October, 2007 Archive

October 5, 2007, 2:03 pm

With Our Arms Around the Future and Our Backs Up Against the Past


Okay, what is up with this thing called Facebook!

I knew it existed, but all of a sudden everyone who is anyone is over there!

I’ve been Super-Poked, high-fived, cheered, had a spell cast on me, been invited to become a vampire, received a bouquet of tulips and have an invite for a mocha! I’ve never had a better social life, and I don’t have to leave my house or get out of my sweats!

This morning my daughter informed me that I could throw a cow at someone if I wanted to! Uh…okay….just let me know if any of you want a cow and I’ll send one over!


(Yes, that is a Moody Blues lyric up there. Another case of a lyric stimulating a post…)



There is going to be a strike here in Northern California in a few days.

Nurses who work for Sutter Health facilities will be walking out in protest. Protesting a lack of concern over patient care and safety/staffing issues. Protesting the attempt to decrease health care benefits and undercut retirement security for RNs.

There are rumors some hospitals will lock the nurses out for a longer period if they strike.

We’ve been recipients of Sutter Health care in the last year or two. Pardon my lack of subtlety, but Sutter Health can go to hell.


And no, I don’t work for them.

I did, once. They moved into the San Francisco Bay Area and took over facility after facility. They promised that together, the associated hospitals would be stronger, better and enable nurses to give appropriate care to their patients.

They promised that they would not cut patient services. They did a publicity campaign that makes Hillary Clinton look like she is selling Girl Scout cookies on a corner in comparison. We (the community) actually voted for them to become involved in the local community hospital.

And the benefits! Nurses could move in-between Sutter facilities without losing pay. The salaries were good. The benefits were good. Of course, they were good before Sutter took over and they stayed that way. For awhile.

But now, in a time when we have an unprecedented shortage of nurses, Sutter Health decides that nurses aren’t worth much. They staff their facilities so the nurses can’t give the standard of care required, and then make it personal by cutting their benefits. Never mind that those 25 – 30 year nurses are the backbone of the nursing organization and there is no one to take their place. Just pull their retirement benefits out from under them.


Oh yeah, they’ll tell you money is tight and reimbursements are down and blah, blah, blah.

That doesn’t stop the virtual non-stop commercials that Sutter is running with nurses talking about what wonderful care they are able to give through Sutter. How much money goes into that promotion?

That doesn’t stop the glossy magazines/advertisements and newsletters that arrive at my home on a regular basis. Who pays for those?

What will it take for these corporate hospital executives to understand that their facilities exist to provide nursing care and to do that they need nurses!

Why wouldn’t a corporation want to be known as the place to work where nurses are concerned?


Why do nurses have to fight so hard to get adequate staffing? And not what some idiotic staffing software says is adequate, but what the nurses believe is required for the care of the patients on a particular shift/unit? Why do we have to fight so hard to keep our benefits and a decent chance at retirement?

Back in the early ’70s, the nurses before us fought tooth and nail to gain the benefits and the salaries that we now enjoy in California. Right here in the Bay Area. There were strikes back then, too. The future of nursing was on the line and those nurses fought hard and made sacrifices so we can have the work environment we have today

Why are these same questions being asked almost forty years later?

The future of nursing is on the line now.


I’ve never even had to take a strike vote in my entire career. Never walked a picket line in my life. My forebears in the profession did. Some of them are still working at the bedside. I have the career I have today because they were willing to take a stand.

Are we willing to take a stand today to protect nursing’s tomorrow? We are at a crossroads, a crisis-point in health care and in nursing.

Our older nursing colleagues had our backs and our patients were the beneficiaries. Our arms are around the future of our profession. Do we embrace it? Do we fight for the respect and renumeration our profession deserves? Do we understand the power this profession has? Do we “have the backs” of our patients and our future colleagues?

Maybe you don’t work for Sutter and don’t think this applies to you. Maybe you work for Tenet, or Kaiser or Catholic Healthcare West.

Eventually, when our contracts expire, this applies to us all.

The nurses of Northern California Sutter facilities are going to send a message next week. They are fighting, and sacrificing for us and for the patients we serve.

The rest of us will be watching.

Let’s hope the other health care corporations in the country are listening.

And learning.

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October 4, 2007, 9:50 am

Change of Shift, iPhones, Uniforms and Jobs!

…is up over at Madness: Tales of an Emergency Room Nurse!

The price is definitely right for this edition as GirlVet as you will see when you visit!

Many, many thanks to GirlVet for hosting!!!

Next time, Change of Shift comes right back here to Emergiblog so get those submissions started!


Some announcements from the world of Emergiblog:


Scrubs Gallery.com has been a long-time advertiser here on Emergiblog, so I am happy to announce that they have put together a brand new site. Scrubs Gallery.com is the place to go for Cherokee brand uniforms. I’ve visited the new site and it is very easy to navigate with a large selection. You can visit by clicking on their ad in the middle sidebar.



