I am a wife, a mother of two awesome kids, a daughter, a sister and a nurse.

I am also a survivor.

At the age of 43 a routine screening mammogram picked up an abnormality in my left breast that turned out to be invasive lobular carcinoma. I had no family history or major risk factors, but there it was: breast cancer. I had breast sparing surgery to remove the tumor and then 6 weeks of radiation therapy. I started oral treatment with tamoxifen to reduce the incidence of a recurrence. My life was saved. The system worked.

Thus, on Nov. 16, 2009, I was horrified, stunned, angry, and scared for myself and all American women when I read that the U.S. Preventive Services Task Force (USPSTF) was recommending against routine screening mammography in women between the ages of 40 and 49. Their assessment in recommending this mind blowing change is "moderate certainty that the net benefit is small."

 What is the USPSTF, anyway? A few clicks on Google told me:  The USPSTF is an independent group of "experts" appointed by the federal Department of Health and established by congressional mandate. It is charged with reviewing the scientific evidence related to the effectiveness, appropriateness and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the healthcare community.

And net benefit to whom? Certainly not women. We should all be asking ourselves these questions.

How will this translate to the lives of American women if this policy becomes the standard of care?  That, it seems, is really the heart of the matter. My American sisters, it means that our right to choose the preventive healthcare that is right for us is on the line. The false positive mammograms in our age group (ages 39-49) cost the insurance companies money. Those false positives often result in retesting, which costs more money.

The ugly and painful truth is that the USPSTF does not think the cost is worth it to save one woman. As one woman whose life was spared by a screening mammogram, I can tell you: American women are not statistics. Each and every woman is of immense worth and value, and we will not have our lives marginalized by a "decision analysis." If the USPSTF guidelines were to become the standard of care I am frightened for the lives of all American women, thousands of whom would likely die due to lack of access to preventive mammography services.

Did the USPSTF consider the "net" cost to society of the deaths of the women aged 40-49 years who will not be alive to raise their children? To be wives to their spouses? To care for their aging parents? To contribute to the workforce, to PTAs, to carpools, to community service projects, to houses of worship? 

The answer is a glaring no, they did not. Make no mistake: The controversy over screening mammography is about women's rights - our right to choose the preventive healthcare that is right for us. The decision to have a screening mammogram should be between a woman and her healthcare provider. It is essential that insurance companies and third party payers fund annual mammography if a woman and her healthcare provider opt for this approach. Healthcare reform legislation is currently being considered in the Senate. If the USPSTF recommendations are widely adopted, insurers could deny payment for screening mammograms. I am standing for myself, and for women everywhere in supporting screening mammography every year for women aged 40 and over.

Let your voice be heard.

For more on this topic, read these additional blogs: Mammography Screening Changing? and When Evidence Scares Us

"I'm keeping my options open" is the line many nurses have recently been overheard saying. Many nurses do not feel secure in their current job. There is a sense of "jinxing" themselves by overtly commenting on their job security. Many experienced nurses are not only holding onto their job by pushing back their retirement but some are acquiring a second job. This sense of pessimistic doom and gloom hasn't been felt in nursing for a long while. Not long ago, nurses stood tall together to demand fair patient ratios, wage compensation, and a safe work environment. Currently, there is a strain that is threatening to separate nurses. Some nurses are unwilling to speak to management about necessary changes on their unit because they fear for their jobs.

"At least I have a job" is another damaging phrase that can be heard too often. Nursing requires focus, compassion, accuracy, continuous knowledge acquisition, and dedication. When a nurse is strained with fear for losing their livelihood, there is a potential for a negative effect on patient care or the nurse.

Listed below are some practical and quick suggestions to alleviate this form of strain from affecting your nursing practice:

• Exercise: not marathon aspirations but simple releasing some negative energy into a tennis ball or golf ball.
• Socialize: not while at work but carve out time to laugh with a friend.
• Play: be fully present (no negative thoughts allowed) and play with a child or animal.
• Talk: schedule an appointment with your manager and share your concerns.
• Touch: get a massage (check out your local massage therapy school of a discounted rate).
• Support: you may have more to offer than you suspect when you look outside of yourself, so support your fellow nurses in their time of need.
• Spirituality: something we encourage our patients to use when in a time of need, rejuvenate your beliefs and passion.
• Hobbies: join your hospital's knitting group or start up a book club.
• Positive thinking: the more you spread optimism with your patients and co-workers, the more apt for some hope to stick on you.

Florence Nightingale once quoted "How very little can be done under the spirit of fear". Nurses must re-focus and lead by example. The new nursing graduates and patients everywhere will benefit from a confident and positive nurse. Change is inevitable. The current job climate is not optimal but when change occurs, look back at a proud and fearless nurse.

