-
June 30th, 2009UncategorizedConsistently ranked among the top graduate programs in the country and second in National Institutes of Health (NIH) funding, the University of Pennsylvania School of Nursing is dedicating to changing the world through the science of nursing. The research we perform defines the course of healthcare practice around the globe, and the students we educate gain the experience and exposure only an Ivy League education can provide at the baccalaureate, masters, and doctoral level.
Recognized worldwide, the 18 master’s programs at Penn Nursing offer valuable opportunities to concentrate in a specific field of nursing while expanding the depth and breadth of nursing science and knowledge. The mission of Penn Nursing focuses on integrating research, education and clinical practice to create a unique academic experience in which faculty, clinicians and students engage in a culture of discovery.
Today’s nurses have more responsibility for healthcare strategies and delivery than ever before, and nurses represent our greatest opportunity to create a healthier world. At Penn Nursing, we offer scientific rigor, seasoned with compassion. We build a trajectory of research, apply it to practice, and create lasting change that improves the quality of the patient experience.
Our motto here is “care to change the world.” I hope you care to join us in our mission to do so.
For more information please visit us at our link, below left. -
June 29th, 2009UncategorizedLast year diversion hours at Community General's emergency department (ED) fell from an average of 6.9 hours per day (2007) to 4.4 hours (2008). That’s a reduction of 39%. And things were better during the fourth quarter when Community's diversion hours dropped from an average 8.5 hours a day to 2.2 hours, a 74% decline.
Syracuse hospitals generally did a better job last year of providing access to emergency care. Collectively the four non-federal hospitals reduced diversion hours by 10% in 2008 -- and by 57% in the fourth quarter.
When a hospital is “on diversion,” its emergency department asks ambulances to “divert” emergency patients elsewhere. If all Syracuse hospitals happen to be on diversion simultaneously, then the emergency medical system (EMS) directs ambulances to each hospital in sequence.
Diversion occurs when there is an imbalance between patient demand and hospital capacity. If too many patients seek care for the size of an ED or its staff, a hospital may request diversion until a balance is restored. Sometimes an internal event (for example, water line break) may prompt diversion status.
When hospitals are on diversion, a patient seeking care at one hospital may end up at another, at a place where her doctors are not available and where her medical records are not at hand. That’s why the American College of Emergency Physicians, among others, has guidelines for ambulance diversion.
Even when on diversion, however, a hospital's ED is not actually closed. Every emergency department will accept a patient who presents herself for emergency care at any time. A patient has the right to insist that an ambulance go to the hospital of her choice, irrespective of diversion status.
Through the Hospital Executive Council (HEC), a planning agency, Syracuse hospitals have worked together to understand and reduce diversion hours. Funded by the hospitals, the HEC shares data, conducts analyses, and helps support cooperative initiatives to improve health care efficiency and quality.
Diversion is not only about emergency department issues. Does a patient remain in the ED longer than necessary while waiting for a hospital bed to become available? Is a hospital’s length of stay extended because of delays in tests or test reports, because of the time it takes to prepare a room for the next patient, or because patients cannot readily be transferred to nursing homes? Diversion is an indicator of the flow and efficiency of, not just a hospital, but of the health care system within a community.
Here’s an interesting note: last month Massachusetts ordered hospitals to stop diversion, except in specific cases. Syracuse hospitals have reduced, but not eliminated, diversion hours, and we’ve done so voluntarily and cooperatively.
It will be interesting to see the experience of Massachusetts with its regulatory approach. -
June 28th, 2009UncategorizedThe NY Times has a regular section that aims to debunk common health-related myths. This week, they take on the claim: Can Hot Liquids Can Ease Symptoms of a Cold or Flu? Unfortunately, there isn't a lot of research examining these effects. However, the research that is out there supports hot liquids over room temperature or cold ones. (See the study referenced here and I searched for any meta-analysis studies and could only find this one study.)
Of course, there are still lots of questions out there regarding how much liquid you should drink, does caffeine affect these results, is there an ideal beverage to drink over others, etc?
So the next time you have a cold or the flu, consider consuming hot liquids over cold ones. Your nasal passages and respiratory tract will thank you for it. Also should you need to visit your health care provider, be sure to tell them all of the self-care steps you are taking to ease the symptoms. They will thank you for it too! -
June 27th, 2009UncategorizedAn article about physician assistants and nurse practitioners appears in the NY Times Jobs section. The article does a very good job of explaining both professions though I would disagree with a few of the statements.
Another important difference is that P.A.’s are generalists, while nurse practitioners train in a specialty like family medicine or women’s health. As a result, P.A.’s can switch fields more easily. - I would say that isn't necessarily true. Since the majority of NPs are trained in family health, I think it's just as easy for these FNPs to transition into different roles.
To patients, the two roles can seem very similar. Salaries can be similar, too. The average total income for physician assistants in full-time clinical practice is about $86,000, according to the P.A. academy. The average total income for nurse practitioners is $92,000. - average salary of $92k? I think that sounds pretty high. Most of the NPs that I know are in the $70 - $90k range and I am referring to the metropolitan New York area. A quick jump to salary.com is consistent with that range. There are higher paying jobs in large cities and they are usually affiliated with large hospital systems. The good news is that salaries are on the increase as the demand for advanced practice clinicians is growing.
Finally, the affectionate term of "mid-level" provider is used in the article. I guess I can't fault them since the term is used commonly to collectively describe NPs and PAs. In reality, it is a poor descriptor. It insinuates the care we deliver is somehow not as good as say, a "high-level" provider (not sure who that would be and how one would become such a provider.)What would that make RNs, EMTs, Medics, respiratory therapists, etc - "low-level" providers?!?
Overall, it is great to see these types of articles in the media. The better that the public is educated about our roles, the easier it will be to practice without barriers. Patient's are increasingly choosing to have care delivered by NPs and PAs and will continue to do so as the abysmal health care system sputters along. We afford an imediate solution to this crisis and are ready, willing and certainly able. -
June 26th, 2009UncategorizedToday's New York Times has an article about the Medical Home concept. These projects are becoming more popular as insurers are deciding to cover the costs. The article refers to a patient who visited his very busy physician that missed a stroke diagnosis because of a hurried exam. While mostly inexcusable, it provides a real life example of the issues occurring every single day due to the system's lack of access, communication, reimbursement, and high-quality. While the article doesn't make specific reference to NPs, Senators from New Mexico, Iowa, Alaska and Maine recently discussed expansion of Medical Home projects to include NPs, and other non-physician providers of primary care to lead medical home demonstrations. Senator Bingamin of New Mexico sums it by saying:
Furthermore, nurse practitioners epitomize the delivery of high quality, cost-effective primary care that is crucial to the medical homes model.
Senator Murkowski of Alaska adds:
Nurse practitioners function as partners in the healthcare of their patients, so that, in addition to clinical services, nurse practitioners focus on health promotion, disease prevention
and health education and counseling, guiding patients to make smarter health and lifestyle choices.
The timing of this NY Times article coincides with a recent report by The Commonwealth Fund, a non profit entity. The report found that the U.S. fails on most measures of health care quality, waiting times, and lack of preventative care. This is just more evidence that we must dramatically change the way healthcare is delivered today. -
June 25th, 2009UncategorizedThe New England Journal of Medicine has published a provocative editorial on capital punishment and the physician's role in carrying it out.
The New England Journal of Medicine has published a provocative editorial on capital punishment and the physician's role in carrying it out. In truth, the position taken, that no physician should agree to facilitate an execution is old and has been endorsed by many medical societies. However, in over 1,000 words, the closest thing to an argument in support of this are these words: "A profession dedicated to healing the sick has no place in the process of execution."
Yet even this statement is offered without proof or justification and is merely a recapitulation of the authors' opinion. Cannot the exact opposite position also be offered, that in a nation that condones the death penalty through its laws and courts (and incidentally in public opinion), medical science should be brought to bear to insure that all executions are administered with compassion and decency?
If that is the case, who better to supervise an execution than a physician; preferably one expert in pain management, anesthesiology, or critical care medicine? After all, the article cites several instances of botched executions that almost certainly increased the pain and suffering of the criminal.
The position that this editorial takes, that the medical community's canon of ethics forbids it from participating in executions may well be heartfelt. Yet consider revealing words such as these:Injected drugs, now used in all but 1 of the 37 states in which capital punishment is legal, have been part of the increasing medicalization of executions and the enlistment of medical personnel to lend them apparent moral legitimacy" (my emphasis).
I can't help but think that something else is going on here. Could it be that these authors are simply opposed to capital punishment and that by promoting a policy forbidding physicians from facilitating it, they in effect render it an impossibility?
If that is truly their agenda then that should have been their thesis and they should be forthright about it. Pardon me for finding it intellectually dishonest however, to hide behind some vague, poorly established interpretation of the Hippocratic Oath (which they also cited). The Oath was never understood to forbid the palliating of pain and suffering when death was imminent due to disease. Why should it be any different here?
By the way, unless you know me well, don't presume to know where I stand on the death penalty. This post is more about being upfront than about capital punishment. -
June 24th, 2009Uncategorized
Hey, wait a minute--did we say that? No, what we meant was that we're going to try really, really hard to save money--somehow.
That was the message American Hospital Association was offering yesterday, in the wake of a spectacular announcement in which a group of leading healthcare organizations said that they could shave $2 trillion off the rate of growth in healthcare costs over the next 10 years.
The announcement, which was hailed by President Obama, was something of a bombshell, despite the fact that the groups offered few specifics as to how they'd get the job done. Now, AHA president Richard Umbdenstock is telling the media and Congress that perceptions his group's plans have "spun way away from the original intent," arguing that everyone involved had misrepresented what was contained in the letter to President Barack Obama on May 11.
Umbdenstock said that the AHA got involved in the process late in the game, and did so to help craft the message and avoid the appearance that its members didn't support reform. But mind you, "we did not say that we would save this country $2 trillion on our own," he said. OK, now we've got it: Someone else will have to do the heavy lifting. Thanks for setting us straight.
-
June 23rd, 2009Uncategorized
A new Danish study concludes that using simulators to train new surgeons makes them quicker at performing procedures, yet better at what they do.
The study, which focused on whether doctors with Britain's National Health Service should be trained this way, responds to calls from observers there that simulators should be part of surgical training.
Researchers at Copenhagen University Hospital concluded that it would indeed be a good idea after monitoring 24 junior surgeons carrying out keyhole surgery. Researchers broke the 24 trainees into two groups; one received traditional training alongside of senior physicians while the other received seven hours of simulator training in addition to standard instruction.
The researchers concluded that that those who used computer simulators were twice as quick as traditionally trained surgeons, taking just 12 minutes to complete their operation. They also used better procedures, according to a points system researchers used to judge work quality.
-
June 22nd, 2009Uncategorized
A group of the country's biggest nursing unions have convened in Washington to lobby for a single-payer health system and fight for federal workplace regulations. The move represents not only activism, but a rare show of unity that bodes ill for those who would oppose them.
The groups--including the California Nurses Association/National Nurses Organizing Committee, the United American Nurses and the Service Employees International Union Nurse Alliance--are pushing hard to see the Employee Free Choice Act move through Congress. The bill includes language forbidding mandatory overtime and sets minimum staffing ratios.
In an indication of how dedicated the groups are to getting the job done, the SEIU and CNA/NNOC are working together on this, despite having had an intense rivalry before. Meanwhile, two other groups doing the protecting--the United American Nurses and Massachusetts Nurses Association--have agreed to merge. These agreements are an indication that nursing unions as a whole is coalescing, in a way.
The groups do have some support. For example, Sen. Barbara Boxer (D-CA) has announced plans to file a bill addressing many of the unions' desires, including, not only nurse-to-patient ratios and workplace limits, but also funding for nurse education and mentoring for new nurses.
-
June 21st, 2009Uncategorized
A civil rights group representing lesbian, gay bisexual and transgender (LGBT) patients has concluded that while progress is being made, the healthcare industry as a whole isn't address this community's needs.
Working in cooperation with the Gay and Lesbian Medical Association, the Human Rights Campaign Foundation has come out with its third annual report looking at how LGBT Americans are treated in healthcare facilities.
The report, which is based on a survey of 166 facilities, concludes that while three-quarters of facilities studied have non-discrimination policies touching on sexual orientation, less than 7 percent offer protections protect patients based on gender identity. Researchers say this is symptomatic of discrimination transgender individuals face in everyday life.
As part of its study, the Human Rights Campaign has developed a Healthcare Equality Index, a set of best practices that healthcare facilities should follow to assure equal treatment of LGBT patients.
These include establishing visitation policies that explicitly include LGBT community members; policies honoring advanced healthcare directives created by LGBT individuals; cultural competency training addressing issues relevant to the LGBT community; and employment non-discrimination policies including both sexual and gender orientation.
