The American Nurses Association (ANA at www.nursingworld.org) has been diligently working on a very important patient and nursing care problem through research and dissemination of vital information. The issue is nurse staffing, or how many nurses care for a particular number of patients in a specific area/floor/unit of a hospital. For those of you who are not health care workers, but are instead the patients, nursing staff numbers on units are vital to patient safety and to nurses continuing their career in nursing (not quitting due to frustration and exhaustion). Suffice to say, good staffing of units is critical to all of us. With the amount of medical center and insurance profits declining, meaning cuts to hospital budgets, nurses are usually the first to go.
The ANA is attempting to get the word out on the importance of safe staffing numbers with their initiative called Safe Staffing Saves Lives (http://www.safestaffingsaveslives.org/). Here nurses and patients can go, read, take the poll, provide their own anecdotal story and become informed. Although mandating staffing ratios at a federal level brings on an entirely new level of paperwork and issues for the nurses who staff the floors and direct the staffing of the floors, the ANA brings up some valid points. With a nursing shortage, outrageous national spending, and a world-wide recession adding to the complexity of something as small as nurse staffing it becomes easy to question whether safe staffing levels can be achieved now. However, it is clear that someone should at least be recognizing and transmitting information on the depth and effect of nurse staffing issues. Thank you to the ANA for being the voice for patients and nurses.
I have a colleague, friend and fellow nurse practitioner who works exclusively with abused children. It is an honor to know her and gain from her knowledge. Below is a recent e-mail she sent to a friend and myself about protecting our children from being victims. With her permission I am publishing it as good information for any parent. Thank you Cindy Tull MSN, APRN, FNP-BC for your work and care of those who cannot defend themselves.
Prior to being a nurse practitioner I have worked in the health care industry for over twenty years from medical assistant, to nursing clinical instructor. (Her primary focus has been pediatrics) I have seen a number of children abused over the years and always had a heart and desire to serve abused children in some capacity. After receiving an opportunity to be a full time medical provider for a child advocacy center my naive view has been broadened; my “eye’s being open” to what children are exposed to has me alarmed and I feel the need to tell others and to hopefully bring more awareness to those raising children of their own.
I would like to humbly give advice to parents and stress the emphasis that today is a different world than when we were a child. I would also like to stress that by living in a rural community or in the “bible belt” does not make you exempt from abuse. Today children are at a greater risk of being abused by older siblings, step siblings, cousins and friends. There are many theories why abuse is more prevalent. I personally believe children are exposed to over sexualization, which is contributing to abuse by older children and adolescents. These children are watching more television and movies than ever before. Likewise, they are not being monitored with Internet or cell phone use.
They are exposed to sex and nudity and it’s all available at their finger tips. Unfortunately, parental controls are not a total safe guard. If you have parental control I encourage you to put in basic images searches such as “models” and see what you find. Also, email and Internet sites like Facebook and MySpace are a source for perpetrators to prey on your kids and for kids to prey on each other. Check out YouTube for yourself, there are plenty of adult sites and inappropriate material. These sites go unchecked and your child is exposed to explicit nudity and graphic dialog.
I previously mentioned the cell phone use. This is a place too where children are exposed to messages with graphic dialog and explicit pictures. There have been known “sex rings” where pictures of one child naked are sent to another child. Some phones have internet access and can easily access pornography. Texting leaves children open to vulgar conversations, language and bullying.
What are you to do?
- Talk to your children. This may seem a bit obvious and it is one of the most crucial tools of parenting. What should you talk about? Tell your children that you know what it is like to want to be “liked” and to have friends. You are the expert, you’ve been there so share your experiences openly. Inform your children what to be mindful of and to be guarded of what they see and hear.
- Tell your child never to go or be alone with anyone, even if they know the person well. For example: If you are at a family gathering and the children are off playing in another room and one of the older children want to tell your child a secret and they need to be alone and they tell the other children to go away.
- Know your children’s friends and their parents. Know who and where your child is going to be. If they tell you they are spending the night with a friend, call the parent of the friend and have the child make contact with you during that visit.
- Tell your child they will not be allowed to have a computer in their room. They can use the computer on the kitchen table or locate a computer desk in the main living area, so you can see at any point what they are working on. Also, check the sites your child is visiting. Know your child’s pass codes. There are ways around these codes too, if you are not a computer specialist…. seek a computer specialist out and utilize them.
