Nursing Notes

April 29, 2011

Confessions of a Psych Nurse

Here is an article I found on NurseTogether that absolutely blew me away.  As a psych nurse for over 20 years, I can empathize and sympathize with this author.  She speaks my thoughts.  It is amazing.  I immediately emailed her for permission to repost this article here for you to read and enjoy.  Won’t you let me know how you feel about the things she has to say?  Please click over to her website and read some of her other posts and maybe leave her a comment while you are there.


A Nurse Confesses:  There is no way to work on a psych ward of a mental hospital and not learn something about life; I have met some of the strangest and most original individuals.  When people find out where I work, and have worked for almost 22 years, their mouths hangs open in awe.  Most of the time the phrase, “I don’t know how you do it” is mentioned, as they shake their heads.

 I confess there are things about working in a mental health institution that I do not like, and there are times when I have to bite my tongue and keep my lips glued together because I become so agitated.  I thought I would list for you my dislikes and explain later what I have learned.  Deep breath…here I go.

 I dislike when someone comes into the hospital just so they can get a check (aka crazy check) when they are clearly healthy but truly too damn lazy to work.

 I dislike when someone is purely and simply mean spirited and uses their diagnosis of being mentally ill as an excuse to cling to.

 I dislike when prisoners come in and break furniture, hurt the staff, share their rude and unintelligent slurs to the staff and demean them, because they have nothing to lose and will be going back to jail.

 I dislike an addicted individual who tries to use their mental illness to be prescribed Benzo to feed their habit, and then becomes demanding when they are told no.

 I dislike restraining someone in the bed.  It makes my heart hurt to see someone, or have to place someone, in that situation.  Even though I know at the time it has to be done – everything else has been exhausted – sometimes it is necessary to protect the staff and the patient. 

 I truly dislike calling a doctor who blows off the fact that the nursing staff have already tried many measures before calling him in the middle of the night for more help, and he refuses it because he doesn’t think it is needed.  I also dislike that he feels he shouldn’t have to come to the unit to observe what is going on, leaving the staff in harm’s way.

 I dislike a doctor who comes to the unit during a high risk situation and hides behind the female staff for protection.  I am not a shield; I am a nurse with a family, just like he has.

 I dislike staff who forget how blessed they are and that they have a home to go home to, when a patient is crying because they are homesick and cannot return to their home.

 I dislike not being able to help a patient understand what he/she is seeing – climbing the walls is part of their illness and not real – but they can clearly can see something there.

 I dislike looking into someone’s eyes and seeing pain, hurt, and loneliness – lost souls that I cannot help.  I really dislike that feeling.

 When a new patient comes onto the unit, I like to learn about who they are, not who the chart says they are.  I want to know where they used to work, where they went to school, how many brothers and sisters they have, and whether they are married and/or have children.  I have found that when I approach a patient as a person, rather than as a patient, they open up and let down the walls that they come in with.  I get to peep inside of their lives for just a moment.  I dislike when staff forget that the people we serve had a life before they arrived on our unit.  They attended school, had some kind of home, they have a mother, father, wife, husband, and/or children.  We have all made some really crappy choices in life – we may not have landed in jail or in a mental hospital, but there were choices made along our path.

 I confess – my psych patients have taught me a lot about life.  I have not always liked working in chaos and in hazardous and dangerous situations, but I have always liked talking to the ones I meet.  They have showed me that we are all one step away from the admission office when life hands us more than we can bear.  They have taught me that just because I cannot see delusions and hallucinations doesn’t mean they are not real.  They have taught me the feelings of real compassion for another human when they cannot help themselves.  They have taught me that being with family is not always the safest place to be.  At times, families hurt family members deeper than a stranger does.

I confess – my life has been changed by a mentally insane person.  Just think…yours could be too.

About the Author: For the first 5 years online, Angela Brooks spent her time in network marketing e-commerce with health products. In the last year, she has followed her passion where she has worked for over 21 years in the same state funded psychiatric hospital, working in a dangerous acute psychiatric ward.

Angela also runs her own company on the side and supports other nurses in how to bring passion into their role at work. Visit

Click here for more information on Angela Brooks.

