Category Archives: Nursing

OUR ELIMATION PROBLEMS

Judging from the commercials and advertisements, it would seem that we Americans have a lot of gastrointestinal problems and are in need of laxatives and stool softeners. Yes, as we age we may need to take more medications and some have side effects that may affect, or upset our “gi” system in some ways. But more so, our American diet leaves much to be desired, including the need for more fresh fruits and vegetables, and less “junk food”.

But instead of saving those coupons, instead of watching commercials and clipping ads in magazine and newspapers, why not take a dried prune or two. Or if you prefer, a small amout of prune juice. A few sips from those handy little cans may just do the trick. For a lot less money and grief.

When I was hospitalized I was practically “forced” to take colace, which I refused. I didn’t want nor need the cramping sensation and “urgency” to find an available toilet! I requested prune juice, instead of the strange mixture of leftover fruit juice that I was offered with my breakfast. One so called “nurse” even told me that my “…doctor wanted me to have the colace.” To which I responded “I don’t care what my doctor wants. I am a well educated nurse who has studied a year of nutrition as a part of my academic education years ago.”

Who are the Beneficiaries of Prescription Medications?

Certainly not the person who pays for prescriptions and ingests them. Yes; it’s the drug companies and it’s only getting worse. As I age I seem to have more prescription drugs recommended, mostly for minor and /or temporary, diagnoses. And when I ask for generics, I find that their cost is no less, or maybe not much less, than the prescribed medications. I was told today by a reputable pharmacist that generics, when they are first developed, do in fact cost the same as the usual medications. So what’s the benefit in buying generics. Oh sure, I could drive for miles to the big box stores in nearby cities to get a bit of a discount. But what’s the discount in wasting money and stress on fuel to drive around for comparison shopping?

The consumer is certainly not the beneficiary in all of this asking for generics and driving around.

I have been spending on the average of about $500/month on medications, some generic, and some with pharmacy discounts. And I do not have several diagnoses. These are for hypertension, and bladder muscle insufficiency. And a temporary edema of my cornea. And due to lay offs from work in my profession, I have no insurance coverage of any sort, and have finally resorted to living on nothing but Social Security benefits, having exhausted my retirement savings, after only 5 years into a forced “retirement”.

I don’t think I am the only one in this dilemma. Any ideas to share with me and others? Yes, AARP offers plans to somewhat solve these problems, but they can be costly as well, deducted from my Social Security benefits!

I recognize two societal problems that need to be dealt with, though both are long term problems ingrained in the core of our economic system.

First, physicians are “trained” by the pharmaceutical industry to treat every ailment with drugs when a sometimes simple lifestyle adjustment can solve a problem. An example: prescribing laxatives and stool softeners when an ounce or two of prune juice is just as effective. Another example is recommending an over the counter drug like prilosec when avoiding acidic or fatty food might be just as effective.

Secondly, some action, perhaps governmental, must be taken to control the costs charged by the pharmaceutical companies. Why do they choose to WAIT before lowering the cost of a new generic? Obviously to make more money awhile longer, certainly for no reason that benefits the consumer.

moms and cell phones

It is well known among child development specialists that “en face” contact and communication is very important for bonding between mother and baby. But it seems like the ever present cell phone is more compelling than a mother’s new baby, sometimes. I find it annoying to say the least when i see moms out for a walk with their new babies, mom’s face turned to the back of the baby’s head, while mom talks on her cell phone. Could these conversation be more important than talking to a young child who craves contact, hearing a mom’s voice, learning his or her earliest sounds and words and songs?

I want to just scream at these mothers “is that call really so important?” I honestly doubt that it is. Sure, I may be over-reacting. Maybe a new baby is not as exciting as it was in the 1980s when some of us “aging moms” who postponed having children for our careers were so enamored by this great event that we had waited for? We were the “supermoms” or tried to be. And there were no cell phones so i can’t do a study to compare…

To your health! Screening Tests

Awhile back, in March of 2010, NPR reported about the “Prostate Test: Lifesaver or Big Mistake?” I sent an email to my sons telling them that they should be aware of this, since testing, I assume and hope, will eventually be recommended to them, and to all men…
…like with breast and cervical cancer screening for women….The important aspect to remember is that screening is just that: screening. It is NOT DIAGNOSIS. It means RISK, not disease (like I repeatedly said in my previous work in newborn screening for genetic diseases).
Screening may need follow up. Please do follow through.

