I was standing at the counter when it hit me.
I became nauseous, my knees buckled, and I almost fell to the floor.
I had been uncomfortable mixing the IV magnesium. It just seemed like too many vials. Then there was the conversion from milliequivalents to milliliters and all. I checked with another nurse, but like me, she was inexperienced.
It was a busy second shift in the ED. The more experienced nurses were involved in a bad trauma.
My patient was breathing poorly, the result of years of smoking. The magnesium was designed to improve his breathing, but instead he got worse. We had stopped the IV and intubated him and he was now "stable".
Then, out of the blue, it hit me.
I had mixed the IV at 10 times the concentration!
My preceptor was out of the trauma by now. I told her and then the admitting doctor, who set her pen on the counter, turned to me, and said, "it will be alright".
I have told this story to many a new nurse. This week I told it to the Quality of Care Advisory Committee at the Connecticut Department of Public Health. It was my first meeting on that committee as a representative of the AFL-CIO.
My point was this.
If we want to establish a Culture of Safety in health care, and I believe we should, then we need to have non punitive reporting.
The airline industry has adopted this philosophy and as a result "near misses" have decreased because systems have improved.
A few weeks after my med error, my boss, Sue Davis, called me to the office. We talked about the error and she said, " I know this will never happen again". It never has. But more important, system changes were put into place to decrease the chance that this or other errors would happen in the future.
No health care provider intends for an error to happen.
The incidences of suicide increase after a nurse makes an error.
Increased reporting of errors or near errors will improve the safety of all patients.
That is why, in my opinion, health care workers need to be encouraged to self report and know that it will not be held against them. This is not always the case.
My patient, he survived.
I am sure that many others have been and continue to be safer, because of the many system changes that followed.
This nurse, I survived too.
Thursday, April 11, 2013
Saturday, April 6, 2013
Seeing is beliving
People feel sorry for Thomas.
Like if you were there, and your friends said they had seen the risen Lord, you wouldn't have said,
"ya right!"?
It's sometimes easier to believe with blind faith then to question and then believe.
Thomas wanted to believe....it's just hard.
Lots of things in life are like that.
A couple of years ago when we met Ole in a coffee house and he told us that we could join together with our fellow nurses, form a union, and make a difference,....I wanted to believe.
I DID believe. Yet a part of me was asking why we met in a coffee house far from the hospital like secret agents.
Looking back, I can see that Ole did a masterful job in giving us enough information for the day, but not too much. He once showed me a video of a mock meeting between management and a worker where the manager tried to scare the worker into submission. He stated that he couldn't show it to everyone because not everyone was ready to see it.
I thought, what makes him think I'm ready?
But when I came up against a similar situation, I was ready, I had been prepared.
So my belief that we could be successful was based on my "seeing" that I was being prepared.
When we started reaching out to others at work, some people and some departments were reluctant to believe that we could be successful, that we could make a difference, that THEY could make a difference.
Now we have delegates in every large unit, we have filed grievances, reversed or modified some discipline and will soon argue our first arbitration. We have the ear of our congressman, senators, governor and state and local legislators, We are well known at our state and national federation and to other labor unions, and we have partnered with non profits to benefit the community.
So yes, many of us, like Thomas, have to see to fully believe, but, like Thomas, we can do great things once we see.
Like if you were there, and your friends said they had seen the risen Lord, you wouldn't have said,
"ya right!"?
It's sometimes easier to believe with blind faith then to question and then believe.
Thomas wanted to believe....it's just hard.
Lots of things in life are like that.
A couple of years ago when we met Ole in a coffee house and he told us that we could join together with our fellow nurses, form a union, and make a difference,....I wanted to believe.
I DID believe. Yet a part of me was asking why we met in a coffee house far from the hospital like secret agents.
Looking back, I can see that Ole did a masterful job in giving us enough information for the day, but not too much. He once showed me a video of a mock meeting between management and a worker where the manager tried to scare the worker into submission. He stated that he couldn't show it to everyone because not everyone was ready to see it.
I thought, what makes him think I'm ready?
But when I came up against a similar situation, I was ready, I had been prepared.
So my belief that we could be successful was based on my "seeing" that I was being prepared.
When we started reaching out to others at work, some people and some departments were reluctant to believe that we could be successful, that we could make a difference, that THEY could make a difference.
Now we have delegates in every large unit, we have filed grievances, reversed or modified some discipline and will soon argue our first arbitration. We have the ear of our congressman, senators, governor and state and local legislators, We are well known at our state and national federation and to other labor unions, and we have partnered with non profits to benefit the community.
So yes, many of us, like Thomas, have to see to fully believe, but, like Thomas, we can do great things once we see.
Cooked, but not Done
Stick a fork in me, I'm Cooked, I'm done!
How many times have you thought that at the end of a shift?
It's not just nurses, it's ALL health care workers.
I've included an email I received from Katherine Kany, the assistant director of AFT Healthcare division, on just this issue.
