Health Care Reform: Where Have All the Nurses Gone?

When it comes to health care reform, we hear a lot from the insurance companies, the pharmaceutical companies, the American Medical Association and all the other stakeholders that could be affected by changes that Congress will or won’t make. But where are the nurses?

I’m not the only one who is wondering.

Health care experts at the Robert Wood Johnson Foundation recently asked that question and others in a survey in which they polled 1,500 “opinion leaders” about what should be done “to ensure nurses’ place at the decision-making table.”

When it comes to nurses – who they are and what they do – there is the image and then there’s the reality, and the two are not the same, according to Susan Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. Hassmiller writes about the need for nurses to be full partners in reforming the health care system and improving patient care.

“Nurses are seen as trusted, caring, compassionate, skilled health care providers,” she writes. “But that image doesn’t fully capture the reality of the roles nurses play in our health care system, which are much more extensive, substantive, pivotal and robust.”

It may be that in former years, nurses were more reactive than proactive, but times have changed. Nurses have advanced degrees and hold high positions in many health care institutions and organizations. They also are on the front lines and can see what needs to be done. Who better to provide ideas on how the system – or lack thereof – can improve?

According to the respondents of the survey, these opinion makers want to see nurses have a greater role in:
• reducing medical errors and improving patient safety (90 percent)
• improving quality of care (89 percent)
• promoting wellness and expanding preventive care (86 percent)
• improving health care efficiency and reducing costs (84 percent)
• coordinating care through the health care system (83 percent)
• helping the health care system adapt to an aging population (83 percent)
• increasing access to health care (74 percent)

Unfortunately, only about one in seven of the leaders said the thought nurses would actually have a significant role in future changes and policies.

When asked why nurses don’t have a seat at the health care reform table, the leaders listed some barriers that prevent nurses’ full participation. They said that:
• nurses are not perceived as important decision makers (69 percent).
• nurses are not revenue generators compared with doctors (68 percent)
• nurses’ focus on primary rather than preventive care (62 percent)
• nurses don’t have a single voice when they speak on national issues (56 percent)
I’m not sure whether nurses should or should not embark upon a giant national public relations campaign to educate the public about what they really do or not. But nurses do need to step up and make some noise – let those who are making the decisions about health care know that they need to listen to what nurses have to say. Nurses at every level can do this; you don’t have to be an administrator or a CEO or a PhD. Let Congress hear from you, whether you are at the top of the corporate ladder of working in the trenches. Tell legislators what you know and what you see and what your patients need.

Do you think there’s a lack of representation by nurses when it comes to developing health care policy?

If so, why do you think nurses have remained in the background?

What information can nurses offer legislators that others can’t and why?

Tell us what you think.

Workin' On the Night Shift: Can You Stay Connected?

I confess: I absolutely hated working nights during the years I was employed by large teaching hospitals in the Midwest and Southern California.

Back then, almost all staff nurses were expected to work all shifts on a rotating basis. There were a few nurses who worked nights permanently because they preferred that shift. The rest of us had to fill in the gaps, so about 20 percent of our shifts were the 11 p.m. to 7 a.m.

No matter how many night shifts were plugged into my schedule, my biorhythms just couldn’t adjust. And I hated going to bed when I knew the rest of the world was waking up. I felt isolated from the rest of humanity— -- like I was missing out.
So I admire nurses who choose to work those “graveyard” hours – whether it’s because they like that shift or they have to in order to meet family and financial obligations. But even nurses who are night owls say that keeping such a schedule often plays havoc with their bodies, brains and social life.

It’s not easy to maintain the usual social connections when everyone else is in bed when you’re on the job and vice versa. I recently read advice from one expert who says that you can’t live in two worlds without a calendar. She believes planning is the key to keeping alive important and cherished relationships.

That makes a lot of sense.

Most families are busy and it’s hard enough keeping track of comings-and-goings even when a night shift is not in the mix.