Kim McAllister, RN, has worked as a staff nurse in the San Francisco Bay Area emergency departments for the past 17 years. She is the author of Emergiblog.com, a blog about ED nursing.

Scary.

That was my first response to the results of the study by the Emergency Nurses Association titled "Violence Against Nurses Working in U.S. Emergency Departments." I participated in the survey, as did 3,464 of my nursing colleagues. Fifty percent of us had experienced physical violence while working, including being "spit on," "hit," "pushed or shoved," "scratched" or "kicked." As noted in the report, "one in four has experienced such violence more than 20 times" in 3 years, with "one in five ... experiencing verbal abuse more than 200 times during the same period."

Wow.

We are talking violence emanating from environments that have 33 percent of surveyed ED nurses considering leaving their departments, or nursing in general, to escape the threat of violence.

That it is what is scary. So, are we just sitting ducks, or can we do something to decrease our chances of being a victim?

The study noted the risk of violence was higher where there were barriers to reporting, so it makes sense that breaking down barriers decreases the risk. First, there is the impression that reporting violent incidents leads to lower customer service scores. To that I say our safety trumps patient satisfaction every time. Why? Because nothing will drop those vaunted patient scores faster than not having nurses to care for patients, and one-third of us are considering quitting! The next barrier was listed as "ambiguous policies for reporting." Here, we can be proactive. Next time you are at work, ask how you would report an act of violence. No policy? Write one, and then take it through every committee until it is adopted. No time for that? Every facility has an incident report procedure. Use it.

Fear of retaliation by management, nursing staff or physicians can be a significant barrier. Reporting is not easy in this environment, but if we don't report, we are being victimized twice: once by the incident and again by not being allowed to talk about it. By reporting, we make it easier for others to do the same and make it harder to ignore problems.

The idea that reporting shows incompetence was yet another barrier. While it may be true we learn from our experiences and may, in retrospect, learn something that we may have done differently, that does not mean that we did anything wrong. If we don't have any physical scars or evidence, we are less likely to report the incident. Feeling threatened and/or intimidated can be just as traumatic as a physical injury. It is more insidious and it is still an act of violence that should be documented.

The issue of workplace violence in the ED is frightening. We can't change the situation overnight, but we do have the power to bust through some of the barriers that keep us from reporting incidents and we can work to make the cultures of our departments more supportive, with a zero tolerance policy for violence against nurses.

Let's stay safe out there.

Tammy Allred is a thoracic oncology nurse navigator for the Multidisciplinary Thoracic Oncology Program and a patient advocate at the North Carolina Clinical Cancer Center in Chapel Hill. She is from Mebane, NC.

I was recently chosen to attend the second annual Lung Cancer Advocacy Summit held in Dallas by the National Lung Cancer Partnership, a nonprofit organization dedicated to decreasing deaths due to lung cancer, and helping patients live longer and better, through research, awareness and advocacy.

As a member of the first state chapter of the National Lung Cancer Partnership in North Carolina, I had some exposure to advocacy and was expecting to hear people speak out for the cause they believed in. I also hoped to learn more about making the cause known to others by getting the message out to the media for much-needed attention for lung cancer awareness. The summit offered these things and so much more.

The opening of this meeting was so emotional and humbling that words cannot really explain it. Joan Schiller, MD, president of the National Lung Cancer Partnership and internationally renowned for her work in lung cancer, welcomed participants in her opening speech. The statistics presented about lung cancer were unbelievable. While lung cancer claims 167,000 deaths per year, it only receives $1,100 in research funding per death, whereas breast cancer receives $24,000 per death. Lung cancer is the least funded of breast, prostate and colorectal cancers, and yet causes the most deaths of all three combined. What is wrong with this picture?

Schiller had everyone go around the room and introduce themselves. I thought most people might be healthcare workers, family members, social workers and maybe a few patients. I was so wrong. I have never been so dumbfounded, humbled, inspired and touched by such an awesome group of people! There were many tears shed at the stories, and also some laughs and cheers. No one was ever alone. There were so many survivors there fighting for their cause - fighting against the evil that was stalking them. So many warriors were in that room to tell their stories. There were also parents there to represent children they had lost, as well as aunts and husbands there, some of whom were left to raise young children or teenagers with no wife or mother. They were all united by this one cause and fighting to raise awareness for the silent killer that stalks so many and has so little research and awareness. Despite the challenges all of these people faced, they still were looking to help others.

Kathy Joosten, Academy Award-winning actress from the television show Desperate Housewives, was a guest speaker for the event. She is a survivor, an advocate, a former nurse and an inspiration to all.

On day 2, we toured the UT Southwestern Medical Center, where Schiller is the chief of the Division of Hematology and Oncology. The scientists there were so enthusiastic and focused about lung cancer research. It was obviously more than just a job to them. They were all vested - personally, emotionally and professionally - in lung cancer research. Seeing our group and knowing that some were survivors brought it home to them. As researchers explained that cancer cells never die, the anguish was visible on survivors' faces. This made me want to do more as an advocate. I wanted to go hug the person and throw away the cells, but I know it would not ultimately make a difference. The difference will occur when research CAN kill these cells and eradicate them from a person. This made it all very personal to me.

