Editor’s Corner, June 2007
Hi everyone, and I hope you're doing well. The summer is back here again and so is your newsletter after a long break. From now on you will receive your Nurse-Recruiter newsletter every month, without fail. As the new N-R editor, I guarantee you that. In this issue we have the best of interesting news items and two feature articles that we hope you'll enjoy.
I'd also like to take this opportunity to remind you that you are welcomed to take full advantage of our new Live Job Chat service which puts you in direct and instant contact with the representatives of the companies that you like. It's an excellent way to learn more about the opportunities that interest you. Try it today.
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Ugur Akinci, Ph.D.
Headline Nursing News
Nevada Plans for Five “Magnet Hospitals” to Attract Top Nurses
The State of Nevada is planning to create five “Magnet Hospitals,” a credential conferred by the American Nurses Credentialing Center, in order to solve its registered nurse shortage problem – one of the worst in the nation. Nevada is also planning to award $20,000 sign-on bonuses as a strong incentive for the qualified RNs. Only 4% of all hospitals in the United States are awarded with the distinction which requires the implementation of a multi-year program. There were 67 such elite hospitals in 2006. The so-called “14 Forces of Magnetism” requires a re-structuring of the candidate hospitals so that it would encourage professional development and allow the nurses participate in the decision making process. For more: Click Here
Nurse-Turned-Episcopal Minister Remembered as Advocate of Poor
Rev. Susan Sager, an Episcopalian priest who passed away recently at age 64 after a battle with cancer, is remembered fondly in her town Albuquerque, NM for her charitable heart and her work on behalf of the poor. Sager received her nursing degree from University of Texas and worked as a nurse at the St. Joseph's Hospital for a while before devoting herself totally to the church. Sager traveled with her husband to Honduras for 11 years to provide medical care to the needy villagers. She is survived by her husband, a daughter and two sons. For more: Click Here
Maryland Nurse Aims to Comfort the Dying
Joy Ufema, 64, a registered nurse serving at two different Maryland hospitals, aims to bring a sense of peace and comfort to the patients in their deathbeds. Ufema's called her project “ Ars Moriendi - The Arte and Crafte of Dying Well,” named after a 15th century Latin text offering advice for those in their last stages of life. She said the idea is to give the “control over experiencing one's life” back to the dying patients. She calls the new venture “Ars Moriendi - The Arte and Crafte of Dying Well”, after a 15th century Latin text that offered advice on achieving a good death. Ufema said it's about giving control over the experience back to the dying person. For more: Click Here
Nurse-Doctor Couple's Marathon Tour to India Brings Medical Service to the Poorest
Nurse Laura Goldman, 48, who just graduated from Univ. of Michigan with a master's degree in nursing and her emergency room doctor husband Mitch Goldman of Troy, MI have recently finished their 9-day whirlwind visit to Andhra Pradesh, India to bring much needed medical services to India's illiterate poor. After setting up a makeshift clinic in the village of Rajahmundry, the nurse-doctor couple treated as many arthritis, malnutrition and even starvation cases as they could. The visit was organized by Kensington Community Church in Troy. Laura is a former Survival Flight nurse for the U-M Medical Center, and she is working toward her certification to become a family nurse practitioner. For more: Click Here
United Nations Recommends Routine HIV Test for All Patients
UNAIDS and the World Health Organization officially adopted a new health policy that will change the way AIDS is diagnosed and treated, especially in developing countries where 80% of HIV-positive cases are found. The new policy recommends routine testing for HIV without necessarily waiting for the patient's request, as is the current practice. Increased diagnosis might increase the demand for lifesaving anti-retrovirals but officials said they cannot wait for all the pieces of the treatment puzzle to be in place before starting to diagnose all infected. They added that since those who learn they are HIV-positive are more likely to engage in safe sex, the higher diagnosis rate should have a positive effect in the long run even if necessary medication is not immediately available for all who need them. UNAIDS estimates that 31 million of the 39.5 million people living with AIDS worldwide are not aware that they are infected. For more: Click Here
Special Feature: More Nurses in Decision Making Roles – Prospects and Challenges
Nurses have always been at the front lines of the “healthcare battle field” more so than anybody else. They are the ones in close touch with patients and their families. They are the ones who are holding the pulse of the healthcare system on a day to day basis.
