The Measure of a Man

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.

- Martin Luther King, Jr.

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Friday, December 19, 2008

Hope for the future of our healthcare system.

Hope and Reform

There is finally real potential for health care reform. With the election of Barack Obama and now his appointment of former Senator Tom Daschle to head Health and Human Services and today’s announcement of Hilda Solis to head the Labor Dept, real reform may be on the way. I say may because I have been let down by politicians before but these three have all expressed a need for change for a long time and I have real hope for the first time that positive reform will happen.

Tom Daschle wrote a book a couple of years ago titled “Critical- what we can do about healthcare”, this book offers real solutions to many of the problems that make our current healthcare system inefficient and unfair to those under and uninsured in our country. The following link will take you to a description of the book and reviews by other prominent politicians and public officials.

Hilda Solis named today as the nominee to head the US Labor Dept is a victory for workers, labor and the healthcare system. She is a strong advocate for organized labor and will be very effective in giving strength to the right to organize and pursue a voice for change and justice in the work place.
See her bio at the following links : , .

I believe that strong healthcare workers and specifically nurses that have protection of unions will be able to advocate for their patients safety. The current system and the weakness of the NLRB (National Labor relations board), allows for hospital corporations both private, public, for profit and not for profit to silence their nurses and providers from speaking out about unsafe staffing, unsafe practices and policies or lack of concern for issues related to safety. In today’s system if you blow the whistle or demand that safety issues are addressed you are labeled a troublemaker and terminated or forced out. A strong, pro employee labor dept and a health secretary interested in reform will strengthen the protections afforded healthcare workers and in my opinion make the system safer for us all.

Unions are not all about the wages and benefits. Like in California and Massachusetts, unions have pushed for real legislative reform and have succeeded in making their systems better. I am not implying that they are without flaw in those states but they through the pressures of the unions and their nurse members have achieved real legislative reforms, like staffing ratios, limits on work hours and mandatory overtime. These issues have been proven to have a real influence on outcomes and the safety of patients in the acute care system.

We have a long way to go but I am very optimistic that the team that will assume power on January 20th will serve the American people well and finally put our healthcare and labor system back on the right track to fairness, justice and safety.

Monday, November 10, 2008

Obama supports the Employee Free Choice Act

Lets hold him to his statements. Support the Employee Free Choice Act.

Employee Free Choice Act

This video says it all. It gives a good over view of why the employee free choice act is needed. I hope you will watch and comment. Please support the act by signing petitions at the SEIU, AFL-CIO or the CNA website.

Friday, November 7, 2008

Now that the election is over and we have a President who supports labor and the working men and women of this country we need to move forward and pass the Employee Free Choice Act.

For those not familiar with the act or its intentions, you may want to read an over view from Wikipedia that does a good job of explaining the act and opinions both for and against the act by our congress and our new President elect Barack Obama. This link will take you to the Wikipedia link

I support the act and believe it is needed in order to give employees a chance to freely associate and organize without the intimidation from the employer. I feel that the current system of secret ballots at the place of employment allows for the employer to target the people they see as supporters of organizing and harass them and threaten their jobs if the pursue a campaign for unionization. Union check cards are the only way I see that allows for employees to freely look at the advantages and disadvantages of organizing without the threats and intimidation of the empoyer.

Please take some time and evaluate the issue closely. Ask a union friend about unionizing and what the advantages are. Ask that person what the relationship is between the employer and employee at their place of work. Take the propaganda that most employers use and check with the union employees you know or call a local union and ask them about the process. You will find that the anti union crowd have much to loose if their employees gain a voice. This is about justice and fairness in the work place. Don't act upon emotion but use the skills of rational observation and critical thinking to make your conclusions. Then show your support by contacting your congressperson and senator to let them know how you feel. You can use the link at the bottom of this blog to find you represenatives.

Also join the AFL-CIO in their campaign to pass the Employee Free Choice Act at the following website.

Thursday, October 30, 2008

Naomi Wolf:

An opinion on the path that our country is on. I believe that this is at very least a video that will get you to think about the supression that we have faced in the last eight years. The destruction of lablr and the surrendering of our rights for the sake of a feelinf of false security. Please get the book get the video and make your vote this year count. Tell your legislator that we want more our democracy back.

Nursing shortage presentation on NOW from PBS

PBS and their program NOW recently aired a story about the nursing shortage that I thought was very well made and a must see for all nurses interested in the future of our profession and quality of patient care. I wish the presentation would have focused more on the impact that the shortage is having on patient safety and our ability or inability to meet the needs of our patients due to our decreasing numbers. However with that said the presentation is one of the best I have seen in a while and would like all interested to see.

You can view the video at

Thursday, October 23, 2008

Employee free choice act and the Presidential election.

We have twelve days left until the Presidential election and possibly a new path for America. One issue that is sure to pass or fail depending on the results of the election is the Employee Free Choice act that just recently passed in the Congress but will be blocked in the Senate and get the veto by President Bush.

Barrack Obama will support our right to organize and has pledged to support the act if elected. view the video link below entitled "Obama support the employee free choice act".

The employee free choice act will give fairness and balance to the right of employees to join an union so that they may collectively bargain with their employer for the rights that they feel they are entitled. I would encourage all who read this to examine the issue of employee rights and remember that all the rights that we currently take for granted like the 40 hour work week, overtime, lunch breaks and vacation time are all a direct or indirect result of the labor movement.

The employee free choice act would level the playing field and allow for employees to get to the point where they can meet and bargain with their employer. Currently the environment is scewed to favor the employer and allows for them to intimidate and suppress our right to associate with a union.

Their are great discussions taking place on the subject at and can be read at this link.

I would encourage you to get involved. You can get information on what the employee free choice act says on this site in the right hand margin of the blog and you can find your senator and congressman link at the bottom of this site to assist you in contacting them to show your support.

Friday, October 10, 2008

ANA position statement on staffing assignments.

The ANA is asking for opinions related to proposed changes to the current position on nurses rights to refuse an unsafe assignment. The language is in my opinion more vague than the existing statement. I support changing the position only if it is stronger and should contain language that condemns hospitals and administrators that intimidate nurses into accepting unsafe assignments or floats. I have written the ANA and stated this and am writing this post to ask you to do the same. the email to the ANA contact is listed below. I have also provided a link to the original position of the ANA related to the nurses right to refuse an unsafe assignment, so that you may compare.

Public Comment: Patient Safety: Rights of Registered Nurses When Considering
a Patient Assignment
10/01/08The ANA Congress on Nursing Practice and
Economics (CNPE) is seeking comments on the ANA position statement, Patient
Safety: Rights of Registered Nurses When Considering a Patient Assignment.
which states: "The American Nurses Association (ANA) upholds that registered
nurses – based on their professional and ethical responsibilities – have the
professional right to accept, reject or object in writing to any patient
assignment that puts patients or themselves at serious and immediate risk for
harm. Registered nurses have the professional obligation to raise concerns
regarding any patient assignment that puts patients or themselves at risk for
harm. The professional obligations of the registered nurse to safeguard patients
are grounded in the Code of Ethics for Nurses with Interpretive Statements (ANA,
2001b), Nursing: Scope and Standards of Practice (ANA, 2004), and state laws,
and rules and regulations governing nursing practice."
Download the position
statment below and send comments to
If you are interested in participating in this review, please provide your
comments to the ANA staff member listed above by 5:00pm EST on November 30,
CNPE appreciates your assistance with reviewing this Position

Original position of ANA on right of nurse to refuse unsafe assignment is available at this link: ANA right to reject assignment 1995.pdf

Please let the ANA know that they represent us and not the corporate interest of the hospital and that it is time to let the administrators know that we demand safe assignments and floating practices and demand the right to refuse unsafe assignments without retribution.

Friday, October 3, 2008

P.O.V. | Critical Condition | Joe's Story | PBS

This is an sample of the documentary critical condition that was presented on PBS on 9/30/08. I hope that you will take the time to watch the entire presentation and see that we are all one major illness or injury away from being at the mercy of a system that is failing us all. Please visit to view the presentation. Vote Obama and lets fix the system.

Thursday, October 2, 2008

NNOC testimony to TBON

Can I get a witness?

The text below is only one small part of the testimony that six RNs with the NNOC presented before the TN Board of Nursing on the morning of September 25, 2008. Issue topics were unsafe floating, short staffing, nurses fired for refusing to sign anti-organizing agreements, and institutional pressures on employees to not join pro-union associations. We received a cordial reception which later turned lukewarm. We were told that the proper way to do it was to file for an "Advisory Ruling". Perhaps we'll do that next...

