Empowering Nurses at the Bedside and in Business

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

  1. Should Tipping be Allowed In Nursing?

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    I do home IV therapy which provides me nutrition and hydration.  I was surprised when I was asked to pay there was a spot to tip the nurse.  While the service was outstanding, I had never thought about tipping a professional. It’s like saying thanks doc for the appendectomy now here is a tip.

    As healthcare professionals, our primary duty is to ensure the well-being and comfort of our patients. Our work is driven by empathy, skill, and a commitment to the highest standards of care. However, amidst the daily challenges we face, the issue of compensation often comes to the forefront. While our salaries may be fair, some argue that the option to receive tips could provide additional financial support and recognition for our hard work.

    On one hand, proponents of allowing nurses to accept tips argue that it could be a tangible way for patients and their families to express gratitude for exceptional care. In many service industries, tipping is customary as a gesture of appreciation for outstanding service. Nurses, who often go above and beyond their call of duty, may benefit from such recognition, both financially and emotionally.

    Moreover, in a healthcare system where resources are often stretched thin, tipping could potentially supplement income and alleviate some of the financial strains that many nurses face. With rising living costs and stagnant wages, the idea of additional income is undoubtedly appealing to some.

    However, the concept of tipping in healthcare also raises significant ethical concerns. Nursing is a profession rooted in principles of altruism, integrity, and ethical conduct. Accepting tips could blur the lines between the altruistic nature of our work and the transactional dynamics of tipping.

    Furthermore, allowing tipping in healthcare may perpetuate disparities in care. Patients who can afford to tip may receive preferential treatment, potentially compromising the principles of fairness and equality that underpin our profession. Additionally, tipping could create an environment where nurses feel obligated to prioritize patients based on their tipping potential rather than the severity of their condition or medical need.

    In many healthcare settings, tipping policies are prohibited or discouraged to maintain professional boundaries and uphold the integrity of patient care. Instead, organizations may implement alternative methods of recognizing and rewarding exceptional performance, such as employee recognition programs, bonuses, or performance-based incentives.

    As nurses, our foremost priority is the well-being and dignity of our patients. While the idea of receiving tips may seem appealing on the surface, it’s crucial to consider the broader implications and ethical considerations that accompany such practices. Ultimately, our dedication to compassionate care and professional integrity should guide our decisions regarding compensation and recognition.

    With the changing role and increased opportunities for nurses to work independently, the laws which nurses must follow have not kept up with the changing times leaving us on our own to determine if we should accept tips.

    In conclusion, the debate over whether nurses should be allowed to accept tips is multifaceted and complex. While the intention behind tipping may be to express gratitude, it’s essential to critically evaluate the potential impact on patient care, professional ethics, and equity within the healthcare system.

    As we continue to navigate the evolving landscape of healthcare, let us uphold the principles of compassion, integrity, and excellence that define our profession.

     

  2. The Silent Epidemic: Understanding Medical Errors and Nursing Practice

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    Did you know that medical mistakes are one of the leading causes of death in this country.  It is estimated that 250,000 medical mistakes occur each year.  To put it into perspective, this figure surpasses the toll of many well-known diseases and conditions, highlighting the urgency of addressing this pervasive issue. The statistics paint a grim picture, revealing a silent epidemic that often goes unnoticed amidst the complexities of modern medicine. Among the healthcare professionals at the forefront of patient care, nurses play a pivotal role in addressing and mitigating the risks associated with medical errors.

    Medical errors encompass a wide spectrum of mistakes, ranging from misdiagnoses and medication errors to surgical complications and preventable infections. They can occur at any point along the continuum of care, from the initial assessment and diagnosis to treatment, monitoring, and follow-up. Factors contributing to medical errors are multifaceted and include system failures, communication breakdowns, human factors, and organizational culture.

    In the complex web of healthcare delivery, nurses serve as linchpins, bridging the gap between patients, providers, and healthcare systems. As frontline caregivers, nurses are uniquely positioned to detect, prevent, and mitigate the risks associated with medical errors. Their holistic perspective, clinical expertise, and unwavering commitment to patient advocacy make them indispensable allies in the pursuit of safe, high-quality care.

    Nursing practice intersects with various aspects of patient safety, offering numerous opportunities to identify and address potential vulnerabilities within the healthcare system. Through vigilant assessment and critical thinking, nurses can recognize early warning signs, anticipate complications, and intervene proactively to prevent adverse outcomes. By fostering open communication and interdisciplinary collaboration, nurses promote a culture of safety where concerns can be voiced, ideas shared, and solutions devised collectively.

    Medication management represents a key domain where nursing practice plays a crucial role in reducing the risk of errors. From medication reconciliation and administration to patient education and monitoring, nurses assume primary responsibility for ensuring the safe and effective use of medications. By adhering to established protocols, conducting thorough medication assessments, and advocating for medication safety practices, nurses help minimize the potential for adverse drug events and medication errors.

    Furthermore, nursing practice encompasses patient education and empowerment, empowering individuals to actively participate in their care and make informed decisions regarding their health. By providing clear, concise information about diagnoses, treatment options, and self-care strategies, nurses empower patients to become partners in the healthcare process, thereby reducing the likelihood of misunderstandings, non-adherence, and adverse events.

    Beyond the bedside, nurses also contribute to quality improvement initiatives aimed at enhancing patient safety and optimizing healthcare delivery. By participating in root cause analyses, incident reporting systems, and evidence-based practice initiatives, nurses help identify system weaknesses, implement corrective measures, and promote a culture of continuous learning and improvement.

    In conclusion, the staggering toll of medical errors underscores the critical importance of nursing practice in safeguarding patient safety and mitigating the risks associated with healthcare delivery. As advocates, educators, and leaders, nurses embody the core principles of patient-centered care, striving to uphold the highest standards of excellence and integrity in their practice. By embracing a culture of safety, collaboration, and continuous improvement, nurses can help turn the tide against medical errors, ensuring that every patient receives the safe, compassionate care they deserve.

    Together, as we confront the challenges of an ever-evolving healthcare landscape, let us reaffirm our commitment to patient safety and celebrate the invaluable contributions of nurses in shaping a healthier, safer future for all.

     

  3. Nurses Under Financial Stress

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    Recently, there have been 2 nurses on social media that discussed the financial difficulties.  One of the nurses lives in his van which he revamped to include a bed, micro kitchen, toilet and solar on the roof.  It is concerning that nurses have this level of stress when it comes to finances.  Nurses are the hardest working people on the planet and should be paid accordingly.

    There are practical steps you can take to navigate financial difficulties and regain a sense of stability. Here are some strategies to consider:

    1. Assess Your Financial Situation: Start by taking a close look at your income, expenses, and debts. Understand where your money is going each month and identify areas where you may be able to cut back or make adjustments.
    2. Create a Budget: Establishing a budget is crucial for managing your finances effectively. Allocate your income to cover essential expenses such as rent/mortgage, utilities, groceries, and transportation first. Then, prioritize debt repayment and savings goals. Be realistic about your spending habits and make sure your budget is sustainable in the long term.
    3. Explore Additional Income Opportunities: Consider seeking supplemental sources of income to supplement your nurse’s salary. This could involve picking up extra shifts, freelancing in your field, or exploring alternative career paths that align with your skills and interests. Just be mindful of maintaining a healthy work-life balance and avoiding burnout.
    4. Take Advantage of Benefits and Resources: Make sure you’re fully utilizing the benefits offered by your employer, such as health insurance, retirement plans, and employee assistance programs. Additionally, explore community resources and government assistance programs that may provide financial support or assistance with basic needs.
    5. Prioritize Financial Goals: Set achievable financial goals that align with your priorities and values. Whether it’s building an emergency fund, paying off debt, or saving for a major expense, having clear objectives can help you stay motivated and focused on improving your financial situation.
    6. Seek Financial Education and Support: Take advantage of financial literacy resources and educational opportunities to improve your understanding of personal finance. Consider attending workshops, reading books/articles, or seeking guidance from a financial advisor or counselor who can provide personalized advice and support.
    7. Practice Self-Care and Mindfulness: It’s important to prioritize self-care and mental well-being, especially during times of financial stress. Find healthy ways to cope with anxiety and overwhelm, such as practicing mindfulness, exercising, spending time with loved ones, or engaging in hobbies and activities that bring you joy and fulfillment.

    Remember, navigating financial challenges as a nurse requires patience, persistence, and resilience. By taking proactive steps to manage your finances and seeking support when needed, you can work towards achieving greater stability and peace of mind. You deserve to thrive both personally and professionally, and with determination and resourcefulness, you can overcome any obstacles that come your way.

     

  4. Be The CEO Of Your Business

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    When I first started my business, I could not afford to hire anyone to help with the administrative aspects of running a business.  Once I was able to grow, I hired part time assistants.  They would work for maybe a year to a year and a half and then they would move on.  This happened over and over and it was hard to find part time help.

    Almost 12 years ago, my part time assistant was going to start her clinicals in school and gave two weeks notice. In my solemn, I went to have breakfast at a place up the street.  I knew the server, Amanda because I ate there frequently.  Amanda took one look at me and asked “what’s wrong?”  I told her the situation and asked if she knew anyone. She said she was looking but wanted full time.  I looked at her and wondered how can this 18 year old help me and my LNC business.  Then I looked at all the tables she served.  Everyone looked happy with their order and their glasses were full.  I thought if she can manage this group of people, she could certainly help me manage my cases.  I had no idea how I would pay her.  I worried with paying her first, there may not be money left for me.  However, I spoke to my coach and she said if you have a part time mentality, you will have a part time business.  She also gave me the best advise ever.  She said make decisions from where you want to be, not where you are.  If you make decisions from where you are such as I can’t afford it, you will stay in the same place.  

    I took a chance on Amanda and it was the best decision I ever made.  I am thankful for her daily as we grew my business together.  So now, my motto is Be the CEO of your Business.  Now when I need to make decisions in my business, I ask what would a CEO like Jeff Bezos do?  When you make decisions as the CEO and focus on expansion, your business will grow.

  5. Substance Abuse and Impaired Nursing

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    I don’t think any nurse wakes up in the morning and says I want to do drugs or get drunk today.  I believe substance abuse is a disease.  The part of the brain affected creates such a craving that the person will lie or do things uncharacteristically to get their drug of choice.  Many nurses say “well I don’t use substances before I go to work or at work.”  Because substance abuse is a disease, if left untreated, it can get out of hand.  The Board does not know when you are using substances and it really does not matter.  The Board does not want a nurse to use controlled substances.

    Imagine a Norco is missing and a nurse has a prescription for Norco for chronic pain.  She is asked to take a drug screen and low and behold it is positive for opiates.  How does the employer or the Board for that matter know the medication was from your prescription?  

    You worked too hard for your license.  If you need help, most states have peer assistance programs.  However, when you go to one of these programs, watch what you are signing.  In Indiana, when you contact the program to get evaluated, they send you a bunch of consents.  One is to release information to the Attorney General’s Office and the other is to release information to the Board of Nursing.  Please do not sign these.  If something happens and you choose not to go into the program or are not compliant with the program, you just gave them permission to report you to the Board.  Check out your Employee Assistance Program (EAP) as help is available there too.  

    I am not sharing this to dissuade you from getting the help you need.  Just like any disease, substance abuse requires treatment and the sooner the better.  If left untreated, it can cost you your life.  

     

  6. Speaking Up as a Nurse Without Fear of Reprisal

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    As nurses, we feel like we have to do everything ourselves.  We are conditioned that if we ask for help, somehow, we are weak. We are also conditioned that if we speak up, we will get in trouble and some of us may not be conditioned but have a fear of speaking up.   

    In the dynamic and challenging world of healthcare, nurses play a crucial role in patient care. While our primary focus is on the well-being of their patients, there are instances where speaking up becomes essential for the betterment of the healthcare environment. However, the fear of retaliation or termination can be a significant barrier. Guidance on how nurses can effectively voice their concerns without jeopardizing their careers.

    1. Know Your Rights: Before taking any steps, it’s crucial to understand your rights as a nurse. Familiarize yourself with the policies and procedures of your healthcare institution regarding reporting concerns. This knowledge will empower you to navigate the process confidently.
    2. Choose the Right Time and Place: Timing is crucial when it comes to expressing concerns. Find an appropriate time and place to discuss your issues with the relevant individuals. It’s essential to ensure that the conversation won’t disrupt patient care and can be conducted in a private and confidential setting.
    3. Pick your Battles:  if what you want communicate is not going to serve a purpose, ask yourself is it worthwhile to share.
    4. Use Constructive Communication: When speaking up, focus on constructive communication. Clearly articulate your concerns, providing specific details and examples. Avoid accusatory language and instead emphasize your commitment to patient safety and the overall well-being of the healthcare team.
    5. Bring Solutions: don’t complain but give your suggestions for improvement.
    6. Document Everything: Keep a detailed record of the incidents or concerns you wish to address. Documenting dates, times, and specific details will not only strengthen your case but also serve as a reference in case of any disputes. Make sure to maintain confidentiality while documenting sensitive information.
    7. Engage in Open Dialogue: Encourage open dialogue by actively listening to the perspectives of others. Engage in a respectful conversation that fosters a collaborative approach to problem-solving. Being receptive to feedback and suggestions can contribute to a more positive resolution.
    8. Involve the Chain of Command: Follow the established chain of command within your healthcare institution. Start by addressing your concerns with your immediate supervisor or manager. If the issue persists, escalate it to higher levels of management, ensuring that you adhere to the proper reporting channels.
    9. Seek Support: Speaking up can be emotionally challenging, and it’s essential to seek support from colleagues, mentors, or professional organizations. Having a support system can provide guidance, reassurance, and validation of your concerns.
    10. Create a win-win:  Your solution should create a win-win for you and your healthcare institution.
    11. Familiarize Yourself with Whistleblower Protection Laws: Be aware of whistleblower protection laws that may apply in your jurisdiction. Understanding these laws can provide you with additional reassurance and protection as you navigate the process of raising concerns.

    Speaking up as a nurse is not only your right but also your responsibility to ensure the highest standards of patient care. By approaching the situation with professionalism, using constructive communication, and following established procedures, nurses can voice their concerns without fear of termination. It’s a collective effort to create a healthcare environment that prioritizes patient safety and the well-being of the entire healthcare team.

  7. Why Some Nurses Stay in a Toxic Work Environment

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    I hear from so many nurses that they are working short staffed and in dangerous conditions.  For example, some nurses are asked to falsify charting, others complain about how they are treated by administration and coworkers and there are many other troublesome situations.

    If you are working in a toxic work environment, please consider leaving.  As I often say, you can always get another job, but you can’t get another license. 

    Nurses stay in toxic environments because we are part of a very loyal profession. We truly care about our patients and want to make sure that our patients are cared for properly.

    In addition, nurses feel like the facility is already short-staffed and if they leave it will have even fewer nurses.  And who then will there be to take care of all the patients?  That is not the nurse’s concern.

    If you are in an unsafe situation or a toxic work environment, why would you want to stay?  

    As humans, we nurses are wired for consistency.  It’s sort of like a hamster on a running wheel.  We get out of bed at roughly the same time every day, we go through the same morning routine, we grab what we can for breakfast and off we go to work.  Afterwards, we come home, try to get a good night’s rest, and then repeat the entire drill starting the next day. 

    Now, let me recommend to you one of the best books I have read titled, Breaking the Habit of Being Yourself: How to Lose Your Mind and Create a New One by Dr. Joe Dispenza.  Dr. Dispenza talks about breaking the notion of being a hamster in a wheel and being very present in the moment of what is happening. 

    All we have is right now, we don’t have yesterday, and we don’t have tomorrow.  The only thing that is happening is at this very moment.  When you work in a toxic work environment, it really affects your self-esteem.  

    There are many reasons why nurses stay in toxic work environments one of which is because of limited job opportunities in the area.  However, you do have a choice; you can move to another area for employment or choose a longer commute.

    In addition, nurses are afraid of repercussions. They’re afraid that if they do find a new job they’ll be blacklisted in the community.  While blacklisting is not legal, it is something that is very difficult to prove.

    Nurses have amazing coping mechanisms to navigate stress and toxicity, but these coping strategies are actually only short-term solutions and should not be utilized for long term because when you are in a toxic work environment and stressed, it will affect your body and your well-being. 

    Should you choose to stay in a toxic work environment, know that your license can be at risk and that there really are better workplaces out there that can provide more supportive work environments where you can feel healthier, fulfilled, and have support of your coworkers.

  8. You Have A Right To Remain Silent

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    If someone wants to talk to you and calls your cell phone, you can ignore the phone call and send it to voicemail. If they want to talk in person, we don’t need to answer the door. However, when it comes to your employer, the police or an investigator, we feel obligated to talk.

    Just know, you have the right to remain silent. It is hard with your employer as they can fire you for not talking but I see it time and time again where nurses think they have not done anything wrong so they spill their guts trying to explain everything which invariably gets them into more trouble. What’s worse is when your employer wants to talk to you, they will not allow you to have an attorney present.

    According to the 5th Amendment of the Constitution of the United States, you have the right to remain silent to protect yourself from self-incrimination. You are not required to testify against yourself. But, as nurses, we forget we don’t have to talk or think that if we talk, they will believe us. You should always have an attorney present if you are asked to talk to the police, an investigator, or any governmental agent. Whatever you say can and will be used against you. Even the most innocent thing you say can be twisted against you and unfortunately, most nurses don’t see it coming.

