A big part of looking at evidence is numbers. Nurses need to question whether something can be considered evidence based on the sample size or if predicted outcomes are small or inconsistent.  As well they must scrutinize where the study came from - do the authors or their supporters stand to gain or lose based on conclusions drawn from the studies.

Makes sense. But when it comes to cancer, especially breast cancer, it is difficult to consider evidence that goes against "what's always been done."

Logic vs. Emotion

I believe our healthcare system needs to change (I don't want to use the "R" word). I think we are too quick to do expensive tests, invasive procedures and prescribe pills. I believe in prevention and personal responsibility. I also believe in science and that decisions that impact the masses should be made based on good science and evidence.

When I heard the new recommendations for PSA testing this summer and mammography this week, I was, and still am, hesitant to accept.

Every Mother's Day and Father's Day I do road races that raise money to support breast and prostate cancer awareness. I have a personal connection to both cancers. I know breast cancer survivors who were diagnosed well before age 50. I don't know that I want to forego my annual mammogram - even if evidence tells me the exam is unnecessary.

It would be easy for me to listen to the hospitals, radiologists, labs and other groups who are speaking out against the new recommendation because they seem to have our best interests in mind. But I can't forget these entities also stand to lose a significant amount of money - just like the insurance companies stand gain - with the change.  

Hype & Health

The most difficult part of assessing information like this is the hype put forth by the media and those with political interests. It's difficult to look logically at any study when being barraged with personal stories of mothers, sisters and daughters being diagnosed with breast cancer at a young age. Do the recommendations really say women younger than 50 aren't worth the cost of a mammogram? Using the same logic, then, what about the 30 year olds and 20 year olds? If we don't test everybody for everything are we saying they are not worth it?

The only conclusion I've come to based on what's happened since the announcement is that I don't trust any source to give me pure logic and science. This announcement has only served to confuse and to fuel the current political strife. I wonder if anybody has our best interests in mind.

For more on this topic, read these additional blogs: Mammography Screening Changing? and Mammagrphy and the Right to Choose

Some people scoff at the younger generation's seeming dependence on social media. "Who needs text messaging or Facebook or MySpace? What's wrong with picking up the phone and calling someone?" ask some old-schoolers.

And they'll further the attack with, "Who cares what Ashton Kutcher has to say about his wife, Demi Moore? He can keep his tweets to himself!"

All true enough. But it was a lone social media person who trumpeted -- and tweeted -- the call for blood from Scott & White, the central Texas hospital which treated victims of the Nov. 5 Fort Hood shooting.

The hospital's Web guru, Aaron Hughling, stayed out of the ED and the Level 1 trauma center. Instead he made his unique contribution to the crisis by tweeting the call for blood.

According to a Nov. 17 story by Lindsey Miller for Ragan.com, "...many of his tweets focused on blood donations, and that night Scott & White became a top trending topic on Twitter, with more than 400 retweets to Hughling's post about blood donation. His efforts to spread the word on Twitter and other social media helped the hospital collect more than 1,000 units of blood at the blood center and in mobile donation trucks."

In fact Miller quotes Hughling as saying, "At one point we actually had to turn people away. They turned away something like 600 people."

While we really may not care what Demi Moore is having for breakfast, we can thank Ashton Kutcher and other celebrity Twitter tweeters for attracting legions to social media. And with the bad that may accompany celebrity fixations, also comes the good: Blood donations at a time when they meant the difference between life and death.

So here's a big "Atta Boy!" to Hughling, certainly no twit, but rather a lone ranger who handled crisis with a 21st century tweet.

According to an MSNBC report, a14-year-old Virginia boy developed Guillain-Barre syndrome (GBS) within hours of receiving an H1N1 vaccine.

