The Case of the Upside-Down Woman

Posted in Nursing, Nursing News, Nursing Specialties

SodanieChea/ Flickr

This is a fascinating case study. It opens with a woman being dangled by her feet by a “giant” in the Emergency Room. Various ER personnel are alarmed and try to get the seven-foot-plus man carrying her to put her down already, but both the (very tall) man and the (very small) woman insist that she needs to stay in her inverted position.

Dr. Louis F. Janeira comes on the scene and tries to make sense of things. He eventually learns that a) the large man holding the small woman is named Jason, b) the small woman is his wife, Mary, who the doctor had in fact seen the day before due a slow heartbeat but didn’t recognize, upside-down.

She’d come in to the Emergency Room the day before with a complete heart block, which is caused when the electrical system that connects the atria to the ventricles fails. Her heart rate had been under 40 beats per minute instead of the normal range for her age group, 60-80 beats per minute. Dr. Janeira had called a colleague for urgent implantation of a pacemaker, which generates rhythmic electrical pulses that bring the heartbeat back to normal.

Dr. Janeira discovered that the pacemaker was successfully installed the day before, and Mary had returned home from the hospital that morning. Everything was fine until about half an hour beforehand, when she had coughed and then collapsed.

Her husband Jason explained that she had fallen behind the bed and he’d picked her up by her ankles, and she regained consciousness. When he’d put her down, she fainted again. This process repeated a few times; she’d pass out, he’d pick her up by her ankles, and she’d be back again. So they’d given up on the experimenting and he was just carting her around by her ankles to keep her conscious.

An Urgent Diagnosis

My mind raced through the possibilities. Mary could have something obstructing the blood flow from her heart to her brain that was overcome when her head was down. Or her blood pressure could be so low that blood reached the brain only when she was upside down. Blood pressure that low could have been triggered by an allergic reaction, anaphylactic shock, or severe dehydration.

Another possibility was that Mary was suffering from cardiac tamponade, a compression of the heart caused by a buildup of blood in the sac covering the organ. If her heart had been perforated during the pacemaker implantation and blood had seeped out into the sac around it, it might be that her ventricles were now being squeezed by this accumulating blood, lowering her cardiac output. That condition could improve when she was upside down by increasing blood flow to the brain.

The first thing to do was to check Mary’s vital signs. “Bring her into a room,” I said. “Let’s get her on a monitor.”

I pointed the way, and Jason carried her into the cardiac room, an entourage of curious ER personnel trailing behind us.

Even once in the cardiac room, Jason was unconvinced that he should let go of her ankles and put her on the bed. “When I put her down, she’ll go out on us,” he said.

I paused for a moment. “We’ll do an assessment of the vital signs first while Mary is upside down. Then we’ll put her in bed and see if and how things change, OK?”

Jason nodded. Mary’s long black hair waved back and forth, which I took for agreement from her, too. Ellie then placed heart monitor electrodes on her chest.

“Normal-paced rhythm,” I said, watching the monitor. “The pacemaker is working perfectly fine right now.”

“And I feel perfectly fine,” said Mary. “Well, except that I’m upside down and have been for about 30 minutes now.”

Ellie wrapped a blood pressure cuff around her arm. “It’s 120 over 66,” said Ellie. “Pretty good.”

“OK, slowly get her on her back,” I said. Jason walked closer to the bed and Ellie and I eased Mary down onto it. The only sound came from the heart monitor: beep, beep, beep, steady at 60 times a minute. We all held our breath.

Then the cardiac monitor showed a sudden change. The alarm began screaming.

“Here I go,” said Mary. “It’s happeni…” Her words dissolved into nothingness.

“No heart rhythm,” Ellie called out. “Pacemaker failure.”

“Get me epinephrine,” I yelled. Also known as adrenaline, epinephrine is a hormone that can constrict blood vessels and get a stalled heart beating again.

“But we don’t have an iv in yet,” said Ellie.