If you can’t afford them, ask the provider if they are available at reduced rate, or for free. Or call you local health department.

Take advantage of all screening tests that are available to you. That’s the bottom line!

what do you do with a fractured leg?

earlier this year i fractured my right leg. and then due to imbalance, i fell and fractured my right shoulder. what wonderful luck! but:

when i saw the orthopedist who diagnosed my leg fracture, he said that my right leg was now 5.5 mm shorter than the left leg. i asked what could be done. the answer “nothing”. so i was to hobble around with this limp for the rest of my life. i guess so. adjust.

i spoke with the orthopedist, the nurse in his office, the sociall worker. no one had any advice or resources to recommend. why? are they irresponsible? is it the state of health care today? why are they working in this specialty. so, as usual, i had to be my own resourceful advocate. and if it weren’t for my status and experience as a health care professional, i would be lost, having expected comptetant “professionals” to help me through this.

what i found: Feet Relief. com. they provide “in soles” for your shoes that can provide a “lift” and support. that, for me, was a temporary correction. and now i have found a company that makes all kinds of orthotics. they say that they can make for me shoe inserts that accomodate my right leg shortening, and can be purchased for all kinds of shoes. (i find athletic shoes to be comfortable and provide the best support.) well i need different kinds of support. i don’t want to wear athletic shoes to that “little black dress” occasion. so this company will apparently also create orthotics to accomodate sandals and dress shoes.

so why am i complaining? the orthotic company cannot make an appliance without an rx from my primary care md or the orhtopedist. try getting a message to them, and request that they fax an rx to the orthotic company. round and round we go. till i suppose i get furious this week and walk sweetly into their offices and ask for the referral (just please make a copy of the damned initial referral) while i wait, thank you.

What is an RN? Really Nothing.

What is an RN? Really Nothing.

Yesterday I had a call from an old friend who was disappointed that her nephew’s wife dropped out of nursing school. I think it was the best decision she could have made. Health care in this country is in such chaos right now; no funding for anything meaningful. I was looking at the ads in the Sunday paper today. I find it interesting that they all say “RN or LPN or CNA”. So they are interchangeable now? One of my reasons for being unemployed is that people see my resume and laugh. I have a bachelors and two masters from three of the best universities in the country. Nobody wants somebody like me anymore. They want technicians, not people who think and are creative and innovative. So I guess I have to keep looking for work at grocery stores and flower shops to supplement my social security checks. As you know, there is no work out there.

Finding Work; Declining Work

My premise is that there is less expected of health care professionals today. Is it just in this state, that I moved to 3 years ago? I think not. Professional positions that not long ago required at least a bachelors degree, if not a masters, now require an associate degree, or any educational level that provides the person with some very basic education and the employer can pay a LOT LESS in salary.

I see this trend not just in my profession, but in many, many professions. Yet we are told  that our economy is strong and there are lots of jobs! Sure, for slightly more than minimum wage, very limited or no benefits, and no job security. More and more I see contracts for a limited time vs. the days of longevity meaning you can invest in a retirement plan and your position is relatively secure. I live in an “at will” state which means you sign a paper,  a contract, which states that you can be terminated, at any time, without notice, with no warning and no reason given. On the other hand, you, the employee, have the same privilege. And I have exercised this right twice this year. Why?

 Now employers are looking for “technicians” or “specialists” which in health “professions”  in this state, means a student, or an entry level worker,  who wants to earn a few dollars, with no higher goals, ambitions for professional growth.

