finally!

A USA Today article earlier this month finally bore out what my friends and I experienced as we tried to get jobs post-RN: while it's true nursing is still a good way to earn a living, it is not exactly "recession-proof".

can they make us? no, no they can't

On Friday, October 16, a judge temporarily blocked the mandate that all health care workers (HCWs) in NYS get both a seasonal flu and a swine flu vaccine before November 30 or face disciplinary action. The judge granted a "temporary restraining order", which I gather means the requirement was temporarily suspended. A further hearing was scheduled for October 30, when the health department would have had the chance to continue making its case.

However, it's doubtful that that hearing will ever take place, since on Thursday, October 22, Governor Paterson rescinded the mandate that all HCWs get the vaccine due to a more limited supply of the vaccine than anticipated. The CDC has thus far only been able to produce about 23% of the anticipated amount of H1N1 vaccine, and the state government has decided it's more important to vaccinate those at risk of becoming seriously ill from the disease (pregnant women, for example) than those at risk of transmitting the disease.

The requirement sparked controversy from the beginning, with health care workers protesting in front of the capitol building and lawsuits filed by three separate groups. Interestingly, each group represented a different demographic: one was nurses, one was public employees, and one was teachers.

iraqi nursing program

Great article from Fox News about a nurse training program in Anbar province, Iraq. The women, mostly in their mid-thirties, are being trained as nurses' aids. They are paid $200 a month by the U.S. State Department's Reconstruction team. For many of them, it is their first career.

Historically, nurses in Iraq have been met with suspicion, due to their willingness to work long hours in a coed setting. The founder of the program, Dr. Ayad al-Hadith, is a physician who specializes in child and maternal health and has devoted his professional life to loweing maternal health in Anbar province. He hopes some of the women trained will go on to become RNs.

that's too bad

Another article, this one in the Wall Street Journal, about how the current recession has put the kibosh on the nursing shortage. Subawesome news for new grads like myself, great news for patients. I saw another article to this effect earlier in the Washington Post. Both articles said many nurses were returning to the workforce to alleviate the financial pressure created when a spouse lost a job, and both said this effect of the recession is a band aid on the nursing shortage, which will re-emerge. The WSJ article quoted a study which said the nation will be short a quarter of a million nurses by 2020; a pretty significant deficit in an industry that is meant to employ about two million per year.

whoops!

I missed International Nurses' Day! It's celebrated every year on May 12 and honors nurses throughout the world. (This also means I missed my free CinnaBun, but oh, well.)

In honor of the day, Gary Cohen, a member of US Fund for UNICEF's board and an executive vice president at a medical technology firm, wrote this interesting column about health clinics for health care providers in the developing world, established and operated by the International Council of Nurses.

report on health care workforce

The Center for Health Workforce Studies, at the University at Albany's School of Public Health, recently published a 136 page study of the health care workforce in New York. The report, which includes a section devoted to NYC, has some fascinating stuff: between 1990 and 2007, the health care workforce of NYC grew by 29%, whereas the workforce of NYC as a whole grew by 16% during the same period. Almost all of the jobs were in the private sector; private hospital jobs increased 3% while public hospital jobs went down 4%. (Hospitals provide about 50% of NYC's healthcare jobs.) Interestingly, the study reports that the number of RN positions in NYC went up 18.9% between 2002 and 2007, while the number of RNs increased only 3.1% between 2003 and 2007. The number of NPs went up 27% between 2003 and 2007. (Good luck with that job search, Laura.)

Overall, the study projects that there will be openings for nearly every type of healthcare job in NYC from 2006-2016. However, recent events have indicated that for RNs, and I would imagine other healthcare workers as well, the the picture has changed dramatically thanks to the recession.

Another unsurprising finding of the study is that minorities are underrepresented in New York State's physician workforce, even as the nonwhite portion of NYS' population continues to grow. Physicians who come from racial minorities are more likely to work in underserved communities and have on average a higher percentage of Medicaid patients.

no kidding

Interesting article Sunday in The Washington Post about how the recession has temporarily made the nursing shortage a thing of the past. Unsurprisingly, nurses are delaying retirement or returning to the workforce in an effort to stay afloat financially, which means even experienced nurses are having trouble finding work. Nursing advocates say this is obviously just a band-aid on the nursing shortage, and continue to urge legislators to consider measure that will alleviate the shortage when it reappears once the recession is over.