SEPTEMBER 25, 2008


My name is Mark. I work as a staff RN at Tennessee hospital. I'm concerned that patient safety is being put at risk because of inadequate staffing levels. Nurses are being put in the position of either refusing a patient assignment and risk losing their jobs, or accepting more patients than they can safely handle. When a nurse has six, seven, or more patients on a medical-surgical floor, it's quite likely that some aspect of patient care will be missed. Charge nurses are frequently assigned a full patient load, rendering them unavailable to be a resource to the nurses under them. A patient has fallen on the floor after a bed alarm was not answered fast enough, another aspirated some food because no one was assisting with feeding, decubitus ulcers got worse when an incontinent patient was not cleaned up often enough, MRSA isolation procedures were incompletely followed in an attempt to save time, and a PCA continuous morphine dose was not turned off before the patient was stuporous. These are only few specific examples. While they may have turned out to be less than sentinel events, they are still very serious.

In addition to direct adverse events to patients, under-staffing has other consequences affecting delivery of safe care. Many experienced nurses have gotten fed up with the workload, and left hospital nursing. New nurses come in to fill vacancies, but many of these don't stay long because of the stressful conditions. We end up with a high percentage of relatively inexperienced nurses doing their best to care for too many patients. It's a recurring situation, one that management is aware of and has said they will address, but so far, nothing much has changed. It's not unique to my hospital; according to reports I've heard, under-staffing may be even worse at other facilities. As a possible solution to the problem, in the interest of patient safety, the retention of experienced professional nurses, and the recruitment of future nurses, would the Board of Nursing be willing support legislation as proposed by the CNA/NNOC for safe nurse to patient ratios?

Thank you for your time and consideration.
The following was not part of the testimony to TBON:

Below is an excerpt from a discussion board posting, written by the nursing instructor of an RN-BSN course I'm taking, Professional Role Development. It may reflect a typical managerial point of view.

"3) Unions-I am not a union fan in hospitals (note my husband is a union member outside of healthcare). As a CNO, I work every day to provide the best ratios, pay, benefits and work environment for my staff that our facility can afford. I don't see how a union would do any thing in our organization other than complicate things. I have to agree with Jennifer [last name withheld] posting that ultimately if you are not happy with your environment and feel that it is not safe than perhaps it is time to look elsewhere."

So, if conditions aren't safe for patients where I work, I should get a job somewhere else, right? Where should the patients go?

Monday, September 15, 2008

Diagnosis: NOW!

Please take a few minute and watch this important video and support the cause of bringing equality and fairness to healthcare for all Americans. You can get involved by visiting

Tuesday, September 9, 2008

Your Money or Your Life

Linked below are two must see videos that put a human story to the injustice of the American medical system. I hope that you will watch these videos and reflect on how all of us are at risk. I believe in personal accountability but I also believe in compassion of my fellow man and that without your health you are without options. I hope that these stories lead you to see that people are often without the needed resources to even provide for the basics of life and that we as a society should and can do better.

Friday, September 5, 2008

Interesting article on education

Please take a few minutes and read this article from a fellow health care blogger related to education and nurse professionalism. The link to the full article is listed below. I will post only the first paragraph here, just to get you started.

Nurse Perspective

Life Needs Nurses

Published July 31, 2008 9:11 AM by Guest Blogger Roxana Gonzalez, RN, CCRN, is critical care educator at Saint Michael's Medical Center in Newark, NJ.
A nurse advocate's strength is dependent on their drive for knowledge development; very few nurses are taking time to learn. The increased demands on nurses has resulted in a practice that's focused on resolving crisis events at the workplace with minimal time spent on maintaining professional well-being. Nursing has faced many critical situations, but probably none more critical than the situation is now in which there are possibilities for serious loss and substantial advance.1 New knowledge not only allows a nurse to practice according to the latest evidence but it builds careers and innovates professionals to take part in shaping the discipline. Being a patient advocate goes far beyond bedside care, it goes deeper into the reasons behind why a patient is entrusted to the care of a nurse.2 Whether we speak up for patients at the bedside or in a public forum, knowledge is an advocacy empowerment tool that nurses need to impact life.

To read the rest of article click here:

Hope you enjoy. Please take the time to leave a comment.

Thursday, August 28, 2008

Broken Levees, Broken Lives: A Post-Katrina Focus on Health

Broken lives is another testimony to the fact that we need healthcare reform now. Please support single payer healthcare. We need toput compassion and empathy back into health care and put the honor and integrity back in our profession that we have lost due to the lust for profit that now controls our healthcare system.

Wednesday, August 20, 2008

Obama supports the Employee Free Choice Act

Vote Obama for President and support the employee free choice act.

Myths in Healthcare

Myth 1: The US Healthcare System Is the Best in the World
This idea has been called the alpha myth because it is fundamentally the root of all other myths.[1] It is the straightforward belief that Americans have access to the highest quality healthcare available in the world. A different way to present this myth is to state that citizens in other countries experience long waits for healthcare, that they must rely on generalists, and that they suffer worse outcomes as a result.
This belief is widespread and well-entrenched in the American mindset. So it is perhaps surprising that in a 10-nation 1990 survey on the level of satisfaction with the national healthcare system, the United States ranked 10th.[2] These results were then reproduced a decade later.[3] Although Americans believe the US system is the best, clearly they are not as satisfied with the healthcare they receive as are citizens of other countries.

For the full article visit the links below. There are also links to other sections of the article that are interestingand informative. You will be required to register at the site to view the entire story, it is free on the medscape site.

Abstract and Introduction
Myth 1: The US Healthcare System Is the Best in the World
Myth 2: There Will Always Be a Certain Segment of the Population That Remains Uninsured
Myth 3: The Uninsured Have Equal Access to Medical Care Through the Emergency Room
Myth 4: A Free Market Is the Best Way to Get the Highest Quality Health Insurance for the Lowest Cost
Myth 5: We Just Cannot Afford to Cover Everyone

Support the Employee Free Choice Act

The paragraph below is copied from the California Nurses Association campaign for the employee free choice act. I believe and support this campiagn and ask that all who visit this blog will review the issue and support bringing fairness and choice to the American worker. At the site linked below you will find testimonials of real nurses struggle to unionize and advocate for their patients and profession.

EFCA - Employee Free Choice Act
60 million American workers have expressed interest in belonging to a union. 79 percent of them agree they are likely to be fired for trying to form one. It’s time put the era of union-busting behind us.
Union membership has been declining over the past several decades.Employers are waging increasingly vicious campaigns against workers and union officials who attempt to organize for better working conditions. The lag between gathering enough cards to file for an election and the election itself creates weeks in which professional "union busters" can infiltrate a workplace, intimidating, misleading, and harassing workers into voting against unionization. If you think your employer wouldn’t do that to you, think again: 92 percent of employers force employees to attend compulsory anti-union meetings.
It’s time for a change.New legislation can end union-busting. The Employee Free Choice Act (EFCA) would make it possible to elect a union by collecting signed union cards from the majority of workers on a job. EFCA will provide a democratic process to workers seeking union representation, without giving management the lead time necessary to coordinate an attack on workers’ rights to freely associate and organize.
Sign the Online Card to Support Employee Free Choice here!
Download the complete EFCA brochure in PDF

Tuesday, August 19, 2008

Your RX for health care reform

I was recently sent this email from Healthcare united asking for my perscription for changing our health care system. I sent in my opinion, at least the short version anyway and would like to ask you to do the same.

These emails are to be delivered to our senators and congressman at the Democratic convention. I see it as another opportunity to get your voice heard.

In full disclosure united healthcare is a campaign run by the SEIU. I do not support all their efforts but we can and should work with each other on those campiagns that we do agree and we agree that health care is in need of real reform.

The link below will take you to the form for you to submit your ideas.

