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Archive for the ‘advocacy/political action’ Category

When Lawmakers and Physicians Hold Nurses Back

February 13, 2012

Editor’s Note: Toni Inglis, MSN, RN, CNS, FAAN, writes opinion for the Austin (TX) American-Statesman. She works at the Seton Healthcare Family in Austin as a neonatal ICU staff nurse and also writes a nursing blog for Seton and edits its monthly NursingNews. This article is a reprint of an April 22nd commentary in the Statesman. Toni was inspired to write the column after a particularly disappointing legislative session, in which Texas advanced practice nurses made fewer gains than in past sessions—despite Texas ranking last in access to health care and having the most restrictive laws in the country regarding APRN scope of practice and prescriptive authority. She believes the poor access and barriers to practice are related.

AJN finds the article particularly relevant as legislatures across the country deliberate on APRN barriers to practice. You can read her commentaries at ingliscommentary.com.

Here’s an idea that wouldn’t cost Texas a dime but would save millions of dollars every year: Remove all barriers restraining nurses from practicing to the full extent of their education and training.

by Brian Romig/via Flickr

No state needs primary care providers more than Texas, which has a severe shortage. Texas ranks last in access to health care and in the percentage of residents without health insurance. Of Texas’ 254 counties, 188 are designated by the federal government as having acute shortages of primary care physicians. Of that number, 16 counties have one and 23 have zero.

If every nurse practitioner and family doctor were deployed, we still couldn’t meet the need. Texans are desperate for health care.

Doing the math and to help meet the need, the Legislative Budget Board recommended autonomous practice of advanced practice nurses after a preceptorship.

In Texas, our legislature — session after session — keeps the most restrictive laws in the country. Nurse practitioners don’t want to perform brain surgery. They just want to provide primary care and are quick to refer cases to a doctor when necessary.

Most states with far less need do not legislate practice barriers to nurse practitioners. Given the severity of our problem, shouldn’t we at least bring ourselves in line with those other states? Read the rest of this entry ?

Posted in advocacy/political action, nurse practitioners, nursing perspective | Tagged APRN, nurse practitioner, nurses, primary care, primary care physicians, scope of practice, Texas | Leave a Comment »

The Case of Amanda Trujillo

February 2, 2012

By Shawn Kennedy, AJN editor-in-chief

Amanda Trujillo, MSN, RN, is a nurse who until recently worked at Banner Del Webb Hospital in Sun City, Arizona, until she was fired for, as she claims, just doing what she’s obligated to do as a nurse—specifically, providing a patient information about a surgical procedure in an attempt to support fully informed decision making. (You can read her e-mail detailing her story here. She did not, as she has pointed out in comments, ever attempt to directly obtain informed consent herself.)

Amanda Trujillo

Ms. Trujillo says that, when the patient had a change of heart about the surgery, she requested a hospice consult. After a physician complained that Trujillo had overstepped her scope of practice, the hospital filed a complaint with the Arizona Board of Nursing, which has launched an investigation.

Ms. Trujillo has gone public with her story, sending e-mails and tweets to editors, public officials, bloggers, and the news media. The nursing blogosphere is full of posts with her story—Emergiblog, vdutton’s posterous (which has her attorney’s response to the complaint), and thenerdynurse, as well as a number of others. On January 31, she was interviewed on local television. She makes a compelling case that she was advocating for the patient’s right to information, and one wonders why she was fired and is under investigation.

As we have been for 112 years, AJN is all for coming out in support of nurses. Do we believe a nurse’s first duty is to the patient? You bet. We’re also all about accuracy and facts, and in this case, it’s been tough getting information from all sides. While certain assertions have been repeated in most of the supportive blog posts we’ve read, the undertone is that there is more to this case than the obvious.

Here’s what we’ve learned so far from the other parties: According to Joey Ridenour, MN, RN, FAAN, executive director of the Arizona Board of Nursing, “While the investigation is ongoing, information is kept private to protect the nurse should the complaint be unfounded.” She noted that while Ms. Trujillo can go public with details, the Board cannot. She did verify that Banner Del Webb Hospital filed a complaint about Ms. Trujillo’s practice on April 26, 2011, for “non-compliance with Federal, State or contractural arrangements.”

