Nursing and Health Care Issues

Addressing the Nursing Faculty: Retention Strategies

2011-11-14T13:46:00.001-07:00

Nursing faculty turnover is increasingly a concern within nursing educational programs. The continuing nursing shortage has placed increased pressure on public and private schools to educate and graduate more nurses to meet the increasing demand. Evolving outcome competencies for new graduates and pressure to achieve high passing rates on NCLEX examinations is an added stressor. Thus the requirement for ongoing curriculum reform, student success, high workloads, and economic challenges, combined with quality outcomes create the need for supportive campus environments.

Review of Literature
There has been limited assessment of nursing faculty retention/turnover. A 2006 study of two-year community colleges, Rosser and Townsend (2006) found faculty most likely to leave their position were dissatisfied with their job. Factors contributing to job dissatisfaction were low salaries, lack of clarity and job expectations, and high workloads. In another study of Iowa community colleges Van Ast (1999) found poor leadership as a significant factor contributing to faculty dissatisfaction. These findings are congruent with those of Martin (2006), Medley and Rochelle (1995), and Cohen and Cohen (1983) that support the hypothesis linking leadership practices of supervisors with faculty satisfaction.

Beverly Kate and Sharon Jordan-Evans (2009) in their book Love ‘ EM or Lose ‘ EM: Getting Good People to Stay provide insightful thoughts on the critical need to retain a company’s best talent. Competent leaders and managers are the heart and soul of any school of nursing. Schools need their best employees to choose to stay with them as our sister schools would gladly hire them. Our nursing leadership has more influence and control in retaining our top nursing academic leaders and nursing faculty than anyone.

A 2011 research publication by Gormley, specifically addressed nursing faculty turnover and confirmed earlier findings. Specifically, if nurse faculty has unsatisfactory working relationships with their academic leader and other campus leadership, they are more likely to leave the organization. Other factors contributing to faculty dissatisfaction are work expectations and disagreements related to academic curriculum and related standards.

Women faculty members tend to have a higher turnover rate then their men counter parts. The increased turnover may be contributed to family obligations, spousal transfers, heavier workloads particularly related to student advising and excessive teaching assignments. Pay is also frequently lower for women when compared to men counterparts (Honeyman and Summers, 1994). Given over 90% of our nursing faculty members are women this finding is even more significant for nursing.

Florida and Texas Nursing Faculty Turnover

Published data that documents actual nursing faculty turnover is limited. The Florida and Texas Centers for Nursing have recent published data on faculty turnover in their respective states. In Florida, for the academic year 2009 – 2010 PN faculty turnover rates (75% percentile quartile) was 33.3% for PN programs and 15.8% for associate degree. The median rate (50% percentile quartile) for PN programs was 11.9% and 5.9% for AD. The median for all programs including BSN was 10.4%. There was no separate data related to career college faculty turnover (Florida Nursing Education and Nurse Faculty Supply and Demand).

In contrast, during the academic year 2009 – 2010 the Texas Nursing Workforce studies report that the faculty turnover rate in practical nurse programs was 23.3%. For career schools the turnover rate was 41.1%. Overall the faculty turnover in metropolitan areas was 25%. The professional nursing faculty turnover rate was 12.3%. Associate degree programs reported a turnover rate of 13.5% (Texas Center for Nursing Workforce Studies). The costs of corporate and faculty turnover go beyond the financial costs of hiring someone new, orienting them, and having them become productive employees.

Turnover has the potential to impact negatively, the quality of corporate leadership to move our vision forward. In addition, nursing faculty turnover may lead to poor student outcomes and decreased student satisfaction. The research maintains that efforts by campus leaders to create a positive and supportive work environment may lead to a decrease in faculty turnover (Klien and Takeda-Tinker, 2009: Gormley and Kennerly, 2011).

Limited turnover in campus based nursing positions may in some case be necessary and; when properly managed, allows the removal of employees whose performance is marginal. New hires may bring to the table renewed energy and positive actions to move the vision, goals and objectives of the School of Nursing and campus schools forward. Dysfunctional leadership is probably the most serious cancer against which as schools we must be most vigilant. The most critical variable that can impact the loss of a Dean and faculty is campus leadership (Gormley and Kennerly, 2011).

It is critical that nursing faculty and Dean be provided mentoring associated with their various academic roles. Strategies and leadership behavior that is collaborative, supports collegiality, and positive working relationships with other corporate team members may lead to improved retention of new and experienced nursing faculty and nursing academic leaders.

Baby Boomer and Generation X

Another issue of considerable importance is the generation gap that may exist between baby boomers and generation X campus leadership and nursing faculty. These groups may have different set of expectations. Baby boomers are individuals born between 1946 and 1964 while generation X were born between 1965 and 1976. The average age of nursing faculty “According to AACN's report on 2010-2011 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing, the average ages of doctorally-prepared nurse faculty holding the ranks of professor, associate professor, and assistant professor were 60.5, 57.1, and 51.5 years, respectively.” This place the majority of our nurses and academic leaders on the cusp of between boomer and generation X.

The research shows that each group needs leadership and management considerations that are somewhat different from each other. Boomers typically thrive on public and private recognition. They need to have campus leadership listen to their ideas. They are usually more individually focused and may need to be coached to understand how a team’s efforts may also support individual recognition. They are the founders of the term “workaholic” and seek promotion, status, and monetary rewards. Restrictive rules and regulations are counterproductive with this group of employees. They most likely comprise schools of nursing most loyal employees and since many are near retirement they need special incentives to keep them within the school (Managing Baby Boomers in the Work Force; Russell – Managing across the generation).

Generation X has grown up being comfortable with technology and its use. Unlike the baby boomers these employees are more loyal to individuals within the school then to nursing school in general. They are more likely to leave the nursing school when it is no longer providing: a) financial stability; b) growth opportunities; and c) a supportive mentoring and growth environment. Generation X thrives on mentoring/coaching and on being provided the opportunity to have flexibility in completing their job requirements. They are more responsive when their entrepreneurial spirit can be tapped. Family and life outside of the business are important. Thus, they are less likely to be satisfied with a job that has heavy work demands (Ronayne, 2007; Generation X in the Work Force). It is critical that school of nursing leadership understand that generation clashes can lead to unwanted nursing faculty and nursing academic leader turnover. It is imperative, particularly when younger generate Xrs are managing baby boomers, that they have an understanding of the boomer leadership requirements. Any nursing team member who feels he/she may not “fit in” the school milieu is at risk of leaving.

Assessment Strategies

“One of my key faculty members yesterday gave me notice she is leaving. I have at least one more faculty who seems to have already retired on the job. I now understand that as a manager that I must continue to engage and strive to retain my key faculty members.” RA From Beverly Kate and Sharon Jordan-Evans (2009) Love ‘ EM or Lose ‘ EM: Getting Good People has created a Retention/Engagement Index: A Manager’s Self Test. This assessment addresses the main theme of each chapter in their book. Please answer honestly and ask yourself if you hold these beliefs about managing others. It is impossible to end up with a no for all 26 questions. See their book for the table and more details related to operationalizing their suggestions.

Conclusion

The literature review nursing turnover data reveal that (given the limitation on our ability to accurately calculate the turnover rate) may lead to poor student outcomes and increase in delivery costs. Thus there is an opportunity to improve retention. The research and other published reports demonstrate that a primary driver of nursing faculty and nursing academic leader retention is supportive leadership attuned to generational related issues. To create such an environment that fosters retention requires, in some cases, new knowledge and attention to management and leadership behaviors by our nursing deans as well as campus leaders.

The demand for nursing faculty and seasoned academic nursing leaders has never been greater. The shortage of these professionals is projected to continue to grow as many educators and academic leaders retire. Fiscal pressure to operate efficiently is understandable. However, without an experienced and stable nursing faculty group and capable leaders to direct them we may be at risk for lower standards which eventually may result in fewer student demands for our programs. Thus, short term gains need to be carefully assessed against their impact on long term outcomes. Fortunately, there is a series of recommendations that when implemented have the potential of contributing to an improved retention rate for our nursing faculty and nursing academic leaders. Many of the following recommendations may be implemented at limited costs. Unknown of course are what are other factors that might impact retention and need to be addressed.

Recommendations

1. Immediate implementation of the Kaye and Beverly (2009) questions designed to ask our key nursing faculty, “What Keeps Them at Your School”. The process involves the sending each faculty member an invitation that includes the following:

You Are Invited to Attend The next step in your continued development. You make a difference and I value your contributions. Let’s discuss some things that are important to you and me.

What will keep you here?
What might entice you away?
What is most energizing about your work?
Are we fully utilizing your talents?
What is inhibiting your success?
What can I do differently to best assist you?

