Sunday, February 15, 2009

News Clipping Archives

 

Maryland / Regional

Mental health matters,' lawmakers told (Star Democrat)

Maryland Nears Deadline to Reduce Childhood Lead Poisoning (Baltimore Afro-American)

O'Malley favors legislation to limit 'abusive' hospital billing (Baltimore Sun)

National / International

Salmonella outbreak eases way for food safety reforms (Baltimore Sun)

Hib infection in children makes a deadly return (USA Today)

Nursing shortage: 1 in 5 quits within first year, study says (USA Today)

Lead law throttles youth powersports (USA Today)

Opinion

Successful nurses (Washington Times Letter to the Editor)

O'Malley's unbalanced budget (Washington Times Letter to the Editor)

 

Maryland / Regional

 

Mental health matters,' lawmakers told

 

Kent Island Editor

By Angela Price

Star Democrat

Sunday, February 15, 2009

 

ANNAPOLIS Families, advocates and providers gathered to discuss and promote the cause of children's mental health with legislators in Annapolis over a recent breakfast. They had two main messages to share: support full funding for the Mental Hygiene Administration, which handles most of the programs concerning children's mental health, and support the student stigma bill, which would change the special education term "emotional disturbance" to "emotional or behavioral disability."

 

Ann Geddes of the Maryland Coalition of Families for Children's Mental Health emphasized that the student stigma bill is a "no cost" bill, important in a year facing huge deficits and a faltering economy.

 

Copyright 2009 Star Democrat.

 

Maryland Nears Deadline to Reduce Childhood Lead Poisoning

State still faces challenges

 

Baltimore Afro-American

Sunday, February 15, 2009

 

ANNAPOLIS - When the ceiling fell down in her mother's two-story Baltimore home, Towanda Malley never considered the possibility of lead exposure. But after a mandatory lead test, her 2-year-old daughter, Paris Shannon, showed elevated levels of lead in her blood.

 

'I didn't know that lead still existed, that it was still in homes,' said Malley, who lives in the house with her three children and her mother, who has lung cancer.

 

With a state-wide goal of eliminating childhood lead poisoning by 2010 nearing, Maryland has made significant progress in decreasing the number of cases among residents in rental property units. But Malley's story is an example of a growing trend of lead poisoning among children who live in owner-occupied housing units, one of the reasons advocates say the state may not meet its 2010 deadline.

 

'What we have found as we have implemented this law over the past 14 years is that the number of children with elevated blood lead levels has decreased in pre-1950 housing units but has increased in rental units from 1950 - 1978 and also in owner-occupied housing pre-1978,' said Alvin Bowles, manager of the lead poisoning prevention program at the Maryland Department of the Environment.

 

Approximately 58 percent of children who are poisoned live in owner-occupied housing or rental units built between 1950 and 1978, according to Bowles.

 

In 1994, Maryland enacted the Reduction of Lead Risk in Housing Law, which requires that owners of rental properties that pre-date 1950 must register their units, distribute materials from the Maryland Department of the Environment to inform tenants of the hazards of lead and meet specific lead-risk reduction standards.

 

The law did not include regulations for owner-occupied housing or rental units built between 1950 and 1978.

 

Nine years ago, when Malley's mother purchased the Garrison Avenue home, which is more than 30 years old, she was told it was lead-free.

 

Lead remains one of the most significant environmental hazards for children in Maryland. Children from birth to age 6 are at the greatest risk because of their developing neurological systems.

 

Lead exposure usually occurs with normal hand-to-mouth activity and comes from lead paint dust from chipped paint or home renovations.

 

Exposure can result in lower intelligence and has been associated with behavior and attention-span problems. It can lead to kidney, liver, brain and nerve damage, and at extreme levels can cause seizures, coma or death.

 

After the exposure, Malley noticed that Paris' eating habits increased as well as incidents of violent behavior. Everyone in the home began to suffer from headaches.

 

Maryland is among the states that have made the greatest progress toward decreasing childhood lead poisoning.

 

In 2006, approximately 1,000 children out of nearly 100,000 tested in Maryland, showed an elevated blood lead level, according to figures from the Centers for Disease Control. That number is down from nearly 16,000 children in 1993, according to Ruth Ann Norton, executive director at the Coalition to End Childhood Lead Poisoning, which is based in Baltimore.

