Nurses Have a Voice and Should Not Go Silent

Posted in Featured, Nursing, Nursing Jobs, Travel Nursing, Travel Nursing

Nurses can’t find jobs either? What’s the truth behind this issue?

One thing that has happened in the past few months as 401Ks and other retirement funds have practically vanished, is that many nurses, who have not been actively employed for possibly even years, have returned to work.

With children in college, spouses losing jobs, and retirement funds evaporating, yes, many inactive or “retired” nurses have returned to the workforce. This will impact the nursing shortage to some extent, but will not solve it.

But, what else is really happening?
Nurses are being threatened and frightened into working mandatory overtime that states have regulated or outlawed. Nurses are being forced to take on nurse-to-patient ratios that are totally unsafe because administrators can hold their jobs over their heads. Working conditions and safe, quality, care are at risk!

Some states have passed nurse-to-patient ratio laws and have strong organized nursing unions enforcing them. But in far too many places, nurses have been afraid of such laws and hate the unions. Nurses will begin to see that hospital administrators, faced with huge reimbursement problems, are going to cut the nursing staff first and foremost because they have new found power to control the nurses.

Fearing the loss of jobs, benefits and retirement funds, nurses will buck up and work under the worst of circumstances once again. Out of a false sense loyalty to the patients they serve, nurses will martyr themselves and continue to try to provide the best care they can.

But what about the quality of patient care and safety issues, never mind putting their own license on the line because they are overworked and burned out? Then where does this loyalty to the patients they serve stand?!

This economic downturn is going to prove to be one of the biggest issues nurses have had to deal with in many years! It already is.

Nurses need to remain strong and stand up for the patients. There is data available to support the theories that quality of care diminishes, and people die when nurses are not supported.

Medicare, for one, has instituted many important reimbursement factors and continues to collect and analyze data regarding the quality of patient care. There are numerous “do not pay” rules that affect reimbursement for hospitals such as decubs, UTIs from catheters, and blood clots post op.

Medicare also maintains a database of hospital comparison based on specific criteria and outcomes which illustrate the quality of care (or lack of) provided in hospitals all across the U.S. This too is used by Medicare to determine reimbursement rates, and it is hoped that consumers will seek out this data and avoid these institutions when they have a choice in health care.

Nurses have the power to make a difference not only in the lives of the patients they individually care for, but also in the overall quality and safety in care they collectively provide. This power cannot be relinquished for fear of losing jobs in a bad economy. Nurses have a voice and cannot go silent!!

Institutions that value patients and continue to strive to provide quality care to patients continue to have nursing vacancies because there continues to be a shortage of nurses. Those institutions who don’t value quality patient care, probably don’t have many vacancies because they have cut staff to the bare bones and have a hiring freeze.

Nurses need to stand strong and work together to continue to demand better working conditions and not lose ground that has been hard fought to gain in the past 30 years by falling prey to those who value the dollar more than lives. There is a lot more to be lost than jobs.

By Kathy Quan RN BSN ©2009 by Ultimate Nurse.com ALL RIGHTS RESERVED
Kathy is the owner/author of TheNursingSite.com and the author of four books including The Everything New Nurse Book.

Home Health Nursing

Posted in Featured, Independent Contractor, Nursing, Nursing Jobs, Per Diem, Permanent Placement, Travel Nursing

Home Health Nursing

Have you ever considered home health nursing? Like any other nursing specialty, it’s not for everyone, but it can be a challenging and rewarding career option for the right candidate.

Not to be confused with private duty assignments in the home, home health nursing involves making several visits each work day to a variety of (at least temporarily) homebound patients.

These visits entail a complete head-to-toe assessment which can be brief or complex depending on the patient, the findings, or the physician’s orders. The visit will also include patent and caregiver teaching. Again the extent and complexity depends on the specifics of the situation. Each visit should build on the previous teachings and may involve some sort of return demonstration or pop quiz, if you will.

There may be a task to perform such as assessment and wound care, incision care, IV administration and/or site change, Foley catheter change, G-tube change, etc. The patient and/or caregivers may need specific instruction in the care of these as well.

Or the patient and caregiver may need in-depth instruction for a new diagnosis such as diabetes which would include such things as blood glucose monitoring, insulin or other medication administration, and how to identify and treat the signs and symptoms of hypo or hyperglycemia.

Patients and caregivers may also need instruction in medications including dose, administration, possible side effects, purpose and desired results. Other areas of common patient/caregiver education include specific dietary and nutritional needs or restrictions, and home safety issues.

Teaching caregivers how to safely assist patients with hygiene care (bathing, showering or a bed bath), transfers and ambulation may require the assistance of a PT or OT, but the home health nurse also needs to know how to perform and instruct in these as well.

Home health care is most often ordered by the physician following discharge from the hospital, or it may be ordered in lieu of hospitalization. In most instances it is not expected to be long term, but rather to help the patient and/or caregivers become independent in the necessary care.

For reimbursement purposes, Medicare and insurance companies have specific guidelines and criteria that patients must meet to be eligible for home health care. The home health nurse is responsible for reviewing this and documenting accurately. One of the worst parts of home health nursing is the paperwork! Much of it can now be done using a laptop or hand held computer, but there is still a lot of documentation to be done.

The nurse is the eyes and ears of the physician in the home. Many times home health referrals are made because the physician suspects that the patient needs more assistance or instruction in order to improve his/her outcomes. Or perhaps a higher level of care is needed.

The home health nurse learns to assess a home situation and to make recommendations for durable medical equipment (DME) and other disciplines to participate in the care such as a PT, OT or ST. A home health aide may be added to assist with hygiene care and to teach the patient and/or caregivers how to safely bathe and groom the patient.

