Nursing Notes

August 31, 2010

Nursing Opportunities Expected to Increase

Filed under: Nursing — Shirley @ 3:40 pm
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Here is an article that states exactly what I have been thinking all along.  Folks, the nursing shortage is still here.  All that happened recently is that our economy took a downturn and nurses went back to work after long “vacations from nursing” or nurses who wanted to “retire” simply were unable to do so.  The median age of nurses is getting older and with all these factors, there simply has to be a shortage of huge proportions in the very near future.  When our economy recovers–note I said when not if–those nurses who want to retire will do so, those nurses who came back to nursing to support the family will go back to caring only for the family, the older nurse working now will start leaving the profession to actually “have a life” and who will be there to fill that void?  Voila!  A nursing shortage!

My biggest concern about new nurses right now is that many may be entering the field for all the wrong reasons.  Nursing is really a calling, not a job.  I hope all the new nurses understand that and come prepared to stay the course for their patients.  I’m not sure that will be the case, but I can try to remain hopeful and positive.

So, what do you think?

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Carol Sorgen

Monday, August 30, 2010; 10:34 AM

For years now, we’ve been hearing about the nursing shortage in this country. Is that still the case? On the whole, yes, say nurse recruiters throughout the Washington metropolitan area, though there has been a temporary “blip” as a result of the recession.

“The economy has certainly had an impact on the job market for nurses, as nurses who were planning to retire have delayed those plans, part-time nurses have requested additional hours, and full-time nurses have sought additional shifts,” says Dennis Hoban, Senior Director of Recruitment for Washington Hospital Center.

But, while short-term the nursing shortage appears to have eased, looks are deceiving, says Hoban. “Long-term, we’re still expecting a shortage for years to come.”

Washington Hospital Center is still hiring both new graduates as well as more experienced nurses, says Hoban, but adds that the application process is more competitive than it has been in recent years, and new grads may have to shift their expectations somewhat. “While we’re always looking to hire nurses, not every unit will have openings,” says Hoban.

In the recent past, new graduates were able to pick and choose their desired area of specialty but openings for new nurses are not as plentiful at this time, agrees Darlene Vrotsos, Vice President and Chief Nursing Officer at Virginia Hospital Center. “Today, employers are searching for factors that will set candidates apart from the rest of the competition,” she says. “Therefore, it is crucial to be flexible and open to where the opportunities are when it comes time to begin interviewing.”

Another way to improve your chances of being selected for a position is by having a customer service attitude, Vrotsos advises. “Today, this skill set is as important to patient outcomes as are critical thinking and technical nursing skills,” she says.

Obtaining employment while still in school as a Certified Nursing Assistant, Patient Care Assistant, or Clinical Technician can also enhance the chances of acquiring a position as a new graduate when the time comes, Vrotsos suggests. “This helps you become acclimated to the clinical environment, while giving your potential employer the opportunity to observe your work ethic and performance first-hand.”

Virginia Hospital Center brings new graduates into all specialties and provides fellowships that are tailored to the individual.

While the 2008 economic downturn has minimized the effects of the nursing shortage, Inova Health System’s nursing and human resource strategists are planning for the near-term when the improving economy will mean nurses are in greater demand. According to Dr. Patti Connor-Ballard, RN and Interim Chief Nurse Executive, despite the lower vacancy rates resulting from the present economy, Inova continues to hire new graduate and experienced nurses to help fill vacancies resulting from promotions and other career enhancement opportunities.

Realizing that the nursing shortage will soon resurface, Inova Health System is committed to its investments in the new graduate fellowship nurse program, designed to provide supplemental education and training to new graduates. “Inova plans to select a number of new graduate nurses who distinguish themselves among their college peers for on-the-job education, mentoring, and training for medical, surgical, oncology and some critical care areas,” says Connor-Ballard.

Inova also continues to seek experienced nurses to provide patient care while allowing for promotions of nurses who are interested in exploring a secondary field of interest such as informatics, professional practice, or quality. Inova also seeks highly trained nurses for areas where there are expansions due to new service lines or new facilities.

According to Connor-Ballard, Inova Health System remains fully dedicated to meeting the evolving needs of the communities it serves by providing the highest quality of nursing care available. “This realization requires Inova to continuously recruit, train, and develop nurses who provide safe and uncompromising care,” she says.

Even in the midst of an unsteady economy, the good news is that nursing remains an excellent career choice, says Eileen Dohmann, Vice President of Nursing at Mary Washington Hospital. “The flexibility and variety that nursing offers continue to be an attractive draw.”

