After learning about cultural diversity by reading a nursing textbook, five nursing students from Pennsylvania College of Technology got to go out and experience diversity firsthand. Participating in a study abroad course, students traveled to the small town of Nueva Santa Rosa, Guatemala to treat patients in a medical clinic for seven days.
The Penn College students were led by Christine B. Kavanagh, the instructor of nursing programs, and accompanied by a larger volunteer group from Glens Falls Medical Mission. Glens Falls is based in New York and leads weekly trips to the small Guatemala community twice a year to help patients who live two hours away from the nearest hospital.
During their weeklong stint at the medical clinic, the group of volunteers saw over 1,300 patients by communicating through translators. They practiced in five clinical areas including triage, dental, pediatrics, women’s health, and general medicine, providing basic screenings, treatments, medical education, fluoride for dental care, and referrals to outside specialists when needed. Students were amazed by the positivity exuded by their patients who experience a wide variety of issues, not just medical.
Penn College offers a variety of study abroad courses, but this was the first time nursing students participated in a trip. After a successful mission, they hope to offer the course and service trip to nursing students every fall. In addition to the nursing trip, Penn College also offers a course in providing dental hygiene education in the Dominican Republic.
Statistics of violence against nurses over the last decade are shocking. According to NursingWorld.org, approximately one in four nurses have been physically assaulted at work in the last year. Although healthcare workers make up only 9 percent of the workforce, OSHA.gov reports that violent injuries in the healthcare industry account for almost as many violent injuries in all other industries combined.
The worst part is there aren’t currently any federal rules in place to mandate that hospitals and healthcare facilities protect nurses from the violence they might experience in the workplace. However, some states have passed protective regulations on their own, requiring the development of violence-prevention programs, teaching de-escalation techniques, and increasing the penalties for people convicted of assaulting healthcare workers. As violence against nurses continues to increase, the US Department of Labor is considering nationwide workplace-safety standards for hospitals to prevent abuse against their employees.
What has caused the spike in violence? A 2015 research study in the Journal of Emergency Nursing found that dementia or Alzheimer’s patients and patients on drugs are the most likely to hurt nurses. An increase in violence also correlates with the recession a few years ago, which led to public and private hospitals cutting budgets and laying off employees. With fewer nurses and security guards on duty at any given time, there is less help available when a patient gets out of control. Many states also cut billions in funding for mental health services while psychiatric patients are increasingly seeking emergency room treatment because they can’t be turned away at a hospital.
Bonnie Castillo, an RN and director of health and safety for National Nurses United, tells TheAtlantic.com that there’s a pervasive notion that dealing with unruly patients is part of a nurse’s job and therefore, “[Nurses] always feel discouraged from reporting it.” While the Department of Labor works toward establishing nationwide safety standards, individual hospitals are beginning to implement their own measures for ensuring employee safety (like offering self-defense classes to staff). However, while the nationwide nursing shortage persists and hospitals don’t have mandated safety regulations, patients and staff will continue suffering from workplace violence in hospitals.
A week from yesterday, 4,000 Allina Health nurses from five Twin Cities hospitals returned to work, ending what was almost a six-week-long strike. The strike began late in the summer during a period where nurse strikes were a hot topic and occurring all over the country. In an effort to fight for workplace safety measures, insurance benefits, and safe staffing ratios, thousands of Minnesota nurses prepared to leave their jobs indefinitely until Allina offered a new contract that they could agree to.
After a 17 hour negotiating session, a majority of the 4,800 nurses on strike under the Minnesota Nurses Association (MNA) voted to approve their latest contract offer. Allina Health and the MNA had been working on a new agreement since February which was followed by four failed contract proposals before the latest one was approved last week.
The approved contract was a win for the Minnesota nurses, earning them 24/7 security in emergency rooms, a 2 percent pay raise, and although the nurses will still be phased out of their health plans by 2018, Allina agreed to contribute to their health reimbursement and savings accounts.
Out of the 4,800 nurses who started the strike, 630 crossed the picket line to return to work before a new contract was reached and 200 left Allina Health completely, leaving 4,000 Minnesota nurses to return after agreeing to the new contract. An exact number for how much the six-week strike cost has not been released by Allina, but the weeklong strike that occurred in June cost $20 million to cover replacement workers.
