Nursing Notes

September 26, 2011

Unique Initiative Designed to Ease National Shortage of Nurse Educators

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I received this press release in my email today and felt I would post it here for you to read and comment on.  I like the idea of this new track, but I am concerned with the push to have nurses get out of nursing by getting a higher degree.  I recognize that we need more nurse educators to facilitate more nursing graduates out on the floors, but it seems to me that there is such a push for all nurses to get that next degree that it takes your focus off why you went into nursing to begin with–patient care.

Let me know what you think about this press release.  I get these all the time and if you want I will be happy to repost them here for discussion.  Just let me know if that is what you want.

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Cleveland State University Creates Innovative Nursing Education Program

Unique Initiative Designed to Ease National Shortage of Nurse Educators

 

Cleveland, Ohio (September 21, 2011) – In an effort to  help ease the national shortage of nurses and nurse educators, Cleveland State University (CSU) has announced a new Nursing Education Specialization track within its Urban Education PhD program.

 

Beginning this fall, the new track will help to alleviate the strain within America’s nursing education infrastructure by preparing nurses for research-oriented faculty positions. There is a rapidly increasing need for well-trained, urban-based nurses throughout the country, as well as a shortage of nursing faculty prepared at the doctoral level. CSU’s doctoral program will teach research based nurse educators how to prepare practitioners to meet the complex healthcare needs in urban and culturally diverse communities.

In order to further encourage the pursuit of careers in nursing education, CSU has received a competitive grant from the Department of Health and Human Services (HHS) to assist graduate students interested in becoming nurse educators. Acting through the Health Resources and Services Administration (HRSA), HHS has allocated Nursing Faculty Loan Program (NFLP) funds to CSU students enrolled in an eligible advanced degree program in nursing (master’s or doctoral) at the School. After graduation from the program, loan recipients may cancel up to 85% of the NFLP loan over a consecutive four-year period, while serving as full-time nursing educators at a school of nursing.

For the city of Cleveland, the specialization track symbolizes a new dawn, as CSU will be the first university in Ohio to offer such a track within their doctoral program. Currently nurses with an interest in teaching have to join programs outside the State of Ohio. As the national demand for nurses continues to increase, CSU’s initiative will exemplify a creative vision to address a long term need.

“Nurse educators have a profound impact on their students and subsequently, those graduating nurses will engage in professional practice to improve health outcomes for patients, their families and the communities they serve,” said Dr. Vida Lock, Dean of Cleveland State University’s School of Nursing. “CSU’s new Nursing Education Specialization Track aligns closely with CSUs mission and is another example of the University’s fostering of interdisciplinary collaboration to prepare professionals focused on leadership, social justice and partnerships to address contemporary urban issues.”

With the demand for doctors and nurses expected to increase as the baby boomer generation reaches retirement, CSU’s new program could not have come at a better time. In addition, the School of Nursing’s community-based curriculum will prove to be an excellent teaching “lab” for future nursing educators to hone their skills.

The School of Nursing is an independent academic unit within the University’s structure, underscoring the commitment to nursing education by the Board of Trustees and University President. Prospective doctoral candidates are required to hold a Master of Science in Nursing degree, an active unrestricted nursing license, and have recent experience in nursing practice or education. Graduate faculty members in CSU’s School of Nursing will mentor candidates in the Nursing Education track and serve on dissertation committees, guiding these future academics in research that will add to the body of scientific knowledge related to preparing future nursing professionals as well as keeping all nurses current with the ever changing practice of health care.

 

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Jacqueline Platt

Senior Account Executive

CORBIN-HILLMAN COMMUNICATIONS

1776 Broadway ● Suite 1610 ● New York, NY 10019 ● www.corbinpr.com

Direct: (646) 233-0465 ● Fax: (212) 246-6533 ● Mobile: (917) 971-0669

Email:Jacqueline@corbinpr.com

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October 5, 2010

Three steps to ensure new charge nurses are successful

Filed under: Nursing — Shirley @ 4:06 am
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As a charge nurse on my unit and having been a charge nurse many times during my career, I read this article with interest.  I have always wondered why, with all the push on nurses to educate patients, we fail so miserably to educate our own?  This is a good article, but I believe it only scratches the surface of the problem we seem to have.

Although all three steps are good and will help a new charge nurse to grow and develop, I feel that we still need to address the bigger problem of why an article like this is even necessary.  Unfortunately, we still seem to want to “eat our young” no matter how many times we have been told to stop.

This article is from Strategies for Nurse Managers and I have found many really great articles at that site.  Please visit and see if you agree that the information there is good and useful.