Jordan McFarland, a high school athlete from Alexandria, reportedly left Inova Fairfax Hospital for Children the evening of Nov. 10 in a wheelchair nearly a week after developing severe headaches, muscle spasms and weakness in his legs following a swine flu shot. He will likely need the assistance of a walker for 4-6 weeks, plus extensive physical therapy, according to the report.

He's one of the six people to have a report on file through the CDC for development of GBS after receiving H1N1 vaccination since Oct. 6, the report claims.

Of approximately 40 million doses of H1N1 vaccine available to date, that's a far lower rate of GBS than the one case that develops in every 1 million people who receive the regular flu vaccine.

In 1976, about one additional case of GBS developed in every 100,000 people who were vaccinated against the swine flu, according to the CDC.

Have you seen any GBS in patients you've vaccinated? Will this news prevent you from vaccinating yourself or your family?

Deadly Reality

His words brought personal perspective to a recent study. Harvard researchers revealed that over 2,280 veterans died in 2008 due to lack of health insurance. They detailed that 1.46 million working-age vets lacked health coverage last year, thus increasing their death rate. Now that is truly a disgrace.

It's startling to realize so many noble vets met their demise not at the hands of an enemy, but at their exclusion from our healthcare system. Lack of insurance proved more fatal than the bullets they dodged in jungles and deserts.

According to information about the study, provided by Physicians for a National Health Program (PNPH), Harvard Medical School estimates 2,266 U.S. military veterans under the age of 65 died last year due to reduced access to health care. That number was juxtaposed against current wartime statistics: It is 14 times higher than the number of deaths suffered by American troops in Afghanistan during the same time period, and more than twice the number of those who have died since the war began in 2001.

In fact, the Harvard findings, published in the American Journal of Public Health, found that being uninsured raises an individual's odds of dying by 40 percent among those ages 17 to 64 -- a demographic in which many deaths are highly preventable.

Analysts Weigh In

"Like other uninsured Americans, most uninsured vets are working people -- too poor to afford private coverage, but not poor enough to qualify for Medicaid or means-tested VA care," said Dr. Steffie Woolhandler, a professor at Harvard Medical School who carried out an analysis, released yesterday, of the Harvard study. "As a result, veterans go without the care they need every day in the U.S., and thousands die each year. That's a disgrace."

But what about VA care and VA hospitals -- don't they offer a care advantage to vets? Not for all, said the analysts. Even some combat veterans are unable to get VA care, according to Woolhandler. Veterans must pass a "means test" and are assigned a priority status according to income. So some working veterans, by virtue of their income, are classified in the lowest priority group and are not eligible for VA enrollment, said the professor.

Battle Cry   

The Harvard researchers pointedly noted that health care reform legislation now pending in the halls of Congress will do little to stem these grim statistics in the short run. "Those bills would do virtually nothing for the uninsured until 2013, and leave at least 17 million uninsured over the long run," said Dr. David Himmelstein, co-author of the analysis and an associate professor of medicine at Harvard. "We need a solution that works for all veterans, and for all Americans." In his opinion: single-payer national health insurance.

Thank a Vet

The healthcare reform battle wages on. And I suppose you could say we are all soldiers in the fight for our collective national health. Being armed with information found in the Harvard study and the PNPH analysis can help us in forming the best battle plan and staking out the most advantageous position.

On this Veterans Day, take time to thank a vet for "stepping up" on our behalf. Regardless of your political leanings, appreciate the people who put their lives on the line. We can't give them back their friends lost in battle, or those lost to gaps in healthcare access. But we can do a lot to assure their human dignity. And guess what: It doesn't take legislation to get it done.

The American Nurses Association President Rebecca M. Patton, MSN, RN, CNOR, has written a letter to all ANA members, urging them to get vaccinated for seasonal influenza and the H1N1 virus. ANA believes it is important to get this message to registered nurses to increase vaccination rates, in light of the public health emergency posed by the H1N1 pandemic.

 There has been a lot of discussion on this site about vaccinations, especially for H1N1. Have you changed your mind about either the season or H1N1 vaccine given the recent discussions?

