$2 Million for What?

Some things make my stomach knot and my blood boil, and this is one of them.

One of our local hospital systems (two hospitals and some other facilities) is paying San Diego Chargers star running back LaDainian Tomlinson $2 million over five years to tell everyone how wonderful their hospitals are. The 29-year-old football player has already made television commercials and various public appearances touting the hospitals (the contract began in July 2007). He also helped the district extract $600,000 last summer from local glitterati and another gala is on the books for June.

Let me be clear: I don’t blame Mr. Tomlinson. Who would turn down such a sweet deal? And in all fairness, he is universally known in these parts as a very decent guy—even by people who are not diehard football fans. To his credit, Mr. Tomlinson has had no drunken encounters with the law, no involvement in shootings, no car crashes in the wee hours of the morning, and he has been generous to his personal charities. So all in all, the young man who has a multimillion-dollar contract with the Chargers presents a package that is very attractive to those who want his endorsement and can afford it.

But I have a problem with a hospital spending $2 million on advertising—on anyone or anything.

The question I ask is whether such an outlandish expenditure is really worth it.

Could that $400,000 a year that Tomlinson receives from the hospital system possibly be used to—um—hire a few more nurses perhaps? Or give pay raises to any of the people who work at the bedside?

This is what gets my goat: Marketing departments spend oodles of bucks on publicizing how wonderful their health facilities are, but when it comes down to it, what happens at the bedside is what the patient remembers. Their care is the yardstick by which patients measure the quality of that facility. And what happens at the bedside is mostly the responsibility of the nurse and those who work closely with him/her. It is the nurse’s burden to live up to all the expensive ads, endorsements and hype.

One thing more: Does an endorsement by a football player really sway people’s choices of hospitals?

It seems to me that most consumers choose their doctors first, and the hospital comes along with the package – not vice versa. Where a person is hospitalized is determined by where the physician or physician group has admitting privileges.

The reason this topic has surfaced again (I was angry the first time around) is that the buzz now is whether Tomlinson will be traded after this season closes. Those who know say he might be wearing an Oakland Raiders or Denver Bronco uniform next year, and the question is whether Tomlinson should still be a spokesperson for the San Diego area hospital district.

I think the decision-makers should skip that debate altogether and focus on finding a better use for the money.

What do you think about using a hospital’s resources for expensive advertising and marketing?

Should hospitals use their resources to more directly benefit its workers and patients?

Tell us what you think.

Got a Problem? Ask a Nurse

In perusing some trade magazines that put forth predictions about the world of nursing, I came upon a concept that began repeating itself: Nurses are the best problem-solvers when it comes to meeting the needs of patients and their families.

In one article, several experts mentioned that the future holds big opportunities for nurses because of the new rules recently handed down by the Centers for Medicare and Medicaid Services (CMS) regarding non-payment for hospital-acquired problems.

“The CMS conditions are a fabulous opportunity to bring nursing to the forefront—to be more influential,” said Susan Odegaard Turner, Ph.D., MBA, MN, RN, chief nursing officer for the California Department of Corrections and Rehabilitation. “Nurses are the choreographers of care. Nurses impact outcomes…(and) evidenced-based outcomes are responsible for the financial growth and stability of health care.”

In other words, hospitals and long-term care facilities aren’t going to be able to prevent pressure sores and pneumonia unless nurses can do their job correctly. They can’t do their jobs properly if working conditions aren’t right. This means health care facilities must meet nurse-to-patient ratios and where there aren’t any, enough nurses should be hired anyway to make workloads doable. If they don’t, institutions will suffer the consequences, which could be costly.

New CMS rules also mean that nurses must have a greater say in what needs to be done and how to do it. Nobody knows better than frontline workers and nurses are no exception.

Another prediction and some advice: Nursing research will be more important than ever but don’t re-invent the wheel.

Patricia McFarland, MSN, RN, FAAN and CEO of the Association of California Nurse Leaders, likes the Transforming Care at the Bedside (TCAB) model. TCAB is not a traditional quality improvement program, according to the Robert Wood Johnson Foundation. TCAB calls for ideas for improving patient care to come from “frontline staff and unit managers,” not from on high or quality-improvement people.