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Rebecca Hendren, for HealthLeaders Media, September 28th, 2010

Leadership development is an oft-overlooked issue in nursing, so it’s no surprise that charge nurses rarely receive the training they need. Many organizations promote nurses into the charge position simply because they are good nurses and no one else wants to do it. But the charge nurse is crucial to the smooth operation of a patient care unit, and spending time on training and development can reap dividends in organizational efficiency.

At the basic level, charge nurses manage the operations of patient care units during a particular shift. They assign tasks, workloads, and oversee the care provided to patients. But they also provide support, mentorship, and guidance to bedside nurses. For those reasons, it’s important to train charge nurses so they are up to the job.

Tammy Berbarie is an accreditation coordinator at Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas, and a former director of education, who created a charge nurse orientation program for her hospital. Berbarie believes charge nurses are an organization’s untapped resource. She says these frontline leaders—the eyes and ears of the patient care operation—are vital to ensuring patient safety, quality, and satisfaction, and staff retention.

“I believe that most organizations are in an infant stage when it comes to developing their charge nurses,” says Berbarie. “It is important to develop a robust orientation program to give them the confidence to manage the patient units.”

Berbarie recommends organizations provide all charge nurses with an orientation program, which includes a preceptor and leadership development training.

1. Charge nurse orientation. To be effective, charge nurses must know their responsibilities. The best way to outline expectations and ensure competency is to spend time orienting them to their new role.

Orientation can be accomplished in a one day workshop or through a series of training sessions. This is the time to cover the charge nurse role, regulatory requirements, coordination and delivery of patient care, patient safety, quality improvement, and leadership topics.

2. Charge nurse preceptors. Following the workshop, new charge nurses should be assigned a preceptor. Preceptors are routine for newly hired nurses and it’s a technique that works well for any new role. Preceptors not only show new charge nurses the ropes, they also serve as mentors who can support them in their new role.

Berbarie advises the precepted time should last two- to three-weeks and that senior leadership should be active participants and strive to present the preceptees with as many experiences as possible.

3. Leadership development. The third part of the orientation program as a whole is the development of leadership skills. At a minimum, Berbarie says charge nurses should receive training on:

  • Leadership
  • Team building
  • Conflict resolution
  • Communication
  • Developing talent

Organizations that do not invest in leadership skills for charge nurses will not get the most from them. The best charge nurses mesh administrative, clinical, and educational expertise with the ability to solve conflicts, reduce nurse-to-nurse hostility, improve communication, and ensure the unit is a collaborative, collegial place to work.

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July 30, 2010

Facilitating Critical Thinking in New Nurses

Filed under: Nursing — Shirley @ 5:44 am
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Here is another informative article from HealthLeadersMedia.com.  This article is about helping new nurses develop critical thinking skills, something every nurse must rely on to navigate the healthcare systems safely–both for the patient as well as for the nurse.

Read this article and let me know what you think about it, won’t you?

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Excerpted from Briefings on Evidence-Based Staff Development, an HCPro publication, July 27, 2010

This article was adapted from one that originally appeared in the August 2010 issue of Briefings on Evidence-Based Staff Development, an HCPro publication.

Critical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes (Foundation for Critical Thinking, 2010). It is a skill that evolves over time and with experience.

Nurses beginning their first jobs after graduation need help developing critical thinking skills. Pamela Schubert Bob, MHA, RN, CPN, NE-BC, nurse manager at Children’s Hospital Boston, wanted to help facilitate critical thinking in new, or as she refers to them, “novice” nurses.

“I overheard one of my nurses tell a doctor, ‘I don’t know anything about that because I wasn’t here yesterday,’ ” said Schubert Bob. “I cringed because this was an unacceptable response. I felt that younger, newer staff weren’t seeing the big picture. They were looking at taking care of patients for a shift, instead of taking care of a patient as a whole.”

“I wanted to create an environment in which it was okay for the staff to ask and answer critical thinking questions,” she says. “So I started to create this environment quite informally.”

Creating a critical thinking program

Schubert Bob began by approaching a newly hired nurse whose patient had a history of seizures. “I asked her what she would do if her patient had a seizure. She wasn’t sure how to respond. We worked through things like what equipment should be at the bedside, what actions to take during a seizure, etc. At the end of those five minutes she felt much more confident.”

Schubert Bob continued these informal critical thinking exercises. After each report, she would interact with new nurses, asking critical thinking questions and sometimes using worst-case scenarios as a starting point.

The impact on nurses’ critical thinking skills was almost immediate. To help with mentoring, she developed a critical thinking program that relied on the expertise of available senior nursing staff. These experienced nurses were trained to interact on a one-to-one basis with new nurses in five-minute sessions.

