Canada votes. On health care?

What a time for an election, Christmas season. Ah well, I suppose if the government is given a lack of confidence vote we most.

I must admit, I have not had the opportunity to follow the candidates as closely as I might like. But I am interested of course in what they have to say about health care.

So far I've heard mention of fulfilling wait list tracking promises, ensuring provisions that all Canadians will get equal opportunity to quality care, whether they can afford to purchase privately or not; but has anyone mentioned (or asked) about health care human resource shortages?

The Alberta government has given more money toward opening more beds in several facilities but little mention of how they intend to care for the patients in those beds.

I emailed them (right from the web site) asking questions on this point and mentioning how some of that monies might have been better spent on more seats in nursing schools, and better pay for instructors.

Surprise, but I never heard back. I think two months is really sufficient time to respond to an email. Don't you?

Nurses, and other health care workers have a rather large voice in Canada (numbers wise). But no one will hear if we don't speak up.

Start asking serious questions.

Settle for nothing less than complete and honest answers.

staffing shortage survey results

I've said it before and I must repeat myself...it sure is hard getting nurses to write. I left the survey up on my web site for 9 month and managed to get only 15 responses. So of course this makes the results (in a researches mind) somewhat limited.

So are nurses too shy to fill in surveys? Too busy? Not intersted?

Or perhaps the nursing shortage is not as severe as we are lead to believe and very few nursing care mistakes occur?

Perhaps for now you should decide for yourselves. In the mean time here are the results.

>Age of nurse respondance: 53.3% had ove 10 years experience; 33.3% had 6 - 10 years experience; 13.3% had 1 -5 years in

>Current education level: Doctoral 0%; Masters 13.3%; Baccalaureate (BN, BSN) 13.3%; Degree/Associate (RN) 73.3%

>Increasing education level in the future? 66.7% said yes; 20% were unsure

>Just over half, 53.3%, said they wouldNOT be intersted in teaching positions in nursing schools

>What should the education level of nursing instructors be? Only 13.3% felt a Doctorate was necessary, compared to 60% who felt a Baccelaureate degree was enough

>60% admitted to making a patient care error

>77.8% were medication errors, 22.2% treatment

>90.9% felt a nursing staff shortage played a role in the error

>But only 53.8 % felt the facility where they presently worked was dealing with a nursing shortage

>85.7% worked overtime shifts, 23.1% because of necessity, and 69.2% worked extra as a combination of necessity and choice

>The final question was addressing whether the nurses were planning on leaving the nursing profession within the next 5 years.
66.7% said no, 13.3% said yes, and unfortunately 20% were still undecided

Invisibility in times of crisis

It is disheartening to hear of the thousands of lives lost in Pakistan from the recent large earth quake. And now there are huge numbers of people homeless; and winter is coming fast.

I visit the World Health web site regularly and yesterday there was a desperate call for help.
Food, water, blankets, shelter, and most of all health care workers.

They are desperate for many more doctors and public health specialist but no where did I read the words "nurse". Doctors may flock to the site to lend their assistance but they will be almost helpless without the support of nurses.

Are we invisible, still, that people don't think of nurses in the first breath of a call for help? I am sure we are in their thoughts, yet never seem to be immediately on the lips.

If you can, if you are in a position to help, even for a short time, why not contact the World Health Organization and find out how you, as a nurse, can help.

www.who.int

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Pandemic scare

Working presently as a Public Health Nurse I have been keeping up with the world wide talk that has been going on about the next Influenza pandemic.

Many feel, looking at what history has done and what the Avian Flu is now doing, that a new Influenza pandemic is not far off.

The recent scare of an unknown respiratory illness that took the lives of atleast 16 people from a Toronto nursing home made my heart jump. We now know it was legionaires disease,but what if it had not been?

Too many cities and townships are still only in the planning stages for handling a pandemic. If this had been influenza, infection could have spread quickly and deaths and illnesses could have been far worse than they could be.

What does this have to do with nurse, besides directly involving us in client care of one sort or another?

