A Year of Questioning Authority

A Year of Questioning Authority

Creative Nursing: A Journal of Values, Issues, Experience, and Collaboration is a peer-reviewed professional journal, with an overarching theme for each year and a related theme for each of our quarterly issues. Creative Nursing 2017 has been a year of Questioning Authority.

Questioning Authority: What Does It Mean?

Our mission for the year was to examine, evaluate, and criticize the body of knowledge that informs our care. The principles that guided our journey were:

Humanize patient care. Let the people we care for decide how they want to be cared for. The unit of experience is the intervention with the individual. Use common sense – no matter what authority says, do what is right for the patient. Think like a nurse.

Know who and what constitutes authority: Self (conscience, judgment, critical thinking); peers; patients, families, and other caregivers; nurse educators and theorists; physicians and other health care professionals; health care organizations and their policies; regulators; third party payers; national and community leaders; social conventions; the media; evidence-based practice. The list goes on.

Standardization values compliance over creativity. At specific times, standardization and compliance are paramount, but of all the actions nurses take in their professional practice, those times are very few. The rest of the time, we need creative nursing: wide eyes, open ears, open minds, and a healthy skepticism, in order to reimagine the next health care system. Topics in this issue included deferring to expertise before authority, Dorothea Orem and self-care, teaching millennials and Generation Z, and whether virtual simulation and pre-op teaching actually work.

Questioning Authority: What Does It Take?

“It is at the intersection of the self and the other that true reflective practice occurs,” says guest editor and Curry College nursing professor Susan A. LaRocco. In this issue, we talk about what it takes—the attributes (personal and system) required—to challenge assumptions.

It takes courage: Facing fears of retaliation or marginalization; finding strength in trial and error and in failing forward; having confidence in our Ways of Knowing.

How do we process what we dare? Through reflection: debriefing for meaningful learning.

What else does it take? Humility, authenticity, tolerance for disruption, leadership that creates a safe environment for questioning.

Other topics included helping teammates work together through “virtues in common;” healthier work environments for academics and certified nursing assistants; helping new nursing professors become excellent teachers; unintended consequences of some JCAHO mandates; how understanding triggers could help nurses influence health behaviors; and how the movement to establish nursing as a profession distinct from medicine succeeded in the face of paternalism and misogyny.

Questioning Authority: What Does It Look Like?

It crosses boundaries. It is interprofessional, interdisciplinary, and respectful of individuals’ unique personal resources and contributions.

It advocates courageously for patients and families.

It uses science and art to humanize care.

For this issue of Creative Nursing, we found role models, exemplars, and stories of responses to educational and societal silos, inspired uses of simulation and art to humanize care, creative ways to recruit and retain valuable individuals in the nursing profession, and the application of nursing expertise to correct a scientific and cultural wrong number. The most moving story is by Joanne Dunn, from a health care skills simulation lab at the University of Worcester in England. Her depiction of a simulation of a typical busy unit on a typical morning moves us to reject the assumption that simulation lab exercises can never truly replicate what it means to be a nurse.

Questioning Authority: What is the Impact?

In this issue of Creative Nursing we explored the impact on both process and outcomes, for both patients and those who care for them, in all arenas. We highlight a nurse theorist (Margaret Newman) who went against prevailing views of what constitutes health and illness; a biomedical scientist who questions currently accepted treatment for patients with breast carcinoma in situ; and a nurse and former Minnesota state senator who found the legislature to be a practice setting in which challenging assumptions and demanding reliable, authoritative, scientific justification for existing or new law is the major function of the role.

We invite you to experience the wisdom of our thought leaders, and to consider making your own contributions to Creative Nursing. To learn more about the journal, visit www.springerpub.com/cn.

Nurses Respond After AMA Launches ‘Turf War’ Over Direct Patient Access

Nurses Respond After AMA Launches ‘Turf War’ Over Direct Patient Access

Following opposition efforts from the American Medical Association (AMA) on new policies that allow advanced practice registered nurses (APRNs) to practice independently of physician supervision, many nursing groups have expressed upset over the ‘turf war’ between nursing and doctor groups. There are four types of APRN roles: nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse midwife.

According to Forbes.com, “AMA opposes ‘the continual, nationwide efforts to grant independent practice…to non-physician practitioners’ including advanced practice registered nurses (APRNs).” AMA, the nation’s largest doctor group, voted at a policy meeting last week in a move designed to combat a national strategy to allow APRNs more direct access to patients.

