Archive for the ‘advocacy/political action’ Category

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In Memory of the Victims in Newtown

December 17, 2012

shawnkennedyBy Shawn Kennedy, AJN editor-in-chief

I could scarcely watch the news coverage of the horrific shooting that occurred in the small Connecticut town of Newton on Friday. It was just too awful. Children no older than seven, all shot, along with several teachers, by a young man who had already killed his mother and who later took his own life after causing unimaginable carnage. When the first reports emerged and newscasters were speculating on the number of people killed, I recalled then-mayor Rudy Giuliani’s reported response to a journalist who asked him how many were killed in the 9/11 attack on the World Trade Center: “More than we can bear.”

As nurses, we are no strangers to what happens when violence occurs. We see the results of it every day in our workplaces. Individuals, families, and communities are changed forever, and often we as caregivers are, too. What begins as an ordinary day becomes a tragic milestone: future events are remembered as “before” or “after” the event.

I’m tired of hearing “Guns don’t kill people, people kill people.” Yes, but some guns make it a heck of a lot easier to do so, and in large numbers. We’ve had Columbine, Virginia Tech, the Aurora movie theater, a Portland mall, Congresswoman Gabby Giffords and others on an Arizona street, and now Newtown.  And as I was writing this, the Chicago Tribune reported that a 60-year-old man in Indiana was arrested after threatening to set his wife on fire and kill people at a nearby elementary school. He had 47 guns in his house.

What are we waiting for?  Automatic weapons are too readily available; we need sensible restrictions on the purchase of automatic weapons. These are not hunting or sport shooting guns; they are rapid-fire machines designed to kill multiple targets in a short period of time. Some question whether anyone other than law enforcement and the military should be in possession of these guns. What does it say about us as a nation that we allow the greed of special interest groups and the politicians who cater to them to continue to block what is clearly for the common good?

In a Sunday column, Nicholas Kristof points out that, in the 18 years before Australia enacted gun control legislation limiting the sale of rapid-fire rifles, there were 14 mass shootings. There have been none since the law was passed.

There are more than 3.1 million nurses in this country. Although we are largely fragmented, choosing affiliations with many different organizations, this violence should bring us together with other health care colleagues to support changes in legislation around ownership of automatic weapons.


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Evidence Contradicts AAFP: NPs Ideal for Leading Patient-Centered Medical Homes

October 3, 2012

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

What will it take to end the turf war physicians are waging  against nurse practitioners? The latest foray is over who should lead patient-centered medical homes (PCMH). According to the American Academy of Family Physicians (AAFP), only physicians should. They insist that nurse practitioners do not have the knowledge or skills to do so and that expanding the NP’s role in primary care would create a “two-tiered health system,” with patients who are cared for by an NP receiving a lower level of care.

That’s not what the evidence says. Or patients for that matter. Studies consistently find that when care provided by NPs is compared to care provided by physicians, the care is similar as far as prescriptions ordered and referrals made—most important, outcomes are the same.

Well, there is one area where differences keep showing up: patient satisfaction. Patients consistently say that they are more satisfied with care provided by nurse practitioners. They say that nurse practitioners listen better, spend more time with them, and provide them with more information.

Not only are nurse practitioners capable of leading medical homes, their education and skills make them ideal for this role. Whereas physicians focus on pathology and have the depth of knowledge and skill to manage highly complex patients, NPs focus on the “human response to disease” and take a more holistic approach to patient care. Nurses coordinate care all the time, identifying the need for and arranging home care, rehabilitative care, nutritional support, and so on. Combine this with an NP’s well-documented diagnostic and patient management skills, and their qualification for this role is obvious.

There already exists a two-tiered health system in this country—but not the one AAFP is imagining. It’s between those who have access to care and those who do not. Expanding the role of nurse practitioners in primary care is one of our best hopes for alleviating that. We know it, the Institute of Medicine (IOM) knows it, and patients know it. It’s time for physicians to accept it.

