Many nurses work in the same state where they graduated high school or attended their first nursing degree program, according to a study appearing in the December issue of Health Affairs magazine. That general lack of geographic mobility could prove problematic for facilities in areas with few nearby nursing schools, say the researchers.

Just over half of newly registered nurses surveyed in 15 states work within 40 miles of their former high school, according to the study's findings. Close to 90% took their initial nursing job in the state where they earned their first nursing degree, the study notes. Overall, about two-thirds of the nurses work within 100 miles of their hometown.

The researchers suggest facility leaders in areas without training opportunities implore local policymakers to expand the number of local nursing educational programs, fund programs that provide incentives for youths to attend nursing school, consider supporting extension programs from accredited nursing schools in the region and review the admission policies and financial aid offerings of area nursing programs.

Federally backed programs such as the National Health Service Corps and the National Area Health Education Center Organization offer financial incentives to new nurses who agree to work in underserved areas. "When sufficiently funded," say the researchers, "such programs could serve to offset the low mobility of new registered nurses that we observed."

Daniel Cook

A survey of surgeons has found that many fail to discuss with patients their medical wishes in the event that a risky operation goes awry. The survey also found that even more say they would not operate if patients' advance directives limited the actions that could be taken to keep them alive.

Margaret Schwarze, MD, an assistant professor at the University of Wisconsin School of Medicine and Public Health, and colleagues polled 912 heart, brain and vascular surgeons who regularly perform risky operations on how they discuss patients' advance directives and whether they influence their decision to operate.

The survey found that more than 4 out of 5 surgeons discussed which forms of life support patients would like to limit. Only about 50%, however, specifically asked about patients' advance directives, which can include restricting the use of feeding tubes and ventilators to keep them alive. More than half said such restrictions would negatively influence their choice to operate.

"[Surgeons] feel the advance directive basically ties their hands behind their back, and they're not given the tools to get them through the surgery," said Dr. Schwarze. She stressed, however, the importance of patients discussing their values and goals with surgeons before a major operation. "It's also incredibly important to discuss this with family members or someone who may need to make decisions," said Dr. Schwarze. These steps can prevent confusion in unexpected emergencies.

Mark McGraw

Steven M. Stoller, MD, and 3 colleagues opened the Paramus (N.J.) Surgical Center in 2000. The solely physician-owned, 2-OR facility saw over a decade of busy profitability until changes in the state's insurance and regulatory climate and a crushing lease on its building threatened its income. The center was faced with a difficult decision: "Close down or cash out."

The sale of a controlling interest to a corporate partner saved the day for the center. Dr. Stoller discusses the steps his facility took while seeking this lifeline in order to secure maximum value in the transaction.

David Bernard

Some of you have bought the last gift and are done with the wrapping. Others have yet to start your shopping. Where do you fit in? Tell us in this week's InstaPoll.

It looks as though 2012 will be a better year than this one for surgery, according to the 376 facility managers who answered last week's survey, in which we asked how next year's case volume was likely to shape up in comparison to 2011's. You answered: