Susan Sonnichsen is looking forward to seeing Helen Cross, a patient with dementia who loves hymns. But Cross is having a rough day. Softly, Sonnichsen tells her, “I know something that will make you feel better. How about a song?’’
She starts in with “Joy in My Heart,’’ followed by “Old Rugged Cross’’ and then a favorite, “Amazing Grace.’’ Sonnichsen’s voice fills the space between nurse and patient. Slowly, Cross allows Sonnichsen to take her hand. “OK, we’re getting somewhere,’’ Sonnichsen says, smiling at Cross.
Sonnichsen has been singing ever since she was a kid belting out songs during family road trips. But in her 30 years in nursing, she never knew it could fit into her work. A dementia class for staff at Hospice of the Valley changed all that and today, music is as much a part of her care as is taking a patient’s vital signs.
“They love to sing along,’’ Sonnichsen says. “Even if they’re off key, it’s wonderful to engage them.’’ She prefers old gospel hymns and tunes from popular musicals, but happily takes requests and learns new songs. When a patient is close to death, she sings a lullaby and offers a gentle touch. When a family asks, she gladly sings at patients’ memorials. Some of her colleagues call her the singing nurse.
“Anyone who has enjoyed the experience of hearing Susan sing can attest that her ability to emote through music is a true gift,’’ says Hospice of the Valley social worker Donna Wetzel.
Sonnichsen says integrating her two callings, music and medicine, is a blessing.
“It’s amazing when patients join in with you. It just fills your heart,’’ she says. “It just touches you, makes you feel like that’s why you’re here.’’
Source: AZ Central
By: Marsha Van Hecke
People pursue careers in nursing for many reasons: they want to help people, they’re natural caregivers or they want to do some good in the world. The 31 nurses of Hospice of the Carolina Foothills add another reason: It’s truly a ministry.
“Hospice is a calling,” Christina Hughes, RN said, “I knew several years ago that this is what I wanted to do, but watching my father pass that prompted me to make the change.”
Previously, Hughes worked in a skilled nursing facility.
Hospice nurses perform all the tasks you’d expect of nurses in a hospital, clinic or nursing home setting. They draw blood, administer and monitor medications, assess patients’ conditions, review charts, consult with doctors, complete paperwork, and attend staff meetings, among many other typical responsibilities. There’s an added dimension to working as a nurse at hospice.
“Hospice work is more of a team effort, patient and family oriented, putting the patients first always,” says Marla Searcy, RN and Homecare clinical manager in North Carolina.
“And,” adds Monica Pierce, LPN, “we do a lot of education with the families, teaching them how to take care of their loved ones.”
Linda Travers, RN agrees. “HCF allows nurses time to listen to patient feelings and concerns. Teaching family caregivers about disease process, symptom management. Providing comfort and support.”
“Working for Hospice, you are able to spend more time with patients and families,” adds Joanie McDade, RN.
“Having the opportunity to build a relationship with some of the patients here is a gift no other job allows you to have,” says Barry Lowman, RN. “But then when they pass you have a piece of you go with them.”
Developing those close bonds with patients and families is not only an important part of the job, but it’s also one of the most enjoyable. And certain patients find a permanent place in the nurses’ hearts.
“I had one patient who served in Japan for 14 months as a medic. When he saw me, he asked if I was Asian. I told him that my mother was Okinawan and my father American. He began speaking Japanese to me. All throughout his journey of dementia, he continued to speak Japanese to me. There were times he couldn’t remember his wife’s name, but he remembered those few Japanese words,” says Hughes.
Homecare RN, Jennifer Greene tells how a simple gesture of gratitude left a lasting impression on her.
“I was taking care of a patient at the Hospice House and when I would give her any personal care, she would say, ‘Thank you, Mama.’ She would say that to me whenever I took care of her, until she passed.”
Hospice House RN Ashley Crissone fondly remembers the woman with whom she played piano duets.
When Crissy Simpson, RN and Homecare clinical manager in South Carolina, first started at hospice, she found herself facing a potentially difficult situation.
“I was sent to see a patient that lived in a rural community. I was told that he was a very challenging patient, not because of his terminal illness, but because he may not be accepting of my race,” she says, “I went to visit him. He wasn’t rude, but asked a lot of questions to see if I was qualified to take care of him.”
After a few visits, the patient became comfortable with her, and Simpson would give him a big hug right before she left. If she got stuck in traffic and arrived a few minutes late, he would tell her he had been worried about her.
“Every visit he would be sitting in his recliner, facing the door, waiting for me to come, with his beautiful blue eyes,” she says.
As the patient began to decline in health, he asked his wife to buy Simpson a gift, a coffee mug that read, “Thank God for Daughters.”
“From that day, he called me his black daughter and he was my white daddy,” Simpson says, “Some people may be offended by that, but I know I meant a lot to him, and so did he to me.”
On the night he passed away, Simpson sang to him the old gospel song, “I’m Going to Take a Trip,” which she also sang at his funeral.
Just as Simpson goes above and beyond her job duties by singing to patients, other nurses contribute their talents and time outside of work. Jennifer Greene makes jewelry, donating necklaces and bracelets to patients, and Christina Hughes attends special events held at the facilities where she serves.
“One facility had ‘Cowboy Day,’ and the HCF social worker and I dressed up, and attended on our day off. The social worker even brought two of her horses for the patients to see,” says Hughes.
Every nurse has had a special person who inspired him or her to pursue the role of caregiver in life. For some it was another nurse who nurtured and mentored them, or a hospice nurse who ministered to one of their relatives. For others, a special family member encouraged them to follow their hearts. In RN Crystal Mitchell’s case, it was both. Her favorite aunt is a nurse and from a very young age, she would visit her at work in the hospital. Now, it seems, Mitchell is paying it forward.
“I’ve known since I was four I’ve wanted to be a nurse from watching her with her patients,” Mitchell says of her aunt. “I have had a similar role to a family friend who is like a little sister, and she is now a pediatric oncology nurse. I never knew I was the reason she wanted to be a nurse until later. How jaw-dropping it was to find out how much my work had influenced her by God’s grace.”
While working for hospice brings nurses many jovial moments, they also deal with the sobering reality of death every day. For that reason, many people hold them in high regard and wonder how they handle such a job.
RN case manager, Kim Griffey shares how people react when she tells them where she works.
“They always say that it takes a certain person to do your job, that they couldn’t do it. I always reply, ‘It’s very rewarding.’”
When asked what is the most important characteristic or skill needed to be a hospice nurse, one word comes up repeatedly.
Lowman and Travers and Pam Essman, RN, come right to the point.
“Compassion,” they say.
“The most important characteristic you need to be successful in hospice is compassion. It’s not always the physical symptoms that you’re relieving, but also the patient’s and family’s psychological pain,” says Simpson.
When hospice nurses go to work every day, they’re not simply going to a job. They’re going to touch someone’s life. They hold patients’ hands, celebrate patients’ birthdays, play games, share stories, help patients create their life stories to leave for their families, offer comfort, a smile, a laugh, and, in some cases, a song.
“I have had so many patients say they look forward to the hospice nurse’s visit. What greater reward in life can we have than to put a little sunshine in someone’s day, maybe their last day,” Searcy says.
Source: Tyron Daily Bulletin
The peak times for student visits to Ronda Kissling’s office are at the start of the school day and around lunch and recess time, but Kissling doesn’t get much downtime.
Kissling is the nurse serving three elementary schools: Croninger, St. Joseph Central and Shambaugh. She began her day Friday at Croninger to see
the students who got off the bus not feeling well. By late morning, she was headed to Shambaugh to give insulin to thehandful of diabetic students there. Shortly after noon she returned to Croninger to give students insulin and just in time to catch any students injured during recess.
Between student visits and charting throughout the day, Kissling checked on an uninsured student who had broken his arm; urged a doctor’s visit for a student with a particularly suspicious-looking rash; and worked on a letter to send home to parents about immunization changes for next school year.
She said most people don’t realize what school nursing is all about.
“They think we sit around all day and just give out ice packs and Band-Aids,” she said. “There’s so much more to it nowadays.”
Increase in ailments
Much has changed in school nursing in the past 10 to 15 years, said Chris Amidon, a registered nurse serving Crawfordsville Community School Corp. and president of the Indiana Association of School Nurses.
One area in particular is the increase in students’ mental health problems.
“A lot of us were not prepared to deal with that,” she said, because of nurses’ inexperience in psychiatry.
She estimates about 32 percent of school nurses’ time is devoted to providing mental health services, whether they realize it or not. Often mental health problems can show up as physical ailments like head or stomach aches, she said.
According to a 2011-12 survey by the Centers for Disease Control and Prevention, about 165,000 Hoosier children have emotional, developmental or behavioral problems that require treatment or counseling, and 41 percent of those children do not receive mental health services.
Children born prematurely or with other challenges now live and attend school.
“There’re so many children with time-consuming needs,” Amidon said, such as tube feedings or students who need help using the restroom. Thirty years ago, she said, these children probably wouldn’t have even attended school.
Rates of overweight and obese children as well as the number of children with food allergies are also increasing.
Mary Hess, head nurse for Fort Wayne Community Schools, said more than 13,000 students in the district report having allergies. That includes food allergies, such as to peanuts, and being allergic to bee stings and latex.
About 760 of those students report severe or anaphylactic symptoms if exposed to a certain allergen, she said.
“There’s been a huge increase in allergies from when I started 15, 16 years ago,” Hess said.
Hess reports allergies and diabetes among the top four reported chronic illness of students in FWCS, now the largest district in the state with about 30,600 students. Asthma and seizure disorders also top the list.
“We see an increase every school year with students reporting some chronic health condition,” Hess said.
According to the National Association of School Nurses, the incidence of obesity in the past 30 years has doubled for 2- to 5-year-olds; tripled among 6- to 11-year-olds; and more than tripled for 12- to 19-year-olds. In Indiana, 32 percent of children ages 10 to 17 are overweight or obese, according to the CDC survey.
A disease such as diabetes requires extra effort to manage as treatments have advanced. Diabetic children used to get insulin in the morning, and their blood sugar levels were simply monitored during the day.
“There was not the constant fine-tuning we see in today’s plans,” she said.
Many children require insulin when they eat, which could be twice a day if the child eats breakfast at school.
FWCS to hire nurses
Students’ insulin needs are what led the Crawfordsville schools to make it a priority to provide funding for a full-time nurse in each of its school buildings, instead of its old policy of staffing based on just a few students in certain buildings.
“We used to do that, but it got to the point where there’s at least one child in each building with diabetes or even food allergies,” she said.
Unlike Crawfordsville, not every school in Fort Wayne Community Schools is staffed with a full-time nurse. This year, about 24 nurses split their time among the district’s 51 school buildings. Some nurses, like Kissling, are responsible for three schools, Hess said.
“My nurses have been stretched very thin,” she said.
Northrop High School is one of the district’s busiest schools with more than 2,000 students. The school’s full-time nurse fields 650 to 850 student visits a month.
“Their traffic flow is extremely busy, but I wouldn’t say that’s particularly new,” Hess said. “I’ve felt for some time we’ve needed more nurses.”
FWCS plans to hire additional nurses for next year, bringing the total number of nurses to 30 with no nurses serving more than two buildings.
Ten years ago, Southwest Allen County Schools employed clinical aides, or someone who has medical training but isn’t licensed, in some of its schools instead of a registered nurse.
Amidon said many districts have moved away from using clinical aides, although some districts like Huntington Community School Corp. still use them or other unlicensed staff instead of registered nurses. And in FWCS if a nurse isn’t available, secretaries and other staff receive special training like CPR and medication dispensing.
Southwest Allen changed its policy when it became clear that student health was becoming more challenging and “too medically intense,” said Phyllis Davis, director of human resources in the district.
“In many schools we have children with severe disabilities and who are very unique, medically,” she said.
Southwest Allen employs 11 nurses, with at least one nurse working full time at each school. Others float among schools to give the full-time nurse assistance.
“I can assure you, they’re very busy,” Davis said.
A student sat on the cot in Kissling’s small clinic Friday waiting patiently for her to finish her phone call with a parent. He had come in because his eyes were red and itchy. After some questions, Kissling determined it wasn’t pink eye, a highly contagious infection, but that the student’s symptoms were caused by his allergies.
“It’s that time of year,” she said.
She offered him a cold cloth for his eyes and sent him on his way. He was the second student within an hour to complain about allergy-related symptoms.
Amidon said research shows that if students see a school nurse, they are more likely to have their problems addressed and to stay at school. Someone unlicensed who is providing care is more likely to send a student home.
School nurses are an important component in helping students achieve academically, Davis said.
“Our nursing staff is an important part of our school district’s success for our students,” she said.
They’re also an important part of children’s health care. Amidon said for many students who don’t have health insurance, school nurses are primary health care providers. She said Mondays are often busy times with students who’ve been sick all weekend, and their parents send them to the nurse to determine how serious the sickness is.
According to the CDC survey, nearly 12 percent of Hoosier children lacked consistent health care coverage last year.
For all they do, school nurses receive their own special day a year. Wednesday is National School Nurse Day, set aside to celebrate the more than 74,000 school nurses across the country.
“It is a very, very rewarding kind of nursing,” Amidon said.
Source: The Journal Gazette
Losing weight is never easy. Every pound you shed is the direct result of your dedication to healthy eating and regular exercise. To commemorate the 100th episode of The Dr. Oz Show, Dr. Oz welcomed 100 individuals who had lost over 100 lbs each – and each member of the “Oz 100” shared their #1 tip for weight loss.
Whether you are trying to lose a few pounds or 100, there are some surprising secrets you may not know. Test your weight-loss know-how with The Oz 100 Ultimate Weight Loss Quiz.
Click here for The Oz 100 Ultimate Weight Loss Quiz
Source: Doctor Oz
An overwhelming majority (90%) of our nation's middle-income Americans say they are not financially prepared for a critical illness diagnosis, according to a new study released by Washington National Institute for Wellness Solutions (IWS).
The study, Middle-Income America's Perspectives on Critical Illness and Financial Security, which surveyed 1,001 Americans ages 30 to 66 with an annual household income of between $35,000 and $99,999, found that only 1-in-10 feels strongly confident they have enough savings to cover family emergencies and handle the financial implications of a critical illness.
Middle-income Americans today face a significant risk of being diagnosed with one or more critical illnesses--including cancer, heart disease, stroke and Alzheimer's disease. For the majority, a critical illness diagnosis can be life-changing both financially and personally.
Level of personal savings
If diagnosed with a critical illness, most middle-income Americans say they would be forced to draw on savings to pay for out-of-pocket expenses not covered by insurance. But according to the study, many have little, if any, savings to fall back on:
-- 75% have less than $20,000 in savings
-- 50% have less than $2,000 in savings
-- 25% have no current savings
Resources used to pay critical illness costs
To pay for critical illness costs, middle-income Americans say they would need to use credit cards (28%) or loans from family/friends (23%) or financial institutions (19%) to offset expenses not covered by health insurance. Another one-fourth (23%) say they simply "don't know" what resources they would use to help offset their expenses. Millennials and Gen Xers anticipate greater reliance on credit cards and loans to pay for critical illness expenses.
Perception of financial impact of critical illness
Americans believe that the financial impact of a critical illness can be lasting. Thirty-eight percent believe they might never financially recover from a battle with cancer and 45% believe they would never recover financially from an Alzheimer's/dementia diagnosis.
Despite the vulnerability in financial preparedness for critical illness, few middle-income Americans have had meaningful discussions about potential care-giving options or financial planning for critical illness. Eighty-eight percent have had no conversations with loved ones or advisers about potential care-giving options and 60% have not discussed financial planning for critical illness. Only 12% have actively explored care-giving options.
"Educate yourself about the real-life costs of critical illness," said Barbara Stewart, President of Washington National Insurance Company. "Find out what your current insurance will--and will not--cover, and then assess your overall financial health. Identify the gaps between the resources you would need and the options already available to you."
Middle-Income America's Perspectives on Critical Illness and Financial Security, a study from the Washington National Institute for Wellness Solutions, was conducted in January 2013 by Zeldis Research, an independent research firm. The full report can be viewed at WNInstituteforWellness.com.
A cross-generational nationwide sample of 1,001 middle-income Americans ages 30 to 66 with an annual household income of between $35,000 and $99,999 participated in the internet-based survey. Females and males each represented approximately 50% of survey participants.
None of the respondents had ever been diagnosed with any of the following critical illnesses: Alzheimer's disease or dementia, cancer, heart disease, multiple sclerosis, Parkinson's disease, and stroke. Respondents were excluded if they had Medicare, Medicaid or Medicare supplement insurance. Significant subsample differences were tested at the 95% confidence level.
About the Washington National Institute for Wellness Solutions
The Institute for Wellness Solutions is Washington National's research and consumer education program. The organization sponsors studies and supports awareness campaigns to help Americans meet the challenges of critical illnesses. Specifically, the institute provides insight and practical advice about wellness and illness prevention, illness care and treatment, and managing the total costs--financial and personal--of critical illnesses. To learn more, visit WNInstituteforWellness.com.
Washington National, a subsidiary of CNO Financial Group, Inc. (NYSE: CNO), has helped Americans since 1911 to protect themselves and their families from the financial hardship that often comes with critical illnesses, accidents and loss of life. The company remains dedicated to helping middle-income Americans who work hard and want to protect themselves and their loved ones. To learn more, visit WashingtonNational.com.
SOURCE: Washington National Institute for Wellness Solutions
The U.S. is currently seeing a physician shortage that will only continue to rise and affect medical practices all over the country. By 2020, the American Association of Medical Colleges (AAMC) estimates there will be a shortage of more than 90,000 physicians, and that number will grow to 130,000 by 2025.
To solve this problem, many healthcare providers are turning to Nurse Practitioners (NPs) and Physician Assistants (PAs). While many people believe NPs and PAs are unable care for patients as well as physicians, studies have found that to be untrue. Victoria Garment, editor at SoftwareAdvice.com--a website that presents reviews and ratings of healthcare technology-- explains:
“Decades of studies have demonstrated that, when permitted to practice to the full extent of their training, NPs and PAs can perform a majority of the tasks that physicians do while providing the same quality of care.”
These tasks can include performing physical exams, diagnosing and treating conditions such as diabetes or high blood pressure, writing prescriptions, order diagnostic tests and more. Additionally, “while PAs cannot practice independently of physicians, there are approximately 250 practices across the U.S. that are run solely by NPs,” Garment said.
Another benefit of hiring NPs and PAs is the significant cost savings:
- Reduced salary expenses - The average base salary of a physician is more than double that of NPs and PAs.
- Lower overhead costs - Studies show PAs require lower overhead costs than physicians by department, patient demographics and medical care resource use, resulting in a $30,000 boost to the bottom line.
- Lower costs of care - The costs of NP-managed practices have been found to be 23 percent below physician-managed practices. This can lead to statewide savings of $4.2-$8.4 billion.
