I have long been opposed to this idiotic system of licensing nurses (and other healthcare professionals) state by state. There is one national licensing exam, and therefore, there should be one national nursing license.

The system as it exists now, allows individuals who have lost a license in one state, who are considered incompetent or even dangerous, to simply pack-up and move across state borders.

From the LATimes:

Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior.

In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly — or harshly — they act on this information, according to interviews with regulators in 14 states.

Under the law in Virginia and Louisiana, for instance, officials must immediately suspend nurses’ licenses for serious misconduct in another state. Nurses are barred from practicing unless they successfully appeal.

Missouri, on the other hand, must personally serve all accused nurses with written charges and offer hearings to contest them. If nurses can’t be found, their licenses remain clear and they are free to continue practicing, said Lori Scheidt, executive director of Missouri’s nursing board.

Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida’s action. California was the last to revoke his license, in 2008, after he had practiced here for several years, apparently without incident.

Even when states share borders, they sometimes fail to heed each other’s disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.

Nurse Karen Rheuame’s Rhode Island license was suspended in 2007 after she was arrested on suspicion of assaulting a woman in a wheelchair in a hospital emergency room and trying to steal her pocketbook, according to state disciplinary records. She also had numerous other convictions and, records show, had once brought two beers to work, which she explained to her boss were for “the ride home.”

But she’s free to practice in Massachusetts. A health department official there said regulators are reviewing Rheuame’s case and others to see if action is warranted, but they haven’t received any complaints about the nurses in Massachusetts.

A unified national system would eliminate this. But of course, state Boards of Nursing would be reduced in size and number. They basically exist to keep this inefficient and dangerous system alive, and as we can see, they are totally inept in doing their job. Having dealt with the Board of Nursing in Washington state, regarding renewing a license, I can vouch for the lack of professionalism and total self-importance seen at least in this state. It took a threat to the governor’s office and other state regulatory agencies, for them to refund money owed to me for licensing fees.

State agencies would need to exist, but in a smaller form, and with less power (and yes, the BOR does not want to get off its power trip). Forcing a nurse to be licensed in each state is simply a means of revenue–it supports an unnecessary BOR, and allows incompetent/dangerous nurses to continue working.

Nurses, listen up. Christine O’Donnell, the new rising star of the Republican party, or is it the Tea Party, has the solution to STDs, teenage pregnancy, and unwanted pregnancies in general. She believes that you can just tell the world to “STOP HAVING SEX.”

And they will listen.

I think she is the new messiah. Or she thinks so. Maybe you can get her to come give lectures at the local nursing and medical schools, because this advice is just so easy. I mean, who would have thought that these major issued can be solved with just three words.

So the next time a patient asks about birth control, or AIDS–just tell them the three magic words and then end the conversation. And if need be, then send them to see Christine O’Donnell.

As in, where is she?

throughout the entire debate on healthcare reform, she has been notoriously silent. I will admit, that I don’t read the news every day, and in fact, try to avoid it, but I did a search and I really can’t find anything about her. Not only with healthcare reform, but giving an opinion on anything.

What is her focus? What is her platform?

The surgeon is supposed to have a bully pulpit, and is supposed to be a vocal advocate of something related to health. But it seems that Dr. Benjamin is of the opinion that her post is meant to be invisible.

Now more than ever, the Obama administration could use some help in advocating for the healthcare reform bill. But I guess that Dr. Benjamin thinks silence is golden. Maybe she thinks that she is supposed to spend her time behind a desk and be neither seen nor heard?

Yesterday I posted about a new addition to the nurses health study, and put out the word, as requested, to recruit more victims..uh subjects for the study.

Now, there is nothing really wrong with the study, except that the data is used to make sweeping conclusions and statements about health. In my opinion, many of the questions are highly flawed in that they don’t allow you to answer correctly. In the questionnaire on diet and supplements, for example, they asked about your intake of fruits and veggies. They have a note in the margin that says..

Please try to average your seasonal use of foods over the entire year. For example, if a food such as cantaloupe is eaten 4 times a week during the approximate 3 months that it is in season, then the average use would be once per week.

Are they kidding or what? But yes, that’s what it said on the questionnaire. As if eating peaches a few times a week when they are in season and then not eating them all winter is the same thing as eating one peach a week all year round. So in other words, the nutrients and fiber that you get from a peach sort of paces itself, just a like a timed release capsule.

Now if that isn’t dumb enough, do I really know how many cups of blueberries I eat a week? I don’t measure them out, I just eat them. How many apricots do I eat in a week?

The only way to keep an accurate account is to have a food diary. But this is to be done from memory.

In some part of this particular questionaire, you also cannot specifically say that you don’t eat a certain food, ever. They give you a choice of “never or less than once per month.” That is not the same as never eating it.

