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 ?
So Nurses Week 2011 has come and gone. I was in Malta at the start of it—at the 2011 International Council of Nurses (ICN) meeting in Valletta—and in New York City at the end of it. From two disparate locations, there was a singular thread: nurses seeking information to improve the lives of their patients and themselves.
In Malta, there were over 2,000 nurses from all over the world. Some participated as their nation’s representatives in the Council of National Representatives (see an earlier post describing ICN activities); some came for the educational sessions, or to share experiences or initiatives that have made a difference in the lives of nurses or patients. (I wrote about two of these moving stories.) The conference also served as a reminder of how much I regret not being fluent in another language—four years of high school French and a French-speaking grandfather helped a little, but there’s nothing like meeting colleagues who speak two or three languages (their own native language, English, and usually a bit of another one) to make you realize how necessary it is to be multilingual in today’s world.
The IOM report The Future of Nursing: Leading Change, Advancing Health came out this past October, causing a flurry of excitement among some in the nursing world and groans of “big deal” among others. My immediate instinct was to shrug my shoulders and wonder if yet another report will really make a difference at the bedside.
AJN addressed the report and its implications in our December 2010 and February 2011 issues—so I knew it must be very important. But, for some reason, I had assumed it was going to be a dry, unreadable bore. And I put off reading it until recently, when I needed to use it as a reference. And wow, was I in for a surprise! I especially liked the inclusion of real case studies of nurses from different backgrounds and work experience who are making a difference in health care.
It’s inspirational, and I encourage all nurses out there—and anyone with a stake in health care (that’s pretty much everybody)—to take a look. (Tip: I found downloading the PDF version didn’t take long, and it was much easier to navigate than the HTML version.) If you’d like to hear more on the report and what it means to nurses, sign up for our upcoming Webcast about it. Let us know if you have any questions or comments, and we can try to address them in the discussion. Here’s the official promo info:
LWW Nurse Editors’ Roundtable – The Future of Nursing
Tuesday, March 22, 2011, at 12:00 pm EDT / 9:00 am PDT Read the rest of this entry ?
Picture this: “Mimi,” an 18-year-old Brazilian girl who speaks little English, arrives in your ED with injuries sustained in a beating. She’s accompanied by an older man who refuses to leave her side and who intercepts and answers questions directed at Mimi. The ED physicians and nurses treat Mimi’s injuries and release her back to this man’s care. Maybe you feel uneasy, but what can you do? Maybe the man really is her uncle; maybe he’s just being overprotective.
In fact, Mimi is a victim of human trafficking, and the man who brought her to the hospital is both her pimp and her trafficker. And you and your colleagues just missed a chance to intervene on her behalf. Unfortunately, you’re not alone. In “The Role of the Nurse in Combating Human Trafficking,” a February CE feature, author Donna Sabella notes that clinicians who encounter victims of human trafficking often don’t realize it, and many such chances to intervene are lost. Sabella, a nursing professor active in helping such victims, hopes to change this. Read the rest of this entry ?
Last week, I spent two days at the summit convened by the Robert Wood Johnson Foundation to launch the Campaign for Action—the strategic plan to implement the recommendations of the Institute of Medicine’s (IOM) report on the future of nursing.
The days were packed with presentations from key players in health care, who offered their perspectives for implementing the recommendations (plus lots of networking, hallway “sidebars,” animated dinner conversation, and commitments from individuals and organizations to continue the momentum). Here are some quotes and snippets of conversation that stick with me as I work on a more comprehensive report:
IOM president Harvey Fineberg, in his opening remarks: “It’s our turn to act to advance nursing and health.”
Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, opening the event: “We will remember that we were here on November 30 at the beginning of a new future for nursing.” And cautioning: “scope of practice is the hot button that could blow all this apart.” (A thought echoed by Jack Rowe, an IOM committee member, professor at Columbia University Mailman School of Public Health, and former CEO of Aetna, who used the term “combustible.”) Read the rest of this entry ?
Of all the holidays, Thanksgiving seems to me to be the most pure—it began way before the greeting card folks thought of it and commercialized it. And it was born out of something that often gets lost during the course of our busy days—connecting with others and saying thank you for what they do or what they mean to us.
