The Secret to Avoiding Nurse Burnout as a People Pleaser

What I am about to say will set you free. If I had known what I know now I would never have burned out to the extent that I did.  

I remember it vividly: I was a new grad so cue the imposter syndrome and people-pleasing.  I was a “yes person” to the extreme. I remember working 12 shifts in a row and at one point remember thinking to myself, “what am I doing? I am so miserable.” I didn’t know how to set a limit and I sure as heck didn’t feel confident enough to say anything other than “sure, sounds good!” 

I wanted to be respected, be viewed as a team player, and for people to be like, “wow she’s such a great NP! Look at her!” I was looking to others to determine my worth…something I now know is a slippery slope that leads to to being overwhelmed, overworked, overcommitmented, and most importantly guilt. 

So here’s the deal: I’m not going to hold you on the edge of your seat for too long.  I am going to tell you the secret and then give you the scoop on how to implement the tools that will legitimately change your life when keeping burnout at bay.  

The secret is BOUNDARIES. 

BOUNDARIES will set you free. I honestly wish they taught this in nursing school because it would have saved me a lot of time, energy, and therapy. 

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I know, we hear the word boundaries and we immediately feel uncomfortable. We all hate having those difficult conversations, but at the end of the day which would you prefer -  a hard conversation or a hard life? 

At this point in my career, I will take the hard conversation 100% of the time. But it’s because I have unlearned all the things that kept me in people-pleasing mode. I now understand that even though boundary setting feels incredibly socially threatening, my own peace, time, and energy are far more important. People that have issues with your boundaries are simply the people that are looking to exploit your kindness and willingness to sacrifice your own needs. 

Maybe you fear that you will sound lazy, that you will let someone down or that you will appear unreliable. But the fact is we can unlearn the idea that we have to be 100% available 100% of the time. As people pleasers we often feel that our availability and willingness to help equals love, respect, and praise. But here’s the thing…you MUST be self-protective. Because at the end of the day others will exploit that and ask more and more from you. You aren’t a robot. You are a human being.

Boundaries are just a limit. 

We have limits because we have limited resources. Boundaries are  just a line in the sand, an allocation of your resources. They are not an emotional exchange.  You are allowed to recognize where your limits are, and use your voice to deploy them and it’s 100% healthy to enforce them and stand firm. You get to decide.

So here are a few things to remember as you flex your boundary-setting muscle.

1. It’s not all or nothing. Boundaries can evolve just like your needs and desires evolve.  It doesn’t always mean “no.” A boundary could be a “yes, but” or a “yes, and”

2. It’s better not to wait until your breaking point to set a boundary. Be self-protective!

3. Boundaries are not a threat! It is just a clear expression about what your limits are.

4. Don’t get paralyzed by the “what ifs.” Don’t try to predict how it’s going to go. Be clear on what you are protecting and be willing to be disliked in order to represent yourself.

5. Saying “no” doesn’t mean you are a bad person or a bad nurse.

6. Boundaries are not always with other people. It could be with yourself or even your phone! 

7. It is NOT better to suffer silently and rage quit three months later than to just have a hard possibly uncomfortable conversation now.

Boundaries will set you free and you are worthy of them. You’ve got this! 

Source: nurse.org

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Hospitals are Turning to Foreign-Educated Nurses Fix The U.S. Staffing Crisis

As the United States continues to deal with staffing shortages in hospitals and nursing homes, some administrators are turning to hire foreign-educated nurses to fill those critical roles. According to ABC News, there are twice as many green cards this year than last year for foreign professionals working in the U.S., including, of course, nurses. 

In fact, one immigration attorney told the news outlet that she has seen more demand for foreign nurses over the course of the past two years than in the entirety of her 18-year career. And she doesn’t expect it to slow down anytime soon. 

With staff nurses leaving their positions because of burnout, childcare issues, or to the allure of the lucrative travel nursing industry, more positions are left unfilled—meaning someone is needed to fill those gaps. 

And with a push towards capping travel nurse pay, there may be even less opportunity for travel nurses to help with staffing issues, meaning foreign-educated nurses could have more opportunities than ever. 