Ridenour also verified that at the January 24 Board meeting, the Board reviewed the case, voted to continue the investigation, and requested a psychological evaluation of Ms. Trujillo. When I asked if this was unusual, she said that in general, if the board feels that there is a lack of understanding in complex cases, the Board will ask for “expert opinion.” The Board will reconvene in March to review the findings and rule on the complaint. In the interim, Ms. Trujillo’s license remains active and without restrictions. Read the rest of this entry ?

Posted in advocacy/political action, ethical issues, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged Amanda Trujillo, Arizona Board of Nursing, Hospice, nursing license, scope of practice | 46 Comments »

Physician-centric vs. Patient-centric?

November 16, 2011

By Shawn Kennedy, AJN editor-in-chief

Last week, we posted here a piece by AJN’s clinical managing editor Karen Roush, decrying the use of the term “physician extender.” It reminded me of a recent article from the New York Times on nurses with doctorates, which reported that if some physicians have their way and their legal strategy succeeds, they will be the only group permitted to use the honorific “doctor.”

Degrees vs. licenses. This borders on the ridiculous, as the title is an academic title that signifies achievement in a field of study; it is not a license. Doctoral degrees are awarded in just about every field of study, from astronomy to zoology. Physicians are awarded a doctor of medicine, dentists are awarded a doctor of dental science, and so it goes. In health care, there are dentists, psychologists, social workers, physical therapists, pharmacists, and yes, nurses too, with doctoral degrees. Nurses have been earning PhDs and EdDs (doctorates in education) and the DNSc (doctorate in nursing science) for years, and now there’s a new nursing doctorate degree—a DNP, doctor of nursing practice—that’s specific to nurses in clinical practice. They are still licensed as nurses, as that’s what they are.

This parochial thinking is held by those physicians (not all, but far too many) who still adhere to the traditional view that they, and they alone, know what’s best for patients and for health care; they’re in favor of teamwork, but only as long as the team recognizes that they are the leaders and decision makers.

Both the media and the health care system bear some responsibility for this. The system itself is physician-centric rather than patient-centric—hospital policies, practitioner admitting privileges, purchasing (especially in the OR), and scheduling have often developed around physician preferences; reimbursements almost always must go through physicians, whether or not they’re actually involved in the delivery of care.

Most media portrayals, both fiction and documentary, focus on physicians as the only important providers in health care, relegating other health professionals to low-level supporting roles (or, as Roush noted,“extensions” of physicians). Read the rest of this entry ?

Posted in advocacy/political action, legal issues, media depictions of nursing, nurse practitioners, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged Doctorate, Health care, nurse, Physician | 1 Comment »

Domestic Violence Screening Matters

October 12, 2011

By Karen Roush, MS, RN, FNP-C, clinical managing editor

I am a nurse. I am a doctoral candidate and a writer. I am a domestic violence survivor. I lived for years with fear and uncertainty—will this be a good day, a day of laughter and affection? Or a brutal day of fists and humiliation? Like many women experiencing domestic violence, I hid it from my family and friends. In fact, I even hid it from myself. I couldn’t see myself as a battered woman, wouldn’t accept that I was that kind of person. But domestic violence doesn’t happen to a certain kind of woman—it happens to anyone, rich or poor, college educated or high school dropout, urban and rural, of every ethnicity. We—you and I—all are the faces of domestic violence.

Just ask. October is National Domestic Violence Awareness Month. How many of your patients have you asked about domestic violence this month? Or any month? Twenty? Ten? None? Screening matters. One of every four women you see has experienced domestic violence. Research tells us that women will talk about it when asked by a provider that they feel cares and can be trusted. They will leave an abusive situation when they feel supported and resources are available to them. Read the rest of this entry ?

Posted in advocacy/political action, human rights, patient perspective | Tagged Abuse, domestic violence, National Domestic Violence Awareness Month, nurses, screening | 5 Comments »

Federal Budget Battles Begin – Health Professions Education at Stake

October 3, 2011

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

U.S. Capitol building/Ed Siasoco, via Flickr

I’m subscribed to many listservs, mailing lists, and eNews alerts that help me keep track of news that may be important to nurses. One e-mail list I’m on is the Health Professions and Nursing Education Coalition (HPNEC), from the Association of American Medical Colleges. It closely monitors funding for health professions education.

