Facing Death But Fighting The Aid-In-Dying Movement

Stephanie Packer was 29 when she found out she has a terminal lung disease.

It’s the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall.  Maynard’s quest for control over the end of her life continues to galvanize the “aid-in-dying” movement nationwide, with legislation pending in California and a dozen other states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

“Wanting the pain to stop, wanting the humiliating side effects to go away – that’s absolutely natural,” Packer says. “I absolutely have been there, and I still get there some days. But I don’t get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn’t have to be.”

A recent spring afternoon in Packer’s kitchen is a good day, as she prepares lunch with her four children.

“Do you want to help?” she asks the eager crowd of siblings gathered tightly around her at the stovetop.

“Yeah!” yells 5-year-old Savannah.

“I do!” says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.

Diagnosis and pain

In 2012, after suffering a series of debilitating lung infections, she went to a doctor who diagnosed her with scleroderma.  The autoimmune disease causes hardening of the skin and, in about a third of cases, other organs. The doctor told Packer that it had settled in her lungs.

“And I said, ‘OK, what does this mean for me?’” she recalls. “And he said, ‘Well, with this condition…you have about three years left to live.’”

Initially, Packer recalls, the news was just too overwhelming to talk about with anyone –including her husband.

“So we just…carried on,” she says. “And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant.”

Packer, 32, is on oxygen full time and takes a slew of medications.

She says she has been diagnosed with a series of conditions linked to or associated with scleroderma, including the auto-immune disease, lupus, and gastroparesis, a disorder that interferes with proper digestion.

Packer’s various maladies have her in constant, sometimes excruciating pain, she says, noting that she also can’t digest food properly and is always “extremely fatigued.”

Some days are good. Others are consumed by low energy and pain that only sleep can relieve.

“For my kids, I need to be able to control the pain because that’s what concerns them the most,” she adds.

Faith and fear

Packer and her husband Brian, 36, are devout Catholics. They agree with their church that doctors should never hasten death.

“We’re a faith-based family,” he says. “God put us here on earth and only God can take us away. And he has a master plan for us, and if suffering is part of that plan, which it seems to be, then so be it.”

They also believe if the California bill on physician-assisted suicide, SB 128,  passes, it would create the potential for abuse. Pressure to end one’s life, they fear, could become a dangerous norm, especially in a world defined by high-cost medical care.

“Death can be beautiful”

Instead of fatal medication, Stephanie says she hopes other terminally ill people consider existing palliative medicine and hospice care.

“Death can be beautiful and peaceful,” she says. “It’s a natural process that should be allowed to happen on its own.”

Stephanie’s illness has also forced the Packers to  make significant changes. Brian has traded his full-time job at a lumber company for that of weekend handyman work at the family church. The schedule shift allows him to act as primary caregiver to Stephanie and the children. But the reduction in income forced the family of six to downsize to a two-bedroom apartment it shares with a dog and two pet geckos.

Even so, Brian says, life is good.

“I have four beautiful children. I get to spend so much more time with them than most head of households,” he says. “I get to spend more time with my wife than most husbands do.”

And it’s that kind of support  from family, friends and those in her community  that Stephanie says keeps her living in gratitude, even as she struggles with the realization that she will not be there to see her children grow up.

“I know eventually that my lungs are going to give out, which will make my heart give out, and  I know that’s going to happen sooner than I would like — sooner than my family would like,” she says. “But I’m not making that my focus. My focus is today.”

Stephanie says she is hoping for a double-lung transplant, which could give her a few more years. In the meantime, next month marks three years since her doctor gave her three years to live.

So every day, she says, is a blessing.

This story is part of a reporting partnership that includes Southern California Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Practice Alert: Should nurses be filling the Pyxis?

Mat Keller headshot`

By Mathew Keller RN JD, MNA Nurse Practice & Policy Specialist

In a cost-cutting move, many Minnesota hospitals are asking registered nurses to take on more pharmacy duties. Where there may have once been pharmacy staff available 24/7 to answer questions, compound pharmaceuticals, and dispense medications, many nurses are finding that such coverage is now limited to 9-5 with an outsourced pharmacist in another city (or state) available by telephone after hours to answer questions and certify prescriptions. This can lead to potentially dangerous situations for patients as well as nurses’ licenses when nurses are asked to dispense and/or compound medications in the absence of a pharmacist.

One disturbing trend we are tracking is nurses being asked to fill the Pyxis or other automatic dispensing machine on the overnight shift. Non-pharmacy staff filling a Pyxis is unacceptable pharmaceutical practice. Furthermore, it is outside the scope of RN practice.

Under state law, only pharmacists are legally qualified to dispense medications, although they may be assisted in the task by up to two pharmacy technicians at one time.[1] Dispensing is defined as “delivering one or more doses of a drug for subsequent administration to, or use by a patient.”[2] When a nurse fills a Pyxis or other automatic dispensing machine, that nurse is delivering doses of drugs for subsequent administration to a patient.

While nurses may legally administer medications, they may not legally dispense them. Filling a Pyxis is outside the scope of RN practice and can lead to discipline against one’s nursing license as well as charges of practicing pharmacy without a license. In addition to scope and licensure issues, a nurse who fills a Pyxis assumes legal liability for any and all errors or patient harm resulting from improper dispensation (e.g. putting the incorrect medication in a Pyxis drawer).

