How many nurses does it take...?

How many nurses does it take to create a safe staffing environment?

That, of course, depends on a lot of things, which the American Nurses Association tried to answer by asking nurses about their working situations. They conducted an online poll from March 31 to May 12 and got more than 10,000 responses. (Ah, the beauty of the Internet.)

Probably the most glaring response indicates that 73 percent of respondents think that the staffing on their unit or shift is inadequate. My guess is they answered that way because they feel as though they are rushed, aren’t getting everything done, are spreading themselves too thin and/or aren’t able to respond to their patients’ calls in a timely matter.

Here are some other stats from the poll:• Nearly 75 percent of the respondents were staff nurses.• Six out of ten said they knew of someone who had left direct-care nursing because of low staffing levels.• Almost half said they wouldn’t feel comfortable having a loved one being cared for in the facility where they worked.• More than one in three nurses said they rarely or never got a break.

(The entire results of the ANA poll and Safe Staffing Saves Lives project can be seen at www.safestaffingsaveslives.org/WhatisANADoing/PollResults.aspx.)

I can remember days while working on a medical teaching floor when I couldn’t even go to the bathroom, and those often were the days that required overtime. Sometimes it was because all hell had broken loose, but more often, it was that there just weren’t enough bodies to do the work. I went home frustrated and wondered until I clocked in the next morning what I had missed or failed to do.

And even more frustrating, it was always someone who didn’t do patient care that asked why I couldn’t get the work done in the allotted eight hours.

Do you experience any of the same frustrations?

How is staffing at your place of work?

At day’s end, are you satisfied that all your work (and that of others) got done?

Should there be a mandatory nurse-to-patient ratio?

Tell us what you think.

Fight to Live or Right To Die?

Say euthanasia and be prepared for The Great Debate.

That’s what’s happening in Washington state right now where death-with-dignity proponents are trying to get a euthanasia measure on the November ballot. It would permit physicians to “prescribe lethal doses of narcotics to terminally ill patients who want to end their own lives,” according to Time magazine.

About a week ago, a survey conducted by ELDR Magazine, a publication for seniors, found that 80 percent of the 1,070 people polled believe in death with dignity. Two-thirds supported laws similar to Oregon’s, which allows physician-assisted suicide. Even so, it looks like an uphill battle for the right-to-die proponents. Similar measures have been defeated repeatedly around the nation, including in Washington in 1992.

Opponents of voluntary euthanasia argue that proposed laws don’t require an exam by a psychiatrist to rule out depression, and that such laws put pressure on women, minorities, the disabled and the poor to avoid being financial and emotional burdens on their families.

Years ago, I wrote a series of stories on this issue and talked to both sides.

One woman was most memorable. Though she never smoked, this woman suffered from COPD for years and the side effects of the necessary steroids had become too much. She wasn’t terminally ill but she endured the chronic pain of severe osteoporosis and was housebound because of it. She so missed the global traveling she had done with her late husband and trips to the theater with friends. She never said, “I want to die,” but told me that she wanted the option available when the pain could not be quelled, and that her adult children concurred with her philosophically.

A few weeks later, I read that this woman was the 99th person to seek Kevorkian’s help.

I also had a friend who had an agreement with his doctor that when death from cancer was perhaps a few days away, the doctor would administer that extra-large dose of morphine. The doctor kept his promise.

I can’t blame either for wanting to end the pain. They were both fighters, but quality of life was important. They endured as long as they could. Neither made the decision lightly or because of depression.

How do you feel about physician-assisted suicide?

Do you think we should have the right to decide when we want to go?

Has anyone ever asked you to help them die?

Tell us what you think.

The Other Side of the Bed

Have you ever been a patient?

Some people think you can’t really be a good and/or sympathetic nurse, physician or any other caregiver unless you’ve been the “caregivee.”

Having been on the other side of the bed several times, I tend to agree.

I’ve spent several stints in hospitals for broken bones, surgeries, infections and other assorted illnesses—once for more than a month. This hospitalization taught me what it felt like to be nearly helpless and completely dependent on caregivers.

This also was the occasion I came across a couple of really nasty nurses.

They seemed not only to lack understanding of my frustration and fear, but at times actually caused pain. It was many years ago and I wasn’t a very assertive patient. Perhaps part of the problem was that I lacked the energy to complain, or figured my complaints would fall on deaf ears. I certainly wouldn’t let that happen today as long as I were conscious.

During that month-long hospitalization, the best care I received was from a nurse’s aide who obviously knew how to handle orthopedic patients. She deftly moved my broken body and I never felt any pain. I looked forward to seeing her each morning and missed her terribly on her days off. I can still see her face, but can’t remember her name.

The nicest thing this aide did for me was to wash my hair. After two weeks of lying in bed, nearly always flat on my back, I was in heaven as she lathered my locks and massaged my scalp. It was a real challenge to do this, considering what little mobility I had, but she acted like it was no big deal.

So I ask: Have you ever been a patient and did the experience change you or the way you care for patients?

Have you ever been extraordinarily grateful for the care you received from a nurse or anyone else?

Tell me about it.

Who will take care of us?

I don’t know about you, but I’m not getting any younger.

If you’re under 50, you probably don’t even think about your possible future as an incapacitated older person in need of caretakers. I never used to, but now, as older friends fall ill and need help, I can’t help but think about what my circumstances might be. It doesn’t help that there is a huge shortage of nurses and that experts predict it will only get worse.

As we speak, there are an estimated 118,000 nursing jobs in want of applicants. By 2020, the prognosticators think that number will grow to one million.

