NursingCenter’s In the Round

A dialog by nurses, for nurses

Ghosts in the Machine

clock November 18, 2011 05:21 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

This blog post is reposted from Show Me the Evidence: The Blog of Lippincott's Evidence-Based Practice Network.

When you appraise research, do you look at who was the principle investigator and wrote the article? I recently attended a session at a symposium that has made me question how I review articles for credibility. Inappropriate authorship (honorary and ghost authorship) and the resulting lack of transparency and accountability have been a substantial concern for the academic community for decades (Wislar, Flanagin, Fontanarosa, & DeAngelis, 2011). For those of you who are unfamiliar with the definitions, an honorary author is someone who is named as an author but did not meet authorship criteria and did not contribute substantially to take public responsibility for the work (Wislar, et al. 2011). A ghostwriter is someone who has made substantial contributions to the writing of the article but was not named as an author (Wislar, et al. 2011). These types of authors call into question the validity and credibility of the published work due to a lack of transparency on what they did or did not contribute to the article. 

In the latest issue of BMJ, Wislar, Flanagin, Fontanarosa, and DeAngelis, explored the issue of ghost writing and honorary authorship in their study "Honorary and ghost authors in high impact biomedical journals: a cross sectional survey."  They used a sample size of 896 authors from the top 2008 high Impact Factor medical journals in the industry, Annals of Internal Medicine, JAMA, Lancet, Nature Medicine, New England Journal of Medicine, and PLoS Medicine. Of the 896 authors, 630 responded to the survey for a 70.3% response rate. The prevalence of honorary and ghost authorship in articles published in major medical journals in 2008 was 21% (Wislar, et al. 2011). This number was a decline from identical study the group did in 1996 looking at the same publications. In 1996, the prevalence of honorary and ghost authorship was 29% (Wislar, et al. 2011). 

Clearly, these results demonstrate a need for the scientific community and peer-reviewed publications to increase their efforts to promote the responsibility, accountability, and transparency in authorship, and to maintain integrity in scientific publication (Wislar, et al. 2011). As healthcare providers who depend on the research evidence to guide our practice, we must carefully appraise the evidence to make sure it is credible and trustworthy; this includes scrutinizing the authors as well as the methodology and the research results, before using the information to change our practice. I applaud the efforts of the study authors to educate the healthcare community on the important issue of inappropriate authorship. It is through their efforts and the efforts of authors, editors, and publishers that we can continue to improve the integrity of the scientific publishing industry. 


Wislar, J., Flanagin, A., Fontanarosa, P., DeAngelis, C. 2011. Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey. BMJ.

Thank you from one nurse to another

Another Nurses Week has made its way to us. It's amazing how fast time goes by as we get older. Nurses Week this year is a little different that previous years for me. My mom was diagnosed with small cell lung cancer  2 months ago. She tried chemo but unfortunately it didn't work,  so 2 weeks ago we placed her on hospice and I moved in with her so she could stay at home and die surrounded by her family and friends.

What has struck me about this entire experience is the importance of nursing throughout the entire process. When my mom was a patient in the hospital where I work on the weekends, I was in awe by the way nurses of all ages and experience delivered care. I always thought our hospital delivered great care, but until I saw it in action with one of my own family members, I have a renewed appreciation for the nurses at the facility.

My mom has quite a few friends who are retired nurses. They  have stepped up to the plate to care for her, and to give me and the rest of our family a break when we need it. The care they deliver is exceptional. They know the importance of "just being" with her,  when to just hold her hand, when to medicate her, and when to talk her through episodes of respiratory distress. Obviously the art of nursing doesn't stop when you retire.

The hospice nurses are some of the most gifted nurses I have ever seen. They have so much to teach the rest of us on managing symptoms of end of life and have no problem with getting what they need for their patients from physicians.

My mom is pain-free and comfortable right now due to all of your efforts. I know she will experience a "good death" based on her terms.

So for all you nurses out there, I would like to say thank you for your dedication to the profession and your ability to make a difference in a person's life. You have certainly made a difference in mine and my mom's.  Happy Nurses's Week!



Call ahead to see which ED has the shortest wait time

clock February 7, 2011 08:57 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

I just returned from another business trip and this time I was at a conference in Las Vegas. What intrigued me most were the number of signs that post a number where you could call to find out wait times for the Emergency Departments of local hospitals. What a novel idea! Prospective patients could call ahead to see where the wait time was less and then go to that institution for service.

Where I live there are 3 hospitals within a 20 mile radius and more often than not, their patient census is bulging at the seams. We know on the weekend and at night, many people will go to the ED for care just because they don't have access to their primary care provider. While the "Minute Clinics" have certainly helped in my area, the EDs of our 3 local hospitals always seem to be busy. What an interesting marketing idea to let patients have the option to go where the wait time is less. This whole idea can really push EDs to streamline their patient flow.  

You guessed it, another health care emergency...

clock January 27, 2011 05:08 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

It always happens whenever I travel on business, there is almost always a health care emergency. I seem to be a magnet for them.

I recently returned from a business trip to China and had the opportunity to see the Chinese Health Care System up close and personal. One of my colleagues had an injury and needed to be taken to the hospital. As the "nurse" in the group, I went with her along with an interpreter. What I saw really opened my eyes to how luckly I am to practice in the United States.

When we arrived in the Emergency Department, there were no wheel chairs to be found, patients were sitting or lying on the waiting area floor. Once back in the treatment area, there were patients on stretchers, in chairs obviously brought from home, and lined up against the walls. The physicians, nurses and many patients were all wearing masks and there weren't any boxes of gloves or containers of anti-bacterial hand wash to be found.

After sometime, we discovered there was a special area for "foreigners" in another section of the hospital. So off we went through dimly lit corridors to our special area. Without an interpreter we would never have been able to register or speak to the nurses and physicians. "Pay for Service" takes on a whole new meaning in this setting. Before every examination and procedure, you had to get an estimate of the cost and then go pay for it with your credit card before the service was rendered. It was the nurses who gave the cost estimates for care. Can you imagine doing that in the U.S.?

Language was a definite barrier. The nurses spoke virtually no English but I was able to communicate with them through the interpreter. The physicians were somewhat more fluent in English medical terminology so it was less difficult communicating with them. When all else failed, hand gestures worked well.

 The care my colleague received, once we found the right place to be, was very good. The physicians and nurses appeared to be very knowledgable and skilled at their jobs despite having minimal supplies and staff.  

What lessons did I learn?

1.We often take supplies, cleanliness and being able to communicate with our patients for granted here in the U.S. In the rest of the world, that simply is not the case.

2. If you travel to a foreign country where you can't speak the native language, you better know where to find an interpreter.

3. Always carry a credit card or local money so you can pay for services.

4. If possible, travel with a nurse or other health care professional, they may save your life.


And finally, on the flight home, you guessed it, another medical emergency. And yes, I was the only health care provider on the plane.


World AIDS Day 2010

clock December 1, 2010 05:35 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Today is World AIDS Day, dedicated to raising awareness of the AIDS pandemic across the globe. AIDS has killed more than 25 million people between 1981 through 2007. Today 33.4 million people live with HIV and there are 2.7 million new cases each year. In the U.S., 1.1 million people are living with HIV and of those, 1 out of 5 people don't know they are HIV positive.

Funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), The Global Fund to Fight AIDS, and with donations from other organizations, AIDS medications are reaching people around the world however, many people still don't have access to these medications and the AIDS pandemic still claims far too many lives.

In the U.S. the effort has been made to make HIV testing part of routine health care. Over 80 million people in the U.S. have been tested at least once. The latest guidelines from the CDC recommend that everyone between the ages of 13 to 64 should be tested at least once and those at high risk should be tested more often and women should be tested during pregnancy.

For more information on World AIDS Day visit,



Veterans Day should be everyday

clock November 12, 2010 01:10 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Yesterday was Veterans Day and all around me I saw people saying thank you to veterans who have served our country by defending our right to freedom. Many of the nursing websites and journals posted messages thanking the veteran nurses who have served our country so well. I also tried to do a blog post yesterday to say thank you to our military nurses but, technology was not on my side and wouldn't allow me to post. As I pondered this experience on my drive to work this morning, I had another thought. It is not the day that is truely important, it's the overall feeling that we should say thank you to our military nurses everyday. They are truely the unsung heros in our profession. I have had the honor to work with many nurses who have served our country over the years. I am in awe of their dedication and devotion to helping individuals who are in need even if it means putting their safety in jeapardy.  The next time you are searching for an example of a nurse who really embody the spirit of giving; look no further than a nurse who is actively serving or who has served in the military.