While Mary Washington hired fewer new graduates last year than it has in recent years, Dohmann expects those numbers to increase in the near future. “I don’t want people not to go to nursing school because they think there aren’t jobs available, because that’s just not true,” she says, adding that Mary Washington is in an excellent position to hire more nurses as the economy improves because it is both located in a growing area and is a growing organization itself.

If you’re a new graduate or soon will be, Dohmann recommends looking for a position sooner rather than later, as well as considering different geographic locations, and different kinds of nursing.

“Get experience anywhere you can,” Dohmann advises. And most importantly, she adds, “Don’t give up.”

This advertorial was contributed by Carol Sorgen (carol@charm.net) in conjunction with The Washington Post Special Section Department. The production of this supplement did not involve The Washington Post news or editorial staff.

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August 26, 2010

Nursing Work Conditions at ANCC-Rated Hospitals Studied

Filed under: Nursing — Shirley @ 11:18 pm
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The nursing pin from the Division of Nursing a...
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Working for a hospital network that has four Magnet Certified hospitals in it, I read this article with some interest.  There was a big push at my hospital to seek and obtain the Pathway to Excellence designation, which we just did so now we are nationally recognized for providing quality care to the population we serve.

With all this national recognition and all this hoopla, why then are our nurses so unhappy and stressed?  That was the question I had in mind as I read this article.  When you read it, tell me if you think this article addresses the question and if you have any suggestions, please.

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Janice Simmons, for HealthLeaders Media, August 23, 2010

While American Nurses Credentialing Center Magnet Recognition Program® (MRP) hospitals have been cited for promoting better patient safety and outcomes, they may not necessarily be providing better working conditions for nurses. Particularly in the area of scheduling and job demands, non-MRP hospitals are comparable to MRP-designated hospitals, according to researchers from the University of Maryland School of Nursing.

Nearly 350 healthcare organizations in the U.S. are currently recognized by the ANCC. Over the years, studies have identified attributes of MRP hospitals that attract nurses: high autonomy, decentralized organizational structure, and supportive management.

But MRP hospitals usually focus on the organization rather than the individual nurse, suggesting that personal demands may remain high among nurses providing frontline care at MRP facilities, they said in their study appearing in the July/August issue of the Journal of Nursing Administration.

“[MRP] Hospital tenets do address schedules, although the focus has been on other important issues” such as nurse autonomy and shared governance, says one of the researchers, Alison Trinkoff, ScD, RN, a professor with the School of Nursing. “It may get overlooked.”  [read the rest of the article here]

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August 17, 2010

Oakwood Hospital Employee Fired for Facebook Posting

Facebook logo
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With the advent of social media sites, nurses are now faced with even more issues.  Can you talk about your day at work or is that forbidden?  Can you vent your frustrations about things that happened to you during the day or are you violating HIPPA law?

Nurses need to be aware that HIPPA is serious and breaking that particular law comes with substantial consequences.  We don’t equate a quick note on Twitter or Facebook as a problem, but it certainly can become one.  Read the article below to see how.

Let me know if you have had any issues like this, or if you feel that this is or isn’t a real issue for nurses.

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By RONNIE DAHL
myFOXDetroit.com

Cheryl James enjoyed her job at Oakwood Hospital. She never imagined posting something on Facebook from her own computer on her own time would get her fired.

“He died for us, protecting us,” said James.

Like so many others, James was emotional following the shooting death of Taylor Police Corporal Matthew Edwards. She worked for the hospital organization that treated the police officer and the shooting suspect, Tyress Mathews.

One night, while at home, she posted on Facebook that she came face-to-face with a cop killer and hoped he rotted in hell. She also posted another remark we can’t repeat.

Tuesday, she got a call. Her bosses wanted to talk.

“They called me in, told me that they got notice and word that I had posted this specific post on Facebook, and that they had to investigate it,” James said.

She says she immediately removed the posting and thought she might get written up or suspended. Instead, she got fired.

“The reason they gave me was that I violated HIPPA regulations by disseminating protected health information about a patient on a public forum, being Facebook, and that it also included disparaging and disrespectful remarks,” said James.

Late Friday afternoon, a representative for Oakwood Hospital released the following statement.

“As healthcare providers, we have a legal and ethical responsibility to protect patient privacy and we are bound by HIPAA rules and regulations to ensure that we do so. All of our employees are trained and expected to protect patient information. This means keeping details confidential that might make it easy to identify a patient even if his or her name has not been revealed. That’s why disciplinary action, even termination, may result from sharing information about patients inappropriately in any public forum or setting.

