Nurses Week is celebrated each year from May 6^th til May 12^th, which is the birthday date of Florence Nightingale.

We all know that nursing today is nothing like it was 100 years ago, right?  Just for fun, there is a link to a graduating class from 1910 .  The truth is, I did start this post thinking about how incredibly different the profession is compared to 100 years ago.  Of course, it has been a little while since I took “History of Nursing 101”.  Plus, I had a bit different perspective back then.

When I was doing a little research to write this, it struck me as an older, wiser head now, that while things indeed have changed radically, with technology, education, new opportunities in the field and more, there are many aspects to nursing that really haven’t changed much at all.

If you go to the link http://www.nurseweek.com/features/99-12/workhist.html and read the article, there is a certain sense of how things never change so much as they stay the same.

Here are some items I thought bear reflection:

• No antibiotics, so nurses were in near constant danger of contracting a serious infection from their patients and environment.

• Long hours, tough jobs

• What we call home health care today was huge “back in the day” and called private duty nursing

• You had to love hard work to enjoy being a nurse

• Attention to detail and follow up was a big part of the nurses’ role

• Scientific knowledge (as far as it went) was a requirement

• Knowledge and practice of good hygiene was paramount

• Compassion, empathy and a commitment to service was part of the nurse’s stock in trade

When you look at today’s environment:

• Home health care is back on the rise due to “new” models in medicine

• We do have treatments for the infectious diseases that our foremothers (and fathers) didn’t have, but today we face other, difficult to treat infections, such as MRSA and C-Diff

• You still gotta love the job, at the end of the day!

• Scientific training and education is still the backbone of nursing education

• Hygiene, infection control are still vital

• Long hours, tough jobs

• Compassion, empathy and a commitment to service remain some of the primary characteristics of today’s nurse

So, while we have “come a long way, baby”, our core values as nursing professionals remain the same.  And that’s a good thing!  Here’s to you…Happy Nurse’s Week!

How Nursing was in the 1900′s

Basic information about Nurse’s Week for 2010

Nursing World Organization

May 19, 2010 at 8:00 PM Eastern – One hour webinar
An Eye for an Eye: The Legal Consequences of Vision Loss
Joseph Citron, MD Esq.

A uniquely qualified presenter, Dr. Joe Citron is both an ophthalmologist and an attorney. He explains the mystery of how we see and what goes wrong when the visual system is injured. Loss of vision can have profound effects on a plaintiff, affecting vocational, social, and psychological issues. Dr. Citron pulls back the covers to share his knowledge. Eyes, vision and injuries have long been the province of a few specially trained medical people. No more! He’ll use common English and a minimum of medical terms to explain how people see. He’ll help you understand the connections between the eyes and the brain as well as the methods used for testing these areas. What’s the eye case worth? Dr. Citron will help you determine the value of eye injuries.

June 29, 2010 at 8:00 PM Eastern – One hour webinar
Nutrition: Was Malnutrition the Culprit? Janet McKee, MS RD CSG LD/N DAPWCA

Forty to eighty five percent of patients and nursing home residents experience protein-calorie malnutrition, which promotes involuntary weight loss, pressure wound development, poor wound healing and other negative patient or resident outcomes.   Because malnutrition and many of its unintended consequences can often be prevented, appropriate recognition and management of malnutrition or the risk for malnutrition is of primary importance in assessing the status of patients and residents. An evaluation of the nutritional assessment, care planning, interventions and monitoring should be completed for each case involving malnutrition, weight loss or pressure wounds. A nutritional expert exposes the practices that lead to malnutrition. This interactive webinar provides the knowledge to determine when nutrition is a key issue in case evaluations and screening a claim for merit.

Wanna join in on one of these webinars?  Go here: http://www.webmarketingmagic.com/app/?af=1059614

A critical aspect of any catastrophic injury lawsuit involves the determination of the injured party’s future medical care. The life care plan is a tool that is written by a professional and often used to specifically identify all of the future care (medical and non-medical) needs of the injured party. The life care plan addresses the costs and frequency of the needed goods and services over a lifetime. It will project the needed equipment, replacement scheduled and maintenance.

In many cases attendant care is needed. The plan will determine how many hours per day care is anticipated and what level of individual is needed to provide the care. Some care may be provided by unskilled labor while other care requires expertise of a licensed individual. Still other care could be calculated to provide respite for the family care givers.

Another large area in injury cases (and particularly those cases which involve children) are the calculations the therapy needs. Therapy needs may consist of physical therapy, speech therapy, occupational therapy, and recreational therapy and may last a lifetime.

A life care plan will also address the number of physician visits required throughout the injured party’s life, any adaptive equipment he or she may require in and around the home, home modifications, transportation needs, diagnostic testing, and often much more. It is common for the nurse life care planner to meet with the injured party’s family in their home to assess the extent of the needs. The plan is a collaborative effort that involves the life care planner as well as the multiple medical professionals involved in the medical care.

Nurses are well suited to this field of life care planning. Beginning in nursing school, nurses learned how to develop a nursing care plan. This same nursing care plan is the essence of Nurse Life Care Planning. The Nurse Life Care Planner initiates the nursing process with a nursing assessment and using a holistic approach to encompass the client, their support system, their environment, and their individual needs related to the injury or illness.

The nursing assessment is based on collecting subjective and objective data from observations, examinations, interviews and written records. The data may include symptoms, growth and development, family health history, information collected by other health team members, culture and religion, ability to perform activities of daily living, educational and vocational background, patterns of coping and interacting, and environmental factors. The Nurse Life Care Plan is intended to follow the client through his or her lifetime to ensure funds will be available to properly care for the client.

Nurse Life Care Planning is an extension of case management where the nurse has learned to perform an assessment, formulate a plan of care in collaboration with the health care team, facilitate medical needs and negotiate costs related to care. Other specialties of nursing that are also well suited to this area include rehabilitation, discharge planning, utilization review nurses and even home health nurses.

The American Association of Nurse Life Care Planners (AANLCP) was established to promote a professional practice within nurse life care planning. To learn more about this exciting field of nursing, I encourage you to contact the association and consider becoming a member.

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The Bureau of Labor Statistics, a division of the U.S. Dept. of Labor, has projected, that from 2008 to 2018 the civilian labor force will grow by 12.6 million and total employment will increase by approximately 15.3 million jobs. Health care and social assistance will add approximately 4 million positions, with 772,200 of these in physician offices. About 106,500 of these new jobs will be for registered nurses.

High demand is expected in specialties such as geriatrics and orthopedic surgery, that provide treatment for age-related conditions.  The only position in a physician’s office not expected to increase is file clerk, primarily because electronic medical records are becoming more common.

One survey, released Nov. 16, 2009, by AMN Healthcare Services Inc., in partnership with the National Council on Physician and Nurse Supply, found that nearly all hospital CEOs believed there was a shortage of physicians, nurses and allied health professionals. About 6% of nursing jobs went unfilled, as did 5% of jobs for allied health professionals.

My daughter is headed to college with plans to become a registered nurse.  It isn’t what she dreamed of as a child.  She prefers veterinary medicine and she is really great with the four legged patients.  After looking at the time and money investment required for veterinary school and the difficulties in making a decent living, she has determined that people medicine might be a better fit for her and her family.  I tend to agree.  It has suited me well and I wish her the best.

I love you Lacy!

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This year marks the centennial year of Florence Nightingale‘s death.  Florence Nightingale (1820-1910) is the founder of modern nursing.  Her contributions to nursing theory, education, practice, research, statistics, public health, and healthcare reform are foundational and inspirational and allow me to do what I do today.  She was a health care advocate to influenced leaders of her time.  She impacted public awareness and changed how people understood and valued health.

Not only was Florence Nightingale a patient advocate, she was also an advocate for nurses and nursing.  She asked that we continually be renewed to sustain our effective, compassionate, and caring practices (something I need to do more of).

This year a grassroots organization has come to honor nurses, our values and wisdom, and to act as catalysts for achieving a healthy world.  There are estimated to be more than 15 million of us.

International Year of the Nurse, has set out 8 goals.

