Don’t these newspapers ever get tired of printing the same story over and over and over and over and over again? I mean, really. The nursing shortage news in most outlets seems to be simply a cut and paste of previous stories, with names, dates and locations changed. That’s it. Nothing that shows that the reporter crept outside the box, or even bothered to find out what an RN even is.

Take this masterpiece from the Dowagiac Daily News. I’m not really sure where it is, but I’m assuming that it’s in Michigan, since it refers to the great shortage of nurses in that state.

Did you know that Michigan is expected to have a shortage of about 7,000 Registered Nurses by 2010 and a shortage of 18,000 RNs by 2015?

No, I didn’t. Please tell me about it. See what I mean about just changing numbers and locations?

There is a growing nursing shortage in Michigan - and the United States. Michigan’s nursing education programs are bottlenecked in their ability to admit, educate and graduate all qualified applicants.

At the same time, our population is aging and will need much more health care in the future.

Still awake? Now how many times has this same tired argument been repeated. Not too long ago, I posted about a website which lists schools that do not have waiting lists. And I clearly recall that when I was looking to get into a nursing program, state schools also had waiting lists. That was in the 1980s, when interest in nursing was pretty low. The reason was the same as now. State schools are cheaper, and nursing programs can only hold xxx amount of students, due to nature of the program. Clinical rotation groups have to be small, and even lecture groups have to be limited in size. And schools are all competing for clinical space at hospitals.

This article goes on to talk about some initiative that will provide tuition and stipends to allow graduate-level nursing students to enroll in full-time programs and graduate as future faculty. In return, they have to teach in a Michigan nursing program for 5 years.

Its’ about time that someone thought of something intelligent to lure nurses into teaching, but even so, this idea still may not do the trick–unless the individual really wants to teach. Is it full tuition, and is the stipend enough to allow the nurse to live on, so he/she doesn’t have to work? How intense is the program? Can a nurse still pull a few shifts if the stipend just doesn’t cut it, ie, the need to eat still exists?

Second, the 5 year obligation. It really may not be worth the nurse’s while in the long run. Paying for grad school is expensive, but working as a teacher for 5 years, at the median pay scales for instructors (and I’m assuming that they’re talking master’s trained, in which the pay would be less than PhD) may not even it out. Other types of jobs for graduate trained nurses pay far more, and they will probably be far ahead, moneywise, if they pay for their own schooling and then get a more lucrative job at the end of the five years.

Plus, if they want tenure, they will have to go on to get a doctoral.

Put it this way, the only way that anyone is going to beef up the instructor market is to pay market wages. A teacher is just going to have to earn more money than the average nurse working on a med/surg floor, which at the moment, they don’t.

So nice try, but no cigar.

For whatever reason, whether it be a school project, scientific dissertation, a book, curiosity, or just time on your hands–I found the perfect spot to hunt down nursing websites.

Yes, websites that are related to nursing in one way or another. It’s run by the Health Sciences Library at the University of Buffalo, the State University of New York. Not to get off track, but when I was applying to colleges, the state university system of New York was as follows:

State University of New York at Buffalo or SUNY at Buffalo. Ditto for SUNY Stony Brook, SUNY Albany, and so on. I don’t know, do they think calling it the University of Buffalo sounds more sophisticated? More classy? You don’t see the UC system in California changing anytime soon. I highly doubt that UCLA is going to become “the University of Los Angeles” any time soon.

But back to the subject at hand (it’s so easy to get distracted), this website is really a nice listing of nursing organizations, nurse practitioners websites, nursing history, nursing informatics, nursing research, and so on. Even nursing theorists, whatever that may be. If its anything like the nursing theories that they tried to enamor us with in nursing school, then I’ll pass on that one.

From Time.com:

On July 17, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, scrapped plans for a large clinical trial of the government’s most advanced HIV vaccine candidate to date. The vaccine, a two-shot injection, was designed to fight HIV infection a new way — by activating the body’s cell-based immune responses rather than by relying on antibodies to HIV.

It’s not a complete surprise, as a similar vaccine failed to live up to expectations last year. Very disappointing, and there’s not much else on the immediate horizon.

Early on in the AIDS epidemic, the experts were very confident that there would be a vaccine within a few years. Once the virus was identified, it was only a matter of putting the components together and coming out with the magic potion. But as the years passed, and vaccine attempt after vaccine attempt failed, the outlook was less rosy.

While I don’t think that efforts to find a vaccine should be abandoned, I do think that the emphasis should be on preventing and treating the disease. We know how its spread, we know how to stop it. Which is why it is so devastating to see the U.S. throwing away funding to meet political and idealogical goals, rather than the needs of the population being served. See my post from July 18.

Like, does it make sense to ignore sex workers? Are they going to disappear if they are ignored, go uneducated about AIDS, and untreated? Are they not going to infect anyone if we refuse to acknowledge that they exist? And do the wealthy politicians in the US have any inkling that sex work is the only job for many of these young girls (and boys)?

Or the idea that needle exchange is going to encourage people to be drug addicts. Please, that philosophy reeks of the “just say no” attitude. Drug addicts don’t live in a vacuum. If they share dirty needles, they spread infectious diseases. It’s as simple as that. And then not only will they become ill (and become a burden on society if you want to look at it monetarily), but they will spread it around.

Anyway, in lieu of the elusive vaccine, we need to work with the information and tools that we have right now.

Well, they didn’t exactly throw it away, but just missed a golden opportunity to make better use of funding. To channel funds where they are needed, and to use the money wisely, and get the most for the buck, so to speak.

The Center for Health and Gender Equity (CHANGE), in partnership with Advocates for Youth, the International Women’s Health Coalition, American Jewish World Service, the Sexuality Information and Education Council of the United States, and the National Council of Jewish Women is issuing the following press statement in response to the recently passed Senate bill (S. 2731) to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR). The organizations emphasize the Senate’s politicization of public health and failure to rectify serious flaws regarding PEPFAR’s prevention policies that will have harmful implications for the health and rights of women and girls worldwide. Please contact CHANGE if you have any questions.

