Sometimes I Feel Heartbroken When My Patient Passes Away, I Hope They Know I Cared

I wonder if the mother of the child that drowned 7 years ago knows that I still think of her. Does she know that her guttural sobs and animalistic screams upon holding her lifeless child still echo in my head if I think about it for too long? Would it bring her comfort or sadness to know that her baby would be the same age as my nephew, and I have thought about her boy and all of the moments she has been forced to miss?

Does the son of an elderly man know that I continue to think of his father every Christmas Eve because years ago I held his father’s hand while he took his last breath so he wouldn’t be alone? I remember thinking about how his family would never hear his voice say Merry Christmas again, and how this day will forever hold a memory of an empty phone call. 

I’m curious if the parents of a teenager know that I will forever think of them when I hear Taylor Swift’s “Love Story” because it was their daughter’s favorite, and they played all of her most beloved songs on repeat after the doctors declared her brain dead.

My shoulder has been the place where childless mothers and motherless children have shed tears. 

Despite this,  these are the stories that I don’t share with many people due to the sacred nature and protection I feel around them. Some of the most gut-wrenching and transformative moments in my career occurred in the solitude of my patient’s room and replays in the tenderness of my memory. Unfortunately, the stories that my friends and family most likely remember involve the stupid, sarcastic, and often times mean comments shared by patients and nurses alike. These soft but painful moments have the tendency to be overshadowed by the humorous and often heartless stories we share as a means of self-protection.

With compassion fatigue at an all-time high in the nursing profession, onlookers could easily make the judgment that such high exposure to sadness and grief for an entire career might drive a nurse to develop a heart of stone. But what strangers don’t realize, is that many nurses don’t want to talk about the cases that have deeply affected us. Sometimes it’s because we don’t know if we will be able to tell the story without audibly choking up reliving those experiences. Other times, it might be because those moments feel too sacred and vulnerable to share with people that can’t empathize with us. But for many nurses, the truth is that many of our patient’s stories have woven their way into our outlook and had an impact on our view of the world.

Our hearts only have the capacity to hold room for so much sadness and tragedy. 

Hospitals don’t attract people when they are having the best day of their lives, and nurses have had to learn to take on aspects of a counselor and therapist to provide the best care for patients during their heartbreaking moments. In order to keep our personal lives minimally affected by the work we do, many nurses have developed coping mechanisms that involve detaching from patient stories or keeping them at an arm’s length away from our hearts. 

When friends or family members ask about our day, we have a tendency to glibly respond by saying how we cared for a patient that had a horrible situation happen to them. And, although we might have deeply cared about this patient and their stories, the way in which we tell our stories might come across as callused and cold. At times, this might be a response to wanting to escape the sadness of the day. At other times it might simply be that once we reach the door of the hospital, we no longer have the capacity to carry our patient’s burdens home with us.

Although the rate that nurses experience burnout has excelled at an exponential rate especially due to COVID and the ongoing nursing shortage, I hope that a positive consequence of the past few years will be normalizing the difficult seasons of nursing. If nurses feel more at ease talking through challenging social aspects of the job with one another, it may lead to a more positive expression of our work to people who do not work in this profession. Similarly, as nurses begin to debrief and build this level of comradery with one another, it might spur on the ability to have more vulnerability in the tender moments with patients.

Sure. There are plenty of nurses in the world that have managed to build strong walls around their hearts and show up to work day after day without being affected. But they are the minority. Many of us care deeply about the joys and trials that our patients face and have come up with individualized methods for creating boundaries between our work and personal lives. 

Despite this, that doesn’t mean that we don’t continue to think of these stories for years to come and wonder if the families know how deeply their loved ones have touched our lives.

Source: nurse.org

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Home Care Agencies Are Desperate For Workers Amid Nursing Shortage

There is a nursing shortage everywhere. Staff nurses are leaving for lucrative travel positions. ICU nurses are burnt out and leaving the bedside for, well, anything but bedside nursing. And home care nurses are in short supply. While hospitals and healthcare systems can hire travel nurses to fill voids, mandate overtime, assign too many patients, and “figure it out” - home care agencies are finding it harder and harder to fill the voids.

Every year, according to the AARP, an estimated 12 million Americans who are infirm, chronically ill, or disabled individuals depend on some form of in-home care, according to the National Association for Home Care and Hospice (NAHC). Many are 65 or older and have serious underlying medical conditions.

Historically speaking, home care nurses are some of the lowest-paid nurses. According to Payscale.com, home care nurses make on average $28.69 per hour while a surgical nurse makes $32.14 per hour. Furthermore, according to data, home care nurses with 10-19 years of experience only make $30.24 an hour on average. This is lower than the average pay for a surgical nurse.

The ongoing nursing crisis is one that there is no foreseeable end to, unfortunately, but the home care nursing shortage is one that requires immediate attention and action. Furthermore, this shortage related to home care isn’t just nurses. There is also an ongoing shortage of certified nursing assistants and home health aides.

The Maine home-based care program, Catholic Charities, has a waitlist 925 people long; those applicants sometimes lack help for months or years, according to officials in Maine, which has the country's oldest population.

Katie Smith Sloan, CEO of Leading Age, which represents nonprofit aging services providers, says the workforce shortage is a nationwide dilemma.

"Millions of older adults are unable to access the affordable care and services that they so desperately need," she said at a recent press event. State and federal reimbursement rates to eldercare agencies are inadequate to cover the cost of quality care and services or to pay a living wage to caregivers, she added.

Effect on Patients

Without home care nurses, home care agencies have had to deny referrals. As a result, patients requiring home care are either remaining in the hospital, are putting stress on loved ones to care for them, or are risking injury by not having the proper individuals to care for them. 

The staffing shortage that Bayada has experienced late is unprecedented, according to David Totaro, the chief government affairs officer of the Moorestown, New Jersey-based Bayada Home Health Care.

Specifically, it has had to deny service to approximately 50% of all new case referrals due to a lack of staffing. That has not improved, even as the pandemic has eased.

“Our denied referrals have increased from half of all new cases to a record 64% in the tri-state area of Pennsylvania, Delaware and New Jersey, which is our largest coverage area,” he said. “We today are declining nearly two out of every three new home care cases due to a shortage of available caregivers.”

Effect on Families

The home care nursing shortage is affecting families across the country. Recently, the NY Times met with the Mead family from New York whose 7-year old son suffers from spinal muscular atrophy, a rare muscle-wasting disorder, and requires around-the-clock nursing care. Prior to the pandemic, the shifts were fully staffed and the parents would serve as a back-up when a nurse was not available. 

Now the family goes upwards of 36 hours without any nursing care. And they aren’t the only family begging for home care nurses. Parents are taking to social media asking for anyone with specific experience to lend a few hours in order to get their loved ones home from the hospital. 

Madeline Michael recently posted on Facebook asking for help filling holes in their son’s home nursing schedule. Some hospitals require around-the-clock nursing care for a specific number of days or weeks following initial discharge from the hospital. This depends on the medical needs of the child. 

Their son, tentatively due for discharge on December 7th, will not be able to be discharged without the nursing coverage. As a result, this young family is desperately seeking local nurses to help fill those vacancies. While appealing on Facebook is a great idea, it often doesn’t yield the results needed. Furthermore, willing individuals must apply to the home care agency, Bayada in this case, and go through the entire onboarding process. This can be long and might not be completed in time to help the family. 

Unlike the Mead family, Michael’s son will not be discharged from the hospital. And they aren’t the only family seeking nurses. Long-term units and trach vent units are full in hospitals waiting for patients to be discharged. But without the nurses and aides to care for the patients, they remain hospitalized. 

