Vanderbilt Nurse On Trial: Will The Outcome Adversely Change Healthcare?

NOTE To The Reader:

This matter has been previously addressed in an entry dated January 28, 2019, headlined as “Vanderbilt University Medical Center Corruption.”

The subject of concern is a complex one, with many “moving parts” which most news-reporting organizations have not mentioned, nor will they. (That’s a whole ‘nother “ball of wax.”) In this entry, I will attempt to enumerate some of those important-yet-unreported situations, scenarios, their corollaries, and relationships, in order to give a more full understanding to the readers.

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One CRITICALLY IMPORTANT MATTER is the as-yet-unreported problem in which CMS found that VUMC had 100% TOTAL responsibility for the failure that led to the patient’s death.

Yet this trial is apparently completely overlooking that matter, and the critical unitarily integrated legal principle of “respondeat superior.”

As written in the journal Proc (Bayl Univ Med Cent). 2010 Jul; 23(3): 313–315., which appears online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900989/, in the article “Responsibility for the acts of others,” by Russell G. Thornton, JD:

“Respondeat superior embodies the general rule that an employer is responsible for the negligent acts or omissions of its employees. Under respondeat superior an employer is liable for the negligent act or omission of any employee acting within the course and scope of his employment (1). This is a purely dependent or vicarious theory of liability, meaning a finding of liability is not based on any improper action by the employer. The fact that the employer may have acted reasonably in hiring, training, supervising, and retaining the employee is irrelevant and does not provide a basis on which the employer can avoid liability for the acts of employees (1). The underlying premise of respondeat superior is that the cost of torts committed in the conduct of a business enterprise should be borne by that enterprise as a cost of doing business (2).

“An employer can also be directly liable for the negligence of its employees. This means that some negligent act or omission of the employer was a cause of, allowed, or led to the negligence of the employee, thereby causing injury to the claimant. This direct or independent liability of the employer generally arises from a claim that it negligently hired, trained, supervised, or retained the employee in question (13). These claims can also involve allegations that proper policies and procedures were not implemented or enforced and that those failures caused the injury at issue (13).

“If a member of your group acts negligently, you must expect there will be a direct liability claim for negligent hiring, training, supervision, or retention of that person. In my experience it is rare that the employee at issue in one of these claims is a longstanding, well-qualified, well-experienced, still-employed exemplary employee that simply made a mistake. More often than not, the employee involved was not very good to begin with, had been talked to before about competency-related issues, and was subsequently let go for similar reasons within 12 months or so of the incident at issue.

“The assertion of a claim against an employee also means that employee’s past experience and performance are relevant. As such, the hiring, training, supervision, and retention of that employee are relevant and discoverable. For this reason, it is imperative that problematic employees not be retained. It is also important that any concerns about employees are quickly and properly addressed and that these steps are noted in that employee’s file.”

The RN undoubtedly made a horrible mistake, a sloppy, lazy one, even, as some have previously noted.

However… the matter turns not on her carelessness, or sloppy work, per se, inasmuch as it OVERLOOKS the CMS findings of FAULT with VUMC, which agency attempted to coverup their doings and activities, by FAILING to report the matter to the appropriate regulatory agencies, State and Federal.

Further, while the RN’s admitted mistakes resulted in a death, it has NEVER been the practice of ANY law enforcement agency to prosecute any practitioner for such careless work, however “negligent” it may be.

Such matters have historically been handled by civil courts, not criminal, and by licensing and/or professional boards of practice.

At first, the TBON (TN Board Of Nursing) did NOT revoke, nor suspend (as best as I recall) her RN license… BUT! After the Davidson County DA obtained a criminal indictment, TBON reversed and rescinded their previous ruling, and revoked her RN license to practice.

Meanwhile… VUMC got off SCOT-FREE.

Not even a 10¢ fine.

VUMC was NOT punished. They only received a threat of what was essentially “fix this NOW, or else we’ll pull the plug.”

WHERE is the JUSTICE in that!?!?

Again, this is NOT to exonerate her sloppy, even careless work, but to illustrate that historically, such matters have NEVER been criminal, only civil, because there was NO MALICE involved.

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Nurses, and the healthcare professions in general, will undoubtedly be watching the State of Tennessee’s criminal lawsuit against RaDonda Vaught, of Bethpage, TN (an unincorporated community in Sumner County, Zip Code 37022), with bated breath.

The outcome of the trial-by-jury case against her in Davidson County Superior Court in Nashville could affect the very future of the Nursing profession, and healthcare delivery in general, on a broad national scale.

The “long and short” of the matter is, that

Another One Bites The Dust: Pregnant Alabama RN & Fetus Die of COVID-19

Family says, “We’re glad she’s not suffering.”

Alabama Family On Pregnant RN & Fetus Dead from COVID
Published: Aug. 23, 2021, 5:39 p.m. – Updated: Aug. 24, 2021, 7:27 a.m.

Haley Richardson, RN, a 32-year old Labor and Delivery Nurse who worked at Ascension Sacred Heart Hospital in Pensacola, FL and lived in Theodore, AL in Mobile County, died of COVID-19 on August 20, 2021. She was NOT vaccinated. The baby within her – whom she had named Ryleigh Beth – had died 2 days before she did.

