DiversityNursing Blog

By Tom Clegg via Nurse.com 

Whistleblowers fear retaliation and the chance that nothing will be done with the information they've provided. An organization's culture should make it's employees feel safe when reporting something. But, there are still times when Nurses refrain from whistleblowing because their work culture has encouraged them not to do so. This delicate area of policy and ethics is a work in progress. As a healthcare worker, what steps do you think would help the process of reporting questionable practices?

A 2015 revision to the ANA Code of Ethics strengthened the wording of its policy that “nurses have a responsibility to assist whistleblowers who identify potentially questionable practices.” Further, New Jersey’s Conscientious Employee Protection Act protects those who report such practices from retribution.

That’s all well and good, but as nurse leaders stressed at the Organization of Nurse Executives New Jersey Research Day Conference in June in Princeton, the best way to ensure nurses and other healthcare workers feel confident they can blow the whistle is by creating the proper work environment.

That was the conclusion of a research committee study at ONE NJ to replicate work done by University of Nevada researcher Lisa Black in 2011, which identified workplace factors that influence nurses’ willingness to report.

“If you have a culture in your organization where people felt safe to report things, they would report it and have less fear of retaliation,” said Patricia Steingall, MS, RN, NE-BC, vice president of patient care services and CNO of Hunterdon Medical Center in Flemington, N.J., and president of ONE NJ.

Steingall said the biggest fears of those considering blowing the whistle are retaliation and that nothing will be done with the information provided. Nurse leaders can alleviate some of those concerns by establishing a culture of openness and by educating “staff on what are the policies about whistleblowing, assure them that there are protections in place for them and let them know what those protections are,” Steingall said.

She also stressed the importance of being sure of the facts, a point echoed by Lucille Joel, EdD, RN, APN, FAAN, Distinguished Professor, Rutgers University School of Nursing, Newark. Joel, who presented “Speaking Up: A Dimension of Professional Practice in an Ethical Context” at the conference, added blowing the whistle never is easy and always has some ambiguity.

“In regards to whistleblowing, it’s an ethical decision that runs contrary to an employer,” Joel said. “You have to be sure of the data. You have to be relatively sure, although you can’t be absolutely positive, that whistleblowing or calling governmental attention to a situation is going to be better for the client than allowing the incident to continue uncontested.”

Attorney and nurse Kathleen Gialanella, RN, JD, LLM, Esq., spoke at the conference on the legal and ethical considerations of blowing the whistle. She encourages anyone considering reporting a potentially unsafe practice to seek guidance, which may include legal counsel. She also said that although certain situations allow whistleblowers to report an incident directly to an outside body, “normally the process needs to unfold within the organization, and the organization needs to be given an opportunity to correct whatever concern the employee has.”

Gialanella said progress has been made by healthcare organizations in making staff feel more comfortable reporting incidents, but not everyone is on board.

“Some organizations are ahead of others in adopting that kind of culture,” she said. “There are many situations where nurses still are not comfortable bringing a concern to the attention of their supervisor, and it’s because of a culture (in which) they’re not really encouraged to do so.”

Tom Clegg is a freelance writer.

By Debra Wood, RN, contributor via www.americanmobile.com 

It appears there will be a positive future relationship between Nurses and health apps that will benefit the healthcare team and patients. These health apps will cause a shift from reactive to proactive care while providing benefits for healthy and chronically ill patients.

Living services, technology that learns and evolves to meet the needs of the consumer, is fast approaching as consumer expectations converge with increasingly sophisticated sensor and communication devices. Nurses may soon see a time when smartphones warn of impending depression or a stomach-activated patient monitoring sensor lets them and the physician know how the patient is taking a prescribed medication.

“It is something that is changing the way medicine is being practiced,” said David Collins, senior director of HIMSS mHealth Community. Collins said that while much of the technology for connected health care is available today, issues remain in regard to reimbursement, and patient acceptance and engagement. However, with accountable care organizations and other shared-risk programs, reimbursement is based on outcomes, not fee-for-service. 

“[This technology] is a tool to allow accountable care organizations to keep cost at a certain level and have an advantage in the marketplace,” Collins added. “Things are moving toward population health management. It’s more of a team-based approach.” 