- Higher patient volumes - Another study found that adding an NP to a practice can double patient numbers and boost yearly revenue by $1.65 million per 100,000 enrollees.
- Reduced insurance and liability costs - Not only is a PA’s liability risk cost one-third of a physician’s, but NPs also have much lower rates of malpractice claims and lower costs per claim.
What’s more, patients often report having an equal or even better experience with an NP or PA compared to a physician. A survey by Medscape found that 80 percent of patients felt NPs “always” listened while carefully compared to 50 percent of physician patients. Similarly, the Kaiser Permanente Center for Health Research released a report that said PA patients ranked their satisfaction levels between 89 to 96 percent for the quality of care they received in the areas of interpersonal care, confidence in the provider and understanding of patient problems.
With all the benefits that NPs and PAs bring, they can be a great addition or alternative to any medical practice, especially those experiencing physician shortages.
To read the full report on The Profitable Practice blog, visit: “Nurse Practitioners and Physician Assistants: Why You Should Hire One (or the Other).”
By: JONATHAN RAUCH
Dr. Angelo Volandes is making a film that he believes will change the way you die. The studio is his living room in Newton, Massachusetts, a suburb of Boston; the control panel is his laptop; the camera crew is a 24-year-old guy named Jake; the star is his wife, Aretha Delight Davis. Volandes, a thickening mesomorph with straight brown hair that is graying at his temples, is wearing a T-shirt and shorts and looks like he belongs at a football game. Davis, a beautiful woman of Guyanese extraction with richly braided hair, is dressed in a white lab coat over a black shirt and stands before a plain gray backdrop.
“Remember: always slow,” Volandes says.
“Sure, hon,” Davis says, annoyed. She has done this many times.
Volandes claps to sync the sound. “Take one: Goals of Care, Dementia.”
You are seeing this video because you are making medical decisions for a person with advanced dementia. Davis intones the words in a calm, uninflected voice. I’ll show you a video of a person with advanced dementia. Then you will see images to help you understand the three options for their medical care.
Her narration will be woven into a 10-minute film. The words I’m hearing will accompany footage of an elderly woman in a wheelchair. The woman is coiffed and dressed in her Sunday finest, wearing pearls and makeup for her film appearance, but her face is vacant and her mouth is frozen in the rictus of a permanent O.
This woman lives in a nursing home and has advanced dementia. She’s seen here with her daughters. She has the typical features of advanced dementia …
Young in affect and appearance, Volandes, 41, is an assistant professor at Harvard Medical School; Davis, also an M.D., is doing her residency in internal medicine, also at Harvard. When I heard about Volandes’s work, I suspected he would be different from other doctors. I was not disappointed. He refuses to let me call him “Dr. Volandes,” for example. Formality impedes communication, he tells me, and “there’s nothing more essential to being a good doctor than your ability to communicate.” More important, he believes that his videos can disrupt the way the medical system handles late-life care, and that the system urgently needs disrupting.
“I think we’re probably the most subversive two doctors to the health system that you will meet today,” he says, a few hours before his shoot begins. “That has been told to me by other people.”
“You sound proud of that,” I say.
“I’m proud of that because it’s being an agent of change, and the more I see poor health care, or health care being delivered that puts patients and families through—”
“We torture people before they die,” Davis interjects, quietly.
Volandes chuckles at my surprise. “Remember, Jon is a reporter,” he tells her, not at all unhappy with her comment.
“My father, if he were sitting here, would be saying ‘Right on,’ ” I tell him.
Volandes nods. “Here’s the sad reality,” he says. “Physicians are good people. They want to do the right things. And yet all of us, behind closed doors, in the cafeteria, say, ‘Do you believe what we did to that patient? Do you believe what we put that patient through?’ Every single physician has stories. Not one. Lots of stories.
“In the health-care debate, we’ve heard a lot about useless care, wasteful care, futile care. What we”—Volandes indicates himself and Davis—“have been struggling with is unwanted care. That’s far more concerning. That’s not avoidable care. That’s wrongfulcare. I think that’s the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”
Unwanted treatment is American medicine’s dark continent. No one knows its extent, and few people want to talk about it. The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention.
In 2009, my father was suffering from an advanced and untreatable neurological condition that would soon kill him. (I wrote about his decline in an article for this magazine in April 2010.) Eating, drinking, and walking were all difficult and dangerous for him. He ate, drank, and walked anyway, because doing his best to lead a normal life sustained his morale and slowed his decline. “Use it or lose it,” he often said. His strategy broke down calamitously when he agreed to be hospitalized for an MRI test. I can only liken his experience to an alien abduction. He was bundled into a bed, tied to tubes, and banned from walking without help or taking anything by mouth. No one asked him about what he wanted. After a few days, and a test that turned up nothing, he left the hospital no longer able to walk. Some weeks later, he managed to get back on his feet; unfortunately, by then he was only a few weeks from death. The episode had only one positive result. Disgusted and angry after his discharge from the hospital, my father turned to me and said, “I am never going back there.” (He never did.)
What should have taken place was what is known in the medical profession as The Conversation. The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired. Alas, evidence shows that The Conversation happens much less regularly than it should, and that, when it does happen, information is typically presented in a brisk, jargony way that patients and families don’t really understand. Many doctors don’t make time for The Conversation, or aren’t good at conducting it (they’re not trained or rewarded for doing so), or worry their patients can’t handle it.
This is a problem, because the assumption that doctors know what their patients want turns out to be wrong: when doctors try to predict the goals and preferences of their patients, they are “highly inaccurate,” according to one summary of the research, published by Benjamin Moulton and Jaime S. King inThe Journal of Law, Medicine & Ethics. Patients are “routinely asked to make decisions about treatment choices in the face of what can only be described as avoidable ignorance,” Moulton and King write. “In the absence of complete information, individuals frequently opt for procedures they would not otherwise choose.”
Though no one knows for sure, unwanted treatment seems especially common near the end of life. A few years ago, at age 94, a friend of mine’s father was hospitalized with internal bleeding and kidney failure. Instead of facing reality (he died within days), the hospital tried to get authorization to remove his colon and put him on dialysis. Even physicians tell me they have difficulty holding back the kind of mindlessly aggressive treatment that one doctor I spoke with calls “the war on death.” Matt Handley, a doctor and an executive with Group Health Cooperative, a big health system in Washington state, described his father-in-law’s experience as a “classic example of overmedicalization.” There was no Conversation. “He went to the ICU for no medical reason,” Handley says. “No one talked to him about the fact that he was going to die, even though outside the room, clinicians, when asked, would say ‘Oh, yes, he’s dying.’ ”
“Sometimes you block the near exits, and all you’ve got left is a far exit, which is not a dignified and comfortable death,” Albert Mulley, a physician and the director of the Dartmouth Center for Health Care Delivery Science, told me recently. As we talked, it emerged that he, too, had had to fend off the medical system when his father died at age 93. “Even though I spent my whole career doing this,” he said, “when I was trying to assure as good a death as I could for my dad, I found it wasn’t easy.”
