Nursing Notes

March 31, 2011

Many don’t take prescriptions because of cost

Here’s an article from Reuters that I read and scratched my head about.  As a nurse I have known that this is a major problem for many years.  I know that patients will take medication if it “works” ( ie.  they get better), they will take it if they feel they need it and it is not too much trouble to acquire, and they will take it if they can afford it.  So, what’s the deal with this study at this time?  With healthcare costs sky rocketing, it seems that someone in charge has finally seen the light.  Maybe we can prevent some of the catastrophic illnesses by starting earlier in the cycle and intervene at a time when medication alone may be able to prevent further bodily damage.  What a thought.

So, after a few minutes of head scratching, I realized that it is a good thing for someone to finally be looking at this issue in a quantitative and measurable way.  Maybe this is how we effect change in our system.

I know that my niece, the doctor, always chooses her medications to prescribe based on the $4.00 list at the local pharmacies so her patients can be sure to get the treatment they needed when they came to see her.  Maybe others should not be so influenced by the drug reps to prescribe the newest, most expensive drugs on the market.  Who knows?  Just my thoughts on this topic.  What are yours?

Please go to the site and read the entire article, then come back here to let me know what your thoughts are on this topic, won’t you?


By Alison McCook

NEW YORK | Wed Mar 30, 2011 11:52am EDT

NEW YORK (Reuters Health) – A significant portion of people – perhaps as many as one in five – don’t take drugs a doctor has prescribed because they can’t pay for them, according to a new survey of people visiting an emergency room.

“I think this is a wake-up call,” study author Dr. Karin Rhodes of the University of Pennsylvania told Reuters Health.

Among a group of more than 1500 people who volunteered to complete a questionnaire, more than 20 percent said they had previously not taken a prescribed drug on account of the price tag.

It’s an issue that many doctors aren’t aware of, noted Rhodes, and the system needs to address it. “Patients need to be asked ‘can you afford your medications?’ and they should get help to pay for them.”

A number of studies have shown that people with chronic health problems, including high blood pressure, diabetes and heart disease, commonly fail to take their medications as prescribed.

Other reports have shown similar rates of so-called “nonadherence,” although the actual estimate tends to vary depending on the exact questions researchers ask, according to Dr. Jae Kennedy of Washington State University, who did not participate in the current project.

One recent study found that 22 percent of prescriptions written for 75,000 Massachusetts patients were never filled. And in another, people were less likely to fill “dispense as written” prescriptions (See Reuters Health report, March 25, 2011).

Some people go to the trouble of filling the prescription, but never pick it up. Looking at information collected from 5 million Americans over 6 months, a study late last year showed that just over 3 percent never retrieve their prescriptions from the pharmacy, and were more likely to abandon expensive medications.

During the current study, 21 percent of the 1506 participants said they had previously not taken medications because of money concerns. Another 5 percent said they were worried they might not be able to pay for drugs.

The researchers, who published their results in the journal Academic Emergency Medicine, considered both groups to be “at risk” of nonadherence with future prescriptions.

Looking at the responses to other questions on the survey, Rhodes and her team found that people were more likely to be at risk of nonadherence if they had money issues – for instance, they worried about money, didn’t have enough food, reported housing problems, and had inadequate health insurance. But they were also more likely to be at risk of nonadherence if they smoked, used illegal drugs, or experienced domestic violence, as either the victim or perpetrator.

“I think (nonadherence) goes along with people who have difficult, disorganized lives,” said Rhodes.

Nonadherence has consequences, she added – one problem, if left untreated, will create others, such as when untreated high blood pressure hurts the kidneys. Research shows that people who don’t fill prescriptions or take medications as they’re prescribed are more likely to get sicker, and become hospitalized, said Kennedy in an e-mail.

“Nonadherence is a widespread and serious public health problem.”…..[read more]


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March 29, 2011

Japan radiation makes way to U.S.