While we cannot discuss specific details regarding any current or former employee, we all have a legal and ethical responsibility to put our personal opinions aside and provide the care required for any patient who has entrusted us with their health.”

“I am familiar with HIPPA. I did not give out any of his information. I did not give out his name. I did not mention the hospital. I did not give out his condition,” James said.

She is still reeling from losing her job. She doesn’t believe her actions warranted being fired. She has two small kids, and her husband can’t work. While her feelings about the accused cop killer haven’t changed, she says she’ll think twice about what she posts on Facebook in the future.

“Hindsight is 20/20. Would I take back what I did? No. Would I do it in a different manner? Maybe,” said James.

She is planning to fight her termination.

read more here

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August 13, 2010

RN Health Coaches Coordinate Smooth Transitions, Prevent Readmissions

Health coaching is an up and coming area for nurses to explore.  I have been interested in this area for quite some time now and I am finally seeing the implementation of a type of health coaching by nurses in the news.  This is exciting news for those of us looking to get out of hospital nursing.  Readmission rates are sky-high in all areas of the country and here is an under-served population that could certainly benefit from good old fashioned nursing expertise.

This is from Nusing Spectrum, so you may have already seen this, but I want every one of us to take another look at this exciting avenue for nurses.

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Julie O’Brien, RN

RN health coaches work at White Plains’ Alicare Medical Management, an affiliate of insurance company Amalgamated Life, to help patients after they are discharged from the hospital. Although initiated informally about two years ago, AMM’s telephonic Patient Transition Coaching Program was officially launched in March and addresses post-discharge needs of patients who are at risk for hospital readmission.

In collaboration with the patient, family and healthcare provider, an RN health coach works with the patient at-risk immediately after discharge by telephone to assess his or her health status and identify any concerns or problem areas. Nurses ensure patients understand their necessary follow-up and self-care responsibilities, which may include knowing about specific signs and symptoms related to their disease, medications and medication administration, what to do in an emergency and when to call the physician.

“This program answers the need for those individuals who were falling through the cracks and were all too often ending up back in the hospital,” said Claire Levitt, president of AMM. These patients might be post-surgical patients, or those with heart failure, chronic obstructive pulmonary disease, asthma and other respiratory and cardiac conditions who can benefit from postdischarge health coaching.

Claire Levitt

“We followed a middle-aged gentleman with diabetes and cellulitis of the foot who had experienced failed outpatient conservative treatment. As a result, he was admitted to the hospital for IV antibiotics,” said Barbara Shaffer, RN, case manager. Working with a limited benefits plan, Shaffer was able to work with hospital case management, the physician and the payor to come up with a proposal that used his remaining benefits cost effectively. The patient was discharged in four days after admission with IV antibiotics, wound care and ongoing telephonic patient education. “His wound healed, he returned to work and he was not readmitted to the hospital,” Shaffer said.

“Our patients can call us at any time 24 hours a day, seven days a week, so we can give them the education and support that they need,” said Julie O’Brien, RN, vice president/COO of AMM.

“We had a patient who was referred to us because of recurring abdominal pain that resulted in frequent admissions through the ED,” Shaffer said. After talking with the patient and recommending a specialty provider, the patient was diagnosed with diverticulitis and given appropriate medications and dietary recommendations. “Working with a health coach, he followed his prescribed medication and dietary regimen and did not return to the ED,” Shaffer added.

Several nurses work telephonically from the Salem, N.H., office and several work telephonically from the Norristown, Pa., office on this program, which is part of AMM’s case management program. All of them are certified in case management and have a minimum of five years of case management experience. Besides the telephone, these nurses depend on the computer for case management system applications, which help identify the appropriate patients for this program. AMM’s website also offers a plethora of information for patients, including health-risk assessments and client resources, which the nurses use and refer to when working with their clients.


Janice Petrella Lynch, RN, MSN, is a regional reporter for Nursing Spectrum. Send letters to editorNJ@nursingspectrum.com or comment below.


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August 11, 2010

Hospital-Acquired MRSA Infections On the Decline, CDC Says

A ruptured MRSA cyst.
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I found this article on Business Week and thought it would be a good piece of information to showcase here.  At my hospital, we are still seeing quite a large number of MRSA patients, but apparently the rest of the country is  not.  I found this article to be informative and helpful and I hope you will also.  If this is indeed true, then it will make nursing easier overall.  MRSA is insidious and has long term effects for both patients and staff.  I will be happy to see its demise.

