Veteran Clinicians: Why Not Become Teachers?

Sometimes the best solutions to problems are right under our noses.

The problems are the shortage of nurses and the lack of nurse educators. One leads to the other leads to the other leads to other—well, you get the picture.

The solution is proposed by Colleen Claffey, MSN, RN, CEN, a nurse educator, in the emergency department at Jackson North Medical Center, North Miami Beach, Florida. In a recent editorial, she tossed out this idea: Why not let veteran nurses on the brink of retirement with unmatchable experience teach student nurses in the clinical setting?

“Nursing is at a crossroads with the horizon being a population of aging nurses who opt out of the profession due to foreseen limitations in their role and professional growth,” she writes. “These nurses, if given the choice, may opt to continue practicing clinically if they could fulfill part of their full-time commitment working in another role that is less physically demanding.”

In other words, hard labor is for the young, but they need supervision and guidance. Veteran clinicians could provide this, remain in the patient-care arena which they love, and still have enough energy at the end of a shift to drive home.

“As an aging emergency department nurse,” Claffey says, “I relish the thought of not having to spend all my time on the nursing floor inundated with tasks.”

If these veteran nurses agreed to stay on, it also would help alleviate some of the nursing shortage. They also should command their same salaries, which according to recent reports, is about twice that of nurse educators. That’s one of several reasons why it’s difficult to attract nurses to the teaching field.

“…generating full-time pay while being offered an opportunity to grow professionally and learn new skills in a supportive environment could reduce the loss of valuable bedside practitioners while bolstering the number of faculty,” Claffey writes.

Are there potential problems with this idea?

Sure, this could engender some turf wars.

Some may think that these veteran bedside nurses don’t have enough letters after their names to be teachers, but if those who do have the letters aren’t interested in teaching, then they shouldn’t squawk.

Besides, a good course or two on teaching, mentoring and supervising students in the hospital would probably provide all the knowledge these veteran clinicians need to change career tracks.

And just imagine what pearls the students could learn from those who have spent years in the trenches.

“Progressive nursing leadership initiatives need to work on establishing communication and dialogue about meeting the needs of their respective organizations while filling voids within the nursing profession,” Claffey writes.

See a need and fill it; see a problem and solve it. Hospitals, bedside nurses, nursing schools and student nurses could all benefit from Claffey’s proposals.

Do you think veteran bedside nurses would make good clinical instructors?

What problems do you foresee?

What pearls of knowledge would you pass along to a student if given the chance?

Tell us what you think.

Strikes: Helpful or Harmful?

Why do nurses strike?

I’ve been fascinated by this question because I know that nurses have to be pushed pretty far before they resort to staying home from work.

I got to thinking about this question again because of the news I heard today regarding registered nurses at three Central California hospitals who decided to cancel a five-day strike that would’ve started Oct. 19. They called off the strike because “management expressed a commitment to continue to meet at the bargaining table until a contract is reached,” according to an account in the Ventura County Star.

The 1,400 nurses at these three hospitals have concerns about staffing, patient care and wages.

The union says the nurses want a 6.5 percent salary increase for this year, followed by a 5.5 percent increase for each of the next two years. The hospitals say these demands could threaten their ability to operate.

The union says the hospitals are reducing support staff, which leaves nurses less time to spend with patients. It also contends that staffing should be calculated not only by the number of patients but also by the severity of illnesses and the amount of care required, as California state law requires.

The hospitals counter that they meet or exceed all of the state’s staffing guidelines.

I’m sympathetic to the nurses because—well, I am one and I can remember the years I worked in hospitals and how administration took advantage of nurses. It asked us to work off the clock, gave no thought to our breaks and scheduled us for three different shifts in one week. Back then, there was no such thing as time-and-a-half or voluntary 10-hour or 12-hour shifts, but it would’ve taken a whole lot more abuse before any of us uttered the word strike.

We felt committed and helpless.

I’m glad that most of today’s nurses have more clout.

On the other hand, I spoke recently to a neighbor whose wife was in the hospital for just under 24 hours and the bill was almost $13,000. Health care costs just keep rising and one wonders when the whole system will implode.

I can understand how the hospitals are concerned about costs, but nurses are their most precious asset, even though on the ledger, they are considered liabilities. (Salaries of all employees make up about 50 percent of hospital budgets.)

A hospital’s reputation rests almost entirely on the care people receive at the bedside by nurses. So administrators might consider taking some of those big bucks they spend on marketing and inflated CEO salaries and hire a few more nurses and/or raise a few of their salaries—or both.

What do you think?

Do you understand and or sympathize with your hospital’s position on holding down costs?

Should there be a re-prioritization of revenue, giving more to nurses and less to administration?

Have your co-workers ever considered striking?

Latex Allergies: Haven't Health Care Employers Solved This Problem?

Latex allergies and the problems they cause for health care workers are subjects we haven’t heard about for awhile. From my reading, I’ve learned that there are a couple of reasons why:

The first is that most hospitals and clinics provide non-latex gloves and substitutes for other products that are usually made from latex. Workplaces are obliged to provide these alternatives under the Americans with Disabilities Act, enacted in 1990.