What’s Behind More Foreign-Educated Nurses

The reason that there are more foreign-educated nurses vying for nursing positions this year is that, because of the pandemic, visas that normally would have been issued to relatives of American citizens went unused, freeing up a total of 280,000 visas that can be given to professionals looking to work in the U.S. That includes other professionals besides nurses, of course, but with the staffing crisis a priority, many slots will go to nurses who can help alleviate the strain hospitals (and thus, patients) are feeling right now. 

In fact, the Biden administration instructed that any applications from nurses willing to work in hard-hit areas should be prioritized. New applicants have until September 2022 to apply before the fiscal year ends, so many foreign-educated nurses are rushing to get in before the deadline ends. 

According to the American Association of International Healthcare Recruitment (AAIHR), 5,000 international nurse visas were waiting to be approved as of September 2021. Back in August of 2021, when COVID numbers began creeping up again, the American Hospital Association (AHA), the American Association of International Healthcare Recruitment (AAIHR), and healthcare staffing firm Avant Healthcare Professionals also pushed for more action from the government to help speed up the process of getting more international nurses to work, reported MedPage Today. 

The pushes have seemed to work. According to the Institute for Nursing, there are about 1,000 nurses currently being hired each month, with 10,000 more on waiting lists. 

According to AAIHR, New York Governor Cathy Hochul said the state was looking to recruit qualified foreign nurses to backfill its shortage. “This is something we have to work with the Department of State on first,” the governor said. “This is a conversation we have already been having to talk about the opportunity we might have in freeing up the visa system.”

Additionally, the CEO of Michigan’s Henry Ford Health, which recently closed beds over an inability to staff them, said the system is working to hire hundreds of nurses from the Philippines.

The president of Nurse Staffing Solutions for AMN Healthcare Sinead Carbery told ABC News that demand for international nurses is as high as 400% more than it was at the beginning of the pandemic and even with the increase of available visas, there still won’t be enough nurses to fill all of the available slots. But nursing recruiters are actively seeking to hire more nurses from overseas due to both demand and eagerness of those nurses to come to the US for work. The BLS reports that it’s projected that there will be 194,500 nurse positions open every year on average.

Furthermore, Sinead Carbery said about 1,000 nurses are arriving in the United States each month from African nations, the Philippines and the Caribbean. Currently, there are an estimated 10,000 foreign nurses with U.S. job offers on waiting lists for interviews at American embassies around the world for the required visas. The reality is - that other “wealthy” countries, including Canada and Great Britain, are also attracting foreign-educated nurses. 

What are the Impacts of Foreign-Educated Nurses Working in the U.S.?

While we can all certainly agree that more nurses are always a good thing, there is some concern that in pushing to hire more foreign-educated nurses—who may be hired in at lower rates—ignores the systemic issues facing staff nurses at hospitals across the country. It may be a band-aid solution when the real issues at hand plaguing staff nurses, including patient-nurse ratios, better wages, safety in the workplace, and mental health crises, are being ignored. 

Additionally, there is the very real fact that the nursing shortage doesn’t just exist here in the U.S., so international nurses leaving their homes to work in the U.S. could have an impact on healthcare internationally as well. For instance, a January 2022 report by the International Centre for Nurse Migration (ICNM) in partnership with CGFNS International, Inc. (CGFNS) and ICN, warned of the importance of addressing nursing shortages worldwide. 

CGFNS President and Chief Executive Officer Dr. Franklin A. Shaffer, a co-author of the report, stated: 

“We can anticipate that there will be a migration tsunami as more than ever before, countries around the world turn to the international nursing supply to meet their workforce needs. The pre-existing unequal distribution of nurses around the world will be exacerbated by large-scale international recruitment to high-income countries as they look for a ‘quick fix’ solution to solving their nursing shortages, which will only widen inequalities in access to healthcare globally.”

There are also hurdles to consider when relying on foreign-born nurses. For one, the process of applying and getting a visa accepted can be a time-consuming one, even when expedited. Additionally, there can be huge cultural components to nurses coming to the U.S. to work. One nurse described it as coming to work on a “different planet,” and staffing agencies must not only help place nurses in positions but help them navigate cultural training as well. 

