Torn ACL or How things can change in a New York Minute. Take 2

Over two weeks ago I slipped while doing a lunge—part of my exercise program to stay strong and flexible now that I have reached my ninth decade. The following day at an Ortho Urgent Care, I found out that I had injured both my Anterior Cruciate Ligament (ACL) and my Medial Cruciate Ligament (MCL). Definitive diagnosis pending.

What follows is one of the many examples of having a mobility problem as an older woman.

One morning, a week ago, I fell out of bed. Well, I just slid out of bed as I attempted to wipe up water from the floor with a bath towel. I had spilled the water out of a bottle with a spout that could be closed just in case I tipped it over from the bedside table it wouldn’t spill. (that only works if I close the spout in the first place.)

I didn’t want to slip on a wet floor and harm my already injured left knee, so I called my husband to bring me a bath towel. Of course, my husband could’ve wiped up the spill, but I am always in a rush to get a job done. While I leaned over trying to soak up all the drops under the bed, I stretched out too far. I couldn’t pull myself back onto the bed. I had no choice but to slither to the floor taking care to keep my injured knee straight. There I was on my stomach. On the floor. Parallel to the bed. Face down. After I managed to roll over, my husband bent to pull me up. No way would I allow him to do so. He might damage his back, or worse. I lay for a few moments trying to figure out how to get up from the floor. Scenarios danced in my head: 911, fire department, neighbors, grandchildren, embarrassment. Finally, I bent my good knee, crawled over to the bed, and pulled myself up. Gazing at the ceiling, I felt lucky as an 80-year-old that I had the strength to wiggle out of a tight situation without injury to me or my husband.

Thank goodness feet first

Yesterday, I had an MRI and today I will see an orthopedic physician to find out the extent of the damage and, most important, what I will need to do to heal the injury. Will the exercises I have done (thanks to Dr. Google and YouTube) show an improvement to my knee? Now I only wear the leg brace and use a cane when I am outside. More recently, I have managed to climb up and down the stairs of our 2-story townhouse.

This injury is teaching me to listen to my body, find ways to keep up my strength and flexibility as I age, and to slow down to smell the flowers.  There are probably more lessons for me to learn as I move forward.

I can hardly wait.

Torn ACL or How things can change in a New York Minute.

So here I am, a new octogenarian who thinks she is still twenty (my birthday was May 3rd).

When I turned 80, I decided that I wanted to stay strong and flexible. Last Thursday, I was doing lunges while watching Grace and Frankie on TV. Grace and Frankie are my role models. Love ‘em and will miss them since this is their last session. I only allow myself one episode at a time.

I had great intentions that evening but didn’t do too well on the execution. While attempting a lunge, my left leg slid sideways which overextended my knee. I toppled backward on the carpet. The pain alerted me that I had caused a big problem. I immediately followed the RICE treatment: rest, ice, compression, and elevation. The next day, after an x-ray and physical manipulation of my knee, the Physician’s Assistant at an Ortho Urgent Care declared that I had a torn anterior cruciate ligament (ACL), a common injury of athletes and more common in women. I lumbered out of the Urgent Care wearing a hinged T scope knee brace and with future MRI and orthopedic physician appointments, and an acute awareness of my advancing age.

My husband and I had spent the middle two weeks in May at the North Carolina beach in celebration of my birthday. I walked twice a day: once with walking shoes on the streets behind our rental home and once on the beach, dipping my bare feet in the cool Atlantic waves as the tide flowed onto shore. I felt wonderful. Walking is my main exercise. It not only keeps me in shape, but clears my brain, letting the creative juices bubble up. This is why I prefer to walk alone—or with a non-communicative husband.

As I write this, it’s been almost 72 hours since my injury. I’ve discarded the ice and am now using a heating pad. My leg is elevated when I’m sitting. I walk with a walker and the knee brace. I borrowed a shower chair and cancelled my social engagements with friends for the next two weeks. My life has narrowed. However, I’m not deterred even if it takes a while to get back to my previous level of activity. Damn that New York minute.

We don’t give a rip what anybody thinks.

At the beach this week.

Rebologged from May 22, 2019.

I talked to my friend Lois the other day. She was telling me how she is orchestrating a skit for Talent Night at her church. “It’s silly,” she said. “It’s a skit that I have done years ago with my family.” 

