Reflections on the Freedom to Harm Yourself

By Marcy Phipps, RN

(Identifying details of the patient and clinician mentioned in this post have been changed to protect their anonymity.)

Last week I took care of a woman who’d shot herself in the abdomen. This was the third suicide attempt she’d survived. She was physically compromised, to say the least, and was looking at a long recovery. Her despondence was palpable. 

A clinical psychologist came to evaluate her and determined that she was experiencing major depression with suicidal ideations. 

Usually, such patients are “Baker Acted.” In accordance with the Florida Mental Health Act, commonly referred to as the Baker Act, individuals who are deemed to be a danger to themselves or to others are held involuntarily and transferred to a treatment facility.

But because this patient stated to the psychologist that she was not only willing to seek mental health treatment, but also planned on checking herself into a facility near her home, she didn’t qualify to be involuntarily hospitalized. She was free to leave at any time.

As the psychologist explained to me, the first criterion of the Baker Act only considers whether or not the person in question is refusing treatment. According to Florida Statute 394.463, as long as said person does not refuse to be examined, the Baker Act does not apply.          

Although the psychologist assured […]

Reading this Blog Post May Lead to Blinking

By Christine Moffa, MS, RN, AJN clinical editor

“VA Hospital May Have Infected 1,800 Veterans With HIV”

I came across this headline when I was looking for the latest news on the Internet. It certainly got my attention. I immediately thought to myself, “Wow, haven’t these soldiers been through enough, and now they might have HIV.” I took the bait and did what the editors of the article hoped I’d do—I clicked on the headline. Sure enough, it was not exactly accurate. Yes, there was a risk that these patients had been exposed to bloodborne pathogens due to the improper cleaning technique performed on dental instruments at a VA hospital, but there was no specific reason to think they actually had that illness. It reminds me of a cautionary tale by Peter Jacobi I came across a number of years ago that demonstrates how statistics can be manipulated by writers: “100% of those who were born in 1850 and ate carrots are now dead. So carrots obviously lead to . . . death.”

While there are worse ones out there, this is an example of how headlines are manipulated to get readers’ attention. Don’t get me wrong: proper cleaning of instruments is an integral part of patient safety and all patients should be able to trust the facility providing them treatment. But wouldn’t it be more responsible to say, “VA hospital may have exposed 1,800 veterans to infection,” since we don’t […]

Requiem for New York’s St. Vincent’s Hospital

A community in mourning leaves its messages

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

Each day, Alison Bulman walks by the closed doors of St. Vincent’s Hospital in Greenwich Village on her way to work as the senior editorial coordinator at the American Journal of Nursing. She has watched the number of testimonies left on the doors boarded up in April grow, as former patients leave messages of gratitude, anger, and sorrow for the loss of this 160-year-old institution.  Alison thought they were worth sharing, and we agreed. So she took a great series of photos, which we’ve now collected in AJN‘s Flickr stream.  

My first news story for AJN was about four nurses who worked at St.Vincent’s and who died while vacationing together. And in AJN’s first issue after September 11, 2001, we wrote about St.Vincent’s major role in treating victims and first responders after the attacks on the World Trade Center. 

As a New Yorker and a nurse, I share the sense of loss felt for this venerable institution—not as much for its past as for the loss of a major health care center in a community that depended on it for access to care. The closing of the emergency department has already had repercussions: the Wall Street Journal reported on June 17 that ER visits in the surrounding hospitals were up. And midwives who practiced at St. Vincent’s were left in the lurch without physician back-up agreements […]

Health Care Reform: What’s In It for Nurses?

A relaxing and safe Fourth of July weekend from the AJN editors to all nurses in the U.S., whether you’re taking it easy or on the job!

A recent poll conducted by the Kaiser Family Foundation shows rising popularity for the health care reform law. Many hard decisions still need to be made; innovation is more crucial than ever. Nurses who’d like a clearer sense of how the health care reform law may affect them in the coming years should have a look at “Health Care Reform: What’s In It for Nursing?” in our July edition. Written by AJN‘s emeritus editor-in-chief Diana Mason, it points out some of the new models of care the law promotes, models in which nurses play an increasingly important and vital role at every level. As often in the dynamic history of this country, there will be new kinds of opportunities for those who are ready for them.—JM, blog editor

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Nurses Under the Influence of Pharma—Not Just an NP Problem

The danger of an NP succumbing to influence is obvious—she or he may prescribe for reasons (which may be on an unconscious level) other than clinical ones. The issues for nurses who do not prescribe medications are subtle and different. AJN's ethics columnist Doug Olsen did a two-part series exploring this last year—in January and February 2009. And AJN's editor-in-chief emeritus Diana Mason wrote on this even earlier, in an editorial in December 2000, noting, among other concerns, that "it's not unusual to see drug company underwriting of speakers at nursing conferences; of course, the topic addressed is almost always related to one of the company's top drugs."

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