It’s Broke, But They Won’t Fix It:
The Senate Authorizes a Global AIDS Relief Package that Comes Up Short

Washington, D.C.–On Wednesday, the Senate voted 80 to 16 to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $48 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.

The Senate missed a golden opportunity to epitomize the generosity of the American people by making U.S. global HIV/AIDS relief more effective, compassionate and fiscally responsible. As a result, millions of people are at greater risk of HIV infection.

Under pressure to act quickly, policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic. Much has been learned since PEPFAR was enacted in 2003. However, rather than heeding to the evidence collected by our own government agencies, the bill passed by the Senate compromises sound public health practice for ideology and political expediency.

* One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding.

This provision was left in the bill despite a 2007 report from The Institute of Medicine, which recommended the removal of PEPFAR’s then-requirement that one-third of prevention funds be spent on abstinence-only-until-marriage programs. The Senate’s decision to leave these de facto restrictions in the bill means that those fighting the HIV epidemic on the front lines will be deprived of the vital discretion they need in determining how funds are best spent.

* The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services. However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.

* The 2003 PEPFAR legislation contains a provision that enables organizations receiving U.S. funding to pick and choose the prevention and treatment services they wish to provide. Millions of dollars go to organizations to provide prevention services, even though they refuse to discuss the potential of condoms or other contraceptives in preventing the spread of HIV. As abstinence and partner reduction programs have outpaced programs that enable individuals to have all the information they need to prevent HIV, the law stands in the way of the effective use of resources.

The Senate has taken this bad policy and made it worse by extending the so-called “conscience clause”, or refusal clause, to organizations that provide care and support to people living with HIV/AIDS, their families and their communities. This provision paves the way for taxpayer-funded discrimination based on “moral” and religious grounds, allowing PEPFAR funding recipients to refuse to provide care for someone based on their religion, how they got infected or any other basis. The refusal clause is yet another damaging provision that flies in the face of good public health practice.

* Lastly, the Senate upheld the requirement that groups fighting HIV/AIDS overseas publicly pledge their opposition to prostitution and sex trafficking before receiving U.S. money. Prevention programs that have reached sex workers, a group that is marginalized and exceedingly vulnerable to HIV infection, have yielded dramatic reductions in HIV transmission. According to numerous reports, the pledge has led to further alienation and discrimination of already-stigmatized groups. This policy drives sex workers underground and away from the non-governmental organizations and health workers best poised to provide them with services they need to protect themselves from infection.

It is our moral obligation and fiscal responsibility to use PEPFAR funding to prevent as many infections as possible. However, large sums of money, spent unwisely, will not save lives and will require an ever growing need for increased resources in the future. The bill fell short exactly where more was needed: full and flexible funding of prevention programs that would enable us to make a difference in the lives of millions.

What is wrong with these people? The purpose of the funding is to prevent and treat infectious diseases, and not spread the moral viewpoints of a few wealthy Americans who can’t even begin to fathom what life must be life for people that the funding is supposed to help. I’m so glad that Brazil refused U.S., because it would compromise the great inroads that they made in treating HIV infection. But unfortunately, other countries don’t have that option–they need the money. So the most vulnerable people will continue to fall through the cracks, organizations that are given funding will have the option to pick and choose patients based on “morality,” and a full third of the funding will be tossed out on the abstinence until marriage programs which have failed miserably.

Sad, sad, sad. A great opportunity has been lost. And we can’t just blame Bush for this, because obviously, this was a bipartisan vote.

Heart surgeon and medical pioneer Michael DeBakey died, at the age of 99. Actually, he was less than 2 months shy of his 100th birthday.

I remember hearing about DeBakey and his contemporary, Christian Barnard, the famed South African cardiac surgeon, in the late 1960s. Heart transplants, artificial hearts–all very distant and vague to a child, but yet the names stuck in my head. Both names would make the medical news over and over again.

DeBakey, as it turns out, was a lot more than just your average long-lived cardiac surgeon. I really knew little about him, other than that he was famous for pioneering a number of surgical techniques, performing the first human heart transplant in the U.S., and helping to develop the artificial heart, as well as implanting the first one into a live patient.

Reading about him now, just after his death, makes me breathless. And at the same time I am inspired and discouraged, because I look at all he accomplished and think of how little I’ve done in my own life. What am I waiting for? The other interesting thing is that DeBakey has shown that old age does not mean internment in a nursing home with a million debilitating illnesses. Yes, the man did look old and wrinkled at age 99, but his mind was razor sharp, and aside from a torn aorta that he experienced at age 97 (and survived surgery to repair it and was back at work after a month in intensive care) his health was excellent. Right up until he died, DeBakey was still active, still consulting and mentoring, and keep up a hectic schedule of writing and travel.

There are a number of really good in-depth articles about his life, his accomplishments, and personal achievements. But here’s a run down from the LA Times:

In his highly influential career, DeBakey performed the first coronary artery bypass surgery and the first carotid endarterectomy to prevent strokes. He developed the pump that is the key component of the heart-and-lung machines routinely used on patients during heart surgery and an artificial heart now used to keep patients alive while they wait for their own heart to improve.

He also developed the concept of the mobile army surgical hospital — immortalized in the film “M*A*S*H.” He also played a key role in the creation of the National Library of Medicine and transformed the Baylor College of Medicine and its Texas Medical Center from a third-rate hospital into a nationally recognized center of excellence for heart care.

I had no idea that he had anything to do with MASH units. Another article I read said that he was influential in convincing President Johnson, who was one of his patients, to sign the bill that established Medicare. He also spoke French, German and Arabic, and in 1939, published the first scientific paper linking cigarette smoking to lung cancer.