New ways to manage pain

clock November 5, 2010 05:56 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

For those of us caring for patients, pain management is always an issue. I rarely see patients in my practice who aren't experiencing some sort of pain issue. Unfortunately, many times what I use to manage pain doesn't work for every patient.

I was glad to see in the latest issue of Nursing2010, an article addressing some of the new advances in pain management. Yvonne D"Arcy, MS, RN, CRNP, CNS does a great job discussing some of the recently developed drug delivery systems and applications for pain control. Her article, "An update on new pain medications," in the Controlling Pain column in the Nursing2010 November issue reviews topical NSAIDS, double-action oral medications that have both opioid and non-opioid activity in one drug, and a new extended release medication, Embeda, which is a combination of an extended release morphine and has a core of naltrexone, an opioid reversal agent that is activated if the drug is crushed, chewed, or dissolved. Quite a nice little abuse deterrent built right into the drug. The article also discusses a new capsaicin patch used to treat intractable pain from postherpetic neuralgia.

Without a doubt, this article will give you some new ideas to help manage your patients' pain. 

Drug shortages...putting people at risk

clock October 27, 2010 05:33 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

I was made aware of a serious problem with drug availability to consumers and health care institutions recently. My youngest daughter is allergic to milk and cheese which requires her to have an epipen available at all times and have an epipen available at school.  When I recently went to refill her perscription from the pharmacy, I was only permitted to get 1 pack of epipens. Each pack has 2 pens in it so we need two, one to carry and one to leave at school.  I was told by the pharmacist that there was a shortage of epinephrine emergency syringes so we were only able to get one at a time.

Today I was reading the health section of and found an article that really peaked my interest, "When vital drugs run out, patients pay the price". The article discussed the drug shortages that exist today and how these shortages are putting the health and welfare of the U.S. population at risk. According to the Food and Drug Administration, the majority of drug shortages are caused by manufacturing issues, safety concerns, and production delays. The article stated that there are 150 drugs currently on the shortage list by the American Society of Health-System Pharmacists. I went to their site,, and found that in fact there are 150 drugs on the list, and the issue is so prevalent that there is an article titled, "ASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems," posted on their site. 

Over the last year, I've noticed a shortages of drugs that are essential to my practice and now the shortage has affected me at home.  Unfortunately, the FDA does not have the authority to ensure that pharmaceutical companies produce adequate supplies of drugs. There has to be a change in the pharmaceutical drug supply chain to fix the drug shortage issue.    

Conference Update: ANCC Magnet Conference

clock October 20, 2010 16:09 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

I just attended the ANCC Magnet Conference in Phoenix last week and I have to say it was one of the best conferences I've attended this year. Each year it seems to grow larger and larger. This year was no exception with over 6,500 attendees. The excitement was certainly palpable as I saw groups of nurses, sometimes 20-30 nurses from the same facility, banding together and celebrating their accomplishments. The sessions were very practical and addressed the issues all institutions face as they are embarking on the Magnet Journey. Deepak Chopra MD gave the keynote speech and spoke about the power and art of caring which nurses do so well.

For those of you who are looking for a conference to reinvigorate your passion for our profession, then I encourage you to attend the ANCC Magnet Conference in 2011.

The Future of Nursing...can we steer through the bureaucracy and make it a reality

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched an initiative that looked at where the nursing profession was and where it needed to go. Their purpose was to make  recommendations for an "action-oriented" blueprint for the future of nursing. The group looked at the educational levels of nurses, the roles of nurses, and where nurses practice. This week, RWJF and the IOM released recommendations on how the nursing profession needs to transform to better meet the healthcare needs of people across the country.

The 4 key messages are:

1. Nurses should practice to the full extent of their education and training.

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

3. Nurses should be full partners, with physicians and other health care professinals, in redesigning health care in the United States.

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

As I read the report brief, it occurred to me that their recommendations seem like common sense. The evidence clearly shows all these things are true. It will be interesting to see if we are able to steer through the "politics of bureaucracy" and make these recommendations a reality. What do you think?

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