As nurses, we are capable of initiating change and advocating for health care consumers. We must get pushy, speak out, and encourage governments and employers to take action faster. Plan now!

Never leave a meeting with merely the promise to meet again. Insist on a date to return and continue planning.

Later may prove to be much too late.

Heroes of New Orleans

Pray and give praise to the nurses and health care staff of the hospitals in flood and fear ravaged New Orleans.
I just read that in one large city hospital the staff are feeding each other intravenous fluids just to keep going. Pray that the governments not forget they too are victims and refugees. Too often we are forgotten; our services merely expected of the profession.
My heart and prayers go out to you. You are the strength, the brick and mortar which is keeping many alive, in mind and body.

Heroes each and every one.

God bless you.

What are they going to do...fire me?

I wonder how many others have heard these words recently from coworkers.

How many people have accidently overheard a nurse say these words?

Have we become so disillusioned with our profession that we have adopted such an attitude? Or have we become so arrogant to think we can break small rules (being late for work, not following employer no smoking rules) then snub our noses at managers and supervisors?

I know not all nurses act or feel this way, but it saddens and angers me to hear about coworkers who do. How can we expect other health care professionals, much less health care consumers, to respect us when they hear such things. What kind of example do we set as we care for clients? Are our attitudes showing through in our daily work without us realizing it?

Ask your coworkers. Have they overheard you say something disrespectful to others or about your profession? What do your actions say?

Something to think about.

Ready...Set...Ready...Set

I have been spending a great deal of time lately reading the enoromous amounts of research done on the nursing shortage and the resulting recommendations. Problem is, I have found little proof of anyone actually acting on these recommendations.
The problem is only getting worse. Organizations continue to concentrate on spending thousands of dollars on recruitment and retention yet they are still falling short of the numbers of required staff. Schools continue to turn away qualified individuals interested in becoming nurses.
The realities here are many of these "would be" student nurses will not return. If the waiting list is 1 to 2 years these individuals will have chosen another career venue. It is seriously time to "fire" on some of those recommendations...and fast.

Customer service is lacking

Like many businesses today, health care institutions often lack in quality customer service. Now I know a lot of nurses will feel upset with health care being referred to as a business, but if they would open their eyes, and pick up the dictionary, it would become obvious that indeed it is a business.

Health care agencies, hospitals, etc provide a service that others need and are willing to pay for. That is a basic definition of business, and we do pay for it, either through taxes or privately.

But on to the point of lack of customer service. A health care agencies' customers are not only those seeking care but also those who work for the company. Otherwise known as employees. Though most businesses try sincerely to offer great customer service to the consumer (apart from what a shortage of professionals can not cover) health care businesses often lack in caring for the employees on a similar footing. So a shortage of nurses leaves businesses scrambling with a new notion of,

"gee, maybe we need to offer nurses special incentives and bonuses".

Those that are smart enough to realize we like to be treated with respect too, will find it easier (and ARE finding it so) to fill in the staffing gaps. To the general public it looks as though nurses are greedy and I guess I can understand why. Yet perhaps if we tried harder to help these people recognize what nursing really entails they might then also agree we deserve certain "perks".

The problem I see is that nurses are terrible at speaking, or speaking out, for the general population to hear (of course, California nurses are progressing nicely in letting their opinions and circumstances be known lately). Too much of what I am reading is simply geared toward, and read by, only other professionals.

My opinion is simple, speak and be sure you are heard or you will simply cease to be of any importance to the world, or atleast continue to go unrecognized in their minds.

