Transcript of #RNchat - a Twitter chat for registered nurses - for Thursday, November 4, 2010. Follow @RNchat - http://Twitter.com/RNchat for regular updates. Topics were provided by the kindness of Palo Alto Medical Foundation (@PaloAlto on Twitter) through Erin Macartney (@emacartney): T1 Are your job responsibilities changing with the advent of health care reform? How? T2 How do you personally maintain excellent standards of care in the face of budget cuts and pressures? T3 What areas of health innovation do you think are most important to patient care? Chat was moderated by Phil Baumann, RN (@PhilBaumann on Twitter)

1. Transcript of #RNchat for November 4, 2010
Follow @RNchat for Regular Updates
Twitter.com/RNchat
RNchat.org
Moderated by @PhilBaumann
rnchat
Welcome to #RNchat everyone! Today's topics will be from
@paloaltomedical - Say Hi to them as we get started with introductions!
nursingpins Thanks @paloaltomedical for your participation. #RNchat
PaloAltoMedical Hi Everyone! Looking forward to the #RNchat!
FreshRN Hello @PaloAltoMedical! Look forward to chatting with you =) #RNchat
pamressler Hello @paloaltomedical #rnchat
PaloAltoMedical @nursingpins Thank you! Glad to be here with you all! #RNchat
IVchat Greetings to all, hello @paloaltomedical!! #RNchat
PaloAltoMedical @pamressler Hello to you too. Thanks for joining today's #RNchat!
renee_berry
--& ;gt; (non-clinical) advocate for patient centered care, involved w/
@Y_A_H_A @hcsmSV @KLXmedia ( @paloaltomedical patient) #rnchat
PaloAltoMedical
Thx! Looking fwd to chatting w/you too! RT @freshrn: Hello
@PaloAltoMedical! Look forward to chatting with you =) #RNchat
PaloAltoMedical
Thanks - Greetings to you too! RT @ivchat: Greetings to all, hello
@paloaltomedical!! #RNchat
rnchat
T1 Are your job responsibilities changing with the advent of health care
reform? How? #RNchat
rnchat
(In case ya missed it :) RT @rnchat: T1 Are your job responsibilities
changing with the advent of health care reform? How? #rnchat
renee_berry
Think community edu is super important but I may have to lurk on this
question bc I wouldn't be able to provide clinical perspective #rnchat
NAPH1981
Great question - curious here, too RT @rnchat: T1 Are your job
responsibilities changing with the advent of health care reform? How?
#RNchat

2. nursingpins
T1 - As far as I can see NOTHING has changed - and getting worse with
ratios and staffing. #RNchat
PerfectServeInc
We are happy to be joining #RNchat today! RT @RNchat T1 Are your job
responsibilities changing with the advent of health care reform? How?
factnurse
T1 the only change I have seen is the initiation of & ;quot;swing beds& ;
quot; and not sure that is r/t HCR #RNchat
nursingpins Glad to see NAPH1981 #RNchat
renee_berry
RT @NAPH1981: Great question - curious here, too RT @rnchat: T1 Are
your job responsibilities changing with the advent of health care reform?
How? #RNchat
factnurse T1 - our ratios and staffing are getting worse as well #RNchat
Gracetx
Greetings to all, hello @paloaltomedical! RN in community mental Health
FT Worth Tx #RNchat
visiting_nurse
T1 From an admin perspc mor regulatory focus also seeing changs in staffn
due 2 cuts in MCR reimbursemnt for home health #RNChat
chemosabe
Hey all lurking at the mo and making school lunches, T1 ur reform not
relevant down under, our reform coming too, not sure how yet #rnchat
onlinenursing
Ooooh I am late. Sorry - Hellow #RNChat - Terri here - just finished an
elluminate class with students.
Gracetx
T1- nothing changed yet. But lots of planning and meetings with community
stakeholders to see what it means for us #RNCHAT
FreshRN
T1 I'm from California where we have state-mandated nurse/staffing ratios,
so we don't have as much as a problem with it I think... #RNchat
NUR3563
@nursingpins I am going to agree with Vernon - no changes yet, too many
scared of not making $ - so decreased staffing. #RNChat
factnurse T1 what changes can I as a staff nurse expect to see? #RNchat
onlinenursing @chemosabe hey down under! Good to see you! Here in #RNChat
IVchat T1 - affecting outpt. services as well. #RNchat
chemosabe @onlinenursing thanx Terri, 0550 Fri here #rnchat
Gracetx
RT @visiting_nurse T1 we haven't seen cuts yet but anticipate them 2 cuts
in MCR reimbursemnt for Community MH #RNChat
onlinenursing
RT @IVchat: T1 - affecting outpt. services as well. #RNchat (Yes - diabetic
foot clinic closed at local hospital) #RNChat

