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.


Thursday, 10 February 2022

Nursing Career, Nursing Job, Nursing News, Nursing Certification, Nursing Responsibilities, Nursing Skill

When I was burned out in 2014, the thing that made the biggest difference was not what you’d think. It was not the yoga classes, the journaling, or the empowering quotes. It was the connection with others. Support from people that I worked with or the dear friends who could see that something was off and checked in on me. I’ll honestly never forget it. 

Burnout took me by surprise. I knew I had lost that spark. I was crying more, and I felt more resentful with each passing day. But I just kept going. I felt guilty for feeling that way. I felt stuck and so lost. I was new and I didn’t want to say anything to appear weak, like I couldn’t handle it, and wanted to be a reliable good nurse. Little did I know I was setting myself on fire to keep other people warm and it would soon catch up with me. 

When people around me started to check in on me a couple of things happened: 

◉ I felt loved and valued

◉ I got clarity on what I was really feeling

◉ I realized that what I was dealing with was unsustainable

◉ I needed to take action

My environment wasn’t changing for me, but instead, I had control over how I reacted to it, how I set boundaries, and how I treated myself. Through my conversations with the people that cared enough to check-in, I felt validated and supported. This empowered me to take the actions I needed to move forward. Actions that didn’t make me any less of a nurse or human being.   

Now, I know it may feel hard to check on others when maybe you are feeling burnout yourself.  Maybe you get through each day by the skin of your teeth and feel like you are in survival mode 24/7. But if we all took just a few minutes here and there to do a little survey of those around us, and took one action (even just a small one) to check in on each other it could make a huge difference for the individuals involved. Even more, it could help shift the nursing culture to one of unwavering respect, kindness, and solidarity.  

Here are 4 tips to approach a colleague you think is overwhelmed, suffering from burnout, moral injury, or trauma…or maybe they just don’t seem themselves:  


Focus on support instead of sharing what you would do unless they specifically ask you. Connect with them, check-in, and ask questions like, "Do you want to talk about it?" then practice active listening. Offering your opinion could overwhelm them more and may make things worse.  Let them guide the conversation.


Rather than ask, "What can I do to help?" which may just overwhelm them more (hello, decision fatigue!), offer something specific.  For example, “Hey I am going to be grabbing lunch. Can I get you something?" or “Hey things are a little slow for me right now, can I do _____ for you?” Even if that means getting them a snack or some water.  


Sometimes it's uncomfortable when people are sad or mad, but let them feel it. Avoid saying things like "It could be worse" or "Let’s just focus on the positive." Validating their emotions helps them move through them. If their emotions are too great for you or are triggering you, communicate that you would love to support them and choose a time to meet up with them that feels good to you. 


If you have a conversation with someone who is struggling, loop back with them and keep your conversation with them private. Don’t engage in gossip. Encourage them to seek additional support if it seems needed. Avoid unsolicited advice unless they ask you for your opinion or you ask for permission to offer it.  


It can be hard to put yourself out there and check in on others. Their emotions may be overwhelming to you at times and sometimes our own discomfort may cause us to say things to try and fix the situation or help minimize the other person’s anguish. We are healers after all. But be careful about what you say especially if it appears to minimize how someone is feeling.  Here are a few examples of what not to say: 

◉ “Wow, that sounds awful but something way worse happened to me last week so it could be worse!”

◉ “I wouldn’t worry about it. Seriously just move on”

◉ “I wouldn't get this upset about it. Just be positive!” 

◉ “This really isn't worth you getting this upset about it”

◉ “I wouldn’t say anything, it will probably just make it worse”

◉ “Do you think maybe you are overreacting?”

◉ “Good vibes only!!”

Nursing Career, Nursing Job, Nursing News, Nursing Certification, Nursing Responsibilities, Nursing Skill

We are navigating rough waters but we are always stronger together. Small acts of kindness can ignite massive changes to the environments we work in. You never know the impact you may have on someone who is struggling. We aren’t meant to do life or nursing alone and I challenge you this week to take a look around and try one of the tools above. 


