DiversityNursing Blog

Study Confirms What We Knew All Along: Nurses Are Key to Hospital Success

Posted by Erica Bettencourt

Mon, Jul 13, 2015 @ 11:47 AM

Amy Rushlow


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We all know and love Nurses, but isn’t it wonderful when a research study validates something you already know? We think you’ll enjoy this article.

If you’ve ever had a loved one in the hospital, you know how important nurses are. Studies show that the amount of time that nurses spend with patients is related to fewer errors. And according to a new study, investing in nursing is key to patient outcomes, including the risk of dying while in the hospital.

The study’s researchers, a team from the University of Pennsylvania, wanted to understand why certain hospitals have better outcomes than others. Specifically, the UPenn team was trying to explain why hospitals in the Kaiser Permanente health care system — an integrated health network in eight states that includes hospitals, insurance, and doctors’ offices all in one system — have such efficient and high-quality care. 

Other organizations have tried to mimic Kaiser Permanente’s organizational structure in order to improve care, but with mixed results. The researchers thought there might be a different X factor that could explain Kaiser’s success: nurses.

In order to find out, the study looked at more than 550 hospitals in California, New Jersey, Pennsylvania, and Florida, including 25 California-based Kaiser Permanente hospitals and 56 Magnet hospitals. Magnet hospitals are recognized by the American Nurses Credentialing Center for being good workplaces for nurses.

Nurses in each hospital answered surveys about their work environment, level of education, job satisfaction, and the number of patients visited during a typical shift. The researchers also pulled data on patient mortality.

“It turns out that, by and large, nursing differences accounted for much of the mortality difference that we saw in Kaiser Permanente hospitals,” says study author Matthew McHugh, PhD, RN, a professor at the University of Pennsylvania School of Nursing.

The results were clear: The odds of dying were about 20 percent lower in Kaiser Permanente and Magnet hospitals, and differences in nursing accounted for “a sizeable portion of the advantage,” according to the study. The analysis adjusted for factors such as hospital size and the severity of patients’ conditions.

“It turns out that these differences we see in nursing, in terms of work environment, staffing levels, investment in nursing around a highly educated workforce, those things translate into better outcomes,” McHugh tells Yahoo Health. 

There were a few specific factors that made Kaiser and Magnet hospitals stand out from the rest, McHugh explains:

1. Better work environments

Happier nurses mean healthier patients, research shows. “We find that places where nurses have a good experience working are places where nurses are better able to do their jobs. They’re more autonomous, they’re supported by management, and they’re integrated into hospital decision-making,” McHugh says.

Empowered nurses have better relationships with physicians, “so when they say ‘something isn’t right,’ they’ll be taken seriously,” McHugh adds. And patients can receive faster and more efficient care when nurses are authorized to make decisions such as when to remove a catheter, for example.

In fact, a study published last year in the Journal of Nursing Administration found that empowered nursing units are more effective and report better patient care compared to units with less authority.

Tangible changes matter, too. In response to the nurse shortage in the early 2000s, Kaiser Permanente made a deliberate, research-based effort to invest in nursing, says Marilyn Chow, PhD, RN, Vice President of National Patient Care Services and Innovation for Kaiser Permanente. 

study of Kaiser hospitals conducted in 2005 and 2006 found that nurses spent more than 35 percent of their time on documentation. Starting in 2005, the system switched to electronic medical records, which helped streamline paperwork. They also observed that nurses spent a lot of time hunting and gathering equipment and information — checking to see if a medication was ready, for instance. In response, Kaiser Permanente rearranged the work environment to make things more convenient. (Nurses now receive a notification when meds are ready for pickup.)

“We wanted to make sure that we were a place that nurses wanted to work,” Chow tells Yahoo Health. “If you have nurses who are happy and joyful at their work, they will definitely pass that on and be caring and compassionate.”

2. More nurses with Bachelor’s degrees

The role of the nurse is much more complex than it used to be, Chow explains. “The role is not only surveillance, but facilitating and coordinating the care, and not just for one patient, but for four to five patients … there are so many things to take care of,” she says. Patients also arrive sicker and leave the hospital earlier, Chow and McHugh say, which puts an extra demand on nurses to coordinate care and teach patients and family members what to do when they arrive home. 

