DiversityNursing Blog

Infections borne by mosquitoes are nothing new, however a new virus has recently gained intense global attention because of its potential link to birth defects.  In the vast majority of cases, the Zika Virus is spread by the bite of infected female mosquitoes of the Aedes genus.  The virus was first isolated in 1947, in the Zika forest located in Uganda.  Before 2015, Zika virus outbreaks had been confirmed only in Africa, Asia, and the Pacific Islands.  In May of 2015, Brazil reported an outbreak of the virus, and since then, the virus has rapidly spread across Central and South America.  The virus has currently been identified in at least 33 countries, and the World Health Organization predicts that 3 to 4 million people will be infected by the virus over the next year. 

Symptoms

Four, out of five people, who contract the illness experience no overt symptoms, and never realize that they are carrying the virus.  Those individuals who do become ill, generally have mild symptoms which may include headaches, conjunctivitis, joint and muscle pain, fever, and a skin rash.  Symptoms appear, approximately 3 to 12 days, after being bitten by an infected mosquito, and normally subside within a week’s time.  Few infected individuals need to go to the hospital, and death is extremely rare.

What makes the Zika virus so frightening, however, is that after the huge Zika virus outbreak in Brazil in 2015, Brazilian mothers are giving birth to babies with microcephaly.  Babies born with microcephaly may have smaller heads than normal because the brain is improperly developed or has stopped growing.  The neurological disorder can cause significant developmental delays, impaired cognitive development, and in some cases, death.  Brazil has confirmed 460 cases of microcephaly in newborns since November, and doctors have reported 4,000 suspected cases.  The clusters of increased microcephaly cases appear to significantly overlap with parts of the country where the Zika virus is flourishing.  The Center for Disease Control and Prevention (CDC) is also investigating a possible link between the Zika virus and increased occurrences of Guillain-Barre syndrome, a rare paralysis disorder. 

How to Avoid Getting It

As no vaccine currently exists to eliminate the disease, the best way to avoid getting the Zika virus is to avoid getting bitten.  Generally, mosquitoes responsible for spreading the virus, bite their victims during the daytime.  The CDC recommends taking the following steps when traveling to countries where the Zika virus has been identified:

• Protect your exposure by wearing long pants and shirts with long sleeves.
• Stay inside as much as possible, in areas that have air conditioning or screens that keep mosquitoes outside.
• Use mosquito bed nets when sleeping outside.
• Use insect repellents.  Environmental Protection Agency (EPA) registered repellents are effective, and can safely be used by pregnant or breast-feeding women.
• Spray clothing and trappings with permethrin, a synthetic insecticide, or buy permethrin-treated gear.
• The CDC’s Travelers Health website posts Zika virus health notices for all countries impacted.

The Zika virus is spread almost exclusively by mosquitoes, but recent research confirms that it can also be transmitted through sexual contact and blood transfusions.  Men who have traveled to active Zika virus areas should wear protection consistently, or abstain from sexual activity, if they have a pregnant partner.  It is not yet clear on how long the risk of transmission should be avoided. 

The available evidence indicates that, for the majority of people, the Zika Virus is a rather benign illness.  The greatest risk involves women who are pregnant, or thinking of becoming pregnant.  These women should take every available caution to avoid contracting this virus.

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Nursing is one of the most stressful occupations in America. Nurses have higher rates of illness and psychiatric problems than other professionals. There are things Nurses and other health professionals can do to minimize the stresses of Nursing. The best way to do this is to look at individual stressors and find ways to minimize or cope with them. 

Long Hours and Shift Work 

Long hours are stressful both physically and mentally. According to USA Today, the long hours Nurses work have become such a problem that the American Nurses Association has made recommendations about how many hours Nurses should work. The recommendations include not allowing Nurses to work more than 12 hours a day. Shift work also causes a lot of stress for Nurses, and the AMA has also made the recommendation to minimize night shifts for Nurses working both day and night shifts. 

