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Longer nurse tenure on hospital units leads to higher quality care

 

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When it comes to the cost and quality of hospital care, nurse tenure and teamwork matters. Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study from researchers at Columbia University School of Nursing and Columbia Business School. The study was published in the current issue of the American Economics Journal: Applied Economics.

The review of more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System is the largest study of its kind to link nurse staffing to . The researchers analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing impacted the length of stay for patients. Because length of stay is increased by delays in delivery of appropriate care and errors in care delivery, a shorter length of stay indicates that the hospital provided better treatment. At the same time, a shorter length of stay also makes care more cost-effective. The study found that a one-year increase in the average tenure of RNs on a hospital unit was associated with a 1.3 percent decrease in length of stay.

"Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care," says senior study author Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at Columbia Nursing. "When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions – disrupting the balance of a team can make quality go down and costs go up."

While many hospitals rely on temporary staffing agencies at least some of the time to fill RN vacancies, the study found that it's more cost-effective for hospitals to pay staff RNs overtime to work more hours on their unit. RNs working overtime resulted in shorter lengths of stay than hours worked by nurses hired from staffing agencies, the study found.

Nursing skill also mattered, the study found. Length of stay decreased more in response to staffing by RNs than by unlicensed assistive personnel. Furthermore, the study showed that length of stay increased when a team of RNs was disrupted by the absence of an experienced member or the addition of a new member.

"This rigorous econometric analysis of  shows that hospital chief executives should be considering policies to retain the most experienced nurses and create a work environment that encourages nurses to remain on their current units," says the senior economist on the study team, Ann Bartel, PhD, Merrill Lynch Professor of Workforce Transformation at Columbia Business School.

The researchers used the VA's Personnel and Accounting Integrated Data for information on each nurse's age, education, prior experience, VA hire date, start date at the current VA facility, and start date for the current unit at that facility. To assess patient outcomes, the researchers used the VA's Patient Treatment File for information on each patient including dates of admission and discharge for each unit and for the overall hospitalization, as well as age and diagnoses. The final sample accounts for 90 percent of all acute care stays in the VA system for the fiscal years 2003 to 2006.

Provided by Columbia University Medical Center

Nurses on the run

 

For nearly a year, the Boston Marathon bombings and their aftermath have haunted Chelsey McGinn, RN, of the Blake 12 Intensive Care Unit (ICU). In December the MGH gave McGinn an opportunity to honor the victims – and begin her own healing process – by running this year’s marathon as part of its Emergency Response Fund team.

“I feel like it’s been almost a year now, and I haven’t really done anything therapeutic sinceBlake12Marathoners resized 600 it happened,” McGinn says. “I felt like other people who I worked with found ways to kind of cope with it, but I hadn’t really found that. When this came up, I thought this was a perfect way to celebrate how far the victims have come and recognize my co-workers.” 

McGinn is one of six nurses on her unit who are planning to run the 2014 Boston Marathon – five for charity teams and one as a qualified runner. Most are first-time runners, and all say they are running in honor of the three bombing victims who were treated on the unit.

“I had a really hard time afterward, and it lasted longer than I expected,” says Laura Lux, RN, who is running for the American Red Cross. “I’m running because I don’t want to be defeated. I know if he could, my patient would be running just to prove a point. Because he can’t, I feel like I need to do this for him. After watching what he and his family went through, I feel like it’s the least I could do for them.”

Lux says she felt an immediate connection with her patient and his family. “Despite everything they were just so determined and so strong,” she says. “Everyone was angry, but there was good coming from it too. We got to know each other because of it. I felt like he was a family member. It’s the most personal experience of my career.”

Lux’s experience is similar to that of the other nurses who are running, including Emily Erhardt, RN, a trauma ICU nurse and member of the MGH Emergency Response Fund Team, who has stayed in touch with her patient and his family since they left the hospital. “This event affected everyone, so it was one of the few times in my career that I felt like all I could do with the family was cry with them. It’s such a terrible thing that happened that there aren’t words to comfort them. You just have to be there for them,” she says. “A year ago they were strangers to me, but now they’re the most inspiring people in my life. I’m not much of an athlete, but I was really affected by the whole thing, and I wanted to do something more.”

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Blake 12 runners receive a boost of support from the Harvard University Employees Credit Union. Included in the photo with members of the ICU are Paul Conners, MGH branch manager; Eugene Foley, president and CEO; and Guillermo Banchiere, MGH director of Environmental Services, who serves as a member of the credit union's board of directors.

Allyson Mendonza, RN, who is running for the Mass General Marathon Team “Fighting Kids Cancer … One Step At a Time,” recalls the moment she knew she too wanted to do something more. Mendonza says her patient had just returned from surgery when she was told President Barack Obama was coming to visit. The woman was excited but was distraught about her appearance, so Mendonza and her colleague soaked her nails and helped shampoo and condition her hair to wash out the cement and clumps of dried blood.

