In Our Own Words

Silent Auction for Dystonia

Broadway  was crowded with tourists today. A cool wind wiped the petals of tulips along Park Avenue. It felt like early March weather. I had done my research. I was visiting the Broadway theaters one by one to ask for donations for a silent auction to benefit dystonia. Something needs to be done. Research is not progressing, except for a form of dystonia that is genetically-based and affects less than 10 % of those afflicted with dystonia.

Broadway is known for its theater district and often is called the “Great White Way” because of its bright lights that shine at all hours of the day.  Broadway originated as a Native American trail, called the Wickquasgeck Trail, which was carved into the brush-land of Manhattan. This trail originally snaked through swamps and rocks along the length of Manhattan Island. Today I was swamping my way through crowds, primarily those carrying maps and NYC tourist bibles.

One by one, theater after theater, I stopped in, asked for a silent auction donation to Care4Dystonia  and the Dystonia Association of Kentucky.  Soon, I had billboards autographed by directors, souvenirs from Mary Poppins, and miscellaneous caps, mugs, and posters. In a few hours I had about $5000 worth of material for the auction. Not too bad, considering this was my first time! I really had no idea how a silent auction worked, but if it brought revenue to nonprofits, then that was all that mattered.

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An Aging Population -- Why Can't NPs Provide Needed Care?

The Washington Post reported last week that by 2030, the number of adults 65 years and older will make up almost 20% of the population. Currently, this age group makes up 12% of the U.S. population and accounts for:

* 26% of all physician office visits
* 35% of all hospital stays
* 34% of all prescriptions
* 38% of all emergency-medical-service responses
* 90% of all nursing-home use

John Rowe, professor of health policy and management at Columbia University headed an Institute of Medicine panel that released a report on the healthcare outlook for the 78 million baby boomers about to begin turning 65. The report from the arm of the National Academy of Sciences reiterated:

*  There aren't enough specialists. It found there are about 7100 US physicians  certified in geriatrics, one per every 2500 older Americans.
*  Insufficient training is available.
*  Specialists are underpaid.
* Medicare fails to provide for team care that many seniors need.

The report said Medicare may hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions, and lack of coverage for preventive services.

Aren’t these aspects of care that nurse practitioners are so well trained in? We may be able to solve the impending looming healthcare crisis.

NPs – what do you think?

English Only?

Over the weekend (after 3 long night shifts in the ICU), there was an incident and controversy about the use of English vs other foreign dialects spoken by employees within the Unit. Imagine that you are on Jeopardy, and Alex Trebek gives the answer:  "This is the official language of the United States."  You buzz in and blurt out, "What is English?" Just like that, you lose the money.

Although English has long held supremacy in our national consciousness, the truth is there is no official language of the United States. So, we may be in for a rude awakening in the form of a civil-rights lawsuit if we have an English-only workplace. Yet, on the other hand…

What should an employer who desires to implement an English-only workplace policy do? First of all, the employer, while recognizing that the workplace is not and cannot be a democracy, should be sensitive to the varying life experiences and perceptions that are brought into the workplace by employees with diverse backgrounds and experiences. Because of this, the employer should take the time to communicate effectively with all employees to ensure that an English-only policy is fully explained to everyone.

All employees may not agree with the business reasons asserted by the employer, but at least they will recognize that the employer believes there is a business reason for the policy, and it is not being imposed simply to discriminate against or offend any group of employees. This seems to be such a sensitive topic….

An English-only policy would be highly controversial in nursing, no matter how it is explained. If it is implemented by simply posting a memorandum on a bulletin board without explanation, the reaction of some nurses is likely to be extremely negative and they may feel personally offended by the policy. Some nurses may well feel they are being discriminated against because they were not born in this country. As immigration patterns have shifted in the United States from Central and Western Europe in the early part of the century to Central and South America today, the emotional issue of language may well be tied to perceptions of national origin discrimination by nurses.

What are your thoughts about an English-only policy in the workplace? Has this been mandated where you work?

Workplace Violence: Disruptive Behavior, Bullying, Verbal Abuse

Over the last couple of weeks there has been a disturbing video shown within the media involving young teenage girls assaulting another teen. Premeditated violence? Their ages range from 14 to 18 years with charges having been filed as adults for each. This leads me to wonder about a new article that I read about workplace gossip within nursing.

