Thanks for being a nurse

Douglas Terrell  RN
CEO CDI
© Critical Difference Inc. 2013
2013 and 2/14 Newsletters
CRITICAL DIFFERENCE INC.
PROFESSIONAL FREEDOM THROUGH INDEPENDENCE
1/15/13  Issue LXXIII  850-477-1234  850-477-1234   Toll Free 866-CDI-NURSE
CRITICAL DIFFERENCE INC.
PROFESSIONAL FREEDOM THROUGH INDEPENDENCE
4/8/13   Issue LXX  850-477-1234  850-477-1234   Toll Free 866-CDI-NURSE
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Making a Difference
A neighbor discovers her popular fried chicken has started her kitchen afire.  Quickly answering the call for help are 2 neighbors
running as fast as their bulk would allow, each armed with a fire extinguisher, neither which worked!  Fortunately, the Fire Dept. was
not far behind.  It turns out there are 167,000 fire extinguishers that have been recalled by one company alone over the years and
most, if not all of us, don't know if we own one or more of them. http://www.cpsc.gov/cpscpub/prerel/prhtml09/09151.html
Recently, at our office, the fire department paid us a visit, a Lt. let's call him Lt. Bubba ...ok, that is his real name. He cited us for not
having an inspection tag on our extinguisher, “as required by NFPA regulations".  After hearing about the damage to my neighbors
house, and the recall info, I decided to replace our office extinguisher with a new shiny model.  Lt. Bubba returned telling Patsy our
CHD that we were going to get another citation, because we did not have an inspection tag on our new extinguisher.  If it is the law, it
is a foolish one, so I called the NFPA, who tells me that the rule the Lt. was referring to was a state requirement, not a NFPA
regulation.  Before we concluded the call he asked "did you fluff your extinguisher"? It turns out the powder in the extinguisher, like
corn flakes, settles with time and can become semisolid, not allowing the powder to be mobilized when needed.    So, for all of us not
acquainted with "Fluffing"…you invert the extinguisher and feel the powder flow to the top.  If it is still solid, tap the bottom with a
rubber mallet.  That afternoon when I got home I fluffed my extinguishers, three were solid and needed a tap to fluff, all were in the
garage and would have been the one to grab and run to the aide of a neighbor.  Got a moment? Get up, check the pressure on your
extinguisher, and fluff the thing, a neighbor may be depending on you.
Nurse Licensure Compact
For the 2 of you that are unfamiliar with the concept, the Nurse Licensure Compact
(NLC) is an agreement that makes your nursing license good in other compact
states.  Of course Florida is not a member of the compact, and it is time that
changed.  At present, there are 24 states in the compact, several other states are
considering joining and it is time Florida joins as well.  FNA, ANA and the Feds have
come out in favor of it.  As yet there is no pending legislation in FL to support,
according to www.ncsbn.org .  Keep your ear out though; this could be a good
thing.


Making a Difference
Sometimes in nursing you bury your mistakes, yesterday was one of those days.  Laura, a masters prepared elementary school teacher
from New York, my neighbor, loved an argument, especially if she got the Republican side of the "discussion". Unfortunately, when she told
me of her mammogram results she listened, but weighed the comforting words of her doctor and went with the lumpectomy route.   I
reviewed with her the information I remembered on the topic, but did not go back and write it out footnoting the information and copying
out the studies. Something I would do now without a second thought, so that others may weigh the strength of the argument, no matter
what my title.  
We lift the casket with ease, it feels uncomfortably empty, 12 years of chemo and pain had taken its toll.
The preacher struggles to find the words that will bring comfort to those few gathered, while trying to tie in an educational theme...he isn't
doing well.   I reflect on my past 36 years in nursing, while he meanders through every passage in the Bible that mentioned the word
teacher, and wonder how much suffering could have been avoided by knowing just a little bit more.  I come to the academic table a bit late
in life and like everything else it is no easier to do as we age.  But, the BSN went quickly and the idea for the Masters Capstone Project
sounds more and more plausible, but why so late in the game?  
I come up from my thoughts to hear the preacher say "so as a second grader he could not have been taught algebra, he was not ready...”
hey maybe that is it, maybe you have to be ready. Like every good teacher, Laura planned a lesson for a day she would be out. If you are
not sure about going back to school, give it a try, you may be amazed the difference that could be made, if we only knew a little bit more.     
Nurse Staffing
You dread to work short, things get patients feel like the staff is ignoring them, injury rates go up and no one is going to get out on time.  
Yet it happens all too frequently, at times because administration won’t let someone work overtime or let outside staff be called in.  A
game changer may have happened since we spoke last, Scompone v. Highland Park Care Center. The family sued and won in Pennsylvania
High Court, against the facility and the parent company, for “corporate negligence”  and makes both responsible if staffing is cut below
what is needed, according to Peter Giglione an attorney for the Scompone’s. Worried about staffing tomorrow?  You may not be the only
one.

