Access Forges Relationship With Continuum Healthcare System

POSTED ON December 4th  - POSTED IN NEWS, Uncategorized

In an effort to support healthcare staffing within  Manhattan hospitals and decrease the nurse to patient ratio, Access is offering Private Duty  Services at hospitals owned by Continuum Healthcare System. This September Continuum opened their doors to Access, following a merger with Mt. Sinai. Currently, ACCESS Registered Nurses,  are seeing patients at Beth Israel Medical Center and New York Eye and Ear Infirmary. Access hopes to offer private duty services at Beth Israel Medical Center in Brooklyn and St. Luke’s and Roosevelt Hospitals in Manhattan in the future.

The new hospital system includes 3,500 hospital beds, almost 200,000 inpatient admissions, more than 2.5 million outpatient visits and approximately 36,000 employees — making it the largest nongovernment employer in New York.

Visit our website to learn more Private Duty Services at Mt. Sinai and Continuum hospitals.

Westchester’s Top Health Leaders 2012:

POSTED ON October 10th  - POSTED IN NEWS

Westchester may well need Louise Weadock-Rowe now more than ever. Just two months after the Centers for Disease Control and Prevention (CDC) revealed that one in 88 American children has some form of autism—a 78-percent increase in five years—Louise Weadock-Rowe, 60, opened WeeZee World of “Yes, I Can!” The Chappaqua-based facility is an indoor sensory play space and occupational-therapy center for children with autism (as well as a wide variety of other disorders, including ADD and ADHD). It’s the first of its kind in Westchester and the largest in the United States.

WeeZee is based on Weadock-Rowe’s experience as a healthcare professional working with those who have what she calls “central nervous-system messaging disorders,” some of which are autism spectrum disorders, while others include ADD, ADHD, cerebral palsy, and Down syndrome. A registered child psychiatric nurse and mother of a child with one of these disorders, Weadock-Rowe began to develop her ideas when she worked with the team at The Johns Hopkins Hospital that researched and defined behaviors which, today, are recognized as signs and symptoms of autism.

WeeZee’s 100 types of equipment are based on the apparatuses that Weadock-Rowe and her son, Paul (who was 7 at the time his sister was diagnosed), devised for her and her husband’s second child, Shannon, to help her overcome the severe disorders with which she was diagnosed as a toddler. Inspired by Shannon, Weadock-Rowe created the nonprofit Sensory Bullets—which “designs, creates, procures, and evaluates the effectiveness of therapeutic, artful, and playful sensory fitness equipment”—in April of this year. The information on and evaluations of the equipment are shared with doctors, hospitals, and relevant organizations, which allows for the spread of therapies that have been shown effective. It has even allowed for the creation of a new facility at the Kennedy Krieger Institute in Baltimore. Today, many children who have had access to Sensory Bullets’ evaluations are doing quite well, improving up to 30 percent in physical coordination and social-interaction abilities, says Weadock-Rowe. Shannon Weadock-Rowe herself is a flourishing college student in Massachusetts.

Gayle Augenbaum, MD, a child psychiatrist and former licensed occupational therapist who worked with Shannon, says that WeeZee will help other children with a number of issues. “Louise utilized what did and did not work for Shannon and took it a step beyond,” says the Mount Kisco-based physician. “She also consulted with other occupational and physical therapists throughout the construction.” Weadock-Rowe used about $1.5 million of her own money to create the facility.

“I want to have all kids performing better and feeling better about themselves,” Weadock-Rowe says, “so that, when they walk out in life, they can confidently say, ‘Yes, I can!’”

Treating Sensory Processing Disorders in One Stop.

POSTED ON October 2nd  - POSTED IN NEWS

The new WeeZee play complex in Westchester has a cute name, but a serious mission: Louise Weadock, a psychiatric nurse and parent, founded the facility, based on her own and others’ research, to provide play and developmental activities for children with (and without) sensory disorders, and to continue the research into the effectiveness of sensory play as therapy.

WeeZee’s goal, and the goal of centers like it, is twofold: to provide the therapeutic activities that help children with sensory processing disorders to adapt and function in an environment that’s fun for all children, and to provide many of the services children with the developmental disorders that often accompany sensory disorders need in a single location. Limiting the travel and scheduling struggles that can surround the effort to get a child who needs a variety of therapies the help she needs benefits the child — and her parents and siblings.

