Tag Archives: advocacy

Celebrate the Opportunity to Do What is Right this Fourth of July…

We have all heard that “freedom isn’t free”, and that it is our armed services who are preserving our freedom. Not so much in this digital age. The Senate Select Committee on Intelligence released it’s investigative conclusions yesterday (July 3, 2018), which support the findings of the joint efforts of the NSA, CIA, and FBI. These findings include,

We assess Russian President Vladimir Putin ordered an influence campaign in
2016 aimed at the U.S. presidential election. Russia’s goals were to undermine
public faith in the U.S. democratic process, denigrate Secretary Clinton, and harm
her electability and potential presidency. We further assess Putin and the Russian
Government developed a clear preference for President-elect Trump.

We also assess Putin and the Russian Government aspired to help President-elect
Trump’s election chances when possible by discrediting Secretary Clinton and
publicly contrasting her unfavorably to him.

Russia’s intelligence services conducted cyber operations against targets
associated with the 2016 U.S. presidential election, including targets
associated with both major U.S. political parties. We assess Russian
intelligence services collected against the U.S . primary campaigns, think
tanks, and lobbying groups they viewed as likely to shape future U.S. policies.
In July 2015, Russian intelligence gained access to Democratic National
Committee (DNC) networks and maintained that access until at least June, 2016.          Source: https://t.co/YFXgwl3BG9

As you gear up to celebrate, please prepare to enter into the most important battle for our freedom yet – one that depends not upon the military but upon civilian action to actively #resist, to speak out to #vote and to take back our country from foreign powers and puppet presidents. We, the nurses of this country, have pledged to do what is right for our patients, and to maintain a strict code of ethics. It’s now time to apply that to our country as the population to be cared for, to fight for, to know that our very values and fundamental structures are being subverted and to work against that subversion by all means possible. Please support the young people on their #RoadToChange, the #MarchForOurLives, and all efforts to use our #VoicesandVotes to remedy this situation.

Please. Ask yourself, what would Flo do?  Resist. It’s the only truly patriotic thing to do.

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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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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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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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APRNs Gain Prescriptive Authority in Florida

The image above was utilized in a blog post today concerning legislation about APRN prescriptive authority in Florida. The entire post can be found at http://floridapolitics.com/archives/204484-florida-nurses-association-praises-huge-victory-nurse-practitioners-physician-assistants, and it reads:

The Florida Nurses Association applauded lawmakers Friday for passing a bill allowing advanced registered nurse practitioners and physician assistants to prescribe controlled substances, a measure the group had put before the legislature for 22 years.

“It’s been a long battle, and well worth the fight,’’ said FNA Executive Director Willa Fuller in a news release. “The passage of this bill is a huge victory for nurses and patients.”

Sponsored by Sebring Republican Rep. Cary Pigman, a physician, and Miami Shores Democratic Rep. Daphne Campbell, a nurse, HB 423 would make Florida the final state in the union to allow ARNPs to prescribe controlled drugs, such as painkillers or ADHD medicine.

“The FNA has advocated for this prescribing legislation since 1993, when the organization convened a task force of advanced practice nurses and midwives,” the release states. “The first controlled substance prescribing bill was filed by state lawmakers in 1995. The legislation has been filed in 21 of the past 22 years the Florida Legislature has met. This year, lawmakers named the legislation after former FNA lobbyist Barbara Lumpkin.”

The Senate passed the bill Friday with a unanimous vote, kicking it back to the House with a pair of minor amendments by Republican Sen. Denise Grimsley, who is also a nurse. The chamber passed the bill 117-to-1, with Tampa Democratic Rep. Janet Cruz casting the lone vote against the bill.

HB 423 now heads to Gov. Rick Scott.

This legislation was sponsored by two legislators, one a physician and the other a nurse. It took twenty-two (22) years for the Florida Nurses Association to get this passed, but it has finally happened.

Supporters of Ken Yonker’s HB5400 in Michigan, take heart! Don’t give up! By persistently and clearly identifying the benefits of unrestricted APRN practice in reducing areas of primary care shortage, the legislature will come around. Did you contact your legislator yet? If not, please do so. It will take all of us (hopefully not 22 years…).

