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Gaining Confidence


From Advance for Nurses By Beth Puliti

The Institute of Medicine recently appealed for a change in nurses' roles, responsibilities and education, proposing to implement nurse residency programs to assist in the clinical practice transition (Advancing Health, October 2010).

The Hospital of the University of Pennsylvania, Philadelphia, identified the need for support much earlier.

Its Gateway to Critical Care Program started 10 years ago and offers new nurses and registered nurses with less than 1 year of critical care experience the opportunity to work alongside experienced ICU nurse preceptors to become safe and competent critical care nurses.

nurses2"The competency-based orientation program helps foster the knowledge and skills necessary to care for patients within the different critical care units in our hospital," said Lisa Fidyk, MSN, MS, RN, coordinator of the Gateway to Critical Care Program.

Catering to the Adult Learner

Participants enrolled in the program adhere to an educational plan that defines competency expectation, patient assignment and preceptor/learner responsibilities.

"We base our program on Patricia Benner's From Novice to Expert model. We work to assist the graduate nurse's progress from advanced beginner to competent nurse utilizing her framework," explained Fidyk, who is also a professional development specialist in the Department of Nursing Education, Innovation and Professional Development.

As Fidyk mentioned, Benner's framework of skill acquisition and development of the essence of critical thinking is utilized in the Gateway to Critical Care Program. Goals are reached through segmented learning, faculty guidance, a supportive environment and preceptor/orientee relationships.

The 16- to 20-week program consists of 4-5 weeks of classroom/clinical and 11-16 weeks of full-time clinical. It enrolls new-to-practice surgical, cardiac, neuroscience, cardiothoracic and medical ICU nurses, as well as nurses from the emergency department. Fidyk noted the nurses learn from various teaching strategies, including classroom instruction, clinician-supervised skill labs and clinical experiences.

"The program caters to the adult learner and provides different ways for these nurses to learn about the critical care arena. We incorporate case studies, lectures, discussions and simulation to help them develop the skills they would need to care for critically ill patients," she said.

Throughout the program, nurses learn the following core competencies: airway and ventilator management; cardiac monitoring; critical care pharmacology; hemodynamic monitoring; arterial blood gases analysis; acid-based balance; pain, sedation, neuromuscular blockade; and end-of-life care.

Working Alongside Experienced Nurses

Clinical support comes in the way of clinical preceptors, Gateway to Critical Care faculty and critical care advanced practice nurses/clinical nurse specialists/clinical nurse IV staff nurses.

While enrolled in the program, nurses work beside experienced ICU nurse preceptors.

"A preceptor is a mentor," Fidyk said. "They work with that person when they are on the unit taking care of patients. Preceptors are experienced nurses who know what it's like to go through the Gateway Program, how to collaborate and how to make it a great experience."

When the nurses return to their floor, they practice and hone their skills with a preceptor for the duration of the program.

"My nurse preceptor was a nurse on the unit for 5 years," recalled Lauren Mang, BSN, RN, clinical nurse I in the neuro ICU at the Hospital of the University of Pennsylvania. "She was fabulous. She really gave me the confidence and courage I needed to become a better nurse."

Mang noted preceptors help new nurses become more at ease because, as an experienced nurse who knows the ins and outs, they are able to impart their knowledge at a comfortable level.

"She was there side by side with me until toward the end when she started to hide from me so I would learn how to answer questions on my own. She gave me the confidence to be able to do that," she said.

New Graduate Nurse Retention

After the Gateway to Critical Care program, nurses are enrolled in the Nurse Residency Program, a yearlong series of learning and work experiences designed to support nurses as they transition into professional nursing practice.

The Hospital of the University of Pennsylvania participates in the United HealthSystem Consortium (UHC)/American Association of Colleges of Nursing (AACN) National Nurse Residency Program and was actually the first Philadelphia hospital to participate in the National Nurse Residency Program.

The UHC/AACN Nurse Residency Program consists of an evidence-based curriculum developed by academic and nursing experts across the country. It boasts a reduction in voluntary turnover rate for first-year nurses to well below the median of 27.1 percent. Programs that have implemented this residency program model have attained retention rates of more than 94 percent.

Fidyk commented that both the Gateway to Critical Care Program and the Residency Program at the Hospital of the University of Pennsylvania act as a great support system, and with that support she's seen a "huge" increase in retention. A 98 percent retention rate to be exact.

A higher nurse retention rate delivers better patient outcomes by increasing the nursing staff's experience and competency. Retention also helps preserve new graduate nurses' knowledge, experience and competence gained during the first year of professional practice.

"I know a lot of hospitals don't have these programs, and when I was in a leadership class in nursing school, we actually talked about Penn's Gateway program. That really opened my eyes to research this program more," Mang said. "I needed just a little bit of extra help one-on-one and it really helps you with that. Right now, I'm only 11 months into this and I feel very confident and have learned a lot from this program."

Fidyk noted that, for most of the nurses who come into the program, it's their first job - and it's an intense arena.

"You're saving people's lives, you're dealing with emotional aspects of your job, you're coming in contact with many different healthcare providers - it's all very overwhelming. The Gateway to Critical Care Program is a great way to help new nurses figure everything out and have someone to talk to who will listen," she concluded.

Work & Life Balance: A Nurse's Impossible Dream?


From By Elizabeth Hanink

Work-life balance is more than good time management. It means having a professional life and personal life that are integrated so well that each part enhances the other. That takes self-knowledge and self-discipline—two traits that we need to cultivate if we ever hope to achieve the balance that brings enjoyment along with achievement. It is a life-long process that requires daily fine-tuning.

All sorts of people have trouble with work-life balance. What makes nurses especially vulnerable is that so much of our professional life is beyond our control. We can’t change the fact that most nursing jobs involve tricky schedules, heavy work-loads, and tons of variables that can shift by the hour, yes, even by the minute.­ Most of us are additionally burdened by wanting to give good care.Nurses Talking

But not having the power to manage many aspects of our jobs doesn’t mean we have no control. Nurses can be like the sleeping elephant, unaware of its strength. If you want to make your dreams come true, wake up to your own power, to the role you play in your own life. Taking control is the key. If you live in a constant state of reaction, you give control to someone else. Time management only enters the equation when you use it as your tool to gain control: over a day, a month, a life-time.

Remember Nursing 101

Where to start? You don’t need a new system of thought. What you learned in nursing 101 about nursing process will serve quite well here. Remember how assess, diagnose, plan, implement, and evaluate worked for all nursing problems. It works for the big picture of your life, too and helps you get the minute by minute obstacles out of the way so the bigger pieces fall into place. It does you no good to manage a perfect work day, every day even, if there is nothing left for family or fun or personal growth.

Let’s start with assessment. What do you want—what is important to you? Knowing that, and it can take some time to figure it out, makes all the difference. Do you want, in the next hour, to have all your charting completed or do you want to be sure that all your patients have a clean, neat room with trash picked up and tray tables cleared? Do you want in five years to have an advanced practice degree or do you want weekends free for hobbies? Do you want to own a home or vacation every year in a different country? All of these are commendable goals but which are yours? Only you really know.

The second step is diagnosis. What is keeping you from achieving your ambitions? Are you stuck in the land of “after this happens?” as in I’ll get to my charting after I have rechecked all the rooms. Or I’ll start school after I feel more settled at work? Or could you be like the man in the Chinese proverb waiting for roasted duck to fly into his mouth? You will wait a very, very long time. The important ingredient is taking responsibility for what is lacking. This step does not allow placing blame anywhere but on you.

