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 […]

2016-11-21T13:07:22-05:00June 5th, 2013|nursing perspective|6 Comments
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AJN’s April Issue: Sustainable Health Care Environments, Preventing Kidney Injury, Lateral Violence, Mental Health, More

AJN0413.Cover.2nd.inddAJN’s April issue is now available on our Web site. Here’s a selection of what not to miss.

Mechanical prophylactic devices such as intermittent pneumatic compression (IPC) devices, are applied, maintained, and monitored exclusively by nursing personnel. In this month’s original research article, “The Application of Intermittent Pneumatic Compression Devices for Thrombophylaxis,” the authors observed frequent misapplications of ordered IPC devices, and highlighted the need to study the consequences of such errors. This article is open access and can earn you 2.3 continuing education (CE) credits.

Over the past decade, the incidence of acute kidney injury requiring dialysis has risen sharply in the U.S., with associated death more than doubling. “Preventing and Responding to Acute Kidney Injury” makes the case that by identifying the signs and symptoms of acute kidney injury in its early stages, nurses may be able to help reduce the severity of injury and improve outcomes. This article is open access and can earn you 2.6 CE credits. You can also listen to a podcast interview with the author.

Lateral violence is a term used to describe what happens when a person acts in a verbally, emotionally, or physically abusive way toward someone else of a similar status or level of authority. As has been noted more than once before, RNs sometimes commit lateral violence against other staff members. “‘Crucial Conversations’ in the Workplace,” the second article in our leadership series, offers nurse managers a framework […]

2016-11-21T13:07:56-05:00April 5th, 2013|nursing perspective|0 Comments
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What Do You Value?

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

“ ‘The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.’—Hubert Humphrey

These are the words that physician Donald Berwick saw as he went to work in the building that bears Humphrey’s name and houses the U.S. Department of Health and Human Services in Washington, DC. They reminded Berwick, the former administrator of the Centers for Medicare & Medicaid Services (CMS), of his most important mission: “to help the people who need our help the most.” And they are at the heart of an important topic of debate during this election season: what is the proper role of government in our lives?”

AJN Oct. cover, detail

So begins a blog post on the JAMA Forum by Diana Mason, PhD, RN, Rudin Professor of Nursing and codirector of the Center for Health, Media, and Policy at Hunter College, City University of New York, as well as president-elect of the American Academy of Nursing (and, for the sake of transparency, former editor-in-chief of AJN).

Her question is a critical one and one that has been a fundamental issue, tug-of-war even, for Americans. Our citizens take a great deal of pride in being independent, self-made, and self-reliant—yet it’s obvious that most of us also believe […]

2016-11-21T13:09:08-05:00October 8th, 2012|nursing perspective|4 Comments
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About Those Death Panels

By Shawn Kennedy, AJN editor-in-chief

Diana Mason, former editor-in-chief of AJN, wrote a post on July 9 on the JAMA Forum blog that’s well worth reading. In it, she talks about the resurgence of “death panels” rhetoric to stir opposition to the Affordable Care Act (ACA), specifically in relation to the Independent Payment Advisory Boards, which are to issue binding recommendations for controlling costs if Medicare grows too rapidly.

In a nutshell, these boards will determine where to reduce costs. If Congress opposes the plan, it will have to come up with same-size cost cuts if it doesn’t want to institute what the board recommends. The message that opponents of the ACA want the public to hear is that their fates will be determined not by them but by an arbitrary committee.

But IPABs are about reducing costs of programs, not passing judgment on individuals.  (As Mason notes, the death panel rhetoric was “declared the “2009 Lie of the Year” by PolitiFact, a project of the Tampa Bay Times and partner news organizations.”)

People should have conversations about how they wish to be treated in their last moments, but these should occur with loved ones and direct care providers and be supported by the legal system. People shouldn’t have to worry that they will be rushed along to death if they’re not ready—in fact, this seems […]

2018-03-28T10:36:14-04:00July 18th, 2012|health care policy|5 Comments
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Transitional Care: How the Affordable Care Act Would Have Helped My Father

By Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. This post is also being published at the Robert Wood Johnson Foundation Human Capital blog.

When I heard that the Supreme Court had upheld the Affordable Care Act, I immediately thought of my father. He suffered mightily at the end of his life. Plagued with multiple chronic illnesses, he spent his last year in and out of hospitals. He received good hospital care, but his health deteriorated every time he left the hospital.

He simply couldn’t keep track of a growing list of prescriptions, tests, and doctor visits. He accidentally skipped antibiotics, which led to infections, which landed him back in the hospital. He accidentally skipped blood tests, which landed him back in the hospital. It seemed that every time he came home, he’d land back in the hospital. I lived thousands of miles away and couldn’t be the advocate that he needed.

What he needed was transitional care—he needed a nurse to meet with him during a hospitalization to devise a plan for managing chronic illnesses and then follow him into his home setting. He needed a nurse to identify reasons for his instability, design a care plan that addressed them, and coordinate various care providers and services. He needed a nurse to check up on […]

2016-11-21T13:09:41-05:00July 12th, 2012|nursing perspective|10 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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