Training nurses to stimulate others’ critical thinking skills

Schubert Bob points out that “not every experienced nurse can mentor and teach others. You really have to want to do it.” Most staff nurses “jumped at the chance,” she says. Schubert Bob provided the initial training, which consisted of a didactic component that included an explanation of critical thinking and its importance to nursing practice, the kinds of questions to ask new nurses for the purpose of improving critical thinking, and how to formulate and ask open-ended questions such as the following:

  • What is the worst-case scenario for your patient?
  • What are your plans for patient education?
  • How will your documentation help your peers to maintain continuity of care? (Schubert Bob, 2009)

These critical thinking sessions were designed to take about five minutes. After training, each senior nurse listened to a critical thinking session between a new nurse and Schubert Bob or another trained facilitator.

“Regular sessions for questions, direction, and support were offered until the senior nurses were comfortable facilitating critical thinking sessions,” says Schubert Bob.

The program in action

Once the program started, either senior or new nurses could initiate sessions. A list of trained critical thinking mentors was posted so new nurses could easily approach trained facilitators.

Both new and experienced nurses felt that this program improved critical thinking skills. In fact, additional tools were developed to facilitate critical thinking among all levels of staff. These included:

  • Bulletin boards. Case study scenarios were presented that offered opportunities for feedback and identification of best possible solutions to patient problems.
  • Independent study folders. Three-page folders were created that explained the critical thinking project, discussed what critical thinking is, and how all staff could be part of the critical thinking process.

Schubert Bob and her staff were able to initiate a critical thinking program that takes only five minutes to implement. Their efforts serve as a good example of education that is cost-effective and efficient.

References

Foundation for Critical Thinking (2010). “Defining Critical Thinking.” Accessed June 25, 2010, here. Schubert Bob, P. (2009). “Critical-Thinking Program for the Novice Nurse.” Journal for Nurses in Staff Development 25 (6): 292?298.

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July 21, 2010

Nursing’s Growing Role

Filed under: Nursing — Shirley @ 5:55 am
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Here’s a great article from HealthLeadersMedia.com that talks about the changes to come for nurses in the new health care arena.  What I like about this article is that the focus is on expanding what nurses today are already doing and placing emphasis on nurses be given credit for the things they are doing.

Please read this entire article.  I think you will enjoy it.  Leave me a comment and then go leave them a comment.  There certainly is an enthusiastic conversation going on in the comment section as well.

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Rebecca Hendren, for HealthLeaders Media, July 13, 2010
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Qualify for a free subscription to HealthLeaders magazine.

As nurses break out of anachronistic models, the new focus is on nurse-led care delivery systems and harnessing the economic power of nursing.

Not so many years ago, nurses wore white uniforms and stiff white caps. They gave up their chairs for physicians at the nurses station. They cared for patients who stayed in the hospital for days or weeks to recuperate from surgery. They received a technical education, often in a diploma program, and carried out task-based nursing duties. This picture is as antiquated now as today’s nursing model will be in 20 years.

Today’s non-cap-wearing, scrub-bedecked nurses are increasingly well-educated at colleges and universities that focus on care coordination and critical thinking, as well as clinical skills. They care for higher-acuity patients with more comorbidities and increasingly complicated care needs in the course of shorter lengths of stay. Nurses today are technologically savvy critical thinkers who coordinate care across a broad spectrum of healthcare. To be successful, they must be well-educated, well-trained, and able to lead patient care.

In 20 years, this picture will have changed again. Changes are in store for the provision of care; changes wrought by healthcare reform, increasing numbers of insured patients, an aging population, and the projected shortage of physicians.

Nurses will assume ever-greater leadership. Nurse-led primary care will be the norm, and advanced practice nurses will no longer have to justify their role. Physicians will be relieved of much of the burden of routine care coordination, allowing them to devote their attention to diagnosis and treatment of patients.

That is the tomorrow that healthcare leaders are building today.

Nurse leaders at the bedside
“In nursing, we have to get away from the task-oriented focus of bedside nurses who are focused on medication administration, activities of daily living, and so on,” says Jill Fuller, RN, president and CEO of Prairie Lakes Healthcare System in Watertown, SD, whose organization is trailblazing a system of nurse leadership at the bedside that may just be a model for the future.

Nurses providing leadership at the bedside is a critical part of the future of patient care and organizations committed to providing high-quality patient care. Patient safety associations have long recognized the importance of strong nursing leadership at the bedside as a way to prevent medical errors and ensure patient safety. Initiatives such as the Institute for Healthcare Improvement’s Transforming Care at the Bedside offer strategies to redesign nursing care to reduce non-value-added, non-patient-care tasks and improve nurse and patient satisfaction.

Although the recession has given us a respite from the nursing shortage, as the economy recovers, the shortage will reappear. To retain nurses and encourage nurse leadership, nursing processes need to be redesigned to remove petty timewasters from nurses’ days and help them focus on what we really need them to be: leaders at the bedside. Nurses are the ones who are with patients 24 hours a day. As healthcare becomes ever more complex, it needs nurses who are leaders. This means redesigning practice models to reduce burnout and dissatisfaction and to help nurses do what they really want to do: care for patients.

Fuller’s organization has been working hard to figure out how to do this and its revolutionary professional practice model is one for the future.

Prairie Lakes Hospital is located in rural South Dakota, 100 miles from the closest academic medical center. The 81-licensed-bed, nondenominational hospital sees all kinds of patients in its 50-staffed- and licensed-bed med-surg unit, from cancer patients to pediatrics. Nurses at the hospital have gone from concentrating solely on what they are going to do with their patients (task-based, narrow focus) to thinking about what the team as a whole will do (care coordination, broad focus).

The organization called for input from staff nurses and was intrigued by what they came up with. Rather than having a model of care imposed from above, nurses at Prairie Lakes designed their own model. They threw away the traditional model of care and created one that sets nurses firmly at the forefront of leading patient care in the hospital…[read more]

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June 9, 2010

Forensic Science for Nurses

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

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

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

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

March 18, 2010

Myths About Nurses Perpetuated by Hollywood and Other Uninformed Media

As promised, here is part two of this article.  The debunking of the persistent myths about nursing.  I enjoyed reading this and hope you will, too.  Please feel free to comment at any time.

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1. Physicians are nurses’ superiors in the hospital hierarchy- nurses “work for” physicians.

Not true. Nursing is a separate, autonomous profession. We work with, not for physicians. We have our own leaders, and we regulate, license, and manage ourselves. Nurses decide what nurses do, not physicians.

2. Nursing doesn’t require much education.

Nursing education is highly specialized, intense, and rigorous, because nursing itself is a profession grounded in science. Many people, if they believe nurses go to college at all, think that most nurses attend a brief 1- or 2-year program. In fact, 58% of nurses presently have a bachelor’s degree or higher, a number that is growing every year. The “2year” nursing program doesn’t really exist – the associate’s degree in nursing requires prerequisites even before entering the nursing program, making it essentially a 3-year program. And in many areas, new graduate nurses undergo extended fellowships in the clinical setting that greatly increase their education and skill in nursing as they enter the profession.

3. Nurses mainly “fetch things” for physicians.

Nursing is a practice that is unique and distinct from medicine. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.[2] Nursing’s focus, and what sets it apart from medicine, is the whole person, not just the specific, presenting health problem, and nursing encompasses both actual and potential health problems. Nursing’s scope of practice has been shown in numerous studies to save lives and improve health outcomes.

4. Nurses are those who aren’t smart enough to get into medical school.

This might be the most irritating myth of all. It presupposes that nursing is just a tiny subset of medicine, a fallback for people who can’t quite make it up the ladder. However, nursing is a different profession, not the same profession watered or dumbed down. Many nurses go on to earn advanced degrees at the master’s or doctoral level, but they are still practicing nursing (note that nurse practitioners and other advanced practice nurses may share some of the same functions as physicians in their specialties, but they are philosophically nursing-oriented in their approach to patients). And research shows that care provided by these advanced practice nurses is equal to or better than that provided by physicians.[3-6]

To be continued………………………………

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March 17, 2010

A Letter to Hollywood: Nurses Are Not Handmaidens

Filed under: Nursing — Shirley @ 3:22 am
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I found this on Medscape of all places and I read it with much enthusiasm.  My experience with how nursing and nurses are portrayed in the media is all negative, so a letter such as this is long overdue.  However, if it should happen to reach “the powers that be” I cannot fathom what the response will be.

This is a three part article, so the next part will be coming tomorrow.

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Dear Hollywood,

We, the nurses of the world, have something to say to you. Nurses are not what you think. Nurses are independent, highly educated, and skilled healthcare experts who save lives every single day. We work hard and are dedicated to making differences in people’s lives.

And we are really sick of going home after a 12-hour shift, turning on the television, and seeing ourselves depicted as brainless bimbos. This has been going on far too long, and it has to stop.

The Clown Took a Job as a Nurse

I remember a time when I was in nursing school, watching TV with my roommate, Liz. A skit came on, in which a famous comedienne of the day was dressed up like a clown. For some reason the clown had to leave the circus. “So,” said the narrator, “the clown took a job as a nurse.” We laughed at the absurdity of this, but I never forgot it. We were in the middle of a demanding 4-year nursing program, and the suggestion that anyone, even a clown, could be a nurse, just like that, was wounding. I think it was then that I began to take notice of how Hollywood represents nurses.

The answer is…badly. But it isn’t just disrespect that comes through in Hollywood portrayals — it’s contempt, and it’s not at all subtle. You scorn us in the way you pigeonhole nurses on the small screen — it seems that we’re either half-wits, nymphomaniacs, or latter-day Nurse Ratcheds. Obviously, you have no concept of nurses as autonomous, knowledgeable professionals. We work alongside physicians, but we are their colleagues, not their subordinates. Yet in every hospital drama, physician characters are ordering nurses around, treating them like uneducated servants, or performing nursing care themselves and getting the credit for it, while the nurse characters just fade from view.

I can almost hear your reaction to my complaints. There, there, dear, don’t take it personally, it’s harmless, it’s funny. Is it, really? Will it still be harmless or funny one day in the future when you are in the hospital and you press your nurse-call button and no one responds? Or it is answered — eventually — by a minimally trained hospital “technician”? The nursing shortage will have reduced our ranks considerably, and driven many of us into early retirement. It doesn’t help the situation when schoolchildren and teens already discount the notion of becoming nurses because of the way nurses are portrayed on Grey’s Anatomy. Becoming a nurse, they believe, is a waste of their talents.[1]

Maybe You’re Misinformed

I’m going to give those in Hollywood the benefit of the doubt, and assume that they just have the wrong impression of nurses, and have no idea what nurses really do. But for the non-nurse readers, we’ll pretend that you are in the hospital, and you’ve just had emergency heart surgery.

  • Who do you suppose will be at your side, watching your blood pressure, making sure you don’t go into shock?
  • Who will be alert for the slightest hint of life-threatening hemorrhage?
  • Who will respond in mere seconds if your heart begins to beat irregularly?
  • Who will make sure that your chest tube doesn’t get blocked and cause you to go into cardiac arrest?
  • Who will keep the circulation moving in your lower legs so you a clot doesn’t develop and you don’t die from a pulmonary embolism?
  • Who will be constantly watching to make sure that you don’t stop breathing, that you are getting enough oxygen, that postoperative pneumonia is not developing?
  • Who will relieve your pain before you even have to ask?
  • Who will explain everything that is happening to you and teach you how to take care of yourself after you go home?

I’ll give you a hint — it’s not your physician. It is your nurses. They will see you safely through one of the most dangerous times of your life, doing all these things and more.

And just so we’re clear, I’ll tell you what your nurses won’t be doing. They won’t be clustered around the nurses’ station as though at a cocktail party, flirting with physicians. They won’t be in the broom closet or the stairwell or behind the patient’s curtain giving sexual favors. They won’t be trailing after the physician as he marches down the hall, in case he needs a cup of coffee or someone to dump on. Nor will they be in the receptionist’s chair, moaning about not being able to get into medical school. If these scenes sound a little familiar — I’m not surprised. This is how nurses are regularly portrayed on television dramas.

No Angels of Mercy, Please

Hollywood, we’re not asking you to glorify nurses. Don’t turn us into heroes or martyrs. We just want to be accorded the respect, the esteem that our education, status, and profession warrant. We want our dignity back. We don’t want the entire world to think of us as sleazy, dim-witted underlings. We want to erase the image of the “naughty nurse” — this is your bizarre fantasy, not ours.

We want young, impressionable children to view nursing as a viable, respected, and even admired profession, one they would be proud to call their own. But most of all, we want our patients to trust us and value our knowledge, so that when we teach them how to become healthier people and live longer, healthier lives, they will listen. This, our most treasured ability — the core of nursing — is what you threaten with your cheap attempts to increase ratings by ridiculing the nursing profession.

So my question to you is, is it worth it? Is the money you make from entertaining viewers with mentally unbalanced, sexually promiscuous, or idiotically subservient nurse characters worth influencing potentially hundreds of thousands of young men and women to shun a career in nursing? Will you feel content, even proud, the next time you encounter a nurse, in the thought that you regularly chip away at her self-respect and her ability to be effective in her job?

Or will you infuse some realism into your tired stereotypes? You can start by discarding the following myths — their demise is long overdue.

To be continued……………….

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February 23, 2010

New York, New Jersey Educators Debate Bsn In 10 Bills

Visiting nurse
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In this article, you get a picture of the disagreement brewing in the profession.  This situation is as old as nursing, I think.  Nurses themselves have disagreements daily on the ability of one nurse to do the work of another nurse.  But is it based on licensure or is it really about experience?

While I feel pretty neutral on this subject, I will say that there are questions arising daily in nursing practice on the floors, but we all sit for the exact same NCLEX exam and we all get the exact same license issued.  So where is the difference and why all the big deal?

I understand the attempt to make a standard and I also understand the need to have nursing considered as a professional occupation by the general population.  But, again, what really is the big deal?