Insufficient Resources 

Having insufficient resources makes a nurses' job more stressful, and it makes it harder for them to do their job properly. Insufficient resources take on different forms in different settings. Many times it is a shortage of Nursing personnel, which of course means the Nurses that are working have a higher workload. Other times, it is a lack of the material resources that Nurses need to do their job, whether it is due to budget cuts or oversight. Even small items like tape cause a big inconvenience when a Nurse has to search for it before she can draw blood or place an IV.  

Resources can be improved by improving pay for Nurses and making sure there is enough room in the hospital budget for other necessities. Proper inventory keeping is also important. If a Nurse notices a shortage in a particular area, it is important to mention it. Hopefully items are ordered immediately and put in the appropriate paces.

Poor Reward System 

Nurses are essential to the proper functioning of hospitals, and they work very hard. Yet many facilities don't have any kind of reward system in place, nor do they take the time to tell Nurses they are valued and appreciated. Many times Nurses are taken for granted.  

Studies have proven that rewarding employees for good behavior is essential to them being satisfied with their jobs and to retaining employees. Hospitals should have a rewards system in place. Nurses should also recognize each other for their hard work. 

Bullying and Abuse 

No one should have to endure bullying and abuse in the workplace. The ANA found that 17% of Nurses report being the victim of physical abuse at work, and 57% of Nurses reported being verbally abused or threatened. Physical abuse was usually perpetrated by patients or family members. Verbal abuse and bullying was usually at the hands of coworkers. 

Hospitals should hold educational seminars about what constitutes verbal abuse and bullying. Human Resources employees should be available to mediate and help employees solve conflicts. To protect against violence from patients and their family members, it is a good idea to have some type of security presence in the hospital. 

Lack of Communication  

Lack of communication also causes stress for Nurses. Communication between Nurses and doctors is essential to a hospital running smoothly. Daily or weekly meetings are one way to ensure proper communication. A suggestion box can give employees an anonymous way to communicate suggestions. 

Compassion Fatigue and Burnout 

Compassion fatigue happens when a Nurse stops caring about their job and patients. Sustained stress over a long period of time can lead to compassion fatigue. Burnout occurs when a Nurse becomes depressed, withdraws from others, and feels fatigued. 

To prevent compassion fatigue and burnout, try to take time off to relax. Don’t over extend yourself. Hospitals that have a reward system in place and make Nurses feel appreciated helps combat burnout. Everyone wants to feel appreciated in both our personal and professional lives.

Related articles: Dealing With Depressed Patients

6 Tips on Stress and Anxiety Management in Nursing

Nurses’ Survey Results Show ‘Dangerous’ Stress Levels

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In an environment where moments can mean life or death, it is undeniable that communication greatly matters. If the same message can be conveyed without losing meaning in a shorter or more efficient way, then it's a duty of the messenger, especially in a professional medical setting to optimize their communication skills. Speaking is literally only half of the equation, with great listening skills and information retention skills being able to effectively make repeated statements unnecessary. There are some ways to think critically about a healthcare organization to determine where it stands as a team regarding their communication abilities. Taking this closer look at the state of communication at a given facility is the crucial first step towards improving the communication therein. Increased efficiency in communication will result in saved time and increased focus that can be dedicated to the needs of patients, where it ultimately should.

Determining the state of the team's communication skills:

• Turn culture clash into culture strength: If there was no top-down strategy around cultural diversity as a marker of strength, then little petty fights about minor topics could escalate into all-out cultural clashes among a workforce. By the promotion an ideal of strength through unity, the team as a whole has the chance to get in front of any potential culture clash issue rather than chasing the problem, always trying to put out fires.
• Hold group meetings to discuss the overall state of communication at the facility: Management can play a massive role in putting the correct, positive spin on the topic of diversity in the workplace. The larger part of any staff will often be found to be on the same page about the acceptance, curiosity and positive interest in new cultures being integrated into the workplace at all times. By it being an official part of a corporate brand message and identity, the company embraces the diversity perspective even further.

