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yael maxwell

Yael Maxwell is CHMP’s inaugural Healthcare Workforce Media Fellow, supported by a grant from the Johnson & Johnson Foundation.

Workforce morale is a concept that sounds nice on paper but is too often shunted to the bottom of the priority list in practice. Working in tandem—and often butting heads—with patients, physicians, hospital staff, and each other, nurses often feel depleted, emotionally and physically, at the end of their shifts. And, as nurse-to-patient ratios continue to grow, ‘burn out’ is something that nurse managers need to be especially vigilant about.

credit: Wolfgang Hunscher, Dortmund

credit: Wolfgang Hunscher, Dortmund

In her talk at last month’s Transcatheter Cardiovascular Therapeutics annual meeting in San Francisco, CA, Bernadette Speiser, MSN, CCRN, RCIS, of the Palo Alto Veteran Administration Health Care System, spoke to all of these challenges facing nurses and nurse managers, specifically those trained to work in the close quarters of the cardiac catheterization laboratory.

 

10-Tips-NM

Tips from Bernadette Speiser, MSN, CCRN, RCIS, of the Palo Alto Veteran Administration Health Care System

Morale, as she defined it, is “the confidence, enthusiasm, and discipline of a person or group at a particular time.” In the cath lab, Speiser said, good morale is a hard state to achieve because “we’re always squeezed from both ends” in trying to find qualified and available staff and simultaneously balancing the budget. Nurse turnover ranges from 8-44 percent annually in the United States, and replacing a single RN lost to turnover costs between $36,000 and $48,000, she said.

 

It’s is the nurse manager’s responsibility to maintain excellent team morale. Speiser explained that a good manager is not only smart and capable, but someone who can focus on building morale and trust within the team by maintaining open communication, setting concrete goals, and “walking the talk.”

 

“Flexibility, flexibility, flexibility,” is the ultimate key toward maintaining good morale, Speiser said. If the staff feel good about what they do on a daily basis, “whatever happens out there economically is not going to be so much of a push for them. And they need to know… they’re providing good patient care when they are in your department.”

[caption id="attachment_10926" align="alignright" width="170"] Yael Maxwell is

http://bit.ly/1WC9YYd

Last week, the World Health Organization released their latest report on the connections between processed meat and cancer. They succeeded in confusing a lot of people — including journalists — who were unclear about what, exactly, the report said.

“Processed meats rank alongside smoking as cancer causes – WHO”

“Bacon, sausage and other processed meats do cause cancer – WHO”


A USA TODAY
video that begins,  

“say goodbye to your favorite meats, because having that burger could be as much of a health risk as having a smoke…”

doesn’t exactly clarify.

 

So what’s really true??

A Working Group of 22 international experts from The International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization, analyzed the accumulated scientific literature. It classified processed meat — like bacon, hot dogs, and, sausage —  as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer. In other words, there’s enough evidence, from enough studies, to show cause and effect.

 

What about red meat?

The IARC also classified the consumption of red meat as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect. So there’s not quite enough evidence yet to say without a doubt. And in these analyses, scientists were looking at colorectal cancers – not any other type of disease.

 

So what’s the problem?

It’s in how these statements were communicated by the WHO — they didn’t discuss what’s known as “risk classification.” That created a lack of appropriate perspective by some media when reporting the story, according to Gary Schwitzer, publisher of the website HealthNewsReview.org. The award-winning site evaluates and grades daily health news reporting by major U.S. news organizations.

 

“Risk communication is not easy work. But if you’re going to communicate with the public regularly about health care risks, you should either be damned good at it or get out of the business,” he told me in an email. “Many health care and public health entities that should know better nonetheless do a dreadful job of risk communication. “

 

It’s important for both researchers and journalists to help their audiences put issues in perspective. Schwitzer pointed to this article in The Atlantic which did just that —  it properly reported the results and took the IARC to task for failing to communicate properly.

 

What did this report mean to say?

The bottom line is that both bacon and smoking, along with other well-documented hazards like asbestos, fall into the same group – “known carcinogens.” It’s one of just five tiers that the IARC groups any substance into. Red meat falls into 2A, “probably carcinogenic,” meaning there’s just not enough evidence at the moment to classify it as tier 1.  

What these various tiers don’t do, however, is quantify degree of risk.

“Messages like this one from the World Health Organization need to meet people where they live – as the saying goes, said Schwitzer. “Many people simply don’t know what to do with a report like the one from the WHO. Give up all red and processed meat?  Immediately and forever, or else I’ll surely die of cancer?” Check out this piece by Schwitzer on reporting relative vs. absolute risk.

 

The good news, relatively speaking

Bloomberg View reporter Justin Fox attempts to appropriately frame the report with his op-ed, “Quantifying the risk that bacon will kill you.” He gives an  easy to understand explanation of the differences between relative and absolute risk and cautions, “Information about relative risk can be misleading, then, unless it’s presented in the context of absolute risk.”

