Nursing

Infectious Disease Drugs in Short Supply

Posted in Nursing, Nursing News, Nursing Specialties

Shortages of cancer drugs aren’t the only drug shortages making news. The January 2012 issue of Clinical Infectious Diseases reports the nation’s supply of go-to drugs to fight infectious disease is running dangerously low. So low, in fact, that hospitals have had to design contingency plans just in case an emergency arises.

So why is this happening? The answer is complicated. One problem is that often only one drug company manufactures a given. Should an ingredient in the drug become difficult to obtain, the supply runs low. Other drugs can be used instead, but in many cases they are either ineffective on the organism or take longer to eradicate the organism.

Ingredients may also become too expensive, with the result that a manufacturer decides to discontinue production of the drug – although drug companies are required to inform the FDA six months before drug production stops.

Among the drugs considered scarce are antibacterials, antifungals and antivirals. Physicians should be prepared to treat with alternative means if it becomes necessary. Every day, more organisms become resistant to drugs that have been on the market for a while, thus making them less effective to treat common illnesses.

Given the fact that drug shortages are expected to occur, what can nurses do when a shortage threatens the health of their patients? Many times, the first notice of a drug shortage occurs when the pharmacy fails to supply a drug to a newly admitted patient. The nurse calls the pharmacy; the pharmacist states the drug is not available on-site at the moment. Whether or not a contingency plan is in place to get the drug from another facility, the nurse needs to inform the physician and get an alternate drug order if the physician deems it necessary. Some drugs, especially in the case of anti-infectives, are critical to the patient’s health and need to be started immediately.

The United States Congress is considering a requirement that would compel drug companies to report to the FDA any expected drug shortages. Also under consideration is a bill requiring speedy review of newly proposed drugs that could mitigate the shortages. Currently new drugs in development take years to reach the U.S. market, which is a much longer process than it is for the Canadian and European markets, for example.

Clinical nurse managers can take an active role in developing their facility’s contingency plans for unavailable drugs. By understanding what drugs are expected to be in short supply, discussing workable alternates with physicians and formulating a list of facilities as go-to secondary suppliers, nurse managers can arm their nursing staff, especially the night crew, with an action plan when a shortage occurs. Because hospital pharmacies are often overwhelmed and understaffed, nurses may have to take a more active role in getting their patients the medications they need.

ANA Among Endorsers of Needlestick Statement

Posted in Nurse Safety, Nursing, Nursing Jobs, Nursing News

Image courtesy of Daniel Paquet via Flickr

A consensus statement and call to action to help healthcare personnel avoid needlesticks has been issued by the American Nurses Association and the International Healthcare Worker Safety Center at the University of Virginia.

The statement is meant to be “a roadmap for future progress,” according to this article on Nurse.com.

The consensus statement and call to action highlights five especially important areas to address. They are improving sharps safety in surgical settings; understanding and reducing exposure risks in nonhospital settings; involving frontline healthcare workers in the selection of safety devices; addressing gaps in safety devices and encouraging innovative design and technology; and enhancing worker education and training.

The president of ANA, Karen Daley, RN, PhD, MPH, FAAN, contracted HIV and hepatitisC from a needle while tending to a patient in the Emergency Department in 1998. Ever since then she has been a staunch advocate for needlestick safety.

“Needlestick injuries are preventable and cannot be tolerated as a cost of doing business,” Daley said in an ANA news release. “Healthcare organizations are charged with ensuring safety and preventing harm — to patients, employees and the public. Unfortunately, needlesticks still occur, whether from lack of education and training, complacency or frugality.”

The federal Needlestick Safety and Prevention Act was passed in 2000, a boost in the effort to reduce the risk of healthcare worker exposure to blood-borne pathogens. But Daley said the law does not by itself ensure worker safety.

“Nurses need to hold employers accountable for following the law and refuse to accept anything less,” she said. “Progress has been made, but the law provides only a framework. It is up to people to create the culture of safety necessary to minimize incidents.”

Healthcare workers in nonhospital settings account for about 65% of the U.S. healthcare workforce, a proportion that will continue to grow over the next decade. Although safety-engineered devices are in widespread use in most hospitals and clinical laboratories, market data show a lag in their use in other settings.

