Indiana – Day 3

The rare joint committee meeting regarding “Right to Work” legislation is taking place in a packed gallery. The Democrats have again refused to leave quorum so no official business can be transacted. However, it will be impossible to slow the vote forever and Republicans are already looking to next week for a vote.

Meanwhile, the NFL Players Association released a statement this morning decrying the Indiana Republicans plan to “ram through so-called ‘right to work’ legislation.” (Read the entire release.)

“As Indianapolis proudly prepares to host the Super Bowl it should be a time to shine in the national spotlight and highlight the hardworking families that make Indiana run instead of launching political attacks on their basic rights,” the release stated. “This Super Bowl should be about celebrating the best of what Indianapolis has to offer, not about legislation that hurts the people of Indiana.”

Indiana – Day 2

Quick recap – on Wednesday, January 4, 2012 “Right to Work” legislation was introduced into the Indiana House. The goal of the Republicans – pass it by February 5 before the Super Bowl comes to town.

In a move that was no doubt based on Governor Mitch Daniels’ realization that the new draconian security measures at the Indiana State Capitol might hinder the voices of the people from being heard and less on the whipping he was taking in the press (insert dubious look here), the path has now been cleared for all those who wish to enter the Capitol to protest the “Right to Work” legislation. And hundreds showed up this morning to take full advantage of the displaced security rules, chanting “our house” and “no right to work.”

However, there were few Dems to be seen in the House. In a movement that started yesterday, the Indiana Democrats have stayed in caucus to discuss the legislation and effectively slow the process of the bill down. Until at least seven Democratics appear, the House does not have the two-thirds needed to conduct business. The Senate has a Republican majority and can move forward.

The Democrats have made it clear that the bill’s process needs to be more thoughtful with hearings held around the state, an idea the Republicans promptly rebuffed. The insistence by the Republicans to push the bill through irritates House Minority Leader B. Patrick Bauer. “We don’t need to ram it through in three days,” he told The Indianapolis Star, referring to the joint committee meeting scheduled for tomorrow. “It’s the quick hit. It’s the rushing it through. We’re willing to sit down and try to work out a reasonable agenda with the state. But first they try to deny access to the building, and the public wouldn’t stand for it. Now they’re trying to rush it through.”

It’s been speculated that the impetus behind getting the bill is to remove the protestors and media attention from the issue before the Super Bowl comes to town. But the fact that in 2011 the NFL’s Players Association denounced “Right to Work” is doubtless causing some Republican sleepless nights.

What a pretty picture for the national media – professional football players carrying “No Right to Work” signs and marching with other union workers in front of the Indiana State House . . .

Watching Indiana

Take a quick quiz. What do you know about Indiana? It’s in the Midwest, with the northern border of Indiana touching the southern border of Michigan. The capitol is Indianapolis. Super Bowl XLVI will be played at the Lucas Oil Stadium in downtown Indianapolis on February 5, 2012 (this is an important date – keep track of it!).

It’s also the site of the first intrusion of the “Right to Work” legislation into the Midwest industrial belt.

On Wednesday, January 4, 2012, Republican Indiana State Representative Jerry Torr introduced ”Right to Work” legislation into the House. According to Reuters, “the legislation is expected to pass the Republican-majority Indiana assembly with the support of Republican Governor Mitch Daniels, who said it is ‘all about new job opportunities.’” The bill is expected to be in the Senate and House labor committees on Friday.

However, Democrats and union supporters are expected to put up a fight and in fact, House Democrats refused to come out of their caucus today in a delay tactic. Rumors are flying that the Dems may escape to nearby Illinois again as they did last year when a “Right to Work” bill was introduced to avoid having to vote for it. Eventually that bill died, but Republicans are geared up this time to go to the mat for the legislation.

Competing ads between the Governor and the Indiana AFL-CIO are already on local TV stations. This morning, people were lined up to get a coveted spot in the halls. In an interesting twist, the Indiana State House has changed the visitor guidelines in what looks like an attempt to avoid protests such as the ones that were held in Wisconsin when “Right to Work” was introduced there. Less than 1,500 people will be allowed to visit at any given time and some meetings will be limited to actual rooms. Sign size has been limited. Visitors will only be allowed to enter and be screened at one of the entrances.

