Thursday, 12 May 2022

Healthcare, Health Professionals, Nursing Skill, Nursing Responsibilities, Nursing Career, Nursing Professionals

Recently, a draft of a U.S. Supreme Court decision regarding Roe v. Wade was leaked to the press. The draft of the decision indicates that the court will overturn the previous decision that made abortion a constitutional right. This would allow individual states to create their own laws regarding the legality of abortion and restrictions limiting access to the procedure. 

What is Roe v. Wade?

Roe v. Wade is the name of the lawsuit that eventually made its way to the Supreme Court and led to a decision by the court to make abortion a right. “Jane Roe” was actually Norma McCovey, a 22-year-old unemployed single mother who sought an abortion in Texas when she became pregnant with her third child. She sued the state of Texas and challenged the state’s law that only allowed abortion when it was the only way to save the mother’s life. Roe argued that the law was vague and a violation of her constitutional right to personal privacy.

As the district attorney of Dallas County, Texas, it was up to Henry Wade to enforce the law and defend the state. Eventually, the Supreme Court had to make the final decision about whether the Constitution recognizes a woman’s right to end her pregnancy through abortion. Ultimately, the court decided in a 7-2 vote that the Constitution did protect a woman’s right to abortion, but that the government also had a responsibility to protect human life. As a result, the court concluded that abortions within the first trimester were legal.  

In the years following Roe v. Wade, there were many challenges to the decision. In 1992, the court issued another important decision in the case of Planned Parenthood v. Casey. Pennsylvania wanted to include a 24-hour waiting period in the abortion law. Another conservative court voted to protect abortion rights, but they also opened the door for states to implement their own restrictions.

Why is the Supreme Court Ruling on Abortion Rights Again?

The current case that is scheduled to be decided this summer is Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health v. Jackson Women’s Health Organization. In 2018, the state passed an act that bans abortions after 15 weeks, which is significantly earlier than the 24-28 week standard outlined in Roe v. Wade. The Jackson Women’s Health Organization sued the state and two courts have already declared the law unconstitutional. However, the Supreme Court decided to review the case.  

While it can be difficult to wade through all the legalese, essentially, a decision to uphold the law would undermine both the Roe v. Wade and Casey decisions. Similar laws have been struck down in other states, but the recent leak of the decision draft revealed that the court plans to rule in favor of Mississippi.   

What Would a Roe v. Wade Reversal Mean for Nurses?

Nurses, along with other medical professionals who provide abortion services could find themselves being legally targeted by state laws. For example, a Texas law that is already on the books allows people to file civil lawsuits against providers. Alabama is also looking to enact a law that would hold physicians criminally responsible with a maximum sentence of life in prison. Essentially, a medical procedure that has been legally performed for decades could now put medical professionals in both civil and criminal danger and the laws and penalties would vary from state to state.

In many cases, nurses are the first point of contact and information for patients looking for information about reproductive health. As part of their own education, nurses are trained to provide comprehensive information and care to each patient. More restrictions around abortions have the potential to create a barrier that would prevent nurses from fully and safely executing their responsibilities.

What Would a Roe v. Wade Reversal Mean for Healthcare?

If the Supreme Court declares the right to physical autonomy is not an innate human right and not protected by the Constitution, then states would have the authority to decide their own laws and restrictions. Currently, 13 states have already passed “trigger laws” which would ban abortions the moment Roe is overturned. Inversely, 17 states along with Washington DC have taken steps to protect abortion rights.     

With different states and jurisdictions implementing different laws and restrictions, it is going to create a confusing landscape for healthcare providers to try and navigate. Some anti-abortion states are making sure that doctors won’t be able to transfer patients to other states to receive the procedure. If they violate the law, they could face a variety of consequences that would include taking away their ability to practice medicine. Ultimately, the healthcare system and providers will be facing a legal minefield.  

What Has Been the Public Response?

The American Nurses Association, American Medical Association, and the U.S. Department of Health and Human Services are just three major organizations that have made public statements in support of everyone’s right to make personal and private decisions about their reproductive health. As you might expect, people are taking to social media to share their own stories and opinions about this divisive topic.

TikToker Rocio Castillo posted a video talking about her own experiences saying, “I'm a woman who's had two abortions. It was hard, but I don't regret it." 

On Twitter, @allycatra87 asked “Overturning Roe v. Wade will not eliminate abortions. It will eliminate safe abortions. How many people will be injured and die because they couldn't choose their own path?"

While the leak regarding the Supreme Court decision was technically only a draft, it has set off a firestorm on all sides of the issue. The final decision won’t be handed down until the end of June or early July. Until then and well after, nurses, healthcare providers, elected representatives, and the public will be continuing the fight; both for and the right to make personal decisions regarding reproductive health.


