DiversityNursing Blog

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

Photo copywrite stavros karabinas

Bed sores (also known as pressure sores or pressure ulcers) are injuries to the skin and underlying tissue that can develop following prolonged pressure to the skin, particularly in areas of the body where bones are close to the surface. Elderly and infirm adults who are bedridden or confined to wheelchairs are particularly prone to bedsores unless they are frequently repositioned so as to relieve pressure on vulnerable areas.

Unfortunately, the presence of bed sores can be a sign that a nursing home resident is being neglected or abused. That's because nursing home staff must be vigilant—frequently moving individuals with limited mobility, as well as performing regular skin inspections—to keep bedsores from developing or to treat bedsores before they become serious. And the fact that understaffing affects a great part of many nursing homes doesn’t help the issue.

Dangers of Bed Sores

According to 2004 research conducted by the Centers for Disease Control about 11 percent of nursing home residents were found to have bed sores. Most of those were Stage Two pressure ulcers, defined as a partial loss of thickness, which may look like a skin abrasion, blister or shallow crater in the skin.

Stage One ulcers appear as red skin without any broken skin. The CDC defines Stage Three pressure sores as "a full thickness of skin is lost, exposing the subcutaneous tissues-present as a deep crater with or without undermining adjacent tissue." Stage Four bedsores, which are the most serious, occur when subcutaneous muscle or bone is visible at the location of the bed sore.

A Sign of Nursing Home Neglect

Remaining attentive to bed-ridden patients is a necessary precaution to avoid the damaging consequences of bed sores. If someone has developed pressure sores while a resident of a hospital, assisted living facility or other nursing home, consider it a warning sign: this individual may not be getting the necessary care and attention given his or her health conditions. At worst, they may be the victim of neglect or even nursing home abuse.

Because pressure ulcers are easier to prevent than to treat, address this issue as soon as possible if you think a nursing home resident is at risk of developing them. If you’re not an attending caregiver, ask nursing home staff what steps they take to prevent pressure sores and alert them of any Stage One or Stage Two bed sores that you observe.

If you observe bed sores developing frequently or severely in the care of others, you should take more urgent action. Anyone who observes these symptoms regularly and without repair should consider contacting their state's Long-Term Care Ombudsman, as well as a nursing home abuse attorney. If the pressure sores developed as a result of neglect or abuse, the assisted living facility can be held responsible for medical costs, pain and suffering, and other expenses.

What are your experiences in handling patient bedsores? What do you think can be done to stem the tide of cases that patients experience every year?

By Alan Brady, part-time caregiver and an author with Attorneys

By PATRICIA R. OLSEN

Monica Parks, 43, of Easley, S.C., has been working as a traveling nurse since 2007.

Q. Why did you decide to do this for a living?

A. Traveling nurses work in different locations for weeks at a time. I like the flexibility of being able to pick where I work and take jobs when I want. This work pays well. I get to work in different environments, and I’m not involved in the politics you might find in a staff job.

How do you get assignments, and what about living arrangements?

There are agencies that cater to nurses and doctors who want to travel around the country for work. I’ve had contracts that run from six or eight to 13 weeks, and they’ve often been renewed. Traveling nurses are often needed to fill in for people who are out. A hospital will either offer lodging or pay a lodging stipend so we can find our own housing.

Doesn’t it get lonely working away from home?

Not at all. I make friends wherever I go. I’m working in South Carolina now, so I’m close to home. But this summer I worked in Washington, D.C. There’s so much to do there, and I got together with colleagues all the time. One was from the South, like me, and had several of us over for a Lowcountry boil — corn, potatoes, shrimp, sausage and crab legs.

What did you do before?

I was a staff nurse in the trauma unit of a South Carolina hospital for 14 years. I felt like I saw just about everything there is to see. After that experience, I’m confident I can work in a lot of areas, but my specialties are the operating room and gastroenterology. I’m given some pretty responsible jobs. I was also at the D.C. hospital before this last assignment there, so they knew me. This summer, a nurse manager going on medical leave asked me to train three nurses on nursing fellowships.

