NURSING STATION  Nursing News $667 Million Fine

A for profit nursing home company, Skilled Healthcare in California, was assessed a $667 million penalty for gross neglect of the patients in its care in a class action suit. The suit which represented 32,000 plaintiffs is supposedly the largest claim of this type to ever be awarded.

The suit was primarily brought by the daughter of a patient who suffered from Alzheimers. She found her father in urine soaked clothes almost daily and often had to wait for lengthy periods before staff would come to help. 

The court ruled that the company had deliberately short staffed its facilities and violated the California law regarding patient to nurse ratios. Read the full article

What is especially disturbing about this story is the fact that in spite of California laws mandating staffing hospitals and other care facilities are ignoring it.

Another disturbing fact is that when stockholders get involved they can influence patient care by putting pressure on corporate leaders to put profits ahead of patients.

Featured Website
Ok, sometimes the serendipity just appeals to me. I found a site called The Nursing Site .  The site is owned by Kathy Quan, a former guide to nursing on About.com. The site has a bounty of articles about nursing. It also has links to nursing history, nursing issues and even some basicskills articles to teach/reinforce nursing skills. I always say when you don't know what to do...go back to the basics. You can never go too far wrong sticking with the ABC's of nursing. Airway, Breathing and Circulation.

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Spotlight on Alternative Careers -Nurse Educator

Have you ever thought about being a nurse educator? Someone has to teach the next generation and share that nursing knowledge with the neophyte nurses.

Sure, you hear the cons. The pay sucks, the students hate you, and the colleges all hate nursing because it costs more to educate nurses than it does to educate accountants or liberal arts majors. 

But, there are pros you know. The hours of work are usually Monday through Friday and you usually do have an eight hour day. Many Nurse Educators work 9 months out of the year but get paid year round. You get all the major holidays off and you don't have to trade to get Christmas off. Additionally, if you work for a state university chances are you have a true retirement program and you can take additional education classes for free. Imagine being able to earn your PhD for practically nothing.

The requirements for being a nurse educator vary. Some 2 year programs will let you be a clinical instructor with a BSN. To teach didactic classes you usally have to have at least a Masters degree.

If you really have a passion for teaching or you think you have a talent for it you definitely owe it to yourself to check it out. And if you have your doubts about being a college educator there are lots of other places a nurse educator can work. Virtually every facility has a nurse educator who is in charge of planning, forecasting, scheduling, teaching, and managing the professional development and mandatory education needs of the organization.

Nurses in History

This issue I am not going to feature a nurse in the Nurses in History section. This issue I want to focus on a unique holiday... Labor Day. This year September 6th is officially Labor Day. For many nurses this is a paid holiday. The history of this holiday or national recognition of the labor of the working person all over the country dates back to 1883.

The first Monday in September 1883 was celebrated by the Central Labor Union of New York City. This eventually grew to be recognized as a national holiday to recognize the efforts and hard work of the average working person in the United States and a formal act was passed by Congress in 1894.

Nurses definitely are hard working and deserve the recognition afforded to all working stiffs by this national holiday. And besides, its usually a great 3 day week-end to enjoy one last family get together before school gets into full swing and the fall weather makes outdoor activities less pleasant. For more information about the history of Labor Day check out http://www.dol.gov/opa/aboutdol/laborday.htm http://www.usa.gov/Topics/Labor_Day.shtml

Nurses and Labor Unions actually have a lot in common. Historically they have championed unpopular but important causes. Labor day, the 40 hour work week, week-ends and holidays off, patient safety, nurse to patient ratios, safe lifting initiatives and much more are all things that we owe historically to nurses and labor unions.

So, while we enjoy our long week-end and the BBQ before the kids get back into the full swing of school and the weather turns nasty lets all give thanks to the nurses and the other people who fight for the right causes. :)

Travel Nurse Tip- Call the Doctor?

It's 0200 and Mrs Smith's pulse is 120 and her BP is 102/62. The two have been going up and down respectively for the last 2 hours. Do you call the doctor? Or do you wait until morning and call just before your shift ends? The answer is not always easy. You just got to this assignment and the nurses have all told you what a bear the doctor covering Mrs Smith is when he is called in the middle of the night. and the MAP is still in safe territory.

Wait and see? Or call now before the crump? Your instincts tell you Mrs Smith is going crump. It's just a matter of when. Here are some things to consider:

What is Mrs Smiths baseline?

Did the Doctor leave any parameters in his standing orders? such as call if: BP < = 100/60 or >= 140/90, Pulse <= 60 or >=120

What is the hospital/nursing policy? Check to see if they have a standing policy for just such a contigency

What are the other factors in this situation?

What is the fluid volume?

Is Mrs Smith a fresh post op?

Does she have a fever?

What is Mrs Smiths level of consciousness? Is she less responsive now or the same?

What are your legal and ethical responsibilities to the patient? why am I including this one you ask? Because, the truth is that most of us know when to call the doctor.

We usually hesitate when we want to spare ourselves some degree of discomfort. Dr Wisenhammer is nasty at 0200. I won't call and then I won't have to answer rhetorical questions like "how stupid are you nurse". Well, sometimes we get to deal with Dr Wisenhammer and the choice is to let the patient suffer or deal with a cranky person who doesn't appreciate being woke up at 0200. I guess it didn't occur to the doctor that this was an occupational hazard when he/she chose it.

So, we get to say witty things like "Dr Wisenhammer, I didn't call to discuss my intelligence. And I do appreciate that you probably are very tired. I called because I think Mrs Smith is getting ready to decompensate. Her pulse has gone from 80 to 120 and her MAP has dropped 20 points in the last 2 hours. What are your medical orders sir?"

Chances are when you put it in terms like that Dr Wisenhammer will respond like the professional he/she is supposed to be. The key is to be professional. Don't hesitate and act like the reason you called is trivial. know your facts and rehearse the details. Don't lead off with...."um, huh, well, you see, she doesn't doesn't look right...you know what I mean?"

No, Dr Wisenhammer does not know what you mean. The medical model is not the nursing model and they deal with facts, physiological changes, parameters and other details that help them diagnose what is going on with the patient. Your misison is to provide those facts and details. Once you do that you can tell the doctor that your instinct tells you she doesn't look right and that you think Mrs Smith is going to crump and you really prefer to be proactive not reactive.

If you still aren't sure after consulting the standing orders and the nursing policies then consult with the charge nurse, a resource nurse, or the house supervisor. Once you have done all this be sure to document what you observed, the details such as vital signs and fluid balances, and your interventions including when you called the doctor, what information you shared with the doctor and what orders you received. 
A special thank you goes to KKelli for suggesting this topic.

Suggest a Topic

Got a topic you'd like to see? Suggest one to alphatraveler@the-travel-nurse.com and you just might see it in our next monthly issue.

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