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Healthcare Policy

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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Thank you Massachusetts Nursing Association

By | Advocacy, Healthcare Policy, Nursing, Unity | No Comments


This year more nursing unions joined with their brothers and sisters at NursesTakeDC, the frontline nurse led grassroots movement fighting for safe staffing. The Massachusetts Nurses Association (MNA) was one of the unions rallying in DC and deserves special recognition. Specifically, we’d like to acknowledge MNA president Donna Kelley Williams RN for her tenacious leadership and advocacy in Massachusetts. The MNA leads the fight for ‘safe patient limits’’; a term they developed that perfectly describes what we are fighting for.

Thanks to the tireless push from the MNA, Massachusetts voters will have a ballot question this November 2018 that decides if ‘safe patient limits’ will be written into state law. Nurses overwhelmingly support safe patient limits. However, the voters of Massachusetts will determine if this becomes a law or not. So far the polls suggest that voters will choose ‘yes’ to safe patient limits, but the fight isn’t over yet!

Massachusetts policy is often viewed as forecast of future national policy. This ballot question is monumental as several states have legislation that has been introduced but has yet to reach committee or the house floor for a vote. A win for Massachusetts nurses could tip the scales in the favor of nurses.

We’ve watched the MNA support the nurses of Massachusetts in their fight for safe patient limits. Now it’s time to do more that watch them work. Now we must support the nurses of Massachusetts in their push for safe patient limits in Massachusetts. We must gain public support and momentum to vote ‘yes’ on this ballot question. At SMYS we believe nurses should support nurses; nursing organizations should support each other; and all nurses in all settings, practicing at all levels should support policy that benefits nurses. Leading up to the November vote, we encourage every nurse to support the nurses of Massachusetts in any way they can.

Social media is a powerful tool. Every nurse can help this cause by sharing information about the ballot question online via Facebook, Twitter, Instagram, and LinkedIn. If you live in Massachusetts or one of the neighboring states (Main, New Hampshire, Vermont, Connecticut, New York, Rhode Island), please consider showing up in person to support the Massachusetts nurses. A win for safe patient limits in Massachusetts is a win for all nurses and patients.

 

Thank you for being here and helping nurses unite,

Jalil A. Johnson PhD, MS, APRN, ANP-BC

Show Me Your Stethoscope Foundation I CEO

NursesTakeDC | Organizer

 

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

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

 

This is the third in a series of guest posts by Kathleen Bartholemew, author of The Dauntless Nurse.  Don’t miss her first two blog posts, “It all comes back to staffing” and “How much weed is to much for Nurses“.  Check out all of Kathleen’s posts and leave comments below!

In 2008 both South Korea and China declared that gaming addiction was their number one public health problem. Today, these countries have sixteen treatment centers, a school internet screening tool, two week detox program and over 5000 counselors trained in internet addiction. In contrast, the CDC does not list internet addiction as even one of its top ten public health concerns – despite the fact that the screen time for America’s youth is over 7 hours a day, and that our children today only spend 4 to 7 minutes a day outdoors.

As a country we have failed to adequately acknowledge this crises as well as the impact it will ultimately have on our society. Most people do not even know that gaming in excess causes physical changes to the brain’s very structure at a time when it is still evolving. According to Dr. Hillarie Cash, founding member of ReStart Life, the signs and symptoms of addiction are:

  • Attention, learning and self-control problems
  • Impaired social skills
  • Emotional problems, anxiety, low self-esteem and depression
  • Aggression and indifference to human pain
  • Physical problems – eye strain, weakness, carpal tunnel
  • Strong correlation with sex and porn

Concerned, I paid a visit to the first digital addiction treatment center in the nation. Dr. Hillarie Cash  gave me a tour of the group treatment center at ReStART, but most enlightening were the personal conversations with the residents themselves who could barely make eye contact with me. Emphatically, these young men relayed what parents should NOT do:

  • Don’t tell kids its bad – tell them and show them the impact gaming has on their lives
  • Don’t get help until children admit there is a problem (it’s usually an event)
  • Don’t act like being on the internet is a reward
  • Don’t say “as long as you do what you are supposed to do (like good grades) then I don’t care

What should parents do? Unanimously these men wished that their parents had put parental controls on with explanations about the power of digital addiction – and they also wanted their parents to sit down and eat dinner with them. Real human connection appears to be a good antidote.

