Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title "doctor," but also the money, power and prestige that often comes with it. As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back. For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines. Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.
Last Saturday, Judith Ming, a 66-year-old patient at Alta Bates Summit Medical Center, died due to an error committed by a replacement nurse. The nurse was on duty because the hospital, which had five-day contracts with substitutes for regular nurses on a one-day strike, locked out the regulars for an additional four days. Yesterday, both the San Francisco Chronicle and the Oakland Tribune reported learning that the patient was killed, in the Chron's account, "by a nutritional supplement that a replacement nurse mistakenly put into a catheter meant for delivering medicine to her bloodstream." The nurses cited the tragedy in calling for an end to the lockout when it was going on, citing patient safety. But recriminations aside, the death raises questions about the quality of hospital care during a strike. Last year, the National Bureau of Economic Research published research on this issue. Written by Jonathan Gruber and Samuel A. Kleiner, the paper is called "Do Strikes Kill? Evidence From New York State." Not that traveling nurses cannot provide excellent care; any of those nurses who fill in during strikes are top-notch clinicians. But they're working in an unfamiliar setting, they often have never been in that hospital before, they don't know which doctors to ask about what. They don't' necessarily know where every single supply is kept. They might not understand the computerized medical record system well, or it might be one they've never worked with before.
The cancer patient who died because of a medical error at Oakland's Alta Bates Summit Medical Center was killed by a nutritional supplement that a replacement nurse mistakenly put into a catheter meant for delivering medicine to her bloodstream, The Chronicle has learned. The supplement was supposed to be put into a tube that ran into 66-year-old Judith Ming's stomach, said one source close to the investigation. Ming, who suffered from ovarian cancer and had been hospitalized since early July, died early Saturday, soon after the replacement nurse made the mistake. The nurse, a 23-year-old woman from New Orleans, was in a state of shock after realizing what had happened, said a source who spoke on condition of anonymity because patient privacy laws prevent public discussion of many of the case's details.
A student midwife was convicted this week of practicing medicine without a license after she delivered a baby without supervision, leading to medical complications, officials said. Katharine "Katie" McCall, 37, was convicted on one felony count in Los Angeles County Superior Court on Wednesday after an investigation by the Operation Safe Medicine team at the Medical Board of California."The mission of the medical board is public protection, and this action reflects the board's ongoing commitment to that mission," said Linda Whitney, the medical board's executive director. The investigation was triggered by a complaint from a witness who saw McCall deliver the baby Nov. 24, 2007 at the mother's home and said McCall, "appeared to lack knowledge and experience," according to a medical board statement and Hubert Yun, the deputy district attorney who handled the case. Yun said the mother met McCall when she was seven months pregnant and had just moved back to Los Angeles from Colorado. McCall, who was also a doula, or birthing coach, had a business for expecting mothers, the Birth Connection, Yun said.
At her home healthcare agency in the District, Venus Ray quizzes 65 job applicants assembled before her: Can they cook? Do they know the right way to wash their hands? Can they safely transfer patients into wheelchairs? If they give wrong answers, speak English poorly or -- God forbid -- forget to turn off their cellphones, she asks them to leave. By the end of the session, Ray has dismissed 42 of the applicants, almost two-thirds, even though she's in dire need of employees. The demand for workers by Ray's company mirrors national trends and is fueled in part by stepped-up efforts to keep seniors and the disabled out of nursing homes. The growth is likely to pick up in coming years as the new federal health law tries to reduce hospital readmissions and expands programs such as Money Follows the Person, which encourages Medicaid recipients to receive care at home. But experts warn that a shortage of qualified labor is looming. Workers often lack the training and support needed to properly care for patients, and poor working conditions lead to high turnover, experts say.
How many nurses does it take to keep hospital patients safe and comfortable? It's a long-running source of tension between nurses and hospitals. It's also one that will intensify as hospitals head into a perhaps-unprecedented era of financial strain. Some argue the solution is government-mandated nurse-patient ratios. Others say the key is to give nurses the loudest voice regarding their staffing. Something approaching a worst-case scenario might have occurred recently at Carlisle Regional Medical Center, where the state painted a frightening picture of conditions that allegedly existed over several weeks in May and June. Insufficient nurse staffing was the root of the problems, according to the state Department of Health. For example, the investigation report cites times when as few as three nurses had to care for 30 medical-surgical patients. It said patients commonly were kept for hours in the emergency room -- even after they were officially admitted -- because there weren't enough nurses staffing inpatient units.