Nursing Notes

March 31, 2010

Calling the Doc-Nurse educators teach new grad nurses how to better communicate with physicians to improve patient care.

SBAR has just come to my hospital and I am sure it will be helpful in the nurse’s dealings with the on-call residents.  Most of the time they are first year residents and know absolutely nothing about giving orders, so they need the help of experienced nurses to help them make the transition to being the “doctor”.  Working in a  teaching facility has its drawbacks, communication between nurses and residents is usually at the top of the list.

I read this article and I fully enjoyed seeing the difference between the different approaches and I loved that there was even a bit of whimsy mixed in with the educational stew.  It’s not only new graduates who sometimes need to have this information; experienced nurses who are stressed and worried about their patients can sometimes forget to get themselves organized and prepared before calling the doctor, so we all benefit from this improved way to communicate.


By Sandy Keefe, MSN, RN

New staff nurses Amanda Alarcon, RN (standing), and Joanne Lukaszewicz, RN, present some patient data to endocrinologist Joseph Rosa, MD, in a chart room on the med/surg unit of St. Vincent’s Medical Center, Bridgeport, CT. Photo courtesy St. Vincent’s Medical Center

When Sheryl Hollyday, MSN, RN, cardiovascular service line educator, and Diane Sheehan, BSN, RN, orientation coordinator, performed a tongue-in-cheek skit that highlighted what not to do when calling a physician, new graduate nurses at St. Vincent’s Medical Center, Bridgeport, CT, were intrigued and wanted to learn more.

“It served as an icebreaker that led to a productive discussion about communication,” Sheehan noted.

The exercise was part of a roundtable of volunteer physicians and newly graduated nurses. The physicians spoke without scripts, sharing examples and tips about how to deal with challenging behavior from doctors.

The physicians “emphasized that if the nurse believes there is an area of concern and communicates that clearly, most physicians will welcome the call and appreciate what’s being done for their patients,” Hollyday said.

Experiential Learning
The idea for the roundtable came from past new graduates.

“Every year we have a staff education retreat, and we invite several new nurses,” said Nina Fausty, MSN, APRN, assistant vice president of patient care services. “We solicit their feedback and ask for recommendations about how we can better meet their needs. Anxiety about physician communications was one of their greatest concerns.”

New grads emphasized their preference for experiential learning over didactic classroom sessions during the roundtable. “As a result, we have made many changes, such as role playing, shadowing experiences in relevant departments and fostering communication, critical thinking and clinical skills through the use of simulation,” Sheehan said.

The roundtable has been a resounding success, she added. “Many [new grads] were apprehensive about asking questions like when to call, what’s important to convey and how to prepare themselves for those phone calls,” Sheehan said. “After we had the open forum meeting with the attending physicians, they were more comfortable and confident on this topic.”

Communication Becomes Curriculum
Marion Smith, MA, RN, AOCN, BC, nurse educator and coordinator of the Nurse Residency Program at NYU Langone Medical Center, New York, NY, believes today’s new grads are more comfortable with communication than their predecessors. “They are coming out of school with more of a sense of their identity, and that allows them to communicate more assertively,” she said. “They expect people to respect them as professionals.”

NYU’s new-grad program builds upon that foundation. “One of our first seminars is on communication in general,” Smith explained. “We talk about assertive communication and active listening. Our new grads write [and share] clinical narratives about communication issues as a way of looking at their practice, and if physician communications come up in one of those narratives we discuss the topic.”

Communication is a theme throughout the first year of the residency program at NYU. During the seminar about handling emergencies, the group discusses the nurse’s role in communicating about the patient’s status in an escalating situation, while an advanced pain management seminar includes advice from an advanced practice nurse.

“The nurse might say, ‘Mrs. Smith seems to be in a lot of pain and doesn’t want to get out of bed today. I’m concerned she won’t be able to go home tomorrow,'” Smith said. “That’s an assertive communication that highlights issues of concern to the physician.”

Facing the Challenge
Anne Walker, MEd, RN, shares a similar perspective in Facing the Challenge: Difficult Conversations, a seminar she teaches for the Vermont Nurses in Partnership.

“New grads face a shock coming into the workforce with an average of less than 450 hours of clinical time,” she explained. “They’re not well-prepared to interact with colleagues and physicians at the professional level. We teach them to voice their needs and to articulate them well.”

Walker recommends reflective practice, staying in the moment, having a common purpose and asking questions to understand the other’s point of view. She uses a process known as MRI (mental, rehearsal and intermission) that allows new grads to identify communication barriers, prepare for the conversation and be proactive rather than reactive.

