Dana Jennings, an editor at the New York Times and a former prostate cancer patient, has written a nice opinion piece called “In Praise of Nurses.” In it, he recounts his experiences as a patient, beginning from when he was a child all the way up to his bout of prostate cancer. Unfortunately, he has had a few health problems which necessitated hospital admissions and care. Fortunately, he was cared for by competent and professional nurses.

It is nice to see this sort of article, in that he offers praise to the nurses who provided his care, without the usual idiotic sugar coated rhetoric. It’s not sentimental, but simply shows the vital role that nurses played in his care.

He appreciated it. He remembers them even if he doesn’t recall their names.

Thank you, Dana! Happy New Year!

Not sure how I missed this story considering that I used to work at this hospital.

D.C. hospital fires 11 nurses, 5 staffers for snowstorm absences

The Washington Hospital Center, which I believe is the largest facility in the area, fired several nurses because they were unable to show up at work during one of the worst–if not the worst–snowstorms in the city’s history. Strange how most of the nurses that were canned have seniority and have been there a while. What a nice way of getting rid of the best paid people and those that might come around begging for a pension sooner rather than later.

In a letter sent to the staff on Friday, hospital President Harry J. Rider sought to quell rumors that hundreds of people had been fired. He said he expects fewer than 20 people will be dismissed.

“Sadly, we did experience some issue with associates who did not show the same commitment as most of their co-workers to the community, our patients and their fellow associates. They are the few who turned away from their scheduled shifts and who tried — and are still trying — to turn the focus on themselves rather than the thousands of Washington Hospital Center workers who fulfilled their commitment to their patients and colleagues, and made it to work,” he wrote.

I wonder if Henry and his other peons managed to make it into work during the snowstorm, and show their “commitment” to the hospital. Did management make it in?

If they hospital was really committed to its staff and patients, they would have made an effort to help nurses get into work. Send out army humvees if need be, but get the nurses to work. Or offer to pay them to come in ahead of the snowstorm, and give them a place to stay. It works both ways, Henry. Nurses are committed to their jobs, but they are not about to kill themselves trying to make it to work, or abandon their children (I guess that Henry never thought of that either–that schools and daycare were closed, so what should nurses do with their kids–not that he’d think to offer daycare at the hospital’s expense).

On one forum, some nurses were saying that their hospitals expected them to come in ahead of time if a storm or something was anticipated. They didn’t get paid for their time, and they could stay in an empty patient room, or stay in a hotel at their own expense. And baah baah baah, most nurses just follow like sheep.

Well I hope all of these fired nurses suit the crap out of the WHC, and in another article, it says that the nurses have voted to become part of a larger union. Yay!

Nurses became a formal part of the military following the Spanish-American War, after about 1500 civilian nurses had been contracted to serve in Hawaii, Cuba, Puerto Rico, Guam and the Philippines, as well as to the Hospital Ship Relief.

The Army Reorganization Act of 1920 gave nurses a little more status–and granted military nurses the status of officers with “relative rank” from second lieutenant to major (but not full rights and privileges). It wasn’t until after WW II that nurses were given permanent commissioned officer status.

Florida, and in particular South Florida on the Atlantic side, is probably not one of the best places to either be a patient or to be an employee.  The pay sucks, unions are almost non-existent, the work force transient (there’s always an enormous number of travel jobs available in Florida), and basically, it shows.

No, I haven’t done a survey or scientific study, but many of the hospital horror stories take place in Florida. Nurses on forums report the often pitiful wages paid to them, and the severe under staffing. And although I worked in Florida quite a long time ago, I felt like I had gone back in time 20 years.  I briefly worked on staff and then through the registry/per diem, and it was an overall nightmarish experience.

But now, I guess I am aiming on one facility in particular. My mother fell and broke her hip, and I have to deal with an assortment of people, ranging from nice and helpful to total incompetent morons. We can start with someone from the county sheriff dept, who didn’t know where Seattle was and thought that I could just get in my car and drive right over. He didn’t seem to understand the distance from California to Florida either. And this is someone who is an officer of the law?

