New RN Survey Results: Nurses a Little Grayer, Slightly More Diverse

New RN Survey Results: Nurses a Little Grayer, Slightly More Diverse

The U.S. nursing population has grown a bit more diverse in recent years, but most RNs are still white and female, according to a national survey from the Health Resources and Services Administration — and the average age is creeping upward.

According to the 2018 National Sample Survey of Registered Nurses (NSSRN), close to 4 million licensed RNs in the U.S. were working as of Dec. 31, 2017, representing a 29% increase from the NSSRN’s 2008 findings.

The report also showed that almost three-quarters of nurses are non-Hispanic white, and that about nine in 10 are women. Also, the current RN population is “graying” — the 2008 survey reported that 44.7% of RNs were over age 50; the 2018 NSSRN survey put that percentage at 47.5%.

The NSSRN findings are in line with what the American Nurses Association (ANA) expected, said Cheryl Peterson, MSN, BSN, vice president of nursing programs for ANA.

But, she added, “I think we would all say that we are disappointed that we didn’t see more of an increase in the diversity of nursing between 2008 and now. We have to look again at… why people of color are not choosing nursing as a profession.”

The NSSRN identified a slight change in the proportion of minority RNs, driven primarily by an increase in Hispanic nurses. Specifically, 10.2% of RNs in the 2018 survey were Hispanic, 7.8% non-Hispanic black, 5.2% Asian, and 1.7% multiracial. Racial and ethnic minority groups accounted for 26.7% of all RNs who responded to the survey.

Healthcare needs to remove barriers to recruiting more nurses in communities where they are underrepresented, Peterson stressed, and “not just Hispanic and African American, but Native American as well as Asian and Pacific Islander and Alaska natives.”

In terms of men entering the RN workforce, the 2018 report found that male RNs made up 9.6% of the total population, a slight bump from 7.1% in the 2008 NSSRN survey.

Scott Kelnhofer, executive director of the American Association for Men in Nursing, said the organization was “encouraged” by the rise in the percentage of men in the profession.

“We anticipate the percentage will continue to grow in the coming years, based on the increasing number of men who are pursuing nursing degrees around the country, and as more men realize the benefits of entering a profession where there is such a high demand for a skilled and diverse workforce,” Kelnhofer wrote in an email.

The U.S. nursing population has grown a bit more diverse in recent years, but most registered nurses (RNs) are still white and female, according to a national survey from the Health Resources and Services Administration — and the average age is creeping upward.

According to the 2018 National Sample Survey of Registered Nurses (NSSRN), close to 4 million licensed RNs in the U.S. were working as of Dec. 31, 2017, representing a 29% increase from the NSSRN’s 2008 findings.

The report also showed that almost three-quarters of nurses are non-Hispanic white, and that about nine in 10 are women. Also, the current RN population is “graying” — the 2008 survey reported that 44.7% of RNs were over age 50; the 2018 NSSRN survey put that percentage at 47.5%.

The NSSRN findings are in line with what the American Nurses Association (ANA) expected, said Cheryl Peterson, MSN, BSN, vice president of nursing programs for ANA.

But, she added, “I think we would all say that we are disappointed that we didn’t see more of an increase in the diversity of nursing between 2008 and now. We have to look again at… why people of color are not choosing nursing as a profession.”

The NSSRN identified a slight change in the proportion of minority RNs, driven primarily by an increase in Hispanic nurses. Specifically, 10.2% of RNs in the 2018 survey were Hispanic, 7.8% non-Hispanic black, 5.2% Asian, and 1.7% multiracial. Racial and ethnic minority groups accounted for 26.7% of all RNs who responded to the survey.

Healthcare needs to remove barriers to recruiting more nurses in communities where they are underrepresented, Peterson stressed, and “not just Hispanic and African American, but Native American as well as Asian and Pacific Islander and Alaska natives.”

In terms of men entering the RN workforce, the 2018 report found that male RNs made up 9.6% of the total population, a slight bump from 7.1% in the 2008 NSSRN survey.

Scott Kelnhofer, executive director of the American Association for Men in Nursing, said the organization was “encouraged” by the rise in the percentage of men in the profession.

“We anticipate the percentage will continue to grow in the coming years, based on the increasing number of men who are pursuing nursing degrees around the country, and as more men realize the benefits of entering a profession where there is such a high demand for a skilled and diverse workforce,” Kelnhofer wrote in an email.