Still, one survey by a staffing agency for international nurses found that hospitals that sponsor international nurses actually report less turnover and higher rates of patient satisfaction and safety. The National Council of State Boards of Nursing, Inc. also states that “it has been noted there is no comparative outcomes research on FENs and U.S.-educated nurses.” Leading nursing organizations haven’t formally issued statements regarding the employment of foreign-educated nurses, but the ANA did release an ethical code of conduct for foreign-educated nurses back in 2009. 

How Do U.S. Trained Nurses Feel? 

The reaction among nurses may be best described as cautious. The very real opportunities for help on the floor, for individuals who desire to come to the U.S. for personal and/or professional reasons, and the diversity that can only strengthen the nursing industry, can’t be understated. 

But there are some who worry that the push to flood the workforce with foreign-educated nurses is another attempt to “solve” the nursing staffing shortage crisis without real and systematic change—and that it may take advantage of international nurses who may be using U.S. visas to leave less-than-desirable conditions in their home countries, along with leaving dire shortages in international areas too.

“Big medicine and the politicians they pay for are pushing to flood the U. S. with foreign nurses,” wrote one commenter on MedPage Today. “They know that foreign nurses are desperate to escape their own lousy countries and poor living conditions. They will labor longer hours, with more patients, and for less money than American nurses, who want to improve their profession's work conditions and compensation here at home….A sadly fitting article so close to Labor Day, showing that U.S. capitalists are still happily, greedily finding innovative ways to oppress America's core Healthcare workers - its nurses - of which there is no true numerical shortage, just a shortage of those willing to work for the hours, pay, staffing, and equipment offered.”

Source: nurse.org

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8 Money-Saving Tips for Busy Nurses

Who isn’t trying to save money right now?

With gas prices up this year over 8% and rent costs up from last year as much as 26%, finding ways to save your money is more important than ever. Maybe you still have some student loans or other debt you are trying to payoff, or just keep up with the rising costs of necessities. 

For nurses working long, 12-hour shifts, saving money can come with specific, unique challenges. Nurses don’t always have set or predictable schedules, and can work many weekends, holidays, or even night hours. It can be hard to find time in your busy schedule to write out a budget, and it can be easier to make quick, last-minute purchases when you are driving home exhausted after those long shifts. 

I have been a nurse for over 11 years and paid off over $48,000 in debt as a single parent working 12-hour shifts in the hospital. I contribute much of my success in paying off my debts to consistent budgeting and putting in extra effort finding ways to save money as much as possible. 

Here are 8 tips to help you save money as a busy nurse.

1. Take advantage of discounts offered to nurses

Many products and services offer discounts to nurses year-round outside of nurses’ week. It can never hurt to ask for and take advantage of these healthcare worker discounts. Some cell phone carriers, such as Verizon and AT&T, offer exclusive discounts for nurses and their families. Scrub stores will often-times offer discounts for nurses as well. 

Nurses can try searching on Healthjob.org for a list of 2022 Discounts for Nurses. Many companies listed on this site offer special deals for nurses, such as sunglasses, shoes, mattresses, and more. GovX.com is another website offering exclusive discounts for health care personnel, including nurses, on over 700 brands.

Check For Nurse Discounts on Common Expenses

◉ I am currently saving 10% per month ($100) on my son’s daycare costs because I am a nurse.

◉ I have also saved money on my monthly rent in the past with a special nurse’s discount. 

Bottom line, always ask for and search for healthcare worker discounts before making any purchase. You would be surprised how much you can save by trying this tip alone. If not, the worst that could happen is you are told no. But you won’t know unless you ask. 

2. Skip or limit the fancy coffee purchases

Yes, we are busy nurses who run on caffeine. It might as well be part of the food pyramid specific for healthcare workers! We all know that Starbucks coffee just hits different (their cold brew iced coffee has a special place in my heart) but indulging every shift can really impact your wallet and overall budget.