- Do away with facebook and MySpace? Talk with your child about only allowing close friends and to not accept friends of friends and especially no one that you do not know personally. AND MONITOR.
- Discuss the cell phone. Tell your child to not accept picture images. Monitor your child’s texted messages.
- Perpetrators at times have a “grooming” process. They get to know your child and gain their trust. They may present an opportunity to your child as a “teaching” opportunity. They are very persuasive and good at what they do.
- Watch for any changes in behaviors. This may be difficult with aging children to adolescents because they are emotional and all over the board at times; obvious signs are new fears or depression. Sleeping problems and decline in school work and or attendance. Verbal comments about “hating themselves” and eating disorders (anorexia or over eating). Also, drug and alcohol use.
- Know the laws. Children ages 12 and under are not able to consent to sex (even if it is consensual). Look at the laws of your state for child abuse.
- Tell your children and teens to use the buddy system. Never go alone. If being abducted “make a huge scene”. Kick, scream, fight…. Knock things over, throw things, and get as much attention as you can. If you are abducted, make every opportunity to fight and run. Never get alone with the person.
- Reassure your child they can tell you anything (and mean it) and if needed report to the child abuse hotline immediately. Do not handle this hideous crime on your own. Help put perpetrators off the streets and behind bars. If your child discloses to you about a friend – hotline!
Last but not least….. LOVE your children. They are precious and valuable human beings who look to you for parenting and love. Unfortunately, we may not be able to always protect our children from harm but we can do our part to prevent it. We are called to an enormous responsibility to be parents to our children. This is the highest honor and also most challenging job in a person’s lifetime. It’s a job you never get to retire from nor take time off from. It’s truly a lifetime of loving and teaching.
Below is just a list off the top of my head that could greatly reform health care if these changes occurred. All of them relate to nurses in some capacity.
1. Nurse practitioners be allowed to write for controlled substances, long term if needed, in classes 2-5 in all states.
2. Nurse practitioners be allowed to own clinics and have independent practice with very limited control over collaborative practice agreements.
3. Nurse practitioners be allowed to order Physical Therapy, Occupational Therapy and sign birth and death certificates in all states.
4. Registered nurses develop nurse run clinics where basic health education on issues like asthma, diabetes, weight loss, and minor health treatments ( that nurses already know how to do) such as immunizations, developmental screenings and wound care be set up. Clinics to be run without need of a physician.
5. ALL 50 states go to an interstate license compact for nursing.
6. The WHO organization look at the development of an international nursing license recognition for nurses. This could occur at a basic level such as LPN so that American and other nurses who are well trained can go in and work in countries where there is a need (many countries have some brief nursing training but then will not recognize or allow nurses with more education from other countries to come in and work.
7. Place a practicing bedside nurse on all hospital and health care committees where patient care and health care reform are being discussed in any way (Let’s be real… who knows more about what is really going on with patients and in there lives?)
8. Allow nurses more autonomy at the bedside. For example, if a patient has Tylenol on their order sheet for fever and percoset for pain, but the patient does not want the percoset for various reasons…. allow the nurse and patient to decide if tylenol (Ordered for FEVER and not PAIN) would be a better option. (THIS IS NOT PRESCRIBING OR PRACTICING MEDICINE….. THIS IS PRACTICALITY).
9. Support all universities and hospitals that are actually doing valid nursing research. For example, St. Lukes Hospital in KC used their Clinical Nurse Specialists to research the importance of a specific oral care protocol that was entirely nurse driven and developed to decrease their ventilator infection days. Likewise, several nurses recently researched the best design for ICU’s and patient visual contact, care, etc…. who else is going to research this but nursing? Such cheap research that makes HUGE impacts in patient care.
10. Graduate nurses with BSN degrees. If you did not know it, nursing has been fighting this battle for several decades. Nurses with associate degrees are finished faster, however their ability to continue on with education, move into management, design research and nursing protocols is quite limited. Likewise, in researched studies patient outcomes are improved and nurses stay longer in nursing if they are educated at a higher degree level.
11. Nurses and nurse practitioners be reimbursed directly for specific care they would provide in nurse run clinics. This occurs to some degree for nurse practitioners, but not with all insurances yet and not for registered nurses.
