May, 2007 Archive

May 8, 2007, 11:41 am

A Different Sort of Monarch: Grand Rounds


I do hope this is a monarch butterfly, or the title of this post makes no sense!

The host for Grand Rounds this week is TBTAM at The Blog That Ate Manhattan and this photo (shamelessly lifted from the site) is a tribute to the still very much missed Barbados Butterly.

Let’s see….I dropped my daughter off at school, sweated my way through Jazzercise (my abs may be showing now, I’m not sure because I haven’t seen them for decades) and I should be cleaning the house…

Nah! It’s time for me to get my Grand Rounds fix on.

But wait!

I have an exciting announcement! (No, I’m not pregnant; good lord! The funeral service for any ova I have left is pending.)

I’ll put it in my next post!



In the meantime…

Don’t forget that Mother Jones over at Nurse Ratched’s Place will be hosting the next Change of Shift on May 17th.

Send in your best stories by or about the nursing profession to nurseratchedsplace at yahoo dot com!

Change of Shift will be the featured carnival over at Blog Carnival on May 12th!

Many thanks to Denise at Blog Carnival for the honor!

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May 7, 2007, 11:33 am

Federal Safe-Staffing Ratios: The SEIU Conference Call With Representative Jan Schakowsky


At 0930 Pacific Time, I had the pleasure of listening in on a national nursing conference call with Illinois Representative Jan Schakowsky. The topic? The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2005 (H.R. 1222), introduced by Rep. Schakowsky this week.

I decided to post after the call so that I could give all my attention to the content.

Nurses from New York to California, both Democrat and Republican were on the line for this call. One nurse was with 110 other nurses as she spoke!

Our host for the conference call was Ms. Cathy Glasson, President of the Nurse Alliance of SEIU.


Cathy Glasson: (Introduces self and welcomes callers) Cathy tells us she is an Iowa nurse with 24 years of experience and is with Representative Schakowsky in her Washington office. She introduces Jan Schakowsky.

Representative Schakowsky: (Is a member of the House Nurse Caucus – Ed note: I didn’t know there was a House Nurse Caucus!) Works closely with Representatives Lois Capps and Carolyn McCarthy, both of whom are nurses. Feels that safe staffing is a “cornerstone” issue. She thanks the nurses for all that they do. She states that our health care system is broken and that nurses are critical to safe patient care. She talks about how nurses are leaving the profession, citing a veteran nurse who had to retire because she could no longer deal with the compromised patient care, and a nurse who still worries about the care she gave in her hospital five years after leaving hospital practice.

National Nurses Week is acknowledged, but Rep. Schakowsky states that nurses need more than just flowers. The problems nurses face, such as working short staffed and mandatory overtime must be addressed. Statistics were cited, the most impressive being that if one, just one full-time nurse is added to a unit per day. the death rate in an ICU will decrease by 9% and on a med/surg unit by 16%.

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2005 (H.R. 1222) would

  • Require hospitals to staff with minimal nurse-to-patient ratios as follows:
    • 1:1 in the OR
    • 1:2 in Critical Care
    • 1:3 in the Emergency Department
    • 1:4 on the Medical/Surgical unit
    • 1:5 in Rehab
    • 1:6 in Mom/Baby (three couplets)
  • In addition, the bill adds:
    • Whistle-blower protection for nurses who report safe-staffing violations
    • Protection for nurses who refuse to accept an unsafe assignment

Nurses are needed; we must speak out and take our stories and evidence to the public. Surveys show that RNs are the most trusted of all health care workers and it is our skills that make the difference. Rep. Schakowsky sends a big hug to the nurses and tells us she needs our help to build the momentum for safe staffing in every hospital!

Cathy Glasson: “2007 is the year for change!”

Question and answer period follows. There were lots of Cathys in the audience, so I will try to keep them straight!

Cathy, Nurse Alliance Member and RN from PA: (listening in a room with a group of 110 nurses!) What can we do to move the bill forward?