Matthew Tully, a columist with The Indianapolis Star, said this: “Since learning of the new policy, I’ve had this vision: On a cold winter morning sometime this month, four Indiana residents get in their respective cars and head for Indianapolis. A home-school advocate from Marion. A union worker from Evansville. A small-businesswoman from Madison. A tea-party activist from Valparaiso. As Hoosiers before them have for generations, all four want to go to the Statehouse to express their views — whether those views are conservative, liberal, moderate or nonpartisan.

But when they arrive at the steps of the state’s most majestic building, the doors are closed. Others who got up earlier or who had fewer miles to travel or who were part of a better organized group already have filled the People’s Building.

And with that, as one critic said last week, the Statehouse will be the People’s Building no longer.”

And finally, as if this scenario wasn’t bad enough, the Republicans have made it clear that this legislation must be passed by February 5, 2012. Why? You can’t have people exercising their First Amendment rights in front of the national sports media and all those Super Bowl fans! What’s a little stripping of people’s union rights when the nation’s biggest football game is on the line?

Indiana workers, we feel for you here in the Mitten State. Like you, we are determined to defend our union rights. But you’re in a terrible situation. Any state government that is restricting its own people from their House and putting a sporting event over the men and women who pay Indiana taxes should be villified in the press and held accountable by the courts.

MNA will continue to follow this developing story in Michigan Nurse Live and on our Facebook page. Need to boost your understanding of “Right to Work” legislation? We have fact sheets, statistics and more at http://www.minurses.org/legislation/resources/rtw.

Bruises (and more) in the Line of Duty

I am delighted to report today that SB 642 and SB 643 have passed out of the Michigan Senate and are on their way to the House, where I hope they will get a quick review and be on to the Governor for a pen scrawl into law. If you haven’t been following these bills, here’s a quick recap. SB 642 is a bill to amend the Michigan Penal Code so that anyone who assaults or batters, or assaults and batters a health care professional while performing his or her professional duties is guilty of a felony punishable by imprisonment or a fine or both. This bill, and SB 643, make smacking a health care professional a felony punishable by higher fines and longer jail sentences. You get mad at the EMT rescuing your mother, take a swing and connect, and you could be looking at up to two years in jail and a possible $5,000 fine.

This bill covers EMTs, ambulance operators and attendants, nurses, physical therapists, occupational therapists, physicians and physician’s assistants. It’s long overdue. The amount of physical and verbal abuse these people have to take in the performance of their job is ridiculous!

Understand that we’re not talking a pyschiatric situation where a person isn’t in control of his actions and lashes out. We’re talking about people who are sad or angry or grieving or mad and choose to take out that emotion on the physical body of the person providing the health care. We’re talking about people who chose to get drunk or high and then ended up in the ER, fighting mad and out of control. And while you might give a patient the benefit of the doubt, there’s no excuse for family members. None at all.

Back in May 2009, the Emergency Nurses Association started a national survey that wrapped up in February 2010. According to their results, they discovered that “more than half of emergency department nurses have been physically assaulted at work.” These episodes of being physically assaulted included being spit on, hit, pushed or shoved, and scratched or kicked. “One in four (nurses) have experienced such violence more than 20 times in the past three years,” the report found. “Just as alarming, one in five nurses have experienced verbal abuse more than 200 times during the same period.”

The most telling statistic – 97.1 percent of the physical violence was perpetrated by patients and their relatives.

I’ve heard nurses shrug off injuries as part of the job and I’ve seen nurses who are now retired because they were so damaged by a patient that they can no longer work. Either way, it’s not right. It’s never been right that misplaced anger is leaving bruises on nurses.

Will SB 642 and SB 643 solve everything? No. People will still get crazy out of control, hurt themselves, get hauled into an ED and be a major problem to deal with. But if SB 642 and SB 643 are put into law – and if they’re posted on the walls in the rooms and health care professionals can refer to them – it might stop an outraged family member or patient. Because even an outraged patient or family member will take a second breath if they’re looking at significant jail time.

The key will be communication. When these bills turn into law, nurses and other health care professionals MUST impress on their workplaces that this information needs to be passed out when patients come into the hospital, posted on the walls in treatment rooms, placed by hospital beds, put in elevators, stuck on the cafeteria doors, and if needed, handstitched on pillows in the hospital gift shop. There is no shortage of places where this information should be placed so that everyone entering the hospital knows the rules – you hit a health care professional in this institution and the law is not going to be on your side. It’s going to be on the side of the bleeding and the bruised.

Stay tuned -  SB 642 and SB 643 are well on their way to becoming reality!

