Nursing Notes

June 30, 2010

Smartphones to the Rescue

Here’s an article from Advanceweb.com about technology and its impact on patient care at the bedside.  After reading this article, I have a new and better appreciation of the newer smartphones and the capabilities they open up for nurses.

Please read this article and let me know what you think.  Are you using this technology where you work?  If so, let us hear from you about the pluses and/or minuses you experience with their use.

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Nurses help pioneer clinical use of devices for time-saving messaging and more.

By Sandy Keefe, MSN, RN

Posted on: June 23, 2010

As relief night charge nurse on a medical unit at Sarasota Memorial Hospital, Sarasota, FL, Jackie Baxter, RN-BC, often was frustrated by communication glitches that negatively impacted patient care.

“We were having problems because patients were waiting too long to see a nurse, but the nurses weren’t always getting the messages about their patients’ needs,” she said. Her graduate studies in nursing informatics made her aware of potential solutions, so she was pleased to be invited to participate in a discussion about smartphone solutions.

Integration

Entrepreneur Trey Lauderdale came to Sarasota to discuss healthcare-focused communications solutions software with nurses and information technology (IT) staff.

“There are so many systems in the hospital setting that produce critical information, notifications and alarms,” he explained. “There are nurse call systems, infusion pumps, smart beds, monitors, alarms and other sources. That’s a lot of information to convey. If your end device is a pager, the nurse won’t get all that rich information. Nurses were getting frustrated with the lack of innovation in end-user devices.”

Lauderdale brought along smartphones preprogrammed with software that integrates some of that vital data. “The nurse walks in, picks up a smartphone from a charger and logs in,” he explained. “The system automatically routes all messages and notifications to the correct end user.”

The synergy between clinicians and IT experts at that meeting gave rise to a long-term working relationship…[read more]…

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June 29, 2010

Nurse to Patient Ratios: The Lucky Few

Here is a follow-up on the article I posted from the NY Times “Is There a Nurse in the House?”  This is from the SEIU Blog and is a very good complement to the original article.   Please read below and let me know what you think.  Do any of you readers sit on your hospital’s Staffing Committee?  If so, tell us about your experiences please.

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cathy.jpg

A recent NY Times editorial — “Is there a nurse in the House?” — hit a nerve with me, and probably many other registered nurses around the country. I rarely see a piece in the paper that is so on point about the challenges professional nurses face providing healthcare to our patients.

The editorial, by Theresa Brown, RN described nurses as first responders and the first providers to act in crises. And yet, as Brown notes, even though research proves that thousands of patients die unnecessarily in hospitals where there are too few nurses to provide care, most hospitals around the country continue to cut nursing staff as a cost-cutting measure.

It doesn’t have to be this way. Patients at Allegheny General Hospital (AGH), a level one-trauma center, where I work in Pittsburgh, PA are among the lucky few in this country. We union nurses sat down as equal partners with management and negotiated safe nurse to patient ratios into our SEIU contract for every department in the hospital. Our facility is definitely not the norm. Outside of California, where SEIU was instrumental along with other nurse unions in winning legislated staffing ratios, there are no requirements for safe staffing ratios. In fact, most hospitals in the rest of the country force nurses to accept overloaded assignments that risk patients’ lives on a daily basis. But, as I said, it doesn’t have to be this way.

When nurses have the time to professionally monitor our patients, we identify the smallest changes in a patient’s condition and thereby prevent complications that might otherwise lead to death. We provide the care that eases pain and reduces fear.
When nurses have too many patients on a shift, that level of attention is impossible to maintain; and patients lie in wait and at risk.

Patients in hospitals where nurse to patient ratios are in place, are free from central-line infections and other hospital-induced complications; they are rarely harmed by medication errors; they learn about their medications from nurses who have time to teach them; and they can go home healthier and prepared to live in a state of wellness rather than returning to the hospital sicker than ever just a short time later.

