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It’s 2016 and APRNs are still not recognized in all of the United States.  

In 2010, the Institute of Medicine released the report, The Future of Nursing, which outlined the need for advanced practice nurses (APRNs) to gain full practice authority in the United States.  This document, a collaboration of the Committee on the Robert Wood Johnson Initiative, set the policy agenda for APRNs to be given full practice authority in the majority of states that did not already have the legislation to support that practice. Full practice authority in every state is necessary to provide consistency in APRN practice, to provide access to healthcare for patients in greater numbers, to reduce healthcare costs and improve preventative health practices.  The IOM points out the disparities and waste in our current system, such as the ability of an APRN to have full practice authority in one state and go to a neighboring state and be unable to prescribe as much as a Tylenol without a physician’s oversight.  The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education set forth the structure in which states could base legislation of APRNs in the hopes to standardize practice.

 

The goal was to implement the model by 2015.Stethoscope-2

As of 2016, twelve states have fully implemented the full Consensus Model through legislation.  Many are close, but some are far from reaching full practice authority for APRNs.  I moved from Oregon, which has full practice authority, to Texas which limits APRN practice and requires burdensome physician oversight.  Instead of serving patients in my rural community, which suffers from disparities in healthcare services, I work in a nursing leader position, with a BSN requirement.   I am working with the state APRNs to advance legislation that will remove barriers to practice, but there is a lot of opposition from another special interest group, physicians.  Some physicians view APRNs as competitors, instead of partners in expanding healthcare services.

Political victories are happening.

West Virginia is on the cusp of expanding APRN practice authority and are waiting for their governor to sign the bill into legislation. Amy Summers, a member of the West Virginia legislature, was the lead sponsor of HB 4334 which expanded APRN authority to practice independently and to expand prescriptive authority.

Summers stated in defense of the bill, “This is not a new idea, this isn’t something that needs studied further. Iowa has allowed full practice authority for 33 years, Alaska 28 years, New Mexico 20 years.  No state has ever repealed full practice authority once it was given.”

I hope that Texas, and the many states that have yet to adopt the Consensus Model, will move towards joining forward thinking states.  States like Oregon, Idaho, Iowa, Utah, Montana, Maine, Nevada, New Mexico, North Dakota, Vermont, Colorado and Hawaii, all of which have given full practice authority to all APRNs.

How does your state measure up? Click here to find out!

 

 

 

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Joy Who?

The internet was in an uproar. Miss Colorado, Kelley Johnson, delivered a monologue about her experience of being “just a nurse” for the talent portion of the Miss America pageant. I watched it on YouTube the night of the contest. Like many nurses, I felt all the warm, fuzzy, nurse feelings and even got a little misty eyed. By Tuesday morning, the news reached my Facebook nursing groups. Joy Behar and Michelle Collins had mocked Miss Colorado on The View. Ms. Collins thought it would be a good laugh to poke fun at the heartfelt monologue delivered by Nurse Kelley. Ms Behar chimed in with the question, “why does she have a doctor’s stethoscope around her neck?”

A doctor’s stethoscope! Behar poked a sleeping bear with those words. Nurses roared into action as the disparaging remarks reached nurses across the globe. Hashtags like #nursesshareyourstethoscopes, #nursesrock, #nursesmatter, #notacostume, #mytalentisnursing, #nursesunite and #notjustanurse began trending on social media. I wish that Ms. Behar and Ms. Collins had supported Nurse Kelley, not only as a healthcare professional, but as a woman. It was disturbing to watch an all-woman-panel mock another woman for sharing her talent, the art of nursing.

The backlash from three million nurses was swift and strong. Pictures of nurses wearing stethoscopes flooded my news feeds. I spent time retweeting every one of my fellow nurses posts about the scandal. I was caught up in the collective outrage and for a few days I felt united with my sister and brother nurses.

Weeks later, the nurse hashtags have stopped trending and the conversation has changed to other hot topics. All of the nurse empowerment energy has evaporated.

Have we once again become stethescope#justnurses?