Her widower, Jordan Richardson, will be taking care of Katie, their 3-year old daughter whom she orphaned. She was pregnant with the couple’s second child, which died in utero 2 days before she did.

Haley and Jordan Richardson with daughter Katie.

Jason Whatley, a family friend whose wife was maid of honor at Haley’s wedding, reported that Haley contracted COVID-19 in late July or early August, about three weeks before she died, and said that, “She was home sick for about a week and then her heart rate went up.”

Haley was initially admitted to the University of South Alabama Health system’s Children’s and Women’s Hospital in Mobile, then after a few days, was transported to the ICU at USA Health’s main hospital campus also in Mobile.

Haley’s mother, Julie Mulkey said, “After about three or four days in the hospital, the OB told her that she was going to lose the baby. And she continued to get worse and worse. At some point, they basically told her that we’ve got to start treating you as if you didn’t have a child. We’ve got to do what we can for you because the baby is going to pass anyway.”

Mr. Whatley said physicians treating Haley had earlier placed her on a transfer waiting list to the University of Alabama at Birmingham hospital to be connected to a ECMO (Extra-Corporeal Membrane Oxygenation) machine, sometimes also called a “heart/lung machine,” which

Can I ask you a question?

Here’s but one story from my storied career.

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Once, upon a time, I worked in a CVICU (CardioVascular Intensive Care Unit) in Greenville, MS – a predominately Black populated area, with high poverty, and all the problems that come along for that ride.

A patient came to us from a SNF (Skilled Nursing Facility, i.e., Nursing Home), and was refusing to communicate/talk with staff. I became his Nurse. He was a Black gent, and I cared for him just like I would for anyone else – with dignity, and empowering them to make decisions regarding their care.

I was working

I’m Thinking About Suicide

Ever thought about suicide?

Many have.

And not all of them are depressed.

Some are epidemiologists – folks whose business it is to think about the source, causes, and prevention of disease. And then, other health professionals such as physicians, Nurses, psychologists, social workers, and others think about suicide – again, not as means to end their own lives, but for the sake of others. And yet Nurses and physicians also personally think about suicide, and often at rates greater than the average population.

I’ve thought about suicide.

I’ve thought about suicide many times.

In fact, I’m thinking about suicide as I write this entry.

But I’m not thinking about suicide as a means to end my own life.

I’m thinking about suicide because…

American Academy of Family Physicians @AAFP Errs on Website Criticizing #Nurses @NCSBN

The American Association of Family Physicians website had a glaringly obvious spelling goof in their headline criticizing Board Certified Advanced Practice Registered Nurses.

In a strangely ironic, even cruel twist, the American Academy of Family Physicians (AAFP) authored a letter dated 10 May 2018 criticizing the efforts of the National Council of State Boards of Nursing (NCSBN) to encourage states to expand their Nursing Scope of Practice laws to more accurately reflect uniformity of standards, and allow professionally Board Certified Advanced Practice Registered Nurses (APRN-BC) with ability, education, and training to practice to the fullest extent of their license for the benefit of patients and Public Health. News of the AAFP’s letter was published on their website 16 May.

However, since that news item’s publication, the website contained an obviously glaring spelling error, which negatively reflects upon the physicians’ professional organization, and has neither been noticed, nor corrected as of the date of publication of this entry – Saturday, 26 May 2018.

The ostensible purpose of the AAFP letter, which also carried the endorsement of 80+ professional physician organizations, was to

Here’s Why, Despite Seeming Political Appearances, We Are Closer To Single Payer #Healthcare Than Many Imagine

In a recent exchange online dialogue with friends – some, whom to the casual observer would be diametrically opposed on many policy ideas – I was, once again, pleased to note that, despite the SEEMING APPEARANCE of differences, we share SIGNIFICANT common ground.

In fact, I have found that to be quite true with many, that when we move past the vitriolic venomous sport of castigating political candidates, and speak in respectful tones, patiently explaining the whys and wherefores of potential policy, we share many common bonds, and similar ideas.

For example, in response to a recent post of the story published by Pro Publica – Pressure Mounts on Insurance Companies to Consider Their Role in Opioid Epidemic – (https://www.propublica.org/article/pressure-mounts-on-insurance-companies-to-consider-their-role-in-opioid-epidemic) written by Charles Ornstein Oct. 19, 6:47 p.m. EDT – I enjoyed reading the following remarks, made toward the conclusion of the online dialogue:

Person A (Physician): “It is a shame our country can’t have

Bullying: Yes, it’s real, and yes, you have ultimate power over bullies.

In the past couple days, in the course of my reading on Professional Nursing Development & other healthcare related topics, I’ve also read about forgiveness.

Nurse bullying is a real thing. It’s tragic, of course, that it exists, but it does exist, and is probably more common than some imagine.

So we’ve moved from forgiveness to bullying, eh?

No… not really.

Here’s why not.

Bullying is never acceptable behavior.

Bullying, of course, is threatening and intimidating behavior used as a manipulative technique by someone who wants to force themselves, their ways, or opinions, on another person. And because Nursing is an exceedingly Female-dominated profession, that means that for the most part, Females are the ones doing bullying in Nurse bullying cases & scenarios.

And to be certain, bullying can occur in any human relationship, personal or business-to-business – it isn’t limited to the schoolyard.