Hmmm, I’m detecting a common thread here; could it be that the people who spend the most time with patients and their families know best?

If more institutions asked nurses for their ideas, they’d not only get good ones but probably save a bundle. And the next hospital could save a bunch, too, if it would just ask the first hospital about what worked and what didn’t.

The problems may not be simple, but maybe the solutions are.

Does your workplace encourage employees to come up with solutions to problems?

Are you consulted about problems in your workplace?

Do you feel your opinion is valued?

Tell us what you think.

When Enough is Enough

Figuring out how to reduce health care spending may be an insurmountable task, but the Obama administration is, thankfully, going to give it a try. I hope one of the things that will be under discussion is our attitude about quality versus quantity of life.

One high-cost item for both public and private spending is the care given to sustain the last days and months of life. A disproportionate amount of the Medicare resources are consumed by medical care given to patients who, despite the extraordinary measures, are going to die. There is a growing awareness among nurses, physicians and families about hospice and its services, but still, many families and doctors choose to initiate or carry on with expensive diagnostics and treatments for terminally ill patients.

Even nurses, who fully understand their loved ones’ conditions, are often reluctant to turn from treatment to palliative care. When it comes to family, they often second-guess themselves, always wondering if enough has been done.

This is the sad story I saw unfolding this past week when a good friend who is a nurse called to talk about his 86-year-old mother. She has been in the hospital for weeks after extensive abdominal surgery that was followed by major complications. She also has mid-stage dementia. The surgeon wanted to take the woman back to the OR, but my friend opined that he wasn’t sure a 46-year-old could survive such a surgery, much less an 86-year-old. He was quite conflicted about giving permission.

Then another physician—a British doctor—spoke to him about his dilemma. She kindly but directly told him that if his mother was in England, no one would be considering further surgery. She then explained how doctors could make his mother comfortable with medication and that she should be placed in a skilled nursing facility.

My friend was relieved. He had mistakenly thought the choices for his mother were surgery or painful death. He was comforted in knowing that his reluctance to put his mother through another major surgery was validated. Still, the hospital insisted on calling in the ethics committee to discuss the case because the mother had never signed a DNR order.

All the while, his mother was being denied palliative care and the meter was running.

I thought for sure there would be no follow-up surgery, but an e-mail today from my friend told me that the doctors decided a second surgery was within the palliative realm. Now his mother is in ICU suffering further complications. My friend finally requested that her code status be changed to “comfort measures only.”

“Both of the RNs and the intern (in the ICU) sounded so relieved when I requested, ‘pleasejust consider comfort and dignity, and let her go peacefully,’” he wrote in an e-mail.

And so, a lot of emotional capital, heartache and money have been spent on a situation that never should have occurred. Sadly, such scenarios are repeated daily all over the country.

How do you feel about having to implement extraordinary measures for the terminally ill?

Should physicians be more honest with patients and families when discussing treatment options?

What should nurses say to families who are searching for help in deciding about further treatments?

When considering how our health care dollars should be spent, do we need new national guidance on care for the terminally ill?

Tell us what you think.

Parental Dilemma: So Many Vaccines

I’m sure glad I don’t have to raise kids in this day and age.

I think that’s what my mother said to me back in the ’70s when my son and daughter were growing up, but really, I think parents have it even harder today. So many decisions, so much fear and so much information with which to grapple.

This thought crossed my mind for the umpteenth time as I read a recent Associated Press story about all the families in Ashland, Oregon, who have decided not to vaccinate their kids. I have visited this topic of vaccinations before, but must revisit after learning that, in this town of 20,000, 28 percent of the kindergarteners are not vaccinated.

In one “alternative school,” two out of three kids have received no vaccinations.

I thought these numbers were pretty shocking, and it makes me wonder if the situation is the result of some subdued mass hysteria; a few parents decide not to vaccinate their kids and suddenly everyone is questioning the validity of one of the chief public health reasons that kids survive childhood.