Rose Roach, Executive Director of MNA, has said that, “The nurses left their jobs and their health benefits so they could win workplace safety guarantees…They won that for both themselves and their patients.” Many of the nurses are looking forward to returning to their patients but Allina will still have to work to repair relationships with their staff.
Caitlin Brassington stopped for milk on her way home from a busy shift when, still wearing her scrubs, she ran into an acquaintance who had never seen her in uniform before. After a short conversation, the woman said she had never realized that Caitlin was ‘just a nurse.’ Shocked by the demeaning sentence, Brassington took to Instagram and Facebook, posting a photo of her in her scrubs along with an emotional post about how after 18 years as a nurse, this wasn’t the first time she had the heart the ‘just a nurse’ comment, and she was finally fed up.
Brassington’s message continues on to say, “I have helped babies into the world, many of whom needed assistance to take their first breath, and yet I am just a nurse. I have held patients hands and ensured their dignity while they take their last breath, yet I am just a nurse.”
The post went viral on Facebook, receiving over 4,000 shares and 20,000 likes since it was posted. According to ABC News, Brassington is a pediatric nurse at St. Vincent’s Private Hospital and Fairholme College in Australia. She says that many people don’t realize how much the role of nurses has evolved over the last 50 years, and her post was on behalf of nurses all over the world.
In her post, Brassington also points out that she is the eyes, ears, and hands of medical offers, and as a nurse she can assess, treat, and manage your illness. And even though she is a mother of three, Brassington has missed out Christmas days, her children’s birthdays, and school musicals, like many other working nurses who are also parents. With all of this in mind, Brassington says, “So, if I am just a nurse, then I am ridiculously proud to be one!”
Many people were moved by the post, commenting their thanks and applauding Brassington for her hard work, and some even sharing their own similar stories. Several physicians also offered their support following Brassington’s viral post. SELF Magazine interviewed Kathryn A. Boling, MD, a primary care physician at Mercy Medical Center in Baltimore, MD, who told SELF that nurses are a vital part of the medical profession and often the first people to notice when a patient is unwell and needs additional care.
During her interview with ABC News, Brassington had the opportunity to speak about the impact of her post saying, “It has started a worldwide conversation about how we value and respect certain service industries within communities. I think this conversation is long overdue.” Many can agree that it is a long overdue conversation, and we applaud Brassington for opening it up for discussion worldwide.
Thank you, Caitlin Brassington, our Nurse of the Week, and nurses all over the world for the brave and selfless work you do every day for your patients and their families.
A new rule from the Centers for Medicare & Medicaid Services (CMS) was released on Wednesday, guaranteeing the rights of patients and their families to sue long-term care facilities (i.e. nursing homes). Currently, most nursing homes use arbitration clauses which require patients and their families to settle disputes of care in arbitration rather than in the court system.
With the new rule, CMS (which controls over $1 trillion in Medicare and Medicaid funding) will prevent nursing homes from forcing serious claims like elder abuse, sexual harassment, and wrongful death into the private arbitration justice system, and into courts instead. The fine print found in nursing home admissions contracts that use arbitration clauses have hidden disputes about safety and quality of care from the public view for over a decade, but that will no longer be the case.
Scheduled to go into effect in November, the new rule will apply to all long-term care and nursing home facilities that receive money from Medicare and Medicaid – which includes almost all of them. According to Andy Slavitt, blogger and Administrator for CMS, this includes nearly 1.5 million residents in over 15,000 long-term care facilities participating in Medicare/Medicaid programs. Advocates for the new ruling consider it a major step forward in improving the care and safety of millions of nursing home residents.
A 2009 study by American Health Care Association found that the average awards to patients and families after arbitration is 35% lower than if the claimant had gone to court. The arbitration system has helped the nursing home industry reduce legal expenses, but at the cost of justice for nursing home residents and their families, even in cases of murder. However, the rule does still leave arbitration as an option in individual cases where both sides agree to it, and only future admissions will fall under the new rule.
A New York Times piece from last November brought to light the negative effects of the arbitration system on nursing home patients and their families. The article discussed several cases in which the families of nursing home residents didn’t receive justice for wrongful care because their cases were initially blocked from court. Amongst the cases included were a 100-year-old woman who had been found murdered in a nursing home after she was strangled by her roommate and another case from the family of a 94-year-old woman who died from a head wound in a nursing home in Pennsylvania.
