DiversityNursing Blog

By Heather Stringer

When Carrie Bilicki, RN, MSN, ACNS-BC, OCN, met a 60-year-old patient who had been diagnosed with aggressive endometrial cancer, she began to have a persistent — albeit unconventional — idea. 

Bilicki, a cancer nurse navigator in Wisconsin at the time, recently had attended a lecture about a progressive treatment for this type of cancer that involved using a chemotherapy drug traditionally prescribed for ovarian cancer. The patient’s cancer had spread to nearby organs, and she had a poor prognosis. Bilicki convinced the physicians to try the alternative medication. Unfortunately, the patient faced another serious hurdle: The insurance company would not cover the cost of the medication because it was not the standard treatment. At that point, the woman seemed to face the unenviable choice between cancer treatment and financial ruin.

Although patients and providers would like to hope this type of extreme dilemma is the exception, the case may be representative of the near future for two reasons. First, as a 60-year-old, the woman was a baby boomer, and researchers predict the incidence of cancer will increase dramatically as this large segment of the population ages. According to a study published in the Journal of Clinical Oncology in 2009, the U.S. can expect a 67% increase in cancer incidence among older adults between 2010 and 2030. 

Second, statistics suggest cancer treatment is becoming increasingly unaffordable, even for those with insurance who struggle to afford steep copayments. For example, The US Oncology Network — a national group of about 1,000 oncology physicians who treat more than 750,000 cancer patients per year — reported about half of the patients covered by a Medicare Part D plan have required copay assistance for oral chemotherapy for the past several years.

“My message to my peers is to know the financial resources available because there are hundreds of them,” Bilicki, who now is a clinical nurse specialist in breast services at Froedtert Center for Diagnostic Imaging in Milwaukee, Wis., said. “There are foundations, specialty organizations and websites that tell us where to get help. If a patient does not have an advocate to link them to that resource, they will never know it is available.” 

What's new?

For many patients, the desire to find a way to afford medication is driven not only by the fact that they have cancer, but also because the treatment options available today have increased the odds of survival. 

“By far one of the biggest advancements is more personalized medicine that targets cancer cells rather than traditional chemotherapy that did not differentiate between good and bad cells,” Kim George, RN, MSN, ACNS-BC, OCN, a cancer program consultant from Wichita Falls, Texas, said. “For example, now we can test biopsy tissue for specific tumor antigens and biomarkers and then prescribe treatments that target those antigens.” 

The advancements in cancer treatment also are reflected in improved survival rates. According to the Surveillance Epidemiology and End Results Cancer Statistics Review 1975-2009, for example, the 5-year survival rate for breast cancer among women in the U.S. between 1975 and 1977 was 75%. Between 2002 and 2008 that number jumped to 90%. During the same time periods, the 5-year survival rate for both men and women with colon cancer has increased from 50% to 65%. 

“Another major advancement has been the increase in availability of oral chemotherapy and biotherapy,” George said. “It has shifted the care setting. Years ago, the majority of cancer patients received IV infusions, and now more patients can take their medication orally at home. It is wonderful for convenience, and it is also less painful.” 

However, George said, reimbursement is not always a given with oral chemotherapy. “A lot of oncology medications are given off-label, which means that the FDA has not approved a drug for a specific diagnosis, so it may not be covered by some insurance policies,” she said. 

Point the way

The art of navigating the path to financial assistance for cancer medication is not simple, and organizations such as The US Oncology Network, based in The Woodlands, Texas, have hired professionals to help patients connect with funding resources and launched the OncologyRx Care Advantage pharmacy in 2006. Nurses in the network can refer patients to Care Advantage staff who help them apply for financial assistance. 

“The types of drugs used to treat cancer today are definitely more expensive than when I started working in oncology almost 30 years ago,” said Lori Lindsey, RN, MSN, NP, OCN, a clinical services program manager with The US Oncology Network. “Multidrug regimens, including oral targeted therapies, can sometimes cost $30,000 for a round of treatment, although the use of these drugs has markedly improved outcomes and increased survival for some diseases.” 