The Fix

Sad to say, there is no quick fix. This will continue to be an ongoing dilemma even once COVID is no longer a concern. The pandemic merely sped up a problem that was going to hit the nursing profession head-on. As an increasing number of baby boomers retire, individuals live longer, and there are treatment options available for chronic medical conditions - the need for home care nurses is going to continue to rise.

More than half of Americans will need formal long-term care and services as they age, according to LeadingAge. According to professionals and government officials, without funding from the government to improve wages, training, and recruiting and retention efforts, the number of home care workers will only continue to decline and the shortage will become even more drastic.

According to home care nurses, the biggest deterrent is pay. While federal guidelines allow Medicaid programs to cover in-home nursing care despite a family’s income, states generally pay home care nurses at much lower rates than they would for equivalent care in a hospital or other medical center. However, Medicaid is reimbursing for similar charges and fees as in the hospital.

Jen Semple, a registered nurse in South Carolina, worked as a home care nurse for one patient over the last four years despite hourly pay that rose just $1 during all that time. When the pandemic began, she cut her home care hours to administer vaccines for a local health care system, at an hourly wage $7 higher than she had been earning.

Jarred Rhatigan, a 31-year-old nurse from Nassau County, worked part-time several days a week for Caring Hands, a home care agency, making roughly $40 per hour. Once a vaccine became readily available, he dropped all those shifts to administer vaccines at sites across areas of New York for upwards of $75 an hour. This in turn allowed him to pay down his student loan.

While both Semple and Rhatigan were sad to leave their home care jobs and patients, the pay difference was too much to walk away from. Money talks, even for nurses, and in the end home care nursing positions can not compete against hospital positions from major healthcare corporations.

Source: nurse.org

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UPMC Launches Internal Travel Nursing Agency, 800 New Jobs

The University of Pittsburgh Medical Center has unveiled its new internal travel nursing program. With nursing shortages exacerbated by the COVID-19 pandemic, hospitals and medical centers are having to find new ways to attract talent and deliver quality care. 

This new program is the first of its kind and provides participants with premium pay and flexibility. 

UPMC hopes that the program will also allow them to send support to the facilities that are most in need. Nurses will change locations every six weeks so that hospitals can keep up with demand and quickly address staffing needs as they arise. UPMC includes 40 hospitals across Pennsylvania, Maryland, and New York, so participating travel nurses will cover this territory.

Many nurses have joined travel programs that send them to cities all over the country. Most are attracted by the chance to travel and earn competitive wages. However, there are some drawbacks to this lifestyle. Travel nurses are often far away from friends and family and don’t get to enjoy the same sense of camaraderie and teamwork that is typical to clinical environments.

Pay Details

UPMC hopes to provide the best of travel nursing while also keeping nurses within the same system for some sense of continuity and familiarity. Participants will stay within the UPMC benefit structure and start at $85 an hour.

Ultimately, the program is hoping to win back those who have left to be travel nurses and hire 800 travel staff. Currently, the network employs 8,000+ nurses, so while the hiring binge sounds ambitious, it still only represents a fraction of the entire staff. 

If the program is successful, other large healthcare systems may follow suit in order to more effectively maintain adequate staffing, especially during times of crisis. 

Source: nurse.org

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5 Things To Think About During The Holidays if You're Working as a Nurse

So often some of the most coveted words we hear nurses speak when they take a new job away from the standard 12-hour shifts are “no weekends and no holidays.” In fact, no holidays are one of the driving forces nurses might leave the bedside for clinic or office jobs. 

Unfortunately, choosing a career in nursing almost guarantees missing out on certain events including holidays due to the unconventional schedules. 

During parts of the year it might mean missing out on the first T-Ball game of the season, while at others it may be sending your spouse solo to Parent-Teacher conferences due to the Thursday work grind. But almost without question, nurses that work at the bedside will have to work some part of the winter and summer holidays.

Although there are often the few unicorns in the department that prefer to work the holidays due to a lack of family or because of the added pay incentive, the large majority of people would much rather have their work schedules mimic their family’s days off. Some departments spend weeks fine-tuning the most perfect blend of pot luck assortments to fill their stomachs in an effort to curb the void of missing sitting around a table with their own family. Other departments have spent their precious few minutes of downtime creating Christmas and holiday décor out of the most unconventional materials. Some hospitals offer employees a free holiday meal in hopes of easing the burden of having to work and miss time with family. 

And yet others seem to ignore it all completely and act as if the hospital maintains running and functioning the same year-round. These hospitals tend to forget that despite the hustle and bustle of the hospital, especially now during the ongoing pandemic, that the staff is silently suffering without their friends and families. 

5 Reflections on Past Holiday Shifts

But, the holiday magic that floats around Hallmark movies like the feather from Forest Gump doesn’t forget the staff that shows up to work all of these special days. There is a different energy in the hospitals on national holidays. All non-essential employees are still snuggled up in their beds, while the faithful and true continue to clomp the hallways in our mystery-stained Dansko’s. The hallways feel empty as management and administration do not show up to work, so it can often feel like mom and dad have left for vacation and it’s time to pull out all of the party tricks. But also management enjoying the holidays at home with loved ones does leave a slightly bitter taste. 

By the time the rest of the team shows up for huddle, it is almost as if everyone has accepted their fortunes and made peace with having to come into work on the holiday. 

1. These shifts lead to some of the most memorable and cherished times with coworkers. The secretary is shoving dollar store hats on the most reserved nurses and the charge nurse announces that our family picnic will commence in four hours. The normally dull unit is now interrupted with a Spotify Christmas station. 

2. Patient interactions can also be much more meaningful during this season as well. To some degree, the holidays bring an added level of stress that can often go unmatched, especially as families are dealing with pain, trauma, and financial burdens. However, grace and kindness also seem to abound with generous fluency. It is almost as if visiting family in the hospitals during Christmas time feels more like an event, and can often be an excuse for family members to simply relocate their traditional gatherings.

3. Special moments between patients and families. Pre-Covid, it wasn’t extremely uncommon to walk into a room and see a family huddled next to Grandma as they brought her leftovers and finished opening gifts together. In fact, those moments are the ones that bring a smile to even the most cold-blooded nurses.

4. A mild and unique bond occurs between a patient, visitor, and nurse. When they realize that neither one of them are where they would like to be. But, since they both find themselves in the same room, they might as well make it an experience worth remembering. Or at least one that doesn’t bring sadness and loneliness into the picture. Even if they recognize one another’s sadness, the magic of the holidays has a way of curating a more vulnerable space between them to fully express themselves. 

5. This time of year leads to many easy conversation starters with patients, particularly the young and the old. Listening to older generations talk about their memories surrounding holidays and traditions can be quite capturing.

These shifts can be hard. Many nurses have small children that do not understand why mommy has to work on Christmas, or why dad had to go sleep and miss eating turkey with them in order to work that night. Although many nurses get more days off a week than other professions, the slow grind prevents us from taking many prolonged stretches of vacation off, particularly around the holidays. In fact, most hospitals don’t even allow for PTO directly around the holidays. 

Hospitals also see a natural rise in patients due to increased travel and time spent in large gatherings. Now more than ever - hospitals continue to see a rise in admissions due to Covid and other winter illnesses. Even though most nurses would much rather be spending the days with their family and friends carrying out old traditions and forging the path for new ones, the holiday magic, and hospital mandates, pull us back to work with hope and expectation that the shifts will be full of laughter, memories, and cherished times.

Source: nurse.org

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“Smart Hospital Rooms” Powered by Alexa are Being Introduced in Many Healthcare Facilities

Move aside, call lights, because there’s a new way to get nurses’ attention: Alexa.