The second reason that we see fewer latex allergies than in the ‘80s and early ‘90s is that with less exposure to latex, fewer allergies have developed.

So, for these reasons, I was surprised to hear that a friend of mine – a physical therapist with a severe latex allergy – was given grief by her new employer when she requested latex-free gloves. While some people’s reactions to latex are limited to skin rashes or itchy eyes, this young woman suffers anaphylactic shock when exposed to latex.

Her employer did supply the latex-free gloves, but not without letting her know that it was an inconvenience.

I was surprised to hear about this, considering how long we’ve known about this allergy.

The first reported case, according to information provided by the American Association of Nurse Anesthetists, didn’t occur in a medical setting. It happened in 1979 to a British woman who developed a sensitivity to household rubber gloves.

After that first case, the reported number of allergic reactions to latex skyrocketed. The reason was partly due to timing. It was in the mid-1980s when hospitals, dentists’ offices and other medical facilities adopted universal precautions that required the use of disposable latex gloves. Some of those who were affected in those early days had to quit work because substitute products were either not available, too expensive or employers refused to provide them.

Thanks to a study conducted by some hospital nurses a few years ago, it was shown that supplying all hospital workers with non-latex gloves was cost effective. By doing so, employers avoided the high costs incurred by treating those who had allergic reactions.

Does your employer readily supply latex-free products in the work place?

If so, are they freely available or do you have to make special requests?

Should employers bear the costs of providing latex-free products or should employees pay for them?

Tell us what you think.

Tough Economic Times: Are Nurses Immune?

With all of the craziness in the economy and the widespread uncertainty about the future, there are few of us who won’t be affected in some way. Well, perhaps Warren Buffet or Bill Gates will dodge this downturn, buy even they may be worth a few billion less than a year ago.

I’m wondering how all of this will affect nurses.

I got to thinking about this yesterday when I saw an ad in our newspaper announcing the opening of a high-end fitness center by our local, large acute-care hospital. The center is separate from the hospital campus and purposely situated in an area of the county where there are many new, upscale homes.

I’m sure the center has been on the drawing boards for several years and the grand plan was for it to help bolster the hospital’s revenues. The site was chosen because of the socioeconomic demographics of the neighborhood, but now, many of these homes are in foreclosure. It’s my guess that the viability of this fitness center may be in jeopardy even before the doors open. In these tight financial times, people are less likely to join pricey gyms or commit to paying monthly membership fees. More likely they’ll opt to walk around the block, which might not be so bad.

Are there scenarios that could cause a drop in medical facility revenues and cause layoffs?

One trend that could have an effect is if people continue to lose their jobs, many of them will also lose their health insurance and thus use fewer medical services. This will hurt facilities’ bottom lines, which could affect nurses.

Of course, hospitals and medical centers will continue to provide care for the insured and uninsured, including those who arrive at the emergency room, because that’s what the law requires. But the number of procedures like gastric bypasses and other purely elective surgeries might take a nosedive, and these are procedures that help boost revenues.

Even with these possible adjustments, however, there seems to be an ongoing need for nurses. With so many approaching retirement age and nursing schools unable to meet the demand for enough graduates, shortages are predicted to continue in the coming decades. So it makes sense that a nurse will always be able to find a job. Whether or not it will be the job of his/her choosing, we don’t know, but opportunities should be available.

What is your situation?

How is this economic downturn affecting you or your area?

Is the recession affecting your place of employment?

Do you think nurses are immune to tough economic times?

Tell us what you think.

Roots in Nursing in North America Reach to 1600s

Throughout nursing school and my years on the job, I never pondered what nursing might have been like in the 1600s.

I usually think about the origins of modern-day nursing as beginning with Florence Nightingale, who wasn’t even born until 1820. Heck, Louis Pasteur didn’t come up with his germ theory until the mid-1800s, so what tools could nurses possibly have had at their disposal in the 17th century?

What jostled my thinking about the state of the profession nearly 400 years ago was the discovery of a plaque during a recent visit to Montreal. I came upon this marker in the historic section of the city. It designates the spot where, in 1642, Jeanne Mance founded Hotel-Dieu de Montreal, one of Canada’s oldest hospitals.

I found the plaque at one end of a beautiful landscaped walkway in an area of the city overlooking the St. Lawrence River. The large brass plate didn’t say a lot, but it did raise my curiosity about Mance’s life and her contributions. I found out that there also is a park dedicated to her in another part of the city.

When I returned home, I “Googled” Jeanne Mance and learned that she was born in 1606 to a well-to-do family in France. She was one of the first women settlers in Canada, which was then called New France, arriving in 1641. A year later, “She founded a hospital in her own home, a very humble one, into which she received the sick, settlers or natives (Iroquois Indians),”according to the Catholic Encyclopedia.

