Empowering Nurses at the Bedside and in Business

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

  1. If It’s Not Documented, It Was Not Done

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    How many times have you heard this “If it’s not documented, it was not done?”  I assume many and it is so true. Your documentation will save you every time.  Some common areas where lack of documentation becomes concerning include: 

    1. Failing to document Verbal Orders.  It is imperative to document verbal orders.  I hear it all the time from ER nurses that they forgot to document the verbal order.   If that verbal order was not documented, it looks like theft and practicing medicine without a license because medication was taken out of the Pyxis without an order and given to the patient.
    2.  Questioning Provider Orders.  I was taking care of a patient who had an order for Bumex in a large dose.  I questioned the physician about it and he said it was the last chance to avoid dialysis to get her kidneys working with this large dose of a diuretic.  I felt comfortable giving it but if I had not documented the conversation, that could have been trouble for me if something happened to the patient.
    3. Failing to go up the Chain of Command.  If the physician in the above matter did not give me a good explanation for the large dose, I needed to go up the chain of command.  Many times, nurses are afraid to go up the chain but it is necessary and needs to be documented to protect yourself.
    4. Failing to Document Timely vital signs.  Unfortunately, with electronic medical records, the time you document is the time on the record so if you are documenting something late, be sure to enter it as a late entry.  This may raise a red flag too but is better than not documenting.
    5. Reporting of changes in condition.  If you do not document a change in condition and what you did about it can also be problematic.
    6. Medications Given.  Again, if you do not document medication given, it can be considered theft.  There are many steps to giving narcotics such as taking it from the Pyxis then scanning the patient’s wrist band that the medication was given.  Don’t forget this step and if the scanners are down or the EMR is down, make sure it gets documented. 
    7.  Patient Response to Medication.  Let’s say the count was off for Norco and you gave a Norco to a patient.  Now you are being accused of taking the Norco but if you document the patient’s response and if the patient says she never received the Norco, this will help protect you.
    8. Discharge Teaching.  If your discharge teaching includes when to call the doctor and it is not documented and the patient does not call the doctor, then it falls back on you. You are liable.

    Nurses are so busy and the last thing we want is to stay late to chart but if you document it today, it will save you a bunch of headaches in the future!

  2. You’ve Been Charged With a Crime

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    I frequently get calls from nurses because they have been charged with a crime and want to protect their license.  Some nurses say to me, well, I was arrested, but it has nothing to do with nursing.  According to the Board, if you do have a criminal matter, they’re concerned about your professionalism and ethics.  Therefore, in some states, like Arizona, you have ten days to report an arrest to the Board, but in other states, you need to notify them upon conviction. 

    Some states may also require you to report even if you made a no-contest plea or even if your matter goes on pretrial diversion.  I highly recommend that you review your state’s Nurse Practice Act so you know exactly what you need to report and when.  In addition, you should know your employee handbook as to what, if, and when you are required to report any matter to your employer.  

    By far, the biggest criminal matter in nursing is DUI.  However, with Uber and Lyft, it seems that it wouldn’t be as prevalent, but it still is.  Be safe, take an Uber or a Lyft, and if you are intoxicated, be careful of being charged with public intoxication as well.  Again, the Boards have a duty to make sure that you’re safe.  They want to make sure that you don’t have a substance abuse problem.  They really take these criminal matters seriously.  It is better to report as required than to hope that they don’t find out because if they do, it could be worse.

  3. Nurses’ Salary Disparity

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    Every healthcare system I have driven by this week each had construction going on.  With nonprofit healthcare systems, they need to reinvest the profits back into the organization.  When healthcare systems say they do not have enough money to pay their nurses more, then why are they remodeling or growing their system?  Nurses are often hailed as the unsung heroes, the backbone of the system, the ones who provide compassionate care around the clock. We dedicate ourselves to healing, comfort, and support for those in need. Yet, despite our crucial role, there exists a glaring disparity in compensation between nurses and top executives, particularly CEOs, within the healthcare industry.

    As a fellow nurse, I understand the frustration and disillusionment that comes with this wage gap. It’s disheartening to see the stark difference between our salaries and those of corporate leaders, especially when we consider the only reason why patients are in the hospital is for nursing care.  

    Let’s delve into some numbers for context. On average, nurses earn a fraction of what healthcare CEOs take home. In the United States, the median annual salary for a registered nurse is around $75,000, whereas healthcare CEOs can rake in millions annually, sometimes even tens of millions, in salary, bonuses, and other perks. This stark contrast raises important questions about fairness, equity, and the value placed on different roles within the healthcare ecosystem.

