DiversityNursing Blog

The Emergence of Telenursing

Posted by Brian Neese

Fri, Jun 09, 2017 @ 03:02 PM

transform.jpegIn many cases, patients are now able to access their health care providers through video conferencing, instant messaging, email and other forms of technology. This field, known as telehealth, is growing due to the demand for greater access and convenience in health care, according to Hospitals & Health Networks.

Advances in technology allow nurses to interact with patients remotely. This has led to the term “telenursing” or “telehealth nursing,” which is defined as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice,” the American Telemedicine Association (ATA) says.

Telenursing is not a specialty area in nursing. Nurses in nearly all practice settings can provide care at a distance. And given the rapid rise of telenursing, current and future nurses can expect to have more career opportunities in this field.

Growth and Benefits

More than half of all U.S. hospitals use some form of telemedicine, according to the ATA. A survey shows that 90 percent of health care executives are developing or implementing a telemedicine program.

Other signs point to the growth of telemedicine and telenursing. State lawmakers are supporting legislation for telemedicine-related reimbursements. These changes have been accepted by private and public insurers. Providers are even extending services across the globe, and the ATA notes that more than 200 academic medical centers in the United States offer video-based consulting in other parts of the world.

Primary benefits associated with telemedicine include the following.

· Cost Savings: A heart failure telemonitoring program led to 11 percent cost savings, with an estimated return on investment of $3.30 in cost savings for every $1 spent on program implementation, according to the American Hospital Association. U.S. employers could save an estimated $6 billion by offering telemedicine, global professional services company Towers Watson says.

· Flexibility: About 20 percent of Americans live in rural areas without easy access to primary care or specialty care. More than 40 percent of hospitals surveyed said that a leading reason for investing in telemedicine tools is filling in gaps due to community remoteness. A survey of patients conducted by Software Advice, a company that compares electronic health records, revealed that 21 percent viewed the top benefit of telemedicine as not having to travel to receive care.

· Quality Care: Patient readmissions in the heart failure telemonitoring program were 44 percent lower over 30 days and 38 percent lower over 90 days, compared to patients not enrolled in the program. A study of 8,000 patient care outcomes using telemedicine services found no difference between the virtual appointment and an in-person office visit. In a Humana Cares remote health monitoring and management program for patients with congestive heart failure, at least 90 percent of patients felt more connected to their nurse, said the virtual care suite was easy to use and said they would recommend the program to their friends.

For patients who have not used a telemedicine service, 75 percent are interested in using one instead of an in-person medical visit, according to the Software Advice survey. For patients who have used telemedicine, 67 percent say that using telemedicine “somewhat” or “significantly increases” their satisfaction with their medical care.

Careers in Telenursing

“Telehealth nursing is practiced in the home, health care clinic, doctor’s office, prisons, hospitals, telehealth nursing call centers and

mobile units,” the ATA says. “Telephone triage, remote monitoring and home care are the fastest growing applications.”

Growth in telehealth has led to several telenursing practice areas:

· TeleICU

· Teletriage

· Teletrauma

· Telestroke

· Telepediatrics

· Telemental health

· Telecardiology

· Telehomecare

· Telerehabilitation

· Forensic telenursing

An example of telehealth transforming health care has been in the ICU. “Although the role of the bedside care-giver can never be replaced or diminished, it can certainly be augmented, enhanced, and facilitated,” Critical Care Nurse says. “The key to the long-term success is the continued consistent collaboration between the bedside team and the tele-ICU nurses, which can transform how critical care nursing is practiced.”

TeleICU has improved outcomes for critically ill patients by reducing ICU mortality, shortening stays in the ICU and in the hospital, increasing compliance with evidence-based best practices, improving outcomes for cardiopulmonary arrest patients and decreasing costs for patient care. ICU nurses use audio and video technology to assess and monitor patients at the patient’s bedside. At the click of a mouse, nurses have access to medical records, diagnostic images and laboratory results, as well as standard monitoring such as electrocardiography and hemodynamic values.