There is no reason why every single hospital in this country cannot model its nursing practice after Allegheny General Hospital in Pittsburgh and frankly, patients in this country cannot wait for it to happen hospital by hospital. Our hospital has had its financial challenges, but nurses and administrators kept working together, focusing on the mission of providing the highest quality of care to the community it serves.

As healthcare reform is implemented and quality care is incentivized, the healthcare industry is finally shifting its attention to quality standards for care. The only way for hospitals to achieve those standards will be to adopt nurse to patient ratios. However, hospitals are notorious for resisting the obvious. That’s why I agree with Theresa Brown that nurse to patient ratios must be mandated by law in order to give every patient in this country the care that our AGH patients in Pittsburgh receive.

It seems to me that patients in New York, or Louisiana, or Alaska might want that kind of nursing care, too. As a nurse I think they deserve it. As a leader of nurses in this country I will fight for it and I hope the rest of the nurses in this country and our patients will stand with us to support the staffing ratios bills from Congresswoman Schakowsky, HR2273, “Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009”; and Senator Boxer, S1031, “National Nursing Shortage Reform and Patient Advocacy Act”. The research leaves no doubt. You are safer in my hands when I have the appropriate number of patients.

Cathy Stoddart, RN, BSN is the Chair of the Nurse Alliance of SEIU Healthcare Policy & Politics Committee and a staff nurse at Allegheny General Hospital in Pittsburgh, PA

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June 25, 2010

Is There a Nurse in the House?

Filed under: Nursing — Shirley @ 5:22 am
Tags: , , ,
Caduceus
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Here is yet another article on the need for “safe staffing levels”, otherwise known as mandated nurse to patient ratios.

This topic is not going to go away.  The public really need to become informed and active in this discussion.  Lives are at stake.  As more and more nurses are driven out of the profession by inhuman demands and dissatisfaction, who will remain to care for the sick and injured?

I do understand that hospitals resistance has to do with the cost of providing this level of care, but isn’t care what a hospital is supposed to be providing?

Enjoy this article and please feel free to go to the original post and leave your own thoughts.  Leave me a comment too, please.

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By THERESA BROWN

PICK any of the hospital dramas that have run for decades on American TV, and chances are the heroes are the doctors, running to a patient’s bedside to save a life whenever an alarm goes off.

Doctors can indeed be heroes. But when a patient takes a sudden turn for the worse, it’s the nurses who are usually the first to respond. Each patient has a specific nurse assigned to watch over him, and it is that nurse’s responsibility to react immediately in the event of an emergency.

That’s getting harder to do, though. Cost-cutting at hospitals often means fewer nurses, so the number of patients each nurse must care for increases, leading to countless unnecessary deaths. Unless Congress mandates a federal standard for nurse-patient ratios, those deaths will continue.

A few states already have minimum ratio requirements, most notably California, which in 2004 instituted a one-to-five ratio for surgery patients — as well as a one-to-four ratio in pediatrics and a one-to-two ratio in intensive care — after a decade-long fight led by the California Nurses Association.

Laws like these could make a huge difference nationally. A recent study led by Linda Aiken, a professor at the University of Pennsylvania School of Nursing, found that New Jersey hospitals would have 14 percent fewer surgical deaths if they matched California’s ratio, while Pennsylvania would have 11 percent fewer. Professor Aiken looked at surgical units only, but it’s reasonable to assume that the percentages would apply on any hospital floor.

The reason is simple. The fewer patients each nurse oversees, the easier it is to respond when a patient has an emergency, like a sudden, severe decline in oxygen saturation, a precipitous drop or rise in blood pressure or a heart rate that suddenly skyrockets. A nurse juggling the needs of too many patients might not have the time to notice, let alone respond.

Nevertheless, hospitals have resisted mandated ratios. While higher personnel costs are most likely at the core of their opposition, they also argue that hospitals that already have good ratios will use the standards to justify cutting the number of nurses on each floor.

