked in nonacute-care settings in 2006. As the population ages, Buerhaus says, there will continue to be a demand for healthcare services, and many baby boomer patients will be unwilling or uninterested in receiving care within hospitals. In addition, the nursing workforce is also aging, according to Buerhaus….

Of course, this article is the usual regurgitated pablum, in that it ignores the fact that nurses are leaving hospitals because working conditions suck. And no, most are not going to work in long term care or skilled nursing facilities–those places have even worse staffing problems than hospitals. But then, Modern Healthcare isn’t going to say anything negative about hospitals. The reason I quoted this was just for the stats. Compares with 20 years ago, the number of nurses working in hospitals has dropped dramatically. And will continue to drop, and mass producing nurses on the assembly line isn’t going to change that trend.

I’ve been away for a change of pace, covering the American Society of Clinical Oncologists annual meeting. I was frantically busy there, scurrying through a convention center that is larger than some cities, attending sessions and writing up reports. Once home, then I had to continue writing up reports. Now I’m off again to another conference, but by mid-week, I should be back and then be able to get into a normal blogging mode again. Plus, I will be revamping this site, and that is also taking some work behind the scenes.

Oh, and by the way, did you know that there’s a nursing shortage? And did you know that everyone is still spewing out their conjectures as to the cause of it? And as I write, some poor nurse is getting whacked in the face by a patient, and the hospital is telling her to “just forget it” because its bad for PR. And in another hospital, nurses are being told that housekeeping services are being curtailed and that they have to pick up the slack (grab that mop, baby!). And in another facility, the union busters are gloating and patting themselves on the back.

And so it goes. Can’t figure out why anyone wants to leave hospital nursing.

That’s essentially, what the expert talking heads are saying about nursing. In these economic downtimes, nursing suddenly becomes an attractive profession. But when the going gets good, and things improve, the floodgates reopen and nurses pour out of the profession and enrollment in nursing programs whittles away to a trickle.

So what does that say about nursing? Not much.

From the Wall Street Journal:

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession — including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks — the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in “The Future of the Nursing Workforce in the U.S.,” a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

In other words, nursing isn’t a first choice of profession, but something people turn to when the economy sucks and its hard to find a job. So why are there always jobs in nursing? Because working conditions suck and nurses get out of it if something better comes along.

Well, I guess this solves the nursing shortage. Just keep the nation in a recession, and we’ll have all the nurses that we’ll ever need.

In a blog, someone commented on this article and wrote that: This easing could be temporary, of course; one hospital administrator quoted in the article notes that as soon as the economy picks up, nurses could leave the field again.

Hey, no kidding. It’s not that nurses “could leave the field again,” it’s they “will leave the field again,” unless hospitals get their act together and make some real changes.

Today is Memorial Day, and for most of us, a holiday. For those who have to work, it may be a day to earn time and a half and bulk up the bank account. That was one of the few perks of nursing–working on holidays like this one, where I really didn’t celebrate it (veggies aren’t much into barbecues), and it was an opportunity to be paid extra. Closer to what I was worth, as opposed to the normal pay.

But the real purpose of having this holiday, which was carved out of VE Day (Victory in Europe) and VJ Day (Victory in Japan) at the end of WW II, was to honor our military. In particular, to honor those who died.

I’m not going to give a history lesson here, but as you can see, the photo is of the Vietnam Memorial which sits on the mall in Washington DC. Well, I tried to upload a photo but it didn’t seem to take. Anyway, Vietnam. A controversial war, a dirty war (as though any war is ever clean), and one which threatened to tear this country apart. However, it is notable in the annuals of nursing history as the first war in which MEN were allowed to serve as nurse. That’s right, the first war where nurses of the male persuasion could actually tend the wounded and sick, and not have to pick up a gun.

In previous wars, and in the military in general, a male nurse was a non-entity. If you were a man and a nurse, you were not permitted to serve as such. Granted, there weren’t all that many male nurses in WW II and Korea, but the military was certainly in dire need of them. There were plenty of able bodied men to draft as soldiers, but the supply of nurses was rather scant. And yet, rather than allow these men to nurse, they gave them a gun and sent them to the front. A poor use of personnel and skill, considering the dire need for nurses, especially towards the end of WWII.

So I thought a photo of the Vietnam War Memorial was fitting. Nurses served and died in every war that this country has fought, so here’s a toast to the brave.

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?

They’re on the move, the nurses that is. Going on strike it seems.

From SF Gate:

As many as 4,000 registered nurses are expected to begin a 10-day strike this morning at eight Bay Area hospitals operated by the Sutter Health network.

This is the third action in six months against Sutter Health hospitals by nurses represented by the California Nurses Association, and today’s walkout is scheduled to be the longest. The union held two-day strikes in October and December, but nurses at some facilities were kept off their jobs longer because hospital managers said they needed to hire replacement workers for longer than two days.