What can we do about it?
Connecticut has a law that says every hospital must have a safe staffing committee, that this committee must be at least 50% bedside RNs, and that this committee must report to the state when requested as to the staff to patient ratio. We have been pushing a bill in Hartford that would make this reporting a regular occurrence, not only when requested, and would publish the results on a public website. Many of you have written testimony in favor of this. The Connecticut Hospital Association is opposing this bill and it looks like they may win this round, but this does not mean defeat. We need to continue to write and speak to legislators and propose it again next year. In addition, we are working to ensure that the hospital is in fact complying with the current law by having real meetings and including real nurses. I also hope that my recent appointment to the Department of Public Health quality of care advisory committee can help.
I want to urge you to visit a new AFT CT web site, SafeStaffingCT.org, and share your stories.
Yes, it's a battle.
There are those who want to continue to short staff to save a buck, hoping that it doesn't hurt patients or staff, in pursuit of larger profits.
But we are many, and together we can ensure our patients safety and
ours, and we know there are better ways to save, that don't put people at risk.
We may be cooked, but we're not done.
What you have always known, now captured and broadcast by the American Organization of Nurse Executives. Highlighting below is from me (Katherine Kany).
Survey: Nurse understaffing, fatigue threatens patient safety
March 21, 2013 | By Julie Bird
Fatigue leaves a majority of nurses concerned about their ability to perform safely, with two-thirds of nurses reporting they had nearly made a mistake at work because of fatigue and more than a quarter saying they had made a fatigue-related error, according to a survey commissioned by Kronos Incorporated.
The "Nurse Staffing Strategy," released this week at the American Organization of Nurse Executives conference in Denver, found nurse fatigue also can negatively affect operational costs, as well as patient and employee satisfaction, according to the research announcement.
Among the findings:
· 39 percent of respondents found current staffing levels inadequate, while 38 percent found them unsatisfactory
· 57 percent said workloads were not distributed evenly in the previous year, with 54 percent saying they had an excessive workload
· 77 percent said their organization had 12-hour nursing shifts
· 96 percent reported feeling tired at the beginning of their shift, and 92 percent while driving home after work
· 63 percent said vacancies affected scheduling and overtime staffing "more often than anticipated"
· 56 percent said their hospitals disregard required rest periods, and 65 percent said their hospitals do not have policies regarding cumulative days of extended shifts
Separate research recently published in JAMA Pediatrics found that nurse understaffing in neonatal intensive care units (NICU) leads to higher infection rates among very low-birth-weight babies.
Meanwhile, Democratic lawmakers in Michigan are joining a nurses' union in calling for a state law requiring hospitals to maintain lower nurse-to-patient ratios so they are adequately staffed without mandatory overtime, Michigan Radio reported.
Sixteen states have rules regarding staff-to-patient ratios, but California is the only state setting minimum hospital staffing levels, according to the report.
"I don't think people realize that when your nurse is handling far too many patients, or working a double-shift or been mandated to stay over, it's probably because the hospital wants it that way," Scott Nesbit, R.N., told Michigan Radio.
The Michigan Health and Hospitals Association opposes the legislation, according to the report.
The nurse staffing survey was conducted by HealthLeaders Media.
Read more: Survey: Nurse understaffing, fatigue threatens patient safety - FierceHealthcare http://www.fiercehealthcare.com/story/survey-nurse-understaffing-fatigue-threatens-patient-safety/2013-03-21#ixzz2OCR9qn7J
Subscribe: http://www.fiercehealthcare.com/signup?sourceform=Viral-Tynt-FierceHealthcare-FierceHealthcare
Katherine Kany, MSN, BS, RN
Assistant Director | AFT Healthcare
Thursday, April 4, 2013
State Budget Cuts and Hospitals
There has been much talk about the state budget cuts to hospitals.
It's confusing.
When I asked State Rep Betsy Ritter about it a month ago, she said even the experts aren't sure what the final impact will be.
In a nutshell, the Affordable Care Act (Obama Care), calls for an increase in the number of patients who will have insurance and a decrease in the compensation hospitals get to treat uninsured patients. (DSH payments) In theory, they balance. The real question, and disagreement, is in whether or not they balance.
To make matters more complicated, part of the equation includes an increase in people on Medicaid, and last summer, the Supreme Court ruled that the federal government could not force states to do this.
In states that have decided not to expand Medicaid, the hospitals will see a decrease in funds for uninsured, and no increase in the number of people on Medicaid, a double whammy.
Luckily, Connecticut is in the forefront of both expanding Medicaid and setting up a "health exchange" where people who make too much for Medicaid will be able to purchase insurance with premiums based on income.
The "Healthy Chats" that you see advertised are information sessions and information gathering sessions on just this. I have attended 2 of these, have learned a lot, and have made contact with the people on the exchange.
OK, maybe it's not a "nutshell".
I said it was confusing.
