EMPOWERING. UNITING. ADVANCING.
Spring 2018
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#NursesTakeDC The Battle for Safe Staffing Levels Goes to The Nation’s Capitol
Is This Legal? Forced to clock out for breaks!
Nurses Week
PLUS
Legal Adv About Nu ice rsing Boards
A time to celebrate... & reflect...
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Nurse Entrepreneurship & Career Alternatives Conference
Las Vegas, Nevada | October 12-14, 2018 Empowering Nurses Through Entrepreneurship Featured speakers including:
Michelle Podlesni, LeAnn Thieman, Melanie Balestra, Sandra Cleveland, Donna Cardillo, Keith Carlson, Pat Crilly, Mila Carlson, Cheryl Peltekis, Brittney Wilson, Kati Kleber, Beth Hawkes, Mary Watts, Shanna Dunbar, Wendy Pickett, VInce Baiera, Renee Thompson, Candy Campbell, Patricia Iyer, Lakesha Reed Curtis, Louise Jakubik AND MORE!
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Products Directory
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EMPOWERING. UNITING. ADVANCING.
Dave Smits
Learn what it means to do what you love. Working at Sharp isn’t just a job — it’s about waking up every day knowing you’ll make a difference.
San Diego’s largest and most comprehensive health care system
Mary Watts
Content & Community Director mary@allnurses.com
Gregg Knorn
Sales Director gregg@allnurses.com
Brian Sorenson
Marketing Director bsorenson@allnurses.com
C.E.O.
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Business Operations Director admin@allnurses.com
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Recruitment Marketing Director claudio@allnurses.com
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Technology Director joe@allnurses.com
Find your next career at Sharp. allnurses.com/jobs/company/15828/Sharp-HealthCare/
EDITORS / CONTRIBUTING WRITERS Mary Watts, BSN, RN Judi Dansizen, MSN, APRN Beth Hawkes, MSN, RN-BC Elizabeth Scala, MSN/MBA, RN, BSN Lorie Brown, RN, MN, JD Brian Sorenson
47 States 74 Hospitals 48 Outpatient Centers 100s of opportunities Take a good look at jobs.tenethealth.com 4
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allnurses is published quarterly by allnurses.com, Inc., 7900 International Dr., Suite 300, Bloomington, MN 55425 All rights reserved. Reproduction in whole or part without written permission of the publisher is prohibited. The opinions of contributing writers to this publication do not necessarily reflect the views of allnurses.com, Inc. Copyright © 2018 by allnurses.com. All rights reserved. Products featured within these pages do not constitute an endorsement by allnurses.com.
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Contents
Is Your Patient Assignment Too Heavy?
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Stress. Exhaustion. Speaking Up? That’s exactly what nurses are doing in a quest for patient safety, safe staffing levels and their goals of improving unsafe working conditions as well as higher quality of care. With resistance seemingly at every turn, the nation’s nurses are taking to Washington, DC to be heard during a two-day rally in late April. The #NursesTakeDC movement takes center stage as the nation’s nurses take their concerns to the nation’s elected officials.
By Beth Hawkes
Forced to Clock Out for Two Meal Breaks – Is This Legal?
This nurse is always the only licensed staff in the building and is being told that she MUST clock out for 30 minute breaks twice per shift. Is this practice legal? 12
By Beth Hawkes
What you don’t know about nursing boards
An inside look at what nursing boards do... and why. 28 By Lorie Brown
Nurses Week
The job is difficult, taxing on both the body and mind but we love it! 30
By Elizabeth Scala
Departments 6 As seen on the Web 7 Nursing News Briefs 10 The Best of... 11 Calendar 12 Career Tips 24 Trending Products 26 Get Social 27 LOL 34 Legal Corner
Connect
From the editor
Welcome to the very first issue of allnurses Magazine. Whether you’re a long-time user of allnurses.com or coming to us as a new reader, we’re happy that you are joining us! All of us at allnurses.com are proud of the in-depth content featured within the pages of this magazine. We have articles from some of our most-talented writers including Beth Hawkes (Nurse Beth), Elizabeth Scala and Lorie Brown. For those of you who are unfamiliar with allnurses.com, we have some of the awesome content from allnurses.com featured within the pages of our first issue. There are also highlights from some of our popular content on Facebook, one of our iconic and topical cartoons for your enjoyment and so much more. The real pride and joy, though, is this issue’s cover story. The #NursesTakeDC rally taking place beginning April 25th. Beth Hawkes has written an amazing in-depth article centered around #NursesTakeDC and the related efforts for improved Nurse-Patient ratios. It truly is a must-read for anyone in the nursing profession. Again, thank you for getting this far in our very first issue. Enjoy!
Contact us
We welcome your story ideas. Reach us at magazine@allnurses. com
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as seen On The Web Trending topics and top stories from allnurses.com
How Working the Night Shift Can Be A Death Sentence
When I have a sleepless night or two, or more, I don’t think of it as a major health issue, but studies now show that it is life threatening. How can that be? All that seems to happen when I go sleepless is that “I’m tired the next day, and of course once I finish this string of nights I’ll just catch up on the weekend”.
My Body Is Not My Resume: Exploring Nursing Dress Codes
Long gone are the days of “nursing whites”, but should our dress codes be even more relaxed? Is society ready for nurses and other healthcare professionals with tattoos, colorful hair and body piercings? Let’s explore the past, present and future of nurse dress codes.
NURSES WEEK IS COMING EARLY THIS YEAR MORE PRIZES. BIGGER PRIZES. CHECK EARLY. CHECK OFTEN.
Nursing News Briefs
Addressing the Opioid Crisis Lofexidine Gets FDA Advisory Committee Backing for Opioid Withdrawal Treatment
kentucky By Mary Watts, BSN, RN The opioid epidemic continues to spread across the United States like wildfire, killing almost 115 Americans every day according to the National Institute of Health(NIH). The President officially declared this epidemic a national public health emergency. Efforts at the federal, state and local levels have increased to identify and implement solutions for combatting this serious national crisis.
The NIH, the nation’s leading medical research agency, has searched for new ways to prevent opioid misuse, treat addictions, and still manage pain. One such way to help with treatment of opioid use disorders is looking for new medications. Lofexidine, a new non-opioid drug has received a vote from an FDA advisory committee to approve its use to treat symptoms of opioid withdrawal symptoms in those who are physically dependent and have abruptly stopped taking opioids. Lofexidine, an oral tablet, works by de-
creasing the release of norepinephrine. According to a press release, Lofexidine “suppresses the neurochemical surge that produces the acute and painful symptoms of opioid withdrawal”. US WorldMeds based in Lexington,KY developed the drug which will be marketed under the brand name Lucemyra if approved. If the FDA approves the drug, it would be the first non-opioid medication approved to help patients successfully overcome opioid misuse and addiction. This is not a cure to this serious national crisis, but it is a start.
