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 Nursosphere, Plus a Great Palliative Care Discussion

First: Twitter delivered a treasure this morning, from @abbrody (Ab Brody, an RN — and PhD — in San Francisco):

Wow,just wow! RT @DianeEMeier Pallimed:Post from husband of Dr. Pardi http://bit.ly/a3TH0X Do not miss this discussion! #hpm #palliative

What’s the big deal? Well, the New York Times ran a piece this week about Dr. Pardi, a palliative care doctor who fought it out against her cancer up to the end. The article was fascinating, disturbing, powerful, and we posted about it—and a related article we’d run in AJN not long ago—at this blog a few days ago.

What Brody’s Twitter message alerts us to today is an ensuing post and discussion at the palliative care blog Pallimed. The discussion has none of the harshness of tone one sometimes gets on Web discussions. Many of the people in the palliative care community seem to know each other, which always helps keep things civil (you don’t typically insult people you’re likely to meet in person).

A big question in the discussion is whether the Times story oversimplified the issues, creating an “either/or”  scenario out of something much more complex, and in the process made palliative care look like it’s all about convincing people to give up and die. But it really gets interesting when Dr. Pardi’s husband pops up in the comments section and attempts to clarify some of the questions and misperceptions raised by the Times story. You’ll […]

Taking A Stand Against Terminal Illness — Self-Delusion, or the ‘Good Fight’?

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

This week, The New York Times published an article about a young palliative care specialist who, when advised her cancer had progressed to the point where she should consider palliative care, rejected the notion and proceeded to pursue all available options. She was only 40 years old and said she was not ready to die. While the aggressive treatments (which she had plenty of money to pursue) gave her about another year, the article explains that her final days were spent heavily medicated for pain from the tumors throughout her body—even as she continued to request brutally painful procedures with little chance of prolonging her life.

That was her choice, and she knew what she was choosing. But that doesn’t always happen; too often, people really don’t know what it may cost them to take a stand against the inevitable. (For an engaging and comprehensive look at the issue and its implications for nurses, see Life Support Interventions at the End of Life: Unintended Consequences in the January issue of AJN.)

This month, AJN’s Reflections essay describes a scenario when full disclosure of the likely results of pursuing treatment wasn’t forthcoming from health providers. It tells of one nurse’s dilemma in balancing her role as family member and as a nurse during the last days of her […]

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 […]

“I often feel anxious and nervous when I care for a dying patient . . .”

As a nursing student, I often feel anxious and nervous when I care for a dying patient. My classroom lectures have been similar to those given in medical school—death is an enemy to be conquered. We focus on treating the disease process and give very little attention to death and dying.

That’s from a letter to the editor now online in our February issue. The article the letter writer was responding to was “Stopping Eating and Drinking,” which we published back in September. The article is about an end-of-life option that is a choice available to patients who aren’t “actively dying” but who have experienced a radical diminution in their quality of life. It’s also about what a nurse legally and ethically should and should not discuss with a patient.

The notion of a nurse advising a patient on stopping eating and drinking is a potentially controversial one, but the responses we received were surprisingly unalarmed that we would publish such an article. Here’s another letter we got in response. We love to hear from our readers, whether in the old print format or here on the blog.


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2016-11-21T13:19:37-05:00February 3rd, 2010|Nursing|0 Comments
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