“We just tried our best to make her feel better about herself and feel good for the day ahead. She actually fell asleep. When she awoke, she said, ‘This is the most relaxed I have felt in days.’ It was just so emotional for us and for her,” Mendonza says.

Caring for the marathon victims brought the unit closer together, and staff once again have come together to support and encourage their fellow colleagues.

“The teamwork and the camaraderie were amazing,” saysKatherine Pyrek, RN, who was the charge nurse during the week of the bombing. “Every one of the nurses was affected by what was going on, but they stayed strong and carried on. The bonds the nurses made with the patients and their families were incredible and really went above and beyond.”

Pyrek, who is running for the Mass General Marathon Team, says the Blake 12 runners offer each other advice and encouragement to help in the training process. “We remind why we’re doing this – for our patients and their families,” she says. “I think about the patients when they were in pain and how scared they were. I think that if they get through it then I can get through however many miles I need to run.”

 

The runners all say they look to Meredith Salony, RN, a veteran marathoner who qualified for the marathon, for guidance. “I’m so proud to be in this unit where there’s so much enthusiasm. Even the people who aren’t running are trying to help out and organize events and find ways for people to contribute,” Salony says.

Each of the nurses says they are overwhelmed when they imagine how they will feel on Marathon Monday.

“I think it’ll be really therapeutic and empowering,” McGinn says. “I’m honored to be a part of it. If I’m ever going to run a marathon, this is the one I want to run. I’ll always remember the way I felt at work that night, and it’s going to be a really nice thing to be able to remember this feeling for the rest of my life too.”

For more information or to support the teams visit www.runformgh.org.

This is the first in a series of articles that MGH Hotline will publish about staff running in this year’s Boston Marathon.

Source: Massachusetts General Hospital

15 Things Every Nursing Student Needs to Know

 

by 


of course I am tired I am a nursing Student

When I entered nursing school I knew very few people who were nurses. I questioned everyone that I thought might know anything about nursing on what I needed to know to do well in nursing school. Honestly I was given very little practical advice. But I don’t think it was the fault of the people I asked. I honestly think that many in nursing school struggle to make it through and wipe many of those memories from their brain. But I’m a firm believer that the nursing school experience doesn’t have to be a terrible one. And even though it’s going to be hard, you will be tired, and you’re probably not going to have a great social life, you can make it through nursing school while enjoying the experience (or at least not completely hating it!).

One of my personal goals in nursing has been to help mentor new and emerging nurses to give them the knowledge they need to be successful. I want to share what I’ve learned with you to make nursing school a little more tolerable.

The following represents 15 things that I feel every nursing student needs to know.

1. Nursing is nothing like you think it will be.

Even if your life is filled with nurses and you think you know exactly what you will encounter when you hit the floor you will soon find that you know nothing. I could give you a hundred examples but you won’t get it until you’ve been there. There are so many facets or nursing that you just can’t understand until you have lived it. Don’t feel bad about it just see it as an opportunity grow and learn.

2. You don’t need nearly as many books as is on your syllabus.

Although many may not agree with me on this, in my humble opinion that $1000 in text books per semester is outrageous and unneeded. Most of the information you need will be delivered in class and you might only look at them for a sentence or two. I suggest finding out who your instructors are and asking them if you really need 4 books for the 2 credit class you are taking. If you can’t reduce the amount of books you need to buy then you should partner with a friend and each buy half the books then share. If you’re working together as study buddies then you won’t miss the books that you didn’t purchase. Also, you should buy your nursing textbooks online from somewhere like Amazon. Most of the time you get free 2-day shipping and it’s usually much cheaper than the college bookstore.

3. You probably won’t keep your 4.0

If you’re a perfectionist then you are among your people. Many nurses have type A personalities and strive for their best. This often includes making good grades. But alas, dear nursling, you might not be able to maintain that immaculate 4.0 you’ve had throughout the rest of your college experience. Nursing school is a different brand of difficult and incredibly smart young men and women find it very difficult to maintain the same grade point average they had going in. You might make a B or two. Heck you might even make a few Cs. That’s ok. As you will find out soon enough, what doesn’t kill you will make you stronger. And I haven’t met a nurse yet who was asked for his or her transcripts when applying for a job.

4. Study groups will help you keep your sanity

On the very first day of nursing school our teachers highly recommended that we find people to carpool with and study with. While I didn’t take them up on this suggestion initially I really wish I had. It wasn’t until my second year in nursing school that I found a group of friends to study with and it really was a huge life saver. I would have done so much better the first year if I had just done this in this first place.