In hospitals and senior centers across the country, a form of Alexa—powered by Amazon and under the brand Alexa Smart Properties, which is already used in hotels and apartment complexes—is being installed as part of integrative healthcare technology. The voice-powered technology is meant to both better connect patients to team members and help them with quality of life. For instance, Alexa can be used to both send a message to the healthcare team when a patient needs something (like a dry turkey sandwich or a new pillow), control things like lights in the room and the TV, as well as bring the patient news or entertainment, all completely hands-free. 

The beauty of using a technology like Alexa in a hospital setting, of course, is that it’s voice-powered. Patients that are bed-bound or have mobility restrictions can still utilize voice in order to communicate or even control things in their room, such as lights or bed settings. 

There are clearly many benefits that can be imagined with Alexa technology and it doesn’t look like it will be too long before voice-powered AI in the healthcare setting is completely normal. But will it be a boon to healthcare? Here’s what we know so far, along with how the technology is being utilized and what nurses can expect from working alongside Alexa. 

“A Game Changer”

While voice-powered technology in patients’ rooms might sound a bit futuristic, apparently it’s already been rolled out. Cedars-Sinai installed Amazon Echoes in 100 patient rooms in 2019 and BayCare Health System in the sunshine state piloted the technology in two hospitals the same year, with plans to install Alexa devices in 2,500 patient rooms across 14 other hospitals. 

Peachy Hain, executive director of Medical and Surgical Services at Cedars-Sinai, said in a statement that the technology will be a “total game-changer” for enhancing the hospital’s experience for patients. 

"Voice is intuitive for patients, regardless of age or tech-savviness," Peachy Hain stated. "Since it's so easy to operate, patients can use Alexa to connect with their care team and stay entertained as soon as they settle in, while care providers can streamline tasks to make more time to care for those patients. It's a total game-changer for enhancing our hospital experience."

The Alexa technology that has already been implemented also works with patients outside of the hospital setting as well. By integrating Alexa into their healthcare systems, some hospitals and healthcare companies are utilizing the technology to provide services to parents and patients who are looking to make an appointment or wondering what the ER wait time is. 

For instance, Boston Children's Hospitals uses a form of the technology to connect with parents of patients for recovery progress updates and schedule post-op appointments. Swedish Health Connect (by Providence St. Joseph Health) uses it to help patients find an urgent care center near them and schedule appointments. And with digital health company Livongo, Alexa can respond with members’ last blood sugar readings, track blood sugar trends, and relay personalized health nudges. 

How Does it Work?

In the initial rollout in Cedar-Sinai, an Amazon Echo was placed in-patient rooms and used for voice control for things like the TV or to send a message to a nurse. The Echo would then “interpret” the message and it would be routed to the appropriate team member. Medication requests would go to a nurse, for instance, while a request for water might go to a CNA. The message is also moved up the chain of command if it is not addressed (which definitely doesn’t happen with a traditional call light, so that’s an interesting feature).

In the upcoming rollouts, the Alexa technology will work much like a smart hub in a home does: the entire room will be a “smart room” and the patient can use voice controls to do things like send a message to the healthcare team, order meals, and adjust the TV or lights. They can even use it as a communication portal to talk to their loved ones directly from their room. Especially during the pandemic, nurses and other healthcare team members used Alexa for “Drop-Ins” to remotely “drop-in” on residents and patients to see how they were doing, communicate something to them, or provide education. 

In assisted living and senior care facilities, the Alexa device also serves as an information hub, relaying information such as the activity schedule, weather, menu, along with brain-boosting entertainment like interactive games and podcasts. Each patient can have its own programmed contact list, so the patient can talk to loved ones with only a voice control. And the Alexa device can even be set to “Do Not Disturb” if the resident would like to take a nap or rest. 

And because the Alexa Smart Properties brand was specifically designed to first be implemented in senior care facilities, the technology is also HIPPA-compliant. So while the devices can be used for helpful medical care like medication tracking, safeguards ensure health information is protected. Additionally, voice recordings are not stored. 

Pros and Cons

Obviously, spokespeople for Amazon are excited about the possibilities for using Alexa in hospitals. (As if Bezos needed more income. Sigh.) 

“The current use cases for Alexa Smart Properties are just the tip of the iceberg,” Liron Torres, global leader of Alexa Smart Properties told Fierce Healthcare. But is that iceberg going to lead to a disaster? Let’s consider some of the pros and cons of using Alexa in a healthcare setting. 

Pros

◉ Less used surfaces to disinfect. This is a big one—things like remotes, in-room phones, light switches, and call lights could all be significantly touched less or even eliminated, cutting down on cleaning and possible contamination between patients and care providers. 

◉ Hands-off communication. Another huge benefit of voice technology is clear after the COVID-19 pandemic—voice technology would enable contact-free communication between a patient and healthcare team. A nurse could safely talk or communicate needs without having to don valuable PPE in order just to find out what the patient needs, then take it all off, dispose of it, then re-don it. 

◉ More patient control. Gone are the days when patients would be left in a room without so much as an update. (That shouldn’t happen anyways, but if you’ve ever worked triage in a small rural hospital short-staffed on a full moon, you know it happens.) A smart room could enable patients to see live updates about their plan of care and feel more in control about their care as well. 

◉ Improve patient spirits. Isolation was a major problem in the pandemic and some patients who had the Echo in their room at Cedars-Sinai spoke highly of having the technology, because it allowed them to feel less alone and more connected with the outside world. 

Cons

◉ Discomfort with technology for some patients. Voice technology could be a barrier for some patients, especially the elderly who may not understand or feel comfortable with voice commands. Additionally, there may be a potential for language barriers.

◉ Glitches with roll-out. New technology will inevitably have glitches that could impact care or perceived quality of care.

◉ AI > humans. Patients may feel a lack of real-live human contact or perceive that AI is preferred over face-to-face communication. 

◉ Costly. Obviously, a technology like Alexa in a healthcare setting will be a costly investment. Not only will that initial rollout cost a pretty penny, but the technology will need continual updating and servicing. One can’t help but wonder how the investment compares to the cost of, say, paying staff nurses more or hiring more staff who could actually check on the patients in-person? 

◉ System burden on staff. Last, but not least, integrating Alexa into current healthcare software and systems means adding yet another new piece of technology that staff will have to learn how to use. 

Source: nurse.org

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This Legislation Could Cap Travel Nurse Pay Rates

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

There have been both state and federal moves towards enacting legislation specifically aimed towards more regulation for staffing agencies. Supporters 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.” 

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.

Source: nurse.org

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How to Find a Nursing Job You Love, If You’re Burned Out

The saying “a change is as good as a rest” holds true—particularly for nurses still grinding away in the trenches through the 4th wave of the Covid-19 pandemic.

Before you find yourself so burnt out from work, you wonder how (or if) you’ll ever recover, it’s probably a good sign you need to look for a different job as soon as possible.

And while you may be thinking “Better the devil I know than the one I don’t” in terms of switching jobs and maybe landing in a tougher job than you have now, we’ve put together this article to help you find a nursing job you love that will also show you some love in return.