Rep. Schakowsky: Legislation moves votes in Congress!!! The Cadillac of legislative contact is to set up a meeting with your representative and tell our nursing stories. Invite members of the legislature to watch you work.

Talk to the media. Get our stories out to the public!

Nurses need to KNOW THEIR POWER!


Rebecca, RN from AL: If the US Congress passes a bill for nurse:patient ratios will it stick when it gets to the hospitals?

Rep. Schakowsky: The legislation will be overseen by the department of Health and Human Services (HHS). Hospitals will submit reports to the HHS. They will be required to meet with their nursing staff once a year to discuss patient care and staff needs. Hospitals in violation would be subject to corrective action, fines being one example.

Cathy Glasson: It will only be as strong as the nurses who make sure the law passes and then work with their employers to implement the law and report violations.


Kathleen, RN from Denver: Congresswoman, here in Colorado, we recently passed whistle blower protection for health care workers, Nurse Alliance members will work with the Governor to address staffing through a new Patient Care Task Force, and we’re working on a comprehensive health care reform initiative for Colorado.

When will Congress tackle nationwide health care reform?
And how do we, as nurses, make sure that higher standards for patient care are an important part of any national health care reform effort?

Rep. Schakowsky: (Gives congratulations to the Nurse Alliance in Colorado for obtaining whistle blower protection and the Patient Care Task Force). The health care situation is at the “tipping point”. It will take a Democratic president before we see a National Health Care system in place. The current system doesn’t work for anyone. Our issues are patient issues. Nursing problems are actually “quality care issues” and directly affect the patient.


An RN from St. Louis: We have recently introduced and had a hearing on a similar bill, SB704, The MO. Health Care Report Card Act. Since The Illinois Hospital Report Card Act has become law, do you feel this has brought about awareness to the public concerning RN staffing levels, and will it help to move Federal staffing legislation?

Rep. Schakowsky: (Gives congratulations on hearing.) When the public has access to quality indicators, it shines a light on the need for nurse/patient ratios.

(Again, reinforces) State level legislation helps get legislation passed on the federal level!


Jane, RN from CA: The nurse-to-patient ratio bill here in CA doesn’t protect ancillary/support staff cuts, does this bill include such protections???

Rep. Schakowsky: Yes!!! The hospitals will be required to factor in all patient care needs that are met by non-RN staff. Health care is delivered as a team. Take away ancillary personnel and the workload of the RN increases. The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2005 (H.R. 1222) protects ancillary personnel.


Delores, RN from WA: How does working at the state level help pass legislation?

Rep. Schakowsky: (Gives example of how the federal needlestick bill was passed by the states giving the bill momentum. Notes that California put the pressure on other states to pass safe-staffing laws)

Nurses must get involved on the local, state and national fronts. Safe staffing saves lives.


Pam, RN from WA: Given the growing shortage of nursing educators and rising tuition costs, how will we recruit and train the nurses that will be mandated by this legislation?

Rep. Schakowsky: We need to increase training programs and education for nursing and fix the reasons nurses are leaving the profession. President Bush is cutting funds for nurses’ education [Ed note: from the 2008 budget}.


{Ed note: I think I was the only Republican on this conference call…..}


Cathy Glasson: This is National Nurses Week. Let’s celebrate by uniting behind this legislation.

Rep. Schakowsky: We need to let nurses know that we respect professionalism and create an environment that shows it. One where we can feel pride in our work. It’s a joy to work in partnership to deliver health care to our nation.

Cathy Glasson: Celebrate Nurses Week by getting involved. Tell a colleague about what you heard during this conference call. You can find out more by logging onto our website: Thanks and Happy Nurses Week.

Rep. Schakowsky: It’s been my pleasure.

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May 5, 2007, 5:47 pm

I’m Worried About Him


Call me crazy, but if you have dysmenorrhea doesn’t that mean you already have symptoms?

Otherwise, you wouldn’t have dysmenorrhea, right?