The U.S. Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health and other government agencies, as well as nongovernmental agencies and professional organizations, should support epidemiological research that evaluates risks to workers in a wide range of nonhospital settings, according to the statement. And professional organizations representing nonhospital care settings should make sharps safety a priority and ensure availability of appropriate devices and educational and training materials specifically for workers in these settings.

“While we celebrate the progress we have made, we must acknowledge the gaps that exist,” Jagger said in the news release. “We must redouble our efforts to ensure that all healthcare workers, regardless of the setting in which they practice or the procedures they perform, are offered the same standard of protection from sharps injuries and exposures to blood-borne pathogens.”

Study Finds that Digital Records May Not Cut Costs

Posted in Nursing, Nursing News

Computerized patient records have been hailed as a major cost-cutter, and are a big part of the Affordable Care Act. Industry experts have estimated savings of as much as 80 billion dollars a year, according to the RAND corporation. More and more hospitals are switching to computerized records (known also as Electronic Medical Records and Electronic Health Records) in advance of the 2014 deadline.

However, a new study has found that while the computerized patient records save money in some ways, they end up not cutting costs overall. The reason is that doctors who are looking at patients’ records in the computerized version are more likely to order expensive tests than doctors looking at old-fashioned paper records, according to this article in the New York Times that reports on the study.

Health policy experts who have championed the adoption of electronic health records were critical of the study. They noted that the data came from the National Ambulatory Medical Care Survey, which is intended mainly for another purpose — to assess how medical care is practiced.

The study, they noted, included any kind of computer access to tracking images, no matter how old or isolated the function.

By contrast, modern electronic health records are meant to give doctors an integrated view of a patient’s care, including medical history, treatments, medications and past tests. The 2008 data predates federal incentive payments for doctors and standards for the “meaningful use” of electronic health records that began last year.

The new study, they said, was also at odds with previous research. It is “one of a small minority of studies” that have doubted the value of health information technology, said Dr. David Blumenthal, a professor at the Harvard Medical School.

Dr. Blumenthal, the former national coordinator for health information technology in the Obama administration, was co-author of a study, published last year in Health Affairs, that surveyed articles in professional journals in recent years on electronic health records.

It found that 92 percent of those articles were “positive over all” about the prospect that technology would improve the efficiency and quality of care.

But Dr. McCormick said the previous research had been primarily statistical models of expected savings, like the RAND study, or research that looked at the use of electronic health records at a relatively small number of flagship health systems.

“We looked at not just a few cutting-edge institutions, but a nationally representative sample,” Dr. McCormick said.

Dr. David J. Brailer, who was the national coordinator for health information technology in the administration of George W. Bush, said he was unconvinced by the study’s conclusions because they were based on a correlation in the data and were not the result of a controlled test.

The study did not explore why physicians in computerized offices ordered more tests. Dr. McCormick speculated that digital technology might simply make ordering tests easier.

Dr. McCormick said he hoped the study would damp any inflated expectations about electronic records. But he added that the technology can improve the actual practice of medicine.

The Cambridge Health Alliance, where he practices, made the switch to electronic records in 2005.

“I’m a primary care doctor,” Dr. McCormick said, “and I would never go back.”

Tougher Penalties for Harming Nurses

Posted in Nurse Safety, Nursing, Nursing News

Image courtesy of KOMUnews via Flickr

Dealing with violent patients is a fact of most nurses’ lives.

New legislation in Nebraska would stiffen the penalties for harming a nurse, bringing it more in line with existing laws about harming police officers, for example.

The Omaha World-Herald has an article explaining that about 1,300 assaults of nurses and other health professionals occur every day nationally, according to the National Institute of Occupational Safety and Health.

In an example of such an assault, one ER nurse reached out to a large man who seemed extremely nervous as he entered the emergency room. She was just doing what she was trained to do but the man turned on her and beat her horribly, which left her out of work for six months and permanently traumatized.

That and similar stories helped push passage in the Nebraska Legislature on Thursday of a bill to toughen penalties on those who assault nurses and others who work in hospitals and health clinics.

Under Legislative Bill 677, sponsored by State Sen. Steve Lathrop of Omaha, assaulting a health professional would bring the same potential penalty as assaulting a police officer: It would be a Class 3A felony, punishable by up to five years in prison or up to a $10,000 fine, or both.

Each emergency room and clinic would also be required to post a sign at the entrance warning that assaulting workers is a felony.

Currently, a typical assault would result in a misdemeanor charge, which carries less serious penalties.

Lathrop said health professionals deserve special treatment because they are particularly vulnerable and because of the work they do. Nurses, he said, must work in close proximity to patients and assume a level of trust with them.

“Nurses open themselves up to provide care to someone and, unexpectedly, they’re assaulted. They’re not expecting to be hit,” he said. “It’s becoming more and more of a problem.”

Lathrop, an attorney, represented a registered nurse at Papillion’s Midlands Hospital who was assaulted by a mentally disturbed patient in 2007. The nurse now has permanent eye injuries.

Several other stories of violence in emergency and hospital rooms in Nebraska were aired at a public hearing on the bill last year. Health professionals say they can be in harm’s way when gang members or upset family members go to an emergency room seeking retaliation after a shooting or an assault.

Officials from Omaha-based Alegent Health testified that 65 assaults occurred in a year’s time at their five hospitals in the Omaha-Council Bluffs area.

“Violence is part of our society, and it’s brought in from the streets to the emergency ward,” said Karen Wiley, an Omaha nurse. “People who are intoxicated will act out and hit someone. Because it’s a misdemeanor, arrests are not always made.”

Minnesota Nurses Lobbying for Safer Workplaces

Posted in Nurse Safety, Nursing, Nursing Jobs, Nursing News

Minnesota State Capitol courtesy of TBoard via Flickr

Nurses in Minnesota are calling for new legislation that would set a limit on how many patients may be assigned to hospital nurses.

A one-day strike by the Minnesota Nurses Association in 2010 was focused on the issue of safe staffing, and union leaders are now accusing hospital officials of breaking promises made after that strike to address staffing questions. The nurses feel that inadequate staffing is endangering their patients, and have collected nearly a thousand reports in just the last half of 2011 to support this claim.

The president of the nurses association, Linda Hamilton, said in this article in the Minneapolis Star-Tribune, “”We’ve been left with no choice but to take our concerns to the state Legislature.”

The new legislation, called the 2012 Staffing for Patient Safety Act, would set a maximum number of patients for each nurse, depending on the level of care required. For example: no more than three patients per nurse in emergency departments, or four patients per nurse in medical and surgical units.

Union officials were joined by two legislative supporters, Sen. Jeff Hayden, DFL-Minneapolis, and Rep. Larry Howes, R-Walker. Hayden said the Legislature generally “doesn’t like to get in the middle” of such disputes, but that in this case, “it’s a necessary evil.”

Two years ago, the union tried unsuccessfully to get hospitals to set specific nursing ratios as part of a new contract, a goal the national union has pressed in other states as well.

Ratios termed unworkable

Hospital officials argued that staffing ratios are expensive and unworkable.

The standoff led to a one-day walkout by some 12,000 Minnesota nurses in June 2010. They eventually reached an agreement that called for the two sides to work together on staffing concerns.

But the problem is “worse than ever,” according to a statement released by the union. Hamilton said the hospitals have been “stonewalling” attempts to address safety concerns, and that “we need legislation like this to hold hospital administrators accountable and keep our patients safe.”

The union cited several examples of staffing reports filed by nurses in 2011, although it declined to give details because of privacy laws. One said that a patient had fallen, “with significant injuries,” because the nurses had too many sick patients at the time. Another said a nurse was unable to properly comfort the parents of a dying baby because she had to care for another infant at the time. The union said the incidents are typically reported to hospital supervisors at the time.

Massa, though, said hospitals need flexibility to respond to changing demands, not inflexible ratios. “We both want to see the best quality care for our patients,” he said. “We just don’t think that this is the right way to approach it.”

New Guidelines for Blood Glucose Testing

Posted in Nursing, Nursing News

Image © Anetta-Fotolia.com

Nurses may soon have to learn a new set of practice guidelines when it comes to all their patients. The Endocrine Society has issued new clinical practice guidelines concerning inpatient monitoring of blood glucose levels. Whether or not patients have been diagnosed as diabetics, patients admitted to a facility should receive blood glucose monitoring as long as they are not receiving intensive nursing care. The January 2012 issues of Journal of Clinical Endocrinology & Metabolism published the new standards.

Citing observational studies which found that hyperglycemia affects 32 to 38 percent of inpatients in community hospitals regardless of a pre-existing diagnosis of diabetes, the eight-person task force – all experts in the field of endocrinology – developed new evidence-based guidelines and designed protocols, system improvements and glycemic targets in order to facilitate better blood glycemic control. Dr. Guillermo Umpierrez of Emory University, the task force chair, stated that long hospital stays, higher infection rates and death in non-critical patients were all linked to hyperglycemia.

The new guidelines for acute care facilities include:

– Blood glucose testing upon admission for all patients admitted to the hospital whether they are a known diabetic or not. Diabetic patients will automatically receive A1c level testing if none has been done in the last two to three months.

– For the majority of hospitalized patients, the target premeal glucose level should not exceed 140 mg/dl; random testing should not reveal more than a 180 mg/dl level. If glucose levels fall under 100 mg/dl or 70 mg/dl, treatment should be reevaluated or modified.

– Closer monitoring should be implemented for patients not at risk for hypoglycemia, and for terminally ill or end-of-life patients and patients who are more likely to develop hypoglycemia.

– Diabetics on injectable insulin should continue to receive insulin as long as they are inpatients.

– As a preventive measure to perioperative complications, all type 1 diabetics and the majority of type 2 diabetics should receive a continuous IV insulin infusion or “sub-q” insulin with bolus insulin used as needed.

– Patients admitted with a higher than 140 mg/dl glucose level and patients receiving enteral or parenteral nutrition should be monitored with bedside glucose testing, whether the patient is diabetic or not. Patients on corticosteroids or octreotide should also receive bedside glucose testing.

– One to two hours after completion of continuous IV insulin, patients should be transitioned to “sub-q” insulin.

The new guidelines were reviewed by Endocrine Society members, the American Diabetes Association, the American Heart Association, the American Association of Diabetes Educators, the European Society of Endocrinology and the Society of Hospital Medicine.

While the new guidelines will likely increase the workload of nurses, better guidelines may decrease the risk of infection and save patients’ lives.

Nurse Practitioners: Health Care Reform’s Missing Link

Posted in California, Nursing, Nursing Jobs, Nursing News, Nursing Specialties

Patricia Dennehy RN NP has written an Op-Ed for the Los Angeles Times explaining the role that Nurse Practitioners have as millions of people find new health care providers as part of expected Health Care reforms.

She says that about 30 million people in America will be looking for new health care providers, about 6.9 million of them in California, where she lives and works.

Unfortunately it won’t be very easy, as primary care physicians are increasingly moving to other types of practices, especially higher-paid specialties.

Dennehy argues that Nurse Practitioners, with their training and experience, are perfectly poised to fill that gap. “We’re fully prepared to provide excellent primary care,” she says.

Clinics like the one I direct in the heart of San Francisco’s Tenderloin district — GLIDE Health Services — offer a hopeful glimpse into California’s healthcare future. We are a federally funded, affordable clinic, run almost entirely by nurse practitioners. At our clinic, we nurses and talented specialists provide high-quality, comprehensive primary care to more than 3,200 patients each year.

Despite the special hardships of our clientele, who daily cope with the negative effects on health caused by poverty, unemployment and substance abuse, our results routinely compare favorably with those of mainstream physicians. Our patients with diabetes, for example, report regularly for checkups, take their meds as directed and maintain relatively low average blood-sugar levels.

This high standard of care provided by nurse practitioners has been confirmed in several studies, including a 2009 Rand Corp. report, which found that “nurse practitioners provide care of equivalent quality to physicians at a lower cost, while achieving high levels of patient satisfaction and providing more disease prevention counseling, health education and health promotion activities than physicians.”

At last count, there were more than 250 nurse-run clinics nationwide similar to GLIDE Health Services. We and about 20 others are funded by a special federal program for affordable care. In all of these projects, nurse practitioners offer both primary and preventive care, including mental health services and screening for HIV and diabetes.

Researchers have confirmed that such clinics not only improve local health but also save taxpayers money. Nurse practitioners’ salaries are generally lower than those of physicians. At the same time, the comprehensive care we provide can significantly reduce the costly emergency room visits used by all too many low-income Americans as their default healthcare.

Unfortunately, some major obstacles stand in the way of expanding our money-saving model. One big hurdle is the reluctance of leading private health plans to contract with nurse practitioners as primary care providers. Even as Medicare, Medi-Cal and pioneering local programs for the uninsured, such as “Healthy San Francisco,” now contract with nurse practitioners to provide such care, a 2009 study by the National Nursing Centers Consortium found that nearly half of the country’s major managed care organizations don’t.

Some of the holdout companies require nurses to bill for their services under a physician’s supervision. California’s insurance code only requires insurance companies to contract with nurse practitioners for primary care when it involves Medicare or Medi-Cal. If the code were expanded to include all coverage, access in the state would be greatly improved. There is room for reform on these fronts and others, and we should get started now to enact change.

In October 2010, the Institute of Medicine, an arm of the National Academy of Sciences, issued a landmark report called “The Future of Nursing,” in which it urged that nurses be “full partners, with physicians and other health care professionals, in redesigning health care in the United States.” At clinics such as GLIDE Health Services, we’re showing that we’re more than ready to answer this challenge, and take our places on the front lines of healthcare reform in America.

Retired Nurse Shares Experience of Integration

Posted in Nursing, Nursing News

The Jackson Sun has a story about a retired African-American nurse who was one of the very first people to desegregate the Jackson General Hospital in Jackson, Tennessee.

Vernice Dixon, 93, was in her 30’s when she decided to quit her job as a dishwasher and try to become a nurse.

In 1952, she became part of a small group of minority nurses — patients were still segregated at that time, and some of the white patients didn’t want anyone but white nurses helping them. (An issue that unfortunately still persists today.)

“I remember one man, who was white, who spoke real bad to me,” Dixon said. “I came into his room and I said, ‘Hello’ and told him that I was there to take his temperature. He cussed so bad and used words that no one around me had used before.”

Dixon told a white colleague who came to her defense.

“I had to learn how to get over things like that,” Dixon said. “As a nurse, whether you’re black or white, you have to deal with patients. Sometimes you just have to grin and bear it.”

One of the most challenging examples of integrating a once-segregated hospital, Dixon said, was the separation of rooms for white and black people.

“There were times when the first floor, where they kept all of the black patients, was overcrowded when the rooms on the third floor were empty,” Dixon said. “There were empty beds, but they were not for black people.”

As a nurse, Dixon earned $300 every two weeks, which was a large pay increase from $1.10 she made cleaning houses.

“I always knew how to stretch a dollar,” Dixon said.

Her ability to make her money last helped improve the lives of her parents and her only daughter Clementine, who she hoped would follow in her footsteps as a nurse.

“She became a teacher instead,” Dixon said.

“Mama loved nursing with a passion; it’s her calling,” said Clementine Spencer, Dixon’s daughter.

Dixon worked in the hospital for 28 years before she retired.

“I saw a lot of changes,” she said. “We (black nurses) broke up a lot of segregation that was going on.”

In one of Dixon’s stories, she asked nursing supervisors about why black nurses didn’t know about training inservice opportunities.

“After that, they posted the inservice trainings,” Dixon said.

Multitalented Nurse Seeks to Inspire Women

Posted in Nursing, Nursing Jobs, Nursing News

Via iStockphoto

Vicki Milazzo is a nurse, but she’s also a legal nurse consultant and an author and CEO of the Vicki Milazzo Institute. She’s a registered nurse (RN) and also has a master’s degree in nursing (MSN) and then also has a doctorate in law (JD).

She put all of these diverse interests and talents together to pioneer the nurse consultant field. In an interview with Laura Raines of the Atlanta Journal-Constitution, Milazzo says that she was working overtime to pay off her mortgage but was no longer feeling fulfilled in a hospital setting.

“I didn’t want to change professions, but I wanted to practice nursing in my own way,” she said.

If she started her own business, Milazzo decided, she could be her own boss. Interested in the relationship between nursing and the law, Milazzo set out to pitch the value of her nursing expertise to medical malpractice attorneys. Although the term “legal nurse consultant” didn’t exist yet, Milazzo became one and went on to start an educational company that trained other nurses in the specialty.

“I had no business skills, so I followed the nursing process I’d learned — assess, diagnose, plan, perform appropriate action, evaluate and start over. I still use that process every day,” she said.

Milazzo also made herself five promises when she realized that having dreams wasn’t enough to change her life and that it would take commitment to realize them.

1. “I will live and work a passionate life.” She wanted to wake up every day feeling excited and energetic.

2. “I will go for it or reject it outright.” You can’t wait for the right time to start living your dreams.

3. “I will take one action step a day toward my passionate vision.” That’s how she created her business.

4. “I commit to being a success student for life.” The quickest way to learn is through the experience of others.

5. “I believe, as a woman, I really can do anything.” If she could save a life in the middle of the night, she could certainly start a business.

“I still live those five promises every day,” Milazzo said.

She encourages nurses to commit to their own promises and reach for their goals. “Nurses today have an incredible knowledge base that can take them in any direction.”

Returning to Nursing

Posted in Nursing, Nursing Jobs, Nursing News

One of the biggest challenges for women seeking to build a career and also have a family is to figure out how to find a balance. Many professions require a level of commitment that is incompatible with raising a family, and it is rare to find a profession that allows you to take a long break and then return to work. Nursing is one of those rare professions.

The story of how one nurse took a long break from nursing, but then was able to return to the profession (and excel) is told in this article on KCCommunityNews.com:

Some nurses break from the bedside and return to their patients with fresh eyes.

“My scope is bigger this time,” said Nan Whalen, RN, MSN.

Whalen stopped nursing for five years to focus on her family. She gradually added PRN shifts and as her children grew older, then flew from the nest, Whalen re-entered the work force full time. She said few professionals can re-enter their field of choice.

“That’s one of the unique benefits of nursing overall,” she said. “There are not a lot of professions that allow you to do that.”

To keep her options open, Whalen never let her nursing license lapse while she stayed home full time to raise children. She also fulfilled 45 hours of continuing education credits every three years required by the state of Iowa, where she lived at the time.

Whalen said it is important to do what is right for you and for your family. Nurses can take a break or scale down their hours, she said if that is what they choose. There is a need for nurses working in a variety of shifts and hours, Whalen said.

“Nurses work everywhere in the community,” she said. “There are so many ways to contribute. I am a firm believer in life balance. It was important to take care of my family and kids.”

Whalen encourages anyone struggling to maintain family and work to take a break or ot scale back, but to keep your eyes on the future.

“You have to be purposeful about it,” she said. “ I need to keep current in it. You‘ve got to take professional accountability.”

Whalen is administrative director of Inpatient Nursing Services at St. Joseph Medical Center, a position she never dreamed she would pursue. As a younger adult in her twenties, she viewed nursing as a means to support herself and her family and did not consider moving into leadership roles, she said. That changed after several decades of motherhood and patient experiences when delivering her children in a hospital. She came back to nursing wanting to make a better experience for patients.

“It was a completely different feeling,” she said. “I definitely viewed patients differently.”

It was tougher than she liked, taking those initial steps back into nursing, Whalen said. Having moved from Iowa, she quickly learned it would be wise to certify on both sides of the state line, she said. There were changes in medications and technology she knew she would face. She spent extra hours in orientation becoming comfortable with electronic record keeping.”

“It’s very scary to leave the field and come back,” she said. “Things change so rapidly in health care.”

Whalen said you cannot take the nurse out of nursing, however. A colleague told her that nurses are hard-wired to do what they need to do and Whalen has come to believe that. In the five years she was gone from the field, she saw equipment like drains, ventilators and computers had changed and grown in hospital settings, but the respiratory and cardiovascular systems remained the same, she said.

“The tools changed but the pathophysiology didn’t change,” she said. “It still provided the same benefit to the patient.”

Nursing

Infectious Disease Drugs in Short Supply

ANA Among Endorsers of Needlestick Statement

Study Finds that Digital Records May Not Cut Costs

Tougher Penalties for Harming Nurses

Minnesota Nurses Lobbying for Safer Workplaces

New Guidelines for Blood Glucose Testing

Nurse Practitioners: Health Care Reform’s Missing Link

Retired Nurse Shares Experience of Integration

Multitalented Nurse Seeks to Inspire Women

Returning to Nursing

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