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Making a Difference
Build a multimillion dollar deep sea oil rig and
not test the shut off system. Incredibly
dangerous and blatant negligence. Build a
multimillion dollar health care system and not
check to see if basic care is being
done…incredibly dangerous and blatant
negligence.

Hospitals have once again become dangerous
places to stay.  The last time humanity saw this
was in the 1800’s. Then, as now, infection is
one of the biggest culprits.  Then, as now, the
vector is the health care providers. Our health
care facilities are basically taking folk’s word
that the proper care is being given.  The
problems left to fix will not be shown by JACHO
type inspections.  After all, we have had them in
and out of our door for 80 years and very few
care givers would testify that things are getting
better.  Results can be measured, the number
of infections tracked, but how to find out who
was the employee that slipped up, darn near
impossible.   Well not impossible.  A secret
shopper system needs to be put in place.  
Nurses that know what proper care is need
quietly to be admitted to the hospitals as
patients so that the offending parties can be
identified, errors corrected, repeat offenders
fired, and standards met.  

How bad is it?  On a recent 24 hour admission,
a local nurse had several connections to her IV
Clave, none of the staff even attempted to wipe
off the device with an alcohol swab… knowing
she was a nurse!  The list of other errors fills a
typed page.  I know, because I typed it.  What to
do while this system is put into place?  Please
be your brother’s keeper.
                          CRITICAL DIFFERENCE INC.
  PROFESSIONAL FREEDOM THROUGH INDEPENDENCE
6/26/10   Issue LXIII 850-477-1234   Toll Free 866-CDI-NURSE
Debt Can Be Crushing.
It affects every aspect of your life.  Your sleep is haunted,
your phone possessed, your mail box seems to be a
collection of certified letters, not even junk mail.  Terms
like underwater mortgages have become the norm, and a
big part of the problem.  Most of us look to our equity as
our buffer in tight times.  Those days, and that equity is 5
years off.  
What to do meanwhile to keep the wolves from the door?  
First, set up a priority list.  Yes, you could live without that
latte.  But that is only going to save you a couple of
hundred a year compared to buying a car that sips gas
instead of the SUV, where thousands of dollars a year
could be saved.  Look hard at renting movies vs. being
enslaved by the cable bill.  Look again at your cell phone
bill.  Could you make some changes there?  There has
never been a better  time to quit smoking.  Talk to the
landlord to see if you can get a rent reduction.  The key is
to down size, not eliminate the things we hold dear.  Yes,
take the vacation, but to Disney, not to Paris.  
Work wisely.  It is a comfort to bring in more money …if
you don’t spend it.  Soon, even the extra shift a week will
get spent and you are toast. When you are tired, you are
more irritable, you are more likely to make a mistake and
much more likely to snap at someone (hopefully not a
patient).  You may well be working your way out the door.  
Need extra work that will refresh instead of kill?  Call
us.            
Making a Difference
You passed your boards, your license proves
it.   You work in Nursing, the lines on your face
reflect the years of concern. Ah, but are you a
professional or do you have a job (just over
broke).  
A professional requires of themselves a
different standard.  They believe that any task
can be improved. They know how, because
the Nursing Process became a mantra as they
went through school.
A professional nurse keeps up with her
education through the usual inservices,
seminars (yes, you must go) and by reading at
least one professional journal monthly, cover
to cover ( not just the articles that sound good
).  Nothing will gain you more respect in the
profession than knowing what you are talking
about.  
A professional nurse finds time to look at
issues that are before the public and it’s
government, she writes to her congressman
voicing her opinion on the topic. As I write, the
feds have announced that most of the oil from
the Deepwater Horizon disaster is gone!  Don’t
bet your food supply on it.
DISCHARGE  NOTE
According to the A.J.N.’s legal folks a patient isn’t
discharged until they have left the hospital.  Not just your
floor!  So take a moment and make sure someone brings
your patient out.  Otherwise, until they leave, you are still
responsible for that patient.
Ask And You Will Receive?
Beth Boynton, RN, MS, and author of "Confident Voices:
The Nurses' Guide to Improving Communication &
Creating Positive Workplaces" points out in her book that it
is healthy to ask for help. “So we have 100 things to do,
it's only humanly possible to do 80; it's not a healthy
situation in terms of us doing a good job and feeling good
about the job we do.”  She points out that if we start now
asking for help, then, and only then, does our supervisor
have an opportunity to see that something needs to be
done. Until the problems are brought to attention nothing
can or will be done about it.
CRITICAL DIFFERENCE INC®
PROFESIONAL FREEDOM THROUGH
INDEPENDENCE
9/25/10   Issue LXIIII  850-477-1234
A professional nurse is a teacher.  It is impossible to
properly prepare for a class and not learn something
yourself.
A professional has the ability to manage their finances,
time and family responsibilities to each others benefit. In
short, the professional nurse is shaping the future of
health care, themselves and their peers each and every
day.  It is impossible not to thrive working in such an
environment.  However, too many of us are immersed in
pools of folks that are working in jobs.   Make a
difference, join the profession.
If you see something being done wrong, stop what is
going on and correct it, yes, even if it is a physician or a
supervisor.  It only takes one person to stiffen the
resolve of others, let them know someone cares and is
watching out for the patients.  
Since the time of Dr. Semmelweis’s  first attempts at
infection control, the answer to the problem is our
willingness to tackle the problem.  We are the problem,
and we are the answer.
