The Official Newsletter of the Philippine Nurses Association of Metropolitan Houston
Spring Issue May 2010
PRESIDENT
Riza V. Mauricio
MSN, RN, CCRN, CPNP-AC /
Executive Officers 2010 - 2012
Dear Colleagues, Friends, and Family,
Greetings!
I am fortunate to follow the footsteps of the past presidents who have made PNAMH a productive professional organization for three decades. This organization has consistently advocated for the Filipino nurses and the Filipino-American community. Indeed, we have etched a positive image of the Filipino nurses – responsive, dedicated, competent, and caring.
However, we cannot be complacent with our success. We cannot be content with the status quo because it appears to be working. The explosion of technological advances, increasing awareness of global health disparity, growing nursing shortage, health care crisis and many more; can affect our nursing profession. We must have a vision for the future. A vision we can call our preferred future. We must have a clear picture of our destination before we can draw a map to get there. Let’s create our preferred future.
CREATE and TRANSFORM, will be our guiding theme as we advance ourselves to be a prime professional organization. I am focused and committed in leading our organization to greater heights as we face the challenges of the 21st century.We will create programs that are in congruence with the mission and vision of PNAA; programs that will:
- Manage our organizational resources through the use of technology.
- Develop sustainable health outreach programs based on the goals of Healthy People 2020 through partnership with community leaders.
- Advocate and implement health promotion and disease prevention initiatives that will improve the health of our Filipino - American community, emphasizing the quality of life and the quality of care based on evidence/research.
- Increase chapter membership so that our voices can be bigger and louder as we position ourselves for an active role in our professional policy discussions and decision-making.
- Enhance educational programs among nurses and improve communication with members through the use of technological advancements.
- Develop and mentor emerging nursing leaders that will guide us to our preferred future.
Sincerely,
Riza Viacrucis Mauricio MSN, RN, CCRN, CPNP-PC/AC
President, Philippine Nurses Association of Metropolitan Houston
Hypertension: The Silent Killer of Filipino Americans
By: Anecita Fadol PhD, RN, FNP-BC,
Filipino Americans are at a greater risk of hypertension (HTN) than other Asian/ Pacific Islander Americans (Klatsky and Armstrong 1991). Although research has shown that certain populations have a propensity for HTN, culture may be a factor both in the health care practices and beliefs that influence the lifestyle and management of the disease process. Hypertension in the early stage is without symptoms, but is a major independent risk factor for the development of coronary artery disease (CAD), stroke and renal failure. It is a major contributor for increased morbidity and mortality in the world and the Filipino Americans living in the United States.
What is hypertension?
Hypertension is a persistent elevation of systolic blood pressure (SBP) at a level of 140 mm Hg or a diastolic blood pressure (DBP) of 90 mm Hg for individuals without a known history CAD or other CAD risk equivalent such as diabetes mellitus (DM), or chronic kidney disease. However, in the presence of any of the CAD risk equivalent, a SBP of 130 mm Hg or SBP 80 mm Hg is considered HTN (Chobanian et al 2003).
Risk Factors for HTN among Filipino Americans
Several risk factors predispose Filipino Americans to develop HTN. The dietary practice which is loaded with fat and salt is highly contributory to the development of HTN. Traditional Filipino cooking uses a lot of salt like bagoong, patis, soy sauce and monosodium glutamate. Even when the meat or fish is broiled, it would not be complete without the “sawsawan” with the salty ingredients. Vegetables taste better when eaten with salted fish. In addition, there’s the fried lumpia and the “lechon” which is the centerpiece during special celebrations. These are high in fat and cholesterol, but it is delectable. Filipinos love to get together and food is the central focus in any Filipino gathering.
Stress brought about by multiple responsibilities, conflicts in gender role expectations, working double jobs, and the demands of job responsibilities are common among Filipino Americans that can result in HTN (dela Cruz et al. 2008). As a consequence of a busy lifestyle, there is no time left for exercise and in order to cope with the above stressors, many individuals resort to smoking and excessive alcohol use which can further contribute to the development of HTN.
Treatment of Hypertension
The ultimate goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality. Lifestyle modification is critical for the prevention of HTN. Major lifestyle modification that are shown to lower blood pressure include: a) weight reduction in individuals who are overweight, b) dietary sodium restriction (minimize the bagoong), c) regular physical activity, d) quitting smoking, and e) moderation of alcohol consumption. If blood pressure remains elevated despite these initial measures, pharmacologic therapy is recommended. There are several classes of drugs supported by clinical trial data to lower BP, including angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), beta blockers, calcium channel blockers, and thiazide / diuretics. The choice of pharmacologic therapy is dependent on the individual characteristics and the presence of risk factors. The goal is to achieve the target blood pressure as recommended in the
Joint National Committee guidelines for blood pressure management
References:
- Chobanian,A. et al (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 289 (19); 2560-72.
- Dela Cruz, F. & Galang, C. (2008) Journal of the American Academy of Nurse Practitioners, 20, 118-127.
SafeHarbor Law and Mandatory Overtime For Texas Nurses
By: Rosalie U. Valdres MSN, RN, CNS, FNP-BC
Hospitals are constantly trying to save money by reducing the number of RNs and other licensed staff to a bare minimum. This is an extremely risky endeavor. The higher the nurse-patient ratio, the higher is the likelihood of a sentinel event (an unanticipated event causing serious injury or death to a patient that has nothing to do with present illness or reason for hospitalization) occurring. Nurses have the right toinvoke SafeHarbor if the nurse believes that accepting the requested assignment would expose one or more patients to an unjustifiable risk of harm. A nurse may not be suspended, terminated, or otherwise disciplined or discriminated against for requesting SafeHarbor in good faith.
What is SafeHarbor?
SafeHarbor is a process that protects a nurse from employer retaliation and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the Nurse Practice Act (NPA) or Board of Nursing rules. Safe Harbor must be invoked prior to engaging in the conduct or assignment for which peer review is requested, and maybe invoked at anytime during the work period when the initial assignment changes.
Case Report:
“Three ICU nurses from a MesquiteHospital refused to take care of three ICU patients assigned to each one of them because they believed it was unsafe patient load. They brought it to the attention of their supervisor that their assignment was considered dangerous understaffing.” Their complaint was ignored and instead they were fired.
Lessons learned from this case:
Filipino nurses are generally compliant and obedient and will just accept their patient assignments without question. In most cases, they are not allowed input by their managers or supervisors. In the above case report, the nurses were fired because of their refusal to take care of their assigned patients, which from the hospital’s viewpoint, the nurses’ behavior was not in the best interest of the patient. The situation could have been avoided if the nurses, after notifying the supervisor invoked the Safe Harbor Peer Review and continue to provide care to their assigned patients. The SafeHarbor Law states that the nurse must continue to workon what is “considered an unsafe patient environment” until the review is done and a report issued.
Texas Board of Nursing (BON): Nurse Practice Act (NPA):
The Texas Board of Nursing (BON) as stated in the Nurse Practice Act does not have the authority over work place issues, such as schedules or number of hours worked, either consecutively, in a given time period or “on call”. In relation to overtime or consecutive hours worked, the nurse has a duty to recognize when he or she is unfit to practice secondary to physical, mental or emotional fatigue. Nursing judgment and provision of nursing care may be impaired if a nurse is physically or emotionally exhausted which could lead to nursing errors.
In October 2009, changes were made during the 81st Legislative Session, SB 476 to the Nurse Practice Act (NPA) and The Health and Safety Code. SB476 applies to hospitals and nurses working in the hospital settings only. The NPA and BON rules emphasized the nurses’ responsibility and duty to the patient is to provide safe and effective nursing care.
NPA changed section 301.356, Retaliation Prohibited which states that “refusal by a nurse to work mandatory overtime as authorized by Chapter 258 of the Health and Safety Code, does not constitute patient abandonment or neglect.
Rule 217.11 Standards of Nursing Practice is the primary rule applied to nursing practice issues.
- Standard 217.11B – requires each nurse to promote safe environment for clients and others
- Standard 217.11 (1) (T) – holds each nurse accountable to accept only assignments that are within the nurse’s ability. If a nurse accepts an assignment, he or she is responsible for adhering to the NPA and BON rules in the delivery of safe patient care.
- Standard 217.11 (1) (S) – applies to charge nurses or who are in management position. Assignments made to other licensed nurses do require forethought and adequate supervision.
- Standard 217.11 (1) (U) – hold the supervisor responsible to oversee the nursing care provided by others to whom supervisor is professionally responsible.
References:
- Texas Board of Nurse Examiner –
- The Dallas Morning News June 16, 2007: dallasnews.com
- – nursing practice – peer review (excellent resource including protection against whistleblower)
2010 Health Care Reform and You: A New Guide
By: Menchu Mante MSN, RN, CNS, FNP-BCThe health care system package passed by the House Sunday March 21, 2010 was signed by President Barack Obama into Law on March 22, 2010. It is the most significant health legislation since the creation of the Medicare and Medicaid programs. Additional changes will occur if the Senate passes the reconciliation-bill to amend the new law.
The entire package will extend insurance coverage to 32 million uninsured Americans by 2019, and will also impact almost / every citizen. The following are highlights of the new health care reform:
- Most Americans would have to have insurance by 2014 or
- Depending on income, you might be eligible for Medicaid, the state-federal program for the poor and disabled. Current poverty guidelines are $14,404 for individuals and $29,326 for a family of four. Government sliding scale subsidies are available to pay for private insurance sold to the new state-based insurance marketplace slated to begin operation in 2014.
- For existing medical condition, insurers would be barred from rejecting applicants based on health status. This year, the bill would create a temporary high-risk insurance pool for people with medical problems who have been rejected by insurers and have been uninsured at least six months. Insurers can no longer set lifetime coverage limits for adults and kids.
- Unmarried adult younger than 26 years old can stay on their parent's insurance coverage as long as they are not offered health coverage at work.
- Individuals over 65 years old who enter the Part D coverage gap, known as the "doughnut hole," would get $250 to help pay for their medications. Drug company-discounts on brand-name drugs and federal subsidies and discounts for all drugs would gradually reduce the gap, eliminating it by 2020. Instead of paying 100%, seniors will pay 25%. After certain amount spent, they would get "catastrophic" coverage and pay only 5 percent of the cost of their medications.
- Beginning this year, the bill would make all Medicare preventive services, such as screenings for colon, prostate and breast cancer, free to beneficiaries.
People who are sick might face lower premiums because insurers wouldn't be permitted to charge more while healthier people might pay more. Older people could still be charged more than younger people, but the gap couldn't be as large. Even with rising medical cost, these may not affect the insurance premiums with the current legislation.
Reference:
- Phil Galewitz, Health reform and you: A new guide. Who Pays? Who benefits? And what about those in between? Kaiser Health News, 03/22/2010
- Health Care for Dummies: What You Need to Know,
2010 – 2012 / 2009 Philippine Nursing Licensure Exam Results
Low passing rate: Who is to blame?
By: Menchu Mante MSN, RN, CNS, FNP-BC
The result of the Philippine Nursing Licensure Examination (NLE), which was held in Manila & all Regional Offices on November 29-30, 2009 was released by the Professional Regional Commission (PRC) on January 31, 2010. Only 37,527 (39.72%) of the 94,462 examinees passed the examination. Of the successful examinees, 49% are first time takers and 51% are repeat takers.
The Commission on Higher Education blamed many of the “fly-by-night” nursing schools in the country. The government is working on evaluating substandard nursing schools that cannot produce quality nursing graduates for possible closure. According to the PRC, there are now 463 nursing schools throughout the country that
produce thousands of graduates every year. As a result, students are not getting enough training because of the lack of facilities and disproportionate patient-student ratio. Instead of 2 patients to 1 student, it is now 15 students to one patient. Many students have to be creative and resourceful in meeting graduation requirements without necessarily handling cases or performing various nursing procedures.
Many students receive poor quality nursing education because many private colleges and universities have become a profit generating business instead of educational institutions. At the government level, the only concern is to produce more nurses for “export” and to bring in substantial Overseas Field Workers (OFW) remittances. In the end, the nursing graduates are inadequately prepared to pass the licensure examination.
Reference:
- Asuncion, Kevin. Stop Nursing’s Decline, Philippine Daily Inquirer. February 2010
- Abs-cbnNews.com, Glut of nursing schools affects passing rate. 2/02/2010
EXECUTIVE OFFICERS
Riza V. Mauricio - MSN, RN, CCRN, CPNP-AC
President
Luz M. Reyes - BSN, RN, CNOR, RNFA
President-Elect
Rosnela Hardesty - BSN, RN, CNOR
Vice President
Gina Shankar – BSN, RN
Secretary
Grace Woodmansee – BSN, RN
Assistant Secretary
Aleza Espinosa - BSN, RN, MBA
Treasurer
Danny Lindog – BSN. RN
Assistant Treasurer
Arlene Granados - BSN, RN, BSBA, CCRN
Auditor
Arlita Pang – BSN, RN
Business Manager
Emee Nisnissan - BSN, RN, CMOM
Public Relations Officer
BOARD MEMBERS
Zenaida Alabbasi BSN, RN, MBA/HCM
Shela Ecobiza BSN, RN, BC
Felice Espinosa BSN, RN, MBA
Cynthia G. Jocson BSN, RN
Vangie Masalta MSN, RN, ANP-BC
Lorna Spiotto, BSN, RN
Merlita Velasquez BSN, RN
Pam Windle MSN, RN, CPAN,CAPA,FAAN
Calendar of Events
Please call PNAMH office for details on these events: (281) 277-2552
May 21-22, 2010– Friday / Saturday
SCR Conference
Dallas, Fort Worth
May 30, 2010– Saturday –10:00pm
Crawfish Boil at Memorial Park
Houston, Texas
June 5, 2010 - Saturday
The PNAMH Scholarship and
Outstanding Filipino Nurse Award
Westside Omni Hotel
13210 Katy Freeway
Houston, TX77079