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Better infection control may have antibiotic-resistant Staph on the run, experts say

By Madonna Behen
HealthDay Reporter

TUESDAY, Aug. 10 (HealthDay News) — Could American patients and health care workers be winning the war against potentially deadly methicillin-resistant Staphylococcus aureus (MRSA) bacteria?

Infections with MRSA that began in hospitals and other health care settings have declined 28 percent in recent years, a new government study of roughly 15 million people finds.

Researchers at the U.S. Centers for Disease Control and Prevention (CDC) report that rates of “invasive” MRSA infections that had their onset in hospitals or other health care facilities declined an average 9 percent annually from 2005 through 2008. Invasive MRSA infections are those that are found in a normally sterile body site, such as the bloodstream.

According to the study, which is published in the Aug. 11 issue of the Journal of the American Medical Association, invasive MRSA infections that were associated with health care settings but began outside, in the community, also declined by about 6 percent annually, for a total of a 17 percent decrease over the four-year period.

“While we don’t know for sure what caused these rates to go down, we’re hopeful and encouraged that the aggressive infection control programs that many hospitals have instituted are having an impact,” said lead author Dr. Alexander J. Kallen, medical officer in the division of Healthcare Quality Promotion at the CDC.

For the study, Kallen and his colleagues evaluated a CDC population-based surveillance system of MRSA infections that covers nine metropolitan areas across the United States. After evaluating all reports of laboratory-identified episodes of invasive MRSA infections, they limited their analysis to infections that began in hospitals or those that began in the community but were associated with a health care setting. MRSA infections associated with health care settings made up 82 percent of the total infections. The researchers did not evaluate community-acquired MRSA infections.

A subset analysis of just bloodstream infections showed even greater decreases: a 34 percent drop in hospital-onset infections, and about a 20 percent decrease in community-onset infections over the four-year period.

The authors of an editorial accompanying the study said that while the findings are encouraging, government surveillance systems should be expanded to more geographical areas and should include all Staphylococcus aureus infections, as well as other important health care-associated pathogens.

“Even if MRSA causes half of all Staph infections, that means that all the other strains of S. aureus are causing the other half, and we need to focus on these infections as well,” said co-author Dr. Daniel J. Diekema, director of the division of infectious diseases  [read the rest of article]

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August 9, 2010

Nursing shortage: 1 in 5 quits within first year, study says

Filed under: Nursing — Shirley @ 5:41 am
Tags: , , , , ,

Here’s an article from 2009 that I found in USA Today.  This is interesting in that today I don’t think there is any difference in the statistics.  My hospital has a Versant program and we frequently work with Versant nurses.  But, even with a residency program, we still loose some of our Versant nurses.

Enjoy the article below and see if you think there has been much improvement since February of 2009.  I really don’t see improvement; actually I think nursing is loosing ground rapidly.  Maybe it’s time for a complete overhaul of the way we nurse and the way we train nurses.  Maybe we need someone to do some oversight of the CEO’s of all the major hospitals and compare their salaries and bonuses to the nurse-to-patient ratios and the actual staffing of their hospitals.  I really don’t care where the problem is attacked, I just know that we have to do something before nursing looses out.

This article is from here.

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Yaima Milian, center, who is in a nursing residency program, examines Carmen Perez, left, as more experienced nurse Marvin Rosete looks at Baptist Health of South Florida in Miami on Feb. 6. More hospitals are investing in longer, more thorough residencies, which can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who burned out is about $50,000, experts estimate.
Enlarge image Enlarge By Wilfredo Lee, AP
Yaima Milian, center, who is in a nursing residency program, examines Carmen Perez, left, as more experienced nurse Marvin Rosete looks at Baptist Health of South Florida in Miami on Feb. 6. More hospitals are investing in longer, more thorough residencies, which can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who burned out is about $50,000, experts estimate.

By Rasha Madkour, Associated Press
MIAMI — Newly minted nurse Katie O’Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

She lasted nine months. The stress of trying to keep her patients from getting much worse as they waited, sometimes for 12 hours, in an overwhelmed Dallas emergency room was just too much. The breaking point came after paramedics brought in a child who’d had seizures. She was told he was stable and to check him in a few minutes, but O’Bryan decided not to wait. She found he had stopped breathing and was turning blue.

“If I hadn’t gone right away, he probably would have died,” O’Bryan said. “I couldn’t do it anymore.”

Many novice nurses like O’Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

That turnover rate is a major contributor to the nation’s growing shortage of nurses. But there are expanding efforts to give new nursing grads better support. Many hospitals are trying to create safety nets with residency training programs.

“It really was, ‘Throw them out there and let them learn,”‘ said University of Portland nursing professor Diane Vines. The university now helps run a year-long program for new nurses.

“This time around, we’re a little more humane in our treatment of first-year grads, knowing they might not stay if we don’t do better,” she said.

The national nursing shortage could reach 500,000 by 2025, as many nurses retire and the demand for nurses balloons with the aging of baby boomers, according to Peter Buerhaus of Vanderbilt University Medical Center. The nursing professor is author of a book about the future of the nursing work force.

Nursing schools have been unable to churn out graduates fast enough to keep up with the demand, which is why hospitals are trying harder to retain them.

Medical school grads get on-the-job training during formal residencies ranging from three to seven years. Many newly licensed nurses do not have a similar protected period as they build their skills and get used to a demanding environment.

Some hospitals have set up their own programs to help new nurses make the transition. Often, they assign novices to more experienced nurses, whom they shadow for a few weeks or months while they learn the ropes. That’s what O’Bryan’s hospital did, but for her, it wasn’t enough.

So more hospitals are investing in longer, more thorough residencies. These can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who washed out is about $50,000, personnel experts estimate.

One national program is the Versant RN Residency, which was developed at Childrens Hospital Los Angeles and since 2004 has spread to 70 other hospitals nationwide. One of those, Baptist Health of South Florida in the Miami area, reports cutting its turnover rate from 22% to 10% in the 18 months since it started its program.

The Versant plan pairs new nurses with more experienced nurses and they share patients. At first, the veterans do the bulk of the work as the rookies watch; by the end of the 18-week training program, those roles are reversed.

The new nurses must complete a 60-item checklist. They must learn how to put in an IV line and urinary catheter; interpret different heart rhythms and know how to treat them; monitor patients on suicide watch and do hourly checkups on very critically ill patients; know how to do a head-to-toe physical assessment on a patient, as well as how to inform families about the condition of their loved one.

For Yaima Milian, who’s currently in the program at Baptist, this is markedly different from the preparation she got at her first hospital in New Jersey. She left after a six-week orientation because she didn’t feel ready to work solo.

While Milian was paired with a more experienced nurse at the New Jersey hospital, they didn’t see patients together; they split the workload. Her first week on the job, Milian was charged with caring for several patients with complicated issues — those on ventilators and with chest tubes — and she felt thoroughly unprepared.

“It just didn’t feel right, it felt very unsafe,” Milian said.

Besides the residency’s professional guidance, which includes classroom instruction, new nurses also get personal support from mentors — people they can call after a bad day or to get career advice. The new nurses also gather with their peers for regular debriefing, or “venting” sessions.

“Here you have this group that is pretty much experiencing the same things you’re experiencing,” Milian said, “and it makes you feel better.”

To be sure, not all the nurses who leave do so because of a rocky transition. But for nurses who do leave because of stress, these programs seem to help.

The American Association of Colleges of Nursing and the University HealthSystem Consortium teamed up in 2002 to create a residency primarily for hospitals affiliated with universities. Fifty-two sites now participate in that year-long program and the average turnover rate for new nurses was about 6% in 2007.

“We believe all new graduates should be given this kind of support system,” said Polly Bednash, the nursing association’s executive director. “We are facing downstream a horrendous nursing shortage as a large number of nurses retire from the field… So you need to keep the people you get and keep them supported.”

The federal government has jumped on the bandwagon. Since 2003, it has awarded $17 million in grants for 75 hospitals to start first-year training programs.

The National Council of State Boards of Nursing is considering a standardized transition program. It cited a study showing a link between residencies and fewer medical errors, but also pointed to the inconsistency among current efforts.

That’s something O’Bryan, the Dallas nurse, knows about. Her hospital — which she declined to identify because she didn’t want to be seen as complaining about a former employer — had a three-month program, in which she attended weekly classes and was assigned a nurse to shadow. After that period was over, though, O’Bryan was abruptly alone, even as she continued to face new situations that she wasn’t sure how to handle.

“When things are going good and I’m not overwhelmed and I’m able to help people, I love it,” she said, recalling the gratification of seeing a bedridden patient finally manage to take a few steps.

“There are always those moments,” she said, “but they’re interrupted pretty quickly.”

The 27-year-old is currently looking for a new job. She’s not sure it will be in nursing.