The stigma that follows this disease is unfair and unjustified. When I see patients suffering from lung cancer every day, it doesn't matter to me whether they are smokers or non-smokers. They are all suffering. No matter what, no one deserves this disease! Everyone deserves good care and treatment. We have to become one united front to stop this silent epidemic. In all of my years of nursing, I have seen too many suffer with this disease. Too many die too young and too fast.

I may have gone there as an advocate, but I came back changed in so many ways. I came back an activist.

This bipartisan legislation would create a pancreatic cancer research initiative to provide strategic direction and accountability, establish a cancer research incubator pilot project, expand the Centers of Excellence in pancreatic cancer, and promote physician and public awareness. We received favorable responses from our visits and are hopeful we secured at least three additional co-sponsors for this legislation from our state. Of course, we won't be celebrating until we've confirmed their co-sponsorship.

One of the realities of Washington, DC, and state government as well, is that on a daily basis, advocacy groups and professional lobbyists are coming in the offices, one right after another. Especially during budget deliberations. We often met other groups as we entered the offices, and there were more groups after us.

As you can imagine, and I can attest from working in a senator's office, there is a steady stream of advocates coming in and asking for things ... money, sponsorships, internships, letters of recommendations, and on and on. The more sophisticated advocates come into these meetings knowing the congressman's voting records, knowing historical stances, and then using that information to craft their persuasive argument. Moreover, it is useful to let your elected official know if there is more to your cause than just an empty hand in front of them waiting for money.

Our group was fortunate in that the Pancreatic Cancer Action Network has a comprehensive plan for paving the path to a cure. The organization does not only request public funding, but facilitates private fundraising, provides direct patient support through the Patient and Liaison Services program, advocates on behalf of research funding that facilitates advances to other cancers, and educates healthcare providers and the general public. It's a multipronged approach that acknowledges organizational responsibility in addition to federal advocacy. It is a responsible funding model.

I love the vibe of DC. The city pulses with energy and power, and I am always awed by the gravity of what happens there. I think we all felt some sense of accomplishment. A sense that this is what the founding fathers had in mind, a government accessible to the people and a population who is willing to be engaged. So, although I'm talking through my rose-colored glasses, and I know the bottom line is often money, we can feel good we did a small part to advocate on behalf of the first ever pancreatic cancer specific legislation in our nation's history.

So, thanks for reading, and for anyone out there suffering with this disease, know there is hope. Although you weren't at the Capitol with us, your voice was heard.

In health,
Julie

PHOTO CAPTIONS: Top: Julie Simani, MS, RN, CBE, CQIA, (right) stands with her sister, Tammy Andries, on the steps of the Capitol Building. Bottom: Kylee Carolfi Malik, (left) Amy Olson, Simani, Andries, Barb Karlen and Korey Kopp stand with Rep. Tammy Baldwin (D-WI),

Today, we had 300 more people join us for specific "advocacy" training. Our numbers on the Hill tomorrow will reach close to 500. That's 500 dedicated volunteers bringing a purple bag and a message of hope. Among us are 41 brave survivors of this most lethal cancer. Tammy, my sister, is one of them. This has been an emotional journey for many at this event, but emotional for my sister and me in a different way.

My sister was diagnosed with a very rare form of pancreatic cancer called a neuroendocrine islet cell tumor. One of the things that has been repeatedly disappointing is people's reaction to my sister's type of cancer. She and I both have been told on numerous occasions we are lucky she has the "good" type of cancer, implying there is such a thing as a good type of cancer! "Oh you didn't have the ‘bad cancer,'" they say to her, as if she hasn't suffered. As if her type of pancreatic cancer doesn't matter as much because it isn't the cancer most people get. Who are these people? 

One of the things she and I have both learned through this medical journey is that many people don't think before they speak. If they did, they would recognize she has suffered, and the phrase "you have cancer" carries with it a very heavy burden. From the 30 pounds she lost while immobile in the hospital, the inability to sit up on her own after major abdominal surgery (whipple) or eat anything for weeks, to the astonishment in the anesthesiologist's eyes when pain relief was finally realized for her when they dosed her for a person 3 times her size, I can assure all this was suffering. One of the most difficult things was the scared look in her children's eyes, then 4, 6 and 8 years old, and her brave and steady reassurance to them she was going to be alright ... she and they would get through this.

