Nursing Notes

September 29, 2010

New OR RNs and Those with More Experience Need Nurturing

Filed under: Nursing — Shirley @ 3:38 am
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Here is an interesting article from Nurse.com that addresses another aspect of the looming nursing shortage as our numbers age and retire.  This article focuses on surgical nurses, but any specialty could be written about in much the same way.  The median age of the nursing workforce is now late 40’s to mid 50’s.  These are people who will be looking to retire at some point in the not too distant future.  Who will be replacing them?

Please read the whole article and then come back here and let me hear your stories.  We all have frustrations and can share personal experiences.  Let’s talk.

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By Heather Stringer
Monday September 20, 2010

When 55-year-old Jim Stobinski, RN, MSN, CNOR, a seasoned Navy OR nurse, started working at a civilian hospital three years ago, he experienced a form of culture shock. He couldn’t ignore the fact that nurses in the civilian OR were noticeably older than his colleagues in the Navy. The discrepancy was so significant that Stobinski started studying age distribution data from the Association of periOperative Registered Nurses and compared it to data from the Navy. As he analyzed the information, Stobinski became aware the nation may be at risk of an impending shortage of well-trained RNs in the OR.

“We are in uncharted territory,” says Stobinski, director of surgical services at St. Luke’s Medical Center in Boise, Idaho. “Our OR nursing workforce is getting older, the demand for surgery is increasing, and we have to bring new nurses into the profession to stay viable.”

Luckily, organizations such as the AORN and hospitals throughout the country are pioneering strategies to not only recruit and train younger nurses into the OR specialty, but also to retain older nurses who have the coveted experience from which the next generation of nurses can benefit.

Age Breakdown
According to 2010 membership data from the AORN, which has more than 40,000 members, the average age of perioperative nurses in the organization is 52. That is five years older than the average age of licensed RNs as a whole, according to data from the 2008 National Sample Survey of Registered Nurses. About 48% of AORN’s members are over 50, and only 7% are under 31. The organization has yet to determine whether this data is representative of OR nursing as a whole. The AORN hopes to conduct a survey with perioperative directors throughout the country in the near future to determine whether their membership data currently reflects the age demographics in ORs nationwide; however, according to the 2004 National Sample Survey of Registered Nurses, there are more than 179,000 perioperative nurses in the U.S.

“The organization is concerned about these statistics,” says Anne Marie Herlehy, RN, DNP, CNOR, AORN president-elect and administrative director for perioperative and cardiovascular services at Alexian Brothers Medical Center in Elk Grove Village, Ill. “We wonder what it will mean for the profession in 10 years.”

One of the main reasons ORs lack younger RNs is related to changes in nursing schools, explains Herlehy. In the past, nursing students spent more time in the OR during clinical rotations, but now students often spend one day at most in the OR.

“Now that the nursing curriculum is so packed, there is less opportunity for nurses to get exposed to surgery,” Herlehy says. “Few schools even offer it as an elective course.”

To get the word out, AORN representatives attend events sponsored by the National Student Nurses Association, where they run an exhibit and talk to student nurses.

The AORN also offers a course called Periop 101: A Core Curriculum, a six-month program hospitals can use to train new perioperative nurses. The program includes reading, clinical assignments and suggested videos. Hospitals tailor the program to include mentoring, hands-on clinical experience and time with a preceptor. Students earn a certificate of completion for the class, which is open to new grads and experienced nurses who want to transfer to the OR.

Not only are hospitals offering this course, but now one Florida college is responding to the high demand. In January, Keiser Career College will begin offering Periop 101 at the Miami Lakes campus. After completing the course, nurses can go on to apply for OR jobs at the hospitals of their choice. When Terry Schmidt, RN, BSN, director of education at Keiser Career College,[…read the rest of the article…]

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September 28, 2010

Study: Broader Telephone-Based Health Coaching May Save Money

Filed under: Nursing — Shirley @ 3:37 am
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Here is an interesting article from The Wall Street Journal Health Blog.   This article is fairly long, so only part of it is below.  Please click over and read the article completely.  Here is an example of “thinking outside of the box” to try to accomplish better outcomes for some of the patients that seem to fall through the cracks or worse, who just give up entirely.

Let me know what you think, won’t you?  There are some interesting comments at the original site, also.

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By Katherine Hobson

Offering telephone health coaching to a broader-than-usual swath of patients may save money, according to a study just published in the New England Journal of Medicine.

Typically this kind of care management, as it’s called, is offered to people who have trouble managing their chronic conditions or who are facing a big treatment decision — such as surgery or medical management for lower back pain. But a randomized study conducted by Health Dialog Services compared that approach to its own program, which offered phone-based health coaching to a larger proportion of those folks and also to some “chaotic users of the health-care system” — people who don’t have a chronic illness but, for example, seem to turn to the ER for all their routine care, David Wennberg, one of the study’s authors and chief science and products officer at Health Dialog, tells the Health Blog.

The study randomly assigned a patient population of 174,120 people to either the traditional support or enhanced support programs. The former, with its more limited criteria, enrolled 3.7% of its patient pool; the latter enrolled 10.4% of its own pool. The support was the same in both groups: helping with behavior changes such as exercise as well as offering shared decision making tools intended to give patients the pros and cons of treatments they’re considering. (Shared decision making is the approach many say should be used in prostate cancer, for example, given its complex array of treatment options.)

Average monthly medical and pharmacy costs were 3.6% lower across all the patients in the enhanced support group compared to the usual-support group. In other words, says Wennberg, if employer A’s company used the enhanced model, it would save an average of $7.96 per employee compared to employer B, using the more restrictive traditional model.

Of course, we should note here that it would be to Health Dialog’s benefit if companies extended these services, at $2 per person, to a greater proportion of their workers.

We wondered if patients are suspicious that the phone coaching was biased in favor of cheaper treatments, whatever their appropriateness for the patient. Wennberg says the decision making tools are created by the nonprofit Foundation for Informed Medical Decision Making. Here’s a description of their partnership.

And we also wanted to know whether doctors are agitated when patients receive outside health coaching about treatments. “The goal of this is to have a well-informed patient talking to a well-informed physician, preferably his or her own primary care physician,” says Wennberg…[read the rest of the article]

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September 24, 2010

Some new videos about nursing

Filed under: Nursing — Shirley @ 6:44 pm
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Since it’s Friday, I think I will show movies.  Sit back and relax and enjoy the show.

September 22, 2010

Nurses Wrestle Schwarzenegger on Staffing

As a nurse who traveled and worked in California, I found this article to be quite entertaining and informative.  I was in California when the Nurse’s Union picketed the state capitol building and when the governor made his now famous statement about “kicking butt”.

It’s strange to me that Arnold Schwarzenegger has chosen nurses and teachers as his enemy.  To me, this indicates just how far out of touch with the real world he is.  He doesn’t worry about getting quality care for his family or for himself and he doesn’t have to worry about his children’s education, thanks to his movie star income and the rich family he married into.  The rest of the world has to worry about such mundane issues.

Please read the article from WeNews and let me know your thoughts, won’t you?  I’ve only posted part of the article here, but I recommend clicking over to read the entire story because it is quite informative.

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By Rebecca Vesely

WeNews correspondent

Thursday, March 24, 2005

In their ongoing wrestling match with Schwarzenegger over hospital staffing, California nurses are proving to be tough opponents for the former action-movie star. Last week they pinned him down in court with a ruling the governor is now appealing.

California nurses protest against Schwarzenegger

SAN FRANCISCO (WOMENSENEWS)–California Governor Arnold Schwarzenegger has met a foe to match any from his blockbuster action movies: nurses.

To counter what they regard as Schwarzenegger’s strong-arm legal tactics to hold back staffing hikes, members of the state’s nurses’ union–the majority of whom are women–have maintained a vigorous schedule of well-attended protests, stunts to protest and embarrass the muscular governor and negative advertising campaigns.