The lure of career fairs

I couldn't resist but to attend a recent career fair in Toronto this weekend. It was a whirlwind 3 day affair for reps from hospitals across the USA and Canada. Actually, now that I think about it, there were very few from hospitals in Canada; mainly Ontario, BC and Calgary. Of course there were prizes and free give-aways and it was a little embarassing to watch participants crowd the tables trying to get their share. I did walk away with a door prize (a pen) and I did pick up a water bottle, but my main focus was obtaining information from the exhibitors, not checking out the "goodies" available. Maybe that's my age showing.
Before the fair opened they held a half hour information/question-answer session in an adjoining meeting room. What came across clearly was that many health facilities were expanding and needed more nurses to staff the facilities. my question again would be,
"and where do you expect to find these nurses?"
I remember only 1 educational institution in attendance in Toronto. I must say I did not pay real close attention as I was focusing on California hospitals that were willing to take an old nurse like me (I'm 45 with 20 years almost full time experience) and update. I have been running into situations of "you're not qualified", and very few (actually only 1) interview opportunities. Monies are getting tight. Supposedly several hospitals are very interested in me, siting I am indeed NOT out of date. We'll see what the next couple of weeks in followup calls and emails bring.
Oh, back to my main point...one of the hospital reps from California was saying she needed to hire 80 to 100 nurses each month for the next several months (I think 8) in order to properly fill their vacancies. Now, there were some new grad RN's and soon to graduate students at the fair the day I attended. But there were also many other professionals, LVN's, CNA, Medical Laboratory Technologists, looking for work opportunities. I wonder if she will actually find the numbers she is seeking? How many months will be needed "on the road" attending career fairs?

Another death in the ER waiting room

On the local news tonight it was reported that a 2 year child died in the ER waiting room of a large city local area hospital. The parents apparently reporting having been waiting one hour to see a doctor, the hospital disputing this. My question is...
...was it related to a nursing shortage?
Could the death have been prevented?
Was the triage nurse properly trained?
What kind of stress level are the nurses now feeling? And does anyone care?
Certainly not the parents. Why should they. They are mourning the loss of a child.

If you build it will they come?

As I am trying to renew my registration with the Alberta Registered Nurses Association, (and still waiting for California to send my varification through) I discovered that there is a new hospital being built in the province. I believe it will be a cardiac care facility. Of course when this came up in conversation I asked what had to be asked,
"and where do they plan on getting the nurses from, to staff this new facility".
The rep I was talking to couldn't really answer the question, or maybe I didn't give her the opportunity. I answered myself. Perhaps a new modern facility will help Alberta attract more nurses.
We all know they are certainly not just going to magically appear out of the sky. Some facility (s) somewhere is going to lose their nurses in order to staff this hospital. Why does it always seem to me that governments and governing boards keep spending the money in the wrong order. I don't want to say on the wrong thing, because I am quite certain, having been in Alberta myself, that some of their hospitals are in great need of updating. But how can you build and expect to staff it with nurses (someone needs to carry out the orders written) when they do not presently exist. The "hire ups" are doing things in backwards order....again.

The International Nursing Shortage

I have nurses and allied health professionals from all over the globe visiting my web site. Many fill in the forms I have placed there, seeking assistance with finding permanent and travel jobs. I am often challenged by those who are writing from developing countries. One such request came recently from a nurse in the Asia/Pacific area. Instead of looking for placement in North America, this nurse was wanting to move to another island. So in my research to locate agencies who recruit through these areas I happened across a radio broadcast from October 2004, on Asia Pacific radio station.
The headline read,
"Nurses abandon developing countries for more lucrative pastures The efforts of developing countries to build up their health systems is under serious threat from a shortage of professionals, especially nurses. Nurses from the Philippines, the Pacific and elsewhere are
leaving their homes and hospitals in increasing numbers for the greener pastures of the UK, the US, New Zealand and richer Asian nations".
This was from the 2004 Asia Pacific Nursing Congress, and the speakers were Professor James Buchan from Queen Margaret University College in Edinburgh (recently involved in the
first global survey of the nursing workforce for the International Council of Nurses), Kuini Lutua (General Secretary of the Fiji Nursing Association), Pelenatete Stowers from Samoa (the Government Chief Nurse).
They were discussing their problems with the nursing shortage. Yes, it is a global problem. Many nurses from Asia and Africa, from the smaller islands as well, are leaving for "greener pastures".
They are actively recruited from developed countries who have more money to offer, plus better working conditions. I was somewhat surprised to learn nursing schools in developing countries are also faced with turning away elligible candidates.
Australia will be short 40,000 nurses by 2010. Africa's growing problem with Aids and HIV infected persons in putting huge strains on the limited nursing population, and the small islands also lose nurses to better paying jobs in developed countries.
When the radio interviewer asked what were the solutions none of the participants could offer an answer. There is work being done on an international agreement dealing with nurses (and I believe nurse recruitment) but as far as I could determine there was nothing set in stone yet.

