Let’s talk about pain

A while back I published several articles on pain and opioid use.  I wrote these article to shed light on the other side of the pain and opioid use debate that seemed to me to be very one-sided.  And while opioid abuse has undoubtedly destroyed many lives, what concerned me most was the focus on opioid abuse without equal time being given to the estimate 25.3 million Americans suffering from chronic pain (8/11/15 NIH press release).

That said you can find my articles on the issue here

Nov. 2011 – Working Nurse Magazine – Chronic Pain: What nurses don’t know about pain management WNM Chronic Pain1 copy

Sept. 2012 – Working Nurse Magazine – The Great Opioid Debate: Balancing the need for pain management with the potential for abuse — WNM The Great Opioid Debate1 copy

May – Apr. 2014 – Working Nurse Magazine — The Opioid “Epidemic”: Why we need to dial back the sensationalism and find common-sense solutions — WNM Opioid Epidemic1 copy

Enough is enough

Since April of last year there has been the constant drone from the California Nurses’ Association (CNA) and their supporters of “just let the Huntington Memorial Hospital (HMH) nurses vote”. Elected officials such as Congresswoman Judy Chu, Pasadena City Councilpersons, Gordo and Tornek, former Pasadena City Councilperson Robinson, various “community leaders” and others have picketed the hospital, held rallies, written letters to the editor and what not echoing this simple plea. However, when the vote which was held in April 2015 showed that a majority of HMH nurses voted no to having union representation these same individuals who claimed they were only interested in the HMH nurses getting to vote suddenly had a change of heart and cried foul, demanding that the vote be stricken and a new vote taken even though well over 90% of eligible HMH RNs came out to cast their vote.

As expected both the CNA and HMH leadership filed charges with the National Labor Relations Board (NLRB), each claiming that the other side had made one type of violation or another. The NLRB rendered numerous decisions, some in upholding the CNA claims and dismissing others. In the meantime the campaign to disparage the care at HMH continued unabated. Even after the CNA and HMH agreed to set aside the vote and hold a new election there were those CNA supporters who seemed unable to control themselves and continued their attempts to vilify HMH and its leadership.

One such person is an individual named John Grula, PhD who writes a column for the Pasadena Weekly. He’s most recent diatribe against HMH can be found here – http://www.pasadenaweekly.com/cms/story/detail/outbreak_of_truth/16130/.

He makes many claims in his article, which on their face sound absolutely outrageous. Claims such as CNA-affiliated RNs provide the best patient care in our state. To bolster this claim he brings up the Olympus scope and how the failure to properly clean them lead to bad consequences for many patients. He goes into great detail about these incidents that occurred at HMH, but failed to mention that there were at least two other LA-area hospitals that had similar outbreaks and breeches in reporting such outbreaks. One such hospital was UCLA Ronald Reagan Medical Center, which ironically he cites as having CNA-affiliated RNs that provide the best care in our state.

At the beginning of Grula’s article he cites a June 1, 2016 LA Times article which if you don’t read beyond the first paragraph paints a dim picture about how HMH handled the drug-resistant Pseudomonas aeruginosa. However, if you read the full article, which you can find here — http://www.latimes.com/business/la-fi-huntington-hospital-scopes-20160601-snap-story.html, a slightly different picture emerges. The article lays out the problem was not just at HMH, but at hospitals across our nation, it also lays out the steps HMH took to correct the matter.

His article goes on to mention the firing of two HMH nurses, which the CNA and their supporters claimed was in response to the nurses’ pro-union stance and unionizing activities. He then writes that the NLRB agreement rescinded their termination, removing any mention of termination from their employment record, that they received back pay and that one nurse had returned to HMH. While some of his statement is correct, he fails to mention that while any mention of their termination was removed from their employment files notating instead that they had voluntarily resigned. Grula goes on to claim that one of these nurses chose to return, but my research shows that the nurse he claims returned to work at HMH, hasn’t. The reason for this appears to be related to the NLRB agreement, which bars both nurses from ever working at or having any business with HMH now or in the future. Not to mention that I know that at least one complaint has been filed with the California Board of Registered Nursing (BRN) about the nurses and the possible violation of our nurse practice act. Several weeks ago, I learned that several HMH nurses have admitted to being questioned by the BRN. Now whether this goes anywhere remains to be seen.

