DiversityNursing Blog

In this day and age, you probably think women don’t die in childbirth, and if they do, it must be an extremely rare occasion or in 3rdworld countries – right? No, it’s happening right here in the US. Find out why and what you can do to help these numbers go down.

More women are dying in childbirth in the US than in any other developed country. And experts say the problem is likely to keep getting worse.

You can see how alarming the issue is in this chart. In other countries, maternal death rates have fallen sharply since 1990. In South Korea, the rate of women dying in childbirth fell from 20.7 deaths per 100,000 live births in 1990 to 12 today. In Germany, it dropped from 18 to 6.5.

But in the United States, the opposite is happening. The rate of women dying in childbirth is going up.

This wasn’t supposed to happen. During the 20th century, the maternal death rate in the United States dropped from 607.9 deaths per 100,000 births in 1915 to 7.2 in 1987. But over the past 30 years, the maternal mortality rate trend reversed and steadily marched upward.

Pregnancy-related deaths are still rare events in the US; only about 700 women die out of 4 million live births annually. But the US is one of the few rich countries in the world where maternal mortality is steadily rising. The maternal mortality rate has more than doubled since 1987, the first year the Centers for Disease Control and Prevention began collecting data through its pregnancy mortality surveillance system.

And experts are just now understanding why this is happening — why the United States looks so different from other countries, and why so many more new mothers are dying. They think maternal deaths are rising because of the rising toll of chronic diseases.

Thirty years ago, women died in the delivery room because of hemorrhages and pregnancy-induced blood pressure spikes. Now they are much more likely to die because of preexisting chronic conditions like heart disease or diabetes.

"We’ve seen a big bump in cardiovascular disease and chronic disease contributing to maternal deaths," said Dr. William Callaghan, chief of maternal and infant health at the CDC. "Underlying heart disease is common, diabetes is common. We now have a group of women bringing with them into pregnancy their entire health history."

Cardiovascular diseases are now the second leading cause of pregnancy-related deaths in the US

Thirty years ago, almost a third of all pregnancy-related deaths were because of hemorrhages — or women bleeding to death.

But today that number has dropped by nearly a third. Hemorrhages now account for 11.4 percent of pregnancy-related deaths. Deaths related to embolisms and pregnancy-related hypertension disorders have also steadily declined. And deaths due to anesthesia complications have almost entirely disappeared.

Instead, more women are dying from pregnancy complications related to preexisting chronic diseases — in particular, cardiovascular diseases.

Cardiovascular conditions are now the second leading cause of pregnancy-related deaths, falling right behind non-cardiovascular diseases. And when combined with cardiomyopathy (diseases related to weakened heart muscle tissue) cardiovascular disorders make up more than a quarter of all pregnancy-related deaths.

Thirty years ago, cardiovascular diseases accounted for less than 10 percent of all pregnancy-related deaths, but as of 1998 to 2005, CDC researchers noted their increased prevalence as a leading cause of death.

Part of the uptick in cardiovascular-related deaths is because more pregnant women in the US have chronic health conditions such as hypertension, diabetes, and obesity, all of which put them at a much greater risk for pregnancy complications.

"It’s a larger problem than just dealing with women during pregnancy, it’s the health of our society," said Callaghan. "Imagine a [pregnant] woman comes in with BMI of 40, and she’s 24 years old — that didn’t happen in the past year, it happened in the past 24 years."

The number of pregnancy deaths caused by infections has, meanwhile, held relatively steady — not a building problem, but an indication of how the American health care system struggles to protect patients from risks once they enter the hospital.

Age doesn’t explain why maternal deaths are increasing

More than a quarter of all pregnancy-related deaths in the US involved women 35 and older. This is a substantial improvement from previous years, when the percentage topped 50 percent.

The risk of dying from pregnancy complications increases with age for women of all races and ethnicities. But experts don’t think older women having children in the US explains the upward trend of the maternal death rate.

"Pregnancy is riskier the older you get and the risk increases exponentially past the age of 35," said Nicholas Kassebaum, assistant professor at the Institute for Health Metrics and Evaluation. "But the number of women who have delayed pregnancy in the US has not gone up more than in other high-income places."

Black women still experience the greatest risk of dying from pregnancy complications

One stark — and somewhat inexplicable — trend in pregnancy-related deaths is that black women are significantly more likely to die than their peers.

