Blog 8: Who will oppose?

My research on this topic has been very thorough and from reputable sources. The facts that I have presented about the current issues of STI and pregnancy rates are undeniable and would be hard for any audience to ignore. However, like with any proposal, there is bound to be some resistance from some group. Using inference and reason, it seems that the group with the biggest resistance to my proposal would be the budgeting office at Longwood University. The solution to this issue wouldn’t require the office to pull money from somewhere else in the budget, but it would require them to raise the student fees by fifty dollars per student annually in order to increase funding for the Student Health Center. Some faculty in the budgeting office may feel that this additional fee is unreasonable to ask students to pay, considering that their tuition and fees will already be increasing next year. To expand on that point, there may even be some students who are resistant to my proposal because they may feel this increase in their fees is unnecessary.

It would be worth some time to consider including the current faculty and staff of the Student Health Center in groups that might oppose as well. After consideration, my proposal is not changing the operations of anything they are currently doing or discrediting them in any way; it is simply improving upon the types of services offered. However, with this improvement would come change. There may be the need to hire additional personnel in the center to administer the testing. Some people currently employed in the facility may also be opposed to conducting such testing in the facility simply because they do not want to handle it or they think the current system is good enough. It is also not within reason to consider that Longwood is a small school in the south, there may be some opposition to offering these tests from some of the current faculty members due to personal beliefs. All of these factors are relevant when thinking about the groups who may oppose implementing the solutions in my proposal. Taking these into consideration, it becomes more important to make these groups realize the threatening problem that exists, and that a solution must be implemented quickly in order to ensure the health of the student population.

Blog 6

Narrowing my issue presents a difficulty considering that it is already focused on one specific problem and population of people. However, there are a few issues that can be more focused on considering the STI rates at Longwood as well as which group of students it affects the most. It is true that nearly half of the STI cases reported to the CDC annually are from people ages 17-25; but what do these rates mean for a college campus? It would be difficult to calculate the true rate on Longwood’s campus because even if a survey was conducted, not all students would fill it out and there is a history of dishonesty even on anonymous surveys. Therefore, it would give a rough idea of the percentage of students that currently have, or have ever contracted an STI while at Longwood. Despite these numbers, the CDC estimates that one in every four students in a college campus have contracted an STI during their time at there and that number continues to grow.

In addition to the STI rates, the need for pregnancy testing becomes a relevant part of the conversation as the rates of unplanned pregnancies begins to rise as well. In 2011, the CDC reported that 83% of pregnancies were unplanned in women ages 18 and 19 and 64% in women ages 20 to 24. Although there has not been an official study published since that date, further reports from the National Center of Family Growth show that there has been no decline in the number of reported unintended births(collected at time of birth, excluding abortion rates).  These numbers are important to a college campus whose female students make up 69% of the total student population.

When combing the STI and unplanned pregnancy rates, there becomes a clear focus on the female population of Longwood University. Ultimately, they are going to be the majority receiving STI testing and the only ones receiving pregnancy testing. Not to exclude the male population from the problem, it is important that males have the opportunity to be tested for STIs as well. However, for the purposes of my proposal, there is an emphasis placed on the female audience of the University that is more relevant to them than males. Keeping this in mind, it is important for me to focus my information on facts that are directly relevant to females in order for my main audience to be on board with recognizing the problem and accepting the solutions I will propose in my later blogs.

Who Would Show Resistance?

When discussing a change in the community, there is bound to be resistance coming from someone. As my solution, to change the way off-campus houses and apartments are built in the future, there is definitely subject to argue against this. There are faculty, staff and landlords who do not wish to allow students with a physical disability to live off-campus. Majority of their reasons are in regards to safety. People believe that it will be difficult and challenging for students in a wheelchair or other walking aid to escape from the house or apartment in case of an emergency.

The first floor of dorm buildings are very accessible for individuals with a disability to escape, if necessary.

