Nursing Notes

October 27, 2011

Engage Nurses to Raise Your Patient Safety Scores

Filed under: Nursing — Shirley @ 1:13 pm
Tags: , , , , ,

Here is an article about patient safety and who owns the indices.  This article is good, in that it talks about how top-down changes never stick and that you have to involve and empower the hands-on staff if you want to make lasting changes.  That I like.  What I was not too keen on, and I could be way off target here, is it also felt that nurses not taking ownership because of administrations policy and ways of dealing with the problem, was somehow to blame for there still being a problem.

After reading the article, I felt “there’s just another thing to throw on the nurse’s plate” when nurses everywhere are already struggling to stay current and afloat with all the healthcare changes that are in the works.  Nurses just want to nurse.  Period.  Let them do what they became nurses to do and maybe some of these problelms would disappear.  However, you would have to have enough nurses first so that each nurse could actually do the nursing she/he went to school to do.  What a concept!  I’m being sarcastic, in case that does not translate well in print.

Here’s the article from HealthLeadersMedia.com so you can read it and decide for yourself how it makes you think and feel.  Let me know, won’t you?

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Rebecca Hendren, for HealthLeaders Media , October 25, 2011

Who owns the quality measure and patient outcome scores in your hospital? Most hospitals have quality, safety, and infection prevention professionals devoted solely to these statistics and ways to improve them.

All their efforts are meaningless unless nurses and other clinical staff are engaged in the process. Too often, they are not. Most staff nurses don’t know what value-based purchasing is or why they should care about it. All they know is that when Administration or “Quality” has a new scheme it will take nurses more time to do their jobs.

Nurses may fully support the changes because they will benefit patients, but they don’t own them and they don’t own those scores.

As the people who actually touch patients, all members of the nursing staff need to feel directly responsible for patient safety. Quality improvement becomes one more meaningless directive from “above” unless nurses feel engaged in the process, involved in the plans, and accountable for the results.

“Culture eats strategy for lunch,” says Mary J. Voutt-Goos, MSN, RN, CCRN, director, Patient Safety Initiatives and Clinical Care Design at Henry Ford Health System in Detroit. “If frontline staff aren’t in agreement and actively engaged in the process, it won’t happen. Top-down approaches to culture change are typically unsuccessful.”

This is one reason why scores can start creeping downward after a successful quality improvement effort has come and gone. If nurses aren’t engaged in the process, they have less inclination to remain on a directed path.

“All frontline staff, not just nurses, should be engaged, as well as empowered to act, if we really want to see a change in our culture of safety,” says Voutt-Goos.

One way to build a feeling of accountability in nurses is to empower them to solve the problems themselves—in conjunction with quality and patient safety professionals, of course. New procedures or processes are more likely to be met with acceptance and to become part of everyday practice when the caregivers themselves are involved in the design.

At Henry Ford Health System, the organization studied aviation industry principles of safety cultures and safety climate literature and identified global indicators of safety culture.

“We use these global indicators as a guiding framework for our culture of safety efforts,” said  Voutt-Goos. “One of the global indicators is employee empowerment.”

Empowering employees involves giving them a level of responsibility and knowledge, which sometimes they may not want, but is vital to achieving an end result of quality patient care in a financially healthy organization.

One common practice to reduce outcomes-related to issues such as patient falls or CAUTIs is to pit units against each other in competition and reward the winner with a pizza or ice cream. While it’s appropriate to celebrate success and recognize hard work, I think it’s a mistake to rely too heavily on competition.

Rewarding the unit that most improves its customer satisfaction scores or reduces patient falls by the greatest percentage is great at building enthusiasm and recognizing hard work, but it’s not an effective long-term strategy. Nurses should be treated like adults and involved in the imperatives behind process improvement, both those related to patient care and those related to the organization’s bottom line.

Just as the hospital should treat nurses as adults, nursing staff should be more interested in quality outcomes. They must seek out and embrace their level of ownership in these metrics. In today’s financial reality, it is no longer acceptable to not take an active role in quality improvement efforts. Organizations should engage nurses in frank and honest communication.

The financial imperative is such that hospitals can’t afford…[read more]

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October 25, 2011

The Truth about Nursing

Filed under: Uncategorized — Shirley @ 8:28 pm

Here is a video about nursing that is really hillarious until you realize it is too sad because it is true.

The public’s view of who a nurse is and what a nurse does has not changed since the inception of the profession, despite our best efforts to give the public correct information.  It is sad that most people still view nurses as sexually loose women or as doctor’s handmaidens–there is no room for any other stereotype in their collective minds.

As a nurse, I am appalled when my profession is maligned in the media.  I hope you feel the same way.

Here is a video to articulate this issue:

October 21, 2011

Vitamin Studies Spell Confusion for Patients

Filed under: Uncategorized — Shirley @ 6:43 am

As a proponent for taking multiple vitamins daily, I am always upset when there is an article or new story about how dangerous and unhealthy it is to take them.  I am always suspect of any and all articles that say “vitamins will cure you”  or “vitamins will kill you”.  This is the type of news reporting that seems to be in favor right now and with most of the public relying on news for their information, I think this is a shame.

The article below, presented by ABC News,and found on MedPage Today is just one of a myriad of articles that say, in effect, don’t take vitamins because you don’t need them.  But, the healthcare system has just recently begun to even check to see if patients show any vitamin deficiency with lab draws.

We all were taught in school that there are several diseases that can be prevented with a simple vitamin.  Is that not still true?  We are told that all we have to do is eat correctly and we will get all that we need.  Who do you know right this minute who eats correctly 100% of the time–that eats 6 servings a day of fruits and vegetables, moderate meat, moderate starch, low fat?  I have to say that I don’t know anyone to fit that description, including me.

What I would hope is happening, but the title to this article seems to think not, is that people are doing their own research and making informed decisions about whether or not they need to supplement their daily intake.  With the crisis in healthcare today, it seems we would be trying to encourage self-care and healthy lifestyles with supplementation of vitamins being only a part of that picture.

Who funds these studies?  My experience, after I dig and dig, is that most of them are funded by Big Pharmacy.  The supplement industry is large and that money is getting away from them because they cannot patent a natural substance.  What is showing up now are called “nutraceuticals”, which are a blending of vitamins and herbs with known prescription drugs.  These can be patented and sold at exorbitant prices to the unwitting public.

Please let me know what your thoughts are on this hot topic, won’t you?

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By Kristina Fiore, Staff Writer, MedPage Today
Published: October 14, 2011

 

If it’s Monday, it must be bad news about multivitamin day — or was that Wednesday? No, Wednesday was good news about vitamin D, not so good news about vitamin E — if you’re confused, join the club.

The alphabet soup of vitamin studies making headlines in the last few weeks has left more than one head spinning, and most clinicians scrambling for answers.

As the dust begins to settle, physicians interviewed by MedPage Today and ABC News agreed on a bit of simple wisdom — a healthy diet is more important than a fistful of supplements.

“I had already asked my patients to stop their vitamin supplements four to five years ago, with the exception of those with a deficiency of vitamin D, … pregnant patients [who should get] folate and prenatal multivitamins, or those with cognitive impairment, when I would recommend a vitamin B complex,” Albert Levy, MD, a primary care physician in New York, said in an email to MedPage Today and ABC News.

Whether patients heed the advice is another question, as recent research has shown that more take supplements now than ever before. More than half of Americans report taking a multivitamin or other dietary supplement, up from 40% just two decades ago.

And there’s sure to be pushback from the largely unregulated dietary supplements market — estimated to be a $20 billion industry — which has already launched multiple critiques of the latest evidence.

The Deluge

Here’s a sample of the supplement headlines over recent weeks: B12 deficiency leads to cognitive decline, vitamin D helps fight off tuberculosis, vitamin E ups the risk of prostate cancer, calcium won’t improve outcomes for Mom or baby.

The one that garnered particular attention reported an increased risk of death in postmenopausal women taking multivitamins, as well as vitamin B6, folic acid, iron, magnesium, zinc, and copper.

