DiversityNursing Blog

By Don Walker of the Journal Sentinel

Rita Higgins was caring for Natalie Engeriser, her 11-year-old patient, when Natalie's mother, Katie, walked into a hospital room on the seventh floor of Children's Hospital of Wisconsin.

There's some kind of disturbance in the hallway, Natalie's mother told Higgins Thursday.

"When she said 'disturbance,' I was thinking one of the kiddos was having a hard time," Higgins said Saturday.

"I stepped into the hallway and I immediately realized something was wrong," Higgins said. "There were two nurses at the nursing station and by the looks on their faces, I knew something was wrong. I heard one of the nurses say, 'Oh my God, they are shooting. Call an active-shooter code.'"

A man police later identified as Ashanti Hendricks was armed and police were trying to arrest him. But Higgins, 37, a registered nurse who started working at Children's last February, didn't really know what was unfolding.

But Higgins, a mother of two just starting her third career, knew what to do, as did the rest of the medical staff.

"I immediately turned back around and I said to Natalie, 'Honey, I'm going to need you to get out of bed and me and your mom are going to help you get into the bathroom.' I was going to need them to go into the bathroom and lock the door behind them," she said.

Higgins wanted to be sure she didn't scare Natalie. The girl is one of Higgins' favorite patients. In fact, when Higgins arrived for work on Thursday, she had been assigned a different floor. Higgins was disappointed because she liked working with Natalie and had made strides in her care.

"A co-worker saw how disappointed I was," Higgins said. "A fellow nurse traded with me, basically. She said, 'Hey, Rita, I know you want to take care of Natalie.'"

Later, as the hospital went into lockdown, she was unsure what was unfolding on the unit. That's when she helped get Natalie out of harm's way.

"We got her and the medical equipment in the bathroom with mom," Higgins said. "I told her to lock the door. I looked them straight in the face and said, 'Don't open the door until I tell you to open the door.' I looked at Natalie and said, 'It's going to be OK.' And I closed the door."

At Children's, doors to the hospital rooms don't lock. But next to the closed door was a small window. As Higgins stood guard, protecting a mother and her little girl, she managed to peer out, trying to make sense of the noise, the chaos.

"Looking back on it, in the period of time when we truly did not know what was going on, we didn't know if someone was just literally shooting, and we didn't know police were involved," Higgins said. "There was that unknown period of time when you think, 'Is this door going to open with a guy with a gun?'"

"For all three of us, that was pretty horrible. All I know is that someone was on the unit with a gun. Shots had been fired," Higgins said.

At some point Higgins saw another nurse in the hallway who was watching a TV monitor where she could see police handcuffing the man elsewhere on the floor.

"That's when I stepped out of the room, looking at the monitor," Higgins said. "Seconds later, I heard more scuffling and the man was suddenly running onto my side down the hall and past me. I went back in the room and closed the door."

Police finally subdued him.

"I knew it was loud and so much stuff was going on," she said. "God knows what (Natalie and her mom) were thinking.

"I told them I was going to stay in here. I told them a bad guy was captured. I told them they were going to hear a lot of stuff."

Natalie and her mother came out of the bathroom. Higgins told Natalie and her mother to turn on the television and turn the volume up loud. Drown out the noise outside.

Two days after the ordeal, Higgins was full of praise for Natalie, her mother and the other nurses on the floor who performed calmly, admirably and courageously.

"I was thinking I was glad I stayed on the floor that day and that I was able to be there for Natalie," Higgins said. "You build up trust and she trusted me."

Later that night, when Higgins was about done for the day, a music therapist came with a guitar to visit Natalie.

The therapist played the Katy Perry hit, "Firework."

"That's the way I ended my shift, rocking out with Natalie with 'Firework,'" Higgins said.

Source: Milwaukee Wisconsin Journal Sentinel

RNs can compare their health, safety and wellness to the overall U.S. population and other nurses within demographic categories, including nursing specialty, by taking the American Nurses Association’s new HealthyNurse Health Risk Appraisal, developed in collaboration with Pfizer, Inc. 

This HIPAA-compliant online survey also allows nurses to assess workplace risks such as patient-lifting injuries and workplace violence, the ANA stated in a news release.

The appraisal is a component of ANA’s HealthyNurse program, which encourages nurses to focus on self-care so they can be at their healthiest — physically, mentally, emotionally and spiritually — to provide the highest quality of care and serve as role models, advocates and educators for their patients. 