Sunday, 10 April 2022

COVID-19, Nursing Degree, Nursing Degree US, Nursing Exam US, Nursing Professionals, Nursing Responsibilities, Nursing Skill

Healthcare workers throw around the term triage like seasoned Italian bakers throw around pizza dough, but many laymen do not understand the full extent of the triage process. The word triage originates from the French word “trier” which translates into English “to sort.” One of the first documented occasions of a medical triage system occurred during the Battle of Jena in 1806 when the lead physician categorized people into three groups to assess who required the most urgent evacuation from the battlegrounds: dangerously wounded, less dangerously wounded, and slightly wounded. The physician that developed this system also takes credit for being the first to utilize ambulances, or horse-drawn buggies with a medical team, to expedite care. 

Triaging has always been a critical part of war medicine, but the priorities for triaging during battle or massive casualty incidents have a slightly different goal than the typical emergency department triage system. Rather than trying to save the sickest people first, they focus on saving as many people that have a higher likelihood of surviving and going back to being active soldiers in the war. Modern-day mass casualty triage systems are categorized by color:

◉ Black (dead)

◉ Red (immediate)

◉ Yellow (delayed)

◉ Green (minimal)

As an emergency nurse, I have thankfully never been directly involved in a mass casualty incident such as the shootings in Las Vegas or Orlando in recent years. However, I have been a part of scenarios in which we were given a “heads up” by local law enforcement that an active shooter was in the service area of the hospital. We were instructed to start preparing for potential “mass cas” patients. In this case, the charge nurse designated one nurse as the triage nurse that would stand out in the ambulance bay and have the job of triaging by color and making the decision of which patient should receive which level of care. This horrendous scenario goes against everything that we stand for as nurses when you have to make the call that someone might be too injured to even attempt to save their life; when the resources could be allocated to save four other lives instead. 

More often, though, the triage system plays an active role in every Emergency Department each time a patient walks, or wheels, through the doors. 

In America, the standard triage system is called the ESI, or Emergency Severity Index, and is a number system from 1 to 5 with 1 being the most critical, and 5 being the most non-acute. An ESI level 1 means that the patient requires “life-saving measures” and needs treatment immediately. A patient scored a 2 indicates that the patient has a high-risk scenario or could have vital signs that are in the dangerous category. Nurses dictate levels 3 to 5 based on the number of resources the patient is going to require which include radiology tests, blood work, medications, procedures, or EKGs. Patients that require multiple resources are level 3’s, 1 resource are level 4’s, and no resources are level 5’s. This numeric system helps indicate which patients in a crowded waiting room should receive the first room once one opens up, and helps physicians see who might be the highest risk and should be evaluated first. 

Acting as the role of a triage nurse on a busy day can leave you with exhaustion that differs from working a typical assignment in the ED. You have one of the highest liabilities within the department because you are responsible for deciding who sees a doctor first, and who can sit and wait for four more hours. If you make the wrong decision, a patient could be sent back out to wait and have a fatal event while someone else was seen before them. Sometimes working in triage feels like a long game of twenty questions; a good nurse needs to be experienced enough to know which questions to ask that will help them decide how sick they might actually be. 

Working in a triage room for twelve hours can provide some of the most comical stories since you get to hear a little bit about every patient’s problems that day. The line of “Sir/ma’am, what brings you into the Emergency Department today?” gives a wide-open arena for patients to fill in the missing space with their choice of stupidity. In many ways, wearing a mask for the past two years has been extremely helpful in hiding my reactions as patients begin to explain the reason for their ED visit. Responses such as “I just tripped and fell onto the soda bottle and it is stuck, well you know where,” to “I just was minding my own business, and someone came and stabbed me,” to “I have this toenail, and there is a part of it that is about to fall off,” are all statements I have heard, and the challenge to remain non-reactionary can be a true struggle. 

The job is complex. You become the gatekeeper for the department and are often placed in a tricky situation when a family member knows their loved one is in the department, but they are either critically ill or might not want the family back, and the triage nurse has to take the wrath from the family about not being allowed back. On busy days, the triage nurse constantly has to deal with sick, hurting, and often grumpy patients who have been waiting for hours and hours to be seen, and the toll weighs on you both physically and emotionally. It is a mixture of customer service and being the face of the department, as well as implementing astute medical knowledge and assessment skills. The triage process is much more complex than many people might expect, and triage nurses often go unrecognized by patients as playing such a vital role in patient safety. 

Hopefully, patients will change their response from “why did they get to go back before me, I have been here for two hours already,” to “thank you for saving lives and asking the right questions to help the entire community out.”


Saturday, 2 April 2022

Nursing Responsibilities, Nursing Professionals, Nursing Career, Nursing Skill, Nursing Practitioners

End-of-life decisions may be amongst the hardest decisions any family member might have to make for a hospitalized loved one. But with the proper advanced health care directives, it can make those decisions easier and less confusing. Unfortunately, most patients do not have advanced directives, especially those in the younger generations. The reality is that unless someone has a terminal illness or works in healthcare, they may not even know what an advanced directive is. 

MIDEO Card is changing the conversation. 