Tuesday, August 12, 2008

Single Payer Now

Fast Facts about Single Payer

by Suzanne Cowan — last modified 2008-06-17 10:24 PM
The June 19 rally is in support of Single Payer health insurance, as opposed to a system run for profit by private insurance companies. But what is Single Payer?
Did you know?
The US spends more that twice as much per person for healthcare as any other nation, yet
One sixth of Americans have no health insurance.
One half of all bankruptcies are caused by healthcare bills.
Three quarters of those people had health insurance.
Despite this spending, the World Health Organization ranks the US 37th in overall health, the worst among industrial countries.
The US is the only industrial country that does not have a plan that provides health care for everybody.
In the US, there are currently more than 1200 separate for-profit insurance plans. The result is that, instead of paying for health care, about 30 cents of every health care dollar pay for:
Administrative costs such as billing
Marketing and advertising
Risk evaluation (allows insurance companies to provide insurance to the healthy and refuse coverage to those with "pre-existing conditions")
Denial management (the search for excuses to delay, deny or renege on payment for health care)
The June 19th rally supports California Senate Bill 840 (SB 840) and federal House Resolution 676 (HR 676). Both bills would establish a single-payer system of universal health care that eliminates insurance companies as middlemen.
Under a single-payer system in California or nationally, we would spend less on healthcare than we do now, and with far better results. Specifically, a single-payer system would:
Eliminate all current premiums, deductibles and co-payments. Instead, employers, employees and individuals would pay an annual tax that would be combined in one fund with monies from existing government programs. This fund would be the sole payer of all medical claims.
Immediately save billions of dollars by eliminating the excessive costs that insurance companies now spend for administration, lobbying, marketing, risk management, denial management, CEO salaries and profits.
Use the bulk purchasing power to reduce the cost of pharmaceuticals and durable medical equipment.
Increase efficiency and stabilize the growth in health care spending by linking spending increases to state/national GDP and relevant demographic indicators.
Allow the vast majority of people to pay less than they do now for medical care, while receiving far more comprehensive coverage.
Both SB 840 and HR 676 specifically permit free choice of health care providers, both public and private. Current for-profit insurance plans restrict choice to "in-plan" providers,
Many federal and state studies since l990 have concluded that a single-payer system is the only model that is truly efficient, equitable and sustainable. It spreads risk, pools funds, and provides all residents access to medical care.

Support single payer bill HR 676 by writing your representative and letting them know that you want justice in health care and a single payer system. You will find links at the bottom of this blog to find your Representatives e-mail and physical address. To get more information on the model for this bill visit

National Single Payer Bill
HR 676, the United States National Health Insurance Act, was introduced by Representative John Conyers, Jr. The bill has 90 cosponsors. HR 676 closely mirrors California’s SB 840.

Sunday, August 10, 2008

THIS FRIDAY re California's proposed SB840-SHOW UP!

In case you don't already know, in Oakland, California - this coming Friday evening, a couple of the co-authors of California's universal healthcare bill SB840 will be having a townhall. Included on the bill is Senator Sheila Kuehl's Healthcare Consultant (who I think did most of the detail on writing the bill), Sarah Rogers and likely more key people.

THIS NEEDS YOUR ATTENTION - it is CRITICAL that people show up and let the powers that be right now know that it is NOT ok to sweep this under the rug yet again and that we are not going to settle for another lame a excuse of a healthcare proposal (regardless of whether it comes from the Obama camp or the governator).

Humanist Hall
27th near Broadway
Oakland, California

For details: visit

Here are highlights from the last hearing on the bill: YouTube - California Considers Healthcare for ALL-The $ issue

Americans Mad and Angry

I recently read a post on allnurses that led me to a site called Americans mad and angry. The site is a non profit that reports on medical errors and the real life stories of the patients affected by them. The organization does not present an opinion as to how nurse ratios or unions play into the rate of medical errors but wanted to take the opportunity to give my two cents on the subject.

I have posted many videos and written post on the issue of patient safety and medical errors as they relate to understaffing. I have also posted or previously discussed how studies have shown that unionized hospitals have been shown to have better outcomes than their non union counter parts.

I would ask that you reflect on the errors that you are aware of and ask yourself if better ratios, better staff development and true whistleblower protections for safety issues may have helped prevent them. Also review the site that I will link below and ask your self if these were preventable and would better trained and prepared staff have done a better job.

I am not suggesting that personal responsibility be removed but that the hospitals have a responsibility to ensure that their staff is educated and adequate in number to provide safe care. Rushing is often the reason that errors occur and that rushing is often caused by understaffing. They as the employer are responsible for staffing and they need to be mandated to set ratios as they have proven to be not up to the task.

Support mandatory staffing ratios and the unions to allow nurses to voice their concerns as they relate to safety. Support unions, support ratios, support whistleblower protection and reject the notion that your administration is doing all they can do. They have let us all down for to long and they need to be held accountable to someone.

Also review the links on the right of this blog to worthy petitions to support the issues discussed above.

Saturday, August 9, 2008

Money-money-money; we need more money!

I hope everyone has read the story out of LA detailing the lengths that hospital CEO's will go to turn a profit. This story details the lack of integrity and compassion that our hospital leadership shows the public and the patients they are trusted to provide care for. I know that some will say well that's only one example but I will tell you to review your history. Take for another example the Columbia/HCA medicare fraud case that resulted in millions of dollars of fines levied against HCA. I would contend that these are only the ones we are aware of and suggest that these examples supports the need to remove profit from health care so that our fine leaders are kept honest. Join me in supporting a universal single payer health care plan. You can find links to several great plans on this site to support.

Please review the article at for more details. Oh, by the way all these hospitals are managed and owned by private for profit groups.

Saturday, August 2, 2008

Critical Condition

Visit the link below to preview the upcomming film by Roger Weisberg titled Critical Condition. The film will be debuted on PBS on Septemebr 30th at 9pm. I hope all persons interested in equality and fairness in health care will watch this video and post their comments on this site. Thanks Nurse Advocate.

Critical Condition
by Roger Weisberg Broadcast Date: September 30, 2008, Special Broadcast at 9 PM (90 minutes) Check local listings
What happens if you fall sick and are one of 47 million people in America without health insurance? "Critical Condition" by Roger Weisberg ("Waging a Living," P.O.V. 2006) puts a human face on the nation's growing health care crisis by capturing the harrowing struggles of four critically ill Americans who discover that being uninsured can cost them their jobs, health, home, savings, even their lives. Filmed in vérité style, "Critical Condition" offers a moving and invaluable expose at a time when the nation is debating how to extend health insurance to all Americans. A production of Public Policy Productions in association with Thirteen/WNET New York and American Documentary P.O.V.

Tuesday, July 22, 2008

Petitions worth you attention!!

Below are several links to web site petitions to help ensure safer staffing and government oversight of health care. Please visit these sites and if you agree show your support by signing the petitions. They share many of the same goals and are similar in language. Please sign them all. The more our congressman and senators hear from us the more they know we are serious.

Monday, July 14, 2008

VA- A model for reform.

Check out this article by Time on the VA. The article was written in 2006 about the reforms and stats of the VA. I believe, although not perfect, the VA system can act as a guide for universal health care. They are not free of issues but have impressive stats on reforming many of the issues that plague the private health care system. The article sites VA representatives who state they are not looking to be the model for universal health care but I feel they may be one anyway. Their numbers are impressive and the private industry can learn much by taking the VA model as best practice.

View the article at,9171,1376238-1,00.html

Tuesday, July 8, 2008

Manhattan Institute's Herzlinger on Who Killed Health Care

Another well educated advocate for health care reform.

Health Care for America Now Ad - Magic Eight Ball

watch this video and check the link atthe top of the page to give your support to this cause. The home page to Helath Care for America Now is
I hope you will visit and show your support.

Monday, July 7, 2008

Health Care Crisis U.S.A. -- Part 1

These are real people with real problems in America. We should have some compassion for the plight of the poor. Not all people as the corporate machine and capitalist free market supporters would have you believe are lazy and deginerates. We can and should do better.

Go Ahead And Die! (Pirates Of The Health Care-ibean)

a funny spofe on the corporate health care sysytem. The problem is that it's not so far from the truth.

AFSCME Council 5

A great campaign taking place in Minnesota offered by the AFSCME.

Health Care Burden

This video supports our need for universal health care. The company provided health care system is crushing not only the employee but the employeer. We need a change and we need it now.

Friday, June 27, 2008

My Healthcare reform proposal

My Healthcare Reform

I have been a registered nurse for ten years and a person with outspoken opinions for longer than that, so here are my health care reform ideas.

I believe that the infrastructure is one of the only things really worth keeping. I believe the health system in America is in need of total reform for it to serve all in need.

I will use one scenario of a patient type to show how my reforms would work. The ideas I will present will be based on this scenario but will apply to all in one way or another.

My mock patient is a 35 year old man with no health coverage offered at his place of employment, a small 6 person heating and Air Conditioning Company. His yearly income is 30,000 a year. He is married has one child and his wife is a clerk at a local convenience store making 18k a year. He is slightly over weight, eats a diet high in fat and low in fiber, the traditional American diet. He sees a physician only when he is ill and usually at the emergency room when he thinks he just can’t take it anymore. His blood pressure is slightly elevated; he has a family history of diabetes and heart disease.

1. Universal Health Care/ Affordable Insurance: Health insurance for all is where the process starts. It could be a single payer system or a hybrid of our current system. As long as all are covered and that coverage includes all aspects of care to include prescriptions. I believe the employer based health insurance system should be entirely scrapped and the premiums paid for by the states or the federal government. The personal financial responsibility would be based on a persons personal income and those below a certain income would be subsidized or receive free insurance. The premiums normally paid by business would have to be paid into the national health care pool that would provide the base asset pool for the program. Your individual premiums would continue to be removed from your check in the same manner that all other income based taxes are removed. We would all have the same insurance and there would be no difference in the programs for the rich or the poor. This would have to be federal law.
The insurance companies would still be able to make a profit but not what they have become accustom to. They would be required to compete for a given market and would be forced to promote prevention and healthy life style over denial of services to increase their profit margins.