Studies have shown that black women are less likely to begin prenatal care in the first trimester and are more likely to have preexisting chronic conditions such as hypertension,diabetes, or obesity than white women. But this still doesn’t account for the enormity of the disparity that currently exists.

Black women are two to three times more likely to die from pregnancy complications than white women. What’s more, researchers found this to be true regardless of age, education, or similarities in living conditions.

And the disparity is growing worse. The maternal death rate for black women rose from 34 percent in 2007 to 42.8 percent in 2011. During the same time period, the maternal death rate for white women only increased by 0.7 percentage points.

Sadly, this finding is not all that surprising. Black people, and in particular black women, are significantly more likely to die from a health condition than their white peers. But according to Dr. Callaghan, the differences in the maternal death rates for white and black women are currently the most severe disparity in US health care.

"It’s the thing that wakes us up in the middle of the night as we try to understand it," said Callaghan. "It’s access issues, differences in care based on geography, differences in health status — it’s all these things … and we’re not going to find the one thing that causes it."

Lots of maternal deaths are preventable. But we don’t have the right public infrastructure in place.

We know that maternal mortality is a big problem in the United States. But one of the most vexing issues researchers face is the absence of reliable data. Some states have maternal death review boards to collect data. But other states don’t. And what the boards do can vary tremendously from state to state, leaving public health researchers with an incomplete view of the problem.

And it's especially important to study pregnancy-related deaths because the best research we have suggests as many as one in three were preventable. So public health officials are now working on a national initiative to review every single pregnancy-related death in America — and the movement is building momentum.

In 2012, the CDC partnered with the Association of Maternal & Child Health Programs (AMCHP), a public health advocacy group, to help create state-level review boards to assess maternal deaths in every single state.

When they started, there were only 18 states with active review boards, but by 2016 at least 39 states had review boards either active or in the works.

How it works is simple: A board of medical experts in each state meets and reviews information on every single maternal death in that state, looking at potential issues ranging from prenatal care to the role preexisting health conditions played.

The idea is that by determining the causes of each maternal death, trends will emerge, which in turn will help doctors and health care providers identify how to best prevent maternal deaths.

In my interview with Dr. Callaghan, he credited the drop in pregnancy-related deaths caused by hemorrhage and pregnancy-induced hypertension to improved medical interventions. Doctors began to use oxytocin to stimulate uterine contractions in the case of hemorrhage and more regular prenatal blood pressure checks to assess risk of hypertension. They learned from what went wrong in previous cases, and worked to prevent those situations.

So Callaghan is hopeful the same success can be replicated for treating and managing more troubling complications, such as cardiovascular diseases, by studying the causes of maternal deaths on a case-by-case basis.

The CDC and AMCHP are analyzing the data collected by the individual review boards. The current plan is to establish an active review board in all 50 states, and produce a national report so that lessons can be more readily shared between states and health care providers.

In case you haven’t heard the latest news about the Zika virus in south Florida, please read this article for the most recent information. We hope you find it helpful.

For the first time, the Zika virus has prompted public health officials to warn pregnant women to avoid traveling to a part of the continental United States. The travel advisory comes in response to a growing outbreak of the mosquito-borne disease in South Florida.

The state on Monday said there are 10 more people who have been infected with the Zika virus who likely contracted it from local mosquitoes, bringing the total number of such cases in the state to 14. All of the cases have surfaced in a densely populated community north of downtown Miami.

Because the virus can have devastating consequences for a fetus, the Centers for Disease Control and Prevention urged pregnant women to avoid traveling to the area, and for pregnant women who live and work there to make every effort to avoid mosquito bites and to get tested for possible exposure during each prenatal visit. It also advised women to use protection during sex, because the virus can be transmitted sexually.

Furthermore, the CDC is advising that all pregnant women should be asked about travel to Zika-infested areas during routine prenatal visits. Any pregnant women who have traveled to Zika areas -- including this area of Florida on or after June 15 -- are advised to talk with their healthcare providers and get tested for Zika.

For couples trying to have a baby, women and men who traveled to this area should wait at least eight weeks before conceiving a pregnancy. Men with symptoms of Zika virus disease should wait at least six months after symptoms begin to attempt conception.

CDC Director Tom Frieden said the agency issued the travel warning because of the additional Zika infections that were identified in the last 48 hours, and because of new information that indicates mosquito control efforts are not working as well as officials would have liked.