“Hospitals are very complex, and integrating all of that information requires a certain set of skills and requires you have a pool of knowledge within the overall nursing staff,” McHugh explains. He adds that the study observed a wide variation in nurse education from hospital to hospital, and that variation was associated with adverse events.

3. More nurses, period

Kaiser Permanente hospitals have a 4-to-1 patient-to-nurse ratio, on average, compared to 5-to-1 in non-Magnet hospitals, the UPenn study found.

Having more nurses ensures that there are enough eyes in rooms monitoring patients. It also means that nurses have sufficient time to follow up with patients and communicate effectively. “Nurses are at the bedside and are working with all the other providers. They’re the essential person for monitoring patient condition, and if something bad does happen, intervening and mobilizing the intervention response,” McHugh says.

We all know and love Nurses, but isn’t it wonderful when a research study validates something you already know? We think you’ll enjoy this article

Topics: study, nursing, nurse, nurses, hospital

Advantages Of Being Bilingual in Nursing

Posted by Erica Bettencourt

Thu, Jun 25, 2015 @ 09:02 AM

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By Pat Magrath – DiversityNursing.com

If you’re considering a career in nursing and are bilingual, this can be a tremendous advantage for you, your patients and their families. With increased diversity in the U.S., patients with limited English-language skills often arrive at the emergency room and there is no one available who speaks their language. This makes it very difficult for everyone involved to try to understand why the patient is there. Sometimes a family member who speaks limited English accompanies the patient and attempts to describe the family member’s symptoms. This is not an ideal situation and can lead to misunderstanding, frustration and an incorrect diagnosis. To drive this scenario home, imagine you’re on vacation in another country and become ill. You need medical attention, and when you arrive at the hospital no one understands you. This is a scary situation!

While most healthcare institutions offer translation services, sometimes the service is provided over the phone. This method is efficient in communicating information such as what the patient’s symptoms are, describing the appropriate course of treatment, or explaining the specific care of a condition at home. However, we all know there’s nothing like the ability to communicate with someone on a more personal, face-to-face basis. The patient may have more questions after the phone conversation is over. They or their family might ask questions such as, how often should I take this medication? Should I take it with or without food? Who do I call if I have questions when I get home?

As a nurse who is bilingual, you can be a tremendous help and source of comfort in answering these questions. Let’s take the example of a Hispanic nurse who not only speaks and understands both English and Spanish, but who also understands Hispanic culture, values and family traditions because of growing up in that community. My friend Esteban, who happens to be a bilingual Hispanic nurse, also knows the prevalence of certain diseases in the Hispanic community. These include diabetes, hypertension and cardiovascular issues. He’s seen these diseases in his family and community. He mentioned that diet and genetics contribute to these problems as the Hispanic diet often contains a lot of pork and fatty foods, which can lead to these conditions.

This is important information he already has because he is a member of the Hispanic community. He also speaks the language and can translate information to the medical team. His ability to communicate between the patient and medical team as well as his knowledge of Hispanic culture is extremely valuable in the care he can give his Hispanic patients. The ability of a patient to communicate directly and effectively with their healthcare provider increases feelings of trust and understanding, which can lead to a higher level of care and well-being. Again, I’ll take you back to becoming ill while traveling in another country and you don’t have the tools to effectively communicate your symptoms. Finding someone on the medical team who speaks English would be a tremendous relief!

The bottom line is clear: open communication, in terms of both verbal and listening skills, is essential to assessing a patient’s problem and determining the appropriate care and treatment. If you’re considering the field of nursing and are bilingual, you know so much already about your community’s language, customs, food and family values. You also have an awareness of healthcare issues prevalent in your community. As a bilingual nurse, you can be incredibly effective in delivering a high standard of care while putting your patient at ease.

As the Hispanic population and the need for nurses continues to grow, consider becoming a nurse. Courses are available online so you can fit classes in that accommodate your schedule and needs. The biggest benefit of online courses is that they offer flexibility. You’ll also save on time and commuting expenses. You can work, take classes online and reach your goal of becoming a nurse on your timeline!