Patient Satisfaction the Disney Way

The other day I was visiting a friend in the hospital and down the hallway I could hear a patient screaming to be let out of the hospital. “You can’t keep me in here!” the patient kept yelling. It was a miscarriage of justice, according to the patient, the doctors were plotting, everyone hated the patient, well, you get the idea. Over the next 48 hours, this patient went off in this vein several different times and I found myself feeling very sorry for the nurses who were listening to the same diatribe over and over again.

So I’m wondering what the nurses in this Lansing institution would make of this statement: “Hospitals ‘need to mobilize all of the ‘nice’ that they can muster in all of their employees to ensure that the total experience of the patient satisifies the patients’ expectations.” This is according to Aaron Liberman, a professor of health services administration at the University of Central Florida.

Liberman continues – “If any (employee) happens to say something out of sorts or creates a bit of ill will with that patient, they may damn the entire hospital.”

The interview with Liberman took place as part of a story on how Disney is advising hospitals and patients on improving the patient experience. Andrew Doughman is the reporter and this story was reported in the July 15 edition of the Orlando Sentinel.

So, get this – a hospital can pay $3,500 per person for health care workers to hang out for three days at the Disney Institute as part of the “Building a Culture of Healthcare Excellence” program. Understand that this isn’t a patient care issue, it’s a patient experience issue.

Doughman states that this new Disney program is “designed to teach health-professionals how to make patients as satisfied with a trip to the hospital – or the doctor’s office – as they are with a trip to a Disney theme park.”

Now, why this new program? Because it increases referrals. Happy patients recommend doctors and hospitals to other patients, thereby increasing – exceptional patient care? No, I believe increased profits would be more of the case here!

Another quote for fun: “A guest is someone who is invited,” said Jeff Williford, a Disney Institute instructor. “A customer is someone who complains.”

I would be the first to agree that Disney does a lot of things right when it comes to making their customers, er, guests feel at home but an amusement park is not a hospital and having administrators buy into the whole “guest experience” for patients is foolhardy thinking. First of all, with the possible exception of having a baby, no one is excited to be going into the hospital. You don’t pack up your camera to take pictures of the doctors and nurses and it’s doubtful that the patient is ever going to enter the gift store looking for something with the hospital’s name on it. Rides in a hospital consist of being placed on a guerney and most “family memories” created in hospitals are not the kind you necessary want to put in this year’s holiday newsletter.

It would be interesting to see how the nurses felt they were supposed to deal with the angry patient down the hall. Were they supposed to make sure that the “guest” was having a good time? Were they required to ask 20 questions of the “guest” as to whether they were comfortable or not? Did the “guest” get confused that they were at Disneyworld because the experience was just like being at an amusement park?

This is all bottom-line, profits first-patients second thinking. When the priority becomes people’s opinions rather than their care, we’ve lost sight of the goals of health care. Sometimes saving people means making them extremely ill. Sometimes people are very, very unhappy to be in the hospital. There are not always happy endings at the hospital. You go for care, not for the experience.

Is it wise to have your health care professionals distracted with worrying whether or not the “guest” is happy? Because, in all reality, if the “guest” is treated with clinical expertise, caring and compassion, he’s probably going to be pretty content. And that will be a much better “check” than whether all 20 questions on the “guest” satisfaction checklist were answered.

Feeding the Poor

It was gorgeous down at the Capitol today – much cooler than it has been in Michigan, with a gentle breeze blowing under the roof of the large white tent we’d had erected on the Capitol grounds and gently rippling the the Main Street Contract banner. Soup to Nuts  had already dropped off the water bottles and sandwiches, and started the steno containers under the pans of chicken noodle soup.  Michigan Nurses Association staff members festively decked out in red MNA t-shirts had been on the streets for the past hour, inviting those they passed to come to lunch for free. And come they did – over 100 of them, ready to eat.

So began “Governor Snyder’s ‘No Soup for You’ Soup Kitchen,” an event that drew the attention of the main stream TV stations in Lansing as well as the Lansing State Journal. Nurses in red scrub tops cheerfully served food to those less unfortunate, and even took bowls and sandwiches to people on the Capitol grounds that were physically not able to go under the tent. One RN noticed a man looking ashen and immediately determined that he was having an asthma attack. Minutes later she had sat him down, put him on his inhaler and was on her cell phone with his case worker. Another nurse with an iphone worked on getting a patient to a free clinic where he could get his prescriptions filled.

