The Mathematics of HIV Infection

A new mathematical model suggests that the HIV virus could be virtually eliminated in 10 years if every person in every country with high infection rates was tested and treated.

Published in "The Lancet", the study is indeed intriguing, and the World Health Organization promises to examine the findings more closely. The model includes voluntary testing of every citizen, with AIDS drugs prescribed for any patient testing positive for the HIV virus, regardless of whether they are symptomatic or not. (Current practices often dictate withholding treatment until a patient has symptoms, or when their T-cells---immune cells that fight opportunistic infection---fall below a certain level.)

At this time, the price tag for such a strategy is estimated at $3.4 billion per year initially, with costs decreasing over time.

With approximately 33 million people infected with HIV worldwide, increased testing and treatment would, of course, cost money. However, an already overwhelmed healthcare infrastructure in places like sub-Saharan Africa (where HIV rates are still rising) would pose significant logistical challenges. (For an interesting map detailing the number of HIV cases and AIDS deaths worldwide, please click here.) How those countries would be financially and logistically supported by the global community in implementing such a strategy remains to be seen.

From a human rights perspective, critics of such an approach feel that universal testing and treatment might infringe on individual rights. And as many patients with HIV and AIDS already know, taking antiretrovirals is not easy, and side effects such as liver toxicity or failure, heart attacks and kidney failure are all relatively common.

Such studies and models for a plausible expansion of the global effort against HIV and AIDS are laudable, and perhaps the AIDS epidemic will indeed be significantly curtailed in the decades to come. Perhaps the greatest gift that we could give to the children of the 22nd century would be to eradicate HIV and AIDS from the face of the earth in the current century, a goal that has generally been seen as virtually impossible until now.

Some nay-sayers may feel that we're getting ahead of ourselves as infection rates steadily rise in Russia and other countries, but there are scientists and researchers around the globe seeing the possibilities of near-complete eradication. One can only hope that plausibility will eventually give way to reality, and someday we will truly look back on the epidemic as a disturbing yet finite piece of post-modern medical and societal history.

So, What Does A Public Health Nurse Do, Anyway?

This is a question that has already been posed to me several times, and coming up with answers helps me to define what it is I'm actually supposed to accomplish in my new job.

Public health nursing has a long and illustrious history which I will not illustrate here, but in terms of my new position, there are a number of things for which I am directly responsible:

-Tuberculosis case management: I closely monitor and follow any cases of active or latent tuberculosis in my community, assuring that patients take their medications as prescribed and follow up with the regional TB clinic as required.

-Emergency preparedness: it is my job to actually make sure that our town has protocols and plans in place for emergency preparedness, whether it be for natural disasters, terrorist attacks, pandemic illness, or other public health emergencies. I will cooperate with other regional agencies and serve as coordinator of our local Medical Reserve Corps.

-Immunization clinics: I will hold monthly immunization clinics for immigrants and other citizens in need of urgent immunizations. Influenza clinics are also an important part of our work in the late Autumn and early Winter.

-Infectious disease surveillance and investigation: I am responsible to track, report, and investigate infectious and communicable diseases in our community.

-Resources and referrals: I will provide the general public with resources, referrals and advice vis-a-vis medical issues, psychosocial issues, and other needs as they arise.

-Employee wellness: on some level, I am supposed to provide employee wellness resources for employees of our town. I'm not sure what this is supposed to look like, and only so much can happen in thirty hours each week. Still, I see this as a potentially interesting aspect of the job if there's any time to actually do it.

There is so much to learn and so much to know. Infectious disease surveillance in general is an enormous area of expertise and I feel ill-prepared to take it on.

The learning curve is indeed quite steep, but in exchange for my own sunny office, a great cafe next door, and excellent health insurance, I think I made the right choice.

Public Health and Me

So, I have officially accepted a position as the Public Health Nurse for my town, and my hours were approved by the town government just yesterday. While I've been filling in as the Interim Public Health Nurse for ten hours each week over the last several months, I will begin working thirty hours a week beginning on Monday.

After ten months of being a free agent, consultant, and general slacker, having a job to responsibly report to four days a week is indeed a wake-up call. While consulting and working per diem jobs has allowed me a great deal of flexibility and self-determination, the need for high-quality health insurance and a more steady income have also reared their heads. Thus, my decision is propelled by economic need as well as the realization that this will certainly be an interesting and growthful career move on many levels.

As a Public Health Nurse for a town of approximately 40,000 people, I will be responsible for emergency preparedness (including the management of the local Medical Reserve Corps), infectious disease surveillance and reporting, tuberculosis case management, a monthly immunization clinic, influenza clinics each fall and winter, fielding questions and calls from citizens and town employees, and other important responsibilities.

I am honestly slightly overwhelmed as I realize the steep learning curve involved in this undertaking, but I also realize that my desire to work for Partners in Health, Doctors Without Borders, or a similar organization in the future will be even more likely with significant public health experience under my belt. While public health is not necessarily hands-on nursing, it is a crucial part of the healthcare infrastructure of the country, and many of my new skills will certainly be transferable to other countries and societies.