Anecdotal evidence from myself and my classmates (we graduated with our BSNs in May 2008) suggests this started to hit NYC last year. I applied to about a dozen hospitals late last summer and early fall, and although I was hired three times, in two cases a hiring freeze twice prevented me from taking the spot. (The third time there was an administrative mix-up.) I was not alone among my classmates in struggling to find work; many people were saying they couldn't even get interviews. Given the number of health sector lay-offs in the city in the past year, none of this is too surprising.

not a moment too soon

Yesterday, two my of roommates, both members of the New York State Nurses Association (NYSNA) received a mailer from that union. It's basically a four page pamphlet, listing hospital closings and layoffs in the NYC area. Consolidated like that, it is kind of jarring: in NYC and Long Island alone, there have been three hospital closings and six hospitals which have laid off more than 50 people in the past year alone. The mailer also says that according to an American Hospital Association survey, 50% of hospitals were considering staff cutbacks to deal with "financial stress" as of October 2008. The mailer includes two index card size postcards you can punch out, sign, and send to your state senator or assemblymember to urge them to oppose the $1.3 billion in healthcare budget cuts proposed by Governor Paterson. The NYSNA is not the only one organizing around the budget cuts; SEIU 1199 and the Greater New York Hospital Association launched a million dollar campaign against them earlier this year.

Presumably, the mailer went out prior to the HHC cuts. Interestingly, some of the responses I've read posted to articles about the HHC cuts discussed how difficult it already was for nurses to get a job in NYC even before those cuts were announced.

nursing and moral distress

Interesting article from the NYT about the changing ethics of nursing and medicine in general. The article focuses on "moral distress" the condition in which a doctor or nurse feels they know what's best for the client but in some way feels prevented from implementing it. This phenomenon is one I noticed even during my clinical rotations; sometimes a really good nurse would have a useful perspective about a client, but wouldn't talk about it with the team because she'd assume they'd brush her off. That said, I also saw a number of situations in which a nurse would see a problem, talk to the doc, and get someone in there to evaluate pretty quickly.

The study discussed in the article can be found in the February 2007 issue of Critical Care Medicine. As mentioned in the article, nurses at both the surveyed sites reported higher levels of moral distress than physicians. Both groups reported the highest incidence of moral distress when they were pressured to "unwarranted aggressive treatment". RNs who had higer moral distress scores also reported a lower perception of ethical environment, a lower satisfaction with the quality of care, and a lower perception of collaboration.

Thanks to Ella Gray, RN, for drawing my attention to this article.

Hello

My first post will be just a quick introduction. I am a registered nurse pursuing a Master's degree in Nursing. My BS in Nursing was my second undergraduate degree; it was a one year accelerated program designed for students who wanted to be nurses but who already had four year degrees in other fields. My BA was in the social sciences, and one of the only two science classes I took in college was nicknamed "Sex" by the student body. (The course guide opted for the more discreet title "The Evolution of Human Nature", but it obviously fooled no one.) So transitioning into classes that actually had right and wrong answers was not easy. However, I was lucky enough to take care of my prereqs quickly, and to begin my nursing degree almost exactly a year after finishing undergad.

I was also lucky enough to get into my first choice nursing school: Columbia University. Its medical campus is centered around Columbia-Presbyterian Hospital, in the Washington Heights area of New York. A year after starting my degree at Columbia, I finished the bachelor's portion of the program and became a registered nurse. Like most people in my class, I moved on immediately to my Master's in Nursing, which, combined with passing the state's nursing boards, will qualify me to practice as a Nurse Practitioner in New York. I will complete my degree in December 2009.

In addition to nursing , I'm interested in public health, particularly in New York and particularly as it pertains to HIV. I intend for this blog to discuss all three subjects, although the ratio is to be determined. To that end, an interesting study recently came out from the New York Department of Health exploring a link between binge drinking and HIV among MSM. You can download the full study at the end of the press release.