CHMP

Source: Florida NP Network

Florida is one of two states in the country that does not permit nurse practitioners to prescribe controlled substances. Imagine being a primary care provider for patients who need an opioid pain medication and having to refer them elsewhere for it. A perfect example of the barriers to access to care that are embedded in laws at the state and federal level. These barriers are costly in time, money, patient suffering and health. Watch this video to its surprising end:

Patricia Volland, MSW

"Care coordination" is a new buzz word in the lexicon of health care reform. Most everyone agrees that it will improve clinical outcomes and reduce costs for patients with multiple chronic illnesses and will also help to improve the health care experience of those who are not as sick. Patricia Volland is a social worker, Senior Vice President and Director of the the Social Work Leadership Institute at the New York Academy of Medicine, who is a national leader in care coordination. In recent years, she has also had personal experience and shares her views on it with Healthstyles producer and moderator, Diana Mason, RN. The program airs this morning at 11:00 AM on WXMR-FM (wxmrfm.com, 100.7 FM in upstate NY and Vermont). Click here to listen to the interview: Volland

On this week’s Healthstyles program, Dr. Nancy Rudner, RN, consultant and health coach, talks about her work as a health coach for frontline workers who may have difficulty accessing health care and living healthy lives. She talks with Healthstyles moderator Diana Mason, RN, about what’s in the Afforldable Care Act (the health care reform law) that is beneficial to frontline workers and shares a new online resource that anyone can use to find out how the new law will affect them. You can hear the program on WBAI-FM (www.wbai.org) on April 26th at 11:00 PM, or on WXMR-FM  (www.wxmrfm.com) on April 23 at 11:00 AM. Or click here to listen to the program: Rudner

JAMA Forum Logo

I was asked by Howard Bauchner, the editor-in-chief of JAMA (the Journal of the American Medical Association, but the journal goes by “JAMA”), to join a group of physicians, economists, and health services researchers this year to blog about the presidential race and health-related events, including the Supreme Court’s hearing of challenges to the Affordable Care Act. This is a first for the JAMA blog (news@JAMA) and has been given a separate name: JAMA Forum. It’s fairly new and most of the posts are about their articles or other health news. The argument for venturing into the realm of the politics of health care was made by JAMA news editor Joan Stephenson, Bauchner, and executive editor Phil Fontanorosa in an editorial in the March 14th issue of the journal. These blogs provide interesting commentaries thus far. But politics is tricky business and it remains to be seen whether the AMA’s members will think the JAMA Forum is a good idea. The editorial independence of JAMA makes it unlikely that the editors or authors of the JAMA Forum would be influenced by any member concerns. Certainly, the editors at JAMA confirmed with the blogging authors that their posts would be lightly edited only.

My first post about dinner conversations and the Supreme Court’s deliberations about the Affordable Care Act. Looking forward to more conversations.

Diana J. Mason, PhD, RN, FAAN, Co-director, CHMP

Health Affairs has just published Amy Berman story about being diagnosed with incurable breast cancer and the challenges she faced–and most terminally ill patient face–in being supported by health care providers to make fully informed decisions about treatment options. Amy is using the remaining time she has to raise the visibility of the issue and help health professionals, as well as patients and families, to understand what “patient-centered care” really means. You can listen to her read her story. Spread the word so we can support Amy in ensuring that we all expect to have full information about our treatment options and to be fully supported in our decision by health care providers.

Jeannette Crenshaw with co-author Elizabeth Winslow

This week on Healthstyles, I interview Dr. Jeannette Crenshaw, RN, DNP, about what the evidence suggests is appropriate for pre-operative fasting--what should you not eat or drink and for how long before surgery. Unfortunately, most people are told to fast for much longer periods of time than is necessary, and this can lead to dehydration and other adverse effects. Catch it on wxmrfm.org or wbai.org. Or click here to listen: Crenshaw

Diana J. Mason,PhD, RN, FAAN, Rudin Professor of Nursing

Center for Medical Consumers

Maryann Napoli joins Healthstyles host Diana Mason to talk about health care issues she’s reported on recently for the Center for Medical Consumers, where she serves as Associate Director. These include an update on recent research that suggests that patients with terminal illnesses may live longer and have a higher quality of life if they are provided with palliative or comfort care; a new “decisional aid” to help women make important decisions about treatment for breast cancer; whether and when people with sinusitis should take antibiotics; and an update on whether and when to get bone density testing. You can listen to the program on WBAI-FM on March 22 at 1:00 PM or WXRM-FM on March 26 at 11:00 AM. Or click here:  Napoli 3.1.2012

