Hospitals are giving their Nurses too many patients and people are dying because of it.

By | Blog, Healthcare Policy, Nurse Politics | No Comments

I sit in my car after a nursing shift. Drained. Again.
Numb but frazzled. Again.
Feeling that sick anxious worry in the pit of my stomach. Again.
I had 6 very sick patients to care for on my shift- too many. Again.
I anxiously review the shift in my mind, questioning. “Did I do enough?”

I did the best I could. I gave everything I had. I didn’t eat, I didn’t even pee.

“But was it enough? Could I have done more? Could I have saved that one patient/not let that patient die alone/been a better nurse/done better”?

I wish the answer was “Yes. My patients received the best care they could.”
But after this shift, my gut and my heart tell me the answer is “No”. Again.

If only I had less patients, a safer level of patients, maybe I could have.

Maybe my first patient wouldn’t have fallen and broken her hip because I would have been there to help her get out of bed.
Maybe Patient #2 wouldn’t have suffered in pain for so long because medications were delayed while we were coding my 3rd patient.
Maybe I would have caught patient #4’s fever earlier, before they became septic and had to be transferred to the ICU.
Maybe I could have comforted the daughter of patient #5 who was just told there was nothing more we could do.
Maybe patient #6 wouldn’t have died, in the dark, afraid, in pain and alone because I was dealing with emergencies with patients 1-5.
These patients were someone’s mom, dad, child.
Maybe if I had a safer number of patients to care for, I could have saved just 1.

This is the norm, rather than the exception for nurses.
No matter how good of a nurse I am, taking care of too many patients is unsafe. Impossible, unfair to patients and nurses. People are dying unnecessarily, or developing complications that could have been avoided.

The evidence is clear. Studies show that there is a “safe” number of patients to care for, and an “unsafe “number of patients to care for.* For every patient over 4 that a nurse cares for on a Med/Surg floor, there is a 7% increased risk of death for her patients. If a nurse cares for 6 patients, that means there is a 14% increased risk of death. 7 patients =21% increase. Not just risk of a complication or a mistake- DEATH.

How would you feel if that was your mom. Your child. Your brother. How many patients do you want their nurse to be taking care of? And why would hospitals staff nurses at levels that put patients at an increased risk for dying?

In Massachusetts, voters will have the chance to save lives. Issue 1, written by nurses, would limit the number of patients that a nurse can care for, based on the the most recent studies that show how many patients are safe.

Opponents of Issue 1 instill fear about the implications of the bill- “there won’t be enough nurses”, “hospitals will close”, “NICU units will shut down” “You will be turned away at the ER” “ER wait times would increase dramatically”

I wish we could see what it would look like 10 years, 15 years later after we passed Issue 1- what would it look like? Would all of these fears come to pass?

Guess what- we can.

California, the only state to have nurse patient limits, passed a nearly identical law in 1999. I went to California and interviewed nurses in Los Angeles and San Francisco from a variety of hospitals and asked them about what it was like before and after their law passed.

They responded with nearly identical responses:
-Hospitals are making more money than ever.
-Not one hospital has closed, even smaller community hospitals
-Nurses are coming back to the bedside to work- they have less stress, less burnout
-Patients are getting better care- they have less infections, less readmission rates
-No units have closed
-Support staff have not been eliminated
-ER wait times? California has some of the lowest ER wait times in the country. Patients aren’t turned away.
-LESS PATIENTS ARE DYING

In fact, most nurses looked at me like I was crazy to even ask those questions. I said “that’s what they are telling Massachusetts nurses”. “Nope” they replied, “we love our patient limit legislation”. They couldn’t even imagine working without these limits. Even nurse managers and hospital administrators had positive stories about the nurse patient limits legislation.
So why are hospitals staffing nurses at an unsafe level? Why are there 2 standards of care? Is it costs? How much is your loved one’s life worth?

Which hospital would you send your mom, or your child to? A California hospital with research based safe patient limit laws. Or a hospital in a state like Massachusetts, without safe patient limits, where nurses may have 7 patients or more, giving your mother, your loved one a 21% higher risk of dying. A hospital where patients have a greater risk of complications, of being in untreated pain, of dying alone, in the dark, in pain and in fear.

I’m choosing California and safe patient limits. I choose Yes on Issue 1 in Massachusetts.

SMYS members, please reach out to family, friends, colleagues in Massachusetts and let them know how important Issue 1 is for patients. Patients deserve better. Bedside nurses, just like you, just like the nurses who wrote this bill, tell us every day, over and over that safe patient limits are needed. They never want to think to themselves after a shift- if only I could have saved just 1 by having a safer patient load. They worry for their patients, their loved ones, your loved ones.

Vote Yes on 1 to save lives. Voting No costs lives.

*Aiken, L.A, et al, Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction, Jama 288 (16), 1987-1993, 2002

-Kelley Muldoon Rieger, MSN PNP

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Show Me Your Stethoscope, Johnson and Johnson Nursing JLabs, and Nurse Innovators Meet in New York for the Nurse Innovators Quickfire Challenge

By | Blog, Contest, Events, Innovation, Nursing | No Comments

Last week, SMYS Founder Janie Garner, met with Johnson and Johnson Nursing and other Nurse Innovators to discuss innovation in Nursing and to announce the Nurse Innovator Quickfire challenge.  The live panel discussion shared the thoughts and experiences of four nurse innovators and the process they went through to bring their innovations to fruition.

The Panel also announced the Johnson and Johnson Nurses Innovate Quickfire Challenge, inviting the more than 3.2 million nurses located throughout the U.S.  to submit ideas for new devices, health technologies, protocols or treatment approaches that have the power to profoundly impact patient care and human health. The nursing innovators with the best idea(s) will receive up to $100,000 in grants and access to mentoring and coaching from Johnson & Johnson, via Johnson & Johnson Innovation, JLABS to help bring their ideas to life.

