Archive for March, 2010

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When Devices Do the Thinking for RNs, What Training Still Matters?

March 15, 2010

By Sheena Jones. (Sheena is an LPN in training to be an RN at Dutchess Community College, Poughkeepsie, NY.)

'Technology Then and Now'/iLoveButter, via Flickr

So I’m sitting at home on a rare day off and I get a phone call. It’s the supervisor trying to locate one of the many devices each staff member has to sign in and out at the beginning and end of each shift. The hospital I work for uses bar code scanners, wireless computers, PDAs, and Vocera badges. These things are supposed to reduce errors and in general make the jobs of staff members easier. Once I get to work I feel like I have to put on a utility belt to carry all of these devices.

With all of these machines to think for me, I wonder if all of the schooling I’m enduring to go from my LPN to RN is obsolete. Yes, compassion and empathy can’t be taught or replaced by technology. But sometimes it seems to me that a technology-savvy teenager could do much of this job, as long as she could stomach the visuals at the bedside. I remember studying night and day for an exam about calculating medication dosages, only to discover that the computers give the exact dosage and that drugs come from the pharmacy just as they should be given.

Maybe we are a little bit dependent on technology. You should see the mass panic when there is an electrical surge. Nurses often waste time finding computers on wheels (affectionately known as “COWs”) that have a full battery. If they’re not charged or there’s not enough charge to go around, very few people get any work done until power is restored.

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Posted in nursing students, professional identity | Tagged , , , , | 5 Comments »

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Advanced Practice Nurses: Pushed Forward by Health Reform Advocates, Pushed Back by Physicians over Turf – Enough Already!

March 12, 2010

By Shawn Kennedy, MA, RN, AJN editor-in-chief

As we’ve noted in past posts on this blog and in AJN editorials in August 2006 and August 2008, organized medicine does not want to acknowledge that nurses can practice independently.  And now the turf war between advanced practice nurses (APRNs, which include nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists) and physicians is heating up.

In California, physicians are suing the state for allowing nurse anesthetists to practice without supervision, using patient safety as a reason. In Kentucky, physicians are opposing legislation to expand the scope of practice for NPs—at issue is whether NPs should need a signed collaborative arrangement with a physician (even though the physician does not supervise the NP). According to an article by a Louisville, Kentucky, newspaper, the Courier-Journal, the physicians charge high fees for their signature or demand a percentage of the practice.  The bill, though, passed the state House committee on March 4, with several members questioning the ethics of physicians’ requiring fees.

Nurses have been and continue to fight for the right to practice, and during this period where the government is seeking solutions to health reform, this is a battle that shouldn’t have to happen—a view shared by Stephen Ferrara, NP, at A Nurse Practitioner’s Place (“I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care”). Read the rest of this entry ?

Posted in advocacy/political action, health care reform, nurse practitioners, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 2 Comments »

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Comic Book Superheroes Meant to Raise AIDS Awareness Raise Some AJN Readers’ Ire

March 11, 2010

By Christine Moffa, MS, RN, AJN clinical editor

Back in January I posed the following question: “Is doing something as silly (and, to some, either sexist or demeaning) as this justified in the name of increasing awareness about a disease?” In that post, I was referring to the bra-focused tactics of a light-hearted campaign intended to raise breast cancer awareness. Along those lines, our March cover has received a lot of attention; unfortunately, not all of it has been positive.

Our goal was to draw attention to our two CE features of the month: “Every Nurse Is an HIV Nurse” and “Aging with HIV: Clinical Considerations for an Emerging Population.” As Shawn Kennedy, interim editor in chief and editorial director at AJN, points out in this month’s editorial, “AIDS awareness in this country seems to have diminished—in fact, for some, it hardly seems a concern at all. A recent CDC report on risk behavior in adolescents found that during 2007, 39% of sexually active high school students ‘had not used a condom during last sexual intercourse.’”

I asked Robert Walker to provide us with this month’s cover art after meeting him through a mutual friend. Through his comic book series O+Men, about nine HIV positive superheroes, he has been getting a lot of recognition for promoting HIV and AIDS awareness. For more information about Walker, read this month’s On the Cover in AJN, or listen to an interview with Walker on National Public Radio.

While many find his work important, some of our readers have found the cover illustration offensive. His comic books are not created for children but for adolescents and adults. I know tastes vary, and I certainly won’t try to tell anyone what they should or shouldn’t find offensive. In my view, though, with all of the images that bombard us in the media these days, a few superheroes showing off their muscles and shapely figures for a good cause is justified in the name of increasing awareness about a disease.

