DiversityNursing Blog

By Amy Standen via NPR

If there is a founding ethos in the world of high-tech startups, it's this: The idea is everything. Facebook's initial public offering might have seemed like the perfect illustration. A simple concept, conceived by a college student, became a $100 billion empire in just 8 years.

But if you look around California's Silicon Valley, ideas all seem to be coming from the same kinds of people. By a recent estimate, 1 percent of technology entrepreneurs are black. Only 8 percent of tech companies are founded by women. Facebook's Mark Zuckerberg isn't just a model of success in the Valley; he's a blueprint.

A new three-week boot camp for entrepreneurs is aimed at adding more diversity to Silicon Valley's startup scene.

Making Their Pitch In Silicon Valley

The New Media Entrepreneurship boot camp trains startup hopefuls to focus their business ideas and present them to investors. Some recent participants:

Seizing Opportunities, From An Early Age

It may be safe to say that some people are just born entrepreneurs. Take Chris Lyons of Johns Creek, Ga., outside Atlanta. When he was 12, he started mowing lawns.

"I'd take my mom's trash can and I would take my lawn mower," he says. "And I would push my lawn mower up and down the hill with one hand, and carry the rolling trash can for the other. I had over 30 lawns in my neighborhood. Then I bought a John Deere tractor."

Someone like that isn't going to stay in John's Creek forever. By the time he was 25, Lyons had set his sights on Silicon Valley.

"There's no other choice," he says. "Like, I want to be in an area that nurtures strong-willed, forward-thinking individuals. And there's no better place than Silicon Valley or San Francisco."

The thing is, when you look at Silicon Valley, especially at people who are starting businesses, they don't typically look like Chris Lyons, who is black.

And that is the whole point of the three-week boot camp for startups called NewMe, for New Media Entrepreneurship.

Reporting To Camp

On the first day of the camp, Lyons is sitting in the living room of a San Francisco townhouse, along with six other entrepreneurs — all women or African-Americans, most of them in their early 20s.

NewME director Angela Benton presents them with bags of swag — sponsor-donated items like shirts, headphones and mobile tablets.

Everyone here came with business ideas. Lyons' company is called PictureMenu, which he hopes will eliminate paper menus.

He's thinking big.

"We're trying to make this a worldwide mobile application," Lyons says.

The idea behind the boot camp is that when it attracts people like Lyons to the area, it also helps nudge Silicon Valley toward diversity.

And that, says venture capitalist and consultant Freada Kapor Klein, is something the Valley badly needs.

"This isn't about being bigots, this isn't about who's mean-spirited and who's enlightened," she says. "This is about how our brains are wired.

Klein says it's human nature: People tend to help people who look like them and who come from similar backgrounds. It's largely subconscious.

"We're not even aware of that hurdle that we've put in the place of a different kind of entrepreneur," she says.

Klein sees the NewME program as a two-way street because without diversity, the industry — and consumers — are missing out.

"If we've got a very insular world, then the kinds of companies that are created — most scratch the itch of a particular set of people and ignore everyone else," she says. "And I think that's the real loss for everybody."

Trouble With The Pipeline

One reason Silicon Valley is so homogenous is what's called the pipeline issue. There just aren't a lot of women, blacks and Latinos enrolling in science and engineering programs.

But there are subtler forces at work, too.

"No one's gonna say, 'I'm not gonna fund you cause you're black,' " says Chris Bennett, a NewME alum who is now a working entrepreneur. "No one's dumb enough to say that. But everyone will tell you that there is a bias."

Working with attorney Nnena Ukuku, Bennett started a Bay Area group called Black Founders.

"I think for some people it's sort of like a chicken-and-egg issue," Ukuku says.

"They've never seen a successful black entrepreneur, so it's hard for them to envision it. But then, they do exist ... it's just a mess."

Removing Self-Imposed Roadblocks

It's a mess because tangled up in all of this are roadblocks that women and people of color often put in front of themselves.

Take, for example, NewME participants Rachel Brooks and Amanda McClure. One day I asked them why instead of NewME, they hadn't applied to a different, more established program, one that wasn't based on race or gender.

