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Wicked local public health advocates

December 2011 -- Over the past year, news items from around the world have shown nurses speaking out on important health issues and getting good coverage in the media. On February 24, the Wicked Local Sharon (Massachusetts) website posted "Sharon nurses lead no-tan pledge," a good report by Paula Vogler about a high school nurse and town nurse who are (together with the Melanoma Foundation) urging local students to pledge not to get tans, so they can avoid skin cancer. On August 7, USA Today ran a very good piece on the importance of asking questions about hospice options by Kelly Kennedy, who relied entirely on a hospice nurse and a Wisconsin nursing professor for expert comment. On November 25, the Harrow Times (UK) ran a helpful article by Suruchi Sharma about local hospital nurses who had organized a "mouth cancer exhibition" in order to help the local Asian community get "clued up" about the health risks posed by tobacco products. And on December 5, the Herald Sun (Melbourne, Australia) published a good piece by Stephen Drill reporting that nurses in Victoria were protesting apparent plans to reduce nurse-to-patient ratios, which the nurses said would lead to an increase in antibiotic-resistant and potentially deadly "superbugs." These short press reports don't just give readers health information that could save their lives. They also show the public that nurses can be strong, knowledgeable health professionals. We thank those responsible for the pieces.

"Tanning is out, your skin is in"

Experts say

Getting clued up

Absolute rubbish

"Tanning is out, your skin is in"

tanning bedThe Wicked Local piece "Sharon nurses lead no-tan pledge" from February describes the efforts of Sharon (Massachusetts) high school nurse Kristine Heck and town nurse Sheila Miller to raise awareness among high school students about the potential risks of getting a tan. The report says the two nurses want to counter the impression that "soaking up the sun" is healthy, since skin cancer is "one of the fastest growing cancers that is the second most common cancer among people aged 15-29." So, in a program conducted with the Melanoma Foundation of New England, the nurses want students at Sharon High School to sign a "no tanning pledge" saying that they will not sunbathe or use tanning beds. In particular, high school nurse Heck says that "people think tanning beds are safe but it really exposes you to more ultraviolet rays than the sun" and that using a tanning bed once a month increases the risk of getting melanoma by 75 percent. The piece notes that melanoma accounts for 71 percent of skin cancer deaths, and that an estimated "1 in 50 Americans will soon be diagnosed with the disease" (it might have been helpful to know what "soon" means here). Now, in a campaign with the slogan "tanning is out, your skin is in," the Melanoma Foundation is offering two $1,000 prizes to the high schools with the highest percentage of students signing the pledge.

skin analyzerThe piece relies most heavily on comment from town nurse Miller. She notes that many people think getting a "base tan" before going on vacation is healthy, but in fact there is (in the report's words) "no such thing as a safe tan." Miller will be at the high school for the "biggest promotion" of the program, bringing "two student nurses from Curry College with her to handle the education portion of the drive." She will also bring a "skin analyzer that will show students where skin damage has already occurred on their bodies but will not diagnose skin cancer." Miller, who has apparently shown students the analyzer in the past, says she surprises most students by showing them how much harm has already occurred. But Miller sounds optimistic about the pledge: "I think kids in Sharon are really into prevention and doing the right thing."

This short item tells the public helpful things about nursing. Miller and Heck are presented as part of a creative and important public health effort, particularly given the potential harm of skin cancer and the susceptibility of the campaign's target population. Both nurses seem to be well-informed health educators. We particularly liked the information Heck provided on the hidden danger of tanning beds, and Miller's comments about her work with the skin analyzer, which sounds like a great tool to illustrate the potential damage from tanning. In addition, the note about Miller bringing the two nursing students is helpful because it indicates that nurses get college degrees and that they are engaged in "education," although we don't like the term "student nurses," since it implies that the students are already nurses, as if that did not require much training. It's unlikely that a piece would describe medical students as "student physicians." On the whole, though, the report is a good portrait of nurses as knowledgeable health advocates.

Experts say

hospice careThe short August USA Today article "Families need to ask questions early about hospice care" is about how families should choose a hospice. The piece is not really about nurses -- it just happens to consult only nurses as experts, which is even better than a report devoted to them, because it indicates to readers (as too few mainstream media pieces do) that nurses are expert at things other than nursing itself. And there's no doubt that is the message here, because the lead says that "when it comes to placing family members into hospice care, experts say, it's critical for families to ask questions to help make more informed decisions."

The report's main source is Dawna White, identified as "a hospice nurse who writes, a blog." White advises people to consider the possibility of hospice as early as possible. That can help families avoid having to "make quick decisions during a stressful time." conflict of interestShe also urges people to think carefully about why a physician may be recommending a specific hospice, noting that (in the piece's words) "there may be a legitimate reason -- such as joint research or good working relationships with health staff at the hospice -- or it may be there is a financial relationship between the physician and the hospice." White suggests that families learn about specific hospices by finding out what services they offer and even talking to families who have used the hospice, "to make sure the hospice offered grief counseling and classes for family members after the patient had died." And the piece notes that White's website describes how Medicare benefits apply to hospice, giving as an example the useful note that patients may leave hospice at any time for any reason, but later return to the program.

Karen KehlThe article also quotes Karen Kehl, an "assistant professor at the school of nursing at the University of Wisconsin-Madison." Kehl says it's important for hospice staff to both answer and ask questions about the patient. She also advises families to consider several different hospices and not to sign anything until they've weighed the options. The piece, perhaps at Kehl's suggestion, notes that good information is available through the National Hospice and Palliative Care Organization and the Hospice and Palliative Nurses Association. Finally, Kehl recommends that families speak with nurses at the hospital or nursing facility: "Physicians make the referrals, but nurses talk to the families after they make that decision." Presumably she means that the nurses can tell you what kind of experience the hospice patient actually has at a given hospice.

This is great. The piece presents two nurses as experts who have important advice about hospice, and simply assumes that readers will accept that, even though the reporter is clearly aware of the basic role that physicians play in referring patients to hospice, including the potential for improper influence in a situation where a physician has a financial relation with the hospital. The theme that nurses are likely to be more aligned with the interests of patients and families is present both in the actual text of the piece and as the implication of the reporter's choice of experts. In fact, a reasonable reader might wonder why it would be the physicians' role to refer patients to hospice, when nurses are generally more focused on and knowledgeable about the service. Of course, the basic answers lie in the traditional power dynamics among patients, nurses, and physicians. In any case, the piece presents nurses as public health advocates and educators. White maintains a blog about hospice that itself shows her expertise, and Kehl is a nursing professor whose work involves end-of-life issues. Obviously, much more might have been said about hospice -- the piece assumes that a decision to use hospice has already been made and does not get into how to make that often difficult and complex choice in the first place -- but the report still conveys helpful information about hospice and nursing.

Getting clued up

Suruchi Sharma's November piece in the Harrow Times is headlined "Nurse tells Asian community to get 'clued up' about tobacco products at Harrow's Northwick Park hospital." The article reports that nurse Sapna Mandalia and her nursing colleagues Nikitika Ghimire and Jocelyn Roberts, who "work" in the hospital's Maxillofacial and Oral Surgery department, organized a "mouth cancer exhibition" for Mouth Cancer Awareness Month. We would have preferred a term like "practice" rather than "work," which suggests that nursing is more a job than a profession.

tar in a jarThe mouth cancer event reportedly included "a year's worth of tar from cigarettes in a jar, pictures of what the cancer looks like and leaflets with advice to encourage people to seek treatment." It also sounds like Mandalia spoke at the event (though it's not clear how much was directly to the reporter) about "Asian tobacco products such as Paan," "the detrimental results of smoking shisha or hookah pipes," and "something now called gutkha, which is very popular among the Asian community and is a major cause of cancer in India." She reportedly stressed that many people don't know about the disease, "how to deal with it and that they could potentially die." The piece concludes with a quote from Mandalia:

The Asian community needs to [get] clued up about what this can do to them. The amount of people who die a year from mouth cancer is increasing and there are many who may have it and are not diagnosed yet.

This piece too presents nurses as knowledgeable public health advocates. Like the skin cancer campaign in the Massachusetts piece, the advocacy of Mandalia and her colleagues appears to be wisely directed at a community that is particularly at risk for the health problem in question. And like the skin cancer campaign, this one seems to have included engaging items to bring home the threat posed by the targeted health problem, in this case the year of tar in a jar.

Absolute rubbish

nurse to patient ratioThe Herald Sun report from earlier this month carries the subhead "Nurses fear a superbug outbreak in hospitals if the State Government slashes nurse-to-patient ratios." The piece seems to be based mainly on views expressed at a rally the prior day at the Royal Women's Hospital:

Angry nurses told the Herald Sun that VRE [vancomycin resistant enterococci] and golden staph would explode if existing ratios of one nurse to four patients were cut and registered nurses replaced with poorly qualified health assistants.

The nurses said that the health assistants would cause more infections, with one unnamed nurse arguing that

health assistants can't replace nurses who have done a three-year degree. This is a false economy from the Government because there will be an increase in infection rates in hospitals. We're not just talking golden staph, we're talking about things like VRE which can cause ongoing health problems.

nurse to patient ratioThe piece explains that VRE "does not respond to antibiotics and is a particular risk to cancer and transplant patients and those who have had heart and lung operations." The article also provides a little background on the dispute that led to the rally, noting that the nurses are "deadlocked" over the ratios in ongoing contract negotiations with the state. The report says that the Victoria Health Minister David Davis "denied he wanted to cut nurse to patient ratios and said health assistants were used in other states." And Victorian Hospitals' Industrial Association chief Alec Djoneff "said suggestions of a superbug outbreak because of the use of health assistants was 'absolute rubbish' as they would always be supervised by registered nurses."

This is a pretty good, if brief, portrayal of nurses as public health advocates, though of course that portrait is more mixed because it is arises in the context of a labor dispute with their employers and any employee has a personal interest in not being given too much work. The piece allows both sides to express their views, though the perspective of the nurses is obviously given more prominence. Victoria was the first major jurisdiction to mandate unit-specific minimum nurse staffing ratios. Of course, whatever the merits of the specific ratios discussed here, it is a little hard to see how anyone could guarantee that these infections would not rise simply because health assistants would be "supervised" by nurses, as if that meant that the assistants would automatically have the same skill as nurses with years more education, or nurses could adequately manage any number of assistants. Registered nurses do not stand over nursing assistants and watch their every move, so they would have little ability to observe when nursing assistants have failed to wash their hands or have contaminated a surface that needs to be cleaned. The spread of infection is very much related to the level of professionalism and understanding of those providing direct care. It might have been nice if the report had found at least one nurse to be named on the record, but still, the report overall presents nurses as raising an alarm that the public should at least seriously consider, and making an argument for the value of the nurses' own direct care skills.

None of these four pieces is long, but each tells the public that nurses are strong, knowledgeable health advocates who try to protect patients from threats posed by things ranging from the patients' own decisions (such as tanning or using tobacco) to clinical environments (such as hospice or hospital infections). We thank those responsible for these reports.


See the article "Sharon nurses lead no-tan pledge" by Paula Vogler from Wicked Local Sharon, published February 24, 2011. You can email the author at

See the article "Families need to ask questions early about hospice care" by Kelly Kennedy, published in the USA Today on August 7, 2011.

See "Nurse tells Asian community to get 'clued up' about tobacco products at Northwick Park hospital" by Suruchi Sharma, published in the Harrow Times on November 25, 2011.

See "Nurses warn of deadly superbugs" by Stephen Drill, published in the Herald Sun on December 5, 2011. You can reach the author at



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