The U.S. Census Bureau in partnership with the National Center for Health Workforce Analysis periodically conducts surveys that examine race, age, gender, educational attainment, and other key characteristics of the nursing workforce. The first survey was conducted in 1977.

More than 50,000 active RNs completed the 2018 survey (online or on paper). The sample was randomly selected from licensure records provided by the National Council of the State Boards of Nursing, and sorted by state, license type, and other demographics in order to determine the appropriate sampling rate from each state. The response rate was 50.1% (49.1% weighted).

Aging Workforce

In the current survey, mean age of survey respondents was 47.9, up from an average of 47.0 in the 2008 NSSRN survey.

Employers who aren’t paying attention to which of their RNs are nearing retirement could find themselves “in a world of hurt,” Peterson said, and may have to reconsider how they can keep RNs in direct patient care for longer.

She said that one strategy would be to rethink traditional nursing work schedules: “Are we so wedded to 12-hour shifts that we can’t reduce to [8-hour shifts], or look at other staffing patterns that might better suit a nurse who is older?”

It’s also important that employers attract younger RNs to their facilities while the more experienced nurses are still available to teach them, she said.

Education and Experience

Almost 64% of nurses said they earned a bachelor’s degree or other higher degree, with 19.3% reporting that they earned a graduate degree. But that leaves 29.6% of RNs whose highest level of education was an associate degree, and 6.4% whose highest attainment was an RN diploma.

“The complexity of healthcare is such that it warrants a higher level of education than even probably a diploma, but those programs are out there… they are part of the house of nursing and we support that,” Peterson said.

She noted that the 2011 Future of Nursing report stated a goal of having 80% of nurses earn a baccalaureate degree by 2020, Peterson noted. Still, while it’s unlikely the workforce will hit that mark this year, “we’ve made significant progress,” she said.

The current report also found that 11.5% of all RNs earned a graduate degree and an advanced practice certification versus 8.1% reporting the same in 2008.

The 2018 survey showed that registered advanced practice nurses (APNs) made up about 11.5% of the nursing workforce. A relative handful of RNs, 5%, received their training outside the U.S.

Telehealth

Telehealth technologies were available to 32.9% of RNs in 2017 and, of those, 50.3% report using some version of telehealth “in their primary nursing position.”

Provider-to-provider consults made up 54.4% of telehealth use and calls from nurses to patients made up about 50%.

Peterson said the rise in telehealth is not surprising. “We see the National Quality Forum, and some of these value-based purchasing plans, that are really …placing value — including monetary value — on follow-up phone calls, [and] follow-up televisits to patients after they’ve left the hospital,” she said.

Peterson said she expects to see more reliance on telehealth with the increasing use of technologies such as wearables.

“I think this is where nursing has the capacity to do … some really good work,” she said, “being able to appropriately and adequately advise patients” by leveraging algorithms and their own critical thinking to provide guidance and feedback to patients outside the office.

Salaries

Full-time RNs earned a median salary of $73,929; the median for part-time RNs was $39,985.

There was a significant gap between male and female for median full-time earnings, with male RNs earning $79,928 per year and female RNs earning $71,960, according to the survey results.

Peterson said that she has not heard any complaints from nurses about a pay disparity. “I think it’s more about career choices,” she said: male RNs tend to work in places where there is a salary differential, such as emergency departments, ICUs, and in management.

by Shannon Firth, Washington Correspondent, MedPage Today

Originally published in MedPage Today

House Hearing: More Research Needed on Health Effects of Cannabis

House Hearing: More Research Needed on Health Effects of Cannabis

WASHINGTON — Healthcare providers don’t know enough about cannabis to talk with patients about the potential risks and benefits, witnesses said at a mid-January House Energy and Commerce Health Subcommittee hearing.

“We need to have much more education with respect to how the use of marijuana products can negatively impact or help someone,” said Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). “The problem is we do not have sufficient evidence that could help us mount those programs in a way that’s actually required. At this point, I don’t feel the evidence is sufficient to say, ‘We’re going to recommend that this product should be used by this patient.'” For example, elderly patients who take marijuana-containing products may be on a lot of other medications, and little is known about potential interactions between marijuana and prescription drugs. “So I do believe in the importance of expanding our knowledge so we can develop educational training programs that are based on knowledge, not on anecdote.”

Making it Easier to Research Cannabis

Rep. John Sarbanes (D-Md.) noted that a 2015 survey of healthcare providers concluded that the providers “perceive a knowledge gap related to cannabis dosing, treatment plans, and different areas related to cannabis products, so providers themselves realize the need for research and expertise to be developed in this area.”

The hearing was held to discuss six bills on cannabis, several of which were aimed at making it easier for researchers to obtain cannabis for research purposes. Currently, the only cannabis legally available for research comes from a single farm housed at the University of Mississippi, and researchers who want to use it must get permission from three agencies: the FDA, the Drug Enforcement Administration (DEA), and the NIH. “We need to figure out a way to take advantage of different producers of cannabis plants to evaluate the diversity of products out there, as opposed to limiting us to the Mississippi farm,” said Volkow.

Rep. Kurt Schrader (D-Ore.) agreed. “The sad part is we’re not testing the right stuff,” he said. “I fail to understand why we have one bloody facility that is the sole nexus for research and analysis of CBD [cannabidiol] products. It seems to me we ought to be testing products on the marketplace.” Subcommittee chairman Anna Eshoo (D-Calif.) agreed. “I don’t understand why the three agencies before us can’t get this done,” she said, referring to NIDA, the FDA, and the DEA, which all had officials testifying at the hearing.

The Cannabis Research “Catch-22”

Several subcommittee members expressed frustration over what they called the “Catch 22” problem that cannabis researchers face. “They can’t conduct cannabis research until they can show cannabis has a medical use, but they can’t demonstrate cannabis has a medical use until they conduct research. It doesn’t make sense,” said Eshoo.

“You’ve got to help us figure out how we’re going to get out of this Catch 22,” Rep. Debbie Dingell (D-Mich.) said to the witnesses at the hearing. “This lack of knowledge poses a public health risk.”

One issue with conducting research on marijuana is its classification as a Schedule 1 drug; these are substances deemed to have no medical value and have a high potential for abuse, and their availability is highly restricted. Several bills the subcommittee is considering, including the Legitimate Use of Medicinal Marijuana Act, the Marijuana Freedom and Opportunity Act, and the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, would either downgrade marijuana from a Schedule 1 drug to a Schedule 2 drug, which has fewer restrictions, or remove it from the drug schedule altogether.

Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said the latter “is going too far,” adding that “using our congressional authority to override this may be a dangerous move, especially given the lack of research.”

So far, only one marijuana-related drug has been approved by the FDA: Epidiolex, which contains cannabidiol, was approved in June 2018 for treating a rare seizure disorder in patients ages 2 and over.

Diverse Testimony from Both Sides of the Aisle

Both the witnesses and the subcommittee members seemed divided on marijuana’s potential harms and benefits for patients. Volkow mentioned research showing that cannabis exposure during pregnancy was associated with low birthweight and preterm delivery, and added that it was also linked with episodes of psychosis. She also said that there was some evidence that cannabis may be useful in treating spasticity, multiple sclerosis, and pain, “but otherwise there is little benefit for other indications for which patients are using it.”

Rep. Morgan Griffith (R-Va.) said that his support of medical marijuana began some years ago when he learned that people were smuggling marijuana into a Virginia hospital to help a terminally ill father who wanted to be feeling well enough to spend time with his 2-year-old son. Years later, when he told that story at a high school town hall, one student raised his hand and said, “They did that for my daddy too.”

“These communities were 20 years apart, 30 years apart, yet doctors were turning a blind eye to allow marijuana to be brought into the hospital because they recognized that for those patients who are dying, that was the only way they would get relief and get the nutrients they needed to spend a little more time with their children,” Griffith said.

Rep. Greg Gianforte (R-Mont.) said he was opposed to efforts to “make any Schedule 1 drug legal without adequate research.” Instead, “we should focus on combating addiction,” he said.

by Joyce Frieden, News Editor, MedPage Today

Originally published in MedPage Today

Anti-Vax Groups Attack Pediatrician for Pro-Vaccine Post

Anti-Vax Groups Attack Pediatrician for Pro-Vaccine Post

“Dead Docs Don’t Lie”

When Nicole Baldwin, MD, made a playful TikTok touting the benefits of vaccination, she wasn’t expecting to fight an endless social media battle that destroyed her online ratings — and even led to a threat against her life.

In her TikTok, Baldwin, a pediatrician in suburban Cincinnati, listed a handful of diseases that vaccines prevent to the pop song “Cupid Shuffle,” ending on the note that vaccines don’t cause autism.

It wasn’t an instant hit when she posted it on Saturday, Jan. 11, but by Sunday it had 50,000 views so Baldwin decided to share it on Twitter.

“That’s when everything exploded,” she told MedPage Today.

Members of the “anti-vax” community discovered it and launched a “global, coordinated attack,” posting negative comments across Baldwin’s social media pages including her Facebook and Twitter.

They also went for the jugular: knowing that a physician’s online presence is critical, they barraged her online review sites, including Yelp and Google Reviews, with one-star reviews to sabotage her practice.

Some even called her practice, Northeast Cincinnati Pediatric Associates, and harassed the staff. One woman — whom Baldwin described as “very angry” — threatened to “come and shut down our practice,” prompting Baldwin to call the police.

But most intimidating was a post from an anti-vax Facebook group that said, “dead doctors don’t lie.”

“Shots Heard Round the World:” A Pro-Vax Sheriff in Town?

“Ultimately what the anti-vax community wants is to scare us into silence,” she told MedPage Today.

Baldwin first tried to stem the tide on her own by deleting comments and reporting abuses. Then she enlisted the help of a friend, and then her husband, until it became too much to manage — which was when she called in Shots Heard Round the World, a network of vaccination advocates who describe themselves as a “rapid-response digital cavalry.”

Founder Todd Wolynn, MD, a pediatrician in Pittsburgh, knows what it’s like to be on the receiving end of a global social media attack from anti-vaxxers. In 2017, his practice Kids Plus Pediatrics posted a video promoting HPV vaccination that triggered a massive blast from the anti-vaccine crowd.

Some 800 different accounts posted more than 10,000 negative anti-vax comments to the practice’s Facebook page, Wolynn said. Associates of Shots Heard who had infiltrated some of the anti-vax Facebook groups sent him screen shots of commenters who were celebrating their efforts of posting bad online reviews for the practice.

The 6-day onslaught against Kids Plus Pediatrics resulted in an academic publication that was widely picked up by the press, including the Los Angeles Times and the Washington Post.

Baldwin had learned about Shots Heard through a talk Wolynn gave in Ohio and had signed up to be part of that team. Little did she know she’d be the one needing the help.

“One doctor has no time to handle all of this,” Wolynn told MedPage Today. “We have a vetted rapid-response network that can come to your aid.”

He said anyone can send an email to the Shots Heard alert box, and once it’s vetted, the request for online help is distributed through an email blast to their network of vaccine advocates — other doctors, nurses, paramedics, parents, and others who promote vaccination science.

Baldwin said that since she allowed Shots Heard to take over her Facebook account, they’ve been posting positive comments and blocking commenters from her page; a total of 5,000 anti-vax accounts have been banned as of Monday night, she said.

“Docs Need to Know That There’s Help Out There”

Shots Heard is also helping to get the fake online reviews taken down, which is never easy, particularly with Google, Wolynn said. But ongoing media coverage likely pressed the tech giant into taking down the reviews, Baldwin said.

Yelp, which has a process for removing fake reviews, took most of them down and posted a box on the page noting that the practice has been in the news recently. Some fake reviews could still be seen on the page on Monday night.

“They’ve been amazing,” Baldwin said of Shots Heard. “Doctors need to know that there’s help out there if we’re attacked. We don’t need to give in to these bullies.”

While there’s been debate in the medical community over the utility of TikTok for sharing messages about medicine and health, Baldwin said she won’t be quitting anytime soon, and that it’s an effective way to reach the young people who are her patients.

That includes aspiring physicians, she said: “I’m getting messages from young people who say they want to go to medical school, asking about classes.” She adds, “It’s also showing that doctors are human and can have fun.”

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today

Originally published in MedPage Today

Taking Food and Drink Away From Docs and Nurses Is Just Cruel

Taking Food and Drink Away From Docs and Nurses Is Just Cruel

By Edwin Leap, MD–

It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.