No time to linger. Now that you know what you want and why you don’t have it, move onto the third step, planning. This involves setting priorities. Out of all the things you want, what is most important? It might be different every day, it might vary by what age you are at a given time, or it might vary by what is realistically possible given your circumstances. If you already have three young children, then the Peace Corps is not feasible.

Your self-knowledge that came through assessment is critical in this step. And because you are employed as a nurse, again, you might not have total control minute by minute. But taking your theoretical goal for today as wanting to get all the charting done on time, how are you going to achieve that with a last minute admission? Take the time to assess where you are and plan. Write it down, even if jotting down will delay you, what 15 seconds. Maybe the new goal will have to be leaving only 15 minutes late instead of the usual hour that a last minute admission would ordinarily require.

Now it’s time to implement and here is where some time management skills can play a part. If you are lacking these, get some. Study the nurses around you who do manage to get it all to happen, because some tricks do not come naturally. Not every experienced nurse is savvy in these skills but most who last in a hectic hospital environment have a clue, and you can learn from them.
There’s a ton of specific information out there.

Role Models

Kathy Quan, RN, has written a book on time management just for nurses, Tips and Strategies for Effective Time Management for Nurses. You can download it as an ebook. If you are a new graduate, try The Everything New Nurse Book also by Kathy Quan(www. Her website and those of others are full of suggestions. If you can get work under control, you will have much more energy left for the rest of life. And don’t wait to get started on that. Life doesn’t wait.

Don’t forget, there are nurses who manage to have long careers meeting interesting challenges and still live interesting lives outside of work. What is the secret, you might ask.

It isn’t a secret says Tilda Shaloff, RN. You have to set priorities (remember planning?). She uses a daily written list (no Blackberry for her) that she often formulates while walking her dog. It contains, every day, day in and day out, 17 items. The number 17 has private significance for her. Your number could be different. The act of writing the list helps her organize what has priority and what can wait.

She also delegates. Her children have always been paid to help around the house and her husband has always been willing to participate fully in chores. She also, and this is key, arranges her clinical work schedule to suit the other important things in her life—her writing and public speaking. Being the author of several books and a very popular motivational speaker, Shaloff says, takes tremendous energy. But these activities are important to her and so she makes the effort to have the time and strength. It is a conscious choice. She can do speaking and writing and work in an ICU but not other things. You need to make the same choices. It might mean saying no to being room mother or working the polls on election day. Or it might mean having a clean as opposed to an immaculate house. Make your life and your job work for you.

Kathleen Singleton, RN, MSN, also makes choices. As the president of the American Association of Medical Surgical Nurses she has a serious obligation on a national stage plus the obligations of her “day job.” For her the secret is, of course, organization, and she is very dependent, she says, on any electronic help she can get. But the real key for her is negotiation and flexibility. Singleton makes her day job work for her.

She has had scads of practice at this; she worked over the years from nursing attendant to MSN all while working full-time. She thinks any nurse can do it. Instead of moaning about them, make the weekend and shift obligations work for you, she says. Take advantage of your ability to trade shifts. Work with your fellow employees and supervisors to have everyone gain. Negotiate your holiday obligations in such a way that the schedule then allows you to do what is vital to your happiness. In Singleton’s case, her employer, an affiliate of the Cleveland Clinics, allows her maximum flexibility in scheduling in exchange for her willingness to be quite flexible in what is required of her.

Keep in mind: achievement without enjoyment is not the way to balance. Taking control is. Plan, choose, and readjust. Balance is achieved both daily and over the long haul and can be different for each of us each day. Adjust as needed, both the goal, and the implementation because there is more than one way to success.

A Jar Full of Rocks

Here’s a strategy to visualize how, without planning and taking control, you can work very hard all day or even all your life and still have no accomplishments and no satisfaction. Picture a large jar like one that old-fashioned delis kept pickles in. Or the type that holds pretzels from Costco. Fill it as full as you can with large rocks. Now fill in the other spaces with small pebbles. Next add sand. Isn’t it amazing how much sand fits into all the nooks and crannies between the rocks and pebbles? Last fill with water. Quite a bit goes in, doesn’t it, despite all those rocks.

But stop. What if you had poured the water in first? It would be impossible to get even one large rock in without spilling everywhere. Now think of all the things you want to do, today and in life. Make sure the large goals, the large rocks, are what you really want from life — to have more education, to write a book, to own a house, to run a business. You choose. Then fill in with the small pebbles. Do they support the rocks? If you took away three pebbles---a ho-hum hobby, a favorite TV show, or say time on Facebook, would you have room for another large rock? And what about the sand in your life? Is it helping you toward your goal or is it just getting between your toes? Are you drowning in all the water that fills up your life? Is the water keeping you from getting any large rocks into the jar?

As for those nurses like Singleton or Shaloff who work, have a rich personal life, and still have time to pursue advanced degrees or run side businesses? Look at what they don’t do. You will probably find they have eliminated those things that don’t move them toward their goals. They don’t know about the latest episode of American Idol. Maybe they don’t have the latest French tips from the manicurist. They dare to bring store-bought to the potluck. They have made the choice that these things matter less than achieving their goals.

You need to do the same. Just remember. To avoid the pickle jar trap or the “as soon as” trap or any other trap that is robbing you of a good work-life balance, you need to take time now to decide what is important (assess),what is keeping me from it (diagnose) how do I get it from here (plan) and execute. Reassess frequently and adjust as needed. Now you have balance.

Telemedicine: Virtual Patient Care and Collaboration


From By Christina Orlovsky

June 13, 2012 - As the population ages and the need for health care increases, access to care is often a challenge, based on location, provider availability, chronic conditions and economic factors. One potential solution to a number of these challenges is the umbrella of care called telemedicine.

According to the American Telemedicine Association (ATA), telemedicine is defined broadly as the delivery of any health care service through any telecommunications medium--for example, a patient seeing a doctor, nurse or allied health professional via a videoconference, rather than in-person, or a patient with a chronic condition utilizing an in-home device to monitor vital signs and transmit data to a nursing center for assessment and medical intervention.Nurse on Computer 2

“The one thing that ties all telemedicine together is that it involves a clinical health care service, it directly contributes to the health and well-being of patients, and the patient and provider are separated by some geographic distance,” said Benjamin Forstag, senior director of communications for the Washington, D.C.-based ATA.

Nurses are directly involved in the virtual delivery of health care through telehealth nursing, defined by the ATA as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice.”

According to Cindy K. Leenknecht, MS, ACNS-BC, chair of the ATA Telehealth Nursing Special Interest Group (SIG), nurses hold a variety of roles in the telehealth arena, depending on their individual scope of practice. They utilize telemedicine technology in the ICU, nursing homes and home-health environments.

“They are reaching into many remote sites using telemedicine, including homes, monitoring for congestive heart failure, diabetes, COPD, hypertension, etc., where they monitor vital signs and question responses, evaluate and call patients to clarify symptoms, and advise on further actions to take, such as call a physician, take a forgotten medicine, etc.,” she explains. “They also deliver timely education and reinforce that education.”

The ATA stresses that telehealth nursing is not a specialty area within nursing. In fact, any nurse who has ever spoken to a patient over the phone has practiced some form of telehealth. As such, the same qualities that attribute to nursing success at the bedside come into play with telemedicine.

“Telehealth nurses need the same nursing skills as all nurses practicing in specialty areas, but with an ability to utilize the technology to the best of its ability to assess and communicate the patient’s physical and mental status,” Leenknecht said. “Excellent organization, critical thinking and communication skills are required also, but the most important skill is to understand the technology and its potential and limitations and have the intuitiveness in how to utilize it to provide the care needed at the time.”