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Posted in advocacy/political action, art and nursing | Tagged , , , , | 1 Comment »

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Pink Slips and Patient Safety

March 10, 2010

By Peggy McDaniel, BSN, RN

It has finally gotten serious. Patient care workers at Abington (PA) Memorial Hospital can be fired for not washing their hands.

It’s as simple as that. After two years of promoting hand hygiene through education and feedback to staff, the “gloves have come off.” Sorry for the pun, but I find this article very timely considering that it is Patient Safety Awareness Week. What does hand hygiene have to do with patient safety? Quite a bit, it turns out. Abington Memorial has a personal story to tell their staff. It is about a patient, Catherine Zakrzewski, who died from an infection acquired while at their hospital. Before she died, this patient gave permission to the infection control staff to use her story for their campaign. Her story lives on and is hard to ignore. Her son happens to be a doctor at the hospital, and as a patient safety committee member he allows the hospital to continue to use his mom’s story as an example. Putting a face to the issue has made a difference.

She sailed through surgery, rehab, and went home,” said Kevin Zakrzewski, her son, a primary-care physician who practices at Abington.

But at home, a kneecap split, which happens from time to time, requiring more surgery.

Back in the hospital, Pat Zakrzewski acquired an infection, one of the worst kinds, MRSA, resistant to antibiotics.

What followed was a nightmare: removal of her new knee, amputation of a leg, and, ultimately, after a combination of 20 surgeries and hospitalizations, her death . . . .

Abington Memorial has spent the last two years focusing on hand hygiene. They employ “spies” who monitor compliance and provide instant feedback, both positive and negative.  Read the rest of this entry ?

Posted in patient safety | Tagged , , , , , | 3 Comments »

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There’s a Place for Speed in Online Publishing–But Peer Review Is More Important Than Ever

March 9, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

"fast movement"/jonasj, via Flickr

I read with interest, and also a little concern, a post on a newish blog called Nurse Story.com, which argued for faster Web-based publishing without peer review or much editing. 

Yes, the open access model of scientific publishing, with full transparency for all aspects of the review and revision process, is worth watching. Yes, more and more publishing companies are going the online only or online mostly route (and while it’s PC to say it’s in pursuit of being green, I’d bet the primary reason is because it’s cheaper). And yes, it’s much faster to publish on the Internet. You can throw up an article or blog post and change content online by the minute. But is fast and quick all we need? Technology is changing nursing practice, but is it changing our knowledge base so quickly that we shouldn’t take time to weigh and sift the good from the bad? Read the rest of this entry ?

Posted in nursing research, Shawn Kennedy, AJN editor-in-chief, writing and nursing | Tagged , , , | 3 Comments »

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Disabled Musicians Featured in Podcasts, AJN Cover, Subject of Oscar-Winning Film

March 8, 2010
  

Liyana performs at Lafeyette Ave. Presbyterian Church, Brooklyn, NY

By Shawn Kennedy, interim editor-in-chief

At the Academy Awards ceremony last night, “Music by Prudence,” the documentary about Prudence Mabhena, won the award for best documentary short. Prudence is the lead singer of Liyana, a group of young Zimbabwean musicians who graced the above cover of our August issue last year. All of the band members have some kind of disability and attended the King George VI School and Centre for Children with Physical Disabilities in Bulawayo, Zimbabwe. When they performed throughout the United States last year, AJN’s senior editorial coordinator Alison Bulman interviewed them after their concert in New York. 

Go here for links to podcasts of interviews with the band and the Oscar-winning documentary filmmaker Roger Ross Williams—and also to some of the music of Liyana (the podcasts will load, but right now can take up to 30 seconds on some computers!). You can also read Bulman’s short article about this remarkable troupe here, or a blog post about Liyana we published some months back. Congratulations to Liyana, and to Williams, who helped them tell their story!

(And click here to read an interview posted yesterday on Huffington Post and WalletPop with Alison about her experience interviewing the film’s director and producer, whose  relationship has been the subject of controversy since an awkward moment at the Academy Awards ceremony.)

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Posted in patient perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | Leave a Comment »

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Notes from the Healthweb and Nursosphere

March 5, 2010

This week Not Nurse Ratched has an amusing, meandering, and thoughtful post about the uses of Facebook by patients in the hospital. There’s a short excerpt below, but read the whole thing here.

They update Facebook constantly. CONSTANTLY. They have us take photos of injuries they can’t reach so they can post the photos to Facebook. I am not making this up. “I want a photo of my hideously dislocated ankle/knee/shoulder but I can’t move, so would you mind using my phone to take a picture for me?” And they keep updating and updating. I have actually said, “I’m about to give you a medicine that is going to render you unconscious immediately, so you should set your phone down.”