Starting to help create a positive communication culture:

• Create regular workshops to go over basic principles in communications: Different individuals from diverse backgrounds will have unique perspective to share on the same topics, even if they technically speak the same language. Then, of course, there are the actual boundaries that exist between nations and languages that are completely distinct. If the staff of a healthcare facility can say "Hello" in ten distinct languages, that group brings themselves one step closer to the perfect awareness and diversity in their facility. 
• Hold regular cultural show and tell days within the staff: Each staff member, once they share their true selves, are going to have their own special cultural tale to share. If there is an encouraging environment in this way, it becomes natural and easy to leverage this diversity to enrich the staff with increased knowledge and awareness. Patients come from all over the world and there's never any way to predict who will become a patient next. With these principles in mind, a staff trained in cultural sensitivity and awareness will be better prepared to interact with new international cultures.
• Leverage modern and inexpensive tools: Any healthcare facility staff member is going to be all too familiar with the app store on their smartphone, but sadly quite few have downloaded any translation or language-learning app onto their phone. When these powerful and groundbreaking tools are now available and often for no outright cost, it's usually just a matter of pointing this out and creating a culture of support towards adopting these excellent tools to enable a team to begin using them.

Once the realization hits that communication is mostly a function of awareness, effort, empathy and genuine bonding experiences with groups, it becomes much easier to cultivate this environment of abundant and fruitful communication. If the entire healthcare facility can start to treat the state of communication at their facility as a togetherness exercise and a mission dedicated to a better experience for the patients, then the real results can start to be noticed.

Individual differences can make a group stronger and more powerful or they can also tear groups apart. The key to ensuring a positive outcome is to apply conscious effort around fostering excellent communication in any arena or avenue possible.

Related links:

4 nurse communication startups to improve patient outcomes

Three Tips for Better Nurse–Physician Communication In The Digital Age

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By Dr. Melissa DeCapua, DNP, PMHNP via www.bartonassociates.com

This article about “what’s in a name” caught our attention. We’re sharing it with you to find out if you’ve run in to this situation where you work. If you’re an NP or a PA, we know you’ve worked very hard to accomplish your degree requirements. Where you work, is your position sometimes referred to as “mid-level”? If so, read on and then tell us of your experience. Have you pointed out to Human Resources that this is a confusing term?

I had just graduated from nurse practitioner (NP) school and was on the job hunt. Skimming through a few job descriptions the word “mid-level provider” caught my attention. Having never heard that word, I assumed the job wasn’t meant for an NP. The next time it happened, a recruiter called my cell phone telling me there was an open position for a “physician extender” in rural Colorado. A what? It’s interesting how you can be an extension of someone who isn’t even present.

Then, a naive new-graduate, I didn’t quite grasp the scope of the problem. Although I did know one thing, neither of those titles captured who I was or what I did. As I’ve progressed through my career, I’ve heard myself called a “mid-level provider,” “physician extender”, and “non-physician” over and over again. Now-a-days my jaw tightens, and I gauge whether this is an appropriate situation to explain why these terms are offensive.

The time is now. This post will explore the words “mid-level provider,” “physician extender,” and “non-physician”, describing their historical uses and detailing three key reasons why this vocabulary should be eliminated.

Historical Use

These terms were originally created by physicians, and they are perpetuated by physician-led organizations and physician-centric corporations (Hoyt, 2012). The U.S. Department of Justice’s Drug Enforcement Administration uses “ mid-level practitioner” to describe professionals other than physicians, dentists, veterinarians, or podiatrists who dispense controlled substances. The Centers for Medicare and Medicaid have also referred to NPs and PAs as “physician extenders” but has more recently used the term “ non-physician practitioners.”

Why these terms should be eliminated

• Devalues Expertise

Describing NPs or PAs as “mid-level” doesn’t just imply, it asserts that they are providing something less than “high-level” care. However, ample evidence demonstrates that the services offered by these professionals is just as safe and effective as those provided by their physician colleagues.

Both NPs and PAs earn advanced degrees and undergo exhaustive course work, high-tech patient case simulations, and extensive clinical practice hours. Moreover, both clinicians pass national board certification exams and may specialize in any variety of medical specialities. The terms “mid-level provider,” “physician extender,” and “non-physician” undermine the expertise and contributions of NPs and PAs.

• Confuses Patients

Imagine you are a patient and being told, “The mid-level will see you now.” Naturally, you might wonder, “Who?” Using vague, collective vocabulary to describe NPs and PAs can confuse patients. When receiving healthcare services all patients expect and deserve the highest level care no matter who they are seeing. NPs and PAs are held to the same standard of care as physicians, offering the similar services of assessing, diagnosing, and treating medical conditions. By using more accurate terminology (i. e. NP and PA), patients can be assured they are receiving the best care at all times.

• Impedes Teamwork

In their seminal publication, Crossing the Quality Chasm, the Institute of Medicine called for interdisciplinary collaboration to solve the significant problems facing modern healthcare. Using a term like “mid-level” perpetuates a hierarchical healthcare system which impedes this need for teamwork. Most NPs and PAs dislike the terms “mid-level,” “physician-extender,” and non-physician. When they hear themselves described this way, it decreases morale and divides the team.

Take a Stand

To stop the use of these terms, everyone must take a stand. First, recruiters should remove this language from job descriptions, contracts, and business discussions. Employers and administrators specifically need to demonstrate their respect for NPs and PAs expertise by removing this language from the company website. Other healthcare professionals should stand up for their colleagues if someone uses this degrading language. Finally, both NPs and PAs should never allow someone to call them something that undermines their unique contribution to healthcare.

NPs and PAs Weigh In

I recently started a discussion thread about this topic on the American Association of Nurse Practitioners LinkedIn page. The overwhelming majority agreed that these terms should not be used to describe NPs or PAs. Some of the comments that stood out the most to me:

• I will not apply for jobs using mid level provider, or extenders. It’s insulting to my profession and education. – Nurse Practitioner in Florida
 
• It would be nice if nurse practitioners received the respect and recognition they’ve earned through good patient care. -Nurse Practitioner in New Hampshire
 
• I have been truly blessed to work with MDs that actually appreciate, value, and acknowledge what we do and who we are. -Nurse Practitioner in India
 
• How do you extend a physician? It is suggesting that somehow we are not capable of working independent and we must be attached to a physician. I am a Nurse Practitioner of the highest level, and I am an extension of no one. -Nurse Practitioner in Florida 
 
• I am fairly certain they are not referring to us as mid-level providers to degrade us, but rather they’re unaware of how offensive it can be. -Nurse Practitioner in California 
 
• The term “mid-level ” is often used in a denigratory manner, lessening our worth and contribution to health care. This term should be retired and the contribution to healthcare overall made by all professionals should be recognized and validated. Nurse Practitioner in Texas

Barton Associates also conducted a poll on its Facebook page, asking NPs and PAs which term were most offensive. Approximately 1,380 NPs and PAs weighed in on the discussion. Here are the results:

• Mid-level (487 votes)
 
• Noctor (356 votes)
 
• Physician Extender (335 votes)

The poll also asked which term was the preferred term (other than NP or PA). Here are those results:

• Provider (919 votes)
 
• Healthcare Professional (122 votes)
 
• Clinician (115 votes)

Let’s be straight; if there is ever a group of people who are called a name that makes them feel disrespected or devalued, the solution is always to stop. If you’re in doubt as to what you should call an NPor a PA just use “NP” and “PA.” Now let’s get back to patient care.

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Depression is a common situation dealt with on a daily basis. Most patients that Nurses find themselves coming in contact with have some form of illness or injury. This makes depression among patients common. Knowing how to spot it and how to react to depressed patients can help you handle the situation properly and deal with it with minimal stress.

