Nursing Notes

November 28, 2009

To blunt nurse shortage, hospitals must address nurse turnover

Filed under: Nursing — Shirley @ 3:39 am
Tags: , , , , , ,

Finally, I have started to find articles on business postings and hospital finance postings that address the shortage and ways to deal with it.  I have always felt that retention would be a key point for hospitals who frequently find themselves unable to  fill the vacant positions they already have, let alone any new ones from nurses who are leaving their positions.

This article is from Healthcare Finance News and to me, seems like a light at the very distant end of the tunnel.  Read  this article and let me know if you feel like I do-hopeful!


November 24, 2009 | Patty Enrado, Contributing Editor
CHARLOTTE, NC – With 100,000 nursing positions currently unfilled and the shortage expected to climb to 340,000 nurses by 2020, healthcare systems need a strategy to reduce nurse turnover.Healthcare systems should shift their focus from why nurses leave to why they stay, said David Rowlee, vice president of research services for Moorehead Associates, an employee survey and research firm.

“Research confirms a strong empirical link between workforce engagement and the challenges and goals of healthcare organizations,” Rowlee told attendees in a recent webinar presentation.

Workforce engagement impacts an organization’s performance, clinical outcomes, patient safety, physician engagement, market penetration and financial performance, he noted.

Research shows that most people leave their jobs because of neutral or positive events, such as spouse relocation or unsolicited job offers, Rowlee said, adding that it is up to organizations to insulate valued employees from these events.

Rowlee thinks a “Links, Fit and Sacrifice” model can help healthcare organizations keep their employees. He said employers should make connections between a new employee and other people or groups in the organization and create a compatible and comfortable work environment for the new employee.

By providing material and psychological benefits that accumulate over time, employers create a situation in which employees won’t want to forfeit these gains by leaving the job.

Healthcare organizations should employ a detailed, streamlined on-boarding survey that measures items that have the most impact on ensuring immediate stabilization and contribution from new employees, Rowlee said.

Successful surveys include demographic coding, reasons for joining the organization, closed-ended items that predict stable contributors and open-ended items about reasons for joining the organization, feelings about the job, realistic job preview and effective orientation, he said.

One large integrated healthcare system in the West implemented a successful RN on-boarding program that used a Links and Fit strategy. Each RN received a welcome letter, had lunch with his/her manager the first week of employment and had a weekly touch-base meeting with his/her on-boarding coordinator within the first three months of joining the staff.

The healthcare system also helped coordinate the orientation checklist, provided mentoring and coaching sessions, facilitated training and development programs, and provided assistance with competencies assessment, among other things.

The average cost to fill a vacant nursing position is $62,480, according to the U.S. Bureau of Labor Statistics. Turnover negatively impacts the quality of patient care and continuity of care, lowers work unit morale, strains physician relationships and increases the patient risk, Rowlee said.

The estimated cost of nurse turnover, which is an average of 15 percent, is nearly $9.4 million. According to Rowlee, this estimate is conservative and doesn’t include loss of productivity. The potential savings by implementing a Links, Fit and Sacrifice model, which would help move nurses to high performance, is nearly $4.4 million, he insisted.

But implementing the model is not enough. Engagement goes through a “honeymoon phase” and rapidly declines before the end of the first year. It is critical therefore to measure and track early and frequently stability and contributors of workforce engagement, Rowlee said.

Read the original article here


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November 27, 2009

Six Best Practice Elements of ThedaCare’s Collaborative Care Model

Illustration of w:Florence Nightingale
Image via Wikipedia

This is an interesting article that discusses the way a hospital system decided to change the way it provided care and establish a goal for the future by addressing patient care and patient perceptions.  That is unique in this field, but what really caught my eye was the fact that the model was developed mainly on the input from nurses who were actually giving that care.  That is unheard of!

It is very nice to see an article that gives credit to the nursing staff and actually has nice things to say about their collective abilities to facilitate changes that make things better.  In this instance, the patients themselves gave the model a good response.

Anyway, read the article here or visit the original and read some of the other articles found there.  It is worth your time, I think, to read and think about this process.  Maybe you can initiate something similar in your own system?  It’s not impossible, but I agree change is always hard.


By Lindsey Dunn October 23, 2009

ThedaCare, a four hospital community health system based in Appleton, Wisc., is a leading healthcare delivery system and is nationally recognized for its continual process improvement efforts. The hospital recently implemented one of its widest-ranging improvement efforts — a truly integrated, collaborative model to guide all inpatient care. The collaborative model has been widely successful in improving the quality of patient care and making that care more efficient, according to Kathryn Correia, senior vice president of ThedaCare and president of Appleton Medical Center and ThedaClark Medical Center in Neenah, Wisc.

