Thursday, February 16, 2017

What Healthcare Professionals Can Do About the Opioid Epidemic

A Guest Post from Daphne Stanford

It’s sobering to put these drug facts into perspective: according to the American Association of Colleges of Nursing, a 2015 White House press release stated, “Opioids are a class of prescription pain medications that includes hydrocodone, oxycodone, morphine, and methadone. Heroin belongs to the same class of drugs, and four in five heroin users started out by misusing prescription opioid pain medications.”

Seeing all those drugs placed into the same category as heroin really makes the imperative abundantly clear: we must treat these substances for what they are: extremely addictive and destructive drugs, not painkillers. They should only be considered worthy of a prescription as a last resort; even then, they should be handled with extreme caution. According to Bradley University, 78 people in the United States die from an opioid overdose every day. This is true despite the fact that Americans have not reported increased levels of pain; moreover, the sales of prescription opioids nearly quadrupled between 1999 and 2014.

Significantly, because of the recently passed Comprehensive Addiction and Recovery Act, nurse practitioners will now be legally allowed to administer drugs like buprenorphine for withdrawals, as well as naloxone, an overdose-reversing drug. This expansion to include nurse practitioners in those allowed to prescribe buprenorphine is a huge step forward since, historically, only physicians have been allowed to prescribe it.

Requiring any healthcare professionals who prescribe opioids to take a certain amout of continuing education about the drugs would be an excellent requirement; so far, however, only a handful of states have implemented this guideline.

In addition to improved access to life-saving medication, opioid addiction prevention and education efforts will also be expanded—among both patients and medical professionals. According to Frontline, drugs now kill more Americans than cars, and twelve states in 2012 had more opioid prescriptions than people. Take Baltimore as an example: from 2013 to 2015, deaths from fentanyl overdoses increased 600 percent—apparently mirroring a trend in other East Coast cities. As a result, the city’s health commissioner, Leana Wen, prescribed the antidote naloxone, which halts overdoses, to all residents.

Encouragingly, Science Magazine reports some clinical studies suggest that marijuana may have medical value for difficult-to-treat pain conditions:
California, which in 1996 became the first U.S. state to legalize medical marijuana, led the way with its Center for Medicinal Cannabis Research, which has done several placebo-controlled studies on pain… The first, published in 2008, found that smoking marijuana reduced pain caused by nerve damage in 38 patients, with minimal side effects. The second, published in 2013, found that vaporized cannabis, even in low doses, relieved pain in a similar group of patients who hadn’t responded to traditional medications, including opioid analgesics.

Though this research is probably not surprising to many, it’s frustrating how little of it seems to have been widely publicized. However, out of sixty peer-reviewed studies from 1990-2014, 68 percent of the results proved favorable to marijuana use to treat conditions such as ALS and Multiple Sclerosis.

The fact that one out of every fifteen people who abuse or misuse prescription painkillers will try heroin seems to suggest that opioids are much more of a ‘gateway drug’ than marijuana ever will be. To consider a few other statistics, the University of New England reports opiate abuse and addiction cost the U.S. 484 billion dollars, every year. Addicts are also responsible for 50% of major crimes.

Furthermore, although the U.S. only makes up 4.6 percent of the world’s population, it consumes 80 percent of its opioids and 99 percent of its hydrocodone, the opiate that is in Vicodin. Lastly, people in rural counties are nearly twice as likely to overdose on prescription painkillers as people in big cities.

What can we do, then, to reverse these trends? The Hazelden Betty Ford Foundation has put forth a series of recommended actions that include evidence-based solutions including comprehensive education and prevention like limits on medications and a ban on direct marketing of opioids. The Betty Ford Center’s Pain Management Program takes a comprehensive approach based on reshaping how the brain reacts to pain, utilizing non-opioid interventions. They also support the integration of community-based recovery and telehealth-based resources to help give patients a chance at full recovery.

Encouragingly, according to Dr. Ted Cicero, professor of psychiatry at Washington University, many doctors have become wary of prescribing opioids after considering the bad publicity surrounding opioid abuse. In late August of this year, the U.S. Surgeon General, Dr. Vivek Murphy, sent U.S. doctors a letter urging them to educate themselves about opioids, screen patients for opioid abuse, and treat addiction as a chronic illness, rather than a moral failing.