Frieden said it's possible the insects have developed resistance to some of the insecticides being used, or that the mosquitoes are able to continue laying eggs in "cryptic breeding places," or that it may simply be that it's very difficult to do mosquito control in this particular area.

He said more infections are likely, because four out of five people with Zika don't have symptoms.

Although the CDC issued a similar travel warning for Puerto Rico in January because of widespread transmission on the island, this is the first time the agency has issued such a travel advisory for the continental U.S., Frieden said.

The CDC already has two of its experts on the ground in Florida, and six more will be there by Tuesday as part of a rapid-response team. The experts include specialists in birth defects, mosquito control and community engagement.

In a statement, Gov. Rick Scott (R) said state health department officials believe that active transmission is occurring in one several-block area that was announced on Friday. This remains the only area of the state where the health department has confirmed ongoing local transmissions of Zika. Among the 10 new cases announced Monday, six people are asymptomatic and were identified from the door-to-door community survey that the health department is conducting.

The Zika area is a dense, diverse section about one-mile-square that includes the neighborhood of Wynwood. It has now become the first area in the continental United States with confirmed local spread of the Zika virus. State and federal officials have warned for months that such a transmission was inevitable.

Wynwood is one of Miami’s trendiest neighborhoods and draws visitors from around the world to gawk at the array of murals and exquisite graffiti on the walls of warehouses. Once known primarily as a Puerto Rican enclave, and sometimes called Little San Juan, Wynwood has gone through multiple transitions in recent decades and a recent spurt of gentrification. In the 1980s it became a magnet for artists looking for affordable studio space. It's now internationally renowned for its outdoor art as bars, cafes and art galleries spread throughout the neighborhood.

Tourists were still visiting the neighborhood this weekend, largely unconcerned about the Zika outbreak, according to local news reports.

At the present time, there is no need for the travel advisory to be broader than this specific Zika-affected area, Frieden said. Unlike other mosquito-borne diseases that can be spread by humans and animals, there are no other animal reservoirs for the Zika virus other than infected humans. The virus spreads most easily in crowded settings where people don't have access to air condition or window screens, and where there are large numbers of Aedes aegyptimosquitoes.

In addition, the mosquito can only travel about about 150 yards during its lifetime, he said.

"There wouldn't be a technical or scientific basis to give a broader recommendation," Frieden said.

"Nothing we've seen so far indicates widespread transmission," he said. "But it's certainly possible we could be seeing sustained transmission in small areas."

About 40 million people from the United States travel every year to the nearly 50 Zika-affected countries that are mainly in Latin America and the Caribbean, and could get infected unknowingly through a mosquito bite.  "Everyone coming back should use repellent for three weeks in case a mosquito bites them and they get infected," Frieden said.

Because the Aedes aegypti mosquito is also present in parts of 30 states, pregnant women in all of those places should protect themselves against mosquito bites, he said.

“The frustration is that this wasn’t unexpected,” and Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. “It’s not like we were caught by surprise. We knew this train has been heading our way.”

Hotez said the outbreak in Florida is beginning to make clear why lawmakers on Capitol Hill should have to appropriated funding for states and counties to prepare for the Zika threat. The Obama administration requested nearly $2 billion to prepare for the virus in February, but the House and Senate left for their summer recess last month without approving any new funding.

“Congress didn’t do their homework,” Hotez said, noting that the congressional recess corresponds nearly exactly with the peak of the season when mosquitoes traditionally spread the most viruses such as Zika. “They left. So I don’t have kind words to say about Congress right now.”

Republicans and Democrats in Congress have been deadlocked for months over a $1.1 billion spending bill that would help fight the spread of Zika and there is no sign that outbreak in Florida will spur either side to action.

Democrats in the Senate have blocked the funding package drafted by congressional Republicans over politically motivated language, including provisions that would deny Zika-related funds from being sent Planned Parenthood and loosen environmental regulations on pesticides. Democrats also want the funding to be increased to nearly $2 billion without corresponding cuts elsewhere in the budget.

Last week, Senate Minority Leader Harry Reid (D-Nev.) called on Senate Majority Leader Mitch McConnell (R-Ky.) call a special session of Congress. “We need to act now," Reid said.