For patients who are uninsured, the best option is to apply directly to the drug manufacturer for patient assistance, said Meg Asher, a patient access coordinator/patient advocate lead at the Care Advantage pharmacy. “When we learn that a patient is without insurance, we notify the doctor’s office and send a manufacturer’s application to them for the patient’s use,” Asher said. “Under these circumstances, we will not be the dispensing pharmacy; the manufacturer has their own specified pharmacy that will service the patient.”

Even those who are insured under Medicare Part D often require assistance because the copayments can be thousands of dollars, Asher said. For these patients, the Care Advantage advocate team helps patients connect with various foundations that provide copay assistance in the form of grants. Some of the foundations assist patients who suffer from a specific disease, while others help those who are taking a specific drug for a disease. 

While some facilities have staff trained to help patients find financial assistance, this is not always the case. For these patients, one resource is the Patient Advocate Foundation, a nonprofit organization with case managers who help patients with life-threatening illnesses to maintain financial stability. 

“When I was a hospital nurse, I honestly didn’t know about a lot of the resources available to help patients after they left my care,” Pat Jolley, RN, the clinical director of research and reporting at PAF, said. “Many people have never had to ask for financial help in the past, and they are unaware that there are options. If they are newly diagnosed, we try to educate them about the likely expenses down the road to help identify potential problems. In my experience, when patients contact us saying they cannot afford one thing, it is usually just the tip of the iceberg.” 

For example, PAF assisted a 62-year-old woman with breast cancer who was insured, but she was having difficulty scheduling her needed mastectomy because of outstanding medical bills. She was living on Social Security disability payments, and her insurance did not cover surgeries, scans or tests. The woman received a bill for $50,000 that included the cost of previous care and several office visits. By negotiating with the hospital and the providers, the PAF case manager was able to reduce the bill to a total of $950 and also facilitate the scheduling of her mastectomy. 

Suffering in silence

For Bilicki, one of her personal goals is to encourage patients to consider the financial aspect of their cancer care before they decide to pursue a particular form of treatment. 
“Nobody wants to talk about their financial state, and I think far too often patients suffer in silence rather than saying that they are having trouble with copayments, so what I do is proactively tell them about some of the resources,” Bilicki said. “Just because they have insurance does not mean they will have resources to afford the costs, so I empower all patients right off the bat to proactively seek out assistance if they need it.”

After patients have been diagnosed with cancer, Bilicki encourages them to learn about the resources at the American Cancer Society, which has patient navigators trained to help people connect with financial resources. She also tells them about a group called Patient Resource LLC, which has a website and a patient magazine that includes national, state and local resources available for financial assistance. 
In the case of the woman with endometrial cancer who could not afford a medication that was not covered by her insurance, Bilicki helped her apply for the drug manufacturer’s patient assistance program. Based on her income and medical necessity, she qualified for full assistance. She was on the medication for 15 months, and, despite her initial grim prognosis, the cancer has been in remission for the past five years. 

“I can always remember the tears and fear in their eyes when I first meet patients, and each time it feels like I’ve won the lottery when I help them secure the treatment they need, and they start smiling again,” Bilicki said. “Part of my big mission for my colleagues is to advocate for these patients so they do not miss out on options that can change their lives.” 

A little help can mean a lot

Point the way for patients who need assistance financing cancer treatments, by seeking resources such as the following:

• PatientAdvocate.org — Provides sources for copay assistance and answers questions about disability and insurance processes
• PatientResource.com — Features information on different types of cancer, newsletters and financial and advocacy resources
• CureToday.com — Provides an extensive list of national resources for advocacy, financial and pharmaceutical assistance
• RxOutreach.org — A nonprofit organization that helps low-income families who cannot afford the medication they need 
• CDFund.org — Chronic Disease Fund — A nonprofit organization that helps patients obtain lifesaving medications
For a list of drug assistance programs from pharmaceutical companies, visit Cancersupportivecare.com/drug_assistance.html.

Source: Nurse.com

By KAYLEIGH SOMMER

Wherever health care is provided, a nurse is likely to be there.