12 tell-tale signs it’s time to look for another nursing job:

1. Quick nurse turnaround with your employer

2. Ongoing bullying

3. Your health is suffering (mentally and/or physically)

4. Lack of satisfaction with your job

5. Recurring or ongoing anxiety and/or depression

6. Struggling with compassion fatigue

7. Poor nursing leadership

8. Patient safety is at risk

9. You’re being asked to work outside your scope of practice 

10. Your license is at risk

11. Patient care is disorganized 

12. Patients are being abused (report this before you leave!)

Some other red flags that should be waving you toward another nursing job include:

◉ You frequently complain about work

◉ You have trouble waking up for work or dread it

◉ You’re drinking more alcohol or using substances to cope 

◉ You often think, dream, or talk about doing something else

◉ You have trouble sleeping—falling asleep or staying asleep

◉ You’re having more conflict with your co-workers than usual

Once you’ve decided it’s time to pack up your stethoscope and move on, it’s important to make sure you find a job you truly love waking up to each day— or at least like going to. 

Before you pull the plug on your current job, take some time to make a list of what’s important to you in your next nursing job. And don’t be afraid to dream! Remember: You don’t get what you don’t ask (or look!) for. 

Write down all the things that would make your next job ideal. 

8 things to think about in an ideal job: 

1. How much money do you want or need to make?

2. What kind of nursing role do you want to fill?

3. Do you want to get out of shift work or work at the bedside?

4. How far do you want to commute to work? Or would you prefer a remote work at home job?

5. What kinds of employer benefits do you want?

6. Is it important to find a family-friendly employer (yes! It’s possible. Keep reading!)?

7. If you need more education to land your dream job, is it time to start hunting for a nursing program (there are lots of online programs for busy working nurses)?

8. Can you find a nurse who is doing the job you want to do? Tell them you would love to buy them coffee or chat over Zoom because you would love to do what they’re doing and want to learn more about it.

Once you find a potential new job, it’s time to become a detective and do some serious sleuthing to find out all the details. 

Besides chatting with a nurse who works with your potential new employer as suggested above, go check out the place where you’d be working. What kind of vibe do you get when you walk in the door? How do the staff seem to be working together? Can you identify any nursing leaders and are they present and supporting their staff? Are the hallways clear, clean and free of bad odors? Peek in some patient rooms. Are they bright, airy and orderly or dingy with stuff strewn everywhere?

Some other important things to find out include the employer’s reputation and if they’re trustworthy, does the employer offer work-life balance benefits such as nutrition consultations, employee and family assistance programs, stress management workshops, grievance counseling, and financial planning help to name a few. 

It’s also critical to learn if nursing leaders are a key part of the leadership and decision-making team which is a key requirement of Magnet hospitals. Finally, does the employer have a good relationship with its employees—do they genuinely care about their staff and is that care and concern felt by the staff who work there?

Is it really possible for nurses to find family-friendly workplaces?

Yes, it is!—even if you work shift work as a nurse. The important thing to keep in mind is that the term “family-friendly” can mean different things to different people. Take some time to think about what this means to you. And what you’re willing to give up in return.

Having lots of work flexibility so you can meet the needs of your family is great but it might mean sacrificing other benefits including paid time off and regular work you can depend on for a paycheck. Keep in mind a salaried position may be more desirable if you’re looking for flexibility in work hours because you won’t be paid just for actual hours worked.

Are you looking for on-site child care? Maybe paid mental health days and paid time off so you can take a sick child or ailing family member to the doctor? Or do you need a flexible work schedule so you can work around the more fixed schedules of your children? Would you prefer to work remotely if possible? Is maternal or paternal leave important to you?

Also, don’t be afraid to ask for benefits that may not yet exist with the employer. The nursing shortage and pandemic has prompted employers to rethink what they need to do to retain nurses. This includes thinking outside the box in terms of nontraditional benefits such as surrogate-support and fertility programs as this job-seeker asked for—and got!—as part of her new job.

What clues can I look for that might suggest a workplace is family-friendly?

Look for keywords on the company website and listen for keywords during the interview that the employer uses to describe themselves such as “compassionate”, “family-oriented”, “work-life balance”, and “mental health”.

A search of the best places to work online is another great way to find family-friendly workplaces based on reviews of current and former employees. Doing an online search for companies that have won awards for “best place to work” and “family-friendly” company or business can also help you find these gems.

How do I know when I should turn down a job offer?

Just because you got a job offer doesn’t mean you should take it. Nursing jobs are plentiful and new opportunities come up every day. If you made it to the stage of getting a job offer, you’ve hopefully had an interview and had a chance to do your homework about the employer. Nevertheless, some real deal-breakers can pop up during or after the interview that should make you rethink working for an organization.

7 Red Flags To Look For During an Interview

1. Distracted, unengaged, or conflicting interviewers

If during your interview the interviewer is distracted checking their phone or emails often, or if there’s more than one interviewer and they don’t agree on what they’re expecting of you as an employee, cross that one off the list. This shows poor leadership and interpersonal skills not to mention conflicting expectations that will be sure to frustrate you as an employee. And if the interviewers give you very different answers to your questions, this lack of consensus shows it may be difficult to meet employer expectations because even the interviewers don’t agree on employee expectations.

2. Lack of workplace diversity 

During your interview, ask about the employer's stance on diversity, equity, and inclusion (DEI) in the workplace. Ask if this is one of their corporate values and if so, how they promote and incorporate that value in the workplace. Ask for examples of what makes their workplace diverse and what they’re currently doing to increase and encourage diversity in their staff.

3. Employer rigidity

Another red flag can be a rigid employer. For example, if there’s no indication from the employer that they’re willing to help accommodate your need to manage family responsibilities such as caring for aging or ill family members or if you’re presented with a job offer without any discussion about what you’re looking for, you’re likely dealing with an employer who is only thinking of their own needs.

4. High staff turnover

During the interview, or sooner if possible, you want to find out how long the position you’re applying for has been vacant and why. If an employer has high staff turnover, it’s usually an indication that staff aren’t happy for some reason and choose to leave. Keep in mind that a large sign-on bonus will quickly pale as an incentive if you dread going to work each day. And large sign-on bonuses can be an indication of high staff turnover or an inability to attract staff.

5. No room for career growth

According to Fast Company, a recent Monster survey during the pandemic shows “the top two reasons people are looking for new jobs are burnout and lack of job growth or opportunities.” 

Employers should be identifying opportunities for career growth and advancement with their organization during the interview to entice and attract good employees to hire on and stay with the company. If an employer can’t describe what career advancement opportunities they can offer you—or you have to ask about this in the interview and they don’t have a good answer, it’s probably time to keep looking.

6. Pressure to accept a job offer quickly

Desperation is never a good bedfellow. If you’re pressured to make a decision about a job offer in a day or less—or even following an interview—be sure to put the brakes on and ask for more time to evaluate the job offer. 

Keep in mind job offers are a two-way street and employers need you as much as you need the job. Take some time to reflect on the job interview and discuss it with someone you respect. Ultimately, trust your gut feeling and don’t be afraid to decline the offer if something doesn’t “feel” right—even if you can’t put your finger on it.

7. No staff retention strategy

Lastly, let’s circle back to that big fat sign-on bonus the employer may be dangling in front of you…that’s a sweet incentive to start a new job. But, arguably, a more important question is, what is the employer doing to keep the great staff they already have? Remember—this will include you soon if you accept the job. This is a crucial question to ask in the interview. Employers who stumble to answer this are not places where you’re likely to be happy working for very long. Time to keep looking.

Source: nurse.org

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What is the TEAS Exam?

This article will explore everything you need to know about the TEAS exam, what subjects are on it, how to study for it, what a passing score is, and a range of other TEAS questions.

1. What is the TEAS Exam?

The TEAS is an exam that nursing students take when applying for nursing school in the United States. It tests what a nursing student’s academic potential may be in nursing school. Universities use this test because studies have shown that those who perform well also perform well academically in higher education.

The TEAS is often part of the whole application process that nursing students must take to get into nursing school, including transcripts, an application, an essay, letters of recommendation, and fees. The TEAS exam is similar to the Health Education Systems Incorporated Admissions (HESI A2) exam, which some institutions use as part of a student’s application.

What Does TEAS Stand For?

TEAS stands for Test of Essential Academic Skills. The exam ensures that the student has the essential academic skills to perform well in nursing school. A good score on the TEAS will help you get into a nursing program.

2. Why Do You Need to Take the TEAS Exam?

Many universities use the TEAS exam to determine how well a student will perform in a higher academic setting. Studies have shown that students who do well on the TEAS also do well in nursing school.

Most schools that include the TEAS are a part of their application process, application, transcripts, an essay, letters of recommendation, and other fees.

3. What is on the TEAS Exam? 

The TEAS will test students on various subjects to see if they are academically proficient enough to succeed in an Associate Degree of Nursing (ADN) or Bachelor Degree of Nursing (BSN) program. 

There are four general subjects on the test: reading, math, science, and English and language usage.

Sections of the TEAs exam

According to the ATI TEAS website, the test has the following sections:

◉ Reading: 53 questions 

    ◉ Including questions on the integration of knowledge and ideas

◉ Math: 36 questions

    ◉ Questions include measurements, numbers, and algebra

◉ Science: 53 questions

    ◉ Human anatomy and physiology, life sciences, and scientific reasoning

◉ English and language usage: 28 questions

    ◉ Knowledge of language and vocabulary

How Many Questions Are on the TEAS?

There are 170 questions on the TEAS, but only 150 of them count in your score. The remaining 20 questions are for internal company purposes only.

Students have 209 minutes in total to complete the exam.

4. What You Need to Know About the TEAS Exam

How Much Does the TEAS Exam Cost?

The exam can cost anywhere between $65 and $140, depending on where you take your exam.

How Many Times Can You Take the TEAS exam?

Every institution has its own rules and requirements for how many times a student can take the TEAS exam and how long you must wait between exams. Some universities allow students to take the test one or two times, but others may allow for more.

Speak with the institution you plan to attend to find out what their program allows. 

Can You Use a Calculator for the TEAS Exam?

You cannot bring a calculator with you to take the exam. There will be a calculator for you to use on your computer. If you are taking a paper exam, there will be a desk calculator provided to you.

What is a Passing Score for the TEAS Exam?

There is no standard passing score on the TEAS. Each university has its own passing requirements, and some may require a higher score in certain areas than others. You must speak with the institution you plan to attend to ensure you know their requirements. 

Universities vary in what they consider a passing score, but most are above 60%.

You should know that questions on the TEAS exam don’t have equal weight. Some questions will hold more points than others, and you will not know which ones they are while taking the test. 

How to Register for the TEAS Exam

You can register to take the TEAS exam online or in person at the ATI testing website. When you register, there are also study materials that you can purchase to help you prepare for the exam. 

5. How to Prepare for the TEAS Exam

Allow yourself a minimum of 6 weeks to prepare for the exam. There are also many study resources available for purchase and for free on the website. ATI has a recommended study plan for students taking the TEAS:

◉ Week 1: English and Language usage

◉ Week 2: Reading

◉ Week 3: Reading

◉ Week 4: Science

◉ Week 5: Science 

◉ Week 6: Math

Each subject can be studied using a manual, lessons, pre-tests, post-tests, quizzes, and practice assessments. Depending on your comfort level in a particular subject, you may want to spend more time on some subjects and less on others. However, the ATI recommended study plan includes recommended hours of study as well.

TEAS Prep Courses

ATI offers six unique study packages depending on your level of knowledge and how much you want to study for the TEAS exam. Each varies in price from $25 to $249 depending on how much study material you need.

It is a great idea to invest in a plan that helps you study and increases your chances of obtaining a higher score. According to the ATI website, about 40% of students end up taking the TEAS at least twice. In many cases, students were not prepared enough to take it the first time.

6. After the TEAS Exam

How Long Does it Take to Get TEAS Results?

If you take the TEAs exam at an on-campus location, you may receive your score immediately, along with your report. Keep in mind that your university may choose not to show students their scores following the exam. In that case, you may need to check with your school to see when you will get your score. 

For candidates taking a paper version of the ATI TEAS exam, ATI will provide you with your score within 24 hours.

How Will You Receive Your TEAS Results?

If you do not receive your results immediately on your computer upon finishing the exam, you can find them in your ATI account under “My Results.”

What Happens if You Fail the TEAS Exam? 

Failing scores can vary between schools. You must check with your school to determine what their failing score is. However, you can always retake the exam if you want to try and achieve a higher score.

Source: nurse.org

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What Nurses Should Know About Flu Season 2021

As the country continues to battle COVID-19, another deadly respiratory illness is starting to emerge. Influenza. Much forgotten last year because of the ongoing pandemic, kids remaining home from school, most still working from home, and the world more or less remaining shut down - flu season has officially begun and the American Nurses Association (ANA) does not want it to be forgotten. 

In September, the ANA in collaboration with Sanofi Pasteur, the global vaccines division of Sanofi, and actress Jennifer Grey launched the Flu Shot Fridays national flu vaccination campaign. According to the press release, the campaign was designed to encourage everyone six months and older focusing specifically on adults 50 years of age and older as well as people living with chronic health conditions to get their annual flu vaccine. 

“The flu vaccine is one of our best defenses to prevent transmission of influenza this fall,” said ANA President Ernest J. Grant, Ph.D., RN, FAAN. “Getting the flu vaccine is especially critical for people with compromised immune systems, as the flu can lead to hospitalization and even death.

2021-2022 Available Flu Vaccines

There are numerous flu vaccines available to the general public, all of which are covered by private and public insurance. Those without insurance can often get a low-cost or even no-cost flu vaccine at major pharmacies. The availability of specific types will vary based on location and population needs. The CDC recommends that all individuals over 6 months of age receive their annual flu vaccine by the end of October. 

The four most common flu shots this year are:

◉ Standard dose flu shots. An inactivated influenza vaccine is given via intramuscular injection.

◉ High-dose shots for people 65 years and older.

◉ Shots made with flu virus grown in cell culture. No eggs are involved in the production of this vaccine.

◉ Live attenuated influenza vaccine. A vaccine made with an attenuated live virus that is given by a nasal spray vaccine.

The CDC has a complete breakdown of all the flu vaccinations available in the United States for the 2021-2022 flu season.

According to the Food and Drug Administration (FDA), the quadrivalent formula for the egg-based influenza vaccine contains the following:

◉ an A/Victoria/2570/2019 (H1N1) pdm09-like virus;

◉ an A/Cambodia/e0826360/2020 (H3N2)-like virus;

◉ a B/Washington/02/2019- like virus (B/Victoria lineage);

◉ a B/Phuket/3073/2013-like virus (B/Yamagata lineage).

According to the FDA, the quadrivalent formula for the cell or recombinant based influenza vaccine contains the following:  

◉ an A/Wisconsin/588/2019 (H1N1) pdm09-like virus;

◉ an A/Cambodia/e0826360/2020 (H3N2)-like virus;

◉ a B/Washington/02/2019- like virus (B/Victoria lineage);

◉ a B/Phuket/3073/2013-like virus (B/Yamagata lineage).

According to the FDA, the trivalent influenza vaccine contains the following: 

◉ A(H1N1) pdm09, 

◉ A(H3N2) 

◉ B/Washington/02/2019-like virus (B/Victoria lineage)

There are very few contraindications for the standard dose flu vaccine but it is important to speak to your doctor if you have any questions.