Thursday, 3 February 2022

Healthcare, Nursing Skill, Nursing Certification, Nursing Job, Nursing Responsibilities

California is currently experiencing the highest number of cases of COVID-19 since the pandemic began, which has prompted some new changes to the state’s policies in the workplaces.

Instead of just following the CDC’s updated COVID guidelines, California’s workplace policies are enacted by Cal/OSHA, the California Division of Safety and Health. Some of the changes affect how employees at workplaces are to be tested if an outbreak occurs at work, who needs to isolate after being exposed, and how vaccination status comes into play. And of course, the fact that COVID-positive nurses can just continue working their shifts. (Yes, really).

Here’s a more detailed breakdown of the changes, especially for healthcare workers. 

What the New CA COVID Rules Say

Some of the most recent general workplace changes—put into effect Jan 14, 2022, and in effect until April 14, 2022—stipulate that: 

◉ If there’s an outbreak in the workplace, the employer has to pay for COVID-19 testing for all employees, vaccinated or not. The tests may be self-administered, but it must be observed and read via telehealth or by the employer. 

◉ Masks are required in all indoor locations, including schools.

◉ Cloth masks are highly frowned upon. If they are worn, they must be tight-fitting and thick enough that light won’t show through them. 

◉ Anyone exposed to COVID-19 (even if they are fully vaccinated and asymptomatic) should be sent home with full pay OR wear a mask and stay six feet away from other people for two weeks. (Are all the nurses reading this laughing right now?) However, big catch with this one, because employers also aren’t obligated to pay sick leave for COVID, so not really sure how this actually works in real life. 

◉ Anyone who tests positive should quarantine for 5 days. 

◉ If transportation is a part of employment, fully vaccinated individuals must now wear a mask. 

CA COVID Rules for Nurses

While the general workplace rules are supposed to be in effect for most businesses, healthcare workers and emergency personnel, of course, also have their own set of rules. Nurses working in California will need to follow the rules that fall under AFL 21-08 set by the California Department of Public Health. 

The rules state that thanks to Omicron taking over and staffing challenges, the CDPH is “temporarily adjusting” the return-to-work criteria from January 8, 2022, through February 1, 2022. In other words, the need to keep hospitals staffed trump the “regular” rules. 

Here’s what temporary rules specify for nurses. And prepare yourself, because it’s a lot: 

◉ Any healthcare worker who tests positive for SARS-CoV-2 and is not showing any symptoms can continue working without isolating and without any additional testing required.  

◉ Any healthcare worker who has been directly exposed to COVID-19 and remains asymptomatic can also return to work immediately without any quarantine or testing required.

The only stipulations for healthcare workers who are either exposed or test positive is that they must continue to wear an N95 respirator while working and if possible, only work with COVID-19 positive patients. Additionally, whenever possible, the guidelines also advise any actively-infected but asymptomatic healthcare workers to keep away from their coworkers as much as possible, such as “using a separate break room and restroom.” Because every hospital definitely has that luxury available.  

These rules are in effect until February 1, 2022, at which time, the “regular” rules could go back into effect (unless, of course, another set of emergency temporary guidelines are passed). The normal rules stipulate: 

◉ Any vaccinated healthcare worker who tests positive should isolate for 5 days and return to work with a negative viral test. Without a test, they need to isolate for 10 days. However, if there is a critical staffing need, that timeline can be bumped under 5 days with a negative test. 

◉ Any unvaccinated healthcare worker who tests positive should isolate for 7 days and return to work with a negative viral test. Without a test, they need to isolate for 10 days. However, if there is a critical staffing need, that timeline can be bumped under 5 days with a negative test.

