By Alison Stanton
When Joanne Clavelle was 12 years old, she began working as a candy striper at a Vermont hospital.
It didn't take her long to realize that she had found what she was meant to do.
"I used to feed patients, change their water pitchers and make eggnog with real eggs," Clavelle says. "After a couple of years of being a candy striper, the nurses at the hospital sort of adopted me, and I moved into a volunteer aide position in the emergency department. I got to wear a white uniform with white stockings and shoes; I thought I was in heaven."
Clavelle was hired as an EKG technician at the same hospital when she was 16. She worked every weekend doing what she loved.
Her dedication to outstanding patient care caught the eye of three physicians at the hospital.
"The doctors had a scholarship program," Clavelle says. "They gave me a scholarship, which helped pay for me to go to nursing school at the University of Vermont.
Thirty-plus years later, Clavelle is still as passionate as ever about her career as a nurse and providing top-notch patient care. Five months ago, she was named senior vice president and chief clinical officer at Scottsdale Healthcare.
"I absolutely love my job here," she says. "I have the opportunity to create a nursing infrastructure that focuses on outstanding patient care and ensures that we maintain our Magnet designation."
This designation, Clavelle says, is given to the top 8 percent of hospitals in the country.
"It recognizes organizations like ours that create a supportive environment for nurses to practice and provide high-quality care," she says. "I am committed to creating a culture where nurses and other providers give the best care possible. That's what it's really all about."
When she is not working, Clavelle enjoys painting.
Watercolors are especially appealing to her, and she takes art classes whenever she can.
Clavelle also likes to spend time with her husband, their adult children and their 14-year-old dog.
Even though Clavelle has spent the past 36 years working in health care, she says things amaze her — in a good way — about her work.
"I was pleasantly surprised and proud to learn that our hospital has a forensic-nursing program, and we also have a wonderful military partnership with the United States Air Force," she says. "It's a unique model for graduate nurses in the Air Force to participate in a number of programs, including a nurse-transition program and critical-care and emergency-trauma-nursing fellowship."
Who's Who in Business 2014
Joanne Clavelle is one of 50 women in various fields profiled in "Who's Who in Business 2014," a publication of Republic Media. Find the full publication online at azcentral.com in July.
By Karen Weintraub
The parents of children with autism often have to cut back on or quit work, and once they reach adulthood, people on the autism spectrum have limited earning potential.
Those income losses, plus the price of services make autism one of the costliest disabilities – adding $2.4 million across the lifespan if the person has intellectual disabilities and $1.4 million if they don't, according to a new study published in the journal JAMA Pediatrics.
"We've known for a long time autism is expensive, but we've really never had data like this to show us the full magnitude of the issue," said Michael Rosanoff, associate director of public health research for the advocacy group Autism Speaks, which funded the research. "These are on top of the costs to care for a typically developing individual."
Jackie Marks knows the problem firsthand. The Staten Island, N.Y., mom has 13-year-old triplets, all on the spectrum and all with intellectual deficits.
Everything about their care costs more money, she says, from the diapers and wipes she still has to buy to the specially trained babysitters she has to hire every time she wants to go out. For karate classes, she has to pay for one-on-one lessons; the therapist helping with social skills costs $150 an hour per child.
"I enjoy my children immensely," Marks said. "I have a wonderful husband. That, at the end of the day makes it all worth it. But is it like a typical experience? No."
Marks quit her job with the state as a bank auditor to care for Tyler, Dylan, and Jacob. Her husband's job not only has to cover day-to-day needs, but he has to put away enough money to pay for both her and the boys after he retires. She hopes the boys will be able to work someday, but they'll never have the kind of earnings that will sustain them, she said, and will probably receive modest Social Security benefits once they turn 18.
Four things need to change to bring down the cost of autism for families and society, according to David Mandell, director of research for the Center for Mental Health Policy and Services at the University of Pennsylvania.
Adults on the spectrum need more job opportunities. There are many small success stories of individuals or small groups of people with autism who are employed, but "we need to be more creative about thinking about employment on a large scale," Mandell said.
Adult care must be improved so only people who really need expensive residential care get it, and everyone else can find support in their own community, he said. "I think in too many cases, these residential settings represent a failure of our society to provide community-based, cheaper options," he said. "More flexible, cheaper options would be a way to bring these costs down."