“Out of my way,” said Jason, pushing us aside to get to Mary’s feet. “I told you this would happen.” The big man grabbed Mary’s ankles and pulled them up in the air. Moments after Mary was upside down again, the heart monitor resumed steadily beeping.

“I’m back,” said Mary.

Something must have gone wrong with her operation yesterday, I thought. Then suddenly it hit me. “The pacemaker lead, the wire going from the pacemaker generator to your right ventricle, must have disconnected. Your coughing spell could have done it,” I said. “Somehow, the lead reconnects when you are upside down and continues to stimulate the heart.”

Pacemakers are made up of two main components, a generator and a lead that carries electrical impulses to the heart. Often the lead tip is screwed directly into the heart muscle, but in rare cases it can dislodge and cease to stimulate the heart. Data from St. Jude Medical, one of the largest pacemaker manufacturers, show that out of about 220,000 implants of the company’s most popular lead attached directly to the heart, only 97 dislodged within 30 days of implantation. Apparently, Mary was one of the rare cases.

Getting The Patient Upright

“How are we going to fix this, doc?” Jason wanted to know.

“You’ll need to go back to surgery to reattach the lead,” I said to Mary. “Let’s page your electrophysiologist stat.” I looked at Jason and sighed. “Meanwhile, keep her upside down.”

We inserted an iv in Mary’s arm and hooked her up to an external pacing device. But pacing her heart through her chest wall gave her severe discomfort and was not a good option, even in the short term. Moreover, it turned out that Mary’s slow beat did not respond at all to medications, including intravenous epinephrine. So she was quickly transported to the electrophysiology laboratory, dangling by her ankles, carried by the only man around with enough strength to do it. And my ER shift continued.

The next day I was back on duty. As I came out of a room after examining a small child with a fever, I heard a familiar voice behind me.

“Dr. Janeira, it’s me, Mary. I’m all fixed up.”

I turned and smiled at Mary and nodded at Jason, who towered massively behind her. “You were right. The pacemaker’s ventricular lead had to be re-screwed in my heart,” she said. “I’ll be having the pacemaker checked in a few days and then every three months.”

“How do you feel now?” I asked.

“Back to normal,” she said. “Thanks for your help!”

And with that, she left my ER walking upright and hand-in-hand with her giant.

A Nurse’s Perspective on Choosing Nursing

Posted in Nursing, Nursing Jobs

Robert Kneschke –

Guest post by Marietta Faris, BSN

Maybe it happens for everyone and for every career, but it seems to me that nurses have their careers questioned more than others do. It could be that I have been a nurse for more years than I wish to state, and that every one of those years I see the question of “why” come up yet again. I do think it’s a good question though, and I even use it as an interview question when hiring new employees. I love telling the story of why I chose nursing myself, because that reason is very special to me.

One of the themes of the answers I get to the “why” question is that family members are or used to be nurses: “My favorite aunt worked as a nurse and I always looked up to her,” or “My mom’s a nurse and I loved the stories of helping with deliveries.” I have even had a few people talk about their fathers being nurses.

Another theme is having been present to see nursing in action when a family member was ill: “When my brother was sick as a kid the nurses were great to him,” and “I saw how comfortable the nurses made my grandma.” People coming to nursing as a second career are likely to talk about having been the caregiver in the family, for a grandparent or other relative.

For me, my career path was set by my father. My dad died at the age of 43. He left behind my mother and five children, of whom I am the youngest. The only memories I have of my father are stories people told me. One of these included his wish for one of his children to become a nurse. I took that wish as my own and decided I would deliver on his wish. Little did I know of the gift he had set before me in my nursing career.

As a young 18-year-old girl going off to nursing school, I had little understanding of what nurses really did. Growing up in rural Illinois, with no nurses in the family or in the local community, pretty much all of the nursing I knew was from television shows. (I’d list them but then you’d really know how old I am, let’s just say it was way before Gray’s Anatomy.)