UWF Nursing Assembly
Special thanks to all that made the assembly such a success.  This year brought together great topics, presentations and speakers, a
difficult task on such a budget.
CRITICAL DIFFERENCE INC®
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
8/1/13   Issue LXXV 850-477-1234
Making a Difference
Ok, ok, tell me if you heard this one before “A nurse walks into a patient’s room…”  If you have been a patient lately you realize this is not
funny. Though several people come and go from a patient's room, through the course of the day, only one will enter the room, scan it and
ask herself is this patient safe?  Has the patient’s color changed, is it the light in the room or does he look duskier than before.  Is the
oxygen flowing, is the meter hooked to oxygen or room air?  Are his vital signs changing because the cuff moved or do we have a problem.  
Is the call light close and plugged in the wall, in case he needs her?  Did they leave the bed too high when they brought him back from x-
ray?  Has the dressing started to cut off his circulation under that sheet? Is that the right medication hanging in the IV, is the battery
powering it about to run out of power.  Has the IV infiltrated, is that medication now destroying tissue in his arm?  Is there anything on the
floor to trip him up?  Are measures put in place to keep him from getting infected?  Is there fresh ice and water at the bedside with a clean
cup handy? She thinks to look at the monitor and is comforted that the patient’s pacemaker is still working properly.  A glance at the patient’
s urimeter shows that his kidneys are not working.  As she leaves the room, she scans again to convince herself that her patient is safe,
washes her hands and places a call to the doctor to request some medication to care for her patient’s fluid retention.  If a hospital needs
anything, it is those people asking are you safe. There needs to be enough of them to ask this question at your bedside every hour. It
doesn’t take long to crump, if you are lucky, you or a loved one will be able to raise someone on the call button, hopefully it won’t be a
construction worker.
     
Making a Difference
The impending nursing shortage….wait for it, wait for it, well where is it?  Florida, the state with the oldest population, both in nursing and as
patients, now has 17 percent of its nurses over the age of 65. In fact 40% of nurses were trained over 40 years ago!  They haven’t left nursing
despite every sinew in their bodies aching at the end of the day because of a love for the job, maybe, more likely, the economy.  (Schaffer,
2013)  Now as the economy reawakens it does not take a rocket scientist to figure out what is about to happen.  If we are planning on filling in
the ranks, by training new nurses we may be in for a surprise.  The impending retirements for instructors will dwarf the loss of nurses, with the
largest retirement wave coming in 2015(Siela, D. 2009). If nursing instructor pay was to come in line with need it will still take 8 years to train up
a new generation of professors.
On the patient side of the house, things are worse.  Increased baby boomer retirements are about to explode giving a generation without
insurance the ability to use Medicare. The Affordable Care Act is going to do the same for the preretirement crowd taking advantage of
supplemented (cheaper) Obama Care.  The results will be a rush to use social medicine, and a back log of patients seen only in places like
Canada and Europe.  So nursing is given a moment’s pause before the plunge. The implication would suggest we need to fill the hospital ranks
now with every RN we can get our hands on, switch to 8 hour shifts in Med/Surg to work these people in, as soon they will be gone, and with
them our hope of filling the hospital ranks
for years to come. A small investment in HR now, will have a return on investment that will benefit all for years to come.
Making a Difference
The new local study, looking at nurse’s attitudes in the Northwest FL area on returning to school shows.... well, we don’t want to go.  
Incentives answered are few, despite research that shows thousands of patients are being harmed or worse dying each year for the
lack of this training (Aikens,2012). Barriers to returning to school are familiar:
Lack of time, despite more nurses than expected working part time or not at all.  
Lack of money, though tuition reimbursement is paying more than the expense of going to school part time.
Inflexible work schedules, despite the advent of asynchronous BSN programs that let you finish assignments around your work
schedules.  
A feeling that there is little improved pay or treatment for going back to school, despite few nurses ever going into nursing for the
money, or for recognition (most of us never see an administrator in our work place anyway). The feeling one gets by being able to share
knowledge with a grateful coworker, is a feeling that is better by far, than hearing empty praise from administration.  
For nurses it has always been about the patient.  Listen to any of us talk and it is about what we learned about a process, a disease, or
a clinical problem.  Why is it then the idea of gaining more knowledge by going back to school draws so little interest?  It is a lot of work,
spread over a long time that makes it quite a commitment. But, we make commitments all the time; this is one we can take a break from
if it is too much.  For those that start a class, 74% finish, so it cannot be that bad, and I can tell you, it isn’t (The Chronicle of Higher
Education, 2004).  Nationally only 17% of nurses will ever return to school, the survey shows that same number here.  If you want to
distinguish yourselves, save lives, stamp out disease, please consider trying one class and see how it goes.  You do make a difference,
and with a little work you can change your life and those around you forever.  
   
712,000
The number of new nursing jobs expected to be created between 2010 and 2020. (Bureau of Labor and Statistics 2012)

495,500
The number of nursing jobs that will be vacated by retiring nurses between 2010 and 2020. (Bureau of Labor and Statistics 2012
CRITICAL DIFFERENCE INC®
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
12/12/13   Issue LXVI
Worse Than Fast Food!
According to the Mexican Congress of Cardiology the only thing worse than fast food is Mexican Food.  Mexico has witnessed a 9.5% increase in
cardiovascular mortality in the past year alone. Now what to do with all my coupons?

Just a Little Nuts
A study in the New England Journal of Medicine this month points out that just an ounce of tree nuts per day can lower your weight and cut
mortality from all causes by 20%.
Is it worth dying for?
The use of tobacco, obesity, lack of physical activity and poor diet, are reported in a WHO Immanent Global Disaster Report as the cause
of about half the cancer deaths in the United States and Western Europe.  To get a feel on how many die for these indiscretions world
wide each year is difficult. But, in the time you spent reading the newsletter 400 more people will have died.  If you want to make an
impact in your work, set the example and remind your patients that smoking and obesity are sure paths to destruction
.   
CRITICAL DIFFERENCE INC®
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
2/14/14 Issue LXXVII
Newsletters from 6-11 to 12-11