1 Percent of Deaths Worldwide Due to Secondhand Smoke

MONDAY, Nov. 29 (HealthDay News) -- An estimated 1 percent of the deaths that occur in the world annually are due to passive smoking, and many of these deaths are in children, according to research published online Nov. 26 in The Lancet.

To calculate the worldwide degree of secondhand smoke exposure and its disease burden on children and adult nonsmokers, Mattias Öberg, Ph.D., of the Karolinska Institute in Stockholm, Sweden, and colleagues used data from 192 countries during 2004 to estimate deaths and disability-adjusted life-years (DALYs) based on estimates of population proportions exposed to secondhand smoke.

The researchers determined that 40 percent of children and approximately a third of adult nonsmokers were exposed to secondhand smoke. The researchers attributed an estimated 603,000 deaths (about 165,000 in children) -- from ischemic heart disease, lower respiratory infections, asthma, and lung cancer -- to this exposure. This figure equaled about 1 percent of worldwide mortality. Secondhand exposure-linked DALY loss reached 10.9 million.

"These estimates of worldwide burden of disease attributable to secondhand smoke suggest that substantial health gains could be made by extending effective public health and clinical interventions to reduce passive smoking worldwide," the authors write.

New Nursing Jobs Dwindles but Nurses are Now Paid More than Before

While reading along for new nursing jobs that may help our Filipino nurses find one, I stumble upon a very interesting news online.  Read this Pinoy nurses and maybe you will salivate on the prospects of getting to the US again.
According to the most recent data from the US Bureau of Labor Statistics, the averageregistered nurse (RN) salary is $66,530 in the United States. Despite the fact that the economy today is worse than it was during that same time period, this is $7,000 higher than the average nursing salary five years ago .
This is good news for those interested in healthcare professions as it shows thathealthcare is fairly recession proof although the demand for nurses really seems to plateau lately.  While the bad economy in the US seems to have affected the majority of professions, other medical fields, aside from nursing, are also doing well.
The average Physician Assistants salary is $84,830; Pharmacists are making $106,630. There are many more average medical salaries you can check on the US Bureau of Labor website. In addition to the above average salaries, the medical industry is expected to increase an estimated 22 percent over the next 7 years, which would be about 600,000 new jobs including nurses. This number can increase significantly if the economy rebounds sooner than expected.
In general registered nursing seems to be one of the more popular professions people are choosing these days but medical assisting and medical billing also pay well and are in demand. Most of the hiring today and in the future is expected to come from private medical practices rather than public hospitals.
Healthcare is clearly a field that will always need servicing no matter what the economic situation.  Nurses and Doctors will always be needed worldwide.   However, nursing jobvacancies are not yet available in the US.  But according to this report, there is some light in the horizon.  The economic factors need to align to such conditions to prepare our newPinoy nurses for better jobs and better pays.  Let’s wait for Obama to turn things around.  Maybe or maybe not.  Who knows?
Hope you like this update. Till next time.

Nurses jobs now in ample supply in Hawaii adding to the oversupply issue

The longtime nursing shortage in Hawaii has now turned into an oversupply, leaving many recent graduates without jobs, and the economic slowdown is to blame, nursing executives here say.
This is further aggravated by the fact that nurses who were scheduled to retire or move to other jobs have postponed their plans, some because their spouses lost jobs or because of substantial losses in retirement savings.
Nurse turnover at Hawaii Pacific Health — the state’s largest health care system, employing nearly 1,600 nurses — has dropped to around 4 percent a year from 18 percent just three years ago, said Gail Lerch, HPH’s executive vice president and a registered nurse.
Overall, the demand for medical services in the Hawaii and mainland US also dropped in recent years as people lost their jobs and health insurance.  Also, many people opted to stop or delay their elective procedures. Financially troubled medical facilities such as Hawaii Medical Center have reduced beds, further diminishing nursing jobs.
There are hundreds of recent nursing graduates that entered the job market just as thisoversupply was brewing, leaving many aggravated and anxious to find work in the profession.  They are now forced to take on jobs not related to nursing.
The stakes are high for the new nursing graduates. Finding a job normally takes between six months to two years for most registered nursing graduates.  If they are lucky to enter thehealthcare sector for the interim, many are working as lower-paid aides, technicians, clerks and other medical-related positions while they look for work. Nurse aides currently earn about $15 an hour, roughly half the pay for an entry-level registered nurse.
Health officials predict the oversupply of registered nurses to be short-lived as a substantial number of working nurses are expected to retire in the next five to 10 years.
According to local officials, the current surplus considered a blip on the radar screen, a phenomenon that caught everyone by surprise when the economy changed.  This phenomenon of new graduates not getting jobs is all over the United States — it’s not just a Hawaii issue. It’s very much economically driven.
In the coming years and decades, demand for nurses will increase with the wave of baby boomer retirees. By 2025, Hawaii’s seniors population will represent 21 percent of the total, up from 14.5 percent now.
The current excess of nurses is in part a result of nursing schools significantly boosting enrollment in recent years to alleviate what had been called a severe nursing shortage.Nursing students typically take two to four years to graduate.
Certain that more nurses will be needed in the future, medical facilities and nursingschools are exploring ways to keep recent graduates in the job pipeline by creating bridge programs.
Medical centers and nursing schools also are exploring creation of the first nurse residency program in Hawaii that would be sponsored by the Hawaii State Center for Nursing.

Turning Knowledge Into Wisdom: Being an Effective Advocate

Is your patient an effective advocate? Here are some tips for empowering your patients to be effective and powerful advocates.
Sue has a serious chronic medical condition and visits many different doctors each month. She is on top of her medical situation and sometimes brings in new research papers to discuss with her team. When a new doctor prescribed her a medication without explaining what and why, she gently but firmly told him, "I am happy to follow doctor's orders as long as I understand them. When would be a good time to answer my questions?" 

Sue is an advocate. She seeks accurate medical facts and information. She empowers herself with knowledge. But knowledge is only half of the story. What good is knowledge without wisdom? Wisdom is knowing how to use knowledge effectively. 

Sue sees herself and her doctors as a team. She believes in a collaborative approach to her medical care. But her style is not without conflict. There have been times when busy doctors with a brusque bedside manner didn't particularly like being "second-guessed." But Sue has a great way about her and it's hard not to like her. She is able to detect when she is starting to get some resistance and goes into her "Conflict Resolution Mode": 

Step 1. Show empathy and understanding for the other person's position. "Ohhh, it looks like you are super busy today and probably don't have time for my questions. I can understand that." 

Step 2. State your position using "AND" and "I" language: "And I can take much better care of myself if I understand the reasons behind your decisions here." 

Step 3. Suggest alternatives: "Is there a time that we could talk about this later by phone or even email? I won't take much of your time, I promise. I just have a few basic questions about what you are suggesting. Thank you for being willing to help me out." 

Sue is a successful advocate for her healthcare because:

1. She is knowledgeable about her medical condition. She actively seeks accurate information from reliable sources. 
2. She stands up for herself and isn't afraid to be assertive.
3. She is calm and respectful even in the face of resistance or conflict. 
4. She doesn't take abrupt (some say "rude") medical professionals personally. 
5. She is not demanding or threatening. 
6. She doesn't tell others what they have to do but instead shares what her needs are. 
7. She understands that having an effective approach is in her own best interest so she works hard at learning good communication skills.
8. She tries to be appreciative of the doctor's knowledge and expertise (even if she doesn't like the doctor as a person).
9. She understands that being an advocate is not the same as being pushy or aggressive.
10. She uses a collaborative approach to solving problems. 

Sue knows that her good health is ultimately up to her and the choices she makes. And, as an effective advocate, she is prepared and empowered to make good decisions that will impact her life, and those who love her, for years to come.