If it is this hard for doctors to navigate their parents’ final days, imagine what many ordinary patients and their families face. “It’s almost impossible for patients really to be in charge,” says Joanne Lynn, a physician and the director of the nonprofit Altarum Center for Elder Care and Advanced Illness in Washington, D.C. “We enforce a kind of learned helplessness, especially in hospitals.” I asked her how much unwanted treatment gets administered. She couldn’t come up with a figure—no one can—but she said, “It’s huge, however you measure it. Especially when people get very, very sick.”
Unwanted treatment is a particularly confounding problem because it is not a product of malevolence but a by-product of two strengths of American medical culture: the system’s determination to save lives, and its technological virtuosity. Change will need to be consonant with that culture. “You have to be comfortable working at the margins of the power structure within medicine, and particularly within academic medicine,” Mulley told me. You need a disrupter, but one who can speak the language of medicine and meet the system on its own terms.
Angelo Volandes was born in 1971, in Brooklyn, to Greek immigrants. His father owned a diner. He and his older sister were the first in their family to go to college—Harvard, in his case. In Cambridge, he got a part-time job cooking for an elderly, childless couple, who became second parents to him. He watched as the wife got mortally sick, he listened to her labored breathing, he talked with her and her husband about pain, death, the end of life. Those conversations led him to courses in medical ethics, which he told me he found abstract and out of touch with “the clinical reality of being short of breath; of fear; of anxiety and suffering; of medications and interventions.” He decided to go to medical school, not just to cure people but “to learn how people suffer and what the implications of dying and suffering and understanding that experience are like.” Halfway through med school at Yale, on the recommendation of a doctor he met one day at the gym, he took a year off to study documentary filmmaking, another of his interests. At the time, it seemed a digression.
On the very first night of his postgraduate medical internship, when he was working the graveyard shift at a hospital in Philadelphia, he found himself examining a woman dying of cancer. She was a bright woman, a retired English professor, but she seemed bewildered when he asked whether she wanted cardiopulmonary resuscitation if her heart stopped beating. So, on an impulse, he invited her to visit the intensive-care unit. By coincidence, she witnessed a “code blue,” an emergency administration of CPR. “When we got back to the room,” Volandes remembered, “she said, ‘I understood what you told me. I am a professor of English—I understood the words. I just didn’t know what you meant. It’s not what I had imagined. It’s not what I saw on TV.’ ” She decided to go home on hospice. Volandes realized that he could make a stronger, clearer impression on patients by showing them treatments than by trying to describe them.
He spent the next few years punching all the tickets he could: mastering the technical arts of doctoring, credentialing himself in medical ethics, learning statistical techniques to perform peer-reviewed clinical trials, joining the Harvard faculty and the clinical and research staff of Massachusetts General Hospital. He held on to his passion, though. During a fellowship at Harvard in 2004, he visited Dr. Muriel Gillick, a Harvard Medical School professor and an authority on late-life care. Volandes “was very distressed by what he saw clinically being done to people with advanced dementia,” Gillick recalls. “He was interested in writing an article about how treatment of patients with advanced dementia was a form of abuse.” Gillick talked him down. Some of what’s done is wrong, she agreed, but raging against it would not help. The following year, with her support, Volandes began his video project.
The first film he made featured a patient with advanced dementia. It showed her inability to converse, move about, or feed herself. When Volandes finished the film, he ran a randomized clinical trial with a group of nine other doctors. All of their patients listened to a verbal description of advanced dementia, and some of them also watched the video. All were then asked whether they preferred life-prolonging care (which does everything possible to keep patients alive), limited care (an intermediate option), or comfort care (which aims to maximize comfort and relieve pain). The results were striking: patients who had seen the video were significantly more likely to choose comfort care than those who hadn’t seen it (86 percent versus 64 percent). Volandes published that study in 2009, following it a year later with an even more striking trial, this one showing a video to patients dying of cancer. Of those who saw it, more than 90 percent chose comfort care—versus 22 percent of those who received only verbal descriptions. The implications, to Volandes, were clear: “Videos communicate better than just a stand-alone conversation. And when people get good communication and understand what’s involved, many, if not most, tend not to want a lot of the aggressive stuff that they’re getting.”
Even now, after years of refinement, Volandes’s finished videos look deceptively unimpressive. They’re short, and they’re bland. But that, it turns out, is what is most impressive about them. Other videos describing treatment options—for, say, breast cancer or heart disease—can last upwards of 30 minutes. Volandes’s films, by contrast, average six or seven minutes. They are meant to be screened on iPads or laptops, amid the bustle of a clinic or hospital room.
They are also meant to be banal, a goal that requires a meticulous, if perverse, application of the filmmaker’s art. “Videos are an aesthetic medium; you can manipulate people’s perspective,” Volandes says. “I want to provide informationwithout evoking visceral emotions.” Any hint that he was appealing to sentiments like revulsion or fear to nudge patients toward a certain course of treatment would discredit his whole project, so Volandes does all he can to eliminate emotional cues. That is why he films advanced-dementia patients dressed and groomed to the nines. “I give them the nicest image,” Volandes told me. “If with the nicest image we show a huge effect, you can imagine what it would be like if they really saw the reality.”
The typical video begins with Davis explaining what the viewer is about to see, stating plainly facts that doctors are sometimes reluctant to mention. She says, for example: People with advanced dementia usually have had the disease for many years and have reached the last stage of dementia. They are nearing the end of life. The video cuts to a shot of a patient. Then Davis outlines the three levels of care, starting with the most aggressive. Over footage of CPR and mechanical ventilation, she explains that in most cases of advanced dementia, CPR does not work, and that patients on breathing machines are usually not aware of their surroundings and cannot eat or talk. Then she describes limited care and comfort care, again speaking bluntly about death. People who choose comfort care choose to avoid these procedures even though, without them, they might die. She concludes by recommending The Conversation.
