When Being Good Means Looking Bad: An Ethical Quandary for Nurses

Performance measurement, an increasingly pervasive trend in health care, is credited with significant improvements in the quality of care . . . . Even so, this is little comfort when a nurse faces a situation where an action necessary for meeting a performance measure isn’t what she or he believes is best for a particular patient. For example, falls are often tallied as a performance measure, but frail patients need to be walked; raising the head of the bed to prevent pneumonia is often counted in performance evaluation but may result in less turning of the patient, which may mean more sacral ulcers—which may or may not be tallied as a separate performance measure.

That’s from an article in this month’s AJN by nurse ethicist Doug Olsen. It’s called “When Being Good Means Looking Bad,” and is about potential unintended effects of some well-intentioned performance measures that don’t easily allow for consideration of clinical context. Olsen writes that the nurse may, in certain situations, find herself or himself faced with three highly imperfect options to choose between:

2016-04-18T15:03:34-04:00October 7th, 2011|career, Ethics, nursing perspective|5 Comments
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Blind Spot – At the Intersection of Mother and Nurse

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.

Being a nurse has changed my reactions to situations at home. For one thing, I don’t get overexcited about non-life-threatening medical problems. I can hardly stand the thought of going to an emergency room (Steri-Strips and ice are my usual “go-to” treatment plans). I’d like to blame this on working in a trauma center—it makes sense that seeing catastrophic injuries every day tends to make less severe injuries look insignificant—but I’m not sure that completely excuses my recent diagnostic error.

My son, who’s 12, came home from school last week complaining that his hand was sore. He’d hit a wall in gym, he said, but it was a padded wall, and he hadn’t hit it very hard. Still, he was absolutely certain that, at the very least, he’d dislocated something, and that, most likely, he’d broken his hand.

To my defense, he has a history of overdramatizing situations, and I took his self-assessment with a grain of salt. Although the side of his hand was slightly swollen, nothing was bruised, and everything seemed to be moving all right.

We iced it, of course, and although hand pain didn’t seem to interfere with his usual activities, he proceeded to tell anyone who would listen that he’d broken his hand.

“Stop saying that!” I told him. […]

2016-11-21T13:11:48-05:00October 6th, 2011|career, Nursing, nursing perspective|7 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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Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole […]

2016-11-21T13:11:50-05:00September 29th, 2011|nursing perspective|2 Comments
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The NLN: Where Nursing Teachers Go to Learn

By Shawn Kennedy, AJN editor-in-chief

As a nursing student, I was always awestruck when an instructor could rattle off a few points that keyed me into what I should be thinking about when I approached a patient, or use questions to lead me through a thought process that ended with the discovery that I’d known the answer all along. It never dawned on me that those were teaching skills, tools of the trade that she’d learned as an educator.

Last week, I spent a few days in Orlando, Florida, attending the 2011 Education Summit of the National League for Nursing, or as most nurses know it, “the NLN.” I’d venture that if you asked most nurses (who aren’t faculty, that is) what they know about the NLN, they’d answer that it’s the body that accredits nursing schools (key information when deciding what nursing program one should attend). While that’s partially correct, that’s only one part of the NLN’s mission. […]

2016-11-21T13:11:51-05:00September 27th, 2011|Nursing|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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