The rules on privacy

The Bush administration recently took the final step in setting comprehensive standards for the privacy of medical records, an action that, for the first time, gives Americans federal protection regarding their medical information.

The U.S. Department of Health and Human Services put forth the final standards. And while ANA commended the measure, which modifies the already existing "Health Insurance Portability and Administration Act," the association stopped short of giving it its full endorsement.

"ANA is pleased that consumers may now inspect and correct their medical records, find out who else has accessed them and take action against parties who misuse the information," said ANA President Barbara Blakeney, MS, APRN,BC, ANP. Also commendable is the current administration's strengthening of a provision that protects against the use of patients' medical information for the marketing of prescription drugs and other products by companies that now have access to individuals' medical records.

But Blakeney added, "We are disappointed that the portion of the rules requiring patients' written consent was omitted in the final rule, and we do not have 'faith' in the administration's assumption that providers will always make 'a good faith effort to obtain a written acknowledgment of the receipt of the notice.'"

ANA has testified on the issue of patient privacy and confidentiality at numerous hearings before Congress in recent years, and the association has been a forerunner in the formation of proposed policy on the subject.

NC nurses & the shortage

At least half of staff nurses in North Carolina long term care and hospital in-patient units reported that short staffing affected their ability to meet patients' needs either weekly or daily in the month prior to participating in a North Carolina Center for Nursing survey.

Staff nurses from community settings, such as medical office practices or public health departments, however, were more likely to report that they were either never affected by short staffing Ð or only affected once or twice Ð during the same time period, according to the report, which was issued in July.

Staff Nurse Satisfaction, Patient Loads and Short Staffing Effects in North Carolina reported findings from a summer 2001 survey of randomly selected RNs and LPNs in three geographic regions of the state. It is part of a larger study investigating staff nurses' attitudes about their workplaces.

Researchers also found that RN and LPN staff nurses generally "seem to be more satisfied with their career in nursing than with their current job situation." Roughly 50 percent of nurses seemed happy with their jobs, some 20 are "definitely not" and about 30 percent are "uncertain."

Nurses who worked in community settings were more likely to report being satisfied with their jobs than those in other settings.

Further, slightly more LPN staff nurses reported feeling valued by their employers than did the RNs who were surveyed.

In terms of average daily patient loads, staff RNs in hospital inpatient units reported a patient load of 8.5, those in long term care 24.7, and those in community settings, 19.2. In inpatient units, RNs working in critical care units reported having the smallest average daily patient loads (2.8) and RNs working in emergency departments, the largest at 21.7 on average.

"This study affirms what we have known, that nurses in hospital settings where patient acuity is highest are experiencing the greatest effects of the nursing shortage," said North Carolina Nurses Association President Martha Barham, MSN, RN, CNAA, vice president for nursing at High Point Regional Health System.

And she added, "Findings of this study support previous research that nurses are more satisfied with nursing as a career choice and less satisfied with their work environment. Our efforts must be directed toward the provision of a professional practice environment that fosters shared decision-making and job satisfaction, ultimately retaining the current workforce and promoting nursing as an attractive career choice."

Sleep & work hours

The American public favors limiting work hours for many professions, particularly those requiring sustained alertness on the job to ensure public health and safety, according to the National Sleep Foundation's (NSF) 2002 "Sleep in America" poll. The findings indicate that the public is at odds with workplace regulations in effect for many occupations that support more grueling schedules for many professionals.

"We often aren't inclined to ask about how much sleep professionals, such as pilots, doctors or nurses, have had in the 24 hours before we use their services," said Richard L. Gelula, NSF executive director. "These results can be an important barometer for policy-makers and others involved in establishing duty hours for the workplace, wherever that workplace may be Ð in the air, on the road, in a schoolroom or in a hospital room."

Poll respondents expressed a high level of concern about doctors' work schedules. If they learned their surgeon had been on duty 24 consecutive hours, 86 percent say they would likely feel anxious about their own safety, and 70 percent would likely ask for a different doctor.

On the other hand, there is support for long work hours for some workers compared to other professions cited. Those polled believe a doctor's workday should be longer than those of other professionals. More than one-half said doctors should have a maximum workday of 10 or more hours. Nurses came in second for the longest workday, with respondents almost evenly split between a maximum day of eight hours (49 percent) and 10 or more hours (45 percent).

But the public also believes workplace policies should allow for personal sleep needs, according to poll results. A majority of respondents (82 percent) agreed that employees should not be required to work beyond a regular shift if they say they are too tired or sleepy.

Highlights of the poll can be found on NSF's Web site at www.sleepfoundation.org.