It seems a minor thing, showing a short video. As, indeed, it will be, if it happens only occasionally. I didn’t get my head around the scale of Volandes’s ambition until I understood that he wants to make his videos ubiquitous. His intention is not only to provide clearer information but, more important, to trigger The Conversation as a matter of medical routine. “We’re saying, ‘You’re not doing your job if you are not having these conversations in a meaningful way with patients and their families,’ ” he tells me. “If every patient watched a video, there’s standardization in the process. That’s why I call it subversive. Very few things in medicine can change the culture like that.”
Routine use, however, is far, far away. According to Volandes, only a few dozen U.S. hospitals, out of more than 5,700, are using his videos. I spoke with physicians and a social worker at three health systems that are piloting them, and all were very enthusiastic about the results. Volandes is particularly hopeful about a collaboration with the Hawaii Medical Service Association, the state’s dominant health-insurance provider, which is piloting the videos in hospitals, nursing homes, and doctors’ offices. Officials say they hope to expand use statewide within three years. Right now, though, Volandes’s videos have a limited reach.
The problem is not his product but the peculiar nature of the market he wants to push it into. His innovation is inexpensive and low-tech, and might avert misunderstanding, prevent suffering, improve doctor-patient relationships, and, incidentally, save the health-care system a lot of money. He goes out of his way not to emphasize cost savings, partly because he sees himself as a patients’-rights advocate rather than a bean counter, and partly because it is so easy to demagogue the issue, as Sarah Palin did so mendaciously (and effectively) in 2009, when she denounced end-of-life-care planning as “death panels.” Anyone who questions medical maximalism risks being attacked for trying to kill grandma—all the more so if he mentions saving money. For all its talk of making the health-care system more rational and less expensive, the political system is still not ready for an honest discussion. And the medical system has its own ways of fighting back.
Volandes works on his videos ceaselessly. He has curtailed his medical practice and his teaching responsibilities, both of which he misses, and last year gave more than 70 speeches evangelizing for the video project. In an effort to batter the medical establishment into submission with the sheer weight of scientific evidence, he has conducted 13 clinical trials using videos to depict different diseases and situations, and he has seven more studies in the pipeline. He says he gets by on three or four hours of sleep a night. The project has taken over his house. Davis would like her living room back; there are floodlights and a big gray backdrop where her paintings should be.
Volandes thinks he can sustain this pace for perhaps five years—by which time he hopes to have revolutionized American medicine. Davis tries to dial back his expectations, but he resists. “Not when I have nurses and doctors use words liketorture as often as they do,” he says. “In order to make a change, you’ve got to be ambitious. If not, then just publish and get your tenure and move on.”
During my visit, I realized that I had encountered Volandes’s type before, but in Silicon Valley. Volandes has entrepreneurial obsessive-compulsive disorder: the gift, and curse, of unswerving faith in a potentially world-changing idea.
It is not a huge exaggeration to say that obsessive entrepreneurs, from Cornelius Vanderbilt to Steve Jobs, made America great. It is also not a huge exaggeration to say that health care, more than any other nongovernmental sector, has made itself impervious to disruptive innovation. Medical training discourages entrepreneurship, embedded practice patterns marginalize it, bureaucrats in medical organizations and insurance companies recoil from it. And would-be disrupters are generally disconnected from patients, their ultimate customers: they have to take their innovations to physicians, who are notoriously change-averse, and then they must get the government—Medicare, first and foremost—to approve and pay for them. Imagine that Jeff Bezos, when he was starting Amazon, had needed to ask permission from bookstores and libraries.
Volandes, therefore, will fail. That is to say, he will fail if success means revolutionizing the doctor-patient relationship and making The Conversation ubiquitous within five years. Meanwhile, if the American health-care system does not learn how to harness the energy and ideas of people like Volandes, it will fail. Somewhere between those failures lies a path forward. We know medical culture can change for the better; it takes the treatment of pain much more seriously than it used to, for example, and it has embraced hospice care.
The best news about U.S. health care today is that a lot of reform-minded entrepreneurship is bubbling up from within. Volandes is not alone. So many patients and doctors and family members feel marginalized and bureaucratized and overwhelmed that some health systems and insurers, in spontaneous mini-rebellions, are starting to innovate, often on their own dime. I think of Dr. Brad Stuart of Sutter Health at Home, who is building a new late-life-care system that bridges the gap between hospital and hospice, allowing the very sick to receive more care at home; I think of Dr. Derek Raghavan of Carolinas HealthCare System’s Levine Cancer Institute, who is building a “cancer center without walls” that uses telemedicine and other tools to make state-of-the-art treatment available to patients, regardless of where they live. I think of Dr. Woody English of Providence Health and Services, who is 67 and wants to make a difference before he retires. At his instigation, Providence has begun using Volandes’s videos. “The changes will come locally,” English told me, “not nationally.” When I look at him and Volandes and the others, I see not only a test of whether the health-care system’s medical culture can change but also a test of whether itsbusiness culture can change—and that change may, in the end, be even more important.
The morning after the shoot, Volandes shows me some of the footage he plans to use. We watch a patient with advanced Alzheimer’s being fed through a tube that has been surgically inserted into her stomach. An attendant uses a big syringe to clear the tube, then attaches a bag of thick fluid. Over the footage, Davis’s voice will say, Often, people hope tube feeding will help the patient live longer. But tube feeding has not been shown to prolong or improve the quality of life in advanced dementia. Tube feeding also does not stop saliva or food from going down the wrong way.
Volandes is explaining to me that tube feeding is overused in elderly dementia patients, but my mind has floated back to 2009. My father’s disease, by then, had destroyed his ability to protect his airway when he swallowed; food, drink, and saliva ended up in his lungs. He coughed violently when he ate or drank. Doctors mentioned tube feeding as an option, and well-intentioned friends nudged us in that direction. But his friends had no real idea what tube feeding entailed, and neither did I, and neither did he.
“Let me ask you this,” Volandes says. “Suppose I’m having a conversation with you about whether your father would want this. And I said ‘feeding tube,’ and you’re thinking to yourself, Food, yeah, I could give food to my mom or dad. We just want to make sure that regardless of the way the gastroenterologist is presenting the procedure, the patient’s loved ones know this is what we’re talking about.”
Not long before my father died, I asked a hospice nurse about tube feeding. He told me, with grim clarity: “I think that would be cruel.” I remember that nurse with gratitude, because he was right. But “that would be cruel” was not a substitute for The Conversation.
