Important Notice for Employers and Licensees: Due to technical issues with the State Board of Nursing’s online renewal computer system, the October 31, 2014 licensure expiration date for RN, CNS, CRNP and CRNP Prescriptive Authority has been extended until November 30, 2014. Please go to https://www.mylicense.state.pa.us/ to renew online or contact the Board Office at 717-783-7142 with questions.
It doesn’t seem like nurses are asking for too much as fears escalate over the spread of Ebola. They’re concerned about safety — not just for themselves but for their patients and for the public.
But hospital management hasn’t responded. Neither has Congress nor the president.
That’s why some 100,000 registered nurses and nurse practitioners across the country, including 400 at a Washington, D.C., hospital, are going on strike, picketing or holding rallies and candlelight vigils as part of a national “Day of Action” Wednesday to protest their lack of protective gear and training for taking care of Ebola patients. In California, 18,000 nurses will strike for two days, starting Tuesday morning.
“It’s a women’s issue,” says RoseAnn DeMoro, executive director of National Nurses United, or NNU, the nation’s largest nurses union, which represents 185,000 registered nurses. “If this were a [predominantly] male profession, the dialog would be different.”
You wouldn’t send a firefighter into a burning building or a soldier to war without the proper equipment, DeMoro and other nurses have said to me. Yet nurses don’t have the kind of equipment or the training they need to deal with Ebola — and potential Ebola — patients. In a survey by NNU of more than 3,000 nurses at more than 1,000 hospitals, 85 percent said that their facilities were not prepared to take care of Ebola patients and that nurses had not been trained adequately.
Strikes by nurses are legal as long as sufficient warning is given to the hospitals, where elective surgeries and procedures are rescheduled and “replacement” nurses are hired.
Nobody wants to go on strike, said registered nurse Megan Ottati, who’s worked at Providence Hospital in Washington for 18 months. “Unfortunately, it seems like the only way to get the attention of upper management at Providence on issues, especially safety,” she said. “You do what you have to do to ensure safety.”
Ottati is a telemetry nurse in a 22-bed unit for patients that have left the intensive care unit but are still being monitored closely. One nurse should have responsibility for four patients, she said, but too often there are only three, and sometimes just two, nurses sharing care for 22 patients. The thought of one of those patients having Ebola is almost overwhelming, considering the current staffing shortages.
“Ebola happens to be a microcosm of the bigger picture of the erosion of standards and conditions in patient care,” said Katy Roemer, a registered nurse for nearly 20 years who works at Kaiser-Permanente’s Oakland Medical Center in Oakland, Calif.
There’s been a dramatic shift in health care, explained DeMoro, as hospitals move from community-run enterprises to corporate institutions where the bottom line rules.
“Patients before profit — that’s what we believe in as nurses,” Roemer said. “What we see is profit before patients.”
Hospitals fail to maintain adequate staffing, compromising patient care while raking in “massive profits,” Roemer said. “But we aren’t given the resources to provide the standards of care we’re trained to…. It creates an impossible situation.”
“We’re tired of hearing, ‘We know what’s better for you than you do,’” from hospital management, DeMoro said. “And we’re tired of being considered expendable.”
Although the Centers for Disease Control and Prevention issued guidelines on equipment to protect against Ebola, they’re just that — guidelines –without any means of enforcement.
Deborah Burger, co-president of NNU, testified Oct. 24 before a Congressional committee asking for legislative mandates, and NNU sent a letter to President Obama requesting an executive order to force compliance with standards to protect nurses and other health-care workers.
DeMoro, who’s also executive director of the California Nurses Association, said she hoped a meeting with Gov. Jerry Brown would result in action that might serve “as an example for the nation.”
The nurses want full-body hazmat suits that meet the American Society for Testing and Materials F1670 standard for blood penetration and F1671 standard for viral penetration and that leave no skin exposed or unprotected, and they want National Institute for Occupational Safety and Health-approved powered air purifying respirators with an assigned protection factor of at least 50.
They also want training, including practice putting on and removing protective gear.
