DailyNurse.com and Springer Publishing Company are pleased to announce the launch of our new podcast, NurseCasts! Hosted by Joe Morita, Senior Acquisitions Editor at Springer, NurseCasts is a podcast for nurses by nurses. Our goal is to help you understand issues in health care affecting nurses from how to advance your nursing career to understanding policies that might affect patient outcomes.
For our very first episode, we wanted to better understand what motivates nurses to join this fast-paced and fulfilling profession. In order to do so, we took our show on the road to interview attendees at the National Student Nurses Association (NSNA) conference in Dallas, TX. We wanted to learn one thing from student nurses: “What motivated you to join this profession?”
Meet the student nurses you’ll hear from on this episode:
Kylee (LSUHSC School of Nursing, New Orleans, LA)
Emily (Messiah College, Mechanicsburg, PA)
Kimberly (Graceland University, Lamoni, IA)
Maria (University of Central Florida, Orlando, FL)
Chloe (Santa Ana College, Santa Ana, CA)
Roslyn (College of Southern Nevada, Las Vegas, NV)
Danielle (Cedar Crest College, Allentown, PA)
Josh (Georgia State University, Atlanta, GA)
Mariah (Indian River State College, Fort Pierce, FL)
Jacqueline (Pace University, Pleasantville, NY)
Listen to our first episode below!
Episode 1: Why Are Students Choosing to Pursue Nursing?
Stethoscopes dangled around the necks of nurses wearing navy NursesTakeDC t-shirts and big smiles. “Where are y’all from? We’re from Arizona!” More than 800 nurses from 40 U.S. states congregated at the NursesTakeDC Rally on May 5th in Washington, DC. The rally was to support legislation establishing federally mandated requirements for safe nurse-to-patient staffing ratios, while drawing public attention to the staffing crisis in many U.S. hospitals. This was the second such rally; last May, the inaugural event drew about 250 participants to the steps of the U.S. Capitol.
The rally was cosponsored by the grassroots nursing movement Show Me Your Stethoscope, a group that formed spontaneously on Facebook after nurse Janie Harvey Garner watched The View host Joy Behar ask why a nurse in the Miss America pageant was wearing “a doctor’s stethoscope” around her neck. That group now has more than 650,000 members. Other rally sponsors and supporters included the Illinois Nurses Association, Hirenurses.com, Nursebuzz, The Gypsy Nurse, Century Health Services, and UAW Local 2213 Professional Registered Nurses.
The NursesTakeDC rally was originally scheduled to take place on the steps of the Capitol, but thunderstorms and downpours forced the meeting indoors at a hotel in nearby Alexandria, Virginia. Although the setting lacked symbolism, participants still raised handmade posters and shouted rally cries. Rally organizers estimated the weather had an impact on overall attendance, but they were still encouraged by the turnout. After the speakers wrapped up, a group of about 150 nurses headed to the U.S. Capitol steps for photographs and final thoughts.
© 2017 David Miller, RN
Two, Four, Six, Eight, Patient Safety Isn’t Fake
“We aren’t laughing, we want staffing!” Cheers and whistles erupted out of the crowd. After 10 minutes of rally cheers and chants, the gathering turned its attention to the first of many speakers who would highlight issues faced by nurses in every specialty and across the profession. Actress Brooke Anne Smith began by reciting a moving poem about nurse warriors on the front lines.
Event organizer Jalil Johnson then took the stage, giving a keynote speech that addressed the challenges bedside nurses face every day. He spoke about nurses as the foundation of health care, and the unrelenting pressure to perform in deteriorating conditions. While discussing dire staffing situations, Johnson said that he fought every day, “making sure I didn’t give anyone a reason to come after the license I had worked so hard for.”
He discussed the paradox that year after year, nurses are rated the most trusted profession, yet no one trusts nurses when they say they are overworked, overburdened, and practicing in unsafe conditions. Nurses alone are not enough to fight this battle, he said. “To the public, we say: Trust us when we say the industry makes it nearly impossible to deliver the care you need. Trust us when we say we need your support.”
Other NursesTakeDC rally speakers included Katie Duke, Terry Foster, Deena McCollum, Linda Boly, Julie Murray, Catherine Costello, Kelsey Rowell, Leslie Silket, Dan Walter, Nicole Reina, Monique Doughty, Doris Carroll, Charlene Harrod-Owuamana, Debbie Hickman, and Janie Harvey Garner.
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act
On May 4th, the day before the rally, Representative Jan Schakowsky (D-IL) and Senator Sherrod Brown (D-OH) reintroduced the latest iterations of the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2392 and S. 1063). The bills seek to amend the Public Health Service Act to establish registered nurse-to-patient staffing ratio requirements in hospitals.
In a press release, Rep. Schakowsky’s office writes: “This bill is about saving lives and improving the health of patients by improving nursing care—ensuring that there are adequate numbers of qualified nurses available to provide the highest possible care.” The press release acknowledges that study after study has shown that safe nurse-to-patient staffing ratios result in better care for patients. “It’s time we act on the evidence and the demands of nurses who have been fighting to end to dangerous staffing,” the release continues. “I’m proud to be a partner with nurses across the country in promoting this bill and working to ensure quality care and patient safety.”
Rep. Schakowksy attended last year’s event, but was unable to attend this year. The Nurse Staffing Standards Act is the latest in a string of bills that have been introduced to Congress every session. Previous bills S. 864 and H.R.1602 died in committee last session. S. 864 was first introduced in May of 2009; H.R. 1602 was first introduced in 2004 and has been sponsored seven times so far. Rally co-chair Doris Carroll explained why: “The legislation is reintroduced session after session, and it continues to die in committee because there is no bipartisan support.”
In today’s environment, politics can be touchy. The day before the rally, the House of Representatives passed the American Health Care Act of 2017. Among nurses there are very polarized viewpoints on health care, abortion, assisted suicide, and other controversial topics. In his speech, Johnson acknowledged that not all nurses think alike. “We are a profession divided,” he admitted. “But when it comes to safe staffing, we all agree. This is a movement devoid of partisanship. Staffing is not a partisan issue.”
The proposed text and ratios for the Nurse Staffing Standards Act are below:
A hospital would be required during each shift, except during a declared emergency, to assign a direct care registered nurse to no more than the following number of patients in designated units:
1 patient in an operating room and trauma emergency unit
2 patients in all critical care units, intensive care, labor and delivery, and post anesthesia units
3 patients in antepartum, emergency, pediatrics, step-down, and telemetry units
4 patients in intermediate care nursery, medical/surgical, and acute care psychiatric care units
5 patients in rehabilitation units
6 patients in postpartum (3 couplets) and well-baby nursery units
Rally speakers encouraged nurses to reach out to their representatives in Congress to show support for safe staffing legislation, and handouts for participants detailed how to find representative names and numbers for letter writing campaigns and phone calls.
Where Is Everybody?
When one of the speakers asked why there wasn’t more involvement in the grassroots movement, and why there weren’t more nurses present, several voices called back from the crowd. “Everyone’s working!” one shouted. Another called out, “They don’t have the money!”
“Really, where the heck is everybody else?” one rally participant said. She gestured to the conference room, which at the time held about 100 nurses. This nurse was part of a group attending from New Jersey, including Kate Mclaughlin, a registered nurse and founder of NJ Safe Patient Ratios, a group dedicated to the support of safe staffing in New Jersey and promotion of ratio law S. 1280 in New Jersey’s Senate.
“In New Jersey, multiple bills have been introduced, every single session, and nothing ever passes,” Mclaughlin said. “In California it was the same thing, and then the tenth year, they involved unions and patients and it finally worked.” She said she started to pay attention to safe staffing laws in her state, and launched a petition on change.org. “I stalked nurses on Facebook and found people that way,” she continued. “Each week, we organize and post the contact information for two state senators.” She is starting a movement in New Jersey, hoping to motivate others to show support for these bills. “It’s an election year,” she said. “Now is the time.”
Mclaughlin said her state’s ratio law was first introduced in February 2016, but there has been no vote and no hearings, “which just feels disrespectful.” She was told the governor didn’t support the bill, and “that we might need to wait until there’s a new governor.”
