Hospital’s Weighty Hiring Policy No Longer Excludes the Obese

Should medical centers be able to refuse to hire nurses and physicians who are overweight?

At least one hospital thought so, but it recently changed its mind.

Citizens’ Medical Center in Victoria, Texas (approximately a two-hour drive southeast of San Antonio), issued a hiring policy in 2011 which declared that overweight health care professionals need not apply.

The hospital defined overweight as someone who has a body mass index (BMI) of 35 or greater – for instance, a person who is 5 feet 5 inches tall and weighs 210 pounds, or someone who is 5 feet 10 inches tall and weighs 245 pounds.

The Texas Tribune reported that an employment lawyer has told the Victoria hospital that its hiring policy isn’t against the law.

“Only the state of Michigan and six U.S. cities — including San Francisco and Washington, D.C. — ban discrimination against the overweight in hiring,” he said. Texas hospitals cannot discriminate against employees because of their race, age or religion, “but being overweight is not a protected category.”

The hospital’s CEO, David Brown, weighed in recently about some of the reasons behind the original policy.

“The majority of our patients are over 65,” he told the Texas Tribune, “and they have expectations that cannot be ignored in terms of personal appearance. We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.”

Then in April of this year, he contacted the Obesity Action Network to tell them about the change in policy.

Perhaps the hospital’s change of heart was based on negative feedback they had received or the intense discussion their policy had sparked. .

Some points of the debate:

·        How do you define obesity? [BMI isn’t everything.]

·        If a hospital can decide not to hire smokers, can’t it also eliminate overweight people from the pool of prospective employees?

·        Being overweight increases the risk of health problems and the cost of medical care, so shouldn’t employers have the right to keep their health insurance premiums as low as possible?

·        Some define obesity as a disability. If this is true, isn’t discriminating against overweight employee-candidates in violation of the Americans with Disabilities Act?

·        Does a BMI greater than 35 interfere with a nurse doing his/her job well?

The debate has engendered a lot of online discussion among the general public and their providers

While some nurses agree with the original policy, others are standing up for their overweight nursing colleagues and what they contribute to the profession. And some are wondering how far employers plan to take these policies now that smoking and weight are two issues that can keep a nurse from being hired.  Might high cholesterol and hypertension be the next exclusionary factors?

Physicians, also affected by the policy, are joining the debate.

What do you think?  Should hospitals have the right to refuse to hire overweight health care professionals?

Should health care professionals be required to set a good example for patients? Or can they still be effective with “Do as I say, not as I do” advice?

Nursing’s Future: Where Are You in the Big Picture?

Just for the heck of it, I recently decided to Google the word “nurses” and see what would pop up.

One of the first links sent me to the Occupational Outlook Handbook compiled by the U.S. Department of Labor’s Bureau of Labor Statistics (BLS), and surprisingly, it made for interesting reading. I was quickly drawn to “What Do Registered Nurses Do?” and I was pleased with what I read. Right at the top was this: “Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.”

I really liked the emphasis on the role of nurses as educators, advisors and coordinators. This is a decided shift from times-gone-by when nurses mainly carried out others’ directions and orders, and had virtually no input and little responsibility for initiating care or care plans. So we’ve come a long way.

How do nurses fair in the pay department?

According to the BLS, the median annual wage in May 2010 was $64,690. (That means half of all nurses earned more; half earned less.) The lowest 10 percent earned less than $44,190, and the top 10 percent earned more than $95,130. This pay rate compares to that of a firefighter whose median annual wage is $45,250 and whose job requires no degree; a dental hygienist at $68,250 whose job requires an associate’s degree; and a physician’s assistant at $86,410 whose position requires a master’s degree.

Where do nurses work?

More than half – 54 percent – work in general medical and surgical hospitals. Eight percent work in physicians’ offices; 5 percent in nursing care facilities; and 5 percent in home health care. The remainder work in education, administration, support services and for the government.

There is always a lot of talk among nurses about job prospects, and it seems that current opportunities are uneven, depending upon where nurses are seeking work and how much experience they have. The official word from the bureau is that the number of nursing jobs will grow 26 percent between now and 2020, “faster than the average for all occupations.” The reasons why revolve mostly around the fact that more people are living longer and will need ongoing care for chronic conditions; and the need for rehabilitation, home health care, and Alzheimer’s and memory care services.

Other reasons more nurses will be needed include the growth of technology, which in turn, means that more health problems will be treated, an increased emphasis on preventive care;, and the increasing number of outpatient procedures. And most people expect the Affordable Care Act, currently under review by the Supreme Court, to bring more and more patients into the realm of the insured, who will then seek additional care; a lot may depend on how much of the legislation remains intact.

When all of these factors converge, which nurses will be in greatest demand?

In general, nurses with at least a bachelor’s degree, and advanced practice nurses – clinical nurse specialists, nurse anesthetists, nurse-midwives and nurse practitioners – will find the most opportunities, especially in rural settings and inner cities. And experts predict that because facilities and institutions will eventually have to compete for nurses, they may offer signing bonuses, family-friendly work schedules, subsidized training and other attractive benefits.

None of this will happen overnight, but on the other hand, some of this is happening now.

Where are you in the big picture of the future of nursing?

Do you think you have enough education or do you plan to get more?

Do you feel your career goals are in line with what the experts predict?

Tell us about it.

Willingness More Important than Age for Nurses Learning New Tricks

I recently had a chat with a nurse who has been working on a hospital unit for more than 40 years. She said that she’s happy to still be working, but confessed that she entertains the notion of retiring “about every other day.”

That’s because she is finding that working with electronic medical records and all other aspects of the digital age within the hospital might be more of a challenge that she’s up to. Whenever she mentions retiring, more than one physician encourages her to stay on.

“They say I have way too much knowledge and experience to quit,” she told me. “It usually keeps me going a few more days before I think about retiring again.”

This nurse wonders, however, if she isn’t “dragging down the team” because she’s not up to speed on the computers. She worries constantly that she’s going to make a major mistake that will be dangerous for the patient, make it difficult for her co-workers or cause her co-workers to spend extra time “cleaning up my messes.”

Knowing what a good nurse she has always been, I sympathized with her. But then I had another conversation that made me see the other side of the situation.

Another friend, who works outside of health care, was telling me how she spends much of her day “cleaning up after” the myriad of mistakes made by one of her co-workers who hasn’t learned their computer system, despite having been in her position for years. My friend is in her mid-50s and well versed in the particular computer skills she needs for her job at a local college. She prides herself on continually updating her knowledge and skills and, according to her, the co-worker in question is mostly “just not interested.”

My friend can’t quite figure out whether her younger co-worker lacks the ability or is just not willing to expend the energy it takes to stay current.

These two stories led me to think about ageism, attitudes and abilities.

I don’t believe you can judge older nurses and other workers to be inadequate just because they are older. Younger workers can be just as lacking. Either age group may be deficient because they either don’t want to learn or don’t have the aptitude.

I think the bottom line is that, regardless of age, nurses must be flexible. We must always be ready and eager to learn because we are in a field and an age that demands it. Gone are the days when life and work are static. It’s true: Nothing is constant except change.

No one is expected to know it all, but a good nurse should always be open to new ideas, and once these ideas have proven their worth, always be willing to learn.

What’s your experience with co-workers who don’t seem to learn new systems or processes? Do you think their problems relate more to age, ability or attitude?

Tell us what you think. 

Mandated Nurse-to-Patient Ratios? The Debate Continues at State and Federal Levels

Tenacity.

That’s what it’s going to take to get nurse-to-patient ratio legislation passed at the federal level, according to those who know their way around the nation’s Capitol.

"In California, it took us 12 years to get safe staffing legislation passed," DeAnn McEwen, MSN, RN, president of the California Nurses Association/National Nurses Organizing Committee told a nurses’ trade publication recently. And since 1999 when the legislation was passed, at least 15 other states have introduced some sort of safe-staffing-level bills.

Now there are attempts at doing the same through Congress, but, as with all things nursing, it’s complicated. There are two bills slowly pushing their way through the federal legislative gauntlet, and great debate ensues from both sides of the aisle.

