A proposed Massachusetts law on minimum safe nurse staffing levels is working through the legislature there, but regional hospitals there are not just standing by and letting the measure pass without a fight. A $70,000 radio campaign has been launched to get the public to stop the compromise committee in its tracks.

This is in response to a radio and TV ad campaign run by the Massachusetts Nurses Association in June, supporting the measure. The Massachusetts State legislature will adjourn for the summer this week and supporters of the bill are hoping to push through a compromise between the house and senate versions of the bill before the recess.

Read the whole article here.

Predictably, the hospitals are saying the bill will increase the cost of health care across the board while the nursing union is citing serious patient safety issues involved in unsafe staffing. This is not an issue that is easily resolved since requiring minimum nurse staffing is not the same as actually putting it into practice.

———————

Check out our interview episode with Zenei Cortez of the California Nurses Association on their nurse staffing law.

Right Click to download (Macs Option Click)

———————

A Complex Problem

Nurse staffing is a complex issue. Hiring and retaining nurses in today’s competitive job marketplace is difficult. Some hospitals are working on methods to hire and retain more nurses and are having some success in the process, but what if they now had to go out and hire 10, 20, or 30 more nurses to fill voids in the schedule created by mandatory staffing levels.

The other side of the staffing issue is where are all of the nurses going to come from? Seriously, if every other story in the news is about plugging hole in the nurse staffing dike, how can you hire more nurses if you don’t have any more nurses to hire? They’ve got to come from somewhere and every statistic I can find says that the schools cannot keep up with the losses from retirement and death in the current nursing staff pool.

So, nurse staffing laws - are they a good idea or a bad idea?

The issue is complex, but if adequate staffing levels are available in the region, then I say that, yes nurse staffing laws can help. We have all seen what happens when businesses are left to police themselves without government oversight of some kind. Relaxed or removed regulation collapsed the savings and loan industry in the 1980’s. De-regulation and lack of effective government auditing created the Enron scandle. The current sub-prime mortgage crisis is another example.

When nurses are overburdened with extra patients, mistakes start to happen. Patient care is ultimately more expensive due to the costly errors that accompany the most common medical errors. Nurse staffing laws are intended to ensure that nurses have the time to provide competent care for their patients, in a safe and non-stressful way.

Just because our industry is health care does not make us immune to greed or the bottom line administrators who will opt to take a chance on patient safety in order to delete one staff position from a department or departments. The for-profit health companies (hospitals and insurers) need some oversight to maintain safe patient staffing.

In a perfect world, each patient would get their own nurse and physician to hold their hand through the illness and recovery process. But we live in a world that is far from perfect. In a time where energy costs are rising and hospitals and businesses everywhere are struggling to maintain a budgetary balance, too often the employees take the hit.

Nurse staffing in the hospital units should not be one of the jobs affected.

————————

Read the Nursing Show blog article, posted earlier this week, on what one hospital is doing to cope with staffing issues.

I’m often asked about how I stay current on so many different aspects of the medical fields. Well, the answer is that I do a lot of reading. It’s not that hard, really. There are a number of excellent resources out there for nurses and nursing students. The most notable of these are the available nursing journals and periodicals published every month.

I’ve compiled a list of my favorites. Many of them also offer online access to full text versions of their articles for subscribers which is a must for those of us who work online all of the time. Here they are in no particular order with links to Amazon.com so you can subscribe if you’d like.

• AJN: American Journal of Nursing
• Nursing Magazine
• Nursing Made Incredibly Easy
• American Nurse Bi-Monthly

Do you have something else that you’d like to share with the listeners.  I’m always looking for other good resources so let us know.  Send an email to Comments@nursingshow.com and share your favorite nursing reading options.

(disclosure: These links are part of the Amazon affiliate store for the Nursing Show and part of what you spend there does come back to help support the Nursing Show site.)

This week, I’ll focus on a couple of articles that deal with nurse staffing issues, both hospital based solutions and legislative solutions. Today, let’s look at one Wichita, Kansas hospital has instituted several interesting programs to retain and attract nurses.

Read the whole article here.

The program in this hospital is based on offering the nurses new opportunities to specialize in different treatment and care areas.  An example cited is the creation of an IV team.  Nurses who do nothing but start and monitor IV lines in the facility, as well as start specialized IV access points like PICC lines.  By having a specialized team for this task, nurses are freed up to take care of other patient needs.