Next, the hospital operator was a total moron, who kept transferring me to arbitrary voice mails and fax machines.  The floor nurses were okay, although they could have been more helpful. I realize that they are probably extremely short staffed, and don’t have time to chat with me, and probably wish that I would just come in and take care of my mother. When I spoke with my mother, before she had surgery, she was trying to get a nurse to come because she had to use the bathroom. And nobody had bothered at first to help her with her hearing aids. They assumed she was demented because she couldn’t hear them.

The ER nurse had asked for my permission to do surgery because my mother is “demented.” Granted, my mother has a lot of mental problems, and she can drive you up the wall, but demented she’s not. I told the ER nurse that I would give my permission, but that the women was dehydrated, had been traumatized, did not have her hearing aids–and that does not add up to dementia.

The best one was this moron nurse caseworker (yes, she is a moron) who called me from the hospital and was trying to talk in that silly “nurse talk” like I have an IQ of 10.  Uh, I don’t think so. She wanted to know if I was the one who would help my mother make a decision on where to go for rehab. I told her that she might first try by asking my mother if she has a preference, or maybe doing something really radical like asking her primary care physician?

We already established that I live 3,000 miles away, so why would she think that I would be familiar with rehab in their area? Or does she think that I spend my spare time reading up on rehab in Florida. She seemed a little surprised by my answer–like it never occurred to her to ask the patient, or doctor.

Anyway, that’s my rant for today. My stepfather died in this hospital, and the ICU nurse that I spoke with right before he died was about as intelligent as the nurse case worker described above.  I’m not impressed with the place, and again, I imagine that the employees are overworked and poorly paid. The caseworker couldn’t wait to push me off the phone. Nice customer service.

I have long been opposed to this idiotic system of licensing nurses (and other healthcare professionals) state by state. There is one national licensing exam, and therefore, there should be one national nursing license.

The system as it exists now, allows individuals who have lost a license in one state, who are considered incompetent or even dangerous, to simply pack-up and move across state borders.

From the LATimes:

Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior.

In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly — or harshly — they act on this information, according to interviews with regulators in 14 states.

Under the law in Virginia and Louisiana, for instance, officials must immediately suspend nurses’ licenses for serious misconduct in another state. Nurses are barred from practicing unless they successfully appeal.

Missouri, on the other hand, must personally serve all accused nurses with written charges and offer hearings to contest them. If nurses can’t be found, their licenses remain clear and they are free to continue practicing, said Lori Scheidt, executive director of Missouri’s nursing board.

Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida’s action. California was the last to revoke his license, in 2008, after he had practiced here for several years, apparently without incident.

Even when states share borders, they sometimes fail to heed each other’s disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.

Nurse Karen Rheuame’s Rhode Island license was suspended in 2007 after she was arrested on suspicion of assaulting a woman in a wheelchair in a hospital emergency room and trying to steal her pocketbook, according to state disciplinary records. She also had numerous other convictions and, records show, had once brought two beers to work, which she explained to her boss were for “the ride home.”

But she’s free to practice in Massachusetts. A health department official there said regulators are reviewing Rheuame’s case and others to see if action is warranted, but they haven’t received any complaints about the nurses in Massachusetts.

A unified national system would eliminate this. But of course, state Boards of Nursing would be reduced in size and number. They basically exist to keep this inefficient and dangerous system alive, and as we can see, they are totally inept in doing their job. Having dealt with the Board of Nursing in Washington state, regarding renewing a license, I can vouch for the lack of professionalism and total self-importance seen at least in this state. It took a threat to the governor’s office and other state regulatory agencies, for them to refund money owed to me for licensing fees.

State agencies would need to exist, but in a smaller form, and with less power (and yes, the BOR does not want to get off its power trip). Forcing a nurse to be licensed in each state is simply a means of revenue–it supports an unnecessary BOR, and allows incompetent/dangerous nurses to continue working.

Now, there is nothing really wrong with the study, except that the data is used to make sweeping conclusions and statements about health. In my opinion, many of the questions are highly flawed in that they don’t allow you to answer correctly. In the questionnaire on diet and supplements, for example, they asked about your intake of fruits and veggies. They have a note in the margin that says..

