Notes on (Men in) Nursing

Cover of "Notes on Nursing"
Cover of Notes on Nursing

In the Preface of Notes on Nursing, Florence Nightingale wrote, “…every woman is a nurse.” That men were—or could be—nurses was not within Nightingale’s Victorian worldview. Men were doctors (husbands) and women were nurses (wives and mothers). A re-read of her book revealed to me one place in which she hints at the fact that men could be useful as nurses. It comes mid-way through her chapter “Noise”:

“A man is now a more handy and far less objectionable being in a sick room than a woman. Compelled by her dress, every woman now either shuffles or waddles—only a man can cross the floor of a sick-room without shaking it!”

She goes on to condemn the wearing of rustling silk and crinoline and the creaking of stays and shoes. Presumably she advocated simple (and quiet) cotton dresses for nurses.

As I wrote in my previous blog post “More than a few more men needed in nursing” (12-15-10), nursing continues to be the least gender balanced of any of the health professions. The traditionally male-dominated medical profession has achieved almost perfect gender balance. The other traditionally female-dominated profession of social work now has at least 20% men, while nursing continues to have a paltry  7% men in the workforce.

Until this week I considered myself an enlightened female nurse on the issue of gender diversity in nursing. But then I started looking at the required readings—especially the ones from nursing textbooks—that I had assigned for my community health course. I realized how un-gender neutral they are. All of the contemporary community/public health nurses who are quoted or included in photographs in the chapters are female. An otherwise well-written chapter on the history of public health nursing in the U.S. only mentions female nurses and uses terms like “our sister nurses” and “our foremothers.” Where are our brother nurses and our forefathers?

Important facts I learned this week from reading up on the topic of men in nursing include:

  • Men in nursing have a long and venerable history that is not acknowledged or taught very well in nursing schools. The history includes monastic orders dating back to the fourth and fifth centuries.
  • In the U.S. beginning after the Civil War men were actively shut out of nursing. For instance, the U.S. Army Nurse Corps banned men until 1955. When men were allowed to be nurses they were mainly confined to psychiatric nursing, which was considered dangerous and undesirable work for female nurses.
  • The commonly held perception (and resentment) among female nurses that men in nursing disproportionately get promoted and hold higher-paying administrative positions over their female counterparts does have merit. Economists call this phenomenon the “glass elevator,” and it applies to men in all female-dominated occupations (pink-collar jobs). However, within nursing this could also be partially explained by the fact that most men enter nursing at an older age and after time in another career versus their female counterparts. (see NYT ” More Men Enter Fields Dominated by Women” by Dewan and Gebeloff/5-20-12 and “More Men Trading Overalls for Nursing Scrubs” by Vigeland/3-21-12).
  • The Institute of Medicine’s Future of Nursing report specifically identifies improvement in gender diversity as a necessity for nursing. Running a profession on only half of the population (gender-wise) is unwise and untenable.

My conclusion: Nursing needs the best and the brightest no matter what their chromosomal make-up happens to be. We need more men in nursing. We need better nursing textbooks….

Nurse Writers Arrive in Wiki-land

English: Manuscript handwritten by Walt Whitma...
English: Manuscript handwritten by Walt Whitman, American poet, for his poem “Broadway, 1861” (Photo credit: Wikipedia)

As I wrote in a previous blog post “Nurses and Writing: Writers and Nurses” (3-31-11) the term “physician writer” is well-known and accepted by the general public, while the term “nurse writer” is not. Physician writer has had an extensive Wikipedia entry since March 2008.

Thanks to Dr. Thomas Lawrence Long, Associate Professor-in-residence at University of Connecticut School of Nursing, there is now a Wikipedia entry for “nurse writers.” Dr. Long has a PhD in English and a master’s degree in Theology. He teaches writing at a school of nursing and maintains a nurse writing website/blog resource called NursingWriting. Here is his Wikipedia definition of nurse writer:

“Nurse writers are registered nurses (RNs) who write for general audiences in the creative genres of poetry, fiction, and drama, as well as in creative non-fiction. The published work of the nurse writer is analogous to that of the physician writer, which may or may not deal explicitly with health topics but is informed by a professional experience of human vulnerability and acute observation.”