R.P. training nurses in Japanese / Caregivers sent to Japan under EPA get hand to overcome language hurdle

MANILA--The Philippine government has begun language classes to help nurses wanting to go and work in Japan overcome the high language barrier, and even pays them to enroll.
The project is aimed at boosting the rate of Philippine applicants who pass Japan's national nursing examination and increasing the number of nurses seeking a career in Japan under the economic partnership agreement (EPA) between the two countries.
During one recent Japanese class, a teacher held up a panel with kanji for difficult words, such as "roasha" (the hearing impaired) and "nenza" (sprain), while the students read the words aloud in unison.
The Philippines' Technical Education and Skills Development Authority conducted a four-month Japanese course on a trial basis, ending in early September. Most participants studied while working at hospitals. During their language training, they acquired basic Japanese conversational skills, and learned medical terms and about Japan's workplace culture.
Participant Ana Melissa Cana said she received a job offer from a Japanese hospital based on the EPA deal, but declined it shortly before leaving for Japan. She said she was suddenly scared by the thought of living in Japan and taking the examination in Japanese.
However, the 31-year-old nurse is now determined to try again, as she still wants to work in Japan, which is known for its excellent medical technology.
But the first step, she said, is tackling the Japanese language.
Manila apparently has growing concerns that it may fail in its role of sending nurses to Japan as outlined in the economic partnership agreement, prompting it to take action. In February, 59 Philippine nurses made their first attempt at Japan's national nursing exams; only one passed. If nurses on the EPA program fail to pass the exam for three straight years, they must return home.
Questions have been raised over the current EPA arrangement, which offers foreign nurses only six months of Japanese language lessons.
To turn the situation around, the Philippine government has allocated 2.2 million peso (4.4 million yen) to launch the Japanese program and has paid as many as 75 participants in the program an allowance of 6,000 peso a month.
The government now appears to be considering participation in the program when selecting nurses to be sent to Japan. It hopes this will encourage capable nurses to go to Japan, which is a less popular destination than Western nations--where English is used more commonly--among many nurses.
Manila also is reportedly considering inviting more applicants and increasing class time.
The EPA between Japan and the Philippines took effect in December 2008. In May last year, the Philippines began dispatching nurses and caregivers to Japan. Under the EPA deal, Japan accepts up to 1,000 such nurses and caregivers for two years, but only 436 have been sent so far.
In Japan, the high cost of getting foreign nurses up to speed because of the language hurdle has deterred some potential employers from hiring them. The EPA will be reviewed next year, and Tokyo likely will seek to tweak the current system.
Viveca Catalig, a deputy administrator at the Philippine Overseas Employment Administration, acknowledged his country's own effort has its limits, and said he hopes Japan will consider expanding its language training and easing requirements for nurses in order not to disappoint motivated Philippine applicants.

Switzerland starts hiring Pinay nannies

By Danny Buenafe - ABS-CBN Europe News Bureau
The close coordination between the Department of Foreign Affairs (DFA) and Swiss authorities proved fruitful as there is now a gradual phase-in of new recruits for Filipino au pairs or nannies in Switzerland.
Ambassador Teresa Lazaro relayed the good news adding that almost 50 newly hired nannies have started working with their respective Swiss employers.
“There’s actually a demand for our Filipina au pairs. We seemed to be very good with languages and very good in taking care of the young children,” said Lazaro.
Under the agreement, there is no placement fee for the applicants, and the average take home pay is almost 1,000 Swiss Francs or almost P43,000 every month.
According to Lazaro, the applicant must meet certain qualifications. Her age should be 18 to 25 years old. She must also be single, and should learn the German language which will be paid up by her employer.
The work contract, as stipulated in the law, will only be for 18 months or one-year-and-a-half and with no renewal.
For those interested, Lazaro said they need to coordinate with the Philippine Overseas Employment Administration (POEA).
“There are certain offices, agencies, here that are specializing on Filipino au pairs,” she said.
Meanwhile, Lazaro is also pushing for the training agreement with Swiss government to allow the recruitment of Filipino nurses to Switzerland.
“Switzerland is already in need of health workers,” Lazaro said.
It is possible, she said, that the recruitment of Filipina nurses would start next year as there is now a big demand in various university hospitals in Switzerland.

Gov’t urged to find migration balance

By Nathaniel R. Melican - BusinessWorld
The Philippines should determine the “optimum level” of migration for different professions to prevent either a shortage or surplus in the country’s human resources.
Such an exercise will benefit both the country and its labor force by ensuring that the economy is well supported and at the same time providing the workers ample opportunity to recover their investments in education, Winfred M. Villamil, dean of the De La Salle University School of Economics, told BusinessWorld in an interview.
Migration for better work abroad is not bad in itself, Mr. Villamil said.
“People who would otherwise not invest in a college degree or in learning a new skill will be encouraged because of the prospect of working abroad and earning more. A certain optimum amount of migration will therefore raise the welfare not only of the migrants but also of the people left behind,” Mr. Villamil said.
But the migration rate must be monitored as an imbalance will have a negative impact, he said.
Mr. Villamil said signs that migration in a particular profession has breached the optimum point is when shortages occur and when average productivity of workers in the profession is declining. Another sign is when there is a surplus of workers in the profession.
Such an imbalance can be observed in the nursing profession, Mr. Villamil said.
“When nursing became in demand abroad and a lot of people were being hired as nurses abroad, you saw all these nursing schools sprout and you see all these people enrolling in nursing schools,” he said, noting that this sudden outflow of nurses temporarily caused a shortage of nurses locally.
“Today, I think we are now experiencing a surplus [of nurses],” he said.
Similarly, the number of Philippine workers in the maritime industry might also be breaching the optimum mark, as the demand abroad is now for more skilled workers.
“In terms of crews for ships, I think the demand is starting to decline.
We are also facing competition from other countries. I think the trend now is more toward the higher skilled level, for people who are going to be officers in ships,” he said.
Mr. Villamil said once the national government determines the optimum level of migration in different sectors, it can encourage people to develop skills in professions where labor supply has not reached the optimum mark, so they can enhance their employment opportunities abroad.
“The government should also think about ways to control migration so that the flow is optimal, but without infringing on the right of people to go where they want to go,” he said.
But Rene E. Ofreneo, professor at the University of the Philippines’ School of Labor and Industrial Relations, is cautious of the promotion of migration, saying this produces a “vicious cycle” that will end in the depletion of the country’s human resources.
“Our dependence on migration drains us of many high-end workers, such as engineers. This will slowly but surely affect the local industry and could even lead to the failure of local industries and even mission-critical services, such as health care,” Mr. Ofreneo said in a telephone interview.
He urged the government to focus on developing the local job market.

Hospital condemned for discriminating vs Pinoy nurses

By Henni Espinosa - ABS-CBN North America Bureau
Filipino nurses, advocates and community groups flocked to the headquarters of the California Pacific Medical Center (CPMC) Wednesday to condemn the hospital chain for discriminating against Filipinos.
“We are here because we are concerned for the Filipino nurses. We have been advocates for the Filipino nurses for many years,” said Lilian Galedo, Executive Director of Filipino Advocates for Justice.
Last August, the California Nurses Association (CNA) filed a class action grievance against CPMC after some former nurse managers complained that they were told not to hire Filipino nurses because “they’re hard to understand.”
CNA cited that in 2008, Filipinos comprised 48% of new hires among nurses at St. Luke’s, one of CPMC’s hospitals. The union said that number decreased to 10% today.
Filipino nurse Ron Villanueva was up for promotion when he said he heard the Vice President for Nursing say that she should stop hiring foreign graduates.
Villanueva said, “I didn’t prod or anything. The mere fact that she said, I was already discouraged. What was the point of me applying?”
Two months after the Filipino nurses and CNA filed a class action grievance, CPMC management agreed to meet with Filipino community leaders, except for complainants like Villanueva.
“That just means they’re really guilty of discrimination. Why can’t they face me and others who personally witnessed what they said against us Filipinos?” he asked.
Terry Valen, Executive Director of the Filipino Community Center, said CPMC’s management denied that discrimination ever took place.
“They told us that they have conducted an internal investigation on this. And we have yet to see the results of that investigation,” Valen said.
Filipino nurse Marilen Logan was also present at the meeting. She said there is no truth to claims of some of her kababayans that CPMC discriminates against Filipinos.
“When I heard about this, I thought it was a joke that came from the rumor mill. People at CPMC hire a lot of Filipino nurses. I just don’t see what they’re saying.”
But protesters stood by their word that CPMC targets Filipino nurses. Community leaders said that unless CPMC corrects this, they will support the Filipino nurses in filing a class action lawsuit against the hospital chain.
Jane Sandoval, a nurse at St. Luke’s Hospital for 25 years and a union leader said, “This is not just a fight for Filipino nurses. This is a fight against discrimination. Whoever feels abused, we will make sure to back them up.”