His ideas were far reaching, and have really become the standard of care. And of course, he was challenged by the status quo who wanted to keep the mediocre status quo. Instead, in-between caring for patients and inventing new surgical techniques, and publishing medical papers, he also dived into reforming Baylor College of Medicine from some backwater school into the world class and world renowned center that it is today.

Later that year, the Baylor University School of Medicine, as it was then known, tried to get DeBakey to join its faculty, but he turned down the offer twice. “They didn’t have any clinical service. They had no hospital. They had no residents, no training program in surgery,” he told the Houston Chronicle.

He ultimately accepted when the university promised him a 20-bed surgical service at Hermann Hospital and a free hand as chief of surgery. He quickly became unpopular.

One of his first controversies involved a rule he announced stating that physicians with no training in surgery could not operate at Baylor-affiliated hospitals. “No one who is unqualified to do good operations should be allowed to operate,” he said.

He was also unpopular with the Harris County Medical Society in Houston because of his new ideas — including the creation of intensive care units at Baylor, establishing new training guidelines for surgeons and admitting black patients — and his frequent appearances in the local newspapers, something that was then against the society’s rules. When the society tried to eject him, he hired attorney Leon Jaworski, who stopped the proceedings with a single letter.

After 20 years as chief of surgery, he became the school’s chief executive at a time when it was near bankruptcy. One of his first actions was to sever it from Baylor so that it could accept federal funds for research.

He also spearheaded a campaign that raised $30 million to eliminate the school’s debt. A foundation he created still contributes $2 million a year to the school.

About the same time, he played a key role in the formation of a new Houston high school designed to attract youths, particularly ethnic and racial minorities, into medical professions. The school is now known as the Michael E. DeBakey High School for Health Professions.

If you’re not exhausted yet from reading about this man, here’s one last tidbit…

He also advocated specialized medical and surgical follow-up systems for military veterans, a program that eventually became the Veterans Affairs healthcare system.”

Thank you, Dr. DeBakey. And now, I am going to get off my ass and do something. Even if it’s just cleaning up my office and getting the last boxes unpacked.

For those who think that computerized order entry and bar coding is second only to the Garden of Eden, think again. Technology is not perfect. While the aforementioned items can certainly help reduce medication errors, technology needs to also fit into the hectic day of people who will actually be using it. And if it doesn’t work properly, they are going to find a way around it, thus defeating its original purpose.

Does this sound like a tongue twister? Well, maybe. A study in the July/August issue of the Journal of the American Medical Informatics Association (JAMIA) found that that the design and implementation of the technology, which is often relied upon as a “cure-all” for medication administration errors, is flawed, and can increase the probabilities of certain errors.

Equally surprising is that the urgencies of care and the ingenuity of nurses to cope with these shortcomings have the unintended consequences of creating other medication errors.

This is the abstract to the study. The entire paper is available online for free.

The authors develop a typology of clinicians’ workarounds when using barcoded medication administration (BCMA) systems. Authors then identify the causes and possible consequences of each workaround. The BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic medication administration records. Ideally, BCMAs help confirm the five “rights” of medication administration: right patient, drug, dose, route, and time.

While BCMAs are reported to reduce medication administration errors—the least likely medication error to be intercepted— these claims have not been clearly demonstrated. The authors studied BCMA use at five hospitals by: (1) observing and shadowing nurses using BCMAs at two hospitals, (2) interviewing staff and hospital leaders at five hospitals, (3) participating in BCMA staff meetings, (4) participating in one hospital’s failure-mode-and-effects analyses, (5) analyzing BCMA override log data. The authors identified 15 types of workarounds, including, for example, affixing patient identification barcodes to computer carts, scanners, doorjambs, or nurses’ belt rings; carrying several patients’ prescanned medications on carts.

The authors identified 31 types of causes of workarounds, such as unreadable medication barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient identification wristbands (chewed, soaked, missing); nonbarcoded medications; failing batteries; uncertain wireless connectivity; emergencies. The authors found nurses overrode BCMA alerts for 4.2% of patients charted and for 10.3% of medications charted. Possible consequences of the workarounds include wrong administration of medications, wrong doses, wrong times, and wrong formulations.

Shortcomings in BCMAs’ design, implementation, and workflow integration encourage workarounds. Integrating BCMAs within real-world clinical workflows requires attention to in situ use to ensure safety features’ correct use.

A lot of news about more babies getting hit with heparin overdoses. But as much of the news in the popular media, the information is incomplete and vague. I’m assuming that since it’s for a general audience, they assume that the public is too stupid to understand anything more detailed.

From the Wall Street Journal:

This time, it’s more infant overdoses: 17 babies at a Texas hospital got too much of the blood thinner; one has died, though hospital officials told CNN that it remains unclear whether the heparin contributed. Nurses keeping IV lines clear apparently used 10,000 units of heparin instead of 10, and the error wasn’t caught until two days later.

What kind of IV lines are they talking about? No one routinely flushes an IV line with heparin, unless it’s an arterial line. And even then, a tiny amount of heparin is mixed in with the IV solution, and that is normally done by the pharmacy. So what kind of lines are they flushing? Hep locks? That would only take a minute amount of fluid to flush through.

It would be nice if they actually explained what happened. Did the nurses add the heparin to the IV solution that was running through an arterial line and make an error–like use the wrong concentration? Was the vial mislabeled?

But of course, everyone has an answer for cutting down on medical errors, while ignoring the obvious.

The quality gurus at the Leapfrog Group, a consortium of employers aiming to improve health quality, said the problems underscored safety issues at hospitals across the country.

“Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take,” said Leapfrog CEO Leah Binder in a statement. Studies cited by Leapfrog suggest that computerized systems could cut drug error by 50% to 100%.

They’re not wrong of course, but I got into a “discussion” with a physician at a conference who also thought that computerized systems were the answer to all our prayers. Perhaps the WSJ article might also have told us about the staffing at these hospitals where the errors took place. How many patients did each nurse have? How sick were they? How many hours of mandatory overtime were they working?

