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September 2006 Archives

   

 

Ananova is all over that miniskirted nurse beat

September 29, 2006 -- Today the Ananova site posted a very short item headlined "Nurses in Romania to wear miniskirts." The piece continues Ananova's aggressive coverage of efforts by local hospitals in Southeast Europe to get their unruly nurses into skirts. One year ago, the site posted a remarkably similar piece about a Croatian hospital that had directed all nurses to wear skirts instead of the "untidy" trousers some had been wearing. That piece included a quote from the hospital director: "The length of those skirts, be they miniskirts or otherwise, is up to the nurses." Today's piece reports that "[d]octors" in a Romanian town have asked that "officials" order all female nurses and physicians (!) to wear miniskirts, ostensibly because it would be more "elegant." We have to wonder if someone at Ananova has a little software reminder pop up every fall ("Time to post miniskirt nurse story!"). But assuming the story is real, the effect of the new proposal would be to enforce an image of female health workers as sex objects rather than professionals, which would have a disproportionately bad effect on nursing at a time of crisis. more...

 

Names in the news

September 29, 2006 -- For months The Baltimore Sun has included a sidebar feature in its weekly Health & Science section called "Names in the news." This feature includes short accounts of the "[g]rants, studies and appointments" of local figures in health care and science. Unsurprisingly, there tends to be more news about physicians than about any other group. But we have been impressed to see that the feature regularly includes reports about nurses at local hospitals and schools. Today, the feature has a short item reporting that University of Maryland nursing Dean Janet D. Allan, PhD, RN, FAAN, has been elected to the board of directors of the Association for Prevention Teaching and Research. On September 15, the feature included a piece explaining that Johns Hopkins nursing professor Jacquelyn Campbell, PhD, RN, FAAN, has been named the 2006 Pathfinder Distinguished Researcher by the Friends of the National Institute for Nursing Research (NINR) for her work on intimate partner violence. We commend the Sun for making the public more aware of nursing achievements. And since the feature appears to be based on press releases from the hospitals and schools, it underlines the importance of reaching out to the media to make it aware of those achievements on a regular basis. more...

 

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Between the Boob and the Tube

September 28, 2006 -- Tonight's episode of NBC's "ER" marked the return of writer Lisa Zwerling, MD, to the County General NICU. Zwerling's January 2004 episode followed a rough NICU rotation by then-medical student Abby Lockhart. This time, physician Lockhart is the mother of a premature infant in the unit. Like the 2004 episode, this one presents the NICU as a physician-intensive care unit. Smart, caring physician characters do everything that matters, including key psychosocial care that nurses generally do in real life. But Zwerling and co-writer Janine Sherman Barrois have expanded the NICU nurse repertoire here. The main nurse character to emerge in 2004 was a battle-axe who suggested that veteran NICU nurses are petty martinets who terrorize medical students. In the new episode, the two nurses who actually get a few lines are utterly incompetent. One is a lactation consultant whose comments are idiotic and insensitive. The other nurse dismisses the concerns of Lockhart's mother Maggie about a critical heart monitor alarm. Maggie has to virtually yell at her to get the physicians--you know, the real life-savers. Naturally, it is a life-threatening problem, and the infant is rushed to surgery. "ER" has at times shown physician incompetence. But it's rarely if ever this extreme, it's usually the result of inexperience, and there are always plenty of counterexamples to balance it. That's not the case for nursing in this episode, which drew more than 14 million U.S. viewers. more...

 

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"We're all 17 years old"

September 28, 2006 -- This season's first two episodes of "Grey's Anatomy" included handmaiden portrayals and physician nursing that flowed naturally from the show's superficial approach to health care. In the September 21 premiere, written by Shonda Rhimes and seen by 25 million U.S. viewers, experienced nurse Olivia confronts a sick newborn much as a deer faces headlights. Intern Alex orders Olivia to get him IV materials as he whisks the baby out of the flu-stricken ED. At first Olivia can only babble "How old's that baby?", and sputter that she's just been sent down from the floor to handle the flu overflow. But she does recover enough to snap that the infant has to be admitted to the hospital--which Alex of course ignores, since he's all about saving lives. In tonight's episode, written by Krista Vernoff and seen by 23.3 million viewers, nurse Tyler informs intern Cristina that he was part of a team that just saved a life in a code. But we get no specifics. And Tyler tells Cristina only to justify his failure to earn the $20 she paid him to act as a lookout, so she could have sex with her boyfriend, an ailing attending surgeon, in his hospital bed. Tyler seems to get the last laugh, but he's still a lackey who accepts $20 tips for tasks other than his real job. Later, we see what Tyler really does for patients. He pages intern George to tell him that a pre-op lung cancer patient has been shoplifting and is planning to leave without having her operation. Then Tyler steps back to let George handle the important health care issues. Seriously? Seriously. read more and send our new letter...

 

Rosie the Nurse

September 25, 2006 -- The cover story of this week's Business Week was Michael Mandel's lengthy "What's Really Propping Up the Economy." The piece offers a detailed argument that the massive growth in health care has been the only thing saving the United States economy from a "deep coma." Mandel stresses that the health care industry has added 1.7 million jobs since 2001, compared to "none" by the rest of the private sector. But he worries that the increasingly health care-focused U.S. economy is unbalanced. He suggests that "restructuring" and information technology may be able to streamline care, reducing spiraling costs--and the number of health jobs. Nursing is literally the poster child for the piece: the cover presents a version of the famous World War II "Rosie the Riveter" poster, but the tough-looking Rosie is now a nurse. Inside, the story points to the growth in nursing jobs, briefly describing the experiences of three enthusiastic second career entrants into nursing, two students and one recent graduate, who is male. But for expert commentary on what all this means, the piece turns to the usual suspects: economists, executives, physicians, and public health experts--and not one of these appears to be a nurse. More fundamentally, we're concerned about the presentation of the explosion in nursing vacancies as a measure of the strength of the profession. A key reason for this growth in vacancies is poor working conditions, like short-staffing. Pieces like this will not encourage society to allocate the resources nursing needs to resolve what is, in fact, a crisis. And while structural reforms and new technology can streamline care, it's important to pursue those with a full awareness of how nurses improve patient outcomes. more...

 

The last line of defense

September 24, 2006 -- Today the Indianapolis Star ran a fairly good article about the tragic deaths of three NICU patients at a local hospital. Tammy Webber and Staci Hupp's "Infant deaths put focus on nurses" reports that three newborns died at Methodist Hospital after five different NICU nurses mistakenly gave patients adult doses of Heparin. That reportedly happened after a pharmacy technician mistakenly supplied the NICU medication cabinet with the far more concentrated adult vials. The piece discusses how the tragedy might have happened, inquiring into staffing levels, though not making much headway there. It explains the "five rights" system for avoiding such errors. And it quotes a local nurse who gives a balanced reaction to the events. It might have consulted a nursing policy expert along with the medical school and pharmacy professors it quotes on issues surrounding such errors. Still, we thank the reporters and the Star for their generally fair coverage, which underlines "nurses' critical role as the last line of defense in treating patients." more...

 

Manifesto

September 20, 2006 -- Today the News Wales site posted an article about a policy "manifesto" issued by the Royal College of Nursing in Wales in advance of next year's Welsh legislative elections. The attention-grabbing headline is "Wales boozing worries nurses," but the manifesto covers a wide range of key health "demands." These include a large increase in the number of school nurses, expanding nursing responsibilities in community care, improvements in emergency care, and measures to improve nursing recruitment and retention. The unsigned piece has good quotes from the RCN Wales director, and it appears to be essentially a description of the RCN's press release. So it might have benefited from some outside comment on the extent to which the manifesto is politically feasible. But it is clearly an example of strong advocacy for nurses and their patients. more...

 

Success!

Debugging the "Electronic Nurse"

September 20, 2006 -- Today we convinced ALR Technologies, Inc. to change the informal name of its new ALRT500 (right) from "Electronic Nurse" to a name that does not suggest that the machine can replace a human nurse. The ALRT500 is a home health management device that aids in treatment compliance and monitoring of those with chronic disease. However, it does not make professional judgments and take skilled clinical actions based on years of college-level science education, as nurses do. After the Center sent an email outlining our concerns, we got a call from Wendy Prabhu, President of Mercom Capital Group, ALR's investment relations firm. Ms. Prabhu said that ALR had no intention of offending nurses, and she promised that ALR would change the "Electronic Nurse" name out of respect for them. She noted that the company works with nurses every day and values their work tremendously. She assured us that ALR President Stan Cruitt feels the same way. We commend ALR Technologies and Mercom Capital Group for being remarkably responsive to nurses' concerns about their product, and for taking steps to address the situation. more...


Daily Mail: "Nurses face ban on thongs and cleavage"

September 19, 2006 -- There's nothing the Center likes better than major newspaper headlines that link nursing and lingerie, and the Daily Mail (U.K.) obliged us today with a short item about proposals for new workplace clothing rules at an Essex hospital. The unsigned piece reports that Southend Hospital is considering rules that would require "[n]urses" to make sure they don't expose cleavage or underwear, and "[d]octors" to refrain from wearing stethoscopes around their necks because of the risk of infection. But just in case anyone missed the basic message--physicians are to health care instruments as nurses are to sexual markers--the piece also resurrects the Christina Aguilera naughty nurse ad for Skechers that nurses ended two years ago. The piece presents the ad with this caption: "Sorry guys: don't expect to see the likes of Christina Aguilera in this nurses uniform at Southend Hospital." more...

 

Jump!

September 19, 2006 -- The Nanaimo News Bulletin (British Columbia) ran a short item today about a bungy jumping promotion that local nurses organized to highlight the importance of child car safety seats. According to Chris Bush's article, the nurses wanted to show the public that bungy jumping was actually safer than riding with an improperly restrained child. We commend the Nanaimo Regional General Hospital maternity nurses (and one of the nurses' sons) for advocacy that serves the interests of nursing as well as the public. And we thank Mr. Bush and the News Bulletin for covering it. more...

 

Success!

Water made less naughty

September 2006 -- Recently, Constellation Brands, Inc. employed naughty nurse images to help sell its Hydra Vodka Water beverage, which is marketed to young adults. One print ad in the "Water made naughty" campaign featured a "naughty nurse" underwater, wearing a very short dress and putting on a surgical glove, while glancing seductively at the camera. Models dressed as naughty nurses also seem to have been a feature at events promoting the drink. We called Constellation Brands to discuss our concern that such imagery discourages practicing and potential nurses, while undermining nursing's claims to adequate resources in the midst of a global shortage. Michael Martin, Vice President of Corporate Communications, immediately agreed to work to discontinue use of the imagery. It has been pulled from the Hydra website and will no longer be placed in print ads. more...

 

The wait

September 17, 2006 -- Today the ABC News site posted an item headlined "Illinois Woman's ER Wait Death Ruled Homicide; Long ER Waits Plague Nation's Hospitals." The item describes a woman who was, sadly, found dead in an emergency department waiting room in July two hours after a nurse told her to wait. The coroner found that the woman had presented with "classic symptoms of a heart attack." The coroner's jury ruled the death a homicide, which could lead to criminal prosecution. The piece rightly highlights the serious consequences that may occur if a triage nurse makes an error, and it also links the apparent problem here to ED overcrowding. But the piece appears to wrongly assume that physicians are ultimately responsible for all ED care. Thus, it consults no nurse experts. It relies instead on comments from the American College of Emergency Physicians (ACEP). These seem reasonable, but they blur the fact that ED triage is a nursing task. And a statement attributed to the president of ACEP advises dissatisfied patients to talk to the triage nurse, but if that "doesn't work," to "ask to speak to the emergency physician." This will reinforce the impression that ED nurses report to physicians, and that physicians are the real triage experts. In fact, patients in such a situation should generally ask to speak with the charge nurse, the clinical nurse specialist or the ED nurse manager. more...

 

Self defense

September 15, 2006 -- Recent media items have highlighted the high level of abuse nurses face, which affects patient care and the global shortage. One of the most striking pieces was the story of Portland (OR) emergency nurse Susan Kuhnhausen, who arrived home one day to find an armed intruder in her house. As a September 9 Associated Press piece reports, Kuhnhausen managed to disarm the man, and strangled him to death. The police viewed this as self-defense--and they later charged Kuhnhausen's estranged husband with having hired the intruder to kill her, as a followup AP piece reported today. This case seems unrelated to nursing, though Kuhnhausen appeared to present a model of a nurse strongly defending herself from a serious threat. But the media coverage still drew attention to issues of workplace violence against nurses. In part that's because Kuhnhausen (right) has herself been a leader in advocating for legislative measures to protect nurses from such violence, as a good article by Robin Moody in the March 11, 2005 Portland Business Journal showed. In addition, the AP's September 9 story led Portland FNP Tracy Klein to write a letter to the Oregonian noting that, contrary to implications in the story, nurses like Kuhnhausen "are not immune to the impact of such violence just because they may see it in the workplace." Klein noted that one study had found that 20% of ED nurses sampled met symptom criteria for post-traumatic stress disorder. In fact, nurses experience abuse in clinical settings across geographic and subspecialty boundaries. A good September 7, 2006 piece by Alison Ribbon in the Mercury (Australia) reported that two thirds of Tasmanian nurses surveyed had been physically or verbally abused in the preceding month. The abuse affected patient care, and more than 10% of the nurses had "left a post because of aggression." Like the Portland Business Journal article, the Mercury piece pointed to a reluctance to address the abuse, which may relate to the "virtue script" nurses are still expected to follow. We thank the news entities above for their attention to these issues. more...

 

We expect you to know what's going on around you

September 14, 2006 -- The May 2006 season finale of NBC's "ER," rebroadcast tonight, is a good example of last season's better episodes for nursing. It includes a commendable number of small portrayals of ED nursing skill. Yet these are offset by suggestions that physicians are ultimately in charge of the clinical setting, as well as by some physician nursing, particularly with regard to triage. After all these years, the ensemble drama's most glaring problem remains that it has one, and only one, major nurse character. The episode, "21 Guns," was written by show runner David Zabel. more...

 

Do Androids Dream of Being Nurses?

September 11, 2006 -- A fairly good piece by Nikki Cobb in today's San Bernadino County Sun highlights the reaction of California nurses to their hospitals' growing reliance on monitoring technology. "Nurses seeking final say: Contracts limit equipment's input" reports that nurses are starting to place provisions in their contracts stating that the nurses' judgment will prevail in any conflict with such technology. The piece relies on quotes from management and union nurses. It makes the point that such technology can be useful, but excessive reliance on it can threaten patient care. The piece might have provided more specifics about the nurse-machine conflicts and the contract provisions that address them. It might also have explored the extent to which technology could constrain nursing practice in the future, and whether it might be used to justify reductions in nurse staffing. more...

 

"ER" series and season 12 review now available

In its 12th season, "ER" seemed less inclined to die than to fade away. With all the NBC show's original characters gone, it seemed at times to struggle for ideas. Yet many characters and plots remained compelling, and the show was still popular by any fair measure. It was still the only network hospital drama with much dramatic depth or understanding of real issues in modern health care, including care in conflict zones like Iraq and Darfur. The big news for nursing was the six-episode arc of formidable nurse manager Eve Peyton, played by Kristen Johnston. Despite Peyton's bizarrely unconvincing exit (in which she attacked a patient), her episodes presented an unprecedented portrait of a mostly autonomous nursing leader who was more or less the clinical peer of the attending physicians. Because of that, and other efforts to show that nurses are skilled and integral to ED care, we have given the show's 12th season a "fair" rating for nursing--the highest we have ever given any serial television show. However, there was still only one major regular nurse character (Sam Taggart). And the show remained focused on the training and practice of its many physician characters. They provided the vast majority of the care the show portrayed as important, including tasks that nurses do in real life. Of course, the show is far better than the abysmal "House" and "Grey's Anatomy," which see nurses as petulant dimwits who are irrelevant to serious care. But "ER" still has a long way to go. see the full review...

 

The deadly virtues

September 5, 2006 -- Today the Liberty Times (Taiwan) ran an unsigned piece about a young nurse at Taichung Hospital. The piece reports that Chuan Ya-lan is an unusually devoted, patient, and hard-working nurse. We appreciate the effort to highlight the value of Chuan's work. Unfortunately, the piece focuses heavily on what Suzanne Gordon has termed the "virtue script," rather than on tangible ways in which nurses improve patient outcomes. And the virtue script--which asks nurses to endure unendurable working conditions without protest--is a factor in the life-threatening nursing shortage. more...

 

Preventable errors

September 4, 2006 -- Judy Foreman's "Health Sense" column, published today in the Boston Globe and syndicated nationwide, focused on ways to prevent medication errors. "Be sure those pills you're given are the right ones" contains valuable information about how patients and health workers can work to reduce errors. The piece refers in passing to the fact that nurses give and can help to explain medications to patients. But it cites no nursing experts, relying instead on four different physician sources. And it misses the key role nurses play in catching most medication errors--a role that calls upon nurses to be critical thinkers and advocates, not just people who mechanically implement the plans of others, as the piece's description implies. The piece also ignores the extent to which the nursing shortage and the general undervaluation of nursing hampers efforts to reduce drug errors. Short-staffed nurses are less able to catch the errors, detect changes in patient conditions, and provide other care that enables drugs to work safely and well. Underpowered nurses have a harder time advocating for changes in medication plans and medication administration systems. And the piece repeatedly suggests that only "doctors" prescribe drugs, even though most of the over 200,000 U.S. advanced practice nurses regularly do so as well. more...

 

Silly nurses! Your killer short-staffing isn't news. It's a chance to leave the bedside for legal consulting!

September 4, 2006 -- A short piece by Vickie Milazzo, RN, MSN, JD, appeared on August 21 on the American Chronicle site and elsewhere. The piece is "Why Are Nurses Leaving Clinical Nursing? Not Because of ER!" It rejects the Center's view that popular Hollywood shows are contributing to the nursing shortage. Milazzo, who is described as an "Inc. Top 10 Entrepreneur," argues that nurses' working conditions are so bad that nurses would be leaving the bedside regardless of what "ER" did. She notes that nurses are "understaffed, underappreciated, underinsured, underpaid and under-you-name-it." Milazzo does not ask why any of this has come about, or whether society's lack of respect for nurses might have anything to do with the information it gets about nursing. Instead, she reports with evident approval that nurses are "finding their own answers" to these problems. Those answers do not appear to involve saving bedside practice, but gladly leaving it to "develop new careers." Milazzo suggests that the Center ask "ER" to do a truly realistic episode about a "nurse who quits her hospital job to become a Certified Legal Nurse Consultant." Coincidentally, the training and certification of legal nurse consultants is the business of the Vickie Milazzo Institute. Today, Milazzo's entry in National Public Radio's "This I Believe" series made her lack of regard for bedside nursing even more clear. In this piece Milazzo describes how she escaped the bedside by overcoming her own "fear of becoming like the other no-risk nurses--tired, burned out and old before their time." Milazzo presents her shift from the bedside to legal consulting as a personal triumph, and she directly links nursing with soul-killing failure. more...

 

The League of Extra Ordinary People

September 2006 -- This fall's U.S. television season has less health-related serial programming than last year, but the top hospital dramas--Fox's "House" (premieres Sept. 5) and ABC's "Grey's Anatomy" (Sept. 21)--will soon resume spreading their misportrayals of nursing to tens of millions each week. These dramas depict physicians providing all key care, and the few nurses who appear are insignificant handmaidens. NBC's long-running "ER" (Sept. 21) returns with a slowly shrinking audience and major nurse character Sam Taggart. The show remains physician-centric, but last season its vision of nurses as skilled sidekicks who are at least capable of challenging physicians presented a sharp contrast to the other hospital dramas. In general, shows with nurse characters often emphasize their ordinariness, using them to set off the more interesting characters around them, and they also focus on the nurses' personal lives, presumably because producers don't know that nursing itself is interesting. NBC's sitcom "Scrubs," with relatively normal nurse character Carla Espinosa, will again return in mid-season. It had a few good episodes for nursing last year, though its overall depiction remained fairly poor. One character in NBC's new drama "Heroes" (Sept. 25) is hospice nurse Peter Petrelli, one of the "ordinary" people who discover they have an extraordinary power (in Peter's case, it's flying). The show web site says Peter has always lived in the shadow of his high-achieving politician brother, but he feels "destined for something bigger" than lowly hospice nursing. Imagine our excitement. HBO's raw sitcom "Lucky Louie" includes major nurse character Kim, who is essentially Alice Kramden's granddaughter. Like Carla, the tough Kim is the fairly normal one in a crew of misfits, though the show is not really about her work life. "Lucky Louie" was a summer show, but HBO is re-broadcasting episodes into the fall. FX's plastic surgery drama "Nip/Tuck" (Sept. 5) kicks off its fourth season, still with no recurring nurse character. And staffing agency Access Nurses may produce another season of its web-based "13 Weeks," an inadequate reality series about travel nurses. more...

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