For nurses who are trying to find a place in their budget to save money, this can be a great place to start. You don’t have to eliminate the Starbucks runs altogether. Try limiting them to once a week, or twice a month; whatever you think is achievable for you. 

You can also try bringing your own coffee maker, coffee, and sweetener to keep on your unit to eliminate those last-minute expensive coffee purchases on the way to work. If you know you are always in a rush in the mornings and just NEED to stop somewhere for coffee, try Circle K’s Sip and Save monthly subscription. For just $5.99 a month you can get one free coffee per day. If you stop for your morning coffee there 3 days per week, that comes out to only 49 cents per coffee.

This won’t save you hundreds of dollars by any means; but it’s a solid option if you are needing to find a place in your budget to cut back on some expenses.

3. Carpool to Work

With the cost of gas nowadays, depending on the distance of your work commute and your schedule, carpooling to work could truly make a difference in decreasing your monthly gas costs.

Some facilities may even offer an incentive for staff members to consistently carpool to work. If you have a work buddy that you know you vibe with, this can be a great way to save you both some money each month on fuel costs.

4. Keep a stash of snacks and essentials in your locker

I am embarrassed to admit, I have spent my fair share of money on vending machine snacks during my hospital shifts. Many times, I just forgot to bring snacks to work. I also loved to pack myself some healthy celery and carrot sticks, and then change my mind last minute and decide that I NEEDED to have a salty bag of potato chips STAT. Vending machine snacks can be as much as $4 per item!

Snack items will ALWAYS be cheaper when bought in bulk at grocery stores. Try making a snack run at the grocery store before your shift and keep your locker full of items such as chips, trail mix, gum, candy, or instant coffee packets. Basically, anything you know you might have a sudden craving for during a stressful shift.

5. Plan your big work purchases around prime discount seasons

Nurses know that good shoes, scrubs, and compression socks can get pricy. Nursing is a very physically demanding job, and these items are essential for nurses to their job well. Nurses spend a LOT of time on their feet and can do a lot of squatting and heavy lifting at work. 

I once ended up with a bad case of plantar fasciitis because I tried to “save money” on buying cheap, off branded shoes to wear to work. The medical bills treating this ended up costing WAY more than an excellent new pair of shoes would have cost me! Also, you do not want to be working a 12-hour shift in scrubs that are poorly made and uncomfortable. I learned that shoes and scrubs, while expensive, are essential for me to spend money on as a nurse.

Try to save on these larger, essential purchases, by trying to plan them around key discount times. I would typically buy new scrubs and new work shoes twice per year. I would always try to buy them during Nurses’ week in May, and again on Black Friday in November when discounts may be larger and more readily available. By planning these essential purchases this way, you can still save yourself some money without sacrificing the quality of the items you need to purchase.

6. Buy nursing supplies gently used

If you know that buying brand new nursing gear is just completely out of your budget right now, buying some gently used nursing gear can be a great option when trying to cut costs.

A quick search on Facebook marketplace shows that you can potentially find gently used Littman Stethoscopes going from as little as $12 up to $50. These stethoscopes can be hundreds of dollars brand new. You do not need a shiny, new stethoscope to do your job effectively. If your nursing gear is clean, and in good working condition, it does not really matter if it was purchased gently used or new.

For the nurse just starting out, or looking to temporarily cut costs, buying some of your supplies used can be a great option until you can save up for a more expensive item on your wish list in the future.

7. Plan your meals and pack your lunches

I know from experience, that when working 12-hour shifts this can be VERY hard to do, especially if your shifts are back to back. I struggled with meal-planning and STILL do. For nurses working irregular schedules and 12-hour shifts, it can be challenging to plan meals and consistently pack lunches. Going to the grocery store was the LAST thing I wanted to do on my days off work.

But packing food can be a great way for nurses to save money. Planning your meals and buying your food at the grocery store will be less expensive than buying your meals at the cafeteria. Especially for night-shifters when the cafeteria may be closed, if you don’t have food packed from home, your only option might be to order from Doordash or Grubhub which comes with a lot of extra fees.

