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Defending Public Healthcare: RPN workforce increasing in Ontario

Registered Practical Nurses (RPNs) have made a modest come-back in Ontario hospitals, according to new  Canadian Institute for Health Information (CIHI) data. After slipping back 1.8% in 2011, the RPN hospital workforce is up 6.3% in 2012, increasing from 13,126 to 13,954. Since 2008, the RPN hospital workforce has increased by 1,594, or 13%.

The number of RPNs working in long-term care has increased even more. Between 2008 and 2012, the LTC RPN workforce increased 2,794, or 29%.   The total LTC RPN workforce now sits at 12,502, only 1,452 less than the number working in hospitals.

Community (Read more…)

Those Emergency Blues: Best. Comment. Ever.

Blog reader “Sarah” REALLY gave me a big old can of whoop-ass when she wrote something on my blog post “The Value of Nurses” She really schooled me! So take it away “Sarah”!

Nursing is critical to patient health and recovery. Nurses are responsible for the day to day care of the patient.

Nurses are also useful for disease prevention and chronic disease management (trust me, MD wants to go to school 12+ training in the medical model of care to tell fat Type 2 diabetics they need to stop eating pie).

That said, yes nurses know how (Read more…)

Those Emergency Blues: A Blogger, Allegedly

So, it’s been awhile, eh?

It was Chuck Norris who found me.

To everyone who emailed and texted and Tweeted, thanks. Everything is hunky and dory. I’m not dead, ok? Let’s get that out of the way. Nor am I afflicted with a Chronic Debilitating Illness, unless you count members of my family. (That would be the topic of long separate blog post + extended psychotherapy.)

So what happened? Much to my surprise and amazement (and frank gratitude if truth be known) I got a new job about this time last year. A job with a very steep learning curve and a (Read more…)

Defending Public Healthcare: Less nursing, more medical errors

Recent Canadian Institute for Health Information (CIHI) data indicates that Ontario has a relatively high number of “nursing-sensitive adverse events” compared to other provinces.  An “adverse event” (or “medical error”) occurs when something happens in the hospital that hurts rather than helps a patient.

Over the last three reported years (ending 2011-12), nursing sensitive adverse events for surgical and medical patients averaged 5.1% higher in Ontario compared to the Canada-wide average.  (If Ontario could be removed from the Canada-wide average, the discrepancy would be higher still.)

Ontario funds hospitals at just about the lowest level of any Canadian province. . . . → Read More: Defending Public Healthcare: Less nursing, more medical errors

Defending Public Healthcare: Nursing levels low and getting lower

Yesterday,  I wrote about the significant lack of nursing care in Ontario hospitals compared to the other provinces.  Even on a Canada-wide basis, there was 5.32 hours more nursing care per patient than in Ontario in 2010-11 (year end March 31).   That sounds kind of shocking. But it looks like it is getting worse.  Other data from CIHI indicates that over the course of 2011, Ontario hospitals lost thousands of nurses. Specifically, there was a sharp reduction in the number of Registered Nurses (RNs) working in Ontario hospitals in 2011, with a cut of 2,750 RNs to 58,699 according . . . → Read More: Defending Public Healthcare: Nursing levels low and getting lower

Defending Public Healthcare: Major decline in nursing in Ontario hospitals

There was a sharp reduction in the number of Registered Nurses (RNs) working in Ontario hospitals in 2011, with a cut of 2,750 RNs to 58,699 according to new CIHI data.  That’s a 4.47% decrease in one year.  Community health numbers also took a very hard hit, while numbers were up very slightly in long-term care.

For the first time in a long time the number of Registered Nurses (RNs) in Ontario has begun to decline.  In 2011, employed RNs declined from 95,185 to 94,723, a  decrease of  462, or just less than one-half of one percent.

Registered Practical Nurses . . . → Read More: Defending Public Healthcare: Major decline in nursing in Ontario hospitals

Those Emergency Blues: Privacy, judgment and ethics aside, I have caring to do.

A few years ago I cared for an acquaintance. She was a friend of a friend who had been living out of the country for several years, but had come home to visit family friends. She was rushed in to the ED and before I even knew who she was I was delivering her 19 week old fetus. When I finally looked up to see the mother’s face I realized we knew each other. I said nothing. In that moment I didn’t care about what the College would say about caring for those you know when there was a real (Read more…)

Those Emergency Blues: Charge Mommy

A few days ago, one of my colleagues said to me after a particularly frantic day in the ED, “You guys aren’t Charge Nurses, you’re Charge Mommies.” She is right. This is what we do:

tell all the kids don’t fight and play nice fix boo-boos give hugs as needed, or tissue make sure all the kids get lunch find things repair broken toys clean up little “accidents” greet guests, and ensure they’re fed and comfortable make sure everyone keeps the place tidy assign chores deal with the unpleasant relatives upstairs

The one thing I don’t do is enforce discipline. (Read more…)

Those Emergency Blues: Treat the Patient Not the Disease

Abscesses and wounds, and especially abscesses and wounds which are infected, suppurative, purulent, and generally awful, are embarrassing for patients and difficult for nurses. Embarrassing for patients because they are disfiguring and smell badly, and difficult for nurses for really the same reasons. Personally I don’t mind caring for and treating wounds and abscesses, but I know plenty of nurses who would rather throw live kittens on a hot barbecue than go anywhere near a draining carbuncle.