Though multivitamins carried only a slightly increased mortality risk, many clinicians say they’ve written off the supplement for good.

That’s because multivitamins were never recommended on the basis of strong evidence anyway, David Katz, MD, of Yale’s prevention research center, told MedPage Today.

“What we had was a notion that this was an insurance policy,” he said in an interview. “Many people don’t eat the way they ought to, so they’re not getting the optimal doses of nutrients from food. Instead, we can rely on a pill that ought to do you some good, and certainly couldn’t do you harm. That was the thinking.”

But more studies have suggested that the health outcomes in patients taking multivitamins appear to be slightly worse, Katz said.

Still, he cautions that the present study is merely observational and can’t prove cause and effect. For instance, some patients may take supplements as a result of being diagnosed with a condition, or they take them because they have a family history of chronic disease and are trying to prevent it, he said.

And clinicians certainly are not concerned that taking multivitamins will kill their patients. It’s just that there is no longer a dearth of evidence that they won’t confer any harm at all, Katz said.

“Considering the weak basis for recommending multivitamins in the first place,” he said, “when you combine that with evidence that maybe it could hurt, the rationale for making routine use of multivitamins goes away.”

Which Supplements Are Supported?

That’s not to say supplements shouldn’t be used at all, Katz said. He recommends omega-3 fatty acids and vitamin D for most of his patients, plus calcium for women. Prenatal vitamins and folic acid supplementation are also on that list.

There’s evidence behind those supplements, he said. The GISSI trial found cardiovascular benefits for omega-3s. Study after study has shown that the majority of Americans are deficient in vitamin D, and the supplement study flood included more positive findings for folic acid supplementation around the time of conception.

As for the rest of the supplement lot — give them only in the face of deficiencies, Katz said.

It’s long established, for instance, that B12 deficiency plays a role in dementia and other neurological disorders, and supplementation can stave that off.

As well, certain vitamins are established treatments for a host of diseases, from vitamin C in scurvy to B12 in pernicious anemia.

Who Is Deficient?

But how can clinicians be sure that their patients actually need specific nutrients, especially since there are usually no obvious symptoms?

Katz said, in most cases, doctors should ask about their patients’ diets and about what vitamins they currently take, though he makes the exception for children who are meeting growth milestones or for adults with good muscle tone.

The majority of clinicians reporting in a MedPage Today poll — 70% — said they supported annual screening of specific vitamin levels to treat deficiencies.

They may simply be following recommendations — in June, the Endocrine Society recommended screening for vitamin D deficiency in at-risk patients, setting various levels of treatment for different risk populations, to keep at bay rickets and bone complications.

Rise and Fall

Just as vitamin E was recently found to be unable to prevent prostate cancer — it was actually associated with an increased risk of developing the cancer, albeit a “marginally significant” one — several other nutrients once touted for their preventive benefits flopped in trials.

“We fell in love with vitamin C in middle of the century, but trials didn’t confirm the benefits of preventing colds or cancer,” Katz said.

Similarly, B-complex vitamins promised to lower heart disease risk, he said. While they did lower homocysteine, trials turned up no clinical cardiovascular benefits.

The carotenoid antioxidants beta-carotene and lycopene also proved to be a bust, with both having no benefit in prostate cancer and the former no use in eye disease nor heart disease.

“We have a long litany of barking up the wrong tree,” Katz said.

Why Don’t They Work?

It’s not clear why these vitamins don’t do what they’re expected to do, and researchers are actively looking into why.

The latest theory is that vitamin isolates don’t work quite as well on their own. The vitamin E isolate used in the prostate cancer trial was alpha-tocopherol, which is only one in the family of E-complex vitamins, Katz said.

Rather, it may take the full blend of antioxidants and phytochemicals found within the context of a whole food in order to deliver any potential benefits.

That appears to concur with clinician consensus on the majority of supplements, particularly in healthy patients: they’re not needed. Eat a healthy diet instead.

