CHMP

Unless you’re a nurse, work in a health care institution where there are nurses, work at Cinnabon, a card shop or flower shop, or a company that prints messages on pens, water bottles or other tchotchkes,  this week could happily pass you by without knowing its National Nurses Week.

In searching for the history of how this came about, you can find this exact sentence in almost every post, “In 1953, Dorothy Sutherland of the U.S. Department of Health, Education, and Welfare sent a proposal to President Eisenhower to proclaim a “Nurse Day”..)  That never happened. I tried to find out more about Ms. Sutherland to no avail. Wonder if one of you may know more about her.  There are too many Dorothy Sutherland’s on Facebook and LinkedIn and nothing came up on my Google search.

Fast forward to 1974 when the International Council of Nurses proclaimed International Nurse Day on May 12, Florence Nightingale’s birthday. In 1990, the American Nurses Association decided it should be a whole week  beginning on May 6 and ending on May 12. We now have National Student Nurses Day too.

This is the week you’ll hear about the Gallop Poll results that show when you ask Americans to rate the honesty and ethics of numerous professions nurses make the top of the list every year since except in 2001 when firefighters were included on a one-time basis after 9/11. They’ve been polling since 1976 and the profession of nursing was added in 1999. We’ve come along way baby.

So we’re trusted (that’s good news).  Let’s leverage that trust and our smarts and expertise to get a seat at the policy table and into other stakeholder positions working to create quality and cost-effective health care that is accessible to all Americans.

How about we take action and unite to tell our colleagues and employers to thank us in different way this year and going forward. Tell them (graciously) that you don’t need another pen, water bottle or tote bag with the institution’s name on it. Ask them to use the dedicated budget (plus more $$$) to financially support the work of your state’s Action Coalition and the Campaign for Action to implement the recommendations of the Institute of Medicine’s report on The Future of Nursing.

Now that’s a proclamation I can sign.

Barbara Glickstein is the co-director of the Center.

Theresa Brown, RN is a member of CHMP’s National Advisory Council and you can see her this Friday, April 27  10:00 – 11:00 pm ET, in the featured segment called True Confessions” on “20/20″on ABC Television.

Theresa is also a paid contributor to the New York Times blog Well.  Her book, Critical Care: A New Nurse Faces Death, Life, and Everything in Between, was released June, 1 2010, by HarperCollins. She has had print pieces in the New York Times “Science Times” section, and in Scrubs Magazine, and Op-Eds on CNN.com, the New York Times, and in the Pittsburgh Post-Gazette.

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 »

Quality care is dependent on the total engagement of nurses by HARVEY V. FINEBERG, MD, PHD AND JOHN W. ROWE, MD is a repost from KevinMD 

Six months after Congress passed the health reform law last year, the Institute of Medicine of the National Academy of Sciences issued a landmark report on nursing. Although seemingly separate events at the time, it’s clear now that they are integrally linked: Never has quality care been more dependent on the total engagement of nurses as well as other health professionals.

At its core, the Affordable Care Act is about providing care. It will enable about 32 million uninsured Americans to get coverage for services and treatment that they previously couldn’t afford, at times with devastating consequences. Yet the nation’s acute shortage of primary care physicians means that many patients still could find themselves going without. Health reform will be a hollow promise if we give people health insurance without giving them access to health care providers.

That’s the crucial point of intersection between the law and the Institute’s report on The Future of Nursing: Leading Change, Advancing Health.

The report identifies the actions needed for the nation’s more than 3 million nurses—the largest segment of U.S. health care ranks—to be able to contribute as essential partners from a patient’s bedside to a hospital boardroom. It calls for an end to barriers that prevent nurses from working to the full extent of their education, training and competency. Such barriers exist in two-thirds of the states and keep advanced-practice nurses from diagnosing and treating routine illnesses, ordering basic tests or prescribing medications without a physician’s oversight.

In the wake of the report’s publication, a nationwide initiative to implement its recommendations launched. Supported by the Robert Wood Johnson Foundation in collaboration with AARP, the Future of Nursing: Campaign for Action is moving forward through coalitions and organizations in almost every state. These groups include nurses and other health professionals, business and association executives, nonprofit and academic leaders, policy-makers and consumer advocates.

In Vermont, the governor is forming a blue-ribbon commission to consider key recommendations from the report. Montana is implementing a rural nurse residency program, and Georgia has begun offering online doctoral programs to speed expansion of nursing faculty—whose shortage has repercussions throughout nursing education.

The 671-page report has drawn attention at the federal level, too. Sen. Daniel Inouye of Hawaii and several of his Senate and House colleagues urged the Federal Trade Commission in April to review state regulations that restrict advanced-practice nurses’ work. In addition, Inouye asked the commission to monitor the regulations for their anticompetitive influence.

Removing scope-of-practice limitations is unquestionably the report’s most controversial section. It need not be. Sixteen states and the District of Columbia allow advanced-practice nurses to see primary care patients independent of a physician, and studies have consistently shown no compromise of patient safety. The expert committee that authored the report conducted a robust evaluation of all the scientific evidence before giving its endorsement.

