Category: News

AUSTRALIAN nurses are pushing back against a change that requires them to “acknowledge white privilege” before treating patients.

Nurses and midwives around the country must now adhere to a new code of conduct with a section specifically dedicated to “culture” and which details white Australians’ inherent privilege “in relation to Aboriginal and Torres Straight Islanders”.

The new code, which came into effect in March, has been labelled “eye-watering”, “cultural madness” and “unacceptable”. A peak body representing nurses in Queensland is even calling for the chairman of the Nursing and Midwifery Board of Australia to be sacked over it.

“This is eye-watering stuff,” Graeme Haycroft from the Nurses Professional Association of Queensland told Sky News host Peta Credlin.

“We’re calling for the resignation of the chairman of the board (Associate Professor Lynette Cusack) because she’s put her name to it and it’s unacceptable.”

Credlin called it “almost too hard to believe”. “Before (a midwife) delivers a baby to an indigenous woman she’s supposed to put her hands up and say: ‘I need to talk to you about my white privilege’, not about my infection control, my qualifications or my training as a midwife?” she asked Mr Haycroft.

He said that was correct, but there’s no requirement to “announce” anything. The nurses must simply abide by the new code which state clearly that “cultural safety is as important to quality care as clinical safety”.

“Cultural safety … requires nurses and midwives to undertake an ongoing process of self-reflection and cultural self-awareness, and an acknowledgment of how a nurse’s/midwife’s personal culture impacts on care,” the code reads.

“In relation to Aboriginal and Torres Strait Islander health, cultural safety provides a decolonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgment of white privilege.

“These actions are a means to challenge racism at personal and institutional levels, and to establish trust in healthcare encounters.”

Mr Haycroft said the code was hastily approved with little consultation.

“It’s all of Australia. There’s 350,000 nurses and midwives Australia-wide and they’re all now subject to this new code,” he said.

“We put a little survey on our website and we asked nurses whether they agreed with the code of conduct. Just over 50 per cent of our members have said ‘this is wrong, do something about it, fight it for us’.”

The Nursing and Midwifery Board of Australia released a statement on March 1 asking nurses and midwives to “reflect on how the news of conduct relate to their practice”.

“These codes provide a foundation for safe practice and give guidance on crucial issues such as bullying and harassment, professional boundaries and cultural safety. Nurses and midwives need to meet the standards set in these codes, even if their employer also has a code of conduct,” Professor Cusack said.

Nurses and midwives fought the board in November last year when it was revealed a draft of the new code of conduct replaced references to “woman-centred care” with “person-centred care”.

“Midwife means with woman,” UniSA midwifery professor Mary Steen told the Adelaide Advertiser. “The woman is at the centre of a midwife’s scope of practice, which is based on the best available evidence to provide the best care and support to meet individual women’s health and wellbeing needs.”

Professor Alison Kitson, vice president and executive dean of the College of Nursing and Health Sciences at Flinders University, agreed.

“Retaining the ‘woman-centred’ term is important to remind us all that our care is focused on the women and the significant life-changing experience they are about to have,” she said.

On social media, users called the new code “stupid”.

“To think that it will help a person with indigenous blood if nurses would acknowledge their ‘white privilege’,” one woman wrote. “This is basically labelling of victims and oppressors by race. How embarrassing for Australia.”

Source:http://www.news.com.au/lifestyle/health/australian-nursing-and-midwifery-code-of-conduct-slammed-over-white-privilege/news-story

Nurse trainees of the Bawku Presbyterian Nursing Training College (PNTC) have been advised not to place the desire for money above their profession but see it as a call to duty in saving humanity.

At their matriculation ceremony, the 101 trainees were advised to use their talents to care for the sick, wounded and the needy with compassion as Florence Nightingale did which earned her the name “the lady with the lamb”.

This is because she cared for the wounded soldiers during the Crimean war with care and compassion.

The students, made up of 45 female and 56 males are pursuing a diploma course in general nursing for three years after which they would be well prepared to compliment the deficit of the human resources in the health sector.

Mr Frank Fusieni Adongo, the Upper East Deputy Regional Minister, made the call at the 20th matriculation ceremony of the college at Bawku in the Upper East Region.

He said nursing had grown to become one of the noble, admirable and rewarding professions in the country as nurses constituted the first point of contact in the health facility and patients’ companion even beyond the walls of the hospital.

