Nurse and Lawyer have been on vacation! Well, Ok, not really. . . Laywer was taking the bar exam, and Nurse was on vacation.  In the mean time, though, I’ve caught up on some reading. Have you seen this article in the Stanford Social Innovation Review? 

palm trees

I don’t just suggest it because on of the authors (Paul Farmer) is a great inspiration to me, but because it shows great wisdom and promise. . . the authors suggest that health care is in crisis in this country, and that’s a great time to fix it– in part by expanding our concept of what health care means. Perhaps, they suggest, we can take lessons from successful programs in low-resource situations– by, for instance, addressing basic physical and social needs. It’s not a new idea– but it’s not often applied in this genreally rich country. Take a look. Give it a think. 

We’ll be back to regularly scheduled programming soon!

xo, Nurse

Update: Debt Collectors in the ER?

A few weeks ago, we wrote about medical debt collection going on in hospitals, and whether it was interfering with treatment or intimidating patients out of seeking needed care. Now Kaiser Health News is reporting on new Treasury Department proposed rules curbing this practice. (See also: straight from the horse’s mouth, here is the press release). Is the Obama administration reading N & L? (I kid, I kid). These rules are called for in the Affordable Care Act, and, as expected, are controversial– the American Hospital Association, for instance, thinks hospitals are being held too responsible for the actions of 3rd parties when required to provide this new protection– which is just too much to ask, apparently? Come on now, let’s not forget that health care is supposed to be about patients!

From the department of righteous indignation:

I will depart from our regularly scheduled programming to bring you a brief bout of righteous indignation, which, while not technically about law or nursing, affects nurses and lawyers, so here ya go! –Nurse

Have ya seen this? Did ya hear this? Women can’t have it all. 

Anne-Marie Slaughter gets it wrong. Her article is not really about women– it’s about parenting. 

First, she identifies a very real problem: that women are in fewer leadership positions in business and government  that women are paid less, and that this needs to change. But for Slaughter, it needs to change so that these women leaders will let other women spend more time with their children. So she has brought this very real issue of gender inequality back to the desire to spend time with children– implying that women care about this greatly, and men do not. She points to a “maternal imperative felt so deeply that the ‘choice’ is reflexive.” Her argument rests on the fact that she, and some other women, don’t WANT to work long hours in high-powered jobs when they have young children. This situation is, in a way, exactly what she insists that it is not: being less committed to work. It is not, however, a problem just for women. Choosing between work and other pursuits affects everyone. Perhaps, a generation behind Slaughter,  I have view my own options as a woman differently; when I went to college, more women were enrolled than men, birth control was available without hassle, and “alpha-wives” could be married to house-husbands.

 

Slaughter writes that the choice to take time out of the fast-track life to be with children is ultimately damaging to women’s careers. This is true– and it’s ok, when the women in question are the ones who choose to spend more time with their families. The effect is the same on men who do this. Why shouldn’t people (not just women) who would rather spend more time at work than raise families advance faster at work? This IS a choice, and not only for women. What is really damaging to women is when employers take the same position that Slaughter just did– that women feel a deep “maternal imperative” and will always choose family over work. This position creates prejudices against young women. Am I going to disengage and quit my job at any minute that my ovaries start tingling? Are my male counterparts immune from the allure of choosing other things over work? Absolutely not. So while “family friendly” policies and work-life balance are  good ideas for a host of reasons, it’s not about women. So let’s call it what is is.  When Slaughter write of “having it all,” she means having a high-powered career while also having children and spending time with them at home. If that is “all,” I’ll pass.

Nurses protesting NATO

Or, a nurses’ union protesting at the NATO meetings, to be more exact. Lots of news stories covered this story today, so I thought I’d touch on it.

 Perhaps this is puzzling to people who think of nurses as doctors’ handmaidens, bedpan emptiers, and bosses at psych hospitals. Or perhaps it’s troubling to people who feel that nurses should be apolitical, providing compassionate care to everyone without ruffling any feathers or making anyone uncomfortable.

The union members at this particular protest seem to be advocating a “Robin Hood tax” along with a general anti-war message. 

 Whether or not you agree with the politics, I think it’s crucial that our society think of nurses, and that nurses think of themselves, as promoters and protectors of well-being. So, yes, you may see your friendly neighborhood R.N. waving a protest sign for a political cause that affects the well-being of the community– more power to her/him. 

(Just to be clear: I’m not talking about bedside nurses engaging in political actions, or god forbid, discrimination, while in the role of direct caregiver. I hope we all agree that at this level, everyone, regardless of politics, should be treated equally. I am talking about nurses as community members, advocating for causes that they feel are important to the health and well-being of the community. Ok? Ok.)

In Nursing News. . .

In nursing news, Centers for Medicare & Medicaid Services made a lot of changes this week, including expanding the definition of “medical staff,” to allow professionals including advanced-practice nurses to practice to the full extent of their training and scope without arbitrary federal rules about physician oversight– state laws already govern scope of practice.

This is a coup on behalf of patient care, healthcare systems, and nurses! CMS is explicitly recognizing that health care is changing, and moving away from a model which is entirely physician-driven.  We had a pretty long discussion   on the issues surrounding advanced practice nurses a while ago. Is this week’s news indicating that the times, they are a changing’?

If there was an anti-AIDS pill, who would get it?

Remember our discussion about the implications of knowingly exposing someone to HIV? I think it’s interesting to revisit that analysis in light of the recent news about Truvada, a drug that potentially reduces risk of HIV infection– it appears to be safe and effective, and a panel will make a recommendation to the FDA this week.

It’s an interesting question– of course, we “know how” to prevent HIV without using drugs– i.e., don’t have unprotected sex, don’t share needles, etc– but we also know that the virus spreads anyway for all kinds of reasons. I can think of a few scenarios where a drug would be useful: people who are high-risk and will not or cannot change their sexual practices or drug use (this may be seen as a harm-reduction strategy), or, perhaps more importantly, for people who are routinely sexually coerced (think of women in cultures that do not allow them to refuse). Of course, there are lots of obstacles– it’s expensive, there are side effects, it’s not completely effective, we don’t know the long-term issues– but still, it’s a very exciting idea.

HIV disproportionately affects marginalized groups. Could a drug like Truvada help to change the sense of victimization associated with some HIV infections? Can we avoid a repeat of the original fiasco associated with HIV drugs, their expense, and the witholding of available treatment based on inability to pay?

On Nurse’s bookshelf. . .

Nurse is a sucker for comics (you read my other blog, nursosaurus, right?). Nurse is also a sucker for health reform (it’s a BFD).

Nurse knows: it's a BFD.

So it should come as no surprise that I picked up Health Care Reform, by economist and long-time health reform expert/advocate Jonathan Gruber, when it came out a few months ago.

It gives a walk-through of the imperiled health law, the PP-ACA, in basic terms– a “what does it mean to ME?” approach.  I think most of the arguing that goes on around this thing doesn’t look at what it means to individuals– so bravo, Gruber, bravo.  Not only is it readable, person-focused, and clear, it’s also very smart (Gruber’s an economist at MIT, has a PhD from Harvard, and worked on MA’s healthcare with Romney back in the day).

My only gripe? Well, it’s not really a gripe– he’s passionate. He wants it to succeed, and he believes it’s right, and he tells us why– but he pretty much ignores the problems with it, which even the loudest booster must know are there. So this comic-book-style explanation of the law is great, if you want to understand the basics– but it won’t prepare you to debate a republican– except maybe Mitt Romney ;)