But “integrating” the services only works if the other pieces of the puzzle come together as well — if the therapies are the right ones, if the insurance coverage (for those lucky enough to have it) works, or the state supports the program, and if the services fit with the child’s needs.

WeeZee is new, but similar facilities have been opening around the country. Has a sensory learning center worked for you and your family? Would you encourage a parent beginning to structure a plan for a recently diagnosed child to try to work with a center? What, in a therapy center, works — and what doesn’t?

Public Reporting Of Health Care Quality: Principles For Moving Forward

POSTED ON June 14th  - POSTED IN Uncategorized

Several papers in the March issue of Health Affairs expose some of the challenges with reporting information about health care quality to the public, including the shortcomings of hospital reporting, the importance of framing quality information in ways consumers can understand and apply to real-world decisions, and the need for more consumer-relevant measures. Each paper offers useful research findings for elements of our national public reporting strategy.

But policymakers and payers shouldn’t draw the wrong conclusion from looking at these snapshots taken through the rear-view mirror. If we extrapolate too much from studies that are based on flawed measures deployed in flawed settings, we won’t get much insight on how to create a flow of information that provides value to the health care system we’re trying to encourage. Those responsible for shaping accountable care organizations, value-based payment programs, or the meaningful use of electronic health records won’t learn much from process measures layered on a fragmented, fee-for-service system with no incentive or accountability for the goals of the Triple Aim.

In fact, most of the findings reported in the March issue have been known for decades and been generally ignored in the design of the large scale reporting programs we see today. (See Note 1) The question is, why?

Let’s consider three commonly cited barriers to progress: .

  • We don’t have relevant measures, particularly for outcomes
  • We don’t know how to communicate effectively to consumers
  • Providers don’t have a ‘business case’ for reporting on quality.

1. We don’t have the measures

There is an abundant, scientific, commonly used library of measures that address symptoms, functioning, and outcomes that matter to patients. Work done by John Ware and many of the PORT grantees, the Picker Institute in the US and Europe, the Foundation for Accountability, and the PROMIS team has generated dozens of instruments and measures of quality. The Swedish approach to orthopedics quality provides one illustration. For every hospital and county in Sweden, they report annually on: .

  • Reported health gain (EQ-5D index gain after one year).
  • Patient satisfaction one year after total hip arthroplasty.
  • Short-term complications two years after total hip arthroplasty.
  • Ten-year implant survival following total hip arthroplasty.
  • One-year implant survival following hemi-arthroplasty.

None of these measures are in general use in the United States, and physicians often protest that accessing patient outcomes data is infeasible. Yet the one-year rate of patient follow-up after surgery in Sweden – where patients report on their pain level, functioning, and satisfaction – is 90 percent. In the United Kingdom, where measurement of orthopedics outcomes is only two years old, 80 percent of patients are reporting on their post-operative outcomes and the results are available by hospital. These data reveal significant variations in patient outcomes after surgery. Comparisons among Swedish regions and hospitals show a 21 percent variation in patient satisfaction results and a 41 percent variation in quality-of-life improvement.

Certainly if we wanted to measure and report on orthopedics outcomes in the United States, the measures and methods to do so exist. And the same could be said for cardiology, gastroenterology, ophthalmology, asthma, breast cancer, diabetes, and many other prevalent conditions.

2. We don’t know how to communicate with consumers

Oddly, Americans are famous for knowing how to influence consumer decisions. Our economy and political campaigns hinge on ever more sophisticated methods. It’s not an exaggeration to say that US hospitals’ advertising and marketing budgets would fund, by a factor of 10, the cost of collecting and distributing quality information about clinical outcomes and patient experience rather than the vacuous self-promotion that dominates urban billboards. The many earnest experiments at publishing quality data – ranging from the CMS Hospital and Physician Compare websites to the Healthgrades commercial products – attract miniscule numbers of consumer users, while Yelp is now in front of 60 million Americans every month looking for restaurant and dry cleaners’ ratings. What do Yelp, Angie’s List, and Urbanspoon know that CMS doesn’t?