1.  Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality

5. Improve maternal health

6. Combat HIV, AIDS, malaria, and all communicable/noncommunicable diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

To learn more go to 2010iynurse.net

Now that you have an understanding of the role of the Nurse Life Care Planner, I wanted to introduce you to the certification process.  The American Association of Certified Nurse Life Care Planners (AANLCP™) was founded in 1998. The Certified Nurse Life Care Planner (CNLCP™) Certification Board was incorporated in 2009 as a separate entity but constituent of the AANLCP™.

The CNLCP™ Certification Board directs the certification program for nurse life care planners and promotes the nurse life care planners’ professional practice and role. This oversight includes item writing and test development, tracking of certified nurse life care planners, quality assurance of the examination, and re-certification of Certified Nurse Life Care Planners.

The CNLCP™ Certification Board provides updates of the examination content based on evidence based specialty standards for Nurse Life Care Planning. A passing score on the certification examination allows a nursing professional to utilize the designation Certified Nurse Life Care Planner (CNLCP).

If you are a Registered Nurse and have at least five years of experience and two years full time experience in case management experience you are eligible to sit for the exam.  Please check out the website for information regarding the upcoming deadlines for application and examination.

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Legal nurse consulting experts Rose Clifford and Pat Iyer are presenting a one-day internship pre-conference event to the NNBA conference. The event is scheduled for October 23 from 9 a.m. to 5 p.m. The NNBA is lowering the registration fee to $199.00 because we feel lowering prices is the way to stimulate the economy in these challenging economic times.

Work one-on-one with Rose and Pat for a full day. Rose will show you how to work smarter with today’s cases and Pat Iyer will teach you how to produce high quality reports in a minimum amount of time.

As an added bonus you get yours truly for one session of the main conference as well.  To learn more just check out the National Nurses in Business Association.

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A state ban on allowing registered nurses to provide expert testimony has been overturned by the Pennsylvania Supreme Court. The impact of the decision may be limited because of 2002 legislation known as the MCARE Act which requires expert witnesses in medical professional liability cases to be a registered physician or a recent retiree. However Justice Debra Todd noted that MCARE does not apply to other cases, such as other professional liability cases or criminal cases.

Read in Law.com

And from Sullivan v. Edwards…

AANA persuasively reasons:

“A physician, who is not a nurse, is no more qualified to offer expert, opinion testimony as to the standard of care for nurses than a nurse would be to offer an opinion as to the physician standard of care. *** Certainly, nurses are not permitted to offer expert testimony against a physician based on their observances of physicians or their familiarity with the procedures involved. An operating room nurse, who stands shoulder to shoulder with surgeons every day, would not be permitted to testify as to the standard of care of a surgeon. An endoscopy nurse would not be permitted to testify as to the standard of care of a gastroenterologist performing a Colonoscopy. A labor and delivery nurse would not be permitted to offer expert, opinion testimony as to the standard of care for an obstetrician or even a midwife. Nor would a nurse be permitted to testify that, in her experience, when she calls a physician, he/she usually responds in a certain manner. Such testimony would be, essentially, expert testimony as to the standard of medical care.”

Scholars share this reasoning:

“Physicians often have no first-hand knowledge of nursing practice except for observations made in patient care settings. The physician rarely, if ever, teaches in a nursing program nor is a physician responsible for content in nursing texts. In many situations, a physician would not be familiar with the standard of care or with nursing policies and procedures which govern the standard of care. Therefore, a physician’s opinions would not be admissible in jurisdictions which hold the expert must be familiar with the standard of care in order to testify as an expert. An example of a common situation which gives rise to allegations of nursing negligence occurs when a nurse fails to follow the institutional ‘chain of command’ in reporting a patient condition to a physician who subsequently refuses to attend to the patient condition. It is unlikely that a physician would be familiar with the policy and procedure involved in handling such a situation. It is as illogical for physicians to testify on nursing standard of care as it would be for nurses to testify about medical malpractice.” E. Beyer & P. Popp, Nursing Standard of Care in Medical Malpractice Litigation: The Role of the Nurse Expert Witness, 23 J. Health & Hosp. L. 363, 365 (1990).

This scholarly insight has spread to litigators:

“Testimony from a physician about the standard of care may be subject to objection because the physician is not a nurse and does not have direct knowledge of nursing standards of care. A physician’s statement that he or she often observes nurses and therefore knows what they do may be inadequate.” P. Sweeney, Proving Nursing Negligence, 27 Trial 34, 36 (May 1991).