Families with autism need more opportunities to stay in the workplace. "Issues that face autism ultimately face all families," Mandell said. "If we had more family-friendly workplace policies, we might see substantial change in the way families were able to manage the work-life balance when they had children with (all kinds of) disabilities."
Society needs to take the long view, he said. Spending money diagnosing and helping young children on the spectrum will probably save money when they are older, by reducing disability and improving employability. "We often talk about the cost of care, and we don't spend much time talking about the cost of not caring," he said.
•Cost of supporting someone with an autism spectrum disorder plus intellectual disability: $2.4 million in the USA and 1.5 million pounds in the United Kingdom ($2.2 million in U.S. dollars)
•Cost of supporting someone with an autism spectrum disorder but no intellectual disability: $1.4 million in the USA and .92 million pounds in the United Kingdom ($1.4 million)
By Ilene MacDonald
Despite new technology and evidence-based guidelines, medical mistakes happen too frequently and may lead to as many as 400,000 preventable deaths each year.
But two new programs, launched at the University of Virginia Medical Center, offer a new approach to patient safety that may prevent medical errors, WVTF Public Radio reports.
This year the organization introduced a simulation lab in the pediatric intensive care unit. The "Room of Errors" features high-tech infant mannequins attached to monitors. When doctors and nurses enter the lab, they have seven minutes to determine what is wrong.
As part of a recent exercise, a doctor-nurse team worked together to spot 54 problems with the scenario, including the fact the ventilator wasn't plugged into the correct outlet, the heat wasn't turned on and the potassium chloride was programmed at the wrong concentration.
The interpersonal, team-based learning approach helps doctors and nurses improve their ability to make decisions together and communicate with one another, Valentina Brashers, M.D., co-director of the Center for Interprofessional Research and Education, an effort headquartered at UVa's Schools of Nursing and Medicine, told WVTF.
"Knowing that there are others that you can work to think with you and share with you their concerns as you work through difficult problems makes care provision a much more enjoyable and rewarding activity. It reduces staff turnover. It creates an environment where we feel like we're all in it together with the patient," she said.
The pilot proved so successful that the medical center intends to roll it out to the entire hospital.
In its quest to eliminate medical mistakes at the organization, UVa also launched a second patient safety initiative that calls for hospital administrators to meet each morning to talk about any problems that occurred in the previous 24 hours, according to a second WVFT article.
The "Situation Room" features white boards and monitors, where administrators review every new infection and unexpected death and then visit the places where the problems took place.
Sometimes the solutions are easy fixes, such as a receptionist who removed a mat that caused patients to trip at the entrance of an outpatient building. Others, caused by communication problems, are more complicated, Richard Shannon, M.D., executive vice president for health affairs, told the publication. To address it, Shannon wants to shake up the medical hierarchy where the physician sits at the top.
"The physician may spend 20 minutes at the bedside a day. The nurse is there 24/7 and has about 13 times more direct contact with the patient than does the physician," he told WVFT. "You can't have someone at the head of the pyramid who is absent a lot of the time."
Finally, to encourage better communication among caregivers, patients and families, Shannon now encourages healthcare professionals to make rounds in the afternoon, when visitors are on premises.
By ANAHAD O'CONNOR
DURHAM, N.C. — Before scrubbing in on a recent Tuesday morning, Dr. Selene Parekh, an orthopedic surgeon here at Duke Medical Center, slipped on a pair of sleek, black glasses — Google Glass, the wearable computer with a built-in camera and monitor.
He gave the Internet-connected glasses a voice command to start recording and turned to the middle-aged motorcycle crash victim on the operating table. He chiseled through bone, repaired a broken metatarsal and drilled a metal plate into the patient’s foot.
Dr. Parekh has been using Glass since last year, when Google began selling test versions of its device to thousands of handpicked “explorers” for $1,500. He now uses it to record and archive all of his surgeries at Duke, and soon he will use it to stream live feeds of his operations to hospitals in India as a way to train and educate orthopedic surgeons there.
“In India, foot and ankle surgery is about 40 years behind where we are in the U.S.,” he said. “So to be able to use Glass to broadcast this and have orthopedic surgeons around the world watch and learn from expert surgeons in the U.S. would be tremendous.”