He explained that the initial encounter of the patient with the nurse could either improve or worsen the condition even before seeing the Doctor and urged the trainees to carry out their work with compassion.

Mr Adongo charged the students to be focused on their studies because they had chosen the right path and were on track to greatness and nobility, adding that all that they needed was to constantly keep in mind the objectives of the course they were pursuing.

The Minister disclosed that government was putting in stringent measures to recruit about 15,667 health staff comprising 11,573 nurses, 247 doctors and 938 allied health staff among others.

Mrs Rhoda Damata Bukari, the Acting principal of the College, urged the students to be disciplined, responsible, respectful, polite, humble, God fearing, punctual and committed to duty as those were the values that would keep them focused and maintain the good name of the college.

These values would help you become very good nurses whose work would impact positively on the people, she told the students.

She said the College recorded 61.9 per cent success in the August 2017 licensing examination, which was not good enough and so the academic board was putting in measures to improve on future performances.

She called on the government to expedite action on the introduction of a Midwifery programme in the school since the area was in need of midwives.

Source: ghananewsagency.org

The Ministry of Health (MoH) has asked over 200 past students of Mampong Midwifery and Nursing Training College to refund monies wrongfully paid to them as allowance covering two months in 2017.

Each student received an amount of GHS800 covering November and December 2017.

According to the MoH, these payments were made despite strict instructions to school authorities to exclude names of all immediate past students.

They have up until 28 February 2018 to refund the monies.

Speaking to Class News, Mr Robert Cudjoe, Public Relations Officer at the MoH explained that: “We had a particular year group of nursing training graduates who at the time were not in school and had completed and gone.

“When we were paying, we sent letters to all principals throughout Ghana asking them to take away those names. They had already received September October [allowance] because at that time, it covered them, but by the time we were paying November-December, they were not in school.

“All schools complied before they sent the certified validated list to us for payment. Later, it was found out that – I don’t know whether the letter we sent to them they did not read it well or it was an oversight – over 200 names were included in the validated list sent to us.

“So upon this revelation, a directive was given to write to the students to refund these two months allowance. When their colleagues in other schools got a hint that they had been paid, they also started agitating, so we made it clear to them that they were not included and that it was a mistake that’s why we are asking them to refund the monies.”

Researches have shown that eight in every ten hospitalized patients receive intravenous infusion, making it the most common therapy in Nigerian hospitals and the world at large. Though safe when proper protocols are followed, it is one of the leading cause of morbidity and mortality when not properly utilized. The rate at which the infusion is set to flow and type of fluid used are the leading keys to success and the prime causes of failure.

DEFINITIONS:
• Intravenous infusion therapy: This is a type of therapy where fluid and medications are delivered directly into the vein to the heart.
• Rate of intravenous infusion: this refers to the time and frequency an infusion is set to flow
• Infusion flow regulation: This is the manual or automated control of rate of flow of intravenous infusions

RATE OF FLOW:
The rate of flow of intravenous infusions can be classified as:
• Continuous infusion: This can be rapid or slow continuous infusion aimed at correcting electrolyte imbalance or replacement of fluid loss. It denotes non – stop flow of fluid. Employed as resuscitative measures, it can also be deployed for Maintainace of fluid balanced normally regulated based on patient need. E.g. over 30mins. 4hrly, 8hrly or 12hrly
• Intermittent Infusion: This process is employed when patient requires intravenous medications only at certain times. e.g. twice (bd), thrice (tds), quarterly (qid) etc.
• Patient controlled infusion: it is otherwise known as infusion on demand, usually programmed to be released controlled dose of medication to the patient based on patient’s order. It is has a preprogrammed ceiling to avoid intoxication due to over dosage. E.g. patient controlled analgesia
• Total parenteral nutrition: in unconscious patients or severely malnourished, nutrients are being delivered via the intravenous route similar to normal mealtime. It is programmed to meat patients body need, in those who are unable to ingest food substance via the enteral route

METHODS OF INTRAVENOUS FLUID DELIVERY
• Standard gravity drip: utilizing the pressure supplied by gravity when the bag is placed above the patient’s level connected by a gravity drip delivery set, fluid is delivered into the body and regulated by a clamp. Using this method, the number of drips needed per minute must be calculated to correspond with the required duration
• Gravity drip with dosage burette: In addition to the aforementioned this contains a metered small – volume chamber designed to limit the amount of solution available to the patient and also for intermittent drug or medication mixture before infusion. It is primarily employed for neonatal and pediatric patients
• External pressure: this involves the usage of pressure bag or inflatable cuff to squeeze the fluid bag aimed at forcing large amount of fluid into the patient for resuscitation.
• Automated intravenous fluid delivery: this involve the use of infusion pumps or automated delivery pump to regulate fluid flow, it is very effective, 99% accurate, and generally safe.