2. Disease prevention: If disease prevention were the focus our healthcare system instead of the treatment of disease and symptom we could prevent many diseases from progressing and contributing to other costly conditions.
Diseases like diabetes and hypertension are chronic conditions that untreated lead to a variety of other costly and often deadly conditions like heart disease, stroke, peripheral vascular diseases, blindness, amputations, renal failure and many more.
We must first begin to promote this with a change in the way we pay our physicians. We should reward our physicians when they keep their patients healthy and for finding problems early when they are less costly to treat. This would require legislation to remove insurance barriers to physicians ordering test for their patients. I am not suggesting a return to fee for service but to a system that values health over short term profits. Our current system does not allow doctors the freedom to treat their patients as they see necessary. After all they are licensed physicians and are supposed to be qualified to make those decisions. I am not advocating for the removal of oversight but do not believe the best person to provide that over sight should be the insurance industry.

Looking at our patient he would have his hypertension treated and that treatment may help prevent his progression to costly treatment of heart, renal and other vascular diseases. The physician would have the tools available to monitor and treat the hypertension with the latest treatments available. The physician also understanding the effects of diabetes and his patients risk factors and could monitor and treat his patient if the disease is present or is found on regular check ups.

If his patient continues to be healthy and meets certain benchmarks then that physician would see and increase in his reimbursement and as a result of his practice would grow.
Many would ask then what will keep practices from refusing patients who are less than healthy and my solution to that issue is to tailor the benchmarks according to the patient’s baseline and accepted theory on disease progression when it is being effectively treated.

Some patients will be non compliant and will continue to work against the goals and measures needed to promote health and those issues would be taken into consideration. You can lead a horse to water but you can’t make it drink. I do not believe in utopia but I do believe that many people are willing to learn a better way and would take advantage of health care if it were available.

3. Inpatient Care: I have been a nurse at the bedside in acute care for ten years now with a brief period of my career as a nurse manager. I believe the greatest reform needs to take place in this arena. There are many issues that the current for profit system cannot solve on its own.

Nurse to patient ratios should be mandated federally and apply to both acute and long term care facilities. There are many ways that this can be done and what ever method is chosen it will require that we deal with increasing the number of nurses willing to work in the inpatient environment.

The studies have been performed and have all come to the conclusion that patients suffer and are more likely to die or end up with costly and debilitating complications due to high nurse to patient ratios. If the ratio of nurse to patients match the reality of the care needed by the patient then we can decrease the days a patient is in the hospital, maximize the patients possibility of return to their baselines and decrease the potential for long and costly treatments as a result of injury due to lack of care. We have failed to keep up with the survival rate of our patient population. Years ago the patient that is now on the medical/surgical floor was in the ICU and those that are now in the ICU were dead. With that said our current for profit system has failed to acknowledge that these patients now require more than they used to and that requires more nurses and fewer patients assigned to each nurse to maximize outcome.

The next issue is the freedom for nurses and other health care providers to report abuse and problems in our system without the threat of termination or reprisal from their employer. Nurses are not allowed to speak freely about the issues that face health care and I have experience the repercussions of speaking out for reform, first hand. Employee’s rights to organize should be strengthened by the formation of a national union for health care workers that promotes fairness in the work place that works for all.

Technology: The use of computerized records should be mandatory. Paper should almost be a thing of the past in a modern health care setting. We spend 40-50% of our time charting and documenting in redundant ways. Technology if used properly could in my opinion reduce that time in half. Physicians placing their orders directly into the patients plan of care instead of having it processed by two or three people would reduce errors in transcription that result in delayed treatment and medication errors that kill thousands of patients every year. Programs have the ability to check the medication against know allergies and to even assist nurses in their recognition of unwanted symptoms and interactions with other medications. We are not taking advantage of what’s available and people are suffering for that. These technologies are expensive but will pay for them selves over time and will decrease the likelihood of costly and potentially deadly errors.

The old timers and the alarmist who are resistant to technology should be helped to get over their fear or be left behind. My health information privacy is important to me and all measures should be taken to protect it. The ability for someone to hack into my information should not keep us from moving forward. I value my life more than I value the information about my life and it is my opinion that the health care system moving into this century out weighs the possible risk to my health information.

If just these reforms were made, I believe we would all be better off. I love my profession and my country and wish for the day that I can say as an American and a nurse that we value human life and that when it comes to the health of our citizens we believe all should be treated equally.

Good Advice

This article gives the new grads a great piece of advice. I agree and see the theme of this advice as respect your self, demand respect from others and be proud of what you do.

May 18, 2008
Advice to future nurses: ask questions, be proud
By Kim McAllister
It's that time of year when nursing and medical students shed their label (and protection) of student and head out to the workforce with their new licenses. Over at Emergiblog, veteran emergency room nurse Kim McAllister shared advice with new nursing graduates.
Here are her words of wisdom.
To the new nursing classes of 2008:
Your first year will be the most difficult as you acclimate to your new role as a professional nurse. Hang in there! Keep your focus on why you went into nursing to begin with.
Keep your eyes and ears open. Watch the nurses around you. You will be surrounded by role models. Take the best of what you see and incorporate it into your own practice. It may be hard to believe, but by the time the next class enters the profession YOU will be the role model they look up to.
Ask questions. Ask a lot of them. Keep asking “why?” This will keep you learning every day. I still do it after 30 years. Don’t take symptoms or lab values or behavior at face value. Find out why.
Don’t let yourself get cynical or burnt out. Don’t work so much that you are exhausted on your days off. Work what you need to work to get by - keep overtime to a minimum. Yes, the money is nice but so is your mental health. Nursing is hard, demanding work. You need your downtime to recharge.
Speaking of cynical or burnt out, you will work with nurses who suffer from both. Don’t let their attitude bring you down. (And I hereby apologize to all those nurses who had to work with me when I was suffering from both those maladies). You will feel the same on occasion, but keep in mind that “this, too, shall pass”. It does.
You are professional nurses! Don’t let anyone treat you like a housemaid, a slave, an underling, or anything other than the educated, professional people that you are. Don’t accept the status quo. Don’t accept that things “have always been done this way.” Don’t accept stupid water bottles with hospital logos on them.
Please, please remember that you practice nursing and not medicine. The professions are complimentary, not identical. Should a patient refer to you as “Doctor”, let them know you are a registered nurse. Act like the consummate professional, and you will find that the doctors will treat you accordingly. Those who don’t have a problem. You do not.
Tell everyone what you do! Promote the profession! Encourage young people to consider nursing. Explain the difference between nursing and medicine to those who are confused.
And finally, there will be days when you leave work exhausted, emotionally drained and aching from head to toe, wondering “What the hell was I thinking?”
On those days remember that you made a difference in someone’s life.
Because you are a nurse.
Congratulations to the Nursing Class of 2008! I’m proud to call you colleague.
May 18, 2008 in Nursing
Benign Neglect and the Nursing Shortage - Brian Klepper

I sit on the Dean's Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses.
A few months ago, I was startled when one of the Deans mentioned that her Nursing program had 500 qualified applicants for 132 student slots. In other words, at a time when the market wants her to gear up, she turns away 3 qualified applicants for each one she accepts. As it turns out, it's a national problem. In 2006, Colleges of Nursing turned away 43,000 qualified applicants.
It's not news that health care institutions face a critical nursing shortage. An April 2006 AHA report estimated that American hospitals currently need 118,000 RNs to fill vacancies. That number is expected to triple by 2020, to 340,000 vacancies.
What is less clear to most of us is exactly why the shortage exists. Most of the facts in this piece were drawn from an excellent presentation by Geraldine Polly Bednash, PhD RN. Dr. Bednash is the Executive Director of the American Association of Colleges of Nursing (AACN). AACN's site has a wealth of data on the problem, and the distinguished members of that association draw a VERY compelling picture of benign neglect of the training process by the sector it serves.

To read the full article click on this link.

The comment below is posted by Nurse Advocate

Pay attention to the comments made at the bottom of the article. There are many good ideas posted there.

I believe that if all hospitals in a state or a group of states would work towards subsidizing the pay differential for nursing professors with the idea that a partnership would be formed between the universities and colleges the shortage could be solved or at very least improved. This however will require a commitment of money and it is my opinion that most hospitals are not interested in redesigning their staffing matrix to fit the higher acuity of our current patient type because it will decrease the all mighty profit margin associated with each patient or unit of service.

