Nursing Notes

January 28, 2010

Nursing Personality – Common Denominators

Filed under: Nursing — Shirley @ 5:12 pm
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Here is an article I enjoyed that I found on Nurse  This is by a guest poster and is her opinion, but after reading it I thought it was fairly accurate.  She does hit on the parts of the personality that makes a person be able to stay in nursing, despite its many detractors.

Read the article and then check your own personality against the list.  I bet you will find most if not all items active in your life at work.  This list is not exclusive nor is it complete, but it is a good start to identifying what it takes to become a nurse, but better yet, what it takes to stay a nurse during rough times.

There are several comments at the site and you might enjoy reading them, also.


I could hardly wait to write this article.  Why?  Because I have always felt that – in general (disclaimer so I don’t offend anyone) – you have to possess a certain type of personality to be successful in nursing.  The question is:  Are there common denominators to the personality of nurses?  I say, yes…

  • Sense of humor: I have found this to be a definite nursing characteristic.  We may, at times, have “darker” humor than others – I will give you that – but we have experienced things in our professional life that would not be complete without the little sarcastic comment or funny pun thrown into the mix.  It’s what keeps us going in the tough times!
  • Professionalism: I have been in other professions and in the military.  I have always found that nurses understand what professionalism and ethics are and apply these qualities to their practice each day.  It is comforting to work with professionals on a daily basis.
  • Diligence: Nurses are some of the hardest-working and energetic people I know.  Does anyone disagree?  We work hard on the job for 8, 10, or 12 hours a day, have the energy to go to our home lives and families, and are up and running to do it again the next day!
  • Compassion: Nurses get it!  Simple as that.  We understand when someone tells a sad story or has a chronic illness.  Maybe we haven’t lived through such circumstances, but we just understand and seem to know what to say and what to do to help and comfort.
  • Sense of deeper understanding to life: We have seen some of the worst parts of life, dealt with death, and understand and appreciate the truly important aspects of life.  We tend not to care about the toilet seat being up or about a dirty dish donning our sink.  We understand what is important in life and focus on that.
  • Sense of hope for what to others may seem hopeless: How many times have you heard a patient tell the worst story you have ever heard about a chronic illness, and seen a nurse immediately smile and offer the positives to that patient?  I have seen it many times and it never ceases to amaze me.  It is not something we were taught – just something we simply are!
  • We never say never:  “Sure, I can pick up that 12 hour shift on Sunday.”  “No problem taking care of an extra patient today.”  Just a couple of examples of the endless “never say never” spirit of nurses.  This spirit makes us seem as if we can accomplish anything at anytime!
  • Sense of pride in saying “I’m a nurse”: Not to offend anyone out there, but I have known several lawyers in my life.  I have NEVER heard one of them admit in public what he/she does for a living…mmmmm.  Anyway, nurses are always quick and proud to say “I’m a nurse” – loud and clear.  Any why not?  Look at our great personalities and all we do for others each day!

About the Author: Sue Heacock, RN, MBA, COHN-S and author of the recently published book – Inspiring the Inspirational: Words of Hope From Nurses to Nurses.  Sue is a Certified Occupational Health Nurse Specialist and has worked in a variety of areas of nursing including pediatrics and research.  Before entering the nursing profession, Sue worked in human resources and equal employment opportunity.

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January 27, 2010

Nursing Excellence Makes a Difference to Patients

Nursing Magnet Application Send-Off
Image by Christiana Care via Flickr

Here is an article that explains quite well why achieving Magnet Status is important to the hospital, but more importantly, to each nurse working in those hospitals.

We nurses moan and groan about getting “no respect” and not being taken seriously as a profession, but Magnet Status is all about getting respected for your nursing knowledge and abilities as well as being taken seriously by everyone involved in patient care.  We should all be participating in helping hospitals achieve this status.

Our patients deserve this level of care.  Our nurses deserve this level of respect and consideration.  Our hospitals need this to stay marketable and to keep us all in our jobs.

What do you think about this topic?  Anyone want to talk about the pros and cons of getting Magnet Status?


Rebecca Hendren, for HealthLeaders Media

January 26, 2010

Last year I moved from Boston to a suburb just north of Charlotte, NC, and I recently needed to make a decision about which hospital I should visit. In Boston, I had been spoiled for choice, with a multitude of famous, big-name hospitals to choose from. Being new to North Carolina, I was faced with a more difficult choice as I knew nothing about the two big players in town.

I did some research and both places appeared to be outstanding. What made me choose one over the other? It was designated as an ANCC Magnet Recognition Program® facility. If I’m going to be hospitalized, I would rather be in a designated center for nursing excellence. Studies have shown that Magnet Recognition Program (MRP) organizations have better patient outcomes, higher nurse to patient ratios, lower nurse turnover, higher rates of nurses with advanced degrees or professional certifications, and happier nurses, which generally translates to happier and more satisfied patients.

Happier nurses improve satisfaction results, which must be regularly measured and benchmarked at MRP hospitals.

I wanted to know what makes nurses more satisfied at MRP-designated facilities, so I spoke with senior nursing leaders at Massachusetts General Hospital, my old stomping grounds. MRP-designated Mass Gen has also been rated highly in US News & World Report‘s annual list of America’s Best Hospitals. It ranked No. 12 on the list for best nursing care (highest percentage of patients who said their nurses were “always” courteous, listened carefully, and gave clear explanations) and No. 7 for patient satisfaction.

Mass Gen’s Chief Nurse and Senior VP for Patient Care, Jeanette Ives Erickson, says the culture of the organization creates an excellent nursing environment and high rates of satisfaction. At Mass Gen, the nursing culture has a unity of purpose, she says.

“What unifies us as a nursing service is the passion for our patients. We are very much a patient- and family-centered organization, and I think that’s what helps to establish our unity of purpose,” says Erickson.

Erickson notes nurses at the hospital are highly educated and that research and education are valued. Of the almost 4,000 RNs, 75.3% have at least a BSN, 7.2% have an advanced degree, and there are 55 doctoral-prepared nurses.

The organization also empowers its nurses to make decisions. “We have had a collaborative shared governance structure in place since 1997. So we have people who give the care at the table contributing to decision making about how we will take care of patients,” says Keith Perleberg, director of nursing quality.

Susan Morash, nursing director, adds that accountability and authority rest with clinicians. “It’s a big satisfier for them to know that bedside decision-making is supported and recognized,” she says, citing the nursing practice committee, where nurses can decide together whether to make changes to their practice.

As chief nurse, Erickson meets each month with the staff nurse advisory committee that represents each clinical area in the hospital. “It’s a wonderful opportunity for them to have dialogue with the chief about the things that are worrying them, such as facilitators and barriers to care delivery. They are not shy about bringing system-related issues, supply-related issues, anything that’s on their mind. We solve problems in the moment, and they feel totally empowered,” says Erickson.

I asked Erickson about nurse-patient ratios at her organization—a big satisfier for nurses and patients—and her answer shows why the organization’s nurses rate it highly.

“At the end of the day, the staff nurses are the ones who are able to make a decision as to whether they need to have more people on duty or less people on duty,” says Erickson. “They don’t have to get my permission or the nursing director’s permission to call someone in for help. They can just go ahead and do it. In my opinion, there is no bigger problem related to patient safety and quality than to have to seek permission when you need assistance to take care of patients. I view all of our nurses as leaders. They are very competent and they can make these decisions about what resources they need in the moment.”

All these things set Mass General’s nurses apart. “The happiness comes from satisfaction with work,” says Morash. “At the end of the day, if you know your patients are getting great care, you’re satisfied with your work, and you feel supported and valued, I think that’s going to translate into friendliness.”