That number is difficult to imagine and who’d have guessed 25 years ago that such a shortage might happen? It was the beginning of the era of managed care, and hospitals and other facilities were laying off nurses like crazy. The targets more often than not were the ones with the most experience because they were the most highly paid. Everyone in those days feared for their employment longevity.

How times have changed.

Salaries for nurses are up, there are often multiple perks, signing bonuses and more bonuses if you can get your best friend to come and work at the same hospital. Nursing has become a desirable profession, but one factor that is keeping the numbers down is the shortage of nursing schools and faculty. Teachers aren’t paid that well and few want those jobs when more money can be made elsewhere.

So besides higher salaries for nursing school instructors, how else do we fill the need for nurses?

How do we attract more men and women to the profession?

What would you say to convince them that nursing is a worthwhile career?

What do you think?

Men in Whites: Where are you?

Why aren’t there more men in nursing?

There are several reasons, according to Chad E. O'Lynn, PhD, RN, and Russell E. Tranbarger, EdD, RN, FAAN. They list them in “Men in Nursing: History, Challenges and Opportunities” (Springer Publishing Co., soft cover; $40).

For one, they say, we can blame Florence.

Ms. Nightingale, according to the nurse/authors, looked around Crimea and noticed how awful the conditions were in the field and in the military hospitals. At that time – the mid-19th century – all the nurses were men. The “Lady with the Lamp” not only held the men responsible for the deplorable state of care, but concluded they really couldn’t change or be taught, so she began recruiting women into the profession.

Nightingale also was a feminist and believed women should be allowed to work outside the home, so maybe she used this as an excuse to promote the profession as “women-only” work.

By the way, the authors note that male nurses were around long before the war in Crimea. All the nurses in ancient Egypt were men, and monks in Europe served as nurses for male visitors who came to their monasteries. (Nuns cared for the women.)

So just how many men have RN after their name?

After some research, I found that no one really knows, but various estimates have it at between 7 and 12 percent. The last time I actually saw a statistic, it was just less than 5 percent. Whatever the number, it isn’t high.

So we’re back to the original question: Why aren’t there more male nurses?

Nurses’ salaries have risen to a respectable level in the past decade, so men can’t complain about that. And today’s nurses are not only caregivers, but must be very tech-savvy – something that you’d think would appeal to the male gender. Also, there are plenty of areas like the emergency room where men can get their adrenalin rush.

So why do you think there is a dearth of men in nursing?

How do you think the profession can attract more men?

Tell us what you think.

Technology: Devil or Angel?

I have a love/hate relationship with technology.

Take my computer and e-mail … the computer is a queen until she doesn’t behave. She has the ability to make my day or ruin my life. When she’s good, she’s very, very good, but when she’s bad—well, don’t get me started.

And e-mail is mostly a blessing, occasionally a curse.

With a large family, I absolutely love having the ability to write an e-mail once, press the send button and have the missive shoot through cyberspace simultaneously to four dozen people. The downside is that my e-mail inbox fills with hundreds of messages every day, and although I’ve gotten pretty adept at trashing them quickly, it still takes time that I don’t have. And when I return from a week’s absence, taking out the trash takes some major minutes.

I have a friend who believes that this whole home mortgage mess can be blamed on computers. If there were no computers, he reasons, there would have been no way all the unscrupulous lenders could have processed all those bad loans and so quickly.

It seems to me that computers, cell phones, faxes and other amazing machines have put our lives—both professional and personal—on high speed. Everyone expects you to produce whatever it is now and to be always available. On the other hand, we have unfathomable amounts of information at our fingertips. That’s usually good news for patients and patient care, but sometimes bad news when patients don’t know how to discern valid information from the invalid, the incorrect and the quackery.

I’ve talked with some nurses who curse the COWs (computers on wheels) that they push through hospital corridors because the machines often don’t work well. These nurses complain that they spend more time dealing with the errant machines than they do giving patient care. But those same nurses couldn’t do without their BlackBerrys, iPhones and MapQuest.

I couldn’t begin to list all the technological advances in diagnostics and imaging. For the most part, they allow us care for patients in more precise and less invasive ways, but they can present dilemmas that were once non-existent.

So I ask: Has technology made your life—personal and/or professional—better or worse?

What’s your favorite techie invention?

What technology do you wish never saw the light of day?

Has technology cranked up your pace to an unacceptable level?

Tell us what you think.

Wealthy Does Not Make Us Wise

I was astounded, but then again, not so surprised by a headline I saw this past week: “Life Expectancy Is Declining in Some Pockets of the Country.”

What?

Haven’t we Americans been living longer and longer?

Yes, we have—up until now.

According to the National Center for Health Statistics, life expectancy for nearly all Americans has steadily increased since the early 1960s. The number of smokers has gone down (it’s now less than one in five), and the rate of heart disease has decreased. But something happened in the mid-1980s. We began putting on weight and developing all those problems that come with obesity—many of them related to type 2 diabetes: heart and vessel disease, stroke, kidney failure and other life-threatening illnesses.

Experts at Harvard sum it up this way: There are places in the wealthiest country in the world, which spends more on health care than anyone else in the world, where health is getting worse.

Not surprisingly, the places where life span is decreasing are some of the poorer counties in the country; they are in Appalachia, the Southeast, Texas, the southern Midwest and along the Mississippi River. (Life expectancy continues to increase in the Northeast and on the Pacific Coast.)

There also are more African Americans in counties with decreasing life spans.

And one last stat: The differences in life spans between the counties with the lowest life spans and the highest are 11 years in men and 7.5 years in women.

So whose fault is it anyway?

Is the problem the lack of personal responsibility, education and/or access?

Is it the high cost of health care, the unequal distribution of resources, or all of the above or something else altogether?

Tell us what you think.