The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention

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This is not a nursing turnover.

When nurses leave a facility, this research says:

  • “costs of nurse turnover have reported results ranging from about $22,000 to over $64,000 (U.S.) per nurse turnover”
  • “Turnover costs, in general, have been estimated to range between 0.75 to 2.0 times the salary of the departing individual”

The cost to facilities also includes:

  • Advertising and recruitment
  • Vacancy costs (e.g., paying for agency nurses, overtime, closed beds, hospital diversions, etc.)
  • Hiring
  • Orientation and training
  • Decreased productivity
  • Termination
  • Potential patient errors, compromised quality of care
  • Poor work environment and culture, dissatisfaction, distrust
  • Loss of organizational knowledge
  • Additional turnover

The real questions are:

Is there really a nursing shortage?

Do facilities assess and measure nurse retention?

Do they conduct exit interviews to find out why nurses leave?

Do employers attempt to address issues that affect low morale?

What is the average amount of experience for the nurses at that facility?

Are employers even asking these questions?

Here is the original research article:

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NurseRetention.aspx

   

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Fun with Spanish Flu Myths

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(author note: this pic is from a photo archive of Spanish Flu victims. One of the dangerous aspects of this epidemic is that it could kill within hours, even a young, healthy subject.)

https://sciencebasedmedicine.org/fun-with-spanish-flu-myths/

This article explores the 1918-1919 Spanish Flu Epidemic. It offers some historical, medical, and social insight on one of the most virulent strains of pathogens to take down a significant portion of the population.  Apparently, the battle against misinformation is an on-going one.

For Hospitals, High Quality Care And Success Depend On The Happiness Of Nursing Staff

Nurses are the lifeblood of a hospital; now there’s just a study to prove it.

Source: For Hospitals, High Quality Care And Success Depend On The Happiness Of Nursing Staff

Author note: I would love to see the data that supports this statement in the article:

“Magnet hospitals are also known as exemplary health care systems, recognized by the American Nurses Credentialing Center as a great place for nurses to work.”

I will have to do some research. Please feel free to add sources in the comments.

Top 10 Things That I Love About Nursing

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10) Patient Education –  I have always wanted to be a teacher.  As it turns out, nursing includes quite a bit of that.  The good news is that the audience is only patients and/or their families, instead of 35 bored, distracted teenagers.

9) Patient Advocacy – There is something very empowering about being the voice of a patient, especially one that is not able to speak up for themselves.

8) Teamwork – There is something very synergistic about working with others, especially if there is a good sense of teamwork.  Coworkers go beyond being other people at work.  They become friends (or work family, at times) and everyone looks out for each other.  The support and encouragement from them can give you more energy to get through a rough shift, as well as make an smoother shift seem even better.  It is also empowering to be able to share insight and discuss how to manage new issues as they arise.  Unfortunately, not all employers provide and/or maintain this kind of environment. Sometimes, you have to work to find them.

7) Scrubs – Having spent decades in the corporate world, I can speak from experience that dress clothes and neckties suck.  Scrubs rock.

6) Improved Time Management Skills – The constant practice of assessing the situation, available resources, and knowing how long it takes to complete a task carries over into my personal life.  Juggling family demands, as well as academic and social demands seems easier, if that makes any sense.

5) Confidence – I am far from being an experienced or expert nurse, but I have faced down some fairly emergent situations that do provide some perspective on what it means to be in a crisis.

4) Doing Something Meaningful – Some people look to make a difference in the world. It is not a requirement, but when applicable, can add an extra layer of satisfaction.

3) Respect – Nurses rank as the most respected and most trusted profession.  I chose nursing because of the overwhelming desire to take care of others.  However, it is nice that I am in a profession that is respected.  It can be troubling, and sometimes annoying when new acquaintances (and even strangers) solicit me for my medical opinion.  A cashier at a gas station, one morning, started rambling on about changing medications. I did not know her.  I just wanted to finish my drive home to get some sleep.  I told her to ask her primary care physician.

2) Evidence-based practice – Anything a nurse does is based on evidence-based practice. In other words, nurses study an issue…..do research….test the findings….then use that data to shape our practice.  Not only does science rock, nurses use it to support their work.

1)Plenty of opportunities to learn – There are so many aspects and layers to nursing that the learning process is always on-going.  Our profession requires continuing education credits, but there is always formal training at work (on-line/in-person classes) as well as informal training (getting a patient with an illness/injury that you’ve never seen before).  For those of us who pursue more education, there are always classes toward a bachelors, masters, or even doctorate.

