National Nursing Shortage

National Nursing Shortage

ANNOUNCEMENTS

The Need For Nurses – Now

“Nurses are the backbone in so many instances that deliver direct patient care.”

A perfect storm is developing that will lead to a national nursing shortage in the coming years. Since 2009, The American Association of Colleges of Nursing has projected “a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows.” They have identified four areas that are contributing to the oncoming demand: lack of interest in nursing, the aging population, the expanding roles of nurses in primary care due to health care policy changes, and the ongoing bottlenecks in nursing education. Health care professionals are working to find a solution to address the two to three million Baby Boomers who will age into Medicare every year for the next 30 years. Joanne McCarthy, RN and Operations Manager of Capital Cardiology Associates, described how the shortage would impact the patients level of care. “Most of the time, when patients are complaining about things in the hospital, it’s about not getting enough attention. I think that reflects on the staffing shortage. I recently shared a presentation on Joy in the Workplace. 50% of physicians complain of burnout, over a third of nurses on their first year on the job are looking for a new employer based on exhaustion. I think the burnout is because there are not enough nurses to go around. When hospitals look at overhead, inevitably that is going to trickle down to how to try and do more with less.”

“Nurses are the backbone in so many instances that deliver direct patient care.” Maryellen King, NP

Capital Cardiology Associates

The need for new nurses

The median age of RNs is currently 46 years old with the largest group now in their 50s. A projected one million RNs that will retire by 2030, leaving severe shortages of nurses in areas of the country. A 2017 report from The National Center for Health Workforce Analysis states that by 2030, the number of registered nurses needed in the United States is estimated to skyrocket by 28.4% from 2.8 million to 3.6 million. California is expected to be short the most registered nurses (45,500), while Alaska is projected to have the most job vacancies (22.7%). In other industries, there is a future generation ready to step in to fill the voids. However, in nursing, there are education barriers and unique challenges facing the new wave of providers. Traditionally, young people interested in a nursing career would volunteer at their local hospital. Maryellen King, NP with Capital Cardiology Associates, began her career in high school. “I was working in a local hospital, bringing books to patients, helping the nurses with changing the linens, giving patients water, and I really liked what I was doing. I am a caregiver at heart. From there, I went to a diploma school of nursing, which that option of living and learning at the hospital is not available anymore. If you want to be a registered nurse now, programs are usually in college — starting with an associates degree program, then you can sit for your nursing license exam or baccalaureate degree. There is a push today for more nurses to be bachelor’s prepared.”

What is a Registered Nurse? Get the answers in this video.

In 2017, New York State enacted the BS in 10 Law based on the recommendation of The Institute of Medicine, who called for at least 80% of the RN population to be baccalaureate prepared by 2020. Nurses who graduate from a New York State diploma or associate degree program must now obtain a baccalaureate degree in Nursing within ten years of becoming a nurse. This new legislation which was intended to improve the overall quality of care by providing better patient outcomes from more educated nurses has created another barrier in the profession: a lack of teachers.

Martha Desmond, RN is the Nursing Department Chairperson at Hudson Valley Community College, she recalls the push for higher education for nurses that began in 1964 with the American Nurses Association House of Delegates first adopted a motion supporting baccalaureate education. “I’ve been a nurse for 40 years. When I graduated, a long time ago, they spoke about this. The whole thought on the BS in 10 is that the theory that is offered for the bachelor’s degree is very important. What’s offered on the associates level is skill sets, critical thinking, but you are not getting the next level of theory or the in-depth medical knowledge that comes with the bachelor’s program. Politically, this has been pushed for years. I think this makes for a better nurse, allowing them to think better on their feet and provide better patient care.”

The BS in 10 law is designed to promote higher education for RN’s while also creating leadership opportunities in education, management, and patient care. The legislation also encourages continuous learning. The medical field is always evolving with innovations and technology, driving new procedures and methods of care and treatment. As in most professional careers, current certifications and continuing education are valued among employees and employers. Currently, New York is the only State with such legislation, but New Jersey and Rhode Island have put forth BSN in 10 bills that have not passed. North Dakota had a similar law in 1987 but was forced to abandon it in 2003 due to a shortage of nurses. There are also 33 states known as “compact states” that recognize a valid RN license obtained in another compact state, allowing that nurse to practice without further requirements.

It is fair to note that with the BS in 10 law in place, New York is the Top 5 States with the least demand for nurses in 2030. The projections show an “overage” of around 18,000 more nurses than what the market calls. “Where I see the problem is on the education side,” shares Martha Desmond. The active RN’s aren’t the only ones looking at retirement: one-third of the current nursing faculty workforce in baccalaureate and graduate programs are expected to retire by 2025. “If we don’t start paying the educators more, there will be a shortage of younger faculty. That’s my fear. What’s going to happen to nursing educators?” The American Associate of Colleges of Nursing reported in March 2017 that the average salary for a master’s prepared Assistant Professor in schools of nursing was $78,575. The average salary of a nurse practitioner with that level of education is $97,083.

Navigating through the perfect storm

Many prospective nursing students seek nursing programs at community colleges or private schools, in large part because nursing schools run by hospitals closed in the mid-1980s. At that time, community colleges became a popular alternative. “Hudson Valley’s applicant pool has always been significantly high. I think it’s because of the cost and value of the program. For example, this year, we have had 900 applicants for our fall program that teaches 100 students,” states Desmond.

Hudson Valley Community College also created an option based on the growing demand of students returning to school for an education needed to start a new career path. The Advanced Option allows eligible students (BA degree) to begin the Nursing program in the summer, condensing two core clinical nursing courses (Nursing 1 and Nursing 2) in the first term. They’ll go into the traditional Nursing 3 in the fall and complete their studies the following spring with Nursing 4, where you will have the option to start taking courses towards your BSN degree through Empire State College. “I’m getting students with degrees in Biology, Psychology who are saying, ‘What I am going to do with this? I thought I wanted a career in research, but it’s not for me.’  They want to be a nurse. Because of the demand of these students, we have created this option,” says Desmond.

There are also online RN to BSN programs available to students. SUNY Empire State College (ESC) RN to Bachelor of Science in Nursing program for RN’s looking for part-time, online, or face-to-face courses. Most ESC students enroll on a part-time basis and complete the program in about 24-36 months. The University of Buffalo offers a two-year track BNS programs. Graduates report high satisfaction with the overall program, calling it a “transformational” experience. A BS in 10 years actually takes less time than you think, once you’ve completed to your associate’s degree in nursing certification, you are more than halfway to your BSN.

Looking back on the factors leading to the projected nursing shortage, it’s refreshing to learn that there is still interest in the field. “I wasn’t thinking about how far I could go with nursing, I was thinking about my options,” recalls Joanne McCarthy. “The flexible hours, you don’t have to work in a hospital, and when most women have to consider the needs of your family — when you have to balance that as a nurse, you still have a good job and make time to be home to take care of your family as well. When I worked three 10 hour shifts or three 12 hours, I looked at it this way; you’re out more but your home more. I personally think for those who have to meet the demands of family and career — it’s a great field. You can be a school nurse, a camp nurse, work for an insurance company, for a doctors office, you can work for the State. Some jobs let you work from home because of Telemedicine. There are plenty of options. I don’t know why someone wouldn’t consider nursing. And, if you want the critical medical experience, you can do that too.”

Capital Cardiology Associates currently has openings Medical Assistants and Registered Nurses. To view our opportunities, click below​.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

National Drug Take Back Day

National Drug Take Back Day

PRACTICE ANNOUNCEMENT

This Saturday You Can Dispose
of Your Old Medications – Safely

National Drug Take Back Day is on
pace to collect more almost
one million pounds of old prescriptions.

National Drug Take-Back Day is Saturday, April 27th. This is a safe, convenient, and responsible way to dispose of unused or expired prescription drugs. Between 10 AM and 2 PM your city police station or county sheriff office (with some other pharmacies and buildings) serve as collection points. To find the location near you, click here. The last Take-Back Day brought in more than 900,000 pounds of unused or expired prescription medication.

Dr. Kate Cabral is a Board Certified Cardiology Pharmacist and an Associate of the American
College of Cardiology. She regularly meets with patients at Capital Cardiology Associates to
discuss their prescriptions and medications. Dr. Carbal spoke of the importance of a “no
questions asked” drug take-back day. “This is a huge public safety and public health issue.
Six million Americans misuse controlled and prescription drugs, a majority which is obtained
from family or friends,” said Dr. Cabral. The Drug Enforcement Agency (DEA) hosts “take-back”
days twice a year to safely collected unwanted or expired medications.

President Trump has brought much attention to our nation’s opioid crisis. Opioid abuse is at epidemic levels in the U.S. and remains a top public health concern. “If you have an old pain medication just sitting in your cabinet, that can be a risk for someone you know,” said Dr. Cabral. According to a national survey, 16.8 percent of high school students took a prescription drug without a doctor’s prescription (such as OxyContin®, Percocet®, Vicodin®, codeine, Adderall®, Ritalin,® or Xanax®), one or more times during their life. The DEA warns that social media sites play a role in providing information and advice to teens on how to use prescription drugs to get high. Parents should be aware of which sites their teens are visiting and should examine credit card and bank statements that may indicate medication purchases. They should also check the browser history to see which sites their teen is visiting on their computers and phones.

National Take-Back Day also provides safe drug disposal. Many Americans are unsure of the proper way to dispose of medications; most choose to dump the unused pills in the toilet and throw the bottle in the trash. The DEA advises if you cannot reach a collection site, you follow these follow steps to dispose of most medicines in the household trash:

Most medications are safe to be flushed down the toilet. Review this list of what’s safe or not. If you still have concerns or questions, mix medicines with an unappealing substance such as dirt, used coffee grounds, or kitty litter. Take them out of their original container first. Do not crush tablets or capsules before mixing.
•Place the mixture in a container (sealed plastic bag or empty can) to prevent the drug from leaking into the garbage.
•Throw the container in the trash.
•When disposing of empty prescription bottles or packages, be sure to mark out identifying personal information to make it unreadable.

Written by: Michael Arce, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Luke Perry Stroke

Luke Perry Stroke

PATIENT EDUCATION

Stroke is no longer
an “old age” risk

Adults as young as
40 are now at risk.

Here’s what you need
to ask your doctor.

Luke Perry’s death, just four days after FOX announced that it would be re-booting “Beverly Hills, 90210”, the TV show that made him 90’s icon, came as a surprise to fans who were hoping he would return as “Dylan McKay.” This role cemented Perry’s iconic image as the standard of cool for the generation who grew up after Jim Stark, the troublemaking teen played by James Dean in the epic 1955 film “Rebel Without A Cause.” The two characters not only shared similar backstories, dangerous loners who lived on the edge; the actors also shared a striking similarity in appearance.

The news report that The Los Angeles Fire Department responded to a “medical assistance” call at Perry’s home on Wednesday, February 27, dominated the headlines. At first, officials say Perry was talking to first responders and was fully conscious. This was just days after TV announcement; fans were shocked to learn that the star, at 52 years old was hospitalized due to a massive stroke. We were all saddened when the news broke the following Monday of his passing.

Redefining stroke

Stroke, as with many other forms of heart disease, is often thought of as an “old person’s” health concern. While there are more than 200,000 stroke cases in the US every year, making it the fifth leading cause of death in our country, the primary age affected is 60 years old and up. However, recent health trends have shown a growth in diagnosis with adults aged 41-60. “People can have strokes at any age,” says Maryellen King, Nurse Practitioner at Capital Cardiology Associates. Ultimately, if you have a concern about your risk of stroke, heart attack, or heart disease make an appointment with your doctor or primary care provider, today.

The traditional factors that put you at risk for stroke are lifestyle, diet, physical activity – which are controllable — tobacco use and smoking double the risk of stroke when compared to a nonsmoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque buildup in the arteries. Abusing alcohol and drugs (cocaine, amphetamines, and heroin) have been associated with an increased risk of stroke. The uncontrollable risk factors are your family history, age, race, gender, and prior heart health history.

There are also uncommon causes of stroke which are usually congenital (birth disorders) or rare vascular blood vessel diseases.

The recommendations for adults in their 40’s who are concerned about lowering their risk of stroke, heart attack or heart disease are:

• Eat a healthy diet, including reducing salt intake.
• Engage in regular physical activity and maintain a healthy weight.
• Manage stress.
• Avoid tobacco smoke.
• Take your medication as prescribed.
• Limit your alcohol consumption.

What is a stroke?

The National Stroke Association defines a stroke as “a brain attack.” Essentially, you have an instance where you’re losing blood flow to a part of the brain. “There are different types of stroke, hemorrhagic (bleeding in the brain), embolic (a blood clot that travels),” says King. Hemorrhagic strokes are less common; only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. They can occur as a cerebral aneurysm, a congenital malformation of the arteries in the brain that can rupture. “There is no way to know if you have an aneurysm or not. If it ruptures, you can have bleeding on the brain, and people can die from that. They would experience sudden severe headache, the bleeding in the brain, patients will say the worst headache of their life. It’s not a warning sign, that’s a symptom,” stated King.

The other form of stroke is called an ischemic stroke. This can happen when a sticky, fatty material called “plaque” builds up in a blood vessel in your brain. Plaque slows your blood flow. It may cause your blood to clot. This can stop the flow of blood completely. This kind of stroke can also happen when a clot travels to your brain from another part of your body, even if you don’t have plaque buildup in your vessels. The most common cause of this type of stroke is A-Fib (atrial fibrillation) when your heart has an abnormal rhythm that produces the opportunity for a clot to form in the left side of the heart, dislodge and travels up and through to the brain.

A patent foramen ovale (above) is a hole in the heart that didn’t close the way it should after birth. The condition affects about 25% of Americans, but many do not know it.

The other type of embolic stroke would be a patent foramen ovale (PFO) or some different kind of congenital hole in the right and left sides of the heart. “The sides of your heart are supposed to be separate; blood comes from the right side of the heart is pushed to the lungs. It comes to the left side of the heart and gets pushed through the body. When there is a hole between the two sides, clots form and can travel from one side to the other,” said King. Most patients with a PFO do not have any symptoms. However, the condition may play a role in migraine headaches and it increases the risk of stroke, transient ischemic attack and heart attack.

Advances in testing

For patients who present stroke symptoms (Numbness or weakness in your face, arm, or leg, especially on one side. Confusion or trouble understanding other people. Difficulty speaking. Trouble seeing with one or both eyes. Problems walking, staying balanced, or loss of coordination. Dizziness. Severe headaches that come for no reason.) there are testing procedures. “The only way to find the holes in the heart would be with an echocardiogram, an ultrasound of the heart, to evaluate to see if a PFO has formed,” said King. Echo tests are performed by specially trained technicians at Capital Cardiology Associates. The test is painless, has no side effects, and usually takes an hour. “Using an echocardiogram (ECG) we can inject ‘fizz’ essentially, a trace amount of agitated saline that we call a ‘Bubble Study.’ These tiny bubbles can be seen on an ECG moving across the septum,” King explained. An ECG allows a physician to view the heart’s structure and check how the heart functions.

The other test available is the Transcranial Doppler (TCD), a non-invasive ultrasound method used to examine the blood circulation within the brain. A specially trained technician at Capital Cardiology Associates Imaging Suite performs this test to determine the amount of blood flow to specific areas of your brain. “The main reason that we started doing this is to detect a shunt or a hole in the heart,” shared Dr. Jeffrey Uzzilia of Capital Cardiology. “Patients that had a stroke, one of the reasons why they had a stroke that is not obvious at the time, is they can have a hole in their heart where a blood clot can form somewhere in the body and cross through that hole from the right side of the heart to the left. Once that blood clot is on the left side of the body it can travel anywhere in the body, including the brain and cause a stroke. Something like a PFO that everyone is born with, for most people it will close, for about 25% of people it will stay open. The TDP is the most accurate, sensitive test to detect that. It’s a very easy thing to see. There’s a good portion of patients, like Luke Perry, that you are shocked as to how young they are when they have a massive stroke,” said Dr. Uzzilia.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

National Wear Red Day

National Wear Red Day

HEART MONTH

Wear Red for Women, Everyday

Heart disease is the number one killer of women and you can take steps to prevent it

National Wear Red Day is the first Friday in February when women are encouraged to wear red to raise awareness about heart disease, the number one killer of women. “This is something that is personally dear to my heart,” stated Dr. Heather Stahura. She recently joined Capital Cardiology Associates in the summer of 2018 and is on a mission to educate women on their risk of heart disease, including the steps they can take to prevent becoming a statistic. “It’s fascinating, I will talk to women and ask them what health issue they think is their biggest worry. Unanimously women will tell me breast cancer. Statistically, breast cancer will affect 1 out of 8 women but most women will do well, thanks to the research and advancements in treatment over the past few years. The staggering fact is 1 out of every three women will die of a cardiovascular disease issue over the span of their lives. That’s our sisters, our mothers, our daughters, our friends. I think that is what the Go Red for Women (movement) is about informing us of our risk, starting that conversation with our doctor, and making the change to live our healthiest life.”