Hospital patients, often scared, sick, and vulnerable, depend upon competent, professional, compassionate nurses. That’s what they’ll remember when they talk to family and friends, or when you’ve asked them to rate their experience.

Note: You can sign up to receive HealthLeaders Media NursingLeaders, a free weekly e-newsletter that offers concise updates on the top nursing leadership headlines of the week from top news sources.

Rebecca Hendren is an editor with HealthLeaders Media. She can be reached at

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January 26, 2010

Does Mandating Nurse-Patient Ratios Improve Care?

Here is an article that presents both sides of the Nurse-Patient Ratio debate.  This is from a management website, so the slant is pro-management, but I think the information presented is fair and accurate.  While I do  believe that there needs to be some mandated ratio in place, I’m not sure the California way is the only way to go, either.  This article presents interpretation of data from follow-up studies done after the implementation of the ratio laws in California and I do have some problems with the interpretation.
While it is easy to believe that the ratios should give better patient outcomes–“the impact of the ratios on safety measures, such as failure to rescue, post-operative sepsis, pneumonia mortality, deep vein thrombosis, and decubitus ulcers”–upon closer inspection, you need to realize that there are other factors involved besides whether or not the nurse had 4 or 8 patients.   What was the acuity of each patient included in this study?  Was the patient compliant with treatment in this study?  What prognosis did each patient have going into the study?  Was the physician available and involved in direct patient care on the unit?   All of these factors can affect patient outcomes as well.
Please read the article below and let me know what your thoughts are on this touchy subject.
Cheryl Clark, for HealthLeaders Media, January 25, 2010

As more than a dozen states consider laws to establish hospital nurse-to-patient ratios, what has been the experience in California—the first state to establish such a rule—since the policy took full effect in 2005?

Do patients get better care, experience fewer adverse events, and have shorter lengths of stay and lower mortality? Are nurses doing a better job, and by extension, are doctors and other hospital workers? And how much has the increased expense affected hospitals’ bottom lines?

Unfortunately, a solid answer remains elusive. As one might expect, hospitals and nursing organizations are divided in their perception of how things are going. The California Nurses Association says the ratios have improved nurse retention, raised the numbers of qualified nurses willing to work, reduced burnout, and improved morale.

Advocates also say narrower ratios in high-intensity areas, such as the emergency room, have improved patient satisfaction and have reduced medical errors, including medication mistakes and falls.

But Jan Emerson, spokeswoman for the California Hospital Association, which fought implementation of the ratios with an unsuccessful court challenge, says they are tough for hospitals to enforce.

“The most onerous aspect to the ratios is the requirement that hospitals be in ‘continuous compliance’—that means in compliance every minute of every shift on every unit every day,” Emerson says.

“If a nurse steps away to use the bathroom down the hall, the regulations require he/she to reassign all the patients to another nurse. That doesn’t make sense and frankly is very difficult to adhere to,” she adds.

The other problem Emerson points to is with ratios in the emergency room, where the ratio is one nurse to four patients. “The only time a hospital can go above this ratio is when there is a local or state declared emergency. This rigid ratio is one of the reasons that ER waiting times can be lengthy—especially if there is an unexpected surge of ER patients because of a car crash.

“Hospitals do the best they can to predict how many nurses they will need during different parts of the day and staff accordingly,” Emerson adds. “But the rigid nature of the ratio doesn’t provide any flexibility when the unexpected occurs.”

California’s nurse-to-patient ratios, which were fully phased in by April 7, 2005, call for one nurse for every two patients in the intensive care, critical care, and neonatal intensive care units, as well as in post-anesthesia recovery, labor and delivery, and when patients in the emergency room require intensive care.

One-to-three patient ratio is called for in step down units. One-to-four patient ratio is required in antepartum, postpartum, pediatric care, and in the emergency room, telemetry, and other specialty care units.

One nurse for every five patients is required in medical-surgical units and one for every six in psychiatric units.

“We’ve been fighting for a similar bill in Massachusetts,” says David Schildmeier, director of communications for the Massachusetts Nurses Association. He says similar legislative proposals are working their way through 13 other states as well.

“We know 90% of our nurses support and desperately want it,” he says. The association in 2008 hired a polling organization to survey patients who had spent time as inpatients “and 30% said safety was compromised because nurses had too many patients.”

DeAnn McEwen, an RN and member of the California Nurses Association board of directors, says the ratios have helped reverse the number of nurses exiting from the profession over the last decade because of burnout.

“Since the ratios took effect in California,” McEwen says, “I don’t see the big turnover of nurses that I used to see and the RN vacancy rate in hospitals has dropped dramatically.”

Before the ratios took effect, she says, “Hospitals in California, in general, had a ‘one-size fits all’ mentality about how many nurses should work in a unit based solely on their bottom-line budget.”

“Legislated standards for safe staffing provides a public safety net and hospitals are still required to staff-up from these minimums based on the acuity of the patients.”

Although she believes quantitative, unbiased scientific studies on the California ratio experience will validate a reduction in adverse events, McEwen says that nurses “feel that their ability to provide safer care is protected because they have a ratio law in place.”

She adds, “Increased moral distress and greater job dissatisfaction in nurses are strongly and significantly associated with high patient-to-nurse ratios when nurses are unable to provide the comprehensive care patients need.”

She and other ratio advocates point to a 2002 study, published in the Journal of the American Medical Association, which said hospitals can “avert both preventable mortality and low nurse retention in hospital practice” by increasing the number of nurses.

The author Linda Aiken, of the Center for Health Outcomes and Policy Research, wrote: “Higher emotional exhaustion and greater job dissatisfaction in nurses were strongly and significantly associated with patient-to-nurse ratios.”

“We’re looking forward to a reputable study in California, similar to Aiken’s and others, that show that complication rates can be reduced by having nursing ratios in place,” McEwen says.

Studies of the actual California experience since the ratios were implemented have not produce conclusive results.

An issue brief published by the California Healthcare Foundation 11 months ago looked at the impact of the ratios on safety measures, such as failure to rescue, post-operative sepsis, pneumonia mortality, deep vein thrombosis, and decubitus ulcers.

“Many of the health care leaders interviewed for the study expressed an expectation that the minimum staffing ratios would increase the quality of care due to increased interaction with patients; however, there was no evident change in patient length of stay or adverse patient safety event,” the report said.

It added that hospital administrators interviewed for the study “found that it was (a) challenge to meet the staffing requirements, particularly in ensuring that staff were available at all times, including during breaks and meals.”

Additionally, hospital officials “reported difficulties in absorbing the costs of the ratios, and many had to reduce budgets, reduce services, or employ other cost-saving measures,” the authors wrote.

However, the report, prepared by Joanne Spetz and colleagues at the Center for California Health Workforce Studies at the University of California San Francisco, said that the minimum nurse staffing regulations did achieve one goal of the legislation: skill mix increased in California hospitals.

“The hours worked per patient by RNs and registry RNs significantly increased,” the study said.

The authors acknowledged that “more detailed analysis of this and other nursing-sensitive outcomes is needed to fully explore the effect of nurse staffing ratios on the quality of patient care.”

Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at

Follow Cheryl Clark on Twitter.

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January 23, 2010

Many Nursing Jobs, But Only the Strong Need Apply

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Having worked as a travel nurse in California, I can say that ratio law has made a difference in how we nurse there.  When I left my permanent job and went traveling, I was the only RN on a unit of 22 adolescents working with an LVN, who gave meds and did treatments, and about 5-6 techs.  I charted on all the patients and assessed each and every one of them.  I also was responsible for the use of any intervention to alleviate out of control behaviors in such a volatile group.

Can you imagine my surprise, when I started my shift and found I had six patients?  I thought I had died and gone to heaven.  My supervisor actually relieved me for 15 min breaks and for 30 min lunches!  I kept thinking it was a joke until a colleague told me about the new law and the cost of infractions to the facility.  Boy!  That shut my mouth hard.

I continued to take assignments in California for the next two years and over time I saw  that there is an up side but there is also a down side.  Having a law that determines how many patients you are able to care for is at first a comfort, but eventually it becomes a binding and you become complacent.  True, I spent much more time with the patients and gave better care to my patients because I could.  However, I found myself with quite a bit of free time and nothing to fill it with–my patients were all well taken care of.  I began to ask to cover for breaks and lunches, then I would go around to see if anyone needed any help.  After that, I was on my own.

Granted, having down time is not a bad thing, but I was raised to believe that if you are getting paid to work, you should be working.  So, I cleaned and organized and kept busy.  The other nurses made fun of me.

Overall, I enjoyed working in California.  I would love to go back again but probably won’t.  I would love to see some type of mandate enacted across the nation that would allow nurses to give quality care to every patient, but not necessarily  a patient ratio law.  Maybe something more like a universal acuity system for patients in every hospital across the United States.  Hospitals will not staff appropriately until they have to–they are a business and need to make a profit.


Are you tough enough?

Filling open nursing positions is no easy task for hospital administrators these days, and there’s every chance the job will get tougher.
This country has a serious nursing shortage: The American Health Care Assn.’s most recent estimates from July 2008 show 116,000 open hospital nursing positions and more than 19,000 vacancies in long-term care settings.
The economic downturn has helped some hospitals as many nurses increase their hours and postpone retirement. But experts say that any lull in shortages is temporary.
A March 2008 report by Dr. Peter Buerhaus of Vanderbilt University Medical Center and colleagues predicted that national nursing shortages could balloon to 500,000 by 2025. Predictions from the U.S. Department of Health and Human Services are more dire: It anticipates a shortage of 1 million nurses by 2020.
A lack of faculty at nursing schools across the country is preventing many people from entering the profession, thereby exacerbating the shortage. Nearly 50,000 qualified applicants were turned away from professional nursing programs in 2008, according to the American Assn. of Colleges of Nursing.
In California, the outlook may be slightly less grim. It’s the only state with legislation requiring minimum nurse-to-patient ratios in acute-care hospitals. The law, which went into effect in 2004, limits the number of patients a nurse can care for on shifts depending on the type of medical unit and the patients’ degree of illness.
A nurse working on an intensive-care unit, for example, cares for no more than two patients per shift. A medical and surgical unit nurse cares for a maximum of five.
Linda Aiken, professor of nursing at the University of Pennsylvania, is studying effects of the legislation. She has found that nurses participating in the survey reported overwhelmingly that the ratio law has had a positive effect on their day-to-day work life.
The California Nurses Assn., which sponsored the legislation, credits the ratio law with helping to mitigate the effects of the nursing shortage and points to statistics that show an increase of 100,000 actively licensed registered nurses in California since the law was adopted.
Three nurses talk about what it’s like to be a hospital-based nurse today:
Mary Bailey RN, 59 years old, medical diabetic unit at Long Beach Memorial Medical Center; nurse for 21 years

Fifteen years ago, with a six- or seven-patient assignment, probably four of them could get up and about. A typical patient [today] has totally restricted movement, so we have to keep turning them as much as possible [to prevent] blood clots.
At the same time, this person can require IV medications every six hours and can be taking three different antibiotics every two to three hours and pain medicine every two hours. We are monitoring all of their lab results, making sure any tests that have been ordered have been followed through, and prepping patients for tests.
That’s just one patient — and I can have up to five.
It would be a good day if I had one patient who could get up and walk around and get to the bathroom and take care of washing up [on their own]. More often than not, I have at least three that require total care, meaning that everything has to be done for them.
It’s pretty hefty — a day with four patients is OK, five is pushing it. It only takes one extra person to push you over the edge in terms of trying to manage your day. They don’t get into the hospital easily nowadays. Insurance companies won’t cover the cost of hospitalization unless the patient is pretty ill.
About 20 years ago, I had nine patients. I think the ratios, by allowing us to only care for a certain number of patients depending on their acuity [degree of illness], has helped immensely. We have more time to see our patients and to do our job adequately.
Martha Kuhl RN, 57, pediatric cancer and hematology unit at Children’s Hospital and Research Center Oakland; nurse for 27 years

As a new nurse in the 1980s, my patient load was probably three to four patients, which is what it is currently in pediatrics, but the patients were not as sick as they are now. There’s been a definite change over time to a higher acuity [sicker] patient, requiring more technology, more paperwork, more intensive monitoring. If you had a patient assignment in the past, you might have one sick patient and several patients on the mend. But that has changed.
Ten years ago, before ratios, if I wanted to have a meal break, my employer didn’t have to provide additional care while I went for my meal. So you had to make a choice as a nurse: Do I stay and watch my patients? Do I leave somebody who is already really busy with their own patients to watch my patients? You know, a buddy system.
And so what you used to do is try to get everything done you possibly could, make sure everybody was comfortable and safe, and then you would run and take your meal break and ask somebody to listen out. Essentially, your patients would not get care while you were gone.
Whereas now, with the ratio law in effect at all times, the employer provides additional nursing care for breaks so that I can say, “OK, this child needs pain medication, can you give it and I can go to dinner?” That’s a huge difference for a family, to not have to wait to get care.
I [used to] go home and be falling asleep and would wake myself up thinking, “Oh my God! Did I do such and such? Did I tell the next nurse about this or that?” Because you’re so rushed you would be continually questioning, “Did I get everything done, was everybody safe?”
I didn’t consider leaving the profession, but I know a lot of nurses did. I know a lot of nurses told me they wouldn’t tell their sons or daughters to become a nurse. But I was one of the people who chose to work hard to get regulations and to make improvements in my collective bargaining agreements so that I could stay a nurse.
Because I like being a nurse, I want to provide patient care, I want to be a patient advocate.
Geri Jenkins RN, 59, intensive care unit nurse at UC San Diego Medical Center; nurse for 32 years

There are all kinds of complicated procedures and technology that the nurse is responsible for monitoring that didn’t exist 10 years ago. A lot of patients are on continuous dialysis with machines. A lot of labs and drugs have to be given on an hourly basis. There are very critical IV drips, and you’re titrating the drugs up and down based on the patients’ clinical picture, and there is constant bedside decision-making with each patient.
We also have [many more] patients who are on isolation precautions [because of infectious diseases] than we used to, which means gowning and gloving every time you walk into their room. That’s very time-consuming, but very, very necessary. There is a much greater risk factor for people who work in healthcare now and it makes the care more complicated. There are a lot of things that have changed over the years that make the delivery of care a lot more complicated.
I still enjoy what I do. I think people who go into nursing don’t go into it for the money but go into it for a sense of altruism and wanting to help and be in a caring profession. But it’s a very high-stress, physically, intellectually and emotionally demanding job, and that’s why I think the ratios are so critical, so that when people go to work they are reassured that they won’t have more than five patients, or more than two in the ICU. That may be a heavy load, but it’s better than it used to be.
Copyright © 2010, The Los Angeles Times
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January 21, 2010

Doctors and Nurses, Still Learning

This is a well written and well thought out article about the actual events on a medical floor in Any Hospital, USA.  These types of events happen all day and all night on any unit anywhere.

I work on a teaching floor at my hospital and regularly interact with new residents, staff physicians, and attendings.  Because I work in psychiatry, where teamwork is the norm and not the exception, I don’t really have problems asking my doctors about patient care issues.  I find most of them to be patient-centered and available to nurses.

There are times, when dealing with a doctor, that you must stand your ground and speak your mind about treatment issues.  Maybe, as this nurse was, you will be shown to be wrong; but you’ll never know unless you ask.  In her case, asking saved a patient irrepairable harm.

In the field of medicine, things change daily.  Research results are released that can cause you to feel as if you have been in an earthquake.  Changes are fast and furious, so it is absolutely necessary that we all work together and spend our time learning and teaching each other as well as our patients if we are to stay abreast of the current information.

Please read this excellent article and let me know what you think about this topic.


Oncology nurse Theresa Brown is a regular contributor to Well. INSERT DESCRIPTION

By Theresa Brown, R.N.

My patient was a young woman struggling with aggressive lymphoma who needed around-the-clock pain control. Because of her youth, and the hope that she might be cured, the attending physician was thinking of her future. He worried a patient-controlled analgesia pump could lead to a psychological dependence on narcotics..

For my part, it was hard to watch her struggle against the pain. “What about a fentanyl patch?” I suggested to the doctor, a “fellow’’ who was second in command to the attending physician. Fentanyl patches are the pain-control version of nicotine patches for smokers, and they’re a great way to treat chronic pain in cancer patients. It seemed like a good idea. A patch would give the patient more consistent pain relief and would obviate the doctor’s concerns about overuse.

The fellow looked at me. “That’s a terrible idea,” he said, “to put a fentanyl patch on a patient who is having fevers.” He didn’t say it aggressively, or meanly. But he was very clear, and he was right. My idea was really, really terrible, even dangerous.

The doctor was referring to the fact that heat can interfere with the patch’s slow-release mechanism, causing it to “dump” a large dose of fentanyl all at once. Some patients wearing the patches have died, and some of those deaths were likely caused by a patient applying a heating pad, or because a patient had a fever.

I knew about these risks because about six months earlier a flurry of e-mails went out to staff nurses alerting us to the dangers of combining fentanyl patches and heat. Stories about patient deaths were posted in the break room, and fentanyl patches became a hot topic of conversation among the nurses on the floor. Remembering those discussions, I couldn’t believe what I had just suggested. Everything I knew about fentanyl patches and fevers rushed to the front of my mind as a reproach, and nine months later the memory of this experience still fills me with shame.

A few weeks later I was caring for another patient who had been having fevers on and off. It was about 10 in the morning, three hours into my shift, and the time of day when we usually get our first chance to catch our breath, when it clicked in my head that my patient with the fevers was wearing a fentanyl patch for pain.

I paged the intern, the doctor-in-training who had my patient for the day, and half-asked, half-explained, “I’m wondering if you want to remove that fentanyl patch since the patient keeps spiking temps?”

The intern paused for a moment. I’m sure he was in the middle of morning rounds and busy, possibly even waiting to present a different patient, on another floor, to the attending physician. “No,” he said, “It’s a low dose — it’ll be O.K.”

Was there some condescension in his voice? I wasn’t sure, but I decided to leave the question of what to do about the patch unanswered for the moment. Twenty minutes seemed like an acceptable amount of time to wait before repaging the intern. After all, he was right, it was a low dose. I had a few meds to give to my other patients, and afterwards I could flag down the charge nurse and ask her whether it was safe to leave the fentanyl patch on the patient.

The 20 minutes was almost up when my phone rang. It was the intern, calling to tell me he had checked with pharmacy about the fentanyl patch and the feverish patient. “They said it would be a good idea to remove it,’’ he told me.

This time I wondered if he sounded embarrassed, but I didn’t linger, just told him I’d remove the patch. “I feel better about that,” I said.

I walked through the double doors that separate one part of my floor from another, on my way to remove the patch, when the intern himself came through the door from the other side. I had not met him before, but I recognized him by the name stitched on his long white coat.

We stopped in the doorway, he and I, for the briefest of conversations. I realized he definitely was embarrassed. I tried to reassure him. “That news about fevers and fentanyl came out maybe a year ago,” I told him, trying to be neutral, to keep any flavor of judgment out of my voice. I knew from experience how bad it felt to make that particular mistake, and I didn’t want to aggravate any bad feelings he already had.

He nodded at me and gave a small smile. I smiled back. Then he hurried through the doors to finish morning rounds, and I went back through the doors in the opposite direction, toward the patient whose patch needed to be removed.

In the book “Complications,” the surgeon Atul Gawande described the difficulties inherent in medicine being learned on the job: “The moral burden of practicing on people is always with us, but for the most part unspoken.” He explained that part of what blunts that moral burden is the supervision interns and residents get from more senior residents and attending physicians, who guide and instruct as needed. What Dr. Gawande did not say, and in my experience what also remains unspoken among nurses and doctors, is that floor nurses do some of that guiding and instructing, too. It’s an ad hoc, unsystematic part of medical education, but it can make a difference in patient care.

We all get emails, read journals and take classes, but still sometimes, in the hurly-burly of the modern hospital, crucial information can fall through individual mental cracks. At those times information gets passed on person to person: doctor to doctor, nurse to nurse, doctor to nurse, and sometimes even nurse to doctor.

Having doctors who are willing to educate nurses makes a difference, too. The fellow who took my suggestion about the fentanyl patch seriously enough to tell me it was a “terrible idea” cemented the information in my brain. When the issue came up again, I could raise it as a question for the intern, who then went to the pharmacy to complete his education.

There’s always more to learn, and no matter how hard any of us try, there’s rarely enough time for one person to learn it all.

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Nurse Leaders Should Champion Peer Review

Filed under: Nursing — Shirley @ 2:00 am
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As a working nurse, I read this article with great interest.  After reading, I was reminded of an occurrence recently at my facility.  Several days after the event, there was a meeting of the involved people to discuss what happened and what did not happen.  Ideas were presented and discussed on changes that might prevent the same event in the future.  At the time, I did not know anything about “peer review” but now I believe that to have been what was happening–except that upper nursing management was well represented at the meeting and the working nurses felt somewhat intimidated.

I’m very interested in this process and will begin looking for more information about how this should work and how to go about starting it in my facility.  I hope this article will spark you, too, into some form of action.


Rebecca Hendren, for HealthLeaders Media, January 19, 2010

Physicians have been doing it for decades, but nursing has been slow to adopt peer review as a quality of care imperative. To avoid being left behind, it’s time nurse leaders added peer review to their strategic plans.

Nursing peer review operates similarly to physician peer review. Following a quality of care issue, the incident is reviewed by a committee of nursing peers to determine the reasons behind the incident and whether anything can be learned from it. This is different to root cause analysis, which is multidisciplinary, much more involved, and usually occurs after an untoward patient outcome. Nursing peer review is nurses’ version of ongoing individual performance evaluation and the process often identifies system failures.

Nursing peer review can identify other issues that relate to organizational performance improvement in two important ways. First, when looking at cases, you may uncover system issues that need to be addressed by the hospital’s performance improvement program. Second, in evaluating individual nurse performance, you may find issues that relate to how care is provided by a specialty or by the entire staff. In these situations, nursing should use the hospital’s performance improvement structure to best decide how the issue should be addressed.

I spoke with Laura Harrington, senior nurse consultant at the Greeley Company, a division of HCPro, Inc. in Marblehead, MA, about how nursing peer review benefits organizations and why it’s worth adopting.

Harrington told of a case that had come before a hospital’s nursing peer review committee. The admitting orders had been written for a patient, but a bed wasn’t free, so the patient waited in the ED for hours. The admitting order had included a medication that was urgent for the patient to receive, but the patient did not receive the medication until hours later when he was finally on the unit.

