A hospice patient in Oklahoma City is being denied his
medications to treat his COPD, while coping with a diagnosis and treatment for
tongue cancer. In Cadillac, Michigan a patient struggling with colon
cancer is being denied insulin to treat his diabetes and is in danger of
Due to a recent and poorly thought out Medicare Part D Prescription Drug policy, dying patients
are revoking hospice services to maintain access to other necessary
prescriptions for diseases unrelated to their terminal illness that Part D paid
for until recently.
Patients’ families are left at the pharmacy counter with no refill of
medications, after the pharmacist announces that because the patient is on hospice,
the pharmacy is no longer allowed to fill their prescriptions – which in not
Or, they are going days and sometimes weeks without the necessary
medication to manage symptoms that were present before they elected the hospice benefit
due to unnecessary complications in approving prescriptions under Part D.
The intention of the new Medicare Part D policy implemented by the Centers for
Medicare and Medicaid Services is to prevent the federal government from
incurring duplicate costs for medications of hospice patients.
NHPCO agrees that hospice providers should be held
responsible for all drugs that are related to the terminal diagnoses and those
drugs that are unrelated should be billed to Medicare Part D.
NHPCO acknowledges that there have been instances of Part D payment for drugs
that should have been covered by the hospice provider under the
Medicare hospice benefit.
“The hospice community understands there is a need to address the
issue. NHPCO has worked with CMS on Part D implementation for months now with
limited success,” said Schumacher. “We requested that CMS convene several
different stakeholder groups to determine the best way to carry out this
process so that it would be uniform and effective and we have been denied that
The National Hospice and Palliative Care Organization has
strongly opposed the inadequate and haphazard implementation of this
“The guidance set forth by CMS requiring a claim to be rejected by Part D
before a prior authorization process can begin has created numerous and
unnecessary challenges for terminally ill patients and their families,” says J.
Donald Schumacher, NHPCO president and CEO.
“Hospice providers are being tasked with sorting out a process
that is difficult, lacks standardization and is incredibly time-consuming,
keeping the hospice clinician in the office when they could be in the
field providing care to patients and families.”
NHPCO continues to encourage CMS to halt the implementation of the Part D
guidance and convene key stakeholder groups to collaborate and create a
strategic and uniform process.
An effective solution can be reached so that Part D providers,
pharmacists, hospice providers and beneficiaries have developed a
coherent process together and hospice patients are not denied the medications
they need at the end of life.
With a workable system, hospice patients and their loved ones can
receive the care they need without suffering, confusion and hassle of an
The preceding is the collective opinion
of the National Hospice and Palliative Care Organization released June
9 in a statement to the press.
Judy Blair is senior vice president, clinical services, and chief nursing officer, Glendale Adventist Medical Center, Glendale, Calif.
As I round and ask what is going well on this unit, I often hear, "Our unit has great teamwork."
What are the characteristics of great teamwork and how do we continue to enhance it? I'd like to share a few of my thoughts. A great team:
- Has purpose, direction and clearly defined goals. The team works to achieve these goals.
- Understands the bigger picture and why it is so important for the goals to be reached.
- Recognizes those who are doing things well; celebrates small and large successes.
- Finds ways to make work fulfilling. It's hard to be motivated and energized if work is a big pain. Ideas such as a monthly birthday celebration or potluck can energize us.
- Conveys a positive attitude. Attitudes are similar to colds - they are contagious. Positive attitudes spread just as easily as negative ones. A great team recognizes that positivity energizes us.
- Is comfortable with coaching and being coached. Sharing trust allows team members to respectfully coach one another as they continuously improve the quality of care for our patients.
I like how Helen Keller put it, "Alone we can do so little; together we can do so much." An energized team can accomplish almost anything it sets its mind to.
To all nurses, thanks for YOUR teamwork!
The prevalence of social media outlets allows us to share every detail of our life in real time, but it also begs the question, how much is too much?
It has become commonplace to share details of your work day, but for social media savvy healthcare providers a seemingly innocent post could actually be a breach of not only a patient's privacy, but also their trust.
Katie Duke, a New York City nurse, found herself out of a job following an Instagram post that pictured "a messy but empty trauma room that had been used to treat a man hit by a New York City subway train. Duke posted the photo with the caption ‘#Man vs. 6 train,'" reported ABC News.
The incident played out during a recently aired episode of "NY Med," a documentary series on ABC that follows medical staff at Manhattan's New York-Presbyterian Hospital and Newark's University Hospital.
Duke told ABC that her dismissal was not due to a breach in hospital policy or HIPAA, but rather insensitivity.
In an interview with the "New York Daily News," Duke said the post was well-intentioned. "Somebody's life was saved in this room," she said. "I just thought it was a moving and impactful picture that I wanted to share with my followers. It was just a very genuine intention of ... want(ing) people to see what goes on in an emergency room, from the perspective of being an ER nurse."
"Make sure you understand what your purpose is on social media," she added. "Be a positive professional role model for the up and coming generation of healthcare workers and students. That's my personal mission for social media."
Since she was fired, Duke has found another job and her search was documented by "NY Med."