Major responsibilities for the teleICU nurse include making rounds via the camera and assessing all patients. The nurse will assess the patient’s physical appearance by video, check equipment for safety,

verify infusions and verbally interact with the patient, the patient’s family and staff. The nurse also acts as a resource for the bedside nurse, quickly retrieving vital pieces of information and data, and drafting detailed admission notes when a patient arrives in the unit to keep complete information about the patient available.

Future Opportunities

“As the US healthcare environment continues to evolve due to changes in reimbursement, legal issues, and shrinking healthcare resources, the expanding role of telehealth nurses will continue to evolve,” the ATA says. “Leadership and collaboration among international nurses is needed to outline the uses of ehealth/telehealth technologies to provide nursing care in an interdisciplinary manner to patients, regardless of staffing, time, or geographic boundaries.”

Career opportunities in areas such as telenursing will rely on candidates with a strong educational background. Educational standards are already on the rise, as more hospitals across the nation require nurses to hold a BSN degree. Aurora University’s online RN to BSN program equips graduates with the skills and knowledge needed to pursue advanced career opportunities. The program takes place in an online learning environment, allowing students the flexibility and convenience to complete their degree while maintaining their work and personal schedule.

Topics: telenursing, medical technologies, healthcare, telehealth

Once A Nurse, Always a Nurse

Posted by Pat Magrath

Mon, Sep 26, 2016 @ 03:33 PM

Medical_Student.jpgCongresswoman Lois Capps of CA is committed to helping people improve their daily lives through better schools, quality health care, and a cleaner environment. During her 20-year tenure as a Nurse and public health advocate, she felt her education and background was needed in Congress to help improve health care in the US and strengthen our Nursing workforce across the country.

This week, the U.S. House of Representatives Energy and Commerce Committee unanimously passed the Title VIII Nursing Workforce Reauthorization Act (H.R. 2713), bipartisan legislation I authored with Representative David Joyce (OH-14) to strengthen the nursing workforce and improve access to health care. While this is an important step forward for the millions of nurses and aspiring nurses in our country, it is particularly poignant as my 18 years in Congress draw to a close.

When my late husband, Congressman Walter Capps, passed away in office, I was not a politician. I was a public health nurse working in our local schools. And while some said that I couldn’t be a Member of Congress because I was “just a nurse,” it quickly became clear to me that the work I did every day was exactly what Washington needed. 

As nurses, we often wear many hats. We spend much of our time listening to our patients and their families to find the root cause of their ailments and truly understand their needs. We are advocates, navigating a complex system to ensure that our patients receive the best care possible, while gaining valuable insight to our health care system’s strengths and weaknesses as a whole. And we are consensus builders, rolling up our sleeves to do whatever is needed to help our patients stay healthy. Simply put: nurses have a critical voice that must be heard. 

So when I came to Congress, it was clear to me what I had to do. And I never stopped being a nurse.

That is why one of the first pieces of legislation I championed was the Nurse Reinvestment Act, a bipartisan effort signed into law by George W. Bush in 2002 to expand our nation’s federal nursing workforce training programs. I also founded and continue to co-chair the bipartisan House Nursing Caucus, the first caucus established to highlight the critical role nurses play in our health care system. And for the past nine years, I have led efforts to improve nurse staffing numbers in hospitals to help ensure better care for patients and protect against nurse burnout.

Nursing issues were also a key component of the Affordable Care Act. When it became law in 2010, our nation took its first steps toward moving our health care system from one that only focused on those who were sick to one that also emphasizes wellness and prevention. In this law I spearheaded efforts to continue nursing workforce programs, as well as expand access to care through school-based health centers for students, nurse-managed health clinics for primary care in underserved areas, and nurse home visiting programs to support new moms and babies. It also included a Graduate Nurse Education demonstration program to explore ways to give more clinical experience to Advanced Practice Registered Nurses, like nurse practitioners. More broadly, the law highlighted the importance of our health care system working in collaboration as a team while helping patients be more active participants in their care. 

Thanks to the Affordable Care Act, more Americans than ever have health insurance. That has made the need for nurses at all levels of care even clearer. Our country has an increasingly dire shortage of primary care physicians. This shortage is especially problematic among rural and vulnerable populations. But nurses, especially graduate-level prepared Advanced Practice Registered Nurses, have the training and expertise to help fill this gap. 

