March of Dimes celebrated their 4th annual “Nurse of the Year” awards banquet last week in Ohio, honoring Debbie Borowske, DNP, RN, GCNS-BC, as their Nurse of the Year. Borowske was recognized for her work in long-term acute care, rehabilitation hospice, and palliative care as the director of Post-Acute Care Services at Southwest General Health Center.
After finding a gap in the hospice services offered by Southwest General, Borowske launched a community-based palliative care program which sees an average of 50 patients per month. Her program consistently achieves its goal of improving life and providing comfort to those with serious, chronic, and life-threatening illnesses. In addition to her work at the health center, Debbie also holds adjunct faculty positions in nursing at Case Western Reserve University, Malone University, and Kent State University.
The annual March of Dimes Event recognizes exceptional nurses, creates awareness of professional excellence, and promotes the future of nursing helping to advance their mission to improve the health of babies by preventing premature birth, birth defects, and infant mortality. To learn more about Debbie Borowske and her Nurse of the Year recognition by March of Dimes, visit here.
Katelyn Nordhoff, 22, a junior nursing student at Indiana University, didn’t realize how few kids in nearby low-income neighborhoods receive regular dental care twice a year until she began a community clinical course this semester. The course is designed to teach students about health disparities in rural and low-income areas.
To complete her community hours, Nordhoff was stationed at Bloomington Housing Authority providing basic health screenings. She began to see a disparity in dental care especially after learning that many families she saw didn’t have normal health insurance, and even those with health insurance didn’t have dental coverage. Referring to dental care, Nordhoff told the Bloomington HeraldTimesOnline.com that, “It’s kind of something you don’t even think about when you think of health care.”
While working with kids from kindergarten through 4th grade, Nordhoff saw the effects of not visiting a dentist twice a year. Many of the kids hadn’t even been to the dentist twice in their lives. Wanting to help teach these young kids the importance of brushing and flossing twice a day, she asked for donations from local dentists and received enough materials to put together 175 dental kits with neon toothbrushes, toothpaste, and floss. After passing out the kits to kids in the local Boys and Girls Club after-school program, Nordhoff taught them the best ways to brush and floss their teeth.
We’re honoring Katelyn as our Nurse of the Week for her inspiring work as a community nursing student helping low-income families and their children receive the health care they need when dental care gets too easily overlooked.
Although the nurse licensure compact gives nurses and employers new workplace and staffing options, critics have concerns about the process for achieving those objectives. Chief among them is that individual nursing boards and legislative entities have been left out of the loop not only in formulating compact statutory language to fit state law, but also in other key administrative ways.
With decision makers residing elsewhere, Ohio nursing leaders complain that the compact skirts state regulations calling for anyone involved in legislative action regarding the state reside in the state. The pact’s current structure leaves Ohioans powerless to modify the pact’s language so that it addresses their state’s unique culture while honoring its sovereignty. That includes lacking the kind of transparency—e.g., complying with open meetings and records acts—required of all other legislation. “We want to make sure that if we join any compact, Ohio decision makers are at the table contributing to its content,” says Lori Chovanak, MN, APRN-BC, chief operating officer for the Ohio Nurses Association.
Even though critics cite the inability to craft or re-craft compact language as a non-starter, they also worry about other long-term effects on the professionals who have to ensure quality patient care. For instance, Minnesota’s nursing leaders aren’t pleased that lawmakers might have to modify existing state law to accommodate a pact they didn’t help create. Yet they’re equally concerned about the state licensing board’s powers, especially regarding licensing and tracking, being usurped overtime. “Knowing which nurses are working in the states and which requirements they’ve met is very important to patient safety,” says Laura Sayles, government affairs specialist for the Minnesota Nurses Association. “But it also matters that by joining the compact, our board’s giving up its rights to do it job.”
Not all nurses belong to unions, but for states that have strong collective bargaining sectors, there is the real fear, say critics, that the multi-state licensing compact could interfere with their efforts to either negotiate the best agreement or even deal with a potential strike. Even though there’s additional concern that a multi-state license compact just opens doors for a mass exit of talent from lower income states to greener pastures, supporters say such hasn’t been the case.
Sandra Evans, MAED, RN, executive director of the Idaho Board of Nursing, an original pact member, and chairwoman of Nurse Licensure Compact Administrators, suggests that in the 16 years since the original pact has been in play, there’s been no evidence that the agreement has interfered with existing labor laws, stymied a union’s ability to do what it needs to do in terms of collective bargaining or even facilitated a shift in manpower. “That might be more perception,” says Evans, “than reality.”
