Posts Tagged ‘American Nurses Association’

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Behind Our Ambivalence About Flu Vaccines

November 9, 2012

By Amy M. Collins, editor

Influenza virus particle/CDC

Tis the season to start thinking about getting the flu vaccination. Every year I consider doing so, but due to my own personal vaccine angst I usually decide to just take my chances (while simultaneously lecturing elderly family members to make sure they get theirs, of course).  Working in Manhattan, with the vaccine available at most pharmacies and even vaccine access through work, gives me very little reason to forgo vaccination. And my theory that I am young and strong and can brave illness gets weaker as I pass the point of being able to comfortably claim youth. Riding the subway every day amid a festival of germs reminds me that I should know better.

The vaccine has caused a stir over the past few years: during the 2009 H1N1 pandemic, people worried about whether or not to get the new combined vaccine, and the question of mandatory vaccination for health care workers remains a hot topic even now.

But a new report, The Compelling Need For Game-Changing Influenza Vaccines, released by scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota, suggests that the flu vaccine may not be as effective as it is touted to be. According to the report, influenza vaccinations provide only modest protection for healthy young and middle-aged adults, and little if any protection for those 65 and older—those who are most likely to contract the illness and suffer its complications. In addition, the report’s authors concluded that federal vaccination recommendations are based on inadequate evidence and poorly executed studies.

With as many as 49,000 Americans dying from influenza each year, approximately 90% of them elderly, should the report matter to those on the fence about getting vaccinated? Not according to Dr. Joseph Bresee, chief of epidemiology and prevention in the CDC’s influenza division, who was quoted in the New York Times as saying, “Does it work as well as the measles vaccine? No, and it’s not likely to. But the vaccine works.” And the risk of being on the safe side and getting the vaccination appears to be quite low—the report acknowledges that currently licensed influenza vaccines in the United States are among the safest of all available vaccines.

The report ends by issuing an urgent call for improved vaccines: “novel-antigen game-changing seasonal and pandemic influenza vaccines that have superior efficacy and effectiveness compared with current vaccines are urgently needed.” These game-changing vaccines, says the report, must demonstrate increased efficacy and effectiveness for populations at increased risk for severe influenza morbidity and mortality.

So, will the report make a difference to nurses’ recommendations to patients this season, or affect their own decision about whether or not to get vaccinated? Will it influence the ongoing debate about mandatory vaccination for health care workers? For the record, it didn’t for me. At my yearly check-up, the flu vaccine was strongly recommended. The American Nurses Association continues to urge people to get vaccinated as part of their Unite to Fight the Flu initiative.

The report is not saying not to get vaccinated, just that it may not work as well as we’d hoped, and knowing this isn’t a deal breaker for me. So now I just have to get over my vaccine angst and take the plunge!

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Posted in H1N1 virus (swine flu), patient perspective, patient safety, public health nursing | Tagged , , , , | 3 Comments »

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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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Posted in advocacy/political action, international nursing, patient safety | Tagged , , , , , , | 39 Comments »

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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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Posted in advocacy/political action, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | Leave a Comment »

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Essential Nursing Resources: A Crucial Tool for Nurses Seeking Information on the Web

April 10, 2012

This nursing resource will help you find anything you need to know

By Maureen Shawn Kennedy, AJN editor-in-chief

Back in the dark ages, before the Web, when I was in school and researching a topic, I would go to the university library (in Manhattan, this meant a subway ride to the main campus), fill out a form, and hand it to the librarian. After a couple of hours, I’d check back and the librarian would have pulled up to eight “on-reserve” books (no more were allowed until these were returned) from the stacks and have them waiting for me. This cycle would repeat itself several times, and sometimes I’d have to wait for an “ILL”—an interlibrary loan. Of course, if I procrastinated, the material I wanted might already have been taken out by other students and I’d be out of luck, facing a deadline with no source material.

Of course, it’s all different now with the Web. This week, even the venerable Encyclopedia Britannica announced it is ceasing print production after almost 250 years and will only be available in digital format.