The first bill is the National Nursing Shortage Reform and Patient Advocacy Act (S. 992/H.R. 2187). It requires hospitals to implement staffing plans that include minimum RN-to-patient and LPN-to-patient ratios. It also allows for adjustments above the minimum ratios "under appropriate circumstances."

The second bill is the Registered Nurse Safe Staffing Act (S. 58/H.R. 876). It requires facilities that accept Medicare payments to create staffing plans for every unit, and those plans would be developed by committees that include at least 55 percent direct-care nurses.

So the debate, as I understand it, is whether hard-and-fast ratios are the way to go, or whether the flexibility that a committee offers is best.

Opinions about the advantages and disadvantages of each bill in particular and of ratios in general abound. Proponents for these bills point to a number of research studies that have found better outcomes for patients and advantages for nurses when staffing levels are put in place, while opponents say that mandated ratios add a great deal of expense and administrative difficulties without adequately considering the characteristics of the nurses and patients involved.

What do you think is the best way to ensure that there is adequate nurse staffing and that patients get the best care possible?

Do you think federal standards are necessary?

Tell us what you think.

The Nurse Who Became an Icon

Nurses who visit San Diego must not miss seeing what is probably the biggest nurse in the world. She is part of a 25-foot sculpture that stands harborside, next to the U.S.S. Midway – an aircraft carrier-turned-museum that attracts millions of visitors each year.

Visitors will You’ll quickly recognize the giant foam-and-urethane creation as a depiction of the famous photo taken by Alfred Eisenstaedt in New York City’s Times Square on V-J Day in 1945. The photo of the sailor kissing the nurse originally appeared on the cover of Life Magazine and is said to be one of the most recognized photos of the 20th century. The location of the huge statue in San Diego, named “Unconditional Surrender,” seems perfect because it sits among several other monuments dedicated to the military and World War II.

To see the sculpture, go to RoadsideAmerica.com.

The statue has been the subject of debate between art critics and the public. The critics have pronounced it “kitschy” and said that the “figures look like something from a cheap souvenir factory, blown up beyond any reason."

The public? Well, they just love it.

It’s fun to catch visitors’ expressions of surprise and amazement when they first come upon the nurse and sailor in the embrace. They relish having their photos mimicking the pose or standing below the nurse’s skirt, gazing upward. (There is nothing to see.)

The sculpture, on loan for free to the Port of San Diego, was installed in 2007. It did, however, cost more than $67,000 to move it from the Los Angeles area to San Diego. The nurse and sailor were scheduled to remain on display for a couple of years, but the expiration date has been extended numerous times by popular demand.

There have been recent news stories about the sculpture because the port authority officials have said that the statue is really, really leaving for good in May. But we are not to fret; volunteers have vowed to raise nearly $1 million to have a bronze likeness of the statue constructed. There are smaller, life-size versions in several other cities in the country, and it’s not clear what size the San Diego bronze will be, but this current foam version weighs 6,000 pounds.

When Eisenstaedt took the photo in 1945 of the two kissing in Times Square, he never obtained their names. For years there was speculation as to who the two might be. Thirty-five years later, Edith Shain of Los Angeles came forward to say that she was the nurse. On V-J Day, she was working at Doctors Hospital in New York City, where she spent most of the war. She and a friend took the subway to Times Square to join the celebration. When they emerged from the subway, a sailor grabbed the then-27-year-old nurse and gave her a “long, long kiss.”

“…I figured since he was fighting for our country, I would let him kiss me," Shain said when interviewed years later.

She also said that her eyes were closed, so she never looked to see who was kissing her. About a dozen men have come forth to claim the distinction, but it’s been impossible to verify the sailor.

Shain was on hand in San Diego in 2007 when the 25-foot sculpture was installed. In her mid-80s then, she still looked happy, healthy and full of energy. She has been the featured guest at many World War II commemorations.

Shain earned her bachelor’s degree in nursing in 1947 at New York University. She became a kindergarten teacher and a producer for public access television. Friends said that she visited hospitalized veterans until she died in June 2010 at the age of 91. To see photos and read about her life, visit Edith Shain's memorial website.

