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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Memorial Day Weekend Notes from the Nursosphere Blog Roundup

As I walked into the exam room and introduced myself as a nurse practitioner, the patient announced she was “forced” to come to our clinic and “wasn’t allowed to see a real doctor” downtown. I was slightly taken aback. Here I was, running on time, in a pretty good mood and ready to assess and treat to the best of my abilities, and then WHAM. I took a deep breath and realized she wasn’t slamming NPs; she had a grudge against military providers, regardless of education background.

That’s from a recent post by a U.S. Air Force family nurse practitioner (NP) who’s been blogging from Afghanistan. She’s home now, and the post, about being discriminated against by a patient—not because she’s an NP, but because she’s a military provider—is worth noting as we prepare for another Memorial Day Weekend.

Are you a nursing student, or just ready for a change in your nursing career? Curious about various nursing specialties and what they really involve? Codeblog has been running a helpful series of posts, each of which focuses on an interview with a particular type of nurse. The latest is with a cardiac catheterization lab nurse.

Nothing like a medication error to ruin everyone’s day. Lisa at In the Round has a useful post that lists the eight “rights” of medication administration.

“So there is very little, in the end, I won’t share. There are some things, however, that […]

2016-11-21T13:12:52-05:00May 27th, 2011|nursing perspective|2 Comments
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An NP Prepares: Calling All Nurse Mentors

Well, I’m here to tell you, from the evidence gathered in my own laborious, and mostly fruitless, job search, that archaic ideas about the ease of finding a position as a nurse are dead wrong.... A seasoned professional or trusted peer is crucial in providing helpful advice, guidance, and inspiration.

2016-11-21T13:14:23-05:00January 7th, 2011|career, students|4 Comments
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Today’s Notes from the Nursosphere

Image of Japanese Attack - Pearl Harbor, Hawai...

As noted today by Joni Watson at Nursetopia, it’s Pearl Harbor Day, and nurses were (surprise) key players in that day’s awful events. Here’s how the post begins:

My heart was racing, the telephone was ringing, the chief nurse, Gertrude Arnest, was saying, “Girls, get into your uniforms at once, This is the real thing!”

Speaking of safety, “Top 10 Health Technology Hazards for 2011” (pdf), from the ECRI Institute, gives us a list of hospital patient safety risks that, according to the authors, “reflects our judgment about which risks should receive priority now, a judgment that is based on our review of recent recalls and other actions . . . , our analysis of information found in the literature and in the medical device reporting databases of ECRI Institute and other organizations, and our experience in investigating and consulting on device-related incidents.” These include “radiation overdose and other dose errors during radiation therapy,” “alarm hazards,” and eight others.

And now to electronic charting vs. doing it the old-fashioned way: we have a comment thread going on at AJN‘s Facebook page about whether or not EHRs save nurses time or not. Go there to comment, or leave a comment here.

Also noted: Stephen Ferrara at A Nurse Practitioner’s View wonders whether the preceptorship model is still adequate for training NPs. Or is it time for a residency model instead?

2016-11-21T13:14:44-05:00December 7th, 2010|nursing perspective|0 Comments
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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing

It’s important for nurses to understand the Medicare and Medicaid incentives to implement electronic health records (EMRs) and to move to their “meaningful use,” as well as the purpose of the Regional Extension Centers created to support nurse practitioners and other “priority primary care providers” in the implementation process.

Dr. Mari Tietze, John Delaney, and I are fortunate to be involved in two of the Regional Extension Centers in Texas. We believe that nursing professionals have many contributions to make in the evolving electronic highway in the U.S. We will blog later about our roles as nursing informaticists in the Regional Extension Center program.

What are ‘Regional Extension Centers’? Under the Office of the National Coordinator (ONC) Health Information Technology Initiative to support getting providers to meaningful use on electronic health records, the ONC has established Regional Extension Centers. There are 60 Regional Extension Centers that will furnish assistance to providers in specific geographic services areas covering virtually all of the U.S. A total of $643 million is devoted to these centers.

The purpose of the Regional Extension Centers is to support priority primary care practitioners in priority settings to implement and use EMRs according to the meaningful use requirements outlined in our previous post (below is a screenshot illustrating one example of how an EMR might align with meaningful use requirements; click image to enlarge). The goal of the program is to provide federally subsidized outreach and support […]

2016-11-21T13:16:22-05:00July 29th, 2010|digital health, Nursing|1 Comment
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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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