    The work we do as nurses is not just physically demanding but emotionally taxing as well. We are on our feet for long hours, providing direct patient care, administering medications, advocating for our patients’ needs, and often serving as a source of comfort and support during difficult times. We juggle multiple responsibilities, often under intense pressure, all while striving to maintain the highest standards of care and professionalism.

    Meanwhile, healthcare CEOs undoubtedly have their own set of challenges and responsibilities. They oversee the strategic direction of healthcare organizations, navigate complex regulatory landscapes, manage budgets, and make critical decisions that impact the entire institution. However, it’s essential to acknowledge that their success is built upon the foundation laid by frontline healthcare workers like nurses. Without us, their lofty visions and strategic plans would be impossible to realize.

    So why the gaping chasm in compensation? Some argue that executive pay is justified by the level of responsibility and accountability they shoulder. While this may hold some truth, it does not negate the fact that nurses are equally accountable for the well-being and safety of patients. We are the ones who spend the most time at the bedside, monitoring vital signs, detecting subtle changes in patient condition, and intervening promptly to prevent adverse outcomes.

    Addressing the issue of salary disparity requires systemic changes at both institutional and societal levels. Healthcare organizations must prioritize fair and equitable compensation structures that reflect the value of all employees, from frontline workers to top executives. This may involve reevaluating executive compensation practices, implementing transparent salary scales, and ensuring that nurses receive competitive wages commensurate with their skills, experience, and contributions.

    Additionally, policymakers, advocacy groups, and the public at large must recognize the importance of investing in nursing workforce development, improving working conditions, and advocating for policies that promote pay equity and fairness across the healthcare sector.

    At a major teaching hospital, the CEO earns $529/hour making 14 times more the average salary of nurses.  

    Let us continue to champion our profession and advocate for the recognition and compensation we deserve. Together, we can work towards a future where the invaluable contributions of nurses are duly acknowledged, respected, and fairly compensated.

  4. The Path To Nurse Business Ownership

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    Years ago, I had a mentor that told the story of how she wanted to hike Machu Picchu over spring break.  She arrived in Peru and had to wait 3 days for her body to acclimate to the altitude.  Then the day of the hike came.  The guide shared the ins and outs of hiking the trail to the top.  A cold sweat broke out as she realized she was completely unprepared to do this.  I remember when I started my business, I felt completely unprepared.

    She had flown across the world to get to Peru so she was not going to quit.  Her guide said he helped hundreds of people climb Machu Picchu every day.  What my mentor realized is that the path has already been paved.  She just needed to follow her guide.  She did not need to blaze her own trail.  Just because business ownership may be new to you, it’s not new to everyone.  Just follow the path!

    1. Passion and Purpose: Every successful business starts with a spark – a passion, a purpose, a vision that ignites the soul. As a nurse, you possess a unique perspective shaped by your experiences, compassion, and dedication to patient care. Reflect on your passions, identify areas of need or opportunity in healthcare, and let your purpose guide you as you envision the business you were destined to create.
    2. Knowledge and Expertise: As a nurse, you bring a wealth of knowledge and expertise to the table – a foundation upon which your business will thrive. Take inventory of your skills, experience, and areas of specialization. Identify your strengths and weaknesses, and seek out opportunities for continuous learning and growth to expand your expertise and position yourself as a leader in your chosen niche.
    3. Market Research and Analysis: Before diving headfirst into entrepreneurship, it’s essential to conduct thorough market research and analysis. Take the time to understand your target market, assess competition, and identify unmet needs or gaps in the healthcare landscape. By gaining a deeper understanding of the market dynamics, you’ll be better equipped to develop a business model that resonates with your audience and stands out from the crowd.
    4. Strategic Planning and Execution: Building a successful business requires careful planning, strategic thinking, and relentless execution. Develop a clear business plan that outlines your goals, objectives, target market, value proposition, and revenue model. Set actionable milestones, create a timeline for implementation, and stay focused on executing your plan with precision and purpose.
    5. Networking and Collaboration: As you embark on your entrepreneurial journey, remember that you don’t have to go it alone. Leverage the power of networking and collaboration to forge meaningful connections, build partnerships, and access valuable resources and support. Surround yourself with mentors, advisors, and fellow entrepreneurs who can offer guidance, inspiration, and encouragement along the way.
    6. Adaptability and Resilience: Entrepreneurship is a journey filled with ups and downs, twists and turns, triumphs and setbacks. Embrace the inevitable challenges and setbacks as opportunities for growth and learning. Cultivate adaptability, resilience, and a mindset of perseverance as you navigate the ever-changing landscape of business ownership.
    7. Passion, Purpose, and Persistence: Above all else, remember the driving forces behind your entrepreneurial journey – your passion, your purpose, and your unwavering persistence. Stay true to your vision, remain committed to your goals, and never lose sight of the profound impact you aspire to make on healthcare and the lives of those you serve.