◉ For simple exposures, vaccinated workers have no restrictions if they test negative upon identification and again after 5-7 days. Unvaccinated workers should isolate for 7 days and get a negative test upon returning to work. Although again, both of those restrictions fly out the window with critical staffing shortages, in which case all that’s needed is a negative test upon identification of exposure and again at 5-7 days. 

It’s also worth noting that the guidelines specify that “asymptomatic” also includes “mildly symptomatic with improving symptoms.” Yes, for real. 

What Nurses are Saying About The New Rules

As you can imagine, California nurses have some thoughts about the new guidelines for healthcare workers. 

The California Nurses Association criticized the guidelines, as did the American Nurses Association (ANA). 

A full press release on the National Nurses United website reads:

“The California Nurses Association (CNA) condemns the decision by the California Department of Public Health (CDPH) to let asymptomatic health care workers who test positive for Covid-19 or have been exposed to the virus and are asymptomatic return to work immediately without isolation or testing.

‘Governor Newsom and our state’s public health leaders are putting the needs of health care corporations before the safety of patients and workers,’ said CNA President Cathy Kennedy, RN. “We want to care for our patients and see them get better – not potentially infect them. Sending nurses and other health care workers back to work while infected is dangerous. If we get sick, who will be left to care for our patients and community?”

Eliminating the isolation time and sending asymptomatic or exposed health care workers to work will guarantee more preventable transmission, infections, hospitalizations, and death. By doing all this, Newsom and CDPH are in effect guaranteeing more transmission.

“We must protect patients and keep nurses healthy and safe on the front lines,” said Kennedy.

Nurses demand that CDPH rescind its guidance, which is in effect from Jan. 8, 2022, until Feb. 1, 2022.”

California Nurses Association President Zenei Triunfo-Cortez also told KCRA3 News that the guidelines are a “major disaster” waiting to happen. "I think it's callous and it's putting our patients and ourselves in grave danger,” she added. 


Wednesday, 2 February 2022

Nursing, Nursing Career, Nursing Responsibilities, Nursing News, Nursing Job

Rationing medical care or resources has been an ongoing conversation in parts of the country as the delta variant rages on. Smaller, rural communities do not have the trained staff or equipment to adequately care for the continuing surge of patients. 

Hospitals in Idaho, Montana, and Alaska have all implemented standards of crisis care which allows medical professionals to do the greatest good for those with the greatest chances of survival. Despite the continued concern regarding the rationing of healthcare, this is not an uncommon occurrence in the United States. 

History of Rationing Medical Care

The word “rationing” has a negative connotation in regards to medical care and treatment so it has rarely been used. During COVID, it has been very clear that rationing was being done. Patients with the greatest survival chance were getting the limited resources available. For example, if three patients needed dialysis and only one machine was available then the patient with the greatest success rate would be given access to the machine. 

Rationing in the United States is most commonly done by insurance, price, pharmaceutical companies, etc. Those with better insurance carriers may have an easier time gaining access to treatment options including scans and medications. For example, since 2012 the cost of insulin has seen an average annual increase of more than 15%. Newer versions of insulin retailed for between $175 and $300 a vial. The dramatic increase in the price of insulin caused some diabetics to no longer be able to afford their insulin. As a result, patients began to ration their insulin to make it last longer. 

Rationing care in the time of COVID 

While rationing medical care isn’t a new practice, the continued surge of the delta variant throughout the country has brought it to the forefront of many healthcare systems. On September 16th, healthcare officials in Idaho expanded health care rationing statewide. The Idaho Department of Health and Welfare made the announcement after St. Luke's Health System, Idaho's largest hospital network, asked state health leaders to allow “crisis standards of care” because of the continued increase in COVID-19 patients has exhausted medical resources. 

Officials announces the standards were implemented due to a severe shortage of staffing and available beds in the northern area of the state caused by the massive increase in patients with COVID-19 who require hospitalization. The crisis standards were initially only limited to ten hospitals and healthcare systems in the panhandle and northern region but were later expanded due to the continuing surge in the number of infected patients. 

