Nurse Safety

Rhode Island has officially become the first state in the United States to mandate flu shots for all healthcare workers, despite objections from unions and the local affiliate of the ACLU (American Civil Liberties Union). This means that all healthcare workers employed by hospitals, nursing homes, home care agencies, or any other healthcare organizations in the state will be forced to roll up their sleeves.

Of course, anyone who has a valid medical reason can be exempted from getting a flu shot. Employees can also refuse to get a flue shot by signing a document; however, these workers must wear a mask at all times when in contact with patients when flu activity is noted in the state.

Arguments Against

– The “Nanny State” argument: Our bodies and anything we put in our bodies should not be controlled by the government. Many people disagree that the government has any right to tell healthcare workers to get a vaccine that is potentially dangerous and could cause dangerous side effects. This argument seems to be the most commonly cited argument against getting an influenza vaccine. Health concerns aside, many people are firmly against the government forcing healthcare workers to get a flu shot, as a matter of principle.

– Ineffectiveness of the vaccine: Many of those against mandatory vaccination state that they do not believe the vaccination is effective in preventing influenza.

– Danger associated with vaccination: Many healthcare workers state that they became ill after receiving a vaccination at some time in the past, and so they have refused to get the vaccine ever since. Although serious reactions are rare, the fact that serious reactions do sometimes occur, even if very rarely, makes many people adamant that they will not get the shot and will not be forced into it by anyone, especially the government.

Arguments For

– Patient protection: We owe it to our patients to get vaccinated. In doing so, we protect those who are vulnerable (i.e., infants, the elderly, immunosuppressed individuals) and could potentially die should they come in contact with the virus.

– Herd immunity: When a large enough portion of the population is immunized against a particular disease, most members of the community will be protected because there is little opportunity for the disease to spread. Herd immunity protects the most vulnerable members of society and, as nurses, it is our duty to protect others.

– Role modeling: Many nurses state that, although they are not against the vaccine per se, they are against the vaccine for themselves. As nurses we are role models for others. When members of the community hear nurses speak out against influenza vaccination, it makes them less likely to get vaccinated, as nurses are respected as being knowledgeable about disease prevention.

– Vaccination reduces sick time: When nurses are immunized, there is less sick time, resulting in lower absenteeism, less overtime and less need to replace ill staff members. This could be an enormous cost-saving measure at a time when many organizations are struggling financially.

There are other arguments, but these arguments cover some of the biggest reasons for and against influenza vaccination. When it comes right down to it, we all have choices. Even the nurses in Rhode Island have a choice — they can get the vaccine or wear a mask when in contact with patients during the height of flu season. Getting the vaccine must be a personal choice for all nurses, one that many nurses struggle with every year.

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How are nurses portrayed in the media? A group of researchers decided to find out, by examining the YouTube database to find the most viewed videos for “nurses” and “nursing” as of July 2010.

According to this article on Nurse.com, out of 96 videos surveyed, about 40% of them presented nurses as smart, educated, and skilled. The rest of them presented nurses as “a sexual plaything and a witless incompetent.”

This was found to be in keeping with other forms of mass media portrayals of nurses. The study indicates that these stereotypes are not merely annoying; they can have a real effect on how patients interact with the nurses who are caring for them. Nurses are highly-trained professionals who play a crucial role in American health care, yet these portrayals trivialize what they do and who they are.

The study authors suggest that the nursing profession harness the power of YouTube to promote a more positive image.

Key findings of the study, which appears in the August issue of the Journal of Advanced Nursing, included:

• The 10 most viewed videos reflected a variety of media, including promotional videos, advertising, excerpts from a TV situation comedy and a cartoon. Some texts dramatized, caricatured and parodied nurse-patient and interprofessional encounters.

• Four of the 10 clips were posted by nurses and presented images of them as educated, smart and technically skilled. They included nurses being interviewed, dancing and performing a rap song, all of which portrayed nursing as a valuable and rewarding career. The nurses were shown as a distinct professional group working in busy clinical hospitals, where their knowledge and skills counted.

• Nurses were portrayed as sexual playthings in media-generated video clips from the sitcom Frasier, a Virgin Mobile commercial set in a hospital, a lingerie advertisement and a “soft news” item on an Internet videocast. All showed the nurses as provocatively dressed objects of male sexual fantasies and willing accomplices in their advances.