3. Providers don’t have a business case

Thanks to Jack Wennberg and others, we have ample evidence that there is enormous variation in the performance of hospitals and doctors. In our California data, for example, the range of performance among primary care doctors on longstanding measures like colorectal cancer screening range from 28 to 78 percent (10th to 90th percentile range). No patient knows that the likelihood of receiving basic preventative screenings and chronic illness monitoring depends on which doctor’s office door they enter.

Payers, purchasers, and regulators have failed to require disclosure of performance data from those with whom they contract, failed to reward positive performance in any significant way, and allowed professionals and facilities to profit from unjustified service volume. We are caught in an unproductive loop: payers will not adopt measures that lack an evidence base and endorsed methodology; providers are not motivated to collect data for measures that are not likely to be used for payment; and the evidence base stagnates since no systems are in place to collect the necessary data.

Let’s consider the positives. Many measures and instruments exist to assess outcomes of interest to patients, but they are not in general or standardized use. American marketers – on the web and in print – know how to push information into consumers’ hands to influence decisions. Public agencies, employers, and insurance plans are moving steadily towards value-based purchasing. Rapid adoption of electronic health records and registries will provide widespread access to reliable clinical data. The research that shows low public interest in measures of low consumer value presented through inaccessible channels should not keep us from giving people the information they want and need to make good, personal health care decisions.

We will need to follow a few key principles: .

  1. Implement measures that consumers say they want – regardless of the inherited and limited data infrastructure. Start building the necessary information systems now, leveraging electronic health records, registries, and standards-based health information exchange.
  2. Recognize that consumers want information relevant to them – not necessarily what experts think they should want. The Consumer-Purchaser Disclosure Project, a leading coalition of purchasers and consumers has some great insightson this.
  3. Meet consumers where they are; don’t try to lure them to a stand-alone website or publication. When shopping for a car or refrigerator, the performance information is on the sticker in the showroom; you don’t have to go to a government website to find it. Let’s integrate accountability information with health plan directories, Yelp, Castlight and similar shopping services, and search engines and kill off the attempt to create central scorecard websites. The search engine Bing’s mash-up of CAHPS and Hospital Compare datawas a great illustration of this approach.
  4. Don’t try to make QI and accountability measures the same. The most vibrant QI work uses external measures to identify opportunities for improvement, but turns to statistical process control, run charts, and other tools to actually alter workflows and care processes. In general, public policy should express what the accountability framework is and then private parties can measure whatever they find useful to drive improvements towards those public objectives. The vast majority of PCPI and PQRS measures do not need to be reported to the public and do not need tight specification; individual societies and enterprises should articulate them however is useful to them.

We are at a critical juncture in the evolution of our health care system. Growing government interest in performance measurement and reporting, the adoption of value purchasing models keyed to measured performance, implementation of standards-based EHRs, disease registries, and health information exchange, and greater consumer exposure to health care decisions – including through the new insurance Exchanges – will all rest upon a foundation of publicly reported quality measures. Let’s not continue the madness of over-specified, highly granular process measures that burden providers with unnecessary cost and frustration yet fail to speak to patients and families.

We can’t let this recent flurry of studies and articles divert our attention and slow us down. Policymakers and private payers must understand and commit to these principles, and use their strength to put us on the right path.

Note 1. A few similar studies from 1993-1996: Hibbard JH, Jewett JJ. What type of quality information do consumers want in a health care report card? Med Care Res Rev. 1996 Mar;53(1):28-47; Edgman-Levitan S, Cleary PD. What information do consumers want and need? Health Aff (Millwood). 1996 Winter;15(4):42-56; Lansky D. A patient-focused approach to measuring the quality of cardiac care. Qual Lett Healthc Lead. 1993 Nov;5(9):18-23; McCarthy MJ Jr, Shroyer AL, Sethi GK et al. Self-report measures for assessing treatment outcomes in cardiac surgery patients. Med Care. 1995 Oct;33(10 Suppl):OS76-85; Ware, JE. What Information Do Consumers Want and How Will They Use It? Medical Care. 33(1):JS25, January 1995

Reprinted with Permission

David Lansky, Public Reporting Of Health Care Quality: Principles For Moving Forward, Health Affairs Blog, April 9, 2012,

http://healthaffairs.org/blog/2012/04/09/public-reporting-of-health-care-quality-principles-for-moving-forward/

 

Copyyright ©2010 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

WeeZee, Sensory Playground, Opens at Chappaqua Crossing

POSTED ON April 25th  - POSTED IN WeeZee

ByTom Auchterlonie and Sarah Studley

With colorful and interactive playspaces ready for kids, WeeZee marked its arrival at Chappaqua Crossing on Tuesday with a special grand opening gala and ribbon cutting.