If you haven’t worked there, or haven’t for a long time, it could be that this lack of understanding is what leads hospital administrations to do one of the stupidest things imaginable. What is that thing? Banning food and drink from our work-spaces.

Now, this isn’t the case in my current job. But it is the case in all too many facilities. I talk to people. I hear things. And it’s usually justified with some unholy combination of infection control, Joint Commission and public health clap-trap, coalesced and refined, then circulated as a cruel policy.

When it’s enacted, clinical staff have their water bottles taken away. Nobody is allowed to eat where they work. Dedicated, compassionate staff members grow tired and dehydrated and hungry. (Maybe it’s a good thing. They often don’t have time to urinate anyway, and water just makes that happen more often.)

Mind you, the water bottles are sometimes kept in a nearby room, or on a nearby shelf. It’s an act of kindness, I guess. And the food? Well, all you have to do is take your break and go to the cafeteria or to the break room, right?

Those who come up with these rules don’t understand that a scheduled break is a great idea … that never happens. It’s an emergency department. It isn’t (technically) a production line; however, we try to impose time restrictions and through-put metrics. It isn’t “raw material in/product out.”

It’s “sick, suffering, dying, crazy human being in” and if all goes well, “somewhat better (at least no worse) human being evaluated, stabilized, saved, calmed, admitted, transferred, and sometimes pronounced dead” out of the other end of the line.

Those Herculean efforts can take anywhere from, oh, 20 minutes to 12 hours. During which time, it’s pretty hard to leave the critical patient in the understaffed department, with the “five minute to doctor” guarantee and the limitless capacity for new tragedy rolling through the door.

That setting makes it remarkably hard for breaks or even meals to happen at all.

As such, it’s nothing short of cruel and unusual for anyone to say to the staff of a modern emergency department, “you can’t have food or drink” — especially when it’s typically uttered by people who have food and drink in their offices and at their desks. People who have lunch meetings with nice meals or who have time to walk to the cafeteria or drive off-campus. And who feel so very good about protecting the staff from their deadly water bottles.

The argument, of course, is that the clinical staff work in a “patient care area.” Even when they aren’t at the bedside but are, for instance, behind a glass wall at a desk. If this is the case, then one could argue that the entire hospital (including administrative suites) is a “patient care area.”

They are afraid we’ll catch something. That it’s unsafe for us to eat or drink where we work. Of course, this is while we positively roll around in MRSA and breathe in the fine particulate sputum of septic pneumonia patients. This is while staff clean up infectious diarrhea and wear the same scrubs all day.

This is after we intubate poor immigrants who may well have tuberculosis and start central lines on HIV patients. This is after we wrestle with meth-addicts who have hepatitis C. And this concern for our “safety” occurs in places where physical security, actual security against potential violent attack, is a geriatric joke which is often tabled until the next budget cycle.

And as for our patients? Our food and drink are no danger to them. They and their families fill the exam rooms with the aroma of fried chicken, fries, and burgers, eaten at the bedside (often by the patient with abdominal pain). Their infants drag pacifiers across floors that would make an infectious disease specialist wake from bacterial nightmares in a sweat-soaked panic. In short, our food or drink are no threat to them and no threat to us.

But the absence of food and drink? That’s a problem. Because the ED is an endless maelstrom of uncontrollable events and tragedies, of things beyond our control for which we are responsible. It is a place of physical, emotional, and spiritual exhaustion where we rise to the challenge and manage (against the odds) to do so much remarkable good by virtue of our knowledge, our training, our courage, and our compassion.

In the midst of all that, a bottle of water, a cup of coffee, a glass of Diet Coke, a Styrofoam cup of iced tea is an oasis in the desert. And that sandwich, slice of pizza, cupcake, or salad is the fuel that helps make it happen.

More than that, food and drink are among the few pleasures we have time for each shift. They serve as bridges to the end of the day, small reminders of normalcy in a place where so little is normal.

Doubtless, one day someone will take away our music so that it doesn’t hurt our ears, or offend our patients. We’ll fight that battle when it comes.

But until then, depriving staff of food and drink proximate to where they work is of no health value and strikes me as just one more way of exerting control over the people actually engaged in the hard, grinding work of saving lives.

And worse, it’s just mean.

Originally published in MedPage Today

Influenza Vaccinations: Do Jails and Prisons Vaccinate Inmates?