 In support of my observations, I must say that I have found that the attitudes of those doing the hiring and firing has become very vindictive and demeaning. Perhaps because the ones “in charge” who have been promoted to the role of supervisor or manager are not qualified, educated, nor experienced for their role. Their communication skills seem to be nonexistent. ?the old “peter principle” at work again?

Do We Really Need These Drugs?

Until I was hospitalized 1 1/2 years ago for a perforated ulcer,  I was only on one daily Rx medication: the  one pill for keeping my hereditary “borderline” blood pressure under control. However, my “provider” felt she needed to add a calcium supplement to prevent osteoporosis and aspirin to prevent a heart attack and a decongestant, in lieu of just standing upright and blowing my nose. And then, during the hospitalization, Protonix was added (I can live with that). As was Norvasc which resulted in severe hair breakage and loss. I just dumped that one. And a bunch of drugs that caused fluid retention and more drugs to cope with constipation (which I never experienced). Lots of drugs prescribed; few that I took.

Now why did I need all these drugs, and even more that I just didn’t take? Well you know my bandwagon about the pill pushers in this country. And why did I even have a perforated ulcer? Too many inappropriate drugs prescribed for back pain., osteoporosis, nasal congestion!  (I have idiopathic scoliosis and a spinal fracture which didn’t bother me at all for many years when I lifted heavy  bags of books).

So now, without health insurance (yes; one of the 47 million Americans), I am trying more and more to reduce any of this junk, these chemicals, that I put into my body. Why? The side effects. And the cost!  Maybe it is my BP med that is making me a little tired , not the aging process? By the way, the insurance company DID NOT PAY FOR ALL OF MY HOSPITALIZATION AND MEDICAL CONSULTANT EXPENSES.  Surprised? I had to. After a “lay off” due to downsizing at work, with no income, and no insurance. (even though I had worked as a manager for a HEALTH insurance company!). Who pays for all these medications? I go to a local neighborhood clinic that is low cost, for the blood pressure med. But anything else? Well check into Partnership for Prescription Assistance (PPA). They have been most helpful with the drug that will prevent another ulcer.

 As a health professional, I have encountered patients/clients/members who are on as many as 21 medications each day. This is incredible. Who is monitoring this regimen? How can  people keep this straight? How do you do this? And what is really necessary? And what interacts with what other medications?   Contraindications? And what are the side effects? And who is helping to monitor this? No one. Does your doctor/provider/”prescriber” have time to do this? Of course not. And what if all these medications have the resultant side effect of confusion?

 Oh! The answer! Health insurance companies are now providing programs like healthy living support programs that  have nurse case managers who give advice to “members”. The nurse case managers are the gate keepers who help the “members” manage their medications (often from many states away) and keep costs down for the insurance companies (don’t go back to your doctor’s office! that will be a bill that the insurance company will be expected to pay). Just call me, your case manager. the nurse case manager  can talk with you after he/she enters your data into 47 computer  screens.

 So what to do? Think about who you vote for in the next election, and why. No; we don’t need another layer of bureaucracy. We need a WELL THOUGHT OUT PROGRAM FOR NATIONAL HEALTH INSURANCE. So that we can be as progressive as other developed countries. This is just one little step. Think about this.  Don’t just go along with a candidate who says she/he supports health care. You need to look way beyond that kind of statement. What is really in mind? What kind of program? Managed by whom? Who will be in charge? Who will do the oversight? THINK!

The Nursing Profession: Is this one that you would want for your children?

I am sure this article, and I will try to keep it brief and not too inflammatory, could really upset some folks. But I make my statements following 39 years in my profession, with a lot of observation, experience, and education.

There is nursing education, and then there is nursing education. I happened to be an undergrad student in nursing at one of the leading universities  in the country in the 60s. We worked at being professionals, taking courses along with med students. We wanted to be the best of the best. And those that didn’t succumb to organic chemistry and anatomy and physiology persevered. Our class diminished from 300 to 99 over four grueling years! But as the years have gone by, I have observed the disintegration of this professional education.