The news about the tragedy in Japan makes my heart sad and it physically hurts me.  I try not to watch all the news coverage, but I do want to stay informed.  I would like to do something to help those poor people and the animals that are now homeless and alone.

I watch the news about the nuclear reactors with trepidation.  I feel that we are only being told part of the story.  So, when I found this article,in the USA Today, I felt compelled to help spread this information.  Please click over and read the article entirely and at the end of this post, there is a link to a free CE for nurses dealing with radiation.


By Judy Keen, USA TODAY

States detecting radiation
Tiny amounts of radiation traced to the nuclear plant crisis in Japan have been detected in at least 14 states


At least 15 states have found trace amounts of radiation from the crippled nuclear plant in Japan, but officials say the levels of radioactivity are much too low to prompt health concerns.

Very low concentrations of iodine-131 were found last week in a rainwater sample in Boston. “It is not a problem for public safety nor is it a threat to the drinking water supply,” said Massachusetts Energy and Environmental Affairs Secretary Richard Sullivan.

Sullivan ordered the collection of drinking water samples from 12 locations Sunday. Tests showed the water was “absolutely clean,” he said.

No radiation has been discovered in Virginia, but state Health Commissioner Karen Remley said she asked that routine quarterly monitoring be conducted this week instead of next week as scheduled. “I am not worried,” she said.

The Environmental Protection Agency said Monday that its nationwide air monitoring system found “slightly higher” radiation levels in some locations than last week but said…[Read More]


Here is the link to the free CEU for nurses on Radiation Incidents and Emergency Preparedness.  Hopefully we can all do our part to be prepared for possible outcomes of this tragedy.

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March 22, 2011

Hospital chief pleads guilty in case over firing of Texas nurses

Map of Texas highlighting Winkler County

Image via Wikipedia

Here is the next chapter in the ongoing saga of the Winkler County nurses, Anne Mitchell and Vickilyn Galle.

If I recall, the doctor involved was fined and reprimanded by the medical board.  The sheriff and county attorney are also up for prosecution.

Please read the following article from Modern Healthcare and feel free to leave them a comment, or come back here and leave me a comment.


By Paul Barr

Posted: March 21, 2011 – 5:45 pm ET

Stan Wiley, former hospital administrator of Winkler County Memorial Hospital, Kermit Texas, pleaded guilty to abuse of official capacity for his role in the firing of two nurses who had complained about a doctor to the Texas Medical Board, according to the Texas attorney general’s office.

Wiley was sentenced to 30 days in the Winkler County Jail by visiting Judge Robert H. Moore III as part of a plea deal in which he has agreed to cooperate in the prosecution of three other defendants, according to a news release from the attorney general’s office, which is prosecuting the case because the Winkler County District Attorney recused himself from the proceedings.

Also being prosecuted are former Winkler County Memorial Hospital physician Dr. Rolando Arafiles, Winkler County Sheriff Robert Roberts and Winkler County Attorney Scott Tidwell. Arafiles recently was fined $5,000, publicly reprimanded and required to undergo training and oversight by the state medical board .

Wiley, Arafiles, Roberts and Tidwell were indicted in January for allegedly retaliating against two nurses who had reported Arafiles to the state medical board in 2009 for actions they believed were endangering hospital patients.

The two nurses, Anne Mitchell and Vickilyn Galle, settled with Winkler County for $750,000 in August, according to their attorneys.

Read more at:  Modern Healthcare

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March 21, 2011

Bill would squeeze nursing staffs

Here’s an article I found in the Citrus County Chronicle Online.  I found this interesting and, although talking about Florida politics and Florida healthcare issues, I think it can be extrapolated out to the entire nation.  We are in a crisis in our country and no one seems to understand that.  Not only can people not afford healthcare in this country, when they can afford it, they may not be getting quality care because of short staffing in our hospitals.

This is not a problem that is going to go away anytime soon.  The shortage of nursing is real and growing.  Maybe if nursing was not so physically and emotionally draining; maybe if nurses could actually give the care they want to give–then there would be no shortage.  I am only one nurse and I certainly don’t have the answer to this looming national problem, but I do work regularly and see and hear the comments of my peers.  I know what I think and how I feel about my nursing career.  Someone out there should be talking to the nurses.

Please click over and read the rest of this article.  I think you will find it both interesting and stimulating.  We need to go back to the drawing boards and draft our own solution to this problem.  Maybe if nursing care was not grouped in with the cost of the bed, but billed separately, then we would have more of a voice.






CMHS authority: We’d have to hire more nurses

By Chris Van Ormer
Saturday, March 19, 2011 at 9:27 pm

If the Florida Legislature passes a bill to mandate a higher ratio of nurses to patients, Citrus Memorial hospital would need another 35 nurses.  The proposed staffing level also comes at a time when the United States as a whole needs 300,000 nurses.  Linda McCarthy, chief nursing officer at Citrus Memorial Health System in Inverness, discussed the bill Monday with the Citrus County Hospital Board. McCarthy advised the trustees about the ways the bill would affect nursing care at CMHS, and got right to the bottom line: “I would need to find 35 nurses.”
Florida Hospital Patient Protection Act is sponsored by Rep. Cynthia Stafford, D-Miami.
“It’s a pretty extensive bill,” McCarthy said. “It’s not the first time it’s hit the floor. It’s a little different each time.”
The bill calls for more registered nurses rather than licensed nurses.  “It defines a direct patient care provider as a registered nurse,” McCarthy said. “Previously, it could be a licensed nurse, it could have been any of those support people but this is a direct care provider. They have not stipulated yet in this document the level of education required.”
As chief nursing officer, McCarthy would need to use a staffing plan based on the severity of the patients’ conditions. This is known as the acuity system of the patients’ needs.  Another difference in practices would be that minimum staffing levels would be mandated at all times, including meal times and other breaks.
“It has a mention of prohibition of mandatory overtime and it uses the nursing process inclusive of assessment, diagnosis, planning, intervention and evaluation that only a registered nurse can do at this point,” McCarthy said. “It also asks that the nurse look at the assessment of orders. She must check for appropriateness, whether it’s licensed by a licensed practitioner and whether the order itself is within the nursing scope of practice.” The registered nurse may decide if the order is inappropriate.  “She has the ability to refuse to implement this order without ramifications, so she needs to be able to accurately assess the order that the physician writes and make sure it’s appropriate,” McCarthy said. “If she disagrees with it or a patient disagrees with it, she is acting as the patient’s advocate and must speak on behalf of the patient.”
McCarthy described some of the issues with the bill.  “The nursing shortage itself is huge and they project it will be more than 300,000 by the year 2015,” McCarthy said. “We are seeing a slight decrease of the nursing shortage because of the economic times we are living in. Many of the nurses who are currently at retirement age have decided to hang on a little longer to build up funds.”  When the economy turns around, it could increase the shortage of nurses as more decide they can afford to retire. McCarthy did not have numbers for the nurse shortage in Florida, but she said the “opening rate” or potential vacant positions across the state stood at 23 percent.
With so many nurses not retiring, the average age of nurses has increased.  “We’re also looking at the aging population,” McCarthy said, “not just of the patients, but that of the nurses. The average age of a nurse right now at Citrus Memorial is 49.6 years old and I have at least 65 nurses who are at or are eligible for some type of retirement program at this time. Should the economy turn around, those could be immediate losses.”
Adding to the crisis of the nurse shortage is the lack of nurse educators.  “The problem most immediate with nurse education is that there are no nurse educators,” McCarthy said. “There is a minimum qualification that you must be master’s prepared to be a nursing instructor, so there are a minimum number of nursing instructors. Even if there were people wanting to take nursing programs, there are very limited supplies of educators.”
Nursing today competes with many other career choices for women.  “At one time, nursing was considered a woman’s profession and she could do very well there,” McCarthy said. “Now we have many opportunities. We can all go to be an astronaut. We can be engineers; we can do all those things. So we have minimized the people who are even getting exposure to the nursing profession.”
If the bill becomes law, CMHS has to have a plan to comply with it.“We need to implement an automated patient acuity system,” McCarthy said. “We currently have an acuity system that is based on each one of the nursing floors and the type of patient that they care for. We have a number system we apply to each patient based on the number of IVs and the number of medications and the type of treatments they need. Most of the more intellectual processes involve adding the data out of an electronic document which loads immediately in and calculates an acuity score for the patient. That would be one of the first things we would be looking at.”
Another option would be primary care nursing, McCarthy said. It is a method of nursing practice…[read the rest of the article here]