And when I asked them this, they seemed kind of stumped.

"I don't know, maybe it just felt a little out of reach," Brooks says.

"Definitely," McClure agrees.

"Maybe that's what it was," Brooks says.

"It wasn't in my realm of conception, you know?" McClure adds.

"That's a much deeper issue," says Ukuku, with a sigh and a laugh.

She's laughing, she says, because she hears this all the time. It's the mindset, Ukuku says, that people have to be brilliant, at the top of their game, to even take a stab at Silicon Valley success.

"And the people that sort of have that tendency to say that tend to be women and minorities," she says. "Whereas I'll talk to some of my friends who I adore, who don't fit into one of those two buckets, and they'll say: 'I got an idea. I'm going for it.' "

Ukuku says she recognizes this confidence because she's seen it among her own relatives back in Nigeria.

"They're the majority in that culture," she says. "There's just an assumption that you will, like — why would you not succeed?"

Campers Pay A Visit To Google

That confidence of belonging is exactly what the NewME participants are trying to cultivate on the program's second day.

They're at the Google headquarters in Mountain View. And guess what? It's exactly the dot-com fantasy everyone imagined it would be. Lyons sounds giddy.

"I just walked outside, and they're playing pool and drinking coffee," he says. "And I saw a yoga session when we walked in here."

But Lyons is nervous, too. Tonight is a bit of an initiation: An American Idol-style pitch session.

At the event, the emcee is Navarrow Wright, an established entrepreneur in the Valley.

"What we're going to do tonight is give the NewME founders an opportunity to pitch their companies for the first time in public," he says. "They will have two minutes to pitch their startup, and we will each have one minute to give feedback."

Making A Pitch To Investors

When it's his turn, Lyons walks up to the lectern and flashes a winning smile at the audience.

"How's everyone doing today? Good, good. Well my name is Chris Lyons and I am the founder and CEO of PictureMenu."

He starts out pretty strong.

"And what we do is we allow any restaurant the opportunity to transform your boring paper menu into a beautiful mobile application for your smartphone, for free."

But after that, things get a little muddy, as Lyons compares the service to the way you can upgrade a car. After he wraps up, the critique begins. One of the judges is Chris Genteel, Google's development manager for global diversity.

"It was a great first half of the pitch and the second half kind of went off the rails," he says.

As Genteel goes on, Lyons' face falls a bit.

"I think you gave me a lot of ideas in the beginning," Genteel says. "And then confused me with a lot of kind of features."

For Lyons and the others, it's just a starting point. They've got three months of training ahead of them. And their pitches are all going to need some work.

By Suvarna Sheth, Hcareers.com

There's been a lot of contentious chatter lately on the state of job boards as social media moves in. Some say job boards are waning in popularity, while others say they're not going anywhere. The fact is the number of job boards are still proliferating and they are widely used by advertisement agencies and HR departments for many professions from retail to research. We speak to some industry insiders for their views on the importance of job boards in implementing an integrative recruitment strategy.

Bruce Dorskind, president of the Dorskind Group, a strategic consulting firm specializing in marketing communications, global recruitment, and business has seen the advertising recruitment industry evolve over decades, from one that relied 90% on print media to one that is dominated by digital media today. Dorskind claims there are over 10,000 job boards in the United States and probably 100,000 around the world, and growing.
"The big general job boards, Monster, Hotjobs and Career Builder were very important early on," says Dorskind," because they educated the public about the concept of a job board." They were basically a game changer says the industry veteran. "What the big job boards did was it sold the American public the idea that a job board is a viable way to find a job."

But today, 20 years into the concept of a job board, the market has changed, according to Dorskind. "Like every nascent market, it starts out in a very general way, and migrates to the specific," he says.

In the beginning, Dorskind explains everyone from the person working behind the retail counter at Wal-Mart to the person developing next generation pharmaceuticals for Genentech went to the same job board. "Now, the market has moved from general to segmented and you have the opportunity to only deliver your message to the specific group of people you are interested in through a targeted job board.