 

'We are determined to try and get this down,' said Norton.

 

According to Norton, from 1993 to 2007, there was a 94 percent decline in the numbers of children with elevated blood lead levels throughout Maryland.

 

Currently, some properties are visually inspected for chipped paint and other tell-tale signs of the presence of lead. But Norton said the state will have difficulty meeting its 2010 goal unless it adopts a lead dust-testing standard that would require more than just a visual inspection of many properties.

 

Even with the increase in cases among owner-occupied units, Maryland remains a national model because of its strong commitment to enforce violations. The Maryland Department of the Environment ensures compliance with mandatory requirements through the Lead Prevention Program.

 

In 2008, enforcement actions increased to 871, up from 708, in 2006, and approximately $650,000 was paid in fines to the department. The money helps fund the lead poisoning prevention program.

 

'Finishing the job is very, very important, but it's a little harder,' said Madeleine Shea, assistant commissioner for Healthy Homes. Finding the smaller mom-and-pop rental properties and owner-occupied units has been a challenge, and often homeowners don't have the funding to fix the problems associated with lead exposure.

 

Healthy Homes has funds available to help people like Towanda Malley and her mother.

 

'Neither one of us have the money to do [renovations] right now, Malley said. Theyre currently waiting to learn if theyre eligible to receive funding to complete the renovations.

 

For now, a plastic sheet covers the hole in the ceiling. Malley and her mother are teaching Paris to keep her hands out of her mouth, as well as following the health department's recommendations on keeping the house clean.

 

After another lead test, Malley was told that Paris' lead level was lower. Her appetite is back to normal and the violent behavior has decreased.

 

She will continue to be tested until her lead level goes below the acceptable standard, or is eliminated altogether.

 

The health department is working to relocate Malley and her kids.

 

'I can't keep having her [Paris] in that situation,' Malley said. 'But finding somewhere to live right away is kind of hard.'

 

For more information on state and national statistics about lead poisoning, visit www.cdc.gov/nceh/lead/ or www.mde.state.md.us/Programs/LandPrograms/LeadCoordination/index.asp.

 

Copyright 2009 Baltimore Afro-American.

 

O'Malley favors legislation to limit 'abusive' hospital billing

O'Malley supports legislation to stop 'abusive' collection practices and increase financial help

 

By James Drew

Baltimore Sun

Sunday, February 15, 2009

 

Gov. Martin O'Malley says he supports legislation to correct "abusive billing and collection practices" by some Maryland hospitals, while expanding health care and financial assistance for lower-income patients.

 

The governor spoke Friday in Baltimore as his administration released a report that recommends defining who is eligible for free and reduced-price hospital care, requiring hospitals to provide financial assistance information to all patients, and banning hospitals and their collection agencies from charging the uninsured interest and penalties on bills before court judgments are entered against them.

 

"These reforms will help secure expanded access to quality hospital care to more people rather than fewer, without fear of financial ruin," O'Malley said.

 

The first-term Democratic governor ordered the report by the Health Services Cost Review Commission in response to an eight-month investigation by The Baltimore Sun that documented how hospitals were aggressively pursing collection of unpaid bills from patients of limited means even though those debts are supposed to be recovered in the rates they charge.

 

The Sun series, "In Their Debt," found that hospital debt collection lawsuits spiked sharply between 2003 and 2006 before falling slightly in 2007. In all, hospitals filed more than 132,000 of these suits over five years and won at least $100 million in judgments.

 

The Maryland Hospital Association says it supports most of the proposals outlined in the report to the governor.

 

Banning prejudgment interest and penalties "strengthens the process," said hospital association spokeswoman Nancy Fiedler, and the trade group is "comfortable" with requiring its members to provide details about the availability of financial assistance.

 

In 2005, the association and state regulators successfully fought provisions in a bill that would have required hospitals to give charity care applications to patients.

 

On Friday, Del. Peter A. Hammen, a Baltimore Democrat who is chairman of the House Health and Government Operations Committee, introduced a bill to require hospitals to provide free care to all Maryland residents whose incomes are less than 1 1/2 times the federal poverty level, which would equal $33,075 for a family of four. It is similar to a bill introduced earlier last week by Sen. George W. Della, a Democrat who represents South Baltimore.

 

"Hospitals have a responsibility to assist lower-income individuals access the health services and programs for which they qualify," Hammen said. "This legislation will ensure that there is a proper safety net for this vulnerable population."