I’m not an expert on the topic, but in the last few months, I’ve read more than once that there is no proof or research that backs up claims that vaccinations cause autism and other problems. I’ve heard the arguments from the anti-vaccination contingent, but I keep thinking how measles epidemics are popping up here and there and how some of those kids who contract measles get really sick and even die.

So I tend to go with the experts—at least those not affiliated with any pharmaceutical interests - but apparently the mistrust factor among Ashland parents is high.

In conversations with befuddled representatives from the CDC—who are paying $50 per interview—parents say they mistrust government, the pharmaceutical industry and mainstream medicine. I do understand, however, why parents feel overwhelmed when they learn how many vaccinations are recommended. Between birth and 6 years old, according to the CDC, children should receive hepatitis B, rotovirus, Haemophilus influenza, pneumococcal, poliovirus, measles, mumps, rubella, varicella, hepatitis A and meningococcal.

Infants should also receive a yearly influenza vaccine and, if you have a daughter, you’ll have to decide whether to give her an HPV vaccine when she reaches age 12.

And the cost? About $1,500 per child (not including the HPV vaccine which costs about $360 for three doses). Most vaccines are covered by insurance and also are free at public health offices, but many pediatricians say that they are losing money because reimbursement doesn’t cover the cost.

One of the town’s doctors is working with nursing students at Oregon Health & Sciences University to produce a pamphlet that promotes the benefits of immunization. I’m not sure this will help—it’s pretty difficult to change minds when opinions and beliefs are based on such emotional premises—but I admire the physician and the students for moving forward with this educational effort.

When asked, should nurses come down on the side of vaccinations or not?

Should nurses promote their personal opinions if they don’t jive with the CDC’s recommendations, or should they support CDC official line?

What do you tell parents if they ask for your opinion?

Tell us what you think.

Celiac Disease Could Be the Answer

As a nurse, you’ve probably experienced requests for advice in the strangest places.

When I first worked for a daily newspaper, I kept my former nursing career a secret, but when the opportunity to apply for the health and medicine beat materialized, I had to justify why I’d be the ideal person for the job. So the secret was out and suddenly there were people at my desk several times a week asking about problems with their health, medical care, medications and insurance.

That’s why I’m going to use the first blog of the year to do a shameless promotion for celiac disease awareness, because you never know when this information might come in handy.

It’s good to know about celiac disease (CD) because there are so many people who have it and don’t know it, and so many who have been up, down and around the diagnostic maze with no answers.

According to the Celiac Foundation, it takes an average of 12 years to 14 years to obtain a diagnosis, and many of these poor patients are labeled crazy before someone actually thinks to test for CD. Maybe, in a serendipitous conversation with a neighbor, a party guest or a dinner date, you’ll be able to provide the crucial information needed to make the correct diagnosis for symptoms that no one can explain.

No one knows why people develop CD, an autoimmune hereditary disease, but we know what happens when they do. A protein called gluten, found in wheat, rye and barley, sets off a complicated chain reaction that causes the destruction of the lining of the small intestine. When the villi are worn away, food and nutrient absorption are difficult or impossible; hence, weight loss, osteoporosis, anemia, infertility and all sorts of problems related to malnutrition occur.

Fortunately, CD has been the object of some good press in the last couple of years, and the term “gluten free” is becoming less strange to people’s ears. Still, when it comes to diagnosing this disease, which has many symptoms that mimic other diseases, nurses and doctors often miss it because CD is just not on their ‘rule-out” list. That’s too bad, because it only takes two or three blood tests and maybe a small bowel biopsy to diagnose. (There is some debate and research about whether the biopsy is necessary in all cases.)

Undiagnosed, CD can eventually cause death.

Health professionals were once taught that CD was a problem found only in infants, but experts now know that one in every 100 to 133 people of all ages in the United States has it. Many are as yet undiagnosed, so you could be the one to suggest that such problems are gluten-related.

For more information, visit the Celiac Foundation’s site at www.celiac.org or the National Institute of Diabetes and Digestive and Kidney Diseases at http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm