Nurse Politics

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.

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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It all comes back to staffing

By | Advocacy, Blog, Kathleen Bartholomew, Nurse Politics, professional, Workplace Safety | No Comments

This is the second guest blog post in a series of blog posts by Kathleen Bartholomew, author of The Dauntless Nurse. Make sure you check out her first blog post, “How much weed is too much weed for Nurses?“.

It’s been 14 years since the Institute of Medicine recommended that nurses not work more than 12 hours within 24 hours.

It’s been 8 years since the Joint Commission issued a sentinel event alert based on the evidence that connected extended work hours, fatigue and decreased patient and worker safety.

It’s been 4 years since Elizabeth Jasper was killed driving home after a 12 hour shift and Editor-in-Chief Maureen Shawn Kennedy wrote an editorial in the AJN pointing out that “Best practices” should also cover the health and safety of those who practice.”

What’s changed? If you listen to the voices of thousands of nurses on the front line, the answer is “Nothing – in fact, it’s gotten worse”. What is staffing like where you work? And how do you normally cope with short staffing situations?
Negative repercussions can be very subtle. One example would be the manager telling you that she can’t approve your time off (when she/he had previously agreed.) It’s difficult, but important, to still act professionally in all of these situations and to find common ground. One nurse approached her manager and began the conversation by saying, “I know you care about the patients and nurses here as much as I do….”

Do you ever feel retaliated against for standing up for safe staffing? Here is a list of some things you can do because so often we feel hopeless and underestimate our power:
• Make a report to the Joint Commission
• Never skip a meal or break – call your manager or house supervisor to step in for you and then keep going up the chain of command. File a missed break/meal report.
• Don’t feel responsible for your organizations failure to hire an adequate number of nurses – travelers, temporary nurses and a float pool are options they know they have
• Advocate for a resource pool to your Board of Directors by using specific examples from your daily practice of how unsafe staffing effected both nurse and patient safety
• Contribute money to your state’s Nursing Political Action Committee
• Stay connected to your 675,000 peers in Show Me Your Stethoscope!

But remember, the day that the profession of nursing is respected will be when nurses have the power to decide for themselves how many nurses they need. And that day is long overdue.

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Fox News SLAMS Nurse Practitioners. How quaint.

By | Healthcare Policy, Nurse Politics, Nursing, VA Nursing | 10 Comments

How do you know an organization knows NOTHING about a subject? Click the big text and watch this video:

VA takes heat over plan to let nurses treat vets without doc supervision

These people are insane.  Twenty-one states have given the GIFT of primary care to their residents by allowing NP’s to practice independently.  The veteran population has so far been denied the choice of a nurse practitioner as a primary care provider, and the VA is said to have long wait times.  This is the obvious solution, and a choice I applaud the VA for making.  And Fox News makes a skewed report that makes it look like *I* will be practicing primary care at the VA next month? “Nurses will have their roles expanded”.  No.  Highly trained Nurse Practitioners will be allowed to practice at the level twenty-one US states say they are able to practice.  And now Veterans are ‘settling for a nurse’.

Really, Fox News? Really?VA-health-care-scandal-590x442

Be clear, the VA is taking no heat from me on the subject.  I am a VA employee and I do not agree with some of their policies, but this one is spot on. I am a veteran and a nurse, and I would be totally OK with a nurse practitioner taking care of my primary care needs at the VA.  As a matter of fact, I am now going to make it a point to register for VA health care. They take my insurance, and it would be extremely convenient to see someone in my building for primary care. Less sick time, less travel time, less wait time.  Everyone wins, especially me.

Even if you are opposed to Nurse Practitioners privately practicing in standalone clinics, the VA is a wonderful environment for NP’s.  There are all kinds of resources, and a physician is a phone call away.  All specialties are represented, and the VA Nurse Practitioner can get patients in to see specialists when necessary, with seamless continuity of care. Patients get their medications from an in-house pharmacy, and the VA Pharmacist has access to the patient’s medical record if there is a question about the dosage or choice of a particular drug.  This is the perfect situation for Nurse Practitioners; they are able to practice to their greatest ability, and they have backup.  Everyone wins – Especially the patient.STLHealthcareSystemLogov2

What people do not seem to understand is that the VA is actually held to way HIGHER standards than the private sector. We are taking care of our veterans, to whom we owe our very lives, so this is appropriate. It may take you 3-4 months to get in to see a new Primary Care Physician in the private sector.  The VA is required to get the new patient seen within thirty days.  Not only that, but if we are unable to get patients seen within thirty days, we run the risk of being dragged through the mud on Fox News.  In the private sector, nobody would be looking and the media would never be told about it. That is the difference between wait times in the private sector and the VA.  Public knowledge.

3e487c3Yellow Journalism at its finest.

I have seen ‘surveys’ of veterans who say they want care outside of the VA on the news.  I want to meet these people and see how random the surveys were.  As stated, I work for the VA.  I have so far had one patient say they wanted to go outside the VA for their healthcare.  The rest of them generally say something along these lines: “I know that I hear a lot of bad stuff about care at the VA, but i’ll tell you, they have always treated me great!” I have scheduled veterans who have insisted on driving four hours to our VA Hospital for a procedure, rather than having the procedure done close to their home because they TRUST the VA. 

Odd how that happens.

Thank you, Secretary McDonald for allowing us to further improve VA healthcare by providing even greater access to primary care.  Our veterans deserve it.  Thank you for utilizing Nurse Practitioners to help veterans get the best care anywhere.








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Nurse Burnout – Why you should worry about it.

By | Healthcare Policy, Nurse Politics, Nursing | 2 Comments

Everyone I know in nursing has said it.  We think it pretty often.  We feel like we are getting burned out, are already burned out, or in danger of being burned out.  While patients are in the hospital for a couple of days, we spend the better part of the year in there.  Every year.  Granted, we are (hopefully) not ill.  However, hospitals are stressful environments on the very best day.  They are even more stressful with chronic understaffing, insane patient satisfaction scoring systems that can cause our hospitals to lose reimbursement because a patient’s soda wasn’t cold, and nurses being expected to document everything 3-4 times.  Oh, and don’t clock out late, either please.  Finish that charting while you are taking care of 8 patients on telemetry.  Did you remember to post your strips?

Anyway…I digress.Stress-Test

When I was in the Navy, we had a saying.  A Dead Corpsman is no good to anyone.  This was naturally a reminder to keep yourself safe, because if you get shot, burned, stabbed, etc you cannot help the wounded.  In the Nursing world, we need to follow this sage advice, given to my by one Master Chief Conyers in 1991. If you are injured, mentally or physically; you are no good to your patients.  You can make deadly medication errors, and suffer compassion fatigue that completely destroys the quality of your care.  It can also decimate how you relate to your family and friends.  Burnout is no good.

And yet, it is an epidemic.

Recipe for a retention disaster:

Recently, we have been understaffed at my job. For the past year, actually.   I came home today feeling completely exhausted, and thinking about a change.  Considering the pains it takes to hire someone at my hospital; the extensive federal background check, and the 9 months it took to hire me, this is bad (and expensive) for the organization.  I work in Cardiac Electrophysiology.  It is easy to hire a procedural nurse; and hard to hire one who even minimally understands what is going on in my specialty.  I have also recently taken on additional responsibilities to cover another nurse who has been ill.  So, doing the job of two people, shorthanded for a year, and rarely taking breaks. This is not going to turn out well in most situations.

distraught-nurse-5361035Luckily, I work with a good manager and ‘sister’ department who assist us whenever they can, but this is only a band aid.  A small, not very sticky off-brand bandage, holding back a flood of hard feelings and desperation.  No amount of temporary help can fix a badly-staffed department; and it makes me hesitant to ask for time off because I know there is a small possibility it could impact patient care. Departments like mine need stability, and people who know what to do in the instance of a (very rare) serious complication.  It concerns me that we are short-staffed, and it makes me hyper-vigilant.   I worry about failing to notice signs of decompensation during a procedure, or breaking the sterile field, or stimulating the heart to pace inappropriately.  It hasn’t happened yet, but what if it does? It is exhausting, and makes it hard to ‘turn it off’ when I get home.

Unfortunately, What draws us to nursing is the thing that makes us so susceptible to burnout – we have a desire to care for others, even at the expense of our own well-being. This is why so many nurses are leaving their first nursing job within a year. High turnover rates have a huge negative impact on quality of care.  This is not good for anyone. It is always less expensive to keep nursing staff happy, with a sense of accomplishment about the care they give; but healthcare organizations do not seem to be able to do this very simple math. Retention is cheap, turnover is expensive, period.  And it is not only expensive in salary and training dollars.  It is expensive in medicare reimbursement penalties for procedural complications, bad outcomes, poor patient satisfaction, and lawsuits.

Nobody wins.

So what is the answer?

It seems like a majority of the problems we have in healthcare can be fixed by appropriately staffing all clinical areas.  We, as nurses keep saying this.  Our voices must be raised as a united profession to protect our patients.  I encourage you to share this post with everyone you know, including laypeople.  Make sure they know that we are worried about them, and that we are fighting for them.  It is time for the general public to fight WITH us. A short and simple list of things they should worry about:

  • Nurses who are exhausted from poor staffing and mandatory overtime make more errors; possibly fatal errors.
  • Nurses who work in a poorly staffed environment are more likely to leave the profession.
  • Departments with lower turnover give a better quality of care.
  • Nurses who are fresh and engaged will notice your deteriorating condition much faster than a burned-out nurse.
  • The hospital wants nurses to keep the staffing level a secret. That says it all.
















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Show Me Your SHIRT! Spirit day for rally! :) Gallery!

By | imageblogs, Nurse Politics | No Comments

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Hi Aunt Liz….. How did you get in here?



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#NursesTakeDC to ensure the safety of our patients.  We are engaged.  We are passionate.  We are united.

You are welcome to join us

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Ian makes this shirt look good 🙂


Want your own?

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