Stay tuned for developments as I dig in to my new position, and I surmise that issues of public health will become an even more intrinsic part of the regular conversation here on Digital Doorway.

Keith's Ephemera

Dear Readers,

If you are so moved, please pay a periodic visit to my newest blog---Fiction, Prose & Ephemera---a collection of fiction and poetry, some of which are works in progress, and others that are more or less complete. It is a project whose time has come.

Thanks,

Keith

The Office of the National Nurse and the Obama Administration

Now that Barack Obama has been elected and some changes in the trajectory of American healthcare are on the way, those of us who support the creation of an Office of the National Nurse are asking that citizens supportive of our cause please communicate that support to the Obama team. For a review of the importance of such an office, please see my previous blog post on the subject. To communicate your opinion to the Obama-Biden team, please click here.

While the current Chief Nurse Officer (CNO) of the United States serves as Assistant Surgeon General, many of us feel strongly that it is time for nurses to be taken seriously as key players in the development of far-reaching preventive measures to improve the health and well-being of the American people. Rather than have the CNO remain in a subservient role to the Surgeon General, giving the National Nurse a prominent, autonomous and equal part in the government's efforts vis-a-vis preventive healthcare would send a clear message that the nursing profession has finally received the recognition it deserves.

Nursing has a great deal to offer to the American healthcare system and to policy discussions vis-a-vis the changes that are needed to improve the health and well-being of all Americans. The establishment of the Office of the National Nurse would be a major step towards recognizing the profession of nursing for its contributions to medicine and health (separate and autonomous from the medical profession), and for moving the United States and its citizens towards improved self-care, improved health outcomes, and renewed standing as a country that views the health of its citizens as a true measure of "national security".

To send the Obama-Biden administration a message regarding this issue---or any issue close to your heart---simply click here to visit a special page for communicating your vision of America to the incoming administration. Your support for the establishment of an Office of the National Nurse would be greatly appreciated.

Obama, Daschle and Healthcare

It is now confirmed that Barack Obama has asked former South Dakota Senator Tom Daschle to serve as the administration's Secretary of Health and Human Services. While the nominee has already undergone a rigorous vetting process by the Obama transition team, he will of course face a Senate confirmation hearing after the President-Elect is inaugurated on January 20th. I will venture a guess that Daschle will be handily confirmed by the Senate, and I imagine that he is already setting his sights on a broad plan of action. Whether that plan leads to successful change in the healthcare trenches remains to be seen.

Meanwhile, a powerful bipartisan group of senators met in the offices of Edward Kennedy (D-MA) today, at the behest of Senator Max Baucus (D-MT), to begin shaping potential Democratic legislation vis-a-vis broad healthcare reform.

With 15% of the country's GDP going to healthcare and the number of American uninsured (estimated at 40 to 47 million) expected to rise as layoffs and unemployment increase in response to the economy, the stakes are high for meaningful healthcare reform.

We all know we can do better. In terms of healthcare access, funding and quality of care, the World Health Organization has ranked the United States as 37th in the world. Concurrently, our ranking in terms of infant mortality and life expectancy also continue to plummet when compared with other nations. These statistics bear out the widely accepted notion that the enormous per capita expenditures on healthcare by the United States government have fallen far short of their potential, and many other countries have somehow managed to produce far better results utilizing a percentage of what we spend here.

The battle regarding the potential benefits and pitfalls of universal healthcare is on. Yesterday on Digital Doorway, I pointed readers towards an excellent website where the arguments for and against universal government-sponsored healthcare is being argued quite cogently. This nationwide conversation will only intensify, and it remains to be seen how the Obama administration will rise to this Herculean challenge.

I am personally and professionally invested in the developments vis-a-vis healthcare reform in the United States, and I assume it will be years before we know the true successes or failures of President Obama's efforts, with support from Tom Daschle and other key players (not to mention the input of the American people, if it is heeded amidst the noise).

These next months and years will be an interesting affair, and great grist for writers, bloggers, healthcare policy professionals, pundits, and ordinary citizens alike. Meanwhile, as the conversation and debate rages, the statistics related to the uninsured and underinsured will certainly worsen. We can only hope and pray that a truly remarkable (and successful) solution is indeed within reach.

Opposing Views: The U.S. and Universal Healthcare

I would like to bring readers' attention to a website called "Opposing Views" wherein "real experts go head-to-head on issues you care about". From the spanking of children to animal rights, an open forum of debate, discussion and commentary allows experts and readers to chime in on pressing issues of the day.

Apropos of Digital Doorway's predilection for issues related to healthcare, there is currently a lively and very interesting debate on the site which poses the question, "Should the U.S. Have Universal Healthcare"? I highly recommend visiting this particular debate, leaving a comment if you so desire, and perusing the site for other debates, such as "Does Marijuana Have Medical Value?", "Is There a God?", "Do Guns Make You Safer?", and "Should Your Daughter Receive the HPV Vaccine?"