I had worked for three months at the local nursing home. The patients there were not actually ill, they were just older and required help with the basics. I learned some of the physical skills I would need later but did not learn anything about nursing as I would come to know it.

Nursing started to come into focus for me when I was assigned to care for an elderly man who had come to the hospital after he was beaten and robbed by a home invader. I had never had anyone hold my hand so tight. He needed me to just be there with him, to show him someone cared, to reassure him that I would help keep him safe. This was nursing. This was caring. This was the first of many times I would be present when a patient needed me for more than the meds I could give or the assessment skills I had. I was in a position to comfort their spirits or share their pain or celebrate their recovery.

I may not remember the time I had with my dad as a child, and only have the memories of him from stories shared with me. He was not there for my graduation from high school or from nursing school. I missed him at my wedding. He will never shake hands with his grandson. Yet, he is here with me every day of my career, for it was his gift to me. Thanks, Dad.

Hospital Noise And Patient Care

Posted in Nursing, Nursing News

FotoLuminate –

Hospitals are places of recuperation, and sleep is essential to recuperation. But hospitals can be very, very noisy places. Patients have criticized the clatter for years, but the alerts emitted by all of the various alarms, whistles and buzzers have typically been deemed by hospital administrators to be more important overall.

That attitude has been changing though with a greater focus on patients, new policies linking hospital reimbursement to patient satisfaction, and more research on the effects of a noisy hospital environment.

In this article in the New York Times, Pauline W. Chen, M.D., says that patients endure a level of noise that “borders occasionally on deafening.” A recent study found that average noise levels in a hospital room way outstripped the recommended 30 decibels (slightly louder than a whisper) that is recommended by the World Health Organization. Meanwhile, peak noise levels were sometimes as loud as a chain saw! The more noise, the more of a negative impact on patients’ sleep. And the less sleep, the worse the health outcomes.

Some noises were found to be more disruptive than others. While all loud noise was problematic, the electronic alarms from monitors and the ringing from telephones were most likely to wake up a patient. And each time patients were awakened, their heart rates jumped.

“There is a threat perceived in those noises,” said Orfeu M. Buxton, lead author of the study and an assistant professor in the division of sleep medicine at Harvard Medical School, “and hospitalized patients are probably in a high state of ‘threat vigilance.’ ”

Manufacturers of monitoring and medication infusion devices have not turned a deaf ear to the problem. The industry has begun sponsoring and conducting research on the amount of noise generated by medical devices, and several groups have begun working on creating more patient- and sleep-friendly products. Some companies, for example, have tapped into the increasing use of wireless technology in hospitals, designing monitors, pumps and nursing call systems that do not buzz or beep right at the patient’s bedside, but rather channel the alarms only to the doctor or nurse responsible.

While these early wireless efforts are promising, many companies and hospitals remain reluctant to switch over completely to the newer designs, and industry standards for device alarms are changing slowly, if at all. “The holy grail is that a pump would never sound its alarm while near a patient,” said Tim Vanderveen, vice president of the Center for Safety and Clinical Excellence at Carefusion, a medical technology company that produces infusion pumps and other health care devices. “But what would happen if a hospital’s wireless system went down?”

The most challenging obstacle in the quest for quiet, however, appears to be not the machines but rather the approach to patient care in most American hospitals. Doctors, nurses and other members of the hospital staff often wake patients up in the middle of the night or during afternoon naps to assess a non-urgent blood pressure or temperature, draw blood or administer medications that could safely be delayed by a couple of hours.

“Everyone in the hospital tends to do things at their own convenience instead of working together as a team to figure out what might be best for the patient,” said Susan B. Frampton, president of Planetree, a nonprofit organization that works with health care providers and organizations to deliver more patient-centered care. “We forget what it is like to be a patient in this alien environment, at the mercy of people and their machines and agendas.”

