Lorie A Brown, R.N., M.N., J.D., Author at Empowered Nurses

Nursing Pay Caps

September 21, 2023 11:33 am Leave a Comment

At the University of Wisconsin, the nurses are unionized. Unfortunately, a year ago Governor Tony Evers stepped in to negotiate a deal to avert a strike at the UW Health hospital in Madison.

The union for the nurses wants UW Health to provide greater pay transparency and to remove salary caps. One of Wisconsin’s US Senators will be speaking to the group to call for urgent progress toward retention and safe staffing in quality care.

The hospital administration announced a 3.5% annual pay increase for staff and a 2.2% increase to the pay scales. Regrettably, for nurses at the top of the pay scale, they will be given a lump sum payout which just gives them a check for roughly $500.

This is insulting and a slap in the face for nurses who have been faithfully serving patients, the community, and the hospital for the longest time.

We need seasoned nurses to mentor our new nurses. Having this cap on their salary is unwise as the nurses can go elsewhere for more pay and possibly even sign on bonuses. Last year the legislatures for the country were trying to cap travel nurses. This is not a way to attract nurses.

What the legislatures really wanted to do was cap the agencies who make money, who profit off the backs of nurses’ hard work by providing them with travel contracts. This is just another chink in the problems with the nursing profession.

If you are working at a place where you have reached the salary cap, I strongly encourage you to reach out to your state representative or senator to change this policy as nurses do deserve to make more.

While I think that there is an ultimate cap at some point, I don’t nurses have yet to reach it.

I would love to hear your thoughts in the comments. Please let me know your thoughts. Thank you.

Nurse’s Rant Goes Viral

September 14, 2023 4:25 pm Leave a Comment

Lex Hinkley, RN, BSN, a traveling nurse posted a video on TikTok that has gone viral. I don’t know her though we both live in San Diego. Regardless, she is very upset and concerned about the safety of our patients. Patients are being discharged from health care facilities with no place to go.

The nurse talked about how these patients are being placed in wheelchairs, taken from the emergency room, and dumped outside on the sidewalk. No need to say it twice but this is obviously very concerning. This is NOT the type of care we want to provide to patients, and it is disturbing to see health care facilities treating human beings like this. She also goes on to say how things will not change until corporate healthcare is dismantled.

While I agree with everything this nurse has said, I am concerned about her use of social media, especially using profanity, in hopes to make a change. I think for changes to be made in health care, we must band together and find solutions rather than hopping on social media and just condemning it.

Remember, social media platforms are not owned by you. Even if it’s a private group, it is possible for your information to still be discovered. I am concerned about this nurse and her future. The Board or current or future employers may consider this unprofessional conduct.

If this nurse is concerned to this level about what is happening in healthcare and it goes against her ethical beliefs, maybe either this isn’t the right fit for her or there are other ways to solve the problems. The other thing she did discuss is the EMTALA law, which is the anti-dumping legislation which requires healthcare facilities to take all patients, stabilize them and then release them.

As long as the patient is stable, the facilities have the right to release them. The problem is where can they be released? Our country is inundated with people that call the streets their home. The nurse called them, “unhoused.” But what do we do with them?

Here in San Diego, there is an anti-camping ordinance which prohibits tent encampments in all public spaces in the city. But they did build some tent cities in which people could camp, rest, shower and maybe even get a hot meal.

However, and unfortunately, the only remedy the police have is to enforce this anti-camping ban. Yet, how can they expect those people to go to court or to pay the fine when, after all, they are homeless?

This is a huge problem in our society, as well as healthcare, which needs to be tackled so that people can be treated humanely in our society.

I would love to hear your thoughts on this matter.

Finally! A Proposal For Mandatory Minimum Staffing Standards For Long-Term Care Facilities.

September 7, 2023 4:47 pm Leave a Comment

I was so excited to see that the Centers for Medicare and Medicaid Services (CMS) issued minimum staffing standards for long-term care facilities. This proposed rule seeks to establish comprehensive nursing staffing requirements. I love this initiative because residents in nursing homes are not always given the best care due to short staffing. Although there are requirements that facilities must provide sufficient levels of staffing pursuant to the OBRA regulations, chronic understaffing is prevalent in long-term care facilities.

The rule proposes 0.55 hours per resident day for nursing care and 2.45 hours per resident day for nurse aids. There is also a requirement to have an RN on site 24 hours a day, seven days a week. It will be so interesting to see if this rule passes. It is open for comment and if you support the rule, I highly recommend that you comment so that your voice can be heard.

I’m sure the long-term care facilities are going to balk at this proposed regulation, but one of our most vulnerable populations, our elderly, deserves to have minimum care. Even a nurse for 0.55 hours per resident day, which is basically less than one hour of care for the entire 24 hours is questionable but hopefully with more nurse aides on staff, patients will get the care that they need.

Residents in long-term care facilities are medically complex and can be high acuity patients. Creating consistent standards will hopefully reduce the risk of unsafe and low-quality care across long-term care facilities.

I also love the idea that an RN be on staff seven days a week to provide direct resident care. While I think LPNs are fantastic, the assessment skills of a registered nurse are definitely needed.

The rule also states that the CMS wants to hold nursing homes accountable to ensure that residents receive safe and high-quality care. I hope that there is some mechanism to hold responsible facilities that do not comply with the mandatory minimum standards. CMS is proposing that it will take away federal funding if the facility fails to implement these mandatory minimum staffing requirements.

The CMS does discuss good faith efforts to hire and retain staff through development and implementation of a recruitment and retention plan but trying isn’t good enough. These residents deserve consistent care.

The plan is to stagger implementation. Phase one would require facilities in urban areas to comply with facility assessment requirement 60 days after publication of the final rule. Phase two would be for urban areas to comply with the requirement for an RN to be on site 24 hours a day, seven days a week. And phase three would require facilities in urban areas to comply with mandatory minimum staffing.

These would be three years after the publication date of the final rule. Seriously, I don’t think we can wait three years! While I understand that the rulemaking process takes time, this needs to be implemented now!.

The CMS does acknowledge that rural long-term care facilities face difficulty providing safe staffing as well. This rule has different requirements.

Although I know staffing is difficult in rural areas, if the facility is competitive, has a great working environment and pays well, they should not have a problem with staffing.

Your comments to this proposed rule are invited through November 6, 2023. I truly hope that you will comment so that our elderly, who are the most deserving of safe staffing can get the care they need.

Will Money Help Solve The Problems In Nursing?

August 31, 2023 6:53 pm Leave a Comment

The Biden Administration announced that it is awarding more than $100,000,000.00 to train more nurses in growing the nursing workforce.

However, will adding more nurses solve the problems in nursing where nurses are leaving in droves?

I don’t think so. The problem is the context of nursing is practice and how nurses don’t feel valued and appreciated by administrations. Context means environment.

$8,700,000.00 is going to help LPNs become RNs; $34,800,000.00 will go towards advancing The Nursing Education Workforce Program; and $30,000,000.00 will go towards advancing nursing education – nurse practitioner residency fellowship programs and $26,500,000.00 will go to nurse faculty loan programs to provide low interest loans and loan cancellation to incentivize careers as nursing faculty.

While I am glad that this bill is addressing nursing faculty, I truly believe that nursing is in our DNA. You cannot pay enough to have people to do the things that nurses are required to do. Therefore, putting money into adding more nurses to the profession is, in my opinion, not going to help.

The system is broken and must be fixed or is going to continue to be a revolving door with people coming and going.

I would love to see more money being put toward nurses’ salaries but putting in more money is not going to solve the problem. Until healthcare facilities show how valuable and appreciated nurses are, listen to them and implement their feedback, things will not change.

At this time, nurses are treated like disposable workers, “we can always get another one!” Unfortunately, it is more difficult these days to get another nurse to replace those who leave.

Also, it takes a lot of money to orient a nurse to a new facility.

What are your thoughts about adding more money to nursing education? Will it solve or decrease the problems in nursing.

Give me your comments and post them below.

What Does “No” Mean?

August 30, 2023 11:33 am Leave a Comment

It has been said that in business, you have to kiss a lot of frogs to get to a potential buyer. The more frogs that say no, the closer you are to “yes”.

Unfortunately, we as nurses are programmed that if someone says “no” to us, we tend to take it personally. But “no” just means “not now”. “No” is nothing personal. How many times do you say no and it’s nothing personal?

Let’s look at it this way. If you are a store owner with people coming to your store and they browse and don’t buy, do you get mad at that person?

Of course not. Because the store owner knows that the next person who comes in or the person after that will be a “yes”.

So, does “no” really mean “no”?

If you’re talking to a potential client, is he really saying “no, I am never going to be interested”, or is he just saying, “not now”? There is an important distinction because if they say, “not now”, ask if you can check back with them later. This is a great follow-up.

Most of the sales are made anywhere after the 5th through the 8th contact. Therefore, if you are not following up with the “no’s” to turn them into “yeses”, you’re wasting a golden opportunity.

I suggest you get permission to check back with the person to see if their circumstances or their desires have changed, and do they really need help with the problem that you can solve for them?

Will Maine Have Safe Staffing Requirements?

August 24, 2023 11:32 am Leave a Comment

In Augusta, Maine, that state has promulgated legislation called the Maine Quality Care Act which sets enforceable nurse to patient ratios in many hospitals. The bill unfortunately does not include long-term care facilities where it seems many of the problems occur.

However, it will cover acute care and psych hospitals as well as freestanding emergency departments and ambulatory surgical facilities. This should provide some relief for many nurses.

The legislation, which passed the state’s Labor and Housing Committee, focused to not only protect patients and nurses, but to bring nurses back to the bedside. Should the legislature enact this measure, Maine would be only the second state in the country with this safe staffing legislation following California which was the first in 1999.

Studies have shown that mandated RN to patient ratios improved patient care and decreased patient mortality as well as decreased complications and medical errors. Safe staffing also helps recruit and retain nurses.

However, the legislation is attracting fierce criticism from the Maine Hospital Association (“MHA”). The first point in their press release states is that the initiative will “Cost well over $100 million dollars”. Clearly the hospitals are concerned about increasing their costs rather than improving the quality of care.

The MHA claims also that there will be limited access to hospital care if hospitals cannot meet the minimum staffing ratios and will strip nurses of autonomy and flexibility by stating that the units are based on the condition of patients and the skill and experience of the nurses.

This legislation will not change that. It’s just requiring mandatory minimum staffing, but staffing can flex up as needed. The MHA also claims that the legislation won’t create a nurse. While that is true, nurses are attracted to places with safe staffing so I believe more nurses will move to Maine to have a better working environment.

The MHA’s main concern is that it will not improve healthcare quality. But that is not true according to research. Quality is improved when staffing is improved.

Additionally, they claim it won’t help recruitment and retention, to which I also disagree. I think many nurses are interested in traveling to California because of the safe staffing ratios and I believe the same would be true of Maine.

What do you think about mandatory minimum staffing ratios. Please let me know in the comments.

Nurses’ Honor Guard

August 17, 2023 7:22 pm Leave a Comment

Did you know that nurses’ honor guards pay tribute to nurses at the time of their deaths? They give the nurse a Nightingale Tribute at the funeral or memorial service.

The nurses who participate in the Nurses Honor Guard dress in the traditional white uniform complete with cap and cape. The ceremony is brief, usually taking only a few brief minutes.

The Nightingale Tribute is a recitation of the late nurse’s name three times after which a triangle is struck to ring out after each call.

As nurses, our identity is tied with our career. For a nurse to be honored in this fashion is so beautiful.

The Nightingale Tribute was copyrighted by Dwayne Jaeger RN, MSN and says, “[e.g., Nurse Smith] was there when a calling, quiet presence was all that was needed, Nurse Smith was there in the excitement and miracle of birth, or in the mystery and loss of life, Nurse Smith was there.

When a silent glance could uplift a patient, a family member, or friend, Nurse Smith was there.

At those times when the unexplainable needed to be explained, Nurse Smith was there.

When the situation demanded a swift foot and a sharp mind, Nurse Smith was there.

When a gentle touch, a firm push or an approaching word was needed, Nurse Smith was there.

In choosing the best one from a family’s ‘thank you’ box of chocolates, Nurse Smith was there.

To witness humanity — its beauty in good times and bad, without judgment, Nurse Smith was there.

To embrace the woes of the world willingly and offer hope, Nurse Smith was there and now that it is time to be at the greater one’s side, Nurse Smith was there.”

Many nurses are starting their own Nurse Honor Guard. If you would like to honor nurses in your area, this sounds like an amazing opportunity to make a difference and honor them.

If you are interested in starting a Nurses Honor Guard, contact Julie Murphy at jmury581@gmail.com. I first heard about the Nurses Honor Guard while on a cruise sponsored by Show Me Your Stethoscope, the largest online group for nurses.

Along with learning about the Nightingale Tribute, I had an amazing time on that cruise and met some amazing and truly brilliant nurses. I learned so much in the process.

So, what are your thoughts about a Nurses Honor Guard? Please feel free to post your reactions in the comments below.

Happiest Areas to Work in Nursing

August 10, 2023 5:50 pm Leave a Comment

Interestingly, Beckers Hospital Review just published its 2023 rankings on an educational resource site called Nursing Process. The survey determined the 15 happiest and unhappiest jobs for nurses.

I was surprised to see that nursing’s number 1 unhappiest job is the school nurse. This is so interesting because as a school nurse, being surrounded by youngsters all day would seem to be enjoyable. However, I once worked for an agency that assigned me to different places all the time. And, personally I did not like being a school nurse.

Guess what was number 5 on the list? Legal nurse consultant!

When I looked over the unhappiest jobs, they tended to correlate with the Nursing Board complaints. Although I have had very few school nurse cases, number 2 on the list was hospital staff nurse followed by emergency room nurse as number 3. Also, at number 10 on the list was nursing home RN and at number 14 hospice nurse.

I thought, most nurses I speak to who do hospice care love it! But, then again, hospital staff nurse, emergency room nurse and home health nurse seemed to have the highest number of Board matters.

Nursing home nurses are also on the unhappy list and again many of them seem to have accusations against their licenses.

I also looked at this list to see how it might correlate with malpractice claims. I know nursing home litigation is very big these days, primarily due to lack of staff. Another big area of malpractice claims is in obstetrics, but I do not see obstetric nurses on the list of 15 happiest or unhappiest jobs.

What do you think? What area do you work in and, are you happy or unhappy with your job?

I would love to hear your comments below.

Another Deadly Med Error

August 2, 2023 5:30 pm Leave a Comment

Last summer, an 81-year-old man admitted to a Lexington, Kentucky hospital and died within 48 hours later. He had a GI bleed in which he was ordered GoLytely which is a bowel prep for colonoscopy but instead, the nurse gave Naturalyte, a dialysis liquid not intended for human consumption.

According to the Kentucky Board of Nursing, no charges were filed against the nurse for this medication error. In addition, I do not believe criminal charges were filed either. The Board, believing many process failures and system issues were involved, did not feel that charges against license of the nurse were warranted.

After treating another patient several days earlier, the dialysis team left the liquid behind on the ICU floor.

Nurses scan barcodes on patients’ wrist bands and then scan the medication they are about to administer. Unfortunately, the container of Naturalyte would not scan and when the nurse called the pharmacy, rather than sending the proper medication or coming up to see the liquid in question, the pharmacy just sent a label to the ICU floor through the hospital’s pneumatic tube system.

The nurse administered eight ounces of Naturalyte which she believed to be GoLytely before her shift ended. The patient was unable to tolerate the liquid and after the nurse left for the evening, a second nurse gave the patient the remainder of the bottle’s liquid through a feeding tube. The medication mix up was caught at about midnight, but the patient died the next morning.

This is so sad. That night, while the patient was being transferred to their hospital, 3 ICU nurses were pulled to work on another unit that night. The nurse who took care of this patient took him on as her third patient.

It is unfortunate that this terrible mistake was made and that the Barcode system wasn’t working which contributed to the nurse failing to scan the liquid to be alerted to the use of the wrong medication. The nurse should have done her Five Rights and known it was the wrong medication.

It’s interesting how one state north of Tennessee views things completely differently as in the Radonda Vaught case. The nurses involved in this Kentucky death did not face criminal charges or have trouble with the Nursing board. It would be nice if there was some consistency with neighboring states, if not the entire country.

So, I’m somewhat relieved that the nurses in the Kentucky medical error matter did not get charged criminally or face a challenge to their nursing licensing. That does not negate the loss.

Are You An Imposter?

July 31, 2023 2:19 pm Leave a Comment

When I began legal nurse consulting, I was surprised just how easy it was. I was simply using my existing nursing knowledge and sharing it with attorneys to help them with their cases.

I used to say to myself, “I can’t believe that they actually pay me for this.” Now I understand how important it is to get paid for your valuable work and not to give it away for free.

Now, in the beginning I felt like an impostor saying to myself, “Who am I to get paid for doing this?” But I came to realize that when I was a baby, I didn’t feel like an impostor, I didn’t feel like a fraud. But as we age, we do begin to feel like frauds or impostors.

We say to ourselves things like. “Who am I to have this business? Who am I to charge this kind of money?” But I say, “Who are you not to?” Playing small does not serve anyone. You have important knowledge to share, and you deserve to be paid for that knowledge.

Many of us are at the top of our game in nursing. However, we did not start that way. When we hit the floor for the first time, we were new, green, and terrified. It took us a while to get our nursing legs. However, we were safe and we did practice competently. We just didn’t yet know everything that we know now, and we still don’t know everything.

When we start a business, we must repeat that phase again and we will probably begin to question ourselves, “Can we really do this?” Well, of course you can. You wouldn’t have the desire to have a business if you couldn’t.

I have no desire to be an astronaut, president or a marathon runner because I can’t do any of these. But I do have a desire to be a business owner, and I absolutely love it. If you have the same desire, you too can own a business and have your dream come true. It just takes consistency, persistence, and a belief in yourself because you absolutely can do it!

You are NOT an impostor. You are NOT a fraud. You are perfectly on the path you need to be to have the business of your dreams.

Author Archives: Lorie A Brown, R.N., M.N., J.D.