“We’re putting our lives on the line, but the hospitals are saying our lives aren’t worth it,” Roemer said. “You can’t imagine the questions from our families. One colleague’s 6-year-old asked, ‘Mommy, do you get to wear the suit that keeps you safe from bad germs?’”
Nurses have activities planned in Boston, Chicago, Houston, Las Vegas, Memphis, Miami, St. Louis and New York City; as well as Augusta, Ga.; Bar Harbor, Maine; Durham, N.C.; El Paso, Tex.; Kansas City, Mo.; Lake City, Va.; Lansing, Mich.; Massilon, Ohio; St. Paul, Minn.; and Tampa, Fla.; and the Philippines.
Two nurses contracted Ebola from caring for just one patient in a Dallas hospital in October and have been treated successfully. It doesn’t take a math genius to realize the danger not just to nurses but to the public.
“I want the public to understand we’re fighting for them, for the patients who are people at their most vulnerable,” Roemer said.
“Nurses have historically been leaders in public health issues,” DeMoro said. “Now they’re rising up again.”
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The Los Angeles County Public Health Department falsified the dates it received complaints about nursing homes as pressure rose to meet state deadlines for launching investigations, according to two employees.
In a letter last month to county, state and federal officials, inspector Kimberly Nguyen cited 11 cases in which she said the dates typed into the computer system were later than the dates the complaints were actually received. The cases mentioned in the letter involve alleged abuse, falls and pressure sores, she said.
“In my belief, falsification is a serious matter and unlawful and our department should know better to not manipulate paperwork to mislead others and the public,” Nguyen wrote in the Oct. 7 letter.
In an Aug. 6 email, Sharon Geraneo, an assistant supervisor in the department, also wrote administrators to protest alleged falsification of complaint dates. She wrote that the department cites nursing homes for fraudulent record-keeping and yet, “here we are falsifying the records.”
Under state law, investigations must be started within 10 days of receipt of a complaint— or 24 hours if the allegation involves the imminent threat of death or serious harm. California Department of Public Health policy requires inspectors to enter the dates based on when the complaint was first received by telephone, fax, email or letter.
In Los Angeles County, the dates of some complaints were entered much later than when they were received — by as much as 79 days, Nguyen said.
Officials with the state public health department said they are investigating the allegations.
The Los Angeles County Department of Public Health issued a statement saying it has “zero tolerance for intentional document falsification” and is not aware of any deliberate falsification of records.
Department officials said they did identify a data entry error by one person that affected 35 cases. The error “prompted swift and appropriate corrective actions,” including re-training that staff member, according to the statement.
The health facilities inspection division “recognizes the importance of handling records in a timely manner,” the statement read.
Los Angeles County is under contract with the state to investigate potential problems at nursing homes, which typically are made by residents or family members, or are reported by the facilities themselves.
Both the county and the state have faced mounting criticism over the past several months for lax oversight of nursing homes. Legislative hearings, audits and reports have faulted public health officials for allowing thousands of open cases to languish, often for a year or more.
The most recent allegations focus on problems at the other end — in starting the investigations. A state audit released last week said that in addition to the delays in finishing cases, officials had not begun investigations within the required time frames. In August, the Los Angeles County Auditor-Controller also faulted the county public health department for problems with entering complaints in the system days after receipt, rather than on the same day as required.
Nguyen said she believes the practice in some cases was deliberate, in part because it continued even after the August audit. She said she decided to speak publicly about her concerns because she believes the department is “putting patients in harm’s way” and should be held accountable. She has made repeated attempts to get her superiors to address problems but said she has received little or no response.
“I’ve exhausted the proper channels,” she said. “It was time for me to come forward … This is a safety issue.”
In an interview, Nguyen said several cases concerned her, one of them involving Imperial Crest Health Care Center in Hawthorne. Documents showed the center submitted a report to the county public health department on Aug. 5, 2013 about a resident suffering a broken finger. The receipt date, however, was listed as Aug. 16 — 11 days later. The investigation was begun within 10 working days after that.