Beyond scholars and litigators, courts have begun to accept this reasoning.

In some jurisdictions, “the physician is no longer permitted to testify about the nursing standard of care since the physician is not a nurse and does not possess direct knowledge of nursing standards.” F. Cavico & N. Cavico, The Nursing Profession in the 1990′s: Negligence and Malpractice Liability, 43 Clev. St. L. Rev. 557, 578 (1995); see Dolan v. Jaeger, 285 A.D.2d 844, 846, 727 N.Y.S.2d 784, 786-87 (2001) (upholding trial court’s dismissal of nursing malpractice action where physician anesthesiologist was only expert to testify as to nurse’s standard of care); Vassey v. Burch, 45 N.C. App. 222, 226, 262 S.E.2d 865, 867 (“Although the affidavit of [the physician] may be sufficient to establish the accepted standard of medical care for a doctor in his office, it does not establish the standard of care for a nurse in a hospital”), rev’d on other grounds, 301 N.C. 68, 269 S.E.2d 137 (1980). According to one scholar:

“These cases represent a growing recognition on the part of courts that nursing, as a profession, has moved beyond its former dependence on the physician, and into a realm where it must and can legally account for its own professional practices. In doing so, the experts who provide the testimony, and the literature from which their opinions are derived, come from the nursing profession.” C. Kehoe, Contemporary Nursing Roles and Legal Accountability: The Challenge of Nursing Malpractice for the Law Librarian, 79 Law Libr. J. 419, 428-29 (1987).

Based on this reasoning, AANA argues that Dr. Barnhart should not be permitted to offer expert testimony against nurse Lewis based on his observation of nurses.

We agree. By enacting the Nursing and Advanced Practice Nursing Act (225 ILCS 65/5-1 et seq. (West 2000)), the legislature has set forth a unique licensing and regulatory scheme for the nursing profession. As AANA observes, under the nursing act, a person with a medical degree, who is licensed to practice medicine, would not meet the qualification for licensure as a registered nurse, nor would that person be competent to sit for the nursing license examination, unless that person completed an accredited program in nursing. See 225 ILCS 65/5-1 et seq. (West 2000). The appellate court in this case correctly reasoned:

“Dr. Barnhart is not a licensed member of the nursing profession. To allow the doctor to testify as to the standard of care applicable to the nursing profession implicates the risks raised by Dolan, namely, the imposition of a higher standard of care and the muddling and mixing of various tenets and practices unique to each profession.” 335 Ill. App. 3d at 272.

‘Nuff said!

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Legal Nurse Consultants are experts in evaluating, analyzing and explaining the injuries asserted as a result of a potentially work related incident, as well as the treatment and the impact of these on the client’s life. For more than 20 years, Legal Nurse Consultants have acted as collaborators and strategists, offering support in medically related litigation and other medical-legal matters to aid in numerous aspects of your cases.

What Lawyers Are Saying about AALNC Members
“Our firm has employed an in-house Legal Nurse Consultant for many years now. She works with our many attorneys on multiple issues and practices. Of particular interest to my practice is the work she does on the Worker’s Compensation files. She has been invaluable in recognizing the areas of strength and weakness of the cases from a medical perspective.

She helps me to fine tune deposition strategy when needed and provides an exceptional advantage in her role in identifying, retaining and working with the medical experts. Our Legal Nurse Consultant is able to digest, interpret and clarify voluminous medical records and provide key illustrative medical evidence when needed. She is able to accurately evaluate the pathological processes and issues of alternate causation. As a nurse, she understands the role of the case manager and issues of catastrophic injury. It has saved our firm immeasurable time and money to have a Legal Nurse Consultant working on the Worker’s Compensation files. I have found our clients are equally impressed to know I work with a Legal Nurse Consultant on their case.”

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The nursing profession was added to the Gallup’s poll for Honesty and Ethics of professions in 1999. Since that time the nursing has been in the number one spot with the exception of 2001 after the attacks of 9/11 in which Firefighters topped the list. Eighty-four percent of Americans rank the ethics of nursing as high or very high.

This is an important statistic that all nurses should be proud of. It shows the trust consumers and other health care professionals put into each and every nurse.