There is also other support. In an article in the New England Journal of Medicine early this year, Linda H. Aiken of the University of Pennsylvania Center for Health Outcomes and Policy Research noted that advanced-practice nurses have permitted the biggest expansion of services at community health centers in a quarter century. And these days, Aiken calculated, advanced-practice nurses provide care at retail clinics to more than 3 million families annually. Those numbers convey real impact that we hope will increase as the Campaign for Action accelerates.

The Future of Nursing continues to rank as one of the most visited reports on the Institute’s website, which bodes well for its staying power and the campaign’s progress during its second year. Although the challenges remain considerable, just as they do with the Affordable Care Act itself, the real promise of this work is a transformed health system and accessible quality care for all.

Harvey V. Fineberg is president of the Institute of Medicine. John W. Rowe, who served on the Institute committee on the future of nursing, is a professor of health policy and management at the Columbia University Mailman School of Public Health. 

Maria E. Robinson, RN, BSN, MSN is a community /public health nurse in Maryland. She is Chair of Community Events for the National Association of Hispanic Nurses. . This June, she completed CHMP’s Media Training as a “Nurse Messenger” funded by AARP’s Center to Champion Nursing. This is her first guest blog for CHMP.

According to the Centers for Disease Control and Prevention (CDC) there are close to 1.2 million people living with HIV today in the United States and 20%, or close to 200,000 people, are undiagnosed. If you don’t know you’re infected you can’t be treated. If your HIV positive and don’t practice safe sex you can infect others.

This past June, I participated in The City Uprising Event which was sponsored by The JACQUES Initiative of the University of Maryland School of Medicine (UMB SOM) and Project SHALEM in conjunction with many community and faith-based organizations in Baltimore, Maryland.   Organizers identified seven communities where they would focus their programming to raise awareness about HIV/AIDs. Each community would focus on educating the community about prevention, provide HIV testing and make referrals for services as needed.

I spent the entire day volunteering at the Esperanza Center in Fells Point, Maryland, a predominantly Hispanic community with residents from El Salvador, Mexico, Panama, Honduras, Columbia, and Puerto Rico. The Esperanza Center is a community health center providing health care to low income uninsured people.

Along with other people in the community, I stood proudly in my City Uprising volunteer T-shirt and distributed flyers outside encouraging people to come in and be tested for HIV and syphilis. As a Spanish speaking nurse my role as translator was critically needed throughout the day to translate for the non-Spanish speaking HIV testers and counselors so they could communicate with the mostly Spanish-speaking community members.  We encouraged people to come in on their way to work or to stop in on their way to the grocery store or market. We promised them there will be no waiting; thanks to this well organized and well staffed event we delivered on that promise.

We offered a free boxed lunch to everyone who was tested. I overheard several people say that it was a good to get tested but getting a free boxed lunch was just as important. For some people it may have been their only meal that day.

There were many stories about the people who came to be tested. Each person’s story matters. One man who arrived to be tested was dressed in torn clothing, had poor hygiene and was drunk. His speech was incoherent. He lost his balance and fell to the floor in front of us.  Another volunteer and I helped him up and escorted him to be evaluated by the health care team including the on-site substance abuse counselor.  This encounter also required a Spanish translator and I stayed with him to assist in his care. He was referred to a drug treatment center for follow-up. While translating for a young Latino man I learned he had been a victim of sexual violence when he lived in El Salvador. The counselor arranged an appointment for him that same day at a STD clinic where he could get comprehensive care and another volunteer drove him to the location.

This day, like almost every day, as a Hispanic community/public health nurse who works in largely Hispanic communities, I was reminded of how important it is to advocate for a more diversified health care workforce in our country. I am proud to be a member of the National Association of Hispanic Nurses (NAHN) that works to recruit and retain a nursing workforce that reflects the communities of our nation. These goals work to assure quality healthcare for Hispanic residents.

It was an exhausting but satisfying day… I ended it with a delicious meal at a local Salvadorian restaurant with my good friend, which was nourishing for my mind, body and community/public health nursing spirit.

Source: Storynory.com

For a long time, I was disappointed in the Leap Frog Group, the consortium of businesses that sought to leverage its clout to improve the quality and safety of health care. They set standards for health care organizations to meet but initially failed to include nurse-sensitive indicators of quality. While they have made some progress on this over the years, the Institute of Medicine‘s report on The Future of Nursing appears to have informed Leap Frog’s decision to include Magnet designation as an indicator of quality. This designation is bestowed by the American Nurses Credentialling Center, an affiliate of the American Nurses Association. It is an indication of excellence in nursing care. While not a perfect process, it is the best method we have to determine whether a hospital is providing high quality, safe nursing care. Since patients are admitted to hospital because they need nursing care (most are treated on an outpatient basis if 24-hour nursing care is not needed), Magnet designation is often times a proxy for overall excellence in patient care.  Nice to see the Leap Frog Group leap forward.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing, CHMP Co-Director