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August 6, 2010

No more big needles? Pain-free vaccine in the works

I regularly receive email from SmartPlanet.com about new technology and future developments.  Below is one of the posts I received that I found really interesting and that had some potential effect on nursing.  It always pays to keep abreast of new developments in medicine and in the technology that delivers it.  I hope you find this post useful as well as interesting.

If you enjoy this, let me know and I will post more from this source as I find it.

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By Christina Hernandez | Jul 29, 2010

Forget large, intimidating needles. Researchers in Georgia are developing a vaccine that feels more like a Band-Aid when administered. The vaccine patch contains hundreds of tiny microneedles that dissolve straight into the skin.

I spoke this week with Sean Sullivan, lead author of the study in Nature: Medicine and a former doctoral student at Georgia Institute of Technology, about the possibility of painless vaccines.

How can a vaccine be made painless?

It really ends up being the delivery device. Currently you use a needle because it’s effective. It’s been shown to deliver a countless number of drugs. It’s effective and most medically-trained personnel can deliver a shot. You usually go into the muscle because it’s easy. That’s the current use.

What we’re looking at is how to make it more patient compliant, how to make people want to get their injector. These microneedles, the reason they don’t hurt is that they don’t go deep enough to where the nerves are. A typical needle is multiple millimeters long. These microneedles are less than a millimeter in length. They’re so short that they go very shallow into the skin and they don’t reach where the nerves are. That’s why these don’t hurt and the current needle does.

How did you develop microneedles that could deliver vaccines?

The idea of microneedles has been around a number of years. In the late ’90s they really started looking into this, the idea of if you use a small needle it won’t hurt. How do we make this effective? They used a number of different technologies. They used glass, metal and silicone for microneedles. When I joined the project when I entered graduate school back in 2002, I was tasked to come up with a way of making a polymer microneedle. The main benefit of a polymer microneedle is it can dissolve in the skin and you have no needles left afterwards. Six years of a Ph.D. later, it works.

If the microneedles don’t go as deep as traditional needles, are they as effective?

This is actually where it gets really gets interesting. For vaccinations specifically, the skin is actually one of the places that people would like to deliver. The skin has a number of immune cells in it. If you can get a vaccine right there, you can actually get a stronger immune response with the same dose. Because of that you can give a lower dose and get the equal immune response. In theory, if you’re able to deliver to the skin and not the muscle for, let’s say, the flu vaccine, you can give a lower dose and get the same response. It’s great. How do you get things in the skin? That’s where you get microneedles. You’re delivering to those immune cells. Microneedles and vaccines are really a match made in heaven. It’s a delivery device that’s perfect for vaccinations. Not only does it not hurt, but you could theoretically get a lower dose with it.

How far along is the technology and what’s the next step?

I’m no longer at Georgia Tech. This technology is all at Georgia Tech and Emory. My adviser is continuing with it. All the vaccinations we did were in animals. The next step would be to move to human trials and I believe they’re working on that right now. The technology is ready to go there, but they would have to be tested in clinical trials first to make sure they’re safe and effective in humans.

In addition to being less painful and more effective, what are the other benefits of microneedles?

You don’t have a needle to get rid of afterwards, so there’s not even a possibility of a re-stick to yourself or someone else. Because that’s the case, there’s a possibility in the future that this could be used at home. You could pick this up at the pharmacy and apply it to yourself and throw the backing away. You could self administer. That’s how easy it is. It’s as easy as putting on a Band-Aid. The self administration idea could have a huge impact.

We talked about mass immunization efforts. With these, you could pick them up or it might be very quick. You don’t need highly-trained medical personnel to apply these to you. Another aspect we talked about is overseas in places where medically-trained personnel aren’t available as much, sharp disposal isn’t available, third-world countries. This would be a perfect vaccination device system for those locations.

Here’s the link to the original article

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August 4, 2010

The Do-It-Yourself House Call

Here’s an article from the Wall Street Journal about the future of medicine as it applies to chronic and debilitating disease–in this case, congestive heart failure.  Although I am sure the issue here was supposed to be the cost savings for the insurance companies, what stood out to me was the importance of the role of the nurse in this scenario.  Without a nurse to review and monitor the data collected remotely, there would be no cost savings.  Hmmm…..

Read this article and then tell me what your thoughts are on this topic.  I do believe that remote monitoring is going to become normal practice in the future, I just hope that nursing gets credit for being the linchpin on which the success lies.

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Insurer-Endorsed Remote-Monitoring Technology Leads Heart Patients to Take Their Readings at Home

By AVERY JOHNSON

Technology that aims to keep congestive heart failure patients out of the hospital is gaining traction.