What caught my attention was the fact that Lois is selling this idea to a group of similar older folks by asking, “Who can get down on their knees?” Only two out of 10 said they could get down on their knees (and, I suppose could get up again). Well, that was all Lois needed because the skit calls for two folks to be animals. She also told her church group that she is not telling them what the skit is about because they have to be “spontaneous.” On top of that, Lois is working on what the “Choir” will sing. I have the inside scoop that Lois is writing alternative rhymes to common ditties, such as Old MacDonald had a Farm.  

Now think about this, here is a group of elder church members who are willing to participate in a skit when they have no idea what it is about, agree to be spontaneous, get down on their knees in order to be animals, and sing farcical words to familiar melodies in front of the church congregation! 

Lois made the point that at a certain age it no longer bothers us old timers to join in comical entertainment. Why should we care how we are perceived at this late stage of our lives? 

So, when I read Tim Hoyt’s, latest story, Playing with Young Minds, under his weekday missive, Story with Morning Coffee, I thought of Lois and her giddy church group. Tim’s story is silly, too, but underneath the seemingly simplistic premise is a profound lesson about growing older.  

 

Stories for Morning Coffee and No Eggs

 

by Tim Hoyt

~Playing with Young Minds~

“Age is just a number.”  I hear that all the time, mostly from men and women who are doing pretty well in spite of knees that don’t think about running a mile any longer and chests that keep on pumping in and out figuring, with proper attitude, they’ve got plenty more good days.  

“Yeah, and it’s a big number,” I say back to anyone who implies that being eighty-six is anything like being forty-six.  Sometimes, I devise devilish mind experiments with them in giant glass test tubes.   

I understand attitude. Attitude is everything when you’re eighty-six.

I’m Samuel if you want to call me something.  Samuel Perkins.  There are a number of things I like about being old.  I like the respect I get from most young people.  They call me “sir.”  That’s kinda sweet.  In my twisted mind, which is short on synapses and long on memories, “sir” translates to “Yikes-a-geezer.”  But they mean well.  They offer to carry my groceries.  I let them sometimes. Occasionally, when one of their tribe is particularly obsequious, like they’re trying to earn a merit badge or something, I’ll hand them five dollars and say, “Here’s five dollars.  Go turn it into ten dollars.”  Everyone my age got that story beat into them in Sunday School. Youngsters under forty haven’t a clue.  But they leave me alone.  “Yikes-a-geezer” is in a foul mood today, they think, and they walk quickly away, probably rethinking the merit inherent in Social Security and Medicare programs.  

So, what do I want to happen today?  Today, being typical of most days.  I want most days to be atypical.  I want life to jump up and smack my behind and surprise the daylights out of me.  

This past Easter, Patrick, my buddy for so long, we forget how we met (not really – that’s just something we tell the Yikes-a-Geezer crowd) and I walked down Central Street holding hands.  Patrick wore his bunny suit.  He skipped and carried a basket of candy which he passed out to gawking little kids.  I was his handler. Patrick-the-Easter-Bunny, obviously, didn’t talk.   I would say, “Now, now, Easter Bunny, we must visit all the children before midnight.  Dad’s laughed.  Mothers just stared at us with pity.  Kids were delighted. 

Why on earth do we do things like this?  Because we don’t give a rip what anybody thinks.  That’s not entirely true, but it is pretty true.  Patrick and I made our marks.  Each of us got an education, made a good living, married, raised a family, paid the mortgage, volunteered for fund-raisers, and a lot more.  We contributed.

At eighty-four and eighty-six,  Patrick and I are secure in who we are.  The self-doubt boat docks in a younger neighborhood now.  

Now, we can be Easter Bunnies (I wore the suit last year). A few months ago, I was roaming through a re-sale store and spotted an old guitar missing some strings, and a damaged ukulele. Patrick and I put on a street concert.  Our sign said, “Lessons Available, Cheap.”  Such fun.  And no self-consciousness whatsoever.  That ship sailed long ago, too.

Patrick asked me if I would like join him and ride our bicycles in the Naked Pride Parade this year. He’s making that up and he knows I know he’s making it up, but I say, “Sure, what should I not wear?” 

