Nurses Doing Primary Care, Hospital-Acquired Infections, Questionable Celebrity Advice, and Tort Reform

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

That’s the start of an MSNBC story called “Doc Deficit? Nurses Role May Grow in 28 States.” Much of the article is about nurse practitioners (NPs)–and the different ways they are (or are not) allowed to practice in different states, as well as the ongoing efforts of physician groups to limit their practice (even as the health care overhaul increases the demand for primary care physicians and invests in nurse-managed clinics). We’ve posted on scope of practice issues here more than once—what’s your take as nurses, or patients?

HAIs persist. Also today, as described from a number of perspectives in a collection of articles on Kaiser Health News, the Department of Health and Human Services (HHS) released a report stating that the rate of hospital-acquired infections did not improve in 2009, despite ongoing attention to this issue in studies, IHI initiatives, nursing journals, and nearly everywhere else. What gives?

Does getting sick make you an expert? Elsewhere, at Covering Health (the blog of the Association of Health Care Journalists), Andrew Van Dam is critical of tennis star Martina Navratilova’s public advocacy for yearly mammograms for women over 40.

In February, Martina […]

2016-11-21T13:18:11-05:00April 14th, 2010|health care policy|0 Comments
Read More

‘What’s Not to Like?’ A British Nurse, Recently Treated for Cancer, Weighs In on U.S. Health Reform

Here’s a little perspective on health care reform in the U.S. from AJN’s contributing editor on international health. Jane Salvage, RGN, BA, MSc, HonLLD, FQNI, is a visiting professor at the Florence Nightingale School of Nursing and Midwifery, King’s College, London, and recently spent a year on the Prime Minister’s Commission on the Future of Nursing and Midwifery.

Just two weeks ago I learned I had a stage 1 endometrioid adenocarcinoma—a cancer in the lining of my womb. In many other countries today, and in the UK until recent years, this would eventually have killed me. But here I am today, happily home after a hysterectomy, probably cancer-free, thanking my lucky stars and our British National Heath Service (NHS).

My life has been saved by an army of people, from nurses and doctors to lab assistants, many of whom I’ll never meet. All my high quality care was free at the point of delivery, efficiently funded from my taxes instead of boosting the profits of insurance officials or millionaire surgeons. And I am pleased that my taxes have also subsidized the care of the demented, impoverished old lady in a nearby bed, even though her hollering and howling kept us awake most of the night.

What’s not to like? A great deal, you’d think from the nonsense talked about our UK NHS during your U.S. health reform debates. Last September, visiting the Robert Wood Johnson Foundation Initiative on the Future of Nursing, I stayed at the same […]

2018-03-27T16:36:45-04:00March 26th, 2010|health care policy, nursing perspective|8 Comments
Read More

Will Anyone Miss Accidents As ‘Preexisting Conditions’ and Other Insurance Doubletalk?

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

It’s interesting to have a firsthand encounter pertinent to the HCR story that is consuming the headlines. Recently, my son had a fall and dislocated his shoulder. He knew what had happened because he did it as a freshman in high school, some 10 years ago while playing sports. So he went to an ER and had the shoulder popped back in, saw an orthopedist as recommended, and went for physical therapy—all covered by his insurance plan. But all his claims for reimbursement were denied. The reason the company gave: his dislocated shoulder was considered a ‘preexisting condition.’

After my husband peeled me off the ceiling, we approached this methodically—we gathered forms, wrote letters, requested letters from the hospital, the orthopedist, the physical therapists—and appealed the ruling. After a bit, we received a response saying that they’d reconsidered and would cover the injury according to policy.

This is not a terribly compelling or poignant case, but it’s an example of the “first deny all claims” approach of some companies. Yes, it was resolved on appeal fairly easily, but why did it need appealing in the first place? I can’t imagine what patients and families with chronic illness must go through in trying to get treatment covered.

If the only thing health reform does is to eliminate the unjust use of preexisting conditions to deny coverage, it will get rid of one of the most critical obstacles to access to care.

2016-11-21T13:18:41-05:00March 22nd, 2010|health care policy, Patients|5 Comments
Read More

Might Health Care Reform Happen? And What Will It Mean for Nurses?

By Shawn Kennedy, AJN editorial director/interim editor-in-chief

Sometime in the next few days, Congress may bring the health care reform issue to a final vote and even a resolution of sorts, though one never knows what new twists may occur before then. I can’t even imagine what will occupy the news if it really does pass. (Philandering professional athletes and pilfering politicians better beware as newspapers seek new headlines.) 

Many Americans are calling their legislators to tell them what they want and don’t want. At the same time, many remain confused by the complexity of the legislative process as well as the particulars of the legislation. The final push received a boost this week from projections by the Congressional Budget Office that the bill would cut the budget deficit by $1.2 trillion over the next two decades. 

As nurses, we need to be knowledgeable and concerned with how health care will shape up—we’ll be delivering it. For information on the current bills under consideration, here’s two accessible sources: the Washington Post has a comparison of what the already passed Senate bill and the reconciliation version under consideration by the House include; the New York Times provides a pdf of the House bill.

Here’s a short list of provisions related to nursing likely to be in a final bill (as we noted in a post back in December about a useful ANA chart comparing House and Senate bills at the time):

2016-11-21T13:18:42-05:00March 19th, 2010|health care policy, nursing perspective|4 Comments
Read More

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”). […]

2016-11-21T13:18:48-05:00March 12th, 2010|health care policy, nursing perspective|2 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top