I find it interesting that she was fired from an organization that has a camera crew on site. How much access should the public have to the day-to-day workings of our healthcare system?
In the face of a society saturated by social media and reality television, it is important to take responsibility for what you put out there and how it may be perceived by others.What do you think? Was this a fire-able offense? Do you use social media in the workplace?
By Elinor Abraham, MSN, APRN, BC, Nurse Coordinator, Federal Occupational Health
Unit, Program Support Center, National Courts Building, Washington, D.C.
The Affordable Care Act (ACA) is designed to help health professionals
like me have more time and opportunity to see our patients and help them remain
A large part of the ACA is about preventative Healthcare services.
Indeed the law itself establishes a National Prevention, Health Promotion, and
Public Health Council headed by the Surgeon General to coordinate federal
prevention, wellness, and public health activities.
The Council is tasked with developing a National strategy to improve
the Nation’s Health. In fact, the healthcare provider literature is full of
evidence-based or research-based health interventions and screenings, and
immunization programs reflective of the intent of the law and giving us
The focus of a National Strategy addresses chronic disease reduction in
city, rural, and frontier areas of the country. The Prevention Council consists
of 17 members of Government agencies, such as Housing, Transportation, Homeland
Security, HHS, Education, Veterans, and EPA.
Some Priorities of Chronic Disease Reduction are:
Tobacco Free Environment
Prevention of Drug/Alcohol Abuse
Injury and Violence Free Neighborhoods
Mental and Emotional Well-being
There will be funding for Community Care Centers especially in
medically underserved communities providing physical, oral, behavioral, and
pharmaceutical services. All children will be able to get the dental services
needed at an early age.
A new model of providing care is the Accountable Care Organization (ACO)
which allows a group of providers and suppliers to jointly coordinate care for
Medicare patients. But this will not restrict a person’s choice of a primary
care physician. Nurses will have a major role in Quality Improvement within the
There will also be School-based Health Centers so students and families
can receive a full range of health services and even Home Visiting so that
health professionals can provide services to pregnant women and small children
to improve health outcomes. Areas with more poverty and fewer resources will
not be left behind more fortunate areas of the country.
Academia and the Center for Medicare and Medicaid Services will partner
to provide Inter-professional Education and Collaborative Team-based Practice
and innovative programs to keep people healthy and out of the hospital. Some
examples: Controlling Blood Pressure and
Cholesterol, Diabetes Self-Management, and not needing re-hospitalization after
an illness or procedure.
As more people will be seeking primary care, we will need doctors,
nurse practitioners, and physician assistants to meet the needs. I asked my own
primary care doctor how he thought the Affordable Care Act would affect his
practice. He said, “I am looking for answers and structure so I know. We need
more primary care providers and assurance of how we will be reimbursed. Waiting
time in offices may become longer.”
Graduate Educational Training Scholarships will be available for all
health professionals with incentives to go into primary care roles. Funding
will target the current Nursing shortage to schools, and hospitals and other
facilities where nurses are employed. Facilities will be eligible for extra
funding as nursing roles are expanded. Nurses will have roles in policy on
State Health Exchanges and Wellness Education for patients, and education for perspective
The new law allows for a new trauma center program to strengthen trauma
care capacity. This has many meanings. The law addresses that mental health
issues will be treated with interventions and services that are on par with
other medical illnesses. The Mental Health Community is talking about the
trauma involved in the lives of the mentally ill. So access to Trauma
Programs/Care is in the literature of Mental Health Recovery. Rehabilitation
from a serious injury or illness is familiar to all of us, but the ACA is also
calling for more ‘habilitation’ services to help people live with chronic
illness such as multiple sclerosis.
A new Public Health Commissioned
Core Ready Reserve will be established to serve during national disasters. A
Senior Care Volunteer Program will encourage Seniors to do more volunteering. The
Indian Healthcare Improvement Act will be reauthorized to aid Native Americans.
Electronic medical records will be implemented and should make having
all reports more seamless. E-Prescribing sends those pesky prescriptions
directly to your pharmacy. The goal is
to take paper work away from providers, so they will have more time with you!
All programs will be implemented
over time as many of these innovations sound overwhelming indeed.
According to a contributor to Forbes magazine, 4 groups will benefit
from the ACA:
Insurance companies will benefit the most from the new law. There will
be a larger pool of insured people, so more customers. Insurance premiums have
already increased, especially for people with more medical problems and fuller
coverage. Some unhappy with cost increases ask “Should sicker people pay more?”
Hospitals will benefit as they will be compensated for services of
indigent people who had no health insurance and now should be covered.
Fitness Clubs and Health Education Providers will benefit as wellness
becomes an important part of healthcare and some insurance policies will offer
discounts to people who join a fitness club or take courses on Healthy Eating
for Heart Health. My own practice at Federal Occupational Health (FOH) focuses
on Wellness programs and Safety for Federal Employees.
Government, local and federal, will benefit as more people will need to
be hired to maintain compliance. And the IRS should be in the mix!