The idea is for heart patients to take readings like their weight, blood pressure and other key metrics using wireless and other technologies; the data are then transmitted to a case manager or medical care giver. That way health care givers can catch, and address, warning signs before the patient lands in the ER with shortness of breath or a heart attack. In the past, patients have found such technology difficult to use. But a number of managed-care companies are experimenting with electronic devices meant to make the process easier.

A big benefit is that it allows patients to stay in their homes, but the systems can’t catch everything, and patients shouldn’t be lulled into a false sense of security by the technology.

HEARTBEAT_2

Alfred Giancarli for The Wall Street Journal

WellPoint Inc.’s Anthem unit in California is piloting a wireless scale and blood-pressure cuff that communicates in real time with nurses on alert for fluctuations that can signal heart failure, or when the heart can no longer pump enough blood to the body’s organs. Humana Inc. in January will launch a program to track heart patients’ vital signs wirelessly and link them up via video to chat with nurses if appropriate.

And Aetna Inc. is running a clinical trial with Intel Corp. to assess how remote monitoring of vital signs can cut down on unnecessary hospitalization for heart patients.

It is more important than ever for health plans and patients to combat medical costs, growing at a clip of between 6% and 9% a year, according to various estimates. Heart failure—which can be triggered by simple mistakes such as consuming too much salt—is a leading cause of hospital readmissions, with about 25% of patients returning to the hospital within 30 days. It’s also one of the biggest single claims expenses at insurance companies. Aetna estimates that 40% of readmissions are avoidable.

For patients, the extra surveillance could cut down on trips to the hospital and provide peace of mind. That’s what Carolyn Brown, a 63-year-old retired teacher’s aide from Bronx, N.Y., found when she started using a new monitoring system covered by her insurer, MetroPlus Health Plan Inc., after she suffered two heart attacks.

“I was constantly going to the doctor. Now they can tell right away if I am in trouble,” she said.

The program puts a scale, blood-pressure cuff and glucose monitor into patients’ homes and then collects the data daily via wireless or landline. Nurse case managers follow up with the patients if any of the vital signs seem worrisome.

The plan, which specializes in Medicaid and Medicare and is owned by the New York City Health and Hospitals Corp., says it pays about $6,300 for a Medicaid heart patient’s typical hospital stay. The plan foots the bill for the remote monitoring system, which is rented and worth approximately $626.

Such remote monitoring programs have limitations. Doctors can get over-alerted when patients put the cuffs on wrong, or step onto the scale with their shoes on. The technology requires ill patients to remember to use it, and can be troublesome if it acts up. For instance, Ms. Brown’s data at first weren’t uploading through the modem correctly, a problem that was solved within 24 hours when the machinery was converted to a wireless hookup.

Heartbeat_2

Ms. Brown’s blood-pressure reading and transmission devices.

Both Humana and WellPoint are incorporating video-chat into their approaches to connect members more closely with nurses. UnitedHealth’s wireless scale asks a series of questions in the morning and evening that are followed up by nurses and doctors if appropriate. “The relationship between the consumer and doctor is primary,” said Sam Meckey, chief operating officer for disease solutions at UnitedHealth’s OptumHealth unit.

Ray Freeland, a 54-year-old heart patient who is part of Anthem’s pilot program, said the system he uses to monitor his weight and blood pressure has “eliminated those trips to the doctor to find out everything is still the same.” But in March, the system picked up through Mr. Freeland’s pulse measurements that he might be experiencing abnormal heart rhythm. Mr. Freeland, who lives in Glendale, Calif., was sent to his doctor to shock his heart back into a normal rhythm. His medical center, Cedars-Sinai, estimates that about $30,000 was saved on Mr. Freeland’s care between March and July.

New approaches aim to find problems earlier. A study of 1,450 patients out Tuesday in Circulation, a journal of the American Heart Association, showed that implantable defibrillators that wirelessly transmit data on the patient’s heart function reduced in-hospital evaluations by 45%. Suspected cardiac events were evaluated in less than two days compared with 36 days.

Another approach being tested by devicemaker CardioMEMS Inc. uses an implantable sensor device to measure pulmonary artery pressure and wirelessly transmit readings to a secure Web site for doctors and nurses. The idea is to detect changes and intervene before the patient has to be hospitalized. The wireless transmitter resulted in a 30% reduction in hospitalization for heart-failure patients, the study of 550 patients released last month showed.