Thus it is also natural that there is an increasing demand in the nursing community to have a more say in the formulation of healthcare policies as well as in the way the system itself is run and governed.
In theory, this is a good thing too since no doubt it will bring much needed invaluable input from the trenches and make sure the best possible solutions reach those in direst need through the most efficient channels possible.
Compared to the situation ten or twenty years ago, nurses today do participate in healthcare decision making in increasing number of course. There is no doubt about that. But, despite all the qualified undergraduate and master's nursing programs across the nation and many professional development programs, there is still long ways to go.
The chief challenge and issue with the expanded participation of the nurses in decision making is that it involves nothing less than the very same leadership and management skills that the movers and shakers in any industry must possess.
That is, when it comes to decision making, strategic planning and policy formulation, it is not enough just to be a highly qualified nurse well versed in medical technology and skills.
One must also be, for example, an excellent coalition-builder in order to build common fronts with other governmental and non-governmental organizations in society in order to influence the decision making process. Basically, it is a political as much as a technical role.
Among other things, our nurses must also master advanced mass communication skills in order to “work” the media and get the appropriate messages across as wide a cross section as possible. In this day and age of hourly news cycles and instant Internet communication, nurses in such leadership roles must have the skills to understand and manipulate the way the news is created, distributed and consumed. They need to plan their strategies by leveraging such comprehensive media expertise.
Again related to that is the necessity for the nursing community as a whole to get involved in better public relations and explain at a higher level the crucial role they play in the national health system.
A case in point -- go to Google News for example on any given day and make a news story search with the key word “nurse” and you would be surprised at the number of stories returned about nurses “taking advantage” of their patients or getting involved in one or other type of vice and character weakness that none of us associates with our dignified profession.
That goes to show that image building and maintenance is a public process that should be tended to with the same care that goes towards our patients and our own professional development. A solid positive image, a “market brand” if you will, that clearly communicates the precious “value added” that nursing profession represents is an invaluable ingredient for all nurses climbing up the proverbial ladder of decision making. It's the “water” that raises all the “boats” effortlessly.
In a recent paper, the International Council of Nurses (ICN) headquartered in Geneva, Switzerland has summarized the various dimensions of increased decision making by nurses as follows: strategic planning, budgeting, efficient resource planning and utilization, and the planning, management and evaluation of programs and services.
The ICN has again stressed that the position of the nurses as the “point guards” of the whole health care system who are in close touch with what's really happening out there uniquely qualifies them for coordination of health services and “strategic planning and the efficient utilization of resources.” Who can argue with that?
One hopes that through such expanded participation in the decision making process at all levels, the trend for “moral and ethical stress” among nurses that has been covered by the recent literature might be countered as well, at least to a certain extent.
The recent research by Mary C. Corley, PhD, RN., Associate Professor at Virginia Commonwealth University found that a large percent of nurses interviewed would not want family members treated in their own hospitals.
The same study also showed a larger percent (25%) of nurses had left a position in the past due to “moral distress” compared to 13% in 1995 -- that is, the “distress” of disillusionment with the various “managed care systems.” Increased political participation in decision making should be expected to work in the other direction and increase job satisfaction among nurses at large. It would help not only the patients, their families and public at large but the nurses themselves too.
The most systematic framework of nurses' participation in decision making process has been developed by the American Nurses Credentialing Center (ANCC), the same organization that confers on US hospitals the prestigious designation of “magnet hospital.” To earn the distinction, hospitals usually invest two to five years of work to change their structure to one that complies with the ANCC criteria.
Some of the “magnet hospital” criteria directly address increased decision making participation for nurses like “decentralized, shared decision-making processes prevail throughout the nursing operations of the organization,” or “ the rehabilitation nurse participates in decision-making regarding allocation of resources used by or for the patient.”
