Inflammatory Breast Cancer

My closest, dearest friend continues her fight against inflammatory breast cancer (IBC). If you have not heard about this disease, it is crucial that, as nurses, you know about this disease. It is very aggressive and often it is first diagnosed as a breast infection and precious time is lost searching for the right diagnosis. Since nurses may be the first health care provider to see a patient, it is very important that you are aware of the signs/symptoms of IBC in order to alert the patient's physician for further diagnostic tests. For more information:

The IBC Research Foundation has some helpful info, such as

There is more than one kind of breast cancer.

We have been taught and are reminded frequently by public service announcements and by the medical community that when a woman discovers a lump on her breast she should go to the doctor immediately. Inflammatory breast cancer usually grows in nests or sheets, rather than as a confined, solid tumor and therefore can be diffuse throughout the breast with no palpable mass. The cancer cells clog the lymphatic system just below the skin. Lymph node involvement is assumed. Increased breast density compared to prior mammograms should be considered suspicious.



Houston Chronicle - FORT WORTH, Texas - American Airlines will unveil two planes Monday featuring a pink ribbon running the length of the fuselage in
honor of its partnership with Susan G. Komen for the Cure, which includes a
$7.5 million pledge from the airline to research a rare form of breast cancer.

The two planes will be the first of eight featuring the pink
ribbon. In press releases Friday, both groups announced American's pledge
will fund research of inflammatory breast cancer, an aggressive and
frequently fatal form of the disease, at the University of Texas M.D. Anderson Cancer Center in Houston. Komen said that kind of breast cancer represents 2
to 5 percent of all breast cancer cases.

Dallas-based Komen said the grant will fund a team of patient
advocates,oncologists, pathologists and scientists working to
improve the ability to diagnose and treat the disease.

Fort Worth-based American, the world's largest airline, has
pledged to raise $1 million annually for eight years to fund the grant. The rest
of the money raised will fund health and community programs.

American said most of the funds will be raised at its annual American
Airlines Celebrity Golf and Tennis Weekend. (press release found in the Houston Chronicle. http://www.chron.com/disp/story.mpl/ap/tx/5932483.html

Also, there is a youtube video taken during the unveiling of the plane that features a survivor of IBC.

A change in name for APNs

The Texas Board of Nursing posted proposed rules for advanced practice nursing. One of the proposed rules is to change the name of an Advanced Practice Nurse (APN) to Advanced Practice Registered Nurse (APRN) because it reflects that the nurse is both a registered nurse and an advanced practice nurse. There has also been some clean up to the advanced practice rules. The rules are available for comment at this time. [There are also other rules being proposed dealing with the Jurisprudence exam, fees, and vocational nursing education]

Extended Evaluation Program - EEP

The Board has more information about the Extended Evaluation Program in their current newsletter. The article explains the basis for the program:

The EEP is primarily intended for nurses who have a one-time positive drug test without any other practice issues and who fail to receive a substance abuse or substance dependency diagnosis. Previously, when RNs and LVNs were reported to TPAPN by third-parties and failed to receive an abuse or dependency diagnosis they were ineligible for TPAPN participation and were subject to possible licensure investigation and action by the BON.

Please do not rely upon the availability of this program and take the risk of taking unprescribed medications or drinking prior, even the night before, a drug screen. The Board extends its concern to many areas that you may not initially consider to be within the scope of nursing practice. For example, a pre-employment screen where you are not working as a nurse when giving the screen, but if the screen comes back positive, you will be under the Board's scrutiny. Many nurses wish that they could go back in time and make a different decision when they borrowed their friend's medication and took it or went out to a party the night before they had to give a screen. Caution will help to avoid future headaches.

TPAPN, the BON and the future

The BON is meeting July 17-18, 2008. One of the agenda items involves the Board's Legislative Appropriations Request. This is how the Board asks for money from the state to fund their activities. There were several issues brought up by the Board that I found interesting (and that also confirm what I have been telling nurses):

1. More nurses are finding themselves before the Board. The number of complaints is increasing and the Board expects 9200 complaints this year. Just two years ago in 2006 there were approximately 5185 complaints and two years before that in 2004, there were approximately 3690 complaints.

2. More nurses are choosing to fight the Board in front of a judge.

3. The cases that are going before a Judge are more complex. This means that there are more nurses challenging the Board rather than choosing not to show up at a hearing and losing by default.

4. More nurses are hiring attorneys to represent them before the Board. After hearing from prior employees of the Board that nurses should never represent themselves before the Board, I am glad to see that more nurses are seeking help when dealing with the Board.

5. The Board is getting tougher on nurses and nursing licensure applicants.

As part of the request, the Board is asking for funding for 3 attorneys, 2 legal assistants and 4 investigators. Below is part of this draft document involving the need for more money to hire more staff:


New Personnel Needed for Enforcement, Legal and Operation Processes -
The agency’s enforcement workload and expenses for its contested cases have steadily and rapidly increased and must be addressed in order for the Board to maintain its mission to protect the public and timely resolve its complaints. The Board needs appropriations to cover the increase in litigation related costs for its expert fees and witness fees. Additionally, the Board will need approximately eleven (11) additional FTEs for FY 2010 and FY 2011 for its Enforcement, Legal and Operation Departments in order to meet the growing demands. Six (6) FTEs are needed for an increased workload due to growing complaints and litigation. This number would include two (2) investigators; two (2) litigation attorneys; one (1)legal assistant; and one (1) administrative assistant. The agency will begin to process criminal background checks for students. The Board will need an additional five (5) FTEs, including one (1) administrative assistant, two (2) investigators, one (1) Attorney and one (1) legal assistant. Although this number appears to be significant, the rise in the number of investigations, plus the complexity of the Board’s disciplinary cases, supports the need to add enforcement, legal and operation staff in order to meet the agency’s mission and timely resolve cases. The Board in FY 2008 will likely receive 9,200 complaints leading to 2,400 disciplinary actions. By comparison, the Texas Department of Licensing and Regulation (TDLR) will have approximately 8,000 complaints in FY 2008 and will likely take approximately 1,240 disciplinary actions (TDLR Statistical Questionnaire, May 2008). TDLR employs thirty-five (35)investigators and ten (10) prosecuting attorneys. Other than the increase in volume of complaints, there are several other reasons why the Board’s enforcement cases will require more resources for the agency to meet its mission effectively and timely:

1. Complaints are increasing by approximately 15% annually;
2. Formal charges statistics and unresolved complaints statistics are increasing;
3. The Board’s policies have tightened with regard to enforcement and
eligibility;
4. Attorney representation has increased significantly; and
5. Proceedings before the State Office of Administrative Hearings (SOAH)
have become more complex.

We project that cost of adding eleven FTEs as follows: four (4) Investigator
IIIs - $167,576; three (3) attorney IIIs - $189,291; two (2) legal assistants -
$88,962; and two (2) administrative assistants - $62,156. Costs of computer
hardware (one time only) - $11,000. Costs of telephones (one time only) $2,750. Costs of Remodeling (one time only) - $11,000. Costs of Furniture (one-time only) $5,500. Costs of annual phone and internet connections - $1,100. Litigation and expert witness fees - $25,000. This will impact the Enforcement and Licensing Strategies.