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 hospital where Ms. Leverington worked that her comment amounted to a threat, suggesting she might give him poor care should he ever become her patient.
The hospital fired the nurse, and now the nurse has countered with a lawsuit. She says she was merely exercising her right to free speech — and expressing her hope that she never see the policeman again.
Much ado about nothing? Are we going out of our way a bit too often lately in our zeal to make people pay for casual, if ill-advised, acts of speech? Or did this nurse cross a line?
For some quick takes on where we are with health care reform implementation, here’s a roundup from Kaiser Health News—which in general has done a great job keeping us abreast of what’s actually happening with this issue, as well as the range of opinions being tossed about. Here’s an excerpt.
Six months after passage of the federal health reform law, major provisions will kick in that supporters say will make it easier for Americans to get and keep health insurance. … Among the major changes: Insurance companies will no longer be able to cancel policies because someone becomes sick, set lifetime caps on coverage or deny insurance to children with pre-existing conditions. … In addition to enabling young people to remain on their parents’ policies up to age 26, several other major provisions kick in on Thursday.
The various nursing blogs are a little quiet today. Since palliative care has been in the news a great deal lately, this might be an appropriate time to note that Pallimed: A Hospice and Palliative Medicine Blog just celebrated post #1,000 with a list, partially excerpted below, of tips for a successful palliative care consult:
- Assume nothing, ever.
- Always talk to the team first.
- Respond to emotion with emotion.
- 75% of what we do is showing up and shutting up.
- Tame the beast inside who just wants to talk, talk, talk.
- Don’t just do something, stand there.
- Acute symptoms = acute meds. (That is – don’t jack around with long-acting/continuous meds for out of control symptoms without first actually making someone comfortable with bolus/immediate-acting meds.) This is a variation of the idea behind:
- NO DRIPS ‘TITRATED FOR COMFORT.’
- ‘Good work’ describes a process, not an outcome.
- Palliative care is just good medicine.
Pallimed is an excellent and thoughtful site, even if the focus may be somewhat more toward the MD perspective than the nurse perspective. It is also hosting the medical blog roundup Grand Rounds this week, if you’d like to do some interesting Internet browsing with a shrewd and useful tour guide. (And the latest Change of Shift, the regular nursing blog roundup, can be found at the nursing blog Emergiblog. We appreciate the mention of a recent post from this blog!)—JM, blog editor
- Palliative Care May Boost Mood, Survival (nlm.nih.gov)