Debate is a healthy way for issues of interest to be discussed under a framework of civil discussion and intellectual sharing. Opposing Views certainly offers a valuable forum for such discussions to take place, and I encourage anyone who enjoys such lively give and take to frequently pay this excellent site a visit.

Hospitals and Consumers on the Edge

Economically speaking, times are tough all over. People are losing their jobs, the unemployment rate is rising, and retailers and consumers alike seem to be facing a lean holiday season.

On the healthcare front, a number of U.S. hospitals are now in the difficult position wherein they now must buy back debt incurred from "Variable Rate Demand Notes" (VRDNs) and other forms of loans that hospitals use to do many things, including making capital improvements to their facilities. According to some reports, U.S. hospitals may be forced to buy back up to $8 billion dollars of debt, not an easy task in these cash-strapped times.

For hospitals, the economic times are indeed challenging. Patients with outstanding bills are less likely to be able to pay on time, if at all. Many employers are scaling back health insurance coverage for their employees, thus patients are often stuck with hospital bills that they cannot afford. Additionally, the numbers of uninsured and under-insured patients is rising in most states, and charity care is becoming increasingly burdensome for hospitals and health systems that provide such services. As some patients shift to Medicaid, hospitals also understand that reimbursement rates from Medicaid and Medicare often cannot match those from some private plans, thus revenues hemorrhage from numerous economic blood vessels simultaneously.

Equally troubling for hospitals, borrowing is exceedingly difficult, despite dire need for improvements to facilities, upgraded IT equipment and systems, and rising labor costs. With increased costs of utilities, food, supplies, and health insurance premiums for their own workers, hospitals also understand that many patients will continue to cancel or postpone many elective surgeries and procedures that bring much needed revenue to hospitals' bank accounts. With consumers charged co-pays of $200 to $400 for elective procedures such as colonoscopies and vasectomies, hospitals face a serious decrease in such procedures which are much less costly since they generally involve a stay of less than 12 hours from registration to discharge.

From The Wall Street Journal to regional news outlets in the mid-West, the signs all seem to be the same: hospitals are in for a difficult season as the economic belt tightens on the healthcare industry.

As a self-appointed advocate for the uninsured and vulnerable in this country, I am seriously concerned that an enormous cohort of Americans currently face a significant decrease in the availability of affordable preventive healthcare in all regions of the country, not to mention access to many specialists and other providers.

Overall, my fear is that the availability of free and low-cost care will suffer in the current economic climate, and patients in need of care will need to travel further and further afield in search of providers willing to see them, a burden that may keep numerous people from seeking medical attention at all. When access to medical attention is limited, it is frequently the uninsured and under-insured who are left in the healthcare dust, and there are millions of children who will fall into this unfortunate group as their parents simply struggle to make ends meet.

There will be much for the new Obama administration to consider when assessing the current (horrible) state of the American healthcare system. As impatient as we all are for change, it may be many months before any improvements are even suggested for fixing healthcare in this country.

Meanwhile, as hospitals struggle with their bottom line and millions of uninsured Americans struggle to stay healthy, we all must hope that there is still a possibility that the damage, as extensive as it may seem, can still be undone. And as for those millions of uninsured children out there, it should never get any worse than this.

The Charter for Compassion

A new organization and movement have been founded with the goal "to build a peaceful and harmonious global community".

Utilizing the minds of some of the greatest religious thinkers of our time---including
Archbishop Desmond Tutu---The Charter for Compassion "seeks to remind the world that while all faiths are not the same, they all share the core principle of compassion and the Golden Rule. The Charter will change the tenor of the conversation around religion. It will be a clarion call to the world."

The following video clearly illustrates the goals of this burgeoning global movement, and simply and coherently verbalizes the widely accepted need for a universal propagation of compassionate tolerance.



The Charter for Compassion will be collaboratively created using input from people from every corner of the globe via new innovative software that enhances a collective decision-making process.

The previously mentioned group of religious elders, dubbed "The Council of Sages", will work together to distill the thoughts and input of thousands of contributors into a concrete document that "will not only speak to the core ideas of compassion but will also address the actions all segments of society can take to bring these ideas into the world more fully. The Charter for Compassion will then be signed by religious leaders of all faiths at a large launch event, followed by a series of other events to publicize and promote the Charter around the world".

First, collaborative suggestions regarding the preamble of the Charter are being sought at this very moment.

Starting on November 20th, input will be sought regarding the "eight core elements of compassion":

• Compassion as empathy not pity.
• Compassion as concrete action.
• Compassion as a lens for scripture.
• Compassion’s role as a spiritual tool and its relation to be
• Compassion as fundamental to all faiths.
• Compassion as an urgent global need.
• Compassion as concern for everybody.
• Compassion and the Golden Rule.