On March 14, nurses managed a legal pin-down when a Sacramento Superior Court judge ruled that the governor had improperly invoked an emergency measure to suspend parts of a landmark nurse staffing law.

The judge ordered hospitals to comply with nurse-to-patient ratios immediately, which mandate 1 nurse to every 5 patients on medical and surgical wards, up from the former 1-to-6 ratio that the governor had moved to uphold.

Judge Judy Holzer Hersher also ruled the state could not suspend other provisions of the ratio law, such as allowing emergency rooms to break the ratios during very busy times. She called the governor’s emergency regulation “an end run around the regulatory process.”

The state, along with the California Hospital Association, filed an appeal within days seeking to overturn the ruling. Ken August, spokesperson for the state Department of Health Services, said the appeal will likely be heard in the next several weeks.

In the meantime the state will urge hospitals to comply with the law and has sent a letter to the hospitals to that effect.

State Senate President Pro Tem Don Perata, an Oakland Democrat, will hold a hearing on the nurse staffing ratios on April 4.

At a Sacramento press conference, Perata predicted that the legislature would be “like junkyard dogs,” in their support of the nurses. He said the hearings would focus on whether the administration violated a legislative mandate to implement and enforce the staffing law.

Hospital Association Outcry

The California Hospital Association, an ally of Schwarzenegger in this issue, said hospitals are closing because they can’t meet the ratio requirements amid a severe nursing shortage. The association estimates hospitals will need an additional 4,000 nurses just to meet the new ratios on medical and surgical floors. This is on top of the 14,000 nurse vacancies that already exist at hospitals statewide, according to the […read the rest here…]

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September 8, 2010

Nursing videos about the shortage

Filed under: Nursing — Shirley @ 2:45 pm
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September 7, 2010

Nursing in the news today

Filed under: Nursing — Shirley @ 9:27 pm
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I know how I feel about this topic and I know what I think but I would like to post this video here for you to watch and think about.  Let me know what you are thinking and feeling about this issue.  This seems to be a really touchy topic and is in the news more and more.  Anyway, watch the video and leave me a comment, won’t you?

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September 6, 2010

Texas Considers Minimum Nurse-to-Patient Staffing Ratios

U.S. Army Nurse at the bedside of a young Iraq...
Image via Wikipedia

I found this today and felt I should post it here.  I read the article and I had to laugh when I got to the last part.  I bet that statement came from a hospital administrator who knows that the nurse on the floor has no control on staffing at all.  I will be following this up since I work in the great state of Texas and serve on my hospital’s Staffing Effectiveness Committee.

I will be trying to find some follow-up since this is from 2009 and I am sure there is more about this initiative somewhere out here on the web.

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Texas is considering legislation that would mandate specific nurse-to-patient ratios on certain hospital units, Nurse.com reports. The Texas Hospital Patient Protection Act of 2009 would require one nurse for every four patients on med/surg units, in the emergency department (ED), on postpartum women-only units and on psychiatric units. Meanwhile, the legislation stipulates one nurse for every two patients on intensive care units (ICUs), neonatal ICUs, on the post-anesthesia recovery unit and in the newborn nursery. A one-to-one nurse-to-patient ratio would be required for operating rooms, conscious sedation, labor and delivery and for trauma patients in the ED. The proposed legislation would require only one nurse for every five patients on rehabilitation units. Advocates of the legislation assert that the proposed ratios will allow nurses to more personally treat patients and possibly attract nurses back to the profession. According to the California Nurses Association, after California passed nurse-to-patient ratios, the state saw an influx of 80,000 nurses. The Texas law would also protect whistle-blowers and hold hospitals accountable for violating the measures. Opponents to the proposed measures, meanwhile, say a bill is unnecessary and that bedside nurses, not legislators, are best equipped to determine optimal nursing ratios (Wood, Nurse.com, 1/12/09).

This is a great site and you can read this article and others like it here.

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