There are twelve days left in the Nursing Voices. com iPhone contest and if you haven’t clicked over now is the time to do it!!!

It’s still anybody’s game, so don’t think, “Oh gee, I don’t have a chance…” because you do! And there are two iPhones to be given away!

I really don’t have a chance because I’m affiliated with Nursing Voices. com as a moderator. Of course, I’m always open to any one who wants to buy me an iPhone. They say charity begins at home; unfortunately, my husband disagrees.



Nursing Jobs.org is helping to make the search for nurse educators easier for colleges and universities by posting any openings free of charge. So, if you are an educator, know of any openings at your university or are interested in finding a position as a nurse educator, Nursing Jobs.org is the place to be. Information on how to post open positions is available on the site.

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October 3, 2007, 10:31 am

The Pursuit of Perfection


Does anybody rememer when an actual registered nurse ran the Central Supply department?

I don’t remember if I was assigned or if I requested it, but we had one whole day to shadow a nurse in a specialty, back in college.

What a cushy job! Put trays together, run the autoclave, make sure the floors had what they needed in terms of sterile equipment…no patient contact!

At least that is what I thought at the time.

I’m sure it had its pressures, but why on earth would you need an RN to run Central Supply?

I can’t imagine that is done anywhere anymore, but I’m interested to know if you know of any exceptions!



The saga of Blogger T. Squirrel continues.

His mom and sibling showed up this morning to partake of the Squirrel Chow, so I guess the whole family has adopted the back yard as their territory!

It will take more than seven cats and two dogs to scare this intrepid group of rowdy rodents!


I’m not perfect.

I’ll wait a moment for the shock of that statement to subside.

But, work wants perfection. No, Joint Commission wants perfection which means work wants perfection which means I am expected to be perfect.

You know what they say “runs downhill”.


There is one small problem.

I can’t be perfect.

I chart neatly enough to consider framing it. I was one of the first nurses to actually complete entire medication reconciliation reports even as I mentally screamed in frustration over more paperwork. The nurses on the floors know who I am by the quality of the written reports I fax upstairs. My patients are happy with their care and I work well with all the doctors.

I do the best I can every single shift; I try to meet every single requirement, dot every “i” and cross every “t” and document my ass off so that administration is happy. I run my ass off to make sure that my patients are well cared for so that they are happy (and safe!). I do everything for everybody and all I get in return is…

Notices of what I didn’t do.


Every registered nurse in the facility gets a letter from the hospital administrator delivered to their home decrying the state of compliance with the fifty million minute Joint Commission requirements for documentation. Guess that mock survey didn’t go so well when it came to the paper trail.

The one chart of mine that gets audited doesn’t have the medication reconciliation record signed, and so I am listed as “not meeting the standard.” I have no idea which chart. For all I know, it was a three page record and I forgot to sign page number three. But, I “don’t meet the standard”.

The hell I don’t!


It’s not just the patient documentation we get dinged on. It’s how we have to chart to get paid.

Here’s an example. I had a critical patient who was going to surgery any minute; the surgeon was at the bedside. I’m flying to finish the documentation and get him ready to go when a patient walks in who is having either an heart attack or a pulmonary embolism – who knows? He looks sick. The department is full, no one else is available to bring this patient to a room, so I stop the surgery paperwork and quickly get the new patient on a monitor, EKG’d and put in an IV.

I run back out just in time to finish putting the paperwork for the surgical patient together and off he goes! Back to the MI/PE patient I go to finish my assessment, when I realize I did not put the “stop time” of the surgical patients IV antibiotic on the chart – it had finished as he was being transported out the door.

We won’t get paid for that IV. Never mind I charted it under the “med” section. Never mind that I charted it under the IV section. Never mind that it is in the narrative, also. There is no “stop” time on the chart.

So we won’t get paid.

If we put in an IV, begin a saline bolus, push Zofran and Morphine for pain and then hang an antibiotic via IV piggy-back, we MUST chart the IV push meds as the initial charge. Not the bolus for hydration. That is secondary, as is the piggy back IV.

Or we don’t get reimbursed.

Yes, we have to remember inane details like that. What the hell has it got to do with nursing care?


I’m tired.

  • Tired of jumping through regulatory hoops.
  • Tired of being bombarded with minutiae.
  • Tired of working my butt off only to get “dinged” as “not meeting the standard” because of one signature.
  • Tired of charting for reimbursement instead of focusing on the patient.

But you see, no one cares.

Oh, they care about Joint Commission. They care about how you chart your IVs and the order in which you charge for them. They care that you put a number on the pain scale and repeat it after a medication is given. They care that you count the narcotics even though you have a computerized medication dispensing system that should do it for you. They care about anything and everything except the nurses actually doing the care.

They want us to be perfect and I am not perfect.

Guess that means that I “don’t meet the standard.”

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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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