In the end, I find it ironic that the CNA and their supporters continue to rant and rave about giving the HMH RNs a voice, but seem to ignore that their “victory” at having the HMH vote overturn effectively gaged the voice of the 539 HMH RNs that voted no to union representation. Throughout this entire contested voting period the CNA and their supporters seem to only advocate for the 445 HMH RNs that voted for union representation and minimize the fact that a majority voted not to unionize.

Where are the CNA and their supporters speaking out in support of these nurses? Nowhere I guess, because it would appear to me that the CNA and many of their supporters appear ethically and morally challenged to acknowledging that these RNs might actually feel that they don’t need a nursing union to speak for them.

You may recall that back in September of last year I blogged about at least one complaint being filed against Nurse Allysha Almada and Vicki Lin with our Board of Nursing (BRN). It’s come to my attention that BRN investigators  have interviewed several Huntington Memorial Hospital (HMH) nurses regarding the Almada/Lin affair.

At this point I have no idea what these nurses told the BRN investigators or what questions that the BRN investigators had for the nurses. However, as I learn more I’ll be sure to share the information on The Nurse Unchained. Of course the BRN investigators may conclude that there wasn’t a violation of our nurse practice act in which case the allegation can be closed with or without merit. However if its decided that the allegation is substantiated then the allegation can be refer to the Attorney General for formal disciplinary action or refer to cite and fine. This is call an accusation and if a nurse has an accusation filed against him/her it will show up on a license search.

You can learn more about the complaint process by pointing your browser here

Also point you browser here for my article on the California BRN WNM California BRN1

Our local paper recently published an article about two Huntington Memorial Hospitals with the claim made by the nurses that they were fired due to their union activity.  However there’s more to the story and below you’ll find both the link to the above mentioned article and my letter to the editor — that the Star News chose not to publish.  I think they were afraid to encourage their readers to think beyond the pablum the union was spoon feeding to both the paper and its readers.

Huntington Memorial terminated 2 nurses; both claim retaliation for efforts to unionize

Dear Editor:

Nurses Almada and Lin with the help of the California Nurses Association (CNA) held a rally to demand that Huntington reinstates the two nurses. The claim is that these two nurses were unfairly terminated due to their support of the recent failed unionization effort at Huntington Memorial. If what they claim is factual, then shame on Huntington Memorial.

However, as a nurse with more than 40 years of experience at all levels of the nursing ladder I’m somewhat hesitant to take their tale at blind faith. Why? Because the hospital is bound by confidentiality in all personnel matters and Almada, Lin, and the CNA know that and are counting on Huntington to adhere to this code. Meanwhile, they can sling all the mud that they want, which they’ve been doing over a year now with support from much of the local media and many local officials who enjoy union support.

I’d prefer to wait and see, because something tells me that there’s more to the tale of the firing of these two nurses than just their involvement in the failed unionization attempt. My nursing instinct tells me that these two nurses may have failed to adhere to our nurse practice act and if this were the case then firing them would’ve been the appropriate action. I also think it is interesting that they’ve made a big deal about going to the NLRB, but said nothing about filing a complaint with our state’s labor board. Not to mention it’d be an act of ultimate stupidity on the part of Huntington to fire any nurse at this time except for cause.

On Monday, August 24, 2015, the California Nurses Association (CNA) held yet one more of their dog and pony shows. This time the subject of their display was the firing of two Huntington Memorial Hospital RN’s.   The nurses, Allysha Almada (CA RN License #802190) and Vicki Lin (RN License #832090), claim that they were fired by Huntington administration for being vocal about their support for a nursing union, a union that if the nurses voted in favor of (which they didn’t) would have been represented by the CNA. Want to check an RN’s license all you have to do is go to the California Board of Registered Nursing (BRN) website here – http://www.rn.ca.gov/online_services/perm-verif.shtml and click the big grey button marked “click to verify a license” and you can check not only if a RN is licensed but pretty much any health/medical profession that is licensed in our state.

Depending on which newspaper you read somewhere between two dozen to 50 nurses/people came out in support of the reinstatement of Almada and Lin. However, if my many years of experience (all up and down the nursing career ladder) has taught me anything, its that sometimes there’s more to the story than what meets the eye – and that would appear to be the case with Almada and Lin.

I’ve learned that at least one complaint has been filed against Almada and Lin. The complaint has been sent to the BRN, the licensing body in our state that has oversight of nearly 400,000 licensed RNs and is responsible for investigating allegations of misdeeds, accusations, etc., lodged against a California RN. So, what pray tell could the complaint be – well it’s not about Almada and Lin’s support of a nursing union for darn sure!

