Hill Day for Nurses 6/21/18 and the Need to Act to Restore Justice

On Thursday, June 7, 2018 the United States Department of Justice indicated it will no longer defend the Affordable Care Act’s protections for patients with pre-existing conditions. Department of Justice. Yes, you read that correctly. Merriam-Webster’s dictionary lists as it’s first entry for the definition of justice;

the maintenance or administration of what is just especially by the impartial adjustment of conflicting claims or the assignment of merited rewards or punishments :meting out justice: social justice.

It is unfathomable what this administration considers to be just, just action, or justice. But it is clear that justice is not for the many, only for the few who can pay the entry fee. This runs completely contrary to the four essential ethical principles which underlie nursing and medical practice – beneficence, nonmaleficence, autonomy and JUSTICE. Justice, in a civil society, requires that all people be treated equally under the law. Justice ensures that the weak are not steamrollered by the strong, and have access to important resources such as food, clean air and water, shelter, and reasonable medical care. Are we not a civilized society?

Apparently not, if this administration continues to destroy our environment, deny people essential dignity, and reap financial gain by preying upon the most vulnerable. It makes me want to both cry and vomit. #Cromit, I guess…

What can we as nurses do? Ask yourself, what would Flo do? Get involved! The American Nurses Association Hill Day is on June 21st this year. I know it’s coming up fast, but if you can possibly make it, it promises to be a phenomenal opportunity to speak directly to those who are charged with representing us in this government. You can learn more (including discounted hotel rooms and how to register) by reading the ANA’s Capital Beat post from June 12, below:

http://anacapitolbeat.org/2018/06/12/trump-administration-again-takes-aim-at-pre-existing-conditions/

And please, please, please, whatever you do, #Vote.

 

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The “Gag Rule” – Trump’s Kowtow to the Religious Right. How we can Fight Back.

Title X provides federal funding for family planning services. Organizations like Planned Parenthood utilize this funding for services such as ;

  • Wellness exams
  • Lifesaving cervical and breast cancer screenings
  • Birth control
  • Contraception education
  • Testing and treatment for sexually transmitted diseases (STDs) and HIV testing.

These services are provided at affordable rates to low-income patients, thanks in part to this funding source. However, a cabal of conservatives has requested that Trump issue a rule that would  effectively ban Planned Parenthood and similar organizations from providing abortion and related services under the same roof as operations funded by federal family-planning grants, according to an administration official. This includes offering patients information and/or referrals to safe abortion providers. This rule would effectively do three things to the Planned Parenthood clientele – 2/3 of whom are below the federal poverty level in terms of income –

  1. Impose new rules designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood.
  2. Prevent health care providers across the country — including doctors, nurses, hospitals, and community health centers — from referring their patients for safe, legal abortion.
  3. Remove the guarantee that patients get full and accurate information about their health care from their doctor.

Just at the moment when historic gains are being made in Ireland regarding a woman’s right to control her own reproductive system, this rule seeks to take the  United States backward to a time when women had little to no control. Shades of The Handmaid’s Tale.

Physicians and nurses have considerable clout. Doctors because of their well-funded lobbying efforts and socioeconomic status. Nurses have two things: sheer numbers and the confidence and trust of the American People. Nurses have now been for 16 years voted the most trusted professionals in this country. It’s time to join our collective voices and advocate for those who cannot – namely the marginalized, socially, economically, and culturally disadvantaged.

OK, so maybe you don’t believe in abortion except in cases of rape or incest. Well, then you do believe a woman should have a right to an abortion, based upon the reason. Who is to judge what is a good or valid reason? If you agree that a woman who was raped should not be made to carry to term, then you believe in abortion rights. Period. You can’t pick and choose the reason. The Supreme Court has again and again reinforced the constitutionality of a woman’s right to choose.

If you believe that no women should be able to have an abortion, then you must also care for their children by providing a safe home, adequate food and health care, education, and support for the parent’s ability to obtain decent child care. Failure to do so rescinds your moral high ground. Christ implored his followers to clothe the naked, feed the hungry, take in those in need in Matthew 25:35-36, “For I was hungry and you gave Me something to eat, I was thirsty and you gave Me something to drink, I was a stranger and you took Me in, 36 I was naked and you clothed Me. I was sick and you looked after Me…” I believe that is pretty clear directive – as we know he goes on to say that whatever you do for the least of his brothers is done directly unto him.

What can you do if you would like to fight the gag rule? You can submit comments to the Department of Health and Human Services via this website

https://www.weareplannedparenthoodaction.org/onlineactions/yOKxyIomxUO-EFoTcvQbHg2?_ga=2.91165785.213420659.1527432943-1212086471.1527432943

You can call/write/text/email your Representatives in congress to ask them not to support this effort to take needed health care services away from those with the least ability to pay. Please, help. So many people are depending upon Nurses to take a greater role politically. The IOM said as much in its vision for the future of health care. Now is the time.

 

 

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Nursing: The Last Ethical Profession? Ethics and mHealth – Published.

It is well known that nurses are the most trusted professionals in the United States. Perhaps this is due to the immutable and fundamental nature of ethics in nursing. The complete LACK of ethics, respect, integrity and honesty in our political system presently, embodied by the person occupying the White House, is appalling. As nurses, we continue to fight the good fight in our jobs. But we must do more, we must # resist on every level.

I had the honor of having another article published in the Online Journal of Nursing Informatics. The link is below. It deals with ethical design for mobile health applications. As nurses, we work to ensure that ethics permeate every aspect of our profession. Now it is time to ensure that this commitment extends to every aspect of our lives. The American Nurses Association offers any number of ways to be involved. Let’s do this… after all – #whatwouldflodo ?

 

Here’s the link to my most recent publication:

http://www.himss.org/library/using-classical-ethical-principles-guide-mhealth-design

 

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Diversity in Nursing, and in our Nation – We Must Protect our Greatest Strength

MULTICULTURALCAPELLAGRADSBuilding a nation of immigrants was long considered America’s greatest strength, and many of our fine Presidents have expressed this eloquently. George Washington, arguably the country’s founding father, said, “The bosom of America is open to receive not only the Opulent and respected Stranger, but the oppressed and persecuted of all Nations and Religions; whom we shall welcome to a participation of all our rights and privileges…” Woodrow Wilson is quoted as saying, ““We came to America, either ourselves or in the persons of our ancestors, to better the ideals of men, to make them see finer things than they had seen before, to get rid of the things that divide and to make sure of the things that unite.”  Franklin Roosevelt is blunt, “Remember, remember always, that all of us, you and I especially, are descended from immigrants and revolutionists.” Unless a person is a Native American, we are all immigrants. Period.

More recently, George W. Bush considered this subject and stated, “Nearly all Americans have ancestors who braved the oceans – liberty-loving risk takers in search of an ideal – the largest voluntary migrations in recorded history… Immigration is not just a link to America’s past; it’s also a bridge to America’s future.” The photo above was taken last week at Capella University’s commencement ceremony. These five women earned their Master’s of Science in Nursing (MSN), specializing in the area of Informatics. They represent President Bush’s prediction that immigrants are America’s (and nursing’s) future. Each one is either an immigrant or a first-generation American. They represent diverse heritages – Jewish, Jamaican, Nepali, Polish, and Hispanic. All are under attack at this terrible time in our country’s history – by neo-Nazis, white supremacists, racists, xenophobes, and the current administration. Why?

The politics of division. Adolf Hitler used this strategy in Germany to upend a society, brainwash and corrupt a citizenry, and murder 6 million innocent people. Because they were not considered “white enough”. Unthinkable in today’s world? Unfortunately the Dylan Roofs of this country continue the tradition of murdering innocents based on nothing more than the color of their skin or the religion they practice. President Wilson said we must get rid of the things that divide. How can we let this continue?

Nursing leaders understand the importance of culturally competent care. National standards for culturally and linguistically appropriate services in health and healthcare (CLAS) have been established by the federal Department of Health and Human Services (HHS). Diversity in the nursing workforce is slowly manifesting, but if this photo is any indication, diversity in nursing leadership is rapidly on the rise. We are tasked to practice in a culturally competent manner. But we need to to more. We must #resist. We must work together with the American Nurses Association to advocate for health care for all, for sane immigration policies, for continuation of the Dream Act, for strengthening of the Affordable Care Act, for the health of our people and our nation.

The current administration’s efforts to build a wall are antithetical to George W. Bush’s view of immigration. This policy direction is unacceptable. It’s un-American. We must take action, and build President Bush’s bridge to the future. It’s the only way to make America great again.

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Northern Michigan Nurses and Community Organize Against Unsafe Staffing…Might they Strike?

Try to run a hospital without nurses. It can’t be done. If people didn’t need nursing care, they would go home. The hospital runs on the backs of the nurses. You can’t pull people from other departments, or cross-train employees. So… if the nurses go on strike you either have to hire a tremendous number of replacements at huge cost (who would still need orientation to the various units and policies), or close. It’s possible the folks at Duke LifePoint have underestimated the “sisu” or just plain guts of the people in the Upper Peninsula of Michigan, because the nurses have struck before and they could do it again.

Nurses at Duke LifePoint’s Marquette General Hospital took to the streets yesterday, to protest the administration’s refusal to address their concerns about unsafe staffing. Supported by community members, hundreds of people gathered in this small, somewhat isolated community in Michigan’s Upper Peninsula, to march with staff RN’s. The nurses had collected and delivered over 3700 signatures on a petition calling for the hospital to bargain in good faith regarding staffing. The petition reads: “I am signing this petition to urge Duke LifePoint/UPHS Marquette to bargain with nurses for an agreement that ensures guaranteed minimum RN staffing levels that are safe for patients, in every department and on every shift.”

The nurses, in contract negotiations since April, are requesting that language be inserted that establishes minimum nurse staffing levels. Although they had agreed to a two-month extension of the previous contract, that contract lapsed in late July due to the administration’s refusal to address staffing levels. Scott Balko, RN – President of the Marquette RN Staff Council/Michigan Nurses Association – described the situation saying, “Duke LifePoint understaffs and overworks nurses to the point that quality of care is compromised. Patients at UPHS Marquette deserve better. Nurses are fighting for safe staffing, and the success of our petition shows that members of this community are with us.”

What may be unique about the Marquette RN Staff Council (RNSC) is it’s history and longevity. Visionary nurses in the 1960’s saw the need for Marquette’s nurses to be represented by a professional labor union. In 1968, the National Labor Relations Board certified the election that established the Michigan Nurses Association (MNA) as the entity representing the RNSC in contract negotiations. The RNSC is now the professional labor organization of the Registered Nurse staff at Marquette General Hospital, which is represented by MNA and affiliated with the AFL-CIO. In the last 45 years, although more than a dozen contracts have been successfully negotiated, the nurses have gone out on strike twice. They could do it again.

Previously the hospital responded by merely stating that there is a national nursing shortage. This is not true in Marquette, where Northern Michigan University graduates BSN’s twice a year (December and May), and any number of other Upper Peninsula universities and community colleges offer LPN, ADN, and BSN, and RN-to-BSN programs. In fact, the hospital has been laying off nursing staff. Marquette is in the unusual position of having an RN surplus!

The hospital updated their response after the petitions were delivered, now claiming that, “UP Health System – Marquette takes very seriously our commitment to deliver high-quality, safe and compassionate care close to home, and we strive daily to create excellent workplaces for our employees. In regard to today’s events, we respect every person’s right to assemble and speak freely, and we value the input of everyone in our community. We are unable to comment further because we are currently negotiating with the Michigan Nurses Association union to develop a contract that meets the needs of our nursing staff and hospital.”

If they want to develop a contract that meets the needs of the nursing staff and patients, they are going to need to put their money where their mouths are. Otherwise, they may be faced with no nurses…and no patients. It is unwise to test the mettle of a Yooper (people who live in the Upper Peninsula). Especially when they are advocating for patient safety.

 

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Nurses Stand in Opposition to the AHCA

The image above comes from NBC news, capturing the “Writers Resist” rally on the steps of the New York City Public Library. What does it have to do with nursing? A lot. The American Nurses Association has been against the proposed “American Health Care Act” from the beginning. The new iteration passed by the House is perhaps even worse than the original version. This has sparked protest by diverse members of society, and broad-based opposition.

So says Gregory Craig, health policy analyst for the American Nurses Association. Rather than restate what he has written, I encourage you to visit his blog at the link below.

http://anacapitolbeat.org/2017/05/10/broad-based-opposition-to-the-american-health-care-act/

As nurses, we must stand united and #resist all efforts to take health care away from the most vulnerable citizens of our country, simply to provide tax breaks to the wealth. It violates every ethical principle that we embraced when we became nurses, and undermines the efforts of our profession to advocate for health and wellness for all.

