1. Mennick, Fran BSN, RN

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It's been well established that there is a high prevalence of chronic heart disease among Hispanics and blacks, yet many may lack the education or skills to manage their illness. A randomized trial conducted in Harlem, a mostly nonwhite neighborhood in New York City, has shown that nurses can improve outcomes in these populations.


Patients with heart failure (46% were black, 33% Hispanic, 15% white, 6% "other"; 54% didn't have a high school education) at four hospitals were randomized into either a "usual care" group (n = 203) or a nurse management group (n = 203). In the latter group, nurses taught patients about the physiology of heart failure, the relationship of sodium intake to fluid buildup and shortness of breath, and how to follow a low-sodium diet. Nurses also discussed adherence to medication regimens, physical activity, smoking cessation, and avoiding alcohol. They gave patients a scale and taught them to weigh themselves daily, record their weight, and call their clinician if symptoms got worse. An initial meeting was followed by regular phone calls from the nurse over 12 months for further counseling and reinforcement. Nurses coordinated care with the treating physician and made medication recommendations according to an evidence-based protocol.


At the end of 12 months, there were fewer hospitalizations in the intervention group (143 versus 180), and patients in that group maintained physical functioning at the "slightly impaired" level, compared with the usual care group, whose physical function declined to "markedly impaired." At the end of the year, patients who had received the intervention began to lose function at the same rate as patients in the usual care group. The authors concluded that a nurse-led, evidence-based protocol "can improve functioning and modestly reduce hospitalizations" in predominately minority ambulatory care patients who have systolic dysfunction and a low level of education. They also noted that "[c]ontinued contact with a nurse seemed to be needed to maintain the intervention's effect."


Fran Mennick, BSN, RN


Sisk JE, et al. Ann Intern Med 2006;145(4): 273-83.



Vermont hospitals must now disclose nurse staffing information. As of July 6, hospitals in the state must publicly post-and provide verbally to patients and callers upon request-the maximum patient census and the numbers of licensed nurses and nursing assistants providing direct patient care on each unit for each shift. Hospitals must also compare their nurse staffing to industry safety standards in their community reports. According to the American Nurses Association, more than 80 bills related to staffing issues have been introduced into state legislatures this year.



RNs who act as permanent "charge" nurses can be considered supervisors-and therefore ineligible for union protection-according to a ruling on October 3 by the National Labor Relations Board (NLRB) involving nurses at Oakwood Heritage Hospital in Taylor, Michigan. The three-to-two decision said RNs "exercised supervisory authority" when assigning RNs to care for specific patients. The NLRB rule did exclude nurses who act as a "rotating charge nurse" from being classified as supervisors because that duty didn't account for a "substantial" part of their work. According to several nursing unions, the effects may be far reaching and disastrous, if nurses without union protection against firing are afraid to speak out against poor conditions and unsafe practices. Read the ruling at


HIV screening for all patients, 13 to 64 years of age, regardless of risk is the new guideline issued by the Centers for Disease Control and Prevention (CDC) in September. Testing is not mandatory, but the CDC suggests that providers make it a routine part of health screening, telling patients that they may "opt out" if they wish. The revised guidelines are available at