Nurses can save on meal costs by investing in some meal prep containers, and plan dinners that will make great lunch leftovers the next day. If this seems WAY too difficult and unachievable, try doing it once per week to start off, and see how it goes. Even eliminating just one big meal purchase at the cafeteria per week can make a huge difference in your budget.

8. Buy your wine in bulk

This final tip speaks for itself. You may think you don’t need this tip, but maybe just keep it in the back of your mind for later. A 750 mL bottle of wine costs at least $10 or more. A 5 Liter box of wine costs as little as $17; and stays fresh in the fridge for over a month. 

Save a little money by keeping that bulk wine ready for when it’s needed after those rough shifts. While you’re at it, might as well stock up on chocolate as well. I got this tip from a friend, of course!

It can be difficult and overwhelming to think about how to find extra money in your budget and save money as a nurse. Our irregular, inconsistent, and long hours can make planning our purchases and tracking expenses a challenge. Try even just a couple of these tips this month and see how much money you can save. Saving money on everyday purchases can really contribute to you staying on budget and getting closer to your financial goals. As nurses we spend hours on our feet saving lives every day at work. Don’t forget to ask for those discounts and take care of yourself too.

Source: nurse.org

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Top 5 Tips to Stay Organized as a New Nurse

Being a new nurse may feel overwhelming no matter how much you have prepared yourself. There are approximately 2,400,000 registered nurses in the United States, and around 155,000 new nurses graduate every year. Nurses are in high demand, and patient ratios can range anywhere between 1:1 in critical care to 60:1 in long-term care.

Your shift can move quickly and be interrupted and changed throughout the day. This is why it is essential to stay organized as a new nurse and be ahead of the game.

Tip #1 - Start Your Shift with a Chart Review 

One of the most important things you can do to stay organized as a new nurse working at the bedside is to start your shift by reviewing the patient's chart before seeing them. This is crucial as you can find laboratory results, medication times, and doctors' notes to give you a clear picture of what is happening with your patient.  

Tip #2 - Use Report Sheets

Also known as a "brain" for some nurses, report sheets are paper notes you have that describe your objectives for the day for each patient. Use your report sheet to make notes from the nurse you are taking over.

Write down what you learned from your chart review by making notes of the medications, a list of doctors, laboratory results, pertinent history, and exam information. Keeping this report sheet with you will help you stay organized as a new nurse.

Tip #3 - Plan Out Your Day

Planning out your day by the hour will help you really help you stay on top of things. Write down your patient's medication times, assessment times, laboratory times, and anything due at a particular time. This could even include meals, glucose checks, Foley care, PIV hourly checks, and other  ADLs. Make a list of hourly times and in each time slot, write down what needs to be done in that hour. This will keep you on task so nothing will be forgotten. Helpful hint: Some report sheets will even have these!

Tip #4 - Prioritize Your Shift

No matter how hard you try, something will happen in your day to cause your plan to be disrupted. Prioritizing tasks is one of the things that new grads struggle with the most. When something changes your plan for the day, try to reorganize to accommodate. 

Hopefully, you have already planned out your day and need to rearrange to make room for something else. Look at your list and see where is the best time to perform the task. How important is this task, is it an emergency, or can it wait? Can you bundle care and include it during another assessment or medication time?

Tip #5 - Stay on Top of Things

Staying organized will help you succeed as a new grad nurse. Organize times for yourself to chart if you cannot chart as you go. Make sure to stock your pockets with all the essentials you need throughout your day and keep items in the same pockets. It can be stressful to find your pens in one of six pockets when trying to take an order or write down useful information. 

It will also be helpful to use check boxes on your report sheet to mark tasks off as you go. This will keep you on track and able to navigate your day efficiently.  

These tips will help you stay organized as a new grad nurse when working in a bedside environment. There are several different ways to organize your day and manage your time efficiently. It can take time to figure out what works best for you and that may even change every shift. Consider speaking to your preceptor or senior staff nurses to find out how they keep their shifts organized. It might help you figure out a way to be even more efficient at the bedside.

