Building Back Better: Constructive Nursing Regulation

As governor of the first COVID-19 epicenter in the country, Andrew Cuomo challenged New Yorkers to think about how the state could “build back better” after the crisis. As registered nurses with experience in health law and policy, we have recommendations for transforming the boards of nursing. The manner in which nurses are regulated must be reformed, not just in New York, but throughout the country. It must begin by understanding the dangerous environments in which nurses are working.

Staffing, safety issues affect both nurses and patients.

In May, for example, Governor Cuomo reported that 12.2% of health care workers in New York city had been diagnosed with COVID-19. Nationwide, more than 164 nurses have died, often because they lacked adequate personal protective equipment. But COVID-19 is not the only dangerous situation. Long-term and psychiatric care facilities, as well as hospitals, are often dangerously understaffed, exposing nurses to violence. Nurses and other workers have been attacked and sometimes killed because they lack necessary resources and protections. Workplace violence is a growing threat which has not been adequately addressed by health care managers and administrators. Danger to patients occurs when nurses are expected to accept assignments outside of their areas of expertise. Nurses cannot care […]

2020-07-27T07:08:18-04:00July 27th, 2020|Nursing, nursing career, nursing perspective, patient safety|2 Comments
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The Baby with Tetralogy of Flow

It is a good day so far—none of the 16 critically ill babies in the neonatal intensive care unit has coded or died. So far, the shrill electronic alarms for dying babies have been silent.

As the neonatologist on call, this gives me the opportunity to talk to Anna and Jake, Baby Milo’s parents. Milo peers up at them with big brown eyes as Anna leans over his crib and whispers to him. A small transparent plastic mask covers Milo’s tiny nose to help him breathe, and a cluster of saliva bubbles percolate between his lips. Despite a sleeve of tape securing his right hand, his tiny fingers tug the orange orogastric tube taped to his cheek.

Milo’s father, a brawny man wearing scuffed brown shoes, ripped blue jeans, a T-shirt, and a tattered Green Bay Packers cap, sits in a chair and nervously taps his knee while he stares with bloodshot eyes at the vital signs on Milo’s bedside monitor.

“Milo is adorable,” I say from the doorway. His parents look over to me as I step into the room.

“We think so,” Anna says with a smile.

“How are you both doing?” I ask. “Being in the NICU can be pretty stressful.”

Milo’s parents glance at each other and nod. Anna takes a seat next to Jake, who touches her shoulder.

I pull up a chair. “Can you tell me Milo’s story? How did you end up in the NICU?” I say.

“We were celebrating my birthday at a steakhouse,” Jake says. “Right after they brought […]

2020-07-15T11:23:21-04:00July 15th, 2020|family, family experience, pediatrics|0 Comments
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Food or Meds? The Lose-Lose Choice Facing Some Older Americans

Food insecurity was already common in older adults before the pandemic.

image by congerdesign from Pixabay

Years ago, when I worked as an ED nurse at Bellevue Hospital, one patient who became a favorite was a charming octogenarian named Sam. He would frequently present in congestive heart failure or pulmonary edema. He always responded quickly to treatment and often just needed a bit of furosemide to get rid of excess fluid.

After one of his almost monthly admissions, we found out that Sam relied on canned soup for much of his diet. The high salt content would cause him to retain too much fluid. He knew the salt wasn’t good for him, but soup was cheap and sometimes all he could afford.

What is food insecurity?

The United States is one of the world’s richest countries, yet we know that hunger is a common problem for many people. Older adults, especially those over 65 with multiple chronic conditions and who take multiple medications, are especially at risk for food insecurity—the inability to afford healthy and nutritious food.

Hard choices for elderly on a fixed income.

Many older adults live on fixed incomes and many don’t have supplemental insurance to cover medications. Some may have to choose between paying for medication or paying for other necessities like housing and food.

Many rely on programs like Meals on Wheels or food banks, but a number of these programs were suspended, at least for a time, during the early days of […]

2020-06-16T15:26:38-04:00June 16th, 2020|Nursing, Patients, Public health|1 Comment
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Cast Into the Shadows: COVID-19’s Power Over Non-COVID Cases

As a pediatric ICU nurse in a hospital that has not experienced an overwhelming surge of COVID-19 patients, it has taken me some time to register the ways this pandemic has affected my perspective and practice.

Non-COVID diagnoses left in the shadows.

Photo by Unjay Markiewicz/ Unsplash

I recently took care of two young patients, each with acute and unexpected conditions. One was under post-operative care after a brain tumor had been removed the day before. The other had been newly diagnosed with acute lymphoblastic leukemia. What stood out to me as I interacted with their families was that these were some of the only people I would interact with in this period who did not have COVID foregrounded in their mental and emotional space. This feeling was followed by the sobering realization that this was only because they found themselves dealing with something just as insidious, if not more so.

In both cases, the families observed confusing symptoms in their children and had to wrestle with whether or not to go to the ED in the midst of a pandemic. Only when the symptoms became so severe and concerning did these families decide they could no longer avoid the ED. Now facing an inpatient hospital stay […]

2020-06-02T09:32:44-04:00June 2nd, 2020|family experience, infectious diseases, Nursing, nursing stories, patient engagement, Public health|1 Comment
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Time Matters, Priorities Change: A Nurse and Cancer Survivor on Living with the Pandemic

Everything is different, and the same.

Michael Himbeault/Wikimedia Commons

It’s going to be a while before things get to normal, if they ever do. It’s more like the future will become the normal.

The only thing in my experience I can liken it to is my cancer survivorship: you start living your life again, but everything is different. Priorities change. Your sense of safety never fully returns, yet because of this you become more purposeful in living: time matters. It’s as though you go on living, but learn a new way to do it.

There’s actually a sense of freedom accompanying the realization that nothing/no one lasts forever.

Finding a middle ground.

After I completed treatment, I watched the Jeff Bridges film Fearless (1993). His character is a survivor of a horrendous airliner crash, and he develops a sense of invincibility as a way of coping. I understood his character really well. You either hide in fear, or you go forward as if you are invincible. Eventually, you discover a middle ground. […]

2020-05-27T10:26:29-04:00May 27th, 2020|infectious diseases, Nursing, patient experience, Public health, wellness|0 Comments
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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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