PURPOSE OF INTRAVENOUS INFUSION AND GENERAL GUIDELINES
• Resuscitation: To restore circulation following severe fluid loss or depletion of intravascular volume; intravenous fluid are needed urgently and fast until patient is stable.
• Guideline: though fluid is needed at rapid rate, the rate must be properly regulated and the appropriate type of fluid must be used to prevent morbidity. Example in patients with severe hypotension due to head injury; late resuscitation can lead to cerebral edema variable extremely rapid infusion of isotonic solution also leads to cerebral edema, additionally using hypertonic solution instead of isotonic solution also leads to cerebral edema. In this case proper regulation of isotonic solution is required. It is therefore mandatory for nurses to manage every patient according to his needs.
• Routine Maintenance: This is needed in patients who cannot meet their normal daily fluid requirement by oral or enteral route or in stabilized patients following resuscitation.
• Guideline: Estimate routine maintenance requirement daily based on patients response as most patients are euvolemic at this level
• Replacement: This is employed in treating loss of certain electrolyte or nutrients.
• Guideline: This requires frequent reassessment of the agent infused. Example. In patients on potassium supplement infusion due to non potassium sparing induced dieresis; strict monitoring and re adjustment of the infusion is required to prevent arrhythmias due to hyperkalemia.

FACTORS THAT DETERMINE THE RATE OF INFUSION
• Patient related factors: This includes the primary need for the therapy and the underlying secondary mal – physiologies; both must be considered before determining the rate and of intravenous infusions. For Example in patient with hypotension secondary to head injury; isotonic solution is required at regulated rate to prevent cerebral edema, though hypotension hitherto requires rapid infusion. Other considerations include renal, cardio – vascular and neurro abnormalities
• Fluid related factors: Some intravenous medications are open and their rates are only patient determined while others having established rates based on their physiologies. Example; isotonic saline can be regulated or given at rapid rate depending on the patients need, while intravenous mannitol, intravenous potassium, and intravenous Chemotherapy MUST be regulated to flow at slow rates.

FACTORS THAT INFLUENCE RATE OF INFUSION
• Size of veins
• Temperature of fluid
• Nature of fluid (i.e. some fluids induce vasodilatation while others induce vasoconstriction
• Pressure on fluid container
• Viscosity of fluid

EFFECTIVE WAYS OF PROPERLY REGULATING FLUID FLOW RATE
• Proper adjustment of roller clamp adaptor until it reaches the calculated flow rate/minute. This can be achieved with full minute count of drip rate
• Check Iv progress every 30 minutes, hourly or according to facility protocols
• Ensure that delivery tube if free from strangulation
• For automated pumps; ensure that the tubing is threaded into the machine correctly
• To deliver the entire dosage volume to be infused (VTBI), the fluid should be increased by 30 cc – 50 cc, else some amount of the fluid will remain in the delivery tube. If increment can not be attained the tube should be emptied completely into the system
Nurse. Abdulmuttalib Musa Maibasira, R.N. Kano State

The School of Nursing, St. Mary’s Hospital, Amaigbo, Imo State has done so much damage to the word called ‘integrity’ to the extent that no nursing student who graduated there in Nov. 2017 would want to be associated with that word for the next fifteen years.

The biggest fraud that nursing council registration has ever witnessed happened in that school this January, 2018.

While we were made to believe that it is a mission school, built and sponsored by faithfuls of the Holy Roman Catholic Church, at the same time, the school has asked their Nov. 2017 Nursing Council candidates to pay #155,000 naira for Basic RN registration, whereas Council charges less than #40,000 for the same.

We have seen their understanding and definition of anti-corruption and integrity.

Even the most basic Christian virtue in the Catholic creed has been abandoned by the Principal of the said, who happened to be a Reverend Sister.

I repeat, the biggest fraud in nursing council registration is taking place in that school right now. And the woman who duped us is still a Reverend Sister.

I hope they would be bold enough to redeem their image by at least reducing that fee to #50,000.

Until then, I will continue to see them like every other fraudster, like the 419 yahoo guys.

I call on the Catholic Bishops and faithfuls in Imo State to checkmate this fraud.

Oh! Nigeria!
By Ernest Okafor RN

About 700 nursing candidates who cannot afford fees this year at Gauteng colleges will be left out in the cold.

Yesterday, Democratic Nursing Organisation of South Africa (Denosa) president Simon Hlungwani said they had received complaints from distressed candidates who qualified for the four-year nursing diploma.

Hlungwani said candidates were informed there would be no intake for this year despite their completion of the selection process.

Candidates had applied to various institutions including Ann Latsky, Chris Hani Baragwanath and SG Lourens nursing colleges.

Hlungwani said the union was concerned that this would worsen the existing shortage of nurses.

He said a gap in the training of nurses would impact heavily on previously disadvantaged communities who relied on the public healthcare system.

Lerato Madumo Gova from the Young Nurses Indaba Trade Union said some candidates who went through psychometric tests, interviews and medical screening forfeited other opportunities because they had passed all the requirements for the nurse course and were looking forward to begin studying and training as nurses.

“This is dire to the training of nurses. It is going to impact on students and citizens,” she said.

Gova said unions would push to meet with health MEC Gwen Ramokgopa to try and resolve the matter.

A 27-year-old mother of two from Soweto who had applied was distressed by the turn of events. “I’m stressed. I can’t even sleep at night.”

The woman showed Sowetan SMSes she received.

“Please come for collection of a provisional acceptance letter for nursing course at Chris Hani Baragwanath Nursing College at 08h00 on 21 December 2017,” the SMS stated.

This was followed by another message informing her not to fetch the document.

“There are new developments regarding 2018 student intake. Please do not report at Bara Nursing College tomorrow until further notice.”

Another disappointed candidate said she abandoned her job hunt after she passed the interviews last year.

The 22-year-old said: “They are telling us a lot of stories. I’m devastated. I don’t even know what to think.”

Spokesman at the provincial department Lesemang Matuka said they would continue to fund second, third and fourth year students. He said colleges would only admit first-year students with external bursaries or those who can afford to pay the fees themselves.

“At this juncture we cannot afford R57-million required to fund first year students.”

He said 700 candidates were affected.
By Zoë Mahopo, South Africa

The American Academy of Nursing promotes management practices in health care organizations and strategies in the nurse’s personal life to support sleep health in nurses and, as a result, an alert nursing workforce fit to perform their jobs and more able to live healthy lives. Society requires critical nursing services around the clock. Consequently, shift work and long work hours are common in health care organizations and negatively affect a significant percent of nurses. Working at night and irregular hours compromise human physiology dictated by the need for sleep and circadian rhythms. The challenge that nurses on shift work face is the need to work at night (when our physiology promotes sleep) and sleep during the day (when our physiology promotes activity). When shift work combines with long work hours (e.g., shifts of 12 hr or more) and leads to sleep deficiency or disruption to circadian rhythms, the health and safety costs of this conflict with human physiology are potentially significant. Sleep deficiency is a broad term that includes inadequate sleep duration, poor sleep quality, untreated sleep disorders, and mistimed sleep that is not synchronized with circadian rhythms. Sleep deficiency can affect nurses’ work readiness and health, safety, and well-being. Evidence is building that long shifts, shift rotations, double shifts, evening, and night shifts are associated with multiple short- and long-term health and safety risks to the nurse (National Institute for Occupational Safety and Health [NIOSH]; NIOSH, Caruso, Geiger-Brown, Takahashi, Trinkoff, & Nakata, 2015). Tired nurses are also at risk for making fatigue-related patient care errors that can endanger their patients (Bae & Fabry, 2014). These risks also extend to the nurse’s family, their employer/health care organization, and the broader society when tired nurses make errors at work and home or crash their vehicle due to drowsy driving. This complex hazard requires a variety of personal, workplace, and public health strategies to reduce these risks. Unfortunately, persons working in health care organizations may not fully understand the health and safety risks that are associated with fatigue and may be unaware of evidence-based strategies to reduce these risks. Yet evidence shows that it is possible to limit or modify the adverse impact of shift work and long work hours on nurses by improving their sleep and reducing fatigue.