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Nurse Staffing: Are the Brits on the Right Track?

June 26, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

hazard/jasleen kaur, via Flickr

According to an article at Nursing Times, hospitals in England may be required to publish “nurse-to-bed” ratios as part of an overall “dashboard” of indicators to measure  performance. While some say this is a step forward, UNISON, the public service union that represents nurses, argues that the better ratio to measure is nurse-to-patient and that variables in patient acuity should also be considered.

Nurse staffing has become an issue in National Health Service hospitals and in April UNISON released results of a survey of over 1,500 nurses and other health care workers about their shifts during the 24-hour period of March 6. The vast majority of respondents (73%) felt they did not have “enough time to spend with patients to deliver dignified, safe, compassionate care.” The Royal College of Nursing also supports mandatory safe-staffing ratios that take into account the skill mix of RNs to “health care support workers” or nursing assistants. 

Here in the United States, California is the only state to achieve any legislation for mandatory hospital staffing and it is a “minimum” nurse-to-patient ratio. While similar legislation has been introduced in a few other states and nationally, it hasn’t advanced.

The ANA does not support mandatory minimum ratios per se, noting in its Principles for Nurse Staffing (2nd edition), released earlier this month, “The solution is not as simple as increasing the number of nurses beyond what is minimally necessary.” The ANA advocates for a “nurse-directed” approach that includes minimum ratios but also takes into account patient acuity, the setting, and the skill set and mix of staff.

At the recent House of Delegates meeting, the ANA reaffirmed that safe staffing is a “top priority.” (Read the press release.) And in a December 16, 2011, letter to the Centers for Medicare and Medicaid Services, the ANA advocated for public posting of “hospital staffing plans” that take into account patient acuity, mix of staffing, and other factors, with these staffing plans to be modified as needed according to measurable patient outcomes—but did not necessarily call for staffing ratios.

What do you think? Should nurse staffing details be made public?

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Big Changes for New York Nurses

May 21, 2012

By Shawn Kennedy, AJN editor-in-chief

On Thursday, May 17, the New York State Nurses Association (NYSNA) held a special members-only meeting at New York City’s Jacob Javits Center to vote on bylaw changes that will drastically alter the future of the organization, morphing it from a professional association into a union. One of the key changes had to do with who could hold office in the organization: going forward, only bedside nurses, retirees, and “non-statutory” supervisors (i.e., those not able to hire or fire employees) would be eligible for office.

Other changes include eliminating the position of CEO and changing it to that of executive director, in order “to better reflect the union’s democratic roots and greater accountability to working nurses,” and a decision to push for nurse–patient staffing ratio legislation in the next session.

The NYSNA, which with 37,000 members, was founded in 1901 and is the oldest state nursing association in the country. Until January, when it was suspended for one year, it was the largest constituent member association of the ANA.

According to ANA documents, the NYSNA violated ANA bylaws by engaging in “dual unionism” when its newly elected board of directors replaced the CEO with Julie Pinkham, who is also the executive director of the Massachusetts Nurses Association (MNA). The MNA had disaffiliated from ANA in the past, along with the California Nurses Association, and were founding members of National Nurses United. The ANA maintains that this is a concerted effort to undermine NYSNA and, by affiliation, the ANA. The NYSNA appealed the decision, but the ANA reaffirmed the suspension in March. This also means that the member benefits of the 37,000 members are also suspended for the year.

I asked Bernie Mulligan, NYSNA’s communications director, about where he thought the organization’s relationship with ANA was heading. He said he felt it was premature to discuss the question of any future relationship and that the board would address that. The top priority for the organization now, he said, was getting nurse–patient ratio staffing legislation passed. “The members are clear, in that they overwhelmingly support this.”

Read more on this here.