To change this culture, some health care systems have initiated hospitalwide campaigns, with names like “Shhh” (Silent Hospitals Help Healing), “Hush” (Help Us Support Healing) or simply “Too Loud,” that institute mandatory quiet times, designate noise reduction teams to encourage compliance and use sound meters in the shape of traffic lights or human ears that turn green when the noise level is acceptable, yellow when it increases, and red when it goes above the acceptable range.

With the support of Planetree, one hospital system, the Department of Veterans Affairs New Jersey Health Care System, has gone beyond minimizing noise and actively elicits suggestions from patients on how the hospital can help them sleep better. When admitted to the hospital, all patients are asked about their sleep patterns, then given a laminated “sleep menu” card from which they can choose a variety of sleep aids, like light-blocking masks, sound machines, warmed blankets and aromatherapy. The patients’ sleep preferences are then posted in their rooms to alert staff members, and a nurse assesses their sleep experience each day.

While it is still too early to know whether any of these initiatives will prove successful, it is now clear that patient complaints about noise and lack of sleep are critical to quality of care. “Sleep is such a powerful source of resilience,” Dr. Buxton said. “Its absence results in a degradation of that resilience.”

“We need to change how we view noise and sleep,” he added. “We need to begin grouping sleep with all the other things we do to make patients better.”

Quality Care and the Bottom Line

Posted in Nursing, Nursing News

VIP Design –

Uncompensated health care is a major issue for hospitals, with an estimated $39.3 billion of care going uncompensated in 2010. The size of this financial burden has forced hospitals to use more creative debt collections, such as asking for payment at time of service versus asking solely for insurance information.

Hospital debt has lead to the development of companies like Accretive Health. Accretive Health states on it’s website, “Accretive Health increases access to care by bringing increased discipline to the revenue cycle.” Non-profit health care organizations would all agree that a positive revenue cycle allows them to fulfill their missions. But how they collect “bad debt” has become the challenge and the legal question.

For many, the hospital is seen as a “sanctuary to treat the sick and infirm” as stated in a report by Minnesota’s Attorney General, Lori Swanson. Swanson has been working to push the issue of debt collection in health care to the forefront, forcing us to wonder what can and should hospitals be doing to address bad debt with the hope of remaining financially stable. It’s important to keep the doors open, but how to best do this?

An ill patient who is asked about payment before care is given may understand or hear the question, “how would you like to pay for your care today” very differently then a patient asked the question after care is provided. And a patient who is able to hand the hospital staff member a health insurance card is likely to have a different level of stress then one who does not have this option.

Nurses, who do not routinely have knowledge of patients’ insurance coverage or ability to pay, need to be aware of the practices being used by their employers to decrease bad debt. As the first health care professional the patient is likely to encounter after completing registration or checking in, nurses are in a key position to reassure patients that the quality of the care they will receive is not based on their ability to pay.

The nurse does this by showing the patient respect and dignity; answering questions about cost and billing honestly; and seeking help from any internal resources available in the organization, such as Social Services, a financial counselor, or a pharmacist. The nurse can also act as a patient advocate in relationship to treatment plans. The selection of a less-expensive dressing or stoma pouch versus selecting the clinic or hospital standard could mean dollar savings for a patient, with no decrease in quality.

Nursing as a profession has the responsibility to understand both sides of the bad debt issue. Advocating for patients to receive quality care regardless of ability to pay is important. However, nurses will fail patients if this is their only involvement. Nurses also can be active in quality improvement and resource projects directed at reducing cost and length of stay for patients. These are the actions that will provide our national health care with sustainable choices by addressing the cost of health care for all patients.

The Nurse’s Role in Helping to Educate Doctors

Posted in Nursing, Nursing News

iceteastock –

In this article on, a professor of nursing named Laurie Gottleib examines the role that nurses have in educating doctors.

She points to the combination of theoretical and practical knowledge that nurses possess, as well as their tendency to be much more accessible than senior doctors. Nurses frequently point out the warning signs of a patient’s deterioration to medical interns and residents, correct their misinterpretations of signs and symptoms, suggest diagnoses, and anticipate when and how to intervene. In this recent post about the “July Effect,” for example, a nurse recounts how she had to convince a new young doctor that his patient was in dire need of more pain medication.