Treating millions of veterans across the miles

One health care system that is uniquely positioned to provide telemedicine services to its patients is the Veterans Health Administration (VHA), the health care arm of the U.S. Department of Veterans Affairs. Responsible for the care of 5.6 million American veterans each year, the VHA utilizes telehealth in a number of ways to be able to meet the health care needs of its extensive patient population, spread out across the entire country.

“In total, in fiscal year 2011, VHA provided telehealth services to 380,000 veterans,” said Adam Darkins, M.D., chief consultant of care coordination services for the VHA Office of Telehealth Services. “We anticipate that number will rise this year by somewhere between 30 to 50 percent.”

The primary use of telehealth for the VHA is through home telehealth, managing chronic conditions like diabetes and depression for 74,000 veterans in their own homes, through the use of telehealth devices that monitor vital signs such as weight, pulse, blood pressure and blood glucose, and ask questions on a daily basis about symptoms and behaviors. A care coordinator--usually a nurse employed in a full-time telehealth role--manages a panel of these patients from a remote location with the goal of educating patients and their caregivers, monitoring their disease symptoms and daily behaviors, and intervening when they’re alerted to warning signs.

“These programs were built to support aging veterans who, as they get older, are living longer and staying healthier and, like all of us, would prefer to live independently,” Darkins explained. “The care coordinator works in partnership with the patient, their family caregiver and their community caregiver to help people with multiple hospitalizations transition home after a discharge, educate them about care management, and intervene early to prevent readmissions. We have seen outcomes of a 30 percent reduction in hospital admissions and bed days of care.”

The anticipated increase in need for care is accompanied by an increased need for care providers--and a need for training.

“These are new areas of care that aren’t taught in schools of nursing or medicine, so one thing the VHA has done is created a training center for each of its areas of telehealth that train to the order of 2,500 people per year, with 90 percent of the training taking place online,” Darkins said, adding that he often sees highly trained nurses turning toward telehealth.

“What we find is often very experienced nurses toward the end of their career are attracted to this and say ‘This is why I came into health care,’” he concluded. “It really gets to the heart of providing holistic care where there’s a real need.”

Nursing Students Make Career Connections at Stanbridge College Career Fair



Vocational Nursing students at Stanbridge College met with over 40 representatives from Southern California healthcare employers to schedule interviews, hand out résumés and gain insight to their future careers.

Nurse StudentStanbridge College, a technical college that offers training in Healthcare and Information Technology, hosted over 40 representatives from Southern California healthcare employers at the Vocational Nursing Career Fair on June 6th. Over 150 students networked with representatives from skilled nursing facilities, home health organizations, hospice organizations, hospitals, medical offices and other healthcare facilities. Many of the students and alumni made lasting impressions on the employers that lead to potential job interviews.

According to Alice Brinkmann, VN student who is scheduled to graduate this July, “I was blown away by yesterday! I handed out my résumé to 10 employers and by 3pm I had email [responses] from 8 out of 10 employers.”

Subsequently, Ms. Brinkmann stated that she received four more interviews as a result of the connections made at the career fair.

Arman Goshtasbe, Assistant Director of Career Services at Stanbridge College also emphasized the positive results of the career fair. He stated, “One student came to me and within 30 minutes had two interviews.”

Stanbridge College offers career fairs as part of its career preparation for its students and alumni. The Career Services Department at Stanbridge College offers assistance with job placement, résumé preparation, mock interviews and career advising. Alumni members are able to receive life-long job placement and access to educational workshops for continuing education.

Mr. Goshtasbe continued, “I think the career fair was a great success. Our VN students came prepared with questions and were very engaged in conversation. I think they walked away with a clear picture of where they need to grow professionally. Many of the employers were also very impressed by the event and our students.”

Parents no impediment to care of kids in ED


From News

Contrary to what many trauma teams believe, the presence of family members does not impede the care of injured children in the ED, according to a study.

Professional medical societies, including the American Academy of Pediatrics and the American College of Emergency Physicians, support family presence during resuscitations and invasive procedures. The degree of family member involvement ranges from observation to participation, depending on the comfort level of families and healthcare providers.describe the image

"Despite the many documented family and patient benefits and previous studies that highlight the safe practice of family presence, trauma providers remain hesitant to adopt this practice," lead author Karen O’Connell, MD, FAAP, a pediatric emergency medicine attending physician at Children’s National Medical Center in Washington, D.C., said in a news release.

"A common concern among medical providers is that this practice may hinder patient care, either because parents will actually interfere with treatment or their presence will increase staff stress and thus decrease procedure performance."

The aim of the study was to evaluate the effect of family presence on the trauma teams’ ability to identify and treat injured children during the initial phase of care using the Advanced Trauma Life Support protocol. ATLS is a standard protocol for trauma resuscitation shown to limit human error and improve survival.

Over a four-month period, researchers reviewed recordings of 145 trauma evaluations of patients younger than 16. Of the patients, 86 had family members present.

Investigators compared how long it took the trauma team to perform important components of the medical evaluation (such as assessing the child’s airway, breath sounds, pulse and neurologic disability, and looking for less obvious injuries) when families were present and when they were not. Investigators also compared how frequently elements of a thorough head-to-toe examination were completed.

Results showed no differences in the time it took to complete the initial assessment with and without family members present. For example, the median time to assessing the airway was 0.9 minutes in both groups. In addition, the researchers found no difference in how often components of the head-to-toe exam were completed. The abdomen was examined in 97% of all patients when families were present, for example, and 98% of patients when families were not present.

"Parents are increasingly asking and expecting to be present during their child’s medical treatment, even if it involves invasive procedures," said O’Connell, who also is an assistant professor of pediatrics and emergency medicine at George Washington University School of Medicine and Health Sciences.

"We found that medical teams were able to successfully perform needed evaluation and treatments of injured children both with and without family members present. Our study supports the practice of allowing parents to be present during the treatment of their children, even during potentially painful or invasive procedures."

Faculty Shortage Turning More Nursing Students Away


From Advance for Nurses

Nursing StudentFindings from the NLN's Annual Survey of Schools of Nursing Academic Year 2010-2011 attest to the continued need for more nurse faculty to meet the needs of the U.S. healthcare system.

Conducted October-November of last year, the NLN survey reveals demand for pre-licensure program entry continues high despite a shifting student demographic, while competition for entry into post-licensure is increasing.

Unfortunately, notes NLN CEO Beverly Malone, PhD, RN, FAAN, the percentage of post-licensure programs that turned away qualified applicants also rose between 2009 and 2011.

Most strikingly, the percentage of MSN programs turning away qualified applicants jumped by 15 percent over the past 2 years, from just one in three programs to almost half in 2011.

The survey also shows the percentage of racial-ethnic minority students enrolled in pre-licensure RN programs fell from a high of 29 percent in 2009 to 24 percent in 2011.

The majority of that decline stems from a steep reduction in African American students enrolled in associate degree nursing programs, which dropped by almost 5 percent to 8.6 percent in just 2 years.

Hispanics remain dramatically underrepresented among nursing students as well, according to NLN, representing only 6 percent of baccalaureate and associate degree nursing students.

But while educational capacity is still insufficient to keep up with demand, some promising trends were uncovered by the survey, says NLN president Judith Halstead, PhD, RN, FAAN,

"For example, the percentage of male pre-licensure graduates in 2011 was up to 15 percent after inching up only a percentage point a year since 2009," she notes. "In addition, the percentage of pre-licensure RN students over age 30 has declined in recent years."