Disaster Training 101

The School of Nursing at The University of Texas at Austin is one of the first academic programs in the nation to offer a course on how to care for victims of a mass casualty event.

"If a mass casualty event like those of Sept. 11 occurs in Austin or anywhere else in the state, nurses at every level will be called upon to employ emergency response skills," said Dolores Sands, PhD, RN, FAAN, dean of the School of Nursing and a Texas Nurses Association member. "Though nursing has had little training or experience with treating victims of weapons of mass destruction, we want our students to be ready."

Earlier this year, Sands was appointed to the International Nursing Coalition for Mass Casualty Education, a new coalition based at Vanderbilt University and comprised of international nursing, medical, military and education experts and organizations, including the ANA.

In the university's elective class, undergraduate and graduate students will learn everything from how to decontaminate victims at an incident site to how to recognize and treat the psychological impact of a mass casualty event on victims and health care professionals. The first course was offered this summer.

Hospital must provide staffing for RN breaks, says WSNA suit

In a lawsuit filed in the Pierce County Superior Court in July, the Washington State Nurses Association charged that Good Samaritan Hospital in Seattle, WA, violated state law by not providing enough staffing for RNs to take rest breaks during their shifts.

Nurses there say that rest breaks play an integral role in keeping them focused and rejuvenated: "Working without rest breaks makes what is already a hectic environment even more stressful," says Jacqueline Williams, RN, who has worked at Good Samaritan for 19 years. "I am very fearful that [without rest breaks] I will make a mistake and harm a patient."

According to Washington state law, employees working in excess of three consecutive hours or a period in excess of four hours total must be allowed a 10-minute rest break. But in the current nurse staffing crisis, some hospitals are functioning without enough nurses to enable those on staff to take routine breaks.

"We are seeing hospitals cut corners in whatever way they can to dig their way out of the nurse staffing crisis Ð whether it's imposing dangerous mandatory overtime practices or making it impossible for a nurse to take a 10-minute break to go to the bathroom," says Cheryl Johnson, RN, chair of United American Nurses (UAN), AFL-CIO, labor arm of the ANA. WSNA is a member of the UAN. "It's got to stop. What hospitals seem not to realize is that cutting corners on staffing will cause more nurses to leave and make an already serious staffing crisis even worse."

Mark Krashin, RN, who also works at Good Samaritan, says, "I've been a nurse for almost 20 years, and I have never felt so tense, angry and frustrated about the current working environment." Krashin noted that rest breaks are critical in allowing nurses to energize themselves to give the best possible patient care. "I am very disappointed in the way Good Samaritan is treating its most experienced employees during the current nursing shortage," he said.

The WSNA lawsuit seeks back wages for paid rest periods during which nurses worked instead. But WSNA spokespeople add that stopping the widespread practice of understaffing Ð not money Ð is the real objective of the lawsuit.

"I think it's great that the Washington nurses are using yet another highly visible route Ð the court system Ð to shine a public spotlight in the increasingly worsening nurse staffing crisis," Johnson added.

ULP upheld for Minnesota nurses

An administrative law judge upheld a National Labor Relations Board ruling that 20 striking Twin Cities RNs who sought temporary employment at other hospitals were discriminated against and denied employment for lawfully exercising their right to strike.

Nearly 1,400 MNA nurses at the Fairview hospitals in the Twin Cities went on strike for 23 days in June 2001.

"This is a significant decision on behalf of our nurses and for others involved in collective bargaining," said Phillip Finkelstein, MNA labor counsel.

"Nurses are the front line of defense for our patients," said Fairview bargaining unit Chairperson Jean Ross, RN. Ross is a director-at-large of United American Nurses (UAN), AFL-CIO, the labor arm of the ANA. "We must be protected in our legal right to act as strong patient advocates -- including going on strike."

Administrative law judge William Pannier ruled that health care employers "committed unfair labor practices affecting commerce by refusing to consider temporary employment and by refusing to temporarily employ" nurses because of their participation in a strike and, in doing so, violated the National Labor Relations Act. The ruling also stated that the nurses involved must be "made whole . . . for any loss of earnings and other benefits suffered as a result of the discrimination against him or her" and stated that employers must pay interest on amounts owed.

"This is a precedent-setting judgment," said UAN Director Susan Bianchi-Sand. "A nurse's determination to strike is both highly personal and professional. We cannot allow her to be coerced in her decision."

Abbott Northwestern Hospital, Mercy Hospital, North Memorial Medical Center, Methodist Hospital, HealthEast Hospitals, Unity Hospital and United Hospital were all charged with unfair labor practices in the ruling.