Nice definition, with the possible exception of the RN part. (Can’t an LPN writer be called a nurse writer? Plus, the RN designation is a relatively recent invention and may not translate to all countries). He also includes a list of nurse writers, beginning with 19th century writers, ranked by date of birth. Curiously, he left out Walt Whitman and Mary Seacole, who were both born before Florence Nightingale (who he lists first.) Including a well-known male nurse/writer (Whitman) and a nurse/writer of color (Seacole) would be a good idea. So someone out there who wants to add these, please do. While they’re at it they can add Mary Jane Nealon (Beautiful Unbroken: One Nurse’s Life, Graywolf Press, 2011) to the 21st century list.

Nurse writer Theresa Brown has a recent post (on Hunter College’s Center for Health Media and Policy blog Healthcetera) “Calling all nurse writers,” in which she encourages nurses to write. As Ms. Brown points out, nurses typically spend a lot of time with patients, have many stories to tell, and have a unique perspective on health care provision.

I have had many inquiries lately from nurses seeking advice on how to develop as creative writers. Here is my (very biased) advice:

1. Read. Read widely. Read great/classic literature as well as current writing from authors in a variety of genres. Read/subscribe to literary magazines. (My current list of literary journals includes Creative Nonfiction, The Examined Life, Bellevue Literary Review, and Fourth Genre. These are all top literary journals in my writing genre of literary nonfiction/narrative medicine.)

2. Write. Write something that is creative–for your eyes only– every day. Even if it is for just five minutes in a bathroom stall at work, during a sacred bathroom break, and you have to write on a paper towel–incorporate writing into your life.

3. Find/join a writer’s group/center in your community. In Seattle I recommend Hugo House as an excellent resource for writers at all ‘levels.’

4. Join  NYU‘s Medical Humanities listserv. Even though this is ‘hosted’ by NYU’s medical school, it is interdisciplinary and their website is an excellent resource.

5. If you are an academic or have to do academic writing in your work, find a way to purge that part of your writing brain–or at least find a way to compartmentalize it. Academic writing is formulaic and anti-creative.

6. Find a way to share your writing. This could be in a supportive writing group or class, at open-mic venues in your community, by submitting to a journal, or by posting to a blog.

Moral Distress: Call for Stories

Moraldistress is the psychological disequilibrium when a person believes he or

Moral Compass
Moral Compass (Photo credit: psd)

she knows the right course of action to take but cannot carry out that action because of an obstacle, such as institutional constraints or lack of power. (source: Arizona Bioethics Network). Moral distress has been studied in nurses—mainly acute care nurses—since the 1980s. Although imperfectly defined and measured, moral distress appears to be strongly related to professional burnout and patient safety issues in a variety of health care professionals including doctors. (see NYT article “When Doctors and Nurses Can’t Do the Right Thing” Pauline Chen, 2-5-09).

A 2010 symposium focused on moral distress was held at the University of Victoria on Vancouver Island. As reported recently by Bernadette Pauly and her colleagues in the journal Healthcare Ethics Committee Forum (2012, issue 24) interventions targeting moral distress have focused on individual coping skills of nurses and other providers. (I’ve mainly seen interventions such as deep breathing, meditation and journaling.) Most research has focused on acute care nurses and has reinforced the notion of “nurse as victim” in the hierarchical hospital system. Pauly and colleagues called for greater attention to structural issues involved with moral distress, including the ethical climate of the hospital administration. In addition, they questioned the current emphasis in nursing education on teaching ethical frameworks instead of specific guidance and skills in how to navigate increasingly complex ethical terrain in everyday practice. They also recommended interprofessional education—bringing together nursing, medical and other health professions students for this sort of ethics education.

The journal Narrative Inquiry in Bioethicshas a call for stories about moral distress from nurses and other health care clinicians. It would be great to see submissions from nurses working in schools, public health, home health, community-based clinics, and occupational health sites, as well as from acute care settings. This is your chance to contribute to a forum that could contribute to some positive structural changes in our health care system—and not just more deep breathing and meditation trainings.

Here’s the information: Narrative Inquiry in Bioethics Call for Stories

Narrative Symposium: The Many Faces of Moral Distress Among Clinicians

Edited by Cynda Hylton Rushton, PhD, RN, F.A.A.N. and Renee Boss, MD, MHS

Narrative Inquiry in Bioethics will publish an issue devoted to personal stories from clinicians regarding situations that cause moral distress and how they have responded to them. Moral distress arises when professionals find that they are unable to act in accordance with their moral convictions. The focus of this inquiry is on the personal and professional short- and long-term impact of moral distress and the ways that clinicians respond to and make meaning from that distress. Appropriate contributors might include nurses, physicians, social workers, nursing assistants, clinical ethicists, occupational and physical therapists, and professionals in training. We want true, personal stories in a form that is easy to read.

