On February 15, 2018, the newest safe nurse staffing bill was introduced to the U.S. Congress. The bill (H.R.5052 and S.2446) has bipartisan support, and is championed by Reps. David Joyce (R-OH), Suzan DelBene (D-WA), Suzanne Bonamici (D-OR), and Tulsi Gabbard (D-HI), as well as Sen. Jeff Merkley (D-OR).
In the past, several safe staffing bills have been presented in previous Congresses but have failed to pass committee. This bill, the Safe Staffing for Nurse and Patient Safety Act of 2018, is slightly different than previous iterations. Under this staffing legislation, Medicare-participating hospitals would be required to form committees that would create and implement unit specific, nurse-to-patient ratio staffing plans. At least half of each committee must comprise direct care nurses.
“It is so important for nurses on the front lines to be able to have a say in what they believe is safe staffing,” says Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, the president of the American Nurses Association (ANA). “This bill benefits bedside nurses by giving them decision-making power, control, and the ability to influence the delivery of safe care,” Cipriano continues.
A committee made of staff nurses—who would make staffing decisions that directly affect their own units—is so important because it is nurses who can best assess patient needs and the resources required to provide safe patient care. Staffing committees would be able to address the unique needs of specific units and patient populations by involving specialty nurses in the decisions, and would have the ability to modify the hospital safety plans as needed.
Overwhelmingly, research supports adequate nurse staffing. Over the last several decades, literature has demonstrated a decrease in patient morbidity and mortality and an increase in patient safety when units are well staffed. “With adequate amounts of staffing we see mortality go down and patient complications can be prevented or diminished,” Cipriano says. “It is important for nurses to have sufficient resources to care for patients, because nurses experience moral distress when they cannot provide the care they know a patient needs.”
Short-changing patients also contributes to nurse burnout, and low nursing retention is expensive. Additionally, adequate nurse staffing leads to reduced health care costs, as a result of fewer hospital readmissions, hospital-acquired infections, medical errors, and other significant measurable patient outcomes. “Patients deserve to have the right care,” Cipriano says. “They need to be kept safe, and the best way to prevent problems and complications is to have the right nurse staffing.”
Is there hope that this bill will pass, when so many previous iterations have not? “It may be difficult to pass the legislation, even this time around,” Cipriano admits. “But the most important impact is that every time we have an opportunity to have this legislation discussed, it’s another opportunity to educate another decision maker. Whether it is congresspeople, their staff, or other leaders in their communities, it gives us the opportunity to continue to reinforce why it is so important to have the right nursing care.”
It is ethically challenging when a nurse is asked to take staffing assignments that do not feel safe. On many units, nurses are expected to care for several acute and critically ill patients at a time, and are given patient loads that stretch them far beyond their reasonable care delivery capabilities. What should a nurse do when faced with an unsafe assignment? Nurses should raise immediate concerns by following the chain of command, and talking with immediate supervisors to express that they believe the situation is unsafe. “The first obligation is to make sure that no patient is left uncared for,” Cipriano says. “Short term, use the chain of command and do everything you can within in your power to make sure that you’re providing at least the minimum care the patient needs.” Longer-term, if nurses truly believe that their organization is not supporting the right staffing ratios, the ANA encourages an active dialogue with leadership, such as a conversation with responsible nursing leaders, quality directors, or patient care committees or councils to focus attention to the issue.
“Nursing care is like a medication,” Cipriano says. “You wouldn’t withhold a life-saving medication, so why would you withhold the right amount or right dose of nursing care?”
If you are passionate about safe staffing laws, consider calling or writing your congressperson and encourage them to support the Safe Staffing for Nurse and Patient Safety Act of 2018.
Our Nurse of the Week is Saman Perera, a Tennessee-native nurse fighting healthcare inequality through Doctors Without Borders. Born in Sri Lanka and raised in Hendersonville, TN, Perera decided to join Doctors Without Borders after graduating from nursing school and is now setting an example for his community on how to get involved in global humanitarian efforts.
After attending the University of Illinois for his bachelor’s degree in nursing and Vanderbilt University for his master’s degree, Perera embarked on his first mission to Haiti following the 2010 earthquake to help with the cholera outbreak there. His missions have also taken him to work in primary care in the Democratic Republic of Congo and to the frontlines of Chad treating war-wounded victims.