3. NAPH1981
@factnurse you can expect to see more patient navigators, team-based care,
coordination, etc ... #hcr #RNchat
CGreaves
RT @naph1981: @factnurse you can expect to see more patient navigators,
team-based care, coordination, etc ... #hcr #RNchat
FreshRN
RT @NAPH1981: @factnurse you can expect to see more patient navigators,
team-based care, coordination, etc ... #hcr #RNchat
renee_berry
awesome, so important RT @NAPH1981 @factnurse you can expect to see
more patient navigators, team-based care, coordination #hcr #rnchat
PerfectServeInc
RT @NAPH1981 @factnurse you can expect to see more patient navigators,
team-based care, coordination, etc ... #hcr #RNchat
FreshRN
@NAPH1981 Who is responsible for implementing those changes?
#RNchat
factnurse @NAPH1981 Okay, I guess that makes sense #RNchat
nursingpins
T1 You will see more patient advocates - which will will help improve
patient care. #RNchat
renee_berry
@NAPH1981 were you involved in advocating for increased #RN patient
navigators in #hcr ? #rnchat
onlinenursing
@factnurse you can expect to see more patient navigators, team-based care,
coordination, etc - sounds like a job for nursing! #RNChat
renee_berry
RT @nursingpins T1 You will see more patient advocates w/ #hcr - which
will will help improve patient care #rnchat
rnchat Shoulder tap: Next topic coming up in a moment! #RNchat
rnchat
T2 How do you personally maintain excellent standards of care in the face
of budget cuts and pressures? #RNchat
visiting_nurse
RT @Gracetx: same hre sum of the community benefit programs R in
jeopardy/cut services staff nurses R having 2 make more visits #RNChat
NAPH1981
T1 @FreshRN theyre delivery system reforms included in #hcr. some need
additl regulations from HHS before they can be implemented #RNchat
PaloAltoMedical
RT @nursingpins: T1 You will see more patient advocates - which will will
help improve patient care. #RNchat
NAPH1981
T1 others are grant programs that states and/or other entities can apply for
and implement #RNchat
chemosabe T2 personally or within work unit? #rnchat

4. FreshRN
Good question! RT @rnchat: T2 How do you personally maintain excellent
standards of care in the face of budget cuts and pressures? #RNchat
onlinenursing
T2 #RNChat - same as always: Look for evidence,/research, listen to
advocate for pt. family, be innovate, be cost cutting.
renee_berry
interesting q RT @rnchat T2 How do you personally maintain excellent
standards of care in the face of budget cuts pressures? #rnchat
nursingpins
T2 - It is very hard to maintain standards - unfortunately I have seen the
integ. of nursing decline because of ridiculous staffing. #RNchat
renee_berry
RT @onlinenursing T2 same as always: Look for evidence/research, listen
to advocate for pt. family #innovate #rnchat
IVchat
T2 - difficult, only a few (conscientious ones) would care to keep up b/c of
low staffing, increased pt. load. #RNchat
PerfectServeInc
@onlinenursing That can be tough to be innovative and cost cutting at the
same time. #RNChat
Gracetx
T2-challenge have to figure out what might not get done when hv less staff.
OR what can unskilled staff do if we have less nurses? #RNchat
NAPH1981
@renee_berry we have been lobbying to include everyone in care
coordination - nurses, physicians, social workers, you name it! T1 #RNchat
nursingpins
T2 Many corners are being cut and many things are not being done.
#RNchat
Gracetx
Exactly! RT @PerfectServeInc @onlinenursing That can be tough to be
innovative and cost cutting at the same time. #RNChat
factnurse
@nursingpins I concur. We are lucky if we get to eat and go to the
bathroom. 12hr days are usually 14hrs at least now. #RNchat
IVchat
so true.. RT @nursingpins: T2 Many corners are being cut and many things
are not being done. #RNchat
nursingpins
T2 Hospitals will be the biggest obstacle to safe staffing and hc
improvement. They will not allow it without mandate. #RNchat
chemosabe
@factnurse We are lucky if we get to eat and go to the bathroom. 12hr days
are usually 14hrs at least now _ paid overtime? #rnchat
visiting_nurse
the documntatn declines 2 RT @IVchat: so tru.. RT @nursingpins: T2 Many
corners R being cut many things R not being done. #RNchat