In writing your story, you might want to think about:

·         Which specific clinical situations give rise to moral distress? Why?

  • How do you experience moral distress—physically, psychologically, socially or spiritually?
  • How do you deal with moral distress? In past distressing situations

o   Did you take actions that allowed you to uphold your deepest values?

o   What conditions within yourself, the people involved, and the external environment allowed you to do this?

o   How did you made sense of the situation?

  • What have been the short or long term consequences?

o   Have you ever been professionally disciplined for acting upon your moral conviction?

o   How has moral distress affected your job performance or your commitment to your job?

o   What has been left undone or been the residual impact?

o   How have your own values evolved as a result of moral distress?

  • How would you change the system (e.g., policies, hierarchies, processes) to alleviate moral distress within your position? Do you think it can be alleviated, or is it inevitable?

You do not need to address all of these questions—write on the issues that you think are most important to share with others. You do not need to be a writer, just tell your story in your own words. We plan to publish 12 stories (800 – 2000 words) on this topic. Additional stories may be published as online-only supplemental material. We also publish two to four commentary articles that discuss the stories in the journal.

If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short 
description of the story you want to tell. Please include a statement about what type of clinician you are and what kind of environment you work in (no institutional names are needed). Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com. We will give preference to story proposals received by Oct 31st. For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and privacy policies, visit our webpage with Johns Hopkins University Press at: http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html

 

Back To School Nursing

Children washing their hands before lunch. Tak...
Children washing their hands before lunch. Taken at the Penasco school in Taos County, New Mexico, United States. (Photo credit: Wikipedia)

School nurses are an important—and often overlooked—part of our health care safety net. RNs at our nation’s schools handle medical emergencies, provide episodic and chronic care (including for the increasing number of children with Type II diabetes), track communicable diseases, connect children with needed insurance and health care providers, promote healthy behaviors, and screen for conditions that negatively affect learning—such as poor vision. They do all of these things mostly independently, while juggling sometimes competing and conflicting demands, rules, and laws of the educational and health care worlds. And now that Michelle Obama and the USDA have successfully added fruits and vegetables to school lunches, our school nurses are extra busy encouraging millions of school children to eat them. Some nurses must be responding to skeptical and creative students with, “No, you are probably not allergic to broccoli—only Justice Scalia is allergic to broccoli.” Given that the average school nurse in the U.S. is responsible for 1,151 students at 2.2 schools, school nurses are an important, overlooked, and overworked workforce.

Lina Rogers Struthers was the nation’s first school nurse. Part of Lillian Wald’s community nursing group, Struthers was employed by the school system of New York City in 1903. The year before she was hired a total of 10,567 children were excluded from NYC schools due to health reasons. The year after the introduction of the school nurse program only 1,101 students were excluded from school for health reasons.

On April 23, 2009 school nurse Mary Pappas in Queens, NY altered the local health department of an unusual outbreak of flu-like illness in her school. The CDC was called in to investigate and it was found to be the first documented outbreak of H1N1 influenza in the U.S., triggering a national response. This past spring in my home state of Washington, school nurse Becky Neff alerted state health officials of an outbreak of pertussis (whooping cough) in Skagit County, north of Seattle. Ms. Neff is the only registered nurse in her 3,700 student school district. (see NYT article “Cutbacks Hurt a State’s Response to Whooping Cough” 5-12-12, by Kirk Johnson) School nurses don’t just help keep students healthy: they help keep entire communities healthy. We need more of them.

Resources:

Robert Wood Johnson Foundation, Unlocking the Potential of School Nursing: Keeping Children Healthy, In School, Ready to Learn. August 2010

National Association of School Nurses (interview with Linda Davis-Aldritt, President NASN on preparation needed for being a school nurse)

CDC’s Division of Adolescent and School Health

Fun video clip about the work of Vermont school nurse Mandy Mayer, “I am a nurse, I am a leader” (won this year’s ANA award).

‘Obamacare’ Working for Young Adults

English: Barack Obama signing the Patient Prot...
English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

One of the provisions of the Affordable Care Act (ACA) that took effect in September 2010 allowed children/young adults to stay on their parent’s health insurance policies until their 26th birthday. The reason for this provision was that young adults ages 19-25 had the highest rates of being uninsured of any age group in the U.S.

For the past two springs in my health policy course I’ve asked students to raise their hands if they were now receiving health insurance under the ACA provision. This past spring about half of the students in this age range raised their hands. My own son who is in graduate school has been able to continue on my health insurance because of the ACA. Highly unscientific evidence for this part of the ACA working, but evidence nonetheless.

Now there is more objective evidence that the ACA is working for young adults. A NYT article today by Sabrina Tavernise “More Young Adults Have Health Insurance After Health Care Law, Study Says,” reports on data from a recent CDC/National Health Interview Survey. Lack of health insurance among young adults 19-25 fell from 33.9 percent in 2010 to 27.9 percent in 2011, translating into about 1.6 million fewer uninsured young adults. There was a corresponding increase in young adults having private insurance over the same time period, from 49.3 percent in the third quarter 2010 to 58.8 percent in the fourth quarter 2011. These positive changes for young adults were seen across different racial groups. Additional evidence that the ACA is working for young adults is that lack of insurance grew for adults ages 26-34.

As most everyone knows by now, young adults have been the hardest hit by the Great Recession. It is good to hear that something is going in their favor.

Becoming a Nurse: The Book

Creative Nonfiction’s anthology is currently in press and due to be released March 12, 2013. The book’s full title is I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (Lee Gutkind, editor/In Fact Books).

Here is the official book blurb:

“This collection of true narratives reflects the dynamism and diversity of nurses, who provide the first vital line of patient care. Here, nurses remember their first ‘sticks,’ first births, and first deaths, and reflect on what gets them though long, demanding shifts, and keeps them in the profession. The stories reveal many voices from nurses at different stages of their careers: One nurse-in-training longs to be trusted with more ‘important’ procedures, while another questions her ability to care for nursing home residents. An efficient young emergency room nurse finds his life and career irrevocably changed by a car accident. A nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS, and a home care case manager is the sole attendee at a funeral for one of her patients. What connects these stories is the passion and strength of the writers, who struggle against burnout and bureaucracy to serve their patients with skill, empathy, and strength.”

Lee Gutkind, dubbed by Vanity Fair as the godfather of creative nonfiction, is currently Distinguished Writer-in-Residence at Arizona State University’s Consortium for Science, Policy and Outcomes—where, among other things, he is “(…) helping scientists, engineers, nurses, lawyers, philosophers, etc share what they know with a general audience.” (Creative Nonfiction blog post 7-7-08).

In Fact Books is the new book imprint of the Creative Nonfiction Foundation. They have published two books this year: An Immense New Power to Heal: The Promise of Personalized Medicine(Lee Gutkind and Pagan Kennedy), and At the End of Life: True Stories About How We Die(Lee Gutkind, editor). Gutkind has a special interest in the narrative of medicine, beginning with his 1990 book Many Sleepless Nights: The World of Organ Transplantation (U. Pittsburg Press). In the introduction to the anthology he edited, Becoming a Doctor: From Student to Specialist, Doctor-writers Share Their Experiences (Norton/2010), Gutkind marvels at how there are so many writers who are doctors and doctors who are writers.

I look forward to reading Gutkind’s introduction to the “Becoming a Nurse” anthology, specifically how he addresses the paucity of nurses who are writers/writers who are nurses. Gutkind was reportedly surprised that they did not receive a flood of submissions for their “Becoming a Nurse” anthology, and wondered why there weren’t more nurses who write about their work.

I can think of many reasons why there are not more nurses who write (see my blog post “Nurses and Writing: Writers and Nurses” 3-31-11). Besides the fact that nursing is a servile, mainly female, “functional doer” profession that doesn’t require a basic four-year liberal arts education, nurses who want to write about their work are bullied out of it by their bosses. Quite frequently I hear from nurses who are writers (or who want to become published writers) that they have been threatened with termination by their employers if they continue to write about their nursing work—even when they are appropriately changing details in order to protect patient privacy. Because of the differences in professional power dynamics and the rigid hierarchy within the health care system, doctors who are writers do not have this barrier to writing—or at least not to the same extent.