By Joyce Pellino Crane
When Diana Walker-Moyer left her Westford home on the morning of April 15 to volunteer at the Boston Marathon, she had no idea that her nursing skills would thrust her into the first known and widespread terrorist attack in this northeast region since 9/11.
According to Walker-Moyer, there were two medical tents set up at the marathon. Medical tent A was located at the finish line, and medical tent B was sited further down the road at Berkley Street near St. James, she said. Inside were emergency room physicians, intensive care unit nurses, and emergency medical technicians.
Walker-Moyer was asked to oversee a team of 15 health care providers charged with scanning the throngs for light-headed runners as they arrived. Her zone stretched along Boylston Street from a point between Clarendon and Dartmouth Streets toward Berkley.
The trickle of elite runners moving past her at the beginning of the race, swelled to a sea of bodies, as the slower runners finished the race.
“It’s like swimming in a sea of lemmings,” she said. “There are so many faces.”
According to the BAA, 23,336 began the race and 17,580 finished.
Her role was to keep people moving toward a supply of water bottles, Mylar blankets and the medals for finishers. Some team members stood by with wheelchairs in case a runner fainted.
“People are running this whole time and their heart is circulating the blood and so are their leg muscles,” Walker-Moyer said. “Then when they stop, that leg action muscle no longer is working the same because they’ve stopped moving and they may not be getting as much blood flow to their head.”
When the first explosion occurred on Boylston between Exeter and Dartmouth Streets, she was walking with a runner. Everyone turned to look. It sounded like a cannon, she said. “But there was no reason for that to happen right then. It made no sense,” Walker-Moyer said.
“Then the second one went off,” she said. “We were probably 100 yards away from it. Then you have all these people going from joy-faced to sad-faced because they’re in pain.” The second bomb was detonated 13 seconds later in front of the Forum Restaurant between Exeter and Fairfield Streets.
Medical tent A quickly became a triage center for the wounded.
“Thank God those people were there because more people would have died just from blood loss,” said Walker-Moyer. “The response was rapid and appropriate and lives were saved.”
As three police officers rushed past her toward the finish line, Walker-Moyer stayed at her post moving runners forward, said Collins.
“Diana was part of the medical sweep teams at the finish line, helping to move runners away from harm’s way after the explosions occurred,” Collins said.
Next year she’ll do it all over again, Walker-Moyer said.
“It’s Patriots’ Day. You think of the citizens who went to fight (in 1775) and we have this citizens medical group who are trained to volunteer when there’s a crisis,” she said. “One of the strengths of our nation has to be a prepared citizenry.”
Source: Wicked Local - Westford
BY ELIZABETH HANINK, RN, BSN, PHN
How do you approach continuing education? Do you seek out courses that will truly enhance your skills as a practitioner? Or do you simply look around a week before the renewal deadline and pick an online course you think you can complete in a short amount of time? Is price a deciding factor for you — getting the most hours for the lowest cost or only considering courses offered for free at the most convenient facility?
We have all probably fallen into several of the above practices at one time or another. While California’s requirement of 30 CEUs per year can hardly be considered onerous, somehow continuing education falls to the bottom of our lists of priorities. Also, some courses are very expensive. Often, a single day at a seminar that offers 7.5 contact hours will run over $200. With the increase in license fees — now $140 — it is quite possible to spend a hefty chunk of money just keeping your license current. Nonetheless, there is real value in many of the courses offered, and we owe it to ourselves to make the most of our continuing education. ➲
Research the Providers
Because the Board of Registered Nursing certifies course providers, not individual courses, the key is to look for a good provider, either one you know from past experience or one that comes recommended.
Courses generally need to be related to either direct or indirect client or patient care, like patient education strategies, cultural and ethnic diversity or skills courses like stoma care. Indirect patient care may include courses in nursing administration, quality assurance and nurse retention, as well as instructor courses for CPR, BLS or ALS.
You can find good courses in any of several formats:
Online: There are wonderful online companies that offer excellent material and the advantages of time flexibility and low cost. California is very generous in allowing all 30 required hours to be completed online; not all states are as accommodating. Almost every online course offers the option of a hardcopy text if you want it, and buying one for a few extra dollars is a good, inexpensive way to build up a reference library. Many online courses also offer the option of retaking the final test several times over a lengthy period (although I have never come across a continuing education test that was even remotely difficult). Several courses also offer a webinar component that allows for greater participation. Virtually all professional organizations offer online courses to their members.
All-day sessions: Usually taught by an expert in a particular field, these classes do not offer as much flexibility or as low a cost as online courses, but can be much more rewarding. Many all-day courses are very hands-on, with tons of take-home material and opportunities to ask the instructor questions — a luxury rarely afforded by online courses. Many all-day sessions target nurses in a particular practice area and presume a certain amount of basic knowledge of the subject matter. (All continuing education courses require that the information provided be above and beyond that required for licensure.)
Fun classes: Some courses promise entertainment, as well as education. Trips to resorts and cruises come to mind, offering sun, scenery, shows and good food — and learning, to boot. Who wouldn’t like that? This is, of course, the most costly option you can choose, but it might be a good way to combine work with pleasure.
Staying Close to Home
Your employer can be a very good source for a wide variety of continuing education programs. These courses are often free to employees and inexpensive for others. Sometimes sponsored by medical equipment vendors or drug companies, many classes of this type are short-term and highly specific. Very often, supervisors are quite accommodating about scheduling if the class is offered in-house — especially if the class is directly related to the care you give. Cross-disciplinary offerings are frequent in hospital settings, and as long as the class is Category I, you can even take courses directed at the medical staff.
Nurses often make the mistake of thinking that if an instructor is local, he or she has nothing useful to say. But you might be surprised at the credentials of some of your fellow employees. Both day-long and short lunch-hour seminars can be a boon to your professional development and easy ways to rack up the CE hours.
As you look for courses to take, don’t forget these essential BRN requirements:
• You cannot take courses designed for nonprofessionals or that focus primarily on self-improvement, like weight reduction or yoga (although some stress-management courses are allowed).
• Providers cannot allow for partial credit, although it is acceptable to break up multiple-day seminars into separate offerings, each with separate CE hours. Staying for only half the day will not cut it.
• If you take a course in California, it must have a California BRN provider number. If taken out of state, courses offered by the American Nurses Credentialing Center are acceptable, as are out-of-state courses offered by providers approved in another state — as long as the course are taken outside of California.