The injury, which required stitches and a splint, resulted from an altercation in which a nursing aide snatched a mobile phone away from the patient, documents show. In fining the facility $10,000, the county said the facility had failed to intervene when the resident earlier accused the aide of being rough and asked for a different aide.
According to an Oct. 3 email, Nguyen raised concerns about falsified dates in other cases to her supervisor, Adewole Adegoke. In a response that day, Adegoke wrote that so much “behind-the-scene” work needs to be done before an investigation can be assigned and that the start dates are “not so black and white.” Also, the supervisor blamed a fax machine, saying it “had not really functioned as designed.”
Meanwhile, the state, which directly oversees nursing homes in every district except Los Angeles County, has had its own history of problems with timely investigations. A lawsuit by California Advocates for Nursing Home Reform, or CANHR, resulted in a 2006 order by a Superior Court judge instructing public health officials to follow the law regarding investigation timelines.
Geraneo noted that order in her e-mail to administrators, referring to a case involving a non-working generator in which the complaint year had allegedly been changed from 2013 to 2014. “We cannot change the initiation dates of these complaints because of the CANHR lawsuit!”
Geraneo declined to be interviewed.
Since Kaiser Health News began writing about the department’s health facilities inspection division in March, administrators have sent e-mails to staff telling them not to speak to the media and to forward all requests. Reached by phone, several inspectors have declined to talk, saying they feared retaliation.
Nguyen said she has been she has been targeted for retaliation as a result of raising questions since July 2013 about the quality of nursing home oversight.
In May 2014, Nguyen was suspended for five days without pay because she allegedly failed to renew her nursing license. A department letter said her license expired on November 30, 2013 and that she worked for six days without a valid license.
But as the Board of Nursing later confirmed in writing, her license actually had been renewed promptly. The Board simply hadn’t entered the renewal on its website. Nguyen called the board on Dec. 11, as soon as she found out about the problem, and it was fixed within an hour.
The suspension occurred five months later — and just days after Nguyen said she provided evidence of allegedly improper case closures to the Los Angeles County Auditor-Controller.
Nguyen said she believes she was being punished by her bosses for exposing the department’s “unethical practices.”
“They were being vindictive,” she said.
A spokesman said the county public health department could not comment on personnel matters.
This article was produced by Kaiser Health News with support from The SCAN Foundation.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
As a tribute to our Veterans this Veterans day, I reached out to one of my Army nurse friends. The following accounting was written by an active duty Army Nurse, who wishes to remain anonymous. The following is taken from a private letter to her family and friends. Hello everyone! I have made it safely […]
The post Veterans Day appeared first on The Gypsy Nurse.
The Supreme Court on Friday agreed to hear a case on a subject that’s important to millions of people who receive subsidies to help purchase coverage under the health-care law. Friday’s decision follows earlier action in July when two U.S. appeals courts issued conflicting rulings on the issue. KHN’s Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers.
Q: What did the Supreme Court do?
The justices decided to hear a case that challenges the federal government’s ability to provide subsidies to individuals in nearly three dozen states where the federal government operates the online marketplaces, or exchanges. There are several legal challenges on this issue that are working their way through the courts. The high court’s decision to accept the case surprised many analysts who thought the Supreme Court might wait until they had a ruling from the full District of Columbia Court of Appeals, one of the other courts considering the issue.
Q: How did the lower courts rule on the subsidy issue?
A three-judge panel from the U.S. Court of Appeals for the District of Columbia Circuit ruled in July that the health law’s subsidies are available only to individuals in states now operating their own health insurance exchanges. In 2014, only 14 states and the District of Columbia ran their own exchanges, while 36 relied on the federal government. Judge Thomas Griffith, writing the majority opinion in the 2-1 decision, said they concluded “that the ACA unambiguously restricts” the subsidies to “exchanges ‘established by the state.’” That ruling was later vacated when the full District of Columbia Court of Appeals agreed to rehear the case, which is scheduled for December next month.