Let’s remember that an effective response to the opioid epidemic requires a comprehensive, multi-pronged approach from all fronts. Rather than be left entirely up to the patient, recovery from addiction involves doctors and nurses, counselors, friends, family, and community members. Only together, with the help of education and science-based treatment, can we heal from this problem, as a nation.

Daphne Stanford hosts "The Poetry Show!" on KRBX, her local community radio station, every Sunday at 5 p.m. A writer of poetry, nonfiction, and lyric essays, her favorite pastimes include hiking, bicycling, and good conversation with friends and family. Follow her on Twitter @TPS_on_KRBX.

Read more from Daphne:

Thanks Daphne!

Tuesday, February 14, 2017

Happy Valentine's Day!

When considering gifts for nurses....

If you have a nurse in your life, consider something outside the box. Something in the realm of  a new stethoscope, new scrubs, compression socks, lab coats, etc.

Be sure to combine them with a special card, a few flowers, chocolates, dinner date plans for her/his next day off,  or your own special brand of love and ideas. 

Other welcome ideas can include a spa day, full body or foot massage, or even just a day without the normal chores.

Enjoy! And make memories with your loved ones.  

Thursday, January 19, 2017

Ramifications of Loss of Affordable Care Act (Obamacare)

By Ted Chan, Founder & CEO of CareDash

Millions of Americans might be about to lose health care, potentially triggering a crisis at medical facilities across the nation. The GOP now controls the executive and legislative branches of the federal government. They will likely make good on their promise to repeal the Affordable Care Act (also known as Obamacare.) While Republican lawmakers have consistently promised to “repeal and replace” the law that insured 22 million, so far Congress has offered no plan for insuring those who can’t afford insurance or can’t get covered because of pre-existing conditions.. We anticipate this will have major ramifications for caregivers, and significantly impact the work experience.

Difficult Decisions When Providing Care for Uninsured
Hospitals cannot turn away patients solely because they lack insurance coverage. The Emergency Medical Treatment and Labor Act (EMTLA) is a federal law mandating the provision of stabilizing treatment in emergency situations and to women in labor. Hospitals that don’t comply can lose Medicaid funding.

Providers are not, however, required to offer anything beyond stabilizing care. No law mandates cancer treatment, extensive diagnostic services for non-emergent medical issues, or other potentially life-saving treatment. The Affordable Care Act provides coverage for preventative care, but that mandate may also soon disappear.

This leaves providers to interpret the law and assess what ethical care demands. Provide too much care to an uninsured patient and you may bankrupt your hospital. Offer too little care, and you could lose Medicaid funding. This dilemma doesn't even take into account that providers are treating human beings. The stress—and bad publicity—of turning away someone in need can be overwhelming.

High Costs of Unpaid Care
The EMTLA is an unfunded mandate. One recent study found that half of hospital bills go unpaid. Compliance with the law, particularly in poor and disenfranchised areas, can cost hospitals millions. Providers may try to make up for this loss by limiting unreimbursed care only to emergencies, and never providing extra care when the law does not require it.

No provider went through years of school to view their patients as paychecks, but the realities of unreimbursed care can fundamentally alter the patient-provider relationship. Health care professionals may find themselves assessing whether a patient can pay before they recommend treatment, or may adjust their care recommendations based on perceptions about a patient's finances. Research shows that the uninsured receive fewer health interventions and stay for shorter periods in hospitals.

Worse Health for Patients and Lower Morale for Health Care Providers
When patients lose insurance coverage, they turn to emergency rooms for treatment. This consistently results in lower quality care. Rather than the ongoing monitoring and communication that marks a healthy doctor-patient relationship, patients seeking care in the emergency room receive only stabilizing treatment. They don’t form relationships with doctors and nurses who understand their lifestyles and needs, and they're unlikely to receive preventative care, weight loss counseling, advice about nutrition, and other medical information that can empower good health.

The cost is high. The uninsured have a 39 percent higher mortality rate. There’s simply no way to quantify the emotional toll on families, friends, and communities of this tragic outcome.

Opponents of government programs to increase health care coverage, including the ACA, argue that the programs are too expensive. Cutting these programs merely shifts the burden. When hospital bills go unpaid, taxpayers and local governments are often forced to pick up the tab. The question is not whether health care coverage should be paid for; it’s who pays. No one benefits when the poorest among us are denied care.