At 16,000 square feet inside a brick office building on the former Reader’s Digest campus, WeeZee offers an array of unique attractions that give it an experience meant to stimulate kids’ senses. Example include a Rain Forest and Storm Zone that is for experiencing wind and water, and stalls for sports and reaction training to help with hand-eye coordination and a light room, to name just a few. Children who can benefit from it include those with sensory problems and those on the Autism spectrum.

WeeZee is a dream come true for Briarcliff Manor resident Louise Weadock, who is its founder and chief executive. Weadock, a registered child psychiatric nurse, has a daughter who was diagnosed with Sensory Integration Disorder. As a result, Weadock had her home turned into a playspace in its own right.

Weadock is a believer in the importance of supporting children’s senses, and believes that providing support for them when they’re young will help them when they get older.

“It’s all about your sensory nervous system” she said. “We are what we respond to, and what we respond to is what we receive through our eyes, our nose, our ears, our sense of touch, our taste and in our overall wellbeing.”

Weadock is also founder of ACCESS Nursing Services, which will be relocating from Pleasantville to share space in Chappaqua Crossing…………

Read the rest of the story HERE

10 Things to Know About Louise Weadock

POSTED ON August 9th  - POSTED IN Access News

Did you know that this fall, Louise Weadock, founder of ACCESS Nursing Services, plans to open Westchester’s first indoor sensory play space for children. Called WEEZEE World of Yes I Can, the 10,000-square-foot facility will be a mix of children’s museum, indoor playground and learning center.

With WEEZEE World scheduled to open in the fall of 2011, here are 10 things you probably didn’t know about Louise Weadock.

http://www.lohud.com/article/20110807/LIFESTYLE01/108070313/Rock-Star-Resident-Briarcliff-s-Louise-Weadock?odyssey=tab|topnews|text|Life&Leisure

Nurses for Africa bring health care to Zambia

POSTED ON July 25th  - POSTED IN Health News, Nursing

Nurses for Africa bring health care to Zambia | garner, nurses, people – The Telegraph.

July 25, 2011 10:36 AM

ALTON – Three caring nurses plan to bring love, support and donations to the “poorest of the poor” in Zambia in September, while also feeding and attending to some of the Africans’ medical needs.

“We go to visit and treat medical issues; we provide care to people who want to get it,” said Valerie Garner, 38, of Greenfield, a registered nurse who made the trip last year. “We reach people who are not even on the ladder of help. They are the poorest of the poor. We provide health basics, but our most important aspect is our ‘touch.’”

Garner, and fellow registered nurses Kay Holyfield, 48, and nursing director Sherry Oettle, 42, both of Alton, all work at Rosewood Care Center in Alton.

Garner said she can’t fully prepare her co-workers for what they will see and experience in Zambia, which is in south-central Africa.

“It’s another world,” she said. “I can’t fathom I was there, but I can’t fathom that I wouldn’t go back. It was an amazing experience. There is only so much we can do for so few, but we can touch people.”

Holyfield said she saw poverty years ago in her native Korea.

“I hope I can plant the seed in somebody’s heart that we cared enough to come to their country, that they will do something to get better and do something to help others,” she said. “People who have been there already are inspiring me a lot. They said it was a life-inspiring experience, and I want to be part of it.”

Oettle said she looks forward to “putting smiles on the Zambians’ faces for bringing them love and compassion and encouragement.”

“They are so appreciative of everything,” Garner said. “We gave them Mardi Gras beads, which break, but they still used them in their hair and made bracelets from the beads. They use everything. They were using bread sacks to carry their books to school.”