The hospital also added to the “hospitality team,” techs and other non-nursing staff that assist with patient care by performing non-nursing duties.  In some areas, the hospital also implemented the use of remote monitoring of patients from a central location.  These programs gave nurses time to perform their dedicated nursing duties without getting bogged down with tasks that can be handled by unlicensed staff.

Finally, the administration addressed the causes of nurse turnover including job dissatisfaction, wages, and work environment.  Money was found in the budget to add to weekend and overtime compensation.  Nurses were included more actively in planning of hospital policies and programs.  Opportunities for education were added for career change or advancement.

The best part of this hospital’s commitment to improving nurse staffing on a long term basis was their response to area nursing schools that requested more clinical time for their students.  Arrangements were made to include more evening and weekend hours, as well as improving support for the student’s education in the various areas of the hospital by encouraging staff involvement in their rotations.

The bottom line effect of these programs is clear to the administrators of the hospital.  Turnover of nurses has dropped from 20% to 17%, meaning less time spent precepting new nurses, and less money spent on advertising for and hiring new nurses.  The net effects need to be fully examined in each facility but this article can go a long way to countering administrators’ claims of feasibility or effectiveness.  One hospital has proved them wrong.

If you had trouble downloading the file for Episode 36 last Friday you may have noticed that it was a duplicate of the previous week’s show. Due to a crossover in the linked files (i.e. Human Error), the previous week’s mp3 file was attached to the download link.

You will now get a refreshed RSS feed file with the corrected link and the real Episode 36 should download to your computer just fine now.

Of course, if you used the link from your Email Newsletter, then you know that your link was just fine, as was the link on the website. It was the link in the iTunes and other download feeds that was mixed up.  Just another reason to be on the newsletter.

Sorry for any inconvenience. I’ll iron out the reasons for the mistake and I can assure you that the person or persons responsible will get a stern talking to.

(I talk to myself all of the time anyway so I’ll just add this to the conversation.)

Jamie, the Podmedic

Welcome to Episode 36

The Nursing Show is a proud member of the Blubrry Podcast Network.

Right Click to download (Macs Option Click)

Subscribe with iTunes here (must have iTunes installed — it’s free)

RSS Feed to subscribe (copy url to Juice, Zune Marketplace, or your favorite podcatcher)

Click the arrow to play the Nursing Show

A podcast for Nurses, Nursing Students, and others interested in what it takes to be a Nurse

Fill out the New Survey and you could win an iPod Touch!

—————————-

Sponsors

Get 10% off Pepid’s portable nursing solutions

Nursing Show Listener Deals –

Save 50% off first month of Blockbuster Total Access (visit MyMovieSavings.com)

———————————–

News–

Rising Gas Prices Affecting Home Health Care Workers

Nursing Homes Unprepared for Pandemic Flu Fallout

Heart Disease Is Linked To Worse Mental Processes

———————————–

Tip of the Week — Red Blood Cell (RBC) Lab Values

Nursing Diagnoses and CBC Results Page

For Students: Flashcard Exchange (lab values)

NIH Clinical Center Test page

Cook, L. (1999). The value of lab values. AJN, American Journal of Nursing, 99(5), 66-69,71,7.

Link to Reference

Subscribe to American Journal of Nursing via Amazon.com here

———————————–

Don’t miss an episode! Get the Nursing Show Newsletter by email. Fill out the email form in the right hand column of the site. Get it now!

Comment or share ideas here on the comment link below or by email:

Comment@NursingShow.com

Other Podcasts from Jamie Davis:

• The MedicCast (for EMTs, Paramedics, EMS field work)
• MedicCast News (Weekly short medical news program)
• MedicCast Live (Monthly live call-in show with a single EMS topic)
  
• Headliner News Roundup (Weekly single new item with facts and commentary)
  

Contact Me!

————————————————

Music from The Podsafe Music Network

This week - “Breathe Deep” by Caitlyn Smith Check out Caitlyn Her

Or use the button below to purchase her music at iTunes.

Click here to check out other Songs from the MedicCast Network Podcasts at the iTunes Store.

————————————-

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

A recent study published in the American Journal of Public Health and discussed in this article at WebMD.com, points to tobacco companies’ manipulation of menthol levels in cigarettes in order to attract younger smokers. The study also points to these same smokers as adults requiring stronger menthol levels in their cigarettes.