 

Vox also does a commendable job explaining the relative risk of eating a burger or a couple of strips of bacon once in a while —  “Specifically, the researchers found evidence that eating a 50-gram portion of processed meat daily (about one hot dog) can increase a person’s relative risk of colorectal cancer by 18 percent. Since a person’s lifetime risk of colorectal cancer is about five percent,  daily meat consumption seems to boost that absolute risk by one percentage point to 6 percent (or 18 percent of the 5 percent lifetime risk).”

 

A companion article chastises the IARC for its confusing communication and points a finger at sloppy journalism by some media outlets. “The trouble is that the IARC uses a very confusing scale for classifying carcinogens. They tell you if something can cause cancer, but not how big the risk actually is.”

 

All other things being equal, that’s why bacon eating isn’t as risky as smoking. Smokers are about 25 times more likely to develop lung cancer than non-smokers. One in every three cancer deaths is attributed to smoking, according to the American Cancer Society.

 

As Vox explained, “The Global Burden of Disease Project attributes about 34,000 cancer deaths each year to diets that are high in processed meat. That sounds like a lot, but it pales beside the 1 million annual cancer deaths attributable to smoking or 600,000 cancer deaths linked to excess alcohol consumption.”

 

Can you see how these numbers create a lot of unnecessary confusion among consumers — and among journalists?

 

So much so that the WHO issued a Q&A to clarify the classification processes and explain that different substances within a group have different relative risks. You need to scroll down to question 9 (!) to find it, though.

 

If journalists are unaware of the IARC’s processes, don’t understand relative vs. absolute risk, or are just going for a clickbait headline, there are bound to be erroneous stories.

 

What’s your reaction to this headline?

Bacon, Sausage Pose The Same Cancer Risk As Smoking: WHO To Give Warning On Carcinogenic Effects Of Processed Meat

Schwitzer recommended that anyone who communicates about health risks read up on Gerd Gigerenzer’s work at the Max Planck Institute in Berlin and its Harding Center for Risk Literacy. “There are people there working full-time on risk communication issues. And there are many lessons available for anyone to read for free online. WHO communicators, journalists, and the general public should read, learn, and improve their understanding. “

 

Incidentally, he added, “they gave this issue the prize for “Bad Statistic of the Month” in an article headlined, Wursthysterie.  (Available only in German on the website).  My own translation of one key line: “Health risks in foodstuffs are turbogenerators of headlines.” 

 

Last week, the World Health Organization released

According to the Advisory Board, almost 50% of those eligible to enroll for health insurance under the Affordable Care Act this year are between 18 to 34 years old. This makes the launch of Open Enrollment 3.0 particularly important to my friends, who text me all the time with their health questions: “Hey, I chopped the tip of my finger off while cooking tonight. Should I go to the ER? Here’s a photo,” is not a strange message to receive when you’re a nurse.

 

Obamacare turned five this year, and open enrollment season, which launched November 1st, turned three. The system has come a long way from its infancy, with healthcare.gov preparing for a whopping possible 10.4 million eligible enrollees for this 2016 season.

 

Enrollment, it seems, is just the first step in creating healthy Americans – many of my friends are covered, thanks to the Affordable Care Act, but they don’t know how to use their coverage, or where to get help when they need it. Health care delivery, or how we get to the providers that facilitate our newly prized coverage, is what my friends are most concerned about.

 

Heath economist and physician-writer, Aaron Carroll, summed up our current healthcare delivery reality in his description of the arduous process that he undertakes four times a year in order to obtain medication for a chronic condition:

“The Affordable Care Act, which seems so complicated to so many, was almost entirely about getting more people in the United States health insurance. That was just a first step, arguably an easy one, and we’re still fighting about it. Reforming the ways in which we actually deliver care and try to improve outcomes? That’s so much more important, and we barely talk about that at all. But that’s what matters to the people who use the system, and it’s why so many of them are frustrated.”

What an incredible statement, considering Carroll’s vast experience with the system as a physician. How do less knowledgeable patients fare?

 

This makes the work of the non-profit The Young Invincibles (YI), especially important. YI is an organization that works to give young people – millennials, specifically – a voice in areas like political advocacy and health. Over e-mail, I interviewed the new YI Northeast division director, Kevin Stump, about his position, YI, their health initiatives, and their new app, HealthYI, which launched this fall.

Kevin Stump, Northeast Director for the organization, Young Invincibles.

Kevin Stump, Northeast Director for the organization, Young Invincibles.