Here’s where the forgiveness part comes in handy.

Our internal response to bullying is

Does $2.9M Jury Verdict Put Western State Hospital, Lakewood, WA On The Ropes?

For those unaware, with well over 800 beds, Western State Hospital is the largest psychiatric hospital West of the Mississippi River. And unfortunately, it has a pockmarked history, and was in jeopardy of losing over $65M in Federal funding from CMS (Centers for Medicare and Medicaid Services) because of gross negligence at the hospital so severe that it was in jeopardy of losing ALL it’s CMS funding.

With well over 800 beds, Western State Hospital, Lakewood, WA is the largest psychiatric hospital West of the Mississippi River.

Chronic rampant abuse and neglect has ranged from staff sexual abuse of patients, patient-on-patient and patient-on-staff violence,  numerous escapes by criminally violent murderers – which caused the CEO to be fired by the Governor, and “wait-listing” dementia patients which may result in the new CEO’s incarceration. They no longer have national Joint Commission certification. The list of criminal wrong-doing at the facility is extensive, and violence alone has cost millions in hospital bills for staff and patients, including time lost from work, and lawsuits.

As the hospital faced inevitable death from loss of $65M in federal funds, a veritable federal hatchet, the state legislature made last-ditch efforts to salvage a rotten-to-the-core system by hiring hundreds of staff, and approved a TEMPORARY pay increase, with retention bonuses, and made other efforts to put lipstick on a dead pig.

According to one senior staff member

Remember American Nurses: 100 years ago WW I’s first casualties – Edith Ayers & Helen Woods

Mrs. Edith Ayres, Illinois Training School Nurse of the Class of 1913. Mrs. Ayres was the first American female casualty of WWI, and was buried with military honors at her home in Attica, Ohio.

Among the first casualties of World War I were two Army Nurses – US Army Nurse Corps Edith Ayers, of Attica, OH, and USANC Helen Burnett Woods, of Evanston, IL who were attached to Base Hospital 12 aboard the USS Mongolia – a passenger vessel which was converted into an armored troop carrier and hospital for the Army March 1917 – en route to France, and died 20 May 1917. Also wounded was Miss Emma Matzen, of the Illinois Training School, Class of 1913.

Miss Helen Burnett Wood was a Nurse graduate of the Evanston Hospital Training School, and was one of the was the first two casualties of WW I.

At that time, military Nurses held no rank.

Woods was attached to the U.S. Army Base Hospital, No. 12, also known as the Northwestern University Base Hospital, because a majority of its personnel came out of the university. In May 1917, she received her official orders to join the Base Hospital staff on its way to New York where the staff would embark for Europe.

The two women were on the Mongolia’s deck observing various weapons firing and were struck by fragments of the 6-inch gun’s propellant caps which had ricocheted off a stanchion.

Their deaths were so shocking to the nation, especially to their respective communities, that following their accidental, and untimely deaths, a Senate hearing – “Casualties Aboard Steamship “Monogolia”” before the Committee on Naval Affairs – was conducted. {Local file, PDF: Casualties Aboard Steamship Mongolia Hearings}

Mrs. Edith Ayres was a graduate of

Which Are The Best & Worst States For Registered Nurses?

Like most segments of the economy, the nursing industry is in a state of significant transition under the weight of major socioeconomic dynamics — from the aging U.S. population to the student-loan crisis to concerns about the future of key entitlement programs. But such concerns are not unique among recent graduates, regardless of industry.

More specific to nursing professionals are the various day-to-day demands placed on them, such as mandatory overtime, overstaffing, unionization and allegations of systemic disrespect. Despite those challenges, however, aspiring nurses have much to look forward to upon certification. Nursing occupations are some of the most lucrative careers with the lowest unemployment rates in the U.S. In fact, the industry is expected to grow at more than double the rate of the average occupation through 2024.

With such bright projections, WalletHub’s analysts took stock of the nursing industry to help registered nurses, particularly the newly minted of the bunch, lay down roots in areas that are conducive to both personal and professional success. We did so by comparing the 50 states and the District of Columbia across 18 key metrics that collectively speak to the nursing-job opportunities in each market. Below, you can check out our findings, expert commentary on the state of the nursing industry as well as the methodology we used to conduct this report.

BIG INSURANCE Companies Fear Single Payer For ONE Reason

A friend had shared the opening paragraph, upon which I remarked.

My response follows.

“At the risk of stating the obvious, I feel compelled to note that insurance companies do not exist to provide health care. They exist to make money. Big money. Big money at your time of greatest vulnerability. This happens by raising income as much as possible and limiting “risk” as much as possible. Now go ponder the implications.”

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And that is the single greatest reason why a

Rethinking Addiction

Perhaps you’ve studied the 12-Step program, or perhaps you’ve practiced it. I have done both. Practicing it was not as a matter of addiction, or any such thing for myself, but instead, was a part of my personal spiritual growth and development.

Over the years, I’ve heard commentary, or news features which interviewed people with divergent perspectives on 12-Step programs, most notably which were skeptical of them, and were thoughtfully seeking answers themselves for the “whys and wherefores” of substance abuse, whether it’s long-term or temporary, and whether it is a genetic fault, or if it is a personality or character flaw in response to external or internal stressors. In other words, it’s the classic “Heredity vs Environment” argument.

