Clinic Vision

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

By Ctd 2005, via Flickr

I’ve begun volunteering at a local free clinic. While it’s been rewarding and satisfying, it’s also been fraught with challenges I didn’t expect; I’ve only worked in an ICU, and the assessment skills specific to critical care don’t translate smoothly to the clinic setting. I’m out of my professional comfort zone, and I feel so inexperienced.

Here’s what I’m used to: By the time a patient is admitted to the ICU, they’ve already been “worked up” in the emergency room. Physicians have been assigned and a preliminary diagnosis is in place. The patients are connected to equipment that displays their vital data continuously, on monitors I can see from almost anywhere, and alarms are triggered by any alterations. I’ve got easy access to radiology reports and films, laboratory values, and microbiology reports. The nursing physical assessment is thorough and paramount; I know what I’m looking for, what I’m listening and feeling for, what certain smells indicate, and I trust my instincts. I’m accustomed to not only the forced intimacy that comes with the in-depth physical assessments of critical care, but the technology and data that supplement my assessments, as well.

At the clinic my nursing role is quite different. I sit at a desk. I am […]

2016-11-21T13:10:52-05:00January 26th, 2012|nursing perspective, Patients, Public health|2 Comments
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Year-End Take: A Hopeful Trend in U.S. Health Care?

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s […]

2016-11-21T13:11:06-05:00December 27th, 2011|health care policy, nursing perspective|3 Comments
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Sarcopenia and Me – Or Why Exercise Really Matters as We Age

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently I started an exercise program with a personal trainer. I’ve been a runner for 25 years, even ran five marathons. I’ve never had a problem being disciplined about running four or five days a week, no matter what the weather. But I’ve never been able to stick to any other exercise program for more than a week or so. Working with weights, yoga, step classes, just doing push-ups in my living room when I get back from a run—never stuck with any of them.

Getting older isn’t kind to those who don’t exercise. Years ago my lack of upper-body fitness was hardly noticeable. Shoveling snow, raking leaves, playing racquetball, carrying my kids around, all of it kept me in good enough shape. That’s not the case now that I’m in my fifties. Lifting my grandson above my head—not happening. Hanging a new shower curtain – three clips – rest – three clips – rest…

When I found I couldn’t blow-dry my very short hair without lowering my arm repeatedly because of muscle fatigue, it was time to do something about it.  That’s when I decided to invest in a personal trainer. It was expensive—but I figured I would just do it long enough to make exercise, other than running, […]

2016-11-21T13:11:13-05:00December 7th, 2011|nursing perspective, personal health practices|3 Comments
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Changes in Latitude: Comparing Health Care Systems with Nurses Down Under

By Peggy McDaniel, BSN, RN, who writes the occasional post for this blog and currently works as a clinical liaison support manager of infusion in Australia, New Zealand, and Asia Pacific.

I recently found myself sitting on a boat, enjoying a “sausage sizzle,” dressed as a pirate no less. In Australia, a party that includes barbecued meat usually includes sausage; thus the name. The pirate theme was an added bonus. As an American and a nurse, I was pleasantly surprised to find myself seated at the same table as two Australian nurses. What were the chances of that? The conversation that evening gave me some insight into the Australian health care system, which I am just getting familiar with.

Comparing health care systems. Once we all realized we were experienced nurses and shared the belief that quality patient care should always be the primary focus of health care, the conversation turned to cost. In Australia, there is a public health option that all Australians can access. It is paid for by taxes. If you choose to do so, you can also purchase a private plan to supplement this public option. I have yet to determine what part, if any, employers play in paying for health care or private insurance. However, a sick Australian will […]

2016-11-21T13:11:39-05:00October 26th, 2011|health care policy, nursing perspective|43 Comments
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Federal Budget Battles Begin – Health Professions Education at Stake

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

I’m subscribed to many listservs, mailing lists, and eNews alerts that help me keep track of news that may be important to nurses. One e-mail list I’m on is the Health Professions and Nursing Education Coalition (HPNEC), from the Association of American Medical Colleges. It closely monitors funding for health professions education.

Last week, the e-mail reported on the proposed 2012 federal budget—that is, the initial draft proposed by the House Labor, Health and Human Services, and Education departments appropriations subcommittee. Among a great deal else, this includes funding for  Medicare, the National Institutes of Health, the CDC, and medical and nursing education (Title VII and Title VIII funding).

There’s already contention over the proposal, with the Democrats claiming they had nothing to do with it. According to ranking Democratic member Rep. Norm Dick, quoted in the minority party press release: “Make no mistake: this is not a committee product. This draft bill represents the ideological position of one committee member—the subcommittee chairman.”

Among other aspects, the proposal includes cuts to all monies to Planned Parenthood (as long as it continues to provide abortion services), National Public Radio, and any programs under the Affordable Health Care for America Act.

According to the HPNEC e-mail: “The bill offers a total of $87.5 million for Title VII programs, a $185 million (67.9 percent) cut, by eliminating funding for the Title VII Health Careers Opportunity Program, scholarships for disadvantaged students, primary care medicine, Area […]

2016-11-21T13:11:49-05:00October 3rd, 2011|health care policy, nursing perspective, students|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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