    One nurse was accused of diversion and was asked to talk to the police. She went alone, unknowingly. The police officers were dressed like 21 Jump Street cops. They looked young, hip, and cool. The nurse shared everything and by the time she was done, the cops had their entire case against her videotaped and tied up in a neat bow. They did not have to pour through all the medical records to find what was ordered and what was given. I am all for honesty but there is no reason to make the police’s job easier.

    Other nurses talk to the Board investigators without counsel. One nurse even had insurance that would have paid an attorney to go with her. Don’t let this be you. Your life, livelihood, and career are too important. Get the counsel you need before you talk to anyone even if it is just to talk to your employer so you can be fully prepared.

  9. You Cannot Fail!

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    I often hear from nurses, “I’m really afraid that I’m going to fail in my business.”  But the truth be known that you cannot fail!.

    Failing is never starting or giving up just when they’re about to make it big.

    I believe there is no failing in business.  It’s all about learning opportunities and if you have a good business that solves a need, and you do the work, you cannot fail.

    I base everything around intention and intention is a predetermined outcome.  It’s going to happen no matter what.  You already know about intention because you had it to go to nursing school and pass the NCLEX.  You didn’t know what school you’d be attending.  You didn’t know what would be required of you, and you didn’t know what classes you needed to take. 

    But somehow with the help of advisors and mentors, you were able to get into nursing school, take the requisite classes and claim your goal by becoming a Registered Nurse.

    The only thing that might stop you from accomplishing this goal is if you were to quit or not even start.  That’s what it is.

    The only time you can fail in the business is if you don’t take any action to get the results you want, or you have a subconscious belief that is sabotaging you.  Those are the only two times that your intention will not work.

    Failure is not an option as long as you are committed no matter what to make your business succeed, and take the necessary actions every day to move your business forward. 

    Now that you know you cannot fail, and that any rocks that are in your path are just learning lessons and not necessarily obstacles.  The only way past the rocks is to go through them.  You can’t go above it, you can’t go over it, you can’t go around it; you’ve got to go through it!  But those rocks, use them as lessons learned to help you in the future.

     

  10. Criminal Matters Against EMTs

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    There have been two different notable criminal matters against EMTs.

    The first involved Elijah McClain of Colorado, a massage therapist who apparently was in the wrong place at the wrong time.  Police noticed he was listening to music on his headphones and thought he appeared suspicious and stopped him and used a control technique, kind of like a carotid hold that restricts blood flow to the brain rendering him unconscious.  Spock did just that in STAR TREK IV to end a punk’s boombox blasting music on a bus. Since this incident, the technique has been banned.

    Two paramedics showed up, one of whom gave Mr. McClain a powerful sedative called ketamine.  Though he weighed about 140 pounds, the dosage administered was for a man weighing 160 pounds.  By the time they arrived at the hospital, he was in cardiac arrest, and they were unable to resuscitate him.

    Police officer’s body cam footage showed what happened after which a grand jury indicted the three officers and the two paramedics with a subsequent trial yielding “guilty” verdicts for the entire quintet.

    The paramedics were subsequently found guilty of criminally negligent homicide and third-degree assault.  Their sentencing will be March 1, 2024.  EMT Jeremy Cooper could get 6 years in prison and fellow EMT Peter Cichuniec could get 16 years in prison.

    Additionally, Mr. McClain’s family sued the city for violation of his civil rights, to which the city settled for $15 million, the largest such award in Colorado history.

    From Illinois comes another case where 911 was called about a man acting confused and disoriented. He was an alcoholic who had no libations for the previous four days. 

    Upon arrival, the EMTs did not take steps to perform a clinical assessment or take vital signs while yelling and swearing, at one time saying, “I am seriously not in the mood for this dumb shit.”  The patient was slammed and strapped prone onto the cot and by the time they arrived at the hospital, he was no longer breathing, and resuscitation efforts failed.  Death was attributed to positional asphyxia.

    The EMTs were charged with first degree murder which will be difficult to prove because it requires intention. Their trial has not happened yet.

    I am not a fan of any health care provider being criminally charged, especially when they are acting within the course and scope of their job, yet here are EMTs shown on body cam footage speaking rudely and swearing at the patient.  This alone is not criminal but looks really bad.  Body cam footage does not lie.  We will see what happens in that trial.

     

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