This new national lobbying strategy from the AMA has been spurred by many states and branches of federal government moving to allow APRNs more direct access to patients without physician supervision. Just last year, the Department of Veterans Affairs granted APRNs direct access to veterans in a landmark decision.

The American Nurses Association (ANA) has accused the AMA of perpetuating “the dangerous and erroneous narrative that APRNs are trying to ‘act’ as physicians and are unqualified to provide timely, effective and efficient care,” as reported by Forbes.com.

[APRNs] practice advanced nursing, not medicine, in which they regularly consult, collaborate and refer as necessary to ensure that the patient receives appropriate diagnosis and treatment. For AMA to imply that APRNs are incapable of providing excellent care or that their care puts the patient at risk is blatantly dishonest. The future of health care calls on health care professionals to work together as a team to meet the growing demand for health care services. 

Pamela Cipriano

President, ANA

Nurse groups like ANA and the American Association of Nurse Practitioners (AANP) have spoken out about the benefits of new state and federal laws that allow direct access as an effort to speed up care to patients. It is part of a larger nationwide move toward value-based care which has also been recognized by government and private insurers who emphasize getting treatment in the right place at the right time, meaning care is often given upfront in a primary care setting where nurses are on the front lines.

To learn more about this ‘turf war’ between doctor and nursing groups debating which health care providers should have direct access to patients, visit here.

Michigan State University College of Nursing Begins Program to Fight Human Trafficking

Michigan State University College of Nursing Begins Program to Fight Human Trafficking

Michigan State University’s (MSU) College of Nursing has taken a step toward increasing reporting and minimizing human trafficking by creating a training program to teach students about this serious public health issue. According to the National Human Trafficking Hotline, 943 human trafficking cases have been reported in the state of Michigan from 2007 to 2017. The Health Law Center has announced that human trafficking has reached an alarming level in the US.

MSU Professional Program Coordinator Kathy Forrest tells StateNews.com, “Human trafficking is very prevalent in the United States. It is a form of human slavery, human bondage. It’s a public health issue for the individuals who are being trafficked. It is often an underground activity that is spread by social media and affects the vulnerable among us.”

StateNews.com cites that 138 individuals in the MSU College of Nursing have completed the online course for human trafficking which requires professionals to take the training to get or renew a new license or registration. Professionals who are required to satisfy the trainings include nurses, counselors, physicians, social workers, and massage therapists. The training includes learning the types and venues of human trafficking in the US and in Michigan, how to identify victims in health care settings, how to identify warning signs, and what resources are available for reporting.

MSU Clinical Associate Professor of Osteopathic Specialties Alan Janssen wants to increase awareness of the public health issue and educate nurses and other healthcare professionals on how to address the problem. He also hopes that increased awareness will lead to better treatment resources.

To learn more about MSU’s online course on human trafficking and steps to begin combatting this dangerous issue, visit here.

Nonprofit “Nurses of Pennsylvania” Vows to Make Changes in Health Care

Nonprofit “Nurses of Pennsylvania” Vows to Make Changes in Health Care

This past summer, a group of nurses in Pennsylvania created the nonprofit Nurses of Pennsylvania with the main goal to be to focus on the safety and care of patients in health care.

According to a statement issued in September, Nurses of Pennsylvania is a group “of, by, and for nurses focused on improving the bedside care nurses provide. PA nurses work in cities and small towns, at large hospitals, in nursing homes, and more—tied together by our commitment to our patients, our families, and our communities. United for quality care, Nurses of Pennsylvania is focused on leading the state to a healthcare system that gives nurses a seat at the decision-making table and puts patients first.”

As stated on their website, more than 10,000 nurses have joined—either online or in-person—since the group launched. Initially funded by union nurses in SEIU HCPA, the Nurses of Pennsylvania is managed by a volunteer board of nurses and advocates in the health care field.

Under the heading “Why Nurses,” the group states: “Nurses are the single biggest group of people in the healthcare system. We spend the most time with our patients, and are the people who they see and interact with the most. We provide most of the care that patients receive, and our priority is always our patients’ well-being first, money second. We are the most respected profession in American for the last 15 years in a row, and we live in every county in the state. If anyone has the power and the motivation to fix healthcare in this country, it is nurses together, and if we can do it in Pennsylvania then we can do it anywhere.”

