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DiversityNursing Blog

New York announces plan to boost HIV testing, treatment to end epidemic

Posted by Erica Bettencourt

Wed, Jul 02, 2014 @ 12:08 PM

By Associated Press

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New York state can end its three-decade HIV crisis by the year 2020, Gov. Andrew Cuomo said Sunday as he announced an ambitious plan to deliver a knockout blow to the epidemic by boosting testing, reducing new infections and expanding treatment.

The governor said the state is aiming to reduce new HIV diagnoses to 750 by the end of the decade - about the same number of tuberculosis cases seen in New York City each year - down from 3,000 expected this year and 14,000 new cases of the disease in 1993. If the state is successful, it would be the first time the number of people living with HIV has gone down since the crisis began with the first widely reported cases in 1981.

"Thirty years ago, New York was the epicenter of the AIDS crisis," Cuomo said. "Today I am proud to announce that we are in a position to be the first state in the nation committed to ending this epidemic."

To expand treatment, the state's Department of Health has negotiated bulk rebates with three companies producing HIV drugs. The state is also taking steps to make it easier to get tested, changing how HIV cases are tracked to ensure patients continue to receive treatment, and boosting access to "pre-exposure" drugs that can help high-risk people avoid infection.

Cuomo did not offer an estimate of the cost of the plan, but said it would end up saving the state more than $300 million per year by 2020 by reducing the amount the state pays for medical care for those with HIV.

Groups that have long advocated for HIV patients praised the governor's announcement, saying it shows that efforts to fight the disease are paying off, and that a scourge that once seemed unbeatable can be successfully fought.

"We have the tools and know-how to end the AIDS epidemic in New York, the only question is whether we have the political will," said Jason Walker, an organizer at VOCAL-NY, which advocates for low-income HIV patients. "Even without a vaccine or cure, Cuomo understands that we can dramatically reduce new infections below epidemic levels and ensure all people living with HIV achieve optimal health."

While the state's plan may sound overly optimistic, the number of new HIV cases in New York has dropped nearly 40 percent in the last 10 years because of better, faster tests; access to condoms; public outreach campaigns and other initiatives. Meanwhile, those with the disease are living longer thanks to significantly more effective treatments.

The goal of bringing the disease to below epidemic levels "is ambitious," said Mark Harrington, executive director of the anti-HIV organization Treatment Action Group, but "grounded in reality."


Topics: New York, epidemic, testing, treatment, HIV

New York nurses share how colleagues inspire them every day

Posted by Alycia Sullivan

Fri, Apr 25, 2014 @ 12:53 PM

In healthcare facilities, it takes a network of teammates to ensure the optimal health of patients who receive care. The most successful teams are those who acknowledge each other’s strengths and work together accordingly where there are weaknesses, inspiring one another along the way. 

In honor of National Nurses Week, we asked nurses in New York and New Jersey to share the many ways in which their colleagues inspire them in their everyday lives to be better nurses, better teammates and better people. On the next few pages, we share their thought-provoking and heartfelt responses with you. 
Benjamin Quinones, RN, coordinator of care, MJHS Home Care, Brooklyn, N.Y.
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My network of team leaders helped me transition into nursing after 16 years as a paramedic. I didn’t get to be part of patients’ follow-up care or journey back to independence while working as a paramedic. 

As part of MJHS Home Care, I see patients one-on-one, but with the support I get from my special colleagues, I’ve never felt alone. Most important, my team leaders have taught me that at the end of the day, it’s all about our patients. 

Stephen R. Marrone, RN-BC, Edd, CTN-A, deputy nursing director, SUNY Downstate Medical Center, Brooklyn, N.Y.

bilde (6) resized 600When I was a high school volunteer in the ICU of a community hospital in Brooklyn, I watched the nurses care for patients and knew I wanted to be a nurse. As a nurse for more than three decades, I continue to be inspired by nurses every day, individually and collectively. 

Individually, I see nurses work tirelessly to provide excellent care during difficult financial times, and I am determined to make sure they have the resources they need to provide safe care. I am inspired when I see younger nurses become leaders on their units and I know I have made a difference. 

Several nurses have mentored and provided a springboard for me to elevate my practice and expand my scope of influence. They did so by recognizing potential in me that was hidden from myself. They helped me gain entry into higher levels of practice and a peer group that role-modeled leadership. 

When I am having one of those days when I ask myself, “Why do I do this?,” I think of those nurses and the patients we care for and remember that I am privileged to be touched by others and to touch others’ lives every day. 

Sylvie Jacobs, RN, BSN, CPAN, postanesthesia care unit, Mount Sinai Hospital, New York City
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The nurse who remains with me as the most inspiring is Patricia Liang. We worked side by side in the postanesthesia care unit for decades. 

She was the go-to resource because she seemed to know what to do in every situation and could impart the information to staff in a kind and supportive way. 

