1. Kennedy, Maureen Shawn MA, RN

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There were so many news stories of such significance in 2005 that it has been difficult to discern which had the biggest impact on U.S. health care and nursing. The list is daunting: the devastation wrought during the busiest and deadliest hurricane season on record; the march of avian influenza A (H5N1) across Asia and into Europe; the politics of the flu vaccine supply and drug approvals (or nonapprovals, as in the case of emergency contraception); the changes to the Medicare and Medicaid systems and a prescription drug plan for which the government had to mount a public relations campaign; hospitals closing or cutting back services because of dwindling reimbursements; and the recognition of an underserved population with unique needs and poor access to care-long-term cancer survivors.


AJN briefly explores what it considers the top stories, chosen because of their profound impact on nursing.


The U.S. health care system in crisis.

The number of uninsured Americans in 2004 was at a new high, 45.8 million, according to a November 1 report in Health Affairs. The rates of obesity, especially in children and adolescents, portend another American generation fraught with type 2 diabetes, heart disease, hypertension, and kidney disease-mostly preventable diseases. Newspapers and medical journals sport more frequent headlines on the growing disparities and high costs in health care, as well as on those who simply go without health care because they can't afford it. What's still missing is a coordinated, long-term strategy from national leaders.


Katrina, the mother of U.S. disasters.

Hurricane Katrina realized many people's fears: that despite the millions of dollars spent on preparedness since 2001, our ability to respond to catastrophic disaster is frightfully inadequate. Cumbersome chains of command paralyzed decision making, while insufficient communications systems and deficient leadership compounded the suffering of many. While most health care professionals in the stricken areas made herculean efforts to get patients to safe ground, at least one nursing home in Louisiana was charged with negligent homicide, and there is an investigation of reported euthanasia in a New Orleans hospital.


For returning Gulf Coast residents, health care access is a problem: thousands of health care workers have left the area. By mid-November, New Orleans still had nine hospitals inoperable, including the city's major trauma center and hospital for the indigent, Medical Center of Louisiana New Orleans-Charity Campus. More than 66,000 people in Louisiana and Mississippi were still living in government emergency housing, and thousands more had fled to 44 other states. Among the casualties of the flooding were medical records. The goal of developing a nationally networked, coordinated electronic medical record has taken on new momentum.


The fear of flying . . . birds.

World leaders and medical experts have us perched on the precipice of an influenza pandemic. They're anticipating the widespread transmission of a particularly virulent and aggressive strain: the A (H5N1) virus that crossed species to humans in 1997 in Hong Kong and that caused deaths in Asia in 2004 and 2005. Migrating birds carried the virus westward into Romania in October, and a mild strain (not the strain) of the H5N1 virus has surfaced in Canadian mallards.


The nursing shortage.

It endures, especially in schools of nursing, where students are turned away because of a lack of faculty. But in a win that's likely to bolster retention efforts, state nurses associations were successful in passing ergonomics legislation to protect nurses in New York, Ohio, and Texas. Other stories to watch include the success of nurses in California in beating back a governor-supported plan to undo legislated staffing ratios and the initiatives of the American Association of Colleges of Nursing to change the education level required of advanced practice nurses.