Jacob Molyneux, senior editor/blog editor, Author at Off the Charts

Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:50-05:00September 29th, 2011|nursing perspective|2 Comments

The NLN: Where Nursing Teachers Go to Learn

By Shawn Kennedy, AJN editor-in-chief

As a nursing student, I was always awestruck when an instructor could rattle off a few points that keyed me into what I should be thinking about when I approached a patient, or use questions to lead me through a thought process that ended with the discovery that I’d known the answer all along. It never dawned on me that those were teaching skills, tools of the trade that she’d learned as an educator.

Last week, I spent a few days in Orlando, Florida, attending the 2011 Education Summit of the National League for Nursing, or as most nurses know it, “the NLN.” I’d venture that if you asked most nurses (who aren’t faculty, that is) what they know about the NLN, they’d answer that it’s the body that accredits nursing schools (key information when deciding what nursing program one should attend). While that’s partially correct, that’s only one part of the NLN’s mission. […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:51-05:00September 27th, 2011|Nursing|0 Comments

Bad Economy Breeds a New Era of Discontent Among Nurses

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 […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:52-05:00September 26th, 2011|career, nursing perspective|5 Comments

‘The Worst I’ve Ever Seen’: One Persistent Nurse’s Take on Somalian Refugee Situation

By Shawn Kennedy, editor-in-chief

Gerry Martone is a nurse who has traveled to the far reaches of the world in his job as director of humanitarian resources at the International Rescue Committee (IRC). We ran a profile of Gerry in 2001 and also a photo essay. He’s also a skilled photographer and we’ve published his photo essays documenting his travels. (See here for one on assessing poverty in Afghanistan and here for one on Sudan refugees; click through to PDF versions for best viewing.)

So when I spoke with Gerry last week, shortly after he came back from a visit to a refugee camp in Kenya, it scared me when he said the situation in East Africa is the worst thing he’s ever seen. The region is plagued by a severe drought (Martone says it’s had no appreciable rain in two years), and while drought is a cyclical phenomenon there, a struggling central government, lack of health and response systems, and ongoing conflicts among local clans have worsened the situation, causing widespread food shortages. The global community is responding with aid, but for many, it will be too late.

He visited a UN camp outside the city of Dadaab, Kenya, to which more than 440,000 displaced people—mostly Somalians, who are the hardest hit—have fled. The IRC runs a hospital at the camp. The situation is dire: the UN estimates that, […]