Can hospital policy strangle your future?

When I was nursing in the USA (2002-2004) I discovered some hospitals have come out with policies that will not allow them to give out references to other employers. I'm not certain the reason for this but I am well aware of the consequences such policies can have on a nurses future employability. Human resource departments will only say that
"yes, this person was employed here as a nurses between such and such dates",
but they will not make any mention of whether you demonstrated safe and competent patient care. Now, if you were an employer, would you not be a little reluctant to hire someone about whom you had no indication of their competency as a nurse?
I am back in Canada at present, trying to re-register in a province where I have worked before. In order for the registering body to give me my certificate one of the things they would like is a simple reference from a recent past employer. Unfortunately that employers' policy is to "not" give out any professional information. So the registering body says to me,
"we have a glitch, the employer will not answer the questions we need answered".
So now what?
My point here is this. If employers practice these policies, which seem to make little sense at this point, could they cause a good, safe practicing, has never had their professional license suspended nurse, lose the ability to practice nursing any more?
Forced (due to circumstances) retirement? Driven from the profession for no reason? How many is this happening to?
Are we (the nursing profession) furthering the nursing shortage through ignorance of what our policies might be doing to individuals?
Think about it.

Nurses unite...and write

I was in the library yesterday doing some research for my book. At this point I need to know what type of competition I am up againsy for nursing non-fiction books. Well, little it seems. There are a number of medical mystery books about, some new ones like "Pandemic" by Dr. Daniel Kalla. What few books there are written by nurses, or about nursing, are mostly non-fiction "how to" or fiction classified under romance. Now these are good, sure, but much to scarce. So much "real" information about nurses and the profession can be portrayed in non fiction mystery or contemporary genre books. So why aren't there any? Either my research is severely lacking or nurses are just not writing.
When in comes to writing many people truly believe they can't. Yet anyone, with a bit of practice, can, and without having to go back to University to take special courses (though if you can afford a couple it sure may help. If you can read, you can probably write the same type of book. My childrens writers course aften reinforced the point, "write what you love"..."read what you write". And nurse have lots of practice writng to get the point across in as short a form as possible.

So write! Please!

Writing is good for you emotionally (and perhaps financially), reading is good for the general public (ask any school teacher), reading and writing exercises the mind which can help ward off Alzheimers, and if you consider non-fiction...WE can help people stay out of hospitals and emergency rooms, especially during this time of shortage of nursing professionals.

Governments close gates to willing nurses

There are nurses from other countries willing to come to the USA but the US government has put a 3 year hold on Phillipine (and I believe other foreign trained) nurses filling positions. I know of atleast one hospital (and surely there are probably others) who tentatively hired a number of nurses recently, expecting them within a year to fill needed positions. What now? The government surely doesn't expect other nurses will magically appear to fill the vacancies when they could not be filled locally (or nationally) before?
Again, it looks as though governments and schools are causing a worse shortage of nursing professionals than there needs to be.