Then, beginning on November 27th, there will be specific calls to action for different groups:

• Educators
• Scholars
• Congregants
• Religious leaders
• Media
• Youth

Subsequently, beginning December 4th, a summary of the Charter's declarations will be created, reflecting on how the Charter will actually bring about change in the world.

If you would like to submit your own story as a part of this growing conversation, click here to visit the segment of the site devoted to contributors' personal testimonies.

The Charter for Compassion may be the exciting birth of a new expression of how compassion, tolerance and global cooperation can change the world and alter humanity's very way of thinking. Please consider visiting the site and perhaps even sharing a story of how you feel compassion can be generated, propagated, and disseminated throughout the world.

Change of Shift is up at Crzegrl

A new edition of Change of Shift, everyone's favorite nursing blog carnival, is up over at Crzegrl, Flight Nurse, complete with one video offering, a new twist on the blogging paradigm. Enjoy!

Radio Interview: Columbus, Ohio

For anyone interested, my interview with Fred Andrle on WOSU, Ohio Public Radio, is available online at http://www.wosu.org/radio/radio-open-line/. Just scroll down the page to the Monday, November 10th section, et voila! You can listen from the website or download it is an MP3 file.

Bloggers Unite---Refugees

Today, November 10th, 2008, bloggers around the world are posting about issues surrounding the plight of refugees. As we writers sit at our computers, composing thoughts to provoke the thinking and compassion of others, millions of men, women, and children on several continents fight for their lives and their rights to a safe home, free from fear and persecution.

For as long as human beings have engaged in battle and warfare, displaced persons have wandered the earth in search of a home. Recently, tens of thousands of refugees within the Democratic Republic of Congo have fled refugee camps due to increased fighting and direct attacks on refugee camps, possibly due to ethnic or religious differences. The Congolese people have suffered for decades, and there is no end in sight to their continued persecution and internal displacement.

The main global organization vis-a-vis the coordination of refugee protection is the Office of the United Nations High Commissioner for Refugees (UNHCR). Other organizations such as Human Rights Watch, Refugees International, and the American Refugee Committee are all committed to protecting refugees and providing relief and financial assistance that can mean all the difference for displaced persons struggling to maintain their health, safety and economic well-being under extraordinarily difficult circumstances. Similarly, organizations such as Doctors Without Borders manage to provide essential medical care to individuals and families suffering from acute injuries, untreated disease, psychological trauma, and the effects of poverty and deprivation.

Refugees from Iraq, Afghanistan, Palestine, Georgia, Darfur, Somalia, Sri Lanka, Myanmar and other troubled regions amount to an enormous population of world citizens who require medical care, advocacy, protection, shelter, clothing, food, and a means by which to make a living and educate their children, many of whom have never known a normal life free from displacement and suffering.

It is our collective responsibility to support the organizations that provide services and advocacy to refugees throughout the world. It is also our individual responsibility to pressure our elected officials to take action and to push for legislation that enhances the work of the lead refugee agencies that bear the brunt of the Herculean labor involved in supporting the millions of displaced people in need of essential services.

War, when waged by any country, almost ubiquitously creates refugees, and such battles frequently stir up---or are originally caused by---religious, ethnic and cultural differences between groups that fuel the fires of hatred and genocide that we have seen all too often in the current century and the last. While much of humanity has called for a universal end to war, there is currently no end in sight, and it is thus incumbent for humanity as a whole to work collectively to assuage the effects of war, racism, hatred, and violence.

Just as it has been said that none of us are truly free while others are enslaved, it can also be said that none of us are ever truly living in peace and safety until all are living in peace and safety. Perhaps a day will come when the plight of refugees will be an historic anomaly. However, the 21st century, indeed in its infancy, has already offered us a myriad of evidence that war, displacement, and genocide are still realities necessitating a powerful communal response.

Yes, today is indeed a day for blogging about refugees. But when the day is done and the articles are read and digested, it is then that the message truly must take wing---and we all begin to take action.

Live Radio Call-in Show about Nursing, Nov. 10th

Dear Readers,

Just an FYI that I will be interviewed live on the radio on Monday, November 10th at 11am EST on WOSU-AM, Columbus, Ohio. The interview will center around the recent publication of "Reflections on Doctors", and will feature myself, another contributing author, and the host of the program, Fred Andrle.

The show will be streamed live at http://www.wosu.org/radio/radio-open-line/ and call-in questions will be accepted from listeners after the first 20 minutes of discussion. Please listen if you can!

Belgian Missive

Europe certainly does charm one easily with its cafes, chocolates, and that otherworldliness that is somehow familiar yet distinct from everything American.

Bicycling with a giggling Dutch seven-year-old girl clutching my jacket from her perch on the seat behind me, my hands and ears are bitter from the cold while my mind gleefully takes in my surroundings. The Belgians don't have that famous tolerance and awareness for bicycles so common to the Dutch, so we're careful as we make our way through the densely populated and crazily busy streets.

I play with my hosts' young children, our only common language being the universal language of play. Their parents, my dear friends, translate as necessary, but we laugh and engage in all sorts of imaginative play without the need for intelligible conversation. I speak to them in English, they speak to me in Dutch. We shrug our shoulders and continue with our games.

