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Recipe For Disaster: More Patients Per Nurse

February 17, 2021 by LORIE A BROWN, R.N., M.N., J.D. 1 Comment

California is the only state that has mandatory minimum staffing.  However, when the pandemic hit and ICUs were filled to capacity, the state’s Department of Public Health allowed hospitals to apply for a temporary expedited waiver which would allow each nurse to care for more patients.

The law had allowed nurses to take only 1 or 2 patients in ICU during the pandemic but now with the introduction of the waiver, nurses must take even more extremely ill patients into their care.  This further burdens nurses who now may have to take care of up to 5 ICU patients at a time.

Although the California Department of Health will no longer accept any expedited staffing waivers as of this past Monday, the hospitals that have the waiver can still flex their staffing and require nurses to take care for more patients.  Kaiser Permanente in San Diego is one of those hospitals that their ICUs were filled with the surge of COVID patients in December and January.  They were not able to comply with the 2 person staffing ratios.

However, the University of California-San Diego did not apply for a waiver and has been able to provide nurses to keep patients safe and ensure they are properly cared for.  Expedited waivers pose a dangerous risk to both patients and nurses.  California nurses have fought hard to have mandatory minimum staffing.

Can you imagine taking care of 3, 4 or even 5 ICU patients?  The amount of care that these patients require would jeopardize nurses’ licenses as well as patient safety.  It is scary that the California Department of Public Health has allowed these ratios to be relaxed, especially during a time when patients are not allowed to sue for any alleged malpractice.

I encourage any who are working in any California facility which has been granted a waiver to talk to their union representatives or, if there is not a union, to communicate with their director of nursing about having those mandatory minimum staffing requirements reinstated so that patients get adequate and proper care.

 

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Filed Under: Employment, Newsletter, Workplace Issues

Top Ten Blog Posts of 2020

January 28, 2021 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

As I always provide at the start of each year, here are the TOP TEN BLOGS of the previous year.  For 2020, we start with number 10 and go up the scale to the top blog of the year.

In at number 10, Can You Train a Nurse in 2 Days to Work in ICU?  The Governor of California said he could train a nurse in 2 days to work in an ICU.  This is completely unrealistic.  I challenge all of you to invite your state representation to work with you.  They have no clue how difficult your job is.

Coming in at number 9, Yikes! My Nursing License is on Probation.  This blog discusses what to do if your license is placed on probation.  It is not the end of the world, but prevention of a problem is the best defense.

In at number 8, Scam BON Actions.  This article discusses how some nurses have been defrauded with a fake letter from their board of nursing asking them to pay money up front like a bond for an investigation.  It is scary that these letters look so official and nurses are falling for it.  They are scared that their license will be suspended and so they go ahead and pay the money.  The article discusses how to detect the red flags in these letters should you receive one.  But I recommend calling the Board itself and NOT the number on the letter to confirm.  No board asks for money up front.

Now down to number 7, Indiana Joins the Nurse Licensure Compact.  This one was a surprise to me.  This blog discusses what a compact license is and the benefits of what is called an eNLC.

Number 6, No Security in Nursing discusses given the pandemic and the closures of outpatient clinics, surgery and procedures, many nurses were furloughed.  This is the first time in history where nurses have been furloughed and with a nursing shortage, it was surprising.

In at number 5, California BRN Finds Fraud in Investigations.  It turns out that in 2016 the State Auditor said there was a backlog of cases with complaints based on unprofessional conduct, drug use and negligence.  It took the Board more than a year-and-a-half to assign the complaints to an investigator who didn’t adequately investigate and led to falsified reports.  Some nurses were disciplined on falsified reports.

Number 4 is an issue that raises lots of questions, Nurses as Independent Contractors.  This blog talked about the problems with nurses who are misclassified as independent contractors and the tax consequences and penalties that can be assessed.