In a few questions, they don’t even give you that.  For example, they ask “How often do you eat toasted breads, bagel or English muffin (e.g., slice or 1 half bagel)?”

There is no way to answer that you don’t eat toast, bagels or English muffins. The “least” answer is less than once a week.

Also omitted are very crucial questions pertaining to the type of food you eat. They ask about adding sugar to beverages, but don’t really ask about the consumption of sugar laden–yes, there are questions about eating cakes, cookies, etc, but it really doesn’t give a full picture. They also don’t ask about the amount of processed foods eaten, about foods containing questionable additives, organic foods, amount of raw food eaten, etc.  If the produce you eat is fresh vs. frozen vs. canned.

The questions about breads, cereals, etc, do not allow you to say that you eat whole wheat pasta, for example. Or sweet potatoes as opposed to regular potatoes. The list of vegetables and fruits  they ask about is pathetically small, and at the end, they allow you to add in any other “important” foods. Three to be exact. Wow, generous.

They ask about eggs, but nowhere can you enter if you eat free range/organic eggs. You can’t say that you absolutely eat no processed meats whatsoever. Or do not drink soda, diet or otherwise.  They list soy products, such as burgers, miso, tempeh, etc, in the vegetable section. I realize that soy is a vegetable, but many people eat it as a main dish, as in soy burgers and hot dogs. They really should split it up–soy as vegetable like edame, and put soy main dishes in a separate category. Ideally, they should really have a separate list for people who eat no meat at all, because it is impossible to answer this questionaire accurately if you happen to adhere to a vegetarian or vegan diet.

Anyway, this questionnaire is really sad, and it is frightening that they are pulling data out of it and drawing conclusions about diet and health. There is so much missing from it, and it relies totally on memory…oh, and idiocy like pro-rating your peach intake.

That was just to draw your attention–it’s not as bad as that. But if you, meaning nurses, are interested in participating in a study–here’s your chance. And its not just any study, its the latest phase of the hallowed Nurses health Study. Yes, that Nurses Study.

If you sense a bit of sarcasm in my tone, well, you’re right. I have very mixed feelings about the results that pop out of this study periodically, being that I have been a participant for 20 years. The methodology is somewhat questionable, as are many studies that rely almost solely on self report. This is especially true of the NHS, which relies on self reported questionnaires that ask questions that are near impossible to answer correctly. Plus, the data they collect has a lot of omissions in it that I think could really affect their results.

Self-reported questionnaires can be useful and accurate if they are focused on one narrow subject, such as side effects from a specific medication, or if yoga has relieved back pain.  But the questions they ask are epic in nature and require things like remembering how many peaches you eat a week, how many hours you stand at work per day…now, unless you are closely monitoring diet/exercise/patterns of daily life, at best, this is something you will only approximate.

Anyway, I’ll discuss it more tomorrow, but I just wanted to make the announcement, in case any nurse is interested in signing on.

For the new cohort,they are enrolling 100,000 or more female RNs and LPNs between 22 and 45 years old (born after January 1, 1965). The new study will be entirely web-based, as roughly half of Nurses’ Health Study II is already. To learn more and to join, nurses should visit www.nhs3.org

No, fortunately, there are people left with working brains. The shooting incident at Johns Hopkins Medical Center was tragic and certainly, terrifying for employees and visitors alike, but precautions have to be reasonable.

Nurses have long been at the receiving end of violence, as they are a vulnerable group due to the nature of the job. This time a physician was shot, which is a more unusual case.

Hospital security often sucks big time, to put it bluntly. Parking garages are often poorly monitored, if monitored at all, security is slow to come when called, security staff is often spread very thin, and there is often just a general lack of standard safety features such as good lighting at night in garages and walkways around the facility. In addition, nurses have often been discouraged from reporting incidents, or even threatened if they do so.  Accusing patients of violence does not make for good PR or customer service.

So in a way, this incident has helped bring to light that violence is a way of life for healthcare workers and that is an area in dire need of improvement. But metal detectors is not the answer since most violence does not involve guns. In fact, it may involve equipment that is already inside the building–a chair thrown at a nurse, for example. Or just being hit, bitten, punched, kicked…

Hospitals need more security and to get rid of the stigma of reporting a crime. Nurse and other staff need to be supported, not criminalized. Disruptive patients, family members, and other visitors need to be shown the door.

From the Baltimore Sun:

While Hopkins has long focused on safety at its sprawling medical campus in crime-plagued East Baltimore, the hospital does not require patients or visitors to pass through metal detectors, as Americans must do now at airports, courthouses and many federal buildings.

With a weekly stream of 80,000 patients and visitors, imposing such security restrictions is “impossible,” Hopkins officials say — and security experts agree. Even as violent incidents appear to be on the upswing at hospitals, they need to remain welcoming places, experts say.

Can you imagine metal detectors in a large hospital like Hopkins? It would take hours just to get inside the building.  As I said, it is fortunate that people are thinking with their brains for a change of pace.

Apparently, the National Nurse movement is alive and well, and still trying to push through an Office of the National Nurse. While all of the arguments for it are well and good, the bottom line is–is this something that we really need to be spending money on?

What many people don’t realize is that there is already a Chief Nurse Officer of the Public Health Service. Just expand this role a little, and you’ve got a national nurse. Make this nurse a little more visible. The bill that the National Nurse advocates are trying to get pushed through lists all of the responsibilities that the new National Nurse would have. But in reality, none of them are new, or require the formation of a whole new office.

In fact, some of it is really a little naive. I wrote up an article about this a few years ago, and one of the people I spoke with was–shall I say–quite unrealistic in what she thought that a nurse was going to accomplish. She kept repeating to me the rhetoric of how nurses are the most trusted profession, and how people listen to nurses (ummm…then why are they so abused in the workplace and so powerless), and so on. But that doesn’t translate to everyone dropping what they’re doing to come and listen to a nurse speak. Or that they will pay more attention to head honcho nurse than the Surgeon General.

Duties- The National Nurse shall carry out the following:

• `(1) Provide leadership and coordination of Public Health Service nursing professional affairs for the Office of the Surgeon General and other agencies of the Public Health Service, including providing representation for the Government of the United States at the Global Forum for Government Chief Nursing and Midwifery Officers and serving as a member of the Federal Nursing Service Council.

• `(2) Represent the Surgeon General and the agencies of Public Health Service in communications with groups and societies concerned with nursing issues at the local, State, national, and international levels.

• `(3) Provide guidance and advice to the Surgeon General and the Nurse Professional Advisory Committee on matters such as standards, recruitment, retention, readiness, and career development of nurses employed by and contracted with agencies of the Public Health Service.

• `(4) Conduct media campaigns and make personal appearances for purposes of paragraphs (5) through (7).

• `(5) Provide guidance and leadership for activities to promote the public health, including encouraging nurses and other health professionals to be volunteers and developing projects that educate the public about and engage the public in prevention practices to achieve better health.

• `(6) Provide guidance and leadership to encourage nurses to become nurse educators.

• `(7) Provide guidance and leadership for activities that will increase public safety and emergency preparedness.

Is there anything on this list that requires a whole new office to be set up? No. Is there anything on this list that the current CNO of the public health service can’t do? No.

Plus there are a lot of vague statements, like number 7. What kind of guidance, exactly, is the National Nurse going to provide? Go around and check up on all of the state and local public health departments? What those places need are more funding and manpower, not a National Nurse “giving guidance.”

Number 6 is not only naive, it is downright silly. Do they really think that “words of wisdom” from the nurse in the sky are going to convince nurses to become educators? That the only problem in convincing nurses to go into teaching is the “lack of guidance”  or “leadership?”

It sounds all nice and good in a document, but in reality, RNs with a 2 year degree from a community college can make more money than an educator with a PhD.  Bottom line is that nurses are not becoming educators because they can make more money (a lot more money) working in other areas of nursing. You need at least a master’s degree to teach, and a PhD if you hope to get a tenured position. Higher degrees cost money, and if you’re going to invest in education, then there are many more opportunities awaiting–for much better pay, that are a lot more interesting, that allow more independence and career advancement, and lack the headache of academia.

So unless the National Nurse is going to work some magic and substantially increase the pay of nursing instructors, nurses are not going to drop what they’re doing and run off to teach school–just because the National Nurse offers them “guidance.” All of this stuff sounds so nice and proper on paper, but in reality, its just silly talk.

If we didn’t already have a CNO in the public health service, then I would say we should consider the National Nurse. But all that needs to be done is expand the current CNOs role a little bit, and let him/her become more visible. That would involve minimal spending, and could easily be put into place.

On yesterday’s theme, about shortage vs. surplus, one thing we don’t need is money spent on more scholarships and funding to increase nurses. There are more than enough nurses, if only hospitals would hire them and improve working conditions.

We don’t need to waste money on trying to push more nurses through school. One major reason is that people will jump at the chance to take the funding, whether they really want to be a nurse or not, because they’ve “heard” that nursing is a recession proof career and plus they’ll get to go to school for free.

So Obama, you’ve got the wrong idea and you’re talking to the wrong people. This constant nonsense about the nursing shortage when nurses can’t find jobs is really getting old. How about using all that scholarship funding to to help fix the broken system? There’s a nursing shortage because hospitals aren’t hiring and working conditions suck–not because nurses are in short supply.