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March 18, 2011

Fun Friday Video

Filed under: Nursing — Shirley @ 9:30 pm
Tags: , , , ,

Let’s have just a little humor today, okay?  This video is funny but true.  Let me know if you enjoy it as much as I do.


When Nurse Staffing Drops, Mortality Rates Rise: Study

Filed under: Nursing — Shirley @ 4:12 am
Tags: , , , ,

Here’s an article I found in my email this morning.  This article simply states what we nurses have always known.  If we don’t have time to see our patient due to staffing shortages, then we don’t have time to do nursing for our patients.

People today don’t come into the hospital for a “rest cure” like they did 50 years ago.  Today you need to really be sick or at death’s door figuratively (or literally for ER and ICU) to even be admitted to a hospital.  When you have critically ill patients to care for, there is a minimal amount of time involved to simply provide basic care and assessment; but when you have 7 or 8 critically ill patients how much time do you think you get to spend with each one during a standard 8 hour shift.  Let’s not even consider charting, answering the phones, talking to doctors and pharmacy, getting lab results, etc.  Let’s just consider time to look at and observe your patient; time to interact with the patient and the family to gather pertinent information about the patient’s condition prior to the current crisis.

Since I am a psychiatric nurse, you may think that this all does not apply.  However, today for a person to actually be admitted to a psychiatric facility, they MUST be in imminent danger to self or others.  In plain English, that means they actively want to kill themselves or plan to hurt/maim/kill someone else.  When you have 8 or 9 of these types of patients to observe and medicate as well as a milieu to manage to maintain everyone’s safety because all of these patients are up walking around in the day area,  there is very little time to actually spend working with your patients.

Here is the article I got this morning from the ANA.  The article is from the Health Day website.  Interesting, don’t you think?


Experts say finding shows clear link to patient safety

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, March 16 (HealthDay News) — When nurse staffing levels fell below target levels in a large hospital, more patients died, a new study discovered.

The finding may provide guidance in an era of nursing shortages and cost-cutting, in that the focus should shift from cost to patient safety, said the authors of the research, appearing in the March 17 issue of the New England Journal of Medicine.

“Hospitals need to know what their nursing needs are for their patients, and they need to bring staffing into line,” said study senior author Jack Needleman, a professor of health services at the School of Public Health of the University of California Los Angeles.

“Patients are entitled to be safe in the hospital and to have care delivered reliably and to have nurses with enough time to make sure they aren’t developing avoidable complications with permanent consequences,” Needleman said.

Previous research has suggested that this might be the case, but many of those studies were dismissed in part because of methodology flaws.

“People had thought maybe [adverse consequences] were due to something else, maybe the quality of the nurses, quality of the doctors, technology, equipment or the hospital doesn’t have a commitment to quality,” Needleman explained.

For this study, the authors looked at almost 200,000 admissions and about 177,000 nursing shifts at 43 patient units at one hospital that generally had high staffing targets.

Presumably, different areas of the hospital had the same quality of nurses, doctors, technology and equipment, thus eliminating these factors as the source of problems.

Units were considered properly staffed if nursing staffing fell within eight hours of the target level.

When units were understaffed, patient mortality increased by 2 percent. On average, a patient stayed in the hospital for three shifts and when they were all understaffed, mortality rose by 6 percent.

And when nurses had to work harder because of high patient turnover on their unit, the mortality risk increased by 4 percent.