Down to number 3, Nurses Terminated For Speaking Their Minds.  This article discusses about nurses in long term care facilities who spoke up about poor care and were terminated.  Nurses should be able to speak their minds about bad care because this is the only way we can improve bad care.

I don’t know why this is number 2.  Maybe due to the popularity of Tik Tok,  Tik-Tok Nurse Implodes her Job.  Interestingly, this article discussed how a nurse talks about how she didn’t wear a mask in the community and lets her children go on play dates.  She lost her job.  Her employer felt that this was improper to share due to all the hard work that nurses are doing to treat COVID patients and prevent others from getting ill.  She, as a nurse in the community, admitted that she had not been following the mandates.

Finally, in at number 1, drum roll please!  The top blog was one of the first ones of 2020 about how Malpractice Claims are on the Rise with Electronic Health Records.  This blog discusses the problems with electronic health records, specifically editing with copying and pasting, autopopulation, selecting items from the dropdown menu and failing to review prior documentation.  Be sure if you are taking your documentation home that your memory of the visit is accurate.  And, if you have a scribe, make sure the scribe’s documentation is accurate as it is your signature

I am always surprised at this top 10 list.  Most of the Covid articles did not seem to be a hit maybe because nurses are in the trenches with it.  I really want to provide useful content to you so please let me know what you would like to learn about in the comments below.

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Filed Under: Newsletter

Can You Train A Nurse In 2 Days To Work In ICU?

December 17, 2020 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

California Governor Gavin Newsom proposes that nurses be trained in ICU care in just 48 hours.  Maybe they can be trained in 2 days but certainly not sufficiently enough to do things safely or within the standard of care.

A nurse with only 48 hours of ICU training may end up being more of a danger to a COVID 19 patient than the virus itself.

But what difference does that make when hospitals cannot be sued for malpractice involving COVID related cases?

I would like to be standing alongside Governor Newsom while he learns to become proficient as an ICU nurse in a mere 2 days.  Of course, it will not happen and, in fact, can NOT happen!  Even if he had a medical background to start with, it just is not feasible for such a Herculean feat, even by a Governor.

To become an effective and safe nurse requires years of practice and continued education for one “to get their nursing legs.”

More precisely, the assumption that one can go from a different type of nursing care to learn ICU practices in 48 hours is also ridiculous!

Many nurses have spoken up saying Newsom’s whimsical idea will not work.  They have talked about how they themselves had 6 months of training before they were allowed to take patients on their own without the support of other already professionally trained medical personnel.

I caution any California nurse to think again if they believe they can become a proficient ICU nurse in less time than it takes to drive from Los Angeles to New York City.

You may not be sued for malpractice because of the laws protecting COVID 19 healthcare providers from legal action but, nevertheless, your LICENSE IS STILL ON THE LINE.

Do not make the mistake of trusting a politician’s statement over the most basic reality of what is known by essentially every person in the healthcare profession.  Which do you believe provides a more trustworthy educated and work-experienced opinion?

2 days?  The idea would be laughable if it did not involve the life-and-death issues accompanying the COVID pandemic.

I strongly encourage you to invite your legislators to shadow you in the ICU so they can see what you are dealing with and decide for themselves if someone can be trained in 2 days.

Let me know below your thoughts on Governor Newsom’s statement.

 

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Filed Under: Employment, License Protection, Newsletter, Workplace Issues

Nurse Between a Rock and a Hard Place

December 10, 2020 by LORIE A BROWN, R.N., M.N., J.D. 6 Comments

A Minnesota emergency room nurse was concerned about having to wear his own scrubs to work during COVID and returning home to his wife and children wearing those potentially contaminated scrubs.  He worried about bringing the virus home and passing it on to his family.

Scrubs were available in the emergency department and healthcare workers at other hospitals in the same system were allowed to wear the scrubs provided by the hospital.

