Saturday, June 26, 2010

Let Down

No, this has nothing to do with breast feeding. This post is really a non-healthcare topic but I just needed to vent. Back in the Winter, I blogged about my passion for technology and looked forward to the new iPad coming out. To preface, I have always been a PC guy and never really understood the whole Apple fascination. I had many PCs and was very comfortable troubleshooting any issues I had. Though, I did have many different of the iPod models and had purchased the 3G iPhone back in October 2008. Well, I did decide to purchase the 32 GB Wi-Fi iPad and hopped on board the Apple gravy train. I woke up early that Saturday in April and headed on down to wait in line at my local Apple store. Overall, I am happy with my purchase as I knew it wasn't really a replacement for any device that I'm currently already using. This for me was really a "nice to have" rather than "need to have" purchase.

I do have an issue with the device which is known by Apple and they still haven't adequately adressed it: the iPad loses my WiFi connection frequently. Apple's response has been to blame the router or to adjust the screen brightness. These "solutions" haven't worked for me. I have been able to find a work around of sorts: when the signal is lost, I press the sleep/wake button and then turn it back on. It reconnects without me having to re-enter my network password (which is highly annoying to do repeatedly). As far as I'm concerned Apple's response is to place blame on anyone but them.

In May, my Dell laptop crapped out and I was forced to look for a replacement. I decided to jump aboard Apple again and purchased a 15" MacBook Pro. This by far is the best laptop I've ever owned and am very pleased with it.

This brings me to my recent iPhone 4 upgrade. I was one of the lucky "few" to reserve a 16 GB iPhone 4 (via the Apple Store app on my current iPhone). I ended up waiting about 1 1/2 hours total on Thursday 6/25 at the Apple store from start to finish - which wasn't that bad considering that some people were waiting many many hours in line. The phone is beautiful itself and is so much faster than my old 3G. But, I am experiencing the dreaded loss of signal reception issue when I hold the phone in my left hand. This is a major issue. To date, Apple's response has been again to blame everyone else ("hold it in your other hand," "you are holding it wrong," or "get a case for it.") Incidentally, I would've bought their $30 piece of rubber they call a "bumper" but they were already sold out at the Apple store when I got there. I ordered one on-line and I am still waiting for it to ship. (Still, $30?!?!)

I am profoundly disappointed in Apple's responses to these well known and ubiquitous issues. To shift the blame to others in completely unacceptable. As a clinician, I take the responsibility for the care that I render and the buck stops with me. Apple should do the same and quickly.

Friday, June 18, 2010

Happy Father's Day - Get a Prostate Exam


With Father's Day just around the corner, now is a great time to remind all men about prostate health and screenings. Follow the link to a video from the Prostate Cancer Foundation.

Happy Father's Day to all Dad's out there!

Thursday, June 17, 2010

Obama: "America's Nurses are the Beating Heart of our Medical System."

Here is President Obama's speech to the American Nurses Association from 6/17/2010.

He specifically refers to NPs by stating:

Now, there is more work to do. And that's why today my administration is announcing a number of investments to expand the primary care workforce. This includes funding to allow students training part-time to become nurse practitioners to start training full-time. (Applause.) We want to speed up the process where folks go from the classroom into the exam room. And we’re going to provide resources for clinics run by registered nurses and nurse practitioners. (Applause.)

More work to do indeed.

Monday, June 14, 2010

NY Newsday Article on NP Practice

Here is an article from NY's Newsday about NP practice and the goal towards the elimination of statutory collaboration in New York. It's a fairly predictable piece with the typical opposition from the organized medicine playbook (How many times do we have to see "If they want to play doctor, they should go t o medical school" in print? Seriously).

Nonetheless, thriving NP practices are mentioned and show the significant impact that NPs are making in the lives of patients and in the health care system.

I will mention it again as I've done countless times in my blog: NPs do not want to replace physicians and are NOT looking to change scope of practice (The presence of a collaborative agreement or not will have no impact on the quality of care I deliver but not having one in place simply renders me unemployed). I do hope that the vocal opposition eventually understand this so that we may begin to deliver care that is truly patient centered.

UPDATE: I did something that I told myself not to do: I gave in and read the "comments" section following the article. Wow. There really is a total lack of understanding about nurse practitioner practice, education, licensure, and certification requirements. So sad. We need to do a much better job so that the public understands who we we are, what we can and can't do and not be portrayed as a less than competent option.

Guest Post: Nurse Walkout Highlights Conflict With Hospitals and Health Insurance Plans

Nurse Walkout Highlights Conflict With Hospitals and Health Insurance Plans

Ideally, all interests in the health care system should work together towards a common goal: the welfare of the patient. Unfortunately, nurses have been pitted against hospitals and the health insurance industry.

The Obama administration's healthcare reform legislation will squeeze insurers and hospitals alike. Medicare payments to facilities are set to be cut over the next several years, and private health plans are set to follow suit.

In order to prepare for these changes, many hospitals are looking for ways to maintain their margins. One of the most common methods is through staff cuts. Nurses, being on the front lines of providing health care services, are largely vulnerable.