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It’s no secret that there are three points of entry into practice as a registered nurse: a four-year baccalaureate program, a two- to three-year community or junior college program, or a diploma program that typically lasts three years. Regardless of the length of study and amount of money spent, candidates from all three programs sit for the same licensure exam.

Even so, Bills S4051/A2079B in New York and S620 (nee S2529)/A3768 in New Jersey are seeking to ensure that the baccalaureate of science in nursing becomes the standard for continued RN licensure in those states. The bills would require all RNs to obtain their BSNs within 10 years of initial licensure. Essentially, if you want to remain an RN in either of those states and are a graduate of an associate degree or diploma program, you would have to go back to school.

What Does It All Mean?

According to 2007 National League for Nursing statistics, there are still far more AD programs than BSN and diploma programs in the U.S. New York has 65 AD programs, 55 BSN programs and just one diploma program. According to the New Jersey Hospital Association, New Jersey is home to 18 schools that offer an AD in nursing, and 19 offering the BSN. It does, however, have 11 hospital-based diploma programs — the largest number of such programs in the U.S. after Pennsylvania.

Passage of the legislation in either state could have serious implications for AD and diploma programs, both positive and negative. For example, enrollment in two- and three-year programs could suffer, as potential candidates opt for the four-year program that would ultimately be required to continue to practice. On the other hand, if they become law, the bills would ensure the BSN becomes the minimal standard for RN licensure within 10 years of practice, a step that already has been implemented in other countries.

Some schools of nursing have begun to prepare for those implications, noting the requirement would benefit nursing as a whole. “We have been very proactive in this regard and well-positioned for the BSN in 10 proposition,” says Mary Lebreck Kelley, RN, MSN, MEd, CNE, dean of the Trinitas School of Nursing and director of education at Trinitas Regional Medical Center. The Elizabeth, N.J., school offers a diploma program in nursing that gives students the option of going on for an AD from Union County College in Cranford.

“In 2004, we formed a partnership with the College of Saint Elizabeth to bring a BSN program on-site to our Elizabeth campus, and in 2007, CSE brought their MSN program on-site, also,” Kelley says.

Kelley believes that the legislation, should it pass, would be more benefit than hazard to Trinitas’ program.

“The BSN in 10 proposition will serve to encourage graduates from our program to take advantage of what we already have in place for them on-site,” she says. “I see it as a win-win situation.”

Other schools have taken a similar position.

“I believe that the impact overall will be very positive,” says Joanna Scalabrini RN, MS, MA, dean of the Hopfer School of Nursing at Sound Shore Health System and professor Emeritus at Westchester Community College.

Scalabrini doesn’t think the legislation would have any impact at all on New York’s lone diploma program, and believes the bills will only serve to make the AD more valuable, as it can be seen as a steppingstone. “This path will allow the candidate to obtain a solid nursing education with emphasis on direct patient care, prior to their BSN completion program,” she says. “This 2-plus-2 plan can save a candidate thousands of dollars in education loans.”

Hopfer’s faculty is in full support of the proposal, notes Scalabrini, as are most of the students who attend. “I ask our incoming students at their orientation to present a written argument for or against the BSN in 10,” she says. “I have been doing this since the Board of Nursing first unveiled the idea. No less than 80% of each and every class fully supports this plan.”

Jennifer A. Ort, RNC, MS, chairwoman of the department of nursing at Monroe College in The Bronx (N.Y) also sees the proposal as a chance for nursing to step up its game and be viewed as other healthcare professions are, while not undervaluing AD or diploma programs. “Master’s degrees and even doctorates are entry-level educational expectations for many other healthcare professions,” she says. “BSN in 10 is a wonderful way to allow those who want to be nurses to continue at the associate or diploma level before continuing for their BS.”

Ort says she is most concerned about what the legislation would mean for practical nurses. “… Our nursing program is a one-plus-one LPN-to-RN program,” she says. “What will happen to LPN education when BSN in 10 passes?”

Bumpy Transition

Although some believe the proposals would provide instant credibility to nursing in New York and New Jersey, others, such as Susan Neville, RN, PhD, chairwoman of the department of nursing at the New York Institute of Technology in Westbury, N.Y., and Maria Elena Pina-Fonti, RN, MA, associate professor at York College in Queens and adjunct professor at Molloy College in Rockville Centre, N.Y., believe it’s not that simple. If the proposals pass, they say, more work would be necessary.

“The issues are complex and will require a collective effort by all levels of nursing education to prepare for and sustain this requirement,” Neville says. “For example, seamless educational level articulation models, strategic faculty system/regional assignments, academic and service partnerships, clinical education models and the increased use of technology in educational pedagogy.”