Milestone Birthday

I celebrated my last milestone birthday ten years ago in Paris. I thought this current milestone would find me riding on an elephant like Gloria Steinem on her 80th. Instead, my husband and I will drive three hours to the North Carolina Coast and spend two weeks in an oceanfront rental on the beach. My immediate family: son and his significant other, daughter, her husband, and three grandsons (with or without their friends) will spend time with us as work and school allows. I won’t play host, cook communal meals, or direct social events.

Besides taking pleasure in my family’s company, I’ll take long walks on the beach, relish fresh fish dinners from nearby restaurants or cooked by volunteer family chefs, sit at the water’s edge reading or watch the sea gulls dive for fish.

In the evening, I shall sit on the open deck and count the stars while the ocean waves break on the shore.

I plan to bring my watercolors in case the mood moves me. Possibly, after my writing has lain fallow for the last few months, I might revisit my “second memoir.” Many memorable events, especially in my younger days, have taken place by the ocean. I’ll indulge myself with introspection by digging deep to uncover details of my past so I can smile, laugh, or perhaps cry.

While I’ll always have Paris, this milestone birthday celebration may prove to be more memorable.

Happy Birthday to me!

Nursing Blogs 2021 – #6 – Nursing Stories – Marianna Crane Profile

I am honored that my blog has won 6th place in the Top Nursing Blogs of 2021 sponsored by IntelyCare. This honor is an especially important recognition to me because the nursing community voted.

The prize is a feature profile on the IntelyCare Website. See below:

Marianna Crane is the author of Nursing Stories and the sixth place winner of our Top Nursing Blogs contest. She has been a nurse for over forty years and has practiced in a variety of settings including hospitals, clinics, home health, and hospice.

Marianna was one of the first people to become a gerontological nurse practitioner. Over the course her career, she developed a passion for home health care.

Marianna is retired from nursing. Her work is now focused on her writing, and her fellow nurses certainly benefit from and appreciate this gift!

Check out Marianna’s blog here and read on for a Q&A.

Maggie Kilgallon / Apr 11, 2022

Q&A

IntelyCare: What inspired you to start writing about nursing?

Marianna: “I have always wanted to be a writer. When I retired after a 40-year nursing career, I began to take writing more seriously. I attended writing classes, workshops, conferences, and joined a writing group. I write about what I know: nursing.

I started my blog, Nursingstories.org, in 2011 and eventually published a book, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, in 2018.”

IntelyCare: What inspires you to continue writing a blog?

Marianna: “I believe that nurses are generally reluctant to call attention to themselves. My blog shows what nurses really do and how they make a difference. Under the umbrella of ‘Olden Days of Nursing,’ I spotlight nurses in my cohort to document the evolution and history of the profession.

The COVID pandemic has opened doors for the public to watch nurses in action and appreciate the contribution they make to health care. This is an unprecedented moment for nurses to take advantage of their popularity and visibility. We see more articles in the media about nurses and nursing practice than ever before. Recently, I have been re-blogging timely facts I have found on the internet or in the news media about nursing that would be of interest to my readers.

I try to include other topics in my blog such as writing, growing older, and confronting ageism, and my love of food. Lately, however, because of all the recent rich material about nursing, my posts center around nursing issues.”

IntelyCare: What advice would you give to other nursing professionals looking to start a blog of their own?

Marianna: “I encourage nurses to start their own blogs and write about their nursing practice. There are many free websites available. The time is ripe to show the challenges the profession faces. The public has seen how much of a difference nurses make to the improvement of health in our communities. There are many changes needed to improve our health care system in general, and nursing practice, in particular. The attention the nursing profession has received of late will only promote better outcomes for our patients if nurses continue to promote themselves. A blog is one way to do so.”

Check out the full list of Top Nursing Blogs here!

Aborted Alphabet Challenge 2022

I had fun last year with the annual Blogging from A-to-Z April Challenge 2021, so I decided to enter again this year. My theme last year was Places I Have Been. This year I planned to blog about my three years in nursing school (1959 to 1962). This would also fall under the Olden Days of Nursing theme I sometimes blog about. I even bought an old Taber’s Cyclopedic Medical Dictionary just like the one I had used in nursing school. Hopefully, it would help me figure out what to write about if I got stuck at one of the letters—especially Z.

I was still working on a tentative list for the letters when I logged on to the 2022 web site to sign up. I had missed the theme deadline. Bummer.