Last week, the e-mail reported on the proposed 2012 federal budget—that is, the initial draft proposed by the House Labor, Health and Human Services, and Education departments appropriations subcommittee. Among a great deal else, this includes funding for Medicare, the National Institutes of Health, the CDC, and medical and nursing education (Title VII and Title VIII funding).

There’s already contention over the proposal, with the Democrats claiming they had nothing to do with it. According to ranking Democratic member Rep. Norm Dick, quoted in the minority party press release: “Make no mistake: this is not a committee product. This draft bill represents the ideological position of one committee member—the subcommittee chairman.”

Among other aspects, the proposal includes cuts to all monies to Planned Parenthood (as long as it continues to provide abortion services), National Public Radio, and any programs under the Affordable Health Care for America Act.

According to the HPNEC e-mail: “The bill offers a total of $87.5 million for Title VII programs, a $185 million (67.9 percent) cut, by eliminating funding for the Title VII Health Careers Opportunity Program, scholarships for disadvantaged students, primary care medicine, Area Health Education Centers, and allied health programs, and drastically reducing some other Title VII programs. For Title VIII [nurse workforce development programs], the draft bill provides $106.828 million, a $135.6 million (55.9 percent) cut, achieved through elimination of funding for the Title VIII loan repayment and scholarship program and comprehensive geriatric education, as well as reductions to other Title VIII programs.”

The press release from the Republican committee members lauds the proposal, quoting chair Hal Rogers: “To protect critical programs and services that many Americans rely on—especially in this time of fiscal crisis—the bill takes decisive action to cut duplicative, inefficient, and wasteful spending to help get these agency budgets onto sustainable financial footing.”

While this is only the first draft and no doubt there will be much haggling and political posturing, it serves as a reminder of the current rancor in Congress, where all issues seem to be battlegrounds.

You can compare funding from the prior year with the President’s request and the proposed bill, and also read the full text of the bill.

Posted in advocacy/political action, health care reform, nursing perspective, nursing students, Shawn Kennedy, AJN editor-in-chief | Tagged 2012 budget cuts, Federal health funding, House budget draft, Planned Parenthood | 1 Comment »

Bad Economy Breeds a New Era of Discontent Among Nurses

September 26, 2011

By Shawn Kennedy, AJN editor-in-chief

Nurses are taking to the picket lines, again. On Sept 22, an estimated 23,000 nurses in California struck at Kaiser Permanente facilities and also at Sutter Health hospitals and Children’s Hospital Oakland. The one-day strike was organized by the California Nurses Association/National Nurses United (CNA/NNU) to protest what they say are unfair rollbacks to nurses’ health coverage and retirement benefits, and was also intended as a show of support for striking coworkers.

But it’s not just U.S. nurses who are engaging in job actions—for example, in the United Kingdom, the 400,000 member Royal College of Nursing is contemplating the first strike in its nearly 100-year history and is soliciting the views of its members as to what action should be taken. The issue is nurses’ pensions and job cuts—according to Nursing Standard, “almost 10,000 NHS [National Health Service] posts in England alone have been earmarked for cuts.”

The poor economy is putting pressure on hospitals and health systems everywhere to reduce costs. One way to do this, of course, is to make cuts in what is traditionally the biggest expense in running the hospital—nursing. While this is a quick fix to the bottom line, it’s also one that doesn’t solve the problem. In fact, evidence shows that inadequate nurse staffing is linked to poor outcomes, which ultimately cost more in the long term—for the patients, for the health care system, and for nurses, who must deal with the burden of short staffing.

Let us know—how are things in your workplace?

Posted in advocacy/political action, nursing perspective, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged California Nurses Association, National Nurses United, nurse staffing, nursing strike | 6 Comments »

Feel the Power (What Nursing Can Learn from the Dancing Man)

July 5, 2011

By Shawn Kennedy, AJN editor-in-chief—Writing in a recent blog post on NursingTimes.net (a UK-based site), Mark Radcliffe poses this question:

“Do you, as a nurse, feel you have any collective power to influence policy? Are we as well versed as other professional groups in articulating loudly and clearly why nursing needs to be the foundation stone of any health service?”