5. Every answer is correct. Your job is to know what is “most” correct.

imageOne of the most difficult things for nursing students to grasp is how to answer NCLEX style test questions. What nursing school is really all about is teaching you how to critically think. This means that the answers aren’t always on the surface and you really have to know how to think about the bigger picture to know what answer is correct. In nursing there are many ways you can take care of patients and perform the same task but there are methods that work best. Nursing school is meant to try and teach you this skill. One of the best things you can do for yourself is find yourself an NCLEX strategy guide (I used Saunders Strategies for Test Success: Passing Nursing School and the NCLEX Exam) and study it before you even start nursing school. This will help you retrain your brain to answers the types of questions that will appear on tests in nursing school and the NCLEX and will really give you an edge in school.

6. If it feels like the teachers are trying to weed you out it’s because they are.

Not everyone is cut out to be a nurse. The hoops you jump through to get into and complete nursing school are not put in place simply to amuse your instructors. Nursing schools are ranked based upon their NCLEX pass rates and they only want students to make it through their program if they are sure they will be able to pass the NCLEX and work as a nurse. Think about all the responsibility a nurse has. Do you want just anyone taking care of you or your loved ones?

7. Your definition of busy will change.

Your priorities will shift and you will determine what is really important to you. Because of this you will have a new definition for what it really means to be busy. In the past you might have said you were busy because you didn’t “feel” like going out. Now you’ll actually be busy because you need to study the entire weekend to pass the test that is scheduled on Monday. You’ll regret many events and outings you blew off before because they won’t even be an option any more.

8. If bodily fluids make you queasy nursing isn’t for you.

no time for datThere’s always at least a few students who make it into nursing school with a deadly fear or blood or an utter revolt for urine and feces. While I can tell you it isn’t all about poop, pee, blood and vomit, I’d be lying if I didn’t say that at least some portion of your nursing school experience will involve these lovely liquids. If you can’t cope with the sight of blood you need to some some serious emersion therapy to get over it now. Your clinical rotation is not the time to come to term with these fears.

9. You will have to give bed baths, wipe butts, and take vital signs.

Someone keeps spreading the rumor to nursing students, especially RN and BSN nursing students, that they won’t have to give bed baths, handle a code brown, take vital signs, and other ‘menial’ task. They’ve been told that nurses aides will take care of this and they will mostly be responsible for ‘paperwork.’ Let me be the first to give you a reality check: you’re gonna do all those things AND do paperwork. You don’t graduate from these responsibilities once you become a nurse. You own them. If you are lucky you might have a nurses aide to help you, but you better appreciate him/her for anything they assist you with. And you should never ask them to do something you have plenty of time to do yourself.

10. Your sense of humor will expand.

imageWhile my sense of humor has always been on the dry side, nursing school gave me a new appreciating for quick a wit and the ability to find humor in any situation. Nursing is stressful, emotional, and can be extremely tragic at times. Sometime in your life you will find yourself in the middle of a code situation with several nurses laughing and carrying on a conversation. You will learn that they aren’t doing this to be cruel or disrespectful. Nurses just have to find ways to cope with the tragedy and pain you will experience. Having a good and expanded sense of humor is a great way to do this.

11. Start networking now!

Do you know 10 people who could help you get a job if you were in a pinch? No? Well you need to start working on it. Yes? Well add 10 more.

Finding a job as a new nurse can be very difficult. And while many would have you believe there is a nursing shortage there are many new nurses who go months without securing employment. You need to make sure you have a good network so you can get your foot in the door and get your first nursing job.

12. Your first job probably won’t be your dream job.

I know you’re still in nursing school, but the time will come when you are seeking employment. The ‘exciting’ areas and specialties in nursing are usually very desirable and don’t often take new graduates. You might get lucky and land your dream job, but if you don’t then don’t let it get you down. With just a few few of years of experience under your belt you should be able to transfer into just about any nursing specialty you desire. And if you hate your first nursing job, after a year most will hire you readily.

13. Being a team-player is critical.

If you’re a introvert the time is now to get comfortable working with others. No nurse can operate on an island. You will often need help from your peers. In nursing school you will need help with studying, group projects, and graduating preparation. On the job you will need the help giving baths, answer call lights, and any number of things you may be too busy to tackle that way. Be prepared to give what you expect to get back or else you’re going to have a miserable experience in nursing school and as a nurse.

14. Maintain contact with your non-nursing friends.

The time will come when you are no longer in nursing school and you may or may not maintain contact with your nursing school classmates. If you do, that’s awesome. Even so, you need to be friends with people who aren’t nurses. Not every conversation has to focus on bodily functions or nursing horror stories. It’s nice to have a friend who doesn’t want to talk about nursing because moments with him or her are moments when you can truly escape from being a caregiver.