“The rehearsal part of the process involves ‘what if’ scenarios,” she said. “Most of the time, the ‘what ifs’ don’t happen, but if they do, how will you handle it? What if the physician yells at you at 3 a.m.?”

Andi Churchill-Boutwell, RN-BC, ONC, clinical educator in the surgical care unit at Rutland Regional Medical Center, Rutland, VT, found Walker’s approach very helpful.

“As a result of the workshop, we will be better able to use the reflective-listening process to have effective conversations,” between nurses and physicians, she said. “As preceptors, we must be good role models for our new nurses. When we are in a difficult situation or conversation, we must treat the other person with respect and truly ‘hear’ the person.”

SBAR Communication
Donna Cill, DNP, FNP-BC, director of continuing education and clinical faculty for the nurse practitioner program at the University of Medicine & Dentistry of New Jersey (UMDNJ) -School of Nursing, Newark, teaches a communication module based on the SBAR (situation, background, assessment, and recommendations) model.

“The only way for a nurse to be confident in communications with a physician is to be competent,” she emphasized. “Are we organized enough?  Do we know enough to give the physician the information needed for good decision-making? The SBAR model helps ensure the nurse can answer those questions appropriately.”

Cill emphasized that attitude matters. “Our nurse residency and nurse refresher programs consistently teach that nurses are the physicians’ colleagues,” she said. “They need us to be advocates for patients, to be insightful and competent clinicians, and to give them the information they need to provide excellent patient care.”

During the program, new grads complete a case study using the SBAR format. “We need to be direct and confident in the way we speak,” Cill emphasized. “The ‘R’ in SBAR refers to recommendation. As nurses, we are the experts on our patients, and we need to make those recommendations. Many times physicians, especially new residents, need those recommendations.”

Overcoming Intimidation
While most SBAR communications do a great job of getting the point across, the nurse has a duty and responsibility to follow through. “If the physician doesn’t seem to take the nurse’s communication seriously, it’s important to think about the patient first,” Cill said. “What would happen if the nurse doesn’t communicate and advocate effectively on the patient’s behalf?”

New grads need guidance to go up the chain of command. “I encourage nurses to work with their preceptors to get used to calling physicians,” Sheehan said. “Instead of calling blindly, we help them prepare by doing a quick head-to-toe assessment that we’ve practiced in our simulation lab. If the physician’s answer sounds totally off the wall, we suggest the new grad say, ‘I’m new and I just want to learn, so could you explain why this is the plan of care?'”

Preparation is the key to successful communication, Hollyday concluded. “Yes, there will be physicians who are grouchy at 2 a.m.,” she said, “but we encourage the new grads to let the doctor know they’re new; hopefully that will cut them some slack.”

Sandy Keefe is a frequent contributor to ADVANCE.

Here’s the link to the original article

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Shortage of Nurses Means Death After Hip Fracture

Pelvis and spine (mine)
Image by wonderferret via Flickr

I found this article on Medscape Medical News.  This certainly is an eye-opener.  Here we have a study done by the medical profession that shows how staffing can affect patient outcomes and how lack of staffing has an effect of increasing morbidity for this particular patient, usually due to preventable complications.  WOW!

I had to read this several times to be sure I had read it correctly.  I know, the study then goes on to say that it does not difinitively connect staffing to outcome, but how could anyone?  Please feel free to visit the site and read other articles about nursing.


By:  Fran Lowry

March 19, 2010 (New Orleans, Louisiana) — Low nurse staffing levels are associated with increased mortality among elderly patients admitted to hospital with hip fractures, new research suggests.

In a retrospective cohort study presented here at the American Association of Orthopaedic Surgeons 2010 Annual Meeting, the risk for death among elderly patients in the hospital with hip fractures increased 22% when the nursing staff was reduced by 1 full-time nurse each day, Peter Schilling, MD, from the University of Michigan Medical Center in Ann Arbor, told meeting delegates.

“It is estimated that nearly 5% of elderly patients admitted with a hip fracture die during their initial hospitalization, and another third die within a year of their injury,” he said. “There is very little research on how to reduce the risk of complications in these patients, but there is growing evidence of the importance of nurse staffing levels in reducing morbidity and mortality in this vulnerable population.”

To shed more light on this issue, he and his colleagues conducted a retrospective cohort study of 13,343 elderly patients admitted between 2003 and 2006 to 39 Michigan hospitals with a primary diagnosis of hip fracture.