A REAL Nurse

When Dad was ill, my sister went to the hospital and told everyone that she was a nurse and she'd be watching them. She is a nurse -- sort of. She's a "Gucci nurse". She comes to work in her Gucci suit and her Prada heels carrying her designer handbag and her Coach briefcase and sits in her corner office with the gorgeous view making policy for a chain of hospitals. She hasn't been near a patient in over 25 years (except for that time where her "fire most of the RNs and hire non-licensed personnel instead" policy caused the remaining RNs to strike . . . ) She arrived to visit Dad wearing $100 blue jeans, a cashmere sweater and carrying the designer handbag and Coach briefcase. I’m sure that her hair and make-up were perfectly done as well. She didn't like Dad's room and insisted he be moved closer to the nurse's station, and then wanted a cot installed for my mother to sleep on and the food on the trays wasn't appetitizing enough and . . . . Nothing, it seemed, was good enough. She was ever so polite, I’m sure, while making it excrutiaitingly obvious that no one was quite as good as she, either.

I arrived a day later in rumpled jeans and sweater and bleary eyes from an overnight flight. I got to the ICU about 6 AM and, having heard from my sister about the 24/7 visiting hours, went directly to the nurse's station to ask if it was a good time to visit my father, Mr. Farmer. "WHO is your father?" asked the nurse rather strangely. "Mr. Farmer," I said. "My sister said he was in CCU."

"Oh," she said. "I'll get your father's nurse."

And so the nurse came hesitantly out of Dad's room, peering around the corner obviously looking for my always impeccably dressed and groomed sibling and seeing only rumpled, overweight and dowdy me. "Did your sister fill you in on your Dad's condition?" he asked. "She says she's a nurse."

I laughed and said, as I always do when asked about what my sister does for a living, "She's a Gucci nurse." This guy didn’t seem to require the explanation about the Gucci suit, designer accessories and corner office with a view.

Dad's nurse began using layman's terms and a gingerly manner, to fill me in on Dad's MI. Turns out it was The "Big One." I asked questions, he provided answers and before either of us quite realized how it happened, he was giving me a nurse-to-nurse report using the big words and everything. For the first time since my mother’s frantic phone call that Dad had chest pain and she was driving him to the hospital, I had a clear idea what was going on. I sat with Dad until physician rounds started and then, out of courtesy, I got up and started gathering my things to leave. My ICU didn’t encourage family to stay for teaching rounds, and I wasn’t going to expect “professional courtesy.”

Dad's nurse surprised me by telling me I should stay for rounds. And then he introduced me to Dad's doctor. "This is Mr. Farmer's other daughter, Ruby," he said to the group. "This one's a REAL nurse."

I never got invited to participate in rounds again -- I was never there at the inhospitable hour of 6AM again. But Dad’s doctors made a point of seeking ME out for the “family updates” and more than once, when my sister was highly visible on the unit, called me to their offices for a private conversation. It was probably far easier to talk to me, a CCU nurse who actually understood what they were saying than to either my mother -- who was probably already sliding into dementia -- or my sister the Gucci nurse. I’ve often regarded that introduction -- as “a REAL nurse” -- one of the nicest compliments I’ve ever recieved!

Teacher turned Nurse

Nursing and Teaching are alike, and not alike.
I miss teaching. I miss summer vacation. Christmas vacation, Easter break, President's day. I miss the bell that says "go home", or the one that signals the end of a horrible class. I miss teenagers, the chatter, the hang-dog looks, the laughter, the tons of long healthy hair.

Even cafeteria duty which used to be a punishment. Listening in on pre-pubescent conversations to get a hint of what the next generation is thinking. Standing in the corner looking bored so they don't know I'm taking it all in.

I miss teaching. Seeing that light bulb go on, hearing myself explain something I really know and looking into young eager eyes that want the information. Priceless. The feeling that something good and real and valuable has happened here today. Sitting quietly with a 14 year old whose friends have decided to 'hate' her today. I miss it.

And yet--nursing the elderly has it's moments too. No doubt it's worthwhile. I still get to intimately connect with other human beings. Only this time it feels like most of the learning is on my part. I've been a teenager, I know what they feel, how they think. But old is something yet to be for me. I can only imagine how old feels. I love hearing the stories when they can tell one and when I have the time. The "good-old-days" when there were no TV's computers or pollution. When people connected in ways we nostalgically wonder about. When Sunday was a day of rest and that meant sitting in the parlor talking. Think about that for a minute.

Looking into old eyes I see the child, the teen, the young man or woman. The lights are still on and someone is in there. They look to me for care, understanding and sustenance. They shake their heads sadly when I just don't get it and I'm frustrated. I can ease their aches for awhile, give them the gift of my time, or a magazine, some cream on their feet. I can try to listen and empathize. They need me, well maybe not me exactly but they need the connection with a younger generation just as we all need connections with people older and younger than ourselves. We are all teachers and we are all students learning how to live how to-be.

So yes I miss teaching and school, but the world is school and learning never ends. Sometimes though I just wish the bell would ring.

A Physician's View: I Taught for an LPN to RN Company- What I Want You to Know

Calling the Code - a coping mechanism in 14 lines

It all started simply enough – a usual day at the station house. We checked in, we checked out the rig, we did our station duties and filled out the logbook; we looked up our duty roster for the day and we even started working on CE’s. There are mornings that the calls come right away, and days you actually get to unpack your gear; some days you might even be able to have a cup of coffee and relax for a bit – but the calls always come. When the calls come, you never know what it’s going to be when you get there or what you’re going to see. You don’t know whether the person you’ll be dealing with even wants you there, or if someone else called on their behalf. You don’t know whether it’s a life-or-death situation, or a stubbed toe. None of that matters. When the calls come, we roll.

Some days you never forget. Some cases stay with you throughout an entire career; you may never remember a name, or a date, but you always remember the faces. A blur of activity, a rush of frantic haste, and then the silence that comes at the end of a futile race to a foregone conclusion. And at the center of it all, one calm, still, angelic face.

When it all comes crashing down on us, how do we cope? How do the comforters ask for comfort? How do you bear the unbearable? Some of us write letters, write articles, or write blogs. Some of us talk. Some of us cry. Some of us punch walls; some of us turn inward and turn mean. Some of us drink. Some of us do some combination of all of these things and more.

Some of us – as silly as it seems – well, we write poetry.

I see her as I'd wish, this stranger's child.
Her smile alive, her childhood still intact,
her purity of skin left undefiled.
The trace of time's caress could not detract
from beauty that was hers by birth and right.
I see her thus. Not as I saw her last,
surrounded by the remnants of my fight
to bring her back - her final struggle past.
Pale lips curved, an enigmatic smile.
Those lips I vainly sealed with mine to breathe
the life back into her. So for a while
I stood -- abashed, exhausted and bereaved,
silenced, for all my furious battle, lost --
Compelled by those who live to hide that cost.

Ted D.