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April 28, 2011

Residential Health’s med monitoring pilot slashes readmissions

HELP Telemedicine clinic 1

Image via Wikipedia

Here is an article that describes another way that telemedicine can be utilized to prevent readmission.  In reading this article, I was confused by the physicians who did not want to participate in this study.  Why?  If this is a way to maintain a patient’s health while out of the hospital, what is the problem?

Please read the entire article and come back here to tell me what you think, okay?  I really would like to hear from you on this topic.  It seems that telemedicine is the wave of the future and we need to be prepared to use it as nurses.  I think it is a great tool for health.  That’s just my opinion.  What’s yours?


By Jay Greene

Crain’s Detroit Business

A pilot project by Madison Heights-based Residential Home Health LLC that uses remote medical monitoring held hospital readmissions to 3 percent last year for 239 patients with congestive heart failure and chronic obstructive pulmonary disease.

National data show that 20 percent of all Medicare patients are readmitted to hospitals within 30 days, and 33 percent are readmitted within 90 days, costing Medicare more than $17 billion annually, according to a 2009 study in the New England Journal of Medicine.

In similar patients who did not participate in Residential’s Cardiopulmonary Hospital Admit Management Program, called CHAMP, during the last six months of 2010, the readmission rate was 25 percent, said David Curtis, Residential’s president.

But remote monitoring isn’t universally popular.

“Not every patient wants to use telemonitoring, and some physicians don’t want it,” Curtis said. “In order to drive down readmissions, we need better alignment (with patients and physicians).”

Curtis said the reduction in readmissions comes by focusing on three areas: educating patients within 24 to 48 hours after going home from the hospital, preventing medication errors, and having patients take vital signs with the devices daily.

Residential uses remote medical monitoring devices provided by Philips Telehealth Solutions including wireless weight scales, blood pressure cuffs and blood glucose meters.

Residential nurses and therapists teach patients to use the Philips devices. The data is transmitted daily to Residential, where nurses monitor it and contact physicians if warranted.

But the use of remote medical monitoring devices to reduce readmissions is still in its infancy and studies have shown mixed results.

For example, a study published November in the New England Journal of Medicine showed no reduction in readmissions from use of telemedicine in heart failure patients. However, the study concluded that many of the patients didn’t take daily readings from the instruments.

Curtis is familiar with the studies and says the effectiveness of the remote monitoring devices is only as good as nurses and therapists following up with patients to make sure they are compliant.

“If we don’t hear from our patients by 11 a.m., we are calling to remind them,” Curtis said. “The value of telemedicine is not in the equipment, it is in the process and patient education we use to prevent readmissions.”

Christopher Kim, M.D., a hospitalist at the University of Michigan Hospitals in Ann Arbor and a readmission reduction expert, said some technology vendors are aggressively promoting the use of telemedicine devices to reduce hospital readmissions.

“I am not sure it is completely justified yet,” he said. “The technology can help, but we have to look at our workflow and make sure we coordinate care with post-acute providers to keep patients out of the hospital.”

Besides the program saving Medicare money and improving patient care, Curtis said demonstrating low readmission rates will help bring more patient referrals to Residential from physicians.

“If we have the best outcomes, we can generate new business,” said Curtis, a health care and manufacturing consultant who acquired Residential six years ago with three other partners, including Chairman and CEO Mike Lewis, a lawyer who was a senior partner at Troy-based Dean & Fulkerson.

The company is already one of the state’s largest non-hospital-based agencies with more than 2,200 patients, according to the Michigan Home Health Association.

Annual revenue for 2010 for Residential and its affiliates totaled $48 million, down from $53 million in 2009, Lewis said. The revenue slide came from rising costs and flat Medicare payments, a shortage of nurses and therapists that limited census, and costs associated with expanding into Illinois, he said.

“We had staffing issues last year because of the nursing shortage, but this year we have hired one clinician every other day (more than 50 nurses and therapists),” Lewis said.

Of Residential’s 473 employees in Michigan, 255 are nurses and therapists and 17 employees are part of the company’s marketing and community liaison team, Curtis said.

In Michigan, Residential averages 1,500 patient home care visits per day, a 20 percent increase from last year. The company also has an agency in Illinois that averages about 300 patient visits per day.