5. renee_berry
@NAPH1981 awesome, I'd love to learn more abt your efforts! I've been
fascinated w/ @HospiceAction community legislative action #rnchat
FreshRN
RT @IVchat: so true.. RT @nursingpins: T2 Many corners are being cut and
many things are not being done. #RNchat
Gracetx
@visiting_nurse T1 #RNchat TX is going to cut 10-15-20% of community
health programs bcuse state funds shortage. Myb #her will help?
visiting_nurse
so u dont kno if it is not getting done or not documentd T2 Many corners R
being cut many things R not being done. #RNchat
chemosabe
@nursingpins T2 Hospitals will be the biggest obstacle to safe staffing and
hc improvement _ industrial action by hcw? #rnchat
Gracetx
So true!!!! Scary! RT @nursingpins T2 Many corners are being cut and
many things are not being done. #RNchat
nursingpins T2 It is documented - but it is not done. #RNchat
FreshRN Wow RT @nursingpins: T2 It is documented - but it is not done. #RNchat
visiting_nurse
Yikes! RT @Gracetx: T1 #RNchat TX is going to cut 10-15-20% of
community health programs bcuse state funds shortage.
HospitalFocus5
RT @PaloAltoMedical: RT @nursingpins: T1 You will see more patient
advocates - which will will help improve patient care. #RNchat
Gracetx
ExactlyRT @visiting_nurse so u dont kno if it is not getting done or not
documentd T2 Many corners R cut things R not being done. #RNchat
PerfectServeInc
At fully staffed, or decreased staffing? RT @nursingpins T2 It is
documented - but it is not done. #RNchat
IVchat scary...RT @nursingpins: T2 It is documented - but it is not done. #RNchat
Gracetx
I find not doc not done too often RT @nursingpins T2 It is documented -
but it is not done. #RNchat
chemosabe T2 adage downunda is if it is documented it didn't happen! #rnchat
nursingpins @PerfectServeInc short staffed. #RNchat
visiting_nurse
not sure HCR will help tho bcuz many nonprofits rely on Medicare to
subsidize Medicaid community health programs RT @Gracetx: T1
#RNchat
factnurse I find doc not done more often than I would like to admit #RNchat
FreshRN
T2 Nurses and patients are obviously both suffering...something needs to be
done #RNchat

6. nursingpins
RT @FreshRN: T2 Nurses and patients are obviously both suffering...
something needs to be done #RNchat
rnchat Shoulder tap: Final topic coming up in a couple minutes! #RNchat
factnurse
@nursingpins I'm afraid advocates can advocate - but will it do much good
if there isn't enough staff to take care of pt #RNchat
CernerPhysician
RT @dorameulman: #NYC health department shows EMR's help primary
docs improve care. http://bit.ly/bnFI1H #health #MDChat #RNChat
#hcsm
Gracetx
In Austin yest./dept state health sd plan on T1 #RNchat TX is gonna cut 10-
15-20% of community health programs bcuse state funds shortage.
rnchat
T3 What areas of health innovation do you think are most important to
patient care? #RNchat
WillowRN
@rnchat T2 Denver RN here - my hospital had a major layoff this year, our
pt loads are too heavy. Too much goes undone. #RNchat
visiting_nurse
Many claims being denied due 2 vry issue w/ increase in noncompliance w/
accrd standrds @Gracetx: I find not doc not done 2 oftn #RNchat
nursingpins
@factnurse Patient advocate groups will pressure hospitals to post their
unsafe staffing and more #RNchat
PerfectServeInc
RT @rnchat T3 What areas of health innovation do you think are most
important to patient care? #RNchat
FreshRN
RT @nursingpins: @factnurse Patient advocate groups will pressure
hospitals to post their unsafe staffing and more #RNchat
renee_berry
RT @rnchat T3 What areas of health innovation do you think are most
important to patient care? #rnchat
CGreaves
RT @rnchat: T3 What areas of health innovation do you think are most
important to patient care? #RNchat
WillowRN
T3 I think before we innovate any further, we need to solve the problem of
staffing hospitals. More nurses would be innovative #RNchat
visiting_nurse
2ndRT @factnurse: @nursingpins I'm afraid advocates cn advocate - but
will it do much gd if thr isn't enough staff 2 take care of pt #RNchat
factnurse @nursingpins thats good #RNchat
nursingpins
T3 The biggest inov. I've seen are touch pads that allow patients to see x-
rays and all kinds of info at the bedside. #RNchat

7. renee_berry
I've been very impressed w/ e-patient movement, advocating patients to
participate in their care http://ow.ly/34D5Y #rnchat
PaloAltoMedical
RT @nursingpins T3 The biggest inov. I've seen are touch pads that allow
patients to see x-rays and all kinds of info at the bedside #RNchat
Gracetx
T3- need to b open 2 nontraditional collaboration w public community
health. Use promotoras etc. #RNchat
PerfectServeInc
Do you think that will help patient care,or patient communication? RT
@nursingpins T3 The biggest inov. I've seen are touch pads.. #RNchat
renee_berry
T3 Also fascinated with the strength of the #hcsm community encouraging
stronger sources for reliable online #health information #rnchat
nursingpins T3 communication helps care in all areas #RNchat
renee_berry
agree RT @Gracetx T3- need to b open 2 nontraditional collaboration w/
#PublicHealth community #rnchat
factnurse
I think anything that shortens the hospital stay will benefit the patient
#RNchat
jodyms
RT @renee_berry: T3 Also fascinated with the strength of the #hcsm
community encouraging stronger sources for reliable online #health
information #rnchat
IVchat
T3 - patients are already innovative...seeking out info using social media..
#RNchat
renee_berry
T3 think this is a great #innovative resource for #oncologists
#communication skills http://ow.ly/34DcS #cancer #rnchat
PerfectServeInc
T3- Are there issues with nurses spending too much time trying to reach
physicians, etc? Improve coordination of care--& ;gt;more time? #RNchat
nursingpins
T3 I've seen more informed patients in the last year than the prev. 10.
#RNchat
WillowRN
T3 #RnChat what would be great is incorporating the pts TV into a demo
system, so pt could view xrays, call RN, etc from the touch screen.
CGreaves
RT @renee_berry: T3 think this is a great #innovative resource for
#oncologists #communication skills http://ow.ly/34DcS #cancer #rnchat
NAPH1981
same! RT @renee_berry: impressed w/ e-patient movement, advocating
patients to participate in their care http://ow.ly/34D5Y #rnchat

8. renee_berry
cool cc @epatientdave RT @nursingpins T3 Ive seen more informed
patients in the last year than the prev 10 #RN #rnchat
nursingpins
@PerfectServeInc reaching phys is only a minor problem - that I have seen.
#RNchat
grimalkinrn
@thesournurse I totes posted that to the wrong account, but you should
lurk on #RNchat when you get a chance, lots of good info.
PerfectServeInc
Thanks! RT @nursingpins @PerfectServeInc reaching phys is only a minor
problem - that I have seen. #RNchat
WillowRN
#RnChat T3 Also, forget touchpads, could we just get more manageable
beds and call lights?? THAT would be huge.
visiting_nurse
tech that allows more intensive services to be provided in home
environment supportive of Hospital @ Home program by Hopkins T3 -
#RNchat
hcsmSV
Yes! RT @nursingpins: T3 I've seen more informed patients in the last year
than the prev. 10. #RNchat #hcsmSV
renee_berry
T3 experience as patient: & ;quot;buzzers& ;quot; for urgent care so you can
go wait in your car, was awesome when I had migraine @paloaltomedical
#rnchat
PerfectServeInc
Wow Rt @renee_berry T3 & ;quot;buzzers& ;quot; for urgent care so you
can go wait in your car, was awesome when I had migraine
@paloaltomedical #rnchat
jodyms
RT @hcsmSV: Yes! RT @nursingpins: T3 I've seen more informed patients
in the last year than the prev. 10. #RNchat #hcsmSV
IVchat
lots of patients w/ blogs, twitter, FB RT @nursingpins: T3 Ive seen more
informed patients in the last year than the prev. 10. #RNchat
FreshRN
@renee_berry T3 is it like those buzzers they give you when you're in line
for a busy restaurant? #RNchat
renee_berry
@FreshRN exactly, I was in excruciating pain, got to go sit in quiet.. Talk
about patient-centered, can't express enough gratitude #rnchat
FreshRN
@renee_berry oh, that's awesome! I haven't seen that yet personally but I
hope to soon #RNchat
jodyms
Five yrs ago you wouldn't have seen this RT@kevinmd RT @efalchuk: Five
Tips 4 Diagnosing Yourself on the Web: http://bit.ly/cSgC9X #RNCHAT