Write to Avery Johnson at avery.johnson@WSJ.com

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August 2, 2010

Scripting Provides Firm Bedrock for New Nurses

Filed under: Nursing — Shirley @ 5:12 am
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Below is an article I found on Strategies for Nurse Managers.   When I first read this article I was taken back to the days that I worked at the phone company as a service representative.  I am intimately familiar with “scripting” after working that job for 10 years.  I would think that anyone with a sales background would also be quite familiar with this process.  I really did not see the transition to nursing, at first.

However, upon further thought, I can actually see where this kind of training would be beneficial for new nurses, but I can see that we old hands have developed our own “scripts” over time.  Think about a normal day at work.  How many things do you find yourself saying over and over and over again?   How many times do you catch yourself repeating information to several different patients?

If you can answer either question with phrases or sentences, you now have an idea of your personal scripting that you use to get through the day.  Actually, scripting is nothing really but a type of shortcut in our conversations with others.  So, please read this article and then lets talk about scripting and how it applies daily in your own practice.  Maybe if we become aware of this practice, then we can actually start to use it to benefit both our patients and ourselves.

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It was not an auspicious arrival in San Diego for the annual conference of the National Nursing Staff Development Organization. I arrived last Wednesday (July 7) just in time for a 5.4 earthquake.

I must confess that I didn’t feel the earth undulating beneath me, which disappointed me greatly when I later watched the news reports and saw items falling off shelves and swimming pools sloshing.

But the earthquake proved to be an interesting metaphor for the graduate experience, which was greatly on the minds of the nursing professional development specialists attending the conference.

We discussed the difficulties new nurses face in their first job as they deal with the transition from nursing school to practice. Considering all the competing demands on their time and the pressure they experience, they can feel like the ground is moving under them as they struggle to keep their footing.

With that in mind, our conversation turned to scripting.

Some nurses and administrators recoil at the term “scripting,” envisioning robotic intonations of “Have a nice day!” and fearing the loss of personalized interactions.

Those who have already tried it, however, know that scripting enhances—rather than stifles—communication, ensures consistency in practice, and arms nurses with tools to handle difficult conversations with patients, peers, and physicians.

Scripting is best known in customer service iterations. If you don’t like the idea of scripting, one of the staff development professionals in San Diego noted, eavesdrop on some of the things nurses say to patients. Staff have their own scripts and they say the same thing day in and day out, much of which is not the message you want delivered to patients.

Some people instinctively know how to greet people, identify themselves, and provide clear and concise explanations that build relationships with patients. Many do not. And new grads are often so focused on trying to remember the technical steps of patient care that the last thing on their mind is explaining what’s going on for the patient.

A script with language cues helps standardize the experience and ensures patients are comfortable. A common example lays out the steps nurses should take when entering a room, including:

  • Acknowledging the patient
  • Introducing themselves
  • Stating why they are there
  • Explaining the process
  • Thanking the patient

Scripts for such interactions can be developed through conversations with nurses. Role play and get everyone involved so they work for the unit’s patient care environment. Encourage nurses to practice so they remember the steps and so they can customize parts to their natural style.

Scripts have far wider use than just improving customer service-type interactions. One of the events that strikes fear into a new grad’s heart is calling the physician in the middle of the night. These conversations often go something like this:

Nurse: Sorry to wake you Dr. Smith. It’s Nurse Jones over at St. Somewhere Hospital and I’m calling about Mr. Williams. He’s complaining of pain and we haven’t been able to relieve it with the medication you ordered.
Physician: What are his vital signs?
Nurse: Hmmm, they are right here. No, actually, they haven’t finished taking them yet.
Physician: When did he last have pain medication?
Nurse: Let’s see. It was right before I arrived for my shift, so it’s been about two hours.

A crude example, but you get my point. New grads can benefit from practicing these calls so they know what information to convey, and the best way to convey them to ensure the conversation proceeds well:

Nurse: Dr. Smith, it’s Nurse Jones over at St. Somewhere Hospital and I’m calling about Mr. Williams. He’s complaining of pain and we haven’t been able to relieve it with the medication he has ordered. His order is ____. His vital signs are ____. The pertinent information you need to know is _____. I’d like you to _____.

With preparation and a script to follow, the conversation goes smoothly and all sides are happy.

Develop scripts for difficult conversations with patients, for confronting hostile peers, or for improving the way information is shared at report. Scripting arms nurses with tools so they know how to act and how to respond in difficult situations. Including scripts in graduate orientation ensures new nurses have a stable footing.

Written by Rebecca Hendren   Visit the original article by clicking here.

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