A recent segment on CBS’ 60 Minutes posed an interesting solution for how to pay for health reform: eliminate Medicare fraud.

Sounds like a good idea. According to the expose, Medicare fraud is a $70 billion a year scam. Times that number by 10, and the government can recoup a good chunk of the $1 trillion estimated cost for covering the uninsured over 10 years.

But let’s get serious.

Listening to the informant on 60 minutes describe how easy it is to rip off the government, makes you wonder. What kind of system lets companies bill for artificial limbs two of a kind over consecutive months – for the same patient! Or pays out $2 million dollars a month to a company address – no questions asked.

"You're waking up every day making $20,000, $30,000, $40,000," the informant told 60 Minutes. “Every day, almost literally.” In fact, Medicare fraud has become so lucrative — and easy to pull off — it is replacing drug dealing as the country’s No. 1 criminal activity.

Opponents to healthcare reform can make their point that the government cannot manage a state-run healthcare system. Their argument? While the extant healthcare system may be inefficient, corrupt and unregulated, so is the government.

Should the government decide to really go after Medicare fraud in the hopes of funding healthcare reform? They have some soul searching to do.

My mother, despite her 92 years of age, maintains the mind of a brilliant, life-loving 30-year-old. Unfortunately, her physical self never sipped from the fountain of youth. Her sight has dimmed, her mobility is nil, and she's done battle with cancer, gall bladder disease, vertigo, hypertension, insomnia and muscular and joint pain as far back as I can remember.

Lately, however, something was going wrong "upstairs." Mother was uncharacteristically depressed, tired, confused. I chalked it up to old age, and assumed, with resignation and personal heartbreak, the end was closing in.

Was This The End?

One day about 3 weeks ago, she showed a small sign of rallying by asking me to take her out - anywhere. I suggested lunch and a wheelchair tour through a dress shop, something she'd always enjoyed. And we were off...

Lunch was, well, thankless as Mother rearranged the food on her plate, uninterested in her order. The dress shop showed a little more promise at first, but after 5 minutes, Mom started to slump in her chair. Next she mumbled she had to lay her head down, bending over at the waist as if to place her head on the floor. Beads of sweat broke out on her forehead and she became less responsive. Her skin drained of color and she seemed to be sinking into some life-draining quicksand.

I frantically cried out to shoppers, "Call 9-1-1! I think my mother is having a stroke!" Sales staff came to my aid, as did a physical therapy student, talking to my mother while trying to calm me.

Exercise in Eternity

Waiting for an ambulance when you think your sainted mother is dying is an exercise in eternity. When the paramedics did arrive, Mother's "high blood pressure" was 78/34, and she was barely conscious.

She was taken to an ED where she remained from 2 p.m. to midnight; then she was admitted. Any guesses?

Mother had suffered a syncope brought on by a nearly lethal interaction of drugs she paid dearly for and obediently ingested at the behest of her primary care physician. There was Valium for the vertigo, antidepressant Trozodone to counteract insomnia, Diazide and Benicar for her high blood pressure, potassium tablets, Darvocet and Relafen for pain, and over-the-counter Benedryl for food allergies.

Back From Beyond

Blessings come in strange packages, even in near-misses. Mother has since been taken off every drug except  occasional Tylenol, taken judiciously for pain. Her blood pressure is holding its own at about 120/75 without a hint of hypertension medicine. An Epi-pen is kept at the ready in case of an extreme food allergy attack. Not only is Mom's appetite back, but her bank account is putting on a little weight these days too. Most important of all, Mother's life-affirming attitude has resurfaced.

On Saturday, I'm taking Mother on a cruise to Bermuda. It's the least I can do, considering she almost took a trip to the great beyond. The Bermuda Triangle has nothing on that perfect storm created by doctor-prescribed drugs in frightening combinations. Besides, Mom's got a few good miles left.