The study used internal documents from tobacco companies, marketing research, lab testing of menthol cigarette brands, and a U.S. drug use survey to gather it’s data. The study proposes that the use of mild menthol levels in cigarettes makes smoking more attractive to youth because it soothes the harshness of the cigarette smoke making initial smoking attempts more palatable.

Cigarette manufacturers deny the study’s claims, saying they have drawn the wrong conclusions from the collected data and pointing out that menthol is not addicting. The study authors agree but conclude that menthol might play a part in potentiating the addictive nature of nicotine in cigarettes.

According to the National Institute of Neurological Disorders and Stroke, approximately 250,000 to 350,000 Americans suffer from Multiple Sclerosis with 200 cases diagnosed each week. Multiple Sclerosis, also known as MS, disseminated sclerosis, or encephalomyelitis disseminate, is a chronic, potentially debilitating auto-immune disease which affects the central nervous system.

An unpredictable disease which varies in severity from person to person, MS may manifest itself through any number of symptoms including, but not limited to, numbness, weakness, tingling or pain, loss of vision, tremors, loss of coordination, fatigue, dizziness, cognitive difficulties, sexual dysfunction, urinary and bowel problems, and depression.

To date, there is no definitive cause for MS although factors such as genetics, diet, gender, environment, and stress are believed to influence whether or not an individual develops this condition. As regards prognosis, most individuals with MS have a relatively normal life span with two-thirds of patients remaining mobile 25 after the onset of the disease. Eventually, about 70% of patients report some physical limitations.

There is no cure for MS. Conventional treatment may include medication to address the various symptoms, and physical therapy when necessary. However, as most of the medications available also carry potentially dangerous side effects, many choose to manage the disease through diet and exercise (both of which have proven beneficial).

In addition to lifestyle changes, a number of individuals seek alternative treatment. Despite the fact that there is “unclear or conflicting evidence” supporting the clinical efficacy of any single alternative treatment for MS, there are several which have been shown to be potentially beneficial.

One such treatment of particular interest is magnetic therapy. To date, several clinical trials have explored its use in the treatment of MS. In one double-blind study performed by researchers at the Department of Radiology, University of Washington, Seattle, which evaluated the efficacy of a magnetic pulsing device in the treatment of MS, it was found that the (Enermed) device had an statistically significant effect both on patient performance scales and on alpha EEG magnitude during a language task.

Another randomized, placebo-controlled, double-blind crossover study evaluating data gathered from multiple research institutes found that, although use of the device did not significantly increase bladder control, it did significantly decrease fatigue in individuals with MS. In their conclusion, researchers stated that that the device should be considered as a treatment for the fatigue associated with MS.

In addition to magnetic therapy, other Integrative, Complementary, and Alternative Medical (ICAM) therapies that have shown promise in the treatment of MS. These include colostrum, creatine, evening primrose oil, ginkgo biloba, vitamin B-12, massage, vitamin D, yoga, acupressure (Shiatsu), acupuncture, the alexander technique, astragalus, bee pollen, boswellia, calcium, chiropractic therapy, detoxification therapy, DHEA, healing touch, Kundalini yoga, liver extract, meditation, music therapy, organic food, ozone therapy, phosphorus, qi gong, reflexology, reishi mushroom, resveratrol, rutin, SAMe, spiritual healing, tai chi, TENS (transcutaneous electrical nerve stimulation), therapeutic touch, and thymus extract. More studies on these and other therapies are ongoing.

References

1. rVita: Alternative Medicine
2. http://www.ninds.nih.gov/disorders/multiple_sclerosis
3. http://www.ncbi.nlm.nih.gov/pubmed/12185153
4. http://faculty.washington.edu/toddr/magnetic
5. http://www.ncbi.nlm.nih.gov/pubmed/17613606

Danielle Grilli is the Content Director of rVita.com

(July 17, 2008 CDC Press Release) — The proportion of U.S. adults who self report they are obese increased nearly 2 percent between 2005 and 2007, according to a report in today’s Morbidity and Mortality Weekly Report (MMWR). An estimated 25.6 percent of U.S. adults reported being obese in 2007 compared to 23.9 percent in 2005, an increase of 1.7 percent. The report also finds that none of the 50 states or the District of Columbia has achieved the Healthy People 2010 goal to reduce obesity prevalence to 15 percent or less.

In three states – Alabama, Mississippi, and Tennessee – the prevalence of self-reported obesity among adults age 18 or older was above 30 percent. Colorado had the lowest obesity prevalence at 18.7 percent. Obesity is defined as a body mass index (BMI) of 30 or above. BMI is calculated using height and weight. For example, a 5-foot, 9-inch adult who weighs 203 pounds would have a BMI of 30, thus putting this person into the obese category.

The data were derived from CDC’s Behavioral Risk Factor Surveillance System, a state-based telephone survey that collects information from adults aged 18 years and older. For this survey more than 350,000 adults are interviewed each year, making BRFSS the largest telephone health survey in the world. BMI was calculated based on this self-reported information.

“The epidemic of adult obesity continues to rise in the United States indicating that we need to step up our efforts at the national, state and local levels,” said Dr. William Dietz, director of CDC’s Division of Nutrition, Physical Activity, and Obesity. “We need to encourage people to eat more fruits and vegetables, engage in more physical activity and reduce the consumption of high calorie foods and sugar sweetened beverages in order to maintain a healthy weight.”

The study found that obesity is more prominent in the South, where 27 percent of respondents were classified as obese. The percentage of obese adults was 25.3 in the Midwest, 23.3 percent in the Northeast, and 22.1 percent in the West.

By age, the prevalence of obesity ranged from 19.1 percent for men and women aged 19-29 years to 31.7 and 30.2 percent, respectively, for men and women aged 50-59 years.

“Obesity is a major risk factor for a number of chronic diseases such as type 2 diabetes, heart disease and stroke. These diseases can be very costly for states and the country as a whole,” said Deb Galuska, associate director for science for CDC’s Division of Nutrition, Physical Activity and Obesity.

For more information on obesity trends, including an animated map, visit http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps

To learn more about CDC’s efforts in the fight against obesity or for more information about nutrition, physical activity, and maintaining a healthy weight, visit http://www.cdc.gov/nccdphp/dnpa.

CDC and FDA investigators are still investigating the Salmonella outbreak of this summer that caused illness in more than 1,200 people.  The lead investigators acknowledge they may never find the answer, even as they lift the nationwide warnings on tomatoes.

The officials are scratching their heads but are not giving up.   This is the largest foodborne illness outbreak in the last 10 years. The challenge is that fresh produce is not tracked as carefully or as easily as prepared food is.  There are no bar codes on a head of lettuce or a bushel of jalapenos, where the investigation is now focusing.

The trick, according to one researcher is finding a sick individual who is a good food historian.  Try to sit down and write down every food item you ate for the last several days and include all condiments, side dishes, garnishes, and provide stores of origin for all of them, too!  I couldn’t do it, or at least not do it with any level of reliability.

It does point out the need to get a complete history for any patient when they present with non-specific symptoms that might be related to an exposure to a pathogen or infectious disease. The patients may remember more the closer to the illnesses origin and a good history early on may help to jog memories later on if public health officials become involved days or even weeks down the road.

Drug companies are back in the news again and probably not in the way they would have liked. A group of 43 states plus the Federal Government joined together to charge drug companies with improperly marketing antipsychotic drugs to pediatric Medicaid patients when the drugs were not approved for use in children.

The states started to notice the improper marketing programs when the cost of anti-psychotic drugs soared from one year to the next. The drug company involved in this case was Bristol-Myers Squib and the settlement cost them $515 million.

Read the article here about the New Hampshire view of the settlement.

What strikes me most about this article is that the drug companies constantly complain that the high cost of medications is because of the cost of research. However, the cost of marketing seems to be pretty ridiculously high when they end up paying an extra $515 million for the cost of their screw up.

Who will ultimately pay for this error? Why the people who buy the next high priced drug the company releases, of course. Fining a company for something like this is not enough, especially when they will simply turn around and pass the cost back to the states in the following years.

The solution seems much simpler to me — allow the states to participate in collective bargaining for drug purchasing, create a national health care program that actually pays the real cost of these drugs without the hyperinflated prices. Finally, the state and Federal Governments need to hold the executives at the top accountable for the profit at any cost attitudes seen recently in the pharmaceutical industry.

It’s an election year in the U.S., folks. Talk to your local, state, and federal candidates to determine what they plan to do to repair the collapsing U.S. health care system. Visit the American Nurses Association site on health care reform and find out the issues and key points from your national nurses’ representative organiztion.

And last but not least, VOTE!