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New Hope for Nurse Practitioners in Michigan

Yesterday, a bill easing restrictions on Advanced Practice Registered Nurses (APRNs) was slated to be introduced to the Michigan House of Representatives by Ken Yonker (R) from District 72. Michigan suffers from a critical shortage of primary care practitioners, with over 300 federally designated Health Professional Shortage Areas (HPSAs) covering practically the entire state. Only two states have a greater number of primary care HPSAs – California and Texas. Both California and Texas have significantly larger populations and land mass. What can we infer from this? It’s pretty bad in Michigan. For a map of all HPSAs in the US click here:

A previously introduced bill was rendered practically moot by significant lobby activity by the Michigan State Medical Society. Arguing that allowing APRNs greater autonomy would put patients at risk, the MSMS was able to dilute the provisions of Senate Bill 68 significantly enough to make it resemble their version of what it should say.  Knowing that a host of studies, meta-studies, and two Cochrane reviews have demonstrated APRN care to be equal to that of primary care physicians in terms of outcomes, safety, and patient satisfaction, this argument is patently false. APRNs only practice within the scope of their training and licensure, and have many more years of clinical training, ethics education, patient interaction and experience than do Physician Assistants. There is no parallel.

Nurses have to get on board with this effort and ensure that, this time, this legislation is not thrown off-course by powerful lobby interests. We owe it to the citizens of the state of Michigan to enhance our residents’ access to affordable, quality health care. Michigan is one of only about 6 states in the entire USA to continue the highest level of restrictions on APRN practice. Get involved! Say something! Do something! At the very least, contact your Representatives and Senators to support Rep. Ken Yonker’s effort to bring greater health access to Michigan’s medically underserved. Frankly, the situation is downright unethical… Please send a thank you to Rep. Yonker at the very least and tweet your support to @MIHouseGOP.




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Afraid of the Zika virus? Is it worth missing the Olympics?

Hope Solo (above), star goalie of the U.S. Women’s Soccer team recently announced that she had overwhelming concerns about the Zika virus threat in Brazil and that, “If I had to make a choice today, I wouldn’t go…”

In the meantime, mosquito repellent is hard to find in Brazil, and is purchased and stockpiled almost immediately after it becomes available. People are scared. Fear is a powerful emotion. The CDC has issued recommendations for pregnant women including a warning to consider postponing travel to areas where Zika virus transmission is ongoing.

The full CDC recommendations regarding Zika and pregnancy are here:


What do WE need to know as nurses? The American Nurses Association has just created an entire webpage to help nurses inform themselves and dispel mis-placed fear and just plain bad information. They have posted it on Facebook and are asking us as nursing professionals to share with colleagues and with the public. This excellent resource can be found here:

So why didn’t I use the Facebook image from the ANA?

As we learn more about the Zika virus, nurses must be America’s first line of defense against both the spread of the…

Posted by RN Action on Tuesday, February 9, 2016

well…although I didn’t probably a lot more people will recognize Hope Solo. It’s all about getting the word out. Let’s help people understand their risks and not let fear and panic spread unchecked. Thanks, ANA!

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Standing Strong Together: E-Sisters and Asheville96

The distress caused by problems with Essure cannot be overemphasized. The link below contains a significant amount of resources to share with those who have been hurt:



The most important thing to do is to REPORT the side effects and add to the data base and evidence that is being used to remove this product from the market.

An update from the Asheville96 is below:

We have endured another emotional week here in Asheville. To say things have settled would be a gross overstatement, but there have been significant developments in our situation. Mission Health System and our current employer, AllCare Clinical Associates, have agreed to an extension of our contract through July 31st, in order to assist with a transition that would better meet the needs of our patients.

Included in the agreement of a contract extension, a non-solicitation clause was lifted, allowing the hospital to approach us regarding employment, again to better meet the needs of our patients here in WNC during the transition.

Now that we can openly explore employment options with Mission Health System, we sincerely hope that dialogue will open up that could result in a mutually acceptable agreement regarding certain details of our employment. Recent history has demonstrated that in a transition such as ours, all parties involved eventually sit down and try to reach an acceptable agreement. Unfortunately, these discussions often take place after much disruption, displacement, and financial loss. We strongly believe if there could be dialogue between CRNAs and Mission Health now — and not 6 months from now– the outcome would be more favorable for CRNAs, hospital administration, surgeons, and most importantly, our patients.

