Nurses are an important part of the medical workforce. They provide crucial supplementary services and are primary caregivers in a lot of industries. As such, the demand for nurses is high, though there are variations according to different states. As the country’s population and access to medicine continues to grow, the demand for nurses does as well.
BY EMMANUELLE SALIBA
After a howling blizzard with hurricane-force winds socked Boston with 21 inches of snow on Tuesday, some nurses and doctors hitched rides with police or put on skis and snowshoes to get to work.
Kelli O'Laughlin, one of the doctor's at Brigham and Women's Hospital who skied to work, found her ride "fun" and "exhilarating." She told NBC's Miguel Almaguer that doctors have to come in to work because"the emergency department is one of those places where 24 hours a day, 7 days a week it's always going."
"Our sincerest thanks to all employees that have gone to extraordinary lengths to get to the hospital during the storm," wrote the hospital in an Instagram post along with a photo of pathology technician Vivian Chan on snowshoes.
Written by James McIntosh
While violence intervention programs have demonstrated that they can be an effective way of preventing violent injury, little has been known about their financial implications. A new study now suggests that these interventions could save various sectors millions of dollars.
Researchers from Drexel University have analyzed the cost-benefit ratio of hospital-based violence intervention programs (HVIPs) and report that - as well as benefiting victims' lives - HVIPs can make costs savings of up to $4 million over a 5-year period in the health care and criminal justice sectors.
"This is the first systematic economic evaluation of a hospital-based violence intervention program, and it's done in a way that can be replicated as new evidence emerges about the programs' impacts across different sectors," states lead author Dr. Jonathan Purtle.
As a major cause of disability, premature mortality and other health problems worldwide, HVIPs have a crucial role to play in helping victims from experiencing further suffering.
The provision of case-management and counseling from combinations of medical professionals and social workers has been associated with not only reducing rates of aggressive behavior and violent re-injury but also improving education, employment and health care utilization for service users.
Many HVIPs still require a sustainable source of funding
Intervention typically begins in the period immediately after a violent injury has been sustained. Not only is this a critical moment in terms of physical health, but it can also be a time when victims may start thinking about retaliation or making changes in their lives.
"The research literature has poetically referred to the time after a traumatic injury as the 'golden hour,'" says study co-author Dr. Ted Corbin.
In 2009, around six programs were in operation and, as word of their success has spread, more and more HVIPs have been initiated.
Calculating the potential financial benefits of HVIPs is crucial, as for many of these programs a stable and sustainable source of funding does not exist. Instead, many rely on a variety of different financial sources such as insurance billing, institutional funding, local government funding and private grants.
For the study, published in the American Journal of Preventive Medicine, the researchers conducted a cost-benefit analysis simulation in order to estimate what savings an HVIP could make over 5 years in a hypothetical population of 180 violently injured patients. Of these, 90 would receive HVIP intervention and 90 would not.
Costs, rates of violent re-injury and violent perpetration incidents that a population would be estimated to experience were calculated by the authors using data from 2012.
The authors made a comparison between the estimated costs of outcomes that would most likely be experienced by the 90 hypothetical patients receiving HVIP intervention - including $350,000 per year costs of the HVIP itself - and the costs of outcomes predicted for 90 patients not receiving any HVIP intervention.
The net benefit of the interventions
A total of four different simulation models were constructed by the researchers to estimate net savings and cost-benefit ratios, and three different estimates of HVIP effect size were used.
Costs that were factored into the simulations included health care costs for re-injury, costs to the criminal justice system if the victims then became perpetrators and societal costs for potential loss of productivity.
Each simulation calculated that HVIPs produced cost savings over the course of 5 years. The simulation model that only included future health costs for the 90 individuals and their potential re-injury produced savings of $82,765. The simulation model including all costs incurred demonstrated savings of over $4 million.
Dr. Purtle acknowledges that estimated lost productivity costs may have been slightly high due to an assumption in their data that all individuals in the simulation were employed. However, he believes that there are also many social benefits to HVIPs that cannot be financially quantifiable:
"Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented."
The authors believe that the findings of their study could be useful in informing public policy decisions. By demonstrating that HVIPs can be financially beneficial, the study suggests that an investment in HVIPs is one that pays off for everyone concerned.
By MICHELLE CASTILLO
Pets are getting some pain relief thanks to a centuries-old method that has helped some of their owners: acupuncture.
A dachshund named Samson benefitted from the treatment. Samson was pawed aggressively by another dog at the park and needed surgery immediately. After his first procedure, it was clear he was still in some pain. Doctors recommended a second surgery, but owner Ellie Sutton wasn't so keen to make Samson go under the knife again.
"I wouldn't want to risk something like paralysis," Sutton told CBS News. She decided "to try every other kind of step first."
To her surprise, the veterinarian suggested acupuncture, the traditional Chinese medicine method of inserting needles into the skin to stimulate parts of the body.
Veterinary acupuncturists can use .2 to .3 mm needles that range in length from .5 inches to 1.5 inches on pooches.
"A lot of people come for acupuncture because they've exhausted a lot of the traditional Western medicine roots, whether it's medication or surgery," Dr. Marc Seibert, Samson's vet, told CBS News. Siebert is the owner and medical director of Heart of Chelsea Animal Hospital and Lower East Side Animal Hospital in New York City.
Seibert explained there are two main theories behind how acupuncture works. Eastern medicine teaches that energy flows through channels in the body called meridians. When the meridians are blocked, the person -- or the animal -- experiences physical pain. The acupuncture needles help direct the energy to the correct path.
Western medicine, on the other hand, suggests that acupuncture may help by bringing oxygen to the area that the doctor is trying to treat. Hormones called endorphins, which promote feelings of well-being, are released, and the anti-inflammatory parts of the immune system kick in.
"Most people think of acupuncture as a pain reliever, but it's more than that," says Dr. Ihor Basko, a holistic veterinarian in private practice in Honolulu, certified by the International Veterinary Acupuncture Society in Ft. Collins, Colo., told Paw Nation. "Acupuncture can boost the immune system and improve organ functions, and it has other benefits. It can complement conventional medicines and procedures without dangerous side effects."
Not everyone is convinced the method works. Veterinarian Craig Smith, the complementary-care expert for the American Veterinary Medical Association, told U.S. and World News Report that it's hard to know for sure if canines and felines are feeling relief from their pain.
"While many people treating pets with acupuncture report success, there isn't any data that proves it works," he said.
Ellie Sutton admitted that a lot of the "energy flow" talk is hard for her to believe. But she says Samson has definitely benefited from the treatment.
"The fact is he walks better afterwards," she said.
By AVIANNE TAN
A Minneapolis mom who wanted a natural birth was more than 13 hours into labor when she felt she wasn't going to make it without something to take the edge off the pain. But rather than asking for an epidural or narcotics, she begged for laughing gas.
"It immediately took my fear away and helped calm me down, though I could still feel the pain," Megan Goodoien, who gave birth at the Minnesota Birthing Center this month, told ABC News today. "I didn't laugh because the labor was so intense, but I everything suddenly felt doable just when I thought I couldn't make it anymore. It's definitely a mental thing."
Though nitrous oxide has long been used in European countries and Canada, the gas is now making a resurgence in the U.S., according to medical experts.
The gas, once popular in the U.S., was sidelined after the advent of the epidural in the 1930's, midwife Kerry Dixon told ABC News, noting she believes epidurals took over because they were more profitable. Dixon did not treat Goodoien but works at the Minnesota Birthing Center.
"The average cost for a woman opting for nitrous oxide is less than a $100, while an epidural can run up to $3,000 because of extra anesthesia fees," Dixon said.
The U.S. Food and Drug Administration approved new nitrous oxide equipment for delivery room use in 2011, which could also explain the resurgence, Dixon told ABC News.
"Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor]," Dr. William Camann, director of obstetric anesthetics at Brigham and Women's Hospital, told ABC News. "Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest."
He added the gas popular in dentists' offices has an "extraordinary safety record" in delivery rooms outside the U.S. But more studies are needed to confirm its safety, other doctors say.
Laughing gas works differently than an epidural or narcotic in that it targets pain more on a mental level than physical, experts said.
"It's a relatively mild pain reliever that causes immediate feelings of relaxation and helps relieve anxiety," Camman said. "It makes you better able to cope with whatever pain you’re having."
But gas can also change awareness, said Dr. Jennifer Ashton, a senior medical contributor for ABC News and practicing OB/GYN.
"In delivering over 1,500 babies, I had never used it nor has anyone asked for [nitrous oxide]," Ashton told ABC News. "[M]ost moms want to be totally aware when they are in labor."
Mothers who have opted for nitrous oxide like that it's self-administered by the patient, who has total control over if and when it's used.
A Nashville mother said she opted for the gas during labor only after she found herself too tense to push.
"I instantly felt relaxed," Shauna Zurawski told ABC News. "Before, I was so tense. I was fighting against the contractions, which definitely wasn't good. But after the laughing gas, my body was able to do what it was supposed to. It was so neat."
Both Goodoien and Zurawski said they put a nitrous oxide machine's mouthpiece over their mouth and nose and inhaled about 30 seconds before their next contraction to get the maximum effect.
Another advantage is that the chemical gets out of your system shortly after stopping inhalation.
"With my first child, I had an epidural, I was numb for so long after the delivery and it took a while to get back to normal," Zurawski said. "But with the nitrous oxide, I was walking around and taking pictures almost right after."
Both Goodoien and Zurawski said they didn't experience any adverse side effects.
Nitrous oxide's possible side effects are usually just minor nuisances such as nausea, dizziness or drowsiness, medical experts told ABC News.
Patients can also choose to stop or get an epidural at any time if they find they don't want the laughing gas.
It's still early to tell how popular this new option will get, but in countries like New Zealand, about 70 percent of women in labor choose to use laughing gas, Dixon said.
"When I was working in New Zealand, I told one of my patients, [laughing gas] wasn't really used in the U.S. and you know what she said?" Dixon asked. "'I thought they have everything in America!'"
By Debra Anscombe Wood, RN
While credentials may seem like an alphabet soup after one’s name, the letters tell the world much about a nurse’s qualifications, including licensure, certifications and fellowships.
“Credentials are not only a source of pride for the nurse, but communicate to patients, colleagues and hospital leaders the nurse’s commitment to standards of excellence,” said Mary Frances Pate, PhD, RN, CNS, associate professor at the University of Portland School of Nursing in Oregon and chairwoman of the board of directors for AACN Certification Corporation, the certification organization for the American Association of Critical-Care Nurses.
Other academic nurses agree. “Credentials matter to the public,” said Rebecca M. Patton, MSN, RN, CNOR, FAAN, Lucy Jo Atkinson Scholar in Perioperative Nursing at Case Western Reserve University in Cleveland, adding that they also demonstrate growth and lifelong learning valuable to the nurse and to nurse managers and administrators.
Depending on the position, “some nursing positions require certification demonstrating expertise, and some do not,” said Robert Hanks, PhD, FNP-C, RNC, assistant professor and clinical/FNP track director at the University of Texas Health Science Center at Houston School of Nursing.
Marianne Horahan, MBA, MPH, RN, CPHQ, director of certification services at the American Nurses Credentialing Center, reported an increase in certification applications this year, in part because of employers’ promotion of certification. A new “Success Pays” program allows the hospital to directly pay for successful exam completion.
Employers also seek nurses with degrees, as evidence suggests organizations with a higher percentage of BSN- or MSN-prepared nurses have greater patient outcomes, said Paulette Heitmeyer, MSN/ED, RN, CNO at Marina Del Rey Hospital in California.
Pate said nurses whose clinical skills and judgment have been validated through certification often make patient care decisions with greater confidence, recognize problems and intervene appropriately.
While many believe credentials lead to better care and patient outcomes, research is limited. The Institute of Medicine recently released a research agenda to help fill this gap.
Nurses should list the highest degree first, immediately after their name, then licensure, any state designations, national certifications, awards, honors and other recognitions, according to the ANCC.
“Certification provides a foundation for lifelong learning and professional development,” Horahan said. “The purpose of certification is to assure the public that this individual has mastered the body of knowledge and acquired skills in the specialty.”