Pass this information along. Educate yourself on the powerful pull of digital media. Bring up the subject in PTA meetings, churches and social gatherings to help raise awareness in our society of the insidious damage of digital media addiction and inform your loved ones- in person! Or maybe download the APP “Moment” to monitor your own screen time (a reality check for my husband and I). As adults, set a good example. Over 60% of adults sleep with their cell phones at night, and half of adults read their emails during the night.

There has been a two year waiting list for ReStart Life for quite a while now – which clearly demonstrates the need. We may be late to the game, but there is still time for us to rally together to preserve the personal connections that make us human, and to protect our children from danger that they cannot see.

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How Much Weed is Too Much for Nurses?

By | Blog, Healthcare Policy, Kathleen Bartholomew, Medical Marijuana | No Comments

This is the first guest blog in a series by Kathleen Bartholomew, author of The Dauntless Nurse. Don’t forget to read her second post in the series “It all comes back to staffing

There -are now 28 states that have approved the use of medical marijuana – and 8 states recreationally. So chances are strong that some nurses are using marijuana for medical reasons, or for recreation. But how much is too much?

One joint in the 1970’s has the same potency of one puff today. Since 1998 the potency of marijuana has doubled. But what if you smoke a few hours before your shift? Edibles can take a few hours to feel the effects – and if you smoke it can take three hours or more to get out of your system. Having a medical-use card does not give nurses sufficient protection, as discussed this Medscape article.

Nurse Mary has lupus and a medical marijuana card. She also wants to make sure she is safe taking care of her patients; and that her license is safe. The laws don’t prohibit use unless it impairs practice, but employers can still take action. So both of these areas are still gray zones as marijuana is not supported federally, there is no consensus on toxicity level, and a hospital can decide independently to fire someone who tests positive whether they have a card or not. In Washington State for example, driving under the influence of marijuana is similar to driving drunk: 0.8 for alcohol – or 5ng/ml THC. But do you know your THC level when you arrive at work?

“If you consistently notice any of the problems listed below in a peer, it is your ethical obligation to compassionately go to your peer, and share your concerns. Our primary obligation as nurses is to protect our patients, but we should also care for each other. A large percentage of nurses are over the age of 45, so some of the symptoms below may be related to menopause! We shouldn’t jump to conclusions or make judgments, but most importantly we can’t ignore impaired nurses.

How would you handle a situation with a nurse that appeared to be impaired?

What would you do if a nurse had symptoms of being impaired by marijuana such as:

  • Short term memory problem
  • Impaired thinking and or delayed decision making
  • Decreased concentration
  • Impaired ability to perform complex tasks
  • Decreased alertness and reaction time
  • Paranoia and/or drowsiness (and of course, Increased appetite!)
  • Washington State Liquor and Cannabis Board

    See more from Kathleen Bartholomew Here: http://www.kathleenbartholomew.com

    Check out the Dauntless Nurse Here: https://www.amazon.com/Dauntless-Nurse-Communi…/…/B01MTLK5QI

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    Undocumented Immigrants, the law, and healthcare

    By | Health, Healthcare Policy, underserved populations | One Comment

    A high school Valedictorian in Texas announced that she was an undocumented immigrant this week, sparking a debate about who should and should not be enjoying the benefits of residency in the US.  Larissa 20160423_blp901Martinez stated the following:

    maxresdefault

    Lovely, brilliant Valedictorian

    “By sharing my story, I hope to convince all of you that if I was able to break every stereotype based on what I’m classified as — Mexican, female, undocumented, first generation, low-income — then so can you.” 

    My maternal grandparents are from Italy.  My mother is a first-generation American.  I was the first person in my family to go to college, which happened later in my life because my parents didn’t really see the benefit.  After all, my father never graduated high school, and no one in either of their families had been to college and they turned out just fine.