“When we model the healthiest behaviors ourselves, it becomes easier to help our patients to do the best thing for their health,” ANA President Karen A. Daley, RN, PhD, FAAN, said in the news release. “This appraisal will help nurses to optimize their health and serve as an online check-up on the health risks they face in their personal and work lives.”

The data-gathering tool is combined with an interactive Web Wellness Portal, a website for respondents to obtain information and educational resources based on their interests, workplace conditions and results in areas such as fitness, nutrition, stress management, health screenings, sleep and tobacco and alcohol use. 

The appraisal, which takes 20 to 30 minutes to complete, will become a continually accumulating database that will enhance the nursing profession’s ability to track trends and set policy and advocacy priorities and strategies, according to the news release. The ANA recognizes a lack of data on nurses’ health and work environment, and demographic comparisons to national health benchmarks. The most applicable data, the Nurses’ Health Study from the Harvard School of Public Health, is more limited in topics and focuses on women’s health issues.

The ANA defines a healthy nurse as one who “actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional well-being,” and who “lives life to the fullest capacity, across the wellness/illness continuum, as they become stronger role models, advocates and educators, personally, for their families, their communities and work environments, and ultimately for their patients.”

The ANA’s concept of a healthy nurse includes five aspects that enable nurses to function at their highest potential: calling to care, priority to self-care, opportunity to serve as a role model, responsibility to educate and authority to advocate. 

All RNs and RN nursing students are encouraged to take the appraisal for free and access the Web Wellness Portal at: www.ANAhra.org. 

Source: Nurse.com

By Madison Lozano

Sgt. Angela Hughes was always interested in nursing, but wasn’t up to the role right out of high school.

Instead, she entered the Army as a supply soldier. Though she loved her job, after 15 years, Hughes developed carpal tunnel syndrome and was moved to Fort Hood’s Warrior Transition Brigade to prepare to leave military service.

Hughes is one of several soldiers taking part in a new brigade program to earn nurse’s aide certifications before they transition out of the Army.

The Gateway program runs in coordination with Skillpoint Alliance, an Austin-based nonprofit that provides training and education to job seekers. This is the first time Skillpoint has worked in the Fort Hood area.

On Monday, four brigade soldiers trained at the Hill Country Nursing and Rehab facility in Copperas Cove. The center is where they spent 40 hands-on clinical hours, in addition to the 60 classroom hours needed to earn the certification. The group will graduate from the program on Friday.

“It’s a great opportunity for soldiers who are transitioning ... at no cost to them,” said Anthony Thomas, the brigade transition coordinator. He was contacted by Skillpoint and served as a liaison between the brigade and the nonprofit.

“We try to accommodate soldiers’ career goals through job fairs and workshops,” he said, but this program is the first of its kind for the brigade.

Bethany Paul, Skillpoint’s Gateway program coordinator, worked directly with the students during the four-week training period.

“My job is to get them graduated and employed,” she said. Her organization has an 80 percent employment rate within the first 30 days after students graduate from the program.

Paul’s role required her to select the students and track them throughout the program to ensure successful completion.

“We love being able to serve this population,” she said. “I’m excited to be able to give back.”

Skillpoint also offers mock interviews, resume support and networking opportunities, Paul said.

The brigade soldiers have been pleased with the outcome of the program.

“At the beginning, I was disappointed,” Hughes said of leaving the Army. But now that she’s had time to accept the idea, she is excited to move on and work in nursing.

The patients have been her biggest joy of working at the rehab center.

“The residents are great to be with,” she said. “It’s always something new every day.”

Hughes will exit the Army in May 2014 and is looking forward to spending more time with her three children. “Things slow down a bit when you get out,” she said. She’s glad her post-military life will still require interaction with people on a daily basis.

Resident Eva Xindaris loved working with the brigade soldiers.

“They’re very thorough,” she said. “They’re not rushing.” Though Xindaris is sad to see them go, she knows there will be more in the future.

For Staff Sgt. Jennifer Adams-Ward, working in the facility has been a pleasure.

“It’s a joy to see me put a smile on someone’s face,” she said. She loves to help people, and the residents at the Hill Country Rehab Center have treated her well. “I enjoy learning the story of them and what they’re done in their lives,” she said.

Adams-Ward’s path differs from her fellow classmates. She will not be transitioning out of the Army. She is a medic, currently serving as the medical noncommissioned officer of the brigade’s 1st Battalion. Earning her nurse’s aide certification is one step towards becoming a registered nurse and an Army officer.