If necessary, a medical social worker (MSW) may be called in to assist the patient and family in making more complex short term or long term plans for care, or help them to cope with life changing circumstances.

The beauty of home health care is being able to spend quality time with patients and caregivers one-on-one. But home health care is a team approach and the nurse is not expected to do it all.

It can be scary at times because there isn’t another nurse just down the hall to call for assistance or consultation. But there is backup a phone call away, and with cameras in cell phones, it can be even easier to get that consultation.

The autonomy and the ability to utilize skills that sometimes seem wasted in the fast pace of a hospital setting often draw nurses into the home health arena. Call a home health agency and ask to make a ride-along visit with a home health nurse to consider if this might be something you’d like to explore further.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the author/owner of TheNursingSite.com

©2009 by UltimateNurse.com. All Rights Reserved

Does Team Nursing work?

Posted in Featured, Nursing

The polite term for task allocation
On 11 August 2006, steven222, a Health Care Support Worker, submitted his view of team nursing:

Team nursing is the polite term for task allocation. It completely destroys all lines of accountability and responsibility as no individual nurse has both control of and responsibility for the care of any individual patient.

Team nursing consists of dividing the nursing workforce into two groups and then treating one group (staff nurses ) as too important ever to do any manual labour whilst treating the other group (HCSWs) as too gormless ever to do anything else. Then we go around looking puzzled at the fact that we don’t get on! It does however make for a good ideology to justify ignoring the patients call bell if you are a staff nurse.

Team nursing reminds me of the joke about the office where four people called Everybody, Nobody, Somebody and Anybody worked – Everybody thought that Somebody would do it ; Anybody could have done it but in the end Nobody did it. Each job and patient needs one nurse who IS responsible for them not four who might be.

Team nursing also means all HCSWs are permanently confined to basic tasks regardless of their level of knowledge and experience which will ensure that the good ones quit and only the timeservers remain. Team nursing does my head in. We need a national database of all wards which practise patient allocation and which practise bloody team nursing so we know which places to go and work and which to avoid like the plague!

Not a quick fix for understaffed wards
Andrew Heenan wrote this in 2004

There really is no quick and easy answer; there are so many variables; you could just as well argue “nothing works”.

A better question would be “How does it work”, followed by “(How) can I apply it my area.

Team nursing will not, by itself, improve morale or reduce staff turnover; but it can (applied appropriately in suitable environment) improve nursing care, which can then contribute to staff job satisfaction, then morale, then staff turnover.

If, for example, the nursing home is on two levels, then there is a good case for considering having a team for each level; staff would know where they’d be working each day, thus reducing instantly a major anxiety for some people. If one area is seen as ‘harder work’ then you could arrange to periodically rotate staff, or adjust staff numbers in each area. Such increased stability would lead to better staff understanding of the need for flexibility in the case of sickness, for example, rather than (for them) a random allocation with no continuity for them or the residents.

‘Geographical’ division is just one perspective; are there any other ways the resident group naturally divides?

There are other issues, such as skill mix and leadership – could it be practical to have two teams, but one leader (it would need to be a good leader!)

That’s just one scenario; it all depends on your local situation.

To me, primary nursing is the ideal, as I believe it offers the patient the best continuity and least potential confusion; team nursing – in practice – has almost always been about stretching resources, not really about improving anything.

In recent years, team nursing has increasingly involved RNs leading a team of untrained staff, whose ‘care’ the RN is accountable for. This means (of course) that the one person with nursing skills cannot actually use them, because of admin and safety responsibilities. The end of Real Nursing as we know it.

But primary nursing (in my view) cannot work in an under resourced unit, as the primary nurse and the relationship stand to ‘take the blame’ for the failings of the organization.

Personally, I prefer a ‘group nursing’ system; smallish teams, with primary nursing within the group – each member being associate nurse for the other nurses’ patients. This can reduce the number of individuals involved in each patient’s care, and can allow for mentorship and teambuilding within the group.

In fact, I don’t know of any system that is safe when nursing is under resourced – but while nursing models have had their reputation blackened by a plethora of time wasting jargon-ridden twaddle based on poorly researched undergraduate course work, promoting independence and involving significant others remains a “least worst” option.

When planning a system of nursing, there is never – ever – a ‘quick fix’.

Team Nursing CAN Work:
Ari Haytin, Student Nurse, UCSF, Submitted this 7th April 2007:

I would like to respond to the article that took the perspective that team nursing was more detrimental than beneficial. First the author believed that team nursing “destroys all lines of accountability and responsibility.” This can be the case if the unit is not a well-organized team. There are teams that people are enthusiastic and committed to being a part of and others where the morale is low and the members are not satisfied to be there.

The author’s experience of team nursing has been one of hierarchy and division, which is one way of organization, but it is important to be aware that there are other ways to organize teams. I am currently a nursing student that came from a counseling position in a community oriented public health clinic and never planned on working in a hospital partly due to the organization of many hospital units that lack a true team environment.

When I say true team environment I mean one that values all of the players on the team, that gives them all a voice and opportunities to grow and expand in their position. I have had the opportunity to observe many different units and truthfully to my surprise found that there are some units in the hospital that have amazingly well-organized teams. My first day observing at the Emergency Department the MD’s introduced themselves to me and welcomed me. The staff gave each other a lot of respect, trust and were there to assist one another when they needed it. I think this organization especially common in ICU and ED departments that have a high rate of success with their patients’ outcomes. I hope that some of the teams with low morale would look for ways of reorganizing their team instead of giving up on the team.