By David McNamee
It has been a dramatic plot device within countless movies and soap operas, but now a new study from Northwestern Medicine and Hines VA Hospital, both in Illinois, has attempted to answer the question: can the voices of family members and loved ones really wake coma patients from unconsciousness?
A coma is defined as an unconscious condition in which the patient is unable to open their eyes. When a patient begins to recover from a coma, they progress first to a minimally conscious or "vegetative state," though these states can last anywhere from a few weeks to several years.
Lead author Theresa Pape was inspired to conduct the new study - the results of which are published in the journal Neurorehabilitation and Neural Repair - while working as a speech therapist for coma patients with traumatic brain injuries. Pape observed that patients appeared to respond better to family members than to strangers.
From this, Pape began to wonder if patients' ability to recover might be increased if therapists were able to stimulate and exercise people's brains while they were unconscious.
As part of the randomized, placebo-controlled study, 15 patients with traumatic closed head injuries who were in a minimally conscious state were enrolled to Familiar Auditory Sensory Training (FAST). The 12 men and three women had an average age of 35 and had been in a vegetative state for an average of 70 days before the FAST treatment began.
At the start of the study, Pape and her colleagues used bells and whistles to test how responsive the patients were to sensory information. They also assessed whether the patients were able to follow directions to open their eyes or if they could visually track someone walking across the room.
Magnetic resonance imaging (MRI) was also used to get a baseline impression of how blood oxygen levels in the patients' brains changed while listening to both familiar and unfamiliar voices tell different stories.
The therapists then asked the patients' families to look at photo albums to identify and piece together at least eight important stories concerning events that the patient and their family took part in together.
"It could be a family wedding or a special road trip together, such as going to visit colleges," Pape explains. "It had to be something they'd remember, and we needed to bring the stories to life with sensations, temperature and movement. Families would describe the air rushing past the patient as he rode in the Corvette with the top down or the cold air on his face as he skied down a mountain slope."
Patients were more responsive to unfamiliar voices after 6 weeks of therapy
The stories were rehearsed and recorded by the families and then played to the coma patients for 6 weeks. Following this listening period, the MRI tests were repeated, with blood oxygen levels being taken while the patients listened to their stories being told by familiar and unfamiliar voices.
The MRI recorded a change in oxygen levels when the unfamiliar voice was telling the story, but there was no change from baseline levels for the familiar voice.
Pape says that these findings demonstrate a greater ability to process and understand speech among the patients, as they are more responsive to the unfamiliar voice telling the story: "At baseline they didn't pay attention to that non-familiar voice. But now they are processing what that person is saying.''
At this point in the treatment, the researchers also found that the patients were less responsive to the sound of a small bell ringing than they had been at the start of the study. The team believes that this indicates the patients were now better able to discriminate between different types of audio information and decide what is most important to listen to.
"Mom's voice telling them familiar stories over and over helped their brains pay attention to important information rather than the bell," Pape says. "They were able to filter out what was relevant and what wasn't."
The first 2 weeks were found to be the most important period for treatment and demonstrated the biggest gains. The remaining 4 weeks of treatment saw smaller, more incremental gains.
"This gives families hope and something they can control," Pape says of the treatment, recommending that families work with a therapist to help construct stories that augment the other therapies the patient may be undergoing.
Now, the team is analyzing the study data to investigate whether the FAST treatment strengthened axons - the fibers that make up the brain's "wiring" and transmit signals between neurons.
By Megan Kurtis
Being a surgical nurse is very different from other specialties, because surgical nurses deal with patients who are asleep. Surgical nurses see the patients very briefly in pre-op and then take them back to the operating room where they will be put to sleep by either an Anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA).
Surgical nurses are very territorial and mysterious. No one else really knows what goes on behind those OR doors, (neither patients or other nurses ). It's a completely different world in surgery and without the proper training you're not permitted to enter the surgical area.
Surgical nurses don't change dressings, they usually don't administer medications (except for local monitoring). They don't answer call lights or deal much with patients families. So what the heck do they do?
Well, behind those surgical doors are some exceptionally trained nurses who deserve recognition and praise, which is something they rarely get.
They don't see how a patient recovers. The patients are so high on Versed that they have amnesia after their whole surgical experience.
If they're on day shift they arrive at the hospital or facility around 6:00 am to be ready to set up a case at 7:00 am. This gives them time to change into scrubs and read their schedule. The schedule is their fate for the next 8-12 hours. They look at the big board by the front desk to find out if they're the scrub nurse that day, or the circulator. The main thing they're looking for on the board is which surgeon they'll be working with. This simple thing can make or break their day. There are both good and bad surgeons, just like any other slice of the population. "Please God, don't let it be such and such."
Surgeons can be friendly, but their skills may be horrible. Or they can be great Surgeons, but real jerks. Hopefully that day you will be assigned all the surgeons that are both friendly and good at what they do ...but it isn't likely.
If you're assigned to be the circulating nurse then you grab your scrub tech/nurse and you both go to locate your first case cart of the day. This could be anywhere in the mess of other carts that have been filled with items needed for other cases. Hmmm what a joy this is when you have a big ortho case and half of the instruments aren't sterile and need to be flashed Better yet, half of the items on the preference sheet are missing.
You have to run and find them while your scrub nurse is opening the sterile field. When you return you "dance with your scrub nurse". Not literally, but to "dance with your scrub nurse" actually means you help the scrub nurse tie her/his sterile gown. They can't do this on their own or it would render them unsterile, for reaching behind their back.
You then must count everything, including all the instruments, raytec, laps, needles and blades. Remember all this is done between 6:30am and 7:00am. Heaven forbid you lose a lap or any of the above items. It's a nightmare when you lose anything. I've been in cases where we were removing a lap sponge, a needle or an instrument, these cases are so much fun. During cases where the surgeon has previously left a sponge inside the patient, you definitely need a dab of wintergreen on your mask, or you are likely to puke your guts up! (and that's putting it lightly). Anyway, once everything is counted, your scrub nurse is happy, your OR bed is sheeted and all the equipment is in the room, it's time to go out and greet the patient.
You go to pre-op to introduce yourself to the patient and evaluate the chart. God only knows what crazy stuff you'll find in there. The labs may be way off and the surgery may be canceled. The patient may be allergic to latex so the whole sterile field has to be broken down, because you've already placed a latex foley on there. You walk into the room and address the patient in as cool a manner as you can, (trying to remember that this patient is scared out of their witts), unless they have had Versed. Such a wonderful drug!
Anesthesia has usually seen and evaluated the patient before you arrive and the patient has already been asked 3 or 4 times whether they've had anything to eat or drink since midnight. But when you ask the patient the same question, all of a sudden their answer changes. They tell you all they had was a doughnut and coffee for breakfast that morning! Okay, so now the case is abruptly canceled and you're lucky enough to have the task of breaking the whole operating room down room down and starting over. One of numerous other scenarios may be that the patient is allergic to shellfish or peanuts, (which is the allergy de joure these days). Everyone and their mother has a peanut allergy. Or maybe, the patient is just allergic to their own snot!
Today the patient has none of these problems. They're not obese nor pregnant, so there'll be no need to pull out the Hercules bed. Hip hip hooray, the surgery will proceed. You begin wheeling her back to the OR after she's had her "margarita in a vial", (Versed), and before she tells everyone in the pre-op area every secret she has.
She goes on to talk your head silly all the way to the surgical suite and she tells you how she'll never forget how wonderful you are. In your mind you're thinking Yeah, right, you won't remember your own name when you wake up, let alone mine. After entering the OR you transfer the patient onto the table and find that she's still wearing her underwear, (complete with latex banding), even though she told you she had a latex allergy.....Awesome!
You assist the CRNA or Anesthesiologist to put her to sleep, (in a hurry, cause she is driving you nuts), with her "jabber, jabber won't shut up".
Alas, she's asleep and all is quiet for a few minutes, until in bursts Doctor Friendly. He's had a bad day doing rounds and he's been paged 54 times by his office staff, so he's in a lovely mood and you're in for a lovely day.