 

The report by the rate-setting commission recommends setting the minimum standard at two times the federal poverty guideline, which would be $44,100 for a family of four. It says more study is needed on the question of how assets should be considered in providing free or reduced-price care.

 

Maryland Secretary of Health and Mental Hygiene John M. Colmers said he supports the report's rationale, which cited recent and proposed expansions of Medicaid to families who earn up to 116 percent of the federal poverty level.

 

Also, most of Maryland's 46 nonprofit hospitals say they use the hospital association's voluntary standard of allowing charity care for those who earn less than 1 1/2 times the federal poverty threshold, wrote Robert B. Murray, the commission's executive director. Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Howard County General Hospital use that standard.

 

Several hospitals - including University of Maryland Medical Center, Franklin Square Medical Center, Bon Secours, Mercy Medical Center and Sinai Hospital - told the rate-setting commission that they already use the standard of two times the federal poverty line. But the hospital association expressed "some reservations about legislating" the minimum standard at that level.

 

"It may prove challenging for some hospitals to provide that amount of free care," Fiedler, the group's spokesman, wrote in an e-mail.

 

The report to the governor said four hospitals informed state regulators that their policies didn't meet the association's voluntary standard for providing free care to lower-income patients.

 

Reached for comment, officials at two of those hospitals - Washington Adventist in Takoma Park and Shady Grove Adventist in Rockville - said they are increasing their policy to 1 1/2 times the federal poverty guideline but maintained they often have provided free care to patients above that level.

 

Tom Grant, a Washington Adventist spokesman, said the hospitals "should not be judged on guidelines" but on what they actually provide in charity care and the amount of debts they write off. He said Washington Adventist had $25.9 million in free and reduced-price care and debt write-offs last year.

 

The Sun'sreport found that Washington Adventist rarely sues patients, even though it lost $5.3 million in 2007 on unpaid and charity care.

 

Copyright 2009 Baltimore Sun.

 

National / International

 

Salmonella outbreak eases way for food safety reforms

Lawmakers, industry in accord after salmonella outbreak

 

By Matthew Hay Brown

Baltimore Sun

Sunday, February 15, 2009

 

WASHINGTON - The salmonella outbreak that has killed as many as nine people and sickened hundreds nationwide has created what advocates say is an unprecedented opportunity to reform the way America safeguards its food supply.

 

"You've had the consumer community, the expert community clamoring for this for over a decade," said Michael R. Taylor, a former deputy commissioner of the Food and Drug Administration. "What's happened with this outbreak is it has just elevated the intensity of the political focus and the demand or expectation that something be done."

 

The Justice Department has opened a criminal investigation into the actions of Peanut Corp. of America, whose Blakely, Ga., plant has been identified as the source of the contamination that has led to the recall of more than 1,900 products.

 

Critics say the outbreak has revealed several gaps in the nation's food safety system, including a personnel shortage that has led the FDA to contract out inspections to state officials, the lack of a program to trace food from the farm to the table, the ability of companies to keep tests results revealing contamination to themselves, and the inability of the federal government to order recalls without their cooperation.

 

"We appear to have a total systemic breakdown," said Rep. Bart Stupak, the Michigan Democrat who chaired a hearing last week into the outbreak.

 

Looking on as Stupak spoke was 3-year-old Jacob Hurley of Portland, Ore. Peter and Brandy Hurley knew last month that their son had contracted salmonella -but they didn't know how. So with the approval of his pediatrician's office, they let him keep eating what his father called "his favorite comfort food": Austin Toasty Crackers with Peanut Butter.

 

Peter Hurley denounced Peanut Corp. of America - and the government watchdogs who were unable for months to trace the source of the contamination.

 

"What is this, China?" he asked. "We need to have a faster 911-oriented medical response for food contamination. ... We need FDA inspectors out there with the authority to stop production immediately when there is a problem. We need the FDA to have the ability to criminally prosecute quickly and effectively."

 

The FDA says the Lynchburg, Va., company continued to ship peanut butter despite at least 12 tests revealing salmonella in 2007 and 2008, and lawmakers have released internal e-mail messages from company owner Stewart Parnell complaining that the tests were "costing us huge $$$$$" and saying that "we ... desperately at least need to turn the Raw Peanuts on our floor into money."

 

As the criminal investigation continues, lawmakers have introduced a variety of reforms, from simply bolstering the FDA with more money and tougher laws to the more sweeping move of combining the food safety functions currently divided among the Food and Drug Administration, the U.S. Department of Agriculture and the Centers for Disease Control into a new agency charged with oversight of the entire food supply.

 

Adding to calls for reform have been members of the food industry itself. Amid costly recalls of products as disparate as beef, spinach, jalapeno peppers and pet food, organizations such as Kraft Foods and PepsiCo Inc. have joined with food safety advocates and several former FDA commissioners to demand stronger regulation.

 

They have a strong business incentive. While Peanut Corp. of America made only about 1 percent of the peanut products sold nationwide, retail sales of all peanut butter fell 22 percent in January, according to the Nielsen Co. The makers of Jif and Peter Pan, not implicated in the current outbreak, have embarked on advertising campaigns to persuade customers that their brands are safe.

 

"Recent events have undermined the confidence of our consumers," said Scott Faber, chief lobbyist for the Grocery Manufacturers Association. "Frankly, in order to continually improve the safety of our food supplies, we need a strong and effective partner" in government.

 

Agriculture Secretary Tom Vilsack, whose department is responsible for monitoring meat and poultry, caught advocates by surprise this month when he advocated merging food safety functions into a single agency. His comments came days after President Barack Obama said the government had been slow to identify food contamination.

 

"I think that the FDA has not been able to catch some of these things as quickly as I expect them to," Obama said an interview broadcast by NBC on Today. He said his daughter Sasha ate peanut butter several times a week - "and, you know, I don't want to have to worry about whether she's going to get sick as a consequence to having her lunch."

 

Obama's interest in the issue predates the current outbreak. Campaigning last summer during a different salmonella outbreak - the one that led to the jalapeno recall - the then-senator introduced legislation intended to improve communication and coordination among federal, state and local agencies.

 

Since the current outbreak, the White House has promised what spokesman Robert Gibbs called a "stricter regulatory structure."

 

Taylor, who worked in the administrations of Jimmy Carter, George H.W. Bush and Bill Clinton, called presidential engagement "critical."

 

"We're at a point unlike any we've had," he said. "We now, I think, have the forces at the table who can make it happen."

 

A common theme among advocates is a need to modernize a regulatory regime they say is outdated. The Food Safety and Inspection Service, for example, the Department of Agriculture agency that monitors meat and poultry, derives authority from a law passed in 1906 in response to the public outcry that followed Upton Sinclair's Chicago meatpacking industry expose, The Jungle.

 

"The law is a hundred years old," said Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest. "The legal structure was built before they even knew about bacteria or pathogens." Smith DeWaal spoke also of a disconnect between the Food Safety and Inspection Service, which stations inspectors inside meat and poultry plants for carcass-by-carcass examinations, and the FDA, whose inspectors visit production sites for other foods only periodically.

 

"So a pepperoni pizza line in a frozen pizza plant will be visited by USDA every single day," she said. "The cheese pizza line in the same plant may be visited by the FDA once in 10 years. And maybe not even then."

 

At the House hearing last week, the director of the FDA's Center for Food Supply and Applied Nutrition said inspectors will now take samples of the product and the production environment as a matter of routine - not only when a problem is suspected. Stephen Sundlof said the agency still needs better access to company food records during routine inspections and "enhanced authority" to order procedures that companies must follow to prevent contamination of high-risk food.

 

Sundlof said the ability to order product recalls "would be a useful tool."

 

The Center for Science in the Public Interest, Consumers Union and other advocates are backing a bill introduced by Rep. Rosa DeLauro, a Connecticut Democrat who has been pushing reform for years. DeLauro would pull the food safety functions out of the FDA and into a new Food Safety Administration, which she says would focus on preventing disease-causing contamination.

 

Her Food Safety Modernization Act would require companies to control health hazards in their operations and meet federal standards for removing contaminants. Companies would be subject to regular inspections, based on the "risk profile" of the food they produce. The government could seize unsafe products and order recalls.

 

"There are good people and good science at the FDA," DeLauro said. "They have not been able to do their jobs and carry out the mission. We need an agency that's fully committed to actively preventing food-borne illness, not just reacting to it."

 

major recalls

January 2009 (peanuts): Salmonella fears trigger the recall of more than 1,900 products made by Peanut Corp. of America in Georgia and Texas. More than 630 illnesses and at least nine deaths so far have been reported.

 

June 2008 (tomatoes, jalapeno peppers): More than $100 million worth of the Mexico-grown crops are recalled because of salmonella contamination. More than 1,200 illnesses - but no deaths - are reported.

 

February 2008 (beef): More than 143 million pounds from a California slaughterhouse is recalled after concerns arise that so-called "downer" cattle illegally entered the food chain. No illnesses or deaths are reported.

 

September 2006 (spinach): E. coli contamination in California sparks a recall that affects more than $86 million in crops. More than 200 illnesses and three deaths are reported.

 

Source: Associated Press

 

Copyright 2009 Baltimore Sun.

 

Hib infection in children makes a deadly return

 

By Anita Manning

USA Today

Sunday, February 15, 2009

 

When a very sick toddler was brought into a Minneapolis-area hospital last winter, doctors immediately suspected meningitis. The baby, 15 months old, was lethargic, had a fever of 104 degrees and was increasingly unresponsive.

 

Within days, test results were in. William Pomputius, an infectious-disease specialist at Children's of Minnesota, was shocked to learn that the girl had Haemophilis influenzae type B, or Hib infection, a disease that has been nearly wiped out by routine vaccination.

 

That was the first of what would be five cases of Hib in Minnesota in 2008, the most since 1992. Normally, the state sees no more than one or two cases a year, often none. Three of the babies, including a 7-month-old who died, had not been immunized. Of the remaining two, one was too young to be fully immunized and one had an immune deficiency, so vaccination was not effective.

 

The cases, along with scattered measles outbreaks last year that infected about 140 children and adults, most of them not immunized, have health officials concerned that a growing trend among some parents to delay or forgo infant vaccinations could create a large enough population of unprotected children to allow outbreaks of diseases that haven't been seen by most doctors for a generation.

 

The Centers for Disease Control and Prevention reports national immunization rates are still high, and in most areas there are enough vaccinated children to create a "herd immunity," a wall of immunized people that prevents spread of disease, so children who are vulnerable — those too young to be vaccinated or who can't be because of immune disorders or other medical problems — are protected.

 

But health officials are concerned that herd immunity is not holding in the face of a rise in the number of parents who, believing that vaccines are unsafe, unnatural or unnecessary, are not allowing their babies to be vaccinated.

 

"Some parents wonder if these diseases are a risk," says Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. "With something like Hib, many people have never heard of it because we haven't seen it.

 

"But it was a killer disease, and we want parents to know it is very dangerous."

 

The vaccine for Hib, which became routinely used in 1991, "was like an overnight miracle," says Kristen Ehresmann, immunization program manager for the Minnesota Department of Health. Rates of severe Hib disease dropped 99%, to less than one in 100,000 children, nationally, the CDC says. "For anyone who has experienced that, to see this increase in the disease is really quite distressing," she says.

 

In Minnesota, the number of parents who choose not to vaccinate their children has increased from fewer than 1% a few years ago to "3, maybe 4%," she says. But "those individuals are extremely vocal, and they're drowning out the majority of parents who want their children to be in an environment where they're not exposed unnecessarily. By vaccinating your child, you're doing good not only for that child, but for the community."

 

A shortage of Hib vaccine that began in late 2007 because of manufacturing problems at Merck could have contributed to the increase in cases, says Patsy Stinchfield, nurse practitioner and director of immunology at Children's Hospitals and Clinics of Minnesota.

 

Merck's problems left only one supplier, Sanofi Pasteur, whose Hib vaccine is given at 2, 4, and 6 months, with a booster dose at 15 months. The CDC says there is enough vaccine for babies to get the first three doses, but because of the shortage, which may continue until summer, it advises holding off on the booster dose for healthy children.

 

But doctors say the missing booster dose could allow an increase of Hib bacteria in the community. More children may be carrying it without symptoms, and with a cough or a sneeze they could spread it to unimmunized babies.

 

"Pediatric physicians have collectively been holding our breath to see if this would happen, and indeed it did," Stinchfield says. "We don't know if this is the tip of the iceberg or not."

 

The CDC and Minnesota health department have begun to interview 2,000 parents and take swabs of children's throats to get a clearer picture of how many children are carriers.