Getting people to sign up for insurance involves politics and the
person’s ability to exercise their rights to enroll. This often is affected by
the individual’s mental state. Scammers who portray themselves as Navigators or
insurance companies are a threat to the vulnerable. Providers from actual
healthcare centers that treat mental illness and substance abuse are discussing
the difficulty getting their clients to trust and understand the new law. Some states are even encouraging prisoners to
sign up for health insurance. I have spoken with many people who are just
waiting for all the website problems to be fixed and see what others are going
to do before they sign up.
Different states have made the implementation of the law either user-friendly
or not according to political beliefs about Obamacare. Those Governors against
the program refuse to expand Medicaid, and may be hurting many vulnerable
citizens. Virginia has not fully embraced the ACA and has little outreach to
consumers, whereas DC has Healthlink and is reaching out to citizens with new
programs for adults and children. Maryland has also set up its own health
insurance exchange and has outreach to consumers.
The story is unfolding.
By Theresa Conejo, RN, cardiovascular nurse at Nazareth Hospital, Mercy-Health System in Philadelphia. She is also a You're the Cure Volunteer Advocate for the American Heart/Stroke Association. Her passion is helping children and adults learn the importance of healthy eating and an active lifestyle.
As nurses, we know eating too much salt leads to high blood pressure and puts us at risk for heart disease and stroke. Most Americans consume too much sodium in the form of processed and restaurant food. It's easy to understand why. Sodium can be sneaky. It slithers into soups and sandwiches and cozies up to cold cuts and cured meats. It plants itself in your favorite pizza and poultry and burrows into breads and rolls. Sodium is an essential nutrient, but you don't need much in your diet. It adds up fast! Take bread, for example. One piece can have up to 230 mg of sodium, while a serving of turkey cold cuts can contain as much as 1,050 mg!
The consumer's confusion occurs with the variance on the daily requirement by organizations. The CDC recommended amount is no more than 2,300 mg a day. (The CDC also recommends that people over age 51, those who have high blood pressure, diabetes or chronic kidney disease stick to no more than 1,500 mg a day.) The WHO (World Health Organization) recommends 2,000 mg or less and the American Heart/Stroke Association recommends 1,500 mg per day.
Regardless of what rule you follow, most people consume about 3,400 mg of sodium a day - far too much than needed.
Why should sodium be on your radar? About one in three Americans has hypertension and a high-sodium diet may be to blame. In some people, sodium increases blood pressure because it holds excess fluid in the body, creating an added burden on the heart. Too much sodium also increases risk for stroke, heart failure, osteoporosis, stomach cancer and kidney disease.
How much sodium a day should we eat and what's the easiest way to track it? Thanks to a growing number of iPhone and smartphone apps, our patients can make healthier choices at home or on the go.
Sodium One sodium counter tracks your daily sodium budget providing a running count of how much sodium has been consumed and how much more you can eat while staying within the CDC recommended amount of no more than 2,300 mg a day. This app provides the sodium content in restaurant and supermarket foods as well and will also create a custom food menu.
Pretty Yellow Dog, a free app, keeps lists of your favorite foods and a running total of the amount of salt consumed. This app is compatible with an iPhone and iPad.
Fooducate an app that is growing in popularity, will allow you to scan the bar code of an item and find it's nutritional content.
iSodium 3.5 is one of 9 iNutrient apps based on the USDA National Nutrient Database.
Whether you patients are trying to lower blood pressure or live a healthier lifestyle, they should learn to read between the lines. When buying prepared and packaged foods, read the Nutrition Facts label.
Here are sodium-related terms you may find on food packages:
Sodium-free: Less than 5 mg of sodium per serving;
Very low sodium: 35 mg or less per serving;
Low sodium: 140 milligrams or less per serving;
Reduced (or less) sodium: Usual sodium level is reduced by 25% percent per serving;
Light (for sodium-reduced products): If the food is "low calorie," "low fat" and sodium is reduced by at least 50% percent per serving;
Light in sodium: If sodium is reduced by at least 50% per serving.
Food labels cannot claim a product is "healthy" if it exceeds 480 mg of sodium per reference amount, according to the U.S. Food and Drug Administration and U.S. Department of Agriculture. "Meal" products must not exceed 600 mg of sodium per labeled serving size.
You can also read the ingredient list to learn more about the source of the sodium. Watch for the words "soda" (referring to sodium bicarbonate, also known as baking soda) and "sodium" (including sodium nitrate, sodium citrate, monosodium glutamate [MSG] and sodium benzoate). Once you start to recognize these terms, you'll see why there's so much sodium in some foods - even those that don't taste very salty.
For more information on sodium and food sources visit www.cdc.gov/salt or take the Sodium Challenge at www.heart.org/sodium.
The following is a statement released June 17 by Biomedical Advanced Research and Development Authority Director and Deputy
Assistant Secretary for Preparedness and Response, Robin Robinson, PhD.
This week, our nation reached a milestone in battling influenza, with
the U.S. Food and Drug Administration’s first approval to manufacture seasonal
influenza vaccine using cell-based technology in a U.S. facility. That
facility, owned by Novartis of Basel, Switzerland, and located in Holly
Springs, N.C., now can manufacture cell-based vaccine against seasonal as well
as pandemic influenza viruses. This new capability demonstrates the
effectiveness of a multi-use approach to emergency preparedness.
Since its establishment in 2006, the Biomedical Advanced Research and
Development Authority (BARDA), part of the U.S. Department of Health and Human
Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR), has sponsored the development of new technologies for
use in emergencies, including the cell-based technology at Holly Springs. These
new technologies are flexible enough to produce vaccines and other medical
products for a variety of public health emergencies.
In pursuing new technology, BARDA leverages public-private
partnerships. We also support development of medical countermeasures – drugs,
vaccines, diagnostics and devices – that can be used to diagnose or treat
illness or injury in public health emergencies like pandemics or following acts
of bioterrorism, as well as day-to-day medical conditions. This multi-use
approach strengthens everyday systems and increases our resilience in
The Holly Springs facility was built through a partnership established
in 2009 between BARDA and Novartis to increase the domestic production capacity
of pandemic influenza vaccine and quickly provide additional influenza vaccines
to combat public health threats.
In 2012, BARDA broadened this partnership with Novartis and expanded
the Holly Springs facility’s role in emergency preparedness as one of three
national Centers for
Innovation in Advanced Development and Manufacturing. These centers provide
support for the development and manufacturing of medical countermeasures and
can transition efficiently to manufacture pandemic influenza vaccines or other
medical products for public health emergencies. The centers also aid in
bringing new medical countermeasures to the market and help train the
biopharmaceutical workforce needed in the future.
As a center, the Holly Springs facility can produce up to 200 million
doses of pandemic influenza vaccine within six months of the declaration of a
In 2012, the Holly Springs facility opened to produce cell-based
influenza vaccine that could be authorized by the FDA for use during the
emergency. That same year cell-based influenza vaccine called Flucelvax, made
by Novartis in Germany, became the first approved by FDA for use in the United
States. Now, with the approval of manufacturing the Holly Springs facility, the
capacity for seasonal influenza vaccine production in the United States has
increase by at least 50 million doses.
This latest FDA approval affirms the value and success possible through
public-private partnerships as we move forward bringing our nation the medical countermeasures needed
to protect health and save lives every day.
To those of you who earned an ADN several decades ago and believe you can nurse circles around today's new grads (and I don't doubt that's true), let me say, before you write a letter, that I understand you are a good and valuable nurses. I don't question your skills, especially at the bedside, and I don't think you should have to go back to school to earn a degree if you have years of experience. That said, I believe the entry level education for nursing should be at least a bachelor's. Healthcare is not what it was 20 years ago and nurses need to change along with it.
To me, it's simple: research supports there are better outcomes when nurses have a BSN. Among the many resources to support this is "Charting Nursing's Future" from the Robert Wood Johnson Foundation. As an industry that supports evidence-based practice, nursing should follow the evidence in regard to education levels.
One of the benefits of the ADN is that is makes entry into nursing affordable. Paying for a two-year degree makes the field accessible to many more people who are qualified academically. Currently, as noted in this issue's cover story, community colleges and four-year universities are partnering in what is now RN-to-BSN programs. A similar model could be developed, but the requirement to take the licensing exam would be a bachelor's degree.
One of the things nursing is doing right is differentiating nurses who practice at advanced levels. Advanced practice nurses (NP, CNS, CRNA, CNM) are recognized by healthcare systems, physicians and increasingly by the public, as having knowledge and skills beyond the staff RN. The acknowledgement is well earned and necessary, especially for nurse practitioners and clinical nurse specialists, who are taking on more leadership roles within health systems (and independent practice in the case of the NP) in conjunction with their clinical expertise.
Nurses have to be part of the health system leadership team. In a recent online article, "Non-Nurse Nursing Directors?" we heard loud and clear that many believe only a nurse can lead nurses. But there are additional skills needed for most leadership positions and education is the way to acquire that knowledge and it begins with a bachelor's degree, which could lead to an MSN or doctoral degree.
Johns Hopkins School of Nursing recognizes the need for higher education for nurse leaders and has taken a unique approach. Just announced is the "Master's Entry Into Nursing" program designed for students with a bachelor's degree not in nursing. Students will graduate with a master's degree and be eligible to take NCLEX.
"The future of healthcare demands that nurses have a solid foundation in evidence-based practice, strong leadership skills, and a commitment to lifelong learning," noted Johns Hopkins School of Nursing Dean Patricia M. Davidson, PhD, MEd, RN, FAAN.
Time for Change
Other healthcare disciplines have successfully changed their entry level requirements. Physical therapy is a good example. It moved from certificate to a bachelor's degree in the ‘50s, to master's in the ‘80s. And now, the vision of the national association (APTA) is "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy." The changes did not result in a devastating shortage, but instead elevated the field academically, professionally and clinically. It's time for nursing to catch up with other healthcare professions and require a bachelor's degree as entry to the field.
reflect upon the significance of Father’s Day, I am reminded of why I decided
to pursue nursing in the first place. The birth of my daughter reaffirms my
commitment to the path I have chosen every day.