At Duke and other hospitals, a growing number of surgeons are using Google Glass to stream their operations online, float medical images in their field of view, and hold video consultations with colleagues as they operate.
Software developers, too, have created programs that transform the Glass projector into a medical dashboard that displays patient vital signs, urgent lab results and surgical checklists.
“I’m sure we’re going to use this in medicine,” said Dr. Oliver J. Muensterer, a pediatric surgeon who recently published the first peer-reviewed study on the use of Glass in clinical medicine. “Not the current version, but a version in the future that is specially made for health care with all the privacy, hardware and software issues worked out.”
For his study, published in The International Journal of Surgery, Dr. Muensterer wore the device daily for four weeks at Maria Fareri Children’s Hospital at Westchester Medical Center in New York. He found that filming rapidly drains the battery and that the camera — which is mounted straight ahead — does not point directly at what he is looking at when he is hunched over a patient with his eyes tilted downward.
He also had to keep the device disconnected from the Internet most of the time to prevent patient data and images from being automatically uploaded to the cloud. “Once it’s on the cloud, you don’t know who has access to it,” Dr. Muensterer said.
Google has yet to announce a release date for Glass, and the company declined to comment on how many of its testers were doctors or affiliated with hospitals. But “demand is high,” said Nate Gross, a co-founder of Rock Health, a medical technology incubator. “I probably get asked every few days by another doctor who wants to somehow incorporate Glass into their practice.”
And already, outside hospitals, privacy concerns have led some bars and restaurants to ban the devices. Legislators have proposed restrictions on the use of Google Glass while driving, citing concerns about distraction. Doctors, too, are raising similar concerns.
The Glass projector is slightly above the user’s right eye, allowing doctors to see medical information without turning away from patients. But the display can also be used to see email and surf the web, potentially allowing doctors to take multitasking to dangerous new levels, said Dr. Peter J. Papadakos at the University of Rochester Medical Center, who has published articles on electronic distractions in medicine.
“Being able to see your laparoscopic images when you’re operating face to face instead of looking across the room at a projection screen is just mind-bogglingly fantastic,” he said. “But the downside is you don’t want that same surgeon interacting with social media while he’s operating.”
Indeed, similar technology has not always had the smoothest results. Studies have found, for example, that navigational displays can help surgeons find tumors, but they can also induce a form of tunnel vision, or perceptual blindness, that makes them more likely to miss unrelated lesions or problems in surrounding tissue. And in aviation, pilots who wear head-mounted displays that show crucial flight information can lose sight of what is happening outside their windshields, said Dr. Caroline G. L. Cao, who studies image-guided surgery at Wright State University.
“Pilots can get so focused on aligning the icons that help them land the plane,” she said, “that they miss another plane that is crossing the runway.”
One doctor who does not allow the device in his practice, Dr. Matthew S. Katz, the medical director of radiation oncology at Lowell General Hospital in Massachusetts, said that security and distractions were primary concerns. A doctor wearing Glass could accidentally stream confidential medical information online, he said, and patients might not feel comfortable with their doctors wearing cameras on their faces.
Until Glass has been better studied in health care and equipped with safeguards, Dr. Katz said, doctors should be forced to check their wearable computers at the clinic door.
“From an ethical standpoint, the bar is higher for use in a medical setting,” said Dr. Katz, who is also an outside adviser for the Mayo Clinic Center for Social Media. “As a doctor, I have to make sure that what I’m doing is safe and secure for my patients — ‘First, do no harm.’ Until I am, I don’t want it in my practice.”
Bakul Patel, the senior policy adviser at the Food and Drug Administration’s Center for Devices, said the agency would regulate only those Glass software programs that function as medical devices, the same approach it takes on health applications on hand-held devices.
“The glasses have been on our radar and we’re excited about it,” Mr. Patel said.
Hospitals that are experimenting with Glass say they are doing so very carefully — obtaining patient consent before procedures, using encrypted networks, and complying with the federal regulation that protects patient privacy, known as Hipaa.
Medical software developers say they, too, have security and privacy in mind. Pristine, a company based in Austin, Tex., createdan app that lets emergency room nurses and doctors beam in specialists for consultations. The company plans to sell a customized version of Glass directly to hospitals. It erases Google’s software and configures the glasses with its own Hipaa-compliant programs.