And that is why getting the Title VIII Nursing Workforce Reauthorization Act into law is so important. First enacted 50 years ago, Title VIII programs have helped make it possible for more nurses to deliver high-quality care as demand has increased. The bill bolsters nursing education at all levels, from entry-level preparation through graduate study, and supports institutions that educate nurses to help open spaces in nursing school programs. It helps nurses repay student loans in exchange for working in underserved areas or for going into academia to teach the nurses of tomorrow. And it places a special focus on ensuring nurses are ready and able to care for our nation’s aging population. 

As anyone who has received medical care can attest, nurses have a powerful presence in medicine. They are caring, attentive and integral members of the health care team. As we look ahead to looming nursing shortages, reauthorization of these critical programs is more important than ever to help bring more nurses into the field, better educate them for the needs in our communities, and keep them in the profession, providing high-quality care to communities across the country.

We know that the important work of strengthening our health care system is not yet done — it’s far from it. But legislation like this will help get us there.
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Topics: healthcare, health laws

Google Glass Improves Parkinson's Symptoms

Posted by Erica Bettencourt

Wed, Jun 10, 2015 @ 02:49 PM

Moving Through Glass Image resized 600

Here’s an interesting option for people with Parkinson’s Disease to cope with the motor skills challenges they face every day. It’s another example of technology improving people’s lives.

Parkinson's Disease is a nervous system disorder that affects a person's movement. The most common sign of this disease is hand tremors. Other signs like stiffness or slow movement can also be common. Parkinson's Disease has symptoms that will worsen with progression of the condition over time. This disease has no cure but, medications or physical therapy programs can help improve symptoms. 

Google Glass was a failure. At least, according to most people. But not for one specific group: people with Parkinson's. They've been experimenting with new software for Glass and say that it improves the quality of their lives.

People suffering from Parkinson's have challenges with their motor skills. Joy Esterberg, who was diagnosed with Parkinson's in 2003, compares the feeling to moving through mud. She was an early adopter of the Glass software, which has been in development for the last year. 

"It is very sci-fi," Esterberg said of Glass. "What I like about it is that I can wear it at home. You have the little screen, you see David dancing, and you can follow the moves." 

She's talking about David Leventhal, the director of the Mark Morris Dance Group's Dance for PD program, which has been offering free dance classes for people with Parkinson's since 2001.

When a user activates Glass, they can choose from a variety of different exercises, like "warm me up" or "balance me." Once selected, they see Leventhal or one of his co-teachers projected in front of them. 

This technology is especially important because when people with Parkinson's walk down the street, they sometimes freeze up. In order to get going again, they often need to watch someone else's movements or footsteps. This can be problematic, especially if there's no one around.

The software, called Moving Through Glass, is based off exercises done in Leventhal's weekly class. The movements have roots in ballet and modern dance, and include a lot of extension exercises, which are particularly helpful for people with Parkinson's. Some students are very mobile, while others are confined to wheelchairs and exercise with assistance. 

To get the Glass project going, Leventhal applied for a $25,000 Google (GOOG) grant. He got it, and then partnered with SS+K, a New-York based advertising agency with a strong focus on social responsibility. It developed the software for free through its innovation lab.

Though still in the pilot stage, it's hoped that the software will make people with Parkinson's more independent and confident when they go outside. 

"It's surprisingly un-weird," Esterberg said. "In New York, nobody is going to look at you if you have something on your face. You'd have to have orange feathers sticking out of it for people to notice." 

More and more of the students in her dance class will be using Glass as part of the program. There are about 50 people who attend each week in Brooklyn, and it's known as a place for camaraderie and acceptance. 

"Everyone comes to dance class for a reason," Leventhal said. "Some people come to escape Parkinson's. Some people come because they want to work on specific skills related to balance or coordination or musicality."

There isn't data on how successful the class has been, but Levanthal said he sees it in students' stories. One student, he said, had been able to dance at a family member's wedding thanks to the class. Esterberg said she dances better now than she did before Parkinson's because she practices every day. 

For now, the Glass software is still in the early stages, and the dance studio has 25 pairs available for students to borrow. However, the future is uncertain because Google stopped selling Glass earlier this year, saying it will focus on future incarnations. 

Whatever Glass 2.0 looks like, Leventhal said his students will have a lot of feedback and, no matter what, they'll still be dancing. Esterberg certainly will be, and said she hopes more people will see that a diagnosis doesn't have to mean giving up. 

"You can do new things," she said. "You don't have to just accept [that Parkinson's is] the end of everything. Because it really isn't."

Contributor: Jillian Eugenios and Erica Bettencourt

Story Source: CNN

Topics: innovation, medical technology, health, healthcare, patients, Google Glass, Parkinson's Disease

Diversity In Nursing [Infographic]

Posted by Erica Bettencourt

Mon, Jun 08, 2015 @ 03:11 PM

Erica Bettencourt

There is a need for diversity in the health industry, especially Nurses. Having more diverse nurses will improve access to healthcare for racial and ethnic minority patients. Also those patients will be more comfortable and have higher satisfaction. Diversity must be increased at all levels especially educational institutions. More cultural healthcare programs and initiatives should be offered for students.

Diversity In Nursing resized 600

 

Topics: diversity in nursing, diversity, nursing, healthcare, patients

Smartphones to Nurses are Doctors on Call

Posted by Erica Bettencourt

Fri, Jun 05, 2015 @ 11:51 AM

ThinkstockPhotos 161859526 resized 600

We found this interesting article about the growth of smartphone use and apps available to Nurses while at work. These apps are being used to research drugs, gather information about home care as well as diseases and disorders. This is an area that will continue to grow and hopefully provide much needed assistance to our hard-working Nurses.

A new survey indicates nurses are relying more than ever on their smartphone for clinical care – to the detriment of the so-called "doctor on call."

Conducted by InCrowd, a Boston-based market intelligence firm, the survey found that 95 percent of the 241 responding nurses own a smartphone and 88 percent use smartphone apps at work. More intriguing, 52 percent said they use an app instead of asking a colleague, and 32 percent said they consult their smartphone instead of a physician.

"The hospital gets very busy and there isn't always someone available to bounce ideas off of," one respondent said. Said another: "It's often easier to get the information needed using my smartphone – I don't have to wait for a response from a coworker."

Nurses have long been seen as an under-appreciated market for mHealth technology, and one that differs significantly from doctors, but that seems to be changing. Companies like Voalte are marketing communications platforms targeted at nurses, and even IBM has come out with a line of nurse-specific apps.

"There's a lot of untapped potential in the use of mobile apps for nursing," Judy Murphy, IBM's chief nursing officer, told mHealth News.

Unlike physicians, who are looking for apps that can retrieve information, enter orders and push notifications, nurses need apps that assist their workflow, offer quick information and coordinate multiple activities.

"It's all about care coordination," Murphy said. "Nurses want apps that can help them organize their day."

The ideal app will be simple in nature, so that it can be used quickly, and will help nurses organize several functions, from taking care of multiple patients to addressing orders from doctors, according to Murphy. Some tasks, like entering complex data into the EMR, actually clutter the form factor of the smartphone and are best handled at a workstation.

According to the InCrowd survey, nurses are quick to point out that their smartphones "enhance but don't substitute" for the physician, but when they're running around and need a quick question answered about medications, illnesses or symptoms, sometimes the app does the job more effectively – such as "in patient homecare situations when I need quick answers without making a bunch of phone calls," or "so I can make an educated suggestion to the doctor."

According to the survey, 73 percent of the nurses surveyed use their smartphones to look up drug information at the bedside, while 72 percent use it to look up various diseases or disorders. And befitting the various roles of the smartphone in the healthcare setting, 69 percent of nurses said they use their smartphones to stay in touch with colleagues. Other uses include viewing images and setting timers for medication administration.

Finally, the survey found that nurses are using smartphones in the workplace no matter who's paying for them. Some 87 percent of those surveyed said their employer isn't covering any costs related to the smartphone, while 9 percent are reimbursed for the cost of the monthly bill, 1 percent receive some reimbursement for the cost of the smartphone, and 3 percent are reimbursed for both the phone and the phone bill. Less than 1 percent, meanwhile, said their institution bans the use of personal smartphones while on duty.