Borrowing can be stressful. But it doesn’t have to be. MEET BHG > FINANCING for healthcare professionals
online at lp.bankershealthcaregroup.com/no-stress-lending Subject to credit approval. Loans will be made in California pursuant to the California Financing Law, License no. 603-G492 Spring 2018
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Nursing News Briefs
Using Robots for Elderly Care? japan By Mary Watts, BSN, RN The baby boomers are entering their senior years in great numbers. As the largest generation continues to age, there will be greater needs for elderly care. With the predicted nursing shortage, who will care for this huge population? We may be turning to Japan for some answers. They have been using
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robots, not to provide medical care but help out in nursing homes. In one nursing home, “Paro the furry seal cries softly while an elderly woman pets it. Pepper, a humanoid, waves while leading a group of senior citizens in exercises. The upright Tree guides a disabled man taking shaky steps, saying in a gentle feminine voice, “right, left, well done!” We might find this a bit of a foreign idea (pardon the pun), having a mechanical device taking the place of hu-
man interaction between 2 humans. But the elderly of Japan seem to think just the opposite. Some of the robotic creations can actually carry on a conversation, making them a welcomed companion for those who are alone in a home or nursing facility. Japan has their eye on exporting these robotic “therapy animals” to other companies. They may just be on to something. Click here For more information or to get your therapy pet.
news wrap-up Title VIII Nursing Workforce Development Programs Providing Care for the Most Vulnerable
The Title VIII Nursing Workforce Development Program Title VIII is a federally funded program that expands funding for nursing education in order to provide care for America’s most vulnerable populations. These programs are under the auspices of the US Department of Health and Human Services, Health Resources and Services Administration (HRSA). This organization also works to fund the education of nursing educators. Without faculty to teach nurses, the infrastructure of nursing fails. This is critical to increasing the numbers of highly educated nurses in America. In order for facilities to receive funding from HRSA, they must apply and meet several qualifications. They have to have a specific purpose such as providing primary healthcare to an underserved population, providing uninsured HIV
New York Senate Bill S6768 requires that all RPNs either have or obtain a bachelor’s degree within 10 years of initial licensure + people with medication or to help families with special needs children. HRSA loan repayment is also available for nurses who agree to practice underserved communities. Some of the programs available are scholarships for nursing students, virtual job fairs, info about school-based loans/scholarships as well as faculty loan repayment. Here is where you can get more info on all the programs.
BSN in 10 - New York
Recent legislation in New York mandates a BSN for all RNs in 10 years. This law has been many years in the making. It started in 1964 and was just passed in December 2017. In 1965, the American Nurses Association (ANA) presented a paper stating that the BSN should be the
entry level to registered nursing. They confirmed this view in 2000. The reason this law was enacted was: “The legislature hereby finds and declares that with the increasing complexity of the American healthcare system and rapidly expanding technology, the educational preparation of the registered professional nurse must be expanded. The nurse of the future must be prepared to partner with multiple disciplines as a collaborator and manager of the complex patient care journey.” This new law states: “This legislation affects future nurses graduating from associate degree or diploma nursing programs who would be required to obtain a baccalaureate in nursing within ten years of initial licensure.” It also addresses current nurses: “All current nurses licensed in New York and students in programs preparing for registered professional nursing are to be exempt from the new requirement.” To explore this further, go to The New York State Senate.
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The Best of allnurses.com Highlights of some of the best comments made by allnurses.com members.
in response to a question about hypotension protocol
Study your pharm, pathophysiology and, first and foremost, know and access your patient. Then you will know what is the best choice in every clinical situation. Treat patient, not numbers, charts or monitor screen. KatieMI One kind of funny thing I did in charting....we have paper charting with my private duty agency...the mom had on Judge Judy on the tv right next to me. I was semi listening while charting and heard the word “prison.” I wrote that the plan was for the patient (a peds case) to return to prison on Monday, instead of school. Orion81RN
a LTC nurse on respect
Oswin
Can we just... respect each other’s specialties? If all nurses were hospital nurses there would be so many neglected people in the community. LTC needs more good nurses, not just people who can’t get a hospital job, but skilled, observant nurses who want to care for others.
The question is, which do you love more, your job or your spouse? bugya90
Seriously? I married my husband, for better or worse until death do us part. I never made that vow to my job and I will retire from my job one day and call it quits. I don’t plan on retiring or quitting from my husband. Do I like my job? Yes on most days. I LIKE my husband on most days too but I LOVE him everyday (anyone who has been in a long-term relationship will understand that comment) However if I ever had to choose between my husband and my job I choose my husband.
In response to one poster who was complaining about a new initiative that directs nurses to wipe down everything before doing anything in a room: JKL33
Just smile and look enthusiastic and tell them what a great idea that is. Then go on about your business, prioritizing appropriately. Someone worked very hard on this initiative, you know. Whatever you do don’t let one soul hear you complain - and tell all your friends to shut their traps, too. Any complaining and you all will find yourselves having Cleaning and Readiness for Administration of Pharmaceuticals “time outs” and clicking CRAP time-out boxes faster than I can say “told you so!”
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Calendar of Events A brief and informative overview of events, conferences and special promotions for the nursing community.
The Oncology Nursing Society Annual Conference Washington, DC MAY
17 #NursesTakeDC
Medical errors are the third leading cause of death in the United States. Nurses, healthcare providers, and the scientific community understand that unsafe nurse-topatient ratios contribute to increased morbidity and mortality for patients.
Come together with more than 4,000 of your nursing peers for the ONS 43rd Annual Congress May 17-20, 2018.
APRIL
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Join thousands of your nursing peers from across the United States for this nurse-driven rally in Washington, DC April 25-26.
The Art of Nursing
An education event to celebrate Nurses Week and beyond created by Elizabeth Scala. The program kicks off Nurses Week on Monday, May 7! For the first four days of Nurses Week, 3 videos will be released throughout the day, totaling twelve for the week. We understand that nurses are very busy, so we will keep the program open to earn CNE credits until the end of August. MAY
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SNGA 45th Annual Course Orlando, FL
Your fellow GI/Endoscopy Nursing colleagues will be at the SGNA 45th Annual Course conference in Orlando on May 18-22, 2018. Come join them! MAY
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AACN – NTI Boston, MA
Evidence-based practice is what nursing is all about. Join your critical care colleagues at the American Association of Critical-Care Nurses (AACN) National Teaching Institute (NTI) premier conference held this year in Boston May 21-24. MAY
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Career Tips
Forced to Clock Out for Two Meal Breaks – Is This Legal?