Senate Republicans responded by blaming Democrats for blocking the House-passed spending bill. McConnell and Florida Sen. Marco Rubio (R-Fla.) have both said President Obama should use money left over from fighting the Ebola virus to combat Zika. On Monday, Rubio  also pushed for Congress to come back to Washington early to vote on a long-term Zika spending bill.

"A week ago, before the cases were announced, I had asked President Obama to take $300 million that’s disposable, that he has under his control," Rubio said at an event in Clearwater. "I’m prepared to go back in a moment’s notice and vote on this and get it done quickly given the state of affairs now."

The lack of funding has hindered the ability of many localities to conduct surveillance that could identify new cases of Zika, Hotez said. In many parts of the Gulf Coast, underfunded districts simply have no capacity to monitor for the disease or to actively fight the mosquitoes that spread it.

“[Miami] is just the one outbreak we know about,” he said. “I think it’s equally possible that multiple outbreaks are simultaneously occurring up and down the Gulf Coast and Florida.”

Like other communities, Hotez said, South Florida has the major elements needed to lay the groundwork for a Zika outbreak – the Aedes aegypti mosquito that primarily carries it, a population never before exposed to the virus and densely populated areas.

“We should expect to see multiple outbreaks of varying sizes occur in South Florida and the Gulf Coast during the traditional peak of arbovirus season,” he said. “Everything we’ve known about this epidemic in the Western Hemisphere indicates this is a virus that, when it gains a foothold in a population, can aggressively spread.”

Scott said health officials have been testing individuals in three locations in Miami-Dade and Broward counties for possible local transmissions through mosquito bites. Two locations have been ruled out for possible local spread. His statement did not provide additional details on location.

Since the health department began its investigation July 7, more than 200 people in Miami-Dade and Broward counties — who live or work near the likely mosquito-borne transmissions — have been tested for the virus. These people have provided blood and urine specimens.

Of the 14 individuals identified, two are women and 12 are men. The governor's statement did not say whether either woman was pregnant.

Although no mosquitoes have yet tested positive for the virus, Frieden explained that confirming infections in mosquitoes is much harder than confirming them in people — which is why there can be local transmission even in the absence of positive insect tests.

Most of the 14 infections were identified within a much smaller geographical section in the center of the Zika area, Frieden said. He described it as 150-yard area surrounding two workplaces.

Mosquito control is difficult in this area because it has a mix of industrial and residential buildings.

Testing for Zika is challenging because four out of five people don't show symptoms.  The virus is primarily spread through the bite of an infected Aedes aegypti mosquito, but it can also be transmitted through sex. That means someone who has been bitten by an infected mosquito could unknowingly spread the virus to a sex partner. And an infected person can pass the virus back to another mosquito, which can then infect another person through a bite.

June 15 is the earliest known date that one of the 14 people in Florida could have been infected, the CDC said.

Scott said Florida would rely on the approach it has taken in tackling similar mosquito-borne viruses, such as dengue and chikungunya, which are spread by the same mosquito species.

He encouraged residents and visitors to drain standing water and use bug spray. But the governor added:  "Florida remains safe and open for business. This year, we have already welcomed a record 30 million tourists and we look forward to welcoming more visitors to Florida this summer.”

The exact location of where the health department believes there are active transmissions of the Zika virus is within the boundaries of the following area: NW Fifth Avenue to the west, U.S. 1 to the east, NW/NE 38th Street to the north and NW/NE 20th Street to the south. This area is about one square mile, and a map below details the area.

Gayle Love, a spokeswoman for Miami-Dade County Solid Waste Management, said officials have been going door-to-door in the affected area, eliminating sources of standing water and spraying for mosquitoes, both from trucks and by hand. Workers also have intensified their efforts just beyond the community where the transmission occurred, in an effort to halt further spread of the virus, she said. Officials also have rotated pesticides in an effort to combat resistance among mosquitoes to the treatments.

The local cases of Zika have gotten the attention of local residents. Love said that on Friday, the day public health officials disclosed the first locally transmitted cases, her department received 224 calls requesting mosquito abatement -- far more than any other day in recent months. "People are concerned," she said.

Still, she said it is imperative that people do their part to cover or drain any water containers around their homes and wear repellent -- messages local authorities have been trying to hammer home for months. "There’s a tremendous level of personal responsibility associated with this," she said.

