…Hospitals Can Set Own Staffing Ratios?

download-16The hospitals back a proposal (S 876), filed by Sen. Richard Moore (D-Uxrbidge, Massachusetts) and co-sponsored by 20 lawmakers, that would establish committees of nurses and other staff at every Massachusetts hospital to develop individualized staffing plans. Such plans would govern “nurse-to-patient staffing guidelines” that take the acuteness of patient illness into account. (Read the full article here.)

Individual hospitals have proven themselves incapable across-the-board of implementing this type of control. This is a fluff-measure offered by the hospital interest groups and lobbyists on behalf of our employers and meant to appease the bureaucrats’ good, but misguided (sarcasm mine), intentions to help the clamoring staff nursing base.

Elected Official, please remember you are in office because of the clamoring and voting base. We are appealing to you for help, not because we are whiners or ignorant of the ways of business, but because we care deeply for our patients.

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Nurses Week. Change of Shift

images-16HAPPY NURSES WEEK! ! !

It is my extreme pleasure to bring you all this edition Change of Shift! My thanks and enduring gratitude to Nurse Kim @ Emergiblog…. beside whom, I just know, I’d love to work.

The theme – The Greatest Nurse… – was a flop. (Is it “themes” in general? or ‘this one’ in particular??) Whatever. Since I am a nurse through and through, I have found a way to get over it.

Here’s to all the Greatest Nurse Bloggers who submitted for this edition AND to their Blogrolls where I ‘discovered’ at least one additional blogger to showcase. (pssst – thanks for listing the nursing and medical blogs that you follow on your sites! Its a GREAT way to find each other.)

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Nursing Documentation is Stupid

The theft of approximately 3 hours of patient-focused nursing availability each shift is nursing documentation.  The culprit for this is the tired, old mantra … “If it is not charted, it was not done.”

Time for a paradigm change for Nurses’ Notes!  In the interest of direct patient care and in deference to the remarkable work we provide at the bedside – none of which is reflected in charting – STOP THE MADNESS!!

From now on, how about …

“If it was not charted, IT WASN’T BLOODY IMPORTANT!”

Ok, ok, how about some middle ground?  Introducing the Muse’s …

Nursing Documentation Theory

~*~

A comprehensive nursing physical assessment is completed and DICTATED.  An electronic copy is generated in the EMR and reviewed (revised, if necessary) and posted.

Each shift thereafter performs a comprehensive nursing physical assessment but *only* documents that “Yes” it was completed and the exceptions, if any, are checked in the appropriate corresponding boxes.

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“Nancy Nurse, RN, MD”

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This weekend at work, I overheard a physician actually verbalize the following to a physician colleague in reference to an amazingly skilled bedside nurse :

If she’s so smart, why isn’t she a doctor?

Yes, Friends, that was a true statement spoken aloud in the United States of America by a real doctor in 2014.

My first thought was:

Duh-uhhh….BECAUSE she is so smart, Dip-wad.

My second through millionth thoughts centered around this:
the great majority of physician-think continues to be –

1) nurses are stupid – otherwise we’d be doctors

2) nurses are not independent practitioners of their own realms with patient responsibilities that contribute immensely to the whole of health maintenance and healing of the populace (without which the whole would be lacking) and

3) nurses remain substandard extensions of doctor’s leadership and authority.

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“The RN Manager Has No Clothes!”

images-19If you are one of the great many that work for and (therefore) have the opportunity to observe the antics of nursing management and sadly shake your head in dismay, you are not alone.  A million of us stand in hallways and nursing stations throughout the realm of healthcare as $300 suits/dresses and $150 pairs of shoes stroll through and share witty banter with us – the hired help.    We laugh with them even though we would rather tell them off.  How can someone with such an important and pivotal position be so righteous and out of touch? we wonder.  Where in the world did they step off the healthcare train that is today’s hospital and enter the Disneyland of their own minds?

Their salaries are in the high 5- and sometimes into the 6-figures. Their annual bonuses are a disgusting secret based on cost (read: labor) control. But make no mistake, getting a Registered Nurse degree is challenging, and see here what they need to go through to become a neonatal nurse.

And, yet their education is questionable – at best; their slips of professional ethics and their past moral goofs are well-discussed fodder in the hallowed halls of the hospital; and what they actually do with their days is so unknown to most all of us that we can never come to grips with the justifications for their selections to lead much less their continued employment in their current positions.