by Beth Hawkes MSN, RN-BC, HACP
Beth Hawkes (Nurse Beth) is accomplished nurse working in Acute Care as a Staff Development Professional Specialist. She is also an accomplished author, blogger and columnist. As Nurse Beth, she regularly answers career-related questions at allnurses.com. Click here to submit your career-related question to Nurse Beth today or visit https://allnurses.wufoo.com/ forms/z1j8p9o81puszdb/
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Dear Nurse Beth, I work as an LPN night shift charge nurse at a nursing home on 12-hour shifts 6p-6a. I am always the only licensed staff in the building. Until recently when the facility was sold to new management, I have always been paid for all 12 hours, but now they are telling us that everyone MUST clock out for 30-minute breaks twice on 12-hour shifts, and will deduct them automatically even if we don’t take breaks. They are demanding that night nurses do this as well, and will only pay for one of the two breaks if we turn in a missed break slip. But, is this legal? I thought they were supposed to have nurse coverage on the floor 24/7... not 23/7??? Has something changed over the years that I am not aware of? Can someone please tell me I’m not crazy and that they are lying or violating some law..? I work in Minnesota. I’ve never been told it’s the law that I have to take unpaid breaks and work off the clock. Dear Is This Legal, Minnesota Meal Breaks Here is Minnesota’s statute on meal breaks: 177.254 MANDATORY MEAL BREAK. Subdivision 1.Meal break. An employer must permit each employee who is working for eight or more consecutive hours sufficient time to eat a meal. Subdivision 2.Payment not required. Nothing in this section requires the employer to pay the employee during the meal break. It is the law to provide you with a meal break. The employer is not required to pay you during said meal break. However, you must be free of all duties during unpaid time, including meal breaks. You should not be answering your phone, you should not
allnurses
be “on-call”, you should not be interrupted. You must be off the clock in terms of pay...and responsibility. In other words, you must be relieved of all work duties during your unpaid meal break. Bona fide meal breaks are not compensable only if they are not worked time. Are you called to answer doctor phone calls during your break? Not OK. Do the nursing assistants approach you on work-related issues during your meal break? Not OK. It is NEVER legal to have wages automatically deducted for breaks not taken. If you did not receive a 30-minute break relieved of all duties, your wages should not be deducted. The facility could be at risk here for a lawsuit, and they wouldn’t be the first. You are either off the clock, and relieved of duties, or on the clock and working. Which is it? Staffing Requirements As far as staffing requirements, Federal law requires Medicare and Medicaid certified nursing homes to have a registered nurse (RN) on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty 24 hours a day. Some states have stricter requirements. 144A.04 QUALIFICATIONS FOR (Nursing home) LICENSE (Minnesota) Subdivision. 7.Minimum nursing staff requirement. The minimum staffing standard for nursing personnel in certified nursing homes is as follows: (a) The minimum number of hours of nursing personnel to be provided in a nursing home is the greater of two hours per resident per 24 hours or 0.95 hours per standardized resident day. (b) For purposes of this subdivision, “hours of nursing personnel” means the paid, on-duty,
productive nursing hours of all nurses and nursing assistants, calculated on the basis of any given 24-hour period. “Productive nursing hours” means all on-duty hours during which nurses and nursing assistants are engaged in nursing duties. Examples of nursing duties may be found in Minnesota Rules, part 4655.6400. Not included are vacations, holidays, sick leave, in-service classroom training, or lunches. Also not included are the nonproductive nursing hours of the in-service training director. In homes with more than 60 licensed beds, the hours of the director of nursing are excluded. “Standardized resident day” means the sum of the number of residents in each case mix class multiplied by the case mix weight for that resident class, as found in Minnesota Rules, part 9549.0059, subpart 2, calculated on the basis of a facility’s census for any given day. For the purpose of determining a facility’s census, the commissioner of health shall exclude the resident days claimed by the facility for resident therapeutic leave or bed hold days. (c) Calculation of nursing hours per standardized resident day is performed by dividing total hours of nursing personnel for a given period by the total of standardized resident days for that same period. (d) A nursing home that is issued a notice of noncompliance under section 144A.10, subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8. So while Minnesota statute does not require 24/7 licensed nurse coverage per se, it does require a requisite number of nursing care hours (NCH) per resident per day. However, Federal law requires a licensed nurse (RN or LPN) on duty 24 hours a day. I do not know if your facility is meeting these requirements.
For example, let’s look at your situation. You provide 12 hours of nursing care hours (NCH) per shift. Or at least, you used to. Now you provide 11 hours of NCH per shift (because time off the clock for meal breaks does not count)... Do your 11 hours of NCH (plus the NCH provide by non-licensed staff) meet the needs of the patients as required for licensing of the facility? The NCH requirements
are a function of the number of residents or census, and according to the formula given above. Disclaimer- I am not an attorney. But this sounds potentially like an attempt to save money by mandating meal breaks - without actually PROVIDING meal breaks. Ask your supervisor for clarifica-
tion on the 2 mandated meal breaks. “Just to clarify, once I clock out, I am not to be contacted for any work-related matters, is that correct?” “During my meal breaks, who should be contacted for urgent patient care issues?’ “By what time must I take the first meal break?” “By what time must I take the second meal break?” “If I am unable to take a meal break, what is the expected process?” Best wishes, Nurse Beth
Have something to say? Click here to comment!
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Is Your Patient Assignment Too Heavy? Nurses are stressed. Nurses are exhausted. And now nurses are speaking up for patient safety and against unsafe working conditions. But it’s important that our voices be heard by the public and our policymakers. With your help, our voices will clearly be heard at #NursesTakeDC on April 25th and 26th.
I
by Beth Hawkes MSN, RN-BC, HACP
Beth Hawkes (Nurse Beth) is accomplished nurse working in Acute Care as a Staff Development Professional Specialist. She is also an accomplished author, blogger at nursecode. com and columnist. As Nurse Beth, she regularly answers career-related questions at allnurses.com.
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n many hospitals nurses run the gauntlet every shift. Placed in unsafe situations, they simply try to make it through the shift without an error. After their shift, their sleep is interrupted by worries that make their way into their dreams- IV alarms going off, nightmares about patients forgotten, meds not given. New nurses cry on the way to work in dread. If you are a nurse who has experienced any of the above, this article is for you.
Show Me Your Stethoscope (SYS)
By now every nurse knows the story of how the Show Me Your Stethoscope (SYS) movement came to be. In 2015, Joy Behar of the day time TV talk show “The View” unwittingly mocked the Miss America contestant, Kelley Johnson of Colorado, (who also happens to be a nurse), by asking ”‘Why does she have on a doctor’s stethoscope?” Joy Behar was referring to nurse Kelley Johnson’s monologue in which Kelley describes a poignant interaction with an Alzheimer’s patient. In the monologue,
Kelley wore scrubs and a stethoscope.
dated minimum nurse-patient ratios.
The backlash to Joy Behar’s remark was immediate and strong. Show Me Your Stethoscope (SYS) was founded by Janie Harvey Garner, a Cath Lab nurse in Missouri. Tens of thousands of nurses posted pictures of themselves wearing their stethoscopes. Currently the SYS FaceBook group has over 660,000 members and the non-profit SYS foundation sponsors the #NursesTakeDC event.
This is the third year of the Show Me Your Stethoscope (SYS) sponsored #NursesTakeDC event and the number of nurses attending is growing each year.