That doesn’t mean, however, that nurse leaders aren’t apprehensive. Although patient safety is its ultimate objective, Sayles admits that as a union, MNA also must focus on the compact’s potential effect on labor issues. “Anything that allows employers to move nurses in and out without our knowledge of that movement,” she says, “is going to be of concern to us.”
According to William J. Pape’s 1918 book “History of Waterbury and Naugatuck Valley, Connecticut,” the City of Waterbury inaugurated the medical inspection of pupils by school nurses in 1904, making them an early adopter of the school nursing revolution. By 1913, the Medical Inspector of Schools had designated a central room to be used as a clinic for the nurses to examine and treat students.
A 1919 City of Waterbury Health Department Report cited that the school was using 5 school nurses to examine each child for contagious and infectious diseases. Infections were given prompt treatments when necessary, and followed up on by the school nurses to accomplish better health and sanitation for students. The 1920s and 30s brought in new standards to differentiate between medical care and school nurses, designating school nurses to tend to first aid, health screenings, and disease prevention. By that time, the Waterbury School Nurses had already pioneered the practice of school nursing, contributing greatly to the health and wellbeing of the city’s school children.
Today, school nursing is considered a specialty that requires advanced education and professional emergency care experience. School nurses promote health and safety practices, providing interventions to actual and potential health problems including acute injuries and managing chronic conditions like food allergies and asthma. For 112 years, Waterbury School Nurses have pioneered and specialized the practice of school of nursing, treating over two million pupils in that time. You can learn more about the School Nurses of Waterbury in their full report here.
Below, I interview Jennifer Randall, a registered nurse (RN) who works at a community health center, about her role as an educator on the infectious disease team.
What is your background in nursing?
I graduated with my bachelor of science in nursing in 2012 from Queens University in Charlotte, North Carolina. My first nursing job was on a telemetry/progressive care unit in North Carolina. From there, I moved to Washington, DC, and worked as an ED nurse in a large, urban hospital for almost two years.
Where do you work now?
I now work at a community health center that provides primary healthcare services for the underserved, uninsured, working poor, and homeless.
How did you find out about your current position?
I heard about the clinic where I currently work through my role as a nurse in the ED. I went to their website and applied for a basic RN position; when I had a phone interview, the recruiter told me about a position on the Infectious Disease (ID) team. I interviewed with the ID team and I was very attracted to the whole model of building relationships with your patients. I looked forward to shifting gears from the ED nurse role to a position with an emphasis on strong patient education. I was excited for that.
What is a “day in the life” like in your job?
I get to work at about 8 a.m. Monday through Friday (which is a major change from the 12-hour rotating shifts I was used to). I get some warm tea or coffee and open my computer to the schedule for the day. I look through each person who is scheduled and make notes of their needs (e.g., insurance issues, adherence issues, food/housing issues, etc).
As patients start to arrive I go in each room chatting with each patient, making sure I address the needs of the patients that I specifically looked into earlier. With the medical assistants doing most of the task work (vital signs, immunizations, etc.) it frees me up to sit with patients as long as I need to and use the nursing knowledge I’ve gained over the years to help patients adhere to their lifestyle regimens.
Working primarily with HIV/AIDS patients, adherence is imperative, and you have to really get creative to figure out how to practically ensure success for someone who is homeless/has no food/no insurance and/or who cannot read. I act as part social worker in a way. We also take care of prior authorizations, adherence phone calls, and much, much more! I then leave work at 4:30 and get all evening, weekends, and holidays off.
What do you find most rewarding about your job?
Gaining the trust of patients—when they let you help them in a very intimate part of their life.
What is challenging about it?
It can be difficult when you feel like you have done all you can to help someone but they are not ready to help themselves.
Who would succeed in this role?
Someone who loves people, relationships, and education
What would you recommend for someone who hoped to get into this type of nursing position?
Just go for it! It is truly rewarding. No, it is not glamorous, and you don’t have gory, horrifying stories to tell like you do when you work in the ED, for example, but you get a chance to really learn about and help people in a different and important way.
It seems that every day there are new discoveries in the field of Alzheimer’s disease. From new treatments to ways to screen for the disease, the condition is in the news as frequently as some politicians. How reliable are these findings, though? Are they published in reputable journals and are they anything more than snake oil? Here are four of the most recent new pieces about Alzheimer’s disease and a look into how likely they are to make an impact on patients’ lives.
The News: An article published in Forbes points to a research article in the scholarly journal Nature that studies the effect of aducanumab, an antibody that has shown promise in attacking the amyloid plaques that form between nerve cells in Alzheimer’s. In a double-blind, four-year trial, the infusion of the antibody showed marked improvement in the symptoms of Alzheimer’s in those with moderate disease indicators.
The Background: The Nature research paper, though compelling, has several flaws that most Alzheimer’s trials suffer from: the sample size. This study, though well planned, only tested the antibody on 145 patients and all were pooled from the United States. Although the study points to positive responses, the research is far from becoming a treatment for Alzheimer’s.
Implications: The study into aducanumab is certainly intriguing, but it is not convincing. Although it offers hope for those with Alzheimer’s, it is not a cure just yet. A larger study is necessary to even bring this treatment into trials, let alone present it for approval by the FDA. While interesting, the breakthrough may not be the miracle cure patients are looking for.
Indicative Gene Signatures
The News: According to an article published on ScienceDaily, a group of researchers have found that younger people with a particular gene signature can show a risk for Alzheimer’s early in life. This gene signature makes parts of the brain more susceptible to the proteins that form in the condition, causing the plaques that are so devastating to the neurons when Alzheimer’s begins in earnest.
The Background: The research was conducted by the University of Cambridge, and it was published in the journal Science Advances. The researchers studied the brain tissues from 500 healthy individuals and found this gene signature common to those that are found in Alzheimer’s patients. This pattern repeated itself in the healthy brain tissue and the Alzheimer’s identified brain tissue alike, though it does not indicate why the patients with healthy brain tissue had the signature and did not have the condition.
The Implications: As with most studies, more research needs to be done to plug up the holes in this study. Why are normal brains showing the same markings as Alzheimer’s brains? Could this be a coincidence? In any case, gene therapy is in its infancy so finding genes that are indicative of Alzheimer’s, while intriguing, does not actually help cure the disease in the immediate future.
Fast-Tracking BACE Inhibitors
The News: Unfortunately, drugs to treat Alzheimer’s are difficult to come by. One drug, named AZD3293, has shown some promise in treating mild to moderate cases of the condition by reducing the amount of amyloid buildup around the neurons. Although it has been fast-tracked, it is nowhere near ready to become a treatment for Alzheimer’s, as this article in the Wall Street Journal relates.
The Background: This new drug is supported by both Eli Lilly and AstraZeneca. The two companies are rivals in the pharmaceutical industry, but since the search for a drug is so elusive, the two have teamed up. They have even agreed to split profits from the drug, which is nearly unheard of. Unfortunately, other Alzheimer’s test drugs have caused severe liver issues and other problems in humans, and none have been viable as a drug to reverse or inhibit the disease, besides Aricept and Namenda.
The Implications: Drug companies are getting closer to finding a treatment for Alzheimer’s, and this fast track is promising. It shows that the FDA is convinced enough to give the green light and allow the companies to proceed. However, the search for a treatment still remains murky, and even this fast-tracked drug can pose problems. Although it can be a bright light in the darkness of Alzheimer’s, it could be another frustrating dead end.
The News: Instead of trying one method of combating Alzheimer’s, the researchers at Sutter Neuroscience Institute in Sacramento, California, are trying as many as five different methods to treat the disease, according to an article published in the Boston Herald. Among these, the use of the intravenous immunoglobulin antibodies, the effects of vitamin D on memory, and the ethnic implications of Alzheimer’s are all under investigation. All of these research projects are ongoing, but none have yet reached the point of publication.
The Background: Although this may seem like a scattershot method of looking for a cure, it actually makes sense. The current drugs for Alzheimer’s are woefully deficient. At best, they can give the patient an extra year of memory health, but they cannot stop the relentless march of the disease. They are inadequate at best, and the frantic search for some treatment means that this sort of research is the only way the medical profession is going to find something that works.
The Implications: Something in these research studies in Sacramento may end up being the cure for Alzheimer’s, or it may end up being something that slows its progress . . . or it may end up another dead end. The implication of this sort of study is the hope for a cure. It isn’t going to help patients now, and it probably won’t help patients in the near future. Someday, though, this sort of research will help patients. With the dedication of people like the researchers in Sacramento and across the country, a solution will eventually be found. It hasn’t been found yet, but everyone still keeps looking. That’s what counts.