• The final two clips were a cartoon that portrayed a nurse in an Alzheimer’s unit as dim and incompetent and a sitcom that showed the nurse as a dumb blonde, expressing bigoted and ignorant views about patients and behaving in a callous and unprofessional way.

“Despite being hailed as a medium of the people, our study showed that YouTube is no different [from] other mass media in the way that it propagates gender-bound, negative and demeaning stereotypes,” Fealy said. “Such stereotypes can influence how people see nurses and behave toward them.

“We feel that professional bodies that regulate and represent nurses need to lobby legislators to protect the profession from undue negative stereotyping and support nurses who are keen to use YouTube to promote their profession in a positive light.”

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A new poll has found that 34% of patients who were hospitalized for at least one night in the past year said that “nurses weren’t available when needed or didn’t respond quickly to requests for help.”

The poll was conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

NPR was surprised at the findings and decided to find out more, so they put a request on Facebook for nurses to respond to the poll and provide their own stories. They received hundreds of responses, with stories about nurses feeling overworked, not getting enough breaks or even no breaks at all, and even barely enough time to go to the bathroom.

Most of the nurses who responded did not want to be interviewed for a broadcast, because they were worried about their employers’ reaction. Many were willing to be interviewed anonymously, though.

They conveyed a picture of being understaffed and overworked — even though the nursing shortage is considered to be over in most places, each individual nurse still has a whole lot on his or her plate.

“We’re always afraid that something will happen to our patients during the time we’re off the floor,” one nurse says, “and I personally don’t feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I’m off the floor.”

This nurse says she rarely stops. Not for 12 hours. She’s an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more — often eight, if she’s covering for a colleague taking a lunch break. She says there are times when she can’t leave patients’ bedsides.

“Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn’t harm them,” she says, “and I can see the call bell going off in the hallway, and there’s no way I could respond to that.”

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she “missed something.”

Another nurse likens her job to “spinning plates,” just “praying,” she says, that one doesn’t fall. “And these are human beings,” she says, “not products on conveyor belts.”

Stories like this suggest there’s a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that’s not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can’t find jobs.

“There’s not an actual nursing shortage,” Aiken says. “There’s a shortage of nursing care in hospitals and other health care facilities.”

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

“In part, it’s because our patients are sicker — coming to us with more intense diseases and disorders than they did 25 years ago,” she says. “In part, it’s because there’s so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health.”

That is terrific, of course, but it’s not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

“Nurses are the surveillance system in hospitals for early detection and intervention [to save patients’ lives],” she says.

According to one nurse, little clues from patients are critical.

“I mean, you might walk into a room, and they are breathing and answering your questions,” the nurse says, “but if you look at their neck and the jugular vein is slightly distended … taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast.”

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Nurses can expect the occasional outburst from a patient whether verbally or physically, but when violence or bullying comes from their co-workers, nurses may find themselves unsure of how to react. Horizontal violence is when some sort of violence comes from a peer, rather than a consumer or a supervisor. Victims of horizontal violence can experience psychological distress, and their workplaces can suffer decreased morale and a higher turnover rate. But why and how does the violence start? It is a mere dislike for a co-worker or a culturally imbedded phenomenon?

One theory suggests that in order to assimilate into a group, an individual first observes the behavior, attitudes and emotional reactions that the members of the group display, and the individual then mimics that behavior in order to be accepted. This pattern is also known as reciprocal determinism. In theory then, if the group engages in bullying a co-worker, the individual who wants to join the group will engage in the same behavior. It is not surprising then that at a 15-member meeting on nursing retention, all but one member could relate a first-hand experience of workplace bullying.

In a study led by Nancy Walrafen, MS, RN, OCN, respondents scored the top five behaviors considered bullying or workplace violence, and as witnessed as being done to others, as follows:

– Backstabbing – complaining to others about one individual (77.0%)
– Failure to respect the privacy of others – gossip or talking about others without their permission (76.0%)
– Nonverbal negative innuendo – raising eyebrows or face-making (72.2%)
– Bickering among peers (72.1%)
– Covert or overt verbal affront – snide remarks, withholding information, abrupt response (66.7%)

The most egregious behavior, undermining clinical activities (not available to help, turning away when asked for help), was witnessed by 50% of the respondents. If half of all nurses witness this behavior, how is it affecting patient outcomes or satisfaction scores?