Christine Moffa, AJN’s clinical editor, and I were discussing the holiday at a staff meeting, saying how we had never minded working on Thanksgiving. Patients, visitors, and colleagues—everyone was in a friendly, appreciative mode. Most hospital cafeterias served turkey dinners to the staff, so everyone was happy about that—and everyone got to have a real dinner break for a change!
It also seems that at Thanksgiving we’re still in the “giving” mode, maybe because it’s early in the holiday season. My first request-for-your-support e-mail this season came from photographer Ed Kashi; it’s one I’m glad he sent. Ed is an incredibly talented megastar of documentary photography (in my humble opinion); we’ve been fortunate to have some of his work grace our covers (July 2007 and our 2008 Family Caregiver supplement, as examples) and articles. His e-mail was about an online auction of photographs called Commit to Action, a collaborative project by VII Photo (a photo agency) and Doctors Without Borders/Médecins Sans Frontières (MSF) to generate funds for MSF work around the world.
The e-mail contained images from another one of their projects, Starved for Attention, in which VII Photo members documented child malnutrition around the world. These images are sobering, especially on the day before Thanksgiving when most of us are consumed with food preparations.
I encourage you to visit these sites. While bidding on the photographs may be out of reach for many, there are two beautiful posters available for a nominal donation. You can at least sign the petition urging world leaders to provide more food aid.
Somehow, in this time when we pay farmers not to grow food, no one, least of all a child, should die from lack of food.
By Christine Moffa, MS, RN, clinical editor at AJN
Not only is antibiotic resistance dangerous and expensive, it’s on the rise. Unfortunately, cold and flu season can make people so uncomfortable they’ll do anything to feel better, including insisting that their health care provider write a prescription for a medication that can’t help them. In an effort to change this, the CDC and FDA have teamed up for the 3rd annual Get Smart about Antibiotics Week (November 15–21). You can check out their websites for various patient education materials and other resources to promote awareness at your facility.
For more information on antibiotic resistance and the Get Smart campaign, look at these articles published in AJN:
Sometimes it’s hard to not give in to the pressure when a patient expects a prescription at the end of a visit. What do you tell your patients or friends and family when they insist they need an antibiotic for cold or flu symptoms?
In 2008, a survey by the American Nurses Association (ANA) indicated that 64% of nurses reported a needlestick injury. That startling figure was reported by Marla Weston, CEO of the ANA, in her opening remarks last week when the ANA relaunched “Safe Needles Save Lives,” its campaign for use of safe needles in the workplace. The campaign originally launched ten years ago and was instrumental in passage of Public Law 106-430, the Needlestick Safety and Prevention Act, which requires employers to “identify, evaluate, and make use of effective safer medical devices.” And while there have been inroads towards use of safer needle systems, the 2008 data show that much needs to be done.
Speaking from experience. Karen Daley, the ANA president, has long been a leader in advocating for safer needle systems. She sustained a needlestick injury while working in the ER a decade ago and contracted hepatitis and HIV infection. Her home state, Massachusetts, has been in the forefront of legislation. According to Angela Laramie from the Massachusetts Department of Public Health, all hospitals in Massachusetts are mandated to use sharps injury prevention devices, maintain a log of any injuries, and submit an annual report to the state. Yet, state data show an average of 3,000 needlestick injuries yearly—and more than half of these are with devices that lack safe needle systems.
Why does this continue? Why can hospitals, clinics, and other workplaces that use sharps continue to not invest in safe devices when they are available and when, by law, their use is mandated? Nurses, does your workplace protect you from needlestick injuries?
The event was focused around a clip (longer than the one above) from “Bevel Up: Drugs, Users and Outreach Nursing,” an award-winning film by Canadian documentary filmmaker Nettie Wild. (A photo of a street nurse from the program appeared on AJN’s cover in July 2009, along with an article about the program.) Fiona Gold, BA, RN, and Juanita Maginley, MA, BSN, RN, whose work in Vancouver is the subject of the film, spoke on the panel about the value of harm reduction and about the systemic flaws and tendency to stigmatize drug addicts that prevent health care from reaching this population.