Lucky, yes we are lucky. Lucky that by pure chance her tumor was found after an abdominal CT designed to diagnosis something else. There are no early detection or screening tests for pancreatic cancer. Lucky that she is a strong woman with a good support network. Lucky that she and I both have the ability to leave our jobs, and our families for 5 days to come to Washington, DC, and advocate on behalf of ALL pancreatic cancers. We have been happy to put our precious time into this effort to help create hope for the future for all those affected, regardless of the type of pancreatic cancer.

As nurses, I believe we are more sensitive to the language we use with patients than the average population. Language is a powerful tool used to provide empathy and support or to dismiss or diminish someone's experience, especially within the context of a person's health. We spent all day learning how to advocate on the Hill, the importance of message becomes critical when you're only given 10-20 minutes of a congressman's time. In the end, the final message was "tell your story."

So that is what I am doing here with you. My name is Julie Simani and I am here in Washington, DC, because 3 years ago, with three small children at home, my sister was diagnosed with pancreatic cancer. Pancreatic cancer research is today where breast cancer research was in the 1930s. This is unacceptable and I want to change that. To start changing the grim statistics I want my members of Congress to co-sponsor the Pancreatic Cancer Research & Education Act, which lays out a strategic plan to streamline progress for pancreatic cancer research within the NIH and the National Cancer Institute (NCI), and I want them to commit to doubling the budget for the NCI over the next 5 years by increasing NCI funding to $6 billion in FY2010, an increase of 20 percent over FY2009.

This is not the end of my advocacy, but only the beginning; please join me.

Julie Olson Simani, MS, RN, CBE, CQIA

March 27, 2009

Hello Nursing Colleagues.

Today is an exciting day for me as I depart for Washington, DC. Although it is spring break season, this trip is not focused on fun, but more on a mission. A little move than 3 years ago, my 38-year-old sister was diagnosed with pancreatic cancer, needless to say it was a devastating blow to our entire family. By the grace of God and a good surgeon, she is living a fulfilling life and together we pour much of our free time into supporting the national organization dedicated to advancing research, supporting patients and creating hope - The Pancreatic Cancer Action Network.

My sister and I will be traveling with four others from the Madison Wisconsin affiliate of the Pancreatic Cancer Action Network, and joining thousands of other advocates, survivors and affected family members from across the country to raise our voices and educate Congress about the urgent need for funding.

Pancreatic cancer is the most deadly cancer with the least funding from the National Cancer Institute (NCI). Currently, the NCI spends less than 2 percent of their budget on pancreatic cancer research. In addition, it is estimated that fewer than 150 researchers nationwide focus on this type cancer. This shrinking pipeline of pancreatic cancer funding also discourages promising young investigators and sends them into other research venues.

So please check back from now through Wednesda, as I add daily comments about our experience, the process, what it means to be a nurse lobbying for increased funding in these econoomic times, and the personal aspects of the relationship my sister and I have and what this trip means to us. We will be exercising the most basic of our rights, active participation in our democracy. I hope you join us on this journey.

Julie Olson Simani, MS, RN, CBE, CQIA

PS: The room was filled with energy and some sadness as we saw more than 200 participants and only a handful with survivor nametags. The mortality rate for pancreatic cancer is so high, most people die within 4 months of diagnosis.  It seems the survivors find each other and have the invisible bond that is created with surviving this type of cancer. Their numbers are few, but together with family and friends, their voices are many.

Tomorrow we begin 2 full days of training, receive updates on the research and new legislation that promoses new hope if passed.

Good night for now.

Julie

 PHOTO CAPTIONS: Top: Tammy Andries and Julie Simani, MS, RN, CBE, CQIA, land in Washington, DC. Bottom: Madison affiliates of the Wisconsin affiliate of the Pancreatic Cancer Action Network travling to DC include Barb Karlin, (left) Amy Olson, Korey Kopp, Kylee Carolfi Malik, Julie Simani, MS, RN, CBE, CQIA, and Tammy Andries. photos courtesy Julie Simani

March 28, 2009

Today was filled with such a mix of emotions, both sadness and hope. The large room where we gathered was filled with family members who have lost someone to this disease, and an obviously small number of survivors. The survivors, identifiable by a purple ribbon with the word survivor on it seemed to find each other and share their journey, making comparisons and acknowledging the similarities. Then there were the silent family members who have had a loved one die from it. The Pancreatic Cancer Action Network gives them an outlet for their pain, anger and passion. It was incredibly powerful to think how many have died from this disease known as the "silent killer." Pancreatic cancer is currently where breast cancer was in the 1930s and there is a lot of ground to cover to improve the statistics.

Each year, 38,000 Americans are diagnosed with pancreatic cancer and 34,000 will die within the same year. It's a difficult disease to diagnosis for several reasons, lack of research dollars have slowed scientific progress in this cancer, no early detection or screening methods are available and typically when it is diagnosed, it has already spread to other organs.