I have come to realize is that these two jobs, fatherhood and nursing, are one in
the same. Both require sacrifice; putting the needs of someone else before your
own. I want to give care to a patient in the same way I would want my family to
be cared for.
many nurses will tell you they had always dreamed of becoming a nurse, I did
not grow up with this dream. My passion for helping and caring for others grew long
before I realized nursing would be my chosen career path. Eventually, this
passion motivated me to make a drastic career change.
after 9/11, I decided to enroll in the U.S. Army and in May 2002, I was
enlisted in the infantry. I deployed in support of Operation Enduring Freedom,
Afghanistan in 2004. After being honorably discharged in 2005 I moved to Las
Vegas and enrolled at the University of Nevada, Las Vegas to eventually earn my bachelor’s degree in business management. I
was soon involuntarily recalled to Afghanistan.
temporarily left everything behind, I was able to return to Las Vegas, where I finished
my degree and started a defense contracting business. Unfortunately, the
economy soon plummeted, and the government cut back its spending. Eventually, I
was forced to close down the business.
these changing circumstances and a desire to be close to family, my wife and I
made the decision to move back to our hometown of Cleveland, Ohio. I started
working odds-and-ends sales jobs, mainly providing business-related services, and
tried to utilize my business management degree. Each job lacked a feeling of internal
satisfaction that I desired.
As I thought
back to my time in the Army, I remembered the strong feeling of accomplishment
I felt. I had made a difference every day and I felt established. I was on the
front lines patrolling the border of Pakistan and Afghanistan and experienced
the rush of combat, but I also helped to build schools and aided sick children.
As I reflected on these times, I realized how much I missed the rewarding
feeling you get when you are a part of something greater than yourself.
at this point in my life, as I was going back and forth between sales jobs,
feeling completely unsatisfied, that I decided to make a career change and
become a nurse, despite the fact that others could not picture me in such a
April 2013, I enrolled in the Bachelor of Science
in Nursing (BSN) degree program at Chamberlain College of Nursing’s Cleveland campus. I decided to make
this career change to nursing because I wanted to make a difference again, I
wanted to feel a bigger sense of accomplishment in my life than just holding a
job for financial gain.
year, my daughter Rose was born. During our stay at the hospital, our nurses
were always there, providing me and my wife with support and guidance. They
were always checking in on us, ready to help us with the nerve-racking
questions all new parents face: How should we feed her? How should we bath her?
Will she be too warm in this blanket?
last day, as we were about to leave the hospital, I joked with the nurse,
asking if she would come home with us. The interactions my wife and I had with
the nurses made me more comfortable caring for my daughter once we left the
safety of the hospital.
start my journey of fatherhood and continue my education to earn my BSN, I hope
that being good at one will help me succeed with the other. I hope to secure a
better future for myself and my family through becoming a nurse. As a father I
want to give my daughter a reason to be proud of me. I want to teach her that
there are many important aspects of life that can be realized through your
career and that careers can offer more meaning than the simple satisfaction of
became a nurse not only to fulfill a personal calling of
wanting to help and care for others, but to show my daughter the power of helping
your fellow people, the people you live with in your community. I want to teach
her that doing so will provide her with a greater sense of completeness than any
pursuit made simply for financial gain.
is an incredibly honorable profession. I hope that one day I can show my
daughter the profound influence she has had on my life and commitment to
becoming a nurse.
Helstein is a student in the
Bachelor of Science in Nursing degree program, Chamberlain College of Nursing’s
By Linda Riccio, BSN, RN, operating room staff nurse at Saint Francis Hospital and Medical Center, Hartford, Conn.
June 11 is National Time Out Day. As a nurse professional I wanted to share how this important day relates to everyday practice in the environment of Saint Francis Hospital's surgical services.
Several years ago with the groundbreaking of a new, state-of-the art, operating room facility there was also an emergence of a culture that incorporated patient safety and satisfaction as its primary goal and focus. The leadership understood, and continues to understand, how important it is to provide the resources that their direct care providers need to foster a safe, high quality patient care environment.
The time out process is an essential part of that culture. Routine educational programs, led by Dawn Hydes, MSN, RN, CNOR, ENB, explain evidence based practice and emphasize compliance with AORN standards as they relate to the time out process. Everyday practice includes a dedicated moment by the entire team to stop and communicate all of the aspects of each patient's case in a standardized format utilizing a script that was collaboratively developed.
A most recent critical stat case, that had become an open thoracotomy prior to arrival to the OR, provides an example of the commitment and consistency of our time out practice as the team continued to perform a time out, despite the chaotic circumstance in which the patient was brought to the OR, ensuring that critical communication was clearly stated in order to safely continue with the procedure and stabilize the patient.
This year National Time Out Day will serve as a day of celebration for our team to honor our progress and commitment to patient safety. At Saint Francis Hospital and Medical Center the patient care providers of the perioperative services will join together for a commemorating breakfast provided by the Department of Surgery to recognize our achievements and continuation of reaching the highest level of safe patient care. Many compliments to our team for making the patient the center focus of our care!