Tuesday marks the start of National Nurses Week, an annual opportunity for communities to recognize the full range of nurses’ contributions. This year’s theme, “Nurses: Leading the Way,” recognizes nurses as leaders in the field.

Nurses are being honored as leaders who improve the quality of health care. Nurses practice in diverse roles, such as clinicians, administrators, researchers, educators and policymakers.

Lizeth Martinez, a registered nurse at Valley Baptist Medical Center in Harlingen, said every nurse is different.

“We each have our scope of practice and me, personally, I always try to be there for my patients,” Martinez said. “From what I have seen I am very fortunate to work with the people that I do.”

Martinez, who was born and raised in Brownsville, is currently working on a graduate degree in nursing at the University of Texas at Brownsville and should be finished by next year.

She said that in the two and half years that she’s been a nurse she has gained a lot of experience.

“I love being a nurse,” Martinez said. “As nurses we care in a different way, in a compassionate and holistic manner promoting health and healing.”

However, being a nurse is not without its challenges, said Martinez, who mainly works with wound care and diabetes patients.

“I think the most challenging thing about being a nurse is the emotional aspect because we see a lot of patients that are chronically ill,” Martinez said.

Garett Byrd, a pediatric registered nurse at Harlingen Medical Center, has worked in the nursing field for nine years.

Byrd, whose parents were nurses, said the profession has changed a lot during that time.

“Over the years I’ve noticed an increase in accountability and technology,” Byrd said. “The nursing profession has moved towards a more evidenced based practice. Were not doing things just to do them, were researching and going by the research.”

He said the community should keep one thing in mind.

“The community needs to remember that we’re human beings too, and we’re here because we care,” Byrd said.

Both Martinez and Byrd said nurses are leaders in the health profession.

“I think we are leaders. The profession is so amazing because there are so many things you can do, so many fields you can go into,” Martinez said.

“As nurses were able to provide and coordinate care and think those aspects of leadership position.”

Karen A. Daley, president of the American Nurses Association, agrees.

“All nurses are leaders, whether they are in direct patient care, administrative roles or meeting consumers’ needs in new roles such as care coordinators or wellness coaches,” Daley said.

“This week, we acknowledge nurses’ vast contributions and how they are leading the way in improving health care and ultimately, the health of the nation.”

Nurses are leading initiatives to increase access to care and improve outcomes by focusing on primary care, prevention, wellness, chronic disease management and the coordination of care among health care providers and settings.

These are areas in which nurses excel given their education and experience, the ANA said.

According to the ANA, nursing is the nation’s largest health care profession, with nearly 3 million employed professionals and is projected to grow faster than all other occupations.

The federal government projects that more than 1 million new registered nurses will be needed by 2022 to fill new jobs and replace nurses who leave the profession.

Demand for nursing care will grow rapidly as Baby Boomers swell Medicare enrollment by 50 percent by 2025 and millions of individuals obtain new or better access to care under the health care reform law, the ANA said.

Source: Valley Morning Star 

By Janice Petrella Lynch, RN, MSN, and Tracey Boyd

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. 

When 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

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. 

Nearly 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.” 

I 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

I 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.

For more responses, visit www.Nurse.com/Article/NJThankYou. 

Source: Nurse.com

When it comes to the cost and quality of hospital care, nurse tenure and teamwork matters. Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study from researchers at Columbia University School of Nursing and Columbia Business School. The study was published in the current issue of the American Economics Journal: Applied Economics.

The review of more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System is the largest study of its kind to link nurse staffing to patient outcomes. The researchers analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing impacted the length of stay for patients. Because length of stay is increased by delays in delivery of appropriate care and errors in care delivery, a shorter length of stay indicates that the hospital provided better treatment. At the same time, a shorter length of stay also makes care more cost-effective. The study found that a one-year increase in the average tenure of RNs on a hospital unit was associated with a 1.3 percent decrease in length of stay.

"Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care," says senior study author Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at Columbia Nursing. "When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions – disrupting the balance of a team can make quality go down and costs go up."

