Hello Nurse Alliance Sisters and Brothers,

What a busy time!

This RoundUp attempts to take a crack at the multiple items we're all juggling. The exciting challenge for me is choosing from the massive amount of material that is important to share. Thankfully, I get great feedback from folks and even submissions that are timely and perfect!

The Nurse Alliance Coordinator, Jen Stange, submitted a piece about the Affordable Care Act; SEIU Industrial Hygienist/HazMat Project Coordinator, Mark Catlin, sent in an important piece about HazMat labeling; and we were given permission to run a full blog post a doctor wrote urging people to celebrate Nurses Week every week of the year!

This issue also includes a study that links staffing issues, burnout, and stress that is both valid and informational. I would love your thoughts on this after you read it: Richard.Negri@NurseAlliance.org

We're also discussing an editorial that appeared in the Los Angeles Times that touches on California's Napa State Hospital's bright idea of rolling out an alarm system attached to lanyards -- one of which was used to strangle a worker just days after the system debuted. SEIU has been fighting this for at least a year.

Aside from all that, I'd like to add that one of the most powerful actions we can take as online union activists is to think of other SEIU nurses who should be getting the RoundUp sent directly to them.  To take that action, click here.

Study: Nurse Staffing, Burnout, and Hospital-Acquired Infection

A study published in the American Journal of Infection Control(AJIC) this month brings added validity to an issue SEIU nurses have spoken up about for years: inadequate nurse staffing and autonomy lead to increased spreading of infection in the hospitals and facilities where we work. SEIU nurses support research and hard evidence proving we are the greatest barrier to infection for our patients, and the reverse is true where we do not have enough nurse staffing.

Equally important, the study provides “plausible explanation[s]” that connects nurse staffing, job burnout, and a slack care environment as the real culprits to hospital-acquired infections.

We have our work cut out for us! We need to push for organizational changes at our facilities so that we have a culture of education, intervention, performance feedback, and strategies to reduce nurse burnout. In doing this, we would end up with strategies to assist in helping control infections at our facilities.

It may seem like a no-brainer, right? We know that insurance providers nationwide frequently deny payment for costs associated with facility-acquired infections – and that the costs are astronomical. In working with our employers to implement ways to improve staffing, reduce burnout and fatigue, it would not only cost a whole lot less – it would keep the nurses safe from burnout and in turn safeguard our patients and communities that deserve the best quality care we can provide.

Bill Borwegen, SEIU Health and Safety Director says, "This latest study is just the most recent linking patient outcomes to a better 'environment of care' for nurses and their patients.  Healthcare associated infections (HAIs) infect 1.7 million and kill nearly 100,000 patients each year according to the CDC.  If higher staffing levels could prevent even a small percentage of these cases, patient lives and healthcare dollars can be saved.  Other recent studies have linked lower nurse staffing levels to higher patient death rates and higher rates of accidental preventable needlestick injuries. “

Please take a moment to learn about the study and its findings. If you can, send over your thoughts about the issues and invite your colleagues to do the same.

Caring for America

By National Nurse Alliance Coordinator Jen Stange

As SEIU nurses, the heart of your work is Caring for America—regardless of your practice setting or specialty.  And, you know that the healthcare law helps patients get healthy and stay healthy.

Did you see these recent posts on seiu.org’s blog by SEIU nurses? Read what they have to say about the Affordable Care Act’s focus on preventive care:

“…One of my sister’s college friends…delayed seeking care because she had no health insurance. When she finally went in to see someone it was discovered that she had stage four breast cancer…with preventive care this young woman and all young women like her could have lived long, happy, healthy lives.”

Norlissa Cooper, RN and member of SEIU Local 1021, celebrates the law’s emphasis on preventive care in this blog post.

“In 38 years I’ve delivered a lot of babies, and with the Affordable Care Act, mothers and babies are getting the care they need to start off life with the best possible odds. At the White House townhall today, I was surrounded by citizens, practitioners and champions of the healthcare law like HHS Secretary Sebelius....  Millions of women have access to free preventive care.”

Bonnie Chappell, RN and member of SEIU Healthcare 1199NW, writes about the free preventive care now available to women in this blog post.

There’s no doubt that the Affordable Care Act’s preventive care benefits will help RNs focus on wellness rather than sickness.

What’s your favorite aspect of the healthcare law? Its emphasis on preventive care? Allowing young adults to stay on their parent’s plan until age 26? No longer permitting insurance companies from denying care due to pre-existing conditions? Closing the prescription drug “donut hole” for Medicare beneficiaries? Share what you like about the Affordable Care Act on the Nurse Alliance’s Facebook timeline!

Uniform Hazardous Materials Labeling and Safety Data Sheets Coming To Your Facility

By Mark Catlin, SEIU Industrial Hygienist/HazMat Project Coordinator

Frustrated by the hazard labels on containers of disinfectants, cleaners, and other hazardous materials used in your workplace? Would you rather have a root canal than read a Material Safety Data Sheet (MSDS)? Well some changes announced by Federal OSHA might brighten your day.

Last Spring, OSHA revised its Hazard Communication Standard (HazCom) for all workplaces, including healthcare. HazCom is the OSHA regulation that defines the minimum requirements your employer and chemical manufacturers must follow for hazard labels, MSDSs, and other elements of informing workers about chemical hazards in their workplaces.

Unions asked for uniform formats for labels and MSDSs during the fight to get OSHA to pass HazCom. But OSHA, then, decided to allow manufacturers and employers to use whatever format they wanted. HazCom has been in effect since about 1986 after a ten year fight by unions to gain the "right to know" about chemical hazards for workers in the U.S. Before this, workers had no legal right to find out what they were being exposed to on the job. OSHA made this recent change to bring our HazCom requirements in line with international standards. The changes you and most workers will see at your facility will be in uniform labels and Safety Data Sheets (SDSs):

Training: By December 1, 2013, your employer must have trained all employees on the new label elements and SDS format. Labels: As of June 1, 2015, all labels will be required to have pictograms, a signal word, hazard and precautionary statements, the product identifier, and supplier identification. Safety Data Sheets: As of June 1, 2015, new Safety Data Sheets (SDSs) (formerly known as Material Safety Data Sheets or MSDSs) must be in a uniform format with 16 specific sections, ensuring consistency in presentation of important information.

For more on these coming changes, go to the OSHA HazCom website.

Safety At Mental Hospitals

This Los Angeles Times editorial has the subtitle, "Staff must be protected from violence without compromising the humane treatment of patients."

Then the second paragraph highlights some facts behind the heinous attacks many of us have witnessed or endured while on the job. "Patient assaults against staff and other patients in total doubled at Metropolitan State Hospital from 2006 to the end of 2011. At Napa, they tripled between 2008 and 2010, declining only after [Donna] Gross' death led to a prohibition on patients walking the grounds themselves."

Following Donna's untimely and entirely preventable death, SEIU members have held numerous discussions with Napa State Hospital to look into safety measures to prevent another senseless murder. The facility's response and new focus was on alarm systems the workers would wear around their necks. One nurse leader from Local 1000 said that since May of last year we'd been telling them that a lanyard around the neck would be just another tool for violent patients to take advantage of. The facility moved on anyway.

Earlier this month, Napa rolled out the new lanyards holding the alarm system...and a worker was strangled with one the very next day.  Thoughts on this?

Why Every Week Should Be Nurse Appreciation Week

By Dr. Secemsky, posted originally at the Huffington Post on 8/20/2012. This is being reprinted in full with permission from Dr. Secemsky.

Earlier this May, nurses around the country were acknowledged on a countrywide scale for their hard work and dedication to patient care during National NursesWeek(May 6 - May 12). Unfortunately, as with most national appreciation days that I cannot personally be recognized for, I failed to take much notice.

Now that new doctors around the country, including myself, are in the process of growing into our roles as team-based health care providers (see earlier article for more on this), we are in the unique position of working extremely closely with nurses on the hospital floors.

From this first-hand observation, I found it amazing what these individuals can accomplish. Below is my attempt of characterizing only a few of the many hats that nurses wear on a typical day in the hospital.