This position statement is consistent with three of the academy’s strategic goals (American Academy of Nursing, 2017). (a) Influence the development and implementation of policy that improves the health of populations and achieves health equity. (b) Influence practice design through nursing science to improve the health of populations. (c) Position the academy and nursing profession to lead change and drive policy and practice to improve health and health care. These efforts will impact the nursing workforce as well as the patient population and the broad range of other people whom nurses interact with at work, home, and during their commutes. Several studies report that nurses working shift work and long work hours are at risk for making errors in the delivery of patient care (Bae & Fabry, 2014). According to the AAA Foundation for Traffic Safety (Tefft, 2016), the risk of vehicle crashes shows a dose–response relationship with sleep duration: less than 4 hr sleep in past 24 hr increases risk of a crash 11.5 times; 4 to 5 hr of sleep increases risk 4.3 times; 5 to 6 hr of sleep increases risk 1.9 times; and 6 to 7 hr of sleep increases risk 1.3 times. RAND reports that insufficient sleep could cost the overall U.S. economy upward of $411 billion annually (2.28% of its gross domestic product) due to a range of negative impacts, reduced productivity, and loss of 1.2 million working days per year (Hafner, Stepanek, Taylor, Troxel, & Van Stolk, 2016).

A growing number of organizations recognize the broad health and safety risks that are linked to shift work, long work hours, and worker fatigue, and are working toward reducing these risks. Governmental agencies, professional and public service organizations, and safety professionals across several industries are working on this critical topic.

Governmental efforts include work by the NIOSH of the Centers for Disease Control and Prevention. NIOSH has a long-standing commitment to reducing the risks from these demanding work hours through research, guidance, and authoritative recommendations, strategic partnerships, and dissemination of information to protect workers and their families, employers, and the community (NIOSH, 2017).

For nurses, NIOSH developed an online continuing education program, NIOSH training for nurses on shift work and long work hours (NOSH et al., 2015). This training relays the risks, the reasons why these occur, and gives strategies for nurses and their managers to reduce these risks. Other governmental efforts include 20 U.S. states that prohibit or restrict mandatory overtime in nurses (American Nurses Association [ANA], 2011). Another example is the U.S. Army Medicine Performance Triad (U.S. Army Medicine, 2016), which aims to improve soldier readiness, increase their resilience, and promote their health. The Performance Triad focuses on three behaviors: (a) get quality sleep; (b) engage in activity; and (c) improve nutrition. An additional example is the federal hours of service regulations for the transportation modes and nuclear power plants. These have been in place for many years to reduce the risk to the public when tired commercial vehicle drivers or workers in nuclear power plants make mistakes that endanger the public.

Several professional and public service organizations as well as safety professionals have initiatives designed to address this hazard. The ANA has been active on this topic. In 2014, ANA released their revised position statement on nurse fatigue that promotes evidence-based strategies to prevent nurse fatigue and sleepiness, promote the health, safety, and wellness of registered nurses, and ensure optimal patient outcomes (ANA, 2014). Recently, ANA began an initiative, Healthy Nurse Healthy Nation, which includes promoting sleep health and preventing fatigue (ANA, 2016). The Pan American Health Organization/World Health Organization published the updated National Institute of Health National Heart Lung and Blood Institute Su Corazon/Su Vida training manual with the first ever session on sleep disorders and sleep health promotion to train Spanish-speaking promotores, nurses, and other health care providers about the relationships between sleep and health (Baldwin, 2014)). Recently, the National Safety Council (2017)) began a new initiative to reduce the broad risks associated with fatigue and inadequate sleep. They are addressing personal health and safety as well as risks at home, at work, and on the roads. Safety and health professionals across many industries are incorporating fatigue risk management systems in their operations (Lerman et al., 2012). These comprehensive systems include seven elements: management policies; addressing vulnerable areas and establishing controls; reporting systems for employees; incident investigation; training for employees and managers; sleep disorder management; and a system of corrective actions and continuous improvement.