What is Depression

Depression is a common disorder that affects many people every day. It affects all age groups, males and females, although females are more likely to suffer from it than males. Stress contributes to depression, making this illness more common in the last few years. The amount of stress an individual handles on a daily basis is on the rise and can contribute to depression.

What Contributes to Depression

There are a number of factors that contribute to depression. Stress is a huge factor. Debt, work and family can weigh heavily on the amount of stress someone experiences today. Age also plays a major role in depression and sickness in the elderly can increase the chances of them suffering from depression. This is a main factor as to why Nurses experience depressed elderly patients the most. Some elderly patients are forced to relocate to a new residence, while others become ill and are unable to live the life they are accustomed to. Some can feel abandoned by their loved ones and find themselves feeling alone. Leaving people without a strong social support network increases the chances of developing depression.

Signs of Depression

There are many warning signs of depression, although some may not be so easy to spot. A feeling of hopelessness or helplessness can lead to depression. Nurses often see this in elderly patients who don't have a lot of family support. A loss of interest in daily activities is another sign of depression. These signs can become apparent when patients are no longer able to get around on their own. Loss of mobility can make a patient no longer want to engage in activities for fear of embarrassment.

Changes in sleep patterns or appetite are another sign of depression. Nurses have to watch this sign as well, because certain medications can interfere with sleep and appetites of patients. Frequent physical complaints or ailments, anger or rage toward others and feelings of anxiety are other signs of depression. Many of these symptoms Nurses experience in their patients frequently. The key is determining when they start happening and ruling out any other possible causes. When there are no other possible causes, depression could be the reason.

How Can Nurses Help or Prevent Depression

Nurses play a vital role in their patient's lives, no matter the age of the patient. There are certain things that Nurses can do to help prevent depression altogether. Encouraging outdoor activities, even when your patient doesn't feel like doing them, is an excellent way to combat depression. A healthy diet and a regular eating schedule helps to recognize any changes in eating patterns. New hobbies help patients realize fun activities they can engage in to be entertained, even though they may not be able to do everything they could once do.

How Nurses Play an Important Role in Depressed Patients

Nurses are the people that patients see the most throughout the day, so it only makes sense that they play an important role dealing with depressed patients. Many things Nurses do can help a depressed patient not feel so worthless, and sometimes even lift their spirits. Talking to patients about their feelings is a good first step in dealing with their depression. Being sympathetic helps them know that you understand their feelings rather than judge them for how they feel.

Be careful about any advice you offer and always refer them to their doctor for specific medical advice. Accept their feelings toward the rest of the world. Trying to reason with them may make it seem like you are just another person who is against them or doesn't care about them. Reassure them of depression treatments and how effective they are. Let them know that treatment has high success rates, and they can work with their doctor to find the best treatment options.

It is common for Nurses to deal with depressed patients on a regular basis. Despite this, it is still important to remember to treat them as if they are all individual cases, and never group them together. A little reassurance could make all the difference in a depressed patient's outlook. The caring compassionate attitude that Nurses are known for could be exactly what a depressed patient needs.

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Social media can and is a wonderful and easy way to connect with people on a personal or professional basis. Most platforms are free and easy to use. It's not difficult to find people and topics of interest. People can find and connect with their peers, family, and friends. They have unlimited access to the entire world.

Before anyone begins (or continues) their adventures into the world of social media, there are a few points to be aware of as a healthcare professional. With freedom comes advantages and disadvantages.

Advantages:

• Connecting with anyone in the world. Simply Googling a word, topic, business, or an individual will give anyone complete access to anything they want to know. Whether they are blogging, using Twitter, Facebook, LinkedIn, or any other social media platform, there are people there to talk to.
• Networking has never been easier. Sharing information and learning is at anyone's fingertips. Whether they are talking to someone local or across the world, social media brings you together. Distance is no longer a problem.
• Since 80% of all internet users are looking for health information, anyone can and will reach a large audience with their outreach and posts. People want information and Nurses have plenty to give them. They are able to correspond at their convenience and have the time to do so.
• Education for Nurses and others is available. There are numerous groups and programs that offer classes and give them opportunities to learn and interact with their peers and other students.