Now, researchers and students have virtually every article published available to them via the Internet. For nurses, there’s something called Essential Nursing Resources (pdf), an annotated listing of resources for nursing published by the Interagency Council on Information Resources in Nursing (ICIRN). 

Virginia Henderson

Founded in 1960 (here’s a brief history) by librarian and nursing organizations, including representatives from the Medical Library Association, the National Library of Medicine, the American Nurses Association, the National League for Nursing, and others (Virginia Henderson was one of the founders), it worked to organize and index the nursing literature.

The 26th edition of Essential Nursing Resources (updates happen biennially) is “a resource for locating nursing information and for collection development.” It lists ”print, electronic, and web sources to support nursing practice, education, administration, and research activities,” plus other information to guide the user when pursuing nursing topics on the Web, like articles on signing up for RSS feeds, a list of nursing blogs of note (this blog is included!), and more.

This isn’t just a resource—it’s a truly essential stop for finding nursing content and Web resources, a gift from some forward-looking people back in 1960.

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Posted in nursing research, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , , | Leave a Comment »

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Boards of Nursing and the Amanda Trujillo Case

February 17, 2012

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

Amanda Trujillo

Our prior post on the Amanda Trujillo case elicited many comments, on a variety of themes. There were also referrals and crosslinks to other sites supporting, analyzing, and weighing in on the situation, including statements from the Arizona Nurses Association and the ANA, and a post on a physician blog, “White Coat’s Call Room,” which has vowed to carry all the details once the case is decided.

One complaint raised by several people in response to our post was that the Arizona Board of Nursing wasn’t supporting Amanda. State nursing or medical boards are regulatory boards that exist to ensure the protection of the public and to regulate professional practice according to the law (in nursing’s case, according to nursing practice acts). They do not aim to protect the individual nurse, but to assure that all those who claim to be nurses are eligible to claim that title and practice within their scope of practice as defined by law.

Some historical context: Regulatory boards were set up back in the early 1900s, after nursing associations successfully lobbied for registration laws to keep out unqualified women who posed as nurses. In 1903, North Carolina was the first state to enact a nurse practice act; by the mid-1920s, all 48 states had laws regulating who could practice and who could use the title “registered nurse.”

Thus, boards of nursing are intended to protect the consumer and the standards of the profession.

While I agree with several comments saying that nurses should be able to practice within the full scope of their education and training, as recommended by the Institute of Medicine Report on the Future of Nursing, what’s also important to keep in mind is that we must do so in accordance with the law—which unfortunately may not always measure up to our ideals or accurately reflect actual professional practice.

Nurses and state associations need to work to change the law where it needs to be changed—and there are many people who devote themselves to making such change happen—but until the law does change, this is how nurses’ actions will be judged, whatever other motives may appear to be in play or not.

(Editor’s note: A few readers have misconstrued the last paragraph as implying a judgment in the Amanda Trujillo case. This is by no means the intended meaning. The focus here is a more general look at the roles of boards of nursing and the importance for all nurses of not leaving themselves vulnerable to accusations of going beyond their scope of practice, as it has been defined in a particular state’s practice acts. Further note: The Arizona Board of Nursing did subsequently release the Notice of Charges against Ms. Trujillo to those who requested a copy. It can be found via a link in this post from nurse/blogger Not Nurse Ratched.)

Addendum: January 10, 2013: The eventual outcome of this case can be seen in the “consent agreement” that Amanda Trujillo has signed with the Arizona Board of Nursing, which states that she “admits the Board’s Findings of Fact and Conclusions of Law” and agrees to fairly onerous terms for continuing to practice as an RN on probation. Thanks to blogger Not Nurse Ratched for providing a link to this document in her recent post about the case and its unfortunate history on the Web.