At the time of this announcement, Idaho was one of the least vaccinated states in the country with only 40% of the population fully vaccinated against COVID-19. As of publication, only 42% of the eligible population is vaccinated and 47% have received at least one dose and the state continues to be in crisis standards of care mode.  

Kootenai Health, in Coeur d'Alene, was the first hospital in the state to officially enter crisis standards of care. Chief of Staff Dr. Robert Scoggins said, “Some patients were being treated in a conference center that had been converted into a field hospital and others received treatment in hallways or in converted emergency room lobbies.” Urgent and elective surgeries are on hold across much of the state. 

St. Luke’s healthcare system reported that 92% of all of the COVID-19 patients hospitalized were unvaccinated and 61 of the hospital's 78 ICU patients had COVID-19.  

Unfortunately, Idaho isn’t the only state currently rationing medical care due to COVID-19. Alaska’s government officials announced at the beginning of October, that twenty healthcare facilities throughout the state would be operating under the State’s crisis standards of care. Officials are pleading with Alaskan residents to get vaccinated and wear a mask. Alaska reports that 51% of the eligible population is fully vaccinated while 57% have received at least one dose.  

Heidi Hedberg, director of the Division of Public Health stated, “We are working alongside our health care facilities to provide state and federal resources to support the surge of patients. We are also imploring Alaskans to do their part. Please get vaccinated if you have not done so already, wear a mask when needed and keep your social circles small. Every action you take helps prevent COVID-19 from spreading and protects you, your family, other Alaskans and our health care system. No one wants to use crisis standards of care guidelines.” 

Ethical Considerations

One of the biggest concerns for healthcare providers is the ethical concerns regarding the rationing of medical care. Nurses and doctors work under the ethical principles of beneficence, nonmaleficence, autonomy, and justice. Nonmaleficence, specifically, is the principle to do no harm. By rationing medical procedures, equipment, and care due to short staffing can and often does lead to undesirable patient outcomes. 

An intensive care unit nurse from Boise told Nurse.Org anonymously, “On a recent shift we didn’t have enough nurses to help with all of the codes that were occurring throughout the hospital at one time in addition to providing regular care to our ICU patients. The doctors, nurses, we were all spread so thin. A patient died. You can’t help but wonder if there was more that could have been done.” 

Nurses aren’t intending to do harm to their patients but it’s the reality when there are not enough resources or trained bodies to go around. While never easy to see a patient get sicker or succumb to their illness, it is happening everyday throughout multiple parts of the country. 

Rationing of Nursing Care

According to research, rationing of nursing care (RONC), refers to “necessary nursing tasks that nurses withheld or failed to carry out due to limited time, staffing level, or skill mix.” The result of rationing nursing care is potentially affecting patient outcomes. 

RONC became popular in 2008 at the start of the nursing shortage and only became increasingly more common due to the ongoing pandemic. According to The American Nurses Association (ANA), more registered nurse jobs will be available through 2022 than any other profession in the United States. There are estimates that an additional million nurses will be needed in the next decade. 

The truth is that the rationing of care has now become more related to the lack of nursing staff, respiratory therapists, and other trained healthcare professionals. "The staffing crisis is the worst it has been," says Siegel of America's Essential Hospitals. Health care systems have hundreds of vacancies that can't be filled, even if they pay top wages because "people just aren't there anymore."


Wednesday, 19 January 2022

Emergency Medical Services Authority (EMSA), Travel Nurses, Travel Nursing, Nursing Responsibilities, Nursing Skill, Nursing Job, Nursing Career

Through the pandemic, the Emergency Medical Services Authority (EMSA) in California enacted policies that allowed nurses who were licensed in any state to work in California. However, on March 31, 2022, the executive order that allowed that provision is expiring.

That means that any out-of-state nurses who do not specifically have a California nursing license will not be allowed to work in California anymore.