In a separate ruling, a three-judge panel for the Fourth Circuit Court of Appeals in Richmond, Va., ruled unanimously for the Obama administration, allowing subsidies to be available to residents in all states. Judge Roger Gregory, writing the opinion, said while the health law is “ambiguous and subject to multiple interpretations,” the court decided to uphold the IRS’s interpretation of the law that residents of states using the federal exchange are entitled to subsidies. That Virginia case, King v. Burwell, is the case the Supreme Court said would hear this term.
Q: What was the issue the lower courts decided on?
The case centers on a brief description in the health law that says subsidies will be available “through an exchange established by the state.”
In implementing the law, the Internal Revenue Service (IRS) interpreted the law to allow eligible consumers to receive subsidies to help purchase coverage, regardless of whether they are in an exchange run by their state or by the federal government.
Opponents of the law questioned that interpretation, saying that the law as written clearly directs subsidies to state-based exchanges only. But proponents – including several lawmakers who helped write it – said lawmakers fully intended that subsidies be offered on all exchanges no matter if they were administered by the feds or state officials.
Q: I live in a state with a federally run exchange, and I get a subsidy to help me buy coverage. Am I going to lose it?
Current subsidies will likely remain in place until there is a final legal decision on the matter.
White House spokesman Josh Earnest said the administration was confident it would prevail. “The ACA is working. These lawsuits won’t stand in the way of the Affordable Care Act and the millions of Americans who can now afford health insurance because of it,” Earnest said in a statement Friday. “We are confident that the financial help afforded millions of Americans was the intent of the law and it is working as Congress designed.” Open enrollment begins again Nov. 15.
Supporters of the court challenge to the IRS interpretation on subsidies also maintain their case is strong. “The Supreme Court’s decision is a rebuke to the Obama administration and its defenders, who dismissed as frivolous the plaintiffs’ efforts to defend their right not to be taxed without congressional authorization,” Michael Cannon, director of health policy studies at the libertarian Cato Institute who championed the subsidy appeals, said in a statement Friday. “It is essential that these cases receive expedited resolution, if only to eliminate the uncertainty currently facing states, employers, insurers, and taxpayers.”
Q: If there are legal disputes ongoing about who qualifies to receive a subsidy, do I still have to buy health insurance?
Yes. The law’s “individual mandate,” which requires most people to purchase health insurance or pay a fine, is still in place and has been upheld by the Supreme Court.
Q. What if I get my insurance through work?
This decision applies only to policies sold on the online marketplaces. It does not affect work-based insurance, Medicare or Medicaid, regardless of where you live.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
Safety First: Hospital safety and violence against nurses are important issues.
The issues of hospital safety and violence against nurses were in the news this week, on the heels of a frightening attack on several nurses at St. John’s Hospital in Minneapolis.
Charles Logan, a 68-year-old patient at St. John’s, removed a metal bar from the side of his hospital bed and used it as a weapon in the disturbing attack, which was caught on video. Logan barreled through a nurse’s station wielding the bar and chased several fleeing nurses through a security door and down the hall.
Logan was followed by patient Adam Linn, a security guard by trade who’d just had his appendix removed. Logan was eventually tackled in the street by police and died at the scene; the medical examiner is investigating the exact cause of his death.
Logan’s attack injured four nurses, also terrifying several others. What motivated the incident is unknown, however, an altercation earlier in the day involving Logan, his family, and his lawyer has been reported.
The Minnesota Nurse Association released a statement that read in part:
“Once again, nurses showed their dedication by responding to the emergency situation to help all the health care workers injured in the attack. Sadly, this incident is another act of patient on nurse violence that nurses and health care workers face every day. Only their training, education and courage prevented this sad situation from becoming worse.”
While the severity of this situation is definitely (and thankfully!) rare, attacks on nurses are sadly not. According to a survey from the International Healthcare Security and Safety Foundation, 60% of workplace assaults occur within healthcare facilities.
Barb Martin, who worked 46 years in nursing, told the Minnesota CBS affiliate that violence against healthcare workers is a persistent problem, and that many nurses report “being spit at, being hit, being shoved, being verbally abused.”