This is a reasonable concern, but one that rarely if ever proves true. In more than a decade of research, Professor Aiken reports never seeing such reductions in the wake of mandated ratios. Moreover, if hospitals were so callous, why do many — including my own — often meet or exceed California’s standards?

Moreover, it’s not as if such low ratios are a luxury; there’s a reason why minimum ratios are also called “safe staffing levels.” Say a nurse can’t come in because of a family emergency. Then another nurse becomes ill and has to go home. The charge nurse will call around to other staff members, trying to find last-minute replacements. But sometimes there’s no one to come in and no nurses available at the last minute to “float” to the understaffed unit. The lower the ratio, the more likely the nursing staff will be able to cover if and when personnel suddenly become unavailable.

The real issue, of course, is cost. There’s no denying that hiring more nurses is more expensive in the short term. But having too few nurses leads to burnout, not only  […more…]

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June 24, 2010

Patient discharge planning receiving more attention

It has always seemed to me that discharge planning was forgotten or simply ignored in the past.  Patients came in, got treated, signed papers and got copies, and they left the hospital.  I always wondered if my patient really understood the correct way to care for themselves at home.  There was a time when home health was available and utilized more, but abuse of that system has curtailed that avenue for the most part.  Home health is still available, just not as readily.

My patients are the mentally ill, so discharge planning is even more important, but at the same time my patients may or may not follow through.  I often worry about patients after they leave the hospital because I know in my heart that they will be back soon.

It’s great to see a push in this industry to have an adequate discharge plan in place and to involve the entire team in this process.  The patients can only win in this situation.

Here’s an article from the Patient Safety Monitor about this topic:

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Discharge planning has been an often neglected time in a patient’s hospital stay, which is likely one of the main reasons 20% of patients return to the hospital within 30 days, reports The New York Times. Several new programs have taken root to reverse this trend and ensure that patient care at discharge is a focal point to prevent patients from returning to the hospital.

Two of these programs, Project BOOST (Better Outcomes for Older adults through Safe Transitions) and Care Transitions Intervention, are leading the way. Project BOOST is a creation of the Society for Hospital Medicine and provides interested hospitals with a toolkit of standardized forms to streamline the discharge process. Care Transitions Intervention is out of the University of Colorado Denver’s School of Medicine, with funding from the John A. Hartford Foundation and the Robert Wood Johnson Foundation.

I wrote about the Care Transition Intervention program a couple of years ago in Briefings on Patient Safety. At that time, this project was a newer take on how to manage the handoff process for patients being discharged from the hospital. It also gave rise to the notion of a “transitions coach,” a similar concept to that of the “patient navigator” I posted about last week.

Has your facility taken part in any program that focuses on patient discharge as a means of preventing rehospitalization?

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About the Author: Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books, webcasts, and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals (www.accreditationprofessional.com) and manages Patient Safety Monitor (www.patientsafetymonitor.com), of which this blog is a part. Contact Heather by e-mailing hcomak@hcpro.com

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June 23, 2010

Going to Work When You’re Sick

Becky's costume: sick person
Image by jadam via Flickr

In case you haven’t noticed, I love the NY Times Well Blog.  I read Tara Parker-Pope all the time and find many great articles by her to share here with you.  She seems to have her pulse on the real world of health and healthcare.  She talks about  nursing issues with authority and she covers problems in the industry without apologizing.  This article is just one example.

In my experience, giving more paid sick days may or may not be the answer.  As a nurse, I have paid time off as one of the benefits of the job.  However, getting to use any of it is the real problem.  If you are sick and call in, you will be manipulated with guilt and treated like a slacker.  The truth is, if you call in sick, your co-workers will, in all probability, have to work short and that means taking even more patients each.  You will feel guilty despite being sick.  There  has to be an answer, but I’m not sure that more paid days is it.  Maybe we need to make it so taking a real sick day is possible, first–then look at the number of paid days available.

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By TARA PARKER-POPE

A new poll shows that most Americans support proposed legislation requiring companies to offer at least seven days of paid sick leave, reports the Economix blog.