According to the California Board of Nursing, any travel nurses who wish to continue working in the state must get a California endorsement. Interim licenses are allowed, but if you don’t have a CA license, you’re out. And unfortunately, those changes may only exacerbate nursing shortages in the state as well. 

How to Get Licensed

With the changes coming up quickly, the California Board of Nursing is encouraging any travel nurses who want to continue to work in the state to get their CA nursing license immediately. Travel nurses who have been working in the state can apply for Licensure by Endorsement online. In order to be eligible for Licensure by Endorsement, you need to meet the following qualifications: 

◉ Have a current and active nursing license in another state

◉ Passed your NCLEX or the State Board Test Pool Examination (SBTPE) 

◉ Completed an educational program that meets all California requirements

It’s that last stipulation—passing a program that meets all California’s requirements–that is tripping some people up because California has a microbiology clinical lab requirement for all of its licensed nurses. If you didn’t take microbiology with a lab as part of your nursing program, you may be required to take the class now and submit documentation of successful completion in order to receive your license. 

Some nurses who have had to go through the process recommend taking it at a community college if it’s required since that will be the most cost-effective strategy. Additionally, you may be able to take the class portion online and complete only the lab portion in person. Nurses from different countries will have additional stipulations as well. 

What You Can Do Now

According to The California Board of Registered Nursing (BRN), out-of-state RNs should apply for licensure by endorsement as soon as possible. They explain that all applications will be processed according to the order they were received; that means that if you wait until the last minute, your application may not be processed in time for you to continue working once that March 31 deadline hits.

The good news is, they also explained that once you apply for your permanent licensure by endorsement, you can apply for a Temporary License right away. The temporary license will be valid for six months, so it should allow any out-of-state nurses enough time to continue working while their permanent license application is processed. 

If you currently are a travel nurse in CA and your agency or healthcare facility has not mentioned the upcoming changes yet, you should definitely speak to them about what you need to do and take steps to apply for your licensure by endorsement right away. Additionally, if you are taking a CA travel nursing position anytime soon, you may need to submit proof that you have applied for licensure by endorsement as well. Some travel nursing jobs are requiring proof of receipt that you have applied, so be prepared if you plan to take a CA nursing job in the next few weeks. 

The bottom line is that if you don’t have a CA nursing license and want to have the option to work in the state as a travel nurse this year, you’re going to want to apply for your Licensure by Endorsement right away. And if you’re already working in the state, don’t forget to apply for your temporary license in the meantime too, so you don’t lose your job come April 1st. 

Nurses who aren’t prepared ahead of time may lose their jobs and staffing agencies may have a harder time finding nurses with the proper licensure to fill positions, so any nurse who has the correct California nursing license is going to be in a prime role to take on higher-paying travel assignments this spring. 


Wednesday, 12 January 2022

Nursing Staff, Nursing Responsibilities, Nursing Job, Nursing Skill

Hospitals throughout the country are dealing with nurse burnout, high turnover rates, and staffing shortages in a variety of ways. Some have brought in travel nurses to fill gaps, others have mandated overtime while other healthcare systems have simply ignored the ongoing issues and let staff drown. 

Shannon Medical Center in San Angelo, Texas has implemented the use of several Moxi Robots on the nursing units. Moxi, named one of Time Magazine's 100 Best Inventions in 2019, is set to revolutionize healthcare. But how much can a robot really help bedside nurses, especially those caring for patients in isolation?

Meet Moxi

Nursing Staff, Nursing Responsibilities, Nursing Job, Nursing Skill

Moxi, created by Diligent Robotics, helps hospitals run 24/7 according to the website. The purpose of Moxi is to assist clinical staff was non-patient-facing tasks such as:

◉ Delivering lab samples 
◉ Delivering medications
◉ Distributing PPE
◉ Fetching items from central supply 
◉ Running patient supplies 

Diligent Robotics, an Austin-based company, was founded in 2017 by two female robotics experts is paving the way for artificial intelligence in the healthcare space. Moxi, the first in-production robot from the company, has been designed to continuously adapt to changes in hospital workflows by learning from the humans it interacts with. Moxi is equipped with an arm, gripping hand, and mobility that allows it to carry light medical resources, navigate the hospital corridors and drop them off for nurses and other staff.