Another company, Augmedix, which has done pilot tests of Glass at medical centers in the San Francisco area, said patients were informed that their doctors would be wearing the device. In a study of 200 cases, only two or three patients asked that their doctors remove it, said Ian K. Shakil, a co-founder of Augmedix.
Some hospitals see Glass as a relatively low-cost and versatile innovation, much like smartphones and tablets, which more than half of all health care providers use to get access to patient data and other medical information.
But hand-held devices are not very useful in the sterile world of surgery. Because Glass is voice-activated and hands-free, it may be particularly well suited for the surgical suite, where camera-guided instruments, robotics and 3D navigation systems have been commonplace for years.
Dr. Pierre Theodore, a cardiothoracic surgeon at the University of California, San Francisco, calls wearable computers “a game changer.”
“In surgery, Google Glass is incredibly illuminating,” said Dr. Theodore, who uses Glass to float X-rays and CT scans in his field of view at the operating table. “It helps you pinpoint what you’re looking for, so you don’t have to shift your attention away from the operation to look at a monitor somewhere else.”
At Indiana University Health, Dr. Paul P. Szotek, a Level 1 trauma surgeon, is developing an app for Glass for use by paramedics.
The app streams a live feed from the glasses to the closest emergency rooms, so that doctors can see accident victims at the scene and give paramedics potentially lifesaving instructions — like when to go directly to a Level 1 trauma center.
“Last year, I lost a lady on the table from a spleen injury that was absolutely survivable because she was taken to a local hospital and then the delay was over two hours to get her to me,” Dr. Szotek said. “With this wearable technology, we’ll be able to assess patients on the scene and decrease the mortality associated with trauma significantly.”
Dr. Szotek met with Google in March to discuss his software, called 1st Sight. He and other Glass-wearing surgeons recently founded a group — the International Society for Wearable Technology in Healthcare — that is holding its first meeting in Indianapolis in July.
At Duke, Dr. Parekh performs back-to-back surgeries on most days, wearing the Glass headset as he moves from one patient to the next.
About six years ago, he founded a charity with the goal of advancing foot and ankle surgery in India. He travels there every year with a team of expert surgeons to hold clinics and training sessions for local orthopedic surgeons.
In January, at a conference in Jaipur, Dr. Parekh performed surgery and used Glass to stream the procedure on his personal website. That day, the site drew in so many visitors from India and elsewhere that it crashed.
“I’ve been even more excited about Google Glass since then,” he said.
by David Tennebaum
The single-use timer that will wholesale for about a dollar is designed to make a nurse’s life easier.In medicine, time isn't just money: it can mean the difference between life and death. Clot-busters must be given in the first hour of arrival in a hectic emergency room. Intravenous medications can spoil, and catheters that overstay their welcome invite infection.
The advance of technology translates into heavier, more complex workloads for the nurses on the frontlines of medical care. To ease the burden, biomedical engineer Sarah Sandock has invented a simple, inexpensive, single-use timer that could be worn like a wristwatch to tell a nurse when to administer a drug or unhook a medical device.
Sandock is a Milwaukee native who received bachelor's and master's degrees in biomedical engineering from Univ. of Wisconsin-Madison (UW-Madison) in 2012 and 2013.
In her first year at the UW, Sandock was inspired by bacteria that had been genetically engineered to create rhythmic pulses. She immediately thought of timing: "I thought, this is cool; you could grow your own timer instead of manufacturing one!"
When that brainstorm seemed impractical, she started thinking of possible uses for a cheap, disposable timer. "As I was in biomedical engineering, and most of my relatives are practicing physicians, I looked for applications in the health care space," she says.
Sandock participated in a Three-day Startup event, a program designed as a dry run for would-be entrepreneurs in Madison, and began to get serious about actually starting a company. She used a disposable-timer business as an academic exercise in two business school classes, "and halfway through, I became passionate about the project."
Sandock knew that one person's passion is nowhere near enough to start a company. Would nurses appreciate the idea? Would they ask for the timer and use it? She says the answer came pretty quickly when she followed nurses working in Madison, Milwaukee and elsewhere: "They asked me, 'Do you have them now? We can use them now.'"
The many technological innovations in health care have countless benefits, but Sandock contends they have not made nurses' lives easier. "They see this as a product that is geared to help them with their problems."