But in order not to waste all my efforts, I want to share with you what I found for the letter Z.

Z  zoanthropy: Delusion that one is an animal. (Taber’s cyclopedic Medical Dictionary, Clarence Wilbur Taber, 11th Edition, 1969, page Z-1)

Okay, I’m reaching here. Who wouldn’t with the letter Z? I actually did have a patient who thought she was a cat. Not that I saw any evidence of this. She looked and acted perfectly normal.

Seton Institute, just outside of Baltimore on a bucolic campus, was a private psychiatric hospital run by the Sisters of Charity. Twelve of us students from St. Peter’s School of Nursing spent three months there in the 1960s. During the tour of the facility, I realized, as a seventeen-year-old, that bizarre-acting patients scared me—even the catatonic woman who didn’t move. Thankfully, our student role was to be recipient of knowledge rather than dispenser of therapy.

One of my memories revolves around two women patients not much older than I. One was recovering from post-partum depression and the other thought she was a cat. We three had more of a social relationship than the professional relationship that I should have promoted.

I took walks with them. I even short-sheeted the cat patient’s bed. The post-partum depressive patient told the cat patient that she must be liked when the “nurses short-sheeted your bed.” If she reported me, would I have been tossed out of school?

There were other nursing schools that sent their students to Seton Institute for psych experience. Not surprisingly, there were a lot of young men hanging about. I dated an enlisted Navy guy and a cadet from the U.S. Naval Academy.

Besides taking leisurely walks with my patients and short-sheeting their beds, learning to play bridge, and dating some interesting boys, I must have learned a bit about psychiatry because when I took the “comprehensive” tests in senior year in preparation for sitting for the State Nursing Boards to become a licensed registered nurse after we graduated, I received my highest score in psychiatry—in the 99th percentile.

I never wanted to work in psych. And in my long nursing career, I never did.

It’s not always better to be treated by a doctor than a nurse

Five Myths about Nursing

by Rebecca Simik

Washington Post

February 3, 2022

The pandemic has shined a spotlight on the critical role of nurses in hospitals — and the risks they routinely encounter while doing their jobs. The field of nursing, however, is still deeply misunderstood. This is perhaps no surprise: Nurses’ work is often undervalued compared with that of doctors, and almost 90 percent of the nursing workforce is women. Here are five common myths about the profession.

Myth No. 1

Nursing is lucrative.

Nursing is sometimes described as a lucrative career. Since the pandemic began, articles have highlighted the huge demand for these highly skilled professionals, as well as the particularly profitable career of travel nurses — who go wherever they’re needed, sometimes earning $5,000 a week, even more than doctors make.

The reality is that most registered nurses make a solidly middle-class salary. A 2020 report from the Bureau of Labor Statistics found that the median annual wage for registered nurses is $75,330 — respectable but not remarkably lucrative, particularly when many employers don’t give pay raises for additional certifications. According to ZipRecruiter, in some states, average salaries hover around $55,000.

Myth No. 2

Nursing is no longer a desirable job.

The great exodus of health-care workers is a pressing concern, two years into the coronavirus crisis. This is evident not just in the steady stream of news stories about fed-up nurses quitting on the spot, but also in viral Twitter videos like one from an ICU nurse who, in an explosion of angry sentiment, quit after 19 months of working in pandemic conditions.

In fact, interest in this career remains high. An NPR segment from October reported that some community college nursing programs have 800 applicants for only 50 openings. Research data from the American Association of Colleges of Nursing shows that 2020 enrollment in bachelor’s degree programs increased by nearly 6 percent, enrollment in master’s degree programs went up by 4 percent, and doctor of nursing practice programs saw their enrollments jump by almost 9 percent.

And according to the American Association of International Healthcare Recruitment, thousands of foreign nurses, ready to work, are awaiting U.S. visa approval.

Myth No. 3

It’s better to have a doctor treat you rather than a nurse.

It’s widely assumed that doctors are the best at all medical procedures, including starting IVs or drawing blood. This myth shows itself in medical TV dramas like “House”andGrey’s Anatomy” that almost exclusively portray doctors as the only members of a treatment team, or editorial cartoons questioning the merits of nurse practitioners. More recently, physician Sandra Lee, from the reality TV show “Dr. Pimple Popper,” received a lot of negative fallout over a tweet questioning why a WebMD article discussing sunburn vs. sun poisoning was written by a nurse instead of a dermatologist.