The "COST" of nursing

I would agree that Registering bodies for nurses is important to protect the public, keeping nurses professional and accountable. But sometimes the cost of a nurses' licensure can drive them from accepting an employment offer.
Today it seems most Associations charge $250.00 and up (USA & Canada) per year, and if you want to work in more than one state/province, or accept a job in another jurisdiction, the cost can be enormous. In my case recently, trying to re-register in a province I have worked in before I needed to provide proof of registration over the last 5 years "in every jurisdiction I have held an RN registration". Plus I needed to provide proof of my "initial" registration after passing the Canadian exams. I understand the need for ensuring a nurse is legite but they already have received some of this information in the past. Everyone charges me a fee for "providing" information to another registering body, anywhere from $28.00 CAD to $60.00 USD. When you are looking for work because you're struggling each month to meet the rent just where are you supposed to find these extra dollars?
There is no real benefit to the nurse member, such as provision of liablilty insurance or free CEUs. Would it not make more sense to have national databases? Faster information for registering bodies, faster fulfillment for employers who are standing by with a job for you ( and a real need for your nursing services) , and certainly more affordable for the individual nurse to accept a job.
I wonder how many nurses have not been able to accept employment offerred because the could not afford to?
Like I said to my husband,
"I'm not sure I can afford to accept this job".

The future of hall way medicine

I wonder what the ER's will be like in 2010 when the continent will be short the predicted 400,000 nurses?

Governments set forth plans and policies to ban hallway medicine, set nurse to patient ratios, give out monies to recruit more nurses yet authorities continue to predict short numbers of nurses.

Our population grows older in larger numbers, and we continue to live longer. But we are also unhealthy. Obesity and all its associated problems continues to rise to near epidemic proportions. People are increasingly going to recur services of hospitals so how is it we are not heading toward MORE problems of hallway medicine.

In one of my more recent past nursing positions I have had to deal with nurses refusing to take anymore patient assignments. The management authority side of the brain says,
"you must, we can not turn people away requiring care".
The more human nursing side of me agrees with the nurse;
"If I take on more patients how can I not endanger the lives of all my patients?"

What happens when nurses on the units refuse to take patients is, for a time anyway, they are placed on stretchers in hallways, cared for the nurses working the ERs. How bloody safe is that!

An ER nurse has his/her more immediate standards of practice to contend with. Now they have to somehow find the time, and energy (and I don't mean that in any nasty way) to care for a med/surg classified patient.

Tell me, Mr Prime Minister, Mr President, how well could you tolerate being cared for in an unsecured, total privacy lacking hallway? Why should you have priviledges above and beyond any other health care consumer?

No more studies. Utilize the excellent resources we already have. A piece of paper does not necessarily mean a better nurse.

Nurse questioning WHY they should stay in the profession

I have spent some time the last couple of days reading through chat rooms. Too many nurses seem to be questioning whether, even after 20 years, to stay in the profession.

They are stating reasons like the way nurses treat each other (you know many are too rough on students and new grads), heavy patient loads, long hours, lack of support or appreciation from superiors.

So in the forums and chat rooms they look for support. They try to look back at how nursing has shaped who they are now, the good things that have come from caring for people. But I have read nothing about looking forward to the future.

Scares the crap out of me. I may need hospitalization some day, yet there might not be enough nurses left to care for me. I think I'd rather dye at home, or atleast instantly from an accident.
A hell of a thing for a nurse to say but it is NOT going to get better. Why? Because the powers that be are not reading through these chat rooms, and if they are, then it is obviously with closed ears and minds.

Shortage of our own creation?

I have read on many news and provincial registering body sites that it is estimated we will be short about 400,000 nurses by the year 2010. And schools repeatedly turn away qualified applicants for nursing programs. In addition, there is a shortage of "qualified" instructors (the reason for turning away students). They require apparently Masters prepared (and preferrably Doctorate) nurses.
Too many meetings, too many committees, too many fancy papered reports on the problem and no one has given, not that I have seen, a concrete suggestion for a solution.
I believe they need to stop wasting time and money, and "qualified" resources. There are very well qualified, educated and experienced nurses who may hold only a Baccalaureatte degree whom they are ignoring.What happens when we hit 2010? What happens when we hit a number greater than 400,000 and the population in need of nursing care far exceeds what it is now?

My fear is too many will be dying waiting for care, excessive hallway medicine and even more nurses leaving the profession due to long hours, burnout and the fear of "accidently" killing someone.