But aren’t you away from your family for several weeks at a time?

That’s the beauty of this type of work: I look for contracts at hospitals and outpatient centers that aren’t too far from home. This summer, my husband and our two children, 16 and 12, stayed with me in my D.C. apartment. My husband works from home, so he was able to work when he was there. When the kids started school, I drove to South Carolina every other weekend. I do the same thing as anyone else whose job takes them out of town, or who lives in one city but works in another.

Source: NY Times 

Source: The Salt Time Tribune

BY ARI BLOOMEKATZ

He was riding in his aunt's sedan, a kid in elementary school, watching senior citizens walk in and out of the Lynwood retirement home where his mother worked. Then she emerged in scrubs.

That's it.

David Fuentes holds on tightly to that simple memory: his mother at work. It's easier than recalling many other parts of his childhood — "a blur," as he calls it.

Like the time when he was little and his father, drunk, socked his mother. She remembers the blood gushing from her face and her child standing in the bathroom saying, "Mom, Mom."

Or the times when he was older and his mother had fallen into addiction. He would stay awake fearful of what might come when she went out looking for a fix.

Or the times he took care of his siblings when no one else would.

"Just like the basic things. That's all I really remember," Fuentes says, "kind of helping to make sure they got fed, and just keeping them company, making sure they were OK."

His face tightens slightly with some questions about the past. But he knows he doesn't need to remember everything.

He has his one simple memory. His mother, a nurse.

She always dreamed of becoming a registered nurse, but life got in the way.

"There's a huge family dynamic," says Fuentes, 26. "I wanted to fulfill for my mom what she envisioned for herself, but could never do."

This summer, he graduated from nursing school at UCLA and landed a job in the intensive-care unit at UCLA Medical Center, Santa Monica.

Beyond being a trailblazer in his family, Fuentes is among a group of men redefining the nursing industry. Although the profession is still dominated by women, the number of men is on the rise.

David Fuentes attends the morning huddle before the shift change in the intensive care unit at UCLA Medical Center, Santa Monica on April 11.

The percentage of male registered nurses more than tripled from 2.7% in 1970 to 9.6% in 2011, and the proportion of licensed male practical and vocational nurses increased from 3.9% to 8.1% over the same period, according to the U.S. Census Bureau.

Researchers cite various reasons for the shift, including diminished legal barriers, increasing demand for nurses as the U.S. population ages, and middle-class pay.

But for Fuentes, a main motivation is the solace he finds in being a caretaker.

"Everything is left behind," he says. "That's why I love it so much."

"It's like therapy ... kind of our way of dealing with our issues."

The sturdy curve of his biceps, the gauge in his left ear, the lip ring and tongue ring might seem intimidating if it weren't for the delicate way Fuentes presses on the legs of a 99-year-old patient to check her blood flow, or how he cups his hands and drums on her back to help her breathe more easily.

It is 45 minutes into his first shift as a registered nurse, and Fuentes and another RN are caring for the elderly woman, who had been in septic shock.

She is blind and mostly unresponsive, but Fuentes asks politely, his voice soft but direct: "I'm going to take your temperature ... OK?"

Another nurse says the woman's family stayed for 15 minutes earlier in the day. But Fuentes will be there the whole night standing guard — giving her medicine and monitoring her pain and breathing on his 12-hour overnight shift.

His black curly hair is pulled back into a ponytail and he's wearing navy blue scrubs, the color of the uniform defining his new rank.

"This is the first day of the rest of my life," Fuentes said before his shift started.

Fuentes thinks it's only natural that some patients feel more comfortable with nurses of the same gender, but mostly, he says, it doesn't come up.

David Fuentes examines Russell Sherman, 87, a patient being treated for a pulmonary embolism. Sherman says he remembers when all nurses were women in white uniforms.