"We're hitting the tip of the iceberg here with apps that a nurse will want and will use," Murphy said.

www.mhealthnews.com

Contributor: Eric Wicklund

Topics: health, healthcare, nurses, doctors, medical, clinical, clinical care, smartphones

We Need More Nurses

Posted by Erica Bettencourt

Fri, May 29, 2015 @ 09:54 AM

By 

www.nytimes.com 

28Robbins blog427 resized 600SEVERAL emergency-room nurses were crying in frustration after their shift ended at a large metropolitan hospital when Molly, who was new to the hospital, walked in. The nurses were scared because their department was so understaffed that they believed their patients — and their nursing licenses — were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent.

The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four (and just two for patients bound for the intensive-care unit). Molly — whom I followed for a year for a book about nursing, on the condition that I use a pseudonym for her — was assigned 20 patients with non-life-threatening conditions.

“The nurse-patient ratio is insane, the hallways are full of patients, most patients aren’t seen by the attending until they’re ready to leave, and the policies are really unsafe,” Molly told the group.

That’s just how the hospital does things, one nurse said, resigned.

Unfortunately, that’s how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios.

Dozens of studies have found that the more patients assigned to a nurse, the higher the patients’ risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital — and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.

In pediatrics, adding even one extra surgical patient to a nurse’s ratio increases a child’s likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses’ working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.

Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patient deaths, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse. (The Massachusetts Nurses Association, a labor union, sponsored the study; it was conducted by an independent research firm and the majority of respondents were not members of the association.)

And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because, during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages. (A spokesman for the hospital disputed this characterization of the events.)

It’s not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. “It happens all the time, and nurses are harassed into taking what they know are not safe assignments,” she said. “The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up.”

The landscape hasn’t always been so alarming. But as the push for hospital profits has increased, important matters like personnel count, most notably nurses, have suffered. “The biggest change in the last five to 10 years is the unrelenting emphasis on boosting their profit margins at the expense of patient safety,” said David Schildmeier, a spokesman for the Massachusetts Nurses Association. “Absolutely every decision is made on the basis of cost savings.”

Experts said that many hospital administrators assume the studies don’t apply to them and fault individuals, not the system, for negative outcomes. “They mistakenly believe their staffing is adequate,” said Judy Smetzer, the vice president of the Institute for Safe Medication Practices, a consumer group. “It’s a vicious cycle. When they’re understaffed, nurses are required to cut corners to get the work done the best they can. Then when there’s a bad outcome, hospitals fire the nurse for cutting corners.”

Nursing advocates continue to push for change. In April, National Nurses United filed a grievance against the James A. Haley Veterans’ Hospital in Tampa, which it said is 100 registered nurses short of the minimum staffing levels mandated by the Department of Veterans Affairs (the hospital said it intends to hire more nurses, but disputes the union’s reading of the mandate).

Nurses are the key to improving American health care; research has proved repeatedly that nurse staffing is directly tied to patient outcomes. Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right.

Topics: nursing, health, healthcare, nurse, nurses, patients, hospital, patient, emergency rooms, nursing licenses

A Look At The Impact Of IT In Nursing

Posted by Erica Bettencourt

Fri, May 29, 2015 @ 09:35 AM

The Nursing profession is in dire need of an IT upgrade. The way the nursing profession currently handles information is costing time, money, patient health and more importantly, lives. Creating an integrated health IT system will address these costs, as well as reducing errors among hospital staff and mistakes with prescriptions both when they are written and when patients obtain them.

To learn more checkout the following infographic, created by the Adventist University of Health Sciences Online RN to BSN program, that illustrates the need, benefit and impact of Health IT in nursing.

ADU BSN Impact of IT in Nursing  resized 600

Topics: BSN, nursing, health, healthcare, RN, nurse, health care, hospital, infographic, IT, health IT, medical staff

Demand For Travel Nurses Hits A 20-Year High

Posted by Erica Bettencourt

Wed, May 27, 2015 @ 02:03 PM

Phil Galewitz

www.usatoday.com 

635679001184311388 Cherisse Dillard Travel Nurse resized 600With her children grown and husband nearing retirement, Amy Reynolds was ready to leave behind snowy Flagstaff, Ariz., to travel but she wasn't ready to give up her nursing career.