    Embark on Your Entrepreneurial Journey Today

    Nurses, the path to business ownership awaits – a journey filled with boundless potential, limitless possibilities, and unparalleled fulfillment. Embrace the challenge, seize the opportunity, and dare to dream of the extraordinary legacy you will leave behind. Together, let us pave the way for a brighter, bolder future in healthcare – one nurse-led business at a time.

    Would you like to hop on a call with me to chart the path for your nurse owned business?  CallWithLorie.com

     

  5. Nurses are Fed Up

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    Recently, eight nurses who were terminated from Saint Vincent Hospital in Worcester, Massachusetts filed a lawsuit for wrongful termination claiming the hospital retaliated against them for reporting unsafe conditions.  According to an article in MedPages Today, there have been over 600 official reports filed by nurses over the last six months regarding staffing shortages in this hospital.  Nurses are frustrated that sometimes there are only four nurses to handle 150 patients who are treated in the emergency room on one shift.  Patients are being left in urine and feces because they don’t have enough staff to clean them up.  One nurse was terminated for theft after receiving a suture for a lacerated finger which allowed her to continue to work and was terminated for using her cell phone.  A nurse was terminated for patient abandonment when she refused to take a fifth patient in a cardiac step-down unit.  

    This hospital is a union yet these things are still happening to the point where there were a number of complaints against this hospital.  The nurses are suing for retaliation of reporting unsafe conditions.  It is sad that these nurses were terminated just for doing their jobs, speaking up about the conditions and being patient advocates.  

    Studies have shown that when the patient outcomes are affected by the staff’s well-being when the staff is experiencing dissatisfaction or problems at home, patient outcomes are significantly affected.  I appreciate these nurses speaking up and trying to do the right thing to advocate for their patients.  It is unfortunate that it had to reach this point of a lawsuit to get the hospital to listen.

  6. The Pitfalls of Social Media

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    Nurses often find solace and connection in the communities we build. These communities extend beyond the walls of our hospitals and clinics, reaching into the vast expanse of social media platforms. While these platforms offer us opportunities to share our experiences, seek support, and celebrate our victories, they also present challenges that we, as nurses, must navigate with care and thoughtfulness.

    In the digital age, it’s all too easy to hit “post” without considering the implications of our words and actions. We’re accustomed to sharing snippets of our lives, from the heartwarming moments of patient recovery to the frustrating encounters with bureaucracy. Yet, in our eagerness to connect and communicate, we may inadvertently breach patient confidentiality, violate professional boundaries, or tarnish the reputation of our profession.

    One of the most pressing concerns in the realm of social media is patient privacy. As nurses, we are bound by ethical and legal obligations to protect the confidentiality of our patients. Each interaction, each diagnosis, each moment of care is sacred and must be treated with the utmost respect. Sharing identifiable information, even inadvertently, can have serious consequences not only for us but also for the individuals under our care. A seemingly harmless post can quickly snowball into a breach of trust and a violation of privacy laws.

    Furthermore, social media blurs the lines between our personal and professional lives, making it difficult to maintain appropriate boundaries. It’s tempting to turn to our online communities for advice or support when we’re grappling with the challenges of our profession. However, we must remember that what we share online can impact our relationships with colleagues, employers, and patients. Venting frustrations or airing grievances in a public forum can erode trust and undermine the integrity of our profession.  Potential employers will do their due diligence and review your social media before they hire you.

    Additionally, our online presence reflects not only on ourselves but also on the nursing profession as a whole. Each post, comment, or like contributes to the public’s perception of who we are and what we stand for. In a world where misinformation runs rampant, it’s more important than ever to uphold the values of integrity, compassion, and professionalism in everything we do, both online and offline.

    So, how can we navigate the complexities of social media while staying true to our values as nurses? It starts with mindfulness and self-awareness. Before hitting “post,” pause and reflect on the potential consequences of your words. Ask yourself: Does this respect patient privacy? Does this uphold professional boundaries? Does this reflect positively on the nursing profession?