A couple of months earlier, during his training, he was checking the oxygen flow into patient Russell Sherman's nostrils when the 87-year-old looked him over admiringly and said he remembered when the only nurses at hospitals were women in white.

"They were always girls," Sherman said. "It doesn't faze me at all. I think it's a good thing for men to be able to do a job without shame."

One of Fuentes' heroes is UCLA School of Nursing Dean Courtney Lyder, the nation's first male minority dean of such an institution.

Lyder, 47, said his own dean at Rush University Medical Center in Chicago, Luther Christman, was the first male dean of a school of nursing in the country. Tall and muscular, he "debunked a lot of preconceived myths about nursing."

Decades later, Lyder said, stereotypes about men in nursing are fading and the experience he had in nursing school — one of five men in a class of 200 — is becoming more uncommon. Although he says "we still have a long way to go" as an industry, 11% of students at UCLA's nursing school during the 2012 - 13 academic year were men.

"Men are seeing that this is a viable option that pays well, you have a good lifestyle, you give back to society," Lyder said, adding that nursing groups such as the American Assembly for Men in Nursing have also surged on college campuses.

"Nursing doesn't have a gender. Society and media have portrayed nursing as feminine," Lyder said. "It's not."

But there are nuances, some more subtle than others.

Huddled around sack lunches at a table outside the hospital, a group of undergraduate students — about eight women and one man squeezed in at the far end — took turns saying that they wanted to become nurses because they want more meaningful relationships with patients, not just because it's a good career.

David Fuentes makes the rounds with registered nurses Pamela Helms, center, and Heather Alfano in the intensive care unit at UCLA Medical Center, Santa Monica.

But they struggled to respond when the conversation shifted to pay grades, and the fact that even though men are far less represented in the field, census data show that women earn less on average, 91 cents for every $1 earned by a man.

"I think men obviously are more stronger than women, so maybe," one of the female students said, grasping for a reason. "I don't know, I'm trying to justify it."

The group packed up a few minutes later and went back to work.

Fuentes says that he decided to go into nursing in his freshman or sophomore year of high school, but his mother says his instinct for caretaking goes back much further than that.

"Sometimes I feel that maybe he grew up a little bit too fast because he wanted to make things easier for me," said Guadalupe Perez, 44. "Always got the impression that he kind of knew what was going on, like he just understood.... You could see the sadness in his eyes."

She's proud of her son, even when he chose to live with his aunt and only saw her on weekends.

"He has a good heart, he was always there for his little brother," she says. "Maybe it's just something that ... got into him, always being there to help someone."

But Fuentes is already thinking much bigger than his first love and about the role that nurses can play in the national debate over healthcare and the changes to the healthcare system.

Even though his past is painful, he doesn't want to put it behind him. "It's made me who I am," he says.

Late one night before graduation, Fuentes scribbled his thoughts about the nursing industry and then read them aloud as if his fellow graduates were listening.

"I am sure every single one of you in those seats, pre-license and licensure students alike, can attest to the roller-coaster ride that your respective nursing journey has taken you on," he wrote.

"There have been lots of ups and downs, unexpected turns this way, that way, every which way you could and never would have fathomed, but look at us now, we made it!"

Source: LA Times

By Maria Sonnenberg

The Boy Scout motto of "be prepared" equally applies to today's school nurses, who not only deal with the typical bruises and tummy aches that have always been part of school life, but must now contend with a student population that is increasingly more medically fragile.

As school systems face budget cuts, nurses must also adapt to a "migrant" lifestyle as they are assigned to several schools during a workweek.

"There have been a lot of changes in the last 20 years," said Pamelia Hamilton, community health nurse consultant and school health coordinator for the Brevard Department of Health, which supervises the 160 nurses and health technicians who serve public schools in Brevard County.