Think about it; If you increase the number of nurses you employ and reduce the ratios because you now have an adequate pool of nurses for the higher acuity patients, your profits fall!!
This is not in the best interest of the current for profit system of health care in America. We must mandate ratios according to acuity or a flat nurse to patient ratio plan. I believe that most bedside nurses and the unit level nurse managers want and do give the best care they can but they are not in control of the purse strings and those at the top owe their loyalty to the stockholders and the profit GOD. Don't be fooled into believing that greed and general business practices are not the dominating force of health care as it is in any other for profit industry.

Sunday, June 22, 2008

National Nurse Campaign

This is a valuable idea worth consideration.

Lets Talk About Your Right To Talk.

This post is a plea to all who read it to consider the state of health care and our society at this time in our history and ask how we got here. Even if you believe that all is good and there is no need for reform, you should never stop exploring new ideas.

It is my opinion that the climate in our corporate culture has been very harsh to those that voice opposition to their position on a subject. Even if we disagree on the solutions to staffing issues, how continuing education for nurses should be handled, unions and the right to organize, floating, pay and benefits, overtime, and the way out of the nursing shortage aren't we better off by communicating on these issues than by creating an environment that fosters silence. When as Americans did we give up our rights to free speech and allow our employer to dictate what we think, who we speak to and ultimately what we believe.

This culture of suppression is an epidemic in health care across the nation and if things are to be improved it needs to be changed. We can never get to reform and solutions if nurses as the frontline providers of acute care services are denied their rights to advocate for needed reform. We are in the trenches every day and see first hand the failings of our current system and approach to the problems I identified in the first paragraph. What are the administrators afraid of? Give the public the respect to figure out the truth of the situation based on a free exchange of ideas and assessments from both sides of the issues.I believe that when you support a free exchange of ideas, even those that are different to your own, you promote positive change and empower people to work towards the betterment of our profession and we all win.

When you suppress information and discussion that is not in agreement with your own you create a breeding ground for discontent, frustration and ultimately we all lose. This method is not democratic is not fair and denies Americans of the basics of civil liberties as established by our Constitution. I believe our founding fathers recognized that if one side is able to dominate the discussion and the voice of dissent is silenced then we all suffer and that true progress is the victim.Please stand up and voice your concerns and opinions to your administrators, congressman, senators and the public as they have a right to know there is a problem. I am not alone in recognizing that there are many areas of health care that are broken. You have a responsibility to voice your concerns. Those that attempt to keep you silent will only be stopped when enough of us say enough.

Friday, June 20, 2008

The Oakwood Decision and Labor Rights
Lewis Maltby
Linda Bennett never realized she was a manager. As a nurse in Oakwood Heritage Hospital in Taylor, Michigan, she had no ability to hire, fire, promote, or discipline other nurses. But because she was a “charge nurse”, who divided up the work that needed to be done on her shift, the National Labor Relations Board recently held that she was a “supervisor” and did not have the right to join the nurses’ union at her facility. She cannot negotiate collectively with other nurses over her pay and benefits, but must accept whatever management offers or quit. She won’t be protected from arbitrary termination; management can fire her at any time on a whim.
Bennett isn’t alone. Millions of other rank and file workers lost the right to join unions on October 3 when the National Labor Relations Board issued three decisions that classified them as supervisors. These decisions hold that any employee who is responsible for the work of another employee is a supervisor, and not protected by the National Relations Act, unless the work is completely routine. By this definition, every teacher with an aide, carpenter or welder with an apprentice, and executive secretary with an assistant in America is a supervisor. The Economic Policy Institute estimates that up to eight million Americans will lose the right to join a union under these decisions.
The Oakwood decision comes on the heels of other Board rulings that are divorced from reality. In a case involving Brown University, the Board held that graduate students who are paid for teaching college courses are not employees of the university. In other cases, it held that disabled workers who receive counseling as part of their compensation and models at art schools are not employees.
This isn’t fair and is not what Congress intended when it passed the National Labor Relations Act. As the Supreme Count stated in the Bell Aerospace case, Congress intended to distinguish between “real supervisors who have genuine management prerogatives” who are considered part of management and “minor supervisors” who are still workers themselves and are to be covered by the Act. The current National Relations Board, led by a majority of Bush Administration appointees, has forgotten this important mandate.
These rulings couldn’t have come at a worse time. Americans have watched their take home pay (adjusted for inflation) shrink for over a decade, despite soaring productivity and record corporate profits. Employers are also cutting back on medical benefits and eliminating pension plans. Employees with unions, while not immune to these problems, do far better. The average union member makes 20% more than employees with comparable jobs that don’t belong to a union. Union members are also far more likely to have employer-paid medical care and retirement plans. Taking away the right to organize denies workers their best opportunity to maintain a decent standard of living.
The Board needs to rethink its rulings in light of the Act’s fundamental objectives. If it can’t, or won’t, Congress needs to amend the National Labor Relations Act to correct these mistakes. At a time when real wages are declining and job security is becoming a thing of the past, the last thing the country needs are misguided rulings that deny employees the right to join a union.

Friday, June 13, 2008


There was a great presentation on the Bill Moyer Journal tonight that examined the demise of the middle class and the obscene growth of the wealthy. I have posted the link to his blog that in a day or two will feature the entire video as presented tonight.

I titled the post depressed because the subject matter is down right depressing. When you think that so many hard working Americans will never reach the American dream and so many others will have it snatched out from under them due to the rising cost and inequalities of health care and the economy in general and the stagnation of wages.

Our government, our corporations and our leaders are letting us all down. We need to take control back. Please vote your conscious this election year. Get involved!!!

Tuesday, June 3, 2008

The Health Care Crisis, Part I

This video presentation by The Pinky Show does an excellant job of presenting the facts about our managed care system and the need for reform. Please view this video and forward it on to your friends and fellow nurses. I will post the second part when it becomes available. I will also post a link to the pinky show web site on our links to the right of this post.

Monday, June 2, 2008

MSN Story on how to fix health care.

Take a look at this story and videos by MSN on health care. The proposals made are moderate and would go a long way to improving our current health care system. Here is the link

Thursday, May 29, 2008

The U.S. compared to other nations health care systems

This is a copied article from Nurse Connect by Jennifer Decker Arevalo.

I found this to be very balanced in it's presentation and facts. I believe it better to show the article in its entirety rather than excerpts.

This article supports my position that we are in need of reform in the US. The money we spend is not providing the care we deserve or have paid for. We are getting ripped off and should demand more. The world has provided us templets to adopt and creat a fair and effective health care system. Get away from the idea of adopting one system from another nation but the idea that we can take the best pieces from the other nations of the world to provide our citizens the best in the world. We must however take profit out of the equation our we will fail. Our goal should be to be fiscaly balanced and to provide the best care.

I hope you read the entire article below and think about why we rank so poorly when compared to other nations despite the fact that we pay twice as much per patient as any other country.

Review by Nurse Advocate.

Article by:
Jennifer Decker Arevalo, MA, contributor

When it comes to issues, such as affordability, access, care coordination and patient safety how does the U.S. stack up against other countries? Not so good, according to the Commonwealth Fund's 10th International Health Policy Survey released in October 2007.
Results from a Harris Interactive survey of 12,000 adults in Australia, Canada, Germany, New Zealand, the United Kingdom, the United States and for the first time, the Netherlands, were published as a Health Affairs Web Exclusive, entitled Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries.

Thirty-four percent of American adults indicated that the U.S. health care system needed to be rebuilt completely; this rate was higher than in any of the other six countries. Although there is no perfect health care system, much can be learned from the innovations and strengths of other countries and then considered for transferability to the U.S.

According to senior vice president for Research and Evaluation and study co-author, Cathy Schoen, in the Commonwealth Fund’s website presentation, “U.S. adults are the most likely to go without care because of costs.”

Thirty-seven percent reported that they skipped medications, did not visit a doctor when they got sick or did not get recommended care because of financial reasons, compared to people from Canada, the Netherlands and the U.K., who were the least likely to skip care because they could not afford it. This may directly correlate to the 47 million Americans who lack health insurance coverage, unlike citizens of the other six countries who have some type of universal health coverage.

“In the U.S., both the insured and uninsured population reported out-of-pocket medical costs as high as $1,000,” said Schoen in the web cast. “Such high out-of-pocket expenses were rare in other countries.”
Only five and four percent of adults in the Netherlands and the U.K., respectively, paid over $1,000 in the past year compared to 30 percent of Americans, 19 percent of Australians and 12 percent of Canadians.
Nearly one-fifth (19 percent) of U.S. adults had trouble paying medical bills; this was more than double the rate of the next highest country.