Joy Behar’s comment was careless. It was a throw away thing to say to fill up space and to seem like she had something intelligent to add to the conversation. I don’t believe that she meant it maliciously, she was being thoughtless. Her thoughtlessness united nurses in a way that I have not seen since nurses jumped on planes and busses to help in the aftermath of Hurricane Katrina. The energy on social media was exciting. It was gratifying to read supportive comments and see nurses being given positive attention. I loved seeing all the stethoscopes and reading nursing stories about where those stethoscopes have been. For a few days it has felt like nurses were united and a part of a large community. United in their outrage of being publicly mocked.
It is now clear that nurses have the ability to direct national conversations. Where have all the hashtags gone? Why aren’t there trending hashtags like #endhealthdisparity, #decreasepatientratios, #stoplateralviolence, #nurseautonomy, or #APRNsIncreaseAccessToHealthcare? Healthcare policy and laws are influenced by a handful of lobbyists and legislators. These lobbyists and legislators number far fewer than three million nurses, but their decisions affect the entire nation. Can you envision a healthcare system being directed by our modern day Florence Nightingales and Clara Bartons, with the support of the national nursing community?
The best thing that could result from this stethoscope spectacle would be for nurses to finally find their voice.

We have power to influence, educate and advocate for the healthcare changes that we know we need. We can command a national stage whenever we choose to unite behind a cause. Its time to come together to influence issues that affect our friends, neighbors and families. Nurses are never just nurses, it is time to prove it.

To take action start here: American Nurses Association

 

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Why the Golden Rule Doesn’t Apply in Healthcare

The Golden Rule has been preached to those in healthcare for decades.  As nurses we were taught that we should treat our patients as if they were our mother or grandfather.  I have heard doctors concluding consults with, “if it were my sister I would tell her to do X procedure.”  I know well meaning nurses whom call all their patients sweetie, because that is how they address family and they want to treat their patients like family. Empathy for our patients, care, and recommendations based on how we would like to be treated seems to be the ethical and correct behavior.  It is not the right thing to do.  To assume that we know what a person should choose or how they would like to be addressed is presumptuous at best and patriarchal at worst.

We should leave the Golden Rule concept in the past.

The Golden Rule, although a benevolent seeming concept, is fundamentally flawed.  Not everyone wants to be treated the way that someone else thinks is right.  This is concept is clearly evident in labor and delivery.  Women that choose to pursue normal means of birth, such as waiting for spontaneous rupture of membranes, are commonly labeled as difficult.  Women that decline an epidural or pain medications are often met with impatience and pressure to not suffer through the pain.  Mothers that wish to give birth vaginally, after one cesarean birth, are discouraged, badgered and bullied into submitting to a repeat surgery.  All this is done by health care providers that believe that they are treating the patient according to the Golden Rule.  Pain is bad, so healthcare providers want to take pain away from mothers.  Vaginal birth after cesarean comes with risks and they would not choose to try it.  By attempting to apply the Golden Rule in these ways, we are actually doing more harm.

We need to think about the Golden Rule in a new way.  It does not mean that we do for our patients what we would like done for ourselves or our loved ones.  We do not decide for a woman, what she should choose to do, based on what we would want our sister to choose.  A truer interpretation of the Golden Rule is respect for our patient’s wishes, requests and declinations.  Ultimately I would want my healthcare providers to respect how I want to be treated.  That is how I take care of my patients.  If they don’t want to know the details of every intervention, then I won’t tell them.  I know that education is important, but some patients do not want to hear how a urinary catheter works.  Many patients want to know every detail, and I accommodate their requests.  Personally, I prefer unmedicated labor and feel that moms miss out on something amazing when they get an epidural.  I do not treat my patients how I like to give birth.  I support them with what they prefer, whether it is an epidural, unmediated birth or somewhere in between.

I feel comfortable sharing my opinions when asked.  I give advice, but I never assume that I know what is the golden answer for each woman.

The old Golden Rule does not apply in health care.  Patient autonomy, as a priority in our nursing care, should become the new Golden Rule.  MC900439242

 

 

 

 

 

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Birth Plan Basics: Using BRAIN

image“Well, you are the expert; we will just do what you tell us.” Admittedly it is nice to be regarded as an expert, but these are dangerous words. There is something about wearing a white coat and a stethoscope that grants healthcare professionals great power over their patients. Intelligent women and men come to the hospital and abdicate their decision making power at the door.

Your perinatal team has varied knowledge, training, experience, bias, fear, and motivation. They are experts, but they are not perfect! They have seen a lot, but they haven’t seen everything. Some have not read a new research article in years, some haven’t slept in 2 days, and some had a maternal death patient with similar risk factors as yours. Sometimes they just want to go home on time and your labor is taking too long. Some of them are biased towards low intervention, others have never met a patient they didn’t want to take to the operating room.

When you are admitted to the hospital you will not know what is behind the smiling faces and monitoring machines. In most cases what you see is what you get. Doctors and nurses that are working hard to make ensure you and your baby make it safely through labor and delivery. There are many paths to that outcome. You need to be a part of the decision making.

The first step is to get educated prior to the delivery. Taking a prenatal class is an excellent way to prepare for childbirth. I personally recommend the Hypnobabies course, but there are many other programs available. Check with your local hospitals. They often offer low/no cost courses and you will be able to learn more about how labor is approached where you will be delivering. If you do not have time to attend a traditional class, there are self study options or online courses available. AWHONN, INJOY, and Evidence Based Birth are websites that have great information.

The second step is to make a birth plan. If a written birth plan is not appealing, you can still take time to discuss with your support person and your doctor/midwife your thoughts, goals and wishes for your labor and delivery. Having a mutual understanding can help make decisions during labor easier.

Third: Use your BRAIN! Every decision you make should be collaborative between you and your healthcare team. The most important person in the equation is you. Each time a decision is required, use the simple decision making tool BRAIN.

Benefits: What are the benefits of the intervention?brain

Risks: What are the risks involved? It is important to explore this and get the full list of risks. Many times healthcare providers will mention the most common or the most devastating risks. You need to be told all the risks to be able to make an informed decision.

Alternatives: Are there alternatives? Sometimes there are no alternatives, but in many situations there are alternative interventions that can be attempted. Find out your options and if you have an alternative in mind, suggest it.

Intuition: Take a minute to think and discuss with your support person. What is your gut telling you? Doctors and nurses use intuition to care for their patients too.

Nothing/not now: What if you did nothing? What if you waited an hour or three? Time can clarify most situations. In other situations doing nothing may cause a bad outcome for you or baby. How does doing nothing affect this particular situation?

Being empowered and educated will help you have the birth experience that is best for you and your baby.

Remember to use your BRAIN!

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What Happened When I breastfed at a Texas High School Football Game…

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I have breastfed almost everywhere, doing almost everything. All together I have breastfed 65 months of my life. That is a lot of opportunity for nursing in public.
As a young mother, nursing my first baby, I was embarrassed and fumbling under large blankets most of the time. It was summer and my poor baby would be drenched with sweat under the modesty shield. My mother breastfed and was supportive, but beyond that I endured all the typical stares, questions and comments that breastfeeding mothers receive. I remember a shopping trip taking longer than I expected. I had to sit in an oven of a car, trying to latch my screaming, hot infant. I should have been sitting in the comfortably cool mall food court.

Something happened that changed how I breastfed my babies. I had more of them. When baby girl arrived, just after baby boy turned one, I had an epiphany about breastfeeding. I HAD to be more flexible! It was mandatory and everyone else would have to live with it. I would breastfeed when and where my baby was hungry, while keeping up with an active toddler.

This strategy worked well for me and in I fit right in with crunchy Oregon mamas. Then I moved to Texas. Women warned me that it is different in Texas, it’s an old boy system, no one breastfeeds there, and I wouldn’t be able to breastfeed in public. I avoided going out for as long as possible.   I am a band mom and I couldn’t miss my oldest son march with the band.   I steeled myself for the first high school football game. I sat in the bleachers, looking at the people around me.  I knew my baby was getting hungrier. I watched buxom blondes and brunettes walk by. Their breasts were barely contained in their school spirit tanks. I had a comeback all ready to go, for when the security guard came to tell me to leave. My comeback speech would be epic and would involve the aforementioned tank tops. Finally I gritted my teeth and slipped my little girl under my band mom T-shirt and she had her dinner.

That’s when it happened……absolutely nothing. Not one person commented or even managed a sideways glance. I was not able to spout off my clever retort.  I wasn’t made a fearless champion for breastfeeding, singled out for ridicule or praise.  I was just a mom watching my kid march with the band while feeding my hungry baby.

I have since breastfed everywhere in Texas, museums, parks, NASA, the DMV line, restaurants, hospitals, schools, and churches. I breastfed for the last time in our town’s Christmas Parade, sitting on a float in the freezing cold.

I didn’t know it would be the last time or my last baby. That’s just how it happened. It happened in Texas.

My advice to all you new and experienced mamas: Feed your babies where and when they are hungry! I wish I had been more comfortable the first go round. I wish I had not tortured myself and my baby because of society’s ideas about public breastfeeding. We have all heard the stories of boobie backlash. I challenge you to go ahead and brave it. You might get some negative comments, but in most states you have the legal right to breastfeed in public. Maybe someone will be watching you, a future mom or dad. Seeing you confidently breastfeed could make their choice to breastfeed easier.

You will be surprised that, in most cases, no one will give you a second glance.