“[Patients] should stop trying to look for health in a pill,” Lee Green, MD, of the University of Michigan, said in an email. “Health is not found in pills. It’s found in good food and regular exercise. There’s something in our psyche that makes us want to believe in magic, and that desire to believe has focused on vitamins.”

This article was developed in collaboration with ABC News.

October 19, 2011

Nurses Worried About Retirement Prospects

Filed under: Uncategorized — Shirley @ 6:28 am

As nurses, we rarely take the time to take care of ourselves.  We go into nursing to care for others, so being outwardly focused is inevitable.  However, the truth is that we must first take care of ourselves in order to be able to care for others.    This article is a prime example of a way that nurses need to be taking care of themselves.

Please click over to the original site at Nurse Zone and read the rest of this enlightening article.  Be sure to leave them a comment about it and let me know if you found it interesting.

 

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By Jennifer Larson, contributor

October 14, 2011 – A recent survey found that most practicing nurses feel secure about their current jobs, but they don’t feel nearly as secure about their retirement prospects.

The 2011 Fidelity Investments Nurses Study surveyed 408 nurses and found that 7 out of 10 don’t feel prepared for retirement. The 71 percent who feel they’re not saving enough for retirement is a significant increase over the 57 percent who reported that sentiment during a similar Fidelity study in 2007.

They’re worried about how the economic climate, including possible future changes to programs like Medicare, is affecting their retirement prospects.  They’re worried about not being able to save enough money. And some of them even fret that they may never be able to retire.

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Cindy Hounsell, president of Women’s Institute for a Secure Retirement, said, “The longer you can put off using that nest egg, the better off you are.”

Those responses, which were collected in August by Versta Research, were not unexpected by Cindy Hounsell, president of Women’s Institute for a Secure Retirement (WISER).

“I’m not surprised, with this economy and this nursing population that’s older, that more people are unprepared,” she said.

The results were similar to those found in a study conducted a few years ago by WISER in conjunction with the Center for American Nurses, Hounsell said. That study also found that many nurses had not prepared adequately for retirement.

Robert Henderson, president of Lansdowne Wealth Management, LLC, in Mystic, Conn., said there doesn’t seem to have been enough emphasis on personal financial planning in the nursing profession.

“I believe that much of it stems from the fact that the field is predominantly women, many of which have working spouses who are the primary breadwinners,” he said.

Start here, start saving

Nurses should start by sitting down and figuring out where they currently stand financially and how much money they will realistically need for retirement, said Cassandra Chandler, MBA, a certified financial planner and author of The Retirement Game for Nurses. Then, they should account for family members that may need care and financial support.

If you haven’t started a retirement account, contact your employer to get information on signing up for your employer-sponsored plan. According to the Fidelity study, 81 percent of the nurses said they do participate in their workplace savings plan. Experts say that’s a very important way to make sure you’re saving for retirement.

If you work for a for-profit facility, you can start a 401(k) plan, or if you work for a not-for-profit, you can open a 403(b) plan. These are accounts that allow you to save pre-tax dollars. Because the funds accrue over time, experts always recommend getting started as soon as possible.

“Sooner is better than later, and later is better than never,” Chandler said.

However, it’s not enough to just sign up for your employer-sponsored retirement plan, Hounsell cautioned. You have to work long enough to become vested in order to be entitled to the matching funds provided by your employer. And not every plan has the same requirements…[read more]

 

October 17, 2011

EDs seeing more children for psychiatric care

Here is an article from Nurse.com that presents the findings of a study showing that mentally ill patients, and in particular, mentally ill children are being forced by cutbacks in mental healthcare to utilize the emergency rooms more and more in order to get the help they need.

Emergency rooms are already overcrowded and when you add in mentally ill patients that come to the ER because they cannot get seen in any outpatient clinic, you have a disaster.  People believe that the ER is the magic answer to their health problems when in reality this system is stretched so far that real emergencies have trouble getting care sometimes.

We all know that going to the emergency room with a non-life-threatening problem means a very, very long wait.  Triage will put you to the end of the line and let the life-threatening problems have first opening.  That is really the way it is supposed to work.  However, it seems that with a population woefully under or non-insured, the ER becomes the place of last resort.  There has to be a solution to this problem.  There just has to be.  ER nurses are burning out at record numbers.