 

I downloaded HealthYI to my iPhone recently. Along with my surprise at how fast it launched (woo-hoo to a low-tech app that doesn’t suck my battery dry), I found that I really liked the program’s simple, ALL CAPS html-ish layout: HEALTH CHECKLIST tops a bold list of four selection options, including MONEY-SAVING TIPS. Fitting, since Federal officials have expressed concern that cost is a reason for Healthcare.gov 3.0 being “tougher” for new-enrollees than in prior years.

 

Although each option leads to some pretty text-heavy pages, HealthYI has some great, basic content for new patients. As a nurse who has treated urban patients of all ages since before the first iPhone was created, I’ll certainly use this at work and with friends looking for a primer on health insurance. The content is welcome; Americans, especially young ones, really don’t know how to be patients, simply because they haven’t had coverage for so long.

 

The HEALTH RIGHTS menu of HealthYI is remarkably comprehensive, with sections pertaining to immigrant rights and LGBT, too. While the SCHEDULE AN ANNUAL PHYSICAL choice doesn’t include my health plan, it looks like a great start, and its platform, which zips through selections without a cinch, will likely appeal to data-restricted young folks looking for a quick and easy guide to understanding health insurance for the first time. Overall, the app is a definitive resource for pointing young people toward the information they need to gain health literacy in an unobtrusive, easily maneuvered way.

 

What stumped me, though, and will perhaps serve as a plausible impetus for launching a league of talented tech-savvy nurse YI volunteers, is the “SEND US YOUR QUESTION!” section. While YI promises to respond within two business days, it doesn’t capitalize on what all insurance companies already provide, and what my texting friends so frequently have no clue about – the oft-overlooked number on the back of every insurance card that leads directly to the 24/7 service of a preventative, available, expert nurse.

Results of a search in the HealthYI app.

Results of a search in the HealthYI app.

 

I was especially puzzled when my query for “nurse” in the search function of HealthYI came back totally empty – nurses might connect, educate on, and speak to all of the possible selections this tool has to offer – from finding providers to answering money-saving questions. In other words, would my friends stop texting me, if apps like this hooked them up with a live nurse instead?

 

Here are some October 2015 excerpts from my exchanges with Kevin, Northeast Director of Young Invincibles, who tweets @KevinStump:

 

Why YI? What, specifically, about the organization interested you?

 

Young Invincibles fills a much needed gap in advocating for and elevating the voices of Millennials, a generation that has too often been left out of today’s most critical policy and societal debates.

 

Millennials were hit the hardest by the Great Recession, and so many hardworking young adults are still facing the ripple effects. Today Millennials still face unique challenges in simply trying to gain an economic foothold – an unemployment rate that is nearly 40 percent higher than the national average, skyrocketing college costs resulting in crippling student debt, and a lack of awareness around affordable healthcare options and how how to use them.

 

In New York and across the country we are tackling these issues and beyond through research, policy, advocacy, organizing, and more. Our perspective must be heard wherever decisions about our collective futures are being made.

 

Tell me about this new YI app — What about it do you think works really well? Doesn’t?

 

The HealthYI app was designed by YI Advisors, Young Invincibles’ non-profit consulting arm, with a number of New York regional partners to bring healthcare to the fingertips of young New Yorkers.

 

This is especially relevant today because young adults are increasingly accessing services via their smartphones.  The app not only provides basic and easy-to-understand resources like a health checklist, tips on how to save money, health care rights and insurance basics, it allows users to schedule an appointment with a healthcare provider or send in a personal question and get an answer.

 

We’re also collecting feedback and watching how young adults use it, as we want to make sure we’re continually adapting and improving the app based on the real needs of its users, so there will likely be more updates and potential new features to come.

 

What’s your plan for getting YI into the hands of those it hopes to serve – young people? What barriers do you face – nationally, but regionally, too?

 

We’re working hard to get the word out there about the new app, with a special focus on reaching typically underserved and low-income communities, which historically have less experience with healthcare options.

 

We are continuing to build new partnerships, for example we’re working with the CUNY University Student Senate and School of Public Affairs to connect this tool to their students. Additionally, we are reaching Millennials where they consume information — on their mobile devices — through a paid social media campaign targeting New York City residents.

 

And we’re already hearing some great results – for example we heard from one young woman who lives in New York City and used the app to find a sports medicine physician after tearing a muscle. She has put it off for the past month because her health care provider’s website is so difficult to navigate. In less than 10 minutes, she downloaded HealthYI and was able to schedule an appointment.

 

A lot of studies are showing that young people, tech savvy ones, even, would rather pay the tax penalty than enroll in insurance because delivery is so poor. Seeing any glimmers of hope on the horizons, or any programs that YI is excited by/pairing with?

 

We know that young adults want and value coverage, and now that affordable options are available to them, they are signing up.  In New York State, 34 percent of those who enrolled in health coverage during the last open enrollment were Millennials, age 18-34.

According to the Advisory Board, almost 50% of