Tuesday, February 28, 2017

Your Failure to Plan Doesn’t Constitute an Emergency On My Part: Mandatory Overtime

 When we think of mandatory – or forced – overtime, our minds might go back to the day before labor unions, when people in factories were steadily working hour after hour, day after day, in unsafe and unpleasant conditions. But mandatory overtime is not a thing of the past for some nurses in Canada. It’s a reality.
No one argues that units must be staffed – there must be a certain number of nurses to maintain a safe level of patient care. But what happens when there is no staff to cover the next shift?
At first, supervisors usually ask for volunteers who would like to work overtime. But what does the hospital do when no nurse steps forward? If they can’t call for outside help (private agencies), their only option may be to pressure nurses into working another shift or, to bluntly tell nurses that they must stay. This is mandatory overtime, although they may not use those words.
While the administrators are solving their staffing problems, they are causing a whole host of problems for their nurses who need or want to go home – they may have daycare issues, classes to attend, senior relatives to care for, important appointments to keep, or they may need to get some much needed sleep.
If nurses refuse to work overtime, they may be threatened with “abandoning their patients.” However, according to the Canadian Federation of Nurses in their position statement on mandatory overtime, this is not true. The union says, ”It is important [to know] that refusing duty to care is not [to be] confused with client abandonment, which occurs when a nurse leaves before the end of a scheduled shift, or being unavailable during a scheduled shift for a period of time that compromises patient/resident/client care.” So, by saying that you can’t/won’t work an extra shift, you cannot be told you are abandoning your patients. But that is on paper. Our conscience may say otherwise.
Research has shown that tired workers make more mistakes. Tired workers have more accidents going home. They are unhappier overall, and their health may suffer over the long-term. In fact, a 2015 review study, published in the Lancet, looked at people who consistently worked more than the usual 40-hour workweek. The researchers found several studies that concluded that these workers are at a higher risk of stroke.
This problem must be addressed, particularly as patients who are in the hospital are sicker than they ever were before. They need more eyes on them, more procedures done with them, and more split second decisions made. Their nurses must be on the ball and refreshed, not tired and frustrated because they are at work against their will.
The union’s position paper goes on to say, “With the exception of disaster situations, or emergency circumstances (where the Code of Ethics outlines the duty to provide care), nurses unions feel that there are no circumstances whereby employers should mandate employees to work overtime. Mismanagement of human resources and chronic unfilled vacancies do not constitute emergency conditions or grounds for ordering mandatory overtime. Additionally, the right to refuse duty to care may also be applied during an emergency situation when ability to provide safe care is compromised by unreasonable expectations, lack of resources or ongoing threats to personal well-being.”
In other words, your failure to plan ahead of time doesn’t constitute an emergency on my part.

What do you think hospitals should do if there is no one available when a nurse’s shift is over?

Friday, February 24, 2017

Do You Take Your New Prescriptions Right Away?

I came across an interesting, but not unsurprising press release this morning. It seems that a study done in Spain found that over 15% of patients who received a new prescription did not get it filled. The study, which was published in the British Journal of Clinical Pharmacology, found that initial medication non-adherence, or non-compliance, was 17.6%.

The most common medication prescriptions not filled were for a certain type of pain reliever (22.6%) and the least common was for ACE inhibitors, usually used to manage high blood pressure, hypertension (7.4%).

Understanding why someone doesn't fill or take a new prescription is important and it can have a substantial impact on a person's health. Do they not fill the prescription because they don't agree with the diagnosis? Can they not afford the medication? Do they plan to do so later but then get too busy or forget? Did someone talk them out of it?

The researchers did find that the patients who were most likely not to fill their prescriptions were:

  • Younger adults, 
  • Americans (the study was done in Spain), 
  • Having a psychological or psychiatric disorder, 
  • Having a pain disorder, or
  • Receiving treatment by a substitute/resident GP in a teaching center.

"We are especially concerned about the high rates of initial medication non-adherence in chronic treatments such as insulins, statins, or antidepressants and suspect that it is also related to an increase in costs, so we are designing an intervention targeting high risk patients," said Dr. Maria Rubio-Valera, senior author of the British Journal of Clinical Pharmacology study.

So what can we do to about this? Patients must take control of the conversation, no matter how hard
it might be. Patients need to ask their doctors why they are prescribing medications. If they don't understand the responses, the patients need to push for clarity. And if the patients feel they won't or don't want to take their medications, they have to relay this to their doctors so alternative treatments can be discussed. It's not a good idea to let the doctor believe you are going to be compliant if you don't plan on it.

And how can healthcare professionals help? Nurses, for example, are often in a good position to question why patients aren't taking their medications and to explain why the medications are necessary. Many times patients will tell nurses things that they would never discuss with their doctor. And doctors need to be aware, or more aware, of why their patients may be reluctant to fill that prescription. Taking a few minutes to explain why it's important and to actually ask if there are any concerns regarding the medication, the treatment overall, or even the cost, could make a big difference.

Monday, February 13, 2017

Facebook, Instagram, and Twitter – Nurses Beware?

Should nurses be using social media? Of course, there’s nothing to stop nurses from having social media accounts. These accounts allow them to chat with friends and family members, share photos, and learn about what’s new in the cyberworld. But when social media crosses over into the work and professional world, things can start to get murky.

© Gajus | Dreamstime.com - woman surfing internet

It’s reality – nurses share stories with each other. I don’t know many nurses who don’t swap some at-work tales about particularly memorable patients or situations. We usually are very mindful of not providing details or enough information that someone could be identified, but part of this peer-to-peer sharing can be helpful in allowing us to blow off steam, to get support, or even to learn things about how other nurses may have handled a particular situation. But speaking to one nurse in a social situation and telling a story online where hundreds of people could see it – or more if the story is spread by others – is a different situation. What may not be recognizable to a person in a one-on-one conversation, may be identifiable to someone in a much bigger crowd.

Some nurses have taken this storytelling a step further by taking photos at work and sharing them online. Taking photos and sharing them without the subject’s permission is almost always a no-no, but to do so in a healthcare environment? It seems surprising that any nurse would think that is ok to do. But it has happened. According to a Medscape article, a nurse in a trauma unit did just that.

We also have to think about ourselves, our privacy, and our safety. Unfortunately, not all the people we deal with at work are nice. While most of our patients, clients, and families are good people and wouldn’t want to harm us, there are always a few who are either very unhappy with the care they’ve received (or didn’t, depending on the situation) or are generally unhappy people overall. With it being so easy to track people down using the Internet, the risk of being found through social media by people who may want to cause problems is there.

It’s also possible for patients or families to investigate nurses by looking at their online profiles. If they find photos or comments that could be seen as unprofessional, this could cause conflict at work, and employers may see this as a breech of ethics.

We could argue that what we do on our own time, professional-looking or not, is our own business, but not everyone sees it that way. The Medscape article says: "We violate our patients' trust if there are pictures of us on Facebook behaving unprofessionally, making off-color remarks, or expressing certain opinions online. Patients do see these things, and some are actively looking for them. It's our professional obligation to behave in a certain manner."

Do you use social media? If you do, do you have rules about what you will post and what you won’t?

Wednesday, February 8, 2017

No Time to Exercise - Short Bursts of Activity Work Too

We hear it all the time when it comes to getting exercise: "Just get moving," or "take the stairs instead of the elevator or escalator," but do those short bursts of energy really make a difference in our overall fitness levels? For those who are used to seeing friends and colleagues going to the gym for hours on end or running long distances, a shorter time for exercise done at home (or at work) may seem too good to be true. But it's not, say many exercise gurus, including the author of the book One-Minute Workout and a new study published in the journal Medicine & Science in Sports & Exercise.

According to a press release issued today:

"Interval training offers a convenient way to fit exercise into your life, rather than having to structure your life around exercise," says Martin Gibala, a professor of kinesiology at McMaster and lead author on the study. "Stair climbing is a form of exercise anyone can do in their own home, after work or during the lunch hour," says "This research takes interval training out of the lab and makes it accessible to everyone."

The researchers performed a small 6-week study (31women) that evaluated two protocols. The women were sedentary before beginning the study. Sessions took place three times a week and took about 30 minutes total over the course of a week, 10 minutes per session for warm up, cool down, and recovery.

© Dirima | Dreamstime.com - Sporty woman running and climbing stairs
The first experiment had subjects performing three 20-second sessions of continuous stair climbing at maximum ability ("all-out") compared with subjects who exercised with the same intensity but on exercise bikes. In the second experiment, the participants vigorously climbed up and down one single flight of stairs for 60 seconds. According to the press release, both protocols increased the participants' cardiorespiratory fitness.  (Note: I was unable to find the study online so I can't be more specific with these findings). Considering how tiring it can be to climb stairs, this doesn't seem to be a stretch.

But not everyone has stairs at home, so if doing stairs isn't your thing, there are other options that may prove equally effective. A new iBook called How to Watch TV and Get Fit, 3 Minutes at a Time, by Debbie Rahman, presents you with a 12-week program that works on helping your cardio, strength, and balance. The book's website has a few sample 3 minute exercise videos (Disclosure: I recently met the art director of this project). Again, this approach may seem too good to be true, but if you're trying to squeeze some exercise into your life but something more structured isn't going to work, a program like this could be the answer.

So whichever approach you use, it's good to know that if you don't have the time or the desire to commit to joining a gym or taking part in lengthy time consuming exercise programs, there is still hope.