“Lean” process improvement
In 2003, ThedaCare executives searched for a way to accelerate the health system’s process improvement efforts and stumbled upon lean management — a management and process improvement method that is focused on eliminating activities that do not add value to the organization’s end product. Executives from the health system found a company in their own backyard that had successfully implemented lean processes to the manufacturing of outdoor equipment and set forward in implementing these same processes in their hospitals.

“We knew there was a lot we didn’t know, but we decided to get our hands dirty and jump right in,” says Ms. Correia. “We brought in facilitators and held week-long rapid improvement events where groups of employees examined various processes and recommended improvements. We looked at the various results from these events and selected a few areas to work on first.”

The hospitals started with improving administrative aspects of hospital processes, and then moved to examining enterprise value streams. Eventually, hospital leaders began to focus on improving inpatient care in order to differentiate ThedaCare’s inpatient services from its competitors, and put an improvement group to work to figure out a way to meet this goal.

“We decided that our vision for the future was creating a unique inpatient and ER experience, which relates back to the mission of our hospitals, and this became part of our strategic plan,” says Ms. Correia. “What resulted from about 18 months of process improvement events examining this was a total redesign of our inpatient care — a truly breakthrough and innovative model for collaborative care.”

Model of success
After a year of trialing the new, employee-developed collaborative-care model, ThedaCare began implementing it system-wide — a process which is expected to be completed by 2012. The model has proven extremely effective so far, reducing costs associated with inpatient stays by 25 percent, patients’ length of stay by 25 percent and various error margins to nearly zero and significantly increasing patient satisfaction scores.

According to Ms. Correia, the model’s effectiveness is due to the input of front-line employees in developing the model. “Innovation happens synergistically. We knew we had to figure out what our differentiator would be in the future for inpatient care, but we weren’t quite sure what it would be,” she says. “Nurses had a good concept of what they wanted collaborative care to look like, but we needed lean processes to really develop something we could implement.”

ThedaCare’s collaborative care model is truly groundbreaking and will likely serve as a model for many other hospitals as they look to integrate their services and provide more collaborative care. The model is composed of six critical elements, all of which encourage the collaboration of caregivers and the removal of non-value added activity in the provision of inpatient care. The six elements are:

1. Collaborative rounding upon admission.
Within 90 minutes of admission, a nurse, physician and pharmacist round on a patient and his or her family and collaboratively develop a care plan specific to the patient. The three-way rounding ensures that all providers understand and agree upon a patient’s course of care, and the presence of the pharmacist additionally reduces the possibility of harmful drug interactions, says Ms. Correia.

2. Evidence-based plans of care. Each patient receives his or her own evidence-based single plan of care, which integrates services from various departments within the hospital. The care plans are developed using care guidelines from Milliman Care Guidelines, a Milliman Company, and all disciplines combine to form a single integrated plan.

3. Nurse as manager of care.
In ThedaCare’s collaborative model, the nurse is the navigator of patient care and is supported by ancillary paraprofessionals. The nurse is responsible for guiding the patient from one phase of care to the next and makes sure that all quality criteria are met during each phase of care. Nurses often suggest options to physicians in order to advance care at a more optimum rate, says Ms. Correia.

4. Tollgates.
As patients move through their care plans, nurses ensure that the patients do not move forward unless they meet certain requirements of their last phase of care. These “tollgates” are based largely on care guidelines and time, and serve stopping points along the path of care. When a patient reaches a tollgate, the nurse will only allow the patient through to the next phase of care if it is documented that the patient has undergone certain measures of quality required in the previous phase of care.

For example, evidence-based medicine suggests that pneumonia patient should receive an antibiotic within four hours of admission. Thus, a ThedaCare nurse is responsible for ensuring that all pneumonia patients receive an antibiotic in this time frame, and if this doesn’t occur, the nurse must stop the care pathway and fix the issue before advancing the patient.

5. Electronic medical record.
Thedacare uses electronic medical records to track the progress of a patient’s care along his or her pathway and share health information among providers from different service areas within the hospitals. The EMRs also include notifications for tollgates, alerting nurses of the need to evaluate a phase of care.

6. Purposeful design of physical space.
Finally, ThedaCare redesigned its inpatient floors in order to make care more efficient. Each patient room includes approximately 80 percent of supplies a nurse would need to care for a patient; this reduces the time a nurse would spend traveling from the room to the central supply location, says Ms. Correia. Additionally, the rooms are designed to reduce the steps staff members take to perform various tasks, thereby making care more efficient.

Learn more about this model here

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November 26, 2009

Drug-resistant bacteria on increase in U.S.: study

MRSA is a very dangerous organism, killing a number of people each year.  With it firmly entrenched out in our communities now, hospitals and nurses have a daunting challenge.  This article simply explains the results of a study that says community-based MRSA needs to be addressed.
We’ve all known that for some time.  However, what I find so interesting about this article and the others I have posted about MRSA and C-Diff, is that now the national media is finally starting to pay attention.  I guess it took a flu pandemic to get their attention, but once under the microscope of the news media, everything is fair game.
As a nurse, you need to arm yourself with whatever information is available, so read this article and then see if you can find the actual study.  I believe that this problem will only get worse.  The sooner we deal with it, the better.
Tue Nov 24, 2009 12:41am EST

More News

Medical workers balk at mandatory flu vaccines
Friday, 13 Nov 2009 06:00pm EST

WASHINGTON (Reuters) – Cases of a drug-resistant bacterial infection known as MRSA have risen by 90 percent since 1999, and they are increasingly being acquired outside hospitals, researchers reported on Tuesday.

They found two new strains of methicillin-resistant Staphylococcus aureus — MRSA for short — were circulating in patients and they are different from the strains normally seen in hospitals.

Ramanan Laxminarayan of Princeton University in New Jersey and colleagues studied data on lab tests from a national network of 300 microbiology laboratories in the United States for their study.

“We found during 1999-2006 that the percentage of S. aureus infections resistant to methicillin increased more than 90 percent, or 10 percent a year, in outpatients admitted to U.S. hospitals,” they wrote in a report published in the journal Emerging Infectious Diseases.

“This increase was caused almost entirely by community-acquired MRSA strains, which increased more than 33 percent annually.”

MRSA is now entrenched in U.S. hospitals. It was also known to be circulating in the community but it was not clear whether patients were carrying the infections out of hospitals, or the other way around.

Laxminarayan’s team found that many more people were being diagnosed with the community-acquired strains, and these strains were not replacing the known hospital strains. Instead, they are just adding to the overall number of MRSA cases.

“Our findings have implications for local and national policies aimed at containing and preventing MRSA,” they wrote.

For one thing, new, fast tests are needed so patients can be diagnosed and treated quickly. It is possible to treat MRSA but doctors need to know straight away so they start patients on the correct antibiotics.

“Lastly, infection control policies should take into account the role that outpatients likely play in the spread of MRSA and promote interventions that could prevent spread of MRSA from outpatient areas to inpatient areas,” they added.

MRSA is one of the most common causes of hospital-acquired infections. It can also now be picked up in schools, at fitness centers and elsewhere.

Symptoms range from abscesses to bloodborne infections that can kill quickly.

The researchers estimate that 20,000 people in the United States die each year from MRSA, and treating MRSA can range from $3,000 to more than $35,000 per case.

(Editing by Cynthia Osterman)

© Thomson Reuters 2009 All rights reserved

Read the original article and others here

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November 25, 2009

The Making Of A Mental Health Professional

Filed under: Nursing — Shirley @ 12:29 am
Tags: , , , ,

As a psychiatric nurse, I naturally read articles about psych. nursing and usually come away with more questions or with feelings of being undervalued.  Here is an posting I found on a blog that I think is excellent in the description of what it takes to be a mental health professional, or just a mental health nurse.

After reading the list, I think these points apply to just about anyone who wants to be in a “helping” profession.

Read the following list and let me know what you think about this.  Is this pretty accurate or not?


I was thinking of all the common characteristics that make up a good mental health worker in my opinion and came up with the following list:

1. Real Life Experience – No book has ever been written that can truly cover what it is like to be at your absolute bottom, to fight for your own life, to understand the emotional turmoil that shows up when the people who are suppose to love you turn around and stab you in the back. There is good reasons why a high number of drug and alcohol counselors are recovered addicts.

2. The Ability To Empathize – Basically to have a heart. If you are unable to feel what the client is expressing then you have no business being in this field. I am not a book or a diagnosis but a person who would love to be cured but even more important I need you to understand where I am coming from and what I am feeling.

3. The Ability To Think Outside Of The Box – Not everyone with depression or any other disorder is going to respond to the same treatment. This field is not like an office where every time problem A shows up the person uses solution A to fix it. The worker needs to see the situation from every possible angle to come up with the best course of action. The DSM is a book of guidelines regarding a diagnosis not a set of instructions.

4. Nonjudgmental – During on of the first classes I took in college the teacher asked who in the room would not treat sex offenders and child molesters. When a couple of people raised their hands the professor responded “Then you should not be in this field for every single person who has a mental or behavioral problem deserves to be treated and seen as a fellow human being who deserves help”. The ability to see the person behind the illness is essential for if all you see is the problem then nothing will be accomplished.

5. Consistent – A major problem with mental illness is it tends to be chaotic with everything in the persons life in a constant state of change. The worker needs to be a rock instead of another piece in the clients life that is unpredictable.

Well I believe that the above criteria are essential to anyone in the mental health field. Any others? Take care.

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November 24, 2009

Are older nurses being forced out of the profession?

Filed under: Nursing — Shirley @ 1:26 am
Tags: , , , , ,
Nursing Magnet Application Send-Off
Image by Christiana Care via Flickr

I found this article on an MD’s blog and it really made me stop and think.  As one of those “older” nurses with 20 years of experience, I will have to watch and rethink my opinions of the profession and of my peers after reading this.

I, too, have always heard the maxim that “nurses eat their young” and I have seen this in action.  I am sure, then, that the opposite must also be true as pointed out by the author of this article.

Now that I think about it, I do believe that I have seen this behavior in action but failed to recognize it for what it really was!

It’s really our loss when we denigrate and devalue all the experience of the older nurse simply because they have trouble staying abreast of all the new technological changes in healthcare.  These are the nurses who know the most about NURSING.  These are the nurses who have stayed at the bedside through all the upheavals in medicine and who have advocated for their patients despite getting no respect.  Just because they can’t text page the doctor, or access labs on the hospital computer system without help, doesn’t change anything about what they have to offer.

Take a look around you the next time you are on the floor and add up the years of nursing experience you are surrounded with on a daily basis.  Maybe, just maybe, you might do well to try to absorb some of it instead of being impatient and intolerant.


November 20, 2009

Originally published in

by Colleen O’Leary, RN, MSN, AOCNS

Last time I talked about how I had never really experienced the concept of nurses eating their young in action.

However, I have seen the opposite begin to evolve. I see this as a bigger issue in nursing these days. The “putting out to pasture” of seasoned, experienced nurses is happening more often and for a variety of reasons.

First, and foremost, is simply the fact that the pool of nurses inevitably follows the general aging of the nation. As baby boomers who once filled the halls of healthcare institutions caring for others begins to age, they will certainly have a more difficult time meeting the demands of current healthcare. More and more institutions are requiring nurses to work longer and longer shifts, changing from an 8-hour day to a 12-hour day. This, along with the fact that patients in the inpatient settings have much higher acuity and a variety of complex issues, makes the demands on nurses even greater.

I know for myself that when I was working 12-hour shifts, I could only do two in a row. If I had to do the third one without a break, I was exhausted. I can only imagine how someone five, 10, or even 15 years older than me would feel. In fact, I remember one time when a new young nurse just starting out came to me and sheepishly asked, “What do you do when you go home after working a 12-hour shift?” He was finding that he was very tired and often unable to do anything but go home, have dinner, and go to bed. If someone that young has difficulty imagine how it is for the older nurse.

Not only are the hours and the complexity of patients difficult, but also the physical strain. Because patients have such high acuities, they often require turning, positioning, and moving that can cause stress on the nurse’s back, neck, arms, and legs. Injuries among nurses are much higher than even injuries among construction workers. Again, more stress and difficulty for the older nurse.

Another point to take into consideration is the advent of new technologies for diagnostics, assessment, and documentation. Often, when facilities start to change to electronic medical records, it’s the older nurses who have the most difficulty. The younger nurses grew up with advanced technology everywhere around them. I remember the first computer class I had to take in college taught us how to do keypunch machines. There were giant computers in a lab that you had to schedule time to use to do your work. Then you carried around a stack of cards with little computer generated holes punched in them, that when read, gave a story. Then many years later when I took a nutrition class and was told we had to do a computer program, I was terrified. I didn’t know how to use computer programs. How times have changed… But that’s the point. If you haven’t grown up with that being a part of your everyday life, it’s very difficult for some to catch on and take hold of new technology.

Finally, the recent change in the economy has put a different kind of strain on older nurses. Where they might have been thinking of retiring, they now find that they must remain in the workforce to survive. I’m just afraid of what is going to happen over the next couple years when the economy starts to rebound; people are feeling safer and we see a mass exodus of retiring nurses. I think it will be a time of extreme nursing shortage and we should start planning for it now.

But what makes nursing different than other professions that are facing an aging workforce, and what is it that really bothers me the most? It’s the concept of not just aging but of truly “putting out to pasture.” If an older nurse has not worked their way through the ranks and is still in the trenches of bedside or chairside nursing, how much support are they getting? Forget the concept of the seasoned nurses not nurturing and helping the newcomers.

As I’ve said, I have not seen that phenomena. But what I have seen is a sense of impatience towards the older nurse; an underlying feeling that they just can’t cut it and not a great sense of wanting to help them. Not only the impatience, but it’s almost a disdain for them. It’s as if they don’t highly regard the years of experience as valuable because the person might have a more difficult time with the newer techniques. I’m not sure how we got to this point. I’m sure it has something to do with the whole outlook that each of the generations have on work, socializing, and facing the world, but it is a bit disheartening to see around me. I have always learned to respect those with more experience and try to learn something from them. That doesn’t mean that I think that we should allow someone who cannot physically do the job stay in the job.

But I think we could, as a profession, hold up our experienced nurses and learn something from them instead of always thinking we need to teach them something.

Colleen O’Leary is a staff educator of medical oncology at Northwestern Memorial Hospital who blogs at Oncolog-e Nurse Talk.

Related posts:

  1. Why are hospitals offering nurses free plastic surgery?
  2. Do nurses complain too much?
  3. Are over half of nurses on antidepressants?
  4. Older primary care doctors can’t retire
  5. Is the nursing shortage overblown?
  6. Phasing out older, male GYNs
  7. Recruiting nurses in a shortage, and lavishing gifts on applicants
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November 23, 2009

Another take on the damage done to nursing by the media

Filed under: Nursing — Shirley @ 3:01 am
Tags: , , , , ,
Filming for Casualty at King Edmund School, Ya...
Image via Wikipedia

Here is another article that talks about the effect on nursing by the way viewers see us on television, only this time the article is coming from England and talks about both English and American TV shows.

To me it is amazing that anyone would believe that what you see on the tube has anything to do with real life, but I guess for some people who don’t have the intimate knowledge and daily experience of the medical arena it could seem to be truth.  I don’t know.

When I watch cop shows, I know that they never catch the perpetrator in 45 minutes.  When I watch legal shows, I know that a trial and verdict does not happen in an hour.  But I don’t guess that viewers understand the way hospitals and clinics work well enough to be discriminating.

Please visit the site and read all the comments, too.  Let me know what you think, won’t you?





Young people ‘put off’ nursing by TV dramas

18 November, 2009

Young people may be discouraged from carers in nursing by watching TV hospital dramas full of staff acting unprofessionally, the head of a widely criticised hospital has said.

Antony Sumara is the new chief executive of Mid Staffordshire NHS Foundation Hospital Trust, where a report found “appalling” standards of care earlier this year.

Mr Sumara said shows such as Casualty were entertaining but off-putting for potential nurses, as they show staff breaching patient confidentially by discussing cases within earshot of the patient or downloading confidential files.

On the BBC website’s Scrubbing Up column, he wrote: “What impression of a career in the NHS is set in the minds of young people aspiring to be the future generation of nurses, doctors or chief executives when they watch programmes filled with unprofessionalism and poor conduct?”

Mr Sumara called on programme-makers to create “a true picture of hospital life”.

He said: “Nurses and doctors have a difficult enough job at the best of times without having to live up to inappropriate role models but perhaps a group of individuals working hard together to save lives and improve the health of its patients in a caring and conscientious manner is just not good TV?”

Visit the original article here and read the comments


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November 22, 2009

Alabama RN says Nurse-Family Partnership is dream job

Breastfeeding an infant
Image via Wikipedia

Here is another nurse who used her nursing education and skills to find a nursing job that is “outside” the box.

She states that she loves the job, but agrees that not everyone should or could handle it.  I have to agree with her.  When I was working Psychiatric home health, I went into places that others would fear, but that was the life of my patients.  It seems the same in this instance.

New mothers today come from all walks of life, may be single and may or may not have support.  They may or may not even know the father of their child, but they want to be good mothers.

In days gone by, new mothers were surrounded by the females in the family and given education, support and guidance.  We have lost that treasure but it appears that nurses are trying to return some of that experience to the communities.

If this kind of nursing appeals to you, don’t hesitate to look into it.  Contact the source of this article to get more information if you need it.


One nurse’s story

By Teri Greene

Patty Galloway has been by the side of mothers as young as 12. Some live in poverty and have no contact with their children’s fathers. Some have limited family support, while others have no support at all.

A year ago, Galloway was among the first nurses hired for the Nurse-Family Partnership, part of the Gift of Life Foundation. It’s a local program that reaches out to low-income, first-time mothers to help ensure the health and future success of both mother and child.

When Galloway heard about the opportunity last November, when the program was just getting started, she thought to herself, “Man! This is my dream job,” she said. “I love the one-on-one teaching, getting to know your client, becoming part of their world.”

Galloway, who is mom to a 13-year-old and a 20-year-old, said she serves as “a support person and a cheerleader” in every aspect of her clients’ lives.

One challenge is keeping the moms’ environment positive.

“So many people we see are surrounded by negativity,” she said. “There is no one to say, ‘You can do this. I believe in you.'”

She cited research that shows that children who were part of NFPs benefit from the program well into their teen years as they hit more of their developmental milestones, finish school and avoid drug use, run-ins with the law and incarceration.

As for the mothers, they’re getting jobs, continuing their education past high school and getting out of the welfare system.