A revolutionary new app, MIDEO Card which stands for My Informed Decision on VidEO, is a video advance directive as well as a video medical order for life-sustaining treatment. The video is in the patient’s own words and has been formulated to translate all wishes into medical provider understanding.

What is an Advanced Directive?

Generally, advanced directives are done via a paper form that can be filled out in the hospital or online and printed. These forms discuss life-sustaining medical treatment and prolonging life. 

According to the American Cancer Society, “life-sustaining medical treatment is any medical intervention, medication, or anything mechanical or artificial that sustains, restores that would prolong the dying process for a terminally ill patient.” These may include : 

◉ Breathing machines

◉ CPR (cardiopulmonary resuscitation) including use of an AED (automated external defibrillator)

◉ Medications such as antibiotics

◉ Nutrition and hydration (food and liquids) given through feeding tubes or IVs

Once an advanced directive has been filled out it then needs to be given to your healthcare provider and placed into your health file. This can be problematic, especially in the case of an emergency. If an advanced directive is completed at home and never given to the primary healthcare team, it is possible that no one will know a patient’s true end-of-life wishes. Furthermore, if the patient is taken to a  hospital out of state or not associated with their primary healthcare provider, then there will not be accessible to the advanced directive.

This is problematic. 

MIDEO eliminates this by creating a digital footprint for the advanced directive and allows all providers access to it regardless of the healthcare system or state. It’s all done with a QR code and smart device. 

According to a 2017 study, of 795,909 people in the 150 studies analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. The proportions of terminal individuals to healthy individuals were similar. Based on this large study as well as others, it is evident that end-of-life discussions are essential to properly care for patients. 

“Improving end-of-life care has been a national conversation for some time now, presumably because it will affect all of us at some point and is a very personal matter,” said senior study author Dr. Katherine Courtright of the Fostering Improvement in End-of-Life Decision Science Program at the University of Pennsylvania in Philadelphia.


MIDEO is designed to allow patients to directly speak their wishes with a representative and is stored on a digital identification card.

MIDEO takes the planning and consultation out of the hands of the hospital and hospital healthcare providers. MIDEO has a team of healthcare specialists that work with patients to find the options that are not only personalized but also the best for them and their loved ones. 

As hospitals continue to feel the strain of the ongoing pandemic and nursing shortage, there are fewer and fewer resources dedicated to informing patients about advance directives and end-of-life decisions. MIDEO is helping to remove the strain. 

Currently, there are three options available for MIDEO Card. Each provides a personalized virtual meeting with a specialist to discuss all aspects of advance directives and end-of-life wishes. 

Essential Package (designed for healthy individuals):

◉ Includes a standardized guided process with a Qualified Healthcare Professional to create your safety statement

◉ 2 Copies of the Identification Cards.

Vital Package (designed for individuals with multiple medical problems or ages 60 & above):

◉ Includes a guided process and detailed healthcare evaluation with a Board Certified Physician to create your safety statement

◉ 2 Copies of the Identification Cards.

VIP Healthcare Concierge Advocate (designed for Individuals (e.g.: those with cancer) Who Require Navigation Through the Complex Medical System Who Have Specific Goals to Be Achieved): 

◉ Includes the Vital Package, but also includes a designated Concierge Physician Advocate who will be available to assist and provide guidance 24 hours a day.

While there is a fee associated with the use of MIDEO Card, most major health insurance plans including Managed Medicare and Medicare with supplemental insurance plans have covered the cost of MIDEO in full or for a small co-pay.  

As of January 1, 2016, Medicare-approved billing codes allow individuals to receive Advance Care Planning Education & Counseling. Commonly, this is considered the end of Life planning or counseling.        

How It Works?

According to the website, the MIDEO video is accessed by any type of smart device including a smartphone and/or tablet. The camera feature scans the QR code technology on the MIDEO ID card of the patient. The video is then quickly retrieved within seconds in a safe and secure manner. 

MIDEO suggests informing all healthcare providers of the QR code and having it stored in your patient file so that it can be accessed immediately if needed. 

The video aspect is essential to the success of MIDEO and the future of advanced directives and end-of-life planning. Because many states allow individuals to complete advanced directives online without assistance, it is possible that individuals do not fully understand the choices presented to them or that they can make their own that are listed. 

“As I like to say, the form is only as good as the conversation and the shared understanding that goes along with it,” said Dr. Rebecca Sudore of the University of California, San Francisco School of Medicine who wasn’t involved in the study.

“Some people do fill out these forms with families or lawyers, and then the forms sit in the dusty recesses of a back drawer and they are not available or shared with family and friends, especially before they are needed,” she told Reuters Health by email.

As Americans live longer, especially with chronic medical conditions, and healthcare continues to make advancements against the fight of once terminal diagnoses, it is essential that individuals make their end-of-life wishes known to not only their families but also to their healthcare providers. MIDEO Card takes away the guesswork. It leaves a lasting gift to families and loved ones having to make difficult decisions. 


