Editor’s Letter
As I write this, I am listening to the weather forecasters spend hours trying to create informative newscasts about a possible impending storm coming to the Northeast tonight. Quite often when I hear the reporters, I think they must be scrambling for interesting news as many of the stories are rather trivial and forgettable. When I started writing for this newsletter a few years ago, I had that fear that I would be hard-pressed to find anything to write about. It has actually been quite the opposite experience. There is so much going on in the nursing world that it is difficult to narrow down which subject to focus on.
One of the articles this month was easy to pick as a topic. The drug shortage seems to be a shared contention amongst medical professionals lately, as this affects doctors, nurses, pharmacists and patients. The second article takes a look at the world of night shift work among nurses. I have a few friends; nurses included, that proudly, and tiredly, enjoy their trek into the third shift each night. It is a challenging shift that many of us would not be able to handle. My hat is off to all of you!
As always, I urge you to send in comments or topics that you would like to see an article on. Or send in an article of your own to be put in the newsletter.
OH, WHAT A NIGHT!
The night shift is viewed by many as not part of the “real world”. Night workers often times feel isolated and alienated from the rest of the staff. Nurses who work nights face many challenges along with certain consequences.
Working the night shift can cause marked stress with physiological and psychological effects. Sleep disorders, health problems, job dissatisfaction and social isolation are common amongst nurses who work at night. Studies show that sleep deprivation increases the risk of patient errors, near misses and personal injuries. The sleep medicine researchers at Brigham and Woman Hospital have found that shift work causes an increase in problems in nearly every system in the body. They report that sleep disturbances and chronic fatigue contributes significantly to a decline in good health. There is also a higher rate of chronic diseases in nurses who work at night. The Institute of Medicine has called for research on methods that will help night shift nurses compensate for fatigue.
In addition to the physical downside to night shift work, nurses also report that they question their level of commitment to nursing, feel socially isolated and often feel disengaged from the day time management and staff. However, there are some strategies that nurses can implement to optimize their night shift work and feel that they are part of the staff.
One strategy is to make oneself more visible and involved, even if that means to come in early or stay later. By routinely attending staff meetings or other unit meetings, it allows your voice and needs to be heard. Rallying fellow shift workers to support changes will help to enhance the work conditions for the night workers.
Another strategy that can help motivate night nurses are to seek out available learning opportunities, such as clinical or management classes. Working nights may be ideal for a nurse to complete an advanced degree program.
Nurses need to persevere and realize that many preconceived notions of night nurses may be challenging to change. It may be helpful to align with night shift colleagues and work on collaborative goals that can be presented to management. Most certainly, working nights comes with many challenges but the payoff can be valuable. Career success does not depend on which shift you work. Nurses all work in the “real world” no matter what shift is worked.
Drug Shortages
The New York Times has reported that a contentious relationship between drug manufacturers and the DEA may cause a continuing shortage problem of the Attention Deficit medication, Adderall. The Food and Drug Administration has now added it to it official drug shortages list. Prescriptions for Adderall went up 13.4% from 2009 to 2010; more than 18 million scripts were written for the widely popular drug. As the demand grows, more and more patients have found that the medicine is out of stock at the local pharmacy.
The experts say it’s difficult to pinpoint the reason for the shortage. In order to manage controlled substances that could potentially be abused, the Drug Enforcement Agency (DEA) sets manufacturing quotas for drug ingredients each year to help control drugs like Adderall. However, Adderall drug manufacturers, which include Shire, P/C & Novartis, Teva and CarePharma LLC all, say they cannot meet the growing demand for Adderall without looser limits from the DEA. The DEA questions if a shortage actually of generic supplies actually exists or whether the companies want to sell more of the expensive brand-name drugs. Special Agent Gary Boggs of the DEA’s diversion control told the New York Times, “We believe there is plenty of supply.”
The addition of Adderall to the FDA shortage list comes shortly after President Obama signed an Executive Order in October 2011 to help ease drug shortages. “The shortage of prescription drugs drives up costs, leaves consumers vulnerable to price gouging and threatens our health and safety,” Obama said in a statement at the time.
Prescription drug shortages worldwide are causing problems for hospitals, pharmacists and patients. “I’ve been doing this for thirty years and it’s the worst I’ve ever seen, “said Dana Darger, director of pharmacy at Rapid City Regional Hospital. “IV morphine is the big shortage right now.” Morphine, in various forms and dosages, is a common pain reliever in any hospital setting. For example, the Rapid City Regional uses between 1,500 and 2,000 doses of injectable morphine each month.
There are many different reasons for the shortages. It could be a lack of raw material, particularly since much of the opiate supply comes from politically unstable parts of the world. It could also be a lack of another ingredient, which is not a drug, such as a needle or glass container. Many times it is the failure of a drug manufacturing facility to pass a DEA or an FDA inspection that can shut down an entire drug line. Some medicines are only manufactured in a handful of facilities worldwide, so a shutdown in one of them can disrupt supplies for months.
Additionally, drug companies no longer keep large inventories on hand, so it does not take long for the supply line to be gone.
There are alternative drugs and dosing substitutions for some pain relievers and antibiotics but it takes a lot of work for all parties involved. It sends doctors and pharmacists back to the drawing board. However, many drugs do not have substitutes. Oncology drugs cannot be changed once a chemotherapy treatment has begun. There are currently more than 200 drugs on the shortage list with the American Society of Health System Pharmacist. The Obama administration is hoping the executive order will result in the FDA giving earlier warnings about potential shortages to the drug manufacturers and to get those shortages resolved more quickly.