One reason this struck such a nerve is that a significant part of what nurses do, besides provide direct medical care, is educate patients and family members. Nurses advise parents on how to care for newborn babies who spent time in the neo-natal intensive care unit. Many procedures typically done by nurses — like placing urinary catheters or, in many states, removing sutures — haven’t been done by doctors since they were in medical school. Furthermore, a physician-run study published in the Lancet research journalfound that nurse practitioners performed as well as junior doctors on all procedures and tasks in their emergency department, except two — taking medical history and educating patients at discharge — on which the nurses performed better.

Myth No. 4

The pandemic has made nurses’ jobs dangerous.

Divisive politics have created increasingly risky situations, with health-care workers sometimes getting threats from those who oppose the coronavirus vaccines or want unproven medical treatments for their sick loved ones. This is reflected in headlines like “Health Workers Once Saluted as Heroes Now Get Threats” and “US hospitals tighten security as violence against staff surges during pandemic.”

The reality, however, is that these jobs were dangerous well before covid-19. Nurses and other health-care workers accounted for 73 percent of all injuries and illnesses resulting from nonfatal workplace violence in 2018, according to a BLS report. The Justice Department and the Occupational Safety and Health Administration have long reported that nurses and other bedside care providers, such as medical technicians and nursing assistants, are most at risk for an incident of workplace violence. The Washington Post’s Petula Dvorak in 2017 called nursing one of America’s most dangerous jobs and highlighted an emergency room nurse in Southbridge, Mass., who survived a vicious stabbing; a Massachusetts health-care safety bill was named after that nurse (the measure stalled in the legislature).

Beyond that, roughly 86 percent of registered nurses are female, and the field is still subject to over-sexualized stereotypes. Each Halloween brings a new wave of “naughty nurse” costumes; type “nurses” into the GIF search box of any messaging app, and you’re likely to find sexually suggestive images. Sandy Summers, a registered nurse, argues convincingly that these images fuse “caregiving with easy sex,” creating a dangerous atmosphere of disrespect. One research review found that 43 percent had reported experiencing some form of sexual harassment. Julia Lehman, an emergency department registered nurse, told me that sexual harassment is so common, she builds deflection statements into nurse trainings that she leads.

Myth No. 5

Nurses are superheroes.

Because of the nature of their jobs, nurses often perform remarkably well under stress. But this has turned into the harmful misconception that nurses are somehow superhuman in their resiliency. A contestant on CBS’s “Tough as Nails” cited being a nurse as a reason she should be successful in the show’s grueling competitions. Well-meaning posters, T-shirts and even art from the likes of Banksy depict medical workers in superhero masks and capes; Marvel Comics created “The Vitals,” a comic book featuring nurses in pandemic-related medical adventures. Research shows that the perception of toughness permeates the field.

The sober reality, however, is that living up to this superhero image is impossible — not unlike Luisa in the Disney movie “Encanto,” who is both heroically strong and tragically anxious. In a Washington Post-Kaiser Family Foundation survey last year, 62 percent of health workers said worry or stress related to covid-19 had a negative effect on their mental health.

A 2020 study from the University of California at San Diego established a higher rate of suicide in nurses compared with the general population, which led the school to develop a suicide prevention program specifically for those in health fields. This and other crisis interventions help considerably. Code Lavender, an alert system created in Hawaii and championed by the Cleveland Clinic, draws a rapid-response team of traditional and holistic practitioners to help hospital staff or patients within 30 minutes of a report of a particularly traumatic incident.

Five myths is a weekly feature challenging everything you think you know. You can check out previous myths, read more from Outlook, or follow our updates on Facebook and Twitter.

By Rebecca Simik

Rebecca Simik is a graduate student in the science writing program at Johns Hopkins University. She was a research associate at University of California, San Diego, for 20 years and managed both clinical psychiatry and neuroscience research groups focused on severe mental illness.

The Nurse Antigone

Re-Blogged

A dramatic reading of Sophocles’ Antigone to help frame powerful, guided discussions about challenges faced by nurses.