As I have come to view it, there is validity for both sides, but I think the stronger case is made for a combination of environment and character flaw, instead of genetic defect.

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“In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.”

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

The Irrationality of Alcoholics Anonymous
By Gabrielle Glaser, April 2015 Issue
Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found

Alabama State Senator Larry Stutts sued for malpractice… again

Alabama State Senator Larry Stutts has once again been named in another malpractice lawsuit in which a patient of his retained placental tissue, and suffered excessive bleeding following delivery of her baby.

The new case is oddly reminiscent of an older case in which Stutts was named defendant, in which his patient retained placental tissue and suffered excessive bleeding, and later died. The new case’s Plaintiff, Greta C. Cooper, did not die.

Read the PDF file of the 2015 Lawsuit against state Sen Larry Stutts

The suit alleges, among other things, that Stutts failed to order powerful antibiotics to be administered EXCLUSIVELY by Licensed Professional Nurses, and that two RNs with Gentiva Home Health Services in Russellville, Alabama, then taught the Plaintiff’s husband how to administer the medication, and that as a result of his failure to properly order, blood levels of the medication were also not taken which resulted in overdose toxicity.

Dr. Larry Stutts, DVM, MD (R), who was first a veterinarian, then became an Obstetrician/Gynecologist (OBGYN), upset 32-year veteran Alabama Senate District 6 State Senator Roger Bedford (D) by 67 votes in the 2014 November General Election. Stutts is also president of Colbert Obstetrics and Gynecology, PC (his private medical practice), located at 1120 S Jackson Hwy #104, Sheffield, AL 35660, (256) 386-0855.

Alabama District 6 State Senator Dr. Larry Stutts, DVM, MD

Alabama State Senate District 6 encompasses all of Franklin County, and portions of Colbert, Marion, Lauderdale and Lawrence Counties in NW Alabama.

Interestingly, Sutts wasn’t the GOP’s original candidate for the Senate District 6 race. Jerry Mays was the original GOP candidate, but dropped out of the primary. In response to Mays’ decision, on March 20, 2014, State Republican Party Chairman Bill Armistead announced that the Alabama Republican Party Candidate Committee had met and named Larry Stutts, who resides in Tuscumbia, to replace Mays candidacy. Stutts had never been in any elected political office.

Stutts is the same physician who was years earlier named in another lawsuit in which his patient Rose Church – a newlywed, and healthy 36-year-old Registered Nurse – died, which in turn,

Best & Worst States to Practice Nursing in 2014

To be certain, there’s plenty of misunderstanding about what exactly Nurses do, and who exactly Nurses are.

So, to clear the air, let’s set the record straight, and get a quick backgrounder before diving into the deep end.

In whatever state they choose to practice, all 50 states requires all Nurses to be licensed before they begin practice. Licensed Vocational Nurses (LNVs) are considered technicians, while Registered Nurses (RNs) are professionals.

The LPN (Licensed Practical Nurse), which in some states is called LVN (Licensed Vocational Nurse), most often has earned a certificate in less than a year, and has a significantly different educational track than a Registered Nurse (RN), even when the RN has an ADN (Associate Degree Nursing). The RN utilizes critical thinking skills, and the responsibilities the RN has are more complex, and therefore always supervisory in nature over the LVN/LPN. Because of the complexities and advances in healthcare, and patient care, LVNs are NOT permitted by license to do the same things as a RN. Pay, of course, comes along for the ride, and RNs are paid more.

Registered Nurses may begin practice by earning an Associate’s Degree Nursing (a two-year degree) typically at a Junior or Community College, or by earning a Bachelor of Science Nursing (BSN), a four-year degree most often earned from a University. Both the ADN & BSN must pass the NCLEX – the National Council Licensure Examination – before they can practice Registered Nursing.

Advanced Practice Nurses (APNs) are BSN-prepared RNs whom have obtained additional education and training, typically a Master of Science Nursing (MSN) in a specialty area of Nursing practice such as Gerontology (specialized care for the elderly), Family Nurse Practitioner (FNP), Acute Care Nurse Practitioner (ACNP), Pediatric Nurse Practitioner (PNP), Certified Registered Nurse Anesthetist (CRNA), etc. Frequently, following earning their MSNs, APNs have also obtained National Certification in their area of specialty, and many have prescriptive authority, depending upon the laws of the state in which they practice. Because they have more education, more experience, and more responsibility, they are also paid more. APNs may also continue education and training to the doctoral and post-doctoral levels.

In some states, APNs are allowed independent practice, and are not required by law to be supervised by a physician. Other states have laws that limit practice of APNs – even though they may be Board Certified – and require physicians to collaborate with them, or in some cases, to oversee their work. Alaska, Arizona, Colorado, Hawaii, Idaho, Iowa, Maine, Montana, New Mexico, Nevada, New Hampshire, North Dakota, Rhode Island, Oregon, Vermont, Washington, Wyoming, and the District of Columbia all allow APNs to practice independently. Alabama is one such state which does not allow Board Certified Advanced Practice Nurses independent practice. According to the American Association of Colleges of Nursing, “in at least 45 states, advanced practice nurses can prescribe medications, while 16 states have granted APNs authority to practice independently without physician collaboration or supervision.”