    Naturally, in our changing economic climate that was a mistake.  However, back to the undocumented part… When my grandparents came here it was much easier to become a legal resident of the US.  My grandfather was so unbelievably proud to become an American Citizen, after the long and grueling process of naturalization.  He only spoke Italian when he arrived, and worked at low-paying jobs doing manual labor.  He learned English.  He studied, he sweated, and he passed the test after 12 years.

    Larissa says that she and her mother have been trying to become a citizen for seven years, and that the US Immigration system is broken.

    I am going to make comparisons here.  Preparing for the tomatoes.  tomatoe-thrown

    While the US Immigration system is probably broken, the Mexican Immigration system is equally as convoluted and full of red tape.  I cannot just walk into Mexico with my children and set up housekeeping, as Larissa’s mother did.  News stories I read about her family stated that they ‘fled’ to the US; from an abusive, alcoholic father, apparently. It seems to me that it was probably not necessary to illegally enter the US for that reason. I will assume that Larissa’s mother wanted an American life for her children.

    In 2011, the Mexican government enacted a ‘softer’ law about undocumented immigrants to Mexico. Up until then, this was the law:

    • Under the Mexican law, illegal immigration is a felony, punishable by up to two years in prison.
    • Immigrants who are deported and attempt to re-enter can be imprisoned for 10 years.
    • Visa violators can be sentenced to six-year terms.
    • Mexicans who help illegal immigrants are considered criminals. 
    • The law also says Mexico can deport foreigners who are deemed detrimental to “economic or national interests,” violate Mexican law, are not “physically or mentally healthy” or lack the “necessary funds for their sustenance” and for their dependents.

    Sick and poor undocumented people are not supported by the Mexican government.

    So, when Larissa’s family arrived in the US, the law in Mexico was pretty harsh.  Had I done the same thing with my children, I would have been imprisoned for two years and charged with a felony, then deported. The law has since been changed to an administrative and financial penalty, and it is possible to obtain Mexican residency unless you are sick or poor. Larissa’s family was poor.

    illegal-immigrants3Having said all that, am I in favor of deporting all undocumented immigrants? No, of course not.  I am in favor of naturalizing them; they already live here and contribute to the economy.  As a matter of fact, they have historically contributed to Social Security and never collect the benefits.  Of course, there are people who work “Off the books”, but the large majority actually contribute to all payroll taxes via a false Social Security number. And this is not the fault of their children, who know no other life.illegal-immigrants-pay

    However, if they commit crimes against other people, I am in favor of instantly deporting them.  Not in a year, not after a prison term that we pay for.  That very moment. Mexico can keep her problem children. They have high standards for Americans emigrating to Mexico.

    Let’s get to the healthcare part! 🙂

    The Affordable Care Act specifically prohibits undocumented immigrants from purchasing health insurance through the marketplace.  Undocumented immigrants can sometimes get coverage through an employer.  They can purchase private health insurance, which is expensive.  If they are a college student, they can purchase a student plan through a university.  These are usually cheap.

    Also, a 2012 federal law provides temporary work authorization and relief from deportation to undocumented children and young adults who arrived in the U.S. before turning 16. It’s part of the Deferred Action for Childhood Arrivals law, known as DACA. Undocumented immigrants who qualify are eligible. Since we really cannot blame kids for the actions of their parents, I think it is a good concept. In California, undocumented immigrants may be allowed coverage under Medi-Cal if they have DACA status.

    I see no problem with undocumented immigrants buying health insurance through the marketplace.  More people = lower prices according to our government.  Also, these folks currently seek primary care in Emergency Departments all over the US because they have no insurance.  11 million undocumented people can clog up a lot of ED’s.  Let’s make them pay for insurance like everyone else, and stop using the ED as a PCP’s office.

    While I do not have the answer to the problems we have with undocumented immigrants, I would say that Larissa probably made an error when she did this.  Many people will see it in a negative light.  She is still in the country illegally.  I hope Yale knows her immigration status, and that she is prepared to get a student visa.  She is a smart kid, so she probably thought of this.

    However, great job on those grades, girl! I hope you are a great neurosurgeon.

    And we don’t need that wall.

    Love,

    Janie

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