#NursesTakeDC Event
Nurses from California to New York and every state in between are convening in Washington, DC on April 25th and 26th, united in their passion for patient safety. #NursesTakeDC is a national nursing rally aimed at passing federal law to protect patients by federally man-
Two bills mandating minimum nurse-patient ratios have been introduced into Congress. These two bills affect every nurse, every patient, and every person in the United States. As Nurse Keith Carlson says “Everyone of us will someday be a patient.” The bills are sponsored by National Nurses United (NNU). What are the two bills? The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act bills. The two identical bills call for federally mandated minimum nurse-patient ratios in all Medicare-particSpring 2018
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ipating acute care hospitals. One bill is in the House of Representatives (H.R.) and one bill is in the Senate (S.). A bill must be passed by both the House and the Senate in identical form and then be signed by the President to become law. • House of Representative Bill (H.R. 2392) (Schakowsky, Illinois) • Senate bill (S.1063) (Brown, Ohio). It’s exciting that there are forty-three legislative co-sponsors for Congresswoman Schakowsy’s bill! Check the list to see if your representative is one of the forty-three. If they are, call them and thank them. If not, call them and ask for their support. Co-sponsors of Senator Brown’s bill include the prominent Senator Elizabeth Warren (MA), Senator Bernie Sanders (VT) and Senator Tammy Baldwin (WI).
#NursesTakeDC Keynote Speaker Dr. Laura Gasparis Vonfrolio History repeats itself.
Back In 1998, over 3,000 nurses stormed Washington, D.C. in search of improved working conditions and patient safety. One courageous, outspoken, and forward-thinking nurse from New Jersey led the rally. Dr. Laura Gasparis Vonfrolio is a living legend among many ICU nurses. Dr. Laura has prepared thousands of RNs for their CCRN certification exam. As a new nurse in the ICU, I attended Laura’s CCRN certification prep course and she is one of the most dynamic and entertaining speakers in nursing. She is a brilliant business woman and keynote speaker. A force to reckon with, she’s down to earth, irreverent, and hilarious- and she calls it like it is. At close to seventy years young, she is still going strong. I saw Dr. Laura Gasparis Vonfrolio in Las Vegas a couple of years ago at the National Nurses in Business
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Proposed Federal RN Ratios
Intensive/Critical Care......................................................1:2 Neonatal Intensive Care...................................................1:2 Operating Room (+at least one additional scrub assistant).......... 1:1 Post-anesthesia................................................................1:2 Labor and Delivery...........................................................1:2 Antepartum.......................................................................1:3 Combined Labor and Delivery, and Postpartum.............1:3 Well Baby Nursery............................................................1:6 Postpartum Couplets........................................................1:3 Intermetiate Care Nursery................................................1:4 Pediatrics..........................................................................1:3 Emergency Room.............................................................1:3 Trauma Patient in ER.......................................................1:1 ICU Patient in ER.............................................................1:2 Step Down........................................................................1:3 Telemetry..........................................................................1:3 Medical/Surgical...............................................................1:4 Coronary Care..................................................................1:2 Acute Respiratory Care....................................................1:2 Burn Unit...........................................................................1:2 Other Specialty Care Units...............................................1:4 Psychiatric.........................................................................1:4 Rehabilitation....................................................................1:5 Skilled Nursing Facility.....................................................1:5 Source: National Nurses United
Association (NNBA)* annual conference she was keynoting and asked her why she still works per diem in the ICU. Without missing a beat, she grinned widely and said “So I can still be a pain in (administration’s) a**. History repeats. Once again, Dr. Laura is commanding the podium in Washington DC. Other rally speakers include Janie Harvey Garner, Jalil A. Johnson (National Director- Show Me Your Stethoscope Foundation,) Kate McLaughlin, and Alene Nitzky. Here is a full list of speakers. Nurse Keith Carlson and Beth Hawkes, will also be attending and speaking at this all-important rally. Allnurses will be there in force representing their community of over 1 million nurses strong. Listen to Nurse Keith and Beth Hawkes discuss the issues on YouTube.
Let’s Talk Meal Breaks
Your representatives and the public probably don’t know that when a nurse caring for six patients takes a meal break, one of two things happen. 1. Another nurse’s patient load immediately increases to twelve patients; or 2. The nurse on “meal break” clocks out and proceeds to be on call/work throughout her/his unpaid meal break. Under the proposed law, mandated minimum nurse-patient ratios are maintained at all times. Patients do not schedule emergencies around meal breaks, staff meetings, night shift, holidays, or potlucks. Patient safety cannot be in place only when it’s convenient for the employer. Every nurse knows what it’s like to be paged, called, and interrupted while gulping down their food. If a doctor rounds while they are at lunch, they rush out to meet them. If a nursing assistant pops in and says someone wants something for pain, they run to give it.
News Flash:
News Flash: It’s NOT a badge of honor to not get a bathroom break for hours on end, and sometimes (yes!) an entire shift. It’s a a wake-up call.
By definition this violates the intention and legal definition of a non-paid break which is “being relieved of all work duties”. The proposed legislation protects against mandatory overtime and violation of labor laws.
Why Mandated Minimum Nurse-Patient Ratios
Congresswoman Jan Schakowsky of Illinois introduced H.R. 1063 and says on her site: “According to the Institute of Medicine, up to 98,000 hospital patients die each year from preventable problems,
many of which could be avoided with safe staffing levels. Further, the Joint Commission found that nurse-staffing shortages are a factor in one out of every four unexpected hospital deaths or injuries caused by errors. The Nurse Staffing bill would establish new minimum federal safety standards – including nurse-to-patient ratios – and require that hospitals work with direct care nurses to develop facility-specific staffing plans. It would also provide whistleblower protections for nurses who speak out to protect their patients’ health and safety.” According to some sources, medical errors account for up to a third of patient deaths. Prior to mandated minimum nurse-patient ratios in California, a patient in ICU at a hospital known to me, the author, received the wrong blood and died as a result. It was an immediate anaphylactic reaction. Every nurse’s worst nightmare. The ICU nurse responsible for the lethal error was caring for 3 critically ill patients and was hanging blood on 2 of them at the same time. The hospital did not change staffing practices as a result of this needless tragedy- they defended them and fired the nurse. Today, in that same hospital and in all California hospitals, it is against the law for ICU nurses in California to have more than two patients. This is thanks to mandated minimum nurse-patient ratios.