President proposes nurse scholarships

AACN Applauds the President’s FY 2010 Budget Request

President Proposes to Increase Funding for Nurse Loan Repayment and Scholarship Programs from $37 Million to $125 Million

WASHINGTON, DC, May 7, 2009 – Today, President Obama released his FY 2010 Department of Health and Human Services Budget that provided specific details on the funding levels he has proposed for nursing education and research programs. The American Association of Colleges of Nursing (AACN) is thrilled that the Administration provided $263 million for the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and $144 million for the National Institute of Nursing Research (NINR).

The proposed funding for Title VIII programs represents a 54% increase over the FY 2009 level of $171.03 million. The greatest increase was awarded to the Nurse Loan Repayment and Scholarship Programs, which received $125 million, a 238% increase over last year’s funding level. The Nurse Faculty Loan Program received $16 million, a 39% increase over the FY 2009 level of $11.5 million.

“President Obama is a true champion for nursing. This proposed funding allocation marks a historical point for nursing education, recruitment, and retention,” said AACN President Fay Raines. “If the President’s request passes Congress, it would be the highest allocation these programs have received since created in 1964. AACN will work diligently with our top nursing advocates in the House and Senate to see this funding level enacted.”

The President’s request would offer significant relief to help alleviate the 11-year national nursing shortage that is projected to grow in the coming years. According to the U.S. Bureau of Labor Statistics (BLS), nursing is the nation’s top profession in terms of projected job growth with more than 587,000 new nursing positions being created through 2016. The demand for nurses will continue to grow as the baby boomer population ages, experienced nurses retire, and the need for primary and specialty health care intensifies. BLS projects that more than one million new and replacement nurses will be needed by 2016.

AACN is also pleased that the President’s budget proposes a 1.4% increase for NINR over last year’s funding level. Moreover, the President’s budget outlined that the NINR will receive $36 million in funding from the American Recovery and Reinvestment Act that would potentially bring the total for FY 2010 to $180 million.

“This substantial investment in nursing education and research signals a strong commitment to ensuring the availability of quality nursing care to all Americans,” said Dr. Raines. “AACN looks forward to working with members of the nursing community to secure these funding levels and will continue to work to advance nursing’s role in the national discussion about patient-centered healthcare reform.”

Here they are, happy grads, ready to go on the unemployment line, where most new graduate nurses are ending up these days.

As many nurses and wanna-be nurses have realized, the late great nursing shortage has virtually vanished. In its place has come a shortage of jobs. So what the…?

To reiterate, as most of us intimately acquainted with healthcare know, there was never really a shortage of nurses, as in living breathing bodies with an RN degree. Rather, nurses were leaving hospitals and healthcare altogether for greener pastures. Hospitals claimed to be interested in hiring more staff, and the drum roll was on to open more nursing programs, shorten the programs currently in existence (to push out fresh new grads sooner), or to break down the barriers to hiring foreign workers.

The idea, as many guessed, would be to flood the field with warm bodies, so that for every nurse who quit, another was waiting to take his/her place. Thus, the perpetual revolving door.

And now, with the current economic status quo, hospitals have jumped full force into the “poor me/financial woes” bit, and have frozen hiring, laid off workers–the whole 9 yards and then some.

To be fair, many facilities were facing financial problems before the great bust, but many were not. And many, as we know, dished out exorbitant executive bonuses at the same time workers were being slapped with their pink notices. And the economic situation was a prime excuse not to hire on more nurses and other staff, and just “make do.” Who needs nurses, aides and housekeepers when you’ve got suits and stockholders to keep happy and smiling?

Here is an excerpt from an interesting story that appeared online at AJN, and it is the epitome of what many nurses are now facing:

Although patient acuity and nurse skill level are considered in making shift assignments, certain situations can’t be predicted or planned for. An extra workload will always negatively affect the nurse and the patient. In the best of circumstances, the nurse won’t get lunch or breaks and the nonessential elements of patient care, such as baths and linen changes, will be skipped. The busier the assignment, the more likely that something critical will be missed. (For more on this, see the Muse, RN’s blog post, Nurse-Staffing Ratios: Nurse’s Perspective.)

I heard her say, “An extra patient shouldn’t make any difference in the standard procedure for passing medications.”

Does anything more need to be said? It would be just karma if that nurse manager ever became ill or in an accident, and she was that “extra” patient that the nurse got stuck with. And then faced the consequence.

Two years after the first telecast, Stand Up to Cancer returns tonight for another fundraising extravaganza. It will be aired, simultaneously and commercial free, by ABC, NBC, CBS and Fox networks and shown in multiple TV channels including BIO, CURRENT, DISCOVERY HEALTH, E, G4, HBO, HBO Latino, Mun2, SHOWTIME, SMITHSONIAN Channel, Style, TV Ne, and MLB Network among others.

Check out this great article on Medscape. (Hint, I wrote it!)