Exceptions to the Rule
The board also excuses certain licensees from needing to accrue CEUs:
• Advanced degree candidates: If you are in the process of obtaining a higher degree, you can count some of your academic courses toward your CE requirement using the following equation: one semester unit equals 15 CEUs, one quarter unit equals 10 CEUs.
• Hardship or disability: You may also be excused from some or all of your continuing education requirement if you can prove a personal hardship, such as a physical disability last more than a year, or if you are solely responsible for a totally disabled family member for more than a year.
• Practicing outside California: If you are employed by a federal agency or in military service and are practicing outside of California, you can maintain your license without CEUs (although those organizations usually have their own requirements).
Not working right now, but want to maintain an active license? You will need the CEUs, just like everyone else. But you can also choose inactive status; if you go on inactive status and then resume active status within eight years, you will only need 30 contact hours in total to be reinstated.
Don’t forget: It is not enough to take the course and earn the hours. You must retain proof of completion for at least four years, just in case you are one of the randomly selected nurses whose CEUs the BRN decides to audit and verify.
Whatever your individual circumstances, don’t waste this opportunity for career growth. Choose your courses wisely and try to avoid having to select your CE hours based on expediency. This is the only post-licensure education some nurses will receive. Get as much as you can.
The California Board of Registered Nursing website
BY KEITH CARLSON, RN, BSN
In 2005, the New York Times published an editorial by Teri Mills, RN, MS, CNE, president of the National Nursing Network Organization (NNNO), calling for the appointment of a national nurse leader who would promote awareness of public health issues. Since then, the NNNO and its supporters have waged a campaign to bring the matter to the attention of nurses, the general public and members of Congress. Could you be a lobbyist?
The United States Public Health Service has had a chief nurse officer (CNO) for decades, working within the Office of the Surgeon General. However, the CNO has largely remained outside the limelight and is mostly unknown to both the public and the more than 3 million nurses currently licensed in this country.
On Feb. 4, 2013, with the strong support of Reps. Eddie Bernice Johnson (D-Texas) and Peter King (R-N.Y.), the National Nurse Act of 2013 was officially introduced to the House of Representatives as H.R. 485.
Johnson, who describes herself as “the first registered nurse in Congress,” explained in an email statement that H.R. 485 would designate the chief nurse officer of the U.S. Public Health Service as the national nurse for public health in order to elevate the visibility of nurses.
A NATIONAL MEGAPHONE
The national nurse, Johnson said, would collaborate with the surgeon general to address national health priorities and would serve as a national spokesperson to engage nurses in leadership opportunities and community prevention efforts.
Under H.R. 485, the national nurse for public health would continue to serve simultaneously as the CNO. However, in his or her new capacity, the national nurse would be a much more public figure than past CNOs, acting as a resource for public health guidance, promoting media campaigns and outreach and garnering support from both healthcare professionals and the general public for public health initiatives.
According to Mills, a major goal of the bill is for the national nurse to serve as a source of encouragement, inspiration and professional direction for nurses.
At a time when this most trusted of American professions struggles with nursing shortages and other challenges, placing a high-profile nurse in such a leadership role could inspire nurses to make positive career choices, including expanded volunteerism and involvement in community prevention efforts.
“We want the position to be more visible,” says Mills, “because we really believe that nurses, encouraged by a prominent national nurse for public health, will mobilize to carry messages of prevention forward.” Nurses, she adds, are well positioned to reach everyday Americans with meaningful health messages and in times of public health crises and disasters, nurse expert opinion and commentary in the media would provide a “welcome and trusted authoritative voice.”
LOCAL NURSES ARE ONBOARD
According to Susan Sullivan, a retired public health nurse living in Southern California and the secretary of NNNO’s board of directors, many California nurses are strongly in favor of establishing a national nurse. She explains, “We see the logic in creating a prominent nurse leader whose national visibility will serve to encourage collaboration and community support for meaningful prevention initiatives.”
She says the national nurse could also play an important role in encouraging and inspiring California nurses to connect with their community’s diverse populations to promote better health outcomes. The national nurse will be a widely recognized public health advocate, a nurse who will have the backing of Congress to take action. “Having this sort of leadership at the national level will produce results.”
Email Susan Sullivan at email@example.com to arrange a conference call or a conference speaker.
NO PLAYING POLITICS
One concern that has arisen about expanding the CNO’s role in this manner is the possibility of turning the position into a political one. Mills maintains that the public health service, like the military, must remain nonpartisan and not take any public stand on legislation or elections.
The supporters of H.R. 485 have had constructive discussions on that subject with representatives of the surgeon general’s office, resulting in several revisions to the language of the bill.
A CALL TO ACTION
As of this writing, the bill has received bipartisan support from more than 35 members of Congress and further co-sponsorship is being actively sought. The bill’s sponsors hope it will make its way through the political process and pass during the current session.
If you are interested in learning more about this initiative and supporting the bill’s passage through Congress, visit the NNNO website, www.nationalnurse.org.
The website includes links to sign up for the campaign’s newsletter, make financial contributions and contact members of the NNNO, as well as opportunities to join the advocacy team and travel to Washington, D.C., as part of the lobbying effort.
The organization can assist you in contacting your representatives, including providing sample phone scripts or letters to mail or email. For a donation of $20, the advocacy team will also deliver an information packet on H.R. 485 to your congressional representative on your behalf.
“Having a national nurse for public health join with the surgeon general will make it possible to expand health promotion and disease prevention efforts in our communities. That’s why I’m a proud co-sponsor of the National Nurse Act of 2013.”
— Congresswoman Linda T. Sánchez (D-Calif.)
Nurse Turns Lobbyist
You don’t need to be political to be involved
In early February, Audrey Bayer, RN, BSN, of Lambertville, N.J., learned that her congressional representative, Leonard Lance (R-N.J.), would be holding mobile office hours near her home.
Although she says she is not “a political person,” Bayer contacted Teri Mills of the National Nursing Network Organization and decided to bring the National Nurse Act (H.R. 485) to Lance’s attention.
“Of course I was nervous,” says Bayer, “since I had never met a person from Congress before. But I felt that this was my moment! He responded in a positive manner, accepting the information I provided, both written and verbal.”
Bayer, who is now in her sixth year as a nurse, says she became interested in the national nurse for public health campaign during her final BSN class at Pennsylvania’s Immaculata University, from which she graduated in January. “Teri got in touch with me and I joined the advocacy team,” Bayer explains.
Our new nurse lobbyist plans to follow up with Lance and other lawmakers about H.R. 485 over the course of the current legislative session.
Source: Working Nurse