Disruptive behavior such as bullying, lateral violence, and verbal abuse is so common in healthcare settings that the Center for American Nurses  recently released a position statement calling for zero tolerance to lateral violence and bullying in nursing work environments. The Joint Commission also proposed new standards that will require organizations to develop codes of conduct that define and address inappropriate workplace behavior.

Whose responsibility is it to stop disruptive behavior? How do we even stop the bullying and gossip that seems to run rampant? Why not use that time to formulate strategies to solve current issues within nursing? Instead, it is all too easy to ignore the behaviors seen within nursing, rather than to confront them? Gossip, backstabbing, withholding of information, and shunning of our co-workers are all forms of workplace violence. Apparently, this trend appears to be growing.

Have you been a victim of workplace violence? If so, please share your story with us.

(For more information on The Center for American Nurses' position statement, visit www.centerforamericannurses.org/positions/lateralviolence.pdf)

Giving to Honduras

My photographer, Michael, who documented my DBS Surgery in 2004 as a pictorial essay (www.parasphotography.com/beka.html), left me a message teling  me that he was headed to Honduras,on a mission once again this  April. In support of the New York Honduran Committee, 11 volunteers travel to Tela, Honduras, one of the poorest countries in the western hemisphere, to provide free health care. The medical team examined more than 220 patients and performed 28 surgical procedures in 2007.

These health professionals performed health evaluations, hearing and speech screenings, and major and minor surgeries for children and adults. In addition, they provided many people with donated hearing devices. The medical mission is always geared first towards children, but each year they see many adults who are in need as well. Michael went along to photograph the journey, the dirt, the isolation, the lack of basic necessities, and other needs. In a country where most people can't afford basic health care, the chance for free surgeries and exams can be a life-saving opportunity.

I have always wanted to go on a medical mission, or even to join the Peace Corps (Maybe I’m too old for that now?) Have any of our readers gone on a medical mission? Tell us about it.

See the Honduras 2007 Essay here.

Some information on joining medical trips:  So You Want to Go on a Medical Mission

A Dreadful Event

I recently attended a fundraiser for movement disorders. It was the worst one ever. During the event I excused myself, and hung out in the gold-plated restroom until I thought the guest speaker was done with her awful, dreadful, unpleasant, and simply terrible speech.

She was a well-known actress who thought we would all be as interested in her life story as she was, including many lurid and explicit details. Her juicy speech seemed to go on forever, making me think the event planners had either not given her a time limit, or that she had ignored it. However, she forgot to mention that there are over 40 million Americans living with a movement disorder today (source: http://www.life-in-motion.org).

The event was for the supporters of a medical school and their expanding movement disorder program. It was all about science, saving lives, research, and how we could help (hint: $$$$). However, I found the disconnect between the speaker and the purpose of the event unbearably painful. I later felt badly for the event planners who had put that one together. But I had heard it all before at other events that I had attended – the galas, dinners, symposiums, “think-tank scientific forums,” “dog walks,”  golf invitational events at exclusive high-end golf  clubs (I certainly was no golfer -- not with my head twisting to the left -- where do you think the ball landed on the greens ?).

At all of these events, there was little focus on actual patients living with movement disorders.
The gist of the event really was that we all wanted to see the celebrity of the evening. Right? Well, I saw her. No doubts about that. But, where was the money for patient care? The movement disorder program? Perhaps forgotten in the focus of the evening.

Maybe we should keep it simpler and keep the emphasis where it should be. How about a fundraiser called “Pizza for a Purpose?!”

Spring Blooms

I don’t like the time re-adjustment that happens in the US in the spring (Daylight Savings Time). Well, that’s not really true: I don’t like the mornings, but I do like the daylight in the evenings. I’m a late riser -- 12 noon usually -- and the time change means I’m getting up earlier, according to my body clock. There isn’t enough Starbucks’ coffee in the world to cope with this sort of thing.

But even as I struggle to adjust, I walk the neighborhoods on the Upper East Side, passing flower shops and bodega cafes. The spring blooms are out on the sidewalks by 10 am. Shipments are delivered well before daylight arrives – around 5 am. Boxes filled with carnations, lilies, tulips, and daffodils- true signs that warmer weather is coming.

Of course, for me -- this could only mean “beach weather” -- time spent on the South Jersey Shore. A few years ago we had had a warm spell in April; I found myself listening to the ocean roar and the waves pounding the white sand, as I munched on a hamburger, sunbathing on the Shore.

I’m ready for spring and the onset of summer. How about you?

New CPR Guidelines Coming?

