It’s hard to believe that in my lifetime I’d ever see layoffs in the nursing field. Like many of you, I remember the good times when there were billboards around my city advertising signing bonuses for nurses at local hospitals. That’s all changing. Two recent articles in the Wall Street Journal (1) (2) and one in the Washington Post are focusing on the fact that, while there is still a nursing shortage, there is now a shortage of nursing jobs. That sounds like a contradiction in terms but it’s not.

In a March 2009 report, the AHA revealed that 53% of the hospitals surveyed were operating at a negative margin or in plain English, they’re losing money. Hospitals in some areas of the country are reducing hospital staff. Just a year ago hospitals that were taking just about any skilled nurse who walked through the door are now finding it easier to be selective in their hiring. In short, this ain’t your mother’s nursing profession anymore.

If the news from nursing wasn’t already bad enough, there’s a news story about Dean Health System which announced its intention to “immediately” lay off 90 employees. This included a nurse who was assisting in a surgical procedure and was called out of surgery to be told she was laid off! Okay, I can understand cost cutting, but don’t you think it’s a little extreme to lay someone off in the middle of a procedure? Has the world just gone crazy? What if they’d laid off the anesthesiologist? Or the surgeon? I shudder to think of the consequences (Dr. Smith, please report to HR, stat!).

The good thing about legal nurse consulting is that medical malpractice and personal injury litigation is recession proof. Now that we’re seeing financial stress on hospitals and doctors, I believe we’re going to start seeing more and more medical and nursing malpractice as well as the delivery of substandard healthcare.

A recent study in the New England Journal of Medicine, showed that a fifth of Medicare patients were rehospitalized within 30 days of their initial discharge! When the pressure is on to cut healthcare costs by reducing care, testing and length of stay; as nursing shifts come under more pressure with fewer nurses covering more patients; and as healthcare continues to devolve into what I call the “Dark Ages of Medicine;” you can be sure that Certified Legal Nurse Consultants will be on the front lines working with attorneys to redress the wrongs that are certain to happen.

One of the things I like best about being a self-employed entrepreneur is that the only person who can lay me off – is me (and that isn’t happening any time soon)!

Stay busy!

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How do you start your day? Does your breakfast contain a line of pills (and I don’t mean vitamins) longer than your middle finger? If you open your medicine cabinet too quickly is there an “orange avalanche” of pill bottles? Have you succumbed to the slick marketing of pharmaceutical companies like many of my baby boomer friends who daily whip out an array of drugs for restless leg syndrome, elevated cholesterol, reduced bone density and sleep deprivation?

If you read any magazine and look at the ads, you’ll see that the pharmaceutical companies have medicalized just about every illness, condition and quirk. Not only are drugs shamelessly marketed directly to potential “patients” but to the physicians who would and do prescribe them. My 27 years of experience consulting on products liability and medical malpractice cases as a legal nurse consultant have caused me to be very suspicious of pharmaceutical companies and the diseases they create, and of course, very agitating to my personal doctors.

My Italian grandmother lived a long life and never took a single prescription drug. In Italy, food is the drug, and she proved to me first hand that what I shove into my mouth directly impacts my energy level and the state of my health. Relax, this isn’t a blog on diet. I don’t advocate any particular diet but I try and stick to a Mediterranean diet (mainly for the spaghetti), it’s what keeps me a healthy size 4 (I wish).

I’m a small woman at 5′ 2½”. When I was diagnosed with osteopenia my physician immediately recommended Fosamax^®. Considering all the side effects of Fosamax, which I’m intimately familiar with because of products liability litigation, I rejected it outright, but I know others who haven’t and others who won’t when their time comes (good luck chewing your steak).

Instead I increased my vitamin D, calcium and vitamin K intake; hit the weights in the gym a lot harder and added a little jump roping; all without the help of estrogen (natural, artificial or otherwise). It took some serious discipline but in one year I had gained significant bone mass – at a time and at an age at which the vast majority of women lose bone mass.

My physician couldn’t believe it and in fact, seemed almost upset that I did it without her help (or her meds). Surely I was an anomaly. No matter the evidence, there was no way she was a believer. She continues to practice medicine like the typical pill-pushing physician who’s been brainwashed by the pharmaceutical companies. Thank God I’m a nurse and can think for myself.

But most consumers can’t, so that’s why the book Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen is one of my favorites on the pharmaceutical industry. Not a day goes by that I don’t read about a new drug’s serious side effects and the products liability cases generating from them. This book focuses on the institutional deception of pharmaceutical companies and is a must read for all Certified Legal Nurse Consultants who consult on pharmaceutical products liability cases, and even medical malpractice cases. The author discusses physicians’ less-than-appropriate relationships with the pharmaceutical industry and how it’s marketing, not science that drives these companies.

You won’t need this book to tell you what you probably already know, but it will help you think differently about your legal nurse consulting business and the CLNC^® services you provide to your attorney-clients in this drug-dependent age.

Add this book to your “must reads.” And be careful what you put in your mouth – remember doctors used to endorse cigarettes once upon a time.

Success Is Inside!

P.S. If you want a truly eye-opening book on food and diet, try this one: Good Calories, Bad Calories by Gary Taubes – it’s not a diet book and not a light read but will change your thinking (it got Tom off beer).

Really, I mean that. Tom says that being around so many nurses has taught him one thing (well, two if you count never turn your back on a proctologist). Hospitals are great places to visit loved ones when you’re well, but they’re a horrible place to be when you’re sick. Studies have shown the longer you’re in a hospital recovering, the more likely you are to develop an infection, iatrogenic injury or even die.