A lot of Galloway’s job is visiting the home, observing potential safety hazards or complications, such as second-hand smoke and cleanliness, as well as emotional interactions with family. Most moms are single, and some have mothers or grandmothers on hand to help them.

Not all of them are that lucky, however.

“There is a paper we give them that asks, ‘Who are my supports?’ and it lists each thing: Who can help me with baby care? Who can take me to the doctor? They write down the names and their phone numbers.

“I’ve had a client who gave me the sheet said, ‘I have no one.’ I said, ‘You do now. Put Miss Patty on there.’

“Their lives are topsy-turvy, controlled chaos,” she said of some of her clients and their relationships “with the baby’s daddy, between them and their moms, where they’re going to live. We’ve had some who have been displaced. It’s always something. Maybe the neighborhoods aren’t safe. All kinds of things surface.”

Galloway said the program might not be a good fit for every nurse.

“Some would not feel comfortable going into the neighborhood, just taking things as they are and accepting clients and working with what’s there,” she said. “We have books, we have nursing skills, but it takes a lot of interpersonal skills to do this job, too.”

There is a checklist: How is the client doing physically? Is the environment safe? Are they pursuing an education? Do they have family planning knowledge?

They also talk about epidurals, breastfeeding, prevention of sudden infant death syndrome (SIDS), personal relationships, emotional stress — whatever topic is pressing at the moment.

And the clients help the program, too, regularly answering “How we’re doing” questionnaires about their nurses’ contributions.

One time, Galloway had a very quiet client. She wasn’t sure the rapport was helping the mom-to-be. She handed the evaluation sheet over.

“I said, ‘be as honest as you can be. You’re not going to hurt Miss Patty’s feelings. It’s going to help me be better.'”

On her next visit, Galloway looked at what the client had written and she almost cried.

“You haven’t had the experience I’ve had,” the client had written, “but I know that you care about me.”

You can read the original article here

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November 21, 2009

When Viruses (Including H1N1) and Bacteria are as Close as your Fingertips; VirWall’s New Innovation Can Disarm Killer Keyboards

Muller Hinton agar with 4% NaCl showing a lawn...
Image via Wikipedia

As hospitals push staff more and more about hand-washing and aseptic technique, I believe that we also need to beef up our “housekeeping” abilities.  I know that as a microbiology student, I had to swab various places touched daily by others and then see what I could grow in the petri dish.  I was amazed, but the worst offender was the telephone that was used in the offices.  Now, with the big push toward computerized health data, nurses find themselve frequently using computer keyboards in common areas.  These items are not touched by our housekeepers, just like the phones and doorknobs are not sanitized.

With the growing problem of pandemics, maybe we all need to just go back to basics and remember how to really clean things.  This article is just a springboard on this topic.  It is interesting that someone was able to take our lack of cleanliness and create a marketable item for sale.  Nurses, put on your thinking caps!


NEW YORK, Nov. 17 /PRNewswire/ — Engineer/pilot/attorney Jon Roberts, PhD, has dozens of inventions to his credit. They include technology that thwarts piracy in movie theatres, gadgets that track important items inadvertently left behind, devices to enhance airport security and even an electronic matchmaker that alerts two nearby individuals with similar interests that they have, indeed, found their match. Now, as Chairman and VP R&D of VirWall Systems Inc., he’s introducing a keyboard sanitizer that uses UV-C light to eradicate bacteria and viruses on computer keyboards in about 45 seconds, for under a hundredth of a penny per exposure. The invention is featured in the November issue of the New Jersey Technology Council’s LifeSciTrends, an update on important health and technological advances.

“I started studying patterns of infection transmission years ago when my son started bringing home a never-ending series of bacteria and viruses from kindergarten. I don’t think we’d ever had as many colds or coughs in succession,” explains Dr. Roberts.

Today Dr. Roberts has parlayed his study of vectors of disease transmission into the design of a streamlined, efficient keyboard sanitizer that stops 99.99+ percent of bacteria and viruses before they can become hitchhiking pathogens. It is effective against influenza A (the family of which H1N1 is a member), staph, strep, salmonella, MRSA, E. coli, norovirus, Avian flu, the common cold and more.

“When you consider that the average computer keyboard can harbor as many as 3000 microbes per square inch, you’ve got a real problem on your hands – literally,” notes Dr. Roberts. In 2008 the CDC reported the first documented case of norovirus transmitted by computer keyboards and peripherals in a school system. In other settings – such as hospitals — contaminated keyboards can pose significant threats to patients and healthcare professionals alike since the resident pathogens may be more virulent and patients are less able to ward off such infections.

“Anywhere you have shared computers,” explains VirWall’s President/CEO, Donald S. Hetzel, PhD, “you also have shared germs. When people eat near their computers, the problem is compounded. Bacteria love to feed and breed on our crumbs.”