They used regression models to control for patient age, sex, comorbidities, and hospital characteristics, including teaching status, hip fracture volume, income and racial composition of each hospital’s zip code, and, finally, seasonal influenza.

The study found a statistically significant association between nurse staffing levels and in-hospital mortality among hip fracture patients.

The odds of in-hospital mortality decreased by 0.16 (P < .003) for every additional full-time-equivalent registered nursing staff per patient-day, even after controlling for covariates.

“This association indicates that the absolute risk of mortality increases by 0.35 percentage points for every 1-unit decrease in full-time-equivalent registered nursing staff per patient-day, or a 16% increase in death,” Dr. Schilling said.

He speculated that more nursing attention could decrease occurrences of urinary tract infection, pneumonia, sepsis, and cardiac arrest. “Two of the most common causes of death for hip fracture patients — pulmonary embolism and acute myocardial infarction — are also considered to be the most preventable causes of in-hospital death. If nurses are responsible for a small number of patients, they might be able to identify and deal with impending complications earlier.”

Senior author Paul Joseph Dougherty, MD, associate professor and director of the Orthopaedic Surgery Residency Program at the University of Michigan, said that although the study has limitations and does not give a definite answer, “it certainly points to the fact that nurse staffing may be an important factor in preventing complications.”

“There’s a great deal of concern with cost-cutting measures, but what you may perceive to be excess nursing staff may in fact prevent long-term problems. The problem is, we don’t have a precise value for that,” he told Medscape Orthopaedics.

More work needs to be done to establish acceptable nursing staffing levels, he said. “This is probably where our efforts should be directed, so that we can make some assumptions for staff, based on the type of patient we are seeing. Hip fracture patients are frail and very vulnerable. They tend to be the oldest patients, and they tend to be the sickest.”

Andrew Pollak, MD, head of the Division of Orthopaedic Trauma at the University of Maryland School of Medicine in Baltimore, said the authors should be congratulated for taking on this important topic.

“This study does not definitively show that nurse staffing levels are associated with mortality. But it suggests that there might be a relationship and that further investigation is warranted,” said Dr. Pollak, who moderated the session at which the study was presented.

Orthopaedic surgeons need to pay more attention to this issue, he added. “As orthopaedic surgeons, we pay a lot of attention to having enough personnel in the operating room with us to take care of our patients, but it is pretty rare that we will actually go up on the floor in a hospital, or other places in the hospital outside of the operating room, and pay any attention to the number of staff around. We don’t really have direct access to that kind of information,” he told Medscape Orthopaedics.

“This type of information tells us that we really ought to start thinking about these things when we start to consider where we are going to put our patients, and whether staffing, or the lack of it, could mean a difference in our patients’ well-being.”

Dr. Schilling, Dr. Dougherty, and Dr. Pollak have disclosed no relevant financial relationships.

American Association of Orthopaedic Surgeons (AAOS) 2010 Annual Meeting: Abstract 125. Presented March 10, 2010

Here’s the link to the article

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March 30, 2010

Nursing Workforce Getting More Diverse, Older

This is another take on an article I posted previously about nursing getting older.  I like this article because of the statistics that really make a point.  I also really like the site this comes from,  According to this article, if we are not truly having a nursing shortage right now (and we all know we are) then we will have a doozy of a shortage in about 10-15 years when the 50ish nurses all get ready to retire and not enough new nurses have come down the pipeline to replace them.  Gives you something to think about, huh?

Let me know if you have any suggestions that we can implement to prevent such a massive shortage.


Joe Cantlupe, for HealthLeaders Media, March 29, 2010

An extensive federal survey of nursing trends from 2004 to 2008 shows a growing diversity of backgrounds in an increasing registered nurse workforce.

The report—entitled The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses—also reveals a trend of more highly educated, male, and foreign-trained nurses.

The trends, however, showed dramatic increases among older registered nurses, prompting concerns from officials about retirements impeding the growth of the nursing workforce.

The Health Resources and Services Administration (HRSA), a division of the Department of Health and Human Services, released the report this month. Published every four years by HRSA’s Bureau of Health Professions, the National Sample Survey of Registered Nurses is what officials describe as the preeminent source of statistics on trends over time for the nation’s largest health profession.

The report also includes comparisons from eight recurring surveys, 1980 through 2008.

The report showed that:

  • The number of licensed registered nurses in the U.S. grew to a new high of 3.1 million between 2004 and 2008.
  • 16.8% of nurses in 2008 were Asian, Black/African-American/American Indian/Alaska Native, and/or Hispanic—an increase from 12.2% in 2004.
  • An estimated 170,235 registered nurses (RN) living in the US received their initial nursing education in another country or a US territory, comprising 5.6% of the US nursing population, compared with 3.7% in 2007. About half of the internationally educated RNs living in the US in 2008 were from the Philippines, with another 11.5% from Canada, and 9.4% from India.
  • Women outnumber men by more than 15 to 1 in the overall number of RNs, but among those who became RNs after 1990, there is one male RN to every 10 women, the report stated.
  • The average age of all licensed RNs increased to 47 years in 2008 from 46.8 in 2004; this represents “stabilization after many years of continuing large increases in the average age,” the report stated.

Nearly 45% of RNs were 50 years of age or older in 2008, a dramatic increase from 33% in 2000 and 25% in 1980. “The aging trends in the RN population has raised concerns that future retirements could substantially reduce the size of the US nursing workforce at the same time the general population is growing older and the proportion who are elderly is increasing,” the report said.

Overall, Dr. Mary K. Wakefield, the HRSA administrator, said officials are “encouraged by growth in the numbers and diversity of registered nurses and HRSA is committed to continuing this trend to ensure an adequate supply and distribution of nurses in the future.”

Reacting to the findings, the American Nurses Association said it was “pleased to note the increasing diversity of the nation’s population of registered nurses.”

“More and more nurses have advanced training; more than half of American registered nurses have a bachelor’s degree or higher,” the ANA said. “Registered nurses in the US exhibit an increasing diversity of origins.”

“By gender, race, and ethnic origin, US nurses are also increasingly diverse,” the ANA said. “In the 2008 data, there were more male nurses, more non-white nurses, and more Hispanic nurses than ever before.”

“Greater minority involvement in the health professions, including nurses, is critical,” Wakefield said in a statement to HealthLeaders Media. “Numerous studies indicate that underserved communities benefit from the service of minority providers, who are more likely to choose to practice in these communities,” she said.

The National Council of State Boards of Nursing reported that there was a large increase in the number of internationally-educated nursing graduates who passed the National Council Licensure Examination, from 5,000 nurses in 1998 to more than 22,000 nurses in 2007.

“The growth in the number of internationally-educated nurses passing the NCLEX is consistent with the substantial growth in the number of internationally educated RNs living in the US,” the report stated.

Additional findings included:

  • There are also wide variations across states in the number of employed nurses per 100,000 people. The lowest numbers of employed RNs per 100,000 were in Utah, (598), Nevada (681), and California (638), while the largest numbers were in the District of Columbia, (1,868), South Dakota, (1,333), and North Dakota, (1,273).
  • Half of RNs have achieved a baccalaureate or higher degree in nursing or a nursing related field in 2008, compared to 27.5% in 1980.
  • The number of RNs with a master’s or doctor’s degree rose to 404,163 in 2008, an increase of 46.9% from 2004, and up from 85,860 in 1980.
  • Average annual earnings for RNs in 2008 were $66,973, an increase of almost 15.9 % from 2004, a figure that slightly outpaced inflation.

Joe Cantlupe is a senior editor with HealthLeaders Media Online. He can be reached at

Here’s the link to the original article

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March 29, 2010

Workplace Violence In The Medical Sector – A Unique Perspective

Here’s an article I found that addresses the differences between they type of violence found in offices and factories and they type found in medical facilities.  There is a difference; we, working in the field, have known this fact for quite some time.  We have even been pretty vocal about the differences, but it appears that no one has listened.  I like the last part of this article that specifies the dilemma nurses are in when faced with violence.    We still have to care for the person because our licenses say we do; because that is the right thing to do; because we care about our patients and our profession.

Let me know what you think of this particular article, won’t you?

By: Jeffrey M. Miller

While the concept of violence in the workplace is not new by any means, any more than workplace violence is an “American-thing,” the medical sector is waking up to the reality that it is in a, so-called, league of its own.

For years, the medical sector, at least that part of it that took action, has been treating the issue of workplace violence as though hospitals, clinics, and doctor’s offices were no different than factories. Those who did take measures to prevent violence in the workplace – who did create workplace violence plans, polices, and procedures for handling this important issue – did so as though they were “just like everybody else.”

And, they have come to find out…

…it just wasn’t so.

The Reality of Workplace Violence In The Health Sector

The truth when it comes to WPV in the healthcare field is that…

  • The health care sector has one of the lowest – if not THE lowest rate of employee-initiated incidents in the corporate world. Good for them. But…
  • The health care sector has THE HIGHEST number of incidents of violence perpetrated against health workers on the job!

We’ll talk about why this is true in another post. But what’s important now is the fact that the health care community made a serious error in judgment. They operated under the premis, and hired workplace violence consultants to assist them based on the premis, that they had the same problem that every other company did, and they could use the same measures.

In fact, when it comes to violence in the workplace, the health sector is in such a unique position that the United States’ Federal Bureau of Investigation – the FBI – has created a seperate listing for health care professionals in the world of workplace violence.


A few reasons.

  1. The typical attack on a health care worker is perpetrated by an assailant who does not fit the profile established using standard workplace violence data and statistics.
  2. The typical assailant in an attack on a medical professional lashes out for very different reasons than in the rest of the corporate world. And…
  3. Health care workers are in a very unique position when it comes to dealing with an attack, in that he or she must defend themselves while simultaneously providing aid to their assailant!

Its Time Has Come

In the past year or so, the medical community has been waking up to the realities of workplace violence as it relates to them. They are re-examining their beliefs, policies, and procedures and seeing the lack of real protection.

In fact, many facilities, just like many standard companies in the corporate world at-large, are realizing that the workplace violence plans, policies, and procedures they have in place…

…just might be creating the very same liability issues they were meant to handle in the first place!

About the Author

Does your company have a solid and complete workplace violence training program? Do you and your workers know what to do should the unthinkable happen and you come face-to-face with violence in the workplace? Or are you betting the lives and safety of everyone involved that there isn’t someone right now, inside or outside your company, planning an attack? Get the facts and stop making safety decisions based on denial, apathy, or ignorance. Read my new workplace violence report, “Attack-Proof Your Facility!” It’s available free at:

Jeffrey M. Miller is an internationally-recognized self defense expert and workplace violence defensive tactics trainer. Every month, he teaches literally thousands of individuals – alone or as members of groups and companies – how to defend against and survive acts of workplace violence. Mr. Miller is a co-author of the books, “Workplace Violence in the Mental and Healthcare Settings,” (Jones and Bartlett Pub. 2010); and “Using GIS in Hospital Emergency Management,” (CRC Press 2010); as well as several others. He may be reached through his international office in the US at (570) 988-2228.

(ArticlesBase SC #2062003)

Article Source: Violence In The Medical Sector – A Unique Perspective

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March 27, 2010

8 Reasons to Stay

Here’s a quickie to address the reasons to stay in nursing.  With all the bad press out there and with all the job stress, it is easy to forget the good things about being a nurse.  So, I thought I’d post this short note from  Please visit them and check out all of the wonderful information about nursing you can find there.
There will be days when you may ask yourself, “should I stay, or should I go”?  Despite the challenges, nursing is a profession of caring. Those who have a passion for nursing don’t need a lot of convincing to stay in the profession.

However, a few reminders never hurt.  Here are 8 to start!  (wink!)

8 Reasons to Stay

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March 26, 2010

Wyoming will review nurse pay plan, governor says

Filed under: Nursing — Shirley @ 6:47 pm
Tags: , , , , ,
Wyoming State Capitol
Image by gravitywave via Flickr
Excuse me!  I am not sure I read this article right.
Could you please read this article and then tell me what you understand it to say.  I thought it said that CNA supervisors would be paid $2.48/hr less than an RN.  I must not have the right glasses on.  Or, I am really becoming senile.  This cannot be correct.  No wonder there is a nursing shortage.
Please let me know what you think about this, won’t you?
By: The Associated Press | 25 Mar 2010 | 09:00 AM ET

CHEYENNE, Wyo. – Gov. Dave Freudenthal says the state will review job classifications for nurses on the Wyoming payroll.

Some nurses at the Wyoming State Hospital at Evanston had threatened to resign because of a new pay plan that awards certified nurse assistant supervisors a higher salary than licensed practical nurses and only $2.48 an hour less than what registered nurses earn.

Dean Fausset of the Department of Administration and Information says job descriptions for the nurses may have changed since the state collected documentation for their job classifications more than a year ago.

About 2,500 state employees will receive raises under the new pay plan, which moves salaries to 85 percent of market pay.


Information from: Casper Star-Tribune – Casper

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March 25, 2010

10 Best Practices for Patient Safety

Filed under: Nursing — Shirley @ 5:08 am
Tags: , , , , ,
"Mother and Child" by Henriette Brow...

Image via Wikipedia

This article lists 10 ways we, as nurses, can advocate for our patient’s safety.  These are not new and really are things we all are already doing in our daily nursing practices, but it never hurts to be reminded that patient safety is our first concern and should be taken seriously.

Read this list and then let me know if you have anything else to add.