The powerful clip showed street nurses searching the city’s alleys and housing complexes for drug addicts, dealers, and sex workers. They carry bags full of syringes, condoms, and crack pipe mouthpieces which they deliver to those willing to take them. They ask street patients whether they might be pregnant, have unsafe sex, may have a disease, and if they want to have the nurses draw blood for testing.
The outreach project started in response to Vancouver’s alarming increase in HIV infections. Medical services were not reaching the most vulnerable people, so nurses devised a plan to go to them, a strategy they referred to as “meeting the client where they are.”
The nurses in the film show an amazing ability to balance gentle persistence and respect for the autonomy of their patients. We all know that some health care workers, including nurses, can be contemptuous of drug addicts, and may perceive addiction as self-indulgent and little more than a burden to the system. And far more money is spent on criminalizing drug use than on treating drug addiction as a disease.
My colleague Christine’s reaction to the clip reflected her experience as a nurse: ED nurses’ job “is difficult, and patients who are using drugs are not always easy to deal with.” But she also stressed that nurses don’t have a choice who they work with, and that the best approach we can take is to make sure they get enough training, both at school and at work, to meet the needs of this population.
To order the DVD of this film, which includes a teaching module, go here. It’s sure to start some lively conversations among health care workers.
This past Tuesday, I attended the release of the highly anticipated (at least by nursing) report by the Institute of Medicine (IOM) on the future of nursing. Spearheaded and supported by the Robert Wood Johnson Foundation (RWJF), the report provides a review of nursing’s role in health care and details what changes need to occur for the future—not just of nursing, but for the future health of the health care system.
While the findings support what nursing has been claiming all along—that nurses have a critical role in health care and the health care system needs nurses to practice to the full extent of their capability—what is especially important about this report is that it is backed by the IOM’s multidisciplinary panel and an “objective evaluation of evidence according to the robust evaluation processes of the National Academy of Sciences,” said John Rowe, a committee member and professor at Mailman School of Public Health at Columbia University.
The panel at the public briefing for the release of the report included some health care heavyweights who voiced strong support for the findings:
Risa Lavizzo-Mourey, president and CEO of the RWJF: “This is not a report about nursing but a report about a key missing piece to fixing health care; it establishes the centrality of nursing in providing safe, high quality, patient-centered care.”
Donna Shalala, president, University of Miami: “This report will usher in the golden age of nursing. Nursing has to be allowed to practice to the full extent of its scope of practice and to be a full partner with other professions in redesigning the U.S. health care system. It’s not about one profession substituting for another but about true collaboration.”
Later, in an interview I conducted with ANA CEO Marla Weston, she made a point of saying that allowing nurses to fully practice “isn’t just about NPs—nurses in all settings need to be allowed to practice according to their education and professional scope. Nurses in institutional settings are often limited by bureaucratic policies and procedures.”
Prior reports by the IOM have spurred transformation of health care delivery—think of the 1999 report on medical errors, To Err is Human: Building a Safer Health System, and how that initiated a focus on creating a culture of safety and brought about new standards for hospital safety. I’m hoping the same will happen now with this report.
What the MDs say. And I hope our professional colleagues will be open to the report’s findings, though I have some doubts. The American Medical Association issued a statement that, after initially noting that “health care professionals will need to continue to work together,” goes on to reveal that the AMA believes in “a physician-led team approach to care—with each member of the team playing the role they are educated and trained to play.” Further, it says, “increasing the responsibility of nurses is not the answer to the physician shortage.”
In that they are correct—the report is not about nurses taking on the functions of physicians; it’s about nurses doing nursing and yes, some nursing and medical tasks and procedures are the same. Physicians need to change their entrenched way of thinking that they and only they know what’s best for patients (case in point: see “No Country for Old Women,” a recent blog post by AJN associate editor Amy Collins about her grandmother) and for health care. Otherwise, we will all fail those we purport to serve.
Names and identifying details of all patients mentioned have been changed to protect their privacy.
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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 ?