The American Academy of Nursing recognizes that safe nursing practice requires health care providers obtaining sleep that is of high quality and adequate duration. Nurse fatigue poses a danger to patients because of increased risk of error, other people on the roads when tired nurses commute to and from work, and the health and safety of nurses themselves. Managers and nurses share in the responsibility of reducing the risks linked to poor sleep health and fatigue. Managers are responsible for using evidence-based practices in the design of their employees’ work schedules and for establishing policies, programs, practices, and systems at work that promote sleep health and an alert workforce. Nurses are responsible for allowing enough time for sleep, adopting evidence-based personal practices and behaviors to maximize sleep and alertness, and educating the important people in their lives to reduce conflicting demands from work and personal responsibilities. The American Academy of Nursing supports initiatives by health care organizations, individual nurses, and public health and governmental agencies to develop strategies that improve the sleep health of nurses. This will help ensure that nurses are fit to provide excellent patient care around the clock as well as help nurses maintain their own health, safety, and sense of well-being. The American Academy of Nursing recommends the following actions.

•

Urge nurses and employers of health care organizations to educate themselves about the health risks linked to shift work and long work hours and the evidence-based strategies to reduce those risks.
•

Urge employers of health care organizations to incorporate evidence-based practices in the design of their employees’ work schedules and establish policies, programs, practices, and systems at work that promote sleep health and an alert workforce.
•

Urge employers to promote a workplace culture that promotes sleep health to achieve optimum functioning, health, safety, and sense of well-being of their workforce.
•

Encourage employers to recognize the role of shift work, long shifts, and nurse fatigue on turnover, absenteeism, patient safety, and related costs.
•

Urge experts to develop additional continuing education courses for nurses and nursing managers that relay evidence-based personal practices and workplace interventions to maximize sleep health and alertness in nurses.

The American Academy of Nursing today released its position statement recommending policies and practices that promote adequate, high quality sleep for nurses to contribute to safe nursing practice and patient care.

The U.S. healthcare system requires critical nursing services around the clock, leading to many nurses working overnight hours and having irregular shifts. The human bodies’ circadian rhythm naturally promotes activity during the day and sleep at night. Long and irregular shift hours, such as a 12-hour work day, disrupts this natural sleep cycle, and has the chance to affect nurses health, readiness, their ability to function in the delivery of patient care, and may lead to more medical errors.

The Academy’s position statement, “Reducing Fatigue Associated with Sleep Deficiency and Work Hours in Nurses,” was published in the November/December 2017 issue of the Academy’s journal, Nursing Outlook.

“The Academy is pleased to publish this important statement on reducing fatigue in nurses,” said Academy President, Karen Cox, PhD, RN, FACHE, FAAN. “Many healthcare organizations may not fully understand the health risks for both nurses and their patients from a tired workforce.”

To address this issue, the US government’s National Institute for Occupational Safety and Health (NIOSH) has developed the online continuing education program, “NIOSH Training for Nurses on Shift Work and Long Work Hours.”

On a broader level, 2017 research published by The Ohio State University College of Nursing in the Journal of Occupational and Environmental Medicine found that depression is common among nurses and is linked to a higher likelihood that they will make medical errors. The study, led by Bernadine Melnyk, dean of the College of Nursing and member of the million hearts subcommittee of the American Academy of Nursing’s Health Behavior Expert Panel, found that more than half of nurses who took part in a national survey reported sub-optimal physical and mental health. Access the study: http://journals.lww.com/joem/Abstract/publishahead/A_National_Study_Links_Nurses__Physical_and_Mental.98797.aspx.

The Academy recommends that healthcare organizations incorporate evidence-based practices in the design of their healthcare workforce schedules, and also educate themselves about the health risks from long work shift hours.

Read the Academy’s full positon statement here: http://www.nursingoutlook.org/article/S0029-6554(17)30600-0/fulltext

The state Department of Health is investigating staffing levels and living conditions for seniors at Sapphire Nursing and Rehab at Goshen, amid calls by local politicians to do so.

U.S. Rep. Sean Patrick Maloney and state Assemblyman James Skoufis asked the state Department of Health on Thursday to investigate staffing levels and living conditions for seniors at Sapphire.

The Health Department confirmed Thursday that an investigation had been launched. Last month, the home formerly known as Elant at Goshen laid off more than half its nurses, according to layoff letters and staff memos obtained by the Times Herald-Record.

Since the recent completion of its sale by nonprofit Elant to for-profit Goshen Operations, the home was rebranded Sapphire.