The VirWall KBS-1 is a lightweight, high tech lid that fits over a standard-size keyboard and uses 254-260 nanometers of UV-C wavelength to deactivate potential pathogens. The sanitizer provides uniform coverage in killing microbes, unlike disinfectant sprays and wipes that are user-dependent. The invention recently earned a medal for innovation in healthcare devices and the Yankee “Green” Award for its ability to kill germs with a novel mechanism that avoids the use of chemical disinfectants which some believe to pose environmental damage over time.

The sanitizer will retail for about $100. VirWall also holds patents for a portfolio of additional protective products including a bio-waste sanitizer/receptacle; a pen sanitizer for use at retail checkouts; and a smart-phone recharger/sanitizer.

“That keyboard in front of you is far more than a keyboard,” explains Dr. Roberts. “It’s a germ factory that can cause a relentless series of illnesses and infections. The good news is that some simple precautions can neutralize its potential to sicken.”

For more information on VirWall, the KBS-1 keyboard sanitizer and to see a demo video, visit

(Dr. Roberts is senior partner with The Marbury Law Group in Reston, VA; Dr. Donald Hetzel, PhD, is the former head of R&D for several multinational pharmaceutical companies.)

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November 20, 2009

Checking the Right Boxes, but Failing the Patient

Oklahoma Army National Guard, 120th Med. Co. -...
Image by The National Guard via Flickr

Here is an article written by a doctor but I believe the message is for all health care providers–including, but not limited to aides, nurses, doctors, administrator, CEOs.

We are all so careful to give good care but in today’s healthcare world, that really means making sure you cannot be sued or at the least, investigated.  I agree that when you are responsible for people’s lives–both physical and emotional–you have an obligation to do your best.  It seems that today we live in such a litigious society that  doing your best is just not enough.  Maybe you didn’t eat breakfast that day, maybe you fought with your spouse, maybe you don’t feel well…all fodder for law suits.  So, we protect ourselves by treating patients legally instead of medically sometimes.

Dr. Rifkin is correct that we may be missing salient and vital information about our patients because we are always “satisfying the system”.  This is really no way to practice medicine, is it?  What can be done, or what can we do differently?  You tell me.


Published: November 16, 2009

The voice on the phone was authoritative, even brusque. A father was calling our after-hours line to ask about his teenage daughter.



Heidi Younger

“She’s got another headache,” he said, as I recall. “I’m going to the pharmacy, just wanted your advice on what strength of Tylenol to get her.”

Those opening lines did not admit much room for questions. I knew neither him nor his daughter, but there seemed to be little margin for error in my response. I could almost hear his foot tapping, waiting for the answer.

I hesitated. Who is this young woman? Why is her father calling about a simple headache?

I began to ask questions. Yes, his daughter had headaches every now and then. No, this one seemed a bit worse, that’s all. He wouldn’t even have called, but he wasn’t sure if Tylenol was safe, now that she was breast-feeding.


Yes, yes, there was a new baby, just a few days old. Yes, there had been some problem with the pregnancy and delivery — something about blood pressure — but she had come home just fine. Could I just tell him the right dose?

I sent the young woman and her father to the emergency room, and she was admitted to the hospital with severe pre-eclampsia, a rare but life-threatening postpartum complication.

It has been 10 years since the Institute of Medicine’s seminal report on deaths caused by medical errors (numbering at least 44,000 a year). Since then, there has been tremendous focus on how many mistakes physicians and hospitals make, how much they cost and how to prevent them.

The response at most hospitals has been brisk and multifaceted. Hospital accreditation committees now audit charts for outdated abbreviations and proper signing of notes. Electronic prescription systems are rapidly becoming the norm. Pay-for-performance interventions by insurers promise to reward those who make the grade and to refuse payment to those whose treatments cause complications like hospital-acquired infections.

I do not dispute the need for these interventions. There is no doubt that hospitals are powerful and dangerous places, that “best practices” are not always followed and that the so-called polypharmaceutical approach — a drug for every ailment a patient may have — offers endless opportunity for adverse reactions.

An accessible and informative electronic medical record might have prevented my near-miss just as effectively as my questions did. (Under the vanished health care system in which doctors were available for their own patients 24 hours a day, this particular kind of error would have been all but impossible.)

None of these interventions, however well meant, address a fundamental problem that is emerging in modern medicine: a change in focus from treating the patient toward satisfying the system. The effects of focusing physicians’ attention on benchmarks and check boxes are not, I think, to the patient’s advantage.

A close family member was recently hospitalized after nearly collapsing at home. He was promptly checked in, and an electrocardiogram was done within 15 minutes. He was given a bar-coded armband, his pain level was assessed, blood was drawn, X-rays and stress tests were performed, and he was discharged 24 hours later with a revised medication list after being offered a pneumonia vaccine and an opportunity to fill out a living will.

