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: 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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The Big Deal

The Big Deal is….who gets to establish the nurse-staffing ratio?

Really.  That is what all the fuss is about.  Control.  The patients have none.  The hospital has all.  The practicing nurses want some.  …And the nurses want the state’s legislature to make the hospitals give them some because there has been no effort on the hospital’s part to do so without this threat.

Patients do not want to be involved in this decision.  They want, expect and deserve proper patient care (a la 1:1 nurse-staffing ratios) and customer service (a la Disney).  Hospitals and nurses that can provide this seamless type of care to patients (not the 1:1 part; maybe 1:4-5?) throughout their facility will not have negative patient satisfaction comments and ratings.  Patients will love this!

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Heading Home


Home is a nebulous sort of place, when you spend most of your life moving all over the countryside, from state to state, and town to town.  As a child, we made our first out of state move when I was five; from Quincy, Massachusetts to Ocean Springs, Mississippi.  We moved the next town over in 5th grade, and then promptly packed up and moved to Gales Ferry, Connecticut for a year and a half.  We went back to Mississippi, lived in several different towns/houses, and just about the time we thought we were “settled”, Dad’s job took him to Newport News, Virginia.  A few years there, and on to Baton Rouge, Louisiana. We didn’t stay long, or rather I didn’t stay long.  I ran back to VA to get married, and stop moving, LOL!

Three years, and three different apartments later, I packed my shit up, got divorced, and moved to my parent’s current job locale, Augusta, GA.  Another few years, an unfortunate move to Texas for 6 months, and then a trip back to Virginia to hopefully settle down.

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Ten On Tuesday– Ramdomness

1.  I should drink milk more.  Had some today with my PB&J (yep, I love them), and it was good. Lord knows, I need the calcium.
2.  We need rain so badly.  I’m being very careful not to smoke outside, and make sure that I *don’t* toss my smokes out the car window.  I sure don’t want to be the source of a fire.  It’s so dry and windy here, that any cigarette in the grass could mean fire.  I wish I could quit, but that’s a project for another day.
3.  I’m hoping the med adjustment psychdoc and I agreed on today will temper some of the overwhelming anxiety I’ve been having lately.  *fingers crossed*
4.  I’m loving Family Guy lately–it makes me smile, and even laugh.  Much needed!

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Have You Ever?

Have You Ever–
1.  Jumped out of an airplane?  I never understood why someone would jump out of a perfectly good airplane.  The rush can’t be THAT huge, or can it?  Either way, you’ll never find me doing this.  Ever.
2.  Won something?  I hit the slots in Central City, CO once, for 500$.  Hugely exciting.  The funny part was that I didn’t want to play (I just think gambling = throwing money away) so my mom gave me a roll of quarters to play with.  She didn’t ask for the winnings, but I took her out for a night on the town as a thank you.  We had a great time!
3.  Moved away from your home town?  I’ve moved something like 20 times.  Wanderlust, I guess.  I’m finding that I don’t really want to do it anymore, which is why I’ve decided to stay here, rather than make the move we were planning.
4.  Been in the hospital?  Way too many times.  The year before I had my gastric bypass, I was in the hospital three different times, for weight related illnesses.  I’m happy to say, I’m healthy now!

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Bipolar Disorder — What It’s Like

When I’m having an episode, I suffer from intense lows and highs.  I was going to write “devastating lows”, but then I realized that the highs are just as devastating, in a different way. Mania is wonderful, until it’s not.  You feel like a million bucks, like every idea that you have is a good one, and like nothing can touch you.
Spending thousands of dollars you don’t have seems like a fantastic idea, and nothing can stop you.  You talk a mile a minute, and the ideas come even faster.  It feels like a jar full of fireflies all going off in your head at once.  Bright, sparkly, and full of life.  While it’s going on, you have almost no sense of anything bad happening, and you never want it to end.
Inevitably, it does.  In my case, it tends to deteriorate into a mixed state, which is a dangerous combination of depression and dysphoric mania.  As opposed to euphoric mania, dysphoric mania is the bad mania.  In a mixed state, everything is negative.
The thoughts come just as hard and fast, but now they’re extremely negative.  I relive all the mistakes I’ve made, over and over.  I continually think about what a horrible person I am, and emotionally beat myself up over and over.  I’m ugly, I’m stupid, I’m fat, I’m crazy.  I get overwhelmed almost immediately, and it snowballs from there.  I don’t want to go to work, I’m overwhelmed by the thought of work, of dealing with people, of leaving the house.

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Ten Things At Work That Make Me Crazy:

1. Unrealistic expectations. The administrator comes up with these ideas that she wants done by the line staff, and she apparently has no idea what their work load is like. Lady, they don’t have TIME for your hare-brained idea.
2. Phone ignoring. No one on the floor answers the phone. Part of the reason is that they are often in a resident’s room, or way down the hall from the desk, but damn, ringing for a half an hour and ignoring it?
3. Pureed food. I spend part of my shift supervising in the dining room. Many times, I help the aides feed residents. Pureed food grosses me out.
4. Smokers. I am the only smoker on my shift, so I automatically get designated the person that escorts the smokers out to the smoking area. I don’t mind, normally, as I get a chance to sit down and have one myself. However, we have one smoker who is demented, and starts going batshit if she doesn’t get her cigarette “on time”. She doesn’t know what time it is, but she knows that I’m “late”. Emergencies could be happening requiring my attention, but getting that cigarette is all she cares about.

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Happy Mental Health Month!

This is a post I wrote back in September 2008. I’ve updated it a bit to make it more relevant to my current situation.

A few facts and figures from the National Institute of Mental Health. “Bipolar Disorder affects approximately 5.7 million adults, or approximately 2.6% of the U.S. population aged 18 and older in a given year.” It is an equal opportunity disorder, affecting people of all races, sexes, and ethnic groups. It is an inherited disorder–more than 2/3 of the people with Bipolar Disorder have one close relative with the disorder or unipolar depression. And the most frightening of all–one in five people with bipolar disorder will complete suicide.

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