Caretaker

As a physician, part of the daily grind involves visiting each patient on my service a few times a day to conduct physical examinations and discuss treatment goals. Much of the rest of the workday takes place away from the patient room: coordinating care, writing orders, and developing short and long-term treatment plans. In an admittedly self-absorbed fashion, I rarely take the time to acknowledge how much patient care is accomplished without my presence at the bedside. And much of this care can be directly attributed to the nursing staff.

Take the ostensibly-effortless activity of dispensing medical regimens as a case in point.

Many hospitalized patients require more than a dozen different daily medications that are to be administrated at various hours and in multiple ways (I'll leave these different routes to your imagination). Although physicians have the responsibility to put in orders and ensure that their patients receive the appropriate daily medication throughout their hospital stay, it is the nurses that actively dispense the medication, often to multiple patients throughout the day.

It makes me winded just thinking about it.

As if this wasn't enough to push nurses into continual overtime, it amazes me how much nursing care is required to keep patients from experiencing hospital-acquired adverse events.

There are dangers in having patients remain in bed for extended periods of time (veins clot, pressure ulcers form, muscles weaken) and someone needs to prevent them from occurring. Although certain preventive medications help reduce these conditions, it is the nurses on duty who routinely check patients for any signs of such de-conditioning.

Adding these instances to the plethora of other nursing care responsibilities (ensuring adequate nutrition and hygiene, preparing patient for admission and discharge, etc.), it is remarkable to think that patient care encompasses only one facet of a career in nursing.

Educator

Any person can become a patient, but only those who have been previously hospitalized know what to expect when being admitted to a medical center. As mentioned in previous articles, a few-day stretch in a hospital room is no five star hotel stay. There is a unique schedule of events surrounding a hospitalized patient's care that is entirely different from an otherwise normal day outside of the medical floors. Consequently, someone is required to educate the patient on what to expect while in the hospital. And that someone is often the nurse on duty.

As much time and effort that may take, especially in the setting of multiple patients, a nurse's role as an educator does not stop there.

Consider myself along with the cluster of 10,000-plus newly-hatched doctors swarming medical centers across the country this summer. Who plays the major role as the bedside teacher of patient safety, the invaluable sage of the local electronic medical record system and the go-to personage for tips regarding the behavioral quirks of patients on the medicine floors?

You guessed it.

A quick side note to medical students and fresh interns: The more respectful and friendly you are to the nurses on your medical team, the easier your professional life will become. Fact.

Health Care Provider

There is no question that nurses have their hands full with the many implied responsibilities they take on when signing up for this career in health care. It is of my opinion that out of all of these functions, the most trying duty of a nurse is assuming the role of a front-line health care provider.

Let me break this down for you with a brief case.

A 65-year-old man with a history of high cholesterol, high blood pressure, and with recent episodes of intermittent chest pain is admitted to the hospital. On the morning of his second day of admission, the patient begins to feel chest pressure, pain in his left arm, sweatiness, and nausea. He calls out for help.

Who do you think is first at the bedside?

One might assume it is the patient's doctor who whimsically appears out of thin air to start up the necessary diagnostics and treatment for this concerning clinical presentation. Indeed, it is the patient's nurse who has the immediate responsibility of identifying the classic signs of this patient's heart attack and initiating life-saving medical care.

(Of note, I've based the above scenario on a real patient's experience, and I have no doubt that the nurse on duty that day saved his life.)

Take Home Point

Throughout history, the culture of medicine has revered the role of a physician as the core to patient care and medical recovery. Yet in my personal work experience, absolutely no care would be delivered without the critical role of a nurse.

So whether you are a doctor or a patient, a friend or casual acquaintance, the next time you run into nurses that you know who are just getting off of a 12-hour shift, buy them a drink. More likely than not, their workday was unrelenting and they are apt to need one.

And who knows, you might need them someday.

Do you want to send a note to Dr. Secemsky about his article? Please do so. I will forward them to him after a week or so of them coming in so that he is not overloaded with email. Send them to me at Richard.Negri@nursealliance.org.

Thank you, as always, for giving me the opportunity to share some news and views of our work world by way of the RoundUp. Until next time, please send me ideas for the next issues. If not sooner, I will hope to see you on our Nurse Alliance Facebook page: https://www.facebook.com/NurseAlliance.