But what that means is that Gutkind’s anthology on “becoming a nurse” is all the more important a contribution to the growing field of narrative medicine/nursing/health care. The book serves as a platform for a total of 21 nurses from around the world to tell their stories about what it means to become a nurse.

Transparency here: my essay “Next of Kin” is included in the anthology. My essay is the “a nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS” in the book blurb. Thanks to a grant from 4Culture, I was able to complete the site visit/research for my essay (and book from which this essay is taken) last fall, in time to submit it to Creative Nonfiction.

At 320 pages and retailing at $15.95, the book I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse ( is available for pre-order from your favorite bookstore—like mine here in Seattle: Elliott Bay Book Company. And if you live in (or want to travel to) the Seattle area, stay tuned for information on several group readings/presentations by some of the authors from the anthology—at Elliott Bay Book Company and at the University of Washington Health Sciences Library. Both events are still in the planning stage and will most likely be in mid-March.

Hospital Dirty Laundry Exposed

Laundry
Laundry (Photo credit: Bilal Kamoon)

Julie Creswell and Reed Abelson of the NYT are writing a series of fascinating articles exposing hospital giant HCA (Hospital Corporation of America), now the largest for-profit hospital chain in the US. Their NYT article today “A Giant Hospital Chain is Blazing a Profit Trail” finally explains to me the story behind the strange digital billboards I saw in June when I was visiting my father in Richmond, Virginia. They seemed to be everywhere along major roads, flashing obnoxious red-lighted wait times for the emergency rooms at two HCA hospitals–one being CJW, which the NYT article calls out as being one of the worst hospitals in the US in terms of bedsores (bedsores being a fairly good indicator of poor nursing care).

Last week (8-6-12, “Hospital Chain Inquiry Cited Unnecessary Cardiac Work) they wrote about a whistleblower, C.T. Tomlinson, a traveling nurse, who in 2010 worked as a cardiac nurse at the Lawnwood Regional Medical Center in Florida. Tomlinson was present in the cardiac catheterization lab when an HCA cardiologist inserted a stent into a patient who did not need it. Tomlinson reported the incident to his nursing supervisor who supposedly told him to forget about it. So he wrote a letter to the chief ethics officer of HCA’s hospitals in Florida who investigated his complaints and found them to be substantiated. Soon after Tomlinson wrote the letter of complaint, his contract to work as a nurse with HCA was terminated. It is not clear from the article whether or not he has filed a lawsuit for wrongful termination under Whistleblower protection. The HCA chief ethics officer’s investigation found that about half of all the cardiac catheterizations at Lawnwood Regional Medical Center were unnecessary, but did not alert the patients involved. It is unclear how many patients may have been harmed by the unnecessary cardiac work they had done. HCA also did not alert Medicare, state Medicaid or private insurers who were charged for the expensive procedures.

 

Ethnomed Local/Global Resource

Harborview Hospital on First Hill seen from Pi...
Harborview Hospital on First Hill seen from Pioneer Square neighborhood, Seattle, Washington, USA. (Photo credit: Wikipedia)

Harborview is the large King County hospital located on “Pill Hill” in the middle of Seattle. It is the only Level 1 Trauma Center for all of Washington, Alaska, Montana and Idaho. Harborview’s specific mission is to care for the county’s most vulnerable patients. As such, it forms the most visible part of the health care safety net for the Seattle area. I am always a bit awed by the scope of what they do, and have been able to see some of that firsthand this summer—from the high-tech trauma ICU to the low-tech/high touch Daryel /Somali Women’s Wellness Project.

A useful Harborview resource I highly recommend is Ethnomed. Ethnomed is Harborview Medical Center‘s ethnic medicine website. The main purpose of Ethnomed is to help busy health care providers integrate cultural information into their clinical practice. While Ethnomed’s focus is on the main refugee and immigrant population groups currently coming to and residing in Seattle/King County, there is also general cross-cultural information that would be useful in any area. There are links to specific cultures, to different clinical topics, and links to printable patient education handouts in different languages including Spanish. On the main page there’s a link to sign-up for Ethnomed’s electronic newsletter.

