Posts from the ‘Diana Mason’ Category
May 15
ACOs: Accountable for What?
My latest blog post for JAMA News Forum answers this question: http://wp.me/p13lz7-2Eu
Centering Health Care: A Group Model
We’re used to one-on-one visits with a health care provideer–even if only for a very brief time as with the 7-minute visit expected of some primary care proviers. In the mid-1990s, certified nurse midwife, Sharon Rising, CNM, MSN, tested a group approach to prenatal care for pregnant women. The model has been so successful that it has been declared one of the top 100 non-profit social innovations by the Social Impact Exchange, and Rising, the founder, CEO and President of the Centering Healthcare Institute, is spreading the to various health conditions and issues, such as diabetes and parenting. Today on Healthstyles on WBAI (www.WBAI.org) from 11:00 to 11:30 PM, co-producer and moderator Diana Mason, PhD, RN, FAAN, interviews Rising about the model, its outcomes, and future directions. To listen to the program after it airs, click here: RISING
Healthstyles is produced by the Center for Health, Media & Policy at Hunter College, City University of New York.
Apr 29
Charles Cullen, The Good Nurse and The Good Organization
Journalist Charles Graeber
I met Charles Graeber, an award-winning journalist, about 5 or 6 years ago through a colleague at the American Journal of Nursing who was his friend. She told me he was working on a very interesting story and would benefit from talking with me. Over lunch, Graeber told me that he was investigating the circumstances surrounding the 16 years of scores of killings by Charles Cullen as a registered nurse. I recalled news reports surrounding Cullen’s arrest at the end of 2003, when press referred to him as the “Angel of Death” because he had injected patients with deadly doses of cardiac drugs, insulin and other powerful medications that are usually used to save lives, not end them. Sometimes his killing was random. Other times, it was carefully planned. The story was disturbing and I worried about how this might affect how the public viewed nurses. One rogue nurse could undermine the public’s confidence in all.
Graeber has published his investigation in a new book, The Good Nurse: A True Story of Medicine, Madness, and Murder,published by Twelve, an imprint of the Hatchette Book Group. I finished the book right before last night’s 60 Minutes aired a half-hour report on Graeber’s investigation and included an interview with Cullen. While the 60 Minutes story illustrates some of the key points in Graeber’s book, it falls short of capturing just how complicit the multiple hospitals were in not reporting their suspicions of Cullen to the state board of nursing or the police. In fact, Graeber’s careful recounting of phone and in-person recordings and depositions shows two hospitals actually resisting detectives’ attempts to gain information and obtain Pyxis records, patient charts, or personnel files.
What had been disturbing to me became appalling. Why would hospitals simply boot Cullen out the door with the promise of a neutral reference, even when it was clear to them that he was involved in patient deaths? Why would they not report it to the state board of nursing, even if they thought the deaths were from errors that Cullen had made? And why would they shut down one of their own nurses, Pat Medellin, who was working at St. Luke’s Hospital in Fountain Hill (Bethlehem), PA, at the time and who had made the connection between Cullen and deaths on her unit? The hospital administration told Medellin that their investigation of Cullen was closed. Medellin had the courage to alert the police anyway. And it took another courageous nurse, Amy Loughren (now Ridgeway), to help detectives get a confession out of her former colleague, Cullen.
Edie Brous, RN, JD, a nurse attorney and former president of The American Association of Nurse Attorneys, told me that the hospitals likely feared the media coverage if Cullen’s murders became public. They would worry about their liability exposure, their reputation in a competitive market, and the impact on donations to their institutions.
At the end of The Good Nurse, Graeber notes that the New Jersey legislature passed two laws in 2004 in response to the Cullen killings. One is the Patient Safety Act and then the Health Care Professional Responsibility and Reporting Enhancement Act. Together, these laws require hospitals to report “serious preventable adverse events” to the Deparment of Health and Human Services, report nurses’ performance problems to the state board of nursing, and maintain records related to patient complaints about staff for seven years. The laws give hospitals a measure of protection from civil liability. But Graeber also notes that there are not teeth to the laws–they do not include penalties for hospitals that don’t comply.