One-third of the respondents reported that they had engaged in negative behavior because they had gotten caught up in the moment or the culture surrounding them. Some did not realize that the displayed behavior was considered bullying or workplace violence.

Nurse victims of workplace bullying often do not report the incidents. Reasons for this vary, from a desire to avoid making waves on a team that needs to maintain cohesion, to feeling that one more report won’t make a difference to supervisors or administrators who have been actively ignoring a problem.

In the study, respondents were also asked to contribute positive suggestions on possible methods for dealing with workplace violence and bullying in the nursing profession. Cultural awareness and appreciation for the differences and similarities was viewed as a possible solution, especially if hospital-sponsored continuing education credits on cultural awareness could be given. One respondent suggested practicing the golden rule of “do unto others” as no one wants to be treated negatively. One nurse offered that adequate staffing could reduce much of the stress on co-workers, giving them the opportunity to focus more on their own needs. All of the respondents agreed that all levels of management should work to address and solve the problem of horizontal violence in their workplace.

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Most nurses can expect to face at least one instance where legal representation becomes necessary in the course of their career. Although most healthcare institutions carry malpractice insurance for nurses and will provide their own in-house counsel or insurance counsel, there may be times when nurses feel they need their own private lawyer to protect their interests.

Generally, the amount of malpractice insurance an institution carries will suffice for protecting a nurse from personal financial loss, but in high liability areas of nursing practice, such as nurse midwifery and surgery, nurses should carry an additional policy. Several companies offer professional liability insurance and the Nursing Service Organization offers several types of insurance policies that are tailor-made for the nursing profession.

Two key instances where a nurse should always seek outside counsel are: 1) any time a complaint has been made with the state Board of Nursing, which includes notice of investigation by the Board of Nursing and, 2) any time a nurse has been given notice of being a named party in a lawsuit.

Patients and family members, upon filing a lawsuit, will name every person that has come into contact with the patient as a party to the action. Parties are discharged as the investigation uncovers which healthcare providers are most likely to have caused the alleged harm to the patient. The process can be upsetting and affect a nurse’s practice, but the investigation is a necessary element in the process of resolving the matter.

Nurses may also wish to retain counsel in matters concerning their employers. This can range from a simple review of a contract before hire, to more serious instances involving action taken by employers, supervisors and physicians. Situations in which a nurse should hire outside representation aren’t always clear however. Consider the following situations and advice from Medscape’s “Ask an Expert” before seeking your own legal counsel:

Forced overtime. Several states prohibit employers from requiring nurses to work overtime, but employers mandate the overtime just the same. Employers may threaten a nurse with patient abandonment, which can cause loss of the nursing license. A nurse should consult an attorney in this situation.

Inadequate staffing. Short staffing can lead to dangerous outcomes for patients, but in this situation, a nurse should first work up through the chain of command and bring the situation to the attention of supervisors and the director of nursing. It’s also good to do some background investigation of state laws for minimum staffing levels, which can add credence to the nurse’s case for proper staffing levels. If the facility is a Magnet hospital, it may also be in violation of the requirements to keep Magnet status.

Derogatory or critical supervisor. Derogatory statements can be actionable if they involve discrimination or harassment. A critical supervisor may focus comments more on the nurse’s job performance; these comments are more disparaging than discriminatory or harassing. In this case, the nurse must first examine the reason for the remarks. Is the nurse performing the job as outlined in the job description? If so, the nurse may wish to seek legal counsel who will determine if a cause of action exists.

Termination of employment. Getting fired is usually an emotional situation, but if a nurse believes that he or she was wrongfully terminated, then consulting legal counsel may help recoup financial loss.

Before hiring an attorney, nurses should investigate whether the attorney has experience in handling employment or malpractice issues. It can also help a lot to do some investigation of the applicable laws and regulations before contacting a lawyer — you may discover that the matter can be handled without legal representation, thereby saving hundreds and maybe thousands of dollars.