Workplace advocacy modules strengthen CMA programs

ANA constituent member associations now have another tool to assist their members in acting as effective patient advocates. Protection for the Nurse Advocate is the latest in a series of four modules produced by the ANA's Commission on Workplace Advocacy (CWPA) on "Strengthening CMA Workplace Advocacy Programs."

Protection for the Nurse Advocate outlines the responsibilities of the nurse as a patient advocate and provides avenues for addressing concerns and issues within the work environment, as well as recommendations for taking concerns to the appropriate outside authorities should the desired outcome not be reached internally. The book provides detailed information on whistleblower protection and on other state and national legislation designed to aid nurses in their role as patient advocates.

The first two modules in the "Strengthening CMA Workplace Advocacy Programs" series addressed starting workplace advocacy programs and education on nurse advocacy in professional practice. The final book, due out the end of this year, will detail concrete skills and techniques needed by the individual nurse as a professional entrusted to care for patients and their families. Each book contains the material and statements published by ANA on the topics addressed.

"Through these four books, the Commission on Workplace Advocacy is offering the CMAs one-stop shopping on issues related to workplace advocacy," said ANA Director of Workplace Advocacy Betsey Snow, MPH, RN. "By strengthening their own programs, the CMAs can in turn strengthen professional practice for the individual registered nurse."

Smoking nurses

ANA\California member Linda Sarna, DNSc, RN, FAAN, wants to help nurses quit smoking and involve RNs in tobacco control advocacy efforts.

With nearly $400,000 in funding from The Robert Wood Johnson Foundation, Sarna, along with another nurse who is a tobacco-control consultant, is spearheading the development of a multi- faceted national campaign aimed at the country's largest group of health professionals Ð a group with a surprisingly high rate of smoking.

"Nurses have a tremendous opportunity to assist in tobacco control efforts," said Sarna, a professor at the University of California Los Angeles School of Nursing. She noted that one barrier to conducting smoking cessation intervention with patients is nurses themselves, who at an estimated 18 percent, represent the largest group of health care professionals who smoke.

"In the past, there has been no coordinated effort to support nurses in their own cessation efforts or to stress the critical importance of being smoke-free role models," Sarna said. "During this planning grant, we will work with a variety of nursing organizations and with tobacco control experts to develop a nationwide campaign that will provide nurses who smoke with cessation resources."

NY home care nurses choose union

Registered nurses at Parker Jewish Home Care and Franklin Home Care won NYSNA representation in late July, despite legal challenges that delayed vote-counting at the Franklin agency. The 40 RNs at Franklin voted on June 27, but ballots were not counted until July 26. The 29 Parker nurses held their election July 12.

Nurses at both agencies sought union representation to help alleviate growing patient loads and paperwork.

"Now we feel we can say to administration: 'This is what we do want and this is what we don't want,'" says Nancy Guillaume, an RN at Parker. "We feel as though we have a voice now Ð we have future."

Med error prevention

Abbot Laboratories in Illinois has pledged to affix "unit-of-use" bar codes to all of its hospital injectable pharmaceuticals and IV solutions product lines by early 2003 as part of an initiative to reduce medication errors and enhance patient safety in hospitals.

A 1999 Institute of Medicine report, "To Err is Human," asserted that medical errors contribute to as many as 98,000 deaths in the United States each year. Studies have shown that supermarket- style bar codes can help significantly reduce the risks associated with one type of medical error, which includes the improper dosing or administration of drugs.

Bar coding systems can scan a patient's wristband, the nurse's ID badge and the drug to be administered and then match them with a computerized list.

About one-quarter of Abbots' injectables and IV solutions will use a new technology Ð Reduced Spaces Symbology¨ (RSS), which allows a miniaturized bar code to be applied to single-unit containers as small as a pen cap.

Abbott already has bar-coded about 45 percent of its more than 1,000 injectable pharmaceuticals and IV solutions and projects it will have 70 percent of these products bar-coded by the end of the year.

DCNA win limits on use of unlicensed personnel

In down-to-the-wire negotiations that went to a strike vote, nurses and other health care professionals represented by the District of Columbia Nurses Association (DCNA) at Howard University Hospital in Washington, DC, ratified a three-year agreement Sept. 24 that will limit use of unlicensed personnel and rectify a wage increase given illegally by management to certain nurses last year.

Members of the bargaining unit, which includes 400 registered nurses, pharmacists, social workers and clinical dietitians, had been negotiating with management and working under an extended contract since the beginning of July.

"We fought long and hard for quality and safe patient care, quality-of-life improvement for union members and a fair and equitable contract for everyone," said Gregg Nurse-Ifill, MEd, RN, the president of the DCNA unit at Howard.