Despite the statistics, nurses certainly do not deserve any level of violence or mistreatment. Here are a few tactics that can help keep nurses safe on the job, based on findings from “Patient Safety and Quality: An Evidence-Based Handbook for Nurses,” in a chapter devoted to “Personal Safety for Nurses”:
The St. John’s video and story are sad on many counts, but we hope to see the issues of hospital safety and violence against nurses better addressed in the future. In the meantime, we know that nurses are a tough group of folks who will do everything they can to take care of themselves and their colleagues — in addition to their patients!
The Pennsylvania State Nurses Association, representing more than 218,000 registered nurses (RNs) in the Commonwealth, congratulates the candidates elected in the 2014 midterm election who have proven to be advocates for a stronger health care system and improved patient care. Based on race outcomes to date, 95 percent of the PSNA Political Action Committee (PSNA-PAC) endorsed candidates will be serving in the Pennsylvania General Assembly when it convenes in December 2014.
“We look forward to working with this bi-partisan group of legislators in progressing health policy in Harrisburg,” stated PSNA Chief Executive Officer Betsy M. Snook, MEd, BSN, RN. “Additionally, PSNA applauds the election of registered nurse Judy Ward (R-80). This appointment marks the first RN in the State House in just under a decade.”
PSNA-PAC-endorsed candidates elected to the Pennsylvania General Assembly include incumbents Patrick Harkins – D-1, Ms. Judy Ward (RN) – R-80, Flo Fabrizio – D-2, Jaret Gibbons – D-10, Ed Gainey – D-24, Steve Santarsiero – D-31, Marc Gergely – D-35, Harry Readshaw – D-36, Pamela Snyder – D-50, Ted Harhai – D-58, Kevin Schreiber – D-95, Mike Sturla – D-96, Patty Kim – D-103, Sid Kavulich – D-114, Gerald Mullery – D-119, Neal Goodman – D-123, Mark Rozzi – D-126, Thomas Caltagirone – D-127, Daniel McNeill – D-133, Robert Freeman – D-136, Madeline Dean – D-153, Steve McCarter – D-154, Brendan Boyle – D-170, Kevin Boyle – D-172, W. Curtis Thomas – D-181, Brian Sims – D-182, Pamela DeLissio – D-194, Stephen Kinsey – D-201, Brian Ellis – R-11, Gene DiGirolamo – R-18, Tim Hennessey – R-26, Bernie O’Neill – R-29, Robert Godshall – R-53, Jeff Pyle – R-60, Kate Harper – R-61, Donna Oberlander – R-63, Mathew Baker – R-68, Matt Gabler – R-75, Adam Harris – R-82, Fred Keller – R-85, Mark Keller – R-86, Sheryl Delozier – R-88, Mike Regan – R-92, Stanley Saylor – R-94, Mauree Gingrich – R-101, Susan Helm – R-104, Ron Marsico – R-105, John Payne – R-106, David Millard – R-109, Tarah Toohil – R-116, Karen Boback – R-117, Mike Tobash – R-125, Mark Gillen – R-128, Jim Cox – R-129, David Maloney – R-130, Frank Farry – R-142, Marguerite Quinn – R-143, Katharine Watson – R-144, Mike Vereb – R-150, Todd Stephens – R-151, Thomas Murt – R-152, Stephen Barrar – R-160, Joe Hackett – R-161, William Adolph – R-165, Kerry Benninghoff – R-171, Scott Petri – R-178, Julie Harhart – R-183 and Seth Grove – R-196. There were also races won in the Pennsylvania State Senate by PSNA-PAC candidates including Mario Scavello – R- 40, Michele Brooks – R-50, Tommy Tomlinson – R-6, Chuck McIllhinney – R-10, Stewart Greenleaf – R-12, John Yudichak – D-14, Pat Browne – R-16, John Blake – D-22, John Rafferty – R-44, Mike Folmer – R-48, Lisa Baker – R-20, Jake Corman – R-34, Randy Vulakovich – R-38.
PSNA looks forward to working with lawmakers to affect positive change by advancing issues important to nurses and patients.