Liang was tiny in stature but relayed an enormous, quiet power, always in a respectful way. The new residents got away with nothing when Liang was around. She not only had a seemingly bottomless wealth of knowledge, but she also had an unfailing moral compass. When there was an ethical issue that needed to be resolved, we knew to ask Liang. 

She was not a talkative person — she was usually focused on coordinating care — but you somehow felt her support and appreciation for your efforts. I always will remember her for not just being an outstanding nurse, but for also being an outstanding person. 

Janice Wright, RN, BSN, staff nurse, 4C med/surg unit, Lutheran Medical Center, Brooklyn, N.Y.

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I have been working at Lutheran Medical Center on a med/surg unit for the past four years. I have had the pleasure of working with an extraordinary group of nursing colleagues. 

It is hard to single out one particular person because I truly can say my professional life has been enriched and my work ethics validated by each of the nurses with whom I work. I feel empowered and energized in my daily work because of my colleagues. 

Mary Farren, RN, MSN, CWOCN, clinical nurse specialist, acute care, VNSNY, Queens, N.Y.

describe the imageNearly every morning for the past 10 years, I have been fortunate to have a chat with Marilyn Liota, RN, as we start our day around 7 a.m. Nearly every conversation begins with Liota saying: “Tell me what is good.” From there, we have gone off in many directions. What a way to open a conversation, and what a way to start the day. 

I consider myself fortunate to have known Liota, worked under her leadership and guidance, and been a part of the special and historic “Marilyn Liota” years at VNSNY. Liota recently retired and I’m truly happy for her, yet underneath it all, I feel a touch of sadness, too. I will miss her so much. 

So typical of a giving soul like hers, Liota’s next steps involve giving generously of herself to help others as a volunteer working with new immigrants for a nonprofit organization called “Literacy Nassau.” 

Kathleen Lanzo, RN, clinical practice coordinator, ASU/OR holding/ENDO/PACU, Plainview (N.Y.) Hospital

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When I think of the most influential person in nursing who has enriched my life, the answer rolls right off my tongue. Her name is Winnie Mele, RN. I have been blessed to work alongside her for 28 years, and still each new day brings a new experience. 

Her style of leadership motivates and inspires all who know her to be successful in their careers. She gets out and circulates among the troops. No matter how dark the day, I always can count on her to make it a learning experience without being punitive. 

We share the same vision and passion for nursing. There is never a day when she won’t sit and have coffee, share a story, sing a song or just listen. “Every patient, every time” is the mantra she taught me and her staff. I am a better person professionally and spiritually because of this special outstanding woman. 

Compassion, honesty, fairness and loyalty are what I have taken from this extraordinary nurse who, throughout my career, has been my role model. Everyone should have someone like Mele in their life. I thank God for her every day. 

Nydia White, RN, critical care unit, South Nassau Communities Hospital, Oceanside, N.Y.

describe the imageI was 21 years old when I was a new RN on a med/surg floor. On that unit there was no such thing as being alone as a nurse — we worked together as a team. It was scary, overwhelming and exciting at the same time. 

Lisa Williams, my first nurse manager, did more than just her job. If there was a sick call, she would take a section of patients. If we needed some extra hands, she would give bed baths. Williams exemplified confidence, leadership and teamwork with a touch of color and a twist of enthusiasm that would radiate to her staff. 

The quality that amazed me most was her compassion for people. It wasn’t just about your abilities as a nurse; it was about tapping into the kind of person you were and helping you grow. She could sense if something was wrong, take you to the side and support you through the challenge. 

Williams’ specialty was to identify a nurse’s potential and mentor her to be a better nurse and a better person. She encouraged me to be the charge nurse and join committees when I didn’t think I was ready, but she assured me I was. Now I am a critical care RN and even host a CCRN review class. I volunteer for many committees. I am a better person and nurse because of Williams, my first nurse manager, mentor and friend. 

Erica Zippo, RNC-OB, BSN, C-EFM, staff nurse, labor and delivery, White Plains (N.Y.) Hospital

describe the imageI was a new graduate nurse when I started working on the labor and delivery unit at White Plains Hospital. In nursing school, we heard that nurses eat their young, so the support, camaraderie and familylike atmosphere I felt on the unit was something I never expected. 

My colleagues took me under their wings and enthusiastically shared their knowledge and individual experiences, most of which were things I had not learned in school. When observing my colleagues in action, I learned how to make a patient and his or her family feel comfortable, calm and welcome; how to complete an efficient history and physical while admitting a woman in labor; and how to make the delivery of every baby special despite the paperwork and nursing tasks. 

This shared knowledge from my colleagues continues to enrich my professional life and has shaped me into the nurse I am today. My colleagues also have supported me in my personal life through many important moments, such as relationships, break-ups, moves, graduate school, marriage and the birth of my daughter. I am thankful for the positive influences of my strong, intelligent and caring colleagues.

