What Nursing Independence? And Other Notes from the Nursosphere…

Here’s some stuff we’re reading online this week:

In one of the health systems that I interface with nurses can no longer document that they held a patient’s medications based on ‘nursing judgment’. Such an instance might be when a patient had hypotension from pain medication and thus the morning anti-hypertensive is held. Instead, they need an order from a physician to hold such medication. Further, something like ‘Tylenol’ on a patient’s medication record ordered for fever could not be administered by the nurse for a headache if the patient requested it because that would be ‘practicing medicine without a license’.  A nurse cannot order a social services consult, flush a urinary catheter should it become clogged, refer a patient for diabetes education, etc., etc., without an order from the supervising physician.

That’s from a smart, if somewhat depressing, blog post at Nurse Story called “Independent Nursing Practice: Reality or Still the ‘Physician’s Hand’?” The writer, Terri Schmitt, goes on to wonder just how nurses can carve out areas of independent practice, even in the most basic matters. Good questions.

And here’s a question of interpretation raised by an incident in Colorado involving a nurse and the policeman who stopped her for speeding:

When Colorado Springs cardiac nurse Miriam Leverington was stopped for speeding, she grumbled to the police officer.

“I hope you are not ever my patient,” she reportedly told him.

What happened next has become a topic of widespread debate in Colorado and on the blogosphere. The police officer, Duaine Peters, complained to the […]

Notes from the Healthweb and Nursosphere

This week Not Nurse Ratched has an amusing, meandering, and thoughtful post about the uses of Facebook by patients in the hospital. There’s a short excerpt below, but read the whole thing here.

They update Facebook constantly. CONSTANTLY. They have us take photos of injuries they can’t reach so they can post the photos to Facebook. I am not making this up. “I want a photo of my hideously dislocated ankle/knee/shoulder but I can’t move, so would you mind using my phone to take a picture for me?” And they keep updating and updating. I have actually said, “I’m about to give you a medicine that is going to render you unconscious immediately, so you should set your phone down.”

How could we have a weekly Web roundup that doesn’t at least mention health insurance reform? The spotlight has been slowly turning toward the insurers themselves, a crucial part of the equation (along with cost control and many other factors). This week Secretary of Health and Human Services Kathleen Sebelius met with the top executives of insurance companies to demand an explanation for the steep increases in rates seen in the last year.

If you’re looking for yet another reason why processed food isn’t good for you (besides the frequent presence of high fructose corn syrup and massive doses of salt, and the inaccurate packaging claims that the foods are “healthy” and “lean”), this week the NY Times reported news […]

Are Domestic Violence and Pregnancy Preexisting Conditions?

By Peggy McDaniel, BSN, RN

Kaiser Health News recently ran a story about an attorney who was denied private insurance coverage based on a “preexisting condition”—that is, treatment she’d received following a domestic abuse incident. A majority of states have passed laws prohibiting insurers from denying coverage based on treatment for domestic violence, but  eight states as well as the District of Columbia have no such legislation. It is a challenge to track the occurrence of such denials. Insurers often use alternative ways to find out about a history of domestic abuse. They have been known to search for protective orders at local courthouses, which is public information, and search through medical records for documentation of treatment related to such incidents. 

A bitter irony is that nurses are expected to be aware of and directly question patients about suspected abuse, yet in doing so we could be setting up patients for future loss or denial of coverage. 

Pregnancy, likewise defined as a preexisting condition, can also be used to deny coverage. Health reform bills under consideration would disallow the practice of basing insurance rates on gender, a practice which has in effect discriminated against women, particularly those of child-bearing age. 

The practice of denying private health insurance coverage based on these and other preexisting conditions must stop. As a nurse and a consumer, I believe that everyone should be able to buy health care at a reasonable price. A rate such as $1,000 per month for a family is not affordable. In the end we all pay if people do not have some […]

Mid-October Rainy Thursday Web Roundup

By Jacob Molyneux, blog editor/senior editor

The nursosphere is thriving and Change of Shift, the always interesting compendium of what’s new on nursing blogs, is up over at Emergiblog.

The health care reform process creeps slowly but surely toward an end someone somewhere can surely envision. One crucial question many are still asking is whether insurance companies might serve consumers a bit more readily and agreeably if they were forced to face a little competition from a public option. After all, isn’t competition supposed to be a good thing?

Most experts don’t expect the H1N1 vaccine to pose any more danger than the seasonal flu vaccine; even so, many Americans (and nurses commenting here, or taking our poll about the mandatory vaccine) continue to be wary, prompting public health officials to engage in especially aggressive surveillance measures in order to quickly detect any possible negative reactions to the vaccine: “Government Keeps Close Eye on Swine Flu Vaccine.”

AJN clinical editor Christine Moffa posted here a while back about how meditation might help cranky or exhausted or overworked nurses stay focused on what matters during the workday. Today the NY Times has a related piece on “doctor burnout” and meditation.

The role of social media in health care is constantly evolving as we all find our way. Its use by hospital workers is at issue in a recent post at Running a Hospital, about one hospital’s decision to ban social media from all its computers. And here’s something else on this: blogger Not Nurse Ratched wonders if social media policies in […]

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