Pinoy nurses accuse travel agency of scam

A group of Filipino nurses expressed disappointment after their supposed European trip a week ago did not push through.
The group said the 13-day trip had been planned for 2 years. They said they had paid for everything–more than $6,000 each to the American Academy of Family Medicine–a travel agency that claims to specialize on trips for nurses and doctors.
However, when they were packed and ready to go, the group never received their tickets from their agent.
“It’s very hurting and unfair. We gave them want they want. They charged us and we paid them on time. But they did not give us anything in return,” said Alice Chavez.
Francis Gonzales, Chief Executive Officer of the American Academy of Family Medicine, reportedly sent out an email to the travelers, saying that added costs in airport and hotel fees caused the postponement of their trip.
In the email, Gonzales reportedly wrote, “As an appreciation for the inconvenience, we will send you a travel coupon valued at $1,000.”
But Gonzales asked for another $600 per person to pay for added costs to the trip, which the company will consider a loan.
“That company is Filipino-owned and operated. Yet they scam fellow Filipinos. I’m very disappointed. We cannot trust them,” said Joy Rosete.
The travelers said the only reason why they bought the tickets was because of the agency’s buy-one-take-one deal.
Ranielle Manzano said this experience taught her to be careful of too-good-to-be-true deals.
“You have to do your research. If you don’t get any trip confirmation from the agency, it’s probably not legitimate,” said Manzano.
The travelers now have 3 weeks off with no vacation and nothing to do.
Class suit
They plan to use the time to file a class action lawsuit and individual small claims suit against the American Academy of Family Medicine.
“We want to recover what’s rightfully ours from the scammer,” said Johnson Lim.
These travelers said they also plan to report the American Academy of Family Medicine to the Better Business Bureau to stop them from scamming other people.
The American Academy of Family Medicine has denied these scam allegations. Gonzales said that the payments they received could not cover all the costs, and he had no choice but to postpone the trip and ask for additional fees. Gonzales said those who do not wish to take a trip at a later time will be reimbursed.
Gonzales also reiterated that his company has been around for 30 years, and has brought several thousands of medical professional in tours and meeting all over the world.

Japan nursing exam won’t be in English – POEA

The Philippine Overseas Employment Administration (POEA) has clarified that the Japanese licensure examination for nurses will not entirely be translated into English. The clarification came from a representative of the Japan Ministry of Health, Labor and Welfare (MHLW), according to the POEA, even as foreign applicants are struggling to pass the difficult exam.
According to the POEA, the MHLW is still studying recommendations from focus group discussions (FGD) that it conducted among stakeholders.
Participants in the FGDs include hospital presidents, officials and professors of nursing schools, and other interest groups in the field of nursing, along with the Institute of Human Language.
“Among the suggestions from the said FGDs were to paraphrase certain difficult words or expressions into easier terms, provide Japanese hiragana characters for certain difficult kanji characters, include the subject and object in the Japanese sentence construction, and annotate special nursing terms and names of diseases in English including internationally recognized abbreviations,” the POEA said.
Hiragana and kanji are Japanese writing systems, with the former being used for traditional Japanese words and the latter being ideographs borrowed from Chinese characters.
The Department of Labor and Employment (DOLE) earlier pushed for intensified language training for Japan-bound nurses and caregivers to give them a better chance of passing the difficult examinations there. (See: DOLE wants intensified Japanese language training for caregivers, nurses)
Labor Secretary Rosalinda Baldoz cited recent reports that no foreign applicant passed last year’s exams and only 1.2 percent of foreign applicants passed the most recent exams.
She said this was due to the difficulty of the examinees in understanding kanji and technical terms written in Japanese.
Maria Luz Talento, Philippine Overseas Labor Office (POLO) in Tokyo officer-in-charge and welfare officer, meanwhile said the language program should focus on communication skills more than simply language skills.
Talento said that while candidate nurses and caregivers are able to speak Japanese, they have problems with oral and written communication with their co-workers and immediate superiors in their place of work.
Filipinos have been hired as nurses and caregivers in Japan under the Japan-Philippines Economic Partnership Agreement or JPEPA, which critics fear will result in further abuse of Filipino nurses in addition to trampling on the country’s sovereignty. (See: Jpepa to legalize abuses vs Pinoy nurses – CBCP) - via GMANews.TV

UK Catholic bishops support Pinay nurses

Catholic bishops in the United Kingdom will help push for the retention of Filipino nurses and carers despite budget cuts in the National Health Service or NHS attributed to the prevailing global recession. His Reverend Patrick Lynch, Auxiliary Bishop of Southwark is one of the influential church leaders of England and Wales because he is responsible for all migrant workers including Filipinos.
Also in charge of asylum seekers in England, Bishop Lynch takes an active role in the forthcoming state and pastoral visit of his holiness, Pope Benedict XVI, starting September 16 to 19.
Bishop Lynch believes in the strong Christian values of Filipino migrants and their sense of professionalism towards work especially those working in hospitals and caring homes.
Like Bishop Lynch, some 30 archbishops in the UK acknowledge the huge contribution rendered by Filipino nurses in the NHS.
They oppose any move to retrench Filipino nurses and carers due to continuing cutbacks in government services.
If by chance, Bishop Lynch and other church leaders will discuss with the Holy Father the good traits of Filipinos and their big contribution to the UK workforce.
Whatever happens, Bishop Lynch thinks the support of the Holy Father would carry an enormous impact on UK government.
There are 6 million Catholics in Scotland, England and Wales.
While certain groups are already protesting the Pope’s arrival, Bishop Lynch believes the police can manage and security preparations will go smooth.
Many Filipinos have lined-up a number of religious activities during the 4-day visit of the Pope. - via ABS-CBN Europe News Bureau


Manila, Philippines - The Professional Regulation Commission (PRC) announced that 37,679 out of 91, 008 (41.40%) passed the Nurse Licensure Examination  also known as the NLE RESULT JULY 2010 or the Nursing Board Exam Result July 2010 given by the Board of Nursing on July 3-4, 2010 in all PRC Regional offices. 

The members of the Board of Nursing are Carmencita M. Abaquin, chairman; Leonila A. Faire, Betty F. Merritt, Perla G. Po, Marco Antonio C. Sto.Tomas (inhibited), Yolanda C. Arugay and Amelia B. Rosales (inhibited), members.

The results of examination for five examinees were withheld pending final determination of their liabilities under the rules and regulations governing licensure examination.

Those who will register are required to bring:

  • duly accomplished Oath Form or Panunumpa ng Propesyonal, 
  • current Community Tax Certificate (cedula), 
  • 2 pieces passport size picture (colored with white background and complete name tag), 
  • 1 piece 1” x 1” picture (colored with white background and complete name tag), 
  • 2 sets of metered documentary stamps, and 1 short brown envelope with name and profession; and to pay the Initial Registration Fee of P600 and Annual Registration Fee of P450 for 2010-2013.

Successful examinees should personally register and sign in the Roster of Registered Professionals.

The oathtaking ceremony of the new nurses, as well as those who have not taken their Oath of Professional will be held before the Board on Monday and Tuesday, September 20 and 21, at 8:00 a.m. and 1:00 p.m. at the SMX Convention Center, SM Mall of Asia, Pasay City.

All must come in their white gala uniform, nurse’s cap, white duty shoes, without earrings, hair not touching the collar and without corsage.

Oathtaking tickets for the National Capital Region (NCR) and nearby regions will be available at the Philippine Nurses Association (PNA) at 1663 F.T. Benitez Street, Malate, Manila, from September 1 - 20, on a “first come first serve” basis.


Filipino Health Workers Struggle in Filling Eldercare Gap

New America Media/Philipine News, News Feature, Maricar C. P. Hampton, Posted: Jun 16, 2010
This is the second of two articles by Maricar Hampton resulting from her 2010 New America Media Fellowship, supported by The Atlantic Philanthropies. You can read part one here.

Nurse Edel Pimentel believes that Filipino health care providers will be especially able to deal with the demands of the 78 million aging boomers in the United States -- plus their elderly parents -- once they enter a healthcare facility, because Filipinos are “natural caregivers.”

In the Philippines, she said, “We tend to take care of our loved ones ourselves until they die. We don’t put them in nursing homes; we just don’t have that,” said Pimentel.

The role of foreign-born health care workers is especially important now because the United States is facing severe shortages of nurses and other eldercare workers. One in six nursing aides and one in nine nurses in the United States are foreign born, according to a 2004 study by the Immigration Policy Center in Washington, D.C.