There’s an entirely different can of worms when comparing the practice of APNs and physicians. One of the ways they differ, are that

Like Jesus, I wept.

It was one of the few times I have wept over others’ misfortunes – especially my patients.

I went into a closet to weep very bitter tears.

The thought of others seeing me so heartbroken was unconscionable, one which I simply could not bear.

Why?

Official Sources: Huntsville Hospital gets low patient safety rating, patients’ lives at risk

Realistically, what does that mean for you, your loved ones or friends if – God forbid – they’re hospitalized at Huntsville Hospital?

It means that when you, your loved ones’ or friends’ are a patient in the hospital, you or they could get an infection, or some other serious bug or problem while being treated for something else entirely different. And by so doing, it could make your stay more unpleasant, and in fact, could increase the risk of complications of your treatment – up to, and including your death – was well as increase the length of your stay, among other factors.

What does that mean for the Hospital?

Because insurance companies and Medicare/Medicaid have STOPPED paying for the treatment of preventable problems that are a direct result of hospitalization, it means that Huntsville Hospital will be stuck with the bill (the costs of treating their own mistakes upon you while you’re there)… and will try to pass the cost along to you to recoup the cost of the loss, which is a DIRECT result of their own sloppiness.

Huntsville Hospital has essentially become a monopolistic monstrosity of an enterprise, gobbling up numerous hospitals in the North Alabama region, including BOTH hospitals in Decatur, the only hospital in Athens, the only hospital in Red Bay, Helen Keller Hospital in Tuscumbia area of the Shoals, and the only hospital in Lawrence county.

Meanwhile, Huntsville hospital has fought tooth-and-nail to keep other hospitals OUT of competition in the Huntsville market, and spent untold millions of dollars in a protracted legal battle against Crestwood Hospital – and continues to spend millions to prevent Crestwood Hospital from offering services that would benefit the entire city and county.

Such anti-competitive practice has all been accomplished by and through the state of Alabama‘s Certificate Of Need Board.

The commentary of Mr. Burr Ingram – Huntsville Hospital’s official mouthpiece – which is contained in this article is entirely and wholly unwarranted, and weasel-like.

Not only that, but Huntsville Hospital is NOT a Nursing Magnet Hospital.

There are many things Huntsville Hospital is not.

And sadly, quality is one of them.

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Watchdog Report: Consumer Reports gives both hospitals in Huntsville low safety ratings

Published: Thursday, July 12, 2012, 9:06 AM     Updated: Thursday, July 12, 2012, 9:30 AM

By Challen Stephens, The Huntsville Times

HUNTSVILLE, Alabama — Consumer Reports magazine ranked the two hospitals in Huntsville as the least safe in Alabama. But the magazine’s list of hospitals is far from complete.

“We were kind of perplexed at some of what it reported,” said Burr Ingram, spokesman at Huntsville Hospital. “When you think about it, it’s fashionable for everyone to rate hospitals. And Consumer Reports is the latest to use public data that is available.

“But at times, it’s difficult to know how these ratings come about.”

Huntsville Hospital, The Huntsville Times

The magazine’s August edition lists scores in four safety categories. Both Huntsville Hospital and Crestwood Medical Center received low marks for poor communication with patients and for high rates of infection. Both received mediocre marks for high rates of re-admission and unnecessary scans.

Yet the report ranked

UK Nurse Punk’d on Royal Family Pregnancy Commits Suicide

While it was meant all in harmless fun, I sincerely doubt that the individual’s response  – to commit suicide – was anything other than an inappropriate response to jesting in good-hearted intent.

It is indeed tragic that the nurse committed suicide.

Perhaps there were other underlying issues, or an inability to cope that predicated her distressing response.

One simply cannot hold others responsible for everything. As tragic as this story is, one must accept responsibility for one’s own actions.

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December 7, 2012

Prank Call Seeking Royal Family Secrets Takes Horrifying Turn

By SARAH LYALL

LONDON — As pranks go, this one appeared outrageous and obnoxious rather than malicious: after convincing a hospital nurse who answered the phone this week that they were Queen Elizabeth and Prince Charles, two Australian radio hosts then tricked another nurse into disclosing medical information about the pregnant Duchess of Cambridge, who had been admitted with acute morning sickness.

The call was broadcast on Australia radio; then it went out around the world.

But the stunt took a horrific and unexpected turn on Friday, when the nurse who answered the call, 46-year-old Jacintha Saldanha, was found dead, an apparent suicide.

The Metropolitan Police would not release details of the death, except to say that they had received a call reporting that there was an unconscious woman at Weymouth Street, in central London, and two ambulance crews had arrived to find Mrs. Saldanha already dead. A police spokesman said they were not treating the death as suspicious.

It was unclear what exactly had happened since the prank itself to make Mrs. Saldanha, who was reportedly married and had two children, take her life. King Edward VII’s Hospital, where she worked, said it had not disciplined her, but rather had been “supporting her during this difficult time.” Nor, apparently, had the royal family raised a fuss with the hospital, an exclusive private institution that has long been the hospital of choice for Britain’s royals.

“At no point did the palace complain to the hospital about the incident,” a spokesman for St. James’s Palace said. “On the contrary, we offered our full and heartfelt support to the nurses involved and the hospital staff at all times.”