While many hospitals rely on temporary staffing agencies at least some of the time to fill RN vacancies, the study found that it's more cost-effective for hospitals to pay staff RNs overtime to work more hours on their unit. RNs working overtime resulted in shorter lengths of stay than hours worked by nurses hired from staffing agencies, the study found.

Nursing skill also mattered, the study found. Length of stay decreased more in response to staffing by RNs than by unlicensed assistive personnel. Furthermore, the study showed that length of stay increased when a team of RNs was disrupted by the absence of an experienced member or the addition of a new member.

"This rigorous econometric analysis of nurse staffing shows that hospital chief executives should be considering policies to retain the most experienced nurses and create a work environment that encourages nurses to remain on their current units," says the senior economist on the study team, Ann Bartel, PhD, Merrill Lynch Professor of Workforce Transformation at Columbia Business School.

The researchers used the VA's Personnel and Accounting Integrated Data for information on each nurse's age, education, prior experience, VA hire date, start date at the current VA facility, and start date for the current unit at that facility. To assess patient outcomes, the researchers used the VA's Patient Treatment File for information on each patient including dates of admission and discharge for each unit and for the overall hospitalization, as well as age and diagnoses. The final sample accounts for 90 percent of all acute care stays in the VA system for the fiscal years 2003 to 2006.

More information: The paper is titled: "Human Capital and Productivity in a Team Environment: Evidence from the Healthcare Sector," and it was published in April 2014.

For nearly a year, the Boston Marathon bombings and their aftermath have haunted Chelsey McGinn, RN, of the Blake 12 Intensive Care Unit (ICU). In December the MGH gave McGinn an opportunity to honor the victims – and begin her own healing process – by running this year’s marathon as part of its Emergency Response Fund team.

“I feel like it’s been almost a year now, and I haven’t really done anything therapeutic since it happened,” McGinn says. “I felt like other people who I worked with found ways to kind of cope with it, but I hadn’t really found that. When this came up, I thought this was a perfect way to celebrate how far the victims have come and recognize my co-workers.” 

McGinn is one of six nurses on her unit who are planning to run the 2014 Boston Marathon – five for charity teams and one as a qualified runner. Most are first-time runners, and all say they are running in honor of the three bombing victims who were treated on the unit.

“I had a really hard time afterward, and it lasted longer than I expected,” says Laura Lux, RN, who is running for the American Red Cross. “I’m running because I don’t want to be defeated. I know if he could, my patient would be running just to prove a point. Because he can’t, I feel like I need to do this for him. After watching what he and his family went through, I feel like it’s the least I could do for them.”

Lux says she felt an immediate connection with her patient and his family. “Despite everything they were just so determined and so strong,” she says. “Everyone was angry, but there was good coming from it too. We got to know each other because of it. I felt like he was a family member. It’s the most personal experience of my career.”

Lux’s experience is similar to that of the other nurses who are running, including Emily Erhardt, RN, a trauma ICU nurse and member of the MGH Emergency Response Fund Team, who has stayed in touch with her patient and his family since they left the hospital. “This event affected everyone, so it was one of the few times in my career that I felt like all I could do with the family was cry with them. It’s such a terrible thing that happened that there aren’t words to comfort them. You just have to be there for them,” she says. “A year ago they were strangers to me, but now they’re the most inspiring people in my life. I’m not much of an athlete, but I was really affected by the whole thing, and I wanted to do something more.”

Blake 12 runners receive a boost of support from the Harvard University Employees Credit Union. Included in the photo with members of the ICU are Paul Conners, MGH branch manager; Eugene Foley, president and CEO; and Guillermo Banchiere, MGH director of Environmental Services, who serves as a member of the credit union's board of directors.

Allyson Mendonza, RN, who is running for the Mass General Marathon Team “Fighting Kids Cancer … One Step At a Time,” recalls the moment she knew she too wanted to do something more. Mendonza says her patient had just returned from surgery when she was told President Barack Obama was coming to visit. The woman was excited but was distraught about her appearance, so Mendonza and her colleague soaked her nails and helped shampoo and condition her hair to wash out the cement and clumps of dried blood.