Garner said it isn’t just gifts the members of Nurses for Africa bring to the small villages, and the medical services they provide. The people, though, are so thrilled just knowing someone is traveling so far to visit and help them.

“They have nothing, but they are happy; they are happy because they don’t know what they don’t have,” she said. “They don’t have television to know what American culture is like.”

As part of their preparations, the women are seeking lightweight donations they can use in their medical mission, such as toys, powdered baby formula and Pedialyte, eyeglasses, school supplies, 4- or 8-ounce plastic bottles used to distribute medications and flip-flop sandals, among other useful but lightweight supplies.

People wanting to donate can call Garner at Rosewood, (618) 465-2626.

The team will use cash donations to buy cough medicine, over-the-counter pain medicine and de-worming and anti-malaria medications, once they are in the Republic of Zambia.

The women will work in teams with local mission workers who pre-arrange activities, including primitive clinics and education. They are going to the town of Kabwe and a small, remote village called Susu, where Garner went last September.

They leave Sept. 1 and return Sept. 14.

She said the country is in the continent’s copper belt. The country is impoverished, but the income level and life conditions in rural areas are even poorer.

They meet with people to discuss and diagnose health problems, dispense medications and de-worm children during a party. People having effects of HIV/AIDS are common, with the nurses also treating coughs, infections of the tooth, eye and in wounds, worms and other parasites.

In such impoverished areas, small problems manifest into larger ones after having no or insufficient treatment. Garner said someone brought in a baby with a bowel obstruction, which would have been easily treated in the United States, but she died in Zambia.

Last year, Garner participated in an orphan feeding program in which Nurses for Africa provided one meal per day on weekdays for 29 children, with the volunteers expecting to feed 44 this time.

The volunteers carry supplies in backpacks as they ride in vans and walk to the isolated areas, so the materials must be portable. The women will stay in non-air-conditioned dormitories with beds protected by mosquito netting and sun-heated water that actually does not get too warm, Garner said.

The Missouri-based, Ten Talents Foundation underwrites the costs of the mission trips, including airfare, Nurses for Africa’s website says (http://www.nursesforafrica.net).

The Alton nurses will use their earned vacation time for the trip.

linda_weller@thetelegraph.com

Nurses for Africa donation needs

Powdered Pedialyte

4- and 8-oz. plastic bottles, toys and trinkets

Flip-flop sandals

School supplies

Dry baby formula and infant supplies

Eyeglasses, used are OK

Cash with which to buy medications

 

Warm Weather Dangers

POSTED ON July 19th  - POSTED IN Health News

When the heat and humidity index reaches dangerously high levels,
everyone needs to know the dangers of overexposure to the sun and heat.

Many of you are probably well aware of concerns about dehydration
and heat-related illnesses, but a “refresher” may be helpful.

The link below is an advisory outlining the dangers of overexposure to the sun and heat, and proactive measures that can be taken to avoid heat related illnesses.

Stay cool and be safe!!

 

WARM WEATHER DANGERS!

U.S. Plays World Cup in ‘Nurse’ Uniforms

POSTED ON June 29th  - POSTED IN Nursing

U.S. play Women’s World Cup in kit resembling nurse’s uniform

By  Brooks Peck

The U.S. began their campaign for their first Women’s World Cup title
since 1999 on Day 3 of the tournament and they did it in a new kit. The
women are once again in their usual all-white home strip. But the new
design, worn in their opening-match win against North Korea, already has
some fans saying that it looks like a nurse’s uniform.

When the new kit was first revealed in April, Dr. Jennifer Doyle of From a Left Wing summed up the problem critics have with it:

A USWNT shirt can always be distinguished from the USMNT
shirt by the two stars that the women’s shirt prominently displays over
the USSF badge – one star for each World Cup trophy they’ve won (1991,
1999). That difference is not enough for Nike and the USSF. They want
you to know, for sure, that this is a not a man’s shirt. So the FIFA #1
ranked women’s team will go to Germany in a nurse’s uniform.

This is quite simply the ugliest women’s football jersey I have ever
seen. It’s central problem is the line someone has drawn down middle of
the shirt – a purely decorous gesture meant to create the impression
that the USSF would like its women to play in an open necked blouse.