Sandock has working prototypes in hand and is focusing on getting the timers manufactured. She sees two key categories of initial demand for her product: medicines that must be delivered within a certain time window, and medical devices that must be removed or changed at a specific time point, often to avoid a hospital-acquired infection.
Sandock has one patent application filed but is reluctant to specify what technology underlies the inexpensive timers. Her company, Dock Technologies, has an office at the Madison co-working space 100state, and is working with people in the medical field to refine the displays for maximum utility in specific uses.
Dock Technologies has attracted investment from the Weinert Applied Ventures in Entrepreneurship (WAVE) class at the Wisconsin School of Business, several Wisconsin physicians and the National Collegiate Innovators and Inventors Alliance.
A single-use medical device that wholesales for about a dollar has to be accurate. And beyond that, the standard is pretty simple, Sandock says. "Does it save time? Does it make a nurse's life easier?"
Would this timer be helpful to you and your job? If so, how?
Source: Univ. of Wisconsin-Madison
By KAYLEIGH SOMMER
Wherever health care is provided, a nurse is likely to be there.
Tuesday marks the start of National Nurses Week, an annual opportunity for communities to recognize the full range of nurses’ contributions. This year’s theme, “Nurses: Leading the Way,” recognizes nurses as leaders in the field.
Nurses are being honored as leaders who improve the quality of health care. Nurses practice in diverse roles, such as clinicians, administrators, researchers, educators and policymakers.
Lizeth Martinez, a registered nurse at Valley Baptist Medical Center in Harlingen, said every nurse is different.
“We each have our scope of practice and me, personally, I always try to be there for my patients,” Martinez said. “From what I have seen I am very fortunate to work with the people that I do.”
Martinez, who was born and raised in Brownsville, is currently working on a graduate degree in nursing at the University of Texas at Brownsville and should be finished by next year.
She said that in the two and half years that she’s been a nurse she has gained a lot of experience.
“I love being a nurse,” Martinez said. “As nurses we care in a different way, in a compassionate and holistic manner promoting health and healing.”
However, being a nurse is not without its challenges, said Martinez, who mainly works with wound care and diabetes patients.
“I think the most challenging thing about being a nurse is the emotional aspect because we see a lot of patients that are chronically ill,” Martinez said.
Garett Byrd, a pediatric registered nurse at Harlingen Medical Center, has worked in the nursing field for nine years.
Byrd, whose parents were nurses, said the profession has changed a lot during that time.
“Over the years I’ve noticed an increase in accountability and technology,” Byrd said. “The nursing profession has moved towards a more evidenced based practice. Were not doing things just to do them, were researching and going by the research.”
He said the community should keep one thing in mind.
“The community needs to remember that we’re human beings too, and we’re here because we care,” Byrd said.
Both Martinez and Byrd said nurses are leaders in the health profession.
“I think we are leaders. The profession is so amazing because there are so many things you can do, so many fields you can go into,” Martinez said.
“As nurses were able to provide and coordinate care and think those aspects of leadership position.”
Karen A. Daley, president of the American Nurses Association, agrees.
“All nurses are leaders, whether they are in direct patient care, administrative roles or meeting consumers’ needs in new roles such as care coordinators or wellness coaches,” Daley said.
“This week, we acknowledge nurses’ vast contributions and how they are leading the way in improving health care and ultimately, the health of the nation.”
Nurses are leading initiatives to increase access to care and improve outcomes by focusing on primary care, prevention, wellness, chronic disease management and the coordination of care among health care providers and settings.
These are areas in which nurses excel given their education and experience, the ANA said.
According to the ANA, nursing is the nation’s largest health care profession, with nearly 3 million employed professionals and is projected to grow faster than all other occupations.
The federal government projects that more than 1 million new registered nurses will be needed by 2022 to fill new jobs and replace nurses who leave the profession.
Demand for nursing care will grow rapidly as Baby Boomers swell Medicare enrollment by 50 percent by 2025 and millions of individuals obtain new or better access to care under the health care reform law, the ANA said.
Source: Valley Morning Star
Nursing continues to be one of the fastest-growing occupations in the nation, as nurses make up the majority of the health care industry workforce. In fact, recent projections from a January 2014 report published in the Bureau of Labor Statistics (BLS) Occupational Outlook Handbook estimate the job growth to be 19 percent faster than the average occupation through 2022.