Most medical errors are generally caused by a cascade of events that happen that lead up to the error–and since the nurse is at the end of the food chain, she often gets the full blame. Which isn’t to say that nurses shouldn’t pay attention to what they’re doing, but the current working conditions actually encourage errors of all kinds, and no amount of computerized systems is going to make up for lack of staff.

But again, nurses should not be working in unsafe conditions. ICU nurses should not be taking 3 patients (I hear complaining about it, but still the good nurse takes the assignment for the “sake of the patient”), and nurses should refuse mandatory overtime. They should take the time to read the labels of the meds they are giving, and if they get behind in their work, then they need to speak up. If they have to stay over to finish, then demand overtime. I met a nurse once who kept talking about how she could never finish her work on time, and generally had to stay over at least an hour every day to finish charting, but never asked for overtime. Even though her workload made it impossible to leave on time. What a dream nurse she was–every CEO’s dream.

Anyway, these hospital error stories, particularly the ones about heparin, are really getting tiring. How about we hear a story about a hospital that has actually done something about it? Like increased their staffing, makes sure pharmacy double checks what gets stocked on units (especially NICUs), gives nurses safe assignment and “stocks” the units with ancillary staff like clerks, respiratory therapists, aides, etc. Uses a computerized system that is user friendly and that actually makes the nurse’s life easier rather than more difficult? Are there any stories like that around?

Now how scary is this. Isn’t being a nurse hard enough without having to worry about being attacked by your wonderful patients or their loving family members?

The NY Times printed a wonderful story about dangers in the hospital. Finally, something other than the usual whining about the nursing shortage and how we have to step up recruitment and sanitize nursing so that students and potential students don’t know what they’re getting themselves in for. Just visit www.discovernursing.com if you want to see the greatest con job ever told.

But getting back to workplace violence–of course, hospitals say that its not their fault.

Richard Wade, a spokesman for the American Hospital Association, said health care facilities should not necessarily be blamed for patient violence. “These things don’t happen because of breaches of security,” he said, “but because something happens that you can’t predict, and nurses are on the front lines.”

But Mr. Wade added that hospitals were very much aware of the issue and were addressing safety concerns in a variety of ways, among them increasing camera surveillance, expanding the security staff and training employees to deal with potentially violent situations.

“You want to have good security, but you don’t want it to feel like going through an airport screening or like a place in lockdown,” he said. “Hospitals are by their very nature supposed to be open, caring places where patients and families feel safe and don’t feel imprisoned.”

Hmmm…does that sound like PR spintalk or what?

Maybe they can’t predict violent episodes, but they can certainly be better equipped to handle them. Like what about having an emergency button in every room, that a nurse can press if a patient or visiting even shows signs of hostility. And the response to the call button is 2 minutes or less. Is that possible? Of course it is, but most hospitals don’t really care if their nurses get beat up. They don’t want to invest money in their protection. In fact, many nurses say that they are discouraged from writing up incident reports. Nursing schools still fail to teach that nurses are not punching bags, and there should be zero tolerance of abuse from anyone. Hospitals are more interested in customer service, and in not antagonize the patient or family, even they push the nurse out the window.

There should be security in the emergency rooms at all times. Security should be patrolling round the clock. But despite Mr. Wade’s cheery spin, most facilities are woefully lacking in trained security, and response time is dismal. And yes, hospitals are places where patients and families should feel safe, but then, so should staff. And having extra security also protects patients.

The article goes on to say that according to the federal Bureau of Labor Statistics, half of all nonfatal injuries resulting from workplace assaults occur in health care and social service settings. While some areas of healthcare are intrinsically more dangerous than the average office, ie, a psychiatric setting, that is still no excuse. There should be extra security. Nurses should never have to be in a vulnerable position in a ward or facility where violence occurs on a regular basis. Nursing homes have some of the poorest staffing, yet they are prime for violence because of the mental disturbances of many of the residents. Yes, that little old lady can pack a punch.

This is the most frightening of all:

The level of violence may well be higher, since the government figures include only the most serious incidents. A booklet published by the Occupational Safety and Health Administration in 2004 noted that violence in health facilities was “likely to be underreported, perhaps due in part to the persistent perception within the health care industry that assaults are part of the job.”

I rest my case. This perception didn’t come out of nowhere. The lack of protection for staff, the idea that nurses aren’t supposed to complain–even if a patient is crashing a chair over their heads, and the failure of hospitals to stand up for their staff. It’s the ER, these things happen. A gunshot isn’t so bad, you’ll get over it. so what if the patient bit your head off–there’s worse things in life…

But you know, this all goes back to nurses and other staff taking a stand. Nurses have to stand up for themselves, they need to file incident report and press charges (horror of horrors) and need to refuse to work if conditions are unsafe.

Is Pharma a dirty word? Do nurses who “defect” and go off to work for pharmaceutical companies sell out their souls and become defiled?

Or is working in the pharm industry simply another option for nurses, and should I add, one that pays well and doesn’t include wiping up puke in the job description?

The reason I bring this up is that I came across a posting by a nurse who seemed absolutely horrified that her coworker would leave the marvelous land of hospital nursing and go off to work at a pharm company. The nerve. And to think that her pay check would double, she would be off on weekends and holidays, and the company actually offered her a pension plan.

Granted, pharmaceutical companies do not have the best reputation, but some of it is media hype. And certainly, some of the problems within the pharm industry are reflections of the healthcare system as a whole.

But this posting reminded me of an essay I had read a number of years in a nursing magazine, one of those first person pieces penned by a nurse who had defected from the hospital but was now “seeing the light.” This particular nurse had worked in ICU, gotten fed up with the usual abuse, poor working hours, low pay, etc., and had left hospital nursing. Now working as a pharm rep, with a job that gave her a huge boost in pay, a company car, an opportunity for travel, and more regular hours, this nurse suddenly felt “dirty.” Like the job was stealing her soul and tainting her with pleasures of the flesh.