Another component to staying sane and healthy is to make sure sleep doesn’t get sacrificed to others’ schedules and needs. Sure, once in a while you may have to give up a few hours of shuteye, but it shouldn’t be a regular habit. Explain to family and friends that you’d much rather be there, but sometimes it’s just not possible.

Good diet and some exercise goes without saying, but don’t be afraid to eat food that might not jive with the time of day. If you’re in the mood for dinner cuisine at 8 a.m., go for it, but keep the portions moderately small if you’re going to bed soon after. I found reading to be an effective way to wind down after getting home in the morning – especially a boring book if I really needed help - but turning on the television (especially the news) kept me awake. This only emphasized that the rest of the world was just beginning its day and I wouldn’t be there.

Every night-shift nurse probably has a few tricks that helps keep biorhythms is sync and mental health stable. What are yours?

Are you on the night shift by chance or choice?

What are the benefits of working the night shift?

What is most difficult about it?

Tell us what you think.

Complementary and Alternative Medicine: Maybe Both is Best

In one of the many press releases I regularly receive, there was recently news of a study conducted by researchers at UC San Diego and UCLA on the attitudes and beliefs of medical students nationwide about complementary and alternative medicine (CAM).

The treatments mentioned in the study include massage, yoga, herbal medicine and acupuncture, among others, and the findings appear in the online issue of Evidence-based Complementary and Alternative Medicine (eCAM).

The questionnaire contained 30 questions and was sent to 126 medical schools and about 68,000 students. The team received 1,770 completed surveys – about 3 percent.

To sum up the findings, today’s doctors-in-training are more open-minded than ever about using CAM with traditional medicine, but they want proof that the methods really work. More than eight out of 10 agree “to some extent” that there are worthy CAM treatments out there, and half have used CAM methods. Few, however, said they’d recommend or use treatments in their practices until they are proven effective.

This news got me to wondering how nurses felt about alternative medicine.

In the past, I’ve interviewed nurses who work in hospitals that incorporate massage, biofeedback, meditation, aroma therapy, music therapy, acupuncture, and relaxation and visualization techniques into patient care plans. Whether insurance covers these treatments I don’t know, but at one hospital, nurses volunteered to give massages on their days off to both family and patients at no charge. The nurses had high praise for this program and the hospital received lots of positive feedback from patients.

I don’t know whether any CAM therapies can actually heal, but they surely can make a hospital stay a better experience.

I did find one discussion about nurses’ opinions of CAM on a chiropractic Web site.

In 2002, a chiropractic organization surveyed nurses on their opinions about therapies that included chiropractic, homeopathic remedies, magnet therapy, macrobiotic diets, and chelation and herbal therapies. The purpose of this survey was to measure nurses’ opinions about chiropractic and how it measured up against other alternative therapies.

More than half of the respondents deemed chiropractic to be “definitely safe” or “probably safe.” (Of course, opinions do make any therapy safe, but opinions were what the survey was after.)

About one in seven nurses said they had used the services of chiropractors. This was less than the number who had used aromatherapy, massage therapy, meditation/relaxation or multivitamins, “but significantly higher than acupuncture, biofeedback, homeopathy or yoga,” according to the author of the article.

The safety and efficacy of CAM is a subject about which debate will never end.

As a nurse, I’m often asked by friends or people who read my features and blogs what I think about the latest research results on disease and treatments – conventional or otherwise. Or they want to know my opinion on the hottest new drugs or alternative therapies. I’m not a research scientist, but I do encourage healthy skepticism, further research and a creed that includes the phrases “there are no magic bullets,” “all things in moderation,” and “both might be better than one or none.”

How do you feel about CAM?

Do you use any of the CAM methods mentioned above?

Do you recommend any CAM treatments to your patients or friends?

Would you like to see more research about the efficacy of CAM?

Tell us what you think?

Web-Based Medical Records: Dream or Nightmare?

Universally available electronic medical records is probably a pipe dream – at least for some time to come.

