The ACA and Me: A Dispatch From the Trenches

Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

 “Reality is the leading cause of stress among those in touch with it.”—Jane Wagner

By 2014, up to 30 million Americans will have gained access to health care insurance under the Affordable Care Act (ACA). As a nurse human being, I support increased access to health care. However, it is naive to believe it can be accomplished without sacrifice.

My job is a casualty of the ACA.

But let’s backtrack:

It’s more accurate (but less dramatic) to say that our country’s need of better health care delivery significantly affects my job. Most hospital nurses are familiar with Medicare tying reimbursement to patient outcomes. Further, built into the ACA is a requirement that hospitals expecting Medicare reimbursement form accountable care organizations (ACOs):

Under the proposed rule, an ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with […]

At Least Once in Every Nursing Career: Final ICN Congress Recap

By Maureen Shawn Kennedy, AJN editor-in-chief

from Great Ocean Road in Australia from Great Ocean Road in Australia

Here’s a final recap of my trip last week to the 25th quadrennial congress of the International Council of Nurses (ICN). (My previous posts on this year’s ICN events are here and here; there’s also a podcast of my interview with outgoing ICN president Rosemary Bryant.)

My final few days were busy with sessions as well as a meeting with some members of AJN’s International Advisory Board. Here are some highlights:

Redeemed by M*A*S*H

Greg Horton is a widely published freelance writer and an adjunct professor at Oklahoma City Community College. With a new generation of veterans struggling to deal with emotional and physical wounds from their experiences in Iraq and Afghanistan, and to find meaningful work in a challenging economy, this story of a father’s 30-year nursing career after his return from the Vietnam War is particularly relevant today.

MASH-dioramaMy father started us on M*A*S*H soon after his return from Korea in 1973. The Vietnam War was nearing its end, although we did not know it at the time. A combat medic during his tour of duty in Vietnam early in the war, on this most recent tour my father had been stationed in Korea for a year at a hospital that received the grievously injured. “Spaghetti and meatball surgery,” he called it.

Our family had moved to Maud, Oklahoma, in 1972 to be near my mother’s family while my dad was in Korea. The endless countryside around our small town, combined with the local dump, gave us more than enough adventures to keep our minds off the war in a country of which we knew little.

M*A*S*H, the legendary television show featuring Alan Alda as the sarcastic antihero, started the year my father left for Korea. We were not a television-watching family, as such. My mother’s Pentecostal background instilled a deep-rooted distrust for the medium, unless Oral Roberts or Rex Humbard was preaching.

However, on my […]

Using Evidence-Based Practice to Reduce CAUTIs

By Karen Roush, AJN clinical managing editor

Using evidence-based practice to . . .

Fill in the blank. There’s something on your unit that could be improved—the rate of ventilator-associated pneumonia (VAP), the engagement of family in care, the readmission rate of patients with heart failure, patient satisfaction with pain management. Whatever it may be, you have the ability to improve it. This month we have a CE article (link is below) about an evidence-based practice (EBP) project to reduce catheter-associated urinary tract infections (CAUTIs).

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

The really interesting thing about this article, and what makes it especially helpful for beginner quality improvers out there, is that it doesn’t just describe an effective project to reduce CAUTIs. It also describes how to do an EBP project, step-by-step. The author, Tina Magers, a novice EBP mentor, followed the seven steps outlined in AJN’s Evidence-Based Practice series and describes the actions involved in each step. It’s a great how-to on applying evidence to practice. Here’s the overview/abstract of this useful June CE article, “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections”:

Overview: In […]

2017-05-27T10:29:02-04:00May 31st, 2013|nursing perspective|0 Comments

On Its Own Terms: An ICU Nurse Considers Human Adaptability

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. Some of the patient’s identifying details in this post have been changed to protect privacy.

by ashraful kadir/ flickr by ashraful kadir/ flickr

I caught an airing of The Shawshank Redemption the other day. It’s one of my favorite movies—full of irony and rich with messages of hope and perseverance.

There’s one line from the movie, in particular, that I love:

“Get busy living, or get busy dying.”

It’s one of my favorite movie quotes, and one that plagued me at work recently as I took care of a woman who’d suffered such a high-level fracture to her cervical spine that her injury was compared to an internal decapitation.

Her doctors had talked with her and her family at length about her injuries and prognosis, and although she’d initially indicated that she wanted to withdraw aggressive care, as time passed her directives became inconsistent—she’d tell her husband one thing, her medical team something else. On the day I was her nurse, she looked at me and very clearly mouthed the words “I don’t want to die,” then shut her eyes tight, ending our brief conversation as effectively as if she’d stood and left the room.

I think that most of the time, at least in the ICU where I work, people aren’t “getting […]

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