The Philippines has been especially important, because its health care education programs have long been patterned after that in the U.S. Also, American long-term care providers actively recruit health care personnel there, even though immigration concerns in the United States have slowed State Department approvals of work visas to a seven-year backlog.

A report by the Philippine Embassy on Filipino medical staff for the year 2008-2009, shows that a total of 1,887 nurses, 1,450 physical therapists and 229 occupational therapists in the Philippines have been recruited by, or have job orders to work for, different hospitals and nursing home facilities all over the United States. However the embassy is not sure whether these people made it to America or are still waiting back home.

Immigrants Fill U.S. Eldercare Shortages
Pimentel was only 23 when she was recruited away from her job as a hospital nurse in the Philippines by Potomac Valley Nursing and Wellness Center to come to its nursing facility in Maryland.
Like many of her colleagues, she initially found it difficult to adjust to her new circumstances. “When I came here it was a struggle; it was depressing being in a nursing home and working with them,” said Pimentel. Over the past 16 years, though, she became a nursing supervisor and data coordinator, and came to love her job.

Today, Pimentel is fortunate to be among the thousands of Filipino nurses and aides, who find satisfaction in providing long-term care to millions of older Americans. Many others who venture abroad as caregivers tell awful stories of abuse, harassment and broken dreams.

Even in non-abusive situations, long-term care staff can find themselves stuck on double shifts and assigned to too many facility residents. Despite doing the most difficult tasks direct-care nurses’ aides typically get paid hourly wages of $10 an hour or less, frequently without benefits.

Immigrants in nursing are particularly needed in geriatric care, because the fragmented U.S. system of long-term care attracts few health care providers, according to Robyn I. Stone, executive director of the Institute for the Future of Aging Services at the American Association of Homes and Services for Aging, in Washington, D.C.

Stone, a former head of the U.S. Administration on Aging, noted, “We have a coalition here in Washington called the Eldercare Workforce Alliance, a group of various associations that are all focused on really trying to get a better geriatric training, education and support for nursing and other health care professions.”

But until the United States  finds ways to fill the shortages, Stone said, immigrants skilled in health care will continue to be vital in both institutional and home or community-based care, she said.

Not only registered nurses such as Pimentel, but nursing caregivers in long-term care, also known as direct care workers, have always played a key role in American eldercare. In nursing facilities, homecare or community-based programs, such as assisted living, direct caregivers provide most of the hands-on care.

In many states on the East and West coasts, caregivers are predominantly from other nations. A 2008 article in the Gerontologist, a journal of the Gerontological Society of America, Globalization, reported that the Philippines has become a major source of long--term care workforce for the U.S., Canada, and European countries and others. Many others come from Africa, the Caribbean and other developing regions.

Grueling Tasks
Direct-care workers in long-term care often perform grueling tasks, such as bathing and feeding frail elders, helping them use the bathroom, cooking, cleaning and serving meals. In addition, they administer basic first aid and, in some cases, are licensed to dispense medications and participate in the care planning process for residents.

For Ted Melon, a caregiver at Maple Ridge, in Rockville, Md., providing real care to seniors greatly depends on resident-staff relationship.

“It’s all about interpersonal relationships with the residents,” he said. Mallon takes time to talk with residents, because “that personal touch” enables him to note subtle changes in a resident’s character that might tip him off to emerging issues in their care.

Direct-care workers, such as Melon, are the lowest paid employees in long-term care. Few work in settings that involve them on the caregiving team, or provide them longer-term career development.

That’s why turnover among direct care workers ranges from 40 to 75 percent annually nationwide, according to the 2009 Direct Support Professionals Wage Study, conducted by ANCOR, a trade group for direct-care providers. A 2001 report by the U.S. Government Accountability Office found that turnover has been as high as 100 percent in a year in some facilities.

Direct caregivers typically need one or more other jobs simply to make ends meet. Such is the case with Melon, who does private-duty caregiving on weeknights, and works in a group home on the weekends.

“I used to work in the mortgage industry. But with the real estate market going down, I had to look for an alternative source of income, which is in healthcare. But even then I still have to have two jobs,” Melon said.

Edita Baua, a patient-care unit manager , is one of Edel Pimentel’s nursing co-workers at Potomac Valley Nursing and Wellness Center in Maryland. “I came here as a tourist and wasn’t planning on staying for good,” she said. When a friend persuaded her to remain, she applied at Potomac Valley, where an administrator welcomed her and said the organization would sponsor Baua to become a legal U.S. resident.

Tess Orlina, director of nursing at Potomac Valley added, “We directly recruit our staff from the Philippines or sponsor them. Our administrator goes to the Philippines and directly interviews nurses from there.”

Currently, Potomac Valley has petitioned the U.S. State Department for three nurses to receive American work visas. But the visas are yet to be approved because of the virtual “freeze” on them, Orlina said.

Pimentel remains hopeful. For Filipino caregivers, she said, the U.S. provides “fertile ground. There are a lot of opportunities for you to move up in this profession. A lot of Filipino nurses thrive and do well because it’s innate in us to be hard working, patient and caring which, in this job, is very much needed.”

As for those nurses trying to emigrate here, she, Pimentel said, “Yes, there is a big need for nurses in this country, but it is limited because of the government restriction. But I hope the U.S. will give them the opportunity to come here too and fill the shortage.”

The Filipino Factor: Dispelling the Filipino worker stereotype

They're not just live-in caregivers. Many are nurses who want to live and work in Canada.

For many Canadians, the image of a Filipino worker is one of a nanny pushing a baby carriage. But the reality is quickly changing. Lawrence Santiago, a Trudeau scholar doing his doctorate at the University of B.C., wants to dispel some stereotypes about Filipino workers in Canada.
As he puts it, only about 12 per cent of the total Filipino population in Canada arrives via the Live-In Caregiver program.
To make his case, Santiago chose to study health care workers from the Philippines.
B.C. has not recruited nurses en masse from the Philippines the way the Prairie provinces have in recent years. But they apply to come anyway. The province's College of Registered Nurses gets more applications for licences to practise nursing from the Philippines than it does from any other country.
Santiago set out to hear the voices of these workers, understand what happens when they leave the Philippines, and see how they eventually fit into Canadian hospitals and clinics.
His project started in a small Saskatoon house, returned to his native Philippines, and this month looped back to B.C.
His research has illuminated the many challenges involved with widespread migration, both here and in the Philippines.
On a personal level, nurses who emigrate for a brighter economic future are often wracked with homesickness and guilt for leaving their families.
Globally, the large-scale exodus of health care workers also takes a toll. The country they leave loses some of its best and brightest nurses and doctors, harming both the quality of health care and training for the next generation.
Last summer, Santiago camped out for several months with five nurses from the Philippines. They were all on temporary work visas, living in Saskatoon, the first batch of recruits hired by the Saskatoon Health Authority in 2008. His initial source was a childhood friend.
"Before he left for Canada, we met regularly in our town and at the community church," said Santiago.
From there, Santiago fanned out to meet and do in-depth interviews with other Filipino nurse migrants in Saskatoon.
"I lived with them in the same household, so I cooked, cleaned, played and did anything that a typical housemate would do," he explained.
His ability to speak to the nurses in Tagalog - and as the son of a middle-class, migrant construction worker himself - allowed him to "jell very quickly" with his subjects. Still, at times it wasn't easy to draw the line: when to be an objective observer and when to be a fellow Filipino.
One day while helping one of the migrant nurses Skype with an ailing father, Santiago wondered how exactly he should handle himself.
"I can eavesdrop in their private family conversation like an ethnographer who takes advantage or exploits his subjects' emotional circumstances, or I can simply stay away from the scene," wrote Santiago. "I decided to do what a friend would do instead. I cooked him sopas or milk macaroni soup, which he has been requesting from me to cook for the last few days because of the rainy weather here in Saskatoon.
"Managing one's emotions is one of the most difficult things migrants face while they're abroad. In situations [such as] when one's loved ones are sick, or worse, just died, the migrant feels a strong sense of fate's betrayal," he noted.
This April, Santiago moved his research to the Philippines to learn what happens on that end when nurses leave in large numbers.
"There is a huge strain on health care delivery in Philippine hospitals. The boom of nursing colleges in the Philippines has become a major business opportunity for many private entrepreneurs and institutions, enabling further migration," said Santiago. "But it has led to a deterioration of the quality of nursing education, since most of the best trained nursing faculty and clinical instructors are leaving the Philippines as well."
Over the next few weeks, Santiago will conduct focus groups with Filipino nurses who are working in B.C. (Some come on temporary work visas to take hard-to-fill positions, often in more remote locations. Some work first in other countries, such as the U.K., the U.S. or in the Middle East, before coming to Canada on temporary work visas or as immigrants under federal skilled worker programs. Still others come first via the live-in caregiver program and then go through many qualifying hoops to work as nurses again once they are permanent residents.)
Eva Mendez, a consultant at Health Match B.C., which places doctors and nurses throughout the province, hopes Santiago will focus on how these Philippine-trained nurses are doing at work.
"Do your peers relate to you as a member of the team as opposed to [being] a temporary foreign worker? If it's a matter of 'You're an RN, but you're not really one of us,' it can lead to a total breakdown of work dynamics. Satisfaction at work is the linchpin."
To promote his research, Santiago is organizing conferences and collaborating on a multimedia, documentary film project. His great hope is that all the players in this story of migration from the Philippines to Canada will somehow "meet" via his project and think of ways to improve education, health, labour and migration policies.