And this “antispasmodic”: cinnamylephedrine. It was also a potent anesthetic and caused spinal cord paralysis in frogs.

Oh, I gotta get me some of that!

And it was far from “exclusive”. Extensive research on my part, aka a Google search, shows it was everywhere.

They probably took it off the market because people were making cinnamon-flavored meth out of it.

It isn’t in Midol anymore. Midol does have an antihistamine guaranteed to knock you on your caboose. Alas, the only “stimulant” it now contains is caffeine.

Heck, a good Venti, non-fat, extra hot Dulce Latte with an add-shot from Starbucks will give you more bang for your stimulant buck.

Trust me.


I’m worried about him.

Young guy, looked healthy. Shows up to the ER at 0400 with a couple of family members.

He didn’t speak English.

It didn’t help that his symptoms were nebulous at best. They were so vague his translators had a hard time putting them into words.

His body was numb.


His mouth was dry.

Okaaaay. “How long has this been going on?”

One month.

“So what is different tonight; what made him feel he had to get to the ER right now?”

“He says he feels like he is going to die tonight.”



The patient spoke awhile to his translators.

“He is always thirsty.”

Oh no.

I asked him in Spanish if he was urinating frequently and a lot.


Oh no

I put him on the gurney and grabbed a fingerstick blood sugar before I did anything else.

390. Well, that explains it.

I threw in a line, grabbed the blood, started saline and called the doctor to the room.

New onset diabetes Type 2.

A little insulin, a little fluid, a few hours of monitoring and the blood sugar began to come down.


I knew we could get his blood sugar down, that wasn’t the issue.

How do you explain to someone that they have diabetes when they don’t speak English?

His translators did their best trying to explain exactly what diabetes was and what it would mean to his life in terms of health care, diet, checking his blood sugar. I tried to make the information as basic and informative as possible. The patient just looked dazed and overwhelmed.

Then he asked his first question.

Would his leg fall off?

His only knowledge of diabetes was that an uncle had lost his lower leg because of the disease.

Oh boy. This was not going to be easy.


It was going to be harder than I thought.

He worked for cash. No health insurance. No doctor. I couldn’t even really gage his ability to take in the information he was being given.

Eventually his blood sugar lowered to the point that he could be discharged.


When did we stop admitting new-onset diabetics? Where do you learn to check your blood sugar? How do you learn what you should and shouldn’t add to your diet? How do you learn about your medications?

Oh, we gave him a referral to the county clinic.

But the only diabetic teaching he left the hospital with was what he got from me. And I don’t even know how much of that he was able to comprehend.

I do know that he was going to have to go to a pharmacy and put out a minimum of $100 for the two medications and a glucometer. He was going to have to do blood sugar checks three times a day. He was going to have to change his alcohol intake, not just because of the diabetes itself, but because of the medications prescribed.

I went to the ADA site and printed all that I could find in Spanish. I gave him our discharge instructions in Spanish. I explained all I could through the translators.

He was quiet the entire time.


Did he fill his prescriptions? Is he checking his blood sugars? Did he get into a diabetes education program at the county clinic? Is he even bothering to do anything to get control over his disease? Does he realize just what this can mean to his life?

I know it’s his responsibility and I have no control over any of it. I did what I could with what I had to offer him in the middle of the night.

But I can’t stop thinking about him.

Maybe because it was a year ago this month that my husband received his diagnosis of diabetes. I remember the shock, the initial numbness, the learning curve with diet and figuring out the new glucometer and the emotional roller-coaster that he went through after the diagnosis. I went through it with him and it was just as scary for me, and I knew what was happening.

Now, if I’m a nurse and was thrown by a diagnosis of diabetes, how much more would it affect someone who didn’t have a grasp of the basic concepts.

All he knew was that his leg might “fall off”. How frightening.

Maybe by letting him know that a controlled blood sugar could help him avoid an amputation in the future, I was able to impart some motivation to take care of himself.

I hope so.

I still worry about him.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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