The shift from reactive to proactive care

Those teams may form around patients at high-risk for costly hospital care. Nurses may coordinate care and monitor incoming information from sensors, scales or other technologies. The nurse may assess remotely and help with self-care or changes in the medical plan, based on protocols or the advice of a provider. 

“Applications could trigger nurses when a patient shows up in an emergency room, and then information could be delivered to the physician at the point of care,” explained Carolyn Richardson, MSN, MBA, RN-BC, regional nursing officer for Zynx Health based in Los Angeles. The company offers ZynxCarebook, a mobile platform to help identify members of a patient’s health team and communicate health information and coordinate care across settings.

Rick Ratliff, managing director of digital health at Accenture based in New York, reported that Accenture has predicted that Food and Drug Administration-approved internet-connected solutions created for detection and treatment of a medical indication are poised to save the health care industry more than $100 billion by the close of 2018.

“Longer-term, these IOT (Internet of Things) technologies represent a shift from reactive care--centering exclusively on in-person visits with nurses and doctors--to proactively managing a patient’s health with interlinked solutions and services geared to an individual,” Ratliff said. 

Benefits for healthy and chronically ill

Currently, Apple has created much buzz with the health apps on Apple Watch, and FitBit has grown quickly in popularity. People are wearing both and tracking their fitness activities. But self-care is also going mainstream, with the health insurer Health Care Service Corp. (HCSC) releasing the Centered app for the watch and phone. The app takes a holistic approach to stress management by allowing users to track their daily physical activity while providing guidance for meditation exercises to help reduce stress levels and improve overall health. Nurses could use this health app to manage their own stress or teach patients how to meditate with it. 

“Our research indicates that an abbreviated, self-guided, online version of the popular Mindfulness-Based Stress Reduction program can help people recognize stress triggers and gain greater insight in managing their health and well-being,” said Conway McDanald, MD, vice president and chief medical officer, Behavioral Health, HCSC. 

While these types of health apps may be valuable to active individuals interested in promoting self-care, Dean Sawyer, CEO of Sentrian in Aliso Viejo, Calif., believes the greater benefit will come from tracking the chronically ill. This can be done with biometric devices able to pick up trends of deterioration in the patient’s condition before symptoms become noticeable--for instance, with congestive heart failure monitoring thoracic fluid and stroke volume changes. Then the clinician can intervene to prevent costly exacerbations. Sentrian is developing and piloting such a remote patient intelligence platform, using biosensors and a rules-based monitoring program. 

“It’s helping physicians make better decisions,” Sawyer said.

Many local health systems are creating various technologies for collating patient data and monitoring indicators of chronic conditions, Ratliff reported. Internet-connected devices using sensors capture continuous health indicators and can transmit real-time patient monitoring data to health care professions. Medical practices and hospitals must create systems to receive and coordinate the incoming data and allow healthcare professionals to take action. 

“Several hospitals are finding early successes in their ability to improve medication adherence, improving behavioral modifications and preventing emergency room visits,” Ratliff said. “It’s the notion that extending care services beyond the brick and mortar that is today’s health care system allows self-care to follow a continuous cycle of prevention, management and improvement.” 

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Craig Silverman via Buzzfeed

This story is about a Nurse who was in a horrific car accident and had the presence of mind to set her 2 broken legs. She realized she’d most likely face amputation if she didn’t do something about it pronto! We think she’s brilliant to have kept her head and used her training in a very stressful situation.

The last thing Stacie Reis remembers before the accident is driving and eating an ice cream cone. Her next memory is of waking up in immense pain inside a mangled car.

Reis was driving on a highway in Northern British Columbia. For some reason, her car went off the road and tumbled down an embankment.

The crash broke both of her legs, as well as her sternum and pelvis. Her heart and lungs suffered contusions. Other parts of her body were fractured.

Reis is a nurse at the University Hospital of Northern BC. She knew from her training that her legs were seriously injured and needed to be set quickly or face amputation.

“The way they were pinned, it wasn’t natural,” she told the Prince George Citizen. “The nurse in me was like, ‘You need to straighten these out otherwise you’re going to cut off your blood supply, you’ll lose your legs.”

Reis picked up her legs and moved them to set them straight. “It was really painful but I did it,” she told Global News.

She spent the next 14 hours praying, thinking, and sleeping as she waited to be found.