According to the National Association of School Nurses, a third of all school districts reduced nursing staff in the past year because of the recession, and a quarter of all school districts in the nation don't have nurses. In these districts, medical emergencies are typically handled by a school's front office staff, the way they were in Brevard until the late 1980s, when nurses were first introduced to local schools.

Brevard's ratio of nurse to students — about 1 per 450 — is exemplary, when considering that Florida, with a nurse-to-student ratio of 1 to 2,537, is at the bottom of the list in the number of nurses in schools. Only Utah, North Dakota and Michigan are worse off in numbers. Vermont, on the other hand, has a ratio of 1 nurse per 396 students.

The National Association of School Nurses recommends a 1-to-750 ratio for well students and 1 to 125 in student populations with complex health care needs.

"People who live here think our nursing program is the norm everywhere, but when they move out, they are in for a shock," Hamilton said.

"What we do is so extraordinary that we've been recognized with several awards."

The health department hires, trains and pays the school district's nurses. In turn, the district reimburses the health department for most costs incurred in running the program.

New responsibilities

The foremost duty of a school nurse is to keep kids learning as long as possible. These days, that can take the form of fixing an accidentally stapled finger or a nasty cold, as it did years ago, but it can also entail helping a pregnant teen stay in school and teaching them to become a good mother. Brevard's Teen Parent Program, for example, assists about 250 pregnant girls at Palm Bay, Eau Gallie, Titusville and Cocoa high schools.

"We explain to them what is happening to their bodies and train them to care for their babies," Hamilton said.

School nurses today also go beyond the traditional boundaries of kindergarten to high school students. Nurse Travia Williams and her team of technicians travel through the county's Head Start program sites to provide the screening, physicals and related services necessary for the little ones to be better prepared when their school days start.

Other nurses are devoted to one-on-one care with medically needy students who otherwise would not be able to attend school.

School nurses are also tasked with managing children's increasingly complex medical conditions and chronic illnesses. A child may have a tracheotomy or require nasal gastric tube feeds by an experienced nurse. Nurses may be required to monitor students' insulin pumps and keep track of inhalers and EpiPens. In some instances, Medicaid pays for a private duty nurse to be with the student one-on-one throughout the school day.

"Professional responsibilities have not changed overall," said Carolyn Duff, president of the National Association of School Nurses. "What has changed is the increasing number of students with chronic health conditions, including asthma, diabetes and severe allergies. All of these conditions have the potential for life-threatening emergencies. What this means for school nurses is an increasing need to train and maintain a competent team of unlicensed school personnel to prevent, recognize and respond to emergencies.

"Another change is a welcome change," Duff said. "There is now a greater emphasis on prevention and wellness in health care."

"School nurses are identifying students at risk for both health and learning problems at an early age and are able to initiate early referrals for intervention and treatment."

The National Association of School Nurses lists data that underscores why school nurses' duties are so varied these days. Among students ages 12 to 19, pre-diabetes and diabetes has increased from 9 percent in 1999 to 23 percent in 2008, and 32 percent of children ages 2 to 19 are obese. More than 10 million children suffer from asthma. The prevalence of food allergies among children younger than 18 increased 19 percent from 1997 to 2007.

Mental health issues among students are on the rise. School nurses estimate they spent about a third of their time providing mental health services.

Overall, 15 percent to 18 percent of children and adolescents have a chronic health condition, nearly half of whom could be considered disabling.

ACA's impact

The enactment of the Affordable Care Act could provide an opportunity to strengthen a nurse program that serves the nation's 52 million school-age children. For many of these students, the school nurse is the sole provider of access to health care.

Health care reform's emphasis on wellness dovetails with the goals of school nurses, who provide continuity of care and promote healthy lifestyles for students during their most critical developmental years. They perform early intervention services such as periodic assessments for vision, hearing and dental problems with the goal of removing barriers to learning.

States are testing different health care models for high value rather than high cost and high volume. School nurses are included in the plan.