She didn't have to.

For the past three years, Reynolds, 55, has been a travel nurse – working for about three months at a time at hospitals in California, Washington, Texas and Idaho, among other states. Her husband accompanies her on the assignments. "It's been wonderful," she said in May after starting a stint in Sacramento. "It's given us a chance to try out other parts of the country."

Reynolds is one of thousands of registered nurses who travel the country helping hospitals and other health care facilities in need of experienced, temporary staff.

With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses such as Reynolds is at a 20-year high, industry analysts say. That's meant Reynolds has her pick of hospitals and cities when it's time for her next assignment. And it's driven up stock prices of the largest publicly traded travel-nurse companies, including San Diego-based AMN Healthcare Services and Cross Country Healthcare of Boca Raton, Fla.

"We've seen a broad uptick in health care employment, which the staffing agencies are riding," said Randle Reece, an analyst with investment firm Avondale Partners. He estimates the demand for nurses and other health care personnel is at its highest level since the mid-1990s.

Demand for travel nursing is expected to increase by 10% this year "due to declining unemployment, which raises demand by increasing commercial admissions to hospitals," according to Staffing Industry Analysts, a research firm. That trend is expected to accelerate, the report said, because of higher hospital admissions propelled by the health law. 

Improved profits — particularly in states that expanded Medicaid — have also made hospitals more amenable to hire travel nurses to help them keep up with rising admissions, analysts say.

At AMN Healthcare, the nation's largest travel-nurse company, demand for nurses is up significantly in the past year: CEO Susan Salka said orders from many hospitals have doubled or tripled in recent years. Much of the demand is for nurses with experience in intensive care, emergency departments and other specialty areas. "We can't fill all the jobs that are out there," she said.

Northside Hospital in Atlanta is among hospitals that have recently increased demand for travel nurses, said David Votta, manager of human resources. "It's a love-hate relationship," he said. From a financial viewpoint, the travel nurses can cost significantly more per hour than regular nurses. But the travel nurses provide a vital role to help the hospital fills gaps in staffing so they can serve more patients. 

Northside is using 40 travel nurses at its three hospitals, an increase of about 52% since last year. The system employs about 4,000 nurses overall. 

Historically, the most common reason why hospitals turn to traveling nurses is seasonal demand, according to a 2011 study by accounting firm KPMG. Nearly half of hospitals surveyed said seasonal influxes in places such as Arizona or Florida, where large numbers of retirees flock every winter, led them to hire traveling nurses. 

Though there have been rare reports of travel nurses involved in patient safety problems, a 2012 study by researchers at the University of Pennsylvania published in the Journal of Health Services Research found no link between travel nurses and patient mortality rates. The study examined more than 1.3 million patients and 40,000 nurses in more than 600 hospitals. "Our study showed these nurses could be lifesavers. Hiring temporary nurses can alleviate shortages that could produce higher patient mortality," said Linda Aiken, director of the university's Center for Health Outcomes and Policy Research. The study was funded by the National Institutes of Health and the American Staffing Association Foundation.

The staffing companies screen and interview nurses to make sure they are qualified, and some hospitals, such as Northside, also make their own checks. Nurses usually spend a couple days getting orientated to a hospital and its operations before beginning work. They have to be licensed in each state they practice in, although about 20 states have reciprocity laws that expedite the process.

Cherisse Dillard, a labor and delivery room nurse, has been a traveler for nearly a decade. In the past few years, she's worked at hospitals in Chicago, Dallas, Houston, Pensacola and the San Francisco area.

While delivering a baby is relatively standard practice, she said she makes it a practice at each new hospital to talk to doctors and other staff to learn what their preferences are with drugs and other procedures. Dillard, 46, often can negotiate to be off on weekends and be paid a high hourly rate. "When the economy crashed in 2008, hospitals became tight with their budget and it was tough to find jobs, but now it's back to full swing and there are abundant jobs for travel nurses," she said.