The new agreement protects RNs' licenses against the use of unlicensed caregivers by allowing patient care technicians (PCT) to provide care only if delegated by RNs who can also assess their skills. Parties also agreed to a 5 percent retroactive pay increase to July 2001, to be issued within 15 days of ratification, for all unit members who did not receive the illegal wage increase.

The pact additionally includes salary increases of 2 percent yearly over the contract term, a minimum salary for all RNs of $45,848 and a ban on mandatory overtime.

NP helps in recovery of missing 4-year-old

A pediatric nurse practitioner played a key role in the recovery of a missing four-year-old in California.

The child, Jessica Cortez, had disappeared from a Los Angeles park Aug. 11. A woman, who was later booked for investigation of kidnaping, brought the child to a local health care clinic three days later, according to an ABC online news report.

At the clinic, a medical receptionist identified Cortez as the missing girl. Clinic staff then notified police and actively worked to prevent the child or the woman from leaving the clinic until authorities arrived.

Pediatric nurse practitioner Denise Hill helped delay the two by doing "the longest physical exam she had done in her life," clinic Executive Director Jim Mangia told ABC News.

Wound care guideline

The Wound, Ostomy and Continence Nurses Society (WOCN) has released its clinical guideline on the management of arterial, pressure, venous and neuropathic ulcers.

The Guideline for the Management of Patients with Lower-Extremity Arterial Disease is the first in a series of four documents relating to wound care to be released over two years. This guideline is intended for use by physicians, nurses, therapists and other health care professionals who work with adults who have lower-extremity arterial disease (LEAD). It's meant to support clinical practice by providing consistent, research-based clinical information with the goal of improved cost-effective patient outcomes.

"The WOCN Society is grateful to the many nurses, physicians, therapists and others who provided the panel with valuable reviews and suggestions," said WOCN President Laurie McNichol. "The Society hopes that the guideline contributes to the consistent management of patients with this complex health problem, provides a strong impetus for education and offers a framework for future research.

Copies of the guideline can be obtained by writing to WOCN, 4700 W. Lake Ave., Glenview, IL, 60025-1485 or online at www.wocn.org.

Easing dying children's pain

Last Acts, the nation's largest coalition promoting improvements in end-of-life care, recently announced a "blueprint" for better care for children who have advanced illnesses.

The Last Acts blueprint will be used to boost recognition and use of pediatric palliative care among health care professionals. It consists of the following key points:

* Respecting the patient and family's goals, preferences and choices.

* Relieving pain and other symptoms, including emotional distress.

* Using multi-disciplinary care teams, including physicians, nurses and child-life specialists.

* Addressing care-giver concerns, such as respite care and babysitting for families coping with other children at home.

* Building systems of support for palliative care through research, innovation, education and sharing of best practices within the field.

ANA is one of more than 950 partners in the Last Acts communications campaign. For more information, go to the Last Acts Web site at www.lastacts.org.

Get vaccinated

The Visiting Nurse Associations of America (VNAA) is urging high-risk persons and the elderly to get vaccinated for the flu during October and calling on healthy Americans to receive the vaccine in November and December.

The Centers for Disease Control and Prevention's (CDC's) timetable for the flu vaccination is a sensible approach, according to Carolyn Markey, VNAA president and CEO.

"CDC's recommendations are designed to help ensure flu shots are administered first to those who need it most in October, and then to everyone else in November and later so that we can all be protected against influenza in time," she said.

Among the high-risk groups for whom October vaccination is recommended are persons 65 years old and older; children and adults with chronic pulmonary disorders, including asthma; residents of nursing homes and other facilities housing persons with chronic illnesses; and children and adults who have diabetes, or heart, kidney or liver disease.

All healthy persons, including those 50 to 64 years old, who want to reduce their risk of contracting influenza should seek vaccination in November, December and later in the season. Since flu activity peaks in January through March, vaccination later in the season is still beneficial, according to the VNAA.

For more information, go to VNAA's Web site at www.vnaa.org.

Going Hollywood

The American Association of Health Plans (AAHP) announced this summer that it is retaining Hollywood talent agency William Morris to build bridges between health plans and the entertainment community.

"More Americans receive their health care information from Hollywood than from the nightly news, yet most groups in Washington focus on news media and entirely ignore the entertainment community," said Karen Ignagni, AAHP president and CEO. "We can't afford to be so dismissive. We have a responsibility to keep Hollywood up-to-date on how health plans help women with mammogram screenings, how we care for over 500,000 individuals who live with HIV and AIDS and how we keep health care more affordable for all Americans."

AAHP says that in the months ahead, William Morris will help it navigate the Hollywood community and foster a meaningful dialogue with producers, write and directors about the complex challenges of modern health care.