Schoen also stated in the website presentation that, “US and Canadian adults were the least likely to report rapid access to seeing a doctor in their community when they got sick.”
For same day appointments, 30 percent of Americans and 22 percent of Canadians had quick access, compared to 50 percent or more of Germans, Dutch and New Zealanders. In the U.S., Canada and Australia, over two-thirds of those surveyed reported difficulty getting care on nights, weekends or holidays.
“The Netherlands reported the least difficulty in getting after hours care,” added Schoen, most probably due to nurses and physicians who staff phone banks to provide assistance.
Care Coordination

Across all seven countries, only 50 to 60 percent of adults had access to a “medical home,” as determined by the following criteria: the physicians and staff knew a patient’s medical history, were available by phone during office hours and coordinated a patient’s care with other providers.

“The vast majority reported having a regular doctor and source of primary care where the staff knew information about their medical history,” said Schoen. “However, this percentage dropped off and varied by country when asked about access, that is how easy and quickly it was to get in. It dropped off even more when asked about coordination of care.”
“In all of the countries, patients with a medical home were the least likely to report problems with coordination of care and the most likely to report that information had flowed well and that their primary care physician had helped them to find the right specialist,” continued Schoen in the web cast.

However, for patients without medical homes, 23 percent of U.S. adults stated that either test results were unavailable at the appointment time or doctors ordered duplicate tests; 19 percent of Germans and 18 percent of Australians reported similar problems.
Across all seven countries, patients in medical homes had more: positive care experiences, time spent with their doctor, and involvement in their care decision.
Patient-centered care is a key element of medical homes. “Across all countries, three out of four patients with a medical home said their doctor provided these key elements of patient-centered care,” said vice president and director of International Program in Health Policy and Practice and study co-author, Robin Osborn, during the website presentation. “This was 20 to 30 percent higher than for those without a medical home.”

“It is critical for patients with chronic medical conditions to have a medical home, as they see multiple providers, take multiple medications, are at higher risk for hospital or emergency room admissions and are at greatest risk for poor handoffs between providers and settings of care,” continued Osborn. “This is the most vulnerable population in the health care system; vulnerable to system shortfalls in coordination of care.”

Patients with medical homes were less likely to report medical errors and the study authors believe that regardless of the type of health system patients have, medical homes improve patient safety and satisfaction, as well as efficiency and care coordination.
Patient Safety

Out of all seven countries, adults in the U.S. reported the highest rates of lab test errors and some of the highest rates of medical or medication errors. Patients with multiple doctors or chronic illnesses experienced most of the reported errors, across the board.
“Combining medical and medication errors, as well as diagnostic test errors, one in five patients in Australia and the U.S. experienced an adverse event,” said Osborn. “This is stunning given that it was a general population sample. As you might expect, the rates went up dramatically with patients’ medical complexity.”

Thirty-two percent of U.S. patients with two or more chronic conditions reported a medical, medication or lab test error in the past two years, compared with 28 percent of patients in Canada, 26 percent in Australia and fewer patients in the other countries. Among adults with multiple chronic conditions, error rates were lowest in Germany, at 16 percent, according to the study authors.

“Country patterns reflect striking differences in policy,” summarized Osborn. “Universal coverage matters for access, quality and equity, as does benefit design. Across all seven countries, the survey underscored the pressing need to develop more system integration. Most compelling, there was overwhelmingly strong public support for designing the health care system around the medical home.”

Thursday, May 22, 2008

The Status Quo

Recently I was having a conversation with a nurse on my unit about Ted Kennedy and his diagnosis of brain cancer. The comment I made was that when they thought he had a stroke he was air lifted to the best hospital in Massachusetts. I commented that we all deserve that level of response and care when or if we ever have an event like that. I went on to state that there should not be class care in this country and that we all deserve to be treated with the best available care.

She responded that I needed to accept that there is a class system and it exist every where and that it will never change. I accept the statement as fact but reject the notion that I should accept it as ethical or moral practice. Furthermore I believe that my professional ethics require me to fight against class care and demand that all patients and people regardless of their circumstances or economic or social position in life places them. With that said we won't change the minds of the world that some are entitled to more because of the size of their wallets or the family to which they were born but we can work on changing the minds of nurses that this concept should not apply to health care.

What is the value of human life. Are you more or less valuable than Kennedy or me or anyone for that matter? Should your ability to pay be part of the treatment process?

Please think about those you have seen in your careers that have lived and died and ask if there have ever been patients who might have survived if they had the money to afford better care. The question is not meant to imply that your facility or you made the choice to give bad care or neglect the patient but would more options have been pursued if the money for those treatments had been available. With that said, health care is one area where we should not have a first class and coach.

I hope you will comment on this post and share your comments about this subject.

Monday, May 19, 2008

Copied Article: Nursing Shortage or Hospitals Short On Nurses?

Nursing Shortage or Hospitals Short on Nurses?Posted by: admin in Laura Gasparis Vonfrolio, RN, PhD, Nurse Staffing Issues
Guest Post by Laura Gasparis Vonfrolio RN, PhD
Let me begin by saying that there is no shortage of nurses. There are over 2.8 million of us. Interesting to note, only 66% are working and 44% are employed full time with 10% of working nurses being “very satisfied” with their jobs. A recent survey found that an astounding 75% of RN’s feel that the quality of nursing care at their facility has declined, with over 68% citing staffing levels as a major contributing factor to this problem.
The statement made by hospitals and administration that there is a nursing shortage, are patently false and evade the real issues of why nurses leave nursing thus contributing to the lack of a sufficient number of nurses at the bedside to meet patient care needs. The term “nursing shortage” becomes a pat excuse for every vacancy that can’t be filled. It is the ultimate answer that absolves the people who are responsible for creating problem – shortage of nurses at the bedside.
There is an annual turnover of approximately 200,000 nurses, which cost the hospital industry a total of nearly 10 billion dollars per year. This staggering cost is the result of the hospitals industry’s failure to retain nurses. If the funds now spent fighting a losing battle to replace disheartened nurses with travel and agency nurses, were instead devoted to improving job conditions, the nursing “shortage” could be largely solved. The Harvard School of Public Health conducted the most comprehensive study linking staffing levels to patient outcomes. The researchers found a strong and consistent relationship between nurse staffing and the outcomes in patients. Higher nurse staffing ratios result in shorter lengths of hospital stay and thus reduce both direct hospital costs of treatment.
Other studies include:
August 2005 – Medical Care“Improving Nurse to Patient Staffing Ratios as a Cost Effective Safety Intervention” Research showed that when nurse staffing is improved, lives are saved in a cost efficient manner.
February 2004 – Medical Care“Nurse Burnout and Satisfaction”Patients were more likely to report high satisfaction with their care and nurses reported less burnout when nurses worked in conditions with adequate staff.
March 2004 – The Agency for Healthcare Research and Quality released its report entitled “Hospital Nurse Staffing And Quality of Care.”Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, urinary tract infections and cardiac arrest.
January 2003 – Medical Care“Fewer Licensed Nurses Leads To A Greater Number Of Adverse Events”
August 2002 – JCAHO issued a report “Nursing Shortage poses Serious Health Care Risk.”Focuses on the severity of the current and future nursing shortage and its detrimental effects on patients.
May 2002 – New England Journal of Medicine“Nurse Short Staffing Leads To Deadly Complications”Jack Needleman and Peter Buerhaus found that nurses short staffing leads to deadly consequences for patients. Attention nursing administrators – focus on retaining your nurses – improve the staffing levels at the bedside!
A Nurse With a Heart
Laura Gasparis Vonfrolio, RN PhD is one of the most dynamic and entertaining speakers you will have the opportunity to experience. Laura has held CCRN certifications for over 15 years and CEN certifications for 13 years. Laura has helped thousands of nurses over the last sixteen years to prepare for the CCRN and the CEN examinations. She has held positions as staff nurse, Staff Development Instructor and Professor of Nursing.
Dr. Vonfrolio is the proprietor of Education Enterprises and the former publisher of REVOLUTION – The Journal of Nurse Empowerment. Laura has authored numerous articles in Nursing, RN, AJN and co-authored/edited eleven books such as NURSE ABUSE: Impact and Resolution, Critical Care Examination Review and 12 Lead EKG STAT! In addition to being series editor of a six volume State Board Review, Nursetest. Dr. Vonfrolio was the organizer of the Nurses March on Washington DC, March 1995 and May 10, 1996 and has appeared on Good Morning America and Nightline with Ted Koppel (May 1996). You can contact Laura at

Wednesday, May 14, 2008

Another nurse week has come and gone.

Another nurses week has come and gone and we are still looking at the same problems that faced our profession last year and the year before that. Things are better these days at my particular facility but will it last? If the past holds any prediction for the future I would say no. Once budgets are analyzed and the meetings are held things will creep back to the norm of short staffing with high ratios and unsafe conditions. I at the moment am fortunate but have not forgotten that there are real problems that are facing our profession and that for the most part are not being delt with by our trusted administrators, universities and goverment.