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Topics: New York, colleagues, inspire, nurses

New York nurse blends art, healing

Posted by Alycia Sullivan

Mon, Apr 07, 2014 @ 01:47 PM

bildeAs a registered nurse in the cardiac surgery ICU at Beth Israel Medical Center, Valley Fox, RN, BSN, MA, AP, CCRN, witnesses the spectrum of life and death. 

Her days are full of pharmaceuticals, imaging studies and other visual elements, which she reinterprets into an artistic language that explores the relationship between body and spirit.

“I take inspiration from the hospital because that’s where I spend my time,” Fox said. “Being in the presence of those images and bodies, it comes through instinctively.”

In one piece of artwork Fox donated to the American Heart Association and the cardiac surgery unit, she subtly embedded a heart in the middle of a flower. Many people did not notice, but her colleagues on the unit spotted it immediately. 

“The heart is the center of everybody,” said Cathy Sullivan, RN, BS, MSN, FNP, CCRN, director of patient care services, Beth Israel Medical Center — Petrie Division. “Without your heart, you wouldn’t have a body or soul.” 

describe the imageBeth Israel Medical Center nurse Valley Fox, RN, recently completed abilde (1) month-long art exhibit at New York University’s medical sciences building called “Origins of Medicine.”
Mary Anne Gallagher, RN, MA, BC, director of quality, standards and practice at Beth Israel, envisioned a fetus and baby in one of Fox’s paintings, which the artist had not intentionally set out to create. “When you are in her presence, there’s a feeling of peace and comfort,” Gallagher said. 

Art came first for Fox, who was born with severe myopia. Her inability to see clearly beyond 10 inches went unrecognized until she was in kindergarten, when she received glasses. “As a child, I was always drawing because that’s how I processed reality,” Fox said. “I would play with Play-Doh. I was constantly doing artwork as a child.”

The school allowed Fox, a gifted student, to paint twice a week in her elementary school years, where she developed her skills and creativity. “Everyone has creative capacities,” Fox said. 

Her parents encouraged Fox to pursue “a practical degree” rather than art. After completing her nursing school prerequisites and waiting to be admitted to a nursing program, she turned to Chinese medicine. She completed a master of oriental medicine at the Atlantic Institute of Oriental Medicine in Fort Lauderdale, Fla., but the timing was not ideal to set up her own practice as an acupuncture physician. 

bilde (2)Still, healthcare intrigued her, and the opportunity to travel, move around and practice in different places cinched her decision to become an RN. She worked in Florida, Illinois and upstate New York before settling in New York City. Nursing is a career path she has not regretted. 

“Being a nurse is incredibly rewarding, to help patients when they are in tremendous need and offer support and listen,” Fox said. “I get to share intimate moments with total strangers, and then there are critical moments where we work together as a team and save someone’s life. It’s an incredible opportunity.” 

Fox credits her artistic background with the intuitive skills she draws from as a critical care nurse. She considers the interconnectivity of the mind and body and draws from her experience in medicine to pick up subtle clues. 

“Sometimes, that right brain element comes through, and we can sense a patient may code and prevent an emergency,” Fox said. 

Fox professionally displays and sells her paintings and recently completed a monthlong exhibit at New York University’s medical science building called “Origins of Medicine,” in which she explored the relationship between the mind and body in medicine.

“Valley looks at the patient as a whole and anticipates,” Sullivan said. “That’s the type of nurse you need, one who pays attention to detail. And artists pay attention to details.”

Topics: New York, Beth Israel Medical Center, nurse, art

With Money at Risk, Hospitals Push Staff to Wash Hands

Posted by Alycia Sullivan

Mon, Jun 03, 2013 @ 10:25 AM

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At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.

Beth Israel promotes hand washing with at least five different buttons to keep interest from flagging.

This Big Brother-ish approach is one of a panoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene. With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.

Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients. So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with “red cards.” They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the “Happy Birthday” song.

All this effort is to coax workers into using more soap and water, or alcohol-based sanitizers like Purell.

“This is not a quick fix; this is a war,” said Dr. Bruce Farber, chief of infectious disease at North Shore.

But the incentive to do something is strong: under new federal rules, hospitals will lose Medicare money when patients get preventable infections.

One puzzle is why health care workers are so bad at it. Among the explanations studies have offered are complaints about dry skin, the pressures of an emergency environment, the tedium of hand washing and resistance to authority (doctors, who have the most authority, tend to be the most resistant, studies have found).

“There are still staff out there who say, ‘How dare they!’ ” said Elaine Larson, a professor in Columbia University’s school of nursing who has made a career out of studying hand-washing.

Philip Liang, who founded a company, General Sensing, that outfits hospital workers with electronic badges that track hand-washing, attributes low compliance to “high cognitive load.”