By Susan Kreimer, MS, contributor

March 18, 2010 – Just before the new millennium, health care began building a foundation to advance patient safety. The catalyst: a 1999 landmark Institute of Medicine report that highlighted safety problems and paved the way for reducing medical errors. Since then, many evidence-based practices have evolved to offer effective solutions to common adverse events.

Many are simple, common-sense practices that need to remain at the forefront of nurses’ work habits, including these 10 important safety measures.

10 Best Practices for Patient Safety:

1. Curb infection spread – Wash and sanitize hands before coming into direct contact with each patient. Data indicate that health care-associated infections are the most common serious hospital complication. Each year, they affect nearly two million patients, lead to an estimated 99,000 deaths, and cost the health care system as much as $20 billion, according to the Centers for Disease Control and Prevention. The most frequent infection of this type is methicillin-resistant Staphylococcus aureus, or MRSA.

2. Identify patients correctly – Rely on at least two pieces of information, such as name and date of birth. This helps ensure that patients receive the medicine or other treatment intended for them. Also, check for the appropriate blood type before a transfusion, according to The Joint Commission’s 2010 Hospital National Patient Safety Goals. (Editor’s Note: See related Devices & Technology column for the latest in patient identification technologies.)

3. Use medicines safely – Label all drugs, including those in syringes, cups and basins. Take extra precautions with patients on blood thinners. With the enormous number of prescription drugs on the market, there is significant potential for error due to confusing brand or generic names and packaging. The Joint Commission’s safety goals require finding out which medicines each patient is taking. Make sure that any additional medication doesn’t conflict with current ones.

4. Avoid surgical errors – Follow The Joint Commission’s “Universal Protocol” to prevent wrong-site or wrong-person surgery and performing the wrong procedure. One effective strategy is called “time-out.” This a specific period for all team members to independently verify an impending clinical action, according to the World Health Organization’s Collaborating Centre for Patient Safety Solutions, which consists of The Joint Commission and The Joint Commission International.

5. Prevent venous thromboembolism (VTE) – Eliminate hospital-acquired VTE, the most common cause of preventable hospital deaths. A free guide from the Agency for Healthcare Research and Quality spells out the essential first steps, presents evidence and identifies best practices, analyzes care delivery, and tracks performance with metrics and interventions.  “Included in the guide are examples of standard order sets that can help ensure patients receive evidence-based care shown to prevent these clots,” said Jeff Brady, MD, MPH, the agency’s lead for the patient safety portfolio. It also would help to classify patients based on risk, ranging from low to mid and high.

6. Customize hospital discharges – Create an easy-to-follow plan for each patient. It should include a medication routine, a record of all upcoming medical visits, and names and numbers of whom to call if problems arise. These steps can help decrease potentially preventable readmissions by 30 percent, according to the agency. Medications and follow-up care may have changed due to hospitalization, Brady said. “It’s not only telling the patient about any changes in medication regimens and what needs to happen after discharge, but also actually scheduling appointments for follow-up evaluation and care,” he added. Equally important is documenting vital information clearly so that a patient understands.

7. Use good hospital design principles — Prevent patient falls with evidence-based design of patient rooms and bathrooms as well as decentralized nurses’ stations. This allows for easier observation and access to patients. Falls can result in serious injuries, extend a patient’s stay and dramatically drive up health care costs. For more information, nurses and administrators can download a free 50-minute DVD from the AHRQ, “Transforming Hospitals: Designing for Safety and Quality.”

8. Assemble better teams and rapid response systems – Encourage everyone on the team, including junior members, to speak up. “One thing that can be a barrier to effective communication is the hierarchy that exists on healthcare teams,” Brady said. A free toolkit called TeamSTEPPS™, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety, can be tailored to any health care setting, from emergency departments to ambulatory clinics.

9. Share data for quality improvement – Participate in The National Database of Nursing Quality Indicators (NDNQI)®. This proprietary database of the American Nurses Association (ANA) collects and evaluates unit-specific, nurse-sensitive data from more than 1,500 participating U.S. hospitals. The facilities receive unit-level data reports that they can compare to similar units regionally, statewide and nationwide. This gives nurses and their managers the opportunity to evaluate performance and staffing levels relative to patient outcomes and set organizational goals for improvement.