Heart disease includes more than a risk of heart attack or stroke

Part of educating women on their risk of heart disease requires breaking old stereotypes. “People constantly think of heart disease as being an older person issue, and it’s not,” said Dr. Stahura. A survey of more than 4,000 healthy individuals with an average age of 30 found that over 65% were unable to identify any of the six major cardiac risk factors. “In my short career, so far I have taken care of people who have had heart attacks in their 20’s and 30’s. These are people with high cholesterol in their 30’s, blood pressure issues starting in their teens.” The Women’s Heart Alliance 2014 survey reported that 45% of all women surveyed reported being unaware that cardiovascular disease was the leading cause of death for women. “We need to break the myth that heart disease doesn’t happen to us because it does – it is – and we are failing to identify it,” said Dr. Stahura.

Recognizing heart attack or stroke

“In movies and TV shows you see this picture of an older gentleman clutching his chest, having the “typical” signs of chest pain,” explained Dr. Stahura. In reality, heart attack symptoms aren’t the same for everyone, especially women. In a Twitter post from December 9, 2018, a female nurse shared her story. “I want to warn women our heart attacks feel different. Last Sunday I had a heart attack. I had a 95% block in my left anterior descending artery. I’m alive because I called 911. I never had chest pain. It wasn’t what you read in pamphlets. I had it off & on for weeks.” She called 911 after being drenched in sweat, after she started vomiting.

Women are more likely than men to have heart attack symptoms unrelated to chest pain. Dr. Stahura cautions women to listen to their body, to be aware of sensations, feelings, or severe pain that persists for more than 15 minutes. “A lot of women that I care for started with jaw pain or abnormal neck pain which came out of nowhere. A lot of women will have numbness, tingling in their hands, maybe some upper back pain where they think they did too much activity the day before. Acid reflux, consistently having reflux that is not improved with over the counter medications. These women are having a heart attack when I see them.”

Stroke is the third leading cause of death for women (in comparison, stroke is the fifth leading cause of death for men). Each year 55,000 more women have a stroke than men. “But when you ask the question, more people think it’s men. We need to talk more about the stroke risk for women,” proclaimed Dr. Stahura. Because in general women live longer than men, a stroke will have a more negative impact on their lives. The National Stroke Association states that more women will “live alone when they have a stroke, be more likely to live in a long term health care facility after a stroke, and have a worse recovery after stroke.”

Not only do women need to be aware of symptoms but they also need to respond faster during a cardiac emergency. A recent study conducted at the Triemli hospital in Zurich, Switzerland, found that women wait 37 minutes longer to seek treatment for heart attack compared to men. Dr. Stahura expressed this comes from not recognizing symptoms but also due to putting their family before their health needs. “I will ask women, ‘What caused you to wait, two days, three days, before seeking help?’ They tell me they have to care for their family. Women are tough. We have this innate sense of being caretakers, focusing on other’s needs before our own. Today, I want women to know, our health should be first too.”

Well Woman Visit

There is a reason National Wear Red Day falls at the beginning of American Heart Month. This month, health care professionals urge all women to discuss their heart health with their doctor. In the 2014 study by The Women’s Heart Alliance, approximately 71% of women did not mention heart health during a visit with a physician. “As a cardiologist, I will start by asking about your health history, what issues you have had in the past,” said Dr. Stahura. Expect a conversation on the risk factors that put you at an increased risk of heart disease. This would be blood pressure, high cholesterol, and if you’re a smoker. “I’ll also address your cancer history. Many patients that have had breast cancer, lymphomas, or leukemia and have had chemo or radiation, as well as therapies to the chest, that put them at risk of undiagnosed or undetected cardiovascular events.”

The goal of the Well Woman Visit is to asses your risk of heart disease and work with your physician on a plan live your best life. “Relationships are not built over one or two visits. I enjoy meeting with my patients and talking about their life. I want to hear about the areas of stress or changes in their life that could impact their overall health.”

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.