Communication flows easily and in abundance on the internet and that's also where the disadvantages come into play.

Disadvantages:

• Privacy doesn't truly exist on the internet. Regardless of any and all security features, once something has been posted, it's there forever. Even deleting it doesn't get rid of it. It is still stored somewhere in the clouds and is never truly gone. It's crucial that a person think twice before posting. Screen shots cause the comment or post to remain forever on someone's computer.
• The risk of inaccurate information becoming a "fact" is common. It takes a bit of work and due diligence to research the accuracy of what you’re reading, but it's worth the time. A person should only share or repeat what they themselves have thoroughly researched and confirmed as accurate.
• Not HIPAA compliant. Very few software programs meet the strict guidelines for HIPAA regulations, including but not limited to Skype and Google Hangouts, texting and email. Unless the individual is discussing a patient as a Nurse and on a secure platform, one should never post anything about their patients.

Violating HIPAA regulations has resulted in healthcare professionals facing disciplinary actions such as:

•  Fines levied
•  Suspension from work
•  Being expelled from Nursing school
•  License revoked/fired
•  Criminal charges being brought
•  Incarceration

Abuses on social media as a Nurse are far reaching. Whether a Nurse violates HIPAA or behaves in an improper and unprofessional manner (arguing online, breaching patient confidentiality, harassment, etc.) can and does impact not only them, but their employer and their professional affiliations as well. This can also involve the state board and violate state laws.

Posting the pictures of patients, even when their identity is concealed, has resulted in the above actions being taken against a Nurse and other healthcare professionals.

The best rule of thumb with social media is this: Remember that what you are about to post will be accessible to 7 billion people, so post as if everyone will read it. Social media can be fun as long as you understand the good and the bad.

Related Articles:
As a nurse, how do you use Social Media?

The new year is here and the opportunities for a fresh start it brings shouldn't be cast aside. Nurturing the opportunity as if it were a patient can yield surprising benefits both in and out of the job title. There is always room for improvement in a position that demands the hardest work for the sweetest reward, the gratitude of well-cared for patients.

Mind and Body

It is never too late to get personal health on the right track. Though the push for a healthier lifestyle should come from within, the simple fact is much like fitness instructors or your fellow doctors, patients ultimately expect those in health care roles to be healthy themselves. So whether it involves starting (and sticking to) that new gym membership or curbing poor eating habits, do your best to stand firm.

As a Nurse, the mind is just as important to nurture as the human body. With the continuous implementation of newer technology into the healthcare field, it can never hurt to be one step ahead by taking classes, particularly given the fact they look great on a resume. Focus on adding in new certifications such as those for operative nursing or ACLS, or expanding current skills. Regardless of qualms, continuing your education or taking the plunge on the journey to a BSN, MSN, NP or PhD is a worthy cause for the new year.

Tools of the Trade

Clearly technology is only as effective as the individual operating it, but that doesn't mean Nursing staff don't benefit from productive upgrades in the work space. Many programs and devices can increase efficiency enough to make good Nursing care, great Nursing care. Even if the requests for technology and program upgrades were rebuffed, all is not lost. Focus on using what is available even if it is only yourself. Vow to be more patient focused and less task and goal focused, which is the line that separates the average from the amazing in the eyes of the patient. Spend the new year becoming a better you, as this will ultimately equal a happier and better Nurse.

Related Story:  Nurses' perseverance to be rewarded New Year's Day

Cultural Diversity

The emergence of cultural diversity in today's society has impacted the inner-framework of the healthcare sector. By the year 2043, studies predict that the current ethnic and racial minority group populations will become the new majority. Diversity, Inclusion and Cultural Competence are topics that carry weight and emphasis in many aspects of the healthcare system. Efforts made to exercise inclusion and integrate cultural knowledge into professional environments have become integral in providing quality service to clientele. The practice of cultural awareness and competence in healthcare organizations leads to an encompassing sense of community and corporate respect of all cultures.