One of the biggest hurdles in controlling the spread of Zika is that most people don't get sick. And in pregnancies, problems may not be apparent until six or seven or eight months later, Frieden said.

Zika can cause microcephaly, a condition where babies are born with abnormally small heads and often underdeveloped brains. But even babies who look normal at birth can have a variety of other severe neurological problems, and no one knows the scope of those problems yet.

"It is a scary situation but it's not immediately apparent to people," Frieden said.

The Aedes aegypti mosquito can breed in the smallest spots in and around homes. Its larvae don’t necessarily need water to survive, and eggs can lie dormant for a year or more, only to hatch once submerged in water. The sticky eggs glue themselves to containers as common and varied as the insides of old tires and the edges of birdbaths.

Aedes aegypti mosquitoes are aggressive daytime biters, especially around dawn and dusk. They can hide under beds, in closets or in other shady places. They are “sip feeders,” meaning they feed often and on multiple hosts — a practice that makes it possible to spread disease quickly. They also are adept, experts say, at launching sneak attacks, in which they approach people from behind and bite them on the ankles and elbows to avoid being detected and slapped.

Joel Achenbach and Kelsey Snell contributed to this report.

Are you wearing a Fitbit or another devise that tracks your daily steps, sleep and other information? Have you ever wondered who else might have access to your data? I’ve been wearing a Fitbit for close to 2 years and I love it, but I never thought about my privacy regarding the information it tracks and who else might have access to details like my weight, height, age and how physically active I am. Should these devices adhere to HIPAA protections? Do you care? Please share your thoughts with us.

The federal patient privacy law known as HIPAA has not kept pace with wearable fitness trackers, mobile health apps and online patient communities, leaving a gaping hole in regulations that needs to be filled, according to a much-delayed government report released today.

The report, which was supposed to be complete in 2010, does not include specific recommendations for fixing the problem, even though Congress asked the U.S. Department of Health and Human Services to provide them.

HHS’ findings largely mirror those in a ProPublica story from last November. The Health Insurance Portability and Accountability Act, the landmark 1996 patient-privacy law, only covers patient information kept by health providers, insurers and data clearinghouses, as well as their business partners. Falling outside the law’s purview: wearables like Fitbit that measure steps and sleep, at-home paternity tests, social media sites, and online repositories where individuals can store their health records.

“Health privacy and security law experts have a reasonably clear idea of where HIPAA protections end, but the layperson likely does not,” said the report written by HHS’ Office of the National Coordinator for Health Information Technology, in conjunction with other agencies. “Moreover, even entrepreneurs, particularly those outside the health care industry … may not have a clear understanding of where HIPAA oversight begins and ends.”

The report was mandated under a 2009 law that called on HHS to work with the Federal Trade Commission — which targets unfair business practices and identity theft — and to submit recommendations to Congress within a year on how to deal with entities handling health information that fall outside of HIPAA. Asked why the report did not include any recommendations, an official said readers could draw their own conclusions from the findings.

“At the end of the day, it’s a very complicated environment that we find ourselves in,” said Lucia Savage, chief privacy officer at the Office of the National Coordinator for Health Information Technology, which took the lead on the report. “We believe we’re fulfilling our duties. If Congress has concerns about that, I’m sure that we will hear about them.”

In 2013, the Privacy Rights Clearinghouse studied 43 free and paid health and fitness apps. The group found that some did not provide a link to a privacy policy and that many with a policy did not accurately describe how the apps transmitted information. For instance, many apps connected to third-party websites without users’ knowledge and sent data in unencrypted ways that potentially exposed personal information.

Paul Stephens, the group’s director of policy and advocacy, said the issue has grown more urgent in recent years as employers give workers incentives to log their activities on mobile apps as part of wellness programs. “It goes beyond someone voluntarily saying I want this app,” Stephens said. “There are basically going to be financial incentives to use the app.”

Stephens also said many people do not read an app’s privacy policy, leaving them open to having their information used in myriad ways.

The new report pointed to a number of major differences between information covered by HIPAA — your medical records, for instance — and data that’s not. Among them:

• Under HIPAA, patients are entitled to copies of their health records. Companies that make trackers and apps “are not obligated by a statute or regulation to provide individuals with access to data about themselves.”
• HIPAA delineates to whom and for what purpose a health provider may share a patient’s health information and limits the use of personal health information for marketing. People who have provided information to companies that fall outside the law “likely will not enjoy the same protections against unwanted marketing unless the data collector has promised in its terms of use not to use data for marketing and does not change its terms of use.”
• HIPAA rules require tight security over personal health information. Apps and wearables may not have the same protections.
• HIPAA requires understandable privacy policies and notices. Outside the law, those may not exist.