Besides a strong job market, a degree in nursing can be even more rewarding than you may think. A nurse usually has a flexible schedule and the option to work in a variety of establishments, from hospitals to schools, home care facilities and even government agencies. Few professions can provide the same number of options in terms of where to work, areas to specialize in, or degrees to use. The range of nursing specialties is almost as varied as the personalities of the nurses themselves. So no matter what kind of person you are, you’ll have a place in nursing.
However, the industry has changed over the years and this has led to a higher demand of registered nurses. Patient treatments have become more complicated, and with an increased workload, nurse positions require even more critical thinking skills.
Brenda McAllister, the national director of nursing of the Brown Mackie College system of schools, knows first-hand how the industry has changed. "I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients,” she says. “There is a more team-oriented approach which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
Nurses must be able to work through problems that don't have a standard cookie-cutter solution. If a life-threatening problem occurs, the nurse must take action within their scope of practice to save a patient. Nurses must have the ability to think on their feet and assure patient safety.
On the other hand, nurses continue to go the extra mile to help their patients. Many people, especially the elderly, are reluctant to take medicine prescribed by a doctor other than their regular doctor. "Nurses will sometimes even call a patient's regular doctor to explain their current health care needs," McAllister says. "Usually a word from that trusted source will help the patient comply. It’s an additional step, but all the more rewarding when you help a patient out.”
In addition, there are a lot of things a nurse can do other than work at a hospital. In fact, not all aspects of nursing require physical, hands-on care. One employment option, which appeals to those who don't necessarily want to touch every patient physically, is to become a care manager or care coordinator. This position involves managing outpatient care to make sure needs are met and health is maintained when a patient leaves a medical facility.
The home health care coordinator's job is broadly based on patient education. Good health assessment skills and good nursing skills are necessary elements of care. These skills, plus teaching skills, continue to help keep the patient as independent as possible.
Another example would be a care coordinator's position at an insurance company, which is similar to one employed by a hospital. They work with an eye toward keeping treatment aspects in line with guidelines. A knowledge base is essential to perform the job. One must be able to be a manager, have a broad understanding of the body and a scientific background.
Even with attractive career options and expanding nursing programs, there is still a growing nursing shortage. Higher complexity of care, a growing geriatric population, expanding health and disease prevention services, and many other conditions regarding individual health demand more qualified nurses to fill an increasing variety of positions. So if this is a path you choose to follow, research your options and determine which fields and programs meet your needs to have a rewarding career in nursing.
Source: Journal Sentinel
His tattoo read "White Power" in 3-inch calligraphic letters. Emblazoned across his chest for all to see, the ink wasn't something I would normally have missed during my physical exam. In this case, though, his tattoo had been hidden by a bulky neck collar and the array of lines and tubes that come with being a comatose trauma patient.
Only on my third day of being this man's physician did I find myself confronted with the aggressive declaration.
I found myself wondering whether he would want me, a black woman, to be his doctor.
There was no dissatisfaction apparent in many interactions with his family, but they were somewhat distant. Was the distance born of shock over a relative's sudden, life-threatening injury? Or of discomfort with me?
As physicians, we take note of patients' demographics in part because it helps with diagnosis: Black patient with anemia? Think sickle cell. Greek patient with anemia? Think of the blood disorder thalassemia.
The Hippocratic Oath cautions us against refusing to treat patients based on these characteristics.
Doctors aren't supposed to be racist. We tend to think of ourselves not so much as people with specific identities, but more as disembodied brains and skilled hands ready to go about the work of healing.
My patient's tattoo was an unwelcome reminder that the skin I inhabit can't be checked at the hospital door.
Race is sometimes overtly discussed in health-care encounters, but usually because a patient expresses a preference for a clinician of a particular racial or ethnic background.
It is rarer for a patient to say that he or she does not want to be cared for by certain people. A few high-profile cases in the last several years involved white patients refusing care by black nurses.
While these requests are perhaps reprehensible, more controversial was the facilities' responses - in all the cases, the patients' wishes were honored. Some of the affected nurses successfully sued their employers for accommodating the racist requests, which had essentially allowed prejudice to affect their working conditions.