Tom usually blogs about technology, but this one was too good for me to pass up. ECRI has come up with a list of the Top 10 Health Technology Hazards! That just sounded like fun. For your legal nurse consulting business, this is an eye-opening list of just what can (and will probably) go wrong with healthcare technology. ECRI even ran the list in order of importance. Here we go:

1. Alarm Hazards. You know you ignore them or worse – turn them off.
2. Needlesticks and other Sharps Injuries. This is really low-tech. We’ve been maliciously sticking unsuspecting patients with needles for years.
3. Air Embolism from Contrast Media Injectors. This I read AFTER my MRI?
4. Retained Devices and Unretrieved Fragments. Suddenly patients find themselves setting off the metal detectors at the airport or they are billed for a missing forceps.
5. Surgical Fires. Another reason why CRNAs shouldn’t smoke at work.
6. Anesthesia Hazards Due to Inadequate Pre-Use Inspection. More likely due to pre-use use by the CRNA and/or the anesthesiologist.
7. Misleading Displays. Especially the one showing brain activity.
8. CT Radiation Dose. Everyone else leaves the room during the x-ray, why shouldn’t the patient?
9. MR Imaging Burns. You stick a damaged headset and goggles on the patient, then ram him into the magnetic bore and wonder why he comes out with his hair on fire?
10. Fiber-Optic Light-Source Burns. Another way to set a patient on fire is by resting a hot “cold light source” on him during surgery.

The ECRI report also lists five of last year’s hazards that didn’t cause enough harm to make this year’s Top 10. They are still described as “significant” concerns. ECRI has taken the time to identify problems that any Certified Legal Nurse Consultant realizes are avoidable. I’d get a copy of this list and keep it handy when screening your medical malpractice cases. For a limited time, you can use the link above to visit ECRI and download a free copy of the report.

It’s like Tom always tells me “Technology is fun – in the right hands.”

Success Is Inside!

P.S. Have you seen any med-mal or products liability cases in your legal nurse consulting business related to these topics? What, in your opinion, is the biggest health technology hazard? Comment here.

A headline in the January 8, 2009, issue of The Wall Street Journal “Hospital Scrubs Are a Germy, Deadly Mess,” caught my eye. The article discusses how hospital scrubs and other garments carry infection, not only around the hospital but outside it too.

A headline in the December 2008 issue of Lawyers USA reads “Hospitals Face Infection Suits.” This article covers, guess what, the increased number of infection suits facing hospitals.

The Center for Medicare and Medicaid Services (CMS) adds certain SSIs and other infections to its list of nonreimbursible “Never Events.”

And, can you guess what the cover article is in the January 2009 issue of Nursing Management (the journal of excellence in nursing leadership)? It’s an article discussing the debate over nursing uniform colors, combinations and identity (as well as patient preference and perception).

Give me a break. I don’t care what you wear as long as you’re not killing me with it. I cannot stand to see a doctor, nurse or even someone who’s probably a med-tec standing around my local Starbucks in their scrubs. Even worse –
a healthcare provider in scrubs or lab coat fondling the veggies in my local supermarket. I can’t assume she’s taking that cucumber to work, so I’m guessing she’s just spreading germs on her way home.

The CDC estimates that more than 2,000,000 hospital-acquired infections result in over 90,000 deaths. What about the civilians who are being infected outside of the hospital? Talk about an issue ripe for Certified Legal Nurse Consultants – I feel like a pig at a feeding trough.

When I entered nursing the color was white (the color of purity). Nurses wore clean white uniforms. We shined our shoes (not “Crocs”) and yes, even wore (anyone remember this?) caps. What’s the point? We looked clean, we were clean and you didn’t see a nurse in white outside the hospital. I constantly tell Tom those nurses you see collecting money outside the mall AREN’T REALLY NURSES.

Today, we’ve got multiple piercings, exposed midriffs and our choice of uniform – if you can call it that. I call some of it inappropriate wear.

I’m not calling to revert back to aprons (although they are being tried in Britain). But I am asking that hospitals go back to laundering scrubs and not allowing them out of the hospital.

The same nurse who won’t touch the door handle in the restroom thinks nothing of wearing those Ebola-ridden scrubs when she picks up her kids to hug them.

Study after study shows that where docs and nurses go infection follows. Why aren’t our nursing executives discussing a real issue – infection, disease and death – instead of the colors of our scrubs? You tell me. And, if you’re one of the offenders, stay out of my neighborhood Denny’s.

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Having just been in the ED for 6 hours with a friend, I witnessed firsthand the secondhand, substandard grade the American College of Emergency Physicians (ACEP) has given to the state of emergency care in the U.S.

The care I witnessed wasn’t deplorable, but it wasn’t inspiring either. The staff’s empathy for a grieving family was hit and miss. The orthopedic resident’s technical ability as well as her interpersonal skills and judgment left a lot to be desired. And the hygiene of the department – well what can I say? It was as much of a hygiene risk as my 4-year-old godson’s preschool playground full of little Ebola viruses.

ACEP reported in a Report Card on the State of Emergency Medicine that the “Economic woes and a failing health care system mean more people than ever before are relying on emergency care at a time when the nation is receiving a substandard C- grade for its support of emergency patients.” Dr. Nicholas Jouriles, president of ACEP said, “Policymakers can no longer remain oblivious to what is happening in emergency departments.” He called on President-elect Obama to make emergency care a top priority in health care reform proposals.

Dr. Angela Gardner, ACEP’s president-elect, said “The emergency care system is a ticking time bomb… a failing health care system means more people than ever before will be relying on emergency care meanwhile, every minute of every day in this country people need emergency medical care, and that need is growing as our population ages and lives longer.”

Emergency care is becoming primary care – it’s the frontline of medicine, and America’s losing the battle. This substandard care will increase the number of medical malpractice emergency cases and increase the demand for Certified Legal Nurse Consultants on emergency care issues.

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