I’m compensated by University of Phoenix for this blog. As always, all thoughts and opinions are my own.

For more information about on-time completion rates, the median debt incurred by students who completed this program and other important information, please visit phoenix.edu.

Topics: language, diversity, nursing, nurse, health care, patients, Bilingual

Nurses Surprise 90-Year-Old Nurse For Birthday [VIDEO]

Posted by Erica Bettencourt

Mon, Jun 22, 2015 @ 10:44 AM

Martie Schultz

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We found a story about a Nurse who has been in the profession for decades and she’s still working a couple days a week. She is an inspiration and we hope you’ll enjoy it.

SeeSee Rigney, an operating room nurse at Tacoma General Hospital in Tacoma, WA, celebrates her 90th birthday with her coworkers, and six decades of nursing. She is an inspiration to all! God bless you my friend. We love you and can only hope to have half of the energy you have at your age.

Topics: nursing, nurse, nurses, hospital, medical staff, operating room nurse

After 2 Liver Transplants Woman Becomes Transplant Nurse

Posted by Erica Bettencourt

Wed, Jun 17, 2015 @ 12:31 PM

By Erica Bettencourt

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When did you first know you wanted to be a Nurse?

This story is very touching about a patient’s perspective of Nurses at a very young age. Her experience with the Nurses who cared for her over the years, made Nursing an obvious choice for her.

Laurie Lukianov, 26, is a woman from Massachusetts who received two liver transplants as a child and is now working to become a transplant nurse. She told Boston Children's Hospital's blog “There is no question in my mind. Since I was 3 years old, I wanted to be a nurse.”

Laurie was born with biliary atresia and she needed liver transplants to save her life. At 3 years old she made headlines when she became one of the first patients in the country to receive a liver transplant from a living donor -- her father, Alex Lukianov.

When she was 13, Laurie Lukianov needed a second liver transplant. It came from an organ donor, and she had to fight for her life.

"I had 13 emergency surgeries from the two-week span from the initial transplant," Laurie Lukianov said.

But she won the fight and continued on to good health with the help of her family, a great surgeon and nurses.

Now the mother to a 6-year-old boy, already works in a local emergency room and is finishing her first year of nursing school.

Laurie Lukianov is also an advocate for organ donation. She tries to let potential donors know that the medical staff will do everything to save a life. Sometimes modern medicine falls short but, the gift of life is never lost on the recipient. 

Topics: emergency room, nursing school, nurse, transplant nurse, liver transplant, biliary atresia, organ donation

We Need More Nurses

Posted by Erica Bettencourt

Fri, May 29, 2015 @ 09:54 AM



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.

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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


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



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



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

Kayla Montgomery: Young Runner's Brave Battle With MS

Posted by Erica Bettencourt

Wed, May 20, 2015 @ 02:18 PM

 Gary Morley and Lisa Cohen


150514175906 h2h kayla4 exlarge 169 resized 600Kayla Montgomery is a runner unlike any other.

Every time she competes in a race, she knows she'll collapse in a sobbing heap at the finish line.

Unable to feel her legs, she'll crumple into the arms of her athletics coaches. Ice-cold water will be applied to calm the misfiring nerve fibers blazing beneath her numb skin.

The teenager has gone through this post-race trauma for the past five years since being diagnosed with multiple sclerosis.

"Every day that I run, it might be my last day -- I could easily wake up tomorrow and not be able to move," the 19-year-old American tells CNN's Human to Hero series. 

"My initial MS attack caused lesions and scarring on my brain and my spine that affects the areas that are in control of how I feel my legs. So when I am overheated the symptoms reappear because my neurones start misfiring more.

"You can never really get used to the lack of feeling and the change of sensation, no matter how long you go through it. Every time it is still a bit of a shock and it's scary -- it freaks me out a little bit."

After five to 10 minutes she's able to get back on her feet again and start walking around, albeit a little stiffly as feeling slowly returns to her lower body.

It sounds like a nightmare ordeal that would put anyone off an athletics career, but Montgomery is determined to pursue her running dream.

She's actually faster now than before her diagnosis -- which, she says, was a painfully long and uncertain process following an accident playing soccer, falling hard on her neck and tailbone.

