I selected the DNP program because I believe that I can become more effective as a nurse practitioner with the added skills as a researcher and educator. Additionally, the nursing profession has been and continues to undergo profound changes. There are political forces in the medical communities that continue to undermine our efforts to close the primary care gap in the myriads of undeserved regions of our country. At the same time there are, fortunately, progressive thinkers who believe that enhancing the nursing professions ability to reach its full potential will solve a lot of the health problems that plague our great society. In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year study to assess and make recommendations for transforming the nursing profession and health care in general. The report of this joint task force basically concluded that we nurses should practice to the full extent of our education and training, achieve higher levels of education and training through an improved education system that promotes seamless academic progression, become full partners with physicians and other health care professionals in redesigning health care in the United States and that we need a new data collection and information infrastructure (IOM 2012). This is a profound statement that serves as a wake up call to all of those stakeholders who are recalcitrant in recognizing that nurses, being the largest workforce in the health care industry, are going to have the greatest impact. Therefore, we as future DNP graduates have the daunting responsibility to step up as leaders of our profession, with expertise in scientific methodology, interventions for prevention and education and transform the health care industry to prevent our country’s impending economic collapse and reach a secure future with a healthier, older and wiser population.

References:

Institute of Medicine (2012). Finding What Works In Health Care: Standards for Systematic Reviews. The National Academies Press, Washington, D.C.

Institute of Medicine (2012). The Future of Nursing: Leading Change, Advancing Health. The National Academies Press, Washington, D.C.

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On the other hand, our privacy is pretty much a thing of the past for anyone who uses the internet. How many times have we had to clean out adware from our hard drives? Those are the little bugs that keep track of our favorite sites and purchases. How many of those little buggers are on everybody’s personal computer that our virus software can’t detect? Chances are that the government already has a complete profile on everything about everybody who owns a computer such as bank accounts, investments, real property, purchases, favorite books, favorite movies and all kinds of personal habits. What if they find out about somebody’s hemorrhoids? Will they tag that poor soul as a terrorist? Thus there doesn’t seem to be much of a risk anymore regarding privacy issues because privacy is a thing of the past and the prevention of medical errors with physician access to a new patient’s complete medical history will save a lot of lives.

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Wrap Up

Ironically, a group of small voices within the massive bureaucracy in the Obama administration actually came up with a workable solution to the health care debacle. The original whistle blower, Dr. Harvey V. Fineberg, president of the Institute of Medicine actually stayed on and introduced an eight point plan called the “New National Priorities”. Astoundingly it could actually work if Obama or anyone in Congress paid attention to it. The plan calls for legislative action to improve patient involvement in the decision making process, engage in preventive action for early detection and treatment, reduce medical and nursing errors, eliminate duplication of services, create hospice with hope, eliminate unnecessary procedures, provide universal access and employ digital health care informatics.

Unfortunately, the proposed eight national priorities in Dr. Finberg’s Future National Directions Committee report is nothing more than a footnote. It’s a matter of public record and it is sitting in the archives of the Department of Health and Human Services, hidden in plain sight. However, we, the public can change that by emailing copies of the eight national priorities to every member of Congress with a note saying that this is how we can achieve real health care reform. Obama challenged us to recommend ways to improve PPACA apparently without even knowing about the report that came from his own government experts, like Dr. Fineberg. Are you in or out?

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Therefore the big political debate is over the question of “What is the moral imperative of our society?” Is it okay to deny access to 50 million people because they are either self-employed, underemployed, unemployed or depend on Medicaid, or can we find some common ground where the bottom rungs can get more while those at the top make do with a little less? The answer depends on who you ask. The leftists have no problem with causing a train wreck because they don’t like the fact that some cars are restricted to those who can pay for first class and the conservatives want no part of any equalization effort that might derail the first class compartments. However, since the health care system in its current state will destroy our economy in the next two decades even with the inequalities unresolved, we have to focus on making it more cost effective before we can equalize all disparities.

Access to healthcare also means having adequate supplies to meet the needs of an aging population with soaring demand. We are now experiencing severe shortages of 178 life-saving prescription drugs as the video below states. I agree with President Obama that, there needs to be an investigation of the pharmaceutical industry to root out hording and price-gouging.

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The second component of overuse is providing more expensive higher levels of care than what the patient needs. For example, intensive care versus regular hospital floor is a serious problem regarding overuse. However, there is the question of patient safety vis-à-vis staffing issues. A physician is going to be reluctant to transferring a patient to a regular floor from the ICU knowing that the floor units are understaffed to the point of being dangerous. On the other hand, one area of overuse that is more easily discernable, as mentioned previously, is the practice of transferring nursing home residents to hospitals for minor health problems that can be treated safely at the nursing home. This practice must be abolished by directing the CMS to change its reimbursement policies.

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Therefore, although end of life care is an important part of the system, it should always be a matter of choice and the decision should never be irreversible or require that the patient lose all hope of survival. In fact I have been working with a hospice organization that does not stand in the way of continuing treatment or bringing in complimentary alternative medicine (CAM). We have established this program in my community and we call it “hospice with hope.” The idea hit me when I was sitting with my friend and client, Sam (of blessed memory) at his oncologist’s office. He had advanced cancer in his pancreas, liver and lungs. The doctor said, “The chemo therapy didn’t work. There is nothing more that can be done, so I am recommending that you go into hospice care.”