Please visit the Nurse.com site and read other articles similar to this one and be sure to leave them a comment.

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Pediatric patients, primarily those who are underinsured, are increasingly receiving psychiatric care in EDs, according to an abstract presented Oct. 14 at the American Academy of Pediatrics National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status and type of care received, from the National Hospital Ambulatory Medical Care Survey between 1999 and 2007. They found during eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8% were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4% in 1999 to 3% in 2007. The underinsured group — patients without insurance or who are on Medicaid — initially accounted for 46% of pediatric ED visits in 1999 and grew to 54% in 2007.

The data show, as anticipated, psychiatric visits by children to EDs continue to increase in number and as a percentage of all patients being seen in EDs, said lead study author Zachary Pittsenbarger, MD, of Children’s Hospital Boston.

“A second, and more novel finding, is that one group in particular is increasing beyond any other sociodemographic group, and that is the publicly insured,” he said. “It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized. This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”


Send comments to editor@nurse.com

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October 14, 2011

More Friday Videos

Filed under: Nursing — Shirley @ 5:03 am
Tags: , , , , ,

Once again, it’s video time. Watch these videos about nursing school, tips for surviving nursing school, and finally what kind of salary you can expect as a nurse. These are all worthwhile videos I hope you enjoy.
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October 12, 2011

Governor Signs Healthcare Law to Save Backs and Bucks

Service Employees International Union

Image via Wikipedia

Here is an article about the new law in California to protect both patient and nurses from lifting injuries.  California has always been in the forefront of the public fight to protect both parties and improve nursing care for all patients.  Patient safety is the number one issue for all nurses; sometimes to our own detriment.  We, as a group, have the highest incidence of musculo-skeletal injuries.  We need some help, too.

This law that was just signed by the Governor is a good first step.  We can hope that the rest of the nation will follow suit; but that is not guaranteed–see the battle ongoing over nurse-to-patient ratios all over the country.

This is an article by the SEIU in California.

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Posted by Michael Cox, 916-799-6784 on October 7, 2011

AB 1136 will help prevent workplace injuries among hospital workers

Sacramento, CA – Today Governor Brown signed landmark Safe Patient Handling legislation (AB 1136) to prevent a staggering epidemic of workplace injuries among hospital workers while improving patient care.

“The SEIU nurses here in California have long recognized the need for safe patient handling legislation and this was the year to finally get that accomplished,” said Ingela Dahlgren, RN, the Executive Director of the SEIU Nurse Alliance of California. “Too many of our nurses and other healthcare workers have been injured on the job while moving or repositioning the patients in their care.”

Due to excessive unnecessary manual patient lifting and transfers, healthcare workers experience some of the nation’s highest rates of disabling neck, back, and shoulder injuries. However for more than a decade, mechanical lifting and transfer devices have proven to be remarkably effective in reducing these injuries while reducing serious patient skin tears and patients being dropped.

“There isn’t a nurse that I’ve met that doesn’t have a story of experiencing an injury while caring for a patient that took them off work either temporarily or permanently or at the very least isn’t dealing with chronic pain in their back, neck or shoulders,” said Dahlgren. “With this important legislation, not only will our patients be provided safer care, but hospitals will have the guidelines to better protect their employees and prevent career ending injuries.”

California nurses and healthcare workers have always lead the charge for safer working conditions and patient care, whether through Nurse-to-Patient ratios, safer needle legislation or Airborne Transmissible Disease Standards, and now Safe Patient Handling isn’t just a hope, it’s a reality.

The nation’s first Safe Patient Handling law requiring the purchase of safe patient handling equipment and training programs was passed in Washington State in 2006. As a result of the implementation of this law, a January 2011 study found that neck, back and shoulder injuries to hospital workers caused by manual patient handling have decreased by more than one third.1

California now joins Washington State and a half dozen other states where SEIU members have succeeded in passing Safe Patient Handling state laws. SEIU is continuing to work with legislators in other states to pass more Safe Patient Handling laws while pursuing passage of a federal law.