15. It’s okay to enjoy nursing school.

imageThere are a million and one things that will irritate you and stress you out in nursing school. There are probably also a million and one articles and books about doing well in nursing school. Many of these tend to focus on the ‘work’ related with nursing school. But don’t let the ‘work’ of nursing school ruined the entire experience for you. While nursing school is hard it can also be fun! You gain an education and experience that will mold you into a nurse. You will make memories that you can get nowhere else. As a nursing student you need to make sure you work hard but you also need to play hard. Don’t forget to take time to enjoy this exciting milestone on your nursing journey!

Top 4 tips that benefit RNs and help advance their careers

 

By Donna Cardillo 

It is imperative that every nurse – new and experienced – realize the healthcare landscape has completely changed. There will be plenty of opportunities for RNs and APNs who stay current with trends in education, technology, care and personal and professional development. Nurses must be willing to step outside their comfort zone and learn new ways — and places — of working and thinking about their profession. Cynthia Nowicki Hnatiuk, RN, EdD, CAE, FAAN, executive director of the American Academy of Ambulatory Care Nurses and the Academy of Medical Surgical Nurses. stresses that, to stay competitive, nurses also will have to be able to articulate the value that they bring to outcomes, beyond tasks, in any setting. So what does every nurse need to do? Here are four key areas:

1| Skill building

Clinical skills alone won’t see us through in this new paradigm. Self-marketing, computer skills, oral and written communication, conflict management, negotiation, leadership and networking skills must be learned and practiced. Hnatiuk said nurses also need to be more business savvy, with an understanding of finances, staffing, acuity and productivity.

2| Education

Higher education is no longer optional. It is a foundation for practice in any setting and fundamental to professional and personal growth and development. Hnatiuk advises that formal and continuing education, along with clinical certification, will help nurses take their practice and careers to the
next level.

For those considering advanced practice, particularly becoming nurse practitioners, the NNCC’s Hansen-Turton advises: “Don’t think too long; jump in. Opportunities will be increasing for NPs over the next 5-10 years. NPs are and will continue to be a hot commodity.” Certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists also will see expanded opportunities.

3| Professional association involvement

Our professional associations are where we connect with one another, form communities, share best practices (local and national), stay current with trends and issues, and find support. Hnatiuk added that through association involvement, you learn more than you could by yourself and progressively learn leadership skills

4| Mentoring

Hnatiuk encourages nurses to take advantage of opportunities to be mentored and to mentor others. “We have so much to share. Mentoring will allow us to achieve all we’re capable of doing.”

For personalized career advice

If you have specific career-related questions, send them to Dear Donna at www.Nurse.com/AsktheExperts/DearDonna for a personalized response.

Source: Nurse.com

What can a new graduate do to setup and update his or her resume to make it more attractive to employers?

 

Question:

Dear Donna,

I'm a recent new graduate and I'm trying to figure out how to setup and update my resume to be more attractive to employers. Are there certain topics or headlines that should be included and what are the rules for putting my clinical experience on
my resume?

Wants a More Attractive Resume 

Dear Donna replies:

Dear Wants a More Attractive Resume,

Although you may hear varying opinions about whether or not your clinical rotations should be on your new nurse resume, it is a good idea for several reasons. It looks good if you're applying to one of the facilities in that healthcare system where you did some clinical time. This is especially true if you're favorably remembered by a staff member and if you did a clinical rotation at a
well-known facility.

It's not necessary to give much detail about each position or to provide dates and time frames other than the year. You can mention significant experiences you had, such as working with ventilators. On the other hand, if you have prior healthcare work experience as an LPN or nurse's aide, it may not be necessary to list clinical rotations. Be sure to include any externships or special internships you did as well. Once you've had your first job as an RN, clinical rotations and externships would no longer be listed.

As far as categories, the other common ones are: work experience; education; licensure/credentials; volunteer work (if applicable); and special skills where you can list other languages you speak, special computer skills or any other noteworthy skills. You'll find very detailed information, including new nurse resume samples, in “The ULTIMATE Career Guide for Nurses” (http://ce.nurse.com/
course/7250/). 

Also read “FAQs about student nurse resumes” (www.Nurse.com/Cardillo/Student-Resumes) for answers to other commonly asked questions.

A good resume certainly is an important marketing tool but there is much more involved in launching a successful job search, especially as a new nurse. Read “New nurse, new job strategies” (www.Nurse.com/Cardillo/Strategies) to help give yourself an edge when looking for that first
full-time position.

Best wishes,
Donna 
Source: Nurse.com

How Immigrant Doctors Became America's Next Generation of Nurses

 

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Isabel Barradas, 48, has been a doctor for 25 years. In her native Venezuela, she was an orthopedic surgeon and head of a hospital department, with expertise in physical rehabilitation. She speaks three languages and—since marrying an American and moving to South Florida more than a decade ago—is a U.S. citizen.