Benefiting Organizations

When there is a marked emphasis on cultural competence, diversity, and inclusion in an organization, a myriad of internal and external benefits result. Below is a list of benefits that organizations have experienced after putting pointed emphasis on supporting diversity. 

• An increase in recruitment of culturally diverse employees
• Better group process (an increase in creativity/communication)
• Reduction in costs
• Wide-spanning marketing

Employing Cultural Advocates

Caucasians fill the majority of Nursing roles in the healthcare system, with minority groups making up only about 19 percent of the Nursing field. As the number of culturally diverse patients increase in the United States, the need for a diverse culture of healthcare workers grows with it. Organizations that rally their employees and their core values around cultural awareness garner support from other organizations and appeal to diverse potential employees. They are showing the community, through practical application, how support of diversity plays an important role in the quality of care that is given and received by employees and clients.

If policies of inclusion are implemented effectively in healthcare, employees become a creative force in improving communication and conflict-resolution. Because the emphasis in inclusion is cohesion, the medical staff is taught the value of going beyond the confines of their own understanding. They gather information from other staff or diverse sources to supplement what they know with other perspectives and values. Nursing staff that exhibit characteristics of inclusion exude flexibility and model cultural competency. They become powerful advocates for respect of diversity in patient-care.

Cultural Competence

Healthcare leaders that emulate cultural competency focus on one key ingredient, respect. If leaders in healthcare teach by example and pass initiatives to support cultural integration, everyone benefits. By providing ample opportunities for cultural understanding to permeate healthcare, healthcare officials communicate respect for diverse groups of people.

We’ve developed a questionnaire to assist you in evaluating how your healthcare system is doing with regard to Diversity, Inclusion and Cultural Competence. Please take a few minutes to assess your strengths and weaknesses.

Many times, Nurses will choose to pursue a career in healthcare so that they will have the chance to spend their days helping others.  There is an added bonus though.  Many of the Nursing Specialties have a career trajectory of solid growth with a Nursing salary that is well above the income level of the median population.

Which one of the Nursing Specialties will give you the most job security though?  Which one has the highest salary?  The specialties listed below have been in demand the most and have the highest nursing salaries.

CRNA (Certified Registered Nurse Anesthetist)

Nursing Salary: $110,000 with 1,975 job postings annually.  This Nursing Specialty is the main provider for anesthesia in hospitals that have rural locations.  These Nurses assist in administering over 34 million anesthetics to various patients every year in the USA.

Pain Management Nurse

The average salary for this type of Nurse is right at $93,000 annually.  Each year there are around 871 job openings for Pain Management Nurses.  These Specialty Nurses work in tandem with other Nurses and doctors in order to treat patients who suffer from both chronic and acute pain.  They also have the responsibility of educating their patients so they can handle pain management in the future.

Geriatrics Nurse/Gerontology Nurse

The mean Nursing salary for a Geriatrics Nurse is $91,000 and annually there are close to 400 job openings across the US per year.  These Nurses can be the primary provider of health care for elderly patients in a variety of settings.  Their duties include exams and diagnosis to actually prescribing medications.  As the Baby Boomers age, this is an area where there is expected to be growth.

Family Nurse Practitioner

The mean salary for this Specialty Nurse is $88,000 annually and there are more than 7,000 job postings per year for this specialty.  These Nurses are like your family doctor.  They work with the same patients throughout their entire lives.  Many times, they will be the only health care professional for patients.  They conduct exams and can prescribe medications.

Psychiatric Nurse Practitioner

The salary for this type of Nurse is $86,000 annually and each year more than 4,500 job openings for this niche are posted.  This type of Nurse will treat, counsel and even medicate their patients who suffer from mental health issues.  They can work in quite a few different settings from private practices to correctional facilities and mental health clinics.