How the Internet has Changed Nursing


From By Christine Contillo

It’s clear that we’ve not just entered the Information Age — we’ve exploded into it. Information exchange is critical to both the advancement of science and patient care, and the impact of the Internet in the medical field has been enormous. Practitioners are now able to jump the barrier of time and access research findings worldwide; and in nursing it’s caused the creation of an entire subspecialty (nursing informatics) meant to manage the amount of information available.

But nurses studying informatics aren’t he only ones finding ways to improve their skills bynurse on computer surfing the web. According to a survey of the American Academy of Nurse Practitioners, more than 98 percent of nurses responded that they use the Internet or email. The survey continued to ask in what way the Internet was used, and the answers may surprise you.

No More Pencils, No More Books

Beginning with nursing education, students everywhere have access to virtual classrooms and degree programs. Online education means that the limits previously imposed by location and time become less important. Busy students with a computer, or those in the workforce trying to fit school into their already packed schedule, should be able to find a few hours at home for study.

Similarly, many states now require continuing education (CE) for licensing. Nursing needing those hours can get them without leaving home, which in many cases removes important constraints such as child care. Sites such as allow the student 24/7 access to courses and technical support. Employers can select educational seminars and show them in real time in a conference room or select courses that have been archived for their nurses to watch later.

Nurses were instrumental in developing accredited online continuing education for Wild Iris Medical Education. The company established the site Nursing Continuing Education to help nurses (and other health professionals) across all 50 states fulfill CE requirements. Prices range from free to $65 depending on the individual requirement and number of contact hours offered. Fees can be paid with a credit card — how else? — online.


For those nurses who are pretty comfortable with technology, podcasts are another avenue to investigate. Similar to audio versions of magazines, they can be heard on MP3 players for up-to-date information. Check out and searching “nursing” or listen to “Nursing Education on the Go” at Podcast Alley.

Streaming Radio

Somewhat similar to podcasts is streaming radio, or radio shows that are available worldwide. AM/FM radio is usually limited by geographical distance, but streaming radio listeners only need access to the web, some free software to download, and a set of speakers.

Barbara Ficarra, RN, BSN, MPA, is a nurse educator in the metro-NYC area and host of “Health in 30,” which airs live at 5:30pm on Fridays on WRCR-AM 1300. Ms. Ficarra lines up expert guests for her weekly show, announces the topic ahead of time, and fields questions as they are phoned in. Without the Internet her show could only be heard locally, but the vast audience afforded by online listeners has enabled her to win wider recognition. In fact, in 2007, she won the Excellence in Journalism award given by the American College of Emergency Physicians.


Nursing blogs are web logs and can range from silly to academic. Just as journals are intimate thoughts, blogs can detail nursing practice issues, patient stories, fears, triumphs or even family and leisure activity. Blogs allow nurses to vent their frustrations to their peers and share valuable resources for patient care. Following a few favorites allows you to peer into the mind of the writer. The ability to comment allows you to enter into an electronic relationship that nurses in remote areas may treasure. Certainly information about individual patients must protect their identity, but sharing the means of resolving practice issues helps to improve practice standards everywhere.

Information Sites

According to Family Nurse Practitioner Roseann Neuberg, the impact brought by the Internet to her clinical nursing practice is “huge,” and she identifies it as a valuable source of patient education material. “There are just so many things I can do in terms of patient education,” she says. “I can look up issues or treatments while my patient is sitting right next to me. I can print it up, hand it out, and be sure that they understand what I’m saying before they leave. When I prescribe a medication I can check the price and look for alternatives. I can even use a program to check for drug interactions.”

Tracy Plaskett, a staff nurse at Beth Israel Hospital in New York City, says, “When I get my patient assignment, I’m able to look up any unfamiliar terms in the notes instantly. I can check spellings and make sure that medication orders are correct.”

Ms. Neuberg is quick to point out that she sticks with sites she knows are accurate and updated frequently in order to feel confident that the advice she is giving is sound. Two such sites are and, which provide current information about clinical management and treatment of disease. Both require a subscription and password.

Mobile Medicine

Lynda O’Grady, RN, has found another important use of the Internet. Ms. O’Grady is part of a large travel medicine clinic, assessing international travelers who participate in academic programs, sometimes to remote and disease-infested areas. Using special software she’s able to assess their individual medical risks. If she has questions she can access advice from organizations like the Center for Disease Control and the World Health Organization. But what she finds most helpful is her membership in the International Society of Travel Medicine. Through a listserv available only to members she’s able to gain up-to-the-minute answers to questions posed, such as, “Where is the nearest medical clinic to Daar es Salaam?” or, “What do you recommend for altitude sickness for a patient allergic to sulfa?” Thousands of members pose and answer questions for each other, some providing clinical advice that only a person actually living in that area might be able to give.

Support Groups for Patients

Nurses may want to suggest online communities to patients experiencing chronic illness or going through debilitating treatments. Immune-compromised patients may be unable to attend in-person meetings, but staying in touch with a virtual group may allow them to feel less isolated. CancerCare is one professional association that helps organize free groups for patients as well as their caregivers. Virtual communities and forums have been vital to patients sharing treatment experience and offering support to each other.


The Internet can be used in a novel way for clinical consults. One home care nurse described how she and her colleagues became discouraged trying to evaluate decubiti. When described in the paper chart by different clinicians using different languages or terms it was often difficult to determine if progress was being made. Solution? They used a digital camera to capture an image that could be sent daily via the web to the practitioner. In this case a picture really was worth a thousand words.

Job Searches

Work-related issues can be shared via the Internet. Nurses interested in relocating can do a web search to conduct virtual tours of hospitals they might be interested in, file an application online, get driving directions, or book travel plans through a travel site such as Velocity. When looking to change jobs they can post their resume online. Even low-cost phone communication can be run through Vonage or Skype — both require an Internet connection and headset instead of a phone line or cell phone.

Creating Community

The Internet facilitates a feeling of community and can create the ability to investigate job issues easily. Union members can use online forums to discuss contract negotiation issues, salary, benefits and legal information. New healthcare legislation and practice agreements, as well as regulatory mandates, can be tracked through blog sites. There is just no excuse now for remaining uninformed.

Brian Short, RN, discovered the importance of a nursing community over a decade ago. When Mr. Short was still a nursing student, he created for the purpose of online support and education. Two years ago the site claimed to cover 400 nursing topics every day and a total of 1.5 million posts. In an interview given at the time of its 10th anniversary, Teresa Burgess, RN, pointed out the importance of the online nursing community for its ability to be used for mentoring and creating a sense of shared purpose.

Let’s end with a word of warning, however, when it comes to using the Internet. While the examples given prove that use of the Internet can be beneficial to nursing practice, we must all bear in mind that much of what we find there remains anonymous and subject to scrutiny.
Our own critical thinking must be used to determine when and how best to use the available information, and to evaluate the value and truth of what we read. Certainly if what we find can nudge us toward being better health professionals, then the monthly cost of Internet service and the time spent in connection with others is well worth it.

The Advocacy Project


by Jennifer Etienne and Anna Diane
Boston College William F. Connell School of Nursing

Our names are Jennifer Etienne and Anna Diane, and we are currently senior nursing students at Boston College. This past January, Boston College’s Connell School of Nursing sponsored a nursing service trip to Leogane, Haiti as a part of the community health clinical requirement. This service trip included Boston College (BC) nursing students, nurse practitioners and registered nurses. We held mobile clinics for ten days and saw over 1100 patients. Over the course of our trip, we encountered many patients who we will never forget.
We were amazed by the beauty and kindness of the Haitian people despite all the myriad challenges of their daily lives. We saw many of the common medical conditions that we see in the U.S., such as hypertension, GERD, and diabetes. Due to the area’s extreme poverty, most of our patients had not received health care in years- if at all. A typical day consisted of waking up at 6 a.m., eating breakfast, and packing up a truck with all of the medications and supplies that we had restocked and repacked the night before. We worked with the resources that were available in the community. We set up the clinic with a triage station, consultation, and pharmacy that were situated in the home of one of the individuals within the community. We were fortunate to have a Haitian dentist participate in our clinic as well. Generous neighbors were kind enough to donate chairs and tables for use in our clinics. The women’s privacy room for pelvic exams was constructed from two sheets and a cement wall on a slab of pavement, and the dentist did his work in a reclining lawn chair. In spite of these challenging conditions, our clinics were very successful with the individuals within the community, as exemplified by their gratitude.

The truth is that the people in Haiti receive little healthcare and basic problems often become major health concerns, which is very frustrating to us as future health care providers. This experience illustrated the importance of preventative health care measures. Preventative health care measures, such as providing health education, not only empowered the people, but also gave us a chance to interact with our patients. For example, we crafted and brought cycle beads, which we handed out to the women who we saw in our clinics. These beads help women with family planning as an alternative to birth control contraceptives because many Haitian women do not have the choice to take birth control or access to contraceptives.
It was clear that education was the most important aspect of health promotion and health prevention in Haiti, because it gave the Haitian people a sense of autonomy. For example, simple measures such as demonstrating to Haitians how to properly carry a bucket of water by evenly distributing their weight could help prevent future back problems. We realized, however, that in order to educate the Haitian people on preventative measures, we had to consider what resources were available to them. For instance, teaching a group of Haitian families how to reduce their risk of hypertension would be difficult since measuring cups and nutritional labels are not always available to them. However we could overcome the issue by demonstrating the healthy amount of salt used to prepare meals by using the tip of one’s pinky as an alternative measuring device. Such measures could help to reduce the risk of hypertension in Haitian families and significantly improve overall health. We believe that the use of primary prevention can help to prevent illness in Haiti and empower the people to make their own healthy choices.
Even though we treated more than eleven hundred patients, the realization that the majority of Haitians still lack access to basic health resources was overwhelming. Despite this sad reality, the people we met and the patients we treated assured us that our work was appreciated and worthwhile. Treating this population was an extremely moving experience. We were able to immediately see the difference that we were making, whether it be through treating a baby with scabies or rehydrating a child, the patients were enormously appreciative. This trip has forever changed how we view the care that we will provide as future nurses. We are more aware of the issues that affect Haitians, such as a pervasive lack of health education and the need for more culturally sensitive health care providers. This experience has further motivated us, because as minorities, we recognize our important role in communicating, advocating, and initiating preventative programs to help improve the care and quality of health of minorities. We hope to apply our nursing skills, education, and experiences to help decrease health disparities both within the U.S. and other countries.

Thank you for allowing us to share about our experience in Haiti. We strongly encourage others to consider doing nursing work abroad. In addition to helping those in need of care, such trips endow nurses with truly invaluable perspective into the issues that face the world of health care. With hope, the insights that nurses gain through these types of trips will benefit their patients for years to come.

Relationship-Based Care


From Advance for Nurses

When a patient enters a hospital, she enters an alien environment. 

Her personal things, even her clothes, are set aside. She is given to wear a billowy gown that is not merely unflattering but starkly revealing if one's free hand isn't vigilant about keeping it cinched.

Inside this linoleum landscape of wheelchairs and rolling beds, where strangers in scrubs politely jab and weigh and probe her, the only haven that offers her a modicum of quiet in which to gather her thoughts and to reclaim herself, to semi-relax, to take stock, or just to escape into the beams of an innocuous sitcom floating overhead - the only personal space in this impersonal world is that humble but all-important retreat, the patient room.

Respecting the sanctity of the patient room is the first lesson Pam White, RN, gives when teaching the basics of relationship-based care (RBC).nurse to patient therapeutic relationship

"When I talk to nurses, I tell them 'We all have busy lives taking care of many patients, but before you walk across the threshold of a patient's room, pause, take a deep breath, let other things go and prepare to focus on that patient's needs,'" said White, director of nursing administration at Mayo Clinic Health System in Eau Claire, WI. "I always reinforce the need for them to reintroduce themselves to each patient every time they enter the room."

RBC - a philosophy based on honoring and respecting your relationship with your patients, your co-workers and yourself - is fast emerging as the care delivery model of necessity.

Experts say respecting patients will become more and more important as healthcare adopts its new culture of accountability. Reimbursement will hinge, in part, on patient satisfaction.

A Way of Being

RBC as a concept appeared in 2000 and coalesced in 2004 with the publication of Relationship-Based Care: A Model for Transforming Practice by Creative Health Care Management Inc., Minneapolis.

"It's a model, a philosophy, a framework and a way of being," said Mary Koloroutis, RN, who co-authored and edited that text. "RBC creates a methodology for aligning values and operations within a healthcare system so clinicians can establish relationships with patients," Koloroutis explained. 

Finding time to develop relationships with patients isn't easy for nurses, though. 

"Time is a nurse's greatest challenge," Koloroutis acknowledged. 

"You are dealing with large volumes of patients with highly complex medical needs," she said. "We don't have a long time to spend with a patient. It could be just 5 minutes at the bedside to learn about the person and plan their care."

However short, interpersonal time with patients is crucial for a successful outcome. 

"The role of the primary nurse is to understand who this patient is, and what it will take to prepare her and her loved ones to take ownership for her own care after discharge," Koloroutis said.

Family members "will be the village surrounding the patient, so they need to be every bit as supported as the patient is," she added. 

"The likelihood that a plan of care will be followed increases with their learning and understanding."


Communicating with patients is becoming as vital as vital signs. Officials from the Center for Medicare & Medicaid Services care so much what patients think they instituted the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

HCAHPS asks patients to rate their hospital stays on a scale of one to five through a series of questions such as: How well did doctors and nurses communicate with you? How well was your pain managed? How clean was the hospital? How quiet?

"As of 2013, there will be reimbursement attached to HCAPS scores, so this is a strong push right now and part of why the patient experience is so potent and important," Koloroutis said.

ThedaCare, an integrated care delivery system in northeastern Wisconsin, increased its patient satisfaction scores by working with a firm called Simpler Consulting to adopt Toyota-inspired "lean" initiatives to streamline its processes and allow nurses to spend more time with patients.

For example, it implemented a variation of a Toyota production strategy called "kanban," so nurses have all the supplies they need at their fingertips.

"We have designed patient rooms so that 90 percent of all nursing supplies are stocked by a central stocking person, using the kanban system," said ThedaCare CEO Emeritus John Toussaint, MD"Nurses are at the bedside nearly all the time. Medications are delivered directly to rooms in portable supply cabinets called nurse servers. There are no central nursing stations. They've all been eliminated."

Thanks to such changes, 95 percent of ThedaCare patients in 2011 gave top approval ratings when asked to assess their stay.

Eye-to-Eye Care

More time spent at the bedside "brings you to the heart of nursing," declared White, who instructs her nurses to sit down when interacting with patients.

"We typically stand up and over a patient," she said. "But research shows if you sit down and speak with them eye-to-eye, patients feel you spend more time with them - even if the amount of time you spend is the same."

She continued: "As a nurse, my needs for the patient are important, but they may differ from the patient's needs. For example, patients need to walk so many times a day, take so many pills. But those are not necessarily the goals of patients. We determine those goals simply by asking them. They could say 'I would like my hair washed,' or 'I would like to call my granddaughter.' Those things are important to them."

For hospitals thinking about instituting RBC, Koloroutis had this advice:

"Recognize that transformation is not a quick fix. It is a cultural evolution. Some aspects of RBC are already alive and well in every organization. Use them and build on that success. Commit to a 3-5 year process."

Healthcare workers, she concluded, "can grow weary of hearing about new programs. They'll ask, 'Is this another flavor of the month?' I say no. This is a way to get back to the basics, back to the care and service of patients."

6 Tips on Stress and Anxiety Management in Nursing


From nursetogether

Everybody deals with fear and anxiety, however sometimes our anxieties can get the best of us.  Here are 6 tips on stress management and anxiety management in nursing to help you manage your daily challenges easily.

stressed nurse

1.    Find a diversion  Often times, nurses get stressed when there is a lot going on all at once, particularly in the workplace. When this happens, take a deep breath and try to find something to do for a few minutes to get your mind off of the problem. You could take a walk, listen to some music, read the newspaper or do an activity that will give you a fresh perspective on things – when time permits.

2.    Positive affirmations work  Another technique that is very helpful is to have a small notebook of positive statements that make us feel good. Whenever you come across an affirmation that makes you feel good, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel anxious, open up your small notebook and read those statements.

3.    Take it one day at a time  In dealing with your anxieties, learn to take it one day at a time. While the consequences of a particular fear may seem real, there are usually other factors that cannot be anticipated and can affect the results of any situation. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

4.    Find gratitude   Sometimes, we can get depressed over a stressful situation. When this happens, take a few minutes to write down all of the things that you are thankful for in your life. This list could include past accomplishments and all the things that you have taken for granted. The next time you feel depressed, review your list and think about the good things that you have in your life.

5.    Think positive  Challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make you fearful or anxious, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense.

6.    Divide and conquer  When facing a current or upcoming task that overwhelms you, divide the task into a series of smaller steps and then complete each of the smaller tasks one at a time. Completing these smaller tasks will make the stress more manageable and increases your chances of success.I know that anxieties and stresses can be difficult to manage, particularly for nurses; however, there are many helpful resources available. Managing stress and anxiety in nursing does take some practice but eventually you will improve in time.

Technology Induced Errors a new RN Concern



I love my computer. I drag it and my iPhone almost everywhere, including to the NANDA-I Conference I attended last week. I take notes while listening to speakers, I use my phone or my digital camera to record the slides the experts use in their presentations, I post conference updates on Twitter and Facebook, and I bring it all together for this blog. I live an e-life it seems.

This is important because it has a direct bearing on healthcare, nursing, and as it would seem, nursing language (what NANDA-I uses to define “the knowledge of nursing”). My vocabulary enlarged last week as I learned a new word, some new phrases, and some new perils to look out for when I am working at the hospital.nursing technology


We should all know that “iatrogenic” means “of or relating to illness caused by medical examination or treatment.” One of the terms we see a lot these days is “HAI” or “hospital acquired infection.” This, along with other illnesses and injuries, which happen as a result of other medical care, are no longer being paid for by the Center for Medicare and Medicaid Services (CMS) or by most insurance companies. And, there is new area of concern of which we must be aware: E-iatrogenic issues.

In the simplest way I can explain it, all the computers we’ve come to rely on in healthcare have their own perils and we are really starting to see evidence of that.

Elizabeth Borycki, RN, PhD, is an assistant professor of health information science the University of Victoria, in British Columbia, Canada. While attending NANDA-I she presented a paper on identifying and reducing “technology-induced errors” (one of those new phrases) or e-iatrogenic.

Technology-induced errors are errors that arise from the design and development of technology and the implementation and customization of that technology. In 1995 the U.S. Institute of Medicine endorsed the use of electronic health records (EHRs) as an intervention that could reduce errors. Healthcare organizations around the world ran with it and some follow-up studies reported the systems could replace the number of errors happening each year.

However, 10 years later, journal articles started publishing findings that described how EHRs and component software systems could, in themselves, lead to errors. Some of the types of errors Borycki highlighted included automatic defaults, incorrect medication dosages, and incorrect patient data. She cited some of the factors involved in these technology-induced mistakes:

  • Human factors including usability and workflow.
  • Organizational behavior such as socio-technical issues and system/organizational fit.
  • Software engineering including testing approaches.

While chatting with Borycki, after her presentation, we noted several ways these errors happen to all of us. For example, you put in some data but forget to hit return and “oops,” the patient’s last set of vital signs don’t actually get recorded. Or the drop down box you have to pick from auto-populates an answer if you don’t pick one, or something unusual happens and there is no free-text box to record the event—all of these are situations I’ve actually dealt with as hospital’s I’ve worked in become more automated. These are all potential patient safety issues.

And this brings us to why Borycki presented at NANDA-I. Borycki and her fellow researchers believe that we need to extend the NANDA-I taxonomy to include the emergence of these new patient safety issues. That is, technology-induced errors arising from the widespread implementation of health information systems. We need some new nursing diagnoses.

According to Borycki, examples of potential interventions include:

  • Reporting if computer system is not working or is malfunctioning.
  • Reporting if computer system causes hazards due to inefficiencies or negatively affects workflow.
  • Awareness of limitations of computer systems in nursing.
  • Questioning computer generated results that may not appear to match the right patient.
  • Recognizing problems in dangerous “work-arounds” due to technology.
  • Training on how to proceed in situations where a computer system goes down or is not available.

Nurses I have worked with come from many camps. Some like charting electronically, some miss paper charting (although there are error problems there too) and some want EMRs to work but don’t trust the systems. The reality is EMRs and electronic charting are here to stay. It is our job as nurses to get involved, to point out where entries could be more efficient or easier to use, to learn more about the systems we are given and use every day and to be proactive in finding the best possible means for using them. For that, we need a language because it all comes back to standardized communication techniques are the best ways to keep our patients safe—our primary concern as RNs. NANDA-I has a new challenge, defining the e-knowledge of nursing.

Coaching the big game: Mentors help nurses get into the swing of things



Alisa Glaister, RN, credits her opportunity to ascend from new grad to nurse manager to a few key colleagues, including a director from a different unit who advised her as she led a project to treat angioplasty patients on the telemetry floor. “He helped me get my foot in the door for this project, which I believe has led to my current management position,” said Glaister, a nurse manager at St. Mary’s Medical Center in San Francisco.

Glaister met with her mentor weekly to discuss techniques of effective leadership. “He was a tremendous help and guide,” she said. 

NurseMentor 300pxMentoring has gained considerable respect as an essential element for training new nurses, whether they’re fresh out of school or recently transferred from another unit. “The first year [out of school] you have those vulnerable moments all the time, and you forget what you have accomplished,” said Hazel Curtis, RN, BSN, MPH, an education specialist for staff development at Loma Linda (Calif.) University Medical Center. “A great mentor picks you up, dusts you off, gives you a pat on the back and says, ‘You can do it.’” 

Going one on one

Formal mentoring programs hatched in professional associations and hospitals are popping up around the country as researchers and managers find the practice boosts a nurse’s job satisfaction and confidence. 

Cecelia Gatson Grindel, RN, PhD, CMSRN, FAAN, studied the outcomes of Nurses Nurturing Nurses (N3), a mentoring program designed by the Academy of Medical-Surgical Nurses. The year-long program was rolled out to 40 medical institutions across the country in 2002. Grindel, a professor and interim dean at Georgia State University in Atlanta, said data she could gather indicated more than 90% of mentored nurses stayed on the job, compared to attrition rates as high as 30%. Feedback collected throughout the pilot year of the program suggested mentored nurses had more job satisfaction and confidence. 

Yvonne Brookes, RN, director of clinical learning at Baptist Health South Florida in Miami, found similar results after implementing a residency program that included a mentorship component. Previously, turnover among the system’s 4,000 nurses averaged 22%, often because new graduates left the profession or pursued an advanced degree after their first year. Since implementing the program in 2007, the new graduate turnover rate dropped to 6%, she said.

“We realized it wasn’t about the science, it was all that other stuff that goes to the head of a new grad,” she said. 

“Other stuff” can range from implementing unit procedure to dealing with difficult managers or unhelpful preceptors. It can be conflict with patients or their families dealing with the shock of witnessing a death for the first time. “Sometimes you just need to vent,” Brookes said.

A mentor also can help a nurse recover from making a medical error — a potentially traumatic experience — by offering emotional support and emphasizing that one mistake doesn’t make a bad nurse. 

Choosing teams

Matching the mentor who responds to help with complaints, concerns, self-doubts and errors with the nurse who needs to share them is somewhat hit and miss in formal mentorship programs. Both parties have to accept the relationship takes time — not an easy pill to swallow in today’s intense work environment.

N3 guidelines advised managers to look for someone with three- to five-years of experience in the same field who worked outside the nurse’s unit. In a new mentoring program at St. Mary’s, nurse managers help match personalities and proximity, among other factors, Glaister said. “We really take into consideration who we’re matching with whom,” she said.

At Baptist Health, the process was more intuitive, Brookes said. Mentors and mentees gathered in one room to talk one on one and then rotated until every mentee had met every mentor. “It’s sort of a speed-dating situation to find a mentor that will work for you,” she said. 

Programs across institutions vary, but the time commitment can range from trading a text message or two per month to having biweekly meetings for one year. Since many new nurses are assigned to the night shift, a good deal of these conversations happen in the evening. But meetings also can be irregular or precipitated by emergent situations, said Abigail Mitchell, RN, DHEd, MSN, a professor at D’Youville College, Buffalo, N.Y., and a nursing supervisor at Kaleida Health, Buffalo, N.Y. “If they’re in crisis, you have to handle it,” said Mitchell, who runs a private mentoring firm. “You can’t just say, ‘It’s not our date to meet.’”

Generation gaps can present challenges in mentor-mentee relationships. For instance, younger nurses are often more comfortable communicating through texting and email. Nurses from the baby-boomer generation are sometimes reluctant to mentor the next generation. “The work ethic is different,” Mitchell said. Boomers will pick up extra time or stay over their shift to help coworkers, while some younger-generation nurses rather go home and pick up extra hours when it works for them, around holidays, for example, she said.

Sometimes the mentor-mentee relationship just doesn’t work out, but that doesn’t necessarily mean mentoring didn’t work. Anecdotal evidence from the N3 program indicated nurses who’d been assigned a mentor were likely to seek out another if the first relationship wasn’t helpful. Managers also have noticed that mentored nurses go on to mentor their junior colleagues. “The process has fed on itself,” Brookes said. “The more professional their approach, the more they want to contribute to the next group coming in.”

The program’s success has inspired Brookes to extend the model to other levels of the profession. A med/surg nurse with 15 years experience still needs guidance when transferring to a different unit, like critical care, she said. She is mentoring four managers to help them ease into their new roles. “They’re degreed up to the caboozle, but that doesn’t mean they know whom to reach out to,” Brookes said.

At this level, mentoring is more about handling people and situations than about patients and skills. Healthcare management involves evaluating staffing ratios, managing human and fiscal resources and strategic planning. Sometimes advice is just practical: a nurse manager would do well to keep a pressed blazer in the office closet, for example. 

Recently, Curtis convened a small mentor circle for managers. The new managers come together about once a week to ask questions and hear presentations on broad topics of interest, such as the hospital culture. The program has boosted their confidence, she said. 

Educating educators

Academia, too, reaps benefits from mentoring. Shellie Bumgarner, RN, MSN, CEN, EMT, a clinical educator at Lenoir-Rhyne University School of Nursing in Hickory, N.C., sought help to implement an education day for nurses at a small rural hospital. 

She found a mentor at the 2010 national convention of the Emergency Nurses Association, which had started EMINENCE (Establishing Mentors InterNationally for Emergency Nurses Creating Excellence) in 2008. The pair worked together for one year, talking about once a month and trading emails frequently. 

Her mentor helped her with the substance of her topic, which focused on pediatric care in smaller, rural facilities. She also contributed creative ideas to help Bumgarner find a way to cover the shifts of nurses who attended her training. “She advised how to tweak my ideas to better fit the smaller hospital,” she said. 

Retention of nursing faculty is as urgent as the need for unit staff, as professors leave academia for higher paying jobs. The National League for Nursing, which focuses on nursing education, released “The Mentoring of Nursing Faculty Tool Kit” to promote recruitment and retention of nurse faculty (available online at 

Beyond orientation, mentoring faculty includes the development of teaching and research skills. 

Mitchell has started her own mentoring program targeting faculty. Managing workload and outlining governance procedures are primary topics, she said.

The idea may be slow to grow, but more nurses at all levels are realizing the importance of mentoring, said Brookes. Is it a widespread practice? “No,” she said. “But it should be.”

Palos Heights, Ill., man seeks Rx for lack of diversity in health care


From SouthtownStar via Chicago Sun-Times

Ray Mendez’s first year of medical school at Loyola University has ended, but there’s no slacking off on his “to-do” list.

Next up is “effect social change.”Student Nurses

Mendez, 26, of Palos Heights, recently was selected for an Albert Schweitzer Fellowship, a program in which fellows design community health initiatives. Mendez was one of just 31 Chicago-area candidates selected.

“This may be one of the most important things I’ve ever done,” Mendez said. “As important as medical school.”

The fellowship, a yearlong program, is designed to develop leaders in community health and give students in health-related fields a unique social and economic perspective on issues they may face as professionals. Recipients can be from a variety of fields, but they have a common goal to improve some aspect of health care in the Chicago area.

“Every fellow creates his own program, and we have to put in 200 hours of work toward it over the next year,” Mendez said.

The projects are varied, ranging from putting together a music therapy program for refugee and immigrant children to one that will provide preventative health care for the homeless.

Mendez’s goal is to increase the presence of minorities in the health care profession.

“There’s an acute (lack of) representation of minorities in the health care field. Less than 9 percent of all physicians are black or Latino, and less than 7 percent for nurses, while they make up 28 percent of the U.S. population,” Mendez said.

He said this is significant because there’s a direct link between low minority representation and a lack of health care support for those minorities.

“One of the most important aspects of the program is making sure students stay in touch afterward so that when they succeed and get out of their communities, they can come back and uplift those same communities,” Mendez said.

He hopes to achieve his goal by expanding on an existing Loyola program that works closely with some Chicago-area high schools. He plans to use motivational speeches, activities and an immersion program with the Loyola School of Medicine to introduce students to the field and to encourage them to pursue careers in health care.

A visit to Cristo Rey Jesuit High School in Chicago as part of a social justice class he took convinced him that putting the idea into action is necessary.

“When I went to Cristo Rey and saw how enthusiastic the students and teachers are about going to school, I thought, ‘Wow, this is what needs to be done,’ ” Mendez said.

