During his two decades building one of the largest union locals in California, Sal Rosselli earned a reputation as a cunning strategist and street fighter — someone who often vilified hospital chains during contract battles.
These days, he is using those brass knuckles on his former colleagues at the Service Employees International Union in a battle that threatens to rip a giant hole in the most powerful union in the nation’s largest state.
The S.E.I.U.’s national leadership ousted Mr. Rosselli last year after a power struggle that ended with a jury finding that he had improperly used member dues to form a breakaway union. Shortly after being ousted, Mr. Rosselli did create a rival union, and now he is trying to lure many of his former members — 43,000 workers at Kaiser Permanente, the largest health care provider in the state.
On Monday, workers at 331 Kaiser facilities across California began voting by mail on whether to bolt the S.E.I.U. and join Mr. Rosselli’s group, the National Union of Healthcare Workers.
A victory would give a vital boost to Mr. Rosselli’s fledgling 6,000-member union, all but assuring its long-term survival. It would also be a huge blow to the 1.9-million-member service employees union, since Mr. Rosselli’s group would gain the stature and dues money to finance a broader war for far more S.E.I.U. members.
For-profit hospitals across the state are performing cesarean sections at higher rates than nonprofit hospitals, a California Watch analysis has found.
A database compiled from state birthing records revealed that women were at least 17 percent more likely to have a cesarean section at a for-profit hospital than at a nonprofit or public hospital from 2005 to 2007. A surgical birth can bring in twice the revenue of a vaginal delivery.
In addition, some hospitals appear to be performing more C-sections for nonmedical reasons -- including an individual doctor's level of patience and the staffing schedules in maternity wards, according to interviews with health professionals.
Nearly half of the nursing workforce is expected to reach retirement age in the next 10 to 15 years, and experts project a shortfall of close to 500,000 nurses by 2025. Health care organizations that expect to recruit, retain and maximize their RN workforces and related staff will need to give them new responsibilities and a greater leadership role. A System of CARE (Clinical Alignment and Resource Effectiveness) must frame these changing roles, providing optimal care management, provider alignment and the right technology infrastructure to keep patients and their caregivers within the system.
Shortages of midlevel providers—including physician assistants and nurse practitioners, as well as physical and occupational therapists, health technicians and others—are also expected in the face of growing patient demand and increased coverage through health care reform. However, the Patient Protection and Affordable Care Act of 2010 does provide for an expanded primary care workforce, including $250 million to train 500 primary care residents, 600 physician assistants and 600 nurse practitioners, as well as to create 10 new nurse practitioner–led clinics in medically underserved areas. The act also provides other incentives for states to expand their primary care workforce by 10% to 25% over the next decade. The new health care reform legislation provides grants for a variety of primary care training programs, degree completion and nurse career advancement programs, as well as $50 million for nurse-managed health centers and a mandatory funding stream for Title VIII programs (nursing workforce development programs). The news is good, but it may not strengthen the workforce soon enough.
The National Institutes of Health has awarded a 1.5 million dollar grant to the University of Louisville for a new oncology program.
The program focuses on palliative care, which combines medicine, nursing, social work and religious education to provide broad care for cancer patients. Students in each discipline will be required to take new courses in palliative medicine so they can better work together to treat patients.
“Palliative medicine includes, but is not limited to, the traditional view of end-of-life care and hospice work. Palliative care starts the day of cancer diagnosis for all patients, focusing on the alleviation of symptoms in the bio, psychosocial, and spiritual realms,” says U of L Chief Medical Officer Mark Pfeifer. ”It meets [patients] at their symptoms, their goals, their worries, their environment, their family. It combines everything, then, from advanced, invasive pharmaceutical procedures, to prayer and music.”
The grant will be paid out over five years as the program is developed.
Why don’t women in the U.S. have access to nitrous oxide, a safe, inexpensive and fairly simple option for alleviating pain during labor, when women in almost all other developed countries use it widely?
A small band of midwives, doctors and mothers are trying to find out.
Sure, nitrous oxide (aka laughing gas, like you get in the dentist’s office) doesn’t have the super-pain-relieving magic of an epidural. Instead, it offers something closer to an elixir of dulled pain tempered by nonchalance, says William Camann, chief of obstetric anesthesia at the Brigham & Women’s Hospital and the co-author of the book “Easy Labor.” “The pain may still exist for some women but the gas may create a feeling of, ‘Painful contraction? Who cares?’”
The New England Journal of Medicine recently published a report showing that cancer patients who began receiving palliative care immediately upon diagnosis were happier, more mobile, suffered less pain and lived longer than those patients receiving oncology treatments alone.
Palliative care is medical treatment that concentrates on reducing symptoms, rather than striving to halt or reverse the progression of the disease itself. The goal is to relieve suffering and improve the quality of life for those facing terminal illness.
Dr. Jennifer S. Temel, an oncologist and author of the published report, says that "Palliative care is traditionally extended to hospitalized patients in the last week of life. When palliative care is given at the onset of diagnosis, it has a positive impact on quality of life and increases longevity."
The study could not determine why the patients lived longer but experts had several theories: Depression is known to shorten life, and the patients treated palliatively slept better, ate better and were more inclined to socialize — all factors that contribute to general well-being.