Demand Media and their golden boy for marketing this site, Lance Armstrong, have teamed up to create an impressive interactive website that is free to users. Livestrong.com is a multipage website with numerous links, articles, and communities in which to connect with others on the topics of health and fitness. You can check out their mission at http://www.livestrong.com/aboutus/
At first glance the website is a little busy, but quite easily utilized. A personal membership is free and allows followers to track meals, exercise, weight gain or loss, a personal journal and goals. Many other sites tout such capabilities, but are not nearly as complete or require fees. Of course members can always upgrade their membership for a fee, however this is not necessary to make good use of the site.
The meal tracking/journaling is one of the most impressive features. Aptly named My Plate, the program boasts one of the most impressive food archives on the web. The feature is a little slow at times, but overall is very useful for those monitoring calories, fat, protein, carbohydrates and other aspects of their diet. Likewise, the site will calculate total caloric need per day for those who wish to loose a little of their extra weight. For women like myself, who need help and connection but are much to busy for some weekly meeting and love our computers more than life itself…. Livestrong.com is a viable solution to our weight loss and fitness goals.
Although the site is obviously for-profit, not connected to any reputable health organization, overly busy on the home page and a little slow on the food journal uptake…. overall it is an impressive and worthy site. One I am encouraging my patients, friends, and students to utilize. Thank you Demand Media, Mr. Armstrong and other contributors for building a site that may be a help to many who need it. Livestrong.com is preventative health care at its funnest, finest, and cheapest.
There are power in numbers, or so its said. One of the largest health care groups in the world, nurses, are banning together to pledge to move the entire world towards increased health. Is this just an over-inflated publicity stunt or do these nurses mean business? In this, the international year of the nurse, it looks like these nurses are serious about fixing the problems that many other health organizations/professionals have yet been unsuccessful at.
A review of the Nightingale Declaration website at www.nightingaledeclaration.net reveals an elaborate and well organized movement to bring nurses together in unit to battle health issues. Informing the public and bring nurses together in collaboration are two of the top priorities of this organization, that aptly notes at its website “There are more than 15 million nurses worldwide. However, NIGH’s recent research reflects that there is still a poor awareness of the critical role played by nurses in society.”
Building on the pioneering efforts of nurse and epidemiologist Florence Nightingale the organization has endorsements from such fames as Dr. Rowan Williams, the Archbishop of Canterbury and pulls its missional drive from statements by the Rev. Tutu, Sir Michael Marmot and Dr. Ruth Bell. Over 19,000 nurses have already signed the declaration and while signature alone does not guarantee movement by nurses it does denote a recognition of the state of health of the world, social responsibility to those in need and the ability of nurses to meet many of the crises the world faces. It is a first and important step in organization and recognition.
If you would like to read more about the initiative you can at: http://www.nightingaledeclaration.net/. Better yet, sign the initiative at https://www.nightingaledeclaration.net/declaration/healthy/.
Well nursing organizations out there, I would like to use this blogpost to provide you with some ‘food for thought’. As a blogger, twitterer, webmaster (for my local STTI chapter), gen-Xer and member of 4 different nursing organizations I feel I am qualified to provide you with a little communication/engaging the membership and future member advice. You need to be social networking more on the web!
There are scores of nurses and nursing students using Twitter, Linkedin and Facebook (to name a few of the most popular and professional so far). Where are you guys? I have yet to see a presence by the ANA, NLN, AACN, or CCNE in any of these venues. I must admit that have seen Sigma Theta Tau international attempting to facebook, and even joined the group, but have only received one direct communication from them in 6 months time. If you are going to do it, do it well. You need to be directly engaging followers or posting updates they can see at least a few times a week.
Understand Your Audience:
According to TechCruch one year ago Twitter had over one-million plus users, with greater than 200,000 new users per week and over 3 million tweets per day (Arrington, 2008). Those statistics have done nothing but increase in the last year. The majority of Twitter users are either professionals, organizations getting a message out, or gen-xers and younger looking to network. You cannot buy the kind of exposure a platform like this offers for targeting a specifc population. You certainly don’t gain this kind of exposure from an add agency or a mailed out flier.
Let’s talk about those fliers too; with so many more people (nurses) becoming environmentally friendly the desire for mailed fliers is decreasing. Look, we misplace them or throw them out. We want to be able to access the information you have at all times. Put it in a webpage and link to it on your Facebook, LinkedIn, Twitter account and home page.