Mance was a devout Catholic, and in the 1600s, Montreal was only a missionary colony. It was established to convert the Iroquois to Catholicism, so many of those who came to New France were priests and nuns. Mance was not a cleric and so is considered the first “lay nurse” to practice in North America, according to the Library and Archives Canada online resource.

The archives go on to say, “Not only did Jeanne Mance establish a hospital but, with remarkable zeal, she directed her energy towards laying the colony's very foundations. When the Montreal mission was in jeopardy, she crossed the Atlantic several times to save it from ruin.” She did this by asking several wealthy families in France to donate money to the colony.

The last sentence on the plaque in Old Montreal expresses a beautiful sentiment:
“Canada’s first lay nurse, Jeanne Mance, remains an inspiration to those who seek a career in the nursing profession.”

Whether we hail from Canada or the United States, we should all be grateful for this brave and caring nurse who dared to make a difference. And thank you, Montreal, for recognizing the contributions of Jeanne Mance and the nursing profession.

Nurses: Red or Blue?

Earlier today, I came across ads for “Nurses for McCain” and “Nurses for Obama” t-shirts and warm-up jackets. It made me think about the political affiliations of nurses. Are there more Republicans or Democrats among the ranks of nurses?

I really have no idea how the percentages run. I suppose that nurses are as diverse in their opinions as the general populace, and I know that, in this election, there are more issues to consider than just health care. But health care is a huge concern for everyone, and nurses have the advantage – or disadvantage – of seeing firsthand the fallout from this country’s lack of a cohesive health care policy or program.

Nurses in clinics, emergency rooms, hospitals and long-term care facilities must deal with the frustrations of trying to get or give care to patients who have no insurance or who are underinsured on a daily basis.

Even though I’m not in a clinical setting, I hear from others frequently about their angst over health care and insurance. They are upset when they learn about the audacious salaries of health insurance executives, especially when they are refused coverage for minor problems.
They are even more distressed when they learn that between 10 and 30 cents of each insurance dollar is never used for actual care. That money is taken right off the top for insurance companies.

Most people I talk to are willing to pay for health insurance. They don’t expect something for nothing. They also generally agree that for those who can’t pay, some basic health coverage should be provided.

The elephant in the room that everyone is ignoring is a really basic question: Should anyone be making a profit off from people’s health or lack thereof?

Some argue that this country prides itself on a free enterprise system (which it really isn’t anymore; witness the latest government bailouts), but is profiting from the certainty that illness will strike most of us the same as making a profit selling cars or flat-screen televisions?

Just to clarify, I’m not suggesting that a non-profit system not pay nurses and doctors and other health care professionals the salaries they deserve. I’d just like to eliminate the need for the millions of dollars that are paid to executives and shareholders.

To be fair, insurance companies provide employment for probably millions of Americans. A non-profit, single-payer system wouldn’t need nearly the number of employees, so eliminating for-profit insurance companies would mean some additional unemployment. There would be no need for the thousands of nurses now employed by insurance companies as case managers, although they should be able to find jobs elsewhere, considering the nursing shortage.

Neither the Republicans nor Democrats are actually proposing a single-payer system. Senator McCain wants to let employers off the hook for providing health insurance, and he wants employees to purchase their own insurance using a $5,000 subsidy. McCain also says there would be a plan for the otherwise uninsurable.

Senator Obama says no American will be turned away because of pre-existing conditions, and that people should have insurance plans similar to the one which members of Congress enjoy.

What are your views on trading a for-profit health care insurance industry for a non-profit system?

Does your party affiliation make a difference in your opinion?

Tell us what you think.

Difficult Patients: Should You Give Up on Them?

How long should you beat your head against a wall before finally realizing you aren’t accomplishing anything?

I’m talking about dealing with difficult patients who insist on continuing their self-destructive behavior, or who don’t follow recommendations, or who continue to resist change—essentially, they just don’t listen to a thing you say?

In the lingo of the health profession, I’m talking about “the non-compliant.”

A person in my family is gravely ill and has health problems that are solely due to really bad lifestyle choices. He’s the poster child for how not to live your life. He ate poorly, smoked and rarely exercised. I can still see the mayo he piled high on the baloney sandwiches, the two hot dogs he made a habit of eating every day, and the thousands of dollars he spent on cigarettes.

Now this person is debilitated and in pain, and the best we can hope for him is a quick death. My family members are doing everything they can to make the time until that happens as comfortable and as safe as possible, but it isn’t easy; he is still resisting. I guess it’s time to accept that this is the way it’s going to be until the end.

You know patients like this. They suck up a lot of time, energy and monetary resources, and cause those who have to watch their deterioration a lot of heartache. Their behavior raises a lot of issues – medical, ethical and moral.

How responsive and responsible should family and friends be when these patients are unresponsive and irresponsible?

Should these difficult people be required to carry more of the burden or cost of care by paying higher insurance premiums? (Some already do; for instance, state employees in Alabama must pay $25 a month, versus nothing, for health care insurance if they smoke or are overweight.)

Are members of the medical profession bound to keep plugging away, hoping difficult patients will change, or do we give up at some point? How far does our professional obligation go?

Tell us what you think.