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RNs …Skilled or UNskilled

RNs have long been traversing the proverbial diverging path.  Ahead the sign reads: “Unskilled/Labor” with an arrow pointing down the left pathway and “Skilled/Professional” directing travelers to the other path.  The definition that actually applies to Nursing has far too long been left to the “beholder.” I recommend everybody to check what it takes to become a fully registered nurse. It’s not that easy!

I don’t know about you, but frankly, I’m a little tired of being escorted to the left path while being told the other is “still under construction” or “not available to staff.”

But here @ ideonautics, you get to choose a path for yourself!

UNskilled: punches time-clock
Professional: salaried or fee-for-service

UNskilled: no college degree needed
Professional: Bachelors degree required (soon), Masters preferred, Doctorate encouraged

UNskilled: collects and notes data
Professional: interprets data and chooses next action(s) based on that interpretation

UNskilled: changes a dressing
Professional: changes a dressing and notes the healing properties present or absent, determines educational status of patient regarding wound care, investigates the patient’s resources for home care, redresses the wound while providing happy banter that supports and educates the patient as well as the family

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RN Mouth Moving Theory

Have you ever observed the interaction of an RN that believes his or her opinion or assessment of a situation is so spot-on-target that they cannot help but reiterate it? Over and over and over again? Beating it like a drum announcing their royal mastery of the subject? If you watch closely, you will observe the interactive dynamic of my latest Nursing Theory: RN Mouth Moving Theory.-

The RN’s mouth is moving
…but there is no response from the masses.

Their peers, co-workers, managers, newbie-nurses, students, doctors, spouse, children – hell, their own friends! … whoever is the audience at the moment just nods, but says nothing in return.

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Nurse-Staffing Ratio’s: What it is

What is a staffing ratio anyway?!

A nurse-staffing ratio refers to the number of hospitalized patients to whom one licensed nurse is assigned. For example, 1 nurse assigned the care of 8 patients would create a 1:8 nurse-staffing ratio.

How many patients for whom one nurse can care is a controversial issue. Each of the players – the patient, the hospital and the nurse – take a stance and most often these stances are at odds with each other. While we would like to think the employee (nurse) and the employer (hospital) stand united in a mutual bond of loyalty and gratitude to serve the patient, they do not.

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Nurse-Staffing Ratio: Patient’s Perspective

The patient’s condition itself is a major piece of the nurse-staffing ratio. For instance, a patient that is fresh out of surgery and arousing from anesthesia is considered to need a nurse-staffing ratio of 1 nurse to 1 patient (1:1) for the first hour of recovery. This usually takes place in the Post Anesthesia Care Unit (PACU) with nurses that are certified in Advanced Cardiac Life Support (ACLS).

When deemed “stable”, the patient can be transferred either to an Intensive Care Unit or to a Medical-Surgical Unit depending on the patient’s diagnosis and/or condition. For example, an uncomplicated appendectomy would go to Med-Surg but an open-heart patient would go to Cardiac ICU.

The OR, PACU, Pediatric ICU, Cardiac ICU, Medical ICU, Surgical ICU, Neonatal ICU, Labor & Delivery, and the ED – are all considered to be Intensive Care Units of a hospital. Patients that are admitted or evaluated in these units are (or are about to become) high-risk patients. The nurses working in these units of a hospital are highly specialized and the best of them are certified in that specific type of care.

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Nurse-Staffing Ratio: Hospital’s Perspective

Nurses are expensive! Nurses comprise the largest labor force in an acute care facility. By the nature of their professional status and licensure and their direct legal responsibilities to the patients they serve, nurses do not trade their professional skills and knowledge for cheap. When their nursing experience at the bedside is calculated in years, their income per nurse can be almost double that of a new graduate nurse. Add a nurse’s certifications, specialty training and graduate degrees to that bottom-line and a single clinically-functioning nurse can cost a hospital almost the same as an exempt nurse manager – sometimes more.

Business 101 explains that labor is the highest expense of most any company. Control labor costs and a business can move along toward solvency. Control labor costs and other expenses hard enough and a business should be profitable. Accordingly, whenever expenses need to be controlled due to decreasing and/or slow payments and/or poor strategic business decisions, labor is the first reviewed for immediate cost savings. Since the Nursing Department comprises the largest number of employees, a single slash to pay raises for clinical nurses accomplishes a lot, but not everything.

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