Facebook has more than 200 million active members world wide, with the average user having more than 120 friends. 20 million of those users update their status each day (Facebook, 2009). Are you, national and local nursing organizations, updating your status every day or directly e-mailing your followers? If people are following you or linked to you as friend they are giving you permission to market to them and keep them informed (you really need to read more Seth Godin on permission marketing).
LinkedIn is the number one place that head hunters and other professionals are going to look at resumes. How great would it be if the nursing organizations such as the ANA, AANP, NLN, etc… would create profiles and link to current members? Talk about a social networking power for nursing….
So the question remains, why aren’t you out there? It is as fast and easy as sending an e-mail. You all are struggling for membership and wonder why you aren’t engaging younger members and yet your appearance within these popular domains is limited to non-existent. It is time to get with the times. Nurses not only are constant change agents, we adapt well. Time to adapt. (Could be a good time to develop a midrange theory on communication, mentoring, and information to keep younger and student nurses engaged in the profession….?).
KUDOS to some organizations at least trying (some not so good at it yet, but maybe the learning curve will begin soon): Missouri Nurses Association (MONA) with a facebookaccount for fans only and Sigma theta tau international with Facebook group page account. Great nurses on Twitter: RNpathways, MedSurgNurses, ElderCareRN, pcRN, AmbulatoryNurse, UVASON, fpbnursing, NursingNews (gannett healthcare), WhatNursesDo, OncologyNursing, FunnyNurse (Journal of Jocularity), bayside747, AmJNurs (AJN), NursingTimes.
References
Arrington, M. (April 29th, 2008) End Of Speculation: The Real Twitter Usage Numbers. TechCrunch. http. 
/www.techcrunch.com/2008/04/29/end-of-speculation-the-real-twitter-usage-numbers/
Facebook (2009). User Statistics. http. /www.facebook.com/press/info.php?statistics
Seth Godin’s Blog (expert on permission marketing): http://sethgodin.typepad.com/seths_blog/2008/01/permission-mark.html
Look, I am a couch potato at heart. I love to eat popcorn and Mexican food and sit on the couch to rest my tired brain after a day of doctoral coursework, teaching overload, volunteering and raising 3 kids, dog and husband. See how I am garnering your sympathy for my lack of exercise? Excuses, excuses, excuses…. Well no more! I am going to give this 8 week thing a try and let you know how it works out.
A challenge is being planned just for us women. The United States Department of Health and Human Services starts a health challenge Monday May 10th for the Chicks! We have a higher risk of heart disease, osteoporosis, depression, fibromyalgia, etc… all of which are best treated by exercise. You would think that I, a seasoned health professional (notice I didn’t say “wise health professional” or even “effective health professional” just seasoned) would be quite active already. At times in my life I have been, I have jogged (not run) a few short races and even once a half-marathon; still I had a week last week where I did not exercises even once. How many of you can relate?
Well, join me and others and maybe we can get ourselves motivated to do something good for ourselves and for the people that have to be around us (I know how bad my mood can get and somehow a little exercise seems to cure that too). The Woman Challenge: http://www.womenshealth.gov/woman/woman-challenge/
I have waited my entire life to go on a medical mission, because of restrictions within the U.S. that means I am going international. It is odd really, for the last 15 years I have been a nurse. A nurse who has seen many new lives come into the world, and several slip peacfully out of it. I have tried to help families, cried with families, prayed with families and done almost every procedure imaginable for a nurse to do (yes, this includes stitches). Why, with all of this important work to do here where I live am I going on a medical mission? I have actually had people ask me this and other questions….. Why would you put yourself in harms way, you have kids to think about? That costs a lot, why wouldn’t you use that expense for your family? Do you think it is ethically sound to go to another country and provide them care for only a little while and then leave without establishing anything? Why don’t we just leave everyone else alone, they don’t have to be just like us you know?