Influenza Vaccinations: Do Jails and Prisons Vaccinate Inmates?

By Jeffrey E. Keller, MD, FAACP

Border detention facilities that house immigrants have been in the news recently because of their policy of not providing influenza vaccinations to their detainees, sparking high-profile protests. Why would an immigration detention facility, tasked among other things with providing comprehensive medical care to its detainees, refuse to provide them with flu vaccines?

To answer this question, it might be instructive to ask how influenza vaccinations are handled at other prisons and jails in the U.S. It depends on what type of facility you are in and how long you will be there. All prison systems I know of offer influenza vaccinations to their inmates. On the other hand, most jails (short-term detention facilities) do not have a routine flu vaccination program, though there are exceptions.

Vaccinations in Prisons

Inmates are sentenced to prison for a minimum of one year and usually longer. As a result, prison populations are stable. Almost all of the inmates in a particular prison now will still be there next year. Also, prisons are tasked with providing comprehensive medical care to their inmates. This includes influenza vaccinations, but also other recommended vaccinations and boosters. Of course, just like in the community at large, not all inmates want to be vaccinated. The percentage of prison inmates who get vaccinated depends on how vigorously the prison pushes the program.

If a prison advertises the availability of the flu vaccine and actively encourages its inmates to be vaccinated, the acceptance rate can be greater than 50% (compared to about 33% of adults in the community who get vaccinated). Most prisons have a “big push” campaign to encourage flu vaccines once a year in the fall. However, if a prison does not advertise the availability of the flu vaccine, the percentage of inmates vaccinated can be very low. It makes economic sense for prisons to actively encourage their inmates to be vaccinated. Every dollar spent on influenza vaccinations will save more than a dollar down the road trying to deal with influenza outbreaks.

Vaccinations in Jail

Influenza programs in jails are different for several reasons. The first issue is that the inmate population in a jail is not stable. The average length of stay in the average jail in the U.S. is around 2-3 weeks and many are released within days. If a jail offers influenza vaccinations in October, most of the inmates vaccinated will be gone by November. The jail will now be filled with new, unvaccinated inmates. If you vaccinate the November inmates, most (again) will be gone by December. So, to be effective, influenza programs in a jail must last the length of the influenza season — making jail influenza programs more difficult and expensive to administer than a prison program.

As an example, remember that one must order influenza vaccines well in advance. In order to have influenza vaccines ready in the fall, a prison or a jail has to order them at least six months earlier. A prison will know how many influenza doses it will need based on its population and previous acceptance rate. But how many doses will a jail need with inmates coming and going over the course of an entire flu season? That can be hard to get right in a jail! It is expensive and maddening to order too many vaccines only to throw the unused doses away at the end of the flu season.

Also, jails vary greatly by size and sophistication of the medical services they provide. There are many small jails in the U.S. (think 10 beds) where no medical personnel ever come to the jail for routine medical care. If their inmates need medical attention, the deputies have to load them into a van and take them to a clinic or ER in the community. Such a jail is unlikely to offer influenza vaccinations to their inmates. On the other hand, bigger jails (say, more than 1,000 beds) with a full-time medical staff may indeed have an influenza vaccination program.

“Kicking the Can Down the Road”

The most successful jail influenza programs that I have seen are done in cooperation with the local health department. The health department is tasked with providing vaccinations to the community at large, which includes jail inmates. When asked, health departments often will come to the local jail once a month to provide influenza vaccinations to any inmate who requests one. (This is also a good way to provide screening for sexually transmitted diseases in asymptomatic inmates.) Even small jails can approach their local health department about providing immunizations to inmates, though few do.

Customs and Border Patrol reportedly defended its policy of not providing influenza vaccinations during border detention by saying that immigrants are only there for a few days and are expected to get the flu vaccine later, when they are moved to a long-term facility. Where I grew up, this was called “kicking the can down the road.” To my mind, deferring vaccinations until later makes little medical or financial sense. Since none of these detainees is going to be released, and since you are going to vaccinate them later anyway (as reported), why not do it as part of their initial medical screening?

Jeffrey E. Keller, MD, FACEP, is a board-certified emergency physician with 25 years of experience before moving full time into his “true calling” of correctional medicine. He now works exclusively in jails and prisons, and blogs about correctional medicine at JailMedicine.com.

This post was originally published in MedPage Today.

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