In addition, several federal agencies have a role in regulating privacy, new technology and consumer protections. The HHS Office for Civil Rights enforces HIPAA; the FTC acts against deceptive or unfair trade practices; and the Office of the National Coordinator encourages adoption of health information technology.

A 2014 study looked at 600 of the most commonly used health apps and found that fewer than a third had privacy policies. And for those that did, you’d have to have the reading level of a college senior to understand them, the HHS report said. Policies on Apple and Google mobile phone platforms “may be inconsistent, not articulated to individuals, or simply ignored by web developers skirting the rules that operating system developers attempt to impose on them.”

Attempts to fix the problem through voluntary efforts do not appear to be working. In 2015, the Consumer Electronics Association issued a set of “Guiding Principles on the Privacy and Security of Personal Wellness Data.”

“These guidelines can be adopted by companies, but are not required of CEA members,” today’s report said. “As of July 2016, we have been unable to identify any companies that have adopted the guidelines.”

The report offers no suggestions to change that, either.

Related Article: How Health Apps Will Change Nursing

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As a Nurse, you see miracles all the time. Here’s an interesting and happy story about the miracle of birth for identical twin sisters. Perhaps you’ve seen or heard something similar?

Twin sisters Sarah Mariuz and Leah Rodgers not only share the same birthday, but their kids do, too.

Mariuz and Rodgers, both 35, each gave birth last Thursday at the same time: 1:18 a.m.

According to Today.com, Rodgers’ baby boy, Reid Joseph, was born in Denver, Colorado, while Mariuz’ girl, Samantha Lynne, was born in La Jolla, California, which is one time zone behind, so the cousins were born an hour apart though both clocks read 1:18.

The sisters insist they didn’t plan to get pregnant at the same time. Instead, they surprised each other at Thanksgiving.

“I wanted it to be a surprise, but when she showed up at the door -– it was the funniest thing –- I opened the door, welcomed her into the home, but as soon as I saw her, I knew she was pregnant too,” Rodgers tells People.com. “I can’t explain it, I just knew. My prediction was that she was five days behind me, and it turned out her due date was four days after me.”

So far, neither sister has been been able to see her niece or nephew, but they aretrying to work out a time to visit each other, according to the Associated Press.

“We’ll definitely spend Christmas together,” Mariuz told Today.com.

Rodgers predicts the bond between cousins should be as strong as the one she shares with her sister.

“It’s a really cool thing to be able to share,” Rodgers told People.com “The adventure will only continue as our babies share the same birthday like we did! We can’t wait for them to grow up together.”

Related Articles: 

Conjoined Twins Plan Party After Reaching Landmark Age

Nurses at Brigham & Women’s Hospital in Boston are threatening a walk-out next Monday, June 27, 2016. The Massachusetts Nurses Union and management at the hospital have been in negotiations and cannot agree on their contract. What are your thoughts about it?

Brigham and Women’s Hospital and the union representing its registered nurses are at an impasse.

Negotiators from Brigham and the Massachusetts Nurses Association have met 20 times to hash out a new contract, but after the latest session on Friday, the dispute seemed only further from resolution.

The union has threatened a one-day strike on June 27, and patient care is likely to be disrupted as hospital leaders scale down operations and hire temporary replacement nurses. The hospital says nurses will be locked out for five days if they walk out.

“In response to what the union said was their greatest concern, we worked hard to develop a generous wage and benefit package for every one of our nurses, despite the tremendous financial pressure in healthcare,” Dr. Ron M. Walls, Brigham’s chief operating officer, said in a statement. “We are disappointed that the union rejected our most recent proposal.”

Brigham is owned by Partners HealthCare, the state’s largest health care provider network.

Union negotiators said in a statement that “nurses are prepared to strike unless Partners offers a fair settlement that values patients over profits… Every patient deserves safe care and every nurse deserves a fair wage and equal benefits.”