“We just tried our best to make her feel better about herself and feel good for the day ahead. She actually fell asleep. When she awoke, she said, ‘This is the most relaxed I have felt in days.’ It was just so emotional for us and for her,” Mendonza says.

Caring for the marathon victims brought the unit closer together, and staff once again have come together to support and encourage their fellow colleagues.

“The teamwork and the camaraderie were amazing,” saysKatherine Pyrek, RN, who was the charge nurse during the week of the bombing. “Every one of the nurses was affected by what was going on, but they stayed strong and carried on. The bonds the nurses made with the patients and their families were incredible and really went above and beyond.”

Pyrek, who is running for the Mass General Marathon Team, says the Blake 12 runners offer each other advice and encouragement to help in the training process. “We remind why we’re doing this – for our patients and their families,” she says. “I think about the patients when they were in pain and how scared they were. I think that if they get through it then I can get through however many miles I need to run.”

The runners all say they look to Meredith Salony, RN, a veteran marathoner who qualified for the marathon, for guidance. “I’m so proud to be in this unit where there’s so much enthusiasm. Even the people who aren’t running are trying to help out and organize events and find ways for people to contribute,” Salony says.

Each of the nurses says they are overwhelmed when they imagine how they will feel on Marathon Monday.

“I think it’ll be really therapeutic and empowering,” McGinn says. “I’m honored to be a part of it. If I’m ever going to run a marathon, this is the one I want to run. I’ll always remember the way I felt at work that night, and it’s going to be a really nice thing to be able to remember this feeling for the rest of my life too.”

For more information or to support the teams visit www.runformgh.org.

This is the first in a series of articles that MGH Hotline will publish about staff running in this year’s Boston Marathon.

Source: Massachusetts General Hospital

By Donna Cardillo 

It is imperative that every nurse – new and experienced – realize the healthcare landscape has completely changed. There will be plenty of opportunities for RNs and APNs who stay current with trends in education, technology, care and personal and professional development. Nurses must be willing to step outside their comfort zone and learn new ways — and places — of working and thinking about their profession. Cynthia Nowicki Hnatiuk, RN, EdD, CAE, FAAN, executive director of the American Academy of Ambulatory Care Nurses and the Academy of Medical Surgical Nurses. stresses that, to stay competitive, nurses also will have to be able to articulate the value that they bring to outcomes, beyond tasks, in any setting. So what does every nurse need to do? Here are four key areas:

1| Skill building

Clinical skills alone won’t see us through in this new paradigm. Self-marketing, computer skills, oral and written communication, conflict management, negotiation, leadership and networking skills must be learned and practiced. Hnatiuk said nurses also need to be more business savvy, with an understanding of finances, staffing, acuity and productivity.

2| Education

Higher education is no longer optional. It is a foundation for practice in any setting and fundamental to professional and personal growth and development. Hnatiuk advises that formal and continuing education, along with clinical certification, will help nurses take their practice and careers to the
next level.

For those considering advanced practice, particularly becoming nurse practitioners, the NNCC’s Hansen-Turton advises: “Don’t think too long; jump in. Opportunities will be increasing for NPs over the next 5-10 years. NPs are and will continue to be a hot commodity.” Certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists also will see expanded opportunities.

3| Professional association involvement

Our professional associations are where we connect with one another, form communities, share best practices (local and national), stay current with trends and issues, and find support. Hnatiuk added that through association involvement, you learn more than you could by yourself and progressively learn leadership skills

4| Mentoring

Hnatiuk encourages nurses to take advantage of opportunities to be mentored and to mentor others. “We have so much to share. Mentoring will allow us to achieve all we’re capable of doing.”

For personalized career advice

If you have specific career-related questions, send them to Dear Donna at www.Nurse.com/AsktheExperts/DearDonna for a personalized response.

Source: Nurse.com

Question:

Dear Donna,

I'm a recent new graduate and I'm trying to figure out how to setup and update my resume to be more attractive to employers. Are there certain topics or headlines that should be included and what are the rules for putting my clinical experience on
my resume?

Wants a More Attractive Resume