Gottleib says that physicians are often grateful for this sort of guidance, yet nurses are not usually given credit for their role in doctors’ education.

Knowledgeable nurses protect the system in countless ways, not least by ensuring that physicians have the most up-to-date and salient information about their patients so they can make medical judgments and take appropriate action.

They are people who have committed themselves to nursing as a career and have selected workplaces that value nursing. Experience working in one place or with one group of patients is required to develop expertise and intuitive know-how – a key to reading the signs correctly and predicting which patients are in trouble.

Two decades of research have exposed the deleterious effects of devaluing and undermining nurses and nursing. The cost has been high in terms of nurse burnout and patient morbidity and mortality.

Research has also revealed the conditions needed to retain professional nurses. When nurses are recognized and respected for their expertise and given status, resources and opportunities to function autonomously within their scope of practice, they stay in the profession. The most intriguing finding in this research is that the most consistent predictor of nurse satisfaction and good personal health (i.e. a low burnout rate) is positive professional relationships with doctors. When doctors partner with nurses and there is clear communication between them, patients’ needs are met.

Within the McGill university and hospital network these lessons have been heeded. For example, there has been ongoing dialogue within McGill’s Faculty of Medicine and School of Nursing about how to improve inter-professional education. (This discussion extends to physical and occupational therapists and speech therapists.) At the Jewish General Hospital, nurse-physician partnership is the organization’s managerial structure in all matters of patient care.

These are important beginning steps for restoring the health-care system and a healthy nursing workforce. We are still recovering from the effects of the recent past, when Quebec’s nursing operations were dismantled and the nursing workforce was left not adequately prepared for today’s health-care challenges.

In the next decade we need to continue to build a workforce of front-line nurses who are well educated, knowledgeable, skilled, compassionate and committed to nursing as a career. Quebec nurses took this step themselves when they voted at this year’s meeting of the Ordre des infirmières et infirmiers du Québec to make university education a basic requirement for entry into the profession.

Employers need to continue to create workplaces where nurses are given support to practise to the full extent of their training, and where physician-nurse partnership is the governance structure. Physicians need to treat nurses as respected and valued partners, not as subordinates. Nurses need to embrace these new opportunities and become accountable for their practice. And governments need to dedicate resources to support innovative nursing roles that complement those of doctors and other health professionals to meet the complex needs of patients and their families.

When this happens, the health-care system will be transformed and quality, safe patient-and family-focused care will follow.

Media Messages about Nursing are Mixed

Posted in Nurse Safety, Nursing, Nursing News

Peter Kim –

How are nurses portrayed in the media? A group of researchers decided to find out, by examining the YouTube database to find the most viewed videos for “nurses” and “nursing” as of July 2010.

According to this article on, out of 96 videos surveyed, about 40% of them presented nurses as smart, educated, and skilled. The rest of them presented nurses as “a sexual plaything and a witless incompetent.”

This was found to be in keeping with other forms of mass media portrayals of nurses. The study indicates that these stereotypes are not merely annoying; they can have a real effect on how patients interact with the nurses who are caring for them. Nurses are highly-trained professionals who play a crucial role in American health care, yet these portrayals trivialize what they do and who they are.

The study authors suggest that the nursing profession harness the power of YouTube to promote a more positive image.

Key findings of the study, which appears in the August issue of the Journal of Advanced Nursing, included:

• The 10 most viewed videos reflected a variety of media, including promotional videos, advertising, excerpts from a TV situation comedy and a cartoon. Some texts dramatized, caricatured and parodied nurse-patient and interprofessional encounters.

• Four of the 10 clips were posted by nurses and presented images of them as educated, smart and technically skilled. They included nurses being interviewed, dancing and performing a rap song, all of which portrayed nursing as a valuable and rewarding career. The nurses were shown as a distinct professional group working in busy clinical hospitals, where their knowledge and skills counted.

