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Combating racism in healthcare

Nurse managers and their staff often face racism in the work place. In 2013, Minority Nurse reported that almost half of minority nurses said they experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

A Cautionary Tale

Plainfield Healthcare Center was faced with a similar dilemma, when some residents of the facility refused care from nonwhite staff members. The center had a policy of honoring such racial preferences, citing the patient’s right to select their providers.

For Brenda Chaney, a CNA at Plainfield Healthcare Center, this caused issues with both her workplace experience and patient safety. Patients verbalized their preference on a regular basis, causing distress and a hostile work environment for Chaney. Additionally, the policy created safety risks for the patients; Chaney shared one such situation: after finding that a patient fell and couldn’t get up, instead of assisting the patient herself, she had to hunt for nonblack staff members to help the resident return to her bed.

Chaney responded to a call one morning from a resident who was struggling to get out of bed. The patient refused her help, and when she eventually helped another staff member with the patient, the staff member reported that Chaney used profanity when helping the patient. After investigating the complaint, they found no evidence to substantiate the complaint, and the resident’s roommate heard no profanity during the incident. Despite this, Chaney was still terminated.

After her termination, Chaney filed a lawsuit under Title VII of the Civil Rights Act of 1964, where she alleged that Plainfield Healthcare Center’s adherence to resident’s racial bias was illegal and contributed to a hostile work environment. The suit was supported by the Equal Employment Opportunity Commission. After an appeals process, the 7th U.S. Circuit Court of Appeals sided with Chaney and found the practice of allowing patients to refuse care based on race in violation of Title VII. Both parties eventually settled the case, with Chaney receiving $150,000 settlement.

Preventative Measures

The New England Journal of Medicine published an article that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

ANA comes out against latest GOP healthcare proposal

In a statement released today, the American Nurses Association (ANA) said that the organization “adamantly opposes” the Graham-Cassidy healthcare proposal being considered in the Senate.

The ANA expressed major concerns about the Senate’s proposal, saying that it would make severe cuts to Medicaid, erode protections for pre-existing conditions and other essential health benefits, and wipe out subsidies for the purchase of private health coverage.

ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, gave the following statement: “ANA denounces the latest Senate proposal as its worst yet. This proposal limits care for those that need it most and fuels greater uncertainty in the insurance market. It poses a serious threat to patients’ care, especially those that need coverage for illnesses or pre-existing conditions. Patients deserve better and we won’t rest until they get it.”

In the wake of disaster, nurses answer the call

While most people were running away from Hurricane Harvey, a team of nurses from the Christus St. Michael Health System flew into the storm to help others.

With just two hours’ notice, the 13 nurses boarded a plane to San Antonio, arriving shortly before Hurricane Harvey made landfall in Texas. Word had spread throughout the health system that patients from around the state were being transferred out of the hurricane’s path into hospitals in the San Antonio area, and they would need more nurses to handle the influx of patients.

By the time the nurses reached the Christus San Antonio Medical Center and Christus Santa Rose New Braunsfel hospital, an additional 70 patients were transferred to these facilities and needed care. One of the nurses, Kelli Thompson, BSN, RN, WCC, SCRN, ended up working the night shift in the MICU with other volunteers. “We helped with admissions, started IVs, cleaned up patients. We did whatever they needed us to do,” Thompson said. “They had patients who were very sick and needed a lot of care.” The MICU had a significant increase in patients, over 150% of its regular capacity. “It was a big difference from what they were used to,” Thompson said.

The volunteer nurses slept in empty patient rooms on cots and hospital beds; flooding concerns meant that they stayed in the hospital for four days straight so they wouldn’t miss a shift. Though the experience was trying, the volunteers felt welcomed by both the patients and the staff nurses. “The nurses who were based there were wonderful and very appreciative of us being there,” Thompson said.

Micah Johnson, MSN, RN, director of nursing at Christus St. Michael Hospital-Atlanta, was also one of the volunteers; for him, the biggest take away was how nurses were able to rally together in a time of crisis and help patients in need.