Yes, it's easy to be charmed, easy to fall into the rhythms and practices that are novel yet familiar. My heart has always partially resided in Europe, a place where I feel strangely at home in so many ways.

My brief time here is precious, and I drink it in like the thirsty traveler I am.

A New Day

Well, here I am in Europe, and Belgian television is awash with news of Barack Obama's massive win over John McCain, and the increasingly Democratic Congress. The news and talk-shows here are absolutely buoyant, and Europe seems to be rejoicing at this turn of events vis-a-vis American politics and world diplomacy.

As for me, I am struck by the historical significance of an African-American President of the United States. I am equally struck by the message that his election sends to young people of color everywhere.

Based on what I'm gleaning from my European perch, I can also see that the world is expecting change, openness, inclusivity, and a major about-face by the U.S. on climate change, global security, the wars in Iraq and Afghanistan, the global economy, and more. Meanwhile, many of us who voted for Barack are also demanding and expecting the same, and much more.

Power is corrupting, and the ways of Washington are devious and deceitful. I send my support and prayers out to the President Elect that he can truly deliver at a time when all eyes are turned on him, ears pricking up at the long-promise of deliverance to a land of hope.

Off to Brussels on Election Day

Well readers, I'm flying off to Brussels, Belgium to visit old friends amidst the maelstrom of Election Day here in the States. I do indeed plan to blog from my European perch a few times during my stay, but it will most likely take a few days for me to find my feet and recover sufficiently from jet lag.

So, until then, be well, and please check back in a few days for an update. By then, I'll hopefully be able to gleefully report on the high quality of chocolate, beer, mussels, and french fries at my disposal.

All the best,

Keith

Value Care, Value Nurses Blogger Scholarship Completed

I have now completed my series of posts under the auspices of the Nurse Blogger Scholarship which I was awarded in July of this year from Value Care, Value Nurses. I would like to take this opportunity to thank VCVN and the Service Employees International Union (SEIU) for their generosity and support. VCVN and SEIU exerted no influence on the subject matter, tone, or content of my posts, and I was given absolutely free reign throughout the length of the scholarship period.

As a way to make all of my entries available in one place, I am creating links to each post---in chronological order of their publication---here.

Value Care, Value Nurses Scholarship
The Nursing Shortage: A Global Crisis, Close to Home
Obama, Healthcare and a Trio of Mythic Figures
The Aging World
Hispanics and the U.S. Healthcare System
Religion and Discrimination in Healthcare
Nurses' Voices, Nurses' Image: Nurses' Power
The Office of the National Nurse
Economics and the Elderly
The Irony of Mental Health Parity
Multiple Chemical Sensitivity: A Hidden Disability
The Nursing Shortage, PBS-Style
New Nurses, Primary Care, and the Calculus of a Multifaceted Shortage

Nurses have a great deal to say, and nurse bloggers are frequently outspoken, taking risks and shining a light in some interesting (and sometimes disturbing) corners of the healthcare system. My hope is that the Value Care, Value Nurses Nurse Blogger Scholarship will become an annual award that will continue to bring nurses' voices to the fore at a time when those voices are greatly needed.

Again, my sincerest gratitude to VCVN and SEIU for their support, generosity, and encouragement.

Hallowe'en Change of Shift

A scary Hallowe'en edition of Change of Shift is ready to spook you over at Crazy Miracle. Visit if you dare......and Happy Hallowe'en.

Reflections on Doctors Reviewed in the NY Times

Reflections on Doctors, the recently-published book of non-fiction by nurses for which I was one of many contributors, has been reviewed for the New York Times by Dr. Abigail Zuger, M.D.

While Dr. Zuger is admittedly underwhelmed by the lack of "literary style" demonstrated by the book's contributors, she states that "each story represents a step in understanding the inherent differences that separate the professions".

Even as the reviewer points out that the relationships described would not elicit "a minute of good television" (an assertion which I reject out of hand), and that the authors "write in shades of gray, describing interactions and relationships that are colorless, courteous, [and] businesslike", the Dr. Zuger seems to conclude that good, thoughtful medical care is, on balance, the end result of nurses' thoughtful reflections on the care that they and their medical colleagues provide.

In the course of her review, Dr. Zuger does indeed bemoan the fact that "no doctor out there is planning to publish a manuscript entitled 'Reflections on Nurses' any time soon", stating that "I am assuming my colleagues concur that such a project would be best left for retirement incommunicado somewhere on a distant Pacific atoll, where the mailman never calls." Sadly, this statement belies the fact that many doctors simply do not take the time to consider the crucial role that nurses play in the delivery of medical care, or, as the reviewer asserts, are potentially concerned that angry letters would ensue whether praise or criticism were duly proffered.

As a nurse blogger, I can attest that some of the best interdisciplinary writing does indeed occur in the medical/nursing blogosphere, and perhaps it is in that venue where the one-way conversation begun in "Reflections on Doctors" can be openly and honestly continued.

