Get Up Close and Personal; It Helps

Empathy.

That’s what we were told to have. Never get involved, our nursing instructors told us. If you sympathize or identify with the patient, you won’t be able to really take care of that patient. Worse yet, you’ll carry the burden of every patient’s illness.

Yes, by all means, stay detached.

If the nurses who were taking care of my sister as she was being prepared to enter the OR for a double mastectomy had followed that creed, she and her husband, who was at her side until she rolled through the OR door, would never have experienced the sense of comfort that they did.

Here’s what my brother-in-law wrote on my sister’s Web site just after he kissed her and watched her wheeled through the double doors:

Ok, she's off to surgery. As you can imagine, the docs are all very confident. The whole staff is supportive. The nurse came to wheel her away. You know how they go through the questioning to make sure they're not cutting off the wrong appendage? The nurse asked what she was having done. After Jenny told her, the nurse said, “I had your surgery a year ago.”'
That's the third survivor we've met today. The woman in the radiology reception room was one. The radiation tech that came to get Jenny was another. It just goes on and on.
Like the nurse said, “The bad news is that everyone you know has had breast cancer. The good news is that everyone you know has had breast cancer.” She also declared, “You'll do great. I never missed a beat.” And, she had to have radiation AND chemo.

That nurse who shared, as well as the other hospital employees, brought solace and confidence to both my sister and her husband. I’m sure she helped relieve their fears.

I can’t imagine initiating that sort of exchange 30 years ago. I probably wouldn’t have had the courage to bend the rules or to have been so open about my personal experiences, but I’m glad times and attitudes have changed. And fortunately, so many women entering the nursing profession these days are older and have had many life experiences that will only add to the psychological support they can offer their patients.

I’d love to know if nursing schools are still teaching empathy these days.

What are nursing schools teaching about sharing personal stories and experiences?

Do you think nurses should offer personal stories to patients who might benefit?

Are there disadvantages of being open with patients and families?

Tell us what you think.

Union Truce: Good, Bad or Somewhere in Between?

Looks like the two naughty children have stopped beating on each other and have decided to join forces. Maybe they remembered what mom always said: You can build a better sand castle if you cooperate.

The misbehaving kids are the country’s two nurses’ unions: the Service Employees International Union (SEIU) and the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC). The SEIU claims 1.8 million members, of which 80,000 are registered nurses. The remaining are non-nurse hospital employees. The CNA/NNOC represents 85,000 nurses in 50 states, but that number will expand to 150,000 members when it merges with United American Nurses and the Massachusetts Nurses Union.

A little background on the war: For more than a year, the two unions have been name-calling, accusing each other of stealing members, and orchestrating dirty tricks like conference-crashing and obstructing employees from joining the other union.

But all that’s in the past, now, the unions say and, on March 19, the two organizations announced that they would quit taking punches, straighten up and play together.

They pledged to work toward common goals which include unionizing as many nurses and other hospital workers as possible; supporting proposals for single-payer health care systems at the state level and, with a couple of exceptions, creating one, big, strong nurses union.

Both parties also want to “advocate for improved patient care conditions and stronger patient safety legislation.”

The initial focus of these efforts, leaders say, will be the nation’s largest hospitals, so I imagine these institutions are none-too-thrilled to see the squabbling stop. And certainly health insurance companies are not happy thinking about the unions’ push for a single-payer system.

I’m not sure whether this truce is all good or all bad, but I’m guessing it’s some combination thereof.

Unions can obtain concessions that a single nurse or a handful of nurses can’t, but I’m not a true believer, either. When unions get big and bloated and their leaders amass power and money, something usually goes wrong. Sometimes it becomes all about the union and not the goals, as it apparently did when the SEIU and the CNA/NNOC were punching and poking each other. So it remains to be seen whether they can continue to cooperate and keep their eyes on their goals.

And I’d like to make a small suggestion: The CNA/NNOC should find a shorter name and one that does not include the word “California?” After all, the union represents nurses nationwide, and it should have a name that reflects who and what it is.

What do you think about the unions joining efforts to promote their goals?

Is pushing for unionization a good thing in this tough economic climate?

Are you ready for a single-payer health insurance system?

Tell us what you think.

A Few Extra Minutes Can Save Time, Prevent Mistakes

Almost everyone is in a hurry.

And I get it, because I, too, am usually in a rush. But sometimes I have to remind myself that rushing not only doesn’t save time (well, okay, maybe a minute or two—sometimes), but it can make more work down the line.

Here’s why I’m thinking about this—and nurses should take note, because you are often the purveyors-of-information and patients depend on you to communicate that information in an understandable way.

My daughter-the-runner had leg pain for several weeks and finally went to the orthopedist. Young guy. Very smart—but in a rush. After her X-ray was done and in his hands (or maybe it was on the laptop he carried around), he told her a bunch of things in a hurry.

After the appointment, she called us to say that he had talked so quickly and was looking at the computer so much of the time, that she really didn’t understand what the diagnosis was or what she was supposed to do next. Was she supposed to avoid weight-bearing for six weeks—or was it 12? Did she really need the MRI he wanted, because without health insurance, she would have to pay cash. And if she got the MRI, would the treatment be any different than if she didn’t?

This meant another call to the doctor the next day, plus several calls from the office staff to my daughter trying to set up an appointment for the MRI, which she wasn’t sure she was going to have. And there were the calls to me and my husband, who had to make further calls to the orthopedist’s office yadda, yadda, yadda…

All of this despite her parents’ connections to the local medical community.

With a little less hurry and three or four more minutes of explanation to my daughter (probable diagnosis: stress fracture), all of the fallout of this botched appointment might have been avoided.

Makes me wonder how many times people with no connections and complicated health problems —like the elderly, disabled and chronically ill—are left wondering what’s going on with their health and health care.

Spending a few more minutes on attention, careful instruction and/or listening—on the part of a physician or nurse—can mean less frustration and fewer mistakes, and at the end of the day, may leave health care professionals with a little extra time.

Do you feel the pressures of time with your job?

Do you think anything can be done to change that?

Do you have any time-saving tips?

Tell us what you think.

One Person's Earmark Is Another Person's Good Cause or Job

Earmarks. Pork. A bridge-to-nowhere.

These have become dirty words when it comes to federal spending bills, especially during this unusual time of economic upheaval and Washington’s attempt to jumpstart our economy.
Just to clarify, earmarks are individual items that lawmakers want for their districts, and they are able to attach these items to bills without having to discuss the details. (I suppose that’s how the very expensive “bridge-to-nowhere” in Alaska was approved. No details!)

For this fiscal year, which ends Sept. 30, there are between 8,000 and 9,000 earmarks (depending whose counting) worth $7.7 billion more or less. The entire bill amounts to $410 billion.

All this after both parties declared the era earmarks was over.

Everybody proclaims earmarks a bad thing, and there’s no doubt about it: sometimes these pet projects should never be paid for by taxpayers and exist solely to fatten the pockets of the undeserving. There are those who argue that the federal government should do nothing but deliver mail, print money (which they’ve been doing a lot of lately), fund the military and build roads.

But wait. Before you condemn earmarks wholesale, check out what they are. You might change your mind about some of this so-called pork.

For instance, I was perusing the newspaper this morning and looking at the items that California senators and representatives have tossed into the giant earmark hopper, and I have to say that some of them look like they’d be money well spent. In this case, health care and nurses are going to benefit, and chances are other states’ representatives are listening to their constituents in the health care industry.

Among the items for the San Diego area are $1.3 million for a regional emergency communications network, $476,000 for a system to aid public health officials in the event of a bioterrorism attack, and $190,000 for equipment for a nursing program at a local college.

They say the devil is in the details and I don’t know the details regarding these earmarks. On the surface they look like reasonable items, and it’s very possible that some of these earmarks might produce jobs, or at least put some more money into circulation. They might also provide needed services and educational tools.

What’s your opinion about earmarks, and requesting/accepting/spending money from the federal government?

Should federal tax dollars be used for such items, or should it be up to the local or private sector to meet the needs of health care institutions?

Tell us what you think.

MRIs: What You Probably Don't Know and How It's Going to Change

It’s so difficult to be a well informed consumer when it comes to health care.

It’s even difficult to be a well informed nurse. We already know stuff, but there is still so much we don’t know. Of course, that’s because there’s too much to know.

I think nurses should at least try to keep up on the topics of the day, and if we don’t have all the answers, we should at least be aware of what the public is hearing, reading and learning. I’m frequently asked questions about anything and everything concerning health care. Sometimes I wonder if I have “Information Booth” written on my forehead.

But seriously folks…Monday’s New York Times carried a story about MRIs that surely got my attention.

The point of the article was that MRI imaging centers do not have to be certified, nor do the technicians. The other shocker is that there are still many old machines in use that produce poor -quality images. According to Dr. Gary Glazer, chairman of radiology at Stanford University, the “gulf” between the quality of images from 10-year-old machines and the newest ones is “vast.”

Change is coming, though.

A law passed last year mandates that as of 2012, Medicare will pay only for scans performed in accredited imaging centers. Currently, all types of insurances pay for nearly all scans, regardless of their quality, center accreditation or lack thereof.

Just so you understand the dollars-and-cents of this situation:
• More than 95 million high-tech scans are performed each year. This includes not just MRIs, but CT scans and PET scans as well.
• Medical imaging is a $100-billion-a-year industry in this country.
• Medicare pays $14 billion of that.

Acording to the Times’ story, recent studies show that 20 percent to 50 percent of all scans shouldn’t have been performed anyway because they just weren’t that useful as a diagnostic tool.

What's a consumer to do?

At this point, there’s not much they can do except question the necessity for the scans, (probably not likely if insurance will pay—and everyone wants a scan!), ask the age of the machines, and inquire about the certification of the centers and technicians. But I’m betting that when the Medicare regulations for certification become active, we’ll see lots of ads touting “new” scanners and “certified” centers and staff.

Are you surprised to learn about the lack of regulation and standards for MRIs?

Do you think there should be more regulation?

Will consumers benefit from the new Medicare law?

Could certification bring down costs – assuming it means that results will be higher quality images?

Tell us what you think.

Octomom: Should Nurses Judge?

I’m a student of the English language and it seems that a new word has crept into our lexicon: octomom.

I always wonder who coins these new terms—many times it’s authors, journalists or others who work in the media—but suddenly, we see the word octomom everywhere and everyone knows exactly who and what it means.

There seems to be no consensus, though, about how we should feel about a woman who has given birth to eight children at one time—on purpose.

In case you’ve been in a cave, 33-year-old Nadya Suleman , a single Los Angeles mother, underwent in vitro fertilization, and the six implanted embryos yielded eight babies, including two sets of twins. This after already having six children, three of whom are said to be special-needs kids. Imagine 14 children under 8 years old, including eight preemies.

Someone has already created a page on the Wikipedia Web site for Ms. Suleman, with a note that the page “is in the middle of an expansion or major revamping” because the birth of the octuplets is an ever-unfolding current event.

I’m embarrassed to admit that I’m rather fixated on this saga.

I don’t’ lose sleep over it, but if a story about Octomom appears in the newspaper, it’s the first one I read. And if Ms. Suleman is being interviewed, the television gets my undivided attention.

I suppose the reason why I’m not the only one mildly obsessed with this anomaly is that it is just so downright outrageous and unbelievable, but it did happen.

As a mother, I can’t even fathom taking care of 14 children, much less eight preemies.

As a nurse, I know full well the care that these tiny bundles of life require. And I’m ever curious about how the Kaiser Permanente hospital, where the octuplets reside for now, is going to handle the discharge of the babies. The Octomom’s family lives in the modest three-bedroom tract home that belongs to her mother. It can’t possibly absorb eight more who will need round-the-clock care for months.

But where will the octuplets go?

Who will be responsible for their care?

How will the mother and the long-suffering grandmother cope?

At this writing, Octomom doesn’t have a clue. She’s turned down offers of help, risking that the babies will be placed in foster care.

As a lay observer of this ever-changing story, I’m puzzled, amazed and angry. Were I Ms. Suleman’s nurse, though, I’d have to suspend judgment and make her needs paramount.

And lay person or nurse, I must remind myself that it’s all about the kids now. They didn’t ask to come into the world, and could be in for a very rough childhood. They are going to need all the help they can get.

What do you think of the story?

Do you care?

And what about the fertility specialist who helped Ms. Suleman become the Octomom? Does he bear high responsibility?

Tell us what you think.

Low Nurse-to-Patient Ratios: Do They Save Money?

California instituted nurse-to-patient ratio legislation in 2004 and one of the pro/con debates was whether mandating this measure would be costly for hospitals.

Well, studies say yes and no.

A new study by the federal Agency for Healthcare Research and Quality found that wages for registered nurses working in California increased by more than the wages of nurses in states without similar regulations. (The study appeared in the journal Health Affairs.)

But, a year ago, the California Nurses Association and the National Nurses Organizing Committee posted a list of studies that, overall, concluded that the nurse-to-patient ratio laws probably do save money in the end.

Here are some of those studies and the publications in which they appeared:

■ RN understaffing in hospital ICUs increases the risk of pneumonia and other preventable infections that can add thousands of dollars to the cost of patient care— Critical Care, 2007.
■ Raising the proportion of RNs by increasing staffing to match the top 25 percent best staffed hospitals would produce net short-term cost savings of $242 million — Health Affairs, January/February 2006.
■ Improving nurse-to-patient ratios from 1-to-8 to 1-to-4 would produce significant cost savings and is less costly than many other basic safety interventions common in hospitals — Medical Care, Journal of the American Public Health Association, August 2005.
■ Johns Hopkins University researchers found that hospitals with fewer nurses in the ICUs during the night shift generated a 14 percent increase in costs — American Journal of Critical Care, November 2001.
■ Harvard researchers cited a 3 percent to 6 percent shorter length of stay for patients in hospitals with a high percentage of RNs — Nurse Staffing and Patient Outcomes in Hospitals, Harvard School of Public Health, 2001 report.
■ It costs hospitals about $42,000 to replace a general medical/surgical-unit RN, and $64,000 to replace a specialty RN — Journal of the American Medical Association, October 2002.

With the new legislation that denies payment by Medicare for hospital-induced medical problems like infections and pressure sores, it’s more important than ever to have adequate staffing. Without it, hospitals are sure to see their costs spiral upward and their collections head downward.

Does your state mandate nurse-to-patient ratios?

If so, how has it changed your job and workplace?

If not, do you think you could do a better job with lower nurse-to-patient ratios?

Are there any disadvantages to nurse-to-patient ratios?

Tell us about it.