Nursing unions in Minnessota and other states are going on strike to protest staffing cuts. While they are certainly concerned about their own pay and benefits, some hospitals may take their cost cutting too far and put patients at risk.

Although it makes them look good to health insurance plans desperate to lower provider payments, understaffed hospitals with overworked, tired nurse practicioners may result in higher rates of medical errors, or even death. Among the nurses' demands during the one-day walkout is a minimum nurse-to-patient ratio. However, the ideal level of staffing is subject to significant debate.

This is a complex issue, especially since the cost of health care has only continued to soar. Health insurers, hospitals, and the subset of well-paid licensed nurse practicioners have each been targeted as the source of the current predicament American health care finds itself. Healthcare reform has only exacerbated the conflict, encouraging the blame game. Regardless, patient safety cannot be sacrificed in the midst.

Guest post submitted by: Yamileth Medina, VitalOne Health Insurance Blog

Submit a guest post to anpview at gmail dot com.

Friday, June 11, 2010

Guest Post: Ageism in nursing, oh my.

Any “older” PhD students out there? This is my latest update in my quest for funding. Enjoy the humor of it all.

As SNL host at the age of 88, Betty White proved she still has it; UConn Coach Calhoun, age 68, is going to get it (5 years and 13 million). So, it is with some cheek that I submit this treatise on aging in the world of academia. I mean, after all it is 2010; but a funny thing happened to me on the way to a fellowship. I am not a victim; I am an unabashed overachiever. I have no apologies for striving for more: more life, more liberty, and more happiness. The happiness for me comes in part from my family, a new “grand” coming in August, my work, my scholarship and my research. My work as a Nurse Practitioner is caring for the vulnerable aging, and the patients, families and communities suffering with dementia. My scholarship and research is from my new road to academia, specifically a Doctorate in Philosophy. My community knows I am striving to be a Doctor-Nurse. I started the PhD curriculum at the wizened age of 50, after an accomplished military career and success in critical care nursing.

I believed I had all the tickets punched, after all, I had been a Commander in the Navy Nurse Corps, ran rings around the residents in the Intensive Care Unit, carried a full academic load, volunteered at professional organizations and helped coach novice YMCA scullers to boot. I developed a program of research. My conceptual framework is nursing theory based, and embraces an achievable comprehensive model to diagnose, treat and support dementia families. I chose incredible advisors, coursework and research projects. I combined my forte of networking with that of grantsmanship principles for a pre-doctoral scholarship application to a prestigious geriatric foundation. I personally commend any and all candidates for merely completing any submission for scholarships or fellowships. Aging is not for sissies and neither is the arduous grant application process. But, I digress.

The upshot: the review board did not select me. My personal failure was not that I submitted an inadequate, sloppy or mediocre package. No seriously, the critical factor I failed was my age; I wasn’t five or ten years younger. That word trickled down to me from conflicted reviewers, who just about whispered the secret, fearful of backlash. When I called the chair and board on it, they didn’t deny it. And what I have since realized is that some people think I am being too dramatic (oh really!); it is only a trivial infraction (really? really?); the board practices in a utilitarian manner (really.); if you fuss, you are burning bridges (so, really.); and, get over it (reeeally!). So be it. But I love a cause and the dialog is good substance for my journaling (and sharing with you). Again, I digress.

Ironic, isn’t it, that in a geriatric rich field of clinicians, educators and researchers, we too have to deal with ageism? We, as nurses, are challenged to think outside the box, tasked to see every person as an individual, and make meaning from each unique experience. We are bound to principles of ethics, honesty and parity. President Obama remarks that in healthcare we need to make difficult choices for stewardship and it’s about odd-ratios and gambling with money versus long odds for a potentially small payout. I counter that we do need to make difficult choices, but we need to be inclusive, culturally competent, and see the individual as just that, an authentic individual.

I was eager to bond with that geriatric foundation because of their superb alumni, their critical acclaim of success, and a shot at professional connection to awesome role models, which naively I thought to demonstrate in my own career. Their stipend would help… hey I have a mortgage payment and financial commitments too! So did the foundation fail me? No, they were playing the odds… and life can be unfair. It is so apt (and LOL), that while I suffer the blues from premature aging, we are deciding a new Supreme Court Judge who will most likely rule until they are 85. So, anyhoo, I am not part of the club, but I am on to other fruitful endeavors and challenges.

But, I would add in conclusion, the foundation is underachieving. It dismisses hardy candidates, clings to unwritten antiquated rules, has cautious agendas and devalues precious assets. It is what it is: ageism. My final salvo: Read the literature and let’s address this head-on, because in our profession when the average nurse age is 47, age discrimination affects hiring, promotion, retention, academia, tenure, research grant money, and fellowships. Oh, and by the way, to the scholarship selection reviewers and advisory board: remember each year I get older, you do too.

Now I’m done… really.

This is just my opinion, I may be wrong (nod to Dennis Miller’s rants). Go Huskies Coach Calhoun. Betty White, you rock.

Living the dream. Elle

Guest post submitted by Elle who blogs at Doctor-Nurse (PhD:o)

Submit a guest post: anpview at gmail dot com.