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The practitioner will see you now: Physicians oppose independent nurse practitioners

The debate about who is qualified to provide primary care rages on this week, following the release of the report Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient  from the American Academy of Family Physicians (AAFP).  In the document, the AAFP advocates for a team-based approach to primary care–in which a physician leads a groups of nurses, nurse practitioners (NP), physician assistants (PA), and other healthcare professionals to provide comprehensive and high quality care –while criticizing proposals to allow NPs to practice independently.

A national shortage of primary care physicians has led to efforts to substitute independently practicing NPs for physicians, but the AAFP points out that NPs “do not have the substance of doctor training or the length of clinical experience required to be doctors.” While it is an inarguable fact that physicians receive several years of training and clinical experience beyond that of NPs, the debate centers more around whether NPs and PAs can provide the necessary healthcare services that patients require while maintaining a high quality of care, without the direct supervision of or collaboration with a physician.  Some states, such as Massachusetts, have already granted a greater degree of independence to advanced practice professionals.

While the AAFP’s argument for solving the primary care gap by instituting ideal ratios of NPs to physicians is compelling, and the model of physician-led healthcare teams does hold promise for improving the healthcare system, the report nonetheless seems to fan the flames when it comes to practitioner qualifications. NPs are referred to as “less-qualified health professionals” and “lesser-trained professionals” who are able to handle only patients with “basic,” “straightforward,” and
“uncomplicated” conditions. The language of the report does not seem to give NPs much credit when it comes to their training and education.

While the AAFP rules out the idea that two models of healthcare–physician-led teams and independently practicing NPs–could coexist harmoniously, one has to wonder whether ultimately the patient should be allowed to decide which model best meets his or her needs. Shouldn’t patients be trusted to make informed decisions about their healthcare? If a patient is aware of the amount of training an NP has received, is aware that it does not equal that of a primary care physician, and is comfortable with that concept, why shouldn’t a patient be able to seek those (potentially more convenient) services rather than hunt for a physician-led team model? The issue is complex, but a solution that allows all Americans to receive quality healthcare must be reached.

What are your thoughts on the AAFP report, and the debate about granting NPs autonomy? Share your comments with us!

Discrimination settlement reveals underlying diversity issues

Earlier this week, a language discrimination settlement–thought to be the largest of its kind in the healthcare industry–awarded $975,000 to immigrant Filipino healthcare workers in California who claimed they endured “harassment and humiliation” from coworkers and management, according to a recent article in the Los Angeles Times.  Nurses involved in the case, which was filed in 2010 against Delano Regional Medical Center in Kern County, Calif., alleged that the hospital forbade them from speaking any language other than English in public spaces such as hallways and break rooms. The nurses also reported being followed by other employees, who would harass them and mock their accents.  One employee claimed that a former hospital executive threatened the nurses with suspension or termination if they were caught speaking their native language.

According to the Los Angeles Times article, Delano Regional Medical Center employs healthcare workers who speak several other languages, including Spanish, Hindi, and Bengali, yet singled out Filipino employees. The terms of the settlement require the hospital to conduct anti-discrimination training and to enforce reporting and handling of discrimination complaints, which will be reviewed by an outside monitor. The hospital denies the claims and stated that it settled the lawsuit to avoid wasting financial resources.

Just a few weeks ago, The Leaders’ Lounge reported on an initiative at George Washington University to attract a more diverse group of students to the nursing profession. We followed up with a poll on StrategiesforNurseManagers.com asking readers how diverse they consider their organizations. Of those who responded, 34% said their staff is not very diverse and 40% replied that their staff is somewhat diverse.  Only 26% of respondents consider their staff to be very diverse.

It seems that establishing a staff that reflects the diverse patient population is an issue that many organizations face, and the lawsuit in California shows that it is not enough to simply attract nurses from different ethnic and economic backgrounds. Employees and leaders alike must receive diversity training, and issues of discrimination / harassment should not be tolerated. A workforce that is divided by prejudice and hostility is a workforce that fails to work together to meet goals for patient safety and high quality healthcare.

Live webcast: Onboarding New Graduate Nurses

Just a reminder that HCPro will present a live, 90-minute webcast on Tuesday, September 18, 2012 at 1:00-2:30 (Eastern) called Onboarding New Graduate Nurses: How to Overcome Hurdles and Retain New Nurses. The webcast demonstrates how the onboarding process for new graduate nurses will increase retention and speed up professional growth.