“Nurses have to remember hundreds — thousands — of procedures,” Mr. Liang said. “Take out the catheter; change four medications. It’s really easy to forget the basic tasks. You’re really concentrating on what’s difficult, not on what’s simple.”

His company uses a technology similar to Wi-Fi or Bluetooth. The badge communicates with a sensor on every sanitizer and soap dispenser, and with a beacon behind the patient’s bed. If the wearer’s hands are not cleaned, the badge vibrates, like a cellphone, so that the health care worker is reminded but not humiliated in front of the patient.

Just waving one’s hands under the dispenser is not enough. “We know if you took a swig of soap,” Mr. Liang said.

The program uses a frequent-flier model to reward workers with incentives, sometimes cash bonuses, the more they wash their hands.

Gojo Industries, which manufactures the ubiquitous Purell, has also developed technology that can be snapped into any of its soap or sanitizer dispensers to track hand-hygiene.

At North Shore, the video monitoring program, run by a company called Arrowsight, has been adapted from the meat industry, where cameras track whether workers who skin animals — the hide can contaminate the meat — wash their hands, knives and electric cutters.

Adam Aronson, the chief executive of Arrowsight, said he was inspired to go from slaughterhouses to hospitals by his father, Dr. Mark Aronson, vice chairman for quality at Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School.

“Nobody would do a free test — they talked about Big Brother, patient privacy — nobody wanted to touch it,” Mr. Aronson said.

He finally got a trial at a small surgery center in Macon, Ga., and in 2008, North Shore also agreed to a trial in its intensive care unit. The medical center at the University of California, San Francisco, is also using Arrowsight’s video system, and Mr. Aronson said eight more hospitals in the United States, Britain, the Netherlands and Pakistan had agreed to test the cameras.

North Shore’s study, published in the journal Clinical Infectious Diseases, found that during a 16-week preliminary period when workers were being filmed but were not informed of the results, hand-hygiene rates were less than 10 percent. When they started getting reports on their filmed behavior, through electronic scoreboards and e-mails, the rates rose to 88 percent. The hospital kept the system, but because of the expense, it has limited it to the intensive care unit, where the payoff is greatest because the patients are sickest.

To get a passing score, workers have to wash their hands within 10 seconds of entering a patient’s room. Only workers who stay in the room for at least a minute are counted, and the quality of their washing is not rated. Scores for each shift are broadcast on hallway scoreboards, which read “Great Shift” for those that top 90 percent compliance.

Technology is not the only means of coercion. The Greater New York Hospital Association, a trade group, and the health care workers union, 1199 S.E.I.U., train employees to be “infection coaches” for other employees.

In a technique borrowed from soccer, hospital workers hand red cards to colleagues who do not wash, said Dr. Brian Koll, chief of infection prevention for Beth Israel Medical Center in Manhattan, who trains coaches. (Unlike soccer players, however, workers do not have to leave.) “It’s a way to communicate in a nonconfrontational way that also builds teamwork,” Dr. Koll said.

“You do not want to say, ‘You did not wash your hands.’ ”

Doctors, nurses and others at Beth Israel who consistently refuse to wash their hands may be forced to take a four-hour remedial infection prevention course, Dr. Koll said. But to turn that into something positive, they are then asked to teach infection prevention to others.

Dr. Koll said that he was not aware of malpractice suits based on hand-washing, but that hand-washing compliance rates often become part of the information used when suing hospitals for infections.

A hospital in the Bronx gave out tickets — sort of like traffic tickets — to workers who did not wash their hands, he said. “That did not work in our institution,” he said. “People made it a negative connotation.” Beth Israel finds that positive reinforcement works better, Dr. Koll said.

Like other hospitals, Beth Israel also uses what it calls secret shoppers — staff members, often medical students, in white coats whose job is to observe whether people are washing their hands. Beth Israel gives high-scoring workers gold stars to wear on their lapels, “hokey as this sounds,” he said; after five gold stars they get a platinum star, or perhaps a coupon for free coffee. “Health care workers like caffeine,” Dr. Koll said.

There are buttons saying, “Ask me if I’ve washed my hands,” and Dr. Koll said that patients’ families did ask because they understood the risks. Especially in pediatrics, he said, “parents do not have a problem at all asking.”

To avoid slogan fatigue, Beth Israel has at least five buttons, including “Got Gel?” and “Hand Hygiene First.”

Dr. Larson, the hand-washing expert, supports the electronic systems being developed, but says none are perfect yet. “People learn to game the system,” she said. “There was one system where the monitoring was waist high, and they learned to crawl under that. Or there are people who will swipe their badges and turn on the water, but not wash their hands. It’s just amazing.”

Source: The New York Times 

Topics: New York, North Shore University Hospital, hand washing, video surveillance, hospital

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