Jennifer Olin over at RNCentral has an excellent blog post on caring for wounds. The first part of her post deals a little (Read more…)

Those Emergency Blues: How Nurses Practice

Working on a PowerPoint presentation, and did up this (yet to be formatted) slide:

Which column do you think represents the current state of nursing practice?

 

Filed under: Good Nursing Practice is Practising with the Heart and Mind, Nursing Naval Gazing Tagged: good nursing practice, Nurses, Nursing

Those Emergency Blues: We Get No Respect

From Ian Miller at ImpactedNurse.com, a few thoughts on under-utilized and under-recognized senior nurses who are leaking out of the profession:

Nursing has few opportunities for promotion and recognition of senior expertise within the clinical setting. How often have you watched senior (and I’m talking about years of experience here) nurses move on to non-clinical management positions, or drift off into non-nursing jobs where their specialised skills are snapped up, or just stagnate on the floor (feeling little respect from the system) with nowhere to go and little exploration of the stuff they might teach. What we are sadly (Read more…)

Those Emergency Blues: When the Police Come Calling

The police are more-or-less a permanent fixture in every Emergency department. They bring in the drunks, the suicidal, the psychotic, the homeless and yes, the criminal, who have either sustained injuries as a result of their activities, or else have developed sudden (and convenient) cardiac symptoms upon their arrest. Most of us in Acme Regional’s ED will cooperate with the police to the point of expediting whatever they need us to do, which usually means filling out the Form 1 or medically clearing the patient. At the same time, most of are pretty clear that ED nurses and physicians are not an extension

. . . → Read More: Those Emergency Blues: When the Police Come Calling

Those Emergency Blues: Do Not Fold, Spindle or Mutilate the Nurse

An unpleasant, no, ugly and unfortunate situation at Victoria General Hospital is preventing a woman from seeing her son. From the National Post article:

A 73-year-old woman who travelled to Victoria from South Africa to care for her seriously ill son has been banned from Victoria General Hospital after she says she tapped a nurse on the head to get her attention. Shirley Spence, originally from England, has been sitting in her rented apartment in Victoria since mid-May, barred from seeing her son, Gary Abbott, 52, who was found to have a brain bleed after falling ill. Instead, every . . . → Read More: Those Emergency Blues: Do Not Fold, Spindle or Mutilate the Nurse

Those Emergency Blues: Epic Hitler Emergency Department Charge Nurse Rant

I never thought I’d use the words “Epic” and “Hitler” and “Emergency Department” and “Charge Nurse” and “Rant” as a blog title, but what the hell. I was bored one night and thought it would be fun to make a Hitler rant parody.

Filed under: What Passes for Humour Around Here Tagged: emergency department, emergency nursing, ER, Hitler parody, Nurse, Nurses, Nursing

Those Emergency Blues: A Nurse Contemplates Leaving the Profession

Dinner last night with an old friend who toils in the mines of Labour and Delivery. She has worked there for four years. She told me of an incident not too long ago working the night shift, faced with a post-partum patient who was bleeding, hypotensive, and tachycardic, in short, showing all the signs of going into hypovolemic shock. She was running around, starting IV lines on flat veins and hanging blood products. Packed red cells. Platelets. Cryoprecipitate. And by-the-by, saline by the bucketful. She called for help from her colleagues. Apart from this patient and another who was walking

. . . → Read More: Those Emergency Blues: A Nurse Contemplates Leaving the Profession

Those Emergency Blues: Guest Post: How We Can Fix the Malaise in the Nursing Profession

Nurse Practitioner (Photo credit: ekea7)

by Amanda Trujillo

If the newer generations of nurses out there are more confused than ever about their roles in healthcare — they should be. I’m one of the newer generations of nurses and I — AM — CONFUSED. Seriously. Think about it. We are taught all of the idyllic, pretty things every good and prudent

Navy nurses attending to a patient, 1960s. (Photo credit: Wikipedia)

nurse should know and should do whilst caring for patients. The Nurses Code of Ethics is drilled into our heads during nursing school, nursing care plans are celebrated (by our

. . . → Read More: Those Emergency Blues: Guest Post: How We Can Fix the Malaise in the Nursing Profession

Those Emergency Blues: Fat Nurses Need Not Apply Revisited

More on the Texas hospital, Citizens Medical Center, which banned fat people from being hired. Citizens Medical Center, you might remember, made it policy to exclude new hires with a body mass index >35, and explicitly stated employees appearance should “fit with a representational image or specific mental projection of the job of a healthcare professional . . . free from distraction” for patients. Medscape has a video (sorry, couldn’t figure out how to embed) from a medical ethicist named Art Caplan with another point of view. Partial transcript:

Look, I’m all for trying to set a good example and . . . → Read More: Those Emergency Blues: Fat Nurses Need Not Apply Revisited