The accident happened around 6:30 p.m. on July 4, when Reis was on her way back from visiting her dying grandfather. He died at 1 a.m. that night.

A group of friends finally found her around 8 a.m. the next morning, the Citizen reported.

The day after the accident, one of her fellow nurses set up a GoFundMe page to raise money for Reis’s recovery. It had hoped to raise $5,000 and is currently at more than $16,000. A fundraiser was also held in a pub on Prince George.

Reis has undergone five surgeries and a skin graft. She’s now able to take small trips on hospital grounds.

Here’s Reis and an adorable visitor who will eventually realize she was in the presence of Canada’s Most Badass Nurse.

Robert Gebelhoff via The Washington Post 

What are your thoughts about delivering a baby at home versus in the hospital? This article explores both options and points out that delivering a baby at home can be cheaper than in the hospital. After reading the article, we’re curious to hear your thoughts. Thank you.

Having a baby is expensive, and the biggest bills almost always come from the hospital.

But a new study from the University of British Columbia, published this week in the journal PLOS One, found that a lot of money can be saved by having the birth at home with the help of a midwife.

The practice is highly controversial in the United States, as some doctors say the practice can be dangerous and is tied to higher infant death rates. Others argue that with a regulated system for midwives, planning home births may reduce health-care costs for pregnant couples.

The UBC researchers looked at all home births attended by registered midwives in British Columbia over a four-year period, and found that for the first 28 days of a baby's life, planned home births saved an average of $2,338 (in Canadian dollars) compared to hospital births with a midwife. The savings were even greater when compared to hospital births with a physician, at $2,541.

Health-care savings continued even to the baby's 1st birthday, the study found, with at-home births saving $810 compared to hospital midwives and $1,146 compared to physicians. These averages account for all planned home births, even if the delivery actually ended up at hospitals due to unanticipated situations or complications requiring emergency cesarean deliveries.

"Mothers are keenly interested about the safety of home birth," said Patricia Janssen, author of the study and a UBC professor. "Having a baby is a healthy process for most people. ... The best place for women is not always a hospital."

She argues that home births are just as safe as those at a hospital, as evidenced by the lower health-care costs for parents who decide to deliver at home.

"Had there been hidden costs, we could have seen them in the health system," Janssen said.

Although out-of-hospital births make up less than 1 percent of total deliveries in the U.S., they have been on the rise between 2004 and 2009, according to the latest data from the Centers for Disease Control.

Previous studies looking at home births found similar health-care savings in the United States. One study, looking at Medicaid claims in Washington State, reported that vaginal hospital deliveries cost $2,971 more than at-home births. Hospital cesarean deliveries cost even more, at $5,550 higher than at-home births, the study found.

Amos Grunebaum, a specialist in maternal-fetal medicine at Weill Cornell Medical College, argued that Janssen's study only applies to Canada due to a few key differences between the Canadian and American health systems.

The Canadian system essentially works like Medicare, but for the entire population — so the discussion of increasing at-home births there is more broadly a matter of public spending policy. The country's midwifery system is also highly regulated at the province level. In British Columbia, all midwives are required to be registered with the College of Midwives of British Columbia to be permitted to practice.

In the United States, there is no blanket licensing system for midwives. Only 28 states legally authorize midwives to practice, but in other states, Grunebaum said, midwives can practice with a high school education.

"I don't even call them midwives," he said. "They are 'so-called midwives.' "

Even if the midwives are licensed, many doctors in the U.S. still urge mothers to go to the hospital for delivery. Grunebaum compared at-home births to going swimming at the beach without a lifeguard on duty or buying a car without seat belts. Even if there are no extra health-care costs reported in the first year of a baby's life, he said there's a higher risk for brain damage in babies that would be seen over the course of their first 10 years.

"A planned home birth is potentially more dangerous," he said. "Interventions in the hospital are meant to save people. ... We should bring the home to the hospital, not the hospital to the home."

Mary Bowerman, USA TODAY Network 

As Nurses, I'm sure you’ve seen a wide variety of ways women deal with their labor pains. But have you ever had a patient dance the pain away? This woman did it and we want to thank her husband for getting it all on video.

A Boston woman suffering from labor pains decided to dance through it in her hospital room.

The video, taken on Tuesday at the Brigham and Women's Hospital in Boston, shows Yuki Nishizawa doing the butterfly, side shuffle and "Tootsee Roll" as her husband and hospital staff laugh in encouragement.

Her husband Connell Cloyd uploaded the video of the dance routine on Tuesday, and as of Thursday the video had over 3 million views.

"I know I shouldn't be laughing as a husband, but she wanted to be famous, so I guess this is how you do it, doing the tootsie roll in labor," Cloyd says while laughing.

In the video, Nishizawa says her "water is breaking" but continues to dance.

Liz Szabo via USA Today 

As a Nurse, I bet you have an opinion on this story about the FDA’s approval of the pain medication, OxyContin, for children as young as 11 years old. If you’re a parent of a severely sick child, I wonder if your opinion is different? This is a controversial decision by the FDA and we welcome your thoughts on this story.

The Food and Drug Administration has approved the powerful narcotic painkiller OxyContin for children as young as 11. While doctors who treat young cancer patients hailed the approval, others expressed concern that prescribing OxyContin to children could put them at risk for addiction.

OxyContin, an extended-release version of the painkiller oxycodone, has gained notoriety in recent years because of its frequent abuse. People addicted to painkillers crush the pills so that they can be snorted or injected, producing a powerful high.

In 2010, Purdue Pharma reformulated OxyContin to make it more difficult to abuse.

The FDA notes that children generally have many fewer options for pain relief than adults. Because of that problem, the FDA asked Purdue to perform studies to see if the drug could be used safely in children ages 11 to 16 with pain caused by cancer, trauma or major surgery, said Sharon Hertz, a physician with the FDA's Center for Drug Evaluation and Research, in an interview on the agency's website.

The FDA approved OxyContin for children this age who need "daily, round-the-clock, long-term" pain relief for which there is no alternative, Hertz said. Doctors should only prescribe OxyContin in children who have already been treated with opiate painkillers and who can tolerate at least 20 milligrams a day of oxycodone.

Other than OxyContin, the only other long-acting painkiller approved for children is Duragesic, also known as fentanyl, Hertz said.

"Children are not treated with opioids very often and usually it's only for a limited period of time with close supervision by health care professionals," Hertz said. "Fewer daily doses may free patients for physical therapy appointments, allow them to go home from the hospital sooner and may help them to sleep through the night without waking up."

Doctors who treat pediatric cancer patients hailed the approval as a way to ease children's suffering. Children at the end of life aren't at risk of addiction.

Having additional long-acting painkillers "is going to be tremendously helpful for treating children with cancer pain or pain at the end of life," said Justin Baker, pediatric oncologist and hospice and palliative medicine doctor at St. Jude Children's Research Hospital. Long-acting medications prevent breakthrough pain, so that youngsters can feel comfortable and "focus their energy on being a kid instead of fighting their pain," Baker said.

But prescribing OxyContin to youngsters with short-term medical needs could be put them at risk for developing an addiction that haunts them long after they leave the hospital, said Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing. Teens are at higher risk of addiction than adults because the brain doesn't mature until about age 25. Studies show that about one in 25 high school seniors has abused OxyContin, said Scott Hadland, a specialist in adolescent medicine and substance abuse treatment at Boston Children’s Hospital and Harvard Medical School.

"Among adolescents who are prescribed OxyContin, a small but significant number are going to become addicted," Hadland said.

The number of prescription painkillers sold in the USA has quadrupled since 1999, according to the Centers for Disease Control and Prevention. More than 44,000 Americans die of drug overdoses each year. Some people who become addicted to prescription painkillers switch to using heroin, which has become cheaper and easier to access than OxyContin.

Kolodny said it's concerning that the FDA approved OxyContin for children without appointing an advisory panel to discuss the risks and benefits, a process traditionally used when the agency faces a controversial decision.

Hadland said doctors need to take special precautions when dispensing painkillers, such as prescribing limited amounts, so that people don't end up with extra pills that they don't need. Doctors should screen patients for drug and alcohol abuse before prescribing OxyContin, Hadland said. And doctors should check their state's prescription drug monitoring program, which allows them to see if patients have already received painkillers from other doctors.

Parents should be in charge of giving children the medication, instead of allowing teens to administer their own painkillers, Hadland said. Parents should keep painkillers locked away at all other time.