Making a Difference
The nurse’s eyes were as big as saucers and
her face bore the expression of a deer caught
in the headlights.  Somehow the nightly
anchorwoman had a microphone in her face
and the ABC camera trained on her.  The eyes
of thousands, maybe 10s of thousands were
watching.  What had she asked me? Oh Lord
help. Every journal she had read said nurses
were invisible to the press. What were they
doing at such a small conference? There it
was, and she had been asked a question,
“What is it that RNs do?”   How to answer that
question? It would take pages, and days, to go
over all the things we do.  She wants an
answer, but what to say… The RN is
responsible for the planning, implementation,
and review of the comprehensive patient care
plan, based on training, observation and the
interpretation of scientific information.   In a
blink of the camera’s eye the interview was
over, and she had done us all proud.
Whatever your definition of your role in
nursing, you should have an answer on the tip
of your tongue.  Please feel free to memorize
the one I was taught 33 years ago, or come up
with your own. We owe it to ourselves, and our
profession, that each and every one of us can
concisely answer the question under any
circumstance.
CRITICAL DIFFERENCE INC®
PROFESIONAL FREEDOM THROUGH
INDEPENDENCE
1/12/11   Issue LXV 850-477-1234
Use a Filter Needle                      Glass flakes have
led to the recall of Sandoz and Parenta brand
injectable methotrexate, a drug used to treat
rheumatoid arthritis, cancer, and psoriasis. The glass
flakes “are the result of delamination of the glass used
to manufacture the vials” of two dosages of the drug,
the FDA says in a news release. “There is the potential
to develop adverse reactions in areas where the
particles lodge,” the FDA says. “Injection of drug from
the affected lots could lead to serious adverse events,
resulting in disability and death. Additionally,
neurologic damage could result from intrathecal
[spinal] administration.”  Please, whenever you give an
IV med, use a filter needle.
Did You Forget The Time Out?              A new
study from Colorado shows surgery on the wrong
body part, or even the wrong patient, is still a
problem. Insurance records show that among some
27,000 adverse events reported by doctors, there
were 107 cases of procedures done on the wrong
part of a patient’s body and 25 done on the wrong
patient.“It is a major preventable problem,” said Dr.
Martin A. Makary, a surgeon at Johns Hopkins
University in Baltimore, who was not involved in the
study. He estimates about one in 75,000 operations
go wrong every year in the U.S. — sometimes with
fatal consequences, as in the case of one patient in
the new report who died following surgery on the
wrong lung. How can this happen, let the “time out”
slip, not pay attention, or not speak out if there is
something wrong.
CRITICAL DIFFERENCE INC®
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
4/2/11   Issue LXVI  850-477-1234
Making a Difference
“We have met the enemy” D. Akst Penguin Press, a recently
released book.  Tells us pretty much what we already know.  
We have met the enemy and it is us.  Our self control as a
nation has slipped away.  We can’t control our diets; we are
almost all overweight.  We have lost the ability to control our
spending.  Private credit card debt now hovers above $866
Billion!  Federal Reserve's G.19 report   We have lost
control of our time.  Today, the average American watches 6
hours 47 minutes of TV a day. We are loosing our balance,
our self discipline, and we and our patients are the worse for
it.  It is time each of us makes a stand in our own lives to
turn this thing around.  The author suggests making a “pre-
commitment”. If you know your downfall is sweets, don’t buy
them, don’t put yourself in a place you would order one… if
served, have it taken away.  Think now of what your
temptation is and look for ways ahead of time to actively
resist.  Get help, others are doing the same thing; snag
somebody to go this road of reform with you.  Do some
reading to see how others have tackled this problem in their
lives, try out a couple, make it work.  Without self control the
rest of your life is going to be a train wreck.  How can we
reject immediate comforts?  Today’s Wii’s, HD tv
programming, open credit cards and food products?  It won’t
be easy.  As daily each is being tweaked to become even
more tempting and expensive.  If we don’t get a handle on it
now, it will be tougher going forward.  It’s hard to gauge how
far off the rails we are and the tough work that needs to be
done to make the changes necessary, but it needs to be
done.  I know, because it says so on the last of the dozen
new apps that just downloaded.  Good Luck
168
The number of new nursing students about
to graduate from just one RN program in
town.  The total number that will be looking
for work is going to be amazing.  We need
them, our population is growing old…heck
we are growing old. The average age of a
nurse in our area is 47!  So we will need
replacement. Those of us left will need
young backs to help us. How to fit them in, if
the all the staff FTE’s are filled?  Move to 8
hour shifts. We moved to the 12 hour shifts
when the shortage began; if it returns, we
can always shift back. This would lower the
cost of nursing care (they get paid less than
you do) lower the amount of overtime (4-
eight hour shifts) and allow for them to get
trained up before we all head for what is left
of Social Security. This could be started in
Med/Surg to bring in the new grads and
then, as they finish their first year and  want
to move to specialty areas, look at opening
8 hour shifts there as well.  As the nursing
population ages, these long shifts become
increasingly dangerous for us older nurses.  
Cutting the shift’s hours will allow for fewer
workmen’s comp. injuries, higher rates of
retention of the more experienced nurse
and less staff turn over.  Not to mention
there will be someone to cover when you
are ready for vacation.
Newsletters from 6/10,9/10,1/11,4/11