So what does the good nurse do? She returned to the hospital, and now felt that she had been “cleansed.” In fact, she now said that she felt “clean.” And here she was, back on night shift, running up and down hallways and would no doubt soon be complaining about her aching back and varicose veins, but at least she was clean.

The essay, as you might be able to tell, left me feeling ill. I think we can look at this from 2 different angles. The first goes back to the ancient concept that nurses are supposed to be poor, work out of love, and should expect to be manhandled and abused. Afterall, they are angels of mercy which is just a step above being a martyr. Any self-respecting nurse who gets to wear a suit to work, and not have a dinner tray thrown at her by an irate patient (with the hospital talking heads warning her to just “forget the incident or else”) should feel defiled. If you’re not suffering, then you’re not a real nurse.

The other take on this is that working for big Pharma is dirty. Period. You touch their brochures, bottles, and cash a check, and you’re dirty. It’s a big bad industry, and only the corrupted Satan worshipers go and work there.

So let’s see. Well, this particularly nurse, from what I can recall, didn’t really have any complaints about the company she was working for. She didn’t say that she was being forced to lie and cheat and adjust clinical trial data so that a big potential blockbuster could come on the market. Nothing of the kind. And for those nurses who think that working for a pharm company is bad just because, well, consider that the next time your patient needs a drug. Do you refuse to administer the prescribed drugs because you think pharma is bad? Do you tell the patient that–sorry, I refuse to give you this insulin because pharma is bad bad bad, and I am defiling myself by having anything to do with them.

Yes, have nurses who think that working for pharma is dirty ever considered that aspect? They develop the drugs but you’re the one who gives them. Touche.

However, I tend to think that my first rendition of this rings truer. It’s the guilt complex, the martyr complex, the idea that nursing is a calling and you shouldn’t even be paid for the privilege of getting stuck with a contaminated needle or berated by a pinhead wearing a manager’s cap.

Not much else to say about Jessie Helms, except the more I read about the details of his tenure in the Senate, the more, well, the more I can say that the world will be a better place without. At least, the world was a better place once he stepped down. Supported all the genocidal dictators in Central America during the 1980s–what a compassionate guy. Well, so as long as they weren’t communist, it didn’t really matter how many people were tortured and killed under their regimes.

But I wonder, as I mentioned in my previous post, if Jessie’s deeds really started to catch up with him. From AP:

As he aged, Helms was slowed by a variety of illnesses, including a bone disorder, prostate cancer and heart problems, and he made his way through the Capitol on a motorized scooter as his career neared an end. In April 2006, his family announced he had been moved into a convalescent center after being diagnosed with vascular dementia, in which repeated minor strokes damage the brain.

Did the horrors that he supported, including his war on funding for AIDS, really manifest as health problems? Did he have a conscience somewhere, buried in the midst of all that hatred and bigotry. Afterall, Helms and his wife adopted a 9 year old boy in 1962 with cerebral palsy–so surely, there had to be a thread of compassion somewhere in his soul.

But at any rate, Helms suffered from a host of physical problems that just kept mounting. I view it as the poison in his soul finally poisoned his body. Maybe it was only after he was suffering and in pain from his illnesses, that he was finally able to feel compassion for AIDS victims.

Who knows.

I suppose that this is a strange blog entry, in that I am commenting on the death of Jesse Helms. There are blog entries and newspaper articles and essays all over the print media and Internet, and I’m sure you can hear all about ol’ Jess on any TV news station.

To say the man was controversial was an understatement, and I can safely say that I didn’t shed any tears when he finally retired from the Senate. He was sickly, decrepit, and maybe his conscience was catching up with him. I remember seeing a photo of him riding around on a scooter, an indication that his mobility was waning and his health was becoming precarious.

How ironic that he died on Independence Day. I suppose that he would think that confirmed him as a true patriot, and indeed, the news is full of people call him one. I kind of think a little differently; a man who excelled in marginalizing large segments of the population cannot be a patriot, any more than one who breathes hate and intolerance can be considered a Christian (think Jesus=love). He even called the University of North Carolina, the outstanding school from his own home state, a “university of Negroes and communists.” Believe me, he didn’t mean it in a complimentary way.

But I’ve gotten off track. I want to focus on one aspect of his career, and that is AIDS (my blog, afterall, is health related). It’s an interesting story about Jesse and AIDS, because he went from being “damn those gays, they brought it on themselves” and trying to block funding for the disease, to publicly repenting and working to help AIDS patients in Africa. Remarkable.

First, here’s a little rundown about Jesse Helms and AIDS from Tom’s Civil Liberties Blog at About.com:

Until his very last year in the Senate (when he finally agreed to support an Africa AIDS funding bill), Helms did everything he could to block federal AIDS funding (declaring AIDS to be a fair punishment for homosexuality) and led that charge throughout the Senate in the 1980s. Because of his partially successful efforts to delay AIDS research and prevention efforts, he is indirectly responsible for the early deaths of millions.

So what can I say positive about Jesse Helms? Well, he became less of a visible segregationist when it became politically unpopular to be a segregationist, and he grew less opposed to AIDS funding when it became politically unpopular to oppose AIDS funding. I guess that demonstrates some kind of moral progress, either on his part or on the part of his constituents. But most of all, he retired in 2002–and the life he has led since then was almost certainly much more noble, much more admirable, than the life he led in the Senate. Could he have become a good man over the past six years? Maybe so. Probably so. Let’s run with that.

Perhaps he realized that he was getting close to the end of his life, and maybe having so much blood on your hands is not the best way to enter the hereafter. Maybe he realized that his behavior was profoundly un-Christian, and he was having visions of hell and a smiling Devil beckoning to him. Because if he really believed in heaven and hell, then his actions on earth directed him to only one path (hint: he wasn’t going to be meeting up with St. Peter any time soon).