Notably, the survey clearly showed what happens when people don’t get paid sick leave: more of them go to work sick and send sick kids to school.

The survey found that 55 percent of respondents who said they were not eligible for paid sick days said they had at some point gone to work with a contagious illness like the flu or a viral infection, compared with 37 percent who said they received paid sick days. Twenty-four percent of those who did not receive paid sick days said they had sent a sick child to school or day care because they had to go to work. That compared with 14 percent of those who were eligible for paid sick days.

To learn more, read the full post, “Most Americans Support Paid Sick Leave, Poll Finds.” What do you think? Has a lack of paid sick leave forced you to expose your coworkers or school children to illness?

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Please go here to read the original and leave a comment in the discussion.  Some of the comments are just as interesting as this article, so please do go read them.

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June 18, 2010

Improve Scheduling To Boost Nurse Satisfaction

Scheduling….ah….scheduling.  This is the thorn in the heart of the problem, I think.  Nursing is such a stressful job.  We want to do the very best we can for our patients, but we are also human and have limits.  The article below addresses the issue of scheduling with a focus on management.  I elected to post the entire article because I felt it was valid and useful here.  I encourage you to go to the original site and read the original article as well as other informative articles found there.  This site, HealthLeaders Media is very good and frequently has current issues and excellent articles.
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Karla Schnell, for HealthLeaders Media, June 8, 2010

A major concern in healthcare today is the nursing shortage, which promises to get worse as the number of people choosing this profession declines while demand for their services continues to grow.

During my career as a registered nurse, I experienced the lifestyle of these caregivers. While nursing is very rewarding, it comes with struggles: long hours, unexpected overtime, and erratic schedules. This can make nurses’ lives emotionally and physically draining.

If we could normalize nursing schedules, not only could we make their lives a little less stressful, we could maximize staffing efficiency for providers, lower their personnel costs, and perhaps contribute to the long-term viability of this important profession.

Here are some of the steps to take to improve conditions for nurses:

  • Don’t let scheduling be an afterthought. Make sure there is a structure in place so that administrative scheduling doesn’t fall on nurses who should be providing care. Be ready for last-minute changes and have a system in place so that everyone knows what to expect.
  • Provide staff schedules in advance. Scheduling problems can make it challenging for nurses to manage family commitments and maintain a satisfying quality of life. Nurses often work long hours and inconsistent shifts, leading to burnout, fatigue, and health problems. Some are given their schedules just two weeks in advance and are frequently asked to work overtime shifts without notice, which makes it hard for them to take care of the day-to-day activities we all take for granted. Hospitals that offer nurses regular schedules, months in advance, will be more successful at recruiting and retaining them. This gives a hospital the upper hand in an industry where there is a shortage of talent and constant competition for the best.
  • Increase continuity of care. Continuity of care, when nurses provide care for a patient for consecutive days, allows nurses to get to know their patients, their conditions, and their treatment plans much better than if they are assigned to a different patient every day. This can improve patient safety and patient satisfaction. An efficient staff-scheduling process can have a major effect on the ability to provide maximum continuity of care.

Every healthcare organization should step back and evaluate the scheduling process for nurses. While this may seem like a small issue on the surface, it can have a serious effect on a company’s bottom line. The largest expenditure for a hospital is its nurses. While it is expected that the nursing staff will naturally have some overtime, approximately 2%-3% of the budget, most hospitals are experiencing unnecessarily high overtime, around 6%-8% of the budget. By harnessing this overspending, a hospital can save a significant amount of money, and free funds to be reinvested into patient care, equipment to improve overall care and efficiency, or other strategic projects.

The potential to provide a safer patient experience is reason enough to pursue the goal of a more balanced scheduling approach, but the additional opportunity to take care of precious and scarce human and financial resources drives the issue to the forefront. We have an opportunity to make a very positive impact on all involved by managing our staff scheduling process better.