Taking the notion one step further, Pina Fonti believes eliminating AD and diploma programs altogether will help nursing get the same respect as other healthcare professions that required a baccalaureate degree as a minimal requirement.

“The myopic view of subdividing our professional educational process into three distinct levels (two-, three- and four-year programs) catapults us to underpin our fundamental structure and compromises our educational product (the nursing graduate) and our nursing profession in the societal realm,” she says.

“I believe that the structural reframing that is necessary must be implemented in a partnership or consortium approach in which initially the AD program is partnered with an existing baccalaureate program to aid in the transition of the student and with a central focus of phasing out the AD program,” she says.

Although the complex process would be fraught with “growing pains,” Pina-Fonti believes the resulting educational infrastructure would define a new era in the history of nursing. “Ultimately, the partnership created would provide opportunities for growth [both for the student and faculty body] that would far outnumber the challenges created in the implementation of the new program.”

Neville agrees the proposals are imperative to nursing. “These initiatives become pivotal to the profession, as nurses move forward in preparing to meet the increasingly complex, multicultural care needs of patients in a fast-paced technological society.”

Neville and Pina-Fonti are not alone in their line of thinking. In its description of nurse training and qualifications, the Bureau of Labor Statistics offers the following advice: “Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher.”

Baccalaureate degree programs offer more clinical experiences in non-hospital settings as well, notes the BLS, and with the complexity of today’s patients, that benefit could make the task of initially choosing a BSN over an AD or diploma program much easier and the passing of the proposals more appealing.


Tracey Boyd is a regional reporter. Send letters to the editor to editorNY@nursingspectrum.com or comment below.

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February 13, 2010

Nursing Certification Has Many Rewards

I have been a nurse for 20 years and all that time I have worked in the same specialty.  It has just recently become a goal of mine to obtain certification in my specialty.  I will get no pay increase for it, I will get no additional pat on the back, but I will feel more professional.

With the current dialogue going on about what should be the “entry level” requirement for educational status in nursing; whether BSN should be required to sit the NCLEX or not, certification could easily fall through the cracks while the fight ensues.  My thought is that certification is something you do for yourself and in doing so, you do something for your patients and their outcomes.  Not everything we do as nurses is about compensation, or at least I hope it’s not.  Sometimes we do something simply because it is the right thing to do.  Certification is the right thing to do.

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There are a myriad of advantages to becoming certified in your field of nursing.  I am a Certified Occupational Health Nurse Specialist (COHN-S) and find that certification has many rewards!  Here are a few reasons to consider:

BENEFITS YOUR PATIENTS: According to the American Association of Critical-Care Nurses (AACN), nursing certification has been linked to better patient outcomes.  Certification is credited with a reduction in medical errors, among other benefits.  If I listed no other reasons to become certified, this one should be enough!

ACCOMPLISHMENT: Becoming certified in your field is both a professional and a personal accomplishment.  Most certifications require extensive studying and experience to initially attain the certification.  Once earned, you carry with you a keen sense of accomplishment as a certified nurse. You are seen by uncertified peers and management as a level above.

CAREER ADVANCEMENT/PART 1: Earning your certification advances your career, and creates opportunities that otherwise may not be available to you.  For example, with my COHN-S certification, I am eligible to apply for case management positions.  Although I have never done case management, one requirement (just to be considered) is either a Case Management or Occupational Health certification.  Nurses certified in specialty areas earn an average of $9,000 more per year than their non-certified peers (Mee, CL. Nursing 2006 salary survey. Nursing. 2006, Oct; 36(10):46-51).  Mee also reports that certification increases confidence and job satisfaction.

CAREER ADVANCEMENT/PART 2: With current job market challenges, certification places you ahead of the competition when applying in a new organization or for promotional opportunities in your current workplace.  Hiring authorities view certifications as a mark of excellence and a sign of commitment to your field.  Additionally, hiring personnel understand you have gone the extra mile to earn your certification. Don’t believe me?

“Nurse Managers surveyed by the American Board of Nursing Specialties (ABNS) overwhelmingly prefer to hire certified nurses because certification attests to an individual’s proven knowledge base and documented experience in a given specialty. In fact, 90% said they clearly prefer to hire certified nurses.” – http://www.medscape.com

SKILL AND KNOWLEDGE: Even though you may have practiced in your field for years, there are aspects of your professional area you may not be familiar with.  For example, when studying for the COHN-S, I learned all about OSHA chemical reporting programs that I have never worked with.  Studying for certification can familiarize you with other paths in your own specialty area that you never knew existed.

KEEPING ABREAST OF THE LATEST CHANGES: Nursing certifications require a lot of continuing education to maintain the certification.  This consistent education validates knowledge, keeps a nurse abreast of the latest changes in his/her field, and enhances patient care.