The live attenuated nasal spray vaccine is contraindicated in the following populations according to the CDC:

◉ Adults age 50 or older

◉ Children 2 years through 17 years of age who are receiving aspirin- or salicylate-containing medications.

◉ Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months.

◉ Children younger than 2

◉ People who are immunocompromised (ex. Cancer patients or individuals living with HIV/AIDS)

◉ People who care for severely immunocompromised persons who require a protected environment

◉ People who have taken influenza antiviral drugs within the previous 48 hours such as Tamiflu.

◉ Pregnant women

The high-dose flu vaccine is specifically designed for people 65 years and older as it is intended to give older individuals a better immune response which will give better protection against the flu. The vaccine contains four times the antigen of a standard dose flu vaccine.

It’s important to note that the flu vaccine will NOT prevent COVID-19 or decrease the symptoms associated with COVID-19. Additionally, getting the flu vaccine will not cause COVID-19 or increase the likelihood of contracting COVID-19.

Initially, it was recommended that individuals that receive the COVID vaccine don’t receive the flu vaccine on the same day; however, new studies published by the CDC state that the COVID vaccine may be administered without regard to the timing of other vaccines. 

Flu Shot Fridays

Flu Shot Friday’s is a PSA, digital and social media posts along with media interviews by Grey as well as ANA President Grant. The campaign is hoping the added star power of Grey, most notably known for her roles in Dirty Dancing and Ferris Bueller’s Day Off, will encourage the public to get their flu vaccine, especially those at increased risk. 

“Everyone remembers the kid who was made into some sort of hero for skipping school, but why? I mean, taking ‘me time’ is great, but there are ways to make it a bit more meaningful,” Grey says in the opening of the TV spot.

“So what are you waiting for? Don’t risk sick days stuck in bed with the flu. Get your flu shot and take some time for yourself,” she adds later.

The website has excellent, easy to read and understand information about the flu shot and flu season while highlighting the importance of becoming vaccinated. Key information relayed include:

◉ According to a 10-year study of 1,227 adults aged 40+ found that a first heart attack is approximately 10 times more likely following a flu infection. The 10-year study also examined 762 adults aged 40+ and showed an approximately 8 times increase in the likelihood of a first stroke following a flu infection. 

◉ An estimated 77% of flu-related hospitalizations in 2018 and 2019 were for adults 50+. 

◉ Even when well-managed, people with diabetes (type 1, type 2, or gestational) are at an increased risk of serious flu-related complications, which can result in hospitalization and sometimes even death. 

◉ The flu can worsen symptoms for people living with lung diseases, such as COPD, asthma, or cystic fibrosis, and may lead to pneumonia. 

Flu Shot Fridays website also has an easy-to-use flu vaccine locator. Individuals can simply click on the link, input their zip code and how far they are willing to travel as well as the type of flu shot desired, and a list of options will populate. It is even possible to make an appointment online directly from the linked website!

Source: nurse.org

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How Does a Nurse Get a Daisy Award?

Nurses don’t become nurses for recognition. More often than not it is a thankless job but ultimately can be more fulfilling than any other career. The hug of a patient’s loved one, the solidarity during an organ donation procession, or the comforting words of a patient are all the thanks most nurses will ever need. But in those rare moments of praise and recognition, the Daisy Award honors exceptional nurses, nursing faculty, and nursing students for their hard work, dedication, and the difference they make in someone’s life. 

History of the Daisy Award

Founded in 1993 by Mark and Bonnie Barnes, the parents of J. Patrick Barnes who died at age 33 of complications of Idiopathic Thrombocytopenic Purpura (ITP), Daisy is an acronym for Diseases Attacking the Immune SYstem. According to the Foundation’s website, the mission and value of the Daisy Award is to “express gratitude to nurses with programs that recognize them for the extraordinary skillful, compassionate care they provide patients and families.”

While the main focus of the Foundation is the annual Daisy Awards, the Daisy Foundation also provides several grants including evidence-based practice research grants and medical mission grants. Individual grant requirements can be found on the website but generally speaking, individuals must be Daisy Award Nominees and be registered with the Daisy Foundation. 

The Daisy Award was started as a way for the Barnes family to thank the exceptional nursing staff that cared for their loved one during a very difficult time. Currently, over 4,900 healthcare facilities and schools of nursing in all 50 states and 31 other countries and territories, are committed to honoring nurses with The DAISY Award. 

Nurses can be nominated by anyone in the organization including patients, family members, other nurses, physicians, other clinicians, and staff. Essentially, anyone who experiences or observes extraordinary compassionate care being provided by a nurse. More often than not - the nominations come from families or patients themselves. It truly is a tremendous honor for any nurse to even be nominated for the Daisy Award. 

Honoring the Founders

While The Daisy Foundation has been focused on the exceptional care of nurses, the founders Mark and Bonnie Barnes were most recently honored with honorary doctorates from Chamberlain University.  Mark and Bonnie received their honorary degrees of Doctor of Humane Letters during the school’s virtual commencement ceremony on October 10th. 

According to a Chamberlain University press release, Chamberlain University president Karen Cox, PhD, RN, FACHE, FAAN said, “We can’t think of two people who deserve this honorary doctorate more than Bonnie and Mark Barnes.”

“Bonnie and Mark Barnes have devoted more than 20 years to ensuring nurses are honored and recognized for their compassionate care, extraordinary clinical skills and patient advocacy. The Barnes’s tireless efforts to support and humanize the nursing profession is inspiring and humbling.”

According to the Barnes’,  nurses are the world’s humble heroes: “Every day you will be someone’s hero,” said Mark Barnes during the commencement speech. “Every day you will have the opportunity to make your patient’s life better in some way, and every day you will make the world a better place because of what you do.”

Daisy Award

The Daisy Award recognizes both national and international nurses for their accomplishments. There are several different types of nurses that are recognized by the Foundation including:

◉ Direct Care Nurses

◉ Health Equity

◉ Lifetime Achievement 

◉ Nurse Leaders

◉ Nursing Faculty

◉ Nursing Student

◉ Team 

In creating The DAISY Award, there were three elements the Foundation wanted to ensure the recognition program included: 

1. A partnership with healthcare organizations to provide on-going recognition of the clinical skill and especially the compassion nurses provide to patients and families all year long.

2. Flexibility so that The DAISY Award may be tailored to each hospital’s unique culture and values.

3. A turn-key program with The DAISY Foundation providing most everything you need to implement The DAISY Award.

The Foundation allows the hospital, healthcare system, nursing program, etc. to determine how many times per year there are award presentations. Some have presentations once a year and larger healthcare institutions hold monthly celebrations. 

While there may be countless Daisy Award nominees, there is only one “winner”. This individual is recognized on the Foundation’s webpage. The “winner” is determined by the institution based on the mission and values. Furthermore, as this award is meant to celebrate the extraordinary compassion of nurses it is not meant to be a merit-based award and is highly discouraged by the Foundation as such. 

The Daisy Award is supported by many key nursing organizations including The American Organization of Nurse Executives (AONE) who helped expand the program when it was first developed as well as The American Nurse Credentialing Center who supports The DAISY Award for all Magnet and Pathway to Excellence organizations and those “on the journey.” Additionally, the DAISY Award was honored with ANCC’s President’s Special Recognition Award at the National Magnet Conference in October, 2010 and with a 20th Anniversary Tribute at the 2019 conference. Currently, there are over 40 professional organizations that work directly with the Daisy Foundation to spread the word. 

The Daisy Award is the perfect opportunity to share the amazing contributions, compassion, dedication, and hard work of your co-workers. There are not enough “thank you’s” for the endless work of nurses, nursing professors, and students but the Daisy Award helps highlight the everyday work of the true heroes. 