Karla Schnell is a consultant with North Highland and works with major national providers throughout the United States. She began her career as a nurse in Canada more than 20 years ago and quickly moved up the ranks to become one of the youngest nursing directors in the Province.

Here is the link to the original article

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June 16, 2010

Hear what it’s like from a real CCU nurse

Filed under: Nursing — Shirley @ 5:08 am
Tags: , , , , , ,

This is a great video. This nurse is real and honest and knows what she is talking about. We need this kind of nurse in large numbers. We only get to hear the negative side of nursing most of the time, but the truth of the matter is that we went into nursing because we wanted to make a difference in the life and the lives of others. This short video describes that desire quite well. What do you think?

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June 15, 2010

Interruptions Risk Medication Errors by Nurses

day 57/365 - Drugs
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This was the topic of a research class I attended last week.  This is such a no-brainer, but at least people are starting to take note that there really are times in the nurse’s day that need to be uninterrupted to assure a good patient outcome.  Medication errors happen, it’s a fact.  What we want to be doing is all we can to minimize the number of occurrences and to eliminate them before they reach the patient.

It’s pretty hard to focus on checking medications when you have eight patients clamoring for their medications and you have admissions telling you to hurry up because they have an admission for you.  On my unit, you can add the possiblity of having a code called for an aggressive patient when you are getting medications ready to pass.  This is very stressful for the nurse and potentially harmful to the patient.

Please read this article and let me know your thoughts.

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By Charles Bankhead, Staff Writer, MedPage Today
April 27, 2010

MedPage Today Action Points

  • Explain to patients that this study showed that interruptions were associated with an increased error rate among nurses administering medication.

Review
When nurses are interrupted while administering medication, the risk of procedural failure and clinical error increases, data from an Australian study showed.

Such interruptions occurred more than half of the time, and three during the same drug administration led to a procedural failure rate of 85% and a clinical error rate of almost 40%, according to a study reported in the April 26 issue of Archives of Internal Medicine.

Every interruption increased the risk of procedural failure and clinical error by 12% to 13%.”We found a significant dose-response relationship between interruptions and procedural failures and clinical errors in medication administration in both study hospitals,” Johanna Westbrook, PhD, of the University of Sydney, and co-authors wrote.

“Furthermore, we found that, as interruptions increased within a single drug administration, the greater the severity of the error. Without interruption, the estimated risk of a major error was 2.3%; with four interruptions this risk doubled to 4.7% (P<0.001).”

Interruptions have been implicated as a cause of clinical errors, but evidence to support the contention has been lacking.

Studies based on surveys and self-reports have indicated the medication error rate might be as high as one per patient per day, the researchers noted. And a study of three dozen U.S. healthcare organizations showed that medication errors occur in almost 20% of administrations (Arch Intern Med 2002; 162: 1897-1903).

In an effort to add to the knowledge base, Westbrook and co-authors conducted a prospective study at two teaching hospitals in Sydney. The two hospitals have a combined 726 beds.

The study involved 98 nurses in six units at the two hospitals. Investigators directly observed the nurses during preparation and administration of medication to 720 adult patients over a total of 500 hours from September 2006 through February 2007.

All observers were registered nurses or physicians. Participation was voluntary, and the nurses at the two hospitals were aware that the study’s objectives included documenting medication errors.

For several weeks before data collection began, observers had multiple practice sessions at both hospitals. Interobserver reliability also was confirmed in practice sessions and during data collection, involving a total of 528 drug administrations.

Procedural failures included occurrences such as failure to read a medication label, failure to check patient identification, and nonseptic technique. Clinical errors involved mistakes that included wrong drug, wrong dose, and wrong strength of medication.

Failures and errors were classified according to severity on a scale of 1 (unlikely to affect patient) to 5 (likely to lead to death). Errors with a severity of 1 or 2 were considered minor and 3 to 5 as major.

Investigators observed 4,271 medication administrations at the two hospitals. Overall, 2,266 (53.1%) of administrations were interrupted one or more times.