The case was reviewed by the nursing peer review council, and it was discovered that there was no policy for ED nurses to initiate admitting orders, which were done on the unit. In this case, the organization identified the lack of policy and changed it so that ED nurses could start admitting orders for urgent medications or procedures.

Harrington says peer review provides nursing with a structure to look at issues when there is a quality of care question and examine the reasons behind it. But successful adoption needs nurse leader backing and support. There are untold competing priorities for nurse leaders’ time, but Harrington says it is worth making nursing peer review a priority. “What it really comes down to is this will benefit everyone. It’s a win-win for nursing, for the hospital, and for the patient,” she says.

Nursing peer review provides an opportunity to learn from mistakes and to improve patient care. It provides a real-time evaluation of care, so changes can be made almost immediately. And by evaluating processes, it decreases the possibility of future process failures.

“It’s been published that if you standardize the care that you are giving and don’t deviate from standardized approach, then the outcomes will be better,” says Harrington. “That means we standardize the nursing care and we do it the same way over and over again, based off the identified best practice.”

Nurse leaders may be concerned with how nursing staff will react to the prospect of peer review. Without education to the contrary, many nurses mistakenly believe it punishes nurses’ mistakes. Harrington says it’s important that nurses understand that peer review is about improving care and fixing system failures, and that the end result is educational.

“I think nurse leadership has to be the one who drives the process,” says Harrington. “They have to have the buy in to say that this is the right thing to do for our patients. So we can identify trends and challenges, barriers to delivering nursing care, and make changes accordingly.”

Harrington says physicians have done peer review for decades and that nursing should too. “If we don’t do it now, someone else will do it to us. I think in the future it will be a mandated requirement,” she says.

That’s already the case in some places. Organizations pursuing ANCC Magnet Recognition Program® designation are required to have some form of nursing peer review in place, the Texas Board of Nurses requires peer review, and it’s likely that other designating bodies will become interested in the process.

“I think the question should be, why wouldn’t you do it?,” Harrington says. “If you haven’t done it, you should. It’s the right thing to do.”

Note: You can sign up to receive HealthLeaders Media NursingLeaders, a free weekly e-newsletter that offers concise updates on the top nursing leadership headlines of the week from top news sources.

Rebecca Hendren is an editor with HealthLeaders Media. She can be reached at

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January 18, 2010

Nursing Leaders Reveal Top Trends Impacting Nurses in 2010 – NurseZone

This is a really interesting article that talks about the challenges facing us this year.  I was pleased to read that nursing as a whole has been energized by the healthcare reform and has finally started acting in unison.  I was also pleased to read about the need for more nurses, not less, with the upcoming changes to the way we provide care to all.

Another point of interest was the need for staffing to become the central point of concern and for hospitals to look for ways to support and nurture new nurses.  I liked the point about nurses being the asset of the facility and should not be the first to be cut in a downturn.

Please read this article and let me know what you think.  I have posted the article in full, just as I found it and have included a link to the original posting.


By Debra Wood, RN, contributor

Jan. 15, 2010 – What are and will be the critical issues facing nurses this year and in the coming decade? NurseZone spoke with several of the country’s top nursing leaders–including association executives, distinguished educators, chief nursing officers and consultants–to get their opinions on the most important issues of the day.  Their insights reveal a number of trends and hot topics that nurses will want to watch in the months ahead.

Health reform and revamped roles for nurses

Cheryl Peterson, MSN, RN
Cheryl Peterson, RN, MSN, reports that health care reform has energized nurses and hopes their interest in governmental processes continues.

Health care reform and how it may affect nursing remains the big unknown as the profession enters 2010, yet regardless of the outcome, the debate has elevated the topic to the forefront of issues facing the country and galvanized many nurses to speak up.

“The health care reform debate has really energized nurses,” said Cheryl Peterson, MSN, RN, director of the American Nurses Association’s department of nursing practice and policy. “They are contacting their members of Congress, have been engaged in that debate and attended the town hall meetings at the local level.”

Peterson hopes the profession can retain that enthusiasm as the legislation moves into a regulatory phase, where the details are worked out.

“We should have health care reform on our radar,” added Beverly Malone, Ph.D., RN, FAAN, chief executive officer of the National League for Nursing. “Nurses need to be prepared to deal with the complex, comprehensive patient in the home and in the community. That is a huge issue we will be dealing with. The nation is gearing up for that, and nurses need to be leaders in that.”

Malone expects preparing nurses to the level they need to provide that complex care will become a “hot issue.”

Fay Raines, RN, PhD
Fay Raines, RN, PhD, said the nursing profession should anticipate an increased demand for nurses and nurse practitioners due to health care reform.

American Association of Colleges of Nursing President Fay Raines agreed, saying that the profession must ensure it educates sufficient entry-level and advanced practice nurses. Raines and most nursing leaders expect health reform will create opportunities for nurses, as millions of formerly uninsured people obtain coverage and seek care.

“Nurses are going to have an expanded role,” said Rosemary E. Mortimer, MSEd, RN, CCBE, instructor at Johns Hopkins School of Nursing in Baltimore and immediate past president of the Maryland Nurses Association. She expects registered nurses will find new positions as hospitals expand, home care embraces telehealth, and prevention and lifestyle change come to the forefront, while nurse practitioners will see greater demand for them to become front-line providers.

“We don’t have the primary care providers to care for those people, so I think the demand for nurse practitioners will grow astronomically,” said Karen Haller, RN, PhD, FAAN, vice president of nursing at Johns Hopkins Hospital.

“This will be as a real opportunity for advanced practice nurses, as primary-care providers and leaders of medical homes, and with enhanced reimbursement opportunities,” said Judith Haber, Ph.D., APRN-BC, FAAN, the Ursula Springer Leadership Professor in Nursing and associate dean of graduate programs at New York University College of Nursing.

Nurse advocacy

What nurses have seen in the past year is that what happens in Washington can and will affect their lives. Many also have found that they can influence those decisions.

“We are going to have to get nursing educators and nurses involved in the Congress of this United States and get the nurse at the bedside up to snuff on terms of what it means to be political while you are a clinician and taking care of patients,” said Malone, suggesting it can be as easy as email, Twitter and Facebook. “There are so many ways to touch Congress and decision makers. It’s about getting the passion for politics into nursing. 2010 will be the beginning of a new decade for that.”

Malone added that nurses must realize that elected officials are interested in funding programs that make a difference for the citizens of the country, not because they are good for the nursing profession, so nurses must tailor the message accordingly.

“That’s the real learning for 2010,” Malone said.

Many nurse leaders expect the trend toward nurses’ greater involvement in shaping the health care debate to continue this year and in the years ahead.

“We will see more interest in legislation,” Mortimer said. “Health care reform has gotten people interested in legislation and lobbying.”

Nursing organizations are starting to speak with one voice to law- and policymakers about broad issues affecting nursing.

“Nursing has finally come together,” said Brenda Nevidjon, MSN, RN, FAAN, president of the Oncology Nursing Society and a clinical professor and specialty director of nursing and healthcare leadership at Duke University School of Nursing in Durham, N.C. “We have figured out a way to come together and not be fractured, and that is making a difference on The Hill. I hope and expect that trend will continue.”

Workplace and workforce issues

“The biggest challenges we’re going to face, from a nursing standpoint, are preparing for the staffing challenges,” said Eileen Gillespie, RN, ND, vice president and chief nurse executive at Advocate South Suburban Hospital in Hazel Crest, Ill. “As we go through 2010 and the economy recovers, more nurses will exit the job market.”

Recent data supports that concern. The U.S. Bureau of Labor Statistics announced in November its expectation that registered nurses will experience greater job growth than any other occupation by 2018, with 581,500 jobs or a 22.2 percent increase.

Not only will the country need more nurses, “the intensity of the work is not going to diminish,” Nevidjon added.

Holy Cross Hospital Executive Director of Nursing Services Taren Ruggiero, MSN, RN, also expects high acuity of inpatients will continue.

“We will need to find nurses who have critical thinking and are getting away from being task oriented,” Ruggiero said. “We are over-hiring to prepare for retirements and such.”

Holy Cross, located in Silver Spring, Md., has a nurse residency program, which has helped with retention of new hires. Increasingly, hospitals are turning to such programs when bringing in recent graduates.

Many leaders believe the economy is improving and will affect nurses’ employment opportunities and decisions.

“New graduates will have an easier time getting jobs, and we may see some experienced nurses who came back into the workforce go back home, which would be too bad,” said Julie Stanik-Hutt, Ph.D., ACNP, CCNS, FAAN, director of the mater’s program at the Johns Hopkins University School of Nursing.

Haller reported steady staffing at Hopkins, with almost no vacancies, which she expects will continue as long as the economy remains level.

“New graduates will have to start looking earlier and broaden their search geographically and clinically,” Haller said. “Eventually, we will see what I call a silver tsunami of retirement, because boomers cannot hang on forever. But right now they are deferring retirement.”

If, as many expect, the nursing shortage returns, “the light will shine again on nurse retention,” said Kristin Baird, RN, president of Baird Consulting of Fort Atkinson, Wis. “We’ll have to pay close attention to nurse engagement, so they stay longer.”

Beth Hammer, RN, MSN, APN-BC
Beth Hammer, RN, MSN, APN-BC, anticipates improving the work environment will be important in 2010, and the American Association of Critical-Care Nurses offers tools to help nurses achieve that goal.

Beth Hammer, RN, MSN, APN-BC, president of the American Association of Critical-Care Nurses, predicts improving the work environment, including resolving staffing, leadership and communication concerns, will become even more important in 2010 as the need for nurses increases.

“This is coming to the forefront with retention and where new nurses want to work,” Hammer said.

Lillee Gelinas, RN, MSN, vice president and chief nursing officer of VHA Inc., a network of not-for-profit hospitals, encourages hospitals to look at capital spending before cutting personnel, which will destroy trust and fuel the fire of unionization.

“Employees are our most important asset,” Gelinas says. “Yet that’s where we go first for cost reduction. Nonlabor expense reduction is the priority for 2010, and we need to make sure we have creative solutions everywhere.”

Provider perspectives and initiatives

Lillee Gelinas, RN, MSN
Lillee Gelinas, RN, MSN, encourages hospitals to look for innovative ways to become more efficient without cutting staff.

“The nursing care model today is FRED–frantically running every day, that we cannot decide between one task and another,” Gelinas says. “To be an effective leader in 2010, we need a clear picture, we need to maintain perspective, focus on the right things and rise above the distractions. For nurses, that means our core skills of assessment, intervention and evaluation have to take precedence, and we need to stay focused on delivering outstanding nursing care, no matter the odds.”

That will require creativity on the part of nurses, she said, and for hospital executives to provide them with a greater understanding of the big picture. Nurses also will need to remain more vigilant in protecting patient privacy, Gelinas indicated, and not give in to the temptation to share confidential information on social media Web sites.

Haller reported a shortage of applicants for nursing leadership positions–nurse managers, clinical nurse specialists and educators.

“This is a good time to be in school,” said Haller, who reported the creation of patient safety officer positions at Hopkins, filled by master’s-prepared nurses. “Quality and safety improvements are by and large led by nurses.”

Quality and safety will remain top concerns. Leaders are paying attention to nurse-sensitive indicators and communication lapses and taking action where they see a need for improvement, said Anne Jadwin, MSN, RN, AOCN, CNA, director of nursing at Fox Chase Cancer Center in Philadelphia.

“It’s become a blueprint for how we conduct day-to-day business, and that movement has been driven by consumers and insurance companies,” added Jadwin, who expects hospitals will also continue to focus on improved productivity, throughput and cost containment.

“We will try to maintain quality but do so under more constrained resources,” Jadwin said. “With all of the stresses the environment is under, this is often a time when you will see the most innovation and creativity, when people are forced to start thinking about how we can do things differently and better.”

The federal government has allocated funds to support implementation of health information technology.

“There’s a push to use information technology to enable clinical practice, to make us more efficient and more effective, so there is a demand for nurses to work in informatics and redesign workflow,” Haller said.

Gillespie added that patient-safety goals require acute-care nurses also prepare patients for taking care of themselves at home.

Home-health nurses also will ensure patients and families have the knowledge and skills they need to manage safely at home, added Meg Doherty, MSN, ANP, MBA, executive director of the Norwell Visiting Nurses Association and Hospice in Boston. She expects a growth in home-health nursing.

“I see more nurses transitioning out of acute care hospitals to work in community settings and in particular what is now acute and sub-acute care at home,” said Doherty, who predicted that will include specialty nurses and nurses with degrees in management and education.

Nevidjon expected more technology will be placed in patients’ home, enabling nurses to monitor, educate and manage care from afar.

Education expectations

While some in academia have seen greater interest in nursing, including Haber at NYU and Mortimer at Hopkins, Patrick R. Coonan, EdD, RN, NEA-BC, dean and professor of the Adelphi University School of Nursing, in Garden City, N.Y., anticipated a drop off as candidates watch fewer new graduates able to secure jobs.

“We’re seeing some decline in applications,” Coonan said. Only half of Adelphi’s new graduates secured jobs this year compared to 100 percent three years ago.

On the other hand, Mortimer reported that all of Hopkins 2009 graduates who wanted a job found one.

“We were used to hiring 300 or 400 people a year, but now it’s much reduced, but compared to other fields, it’s still a good field to be in,” Haller said.

The American Association of Colleges of Nursing will introduce a central application service this year, making it easier for potential students to apply to multiple nursing programs.

If as most experts and data suggest the country needs more nurses, nursing leaders from the provider side and academia agree that the profession needs more faculty.

“We’re going to have to look at issues of how nurse educators are recruited and retained, and compensation is going to be a part of that issue,” Malone said.

Gillespie added nurse employers will need to continue working with educators to ensure they have enough faculty.

“From a nurse executive perspective, the challenge continues to be strengthening partnerships between academia and practice, so we can help support the ongoing education and development of our future nursing staff,” Gillespie said.

Haber reports significant investments are being made in simulators to aid in training nurses and advanced practice nurses to provide measurable, standardized clinical experiences and ensure they possess needed competencies. At NYU, students spend half of their clinical time in the simulation lab and half with real patients. Preparation also includes the use of actors to allow nurses to hone history-taking and communication skills.

Educators also anticipate the growth of specialties, such as forensic nursing, reported by Vida Lock, PhD, RN-BC, director of the school of nursing at Cleveland State University in Ohio, and genetics, according to Nevidjon.

Overall, the nursing profession remains strong but with some uncertainty that mirrors the nation and the health care industry as a whole.

“We’re looking at a time with lots of challenges and also opportunities,” Raines said. “If the number of people who have access to care is expanded with health care reform, the need for nurses will increase to provide care to these people. … We need to make sure we are preparing sufficient numbers of nurses and nurse practitioners to meet the demand.”

© 2010. AMN Healthcare, Inc. All Rights Reserved.

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January 17, 2010

Nurse to Patient Ratios

I read the article below and found myself rethinking some of my attitudes and opinions about staff ratios.  I believe I will be buying this book along with another book about how the media’s portrayal of nurses affects us all called, Saving Lives.

Please read this article and then let me know what you think about nurse-to-patient ratios.  I have worked as a travel nurse in California and so I have seen first-hand what that law has done for nurses there.  I cannot say that I think California’s way is the best way, but when you are ignored over and over while you are drowning, you get desperate.

I do support a ratio–whether mandated by law, or by healthcare authorities, to promote safe and responsible care for patients while protecting the nurse from harm–physical, mental, or professional.  I believe that if an acuity system that is an actual accounting of the needs of the patient in hands-on care and monitoring was implemented nationally, it would improve staffing, but more importantly, nursing care of patients would improve.  Isn’t that what we all should want?


by:    Suzanne Gordon

Last May I published my latest book Safety in Numbers: Nurse – to – Patient Ratios and the Future of Health Care.  I co-authored the book with workforce researchers John Buchanan and Tanya Bretherton who are at the University of Sydney’s Workforce Research Centre, and it was published by the Culture and Politics of Health Care Work Series of Cornell University Press.

Safety in Numbers is an in-depth look at the struggle for, implementation of, and success of staffing ratios in the state of California in the U.S and the state of Victoria in Australia.  These are the only two places on the planet that have government mandated nurse-to-patient ratios.  Our book considers why ratios have become the number one solution to containing an out of control and unsafe nursing workload.  It looks at the history of nursing ratios in these two states and describes in detail how nurses won these ratios.  In the case of California, the ratios of 1:5 nurse-to-patient ratios on medical surgical units – at all times — (and other ratios on other units) was a result of an almost ten year struggle led by the California Nurses Association, the most powerful nurses’ union in that state.  The ratios were legislated in a bill that was passed in 1999 and signed by the state’s governor in the same year.  After a three year period, the California Department of Health Services determined the exact numbers of the ratios and the length of their phase-in period.  The legislation mandates not only ratios, but maintains that hospitals use patient-acuity systems to determine if patients need more nursing care.

In Australia, the ratio of 5 nurses to 20 patients – which comes down to a 1:4 ratio – is the product of a collective bargaining agreement that was first reached in 2000.  It has been revisited every four years when the union contract between the Victorian Branch of the Australian Nursing Federation and the Victorian Government is negotiated.  The nurses won this agreement by doing outreach to and mobilizing all nurses in the public health care system in Victoria.  The nurses also led a public campaign and gained support from all of those who depend for their health and well-being of the state’s public hospital system.

John Buchanan and Tanya Bretherton, my co-authors, have done extensive work studying the implementation and success of the ratios in Victoria.  A 2003 survey they conducted affirmed that nurses overwhelmingly believed that working life would have been worse had ratios not been introduced.  Eighty-one percent of nurses who had worked to ratios for three or more years said the quality of patient care would have declined without them.  Eighty-four percent reported that nurses’ working conditions would be worse.  Over half (53%) said that if the ratios were altered they would reduce the amount of time they worked as nurses: 24 percent would consider leaving nursing altogether; 20 percent would consider cutting their hours; and 9 percent would consider retiring early.  The degree to which ratios continue to directly affect decisions on staff flight is illustrated by this 2006 comment from one nurse, who works at an outer suburban Melbourne hospital: “God help us if we hadn’t had them.  I would have long since gone.  It is the only thing that has kept me nursing.”

The researchers believe that the ratios have led to a rebuilding of the profession, improved nurses’ status as professionals, and given them more time to engage in the “emotional labor” and empathic work of nursing.  Although nurses still contribute far too much voluntary labor and overtime in the system, the ratios, the government says, has brought more than 7000 inactive nurses back into the system.

In California, the ratios have been similarly successful in their intent which is to deal with nurse work overload or work intensification.  According to my interviews with California nurses, they say they finally feel they have some control over their workload.  In April of 2008, University of California nurse workforce researcher Joanne Spetz published an article that affirms the nature of the success of ratios. [1] She analyzes data collected in surveys done by the California Board of Registered Nursing in 2004 and 2006.  She found that “average nurse satisfaction improved with most survey items, including their overall rating of the job.”  Nurses were satisfied with adequacy of staff, time for patient education, and clerical support.  Nurse turnover was also reduced – which directly impacts patient care.

Researchers Linda Aiken, Sean Clarke and colleagues also surveyed nurses in California, Pennsylvania and New Jersey – states with no ratios. They found patient loads were reduced in California, and nurses there were more satisfied with their job conditions than nurses in either Pennsylvania or New Jersey.

The writing is clearly on the wall.  Ratios work – to manage nurse workload. They impact nurse job satisfaction and retention and turn-over.   Patients need them and so do nurses.

[1] Spetz, Joanne.  Nurse Satisfaction and the Implementation of Minimum Nurse Staffing Regulations.  Policy Politics Nursing Practice OnlineFirst, published April 3, 2008.

Click here to read more on Suzanne Gordon.

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January 16, 2010

Nurses Reach Out To Victims Of Haiti Earthquake

With the horrible ordeal going on in Haiti, I felt compelled to post an article that shows the response of nursing as a profession.    This is a really good article and the nursing response warms my heart.

Not every nurse will be able to go to Haiti, but we all can support those who can.  This is a global tragedy and we all need to help each other.  If, after reading this, you would like to help, please contact your nursing organization for information about ways you can help.

Nurses across the U.S. immediately mobilized this week to offer aid to people in Haiti after Tuesday’s devastating 7.0 earthquake. The World Health Organization reports at least eight hospitals have been damaged or destroyed in the Caribbean island nation and there are a large number of survivors suffering severe trauma injuries.

The U.N. estimates one-third of Haiti’s 9 million people, including 2 million in the capital of Port-au-Prince, have been affected by the earthquake. Oxfam’s humanitarian coordinator in Port-au-Prince, Cedric Perus, estimates several thousand people are dead.

Immediate health priorities include: search and rescue of survivors trapped underneath rubble; treatment of people with major trauma injuries; preventing the infection of wounds; provision of clean water and sanitation; and ensuring breast-feeding is continued, according to the WHO.

Another priority will be to prevent communicable diseases, such as respiratory infections and diarrhea, from spreading.

“Most patients that we have seen are suffering from broken bones, but some are in more serious condition and there is no hospital to refer them to. Medical supplies, such as IVs, pain medicines and bandages, are extremely limited,” Margaret Aguirre, director of global communications for International Medical Corps, said in a news release.

Nurse-Led Effort
Some 4,500 nurses have responded to a call by a national nursing union for volunteers to travel to Haiti to assist earthquake victims. The first response teams will fly to Miami as early as Saturday and prepare to deploy to Haiti as soon as proper security for the nurses is in place, says Rose Ann DeMoro, executive director of the National Nurses Union, which was created last month by a merger of the California Nurses Association, the United American Nurses and the Massachusetts Nurses Association.

“Nurses will be fundamental to the disaster relief process to provide immediate healing and therapeutic support to the patients and families facing the devastation from this tragic earthquake,” DeMoro said.

The union’s relief arm, the Registered Nurse Response Network, is interviewing nurses who have applied to go to Haiti through the organization’s Web site. Priority at this point is being given to those who have disaster response training, speak the language of the country, and have trauma, emergency or pediatric experience, organizers say, but as the crisis continues new teams will replace those who go as part of the first wave of responders.

Nurses who go to Haiti must have proper immunizations and prophylactics against typhoid fever, hepatitis A and B, tetanus and malaria, as well as a current passport, though organizers say they are working with government officials to see whether passport requirements could be expedited or waived.

The union is also working with hospitals to get time off for nurses who want to go to Haiti, and many hospitals are cooperating with the effort, DeMoro says.

DeMoro and others cautioned nurses to be patient during an informational conference call about the mission, saying they were working with the Obama administration and other government officials to provide security and safe passage for nurses who would be working in Haiti, and would get them to Haiti as soon as they could do so safely. They said they understood the frustration of nurses who saw photos and videos of people in pain and who wanted to leave for Haiti immediately, but reiterated the need to give help in an organized, systematic fashion.

“No one should be going on their own,” said Karen Higgins, RN, president of the Massachusetts Nursing Association. “It takes time [to deploy], but it does happen.”

Nurses interested in working with the RNRN relief effort can sign up on the group’s Web site,, or visit @NationalNurses on Twitter or by following: #haitiRN; or by calling the RNRN hotline: 800-578-8225.

Donations, which will be used to pay for travel-related costs and medical supplies for volunteer RNs on the emergency mission, can be sent to the California Nurses Foundation, 2000 Franklin St., Oakland, CA 94612.

Facilities and Groups Pitch In
Partners in Health of Boston coordinated relief efforts with nearly 500 nurses and more than 120 physicians on site two hours outside the Haitian capital of Port-au-Prince. “We have already begun to implement a two-part strategy to address the immediate need for emergency medical care in Port-au-Prince,” Ophelia Dahl, the current executive director of Partners in Health, wrote in an e-mail.

“First, we are organizing the logistics to get the medical staff and supplies needed for setting up field hospital sites in Port-au-Prince where we can triage patients, provide emergency care and send those who need surgery or more complex treatment to our functioning hospitals and surgical facilities,” Dahl wrote. “To do this, we are creating a supply chain through the Dominican Republic. Second, we are ensuring that our facilities in the Central Plateau are ready to serve the flow of patients from Port-au-Prince. Operating and procedure rooms are staffed, supplied and equipped for surgeries and we have converted a church in Cange into a large triage area. Already our sites in Cange and Hinche are reporting a steady flow of people coming with medical needs from the capital city. In the days that come we will need to make sure our pharmacies and supplies stay stocked and our staff continue to be able to respond.”

Dahl says the group is most in need of funding to pay for the response.

Massachusetts General Hospital sent 17 staff members, eight of which are nurses, with the International Medical Surgical Response Team East, the U.S. Department of Homeland Security’s international clinical outreach team for which Mass General has oversight, Wednesday night, according to Georgia Peirce of Mass General. Members came from various units throughout the hospital, including surgical ICU, emergency, pharmacy, social services, OB/GYN, police and security, trauma and pre-admission testing. They also sent five staff members with the MA-1 disaster medical assistance team, including three nurses. The hospital plans to send at least 12 nurses with Project HOPE on Saturday. They are calling for volunteers for the project, which has civilians working alongside the military. It first was used during the tsunami relief effort off the coast of Indonesia and then in the Gulf Coast after Katrina.

Jersey City (N.J.) Medical Center is planning to send a small team of physicians and nurses to Haiti “as soon as possible,” according to hospital spokesman Mark Rabson. More than 200 of the hospital’s 3,000 or so employees are of Haitian descent.

As of Thursday, Doctors Without Borders had to evacuate patients from its damaged medical facilities and was waiting for an inflatable hospital with two operating rooms to arrive. The group had treated 1,000 people in four tents and one city hospital in the meantime, according to a news release.

Unplanned Nursing Assistance
Twenty-three nurse practitioners, nursing students and support staff of the Little by Little Haiti medical mission group out of Glenview, Ill., who were scheduled to fly back from their week-long mission Wednesday, are offering care to disaster victims and do not know when they will be able to leave the country.

“The team is intact and well,” said Mary Gomez, RN, MSN, APN, nurse at Children’s Memorial Hospital in Chicago, of her colleagues. She has been getting occasional updates from her colleagues via Facebook and blog postings. Among the current group, four of the team members are from Children’s Memorial and seven are from the Glenview area, Gomez said. Since the earthquake, Gomez said the team has cared for more than 200 victims.

Because the Little by Little group was finishing its visit, it had few supplies remaining when the earthquake struck. “Their supplies were depleted,” Gomez said. “They were at the end of their week.”

The team usually helps patients with skin infections, gastrointestinal problems and nutritional support. “We don’t bring trauma supplies,” Gomez said. “They can only make due with what they have.”

That has included using broomsticks for splints and also tearing up scrubs to use as bandages. The most obvious need right now for the Haitian people, Gomez said, is funding. The military is still in search-and-rescue mode, she said. When working in Haiti, the Little by Little teams are hosted by Indiana native Beth Charles and her husband, Willem, who is a native of Haiti.

The Charles family runs Mountain Top Ministries in Petionville, Haiti, which is about 15 miles southeast of the capital city of Port-au-Prince. The clinic where Little by Little teams work is two miles from Petionville, in the mountain town of Gramothe. Nurses from Children’s Memorial have been part of seven Little by Little teams that have gone to Haiti since 2006, Gomez said.

Barry Bottino is a regional editor, Cathryn Domrose is a staff writer and John Leighty is a contributing writer for

The original article can be found here

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January 15, 2010

57% Nurse Case Managers and Non-Clinical Nurses Look for New Jobs in 2010!

Filed under: Nursing — Shirley @ 3:04 am
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Here’s an interesting article that appears to corroborate another study done about non-nurses.  The idea was to see if the figures from the first non-nurse study would match if the study only followed nurses.  It seems that the figures mesh between the two studies, so nurses follow the trend of the rest of the workforce when it comes to looking for new jobs.

I could have told them that.  Nurses are historically mobile.  Nurses are always looking for a way to get better working conditions, better hours, better salary, better benefits–just like the rest of the working population.  The difference is that nurses stay in the field of nursing even when moving around, while the general population has the benefit of trying new and different types of jobs when they move.


January 11th, 2010

A recent study conducted by and the Human Capital Institute regarding employee attitudes and the global recession found that 79% of employees are “aggressively seeking work elsewhere.”  The study noted that 54% of employees have significantly increased their pursuit of new job opportunities and another 23% have stepped up their job search efforts in response to the current economy (1).

Pathway Medical Staffing, a nurse case management and non-clinical nurse recruiting firm, conducted an informal survey to see if these results held true for nurse case managers and other non-clinical nursing professionals. The results proved to be closely aligned with the broader employment study from and the Human Capital Institute.

In December 2009 Pathway Medical Staffing surveyed 147 nurse case managers and non-clinical nursing professionals, representing nurses from 23 states (2).

The survey revealed that a whopping 57% of nurse case managers and non-clinical nursing professionals plan to look for a new job in 2010. Not surprisingly, the majority (53%) of nurse case managers indicated that they plan to look for a new job in order to increase their salary.

2010 Career Resolutions for Nurse Case Managers & Non-Clinical Nurses

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However, there are several other areas that are causing these specialzed nurses to look for employment elsewhere.  Leading the reasons was 41% of respondents indicating that they were looking for a job that is more challenging, makes better use of their experience and / or finding a job that will help move to the next level of their career.  Closely following were 31% of respondents that indicated they were seeking new employment opportunities for better benefits than they currently have with their present employer.

Other motivators for finding a new job included: being closer to home (19% of respondents), better schedule (14% respondents) and plans to semi-retire and search for project or temporary work (5% respondents).

While most of the job market is still in a slump, there is good news for nurse case managers and non-clinical nurses that are searching for new jobs.  In a December 28, 2009 article, The Wall Street Journal reported that “Healthcare is expected to continue to see a surge in hiring with more than four million new openings estimated by 2018… [including] new specialties, particularly in case management (3).”

For the original article: click here

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