 

What is already clear, Stinchfield says, is that "to not vaccinate could potentially cause the death of a child, and that has happened here in Minnesota. And to not follow the schedule that has been scientifically documented and proven has its consequences."

 

 

Copyright 2009 USA Today.

 

Nursing shortage: 1 in 5 quits within first year, study says

 

Associated Press

By Rasha Madkour

USA Today

Sunday, February 15, 2009

 

MIAMI — Newly minted nurse Katie O'Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

 

She lasted nine months. The stress of trying to keep her patients from getting much worse as they waited, sometimes for 12 hours, in an overwhelmed Dallas emergency room was just too much. The breaking point came after paramedics brought in a child who'd had seizures. She was told he was stable and to check him in a few minutes, but O'Bryan decided not to wait. She found he had stopped breathing and was turning blue.

 

"If I hadn't gone right away, he probably would have died," O'Bryan said. "I couldn't do it anymore."

 

Many novice nurses like O'Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

 

That turnover rate is a major contributor to the nation's growing shortage of nurses. But there are expanding efforts to give new nursing grads better support. Many hospitals are trying to create safety nets with residency training programs.

 

"It really was, 'Throw them out there and let them learn,"' said University of Portland nursing professor Diane Vines. The university now helps run a year-long program for new nurses.

 

"This time around, we're a little more humane in our treatment of first-year grads, knowing they might not stay if we don't do better," she said.

 

The national nursing shortage could reach 500,000 by 2025, as many nurses retire and the demand for nurses balloons with the aging of baby boomers, according to Peter Buerhaus of Vanderbilt University Medical Center. The nursing professor is author of a book about the future of the nursing work force.

 

Nursing schools have been unable to churn out graduates fast enough to keep up with the demand, which is why hospitals are trying harder to retain them.

 

Medical school grads get on-the-job training during formal residencies ranging from three to seven years. Many newly licensed nurses do not have a similar protected period as they build their skills and get used to a demanding environment.

 

Some hospitals have set up their own programs to help new nurses make the transition. Often, they assign novices to more experienced nurses, whom they shadow for a few weeks or months while they learn the ropes. That's what O'Bryan's hospital did, but for her, it wasn't enough.

 

So more hospitals are investing in longer, more thorough residencies. These can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who washed out is about $50,000, personnel experts estimate.

 

One national program is the Versant RN Residency, which was developed at Childrens Hospital Los Angeles and since 2004 has spread to 70 other hospitals nationwide. One of those, Baptist Health of South Florida in the Miami area, reports cutting its turnover rate from 22% to 10% in the 18 months since it started its program.

 

The Versant plan pairs new nurses with more experienced nurses and they share patients. At first, the veterans do the bulk of the work as the rookies watch; by the end of the 18-week training program, those roles are reversed.

 

The new nurses must complete a 60-item checklist. They must learn how to put in an IV line and urinary catheter; interpret different heart rhythms and know how to treat them; monitor patients on suicide watch and do hourly checkups on very critically ill patients; know how to do a head-to-toe physical assessment on a patient, as well as how to inform families about the condition of their loved one.

 

For Yaima Milian, who's currently in the program at Baptist, this is markedly different from the preparation she got at her first hospital in New Jersey. She left after a six-week orientation because she didn't feel ready to work solo.

 

While Milian was paired with a more experienced nurse at the New Jersey hospital, they didn't see patients together; they split the workload. Her first week on the job, Milian was charged with caring for several patients with complicated issues — those on ventilators and with chest tubes — and she felt thoroughly unprepared.

 

"It just didn't feel right, it felt very unsafe," Milian said.

 

Besides the residency's professional guidance, which includes classroom instruction, new nurses also get personal support from mentors — people they can call after a bad day or to get career advice. The new nurses also gather with their peers for regular debriefing, or "venting" sessions.

 

"Here you have this group that is pretty much experiencing the same things you're experiencing," Milian said, "and it makes you feel better."

 

To be sure, not all the nurses who leave do so because of a rocky transition. But for nurses who do leave because of stress, these programs seem to help.

 

The American Association of Colleges of Nursing and the University HealthSystem Consortium teamed up in 2002 to create a residency primarily for hospitals affiliated with universities. Fifty-two sites now participate in that year-long program and the average turnover rate for new nurses was about 6% in 2007.

 

"We believe all new graduates should be given this kind of support system," said Polly Bednash, the nursing association's executive director. "We are facing downstream a horrendous nursing shortage as a large number of nurses retire from the field... So you need to keep the people you get and keep them supported."

 

The federal government has jumped on the bandwagon. Since 2003, it has awarded $17 million in grants for 75 hospitals to start first-year training programs.

 

The National Council of State Boards of Nursing is considering a standardized transition program. It cited a study showing a link between residencies and fewer medical errors, but also pointed to the inconsistency among current efforts.

 

That's something O'Bryan, the Dallas nurse, knows about. Her hospital — which she declined to identify because she didn't want to be seen as complaining about a former employer — had a three-month program, in which she attended weekly classes and was assigned a nurse to shadow. After that period was over, though, O'Bryan was abruptly alone, even as she continued to face new situations that she wasn't sure how to handle.

 

"When things are going good and I'm not overwhelmed and I'm able to help people, I love it," she said, recalling the gratification of seeing a bedridden patient finally manage to take a few steps.

 

"There are always those moments," she said, "but they're interrupted pretty quickly."

 

The 27-year-old is currently looking for a new job. She's not sure it will be in nursing.

 

Copyright 2009 The Associated Press. All rights reserved.

 

Lead law throttles youth powersports

 

By William M. Welch

USA Today

Sunday, February 15, 2009

 

IRVINE, Calif. — A new federal law aimed at protecting children from lead in toys has also forced a nationwide halt in sales of off-road motorcycles and recreational vehicles built for young riders, killing off a multimillion-dollar industry that was thriving despite the recession.

 

Thousands of powersports dealers were told to halt sales of vehicles designed for children 12 and younger because of new lead restrictions in an act of Congress that took effect Feb. 10.

 

Even used vehicle sales are banned by law passed in response to lead found in toys imported from China.

 

"We're out of business as far as the youth market goes," says Rick Rizzon, owner of Rizzon Cycle in Middlesex, N.J. "It's crazy."

 

With the motor vehicle industry already hurting from recession, he said the ban means a 20% drop in sales of youth off-road motorcycles and the parts business for bikes already sold.

 

The ban hits California especially hard. Off-roading is hugely popular among families in the state and several state parks are devoted to dirt riding.

 

Kevin Matty, finance director at Temecula Motorsports in Temecula, Calif., (where the desert is a big draw for dirt bikers) estimates the ban will wipe out half of his business sales.

 

"I thought it was a joke," Matty said, until the manufacturers told him he had to take the youth vehicles off the showroom floor.

 

Economic repercussions

Passed by Congress after a series of reports concerning toys made in China with lead, the law bans sale of products aimed at children if they contain more than 600 parts per million of lead, says Joseph Martyak, chief of staff to the acting chairman of the U.S. Consumer Product Safety Commission.

 

Lead is found in steel and other metal alloys in the frame, motor and multiple other parts, said Paul Vitrano, general counsel for the Motorcycle Industry Council. The lead strengthens the metals and resists corrosion.

 

Supporters of the law hailed its passage in August.

 

Rep. John Conyers, D-Mich., a bill co-sponsor, said at the time that supporting the law "is a vote for industry accountability, regulatory integrity, and most importantly, child safety."

 

Martyak said the wording of the law left the commission no choice but to enforce the ban on youth cycles and ATVs even with no evidence children would ingest or absorb the items. The industry has petitioned the commission for an exemption.

 

The ban will have repercussions economically.

 

The Motorcycle Industry Council estimates nearly 100,000 youth bikes were sold in the USA in 2008, though some were aimed at kids 13 and older and not covered by the ban. Dealernews, an industry trade publication, estimates that the value of inventory at U.S. dealers that can no longer be sold probably exceeds $100 million.

 

Beyond current inventory, Kawasaki spokeswoman Jan Plessner said the company has "millions and millions of dollars" worth of parts now in the product pipeline to dealers that cannot be sold.

 

Most cycles and ATVs are made overseas, but there are tens of thousands of jobs attached to the industry here. More than 13,000 powersports dealers sell products in the United States, according to the Motorcycle Industry Council, employing an estimated 124,000 people. Vitrano says the industry estimates the retail market value for all off-road cycles and ATVs is $14.5 billion a year, including sales, service, parts, accessories and payroll.