I titled this post nurses week to expose the bribe, although admittedly a small one, that the trinkets, bobbles and food they give us in the name of celebrating our profession and work is meerly a distraction and a bribe. They are avoiding the hard and expensive solution to the real problems that face our profession and the health care industry as a whole. I see thier hallow actions as an insult and do not participate in the game.

If the moneys from all the little parties and socials that were held all over the country this last week were pooled and used for scholarships or for the building of a new nursing program at a university or the hiring of an additional nurse educator or more ancillary staff to assist with patient care then you could say your work was being respected. These measures would take commitment and a larger acknowledgment that their is a problem. But pizza, ice cream, cookies and other door prizes are cheap and fun and isn't that what we are really all about!

We are a caring profession but more accurately we are a highly skilled analytical profession that save peoples lives on a regular basis. Until we accept that and demand the respect we are entitled to we will not get it from our administrators or politicians. Show me you respect me with better working conditions, better equipment to aid me in my care, better pay, better benefits and education and keep your door prizes and cake and ice cream.

Join me in the future by asking your leaders and administrators to keep their parties and the trinkets and bobbles and to create a scholarship or put that money into something constructive and lasting for our profession.

Saturday, May 10, 2008

A look at health care by Bill Moyer of PBS

This video is a must see. The evidence is clear and supported by facts that our current health care system is broken. This video looks at the CNA and their efforts to reform our health care system. The argument is that all Americans are entitled, (yes I said it entitled), to quality health care.

I believe that health care is a basic human right and that the basis of this countries morals and ethics are based on helping those less fortunate than ourselves without regard to their beliefs. I also believe that in order for our country and economy to be strong we have to be healthy as a people.

The act of providing emergency care when people are at their most critical but not the care to avoid getting to deaths door is negligent and inefficient. The sysytem cost the American people Millions of dollars every day. Every time a person due to lack of insurance or the funds to afford medications or routine medical care ends up in our ER's or ICU or the floors for that matter cost every person in the form of higher insurance premiums, more expensive cost of services, higher drug cost ect. The hospitals, insurance companies, drug companies all document millions in charity care however they also regularly increase the cost of their services to recover the losses they incure with that charity care. So I ask you is it really charity? I say yes but we are the ones providing it. So with that said I think it would be much more efficiant and cost effective to cut out the middle man and provide universal single payer coverage to all Americans. We are paying for it any way.

My premiums that I currently pay to Aetna along with your premiums and the premiums paid by the employeers would go to providing coverage for all. The sysytem in the end would cost us all less. Do your reserch and look at the cost of our system compared to that of other nations. We are not getting our moneys worth in our current system and we all need to become better consumers and demand that profit be removed from health care and that we get what we are all paying for.

Do your own research and examine the profits posted by the big insurance companies and health care corporations. Look at the salaries of the CEO's who run those companies and remember that they earn their money by increasing profit for the company which means denial of claims and services. Trimming the "fat" which in most instances is the lay off of staff that provide care is another way profits are increased. Nurses demands for safe ratios are fought because the more patients each nurse provides care for at one time increases profit by reducing the staffing budget. Don't be fooled, profit is king and you and I are only valued as long as we are making that profit. But don't forget that they can not operate without us. We hold all the power to influence change as long as we act toghter. Join me in this cause and take some kind of action now.

Tuesday, April 29, 2008

CNA and SEIU fighting hurts us all.

I am a member of the NNOC the national arm of the CNA and I agree with your call for the two unions to make peace and see that their fights are hurting the nurses they are charged to represent. I have asked the CNA to stop their anti SEIU campaign and focus on the promotion of better working environments for nurses and safer patient care.

I support ratios and much of what is being proposed by the CNA and do feel that we have to be firm with hospital administrations as they are with us. We will not succeed if we continue to be our own worst enemy. There is so much to do and we will all lose if we focus on our differences as opposed to our common goals of making the acute care setting a safer place for nurses and patients.
I plan to post your comments on my blog at

On Wed, Apr 23, 2008 at 11:18 PM, The Nurse Unchained wrote:
The Nurse Unchained
Nurses alleged that nurses attack them!
Posted: 23 Apr 2008 12:13 PM CDT
Dateline Dearborn, Michigan – Nurses alleged that nurses attack them!Yes, you read correctly, the nurses and other members of the California Nurses Association/National Nurses Organizing Committee (C.N.A./N.N.O.C.) alleged that during their convention in Dearborn that members of the Service Employee International Union (S.E.I.U.), a rival nursing union, barged into their event and began to harass and attack their members. C.N.A./N.N.O.C representatives have alleged that at least one woman was injured during this altercation and had to be treated at a local hospital for her injuries.When I read this report in my e-mail and later in my local newspaper I thought what a sad, sad day for the nursing profession; and a sense of déjà vu came over me. Since several years ago I was very nearly “that” woman who had to be taken to the hospital after being accosted by a male RN who was a C.N.A. member.During a special election that had been called by our Governor the C.N.A., S.E.I.U. took issue with a request from the Governor to delay the implementation of phase two of the California mandated nurse/patient ratio law, asking that a review and report of the impact of phase one first; this request seemed reasonable to me since many hospitals were claiming the law had been at the heart of a series of hospital closure and the nurses were arguing that it had “solved” our state’s nursing shortage. A review of what phase one had or had not done seemed reasonable however some chose to interpret that to mean a rollback of the law. So the C.N.A. started its now famous campaign where it dogged the Governor and many other elected officials to various events throughout the state holding loud and boisterous demonstrations and even interrupting the “non-political” annual Governor’s Conference on Women. Historically this conference has placed a focus on women and women issues with little to no political agenda, a rare venue where divergent groups could gather for an open exchange of ideas – no more because since that day the conference has become like so many public meetings have become susceptible to “hijacking” by one group or another for its own political agenda.I was with a group of nurses who decided that we had had enough with members of the C.N.A. disrupting events through-out our state and when the C.N.A. decided to hold their post-election night event at the same venue as ours we decided to take our signs and hold a low-key, peaceful demonstration outside their room; since of course what’s good for the goose is good for the gander – no? As we stood outside the door of their event with our signs; members of the C.N.A. came out to demand that we leave, when that failed they tried to drown us out and when that didn’t work they tried kicking my cane out from under me so I’d fall.So, while I found it very distressing that nurses would resort to physically assaulting one another (as if they don’t experience this type of bullying enough in the workplace) I found it rather ironic that Rose Ann DeMoro would yell “foul” when treated to some of the same tactics she and some members of the C.N.A./N.N.O.C. was infamous for – talk about the pot calling the kettle black. This recent event also helps highlight what happens when people are intentionally “radicalized”, allowed to funnel all their frustration (both real and imagined) into a perceived “foe”, and then let lose to vent. The past several years have seen the C.N.A./N.N.O.C. aggressively recruiting for new nurse members throughout the country. In many of these recruitment activities there have been accusations made that the C.N.A./N.N.O.C. has engaged in union raiding, the use of State Board of Nursing mailing lists to recruit (this is usually prohibited), and even the attempt to recruit under the guise of emergency response, etc.There is little doubt that the C.N.A./N.N.O.C. has developed a reputation for “bare-knuckle” fighting and not being shy at calling out those that they perceive are hampering their agenda. Most organization members would welcome such aggressive “protection”, however sometimes when a group behaves in a way that is very much outside the societal norm and don’t face consequences then the groundwork is laid for the potential of even more outrageous behavior in the future and where does the line get drawn?Time for disclosure, for those who may be unaware of my personal bias let me make it clear I am not one who supports or promotes the idea of unions for nurses. I am however a firm believer that nurses should seek out, participate and join professional associations, but NOT unions. Strikes and the behavior exhibited by the rival nursing unions in Michigan are a good example of what happens when nurses adopt the no-holds barred mentality of unions.Another thing that has concerned me about the recent confrontations in Michigan is the silence from organizations that claim to be professional nursing associations and advocacy groups on the alleged nurse on nurse violence that was reported to have occurred in Dearborn, MI. You’d think that they would at least issued a statement denouncing such unprofessional, let alone poor human behavior. Of course, I’m sure that if this had been an episode of E.R. or House maybe we’d have received a denouncement.I’m also concerned at the fall-out from this violent encounter, since the S.E.I.U. and C.N.A./N.N.O.C. confrontation over the stalled unionization in Ohio I have received numerous mailers from the S.E.I.U. about the transgression; and now with the events in Dearborn one wonder if there will be an intervention or will things continue to escalate? However, Ms. DeMoro shouldn’t be allowed to cry wolf about the S.E.I.U. members “stalking” C.N.A./N.N.O.C. members since it has been my experience that the C.N.A./N.N.O.C. has engaged in this behavior, usually meant to coerce uncooperative nurses at hospitals targeted by the C.N.A./N.N.O.C. for union organizing. Don’t believe me just read the testimony of nurses from Cedars-Sinai hospital that describe what they experienced at the hands of C.N.A. representatives when they opposed unionization; as well as the documented threats made to some nurses’ families. This does not mean I believe such behavior is justifiable or acceptable but it is interesting that when C.N.A./N.N.O.C. members experience such hostility it is suddenly not so palatable. Maybe this might be a significant emotional event for both groups to step back and take a look at what has happened and what is happening and maybe alter the collision course they are both on. Of course there are some observers who also see this as an opportunity to expose the darker side of nursing unions, and it very well maybe but the question remaining is will the media report and investigate, or will they take their usual role of union sympathizer and sweep it under the rug? Meanwhile, this morning a brief news article revealed that a court official had lifted the temporary restraining order that had been granted to the C.N.A./N.N.O.C. against the S.E.I.U. The court official ruled that the restraining order was “not supported” by the evidence filed by the C.N.A./N.N.O.C. (source Los Angeles Times, April 23, 2008)