The niche job board has managed to be a very successful model for many reasons. One is that it has allowed employers to get resumes or responses from people that are relevant. "And it allows you to pay for the candidates you are getting, while with a general job board, you're paying for the entire audience, 95% of who aren't qualified," says Dorskind.

Still, not all niche job boards are successful. The ones that are, according to Dorskind are the ones that get their visitors involved, constantly produce fresh material, have current and real jobs and promote potential advertisers.

Dorskind says ad agencies and individual employers have five benefits to using niche job boards: you have a targeted audience, you can build a brand among the people you're trying to reach, they tend to be far more cost efficient, they tend to be where you're competitors are advertising, and they tend to do a better job reaching the passive job seeker than the general job boards.

Whether a particular recruitment strategy involves using large or niche job boards, Dorskind recommends ad agencies to use the strategy that meets their client's needs most efficiently.

"Certainly if they're looking for hundreds of people working in thousands of different locations for a retail store, then a strategy of being on a large job boards makes sense," he notes.

The problem for ad agencies, according to Dorskind is that there are too many job boards, and there is too much noise in the marketplace and within given industries. "In healthcare, there are over 500 job boards and it's impossible to keep up with all the new job boards unless it's a dominant player in its market," he adds.
Dorskind says niche job boards are a way to go for recruitment advertising. "I think in a world where technology is changing as quickly as ours and the options are as great as ours, there is no one solution," he remarks.

Like Dorskind, Sean Quigley, senior director of digital media at Bernard HODES Group says it's the obligation of the ad agency to do what's best for the client.
Quigley, who works on building strategies for clients and formulating digital media plans based on a given budget and set of targets, says there's definitely a shift going on in the recruitment world because of digital media.

And that's why he says it's not only about job postings at Hodes. "E-mail campaigns, banners, videos, as well as traditional job boards and niche job boards are all usually considered as part of a recruitment strategy," he says, "It's different for every client and there are more options on the table now so we're looking to take advantage of everything we can," he says.

According to Quigley, it's also important to have strategy on some of the more generic boards because that's where a lot of the target is ending up anyway. "On the other hand, we do see awesome results on more targeted job boards, which preform extremely well and rise to the top, delivering great results for certain accounts," he states.

For example, for a large pharmaceutical client who was more engaged in science oriented candidates, Quiqley and his team did extremely well on BioSpace.com, using large posting packages and creating a very strong branding presence throughout the site including e-mail sponsorships and a continual presence on the BioSpace pages. "BioSpace was an extremely beneficial option for us to have; it really helped us reach our client goals," he says.
Adele Mirabelli, a field sales representative within the healthcare division of onTargetjobs works with ad agencies to create media plans and posting packages for their healthcare clients.

She says the benefits to using a niche job board is quality vs. quantity. "Clients may not get as many candidates but the few that they do will be better qualified candidates," she states.

Also, she says clients can get lost within a general job board. "They have so many more jobs and unqualified candidates and at times healthcare employers can get lost in the mix of all the other industries out there."

Since niche job boards are focused and targeted to one industry, it makes it a lot easier for job seekers to find the jobs that they are looking for.
Mirabelli can't say without a doubt that niche boards are more successful than larger boards because it depends on the client and the job advertisement. "A lot of factors come into play when it comes to measuring success for our clients and the job boards they use," she says. However, with the economy picking up and recruitment opportunities on the rise, there is a need for better qualified candidates.

And when it comes to finding quality, Mirabelli is hearing that her clients are not finding it on general job boards like Monster. She finds that specifically healthcare employers are using niche job boards more because they are finding that the quality of the candidates is better.
Mirabelli says a lot of ad agencies use niche job boards for some of their client's hard to fill vacancies because they find they can reach a higher caliber of job seekers through them.

"At the end of the day, it's all about ROI and the quality of the candidates that they bring on board," she says. Like Dorskind and Quiqley, she notes that ad agencies need to recommend the best solutions out there to ensure that their clients are performing as well as possible.

This is true today, especially when everyone is tightening their belts and spending less. "When budgets are being cut, ad agencies really need to focus on what is the best solution for their clients and how they can help their clients achieve the best ROI," Mirabelli comments.

As for whether niche job boards are going to survive the rampant changes going on in digital media, Quiqley has no doubt. "Any site that's able to attract a high value audience that is engaged in looking for jobs-that's always going to be something that's going to be valuable," he notes.

"I don't see any evidence for job boards becoming extinct," Quiqley states, "While social media is powerful and is going to get more and more important, it's a different function in terms of actually being a destination where someone in a given career can look for job openings," he says.

The digital media expert says the business model for job placement on social media sites hasn't really developed yet, and while the potential may be there, nothing compares to achieving goals in a measurable way than job boards, SEO, smart placement of advertising and e-mails to targeted candidates.
"None of them are going to be replaced," he says, "there are different stages and audiences you're simultaneously reaching with these tools, so none of the individual tactics are going to be completely ruled out because of social media," he comments.

From Forbes.com

You might think working well into your eighth decade is preposterous. But it is becoming relatively commonplace. The number of working people age 65 and older reached an all-time low in 2001, when just 13% held jobs. Now that rate is rebounding, and the number of workers older than 65 is 18% of the workforce.

The Future Workplace “Multiple Generations @ Work” survey asked 1,189 workers across the generations how likely they thought they were to work past age 70.

Seventy-seven percent of baby boomers (between ages of 48 and 66) said they believed they would work into their 70s. What is surprising is that 82% of Gen Xers (between ages of 36 and 47) agreed.

There are a number of reasons for employees to believe they will be working longer. First, they are already living longer. Boomers are expected to live longer than any previous generation of Americans. Of the 3.4 million born in 1946 — including Bill Clinton, George and Laura Bush, Donald Trump, Susan Sarandon, Steven Speilberg and Sylvester Stallone — 2.8 million are still alive. The men can expect to live another 22 years, the women another 25.

By 2030, when the first baby boomers reach the age of 84, the number of Americans older than 65 will have grown by 75%, to 69 million. This means more than 20% of the population will be older then 65.

And since we are living longer, we may want and need to work longer – especially to meet the financial needs caused by sagging retirement accounts, and plunging property values. As careers get longer, workplace culture will have to accommodate age diversity. Some traditionalists (those 66 and older) and baby boomers are already working further into their 70s and 80s, so as a new batch of employees from “Generation 2020″ (born after 1997) graduates from college and joins the workforce, it will become common to find five generations working side by side at the office.

A multigenerational workplace has plenty of advantages, including the potential for knowledge sharing, mentoring and coaching. But it can also create tension, the likes of which can erode office morale and sabotage productivity.

The “Generations @ Work” survey asked workers about their expectations and requirements for an employer.  The study found the struggles among the generations often eclipsed the advantages.

As originally discussed, in my book, The 2020 Workplace, each generation brings its own lens to the workplace, and individual and group talents can become obscured by assumptions, myths and real or perceived tensions and criticisms. This can lead to  havoc in the workplace.

Here are five ways to address and prevent generational tension at your company:

Teach your managers to anticipate generational differences, starting in the recruiting process.

Many young workers today approach job interviews differently than their predecessors. For our survey, we asked a sample of 150 managers to give us examples of surprising questions they’ve been asked by interviewees, most of whom were of millennial age. To the surprise of managers, millennials asked questions such as:

“Do I have to show up each day?”

“Can I use my own tablet, phone and laptop at work?

“Do I have to wear shoes to work?”

These questions can seem irreverent, but managers must understand what’s really behind them. The applicant who asks if he has to show up each day is really inquiring about the company’s telework policies and flexibility. The applicant who inquires about her ability to bring her own devices to work each day is really asking if the company has a Bring Your Own Device (BYOD) to work policy in place to allow employees to use their own devices instead of company-owned, standard devices.

And, if you are ever faced with a question about shoes, remember Steve Jobs – he frequently went barefoot to work!