These series of questions will create a dialogue with the Dean. The content is the Dean telling his/her faculty how important they are to the School of Nursing and how important it is that they stay. Based on careful listening to their answers, the Dean will need to work in collaboration with the others to address any responses of concern.

2. When hiring campus academic leaders insure those employed have leadership traits supportive of creating high levels of job satisfaction among faculty including nursing academic leaders. Interviews with applicants should include questions related to leadership style, experience in working with professionals from high demand professions, openness to shared governance, decentralized budget process which allows the Dean to manage their budgets within certain prescribed parameters, etc.

3. Include in annual performance goals the creation of school of nursing faculty retention goals. Such goals need to be accompanied by significant staff development opportunities to enhance campus leadership’s competency in managing baby boomer, generation X and to a lesser extent generation Y (born 1977 to 1998). To achieve success will require significant coaching and educational offerings to insure nursing leadership have the necessary competencies to manage the nursing faculty workforce.

4. Include the creation of a school of nursing retention committee whose members collaborate to insure the working environment is congruent with school’s values and fosters retention. Simple suggestions such as those found in Love ‘ EM or Lose ‘EM: Getting Good People to Stay (Kaye and Jordan-Evans, 2008) can be a focus of campus retention. Dean’s should consider the recommendations created from the school based retention activities for implementation. For those beyond the scope of control for the school of nursing the Dean should forward such to upper administration for consideration.

5. Insure a faculty competency based orientation that includes both a campus and School of Nursing component. 6. Implement the Retention/Engagement Index: A Manager’s Self Test (Kaye and Beverly, 2009) and complete the recommended follow-ups. Work on the yes responses and attempt one or two strategies to address such. Get feedback as you try something different. Reward yourself and choose again when you have successfully implemented a new retention/engagement strategy. Identify your top three employees and do a stay interview with them and find out how what matters to them most. Design your plan and stay with it. If overwhelmed with the 26 items then figure out “one thing” that is essential to do. Efforts to improve the quality of faculty life and addressing issues impacting retention should be dealt with to potentially reduce turnover and improve faculty satisfaction.

References
2010-2011 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing, Retrieved from the Internet on November 14, 2011. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage

Florida Nursing Education and Nurse Faculty Supply and Demand: 2010 Survey Results Retrieved from the Internet on August 11, 2011 http://www.flcenterfornursing.org/files/2011_Education_Report.pdf

Generation X in the Work Force. Wiley Manager.com Retrieved from the Internet on August 15, 2011. http://www.wilymanager.com/generation-x-in-the-workplace/

Gormley, D, Kennerly, S. (2011). Predictors of turnover intention in nurse faculty. Journal of Nursing Education. 50(4): 190-6.

Honeyman, D. S., & Summers, S. R. (1994). Faculty turnover: An analysis by rank, gender, ethnicity and reason. Proceedings of the National Conference on Successful College Teaching.

Klien, J. and Takeda-Tinker, B. (2009). The Impact of Leadership on Community College Faculty Job Satisfaction. 7(2). Retrieved from Internet on August 11, 2011, http://www.academicleadership.org/article/the-impact-of-leadership-on-community-college-faculty-job-satisfaction

Kaye, B and Jordan-Evans, S. (2008). Love ’EM or Lose ‘ EM: Getting Good People to Stay. Berrett-Koehler Publishers, Inc.: San Francisco, CA. Managing Baby Boomers in the Work Force. Wiley Manager.com Retrieved from the Internet on August 15, 2011 http://www.wilymanager.com/manage-baby-boomers-in-the-workforce/

Posner, B. Z., & Kouzes, J. M. (2002). The leadership practices inventory: Theory and evidence behind the five practices of exemplary leaders. Retrieved November 14, 2011, from http://media.wiley.com/assets/463/74/lc_jb_appendix.pdf

Ronayne, P. (2007). Getting the “X” Into Senior Executive Service: Thoughts on Generation X and the Future of the SES. THOUGHT LEADER FORUM WASHINGTON, DC APRIL 10, 2007. Federal Executive Institute. Retrieve from the Internet on August 15, 2011 http://www.opm.gov/ses/executive_development/GettingXintoSES.pdf

Rosser, V., & Townsend, B. (2006). Determining public two-year college faculty's intent to leave: An empirical model. The Journal of Higher Education, 77(1), 124-147.

Russell, G. Managing across the generations. American Academy of Orthopedic Surgeons. Retrieve from the Internet on August 15, 2011 http://www.aaos.org/news/aaosnow/aug09/managing3.asp

Spector, P. (2007). Job Satisfaction Survey Website. Retrieved from the Internet on August 11, 2011 http://chuma.cas.usf.edu/~spector/scales/jsspag.html

Texas Center for Nursing Workforce Studies, Nursing Education Program Information Survey 2009, Faculty Demographic Updates Vocational Nursing Programs. Retrieved from the Internet on August 11, 2011. http://www.docstoc.com/docs/82467093/

Faculty-Positions-in-Vocational-Nursing-Programs-Vacancy-and-Turnover-of-Faculty-in-Vocational-Nursing-Programs Texas Center for Nursing Workforce Studies, Nursing Education Program Information Survey 2010, Faculty Demographic Updates Professional Nursing Programs. Retrieved from Internet on August 11, 2011. http://www.dshs.state.tx.us/chs/cnws/2010_RN_Faculty_Demographics_F.pdf

Van Ast, J. (1999). Community college faculty: Making the paradigm shift. Community College Journal of Research and Practice (23), 559-579

Obama Administration Proposes Potentially Cutting 9% of the US Nursing Schools Enrollments

2010-12-29T18:59:00.004-07:00

The Department of Education (DOE) has crafted new proposed “gainful employment” educational regulations that may potentially reduce the capacity in nursing schools that; in the past year, educated 9% of the nurses and 54% of the allied health workers.

This reduction comes at a time when the nursing shortage continues unabated. A higher ratio of nurses to patients shortens the number of hospital days, improves patient outcomes, and reduces the rates of hospital acquired infections. For-profit nursing programs are currently under attack by the DOE. This seems incongruent with President Obama’s campaign promises to support nurses as well as other healthcare providers.

600,000 New Nurses Needed
These proposed rules come at a time when; according to the Bureau of Labor Statistics, nearly 600,000 new positions for registered nurses will be created between 2008 and 2018. This is an increase of 22% or 2.12% growth per year. While unemployment has remained at record high; the healthcare sector, according to the US Bureau of Labor Statistics, has shown a net gain of 613,000 jobs since the recession started. Passage of the Affordable Care Act assures the continuing need for nurses. Why then, at this time of increased demand for health services, and a growing documented need for nurses is the Obama administration attempting to restrict students’ access to nursing education? Current efforts to reduce enrollments in for-profit sector nursing programs that are creating jobs and contributing to improvement the health of our citizens seems incongruent with national goals.

The issue seems to stem from a philosophical approach of the Obama administration that health care education should only occur in public sector educational programs. This is directly related to incidences of abuse by some for-profit colleges. By supporting the aggressive pursuit of any public or for-profit schools that employ deceptive practices, the DOE indicates its intention to decrease educational options for millions of Americans.

Some key politicians in the Senate and their enforcers in the DOE have apparently decided that the for-profit education sector should not play a continuing role in the education of nurses and other allied health workers. Apparently, restricting nursing students’ access to schools of their choice and access to private for-profit institutions will serve the public’s interest, i.e. potentially reducing nursing enrollment and those of other health care professionals.

For-Profit Schools Targeted
These concerted attacks on for-profit education sector seem driven by a bias that ALL such schools are only interested in “fast bucks” obtained primarily from Federal student grants and loans administered by DOE through its Title IV regulations. The “for-profit” educational sectors, like all tax payers looks for existing Federal regulations and their approved accrediting agencies to insure any unethical practices are not tolerated. The Federal regulations and accrediting oversight should apply to ALL public and private sector educational programs who participate in the Title IV programs.

The General Accounting Office (GAO) in August of 2010, the General Accounting Office (GAO) released a report to the Senate’s Health, Education, labor, and Pension Committee hearings regarding “for-profit” educational institutions. The GAO; that is supposed to be the Federal Watchdog and must remain unaffected by industry and political influences, provided the Committee Chairman with testimony that illustrated illegal and unethical activities allegedly done during the undercover investigation of “for-profit” schools. In November, under mounting evidence of the bias and untruths in the report, the GAO released a corrected report that acknowledges significant errors in its findings.
While the ‘for-profit” sector is a relatively minor recipient of Title IV funds in comparison to the public sector, the investigation failed to examine these schools.

