DiversityNursing Blog

By Nurse.com News

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: Nurse.com

By LAWRENCE K. ALTMAN, M.D.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: Well: NY Times 

By: Aditi Pai

Nurse scheduling platform OnShift raised $7 million in a round led by HLM Venture Partners with additional funding from Draper Triangle Ventures of Pittsburgh, Early Stage Partners of Cleveland, Fifth Third Capital, Glengary LLC of Beachwood, and West Capital Advisors of Cincinnati. This brings OnShift’s total funding to $15 million.

OnShift will use the funds to add between 20 and 25 employees to its 60-person staff, including new engineering and marketing employees.

OnShift is a nurse scheduling and shift management system for long term and senior living care. The cloud-based program can be accessed via web or an app and offers automated scheduling, overtime prevention, and open shift management. The company aims to expand within the assisted living market for now.

“We’re solely focused in that market,” VP of Finance Mike Rich told MobiHealthNews. “There are very specific regulatory needs they have in terms of scheduling that we are able to cater to within our software and within our app.”

Rich explained the technology helps this specific sector of the healthcare market because they have an “extremely thin margin for business” so overstaffing is a big problem for them.

“First and foremost what people talk about is our ability to mitigate overtime, so when a nurse calls out sick, the easiest thing to do is ask a nurse to do a double shift and that instantly puts [him or her] in an overtime position,” Rich said. “What our software does is it lets schedulers see who is able and eligible to take a shift that will not put them in overtime now or in the current day period, and then we can blast a message either through an email or text message to say there’s a position open. Then people get that message and they can instantly say ‘I want that position’. [The message] comes back to the scheduler and literally within 10 minutes they have that schedule filled with a non overtime position.”

According to Rich, 85 percent of staffing in these types of care facilities is done on paper and Excel so if the facility is staffed with 25 people one week, it will most likely be staffed the same even if three patients were discharged. OnShift also takes that into account when staffing assisted living centers.

So far, OnShift is in 1,100 different longterm care facilities and in every US state. The company also doubled in size over the last year.

Source: MobiHealthNews

“Nurses serve in a variety of professional leadership positions, from administrators and unit managers to chief nursing officers and hospital board members. Today, the challenges of leading in an increasingly complex health care environment are great; therefore, nurses need to take every opportunity to develop and hone their leadership qualities and skills. The question for every nurse—no matter the stage of her or his education or career—is: Are you the best leader you can be?” writes Sue Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action, and Julie Truelove, student at the University of Virginia School of Nursing, in an article in the January 2014 issue of the American Journal of Nursing.

The article, “Are You the Best Leader You Can Be?,” discusses the Institute of Medicine’s recommendations on nursing leadership in the 2010 report, The Future of Nursing: Leading Change, Advancing Health. The recommendations call on the health care system to “prepare and enable nurses to lead change to advance health,” by developing leadership programs and providing increased opportunities to lead. The article features a table of nurse leadership programs for nursing students and professional nurses as well as a nursing leadership resource list.

Table: Leadership at Every Level -  Click here to view the full table. 

“Nurses with strong leadership and management skills are better prepared to serve individuals and their families and the community, and to collaborate with colleagues,” the authors write. Regardless of where you are in your career, “a leadership program is a step toward becoming the best leader you can be.”  Read the full article here.

Source: CampaignforAction.org 

The American Association of Colleges of Nursing released preliminary survey data showing that enrollment in entry-level baccalaureate nursing programs increased by 2.6% from 2012 to 2013, which marks the lowest enrollment increase in professional RN programs over the past five years. 

Findings are based on data reported from 720 of the 858 schools of nursing in the U.S. with baccalaureate or graduate programs. Although RN enrollment increased for the 13th consecutive year, nursing schools have identified a shortage of faculty and clinical education sites as potential barriers to realizing future growth and meeting the nation’s need for healthcare providers.

“Given the calls for a more highly educated nursing workforce from the Institute of Medicine, the Tri-Council for Nursing, nurse employers and other stakeholders, we are pleased to see at least modest growth in the pipeline of new baccalaureate-prepared nurses,” AACN President Jane Kirschling, RN, PhD, FAAN, said in a news release.

Preliminary AACN data also show a strong enrollment surge in baccalaureate nursing programs designed for practicing nurses looking to expand their education in response to employer demands and patient expectations. 

The number of students enrolled in baccalaureate degree completion programs, also known as RN-to-BSN programs, increased by 12.4% last year (among 512 schools reporting). This year marks the 11th year of enrollment increases in these programs and offers further validation of the desire among nurses to advance their education to remain competitive in today’s workforce, according to the AACN.

Looking ahead, AACN plans to work collaboratively with stakeholders to ensure that enrollment in both baccalaureate and master’s level degree completion programs for RNs expands even further to meet the recommendations outlined in the 2010 “Future of Nursing” report prepared by the Institute of Medicine, including a goal of 80% of nurses having BSNs by 2020.