Please try to average your seasonal use of foods over the entire year. For example, if a food such as cantaloupe is eaten 4 times a week during the approximate 3 months that it is in season, then the average use would be once per week.

Are they kidding or what? But yes, that’s what it said on the questionnaire. As if eating peaches a few times a week when they are in season and then not eating them all winter is the same thing as eating one peach a week all year round. So in other words, the nutrients and fiber that you get from a peach sort of paces itself, just a like a timed release capsule.

Now if that isn’t dumb enough, do I really know how many cups of blueberries I eat a week? I don’t measure them out, I just eat them. How many apricots do I eat in a week?

The only way to keep an accurate account is to have a food diary. But this is to be done from memory.

In some part of this particular questionaire, you also cannot specifically say that you don’t eat a certain food, ever. They give you a choice of “never or less than once per month.” That is not the same as never eating it.

In a few questions, they don’t even give you that.  For example, they ask “How often do you eat toasted breads, bagel or English muffin (e.g., slice or 1 half bagel)?”

There is no way to answer that you don’t eat toast, bagels or English muffins. The “least” answer is less than once a week.

Also omitted are very crucial questions pertaining to the type of food you eat. They ask about adding sugar to beverages, but don’t really ask about the consumption of sugar laden–yes, there are questions about eating cakes, cookies, etc, but it really doesn’t give a full picture. They also don’t ask about the amount of processed foods eaten, about foods containing questionable additives, organic foods, amount of raw food eaten, etc.  If the produce you eat is fresh vs. frozen vs. canned.

The questions about breads, cereals, etc, do not allow you to say that you eat whole wheat pasta, for example. Or sweet potatoes as opposed to regular potatoes. The list of vegetables and fruits  they ask about is pathetically small, and at the end, they allow you to add in any other “important” foods. Three to be exact. Wow, generous.

They ask about eggs, but nowhere can you enter if you eat free range/organic eggs. You can’t say that you absolutely eat no processed meats whatsoever. Or do not drink soda, diet or otherwise.  They list soy products, such as burgers, miso, tempeh, etc, in the vegetable section. I realize that soy is a vegetable, but many people eat it as a main dish, as in soy burgers and hot dogs. They really should split it up–soy as vegetable like edame, and put soy main dishes in a separate category. Ideally, they should really have a separate list for people who eat no meat at all, because it is impossible to answer this questionaire accurately if you happen to adhere to a vegetarian or vegan diet.

Anyway, this questionnaire is really sad, and it is frightening that they are pulling data out of it and drawing conclusions about diet and health. There is so much missing from it, and it relies totally on memory…oh, and idiocy like pro-rating your peach intake.

If you sense a bit of sarcasm in my tone, well, you’re right. I have very mixed feelings about the results that pop out of this study periodically, being that I have been a participant for 20 years. The methodology is somewhat questionable, as are many studies that rely almost solely on self report. This is especially true of the NHS, which relies on self reported questionnaires that ask questions that are near impossible to answer correctly. Plus, the data they collect has a lot of omissions in it that I think could really affect their results.

Self-reported questionnaires can be useful and accurate if they are focused on one narrow subject, such as side effects from a specific medication, or if yoga has relieved back pain.  But the questions they ask are epic in nature and require things like remembering how many peaches you eat a week, how many hours you stand at work per day…now, unless you are closely monitoring diet/exercise/patterns of daily life, at best, this is something you will only approximate.

Anyway, I’ll discuss it more tomorrow, but I just wanted to make the announcement, in case any nurse is interested in signing on.

For the new cohort,they are enrolling 100,000 or more female RNs and LPNs between 22 and 45 years old (born after January 1, 1965). The new study will be entirely web-based, as roughly half of Nurses’ Health Study II is already. To learn more and to join, nurses should visit www.nhs3.org

Nurses have long been at the receiving end of violence, as they are a vulnerable group due to the nature of the job. This time a physician was shot, which is a more unusual case.

Hospital security often sucks big time, to put it bluntly. Parking garages are often poorly monitored, if monitored at all, security is slow to come when called, security staff is often spread very thin, and there is often just a general lack of standard safety features such as good lighting at night in garages and walkways around the facility. In addition, nurses have often been discouraged from reporting incidents, or even threatened if they do so.  Accusing patients of violence does not make for good PR or customer service.

So in a way, this incident has helped bring to light that violence is a way of life for healthcare workers and that is an area in dire need of improvement. But metal detectors is not the answer since most violence does not involve guns. In fact, it may involve equipment that is already inside the building–a chair thrown at a nurse, for example. Or just being hit, bitten, punched, kicked…

Hospitals need more security and to get rid of the stigma of reporting a crime. Nurse and other staff need to be supported, not criminalized. Disruptive patients, family members, and other visitors need to be shown the door.

From the Baltimore Sun:

While Hopkins has long focused on safety at its sprawling medical campus in crime-plagued East Baltimore, the hospital does not require patients or visitors to pass through metal detectors, as Americans must do now at airports, courthouses and many federal buildings.

With a weekly stream of 80,000 patients and visitors, imposing such security restrictions is “impossible,” Hopkins officials say — and security experts agree. Even as violent incidents appear to be on the upswing at hospitals, they need to remain welcoming places, experts say.

Can you imagine metal detectors in a large hospital like Hopkins? It would take hours just to get inside the building.  As I said, it is fortunate that people are thinking with their brains for a change of pace.

Apparently, the National Nurse movement is alive and well, and still trying to push through an Office of the National Nurse. While all of the arguments for it are well and good, the bottom line is–is this something that we really need to be spending money on?

What many people don’t realize is that there is already a Chief Nurse Officer of the Public Health Service. Just expand this role a little, and you’ve got a national nurse. Make this nurse a little more visible. The bill that the National Nurse advocates are trying to get pushed through lists all of the responsibilities that the new National Nurse would have. But in reality, none of them are new, or require the formation of a whole new office.

In fact, some of it is really a little naive. I wrote up an article about this a few years ago, and one of the people I spoke with was–shall I say–quite unrealistic in what she thought that a nurse was going to accomplish. She kept repeating to me the rhetoric of how nurses are the most trusted profession, and how people listen to nurses (ummm…then why are they so abused in the workplace and so powerless), and so on. But that doesn’t translate to everyone dropping what they’re doing to come and listen to a nurse speak. Or that they will pay more attention to head honcho nurse than the Surgeon General.

Duties- The National Nurse shall carry out the following:

• `(1) Provide leadership and coordination of Public Health Service nursing professional affairs for the Office of the Surgeon General and other agencies of the Public Health Service, including providing representation for the Government of the United States at the Global Forum for Government Chief Nursing and Midwifery Officers and serving as a member of the Federal Nursing Service Council.

• `(2) Represent the Surgeon General and the agencies of Public Health Service in communications with groups and societies concerned with nursing issues at the local, State, national, and international levels.

• `(3) Provide guidance and advice to the Surgeon General and the Nurse Professional Advisory Committee on matters such as standards, recruitment, retention, readiness, and career development of nurses employed by and contracted with agencies of the Public Health Service.

• `(4) Conduct media campaigns and make personal appearances for purposes of paragraphs (5) through (7).

• `(5) Provide guidance and leadership for activities to promote the public health, including encouraging nurses and other health professionals to be volunteers and developing projects that educate the public about and engage the public in prevention practices to achieve better health.

• `(6) Provide guidance and leadership to encourage nurses to become nurse educators.

• `(7) Provide guidance and leadership for activities that will increase public safety and emergency preparedness.

Is there anything on this list that requires a whole new office to be set up? No. Is there anything on this list that the current CNO of the public health service can’t do? No.

Plus there are a lot of vague statements, like number 7. What kind of guidance, exactly, is the National Nurse going to provide? Go around and check up on all of the state and local public health departments? What those places need are more funding and manpower, not a National Nurse “giving guidance.”