 

'Are you kidding?'

Children appeared perplexed by the ban.

 

"Are you kidding? This is silly," says Zack Bartell, 12, who was taking a dirt-bike riding lesson at School for Dirt's track next to Kawasaki Motors' U.S. headquarters here. "There's no way I'm going to stick a motorcycle part in my mouth."

 

The 12-and-under market is a huge focus for the industry because it believes children who ride will grow up to be adult riders and consumers as well. It builds bikes with single-cylinder motors as small as 50cc that fit children.

 

Children as young as Karsyn Boyd, who said she was "6 and a quarter," were riding with ease after an hour or so of instruction, carving figure eights, traversing hills and cutting around orange cones.

 

Vitrano says the ban will have a perverse effect: Rather than no longer riding, kids who can't get a cycle their size may hop on a bike made for older children or adults — one inappropriate and dangerous for a smaller child.

 

Terry Dempsey, sales manager at Long Beach Motorsports in Long Beach, Calif., said he sold $120,000 worth of youth bikes last year, plus more in parts, service and accessories.

 

"We're already down 30% (from recession), and now we just lost another 10% to 15% of our customer base," Dempsey says.

 

The economy notwithstanding, enthusiasts say the ban needlessly kills a family-oriented sport where children ride with their moms and dads and, like other sports, can induce children to behave.

 

"I know if I keep my grades up, I can keep riding," says Zack, who started riding at age 5.

 

Copyright 2009 USA Today.

 

Opinion

 

Successful nurses

 

Washington Times Letter to the Editor

Sunday, February 15, 2009

 

The article "Study finds bid to cut Medicare costs failed" (Nation, Thursday) mainly focuses on disappointing results that show how tough it is to manage older patients with chronic conditions, but it also shares Jim Reid's success story. Mr. Reid credits his success in losing weight, improving his cholesterol and blood pressure and managing his pre-diabetes to the fact that his care was coordinated by nurses. The article refers to this as a "rare" success story, but the truth is that Americans all over the country are experiencing better health outcomes thanks to care coordination led by nurses.

 

For example, Mary D. Naylor of the University of Pennsylvania School of Nursing has developed effective ways to transition elderly patients from hospitals to their homes. Ms. Naylor's evidence-based, innovative model of hospital-to-home care, in which advanced-practice nurses work to ensure a smooth transition, has repeatedly shown longer intervals before rehospitalizations and fewer rehospitalizations overall when compared to traditional methods of transition. Following a four-year trial with a group of elderly patients hospitalized with heart failure, the Advanced Nurse Practitioners (APN) Care Model cut hospitalization costs by more than $500,000 compared with a group receiving standard care - for an average savings of approximately $5,000 per Medicare patient.

 

PATRICIA FORD-ROEGNER

Chief executive officer

American Academy of Nursing

Washington

 

Copyright 2009 Washington Times.

 

O'Malley's unbalanced budget

 

Washington Times Letter to the Editor

Monday, February 16, 2009

 

Maryland Gov. Martin O'Malley in his budget plan proposed laying off 700 state employees in response to a $2 billion deficit.

 

In December 2006, the Baltimore Board of Estimates (BBE) reviewed city salaries. State's Attorney Patricia C. Jessamy requested "a reasonable salary increase" from the BBE. The BBE voted to increase her salary by $10,000 from $140,000 to a tidy base of $150,000, a 7 percent increase.

 

Mrs. Jessamy was satisfied with this decision. However Mr. O'Malley thought better of the position and intervened to progressively elevate the salary of this employee to $225,000 annually through 2010, or a whopping 60 percent increase of $85,000. (Daily Record, Baltimore Dec. 21, 2006). Baltimore magazine this year puts her salary at $229,500.

 

Note: The annual salary of the vice president of the United States and the chief justice of the United States are $221,100 and $217,400 respectively.

 

Perhaps Mr. O'Malley might reconsider his decision and go along with the $10,000 increase in salary the BBE originally approved - and rescind all but $10,000 of the salary increase and return the $79,500 excess to the state coffers.

 

One would think the Maryland government would be able to find an entry-level state employee willing to work for a base salary of $79,500 plus benefits. Mr. O'Malley would need to lay off just 699 employees.

 

MARJORIE SCHLUETER

Crofton, Md.

 

Copyright 2009 Washington Times.

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