Imagine – sitting on the bus (no one knows you are a nurse) and someone calls out “Help!”  A person collapses. Everyone stands still as the bus comes to a sudden halt. What do you do? Run off the bus, or say “I can help- I’m a nurse?” Bystanders who see someone suddenly collapse should quickly give the person chest compressions even if they are not trained in cardiopulmonary resuscitation -- the American Heart Association (AHA) released this new recommendation this past week.

The AHA urged people not to stand idly by because they do not think they know how to administer CPR while an adult stricken with acute cardiac arrest is dying in front of them. (People still stand by idly and watch dumbfounded at these events, don’t you think?)

In recommendations published in its journal Circulation, the group emphasized "hands-only" CPR -- a simple procedure that bystanders can perform without worrying about doing the mouth-to-mouth part of CPR. All too often, no one at the scene does anything to help the victim of sudden cardiac arrest -- often because there is no one trained in CPR and the general public is scared that they will do something to make the victim's condition worse.

Will this be a new recommendation added to BCLS?  Have you tried to save a life outside of the medical setting? If so, do share your amazing story with us.

Change of Shift - Enterprise Edition

Don't miss the newest edition of Change of Shift -- seen through the eyes of the Enterprise's Nurse Chapel!

The PBDS Test for Nurse Travelers

Quite a few nurse travelers have been hired throughout the New York City area to cover hiring freezes and staffing shortages. Ever since I placed my resume online, I have had calls from various travel nurse companies looking to fill a variety of positions, although I am primarily looking for an optimal NP position that will not tire me out or induce dystonia symptoms. (Lately I feel like the actor Michael J. Fox -- I want to hide and not be seen or questioned about abnormal movements or possible and current treatments.)

A requirement for travel nurses to prove their competency in their area of specialty is to take the "Performance Based Development System,"  otherwise known as the PBDS Exam. It consists of video scenarios of multiple clinical situations requiring you to evaluate the clinical diagnosis (are nurses allowed to diagnose? Uhmmm? I thought not…), identify it, and list actions you would take to correct the problem. (Avoiding the answer – “Call the Doctor” is a must to passing the exam.) Travel nurses cannot begin a contract assignment without passing this test.

Some of the scenarios might include:
* What would you do if a family member arrests in a semi-private room (Scream for help!)
* A doctor makes the comment “I don’t know why hospital administration won’t hire any decent nurses when there are plenty of girls out there?” (What sort of girls is he referring to?)

The test seems to focus on nursing actions used to correct a medical diagnosis. I thought we were nurses, not physicians, or is there now overlap between the two professions? When was the last time a white-coated physician gave a patient a bedpan? Anyone recall?

Whatever happened to the good ole resume and job interview format? Is this the right exam to test the competency of skills and knowledge for a nurse? I'd like to hear from others who have more experience with this.

John McCain and Healthcare

As Election 2008 moves forward, I decided to read up on John McCain. The only 3 things I know about the man are: he’s a senator from Arizona, he’s a former POW released in 1975, and he’s had a bout with skin melanoma (I won’t admit to the fact that his wife does like she stepped out of Vogue magazine each week! She never has a hair out of place.)  But I know nothing about his political views, especially those surrounding our healthcare system.

John McCain is bolstering his reputation as a maverick by encouraging Americans to buy lower-priced drugs from Canada, a plan that may cost Pfizer, Inc, and the drug industry $40 billion over 10 years. Isn’t that a lot of monetary revenue? Enough to rebuild the Lower 9th Ward in New Orleans! McCain, the Republican presidential candidate, says crossing the border for less-expensive drugs will increase healthcare access by lowering costs. Spending on physician services can be cut too, he says, by paying set fees for disease treatments, not on the amount of care provided. He also wants to encourage the purchase of insurance by offering a tax credit paid for by taxing workers' health benefits for the first time.

Supporters say that by attacking health costs, the Arizona Senator can make care more affordable for the 47 million Americans without insurance coverage. Opponents say the ideas are unrealistic. To me, it all seems rather confusing….To save money, McCain wants to give physicians a so-called bundled fee for treating a condition such as heart disease instead of reimbursing each procedure as they do now. Now, I wonder how that would affect private practicing nurse practitioners.

What are your thoughts? Should we be going to Canada to buy our prescriptions?

Health Matters in the 2008 Election

Nurse Bloggers - New Links

Check out all the featured nurse bloggers this week. There are more out there than you might imagine! You will find the link here, at Emergiblog.

Organ Transplant Tourism

Need a kidney? Buy one for $20k in Russia.
Need a liver transplant? Visit the Philippines. Cost $129k.
Need a heart?  South Africa has them for $140k.
(Lisa Ling, Reporter, National Geographic Special on Organ Donation)

The shortage of organs available for transplantation continues to rise in the United States and the demand for organs exceeds the supply. Thus, many Americans, rather than staying on waiting lists for 5 to 15 years, are traveling to various countries to obtain necessary organs to remain alive. China recently stopped allowing Americans to travel to that country for organ donations. Executed prisoners often were utilized as organ donors in the land of the Great Wall. To me, this sounds rather barbaric.

The shortage of donated organs and the lack of supervision of hospitals in China have led many to view transplant surgery as a cash cow. Many people have been enticed to profit from this situation by offering their organs for sale. The same seems to now be occurring in Russia, India, and other under-developed countries as well.

I kept thinking about how needless all of this would be if we didn't have such loose organ donation policies in the United States. Do we even have a governmental policy on organ donation? The US government’s site on organ donation and transplantation (http://www.organdonor.gov/ ) offers the following statistic: "Each day, about 74 people receive organ transplants. However, 18 people die each day waiting for transplants that can’t take place because of the shortage of donated organs." That's about 6500 people who die every year in the United States waiting for an organ donation -- two times the number dead in the 911 attacks. Should we be doing something more – education, public service announcements, or online marketing to lower these drastic numbers?

About 2.4 million people die each year in the United States. Only a fraction of these people are organ donors. Why are so many life-saving organs being thrown away? What do we do with the growing number of people requiring organs? Do we let them live out their lives as they are or institute a change in the voluntary "Become an Organ Donor" card, such as somehow making it mandatory in nature? What are other countries doing to solve the problem of organ donation?

Please share your suggestions.

Work-Life Managers on Staff

A news feed from Google caught my eye – “Medical School Hires Work-Life Manager.” Interesting, don’t you think?  I have always thought that the some of the best nursing managers I have had in the past are those who recognize that their employees cope with the daily struggle of trying to balance the demands of work and home. It’s not easy, is it?

The truth is that workers do bring their personal lives to work with them. How often do we  have conversations about our kids, soccer games, homework assignments, etc. at work? Organizations that ignore this fact are probably risking poorer performance, stressed-out employees, and the loss of an opportunity to fully capitalize and enhance on the skills and expertise of workers.

However, I do have to ask, at those workplaces offering work-life managers and similar support systems, if a perception exists that those who use these services are less "serious" about their work? In some places, employees who use flexible work policies, employee assistance programs, and/or childcare and eldercare supports, are sometimes labeled as "slackers" or “weaklings.” I would suspect that by not supporting workers with personal/family commitments, managers lose in the long run, employees lose, and therefore the company loses as well.

I’ve never used any sort of work-life support systems at my workplace. I don’t even know if they  exist! But, it is an idea that may be of benefit to all of us, taking into account over 110,000 of us are going to retire in 4 years! So, why not implement Work-Life Managers to ease the current stressors at work and at home?

Does anyone work in a facility that offers these services? If so, please tell us about it.

Change of Shift Posts at Emergiblog

If you want to keep up with blogs by and about nurses, don't miss Change of Shift, just posted today.

Another Super Tuesday

I woke up early today and convinced my neighbor, a young chap, to carry my hybrid bicycle down four flights of stairs to street level. Spring was coming. The air has been warm and breezy, although it looks like it is going to pour buckets later on today. As my neighbor brought my bike downstairs, I loaded myself with oil cans, polish, torn wash clothes no longer useful to the human body, and a tire pump to clean the dust that had accumulated on my bicycle during the long winter months. I haven’t ridden my bike in over a year. Balance is still a problem for me. The last time I tried riding a bicycle was in Aruba and I ran into a vehicle instead.

I used to be an avid cyclist, often riding along the Erie Canal for miles in Upstate New York. Riding 40 to 50 miles a week was not unusual until dystonia hit me. Cycling soon evaporated as symptoms progressed. I used to be a true cycling junkie! Now I’ve become a political news junkie!