"Health care reform will lead to greater opportunity for school nurses to successfully connect students from low-income families to medical homes, because more students will be insured," Duff said.

"More widespread access to medical homes will provide greater opportunity for school health services to focus on prevention and wellness and tighter management of students with chronic disease."

Source: USA Today

By: Marilyn Hagerty, Grand Forks Herald

She sets her alarm on weekdays for 5:30 a.m., and she jumps in the shower when it rings. She slips into her green nursing scrubs.

“I always listen to the 6 o’clock news,” says Amanda Lako, a third semester nursing student at UND.

From 8 a.m. until 4 p.m., on a typical day she’s in classes, sometimes at the Public Health Department at the Grand Forks County Office building, sometimes at the College of Nursing and Professional Disciplines at UND and sometimes at Altru Hospital.

In her rush for class, she might bring a baggie with dry cereal in it to eat. “I’m terrible,” she said. She depends on coffee to keep her running. And there are times when she is so tired that she sets her alarm to ring in eight minutes. She gives herself a short, short nap.

The road to a degree as an RN, or registered nurse, is long and challenging.

Amanda Lako is one of 324 students in the undergraduate baccalaureate program at UND. Lako is a junior in her third of five semesters. Beyond that, there will be a semester of practical work in a hospital setting before she graduates in December 2014.

She is passionate about nursing.

“It is a calling,” she told me. “Once you start it you know if it is right for you. There has to be a big desire.”

For Lako, that desire began when she was growing up on a farm near Arthur, N.D. She was 4 when she started shadowing an aunt who was a nurse. She had other aunts who were nurses.

She was smitten with nursing. As a freshman at UND, she became a CAN, or certified nurse assistant. And, she said, “I loved each and every one of the residents I helped.”

Her work as a CNA taught her how to relate to patients. “It was amazing to work on the CNA float pool at Altru. I worked on every floor wearing my light baby blue scrubs,” she said.

Her class of 52 has five male students. And Lako thinks it is awesome for a man to go into the career. “It takes the kind of men who have the biggest hearts and are so kind and gentle.”

In Lako’s mind, nurses are selfless. She admires people who have been her mentors including her school nurse, her church leaders. And she said, “Certain people just push you. I was adopted and I think I learned to be selfless from my parents.”

She isn’t always that serious. She works away at the pages of papers she must keep on patients. And she gets supper around 7 to 8 p.m.

Then there are the times in the evenings when she sits around the kitchen table with four other nursing students. They live together.

“We laugh, we sing, we complain. I depend on them to lighten things up.” 

UND’s nursing program

UND offered non-degree courses of study for nurses beginning in 1909.

In 1949, the first baccalaureate program in nursing was established and a Division of Nursing was created at UND. The same year, the State Board of Higher Education authorized the creation of the College of Nursing as a unit on campus.

The baccalaureate program was fully accredited by the National League for Nursing in 1963 and has remained accredited since that time, according to information provided by Lucy Heintz, clinical assistant professor and director of the Office of Student Services.

In 2013, in addition to the Department of Nutrition and Dietetics, the College of Nursing was joined by the Department of Social Work and the name was officially changed to the College of Nursing and Professional Disciplines.

Currently, the Department of Nursing has 324 students in its undergraduate baccalaureate program. The graduate program with 269 enrolled offers two doctoral programs. Master of Science degrees are available.

The graduate program has an enrollment of 269.

Source: Grand Forks Herald

Despite “measurable progress” in the three years since the release of the Institute of Medicine’s landmark report on the future of nursing, more work remains “to fully realize the potential of qualified nurses to improve health and provide care to people who need it.”

That assessment is part of a commentary by Harvey V. Fineberg, MD, PhD, president of the IOM, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, on the aftermath of the report.

“The Future of Nursing: Leading Change, Advancing Health” was released Oct. 5, 2010, by the IOM with the support of RWJF. It provided a blueprint for transforming the nursing profession to “respond effectively to rapidly changing healthcare settings and an evolving healthcare system,” according to a report brief.