Clearly, such expansion of nurses' administrative, leadership and political roles is here to stay thanks to the wide-spread consensus that it would only increase the efficiency, rationality and fairness of our existing healthcare system.
Now it's up to us to run through this portal of opportunity and make the best of it. The decades ahead will be an exciting one for our nursing community, full of fascinating professional challenges and growth opportunities. It's a good time to serve as nurses again.
Special Feature: Should Nurses be Paid by Pharmaceutical Companies to Visit Patients?
It is an intricate situation... Most states or local administrative regions do not have enough funds to check up and monitor all those who need medical treatment, especially those suffering from chronic diseases like diabetes and asthma.
So what if a pharmaceutical companies puts up the funds to have qualified nurses visit doctors' offices to review the charts of the patients and to assess their progress? They sometimes also provide much needed professional development training for the office staff as well.
The practice, generally referred to as “disease-management programs,” started in U.K. but is spreading to Ireland, Germany and Belgium as well. The French drug maker Sanofi-Aventis SA, for example, is funding programs in Britain to provide training materials and classes for the staff nurses working in doctors' offices. However, the company officially claims that no attempt is made to push any proprietary drugs.
Critics of the practice charge that such pharmaceutical company programs are nothing but a thinly veiled attempt to push more highly-priced pills that the company manufactures. Dr. Jim Kennedy, the spokesman for the Royal College of General Practitioners, is reported in American press as saying that there is a "perceived or real risk of the pharmaceutical companies' interests taking precedence over the patients' interests.”
The conflict of interest perhaps cannot be proven with 100% certainty but it's there and everyone knows it, the critics claim.
As proof, the point at what happened to Merck last year in Britain where such paid-nurse visits are very prevalent. The Prescription Medicines Code of Practice Authority, a British watchdog group, has examined the complaint filed by a former Merck sales representative and decided that the program was indeed a “reward program” for those doctors prescribing “Cozaar,” a Merck product.
After being suspended for three months, Merck wrote a letter to all doctors involved and said it was taking the issue "very seriously," and that it "is working hard on corrective actions."
Another issue that the critics of the program like Royal College of Nursing bring up is the alleged violation of the patients' privacy when these “contract nurses” examine the patient charts usually without the knowledge or the consent of the patients involved. In a recent $80,000 program sponsored by several big drug companies, for example, the nurses contracted from outside examined patient records for six months to find out instances of heart disease. The defenders of the program insist that the nurses are prohibited from sharing such patient information with the pharmaceuticals and the abide by that rule.
The practice is not totally unknown in the United States. Pfizer Health Solutions have sponsored similar “disease-management programs” in Florida, especially for Medicaid and Medicare patients. Between 2001 and 2005, a group of Pfizer-paid nurses visited tens of thousands of Florida patients with asthma, diabetes and heart disease or talked to them over the phone. The “contract nurses” encouraged these patients with chronic illness to eat well, consulted with them on how to exercise properly and take their medications regularly.
As in all other cases, Pfizer claimed it was rendering the State of Florida an important public health service by diagnosing chronic problems before they evolved into much more serious and costly cases. Florida saved money by allowing Pfizer to carry out such programs, the company officials claimed.
The Sunshine State, in return, seems to have agreed with that assessment since it gave a “preferred status” to Pfizer drugs for its Medicaid patients.
So it's a delicate symbiotic situation in which the states and governments, on the one hand, and the pharmaceutical companies, on the other, are trying to come up with a middle-path solution in which one side would manage to stem the ever-increasing cost of treating chronic diseases while the other side is guaranteed an inelastic demand for its prescription drugs. Caught in between are our professional nurses who have to rely more on their innate sense of right and wrong and their oath “not to do any harm” than anything else.
Given the trend in rising medical care costs and tight state budgets, I think we will see more cases of similar “disease-management programs” in the United States and more opportunities for RNs to offer their services through quality professional agencies like those found on Nurse-Recruiter.