The Nike press release says, “The kit is designed specifically for
the female athlete, to enhance the range of motion and create a uniquely
feminine silhouette.” But for anyone fearing that the nurse look isn’t
intimidating enough for a side aiming to win the World Cup for the first
time in 12 years, the black away kit (which has the same design) is
“inspired by the beautiful but deadly Black Widow spider.” So, deadly
Black Widow nurse spiders. Got it.

Whatever it looks like, it certainly didn’t hurt their performance as
they beat North Korea 2-0 — the largest margin of victory so far in
the tournament.

For the full article and to view the uniforms for yourself, click here:
http://sports.yahoo.com/soccer/blog/dirty-tackle/post/U-S-play-Women-8217-s-World-Cup-in-kits-resemb?urn=sow-wp2837

Do doctors and nurses hate each other?

POSTED ON June 22nd  - POSTED IN Nursing

On Salon.com, a doctor asks a nurse about tension between doctors and nurses…

The relationship between the professions is fraught with class and gender issues. I spoke with an expert — an R.N.

By Rahul Parikh

Not long ago, nurse Theresa Brown wrote a provocative Op-Ed
in the New York Times about the tension between nurses and doctors.
“It’s a time-honored tradition,” one doctor sniped at her, “blame the
nurse whenever anything goes wrong!”

Publicly airing this friction opened Brown up to sharp criticism.
“Drawing and quartering your coworkers in the Sunday New York Times
might be run-of-the-mill for politicians. I’d like to see something
better out of doctors and nurses,” wrote one physician over at the Atlantic.
But don’t count me among her detractors. Brown used her story to
advocate for civility in medicine. Mutual respect, she correctly argued,
would improve teamwork and the care of patients. Her essay raised a
question far more important than who was right or wrong: If both nurses
and doctors want to make their patients better, why is there so much
conflict and controversy between them? And how do we do a better job of
working together? To help me answer these questions, I asked Theresa
Brown herself.

Before I get to that, it’s useful to understand the cultural
underpinnings of the doctor-nurse relationship. In one sense, nurses
have spent the last half-century fighting to overcome the stereotype
that they are defanged doctors. It’s a division rooted in education,
income and gender. Doctors — men, affluent, with a professional
education — reigned supreme in the hospital. Nurses — female,
working-class, with a trade school-level education — were their
handmaidens. This stereotype is probably something you would expect to
see on a vintage TV medical drama, though critics point out that it still is the norm on contemporary shows like “Grey’s Anatomy.”

Despite the rigidity of that power structure, nurses smartly honed
their own skills of influence. This was best described in 1967 when a
psychiatrist named Leonard Stein published an essay called “The Doctor-Nurse Game.”
“The nurse is to be bold, have initiative and be responsible for making
significant recommendations, while at the same time be passive. This
must be done in such a manner so as to make her recommendations appear
to be initiated by a physician,” Stein wrote. If a nurse didn’t play
well, she was “a bitch,” or “unconsciously suffering from penis envy.”

What changed between then and now? In 1990, Stein published “The
Doctor-Nurse Game Revisited” to answer that question. The public lost
confidence in doctors and medicine (something I’ve addressed before in this column).
There was a rising demand for nurses, and the profession evolved into
one with specialties (pediatric nurses, ICU nurses, etc)

That’s the context in which I approached Brown. Why, despite all of these changes,
does so much tension fester between doctors and nurses? Brown holds a
Ph.D. in English from the University of Chicago and she also wrote the
book “Critical Care: A New Nurse Faces Death, Life, and Everything in
Between,” recently out in paperback. As you might expect, she is
articulate and smart. She is also warm and introspective and, despite
what her critics say, does not have an ax to grind. She has written just
as strongly about bad behavior between nurses.