Wednesday, 23 March 2022

Travel Nursing, Nursing Responsibilities, Nursing Professionals, Nursing Career, Nursing News, Nursing Exam US

It’s no secret that there has been a disparity in agency nurse and staff nurse wages over the past year and a half. And the disparity is becoming increasingly bigger as the weeks pass by. Travel nurse pay has never been higher since the pandemic started, with August numbers showing a weekly average rate of over $2.5K, compared to a December 2019 average weekly pay of just over $1K. And as staffing issues continue to plague the entire country, they show no signs of slowing down.

However, in an attempt to stop the ballooning wages—and perhaps better balance the gap between staff and travel nurse pay—some states have introduced legislation to cap agency nurse pay. As you can imagine, the idea has a lot of people talking, so here’s more on what the legislation is proposing, and how nurses are responding. 

State and Federal Moves

During the pandemic, there have been both state and federal moves towards enacting legislation specifically aimed towards more regulation for staffing agencies and limiting travel nurse pay rates. Most recently, the American Health Care Association/National Center for Assisted Living, LeadingAge and a coalition of long-term care and senior living organizations sent a letter to White House officials warning against the “price gouging” happening in staffing agencies and how the practice is harmful to both patients and providers, who receive fixed reimbursement primarily through Medicare and Medicaid. 

That letter was followed by another one, signed by 200 supporters, urging Congress to enlist federal agencies with competition and consumer protection authority to investigate the conduct of nurse staffing agencies to determine if it is the product of anticompetitive activity and/or violates consumer protection laws. The letter cited that nursing staffing agencies are sometimes taking as much as 40% of the fee collected from hospitals, adding that continuing to pay the high fees to staffing agencies is “ simply unsustainable.”

Supporters behind the movement to cap travel nurses’ pay say that the pandemic has thrust the need for more requirements for staffing agencies into a major spotlight and that ignoring the financial and regulatory issues brought on could lead to long-term impacts. 

Nationally, the American Health Care Association (AHCA) sent a letter to the Federal Trade Commission (FTC), urging the FTC to use its authority to protect consumers from anti-competitive and unfair practices regarding agency staffing. Statewide, Massachusetts and Minnesota are the only two states to already have agency wage caps in place, but some states did make initial moves to address high wages during the pandemic. (Although, notably, Massachusetts raised its caps by 35% for the amount agency staff for nursing homes could be paid during the pandemic.) In Minnesota, wages were also raised, but only slightly: agency RNs can make a max of $58.08/hour at regular pay and up to $99.90/hour for holiday pay. 

Other states have tried to make some kind of moves towards regulating staffing agencies. For instance, with the advent of the pandemic, Connecticut prohibited profiteering during emergencies, with violators subject to fines by the state Department of Consumer Protection and the Office of the Attorney General. The New York State Health Care Facilities Association has also tried to introduce legislation but has not been successful yet. So far, Pennsylvania is the only state that appears to have the most concrete plan in place for moving forward with legislation specifically aimed at regulating staffing agencies. 

What the Legislation Says 

Although the legislation in Pennsylvania hasn’t been formally introduced yet, Pennsylvania Representative Timothy R. Bonner wrote a memorandum on November 5, 2021, that he plans to introduce Pennsylvania Health Care Association (PHCA)-supported legislation that will “require Contract Health Care Service Agencies who provide temporary employment in nursing homes, assisted living residences and personal care homes to register with the Department of Human Services (DHS) as a condition of their operations in Pennsylvania.”

As part of the requirements, the proposed legislation would establish maximum rates on agency health care personnel. Bonner noted that nursing homes in Pennsylvania lost 18% of their workforce, with 68% of the state’s facilities struggling to meet minimum staffing requirements. As a result—like many other healthcare facilities in the nation—agency staff filled those needs. However, in his memo, Bonner cited a statistic that 39% of the surveyed facilities said that they would not be able to afford to keep their facilities open for more than one year. 

Part of that, he added, was the added cost of paying staffing agencies. In some cases, wages have ballooned to over 400% above the median wage rate for long-term care facility staff. Additionally, some of the facilities themselves have lost their own staff to travel agencies. And because long-term care facilities are funded primarily through Medicare (70% of all care in the state’s facilities are through the Medicare program), paying high agency staff wages has significantly drained Medicare funds as well.  

Although the legislation would incorporate a cap on agency pay, it also aims to allow state agencies oversight of supplemental health care service agencies, which they currently do not have. That would include everything from registration requirements to an established system for reporting and penalties. 

“Recognizing the increased role that these agencies play in the day-to-day operations of nearly 700 nursing homes and 1200 assisted living residences and personal care homes, we must ensure they are operating in a manner that supports the long-term care sector and high-quality resident care,” Bonner wrote. 

What Nurses Think

As you can imagine, travel nurses have something to say about this legislation. In a travel nursing group on Facebook, over 270 comments poured in during a discussion on travel nurse wage caps. 