The turn of events was seen as so shocking that it provoked a response from even the prime minister of Australia, Julia Gillard, who called it “a terrible tragedy.”

Whatever the immediate impetus for Mrs. Saldanha’s death, the episode was

Reaching the End of Life: What Do We & Loved Ones REALLY Need?

Recollecting, one of my patients was similarly diagnosed, suffering terminal lung cancer of the small cell carcinoma type, and had one lung removed. He had presented to the ED (Emergency Department) with extreme hypoxia (lack of oxygen), to such an extent that his lips had a distinctive blue cast to them. His oxygenation was so exceedingly poor, that he would turn in bed, and his sats (oxygen saturation level) would drop to 70% – neither a good, nor one that would sustain life.

In conversation with him, I asked him what he wanted to have happen to him, how he wanted things to turn out for him. He wasn’t under any misguided notion about his state of well-being or health and wanted to depart the ICU.

He said, “I want to go home to die.”

I responded by saying, “We want you to go home too. Let’s see what we can do to get you back there.” At that point, I began some very simple teaching about his breathing. He was a habitual mouth breather, and he knew it. I’d glance up at him, and his mouth would be gaping open as he watched teevee. Problem was, that every time his mouth opened, his sats dropped, even though he was receiving high flow O2 therapy via specialized nasal cannula.

So I instructed him that by keeping his mouth closed and breathing through his nose, his sats would increase. And barring any other unforeseen circumstance, were his sats to consistently maintain above 90%, that would be the greatest step toward his objective to go home.

At the end of my shift, he was consistently satting 98%.

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Doctors are practicing irrational medicine at the end of life

by Monica Williams-Murphy, MD on September 22nd, 2012, in Physician

I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills and procedures used to address abnormal lab values or abnormal organ function, to rightly perceive what might be best for the whole person, or even what may no longer be needed. Our typical practice habits may in fact become inappropriate medical practiceat life’s end.Ms. King was a case in point: She was a 92-year-old nursing homepatient on hospice for metastatic breast cancer. Ms King had been transferred to the ER for a sudden drop in blood sugar, presumably due to her oral diabetes medication. Her appetite had apparently been trailing off, as is common at the end of life, and her medication appeared to have become “too strong.” Her glucose level had been corrected by EMS during her trip from the nursing home to the Hospital, so when I came into see Ms King she was at her ‘baseline.’I opened the door to bed 24 and a grinning little white-haired lady peered at me from over her sheet. “Hi,” she said greeting me first.“Hi, Ms King,” I smiled back at her and picked up her hand.

She reached over with her free hand to pat me on my forearm, “You sure are a cute little doctor,” she said smiling.

I couldn’t hold back a little laughter. “Well, you sure are a cute patient too,” I smiled and winked at her.

She winked back at me.

“Wow, this is the most pleasant 90-year-old I have cared for in a while,” I thought to myself.

As we chatted it became clear to me that she had some mild dementia but had no pain or complaints at the time. She just said, “I think I had a ‘spell’” ( a “Southernism” for some type of unusual and undefined episode of feeling ill or fainting); and “I’m not hungry” when I offered her food.

Leaving her room still smiling after our pleasant exchange, I went back to look at her medical record from the nursing home and two things immediately struck me:

Nursing shortage could be compounded by faculty shortage

One of the inevitable consequences of an aging population is the loss of their significant contribution and influence upon society from myriad perspectives.

To account and plan for such inevitabilities is not simply wise, but rather, it is common sense and a hallmark of effective and competent management.

Having been warned of the potential for crisis, we would be wise to double down on solutions.

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Nursing Schools Brace For Faculty Shortage

by Sandy Hausman, WVTF

Listen to the Story Morning Edition; August 3, 2012; [4 min 16 sec] Download; 04:43 am

There have been lots of goodbye parties this year at the University of Virginia School of Nursing. So far, eleven professors have retired. That’s one-fourth of the faculty, and Dean Dorrie Fontaine is in no mood to celebrate.

Nursing students in a simulation lab at the University of Virginia School of Nursing. Photo by: Elizabeth Lee Cantrell/UVA School of Nursing

Over the next few years, the Affordable Care Act will probably boost demand for nurses to take care of the newly-insured, she says, “And I need faculty to teach the practitioners that are going to take care of these uninsured.”

In the last year, more than 76,000 qualified applicants were turned away, in large part because nursing schools didn’t have enough professors. Polly Bednash heads the American Association of Colleges of Nursing. She explains that nurses comprise the oldest workforce in the nation, and many of them kept working during the recession.

“They are going to leave in droves and are already leaving in some places where the economy is getting better,” she says.

Finding professors to

Where the Jobs Are: Is the Nursing Job Market a mixed bag?

Eminent nursing researcher & scholar Dr. Peter Buerhaus, PhD, RN, FAAN has made a career studying Nurses, and suggests that the jobs picture for new nurse grads is good, and that they may be facing one of the best job markets in decades.

A 2009 study he conducted found that, “Registered nurse (RN) employment has increased during the current recession, and we may soon see an end to the decade-long nurse shortage. This would give hospitals welcome relief and an opportunity to strengthen the nurse workforce by addressing issues associated with an increasingly older and foreign-born workforce. The recent increase in employment is also improving projections of the future supply of RNs, yet large shortages are still expected in the next decade. Until nursing education capacity is increased, future imbalances in the nurse labor market will be unavoidable.”