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October 10, 2011

Hire education Unfilled school nurse positions jeopardize school healthcare

old school room

Image by Caitlyn Willows via Flickr

Here is an article from Nurse.com about the lack of school nurses and the effect it is having on our childrens health.  Be sure to click over and read the entire article and while you are there leave them a comment.

This is just another example of how the state and federal budget cuts are affecting the innocent and the unprotected in this country.  Our children have no one fighting for them in Washington.  The parents fight for them at the local level, but we all know how effective that is.  Do we really want our next generation to be unhealthy and uneducated?  What does that say about us as a nation?

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By Cathryn Domrose
Monday September 26, 2011

Two years ago, Susan Zacharski, RN, BSN, MEd, was one of five school nurses in an urban school district in Michigan caring for a general population of students in 14 buildings, developing care plans, administering vision, hearing and dental checks and coordinating with community groups to provide health services to children who needed them.

In June 2009, budget cuts eliminated all five general nursing positions, and Zacharski was moved to a building that serves students with special health needs. “No one covers the other buildings at all,” she said. But it could be worse in a state that averages one school nurse for every 4,411 students, the worst ratio in the country. “I’m the only nurse in this district,” Zacharski said, “but there are far more districts that don’t have any nurses at all.”

Though the overall number of school nurses nationwide has increased through 2009, it has been far eclipsed by the increase in students with complicated medical conditions, said Martha Dewey Bergren, RN, DNS, NCSN, director of research for the National Association of School Nurses. Many cuts have been made in the past three years, she said, and though they are uncertain what the economic crisis will bring, school nurse leaders say school health systems already are cut to the bone. “We really need to be looking at another way of funding school health,” Bergren said. “We have to look to the healthcare system.”

Student needs surpass funding

Getting money for school nursing always has been difficult, said Sally Schoessler, RN, BSN, MSEd, interim executive director of NASN, but it becomes even more challenging in a poor economy. Though statistics won’t reflect the effects of the latest recession for one or two more years, Bergren said, “this is the year the districts are really getting hit by [cuts in] state budgets. This is the year we’re hearing anecdotally about the number of nurses who are losing their positions.”

In some places, the damage already has been done. School nursing in California took a hit about five years ago when the state’s Medicaid funds — which used to help pay for school nurses — were slashed, said Barbara Miller, RN, MSN, PNP, past president of the California School Nurses Organization. “I don’t know what more they can cut,” she said.

Ironically, some districts report difficulty filling positions because of the uncertainty of the job or cuts in salary or benefits, Bergren said. For the first time in the more than 20 years she’s been in student health, Lisa Kern, RN, MSN, NCSN, said she has had to scramble to fill nursing positions in her Florida school district. A number of nurses left to go into private sector nursing “where they can earn more money than working as school nurses,” said Kern, supervisor of health services for the Pasco County School District just north of St. Petersburg, Fla. Facing potential cuts in positions, furloughs and increasing pension contribution requirements, “they’ve had to go where the money is,” she said.

Meanwhile, school nurses report seeing increasing numbers of students who need specialized healthcare. The percentage of children younger than 18 with asthma more than doubled from 1980 to 2009, according to the Centers for Disease Control and Prevention. The percentage with food allergies rose from 3.3% in 1997 to 3.9% in 2007. The CDC estimates more than 200,000 children and teens have diagnosed diabetes. The percentage of students in federally supported special education programs increased from 8% to 13% between 1977 and 2008, and within that group, the rates of children with health impairments more than doubled between 2002 and 2008, according to the National Center for Education Statistics. Higher rates of NICU survival mean schools are seeing more medically fragile children requiring ventilators, tube feedings, medication and other complex nursing services, according to NASN reports.