Nursing professional development experts Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, and Jim Hansen, MSN, RN-BC will discuss topics such as externships, internships, unit orientation, cultural and social integration, and nurse residency programs. They will also show how onboarding is key for moving new graduates beyond academic theory and technical skill to become competent, confident, professional nurses. Following the program, Diana Swihart and Jim Hansen will participate in a live question and answer session.

This webcast promises to be a great resource for nurse managers, assistant nurse managers, nurse leaders, charge nurses, directors of nursing, patient care managers, directors of patient care, directors of staff development, nursing professional development specialists, chief nursing officers, VPs of nursing, VPs of patient care services, and nurse residency coordinators. Sign up now and pay one price for your entire staff!

For more information or to sign up for the webcast, please visit www.hcmarketplace.com.

Physician places weight limits on patients in the name of safety

Editor’s note: This blog post originally appeared on the Patient Safety Monitor blog.

A physician in Massachusetts gained attention last week when she announced that she would no longer accept patients who weight over 200 pounds. According to Helen Carter, MD, two of her staff members have sustained injuries from treating obese patients. One suffered a neck strain when attempting to pull out an examination table foot rest while the 284-pound patient was lying on the table, and the other staff member herniated two lumbar spine disks while performing a physical examination. According to Dr. Carter, her exam tables are ill-equipped for heavy patients, and she cannot afford the estimated $7,000 electric exam table.

In an interview for CommonHealth, Dr. Carter stated that she is not dismissing any of her current patients who are obese, but instead is encouraging them to lose weight. She compared her policy to turn away new patients who are overweight to turning away people seeking treatment for addiction, since she is not an addiction medicine specialist. She recommends that obese patients instead seek treatment at facilities with equipment designed to safely handle patients’ extra weight and specific programs to assist with weight loss.

Dr. Carter’s policy has been met by mixed reviews. Some of the sources interviewed for the articles mentioned above see the policy as discrimination against obese patients, while others agree with the policy and note that obesity is contributing to rising healthcare costs and safety issues.

It’s a difficult argument from either side, however. Dr. Carter can justify her decision under the American Medical Association’s (AMA) Medical Code of Ethics, which states that physicians may choose whom to serve, and her argument for the safety of her staff and the lack of proper equipment is compelling. However, by refusing to treat patients she is arguably putting them at risk, and possibly violating another of the AMA’s principles: providing competent medical care, with compassion and respect for human dignity and rights.

Is Dr. Carter within her rights to refuse treatment for obese patients, or does this move beyond a safety issue to one of prejudice? Share your thoughts in the comments section!

Bringing diversity to the nursing workforce

This past month, the George Washington University School of Nursing (GW) received a three-year, $1 million grant from the U.S. Health Resources and Services Administration to fund a program that aims to increase the diversity of nursing professionals, according to a press release from GW. The school’s Success in Nursing Education project focuses not only on drawing in African-American, Asian, Hispanic, and Native American students, but also male students and economically disadvantaged students from Washington, D.C., and rural Virginia. A report released by the U.S. Department of Health and Human Services (HHS) in September 2010 showed that men made up less than 10% of employed RNs licensed between 2000 and 2008, while non-white or Hispanic nurses represented only 16.8% of all registered nurses in 2008. While those percentages may have grown in years since the HHS survey, it is unlikely that the gap has become significantly smaller.

The lack of ethnic minorities, males, and economically disadvantaged nursing students does not reflect the immense diversity of the patients these students will soon be treating. As an article in GW’s student newspaper The GW Hatchet cites the school of nursing’s Dean Jean Johnson as saying, “the nursing workforce should reflect what the population at large looks like.”

GW will use the grant to launch a recruitment campaign to reach disadvantage students, as well as students who are changing careers. The program will offer both undergraduate and graduate degrees in nursing, and will utilize retention tools such as mentoring programs. The grant will also create scholarships and financial aid for some students, according to the GW press release.

Has your organization made efforts to diversify its staff? What are your thoughts on the GW program? Leave a comment and let us know!

Live webcast: Onboarding New Graduate Nurses

HCPro will present a live, 90-minute webcast on Tuesday, September 18, 2012 at 1:00-2:30 (Eastern). Onboarding New Graduate Nurses: How to Overcome Hurdles and Retain New Nurses demonstrates how the onboarding process for new graduate nurses will increase retention and speed up professional growth.

Join nursing professional development experts Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, and Jim Hansen, MSN, RN-BC, as they provide strategies for helping new graduate nurses navigate their first job hurdles through the onboarding process, from pre-hire to a successful transition into professional practice. Moving new graduates beyond academic theory and technical skill to become competent, confident, professional nurses begins with onboarding.

