Monthly Archives: February 2017

Travel Ban, Boehner, and Obamacare – The Importance of Sane Policy

The photo above was taken on the last day of  #HIMSS17, the Health Information Management Systems Society’s (HIMSS) 17th (inter)national conference in Orlando. The people are all “program assistants” – students who were selected by a very competitive process to attend and assist with the conference. I was fortunate to be one of them.

But look closely. As a white American woman, I was not really “one of them”. I was in the minority. The students were from all over the world –  Nigeria, India, China, Latin America, Singapore, and some were from the USA. But as an old white woman, I was an anomaly. These are the best and the brightest in the world of health information technology (HIT). We are made stronger by their presence in our country.

It was at HIMSS17 that John Boehner uttered the now famous words that a full repeal and replace of Obamacare is, “not what’s going to happen”. I saw it. I heard it. I believe it. Also brought up in the keynote discussion between former Speaker Boehner and former Pennsylvania Governor Ed Rendell was the fact that 30% of the American People want to repeal Obamacare but keep the Affordable Care Act. Oy vey.

How can we educate the American People as to the importance of allowing immigration which benefits all of us, and informing themselves about health care policy and what it truly is and means for them? It’s up to each one of us to continue to #resist and educate our fellow Americans as to the realities in today’s health care sector. Our health depends upon it.

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The Future of Nursing is…Now!

I’m at #HIMSS17, seeing all of the people who are shaping the future of health care in our country. How many nurses? Not a whole ton. HIMSS stands for the Health Information Management Systems Society. Health care is increasingly being defined by technology and data. This is not a bad thing, as we want to move into a system in which evidence-based practice is the norm rather than the exception. In this case, the transition cannot be gradual.  Value-based reimbursement is a reality. This impacts providers, systems, and clinicians in the immediate future. Sometimes it’s hard to adapt.

Change management and collaboration are two themes that are continuously emerging at HIMSS17. Clinicians have to see and believe in the benefits that technology has to offer. Disparate software systems/vendors need to step up to the plate in terms of interoperability and establish a means to facilitate the flow of information. It’s just that simple.

Kudos to those who are actively involved in the quest to make this happen. One thing I have learned as a result of this experience is that we need to keep the patient, a human being, squarely in the focus as the most important player in this scenario. Nurses are uniquely positioned to do so.

By empowering nurses to bring their training and skills into the provision of primary care services, everyone wins. Legislation to allow APRNs to practice unrestricted in the VA system was the first step. We must continue to insert ourselves into all conversations, and take our rightful place within the industry as the largest group of care providers in the country!

Recent progress in this regard was reported by the ANA here:

Let’s keep it going!

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Trump Travel Ban Bad for Veterans’ Health Care and the VA

The writer is fortunate to have the time to read several news feeds including the American Nursing Association’s (ANA) “Smartbrief” and Medscape’s various updates. In both of these, analysis of recent political action demonstrates the gravity of the repercussions from poor policy making.

Donald Trump issued an executive order recently, banning immigration from 7 countries with largely Muslim populations and suspending the Visa Interview Waiver Program. According to a recent article in the New England Journal of Medicine, this is causing not only chaos, fear and uncertainty, it is undermining medical education and patient care (Ault, 2017).

Physicians have expressed widespread opposition to the ban, stating that it threatens the very foundation of American medicine – the free exchange of ideas, experience, and perspectives. But it affects them on more than just a philosophical level. On an individual level, fear is palpable among patient and physicians, who are unsure of their immigration status. A shortage of primary care and internal medicine residents is also a likely result. More than 50% of the internal medicine residency slots are filled by international medical graduates. These Residents care for America’s veterans in VA facilities, and any number of underserved populations. Some international medical students were not allowed to board their flights back to the US when the ban was issued. Others are in the process of obtaining a Visa. A large number of residents and medical students originate from Muslim-majority countries, and their inability to enter the country would deeply impact primary care for these vulnerable populations (Ault, 2017).

The numbers are there. Medical school graduates from Iran, Iraq, Syria and Sudan accounted for 753 applications for Internal Medicine residencies in 2013, and 40% of these were matched into a program (got a job as a Resident in the US). In addition, 1879 doctors in the US were here with J-1 Visas in 2015. J-1 Visas require that these doctors return home for 2 years after finishing their training, unless they take jobs in medically underserved areas (Ault, 2017). The impact on primary care and vulnerable populations is clear.

The writer can attest to this. Her daughter is a first-year Resident in an Internal Medicine. Previously, she studied medicine in downtown Detroit at WSU. In both cases, she has worked at VA facilities, and with underserved and vulnerable populations. Should this country be unable to fill its Internal Medicine Residency slots, veterans and minorities will suffer.

The medical community has come together to advocate for allowing qualified international medical graduates to enter the United States, regardless of country of origin. Residency programs’ selection committees are already reacting to the ban, altering their rankings of applicants based on country of origin – essentially discriminating against qualified young physicians on the basis of race and religion (Ault, 2017). This is not only ethically repugnant, it diminishes the quality of medical care for all. As nurses, we must advocate for quality care for all of our patients, and stand with physicians against this ill-advised policy.


Ault, A. (2017, February 2). Trump immigration order causing chaos for medical centers: NEJM [Blog post]. Retrieved from


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Nursing Informatics and the Metaparadigms of Nursing…published!

This must be what everyone feels like when their first article is published in a peer-reviewed journal. This month, the Online Journal of Nursing Informatics published a paper I submitted to them about 8 months. ago. It offers a rudimentary model for informatics practice, based on Florence Nightingale’s metaparadigms. The link is below.

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