Along with the litigation changes, NPR’s Rebecca Hersher reports that a number of new rules are being rolled out to expand regulations regarding food, medical treatment, and personnel requirements. Starting in November, nursing homes will be required to provide nourishing and palatable foods, develop a care plan for each resident within 48 hours of their admission, and due to increased fears of institutionally-spread infections and antibiotic resistance, infection prevention and control programs and plans for monitoring the use of antibiotics will be mandatory.
The new rule is being enacted after officials in 16 states and the District of Columbia urged the government to cut off funding to nursing homes using arbitration clauses, arguing that the clauses have kept patterns of wrongdoing hidden from prospective residents. A recent New York Times article reports that members of the nursing home industry have largely reacted against the changes being put forth by CMS, saying it was unnecessary to use the new rule to protect nursing home residents’ health and safety. However, with the enactment of their new rule, CMS has restored a fundamental right of millions of Americans: the right to present their case in court.
Every nurse who has stepped on a unit knows that nursing has its problems. Unfortunately, when confronted with these problems, many nurses feel as helpless as some of the patients they care for. Management is nonresponsive, there are no unions to support the common good, and one nurse can’t seem to make a difference. However, with the advent of social media, that primary assumption is changing. Nurses can affect change in the profession, and this is primarily through grassroots efforts.
What is a grassroots effort? It is an organization of nurses that come together of their own accord to affect change from the bottom up. They are usually not supported by larger, more established groups, but sometimes they are.
“Nurses need to understand that they have a voice and a powerful one when they all act together,” says Doris H. Carroll, BSN, RN-BC, CCRC, vice president of the Illinois Nurses Association (INA). “There is no way a single person can do it, but a group can. It is important to not be complacent, to stand up for patients and stand up for yourself. Standing up for you ultimately means standing up for your patients.”
Nurses can get involved in grassroots efforts in many ways. First, large, nationwide efforts exist that are fighting for the betterment of nurses across the boards. One notable example of this type is Show Me Your Stethoscope (SMYS), a group initiated completely through a Facebook group. Unions are another engine of change in the nursing landscape, though they aren’t present in every state. Finally, patient advocacy groups can allow nurses to become part of the stories of patients who have experienced medical errors.
The important part of the equation is for individual nurses to get involved in any way they can to become part of the conversation that will change nursing. “With today’s online availability, look for a cause you are interested in,” states Catherine Stokes, RN, BSN, executive chair of NursesTakeDC with SMYS. “Use Google and look for groups that you are advocating for. Ask to join; make friends; offer your participation.”
It really can be as easy as that to be part of the solution to change the landscape of nursing.
Large Scale Movements for Nurses
Large scale grassroots movements sound like they would be obvious, high profile groups, but they often are not. In fact, not many nurses know that grassroots movements exist, particularly if they are not on the internet or connected with social media.
One of the most popular groups large scale groups is SMYS, which was started after the insensitive comments made about nurses on The View. Why get involved with a group this large? What possible difference can one voice make?
“It is a place where any nurse can bring their idea to the table,” explains Jalil Johnson, BSN, MS, ANP-BC, the national director of SMYS. “There are other nurses that have the same interests, and the group helps to actualize that. We help with the empowerment in what individual nurses think is important. Our method is different in that we don’t direct nurses in what they should be involved in. It is driven by the nurses.”
SMYS is a grassroots efforts that seeks to be all-inclusive for nurses, but you don’t have to be a national director to affect change on the national level or even around your neighborhood. The group suggests talking to your local legislators, sending letters and emails, and corresponding with those who are in positions of influence to create the changes you want to see. Essentially, your level of involvement in large scale groups such as SMYS is completely determined by your comfort level.
Johnson adds: “We want to empower nurses to have voice and talk about the struggles publicly. We are not sure if legislators are aware of the problems nurses are facing. We want to connect to them and to let them know. We want to unite around issues to move conversation forward without getting bogged down in the specific issues to make change happen. Our goal is to move the conversation forward.”
Large scale grassroots movements need many nurses working together to move the conversations forward for better staffing ratios, attention to medical errors, and nurse bullying, but they are not the only ways that nurses can get involved. There are many other ways nurses can get involved in organizations that aren’t “official” and still get their voices heard.
Joining Nurse Unions
Unions have a bad rap in nursing and across the nation. Nurses have lost their jobs by attempting to form or join unions in their states, and that is a blow to the grassroots movement. National Nurses United is one of the largest unions in the nation, and it is worth getting involved with it. Like the American Nurses Association, it is not essentially grassroots. These organizations are really driven more by boards than by nurses who are interested in creating change on their own.