Sam stared at the doctor with a stone like expression on his face in response to this shocking news and replied, “That’s a death sentence.”

I interjected with, “Doctor, are you saying nothing can be done, or that there is nothing that you know of that will help.”

The doctor replied, “There is nothing that I personally know of to treat this condition.”

At that point, Sam decided to enter into the world of alternative medicine, but it was too late because the chemotherapy had wrecked his appetite and nutritional status and caused him to suffer from dehydration and starvation syndrome; which, of course, destroyed his natural ability to fight the cancer with the help of herbs, and other recognized methodologies. Nonetheless, there should have at least been a concerted effort to protect Sam’s nutritional status during the chemotherapy with herbal and nutritional supplements. Without these considerations the entire concept of “palliative” care becomes nothing more than a design for a death panel.

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Hospitals and nursing facilities are responsible for the safety of their patients or residents; this includes preventing abduction. Such crimes can be avoided by requiring that every patient being discharged by accompanied by a staff member to the exit. If the patient refuses to comply, then security personnel at all exist must be notified to make an assessment as to whether the patient is leaving of his or her own accord. The PSA must require that all health care facilities orient their staff to guard against abduction be knowing where their patients are at all times. When patients have to be moved to other parts of the hospital for tests or procedures, there must be a system of verifying that the patient has safely reached the intended destination.

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27.      Sexual assault on a patient within or on the grounds of the health care facility

Sexual assault on a patient in a health care facility is especially tragic because when people enter into these environments there is an expectation of being able to trust the staff. People often find themselves with their modesty compromised when examined and treated by medical personnel. Health care management personnel have an absolute obligation to provide criminal background screening on all hires and contractors who have access to patient areas. There also must be adequate security precautions of taking down the identification of every visitor. The practice of printing temporary picture identification for every visitor as done in some hospitals must be standardized by Federal law. There too many facilities in which the security is shabby or non-existent. It is not enough to hold criminally negligent managers liable, these types of attacks must be prevented.

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28.      Physical assault of a patient in a health care facility resulting in death or significant injury

All too often staff members who have total power and control over patients commit physical and verbal abuse and then try to use intimidation to make their victims keep silent. The elderly in nursing homes and psychiatric patients are especially vulnerable, although such crimes occur in general hospitals as well. Careful screening of employees and contractors can prevent almost all occurrences with the kind of technology that exists today in law enforcement communities. Facilities that have a history of patient abuse should be required to give full disclosure to the public of the number of incidences and on which units in the manner that restaurants face public disclosure of non-compliance with health codes that put customers at risk. The PSA should also give the government to put any health care facility into receivership to replace the governing body and management personnel for non-compliance with patient safety laws. Public safety must be the first priority as it is with the airline and food service industries.

Because of the number of people who were hanged or lost their limbs because of improper use of standard restraints or the use of makeshift materials to tie people down, those states that have adopted the uniform public health code have added rules and regulations in the use of restraints. Moreover, bedrails also cause problems because people try to climb over or slip around them. When patient falls with the bedrail involved it usually exacerbates the trauma. The rules regarding restraints and bedrails are clear and every nurse knows that when he/she violates those rules death or disability ensues. Therefore, willful non-compliance cannot be tolerated any longer.

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25.      Any health care service provided by or on the orders of a non-licensed individual

No patient or family member should expect to be the victim of a quack. However, despite that we have laws that are supposed to protect us from such criminal activity, it still happens. It’s one thing for people in a community to find out that a “doctor” was practicing without a license after some time, but to be in a hospital and find that a quack has been prescribing medicine or preforming invasive procedures is frightening. The new PSA must address this issue and require that safety precautions be followed with zero tolerance for willful non-compliance. Every health care provider should be required to show their credentials on demand to the patient or family member. Hospitals should be required to provide their patients with pamphlets with instructions on how to access the state licensing agency website to check to see if any individual’s license is valid. Finally, every staff person who encounters an unfamiliar provider must take the name of the stranger and verify his/her authorization to be in that location providing services.

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Scalding beverages and hot soaks cause most thermal injuries hospitals and nursing homes. Sometimes flash fires occur from lighting a match or cigarette lighter in a room with a high concentration of oxygen. The preventive safety protocols are simple; measure the temperature of all heated liquids and do not bring it to the patient if the temperature is more than 110 degrees Fahrenheit. However, such accidents occur with astounding regularity because there is no accountability for such wanton carelessness.

Regarding flash fires, the nurses owe a duty to the patient to search for and remove all lighters, matches and flammable liquids such as rubbing alcohol in all rooms. The failure to do so should be tantamount to criminal negligence as the danger is obvious.

24.      Patient death or serious disability associated with a fall in a health care facility

Patients fall every day in virtually every hospital and nursing facility. The current standards of care require that every patient receive a fall risk assessment and that interventions for prevention be in place depending on the level of risk. The health care managers resign themselves to believing that not all falls are preventable and they have a legal defense when they can show that the patient fell despite the exercise of reasonable precautions. Once health care management develops a zero tolerance for falls, then all falls can become preventable. The only way to prevent almost all falls is to have one person sitting with each patient at all times. A staff of volunteers could be utilized to perform sitter services. There is no shortage of volunteers in most areas as all high school students need a certain number of community service hours to graduate and there plenty of people given the opportunity for community service in lieu of jail time for minor offenses. Therefore, the PSA should mandate that volunteers be assigned to every patient unit to perform safety precaution services to prevent falling.

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