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Evidence Links Nurse-Patient Ratios and Patient Outcomes
*When healthcare systems cut corners on spending, they really cut corners on human lives* We all know by now that nurse-patient ratios directly affect patient outcomes. The odds of patient death increase by 7% for each additional patient the nurse must take on (Journal of the American Medical Association, 2002). Nurses know only too well that understaffing results in longer hospital stays, increased infections, and avoidable injuries. Understaffing also leads to lower nurse retention, higher rates of injury and burnout. Dr. Ruth Neese, in her well researched Talking Points for Safe Nurse Staffing, tells us lower patientto-nurse staffing ratios have been significantly associated with lower rates of: • Hospital mortality • Failure to rescue • Cardiac arrest • Hospital-acquired pneumonia • Respiratory failure • Patient falls (with and without injury) • Pressure ulcers
How it Works in California
As of today California is the only state to have safe, mandated minimum
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The public does not know that hospital nurse staffing is at a crisis. In order to bring
about change, our legislators and the public need to know what’s really happening inside hospitals. They need to know that: • Hospitals send nurses home mid-shift at the drop of a hat the minute the census drops in order to save money • Patient call lights are not answered in a timely manner • Patient falls with injury continue to be a serious concern • Patient satisfaction scores appear to trump patient care • Nurses are given completely overwhelming patient loads and then reprimanded for five minutes overtime • Nurses routinely clock out for meal breaks but don’t take meal breaks • Missing meal breaks is the norm, not the exception • Nurses routinely clock out at the end of shift and then continue working to finish charting while some managers look the other way • Nurses are blamed for overtime, doctors’ failures to enter orders properly, re-admissions, low patient satisfaction scores, and more
nurse-patient ratios. In California patient safety is the law. “Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.” (Aiken, et al. 2010. Implications of the California Nurse Staffing Mandate for Other States. In every state except California, the number of patients assigned to a nurse is entirely up to the discretion of the employer/hospital/manager/supervisor on duty. Or the hospital’s “Staffing Committee”. Lack of federally mandated minimum nurse-patient ratios is why a MedSurg unit in Florida can have 1:7 nurse patient ratios while an identical MedSurg unit in another state can have a 1:8, 1:5, or for that matter, any ratio. Nurses in California successfully put an end to the madness in 2004 and legislated minimum nurse-patient ratios. They know that nurse-patient ratios are a matter of life and death. Safe staffing saves lives. They know that hospitals will not voluntarily decrease nurses’ workload. They took patient safety out of the hospital’s hands and put it into the voter’s hands. They advocated for patients over profits until it became the law. Under mandated minimum nurse-patient ratios, ratios are upwardly adjustable based on patient acuity. Hospitals are free to change the assignment based on patient acuity as long as they do not violate the
minimum nurse-patient ratio. For example, in California, currently the minimum nurse-patient ratio on MedSurg is 1:5 (it will change to 1:4 pending legislation). But a nurse with a high-acuity patient requiring frequent monitoring, such as a patient with a fresh continuous bladder irrigation (CBI), may be typically assigned only three patients (1:3) for a duration based on patient acuity and safety.
The American Hospital Association
Not surprisingly, there is fierce opposition from hospital executives.The powerful American Hospital Association (AHA) and its state chapters do not support federally mandated minimum nurse-patient ratios. The AHA wants hospitals to maintain control over all staffing assignments via “Staffing Committees”. There is a fear that mandated minimum nurse-patient ratios will affect their bottom line in the short-term. Of course, every nurse knows that reducing infections and increasing retention saves money in the long run.
The American Nurses Association (ANA)
So where is the ANA in all of this? Aligning with the AHA. Sadly, the American Nurses Association, the ANA, the organization whose reason for being is to represent nurses, does not support this legislation to put patients over profits. They staunchly oppose it. The ANA, along with the Association of Nurse Executives (AONE), chooses to stand with the hospital industry and not with its members, clinical bedside nurses. As a result, many nurses do not feel supported or represented by the ANA or their nurse executives.
ANA’s Suspect Solution: Staffing Committees
Both the ANA and the AHA have blocked mandated minimum nurse-patient ratios legislation by initiating opposing legislation as a smoke screen.
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Opposing legislation allows hospitals to continue to set arbitrary staffing levels under the guise of “Staffing Committees”. These bills require hospitals to establish a “Staffing Committee” composed of at least 55 percent direct care nurses, to create nurse staffing plans that are specific to each unit.
empty bed you will take 8 because your director says you can safely do it based off his or her evaluation of the unit at that time. Also, they say the grid is a GUIDE it is NOT set in stone. It’s based off the unit director or manager’s assessment of the unit. That is how this “safe staffing law” works in Texas.”
The problem is that the hospital is the employer of the nurses serving on said “Staffing Committee”.
As such, “Staffing Committees” do not provide accountability. Nurses are not fooled by the rhetoric of empowering nurses through “Staffing Committees”, although congressional representatives are.
The ANA claims that “Staffing Committees” empowers nurses. But nurses working in hospitals with “Staffing Committees” say otherwise. One such nurse is Deena Sowa McCollum. Deena Sowa McCollum has worked as a nurse manager in Texas in no less than three major hospital systems where “Staffing Committees” are in effect.
Tip:
The way to differentiate the bill supported by the #NurseTakeDC movement for the one driven by ANA and the hospital industry, is the presence of the word QUALITY in the #NursesTakeDC supported bill and not in the hospital driven bill Deena says flatly that it’s all about profit, not patients: “The “Staffing Committee” is given budget constraints for each unit.
This is precisely why #NursesTakeDC needs you.
David and Goliath
As of this publication, the hospital industry has successfully blocked any proposed staffing regulations that could potentially affect their bottom line. What does this all this mean? It means clinical practice nurses are fighting a formidable foe. The foe is profits. The deep-pocketed ANA and AHA employ well spoken lobbyists to fight against mandated minimum nurse-patient ratios and for “Staffing Committees”.
But maybe they forget that we are nurses, the most trusted profession in the United States. Maybe they forget what it’s like to be on the front lines. Remember that, we, too, are well spoken. In addition, we are voting constituents. Not special interest lobbyists. We can do this. We must educate our legislators about the nonsense of “Staffing Committees’ as put forth by the ANA and the AHA and ask them to vote as follows:
Let’s say 5 West is budgeted to provide 6 hours of nursing care per patient day (HPPD), which translates to 10 registered nurses on duty every 24 hours when the census is full.
FOR The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2018 (HR 2392/S.1063). Driven by grassroot nurses.
The committee can make recommendations for a staffing plan but may not increase the budget. For example, they can recommend allocating 6 nurses on day shift and 4 on night shift, or 5 and 5.
AGAINST The Safe Staffing for Nurse and Patient Safety Act of 2018 (HR 5052/S.2446). Driven by the hospital industry.
They could even recommend changing the skill mix by forgoing unit secretaries and instead have 11 nurses on duty -as long as if it doesn’t put them over budget. Still it is usually a 7 patient load with an aide and a clerk for a 21 census in acute rehab and if there is an 20 Spring 2018
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Stat: Calling all Oregon, Ohio, Hawaii, Washington Nurses
Do you know what some of your representatives did in February of this year?
How do I discuss nurse patient ratios with lawmakers...
Give a Short Story
Talk in stories. Stories are memorable. Here’s an example: “My mother had just been transferred out of ICU to MedSurg and the nurse told me she had seven patients that day. I’m a nurse, too, so I understood and felt bad when I saw her rushing and racing from room to room. I know what it’s like. The phone in her pocket rang constantly. I didn’t want to bother her or act like I was telling her what to do. But what scared me was when Mom got short of breath and needed a treatment. In that moment I was a daughter, not a nurse. I pulled the call light. No one came. My Mom was getting short of breath and more and more anxious. She looked at me. I felt helpless. How long should I wait? I went out in the hall but could only see one person (not Mom’s nurse). Her head was down as she was on the phone and typing into her computer. She looked intense and stressed, clearly radiating a “Do Not Disturb” vibe. I ran by her towards the nurses station and waited while a unit secretary finally looked up and said she’d page Mom’s nurse. I went back to hold my Mom’s hand. “They’re coming, Mom. Someone is coming now”.