AHRQ Report: Shame-and-Blame Culture Still Prevalent in Many Hospitals

It’s been five years since the Agency for Healthcare Research and Quality (AHRQ) dispensed its first report on patient-safety culture in hospitals. In that 2007 report, AHRQ said that hospitals should shed the shame-and-blame philosophy in dealing with errors and adopt a “culture of safety” that encourages employees to discuss mistakes openly.

Most nurses, doctors and pharmacists, however, still believe their institutions are more interested in punishing mistakes than in discovering why mistakes occur and using that information to create a safer patient environment.

These are the conclusions drawn from data recently collected by the AHRQ.

In their latest survey, 600,000 staffers at more than 1,100 hospitals were questioned. Half said they felt that “their mistakes are held against them,” according to a story in the Feb. 27 edition of the American Medical News. More than half also said they feel that there is more emphasis on the person who committed the error than on what might have contributed to the error.

The 2012 report also states that about 20 percent of hospitals surveyed have improved procedures for dealing with errors, but 16 percent have “worsened with time.” The remaining hospitals have neither improved nor worsened, and have a “similar pattern” as before when it comes to open communication.

According to the Joint Commission, hospital staffers should operate in an environment that is free of fear of disciplining, and should feel confident that problems of safety can be addressed with free communication. The only way to accomplish this, according to one expert, is to “just do it” – and make sure all employees know about it. This is the best way to develop trust and change the culture.

What do you think are the key factors in creating a culture of safety?

Have you had any experiences, good or bad, with reporting errors?


Tell us about it.

Nurses Have Known All Along: Everyone Needs Health Care Insurance

I don’t know about you, but I’m hanging on almost every word, opinion and explanation of the case that is before the Supreme Court this week. Nine justices are hearing the arguments for and against mandated health care coverage; whether the federal government is “coercing” states into expanding Medicaid; and whether the rest of the Affordable Care Act is valid if the individual mandate is struck down.

It’s been two years since this monumental health care reform package was signed into law, and I think I’m almost starting to understand the arguments and explanations. Not that I’m going to attempt to explain them here, but I do have a few thoughts and opinions on the issues and how the legislation relates to nurses.

As a patient advocate, I feel compelled to argue that health care is a right, not a privilege. Except for those who are too poor to pay, we all need to contribute to the cost of health care because a good insurance system isn’t going to work unless contributions are made by both the sick and the well. Besides, unless you get hit by a truck and are declared dead at the scene and have never had any health problems prior to this accident, you will need medical care sooner or later. You might pay for someone else’s surgery today, but someone else is going to pay for yours next year.

A quick digression: One question not before the Supreme Court is whether anyone should be making a profit from selling health insurance. Currently, a goodly portion of insurance premium dollars never get to patients. This money pays salaries, bonuses and dividends to company owners, executives and shareholders whose main goal is to maximize profits. That means keeping costs as low as possible, which translates into denying as much care as possible.

Back to the subject at hand: Nurses are, most importantly, concerned with preventing disease and preserving and promoting health. They can accomplish this only if all citizens are covered by some form of basic health care insurance. Though not perfect, the Affordable Care Act contains many provisions for furthering preventive care and the education of nurses who, as time passes, will carry out this work more and more.

It’s been more than 20 years since the American Nurses Association (ANA) put forth its “Nursing's Agenda for Health Care Reform,” which calls for a “restructured health care system” that focuses on wellness, accessibility and convenience, as wells as case management for the chronically ill and greater patient responsibility. The position paper supports a “nationally standardized package of essential services” that includes coverage of pregnant women and children–a “cost effective investment in the future health and prosperity of the nation.”

You can read the entire position paper at Nursing's Agenda for Health Care Reform.

It seems to me that the ANA’s position paper mirrors much of what is in the Affordable Care Act. Can it be that, all along, nurses knew best?

Tell us what you think.

P.S.: NurseZone is carrying daily updates from the Supreme Court hearings this week; stay tuned to what’s happening on this page.