5 Reasons There Are Not Enough Nurses.

Some industries are rebounding from the recession better than others. In April, the U.S. Bureau of Labor Statistics reported that the healthcare industry recorded the biggest increase of any employment sector, adding 37 000 jobs in March 2011. Positions mostly filled by nurses, the largest segment of the healthcare workforce. And yet, the American Association of Colleges of Nursing (AACN) is still predicting a huge nursing shortage to hit the country in less than ten years.

In job-starved America, what is stopping us from graduating enough nurses to meet the demand?

  1. Nursing school enrollment is not increasing quickly enough. Though enrollment increased from 2.2 percent from 2007 to 2008, according to the Council on Physician and Nurse Supply, 30 000 more nurses need to graduate annually— an expansion of 30 percent.
  2. Schools are turning away qualified applicants. Because enrollment hasn’t expanded, the AACN reported that 67 563 qualified applicants were turned away from nursing programs in 2010. In the survey, the AACN also found that faculty shortages were the number on reason for not accepting qualified applicants at two-thirds of (responding) nursing schools. Read about one aspiring nurse’s experience here.
  3. There are not enough high-level nurses to fill faculty positions. Matthew McHugh, assistant professor of nursing at the University of Pennsylvania, believes that this is where the real bottleneck lies. He said in a phone interview that 65 percent of nurses graduate from an associates degree program, and only 20 percent of those nurses go on to get a bachelors degree, leaving only a small pool of nurses in a position to seek the advanced degrees required to teach. “Addressing the nursing shortage means opening up the pipeline to move students to the potential to be in a teaching role,” he said.
  4. Pay discrepancy discourages advanced-practice nurses from becoming educators. Judy Beal, chief academic officer for nursing and health sciences at Simmons College in Boston, estimates that a new nurse with a PhD can make two to three times more money working in a clinical setting than he or she can in a teaching job. “We as the profession are going to have to at some point bite the bullet and say ‘we’ve got to pay our faculty more,'” she said.
  5. Current nurse educators are aging— and retiring. Beal, 59, estimates that she is the mean age for nursing faculty and that 40 percent of the nurse educators at Simmons plan to retire in the next five to ten years, herself included.
According to Beal, the recession is “the calm before the hurricane.”
“We really are not going to be able to provide the number of nurses that we are going to need to care for all of these aging baby boomers, who are going to live many many years longer than our parents,” Beal said. She just hopes there will be enough nurses to take care of her, when the time comes.

A Short History of Restraint Use.

Leather Restraint

“The great stumbling-block of the American superintendents is their most unfortunate and unhappy resistance to the abolition of mechanical restraint,” said British asylum superintendent John Charles Bucknill in 1876.

In the mid-19th century, after a long history of poor conditions, England started reforming its insane asylums. Cases like that of James Norris, a former seaman who spent ten years shackled to his bed with an iron harness, lead the reformers to push for the near-total abolition of restraint use. The British believed that in a well-run asylum with properly trained physicians on staff, they would rarely be necessary.

Since the first state-run mental hospital in the United States wasn’t established until 1822, Americans didn’t have the same negative history during the British reformation. Rather than seeing restraints as evidence of mistreatment, American physicians believed that restraints were a valuable tool to keep patients safe. They also believed that patients of a democratic nation were less tolerant of authority, and that the American insane were more violent than their British counterparts.

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Cultural Insensitivity.

A 20 minute seizure is considered life threatening. When Lia Lee was four years old, she suffered a seizure that lasted for nearly two hours.

When Lia had first begun to seize, her father, Nao Kao Lee, quickly realized that this seizure was worse than any Lia had before and called his English-speaking nephew over to call an ambulance, delaying Lia’s arrival to the hospital by a critically long 20 minutes.

When journalist Anne Fadiman asked Nao Kao why he had waited for his nephew and then the ambulance to come and get Lia, rather than running the three blocks to the hospital as he had before.

“If you take her in an ambulance, they would pay more attention to her at the hospital,” he replied.

Cultural sensitivity in medicine has become a very vogue topic. But, unless you work in the medical profession, it’s difficult to understand how catastrophic culturally insensitive medicine can be. Luckily, Fadiman successfully portrays the complications surrounding medicine and culture through the Lee family in her book The Spirit Catches You and You Fall Down for all of us who cannot see them first hand.

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Health and Social Hierarchy: Preschool Edition

(c) Nurse Blog

As every teacher knows (and hates), people start forming social hierarchies in preschool. But the dominant children aren’t just steamrolling the subordinate kids into giving up their toys, they may also be sentencing them to a life time of poor health.

University of British Columbia Neurologist and Child Development Special, Dr. Thomas Boyce, spoke about the “biology of misfortune” at the Harvard School of Public Health yesterday afternoon. Dr. Boyce began studying social hierarchies in children to try and explain why some children have medical charts with just a few pages, while others have charts as thick as phone books.

Socioeconomic status is frequently singled out as the biggest predictor of future health. It’s more influential than age, height, social support, and even smoking habits.  On top of that, health isn’t just related to objective social status, but also subjective social status— where people places themselves in the hierarchy. Suspecting that perceived social status started in childhood, Dr. Boyce decided to dig a little deeper.

Playing short video clips of children playing with one another, Dr. Boyce described the different kinds of hierarchy-establishing behaviour he found, including imitation, displacement, directing behavior, and good old-fashion physical attack.

In one clip, two small children are shown digging, with a third child, a little brown haired girl, first attempting to displace one child digging next to a tree before successfully displacing the second from his digging spot. After she tires of digging and moves on to something else, the child she originally tried to displace, a boy with a head full of blond curls, chases after her, grabbing her around the waist and trying to drag her back to the tree.

Dr. Boyce described this as “another demonstration of nuanced male behavior,” to laughs from the audience. The boy eventually figured out he could get the little girl to keep digging with him if he just asked her.

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Why Do Boys Get All The Circumcision?

Nawal Nour speaking with a Sudanese interpreter (c) Brigham and Women's Hospital

Though infant male circumcision is left to the discretion of parents, female circumcision performed on a minor is completely banned in the United States. This strange kind of sexism was the topic of debate at a Harvard Law School panel discussion today.

Male circumcision has long claimed to be the lesser of the two evils— safer, and with potential health benefits. Unfortunately, those potential health benefits are for people facing an AIDS epidemic, not Americans, and every medical procedure has risks.

“I don’t like seeing the poor little penises bleeding,” said panelist Dr. Nawal Nour, an obstetrician/gynecologist who founded the African Women’s Health Center in Boston. She stopped performing the procedure. Another panelist, Law Professor Sarah Waldeck, said that as a middle-age white woman from the midwest she couldn’t be objective on the issue— in her demographic, circumcision is the norm.

Waldeck’s perspective on male circumcision spoke to her early point about female circumcision— that the cultural aspects have to be taken into account when determining laws if they are going to be effective. Because the people the ban is aimed at view female circumcision as normal, she argued, the law is more likely to provoke backlash than lasting change.

“Getting people to stop circumcising their daughters is as difficult as trying to convince Jewish people to stop circumcising their sons,” Waldeck said. Dr. Nour pointed out that in a traditional Jewish bris, the circumcision is not performed in a hospital, or even by a medical professional.

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And The Women Come Last.

I feel bad for Sandeep Jauhal‘s wife. In his memoir about his medical internship, aptly named Intern, he seems a little indifferent to her. But that’s the point of the medical memoir: to drive home the point that doctors only have time to be doctors. They have to sleep, eat, breathe medicine or they will get crushed. And that is just one of the cliches this memoir falls into.

Intern begins with Jauhal not wanting to be a doctor. He’s just another Average Joe doing PhD work on quantum dots at Berkley when he finds out that his girlfriend has lupus. Cut to the medical research montage that not surprisingly, turns up empty. Strangely, he doesn’t want to go to medical school to save her (which would be no more absurd than thinking he could find the cure for lupus in the research library), he wants to go so that he can help someone. Which is probably a good thing, since the girlfriend disappears from the narrative as soon as his mind is made up.

After medical school, he goes to do his internship in New York, “hoping that in a city of eight million people, I’d be lucky enough to meet someone to fall in love with.” Since he never explained what happened to the lupus-sufferer, this admission is more jarring than sweet.

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How To Mortgage Your Future.

A needle depot in Vancouver, Canada.

Just when The Washington Post reports the demise of needle exchange services in D.C., The New York Times catches up, covering the only safe injection facility in North America. Which is in Canada, of course.

The irony would be better if Vancouver had just started opened this facility, but I mean it when I say that The New York Times is catching up. InSite opened in 2003.

Still, the irony is pretty good.

As the Time’s reports, the Downtown Eastside of Vancouver was once home to the fastest-growing AIDS population in North America.

The city took action, and along with implementing needle exchange programs, they went one step further, opening InSite. People suffering with addiction bring their own drugs to the center, staffed with health care professionals, and shoot up. The facility reduces disease transmission and the risk of death from overdose.

To watch the multimedia piece, click here.

Back in the U.S., D.C. is the HIV/AIDS epidemic epicenter, and the State has responded by delaying funding to it’s needle exchange program. Both the federal and state governments are cutting funding to programs that prevent the spread of HIV, Hepatitis and STDs. I mean, why raise taxes when you can cut frivolous expenses like needle exchange programs and Planned Parenthood?

Unfortunately, cutting these programs isn’t even going to save money. The cost of running the needle exchange program in D.C. for a year is less than the cost of care for a single AIDS patient over a lifetime. Did I mention that the program serves 2,200 people?

But, I guess when even programs for starving babies are getting the axe, it’s not surprising that drug addicts aren’t garnering much sympathy.