Hospital Execs Assert They’re ‘Scared to Death’ by Reform Measures

By Shawn Kennedy, AJN interim editor-in-chief

On Friday, at the Association of Health Care Journalists (AHCJ) meeting in Chicago, I attended a session in which a panel of hospital executives discussed how their facilities would be affected by health care reform. They weren’t really sure of anything except that they’d probably lose money.

The panel included Richard Gamelli of Stritch School of Medicine and the Loyola University Health System, Jeffrey Hillebrand from NorthShore University HealthSystem, and Jim Skogsbergh from Advocate Health Care.

Skogsbergh was the most dire: “I’m scared to death about health care reform and I’m not sure how it will all shake out. The only thing I do expect is to that I’m going to get paid a lot less.” An attendee asked if hospitals would do better now that patients they cared for as charity patients would have health insurance under the new law. Gamelli answered that that depended on the insurance. Currently, he said, his facility is only reimbursed for 90% of costs incurred by Medicaid patients and 50% of those incurred by Medicare patients.

Where’s the innovation? The session was disappointing in that it was mostly about how these megahospital systems would deal with the financial implications. It would have been interesting to have a perspective from a small community hospital. And other than a program mentioned by Hillebrand to try to reduce hospital readmissions among patients with chronic disease, there seemed to be little focus on finding new approaches to cutting costs through improving quality.

2016-11-21T13:18:03-05:00April 26th, 2010|health care policy|0 Comments
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CDC’s Frieden: Some States Lag Far Behind Others In Reducing Smoking

By Shawn Kennedy, MA, RN, editorial director

At the opening briefing at the conference of the Association of Health Care Journalists, Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), unveiled a new report on state-specific tobacco control measures. As health commissioner in New York City until he took his current post last June, Frieden gained a reputation for tackling chronic health issues. (We reported in 2007 on his controversial diabetes initiative.)

Frieden says that while there is a clear change in societal attitudes towards tobacco use (for example, he says, we’ve moved from “Would you like a cigarette?” to “Do you mind if I smoke?”), progress in reducing tobacco use has been stalled since 2004. He noted the significant success of graphic “counter-marketing” efforts (ads depicting individuals who have physical disabilities, amputations, and laryngectomies as a result of tobacco use) in reducing smoking rates (though at least one study reported by the BBC has suggested that such in-your-face ads may be more likely to keep people smoking than to make them quit). However, said Frieden, “Tobacco taxation is the single most effective tool, accounting for half or more of the reduction in tobacco use.” Among the findings Frieden highlighted: […]

2016-11-21T13:18:04-05:00April 23rd, 2010|Nursing|0 Comments
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Medication Adherence in the Mentally Ill, the Mixed State of Cancer Survivorship Care, When Good People Faint, More

We’ve already noted one or two of them here in recent weeks, but here are some excerpts and links to several other articles of note in the April issue of AJN, in case you missed them:

The percentage of prescribed medications that are actually taken by patients is estimated to be as low as 60%—and among patients with chronic conditions, it may be even less. Patients with mental disorders may have even lower rates of adherence than those with physical conditions. Suzanne Hardeman, an NP and licensed professional counselor, and Meera Narasimhan, a physician, have culled from the available literature a list of strategies that have been shown to improve adherence in patients with mood and psychotic disorders.

That’s from a sensible and useful article on improving medication adherence in patients with mental disorders.

For a report on the good and bad news about where we are with providing cancer survivorship programs and support, read “Building Cancer Survivorship Care,” which points out some excellent resources, but also notes that “few cancer patients have access to survivorship care.” Still!

Laura Dean faints after witnessing an elderly man collapse with an apparent heart attack. James Parsons passes out as an RN begins venipuncture for collection of a lab specimen. Nursing student Melanie Simms faints while observing her first surgical procedure.

“Recognizing and Treating Vasovagal Syncope” gives a nice overview of this common problem, who is most likely to be afflicted by it, how to prevent injuries when it happens, and how nurses can […]

2016-11-21T13:18:06-05:00April 22nd, 2010|nursing perspective, nursing research|0 Comments
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Turf Wars Aside, How Do NPs and MDs Really Differ?

By Christine Moffa, MS, RN, AJN clinical editor

There’s been a lot of talk lately about turf wars between NP’s and physicians, especially when it comes to the much discussed U.S. shortage of primary care providers. Before going back to school and getting a master’s in nursing education, I batted around the idea of becoming a nurse practitioner. It seemed like the ideal next step for someone who was happy being a clinician but wanted to take on an advanced role.

However, there was something that didn’t sit right with me about becoming an NP—namely, my fear of public perception. I’m not sure most people know exactly what the role of an NP is and how it differs from that of a physician, particularly in primary care. I’ve seen patients call their primary care NP “doctor [insert first name here],” which to me illustrates the confusion.

When people ask me the difference, I myself have a hard time articulating it. How do I respond when someone says something like this: “if entry to medical school and residency is typically more competitive than for advanced degree nursing programs, and if physicians spend a longer time attending tougher programs, how do you justify their doing the same work as NPs?” (For instance, when I was in school we, along with the NP candidates, were only required to take two semesters of pathophysiology!)

Now, I’ve been to an NP as a patient, and I was happy with the care I received. She certainly […]

2016-11-21T13:18:07-05:00April 20th, 2010|career, nursing perspective, students|6 Comments
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Are Nursing Strikes Ethical? New Research Raises the Stakes

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

Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.

In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.

These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units […]

2016-11-21T13:18:09-05:00April 16th, 2010|career, Ethics, nursing perspective|5 Comments
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