Another common issue involves nurses being asked to mix IV medications in the absence of pharmacy coverage. The propriety of this practice is situationally dependent: reconstituting medications is acceptable nursing practice; compounding medications is not. Compounding is defined as mixing, packaging, and labeling a drug for an identified individual patient’s use.[3] The determining factor in whether or not you are compounding medications is whether the medication is for immediate use or not.  If a medication is being mixed for immediate use, it is acceptable reconstitution.  If the medication is being mixed for storage and later use, it is unacceptable compounding.

Lastly, many nurses are being given pharmacy access for after-hours care.  Under Minnesota rules[4], after-hours nurse access to the pharmacy should fulfill the following guidelines:

  • Withdrawal of medications must be limited to “emergency” situations, interpreted broadly by the Board of Pharmacy to include any time a necessary medication is needed but unavailable;
  •  Only one designated RN on a given shift may have emergency access;
  • The standard of practice is that narcotic access is limited to a locked narcotic drawer with a small supply of available medications, not full access to the narcotics safe;
  • The designated RN must properly document medications removed from the pharmacy;
  • The designated RN should have proper training from the pharmacy staff in pharmacy policies and procedures, as well as specific training regarding after-hours access.

MNA has and will continue to work with the Minnesota Board of Pharmacy in order to ensure that our patients are protected through proper pharmaceutical and nursing practice. Have you been asked to fill a Pyxis or compound medications? Please let us know at Mathew.keller@mnnurses.org.

[1] MN Statute §151.01 Subd. 27 (2)
[2] MN Rule 6800.7100
[3] MN Statute §151.01 Subd. 35
[4] MN Rule 6800.7530

Back-breaking work? Nurses face extraordinary health risks

Chart: Musculoskeletal work injuries by occupation: percentages

Nursing assistants, orderlies and registered nurses make up a significant chunk of the total number of back injuries suffered at work every year

NPR conducted an in-depth investigation into the working conditions of nurses, focusing specifically on how nurses suffer a shockingly disproportional number of back injuries. The authors concluded that “nursing employees suffer more debilitating back and other injuries than almost any other occupation — and they get those injuries mainly from doing the everyday tasks of lifting and moving patients”.

The NPR reporting was published as a series of articles, full of worrying data and heartbreaking stories, and the first four pieces alone added up to some 10,000+ words. Luckily the NursingJobs.us blog published a handy summary:

Back-breaking work? A shocking 4-part NPR report on the extraordinary health risks nurses face – and a couple of charts and leads of our own

The post does some follow-up work too, describing some of the impact the NPR stories had, and taking a closer look at one of the hospitals where the reporters found management to have treated injured nurses particularly callously.

The writer also observes that the NPR stories haven’t been the only recent reporting about the health risks nurses face. Nurses working rotating night shifts have an increased risk of death from cardiovascular disease and lung cancer, recent research has found; nurses suffer depression at twice the rate of the national population; and health care and social assistance workers in general are four times as likely to suffer an injury or illness because of violence at the workplace as other workers.

Safe patient handling: Be aware, be safe [quote, chart]

The number of musculoskeletal injuries by occupation, and how nursing assistants and registered nurses rank

Sen Sanders Joins Forces with Nurses and Students, Introduces ”College For All Act”

The Robin Hood Tax swooped into America’s national spotlight when presidential contender Sen. Bernie Sanders joined with National Nurses United and student groups in Washington, D.C. at a press conference today to announce his introduction of two Senate bills  – the College for All Act and the Robin Hood tax bill that would levy a small tax on Wall Street financial transactions in order to fund free tuition at every public college and university in the United States, as well as slash interest rates on existing student loans.

The College for All Act and the Robin Hood Tax would set a 0.5 percent tax on most stock transactions, and a lesser tax on bond and derivative trades. Such a tax has been championed for years by NNU, the country’s largest organization of registered nurses, and other healthcare and climate change groups and is already in effect in more than 40 countries around the world, including Britain, Germany, Switzerland, and China. A similar Robin Hood Tax bill, H.R. 1464, introduced by Rep. Keith Ellison, is pending in the House of Representatives. The tax is estimated to raise about $300 billion per year to fund programs such as free higher education, healthcare for all, and a reversal of climate change.

RoseAnn DeMoro, NNU’s executive director, said that nurses often see the health results that a lifetime of accumulated debt, stress, and poverty cause.

“The nurses are here because we have fought long and hard for a Robin Hood Tax to fund education, healthcare, shoring up our environment, to fund everything that has to do with human suffering,” said DeMoro. “Because what the nurses end up seeing at the bedside is all the unnecessary human despair and suffering when we don’t have these things.”

The country’s young adults are currently drowning in about $1.3 trillion of student loan debt that is borrowed at rates often set higher than mortgage and car loan rates. This crushing debt is a huge burden that prevents many young people from advancing in their careers and lives, stopping them from buying a car, getting married, buying a house, or having children.