This post sort of continues the previous one, about violent attacks against nurses. There is an interesting new thread about on allnurses.com, about the Tao of being hit by a patient.

What I find astonishing, that in this day and age, the nurse is asking what to do about it. As though assault is still a fuzzy area, and the wonderful professional called nurse should still be wondering if it is okay for a patient (who is completely coherent and not suffering from dementia) to slap her across the face. And wondering what she should do about it.

Fortunately, most of the responses are positive, in that they are telling her to file charges against the person who hit her. Afterall, if someone slaps you in the supermarket, would you just smile and say that it’s okay? That the person who hit you is a little stressed and need to get out their aggression. What if you were working as a supermarket checker and a customer slapped you across the face, because she said you were moving too slow? Would it be okay?

Is it okay for a child/teen to smack his teacher? Does the teacher just say, “Oh, that’s okay. I know this is a rough class.”

What would your doctor do if you smacked him/her? Would the CEO of the hospital take kindly to be being whacked across the face? Or some middle-management weenie who crunches numbers all day? Would they just say that the customer is always right, even though that’s often still the message given to nurses?

If You Get Hit…

If you are working as a nurse in a clinical area, or any area, it is NEVER okay for anyone to abuse you. I don’t care about the idiocy that instructors are still dishing out, or the “customer training” that is becoming rampant in hospitals today (they think its a solution to the nursing shortage). It is not okay.

If the patient has dementia, or is otherwise not in the right mind, then it would be difficult to press charges. However, you should never again be alone with that patient and if the patient is prone to violence, the facility needs to take appropriate precautions. Do not place yourself in danger. Tell the CEO to go in and give the patient his medication, if he doesn’t think there is a need to hire on extra security.

But if anyone in their right state of mind (arguable, of course, as to who really is right in the mind) ever hits you, immediately react. I don’t care if its the Chief of Staff. Call the police and press charges. File an incident report. Don’t let anyone talk you out of it. If you don’t do it, then not only are you telling the world that nurses are somehow “different” from everyone else, and not entitled to the same protection, but it will happen again. The same person that hit you may again strike you, only next time harder. He/she may also feel free to attack someone else, since they know there are no consequences. And your hospital won’t do anything to protect its nurses.

As a human being, you have a right to a safe and stable work environment. Don’t let anyone tell you otherwise.

FYI, the person who posted this says she is a new nurse and still on orientation. That means that her schooling was insufficient, and that her instructors managed to skim over that huge white elephant sitting in the classroom–that nurses are vulnerable to physical and mental abuse. Or they delivered the old school line of thought about how the nurse should rise above that, she should report it to her charge nurse, etc. In other words, suck it up baby.

This is part of what this nurse wrote:

So, my question is this….at what point does a nurse actually look at a situation as being assaulted. If this lady slapped me across the face in the middle of the grocery store, I would have called the police.

What is that fine line? What if she bruised my face? Is that different?

I think she answered her own question, but isn’t it sad, that she thinks that because she’s a nurse, there is somehow another standard for assault. Or that a certain amount of damage needs to be done before a nurse can consider a physical attack “assault.”

It seems that’s what needed in addition to education and getting a license in the UK. A startling news release from Unison, a British nursing union, reported that one in three nurses in the UK have been attacked. Where is Rambo when you need him most?

Nurses are vulnerable to both physical and verbal attack in the U.S., but these stats are ludicrous. Why are nurses in so much danger? Do hospitals just consider violent attacks on nurses akin to vandalism–you know, that nurses are things not people, and attacking a nurse is similar to painting graffiti on the hospital wall? Do the words “increase security” ring a bell?

And then hospitals around the world wonder why no one wants to be a sweet nursey anymore.

From Unison:

04/03/08) Almost a third of UK nurses suffer frequent violence at work, according to new research.

UNISON has condemned the findings, which reveal one of the highest rates in Europe. Only in France are more nurses attacked.

The study, published in the journal Occupational Medicine, found that 29% of UK nurses had suffered frequent violent incidents at the hands of patients or their relatives.

“These statistics should make people in the UK ashamed,” said UNISON head of nursing Gail Adams.

“It is totally unacceptable for nurses to face rising levels of violence, when all they are trying to do is help and care for their patients.”

More needs to be done to protect staff, Ms Adams said.

She stressed that prevention is the key, coupled with better training and tough penalties for anyone found guilty of assault.

And she urged hospitals to review the support they offer staff, to ensure they offer good occupational health services.

“The survey shows many feel abandoned and depressed following an assault, which should not be allowed to happen.”

The researchers surveyed 39,894 nurses in 10 countries.

They found that violence had wide-reaching effects including recruitment and retention problems, increased amounts of sick leave and burnout.

Whatever happened to those dear beloved nurse angels? Hospitals would like to know, especially when faced with angels who have been unionized.