Some nurses hinted that they would strike if legislation capping pay came to pass, while others warned that there would be no need for a formal strike--travel nurses could simply not pick up new assignments, making staffing shortages even worse. 

“I have just had my best year ever. I could easily sit out for 6 months or change careers,” wrote one nurse. “They do not want to screw around with nurses right now. It is curious that people making legal policy don't possess the professional credentials to do our jobs but believe that they know better than us anyway,” this nurse added. 

Other nurses pointed out that a wage cap could potentially put both patients and healthcare facilities at risk amidst another COVID-19 surge or even another health emergency. “If they try to cap RN pay, what will happen if there’s another COVID surge,” commented another nurse. “Let’s say they cap our rate at 5K, if there’s another surge they will most likely not get much RN’s wanting to help. So they better tread lightly otherwise they will have bigger problems in their hands. A severe nursing shortage.” 

Another commenter chimed in to agree with Celne: “Right?” wrote a nurse. “If they cap, why would anyone want to go help with surges. I’m not going into a hot mess doing more work when I can stay capped right where I am for less work.” 

There is also a petition circulating online as a result of the letter to Congress that aims to stop the efforts to cap travel nurses pay. “We all know that wage caps are going to have a detrimental effect on staffing, forcing even more nurses to give up working at the bedside and further worsening the problem at hand,” the petition reads. “What about encouraging legislation to protect the safety and rights of nurses? What about legislation to nationalize safe nurse-to-patient ratios? What about legislation to set a fair, competitive minimum pay for nursing? Reach out to your elected officials and voice your concerns. There are many solutions out there, but this isn't one of them.”  

It’s left to be determined exactly if the legislation will pass and what the possible ramifications could be for both the travel nursing industry as well as the ongoing nursing shortage.


Saturday, 19 March 2022

COVID-19, Nursing Responsibilities, Nursing Professionals, Nursing Skill, Nursing Exam US, Nursing Degree, Nursing Degree US

In a major move that signals just how far we have come in the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) announced drastic changes to its facial mask recommendations for a majority of the country on Friday.

Using data available from hospitals and public health departments, the CDC announced that nearly 70% of the country is considered “low-risk” for COVID-19 transmission which means they can ditch wearing a mask in indoor settings.

What the New Guidelines Mean

The new guidelines use the CDC’s COVID-19 Community Levels (you can check your community’s risk in the link) to determine their recommendation for using a mask indoors. They also use data that assesses how many hospitalizations are in the area along with available hospital beds to determine risk. Under the new guidelines, the hospitalizations and available beds are utilized more than the rate of new infections.

The risk levels go by color:

◉ Green = low risk. People in areas with a low risk are advised to wear a mask as they feel comfortable, based on their own personal preference.

◉ Yellow = medium risk. People who are immunocompromised or at high risk for getting severely sick are advised to wear a mask indoors.

◉ Orange = high risk. The CDC recommends that all people, regardless of vaccination status or personal risk, wear a well-fitting mask indoors. This includes K-12 schools and other community settings. 

The CDC also recommends that certain people and in certain situations, mask-wearing should continue. For instance, anyone with disabilities, anyone traveling, and anyone who is sick or caring for people with COVID-19 should continue to wear masks indoors. Additionally, the CDC continues to recommend masks on public transportation. However, the CDC does not require masks be worn on either private or public school buses, although schools may elect to put mask mandates into place. 

Why the Change?

The change has happened in response to a few different factors: rates of both new COVID cases and hospitalizations have plummeted in the last few weeks and a large majority of Americans are vaccinated, boosted, and yes, previously infected. Additionally, health leaders have agreed that the way we need to treat the pandemic has shifted as well.

Earlier in February, Dr. Fauci explained that COVID will never be eradicated, and even while the “full-blown pandemic phase” of the virus comes to an end, the virus will most likely live on as an endemic. In other words, COVID is here to stay and we need to learn to live with it.

Part of how we learn to live with it involves taking things like mask-wearing to the local level, based on both personal risk (for people who may be immunocompromised, for instance) and community transmission, as well as available hospital resources.

"We want to give people a break from things like mask-wearing," CDC director Rochelle Walensky explained at a news briefing announcing the shift. 

But the agency also explained that basing mask recommendations on community risk and hospital strain allows for changes as needed. In other words, if COVID transmission picks up again—or hospitals become strained under a surge—your area could shift from low-risk to high-risk, meaning masks may be recommended once again. 

“As the virus continues to circulate in our communities, we must focus our metrics beyond just cases in the community and direct our efforts toward protecting people at high risk for severe illness and preventing COVID-19 from overwhelming our hospitals and our health care system," Walensky added. 

Leading nursing organizations like the American Nursing Association (ANA) have yet to respond to the updated mask guidelines. On social media, people have expressed confusion over how a decrease in masking could affect high-risk individuals who may have even less protection if others around them aren’t masking, as well as children who are too young to be vaccinated.