Enrollment changes since 1994: www.aacn.nche.edu/Media-Relations/EnrollChanges.pdf

Fact sheet: www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce

Source: Nurse.com 

By Eileen Beal for HealthCallings.com

Acing an interview: It’s all about how you respond to questions

A strong resume, sent to the right hospitals, practices, or clinics–healthcare employers that you’ve researched online and scored tips from other nurses who work or have worked there–is step one in getting the job you want.

Nurse recruiters, hiring managers, and HR staff, who review your resume, are looking for far more than just making a skill set match.  Step two is convincing them that you aren’t just qualified for the position you’ve applied for–you are the position’s best candidate!   And, while your resume gets you the face-to-face job interview, it’s the rapport you establish the moment you sit down in front of the interviewer that will land you that job offer.  They want to know:

• How you communicate your capabilities, experience, achievements, and skills and your expectations about the position for which you are interviewing; and
• How you respond (and react) to the questions and situations pitched at you during the interview.

Employers are concerned with three basic questions

According to Mary M. Somers, author of The Complete Guide to Successful Interviewing for Nursing Students, most interview questions come from an employer’s concern with three basic questions:

• What can you do for us?
• Why do you want to work with us?
• What are you like once we’ve gotten to know you?

Knowing how to respond to the questions you’ll be fielding during an interview–some predictable, some challenging, and some with no “right” answer–doesn’t just position you as a confident and prepared interviewee, it puts you ahead of the competition, too.

Practice answering job interview questions

Ask friends and colleagues about their job interview experiences to get an idea of what questions to expect.  Practice answering the questions by consciously thinking about how you will answer them and about personal situations and experiences that will enhance your responses.  Below is a list of other useful job interview sources for nurses.

• 65 Interview Questions For Nurses
• Interview Questions & Answers For Nurses
• Pre-Interview Prep
• Prepare For A Behavioral Interview…Then Ace It!
• Sample Interview Questions For Nurses
• Sample Nursing Interview Questions & Tips

What to avoid during the job interview

According to career expert Somers, exhibiting the following traits, characteristics, and actions during an interview will decrease your chances of getting a job offer.

• Overbearing presence
• Inability to express yourself clearly
• Lack of planning for career
• Lack of interest and enthusiasm
• Lack of confidence and poise
• Failure to participate in activities
• Overemphasis on money
• Poor scholastic record
• Evasiveness
• Lack of tact
• Lack of maturity
• Lack of courtesy
• Condemnation of past employers
• Lack of vitality
• Failure to maintain eye contact
• Indecision
• Little sense of humor
• Lack of knowledge in field of specialization
• No interest in company or in industry
• Narrow interests
• Inability to accept criticism
• Radical ideas
• Lack of familiarity with company 

Written by Sarah Okeson

Joe Long first thought of becoming a nurse when his wife was hospitalized for a week during her pregnancy with their second child. He now works at Mercy Hospital Springfield, taking care of patients in the intensive care unit.

“Nursing is manly,” Long said. “It’s not just for women.”

About 6.6 percent of nurses nationwide are male, according to the American Association of Colleges of Nursing. In Springfield, about 7.3 percent of nurses at CoxHealth are male. At Mercy, about 11.4 percent of the nurses are male.

The American Assembly of Men in Nursing was formed in 1971 in Michigan to provide support for male nurses. An Ozarks chapter is being started. There are also chapters in St. Louis and Kansas City. The organization also is open to women.

“It’s a very female-oriented world and we’re OK with that, but men still need to socialize,” said Paul Pope, the chapter president and a nursing instructor at Southwest Baptist University.

The executive director of nursing at Mercy Hospital Springfield is a male nurse, Kurtis Abbey.

Nurses like him have faced some of the obstacles that women entering predominantly male fields have faced. There have been lawsuits and complaints about isolation.

Rick Leroux, a nursing instructor at Southwest Baptist, got into nursing with the encouragement of his aunt. He learned how to make chitchat with children and to be absolutely honest about whether a medical procedure would hurt.

He treasures moments such as an encounter with the adult daughter of a man he had cared for who had a heart attack. She hugged Leroux and thanked him.

“Those are the moments we live for,” Leroux said.

Female employees at Mercy said they appreciate male nurses when it comes to lifting patients. They also value other qualities such as help in dealing with sometimes-disruptive families.

“We have a lot of difficult patients,” said Becky Pierce, who has worked at Mercy for about 40 years. “For each difficult patient, you have family members who sometimes need the physical presence of a man.”

Dr. Tobey Cronnell said male nurses tend to be more supportive of female doctors.

“I particularly enjoy working with male nurses as a female physician,” Cronnell said.

Long recently tended to John Goar, 73, who was admitted to Mercy Hospital Springfield after having trouble breathing.

Long gave him insulin and some other medication and then told Goar that his relatives were on their way to visit.

“He’s as good as a woman,” Goar said.

Long left Goar’s room. He was about halfway through his 12-hour shift. He doesn’t miss his previous career as a loan officer for a mortgage company.

“It’s the first time I have a job where I actually look forward to going to work,” he said.

Source: News-Leader.com