• Nurses were portrayed as sexual playthings in media-generated video clips from the sitcom Frasier, a Virgin Mobile commercial set in a hospital, a lingerie advertisement and a “soft news” item on an Internet videocast. All showed the nurses as provocatively dressed objects of male sexual fantasies and willing accomplices in their advances.

• The final two clips were a cartoon that portrayed a nurse in an Alzheimer’s unit as dim and incompetent and a sitcom that showed the nurse as a dumb blonde, expressing bigoted and ignorant views about patients and behaving in a callous and unprofessional way.

“Despite being hailed as a medium of the people, our study showed that YouTube is no different [from] other mass media in the way that it propagates gender-bound, negative and demeaning stereotypes,” Fealy said. “Such stereotypes can influence how people see nurses and behave toward them.

“We feel that professional bodies that regulate and represent nurses need to lobby legislators to protect the profession from undue negative stereotyping and support nurses who are keen to use YouTube to promote their profession in a positive light.”

The July Effect

Posted in Nursing, Nursing News, Nursing Specialties

MAFord –

July is the month that medical students, fresh from medical school, start learning how to be doctors. That gives rise to the “July Effect,” where medical error rates increase as these new doctors learn on the job.

In this article in the New York Times, Theresa Brown, a nurse, looks at whether the July Effect exists, and how nurses can deal with it if so.

She notes that the medical literature is inconclusive regarding the July Effect, but cites two articles that found evidence of it. The author of one off the articles compared the deployment of new resident so to having rookie football players replace veterans “during a high-stakes game, and in the middle of that final drive.”

Brown’s own conclusion is that the July Effect “is undeniably real in terms of adequacy and quality of care delivery.”

She goes on to describe an experience she had as an oncology nurse, where a patient was dying of cancer and was in unbearable pain. She paged the first-year resident, brand-new to actual doctoring, and explained why the patient needed a much higher dose of pain medication. The doctor refused to up the dose. After trying repeatedly to convince him, as her patient writhed in pain, Brown paged the palliative care physician on call, who she had talked to about the patient day before.

I described the patient’s sudden lurch toward death, the sharp increase in pain and the resident’s reluctance to medicate the patient enough to give him relief. “Ah,” she said, “I was worried about that,” meaning that the patient might begin actively dying sooner than the medical team had expected. She ordered a morphine pump. I got the drug, loaded and programmed the machine. The patient died fairly soon after. He was conscious to the very end, and I can say he did not meet his death in agonizing pain.

A FEW hours later I ended up in the elevator with the new resident. He and I both started talking at once. Looking stricken, he apologized to me for having been busy, overwhelmed with several new patients. Knowing it is never easy to have someone’s footprint on your head, I apologized for having called in an attending physician. “I don’t usually jump the line,” I started to explain, when he interrupted me. “You did the right thing for the patient,” he said.

Such an exchange is rare. A nurse who goes over a doctor’s head because she finds his care decisions inappropriate risks a charge of insubordination. A resident who doesn’t deliver good care risks the derision of the nurse caring for that patient. Nurses aren’t typically consulted about care decisions, and this expectation of silence may lead them to lash out at doctors they see as inadequate.

The July Effect brings into sharp relief a reality of hospital care: care is becoming more specialized, and nurses, who sometimes have years of experience, often know more than the greenest physicians. We know about medicating dying patients for pain, but we know a lot of other things, too: appropriate dosages for all kinds of drugs, when transfusions and electrolyte replacements are needed, which lab tests to order and how to order them, whether consulting another specialist is a good idea, whether a patient needs to go to intensive care because his vital signs are worryingly unstable.

The problem can be limited by better supervision from senior residents, fellows and attending physicians, as well as by nurses. We need to acknowledge this fact, because admitting that new residents need help, and that nurses can and do help them, is the beginning of owning up to our shared responsibilities in providing care. For the good of our patients, nurses and doctors need to collaborate.