“The future of health care is evidence-based practice. To have the evidence, you need to collect the data and make apples-to-apples comparisons – your nursing unit’s performance versus similar hospitals’ performance for the same type of unit,” said Isis Montalvo, MBA, MS, RN, director of ANA’s National Center for Nursing Quality®, which oversees the NDNQI program. “The days are gone when nurses did what seemed right, or did things because that’s the way they had always been done. Our decisions today should be made based on a scientific foundation. Through NDNQI, we have data that allows us to make the best practice decisions possible. We know what practices lead to reduced fall rates, reduced hospital-acquired pressure ulcers and other adverse patient outcomes.”

10. Foster an open-communication culture – Minimize mistakes due to lack of communication between doctors, nurses and other health professionals. A similar strategy worked for the airline industry. About 30 years ago, it became obvious that better communication between a pilot and crew members reduced human-error-related accidents and fatalities. The Institute of Medicine in 2004 suggested emulating high-reliability industries such as the airlines to transform nursing. Since then, various “Crew Resource Management (CRM)” programs have been adopted in many U.S. hospitals. Through interactive sessions, nurses learn to maintain awareness in changing clinical situations, said Gary Sculli, RN, MSN, a former airline transport pilot who is now program manager at the VA National Center for Patient Safety in Ann Arbor, Mich. This approach “challenges nurses to think differently about their work and empowers them to transform their practice.”

Here’s the link to the original article

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March 24, 2010

DC/Maryland/Virginia Letters To The Editor

Here are two letters to the editors of that address the issue of staffing and safe patient to nurse ratios.  I found them to be quite interesting, even though they come from two different perspectives.  Please read these and then go to the original article to read it.  Let me know what you think, won’t you?

Staffing Ratios Need Everyone’s Attention
I was pleased to see your article (“The Sum of Staffing,” Feb. 8 issue) on nurse-to-patient ratios. As an RN for 34 years and an ER nurse at Temple University Hospital in Philadelphia for 11 years, I can attest to the need for such ratios in Pennsylvania.

Many days, I have gone home from work exhausted and frustrated with the knowledge that I often was unable to give the most appropriate, and, at times, safe care.

As the president of the Pennsylvania Association of Staff Nurses & Allied Professionals, I have worked with many nurses across the state who have expressed the same concern about unsafe conditions and the need for ratios.

Bedside nurses know from experience that minimum ratios are the best guarantee for patient safety.

We have ratios in our day care facilities and our prisons, so why not in our hospitals where it is a matter of life and death? As nurses, we should be able to work under the conditions that enable us to apply our clinical skills, not simply juggle impossible patient loads.

We have therefore introduced a bill in the state Senate that would mandate safe, minimum ratios in hospital units, similar to California.

The chief sponsor of this bill, called the Pennsylvania Hospital Patient Protection Act, is Sen. Daylin Leach, and the bill number is Senate Bill 742. Similar legislation is in the house as House Bill 147.

We plan to have hearings and rallies and conduct a public campaign to achieve passage of this important legislation. Pennsylvania nurses and patients deserve a safe working environment.

— Patricia Eakin, RN
President, Pennsylvania Association of Staff Nurses & Allied Professionals Philadelphia

‘Sum of Staffing’ Equals Misinformation for RNs
To say I am disappointed with the article “The Sum of Staffing” (Feb. 8 issue) would be a major understatement. It does not present an unbiased picture of the staffing-ratio issue for nurses to consider and merely fosters misinformation that is favorable to the industry.

We all understand that having the appropriate number of nurses on the unit is critical to safe care and the skills mix. The issue boils down to whether we, as nurses, and the public, as patients, can trust the facilities to do the right thing when it comes to staffing.

It is not an issue of occasionally shifting into high gear to handle an overload, but rather the chronic need to shift gears.

Some of the article is true. Ratios improve patient satisfaction and patient care. There is strong evidence to support improved patient outcomes, and the work by Linda Aiken appears well done.

The intangible benefit may be that nurses stay in the workforce longer, burn out less and are safer practitioners. Given a recent poll that shows 30% of nurses are considering changing career paths, this becomes critical when we consider the looming nursing shortage.

The recent emphasis on a staff nurse component of the decision-making team is a farce, and once again we will be at the mercy of an industry that already has demonstrated its reluctance to institute rational staffing. Which staff nurses are to be included? Who decides which nurses sit on these committees?

I hear it from my friends. I hear it from my students, and I read about it on blogs.

The loads are just too heavy, the acuities too high.

It’s time we stop pretending there is no problem and start acting to protect ourselves and our patients. We need to become the patient advocates we think we are.

— John Silver, RN PhDc
Assistant Professor of Nursing
Nova Southeastern University
Fort Lauderdale, Fla.

Letters to the editor may be edited for content, length and clarity. Letter writers must be identified by name and location, although names may be withheld upon request at the discretion of the editor. E-mail letters to or post your comment online.