"It was really scary. I was so young. Most people with MS aren't diagnosed until their mid to late 20s, 30s. There wasn't anybody my age to relate to and understand what I was going through," she recalls. 

"It took so long to get back results and we were ruling things out and leaving MS as the last option. For a while they thought maybe it was cancer."

When the diagnosis finally came, it sent Montgomery into a spiral of anger, depression and denial.

She avoided confronting the issue with her parents -- Keith, a salesman, and mom Alysia, recently qualified as a nurse -- and younger sister Courtney.

"I tried to pretend I wasn't sick or anything -- I wanted to go on with life as normal as possible," Kayla says.

"Nobody at school knew, and we were not allowed to talk about it at home. I just avoided it at all costs, and that actually made it a lot harder. 

"The first couple of years after my diagnosis were impossibly hard -- I was so alone and still really scared. It was definitely a darker time in my life."

Running has proved to be her salvation. After a short break, in which she received treatment that made the numbness temporary, Montgomery decided she was going to make use of her legs while she still could -- despite knowing that exertion would bring back the symptoms.

"I wasn't amazing by any means but I was eighth on the team, so if somebody got hurt then I was there! And I wanted to be there if they needed me, so I trained so hard all the time and that definitely helped to deal with the things I wouldn't talk about," she says.

Montgomery's determination to succeed won her the North Carolina high school state title in the 3,200 meters last year, as she ran the 21st fastest time in the U.S.

She was team captain at Mount Tabor High School, setting several age-group records, and also excelled off the track in cross-country.

Now a freshman on an athletics scholarship at Nashville's Lipscomb University, she is studying molecular biology and has dreams of becoming a forensic scientist.

But before a career in CSI beckons, Montgomery is making the most of her chance to run for the college team.

"Racing is one of the greatest feelings in the world. I love it," she says. 

"Long-distance running is my favorite ... you have to have so much stamina, strength and determination. I like to push myself to my limits for as long as I can."

One of the big challenges is staying on her feet during a race. If she gets knocked over or falls, which sometimes happens, then it's difficult to get up again -- especially in the later stages.

"If it is a track meet you can't grab on to something, whereas cross country there might be a tree close by that you can pull yourself up on," Montgomery explains.

"It all depends on when I fall as to how it will affect the outcome of my race."

Montgomery trains three hours a day, six days a week, covering 60-75 miles.

Without being able to judge pace through her legs, she has learned a new way to run, by focusing on the movement of her arms.

The hard work is paying off. Lipscomb is a Division One university in NCAA competitions, giving her an elite platform on which to impress.

It's a long way from those early high-school days when she asked her coach, mentor and "second father" Patrick Cromwell about her chances of running at college level.

"He said, 'I don't know, you might be lucky if you can be a walk-on.' I was like, 'Well I'll show you, I'm going to run in college and not only that I'm going to run for a D1 school.' And I am! 

"Lipscomb is one of the best, it's really awesome to achieve that once really far-fetched dream."

Montgomery was actively recruited by Lipscomb, the first school to contact her -- others also rang "but a lot of them never called back" after she explained her condition.

"They made me feel so welcome," she says of her first visit to Lipscomb's campus. "They all knew my situation and it didn't bother them, and they didn't acknowledge it or ignore it either. It was exactly what I was looking for."

Her debut collegiate cross-country season was a steep learning curve, but Montgomery helped Lipscomb win a fourth successive conference championship in November, placing 13th overall and seventh in her team in the 5 km race.

On the track, she was sixth in the 10,000 meters last weekend as Lipscomb's women's team finished third at the Atlantic Sun championships in Florida, its best result at the event -- and a continuation of its rapid improvement since Bill Taylor, who recruited Montgomery, took over the athletics program in 2007.

She says the coach has given her the confidence to keep pushing herself, having taken a chance on her even though he realizes she may not be able to fulfill the four years of her scholarship if her condition gets worse.

"I keep running because it makes me happy," Montgomery says. "It makes me feel whole and safe, just because I know as long as I am running and still moving, I am still OK."

Topics: diagnosis, health, healthcare, nurse, nurses, doctors, medical, hospital, patient, treatment, college, MS, runner, multiple sclerosis

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