April 26, 2004
I was a bit late in reading the article on
the IOM report on the work environment of nurses
(“In
Good Hands,” Feb. 2). I have
difficulty believing their recommendation for
research on development and testing of methods
to fight fatigue or compensate for it. Why not
start out by limiting shifts to eight hours
with reasonable meal breaks? I know some nurses
want the 12-hour shifts because of time off,
but consider how long UPS, for example, allows
employees to sort packages.
It seems like, in nursing, we are always doing
a study and making recommendations that those
in the positions to enact them disregard.
I was sorting through and discarding old nursing
journals when my attention was caught by an
article titled “Nursing Shortage, circa
1915” [King, MG. J Nurs Scholarsh. 1989;
21(3)]. King cited papers by Mary Adelaide Nutting
and Isabel Stewart on the shortage of students
who, at that time, staffed the hospitals. Her
conclusion was “They could not shorten
the work hours if the hospital administrators
did not approve. ... Nursing’s early professional
reform movement did not address the power imbalance
within the organizational structure of the hospital
that was, and is, a critical factor in recurring
nursing shortages.”
Whether it is 1915, 1989, or 2004, if nurses
do not have strong representation in the power
structure of the hospital organization, they
will not have safe staffing levels, input on
scheduling, a voice in how care is to be carried
out, and work environments in which to promote
the highest possible levels of patient safety.
I don’t think it is so much a matter
of needing research to strengthen work environments
as it is having the organizational power to
apply what is known.
ROSALEE YEAWORTH,
RN, PhD
Omaha, Neb.
The argument is not whether specialty hospitals
siphon revenue away from the financing of unprofitable
medical services of general hospitals (“Chic
Boutiques,” April 12). They
do. The argument is whether this is OK.
The reason specialty hospitals are “safer”
is not because of more focused care. The reason
is that the criteria for admission include low-risk
patients (high volume + quick turnover = greater
return on investment). By extension, the “safer”
a specialty hospital is by dumping its riskier
patients on the community hospital, the “more
dangerous” the community hospital becomes.
I doubt that the wonderful staffing ratios
cited are the norm rather than the exception.
They aren’t here. That kind of staffing
would cut into the corporate and physician-owners’
profits.
CHARLES GREGORY,
RN
Albuquerque, N.M.
I would ask you to modify your report on hand
contamination and ring wearing (“The
Risk of Rings,” April 9,
online) to include all nurses and nursing assistants,
not just RNs. Speaking as a dedicated nurse
for more than 25 years now, I personally and
professionally object to nurses wearing rings
and having long fingernails, as well as having
long hair flowing down over their shoulders
(and in patients’ faces).
During my training, we were disallowed such
selfish behavior. It seems to me that most nurses
these days do not put the welfare of their patients
ahead of their own vanity. Pretty selfish when
you are dealing with people who are ill and
do not need risk of infection from their caretakers
by ring and fingernail scratches.
With the demise of white uniforms, caps, and
white shoes, I have seen nurses who walk around
in the hospital and doctors’ offices with
dirty, unpressed uniforms and dirty shoes. Most
people I meet complain about not being able
to recognize who the nurses are anymore. I am,
and always will be, proud to be a well-groomed
nurse in a white uniform.
My patients and their family members frequently
express their appreciation for this and make
comparisons to other nurses on the floor. Professional
appearance instills a sense of confidence in
the patient for the quality of care they are
receiving.
Perhaps the national Centers for Disease Control
and Prevention can someday soon make a small
improvement in this situation. It is sad that
most nurses don’t care enough about their
patients and their own professionalism to do
it voluntarily.
BARBARA PARKER, LPN
2
Ocala, Fla.
I feel compelled to reply to this article (“Filling
Stations,” March 11, online).
I am a retired RN — just a registered
“professional” nurse — previously
licensed in New York state and then in California.
I graduated from a diploma school of nursing,
and later in my career I taught med/surg in
the same school.
I took liberal arts classes at a local university
while teaching in order to satisfy National
League for Nursing requirements for certification.
I participated in establishing goals and objectives,
in addition to helping to develop curricula
and clinical experience objectives. I recall
that only three to four of my students, out
of about 60 to 70, did not pass the state boards
the first time. I worked very hard and was proud
of my students, many of whom proceeded to obtain
their BSNs.
I’m telling you this because about seven
years ago, that school was closed due to financial
constraints, as were many other diploma schools.
Diploma schools definitely filled a need then,
and I believe that they could now.
At our hospital here, we have some “old
time” diploma grads and RNs with BSNs.
They are working side by side and all are providing
excellence in patient care.
We also provide clinical experience for a local
college of nursing, which is turning away students
for lack of faculty.
My school was St. James Mercy Hospital School
of Nursing in Hornell, N.Y. “My”
hospital here in Oregon is Three Rivers Community
Hospital in Grants Pass. I am so proud to be
affiliated with both.
Hospital-based programs should be reinstated,
along with college-provided programs. Let’s
get politics out of nursing.
MARYJANE ARMSTRONG,
RN (RETIRED)
Grants Pass, Ore.