Sapphire’s nurse tally has fallen 54 percent since June to 17 nurses, including two registered nurses and 15 licensed practical nurses, according to 1199 SEIU United Healthcare Workers East.

Six months ago, there were 37 nurses — 12 RNs and 25 LPNs, the union said.

This month, the 120-bed home began using one LPN per every 40 residents from 7 a.m. to 11 p.m. compared with one LPN per 20 residents previously, the union said. Seven of the home’s leaders, including Sapphire Executive Administrator Crystal Cummings, and key staff members have either resigned or been laid off since mid-December, the union added.

“The reports we’re getting from family members of folks at Sapphire and the local health care community are incredibly disturbing, and we must get to the bottom of it,” Maloney said in a statement. “Denying these older Americans the dignity and comprehensive care they deserve is infuriating, and Assemblyman Skoufis and I will stay on this until we’re sure they’re getting the level of respect and care they deserve.”

Skoufis released his own statement echoing Maloney’s concerns.

“Patients, family members and their nurses deserve far better than what we’ve seen out of Sapphire,” Skoufis wrote. “From the reports I’ve received, the level of care has been ravaged due to the for-profit owners’ excessive cuts. The Department of Health needs to intervene, and quickly.”

Reached by phone Thursday, new Sapphire Administrator Audrey Lewin declined to comment.

State Department of Health spokeswoman Jill Montag said, “The New York state Department of Health takes the safety and well-being of nursing home residents very seriously.” She declined to comment further because the department’s investigation is ongoing.

On the eve of Baystate Franklin Medical Center President Cindy Russo’s final night at the helm, negotiations between the hospital and the nurses union went past the 12-hour mark as they continued to search for some common ground in the 15th month of bargaining.

While the two parties did not get out of negotiations before press time, the meeting came on the heels of some relative momentum in what has been a contentious dispute over the contract for the nurses at the Greenfield hospital.

“While there has been some conceptual progress, there is not agreement on core issues yet,” Massachusetts Nurses Association spokesman Joe Markman said in a statement, adding the talks have been “off the record.”

Typically these meetings last about eight hours, while in this case, “it’s not typical to go so long into the night,” Markman added.

Shortly before press time Thursday night, the hospital’s spokeswoman Shelly Hazlett declined to comment on any of the matters regarding the negotiations.

Negotiations date back to November 2016, just before when the nurses’ contract was supposed to end at the end of the calendar year. Instead, the two parties have been debating a potential contract for now past a year.

Staffing concerns has remained the chief demand by nurses, looking for what they describe as “safe staffing ratios.” Other issues have included overtime, holiday and sick time, and health insurance plans.

The negotiations flared to its peak in late June when the nurses announced a one-day strike, which was followed by the hospital’s announcement of a concurrent three-day lockout of the nurses.

Russo had called the strike “illegal” and a spokeswoman for the hospital angled the strike was “planned,” both to the vehement denial by the nurses.

As for the lockout, union representatives had called the lockout, which prevented the nurses from entering the hospital starting the day of their strike to two full days after, as unprecedented. The hospital had said it was the only way it could handle the one-day strike by the nurses because it had to hire travel nurses to fill their spots, and a three-day contract with those interim nurses was the only way they could do so.

This past November, nurses at Westfield’s Baystate Noble ratified its contract with the hospital after a similarly lengthy process.

At the time, Stern expressed that she had hoped that signaled a step in the right direction.

“What makes that so positive is it demonstrates a pathway to settlement for us,” Stern said in early December. “It shows after a 1.5 years of long negotiations for them, management came back to the table and really started working with nurses in a collaborative way.”

A major point of contention that the nurses union have held, expressed from comments by Stern to songs chanted at rallies on the Greenfield Town Common, is that they felt the negotiations have been dictated by upper Baystate Health management, instead of local management of Baystate Franklin.

As talks started to turn the corner following Noble’s ratification of its contract, according to Stern, a main factor was the presence of Baystate Franklin Medical Center President Cindy Russo at the negotiation table.

When Russo announced her resignation from the job in early December after 18 months on the job, Stern and the nurses declined to comment on it.

The hospital’s security union wrapped the resignation into the point that their own charges that named Russo, which the regional office of the National Labor Relations Board had ruled to have merit in the week prior, showed that the president’s connection to union activity ultimately led to her resignation.

Russo is scheduled to stay on as president of the Greenfield hospital until Jan. 12.