9. nursingpins
T3 another nice innovation with touch pads - phys can see x-rays EKG's
from anywhere. #RNchat
factnurse Innovation: 1st I've ever done this. #RNchat
IVchat
RT @FreshRN: @renee_berry T3 is it like those buzzers they give you when
youre in line for a busy restaurant? #RNchat
chemosabe
T3 best innovation - transforming care at the bedside - good old fashioned
pt focussed care!!! #rnchat
rnchat Fast fast hour! We'll wrap up in a few moments. #RNchat
PerfectServeInc
RT @chemosabe T3 best innovation - transforming care at the bedside -
good old fashioned pt focussed care!!! #rnchat
nursingpins
@chemosabe and innovation can be an extension of pt. centered care.
#RNchat
rnchat Before we leave, give us your parting thoughts or wishes. #RNchat
erlanovation
RT @renee_berry: T3 think this is a great #innovative resource for
#oncologists #communication skills http://ow.ly/34DcS #cancer #rnchat
renee_berry
@PhilBaumann #IsCool T3 how about TweetChats for improving #health
systems #AWESOME #innovation opening doors/spreading good ideas
#rnchat
chemosabe
By all enjoy thursday nite, i'll try enjoy fri at the coal face! @nursing pins, of
course tech is helping transforming care! #rnchat
IVchat Nurses rule!! Thank you for the chat! Bye! #RNchat
factnurse So glad I did this. How often is the chat? #RNchat
PerfectServeInc Enjoyed our first #RNchat today. We will be sure to attend more!
Gracetx
Same RT@NAPH1981 @renee_berry: impressed w/ e-patient movement,
advocating patients to participate in their care http://ow.ly/34D5Y #rnchat
FreshRN
Thanks for another opportunity to share ideas and discuss important
topics! Together we can make a difference #RNchat
rnchat
THANK YOU, everybody! And thank you @paloaltomedical for the topics.
Transcript will be up soon! Next chat TBA. #RNchat
Official End of Chat
Additional Remarks:
nursingpins Thanks to RNchat and all interested. - and what @FreshRN said. #RNchat

10. renee_berry
Don't forget it's National #Hospice Month this November http://ow.
ly/34Bzs #myPassion Thanks for a great Chat! #rnchat
Gracetx
Love it RT @WillowRN T3 #RnChat wd b great incorporating pts TV into
demo system, pt could view xrays, call RN, etc from the touch screen.
PaloAltoMedical
Final thoughts: Thanks to nurses for providing patient-centered care and
advocacy! #RNchat
nursingpins Thanks to @paloaltomedical #RNchat
PaloAltoMedical
TY too! RT @rnchat: THANK YOU, everybody! And thank you
@paloaltomedical for the topics. Transcript will be up soon! Next chat TBA.
#RNchat
renee_berry
Looking forward to next time! RT @rnchat THANK YOU, everybody! And
thank you @paloaltomedical for the topics. #rnchat
WhatNursesDo
RT @renee_berry: Don't forget it's National #Hospice Month this
November http://ow.ly/34Bzs #myPassion Thanks for a great Chat!
#rnchat
renee_berry
RT @PaloAltoMedical: Final thoughts: Thanks to nurses for providing
patient-centered care advocacy! #RN #nurse #rnchat
Gracetx RT @nursingpins: Thanks to @paloaltomedical #RNchat
DrDeanBurke
T3 #RNChat (late joining)-research team approach similar to onc. Will
require hi tech to coordinate and communicate. doc, nurse,soc.ser
PaloAltoMedical
Thanks to @RNchat for hosting and allowing us to join in today. We
appreciate everyone who participated ( watched). Voices!! #RNchat
PaloAltoMedical
Thanks to you too. Enjoyed learning and sharing! RT @nursingpins:
Thanks to @paloaltomedical #RNchat
rnchat @PaloAltoMedical Thank you! A great chat! #RNchat
PerfectServeInc
Great to chat with @paloaltomedical today during #RNchat. One of our
board members is on staff at @paloaltomedical --& ;gt;Dr. Aigen.