Brown answered the question by talking about the way nursing
education has changed. In the past, nursing schools were based in
hospitals, which put students directly under doctors’ influence. While
that no doubt perpetuated the doctor-nurse game, at least it exposed
both groups to each other. But over the past 40 or so years, nursing
schools have become university-based. “Nursing school was now
independent of doctors,” Brown explained. “Yes, we are taught to be
patient advocates, but we are also taught to be a check on the doctor.
The problem with that is we’re only taught to see docs as adversaries,”
she told me. An essay by a nurse in the British Medical Journal
echoes this idea. “Nurses have been indoctrinated with the belief that
doctors are capable of exercising only a cold, scientific medical
model,” she writes. “They treat the disease, not the patient. Nursing
literature is full of anecdotal accounts of the distant approach that
doctors have towards patients and their careers.”As a result, Brown admitted that nurses “never get a good
understanding of the stresses and strains of what it’s like to be a
physician.” I told her that medical school provides next to nothing in
terms of how nurses approach patients either.

“If that’s the case, how do doctors and nurses learn to behave and
negotiate with each other?” she asked. I didn’t have an answer, but in
reflecting on what she said, I realized that over the years, I hadn’t
made much of an effort to understand nurses myself. As a resident, for
example, I never read a single note in a patient chart penned by an R.N.
– a “care plan” as they’re usually called. They seemed extraneous to
me, and doctors have argued that they don’t impact their care of
patients. But had I read them, I may have been able to bridge at least a
small divide between me and the nurses who cared, side by side with me,
for my pediatric patients.We compared other notes. What do nurses want from doctors? I asked.
“Respect, a willingness to listen even when we’re bringing up something
stupid, a sense that we’re on the same team,” Brown replied. Doctors
demonstrate a great deal of variability in all of those things. Again,
though, we agreed that this variability goes both ways. I’ve worked
with, and continue to work with, amazing, caring and competent nurses.
These are the R.N.s who would be my first-round draft picks, even over
other doctors. On the other hand, I’ve been driven nuts by nurses who
consistently botch a patient’s care plan, misinform parents about their
child’s health, or simply refuse to do what’s needed of them.

That brought up the next question: Can doctors and nurses hold one
another accountable without picking the scabs off old emotional wounds?
Her suggestion was that if there’s conflict or a mistake made, debrief
together. “Be honest, say what happened, work together to solve a
problem.” One way doctors do this is by having regular “morbidity and
mortality meetings,” where individual cases are discussed and the
physicians involved are asked to explain why a patient was hurt or
another bad outcome occurred. Nurses are not part of that process, and
the tendency among them is to “just say something bad happened, not talk
about it again.””If we really want parity and respect we also need to be held
accountable,” she said. In principle, Brown has a point. In practice,
the jury is out on how doctors and nurses can hold each other
accountable when their skill sets are complementary but still very
different.

Brown and I both agreed that bad behavior between health professionals (be it between doctors and nurses or even between doctors and other doctors) is bad for business. In her case, it’s unforgivable that the doctor who
chastised her didn’t have the decency to confront her privately about
any concerns. His goal wasn’t to figure out what happened but, like a
hot teakettle, merely to blow off steam. A recent survey
suggests that this abusive behavior really is disturbingly common among
physicians. That kind of behavior undermines the patient’s confidence
in his or her medical team, and we absolutely need teams to be
successful in an era of medicine as complex as ours.If there’s one hope for both of us, it’s our patients. As one
observer points out, “for decades we understood the professions as a
conventional nuclear family, with doctor-father, nurse-mother, and
patient-child. But our hope for total wisdom and protection from father
is forlorn, our wish for total comfort and protection from mother
unachievable, and the patient has grown up. A new three-way partnership
should displace this vanishing family.”

Finally, I asked Brown which fictional character she might give
credit to for being a more realistic portrayal of a nurse. “Nurse
Jackie,” she said.A foul-mouthed, grouchy drug addict as an iconic nurse for the
masses? Yes, she confirmed. Because Jackie is flawed, fallible and
therefore as human as a nurse can be. I suspect that if all of us,
doctors and nurses, embraced our own flaws, admitted our own fallibility
and realized that we need each other every single day, we would take
yet another step forward at getting better together.

Rahul K. Parikh is a physician and writer in the San Francisco Bay Area. He wrote the Vital Signs column on Salon in 2008-2009. His pop culture-medical column, PopRx, runs every Monday.

Read the entire article here… http://www.salon.com/life/feature/2011/05/30/doctors_and_nurses_poprx/index.html

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