Ted Chan created CareDash to address the need for transparency and improve the quality of healthcare information available for all Americans.


Thanks Ted. We also need to consider the vast number of jobs to be LOST by eliminating the ACA. Just another ramification. Please contact your elected officials immediately!


Tuesday, January 10, 2017

Seven Things You Should Know about ATI TEAS (TEAS VI) VS. TEAS V

A Guest Post by Katie Meir

The official TEAS test entered its 6th edition and is called the "ATI TEAS." If you are starting to research the TEAS exam, or preparing for your upcoming exam, you must be aware of the differences between the old and new versions. While, some schools still accept TEAS V results, you can no longer take it. So, what should you take into consideration before taking this exam?

1. What is the TEAS exam?
The TEAS is a nursing entrance exam with four sections: English and Language Usage, Reading, Math, and Science. Most nursing programs will either require you to take the TEAS before submitting your application or will invite you to take the test once you have passed the preliminary rounds of the application process. ATI TEAS includes changes in both format and content. Therefore, in order to outperform your competition, use updated preparation materials.

2. What is the test format?
The TEAS is a multiple-choice test. Each section has its own time limit and breaks are allowed between the sections. Check with your test center in advance to help you better prepare for your test day. The test includes 170 questions, only 150 of which are graded. However, you cannot know which questions count and which do not.

3. How is the Reading section formatted?
On the ATI TEAS, the Reading section consists of 53 questions to be answered in 64 minutes. This section includes three main topics: key ideas and details, craft and structure, and integration of knowledge and ideas. This section examines your ability to read and interpret text, identify arguments and key themes, and draw conclusion.

4. How is the Math section formatted?
The new TEAS Math section includes 36 questions with a 54-minute time limit. The most important change is that calculators are permitted on the ATI TEAS. The math section includes two topics: number & algebra and measurement & date. You’re required to demonstrate various abilities and knowledge of arithmetic, ratios, proportions, algebra, data presentation analysis, etc.

5. How is the Science section formatted?
The Science section is notoriously difficult for many. 53 questions must be answered in 63 minutes. The three main topics are human anatomy & physiology, life & physical sciences, and scientific reasoning. The main focus is on anatomy & physiology. While you prepare for the Science section, you should focus on understating the functions of different body systems.

6. How is the English section formatted?
In the English section, there are only 28 minutes to answer 28 questions. To answer questions accurately, a solid understanding of grammar is required. In addition, you’ll need to demonstrate your abilities in spelling, punctuation, sentence structure, and word meaning.

7. How would it be best to prepare?
Now that you are aware of the differences between the two versions, search for material that may be beneficial to your preparations. Look for transparency and clarity, and try to evaluate how much you can benefit from it and how relevant it is to your test prep. Free resources might help, but if you really want to outperform your competition, you should consider using some paid resources. Invest now in your future. Good luck!

Katie Meir is a product manager at TestPrep-Online and a TEAS specialist.
TestPrep-Online offers exclusive PrepPacks™ for a wide variety of tests for students from kindergarten through graduate school and has helped thousands of test takers reach their academic goals through using online PrepPacks™.

Great information. Thanks Katie!

Sunday, January 1, 2017

Happy New Year 2017!

The new year always brings renewed energy and focus. May your choices be wise and fruitful. Wishing you success and happiness. Remember to take care of YOU so that you can give your best to your patients, your colleagues and families. Happy 2017!

Sunday, December 25, 2016

Wednesday, December 21, 2016

Book Review: The Joy of Nursing Reclaiming Our Nobility

Have you ever thought about how many "first patients" you have had in your career? I certainly remember my very first patient in nursing school for a variety of reasons, but that's a story for another day.  I don't think I really ever thought about categorizing all of the other "firsts" into one bigger category however.  The first baby I saw being born, the first patient who coded, the first one who died, the first time I truly saved a patient's life, and then the first one who truly practically pulled my heart strings out. WOW! Yes, I've had a great career.

Today I picked up a book sent to me for review and I couldn't put it down.  The Joy of Nursing Reclaiming Our Nobility by Juliana Adams, BSN, MSN, MA, is one of the most compelling books about a nurse's long career that I have read in a long time.  She validates the reasons I wanted to become a nurse as she tells her stories and finds her concept of nobility in nursing.

It's no surprise the book was a finalist for the 2016 USA Best Book Award. It's a must read for anyone considering a career in nursing. Adams doesn't mince words as she shares stories of her real world challenges and triumphs in the nursing profession. "To be a nurse you have to be tough, and you have to be gentle." She tells it like it is, and also leads the reader to see the silver lining and understand the calling to be a nurse and to truly make a difference in lives everyday.

Thursday, December 1, 2016

National CPR Association Honors the

I recently received notice that TheNursingSiteBlog was chosen as one of the Top 10 Blogs for Nurses in 2016 by the National CPR Association. I am always humbled to be honored and to be listed in such great company. Please check out the other 9 blogs in this list. They are all terrific! Thank you National CPR Association.

Thursday, November 24, 2016

Happy Thanksgiving!

Thursday, November 10, 2016

American Healthcare is in Jeopardy

Healthcare is on the front burner in American politics. The new regime has promised to overturn the ACA (Affordable Care Act) aka "Obamacare," something that has been tried many times since it became law and has failed. This time it might not. And they have assured us they intend to act swiftly. We need to act now!!

What are the consequences?
It is TERRIFYING to think that the action may be taken without a thought or care as to what to do after the fact.  Suddenly literally Millions of Americans could find themselves without ANY health insurance and NO options.

For years the Republican party has shouted they have a better plan and idea, but never once have they brought forth any ideas for change except to dump it all together despite multiple invitations from President Obama. NOW is the time to speak up and make a better plan.

The ACA is not perfect
It was never a clean bill. For one thing it is cluttered with so many extraneous attachments that have nothing to do with healthcare whatsoever. The bill is over 900 pages and really only about 100 pages actually pertain to the ACA.

It was flawed bill from the beginning particularly when no restraints were placed on insurance companies to continue to gouge employers, individuals, and pay providers intentionally minute payments. The business of health insurance was basically untouched. The CEOs still receive enormous salaries and bonuses and the insurance companies have done their best to build a maze to confuse and frustrate!!! There were better options, but they were defeated.
On a personal note: my ACA policy's rates continue to rise exponentially every year. BUT despite that, the alternative would absolutely bankrupt me if I had to once again pay out of pocket just for medications for my family member. I'm STILL paying the credit card bills from several years of no insurance due to the preexisting conditions  that the ACA eliminated.
Another complication stems from basing premiums on the number of insured in a particular plan. There are simply too many plans and not enough people in each one to keep the costs down!! The process must be simplified without sacrificing options. The healthy don't need to have the same plan as someone with multiple conditions and medications, but neither needs to be penalized. It can be done. There just needs to be care and consideration of consequences and an effort to work together for the best for all Americans!!

Healthcare is NOT A PARTISAN ISSUE!! 
It should not be treated as an "Us vs Them" matter. We have to get real about this. Bullying has NO place! There are so many new illnesses and viruses and challenges facing us every year in addition to the fact that we have an aging population with a whole different set of challenges. We are ALL affected equally. And no one is immune.

Despite it's problems, the ACA has afforded millions more Americans with some form of healthcare and saved so very many from needless
suffering and death with medications and treatments they otherwise had no access to or means to afford. More children than ever before have access to wellness and preventative care to set them on the right foot towards long, healthy lives.

We are not a 3rd world country! We need to fight to remain a world leader and to retain respect especially in the global economy and healthcare realms. We can't do that if we don't take care of our own!!

Healthcare Professionals Need to Unite and Educate
As healthcare professionals we need to stand together and fight for a better plan for all Americans; not to eliminate it all together. We need to be bold enough to demand insurance companies provide affordable options and assistance to everyone and reasonable payments to providers.

Most importantly, we need to contact our legislators (most of whom remain from the previous term) and make them aware of the measure of crisis they can create if the abolish the ACA with wild abandonment and don't make provisions. Better yet, work together as a TEAM and fix the ACA. We cannot return to having more than half of our population without healthcare. It's simple Email or Call your legislators today!

PREVENTION Lowers Risks and Costs
As nurses we are charged with the most important role of patient education. When 50% of the population doesn't understand enough about their own health status, needs, prevention and care we have to step up to the plate and educate them.

By improving the process of PREVENTION and lowering the RISKS, we help to lower the overall costs. If we deny Americans access again, the RISKS will rise again and only drive costs higher and higher. NONE of us can afford that!!!