The problem, according to several nurses at the rally, isn’t a lack of awareness. “I think it’s apathy,” Mclaughlin said. “This is a profession of predominantly women, and we are taken advantage of. They know we don’t get breaks, but they’re okay with the labor law violations. We’ve somehow accepted that this is normal—this is not normal.”
Carroll also expressed discontent that no one seems to care about this issue. “Why has this taken so long? Why hasn’t California’s success spread like wildfire?” she asked. “Well, health care changed, and it became a multi-billion dollar business for hospitals and insurance companies.”
Dan Walter, another speaker, acknowledged that sometimes nurses do not report safety issues because they fear retribution. Walter is a former political consultant and publisher of HospitalSafetyReviews.com, a web site that he established for nurses to anonymously post about patient safety issues where they work. In his speech, he explained the inspiration for creating the site: “You are the activists and you know what needs to be done. I want people to be able to go there, post, and we will keep it as anonymous as possible so we can protect you.” He expressed hope that this web site will be a powerful platform to improve patient ratios.
How Bad Is Staffing?
Nurses from a hospital in downtown Washington, DC, expressed frustration with the lack of support and resources from hospital administrators. “The other day, we had so many critical patients in the department we ran out of monitors,” one said. Another said that 80% of the nurses who work in her hospital’s emergency department have less than two years’ experience. “The turnover is so high,” she said. “People get so burned out because of the short staffing.”
Just how short are units staffed? “In our ED [emergency department], someone the other night was taking care of seven patients,” one nurse from this group said. “And these were sick patients, people with LVADs [left ventricular assist devices], and ICU patients.” This is common all over the country. A medical-surgical nurse may be taking care of up to eight or more patients at a time.
Llubia Albrechtsen, a registered nurse and family nurse practitioner at the rally, said there have been times she has refused to take on additional patients in the emergency department where she works. “When I have five patients, I need to take a step back and pay more attention, because their conditions may worsen,” she said. “It’s hard, because we could be providing excellent care to many of our patients, but with limited resources we have to do the best we can and hope nothing bad happens.”
Albrechtsen said that although hospital administration makes an effort to listen to nurse concerns about staffing, through town halls or open meetings, not much has changed. “Many areas still work understaffed,” she said.
Why Does Staffing Matter?
A policy brief disseminated at the rally lists the effects of inadequate nurse staffing, including the overwhelming evidence that safe staffing saves lives. High patient-to-nurse ratios lead to poor outcomes and a demonstrated increase in patient morbidity and mortality. Inadequate staffing has been associated with an increase in hospital readmissions, falls, pressure ulcers, hospital-acquired infections, and medication errors.
Poor staffing is expensive. In addition to causing poor patient outcomes, nurse burnout causes injuries, illness, and contributes to the growing nursing shortage. Replacing nurses due to turnover takes between 28 to 110 days, and costs the average hospital $6.2 million per year.
“The health care industry generates $3 trillion annually,” Johnson said in his address. “We are living in an age of greed, where the health care industry measures patient satisfaction by a customer service model. This is prioritized over quality and safety. Reducing burnout, staff retention, and caring for your staff are at the bottom of the barrel of priorities.”
The grassroots movement behind safe staffing is fighting for environments that allow nurses to do their work in the way in which they were trained. “[A nurse’s] work has been diminished to defensive practices; it has been reduced to a list of tasks to complete,” Johnson said. “That is not nursing.”
In Johnson’s final remarks, he spoke to empower nurses to return to their states, hospitals, and colleagues with a message to inspire change. “We have to show up in person, put boots on the ground, and be ready to engage and pull more nurses into this movement,” Johnson said. “Most importantly, we have to believe that with over 3 million registered nurses and over 1 million licensed practical nurses, our profession can come together as one. We will take back our profession and regain control of our practice.”
Another rally is already in the works for next year. The organizers of NursesTakeDC will now direct their focus toward supporting any state that has pending policy and legislation aimed at improving nurse-to-patient ratios and safe staffing. Organizer Carroll said that this year is a learning curve for the organizers, and they hope that next year they will have something even better with an even bigger audience.