The nonprofit has already released a report, “Breaking Point: Pennsylvania’s Patient Care Crisis,” the results of which are based on a survey of 1,000 nurses located throughout the state of Pennsylvania. The results found that while Pennsylvania is not currently experiencing a nursing shortage, staffing decisions made by individual facilities and the ability to retain qualified nurses have fueled a crisis in patient care. An overwhelming 94% of nurses reported that their facility does not have enough nursing staff and 87% reported that staffing levels affecting patient care are getting worse.

“We spend the most time with patients, and we’re the people patients and their families rely on the most,” Jake Reese, a nurse in Scranton, PA as well as a Nurses of Pennsylvania board member, said in a statement. “As nurses, we take pride in buckling down and figuring out solutions at warp speed, but there is only so far any one of us can stretch. Giant corporations and multi-billion-dollar hospital systems are making decisions about care and care delivery farther and farther away from the bedside. This has to stop. We’re playing with first and we cannot stand by any longer. As Nurses of Pennsylvania, we’re speaking out and sharing our stories like never before.”

For more information about the Nurses of Pennsylvania, visit www.nursesofpa.org.

Arizona State University Nursing Professor Advocates for Human Trafficking Education

Arizona State University Nursing Professor Advocates for Human Trafficking Education

Samantha Calvin, Arizona State University College of Nursing and Health Innovation Assistant Professor, recently spoke at the 14th Annual Human Trafficking and Social Justice Conference held in Ohio. Calvin also teaches an innovate new course at ASU called “Fundamentals of Human Trafficking” which is one of the only courses on human trafficking available in a nursing school.

The conference is intended to bring together researchers, service providers, politicians, advocates, and students from across the globe to learn from each together and work toward finding real-world solutions to this problem. Calvin’s presentation focused on human trafficking in the clinic setting, red flags to look for, questions to ask, and what to do if someone is identified.

“What we’re finding is that health professionals do not feel comfortable identifying and treating someone who has been human trafficked.”

Calvin tells ASUNow.edu, “What we’re finding is that health professionals do not feel comfortable identifying and treating someone who has been human trafficked.” Her research is focused on female adolescent sex trafficking which she uses as course content for the human trafficking course she teaches in the nursing school.

Many schools of social work offer courses on human trafficking, but Calvin is advocating for the importance of knowing how to identify and treat human trafficking patients in a clinical setting. Calvin tells ASUNow.edu, “Even though a lot of these victims seek medical care they are not being identified and end up remaining in the cycle of human trafficking.”

Calvin hopes that sharing her research with other nursing schools across the country will help show the importance of her course at ASU and encourage other schools to add similar courses to their nursing curriculums.

To learn more about Calvin’s research and nursing course on human trafficking, visit here.

Nursing Community Condemns Graham-Cassidy Healthcare Bill

Nursing Community Condemns Graham-Cassidy Healthcare Bill

In the latest effort to repeal and replace the Affordable Care Act, Republican lawmakers have introduced the Graham-Cassidy Healthcare Bill which many anticipate will deny healthcare to millions of low and middle-income Americans. The bill has received widespread criticism from the healthcare community including nursing organizations, insurance groups, state hospital associations, and more.

The Capitol Beat, published by the American Nurses Association (ANA), states that the legislation sponsored by Sens. Bill Cassidy and Lindsey Graham would make drastic and dangerous cuts to the American healthcare system by repealing Medicaid expansion starting in 2020, eliminating the critical Prevention and Public Health Fund, and creating high-risk pools for individuals with pre-existing conditions, among other misguided policies.

The legislation would also eliminate the definition of essential health benefits, allowing individual states and insurance companies to opt out of covering maternity care, mental health, substance abuse treatment, and hospitalization, while also allowing insurers to deny coverage to people with pre-existing conditions, according to CommonDreams.org.

Proposed just 10 days before the September 30 deadline for Republicans to pass ACA repeal, nurses believe the Graham-Cassidy Amendment is worse than previous versions of ACA repeal. National Nurses United (NNU) Co-President Deborah Burger tells CommonDreams.org, “Graham-Cassidy is especially punitive to the sick and ill, and others with pre-existing health conditions who stand to lose any of the protections established by the ACA under the state waiver provisions to the proposal.”

To learn more about the Graham-Cassidy Bill and nurse opposition to the pending ACA repeal, visit here.