How could we have a weekly Web roundup that doesn’t at least mention health insurance reform? The spotlight has been slowly turning toward the insurers themselves, a crucial part of the equation (along with cost control and many other factors). This week Secretary of Health and Human Services Kathleen Sebelius met with the top executives of insurance companies to demand an explanation for the steep increases in rates seen in the last year.

salmonella/via CDC

If you’re looking for yet another reason why processed food isn’t good for you (besides the frequent presence of high fructose corn syrup and massive doses of salt, and the inaccurate packaging claims that the foods are “healthy” and “lean”), this week the NY Times reported news of a widespread food recall, stating that “[t]housands of processed food products – from chilis to hot dogs to dips – contain an ingredient that federal food regulators say was contaminated with salmonella . . . “

Also this week: hopes were crushed for a pill thought promising for the treatment of Alzheimer’s. Garry Schwitzer of HealthNewsReview.org isn’t surprised, though–no one’s better at pointing out the way drugs are hyped by mainstream coverage, whether they work and are safe or not. Here’s the short take at his blog.

Lastly, for some widely varying provider-level perspectives on palliative care and end-of-life issues, there’s an excellent roundup of posts and links to blogs and Websites at the Palliative Care Grand Rounds hosted by Larry Beresford.

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Posted in health care reform, nursing perspective, palliative care | Tagged , , , , , , , , | 1 Comment »

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Is This Teamwork? Learning to Supervise Isn’t Easy

March 4, 2010

By Sheena Jones, who attends Dutchess Community College and lives in Beacon, NY

hourglass 4/graymalkn, via Flickr

So I’m a young nurse, one of the youngest in my facility. I used to be a nurse’s aide; now I’m an LPN in training to be an RN. It’s very difficult when the aides are either the same age as me or old enough to be my grandmother.

What do you tell a 19-year-old aide who just got mandated for a second shift on a Saturday evening and who is texting all shift but getting her work done? Do you tell her to put it away, knowing that you would be doing the same thing if you were still a young aide and had already gone the extra mile to check that all the patients were safe and happy?

What do you tell the 57-year-old aide who is always the last one struggling to finish her assignment because she can’t keep up? She can’t get her two baths done plus get the other eight residents washed and in bed by 10 pm, even though everyone else is done by 8:30 pm. Do you tell her to hurry up and finish? Do you send the frustrated younger aide to finish her assignment, and call it ‘teamwork’? Who wants to do extra work? 

This is the situation I face every couple of weekends. I’ve tried changing the aide assignments to make the older aide’s workload easier, but she just can’t seem to work fast enough no matter what I do. I have a frustrated younger aide who always finishes her own assignment and half of the older woman’s. I even help put some of the older aide’s patients to bed, and then I’m behind on my medication rounds. As a facility, we’re short on help most weekends, snowstorms, and holidays—and everyone is frustrated when they arrive and learn they are mandated by law to stay another shift for the safety of the residents.

As a young nurse, do I tell the 19-year-old who is doing her job to do extra, or do I tell the lady who is old enough to be my grandmother and has been working as an aide longer than I’ve been alive to work harder?

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Posted in nursing perspective | Tagged , , , , | 15 Comments »

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‘Ask Me Three Questions’: Engaging Patients to Promote Safety

March 3, 2010

By Peggy McDaniel, BSN, RN

Next week, March 7–13, is Patient Safety Awareness Week. The National Patient Safety Foundation (NPSF) has sponsored Patient Safety Awareness Week since 2002 to help promote awareness of patient safety issues among hospital staff, patients, and communities. This year’s campaign focuses on engaging patients in theior own care, and it draws upon the NPSF template “Ask Me Three,” which encourages patients to ask these questions: 

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Read the rest of this entry ?

Posted in health care reform, patient perspective, patient safety | Tagged , , | Leave a Comment »

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Why the ‘Greatest Generation’ Is Bagging Groceries (No, It’s Not Because of Taxes)

March 2, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

In surfing the Web Monday, I came across this interesting tidbit on the blog run by Gary Schwitzer, creator of HealthNewsReview.org, a site devoted to assessing the accuracy of health news coverage. He quoted statistics from a report  by the Center for Public Integrity, which claims that “there are eight lobbyists for every member of Congress.” The number of lobbyists went from about 1,400 in the first quarter of 2009 to nearly 3,700 by year’s end. 

I see elderly people in the supermarket bagging groceries—some may like the company, but others are doing it to pay for medical care not covered under plans. My uncle—one of the “greatest generation”—used to cut his pills in half to make them last longer. Does this qualify as “rationing care”? Read the rest of this entry ?

Posted in health care reform, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 5 Comments »

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