Be aware of each generation’s preferred learning and communication styles.

In our survey, 35% of Generation 2020 said they consider mentoring and coaching the most valuable form of career development with only 20% preferring the classroom. This generation also prefers to use the latest tools – such as mobile devices, gaming, video sharing and social networks – for learning new skills.

A study by Deloitte Consulting and the IABC confirms this finding as it relates to communication styles. The study concluded that younger workers want information delivered immediately, and in shorter and more-frequent chunks. Speed and frequency of communication are important to them.

Google provides a good example of how to use games to boost productivity. Google‘s management realized that the company’s large spread of office space was cutting down on human interaction. To help foster connections, the company built an online, multiplayer social game called GoCrossOffice, modeled after the game Risk. Players collaborate, organize and socialize with each other, and in the process, strengthen their team-building and strategic-thinking skills. Since then, other companies have joined in this trend, too.

Enlist Millennials as subject-matter experts on what appeals to their generation.

Some companies think of millennials as a problem to be solved in the workplace. But the forward-looking ones enlist millennials when they are trying to adopt a new product or service inside the company.

Neiman Marcus Director of Learning and Development Keith Meyerson relied on millennials who work for Neiman Marcus to promote the collaboration module of the company’s learning management system (LMS). Instead of using a top-down communication program, Neiman Marcus focused on communicating from the bottom up by using millennials to drive participation and share this practice with older workers who are typically not early adopters of new tools in the workplace.

Don’t believe the myths about each generation in the workplace.

It would be easy to put each generation in a box and characterize them based on stereotypes. But there are also plenty of similarities to be found among workers of all ages.

For instance, flexibility has become an increasingly valued workplace characteristic by workers of every generation. When Future Workplace asked how important a flexible work environment was, 35% of our survey respondents, across all ages, answered either “important” or “very important.” For all generations, flexibility –flexible hours and flexibility of location (i.e., telework) – was more important than both compensation and opportunities for advancement.

As more organizations see the importance of offering flexibility in the workplace, we will see this touted in recruiting materials as a way to attract talented new hires.  Organizations will need to probe for more cross-generational priorities such as flexibility, and communicate with both current and prospective employees about how they are delivering on those demands.

Be prepared for generational tension.

Intergenerational conflict is impossible to prevent entirely, so be prepared to address it when it does arise.

In our survey, 66% of millennials agreed with the statement, “my personal drive can be intimidating to other generations in the workplace,” and the generations’ divergent views on what to expect in the workplace of the future further outlined that tension. A study by PricewaterhouseCoopers found the same.

Take a cue from Bank of America and Pratt & Whitney. Both  organizations have created Employee Resource Groups focusing on Multi Generational issues.

Why focus on the needs and expectations of a multi-generational workforce? Just think of your future employee, the one entering your workplace in 2030. According to the Office of National Statistics, one third of the babies born today in 2012 will live to see their hundredth birthday! Now consider the age of the oldest member on your team in 2030.

The employers who adapt most quickly to the realities of a multigenerational workforce will become the ones who attract and retain the highest-quality employees now and in the future.

From Management-Issues.com

Many tribal cultures don't have a word for "boredom". Sitting under a tree for hours at a time, waiting in line to get water from the well, or walking four days to a nearby village for medical help is just a way of life. But as technological advances penetrate societies all over the globe, impatience is mounting everywhere.

Google slowed down the speed of search results by four tenths of a second to see what impact it would have. The result was eight million fewer searches a day! A quarter of us abandon a webpage if it doesn't load within four seconds. An email that doesn't get a response within 24 hours is considered unresponsive. And one USA Today study found that most North Americans won't wait in line for more than 15 minutes.

But "impatience" + "cross-cultural" don't work well together. Cross-cultural relationships and projects inevitably take more time, more effort, and more patience. Slowing down often goes against the grain of what we're trying to accomplish.

A volunteer construction team from the U.S. traveled to Liberia to put a roof on a Monrovian school. The Liberians were extremely grateful for the N. Americans' generosity but the first day into the project, the Liberians expressed concern about whether the new roof would be well-suited to the Monrovian climate and environment.