Sutter facilities in the San Francisco Bay Area may soon be faced with a strike, but it seems a little unclear what the strike is about, or how serious the infractions are.

From the MercuryNews.com:

A strike could come as soon as the middle of the month for the nurses, who are represented by the California Nurses Association. The union and management have failed to reach an agreement in contract negotiations that began in May. The dispute has already resulted in two strikes, each lasting two days, in October and December.

The nurses say the stalemate is not about salaries, but the issues of patient care, under-staffing and their health and retirement benefits. The nurses described a “hostile” bargaining attitude by Sutter Health, and expect to approve the strike vote.

In general, hospitals are not known for being benevolent employers and their attitude towards nurses is usually deplorable. Nurses are a service, not people, and its something that’s thrown in with the laundry, dietary service, and housekeeping. In fact, a nurse can double for all of those.

But in this case, I’ve seen a few differing reports about the strike, so I don’t have an opinion on it at the moment. Perhaps as the story unfolds…

The solution to the nursing shortage is simple–pay instructors more money. How is it that no one thought of that before?

That is one of the politically correct responses to the late great shortage of nurses, that it is merely a matter of not enough slots in school and a lack of instructors.

This article appeared in October 2007, and I never got around to linking to it. But it is from Health Care blog, which says that it will tell you everything you ever wanted to know about healthcare but were afraid to ask. This particular article was penned by Maggie Mahar, and it is entitled: HOSPITALS: Why We Don‘t Have Enough Nurses (It’s Not Low Wages)

Consider this: In the San Francisco area, a nurse with a bachelor’s degree can hope to start out with a salary of $104,000. The salary for a nursing professor with a Ph.D. at University of California San Francisco starts at about $60,000.

This goes a long way toward explaining why nursing schools turned away 42,000 qualified applications in 2006-2007—even as U.S. hospitals scramble to find nurses. We don’t have enough teachers in nursing schools and the fact that the average nursing professor is nearly 59 while the average assistant professor is about 52 suggests that, as they retire, the shortage could turn into a crisis. The most recent issue of JAMA (October 10, 1007) reports that in 2005 we had 218,800 fewer nurses than we needed and by 2012, it’s estimated that we’ll be short some 1 million nurses.

So according to Mahar’s report, nurses are now all making 6 figure salaries when they are fresh out of school, and the only reason that there is a nursing shortage is that there just aren’t enough teachers or schools to train them.

There are a few hospitals in the Bay Area, notably Kaiser facilities, that are organized by the CNA and pay high wages. Although, someone fresh out of school is not going to get top dollar instantaneously. Even at Kaiser, which is probably the highest paying, a new grad may earn $40/hour, which is good money to be sure, but doesn’t translate to $104,000 (where on earth did she get that figure from?) It’s more like $80,000.

And that’s Kaiser. Small hospitals don’t come near that figure, and once you leave the heart of the Bay Area, wages vary considerably. So Mahar is using a small sliver of very high paying facilities in one small section of the U.S. (and still overinflating the amount for new grads) and using that as a basis for her argument–that salary is not a reason for the nursing shortage.

Hospitals have had to raise nursing salaries (as well they should), not just because nurses are scarce but because, in our chaotic hospital system, the work can be extraordinarily stressful.

I hate to break this to Mahar, but nursing has always been stressful. And chaotic. And nurses have always been for the most part, treated poorly. This is nothing new, and most hospitals are not jumping on the bandwagon to improve either salaries or working conditions. Perhaps Mahar might remove her blinders and look at the salary stats in other part of the country, or even in California. For example, new grads in Florida (and this reported from a recent new grad) are making $16/ hour. Now isn’t that a stimulus to go into nursing. The average nursing salary nationwide is about $50,000–that’s averaging out the very high and the very low.

Mahar is also ignoring the fact that isn’t just money which keeps nurses out of teaching. The climate of academia can be just as stressful as working in a hospital, albeit in a different manner. There’s the pressure to publish, to kiss ass, to deal with students and university politics, etc. Universities also want their nursing professors to have a PhD, and many nurses just aren’t interested in going to school for that long, just to teach. If they do get a PhD, they can get a more interesting job. An advanced degree in nursing can open the door to a lot of different opportunities, and teaching just isn’t high on the list of being either well paid, or all that enticing.

Many of the nursing programs that have these huge lists of applicants are state funded universities or community colleges. The schools are cheaper, so people apply there first. I wonder if private universities have long lists to get into their nursing programs. It has always been harder to get into state schools, even back in the early 80s when I was attending. So this really isn’t anything new, although this small part of the nursing shortage is being targeted and highlighted.

Mahar also didn’t mention nurses leaving the profession, or hospital jobs, another source of the chronic vacancies. She also didn’t mention how some hospitals have very low turnover and vacancy rates, despite the nursing shortage.

All in all, its a rather myopic little ditty of trying to explain the nursing shortage in 10 words or less.