Jerry Wilborn, M.D., a pulmonary critical care specialist and hospitalist who refers some patients from Botsford Hospital to Residential, said he uses data collected by Residential to determine…[read the rest here]

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April 25, 2011

Nurses fear even more ER assaults as programs cut

Here is an article that is a bit old, but still imparts useful information. The violence against nurses is escalating.   When you go to your work prepared to do whatever it takes to help people survive and improve, the last thing you expect is to be attacked or killed.  It seems that violence against nurses is becoming  the norm not the exception.  What really bothers me is that we seem to have become used to hearing about this violence and no longer react with appropriate dismay.

One of the factors that contribute to this violence may be the actual staffing ratios that hospitals use to staff.  When a very few staff are expected to do all, you set the stage for frustration and violence.  We see evidence of this everywhere today.  Simple frustration regularly erupts into full blown violence.

Please read this article and tell me your thoughts on the topic, won’t you?  This article is from the San Diego Union-Tribune.   You can visit the site to read comments and leave your own.


By JULIE CARR SMYTH, Associated Press Writer

Tuesday, August 10, 2010 at 11 a.m.

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

// / AP//

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio. A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press. Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

U.S. map and chart show expected state mental health budget cuts;

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

In this July 29, 2010 photo, emergency room nurse Jeaux Rinehart sits in a treatment room at Virginia Mason Hospital in Seattle. Rinehart was accustomed to fielding kicks, spits, scratches and flying punches from his patients there, but one day in 2007 he didn’t move quickly enough. An erratic intravenous drug user who had entered the ER in search of a fix, grabbed a club, came up from behind and, as Rinehart turned, smashed it into his face. Bones broken, Rinehart sucked meals from a straw for weeks. (AP Photo/Elaine Thompson)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

COLUMBUS, Ohio — Emergency room nurse Erin Riley suffered bruises, scratches and a chipped tooth last year from trying to pull the clamped jaws of a psychotic patient off the hand of a doctor at a suburban Cleveland hospital.

A second assault just months later was even more upsetting: She had just finished cutting the shirt off a drunken patient and was helping him into his hospital gown when he groped her.

“The patients always come first – and I don’t think anybody has a question about that – but I don’t think it has to be an either-or situation,” said Riley, a registered nurse for five years.

Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.

Nurses have responded, in part, by seeking tougher criminal penalties for assaults against health care workers.

“It’s come to the point where nurses are saying, `Enough is enough. The slapping, screaming and groping are not part of the job,'” said Joseph Bellino, president of the International Association for Healthcare Security and Safety, which represents professionals who manage security at hospitals.

Visits to ERs for drug- and alcohol-related incidents climbed from about 1.6 million in 2005 to nearly 2 million in 2008, according to the federal Substance Abuse and Mental Health Services Administration. From 2006 to 2008, the number of those visits resulting in violence jumped from 16,277 to 21,406, the agency said.

Nurses and experts in mental health and addiction say the problem has only been getting worse since then because of the downturn in the economy, as cash-strapped states close state hospitals, cut mental health jobs, eliminate addiction programs and curtail other services.

After her second attack in a year, Riley began pushing her hospital to put uniformed police on duty.

The American College of Emergency Physicians has recommended other safety measures, including 24-hour security guards, coded ID badges, bulletproof glass and “panic buttons” for medical staff to push. Detroit’s Henry Ford Hospital is among hospitals that have had success with metal detectors, confiscating 33 handguns, 1,324 knives, and 97 Mace sprays in the first six months of the program.

But there are practical and philosophical obstacles to locking down an ER. Bellino and others say safety begins with training health care workers to recognize signs of impending violence and defuse volatile situations with their tone of voice, their body language, even the time-outs parents use with children.

He said nurses, doctors, administrators and security guards should have a plan for working together when violence erupts. “In my opinion, every place we’ve put teamwork in, we’ve been able to de-escalate the violence and keep the staff safer,” he said.

Also, he and others said it is important to combat the notion among police, prosecutors, courts – and, at times, nurses themselves, who are often reluctant to press charges – that violence is just part of the job.

“There’s a real acceptance of violence. We’re still dealing with that really intensely,” said Donna Graves, a University of Cincinnati professor who is helping the federal government study solutions.