To fight back on this resistance; new apartments and houses that will be built in the future will allow and provide easy access to wheelchair in the rare case of an emergency. There will be ramps and elevators provided for a quick escape.

 

Steps to the Solution

The lack of accessible housing off-campus is forcing sophomores, juniors and seniors to remain in dorm rooms on campus. This issue is frustrating to those students who use a wheelchair or other type of walking aid. The Longwood and Farmville community needs to be made aware of this and we all need to show support and fight for equal housing opportunities.

These individual students who are constrained to a wheelchair are not only not able to live off campus, but it is extremely difficult for them to visit friends who live in off campus houses or apartments.

My goal is to improve and increase the accessibility in off-campus housing over the next few years. Longwood University has increased in size over the past couple years and it will continue. More dorms, apartments and houses will need to be built in order to house all of the students. These future student off campus homes need to be made accessible.

The steps to this proposal are simple. The first step consists of awareness. The Longwood and Farmville community need to be made aware of the situation and be educated about the public laws and acts. Making the community aware will gain the support we need in order to make a change.

            Step two will require research and reaching out to the Americans with Disabilities Act and other public laws. Understanding the rules and regulations with houses and apartments can help the fight for change. After understanding the policies, certain actions must be taken in order to improve the accessibility.

Step three is receiving the proper funds from the government to make these housing changes now or in future construction.

I am looking forward to the progress Longwood and Farmville show in the next few years. I know for a fact that all students with physical disabilities will be thrilled for their future Longwood classmates to have more opportunities to live off-campus.

Why Is There Resistance?

With any argument and solution, there are groups who will resist your solution and ideas. There are 26 states that are hesitant about joining the nursing compact. It is to be expected that asking states to change the way they run things will stir up some commotion, and that is was these 26 states see the compact as. They think that the National Council of State Boards of Nursing (NCSBN) is trying to come into the states and run and over see every little thing and act they perform in their hospitals and other health care facilities.

Improving Healthcare Across the Nation

However, these states being uninformed of everything that the entire compact has to offer is allowing these incorrect thoughts to form within the non-compact states. What I think a lot of states forget, is the main goal of the NCSBN is to maintain their responsibility of providing regulatory excellence for the public health, safety, and welfare. By the NCSBN creating the Nurse Licensure Compact, expanding nursing job opportunities across all state lines is obviously a huge plus, but their main focus is to nationally regulate the care that is being provided in each state by ensuring that healthcare facilities have safe and competent nursing practice being provided by registered and skilled nurses.

Of the twenty-six state left that have not joined the compact, not all of them are completely against it. Florida for example wants to join the compact and is waiting for their state to implement the compact legislation.

Should We Join The Compact?

Other states, however, Massachusetts for example, is completely against it. It is states like these that are creating the most resistance when it comes to expanding the compact. Part of their resistance is based on morals and partially on loss of power and money.

Massachusetts feels that morally joining the compact is wrong based on the privacy of their patients. They feel that joining a national database will not only expose personal information of their nurses but of their patients as well. While Nursys will have information on their nurses, it is not considered too personal because the non-compact state has access to that same information if they wanted it. Nursys just compiles it all in one database, which ensures that we have competent, safe nurses practicing in our states.

Another issue they have is the expansion of telemedicine and telenursing. They view it as a poor alternative to providing patient care because they stated that “its having nurses on the phone rather than providing direct care”. This is not the case thought. While nurses and other health care providers will be practicing over the phone or Internet, they will still be practicing in person and by the bedside of the patient in their own facilities. Telehealth just increases the collaboration opportunities when caring for people who require complex care.