Source: Nurse.com

Nurse’s controversial arrest sparks outrage and reform

Last week, body-cam footage was released of a Salt Lake City detective arresting a nurse for refusing to let them draw blood from their unconscious patient. Alex Wubbels, RN, the head nurse at the University of Utah Hospital’s burn unit, was following hospital policy and state regulations by refusing consent, but she was still handcuffed and arrested despite protests from the hospital staff.

Shortly after footage of the incident was released, The American Nurses Association (ANA) issued the following statement, “The ANA is outraged that a registered nurse was handcuffed and arrested by a police officer for following her hospital’s policy and the law, and is calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.”

In the video, Wubbels consulted with her supervisors and presented details about the hospital’s policy, which states that that blood could not be taken from an unconscious patient unless a warrant was issued for the blood draw or the patient consents. The officer stated that they had implied consent to get the sample; however, implied consent has not been Utah law for over a decade, and the Supreme Court ruled against warrantless blood tests in 2016. When Wubbels and the hospital staff continued to refuse, the officer grew irritated and made the arrest.

“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN, NEA-BC, FAAN.

In a press conference last week, Wubbels’ lawyer Karra Porter called her arrest unlawful: “The law is well-established. And it’s not what we were hearing in the video,” she said. “I don’t know what was driving this situation.”

In the same conference, Wubbels gave the following statement: “I want to see people do the right thing first and I want to see this be a civil discourse. If that’s not something that’s going to happen and there is refusal to acknowledge the need for growth and the need for re-education, then we will likely be forced to take [legal action]. But people need to know that this is out there.”

The mayor and police chief of Salt Lake City have apologized to Ms. Wubbels, and have agreed to perform an investigation of the incident. The police officer involved and his supervisor have been suspended as well.

Because of this incident, facilities throughout the country are reassessing their policies. The University of Utah has already changed their policy so that nurses will no longer have direct contact with the police, and other facilities are hoping to do the same.

McCain votes no, derails “skinny repeal” in marathon session

This article appeared on Kaiser Health News on July 28, 2017.

By Michael McAuliff

WASHINGTON — Sen. John McCain (R-Ariz.), who interrupted brain cancer treatment to return to Capitol Hill and advance the health law repeal efforts, cast the dramatic and decisive “no” vote in the early morning hours that upended the Republican effort to repeal the Affordable Care Act.

The Senate struggled late into the night to craft and then vote on a “skinny repeal” of the health law, but came up empty as the bill was defeated in a 51-49 vote that prompted gasps in the chamber. McCain’s vote was unexpected and ends — for now — the Republican Party’s effort to kill Obamacare.

Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) cast the two other Republican “no” votes in a cliffhanger drama that ended just before 2:00 a.m. Friday.

Earlier, a group of Republican senators trashed the new measure, widely dubbed a “skinny repeal,” saying it would only worsen the health care system, and they demanded unprecedented promises from their House colleagues to change it.

“The skinny bill in the Senate doesn’t even come close to honoring our promises of repealing Obamacare,” said Sen. Ron Johnson (R-Wis.). “Virtually nothing we’re doing in any of these bills and proposals are addressing the challenges, the problems, the damage done [by the Affordable Care Act].”

Staff of Senate Majority Leader Mitch McConnell (R-Ky.) crafted the new bill, which was under discussion all afternoon and posted publicly late Thursday evening.

The slimmed-down version of the Senate bill — The Health Care Freedom Act, which the White House refers to as the “freedom bill” — included an end to key elements of the health law. Among them were rollbacks of the mandates for individuals and employers to buy health insurance, changes to waivers available under Section 1332 of the ACA that would give states more leeway to alter essential benefits in insurance plans, and a repeal of the medical-device tax.

It was not immediately clear how the bill achieved savings similar to $133 billion in the House’s version of repeal legislation. An equal or better level of savings is required under the arcane budgetary process that is being used to advance the bill, known as reconciliation.