They introduced opposing legislation- The Safe Staffing for Nurse and Patient Safety Act of 2018 (“Staffing Committees’). Contact your representatives. Tell them you are a nurse, a voting constituent. Educate them to the fallacies of “Staffing Committees” and inform him about mandated minimum nurse-patient ratios. Oregon Oregon nurses- reach out to Senator Jeff Merkley, who introduced the misguided Senate bill S.2446 (“Staffing Committees”). Ask why he introduced the bill, and who authored it. Who is really behind
I don’t know how long it took. It seemed like forever. Finally my nurse came in and apologized “I’m so sorry, I was at lunch”. It was three thirty in the afternoon. She quickly paged Respiratory Therapy and Mom received the treatment she needed. Do I blame her? No. I’m sure she was doing the best she could for each of her seven patients . What really struck me is that she didn’t seem to have any time to think. She was clearly only reacting. Reacting to the IV alarm, then her phone, then the next call light...reacting, not thinking or planning. If I hadn’t gone to the nurse’s station, or if I hadn’t been there, would my Mom have just gone into respiratory arrest?” The above scenario took place in a hospital in Florida. The nurse chooses to remain anonymous. It could not have taken place in California, a state with mandated minimum nurse-patient ratios, because in California, a nurse on MedSurg can only have five patients (this will be changed to 1: 4 when pending legislation is passed).
this bill? Respectfully educate him and explain that the ANA does not represent your views and your experience. Ohio Ohio nurses, please contact Representative David P. Joyce, who did a disservice to patients in your state by introducing H.R. 5052 (“Staffing Committees”) Note: By contrast, Ohio Senator Sherrod Brown stood up for patient safety and not big business by introducing the (good) bill S.1063. (Mandated Nurse-Patient Ratios). Thank you, Senator. Ohio’s own and activist RN Doris Carroll will be speakSpring 2018
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ing in Washington, DC at #NursesTakeDC. Ohio nurses, come support her! Washington Washington nurses, Representative Suzan K. DelBene is co-sponsoring H.R. 5052 (“Staffing Committees”) Hawaii Aloha! In Hawaii, Representative Tulsi Gabbard is co-sponsoring H.R. 5052 (“Staffing Committees”) There are passionate nurse activists working for the cause and speaking to their legislators daily; Doris Carroll (Ohio), Kate McLaughlin (New Jersey), Andrew Lopez (New Jersey), Cathy Spokes (Missouri), just to name just a few. But not enough. Your voice is needed. Many of you can go to DC to support the #NursesTakeDC event on April 25th and April 26th this year. And all of you can do something. Here’s what you can do. First find out who your representatives are by your zipcode. Use this link to find your representative and Senators by your zip code. You have one representative and two Senators. You should contact all three. Your representatives want to hear from you, their constituents. Nurses are regarded as the most trusted profession. Tell them who you are, and how you’d like them to vote.
CALL Your Legislators
Everyone reading this can make three phone calls. Call your representative. You are a voting constituent and trusted nurse. Your phone call counts. Your representative will be voting on H.R. 2392 (vote YES) and H.R.5052 (vote NO). Call your two Senators. You are a voting constituent and trusted nurse. Your phone call counts. Your Senators will be voting on S.1063 (vote YES) and S.2446 (vote NO).
Yesterday I called Representative Kevin McCarthy’s local office. It’s easy to find the phone number of your representative or your Senators. When you contact your representative or senators, be clear and to the point. Here’s an example: “Hello, my name is Beth Hawkes, I’m an RN and a constituent of Kevin McCarthy. I am calling to ask that Representative Kevin McCarthy vote for HR bill 2392”. The secretary or administrative person answering the phone carefully tallies each and every phone call related to pending bills. As a voting constituent, your opinion is valuable.
WRITE Your Legislators
When you write or email, include your credentials. You are writing as a professional nurse on behalf of your profession and for your patients. • Write a letter. You are a voting constituent and trusted nurse. Your letter counts. • Send an email. You are a voting constituent and trusted nurse. Your email counts.
When you contact your legislators by email or by letter, address them in the salutation as “The Honorable” as in ‘The Honorable Kevin McCarthy”. Be respectful, and assume agreement. Never be argumentative or threatening. References
Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health services research, 45(4), 904-921. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993.
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Cho, E., Chin, D., Kim, S., & Hong, O. (2016) The relationship of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48 (1), 74-82. doi: 10.1111/jnu.12183 Cimiotti, J., Aiken, L., Sloane, D., & Wu, E. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40 (6), 486-490. doi: 10.1016/j.ajic.2012.02.029 Diya, L., Van Den Heede, K., Sermeus, W., & Lesaffre, E. (2012). The relationship between in-hospital mortality, readmission to the intensive
care nursing unit and/or operating theater, and nurse staffing levels. Journal of Advanced Nursing, 68(5), 1073-1081. doi: 10.1111/j.13652648.2011.05812.x Nicely, K., Sloan, D., & Aiken, L. (2013). Lower mortality for abdominal aortic aneurysm repair in high-volume hospitals is contingent upon nurse staffing. Health ServicesResearch, 48 (3), 972-991. doi: 10.1111/14756773.12004
Avoid form letters and include a personal story or example. Stories are remembered.Keep the letter to one page and ask for a response.
States with Staffing Laws
MEET Your Legislators
Call your representative’s local office and make an appointment. Your representative’s office is located in your district, so make an appointment to meet him or her when they home and in their local office. Face to face meetings are the most impactful. Take a friend or two, fellow nurses, and briefly explain why you’d like them to vote Yes on HR 1063.
Conclusion
Enacted legislation/adopted regulations to date: CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT and WA
Only California has mandated minimum nurse-patient ratios (since 2004) but here’s a synopsis of what other states are doing. There is a smattering of weaker legislation in a handful of other states.
Many nurses are afraid to speak up for fear of retaliation or even for fear of losing their jobs. Nurses do not want to be labeled as “troublesome”.
Thirteen states other than California currently address nurse staffing to some degree in hospitals in their state law.
There are over 3 million nurses in the United States. If just half of us were to speak up, we can bring about needed change.
CT, IL, NV, OH, OR, TX, WA. are required to have “Staffing Committees”. “Staffing Committees” are the equivalent of the fox watching the hen house.
Activist and best-selling author Sonja M. Schwartzbach, BSN, RN, CCRN urges us: “NURSES: WE’RE ON A MISSION. IT’S TIME TO STOP GIVING IN, AND START GIVING A DAMN. We don’t need another cup of coffee. We don’t want another free pen. We want safe patient ratios: if not you, whom? If not today, when?” Please join in putting patients over profits.
Have something to say? Click here to comment!
These states are: CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA.
There is a law in MA mandating a 1:1 or 1:2 nurse to patient ratio in ICU. This is great and provides patient safety in the ICU. What about patients in other units? Public reporting of staffing is required in the states of IL, NJ, NY, RI, VT. Public Disclosure is a good first step towards transparency. Mandated nurse-patient ratios are the next step. The CNO or designee is required to develop a core staffing plan and include input from others in MN. This sounds like the status quo in hospitals everywhere. CA is the only state that legislates mandated minimum nurse to patient ratios be maintained in all units at all times. With the exception of California, none of these initiatives approach the comprehensiveness, patient safety and and accountability of HR 2392 and S. 1063. All patients deserve to have a nurse who has a manageable and safe workload. All nurses deserve to practice nursing safely. Spring 2018
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Get Social A glimpse at some of the most popular comments from our various Facebook channels... Be sure to click the headlines to add your comment!