A short program, hosted by Jeff Breslin, MNA President, featured heartwrenching stories from Susan  Cancro, Executive Director of Advent House Ministries in Lansing; Deb McMillan, an elementary teacher from the Lansing School District; Jennifer Shaw, a Speech Language Pathologist with the Lansing School Distrct; and Ashley Forsberg, a registered nurse at Sparrow Hospital. All focused on the needs of adults and children, and shared their concerns that Governor Snyder’s budget cuts would excaberate an already precarious social system.

A man, accompanied by two children, stood and watched. “Would you like something to eat?” I asked. “Nah,” he said. “We’re okay. My son here (he looked about 9) wanted to attend a protest. So what’s this all about?” So I explained to them why nurses would take time from their schedules to serve soup, why nurses cared. They listened to the speeches. The boy looked thoughtful. We shared some leftover cookies with them. They left after the soup kitchen was finished, the boy occasionally looking over his shoulder at the tent.

I wonder if this boy realizes how badly America needs a Main Street Contract for his future. I wonder if because of what he’d seen today if the man he will become will be a voice for justice. I was thankful that he’d already had lunch, that his father appeared to be able to take good care of his family without need of Lansing’s social system for families. The idea of nurses reaching out to the poor captured the boy’s attention and left him frowning with concentration – why nurses? Why now?

It was bringing the Main Street Contract to life in the simplest of ways – supplying protection from hunger for at least one meal. It was a wonderful day.

 

Lymph Nodes Revisited

When she met us at the door, the first thing I noticed was her hair. It was halfway down her back, brown and curly the last time I’d seen her. Now it was a short cap with streaks of grey showing. “It’s growing back,” she laughed, running her fingers through it.

This was her third time through chemo for reoccurring breast cancer and the elephant in the room was that we all knew she wouldn’t be coming back this time. The cancer had spread and this visit was more or less a chance to say goodbye while she was still able to receive visitors.

She was packing a picnic lunch, with the help of her husband, for an outdoor concert we planned to attend that night. It was difficult for her, as her right arm was swollen at least twice its size and wrapped in numerous Ace bandages. “I have lymphedema,” she explained. “We’re using the bandages to force some of the liquid into the lymph nodes I still have left.” “Is it painful?” I asked. “Oh, yeah,” she said. “I can’t sleep, I can’t use this arm, and it’s just one more misery on top of everything else.”

Like many women, when the lump had been discovered, her lymph nodes had been removed from under her arm as a precaution. Now a new report shows that 40,000 women a year in the United States, ones that meet certain criteria, will not benefit from having their lymph nodes removed. If a woman has had chemo and radiation, as did my friend, it would have killed anything residing in the lymph nodes, making it unnecessary to remove them.

Her doctors were playing it safe with the known facts at that time. But it’s a shame that her final 12 months had to be marked with the pain and uncomfortableness of lymphedema when it very possibly could have been avoided.

I wish we’d known then what we know now.

Lymph Node Study Shakes Pillar of Breast Cancer Care

 

I’m Sorry

“I’ve had it,” she told me. “And it’s only been 9 months.” This is a smart, capable, intelligent, compassionate new nurse, a former Michigan Nursing Students Association Board member, and a friend. I remember her excitement and nervousness about taking the NCLEX. I remember the excited Facebook posting when she passed and then when she was hired. And now she’s had it. After 9 months.

She wasn’t naive about the nursing profession. She was fully aware of short staffing and paperwork and all the things that drive nurses crazy. She went into her first job with her eyes wide open.

And yet, something has gotten to her. She didn’t specify and I didn’t ask but it probably wasn’t one thing. I imagine it was months of frustration. If there’s one thing I know about her, she was committed to being able to care for and educate her patients. I would guess that she’s been robbed of those opportunities, whether it’s through poor management or not enough co-workers or just too many patients.

I wish I could say that’s the first time I’ve ever had an MNSA Board member tell me that they’ve had it, but unfortunately it happens quite frequently. To me, MNSA Board members are the best of the best, the cream of the crop, and when I hear them wondering about their chosen profession within the first 12 months of their practice, I have to wonder what we’re missing.

I’m sorry, my friend, I really am. I wish I could make things better for you. I’m heartsick that the dream you held for your career has turned into a nightmare. All I can say is – get out of where you’re at before it eats you alive and look for a better practice situation.

You’re just too good for us to lose you.

