janice d

anonymous asked:

Hi there! I'm about six months from graduating and I'm very interested in doing a nurse residency. I live in California right now but I am willing to move. A big thing holding me back though is the horror stories I've heard about nurse-patient ratios. How are they in your state? Are they manageable? Do you know anything about other states?

Dear Anonymous,

That’s a complicated question with a complex answer. As far as I know California is the only state in the country with laws and regulations that mandate nurse-to-patient rations in all units (lucky ducks). Thirteen other states (CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA) also have laws and regulations addressing safe staffing ratios, but none as thorough as California. And my state, Virginia, has nothing. Every hospital is different, so it just depends on where you work. Some are good, some are not so good.

Outside of those 14 states, it’s pretty much the wild west and you’re right, it can be scary and downright dangerous.

Originally posted by thosevideogamemoments

When I first interviewed with my current facility, I applied for a PCU RN position, but they ended up offering me an ICU RN position and that was my goal, so I jumped on it. During the interview, I asked about PCU’s typical nurse-to-patient ratio and they told me they tried to keep it to 1:4, but there were times when nurses would carry six patients. My jaw dropped. 

Originally posted by harta-romaniei

Six to one is something I would expect on a med-surg floor, not a PCU. I told them that I wouldn’t feel comfortable taking that many patients on a step-down unit. Perhaps that’s why they ultimately offered me an ICU position. I’m fine with that.

As for you and looking to travel to the wild west of nursing, there are a lot of us here who do it and it can be done safely. Ultimately, it’s up to you. Research any hospital you plan to apply to and ask the management team if you can interview the nurses on the unit. Ask them about the staffing ratios. Ask what happens if you refused to take an unsafe patient load? Is that grounds for dismissal or do they have a system in place to bring in additional staff?

If you don’t feel safe taking more than the recommended patient load, you need to stand up for yourself and put your foot down. I did that the other night. They tried to give me three ICU patients, including one that was ventilated. I told them, “no.” The safe ratio in an ICU is 1:2 and I refused to put my license on the line because they failed to staff the unit properly. They ended up calling in another nurse.

Legislatively speaking, I should point out there is a Federal regulation, 42 Code of Federal Regulations (42CFR, 482.23(b)), that’s been on the books for quite awhile. It addresses nurse staffing ratios for any hospital facility that accepts Medicare, but the language is nonspecific and open to interpretation. It reads as follows:

(b) Standard: Staffing and delivery of care. The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.

“Adequate numbers of licensed registered nurses.” What does “adequate” mean? See? The language is not specific, which is why those 14 states decided to take things a step further and to help address the problem.

There are two safe patient ratio bills sitting in Congress: Senate Bill 864 (S.864) and House Bill 1602 (H.R.1602). Both bills were introduced on their respective floors on March 25, 2015. S.864 was introduced by former Sen. Barbara Boxer (D-California), who retired earlier this year after the new Congress was sworn in. H.R.1602 was introduced by Rep. Janice Schakowsky (D-Illinois). The Senate bill was sent to a committee and the House bill to a subcommittee where they’ve sat for nearly two years.

What can we do? We can act. We can get involved. I have lobbied on Capitol Hill for nurses and I plan on being back up there again soon. It is an empowering feeling when you sit down to talk with a member of Congress about your concerns. Yes, there is the skepticism that they’re not listening, but they are. They do keep track of every meeting and they keep track of how many people are voicing their concerns about particular topics. Nothing, I repeat NOTHING, gets the attention of a member of Congress like a large group of people from their district or state that may vote against them in the next election. There are more than 3 million nurses in this country. We have tremendous potential, but only if we come together and present a united front.

Here’s what you can do - visit this website: http://www.nationalnursesunited.org/issues/entry/ratios and educate yourself on the topic and the bills currently in committee, and then call your Senators and/or Congressperson and tell them to support S.864 and H.R.1602, respectively.

TL;DR - There are no Federal laws enforcing safe nurse-to-patient ratios. California is the only state that does. There are two bills that would change that, but they’ve been in congressional purgatory for two years. Call your representatives today and tell them to vote/support H.R.1602 and S.864!

Sincerely,
Mursenary Gary

Evenings I sit in the hostel kitchen, writing, with a pot of strong tea and a candle for comfort. The immense quiet is broken only by those snaps and creaks that inhabit old houses. I am partial to old things: old peeling doors, rusty gates, overgrown paths. Old things know how to relinquish the past; they have learned how to make peace.
—  Janice D. Soderling, closing lines to “Vanitas,” Literary Bohemian (no. 1, November 2008)
7

PHIL’S YOUNOW:
(Let me know if you’re still enjoying the Updates <3 )

-4th of July
-fireworks
-the weather
-they had 32 degrees in the hallway
-he went shopping
-he bought a frying pan today :D
(They broke their old pan)
-“fingers crossed for a US/World Tour next year”
-the thunderstorm
-they had friends over to play some board games and phil switched all the lights off and made everyone watch the lightning outside
-the Akinator video
-new danisnotonfire video soon
-“we’re all Akinator”
-another baking video should happen
-He watched F1 with Dan
-Dogs
-he was not wearing any socks
-the landlord lets them keep the house! (Contract has been signed)
-moving from Manchester to London was horrific
-Dan was editing his new video
-He got a haircut yesterday
-he might do Shelter 2 videos soon
-next gaming video will be a Dil video
-Janice from the shop :D
-0/0 (Siri)
-behind the scenes of a Dan video
-he met Crabstickz (had a bit of a catch up)
-they’ll be at Vidcon soon
-Dil’s wedding
-many cringy videos are private
-his favorite Disney princess is Belle
-RADIO SHOW TOMORROW AT 9PM
-driving lessons
-still haven’t seen Jurassic World
-He made a new ringtone for someone :D
-the new AHS season
-cats
-he’s very hungry
-a lot of good byes <3

(THANK’S FOR READING)

MENTIONED DAN: ||||| |||| (9)

Not valid reasons

I feel like I need to say something on the Janice Dickinson/ Bill Cosby news; 

I understand if you don’t like Janice D, I have never been a fan either but; PLEASE think before you list her being an addict/fresh out of rehab, and especially that she is “crazy”, as reasons you may not believe her. I have seen this at several internet sites. Many times the mentally ill, as well as people with “bad” reputations, addictions, etc. are targeted by rapists because they think no one will believe their story. And you know what? They are right a lot of the time. “don’t believe that crazy bitch, she is a druggie whore…” sound familiar? Please think about it.  These are not solid reasons that prove she is lying. Period. 

Thanks for listening xo xo