The only problem was an utter lack of human attention. An emergency room physician admitted him to a hospital service that rapidly evaluates patients for potential heart attacks. No one noted the blood tests that suggested severe dehydration or took enough history to figure out why he might be fatigued.

A doctor was present for a few minutes at the beginning of his stay, and fewer the next day. Even my presence, as a family member and physician, did not change the cursory attitude of the doctors and nurses we met.

Yet his hospitalization met all the current standards for quality care.

As a profession, we are paying attention to the details of medical errors — to ambiguous chart abbreviations, to vaccination practices and hand-washing and many other important, or at least quantifiable, matters.

But as we bustle from one well-documented chart to the next, no one is counting whether we are still paying attention to the human beings. No one is counting whether we admit that the best source of information, the best protection from medical error, the best opportunity to make a difference — that all of these things have been here all along.

The answers are with the patients, and we must remember the unquantifiable value of asking the right questions.

Dr. Dena Rifkin is a physician at the University of California, San Diego.

Read the original article and more>>click here

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November 19, 2009

Nurse moves ‘toward health and wellness’

Filed under: Nursing — Shirley @ 12:55 am
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Below is an article I found that describes what one nurse has done to enhance her career by thinking outside of the box.  She, like many of her counterparts, tired of dealing with death and illness and wanted to instead move toward health and wellness.  I have to applaud her on finding the right balance between nursing and her new profession, massage.  It sounds as if she enjoys teaching others about her new profession as well.  I wonder how many of those students turn out to be fellow nurses who are fed up with nursing?

According to the recent studies of the nursing shortage, older more experienced nurses are leaving the profession in large numbers due to health, retirement, stress, or just being too tired to continue.  Here is one nurse who met her challenge by utilizing her nursing experience to embrace health and wellness.  Congratulations!


At Work: Jean Wible of CCBC’s massage therapy program

Jean WibleJean Wible, framed by a massage table headrest, maintains a private practice but also is coordinator of the community college’s Student Massage Therapy and Bodywork Clinic. (Baltimore Sun photo by Kenneth K. Lam / November 12, 2009)
By Nancy Jones Bonbrest Special to The Baltimore Sun
November 15, 2009

Salary: $60,000

Age: 52


Years on the job: 1.5 years

How she got started: Jean Wible graduated with a degree in nursing from Marywood University in Pennsylvania. She worked as a nurse for more than 20 years, specializing in geriatric nursing and hospice care.

In 1997 she became certified in massage therapy and built a private practice as a massage therapist while working part time as a nurse.

The combination worked well, Wible said.

“I was looking to balance things out. I wanted to move toward health and wellness instead of death and illness. I loved hospice, but it takes a toll.”

Throughout her career she always taught nursing and massage and has written two books: “Pharmacology for Massage Therapy” and “Drug Handbook for Massage Therapists.”

She accepted her current position in April 2008.

Wible is a registered nurse and massage therapist licensed by the state and certified by the National Certification Board for Therapeutic Massage and Bodywork.

Typical day: Wible works four or five days a week, putting in nine to 10 hours a day. She is considered a 10-month employee but continues to teach classes throughout the summer.

She’s responsible for coordinating and overseeing student clinical rotations in the massage therapy school, which is offered at the Essex campus. This includes setting clinic dates, prepping the clinic, instructing students and scheduling their clinical hours.

The bodywork clinic allows community members to come in for a massage so students can practice technique. Students must get 225 hours of hands-on, supervised massage experience.

She also assists in answering calls and e-mail messages from people requesting information about the massage program, and meets with prospective students.

Wible regularly teaches two or three classes a semester, which involves preparing instruction, meeting with students, tutoring, grading papers and tests and administrative tasks.

Classes she instructs include anatomy, massage, exploration of movement and introduction to research.

The program: It’s relatively new, with the first class graduating in 2002. It now has 32 students, double the number of the year before.

Students graduate from the two-year, 65-credit program with an associate’s degree in applied science.

Hardest part: Students must learn the many muscles and bones in the human body and the physiology of how they work.

“It’s so detailed it takes people by surprise, but it’s essential.”

The good: “Seeing students come in without a clue and watching them grow into professionals.”

The bad: Paperwork. “I love the teaching part, but there’s a certain amount of paperwork and administrative work that has to be done.”

Private practice: Wible still maintains her private massage therapist practice, seeing clients one or two days a week.

She charges $70 per hour and works with clients seeking general relaxation massage therapy, as well as those who suffer from depression, cancer and chronic back and neck pain.

Philosophy: “We want to give our students the highest level of education possible and as much real-life experience as possible so they are prepared to work anywhere.”


Copyright © 2009, The Baltimore Sun

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