Empowerment starts here
I'm writing in response to "Encouraging Clinical Nurse Empowerment" by Daniel Linnen, MS, BSN, RN, and Adam Rowley, BSN, RN, in the February issue. As an RN in management and a previous chairperson of my unit-based council, I feel that there's a need to strengthen our unit-based councils and conduct more research that can help define what it means to have strong shared governance. This can give us insight into how we can help our clinical nurses to be more empowered.
Clinical nurses absolutely need to encompass nurse empowerment into their practice not only for the well-being of their patients, but also for the well-being of the organization in which they work. Your article clearly defines the cost associated with nurse turnover related to burnout. Yes, everything comes down to the dollar. With that aside, for nurses to be empowered, they have to embrace what it means to be empowered. Nurses need to be given opportunities to provide feedback on how to prevent falls or on how auditing the stroke charts is done to have the ability to embrace their worth and power in making these decisions. Shared governance is a wonderful venue to make these things happen. This is a cornerstone of how to make nurse empowerment happen.
Nurse leadership needs to make sure that the unit-based councils are strong and that they've been given the necessary education on how to make this valued tool successful for their unit-based council chairperson to lead the way. Since the 1990s, little research has been done on shared governance. Magnet(R) facilities strive to empower their nurses, and it has been implied in the literature that this can be done through shared governance. As nurse leaders, how do we verify that our shared governance councils are good enough to empower our nurses? Obviously, more research is needed, followed by actions or interventions to increase the strength of shared governance.
As leaders of hospital-based nurses, we definitely need to help our staff members be empowered in their practice. Magnet recognition has set a high standard, and most facilities want to develop this culture to empower their staff. There's plenty of research to verify this outcome. However, effective and powerful shared governance doesn't just happen. It's a process that needs to be looked at to strengthen its goals and educate the clinical staff on how to make it a worthwhile opportunity to strengthen a nurse's feeling of empowerment. The leader of shared governance needs to know its true abilities and expound upon that to better any organization, and then empowerment of nurses will truly happen.
U.S. flu shots: Arguing for choice
I'm an RN with 16 years' of experience. I, like so many others, have heard the debate and arguments for and against influenza vaccines, as well as the discussions around making such vaccines mandatory not only for healthcare providers, but also the general public at large. I, for one, wholeheartedly disagree with any approach that makes influenza vaccinations for any or all groups mandatory. The letter in the November 2013 issue entitled "Thumbs Up for Flu Shots" in response to the article "Mandatory Influenza Vaccination: Is It Part of the Answer?" by Kristin K. Vondrak, DNP, ARNP-BC, NE, CPHQ; Patricia Starling, BSN, RN, CIC; and Jessica de Guzman, RN MAN, NE-BC (August 2013) is typical of the style of rhetoric that I often hear coming from managers and administrators.
Often, the policy is that anyone not receiving a vaccine must at least wear a mask to help prevent the spread of the flu. Yet, it's still possible to contract the flu even after the vaccine is received. Moreover, the virus is shed from the infected person 24 to 48 hours before showing symptoms. So, I ask you, why aren't hospitals and healthcare organizations pushing for everyone to wear a mask as another line of defense along with good hand-washing technique? Are they simply not aware of this? Or is the wearing of a mask intended to be a visible stigma and a daily annoyance to healthcare workers to shame them into capitulating to receive the vaccine?
The CDC has on its website a 30-year compilation of statistics gathered from the 1976 to 1977 flu season to the 2006 to 2007 season. The data show the estimated number of annual influenza-associated deaths with underlying pneumonia and influenza causes from season to season, as well as the estimated number of annual influenza-associated deaths with underlying respiratory and circulatory causes. The tables also show the major strains of the virus identified each year.
The data show that the influenza-associated deaths with underlying pneumonia and influenza causes had a maximum number of fatalities of 14,715, a minimum number of fatalities of 961, and an average of 6,309 fatalities each flu season. For the estimated number of annual influenza-associated deaths with underlying respiratory and circulatory causes, it was a maximum number of fatalities of 48,614, a minimum of fatalities of 3,349, and an average of 23,607 fatalities each flu season. Taking the two maximum estimates together (both of the maximum estimates fall in the 2003 to 2004 season), the total is 63,329 deaths. A very large number, until you compare it with the population of the United States at that time-292.81 million. That works out to be 0.021% of the overall population in 2004 dying from influenza complications.
The pharmaceutical companies are paid billions of dollars in contracts to provide the vaccine, which isn't completely effective and has to be renewed every year. On the CDC website, the effectiveness of last season's (2012 to 2013) flu vaccine is listed as 56%. Let me state this again: last year's vaccine was only 56% effective. Why are we paying billions of dollars to pharmaceutical companies for a faulty product that only works about 50% of the time? The staggeringly low percentage of the overall U.S. population that dies from influenza complications wouldn't appear to justify such a cost.
As far as hospitalizations go, there's a separate article on the CDC website that states an estimated 200,000 people were hospitalized each year between the years 1979 and 2001 due to the flu. This number appears to be unwavering from year to year regardless of the effectiveness of the flu vaccine, the number of people vaccinated, or the dominant strains of the virus. One conclusion to draw from these numbers is that it doesn't matter if you're vaccinated or not, the numbers will stay roughly the same.
If the healthcare industry and its managers and administrators are so passionate regarding flu vaccines, why not turn that passion to smoking cessation? The CDC website lists smoking as the leading preventable cause of death in the United States. It causes an estimated 443,000 deaths annually. The maximum associated deaths due to influenza are only 14.7% of this number. Depending on the source found, the annual cost of treating smoking-related illnesses and diseases varies widely, but it's always in the multiple billions of dollars range. Where's the passion to make it mandatory that healthcare workers are forbidden to smoke? It would promote the health of the workforce, increase productivity, and cut down on lost working hours and sick time taken due to smoking-related illnesses and complications. And it would set a great example for the public at large.
The answer opens up a huge can of worms because the discussion would then wander into the murky swamp of individual rights-the real specter that hospitals and pharmaceutical companies want to avoid. Although I agree that being vaccinated against diseases such as polio, measles, and mumps should be mandatory, I disagree that a yearly shot that isn't very effective needs to be added to the list of mandatory vaccinations; it should remain an individual's right to choose. Until statistics can support the claim that the influenza vaccine actually has any significant impact at all on the health and well-being of Americans, I say it should still be a choice. My choice to not receive the vaccine was made after looking not only at the numbers, but also looking beyond the numbers at the political motivations behind the push for the vaccine. After I followed the money trail, I saw exactly who was profiting from the yearly push to stick a needle in my arm.
An international opinion on mandatory flu shots
The August 2013 article "Mandatory Influenza Vaccination: Is It Part of the Answer?" by Kristin K. Vondrak, DNP, ARNP-BC, NE, CPHQ; Patricia Starling, BSN, RN, CIC; and Jessica de Guzman, RN, MAN, NE-BC, is quite interesting. The problem of flu vaccination coverage is a common topic worldwide. How to succeed in promoting coverage of the flu vaccination has been widely discussed. Mandatory policies can be the most effective way to increase coverage. However, these policies are a real challenge and there are both pros and cons. Some might raise the issue of privacy as a reason to debate the mandatory rule. Others might raise concern about the cost. However, based on the present risk for pandemic influenza, we feel that a mandatory policy should be supported.
Maureen Martinack, BSN, RN
Mark C. Cordia, RN
Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok, Thailand, and Viroj Wiwanitkit, Hainan Medical University, Haikou, Hainan, China