Barradas passed her U.S. medical licensing exams with flying colors. But she didn't get a residency position in the specialty she loves. "Orthopedic surgery? Forget it. In this country, that is so elite," Barradas says. Competition for the training positions required for medical licensure is fierce, and most go to seniors at U.S. medical schools. Barradas decided that the position she did get—internal medicine in Buffalo, N.Y.—wasn't worth leaving her family in Miami for.

Thousands of foreign-educated doctors living in the U.S. would like to practice medicine here but don't have the time, money or language skills to compete for and complete a residency. Miami's Florida International University offers other options: accelerated programs leading to a bachelor's and master's of science in nursing which train foreign-educated doctors to be nurse practitioners. FIU's programs both give internationally educated professionals an outlet for their skills and helps add much-needed diversity to the health care workforce.

The U.S. faces a dearth of 20,400 primary care physicians by 2025, according to federal statistics. The Association of American Medical Colleges projects a shortage of thousands of surgeons and other specialists too. While an aging population and health insurance expansion increase demand for health care services, medical schools and residency programs aren't producing enough doctors to meet demand.

There are thousands of foreign-educated doctors living in the U.S. who have the expertise needed to address some of this growing need. Every year for the past decade, between 5,000 and 12,000 foreign-educated physicians who have passed their licensing exams apply for a residency position. Typically, about half get one, compared with more than 90 percent of U.S. medical school seniors who apply, according to data from the National Resident Matching Program.

International medical school graduates, like minority doctors, often go on to serve medically underserved populations. Graduates of international medical schools make up a quarter of U.S. office-based physicians, and are more likely than their U.S.-educated peers to treat minority patients, foreign-born patients, patients who speak little English and patients who qualify for Medicaid, according to a 2009 study from the Centers for Disease Control and Prevention.

Demand for highly trained nurses is also growing, particularly for nurses who speak moreisabel resized 600 than one language and reflect the growing diversity of the U.S. population. If highly trained professionals like nurse practitioners and physician assistants were to take on more primary care responsibilities, the shortage of primary care doctors could be cut by more than two-thirds, according to the Health Resources and Services administration.

FIU introduced its accelerated nursing degree program in 2000, in response to pressure from underemployed Cuban doctors living in the area. The FEP-BSN/MSN program began as a bachelor's degree program that prepared students to become registered nurses. In 2010, FIU added a master's degree, and graduates of the full program can now find work as nurse practitioners—an advanced role that can include prescribing medicine and diagnosing patients. In Florida, nurse practitioners earn about $86,800 per year. Barradas hopes to find work with an orthopedic surgeon.

Isabel Barradas (left) and Mariana Luque, trained and credentialed as physicians in their native Venezuela and Colombia respectively, are nursing students at Florida International University. (Sophie Quinton)The program compresses six years of education into four, mostly by moving quickly through undergraduate-level material. English language learners get help with reading and writing academic papers, and courses are scheduled in the evenings or compressed into one day a week to fit the needs of working adults. For the past few years, the graduation rate has been close to 100 percent.

Despite its South Florida roots, the program has begun to attract students from all over the U.S. "I ask them, why don't you just go to the accelerated program where you live? And it's not the same for them," says Maria Olenick, program director. "They choose to come here because they know that there are other people in the same situation."

Most of the 200 doctors enrolled in FIU's program this year are bilingual. About 39 percent are from Cuba, 28 percent are from Haiti, and 6 percent are from Colombia, with the rest hailing from Nigeria to Lithuania. Students are evenly split between men and women, and the average age is about 40. Applicants must be U.S. citizens or permanent residents.

Some doctors are initially reluctant to enter a nursing program, Olenick says, fearing loss of prestige, but usually the negative feelings don't last. "What we're hearing from them is that they're actually really, really enjoy the role of nurse practitioner in the United States, because it's more like the way they practiced in their home countries," she says. American physicians tend to spend less time with patients and more time processing paperwork than their counterparts overseas. Barradas' patients in Venezuela used to come by just to chat.

It's not always easy for graduates of the accelerated degree program to find the kind of work they want, says Carlos Arias, chief operating officer of Access Healthcare. Although they're armed with an advanced nursing degree and have medical training, graduates are often offered entry-level positions with low salaries. Arias, a Cuban-educated doctor himself, now heads a Florida independent practice association that has hired two graduates of FIU's program to date.

Not all graduates choose to enter the workforce right away. The first class of nurse practitioners graduated last summer, and of 55 graduates 12 returned to FIU to enroll in a doctoral program. "We're looking now at making the program a BSN to DNP program, because we have so many that are interested," Olenick says of the doctoral program. "The way that nursing is moving, eventually a DNP will be required to practice as a nurse practitioner."

For the foreign-educated physicians in the program, the doctorate offers another perk. As a graduate, you get to be titled Dr. again.

CORRECTION: An earlier version of this article misspelled the name of Carlos Arias. It also omitted the number of graduates who returned to FIU to enroll in a doctoral program. Twelve did.

Source: NationalJournal

Do Health Exchange policies Change the Game for Full-Time Nurses?

 

by

For: http://onlinelpntorn.org

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It just occurred to me that the new health exchange insurance policies could change the nursing career marketplace and give nurses a lot of new employment options: we can play job Tetris. Why? Read on.

Before the individual policies were available, nurses without spouses or another source of health insurance were bound to full-time work with benefits unless they opted to live dangerously. Individual policies were just totally unaffordable (I used to pay about $1,000 per month for an individual policy when I was self-employed). Now they are affordable, and they are particularly so if you consider the salary differential between full-time and PRN hourly wages. It is usually significant.

This one factor allows some mix-and-match in job searches. Perhaps your dream job has a part-time position available, so you take that and pick up PRN shifts somewhere else. Perhaps you have interests in two areas, so you find PRN positions in both. Perhaps it even works out financially for you to work full-time hours as a PRN nurse where you already are, if you work at one of the hospitals where PRN nurses can always pick and choose hours (this plan will not work if PRN hours are what they were intended to be and not guaranteed).

Disclaimer: this does not include other benefits such as retirement contributions and term life insurance that are generally offered, nor does it generally offer paid time off. Speaking as someone who was self-employed for a decade, I can readily state that employer matching for retirement and paid time off are benefits worth accepting a lower hourly rate than I would get for PRN status. However, I know that for many people health insurance is the sticking point, and for those people a whole new world may have just opened up.

Of course, your mileage may vary with the exchange policies versus a group insurance policy with an employer. I have found so far that with mine, the benefits are either similar to or better than the group policy I used to have, and I even bought a lower-tier policy because I thought it would be much more temporary than it has ended up being. They really do cover preventive screens and such at 100%. They really do pay what they say they will for copays and prescriptions, and this was not the case for my group policy. There was always an exception. As I say, this is my mileage only.

Just think, though, of the possibilities. This is important given the tight job market for nurses right now. What if you were not tied to benefits? Do you have a hobby or a sideline you could monetize and be a nurse two shifts per week? Do you have a previous career you could still put to use part time and pick up shifts now and then as a nurse?

Thinking of job opportunities this way opens up a new range of options if you are willing to, I hate to say it, think outside the box. Just keep in mind the question, “What if I didn’t have to look just in the full-time section?”

Norwich University Future of Nursing

 

The nursing profession is facing multiple challenges in the years ahead. From the Affordable Care Act and its focus on the introduction of electronic medical records, to the aging US population, many people question what healthcare will look like in the future.

What remains certain, however, is the future of nursing is bright. Nurses are a vital part of the health care system and a valuable resource for our society.

What can nurses and nursing industry expect in the years ahead?

At this point in time:

- One third of nurses are over 50 years old.
- 1/3 of the current workforce will reach retirement within the next decade or so.
- Nurses work more hours now than they did in 2000.

How the Health Care Reform Will Affect Nurses

Nurses will be prepared to take on more responsibility than they currently have.

This will be helpful, since:

- Within 15 years, the country will be short 150,000 doctors.
- Primary Care Physicians (PCP) will be in the greatest demand, with an estimated 45,000 needed by 2020.
- Millions of new patients are expected to flood the healthcare system as new insurance takes hold.
- More nurses will work in rural areas where the nurse may be the only health care provider available.

Ever-Changing Technology

As we move into the future, nursing will change thanks to new technology, such as:
- The Computerized Provider Order Entry (CPOE) will reduce medication errors by about 55%.
- Medication will be scanned before the patient takes it, to ensure correct dosage and type.
- Transcriptions can be replaced by CPOE.
- Electronic medical records will link hospitals, physician’s practices and home healthcare agencies.

To learn more about the future of nursing, checkout the infographic below created by Norwich University’s Online Master of Science in Nursing program.

The nursing profession is facing multiple challenges in the years ahead. From the Affordable Care Act and its focus on the introduction of electronic medical records, to the aging US population, many people question what healthcare will look like in the future.

What remains certain, however, is the future of nursing is bright. Nurses are a vital part of the health care system and a valuable resource for our society.

What can nurses and nursing industry expect in the years ahead?

At this point in time:

- One third of nurses are over 50 years old.
- 1/3 of the current workforce will reach retirement within the next decade or so.
- Nurses work more hours now than they did in 2000.