A friend called me the other day and read an H1N1 memo that had been distributed to the approximately 120 employees at her Southeastern Pennsylvania office. It read:

Workers are expected to be at their work stations. If you have been exposed to H1N1, that does not mean you are sick or should stay home. If you do feel you must report off sick, we have a right to require a note from a doctor's office or emergency department to identify if the illness is, or is not, H1N1. We will also require written medical clearance before you may return to work.

Might Doesn't Always Make Right

In the interest of reducing employee malingering, this employer will be sending sick, maybe sick, or not-even-sick employees to overburdened healthcare providers to prove a sick day is legitimate, or not. The memo, however well-intentioned, actually sends a message to workers that calling off sick may suggest a misuse of sick leave. So they will be "taxed," not only with a doctor's visit to stay out, but also one to return. Since this particular company has a very non-comprehensive healthcare plan, this also will require affected employees, already concerned about looking like malingerers, to dig into their sometimes shallow pockets for hefty co-pays. The result? They'll report to work. They'll tough-it-out. They'll sit at their shared computer keyboards and spread germs like crazy. That's scary.

Where Is Plan B?

Sadly, this company seems to be exerting little effort to have a viable "Plan B" in the event of a widespread flu situation at the office. No one has suggested a chain of work in the event of unusual absenteeism; there are no proposed work-from-home alternatives being circulated by administrative memos. And there aren't even any hand washing advisories tacked to the lunch room walls. Certainly no 'flu'-id thinkers at work there.

I am getting nearly obsessive in my interest in asking what is being done to stem the spread of flu at area businesses. The bank where my son works has been more "proactive" than most: one bottle of hand sanitizer and a box of Kleenex. That beats what many people have told me about their employers' plans which are often identical in description: nothing.

Even Small Efforts Count

I suggest every one of us reach out and "adopt" just one business or organization to educate, in some manner. I am not a nurse, so my means of "educating" the original company was to write to a manager there and suggest he relax -- not tighten -- the sick leave policy. Better to have one malingerer stay home than 10 good workers being infected by someone who is really sick on the job. And it goes without saying, I've also adopted my son's bank: They now have four giant bottles of hand sanitizer, multiple boxes of Kleenex and a continuing, effusive sermon from this mother-turned-customer about the necessity of washing hands whenever possible. Amen.

Know anyone -- maybe a patient or a family member -- who's taking an antidepressant to help with sleep, a relatively common off-label treatment prescribed by physicians for menopausal women? Or anyone who takes low-dose statin cholesterol-lowering drugs as a prophylactic measure against heart attack and stroke -- not to treat high cholesterol?

They could be hurting their changes of getting health insurance.

Insurance companies, as reported in a fascinating, alarming BusinessWeek article, are using prescription databases to weed out and screen out applicants based on their drug purchases.

This primarily affects people seeking individual insurance, not those covered under their employer's plan. Roughly 18 million people are covered by individual policies.

The article highlights the case of Walter and Paula Shelton of Gilbert, LA. When the article was published in August 2008, the Sheltons had recently applied for coverage to Louisville, KY-based insurance company Humana. Shortly thereafter, an employee checked their prescription profiles. At their local Randalls grocery store and Walmart, the Sheltons had filled prescriptions for blood-pressure and antidepressant medications. Medications used to treat mental health conditions, depression being one of them, are big red flags to insurers.

Actually, the blood-pressure prescription was for a minor problem Paula Shelton was having with ankle swelling. The antidepressant had been prescribed by her physician to help her sleep.

The Humana representative called the Sheltons to ask about the prescriptions. Walter Shelton explained that the drugs weren't for serious conditions, but the conversation "just went south," he said. The Sheltons were denied coverage.

Prescription Profiling

How does it work? MedPoint and IntelliScript are the companies that provide the prescription profiles, at a cost of only about $15 per search. They buy the data from companies called pharmacy-benefits managers (PBMs). PBMs have access to prescription information from drugstores. No privacy laws prevent the gathering of the prescription data.