General Nurse Practitioner

The mean salary for a general Nurse Practitioner is $81,000 and there are more than 85,500 job postings for this specialty each year.  These Nurses are a critical element in regard to the health care industry and they are expected to fill the gap of primary care physicians in the years to come.  They are able to prescribe medicines and many times, they are the only health care professional that some people have.

Clinical Nurse Specialist

The Nursing salary for this specialty is $80,000 and each year there are nearly 7,000 job postings.  This type of Nurse focuses on a single area of expertise and they act as a sort of consultant to all of the rest of the Nurses on staff.  Their specialties can be anything from oncology to pediatrics and they also serve as coaches for both the staff and the patients.

Armed with this information, which one appeals to you?  If you are already on this list, would you switch to another specialty?  Which one and why?

Top 10 highest paying nursing specialties (national average)

More accurate due dates are something both mother and medical professionals want. But is it something possible to achieve? Ultrasound scans are helpful but they can only give an estimate date. 

Predicting when a woman is likely to give birth is an inexact science. It is also a question with important medical and personal implications. A meta-analysis published this week in BJOG: An International Journal of Obstetrics and Gynaecologysheds some welcome light on the subject.

Predicting exactly when a woman is likely to go into labor has always been challenging; only 5% of women go into labor on their exact due date. 

For about 90% of women who are overdue (a pregnancy lasting over 42 weeks), contractions begin on their own within 2 weeks of the due date. But the exact date within those 2 weeks is frustratingly difficult to predict.

Of course, most women do not know the exact date the baby was conceived, and as such, any due date given can only be an estimate. 

Currently, the best methods for predicting the date of a child's birth are either by using the last menstrual period as a starting point, or by measuring the fetus size with an ultrasound scan. Neither of these methods are without some measure of inaccuracy.

An analysis carried out by Dr. Vincenzo Berghella, at Thomas Jefferson University Hospital and the Sidney Kimmel Medical College at Thomas Jefferson University, hopes to paint a slightly more accurate picture.

There are a number of reasons why people desire a more accurate prediction for their due date. As Berghella explains:

"Women always ask for a better sense of their delivery date in order to help them prepare for work leave, or to make contingency plans for sibling-care during labor. These are plans which help reduce a woman's anxiety about the onset of labor."

On top of these more logistical issues, there are very real health concerns, too:

"Women with a higher risk of stillbirth may be better off receiving a labor induction if the cervix is still long at her due date, since the chances of timely spontaneous birth are low, for example."

Cervix measurement of more or less than 30 mm is key

Currently, cervical length is measured in women who are considered at risk of a premature birth. The shorter the cervix, the more imminent the birth will be. This method of transvaginal ultrasound is considered a gold standard for predicting early births. 

During pregnancy, the cervix hardens in order to keep the fetus from dropping into the birth canal. As the due date draws near, the cervix softens. This softening causes the cone shape of the cervix to shorten and flatten, which can be used as a signal that the birth is imminent.

This precision has led a number of researchers to investigate a link between cervical length and birth at term - the hope being that if it can predict an early birth, it might have the same use for longer pregnancies.

These studies matching cervical length after 40 weeks of pregnancy, to date, have been inconclusive and sparked lively debate in the field.

Berghella has reopened this line of investigation and scooped together data from five different studies; the data included 735 women with single-child pregnancies who had babies in the standard head-down position.

This increase in data has given the research team a new and improved overview of the field of study and garnered some interesting results:

The researchers found that when the cervix measured more than 30 mm at a woman's due date, she had less than a 50% chance of delivering within 7 days. However, when the cervix measures 10 mm or less, women had more than an 85% chance of delivering within 7 days.

The results of the study give a glimmer of hope to mothers who are facing an uncertain stretch of time before they give birth. Further study in the area and its consequent analysis will help solidify these findings.

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