    Furthermore, familiarize yourself with your organization’s social media policy and adhere to it diligently. Seek guidance from mentors or colleagues if you’re unsure about the appropriateness of a post. And above all, lead by example. Be a beacon of integrity and professionalism in the vast sea of social media, inspiring others to do the same.

    I have heard nurses eat their young on social media by cannibalizing another nurse. Always remember to be professional.

    In closing, let us remember that our words and actions have the power to shape the narrative of nursing in the digital age. Let us wield that power with wisdom, compassion, and respect. Together, we can build a stronger, more united nursing community—one that uplifts and empowers both its members and the patients we serve.

  7. Inadvertent Errors is one of the Leading Causes of Death in Hospitals

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    In the In the world of hospitals, where every beep and shuffle tells a story, there’s a tough truth that weighs on us nurses: 250,000 people die in hospitals every year because of mistakes. It’s a big number, but each one represents a real person with real dreams, loved ones, and stories.

    As nurses, we’re there in the thick of it all. We see the ups and downs, the hope and the heartache. We’re there to hold hands and offer comfort, but we’re also part of a system that sometimes fails people.

    It’s tough to hear that so many lives are lost because of mistakes. It’s like a heavy cloud hanging over our heads, making us wonder if we could have done more.

    But even in the face of such sadness, there’s hope. We nurses are like frontline soldiers fighting against these mistakes. We work hard to keep our patients safe, to learn from our mistakes, and to make things better.

    We need to talk about what goes wrong and figure out how to fix it. We need to make sure that patients and their families are part of the team, so they can help us catch mistakes before they happen.

    But most importantly, we need to remember why we became nurses in the first place. It’s not just about giving medicine or doing procedures. It’s about being there for people when they’re scared, in pain, or just need someone to listen.

    So, let’s keep doing our best, even when things get tough. Let’s honor the memories of those we’ve lost by working together to make things better. And let’s never forget that every life we touch is a chance to make a difference.

  8. The Silent Sacrifice: Is Your Job Killing You?

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    The commitment of healthcare providers to their patients is often unparalleled. They are the frontline warriors battling against diseases, injuries, and tragedies, striving to preserve life and alleviate suffering. However, amidst their noble dedication, a silent and somber reality persists: healthcare providers are sometimes compelled to sacrifice their own well-being, even their lives, due to a sense of loyalty or the absence of permission to leave their posts.

    This commitment is not merely a job requirement but a deeply ingrained ethos that drives healthcare providers to brave exhaustion, stress, and personal sacrifice for the sake of those under their care.

    However, within this noble pursuit of service lies a darker narrative. Many healthcare providers feel bound by a sense of loyalty to their patients and colleagues, even at the expense of their own well-being. They work extended shifts, forgo breaks, and ignore signs of burnout, driven by a deep-seated commitment to their profession and a desire to fulfill their duty to those in need.

    Tragically, this devotion sometimes leads to dire consequences. Instances abound of healthcare providers succumbing to exhaustion, stress-related illnesses, and, in the most heartbreaking cases, death. These individuals, who dedicated their lives to healing others, find themselves victims of a system that often fails to prioritize their own health and safety.

    One such heartbreaking story is that of Ashleigh Anderson, a CVS pharmacist who tragically lost her life due to the demands of her profession. Ashleigh’s story serves as a poignant reminder of the sacrifices made by healthcare providers every day. Despite facing immense challenges and personal struggles, Ashleigh remained dedicated to her patients, working tirelessly to ensure their well-being.

    Ashleigh was only 41 years old when she experienced chest pain at work.  No one was able to cover her if she left so she stayed and collapsed on the pharmacy floor and was unable to be resuscitated when help came.

    Ashleigh’s death has become a rallying cry for change within the healthcare industry. Her story highlights the urgent need for better support systems, increased awareness of mental health issues, and policies that prioritize the well-being of healthcare workers. As we mourn the loss of Ashleigh and others like her, we must also honor their memory by advocating for meaningful reform and ensuring that no healthcare provider feels compelled to sacrifice their own well-being for the sake of their patients.

    Moreover, in certain circumstances, healthcare providers may find themselves unable to leave their posts even when faced with imminent danger. During emergencies or disasters, when hospitals are inundated with patients and resources are stretched thin, providers may be prohibited from abandoning their duties, regardless of the risks involved. This lack of autonomy can leave them feeling trapped, and powerless to prioritize their own safety and well-being.

    The issue of healthcare providers dying on the job due to loyalty or the inability to leave speaks to broader systemic challenges within the healthcare industry. It highlights the need for better support systems, both for individual providers and the healthcare infrastructure as a whole. Adequate staffing levels, access to mental health resources, and policies that prioritize the well-being of healthcare workers are essential steps toward addressing this pressing issue.

