DiversityNursing Blog

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We all know and love Nurses, but isn’t it wonderful when a research study validates something you already know? We think you’ll enjoy this article.

If you’ve ever had a loved one in the hospital, you know how important nurses are. Studies show that the amount of time that nurses spend with patients is related to fewer errors. And according to a new study, investing in nursing is key to patient outcomes, including the risk of dying while in the hospital.

The study’s researchers, a team from the University of Pennsylvania, wanted to understand why certain hospitals have better outcomes than others. Specifically, the UPenn team was trying to explain why hospitals in the Kaiser Permanente health care system — an integrated health network in eight states that includes hospitals, insurance, and doctors’ offices all in one system — have such efficient and high-quality care. 

Other organizations have tried to mimic Kaiser Permanente’s organizational structure in order to improve care, but with mixed results. The researchers thought there might be a different X factor that could explain Kaiser’s success: nurses.

In order to find out, the study looked at more than 550 hospitals in California, New Jersey, Pennsylvania, and Florida, including 25 California-based Kaiser Permanente hospitals and 56 Magnet hospitals. Magnet hospitals are recognized by the American Nurses Credentialing Center for being good workplaces for nurses.

Nurses in each hospital answered surveys about their work environment, level of education, job satisfaction, and the number of patients visited during a typical shift. The researchers also pulled data on patient mortality.

“It turns out that, by and large, nursing differences accounted for much of the mortality difference that we saw in Kaiser Permanente hospitals,” says study author Matthew McHugh, PhD, RN, a professor at the University of Pennsylvania School of Nursing.

The results were clear: The odds of dying were about 20 percent lower in Kaiser Permanente and Magnet hospitals, and differences in nursing accounted for “a sizeable portion of the advantage,” according to the study. The analysis adjusted for factors such as hospital size and the severity of patients’ conditions.

“It turns out that these differences we see in nursing, in terms of work environment, staffing levels, investment in nursing around a highly educated workforce, those things translate into better outcomes,” McHugh tells Yahoo Health. 

There were a few specific factors that made Kaiser and Magnet hospitals stand out from the rest, McHugh explains:

1. Better work environments

Happier nurses mean healthier patients, research shows. “We find that places where nurses have a good experience working are places where nurses are better able to do their jobs. They’re more autonomous, they’re supported by management, and they’re integrated into hospital decision-making,” McHugh says.

Empowered nurses have better relationships with physicians, “so when they say ‘something isn’t right,’ they’ll be taken seriously,” McHugh adds. And patients can receive faster and more efficient care when nurses are authorized to make decisions such as when to remove a catheter, for example.

In fact, a study published last year in the Journal of Nursing Administration found that empowered nursing units are more effective and report better patient care compared to units with less authority.

Tangible changes matter, too. In response to the nurse shortage in the early 2000s, Kaiser Permanente made a deliberate, research-based effort to invest in nursing, says Marilyn Chow, PhD, RN, Vice President of National Patient Care Services and Innovation for Kaiser Permanente. 

A study of Kaiser hospitals conducted in 2005 and 2006 found that nurses spent more than 35 percent of their time on documentation. Starting in 2005, the system switched to electronic medical records, which helped streamline paperwork. They also observed that nurses spent a lot of time hunting and gathering equipment and information — checking to see if a medication was ready, for instance. In response, Kaiser Permanente rearranged the work environment to make things more convenient. (Nurses now receive a notification when meds are ready for pickup.)

“We wanted to make sure that we were a place that nurses wanted to work,” Chow tells Yahoo Health. “If you have nurses who are happy and joyful at their work, they will definitely pass that on and be caring and compassionate.”

2. More nurses with Bachelor’s degrees

The role of the nurse is much more complex than it used to be, Chow explains. “The role is not only surveillance, but facilitating and coordinating the care, and not just for one patient, but for four to five patients … there are so many things to take care of,” she says. Patients also arrive sicker and leave the hospital earlier, Chow and McHugh say, which puts an extra demand on nurses to coordinate care and teach patients and family members what to do when they arrive home. 