Source: nurse.org

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Nurse Substance Abuse, How Alternative to Discipline Programs Can Help

“It’s weird to say I’m an IV drug user but I am,” says Leslie L., a Registered Nurse in Georgia.  Leslie says her addiction began when she was working as a surgical nurse at a hospital in Georgia. She accidentally took Dilaudid home in her pocket she had meant to waste. She called her employer who told her to throw the drug away and not to worry. But Leslie says she had seen the effects narcotic drugs had on her patients, and she wanted to get a good night’s sleep and to “…. stop the world for a minute….” Within the week Leslie says she was addicted to narcotic drugs and regularly diverting from her employer, taking narcotics meant to be wasted by the end of her shift. “If you told me I was going to try heroin I would have recoiled. ‘Oh my God are you crazy,’” she says. Leslie diverted narcotics for about a year before her employer intervened.

Alternative To Discipline Programs (ATD)

Leslie is not the only Registered Nurse to confront addiction. The number of nurses struggling with addiction is an estimated ten percent and is on par with the rates of addiction in the general public. And with the pandemic raging, the number of nurses facing addiction battles may be rising too.  Alternative to Discipline (ATD) programs began in the 1980s when state boards of nursing began to see addiction as a disease and offer help to addicted nurses instead of automatically removing them from practice. Today there are ATD programs in 40 states across the country, and length and requirements vary among the programs. What’s more, ATD programs are underutilized, with low enrollment numbers compared to the population of nurses in most states.  The National Council of State Boards of Nursing (NCSBN) conducted an analysis of ATD programs and found that successful programs last at least 3 years and include frequent check-ins and random drug testing using different methods, including hair, and nails, and urine. Additionally, NCSBN found program completion rates for ATD programs to be between 52%-72%. This year NCSBN plans to conduct a pilot study this year to measure program outcomes beyond ATD programs.

Ridgeview Institute: A Successful Program

Leslie L. is currently under a 5- year consent order from the Georgia State Board of Nursing and enrolled in a treatment program at Ridgeview Institute in Smyrna, Georgia. Ridgeview Institute offers a comprehensive treatment program for nurses struggling with addiction. “Ridgeview offers 5 years of monitoring, and that monitoring is a nurses’ group and generally a therapy group,…The nurses have to call in every day and see if they have a drug screen, “ says Donna McGrane, RN Community Liaison at  Ridgeview.

According to McGrane, the state writes up the requirements for the diverting nurse. After an investigation, the Georgia State Board of Nursing issues a consent order and a formal mental evaluation. A nurse’s treatment experience is based on the results of that mental evaluation and recommendations of a treatment team. Ridgeview then monitors the results of the drug screens and makes sure nurses are in compliance with state requirements.

McGrane says the nurses in the program get close because of their shared experience and have an intimate bond that is special to see. “They know what it's like to be the patient now,” McGrane says. According to McGrane a program with support is huge. Ridgeview also offers a mixed professionals group made up of addicts from a variety of professions including nurses, doctors, pilots, and pharmacists. There is a common thread that runs through these professions, says McGrane.

The Coming Addiction Crisis?

McGrane says she has seen firsthand the negative effects the stress of the pandemic has placed on the nursing profession. According to McGrane, she has seen more nurses entering the program with depression and drug and alcohol relapses since the start of the pandemic. “Nurses come to our program saying ‘I can’t watch another person die,’” she says. According to McGrane, nurses who did not have a problem with alcohol or drugs before the pandemic is at risk when they turn to addictive substances as stress relief. “Definitely in the recovering community there have been more relapses,” McGrane says.

Paying the Piper

Leslie L. credits Ridgeview with saving her life, but she says the corporate nature of treatment is a drawback to the treatment model. “They may admit you for a few days without payment but you can’t enter into the program without substantial financial resources. If you don’t have the financial resources, you may be out of luck,’ Leslie says. Donna McGrane agrees. “The challenge is the hospital fires them and then the nurse doesn’t have the health insurance and they don’t get the help,” McGrane says. Leslie L. was one of the lucky ones. “I was fortunate enough I did not lose my job,” says Leslie. “I was asked to resign, but not before I went on medical leave and FMLA. I had insurance to get me through it,” she says. Ridgeview gave her a safe comfortable place to begin to recover, Leslie says. 