The key recommendations: allow nurses to practice to the full scope of their education and training, provide opportunities for nurses to serve as healthcare leaders and increase the proportion of nurses with a BSN to 80% by 2020. Following the report, RWJF and AARP formed the Campaign for Action to implement the report’s recommendations at the state level. 

Regarding scope of practice for advanced practice registered nurses, Fineberg and Lavizzo-Mourey wrote that 43 state action coalitions have prioritized initiatives to remove scope-of-practice regulations that prevent APRNs from delivering care to the full extent of their education and training. Iowa, Kentucky, Maryland , Nevada, North Dakota, Oregon and Rhode Island have removed barriers to APRN practice and care, and 15 states introduced bills this year to remove physician supervision requirements that can hinder APRN care.

Regarding education and training, the proportion of employed nurses with a BSN or higher degree was 49% in 2010 and 50% in 2011. “Progress is likely to accelerate in the years to come,” Fineberg and Lavizzo-Mourey wrote, “because between 2011 and 2012 along there was a 22.2% increase in enrollment in RN-to-BSN programs and a 3.5% increase in enrollment in entry-level BSN programs.” The authors also noted a recent increase in the number of students enrolled in nursing doctorate programs. Of the 51 action coalitions, 48 have worked to enable seamless academic progression in nursing.

The authors noted that the influence of the campaign has paid off with a $200 million Medicare initiative to support the training of APRNs at hospital systems in Arizona, Illinois, North Carolina, Pennsylvania and Texas.

Regarding nurse leadership, Fineberg and Lavizzo-Mourey wrote, the “Campaign for Action has tapped established and emerging nurse leaders across the nation and is working to provide them with opportunities for networking, skills development and mentoring. A key strategy is to advocate for more nurses to serve on hospital boards.” 

Full commentary: http://bit.ly/176XyZs

Campaign for Action: http://www.rwjf.org/en/topics/rwjf-topic-areas/nursing/action-coalitions.html

“Future of Nursing” report: www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Graduate Nurse Education Demonstration: http://innovation.cms.gov/initiatives/gne/. 

Source: Nurse.com

By Debra Wood, RN

To achieve the national goal of improved health outcomes, many researchers and health advocates agree that patients must assume a greater role in managing their health

care. But how can facilities and health systems accomplish this kind of patient engagement? The answer may rest with nurses and nurse leaders, who have long overseen patient education about how to care for chronic conditions and make lifestyle changes to improve health.

“Promoting patient education has always been a part of our nursing role and obligation to the
patient,” said Debi Sampsel, DNP, MSN, BA, RN, chief officer of innovation and entrepreneurship at the University of Cincinnati’s College of Nursing in Ohio. “It has been a long-standing practice that nurses involve the patient across the life span in their own care.”

Sampsel finds nurses strive to and take great pride in promoting healthy lifestyles. And research has demonstrated that active, engaged individuals have far better health outcomes. The University of Cincinnati includes health promotion in the nursing curriculum and gives students an opportunity gain patient-engagement experience while working with the homeless and elementary and secondary school age youth.

“What’s new is old,” added Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, dean and professor at the College of Nursing and Public Health at Adelphi University in Garden City, N.Y. “I went to nursing school 35, 40 years ago and what did they teach but to be the patient advocate, to teach the patient. But we got away from that in the last few decades.”

Coonan pointed out that today’s consumers and patients, particularly baby boomers, are better informed. They often turn to the Internet for facts, but he called it a nursing professional’s obligation to verify whether the online information is accurate. Boomers are not going to settle for a paternalistic “Just take this pill” without knowing why and how it will benefit them. And that often falls to the nurse.”

“We have to get away from the patient-doctor or patient–nurse relationship that is almost like a parent–child relationship, in existence for many years, to a more informed and empowered [consumer] who will take responsibility for their health,” said Rosemary Glavan, RN, MPA, CCM, senior vice president of clinical operations at AMC Health, a telehealth provider based in New York. “Baby boomers have been go-getters and always wanted to be in charge. They want to be empowered.”