Written by Richard Harris via www.npr.org 

Bob Marley said, "One good thing about music, when it hits you, you feel no pain." Another good thing about music, researchers believe it can reduce pain. 

Hospitals have a free and powerful tool that they could use more often to help reduce the pain that surgery patients experience: music.

Scores of studies over the years have looked at the power of music to ease this kind of pain; an analysis published Wednesday in The Lancet that pulls all those findings together builds a strong case.

When researchers in London started combing the medical literature for studies about music's soothing power, they found hundreds of small studies suggesting some benefit. The idea goes back to the days of Florence Nightingale, and music was used to ease surgical pain as early as 1914. (My colleague Patricia Neighmond reported on one of these studies just a few months ago.)

Dr. Catherine Meads at Brunel University focused her attention on 73 rigorous, randomized clinical trials about the role of music among surgery patients.

"As the studies themselves were small, they really didn't find all that much," Meads says. "But once we put them all together, we had much more power to find whether music worked or not."

She and her colleagues now report that, yes indeed, surgery patients who listened to music, either before, during or after surgery, were better off — in terms of reduced pain, less anxiety and more patient satisfaction.

Maybe most notably, patients listening to music used significantly less pain medication. Meads says, on average, music helped the patients drop two notches on the 10-point pain scale. That's the same relief typically reported with a dose of painkilling medicine.

Some hospitals do encourage patients to listen to music, but Meads says the practice should be more widely adopted, given the evidence of its effectiveness.

In many of these studies, she notes, the patients chose the music they listened to. "It could be anything from Spanish guitar to Chinese classical music."

And, unlike drugs, she says, music "doesn't seem to have any side effects."

Well, there may be one side effect. A few studies (such as this one) have noted that operating rooms are very noisy places, and music played in the room can make it harder for the surgical staff to hear what's going on. Doctors sometimes have to repeat their commands, creating opportunities for misunderstanding or error.

"If surgeons are listening to music, it can be a bit of a distraction," Meads says. "So it may be it's not such a wise idea to have it during the operation itself."

That was not, however, something Meads analyzed in her study of music and medicine. Many surgeons listen to music during a procedure; discouraging that habit could be a tough sell.

Meredith Melnick and Lilly Workneh via www.huffingtonpost.com 

The Huffington Post is launching “Better Black Health” this week to address the ever-increasing health disparities in the black community. Their editorials hope to raise awareness, create discussions and discover ways to fix these disparities. Please read on for more information.

The inequalities African Americans battle are plenty and severe -- but the widening health gap is arguably among one of the most crucial and inadequately addressed concerns.

Better Black Health hopes to help change that.

Today, HuffPost's Black Voices and Healthy Living are launching a new editorial initiative that aims to dissect disparities in health and discuss ways to combat them.

Better Black Health seeks to raise awareness around the health gap and spotlight efforts to make the medical field more inclusive. We hope, through our reporting, to inspire efforts to engage communities in practicing healthy habits and empower people to make wellness a priority.

During Breast Cancer Awareness Month, we spoke with Dr. Karen M. Winkfield, a Harvard affiliated oncologist about disparities in breast cancer survival rates. Nationally, she said black women are 40 percent more likely to die from breast cancer following a diagnosis, compared to white women. In some cities, she said that disparity can jump to as high as 111 percent.

But that wasn't the most shocking discovery we made during our interview: Winkfield revealed that she was the only black radiation oncologist in Boston -- and only one of three black radiation oncologists in all of New England. Her career experiences may be not common among black men and women, but her story, and her voice, should be shared as a way to help inspire others.

Looking at the larger scale, African Americans make up just 5 percent of clinical trial participants. They have the highest cancer death rate and shortest survival time of any ethnic group in the United States, according to the American Cancer Society. African Americans are 20 times more likely to have heart failure before the age of 50, and the list goes on: when it comes to diabetes, early onset Alzheimer's and a host of other conditions, the black community fares worse.

When we talk about structural injustice, we cannot forget our health institutions. From clinical research to quality hospital access to diversity in the very profession of medicine, representation of African Americans is woefully low.

As the Black Lives Matter movement sweeps the nation, it would be remiss to not use this time as a moment to discuss not just the death, but the preservation and physical conditions of black bodies. Conversations can't end at violence and injury -- instead, we must also acknowledge that health, wellness and the security of quality health care are important aspects of a life well-lived.