How the Health Care Reform Will Affect Nurses

Nurses will be prepared to take on more responsibility than they currently have.

This will be helpful, since:

- Within 15 years, the country will be short 150,000 doctors.
- Primary Care Physicians (PCP) will be in the greatest demand, with an estimated 45,000 needed by 2020.
- Millions of new patients are expected to flood the healthcare system as new insurance takes hold.
- More nurses will work in rural areas where the nurse may be the only health care provider available.

Ever-Changing Technology

As we move into the future, nursing will change thanks to new technology, such as:
- The Computerized Provider Order Entry (CPOE) will reduce medication errors by about 55%.
- Medication will be scanned before the patient takes it, to ensure correct dosage and type.
- Transcriptions can be replaced by CPOE.
- Electronic medical records will link hospitals, physician’s practices and home healthcare agencies.

To learn more about the future of nursing, checkout the infographic below created by Norwich University’s Online Master of Science in Nursing program.

The nursing profession is facing multiple challenges in the years ahead. From the Affordable Care Act and its focus on the introduction of electronic medical records, to the aging US population, many people question what healthcare will look like in the future.

What remains certain, however, is the future of nursing is bright. Nurses are a vital part of the health care system and a valuable resource for our society.

What can nurses and nursing industry expect in the years ahead?

At this point in time:

- One third of nurses are over 50 years old.
- 1/3 of the current workforce will reach retirement within the next decade or so.
- Nurses work more hours now than they did in 2000.

How the Health Care Reform Will Affect Nurses

Nurses will be prepared to take on more responsibility than they currently have.

This will be helpful, since:

- Within 15 years, the country will be short 150,000 doctors.
- Primary Care Physicians (PCP) will be in the greatest demand, with an estimated 45,000 needed by 2020.
- Millions of new patients are expected to flood the healthcare system as new insurance takes hold.
- More nurses will work in rural areas where the nurse may be the only health care provider available.

Ever-Changing Technology

As we move into the future, nursing will change thanks to new technology, such as:
- The Computerized Provider Order Entry (CPOE) will reduce medication errors by about 55%.
- Medication will be scanned before the patient takes it, to ensure correct dosage and type.
- Transcriptions can be replaced by CPOE.
- Electronic medical records will link hospitals, physician’s practices and home healthcare agencies.

To learn more about the future of nursing, checkout the infographic below created by Norwich University’s Online Master of Science in Nursing program.

norwichuniversity resized 600Source: Norwich University Online

Study pinpoints issues that leave ED nurses vulnerable

 

By Nurse.com News

A qualitative study on assaults on emergency nurses, sponsored by the Emergency Nurses Association, found a need to change the culture of acceptance that is prevalent among hospital administrators and law enforcement.

Better training to help nurses recognize signs of potential trouble also is key, according to researchers, whose study was published Jan. 17 on the website of the Journal of Emergency Nursing.

“Assaults on emergency nurses have lasting impacts on the nurses and the ability of emergency care facilities to provide quality care,” 2014 ENA President Deena Brecher, RN, MSN, APN, ACNS-BC, CEN, CPEN, said in a news release. 

“More than 70% of emergency nurses reported physical or verbal assaults by patients or visitors while they were providing care. As a result, we lose experienced and dedicated nurses to physical or psychological trauma for days or sometimes permanently. Healthcare organizations have a responsibility to nurses and the public to provide a safe and secure environment.”

According to Bureau of Labor statistics, an assault on a healthcare worker is the most common source of nonfatal injury or illness requiring days off from work in the healthcare and social assistance industry. 

Despite that statistic, the qualitative research study discovered a culture of acceptance among hospital administrators, prosecutors and judges. One emergency nurse assault victim told the researchers the “administration will only take action when some lethal event happens.”

Perhaps in correlation with the culture of acceptance, the study also concluded that emergency nurses and hospital personnel in general are not trained to recognize cues for violent behavior. 

“It is imperative that hospitals and emergency care workers address the issue preemptively through adoption of violence prevention education, zero-tolerance policies, safety measures and procedures for reporting and responding to incidents of workplace violence when they do occur,” the researchers noted. “Such actions are necessary to help nurses recognize incipient violence.”

The ENA long has taken the position that healthcare organizations must take preventive measures to circumvent workplace violence and ensure the safety of all healthcare workers, their patients and visitors.

“There will always be the potential for violence against emergency nurses,” Brecher said. “But we must not accept it as the price of helping the sick and injured. With training and a change of culture, we can significantly decrease the occurrence of assaults against emergency nurses.”

The study was conducted using a qualitative descriptive exploratory design. In the fall of 2012, a sample of ED nurses was recruited by email from the roster of ENA nurses and through an announcement on the ENA website. Eight men, 37 women and one person of unknown gender responded to the question, “Tell me about your experience of violence in the emergency setting.” Answers were emailed to and analyzed by the Institute for Emergency Nursing Research. 