Robert Glover, executive director of the National Association of State Mental Health Program Directors, said economic hard times are the worst time for cuts to mental health programs because anxieties about job loss and lack of insurance increase drug and alcohol use and family fights.

“Most of them, if it’s a crisis, will end up in emergency rooms,” he said.

Vermont nurse David DeRosia, who has been attacked at work, said patients want McDonald’s-like fast service even when they visit busy emergency rooms. When they don’t get it, some lash out.

“They want to be able to pop in and get what they need immediately, when the emergency department has to see the sickest patients first,” he said. “There are many people who have unrealistic expectations they can get whatever they want immediately, and it isn’t a reality.”

What has heightened fears among nurses and other health professionals is that attacks have become more violent, Graves said. “What’s bringing attention to it now is the type of violence: the increase in guns, in weapons coming in, in drugs, the many psychiatric patients, the alcohol, the people with dementia,” she said.

Twenty-six states apply tougher penalties for assaults against on-the-job health care workers. A renewed push to stiffen punishment began the Emergency Nurses Association reported last year that more than half of 3,465 emergency nurses who participated in an anonymous, online survey had been assaulted at work.

“It came as news to me that they are one of the most assaulted professions out there,” said state Rep. Denise Driehaus, who is pushing tougher nurse-assault penalties in Ohio.

Yet bills making an assault on a nurse a felony instead of a misdemeanor failed in North Carolina and Vermont during sessions that just ended, and Virginia shunted its proposal to a state crime commission.

Rita Anderson, a former emergency nurse who pioneered efforts in New York in 1996 to make it a felony to assault a nurse, said resistance is often strong – among both nurses and law enforcement officials.

In 1999, after her jaw was dislocated by a 250-pound teenager, Anderson pursued charges under the state law she had worked hard to pass. She said police were surprised a nurse would press charges against a patient, and prosecutors were skeptical of the case.

“It doesn’t matter if you’re drunk or you’re on drugs or you’re in pain,” she said. “That doesn’t give you the right to hit another person.”

Seattle ER nurse Jeaux Rinehart had learned to get outside fast to avoid kicks, spit, scratches and punches on the job at Virginia Mason Hospital. Then one day in 2007 Rinehart didn’t move quickly enough and a junkie who had entered the ER in search of a fix smashed him in the face with a billy club. Bones broken, Rinehart sucked meals from a straw for weeks.

“A thing like that sticks in your mind to the point where it’s always there, it’s always present,” Rinehart said. “I’m on heightened alert a hundred percent of the time.”

Rinehart was attacked again in July. An intoxicated patient punched and spit on him, then threatened to come back with a gun and kill him. He is pursuing felony charges.

Please go to the original site to read this and others like it:


Emergency Nurses Association:

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April 19, 2011


I frequently read articles from H&HN (Hospitals and Health Networks).  Although slanted more for hospital CEO’s and management, I find many really interesting articles that show nursing as an integral part of hospital management, and in a positive light.

This article, though not about nursing, is about how our patients are changing the way they take care of themselves and how the healthcare field can help patients be better informed about their personal health issues.  It is a really good article and one that we should all think about.  Just this morning, I received an email trying to sell me  a program to make “Apps” without knowing any technical information.

The future is here.  We need to keep up.

By Howard Larkin

Patients and doctors are jumping on the mobile app bandwagon, changing health care as we know it

Got kidney stones? There’s an app for that—and for just about every other clinical and administrative function. As mobile applications reshape health care, hospitals will be pressed to keep up.

“The No. 1 thing that patients can do to reduce their risk of kidney stones is to drink more fluid. But people don’t drink as much as they think they do, so how do you keep track?” asks William Johnston III, M.D., a urologist practicing at NorthShore University HealthSystem in Chicago’s northern suburbs.

Johnston’s answer is a mobile app he developed for the iPhone. Since going live on the Apple Store in June 2010, the free program has been downloaded more than 2,500 times.

Every time a patient drinks a soda or coffee or a glass of water, he opens the app, taps a picture of the beverage and enters the amount. The application automatically tracks the quantity and displays it as a percentage of the daily target—typically set at 75 ounces. It also charts fluid intake over the last week and month. It even can e-mail the information right to a physician.