More information about the challenge can be found here

If you missed the Panel Discussion, you can watch it now!

 

Don’t forget to follow us on Instagram, Twitter, and the Show Me Your Stethoscope Facebook Page and then please join us in the closed Show Me Your Stethoscope Facebook Group!

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Cases of Necrotizing Fasciitis, Serious Genital Infection with certain Diabetic Medications, FDA warns

By | Blog, Health, News, Public Health | No Comments

The US Food and Drug Administration has put out a warning about certain Type II Diabetes medications causing cases of genital infection and necrotizing fasciitis in the perineum.

According to Medscape

“The new warning will be added to the prescribing information and the patient medication guides for all single and combination agents in the glucose-lowering SGLT2 inhibitor class of drugs approved to treat type 2 diabetes. Those drugs include the following:

  • Canagliflozin (Invokana, Invokamet, Invokamet XR; Janssen)
  • Dapagliflozin (Farxiga, Xigduo XR, Qtern, AstraZeneca)
  • Empagliflozin (Jardiance, Glyxambi, Synjardy, Synjardy XR; Boehringer Ingelheim/Eli Lilly)
  • Ertugliflozin (Steglatro, Segluromet, Stelujan; Merck)

Necrotizing fasciitis of the perineum, also called Fournier’s gangrene, is an extremely rare but life-threatening bacterial infection of the tissues underlying the skin surrounding the perineal muscles, nerves, fat, and blood vessels. It is estimated to occur in about 1.6 of 100,000 males annually in the United States, most often among those aged 50 to 79 years (3.3/100,000).

However, from March 2013 to May 2018, the FDA received reports of 12 cases of Fournier’s gangrene among patients taking SGLT2 inhibitors, of whom five were women and seven were men. The condition has rarely been reported among women. The patients ranged in age from 38 to 78 years.”

Read on at Medscape to find out about treatment options and what patients and healthcare professionals should do.

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A Pause At The Door: Regaining Time with Patients

By | Blog, Kathleen Bartholomew | No Comments
Here is another excellent guest post by Kathleen Bartholomew, author of the book The Dauntless Nurse and website I am Dauntless.

I recently read that 70% of physicians said that their bond with their patients has eroded. I wonder what the statistic is for nurses? I’m guessing even lower as electronic charting takes up more than 30% of our time, and hospitals crunch staffing grids for survival.

Forming a bond takes time.

I remember an older man who seemed to be fighting death with all he had – even the doctor was perplexed! Finally I asked everyone to leave and listened carefully to his incoherent mumbling while giving him a bath. I discovered that when he was only 19 he had joined the Navy and gone to a brothel and was terrified of going to hell. I provided comfort and reassurance. There is no pill for a peaceful death. He died serenely within the hour.

Share your story! The stories of our bonds with our patients energize us and remind us why this profession is so amazing.

Maybe this lack of time explains why nurses have twice the depression rate – 18.2% compared to 9% for the general population. The time we have to listen and connect has eroded like a massive mudslide over the last 10 years as acuity and complexity increased and length of stay became shorter. As humans, we don’t notice minute changes because we are so awesome at adapting. How can we can reclaim this time with our patients again, and protect it from eroding even more? It was, and will always be, time with my patients that nourishes my soul and validates why I chose nursing in the first place.

What tips or tools have you found that are helpful to regain quality time with your patients? Try the ‘pause at the door’. Just stopping at the threshold before entering a patient’s room long enough to inhale and exhale deeply two times will have a centering effect on your nervous systems. When you have a list of 20 things to do, and medications are late, and someone turned up the invisible treadmill to high, use breathing as a powerful way to stop the crazy cycle. And any intervention that helps a nurse, helps the patient.

Try it!

Don’t miss Kathleen’s other guest posts

How Much Weed is Too Much Weed for Nurses

It all comes back to staffing

Late to the game:What can China and South Korea teach America?

A Loneliness Epidemic

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A Loneliness Epidemic

By | Blog, Kathleen Bartholomew, Public Health | No Comments

Kathleen Bartholomew is back with another excellent blog post. Kathleen is a well known Nurse speaker and the author of “The Dauntless Nurse”. She can be found at her website Kathleen Bartholomew as well I Am Dauntless.  You don’t want to miss her other posts on the SMYS Blog How Much Weed is Too Much Weed for NursesIt all comes back to staffing, and Late to the game:What can China and South Korea teach America?

 

Just this week a survey of 20,000 adults conducted for the health insurer Cigna found that 50% of adults said they sometimes or always felt alone or left out. That’s a big leap from 1985 when only 10% of our population had no one to confide in about serious matters.

Can you guess which age group was the worst affected? Ages 18-22. Alarming!

In our Instagram world where we are constantly texting friends and family, the Great Nothing of loneliness has taken up residence in our souls. What gives? It turns out that a “like” is not the same as real human connection where we feel truly seen.

Most nurses know that loneliness is a predictor of functional decline and mortality and is associated with depression, poverty, arthritis, and heart and lung disease. A 2010 study found that being lonely has the same effect on mortality as smoking 15 cigarettes a day!

Let’s recognize outliers and do something about strengthening community before Loneliness turns into yet another billing code and treatable commodity where big pharma can make big money by creating new drugs like “Forlorn-azol”, or immunize us from loneliness with “Dejectacillan”.

Look around. A good place to start is your own unit. Engage in conversation with someone new, initiate genuine conversation instead of always diverting into our own smartphones at breaks, and discover something unique and good to say about a co-worker every day.

We are over 3.6 million nurses. We can reverse this trend.

Tell us what you think in the comments section and over on the SMYS Facebook Page and join us in the SMYS Facebook Group

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