Strange Women Want To Talk About Your Genitals

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The latest rounds of commercials have various women wanting to talk about the “romantic arts” that involve male genitalia.  Nobody knows who they are.  They invite complete strangers  into their luxurious homes. then suddenly, they want to be confidants and advise us about what our partner (it’s not like she’s asking to see the results of taking these ‘little blue pills’) wants. There is also no mention of credentials that involve training or certification of a medical or psychological nature.  We don’t even get to hear a mention of any counseling in this woman’s background.  Sounds risky, even before considering that taking the advice of a random female to apply to another relationship is inherently foolish and/or dangerous. Imagine THAT conversation!

Would you discuss your genitals with a complete stranger on an elevator? In the check-out line in Wal*Mart? What if this woman step out of a non-descript van with the words “Free Candy” spraypainted on the side of it? THE ANSWER IS NO. Which, of course, leads to the question of who is the target audience is.  There are many different scenarios where this (and the competitor) can be used, even in non-romantic scenarios.  Had this woman and her counterparts had some medical training, they might have known that. Does this woman even know what happens after “lasting longer than four hours??”  Try surgical intervention.

Maybe even Kelly Hu (Actress who plays Deathstrike on the X-Men movie series) who has joined the odd bevy of genital-curious women could even a strange portent ….as she plays a character that have adamantium claws (what was that about ‘surgical intervention?). It’s not like we really know her either, nor is she any more likely to want to see what happens with pill administration here, too. Goes to show you that you can’t believe everything on television.

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Consider yourself warned!

 

Setting Unrealistic (Medical) Expectations

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Laser Spine Institute Commercial

Being in the medical field, I take care of wide range of patients….including those with joint and spinal problems.  Pain not only can make doing everyday tasks difficult; it can also be difficult to manage.  Sometimes, pain management is finding the right combination of the type of pain medicine, physical therapy, and even other non-invasive procedures.  Surgery can be an option, but it shouldn’t be the first choice.  Doctors are required to present patients with information about what the surgical procedure is, what the possible benefits are, what the risks are, and what to expect afterwards.  There is ALWAYS a risk with surgery.  It can happen for any number of reasons, including allergic reactions or extrapyramidal responses to medicine, comorbidities with the patient, or any complication during the procedure.  Every person is different; therefore, their response to the medicines, treatment, and surgery can be different, as well. Here is where I begin to have a problem with commercials with the Laser Spine Institute.  It presents all of the benefit with none of the risk. Setting expectations really high….unrealistically high, in my opinion.

I found one website that gives patient reviews about the organization. Granted, I am not completely sure of the credibility of the website….or those who present any information about it.  I am not gullible enough to believe that any presence of data on the Internet means it is true. I also found a Bloomberg Business article about lawsuits against Laser Spine Institute, so I would think there may be more credibility with this information. I will leave it up to the reader to check its veracity of its statements.

Speaking of veracity of its statements, I am reminded of a similar “rosy picture” painted by commercials produced by the Cancer Treatment Centers of America.  I have read articles that say that their success rates are heavily influenced by not taking on patient cases that may have more serious, more aggressive forms of cancer (that may not be as likely to survive).  Quoting a Doctor interviewed for an article from Reuters News Service that Iinked to:

Accepting only selected patients and calculating survival outcomes from only some of them “is a huge bias and gives an enormous advantage to CTCA,” said biostatistician Donald Berry of MD Anderson Cancer Center in Houston.

This is more than just a nurse pointing out nonsensical responses to medical crises on Grey’s Anatomy (Don’t get me started!). This is irresponsibility among those whose motives are financially-oriented that patient-driven.

 

 

 

 

Exploring The Apocalypse: Economy

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If something were to affect our access to our wealth (like money), I doubt it would last long. The scarcity of money may occur if financial institutions are inaccessible.  People would, at first, try to fall back on a system they are intimately familiar with – however, I believe it would quickly shift to a barter system.

Goods and services would gain value among the masses, as they vie for what is actually needed. Supply and demand would shape the perceived value of anything, as it always has been.  Food, clothing, shelter building supplies, and items for basic needs would have the most value. Followed by the anything for social or emotional survival, such as comfort goods (coffee, alcohol, etc.)  Those possessing skills that would have meaning in the apocalyptic world, such as construction, manufacturing (both limited by power and tool issues), as well as medical, food prep, and other basic life skills.