Only one other previous qualitative study is known to have been conducted to address workplace violence against emergency nurses in the United States since at least 2004, according to the news release.

Study abstract: http://bit.ly/1iwMuM8 

Source: Nurse.com

A Patient’s Eye-View of Nurses

 

By LAWRENCE K. ALTMAN, M.D.

Last June, the month he turned 90, Dr. Arnold S. Relman, the eminent former medical educatorDr. Arnold S. Relman, 90, with his wife, Dr. Marcia Angell, in 2012. He  fell in June and suffered multiple fractures. and editor, fell down a flight of stairs at his home in Cambridge, Mass. He cracked his skull and broke three vertebrae in his neck and more bones in his face.

By the time he arrived at the emergency room, blood was flowing into his brain and impinging on his windpipe, leading to severe choking and dangerously low oxygen levels. Surgeons cut into his neck to connect a breathing tube from his trachea to a mechanical respirator.

Amid the disciplined medical havoc, his heart stopped three times. Resuscitation efforts saved his life, but at the cost of several broken ribs. His condition remained precarious as he developed complications and endured still more medical procedures.

Astonishingly, he lived to write about all this. After a painful 10-week hospital stay and months of rehabilitation, he can walk — gingerly, with a cane — and is largely recovered, with his mental faculties intact.

His riveting account of the medical adventure, in the Feb. 6 issue of The New York Review of Books, is a testimonial to the best emergency medical care and a tremendous will to live. At the same time, however, it betrays a surprising lack of awareness of some critical aspects of the medical profession and the nation’s fragmented health care system.

Despite decades as a medical educator, researcher, author and editor of The New England Journal of Medicine, Dr. Relman confesses that he “had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled.” Nor did he appreciate the hypnotizing effects of technology, which robs patients of the physician’s bedside manner and affects the training of younger doctors.

How is it that a leading medical professor like Dr. Relman — who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard — might not have known about the value of modern-day Florence Nightingales?

A number of doctors who have talked to me about Dr. Relman’s article suggest that the culture of medical education may be largely to blame. For example, younger doctors in hospitals spend part of the day on rounds, following professors in their long white coats. Many of these august figures are supremely confident in their observations and opinions; others are more compassionate.

What professors impart on those rounds can have a major effect on the behavior of younger doctors when they go into practice and teach succeeding generations.

Dr. Relman’s initial care was in a major teaching hospital, Massachusetts General in Boston, where the kind of doctors he taught — students, interns and residents — provided the round-the-clock attention that kept him alive. Yet he did not write directly about their role, referring to them only as “a team.”

On their rounds, some medical professors prefer to talk in a hallway just outside the patient’s room as they discuss test results that are crucial in planning further care. Such behavior appears impersonal, perceived perhaps as a way of shielding bad information.

But many doctors see it as efficient, because they can note the information they deem most important — like heart rate, blood pressure and rate of intravenous drip — by standing at a patient’s door and looking in at the monitors. Feeling no need to go to the bedside, they do not. Instead they rely on nurses, failing to recognize that such behavior omits crucial elements in patient care — the physical touch and the personal touch.

Dr. Relman owes the extension of his life to drugs and devices that did not exist in their present form, if at all, when he was younger. Over the years, the surge in the number of such advances, and most importantly in their hazards, has made work vastly more complicated for doctors, nurses and other health workers. Despite the advantages of technology, tender, loving care from family and nurses is priceless, as is the bedside manner of a sympathetic doctor.

But technology’s monitors, images and devices can deflect that doctor’s attention, as Dr. Relman learned when he reviewed his hospital records and the notes he wrote to nurses and his wife, Dr. Marcia Angell (particularly while he was unable to speak because of the breathing tube).

Instead of descriptions of his appearance and feelings, the doctors’ progress notes in his electronic medical records were filled with technical data. “Conversations with my physicians were infrequent, brief and hardly ever reported,” he wrote, adding:

“What personal care hospitalized patients now get is mostly from nurses. When nursing is not optimal, patient care is never good.”

Many hospital administrators have cut nursing staffs. They say it is to make ends meet; many doctors say it is usually to increase the bottom line.

Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.

In many ways, Dr. Relman’s insights reflect changes and generational gaps in training doctors, nurses and other health professionals. Because these disciplines have traditionally been taught in separate silos, they often do not work as tightly as they should.

Now, as health care financing changes and doctors spend more time training in outpatient settings, a growing movement demands coordinating the education of health professionals to prepare them to work more smoothly in teams. If these efforts succeed, perhaps the next generation of doctors will no longer be surprised at the importance of nurses and other allied professionals.

Source: Well: NY Times 

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