Advocating with a personal connection

“As patient advocates, nurses and nurse leaders play a key role in promoting patient engagement,” said Cynthia M. Friis, MEd, BSN, RN-BC, associate association executive for SmithBucklin’s healthcare and scientific industry practice in Chicago. “Nurses are privileged with having the opportunity to spend more time with the patients to assess, plan, implement and then help clarify the plan of care with the patient and his/her family or caregivers. Nurse leaders are key in helping to ensure this role is realized. Nurses can do their jobs better with the full support of our nurse leaders.”

Nurses ask questions, she added, and draw patients into thoughtful discussions about their care, helping them move forward when they feel overwhelmed and understand how to best care for themselves.

Establishing principles of engagement

Patewood Memorial Hospital in Greenville, S.C., participated in a national study by the Agency for Healthcare Research and Quality (AHRQ) and in the development of theGuide to Patient and Family Engagement in Hospital Quality and Safety.

Recommendations in the AHRQ guide include:

• Working with patients as advisors;
• Communicating effectively; 
• Giving bedside shift reports, where nurses do not talk with each other but involve the patient and family members he or she wants to participate; and 
• Engaging patients in transitions to home.

The hospital has experienced improvements to its HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey since implementing the program.

“The patients and families are much happier,” said Kerrie Roberson, MBA, MSN, RN-BC, CMS, nurse educator at Patewood. “Patient engagement is a partnership with the patient and families, and they trust you more when they see you are open about their care.”

Nurses at Patewood are leading discussions about patient engagement across the Greenville Health System and have begun sharing their experiences with others.

Other nurses gathered to develop Guiding Principles for Patient Engagement, released last year by the Nursing Alliance for Quality Care (NAQC), which was supported by the Robert Wood Johnson Foundation.

Principles in the NAQC guide include:

• Having a dynamic partnership with patients and their families; 
• Respecting boundaries; 
• Maintaining confidentiality; 
• Adhering to responsibilities and accountabilities; 
• Recognizing patients able to engage; 
• Appreciating patient rights; 
• Sharing information and decision making; and 
• Advocating for the patient.

“Patient-centered care and engaging patients is very important to improving quality outcomes, which includes reducing cost and better health of populations in the community, but also reductions in disparities of care,” said Maureen Dailey, PhD, RN, CWOCN, senior policy fellow for nursing practice and policy at the American Nurses Association (ANA), a member organization of the NAQC. “The patient is at the center of the team and must assume accountability for self-care and part of the outcome. But that evolution has yet to take place.”

Nurses must instill confidence and competence in patients’ self-care, Dailey explained. And patients need nurses to provide knowledge, support and symptom management.

“Nurses hold a central role in patient engagement,” Dailey concluded.

Combing nursing skills with technology

Along with the personal touch, many nurses are finding technology can assist with their patient-engagement efforts.

“As the responsibility of nursing advances to one of building and sustaining patient activation and the role of nursing moves to be more consultative across care settings, technology will play a vital role for both the nurse and the patient,” said Karen Drenkard, PhD, RN, NEA-BC, FAAN.

Drenkard, who has served as executive director of the American Nurses Credentialing Center (ANCC) and past director of the ANCC Magnet Recognition Program, will join GetWellNetwork in January as chief clinical/nursing officer, where she will lead the development of a nursing model of patient engagement. Her responsibilities will include studying and designing new ways to assess and improve patient activation through clinical practice and technology solutions across all care settings.

“Nursing can use interactive patient care technology to proactively engage the patient and shift the responsibility for completing certain care interventions,” said Drenkard, explaining patients can document daily signs and symptoms. Care providers use the network to send reminders about taking medications or the need for follow-up visits to their physician when data and input from the patient indicates the need to do so.