“Hospitals are very complex, and integrating all of that information requires a certain set of skills and requires you have a pool of knowledge within the overall nursing staff,” McHugh explains. He adds that the study observed a wide variation in nurse education from hospital to hospital, and that variation was associated with adverse events.

3. More nurses, period

Kaiser Permanente hospitals have a 4-to-1 patient-to-nurse ratio, on average, compared to 5-to-1 in non-Magnet hospitals, the UPenn study found.

Having more nurses ensures that there are enough eyes in rooms monitoring patients. It also means that nurses have sufficient time to follow up with patients and communicate effectively. “Nurses are at the bedside and are working with all the other providers. They’re the essential person for monitoring patient condition, and if something bad does happen, intervening and mobilizing the intervention response,” McHugh says.

Shelly Lopez Gray

Recently, a nurse made headlines for dropping a newborn, fracturing the baby's skull. The parents, understandably upset, claim the nurse should have known better than to hold the baby if she was sleepy. As a labor and delivery nurse, here is what I wish I could say to every mother out there, what I'm sure many of us would want to say to the families we care for:

Accidentally hurting your baby is one of our biggest fears. No nurse goes to work thinking they want to hurt someone. None of us leave our house thinking, "I really want to make someone suffer." There are a million and one ways a nurse can accidentally do something wrong. And every day, all day, we are very conscious of this fact and we work hard to provide the best care we possibly can... even if we're short-staffed, even if our assignments are difficult, even if every room on our unit is full. Even though we literally have 20 things to do at any given moment with a handful of different, complicated patients, we strive to provide compassionate care in a timely manner while struggling to chart every single action we take. We know we're going to make mistakes... our only hope is that the mistakes we make do not cause harm.

That nurse made a lot of right decisions. I'm just keeping it real -- but seriously, that nurse could have made a lot of other really bad decisions. She could have dropped the baby and not told anyone. Even though she was probably frightened and distraught that her action caused a baby harm, she chose to do the right thing and immediately get the baby evaluated.

A nurse's mistake can have many consequences. No one is asking why the nurse had the baby in the first place. I would bet any amount of money that she was trying to allow an exhausted mother to get a few minutes of uninterrupted sleep. And although I do not agree with this practice, I'm sure her intentions were pure. What people who are not nurses do not understand is that our mistakes can have many consequences. If we make a mistake, we can be peer-reviewed, which means our actions are brought before a committee to determine our nursing fate. We could lose our nursing license, leaving us unable to work or financially support ourselves or our family. If it's deemed we were neglectful, criminal charges could be filed against us, and we could face hefty fines or even jail time. And our actions at work and at home are all up for examination and scrutiny.

That nurse is suffering right now. I don't say this to diminish any anguish the family must feel that their baby was hurt while in the care of a healthcare provider. But wherever that nurse is right now, I promise you that she has been suffering. As I said before, no nurse goes to work wanting to hurt someone. She has had to endure being judged by her peers, questioning whether or not her facility would support her, and knowing that she caused a family distress. This is an incident that she will never forget, an incident that will probably taint her 30-year memory of nursing.

If you would have dropped your baby while in the hospital, the nurse would also be blamed. I don't believe healthy mothers and healthy babies should be separated while in the hospital. I don't believe a nurse should take a baby from a mother, even at her request, so that the mother can get uninterrupted sleep. This may not be a popular opinion, but as nurses, we need to see how these mothers interact with their babies even when they're exhausted and sleep-deprived. But this leads to another issue... even if this mother would have dropped her own baby, the nurse and hospital would still be blamed. It would have been all about rounding and if it was documented that the nurse educated the patient not to sleep with the baby in the bed or if the room was free of clutter. As nurses, we have to be everything to everyone.