Tomorrow we have advocacy training before we head for the Hill on Tuesday. Pancreatic cancer is the most underfunded, under-recognized and the least studied of all major cancer killers securing less than 2 percent of the National Cancer Institute's annual research budget. HR 745, the Pancreatic Cancer Research & Education Act has been introduced by Rep. Eshoo and Rep. Brown-Waite, and we will hopefully be securing more co-sponsorships on Tuesday. There will be opportunity for everyone to supply information to their members of Congress during the spring recess April 6-17. If you are interested in learning how you can help this cause, please sign on to http://www.pancan.org/Public/take.html to find your local area coordinator who can provide guidance. A simple visit to a congressman's home office can make a huge impact. Please log on to find out more.

Julie Simani MS, RN

PHOTO CAPTIONS: Top: Tammy Andries, (left) a 3-year survivor of pancreatic cancer, and her sister Julie Simani, MS, RN, CBE, CQIA, meet with Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network. Bottom: Friends, family members and advocates sign the wall of honor and memory created by the Pancreatic Cancer Action Network. photos courtesy Julie Simani

Bob is looking for someone to adopt him. Well not him, his disease. Bob is not a child. Bob, a 38-year-old male, has Behcet's syndrome, a rare disorder that affects less than 20,000 people in the U.S. yearly. There is no known cause or cure.

Bob's disease is classified as an "orphan disease." This is a disease that has not been "adopted" by the pharmaceutical industry because it provides little financial incentive for the private sector to make and market new medications to treat or prevent it. An orphan disease is one that affects fewer than 200,000 people.

There are an estimated 5,000 known rare disorders. Many have a genetic component. These diseases are generally not known by nurses or physicians much less to the general public. Many are fatal.

Without strong advocacy from those who care, a cure will not be found for these conditions. Many of these diseases have organizations that are usually made up of members who have the disease. They are often poorly funded and lack the clout to get their message out about the need for research. They need advocates.

Can you help?

Why Should a Nurse Adopt an Orphan Disease

Who better to adopt than a nurse? Nurses are, according to Gallup, the most trusted profession. Learning about orphan diseases will allow nurses to become an expert in an area of healthcare others will not know about and can disperse this knowledge to others.

Learning about a rare disorder can increase your knowledge of several areas of nursing. We had a patient admitted to our unit with Behcet's syndome. We had never seen a case before. We had to learn about it so we could aid the patient.

Patients with Behcets' syndrome receive treatment from opthamology, neurology, rheumatology, orthopedics, dermatology, and take a multitude or medications used in other diseases. Learning about this disease greatly increased our knowledge in many related diseases that these medications are used in.

How Can You Advocate?

Once you adopt a disease you can do in-services about it to other nurses, healthcare providers and the general public. I did several in-services on Behcet's disease. The turnouts were good; nurses were curious about this "new" disorder and had many questions. You can donate the proceeds of in-services to the organizations dedicated to educate the public or ask that a donation be sent. Remember when you're an orphan every penny helps.

Although the U.S. Orphan Drug Act offers tax incentives on clinical trials and 7 years of marketing exclusivity for drugs developed for conditions that occur only rarely in the U.S., given the current economic climate, research efforts may actually decrease.

Connecting with an organization is a good way to obtain materials for in-service. They will be glad to assist you in becoming knowledgeable about their disease. Many train people to train others and some provide continuing education to healthcare providers.

When you adopt an orphan disease you will be adopting many people who will be grateful for your help. You'll be using your position and prestige as a nurse to bring attention to patients you may never meet or a disease you may never see a case of. But to that one case, you could mean all the difference in the world.

Isn't that what nursing is all about?

The Editorial by Gail Guterl was so pertinent to my current situation.

I was recently let go from a third party administrator in Worker's Compensation after being there for 6 years. My work history has focused on telephonic case management for many years , specializing in Worker's Compensation.

As I assess my current nursing strengths, I observe that I have become pigeon-holed as a telephonic nurse case manager despite my educational background; that being BSN and MSN prepared. In addition, I no longer obtain any satisfaction from the role of case manager in an insurance setting because the insurance business has lost site of the professional role of the nurse, and the nurse's ability to develop the proper plan of care for an injured individual.

As a result, I am now researching RN refresher courses to update my hands-on skills. There are several onsite programs in Northern NJ ; however, I have found only one online course which would allow me to take on a new full-time position concurrently, then requiring 80 hours of clinical time at the end of the course. These courses cost approximately $1000 to $1500.This cost is much less than enrolling in a college program.

This brings to mind several questions: 1) Is the investment of $1000 going to reap the benefits sought, 2)Are there full-time jobs available for a nurse who has been away from the bedside for twenty years, 3)Will the jobs provide comparable salaries to that of the previous case management jobs?

My conclusion to date is to continue my search for an employment position that can maintain my family income at the level to which we are accustomed. This may well lead me back to the position that I have just vacated in the insurance business.