Pinoy nurses in CNMI hit delayed, partial wages

By Haidee V. Eugenio
At least 22 Filipino nurses and auxiliary personnel in the Commonwealth of the Northern Mariana Islands (CNMI) have complained they have not been paid on time for as long as three months now.

Some nurses received partial payments for their salaries, but are still uncertain whether they would get paid in full or if they would get paid after all in the next pay period.

The 22 overseas health workers are employed by a private employment agency, Saipan Employment Agency and Services, for work in the CNMI, a U.S. territory some three hours away from Manila.

These Filipino nurses are assigned to the CNMI government-run Rota Health Center and Tinian Health Center, located in two other major islands of the CNMI.

In the CNMI’s capital island of Saipan, nurses in the government-run hospital are directly employed by the government and do not experience salary delays.

Most of the government nurses in Saipan and in the whole Northern Marianas are Filipinos.
“Nagi-stay pa rin kami dito dahil ayaw naman naming iwanan ang mga pasyente namin. Pero sana maayos na itong problema namin. Sana ma-hire na kami directly ng gobyerno. Hindi na namin makakayanan kapag ‘di pa kami makatanggap ng sweldo,” one of the Filipino nurses at the Rota Health Center told GMANews.TV.
(We’re staying here because we don’t want to abandon our patients. But we’re hoping that our problem would be addressed. We hope we’d be hired directly by the government. We can’t stand it any longer if we still don’t receive our wages.)

Filipino nurses in both Tinian and Rota do not want to be identified, fearing retaliation from either the employment agency or the CNMI government.

Since March 2010, nurses in Rota received payments covering only the hourly $4.55 minimum wage of their salaries, and not their complete hourly salary of $8.93 to $9.20 an hour.

These nurses’ employment agency, SEAS, has also been permanently barred and disqualified from hiring, renewing or employing foreign workers in the CNMI because of labor violations.

SEAS appealed the decision, but the CNMI Department of Labor upheld the debarment and disqualification. The agency can still appeal the latest decision.

The employment agency likewise said it has not been receiving payments from the CNMI government and, as a result, could not pay these Filipino nurses for the services they render at the government health centers.

CNMI lawmakers stepped in to identify funds to pay the nurses salary. However, the funding appropriated by lawmakers and approved by the governor could only cover partial payment of the salaries.

The Philippine Consulate General in Saipan could not be reached as of posting time.

Records from the Philippine Overseas Employment Administration show there are over 3,200 Filipino workers in the US territory as of 2009.

4 Pinay nurses sue Baltimore hospital for discrimination

Four Filipino nurses filed a discrimination complaint before the US Equal Employment Opportunity Commission (EEOC) against a hospital that allegedly fired them for speaking their native language at work.
Nurses Corina Capunitan Yap, Anna Rowena Rosales, Hachelle Natano, and Jazziel Granada claimed the Bon Secours Health System terminated them without due process and dismissed them solely for speaking in their native tongue.

The hospital’s policy states that English is the principal language and must be the exclusive language spoken and written by all employees while on duty in the emergency department.

However, the nurses, who are being represented by the Migrant Heritage Commission, said that they do not recall speaking in Tagalog in front or while providing patient care in the Emergency Department. They admitted speaking in their native language only during breaks at the Nurses’ Station.

The nurses’ lawyer, Atty. Arnedo Valera had asked the EEOC to investigate the complaint and if the hospital’s English-only rule in the workplace violates the Civil Rights Act.

Valera cited prior findings of the EEOC which did not favor this rule, “There were previous findings of the EEOC that this is burdensome as a condition of employment because it creates a disparate treatment which leads to discriminatory practice”.

Valera added that based on the nurses’ claims, speaking Tagalog during break time does not impede their work.

He added that should the EEOC find probable cause in the nurses’ complaint, the commission will issue a right to sue, after which they will file a case against the hospital before the district court and seek punitive damages of up to $500,000 for all four nurses. - via Balitang America

Norway may hire Filipino health workers

The possible deployment of Filipino health workers to Norway will increase the country’s intellectual capital and wealth, the Department of Labor and Employment (DoLE) said on Saturday.

Labor Acting Secretary Romeo Lagman made the statement after disclosing that Filipino nurses and caregivers may likely be deployed to Norway as soon as labor and health officials of Norway and the Philippines finalized talks on the matter.

“There are still apprehensions on the part of Norway particularly on the issue of ‘brain drain’ and the language training,” Lagman said in an interview.

“But we have 60,000 nurses produced every year, and enrollment for such course is not going down. We have an oversupply of nurses and we do not see a draining in our medical pool by increasing our deployment overseas,’’ he said.

According to Lagman, most European countries are now looking at the impact of social migration and do not want to take advantage of countries that are experiencing the brain drain phenomenon.
Norway labor and health officials are expected to visit the Philippines within the year to continue talks on ways to create employment for Filipino health workers.

Norway is open for employment and has huge requirement for nurses, said Lagman.
Should the deployment of Filipino nurses to Norway pushes through, he said the Philippines will be gaining so much not only from the job opportunities but also from the skills learned by the workers while in that country.
Currently, he said the country offers good compensation for health workers ranging from $3,000 to $7,000 per month.

Earlier, Norway had opened its doors to Filipino engineers and offering salaries ranging from $5,000 to $7,000 per month.

Apart from Norway, Lagman said Denmark is also open for Filipino workers although details on possible employment are yet to be discussed. - via www.mb.com.ph

Limiting Nurse Workloads Good for RNs and Patients

April 21, 2010 — A law passed in California in 2004 limiting the number of patients that can be assigned to a nurse has contributed to lower mortality rates among general surgery patients and increased job satisfaction among the state's nurses, according to the first comprehensive evaluation of the legislation, published online April 9 in Health Services Research.
The California law, the first in the nation, specifies that nurses may care for no more than