The CRNAs are extremely unsettled and unsure of what our future holds. Many of us are actively searching, applying, and interviewing for employment outside of Western North Carolina. While we have remained committed to the safety and well-being of our patients throughout this difficult 6 weeks, we are now realizing that we must make decisions based on what is best for our families. We desperately want to stay in Asheville, but fear our quality of life and time spent with our families is in grave danger. While we are faced with these difficult decisions and in hopes that we will open dialogue with hospital administration, we ask that you continue to respect our position and give us time and space to hopefully reach a mutual agreement.

Please continue to follow these issues and lend them your voice and your support. Together, we are making a difference in the world.

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In Defense of Women: Support the E-Sisters

The image above is an ultrasound of Essure implants in fallopian tubes. What’s wrong with that? Essure implants have resulted in an enormous amount of harm to a significant number of women. So much so, that these women banded together to form the E-Sisters, taking their complaints to Washington and threatening a hunger strike if nothing was done about it!

They have had some success. Congressman Mike Fitzpatrick (R – Pennsylvania) introduced a bill calling for the removal of Essure from the market. It is important to note that Essure received pre-market approval from the FDA, making Bayer (the manufacturer) immune from lawsuits and litigation. Hmmmmm…… Kudos to Congressman Fitzpatrick! Find out more about it here:


On another front, on 02/01/2016 it was announced that the FDA has “initiated a review” of Essure after thousands of women complained of severe side effects. This story is below:

Outcry over Bayer Essure Inc (NASDAQ:CPTS)’s birth control side effects prompts review by The FDA

#WhatWouldFloDo? Give Congressman Fitzpatrick props for introducing this important legislation.  Tweet him a , “way to go” @RepFitzpatrick ! Support the E-Sisters and their cause at #SupportE-Free, #Essure, and http://essureproblems.webs.com/

Let us unite with these women in protecting our reproductive health!

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Reimbursement for Nursing Services: A Pipe Dream or Potential Reality

I have the privilege of studying for my MSN in Informatics in an entirely online format with Capella University. An interesting line of analysis arose, during a discussion of universal nursing terminology. There are a number of universal terminologies, perhaps the best known being NANDA, NIC and NOC. The Omaha System is integrated within SNOMED, perhaps making it the most likely candidate for eventual universal utilization.

Be that as it may, the question arose: would the use of standardized nursing terminology ultimately lead to billing separately for nursing services. Why or why not? Would nursing be perceived differently if their departments were revenue-earning? My reply is below:

I think the key lies in re-framing both the public and the industry’s perception of nursing as ‘revenue draining’, and instead creating a ‘value added’ perception.

Increasingly numerous studies are indicating that better nursing environments lead to nurses’ ability to perform their job better and subsequently better patient outcomes. Because of my passionate belief in advocacy and the use of social media to change perception, I would like to refer you to my blog post in in this regard which can be found here:


This post refers to a study authored by Jeffrey H. Silber, MD, PhD, from the Perelman School of Medicine at the University of Pennsylvania. Dr. Silber found that the higher the acuity of the patient, the more difference the nursing environment made. Perhaps most germane to this discussion was Dr. Silber’s conclusion:

Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients.

Simply put, more nurses working in a better environment result in better patient care and lower mortality with similar costs. On a systemic level, more nurses and better working conditions for nurses actually results in decreased cost relative to outcomes, and increased value. The abstract is accessible from the reference citation below. I was made aware of it through the ANA’s news outlet for members, ANA SmartBrief. Members can subscribe at the ANA member website to read the most current news about nursing.

Whether or not the government – driver of reimbursement reform and change – will pick up on this and ultimately require nursing services to be unbundled and tracked for outcomes will probably be the determining factor as to whether floor nursing services will be separately reimbursable. Hospitals, however, could conceivably offer a ‘tiered’ service. OK, that sounds terrible but it is the way this county works. We are definitely a health care industry, not a socialistic system where everyone gets the same. As such, market forces prevail. Hospitals could offer patients Cadillac services at a higher price, which the patient/family would pay out of pocket. Sort of like staying at the Hilton as opposed to the Red Roof Inn…

It is a fascinating discussion (here comes the soap box), but unless we as individuals and as a profession advocate for such a change, it is highly unlikely. Unless, perhaps, President Sanders is elected. (Where is my unicorn?).


Silber J., Rosenbaum P., McHugh MD, et al. (2016). Comparison of the value of nursing work environments in hospitals across different levels of patient risk. JAMASurg.  Advance online publication. doi:10.1001/jamasurg.2015.4908.

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