So, what’s preventing an agreement? As hospital and union leaders prepared to continue talks Monday, they shared details of their latest proposals with the Globe:

Wages

Brigham nurses receive 5 percent annual raises for their first 18 years on the job. The hospital proposed keeping those step raises and adding a new step at the top of the pay scale. Those at the top would receive a 4 percent increase, plus a $500 bonus, over three years, bringing pay for full-time nurses at the top of the scale to $148,616. The average Brigham nurse currently makes $106,000 a year. The hospital also offered $1.4 million in bonuses, but after the union rejected its offer, it directed that money to hiring temporary nurses to work in case of a strike.

The union also wanted to keep step raises in place and add a top step to the scale. But it wanted bigger raises than the hospital proposed: a 5 percent raise for nurses at the top of the scale, and an additional 4 percent increase for all nurses over two years.

Benefits

Brigham wants to place newly hired nurses into a “flex” insurance plan already offered to other Brigham and Partners employees. The hospital calls it a comprehensive plan with a wide range of options, which many union nurses have voluntarily selected in the past. Brigham officials said they offered to set a maximum employee premium contribution rate so they wouldn’t be able to increase what nurses pay without future negotiations.

But the union says the hospital is forcing newly hired nurses into “lesser benefits.” Officials say the hospital has already “lured” many nurses into its preferred insurance plan only to increase employee costs over time. They want new nurses to be able to choose from the same health insurance options that existing nurses have.

Staffing

The union says Brigham has been cutting nurse staffing in one unit of the hospital, where patients are recovering from major thoracic procedures, such as lung transplants. Union officials say the unit was historically staffed with 15 nurses at a time, and they want to keep staffing at that level.

Hospital officials maintain that staffing in that unit is “comparable to or better than similar units within the hospital and at other hospitals throughout the state.” They want to set staffing levels according to the number of patients in the unit at a given time, and how sick the patients are. On Friday, the hospital asked the union to agree to a plan for submitting complaints about staffing to senior nursing officials, but the union said this was “unacceptable” because nurses already complain when they have concerns about staffing and “nothing is done.”

This week is Men’s Health Week and this article serves as a reminder about the importance of men paying attention to their health. As a Nurse, you are in the perfect position to remind your male and female patients to take care of themselves, exercise, eat healthy, listen to their bodies and get help if they notice any persistent changes.

Men’s Health Week is being recognized across the U.S. during the week leading up to and including Father’s Day (June 13-19). And while I have said it before, it bears repeating, this is not just a men’s issue — we all need to be aware and support our men’s (young to old) good health and prevention of health problems. To that end, I am sharing key information in three parts to help spotlight Men’s Health. There are many medical and social factors that impact the physical, social, emotional and spiritual health and wellbeing of all our men and boys.

Studies show that culturally women surpass men in asking for help with their health and too, our boys and men have been raised in a culture “to be emotionally restrained, keeping things close to the vest, being in control, independent, competitive and to endure pain.” Research shows that many men only seek medical counsel when under duress from a family member or when their condition has deteriorated to a severe state. This in itself is an issue but add to this, these staggering statistics:

• Men die at much higher rates from the most common forms of cancers that affect both sexes
• Experts agree there is a focus on women’s health with multiple commissions – but the same lags for men with substantial amount of health disparities in men/boy’s health research

The purpose of Men’s Health Week is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among our men and boys. This Part 2 (of 3) spotlights some additional key concerns while underscoring that having an awareness of preventable health problems along with early detection and treatment of chronic illnesses are imperative to improving men’s health. (Part 1 is here.)

Dr. Nina’s What You Need to Know: About Men’s Health Part 2

Depression While depression in men is common, they often times do not gain the relief needed as they believe they have to be strong and in control of their emotions at all times. And mental health can also affect our physical health; depression can increase the risk for heart disease and other serious medical problems.

Research shows, too, that when feeling hopeless, helpless, or overwhelmed by despair, men and boys tend to deny it or cover it up by physical pain, reckless behavior, anger, or drinking too much. While a key step to recovery is to understand that there’s no reason to feel ashamed – that is more convoluted for men as a result of our culture.

And unfortunately, depression in our men can be overlooked—they can find it difficult to “open up” to talk about their feelings. This can result in the underlying depression going untreated, which can have serious consequences—men suffering from depression are four times more likely to commit suicide than women. It is important for any man to seek help with depression before feelings of despair become feelings of suicide.