  • 5 patients in a medical-surgical unit,
  • 4 pediatric patients,
  • 2 intensive care patients,
  • 6 psychiatric patients, or
  • 3 patients in labor and delivery.
Linda H. Aiken, PhD, RN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, Philadelphia, and colleagues examined general surgery outcomes data and hospital staffing information from California in 2006, 2 years after the law was enacted. The researchers did the same in Pennsylvania and New Jersey — 2 states without mandated nurse staffing requirements — and compared how nurse and patient outcomes are affected by differences in nurse workloads across the hospitals in these 3 states.
The analysis included 22,336 hospital staff nurses working in 604 adult nonfederal acute care hospitals in California (n = 9257 registered nurses [RNs] in 353 hospitals), New Jersey (n = 5818 RNs in 73 hospitals), and Pennsylvania (n = 7261 RNs in 178 hospitals). Small (<100 beds), medium (101 - 250 beds), and large (>251 beds) hospitals were represented.
The authors report that average workloads were significantly lower (P < .05) for RNs in California than in New Jersey and Pennsylvania (mean patients per shift, 4.1 in California vs 5.4 in New Jersey and Pennsylvania). The percentage of California nurses on medical-surgical wards who reported overseeing 5 or fewer patients on their last shift, as mandated under California law, was 88%; the same was true of only 19% and 33% of medical-surgical nurses in New Jersey and Pennsylvania, respectively. On medical-surgical wards, California RNs cared for 2 fewer patients on average than New Jersey RNs and 1.7 fewer patients than Pennsylvania RNs.
"Sizeable" Effects on Surgical Inpatient Mortality
Dr. Aiken's team used logistic regression models to estimate the effects of nurse staffing on 30-day inpatient mortality. The results suggested that there would have been 13.9% fewer deaths among surgery patients in New Jersey and 10.6% fewer in Pennsylvania if hospitals in those states had been staffed at the same average level as California hospitals .
"In these two states alone, 468 lives might have been saved over the 2-year period just among general surgery patients if the California nurse staffing levels were adopted," Dr. Aiken notes in a university-issued statement. "Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year," she predicted.
Better Work Environment
The survey also found significantly and consistently greater job satisfaction among California RNs. Higher percentages of nurses in California than in New Jersey and Pennsylvania reported that
  • their workloads are reasonable (73% vs 59% and 61% for New Jersey and Pennsylvania, respectively),
  • they receive substantial support in doing their jobs (66% vs 53% and 55%, respectively),
  • there are enough staff RNs to provide quality care (58% vs 41% and 44%, respectively),
  • there are enough staff RNs to get their work done (56% vs 40% and 44%, respectively), and
  • 30-minute breaks are part of their typical workday (74% vs 51% and 45%, respectively).
All of these differences were significant to the P < .01 level.
In addition, a smaller percentage of nurses in California than in New Jersey and Pennsylvania reported that their workloads caused them to miss changes in patient conditions (33% vs 41% and 37%, respectively; P < .01). There was also evidence that a significantly lower proportion of California RNs experience high burnout (29% vs 34% and 36%, respectively).
Dr. Aiken's team notes that although nurse self-reports of workloads may be prone to bias, in previous research they found them to have "considerable predictive validity and better predictive validity than [American Hospital Association] measures of nurse staffing." The researchers also say they rigorously controlled for a variety of nurse characteristics that might affect the data, such as education and experience, as well as patient and hospital characteristics that might affect the results.
"The California experience may inform other states that are currently debating nurse ratio legislation," Dr. Aiken and colleagues conclude, noting that Massachusetts, Minnesota, New Jersey, Illinois, and Oregon are among 18 states currently evaluating nurse staffing issues.
The study was supported by the National Institute of Nursing Research, National Institutes of Health, the Robert Wood Johnson Foundation, and AMN Healthcare Inc. The authors have disclosed no relevant financial relationships.

Better Nurse-Patient Ratios Could Save Thousands of Lives Annually, Says Study

If California's mandatory nurse-patient ratios had been in effect in Pennsylvania and New Jersey hospitals in 2006, those states would have seen 10.6% and 13.9% fewer deaths among general surgical patients, according to a Pennsylvania researcher's analysis.

That equated to 468 lives that might have been saved, says Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and the study's lead author.

Her report was published in the journal Health Services Research, and is considered the first comprehensive evaluation of California's controversial 2004 nurse staffing ratio mandate and may inform decisions in 18 other states that are considering lowering their nurse-staff ratios, such as Massachusetts, Minnesota, and Illinois.
Aiken's study received funding support from the Robert Wood Johnson Foundation and the National Institute of Nursing Research at the National Institutes of Health.

Aiken, a registered nurse and a well-known nursing workforce investigator, says that the difference between staffing at hospitals in California versus New Jersey and Pennsylvania "is very large, about two more patients per nurse [in medical surgical units]. And that's very significant."

To explain the decline in California mortality that she attributes to better nurse-patient ratios, Aiken says, "Nurses are the main surveillance system in hospitals.

"Nurses detect the majority of complications; the majority of medication errors that are detected by anyone are detected by nurses first. And nurses can distinguish between patients who are shivering after surgery because the operating rooms are cold, or who are shivering because they are in shock and are going into multiple organ failure that can't be reversed if it isn't caught early enough."

"All hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients," Aiken says, adding that "the potential number of lives that could be saved by improving nurse staffing in hospitals is likely to be many thousands a year."

A spokeswoman for the California Hospital Association, which opposed the patient-nurse ratios and has criticized their effectiveness, said the organization was reviewing the report, but did not yet have a comment.
However, officials for the 155,000-member California Nurses Association were delighted with the report because it sponsored the law that mandated the lower ratios.

"This research documents what California RNs have long known–safe staffing saves lives," says Malinda Markowitz, CNA and National Nurses United co-president. "We see the effects every day at the bedside in improved patient care, an enhanced quality of life for patients, and nurses able to more safely practice the profession to which we have dedicated our lives."

Her study compared patient outcomes data reported by hospitals to state agencies and surveyed 22,236 hospital staff nurses in those three states. The report was long anticipated because California remains the first and only state to implement minimum nurse-patient staff ratios in its acute care hospitals, as of Jan. 1, 2004.
The law says a nurse must care for no more than five patients on a medical-surgical unit, four pediatric patients, two in intensive care, six in a psychiatric unit, and three in labor and delivery.

According to a table in Aiken's report, adjusted 30-day inpatient mortality in California was also significantly lower than in New Jersey or Pennsylvania.

Also, Aiken reported, 88% of nurses surveyed in a medical-surgical unit reported having five patients, but in New Jersey only 19% and in Pennsylvania only 33% reported those ratios. The rest had higher ratios.
Similar disparities were seen for nurses working in intensive care, telemetry, oncology, labor and delivery, and pediatric units, according to Aiken's report.

Aiken's surveys of nurses in those three states revealed that in California, nurses had better job satisfaction, less burnout, and said they provided better quality of care than did nurses who responded in Pennsylvania and New Jersey. "California nurses were more likely to rate quality of care as excellent than nurses in the other two states," she says.

Aiken's report from 2002 found that each patient added to a nurse's workload added 7% to the mortality rate for patients undergoing common surgeries. Also, she reported, higher nurse to patient ratios were also associated with more nurse burnout, job dissatisfaction, and precursors of voluntary turnover.

Since 2004, the state has increased the number of actively licensed RNs by more than 110,000, tripling the average annual increase before 1999 when the law was enacted, and five years before it took effect.
"From a policy perspective, our findings are revealing," Aiken wrote in her conclusion. "The California experience may inform other states that are currently debating nurse ratio legislation."

McAfee antivirus program goes berserk, freezes PCs

NEW YORK – Computers in companies, hospitals and schools around the world got stuck repeatedly rebooting themselves Wednesday after an antivirus program identified a normal Windows file as a virus.
McAfee Inc. confirmed that a software update it posted at 9 a.m. Eastern time caused its antivirus program for corporate customers to misidentify a harmless file. It has posted a replacement update for download.
McAfee could not say how many computers were affected, but judging by online postings, the number was at least in the thousands and possibly in the hundreds of thousands.
McAfee said it did not appear that consumer versions of its software caused similar problems. It is investigating how the error happened "and will take measures" to prevent it from recurring, the company said in a statement.
The computer problem forced about a third of the hospitals in Rhode Island to postpone elective surgeries and stop treating patients without traumas in emergency rooms, said Nancy Jean, a spokeswoman for the Lifespan system of hospitals. The system includes Rhode Island Hospital, the state's largest, and Newport Hospital. Jean said patients who required treatment for gunshot wounds, car accidents, blunt trauma and other potentially fatal injuries were still being admitted to the emergency rooms.
In Kentucky, state police were told to shut down the computers in their patrol cars as technicians tried to fix the problem. The National Science Foundation headquarters in Arlington, Va., also lost computer access.
Intel Corp. appeared to be among the victims, according to employee posts on Twitter. Intel did not immediately return calls for comment.
Peter Juvinall, systems administrator at Illinois State University in Normal, said that when the first computer started rebooting it quickly became evident that it was a major problem, affecting dozens of computers at the College of Business alone.
"I originally thought it was a virus," he said. When the tech support people concluded McAfee's update was to blame, they stopped further downloads of the faulty software update and started shuttling from computer to computer to get the machines working again.
In many offices, personal attention to each PC from a technician appeared to be the only way to fix the problem because the computers weren't receptive to remote software updates when stuck in the reboot cycle. That slowed the recovery.
It's not uncommon for antivirus programs to misidentify legitimate files as viruses. Last month, antivirus software from Bitdefender locked up PCs running several different versions of Windows.
However, the scale of this outage was unusual, said Mike Rothman, president of computer security firm Securosis.
"It looks to be a train wreck," Rothman said.

