The 51 licensed practical nurses at Schuylkill Medical Center-South Jackson Street will be phased out over the next several months, hospital spokesman M. Michael Peckman said Tuesday night. The Schuylkill Health Board of Directors is planning to add more registered nurses and nursing aides in order to establish a new health care delivery model. The positions held by the 41 full-time and 10 part-time LPNs will be phased out within six months, Peckman said. "We're changing to a new healthcare delivery model. And in this model we're going to replace LPNs with more RNs and also more nurse aides. It's a model which, essentially, does not use LPNs." The LPNs at the South Jackson Street facility will have the opportunity of either becoming nursing aides, which will lead to a salary cut, or studying to become RNs and apply for those positions, Peckman said.
California is among 23 states that allow nurse practitioners to act as primary care providers without a doctor's supervision, a move aimed at stemming a shortage of physicians and reducing costs. Now the nurses are poised to take on an even greater role as Los Angeles County and other health systems develop "medical home" models of care that expand the number of primary care providers, including nurses, to meet the requirements of national healthcare legislation, reduce unnecessary hospital visits and cut costs. Proponents say allowing such nurses to work as primary care providers can ensure that patients get quick, cheap access to care. But some doctors worry that the nurses overreach, doing more than they are trained to do.
Nearly a decade to the day after Denise Sullivan tended to Ronald Reagan during the darkest night of his life, the nurse received a handwritten letter from the former president. "Your hand clasp was one of the most comforting things done for me during my stay," Reagan wrote, describing his gratitude toward a nurse who hovered by his bedside in the hours after surgeons removed a would-be assassin's bullet lodged just an inch from his heart. The letter, which came days after Reagan had been reintroduced to Sullivan at a ceremony naming the emergency room at George Washington University Hospital in the former president's honor, highlighted the instrumental and often overshadowed role that nurses and technicians played in saving the president's life after he was shot on March 30, 1981. It was during those tense hours ? while inserting IV lines, checking his vital signs and monitoring his breathing ? that a small cadre of nurses got an unvarnished glimpse of a president. And, as happens every day in hospitals across the country, it was the nurses who left a lasting impression on their patient.
All the big-picture policy talk about controlling the cost of healthcare runs smack into the real world at the hospital nursing station. This is true across the country, but especially in Massachusetts, where nurses are pressing several hospitals in contract talks. Two negotiations in particular—at Tufts Medical Center in Boston and St. Vincent Hospital in Worcester—are focused on staffing levels for nurses. Hospital administrators say they are trying to manage in challenging times, reorganizing work to become more efficient while maintaining the quality of care. Many nurses and their union say the practical result of efficiency plans is a thin staff that put patients at greater risk.
Born out of the physician shortage of the 1960s, the nurse practitioner role seems to have come full circle with the recommendations of the Institute of Medicine and Robert Wood Johnson Foundation's 2010 report on the future of nursing. The report states, "the healthcare system needs to tap into the capabilities of advanced practice nurses to meet the increased demand for primary care." But there's a major difference this time. The report also recommends that advanced practice nurses take a larger and more independent role in leading change and advancing healthcare. By continuously expanding their roles, proving their competency and pushing the barriers of acceptance and authority for more than 45 years, nurse practitioners have not only earned a place at the leadership table, they have found more ways to practice.
The Food and Drug Administration is now requiring stronger safety warnings for a popular treatment to prevent pregnant women from prematurely giving birth. Women should not be given injections of the drug terbutaline for more than three days "because of the potential for serious maternal heart problems and death," the FDA said Thursday. It is now requiring a boxed warning — the FDA's most serious type of warning — be added to the drug's label. The FDA also warned doctors against prescribing a pill form of the drug for "any treatment of preterm labor" because it has not been shown to be effective and carries similar risks.