The complaint alleges the following:

  • Nurse Almada provided her username and password to Nurse Lin
  • Nurse Almada provided this in the form of a note, which was later found in a patient’s medical record, and perhaps the most serious of charges
  • Nurse Almada did this so that Nurse Lin could use Nurse Almada’s username and password to confirm as a second “signatory” that Nurse Almada had double-checked a medication that required two nurses to check-off, without Nurse Almada actually being present and having actually verified that she had indeed confirmed that the appropriate amount of medication had been titrated/drawn by Nurse Lin.

If indeed, Nurse Almada did as alleged and Nurse Lin “signed” as Nurse Almada as alleged in the complaint then it would appear to this nurse that they clearly violated our nurse practice act, not to mention potentially placing a patient in harms way – because the medication that was being administered could be deadly – which is why our nursing protocols call for the first nurse to draw the medication and check that the amount is appropriate and for a second nurse to come and verify that indeed the medication is the appropriate medication and that the appropriate amount is about to be administered. Remember the “rights” — the right patient, at the right time, and so forth.

What’s the big deal about requiring two or more nurses to verify that the appropriate medication is about to be administered to a patient, simple some of the medications that a nurse administers can KILL their patient and nurses are only human and can make a calculation error, inadvertently draw too much medication, misread an order and so forth, so nursing protocols require that certain medications such as insulin, heparin and others require a two nurse protocol. Because too much insulin can kill and too much heparin and your patient can bleed out of every orifice of their body. So the two-nurse protocol protects both patient and nurse and to circumvent this safety protocol is unconscionable.

The question that now begs to be asked is how come the CNA is demanding the reinstatement of two nurses that allegedly engaged in acts of what would appear to be not only the falsification of a medical record and the possibility that these two nurses engaged in an act of patient endangerment? I guess, when the rubber hits the road patient safety isn’t what concerns them as much as holding press conferences that continue to spread their propaganda and accuse Huntington Memorial Hospital of being a “bad” hospital that’s mean to its RNs on staff.

A lot’s been “said” in print about the recent vote to unionize/not-unionize the RNs at Huntington Memorial Hospital (HMH). If you’d listened to the California Nurses Association (CNA) and many of their vociferous supporters you’d think that it was HMH management that was trying to suppress the vote, but you’d be wrong. You may wonder how I came to this conclusion, simple by looking at the outcome of the NLRB-led and supervised April 15th – 16th election. The unofficial outcome of the vote was as follows – 539 No to 445 Yes with 176 Challenged ballots. There are 176 ballots left to be counted and were challenged by either HMH or the CNA, which is their prerogative. However, if you’re a “true believer” of the CNA party line you might assume that it’s HMH that has challenged the lion’s share of the 176 ballots, but you’d be wrong. It’s my understanding that HMH has challenged only five that’s right five of the 176 challenged ballots, leaving 171 votes challenged by the CNA, that’s right the CNA is the side that has chosen to challenge the largest number of ballots. On the bright side, it looks like pretty much every eligible RN who was entitled to vote did just that with only about 40 nurses abstaining. This, in my humble opinion, is proof that contrary to the heated rhetoric of the past several months show that the HMH RN’s felt free to vote! Now why would the CNA, the nursing union that kept spewing the “just let the nurses vote” mantra at every media source they could find and painting HMH as some kind of boogey man when it came to the nurses voting on the issue of whether or not to unionize, challenge so many ballots? Why, because they feared that the majority of these 171 ballots were not in favor of the union and thus their strategy was to challenge these ballots, thus hopefully swinging the outcome of the vote in their favor. However it would appear that this strategy might have backfired. We should know the final results on April 27th and if the NO votes win the day the CNA will of course respect the nurses will – NOT! They’ve already made it clear (just take a peek at their newest flyer handed out the very next day – CNA Flyer) that they plan to continue their campaign to unionize the RNs at HMH – so much for “just let the nurses vote”. Hypocrite, thy name is the CNA.

I would hope that Professor Dreier is a better fact checker of his instructional material than he is of his columns, because in his above entitled column he failed to fact check the statements about me provided to him in all likelihood by the California Nurses Association (CNA).