To participate in discussions regarding continuing education programs and certificates, go to our  Continuing Education forum.

About the Author: Sue Heacock, RN, MBA, COHN-S and author of the recently published book – Inspiring the Inspirational: Words of Hope From Nurses to Nurses.  Sue is a Certified Occupational Health Nurse Specialist and has worked in a variety of areas of nursing including pediatrics and research. Before entering the nursing profession, Sue worked in human resources and equal employment opportunity.

Click here to read more on Sue Heacock.

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February 7, 2010

Don’t Let Burnout Ruin Your Career

Filed under: Nursing — Shirley @ 7:05 am
Tags: , , , , ,
Stress Reduction Kit
Image by programwitch via Flickr

This article makes me mad.  On the one hand, I understand that burnout is serious and real and seems to happen to nurses quite a lot.  We all need to do everything we can to take care of ourselves if we want to be able to continue doing our jobs well.  That is a given.

Where I have a problem is that going to the movie, or out to dinner or getting a massage, while excellent for relaxation and self-care; these things will do nothing to relieve the daily stress of too much to do and not enough time in the day to do it.

I don’t know a single nurse working today who does not want to do the very best job possible and who does not want to be of help and service to the patients.  Unfortunately, whenever there are any cutbacks in the hospital staffing, it seems that nurses are the ones assigned to pick up the slack.  We do phlebotomy, we do housekeeping, we do dietary, we do clerk work, we do admission work, we do aide work, we do it all at times.

In my field, psychiatry, hospitals cut out numerous therapies–art, music, occupational, recreational, etc.  When this occurred nurses were the chosen to do those tasks in addition to the nursing responsibilities.  So, we are stressed to the max all the time.  I would love to do all for each of my patients, but when my patient load is 8 or more, I simply cannot do even the necessary things and do them well.

So, in my opinion, this article is quite simplistic although the information presented is good.  Nurses need help from more than themselves.  We can’t nurse the nurses and take care of patients too.

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Burnout is one of the most dangerous aspects of a nursing career because it is one of the most challenging professions, both emotionally and physically. Any given day can be completely exhausting, and you may not even know why.

As patient educators, nurses are often teaching patients and family members that caregivers need respite and to replenish their spirits frequently, especially if the demands are many and heavy.

Typical of many health care professionals, nurses don’t always heed the great advice they dole out. Without taking the time or making the effort to regularly replenish themselves, nurses are quite vulnerable to burnout.

Part of the problem can be that it’s easier to advise someone else about their situation than to assess and evaluate your own.

Telling new parents they need to take turns getting up with the baby, or that they should ask grandparents or friends to babysit when perhaps all they need is a nap, is sound advice that hopefully they will heed.

Encouraging the hospice patient’s wife to take a break every few days, and to get out of the house while the aide comes to bathe him, seems like a no brainer.

Yet what exactly can nurses do to replenish themselves? One of the most important things you can do is to give yourself credit and a thank you for the patients that you help each day. On your ride home after each shift, think about the patients for whom you made a difference today. Don’t dwell on the negatives.

You probably worked short handed, didn’t get a break and skipped your meal break to finish something. Maybe you had to leave something for the next shift to complete, or feel guilty for having to delegate so many tasks. You can’t change these things. You can try to be more productive tomorrow, but today is over. Dwell on what went right and let go of the rest.

Next, think about the things you enjoy doing such as reading a good book, having a massage, sitting at your favorite coffee house people watching. Maybe going to the movies with your significant other relaxes you, or having a nice dinner out with a glass of good wine. Playing a round of golf or a good racquetball match with a friend, or shooting some hoops with your son or daughter.

Indulge yourself in the things you enjoy. Hire a babysitter or ask a family member to stay with your children for a couple of hours. Find some time on a regular basis to do something for you. You may have to make a few changes occasionally to accommodate your friends or family, but don’t neglect to reschedule your time.

Don’t be put off by a bad economy. Build a small savings by putting your loose change in a jar and after a couple of weeks see how much you have saved. Go to a matinée movie when the tickets are cheaper. Look for coupons for savings on meals. Buy your own wine and enjoy it at home with some music rather than going out.

You need to put yourself first and remind yourself you are worth it! If you don’t take care of you, you will not have the physical or emotional strength to continue to give.

If you are truly unhappy with your work situation, make a change!

Are you burned out nurses? Do you have any advice for those who are? Please leave a comment below or share your advice and experiences in the Decompression Room!

About the Author: Kathy Quan, RN, BSN, PHN is an accomplished writer and author of four books including: The Everything New Nurse Book and 150 Tips and Tricks for New Nurses.  Kathy has been in the nursing profession for over thirty years and is very passionate about patient education and mentoring new nurses.

Click here to read more on Kathy Quan.

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