However, Perera was most recently stationed on a two-month medical mission in Bentiu, South Sudan, working in a refugee camp hospital made up of 130,000 residents. The camp was created as a result of a civil war breakout in the area. Although his missions often take him to volatile, war-torn environments lacking housing and running water, Perera says the toughest aspect of his job is managing the emotions involved. Perera has found that the best way to cope with the emotions of treating victims of war is to focus on task-oriented jobs like training local nurses.
For Perera, his work with Doctors Without Borders goes beyond just nursing and medicine. He tells UTDailyBeacon.com, “I realized that medicine, for me, is a Band-Aid to something a lot bigger; we’re talking wars, huge injustices, malnutrition in countries like Congo. For me, my presence there and the presence of Doctors Without Borders is more than medicine, it’s a way of saying injustice is not okay.”
Perera recently moved to Knoxville, TN after returning from his two-month mission in South Sudan. He plans to work as a hospital nurse practitioner while he prepares for another Doctors Without Borders mission trip. In his spare time, Perera encourages other current and future healthcare workers to get involved in global aid and serve those in need.
To learn more about Perera’s time as a medical mission nurse for Doctors Without Borders, visit here.
Barbara and Donald Jonas, founders of The Jonas Center for Nursing and Veterans Healthcare, recently unveiled a new vision to support the country’s most vulnerable citizens through Jonas Philanthropies. Building on more than a decade of high-impact investments in nursing scholarship, leadership, and innovation, Jonas Philanthropies will begin expanding the organization’s scope to fund other scalable solutions aimed at the most vulnerable and neglected.
According to a press release from JonasPhilanthropies.com, “The organization’s new model will invest where it matters most – meeting needs of the country’s most vulnerable citizens with high-impact solutions to transform healthcare.”
The Jonases have always had a deep passion for the nursing industry and its integral role as the backbone of the American healthcare system. Their venture began over a decade ago when they decided to sell their impressive art collection to fund the basic human needs of healthcare through their first philanthropic organization, the Jonas Center for Nursing and Veterans Healthcare.
Their impact spans the country, funding more than 1,000 doctoral nursing scholars to help care for the most vulnerable populations and improve care for veterans. They have since expanded to help support low vision and blindness and children’s environmental health.
Donald Jonas, Co-founder and President of Jonas Philanthropies, says, “Jonas Philanthropies is an evolution of our work and personal passion, but it also reflects the broader needs of the healthcare industry, which will help ensure its impact and scalability for generations to come. We are incredibly excited to celebrate this next chapter.”
Their new name, Jonas Philanthropies, represents their expansion beyond nursing and veterans care. To learn more about Jonas Philanthropies and their impact on the field of nursing, visit here.
As the long history of sexual harassment in Hollywood continues to come to light, many other fields are beginning to speak up as well, including the nursing profession. This female-dominated field is not immune to the nationwide issue of sexual assault.
Experts put some of the blame for sexual harassment against nurses on the sexualization of nurses by the media. Sexual harassment of nurses can vary from offensive jokes and sexual comments to unwanted patient advances and hospital physicians assaulting their employees.
Several nurse organizations have published coverage on this issue, including the American Nurses Association (ANA) Position Statement:
“ANA is deeply committed to the principles of civil rights and opposes any form of discrimination against individuals or groups of individuals based on sex, race, age, national origin, religion, disability, or sexual orientation. ANA believes that nurses and students of nursing have a right to and responsibility for a workplace free of sexual harassment. Sexual harassment has an adverse impact on the health care environment.”
A 2001 NurseWeek study revealed that 19 percent of nurses surveyed reported being sexually harassed in the previous year. However, underreporting is still a major issue. Many nurses become thick-skinned due to dealing with difficult patients, and this can cause them to make light of the seriousness of sexual harassment.
Hospital procedure usually enables direct-care workers to remove themselves from patient cases where patients have crossed the line, but nurses rarely do so. Many nurses and healthcare workers receive training on how to deal with sexual harassment, especially if they work for a hospital, but training appears to yield limited results.