We are all human. As I drive to work tomorrow, I will think of the patients I will meet and care for. And as I walk through the doors of my hospital, I will think the same thing I have thought every single day since I graduated from nursing school: Just don't hurt anyone. I know I will make mistakes. I'm human. But I hope I never make a mistake that hurts or kills someone. And that is a fear that lives inside of every nurse everywhere. My thoughts are with this family, and my thoughts are also with this nurse. To every nurse out there -- May the mistakes we make tomorrow bring no harm to the patients we try to give so much to.

Until my next delivery ♥

www.huffingtonpost.com

Wait until you see this beautiful surprise! She’s amazing; he’s a thoughtful guy; and they’re are a special couple.

Lucas D'onofrio's girlfriend will remember her last chemotherapy session for the rest of her life. 

Martie Schultz

We found a story about a Nurse who has been in the profession for decades and she’s still working a couple days a week. She is an inspiration and we hope you’ll enjoy it.

SeeSee Rigney, an operating room nurse at Tacoma General Hospital in Tacoma, WA, celebrates her 90th birthday with her coworkers, and six decades of nursing. She is an inspiration to all! God bless you my friend. We love you and can only hope to have half of the energy you have at your age.

By ALEXANDRA ROBBINS

www.nytimes.com 

SEVERAL emergency-room nurses were crying in frustration after their shift ended at a large metropolitan hospital when Molly, who was new to the hospital, walked in. The nurses were scared because their department was so understaffed that they believed their patients — and their nursing licenses — were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent.

The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four (and just two for patients bound for the intensive-care unit). Molly — whom I followed for a year for a book about nursing, on the condition that I use a pseudonym for her — was assigned 20 patients with non-life-threatening conditions.

“The nurse-patient ratio is insane, the hallways are full of patients, most patients aren’t seen by the attending until they’re ready to leave, and the policies are really unsafe,” Molly told the group.

That’s just how the hospital does things, one nurse said, resigned.

Unfortunately, that’s how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios.

Dozens of studies have found that the more patients assigned to a nurse, the higher the patients’ risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital — and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.

In pediatrics, adding even one extra surgical patient to a nurse’s ratio increases a child’s likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses’ working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.

Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patient deaths, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse. (The Massachusetts Nurses Association, a labor union, sponsored the study; it was conducted by an independent research firm and the majority of respondents were not members of the association.)

And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because, during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages. (A spokesman for the hospital disputed this characterization of the events.)

It’s not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. “It happens all the time, and nurses are harassed into taking what they know are not safe assignments,” she said. “The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up.”

The landscape hasn’t always been so alarming. But as the push for hospital profits has increased, important matters like personnel count, most notably nurses, have suffered. “The biggest change in the last five to 10 years is the unrelenting emphasis on boosting their profit margins at the expense of patient safety,” said David Schildmeier, a spokesman for the Massachusetts Nurses Association. “Absolutely every decision is made on the basis of cost savings.”

Experts said that many hospital administrators assume the studies don’t apply to them and fault individuals, not the system, for negative outcomes. “They mistakenly believe their staffing is adequate,” said Judy Smetzer, the vice president of the Institute for Safe Medication Practices, a consumer group. “It’s a vicious cycle. When they’re understaffed, nurses are required to cut corners to get the work done the best they can. Then when there’s a bad outcome, hospitals fire the nurse for cutting corners.”

Nursing advocates continue to push for change. In April, National Nurses United filed a grievance against the James A. Haley Veterans’ Hospital in Tampa, which it said is 100 registered nurses short of the minimum staffing levels mandated by the Department of Veterans Affairs (the hospital said it intends to hire more nurses, but disputes the union’s reading of the mandate).

Nurses are the key to improving American health care; research has proved repeatedly that nurse staffing is directly tied to patient outcomes. Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right.

The Nursing profession is in dire need of an IT upgrade. The way the nursing profession currently handles information is costing time, money, patient health and more importantly, lives. Creating an integrated health IT system will address these costs, as well as reducing errors among hospital staff and mistakes with prescriptions both when they are written and when patients obtain them.