Should I add co-workers as friends on Facebook? I see all these responses and I cannot help but think how lucky I am. Not only do I have the people I work with on FB, but as a manager I actually have my staff as well. It’s no big deal to me since we are a small group of 25-30. They understand that my role is a supervisor role and that comes first. However, I do care about them as individuals and want to share in their life experiences as well. Maybe we are not the norm...but our nursing department seems to work (my nurses/c.n.as/q.m.a.s stay).
Better Health Care Elsewhere You really can’t say which area is better. It may be coincidence, luck, or just plain researching physicians that grants you a better experience. In any given town or state, you can receive polar opposite experiences simply by changing doctors.
Nurses Smoking: Compassion Instead of Judgement Just because someone chooses to be a nurse it doesn’t mean they have to stop living their life however they want (as long as it’s legal) There are nursing shortages worldwide as it is and if some of the people on here had their way nurses wouldn’t smoke, have tattoos, be overweight or do anything that brings them pleasure... apart from alcohol!! For some reason that seems to be acceptable even though it’s prob as harmful as smoking... So maybe the holier than thou nurses need to just chillax a bit and just worry about their lives, and not be judgemental of others that choose to live differently than them!!
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LOL
You know the feeling The struggle is real. Having to “hold it” for hours – even an entire shift – happens all too frequently. While it’s depicted here in humorous form, the ongoing battle for proper staffing levels across all levels of care is real and it’s heading to Washington, DC this April. Putting real faces to the #NursesTakeDC movement is an excellent step but contacting your elected officials isn’t just helpful, it’s necessary.
What are your thoughts on this issue’s cartoon? Click to comment and let us know!
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What you don’t know about nursing boards by Lorie Brown RN, MN, JD
Lorie A. Brown is a Nurse Attorney representing nurses before the licensing board and founder of EmpoweredNurses. org. Empowering Nurses at the bedside and in business. Are you an Empowered Nurse? Take the quiz at areyouanempowerednurse.com
W
hen one takes a test for a driver’s license, that person must know the rules of the road. However, when nurses take the NCLEX examination, they are tested on how to be a nurse and not necessarily on the rules that must be followed as a nurse. Most schools teach to the test. They want nurses to pass the test because the school can find itself in trouble if the examination results show low pass rates. The same Board that regulates nursing licenses also regulates nursing education. The way a nursing board works is all prescribed by statute and regulations. The nursing board is charged with the task of keeping the public safe. So, any concerns about a nurse’s action could be subject to discipline. There are 4 types of laws. Criminal law is where your freedom is at stake. Civil law is where there is a civil wrong like breach of contract and malpractice. Military law is for our
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armed forces. Administrative law is the body of law that covers the nursing board. The protections that one has in a criminal matter such as innocent until proven guilty beyond a reasonable doubt do not apply in administrative law and the protections on what evidence can be used against you is not available in administrative law. Let’s see how this process works. CONSUMER COMPLAINT/ INVESTIGATION PROCESS Anyone can file a complaint against his/her nursing license. Believe it or not, I’ve seen complaints filed by ex-spouses, neighbors, coworkers and patients. At this point, the complaint is confidential. In some states, the complaint is reviewed by board investigators, and in other states, the investigation is performed by staff at the state’s attorney general’s office. If you are subject to an investigation, you will receive either a letter or a phone call. Therefore, it is very important to keep
your information up-to-date so an investigator can contact you. I advise that you keep a list of places to notify when you move with the nursing board be on top of the list. The investigation process can take quite some time. We are talking in some cases about years. The investigators perform a thorough investigation. If there are concerns about impairment or diversion, they may subpoena pharmacy records and medical records for any controlled substances that you been have prescribed. They can also go back and obtain employment records of all your past jobs. They are able to locate all the places that you have worked through employers which paid state taxes on your behalf.
prominently displayed online or easily searchable. If you have a complaint filed, you could settle your case or go to a hearing. Either way, the Board can give you a reprimand, which is a like a “slap on the wrist and don’t do it again.” They can put your license on probation meaning they just want to watch you. Your license under probation is considered an encumbered license. They can suspend or even revoke your license. In either of the two latter cases, you would not be able to work as a nurse. You would not be able to practice or even sign your name as “R.N.” If action is taken against your license, it will become public record on nursys.com and on the state’s license verification systems.
Since the investigator can obtain employment records, a word of caution. When you fill out a job application, make sure that you include all of your jobs and are accurate in why you left. Were you terminated or did you resign? If you were terminated, it is ok to state that you will discuss the reason in an interview. Nursing boards are very concerned about a nurse’s ethics and honesty. If you were terminated from one position and put on a job application that you resigned, that is going to be a red flag.
In most states, there is no way to get the administrative action removed from your records. It will stay with you for your entire career.
If you worked at one place for a short period of time and did not include that in your job application, that’s another red flag. Some states also require that you answer questions on your license renewal application, such as “have you ever been disciplined, reprimanded or terminated in your capacity as a healthcare professional. If you answer no to that question and they later find discipline and reprimands in your employment records, that will be of concern. The Board even considers any reprimands for attendance to be reported as that can be considered patient abandonment.
If you do not keep the board apprised of your current address, they can take action on your license and you just might not even know it. That is considered a “default” and the board will do whatever they deem necessary.
Once the investigation is concluded, the investigator will decide whether your matter should be closed or if an administrative complaint / accusation should be filed against your license. ADMINISTRATIVE COMPLAINT OR ACCUSATION Once an administrative complaint or accusation is filed against your license, this matter becomes public. Anybody can find out about it and in some states, it is
ALTERNATIVE TO DISCIPLINE Some states do have an alternative to discipline process where any action or recommendations that they take would be deemed confidential but it is available only in certain limited circumstances. DEFAULT
EMERGENCY SUSPENSION Also, your license can be emergency suspended. If the board thinks that you are a clear and present danger to the public, they can take steps to emergency suspend your license until the investigation can be completed. CONCLUSION Make sure you know your state’s Nurse Practice Act and if you get a chance to go to a Board meeting, it is an eye-opening experience. All of these measures that the board can do seem to be quite draconian and I believe being proactive is the best way to protect your license. To learn how to be proactive in protecting your license, be sure to join me in the article in next month’s issue.
Have something to say? Click here to comment! Spring 2018
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NursesWeek An Opportunity to Reflect and Celebrate
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urses Week is fast-approaching and will be here before we know it! I see this very special time as one of reflection and celebration. Nursing can be difficult work. It’s hard on the body, draining on emotions, and can be tiring to the soul. And still – we LOVE it! I’d imagine you would agree- we love being a nurse, but our joy of nursing can wax and wane, depending on our current career circumstances. Rather than allowing external influences to impact your Nurses Week – you have an opportunity. You can choose to enjoy your career and celebrate your nursing experiences thus far.
by Elizabeth Scala MSN/MBA, RN
Through her work on burnout prevention and career resilience, Elizabeth Scala supports nurses to reconnect to the joy of nursing. Additionally, Elizabeth is the creator and founder of the annual Nurses Week online program, The Art of Nursing. This will mark the fifth year that Elizabeth and nurses from across the country have celebrated professional development and personal growth during this very special time.