California hospital plans to use 100 Apple iPad

A California hospital plans to distribute more than 100 Apple iPads among its health care workers to allow them look at X-ray images, EKG results and more on the portable touchscreen device, according to a new report.

Nick Volosin, director of technical services at Kaweah Health Care District in Visalia, Calif., told Network World that he bought three iPads for testing, and plans to implement more than 100 at the facility in the next two months. Various patient monitoring programs will be accessed through Citrix virtual desktop and application delivery software. Using the Citrix Receiver, the hospital will be able to have its workers access desktop applications without writing proprietary software for the iPad.

The iPads will be distributed to home health care and hospice workers, nurses, dietitians and pharmacists. Because tight supply has forced Apple to turn down volume orders, the hospital had to work with Apple directly to make such a large purchase.

Volosin told author Jon Brodkin that the iPad and its 10-hour battery life will replace a laptop for many employees, particularly because it will eliminate the need to charge multiple times throughout the day, and it doesn’t need to be turned on and off. In addition to patient-related services, employees will also be able to use the device to do traditional office tasks like check their e-mail.

Another selling point for the iPad: the price. Starting at $500 for the 16GB Wi-Fi model, Volosin reportedly said that it is a more affordable option when compared to a traditional touchscreen tablet, which can cost as much as $3,000.

In addition to Volosin’s three test units, about 20 doctors have purchased their own iPads to use at the office. One kidney specialist said the device has made him more efficient and also improved patient safety.

Many hospitals have eyed Apple’s iPad since the device was first announced earlier this year. Some health care workers believe tablet computers help doctors and nurses spend more time with patients. One San Francisco program dubbed “Destination Bedside” uses tablet computers to provide X-rays, charts, prescriptions and notes.

In February, one study found that one in five physicians intended to buy an iPad, just days after it was announced. Epocrates Inc.’s survey of more than 350 clinicians found that 9 percent would buy an iPad when it became available, while another 13 percent intend to buy one in the first year. Another 38 percent said they were interested in the iPad, but wanted more information before they would decide whether or not to purchase.

Stress Hormones May Promote Ovarian Cancer Metastasis

FRIDAY, April 23 (HealthDay News) -- In patients with ovarian cancer, focal adhesion kinase (FAK) modulation by stress hormones -- especially norepinephrine and epinephrine -- may contribute to tumor progression, according to research published online April 12 in the Journal of Clinical Investigation.

Anil K. Sood, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues studied human ovarian cancer cells which were exposed to either norepinephrine or epinephrine, and mice with a model of human ovarian cancer which were subjected to restraint stress. They also examined 80 cases of invasive epithelial ovarian cancer to assess the role of stress-induced FAK activity.

The researchers found that cancer cells exposed to the hormones exhibited lower levels of anoikis. In the mice, they found that the associated increases in norepinephrine and epinephrine protected the tumor cells from anoikis and promoted their growth by binding with the β2-adrenergic receptor and activating FAK. In the human cases, they found that 67 percent had increased FAK expression and that 50 percent had heightened levels of phosphorylated FAK. Three-year survival was significantly lower in those with increased FAK expression or heightened levels of phosphorylated FAK (30 and 15 percent, respectively) than in those with low FAK expression (65 percent).

"These findings also imply that the neuroendocrine 'macroenvironment' may play a significant role in shaping cellular activity in the tumor microenvironment in ways that ultimately facilitate cancer progression," the authors write. "Thus, protective interventions targeting the neuroendocrine system might simultaneously modulate multiple molecular pathways involved in tumor metastasis (e.g., anoikis, angiogenesis, and invasion)."

Nursing our way out of a doctor shortage

Give non-physicians more freedom to help patients.

Thanks to health care reform, millions of previously uninsured Americans will have policies enabling them to go to the doctor when necessary without financial fear. But it's a bit like giving everyone a plane ticket to fly tomorrow. If the planes are all full, you won't be going anywhere.

There are not a lot of doctors sitting in their offices like the Maytag repairman, playing solitaire and wishing a patient would drop by. Most of them manage to stay plenty busy. Nor is there a tidal wave of young physicians about to roll in to quench this new thirst for medical care.

On the contrary. The Association of American Medical Colleges says that by 2025, the nation could be 150,000 doctors short of the number we need. Meanwhile, the number of med students entering primary care, the area of greatest need, is on the decline.

It's hard to quickly boost the supply of physicians, since the necessary training usually takes at least seven years beyond college. The result, as an AAMC official told The Wall Street Journal: "It will probably take 10 years to even make a dent into the number of doctors that we need out there."

That, of course, is assuming that the new health insurance system doesn't drive aspiring or existing doctors out of medicine, which is entirely possible. Regardless, there seems to be no doubt that it will get harder to find someone to treat you, it may cost more and you'll spend two hours in the waiting room instead of one.

Or maybe not. What people with medical problems need is medical care, but you don't always need a physician to get treatment. You might also see a different sort of trained professional — say, a nurse practitioner, physician's assistant, nurse or physical therapist.

Not every ailment demands Dr. McDreamy, any more than every car trip requires a Lexus. If you have a sore throat, earache or runny nose, you probably don't absolutely require a board-certified internist to conduct an exam and dispense a remedy.

But it may not be up to you to decide who is suited to provide the care you want. Different states have different rules on what these clinicians may do. In many places, a nurse practitioner has to be under the supervision of a doctor. In others, she may not prescribe medicines or use the title "Dr." even if she has a doctorate (as many do).

Medicare typically reimburses nurse practitioners at a lower rate than physicians. In Chicago, an office visit that would bring $70 to a doctor is worth only $60 to a nurse practitioner.

But the need for more primary care is forcing a welcome reassessment of these policies. So 28 states are reportedly considering loosening the regulations for nurse practitioners, on the novel theory that any competent professional health care is better than none.

Private enterprise is already responding to what consumers want. Walgreens, for example, has established more than 700 retail health clinics staffed by nurses, nurse practitioners and other non-doctor professionals. CVS has its own version. The number of these facilities is expected to soar in the next few years.

You might fear that this sort of treatment is inferior to what you'd get from your personal doctor. Your doctor might agree. The American Medical Association, reports The Associated Press, warns that "a doctor shortage is no reason to put nurses in charge and endanger patients."

But put your mind at ease. A 2000 study published in the Journal of the American Medical Association found that where nurse practitioners have full latitude to do their jobs, their patients did just as well as patients sent to physicians. Other research confirms that finding, while noting that retail clinics provide their services for far less money than doctors' offices and emergency rooms.

Obviously, if you wake up with crushing pain in your chest or fall out of a second-story window, you'd be well-advised to see a specialist. But for common ailments that are mainly a nuisance, a physician may be a superfluous luxury.

Obama's health care reform rests on the assumption that expanding access demands a bigger government role. But even its supporters should be able to see that sometimes, it helps to get the government out of the way.

Steve Chapman is a member of the Tribune's editorial board and blogs at chicagotribune.com/chapman