However, this is another interesting story about his conversion to compassion. An interesting essay about Helms by David Waters at the Washington Post, entitled “Under God.”

Helms, who had spent many years slashing foreign aid budgets, had rendered his judgment on AIDS loudly and clearly. In 1995, for example, he told The New York Times that the government should spend less money on people with AIDS because they got sick as a result of “deliberate, disgusting, revolting conduct.”

But after talking to Bono, Helms apologized and said he was ashamed. “I have been too lax too long in doing something really significant about AIDS,” Helms said.

What did Bono tell him?

“Christ only speaks about judgment once and it’s not about sex but about how we deal with the poor, and I quoted Matthew, ‘I was naked and you clothed me, I was hungry and you fed me.’ Jesse got very emotional, and the next day he brought in the reporters and publicly repented about Aids. I explained to him that AIDS was like the leprosy of the New Testament.”

If a rock star can have that sort of impact on Jesse Helms, there’s no telling what Jesus can do.

What strange bedfellows, Bono and Jesse Helms, but maybe it did actually happen this way. Although I suspect that Helms was already feeling some degree of remorse, that maybe he needed to embrace the 21st century and perhaps try to amend for some of the devastation that he was responsible for.

I hope that his change of heart helped generate funding for AIDS in Africa. I hope that at least one human being has been helped by his change of attitude.

After reading less than stimulating articles on the nursing shortage, and listening the mantra of “train more, train more,” or shorten the training time period for nurses so we can push them into unsafe working conditions sooner and make it even more likely that they’ll get fed up that much faster–it’s always refreshing to find articles that show a little depth and honesty of the situation.

This is from a website about getting a nursing degree online, and this is an excerpt from an article about the wisdom of importing foreign nurses:

I know this much - the domestic workforce doesn’t seem to share the same excitement about the profession as staffing agencies. Nurses’ unions disagree with the premise that nurses from abroad will help solve the problem. Nursing organizations are voicing a deep concern that foreign nurses are not being incorporated into the unions upon entering the workforce. And this means hospitals and the like can hire foreign workers far cheaper than domestic nurses plus they don’t complain about working conditions, because it’s better than their home country. The result is a national deterioration of the nursing wage, which affects all nurses.

“There is no shortage of nurses in Massachusetts,” says David Schildmeier, spokesperson for the Massachusetts Nurses Association. “There is a shortage of nurses willing to work in hospitals under current conditions, assigned to too many patients, that is why people are leaving.”

Well of course staffing agencies support importing nurses–the poorer the home country the better. They make a bundle from the hospital and in fact, an entire industry has developed around recruiting nurses and passing them around the globe.

And what Schildmeier says is so true. I’ve been saying it for years. And isn’t it odd, that despite all the endless hoopla about the nursing shortage, that very few facilities have stepped up to the plate and made real progress in improving their work environment. It’s as if they want nurses to quit, so that they can keep replacing them with new grads (read cheaper) and foreign help.

I came across this website while just doing a little browsing for any new insights into the nursing shortage–you know, hoping to find an article about how a facility has discontinued canceling nursing shifts when patient census is down, or how they are stocking their place with state of the art technology that will make the lives of nurses easier, or have adopted realistic nurse-patient ratios –you know, stuff that will help keep nurses on the job.

Instead, I found this odd website devoted to the nursing shortage. The title of the website is “Nursing Shortage” and then it has a nice little set of buttons down the side which are supposed to tell you all that you ever wanted to know about the nurse scarcity gripping the nation.

There is no mention of who owns this site, who runs it, or anything–just a half-baked generic email address. And if you actually click on the buttons and read the content…well, with each click, it looks suspiciously more and more like PR double talk.

“Reasons behind the nursing shortage” makes no mention of burn-out or experienced nurses leaving the profession. It only gives the usual, tired, let’s get out the violins excuse of how schools can’t mass produce enough little nurses on the assembly line. And yes, it also squeezes in about the boomers getting old, decrepit, and sickly, and how they will need nurses to change their catheters and bedpans…

And yet, the usual schtick about nurses retiring…

Are we in Kansas yet?

The other sections are no more enlightening. This is from their section on “addressing the shortage:”

When the factors behind the nursing shortage are thoroughly analyzed, it becomes apparent that in order to begin to fix the problem, one of the factors in this cycle needs to be stopped. The cycle is such that there are fewer nurses because many older nurses are retiring. However, there are fewer nursing graduates entering the field because of a lack of funding to nursing schools and programs. How can these younger nurses be expected to enter the field if their educational needs cannot be met? The most important way in which the nursing shortage can be addressed is through this avenue. In order for the shortage to begin to be alleviated, the lack of funding and space in these nursing programs needs to be evaluated. Because of these constraining factors, not enough applicants can be accepted and therefore graduate ready to enter the field –and the shortage continues to grow.

The rest of the section is just as silly. Nothing about improving working conditions, retention of nurses, and so on. The section called “World of Nursing” does mention burn-out, but its entire focus is on long hours–12 hours shifts which many nurses actually prefer working–and on unsafe patient loads. But the way they put it:

Nursing shortages and turnover rates have been reported to be the highest in critical care facilities, in which nurses are worked for long hours and have to care for more patients then they feel they can safely care for.

Uh, what about other areas of the hospital? Unsafe patient loads are not mentioned, like the med/surg nurse assigned 10 patients–6 with IV meds, 4 who can’t get out of bed, 5 with colostomies, 3 with NG tubes, 2 on oxygen…you get the idea.

They also make no mention of mandatory overtime, which is one of the reasons why nurses are working such long hours. Or of the general disrespect that nurses get on the job, or verbal/physical abuse, or hospital PR weenies screaming that the “customer is always right” even if the patient slugs the nurse in the face….and so on.

