Letters – October 2012

Standing Up for Nurses Who Take a Stand

Our professional organizations need to stand up for bedside nurses who take a stand to protect their patients and exercise their legal right to refuse unsafe nursing assignments.

To paraphrase the theories of Martha Rogers, each of us is an exaggerated sum of our parts, and each time we react to our environment we contribute to creating ourselves as unique individuals.

Reaction is what separates us from one another and “exaggerates” us into unique individuals. Does this not require nurses to empower patients so they recognize that their outcomes greatly depend on how they react to their lives and their health?

In turn, does this not require hospitals to staff appropriately so nursing practice becomes less fragmented and more focused?

Patient and family education rarely gets addressed, because nurses can’t get beyond maintenance of essential care, often leaving our shift thankful that we didn’t kill anyone. Maintenance will never shorten length of stay or improve outcomes.

Bare-bones staffing levels sacrifice outcomes and create moral distress. They shrink profit margins and create an environment where mistakes are more likely.

Debra Ball-Mills
Indianapolis, Ind.

Nurse Obesity

Re: Page 12 in August AACN Bold Voices

Nearly 45 percent of nurses work the night shift, cut off from sleep, healthy food, interaction with many health team members and a general sense of community. There always seems to be plenty of candy, soda, pizza and left-over doughnuts at night, but no salad, vegetables and fruit.

When sugary, caffeinated, salty food is all that’s available, that’s what our staff eats. There are usually vending machines with non-healthy choices, but the healthy choice cafeteria — if there is one — is closed.

What about opportunities for exercise? Treadmills near the units would allow exercise and reduce stress. Several medical centers have tried to address these needs, but they are few.

I appreciate that AACN Bold Voices has brought up this issue.

S.J. Sparling
Philadelphia, Pa.

Nurses, like other people, can choose to lead a healthier lifestyle. Look around.

Many patients require our care, because they did not take care of their own health. Do we want to be like them?

I know I don’t, so I choose to exercise and pack food for my day because my hospital offers very unhealthy food to both staff and patients. (It’s also a highly regarded cardiac hospital that still allows smoking on hospital grounds.)

I choose a 12-hour shift because it allows me to work three days a week, and working in the operating room keeps me physically active. Those who work at night should be offered a time to nap and healthy food options.

If only vending machines are available, why not stock them with fruits, nuts, low-fat cheese and water? Wellness programs need to provide information about change that truly helps nurses see that we’ll soon become patients if we don’t take care of our health.

Amy Fiebke

Quality of Sleep in ICU

Re: Page 14 in August AACN Bold Voices

I have seen several things improve quality of sleep for ICU patients who are not mechanically ventilated or chemically sedated. Our unit stocks eye masks and earplugs.

The volume of all our pumps, monitors and other noise-making devices can be lowered. We darken the room and close the door when a patient’s condition allows, leaving a glass window open to view their status.

To avoid awakening patients during the night, we cluster care when possible. Finally, we try to avoid conversation outside patients’ rooms.

Together, these create an environment for healthy, normal sleep patterns. But our system isn’t foolproof.

So I look forward to reading more research and suggestions to promote full sleep cycles for ICU patients.

Nicole Brynes
Rochester, Minn.

Loved the article on hospital noise.

When did this culture shift occur? And how?

It’s going to be hard to change.

Bonnie McCarty
Metairie, La.

Patient Satisfaction

Re: Page 8 in August AACN Bold Voices

I am tired of hospitals being run by business people who try to turn them into hotels. Therefore, Medicare jumping in also with patient satisfaction goals affecting reimbursement really angers me.

Hospitals are not intended to be fun. If they were there would be no room at the inn.

Being nice to someone and making the experience as pleasant as possible is one thing. But satisfaction cannot be a goal for reimbursement when patients are much sicker, because criteria for inpatient care have become stiffer.

My goal is for a patient to make it to the front door. That means good outcomes with the best possible trip — which may not always be a pleasant one.

Terry Cahill
Union, Ky.

I am impressed with Theresa Brown’s insight about the requirement for patient satisfaction ratings.

I believe consumers need to be educated about the things the healthcare team should be doing that make a dramatic impact on someone’s life, because saying the right phrases each time one enters a room doesn’t translate into competency and good outcomes.

Has anyone developed an evaluation tool that asks about actions that impact outcomes? Possible questions could include:

  • Did everyone who cared for you wash their hands every time they came into your room?
  • Were you offered help when you couldn’t do your own hygiene?
  • Were you encouraged to walk every shift?
  • Did you wear special devices to prevent blood clots?
  • Were you turned frequently if you were unable to talk?

Not only would this help patients and families evaluate care, it would give them insight about expected standards of care.

Bonnie J. Carlin
Gainesville, Fla.

I totally agree with Theresa Brown. I believe in quality care that can be confirmed by data from NDNQI and other sources, not by opinions.

Surveys don’t ask how a patient is feeling or their perspective about how the procedure, surgery or reason for admission went. Instead, surveys ask about the room and the food, and don’t find out anything that’s not already known or can be found in other hospital data.

Those who determine healthcare reimbursement promote the expectation that hospitals should be hotels and staff should treat patients as if they were on vacation. Hospitals aren’t a vacation destination.

Gerri Ann Danilowicz
Bloomsburg, Pa.

Theresa Brown nails it about the ridiculous requirement of hospitals being graded for patient satisfaction.

Hospitals are not pleasure palaces. They are where illnesses are treated, which often goes hand-in-hand with pain and unpleasant memories.

I agree with Brown that outcomes should drive the grading system. Outcomes count, not perceptions.

A person may have received excellent care, recuperated well, yet their perception is one of dislike for the hospital. And it is the perception that determines Medicare reimbursement. Who devised this clever idea?

Susan M. Dirkes
Newport, Mich.

AACN Bold Voices encourages your letters for possible print and/or online publication. Please be concise. Letters may be edited before publication.

Include your name, credentials, city, state and email address (for verification).

Write to aacnboldvoices@aacn.org.

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