On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

President Barack Obama speaks to a joint sessi...

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful […]

2016-11-21T13:13:54-05:00March 8th, 2011|Nursing|1 Comment
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Psychiatrists as Therapists: A Vanishing Breed

By Maureen Shawn Kennedy, AJN editor-in-chief

In an article in the New York Times on Sunday, writer Gardiner Harris described how many psychiatrists have abandoned psychotherapy in favor of short consultations and pharmacotherapy; if patients want to discuss their problems, they are referred to a therapist. The main driver of this trend is money—with other, cheaper professionals available to provide therapy with comparable results, insurance companies won’t pay the higher fees most psychiatrists charge. So, instead of seeing 50 to 60 patients a week for the traditional 45-minute session on the psychiatrist’s couch, the psychiatrist can see 1,000 or more patients in a 15-minute, “what’s happening? do you need a medication adjustment? see you next week” check-up. As the wife and business manager of the psychiatrist profiled in the article says, “It’s all about volume.” One only hopes that most of the patients take his advice to see a therapist.

In fact, there is a growing body of evidence favoring psychotherapy over medications in mental health, notably in depression. In a recent meta-analysis in the Journal of Nervous and Mental Disease comparing psychotherapy with second-generation antidepressants (SGAs), researchers found that “ [b]ona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.” 

And in the March issue of AJN, we report on a study published in the Archives of General Psychiatry, which found that “cognitive therapy combined with […]

2016-11-21T13:13:55-05:00March 7th, 2011|Nursing|1 Comment
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Workplace Violence: Whose Problem Is It?

By Julianna Paradisi, RN

Once upon a time, I was the assured quality (AQ) representative for a nursing unit. I attended monthly AQ committee meetings with members from medicine, pharmacy, laboratory, and respiratory therapy to review incident reports. We developed processes for improving patient safety and work flow. Agenda items changed monthly, except for the paper towel dispenser problem.

The unit had a paper towel dispenser, which operated by a lever. It was noisy, disturbing the patients. It did not hold enough paper towels for 24 hours. Since housekeeping did not staff to fill paper towel holders on night shift, physicians and nurses entering the room found them empty after washing their hands in the morning. This angered everyone, so it went on the AQ committee’s agenda.

The unit needed new towel dispensers. However, the committee could not determine whose job it was to research replacements. No one knew which department was responsible for ordering new dispensers, or whose budget would pay for them. Since there were other agenda items to discuss, every month the towel dispenser problem was “parked” for the next meeting. This continued for the entire time I served on AQ. The problem remained unresolved when I moved on.

Workplace violence toward nurses feels like the “irresolvable dilemma” of the paper towel dispenser. Over the years, statistics […]

2016-11-21T13:13:58-05:00February 28th, 2011|career, Nursing|1 Comment
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When Patient Safety Trumps All: Conversations With the Texas Whistleblower Nurses

Map of USA with Texas highlighted Image via Wikipedia

You may not remember February 11, 2010, all that well, but it’s a date nurse Anne Mitchell will never forget. It was the date she was acquitted of all criminal charges in a case that garnered widespread coverage not only in the nursing world (see our October 2009 report) but in the general media (see the New York Times article).  Mitchell was the Texas nurse criminally prosecuted for filing a complaint with the Texas Medical Board against a physician for unsafe and substandard practices (that board did agree with her). She and a colleague found themselves embroiled in a nightmare in which they were fired, arrested, and indicted. (Charges were eventually dismissed against Vicki Galle and only Mitchell went to trial.)

The case raised questions about a nurse’s professional and legal duty to safeguard patients—and about the strength of whistleblower protections (Texas has a whistleblower protection law).

In a “what goes around comes around” scenario, this past February those who pressed the charges—the sheriff (who was a patient, friend, and business partner of the physician); the Winkler County attorney; the former hospital administrator; and the physician—were all indicted by a grand jury. Ironically, the indictment was partially for misuse of official information, the same charge they had brought against the nurses.

On February 18, I interviewed Mitchell, Galle, and another colleague, Naomi Warren, who also wrote a […]

2018-03-13T10:43:04-04:00February 25th, 2011|career, nursing perspective|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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