When they voiced their concern, the volunteers replied, "Look. You have to trust us. We've worked on buildings like this all over the world. We're only here for six days. So the only way we'll get this done is if we stick with our plan."

Three months later, a monsoon came in off the Atlantic coast and the new roof came crashing down. A couple Liberian students died and several others were injured. Sometimes our "efficient"(impatient!) approach is not so great after all.

Just about everything takes longer when working and relating cross-culturally. Communication, trust-building, and just getting things done requires more effort and perseverance. Whether it's dealing with long queues when traveling, merging different technology systems, or trying to get to the bottom of a conflict, understanding and effectiveness come more slowly when different cultures are involved.

Patience needs to be factored in from the very beginning of any cross-cultural project. Long before the U.S. construction team ever arrived in Liberia, a more thorough process of determining what the need was and how to best meet it would have been valuable.

For a fraction of the cost of shipping a team to Africa, the volunteers could have sent money to have local builders put on a new roof. Or with a deeper level of analysis, they may have concluded that the roof wasn't really the problem but instead, was a symptom of deeper problems of poverty and conflict that could be better addressed by partnering with development experts.

Full disclosure. I'm terribly impatient. I hate waiting in lines, I calculate which driving lane is moving fastest, and I want things to happen quickly and according to plan. But on the rare occasion when I exercise patience, the end result is almost always better: the partnership is richer, the project gains wider acceptance, and the money invested goes further.

In a world of instant information and feedback, it's counterintuitive to step back and move more slowly. But slow is the new fast when you're working across cultures. Take a deep breath and trust that something far bigger and better can be accomplished when you patiently persevere through the hard work of listening, understanding, and discovering the possibilities that may otherwise go unnoticed when rushing to the finish line.

From USA Today

WASHINGTON – A narrowly divided Supreme Court upheld President Obama's health care law Thursday in a complex opinion that gives the president a major election-year victory.

The historic 5-4 decision will affect the way Americans receive and pay for their personal medical care in the future. It upholds the individual mandate that most Americans get health insurance or pay a penalty — and it was the penalty, or tax, that ultimately saved the law.

Chief Justice John Roberts announced the decision that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. He argued that the mandate is constitutional only because the penalty "functions like a tax" and is therefore allowed under Congress' taxing power.

"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts wrote.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the majority vote. They argued for a more sweeping approval based on the commerce clause, but the end result was the same.

Conservative Justices Samuel Alito, Anthony Kennedy,Antonin Scalia and Clarence Thomas dissented. Kennedy, who was thought to be the most likely swing vote, delivered a scathing denunciation from the bench.

"The majority rewrites the statute Congress wrote. … What Congress called a penalty, the court calls a tax," Kennedy said. "The Affordable Care Act now must operate as the court has revised it, not as Congress designed it."

President Obama, speaking from the White House after the decision, said, "Whatever the politics, today was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it.

"It should be pretty clear by now that I didn't do this because it's good politics," Obama said. "I did it because I believed it was good for the country."

Roberts — a conservative appointed by President George W. Bush— provided the key vote to preserve the landmark health care law, which figures to be a major issue in Obama's re-election bid against Republican opponent Mitt Romney.

From Advance for Nurses By Beth Puliti

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

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

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

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

Catering to the Adult Learner

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

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

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

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

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

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

Working Alongside Experienced Nurses

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

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

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

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

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

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

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

New Graduate Nurse Retention

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

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

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

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

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

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

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

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

From WorkingNurse.com By Elizabeth Hanink

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

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

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

Remember Nursing 101

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

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

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

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

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

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

Role Models

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

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

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

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

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

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

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

A Jar Full of Rocks

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

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

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

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

From NurseZone.com By Christina Orlovsky

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

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

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

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

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

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

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

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

Treating millions of veterans across the miles

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

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

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

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

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

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

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

From pr-inside.com

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

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

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

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

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

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

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

From Nurse.com News

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

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

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

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

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

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

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

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

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

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