FTC Crackdown

A 2007 investigation by the Federal Trade Commission (FTC) found MedPoint and IntelliScript violated federal law for years by hiding their methods from consumers. Not surprisingly, many consumers -- and even many insurance agents, according to BusinessWeek -- don't realize the insurance biggies, such as Humana, Aetna, Blue Cross and UnitedHealth Group, have access to applicants' prescription histories.

An FTC order required disclosure if information about prescriptions results in denial of coverage. MedPoint and IntelliScript say they are now fully complying with the order. And under the federal Fair Credit Reporting Act, the FTC mandated that insurers now tell applicants the address of the company that compiled the prescription data.

Privacy, Anyone?

Wondering how HIPAA fits into all this? When applying for coverage, individuals sign forms allowing providers to review their medical history. To be HIPAA-compliant, most insurers have now added a note that this also includes prescription history. Yes, it's in the fine print.

I understand that people with differing medical situations pay different prices for health insurance. When it comes to driving, a teenager or someone who's racked up a bunch of speeding tickets is going to pay higher premiums. Insurance, in large part, comes down to numbers, and I get that.

But what about when someone is denied coverage, like Paula Shelton, because she was following the advice of her physician? If this is the exception, not the rule, I foresee a bevy of Paula Sheltons.

Hey, inquiring minds want to know, especially when one is attached to a pair of legs happy for any help they can get! The lure of shoes capable of firming calf muscles, minimizing the derriere, tightening the tummy, strengthening the back, exciting circulation, improving posture and even burning calories was too much for me to ignore. Where do I sign up?

Getting My Hands, and Feet, on a Pair

When my all-black pair of Skechers Shape-Ups arrived by mail, I half expected them to jump out of the box on their own, make dinner, then tidy up the kitchen before finding their way to my bedroom closet.

It so happens I purchased the all-black style, with a hint of sparkles along the edges, because I am usually in an office situation - one in which the wearing of running shoes is frowned upon. So these black numbers hide discreetly beneath my ubiquitous black slacks. And hey, if anyone does mention the fact that they resemble athletic wear, perhaps I can claim they are indeed as essential to my health as an in-your-dreams all-inclusive HMO. Ah, but I digress...

They're in Demand

I bought these advertised gam-enhancers on the Web at the only online service which carried my very average shoe size. They were sold out everywhere else I looked - at the mall, at stand-alone shoe stores and at other Internet shoe warehouses. This, I assumed, was a good sign. These things evidently have the enthusiasm of John Q. Public and his missus, Jane Doe (she's modern, kept her maiden name). But more interesting to me was the fact that online literature suggests that the patent-pending shoes have been studied and researched and that their claims have been born out in actual clinical trials. Wow! That's a shoe with a pedigree.

Getting Started

Now lest you think you can simply tie these babies on and start moving: Listen up. The shoes arrive with an instructional CD (I kid you not) and printed instructions on how to walk in them! Oh, and there are pictures to show potential wearers how to warm up before they start walking in them. Rock this way, then that way... In addition there is a warning to start small and build up to wearing them for longer periods of time!

   What had I gotten myself into? Would I be able to handle these new-age leg reshapers? I have never considered myself much of an athlete, but to my great surprise I found that I mastered the technique quickly: Put one foot down, pick other foot up, repeat.... Hmmm.... I may not exhibit perfect form, but I find I can wear these slightly cumbersome, inanimate fitness coaches from morning to night in complete comfort.

Do They Deliver?

Now the litmus test: Will they beautify my legs? REALLY? Other inquiring minds seem to want to known as well, because I've been asked the question multiple times by others noticing their "unique," if not somewhat bulky, rounded shape. I have even been stopped on the street by strangers who undoubtedly noticed I had cleverly mastered the art of walking without falling on my head. "Do they work?" they ask.