Not only does he mangle the name of my company (it’s Solutions Outside the Box, not Outside the Box Solutions), he also falsely accuses me of having been hired by Huntington Memorial Hospital (HMH) to as he puts it “to harass and intimidate nurses and undermine their organizing efforts”. I’ve not received, been paid, promised, etc., a single red cent by Huntington Memorial Hospital. I’ve also not engaged in any way shape or form to harass or intimidate any HMH nurse. The CNA (whose leadership fears me as well as any nurse willing to stand up to their machinations) is always happy to spread lies and untruths – in short they know that I’m not being compensated but they are happy to say I am because more often then not the folks that support them (like Prof. Dreier) don’t bother to fact check the information that the CNA spoon feeds them.

Prof. Dreier goes on in his column to illustrate, as so often happens when ideologues from either side of the political spectrum get their “panties in a wad” to tell the tale of woe of their favorite side and ignore the experiences from the other side of the discussion. So, since Prof. Dreier’s fact checking is lacking let me set a few things straight.

First, I was contacted by several HMH nurses that wanted to learn what their options were to avoid a union. In that spirit, I met with a group who came on their own time and dime to learn what resources and recourses they had to provide a counter-point to the “let’s join a nursing union” advocates. They didn’t pay me a red cent. I did however secure the domain name of their group, IStandWithHuntington.com to ensure that it couldn’t be co-opted for other uses, but it’s the IStandWithHuntington nurses that run it and moderate it.

Second, I know that many of the “we don’t need or want to join the union” nurses have shared stories of being followed, tires being slashed, secure areas (key-card accessible only areas) doors of the hospital being propped opened with orange traffic cones bearing the name of hospitals other than HMH have been reported. One nurse who has vocally opposed the CNA returned to her station to find that someone had left feces on her chair. In case you think she imagined such a disgusting act, a third party observed a pro-union nurse committing the act. As for the incident that Prof. Dreier states occurred in the HMH cafeteria, I understand that there is a video of the event and from what has been described to me the pro-CNA nurses weren’t just sitting politely at a table, but instead were blocking egress to the cafeteria and one of their supporters went so far as to go over to the IStandWithHuntington group in a confrontational manner to verbal abuse the nurses for not coming along with the program. So it would appear that there might be bad actors on both sides, which is why such a campaign often leaves open wounds in its wake regardless of which side prevails.

Third, Prof. Dreier parrots the plea for “just let the nurses vote”, but what he fails to inform his readers is that the CNA doesn’t want to let all eligible nurses vote, they want to pick and chose which nurses can vote and they do this by challenging a particular nurses’ vote. When the NLRB called the election the first thing the CNA did was challenge the right of the Patient Flow Coordinators (PFC) to cast a ballot. The NLRB didn’t agree and said the PFC’s could vote but that their ballot would be a different color (a Scarlet letter so to speak), segregated from the other ballots and only counted if the vote was close. Then the CNA, not happy with this, made it clear they planned to “challenge” some of but not all of the PFC ballots – guess which one they didn’t want counted. Finally, the CNA declared that they didn’t want any PFC ballot counted, even though theses nurses if the CNA prevailed would fall under the CNA representation. So I guess when the CNA stomps their feet and shout “just let all the eligible nurses vote” what they really meant to say was “Just let the ones we say have the right to vote, cast a ballot”.

Back in the day when I was a professor of Nursing the need to fact check our information was considered paramount. Perhaps the same exacting standards aren’t required for Prof. Dreier’s department of Urban & Environmental Policy or Occidental College – one would hope not.

You can read Dreier’s column here – http://www.huffingtonpost.com/peter-dreier/huntington-hospital-nurses-defy-union-busting-campaign_b_7051072.html

By Genevieve M. Clavreul, RN, Ph.D.

Working Nurse Magazine

I know that for a lot of nurses, talking about politics is about as appealing as going to the dentist. However, legislation and policy decisions can shape the way we practice at every level, sometimes dramatically. That’s why it’s important for nurses to pay close attention to proposed laws or new regulations affecting our profession.

Let’s take a look at some current healthcare-related measures and what they could mean to you.

Opioid Restrictions

If you or any of your patients suffer chronic pain and have a liver condition that contraindicates acetaminophen (the active ingredient in Tylenol), you should be very alarmed by S.2134 and H.R.4241.

These bills, prompted by the recent fear-mongering about prescription opioid abuse, would ban Zohydro ER, the only FDA-approved opioid that doesn’t contain acetaminophen. The legislation would also prohibit the FDA from re-approving Zohydro “unless it is formulated to prevent abuse.”

Aside from its impact on chronic pain sufferers, this attempt by some members of Congress to usurp the function of the FDA would set a frightening precedent. If Congress can summarily ban a drug that’s already passed the FDA’s approval process, what’s to prevent legislators from banning other approved drugs, like contraceptives, in hopes of scoring political points? I shudder at the potential consequences.

Safe Staffing Ratios

There’s brighter news in the area of nurse staffing requirements. As most of us know, California has had mandatory nurse-patient staffing ratios for the past decade and Congress is now considering national requirements.

The federal Registered Nurse Safe Staffing Act (H.R.1821 and S.2353), which would apply to all Medicare-participating hospitals, is quite different from California’s rules, which mandate specific ratios for each type of unit. Instead, the proposed federal law would require each hospital to establish a committee — at least 55 percent of which must be RNs providing direct patient care — that will create staffing plans based on patient acuity, staff experience and other factors.

Longtime readers know that I’m very critical of California’s “one size fits all” approach to staffing ratios. I strongly believe that an acuity-based system makes more sense, allowing managers to match nurses to patients based on the nurse’s skills and training rather than arbitrary legislative dictates. The federal law would also give nurses a greater voice in those decisions.

Unfortunately, these bills wouldn’t change California’s current requirements. If this law passes, Medicare hospitals in our state would still need to organize the required committees and create staffing plans, but those plans would have to comply with existing state laws.

Lab Result Reporting

Till now, patients have always been told, “The doctor will call you when your test results come back.” However, in February, the Center for Medicare and Medicaid Services amended the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to give patients the right to request test results directly from the laboratory. All entities subject to HIPAA must comply with the regulation by October 6.

It will be interesting to see how the new rule will affect the patient-provider relationship. Will patients be better informed or will they be panic-stricken after trying to interpret their test results based on Internet searches? Will patients even be informed of the new rule? (I know my and my daughter’s providers have yet to say anything about it.)

If your facility’s lab is subject to CLIA, have you been educated about the new regulation? How do you feel it’s working so far? Drop me a line and let me know.

MRSA and Worker’s Comp

If you’re unlucky enough to contract a methicillin-resistant Staphylococcus aureus (MRSA) skin infection while working in patient care, a proposed state law (AB 2616) would make it easier for you to file a workers’ compensation claim. The bill, which is supported by the  California Nurses Association and National Nurses United, passed both houses of the Legislature in August and now awaits the governor’s signature.

AB 2616 states that MRSA skin infections contracted while providing direct patient care will now be presumed to be work-related unless there’s specific evidence to the contrary. That means if you file an MRSA-related claim, the burden of proof will no longer be on you, which is good news.

Workplace Violence

Workplace violence is an ongoing concern for nurses and other healthcare workers. There’s been some progress since Napa State Hospital psychiatric technician Donna Gross was strangled to death by a patient in 2010, but nursing organizations and unions have been calling for more.

SB 1299, which went to the governor’s office on August 28, is intended to light a fire under the state Occupational Safety and Health Standards Board and push state hospitals to take action. The bill would require acute care and acute psychiatric hospitals to establish plans to prevent workplace violence in both inpatient and outpatient settings.

The plans must include training and education for workers, procedures for investigating incidents, and policies for documenting and reporting incidents to the Division of Occupational Safety and Health, which would be required to post anonymized reports online starting in 2017.

Quicker Licensure

Too many new RNs have passed the NCLEX, graduated from nursing school and started applying for work — only to wait and wait for the BRN to issue their licenses. A bill in the Assembly, AB 2165, seeks to address that problem by giving professional licensing boards a 45-day deadline to issue licenses to candidates who’ve completed all the requirements.

The 45-day clock wouldn’t start ticking until you have completed all the application requirements, so this law wouldn’t help if you had missing paperwork or problems with your background check. The point is to keep qualified applicants from being held up by bureaucratic backlog.

Using our Power

This list is by no means comprehensive. New measures come up all the time, including ones that aren’t specific to nursing, but may still affect our work.

The good news is that we don’t have to sit back and watch idly. With almost 400,000 active RNs in California alone, we have more political power than many of us realize. However, for us to use that power, we have to be aware of what’s going on and willing to get involved. We can’t afford to let politics be a spectator sport.

 

How to Stay Informed

If you want to find out more about these bills and others like them, check out the following links:

•  The Library of Congress THOMAS database allows you to look up information about federal bills.

•  GovTrack.us  is another option for keeping track of happenings in Washington. It requires registration.

•  The Official California Legislative Information webpage includes information on current state laws and proposed legislation.

•  LegTrack is another search engine for state measures. It requires registration.

•  Ballotpedia is “an interactive almanac of U.S. politics,” including neutral descriptions of federal and state measures.

•  The Board of Registered Nursing (BRN) website often provides useful information on pending legislation. The BRN’s legislative committee examines all measures and decides whether the board should support, oppose or watch each measure.

•  Professional organizations and unions such as the American Nurses Association, California and the California Nurses Association/National Nurses Organizing Committee also monitor relevant legislation, although these organizations’ information may be available only to members.

Some professional organizations also organize “lobby days,” which are a great opportunity for nurses to learn about important current issues and the political process in general.

Working Nurse Magazine – Issue

Nurses Answering the Call

Hurricanes, floods and earthquakes are no match for heroic nurses

By Genevieve M. Clavreul, RN, Ph.D.Working Nurse Magazine

Nurses across the country have long been at the forefront of disaster response, whether the crisis is an earthquake, hurricane or tsunami, a flood or some manmade tragedy. When disaster strikes, nurses respond at the drop of a hat, often putting their own lives on hold to offer their services and compassion to those in need.

Tales of Heroism

In 2001, nurses answered the call when terrorists flew two hijacked Boeing 767s into the Twin Towers of the World Trade Center in Manhattan. Some of the first nurses on the scene were sent to the Jacob K. Javits Convention Center, which had been converted into a makeshift 40-bed emergency hospital. At first, nurses could do little more than pour bottled water over the eyes of rescue workers.

Even when more supplies did arrive courtesy of the American Red Cross, the nurses had to cope with limited resources and nurse-patient ratios of more than 5,000 to 1.

After Hurricane Katrina in 2005, volunteer nurses streamed into the Gulf Coast, many taking unpaid leave and using vacation hours to help survivors in some of the hardest-hit areas of Louisiana, Mississippi and Texas. In response to the devastation, the California Nurses Association (CNA) formed the Registered Nurse Response Network (RNRN) to serve as a “clearinghouse” for RNs responding to disasters. The RNRN reports that some 300 nurses traveled to Gulf communities to offer aid and nursing assistance after Katrina.

Even nurses who were unable to make the trip found ways to help. One nurse answered phones at her local Red Cross. After watching television coverage of the disaster, another nurse volunteered to work in the temporary pediatric clinic that had been set up at the Houston Astrodome, treating and comforting children suffering from cuts, bruises, hunger, dehydration, disorientation and exhaustion.

Local nurses, too, put their personal needs on hold to provide much-needed assistance in the wake of Katrina. At the partially flooded Memorial Medical Center in New Orleans, where as many as 2,000 people and 200 patients were trapped without power or running water in stifling heat, nurses struggled for days to provide continuity of care and then navigated darkened stairwells and manually operated Ambu bags to transport patients to the helipad for evacuation.

International Efforts

The disasters to which American nurses have responded have not been limited to the borders of our country. In 2010, U.S. civilian nurses joined their military colleagues aboard the amphibious assault ship USS Iwo Jima for Operation Continuing Promise 2010, a four-month humanitarian deployment. Nurses provided medical assistance to Haitians after Hurricane Tomas, treating a total of 4,054 patients onboard and ashore (as well as more than 1,200 veterinary patients). As part of that operation, nurses went on to participate in seven other missions in Latin America and the Caribbean.

In 2013, Typhoon Haiyan struck the Philippines, killing more than 6,000 people and leaving almost 30,000 injured. Medical and nursing teams from hospitals and nursing associations through the U.S. raised relief funds, donated food and clothing and assembled healthcare teams to aid in disaster relief.

One team saw more than 250 patients a day, many of whom had suffered injuries that became potentially life-threatening due to the harsh conditions and delays in obtaining treatment. In addition to treating physical injuries, the healthcare teams also assisted survivors with mental health issues like anxiety, insomnia and overwhelming grief in the wake of this horrific event.

An Ethical Obligation

When a crisis strikes, people look to nurses and other medically trained professionals for information and guidance as well as care, which makes it all the more important that we learn basic disaster preparedness skills.