The nurses "instinct"

Not too long ago a couple of local area (my home town) nurses saved the lives of 5 people. Not so unusally you may say? Well, using their keen instincts and knowledge about poisonous substances (in this acse carbon monoxide), they noted that the patient they were caring for in hospital (acutely ill in the ER) lived with 5 other people. With little hesitation they had emergency vehicles dispatched to the patients home immediately. There were indeed 5 people in the home who were in need of immediate assistance. Thanks to their instincts, and not fearing to act on them, they were heros (atleast in my eyes).
But how many other peole recognize them as such? Not enough!

speciality as necessity

After 19 plus years of nursing, seems I have worked myself into neer unemployability.
Nursing has become very specialized, requiring certificates for every area of practice.
I would recommend to all nurses to not stay too generalized. Just keeping updated on CPR and ACLS proves to be of little value to most employers now adays.
I have been trained (as an outpost/community health nurse) to do extensive history/physical exams, deliver babes, suture minor wounds, immunize adults and children, even diagnose and prescribe for simple illnesses. I have had management and supervisory positions where I trained, taught, hired, worked on policy and procedures. Yet after 19 years people are telling me I am under-qualified. I am even not qualified for working PostPartum.
It sort of feels like a nasty kick in the teeth. Afterall, havn't I been working on a BN? Yes, but I have yet to have that paper in hand...;.it makes a huge difference.

Nurse / patient ratios

I was thinking again today about the nurse to patient ratios the California government is bringing in. They are at 6 now (other States have followed suit; not sure which state started this) and were hoping to move to 5:1 this month. That has apparently been put on hold, and nurses are angry. I understand the desire to have limited patient numbers. Lord knows med/surg patient care is heavier today then when I first started nursing. My question is, aside from turning away patients how are people that need hospitalization going to be cared for? There is a shortage of nurses world wide, so what do governments, and nurses, expect to happen? People will not stop getting sick. We are living longer yes, but with more and prolonged illness.
The USA, and probably Canada, has waiting lists at nursing schools. The shortage of qualified instructors seems to be a big problem. Perhaps the real problem, schools and governments want Masters prepared (and up) instructors. Sorry, but there are just not enough to go around. So are we unnecessarily causing a shortage of professionals. There are some wonderfully talented and seasoned nurses out there, with only a Diploma or BN degree, who would make wonderful teachers.
I have a strong distaste for those who see more value in a piece of paper than the person standing before them. Experience counts for not? Sometimes (I have seen) all you get is the paper...useless.

Government cuts...again

So the Ontario government is cutting nursing jobs again. Hospitals are in an awful budget crunch, as is the provincial government. In an effort (supposedly) to better meet the needs of health care consumers, they want to focus more on Public Health and prevention. I think they have done this before though; cut in one program before the other is in place. The Health Minister says no worry though, as laid off nurses will soon find other positions opening in the new focus. Don't suppose he stopped to think that many of these hospital nurses will not be qualified to fill new public health positions? No, don't suppose.

Intro to nightinglae lost

I created this blog to keep thoughts, comments and feedback from others as I reflect on my own nursing profession and the status of nurses world wide.

I am a freelance writer and hope to publish real life stories of REAL nursing. Too often it's not pretty, and it the profession is little appreciated by many.

Since Florence Nightingales time, there are days I feel nursing has made little more progress than mere handmaids of physicians. Even nurses, though registering bodies "talk the talk" sort to speak, think little of their own knowledge and abilities. We could be, we are , so much more than most realize or want to talk about.

This blog is a chance to share, freely and openly, thoughts, feeling, encounters with the nursing profession. Please be aware, I will probably use posts to this blog in my book. But also realize anonimity will be respected as much as possible. I for one am not afraid to speak, for the good or bad , about the truths of the profession, as I see and have experienced them.

It is a good profession, an honest one, and a hellishly difficult one. Nurses can be abused, ignored, misused, revered, abandoned and loved. I still recommend it as a career for men or women, but suggest any person entering do so with a strong will and an open mind.