DiversityNursing Blog

Think you need to hire a physician to fill an opening at your hospital, practice, or organization? Not necessarily: A nurse practitioner (NP) may be able to get the job done, says Tay Kopanos, DNP, NP, the Vice President of State Government Affairs for the American Association of Nurse Practitioners. As an added bonus, it typically takes less time to find a locum tenens NP to fill an open position.

So, could bringing on an NP work for you? Use our infographic to find out www.bartonassociates.com:

www.bartonassociates.com

We here at DiversityNursing.com are looking for a variety of topics that we hope you’ll find interesting. Is this article about new bundled payments models something that is helpful and informative for you? Please let us know your thoughts.

On July 25, the Centers for Medicare and Medicaid Services (CMS) proposed a new bundled payment model for heart attacks and bypass surgeries; it will be launched in 98 markets that have yet to be determined. The proposed model is scheduled to go into effect over a five year period, beginning in July of 2017.

“The extension of mandatory bundled payments to cardiac care provides further confirmation that CMS means to reshape healthcare delivery away from fee-for-service and towards value-based care,” says Michel Abrams, co-founder and managing partner of Numerof & Associates. “Practically speaking, it means that the profitability of two high utilization treatments in cardiology has likely peaked, and for many hospitals, these important revenue centers have leaner days ahead.”

The CMS proposal also extends the current Comprehensive Care for Joint Replacement (CJR) model to include other surgical treatments for hip and femur fractures beyond hip replacement. It also includes:

• A new model to increase cardiac rehabilitation utilization; and
• A proposed pathway for physicians with significant participation in bundled payment models to qualify for payment incentives under the proposed Quality Payment Program.

How the proposal will affect continuity of care

Abrams says the fee-for-service model has, over time, encouraged healthcare delivery organizations to allocate fewer resources to activities that weren’t explicitly paid for, such as care coordination. “This has been one of the drivers of the high costs and mediocre results that characterize our current system of care,” Abrams says. “Making acute care providers accountable for the costs and outcomes of the total care experience is a logical path to reversing the current situation.”

“Bundles encourage care redesign by incentivizing gainsharing and risk taking among previously disparate provider groups,” says Christopher Donovan, partner at Foley & Lardner LLP. “This will produce better outcomes over the long term through IT investments and clinical practices that focus on care management and continuity/prevention.”

Do bundled payments keep costs down?

To make its case for mandatory bundled payments, CMS points to a number of pilot programs it claims have shown they can help providers work more closely together to provide better care at lower costs. These programs include:

• The Medicare Acute Care Episode (ACE) demonstration project tested bundled payments for cardiovascular and orthopedic care;
• The Medicare Participating Heart Bypass Center Demonstration project tested bundled payments for bypass surgery; and
• The Bundled Payments for Care Improvement Initiative included cardiac and orthopedic bundles.

“Data from these pilots and other state and private research initiatives all suggest that bundled payments encourage better care coordination and lower delivery costs,” says Abrams.

But according to Denise Burke, a partner in the Memphis office of Waller Lansden Dortch & Davis, LLP, official CMS studies show that bundled payments have had only limited success so far. For example, Burke says the CMS ACE pilot project, which included 28 cardiac and nine orthopedic procedures, reported a savings of only $319 per patient. “Preliminary results from the voluntary programs, however, show promise,” she says. 

Why make bundled payments mandatory?

CMS has set a goal of having 50% of traditional Medicare payments flowing through alternative payment models by 2018. According to Abrams, results of a recent company survey, which assessed U.S. hospital progress toward adopting value-based care models, “confirmed that hospitals, given the option of staying with the historical fee-for service model, won’t meaningfully change their approach to care delivery on their own.”

“CMS is in a unique position to reshape the industry, and it must do so if it is to connect payments with improved outcomes and avoid the sea of red ink that waits at the end of the current trend in healthcare cost inflation,” Abrams says.

What could be bundled next?

Jerrod Ullah, RN, BSN VP Product Management at ViiMed, says based on conversations with practitioners and experts, he believes the industry can expect to see similar models on the horizon for oncology and maternity care. “Each of these areas involves a significant amount of care coordination throughout the treatment process, and patients could see big benefits through a bundled payment approach,” he says.

According to Abrams, the industry can expect to see the subsequent expansion of bundled payments for chronic conditions within already established service lines. “For example, congestive heart failure is a likely candidate for expansion once the cardiology project is underway,” he says.

The proposed rule was published in the Federal Register on August 2. Comments will be accepted for 60 days after publication.

If you have more questions about bundle payments please click below to ask one of our Nurse Leaders! 

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.

If your hospital is experiencing high turnover among your newly licensed Nurses, this article may give you an idea of why they’re leaving and areas where you can improve your work environment.

Some factors influencing low unit-level turnover: first professional degree was a baccalaureate or higher, greater variety and autonomy, and better perceived RN-MD relations

“About 80% of newly licensed nurses find their first work in hospitals,” says New York University Rory Meyers College of Nursing (NYU Meyers) Professor Christine T. Kovner, PhD, RN, FAAN. “Turnovers are one of the costliest expenditures in our profession. In fact, costs are estimated at $62,000 to $67,000 per departure, amounting to $1.4 to 2.1 billion in expenses for new nurses who leave their first jobs within three years of starting.”

Prior research on newly licensed nurses tended to focus on organizational turnover, where a nurse leaves the hospital or organization. However, there is scant literature on internal or unit-level turnover, which occurs when a nurse leaves their current assignment to take up new roles or positions within the organization or hospital.

Recently, Dr. Kovner led a team of researchers at NYU Meyers and the School of Nursing at SUNY Buffalo in conducting a study to fill in the gaps. Published in the International Journal of Nursing Studies, the study of a nationally representative sample of new nurses working in hospitals, sought to better inform unit-level retention strategies by pinpointing factors associated with job retention among newly licensed nurses.