“The time is long overdue for the American Congress to start listening to the needs of the American people and not just Wall Street,” said Sanders, flanked by students and registered nurses. “This is not a radical idea. Only in a Congress dominated by Wall Street and big money is this considered a radical idea

A huge student loan industry, as well as the federal government, has sprung up to service and profit off this need for loans, and student loans are currently bought and sold just like toxic mortgage debt was before the mortgage bubble burst in 2008. Some economists believe another bubble has ballooned around student debt, and is poised to pop soon, as well.

Sanders pointed out that many European nations make public secondary learning free for all qualified and willing students. Last year, Germany eliminated tuition at its public colleges. Denmark not only makes college free, but pays students to attend. In Sweden and Finland, public colleges are not only free to citizens but foreign students. Even in the United States, many public universities just a couple generations ago used to be free or at least very low cost.

Contrast that to today, when Sanders said that he cannot go anywhere in Vermont without parents coming up to him to discuss this crisis. “They come up to me and say, ‘This is crazy,’” recounted Sanders. “The other day I talked to a young doctor who told me her crime, the crime of becoming a general practitioner, was $300,000 of student debt.”

Some students at the press conference testified to not only the burden of graduating with major student loans, but how difficult it was to not be able to focus on their college studies while they were working two, three, four jobs to make ends meet – even with loans.

“While I was in school, I worked multiple jobs and often did not know whether I would have enough money to return to school the next semester,” said Alexandra Flores-Quilty (pictured left) of the United States Student Association, a group that advocates for students. She graduated late from the University of Oregon and now owes about $20,000 in student loans as well as $30,000 to her single mom. “Education is the foundation of any country. A free education means a free society. We need Sen. Sanders legislation to make sure that education is a right, not a privilege.”

Octavia Savage (pictured right), a recent accounting graduate from Bloomfield College, said that she worked day and night to afford college, on top of student loans. “When applying for college, the most important concern about college was, ‘How am I going to pay for school?’” said Savage, who worked in the college library, at UPS, at Sprint, and at Wal-Mart to make ends meet and still graduated with $26,000 in debt. “Students shouldn’t have to drown in debt to get the education they need to survive.”

 NNU’s DeMoro added, “People say, why are the nurses supporting a Robin Hood Tax? Because they experience despair and human suffering with every shift that is completely unnecessary.”

 

Click here to watch the press conference.

Watch the Robin Hood Tax USA live stream.

CNO of the Commonwealth

In May 2015, HB 389 Chief Nursing Officer (CNO) of the Commonwealth was passed in the House (final passage 187-6). HB 389 adds language establishing the office of the CNO of the Commonwealth within the Department of Health.

The CNO shall be appointed by the Governor with the advice and consent of the Senate. HB 389 requirements states that the CNO will:

  • be a practicing RN licensed by the Commonwealth,
  • be an RN with an unencumbered license,
  • have at least 10 years of working experience as an RN and
  • have a master’s degree in nursing or a master’s degree in public health.

Strong leadership is critical to realizing a transformed health care system in the Commonwealth.  Nurse leaders working in collaboration with other health care professionals is a key strategy for achieving innovative health care. To achieve this, RNs must actively serve on committees, commissions and boards. These committees often include Governor-appointed cabinet officials, but lack the engagement of the largest segment of health care providers — the RNs. The development of the role of HB 389 CNO of the Commonwealth is a significant step in achieving this goal.

The Shift Never Ends – Best Nurse for 2015

As a Nurse, it can be said that for some the shift never ends. This couldn’t be more true than for Diana Wright, founder of The Right Solutions. Diana was recently honored as Northwest Arkansas Democrat-Gazette’s Best Nurse for 2015. Join me in congratulating her for this exciting achievement. “When you put on your scrubs […]

The post The Shift Never Ends – Best Nurse for 2015 appeared first on The Gypsy Nurse.

Pet-friendly State Parks for Travel Nurses

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Pet-friendly State Parks for Travel Nurses

Have an awesome adventure with your best friend at one of these pet-friendly state parks for Travel Nurses!

For many Travel Nurses, whether to bring your pet on assignment or not is not even a question. Of course you want to hit the road with your best pal(s)!

Studies have shown that pet owners often cope better with new or difficult situations, making traveling with your pet good for your spirit and performance.

So, luckily, there are pet-friendly Travel Nursing agencies that will make traveling with your pets easier for you. But even though a pet-friendly company can help you with housing and other resources to make you and your pet happy on the road, once you arrive at your new location it can be a challenge locating dog parks or other good spots to go play with your pet(s) when you don’t know .

So I totally thought of you pet-loving Travel Nurses, when I saw a recent Roadtrippers post that shares some really great information about pet-friendly state parks. For Travel Nurses, it offers lots of great opportunities for pet-friendly fun and sightseeing with your pet on the road in Texas, New York, South Carolina, Kentucky, Utah, Alabama, Arizona, California and other locations.

Click here to learn more about some of these great pet-friendly state parks for Travel Nurses. And, bonus, you’ll also find a discount code for Rover.com where you can get a free night of pet-sitting!

Do you know of any great pet-friendly state parks for Travel Nurses? Share your faves in the comments!