Prior to launching the company and designing Moxi, cofounders Dr. Andrea Thomaz and Dr. Vivian Chuh, as well as a team of researchers spent over 150 hours shadowing nurses at three major hospitals in Texas. During their time, they learned healthcare workers spent up to 30% of their time "hunting and gathering" for supplies, in which Thomaz felt could be better spent focusing on what nurses do best — patient care.

"Nurses and clinicians are amazing," Thomaz said. "They do anything for their patients. If they need to run to the lab to get something, they do it. If they need to run to the pharmacy, they'll do it without complaint." Moxi was the solution -  way to help healthcare workers, specifically nurses. And thus, Diligent Robotics was born. 

According to the website, Moxi’s core technical features were designed to be compatible with the busy, semi-structured environments of hospitals,  including: 

◉ Social intelligence: opens elevators and doors on its own, won’t bump into people or objects in hallways, happily poses for selfies 

◉ Mobile manipulation: Moxi can interact with the hospital’s existing environment such as ADA doors and elevators to gain access across the entire facility without requiring a significant investment in infrastructure.

◉ Human-guided learning: The more your staff uses Moxi, the more Moxi learns and adapts to your environment and way of doing things

Nursing Staff, Nursing Responsibilities, Nursing Job, Nursing Skill
Co-founders Dr. Andrea Thomaz and Dr. Vivian Chuh and Moxi

Shannon Medical Center currently has two Moxi’s that rotate between the units and work day and night shifts. “She is a point-to-point delivery system for our hospital so she can go between different units and go to the lab, pharmacy and central sterile to be able to pick up supplies so that nurses do not have to leave the unit to pick those things up and it’s a big-time saver and staff satisfaction,” Shannon Medical Center Director of Innovation, Steven Short, said.

As one of the first hospitals in the country to implement Moxi, staff nurses are leery of its capabilities but also are thankful for the time saving especially in the more mundane tasks. “It won't take us away from the bedside nearly as much to go downstairs and wait for somebody to be available, we can allow Moxi to do that for us,” Shannon Medical Center Nurse Manager, Michael Smith said.

Shannon Medical Center isn’t the only major healthcare company to utilize Moxi robots. Moxi has appeared at other hospital facilities, including Medical City Dallas Hospital and Cedars-Sinai in Los Angeles.

Is Moxi a Viable Answer to the Nursing Shortage?

According to a labor analysis by the Texas Workforce Commission released Thursday, December  16, 2021, there were 35,634 advertised job openings for registered nurses — the highest number of unfilled jobs across the state. Four days later that number rose to 38,489 job openings.

Healthcare companies, legislators, and honestly nurses realize there are not enough new nurses or available nurses to fill the openings. Truthfully, there aren’t enough to even make a dent in the number. “There's no pipeline of staff that we see ready to just hop in and start helping,” said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association.

The reality is, while Moxi does assist nurses in non-patient-related tasks like delivering labs or medications - the robot doesn’t ultimately help the nursing shortage. Moxi

Yes, Moxi can run labs which saves time or go to the cafeteria to pick up a tray for a post-op patient or restock personal protective equipment (PPE) for isolation patients but it doesn’t solve the need for more bodies. Moxi can’t help in a code situation. Moxi can’t administer the medication it retrieves from the pharmacy. Moxi can’t help during a code situation. 

During normal times, perhaps Moxi would be seen as more than just an expensive piece of hospital equipment - but until it can take on more responsibilities, as a nurse, it is simply that - a task runner. A volunteer. Perhaps the hospitals using Moxi or interested in the product could better spend the money on new staff or retaining the current staff?




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