“The internal turnover rate for the one year between the two waves of the survey was nearly 30%,” said Dr. Kovner. “This turnover is in addition to those leaving the organization. This figure is substantially larger than previously reported in other studies, which estimated a 13% one-year internal turnover rate among new nurses.”

The researchers looked to bolster the existing evidence on internal turnover to determine precursors to remaining on the same title and unit-type from the first to the second year of employment.

The nurses (n=1,569) were classified into four categories based their unit and title retention. 1090 nurses (69.5%) remained in the same title and unit-type at wave two, while 129 (8.2%) saw a change in title, but not in unit-type. A similarly small group of 185 (11.8%) had no change in title, but changed unit-types, while 165 (10.5%) had a change in their title and unit-type.

In addition to collecting the new nurses’ demographical data, Dr. Kovner and her team assessed their perceptions of their work environment in both surveys.

“In doing this we were able to examine the changes in work environment perceptions over time between nurses who remained in the same unit and title to those who changed unit and/or title,” said Dr. Kovner.

Upon analysis, the researchers found five factors most strongly associated with retention: holding more than one job for pay (negative), first professional degree was a baccalaureate or higher, negative affectivity, greater variety and autonomy, and better perceived RN-MD relations, all positively related.

“Our results point to the variables on which managers can focus to improve unit-level retention of new nurses,” said Kovner.

Related Article: Fellowship Program Improves New Nurse Retention, Nets Savings

Have more questions about employee retention? Click below to ask one of our Nurse Leaders!

Funding. Funding for this research was provided by the Robert Wood Johnson Foundation.
www.nyu.edu

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.

It seems like just yesterday everyone was pouring ice water on their heads to promote awareness for ALS. This silly challenge went viral and even celebrities joined in to raise money for the research foundation. Good news, it is paying off! 

ALS, or amyotrophic lateral sclerosis, is a progressive disease that attacks the nerve cells in the brain and spinal cord.

The average life expectancy after diagnosis is two to five years, and currently there is no cure.

Two years after the ALS ice bucket challenge rocked the internet, however, things might be about to change. 

A project called MinE at the University of Massachusetts Medical School has just discovered the gene that's responsible for ALS.

Until recently, one of the biggest obstacles to finding a cure for ALS had been not knowing what caused the disease. Now that researchers can pinpoint the gene (which is called NEK1), it will be that much easier to figure out how to reverse and/or treat its effects.

This incredible scientific breakthrough would not have been possible had MinE not received a $1,000,000 grant from the ALS Association/Ice Bucket Challenge. 

As such, it's only right that we pay tribute to the many people who sacrificed their dryness and dignity for the greater good.

Over 6,000 people are diagnosed with ALS each year in the United States alone. But this discovery puts us a big step closer finding a cure.

It's mostly thanks to a meme — a truth-or-dare type challenge that many at the time called pointless. This breakthrough, two years after the fact, just goes to show that virality does have power, power that, when harnessed in positive ways, can absolutely be used for the greater good.

Imagine working for 72 years! This exceptional South Dakota Nurses did it. Her colleagues and patients honored her with a lovely surprise ceremony. We think you’ll enjoy her story.

In a nursing career that started during World War II and spanned seven decades, Alice Graber, 93, always made sure one thing never changed.

"It's always a thrill when you can help somebody else,'' Graber said.

The great-grandmother from Freeman, South Dakota, found out just how many lives she touched over the years when she decided to retire from nursing after 72 years last month.

About 150 people from the town of 1,300 showed up to honor Graber in a ceremony earlier this month at the Salem Mennonite Home, an assisted living home where she was working when she retired.

"I didn't know what to think,'' Graber said. "I was just flabbergasted."

"She touched a lot of lives," Shirley Knodel, administrator and director of nursing at Salem Mennonite Home, said. "She smiled the whole time, even though it was overwhelming to her."

Graber was the oldest nurse in the state, according to Knodel. Everyone from people whom Graber helped deliver as babies to retired nurses who were trained by her when they began their careers showed up to celebrate her career.

"We realized one of the children she delivered was now 52, and his parents still remembered like it was yesterday,'' Graber's daughter, Sharon Waltner, 67, told us.

Graber's father died when she was 9 and her mother passed away when she was 14, leaving her and two younger siblings to be raised by an aunt and uncle.

"I didn't have a very good life growing up, but my mother always said, 'You've got to get an education,''' Graber said. "I felt that it was a gift that I got into nurse's training."

On the advice of an aunt, she moved from Colorado to Lincoln, Nebraska, where she graduated from nursing school in 1944. A year later, she moved to South Dakota with her late husband, Wilbert "Jim" Graber, who died in 2006.

The couple raised two children together, and Graber now has seven grandchildren and five great-grandchildren.

"My brother and I were always annoyed when the phone would ring and they would call her to come in and help at the hospital, but now that we're much older, we're very proud of her that she has been so persistent to pursue a career in health care,'' Waltner said. "What she does makes a difference in people's lives."

Graber worked at four different hospitals in South Dakota during her career, most recently working in assisted living and nursing homes. In recent years, she has been older than the majority of the residents.

She taught us a respect in putting the patient first, which is always what you want,'' said Knodel, who was trained by Graber.

Despite retiring, Graber remains as active as ever. She still helps feed residents at Salem Mennonite Home multiple nights per week and volunteers for several organizations in town. She also walks six blocks each way from her apartment to the Salem Mennonite Home.

"As a daughter, I'm sorry I did not inherit the Energizer bunny battery she has,'' Waltner said. "I joked that if she just worked in assisted living for a few more years, perhaps she could take care of me when I was admitted."

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