An article in the Australian Nursing Journal estimates that each nurse who is helpless in the face of a disaster may leave 50 or more patients in the lurch. That’s why Joanne Langan, RN, Ph.D., CNE, coauthor of the 2004 book Preparing Nurses for Disaster Management, argues that every nurse has an ethical obligation to be prepared for disasters.

Responding to a disaster doesn’t have to mean jumping on a plane at a moment’s notice. Relief efforts often need volunteers to help organize and coordinate the first responders, a role in which a nurse’s training and experience can be invaluable. Of course, nurses can also get involved by donating food, clothing, medical supplies or money to aid the victims of the disaster.

Many hospitals have established on-site disaster response teams, but nurses should also consider joining an outside organization involved in relief efforts. It’s a great way to learn more about disaster response and find opportunities to help. Below are a few places to start:

I think what nurses bring to crisis response is best summed up by a remark made by Marirose Bernard, MN, APRN, CNA-BC, then a nurse supervisor at Memorial Medical Center in New Orleans. When a reporter asked why Bernard and her colleagues didn’t leave the devastated hospital, Bernard responded, “I would never have thought of that. We were there; we were there to take care of our patients. Because we’re nurses, and that’s what nurses do.”

So, to all my fellow nurses: Keep doing what you do and have a Happy Nurses Week!

Here’s my latest article in Working Nurse Magazine —

One of nurses’ most important and underappreciated duties is advocating for our patients. While much of that advocacy takes place at the bedside, we are also in a unique position to address the larger issues that affect the practice of nursing and medicine.

The latest issue that demands our attention is the controversy over prescription opioids and the efforts of the Medical Board of California to crack down on these dangerous but necessary medications.

THE PERILS OF STATISTICS

If you listen to the fearless pundits of the Fourth Estate, deaths related to prescription drugs are a national crisis. According to the Centers for Disease Control and Prevention, 38,329 Americans died of drug overdoses in 2010 and about 60 percent of those deaths involved prescription medications, many of them opioids.

Back in 2012, the Los Angeles Times ran a four-part investigative report on the human cost of opioid abuse and the role of some physicians in overprescribing painkillers. The story reported that between 2006 and 2011, there were 3,733 deaths related to opioid use in just four Southern California counties: Los Angeles, Orange, San Diego and Ventura. That story and others like it have put pressure on the Medical Board of California to respond to the growing “epidemic.”

I put the word “epidemic” in quotes because the outcry is somewhat out of proportion to the reality. As alarming as the number of opioid-related deaths sounds in isolation, the L.A. Times report failed to contextualize that statistic in terms of the combined population of those four counties (16.9 million as of July 2011), the population of California as a whole (37.7 million) or the number of deaths due to other causes during the same period. For example, according to the California Highway Patrol, car crashes killed 18,416 Californians between 2006 and 2011: almost five times the death toll of the headline-grabbing opioid menace.

PSE AND THE METH EPIDEMIC

I don’t mean to diminish the significance of those deaths or suggest that there isn’t a problem, but it’s important not to let alarmism triumph over common sense. While the number of collision-related deaths may indicate a need for better traffic safety, no one is seriously suggesting closing our freeways or restricting how far commuters are allowed to drive!

Unfortunately, when it comes to drugs, such overreaction is the rule rather than the exception. For instance, many of us are familiar with the federal Combat Methamphetamine Epidemic Act of 2005 (CMEA), which sought to stem the rise of methamphetamine abuse by restricting the sale of products containing the nasal decongestant pseudoephedrine (PSE).

PSE is not a prescription drug in most states, but the CMEA limited how much PSE a customer could buy at one time, mandated behind-the-counter placement in stores, required photo identification for purchase and forced sellers to maintain logbooks of sales and customer information. Those measures have had little impact on the meth epidemic. At a conference this February, DEA Office of Diversion Control Deputy Assistant Administrator Joseph Rannazzisi admitted that “NEITHER of these systems [tracking or rescheduling PSE] will have ANY impact on methamphetamine availability in the United States.” [emphasis in the original]. In short, these restrictions  have not curbed the meth supply, but have added a considerable bookkeeping burden for retailers while inconveniencing millions of cold and allergy sufferers.

The effects of the state medical board’s response to the outrage over opioid-related deaths may be far worse. Some of the suggestions I heard at a recent meeting of the board’s Prescribing Task Force left me wanting to tear out my hair in frustration.
the role of alcohol

California’s medical community has good reason to be embarrassed by the L.A. Times expose, which linked a substantial number of overdose deaths in Southern California to a surprisingly small number of doctors.