At this time, the brigade and Skillpoint are offering an electrician apprenticeship program too. Thomas hopes to add more options in the coming year. The Gateway program is also open to spouses and dependents.

“It’s been very successful,” Thomas said. “I appreciate the fact that they’re giving soldiers this (chance).”

Source: Fort Hood Herald

By VI-AN NGUYEN

Nursing is often ranked among America’s most stressful careers, thanks to the job’s notorious long hours, physical exhaustion, and emotional toll. So when a nursing student in South Burlington, Vermont, found a veteran nurse’s touching, anonymous note of encouragement—along with a $10 Starbucks gift card—tucked inside a licensing exam study guide at Barnes and Noble, she felt moved to share it online.

“I’m assuming that if you’re thumbing through an NCLEX book that you’re probably nearing the end of nursing school,” the note, which was posted to social news site Reddit and has gone viral, begins. “I want to start by saying that you should be so proud of yourself! You’ve worked so hard to get here, and I promise you, it’s so worth it. I’ve been a nurse for 12 years and can’t imagine doing anything else.”

The handwritten letter included some thoughtful advice about how to deal with the stresses of a nursing career. “I want to let you know that the first year or two out of school is the hardest. But don’t give up and remember why you decided to become a nurse in the first place,” the note reads. “Be patient, and don’t beat yourself up. Don’t take things personally and when you’ve had a difficult situation, try to leave work at work.”

The note continues: “Two more very important things to remember are 1, be proud to be a nurse, and 2, believe in yourself. Also trust your instincts—they’re usually right!”

The letter ended with a pre-exam pep talk—along with the Starbucks gift card. “So grab some coffee and study for the NCLEX. I’m certain you’ll do fine,” the note says. “You’re going to be a great nurse! Remember, be proud and believe in yourself! You can do it!”

The note is signed: “XOXOXO, another nurse.”

Amazingly, although the moving gesture was anonymous, the letter-writer and the student who found it connected online. “My wife put that letter in the book. South Burlington VT, right?” Reddit user TreeBore posted.

“YES!!! South Burlington VT!!! That’s awesome,” the original poster replied. “It was an amazing find, tell your wife thank you and that it really has inspired a lot of people, including my girlfriend. She takes her test tomorrow!”

“We both wish your girlfriend all the luck in the world!” TreeBore responded. “She will do fantastic.”

Several other nurses chimed online to say how spot-on the letter was. “As a registered nurse, who is working a night shift as I type this, this letter is exactly correct,” one commenter said. “Prioritization and believing in yourself are key when becoming a new nurse. Don’t let intimidation affect you. You will be amazed how much you will grow from your first day on the job compared to a year later.”

Another commenter agreed: “I would never have gotten where I am now if it weren’t for adherence to the things she listed in the note.”

By Patrick Healy and Jonathan Lloyd

Nearly 500 registered nurses from across the country have volunteered to go to the Philippines to help victims on the ground after the devastation of Typhoon Haiyan.

Many of the volunteers are originally from the Philippines, where at least 1,700 are dead and more than 2,500 injured.

"I think our expertise is much-needed over there," said nurse Sussette Nacorda "I think it's my way of giving back to my country, to my town."

The Southern California nurse responded to a call for help from the Registered Nurse Response Network. The agency organizes nurses for disaster responses.

Nurses sign up on the network's website, providing information about when they are available. The RNRN also organized volunteer responses for hurricanes Katrina and Sandy, the 2010 Haiti earthquake and other disasters in the past 10 years.

"It's just in our nature," said Nacorda. "We're very compassionate. We like to take care of people.

"We're familiar with doing this on a different level."

Some nurse volunteers, including Nacorda, are still waiting to hear from family members living in the Philippines. She has pictures of the damage that left her sister's home uninhabitable and gets updates on Facebook about her mother and siblings.

Nacorda grew up and attended nursing school in the Philippines. She has worked in Los Angeles for the last three decades.

RNRN is attempting to get an advance team together to make assessments and arrange for the nurses' deployment.

By Erin Tolbert, RN, MSN for MidlevelU.com

While there are plenty of apps out there promising to make my life as a nurse practitioner easier, once downloaded to my phone they go largely unused.  Rarely do I calculate pediatric dosages with special programs, rather I go straight for pen and paper.  I don't check apps streaming medical news- the last thing I want to do after work is be inundated with more information from the world of medicine.  But, this week I stumbled across a true winner in the healthcare app world.  PingMD, an app that facilitates patient-provider texting offers real value to NPs.