Well, the answer is.... It's too early to tell. But I did take my measurements before the first wearing, and I will take them again in a month or two. (Now if you think I am actually going to publish my measurements right here, you better strap one of these shoes onto your head and hope it works on your brain, too!) But I promise I will report back on whether I've seen the promised improvements.

And I can tell you one thing, right now, for sure: When walking in these things I do feel a certain tensing and engagement of muscles found in that general region where my body meets my chair. And I do feel a little smug superiority in knowing I have found a way to "work out" when I am walking to the vending machines.

Imagine! Shoes that shape you up! What will they think of next? How about gloves that can clean out a toilet bowl or a hat that can file income taxes? It could happen.

The September 30th episode of the NBC show Mercy was centered on patient advocacy.  Each of the three main characters had to advocate for their patients in a rather dramatic way.  Yes, it was dramatic because it was television, but it left me wondering how far "real life" nurses have gone to advocate for their patients.  Nurses say they are patient advocates, but what does that really mean in the daily functions of the profession?

 In the episode, Veronica was caring for a young patient after an accident, whose leg was virtually crushed.  After a severe infection set in and the patient lost consciousness, his leg had to be amputated.  After discovering this upon waking, the patient was traumatized by the experience.  In a story arch that involved having "closure", Veronica found his post-surgery amputated leg, still sealed in its plastic bag and brought it to him.  That's pretty dramatic.

 The character of Sonia was caring for a middle-aged woman who was brought in unconscious.  She was a "Jane Doe", found in the bathroom of a run down doughnut shop.  HIV positive with multiple conditions, the woman was dying.  A charm bracelet was her only clue to the woman's identity and with the help of a police officer and friend, she was able to locate the woman's son.  The man disowned his mother as a "drunk and a liar".  Ultimately, Sonia stayed with the woman until she passed.

The newbie, Chloe was charged with a patient who was suspected of being a drug addict because of his odd behaviors.  Later, she would take it upon herself to use a fetal heart monitor to hear the sound of an artery near rupture inside his head.

These cases, particularly that of Sonia, remind me of a cover story ADVANCE did last year about a nurse in Templeton, CA who was able to convince hospital administration to keep a homeless man admitted for weeks, even after he was stabilized, until she discovered his identity and found a home for him.  He was completely alone in the world.  Eventually, she discovered his name and was able to place him in assisted living.  Even after the fact, she visited him twice each week to do his laundry, cut his hair and provide companionship until his passing.

What does it really mean to be a patient advocate?  That term is passed around quite a bit, but how far would you go or have you gone to intervene for a patient? 

At some point in our lives we'll all want a personal patient safety advocate to stand up for us when we're not receiving the care we need. As nurses, this job often falls in your lap. In fact, you're mandated by your boards of nursing to report substandard care. Simply put, it's your job to protect the patient; even when he needs protection from the physician.

Anne Mitchell, RN, and Vicki Galle, RN, have been caring for their patients for more than 20 years. But this summer, after both nurses tried to report what they considered to be subpar care by a physician, they ended losing their jobs and getting arrested. Today, they face third-degree felony charges and could wind up serving 10 years in prison.

You can read more about their case here, but in the time since I wrote that article, I learned more about this case and the key players who are at the center of it. And despite all the research I've done, I seem to have more questions than answers.

Seeing the Sheriff

At the heart of the story are two nurses who filed an anonymous complaint to the Texas Medical Board (TMB) on April 7 to report what they considered unprofessional services by Rolando Arafiles Jr., MD, one of only three physicians at the 15-bed county hospital in Kermit, TX, and reportedly the only physician who lives in the small town.

The nurses complained that Arafiles improperly encouraged patients at the hospital ED and the Winkler County Rural Health Clinic to buy herbal medicines and said that the hospital's chief of staff once stopped the physician from taking medical supplies to perform a procedure at a patient's home.