Here’s a look at the agenda for the webcast:

  • Pre-hire onboarding: Externships, selective hiring, BCAT, physicals, medication administration exams, and interviews
    • Workplace demographics and roles of new graduates in workforce metrics
  • General and unit-specific orientation: The roles of internships, preceptorships, and unit orientation
    • Cultural and social integration
    • Trusting clinical decisions through critical thinking and clinical judgment
    • Early career support
    • Developing skills in organization, prioritization, and delegation to build professional competence and confidence
  • Transitioning into the professional role best practice: a Nurse Residency Program
    • Essential knowledge, skills, and abilities for their new role: Moving beyond technical skills to professionalism

There will also be a live question and answer session following the program.

This webcast promises to be a great resource for nurse managers, assistant nurse managers, nurse leaders, charge nurses, directors of nursing, patient care managers, directors of patient care, directors of staff development, nursing professional development specialists, chief nursing officers, VPs of nursing, VPs of patient care services, and nurse residency coordinators. Sign up now and pay one price for your entire staff!

For more information or to sign up for the webcast, please visit www.hcmarketplace.com.

Burnout: A preventable occurrence or a likely outcome?

If you work in healthcare, it’s highly likely that you have worked with at least one colleague who has experienced burnout. It’s possible that you have suffered from burnout yourself. We’ve previously discussed nurse burnout and depression on this blog, and there have been several studies on the underlying causes of burnout, such as poor environment, staffing, lack of teamwork, as well as the effects of burnout on patient care. Most recently, a study conducted by researchers at the University of Pennsylvania showed a correlation between a high rate of nurse burnout and the number of healthcare-acquired infections.

As if the findings on nurse burnout were not alarming enough, a study recently published in the Archives of Internal Medicine found that physicians are more likely to experience burnout than other U.S. workers.  In a national survey of 7,299 physicians, 37.9% of physicians were likely to have symptoms of burnout, compared to 27.8% of a sample of 3,442 working adults. Physicians were also almost twice as likely to be dissatisfied with work-life balance than workers in other professions. Physicians practicing general surgery and its subspecialties, as well as physicians practicing obstetrics and gynecology reported the lowest rates of satisfaction with work-life balance, while physicians in emergency medicine, internal medicine, and neurology had the highest rates of burnout.

As the authors of the study point out, burnout can have serious effects on the personal and professional lives of physicians, including alcohol abuse, destruction of relationships, and thoughts of suicide. Several studies have also found evidence that burnout adversely affects the quality of care. The researchers of the physician burnout study state that the high rate of burnout among U.S. physicians “implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.”

In an interview with HealthLeaders Media, one of the authors of the report noted that physicians affected by burnout are more likely to see other people as objects rather than people, and become callous towards others. He compared the feeling of burnout to constantly feeling emotionally exhausted and “at the end of your rope.”

It is interesting to get a perspective on physician burnout when considering the impact of job dissatisfaction and fatigue in an organization. It seems as though healthcare professionals are experiencing increasingly high rates of burnout, yet little research has been done into methods for preventing burnout. Is it possible that burnout is just a given in healthcare? Should students head into healthcare professions anticipating burnout within a decade?

We want to hear from you: has your organization ever addressed the issue of burnout? If so, how? Leave your comments below!

Joint Commission issues Sentinel Event Alert on opioid use

Editor’s note: This blog post originally appeared on the Patient Safety Monitor blog

On August 8, The Joint Commission issued a Sentinel Event Alert regarding specific steps hospitals should take to prevent complications or deaths from opioid use. Opioids can cause adverse reactions such as nausea, vomiting, delirium, and respiratory depression, according to the Alert. Opioids are also commonly implicated in adverse drug reactions.

Lack of familiarity with different opioid potency, inappropriate prescribing and administration, and failure to properly monitor patients on opioids were among the causes cited by The Joint Commission for adverse events associated with opioid use. Nearly half of all the opioid-related adverse drug events reported to The Joint Commission between 2004 and 2011 were related to wrong dose medication errors.

The Joint Commission recommended the following safety measures for minimizing the risk of an adverse event:

  • Assessing patients for risk factors of respiratory depression, which include sleep apnea, snoring, morbid obesity, older age, preexisting pulmonary or cardiac disease, and receipt of other sedating drugs
  • Evaluating a patient’s previous history of painkiller use or abuse
  • Checking for an implanted drug delivery system or infusion pump by conducting a full body skin assessment before opioid administration
  • Employing individualized treatment plans for pain management

Giving additional consideration to patients who have never used opioids or are resuming opioid use. The Joint Commission also recommended that hospitals establish various policies and procedures to minimize the risk of opioid-related adverse events.  The full text of the Sentinel Event Alert can be found here.