Budget reconciliation allows the measure to pass the Senate on a simple majority vote, but requires that all of its provisions pass muster with the Senate parliamentarian as budget-related. The text of the bill posted publicly at 10 p.m. The CBO report on it began circulating on Twitter around midnight and the vote finally closed around 1:45 a.m. Friday.

One provision that had been restored after the parliamentarian initially struck it was an attempt to defund Planned Parenthood for a year. The new provision took in at least one additional abortion provider, and was expected to survive. The funding for Planned Parenthood was to be shifted to community health centers.

Keeping the attack on Planned Parenthood solidified Murkowski and Collins’ opposition to the vote.

This new iteration of the repeal comes after two versions failed to win over the 50 GOP senators needed. But even with all the rewriting and behind-the-scenes negotiation, four senators called a press conference to declare they will not vote for this “skinny repeal” unless House Speaker Paul Ryan (R-Wis.) promises not to merely pass the measure but send it to a conference committee between the two chambers, where it can be substantively altered.

The four senators slammed the trimmed-down compromise.

“I am not going to vote for a piece of legislation that I believe is not a replacement, that politically would be the dumbest thing in history to throw this out there,” said Sen. Lindsey Graham (R-S.C.).

He said that he, Johnson and McCain and Sen. Bill Cassidy (R-La.) would not vote for the skinny repeal until Ryan pledges to “go to conference,” where Graham can include a measure to shift current Obamacare funding into a block-grant program for states.

His fear, Graham said, is that the House might simply take up and pass the skinny repeal in order to be done with it and notch a win in their seven-year battle against Obamacare.

Graham referred to estimates that said the repeal of the ACA mandates would “collapse the individual market” and leave the GOP to “own the problem at a time when Obamacare is collapsing.”

Ryan did release a statement with a conditional promise to take the bill to conference. Initially, it did not satisfy Graham or McCain. Graham and Johnson were persuaded, however, after a phone conversation with Ryan. McCain was not.

For their part, Democrats uniformly panned the GOP’s efforts.

“We’ve had one bad bill after another. There is no bill that is a good bill,” said Sen. Dianne Feinstein (D-Calif.). “Every bill takes people off health care. Every bill makes you pay more for less. There’s a race to the bottom, so to speak.”

Sen. Chris Murphy (D-Conn.), hammered the entire process: “This is nuclear grade bonkers.”

ANA continues to oppose Senate health care bill

The American Nurses Association (ANA) weighed in last week on the potential cuts to Medicaid and Essential Health Benefits in the proposed Senate bill.

In a press conference on June 22, ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN outlined the harmful effects of eliminating the Essential Health Benefits used by millions in the U.S. The draft health care proposal from Senate GOP would make drastic cuts to Medicaid and increase the number of uninsured Americans by 22 million, according to the most recent Congressional Budget Office (CBO) estimate.

“In addition to eliminating the (essential health) benefits, the Senate Republican draft health care bill’s changes to Medicaid would be disastrous for our nation’s most vulnerable,” Cipriano said. “Medicaid is the safety net for tens of millions of children, as well as the poor and disabled. We’re nurses, and we’re here because we are very worried about our patients. We won’t stop fighting for them. We can do better and Americans truly deserve a better plan.”

The ANA has consistently spoke out against cuts to health care and Medicaid, voicing strong opposition to the American Health Care Act passed by the House of Representatives in May. ANA members, area nurses, and nursing students also participated in an “Emergency White Coat Fly-in,” and hopes to meet with Republican senators from key states that would be hurt the most by this bill and persuade them to protect health care.

Find more information on the ANA’s official website.

American Nurses Association express dissapointment with American Health Care Act

Yesterday, the House of Representatives narrowly passed the American Health Care Act, which is aimed to undo much of the bulk of the legislation of the Affordable Care Act. The American Nurses Association expressed disappointment with its passage. releasing the following statement:

The American Nurses Association (ANA) strongly opposed the American Health Care Act (AHCA) and is deeply disappointed with the passage of this legislation by the United States House of Representatives. 