As it turns out, Arafiles operates under a restricted license and cannot supervise or sign off on prescriptions written by a PA, nurse or surgical assistant. Apparently, his license was up for review in April 2007 by the TMB which stated that Arafiles "failed to make an independent medical professional decision about the appropriateness of the protocol" at the weight loss clinic where he authorized prescriptions for the diet drug phentermine for patients who were not classified as obese.

And yet, when the TMB notified the physician he was under investigation again, Arafiles called the sheriff.

This is where the story gets strange. Why didn't Arafiles go to a supervisor or the hospital board instead of contacting local authorities? As it turns out, Arafiles and Sheriff Robert Roberts are reportedly friends, and the sheriff is also a customer of Arafiles' herbal supplement business.

Arafiles filed a harassment complaint with the Winkler County Sheriff's Office which then launched an investigation that led to indictments charging the nurses for "taking non-public information and using it for a non-governmental purpose."

Criminals?

Because Roberts was conducting a "criminal" investigation, he was able to request a copy of the nurses' complaint from the TMB. The report indicated that the person making the complaint was a female RN, over 50 years old who had worked at the hospital for over 20 years - a description fitting both Mitchell and Galle.

The letter was not signed due to the author's fear that she would lose her job. Roberts also interviewed the patients whose medical record case numbers were listed in the report and asked the hospital to identify who would have had access to the patient records in question. The complaint included six patient numbers, but did not include the patients' names. The sheriff then obtained a search warrant to seize the nurses' work computers and found a copy of the anonymous complaint letter to the TMB on one of the computers.

The search and arrest warrant reads that "certain subjects interviewed appeared deceptive about facts surrounding the alleged improper use of medical and/or hospital records."

"Appeared deceptive?" How does one appear to be deceptive? What were the "facts" at the time? Was the sheriff not familiar with the BON mandate that requires nurses to report substandard care? Why did the sheriff immediately assume the nurses were guilty and the physician innocent?

Fighting Back

On Aug. 28, attorneys for Mitchell and Galle struck back by filing suit in federal court alleging not only illegal retaliation for patient advocacy activities, but also civil rights and due process violations, said Jim Willmann, JD, Texas Nurses Association general counsel and director, governmental affairs. The lawsuit names not only the hospital, but also the county, hospital administrator, and physician as defendants. Additionally, because the nurses claim violation of their civil rights, the district attorney, county attorney and sheriff are also named.

The nurses' complaint states that their termination and criminal indictment was illegal retaliation in violation of the Nurses Protection Act (NPA) and several other Texas laws. The TNA stated that several pretrial motions have been filed by the nurses' attorneys, but as of Sept. 1, all but two of have been denied. Those that stuck include a motion to dismiss the case due to prosecutorial vindictiveness and a motion for access to HIPAA protected patient records.

The nurses' attorneys were seeking dismissal of the charges, but a district judge denied the motions and ordered the case to trial. Although a trial date has not yet been scheduled, the only date open for the 2009 docket for a Winkler County trial is Nov. 3, according to the Winkler County District Clerk's office. However, due to the publicity surrounding the case, the possibility of changing the venue of the trial is also in consideration.

According to the TNA, no current Texas law, or laws in any other state, prohibits a local prosecutor from pursuing criminal action as the Winkler County district attorney has done in this case.  It may be an abuse of prosecutorial discretion, and the nurses may ultimately have an action (lawsuit) for malicious prosecution, but no one anticipated the need to try to limit the discretion of local prosecutors.  No one ever imagined that a nurse would be criminally prosecuted for reporting a patient care concern to a licensing agency. 

And yet, two nurses in Texas must defend themselves against the criminal charge. If these two nurses are found guilty, the person who will suffer in the end is the patient.