“A telling outcome is that they looked at a hospital that really had pretty good staffing levels and they still found that there was a difference,” said Sharon Wilkerson, dean of the Texas A&M Health Science Center College of Nursing in Bryan. “When I think about the number of hospitals that do not maintain good staffing levels, either because they can’t find the nurses or maybe they’re rural or they’re just aren’t as many people they can hire, that’s even more frightening.”

The authors believe the findings…[click here to read the rest]


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March 16, 2011

Talk to Nurses About Facebook Before They Talk About You

Filed under: Nursing — Shirley @ 6:47 pm
Tags: , , , ,
Facebook profile shown in 2007

Image via Wikipedia

This issue continues to be a real “hot potato” in the healthcare industry.  I know many people are on Facebook and I am one of them.  It is easy to stay connected and to meet new people on Facebook.  I love it.  But, we all are becoming lax about what we should and should not “post” on such a public forum.

My boss spoke to me after I simply posted to a friend who was having a really bad day, to just “remember where you work”.  I did not identify the workplace, nor did I say any other thing about my job.  This innocent comment was enough to get me in HOT WATER at work.

I’m sure there are many other stories out there about the effects on your nursing practice from an innocent and unintentionally damaging post on Facebook.  Won’t you tell us your story?

So, here’s the article I found that got me thinking about this post.  I hope you click over and read the whole article as well as others that you will find on the site.  Actually, this site is one of my favorites and I visit it regularly.


Rebecca Hendren, for HealthLeaders Media , January 11, 2011


Yesterday, my mother joined Facebook. When she told me she wanted to sign up, I was perplexed. Who would she be friends with on Facebook, other than my brother and me? Turns out, a lot of her friends are on Facebook and she wants to stay in touch. Plus she wants to stay up-to-date with this exciting development of the modern world.

So my brother helped her set up an account and now she’s off and running. Last night, in her first status update, I learned she was excited to watch a new TV series premiering that night.

And with that harmless post, I realized that everyone I know is on Facebook. Short of my 92-year-old grandmother—who takes her TV remote control into a repair shop to get the batteries replaced, so I’m pretty sure Facebook isn’t on her radar—I can keep up with everyone I know, to a greater or lesser extent, via this one medium.

Facebook’s ubiquity makes people not think about it very much. It’s just part of life. But when your profession involves interacting in other people’s lives, the lines can be blurred.

Last month, four nursing students were thrown out of school after they posted photos of themselves with a placenta on Facebook. The students from Johnson County Community College, in Overland Park, KS, were taking part in a lab experience at Olathe Medical Center. After posting the photos on their Facebook accounts, the students got the boot.

One of the students, Doyle Byrnes, took the college to court to seek an injunction that would allow her to resume classes. According to the suit, the students asked their instructor whether they could take photos.

The placenta had no identification that could have linked it to a particular patient. Byrnes included a letter in the court case that she sent to the school after her dismissal. In it, she wrote:


“In my excitement to be able to share with my loved ones the phenomenal learning experience in which I had been blessed enough to take part, I did not consider that others might view this photograph as unprofessional, offensive to the school I was representing, and more importantly the sanctity of human life,” Byrnes wrote. “For my actions I am truly sorry.”

And herein lies the problem for employers. We are so accustomed to sharing our lives with our friends and families on Facebook, and it is so quick and easy to do so, that many of us do not take the time to think through the implications. What seemed a personal account of an interesting learning experience to Byrnes, through such a public medium became a potential patient privacy violation, with many considering it disrespectful and embarrassing.

Interestingly, the court sided with Byrnes and ordered she be reinstated. In court, all four students testified they had asked for  and received permission to take the photo. The lawyer argued that no patient privacy violation occurred because there was nothing identifiable in the photos. The judge found the school did not give Byrnes a fair hearing, and she and her Byrnes and her classmates are slated to resume their studies.

This case is simply the latest in a string of stories about nurses getting into trouble over Facebook and other social media sites…[click here to read the rest of this article]

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