Better Black Health is committed to carrying on that conversation -- and we hope you join the discussion.

Jennifer Thew, RN, for HealthLeaders Media

Have you ever been at work and found yourself having a repeated conversation about the same topic over and over again? Do some days feel like dejavu? Well, you are not alone. The Nursing profession has issues that have been around forever and these professionals want to discuss ways of moving towards the future instead of being held back by its past.

A dean of nursing, a CNO, and a former staff nurse share their thoughts on issues that have long plagued nursing, and discuss how to create a more cohesive profession.

Cherry Ames, The English Patient, and Nurse Jackie are all well-known, fictional works that depict nurses. Yet, if I had to choose the one that most accurately represented our profession, I'd actually go with a write-in candidate— the movie Groundhog Day. Yes, the Bill Murray movie. Yes, I know none of the characters are nurses.

I'd choose it because Murray's character is forced to repeat the same day over and over until he's finally able to learn from his mistakes and break the cycle. I think the nursing profession suffers this same fate at times. For decades, we've been going around and around on issues such as educational preparation, staffing levels, and even proper hand washing.

Unlike Bill Murray's vexed, but persistent character, we can't seem to come to a resolution that will break the cycle of repetition.

I spent the majority of my nursing career as a staff nurse, with a brief foray into management, so when the book, The Nurse's Reality Shift: Using History to Transform the Future, crossed my path, I was eager to talk with its author, Leslie Neal-Boylan, PhD, RN, to get some insight on how nursing can move forward to the future rather than continuing to be bogged down by the past.

For our discussion, Neal-Boylan, who is dean and professor of the College of Nursing at the University of Wisconsin-Oshkosh (my alma mater), we focused on a few issues that persist in nursing: staff shortages and disunity.

After we spoke, I caught up with Kathy Bonser, MS, RN, vice president and chief nursing officer at SSM Health DePaul Hospital in St. Louis, to get a nurse executive's take on the same issues:

Shortages: A Thing of the Past, and of the Future

Since the 1930s, nursing has gone through cycles of shortages and surpluses. While the RN shortage predicted to occur around 2014 was muted by the 2008 economic crash that prevented seasoned nurses from retiring, the Health Resources and Services Administration says about one-third of the nursing workforce is approaching typical retirement age. If this group does retire, we'll need to educate new nurses to fill the open positions.

Fortunately nursing school enrollment is up, says the American Association of Colleges of Nursing. However, qualified candidates are being turned away—68,938 from baccalaureate and graduate programs in 2014—and one of the contributing factors is a shortage of nursing faculty. According to the association's survey on vacant faculty positions, there were 1,236 vacant full-time faculty positions for the 2014–2015 academic year.

"In academe, shortages of qualified faculty are a big challenge," says Neal-Boylan. "More and more people want to be nurses, which is wonderful, but having doctorally prepared nurses is a challenge. And certainly the DNP has helped with that, but it really was not designed for a nurse educator per se in academe."

While Bonser has not yet seen a large shortage of nurses at her facility, she says that a faculty shortage could indeed affect the number of nurses coming into the pipeline. And if hospitals choose to go the route of only hiring BSN-prepared nurses, they may feel the pinch sooner rather than later.

At SSM, they've "been pretty successful recruiting the graduate nurses because some of our competitors in the market made that choice to only hire BSN," she says. "We've stayed committed [to hiring ADN nurses] because of relationships that we have with many of our community colleges that surround our hospitals."

I graduated with a BSN in 1998, at the beginning of a nursing shortage. My career advice to new nurses is to be flexible and be willing to move to find a job. My advice to nurse executives looking to fill nurse vacancies is to extend your recruitment efforts nationwide rather than just locally.

Disunity: 3.1 Million Nurses Can't Agree

Nursing administration and staff nurses often don't see eye-to-eye on major issues and a gap the size of the Grand Canyon has opened between them.

"Because of how we've set things up in nursing, there's not a lot of opportunity for those two groups to interact and to appreciate and understand what the other is doing for nursing and to really maximize what we could do if we were much more cohesive," says Neal-Boylan.

This can result in "…people who are very much in the position of making a lot of decisions for the profession and might not necessarily be close anymore to what the actual needs are of the nurse who's taking care of the patient," she says.