Number 6 is not only naive, it is downright silly. Do they really think that “words of wisdom” from the nurse in the sky are going to convince nurses to become educators? That the only problem in convincing nurses to go into teaching is the “lack of guidance”  or “leadership?”

It sounds all nice and good in a document, but in reality, RNs with a 2 year degree from a community college can make more money than an educator with a PhD.  Bottom line is that nurses are not becoming educators because they can make more money (a lot more money) working in other areas of nursing. You need at least a master’s degree to teach, and a PhD if you hope to get a tenured position. Higher degrees cost money, and if you’re going to invest in education, then there are many more opportunities awaiting–for much better pay, that are a lot more interesting, that allow more independence and career advancement, and lack the headache of academia.

So unless the National Nurse is going to work some magic and substantially increase the pay of nursing instructors, nurses are not going to drop what they’re doing and run off to teach school–just because the National Nurse offers them “guidance.” All of this stuff sounds so nice and proper on paper, but in reality, its just silly talk.

If we didn’t already have a CNO in the public health service, then I would say we should consider the National Nurse. But all that needs to be done is expand the current CNOs role a little bit, and let him/her become more visible. That would involve minimal spending, and could easily be put into place.

We don’t need to waste money on trying to push more nurses through school. One major reason is that people will jump at the chance to take the funding, whether they really want to be a nurse or not, because they’ve “heard” that nursing is a recession proof career and plus they’ll get to go to school for free.

So Obama, you’ve got the wrong idea and you’re talking to the wrong people. This constant nonsense about the nursing shortage when nurses can’t find jobs is really getting old. How about using all that scholarship funding to to help fix the broken system? There’s a nursing shortage because hospitals aren’t hiring and working conditions suck–not because nurses are in short supply.

President proposes nurse scholarships

AACN Applauds the President’s FY 2010 Budget Request

President Proposes to Increase Funding for Nurse Loan Repayment and Scholarship Programs from $37 Million to $125 Million

WASHINGTON, DC, May 7, 2009 – Today, President Obama released his FY 2010 Department of Health and Human Services Budget that provided specific details on the funding levels he has proposed for nursing education and research programs. The American Association of Colleges of Nursing (AACN) is thrilled that the Administration provided $263 million for the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and $144 million for the National Institute of Nursing Research (NINR).

The proposed funding for Title VIII programs represents a 54% increase over the FY 2009 level of $171.03 million. The greatest increase was awarded to the Nurse Loan Repayment and Scholarship Programs, which received $125 million, a 238% increase over last year’s funding level. The Nurse Faculty Loan Program received $16 million, a 39% increase over the FY 2009 level of $11.5 million.

“President Obama is a true champion for nursing. This proposed funding allocation marks a historical point for nursing education, recruitment, and retention,” said AACN President Fay Raines. “If the President’s request passes Congress, it would be the highest allocation these programs have received since created in 1964. AACN will work diligently with our top nursing advocates in the House and Senate to see this funding level enacted.”

The President’s request would offer significant relief to help alleviate the 11-year national nursing shortage that is projected to grow in the coming years. According to the U.S. Bureau of Labor Statistics (BLS), nursing is the nation’s top profession in terms of projected job growth with more than 587,000 new nursing positions being created through 2016. The demand for nurses will continue to grow as the baby boomer population ages, experienced nurses retire, and the need for primary and specialty health care intensifies. BLS projects that more than one million new and replacement nurses will be needed by 2016.

AACN is also pleased that the President’s budget proposes a 1.4% increase for NINR over last year’s funding level. Moreover, the President’s budget outlined that the NINR will receive $36 million in funding from the American Recovery and Reinvestment Act that would potentially bring the total for FY 2010 to $180 million.

“This substantial investment in nursing education and research signals a strong commitment to ensuring the availability of quality nursing care to all Americans,” said Dr. Raines. “AACN looks forward to working with members of the nursing community to secure these funding levels and will continue to work to advance nursing’s role in the national discussion about patient-centered healthcare reform.”

Here they are, happy grads, ready to go on the unemployment line, where most new graduate nurses are ending up these days.