PBDS and Nurse Skill Testing

Posted in Nursing, Nursing Jobs, Nursing News

landrade78 –

If you want to discuss a nursing topic that everyone has an opinion about, just bring up Dr. Dorothy del Bueno’s PBDS testing program among a group of travel nurses or nurse managers.

The testing was designed to be used as a tool to help identify nurses’ weak areas so that they might receive additional training in those areas. The end goal of the testing would be a better equipped nursing staff at a reduced cost to the facility in terms of both time and money. However, some people view the test as a tool to keep licensed nurses from gainful employment even after they have passed all of the state licensing requirements to practice nursing.

According to the National Council for State Boards of Nursing website, “NCSBN Member Board jurisdictions require a candidate for licensure to pass an examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry-level nurse.” But the nurses being subjected to the testing are not always entry-level, but seasoned RN’s who oftentimes have many years of practice and travel nursing experience. In this economy, nothing can strike more fear into one’s heart than the prospect of losing a good employment opportunity because of superfluous testing.

In nursing forums and on nursing blogs, travel nurses have reported having very different experiences with the testing. Some have reported the testing was fairly basic, while others say that it was silly and included unrealistic scenarios. Others complained more generally about being “tested to death”.

Either way, easy or difficult, travel nurses have reported becoming anxious in response to the idea that the testing might be a road block to landing a job. Whether it stems from the litigious nature of society, or the focus on better quality of care, skill testing is not likely to go away. If anything, testing seems to have become more prevalent in workplaces over the last decade.

The PBDS tests three skill areas: interpersonal skills which relate to customer relations, team building, and conflict resolution. These critical thinking skills encompass nursing processes used on medical and surgical floors, in critical care wards, OB and the ICU, along with other technical elements which may include creating and following a variety of care plans, based upon the diagnosis.

PBDS testing, of course, was not created to prevent nurses from working, but to be used as a tool, to keep nurses safe and to help provide the most positive patient outcomes. In response to skill testing, travel nursing companies and other staffing agencies have begun to provide study guides and additional test prep information to their nurses, both to reduce testing anxiety and to present the most qualified candidates to employers.

Bugs Be Gone

Posted in Nursing, Nursing News, Nursing Specialties

alexfiodorov –

The “Bugs Be Gone” educational session outlined in this article wasn’t about the things that bite you when you’re out on an evening walk. The bugs in question are the ones that cause infections, a serious issue for hospitals, with about one in every 20 patients developing an infection related to hospital care.

Over 60 healthcare professionals from a variety of disciplines, including many nurses, attended the half-day event to learn how to reduce that number of infections.

A registered nurse named Ellen Rankin said that it was important to gather healthcare professionals from many different disciplines “to show that this is a cross-setting issue and that we all face the same problem.”

One speaker was Janet Phillips, RN, Healthcare Quality Strategies Inc., New Jersey’s federally designated quality improvement organization, who summarized the healthcare-associated infections focus under the Centers for Medicare & Medicaid Services’ nationwide initiatives.

“The event highlighted the problem and encouraged shared improvements that can positively affect us all no matter what area we’re in,” Susan Hermida, RN, MSN, GCNS, CWCN, clinical nurse specialist at RWJ Hamilton, said in the release. “The most important step toward that goal is for everyone to wash their hands. Wash, wash, wash their hands.”

Neha Merchant, RN, of Hamilton Continuing Care, emphasized the importance of hand washing before providing a detailed look at catheter-associated urinary tract infection, central line-associated bloodstream infection and the components of an effective infection prevention program.

Among the attendees was a group of nursing students from The College of New Jersey School of Nursing. “The information presented today was really valuable,” said Corimae Gibson, a Robert Wood Johnson clinical program participant. “I’m a student at TCNJ and I’m about to enter the nursing profession. This information is the first step toward avoiding all the complications and patient loss we heard about today.”

