Dialogue

Nurses for change

A great study ["Let Nurses Fill the Gap," Wholly Hopkins, Winter 2011]. NPs have made a well-documented and high-quality contribution to providing care in areas of need for more than 40 years. Barriers to practice remain, with outdated practice acts and barriers to prescribing. As a recent transplant to California, I was surprised to find that many new FNPs are unable to be hired due to regulations that require more than 500 hours of supervised prescribing before receiving prescriptive authority or "furnishing" privileges. Barriers to prescribing need to be addressed at many levels and, although it is a state-by-state process, advocacy and mutual aid for states are key resources for change.

Karen Anne Wolf, Nurs '73
Professor of Nursing, Samuel Merritt University; Chair of the Nursing Academy of the National Academies of Practice
Oakland, California
Comment from magazine.jhu.edu

We the people . . .

In the James Madison monument controversy [Letters, "Monument Muddle," Winter 2011], the important thing is not at all anything about some stones (or whatever); it is the marvel that we are still honoring authors of the disastrous Constitution that some Virginians wrote in the 18th century and which is going to inevitably wreck the United States.

These Southern gentlemen thought they knew everything that would be valid forever and that nothing should ever be changed. It shows: In 220-plus years, only three amendments of significance have ever been made while Southerners were sitting in the Congress. The three we got through when they were out were of course amendments 13-15. The three of significance when they were in attendance were 16, 19, and 24. All the rest were merely procedural or reversed, and of no essential importance.

Today, with the Southerners, Midwesterners (my home area), the Westerners, and the Alaskans (and plenty of know-nothings elsewhere, too) firmly in authority and powered by uneducated and sad people watching television, there is no hope whatsoever of amending the Constitution, though only a small minority, about 13 percent, now rule.

It is essentially all over, and all we need to do now is watch it play out.

Dennis K. McDaniel
Washington, D.C.

The "collector's gene"

I enjoyed "Why Can't Some People Throw Anything Away?" [Wholly Hopkins, Winter 2011] because it allows me free rein for my favorite theory: The existence of a "collector's gene." There are hoarders, collectors, and those who don't understand either.

Hoarding is a mutation of the collector's gene. In some individuals, instead of simply being dominant, it goes rogue and frequently leads to news articles, some serious (animal hoarders with 75 cats or dogs), some less so (hermit dies in a room filled with old newspapers).

But a healthy collector's gene provides a lifetime of pleasure, the thrill of the hunt. I have been an inveterate collector since childhood and even in old age the thrill remains. Any real collector knows that sooner or later someone will say, "You're sick." It's usually some benighted individual who lacks the gene. Looking concerned, the collector will say gently, "No, I'm not sick. I'm simply lucky enough to have been born with the collector's gene. It's a dominant characteristic and I have no control over it; it's just there. And I love it."

Robert A. Erlandson, A&S '53
Towson, Maryland
Comment from magazine.jhu.edu

The perils of distraction

The Internet and technology have given all of us a diagnosis of attention deficit disorder ["Paying Attention to Distraction," Winter 2011]. I work in health care and believe the amount of time required for nurses and others to complete their documentation on patients has to impact patient care. Although the software programs used to manage medical records have made great strides in streamlining information, the record itself is a distraction with its volumes of forms, task lists, and variety of ways one can navigate the patient information. Combine this with the rapid turnover of beds in today's hospitals, and you will find that patients are not there long enough for doctors and nurses to get to know anything about them without the crutch of the computer. Add to this the sensory bombardment from electronic equipment and alarms. Has anyone ever studied how the human brain is supposed to deal with this in an environment where sustaining life often depends upon knowing what is going on with the patient?

Computers have been great for capturing data, providing safer care, and measuring outcomes, but I can only wonder what is being forfeited.

Mary Garland, Bus '00 (MS)
Kingsville, Maryland
Comment from magazine.jhu.edu

Younger minds

I enjoyed reading Dale Keiger's article "Paying Attention to Distraction." However, P.M. Forni's concern about undergraduates' ability to think does not worry me. Since 1965, when I left Johns Hopkins, I have seen remarkable progress in every field.

Steve Jobs never made it to the top of his undergraduate class—but still did wonders. In his MBA thesis at the University of Virginia Darden School of Business, Doug Lebda wrote about mortgage process difficulties based on his first experience out of Bucknell University, then later founded LendingTree. Michael Bloomberg, Engr '64, left a lucrative career on Wall Street to form his own company, and he succeeded. Sam Palmisano, A&S '73, another Johns Hopkins undergraduate, turned IBM around.

My experience is that younger minds think everything is easy, but older minds think everything is hard. I remain optimistic about our younger minds and America's future.

Satinder Mullick, Engr '65 (PhD)
Corning, New York