Last week, the Hunter-Bellevue School of Nursing’s students and faculty, as well as guests from clinical agencies, heard an outstanding presentation on the Institute of Medicine’s report on The Future of Nursing and the relevance of the Affordable Care Act. Mary Ann Christopher, MSN, FAAN, the new president and CEO of the Visiting Nurse Service of New York, was the featured speaker. The students were clearly engaged in her presentation and had the opportunity to interact during the discussion period with Ms.Christopher. Repeatedly, the students who came to the microphone to pose questions and react to her presentation identified themselves by first name. As moderator, I asked them to give their full name on several occasions. But it was disturbing to see that they had to be prompted to do so.

This is a common occurrence when I’m with staff nurses, including those who are graduate students. I have been puzzled about why, then recently received an email from a colleague who earned a PhD last year:

“What do you think about nursing badges with the nurses’ first name only on the top line, yet physicians have their first and last name on the top line. I was told if I had my first and last name on the top line of my badge patients might confuse me with a physician.”

This is such rubbish and leads to physicians being called “Dr. Lastname” and nurses being referred to by their first names. Nurses can tell you that both nurses and MDs use first names with each other when the physicians are medical students, interns or residents; but once they become attending physicians, they expect to be called “Dr. Lastname” while still referring to the nurses by first name.

I know that some nurses are afraid that a patient might try to track them down at their homes if they include their last name, but why aren’t physicians? What about social workers or nutritionists or other providers? And why are nurses perpetuating this inequality?

What’s in a name? A lot.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

Nancy Short. DrPH, MBA, RN

Dr. Nancy Short is a professor of nursing who knew that the surgeon you’ve talked with may not be the person who does all or any of your surgery. In the spirit of “patient-centered care”, she discussed with her surgeon a request that he do all of her abdominal surgery that had been scheduled. The surgeon’s, hospital’s, and health plan’s response to Dr. Short’s request and her recommendations for others who are undergoing elective or urgent surgery are the subject of this week’s Healthstyles program on WBAI-FM and WXMR-FM. Producer and moderator Diana Mason, PhD, RN, FAAN, discusses with Dr. Short one of healthcare’s surprising secrets, particularly in academic medical centers. Click here to listen to the program: Nancy_Short

Amanda Trujillo, RN

Would you want Amanda Trujillo to be your nurse?

Amanda Trujillo is a master’s-prepared nurse who was working the night shift at Banner Del E. Webb Medical Center in Arizona in early 2011. One of her patients was a critically ill 60 year old woman who had been scheduled for evaluation for a transplant.

According to Amanda, she assessed the woman’s knowledge of her illness and says that the patient didn’t understand her disease, the lab tests, medications, or the self-care that would be needed to recover from a liver transplant for which she was being evaluated. By Amanda’s assessment, no one had ever discussed hospice care with her, even though a consulting physician had noted in the chart that the only two options for the patient were transplant or hospice. Amanda believed that the attending physician’s failure to discuss this option with the patient was an ethical breach of the concept of informed consent.

Amanda had worked on a transplant unit for five years at another hospital and was used to having conversations with patients about preparing for the evaluation and post-transplant self-management.  Amanda says that, after talking with the night charge nurse, she accessed the current hospital’s educational materials and prepared a binder of information that she reviewed with the patient. When the patient said that she wanted to go home to be with her father and think about what she wanted, Amanda made a referral for a hospice case management consultation as she had done before without any objections from physicians or the hospital administration. She documented everything in the patient’s record and reported her ethical concerns to the charge nurse.

According to Amanda, she was fired by the hospital for her advocacy on behalf of the patient after the transplant service’s physician expressed his fury at the change in the patient’s decision. Amanda was told that had interfered with the patient’s surgery and that it was not in her scope of practice to make a referral to hospice case management for a consultation without the approval or order of the physician in charge of the patient’s case. The hospital filed a complaint with the Arizona State Board for Nursing.  Amanda, as a single mother, found herself unemployed and an “untouchable” in the eyes of other employers. Read the rest of this entry »