Developing a presentation to take on the road is the collaborative’s next goal. By traveling to educate nurses in Mercer County, the team can help them identify signs and symptoms of infections that may reduce readmissions and improve patient care.

NPR Offers Answers to ACA Questions

Posted in Nursing, Nursing News

Matthew Benoit –

The Supreme Court has upheld almost all of the Affordable Care Act, a fact applauded by many nurses. It’s a complicated law, though, and many people are not completely sure what’s in it.

NPR solicited questions from their audience online and on air and received many questions, and then went ahead and answered those health care questions in this article.

Many of the questions have a short answer and a long answer — which is part of why there is so much confusion. For example, when someone asked about whether the penalty for not having health insurance affects people at all income levels, or whether low-income people will be spared, a simple yes or no answer doesn’t quite suffice. Basically, if you can’t afford insurance, you don’t have to buy it. That means (using 2010 numbers) $9,350/ year for an individual, or $18,700 for a married couple.

What if you make more than that, but you still are struggling financially? ($19,000 a year still doesn’t go very far.) Under the ACA, you can’t pay more than 8% of your household’s income for health insurance, after whatever help you might qualify for from your employer or government subsidies.

Some other questions and answers:

Q: I understand that businesses above a certain size have to provide a health care insurance option, but do they have to pay for it? Does the law require a certain contribution from the employer, or can the employer make the employees just pay, say, 99 percent of the premiums?

A: This is where the law seems a little bit tricky. It doesn’t stipulate how much of the premiums employers have to pay, but it does say that overall, employers with more than 50 workers have to provide a plan that covers 60 percent of the covered expenses for a typical population. And that plan can’t cost more than 9.5 percent of family income.

Q: How does the law affect Medicare recipients? I heard it cuts billions of dollars from the program. Does it have other effects?

A: Let’s take these one at a time. Yes, the law does reduce Medicare spending by roughly $500 billion less than it would have been without the law. That’s over 10 years, by the way, and Medicare will cost a little under $500 billion this year. But none of that comes out of benefits guaranteed under the law.

The biggest single chunk comes from reducing what had been overpayments to private HMOs and other health plans that serve about 20 percent of Medicare patients.

The next biggest chunk comes from hospitals and other providers of health care that hope to get that money back because more people will have insurance.

As to other changes to Medicare, there are actually some new benefits. The doughnut hole, that gap in coverage for prescription drugs, is being gradually closed. And Medicare patients are now getting new preventive screenings, like mammograms, without having to pay a deductible.

Q: My son lives overseas, where he is covered by the national health insurance plan. As an American citizen, would he be required to pay the fee for not being covered under an American plan?

A: No, only residents of the U.S. and its territories are subject to the insurance requirements.

Q: I am a veteran getting my medical care from Veterans Affairs. Am I correct that this counts as having insurance, when it comes to the requirement that everyone be covered or pay a penalty?

A: Yes, the VA counts. So does TRICARE and other military health plans. In fact, just about all government health care program, including Medicare and Medicaid, count as well. That’s why the Urban Institute estimates that come 2014, only about 7 million people out of the U.S. population of well over 300 million will have to either purchase insurance or be subject to paying the penalty.

Q: If my current insurance policy does not meet the minimum requirements in the Affordable Care Act, and my insurer must raise the standards of my policy, can my insurer raise the premiums I pay?

A: In a word, yes. That was part of the goal of the law, not just to get people without insurance to have it, but to get people with what was considered substandard insurance up to par. This is controversial, and it’s the part that leads to claims that the government is interfering in the private insurance market, which in this case it is. But it’s in the law because Congress heard about lots and lots and lots of cases where people who had insurance nevertheless ended up bankrupt because the insurance didn’t cover what they thought it did. So will this make healthy people who have to spend more unhappy? Yes. But will it protect people better when they do get sick? Yes, it will do that, too. And will the arguments about it continue? Yes, undoubtedly.