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Posted in ethical issues, legal issues, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 12 Comments »

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Webnotes: Nurse Comics, Uninsurance, Hospital Image vs. Reality, Social Media Guidance

September 15, 2011

The Web comes back to life after Labor Day weekend. Will, the nurse and artist who relates episodes from his life in comics at Drawing on Experience, has a new post about starting a job in a cardiothoracic intensive care unit (CTICU). There’s a thumbnail version of it below—click it to see the actual post in full size at his blog.

The best hospitals? The New York Times reports that “the country’s leading hospital accreditation board, the Joint Commission, released a list on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia.” Many of the hospitals often considered among the “best” (including those in New York City) did not, however, make this list (though some came very close). While hospital representatives argue that there are several mitigating factors that might have influenced these findings, this is a reminder that reputation and the presence of famous specialists may not necessarily mean the best care.

Their own darn fault. Though some may laugh at letting sick people who can’t pay for care just die, many of us are able to imagine ourselves, a friend, or neighbor in such a situation. For those who believe America should be more like Victorian England in its division between the the haves and have-nots (bring back debtors’ prisons!), good news: such hilarious down-on-their-luck characters should be easier than ever to find:

Nearly one million more Americans went without health insurance in 2010 than in 2009. This distressing news is further evidence of the need for government safety net programs and the national health care reforms that will take effect mostly in 2014.

Social media guidance for nurses. Last, but not least, the American Nurses Association (ANA) has released new social networking principles (which, somewhat surprisingly, given the topic, you have to purchase!). Still, it’s good that these exist, since nurse blogger Megen Duffy recently noted in her September iNurse column in AJN, “Patient Privacy and Company Policy in Online Life”:

Social media is a newcomer to health care, and policies are still being formulated. Mistakes will occur, and policies will be revised. Nurses can rise to the challenge and make sure their voices are heard in the formulation of workable guidelines; we live and breathe the nursing process, and if something isn’t working, we reassess and implement another plan.

Leave us your comments. This is social media, after all.—Jacob Molyneux, senior editor 

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Posted in art and nursing, health care reform, nursing perspective | Tagged , , , , | 3 Comments »

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HCR: Been There, Done That

January 18, 2011

By Maureen ‘Shawn’ Kennedy, AJN editor in chief

I was doing some research in the AJN archives and came across an editorial written in November 1993 by Virginia Trotter Betts, then-president of the American Nurses Association. “The Best Buy in Health Care” (click through to the PDF option; article will be free until July 18) reads like it was written with the Institute of Medicine’s Future of Nursing report in mind. Here’s an excerpt for those who don’t have access to the AJN archives (a shameless plug: subscribers have full access to ALL the issues of AJN, back to the very first issue in 1900—a treasure trove of nursing history):

“But we must also face the fact that such reform will require significant changes in nursing. Nurses will have to operate with greater autonomy and deliver care to a broader clientele. To foster enhanced roles for nurses as case managers and team leaders, nursing administrators must alert the work environment to offer a continuum of care on site and off site. Nurse educators will need to offer innovative programs, curricula, and clinical placements that prepare nurses for careers characterized by critical thinking and maximum flexibility. Nurse researchers will need to add more health care system, economic and policy studies to their repertoire.”

And another:

“Nurses want to do more in a reformed system to facilitate access at a reasonable cost.  We want to do what we are educated to do – provide basic health services like well and ill baby care, immunizations, and health screenings; manage chronic conditions; care for the sick and dying using both technology and interpersonal techniques; and a multitude of other essential services that are well within our expertise.  We want to educate our client and our communities and form a health care partnership with them.  We are team players and are ready to try to make new systems work for consumers.”

If only nurses ruled the world . . .

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Posted in from the archives, health care reform, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | Leave a Comment »

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Placenta Facebook Photos: Nurse and Mommy Tribes See Student Expulsion Differently

January 12, 2011

By Shawn Kennedy, AJN editor in chief

Many of you may be familiar with the recent “nursing-in-the-news” topic involving nursing students and a placenta. (For those who’ve been out of touch, here it is in a nutshell: three students were involved in photographing themselves with a placenta from a recently delivered mother and posting it on, where else, Facebook. The students were expelled. One student sued; the judge ordered all the students reinstated. See this article by the Kansas City Star that sums it up.)