However, smaller unions are often more powerful with grassroots efforts, and this is where nurses can make a difference in the profession. “Joining a union is an opportunity to join an organization that has an infrastructure in place to assist in getting change,” explains INA Vice President Carroll. “It is easier than doing it on your own. Joining the union is one of the best ways to do it.”
So, how exactly do unions help nurses? “We fight for labor issues on all of our units on a daily basis,” Carroll states. “It is not just about wages. We negotiate for self-scheduling and floating. We impact ratios. Illinois is one of first states that has a law that all hospitals have staffing committees to address staffing issues based on acuity.” Unions can fight for these issues in the profession that need to be addressed, and the infrastructure of unions makes it likely they will get accomplished. The downside is the difficulty of getting unions in place, but once they are, they are a powerful grassroots effort for nursing change.
For example, the Illinois State Union worked with SMYS to organize the 2016 rally in Washington, DC. Not only did the group donate a great deal of funds to the cause, they also arranged for important legislators, such as Representative Jan Schakowsky, to appear at the rally. Without the joint effort of unions and large scale grassroots nursing efforts joining in on the conversation about nursing, the changes would be less likely to come to pass.
Getting Involved with Patient Advocacy Groups
Patient advocacy groups may seem like an odd area for a nurse to affect change in the profession. They are essentially groups started by laypeople after they encounter life-changing issues when interacting with medical institutions. “The majority of advocacy groups are started by patients,” says Deena Sowa McCollum, BSN, RN, a patient advocate. “They can focus on topics such as medical error transparency. For instance, the mother of a victim of medical errors can speak out. Many hurt families are starting groups.”
How does this help nurses to change their profession specifically? “Groups are influencing nurses whether we are involved or not,” McCollum continues. “When nurses advocate for themselves, they sound to [the] layperson like they don’t want to work too hard. Patient advocate groups have stories. Nurses have stories about these problems but don’t share them. There are errors every day, but we don’t use stories about real people. Advocates are sharing war stories, and that makes a difference to the public perception.”
When patients are injured, their loved ones speak out. They are sharing their stories, going on talk shows, and drawing attention to themselves. Nurses, on the other hand, are not doing this. If nurses could get involved in these groups and make themselves part of the solution to the problems, they could affect changes for nurses as well as patients. Some patient advocacy groups tend to reject nurses as part of the problem, but many realize that nurses are caught up in the same medical machinery their loved one was. By coming together, patient and nurse, more change can happen.
This makes patient advocacy groups a very powerful tool for the grassroots effort. It is important to find a group and get involved. “Start by Googling advocacy groups that you believe in,” suggests McCollum. “Get on Facebook. Put in a search for advocacy groups. Nurses need to find the right group. Advocacy groups want to know how can you help us for our end. How can we all stand up on our end for safety? Don’t be defensive or try to defend the nurses. There are nurses and other people that desperately want what is better for the patient.”
Strategies for the Individual Nurse
All of this boils down to the individual nurse. How can you, the nurse reading this, get involved in grassroots efforts? How can you make a positive change in the profession that you love?
“Nurses can start their own movements,” says Stokes. “Using social media, start a movement for your cause, find like-minded people, and ask them to participate.” It really can be that easy, but it isn’t necessarily the only way.
It is much more likely that individual nurses can get involved in pre-existing groups. “Nurses must get involved,” Stokes states. “As a profession, we should not sit back and let things continue. We can’t continue the habit of ‘this is the way it’s always been done.’ It’s not really hard to type a search into Facebook, say hello, and start putting ideas out there. See where it goes. Find out who is in charge and find out what you can do.”
Carroll agrees: “Working together is essential with grassroots campaigns. Everyone comes with different experiences. It isn’t easy to organize online because many nurses are not online. We need to do this together.” The way we do this together is for individual nurses to get involved with grassroots campaigns on some level. Even if it is as simple as writing a letter or as complex as volunteering to be a national director, nurses need to come together if change is ever going to happen.
Johnson sums it up: “Change is what nurses are interested in. They aren’t interested in the methodology, or the back and forth. They want to move this forward. We believe that professional organizations are contributing. They have a seat at the table, but the conversation hasn’t moved very far since the first nurse march on Washington in 1995.”
The question is and always has been, do you want a seat at that table, too? What will be your contribution to the conversation about change in nursing?