I thought it was a good question for us here in the United States. Most U.S. nursing associations, nurse executives, and deans are invested in politics. The recent Institute of Medicine Report on the Future of Nursing is the most recent example of how nursing is collectively trying to influence health policy.

But I still wonder how many nurses involved in direct care feel that the politics of health is something they need to pay attention to. It seems that it’s only when it becomes part of the job, directly affects one’s ability to perform a job, or has an impact on one’s financial well-being that many people get involved.

When I was a young nurse, I and many in my cohort didn’t pay attention to things like politics or getting involved in associations. We were new and intent on acquiring skills and becoming competent in our jobs, and politics seemed esoteric and something we needn’t be concerned about.

But within two years, I found myself in court on a workmen’s compensation claim for an illness I’d contracted from a patient. I was going to be out of work for four to six weeks and was concerned how I was going to manage rent and other bills. However, because my professional association had fought for and won compensation for job-related illnesses, I received full pay while I was on medical leave. It opened my eyes to what collective action could do.

Nurses, especially those at the point of care, seem to come together readily enough to protect our rights as workers. But it doesn’t seem to go much further than that. Direct care nurses need to add their voices, support (and that includes financial support), and energy to the organizations and initiatives that are campaigning for our collective rights to practice as professionals, unencumbered by policies and laws that ignore the evidence of our value.

All nurses play a part in the politics of health—the question is, do we prefer to be mute bystanders and recipients of others’ rules and policies, or become the drivers and shapers of a new movement? (Since it’s July, see the video below for a somewhat frivolous take on becoming part of a movement.)

You can get involved: go to thefutureofnursing.org for ways to play a part.

Posted in advocacy/political action, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged activism, Dancing Man, how can nurses influence our health system?, Institute of Medicine | 1 Comment »

Year of the Nurse? ‘Don’t Get Mad, Get Elected’

June 15, 2011

By Maureen Shawn Kennedy, AJN editor-in-chief—Comparing the increase of nurses in Congress in the 2010 midterm elections to the near doubling of the number of women in Congress back in 1992, an article in a Robert Wood Johnson Foundation electronic newsletter last week suggested that perhaps 2010 could be called ‘The Year of the Nurse.’ The article noted that there are now seven nurses in the U.S. House of Representatives—four Democrats and three Republicans—up from three in the previous Congress. This is certainly progress, but we’ve yet to gain a nurse in the U.S. Senate.

Nurses see the results of failed social policies every day. We do tremendous work providing restorative care, teaching self-care practices, and promoting behaviors that will maximize health. But how many of us seriously think of engaging in the politics of health care? Instead of promoting health and changing lives on a case-by-case basis, when you hold political office you can affect the health of an entire population. Nursing education provides us with an incredible set of skills: critical thinking, creative problem solving, people skills, time management, the ability to set priorities and to constantly reevaluate their order—to say nothing of multitasking. Read the rest of this entry ?

Posted in advocacy/political action, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged Robert Wood Johnson Foundation | 1 Comment »

Tragedy into Policy: A Hepatitis C Outbreak and a Study of Nevada RNs Lead to New Protections for Whistleblowers

June 7, 2011

By Sylvia Foley, AJN senior editor

In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.

Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?

Posted in advocacy/political action, audio interviews, continuing education, ethical issues, infection control, legal issues, nurses, nursing perspective, nursing research, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged hepatitis C outbreak, infection control, Nevada whistleblower protection law, nursing research, patient safety, public health, Texas whistleblowers | 2 Comments »

Off the Charts

Archive for the ‘advocacy/political action’ Category

When Lawmakers and Physicians Hold Nurses Back

The Case of Amanda Trujillo

Physician-centric vs. Patient-centric?

Domestic Violence Screening Matters

Federal Budget Battles Begin – Health Professions Education at Stake

Bad Economy Breeds a New Era of Discontent Among Nurses

Feel the Power (What Nursing Can Learn from the Dancing Man)

Year of the Nurse? ‘Don’t Get Mad, Get Elected’

Tragedy into Policy: A Hepatitis C Outbreak and a Study of Nevada RNs Lead to New Protections for Whistleblowers

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