About this event

A groundbreaking project by and for nurses, The Nurse Antigone presents dramatic readings of Sophocles’ Antigone on Zoom—featuring professional actors and a chorus of frontline nurses—to help frame powerful, guided discussions about the unique challenges faced by nurses before, during, and after the COVID-19 pandemic. Antigone, an ancient play about a young woman who puts everything on the line to do what she believes is right, dramatizes the heavy cost of silencing and marginalizing caregivers, especially during times of crisis. By performing Sophocles’ play for diverse audiences, including nurses as well as concerned citizens, The Nurse Antigone aims to generate compassion, awareness, connection, and much-needed healing, while celebrating and advocating for nurses at this critical juncture in the history of their profession.

Co-presented by Theater of War Productions, the Johns Hopkins School of Nursing, the Johns Hopkins Berman Institute of Bioethics, and the Resilient Nurses Initiative – Maryland.

Supported by the Laurie M. Tisch Illumination Fund.

Support for our digital programming is provided, in part, by The Andrew W. Mellon Foundation.

Featuring performances by Margaret Atwood, Tracie Thoms (Rent), Taylor Schilling (Orange is the New Black), Ato Blankson-Wood (Detroit), Bill Camp (The Queen’s Gambit), Cherlaine Lasse (Registered Nurse, IV Therapy, Neonatal Intensive Care), Amy Smith (Nurse Practitioner, Northwell Health, Hofstra University), and New York City Public Advocate Jumaane Williams.

The Nurse Antigone will take place on Zoom Webinar and can be accessed on personal devices. The event Zoom link will be distributed via email and available to registered attendees starting 2 days prior to the event.

This event will be captioned in English.

All of Theater of War Productions‘ events follow the same format:

  • The performers will read the text.
  • Community panelists will kick off the discussion with their gut responses to what resonated with them across time
  • We will open the discussion to the audience, facilitated by Bryan Doerries. During the discussion, please raise your hand using the button at the bottom center of the screen. If called upon, you will be promoted to speak and you will be visible and heard by the entire audience for the duration of your comments. If you would prefer not to be seen, please disable your video.

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Date and time

Thu, March 17, 2022

5:00 PM – 7:00 PM EDT

Location

Online event

Theater of War Productions

Organizer of The Nurse Antigone

Research Supports Improving Nurse-to-Patient Ratios

Patricia Pittman, PhD, Director of Health Workforce Research Center at George Washington University, discusses the research behind improving nurse-to-patient staffing ratioson KUOW radio station.

Transcript here.

*************************************

A healthcare researcher weighs in on the nurse-to-patient ratio debate

KUOW is the Puget Sound region’s #1 radio station for news. Our independent, nonprofit newsroom produces award-winning stories, podcasts and events.

Feb 09, 2022 at 6:39 pm

By: Kim Malcolm

Washington state lawmakers are considering a new law that would set nurse-to-patient ratios at hospitals. A group of healthcare unions called Washington Safe + Healthy is pushing hard for the proposal. They say even before Covid, nurses had way too many patients, which was leading to burnout and poor outcomes for patients.

What’s the evidence that’s true? To find out, KUOW’s Kim Malcolm spoke with Patricia Pittman, a health policy researcher at George Washington University, and director of its Health Workforce Research Center. She was hired by the union group to analyze previous studies on healthcare staffing.

This interview has been edited for clarity.

Patricia Pittman: There have really been decades of research and hundreds of studies that have shown that low nurse-to-patient staffing ratios have a negative effect on patient outcomes. In particular, we know that patients die more frequently if there’s low nurse staffing. We also know that there are more hospital-acquired infections and other kinds of harms that can occur when patients are in the hospital if they’re not sufficiently staffed with nurses.

Kim Malcolm: Can you give us a concrete example of how not having enough nurses working on a particular shift could lead to a patient dying?

The primary mechanism here is what’s called “missed care,” where nurses are covering say six different patients, as opposed to four, and two patients are having a crisis at the same time. They may not be able to attend to that patient in a timely fashion, so care is missed. That may begin an infection, that may be actually sepsis when a patient is dying, and the nurse doesn’t get there in time to be able to rescue the patient. There are a variety of situations that can occur, but the main problem is that nurses can’t be everywhere at once, and that leads to missed care.

I understand you’ve also looked into how staffing ratios affect the nurses who are on the job. What did you find there?