Interruptions were more common at one hospital (73.9% of cases) than at the other (39.5%).  […read more…]

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June 11, 2010

New Way Bacterium Spreads in Hospital

Clostridium difficile
Image by AJC1 via Flickr

I am always interested when I find new research that helps me stay safe and helps me keep my patients safe from being exposed to organisms that can be potentially harmful or even fatal.  C-diff is a very nasty bug and one I would like to stay far away from.

This article exposes the newest research in how this bacteria is spread.  This makes me shudder.  It seems you cannot be safe anywhere, especially inside of a hospital.

This article is from the New York Times “Health” column.  I highly recommend this site for up-to-date information about current issues.

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Health care workers and patients have yet another source of hospital-acquired infection to worry about, British researchers are reporting.

Clostridium difficile, a germ that causes deadly intestinal infections in hospital patients, has long been thought to be spread only by contact with contaminated surfaces. But a new study finds that it can also travel through the air.

The researchers emphasized that there is no evidence that C. difficile can be contracted by inhaling the germs. Rather, they float on the air, landing in places where more people can touch them.

The bug is commonly spread by contact with infected feces, and the British scientists said the new study made it even more urgent to isolate hospital patients with diarrhea as soon as possible — even before tests confirm a C. difficile infection.

“We don’t want people to wait for the confirmation,” said the study’s senior author, Dr. Mark H. Wilcox, a professor of medical microbiology at the University of Leeds. “By then, the cat’s out of the bag.”

Outbreaks of C. difficile, a bacterium resistant to many antibiotics, have been increasing in the United States since 2001, along with the evolution of more virulent strains.

People in good health are rarely infected. But broad-spectrum antibiotics can wipe out the bacteria that normally live in the intestines, allowing C. difficile to flourish. Hospitalized people on antibiotics and the elderly, even when not taking medicine, are at high risk.

Health care workers who touch contaminated feces can spread the disease by direct contact with other people or just by touching objects. The spores are resistant to disinfectants and can survive in open areas for months.

The bacterium produces toxins that can cause fever, nausea, abdominal pain, severe diarrhea — and sometimes colitis, a serious inflammation of the large intestine.

Treatment involves replacing the broad-spectrum antibiotics with other antibiotics, usually vancomycin or metronidazole.

The British researchers began with a six-month investigation of 50 patients, symptomatic and not, with confirmed infection. The air near 12 percent of them was found to be contaminated with C. difficile. The more active their diarrheal symptoms, the more likely they were to have spores in the air around them.

Then the scientists repeatedly tested 10 patients with symptomatic illness over a 10-hour period, and the air near 7 was positive for c. difficile, usually during visiting hours or when there was activity in patient rooms like food delivery, ward rounds or bedding changes […more…]

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June 9, 2010

Forensic Science for Nurses

Filed under: Nursing — Shirley @ 3:10 am
Tags: , , ,
Cover page of the book "Self Assessment a...
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There’s a new blog I just found that talks about forensic nursing.  There is quite a bit of information there, so I wanted to post here about this blog and give the address to go check it out for yourself.  Go to Forensic Science for Nurses.spacer (1K) Be sure to leave Pat a comment.  I learned quite a bit about this area of nursing just by reading her blog.

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I’ve started a blog about forensic nursing to introduce questions regarding forensic nursing, purpose model answers, and promote discussion.

 Forensic nursing science is an investigative nursing approach to explain the events and associated medical-legal issues when injury is sustained by trauma, abuse, neglect, violence, traumatic accidents, and traumatic events of nature.  The overall goal of the forensic nurse is to work with the law enforcement to find the truth, catch perpetrators, exonerate the innocent, and reduce crime.  Medical-legal issues are also encountered in other areas where the law regulates the practice.

What are the eight practice areas of forensic nursing?  Read the blog to find the answer.  Follow this link:   http://forensicsciencefornurses.com/.

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