For more information on National Time Out Day, go to www.aorn.org/timeout
The American Nurses Association (ANA) collectively applauds the
introduction of federal legislation in the U.S. Senate that empowers registered
nurses (RNs) to drive staffing decisions in hospitals, protect patients and
improve the quality of care.
The Registered Nurse Safe Staffing Act of 2014 (S. 2353), crafted with
input from ANA, is sponsored by Sen. Jeff Merkley (D-OR). ANA supports a companion staffing
bill introduced in the House in May 2013, the
Registered Nurse Safe Staffing Act of 2013 (H.R. 1821).
“It is encouraging that members of both chambers of Congress understand
the connection between nurse staffing and patient safety. There is no room for
debate: when there are appropriate nurse staffing levels, lives are saved and
patient outcomes improve,” says ANA President Karen A. Daley, PhD, RN, FAAN.
“With federal legislation we can vastly advance the quality of patient care and
improve working conditions for nurses.”
According to ANA, research has shown that higher staffing levels by experienced
RNs are linked to lower rates of patient falls, infections, medication errors,
and even death. And when unanticipated events happen in a hospital
resulting in patient death, injury, or permanent loss of function, inadequate
nurse staffing often is cited as a contributing factor.
“As the husband of a nurse, I know firsthand the many challenges nurses
face and how critical their care is to patients,” says Sen. Merkley. “Safe
staffing that enhances patient care, reduces medical errors and bolsters nurse
retention all at the same time would be a tremendous improvement to health care
The bill would require hospitals to establish committees that would
create unit-by-unit nurse staffing plans based on multiple factors, such as the
number of patients on the unit, severity of the patients’ conditions,
experience and skill level of the RNs, availability of support staff, and
“As a nurse, and someone who’s been involved in both patient care
and policy discussions about staffing for decades, I’m so pleased to see Sen.
Merkley standing up for patients in hospitals across the country,” said Susan
King, MS, RN, CEN, FAAN, executive director of the Oregon Nurses Association, a
constituent member of ANA.
“We know that nurse staffing levels impact patient outcomes and nurse
retention, and—as the people providing care to patients—nurses bring an
intimate understanding of patient needs to the discussion about how to most
appropriately staff a facility. This is critical legislation for every
patient in a hospital and for the nurses who care for them.”
The safe staffing bill also would require hospitals that participate in
Medicare to publicly report nurse staffing plans for each unit.
It would place limits on the practice of “floating” nurses by ensuring
that RNs are not forced to work on units if they lack the education and
experience in that specialty.
It also would hold hospitals accountable for safe nurse staffing by
requiring the development of procedures for receiving and investigating
complaints; allowing imposition of civil monetary penalties for knowing
violations; and providing whistle-blower protections for those who file a
complaint about staffing.
Additionally, ANA has advocated for optimal nurse staffing through the
development and updating of ANA’s Principles for Nurse Staffing, and development
of a national
nursing quality database program that correlates staffing to patient
To date, seven states have passed nurse safe staffing legislation that
closely resembles ANA’s recommended approach to ensure safe staffing,
utilizing a hospital-wide staffing committee in which direct care nurses have a
voice in creating the appropriate staffing levels. Those states are
Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington.
For more information on ANA’s safe staffing legislative efforts, please
By Deborah Hunt, PhD, RN, who is a member of the School of Nursing faculty at The College of New Rochelle in New Rochelle, N.Y
During National Nurses Week I attended the premier of The American Nurse in NYC as a guest of Abigail Cuffey, who is the Health Director from Woman's Day Magazine. This film is based on the professional and personal lives of the five nurses who were originally included in Carolyn Jones's book, The American Nurse, which was published in 2012. The book included pictures and interviews of 75 nurses from around the country demonstrating the significant role nurses play in the health of our nation.
Cuffey, who is not a nurse, had this comment on the film: "Most people know that nurses are an integral part of the healthcare system, but this movie shows just how much of a difference they really make in their patients' lives. And the serious positive impact they have on society."
I thoroughly enjoyed every minute of the film and the Q&A session that followed. This documentary is about five nurses and the lives they touch while providing holistic, high-quality and compassionate nursing care in a variety of different settings.
The nurses include: Tonia Faust with maximum-security prison inmates; Jason Short with home health patients in Appalachia; Brian McMillion with soldiers returning from war; Naomi Cross with mothers giving birth; and Sister Stephen with nursing home patients at the end of life. Carolyn Jones and Lisa Frank, along with the rest of the team and the nurses, did a great job.
Fresenius Kabi USA, Rhonda Collins, MSN, RN, and Digiplex theatres should also be recognized for their support of this film, which is being shown in theatres around the country.
This film is very well-done and quite poignant. Although the nurses and their roles are different they each portray the essence - both the art and science - of the professional nurse. There are so many negative portrayals of nurses in the media, and it is refreshing to see nurses in action and accurately portrayed in their everyday lives providing holistic, high-quality nursing care to a diverse group of patients. I experienced myriad emotions while viewing this film - happiness, joy, sorrow, pride, compassion, empathy and gratitude. And even though I have been a nurse for many years I learned a lesson from each one of these inspiring nurses.