Here’s the link to the original article

Here’s the link to the original letters to the editors

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March 23, 2010

Nurses’ Research Settles a Common Cancer Concern: Skin Care

Filed under: Nursing — Shirley @ 1:53 pm
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Here is a wonderful article that describes how a single nurse can have a remarkable impact on both  patients and the medical community as a whole.  I love when I find positive articles about the power of a nurse’s determination.  Nursing research usually gets shrugged off as “fluff” or as not really important, but nurses are out there daily caring for the ill and we see areas that need to be addressed to make patients more comfortable and more likely to continue treatment.  Please read this article and let me know of any positive nursing research you may know about.


ScienceDaily (Mar. 22, 2010) — Given the complexity of cancer treatment, skin care may seem like a small matter. However, a nurse at the James P. Wilmot Cancer Center knew that skin issues were a constant source of anxiety for many patients receiving radiation therapy, and through research she discovered that routine advice was rooted in myth instead of scientific evidence.

Her findings, which have been published in the Clinical Journal of Oncology Nursing, are prompting change locally and across the country.

“We’ve had a lot of feedback and we’re very pleased we could explore a topic that makes a difference for patients going through cancer treatment,” said Trish Bieck, R.N., the study’s lead author, who also credited co-author Shannon Phillips, R.N. Both are senior nurse specialists at Wilmot.

As a result of Bieck’s study, the National Cancer Institute revised its recommendations for patients and rewrote its widely distributed brochure, Radiation Therapy and You, to incorporate the new findings. The Oncology Nursing Society also invited Bieck to serve on its national committee to update patient guidelines.

At the crux of her investigation was whether evidence supports the exclusion of moisturizer or any topical agent on the radiation field within four hours of treatment. Generally, the use of skin lotion is viewed as a way to prevent skin changes, which are a common and distressing side effect of radiation treatment.

However, one widely held theory is that the presence of lotion can actually increase the risk of a bad skin reaction by inducing a bolus effect, or inadvertently making the skin thicker and thereby boosting the surface dose of radiation.

On the other hand, going without lotion can result in skin damage and dryness. This can lead to infection and pain, resulting in the interruption of treatment and an increased chance that malignant cells will repopulate while the skin heals.

So, until now, the patient was left to wonder: Should I use lotion prior to therapy and worry that my treatment is not as effective as it could be? Or do I skip the lotion and risk a skin reaction, infection, or discomfort?

As a compromise, many institutions, including the NCI and the University of Rochester Medical Center’s Wilmot Cancer Center, have been telling patients for years to avoid lotions at least four hours before therapy.

“It always bothered me that there didn’t seem to be any rationale behind restricting lotions during that particular timeframe,” said Bieck, who has worked in Radiation Oncology for 20 years. “When I looked into it, I discovered little evidence to support the four-hour policies. Instead, the practice was based on historical practice — in other words, ‘just because, that’s the way we do it.’ ”

She conducted a literature review of relevant articles published between 1992 and 2009, interviewed experts, examined benchmarks at international cancer centers, and consulted with professional organizations. In the United States, she found wide variation in practice: for example, among five institutions spread across all regions of the country, their advice ranged from no lotion restrictions at all to complete avoidance of lotions to restriction of lotions one hour before treatment.

No scientific evidence supported a four-hour restriction of lotions, and no evidence showed that lotion or topical agents such as deodorants made radiation therapy less effective.

Only five scientific articles addressed the topic, though, and based on that small number Bieck believes more research is needed on the safety of lotions used on irradiated skin.

Meanwhile, as a direct result of the project, the Wilmot Cancer Center developed standardized skin-care guidelines and revised its education materials. Now, staff recommends that patients avoid applying lotions immediately before treatment, but allows the patient to maintain some control over their usual skin-care regimen.

Story Source:

Adapted from materials provided by University of Rochester Medical Center.

Journal Reference:

  1. Trish Bieck, Shannon Phillips. Appraising the Evidence for Avoiding Lotions or Topical Agents Prior to Radiation Therapy. Clinical Journal of Oncology Nursing, 2010; 14 (1): 103 DOI: 10.1188/10.CJON.103-105
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March 22, 2010

Who is the ideal nurse?

Filed under: Nursing — Shirley @ 11:53 pm
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I found a wonderful site that has numerous links with information about the history of nursing with a focus on men in nursing.  Check it out.  There is some really great information at the site.  I spent quite a bit of time reading these tidbits of knowledge and came away enlightened.

Be sure to check out the site:

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