Sunday, April 27, 2008

Redifining Nursing

I am in the middle of a book titled the The Complexities of Care, Nursing Reconsidered. The book examines the definition of nursing as it is defined by it self, hospital administrations and the public. The Editors of the book make the point that nursing definition of it self is a large part of the current problem that face our profession. It asserts that because we allow and reinforce the virtue side of our profession instead of the science based, knowledge based and skill based profession that we are, we are able to be trivialized and have no real voice at the national and local tables that decide our professional fate.

I agree and ask every person who reads this blog to think hard about what they do. I care about my patients and I define that as giving great care. I assess my patients and report the findings to the appropriate physician so that treatment may be adjusted. That physician has already been there for the day, so without my eyes and ears and most importantly my knowledge and ability to understand what I am seeing and hearing my patient may experience a prolonged recovery, or even death. I am the patients advocate. We are the hub of all the other disciplines as they interact with our patients to include PT, OT, Speech, Case Managers, Social Services, Dietary and many others. The quality of the nursing that a patient encounters during their hospital stay is in my opinion as important as the quality of their surgeon or physician and in some cases more important. If you have a bad physician, a good nurse can be the difference between life and death for a patient. If you have a great surgeon and a bad nurse you are also at great risk of death. We should take both of those extremes and understand the great influence we have over the outcomes our patients experience.

We need to let our patience know what we really do. It may seem like patients should just see what we are doing and make the connection to the fact that we are helping them recover and that we in some cases are the difference between life and death but studies show that they appreciate and respect us for traits like caring and compassion but not for our knowledge and skill.

We need to take credit were credit is due and stop giving it away to other disciplines. Stop covering for physicians and the administration. We are hurting ourselves every time we shelter our patients from the truth about their doctors lack of caring or the hospitals lack of concern when they jeopardize patient safety with poor staffing. If a patient ask what took so long let them know we are short staffed and I got here just as soon as I could. If they ask you why the physician has not called the family don't make excuses tell them you informed him or her three times that the family wished to speak with them and you don't know why they haven't called or came by. These excuses allow the system to avoid change. Or patients are entitled to know the risk and benefits of their care at the hospital they choose. Its time we gave out a little tough love to the administrations.

We are not their public relations people we are the nurses in their employee that have the right and responsibly to provide safe patient care to those patients that choose that particular hospital.

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My Story

My Story

I have been a nurse for just over ten years. I earned my degree with the support of my wife and financial assistance for the GI bill. I was drawn to the profession of nursing after a brief exposure to an advanced course in field triage while serving in the army. I find the human body fascinating and am always learning. I also was attracted to the profession for all the usual reasons that bring people to the profession of nursing. I enjoy the reward of giving to my fellow man.

I believe that health care and the advocacy of safe care is the foundation of nursing that was started by our founders like Florence Nightingale. Our practice act calls for our profession to advocate for our patients and against practices that puts their safety in jeopardy.

The healthcare industry has for the last twenty plus years constructed an environment to maximize profits at the expense of patient safety and our profession. We as nurses have stood by fairly quit and allowed for this to happen.

Recently, I and others voiced concerns related to patient safety and working conditions at Summit Hospital a hospital owned by Healthcare Corporation of America. Our issues included the working of nurse with approximately six month of experience for more than twenty four hours straight. This particular nurse did volunteer to work these hours but in my opinion should not have been ask to do so. She is a great nurse for her limited experience but put her license and the safety of her patients at risk that night. The manager of the unit failed her and the patients in her charge. Study after study has shown that the error rate goes off the chart after twelve hours. I and fifteen other nurses also expressed to management our concerns over the floating policies that were sending unqualified nurses to our unit. We noted several instances were these nurse made errors that put the patient in potential jeopardy. We also expressed our concerns over ratios of 3 to 1 becoming the norm in the unit when 2 to 1 is considered the norm in intensive care across most of the country.

We submitted these concerns in writing and signed by sixteen nurses from our unit. Management responded by holding meetings with a group of employees that they chose and their representatives which included the director of HR, our unit manager and the director of nursing. The meetings at their start gave us some hope that our issues might be taken seriously and dealt with. It was soon apparent that would not be the case and these meetings quickly moved away from our issues to their issues. They would agree that their were problems but would not put any solutions into writing, stating that they needed to be able to remain flexible and made statements like we will try instead of we will.

At around this same time I was informed of an organization called the NNOC or National Nurses Organizing Committee, that was holding meetings in the Nashville area to organize nurses to advocate for patients and against many of the problems that I expressed above. I met with their organizer and felt that their movement was something that I could support. I became a member of the NNOC and began attending meetings on a regular basis. I also began placing invitations to attend meetings in the break room of my unit and speaking with interested coworkers, while on break, about the need to organize and advocate for our patients and our profession.

After a short period of time I was ask by my manager about my involvement with the NNOC and my desire to form a union at Summit Hospital. I did not deny my association and did not hide my opinion as to why I felt that organizing was needed. I also informed them that I had the right as outlined in the National Labor Relation Act. The nursing staff at Summit was then subjected to mandatory anti union meetings and letter sent to our homes and to our email accounts at work. I was required to attend meetings with the hospital attorney and informed that because I was a charge nurse I was considered management and could not associate with the NNOC. I contested that I was a member of management but submitted to their demands to end my association with the NNOC. I never attended another meeting or recruited for the cause after that meeting. I did however continue to operate a blog, , that advocated for reform of the healthcare system and employee rights to organize. I did not use computers at work for this endeavor and did not use my real name on the blog or use any other names that would tell a reader where I worked or who I worked for.

I was ultimately terminated from Summit Medical Center on June 11th, 2008 for what I was told was the operation of a blog. I was given no specifics of what about the blog was grounds for my termination despite my asking. I appealed my termination through the hospitals employment dispute resolution process, attempting to get clarification as to what about my blog was cause for my termination. The peer panel dispute process was a sham. The panel as outlined by the hospitals policy was to be made up of my peers, who were “not familiar with the problem or have a close relationship with any of the parties involved”. The panel was anything but and was made up of persons who had expressed an open hostility to my rights to organize and to freely associate with the NNOC in the past. Two of the panel members were charge nurses from the ER also under the supervision of my manager, who had terminated me. These two persons were also at the meeting with the hospitals attorney and expressed anti union sentiment. Another panel member was a person who was well aware of my personal views related to unions and the right to organize and had been present at private settings outside the hospital were I had expressed my opinions related to the issues that started all this. This puts three of the five panel members in clear violation of the policy. I then was refused the right to seek any clarification as to what about the blog was grounds for my termination despite that being the stated reason for the panel. I was not given the right to hear the reasons as stated by my manager and the director of HR.

I am writing this because I believe that my fundamental right to due process has been violated. This is a right to work state and right or wrong that gives Summit the right to do as the please when it comes to hiring and firing of employees but most people believe and Summit attempts to mislead their employees that they are fair and just when it comes to matters of employee issues.

If Summit is allowed to get away with this and is not challenged then patients are at risk. Health care workers need to be free to advocate for safety for their patients and if they are scared into submission then patients will suffer.

Join me in fighting for our rights to free association and to advocate for our patients as our practice act requires. Support the employee free choice act, and send a message to Summit and other corporate bullies that feel you are entitled to the rights they give you and nothing more.
Also visit sited like Leap for Safety and support petitions to mandate stronger legislation that will ensure a safer environment. Visit to get involved.

I truly believe that our healthcare system is in dire trouble and we as nurses have a responsibility to get involved. Please join the fight. Your family may one day depend on what we do today.

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