Do as I say, and as I do: Setting a healthy example for patients

More than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention, and many speculate that percentage will continue growing in the coming years. With so many health issues linked to being overweight or obese, it is in the best interest of patients to listen to their healthcare professionals’ advice and move toward a healthier lifestyle and a lower weight. But what happens when physicians, nurses, and other healthcare professionals are the ones with the extra pounds?

Two students from Johns Hopkins School of Medicine asked this question, and responded by establishing The Patient Promise, an initiative aimed at addressing clinician health and encouraging physicians and other healthcare professionals to adopt the healthier habits they prescribe to their patients. The initiative’s website cited data that found 63% of physicians and 55% of nurses were overweight or obese, and pointed to additional research that showed physicians who live healthier lifestyles and are at healthier weights are more likely to address weight issues with their patients. Within a few weeks of launching The Patient Promise, 300 healthcare professionals and medical students across the country had signed the pledge to show their support.

Earlier this year, we posted on the blog about a study from the University of Maryland that examined the impacts of job stress and irregular work hours on nurses’ weight. The obesity issue, and more broadly the issue of leading a healthy lifestyle, is one that needs to be addressed, and projects like The Patient Promise are steps in the right direction. As the Patient Promise website says, “Hippocrates, not hypocrisy.” Nurses and physicians have the opportunity to lead by example and make a positive change in both their own lives and the lives of their patients; it is an opportunity that should not be wasted.

Leave a comment and let us know about any initiatives your organization has in place or is considering for promoting a healthier lifestyle among your nurses and physicians.

Celebrate a nurse through donation of roses for Nurses’ Float

Editor’s note: The following is a press release from Bare Root, Inc.

Blossoming Appreciation for Nurses: “Buy a Rose” to Decorate Inaugural “Nurses’ Float” at 2013 Tournament of Roses Parade

Funds Raised through $25 Donations to Support Nursing Programs, Scholarships and Grants

PASADENA, Calif. (July 19, 2012) – Bare Root, the nonprofit organization consisting of five California-based nurses who independently spearheaded the effort to build a float to honor 2013 Tournament of Roses president Sally Bixby, RN, and nursing professionals worldwide, announced today that they’re providing the opportunity for others to individually honor nurses by donating roses on their behalf via the foundation’s web site at www.flowers4thefloat.org.

“When we decided to build a float to honor Sally, we realized that we also wanted to honor nurses everywhere.  Nurses are really the unsung heroes of healthcare and healing,” said Monica Weisbrich, RN, president of Bare Root. “So many people have approached us asking how they can honor a special nurse in their life.  We thought this would be a wonderful way to allow them to express gratitude and to share their story if they would like to.”

Visitors of the Flowers for the Float web site have the ability to access the online store and select a quantity of roses to purchase for $25 each.   During the donation process online, users have the ability to indicate the name of the nurse they are honoring and also provide a story if they would like.  These stories are being shared on the web site’s “Celebrate a Nurse” page.  The roses purchased will be labeled with the names provided and placed on the float during live decoration.

The theme of the float, “A Healing Place,” serves as a metaphor for the healing environments nurses create through the use of their qualities and skills.  “A Healing Place” is created anywhere there is a nurse and a patient – from the hospital to the battlefield; from a school to a home; from a clinic to a specialty care center.  The words that surround and support the float explain those qualities.

“There are so many people in the world who have been touched in their lives by a special nurse,” said Weisbrich. “This is just one way we can bring all of those good messages and thoughts together in a single place.”

About Bare Root and the Nurses’ Float

In 2007 five registered nurses in California formed a nonprofit organization, “Bare Root,” to raise money and build a float to honor 2013 Tournament of Roses president Sally Bixby, RN, and nursing professionals worldwide for their tireless efforts.

2013 will be the first time that a nurse will be president of the Tournament of Roses, and only the second time that a woman was named to the top role.

To date, Bare Root has raised more than $300,000. One hundred percent of funds raised supported the development of the Nurses’ Float, with continued fundraising efforts being used for scholarships and grants to qualifying organizations.

For more information about the Nurses’ float, visit www.flowers4thefloat.org or the Nurses’ Float Facebook page at http://www.facebook.com/NursesFloat.

 

CONTACT:

Sharon Noot
Noot Inc.
714.527.7735
sharon@nootinc.com