 

Blockbuster Moment

English: Camden, New Jersey is one of the poor...
English: Camden, New Jersey is one of the poorest cities in the United States. Camden suffers from unemployment, urban decay, poverty, and many other social issues. Much of the city of Camden, New Jersey suffers from urban decay. 日本語: ニュージャージー州カムデンのスラム. Svenska: Camden, New Jersey is one of the poorest cities in the United States. Kiswahili: Camden, New Jersey ni moja ya mataifa maskini zaidi katika miji ya Marekani. (Photo credit: Wikipedia)

Dr. Jeffrey Brenner, a family physician in Camden, New Jersey, talks about this as being a Blockbuster Moment in US health care in the US, a time for game changing innovations. He is the head of one such health care game-changer, the Camden Coalition of Healthcare Providers.

Camden, New Jersey is one of the poorest and most crime-ridden cities in the US. After completing his residency in family medicine here in Seattle in the late 1990’s, Dr. Brenner returned to his hometown of Philadelphia to establish a family practice. But a series of events–including the murder of young man outside his house– led him out of his private practice and into community work in nearby Camden.

Working with hospitals and local physicians, Dr. Brenner was able to map and identify the high utilizers of health care–people who were the most medically complex and the most expensive to treat. He found that 1% of the Camden residents accounted for 30% of all hospitals charges, mostly for emergency department visits for health problems that could have been treated and prevented with primary health care. After some good old-fashioned community coalition building, Dr. Brenner and his group hired a team of nurse practitioners, social workers, and community health workers to work with the “high utilizers” to help coordinate their health care, housing, benefits and other needs. The Camden Coalition model of care is showing results indicating they are able to provide better health care at lower cost to the most difficult to treat patients in one of the poorest cities in the US. As Dr. Brenner states, “If Camden can do it, it makes the rest of the country look silly.”

There is a very good 13min PBS Frontline video “Doctor Hotspot” by Atul Gawande highlighting the work of the Camden Coalition of Healthcare Providers. It features an interview with Dr. Brenner and also follows Coalition nurse practitioner Kathy Jackson on a home visit with one of her patients, a young man with asthma and a seizure disorder. Through her work with this young man, his ER visits went from 35 over six months to just 2 over six months.

In the Frontline video, Atul Gawande points out to Dr. Brenner that “there’s a catch” to the work of the Coalition being too successful. The catch is that they are taking away from the hospitals their most expensive, most lucrative patients and the hospital administrators will resist that change.

Atul Gawande also published an interesting article “The Hot Spotters” related to Dr. Brenner’s work in the New Yorker (1-24-11).

Also–for anyone with a NJ RN license, check out the two open RN positions on the Camden Coalition of Healthcare Provider’s website. They both look like exciting jobs with a terrific team. They also have volunteer opportunities listed.

Home Health

Wisconsin Home Care Victory
Wisconsin Home Care Victory (Photo credit: SEIU International)

The Department of Labor is considering expanding the Fair Labor Standards Act (FLSA) to cover the estimated 2.5 million home health aids working in the US. As its name implies, the FLSA mandates minimum wage and overtime pay for employees.

Home health aids assist elderly, ill and disabled persons with shopping, cooking, housecleaning and laundry to help them stay as independent as possible in their own homes—and out of expensive and oftentimes dehumanizing long term care institutions.

Currently, home health aids are considered companionship services, like babysitters, and as such are excluded from FLSA protections. These exclusions benefit for-profit home health and hospice agencies, an $84 billion industry—and growing, thanks to our aging (and dying) population. Republican US Senator Johanns (Nebraska) is sponsoring a bill in Congress to permanently block home health aids from FLSA protection. He is also backing repeal of the Affordable Care Act.

Home health aids are dear to me. I got my start in nursing as a home health aid in the North End of Boston, tending to several elderly first generation Italian immigrants. I was jumping out of the Ivory Tower of Harvard University at the time, on my way to becoming a Harvard dropout. One of my professors of health policy recommended I work for a home health agency to gain first hand knowledge of health care needs in the community. It was hard work and didn’t pay enough to keep me working in it for long. But it was rewarding and the experience convinced me to apply to nursing school.

Home health aids are a part of my life today. My 89-year-old father with advanced congestive heart failure is able to live at home with the help of home health aids. They are skilled, dedicated, and caring workers and not some glorified passive ‘companions’—and they deserve fair labor standards.

(see Borris and Klein’s NYT Op-ed “Home-care workers aren’t just ‘companions.'” 7-1-12)