“I appreciate the push to take us back to some modicum of normalcy, I just wish it was not until all people who can be vaccinated are (little kids for example) and national mortality rates fall within one standard deviation of the pre-Covid average,” commented Sarah Kahn on Facebook.

What About Healthcare Professionals?

So if mask mandates are being dropped left and right across the country, does that mean that nurses don’t have to wear masks anymore?

Not exactly. The CDC is clear on this one: the new guidelines do not apply to healthcare workers. The CDC’s website states: “CDC’s new COVID-19 Community Levels recommendations do not apply in healthcare settings, such as hospitals and nursing homes. Instead, healthcare settings should continue to use community transmission rates and continue to follow CDC’s infection prevention and control recommendations for healthcare settings.” 

Considering the fact that hospitals and healthcare settings contain both a potential for high transmission and immunocompromised individuals who could become severely ill if infected, it’s expected that universal masking for healthcare workers is here to stay. Additionally, nurses and healthcare professionals can expect to be required to wear an N95 when caring for patients with active COVID-19 infections.

Masks may be here to stay, but as nurses, we can look at the bright side: it will make dealing with unpleasant smells a whole lot easier, right?


Wednesday, 16 March 2022

Violence against healthcare workers, especially nurses, is not a new conversation. In fact, the conversation has recently been highlighted as over the course of the last three years there have been an increasing number of attacks on nurses. Isolation, ever-changing mask, and quarantine rules have made healthcare workers prime punching bags for the frustration that patients have felt, especially since the start of the pandemic in March 2020.

Violence against nurses is the true epidemic

Most recently at Ochsner Health System located in New Orleans, Louisiana, an ICU nurse was attacked and knocked unconscious inside a hospital. The nurse suffered a broken jaw and broken teeth that required surgery, according to authorities. A nurse was attacked by a patient visiting a family member. Specific details surrounding the attack still remain unknown but thankfully after a $12,500 reward, $10,000 from the hospital, was offered as well as extensive media coverage, the suspect was arrested and charged for the brutal attack.

"Workplace violence in any form — physical, verbal, non-verbal or emotional — is unacceptable, and we will not tolerate this behavior," Ochsner President and CEO Warner Thomas said in a statement released by the hospital.

Louisiana Takes Action

While the assault on anyone is a crime in all 50 states, for some reason assaults against nurses and healthcare providers seem to go either unreported, unfounded, or the attacker is not caught. In the case of the ICU nurse at Ochsner, assault charges were filed; however, this is not always the case. 

Despite the arrest, this assault should never have taken place and Oschner as well as the state of Louisiana are doing everything in their power to stop violence against healthcare workers. Oschner’s CEO is personally invested stating, “workplace violence against healthcare workers has been escalating throughout the pandemic and has reached a point that legislation needs to be considered to make this violence a felony. This consideration under review by a Louisiana task force comes as U.S. hospitals grapple with an increase in disruptive or violent incidents in hospitals — many involving hostile visitors – adding further stress to the healthcare workplace.”

The Healthcare Workplace Violence Tasks Force in Louisiana led by Ahnyel Jones-Burkes, DNP, is helping to make changes to the conversation regarding violence against healthcare workers. 

“No one should be afraid to go to work especially when they’re providing care for patients, especially in a pandemic setting,” said Jones-Burkes.

As a result of the uptick in recent attacks, the task force which includes not only healthcare professionals but also law enforcement representatives approved recommendations for the Louisiana Department of Health.

One of the recommendations is that healthcare settings post signs warning that abuse or assault of health workers is a serious crime.

An additional recommendation requires health care systems to report violent acts against their staff that occur on their property within 24 hours to the appropriate authorities.

“My personal philosophy would be that all of these need to be reported within 24 hours,” said Karen Lyon, Ph.D., a member of the task force.

Jones-Burkes said, “We settled on 24 hours, so that was a big step for us because right now the way it’s set up a victim has to report and after you’ve been assaulted, or something has happened maybe that’s not the first thing that you are thinking that you are going to do.

While these actions may seem small, they are a step in the right direction. It provides guidance to healthcare systems as well as staff. Furthermore, it gives reassurance to staff members that all assaults will be taken seriously and appropriately reported. 

Underreporting, which is the cause of most violent assaults, is a common occurrence for fear of retaliation. Most assaults are not reported to the authorities or even the hospital management. 

White House Support, Stalled by the Senate

In spring 2021, the U.S. House of Representatives passed the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195). The bill, which passed the House with full bipartisan support, would require healthcare and social service providers to develop workplace violence prevention plans. Furthermore, all employers would have to provide additional training to staff members and submit annual reports of violent incidents to the U.S. Department of Labor.

The White House said it supports the bill. Unfortunately, the bill has yet to be voted on by the Senate. 

This bill, while not going to stop all violence, is a HUGE step in the right direction. It provides clarity regarding the measures that need to be taken to help prevent healthcare workplace violence. However, until it is passed by the Senate the aforementioned prevention plans, training, and annual reports will not occur. It is crucial that the Senate vote on the bill but at this time there is no clear date for discussion.


Tuesday, 15 March 2022

Travel Nursing, Nursing Responsibilities, Nursing Career, Nursing Professionals, Nursing Degree, Nursing Degree US

There have been many days after working a twelve-hour shift that I have left feeling like a failure.

And to be quite frank, it has nothing to do with my own ability or actions, but it is often a result of a systemic failure of unsafe staffing on not only the unit but for the entire hospital. I have worked so many shifts prioritizing and juggling a to-do list longer than a mother-of-four’s grocery list. The physical and emotional fatigue of constantly living in sympathetic response slowly breaks nurses down. 

It is a horrible feeling to realize that a patient had to sit in their wet briefs, had to wait hours for pain medications or even started to decompensate without anyone noticing because I had been stuck in a room of an actively dying patient. In those moments how do I choose where to be and which patient needs me more? Ultimately, I shouldn’t have to, there should be someone to help with my other patients but there isn’t. Our country has been dealing with safe staffing issues for decades, and the pandemic has only exacerbated an already detrimental problem. 

After spending 5 years as a travel nurse and experiencing hospitals in 11 different states, I am personally familiar with the large discrepancies within the staffing ratios across our country. Depending on the hospital’s normal ratios, the role can feel like two completely different jobs entirely. I have worked in Emergency Departments where I was responsible for 9 different patients at a time, but I have also worked in hospitals where I have only had to care for a max of 3 patients at any given time. That means that just based on hospital location and management, I essentially have had to work the role of three nurses. 

One of the most shocking details of this scenario that onlookers from outside the medical field do not realize is that even though nurses in the states with higher ratios essentially do the work of three nurses, they oftentimes get paid even less than the hospitals with smaller ratios. As a general rule, the west coast far surpasses the east coast in terms of safe staffing as well as pay. With a higher concentration of nursing unions (specifically California) and legislation that supports safe staffing, the west coast, as a generic blanket statement, provides some of the most ideal working conditions in terms of staffing ratios. Although nursing wages fluctuate nationally based on the cost of living, it remains mind-blowing that our country will not implement national standards for staffing demands. 

I will never forget the moment when I became so overwhelmed with my patient load, that I just stood in the hallway, gazed at all of my rooms as the list of tasks I needed to complete scrolled through my head like the beginning of Star Wars. At that moment I thought to myself, “who is going to die first; because I certainly can’t keep all of them alive right now by myself.” 

It was a November day and I was working a mid-shift, and the day started out like many of them did at that hospital. Chaotic. This was my very first travel assignment and I felt unsure of myself in so many ways, and insecure about what “normal” was. I didn’t want to complain, because maybe this is how all hospitals in the country function, and my first job was some diamond in the rough that only had a 4:1 ratio instead of a 7:1. 

I was responsible for four rooms and three hall beds. My first sick patient to arrive was morbidly obese, experiencing massive cardiac problems, and we had to call anesthesia to intubate him due to his large habitus. I was giving cardiac meds I had never hung before through a single 22G IV in his chest, and the physicians wouldn’t take the time to put a central line in him in the ED, because they wanted to let the ICU residents do it. Unfortunately, I couldn’t advocate for them to place one in the ED.

Approximately 30 minutes after his arrival, they put an elderly lady experiencing a stroke next door. We ended up hanging TPA which normally would have required a nurse to stay with her for at least the first hour, but we didn’t have any additional staff to come help. So, in between all of my NIH’s, I would peek in next door, secure the soft restraints a bit tighter and crank the sedation as high as I could, and just pray that both of them were stable enough to safely make it upstairs when the time would allow.  

But, then I got a call about 45 min after her arrival from the charge that said “Hi, sorry but you have the last available room. I’m sending you an LVAD patient in V-Tach to your last room.” 

This was the moment. 

This is when I looked down the hall and wondered which patient’s care would be so horribly mismanaged that I might unintentionally kill someone. Not only did I have three patients that a lot of hospitals would dedicate one nurse to each of them, but I also had the additional four patients that I hadn’t even looked at in hours. 

Unfortunately, this enormously unsafe scenario is not a rare scenario, especially given the current events over the last several years and nurses leaving the bedside at an unprecedented rate. ICU nurses have been forced to often double and triple their normal patient load, and floor nurses have been asked to do dramatically more work for more patients with even less payout and resources. 

The saying “safe staffing saves lives” not only applies to patient lives but also directly relates to helping preserve as many nurses at the bedside as possible. Thankfully crisis travelers and additional government funds have helped decrease the load on many hospitals, but they are only a temporary fix that allows the staff to come up for a few gasps of air, but as soon as they leave, the staff returns to their drowning. Staffing issues will continue to be one of the most concerning problems in the field of nursing for years to come, and I can only hope and pray that my fellow nurses will find relief quickly. 