Leslie works in case management now, and although she misses bedside nursing, she is in a good place in her life and career now. She will be at the end of her 5-year consent order this coming August and she feels ready to manage sobriety on her own. Leslie says, “Between Ridgeview and the Georgia Board of Nursing I don’t know if I would be here.”

Getting Help Now

If you are facing mental or substance abuse struggles SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Source: nurse.org

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How Nurses Can Prevent Career-Ending Back Injuries, Practice Good Body Mechanics

I want you to think back to nursing school. Remember all the sacrifices you and your family made to get to the end goal of becoming a nurse. Remember all the grueling hours you put into making the grade? Now, what if I told you all that hard work could be erased with one wrong move? Well, it can be!

Incorporating good body mechanics into your daily work routine is vital to ensuring you can continue to physically keep up with the everyday demands of nursing. It could mean the difference between longevity in your nursing career versus retiring early due to a likely preventable injury.

What Is Proper Body Mechanics

Proper body mechanics in healthcare can be defined as using specific techniques and muscles to carry out high-risk tasks without causing strain or injury to the body.

We have all sat through boring lectures and in-services on proper body mechanics. How much thought do we give it when we are performing our job duties though? Is it really that important?

How Important Is Proper Body Mechanics

We are taught proper techniques for lifting and performing other high-risk duties as nurses, but how important is proper body mechanics?

◉ Musculoskeletal disorders (MSDs) are a major cause of injury in healthcare workers, according to OSHA.  The lower back is one of the most affected areas. Often, this is attributed to poor body mechanics.

◉ 38% of nurses are affected by a disabling back injury or back pain, the American Journal of Critical Care found. Staggeringly, 9,000 healthcare workers are injured every day while performing work-related tasks!

◉ 78,740 nonfatal injury and illness cases involving registered nurses (RNs) in the private industry alone were documented by the  US Bureau of Labor Statistics in 2020. Of those cases, five thousand eight hundred and fifty involved a back injury. These statistics only include RNs! The numbers are even higher when you factor other healthcare workers into the equation.

◉ Newer studies are now finding a link between work-related low back injuries and higher mortality rates. Further studies are needed to substantiate this claim and nail down the specifics. Nonetheless, research is suggesting a link between the two.

Do you think those numbers are scary? Now that is something to think about!

Understanding The “Why” Factor

It is so important to understand the “why” factor as opposed to just being told we need to do something. When we understand why something is important, we are much more apt to follow through with it. 

These statistics shine some much-needed light on the “why” factor and strengthen the importance of following proper body mechanics guidelines.

How To Prevent Back Injuries as a Nurse

The good news is by practicing good body mechanics you can markedly reduce your risk of becoming a part of these statistics.

Some basic techniques you can use to prevent injury when lifting include the following:

◉ Stand with your feet shoulder-width apart to provide a good base for support

◉ Get as close to the patient as possible

◉ Face the patient when lifting

◉ Don’t bend or twist at the waist

◉ Bend with your knees

◉ Lift with your legs and not your back

◉ Use a mechanical lift when available and not contraindicated for the patient

Practice Makes Perfect

It is so easy in a fast-paced environment like nursing to forget about good body mechanics. However, it is an absolute necessity to remember it. 

Practice brushing up on your body mechanics, so it becomes a habit.

The more you practice, the better you will become, and the less likely you will be to sustain a work-related injury due to poor body mechanics.

Protect the investment you made in yourself when you started your nursing journey. Don’t become another statistic!

Source: nurse.org

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As a Nurse It's Hard To Move On From Some Patients, You're Not Alone If You Struggle Too

A few weeks ago I heard a doctor tell me, “That is a five-shower case.” My mind automatically started to think about what physiologic cascading effect he might be referring to. After witnessing my perplexed face, he gently responded by saying “after five showers, I might be able to stop thinking about that one constantly.” There was something so comforting in hearing that I would not be alone in my confusion, sadness, or insufficiency towards the events that had transpired during that shift.

