Some of the highlights that I picked up on during this panel discussion included efforts to increase diversity in nursing as well as career mobility, and national efforts to increase scope-of-practice for nurse practitioners. Currently there are 17 states that allow nurse practitioners to be fully independent and two additional states that allow nurse practitioners to be ‘almost’ fully independent (Maryland and Utah). In the past three years seven states have removed major barriers to practice, and Nevada recently gave nurse practitioners full practice authority. Opposition by state medical organizations blocked passage of similar bills in Connecticut, Kentucky, New York, and most recently in California. But the momentum is growing in favor of independent practice for nurse practitioners across the country. The Federal Trade Commission is challenging limits to nursing scope-of-practice in many of the recalcitrant states (including, I hope, my home state of Virginia).
At the end of today’s lecture there was an excellent televised address by Rissa Lavizzo-Mourey, MD, who is the director of the Robert Wood Johnson Foundation (sponsor the FON report and follow-up efforts). Among other things she spoke of the need to change the “caste system in hospitals” that treats nurses as second-class citizens. That seems to be a daunting task.
I have read the entire IOM FON report several times and think it is an excellent document. (Previous blog post Undoing Nurses as Functional Doers Nov 24, 2010). Of course, being a primary care nurse practitioner myself with previous run-ins with state health regulatory boards over scope-of-practice issues (see To Forgive, Divineblog post), I have been cheering the efforts in this area spurred on by the IOM Future of Nursing report. And being a nurse educator who loves teaching (and who abhors most approaches to nursing education–another nursing care plan anyone?), I applaud the IOM/FON report section on changes needed within nursing education.
So what has changed for me in the past three years since the IOM FON report? Many faculty members invoke the FON report from time-to-time when making various points about needed changes in the curriculum. Not many of our current students have even heard of the report (shame! I need to assign parts of it as required reading). I’ve seen a large uptick in the support for interprofessional educational experiences for students and faculty. And I’ve seen an increased emphasis on adding leadership content as well as political advocacy skill-building activities for students within our various programs (although there’s still a shameful paucity of resources and nursing role models in these areas). The other thing that bugs me in the area of politics and policy education for nurses is the emphasis on self-advocacy for nursing practice. While that’s important, nurses can and should be using their advocacy skills and energies for less self-serving health policy changes.
I was discouraged after yesterday’s Supreme Court ruling effectively dismantling parts of the Voting Rights Act, thus (in my opinion) stoking racism. We didn’t need Paula Deen‘s version of twisted Southern Hospitality to remind us that racism is alive and festering in our country… Unfortunately, the Voting Rights Act is still needed in the South and elsewhere.
“For same-sex couples who wished to be married, the State acted to give their lawful conduct a lawful status. This status is a far-reaching legal acknowledgment of the intimate relationship between two people, a relationship deemed by the State worthy of dignity in the community equal with all other marriages. It reflects both the community’s considered perspective on the historical roots of the institution of marriage and its evolving understanding of the meaning of equality.” (page 24/ Majority Opinion)
The Supreme Court also refused to hear a case, effectively permitting same-sex marriage in California. While there is still no constitutional right to same-sex marriages, today’s Supreme Court rulings are major victories for same-sex couples and their families. So, in the words of Gail Collins: happy demise of DOMA day!
And in the words of one of my former students, Jonathan Halldorson, who e-mailed me his celebratory American Sentence (which he told me he composed while taking a short break from studying for the NCLEX exam):
Late last month more than 23,000 nurses at Sutter, Kaiser, and Children’s Hospital Oakland had a one-day planned strike protesting proposed cuts in employee benefits and patient services. Sutter hospitals locked out the nurses for four days after the strike, saying they had to sign five to eight day contracts with the firms who brought in the temporary nurses. During the lockout a temporary nurse reportedly administered a nutritional supplement through a central line (into the bloodstream) instead of through an abdominal feeding tube. Hospital spokespersons have called it a highly unusual medication error, but quickly added it didn’t have anything to do with the lockout or the use of temporary nurses. Nurses’ union officials have said the patient death wouldn’t have happened if they hadn’t been locked out after the strike. They have filed a complaint with the National Labor Relations Board over the lock out. And they have stated that it reveals that the use of temporary nurses endangers patient safety.
So what is the evidence in terms of temporary nurse staffing and patient safety and quality of care? An oft-cited study by Linda Aiken published in 2007 in the Journal of Nursing Administration, did not find that hospital patient safety was negatively affected by use of temporary nurses. However, her study used survey/self-reported data, and only included Pennsylvania hospitals. A recent large national study found that emergency department medication errors associated with temporary staff were more frequent and more likely to be life-threatening than those by permanent staff (Pham, et al, Journal of Healthcare Quality, July/August 2011). The authors point out that the use of temporary nurses (and other hospital staff) is on the rise due to work-force shortages and perceived cost savings to hospitals.