It’s hard to figure out who put together this brilliant little piece of information. There’s a lot in it about agency nursing and travel nursing, so I’m assuming that a temp agency put it together. If anyone thinks that putting out nonsense like this is “helping” the nursing shortage, they are sadly mistaken. It merely just helps to fuel the myth that hospitals are desperate and willing to do anything to hire and keep their nurses, that workplace abuse just doesn’t exist, and that the primary reason for the shortage is a lack of new nurses.

This is like, getting so old…

It seems that our neighbors north of the border are also having a little crisis in healthcare. Canada’s healthcare system is remarkably different from ours, but it seems that they are plagued with the same problems when it comes to staffing shortages. And according to this article from the National Post, it seems that they are taking the same dumb-assed approach to solving a physician shortage (which was artificially created in the first place) that we are taking to solve the nursing shortage here (also artificially created).

The country [Canada] has approximately 15,000 too few doctors, a figure roughly double the total number of students in all years of study at our 17 medical schools combined. At a doctor-patient ratio of just 2.3 per 1,000 population, we are 24th on the list of 28 industrialized countries. Approximately 1.5 million Canadians cannot find a family physician as a result.

No, it isn’t the climate that is causing the shortage in Canada. The problem is multifaceted and complex, just like the nursing shortage here. It was created artificially, and the brilliant idea to solve it is to shorten medical training.

Yep, you heard right. Shave off a year of medical school, from 4 years to 3. And voila, all the issues that caused the shortage in the first place will disappear. Surely, whoever dreamed up this idiocy must have been receiving intel from the same idiot who decided that shortening nursing education in the US was the key to solving the shortage. Some brilliant minds at work no doubt. Just mass produce them puppies, and all troubles will melt like lemon drops.

The writer of this editorial agrees with me, and thinks that the idea is insane. Just like putting a bandaid on a head injury where your brains are oozing out of the skull.

If this scarcity can be alleviated, even in part, by shortening the duration of doctor training, it might be worth a look, provided Canadians can also be reassured the change will not dull the skill of the country’s new doctors. However, it doesn’t go to the twin hearts of the problem: socialized medicine and centralized planning of health care. Graduating more doctors sooner won’t cure the underlying condition. Rather, it is more like treating a wound on the left hand by suturing the right one.

The doctor shortage began in the mid-1980s — not coincidentally, at the same time the last Trudeau government passed the Canada Health Act, which forbade user fees, balanced billing by doctors and private clinics and hospitals. Immediately, doctors began moving to the United States by the hundreds every year. The effects of this exodus were compounded in the early 1990s when provincial health ministers consciously decided to limit enrolments in their medical schools. Doctors, they reasoned, were the enemies of health budgets; limit the number of doctors and there would be fewer tests ordered, fewer hospital beds filled, fewer surgeries performed and lower costs to their department’s budget. (By this thinking, eliminating doctors altogether would really bring provincial cost into line.)

And here I thought that the Canadians had more sense when it came to healthcare. Guess I was wrong.

Yes it’s true, nurses are packing it in and moving on. Moving on from hospitals, that is. As working conditions within hospitals continue to deteriorate, and opportunities outside the hospital continue to proliferate, what do you think the outcome will be? Will nurses remain angels of mercy or martyrs, or will they get out of Dodge while they’re still in one piece?

From Modern Healthcare:

If hospital administrators think they face a nursing shortage now, they have more than another thing coming.

That’s because the looming problem has many parts to it, experts say. First, there continues to be great demand for Nursing care outside the hospital setting, a need that will persist as the baby boomer generation ages and seeks care at home, in skilled-nursing facilities, and in outpatient clinics. At the same time, the average age of nurses who work outside hospitals is older than the age of those who work in acute-care settings. So as they retire, these other facilities will look to hospitals to replenish their workforce. And data from the National League for Nursing just compound the problem. The league estimates that 3,500 nursing faculty will retire in 2009, with that number growing steadily to 11,500 in 2013 and just under 28,000 in 2023.

“We are not replacing the nurses in retirement as fast as they are aging,” says Mary Jean Schumann, director of nursing practice and policy at the American Nurses Association. “And the ones that we are putting out are not your 19- to 22-year-old nurses; they’re older. It’s a problem that self-perpetuates.”

Peter Buerhaus is the director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tenn. He notes that 73% of registered nurses worked in hospitals and 27% served in other settings in 1983, compared with 60% of nurses who worked in hospitals and 40% who worked in nonacute-care settings in 2006. As the population ages, Buerhaus says, there will continue to be a demand for healthcare services, and many baby boomer patients will be unwilling or uninterested in receiving care within hospitals. In addition, the nursing workforce is also aging, according to Buerhaus….

Of course, this article is the usual regurgitated pablum, in that it ignores the fact that nurses are leaving hospitals because working conditions suck. And no, most are not going to work in long term care or skilled nursing facilities–those places have even worse staffing problems than hospitals. But then, Modern Healthcare isn’t going to say anything negative about hospitals. The reason I quoted this was just for the stats. Compares with 20 years ago, the number of nurses working in hospitals has dropped dramatically. And will continue to drop, and mass producing nurses on the assembly line isn’t going to change that trend.

I’ve been away for a change of pace, covering the American Society of Clinical Oncologists annual meeting. I was frantically busy there, scurrying through a convention center that is larger than some cities, attending sessions and writing up reports. Once home, then I had to continue writing up reports. Now I’m off again to another conference, but by mid-week, I should be back and then be able to get into a normal blogging mode again. Plus, I will be revamping this site, and that is also taking some work behind the scenes.

Oh, and by the way, did you know that there’s a nursing shortage? And did you know that everyone is still spewing out their conjectures as to the cause of it? And as I write, some poor nurse is getting whacked in the face by a patient, and the hospital is telling her to “just forget it” because its bad for PR. And in another hospital, nurses are being told that housekeeping services are being curtailed and that they have to pick up the slack (grab that mop, baby!). And in another facility, the union busters are gloating and patting themselves on the back.