A 2004 study of his said that, “Wage increases, relatively high national unemployment, and widespread private-sector initiatives aimed at increasing the number of people who become nurses has resulted in a second straight year of strong employment growth among registered nurses (RNs). In 2003, older women and, to a lesser extent, foreign-born RNs accounted for a large share of employment growth. We also observe unusually large employment growth from two new demographic groups: younger people, particularly women in their early thirties, and men. Yet, despite the increase in employment of nearly 185,000 hospital RNs since 2001, the evidence suggests that the current nurse shortage has not been eliminated.”

Most recently, research he worked upon which was published in the December 2011 issue of Health Affairs found that “because of this surge in the number of young people entering nursing during the past decade, the nurse workforce is projected to grow faster during the next two decades than previously anticipated.”

In essence, “...the nurse workforce is now expected to grow at roughly the same rate as the population through 2030.”

They also cautioned however, “that the dynamics of the nursing workforce are more complex than sheer numbers.”

Lead researcher and RAND health economist David Auerbach said, “Instead of worrying about a decline, we are now growing the supply of nurses.”

Here’s something very interesting, however.

In that same issue of Health Affairs, a survey conducted by Christine Kovner of New York University examined the low “mobility” of new RNs. The most striking finding was that

UPDATED: Army Nurse Dies in Afghanistan while Off Duty

UPDATE: Monday, 07 May 2012

Army officials have not yet released the 43-year-old Nurse/Soldier’s cause of death, but confirmed Monday that he was not shot.

Spokeswoman Chris Grey said, “Although the investigation into his death is open and ongoing by Special Agents from the US Army Criminal Investigation Command, we can positively say that Captain Clark was not shot. Agents conducting the investigation, found no trauma to the body beyond minor abrasions and a possible broken nose most likely caused from Captain Clark striking his face on his desk when he collapsed. Investigators will continue to probe the death but they do not “suspect foul play.”

Beaumont Army Medical Center Public Affars Officer Clarence Davis said the cause of death has not been determined, and that “The autopsy and investigation will reveal the cause of death.”

According to CPT Clark’s brother Justin Hallenbeck, he even spent time as a volunteer firefighter.

CPT Clark was a part of A Company, Troop Command at Beaumont, and deployed to Afghanistan in March.

He was stationed in Tarin Kowt, Afghanistan, which was described by Army officials as a town of about 10,000 people.

His awards include the Army Commendation Award, Military Outstanding Volunteer Service Medal, National Defense Service Medal, Global War on Terrorism Service Medal and the Army Service Medal.

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It’s still a dangerous place in Afghanistan, as this story testifies.

Oh yes… men make great nurses, and in the Armed Services all RNs are officers.

May his family be comforted during their time of grief.

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Army officer dies during Skype chat with wife

May 6, 2012 8:23 PM

US Army CPT Bruce Kevin Clark, RN was thought to have been killed by a bullet in Afghanistan while off-duty during a Skype video conference session with his wife, who is stateside.

(AP) HOUSTON – The wife of an Army officer serving in Afghanistan witnessed her husband’s death as the two video chatted via Skype, his family said Friday.

The circumstances of Capt. Bruce Kevin Clark’s death were not immediately available. The Pentagon said it was under investigation, and his brother-in-law said he didn’t have details.

“We are entrusting the military with investigating and with finding out what happened to Capt. Clark,” Bradley Taber-Thomas told The Associated Press.

Clark, a 43-year-old Army chief nurse, grew up in Michigan and lived previously in Spencerport, N.Y., a suburb of Rochester and his wife’s hometown. He joined the Army in 2006 and was stationed in Hawaii before he was assigned to the William Beaumont Army Medical Center in El Paso. He deployed to Afghanistan in March.

A statement from the family released by Taber-Thomas said Clark died Monday while

What happens when physician pay is tied to efficiency & quality?

What would it be like if you were paid for your success?

What would it be like if you were rewarded for high efficiency?

Is it possible that successful patient outcomes could be correlated to compensation?

How would one measure non-compliant patients, or those with poor prognoses?

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Medicare moves to tie doctors’ pay to quality and cost of care

By Jordan Rau, jrau@kff.org Published: April 14

CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.

Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.

The “resource use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.

Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.

But applying these same precepts to doctors is

Registered Nurse job aboard private Mediterranean Yacht

How would you like to be an Registered Nurse based out of London, work aboard a Private Yacht traveling the Mediterranean earning a tax-free salary, paid housing, health insurance and flight?

If you’re a female – sorry guys – here’s your chance!

Salary, based upon current rate of exchange, is $57, 283/year with a one year contract.

More details and application below…

Rhode Island Nurses May Strike; Short Term Contracts Available

Registered Nurses to provide Patient Care during a possible labor dispute in Rhode Island, which is also a participating state in the Nurse Licensure Compact.

The pay rate for this short term assignment is

New Registered Nurse Grads Face Tough Job Market

For the first time in many years, new Registered Nurse graduates face a contracted job market, and may face tough employment prospects, adding to an already dismal national economic portrait.