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Medicaid Expansion Fiscally Sound: Trump Policy – Not So Much…

The powerful image above is Dr. Pamela Cipriano, President of the American Nurses Association (ANA) addressing Congressional staffers. The ANA is the voice of nurses in this country, and advocates for better health and health care for all. The link below will take you to an article explaining the title of this post. Simply put, offering people primary care through Medicaid keeps them out of the Emergency Department, ultimately saving money all the way around. Trump has decided to undo his predecessor’s freeze on funding uncompensated care for states who refused to expand their Medicaid programs as offered by the Affordable Care Act. Not a good move.

States who refused federal funding to expand Medicaid did so out of political spite and fear of criticism by the extreme right wing of the Republican party. They did so not thinking or caring one bit about the people who live in their state. They did so knowing their actions were fiscally irresponsible and detrimental to the health of their constituents. Really? How much longer can we keep this farce going?

Thanks to the ANA for its continued advocacy on the part of those who are vulnerable, uninsured and clearly unrepresented. Inform yourself. Call your Congressional representatives. Be a part of the solution. #Resist !

http://anacapitolbeat.org/2017/05/02/new-study-highlights-positive-experiences-of-medicaid-enrollees/

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And Now for Some Good News: RN to BSN with Finlandia University

Rural nursing is a completely different type of practice, considered by some to merit a sub-specialty of its own. Rural nurses must have a generalist type of practice, and understand challenges their patients face including distance to care, lack of insurance, adverse weather conditions, and cultural barriers to accessing care. Such is the case in Michigan’s Upper Peninsula (the Yoop).

Mark Miron, director of Finlandia University’s RN to BSN program was kind enough to speak with me today regarding his program. I have been researching virtual reality simulation as a means to facilitate clinical or practical course content delivery for online, rural learners in RN to BSN programs. Typically, clinical placements are difficult to find and there is only limited course content regarding culturally competent care. Not so at Finlandia!
At the time that Mr. Miron took over the program, there were only two or three enrollees. By altering the pricing to be competitive with the majority of online programs and enhancing marketing efforts, he was able to grow the program to its current enrollment of about 20 students. While most students come from the Yoop, there are several learners from “downstate” Michigan and a few out-of-state. In his RN to BSN curriculum, he highlights culturally competent care, offering an entire course devoted to spirituality in health care. He also weaves threads of cultural competence into Mental Health Nursing in the regular undergraduate Baccalaureate program, which offers an elective specific to nursing in Finland called “Finland Connection”. Perhaps the most impressive cultural offering in Finlandia’s nursing curriculum – and one Miron is very proud of – is a trip to Tanzania for BSN students, including those in the RN to BSN program. While there, students have the opportunity to spend a week learning about health care challenges for this country’s population at Muhibili National Hospital in Dar es Salaam. It’s the only major hospital in a country of 45 million people. Staggering.

Mr. Miron views growing enrollment as the largest challenge facing his program. Although he has made significant progress, the administration would be happy to see the program expand even further. With growth come challenges of accommodating all learners in terms of faculty and other resources. But with their unique “price guarantee” this seems like it should be do-able. Finlandia offers one price – $15,000 for all RN to BSN learners regardless of number of credits needed. Whether a student needs 30 or 54 credits to graduate, once they hit $15,000 of expense they will receive no more bills. Guaranteed. Students have as long as 5 years to complete all curricular requirements. For students needing upwards of 48 credits, this is an incredible offer as compared to tuition rates from online giants such as University of Phoenix, Kaplan and SNHU.

Kudos to Mark Miron and Finlandia University for prioritizing the needs of working nurses striving to earn their BSN online, while ensuring that cultural competence is an essential part of their coursework. There is one aspect of Yooper culture, however, that is difficult to overcome. Folks up here are typically stoic. According to Mark, health care culture in the Yoop is exemplified by the proud statement, “I haven’t been to the doctor in years!” Perhaps one of his graduates will design a program to crack this nut. In the meantime, this little jewel of a program should get more attention.

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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:

http://campaignforaction.org/lights-camera-action-inside-scoop-highlights-work-aarps-nursing-center/

Let’s keep it going!

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