And so it goes. Can’t figure out why anyone wants to leave hospital nursing.

That’s essentially, what the expert talking heads are saying about nursing. In these economic downtimes, nursing suddenly becomes an attractive profession. But when the going gets good, and things improve, the floodgates reopen and nurses pour out of the profession and enrollment in nursing programs whittles away to a trickle.

So what does that say about nursing? Not much.

From the Wall Street Journal:

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession — including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks — the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in “The Future of the Nursing Workforce in the U.S.,” a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

In other words, nursing isn’t a first choice of profession, but something people turn to when the economy sucks and its hard to find a job. So why are there always jobs in nursing? Because working conditions suck and nurses get out of it if something better comes along.

Well, I guess this solves the nursing shortage. Just keep the nation in a recession, and we’ll have all the nurses that we’ll ever need.

In a blog, someone commented on this article and wrote that: This easing could be temporary, of course; one hospital administrator quoted in the article notes that as soon as the economy picks up, nurses could leave the field again.

Hey, no kidding. It’s not that nurses “could leave the field again,” it’s they “will leave the field again,” unless hospitals get their act together and make some real changes.

Today is Memorial Day, and for most of us, a holiday. For those who have to work, it may be a day to earn time and a half and bulk up the bank account. That was one of the few perks of nursing–working on holidays like this one, where I really didn’t celebrate it (veggies aren’t much into barbecues), and it was an opportunity to be paid extra. Closer to what I was worth, as opposed to the normal pay.

But the real purpose of having this holiday, which was carved out of VE Day (Victory in Europe) and VJ Day (Victory in Japan) at the end of WW II, was to honor our military. In particular, to honor those who died.

I’m not going to give a history lesson here, but as you can see, the photo is of the Vietnam Memorial which sits on the mall in Washington DC. Well, I tried to upload a photo but it didn’t seem to take. Anyway, Vietnam. A controversial war, a dirty war (as though any war is ever clean), and one which threatened to tear this country apart. However, it is notable in the annuals of nursing history as the first war in which MEN were allowed to serve as nurse. That’s right, the first war where nurses of the male persuasion could actually tend the wounded and sick, and not have to pick up a gun.

In previous wars, and in the military in general, a male nurse was a non-entity. If you were a man and a nurse, you were not permitted to serve as such. Granted, there weren’t all that many male nurses in WW II and Korea, but the military was certainly in dire need of them. There were plenty of able bodied men to draft as soldiers, but the supply of nurses was rather scant. And yet, rather than allow these men to nurse, they gave them a gun and sent them to the front. A poor use of personnel and skill, considering the dire need for nurses, especially towards the end of WWII.

So I thought a photo of the Vietnam War Memorial was fitting. Nurses served and died in every war that this country has fought, so here’s a toast to the brave.

I know that I bitch and complain a lot about the spam, but as I was deleting it a few minutes ago, a gem caught my eye. Now you really have to wonder about the mentality of the people sending this stuff. Is it safe for them to be playing with computers, let alone walking the streets? Too bad all of those mental health institutions were closed down. I think the beds could very easily be filled…

Weird anal insertions

Frog Sex

Weird anal insertions–I can’t even begin to think of the pain associated with that. Hey, if you want some asshole pain, just grow a few hemorrhoids. That should give you all the anal enjoyment you’ll ever need. And frog sex. Do frogs have sex? Are there really people around who are interested in two frogs getting it on, or in having sex with a frog.

So about those mental health beds…

Now how could I have possibly missed National Nurses Week. I mean, why wasn’t it highlighted on my calendar in dayglo green, or why didn’t I have some sort of alarm system chiming…”We are now entering National Nurses Week, please put a smile on your face.”

National Nurses Week is one of those things, something that some dweeb thought up to “honor” nurses. It runs from May 6-May 12, this year, to coincide with the birthday of the grand-dam of nursing herself, Florence Nightingale. It would be one thing if it was a sort of May Day type thing, where nurses all over the country dropped their bedpans and took to the streets. It would be one thing if facilities thought to actually honor nurses during this sacred week, by doing something that shows that nurses are respected and considered an important member of the team, instead of something they figure that they can work to death, and toss out the door if they think they need to make cuts somewhere.

This is from the American Nurses Association:

As we celebrate National Nurses Week 2008 (NNW) May 6 - 12, the American Nurses Association (ANA) and its constituent member associations (CMAs) salute nurses across the country with the theme Nurses: Making a Difference Every Day. Nursing is often described as both an art and a science; this year’s theme reflects the commitment nurses make every day for their patients and the compassion and quality of care they provide for their community.

Today’s nurses must have the strength to care for patients during times of disaster and crisis; the commitment to remain involved in continuing education throughout their careers; and the compassion to provide hands-on patient care at the bedside – as they have done throughout the centuries. Moreover, at 2.9 million strong, nurses represent the largest group of health care workers in America, and we have the power to achieve much-needed reform in nursing and in health care. That is why it is important to take time out during National Nurses Week to thank nurses for what they do and to remind the public just how vital our nation’s nurses are to patients, their families and society.

It shows you just how out of touch with reality they are. Nurses don’t want to be thanked, they want to be treated as professionals, respected, and paid what they are worth. Of course, far too many nurses still believe that it’s okay to be abused on the job, okay if a patient hits them or a physician smacks them around….hospitals tend to think so as well. It would be really nice if the ANA was an organization akin to the American Medical Association, and had real clout and a real vision.

But less than 10% of all nurses belong to the ANA, and it’s not hard to understand why. They do nothing, have no vision except to throw around fancy rhetoric, and tend to skim over real issues. Like last week, which was supposed to honor nurses. How about getting a little more militant, and striving to motivate nurses to stand up for themselves, to organize and fight abuse?

I guess that would go against the spirit of National Nurses Week, though. Nurses are supposed to be sweet and compassionate. They should be thankful that their employers don’t kick them in the ass more than once a day. Right?