Tag Archives: power

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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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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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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Taking Care of our Veterans: Supporting HR 1247

The Veterans Administration would like to update their policies to allow APRNs to practice to the full extent of their license and training within the VA system. On January 8th, the draft regulation to implement this policy was transmitted to the Office of Management and Budget. It is reflected in the language of HR 1247. After the OMB clears the regulation as drafted, it will be published in the Federal Register for comment.

I am somewhat stymied to report that the House Representative from Michigan’s 1st Congressional District (where I live…) has written a letter opposing this policy. Dr. Dan Benishek stated that the concern he had was that this may imperil the health of fragile Veterans by allowing CRNAs to practice without direction physician supervision.

This is a false claim. The definitive source for meta-analysis of medical issues with absolute global credibility is the Cochrane Review. On July 11, 2014, a review entitled, “Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients” was published, authored by Lewis, Nicholson, Smith and Alderson. They found that there is no evidence sufficient to show any difference between the two types of providers. It is difficult to argue with the Cochrane Review.

Disclosure: my husband is a veteran and gets almost all of his medical care from a Veteran’s Facility. He has no complaints about the CRNA who performed his anesthesia. He agrees that better access to care, decreased cost to taxpayers, and less waiting time to see a provider are benefits that he and all his fellow Vets value. He understands that APRNs practice to the extent of their training and licensure, and don’t infringe upon the practice of physicians. He understands that there are many things that physicians do that APRNs are not licensed or trained to do, and that there is no risk whatsoever to the patient. Why can we not get this message across to the general public?

What can you do? Learn more about this issue here:


Write to your Representatives and Senators and ask them to support the VA’s decision to allow APRNs to manifest the Institute of Medicine’s recommendation that they be allowed to practice to the full extent of their training. Why not take a moment to get involved? The men and women who have served our country deserve our support.


Lewis SR, Nicholson A, Smith AF, Alderson P. Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010357. DOI: 10.1002/14651858.CD010357.pub2.

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Water Crisis in Flint, Michigan:What Would Flo Do?

Children in Michigan are screaming while being tested for lead poisoning, and already exhibiting signs and symptoms. All of this because the state and local legislators wanted to save a little bit of money and alter the source of their drinking water. Now it is polluted, poisonous, and there is no relief in sight.

For the latest on this subject, follow Eclectablog here:

The question we must pose ourselves as nurses is, what would Florence Nightingale do? I submit that she would speak out strongly in an effort to obtain clean water for Flint’s population and to ensure adequate resources were dedicated to that effort. Children will be permanently affected by this example of uncaring and appalling action on the part of Michigan’s politicians. Please lend your voice in support of the children of Flint. You can contact your local office of your state representatives, post your own commentary on Facebook, and contribute to the Twitter conversation at #FlintWaterCrisis.

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Happy CRNA Week – January 24-30, 2016

It’s CRNA week, and I am glad to report good news for the #Michigan68.

First to the celebration:

They are celebrating in Michigan, as a legitimate and fair contract has finally been negotiated, allowing the #MI68 to go back to the jobs and patients they love. Find the whole story here:


Perhaps the most powerful statement made in the news from the #MI68 is this one-

We have proven our conviction to stand up for what is right. We have shown the extent of our moral fortitude by remaining committed to the CRNA profession and our campaign despite the personal cost. And, most importantly, have shown the selfless ability to forgive – exemplifying the compassion and professionalism inherent throughout the entire nurse and advanced nurse practice field.

Nurses, exhibiting compassion, professionalism and CARING, while remaining true to their values. It is truly worth celebrating that your efforts, their efforts, and the combined pressure of public opinion, nursing professionals, and just plain ethics resulted in the ability for all parties to come to a reasonable and appropriate agreement.

I hope you will join me in now turning your attention to the #Asheville96 and support them in any way you can as they work through these same issues. Together we can keep CARING in nursing without sacrificing our core values. It takes a village…



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High-Quality Nursing Environment = Better Outcomes. Is that not what we want?

This photo of a Civil War era nurse reminds us of where we have come from. We have made such significant progress in all areas of nursing and medical care, except perhaps in the area of nursing’s status as an independent profession deserving of respect and equality. In this era of outcomes-driven healthcare regulation, it only seems logical to ensure the availability of well-educated nurses in a supportive environment. This week’s ANA Smart Brief highlighted a Journal of the American Medical Association – Surgery article which stated clearly that high-quality nursing environments cost no more but result in better survival of surgical patients. Here is the cite:

Hospital study links high-quality nursing environment to better outcomes
A study that included hospitals in Illinois, New York and Texas found higher-quality nursing environments had similar costs but better survival rates for surgical patients, compared with hospitals that had poorer nursing environments. “While better outcomes and value may be owing to other features of hospitals with good nursing, excellent nursing environments appear to provide a strong signal to patients and referring physicians for better quality, lower cost, and higher value,” researchers reported in JAMA Surgery.

…better quality…lower cost…higher value. What then is the impetus for higher nurse-to-patient ratios, reducing compensation for CRNAs and diminishing or decreasing the quality of the nursing environment? It is outright counter-productive!

As study results mount demonstrating the added value of an educated and supported nursing staff, perhaps we will finally be able to address these issues with legislation. Some active issues include:

  • legislating nurse-to-patient staffing ratios that cannot be exceeded as in California
  • lifting restrictions on APRN practice
  • Safe Patient Handling and Mobility (SPHM)
  • workplace violence.

Becoming politically active is not a huge commitment. It could be a single phone call or email to one of your representatives to educate them about an issue that is important to you as a nurse. Just imagine if we all did this. Now, imagine if we all did it as an entire profession! If nursing took up just one issue, focused on it with the power of the entire profession, and reached out to politicians and policymakers, I am sure we could advance our agenda a great deal. Let’s all commit to taking the first step. Remember Meryl Williamson’s inspirational video. We are the only things in our way!








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