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Kony 2012: A Real Villain, Plus a Few Questions

March 12, 2012

By Maureen ‘Shawn’ Kennedy, MA, RN, AJN editor-in-chief

Social media is once again proving its power to engage people around the world—this time, in the efforts to find and capture Joseph Kony, the leader of the Lord’s Resistance Army (LRA), a brutal militia group that waged a war of terror in Uganda for two decades and is now operating, in a diminished but still lethal capacity, in the Central African Republic, the Democratic Republic of the Congo, and South Sudan.

Kony was indicted for war crimes by the International Criminal Court in 2005 based on his record of murder, torture, rape, and the enslavement of thousands of people, mostly women and children. At its height, his army was said to be comprised mostly of child soldiers—the children he abducted and forced to become killers, whose first victims were often their parents. Filmmakers with Invisible Children, a nonprofit organization dedicated to influencing change in Africa, created Kony 2012, a film that “went viral” last week and fuelled widespread support for a campaign to support efforts to capture Kony.

Kony and the atrocities of the LRA are not new “news.” AJN reported on the issue of child soldiers in Uganda and numerous other countries in 2005, when we profiled the work of nurses Susan McKay and Dyan Mazurana, who researched and wrote about the plight of girl soldiers in their 2004 book, Where Are the Girls? The New York Times carried an article on LRA activities in 1997. For more than a decade there were official reports and fact-finding committees by the U.S. Congress, the United Nations, the World Health Organization, and others. In 2004, Uganda’s child soldiers was described by the UN as one of the “10 stories the world should hear more about.” In 2008, the UN Security Council passed Resolution 1856, condemning the LRA’s continued activities.

And last October, President Obama notified Congress that he had “authorized a small number of combat equipped U.S. forces to deploy to central Africa to provide assistance to regional forces that are working toward the removal of Joseph Kony from the battlefield.”

So why the emphasis now? Social media and the activation of a grass roots campaign with a targeted message enabled the message to spread rapidly. The film has been viewed over 55 million times on YouTube and the campaign has made headlines and the evening news shows, with celebrities jumping on the bandwagon, calling via Facebook and Twitter for Kony’s capture. The idea has been to make Kony so famous that he will have no place to hide, and to move people to demand that policy makers intervene.

Emerging questions. As a number of criticisms of the film and the organization behind it have noted (see this New York Times article and this Foreign Policy blog post), the video doesn’t make it very clear that the Ugandan army targeted Kony and drove him out of the country a number of years ago, nor that his marauding forces have since shrunk to several hundred, with most of the original child soldiers considerably older now and no longer with him. The articles also cite a number of sources who have raised questions about Invisible Children and its finances as well as about whether this campaign, however well meaning, is likely to be the best use of resources in a region beset by human rights and public health issues. Read the rest of this entry ?

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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 ?

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The Case of Amanda Trujillo

February 2, 2012

By Shawn Kennedy, AJN editor-in-chief

Post updated on January 10, 2013; see final paragraph. 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 ?

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Remembering the Big Picture, Hypothermia, Nursing Books of the Year

January 20, 2012

From its earliest beginnings, nursing has embraced a holistic view of health. What we eat, the environments in which we work and live, our social relationships—all these influence health. Yet, as nurses, many of us shy away from looking at the big picture; instead we narrow our focus, addressing only the immediate problems of this patient, this family. It’s true that many patients treated in hospitals or outpatient clinics are there only for a short time. But how will such patients and their families fare in the long run if they lack access to public transportation to get to their follow-up appointments? How can patients recover from illness when they must choose between paying the mortgage and filling prescriptions?

That’s an excerpt from “Voices Rising,” the editorial in the January issue of AJN by Shawn Kennedy, editor-in-chief. We hope you’ll take a moment to read the whole thing and give it some thought.

Also in the January issue, you’ll find plenty of reading suggestions in the AJN 2011 Book of the Year Awards; a CE on the causes, diagnosis, and management of hypothermia; and a great deal more, including a feature, “Cardiac Catheterization Through the Radial Artery,” that advocates the use of the transradial artery rather than the femoral artery for cardiac catheterization in certain situations.—JM, senior editor

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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 ?

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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 ?

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