For-Profits Colleges Are More Cost Effective
Total federal and state grant subsidies for public colleges are over twice that of proprietary colleges: approximately $7,500 per full-time eligible student subsidy for public colleges versus approximately $3,000 per student (including total cost of defaults) for proprietary colleges. The average community college graduation rate of nearly 7%, costs the taxpayers around $137,000 per graduate. This is more than $32,000 or four times more than it costs taxpayers to educate the same student in a for-profit school. Those who attend a public community college most take up to 5 years to graduate. Students who attend a public community college generally graduate in five (5) years and over 50% drop out by the second year. Only 22% finish within 3 years while for-profits have a two year graduation rate of 60%. While proprietary institutions are criticized for making profits, approximately 40 percent of these profits are returned to the government in taxes.

One argument by the DOE is that “for-profit” students have a significant higher default rate on student loans than those in the public sector. When one compares “apples to apples”, the type of student, not the tax status of the institution influences the default rate. Community Colleges and proprietary schools’ default rates are the same when calculations take into account the higher number of minority and lower income students in each organization.

For-Profit and Public Schools Need To Be Treated Equally
Educating nurses requires innovation, creativity, all within an educational framework of insuring the highest standards. This is not the time to single out one segment of the educational system who is currently educating over 42% of all medical workers. Overzealous regulators and politicians who are opposed to free market solutions to education reform, will hopefully “take a deep breath” and realize that solutions to increasing the number of nurses should be applied to all education institutions. Together, we can work to insure our citizens have access to practical and registered nurses.

7 Free Web Quizzes to Grade Your Physical Health

2009-11-25T11:14:00.002-07:00

Guest Posting by Mary Ward

It takes a lot of work to stay health conscious when life is so busy. Yet, for many people the need to evaluate their physical health can become a necessity. In some cases, a sudden illness may have prompted you to think more about your health. You might wonder what resources are out there to make it easier to evaluate you physical health. A great way to do this is to take an online quiz. Take a look at 7 free web quizzes to grade your physical health.

They are available on the following websites. Some offer multiple quiz options while other use a single quiz as a guide to help you get a handle on you current health status. Take some time to read through and take each one to see what they offer.

Quick Nutrition and Physical Activity Quiz – Established by the California Health Department, this website is a community outreach that offers a great quiz that not only tests your knowledge of proper foods and exercise, but also how these things impact your physical health. The network toolbox provides other sources as well, but its Quick Nutrition and Physical Activity Quiz is a main feature.

Better Health Channel – This Australian government website doesn't just offer one quiz it hosts nearly 50 distinct quizzes in six health and fitness categories. Whether you want to take a quick on digestive health or evaluate your personal exercise habits, you should be able to find a quiz that fits your situation.

Alive.com – Targeting the vegan, the holistic health, and other progressive communities, this page have a selection of quizzes that can be used to grade your physical health, among other things. Take a quiz to see if you're getting enough sleep. Rate your physical activity. Maybe you would like to evaluate how your physical health is affected by your workplace environment.

The American Heart Association – This interactive web quiz is used to evaluate how physical activity directly influences heart health. If you have questions about your own heart, you may want to take this quiz to find out how much you know—and what you can learn that could help you.

Free Health Test – If you haven't make physical health a priority, you should think about starting now. There is no reason to avoid this any longer. Start by taking this free health test offered by Sixwise.com. While it is a short quiz, it can help you re-prioritize physical health in your life.

Free Health Quizzes – Similar to what the Better Health channel offers, FunQuizCards.com offer a whole list of physical health quizzes that can help your rate your personal health levels. You can also investigate certain health issues by taking an informational quiz to help fill in the blanks.

OrganizedWisdom.com free health quizzes – Again, a great collection of diagnostic quizzes to help you shed some light on physical health. If you want to grade the quality of your current health, then one of these quizzes could be just what you need.

All of these free web quizzes exist to inform and challenge you to care more about your health and maybe take steps to make things better. Only you can improve your physical health. Often it takes a little information—or lack of it—to get you focused on what matters.

Mary E. Ward writes about how to apply to phlebotomy technician schools.

As a Country Have We Lost Compassion for Others?

2009-11-24T10:06:00.004-07:00

It’s strange that elected officials in a nation founded on Christian principles are focused on insuring that our citizens with limited financial resources do not enjoy the same access to health care as they do. After all health care from their perspective is NOT a right, it is a privilege for those with resources. The Senate minority while striving to be an inclusive party is clearly opposed to any health insurance program that provides a public option. After all Medicare, Medicaid, Tri Care, military health care system and the Veteran’s Administration have demonstrated they are unable to provide quality care that is cost effective. The private insurance companies certainly have demonstrated they are very able to provide quality and cost effective care for those with the resources to pay for such. The conservative opposition means that for the vast majority of the uninsured and/or underinsured they are just out of luck. They had better get a job that provides health insurance, never get sick or maybe simply move to a more welcoming country. What a sad commentary on our nation and its values. We claim to be a Christian nation that welcomes all people and yet the very essence of Christ’s teaching are only used when it seems useful to further one’s personal agenda.

Is the United States becoming a country that is so individually focused that the need of our neighbor is simply not our concern? Are we becoming a country of self righteous individuals who only wants laws and policies passed that benefit themselves and to the “heck” with the “love thy neighbor” concept? Are we moving to country like ancient Rome when just before its fall the wealthy and politicians were only concerned about what was best for themselves. The needs of the people did not matter.

Would our economic problems been different if financial institutes were governed by a strict code of ethics? Should former Wall Street financial managers become regulators in the US Treasury Department with the sole intent of changing the regulators and rules that would allow their counterparts to profit through taking advantage of those with the most to lose?

Are we a country that is rapidly becoming one without morals? Why do we tolerate the killing of African Americans school children in one of our largest cities? What would be the Senate minority (largely white men) response if it was their children and grandchildren being killed? Why do we tolerate a 10 year child dying within sight of US capital from a tooth abscess?

Now why in the world would this group not figure out a way that health insurance can be provided for those who cannot afford such? Could it be that we are rapidly moving to a country which only cares about special interest groups, profits for themselves and their supporters, and those who look like themselves? The objection logically cannot be costs given this same group of legislators approved huge deficits during the George Bush regime. Our elected officials have an opportunity to start putting ethics and caring for each other back into government and and our society. Our churches of all dominations need to start acting upon the teaching in their Holy books be it the Bible, Koran, or Tara.

Maybe, just maybe if we can as a country muster enough courage to start demanding our elected official do what is right for our country; to live up to the constitution and declaration of independence, and our religious teaching maybe there will be hope for a new beginning. President Obama cannot do this alone. We must each awaken and take responsibility to again insure our country is a model that the citizens of the world want to look up to. Let’s start with insuring health care for our citizens.

Managing the Cost of Medications

2009-06-02T11:13:00.000-06:00

Speaking up, being patient and using simple math can be the best medicine for your wallet.
Prescription medications are one of the most expensive and reoccurring costs you’ll face. Fortunately, many of them have generic counterparts that are available and less expensive. The U.S. Food and Drug Administration requires that generic drugs be as safe and effective as their brand-name counterpart. More than half of all prescriptions are for generic drugs. When your provider writes a prescription, ask for the generic substitute. If the provider gives you a sample drug, also ask for a generic prescription so you can use it for a refill if needed.
You also can call different pharmacies to find out their price for your prescribed medicine. In most cases, the prices will be similar. In others, you’ll be thanking yourself for making the effort.
If you have prescription coverage that includes a co-pay, it may be cheaper to pay the generic price of $10 of the medication versus the co-pay depending on your co-pay amount. For example, the co-pay on a prescription plan for a 90-day supply could run from $27 to $75. In this case, it is more cost effective to pay the $10.
Mail order also may be another option when the medicine is not needed immediately. Mail order usually is substantially cheaper and a 90-day supply is the usual order.
In some cases, over-the-counter drugs may be substituted for some prescribed medications. For instance, Claritin (Loratadine) can be purchased over the counter while its counterpart requires a prescription from a health care provider. The savings between the two can be substantial while the results are similar. Do yourself a favor and check with your health care provider or pharmacist.
Most of the time, the cost of medication does not depend on the dose. For example, a 100 mg Viagra tablet could cost the same as a 50 mg. Ask your provider or the pharmacist if the medication can be split. You may also find relative information on the Internet or through Consumer Reports about splitting drugs. If yes, you can save some money by getting a double dose of your prescription.
Using Pravastatin as an example, if your provider approves and your daily dose is 20 mg you can cut the 40 mg tablet in half and get a 180-day supply for $10. This is a substantial cost saving.
Those with numerous chronic illnesses may be in a situation where different providers prescribe a variety of medications. Ask your primary provider to review the medications and together you can determine which are needed. This could result in cost savings as well as the benefits to your health.
The pharmaceutical industry spends millions of dollars marketing directly to consumers. We are bombarded daily with television and print ads that promote numerous medications. The industry has found that their campaigns can direct patients to their specific product when other less costly options might be available.
Be careful about being persuaded that a heavily marketed medication is appropriate for you. A substitute drug for a 10th of the cost may be just as beneficial.
So be aware and speak up when it comes to your health. You’ll save money and not sacrifice quality medications.

Stimulus Plan A Potential Boost for UTEP's SON

2009-02-26T09:44:00.001-07:00

With the signing of the American Recovery and Reinvestment Act, into law this week should provide a significant opportunity for UTEP and its health related disciplines and researchers to secure additional funding. Nearly $140 billion in funding for health care is targeted to support a number of healthcare activities that could significantly impact UTEP ‘s research agenda. The National Institutes of Health (NIH) will receive $10 billion with more than $8 billion targeted to fund research. The funding for NIH has been relatively flat for the past six years resulting in limited growth in the creation of new knowledge. The $10 billion will be on top of the existing $29 billion annual funding.

Currently NIH funds on an average 10% of the research proposals submitted. These new funds which must be spent over the next two years means that other competitive research applications that did not make the cut will now have an opportunity to be considered. This may mean that for UTEP researchers engaged in research such HIV/AIDs, environmental health, Hispanic health disparities, diabetes, obesity, Alzheimer’s disease, heart disease as well as other areas of investigations may be able to secure additional moneys.

While investigating important health issues the infusion of funds will also mean the creation of new jobs and opportunities for local vendors to provide supplies and equipment needed to conduct the research. It is estimated that nationally some 70,000 jobs can be created as a result of this investment in research. In the School of Nursing alone over 20 positions are funded in whole or part by either NIH or Health Service Resources Administration (HRSA) funds.

Another $1.1 million is targeted to fund comparative research that will support investigations that compare different treatment approaches against each other. For example, projects that compare newer drugs prescribed to manage elevated cholesterol with less expensive generic formulas are the type of comparisons that are anticipated to be funded. There is evidence suggesting that some existing treatments and medications may not be as effective as those that cost less. Pharmaceutical, medical supplies and equipment manufactures in a free market system have incentives to push their latest product even thought the effectiveness of such may be the same or less than a cheaper option. The Obama stimulus package will encourage investigations to evaluate alternatives so that any costs savings can be pass on the consumer without impacting outcomes of care. Potentially billions in cost saving can be achieved from the results of such comparisons.

With support provided in part by the Hispanic Health Disparities Research Center a NIH Center of Excellence and the Office of Research and Sponsored Projects, UTEP investigators from across the campus have been actively engaged in drafting new and refining prior submissions in anticipation of the opportunity to tap these new funds. UTEP’s School of Nursing ranks 28th in the nation (out over 700 bachelor and higher degree granting Schools of Nursing in nation) for the amount of its NIH funding.

The stimulus package also provides $500 million for health professional education. Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII) were allocated $300. This means your School of Nursing will hopefully receive additional funds to educate more nurses for our community.

Ensuring Quality Nursing Care

2009-02-04T15:43:00.001-07:00

Ever wonder how nurses and physicians learn to manage medical emergencies? In many health care professional educational curricula the age old apprentice model of “See One, Do One, Teach One” is a common methodology. This in essence means that nurses and physicians rely primarily upon learning how to care for patients in clinical settings after they have had a period of “book learning” that theoretically prepared them to provide competent care. Given the infrequent occurrence of emergencies (with the exceptions of those seen in emergency rooms) only a few students may actual be on the unit to participate in an emergency. Thus learning how to manage life threatening emergencies is taught primarily in the classroom. This model of education does not assure providers’ competency.

Can you image an airline pilot learning how to handle emergencies solely through classroom instruction? Given the significant risk to the public, airlines are required to include simulation training in the education of pilots. Commercial pilots must demonstrate competency in managing flight emergencies via simulators at least every six months. Further safety protocols include check rides with expert flight instructors to assure that the pilots are competent.

One would think that perhaps in health care when a person’s well being is often dependent upon the expertise of a provider’s competency there would be a similar quality process in place. Unfortunately, preventable medical errors are so frequent in a 1999 report “To Err is Human” issued by the Institute of Medicine, it was estimated that up to 98,000 people in the U.S. die annually from medical errors. This is equivalent to 245 Boeing 747’s crashing each year in which 400 passengers die. Imagine the public outcry if the flying public was subject to such a high death rate.

Have you heard a protest about the unnecessary deaths and injury that occur daily in our nation’s hospitals? Given the deaths and injuries occurring in hospitals all over the country, the reporting in aggregate numbers does not occur. The extent of the problems with quality of care and the prevalence of medical errors have not drawn the national attention that they deserve. Thus our system of “sick care” has not had the same degree of public accountability.

The National Quality Forum and the Joint Commission on Healthcare Organizations (accrediting agency for hospitals) as well as other national professional groups have launched major efforts to improve the quality of care provided in our nation’s hospitals. “To Err is Human” and a follow up report also by the Institute of Medicine “Crossing the Quality Chasm” are the driving forces for the Institute of Healthcare Improvement’s 100,000 Lives Campaign. This 2006 initiative claims to have saved an estimated 124,000 lives in an 18-month period through care improvement activities conducted in over 3,000 of the counties 7,569 hospitals.

Where does the fault lie? As Harry Truman would say, “The buck stops here!” And in this case it appears to be our nation’s hospitals and their quality monitoring processes used to ensure safe care to patients. The shortage of registered nurses, inefficiency of existing care delivery models, lack of electronic medical records that can be programmed to alert staff to potential errors, health care providers who have not keep current in their practice, and economic pressures have contributed to these quality challenges. Health care provider education is certainly a critical factor in this mix. Registered nurses, physicians and others on the health care team must be educated to be critical thinkers, problem solvers, committed to lifelong learning, and taught how to assess and improve the care they provide.

Fortunately, the apprentice model of educating nurses at the University of Texas at El Paso is a thing of the past. The School of Nursing is 100 percent committed to improving the quality of care provided to our citizens through changing the paradigm of educating tomorrow’s nurses.

A major feature of this new shift is the use of scenario based education. In this model students learn how to care for complex patient conditions without ever stepping foot in a hospital. Through the use of “life like” computerized mannequins students are taught how to assess the most common conditions of patients found in hospitals, to implement an evidenced based plan of care, and to evaluate the outcome of the interventions. The mannequins are programmed by the faculty to simulate a variety of conditions and to introduce complications to teach the students how to manage safely even the most complex patients. The simulated patient’s condition changes depending on the interventions implemented.

By doing this the student is able to learn how to safely provide nursing care in the safety of the Simulation Center. The student can practice repeatedly procedures, assessments, interventions, etc until achieving competency in safely managing the condition or conditions presented. The UTEP students before graduating must demonstrate competency in managing emergencies and the most common diagnoses. This is one method used to insure students are safe and competent nurses thus hopefully contributing to the reduction of medical errors and resulting unnecessary deaths.

Just like the airline industry UTEP’s School of Nursing is rapidly incorporating into its program the use of technology. Such a move provides a rich learning environment for students while not placing any patients at risk. In the near future we will also be using standardized patients who are actors that use a faculty developed script designed to teach the student to interact with a “real live” person. The student is provided lab data and other assessment information. Thus the technique provides another means to teach students how to competently managed selected patient conditions.

Thus, in creating the new health professionals building for the School of Nursing and College of Health Sciences, designers have created spaces and infrastructure that can be adapted to changes in curriculum as they emerge. Our existing simulation centers, currently located on the UTEP campus as well as at Sierra Medical Center and Del Sol Medical Center, are our central hubs of learning activities. The centers are becoming a focus of credentialing not only for UTEP students, but also for health professionals in our Far West Texas region and potentially in Central and South America.

In the immediate future, our primary focus will be educating more BSN and graduate prepared nurses. By 2017, the Upper Rio Grande Workforce estimates El Paso County will need nearly 2,400 new nurses, of which at least 80 percent should be prepared at the undergraduate level. We will continue to expand our traditional and Fast Track BSN options, and offer an LVN to BSN program beginning in summer of 2009, that incorporates online and other instructional technology. The five-year goal is to increase by 125 percent of our existing number of BSN graduates from our 2006-07 baseline of 159 students.

Your School of Nursing is committed to educating the nurses needed for our community to ensure the highest quality of care available is being given. Increasing the number of registered nurses, with a BSN degree, at the bedside ensures a higher quality of care. You can rest assured that the UTEP School of Nursing is committed to its vision of becoming the premier Hispanic-serving School of Nursing in the nation thus contributing excellence in its graduates.

What Would Obama’s Health Plan Do for El Paso?

2009-02-03T13:27:00.002-07:00

In El Paso County nearly 40% of its’ population are without access to health insurance. In some colonias the rate of uninsured approaches 60%. Despite this high percentage of underinsured for profit healthcare systems have flag ship hospitals located in El Paso and our taxpayer supported Thomason Hospital reports they are in the best financial position than they have been in recent years. Clearly even with our high rate of underserved healthcare is big business in our community.

It is estimated in 2005 between the for-profit hospitals and the public sector facilities nearly $900 million in net patient revenues was generated. While the percentage of uncompensated care averaged 4.72% for the Tenet and HCA hospitals, Thomason provided 37.6% uncompensated care and still reported net operating income totaling for the past two years of nearly $70 million.

The Obama plan calls for coverage for all Americans. If an individual has insurance under his proposed plan individual premiums will decrease. Every individual will be able to buy into a health insurance plan similar to those provided to Federal employees including our enjoyed by our Congressional delegation.

No one will be turned away because of pre-existing conditions, employment status or ability to pay. No longer will an individuals’ health status or history be the basis for denial of health coverage.

Obama’s health plan will require a full range of services including mental health and disease management requirements. A significant component will be supporting health promotion and disease preventions strategies with proven effectiveness. Our public health system long neglected will see a revitalization to insure programs and surveillance systems are in place to protect our nation’s health. Hopefully this means we will no longer need to be concerned about clean water that is free of pollutants, or foods contaminated with salmonella.

A major initiative will be on supporting the continuing development of our infrastructure for disaster response. Katrina revealed the serious challenges that our existing disaster response system faces. While substantial progress has been made through a variety of Homeland Defense programs aimed to improving local, state, and national responses to both terrorist and natural disasters challenges remain. The Obama economic stimulus plan (being considered at press time) provides up to $100 million to prepare for a national health disaster.

Like plans in Japan small business will be able to purchase insurance from low risk pools and not have to pay high premiums because of the inability to purchase coverage at reasonable rates.

The Obama plan will provide tax credits that will cover up to 50% of the costs. The secondary insurance pool will provide coverage for those with catastrophic health problems.
The free market insurance system will continue with individuals having the option of purchasing private insurance plans that will provide more options for those desiring such. This is similar to private plans in Australia and Canada. Individuals with these plans (depending on the benefit and payment options) can select plans that allow more flexibility.

Obama also promises to take on the big insurance, pharmaceutical and medical supplies/equipment companies in addition to other special interest groups who spend millions of dollars lobbying against reform of the healthcare system to maintain generous profits. No longer will the US subsidize the costs of developing new drugs, emerging technologies, and other innovations while the same products/drugs are sold in other countries sometimes for a less than 25% of the cost charged in the US.

High standards for quality will be required and will be achieved in part through implementation of electronic medical records and more efficiencies in the delivery of health services and in the administration of the health plans. Obama is already moving forward with his plans to encourage the adaption of IT innovations in health care. In the administration’s economic stimulus package (being considered at press time) allocates more than $20 billion for the implementation of IT enhancement such as electronic medical records.

Physicians who agree to participate in the IT enhancement would be eligible for higher reimbursement rates from Medicare and Medicaid as well as payments between $45,000 and $65,000 once they can prove they are using IT effectively. In addition, hospitals would also be eligible to receive millions of dollars for IT adaptations.

Image the impact on our local economy if the 40% of our citizens without insurance are suddenly eligible for health care. Assuming Obama’s health reform plan is passed or something similar by the end of 2012, El Paso will benefit from this tremendous growth that will occur when our large population of uninsured individuals are suddenly eligible for health care.

As a community we are already challenged with a having adequate numbers of hospital beds, nurses, physicians, and other health care providers. The impact of the growth at Fort Bliss has facilitated significant increase in the number of military personnel, their dependents, and retirees. With this growth alone we will need by 2012 another 2,300 nurses, a significant increase in the number of physicians, and other healthcare provider.

The existing infrastructure is not ready for the current growth let alone the increase demand that could come from increasing health care coverage for all citizens. Schools of Nursing and Medicine will need to significantly increase their capacity. The number of residency positions for new medical school graduates will need to be increased to assure the new physicians will stay in El Paso. Other health professionals including ancillary health related occupations will also need to gear up to help meet the workforce needs.

The existing practice acts particularly for advance practice nurses, optometrists, podiatrists, physical therapists, pharmacists, psychologists to name a few must be updated and scope of practice enlarged. The restrictions while in the past perhaps were warranted are no longer justified given the current educational preparation of these non physician health care providers, The demands for high quality health services are going to be unrelenting and the practice acts for non physician providers will need to amended to insure the public will receive quality care.

The economic impact of forthcoming health care reform will have a significant impact on El Paso in the near future. We must plan now to insure we are ready for this new growth. High school students need to be encouraged to seek health career so they can be academically prepared for health care professional education. Fast track educational preparation for health care professions needs to be incorporated into early college programs that are available to high school students.

We will have an unprecedented demand for hospitals beds, home health care, primary care, and specialty care. Unfortunately as with most countries with universal coverage longer waiting times for elective procedures as well as delays in obtaining appointment from specialists will probably be the norm. Those who purchase the private insurance options will most likely have quicker access to care due to their ability to pay the higher fees associated with private care.

The bottom line is that El Paso will experience substantial growth in its healthcare industry. Significant economic opportunities will emerge given our pent up demands for health care. The growth will come with challenges and perhaps a change in how those who now have health insurance will be able to obtain such in a timely manner.

As a community we need to be aggressive in our planning to insure our citizens will have the health resources needed. This means an active engagement in strategic planning to assure we ready to meet this challenge. Are we committed?

Investing in Health Disparities

2008-12-30T06:34:00.001-07:00

I am tired of attending funerals and hearing of the needless deaths of individuals who have died unnecessarily from conditions that could have been cured if treated or prevented in the first place.
This holiday season reminds me of twelve-year old Deamonte Driver, a young African American who died in the shadows of our nation’s capital last February from a toothache that progressed to a brain abscess.
Deamonte’s mother was repeatedly refused dental services for an $80 tooth extraction that could have saved the life of this young boy. He died because he had no insurance and no dentist would pull his rotten tooth without payment up front.
Another tragic death from a treatable cancer occurred with one of my student’s father, a retired El Paso fireman whose retirement left him without insurance. He was too young for Medicare and had “too much” income to qualify for Medicaid. No one would give him the potential life saving chemotherapy he needed without putting money up front.
My father, a sailor in the Pacific front during World War II, survived the sinking of his destroyer by a Japanese submarine, and somehow escaped death or injury in the insuring kamikaze suicide attacks; lived only to be killed 50 years later from an addiction to nicotine that the tobacco industry knew would kill people.
Our current health care system is a “sick care system” with over 70% of the health costs occurring in the last year of life. In 2007, as a country we spent over $2.3 trillion dollars on sick care or over $7,600 for each person living in our nation. What do we get? We have one of the most sophisticated sick care delivery systems in the world, yet we rank 37th when our health outcomes are compared against others such as Cuba at 39th and Costa Rica at 36th.
According to the Paso del Norte Region Health Report of 2007-2008 our local health indicators are some of the worse in the nation. Among USA counties, El Paso has the highest rates of cancer, stroke, and diabetes. Otero County has the highest rates of heart disease, chronic lung disease and injuries. Doña Ana and El Paso counties have the highest rate of death from cancer and heart diseases. Juarez has the highest rates of death from influenza, diabetes, and AIDS.
We have fewer registered nurses, physicians, dentists and other health care workers than in any other part of Texas except for the Lower Rio Grande Valley. Outside of the metropolitan area the rest of the county is considered medically underserved. The number of primary care providers to serve our population is half of the average found in the rest of Texas.
The majority of the causes of death such as diabetes, heart disease, stroke, and cancer are the result of smoking, obesity, and lack of physical activities. In fact depending on where you live your chances of dying is influenced by access to health care, healthy foods, transportation, quality education provided to you and your children, air quality and other environmental hazards.
The proportional importance of factors shaping health is determined 40% on behavior, 20% related to environment, 20 %t on genes, and 10 % on health care.
Where we are in our social structure is the highest predictor of health. Those at the bottom of the social economic ring are unhealthier and die younger. In comparison those at the upper end of the economic spectrum even when they smoke and are obese are healthier and live longer.
According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50% higher chance of dying sooner than those on the top. Furthermore, those in the lower economic sector are 400% more likely to die sooner than the upper economic sector.
El Paso ranks as the 7th poorest county in the nation with 26.4% of our population considered poor. We have over 32% of the population without health insurance and in some colonias the rate exceeds 60%. In El Paso 68% of our residents have a high school education and dropout rates in some of our public schools are as high as 50%.
However as a city and county we can take action now to start addressing the other 60% of the other determinates of health. A health population equates to an educated and healthy workforce.
Our schools must be held accountable for their outcomes. New and innovative teaching methods must be implemented to insure that no child, particularly boys, are left behind. A young boy who cannot read by the third grade is at substantial risk to be a high school dropout. Charter schools that are not hampered by bureaucratic restrictions should be financially supported and encouraged to locate in our poor communities. A child with an education insures opportunities for more economic security and the ability to make informed decision about healthy options.
Access to healthy foods for those areas without easy access to grocery stores is critical. Food desserts that exist in many of our poor neighbors must stop. We need to insure, in collaboration with our local government and private sector, local markets are given recognition for being a good neighbor. This recognition would only be awarded when fresh fruits, vegetables, meats, and other products are made available at rates found in more accessible communities. The creation of public garden plots, support for farmer markets, financially supporting local grocery vendors to sell fresh produce, diary products door to door as was once common practice will all assist in making healthy foods available. In other parts of the nation where this approach has been used the health of community members improved as well as the profits of the local vendors who offered the service.
Public transportation must be improved. Our city does not seem to have a transportation plan that encourages the use of public transportation. People without transportation particularly in the rural and in some of our poor areas are left with few options. Our sister city of Juarez has public transportations that serves their entire city. New transportation models must be developed and a long term strategy for transportation must be implemented.
Parks and recreational facilities for our youth must be a high priority. We must demand that physical education is taught in our schools along with curriculums that teach children how to be healthy. Food selections in our schools must include healthy options. Highly addictive food containing high sugar content and Trans fats must be completely eliminated from the school lunch menus. The Women’s Infant and Children program must include access to fresh fruits and vegetables.
A child who is obese will in most cases be an obese adult. We know that obesity kills. In fact the progress made in extending the life expectancy of our citizens may be lost through premature deaths due to health problems associated with obesity. The obesity epidemic will kill our children in their prime of life.
We are surrounded by environmental pollutants that may come from our proximity to smelters, refineries, asphalt plants, auto emissions, pesticides, lead both naturally occurring and as result of paint and other industrial activities, and polluted water. Studies to better understand these environmental hazards and solutions to minimize their impact are urgently needed. The economic impacts to our community from these industries must be balanced with their impact on the health of our citizens.
As a community we must muster the political will to say “enough is enough”. Our communities must be empowered to find solutions. We create through a shared vision solutions to these challenges. We can work with both our elected officials and the private sector to insure we have adequate number of health care providers, more Federally Qualified Health Plans, that our schools take action so they become part of the solution to create a healthier community, that we begin to believe that access to healthy food is a right, that parks and recreational activities means a stronger workforce, that public transportation means more opportunities to create a more educated labor force and enhances access to health services, and that our environment must not be a contributor to poor health no matter how much the economic benefit.
The Obama election may mean that perhaps the “stars” are aligning so that healthcare becomes a right and as a nation we may have finally place significant emphasis on health promotion and disease prevention activities that can improve our health and assure quality health care is available to all individuals living in our country. Maybe such an investment will mean that young people like Deamonte Driver won’t die from a tooth ache.
References
Portions of this article were inspired by a speech given by US Representative Elijah Cummings, (D-ND) Key Note Address on December 18, 2008 at the National Health Institutes, National Center for Minority Health Disparities conference on the Science of Eliminating Health Disparities. Representative Cummings gave a very moving speech about health disparities.
Regional health status data was taken from Paso Del Norte Health Foundation: Strategic Health Intelligence Planning Group Assessment of Determinants of Health in the PdNHF Region: A Review of Select Health Indicators for the counties of El Paso and Hudspeth in Texas; the counties of Doña Ana and Otero in New Mexico; and the city of Ciudad Juárez, Chihuahua, Mexico. Retrieved from Internet on December 19, 2008 from http://www.pdnhf.org/documents/659PdNHFRegionalHealthAssessment5-6-08Revised.pdf
And references from Unnatural causes taken from Unnatural Causes: Is inequality making us sick? Retrieved from Internet on December 19, 2008 from http://www.unnaturalcauses.org

This story first appeared in El Paso News Paper Tree on December 22, 2008.

Social Determinates of Health - More than health Care

2008-11-24T12:24:00.002-07:00

Positioning El Paso as a major center for medical care is an admirable goal and yet is only part of the solution to create a healthy community. What has not received much attention from our policymakers and funders is a comprehensive plan to address the social limitations of health.

Many health problems can either be eliminated or their impact markedly diminished through addressing the root cause of many of these challenges.

The proportional importance of factors shaping health is determined 40 percent on behavior, 20 percent related to environment, 20 percent on genes, and 10 percent on health care.

Proximity to health care does not mean that our community will have improvement in their health status.

The strongest predictor of health is where we stand as individuals in our social structure. Those at the top have the most power and on average live longer and healthier. Those at the low end of the social pyramid are unhealthier and die younger.

According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50 percent higher chance of dying sooner then those on the top. Furthermore, those in the lower economic sector are 400 percent more likely to die sooner than the upper economic sector. This is true despite unhealthy behaviors such as smoking and obesity.

The choices that we make are based on what is available to us. For example, does our zoning regulations require parks, walking paths, playgrounds and grocery stores located within walking distance of residential areas. Or do we see more fast food outlets, liquor stores and lack access to affordable fresh foods? Public transportation that is inconsistent, has limited routes and runs at inconvenient times can mean many are unable to access healthier options.

Are our schools held accountable for educating graduates who can compete in our modern world? Are extracurricular activities, such as after school programs, music, art and gym, made available to all students? If we improve access to preschools, community college and universities, and create jobs that are “green friendly” we can enhance the health of our community.

As “Unnatural Causes” illustrates it is not the CEOs that are dying of stress-induced illnesses, it those with low paying jobs who have limited access for housing, food, health care, inadequate public transportation and unsafe living conditions who are suffering the most.

When we do not have money, a sense of control in our lives and an education to allow access to greater economic security then no health insurance, poor health and premature death are the norm. It is this kind of stress that kills!

Social policies such as minimum wages, improved working conditions, mandatory schooling, civil rights laws and improved housing have contributed to an increase in our life expectancy. But more must be done.

We are paying the price by our lack of commitment to address the social determinates of health. Many of us are obese, have cardiovascular diseases and diabetes. In many cases these conditions can be directly related to the limitation of our social status.

The cost of treating our health problems is the highest in the world and will continue to escalate if we do not address these other factors that contribute to disease.

We must also provide resources to tackle these issues. Continuing to educate more nurses, physicians and other members of the health care team—while urgently needed—must also be done in tandem with developing community-based solutions to address these social determinates. We need to invest now or our health disparities and inequities will continue to grow.

Martin Luther King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This statement is still true 40 years after this death.

PTSD - Growing Problem

2008-10-29T16:00:00.000-06:00

Post traumatic stress disorder (PTSD) has recently received a significant amount of attention. Most frequently PTSD is associated with members of the armed forces who have been deployed to Iraq or Afghanistan. A recent report by the RAND Center for Military Health Policy Research shows of the approximately 1.64 million military service members who have been deployed to the war zone as spring 2007, 14% screened positive for PTSD and 14% for major depression.
PTSD is an anxiety disorder that is associated with a dramatic event in which the person experiences the threat of death or serious injury. The most common PTSD exposure in the United States comes from individuals who have been involved in automobile accidents. It is estimated that approximately 20% of those in automobile accidents suffer from PTSD. According to the National Highway Traffic Safety Administration, approximately 2.5 million people are injured in automobile accidents annually. So a significant number of individuals are potentially at risk for PTSD and associated conditions.
PTSD and depression both are biological disorders, which can be manifested from exposure to excessive levels of stress. Basically, the body’s stress response system is overloaded. Symptoms of PTSD include insomnia, nightmares, flashbacks of the traumatic event, startling easily, avoiding a situation that reminds the individual of the traumatic episode, difficulty in concentrating, emotional withdrawal, aggression, and irritability. Depression has similar symptoms including ongoing sadness, hopelessness, difficulty sleeping, and fatigue, feelings of worthlessness or guilt for no specific reason, weight change, and loss of interest in usual daily activities.
According to a recent study done by Joseph Boscarino of the Geisinger Health Systems in Danvile, PA, Vietnam veterans with a history of PTSD had a 50% greater chance of dying from heart disease in their 50s compared to those veterans without PTSD. Many individuals with PTSD delay treatment and thus may manage their symptoms with drugs and/or alcohol.
The highest level of evidence for the treatment of PTSD includes exposure therapy, stress inoculation training, cognitive therapy, eye- movement decentralization and reprocessing, psychopharmacology primarily the use of Zoloft and other selective serotonin re-uptake inhibitors, psychodynamic and group therapy. All of these treatment procedures are considered to have a level A of efficacy. Level A evidence is derived from randomized clinical trials for individuals with PTSD.
The Department of Defense has earmarked over $300 million for research on PTSD and brain injuries. The Veterans Administration also has designated significant resources to the treatment of former service members who may have suffered from these conditions. The key to a more successful outcome is early recognition and treatment. Here in El Paso, the military has treatment programs available for active duty personnel. Dependents and retirees are eligible to receive care under the Tri-Care insurance program. Retirees also can see care at the Veterans Administration facility as well. Given the significant number of automobile accidents that occur annually in our community the civilian population, as previously mentioned is also at risk for PTSD and depression. PTSD should be considered a stress injury and care should be sought as soon as symptoms begin to emerge.

Health Interpreters for Spanish Speaking Patients - Quality of Care Issue

2008-09-01T11:56:00.000-06:00

What options does a non Spanish speaking healthcare have to insure his/her Spanish speaking patients achieve quality care? Tried methods include the use of bi-lingual children, other relatives, non healthcare employees such as those in housekeeping, maintenance, and dietary who have some English language skills are used and continued to be used to translate conversations between healthcare providers and their Spanish speaking patients. While this might seem to be an appropriate avenue, such an approach should only be used in dire emergencies.

The challenge with this approach is the provider may assume the translator is literate and competent to translated medical terms and related conversations. Given that education is only mandatory up to the 6th grade in Mexico it may be a huge error to assume an immigrant who is asked to translated may have sufficient literacy to serve as a translator. Medical terms are not commonly spoken in Spanish by the general population or for that fact with USA residents who have low educational levels.

Given the privacy of communication between the healthcare provider and the patient the use of non health professionals who lack proper education and credentialing to service as translators is inappropriate. Issues such as HIV status, substance abuse, mental health issues such as child maltreatment and domestic abuse need to be discussed using the highest levels of confidentiality. Thus using a child or other relative to serve as the translator is totally inappropriate, particularly in these situations.

For some time healthcare providers can out source translations to vendors who will provide such services via the telephone. This is certainly a step in the right direction, particularly if the provider is unable to secure such translation services locally. The provider needs to insure the questions being asked of the non English speaking are kept short so the translator can provide an accurate word for word translation and not attempt to summary a lengthy questioning and/or discussion. The same is also true when the patient is asked to respond to the provider question. There is always the danger that the translator may not be able to retain all of the information and accurately summarize the response. The provider should ask the translator to repeat back to the him/her the question to help assure the individual doing the translation did understand the communication. While this is a more time consuming process the accuracy of the translation is improved. The tendency for the non Spanish provider to limit the interaction with the patient due to the language problem is common. This can lead to the patient not fully understanding the communication and may lead to more frequent follow-up visits by the patient to seek answers that were not addressed during the initial interview.

Increasing Health and Human Service Administration requirements for cultural competent care and new standards from the Joint Commission on Healthcare Organizations means that healthcare providers must find more suitable solutions to insure competent translations as well as confidentiality of the communications. Spanish speaking individuals who are appropriated educated in the use of medical terminology and knowledgeable about health privacy issues, and can provide proper word for word translations are urgently needed. These individuals with such training and resulting credentialing should be employed in clinics, emergency rooms, and hospitals. They can potentially make an significant contribution to improving the quality of care provided to our monolingual Spanish speaking patients.

Access to Healthcare and Health Literacy - Critical Issues for Hispanics

2008-08-31T14:41:00.001-06:00

A recent report released by the Pew Foundation and the Robert Wood Johnson Foundation HispanicTips » » Hispanics Need “Health Reform Plus,” with ...indicates that access to health care is only part of the problem facing Hispanics in their search for health care. While a significant number of Hispanics lack health insurance and this is a critical issue related to access, an even greater concern is how many Hispanics access care and what happens in that encounter. Once care is accessed the health care is often not provided in a linguist and culturally appropriate manner, thus the individual may leave the encounter with incomplete understanding of the treatment plan prescribed by the provider.

Given the high percentage of Hispanics with lower paying positions (many of which have insurance) a high percentage are unable to take time off from work to seek health care. For lower income employees who work hourly or are paid based on their production (i.e. how many sack of onions picked) they are simply unable to afford the time for health care. Taking time off from work means loss of income and choices between having enough income to care for their families and seeking treatment for a health problem have to be made. Thus when the health problem is significant enough (in the judgment of the individual) healthcare for most of these individuals must be sought during regular business hours and frequently travel to some distant clinic/hospitals is required.

For immigrants another challenge in seeking health care is a lack of understanding how the USA health care system works. For example, unlike programs in Mexico where the care is free or requires a small co-payment those who seek care at hospital emergency rooms can find themselves saddled with unwieldy medical bills. Even with insurance the co-payment when seeking care at emergency rooms for non emergency treatment can create a substantial co-payment requirement. Unlike Mexico where individuals can purchase many medications at the local pharmacy such options in the USA are not available. Our system requires a prescription for most medication and this means the individual who need medications must first be examined by a healthcare provider. A lack of understanding in how the USA and Mexico healthcare systems differ may lead immigrants to spend more money on healthcare and eventually lead to less access. Hispanics in compared to other minority groups already are reported to spend a higher percentage of their personal income on healthcare than others.

Another challenge for Hispanics particularly those with limited health literacy and who lack English language skills, they are unable to communicate effectively with their healthcare provider. Even those of us who have the ability to read, write, and speak English fluently our encounter with a physician may leave us with a lack of understanding regarding what transpired in the office visit including the treatment plan prescribed. This lack of health literacy is even more critical when the patient is unable to speak English and when the health encounter is conducted in English. This lack of understanding can lead to errors in taking prescribed medications, uncertainty about follow-up treatment recommendations, and lack of knowledge regarding the diagnosis.
Insuring that healthcare is provided both in an appropriate linguist and culturally relevant manner is critical if we are going to make inroads to eliminating the gaps in health disparities in Hispanics compared to Anglos.

At UTEP, School of Nursing we are committed to insuring our graduates are able to provide such care to this growing segment of our population. We offer courses in Spanish for healthcare providers and are actively integrating the Health and Human Resources Administration recommendations regarding cultural competency and work force diversity into both our undergraduate and graduate curriculum. The need to address these access and quality of care issues impacting Hispanic is urgent.

Salmonella Outbreak is now Over – But for How Long?

2008-08-31T09:21:00.000-06:00

According to the Center for Disease Control (CDC) the most current salmonella outbreak is now over. The bacteria were found primarily in Jalapeño peppers, secondarily in Serrano peppers, and possibility early in the outbreak in tomatoes. Over a 1000 cases of individuals with confirmed cases of salmonella infections were reported.
University of Texas at El Paso students enrolled in an international health research course while conducting a health survey of farm worker harvesting Jalapeño peppers in the Mexico state of Chihuahua during the summer of 2008 reported a variety of environmental issues. While the students were not specifically researching salmonella, however in the process of interviewing the farm workers they noted the unsanitary working conditions. The workers had no fresh water supply, there were no toilets, and no way for them to wash their hands. Shortly after this field visit officials of the Department of Health in the State of Chihuahua notified the public that Jalapeño peppers from their area were found to be contaminated with salmonella.
The crops may have contaminated by unclean water, from unsanitary harvesting procedures, and possible contamination during the transportation and processing of the peppers at the variety of way points as the pepper found their way into the USA.
The CDC and the US Department of Agriculture (USDA) really lack the resources to provide the necessary timely testing of imports to insure fruits and vegetables are safe. The use of irradiation has been approved by the USDA but costs associated with using this technology and consumer acceptance create a significant barrier to its widespread adoption. Do not look for this technology at least in the next few years to be available to help protect our food supply.
Standards for the production of agricultural products do exist and with enforcement in both USA and other international settings particularly in Mexico and Chile the safety of our fresh fruits and vegetables have a greater chance of being safe for consumers. Food preparation is still the first line of defense. Suppliers should be held accountable to insure that the food products being sold are safe. A simply field visits to the peppers fields such as that conducted by our UTEP students are needed.
Growers and middle men should be required to adhere to standards that will insure our fruits and vegetable are safe. The costs of having hand washing facilities, providing clean drinking water to the farm workers, providing proper toileting facilities, insuring a clean processing plant and transportation that is free from contamination, and using non polluted water to irrigate the crops are costs effective and should be enforced.
Illnesses that can result from eating unsafe food products should not be underestimated. Children, the elderly, and those with impaired immunities are at particular risk. Some of us in the USA may have taken for granted the safety of our food products. The most recent outbreak reminds us that we must also take responsibility for food safety. All fresh produce and fruits should be washed thoroughly with running tap water prior to being used. Additional safeguards are cooking, using only canned items or peeling the product.

April is Minority Health Month

2008-04-01T10:05:00.001-06:00

April is Minority Health Month and is a cause to reflect on such particularly here in our border community in which nearly 80% of our residents are Hispanics of Mexican origin. According to a recently released report by the Agency for Healthcare Research and Quality a Health and Human Resources Administration of the USA government the majority of minorities EXCEPT Hispanics when compared to non Hispanic white are not making significant progress towards the elimination of health disparities. The rate of HIV/AIDS among Hispanics is now more than three times higher than their comparison group. The rate of obesity is significantly higher among Hispanics and it’s now known that such can lead to cardiac disease and diabetes. Obesity is now becoming the primary cause of cancer. A number of studies have linked obesity to breast and colon cancer and also to cancer of rectum, kidney, pancreas, and esophagus. Obesity is approaching epidemic proportions and with Hispanics the rate of obesity is higher than in other minority groups. Diabetes is the third leading cause of death in the border and the number one cause of death on the Mexico side of the U.S.-Mexico border. A tuberculosis infection along the border is 8.96 per 100,000 compared to 4.6 per 100,000 in the rest of the USA.
In El Paso County the uninsured rate is 40% and in studies conducted by the School of Nursing at The University of Texas at El Paso shows the rate exceeds 60% in some colonias. Those uninsured remain in many cases our most vulnerable: women and children. Further more a serious shortage of health care providers along the border and in some cases restrictive practice acts limit the access of residents to health care. The numbers of nurse practitioners who can provide high quality care is significantly below the ratio in metropolitan areas 22.3 compared to 14.2 per 100,000 in the metropolitan border areas. The number of registered nurses is 468.9 in metropolitan border areas compared to non border metropolitan areas of 715.3 per 100,000.
The School of Nursing at UTEP is meeting this challenge, which is to provide more nurse practitioners and registered nurses through substantial increases in its enrollment and this academic year will have one of the largest groups of nurses graduating in the history of the School. Faculty shortages, limited clinical sites, and salary pressure have created challenges. However innovations in curriculum, state of the art teaching methodologies and committed faculty are assisting UTEP in meeting these challenges. It takes a health care team involved in education, patients care, and research to eliminate health disparities in our Hispanic population.

Tips in How to Get Admitted to a Bachelor of Science Nursing Program

2008-03-08T13:32:00.009-07:00

Given the demand for admissions to Schools of Nursing across the country many qualified applicants are being turned away due t0 lack of capacity to enrolled everyone. Those who are admitted to the top Schools such as the UTEP program, where in general, we receive twice as many applications as we have openings, the applicants have science GPA of at least a 3.0 and in most cases higher. The scores on the Nurse Entrance Test (NET) for reading and math are at least at the high school level and frequently higher. Overall GPA vary from 4.0 to 2.9 or higher. The exact GPA scores does vary with applicant pool.

Students interested in nursing should start taking pre college course work while in high school. A number of school districts have health academies and these programs provide individualized counseling and adcademic guidance to insure students complete the appropriate courses. This preparation in high school is extremely important as it assist the student in being ready to begin the pre-nursing currculum once admitted to a univeristy or community college.

Some school districts have dual enrollment programs. In this program students can enroll and complete college courses while still in high schools. In some cases students can complete a Associate Degree while still in high school. Some health academes have curriculums that will allow the student to complete the requirements for a licensed vocational nurse along with their high school diploma.

Once admitted to the pre-nursing major the student should meet at least once per semester with their academic advisor to insure he/she are on target with their goal to become a nurse. Students should take advantage of tutors provided by their university or community college. The importance of studying and receiving grades of A and B is very critical if he/she is going to have a competitive GPA to be admitted to a BSN program. Achieving excellent grades means that the student must be committed to reaching his/his goals through making wise decision about time managment and dedicating ample time to his/her studies.

While some students find they must work while going to school it is highly recommended that students take full advantage of all financial aid resources available and limit the hours worked. The financial aid may also include the use of low interest loans that are supplemented by the US government. While many students do have to work it is best to limit the number of hours per week and concentrate working during holidays and vacation times. Working too many hours often leads to poor academic performance and thus non admission to a nursing programs. The financial aid office at your university or community college can assist you in finding funds for your education. DO NOT be afraid to consider financing part of your educational investment using loans if necessary. The time you delay your educating while working for $6.00 per hour compared to $30 per hour rate as a registered nurse does not make much economic sense.

Once you have completed all of the required course or will be finished by the end of the semeter, you are ready to apply to the School of Nursing. The fall applicant pool is typically larger and thus more competitive. The Accelerated (Fast Track) program typically has a smaller number of students applying than those seeking admission to the traditional program. So if you have a bachelor degree in some other areas, have at least a 3.0 GPA in your science courses plus have high school or post high school scores on the NET then your chances of being admitted are enhanced.

The bottom line is to study, study, study. As in other health related professions only the top applicants are accepted and eventually graduate. For example the BSN program at UTEP is very challenging. The current retention is around 80% and we are working very hard to achieve our goal of 85%. Students are provided academic coaches at no cost to assist them with their studies. All students have access to their faculty for one on one coaching during the faculty's weekly office hours. Selected courses are digitally recorded and placed on the course web site so students can view via video streaming the lecture and/or download the audio to a mp3 player. They can again listen to the lecture and review the power point slides posted on the course web site. (The majority of all undergraduate nursing courses at UTEP have power point slides of the lectures posted on the course web site).

All nursing students who have academic challenges are required to be a member of a study group and to meet with the retention coach. This coach is a season faculty member who assist students with test taking skills, problem solving, time management, and perhaps most importantly provides encouragement and emotional support. As appropriate students who have special needs are referred to other campus or community resources.

The nursing program at UTEP is tough as our graduates are one of the best in the nation. We expect outstanding academic performance combined with a humanistic and caring concern for our fellow humans. This past year (2006-2007) our passing rate on the NCLEX-RN exam was slightly over 96%, statistically the same as those students graduating from UT Austin. We have more graduates than Austin and 78% of our students are Hispanic. Thus we are living our Vision of Becoming the Premier Hispanic Serving School of Nursing in the Nation.

For more information about the University of Texas at El Paso School of Nursing please visit our web site. www.utep.edu/nursing

Nursing Shortage

2008-03-02T22:22:00.000-07:00

The shortage of registered nurses practically those with baccalaureate and higher degrees continues. The Kaiser edu.org Kaiser citing a study released by the Health Resources and Services Administration within the Department of Health and Human Services reports that by 2020 there will be a shortage of 340,000 nurses with 44 states anticipating shortages.

The aging population and increasing demand for health services contributes in part to the demand for more registered nurses. Kaiser reports that a significant growth in demand for long term care is also contributing to this projected shortage. They report there will be a 66% growth in nurses needed in geriatric related services.

An excellent video on You Tube Amesricanneednurse points out the need for nurses. Another You Tube video series also discusses the nursing shortage and reasons for such. Nursingcrisis

Nursing schools across the country have responded to the demand for increase their enrollments. Innovations in curriculum that includes the use of simulations, accelerated programs for those who have degrees in other areas have been developed, and new partnerships between academia and healthcare service settings have been forged. The ability of schools of nursing to rapidly increase their capacity have been hampered by a shortage of faculty, limited clinical sites, and inadequate budgets to expand enrollments.

Hopefully, this dialogue will start conversations about the shortage and potential solutions.

Healthcare Costs are Soaring and Our Health is Worse

2008-03-02T21:09:00.000-07:00

Healthcare costs are expected to soar to $4.3 trillion by 2017 which is estimated to be nearly 20% of the gross domestic product. The increasing demand for health services will continue to drive the costs of care. Read the full story at Healthcare cost.

The increase in cost is driven in part by increasing demand for complex technology, demand for new pharameuticals, increasing number of uninsured, shortage of healthcare professionals, lack of a national health insurance, malpractice claims, restictive practice acts, inconsistent quality of care, medical errors, and aging of the baby boomer who are now seeking more healthcare services.

Unhealthy lifestyles that have contributed to what some see as an epidemic of obesity that can result health problems such as diabetes, heart diseases, and cancer. Most when asked seem aware of the need to have a health lifestyle that includes proper diets, exercise, and management of stress. However, for what ever reasons particularly in the USA achieving these goals for many has been unreachable. For example, the adverse health problems related to smoking are common knowledge. For a number of years the Surgeon General has required that warnings are placed on all tobacco products. Yet in Kentucky 28.5% of the population smokes while Utah has the lowest rate at 9.8%. To see how your state ranks national on smoking as well as on other health issues take a look at the Kaiser State Health Facts. Statehealthfacts.

Clearly the cause of increasing healthcare costs is caused by multiple factors. The United States is the only industrial nation in the world without national health insurance. Over 44 million citizens do not have insurance. Most of these individuals are women and children. In some parts of the country such as along the US Mexico border over 40% are without insurance. Some areas the percentage is nearly 60%. Without health insurance people simple put off obtaining care when the problem is just emerging. Then when the problem becomes acute they are forced to seek expensive emergency room care. The system as depicted extremely well in Michael Moore's the movie Sicko broken and without a political commitment to change the existing piece meal system of insurance and public policies that tend to favor the status quo countless American will die and/or suffer from unnecessary health challenges.