Oh. So THIS Is the Way It’s Going To Be

Here’s a little article that might have caught your eye today. The version below is from a website called Fierce Healthcare. Sandra Yin is the author.

House GOP plans early vote to repeal healthcare reform

House Republicans hope to make good on a campaign promise to undo the healthcare reform law by scheduling an early vote to repeal it before President Obama’s State of the Union address in late January, the Washington Post reports.

The repeal will be a top priority for the House, Rep. Fred Upton (R-Mich.), the incoming chair of the House committee that oversees health policy, said.

If the new House fails to reach a two-thirds majority to override a presidential veto, Upton said that GOP leaders will ”go after the bill piece by piece.” He continued, “We will look at these individual pieces to see if we can’t have the thing crumble.”

Such a repeal vote would be largely symbolic, the New York Times reports.

The prospects of a repeal bill making it through the Senate, where Democrats cling to a narrow majority, is much less likely.

Democrats are preparing for a fight to defend the reform, noting that consumers already are benefiting from changes made under reform. They argue that undoing the law would increase the number of uninsured; put insurers back in control of health insurance, allowing them to increase premiums at will; and lead the federal budget deficit to grow quicker.

“[Republicans are] talking about wasting time repealing healthcare, when they know that the Senate and administration won’t go along with it. Don’t waste time,” Rep. Steve Israel (D-N.Y.), chairman of the Democratic Congressional Campaign Committee, said on CNN’s “State of the Union.”

Wasn’t it Senator Mitch McConnell who said recently “The single most important thing we want to achieve is for President Obama to be a one-term president.”

Isn’t it nice to see that bi-partianship will be alive and well in 2011. You might want to drop Representative Upton a note asking him to do something in his new role as Chair of the Health committee other than waste time on a “symbolic” gesture.

Representative Fred Upton
Washington, DC Office
2183 Rayburn House Office Bldg
Washington, D.C. 20515
Telephone: (202) 225-3761
Email: https://upton.house.gov

Turf Wars with the Docs

The source of this article is Fierce Healthcare, a daily e-newsletter for health care executives. Here are their comments regarding the recent Institute of Medicine report and the American Medical Association’s response.

The American Medical Association was swift to respond to yesterday’s Institute of Medicine report that called for nurses to take on a larger, more independent role in transforming healthcare in America. By 2 p.m., it had shot out a board member’s response to media outlets. It’s main message: Nurses are not equal to physicians. Besides reinforcing the importance of a physician-led team approach, the statement underlined the difference in education and training between nurses and physicians. The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, “Nurses are critical to the healthcare team, but there is no substitute for education and training.” She goes on to compare physicians’ seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners’ two to three years of postgraduate education and less clinical experience than that of a first-year medical resident. It’s possible the physicians fear the report’s proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses–such as nurse practitioners and anesthetists–at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses’ scope of practice.

Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report’s recommendations. In response to the AMA’s comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers. She argued against limiting their practice to whatever could be supervised by physicians. “If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we’ve just cut off access to primary care in that community,” she said. “We’re not using nurses to the full extent. They are an untapped resource.”

The medical community, and by that I mean the physicians, needs to swallow a reality pill. If we are suffering a shortage of general practitioners and at the same time are going to offer health care to millions of people that weren’t covered before, we’re going to need a lot of help on the front lines for chronic disease teaching, dealing with the kinds of medical conditions that could be easily treated in an examining room that are now showing up in the ER, and general care. Physicians cannot be counted on to take care of everyone simply due to sheer numbers and that’s where the APNs come in.

But see, it’s about the money. Did you note where the IOM report says that  APNs and anesthetists should be reimbursed the same as the physicians? And that their scope of practice should not be limited?

Apparently the AMA cannot stomach the thought of those nurses – nurses, for heaven’s sake - being paid the same as a physician. The idea of APNs functioning independently appears to be terrifying to the AMA, as if nurses are poised to run roughshod over the medical profession leaving nothing but destruction in their wake.

Obviously physicians have more education and obviously, nurses are not going to be performing brain surgery. Nurses understand their scope of practice and can function quite well independently based on their education and clinical experience. But they have to be allowed to use that background in areas where they are well suited and that means that the physicians must give up some control of their domain.

Face it, you have to scoot over a little, physicians. You need the APNs now. It may take a little getting used to, but in the end you’ll see that having APNs as partners, not turf intruders, will benefit your practice in ways you never dreamed of.

No one’s trying to topple your castle. They’re just asking that you lower the drawbridge.