Health Literacy • Foreign-Educated Nurses • Halting MRSA • Disaster Preparedness

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Health Literacy • Foreign-Educated Nurses • Halting MRSA • Disaster Preparedness

By Elizabeth Hanink, RN, BSN, PHN
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Foreign–Educated nurses (FENs) have long helped offset shortages in the United States. Now the American Nurses Association, along with educational and licensure bodies, unions, recruiters and healthcare organizations, has issued standards for all stakeholders. The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States safeguards quality patient care and the rights of individual practitioners.

While the code is voluntary, minimum standards require adherence to all U. S. laws, including but not limited to the Fair Labor Standards Act, the Civil Rights Act of 1964, the National Labor Relations Act, the Occupational Safety and Health Act and the Immigration and Nationality Act.

Other elements of the code seek transparency in recruitment and written communication of all terms of employment.

“Best practice” goals, which all institutions should strive for but might not yet meet, address the problems caused in source communities when nurses leave in large numbers. The code suggests key steps stateside employers and recruiters can take to minimize the disruption. These steps include offering scholarships, using visiting faculty and sending medical supplies to home countries — while avoiding recruitment in areas experiencing a crisis or chronic shortage of workers. Institutions should also honor the contractual obligations FENs may owe in home nations due to scholarships and public education.

Whether foreign-educated nurses will relieve our nurse shortage in the long term is debatable. Meanwhile, this code protects everyone’s interest.



October is Health Literacy Month. Started in 1999 by Helen Osborne, one of the nation’s leading advocates of health education, this month-long event involves healthcare workers and institutions at all levels, including drug companies, the NIH — and, maybe, your institution.

What is health literacy? Briefly, it is the patient’s understanding of what’s been taught. Multiple studies show that at least half the population, about 90 million people, do not understand instructions given by healthcare providers well enough to take prescriptions accurately, use equipment, arrange follow-up care or access the services they need. When this happens there are serious implications for the individual’s health and for soaring medical care costs in general.

With some groups, the health literacy rate is even lower. But make no mistake. Low health literacy occurs in all ages, races and levels of overall education; it is a problem in every state. Nor does the entire fault lie with the patient. Some healthcare providers communicate poorly, at best. Others just don’t get how important it is to communicate effectively.

Nurses are pivotal here. Many patients find us much less intimidating than they do physicians. Ordinarily we spend more time with patients, and we can use that time to explore gaps in understanding. Techniques like repeating back instructions and return demonstrations, even using comics, can help patients gain competence.

For more information on how to incorporate sound education principles into your patient teaching, check out Helen Osborne’s site at



It will probably happen here before too long. American hospitals will follow the British and modify their dress codes.

In England, starting this year, physicians are to place less emphasis on professional appearance and more on sanitation. “Bare below the elbow” includes ties, long sleeves and lab coats, to be specific. Fake nails, jewelry and watches are also out. Of course, nurses wear these items, too, hence the warning. We could be next.

Silly overreaction or sensible precaution? Medical opinion is divided. In fact, a 2004 study of doctors’ neckties at the New York Hospital Medical Center of Queens found that nearly half of them carried a least one species of infectious microbe. A control group of security guards had cleaner uniforms! Ties do dangle in the bed and across the patient, and if you have ever worn a long sleeve to work, you know how dirty it is at the end of the day. Picture as well all the adjustments to ties, watches and the like after hand washing. Recontamination galore!

The superbug, Methicillin-resistant Staphylococcus aureus, or MRSA, is the main target here. While there is no evidence of actual transmission from personnel to patients via articles of clothing, the debate continues. Malaysia and Israel, among other countries, also ban ties for direct contact


What do lawyers have to do with disaster preparedness? Plenty, it turns out. Katrina, and now Gustav and Ike, will surely result in a great many claims of negligence against first responders, long-term care facilities and healthcare providers. Plus, different types of disasters loom constantly. Bioterrorism comes to mind. Another is the strong likelihood of pandemic influenza — maybe not bird flu, but something equally rapacious.

Now the American Health Lawyers Association has published a guide: The Community Pan-Flu Preparedness: A Checklist of Key Legal Issues for Healthcare Providers. Ninety-six pages long and chock full of questions, it should be part of any facility’s emergency planning. As nurses we often participate in these discussions, and as practitioners we need to understand expectations when disasters strike.

The checklist is well organized and comprehensive, including such issues as staffing, materials, communications, quarantine and the like. The lawyers borrowed their guiding principle from Sir Winston Churchill: “It’s no use saying ‘We’re doing our best.’ You have got to succeed in doing what is necessary.”

Who gives consent for minors with newly incapacitated guardians? Can standards of care change when staff or supplies are scarce? Can care be mandatory if the patient has a communicable disease, or only if his life is in danger? It’s all here and more, including the biggest question of all: “Who decides?”

Look it up or obtain a free copy from:

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