Throughout my professional journey I have had many rewarding roles and have met so many nurses who all bring something unique to the profession and have a profound effect on the lives of their patients and families. I hope this film is the first of many more to come that portray real-life nurses demonstrating their vast knowledge, compassion, critical thinking, professionalism, dedication and caring. As a nursing professor I will be sharing this film far and wide, and believe that every patient, nurse and nursing student should view this film. I also believe Siskel and Ebert would agree with my review and give this film two thumbs up.
Click her to see a trailer of the film.
By Susanne Marie Johnson, BSN, RN
In February 2013, Barbara Mancini of Philadelphia was arrested and
subsequently charged with a felony of assisted suicide. The prosecution
asserts Mancini provided her 93-year-old and terminally ill father, Joe
Yourshaw, with the bottle of morphine that allowed him to take a lethal dose in
an attempt to end his life.
Mancini’s father suffered from at least two end-stage diseases and was
under hospice care in his Pottstown home. Ms. Manicini maintains that she
provided her father with the morphine because he had requested it in an effort
to relieve his own suffering. Despite Ms. Mancini’s assertion that her father
would not want further treatment, Mr. Yourshaw was transferred to a local
hospital, resuscitated, and given even more morphine for his pain after his
hospice nurse called 911. He would die four days later.
If Pennsylvania and other states had legislation permitting
physician-assisted suicide (PAS), Mr. Yourshaw might have died comfortably at
home, surrounded by those he loved, feeling secure in the knowledge that he did
not have to succumb to his diseases but could assert his right to autonomy as a
patient and leave this world of his own accord.
The Netherlands has legally allowed physician-assisted suicide since
1992. In the U.S., Oregon made physician-assisted suicide legal in 1997 when
voters passed the Death With Dignity Act (DWDA) and Washington passed similar
legislation in 2009. The DWDA act permits a mentally competent and terminally
ill individual who is over the age of 18 and a citizen of the state of Oregon
to request a lethal dose of medication (usually an oral dose of a barbiturate)
from their physician for the purpose of ending their life.
In order for a patient to be considered eligible to participate in the
act, they must also meet the following criteria:
1. The patient must make two
verbal requests separated
by a period of at least 15 days to their attending physician .
2. The patient must also make a written
request to their attending physician in the presence of two witnesses.
3. An attending
and consulting physician must then confirm the patient’s diagnosis and
prognosis and whether or not the patient is capable of making healthcare
decisions for themselves.
4. If the patient’s judgment is believed to be impaired
either by psychiatric condition or coercion, the patient must be referred for psychological
5. The attending physician must educate the patient about
alternatives including, but not limited to, palliative care, hospice care, and
6. The attending physician must request, but must not require,
that the patient notify their next-of-kin of the request for the prescription.
Patients may retract their request at any time.
7. Physicians must report all
requests for prescriptions of lethal medications to the Oregon Health Authority
and pharmacists must be notified if the prescribed medication is used.
The right to die is not the same as the duty to die. The DWDA is not a
tool to advocate for the removal of life-prolonging treatments or devices. Many
detractors of the DWDA have asserted that this type of legislation smacks of
health care rationing and will likely prevent the terminally ill in vulnerable
populations such as the poor, the under-educated, and those without health
insurance from receiving palliative care and hospice services. The Oregon
Health Authority makes available to the public extensive yearly reports
regarding compliance with the Act, the number of individuals who request
prescriptions, and the subsequent number of deaths of individuals that occur
from use of the obtained prescriptions.
According to the 2013 report, 115 individuals obtained prescriptions
for lethal medications, but only 77 individuals died as a direct result of
using those prescriptions. Supporters of the DWDA maintain that the aim of legalizing
PAS is strictly to empower the terminally-ill patient; to provide them with a
sense of control over the circumstances of death, to diminish their feelings of
dependence on others, to alleviate the fear of dying with uncontrolled symptoms
such as intractable pain and loss of bowel/bladder control, and to allow for
better preparation for death. In fact, current literature indicates that those
who most often use the DWDA are wealthy and highly educated. Still more
opponents of PAS believe that it would become a stand-in for quality EOL care
and that patients will not be adequately informed by their physicians of other
options for symptom management, pain control, and hospice services.
There is still a widely held belief that access to quality palliative
care and hospice services will fail to improve if patients have the option to
take their own life. Oregon’s DWDA clearly stipulates that any patient
requesting a prescription for lethal medication must be informed of alternative
therapies and options by their physician to avoid this specific conflict.
Family members of those who chose PAS actually noted that their loved ones had
greater symptom control, better energy and interaction with their environment,
and seemed more prepared for death according to those who participated in a
study using a 33-item measurement tool of the quality of death and dying.
Physician-assisted suicide and the Oregon Death With Dignity Act
continue to be controversial ethical and moral topics within healthcare and the
U.S. legislature. As we move toward providing patients with greater healthcare
options in the U.S. through the Affordable Care Act, it seems that we must also
provide patients with a greater variety of options at the end of life, a time
when choice and autonomy may be most important. Physician-assisted suicide in
no way detracts from the care that terminally ill patients receive. Instead,
physician-assisted suicide may be the intervention that most meets patients’
desire for increased control in situations where they are afforded very little
determination in the outcome of their illness.