Bottom line, hospitals will get less money for uninsured patients but will see less uninsured and whether they balance is the million dollar question.
I have included the conclusion of a study on this issue from the
Urban Institute’s Health Policy Center, funded by the Robert Wood Johnson Foundation. If you would like to see the entire study, I am happy to email it to you.
Conclusion
Federal lawmakers who passed the ACA offered hospitals an implicit bargain: help fund the ACA’s coverage expansions by giving up some Medicaid and Medicare reimbursement, and in return receive new revenue when formerly uninsured patients enroll in Medicaid or private coverage.
Last June, the Supreme Court placed the fate of this implicit bargain in state hands. Regardless of what each state decides, its hospitals will help pay for the ACA. But whether hospitals receive the ACA’s promised financial rewards depends on state decisions about Medicaid expansion. Although expansion would reduce hospitals’ private payments, the accompanying boost to Medicaid revenue is over 2.5 times the size of those losses in the average state, even without considering the potentially significant benefits of hospital-based presumptive eligibility in further reducing uncompensated care burdens.
Put simply, hospitals’ financial pain from the ACA remains mandatory. But the extent of their offsetting gains now depends significantly on whether state leaders decide to expand Medicaid.
It's confusing.
When I asked State Rep Betsy Ritter about it a month ago, she said even the experts aren't sure what the final impact will be.
In a nutshell, the Affordable Care Act (Obama Care), calls for an increase in the number of patients who will have insurance and a decrease in the compensation hospitals get to treat uninsured patients. (DSH payments) In theory, they balance. The real question, and disagreement, is in whether or not they balance.
To make matters more complicated, part of the equation includes an increase in people on Medicaid, and last summer, the Supreme Court ruled that the federal government could not force states to do this.
In states that have decided not to expand Medicaid, the hospitals will see a decrease in funds for uninsured, and no increase in the number of people on Medicaid, a double whammy.
Luckily, Connecticut is in the forefront of both expanding Medicaid and setting up a "health exchange" where people who make too much for Medicaid will be able to purchase insurance with premiums based on income.
The "Healthy Chats" that you see advertised are information sessions and information gathering sessions on just this. I have attended 2 of these, have learned a lot, and have made contact with the people on the exchange.
OK, maybe it's not a "nutshell".
I said it was confusing.
Bottom line, hospitals will get less money for uninsured patients but will see less uninsured and whether they balance is the million dollar question.
I have included the conclusion of a study on this issue from the
Urban Institute’s Health Policy Center, funded by the Robert Wood Johnson Foundation. If you would like to see the entire study, I am happy to email it to you.
Conclusion
Federal lawmakers who passed the ACA offered hospitals an implicit bargain: help fund the ACA’s coverage expansions by giving up some Medicaid and Medicare reimbursement, and in return receive new revenue when formerly uninsured patients enroll in Medicaid or private coverage.
Last June, the Supreme Court placed the fate of this implicit bargain in state hands. Regardless of what each state decides, its hospitals will help pay for the ACA. But whether hospitals receive the ACA’s promised financial rewards depends on state decisions about Medicaid expansion. Although expansion would reduce hospitals’ private payments, the accompanying boost to Medicaid revenue is over 2.5 times the size of those losses in the average state, even without considering the potentially significant benefits of hospital-based presumptive eligibility in further reducing uncompensated care burdens.
Put simply, hospitals’ financial pain from the ACA remains mandatory. But the extent of their offsetting gains now depends significantly on whether state leaders decide to expand Medicaid.
Monday, April 1, 2013
There is "buying" power in a union
There's an old song, "There is power in a union"
As it turns out, there is "buying power" in a union too.
So, when the presidents of AFT Locals 5049, 5051, 5123, and 5149 (L+M and Backus hospitals) visited Bob Veleti of Velenti Automall in Mystic, CT with our field rep, we were representing the united buying power of 2,000 people.
As a result, any member or spouce of the 4 locals who visits Velenti will be given preferential pricing on the three big American brands, Chevrolet, Ford, and Chrysler, Dodge, Jeep, Ram.
I'm told this can be a savings or $2,000-$3,000 off the list price.
Details of this benefit and other member benefits are on our web page under "member Benefits" @
http://backusunited.ct.aft.org/member-benefits
As it turns out, there is "buying power" in a union too.
So, when the presidents of AFT Locals 5049, 5051, 5123, and 5149 (L+M and Backus hospitals) visited Bob Veleti of Velenti Automall in Mystic, CT with our field rep, we were representing the united buying power of 2,000 people.
As a result, any member or spouce of the 4 locals who visits Velenti will be given preferential pricing on the three big American brands, Chevrolet, Ford, and Chrysler, Dodge, Jeep, Ram.
I'm told this can be a savings or $2,000-$3,000 off the list price.
Details of this benefit and other member benefits are on our web page under "member Benefits" @
http://backusunited.ct.aft.org/member-benefits
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