As a Latino student, he has realized the difficulty a minority can face pursuing a career in health care.

“I definitely didn’t have a lack of educational opportunities in Palos, but when I was applying to medical schools, it was still really hard. I didn’t have a mentor to look up to and to guide me through the process,” he said.

He said he didn’t understand why more minorities were not applying to medical school, and he feels like it is his responsibility to help change that. So after some reflection and research, he applied for the Schweitzer Fellowship.

“I feel I have the power and time to do it,” Mendez said.

He said he’s prepared for the challenge of balancing medical school and his fellowship work. He said he’s dropped a few extracurricular activities.

“It’s gonna be tough definitely, but I’ve created a pretty good support network of friends who are really interested in this project,” he said. “So I think I can handle it.”

Morehouse School of Medicine Establishes Endowed Chair in Sexuality and Religion


From PRNewswire

Academic Program is First of Its Kind

ATLANTA, May 30, 2012 /PRNewswire/ -- Morehouse School of Medicine today announced the creation of an endowed academic chair devoted to issues related to sexuality and religion.  The Marta S. Weeks and David E. Richards Endowed Chair in Sexuality and Religion will develop innovative health and pastoral services as well as teaching, research and public leadership related to issues that bridge the topics of sexuality, religion and medicine.

nurse training e1325184548891"Through this unique chair, Morehouse School of Medicine will provide national and international leadership addressing the challenges of sexuality and sexual health in the worlds of medicine and religion," said David Satcher, M.D. Ph.D., 16th Surgeon General of the United States and founder of Morehouse School of Medicine's Satcher Health Leadership Instituteand its Center of Excellence for Sexual Health.

The Marta S. Weeks and David E. Richards Endowed Chair in Sexuality and Religion is a major accomplishment of more than a decade of work by Satcher, who in 2001 released the Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. That document outlined a framework of initiatives to strengthen the national dialogue on sexual health. It recognized that sexuality and religion are deeply connected in the United States and that public health would benefit from coordinated efforts of leaders in public health and religion as well as other major constituencies with deeply held beliefs relating to sexuality.

"While the chair will address sexual health issues in all communities, it will place a particular emphasis on underserved populations which is integral to Morehouse School of Medicine's mission," added Satcher. "The continuing disparities in access to quality health care services for minorities, poor people, and other disadvantaged groups results in a weakened public health infrastructure, which ultimately affects everyone."

The endowed chair will focus its efforts on:

  • Teaching sexuality and sexual health topics to current theological and medical students;
  • Training the next generation of religious and healthcare leaders to meet the sexual health challenges of  both disciplines;
  • Bringing together leaders of constituency organizations that have diverse viewpoints for consultations and consensus-building;
  • Research directed toward documenting and suggesting ways to overcome disparities in sexual health with a special focus on underserved communities.

For more information on Morehouse School of Medicine and the institution's latest endowed chair in sexuality and religion, please visit

Health: Language barriers hamper both patients and providers


From The Associated Press via

A visit to the emergency department or a physician's office can be confusing and even frightening when you're trying to digest complicated medical information, perhaps while you're feeling pain or discomfort. For the 25 million people in the United States with limited English proficiency, the potential for medical mishaps is multiplied.

A trained medical interpreter can make all the difference. Too often, however, interpreter services at hospitals and other medical settings are inadequate. Family members, including children, often step in, or the task falls to medical staff who speak the required language with varying degrees of fluency.

According to a study published in March, such ad hoc interpreters make nearly twice as many potentially clinically significant interpreting errors as do trained interpreters.nurse with patient2

The study, published online in the Annals of Emergency Medicine, examined 57 interactions at two large pediatric emergency departments in Massachusetts. These encounters involved patients who spoke Spanish at home and had limited proficiency in English.

Researchers analyzed audiotapes of the visits, looking for five types of errors, including word omissions, additions and substitutions as well as editorial comments and instances of false fluency (making up a term, such as calling an ear an "ear-o" instead of an "oreja").

They recorded 1,884 errors, of which 18 percent had potential clinical consequences.

For professionally trained interpreters with at least 100 hours of training, the proportion of errors with potential clinical significance was 2 percent. For professional interpreters with less training, the figure was 12 percent. Ad hoc interpreter errors were potentially clinically significant in nearly twice as many instances — 22 percent. The figure was actually slightly lower — 20 percent — for people with no interpreter at all.

It makes sense that trained interpreters, especially those with more experience, would make fewer errors, says Glenn Flores, a professor and director of the division of general pediatrics at UT Southwestern Medical Center and Children's Medical Center of Dallas, who was the study's lead author. Experienced interpreters "know the medical terminology, ethics, and have experience in key situations where you need a knowledge base to draw on," he says.

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color or national origin. Courts have interpreted that to mean that all health-care providers that accept federal funds — because they serve Medicare and Medicaid recipients, for example — must take steps to ensure that their services are accessible to people who don't speak English well, according to the National Health Law Program, a nonprofit that advocates for low-income and underserved people. (Doctors whose only federal payments are through Medicare Part B are exempt from this requirement, however.) The Census Bureau estimates that nearly 9 percent of the population age 5 or older has limited English proficiency, which the bureau defines as people who describe themselves as speaking English less than "very well."

Hospitals and other medical providers are in a tough spot, say experts. The law prohibits them from asking patients to pay for translation services, and they may not receive adequate or in some cases any other reimbursement. "It's a civil rights law, not a funding law," says Mara Youdelman, managing attorney in the Washington office of the National Health Law Program.

A dozen states and the District of Columbia reimburse hospitals, doctors and other providers for giving language services to enrollees in Medicaid, the joint federal-state program for low income people, and in CHIP, a federal-state health program for children, according to Youdelman. Virginia and Maryland do not.

A 2008 survey by America's Health Insurance Plans, an industry trade group, found that 98 percent of health insurers provide access to interpreter services, but providers and policy experts question that figure. According to a survey by the Health Research and Educational Trust, in partnership with the American Hospital Association, 3 percent of hospitals received direct reimbursement for interpreter services, most of that from the Medicaid program.

"Most hospitals that make this a priority make it a budget item," Youdelman says.

Hospitals and other providers realize that offering competent interpreter services can help ensure that they don't miss or misdiagnose a condition that results in serious injury or death, experts say. Trained interpreters can also help providers save money by avoiding unnecessary tests and procedures.

Youdelman cites the example of a Russian-speaking patient in Upstate New York who arrived at an emergency department saying a word that sounded like "angina." The emergency staff ran thousands of dollars' worth of tests, thinking he might be having a heart attack. The real reason for his visit: a bad sore throat.

Like many hospitals, Children's Medical Center of Dallas provides interpreter services around the clock via varying modes of communication — face-to-face, telephone and video — delivered by a mix of trained staff interpreters and outside contractors.

When Nadia Compean, 23, was six months pregnant, her doctor in Odessa, Texas, told her that her baby had spina bifida, a condition in which the spinal cord doesn't close properly, leading to permanent nerve and other damage.

The local hospital wasn't equipped to handle the birth and subsequent surgery that her daughter would require, so Nadia and the child's father traveled to Dallas, about 350 miles away.

Neither speaks much English, but at Children's Medical Center of Dallas, interpreters helped them understand what to expect, Nadia said (through an interpreter).

Nadia says she learned that her daughter, Eva, would be born with a lump on her back and would require immediate surgery. She also learned about problems that Eva may experience walking and using the toilet, she says.

Eva was born March 6. Because of her medical needs and the lack of adequate interpreter services in Odessa, the couple is considering relocating to Dallas, where the father hopes he can find construction work.

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

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