Advanced Practice Nurses: Pushed Forward by Health Reform Advocates, Pushed Back by Physicians over Turf – Enough Already!

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

As we’ve noted in past posts on this blog and in AJN editorials in August 2006 and August 2008, organized medicine does not want to acknowledge that nurses can practice independently.  And now the turf war between advanced practice nurses (APRNs, which include nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists) and physicians is heating up.

In California, physicians are suing the state for allowing nurse anesthetists to practice without supervision, using patient safety as a reason. In Kentucky, physicians are opposing legislation to expand the scope of practice for NPs—at issue is whether NPs should need a signed collaborative arrangement with a physician (even though the physician does not supervise the NP). According to an article by a Louisville, Kentucky, newspaper, the Courier-Journal, the physicians charge high fees for their signature or demand a percentage of the practice.  The bill, though, passed the state House committee on March 4, with several members questioning the ethics of physicians’ requiring fees.

Nurses have been and continue to fight for the right to practice, and during this period where the government is seeking solutions to health reform, this is a battle that shouldn’t have to happen—a view shared by Stephen Ferrara, NP, at A Nurse Practitioner’s Place (“I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care”). […]

Notes from the Healthweb and Nursosphere

This week Not Nurse Ratched has an amusing, meandering, and thoughtful post about the uses of Facebook by patients in the hospital. There’s a short excerpt below, but read the whole thing here.

They update Facebook constantly. CONSTANTLY. They have us take photos of injuries they can’t reach so they can post the photos to Facebook. I am not making this up. “I want a photo of my hideously dislocated ankle/knee/shoulder but I can’t move, so would you mind using my phone to take a picture for me?” And they keep updating and updating. I have actually said, “I’m about to give you a medicine that is going to render you unconscious immediately, so you should set your phone down.”

How could we have a weekly Web roundup that doesn’t at least mention health insurance reform? The spotlight has been slowly turning toward the insurers themselves, a crucial part of the equation (along with cost control and many other factors). This week Secretary of Health and Human Services Kathleen Sebelius met with the top executives of insurance companies to demand an explanation for the steep increases in rates seen in the last year.

If you’re looking for yet another reason why processed food isn’t good for you (besides the frequent presence of high fructose corn syrup and massive doses of salt, and the inaccurate packaging claims that the foods are “healthy” and “lean”), this week the NY Times reported news […]

‘Ask Me Three Questions’: Engaging Patients to Promote Safety

By Peggy McDaniel, BSN, RN

Next week, March 7–13, is Patient Safety Awareness Week. The National Patient Safety Foundation (NPSF) has sponsored Patient Safety Awareness Week since 2002 to help promote awareness of patient safety issues among hospital staff, patients, and communities. This year’s campaign focuses on engaging patients in theior own care, and it draws upon the NPSF template “Ask Me Three,” which encourages patients to ask these questions:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

[…]

Why the ‘Greatest Generation’ Is Bagging Groceries (No, It’s Not Because of Taxes)

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

In surfing the Web Monday, I came across this interesting tidbit on the blog run by Gary Schwitzer, creator of HealthNewsReview.org, a site devoted to assessing the accuracy of health news coverage. He quoted statistics from a report  by the Center for Public Integrity, which claims that “there are eight lobbyists for every member of Congress.” The number of lobbyists went from about 1,400 in the first quarter of 2009 to nearly 3,700 by year’s end. 

I see elderly people in the supermarket bagging groceries—some may like the company, but others are doing it to pay for medical care not covered under plans. My uncle—one of the “greatest generation”—used to cut his pills in half to make them last longer. Does this qualify as “rationing care”? […]

The Power of No

. . . . What really struck me about the meeting, however, was the inability of Republicans to explain how they propose dealing with the issue that, rightly, is at the emotional center of much health care debate: the plight of Americans who suffer from pre-existing medical conditions. In other advanced countries, everyone gets essential care whatever their medical history. But in America, a bout of cancer, an inherited genetic disorder, or even, in some states, having been a victim of domestic violence can make you uninsurable, and thus make adequate health care unaffordable.

One of the great virtues of the Democratic plan is that it would finally put an end to this unacceptable case of American exceptionalism. But what’s the Republican answer? Mr. Alexander was strangely inarticulate on the matter, saying only that “House Republicans have some ideas about how my friend in Tullahoma can continue to afford insurance for his wife who has had breast cancer.” He offered no clue about what those ideas might be.

That’s from “Afflicting the Afflicted,” Paul Krugman’s NY Times column about the health care reform summit that took place yesterday. It really is bewildering that so many elected officials can simply refuse to engage one of the major issues of our time. How can their supporters not begin to wonder at this as they themselves in ever greater numbers go into medical bankruptcy, are forced to choose between basic medications for chronic illnesses, […]

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