When I heard about the new PingMD app, I was thrilled that someone had finally come up with a way to bring patient-provider communication into the 21st century.  The medical world is notoriously behind technologically and I was excited by the prospect of weaving my favorite form of communication, texting, in with my work.  So, I decided to contact the app's creator, neurosurgeon Dr. Gopal Chopra, to get the story behind PingMD.  Here's what he had to say about bringing texting to the patient-provider relationship.

What inspired you to develop a way for providers and patients to text?

Dr. Chopra explains that his wife is a pediatrician who initially sparked his idea for the texting app.  She described what she saw as "spillover".  Office visits with patients are getting shorter and shorter.  When patients don't retain the information they get from visiting their healthcare provider, or are unable to reach them during a time of need, they end up in the emergency department.  If she had known about the patient's problem, Dr. Chopra feels that she could have prevented the patient from going to the emergency room, and probably answered their question or given them direction for their medical problem in just a few seconds.  But, without an easy way to communicate, she is unable to avert unnecessary emergency department visits. 

Dr. Chopra also describes the experience in his own clinic. The nurse practitioner in Dr. Chopra's neurosurgery office takes about 80 percent of patient calls. He describes that it only takes this NP about 30 seconds to decide the best course of action for the patient. The problem with patient-provider communication isn't that providers don't know the best course of action for their patients, it’s the communication system that's broken.  PingMD, Dr. Chopra's new app solves this problem.

We all know HIPAA is a major barrier to streamlining patient-provider communication. Does PingMD comply with HIPAA?

When I ask this question, Dr. Chopra brings up an excellent point.  In order for communication to be secure, it must do so from both the patient and provider's end.  This is why texting between patients and providers can be difficult.  Even if the provider's phone is secure, the patient's phone may not have necessary privacy and security measures in place.  The PingMD app addresses this issue.

PingMD complies with HIPAA regulations through password protection, requiring authentication and encrypting stored information on the end of the patient and provider. 

How much does PingMD cost patients?  Providers?

PingMD creates obvious value for medical practices, so I decide to get to the bottom-line asking Dr. Copra about pricing.  I'm shocked by his reply.  The PingMD app is free!  Both healthcare providers and patients are welcome to create PingMD accounts free of charge and begin texting.

PingMD does charge for one service.  The app has the ability to integrate with electronic medical records recording the text conversation in the patient's personal medical record.  This saves you as a provider from going back to record the conversation later, well worth the expense. 

Most providers don't like taking calls from patients after-hours.  Isn't allowing your patients to text you even more intrusive to your private life?

I think I have thrown Dr. Chopra a zinger here. During my time working as a primary care nurse practitioner, I dreaded hearing my work phone ring. It meant a great deal of work to follow. First, I would talk with the patient, then possibly call a medication in to the pharmacy, followed by opening my laptop to record the interaction...on a Saturday evening.  I imagine that by making communication easier, communicating with patients will require even more of my weekend time. Quickly, I see that I am mistaken.

Dr. Chopra explains that texting patients makes being on-call a more palatable prospect. Rather than interrupting your day to answer the phone, PingMD allows you to answer a patient's questions with a simple text message. If your practice pays for PingMD, this message is then integrated into the patient's health record eliminating the need to record the interaction. Texts from patients using PingMD are confined within the app keeping your personal and work-related texts separate.  Overall, texting is a more efficient, less invasive way to communicate with your patients than phone. 

How have providers seen PingMD improve their practice?

Dr. Chopra says providers of all backgrounds, from primary care to anesthesiology clinics, love to ping.  Not only does it make communication with patients easier on the provider-side, it also increases patient satisfaction.  Sounds like a win-win situation. 

The idea behind PingMD is simple, but seamless patient-provider texting just might revolutionize your practice. 

There are 5.5 million nurses and nurse’s aides in America. That’s 2.6% of the population and yet nursing is still one of the fastest growing occupations. In fact, the country is currently facing a nursing shortage unlike any other before. 

Nursing is essential for a smooth running health care system. Nurses are far from one-trick employees – they perform countless vital tasks in hospitals, nursing homes, schools, and more. The number of nurses on hand (or a lower nurse-to-patient ratio) has been directly related to patient survival and recovery without additional complications.

Some of the most in-demand specializations for nurses include:

• Forensic Nursing: Nurses who care for patients that were victims of crime. These nurses assist with collecting evidence from their patient’s injuries in order to build a case against the attacker.
• Infection Control: Nurses who care for patients infected with diseases such as HIV, STDs, or tuberculosis must be specially trained to ensure the contagious disease is not passed along unintentionally to either the nurse themselves or other patients.
• Management: These days, nurses who can educate or manage other nurses are in high demand. These career-oriented positions typically pay better, sometimes even into the six figures, but do require additional education. Management, education, and advocacy are three essential roles in recruiting more high quality professional nurses to the field.