To learn more checkout the following infographic, created by the Adventist University of Health Sciences Online RN to BSN program, that illustrates the need, benefit and impact of Health IT in nursing.

By GILLIAN MOHNEY

http://abcnews.go.com 

A 15-year-old California softball player is reportedly fighting for her life days after a brain aneurysm led her to collapse on the field.

Dana Housley told her coach she “felt dizzy” before collapsing on the field, according to ABC's Los Angeles station KABC.

She was taken to Kaiser Permanente in Fontana, California, where she is on life support, according to KABC. Hospital officials did not comment further on the case, citing privacy laws.

As Housley’s teammates rally with messages of support with the hashtag #PrayforDana, experts said that the teen’s case can help put the spotlight on this mysterious condition that affects an estimated 6 million Americans.

Experts are quick to point out that Housley’s activity on the softball team likely had no bearing on her developing a brain aneurysm or having it rupture.

“The biggest mystery is why they form,” Christine Buckley, the executive director of the Brain Aneurysm Foundation told ABC News.

Just two days after Housley’s hospitalization, a teen baseball player reportedly died after being hit by a baseball. In that case, the cause of death was not yet released, though his grandfather told a local newspaper that one cause may have been an underlying condition, including possibly an aneurysm.

Teens rarely develop aneurysms, but those that do often do not understand their symptoms including headache, eye pain and sometimes earache, Buckley said.

“Early detection is the key,” she said, noting that people should seek treatment at a hospital if they experience signs and symptoms.

An aneurysm develops when a weak spot develops on the wall of a brain artery, leading to a bulge. Should the weak spot rupture, the blood loss can lead devastating results, including stroke, brain injury or death.

Aneurysms can run in families and ruptured aneurysms are more associated with smoking, but no specific activity is associated with developing an aneurysm or having it rupture, Buckley said.

Dr. Nicholas Bambakidis, director of Cerebrovascular and Skull Base Surgery at University Hospitals Case Medical Center in Cleveland, said brain aneurysms in teenagers and children are rare but they do occur.

“It’s a severe tremendous headache, almost always accompanied by loss of consciousness,” Bambakidis said of brain aneurysm symptoms. "Worst headache of my life. It’s not like a tension headache or a headache after a bad day."

Bambakidis said even an outside trauma like a baseball hitting the head may not lead to rupture and that they are mostly likely to be rupture due to severe trauma that actually pierces the brain.

The biggest predictor of survival is how a patient is doing when they arrive to get treatment, he said.

“How bad was the bleeding and how much damage was done to the brain when it’s bleeding?” Bambakidis said of figuring out the likelihood of a patient surviving.

Brain aneurysms are most prevalent for people between the ages of 35 to 60, according to the Brain Aneurysm Foundation. The condition can be deadly if ruptured and approximately 15 percent of patients with a specific type of aneurysm called an aneurysmal subarachnoid hemorrhage, die before reaching the hospital.

Approximately 30,000 Americans will have a brain aneurysm rupture annually and about 40 percent of these cases are fatal.

By Jethro Mullen

www.cnn.com 

But not for Annegret Raunigk.

The 65-year-old German grandmother recently gave birth to quadruplets, making her the oldest woman ever to do so.

The new arrivals increase her progeny to a total of 17 children. And let's not forget her seven grandchildren.

Raunigk, a single mother, gave birth last week to three boys and one girl after a pregnancy of just under 26 weeks, the German broadcaster RTL reported. 

The newborns -- whose names are Neeta, Dries, Bence and Fjonn -- were delivered by C-section and are being kept in incubators for premature babies, according to RTL.

Daughter wanted a younger sibling

Raunigk, a teacher from Berlin, made headlines 10 years ago when, at the age of 55, she gave birth to a daughter, Leila. And it was apparently Leila's plea for a younger sibling that encouraged her mother to try again.

"I myself find life with children great," Raunigk said earlier this year. "You constantly have to live up to new challenges. And that probably also keeps you young."

To become pregnant, she used in vitro fertilization (IVF) treatment with donated eggs that were fertilized.

One doctor tried to persuade her to abort one or two of the fetuses, but she refused to consider it.

Indian woman holds record

Raunigk, who had her first child at 21, is still not the oldest woman to give birth.

That record is held by Rajo Devi Lohan, an Indian woman who at 70 became the world's oldest known first time mother after three rounds of IVF.

Her daughter Naveen will turn 7 later this year.

What are your thoughts about this story?

www.npr.org 

A couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later, a study suggests.

Children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. The results showed no differences in IQ.

"There is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth," said Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom. Rabe's editorial accompanied the study published Tuesday in the journal JAMA Pediatrics.

Delaying the clamping of the cord allows more blood to transfer from the placenta to the infant, sometimes increasing the infant's blood volume by up to a third. The iron in the blood increases infants' iron storage, and iron is essential for healthy brain development.

"The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world," Rabe said. "Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly."

Past studies have shown higher levels of iron and other positive effects later in infancy among babies whose cords were clamped after several minutes, but few studies have looked at results past infancy.

In this study, researchers randomly assigned half of 263 healthy Swedish full-term newborns to have their cords clamped more than three minutes after birth. The other half were clamped less than 10 seconds after birth.

Four years later, the children underwent a series of assessments for IQ, motor skills, social skills, problem-solving, communication skills and behavior. Those with delayed cord clamping showed modestly higher scores in social skills and fine motor skills. When separated by sex, only the boys showed statistically significant improvement.

"We don't know exactly why, but speculate that girls receive extra protection through higher estrogen levels whilst being in the womb," Rabe said. "The results in term infants are consistent with those of follow-up in preterm infants."

Delayed cord clamping has garnered more attention in the past few years for its potential benefits to the newborn. Until recently, clinicians believed early clamping reduced the risk of hemorrhaging in the mother, but research hasn't borne that out.

Much of the research has focused on preterm infants, who appear to benefit most from delayed cord clamping, Rabe said. Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure, need fewer blood transfusions, have less bleeding into the brain and have a lower risk of necrotizing enterocolitis, a life-threatening bowel injury, she said.

This study is among the few looking at healthy, full-term infants in a country high in resources, as opposed to developing countries where iron deficiency may be more likely.

The American Congress of Obstetricians and Gynecologists has not yet endorsed the practice, citing insufficient evidence for full-term infants. The World Health Organization recommends delayed cord clamping of not less than one minute.

It is unclear whether the practice could harm infants' health. Some studies have found a higher risk of jaundice, a buildup of bilirubin in the blood from the breakdown of red blood cells. Jaundice is treated with blue light therapy and rarely has serious complications.

Another potential risk is a condition called polycythemia, a very high red blood cell count, said Dr. Scott Lorch, an associate professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and director of the Center for Perinatal and Pediatric Health Disparities Research at Children's Hospital of Philadelphia.

"Polycythemia can have medical consequences for the infant, including blood clots, respiratory distress and even strokes in the worst-case scenario," Lorch said. Some studies have found higher levels of red blood cells in babies with delayed cord clamping, but there were no complications.

Lorch also pointed out that this study involved a mostly homogenous population in a country outside the U.S.

"We should see whether similar effects are seen in higher-risk populations, such as the low socioeconomic population, racial and ethnic minorities and those at higher risk for neurodevelopmental delay," Lorch said.

So far, studies on delayed cord clamping have excluded infants born in distress, such as those with breathing difficulties or other problems. But Rabe said these infants may actually benefit most from the practice.

These babies often need more blood volume to help with blood pressure, breathing and circulation problems, Rabe said. "Also, the placental blood is rich with stem cells, which could help to repair any brain damage the baby might have suffered during a difficult birth," she added. "Milking of the cord would be the easiest way to get the extra blood into the baby quickly in an emergency situation."

 Gary Morley and Lisa Cohen

www.cnn.com 

Every time she competes in a race, she knows she'll collapse in a sobbing heap at the finish line.