The story also raised serious questions about the medical board’s effectiveness in responding to complaints about excessive or reckless prescriptions. The board seldom suspends a doctor’s prescribing authority even if he or she is being actively investigated or has already been disciplined for reckless prescribing.

Given all that, you might expect that the Prescribing Task Force’s focus would be on improving the medical board’s oversight of its own members. Instead, I listened to hour after hour of experts proposing new restrictions on patients. The suggestions ranged from requiring patients to sign a contract with their physician prior to receiving prescription opioids to forcing all patients to submit to pill counts and random urine tests. Such measures would be tantamount to treating patients like criminals!

There were more sensible proposals calling for greater patient education, but overall, I was dismayed by the lack of clear-headed perspective on the issues involved. For example, one expert pontificated at length about the evils of opioid abuse without once mentioning the role of alcohol in many painkiller overdose cases. When I asked him about it, he replied that he would touch on that point at the end of his presentation, suggesting that he considered alcohol a trivial footnote rather than a significant contributing factor in many overdose deaths.

PUTTING PATIENTS LAST?

As a nurse and as one of the estimated 100 million Americans living with some degree of chronic pain, I am well aware of both the power and the dangers of opioid painkillers. There’s no argument that opioids carry a high potential for abuse and can kill if misused.

However, I’ve also witnessed the consequences of overzealous protocols that prevent patients from getting needed medication. If you suffer chronic pain, draconian limits on how much painkiller you’re allowed do not protect you; they just reduce your ability to function and increase the chances that you’ll find some other way to self-medicate — possibly with lethal consequences.

Tools like pill counting or contracts may be appropriate in certain cases, but imposing such restrictions on all patients would only have a chilling effect on the provider-patient relationship. If our approach to patients defaults to suspicion and mistrust, we only discourage our patients from communicating openly with us about issues like abuse and addiction.
comprehensive approach

So, what should be done? A better solution would include all of the following:

  • Improved education for patients about the dangers and proper use of opioids, including the risk of adverse interactions with alcohol or other drugs.
  • Better educating physicians and their healthcare teams about the signs of opioid abuse, including how to recognize potential risk factors like addictive personalities.
  • Fully implementing a real-time prescription drug monitoring program that can flag suspected prescription shoppers and physicians who may be recklessly prescribing opioids or running “pill mills.” California’s CURES (Controlled Substance Utilization Review and Evaluation System) could be but currently isn’t used for that purpose due to a lack of resources and interest.
  • More effective sanctions for doctors whose prescription history suggests a pattern of reckless or inappropriate prescribing.
  • Finding and funding alternative treatments for chronic pain and conditions that cause it. If you remove the source of the pain, you also remove the need to treat it with opioids.

Obviously, many of these are long-term solutions. In the short term, it’s important that nurses get involved in the debate. The Prescribing Task Force’s next meeting is in May. (See www.mbc.ca.gov for a schedule.) The meetings are open to the public and I urge readers to attend and participate.

This is an issue that directly affects many of us, our loved ones and our patients. We should not sit idly by while the medical community devises quick-fix solutions that may ultimately do more harm than good.

Genevieve Clavreul’s earlier article on this topic, “The Great Opioid Debate of 2012,” was published in WN127, Sept. 3, 2012.

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Scott Glover and Lisa Girion, “Dying for Relief: A Times Investigation,” Los Angeles Times:

Part 1 (“Legal Drugs, Deadly Outcomes,” 11 Nov. 2012)

Part 2 (“Reckless Prescribing, Lost Lives,” 9 Dec. 2012)

Part 3 (“Rogue Pharmacists Feed Addiction,” 20 Dec. 2012)

Part 4 (“Unused Tool Could Help State Flag Deadly Doctors,” 30 Dec. 2012)

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CDC, “Drug Overdose in the United States: Fact Sheet,” last updated 10 February 2014. The fact sheet says 60 percent of 2010 overdose deaths were pharmaceuticals, of which 75 percent involved opioids and 30 percent involved benzodiazepines.

Physicians for Responsible Opioid Prescribing, “Cautious, Evidence-Based Opioid Prescribing.”

The American Academy of Pain Management, cites 100 million chronic pain sufferers in America, per Institute of Medicine Report, “Relieving Pain in America.”

Transforming Prevention, Care, Education and Research (Washington, D.C.: The National Academies Press, 2011.