Medicine and medical supplies would dwindle. Those dependent on lifesaving medications (heart/respiratory/diabetes-related meds) would not likely survive long – depending on the acuity and comorbidities involved.  Those physically injured or unable to ambulate independently, as well as the very young/very old/immunologically compromised would likely die quickly, as well.  Especially if the power grid were not able to provide energy for heating and cooling, as well as fire fighting and emergency services were no longer available.  Speaking of healthcare, it changes focus during global disasters.  The concept of “triaging” patients, or deciding which should get some of the limited resources to be saved – and those “beyond hope” where using resources would not likely alter their demise.  That is not going to sit well with most people.Surgeries will come to a screeching halt. Also, other medical interventions will also stop – including those to prevent or reduce the chances of death.  Complications during birth, come to mind, as well as any serious health issues with babies or complications with the mother’s health. We are going to be revisiting the late 1800s/early 1900s medically. On a lighter note, health insurance and deductables will become a thing of the past. However, waiting to be treated could ultimately be extended well beyond anything we’ve experienced in a doctors office.

Vaccinations would help keep some pathogens at bay, but will eventually lose efficacy when they are not repeated or given to prevent illness and disease that occurs naturally.  There is also pathogens that become more apparent when food and water supplies co-mingle with human and animal waste.  Especially those who do not take steps to reduce/prevent illness transmission with standard procedures such as handwashing. Speaking of medications again, stockpiling meds – even those doomsday preppers who advocate for using “fish medicine” (as shown within Pinterest SHTF boards) to treat human illness.  The medical knowledge needed will be limited to those with training. The side effects of too much medicine will cause additional, even potentially irreversible health problems (many drugs are toxic to the liver and kidneys).  Once also needs to know the specific germ and whether or not it is susceptible or resistant to a particular medicine. Taking something that does not kill a pathogen will not only waste that drug, but it will allow germs exposed to it to become resistant to it.

Ultimately, the threat of other people taking our supplies may not be the most plausible or likely one if we are trying to emotionally adjust ourselves to the new reality of survival mode.  I would guess that people might be more risk-taking at first, only to find themselves injured beyond the resources available. The rest of us will be left to fend for the leftover resources not contaminated or damaged. Not amount of youtube viewing now will mitigate that either. Our new economy will not only look different than our current system; healthcare workers or those with training may find themselves more in demand than originally planned.

Keeping it (too) real

-D

Author edit: I don’t see the value of gold or gems, necessarily, having value in the collapse.  Having shiny objects will mean nothing if one does not have their basic needs met. Wealth is not just having stuff.  So, those info-mercials pushing the hype of buying precious metals are even more speculative.

Exploring The Apocalypse: Disaster Types

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(I couldn’t find any good apocalypse photos, so I used this one I found in my scrapbook that captures my experience from high school. )

For those of you who have been following my blog, I have already shared some initial thoughts about Doomsday Preppers (who are waiting for when the SHTF).  Rather than wallow in depressive hopelessness, I want to explore the issues in an academic manner.  I think there are some things that aren’t being taken into consideration, like what we may actually face versus what we can prepare for.

The types of disasters, according to the U.S. Federal Government, include: biological, chemical, drought, earthquake, fire, flood, heat, hurricane, nuclear, tornado, tsunami, volcano, wildfires, and winter storm. Most of these appear to be natural disasters, so the scale isn’t necessarily global. Many of these are globally-specific threats, as well. Volcanos are dependent on proximity to tectonic plate borders. Hurricanes and tornadoes are heavily mitigated by mountainous areas, and more likely to roam in flatter topographical areas. Tsunamis are limited to coastal areas; just like flooding will be limited to those near rivers and streams. Flooding, just as wildfires and droughts are fairly cyclical – and occur naturally. Winter storms, as well as heat, are seasonal (and conditional) threats. This leaves us with chemical, biological, and nuclear.

Chemical threats would include mismanagement of the resources we already use. It isn’t necessarily something triggered by terrorists.  Taking illegally dumped chemicals out of the equation for the moment, we have countless chemical plants used in a variety of uses all around us.  We also have industrial chemicals in our environment already. For example, the natural gas industry pumps a liquid, deep into the ground to shatter rock which allows them to collect the gas.  This process called ‘fracking’ already poses a threat to our global environment. The BBC wrote an article to identify what fracking is and the controversies around it, including pumping carcinogenic compounds into our water tables. A USA Today article points out that a Duke University study shows increases radioactive materials in the water table, as a result of fracking. Let’s not forget to mention that there are many other nasty chemicals, according to this New York Times magazine article. My point is that the chemical threats are already here. It won’t necessarily be some external threat.  We have our own home-grown people who may have some ideations to initiate “end times” by sabotaging such places. There are also businesses that have used oils and hydraulic fluids, concentration of heavy metals, acids, and other caustic chemicals on premises. Those chemicals are also just an accident away from exposing us, too.

Nuclear threats are real, too. Again, it is already integrated into our society.  Bad guys don’t have to run to the store to pick-up radioactive material or have it shipped into the country. It is here already.  Yucca Mountain is one such place, but used radioactive material is stored in nearly every state in the United States – as seen here on this Federal Government website.  These are highly secured areas, but are just as subject to accidents – as well as any potential home-grown threats.  The Federal Government has many resources, including this page on potential nuclear fallout from our current nuclear reactors. While the dropping of nuclear bombs on Nagasaki and Hiroshima in the 1940s provided a great deal of data about radiation fallout, sickness, and radii of contamination; there is still a hypothetical element to any potential future radioactive events – which include weather systems, topography, water table, as well as the amount and time that exposure occurs.  All of these factors will shape the intensity of radiation sickness one might experience, which is a public group. Radiation sickness is also documented on Federal Government websites, too. I have a feeling that if a wide-scale nuclear disaster were to occur; a Pinterest-inspired bug out bag and stockpile may not really change the  drastically horrible outcomes that would follow.

Biological threats would not be limited to man-made ones.  We are in the middle of many battles within a wide-range war with microorganisms, as we speak.  MRSA (Methicillin-resistant Staphylococcus aureus) is one such potential threat. VRE (Vancomycin-resistant enterococci) is another. Yet another, newly emerging threat is CRE (Carbapenem-resistant Enterobacteriaceae) explained on a governmental website.  These “superbugs” have developed a resistance to powerful medications, which means that they pose a threat – especially once they become pathogenic. In other words, once these “germs” cause illness – we are in serious trouble.  The same Darwinistic ability to adapt to their environment that humans have is shared with other organisms. Our environment poses a threat to a living organism. Some die. Some survive. Those that do, pass on their ability to survive that threat – or, at least provide some level of protection from that environmental condition. We have created a pattern of make a drug/see resistance appear to it as an on-going cycle. That has brought us to this point. However, I have seen a TED TALK from a molecular biologist named Bonnie Bassler that discusses “quorum sensing” which is how microorganisms chemically “talk” amongst themselves to function. I am not sure where this stands on the experimental process, as the talk was in 2009. It does sound promising.  The bottom line is that this threat is, again, a natural one.  Once again, natural recurrence of microorganistic threats are cyclical – as documented at this Federal Governmental website.  Even with the knowledge of standard precautions to prevent the spread of infection, things could get ugly very quickly – depending on the germ, exposure, and how it is managed.

I would also add that a power grid failure, or collapse of our network that provides power to everyone would be another cause for potentially apocalyptic conditions.  A few years ago, we all experienced large regional outages that cause quite a disruption of our lives.  There was a cascading effect where one site failed, which then led to other sections failing.  The talk was that our power grid is outdated and piecemealed together, and needed serious upgrades. Unfortunately, the “out of sight, out of mind” mentality has kept that issue out of the spotlight.  Have we taken our access to electricity for granted (not granite, people) that we are assuming that it won’t fail? Or that we can pick up the pieces fast enough when it crashes again?  If it were to fail, our whole infrastructure would follow in the collapse.  Our commerce, our businesses, our economy, our ability to communicate, our livelihood, our wealth……everything lost without access, once the power goes out.  Our data on our harddrives, documents, etc. Gone. I would think that our ability to travel would be lost, as well.  Power is needed to pump fuel from the ground, yes? People can’t get around. Goods can’t be moved. And, once again, a few days supply of water/food/stuff may not ultimately help. Somehow, the acronym “SHTF” will likely fall short of what we can expect from such an event. It could be a chain reaction that makes the apocalypse a long, drawn out event. We will be ultimately left to survive off the land, shaped by the catastrophic events that lay before us.