Source: nurse.org

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This is Why Nurse Coworkers Have a Special Bond (that can’t be replaced)

We have an odd bond. We have a working relationship that involves many moments of "you hold this butt cheek while I hold the other" interspersed with tender moments debriefing some of the horrible stories we have witnessed. We have shared many shifts affirming one another's eye rolls while also pulling the other into rooms to view sites that words cannot do justice. Unlike many professional coworking relationships, the chaos we endure coupled with the reliance on a strong team effort makes our dynamic unique but also unwavering. We don't have the option to isolate ourselves in a cubicle with headphones on while virtually chatting with our coworkers. I rely on you to help me conquer code browns, answer the 739th call light from my patient, provide a second opinion to my gut feeling, and to build me back up when patients and other hospital staff make me feel small.

We have been through a lot. More than I like to admit sometimes. One of the reasons nurses have such a wildly unique bond is similar to the reason that so many soldiers come back from war with a connection to their peers. We have shared an experience with one another. Experiences that the people in our lives will never fully understand. While they will be there to support us, it’s my peers' support that is most needed. You stood by my side and heard the raspy wail of the mother when we called time of death. You helped hold the head down of the psychotic patient on drugs trying to spit in my face. You sang songs with me and helped distract me from the massacre of a room once the patient left for the OR. You held the trashcan at the side of the bed while diarrhea ran like the Amazon River through the blanket barricades. You helped me remove the IVs and tubes while bagging the body of the grandpa who died alone so I wouldn't have to be in the room by myself while completing the task. You have walked beside me and been my shoulder to cry on and my partner to laugh with for scenarios that no one else will fully understand.

Despite this, I do owe you an apology. You have seen me in some of the worst moments of my life. I wish I could say that I put my best face forward at this job, but unfortunately, you have had to deal with me on some rough days and there will be even more in the future I’m sure. Bless your heart for still working with me when I waltz in with no makeup, hair on day four of no-wash with a headband thrown in to disguise the grease, scrubs that could give the models on the Snuggie infomercials a run for their money in the comfort department, three tumblers of varying forms of caffeine, and an attitude comparable to the Grinch.

I am sorry for the days that I have complained about every meaningless task and brought my personal issues to work with me. Our jobs are not easy, and unfortunately, that means when I am not at my best it carries over into our work. So thank you for carrying my weight on certain days and doing what you can to lighten my load.

Most importantly, thank you for the moments. Those moments when we have found ourselves in a patient's room and an event occurs that is either so unbelievably inappropriate, hysterical, horrendously disgusting or just unimaginably odd but we must remain professional and keep silent. The second that we return to the nursing station and make eye contact has historically been one of the funniest and most bonding moments of working with you. We will forever reflect on those moments - the awkward eye contact across the room, or the image of the other one stifling a laugh into their arm to prevent an ill-timed outburst in a room. Some of these moments have been the catalyst that turned an ordinary peer relationship into a friendship that has made going to work so much more fun. 

This job would be impossible without you. Seriously, it would. Can you imagine the overall job satisfaction if we were forced to work independently or work every shift surrounded by coworkers that we didn't enjoy? It would not only be unsafe and unattainable, but our nursing relationships bring so much life and joy into such hard shifts. It is in the little details like the rolly-chair charting break races, the snacks in the supply room, and the secret bets we place on our patient’s lab values that help make this job so much fun.

You have taught me so much. I consider myself incredibly lucky to stand on your sidelines and watch you handle hard situations with grace and confidence. You have taught me through your successes and failures and advocated for patients and peers alike. Our 3 AM conversations make me believe that I might know more about you than your significant other does because we have managed to keep each other awake for numerous shifts by diving into the menial details of our lives. I consider myself incredibly privileged and lucky to have worked and learned alongside you for all these years. Our profession can be challenging in so many ways, and it is such a great comfort knowing that you share it with me for the good, the bad, the ugly, and the countless code browns. 

Source: nurse.org

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6 Emerging COVID-19 Treatment Options

We’ve come a long way from the early days of trying to treat the novel coronavirus (COVID-19) that literally changed the world overnight.

We know now that COVID-19 patients are best treated on their stomachs which improves oxygenation in the lungs, that the disease can affect the blood, and most notably, of course, we have a vaccine to prevent against severe impacts from infection.

But there are also some exciting new and emerging COVID-19 treatment options on the scene that deserve to be looked at as well--and some “popular” suggestions that should be skipped. If you’re wondering what the credible COVID-19 treatment options are, here’s what we know so far.

Anti-virals

Veklury (remdesivir)

Remdesiver is an antiviral that’s been on the scene for some time and has been used effectively in the past on other viral infections, like malaria. Like most anti-virals, it has the best chance of working when administered early during an active infection, to stop the virus from replicating.

Remdesiver is authorized for use against COVID-19 under Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA). However, remdesiver can only be administered in a hospital or other in-patient care setting, so it can be difficult to use to treat early on in the course of the infection. Additionally, there are conflicting studies about the true effectiveness of remdesiver against COVID-19. For instance, a 2021 study found that it may help reduce the length of hospital stay, but does not improve chances of survival. Another 2020 study found similar results: the drug helped shorten hospital stays, but was also associated with 131 “serious adverse” effects in the 531 patients who took it.

Molnupiravir

As opposed to remdesiver, Molnupiravir looks like the more promising antiviral to treat COVID-19. This drug is an oral antiviral sold by Merck that showed promise for both being cheap, easily accessible (you can get it right at a normal pharmacy and you can take it at home), and effective. The medication works by introducing errors into the genetic code of the virus, which stops it from being able to successfully replicate. One clinical trial showed it reduced the risk of hospitalization and death from COVID when given to patients who were high-risk early on in their infection.

On Thursday, Nov. 4th, the United Kingdom became the first country to officially authorize molnupiravir as a treatment for COVID-19. Britain ordered enough of the drug for 480,000 people, while the U.S. has already placed a pre-order for the treatment of 1.7 million individuals, costing the government about $700/person. It is expected that the FDA will authorize the drug in the U.S. as well, following an FDA advisory panel meeting later in November. Molnupiravir could be accessible to the U.S. as early as December.

In order for the drug to be the most effective, it’s recommended that you start taking it within 5 days of the onset of your symptoms and full treatment is 40 pills over the course of 5 days. Breastfeeding and pregnant women should not take the drug and in fact, it’s recommended that women who could become pregnant take contraceptives while on the drug and for four days after.

PF-07321332

Pfizer also has its own COVID antiviral in the works. Dubbed PF-07321332, Pfizer’s version is a protease inhibitor, meaning it inhibits a protease enzyme that the virus needs to replicate. The company is currently testing both an oral and IV version of the medication and the oral version is now in Phase 2 of 3 of clinical trials.

Like the other antivirals, Pfizer’s is meant to be given only with confirmed COVID-19 cases and early on in the infection process. Britain has already ordered enough treatment of the Pfizer anti-viral for 250,000 people.

Antibody Treatments

Convalescent Plasma

In February 2021, the FDA revised its EUA for convalescent plasma. Now, high-titer convalescent plasma is only authorized under EUA for high-risk, hospitalized patients with COVID-19.

This was based on findings from the National Institutes of Health’s clinical trial, which found that administering the plasma (containing antibodies from survivors of COVID-19) did not help improve outcomes in patients who were not hospitalized.

Monoclonal antibody treatments

As opposed to convalescent plasma--which uses real blood products containing antibodies from survivors of COVID-19--monoclonal antibody treatments are lab-manufactured antibodies that are then infused into someone who’s already infected with COVID-19. They can be used out-patient and have shown some degree of effectiveness, especially when given on in the course of infection and for those who are at high-risk.