I had a small degree of peace that occurred thinking of the visual of showers clearing out my headspace from thinking and dreaming about work. I think so often we forget to allow ourselves the space to acknowledge that our work can be emotionally draining and difficult to process through and that we are not the only ones processing this response.

It has always been interesting to me which cases stir up an emotional rise, and which horrific stories turned out to be unpredictably easy to move on from. Sometimes the sad cases for other people make me question whether or not I have the capacity for an emotional response anymore. Then a seemingly standard patient will cross my path and something about their story makes it hard to shower off.

After working in a critical care setting for multiple years, most nurses carry at least one or two patient stories near to their hearts for years to come. However, our nursing culture has taught us to normalize the unthinkable, and quickly pick up the pieces and move on to the next patient. Most call it compartmentalizing. The longer you do this - the easier (at times) it becomes and it even becomes our norm. Spilling over into our personal lives more often than not.  Or, maybe a more likely scenario is that many nurses don’t talk about these stories because it feels too personal. After seeing and witnessing some of the most gut-wrenching and raw moments, it almost feels insincere to share their stories with complete strangers of the patient.  After all, how can you put into words the gravity of watching air leave someone’s lungs forever, and see it strip part of the life away from their family while watching it happen?

I have come to realize that I get to participate in some of the most sacred and horrifyingly tender moments in some people’s lives. They are the moments that movies layer with soft music and a dramatic crescendo to help produce an emotional reaction for the audience. Unfortunately, when you are in the room with the patient and watching the scene unfold before your own eyes, it doesn’t need music to cause the feelings to swell inside of you. They are the moments that have small details that will be etched into your mind for weeks to come. The sound of a cry, the position of the hands, the words families choose to speak during the remaining few moments with a loved one, or the lingering eye contact that you had with the patient right before they lost consciousness.

These images have woven their way into my dreams and my subconscious thinking for short periods after caring for the patient, and so often they are moments I don’t want to share with anyone else, because although I don’t see it as a burden to carry, it feels like I witness such an intimate moment of closeness with that family, that it isn’t my story to share.

The moment on replay for this five-shower case occurred when the patient ripped off her BiPAP, grasped at my arms, and looked me directly in the eyes saying “what you are doing isn’t working. Change something.” And I couldn’t.

We were doing everything we could at that moment to help her, but it just wasn’t enough. We debriefed everything that had occurred later that night, and the “what if” questions began flowing. What if we could have gotten better IV access a few minutes sooner? What if we could have given more fluids and meds seconds earlier? What if the family had called 9-1-1 twenty minutes quicker? A lot of the five shower stories make you question your competency as a provider when you become fixated on these questions. Did I do enough? Could another nurse have kept the patient alive?

Five showers. Sometimes time and leaning against a wall with hot water pouring over the body can wash off more than just small dirt particles. I hope we get to a point as collective healthcare providers that we allow for a space to process and grieve the intense interactions we often witness and stop downplaying the notion that the “strong ones” don’t need to pause and reflect. Each individual absorbs emotional reactions and attachments to very different stories, and we need to have empathy for allowing them the ability to feel whatever reactions it might stir. Sometimes it is sadness, other times anger, but I have also seen some nurses completely shut down in a response to a positive emotion that they might not have received in their own walk of life. Maybe they just need five showers to process through it and come out on the other side as a more whole, and complete human.

Source: nurse.org

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

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.

Source: nurse.org

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This is What It's Like To Be a Triage Nurse in The ED

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.” 

https://ncbi.nlm.nih.gov/pmc/articles/PMC5649292/

Source: nurse.org

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Living-Will, Advanced Directives Can Be Saved in a New Video App

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.

Why MIDEO?

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. 

Source: nurse.org

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This Legislation Could Cap Travel Nurse Pay, Staffing Agencies Accused of "Price Gouging"

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 Change.org 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.

Source: nurse.org

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CDC Eases Mask Requirements for Majority of the Country

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?

Source: nurse.org

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Louisiana Takes Action to Stop Assaults Against Nurses

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.

Source: nurse.org

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