I would greatly appreciate comments from ADVANCE subscribers who may be in a similar situation.

Thank you

Susan G. Williams MSN, RN, is an instructor at the University of South Alabama College of Nursing.

At the end of last semester, I was asked to teach an online RN-BSN class. The idea of teaching an online class was exciting, but also scary. As I told my students from the beginning, online classes are a lot of work, but are great because they can be done at your own pace in your own private environment.

The class began with 40 students. A few weeks into the course, the number had dropped to 38 (not bad). This was a course that was filled with writing assignments, but I was up for the challenge. The first assignment allowed the students to share who they were and tell a little about their area of expertise. What an exciting opportunity to work with so many RNs with so many areas of experience. Some nurses had as little as 1 year of experience, while others had more than 25.

What struck me soon after beginning this class was how excited these students were about returning to school. That said, the idea of using a computer was totally new to some of the students, and that posed the most stress to them. Many of these students had gone to nursing school at a time when computers were only available in the hospital and only used by administrators or special personnel. The idea of a webliography, literature searches, APA format, posting, cross posting, uploads, downloads and pdf files versus Word documents was a whole new language and extremely overwhelming for some.

Many students sent photos of themselves, and it was nice to put a name with a face in the online environment. Several students called, which allowed me to get to know them on a more personal level and give individualized help. One student actually came in to meet me in the office. This was interesting, considering that most of the students were 50-100 miles from our campus. Several students were in states on the other side of the country.

Overall, it was a great experience for me as an instructor. I learned from the students and hope they also learned from me. The students were very mature, caring and kind. Instructors appreciate being told "thanks" once in a while and working with students who have a respectful attitude in all situations. Teaching an online class is definitely something I would like to do again!

While recently watching the movie "Meet the Parents" I was disheartened as Ben  Stiller's character is ridiculed repeatedly for his career choice. His character is a nurse and he is mocked for choosing nursing instead of medicine. I have watched this movie before but these scenes recently struck a chord as my youngest son and two of my nieces have contemplated careers in healthcare yet not given nursing serious consideration.

 As we are faced with an intensifying nursing shortage I ask: Why does the public hold medicine in higher esteem than nursing?  I believe the inaccurate portrayals of nurses in the media have distorted the public perception of nursing. What can be done to change this?

In nursing school, we are told that nursing roles include patient advocate, educator, communicator, caregiver, counselor, leader, manager, and agent of change to name but a few. I am recommending that we actively extend these roles into our profession. We must be advocates for nursing. We must educate the public regarding nursing. We must positively communicate what nursing is and means at every opportunity. We must be caregivers for our patients, ourselves, and for each other. We must provide counsel to assist in recruiting and retaining nurses. We must be leaders in our profession by accepting these challenges. We must manage our careers and professional responsibilities with accountability. And we must be agents of change by becoming involved in the processes that affect healthcare policy and nursing. The roles of nursing do not stop as we move away from the bedside.

In the event of hospitalization, it is the nurses who provide constant patient care and monitoring. It is my hope that by becoming more informed on the subject, society will increase the value placed in nursing thus emboldening more individuals to join our profession and provide this essential service.  From the perspective of a patient and RN, I welcome them wholeheartedly.

You may ask yourself, why worry about healthcare and nursing in far off reaches of the world? Russia, Portugal and China really do not have an impact on my daily life as a nurse.

You are very wrong if your thinking is on this path. Nurses worldwide need to come together and focus on health promotion and guiding the future nurses of tomorrow. We need to not only look at our little corner of the globe but the far reaches as well. The Internet makes this possible.

Not only can nurse's research and track disease trends worldwide, we can educate others while networking information. Today's society is volatile at times, not only is terrorism a threat but a global disease outbreak is just as equal a threat to us all. Global change is everywhere.

The population of the world is aging and half of that same world has no access to healthcare. There is political unrest on many continents, women's rights are underserved in developing countries and life is being extended due to technological advances. This is in stark contrast to nurses being in short demand with the workforce aging and less educators to teach prospective students. Nursing autonomy was forged out of necessity. We must take this autonomy and develop a sense of common purpose in which health is recognized as a right rather than a privilege.

This may seem like a daunting task, establishing a global network which works together cohesively. Did you know Florence Nightingale spoke several languages, traveled extensively and consulted with the governments of several countries?

It is in this tradition that The Nightingale Declaration Campaign (http://www.nightingaledeclaration.net/) was established. It is a program of the Nightingale Initiative for Global health (NIGH), which is a grassroots to global signature campaign to establish a UN resolution for an International Year of the Nurse in 2010, which is the Centennial of Florence Nightingale's death. The strategies will build from local and regional workshops and outreach to global interactive websites, distance learning, establishing a worldwide publication and videoconferencing,

There is a plethora of information to be shared and much to be learned, from the rapidly rising nursing shortage to innovative treatments. As nurses we need to take a broad look at the world and the health issues affecting varied populations. An understanding of the political climate, demographics, culture, religion and health options offered in each region has an affect on health. In the U. S. we are faced with a diversified patient population. Think how beneficial information gained from a variety of global resources would be when treating patients.