The FDA has issued EUA for REGEN-COV, a monoclonal antibody product, for people over 12 who weigh at least 40 kg. The U.S. government also has an official website detailing more about the treatment, along with infusion treatment centers.

With the ongoing development of treatment options to treat COVID-19, including Merck’s antiviral pill and Pfizer developing another treatment option, there is increasing hope that medicine is finally getting a grasp on the novel coronavirus.

Source: nurse.org

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Kaiser Permanente Nurses Prepare to Strike Nationwide

Kaiser Permanente, one of the nation's largest not-for-profit health plans and the largest healthcare employer in California, is facing potential strikes from over 52,000 workers in 8 different states. The system has 39 hospitals ranging from California to D.C., employs over 63,847 nurses and 216,738 other employees, and reported operating revenue of $88.7 billion in 2020.

The United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP), which represents over 32,000 registered nurses and other health care professionals, is preparing for a strike authorization vote after failing to reach an agreement with Kaiser Permanente at several California and Oregon hospitals. On their website, the UNAC/UHCP explained that the critical vote is necessary because “everything we've fought for and won in the past 50 years is at stake.” 

The UNAC/UHCP has an entire section of their site set up as an Online Strike Vote HQ, where nurses can read Kaiser’s proposals, attend virtual meetings, and even cast their votes online. According to the site, the union is representing the 24,000 RNs that work at Kaiser and is fighting for issues that include: 

◉ Addressing chronic understaffing and burnout

◉ Improving wages--4% each over the next 3 years

◉ Preserving benefits

◉ Protecting patient standards of care and access

◉ Social justice program that includes recognition of Juneteenth as a holiday 

◉ Stopping cost-cutting without accountability

According to 10News.com, the current contract between Kaiser and the California Nurses Union will expire today, October 7, at midnight. Nurses have until October 10th to cast their strike authorization vote; after that, if enough nurses vote in support, the strike will go into effect. Voting is entirely virtual and if a strike authorization is voted through, the union has to give a 10-day notice to the hospital before the strike begins.

Oregon Prepared to Strike

In Oregon, nurses and other healthcare workers at three different Kaiser locations in the state have been voting on a strike authorization since Monday, October 4th. Kaiser’s contract with the Oregon Federation of Nurses and Health Professionals union expired on September 30th and members have been working on a contract since then. 

According to the Oregon Federation of Nurses and Health Professionals (OFNHP), one of the main concerns that the union has been discussing with Kaiser is the health system’s proposal for a 2-tiered wage system, which would mean that new hire healthcare workers would sign on with lower wages and a decreased benefit package. They also accused Kaiser of releasing “misleading” statements surrounding contract negotiations and current employee wages. 

“Kaiser claims that we are paid above market rate, but this is absolutely false,” a statement from Jodi Barschow, a Kaiser Sunnyside RN and President of the Oregon Federation of Nurses and Health Professionals (OFNHP) read on the OFNHP website. “Kaiser’s proposals are an attack on patient care and the frontline healthcare workers who provide it, and all the while they are spreading untruths about how much we make and how they have handled negotiations. Lower wages will make it impossible to recruit and retain the healthcare professionals our patients depend on for care. We have a staffing crisis now; what do you think would happen if we allowed Kaiser to offer even less pay to prospective employees? It would create a healthcare disaster.”

The union also claims that Kaiser has been unwilling to negotiate after strike authorization voting began and has even walked back on previously agreed upon proposals. 

If the Oregon union authorizes the strike, it would be one of the largest healthcare strikes in the state’s history, involving some 3,400 workers. 

Why Strike? 

So why exactly are Kaiser nurses striking? 

According to the union’s statements as well as nurses that have worked in the facilities who are sharing their stories, the healthcare giant is prioritizing profits over patient safety and is endangering both employee and patient’s health and well-being. 

“KP continues its narrative of competitors threatening to overtake a health care giant with pop-up clinics and expanding virtual care. The reality is that the employer emerged from the pandemic with at least $44 billion in cash reserves and a healthier outlook than many health care systems,” the UNAC/UHCP union states on its site. “The real threat is that a new crop of KP leaders has redefined the organization's legacy of partnership, justice, and equity.”

The site also lists some pretty damning statistics about where KP is sitting financially as its staff members struggle, such as the fact that KP earned $6 million per day during the pandemic, holds $44 billion in reserves (yes, you read that right--billions!), and would fall as the 34th wealthiest company on the Fortune 500 list, above even Disney and Nike. Kaiser isn’t on the list because they are technically classified as a non-profit, which excludes them from the list.  

“We're not asking for anything outrageous, we're just trying to be fair and they've taken the stance they want more profits, so this is where we're going,” Rob Jones, an RN at a Kaiser’s San Diego County location, told a local news outlet.

Oregon’s nursing union also cited statistics that 42.2% of healthcare workers are considering leaving the field entirely over the treatment they have received at Kaiser, while over 60% reported they are considering leaving Kaiser Permanente. 

Nurses Speak Out on Striking

Nurses have also been taking to social media to share some of the information about strikes that are going on around the country. One nurse in a video shared by Nurse Erica on Instagram, even explained that October has been dubbed “Striketober” in light of so many nursing unions deciding to vote on strikes. 

For instance, 350 union workers, including nurses, X-ray techs, and respiratory therapists, at Sutter Delta Medical Center in Antioch, California also went on strike early Monday morning, citing unsafe staffing and “dire” conditions. The strike will last until Saturday morning and Sutter has already released a statement noting that they were “disappointed” in the union leaders who had “chosen to distract” and proven “disregard” for their patients and communities. 

Other prominent nursing influencers are urging their fellow RNs to get involved with their nursing unions as they fight for better working conditions. 

For example, Nurse.tori_ shared information with her Instagram followers about the importance of nursing unions and how they work to protect nurses and the best interests of patients over the profits of the business of healthcare. 

“Take time to understand your organization as well as your health professional’s issues,” she wrote in an Instagram post. “If you are part of a union, get invested in understanding. It’s going to take all of us to make changes in our health system. We are in the business of humans. Humanizing what we do should be worth the investment.”

She also shared that strike votes against Kaiser are taking place in the following locations: 

◉ UNAC/UHCP in So Cal, No Cal, HI

◉ USW in Riverside, San Bernardino

◉ OFNHPT/AFT in Oregon, WA

A travel nurse called Lex, who goes by the handle of @wanderlex on Instagram, also took to stories to share her experience actually working at Kaiser, which she described as “a horrible time,” adding that she would never work at another Kaiser facility again nor ever let her family be treated at one. 

“I watched multiple patients die,” she described in her stories. “I watched them put profits over patients a thousand times. We are talking about one of the wealthiest companies in the country and virtually every room had broken or outdated equipment...I completely support the staff of Kaiser in advocating for better company policies and better treatment.” 

Kaiser Permanente in Seattle is already struggling with staffing, especially in light of the COVID vaccine mandate. The health system announced on Tuesday, October 5th that they had placed 2,200 employees on unpaid leave for failing to get the vaccine or securing an appropriate exemption. 

In response to the threats of strike, 10news.com reports that Kaiser has released the following statement: 

“We have been bargaining in good faith with the Alliance of Health Care Unions to reach fair and equitable agreements that provide our employees with excellent, market-competitive wages and benefits, and we are optimistic that we will reach an agreement before a potential strike would begin.”

Sign The Petition

The California Nurses’ Union is also asking anyone--from nurses outside of the union to the general public--to sign a petition to Kaiser to invest in better patient care. You can sign the petition here.

Source: nurse.org

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