In the state where I now reside, continuing professional education for nurses is not even required. How embarrassing to the profession. Just send in your 50 bucks each year. It wouldn’t take much science to figure out where I live. Not that it matters. My first position in this state was to spend 2 months teaching maternal and child health, because if I had not been hired that summer, the students would not have been able to graduate in the spring. This was an LPN to RN program. I had 12 students (4 men; 8 women). I tried so hard to motivate them to look toward higher education, to think about what opportunities they might have in their careers. But their sole motivation seemed to just make a few more dollars in the hospital. I found this most disappointing.

And maternal and child health? I was to follow a rigid curriculum and monitor clinical practice. The curriculum was labor and delivery, with clinicals in the hospital. No curricula about maternal health. No curricula about child growth and development.

In my work since then, I have met some young nurses who are truly enthusiastic, motivated, wanting to grow professionally, hopefully into a specialty. I would do anything to help them, even if all it means is a great letter of reference and a lot of support. It is of interest that they came from major universities, but not in this state.

I am still trying to make sense of this state that I have been living in for 3 years. Is it the education in this state? Is it the value system of this state? Or is it a more systemic problem that I have lost track of, despite my staying on top of professional literature. The political climate? At any rate, would you really, in good faith, encourage your child to study for the nursing profession? Is it even a “profession” anymore?

 Well here is my arm chair diatribe, and again, I would like to say, I have no intent of offending anyone, but I am very disappointed in most of my nursing colleagues. Which explains, to a degree, why I left 3 positions this year. I was embarrassed to work for colleagues that I could not respect.

More About Diagnoses And Pharmaceuticals

To those of you who have read my blog, I apologize for repetition. But some issues just don’t go away.

I just heard an ad on tv for health insurance plans to supplement what medicare offers. First of all, just what does medicare offer? And what about the 47 million of us who have no health insurance and are not yet ready for medicare? The ad was about a certain supplemental insurance company, and it was recommended that you discuss this plan with your “doctor” who will help you decide if this plan it right for you. Yah sure! Since when do “doctors” recommend health insurance plans? Well, someone is getting a kick back here from an insurance company. You need to count on your friends and colleagues for this kind of advice: not your “doctor” and not the insurance companies!

All research must be taken with a grain of salt. I was recruited, years ago, for the Nurses’ Health Study. After filling out their questionnaire, I received a letter informing me that I was ineligible as a participant since I had taken steroids. I had  never taken steroids in my life! I didn’t write back because I didn’t have the time (full time working mom, grad student, with two little boys). So now I look at all health care research with more acute skepticism.

As for HRT (Hormone Replacement Therapy), I did that for about 5 years, then quit cold turkey because my gynecologist told me she could not in good faith prescribe it anymore. I have a friend who has been “tapering off” HRT for the 3 years I have known her. Tapering off HRT? No need to. Doing this will not affect your blood pressure and heart rate, and will probably do nothing except have you discontinuing HRT.  I can only suspect that her gynecologist is her age as well, and the looks of skin and hair are more important than the total health picture? Or maybe not? Maybe it doesn’t matter if we do HRT or not? Once again, conflicting conclusions from research.

There is a lot of spurious, and confounding, information in these studies…I am a medical professional, but also a skeptic. I have attended prestigious universities, have worked at prestigious universities. But that doesn’t mean anything. What is important is the integrity of their representatives,  their scientists, of their reporting of results of their studies. They need to be honest, not just writing what the public wants to hear.

So now we need drugs to fall asleep, drugs to stop restless leg, drugs to make us “regular”? Soon we will need drugs to wake up, get our legs going, and be able to use the bathroom normally?

Have we forgotten to eat a normal, well balanced diet, with fiber,  that would prevent some of these “problems” in the first place? Have we forgotten to just go to sleep to some nice music at 10pm after walking the dog in fresh air? And though I am lax myself about taking vitamins, popping a pill or two each day, if it doesn’t burn up your stomach (drink plenty of water), you won’t have legs that fly around or get stiff and achy, most likely.