“Patients are mobile, so this makes it easier to keep accurate records and get them to the physician,” Johnston says. Currently, clinic staff must transfer data manually from the app to NorthShore’s sophisticated electronic medical record, but Johnston is working on systems that will enable mobile apps to populate patient health records directly .

But does the app really help patients drink more—or reduce kidney stones? “Our observation in clinic is it definitely does,” Johnston says. “When they start using it, most patients find they are not anywhere close to the goal. If you look at it in the afternoon and you are at 25 percent, it makes you want to drink some water. I use it myself.” He is planning a clinical trial to measure the impact of the app on patient behavior and outcomes.

He’s also developing an app to help patients with enlarged prostates monitor urine flow. Other apps will provide prostate surgery patients with day-by-day perioperative and discharge instructions—complete with checklists, warning signs, and automated medication and follow-up appointment reminders.

“If the patient is at the mall and they see blood in their urine after prostate surgery, the information they need is right in their pocket. If they need help, they can call or message right away. It really opens up a new frontier for patient care, patient safety and access to doctors,” Johnston says.

17,000 Apps—and Counting

As of November, there were more than 17,000 medical applications available for download from major app stores for the Apple iPhone and iPad, and for smart phones and mobile computers using the Android, Microsoft Mobile, Blackberry, Palm and Symbian operating systems, says Ralf-Gordon Jahns, head of research at, a Munich, Germany-based IT consultancy specializing in mobile technologies.

And that’s just the consumer end of the market, which is dominated by mobile phone operators and specialized health care firms. Countless mobile apps exist or are being developed by traditional health care providers, device manufacturers, pharmaceutical manufacturers and researchers around the world. They range from dedicated devices linked to glucometers and blood pressure cuffs that have been around for more than a decade to new applications that take advantage of the accelerometer and GPS capabilities of the latest smart phones to detect and automatically report patient falls and even elopements of patients with dementia. Bluetooth-enabled scales and other detectors that will automate home monitoring of a wide range of clinical conditions also are hitting the market.

Applications for monitoring patients and accessing electronic records inside the hospital using smart phones and tablets also are proliferating. Indeed, many major electronic medical-record suppliers now are developing interfaces that can run as native applications on mobile devices. “Our Haiku application for physicians and nurses allows users to look up any patient in the system and review the chart, notes, labs, X-ray results, medications. Everything that is in the chart can be viewed on the iPhone,” says Sam Butler, M.D., a pulmonary and critical care specialist who is now a clinical informatics team member for Epic. The iPhone app also supports clinical scheduling and dictation, and e-prescribing is in the works. An iPad version also is being developed. Epic, as well as other EMR suppliers, also makes personal health records available to patients over the Internet.

But more significant than the sheer volume of apps is the growing public acceptance of the technology and the increasing ability to integrate capabilities, which heretofore largely have been siloed in phones or dedicated devices, into the mainstream workflow of providers, Jahns says. He points out that many remote applications have been around for years, but haven’t gotten past the trial stage because of provider concerns about privacy and a lack of a standardized way to engage patients. But with the broad acceptance of smart phone apps, he believes the tipping point is at hand.

“In the next three to five years, we see the likelihood that doctors and patients both will realize they have smart phones, and there will be discussions like ‘I see an app for my condition. Is there a chance to include it in my treatment plan so I don’t have to come in all the time?'” Jahns says. Insurance arrangements that reward use of efficiency-creating technology, either directly or through arrangements such as global payment for episodes of care, will cement the deal. He projects that by 2015, 500 million of an estimated 1.4 billion smart phone users worldwide will use an mHealth app—and millions of U.S. baby boomers will be at the forefront.

Jahns also believes that health care providers, as well as pharmaceutical manufacturers, will supplant mobile phone companies as the primary distributors of mHealth apps, with diabetes management leading the way. Until now, charges per download and data transmission charges have paid for mHealth apps, but increasingly the funding will come from providers who can leverage the technology to improve efficiency, and pharmaceutical companies that can use it as a promotional and advertising vehicle, he believes.

“Patient demand is driving it,” Jahns says.

The iPad Effect

And so will physician demand, says William Phillips, vice president and chief information officer of University Health System in San Antonio, a 500-bed county-owned facility that conducts more than 550,000 outpatient visits annually. The main reason is the iPad. Nineteen million of them were sold in a mere nine months after they were introduced. That caught the e-media punditry off guard, and their popularity among physicians startled hospitals and EMR developers.

“We anticipated that mobile apps were coming, but we weren’t quite prepared for the iPad,” Phillips says. “They [physicians] are buying their own and asking, ‘Can you connect this with the hospital network?’ The portability, intuitive interface and 10-hour-plus battery life made it an instant hit with clinicians. The quality of radiology images is actually better on the iPad than on some of the hardwired clinical workstations.”

Doctors like the device because it allows them to keep tabs on more patients without being physically present—a big plus in these days of shrinking reimbursement. For example, anesthesiologists at Emory University developed an iPad app that allows them to monitor patients before and after surgery, increasing their efficiency as well as improving patient safety.

Responding to physician demand, University Health System developed a Citrix interface, which is a commercial program that not only allows remote access to PCs and other computers, but also allows physicians to use their iPads to use the system’s Allscripts EMR. Traffic over the hospital’s Wi-Fi network has increased by about one-third since the Citrix app went online, Phillips says.

Like many emerging eHealth apps, integration with commercially available mobile devices appeared decisive. Allscripts is developing a native iPad interface, and Phillips expects it to be available by year’s end.

But the advantages to even the Citrix interface, which may be slower than a native application and restrict access to some EMR functions, are so compelling that he already has begun implementing it in some nursing units. “We wanted to wait for the native app, but we couldn’t.”

Phillips notes that the cost of the iPad is about one-third of a similarly capable laptop. Essentially, it is set up as a dumb terminal accessing the main EMR database. All data processing takes place on the secure computer system, which communicates wirelessly with mobile devices using appropriate encryption and other data safety features. The battery life and convenience of recharging the device is a huge advance over the typical computer on wheels, or COW, which requires not only a laptop computer, but also an expensive cart and mobile battery to ensure it can make it through an 8- to 12-hour nursing shift. “The cost of a COW is up to six times [that of] an iPad,” Phillips says

Of course, it’s also a lot easier for nurses to tuck an iPad or similar device under their arm than to push an unwieldy COW from room to room, all the time worrying about when it will need to be recharged—in a location that does not violate Joint Commission standards for keeping hallways clear. That’s no small advantage for nurses who often are being asked to care for more and more patients. Moreoever, iPads eliminate the fight for COWs that can take place at the beginning of shifts.

While the durability of iPad battery life is an open question, so far it is even longer than the 10 hours advertised, Phillips says. In its new inpatient facility, University HealthSystem is incorporating not only iPad docking stations in patient rooms, but also a much more robust mobile wireless network, including antennae in stairwells and lobbies, to support an anticipated geometric increase in clinical mobile use within the hospital.

Moving Target

But while the expansion of mobile health apps seems inevitable, the precise technology that will be needed is an open question. For example, the latest Wi-Fi protocol—802.11n—allows communication over 5 GHz transmitters as well as the earlier 2.4 GHz bands, and may interfere with 2.4 GHz 802.11a-g transmissions from existing devices. The upcoming 802.11ac standard may jam existing 2.4 GHz signals altogether. This could require hospitals to install new antennae to keep up with changing standards, as well as higher-capacity wireless routers to keep up with growing bandwidth demands.

“Ten years ago, who knew that 802.11n at 5.2 GHz would be in place today?” says Scott W. Johnson, vice president of communications planning for engineering firm SSR Inc. in Nashville. “If you installed 2.4 GHz antennae, you may be ripping it out today. The industry has not been very good at future-proofing technology.”…..[read the rest of this article]

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April 15, 2011

Nurse Dies After Assault At Cape Mental Health Center

As a mental health nurse, of course, this article held some significance for me.  But the problem discussed here–death and physical damage done to nurses during normal work hours–really belongs to all of nursing.  I don’t think about the potential for being hurt when I get up each morning, but the truth of the matter is that I deal with a very volatile population and that staffing for this type of patient is never adequate.  99% of the people I care for would never, ever hurt me or any other person; dispite having a mental illness.  It is that 1% that I have to worry about.  My difficulty is in identifying them in time to protect myself.