    Furthermore, fostering a culture of empathy and compassion within healthcare institutions is crucial. Providers should feel empowered to prioritize self-care without fear of judgment or retribution. Organizations must recognize the humanity of their staff, acknowledging the sacrifices they make while ensuring they are not subjected to undue harm or exploitation.

    Ultimately, the stories of healthcare providers who sacrifice their lives in the line of duty serve as a sobering reminder of the profound dedication and resilience that characterize the profession. Their sacrifices should not be in vain but should inspire meaningful change within the healthcare system, ensuring that the well-being of providers is as valued and protected as that of the patients they serve. As we honor their memory, let us also commit ourselves to creating a healthcare environment that upholds the dignity and safety of all who dedicate their lives to healing others.

     

  9. How Indiana is Attracting More Nurses

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    With the continuing nursing shortage, it is estimated that one in four Hoosier nurses will be retiring by the end of the decade.  This is happening in all states.  Some states have chosen to provide $125 million to lure students into the profession.  Other states provide a living allowance alongside child care benefits.  

    House Bill 1259 was introduced in Indiana and it cleared the senate and then will be voted on by the house.  The previous law had a requirement that a nurse must have 18 months experience before they could mentor or teach other nurses. Shockingly, this language was removed.  The thought was that the facility is in a better position to judge whether someone is ready to precept without 18 months experience is really scary.  According to the only Nurse Practitioner in the Indiana legislature, a brand new nurse may not be ready to translate what they learned in the classroom into a real world scenario.  The other legislators felt that it is up to the facility to pick the right person for the right situation.  Obviously, they have never worked in healthcare.  

    The proposed legislation also discussed making it easier for foreign trained nurses.  The Indiana Healthcare Association which is the for profit nursing home association has concerns about the proposed federal legislation for mandatory minimum staffing in long term care facilities.  My position is if it is not legislated, the facilities will not do it.  Therefore, mandatory minimum staffing and a length of time to practice before you can teach or precept is important.

  10. The Success Principles Work for Everything

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    I want to share a very personal journey with you.  Eight years ago, I was planning to move to California.  I did not have a law or nursing license there so I decided to take the California Bar Exam.  I hired a coach and started studying.  I was relearning subjects I had not looked at in 25 years!  The California exam is all essay for attorneys and the pass rate was 32% at that time.  Yikes!  My coach kept saying “you can’t think like a lawyer to pass the bar.”  I wondered how else can I think, it’s only been 25 years.  I let the statistics and negative feedback get to me.  I thought all the studying was taking me away from my clients, so I quit.  I am not a quitter but I did. Was it really because of my clients?  No.  It was fear, plain old-fashioned fear because what if I failed?  I would be embarrassed and ashamed. I had already failed by quitting.

    However, last year my son passed the Indiana bar and we decided to study together to take the California Bar.  This time was different.  Why? Because of my mindset.  I did not let the low pass rate and negative feedback on my essays derail me.  I persevered.  Having a study buddy really helps! However, I realized that I still was not telling anyone for fear that I might fail.

    When you undertake a project (business), you have to be committed whatever it takes.  Commitment does not stick and life will get in the way (as it did 8 years ago).  Every minute you have to renew your commitment to do whatever it takes to help you win. 

    Next, you get to create your intention.  An intention is a predetermined outcome that will happen no matter what.  Even though I thought I wanted to take the bar 8 years ago, based on my results (quitting), my intention was really not to take the exam.  This time was different. My intention, which I reminded myself often, was to pass the California bar exam on the first try in February of 2024.  Your intention must be specific. If my intention was to just pass, it could have been on the 2nd or 3rd try.

    Lastly, intention plus action equals results.  I can’t just intend for something to happen, I had to do the work.  Your comfort zone will always pull you back in.  For me, I kept getting pulled back for my clients so I did not study as much as I would have liked.  

    When I pass, it was due to commitment, intention and hard work (study).  If for some reason I don’t pass, it was because I did not do whatever it takes.  In order for me to get a result, I had to get out of my comfort zone and face the fear and do it anyway.  

    This process has been a journey of self love and self care. I wanted to be my best for the exam so I have been losing weight and eating Keto to improve my brain function.  I also did neurofeedback to get all parts of my brain talking to each other.  It was easy to eat keto and do the neurofeedback but to get myself to sit down and study was another matter!

    Whether I pass or fail, I did it and it was an incredible journey!

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