However, at this particular hospital, he was told he could NOT use the hospital scrubs.  He continued to wear the hospital acquired scrubs rather than his own and, as a result, was terminated.  Since then, he received a letter from the Board.

It is so aggravating to learn that nurses, who are trying to protect their families, cannot wear hospital provided scrubs but are forced to wear their own scrubs and to wear home after working with possible COVID patients at the hospital.

However, I do not condone violating hospital policy and he did receive a warning after which he continued to disobey the hospital policy and continued using the hospital provided scrubs.

The nurse felt he was forced to decide whether the most important point was the policy or the safety of his workplace, public health, and family.

There is an appropriate way to make change and there are appropriate channels for this.  If you cannot make change, then you can decide if you want to leave.

There are also other ways to protect your family’s health.  I know of nurses who brought an extra set of scrubs and changed clothes in the hospital before leaving.  I know nurses who, on arriving home, have changed in the garage and immediately took their potentially contaminated scrubs to their washing machines for cleaning.

Unfortunately, this particular nurse who chose to violate hospital policy has now received a complaint from the Board.

Anyone can file a complaint against a nurse and the Board will subsequently investigate to determine whether the file should be closed or the action on the complaint should proceed.

I have represented nurses who have taken from their hospital IV supplies for hydration and the Board considers that as theft.  Just borrowing hospital-provided scrubs which you don’t take home and are still laundered by the hospital … well, I’m not sure what the Board will think.

Unfortunately, this nurse now is unable to get a new job.  He believes he has been “blackballed.”  However, this nurse has been very vocal in publicizing his case on a website and on Twitter.

Hospitals do check you out and especially so with social media.  Would they want to hire a nurse who knowingly violated hospital policy?

If you want to make change, make it the appropriate way and be careful what you put on social media.  What are your thoughts about this matter?  Comment below please.

 

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Filed Under: Employment, License Protection, Newsletter, Workplace Issues

Tik Tok Nurse Implodes Her Job

December 3, 2020 by LORIE A BROWN, R.N., M.N., J.D. 5 Comments

An Oregon oncology nurse posted a video on Tik Tok saying that she does not wear masks in public, continues to travel and allows her children to have playdates. Someone who viewed the video reported her to her employer.  She was placed on administrative leave.

In the video, this nurse apparently is in the break room at work and wearing scrubs with a stethoscope around her neck.  The hospital felt the nurse displayed “cavalier disregard for the seriousness of this pandemic and her indifference towards physical distancing and masking outside of work.”

Her employer responded with a statement saying that the video does not speak for the health system: “We also want to assure you that this one careless statement does not reflect the position of Salem Health or the hardworking and dedicated caregivers who work here.”

I have several thoughts on this issue.  The first is to advise you to be very careful of what you put on social media.  Do not do a Tik-Tok video in scrubs in your break room.  Even though you are on break, you are still on hospital property.  Even if you were not at work, you are considered a nurse 24/7 and while you may not like this, if your statement can impact your employer, that is not being professional as a nurse. Before doing a video or putting something on social media, ask yourself, “What is the purpose?”  I am not sure what this nurse’s purpose was in posting her video.  If your purpose is to educate the public that is one thing but if it is to create controversy or show your hospital or health facility is doing something wrong, that is another thing.

But my biggest concern is freedom of speech.  This nurse should be able to speak her mind regardless of whether or not it’s in line with company policies.

While there are very strong feelings on both sides of this pandemic, including whether to get vaccinated, whether to wear a mask, whether to travel, whether to allow your children to have playdates … all of these are very polarizing issues.  However, I do believe every nurse, just like every person, has the right to free speech and should not have his or her job placed on the line because of it. Check out these related blog posts.  https://empowerednurses.org/beware-of-using-social-media-as-a-nurse/  https://yournurseattorney.com/speech-is-not-always-free/

What are your thoughts?  Let us read your comments below.

 

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Filed Under: Employment, License Protection, Newsletter, Workplace Issues

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