References can be accessed at www.advanceweb.com/Nurses.
Susanne Marie Johnson is
on staff at Hospital of the University of Pennsylvania and a graduate student
in the Family and Community Health Nurse Practitioner program with a focus on
Palliative Care at the University of Pennsylvania School of Nursing.
Earth Day is April 22. It's a time to give back to the earth to protect it, maintain it, clean it or celebrate it - whatever it is you believe the earth needs from you. But what you shouldn't do is feed it drugs.
Nurses can play an important role by educating their patients of how to properly dispose of unwanted medications - and it's not flushing them down the toilet. If it's flushed, it ends up back in your water glass.
A vast array of pharmaceuticals - including antibiotics, anti-convulsants, mood stabilizers and sex hormones - have been found in the drinking water supplies of at least 41 million Americans, according to the site, Dispose My Meds.
The federal Drug Enforcement Agency (DEA) is organizing another nationwide Prescription Drug Take-Back Day on Saturday, April 26. While this is a good opportunity for individuals to properly dispose of unused or expired medications at a safe location, consumers need more convenient access to disposal locations more than twice a year, which is how often DEA schedules these events.
That's why independent pharmacist members of the National Community Pharmacists Association (NCPA) have stepped up to help their patients through the Dispose My MedsTM program. Since its inception in 2009, Dispose My Meds has collected more than 200 tons of medications at more than 1,600 participating community pharmacies in 40 states across the country. (Note: opioids and other controlled substances are not allowed.)
Many of the medications being dropped off for safe disposal at community pharmacies come from excess mail order prescriptions that are auto-shipped to patients, whether they want the medication or not. NCPA has compiled an astounding collection of 114 photos of mail order waste examples in our "Waste Not, Want Not" slideshow.
So this Earth Day, make a commitment to give back. Remember to reuse, reduce and recycle and help your patients properly dispose of unwanted medications.
PSNA Focuses on the Environment
Drug Waste Dilemma
Karen Pischke, BSN, RN, CCRN, RMT, CHT, TTS, is a regular contributor to ADVANCE, and is a Reiki practitioner.
"There but for the Grace.... "
April 15, 2013, I was making a bee-line to the finish line when I looked back over my shoulder and paused. I took a few steps back to the corner of Hereford and Boylston, taking photos of runners coming around the bend to cross the finish line. Ten minutes later (time stamped on my camera) we hear the 1st explosion.
One year later, sights and sounds of the next few hours still ringing in my mind.
Stopping for those 10 minutes may have saved my life. For the next few hours, I was there with friends trying to find out if loved ones were okay, not knowing what might happen next. I was there 'with Reiki,' feeling a surreal sense of calmness. Hoping to bring a sense of 'peace and calm,' and help in some small way to find order in the midst of chaos and uncertainty.
Today as I reflect, I think about the people I met that day, those impacted, my family, friends and co-workers that were there, most safe, some injured. Lives changed. Some lost. Sending prayers, positive thoughts and Reiki to all those impacted. Honoring the strength, courage, and resiliency of those that survived.
Feeling very grateful today.
Petrillo, MSN, RN-BC
As nurses, we are charged with the responsibility of ensuring patient
safety and improving patient satisfaction. Although at first it may seem like
another task to add to the list, hourly rounding can help us achieve these
goals while also organizing our workflow. Hourly rounding, or checking on the patient
at regular intervals to assess the 4 P’s- pain, position, potty and proximity
of personal items, does not have to be done by the RN alone. Sharing the
responsibility with the CNA is a good way to avoid becoming overwhelmed. For
example, RNs can check on the patients on even hours and CNAs on odd hours
Hourly rounding has been shown to decrease call bell usage, improve patient
satisfaction and decrease falls rates (Olrich, Kalman & Nigolian, 212).
These are three things that nurses are always striving to do! By planning ahead
and performing hourly rounds while clustering tasks such as pain assessments
and medication administration, nurses can achieve goals while organizing their
workflow and becoming more efficient with time spent in patient rooms. When the
patient knows when to expect someone back in his/her room, he/she is less
likely to press the call bell, thus limiting interruptions to the nurse’s
Hourly rounding is a multidisciplinary action which can help improve
the patient experience. By assessing patient needs on regular intervals, the
patient is more satisfied, less likely to call and less likely to fall. In my
institution, we hold each other accountable for performing hourly rounds by
having a sheet in each room where the staff member making rounds on that
patient can initial in the space next to the corresponding hour. We hold each
other accountable by reminding each other to make rounds and passing along
messages regarding patient needs discovered during rounds to the appropriate
staff members. Making this a shared responsibility helps improve teamwork and
Lauren Petrillo s a senior staff nurse at New
York-Presbyterian/Weill Cornell Medical Center, New York City.
Halm, M. A. (2009). Hourly Rounds: What Does the Evidence Indicate? Am J Crit Care,18, 581-584.
Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly Rounding: A Replication Study. MESURG Nursing, 21(1), 23-36.