Those Emergency Blues: Nursing Week Ain’t What It Used to Be

My Nurses Week joy was shattered last night when the son of a patient reamed me out for discussing the patient’s condition and treatment plan — wait for it — with the patient. He thought his father, who was a rather elderly but very independent and shrewd man who still lived in his own house and putted around in a low-mileage 1992 K-car, might be disturbed and upset. I thought the son was a controlling little freakazoid, but didn’t say so. Not very nurse-like, I know, but your humble writer smiled and nodded and went on, curiously enough, to validate

. . . → Read More: Those Emergency Blues: Nursing Week Ain’t What It Used to Be

Those Emergency Blues: Nurses Practice Beyond Their Scope — And It’s Not a Bad Thing

A very good, if obvious, idea on the use of RNs: nurses should be used to the full extent of their abilities. From the Toronto Star (and kudos to the paper for their Nursing Week insert in Saturday’s edition):

“The bottom line is that we’re wasting valuable resources with our RNs,” says Doris Grinspun, the Registered Nurses’ Association of Ontario’s chief executive officer. “European countries like the U.K. have been using RNs to their full capacity for years. It will be a missed opportunity for the public, taxpayers and patients if we don’t move to full utilization of . . . → Read More: Those Emergency Blues: Nurses Practice Beyond Their Scope — And It’s Not a Bad Thing

Those Emergency Blues: If You See a Teddy Bear, Shoot It

That would be the taste of barf in my throat

Nurses Week is fast approaching. I am steeling myself mentally for the steady drizzle of syrupy tributes from various health care apparatchiks and functionaries, who will inevitably make some reference to nurses as “angels” and the “beating heart of health care” or some such tripe. I have yet to see an article this year illustrated with a teddy bear dressed up as a nurse, but it is early days yet. A reminder: if anyone approaches you with such a teddy bear in recognition of Nurses Week, do not look the bear in

. . . → Read More: Those Emergency Blues: If You See a Teddy Bear, Shoot It

Those Emergency Blues: Nurses Grieve Too

An underexplored or ignored aspect of nursing professional life: how nurses working in a Labour and Delivery unit grieve over the loss of their patients, and how this grief affects care and support of survivors. What is really striking about the film is the culture of mutual support and respect among the nurses working in this unit — I hope it’s real and not just the product of the filmmaker’s eye, but the cynical side of me wants to think it’s idealized.

Though the film’s focus is in L & D, it makes me think of how nurses deal with

. . . → Read More: Those Emergency Blues: Nurses Grieve Too

Those Emergency Blues: How Nurses View Themselves

A selection of “What I Actually Do” meme posters” related to nursing, which have been making the rounds on the Interwebs. Some of them, I guess, are funny and clever, and they’re meant (I suppose) to educate the public at large about the realities of nursing. But what I think is interesting is the way they reflect nurses’ perceptions of themselves, and how nurses perceive how others view them. Some common themes: nurse as lazy (by managers), nurse as bimbo, nurse as angel, nurse as waitress/bellhop, nurse as money-grubbing, nurse as menial. What do you guys think of them? Do

. . . → Read More: Those Emergency Blues: How Nurses View Themselves

Those Emergency Blues: What I Have Learned from Nursing

The world of nursing on a couple of dozen flash cards. From The Nursing Channel on YouTube. While I don’t agree necessarily with every card — some of them, I think, play into some old stereotypes on how nurses behave — it’s still a fresh perspective on nursing. What do you think?

Filed under: Good Nursing Practice is Practising with the Heart and Mind Tagged: empathy, nurse stereotypes, Nurses, Nursing, registerd nurse, RN, Things Nurses Say, YouTube

. . . → Read More: Those Emergency Blues: What I Have Learned from Nursing

Those Emergency Blues: In Which TorontoEmerg is So Busted, or, Welcome, Jean Hill

A few weeks ago, I was talking with a colleague, whom I will call Jean Hill, and by-the-by the conversation fell to nurse bloggers. Several prominent ones were mentioned, like Crass-Pollination and Emergiblog and Nerdy Nurse.

“Oh,” said Jean Hill innocently. “I wish I could write like these guys.”

At which point your humble blogger’s eyes began to sparkle rather a cat’s contemplating a mouse. Come in my parlour, said the spider to the fly, I thought. You see, dear readers, I have been contemplating the addition of a co-blogger for some time. *

Nurse Jean Hill. (Dramatic reconstruction.

. . . → Read More: Those Emergency Blues: In Which TorontoEmerg is So Busted, or, Welcome, Jean Hill

Those Emergency Blues: Nurse Love, The Real Kind

Some real nurse love — and incidentally reminding us why we have the most tremendous profession in the world and how we each day make a powerful difference in the lives of our patients. Via the blog The Spohrs are Multiplying, Mike Spohr writes about the day his child died:

On the horrible day that Maddie passed there was a nurse who stayed by Heather’s side the whole time, and I am so thankful for her kindness to my wife. There was a nurse that mattered to me too that night, though she didn’t stay by my side,

. . . → Read More: Those Emergency Blues: Nurse Love, The Real Kind