There are a number of studies, at least six, that show that low nurse-to-patient ratios lead to low job satisfaction. A few studies started using the burnout measure as well. We know that higher burnout leads to turnover and the kind of crisis that we’re seeing in hospitals today where large numbers of nurses are leaving the bedside. We’ve also seen some research showing an increase in injuries to nurses themselves, in particular needlestick injuries, related to nurse staffing.

Does the research indicate anything on what staffing ratios mean for the economics of hospitals?

Actually, it does. There are at least three studies that suggest that increased nurse staffing may actually not only pay for itself but have significant benefits to payers and to patients in terms of reducing costs over time. It’s also a big question now as hospitals have had to rely increasingly on travel nurses, which are four or five times more expensive for the hospital than increasing the number of nurses that they directly hire.

The old equation of when it might make sense to use travel nurses versus increasing the number of budgeted positions, I think, is beginning to change. So hopefully, there are some hospitals beginning to see that this is potentially not entirely negative, or at all negative for them.

The Washington State Hospital Association is against this legislation. The association says we’re having a nursing shortage right now, and a law like this is not going to help solve that problem. What do you say to that?

Well, it might actually solve that problem. One of the reasons that nurses are leaving is precisely because they feel that they’re working in unsafe conditions, and that has everything to do with nurse staffing. The problem is, in the last 20 years, despite this massive evidence base, hospitals have really not been investing in nurses to the extent that is needed to improve health outcomes, and nurses under the current circumstances are fed up. I think if hospitals want to attract nurses back to the bedside, things are going to have to change.

Kim Malcolm

Afternoon News Host

Kim hosts KUOW’s All Things Considered. She joined KUOW as a newscaster and hosted KUOW’s Morning Edition for a time.

She previously worked at KERA in Dallas as a reporter, All Things Considered host, and occasional host of Think, KERA’s award-winning live interview and listener call-in program.

Kim got her start at the Canadian Broadcasting Corp.

Life Review?

Yesterday, I sat on the floor of my office skimming through one of my journals. The other 19 5-subject wide ruled notebooks with 200 sheets lay scattered on the floor around me. Okay, a couple were only 3-subject notebooks. The notebook on my lap spanned from May 2002 to May 2004. I had randomly pulled it from the heap. I didn’t intend to open it but when I did, I was back at the VA in Durham, North Carolina planning to retire early. My husband and I wanted to take a special vacation—Italy for five weeks—staying at a monastery in Venice and a villa in Tuscany. Would the VA give me the time off? Maybe it was best just to retire and enjoy this trip.

I began to journal in the ‘80s when my job proved so stressful that journaling seemed to help me cope. In the ‘90s I began to take myself seriously as a writer. Natalie Goldberg (Wild Mind) and Julia Cameron (The Artist’s Way) touted daily longhand writing to prime the creative pump. I never bought into daily journaling. Over the years there were large gaps between entries in my notebooks.

In the journal I wrote that I had given notice of retirement to the Chief Nurse. Then I wrote questions on the last page. Will we take the Italy trip? Will I continue to write? Tap into my creativity? See more of the grandkids? Finally, I asked: What will the future hold?

That was 18 years ago.

Yes, we did go on an unforgettable 5-week vacation to Italy staying at the Casa Vacanza Madonna delli’Orto in the Cannaregio neighborhood of Venice for a week and later, at the Villa Casa Pavon in Castigline d’Orcia in Tuscany. In a rented Ford station wagon we made day trips to Montalcino, Siena, Assisi and visited the dark, cool altars inside small chapels that dotted the winding roads, stopping along the way at local markets for groceries and wine.

I continued to write, eventually publishing a book about working as a NP in a clinic in Chicago. Most of the stories had already been documented in my journals. 

I took art classes in various media over the years.

Of course, I had discretionary time to enjoy the grandkids.

When I was done reading through the journal, the sun had set, and it was too late for my afternoon walk. However, I felt a sense of comfort in this reminiscent exercise. Or was it a nostalgia trip? Or, as Robert Butler first coined in 1963, did I experience a sort of life review?

Now as I am facing my upcoming 80th birthday, the last question on my journal page still remains: What will the future hold?  I can only hope life still holds many pleasant experiences.

And maybe a trip back to Italy.

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