By “universally available” I mean medical records that are obtainable by anyone from anywhere, provided of course, that the person who wants access has the magic password and permission of the patient.

My understanding is that the only way to do this is with a Web-based system. A few hospitals and medical groups have such a system, although the records available are somewhat limited in most cases. For instance, patients and their doctors can access via the Web personal data like address and phone number, and certain test results, but they can’t access physician notes, OR notes or other test results.

Very few hospitals and medical groups do give patients access to their complete medical records, and despite initial misgivings – mostly by physicians – officials say it has worked well. Nurses with whom I’ve spoken say that it helps patients, families and caretakers to be more educated, more proactive and more responsible for their overall health care.

I see the value of Web-based access to all medical records or chronically ill patients who must see multiple doctors and undergo multiple tests and hospital admissions. Any one of the doctors can pull up test results or opinions of other specialists at anytime and from anywhere. Those in favor of total access say it saves physicians and nurses a great deal of time and avoids test duplication –both of which saves dollars.

I also see Web-based medical records as a terrific convenience for home health care nurses or any nurses involved in chronic disease management. Those who oversee the care of parents, relatives or friends who live down the block or cross-country can avoid hours of frustrating waits and the cost of duplicate tests. Being able to see test results and doctors’ notes online from their home, their cell phone or wherever gives patients and advocates all the time they need to understand and digest information about their conditions.

And for frequent fliers and other travelers, getting sick far away from home can be a less frightening experience if they know physicians anywhere in the world can access patients’ medical histories.

A couple of hospital systems in San Diego announced recently that they have taken the first steps toward what the story in the San Diego Union Tribune calls “the much touted but equally elusive national health records system.”

What do you think?

Do you like the idea of a national, Web-based medical records system?

Would such a system help or hinder your work?

What do you see as the advantages and/or disadvantages of universal access to medical records?

Have you had any experience with Web-based medical records?

Tell us what you think.

The Nursing Profession: Full Employment Anytime, Anywhere?

I’m amazed at how many times I hear news stories or read articles about nursing.

Just the other morning, I heard a piece on NPR about how nursing is one field of employment that is expanding. The story also stated that the average annual salary for nurses working full time is about $62,000. That seemed a bit high, taking into account the different type of nursing jobs and standards of living in different areas of the county. But if those numbers are true, an education in nursing is truly a good investment.

The problem is, of course, that the waiting lists to get into nursing schools are horrendous in most areas. In my neighborhood, the average wait to get into a two-year, associate degree program is three years. Thankfully, one of the local community colleges is starting a four-year, bachelor degree program soon. That will help some, but certainly won’t erase the problem of long lines to enter nursing school.

Nursing degree programs aren’t as easy to establish as some other degree programs. Educating and training nurses requires a lot more resources than just classrooms, and the resources are expensive and labor intensive. There is an acute shortage of nurse teachers and clinical instructors because the pay just doesn’t come close to that of hospital clinicians, nurse practitioners or administrators. Many nurse instructors are part-time and say they do it for the love of the profession, but that makes it hard to build a solid base of experts.

A challenging economy has caused some hospitals to close entire wings and lay off staff nurses and nurse administrators. The weak economy also has kept nurses who would otherwise retire on the job, thus eliminating slots for new grads and nurses who are returning to work after years off the job. Some hospitals aren’t as interested in new grads because they necessitate an investment of time and training, something they can’t currently afford in this recession.

All of this said, I’d still encourage anyone who wants to be a nurse to pursue that goal. The scope of practice for nurses is ever-expanding, and the variety of nursing jobs is growing. Forty years ago, a new graduate could work in a hospital, a physician’s office or perhaps teach. Today, the possibilities are endless, including eventually establishing his/her own practice.

What do you think the future of nursing holds?

Are you satisfied with your chosen field or are you looking for a change?

Have nursing jobs in your area been affected?

Tell us about it.