“We encourage all nurses, practicing at all levels and in all settings, to unify and support beside nurses in the fight for safe staffing,” said Johnson to a room full of applause and cheers. “We fight for recognition—we will not justify our existence! There is no health care industry without us, and we will determine what is best for our practice and for our patients.”
Our two Nurses of the Week are University of Pennsylvania nursing seniors Marcus Henderson and Ian McCurry who are working to transform the way the homeless community in Philadelphia receives health care. Both students are focused on using a community-oriented approach to health care to target shortcomings in the current health system.
Their project “Homeless Health and Nursing: Building Community Partnerships for a Healthier Future” was awarded the 2017 President’s Engagement Prize which includes $100,000 in funding. The senior students partnered with the Bethesda Project, a Philadelphia nonprofit working to reduce homelessness and provide more community-oriented health care by being proactive in addressing health disparities before these homeless individuals reach the emergency room.
Henderson and McCurry have both been caretakers in their young lives. In middle school, Henderson took care of his great aunt with Down syndrome and his grandmother who was diagnosed with Alzheimer’s disease after school each day. This led him to study public health in high school and eventually join Penn’s nursing program.
McCurry was inspired to become a nurse and caregiver by his veteran mom who he says taught him to look at communities through a nursing lens. As a teenager, he helped adults in his community with developmental disabilities and later worked as a counselor for them, leading him down a natural path to nursing.
Now, both senior nursing students are pursuing their passions and breaking stereotypes about male nurses. Many male nurses choose to go into military or administrative roles, but Henderson and McCurry plan to continue on their path to community nursing and breaking down barriers for marginalized community populations.
To learn more about Henderson and McCurry and their passion project to revolutionize community healthcare for homeless individuals, visit here.
A new study published in the journal Policy, Politics, & Nursing Practice titled “Nurses Improve their Communities’ Health Where They Live, Learn, Work, and Play,” shows that nurse volunteer activities improve the health of their communities.
The data comes from 315 written responses to the question, “Please tell us about what you have done in the past year to improve the health of your community.” The question was originally included in a 2016 RN Workforce Study funded by the Robert Wood Johnson Foundation.
The study was conducted by two professors: Meriel McCollum, BSN, RN, researcher at the University of North Carolina School of Nursing at Chapel Hill, and Christine T. Kovner, PhD, RN, FAAN, professor in the New York University (NYU) Rory Meyers College of Nursing. According to NYU.edu, the authors describe nurse respondents’ perceptions of how they promote health in their communities through both formal and informal volunteer work.
In recent years there has been increased visibility for nurses who serve as disaster respondents or international aid volunteers. The American Red Cross currently has over 20,000 nurse volunteers who support victims of natural and man-made disasters, and thousands more nurses informally promote health behaviors in community-based settings where people live, work, and socialize by fostering a culture of health in their own communities.
According to NYU.edu, McCollum states: “We found that nurses are committed to promoting a culture of health in their communities both at work and in their daily lives. Leveraging nurses’ interest in volunteer work could improve the way nurses engage with their communities, expand the role of nurses as public health professionals, and foster the social desirability of healthful living.”
Final results of the study reported that 17% of respondents identified job-related volunteer activities; 74% identified non-job-related activities; and 9% of respondents indicated that they do not participate in volunteer work.
To learn more about this study and how nursing volunteer work affects the communities they serve, visit here.
Kierkegaard said, “Once you label me, you negate me.” And, so it goes for the many labels we unwittingly assign people in our health care interactions. Those affected by homelessness, who are often labeled as “the homeless,” are no different. People are not their circumstances and as nurses we want to support a forward momentum out of unhealthy situations. Here are 10 ways you can help.
1. Change the language.
Anchoring someone down under a label creates the risk of someone officially taking on that label and identity permanently. It’s time to change the language so that those affected by a circumstance or condition are upheld in the energy of transitioning into a better outcome.
2. Offer frost bite checks in the streets and the shelters.
When I was a city hospital war horse, I took care of more post-operative amputations than seemed reasonable. Many were individuals who experienced one bad night out there on the streets. Frost bite is a killer of digits, ear lobes, and limbs. As we know, prevention is best and early treatment is second best. It can be a slower row to hoe toward amputation from peripheral vascular disease, diabetes, and wound infection.