Regulatory mishmash creates confusion

Federal law requires schools to accommodate all students, regardless of health status. But state laws on who cares for these students vary greatly. “It’s not like healthcare, where you go to the hospital in California versus New York” and get the same level of care by licensed providers, said Barbara J. Zimmerman, RN, PhD, CNS, FNASN, professor and coordinator of the school nurse certification program at Millersville (Pa.) University, and co-author of a study of school nurse regulations and requirements across the country. Some states leave it up to school districts, which may allow unlicensed clerks or teachers to administer medications because they can’t afford nurses. And state school nurse education requirements vary from a BSN degree with a school nursing accreditation to nothing, Zimmerman said.

Funding also varies widely, coming from a combination of school districts, state budgets, Medicaid, public health, and federal funds for mandated programs, according to Zimmerman’s study. And funding even for mandated programs is not guaranteed. For example…[read the rest of the article here]

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October 5, 2011

Nurses Don’t Want To Be Doctors

Here is an interesting article about the discord between nurses with graduate degrees and physicians.  This is a “hot topic” right now as the ANA encourages more and more nurses to pursue higher education as a means of advancing the practice of nursing.
Physicians have a point, I guess.  But mostly I think that they have missed the point. Nurses do not want to BE physicians, they want to be nurses.  But they want to be the best nurses they can be.  Receiving your doctorate in nursing only means that you value the profession and you want to pass on to your patients the benefit of you learning.  Nurses are much more global thinkers than physicians.  We are trained to look at the whole picture and then figure out the way the symptoms are affecting the persons health.  Doctors are symptom driven and deal with specifics.  Have you ever gone to the doctor with a complaint of, “I just don’t feel right” and gotten a concerned and interested response.  The usual response would be to send you for a million tests to rule out things.  Nurses will get inquisitive and ask lots and lots of personal questions until they have an “ah-ha” moment.
This article is from HealthLeadersmedia, which I have used before.  I really love this site and hope that you will click over to finish reading this great article.  Leave us both a comment about your take on this issue, won’t you?
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Rebecca Hendren, for HealthLeaders Media, October 4, 2011

As a child addressing thank you notes for birthday gifts, I was perplexed by the one relative whose address began “Dr. and Mrs. John Doe.” I knew he was not a Doctor and yet he was called doctor. My mother explained he was a doctor, but not a “Doctor,” and you can imagine the emphasis on the second doctor.

This was my first introduction to the confusing world of honorifics and it hasn’t become any simpler since.

We all know that the title “doctor” refers both to physicians with medical degrees and to people who have been awarded a doctorate in a certain subject. These days patients often visit “the doctor” and are seen by a nurse who has an advanced practice degree and whose title includes the right to use the honorific term doctor.

Physician groups have been voicing concerns that the growing numbers of nurses who are also doctors are confusing for patients. Nurses are concerned that advanced practice professionals who have received doctorates in their field are afforded the proper respect and receive the designation that advanced study and knowledge is usually afforded in other fields.

Patients are left in the middle. Most patients grasp the differences between a physician and a nurse practitioner (or a physician assistant). Where many patients become confused is when the advanced practice nurse is referred to as doctor. As in, “Hello Mr. Green, I’m your nurse, Dr. Blue.”

Nurse practitioners who use the title with patients in care settings makes some physicians apoplectic. Their reaction leaves advanced practice nurses fuming. It leaves me perplexed. Why would any nurse want patients to think he or she was a medical doctor?

Nurses don’t want to be doctors. Advanced practice nurses could have chosen medical school if they wanted to become doctors. Instead, they chose to expand their study of nursing through advanced practice programs such as anesthesia, nurse practitioners, or the rapidly expanding doctorate in nursing practice.

Choosing further study in the nursing profession is a commitment to the nursing model, which emphasizes holistic patient care. Nurses approach their profession in a very different manner than physicians approach theirs and both are valuable and necessary to the overall provision of care in this country. Indeed, given the physician shortage, particularly in rural areas, the only way to meet the country’s needs for primary care is through advanced practice nurses.

So advanced practice nurses are necessary, vital, and supported by the public. Study after study has shown equal, or in some cases better, outcomes in patient care from advanced practice nurses. A study in the northwest last year revealed patients found nurse practitioner care just as good as physician care and the nurse…[read more]

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