ANA, which represents the interests of more than 3.6 million registered nurses, has expressed serious concerns throughout negotiations about the critical impact the AHCA would have on the 24 million people who stand to lose insurance coverage if the bill becomes law.

“Over the past several weeks, nurses from across the country expressed their strong disapproval of this bill which would negatively impact the health of the nation,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Today, Congress not only ignored the voice of the nation’s most honest and ethical profession and largest group of health care professionals, it also ignored the almost 15 million people in the United States with pre-existing conditions who will now have no protection from insurer discrimination.”

As it is currently written, the AHCA would cut Medicaid funding by $880 billion over 10 years, dramatically increase premiums on seniors, restrict millions of women from access to health care, weaken the sustainability of Medicare, and repeal income-based subsidies that have made it possible for millions of families to buy health insurance. In addition, states would have the option to waive essential health benefit protections that prevent insurance companies from charging individuals with pre-existing conditions significantly more for coverage. Even worse, insurers could decline coverage for substance abuse treatment, maternity care, and preventive services. Late efforts to stabilize the bill’s risk pools for more than 15 million people with pre-existing conditions were wholly inadequate and will leave the nation’s sickest vulnerable.

As this legislation moves to the United States Senate, ANA urges the Senate to allow for opportunities for thoughtful, public feedback in the face of reforms that would have such a far-reaching and personal impact across the nation.

ANA asks the Senate to oppose AHCA in its current form, and stands ready to work with Senators to protect and improve health care access, quality and affordability for all.

Nurse takes on the role of Surgeon General

Rear Adm. Sylvia Trent-Adams, a registered nurse, becomes one of the first nurses to serve as Attorney General.

Surgeon General Vivek H. Murthy was replaced on Friday by his deputy, Rear Adm. Sylvia Trent-Adams. Serving on an interim basis, Admiral Trent-Adams becomes the second nurse to have served in this position, and the first non-physician to take the job.

Admiral Trent-Adams worked as a nurse officer in the Army, and served as a research nurse at the University of Maryland, where she received her PhD. In 1992, she joined the Commissioned Corps of the Public Health Service, where she served in the HIV/AIDS bureau of the Health Resources and Services Administration before joining the surgeon general’s office.

Surgeons general have limited staff and direct influence, but they often use their position to call attention to important public health priorities. Dr. Murthy, Adm. Trent-Adams predecessor, used his platform to speak out against gun violence, labeling it as a threat to public health. It is unclear why Murthy was relieved of duty; the Department of Health and Human Services said that the Trump administration asked him to step down after “assisting in a smooth transition,” but Dr. Murthy’s wife, Alice Chen, said that her husband was fired after he refused to resign.

Nursing strike cost Allina Health $149 million

Last year was a tumultuous one for Allina Health in Minneapolis and its nursing staff. After a week-long walkout in June, Allina nurses went on strike in the fall as part of ongoing contract negotiations centered around the elimination of union-backed health plans. After a six-week strike, both sides finally reached an agreement that ended the strike and sent the nurses back to work.

As part of its 2016 earnings report, Allina Health reported that while revenue increased over the year, operating income dropped, thanks in part to expenses related to the nursing strike. Allina recorded a $30 million operating loss, a significant $179-million-dollar swing from the $149 million operating gain Allina posted in 2015. As part of its report, Allina cites a $149.3 million of strike expenses, which included hiring 1,400 replacement nurses to cover for the striking staff.

For more information on nursing strikes, check out the Strategies for Nurse Managers Reading Room.

Trump: for every new healthcare regulation, two must be removed

On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for healthcare regulations. Under the executive order, for a new healthcare regulation to be implemented two older regulations will have to be eliminated.

http://www.modernhealthcare.com/article/20170130/NEWS/170139994

“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”

http://www.nbcnews.com/politics/politics-news/trump-signs-executive-order-reduce-regulations-n714151

The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.

While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.