Nursing isn’t an easy job. Over half of nurses report that stress and frustration plague them daily in their job. However, most nurses also agree that their job is very fulfilling. Very few careers are as directly related to public health and serving the community as nursing. Also, the public is genuinely grateful for nurses. For the last eleven years, nurses have been ranked by Americans as the most trusted profession – a pretty impressive feat.
Currently, there is a shortage of nurses in the workplace. This shortage is caused by a range of reasons, but the main ones are:

• Baby boomers are aging and require more intensive care
• The recession forced many people to neglect preventative care or lose their insurance, driving up the demand for health care in the long term
• Fewer nurses are pursuing bachelor’s degree which would enable them to get the best nursing jobs

The shortage is leading to salary wars (hospitals offering hefty bonuses to new nurses and more). At the end of the day, professional, skilled, and intelligent people are desperately needed in the nursing field in the US and around the world.

A generational gap is showing in nurses’ views of the practice, with younger RNs more likely to have a positive opinion of the nurse supply and use of electronic medical records, according to a survey.

The fourth annual survey was conducted by AMN Healthcare, a healthcare workforce and staffing company. Results were based on 3,413 responses from questionnaires emailed to 101,431 RNs during April 2013. 

“In a time of unprecedented change in the healthcare industry, it becomes even more important to study how the nursing workforce is responding to the myriad new systems, requirements and quality measurements that accompany healthcare reform,” Marcia Faller, RN, PhD, chief clinical officer of AMN Healthcare, said in a news release. 

“While the vast majority of nurses remain satisfied with career choice, the younger generation is more optimistic about the profession and more receptive to the changes the industry is experiencing. These are differences that health systems must understand as they work with multiple generations of nurses.”

Despite existing shortages, RNs ages 19-39 are more confident about the supply of nurses and their ability to meet the demands of healthcare reform, according to the survey. Findings show 45% of younger RNs believe the shortage has improved during the past five years, compared with 41% of RNs ages 40-54 and 34% of RNs ages 55 and older. 

The generational differences widened when nurses were asked whether healthcare reform will ensure an adequate supply of quality nurses, with 38% of younger nurses saying they were “very confident” or “somewhat confident,” compared with 29% and 27% of nurses 40-54 and 55 and older, respectively.

Generational differences also appeared in answers about the use of electronic medical records, a requirement of the Affordable Care Act. Younger RNs were more likely to believe their use positively influenced job satisfaction, efficiency and patient care. While 67% of younger nurses agreed or strongly agreed EMRs were a positive influence on job satisfaction, that number fell to 51% for nurses 40-54 and 45% for RNs 55 and older. 

Similarly, more young RNs (60%) agreed EMRs positively influence productivity and time management compared with older RNs (38%), the survey found. 

Other key findings:

• Almost 90% of nurses, regardless of age, are satisfied with their career choice, and 73% are satisfied with their current jobs.

• With the improving economy, approximately 23% of nurses age 55 and older plan to dramatically change their work life, citing retirement, taking a non-nursing job or working part-time as very near-term possibilities.

• Less than half of RNs with an associate’s degree or a diploma plan to pursue any additional education in nursing. However, RNs ages 19-39 are more likely to pursue higher education, with nearly 25% saying they expect to pursue a BSN and 34% planning to obtain an MSN, compared with 22% of RNs ages 40-54 planning to pursue a BSN and 22% eying an MSN.

• Of younger nurses, 21% are certified in their specialty, but 59% expect to seek certification.

• RNs ages 19-39 were less likely to believe the quality of care has generally declined (37%), compared with RNs 40-54 (56%) and RNs 55 and older (66%).

“The potential departure of a significant number of older nurses from the workforce can be concerning, given the unclear supply and demand for nurses in the coming years, but is to be expected as nurses approach retirement age,” Faller said in the news release. 

“Healthcare systems must use innovative approaches to attract and retain their workforce while keeping them effective and satisfied. Innovative workforce solutions could help maintain high standards of patient care and efficiency in the era of dramatic change in the healthcare industry.”

Report (registration required): www.amnhealthcare.com/industry-research/2147484433/1033/

Source: Nurse.com

Kelly Kennedy, USA TODAY