However, I can attest that "Reflections on Doctors" is one more step in further elucidating the multifaceted relationships between nurses, doctors and surgeons. Such literary excursions can only serve to inform the public, empower nurses and doctors to communicate, and to open additional avenues for future discussion.

New Nurses, Primary Care, and the Calculus of a Multifaceted Shortage

(Note: This is my twelfth---and final---post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

It seems that everywhere I turn, someone is telling me that, a) they just applied to nursing school, b) someone they know just applied, or c) they or someone they know was just accepted/rejected from nursing school.

New nurses---and those who wish to be nurses---are entering a profession in transition, a profession that is losing its older members more quickly than its educational institutions can churn out novices ready to enter the fray.

Today I was interviewed on a radio program in Gainseville, Florida about a recently published book of non-fiction writing by nurses in which I was a featured contributor. The show's hosts seemed sincerely perplexed when I explained that older nurses are retiring faster than they can be replaced, and that nursing schools simply cannot offer faculty salaries that can compete with what nurses are paid in clinical positions. Thus, thousands of qualified applicants for nursing school programs are turned away each year since there are not enough professors to educate them.

As a consequence, far too many eager and highly qualified applicants are rejected from nursing schools around the country---and in fact, around the world, as well---and where do they turn? Do they re-apply the following year? Do they look for another school to which they might have a chance of acceptance? Or do they give up their quest to join the nursing profession and simply move in another career direction entirely?

At a time when aging Baby Boomers are living longer with chronic illnesses and are increasingly in need of quality nursing and medical care, it's time for our government and other influential entities to step up to the plate. The government itself must realize that the calculus of the nursing shortage must change, and this continuous hemorrhage of nurses from the profession without a consistent transfusion of new nurses must be short-circuited.

I will grant that we are in difficult economic times. I will also admit that the U.S. healthcare system is dysfunctional at best, and broken at worst. It is also plainly apparent to me that a growing lack of sufficient nurses to provide care in numerous facilities across the country is a recipe for a public health disaster of enormous proportions.

Meanwhile, if an Obama administration gains control of the White House, a push for near-universal healthcare coverage for all Americans will most likely be an important agenda item in the first year of such as administration. This is a laudable goal that may or may not be achieved. However, it must be acknowledged that the process of bringing more citizens into the healthcare system must be met by a similar process of encouraging more healthcare providers to take part in delivering that care.

The nursing shortage is real, and it is effecting how healthcare is provided around the country. Similarly, there is a very real shortage of primary care physicians, with more physicians opting for specialties in which the demands and low pay of primary care are eschewed.

Now, it is easy to see that if more citizens are insured (a goal that should absolutely be pursued despite the current economic climate), then we must simultaneously ensure that a sufficient number of physicians and nurses are available to provide the quality care that would consequently be delivered.

We must create incentives to lure physicians back into primary care, perhaps by reaching out to medical students and residents with a campaign to describe the value and rewards of primary care. Financial incentives such as loan repayment programs could also be enacted for new doctors who enter the field of primary care or family medicine, whether they work with vulnerable populations or not.

In terms of the provision of primary care, an expansion of Masters-level Nurse Practitioner programs and Doctoral nursing programs (especially for the new Doctor of Nursing Practice designation), could go a long way toward assuaging the nationwide shortage of primary care physicians, especially if interest-free loan programs and other incentives are created and fully funded.

We also must urgently expand the capacity of nursing schools by subsidizing nursing professors' salaries, expanding programs, and enacting a massive campaign of grants, scholarships and interest-free loans to make nursing school more readily affordable for a broad spectrum of prospective students.

Yes, these programs would indeed be expensive, and a great deal of money would need to be designated for such a sizable undertaking. Yet we must examine the relative costs of our inaction, and the crisis of untreated chronic illness and substandard medical care that will be the result of such a failure to act.

As the population ages and people live longer with more complicated constellations of chronic illness and multiple comorbidities, the provision of medical care will necessitate an enormous number of nurses as well as a solid base of primary care providers for patients across the lifespan. Nursing education must be funded and supported, nursing faculty must be recruited and well-compensated, and primary care providers must be given viable reasons for remaining in an area of medicine that has fallen from favor.

We cannot afford to ignore the multifaceted issues which are throwing the American healthcare system into crisis, and rest assured that any money invested now in improving the delivery of care will pay astronomical dividends in terms of prevention, improved healthcare maintenance, and increased cost-effectiveness. It is in our best interest to act, and we can only hope that political will and popular support will be enough to set these wheels in motion.

Nurse, Heal Thyself

The stresses and challenges of practicing as a nurse often seem to preclude something which appears to be ubiquitously foreign to most nurses: self-care. Nurses are notorious for being bad patients, are they not? They work long shifts, spend countless hours perfecting the care of others, give great attention to the details of their patients' care, yet often miss a very important patient---quite well-known to them, in fact---who's just screaming for attention. What's a busy nurse to do?

