Recalling the Why of Health Care Reform

By Jacob Molyneux, AJN senior editor ACA ruling imageIn a brief analysis of the gradual rollout and effects so far of the Affordable Care Act (ACA) at the start of this year (“The ACA Continues to Run the Gauntlet”), I reviewed a few of the issues the law was intended to address when it was passed in 2010:

* the highest per capita expenditures of any health care system in the world

* consistently worse outcomes on measures such as infant mortality rate than most other developed nations

* increasing numbers of uninsured Americans each year, to over 50 million in 2009, the year before passage of the ACA

* unsustainable annual increases in health insurance premiums and drugs costs, leading to astonishing rates of medical bankruptcy

* a Medicare reimbursement process that rewarded the volume of care provided rather than the effectiveness of that care

These worsening issues had become impossible to ignore. No one believes the ACA is a perfect law; there were too many cooks in the kitchen for that. But it’s at least a good faith attempt to address real problems, to get a framework on the table that can potentially be improved upon. […]

2016-11-21T13:02:55-05:00March 4th, 2015|health care policy, Nursing, Patients|0 Comments
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Addressing Alarm Fatigue in Nursing

by flattop341/via flickr by flattop341/via flickr

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

“Will you please silence that alarm?!” The nurse is on the phone, and can’t reach the screaming cardiac monitor. It’s a normal request, considering that we’re working together in an ICU and the alarm has been ringing for awhile.

But her request for silencing the alarm isn’t issued to me; she’s talking to the unit clerk. Stuck in my patient’s room, I watch as this untrained staff member taps the flashing rectangle on the unit’s central monitor. Without having first been appropriately evaluated, the ringing disappears, along with the words “Multifocal PVCs.”

Later, the same unit clerk absentmindedly turns off a sounding alarm, without encouragement from a nurse. I’m floating today, and although I’ve just met her, I can’t help but ask, “Do you know what that alarm was saying? Was it accurate?”

She is clearly startled by my admonishment, but I persist. “A lot of the alarms around here do seem to be false, but what if this one wasn’t? Do you have the training to know the difference, and to report it?”

If looks could kill, the one that meets my gaze is certainly homicidal, but it’s paired with a grumbled promise to never touch the screen again. So maybe my […]

2016-11-21T13:02:55-05:00March 2nd, 2015|Nursing, nursing perspective, Patients|5 Comments
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AJN in March: Post-ICU Syndrome, Workplace Conflict Resolution, Prostate Cancer Options, More

AJN0315.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss.

New program for postintensive care syndrome (PICS). With increased ICU survival rates, we are seeing more complex cognitive, physical, and psychological sequelae. The authors of “Critical Care Recovery Center: An Innovative Collaborative Care Model for ICU Survivors” share how they created and implemented an evidence-based collaborative care program for ICU survivors to reduce morbidities that can affect their quality of life. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Helping men with localized prostate cancer make informed decisions. The information men receive at diagnosis of prostate cancer can be overwhelming. “Early Localized Prostate Cancer” reviews the multiple treatment options available for men with newly diagnosed, low-risk, localized prostate cancer and explains how nurses can help these men make informed decisions. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes). […]

2016-11-21T13:02:56-05:00February 27th, 2015|career, Nursing, nursing perspective, nursing research, patient engagement|0 Comments
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Tips for Getting a Nursing Job Interview in the Age of Electronic Applications

Illustration by the author

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration is by the author.

Twenty-plus years ago I was job hunting in Portland, without a local connection in health care. Prepared with an Oregon nursing license, I applied for the only two open pediatric ICU positions in the city, found in newspaper want ads. The positions were in the same unit. Having several years of PICU experience, I was hopeful that I’d get an interview.

Two weeks went by without a phone call for an interview. Worse, I noticed that only one of the postings remained. With nothing to lose, I called the hospital’s human resources department.

“Hi, I applied for the positions of pediatric intensive care nurse at your hospital,” I said. “I see that one has been filled. I have seven years of experience, including transport of critically ill children, and PALS certification. I’m curious if there’s a reason I haven’t been offered an interview? I know if the manager meets me, she’ll love me.”

“I’ll look up your application, and get back to you,” was the response. Half an hour later, the PICU nurse manager called to set up an interview. “I’m sorry,” she explained. “Your application didn’t make it to my desk. Apparently it was misplaced by HR.”

I was hired at the interview, and held […]

2016-11-21T13:02:56-05:00February 26th, 2015|career, healthcare social media, Nursing, nursing perspective|2 Comments
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The Delicate Dance for Stability

By Patricia O’Brien

Loïe Fuller sketched by Henri de Toulouse-Lautrec/via Wikimedia Commons Loïe Fuller sketched by Henri de Toulouse-Lautrec/via Wikimedia Commons

In college I got a part-time job as a companion to an elderly widow named Fran, driving her around town and assisting with errands: post office, hairdresser, the market, her psychiatrist. The routine was set, and all was well for many months.

But one day, something unusual happened. Fran opened her door with a grand flourish, eyes shining. The television, radio, and blender were blasting. “Shall we go,” I asked, hurrying to turn off the noisy electronics.

“Fran,” I observed, “the blender’s empty.”

“Let’s not bother with tiresome details. I’m out of my head today,” she said, with purposeful excitement. At the pharmacy, this time, I took notice of the medication I picked up for her: lithium.

“What’s lithium for?” I asked, sliding into the car.

“A bipolar disorder. Not to worry. I’ve navigated these choppy seas half my life.”

We did errands. All the while, she acted like she was on the campaign trail for mayor, laughing, waving to friends, and smoking up a storm. At the market she hugged the meat manager, who was arranging Italian sausages. He looked confused, but smiled and told her there was a special on calf’s liver.

“I’ll take it all,” she declared, making a […]

2016-11-21T13:02:57-05:00February 23rd, 2015|Nursing, patient experience, Patients|1 Comment
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