Now, before we get to some practical strategies, I do think that taking time to pause and reflect can also empower us nurses. I encourage you to think about the following questions: • Why did you go into nursing in the first place? • What do you love about being a nurse? • How has your nursing career made you a better human being? Spend time with these. Even journal your responses, as you approach this special time of Nurses Week. After you’ve had time to marinate on the above, I’ve also got some innovative strategies for a fun Nurses Week, whether your organization celebrates or not.
Here are 3 ways for nurses to celebrate nursing during National Nurses Week Treat yourself like a dog
1.
Yup, you read that right. In the book, Stop Nurse Burnout, I talk about the nurse superhero. We all know him/
her. And let’s be honest – we’ve all been him/her! You know the drill. Always volunteering when help is needed. Coming to a teammate’s rescue during a chaotic shift. And even saying things like “I was just doing my job” when we receive any type of recognition or compliment. Well, this has got to stop! In fact, if you have a dog, cat, or other type of animal for a pet… you can use your interactions with them as a guide. Picture this. You get home from work and there is your cute puppy. He’s wagging his tail furiously at the door, waiting for you to come over and say “Hello”. As you approach, you start to smile and speaking in a high-pitched sing-song voice, you say: “Where’s my good boy? You’re such a good boy! Look how great you are today!!” You pet him, smile, and continue to whisper love notes in his ears. Now- what about you? Have you ever talked to yourself in this way? Have you ever come home from work, patting yourself on the back, saying how good of a job you did? Or looked in the mirror, telling you that you love yourself?? I doubt it! This type of self-recognition and praise is often difficult for us to do. We weren’t taught these practices in nursing school, but they sure can come in handy. And here’s what you can do to celebrate yourself and your nursing career this Nurses Week… From this point, going forward, keep a “Great Job” journal. Every time a nurse, patient, family member, or leader praises you for a job well done come home and write it down. In fact, you can even write experiences down without the formal praise from others. Keep track of the positive work days in a journal, notebook, or even placing Spring 2018
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single papers in a cubby or box.
behind.
Then, each year during Nurses Week, take the box or notebook off of the shelf. Refer back to it and read through all of the kind words that you’ve noted throughout the year. Make this an annual ritual to reconnect you to the joy of the nursing job again.
Most nurses are often lifelong learners. We want to read, study, and gain new information that will support us in our roles. Nurses become certified in specialties and attend conferences so that they can continue to develop and grow.
Bless your team
Why not set up a routine that supports your professional growth and personal development? This is where a “life curriculum” could come into play. And Nurses Week is a wonderful time of year to remind us to do just that!
2.
Many nursing teams celebrate Nurses Week with a blessing of the hands. You can do this too and without bringing in a formal ordained minister or chaplain. In fact, I like to call this “Blessing of the Hands- With a Twist!” Here’s what you do. Get your nursing team together and perform the “blessing of the hands” with each other. Gather in a circle and go around the room, passing the blessing clockwise throughout the group. Let the person to your right look at you, tell you something that they appreciate about you, and gift you with a short word, phrase, or mantra of encouragement. Then, you turn and do the same to the person on your left. Pass the blessing down and around until everyone in the group has experienced it. This is not only an energy booster for you- but a great way to have the entire team recognize and appreciate each other this Nurses Week.
Enroll in your life curriculum
3.
Just a few weeks ago, I interviewed a fitness nurse on the Your Next Shift podcast. When I asked the question related to professional development and reaching career goals, she shared the most amazing practice!
Think about it this way. During nursing school- what happens? You have a curriculum to follow, semester after semester, until you’ve graduated. And then after nursing school? No more formal agenda with a professor or advisor telling you what to do. While this is very nice- to be out, enjoying the independence of your career- it also can cause us to fall
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So, going forward, each year during National Nurses Week you may reflect upon your current skills, training, and knowledge related to nursing. Then, as you realize gaps or opportunities for growth, you can set out to enroll in a course, read a new book, or get some other type of training that will support your nursing career. Trust me. In my work with the online Art of Nursing program, I have asked nurses what they want and do not want for Nurses Week gifts. The days of trinkets or unhealthy foods are over. Nurses want to be appreciated with meaningful recognition. And often, nurses prefer to learn and gain knowledge that will support their careers! Well, you can take ownership of that very easily. Make this time of year a habit. Look back on your growth as a nurse to where you are now. And figure out what else you’d like to learn about. Treat yourself to professional development and personal growth. Invest in yourself and set goals for your personal nursing career curriculum. As you continue to develop as a nurse, you celebrate the profession of nursing and the patients and families that you care for! What else? What have you done to reflect upon and celebrate your nursing career? We’d love to hear from you! Be sure to drop us a line at allnurses.com during one, two or all of our Nurses Week 2018 contests! Thanks for reading; and Happy Nurses Week to you!
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33
Legal Corner
Should I carry my own malpractice insurance? insurance is that certain policies cover you for “disciplinary defense.” This means that if you have an action filed against your license, you may be entitled to reimbursement for the attorney fees spent in your defense. Mind you, depending on the attorney, you may need to pay those fees up front but will get some or all of the fees back.
P
robably the number one question I get asked as a nurse attorney is “should I carry my own malpractice insurance?” You would think I would have an easy answer, like “yes” or “no,” but that is not the case. I think it is an individual’s decision and there are both pros and cons to whether you should have your own.
by Lorie Brown RN, MN, JD
Lorie A. Brown is a Nurse Attorney representing nurses before the licensing board and founder of EmpoweredNurses. org. Empowering Nurses at the bedside and in business.
Many times nurses are not named individually in a lawsuit; it is their employer. The employer has an obligation to defend you and cover you for any of your actions as long as you were acting within the scope of your employment at the time of the alleged malpractice. If you did something outside the scope of your employment such as stealing from a patient or, as an absurd example, having sex with a patient, these clearly would be outside the scope of your responsibilities and would not be covered by your malpractice insurance. A benefit for having your own malpractice insurance gives you the right to have your own attorney. That’s an extremely valuable benefit when your interests are at odds with those of your employer. Another benefit for having your own
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Most malpractice insurance policies are called “excess policies” which means that they don’t come into effect until coverage with your employer is exhausted but again, you have the right to have your own attorney. There are downsides too for having your own malpractice insurance. If you are in a state that has a cap on damages and your insurance coverage is not covered by the cap, you may have more potential to be named in the lawsuit for the extra coverage. But, let’s say that your state does not have a cap, having your own insurance coverage may subject you to being named individually as a defendant in an action because of the additional insurance coverage. So, the choice is yours as to whether you buy malpractice insurance. The cost is relatively low. However, being one who appears with clients before licensing boards, I hear repeatedly from nurses that they never thought they would get in trouble with the Board. Yet every day, I have clients who have complaints filed against them with the Nursing Board. Having malpractice insurance with disciplinary defense coverage would then be invaluable in these cases.
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Whether you’re just beginning your nursing journey...
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Empowered
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