We all enter nursing for various reasons, but one would hope that the majority are there due to a love of people, a willingness to provide quality care, and a sincere desire to be a participant in the healing of others. Nursing has been espoused to be a "calling" (some of us do indeed hear voices!), an "art", a science, a career, a vocation, and a profession. Bravo to each descriptor listed above, yet nursing can also be defined as a purgatory of stress, a miasma of unmet need, and a mania of martyrdom. To where does the overworked nurse turn?

Self-care is an essential tool in the arsenal wielded by the prudent and self-aware nurse. One must recognize that one's effectiveness in the world---both as a nurse and an individual---is directly affected by one's level of inner satisfaction, healing, and ability to weather the vicissitudes of life. We have all heard stories about nurses suffering from addiction. Whether said nurse has a genetic predisposition to addiction or simply a conscious desire to self-medicate due to stress, that nurse's active healing is paramount to his or her ability to provide optimal care and move effectively in the world.

Whether it be exercise, meditation, gardening, baking, psychotherapy, or blogging, each of us must find ways to nurture ourselves amidst the frequently tumultuous maelstrom of nursing. No matter what aspect of nursing where we find ourselves---university, clinic, homecare, hospital, or research---self-awareness, self-care, and an active role in pursuing optimal mental and physical health is paramount. Sadly, many employers do little to support or encourage self-care, focusing instead on productivity, attendance, and other quantifiable measurements of one's performance. When was the last time your supervisor evaluated you to make sure that you're taking enough vacation time or eating well at lunch? Does your supervisor make sure that you're satisfied and feel cared for at work? Does your annual "performance evaluation" include your employer's sincere desire to ascertain whether your workplace is healthy for you? I would think not. If so, where do you work and are they hiring?

I personally use many forms of healing---both Eastern and Western, orthodox and unorthodox---to continue my own trajectory towards self-actualization and health. With a number of chronic illnesses and personal struggles, my work certainly does impact my life at home, and vice-versa. My many responsibilities seem to bleed into one another, with the "workplace immune system" occasionally invading that of the home, both systems stressed beyond their perceived limits. Exhaustion at work leads to exhaustion at home. Relationships suffer. Personal goals are relinquished. Volunteer activities atrophy. Joy appears to vanish.

So, Nurse Martyr, it's time to focus on yourself. Your employer will not do it for you, and most healthcare institutions will suck you dry and spit you out without a second thought. Protect yourself from the ravages of this most rewarding and exhausting of careers. You deserve it. Your family deserves it. Your patients deserve it. The world deserves it.

Nurse, heal thyself.

The Nursing Shortage, PBS-Style

(Note: This is my eleventh post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

Well, it finally happened. The nursing shortage received some well-deserved coverage that, in many ways, actually did the subject justice. Now with David Brancaccio, a weekly half-hour television show of investigative journalism on PBS (previously hosted and made famous by Bill Moyers), focused its attention on the nursing shortage in America, and I can only hope that the message delivered is heard by the people who most need to hear it.

With a shortage of as many as one million nurses projected by the year 2020, calls to address this crisis within the troubled American healthcare system are becoming louder and louder.

As described in the course of the program which aired this evening on PBS, nurses are the engine that keep the healthcare system humming. While doctors may sometimes receive the lions' share of the praise for life-saving surgical techniques and heroic medical measures, it is round-the-clock nursing care that can often mean the difference between life and death. And as outlined during Mr. Brancaccio's investigative story, a number of studies have demonstrated quite clearly that when the number of patients cared for by nurses increases, mortality also increases. And by most measures, successful outcomes most often directly correspond to the quality of nursing care received.

As the population ages and lives longer with more chronic illness, the need for nurses in hospitals, health centers, nursing homes, and in home care will continue to increase exponentially. (It was pointed out during the broadcast that approximately 75 cents of every healthcare dollar is spent on chronic illness.) And with nurses working harder as salaries remain essentially stagnant in the face of increasing workloads and a sagging economy, attrition from the profession should be of paramount concern.

Speaking of attrition, approximately 25% of new nurses reportedly leave the profession each year, and one can only imagine that falling from the frying pan of nursing school into the fire of full-time nursing may be one of the many factors that push new graduates right out of the profession before they have even had the chance to settle in.

As 25% of new nurses leave the profession, the average age of the American nurse continues to increase, with retirements from active duty occurring on a daily basis. Meanwhile, 70% of nursing schools turn away thousands of qualified applicants due to a shortage of nursing faculty which, if left unchecked, will continue to cripple any efforts to assuage a shortage that only seems to expand with each year that passes.

When it comes to retaining new nurses who have recently entered the field, some facilities (as shown during the broadcast), utilize a year-long residency or internship structure so that new graduates actually receive the guidance and mentorship needed to make it in the real world, post-nursing school. Similar to the medical residency that newly-minted doctors receive, a nursing residency or internship allows a new nurse sufficient time to receive the focused training that he or she will need in order to deliver high quality and safe care. Thus prepared for full-time nursing, the new graduate is thus less likely to burn out, and more likely to succeed in his or her work and be satisfied with a newly chosen profession that desperately needs to retain its newest recruits.

