Action needed to support retention of nursing staff in Wales

Wales staffing act must be extended to all settings where NHS Wales commissions or provides nursing care.

National action across Wales needs to be taken to support the retention of nursing staff, so safe nurse staffing levels can be achieved, the RCN has said.

The comments were made as RCN Wales launched a new report that provides detail on the progress made by health boards on nurse staffing in the past 18 months.

The RCN says that overall, the Nurse Staffing Levels (Wales) Act 2016 has changed NHS culture in Wales for the better. Significant investment has already been made to increase the numbers of nursing staff in wards covered by the act. In addition, nurse leadership has been strengthened and safe nurse staffing levels are being discussed at board level.

Helen Whyley, Director RCN Wales, has challenged the Welsh Government to work with the RCN to develop a national retention strategy for nursing that includes flexible working and career opportunities, as well as improved access to continuing professional development, as part of their ‘Healthier Wales’ programme.  

She added: “NHS Wales has more to do to support the retention of nursing staff in a strategic and meaningful way. This action is needed now to achieve the implementation of safe nurse staffing levels in every setting to protect patient care.”

There are more than 1,500 nursing vacancies in the NHS in Wales alone and the care home sector is also struggling - for registered nurses and health care support workers.

What are some important things to know as a cardiac nurse?

Things to know:

1. Cardiac rhythms
2. ACLS/BLS
3. Cardiac meds and diuretics
4. Cardiac muscle structure and function
5. Understand, I mean really understand all forms of MI and stroke. 
6. Labs associated with the above
7. Understand hypertension and meds
8. Understand how diuretics influence kidney and cardiovascular function
9. Understand anticoagulant function and associated labs and the physical manifestations of bleeding
10. Know the code cart like the back of your hand.  Know how to use the equipment
11. Understand and know how to physically use various oxygen delivery systems such as BiPAP and CPAP and non-rebreather masks
12. Get very good at placing large-bore IVs
13. Understand pacemakers and their associated influences on EKG rhythms and what it looks like when they aren't working
14. Recognize the various lung sounds and their clinical significance.  Particularly, fluid overload.
15. Understand COPD and interventions
16. Have strong general nursing skills as all the body systems are connected and can influence the heart.
17. Understand ABGs

- Frank

What are some societal problems in nursing?

Safe staffing is a big political issue among nurses just now. Depending on state laws and the institution in question, some employers can require nurses to work overtime on short notice, or to take patient loads that they see as unsafe. I’ve also worked for some employers who subtly encouraged nurses to violate labor laws, e.g. to get to work early, take reports on patients and “get themselves organized” before punching in.

Any job with as many variables as nursing is inevitably going to be difficult at times: we all are familiar with having to work late when an emergency derails our routine; we’re all used to being called and asked to pick up more hours; we’re sometimes called on to work shorthanded. The problem arises when short staffing is the norm rather than the exception.

There have been many studies on this issue. Although results have been varied, the general consensus is that, all other things being equal, a higher nurse-to-patient ratio does result is fewer patient complications, and lower mortality rates.

What is a certified nurse-midwife?

A nurse-midwife becomes an RN first and then goes to school to be a midwife for another 2 yrs. So she has a master in midwifery. She is a CNM and can prescribe medications and do hospital births. Rarely does a CNM do home births.

A direct-entry midwife goes straight into midwifery school for 2 yrs, pass a national exam and do about 3–5 yrs of internship She is a Certified professional midwife, usually with a state license. “ CPM”. CPM’s do mostly home or birth center births. Generally, she can’t do hospital births and have only a few medications they can use, taking only low-risk clients.

Then there are “traditional” midwives that are not licensed, have no requirements for schooling, usually trained by apprenticeship only. In some states this is legal and other states a traditional midwife is illegal.

Do you think people in comas can hear

Yes. I, too, had a tough time accepting that comatose patients can hear us because, like many others, I was fooled by movies into believing that coma = a state of being sort of dead.

But then, in the first year, just before allowing us to start clinical rotations at the hospital, the school gave an instructional class on bedside manners and etiquette.

It was stressed, over and over, that we must greet the patients, introduce ourselves, and give them an overview of what it is that we’d be doing next.

For example, ‘Good Morning, Mr. Potter! I’m Shreya, your respiratory therapist for today. I’ll take a quick listen to your lungs and then draw a bit of blood to see where we stand on that oxygen this morning. I’ll talk you through it, okay? Let’s get started’

It was emphasized that the etiquette remains the same across all patients — conscious or unconscious, sedated or comatose.

Why? you may ask. Precisely because several comatose patients have been reported to be able to hear us and hence, as a general rule, all of them deserve to be forewarned about any poking and prodding they’d be a recipient to.

The guest lecturer, a Physician himself, continued to share a related incident to drive his point home.

He told us that once, while in the room of a comatose patient, he let his usual ‘serious doctor’ guard down while writing new orders to tell his colleague that he couldn’t find his wallet anywhere. He was upset because he thought he’d lost it and replacing all the cards in the wallet was going to be a lot of work.

He had since forgotten all about the conversation.

A few weeks later, while in the company of the same patient, who had now woken up from the deep slumber, he was asked this —

Refer: Shreya Thacker

As a surgical nurse, what's the weirdest thing you've seen

It’s difficult to say which is the weirdest as you see a lot of odd things! There was a Vicar with a potato lodged in his bottom, a teenage boy with a glass tomato sauce bottle stuck on his penis (which he had tried to smash off with a hammer), an elderly gentleman with an umbrella handle stuck in his bottom… the best bit is the stories of how said items became stuck!

The strangest thing I’ve seen was a well educated business woman who was absolutely convinced that she needed her ovary removed, despite the fact that there was nothing wrong with it (she had CT scans, Ultrasound scans, x-rays, blood tests). She was adamant, she screamed and shouted and had about 5 diffferent medical opinions. Threatened to sue the hospital if else didn’t comply… being the NHS we are not prone to giving patients surgery just because they want it. She refused to have a Psyciatric evaluation and discharged herself-to find a hospital that would comply with her request.

Can a midwife become a gynecologist

You would need to apply to medical school then to an Ob-gyn residency. I have met a few nurses that have done just that, RN to MD but not from CNM to MD.

But if you want to do surgery than that is the way to go.

The midwives that were in my practice did a lot of office gyn (Well Woman Care) but had no interest in surgery.

If you are already a midwife why would you want to spend 8 more years relearning many of the things you already know?

 Refer: Claudio Delise