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Ann Neumann

Ann Neumann

Barbara Glickstein interviewed Ann Neumann,  Editor, The Revealer at New York University’s Center for Religion and Media on August 11. 2011. The segment has been archived on WBAI.org here. Neumann has written about religion and health care for The Nation,  AlterNet (where she also blogs), Religion Dispatches, and Killing the Buddha. A hospice volunteer, she keeps the blog otherspoon, devoted to issues surrounding religion and end of life care.

This is part one of a two-part series. The second segment will be aired on Thursday, August 25 at 11 PM.

[caption id="attachment_10376" align="alignleft" width="300"] Ann Neumann[/caption] Barbara Glickstein

incentives-pay-for-performance1Strikingly, nurses saw the potential of such incentives (and disincentives, such as not paying for care needed for hospital-acquired conditions–bloodstream and urinary tract infections are two examples) in improving the quality of care patients receive, but their fear was that they could potentially lay the blame for poor performance on at the feet of nurses. Maybe nurses are not delivering the quality of care that patients need and should assume blame. But if one takes a systems perspective and recognizes that most nurses have too little say over staffing ratios and their work environment (inefficient and unsafe systems of care), then their fea may be well-founded. Think about the CEO of a hospital that has a higher-than-average rate of pressure ulcers, a condition that is often attributed to poor nursing care. As the hospital loses the revenue to cover the care of hospital-acquired pressure ulcers in Medicare patients, the CEO decides to cut nurse staffing to balance a budget with declining revenues and increasing expenses. The cut in nurse staffing leads to even poorer outcomes, as has been demonstrated in study after study. But the hospital leaders in this study were statistically less likely to view PFP as potentially leading to blaming nurses for poor peerformance.

Almost one quarter of the nurses in the study saw PFP as a burden, often in terms of increasing documentation, additional personnel needed to manage the data and reporting requirements, training of staff, etc. Only 10% of the hospital leaders spoke about PFP as being a burden.

The study has significant implications for policymakers and hospital administrators. For example, Kurtzman and colleagues note: “Nurses, who bear major responsibility in the adoption of these policies, may be vulnerable to expanded workloads and negative work-environment effects” and calls for Medicare to bear some portion of the costs of investing in the infrastructure that will be needed to manage and minimize any burdens that may be associated with PFP.

The authors also call for building non-punitive work environments and that the effects of PFP be evaluated. This latter recommendation needs to include looking for unintended consequences of the policy.

This study is also significant because most discussions of PFP seldom mention nurses. It’s time to heed the IOM’s recommendation that nurses be at all decisionmaking tables in health care, including in hospitals and other healthcare organizations. Kurtzman and colleagues concur. How do we get there?

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing and Co-Director, CHMP

Strikingly, nurses saw the potential of such

Maria E. Robinson, RN, BSN, MSN is a community /public health nurse in Maryland. She is Chair of Community Events for the National Association of Hispanic Nurses. . This June, she completed CHMP’s Media Training as a “Nurse Messenger” funded by AARP’s Center to Champion Nursing. This is her first guest blog for CHMP.

diversity-in-healthcareAccording to the Centers for Disease Control and Prevention (CDC) there are close to 1.2 million people living with HIV today in the United States and 20%, or close to 200,000 people, are undiagnosed. If you don’t know you’re infected you can’t be treated. If your HIV positive and don’t practice safe sex you can infect others.

This past June, I participated in The City Uprising Event which was sponsored by The JACQUES Initiative of the University of Maryland School of Medicine (UMB SOM) and Project SHALEM in conjunction with many community and faith-based organizations in Baltimore, Maryland.   Organizers identified seven communities where they would focus their programming to raise awareness about HIV/AIDs. Each community would focus on educating the community about prevention, provide HIV testing and make referrals for services as needed.

I spent the entire day volunteering at the Esperanza Center in Fells Point, Maryland, a predominantly Hispanic community with residents from El Salvador, Mexico, Panama, Honduras, Columbia, and Puerto Rico. The Esperanza Center is a community health center providing health care to low income uninsured people.

Along with other people in the community, I stood proudly in my City Uprising volunteer T-shirt and distributed flyers outside encouraging people to come in and be tested for HIV and syphilis. As a Spanish speaking nurse my role as translator was critically needed throughout the day to translate for the non-Spanish speaking HIV testers and counselors so they could communicate with the mostly Spanish-speaking community members.  We encouraged people to come in on their way to work or to stop in on their way to the grocery store or market. We promised them there will be no waiting; thanks to this well organized and well staffed event we delivered on that promise.

We offered a free boxed lunch to everyone who was tested. I overheard several people say that it was a good to get tested but getting a free boxed lunch was just as important. For some people it may have been their only meal that day.

There were many stories about the people who came to be tested. Each person’s story matters. One man who arrived to be tested was dressed in torn clothing, had poor hygiene and was drunk. His speech was incoherent. He lost his balance and fell to the floor in front of us.  Another volunteer and I helped him up and escorted him to be evaluated by the health care team including the on-site substance abuse counselor.  This encounter also required a Spanish translator and I stayed with him to assist in his care. He was referred to a drug treatment center for follow-up. While translating for a young Latino man I learned he had been a victim of sexual violence when he lived in El Salvador. The counselor arranged an appointment for him that same day at a STD clinic where he could get comprehensive care and another volunteer drove him to the location.

This day, like almost every day, as a Hispanic community/public health nurse who works in largely Hispanic communities, I was reminded of how important it is to advocate for a more diversified health care workforce in our country. I am proud to be a member of the National Association of Hispanic Nurses (NAHN) that works to recruit and retain a nursing workforce that reflects the communities of our nation. These goals work to assure quality healthcare for Hispanic residents.

It was an exhausting but satisfying day… I ended it with a delicious meal at a local Salvadorian restaurant with my good friend, which was nourishing for my mind, body and community/public health nursing spirit.

Maria E. Robinson, RN, BSN, MSN is