Depression is not a sign of emotional weakness or failing of masculinity. It is a treatable health condition that affects millions of men of all ages and backgrounds, as well as those who care about them—spouses, partners, friends, and family. If you (or someone you know) is dealing with depression – talk honestly with a friend, loved one, or doctor about what’s going on in your mind as well as your body. Once correctly diagnosed, there is plenty you can do to successfully treat and manage depression.

Connecting and Isolation: I am currently reading a book by therapist, psychiatrist Dr. Rob Garfield (2015), titled: “Breaking the Male Code: Unlocking the Power of Friendship” about the “connecting” breakthroughs and valuable benefits from men that had personally felt disconnected – and an insightful introspect of what, as a culture, we reinforce in our men “boy code” – “guy code.”

Research shows men may have as many friendships as women have but the quality is often very different. If a guy has a good friend, he may see them once every 3 to 5 years. Social relationships and connection for men are equally vital to men’s wellbeing, as to women’s. Loneliness can send both men and women down a path toward bad health, and even more intense loneliness, studies have shown. We want to encourage healthy connections and examine our views and related behaviors on “guy codes.”

Decrease alcohol use According to The Centers for Disease Control and Prevention, men are more likely than women to drink excessively: 58% report drinking alcohol in the last 30 days and 23% report binge drinking 5 times a month (equates to 8 drinks). In addition to the numerous illnesses that chronic heavy alcohol use increases the risk for—liver disease, heart problems, dementia, cancer—being intoxicated has also been shown to elevate the risk for aggression, accidents, injuries, and deaths.

The Federal Dietary Guidelines on Alcohol Consumption state the following regarding drinking in moderation: For men 65 years of age and younger, no more than two drinks per day and for men who are older than 65 years, no more than one drink a day. They even recommend that some should not drink alcoholic beverages at all including those who cannot restrict their drinking to moderate levels; plan to drive or operate machinery; are taking prescription or over-the-counter medications that can interact with alcohol; have certain medical conditions; and are recovering from alcoholism.

According to a statement from an editor of American Journal of Men’s Health, “facts are that men put their health last and it has been researched to find that most men’s thinking is, if they can live up to their roles in society, then they’re healthy.” From infancy to old age, women are simply healthier than men. Out of the 15 leading causes of death, men lead women in all of them except Alzheimer’s disease, which many men don’t live long enough to develop.

Our men deserve better – their health needs all our attention, on every front — at home; in our communities; and the national level (as we advance more research as well as commission additional understandings to break through the health gap). Let’s rally to help make a difference!!

• Classes:  Although classes in the summer are not usually work related, there are many that can help with relaxation.  There are classes available from Feng Shui and Tai Chi to crocheting, woodworking or pottery making.   If you live in or near a fairly large city, you should have literally hundreds of choices. Anything that involves learning something new, movement or concentration is good to relieve stress.
  
  
• Hobbies:  Already have a hobby?  Summer is a great time to pursue them.  Hiking, gardening, camping and rock collecting are all good summertime hobbies. These are all outdoor, fresh air pursuits.  Some for indoors include reading, stamp or coin collecting, knitting, baking or cooking, making jewelry or scrapbooking. 
  Starting an aquarium is fun and watching the fish is very soothing.  Learn to play a musical instrument like the piano.  The right type of music can be very relaxing.
  
  
• Meditation: Learning to meditate is terrific for stress relief.  There are CD's you can buy or get from the library that can teach you meditation. There are also music CD's available for meditation.  Meditation also helps to lower blood pressure and relieve anxiety. Tai Chi is an active meditation and it's highly recommended to help deal with stress.

• Exercise: Bicycling, walking, yoga and swimming are all good stress relievers along with most other forms of exercise. Take a dance class or Zumba. Get out in the sunshine with boating, fishing, water skiing, flea markets and garage sales. Go antiquing or to auctions. Plenty of sun and vitamin D are great for stress.  Be sure to wear a sunscreen!

Want more tips on dealing with stress in the Nursing field? Just ask one of our Nurse Leaders, they will be glad to help! Just click below! 

This video shows Will Cristobal who is an Emergency Room Nurse. Will discusses what it is like to be an Emergency Room Nurse and the path that got him there. The video also goes over some common things that happen on a daily basis in the Emergency Room. 

If you are interested in becoming an Emergency Room Nurse and have a few questions, feel free to ask one of our Nurse Leaders by clicking on the image below!