The nursing shortage is an issue not only confined to the U.S. but it is a global shortage having a direct impact on health issues. In the U.S., as the population ages the nursing workforce is slowly diminishing. If we do not promote and recruit nursing to potential students in the U.S., we will be forced to continue to recruit foreign students. Is this ethically feasible, given the state of health in these underprivileged countries. To bankrupt the supply of international nurses just compounds the problem further.

One positive aspect of these economically trying times is the increased appeal of the nursing profession. Steady employment, varied job opportunities and flexibility are becoming quiet attractive when it seems that everyone around us is experiencing alterations in job status, ready to fall to the abyss. Nurse educators are the cornerstone of this increase in interest. Not having the educators to teach will be a great detriment to the profession's future.

One Step at a Time

Many efforts have been set forth to increase the number of educators. Johnson and Johnson (http://www.jnj.com/) has launched one such effort. They have many programs and initiatives to promote nursing and nursing education globally. The Campaign for Nursing Future promotes the image of the nurse with public awareness, recruitment, grants and scholarships. Through another initiative, SOS, they sponsor a program for training nurses in Somalia. It not only trains them for successful careers but also supplies nurses for this much needed area.

Globalization starts with tiny little steps for nurses at the local level. Building to giant leaps across continents. If we all make the effort, voice our concerns, share our knowledge, opinions and advocate for quality nursing internationally, the effort will grow. Each of us can take part in this endeavor. Join a local nursing organization chapter, Attend a conference, search the web for resources, Most importantly, promote your profession and be a positive role model and think from a global perspective.

Yes, I was one of "those" patients that rang the call light 20 times a day. I can hear the grumbling now. What you need to realize is that I had 2 major surgeries and 2 other procedures that required anesthesia within 10 days.

I was in constant pain. Yes, I had some scheduled pain medication, but I had to call for prn pain medication 4-5x a day. My foley catheter leaked, so I called every couple of hours to get a dry pad as I was no longer strong enough to change it myself. I needed to use the bedside commode. I wanted to sit up in a chair or I needed to lie back down. The IV pole was beeping. I was helpless. Yes, some of my needs were anticipated by the nursing staff and my family, but I still required a significant amount of care.

My first issue with the intercom system is that I had an NG tube and talking was difficult. Most of my communication was written because it hurt to talk. When I rang the call light, a nurse on the intercom would say "Can I help you?" I would attempt to speak, and was usually not understood. Finally I wrote to an aide and said "please tell the nurses that I cannot talk well into the intercom and would appreciate it if they would answer my call light in person!"

When the NG tube was removed, I could tell the nurse what I needed over the intercom but it felt very impersonal. "Can I help you?" even in a polite tone made me feel like I was imposing and at times it even sounded sarcastic.

We have all heard the great sentiment "treat your patient like they were a family member." We also need to remember the golden rule "do unto others as you would have them do unto you."  Imagine you are lying in a hospital bed, in pain or needing to be changed and you weren't strong enough to help yourself. Imagine you are unable to communicate clearly with the intercom (think of all of your aphasic, pediatric, dementia and geriatric patients) and you're waiting for someone to come into your room to help you.

Intercom systems may benefit the nursing staff, but I fail to see how they benefit the patient. Call lights should be answered in person, not by an intercom system. After all, isn't that why I rang in the first place?

The American healthcare system is in dire need of reform. Tanner stated that Americans spend Umbdenstockmore money on healthcare than any other country, and it accounts for 16% of the Gross Domestic Product (GDP). Healthcare costs are rising faster than the GDP growth and total more than $1.8 trillion dollars. This is more money than Americans spend on housing, food, national defense, automobiles, and oil. Umbdenstock noted that 47% of American citizens have no health insurance. Healthcare premiums have risen 78% since 2001, and an estimated 133 million Americans have at least one chronic illness that requires medical attention. This article will discuss the insights gained regarding the healthcare provider's role in effecting change within the healthcare industry.

Changes in Attitude Toward Other Healthcare Professionals

It has always been know that every healthcare discipline has had a responsibility to provide the best patient care possible while controlling costs. Providing the best possible patient care while controlling costs means that each discipline must work with each other and not independently. The best patient and financial outcomes occurs with an interdisciplinary approach to patient care. Cohen and Cesta found that collaborative healthcare models have controlled hospital costs, provided quality outcomes, and increased both patient and staff satisfaction.

As the national presidential election approaches this fall, every healthcare discipline must make their collective voice heard so that healthcare reform may become a reality. Anyone can become a political advocate by joining a professional association or organization. Mason, Levitt, and Chaffee stated that the power of one is great, but the power base multiplies when everyone comes together with a "unified voice to advocate for change." In order for health reform to ensue, all healthcare workers, organizations, associations, and most importantly the consumer, which comprise the healthcare industry, must become politically active and voice for change. It is not a matter of if healthcare reform occurs, but rather when.    

Reform Forward

An individual is unlikely to make healthcare changes by themselves. Changing public policy is not an easy task and does not just happen, but rather takes many years, financial support, a well thought-out plan, as well as public and political support. Most often public policy changes occur when the American population views an issue as a societal problem and not a personal issue. When the American citizens and our elected government officials promote and support an issue, awareness and funding of this concern augment dramatically, which increases the likelihood the bill becomes law.

To move any healthcare reform forward the American voting population has to support any proposed change, first. If the majority of voters do not support a proposed piece of healthcare reform legislation, it is nearly impossible to get the bill through Congress. The voting population needs to have a sense of how valid healthcare issues are in America and that these problems are America's problems, not individual ones. To influence political change one must become an active member of an organization, committee, or association. Healthcare associations, organizations, and coalitions are powerful players within the political arena.

During the 2004 presidential election, the American Medical Association and the American Hospital Association were two healthcare organizations that contributed over $2 million dollars each to both the Republican and Democratic nominees; a total of almost $124 million dollars was donated to the candidates by other healthcare organizations (Mason, et al). These two organizations wanted to make sure that the winner of the election would be the person who had similar views and would not impose change, which could hurt their business. In addition, non-healthcare organizations, such as the American Association of Retired Persons (AARP), which has over 39 million members, has been able to successfully lobby on behalf of its members for healthcare reform for many years.

When people join forces in large numbers, change is possible. Healthcare reform is likely to happen when financially successful associations, organizations, and coalitions, lobby for healthcare modifications on behalf of its members.

Conclusions

As the presidential election nears this fall, healthcare reform will likely play an important role in distinguishing the two candidates from each other. The winner of the 2008 election may or may not be the best man for the job, but will likely be the person who gains the support of the majority of American voters, large associations, coalitions, and other organizations who hold similar political views. As noted earlier, almost half of Americans are uninsured with another 133 million who suffer from a chronic illness that needs medical attention. People within these two populations represent a significant number who could make healthcare changes simply by joining forces and exercising their voices this fall and voting for healthcare change.

References

Cohen, E.L., & Cesta, T.G. (2005). Nursing case management from essentials to advanced practice applications (4^th ed). St. Louis: Elsevier Mosby.

Mason, D.J., Leavitt, J.K., & Chaffee, M.W. (2007). Policy & politics in nursing and healthcare (5th ed.). St. Louis: Saunders/Elsevier.

Umbdenstock, R. (2007). Use your political voice wisely. Modern Healthcare, 37(47), 36.

Today cell phones are everywhere. People cannot seem to live without them. When an emergency occurs, if you have a cell phone, help can be notified faster. It is estimated over a million people carry a cell phone.

Cell phones are being used by nurses and patient care techs to ease the load of communication. The overhead pager is slowly disappearing. Patients focus is to lessen the noise level and call bells to be responded to faster are just a few of the many perks of caring a cell phone while at work. Cell phone used while working in hospitals started about 10 years ago. Some nurses even give out their cell phone number at work to their patients so they can reach them instead of pushing a call button. When doctors are paged, they no longer have to wait for nurses to pick up the phone they can be connected right away to the nurses cell phone.

So if cell phones are great what's the problem? Until you carry a cell phone while working 12 hours you will never know.

Nurses have a hard time trying to get breaks in for lunch and going to the bathroom, and now nurses have to answer the phone during these times. What about HIPPA? Many times nurses are in a patient room doing a dressing change or inserting an IV and guess what happens the nurse's cell phone rings? Also when doctor calls back to give orders or ask about another patient's condition sometimes nurses get stuck in awkward moments and have to give the other patients name out and personal information. Nurses don't mean to, but they are in a situation sometimes that they can't easily slip out of the room to talk.

Some nurses where I work simply say they don't answer the phone unless they can talk, but then the call gets transferred back to the nurses station secretary, who then just sends back the call to the nurse. The talk time is also recorded, so when the nurse manager receives the cell phone usage report it reveals 1-2 hours of talk time. What nurse or PCT has that much extra time to waste? Long distance personal calls have showed up on these reports. Speaking of personal calls, I notice at my job several times a day nurses and PCTs use the cell phones for personal calls. Why not? We are use to using cell phones all the time. Our society seems to be dependent on cell phones.

Justifying what is right and wrong with cell phones at work has to be initiated in the beginning and followed up on. Cell phones can benefit patient care but they can also do harm.