As the morning went by, the polish came out and I began attacking the dust on my bike – one of my treasured prizes, second only to my Turkish carpet. Slowly, my neighbors began accumulating on the steps as I scrubbed. And soon, talk about today's  Texas and Ohio primary races erupted, leading to our own lively sidewalk debate. I was becoming confused by the entire Electoral race, not really sure who the right candidate should or even if the Democratic race would be decided by tonight -- March 4, 2008. Super delegates, allegations, and other issues were discussed. Essentially I was an “undecided,” not knowing which issue was of more importance – national security, the economy, or healthcare?

Laughter was mixed with the verbal exchanges with each resident having his or her own opinion. How divided the country truly is… One of my neighbors pumped up my tires for me. I climbed aboard to the applause of my neighbors -- all knew that I had dystonia, a movement disorder. They had seen me in the media spotlight, most recently on Dr. Oz's Oprah and Friends Radio Show.

However, riding a bike proved to be a feat and a challenge still, just like Super Tuesday. Perhaps I’d better go back to debating! Any thoughts on the primary process or the candidates?

The Lipitor Ad Controversy

The Lipitor advertisement  featuring Dr. Jarvik, inventor of the first artificial heart, has been taken off the air. (Pfizer Pulls Lipitor Ads With Heart Expert Jarvik).   A congressional subcommittee is investigating celebrity endorsements in direct-to-consumer drug ads, including the ads featuring Robert Jarvik. Okay, does that include the “Flying Nun” -- Sally Fields, and the osteoporosis drug, Boniva, too?

It all seems pretty silly to me to spend time on this controversy. Although I must say I did think that Jarvik was a practicing physician of some sort. He finished medical school, but never completed a residency. Thus, he can’t prescribe medications or practice medicine. I recall seeing the videos of Barney Clark in Utah who was implanted with one of Jarvik’s devices in the 1980s. Remember?

I guess the controversy centers on this question: Is Dr. Jarvik entitled to appear in advertisements and give the impression he can prescribe pharmaceuticals for patients?

But, let’s leave the “Flying Nun” alone! (Wasn’t Gidget great?)

Hospitals More Like Hotels

I recently revisited my old workplace in Rochester - Highland Hospital.  A wonderful, clear, glass atrium with painted ceramic tiles greet you as you enter the interior lobby, with welcoming and peaceful colors of mauve and lavender. A loft above the lobby holds a grand piano for patients to enjoy music therapy. Mahogany wood greets visitors by the gift shop, which has perfectly arranged, uncluttered rows of cards and miniature bears and dolls.

The old hallway is now painted in various shades of purple and lavender as well. It’s obvious there has been some planning in color schemes. There’ is even carpeting now! A recent report in the New York Times  explored the redesign of hospitals. I must admit that Highland Hospital has turned into a mini-hotel with multiple amenities for patients and even massage therapy for staff. I wish still worked there!

Are other medical facilities doing similar things? Here in New York I really don’t see much of that – many facilities look like they are crumbling, with wall plaster peeling, overflowing garbage cans, dust on window sills, and a lack of carpeting unless it’s a designated VIP ward. And those uncoordinated ceiling colors – some are the color of bile combined with tan. One has to wonder if the environment does play a role in a patient’s recovery. I’m not sure I would want to wake up gazing at a ceiling the color of gallbladder bile after surgery….

What are your thoughts on this topic? Has your work setting done anything to make the environment more comfortable and welcoming, for patients and staff alike?

For Patients, More Comfort and a Bigger Dose of Respect

Anti-Complaining Campaign

How often during the day do we hear the following?

* “Gee, the charge person gave me a horrible assignment again.”
* “Can’t we do something about these beds? None of the scales are working. “
* “What a mess my patient was left in today.”
* “Why can’t the night shift change the IV bags and tubing? They have enough time.”

I just read an interesting article describing a Canadian Medical Facility that has initiated an “Employee Anti-Complaining Program.” Two nurses bet one another in this facility that neither could do without complaining during a shift. The challenge was overheard and evolved, as more staff on the floor joined a month-long campaign to quit complaining.

“Can the complaining. Nix the negativity. Cut the criticism.” Those were the messages staff at Windsor Regional Hospital  in Canada embraced, as part of an anti-negativity, anti-complaining mission created by bedside nurses! The campaign has been so successful that now the entire medical facility is involved. Employees wear purple silicon bracelets as a symbol of membership in the program. Apparently morale has improved since the initiation of the campaign.

This is an innovative idea within the workplace. I wonder if it could be recreated by nurses worldwide to improve morale? After all, don’t we do a lot of complaining? Maybe not? What are your thoughts about this? Has your workplace initiated any innovative ideas?

A Complaint Free World