3. Offer foot gear.
Start a boot and shoe brigade. Foot gear needs to be protective. The average person affected by homelessness walks five miles per day. Even those who stay overnight in shelters cannot stay there during the day. It’s out into the elements in the morning. Try doing that in lousy shoes or boots and paper thin socks. Offer shoes and boots at the shelters and neighborhoods that have been identified as areas of need. Enroll some shoe outlets and podiatrists to set up a “give away” table in neighborhoods of high need, announce a foot gear day at the local church or community center. Shoes don’t have to be new; however, be kind and do not donate anything you would not wear yourself. Dignity needs to be a part of the equation.
4. Offer foot care clinics at shelters or request to use space at a church or community center.
This can be a great monthly event among nurse friends. You can check for peripheral vascular symptoms, diabetic ulcers, the need for nail trimmings, wash feet, moisturize, offer clean socks, and recommend appropriate medical follow-up. Folks are having it hard enough without adding a missing limb to the mix. I became a WOCN board Certified Foot Care Nurse (CFCN) and travel with my nail trimming tools as part of my amputation prevention initiative.
5. Provide socks.
In the winter, wool cotton socks go a long way at preventing frost bite. The wool cotton hikers found in multi-packs at Sam’s Club or BJ’s have been a great resource for my work. While you’re at it, throw in some winter hats, gloves, and scarves. In the summer, give them cotton blend, moisture-wicking socks with comfort cushion. Remember, there is a lot of walking within this population. Throw in some fabric band-aids for blisters.
6. Give them coffee shop cards.
This will get someone out of the elements and into a place where they are a paying customer. Whether it’s the heat of the summer or cold of the winter, imagine being outside and just wanting to sit somewhere out of the extremes. In New England, we use Dunkin Donuts. Five dollar increments prevent folks from mugging each other for a higher value item. Bear in mind, it can be like Mad Max and the Thunderdome on the streets.
7. Donate feminine hygiene products.
Women affected by homelessness get menstrual cycles. It’s tough going enough without dealing with the need for pads, tampons, and wipes. Donate feminine hygiene products to shelters, offer feminine hygiene products in “benevolent baggies” (see #9). Offer neighborhood pharmacy cards so a woman can choose her own products.
8. No judgement, just help.
Do conscious inner work to extinguish the urge to judge what brings a person to be without a permanent residence. There are married couples who both work full time but still cannot afford to pay rent; there are those who served to protect your freedoms in the military who are now affected by PTSD and cannot support themselves; there are children born into extenuating situations; and there are those who find it safer to be on the streets instead of shelters, and if you knew more, you would understand why. There are those with mental health and addiction issues. While I was offering foot care at a shelter, I learned of a fellow nurse staying there. He was in a terrible car accident, had spinal fractures, could not work, and lost his apartment due to an inability to keep up with the rent. The circumstances are as individual as the person. Take time to listen; everyone wants to be known. When we care for others within compassion, we care for ourselves.
9. Offer “benevolent baggies.”
If you see someone panhandling and you don’t want to offer cash, benevolent baggies (as I call them) are a way to go. You can include whatever you personally would appreciate if you were humbled to having to stand on the street and ask for immediate help. Use a small or large freezer weight Ziploc bag, which works better for those on the street. You can include a coffee shop card, neighborhood pharmacy card, snack bar, water, socks, underwear, feminine hygiene products, a quote you find inspiring that may encourage someone else. I keep a small stack of $5 Dunkin Donuts coffee shop cards in the center console of my car. I know many feel uneasy about giving to panhandlers. I hope this will put it in perspective for you: A woman once said, “I would rather panhandle than sell my body or steal.” Let’s all work toward a healthy society where people do not have to make these types of decisions.
10. Work for social change.
Pick any piece of this huge puzzle and go for it. Ask yourself the bigger questions about this issue. Jump on an initiative with some integrity or start your own. You are smart, caring, and a creative problem solver. You’re a nurse who can facilitate healing far reaching into the community. You don’t need any formal permission to bring that to the world.