Nothing on the preference card is right and you spend your time running around searching for instruments, (dirty ones, that need to be flashed). This only pisses the surgeon off more and enhances your day further. The bovie isn't working and the Rad tech has been called for a C-arm 10 times but is still MIA.
When everything begins to settle down and all the issues have been resolved you can relax for 5 minutes and sit quietly, hoping it stays that way. finally the surgeon is closing and you begin counting. Laps and raytec first, followed by instruments, then needles. All are correct, (well except for one tiny needle) that is no where to be found. The scrub counts again. "No, still missing". The surgeon is about to knock someones head off and freely verbalizes it. You run for the magnet on a stick to roll it on the floor and find the friggin needle. Finally you find it next to the scrub nurse's foot.
The patient is beginning to rouse and you are finished with the case. You transfer the patient to post-op and give the PACU nurse report. Yay, it's lunch time and you're exhausted, with only 5 more cases to go.
This is a day in the life of a surgical nurse. Many nurses in other specialties believe that surgical nurses really don't do much or aren't "real nurses". While the surgical nurses role is very non-traditional, they work very hard and they're an integral part of the nursing profession. Unfortunately, they don't get to see the fruits of their labor. Once the surgery is over they never see that patient again and usualy have no idea how well the patient did in their recovery. The patient doesn't remember the great care they got from all the OR staff and for the patient's sake, it's probably just as well.
surgical Nurses are highly skilled at what they do and really deserve more respect from both surgeons and other nurses. So, the next time you meet a surgical nurse treat them right, you may be the next one to come through those mysterious double doors and onto that OR table.
By JOANN S. LUBLIN
Is there such a thing as a diversity dividend?
A new study of 366 public companies in the U.S., Canada, U.K., Brazil, Mexico and Chile by McKinsey & Co., a major management consultancy, found a statistically significant relationship between companies with women and minorities in their upper ranks and better financial performance as measured by earnings before interest and tax, or EBIT.
The findings could further fuel employers’ efforts to increase the ranks of women and people of color for executive suites and boardrooms — an issue where some progress is being made, albeit slowly.
McKinsey researchers examined the gender, ethnic and racial makeup of top management teams and boards for large concerns across a range of industries as of 2014. Then, they analyzed the firms’ average earnings before interest and taxes between 2010 and 2013. They collected but didn’t analyze other financial measures such as return on equity.
Businesses with the most gender diverse leadership were 15% more likely to report financial returns above their national industry median, the study showed. An even more striking link turned up at concerns with extensive ethnic diversity. Those best performers were 35% more likely to have financial returns that outpace their industry, according to the analysis. The report did not disclose specific companies.
Highly diverse companies appear to excel financially due to their talent recruitment efforts, strong customer orientation, increased employee satisfaction and improved decision making, the report said. Those possible factors emerged from prior McKinsey research about diversity.
McKinsey cited “measurable progress” among U.S. companies, where women now represent about 16% of executive teams — compared with 12% for U.K. ones and 6% for Brazilian ones. But American businesses don’t see a financial payoff from gender diversity “until women constitute at least 22% of a senior executive team,’’ the study noted. (McKinsey tracked 186 U.S. and Canadian firms.)
The study marks the first time “that the impact of ethnic and gender diversity on financial performance has been looked at for an international sample of companies,’’ said Vivian Hunt, a co-author, in an interview. Yet “no company is a high performer on both ethnic diversity and on gender,’’ she reported.
And “very few U.S. companies yet have a systematic approach to diversity that is able to consistently achieve a diverse global talent pool,” Ms. Hunt added.
McKinsey has long tracked workplace diversity. A 2007 study, for instance, uncovered a positive relationship between corporate performance and the elevated presence of working women in European countries such as the U.K., France and Germany.
6. …but people still expect them to show up the second they ring the call bell.
7. Sometimes they’re working so hard, they can go entire shifts without eating, drinking water, or sitting.
Lunch break? What’s that?
8. Ditto going to the bathroom.
9. Some patients will incessantly hit on them.
10. Others will expose themselves for no clear medical reason.
“Your arm is broken… so why is your dick out?”