After reading the book, I’m left wondering why the attorneys general for PA and NJ would not investigate hospital administrators whose actions could constitute aiding and abetting a criminal and covering up knowledge of a crime. Because the hospitals didn’t report Cullen when he was still in their employ, he went on to kill more patients. Graeber estimates that as many as 300 patients died at Cullen’s hand, making him possibly the most prolific serial killer in the nation’s history. But the hospitals that let him go quietly from their institutions without even alerting the police and state board of nursing bear some responsibility for subsequent deaths by Cullen. They put their own reputations and interests before the wellbeing and protection of patients.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing
Health Care Decision Day at Hunter College
Hunter College Nursing Students on National Healthcare Decision Day
Today is National Healthcare Decision Day–a time to make sure that you and your loved ones have documentation confirming who will be your health care proxy or agent in the event that you are unable to make your own health care decisions. Today, these fabulous Hunter College School of Nursing students are at the Brookdale Campus, talking with people about “advance directives” and helping them to complete a health care proxy form, living will, and other forms to ensure that people’s preferences regarding treatment are respected. Other students will be joining them throughout the day. Tomorrow, the students will do the same thing at the Main Campus on Lexington and 68th Street in NYC.
If you can’t get there, go to the web site for the National Healthcare Decision Day campaign at http://www.nhdd.org/ad/ for information and resources about these issues. And remember to tune in to Healthstyles this Thursday night from 11:00 to 11:30 on WBAI, 99.5 FM, NYC (www.wbai.org) to hear my Hunter colleague Dr. Vidette Todaro-Franceschi, PhD, RN, and lawyer Tina Janssen-Spinosa of the New York Legal Assistance Group talk about these issues.
As yesterday’s events in Boston demonstrated, you never know when you might need a health care proxy, so why wait?
These fabulous Hunter nursing students didn’t wait. They have theirs completed and have planned the two-days of information sharing at the College to help others do the same.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing
Health Care Decision Day
April 16th is Health Care Decision Day. It’s an opportunity to jump start those conversations about end of life preferences–or advance directives–that you’ve postponed. At Hunter College, the Hunter Student Nurses Association, the Hunter-Bellevue School of Nursing, and the Center for Health, Media & Policy at Hunter College are sponsoring an information table at the Brookdale Campus on 25th Street and 1st Avenue on April 16th from 1:00 to 8:00, and on the Main Campus at 68th and Lexington on April 17th from noon to 6:00. The undergraduate nursing students, in addition to helping to plan the two days, will staff the tables and help people to make sense of the various forms that will be available. (The photo above was taken at a similar event that the students did earlier in the academic season at the Main Campus.)
Of course, people will be encouraged to first talk with their loved ones about their preferences for end-of-life care and what’s important to them. The forms can be completed when having these conversations and then mailed into the New York Legal Assistance Group for registering them on a secure online storage service to enable health care providers anywhere to respect and honor your health care wishes. This service is available thanks to Tina Janssen-Spinosa, JD, of the NYLAG. Or people can simply make copies and give them to their health care providers, though the online repository ensures that new providers also know your wishes.
I wrote a commentary in the American Journal of Nursing about the need for health care professionals–nurses, in particular–to lead the public conversations about the importance of these “advance directives” and received an email from Jerry Soucy, RN, BSN, CSS, CHPN, Staff Educator at the VNA Care Network and Hospice in Southborough, MA. He shared a blog post from the local chapter of the Hospice and Palliative Nurses Association about MOLST–Medical Orders for Life-Sustaining Treatment–another opportunity to have patients wishes be visible to health care providers no matter where they are moved in a hospital. The post emphasizes that Susan Block’s four questions to guide end-of-life conversations are probably more important than any form: Read more
Mar 26
What’s Missing from the Conversations about Nurse Practitioners and Primary Care?
Source: Vanderbilt University School of Nursing; http://www.nursing.vanderbilt.edu
Today, Diane Rehm’s radio program included an hour-long discussion on the role of nurse practitioners with Reid Blackwelder, MD, family physician and president-elect of the American Academy of Family Physicians; Mary Agnes Carey, senior correspondent for Kaiser Health News; Ken Miller, PhD, RN, CFNP, nurse practitioner and associate dean of The Catholic University of America School of Nursing; and Sandra Nettina, MS, ANP, nurse practitioner at Columbia Medical Practice in Columbia, Md., and past president of Nurse Practitioner Association of Maryland.
There was one thing missing from this otherwise great discussion of the issues related to nurse practitioners being able to practice with full authority (without legally mandated physician collaboration or supervision). Nurse practitioners bring additional knowledge and skills to their practice that are just what primary care needs. They understand patient-centered care, listening carefully and responding to what patients and families say they need and want. They are experts in health education and counseling, as well as care coordination. These skills matter when we’re trying to transform our health care system into one that emphasizes health promotion, wellness, and chronic care management.
Most discussion of nurse practitioners’ roles center around their ability to diagnose and treat disease. They are prepared to do so with common acute and chronic conditions, and they know when to refer patient with symptoms of uncommon diseases to physicians–and without a legal mandate to do so, as has been shown in about a third of the states in the U.S. But we need a primary care system that can focus more on preventing diseases, promoting health, and helping patients to be knowledgale about and capable of promoting their health.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing
