Rudy Bermudez was so upset when his fellow members on the Medical Board of California restored the license of a doctor convicted of sexually abusing a patient that when Bermudez was later elected to the state Assembly he penned legislation to revoke the license automatically of every doctor with a sex-crime conviction.
As Illinois policymakers begin crafting better ways to stop sexual misconduct by physicians in this state, Bermudez says they should consider his law, which has permanently stripped the licenses of sex-offending doctors across California.
National Nurses United, the largest nurses union in the country, has helped organize strikes or threatened them this year at hospitals in California, Pennsylvania, Maine, Michigan and Minnesota. The Oakland, Calif.-based union has tapped into concerns of registered nurses worried about losing jobs at a time when hospitals and health-care organizations are under enormous pressure to cut costs.
"They have been very aggressive in legislative lobbying efforts, influencing public policy through informational picketing, and willingness to get out there and strike," said Joanne Spetz, an economist who specializes in nursing workforce issues at the University of California at San Francisco. "Love them or hate them, you have to respect their success."
Nurse practitioners may help reduce wait times without impairing quality of care. Ninety-six percent of patients with back problems were satisfied with the assessment carried out by a specially trained nurse practitioner, according to a study in the December issue of the Journal of Advanced Nursing.
Moreover, the NP came up with exactly the same clinical diagnosis as two orthopedic spine surgeons in all 177 patients she assessed. She also suggested the same management plan as the two surgeons in 95% of cases.
"Nurse practitioners can play an effective and efficient role in delivering care to patients requiring specific disease management in a specialty setting. Although the required skill set in assessing these patients may vary from NP to NP, collaboration and support from the physician can help to develop expertise in a specialty area," the paper concludes.
The aim of the year-long pilot study, conducted Toronto Western Hospital in Ontario, was to determine whether a clinic led by a nurse practitioner could speed up the diagnosis and management of patients with certain spinal conditions. (Most patients seen by spine surgeons are not surgical candidates, the researchers note; their treatment plan usually consists of education, and non-invasive therapies to help manage their conditions.)
The 96 male and 81 female patients with suspected disc herniation, spinal stenosis, or degenerative disc disease had been referred by their family doctors.
Just under 10% were correctly identified as surgical candidates by the nurse practitioner. In addition, 66 were referred for specific nerve root block, 14 for facet block, and 26 for further radiological imaging.
Overallsatisfaction was very high (96%), and 91% of patients reported that they understood their condition better after seeing the nurse practitioner.
Patients waited10 to 21 weeks to see the NP, with an average wait of 12 weeks. This compared with 10 to 52 weeks to be seen by the surgeons in a conventional clinic, with average waiting times ranging from three to four months for disc herniations to eight to 12 months for spinal stenosis.
Seventy-four percent of the patients were happy to see the NP rather than wait up to a year to see a surgeon. Twenty-six percent said they would have preferred to have been seen by a surgeon in a conventional clinic, but of those, 77% said they would not have been prepared to wait an extra three to four months to do so.
Clinical, legal, and funding barriers in the Canadian health system prevent nurse practitioners from being fully independent when it comes to assessing and managing patients who require specialist care, notes nurse practitioner Angela Sarro, the nurse practitionerand a study co-author. She sees the potential for government-funded triage clinics led by NPs to reduce waiting times for spine consultations.
The findings have implications beyond back issues, she adds. "I feel the findings can be applied to various specialties in which the nurse practitioner has the knowledge and expertise to assess, diagnose, and recommend a plan of care for patients," Sarro tells HealthLeaders Media. "Wait times in other specialties can be long, and with more timely access to care, patients can be informed of their condition, and be provided with education and knowledge to help improve health outcomes."
In fact, Toronto Western Hospital is now assessing the potential to expand the practice of nurse practitioners being the point of contact for ongoing care of patients with a variety of conditions.
Whether the approach could be implemented in the United States or elsewhere, says Sarro, "would depend on the scope of practice that is allotted to nurse practitioners in that country based on legislation."
The first locally acquired case of dengue fever in Miami-Dade County in more than 50 years was confirmed Thursday by health officials. They warned people countywide to take precautions against the human-loving mosquitoes that carry it.
"This is a big deal,'' said Lillian Rivera, administrator of the Miami-Dade Health Department.
"We have not had a locally acquired case of dengue fever since the 1950s,'' said Dr. Fermin Leguen, the department's chief epidemiologist.
As we inch toward 2014, the year that the Patient Protection and Affordable Care Act, the centerpiece of the health care overhaul, takes effect, it has become increasingly clear that the ship known as our health care system is in the process of sinking. And it is not spiraling costs or an overreliance on technology that is weighing most heavily on the health care system, but the sheer volume of patients it must serve.
Currently overloaded with a rapidly aging patient population and their attendant complex medical problems, the system has yet to absorb the 32 million newly insured patients on the horizon. Moreover, over the next 10 years, a third of current physicians will retire, and the physician deficit will increase from just over 7,000 to almost 100,000, with shortages in all specialties, and not just primary care.
The security personnel on duty at the Georgetown Pub-lic Hospital (GPH) on Sunday night when a nurse/midwife was attacked by her former lover, failed to perform their duties, Chief Executive Officer (CEO), Michael Khan said.
Khan, speaking with Stabroek News briefly via telephone yesterday, said that the negligent security personnel will be dealt with.
He further explained that a security guard is always present at the entrance to the compound where the maternity ward is located. Another security guard, according to the CEO, is stationed in the ward. All security personnel were on duty at the time of the attack.