The TNA established a legal defense fund with the hope of raising at least $10,000 to help pay the legal expenses of the two nurses. To date, the fund has generated over $35,000. To make a donation, visit the TNA Web site at http://www.texasnurses.org/.

Just when you thought nurses were under-represented on TV, we now have no fewer than three primetime series about the lives of nurses. Since the "nursing shortage" in primetime has all but been eliminated, the question now is: Which series most accurately depicts the "real" lives of nurses? Keep in mind that all TV is "heightened reality." No one wants to tune in and see what literally happens in the course of anyone's day. "Real" reality can be boring. That's why even "reality" shows are scripted and manipulated to a certain degree. Sorry to disappoint you, Survivor fans.

Understanding that, I have to say of three nursing shows that grace the airwaves now, I believe Mercy, which debuts tonight on NBC 8/7c, is the best choice by far. It gives those not familiar with nursing a peek into the passion and struggle of the lives of nurses that isn't so far inflated that it's a laughable fairytale. It also gives nurses a sense of validation for the challenges they face, enough suspense to not become predictable and a cast with quality writing that provides nurses with the respect they deserve. 

While Showtime's ethically-challenged, Nurse Jackie features a renegade nurse who does things most nurses only wish they could do, it might provide a sense of escapism for viewers but does nothing to promote the true essence of what nursing really is. We all know the media has a terrible track record with that. 

If you saw the scene from TNT's HawthoRNe where the chief nursing officer leaves her home after being paged at 4:00 a.m. to "talk down" a suicidal patient from the hospital roof ... I don't think I need to say anymore about that show. Still, both have been renewed for another season.

Mercy feels like Grey's Anatomy for nurses ... at least Grey's Anatomy when it was good.  I believe the public will be entertained and educated by it while nurses get a sense of pride and vindication. 

While the show is terrific, as a whole, there is one misstep. The lone male nurse character is gay. While I completely support the presence of gay characters on TV, we all know male nurses have always had an uphill battle with stereotypes in this department.  When I interviewed the producers several months ago, I was told the choice was made because they really wanted the nursing focus to be based in female camaraderie and that a straight male nurse could tip this dynamic in a different direction. The possibility remained open for a male nurse later in the series, but this was the preferred way to debut Mercy. Tune in tonight and let us know what you think.

When Matt Lauer introduced the segment, which showed pictures of a heretofore 220-pound Rosemarie, with a voiceover description of the sad state of her then-fatty life, he made this point: She lost the weight without any surgery.

Interesting, isn't it, that we've come to a point when people assume you've had surgery if you've lost a lot of weight. It's as if the idea of self-discipline and self-awarness have become passé with the advance of bariatric medicine. This is not meant as an indictment of bariatric care. Many lives are improved if not saved through this important specialty.

The old-fashioned way

But let's not forget that we also have intellect and decision-making in our personal toolkits. Rosemarie, it seems, decided to make all the right choices once her doctor warned her she was a candidate for a heart attack. She swapped a high-carb, high-fat, overindulgent diet for more intelligent choices - healthy carbs, whole grains, lean protein. She first put herself on a low regimen exercise program that grew to an hour treadmill run, then translated into a passion for hill-and-dale running. She's now running - and  even winning - marathons. Inside her formerly fat form lurked the heart of an athlete. Who knew?

Matt Lauer injected another interesting commentary into the segment when he said he had a feeling Rosemarie would have no problem maintaining her newfound state of health. The now diminutive nurse concurred, noting, "It's do-able. It's self-discipline."

I've personally known two people who underwent surgery for purposes of weight reduction only to gain back the weight two or three years after immense losses. Medical intervention can certainly help you lose, but it won't do the maintenance work for you. But when you truly embrace a positive attitude - "do-able, self-discipline" - the outcome is likely to be much better. And the side effects? The only one I know of is improved self-esteem.

    Check out the inspiring Today Show segment by clicking here. Read an earlier story on Jeanpierre, published by ADVANCE in 2008 by clicking here.