The incident has provoked debate on various Web sites, including our own Facebook page, where the discussion mainly concerns whether the students were treated fairly or too harshly:

“It’s a placenta. I agree that it can seem a bit juvenile to photograph yourself with it, but an offense worthy of expulsion?”

“Juvenile? Perhaps. Punishable by expulsion? Absolutely not, imo. What exactly was wrong with taking a picture of a placenta? It’s not like you can identify who the placenta came from.”

“I think she should be punished but not expelled. in all reality a placenta is medical waste after delivery but it showed no respect for her patient, which needs to be addressed.”

And a really interesting question:

“Would she have been handed the same punishment had it been a picture of a full bed pan?”

Other sites also argue the “no harm, no foul” rationale—since there was no way to link the organ to a patient and so no breach of privacy, what was the harm? Comments on one of several posts about this issue at Those Emergency Blues came out in favor of the students. Nurse and blogger Phil Baumann’s post, “The Placenta Incident and The Shawshank Redemption,” did as well.

The school did seem to react harshly, especially when there seems to be some question as to whether the clinical faculty member might have been aware of the students’ activities.

However, there was a decidedly different tone on a blog called The Stir at CafeMom, a Web site focusing on pregnancy and motherhood, that should give us pause. Author Jean Sager writes the following in a post called “New Pregnancy Fear: Who’s Got Your Placenta Now?”: Read the rest of this entry ?

Posted in ethical issues, legal issues, media depictions of nursing, nurses, nursing perspective, nursing students, patient perspective, professional identity, Shawn Kennedy, AJN editor-in-chief, social media | Tagged , , , , , , , , , | 18 Comments »

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On the Road to the Future of Nursing

November 29, 2010

By Shawn Kennedy, interim editor-in-chief  

by wfyurasko/via Flickr

I’m writing this on the train to Washington, DC, heading to the National Summit on Advancing Health through Nursing, which is taking place November 30 and December 1. This is the next step of the Robert Wood Johnson Foundation’s Initiative on the Future of Nursing (see my October 8 blog post) and will launch the Campaign for Action—the plan for implementing the recommendations of the Institute of Medicine’s report, The Future of Nursing. (You’ll be able to access the webcast and a live chat of webcast users on November 30 here.)

If you haven’t read anything about this initiative, do so. If you’re a nurse and plan to be working for the next 10 years, the recommendations from this report, if implemented, will affect you in some way. Expect to see changes in the following areas, to name just a few:

  • how and where nurses practice
  • undergraduate and graduate curricula
  • licensing and certification criteria
  • reimbursement policies
     

Other nursing initiatives have come and gone, some more successful in achieving their goals than others. AJN will cover the progress of this initiative as it attempts to evolve from a written report to an active process that creates sustainable change. As a start, in the December issue, now available at ajnonline.com, AJN brings you a guest editorial by Susan Hassmiller, director of the Initiative on the Future of Nursing. There’s also a summary and analysis of the report in AJN Reports, and a podcast interview with Marla Weston, CEO of the American Nurses Association, discussing the recommendations. And I’ll be posting updates here on the blog.

The weight of the IOM, the Affordable Care Act mandating health reform, the aging of America, and the numbers of Americans living with chronic diseases—all have come together to create the “perfect storm” for significant change. This is perhaps the best opportunity nursing will have in our lifetime to become a decision maker in shaping health care delivery in this country. Here’s hoping . . .

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Posted in professional identity, nursing shortage, Shawn Kennedy, AJN editor-in-chief, media depictions of nursing, patient safety | Tagged , , , , | 1 Comment »

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Why Do Needlestick Injuries Still Haunt Us 10 Years after Protective Legislation?

November 8, 2010

By Shawn Kennedy, AJN interim editor-in-chief

By ad-vantage / Vanessa Agressti, via Flickr

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?

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Posted in advocacy/political action, infection control, practice tips, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 8 Comments »

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