Tuesday, March 13, 2018

Welcome Back

I had a very busy 2 months during which I taught a medical-surgical nursing course, a deep immersion into complicated subject matter, which I had not taught before, so I had to hatch everything anew. I had a lot of fun but it was also a lot of work, since I'm already teaching an overload and seeing my usual compliment of office and hospice patients. Whew!

So what's happened over the past 2 months?

First, The Pennsylvania House of Representatives seems ready to take up House Bill 100, which would remove the formal physician-collaboration requirement currently in force. Why do I care? The main reasons are these:

  • The Institute of Medicine, the Office of Technology Assessment, and other major organizations support this as a means of expanding health care access.
  • No study has shown that these agreements add to patient safety. NPs seek physician guidance even without such a requirement when conditions warrant.
  • The requirement often interferes with NPs attempting to open practices in medically-underserved areas, such as inner cities and rural areas. In such cases this is often because either the NP cannot find any physician willing to join a collaborative practice agreement, or because the physician practice charges so much for the service that a new practice cannot afford it. 
Take that last point. If my doc backs out at some point, I might have to close my practice. This happened a few years ago when my former doc, Dr. John Sullivan, retired. There was about a year there when I wasn't sure I'd be able to keep my doors open!

The PA State Senate has already signed off on this legislation. It has a lot of support in the PA House. If passed, Pennsylvania would join over 20 states in which full NP practice has opened the market to greater health care access and innovative team-care models.

The map suggests that states in which physician organizations have the most influence
also have the most restrictive practice laws. Many Western states
which have vast rural areas have been the most innovative in changing those laws.
Map from Alvernia University, 2017. 


What can YOU do? If you are a Pennsylvania resident, call your representative now! The bill is up for consideration this week. Ask that it be voted out to the full House for consideration (where the bill has enough co-sponsors that it is likely to pass). AARP is among the many organizations that supports this bill, and they have set up a hotline for you to dial direct to your representative. That number is The number is: 844-250-5540. Thanks for your support!

So what else happened?

Well with that course I just finished teaching I was reminded of how disdainful I've become about hospital-based health care over the last several years. Now, for the past 2 months, I've been steeped again in hospital practice, culture, and method. I'm reminded of why I left it.

I've been reminded of how much hospitals have grown into sprawling corporate enterprises. Yes, these corporations do good, and the people in them mean well. But it's interesting to see the students' eyes opened to all of the real tensions at work in our health care system, as they themselves are learning new skills. Money, corporate hierarchies, professional jealousy, how the poor are treated differently than the rich by these systems, the emphasis on cost cutting...it really changes their framework of understanding. They go from wide-eyed young people intent on helping others, to seeing how the system--what I often call here "The Factory"--really operates.

Medical-surgical nursing is still the "bread and butter" of what students learn in a nursing program. So having the opportunity to spend a lot of time in this world again after being away from it for several years reminds me of how much money drives a system that is supposed to help people.

I get it. We all need to make a living. But at what cost to our morality? My hope is that having access to students of the art allows me and my colleagues to mitigate that financial influence.

I was also reminded as to how little alternative medicine has penetrated the classic hospital-based care setting. There have been advances, with pet therapy, music, and art being introduced to many hospital units. But aromatherapy, herbalism, homeopathy, chiropractic, yoga, and all sorts of other useful tools are still rare to non-existent. At Penn State Harrisburg, we try to incorporate some of these modalities into the education of our students, but it's an uphill climb, given all of the more traditional things they have to learn, as well as the general lack of interest in alternative therapies among hospitals and many physicians.

Well that's it for now. I expect to be more active again with this blog now that the first half of spring semester is over and I concentrate on my other classes as well as my practice.

Be well!

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