Despite the issue of underreporting, it is still an employer’s job to create a work environment that prevents sexual harassment. Nurses who are sexually harassed at work often face frustration, emotional distress, and professional setbacks. Many even leave the field altogether. It’s important that nurses watch out for each other and report inappropriate behavior so that hospitals can become safer places to work.
ANA offers this advice on What to Do If You’re Harassed:
- Confront the harasser, and make it clear the attention is unwanted.
- Report the harassment to your supervisor or to a higher authority if your supervisor is the harasser. Go to a government agency or the courts if necessary.
- Document the harassment promptly in writing.
- Seek support from friends, relatives, colleagues, or your state nurses association.
Creative Nursing: A Journal of Values, Issues, Experience, and Collaboration is a peer-reviewed professional journal, with an overarching theme for each year and a related theme for each of our quarterly issues. Creative Nursing 2017 has been a year of Questioning Authority.
Questioning Authority: What Does It Mean?
Our mission for the year was to examine, evaluate, and criticize the body of knowledge that informs our care. The principles that guided our journey were:
Humanize patient care. Let the people we care for decide how they want to be cared for. The unit of experience is the intervention with the individual. Use common sense – no matter what authority says, do what is right for the patient. Think like a nurse.
Know who and what constitutes authority: Self (conscience, judgment, critical thinking); peers; patients, families, and other caregivers; nurse educators and theorists; physicians and other health care professionals; health care organizations and their policies; regulators; third party payers; national and community leaders; social conventions; the media; evidence-based practice. The list goes on.
Standardization values compliance over creativity. At specific times, standardization and compliance are paramount, but of all the actions nurses take in their professional practice, those times are very few. The rest of the time, we need creative nursing: wide eyes, open ears, open minds, and a healthy skepticism, in order to reimagine the next health care system. Topics in this issue included deferring to expertise before authority, Dorothea Orem and self-care, teaching millennials and Generation Z, and whether virtual simulation and pre-op teaching actually work.
Questioning Authority: What Does It Take?
“It is at the intersection of the self and the other that true reflective practice occurs,” says guest editor and Curry College nursing professor Susan A. LaRocco. In this issue, we talk about what it takes—the attributes (personal and system) required—to challenge assumptions.
It takes courage: Facing fears of retaliation or marginalization; finding strength in trial and error and in failing forward; having confidence in our Ways of Knowing.
How do we process what we dare? Through reflection: debriefing for meaningful learning.
What else does it take? Humility, authenticity, tolerance for disruption, leadership that creates a safe environment for questioning.
Other topics included helping teammates work together through “virtues in common;” healthier work environments for academics and certified nursing assistants; helping new nursing professors become excellent teachers; unintended consequences of some JCAHO mandates; how understanding triggers could help nurses influence health behaviors; and how the movement to establish nursing as a profession distinct from medicine succeeded in the face of paternalism and misogyny.
Questioning Authority: What Does It Look Like?
It crosses boundaries. It is interprofessional, interdisciplinary, and respectful of individuals’ unique personal resources and contributions.
It advocates courageously for patients and families.
It uses science and art to humanize care.
For this issue of Creative Nursing, we found role models, exemplars, and stories of responses to educational and societal silos, inspired uses of simulation and art to humanize care, creative ways to recruit and retain valuable individuals in the nursing profession, and the application of nursing expertise to correct a scientific and cultural wrong number. The most moving story is by Joanne Dunn, from a health care skills simulation lab at the University of Worcester in England. Her depiction of a simulation of a typical busy unit on a typical morning moves us to reject the assumption that simulation lab exercises can never truly replicate what it means to be a nurse.
Questioning Authority: What is the Impact?
In this issue of Creative Nursing we explored the impact on both process and outcomes, for both patients and those who care for them, in all arenas. We highlight a nurse theorist (Margaret Newman) who went against prevailing views of what constitutes health and illness; a biomedical scientist who questions currently accepted treatment for patients with breast carcinoma in situ; and a nurse and former Minnesota state senator who found the legislature to be a practice setting in which challenging assumptions and demanding reliable, authoritative, scientific justification for existing or new law is the major function of the role.
We invite you to experience the wisdom of our thought leaders, and to consider making your own contributions to Creative Nursing. To learn more about the journal, visit www.springerpub.com/cn.