Bonser says she does not feel this disconnect at SSM DePaul, but she agrees that nurse executives need to stay attuned to what direct care nurses need. She even encourages giving those at the point- of-care the power to make decisions. "From an organizational perspective… I've got to have the people at the bedside making decisions about how the work is done because I can't possibly know that," she says.

In addition to a shared governance model, executives at SSM DePaul do monthly leadership rounds in all of the hospital's departments. "That's how we stay connected to our front line staff and understand and learn from their perspective what is satisfying them in their work, what's making their work harder, and what barriers do I, as a leader, need to help remove for them."

I have to say that this topic cuts both ways. I've heard many staff nurses say they have never felt valued by a CNO or nurse manager, but I also wonder if these same nurses extend the respect they crave to their executives.

When something does go right or a good decision is made do they thank their unit director or other nurse executives? Do they have the moral courage to speak up and articulate a problem in a professional way so it can be solved? If not, they probably should, because as I learned from a CNO I once worked with, "a closed mouth cannot be fed."

In order for things to change, you have to ask for what you need in a respectful, articulate manner. Working to make respect flow back and forth among nurses of all positions is one way I think we can to start building a united profession.

Think of all that nurses could accomplish if they could set a unified agenda and speak with a unified voice. We could truly change the health of the nation if all 3.1 million of us acted as one.

Written by Peter Lam www.medicalnewstoday.com

I think many parents would agree that high school starts too early in the morning. Some may even say students probably sleep through the first class of the day. The CDC has conducted a massive study and found that students should not be getting up so early. Maybe this study will help change the start times of high schools.

Morning can often be a challenging period for tired students as they prepare themselves for the coming day, but should they be getting up so early?

According to a study published in the journal Pediatrics, the answer is no.

Sleep is particularly critical for teenagers, but many do not get enough. Medical News Today earlier reported how the number of hours slept per night has decreased among teenagers in the US over the past 20 years.

Between 8.5-9.5 hours of sleep per night are recommended for teenagers. However, the proportion of high school students who fail to get enough sleep is estimated to be 2 out of 3 and has remained like this since 2007.

To investigate the role of school times on students' sleep patterns, researchers from the Centers for Disease Control and Prevention (CDC) and the US Department of Education reviewed data collected from the 2011-2012 Schools and Staffing Survey. Nearly 40,000 public, middle, high and combined schools were reviewed in the study.

They found the majority of middle and high schools were starting the day too early. Fewer than 1 in 5 schools began at the recommended time of 8.30 am or later.

Lead author Anne Wheaton, PhD, an epidemiologist in the CDC's Division of Population Health explains the importance of sleeping. She says:

"Getting enough sleep is important for students' health, safety, and academic performance. Early school start times, however, are preventing many adolescents from getting the sleep they need."

Other key findings from the study include:

• 42 states reported that 75-100% of the public schools in their respective states started before 8.30 am
• The average start time was 8.03 am
• The percentage of schools with start times of 8.30 am or later varied greatly by state. No schools in Hawaii, Mississippi, and Wyoming started at 8.30 am or later; more than 75% of schools in Alaska and North Dakota started at 8.30 am or later
• Louisiana had the earliest average school start time (7.40 am), while Alaska had the latest (8.33 am).

Study strongly recommends schools start later

The study concludes by strongly recommending schools start later, but also warns other factors must be addressed to have a significant effect.

The study advises health care professionals, especially those working in schools, should be raising awareness of the importance of adequate sleep. Earlier this year, MNT reported how teenagers' sleep was being "adversely affected" by media devices.

To combat this, the study recommends pediatricians take an active approach supporting and educating families on healthy sleeping habits. In particular, parental involvement in setting bedtimes and supervising sleep practices is encouraged, such as the use of a "media curfew."

The decision of school start times are not determined at federal or state level but at district or individual school level. The data utilized was taken between 2011-2012, so further research is required to see if schools have heeded the recommendation, and if so, what effect this has had.

Sleep can easily be neglected in today's world. Last year, the CDC described the issue of insufficient sleep in society as a "public health epidemic." The US Government has sought to address the issue of insufficient sleep by selecting it as one of the new topics of the Healthy People 2020 initiative.