A dozen nurses in New Jersey have rekindled the contentious debate over when health-care workers can refuse to play a role in caring for women getting abortions. In a lawsuit filed in federal court Oct. 31, 12 nurses charge that the University of Medicine & Dentistry of New Jersey violated state and federal laws by abruptly announcing in September that nurses would have to help with abortion patients before and after the procedure, reversing a long-standing policy exempting employees who refuse based on religious or moral objections. "I'm a nurse so I can help people, not help kill, and it just doesn't seem right to me," said Beryl Otieno-Negoje, one of the nurses.
While a majority of doctors and nurses think it is important to check in with patients about what they expect to get from their care during a hospitalization, few have the training or awareness needed to ask the right questions, a team led by researchers at Brigham and Women's Hospital found in a study released today in BMJ Quality & Safety. The use of patient satisfaction surveys as a measure of hospital quality has grown in recent years. And some studies have shown that patients, such as those who suffer heart attacks, may have better health outcomes if they report being happier with the care they have received.
Lost in the contract dispute between Clark County and the Service Employees International Union are real concerns that wages for the unionized nurses at University Medical Center are far below those of private hospitals. The result, the argument goes, is that private hospitals easily poach UMC's nurses by offering higher pay. That disparity in pay might now be addressed.Two weeks ago, Clark County commissioners, who are also UMC's board of trustees, accepted a report from the hospital on the income disparity. And they gave the hospital approval to increase the pay range for registered nurses.
"Don't just do something; stand there!" It's one of those phrases that attending physicians will spout off to their medical students while on rounds, trying to sound both sagacious and clever at the same time. It sometimes grates, but it does make a valid point, because so much of medicine is about "doing something." Sore throat? Prescribe an antibiotic. New headache? Get a CT scan. P.S.A. at the upper limit of normal? Get a biopsy. Blood pressure still high? Add on another medication. Doctors tend to want to "do something" whenever they note something amiss. And patients, by and large, want something done when they have a symptom. Few people like being told just to watch and wait. Of course, every "thing" a doctor does also has side effects—rampant bacterial resistance from antibiotic overuse; major increases in radiation exposure from unnecessary CT scans; incontinence or impotence from prostate cancer treatments that may do nothing to prolong life; toxic drug interactions from multiple medications, particularly in the elderly. The admonishment "Don't just do something; stand there!" reminds us that we should stop and think before we act, that there are many instances in which doing nothing is greatly preferable to doing something.
Most of us believe we are rational decision makers. But medical decisions are especially complex, thanks to the numerous unknowns and the uniqueness of each person's body. Suppose you've just found out that you or a loved one has prostate cancer, one of the many examples in Jerome Groopman and Pamela Hartzband's illuminating new book, "Your Medical Mind." Nearly every urologist would recommend radical surgery to remove the organ. Sounds reasonable, doesn't it? But let's look at the numbers more closely. Prostate cancer is slow-moving; more people die with it than from it. According to one 2004 study, for every 48 prostate surgeries performed, only one patient benefits—the other 47 patients would have lived just as long without surgery.
The union representing registered nurses who went on strike Sept. 22 filed a complaint with the National Labor Relations Board that accuses Sutter Health of unlawfully locking out the nurses for four days after the walkout. California Nurses Association-National Nurses United, in charges filed this week, accused the hospital network of retaliating against the nurses and violating their right to strike. Kaiser nurses struck in sympathy that same day with optical and mental health workers, but Kaiser's administration allowed the nurses back the next day. Sutter officials have said they signed a five-day contract with the agency that supplied replacement nurses to fill in for striking employees. The strike took a tragic turn when a cancer patient at Alta Bates Summit Medical Center died because of a medical error by a replacement nurse. The incident remains under investigation.