My heart goes out to this nurse’s family.  My heart goes out to this nurse’s workmates.  There is nothing quite a scary to a mental health team as the death of one of their own while at work.  I hope that hospital provides the staff with some type of counseling to deal with this event.

Here is the article.  Please read the entire article and feel free to visit the original site to leave a comment there.  Please leave me a comment if you have any thoughts about this article.


April 14, 2011 11:13 AM

Cape Cod & the Islands Community Mental Health Center in Pocasset. (photo courtesy: David G. Curran/

Cape Cod & the Islands Community Mental Health Center in Pocasset. (photo courtesy: David G. Curran/

POCASSET (CBS) – The death of a nurse at a Cape Cod mental health center may mean new charges for the patient suspected in the crime.

Back in late March, 60-year old Jason Lew, a nurse at the Cape Cod and islands Community Mental Health Center, was assaulted by a patient. Lew’s injuries were so serious he was brought to several different hospitals before he died last Friday.

“There was some kind of an altercation. The nurse who subsequently died was assaulted during the course of the altercation,” said Cape and Islands District Attorney Michael O’Keefe.

O’Keefe said the suspect was immediately arraigned on assault charges, but depending on what the medical examiner finds, more charges could follow.

“It was a couple days later that the individual was deceased. So, it’s that full sequence of events that is the subject of an investigation to see what, if any, other charges might be appropriate,” said O’Keefe.

If the assault is found to have played a role in Lew’s death, it would make it the third worker in a local mental health center to have been killed by residents in the past four months.

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April 9, 2011

Prevent Readmissions With Discharge Planning

With The Joint Commission looking at “revolving door” admissions, it is time for everyone to get on board and start working to prevent readmissions.  Being readmitted benefits no one.  The patient feels like their health has become unmanageable and they are frightened.  The family becomes convinced that they cannot handle the needs of the patient safely.  The hospital, once a safe haven, becomes a scary place.

We have to work “better” not harder at discharge planning.  We need to be looking at the patients’ needs and desires as much as possible.  Just getting patients out of the hospital is no longer acceptable.

The article below is long, but well worth your time.  Only part of it is below, so please do click over to finish reading.  This is from one of my favorite sites, Health Leaders Media, where you will find many other great articles dealing with various issues in today’s nursing.


Rebecca Hendren, for HealthLeaders Media , April 5, 2011


Discharge planning is a process that should begin as soon as patients are admitted to the hospital. In a perfect world, healthcare team members, patients, and families communicate and work together to move patients quickly and safely to home or the next level of care.

In reality, discharge planning can be fractious. Older adult patients and their families face many choices about where to go and often disagree on the best course of care. Communication among caregivers can be far from ideal and communication between patients and families can be fraught with disagreements.

As hospitals battle readmission rates, more attention is being paid to discharge planning. Lori Popejoy, Phd, APRN, GCNS-BC, assistant professor in the Sinclair School of Nursing at the University of Missouri, has been studying the discharge planning process around older adults and recommends hospitals pay more attention to the decision-making process with these patients.

Popejoy, who has years of experience with care of the older adult before entering academia, recently published a study, “Complexity of Family Caregiving and Discharge Planning,” in the Journal of Family Nursing. I spoke to her about the problems nurses face as they work with older adults and their families, the challenges faced by healthcare providers as they discharge older adults from the hospital, and the healthcare transitions faced by elderly people and their families following hospitalizations.

Popejoy says that our understanding of discharge planning and how patients make decisions is quite simplistic. We usually think about conversations between physicians and their patients or between physicians and families. In reality, dozens of people are involved in any decision. So she examined interactions between healthcare team members, including nurses and social workers, and older adult patients and their families. She wanted to understand how these diverse stakeholders come together to make a single decision about leaving the hospital and where they are going to go. She wanted to understand how much participation in decisions patients and families want the healthcare team to have and what actually happens as decisions unfold.


“Every participant comes to the situation with their own values, their own beliefs, and what they want to get out of it,” says Popejoy. “What stands out for nurses or social workers is their overall concern for patient safety. Their input into the decision making process is to find the most reasonable choice and the safest choice.”

For older patients, most just want to go home. Some recognized they were too weak and were willing to go somewhere else, but for them, it was to be a short-term stay where they could get stronger and then ultimately go home.

For families, safety is important, but also the issue of ‘I want my parent to be able to live the life they want to live,’ says Popejoy. “For a spouse, it’s a whole different ball game—they just want their spouse to go home with them.”

Within child-parent relationships, some want their parents to live with them; others recognize that their lives are too complicated to handle a parent at home who is functionally unable to care for themselves. Some can handle a short-term stay, but not one for the long term.

Popejoy says that hospitals need to figure out who the key players are who can influence decisions. “Listen to older adults and find out what they want, but also listen to the family and what they can do,” she says.

She cautions decision makers are often not available during Monday to Friday business hours. Although most organizations know this, it can be difficult to get good information across the week, not just during traditional work days. Discharge planning and communication may have to be done via conference calls or during off hours.

Another important thing that leaves healthcare teams in difficult positions is the idea of autonomy.


“In the United States, we value autonomy and your independence above all…[read more]

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April 4, 2011

A New Program for Foot Care Nursing is Available Online

Foot care is not the most glamorous  area of nursing care, but I believe it is one of the building blocks to good health.  If feet are not assessed and cared for properly, all types of physical and emotional issues can arise.

I have always been interested in learning how to do proper foot care and used to follow a particular thread on’s forum that was about foot care as a business idea for nurses.  I got frustrated when I learned that to become trained and certified, I would need to go the west coast to take classes and then I would need to certify with Wound Care certification.  It seemed like quite a bit of effort and money to maybe be able to make a living as an entrepreneur nurse.

Imagine my surprise and delight when I found this PR in my email.  I am really interested in checking this out, and I thought someone out there also might enjoy this information, so I am posting it here.

Poor or no foot care can cause infections, amputations even death of Diabetics. Professional Education, LLC, is launching a comprehensive Foot Care Program online for nurses.

This program requires no travel, no time away from home or work and no specific dates or hours of attendance. It can be the prep program for the exam for Certified Foot Care Nurse, a new specialty nurses can add to their career resume.
Austin, TX (Vocus/PRWEB) January 29, 2011

Professional Education, LLC, has a Foot Care Program for RNs that is entirely online. The program brings their knowledge-base in diabetic foot care to where it should be. Regular and monitored foot care is essential for diabetics and those with other chronic illnesses, and a deficiency in this care can be deadly. Diabetes Mellitus is said to be diagnosed in over 11.2% of men and 10.2% of women over 20 years old, according to the American Diabetes Association, but few nursing schools include more than a cursory mention of care of the feet in their curriculums. No nursing text reviewed had over 1.5 pages of text on the feet and many less than one.

A new specialty, Foot Care Nurse (CFCN) now provides the information for nurses to perform appropriate foot care to diabetics and other chronically ill patients. Professional Education’s RN Foot Care Program on is a prep class for the Wound, Ostomy and Continence Nursing Certification Board exam ( to become a Foot Care Nurse (CFCN®) or can be taken just for added information. This specialty is growing rapidly because of the maturing of our population and the rapid increase in diabetics. A Certificate of Attendance to a prep course and an Internship are required for taking the FCN exam. The exam is taken at nearby test centers.

The trend in attaining specialty certifications makes this Program attractive. Nurses with a specialty certification are paid an average of $12.81 more per hour, according to the RN Magazine’s 2009 Nurse Earnings Survey. Though not defined by specialty, this Survey does indicate that a specialty increases the earning power of RNs.

“Foot Care Nurses are valuable in these days of the high rate of diabetes,” says Suzie Fleak, R.N., Centrum Manager, Columbus, OH. “Foot care is important to maintaining health for the diabetic.” Fleak suggests these specially trained nurses can be utilized in nursing homes, wound care facilities, critical and emergency care units; in community and home health nursing, medical and podiatry offices and many other locations where health care is provided.

Professional Education, LLC, launched January 2011, will be offering quality courses within a wide array of professional specialties and strives for excellence in the programs. All courses will be on-line only, though when needed by the specialty, Internships will be designed for that purpose. All courses are written by experts in the specialty. For questions and if you know of courses that would meet our site goals, see or contact us at 512-763-9340.

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