How should health-care providers respond to a racist, sexist, or bigoted patient? Sachin Jain is a physician of Indian descent who wrote about his experience with a patient who yelled at him to go back to India. Jain chose to yell back, a decision he later questioned.
In the New York Times' "Well" blog, Asian physician Pauline Chen revisits the Jain story and describes her own encounter with a combative swastika-decorated patient in the emergency room. She didn't wait for the patient to express his discomfort with her - she instead chose to remove herself from his presence as soon as it was clinically appropriate.
I explored the topic of racist patients in a piece for the Journal of the American Medical Association this month. I argued that I wholeheartedly reject racism and race-based prejudice, but I also recognize that patients have the right to choose their care providers and to have some control over the conditions of their care.
The therapeutic relationship between doctors and nurses and their patients is founded on mutual trust and respect; when these are missing, communication suffers and care plans fall apart. If I care for a patient who does not want me as a doctor, I have done that patient a disservice.
The responses I received to the JAMA piece were mixed. Many people thanked me for tackling a difficult issue for minority clinicians.
A few, though, criticized me for condoning inappropriate behavior. One person suggested that the clinical encounter could become a "teachable moment" in which I could fight prejudicial tendencies.
As much as I want to stamp out racism, I continue to believe that a one-on-one clinical encounter is the wrong venue to address this issue, for at least two reasons.
First, behavior is difficult to change. If I cannot persuade a patient to stop smoking or to eat more healthily, how will I convince them to shed long-held beliefs?
Second, asking for someone's respect when they are not inclined to give it is an exercise in futility. I learned that in high school.
I do think that there is a role for hospitals and other institutions to express that racism is not tolerated in clinical encounters. Similar to the "no smoking" signs that adorn healthcare facilities, I can imagine a "no offensive language or pre-judging" sign.
Health-care providers are under no obligation to treat patients in nonemergency situations, so perhaps instead of merely changing their clinicians, we should be referring bigoted patients to facilities willing to care for them.
That wouldn't have helped my trauma patient, though. He was at the brink of death, unable to declare his preference for care providers one way or the other.
As a result, he received superior care from people that he might have deemed inferior. Maybe the fact that we saved his life will serve as the ultimate teachable moment.
by Meaghan O'Keeffe, RN, BSN
As the institution of healthcare continues to evolve, nurses across the country are being asked to change with it. It can be easy to lose focus on the larger picture, however, when faced with the day-to-day challenges on the job.
These five reports are an eye-opening look at the healthcare system in crisis, but most importantly, they offer the nursing profession inspiring, actionable plans for how to change it.
Each of these reports is a must-read. They’re engaging and provocative and will help you come to informed opinions about the state of healthcare and your role as a nurse. Consider choosing a report every other month to distribute to your co-workers and then hold semi-formal discussion sessions to explore the themes and how they relate to your experience as a nurse.
5 Must-Read Reports for Nurses
In this ground-breaking study, published by Vital Smarts and the American Association of Critical Care Nurses in 2005, seven areas where communication breakdown occurs in healthcare delivery were identified. They found that fewer than 10 percent of healthcare works speak up when they’ve observed medical errors, incompetency and other potential harmful behaviors. One of the more interesting findings of the study was that the few who do speak up in challenging circumstances have better patient outcomes and are more likely to stay in their jobs.
A follow-up to Silence Kills, The Silent Treatment takes a closer look at the many reasons why nurses fail to speak up during crucial moments in healthcare delivery and what identifies the characteristics shared by nurses who find the courage to say something when it counts.
Published in 2010, The Robert Johnson Wood Foundation, along with the Institute of Medicine, presented a call to action. In The Future of Nursing, the authors present data, and outline constructive ways, in which the nursing profession can become a leading voice in the revolution of the healthcare system.
The American Association of Critical Care Nurses published the AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey To Excellence in 2005. In it, they identify the factors necessary to create and sustain a work environment that empowers nurses to deliver the best care possible. As you read through it, critically think about which standards your institution or unit meet, and which might be areas for improvement.
The Insitute of Medicine recognizes the relationship between a healthy work environment for nurses and optimal patient care outcomes. In Keeping Patients Safe, the IOM provides recommendations that address adequate staffing, trust in organizations, and other “bundles of change” that will ensure an optimal environment for nurses to do the jobs required of them.