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There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy. It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. ... But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. ... The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away. (Tavernise, 5/25)

Hospitals are trying new early-warning systems to monitor patients for subtle but dangerous signs of a worsening condition. After surgery or during hospitalization for illness, patients are at risk for complications that can quickly turn fatal, such as a depressed breathing rate that can lead to cardiac arrest caused by over-sedation or an adverse reaction to narcotic pain medications. ... Among the strategies hospitals are adopting is a wireless monitor that slips under a mattress and alerts nurses to changes in breathing and heart rate. Another approach rates a patient’s risk of serious deterioration in real time based on lab results, vital signs and nurses’ assessments gathered from electronic medical records. (Landro, 5/25)

KHN consumer columnist Michelle Andrews writes: "When confronted with the diagnosis of a serious illness or confusing treatment options, everyone agrees it can be useful to seek out another perspective. Even if the second physician agrees with the first one, knowing that can provide clarity and peace of mind. A second set of eyes, however, may identify information that was missed or misinterpreted the first time. ... But here’s the rub: While it’s clear that second opinions can help individual patients make better medical decisions, there’s little hard data showing that second opinions lead to better health results overall." (Andrews, 5/26)

Second opinions are valuable for a number of reasons, experts say. Several recent studies found that as many as 60% of patients who sought a second opinion received a major change in their diagnosis or treatment. Yet according to a 2010 Gallup Poll, 70% of Americans don't feel the need to ask for one — most said they feel confident in their doctor's advice and saw no need to gather additional information. (Zamosky, 5/24)

They're more common than ever, but some company initiatives don't have the intended effect. (Greenfield, 5/22)