If you would like to watch the Now broadcast in streaming video on your computer, you can click here. To watch a four-minute interview with a University of Pennsylvania School of Nursing professor regarding continuity of care from the hospital to the home, click here. To find what hospitals in your state have received the American Nurses Association "stamp of approval", click here. And to follow a week in the life of a new graduate working on a New York City burn unit, follow this link.

My one criticism of the program is that, like all media covering nursing and the shortage, only hospital-based nursing was addressed. There was no mention of home care, community health, public health, or school nursing, areas which are also struggling mightily with the effects of the shortage. This focus on hospital nursing---however important hospital care certainly is---only serves to underscore the public's (and the media's) misconceptions about nursing. Our society seems to ubiquitously see nurses solely as workers in the hospital, overlooking the fact that nurses provide crucial care to myriad populations of citizens well beyond the walls of the nation's hospitals.

Such media attention on the crisis of the national---and global---nursing shortage is truly needed, and it is only by educating the public (and our elected officials) about the crucial need for nurses that change and growth might occur. While Barack Obama and John McCain both have, to some extent, made gestures vis-a-vis the shortage of nurses in America today, a new administration in Washington will have many pressing issues to address as power is assumed in January of 2009, and fixes to the healthcare system will certainly take time.

No matter how the enonomic climate evolves, people will still get sick and need nursing care and medical care. No matter how many banks fail, hospital doors will still be open, visiting nurse agencies will visit patients at home, and surgeries and emergencies will continue to occur. Even as the global economy reels from the latest financial implosion, qualified applicants will be turned away from nursing schools and shortages of nursing faculty (due to relatively low salaries and other factors) will plague the halls of academia.

A new administration will need to have the political will to take some bold strides vis-a-vis the American healthcare system. The delivery of care as it pertains to chronic illness will need to be addressed. Nursing faculty---the key to educating new nurses in preparation for the workforce---will need to receive improved compensation for their important work as educators of future nurses. Nursing students from a broad socioeconomic spectrum will need scholarships and grants to offset the costs of a community college or university education. And healthcare facilities will need funds to give new graduates the time and attention they need for mentorship and preparation for autonmous practice.

The list above is by no means exhaustive, and the program aired on PBS is also by no means the final word on a shortage that currently is without a forseeable end. Creativity, forethought, vision, and a savvy understanding of both the economy and the vicissitudes of the healthcare industry are all necessary in order for current healthcare problems to be sufficiently addressed and remedied. Many of us are cynical that any meaningful change is close at hand, but we can only hope that our pleading, explanations and supplications do not, in the end, fall on the deaf ears of bureaucrats who just cannot see the healthcare forest for the trees.

Fiction, Prose and Ephemera

Dear Readers,

I am writing to inform you that, as my creative writing practice grows, I've decided to create a separate blog where I will post poetry, prose, fiction, and other ephemera several times each week. Since Digital Doorway seems to focus mostly on health, healthcare, human rights, and nursing (with some spirituality and politics, for good measure!), I felt it was time for the birth of a new venue that falls outside of my own perceived scope for Digital Doorway.

This new blog is called Fiction, Prose and Ephemera, and will be bookmarked on the right side of Digital Doorway's homepage, where you can also find links to Latter Day Sparks (the story of my dog Sparkey and his final days of life) and A Nurse and His Treo (a photography experiment), two of my other adventures in blogging.

Thank you for your readership, and please know that Digital Doorway is alive and well as it approaches its fourth birthday. Please visit often, and do say hello from time to time.

All the best,

Keith

Blog Action Day Wrap Up

On October 15th, I took part in Blog Action Day, an annual event wherein bloggers from around the world come together to write posts about the same subject, generally something of import to humanity as a whole. This year, the subject was poverty, and a wrap-up of the event can be found by clicking here.

Apparently, 12,800 bloggers took part this year in writing over 14,000 posts for a total audience of of over 13,000,000 readers.

To read my post, please click here. And if you're moved to take a moment to do something in the fight against poverty, then the movement has been effective. Here are just a few ideas for actions you can take:

• make a donation to a local soup kitchen, food bank, or food pantry
• volunteer to tutor a child
• become a Big Brother or Big Sister
• start your own non-profit organization
• volunteer, volunteer, volunteer
• make a donation to a national or local anti-poverty agency
• type "poverty" into Google and do some reading and become more informed
  
• talk to your friends and family about the reality of global poverty
• donate time and money in lieu of buying holiday gifts this year
• sponsor a child in need of education
• vote
  

Change of Shift Goes to Nursing School

The latest edition of Change of Shift (that nursing blog carnival that we love) is up and ready for your perusal over at Nurse Ratched's Place. Please pay the good nurse a visit if you can.

The home page of Change of Shift can be found here.