Some non-compact states are also worried about how disciplinary actions will be held under the compact. They think that it would be very difficult to locate and follow-up with the nurses after they have been involved in a bad incident if they can be located all of the country. While the nurse can move to somewhere else in the country, her information and the disciplinary information and outcomes will all be documented in Nursys as well. The disciplinary issue will be handled by the legislature in the state that it occurred in, and the information and outcome will be reported back to the nurses “home state” for them to enter it into the database. This documentation of disciplinary issues is beneficial for hospitals looking to hire the nurse because they are able to see what exactly happened and it ensures that we only have safe nurses practicing in the states.

Some states are also worried about the lose of revenue from requiring new licensure for their own state for a nurse that wishes to work there. While this is a reasonable concern, joining the compact will eventually save these states money. Several non-compact states are understaffed which in turns means they are not able to provide the proper care needed in nursing homes, which are becoming over populated because of the aging of America. There is a high incidence rate of nosocomial infections, which are hospital-acquired infections that patients suffer from while their stay in a health care facility, along with a high incidence rate of bed or pressure ulcers. Bed ulcers are too common in nursing comes which comes from nurses not turning and ambulating their patients every two hours. These two infections cause that health care facility and its state millions of dollars because legally through insurance, they are required to pay for the care needed to health them. By joining the compact, it allows for more nurses to move across their lines and work in their understaffed facilities. This in turn, will lower the patient to nurse ratio, allowing nurses to provide more competent individualized care for each of their patients, eliminating the high incidence rates of nosocomial infections and bed ulcers.

Many states view the compact as coming in and changing all of their rules and the way they run their facilities. This is not true. Hospitals still have complete say in who they hire and why, along with keeping or making continuing education for their nurses mandatory. The compact encourages this because continuing education means that their nurses are as highly educated as possible on new ways of practicing and health discoveries along with being aware of  the current evidence based practice laws for nurses.

The non-compact states have a major influence that will make it hard to fulfill the solution created to expand the compact. Educating these states on all the benefits the compact has to offer is so important when trying to convince the states to join. There are several nurse advocates in non-compact states who are against the compact. These people are seen as community leaders and several people in their states listen to them and agree with what the nurse advocate sees as best for the state. This poses serious problems when trying to talk to other nurses because they have usually already formed an opinion on what is best for their state.

While there is resistance to the solution and expanding the nurse licensure compact, it seems to be that people are forgetting who is of the most concern here. Our patients are suffering terribly from the compact not being expanded because it is hindering the elimination of the high patient to nurse ratio. This high patient to nurse ratio is causing infections and illnesses to be acquired in our patients that are easily preventable if a facility is properly staffed.

Compact States In the United States

These states being properly educated on what the nurse compact is aiming to do and how they are planning to achieve their goals will help inform people on how beneficial the compact can be to every state and their facilities and the care being provided by their nurses. The twenty-four states that have joined the compact are perfect examples of how beneficial it can be to nursing opportunities as well as improving patient healthcare across the board.

References

Nine reasons nurses oppose compact. (2007). Massachusetts Nurse Advocate78(10), 12-13.

Blog 7: Finding a Solution

After defining the issues with the student health center, it is now time to focus on a more detailed solution. As I have previously outlined, the Longwood Student Health center needs longer hours in  addition to improved family planning services such as STI and pregnancy testing. With nearly half of people ages seventeen to twenty five contracting STIs , and this number continuing to grow every year, it becomes clear that Longwood University needs to be offering these services, just as many other colleges and universities have already recognized.

The first step in solving this issue is the increase of funding that is given to the Student Health Center. This budget falls as a category in the Longwood’s Auxiliary budget. The current total of this budget is $44,516,541. Student Health is currently allocated 1.6% of this budget, which is $699,298. This is the second lowest item on the Auxiliary budget list and it may be possible to change this through the gaining of additional funds. It could be proposed to ask the University for more money, however this would most likely be an unsuccessful approach given that all of Longwood’s extra funding is being put towards the addition of new housing and renovating the campus all in an effort to increase the student population.

Modeling after several other colleges, I propose that the university create a fee that would be included in the standard tuition and fees that every student has to pay at the beginning of the academic year that would cover the additional cost to be put towards the student health center. After looking at budget models from several other universities such as George Mason University and Virginia Commonwealth University, it is evident that other colleges do include such a fee to fund their student health center. The model that Longwood currently follows is charging students a “Comprehensive Fee” which is currently $157.00. However, this fee is split into eight different categories including Safety Initiatives, Building Repair & Maintenance, Campus Beautification & Grounds Maintenance, Student Health & Wellness Services, LCVA Center for the Visual Arts, Farmville Area Bus Service, Athletics, Student Union/Programming, and other services. Although it is not made clear how much money is going to each of these different categories, more than likely some of them are receiving more than others. Just for the sake of breaking down the budget evenly to see how much the University could potentially charge, it would be around $19.67 going to each category( once again this is if the money were being distributed evenly).

My proposal is to raise this Comprehensive Fee to an even $207.00. This would allow an increase of $50.00 per student that could be given to Student Health and Wellness Services.  There are currently 4,834 students enrolled at Longwood that pay tuition and fees. If each student were to pay an increase of $50.00 to their fees, this would generate an additional $241,700 that could be put towards the Student Health Center. This would be enough funds to increase the hours of the clinic as well as provide a better family planning program. With the provision of this extra funding, it would be feasible for the University to make improvements that are necessary to the health of their students and in turn, create a better functioning community at the University.

Why Not?

No one at Longwood University will say that the health and safety of their students, faculty, and staff are not of the utmost importance but when it comes to renovations of any sort, even for the benefit of students, there are considerations that generate a certain about of resistance. Resistance will be greatest from Capital Planning which is the campus’s office that allocates money for small renovations (water fountain installation, key card access, etc.) and requests money for specific projects from the general assembly (larger renovation like the Wygal Hall renovation in 2018 or Performing Arts Center construction).

One argument is the “wait your turn, Wygal” argument, which I have addressed previously. In this argument, the future construction of the Performing Arts Center (2016-2021) and Wygal Hall renovations (2018-2021) are cited as being soon enough that changes to building should just wait. The problem is that it is only the start date that is in the near future, but how much activity does the university anticipate allowing during construction? Between now (2013) and the beginning of the Wygal Hall renovations, the freshmen of 2013 and 2014 along with the current second year and older music majors, will have a full four years of Wygal Hall’s shortcomings. The music department has averages 70 music majors per a year for the past five years which means that at least 70 students for the next five years are effected by the building.

As for the actual changes begin proposed, the need for both changes is real, as is the resistance based on financial constraints. In both cases, prices are dependent on the models and the contractor purchased through. The installation of water bottle compatible fountains is not a cheap endeavor. The fountain in the gym (which is same model that would be ideal for Wygal Hall) alone cost $960.00 (Elkay EZH2O LZS8WSSK) and is not including the cost of installation or filters over time. However, in the long run the installation will save the school and students money as well as help the school by furthering the university’s sustainability goals.

Secondly, the installation of Hughes Identification Devices to allow after hours key card access to the building for music students only is expensive but it a change that not only students, faculty, and staff want, but also members of the campus police department. The cost of the reader itself is at least $370.00 (HID 5355) but there are the additional costs of cable fitting, cables (5 and 20 conductors), DC power supplies, and the building system control panel. I do not have the construction knowledge to make an accurate estimate, however, one student who previously did a proposal on the topic of key card access to Wygal Hall priced the project at $15,000.

Capital Planning recognizes that Wygal Hall is a problem on the Longwood University campus so their arguments against these improvements is not out of a lack of care or recognition of building problems.

Who might be against this?

With any problem, people want a solution.  If a solution is given then there is usually resistance.  So, how can we convince people that your solution is the best and take away their resistance with your solution?  The problem I have come up with a solution for is lack of prenatal care.  My solution is to incorporate an educational program for prenatal care through WIC at the Prince Edward Health Department.

This solution definitely comes with its resistance though.  One institution that might resist this solution is the health department.  Their resistance would come because they might think that the program has enough educational information already or that further prenatal care education is not needed.  They also would have resistance because of the issue of money.  They may not have the funds to pay someone to give an educational class to these women, especially with the high numbers of people applying to WIC, which means many classes would have to be given.

Another form of resistance could come from the state government because WIC is a government funded program.  The main reason for resistance from the government would be the issue of money.  Incorporating this class in the WIC program is probably not at the top of their list of things to fix in the state.  Since they have control over the funding for WIC, adding more to it would mean more money and convincing them to increase the budget would be difficult.  The state may also have resistance because since this is a program they are in charge of, if something could be done to better it their reputation may be hurt.  It might make people think that the government had overlooked some important things when forming to program in the first place.

Both the health department and the state could make it harder to implement a new program in WIC because of money and the fact that they might not think it is needed.

Slam on the Breaks

Money.  It’s a beautiful yet nasty thing.  Money allows us to do more, to create more, to go more.  But money also hinders us in many ways. 

The idea of installing life saving precautions on route 20 is brilliant.  But it, like all other proposed topics, finds resistance.  The main resistance of installing shoulder rumble strips along route 20 comes from financial bodies.  Two of these bodies include government assistance and local taxpayers. 

The government and VDOT work together to plan and finance projects that are implemented to better the roadways.  In many cases these projects take years to become successful because the needs of the entire state highways are prioritized.  This is not a bad thing.  But, if the big level decision makers do not find shoulder rumble strips on route 20 of highest priority, it will take a while to see any results. 

While the governmental assistance would be highly beneficial, it would not likely cover the entire costs of a project like the one proposed.  In such cases, the local government raises the taxes to provide additional funds.  This leaves the residents of Orange County funding the highway improvements.  Personally, I do not see where this is a problem, but I do know that many residents will find this news disturbing.  In today’s society, people are already struggling to get by and adding another cost would be upsetting. 

Some of these local taxpayers have another issue with the shoulder rumble strip proposal.  For those who reside right along route 20, parts of their property could be taken away to install the rumble strips.  For those who have had to respond to and clean the debris of previous accidents up from their yards, they would likely welcome the change.  Those who have yards that have remained spotless, they might disagree with the change.   

Because the majority of the resistance of shoulder rumble strips along route 20 resides in money, the battle could hinder the installation of the rumble strips.

Where Are We Going?

*****Apparently, I never actually published this post.  Sorry y’all! I definitely wrote it last week!!****

 

The Rearview Mirror:

Route 20 is a two-lane, rural highway that runs through Orange County virtually connecting Charlottesville to Fredericksburg.  This road has proven itself to be a dangerous—sometimes even fatal—road.  There are areas where the curves are sharp but the signs that note this are lacking.  There are dips in the road.  There are parts of the road with essentially no shoulder.

 

Start Your Engine:

Route 20 is the type of road that driver’s need to focus on.  Distractions are everywhere but on roads like route 20, distraction are deadly.  To fix this and eliminate the distractions, shoulder rumble strips are desired.  These rumble strips are installed on the shoulder of the highway and when cars run over them, they make a startling noise that alerts drivers back to the highway before them.


Shifting Gears:

Now, we have to go through a bit of a process to install rumble strips.  A few posts ago, I mentioned that they are not free.  While an entire highway of rumble strips would be wonderful, that is just not an attainable solution.  So instead, I propose that we install rumble strips on the shoulder of route 20 in certain hotspot areas that have seen the most accidents or are the most threatening areas. 

A Sustainability Enhancement Tool has been created for State Departments of Transportation to use to measure road performance.  Basically, this tool looks at all aspects of the road to identify areas in need of improvements.  Using this tool during the highway-corridor planning phase would help VDOT identify the hotspots along route 20 before they would begin to install rumble strips. 

 

“Your destination is on the right.”