Monday, 14 February 2022

Nursing Skill, Nursing Job, Nursing Responsibilities, Nursing Professionals, Nursing Degree, Nursing Roles, Nursing Staff

Finally, a big change is coming for the nursing industry. Is it safe staffing ratios at last? How about an increase in pay for the staff nurses that have endured literal years of a worldwide pandemic? Protections for nurses at work and policies that don’t require them clocking in while infected with a dangerous virus?


It’s Uber for nurses. Yup, that’s right.

Instead of policies at the leadership level that could enact positive and lasting change for both current and future nurses, there is a push to introduce legislation that will make nurses independent contractors working in an “on-demand” fashion with hospitals and facilities as they are needed. But some are concerned the move could further exploit nurses and negatively impact the travel nursing industry especially. 

Here’s what nurses need to know about the movement towards making RNs independent contractors. 

How it Works

It would work like this: instead of being hired by a standalone staffing agency, nurses could become independent contractors and get hired directly by hospitals on an on-demand basis. For instance, the app CareRev is already offering this service. According to CareReve’s website, the platform is one that “seamlessly connects healthcare facilities and local, flexible healthcare professionals.” A facility posts open shifts and then healthcare professionals can book the shifts directly from the app, without any staffing agency, contracts, or max or minimums involved.  

Because the healthcare workers that use the service are acting as independent contractors, that also means that they will have zero protections or benefits from either the facility they work at or a staffing agency. The nurse as an independent contractor is then responsible for:

◉ Deducting and paying their own taxes

◉ Purchasing all insurance coverage, including health insurance, other medical insurances, and liability insurances

◉ Setting up their own retirement plan

Additionally, the nurse may not have access to any employee-only benefits or services, such as mental health or wellness resources, educational benefits, and training. Some reviews of the app have also warned that there are no placement protections and nurses have been placed in unsafe staffing conditions and working placements outside of the scope of their practice. 

On the flip side, some nurses have raved about the flexibility the app provides. It doesn’t require signing with a travel agency, they can book shifts only as they want or need them, and if they aren’t in need of benefits, it’s an easy way to make their own schedule and build the income that they want. 

The Legislation

With the advent of apps like CareRev and other nurse-for-hire services popping up, California has introduced legislation to legally declare that any nurse or healthcare worker using digital services to book shifts be classified as an independent contractor. The primary purpose of the bill is to classify healthcare workers who use digital platforms and meet certain criteria, as independent contractors. That means, just like an Uber driver, they will not be classified as employees and will not have access to the protections and benefits provided to employees. 

The measure was filed last week with the state’s attorney general’s office and was submitted by the same law firm that was involved with the Uber campaign (Proposal 22) to keep DoorDash, Uber, Lyft, and Instacart workers as independent contractors instead of employees. Coincidence? Maybe not, especially considering that the firm is probably well aware of the fact that the healthcare industry is projected to be one of the fastest-growing in the entire nation. 

And as we all know, the nursing shortage, only exacerbated by the pandemic, is also expected to grow to critical levels. California alone is expected to have a need for 40,567 full-time equivalent RNs, or a 13.6% gap, until 2026. 

MarketWatch revealed that the group proposing the ballot initiative is called Californians for Equitable Healthcare Access and has not revealed its backers yet. But Silicon Valley is already heavily involved in healthcare staffing technology, pouring millions of dollars into apps and websites that will match healthcare workers directly with open shifts. 

MarketWatch also pointed out that California tends to lead the rest of the nation in terms of healthcare policies and legislation, so if the initiative passes, it could very well have an impact on the rest of the country’s nurses and healthcare workers very soon. 

How Could This Affect Nurses?

The biggest concern with a piece of legislation like this is that it could further exploit nurses, who some argue, are far more than gig workers. 

“Nursing…is fundamentally different from gig work,”  Sarah Gray, founder of Trusted Health, an on-demand staffing agency that treats nurses as employees, not contractors, told Market Watch. “There’s a high barrier to entry. It’s a professional career, and in order to sustain that career and provide high-quality care, nurses need to have that proper care themselves in the form of employee benefits.”

Other experts took their caution even further, warning that turning nurses into gig workers will only make the understaffed for-profit model that hospitals operate on even worse. There’s also concern that the initiative could have a ripple effect, impacting all healthcare workers, from nursing assistants to home health workers, stripping them of protections, benefits, and even lowering pay. Currently, California nurses make the highest wages in the entire country, with an annual salary of over $120,000, according to the Bureau of Labor and Statistics. Turning the nurses in the state into gig workers could significantly impact pay and of course, benefits. 

Notably, the move to reclassify nurses utilizing digital services to book work as independent contractors would also take them away from unions, which offer protection. And while flexibility is marketed as the primary benefit of on-demand work, it also leaves out the bigger picture: that “flexibility” means taking shifts that may not be ideal if nothing else is available, and a marketplace that, by definition, puts workers in constant competition with each other. 

Plus, as another source pointed out, it’s important to remember that the customer market of apps that hire nurses for open shifts is not actually nurses—it’s hospitals that are looking to save on labor costs.




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