Researchers such as Vanderbilt University’s Dr. Peter Buerhaus, PhD, RN, FAAN, the U.S. Bureau of Labor Statistics (BLS) and others have warned about the impending Nursing shortage. However, because of the poor overall economic conditions of the United States, many experienced RNs have foregone retirement, and or have come out of semi-retirement or translated part-time and PRN jobs into full-time status and have therefore made many hospitals flush with Nurses.

Previously, many experienced Nurses would have taken PRN (Latin for “pro re nata,” meaning “as needed”) or part-time positions, working anywhere from one shift every two weeks, 12 hours weekly, or in some cases no more than 24 hours weekly at most. Most Nurses are hospital-based employees, and work 12-hour shifts, and a typical full-time work week for Nurses is three, 12-hour shifts in a 7-day (one week) period.

Nursing has been, and continues to be a predominately female-populated profession, so the indicator of hospitals flush with Nurses is indeed a fascinating observation on at least two accounts. It speaks volumes about dire national economic conditions because women have found themselves in the unenviable position of having to work, and in many cases being their family’s primary breadwinner.

In an article published by Alabama & New Jersey’s State Nurses Association, Dr. Buerhaus shared his perspective on “The Short and Long-term Outlook for Registered Nurses in the US.” He wrote in part “that once the jobs recovery begins and RN’s spouses return to work, many currently employed RNs could leave the workforce.”

He noted further that while RNs’ employment prospects continue to be… To read more, click here.

My Abortion Story

I’m a Registered Nurse.

I’m a man.

Here’s my abortion story.

Good News! California’s Nurse:Patient Ratio Law Saves Lives!

Extra! Extra!

Read all about it!

Should that, or

“Told ‘ya so!”

be the cry?

California and her residents, often maligned within and without, on occasion do come up with some good ideas.

Here’s one of the better ones.

Is there a Doctor (of Nursing) in the house?

I recollect one day, several years ago, at a then-small, rural community/junior college where I began my higher education, while walking across a parking lot, that I greeted an administrator whom I saw.

“Hello, Dr. Gudger!,” I cheerily greeted him.

“Good morning!,” came his reply.

Just then, another student, unknown to me or Dr. Gudger, called out, “Doctor! Oh, doctor! I have a question about my mama’s ...”

“I’m sorry I can’t help you. I’m not that kind of doctor,” replied Dr. Gudger, as he turned and looked the student in the eye.

At the time, I thought it rather odd, then quickly considered that the fellow – likely from a very rural and poor background – was there to obtain an education. And so in part, he was schooled that day.

However, interesting stories aside, as healthcare goes, our nation is experiencing a significantly decreasing interest in rural healthcare practice, as well as family practice, followed by internal medicine.

Now, I realize that some would pooh-pooh lawyers and blame law suits (everybody hates lawyers… until they need one), claiming that sue-happy folk are to blame for the problems. However, while law suits may have a role – albeit an insignificant one – insurance companies are probably more to blame for increased costs of healthcare and rationing the delivery of health related services.

It’s really rather easy to understand: Anytime anyone gets in between you and the checkout stand, you’re gonna’ pay more. From a fiscal perspective, that’s essentially what happens.

Now, while I could drone on and on about the hows and whys that the insurance industry is (in my opinion) corrupt (the federal government has also bailed them out, along with banks – which, along with stock brokerage houses enjoy an incestuous fiscal orgy), and has corrupted whatever thing their hand touches, I shall confine my remarks toward the more germane and problematic topic at hand, which is the shortage of healthcare delivery to rural areas, and among the poor.

Huntsville Hospital… all that AND a bag of chips? Wow! …NOT QUITE!

Most folks don’t know it, but Huntsville Hospital is NOT, has not ever been, does not meet criteria for, and is not making any plans to obtain or become:

1.) a certified or verified Trauma Center;
2.) meet the a) American College of Surgeons, or, b) American Trauma Society qualifications for Trauma Center status;
3.) an Academic Medical Center;
4.) university affiliate;
5.) teaching hospital;
6.) research center; nor
7.) Nursing Magnet Hospital.

So what? What does that mean for you, your family, friends and others in this part of the Tennessee Valley?

NCLEX Nurse Entrance Exam Gets Tougher

Studies continue to demonstrate that among all professions (jobs for which one has specific higher education, must be licensed often at a state level, and typically has continuing education requirements), Nurses continue to be held in highest esteem. And, rightfully so.

Nursing is not just hand holding and bedpan emptying, although there is a component of that in almost every nursing assignment.

Now Nursing Students will become even more challenged – as right they should. Increasing burdens call for increasing competency, and hardly anyone could disagree with “raising the bar” for entrance just a wee bit higher… particularly when your life depends upon it!

More than enough

I have a confession to make.

I recognize that I must confess to… well, I must confess to… to… to…

Not being exactly sure about how to proceed, I suppose it might be wise to be honest.

On occasion throughout my life, I have periodically engaged in

ICU had Bowel Movements

Yesterday, I received a patient transfer from ICU after a carotid endarterectomy. She was stable, elderly, though was best described as “needy” at times. Some folks are just that way. I think it’s a type of abuse.

Anyway, the Nurse whom had cared for her gave me report on the patient’s condition (in person), and when she got to the bowel/GI part, she mentioned that