Well, I have pondered these questions and find some of them to be valid concerns. Let me address them as best I can to help others understand my perspective. This gift I have, nursing and motherhood, equip me for compassionate knowledgeable care that not everyone can provide. It is a gift and I am therefore obliged to share it where I can. I do share it in my work, but find that there are others who need my gift freely. I also believe that I am fairly young (as a matter of personal opinion I know) and strong and I am able to go to places that others cannot and do things that others might dare not. I ask the question, if I don’t go ’there’ who will? If I don’t do this now then when and why the heck not? I have enough money that everyone gets fed and the bills get paid and we are warm and safe. What possibly more could I want? Also, showing my children by example what they are called to give up in their own lives and in their future is important. This last point is so important that I have decided to take my 11 year old son with me so that he can work/experience/be changed by this international medical mission. We will be working with some of the poorest people in a country that does not experience wealth nearly by Western standards. This is something he and I both need to live with for a while. Finally, I am not allowed by state laws, insurance companies, etc… to provide free medical care to the neediest people without grilling them about their income, their insurance, and certainly not passing over state lines unless of a natural disaster. This makes U.S. medical missions quite difficult, likewise litigation against even bystanders who try to help is a fear within this society http://www.usatoday.com/news/nation/2007-03-23-samaritan-accident_N.htm.
Anyway, we are preparing in knowledge, patience, strength, and in our spirits for this trip. Maybe this video will explain why…. this is done by Sarah Groves and chronicles her experience going to Rwanda. Well written and does express this longing/understanding of a call to help others well. http://www.youtube.com/watch?v=OSdP6PqsbJY.
Recently I was sent a link to a very important health care paper that I wish more people would read. Although the paper was written in November of last year its message is clear and accurate. Access to health care is an issue because of many of the points brought up in the paper. I do not practice in Florida, but in a state that has very similar restrictions on Advance Nursing Practice. The key problems that it brings out about advanced nursing practice and health care access are critical to solving some of our nation’s health care problem.
The Florida APN’s clearly point out that inability to prescribe controlled substances, inability to be directly reimbursed by medicare and many insurance companies, inability to obtain medical staff privileges at many hospitals, inability to order Occupational or Physcal Therapy for patients, inability to sign death certificates, and inability for APN’s to empanel insurance companies are all major obstacles for heath care access for many. Where physicians require larger salaries and often choose to specialize, NP’s offer a more affordable option to expansion of primary care access. Do not hear me incorrectly, do we need good physicians who specialize and do extensive procedures and surgery… absolutely! However, access to by self-pay and lower income patients is enhanced by ANP access.
As previously noted on this blog, NP practice is noted in many research studies to be equivalent to or better than physician care in important primary care areas (see — http://nursestory.wordpress.com/2008/06/10/np-care-cost-effective-and-on-par-with-physician-care-according-to-research/ ). Without socializing the system we can still improve access. Advanced practice nurses offer a practical and important alternative.
You can access the Florida Coalition of Advance Practice Nurses white paper at: http://www.floridanurse.org/Resources/documents/ARNPWhitePaper.pdf
In late July Medscape and Nursing Outlook published an excellent article on the Nurses Faculty shortage. Important information for a still aging generation and while the economy is grim, the need for health care does not change (See: http://www.medscape.com/viewarticle/586845). Interestingly, many hospitals and health systems want to continue to maintain their profit margin and are thus laying off nurses, placing a hiring freeze, or cutting out over time. While such cost cutting measures are understandable, cutting nurses first is not the wisest choice. Nurses are all ready often overwhelmed with patient loads and with new automation of health care records, which is an excellent step forward, time for patient care is more limited.
On a similar thread, Kindle 2.0 is out and you can check it out at: http://www.fastcompany.com/blog/chuck-salter/dash-salt/kindle-20-ships-february-24-359. However, it may have competition with Plastic Logic. You can check it out at: http://www.plasticlogic.com/. In either case, the world of print is changing. For those of us who are nursing faculty this means text books and the ways that we deliver content are changing. This process is both good and bad. While I am a believer in automation and love the chance to carry around many books all in the pocket of my lab coat, other older students are not so enthusiastic. Staying abreast and viable is critical though for our students who will work in completely automated systems.
Are nursing text taking the lead and migrating to Kindle? A quick search of one of the leading textbook manufacturers Elsevier’s Nursing site reveals that no hits for the term “Kindle” or “Kindle format” are returned from quicksearch. Further, the terms “electronic book”, “electronic text” or “electronic format” only yield 4 book results. Time to pick it up Nursing. Faculty and publishers need to lead the way into this age of technology….