Topics: health coverage, affordable care act, healthcare, RN, nurse, nurses, hospitals, travel nurse, travel nurses

Your Roommate In The Nursing Home Might Be A Bedbug

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 03:09 PM

ANGUS CHEN

www.npr.org 

hospital bed custom 6b164486756a615b302de54c474c2361d4c33e1f s800 c85 resized 600If you're in the hospital or a nursing home, the last thing you want to be dealing with is bedbugs. But exterminators saying they're getting more and more calls for bedbug infestations in nursing homes, hospitals and doctor's offices.

Nearly 60 percent of pest control professionals have found bedbugs in nursing homes in the past year, according to an industry survey, up from 46 percent in 2013. Bedbug reports in other medical facilities have gone up slightly. Thirty-six percent of exterminators reported seeing them in hospitals, up from 33 percent. Infestations seen in doctors' offices rose from 26 percent to 33 percent in the past two years.

"Nursing homes would be difficult to treat for the simple reason you don't use any pesticides there," says Billy Swan, an exterminator who runs a pest-control company in New York City. That and the fact that there's a lot more stuff. "Somebody's gotta wash and dry all the linens, you know, and all their personal artifacts and picture frames."

Those personal belongings might help account for the big disparity in infestations between nursing homes and hospitals, according to Dr. Silvia Munoz-Price, an epidemiologist at the Medical College of Wisconsin who studies infection control in health care facilities. "The more things you bring with you, the more likely you're bringing bedbugs, if you have a bedbug problem... and you live in a nursing home, so all your things are there."

By contrast, "When bedbugs are located in a hospital, they're usually confined to a couple of hospital rooms," Munoz-Price says.

And it may be easier for hospital staff to spot bedbugs.

"Hospital cleaning staff, nurses, doctors are extremely vigilant," says Jim Fredericks, chief entomologist for the National Pest Management Association, which conducted the survey along with the University of Kentucky. "[Bedbugs] don't go unnoticed for long."

And hospitals are typically brightly lit, routinely cleaned places. It's just much easier to find pests in this setting than in a dark movie theater, where only 16 percent of pest professionals report seeing bedbugs, according to the survey.

Fredericks says the recent multiplication of bedbug reports in medical facilities is just a part of a larger trend. Exterminators have been finding more of the bugs everywhere the parasites are most commonly found like hotels, offices, and homes, where virtually 100 percent of pest control professionals have treated bedbugs in the past year. And they've been popping up in a few unexpected places, too, like a prosthetic leg and in an occupied casket.

"There are a lot of theories as to why they've made a comeback," Fredericks says. It could be differences in pest management practices, insecticide resistance, or just increased travel. "Bottom line is nobody knows what caused it, but bedbugs are back." He falters for a moment. "And they're most likely here to stay."

The good news is bedbugs aren't known to transmit any diseases, and a quick inspection under mattresses or in the odd nook or cranny while traveling can lower the risk of picking the hitchhiking bugs up. Swan says a simple wash or freezing will kill any bedbug. "If you came home, took off all your clothes, put 'em in a bag – you'd never bring a bedbug home," he says. "But who does that?"

At least one reporter might start.

Topics: health, healthcare, nurse, nurses, patients, patient, treatment, hospitals, nursing homes, bed bugs

Doctoring, Without the Doctor

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 02:59 PM

By 

www.nytimes.com 

26NEBRASKA master675 resized 600There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy.

It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.

“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”

But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.

“I was like, ‘Oh, my gosh, this is such a wonderful victory,’” said Ms. Osburn, who was delivering a calf when she got the news in a text message.

The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away.

“The situation could be viewed as an emergency, especially in rural counties,” said Jim P. Stimpson, director of the Center for Health Policy at the University of Nebraska, referring to the shortage.

Groups representing doctors, including the American Medical Association, are fighting the laws. They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the A.M.A., said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”

Dr. Richard Blatny, the president of the Nebraska Medical Association, which opposed the state legislation, said nurse practitioners have just 4 percent of the total clinical hours that doctors do when they start out. They are more likely than doctors, he said, to refer patients to specialists and to order diagnostic imaging like X-rays, a pattern that could increase costs.

Nurses say their aim is not to go it alone, which is rarely feasible in the modern age of complex medical care, but to have more freedom to perform the tasks that their licenses allow without getting a permission slip from a doctor — a rule that they argue is more about competition than safety. They say advanced-practice nurses deliver primary care that is as good as that of doctors, and cite research that they say proves it.

What is more, nurses say, they are far less costly to employ and train than doctors and can help provide primary care for the millions of Americans who have become newly insured under the Affordable Care Act in an era of shrinking budgets and shortages of primary care doctors. Three to 14 nurse practitioners can be educated for the same cost as one physician, according to a 2011 report by the Institute of Medicine, a prestigious panel of scientists and other experts that is part of the National Academy of Sciences.

In all, nurse practitioners are about a quarter of the primary care work force, according to the institute, which called on states to lift barriers to their full practice.

There is evidence that the legal tide is turning. Not only are more states passing laws, but a February decision by the Supreme Court found that North Carolina’s dental board did not have the authority to stop dental technicians from whitening teeth in nonclinical settings like shopping malls. The ruling tilted the balance toward more independence for professionals with less training.

“The doctors are fighting a losing battle,” said Uwe E. Reinhardt, a health economist at Princeton University. “The nurses are like insurgents. They are occasionally beaten back, but they’ll win in the long run. They have economics and common sense on their side.”

Nurses acknowledge they need help. Elizabeth Nelson, a nurse practitioner in northern Nebraska, said she was on her own last year when an obese woman with a dislocated hip showed up in the emergency room of her small-town hospital. The hospital’s only doctor came from South Dakota once a month to sign paperwork and see patients.

“I was thinking, ‘I’m not ready for this,’ ” said Ms. Nelson, 35, who has been practicing for three years. “It was such a lonely feeling.”

Ms. Osburn, 55, has been on the plains her whole life, first on a sugar beet farm in eastern Montana and more recently in the Sandhills region of Nebraska, a haunting, lonely landscape of yellow grasses dotted with Black Angus cattle. She has been a nurse since 1982, working in nursing homes, hospitals and a state-run psychiatric facility.

As farming has advanced and required fewer workers, the population has shrunk. In the 1960s, the school in Wood Lake had high school graduating classes. Now it has only four students. Ms. Osburn and her family are the only ones still living on a 14-mile road. Three other farmhouses along it are vacant.

The isolation takes a toll on people with mental illness. And the culture on the plains — self-reliance and fiercely guarded privacy — makes it hard to seek help. Ms. Osburn’s aunt had schizophrenia, and her best friend, a victim of domestic abuse, committed suicide in 2009. She herself suffered through a deep depression after her son died in a farm accident in the late 1990s, with no psychiatrist within hundreds of miles to help her through it.

“The need here is so great,” she said, sitting in her kitchen with windows that look out over the plains. She sometimes uses binoculars to see whether her husband is coming home. “Just finding someone who can listen. That’s what we are missing.”

That conviction drove her to apply to a psychiatric nursing program at the University of Nebraska, which she completed in December 2012. She received her national certification in 2013, giving her the right to act as a therapist, and to diagnose and prescribe medication for patients with mental illness. The new state law still requires some supervision at first, but it can be provided by another psychiatric nurse — help Ms. Osburn said she would gladly accept.

Ms. Nelson, the nurse who treated the obese patient, now works in a different hospital. These days when she is alone on a shift, she has backup. A television monitor beams an emergency medicine doctor and staff into her workstation from an office in Sioux Falls, S.D. They recently helped her insert a breathing tube in a patient.

The doctor shortage remains. The hospital, Brown County Hospital in Ainsworth, Neb., has been searching for a doctor since the spring of 2012. “We have no malls and no Walmart,” Ms. Nelson said. “Recruitment is nearly impossible.”

Ms. Osburn is looking for office space. The law will take effect in September, and she wants to be ready. She has already picked a name: Sandhill Behavioral Services. Three nursing homes have requested her services, and there have been inquiries from a prison.

“I’m planning on getting in this little car and driving everywhere,” she said, smiling, behind the wheel of her 2004 Ford Taurus. “I’m going to drive the wheels off this thing.”

Topics: mental health, AANP, health, healthcare, nurse, medical, patients, medicine, patient, treatment, psychiatrist, psychiatric nurse, health laws

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