This is shaping my views of doomsday prepping to more of a “embrace the chaos” plan.  I can hope my family will be around each other when such an event occurs. For there, we would have to figure out what our assets and liabilities are.  Not a pleasant thing to consider, but seemingly more real.

Peace out.

 

Doomsday Preppers, The History Channel, and when the SHTF

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While digging through YouTube videos to find new music, as well as nurse bullying info; I found a bunch of Doomsday Preppers/When the SHTF stuff.  Apparently, my NURSE BULLYING (her story) post is from The Patriot Nurse. From what I’ve been able to see, she is an experienced nurse who has an established following who watch her post-apocalypse survival tips. They range from the medical to the social aspects of things to consider when the SHTF (which is prep talk for excrement hitting the fan).  I know that Doomsday Prepping is a television show (I’ve seen a few episodes). The theme has also managed to appear in Pinterest, which is a nice change of pace from womens’ hair styles, clothing, and “smokey eye” tips.  Still, I hesistate about embracing the end-of-the-world movement.

As if the prepping movement needed any help with resting the depressing thought on our collective shoulders that the world will eventually end as we know it; the History Channel offers up a great line-up of shows that share the same theme: We’re All Gonna Die!  Featuring the predictions from Nostradamus, or some computer program that has allegedly made its own apocalyptic predictions.  There are also segments on Biblical passages, including the book of Revelations, the rise of the Anti-Christ, and the End of Days.  There seems to be no end to the film footage of terrorist acts, explosions, gun play, and other violent acts to drive their point home. Oh, I am not sure if it’s the History Channel, but there is also a TV show called Life After People. It shows the world in decay after people are no longer around. It will look a great deal like the I am Legend film (Isaac Asimov’s book made into a film, starring Will Smith).

After watching such shows and/or youtube videos, I usually end up having nightmares for an evening or two. Now, what do I do with this?

  • Go full out prepper – Build a shelter, buy generators, meds, weapons, etc.
  • Go partial prepper – Build shelves in my garage, get some stuff
  • Go mini-prepper – Put together a bug-out bag
  • Embrace the chaos when it happens

If the societal infrastructure were to collapse, due to any number of scenarios; my guess is that the freefall we would experience could last months, if not years.  We have no idea what parts of the system would emerge as the new norms.  Money, in any of its forms, would be obsolete. Much of our wealth is stored electronically. If the power grid were to fail, we would lose access to that data. I am guessing the barter system would come back, that is….once the rioting slowed down. Nature abhors a vacuum. Panic, fear, and hate are all temporary states. People would freak out, then likely settle down after a time.

Healthcare priorities would change as the sickly, injured, frail, and weak would ultimately die off as medicine, medical equipment, and supplies would stop being available.  For those newly injured or maimed under the absence of the current health care system would find themselves divided into one of two categories: those we can save and those who are/will be beyond help.  I can’t imagine that playing out well. While we would reap some benefit of having vaccinations, the pathogenic threats would rise – especially if the waste removal system were to fail. The historic blending of waste and water supplies will not bode well for the masses.  The concept of infection control would be harder to follow, for those even aware of how to maintain it.

The demand for certain skill sets will arise. Here is where we will see drastic changes in how we contribute to society. The Haves-&-Have-Nots will change from financial to those who have the ability to work with their hands.  Building, creating, and repairing skills will become valuable. Those in health care will probably have some value in the new world.  Those in education will have a place in the new world, especially when the emphasis changes from rioting to society rebuilding.  Those who lived off the system, who may not have had the benefit of specific training, or even those with general office skills may be at some disadvantage.  Those familiar with hunting will obviously have some advantage, although the wildlife may not be able to keep up with the demand – if the food supplies dwindle too quickly.  Farmers will have some advantage as well. Which points out the next issue, those who don’t have may feel compelled to take from those that do. That’s gonna be ugly. Those in law enforcement may find themselves falling back to protect themselves, like everyone else. The demand for rules may take some time to become valuable again. Education and the need to train the next generation may also take time to gain value again. Books will come back into vogue again.  Knowledge and skill  not be something we can Google.

I can’t help but think that most Doomsday Preppers are thinking that we will be living in a RED DAWN movie existence….or some kind of post-Pinterest experiment.  I think, however, we are probably looking at something a lot messier….like third-world country messy.  Unreliable power, unstable social structure, and the masses fighting to gather their own resources.  It will be ugly. I am not sure that even a bug-out bag will help all that much.