Unable to feel her legs, she'll crumple into the arms of her athletics coaches. Ice-cold water will be applied to calm the misfiring nerve fibers blazing beneath her numb skin.

The teenager has gone through this post-race trauma for the past five years since being diagnosed with multiple sclerosis.

"Every day that I run, it might be my last day -- I could easily wake up tomorrow and not be able to move," the 19-year-old American tells CNN's Human to Hero series. 

"My initial MS attack caused lesions and scarring on my brain and my spine that affects the areas that are in control of how I feel my legs. So when I am overheated the symptoms reappear because my neurones start misfiring more.

"You can never really get used to the lack of feeling and the change of sensation, no matter how long you go through it. Every time it is still a bit of a shock and it's scary -- it freaks me out a little bit."

After five to 10 minutes she's able to get back on her feet again and start walking around, albeit a little stiffly as feeling slowly returns to her lower body.

It sounds like a nightmare ordeal that would put anyone off an athletics career, but Montgomery is determined to pursue her running dream.

She's actually faster now than before her diagnosis -- which, she says, was a painfully long and uncertain process following an accident playing soccer, falling hard on her neck and tailbone.

"It was really scary. I was so young. Most people with MS aren't diagnosed until their mid to late 20s, 30s. There wasn't anybody my age to relate to and understand what I was going through," she recalls. 

"It took so long to get back results and we were ruling things out and leaving MS as the last option. For a while they thought maybe it was cancer."

When the diagnosis finally came, it sent Montgomery into a spiral of anger, depression and denial.

She avoided confronting the issue with her parents -- Keith, a salesman, and mom Alysia, recently qualified as a nurse -- and younger sister Courtney.

"I tried to pretend I wasn't sick or anything -- I wanted to go on with life as normal as possible," Kayla says.

"Nobody at school knew, and we were not allowed to talk about it at home. I just avoided it at all costs, and that actually made it a lot harder. 

"The first couple of years after my diagnosis were impossibly hard -- I was so alone and still really scared. It was definitely a darker time in my life."

Running has proved to be her salvation. After a short break, in which she received treatment that made the numbness temporary, Montgomery decided she was going to make use of her legs while she still could -- despite knowing that exertion would bring back the symptoms.

"I wasn't amazing by any means but I was eighth on the team, so if somebody got hurt then I was there! And I wanted to be there if they needed me, so I trained so hard all the time and that definitely helped to deal with the things I wouldn't talk about," she says.

Montgomery's determination to succeed won her the North Carolina high school state title in the 3,200 meters last year, as she ran the 21st fastest time in the U.S.

She was team captain at Mount Tabor High School, setting several age-group records, and also excelled off the track in cross-country.

Now a freshman on an athletics scholarship at Nashville's Lipscomb University, she is studying molecular biology and has dreams of becoming a forensic scientist.

But before a career in CSI beckons, Montgomery is making the most of her chance to run for the college team.

"Racing is one of the greatest feelings in the world. I love it," she says. 

"Long-distance running is my favorite ... you have to have so much stamina, strength and determination. I like to push myself to my limits for as long as I can."

One of the big challenges is staying on her feet during a race. If she gets knocked over or falls, which sometimes happens, then it's difficult to get up again -- especially in the later stages.

"If it is a track meet you can't grab on to something, whereas cross country there might be a tree close by that you can pull yourself up on," Montgomery explains.

"It all depends on when I fall as to how it will affect the outcome of my race."

Montgomery trains three hours a day, six days a week, covering 60-75 miles.

Without being able to judge pace through her legs, she has learned a new way to run, by focusing on the movement of her arms.

The hard work is paying off. Lipscomb is a Division One university in NCAA competitions, giving her an elite platform on which to impress.

It's a long way from those early high-school days when she asked her coach, mentor and "second father" Patrick Cromwell about her chances of running at college level.

"He said, 'I don't know, you might be lucky if you can be a walk-on.' I was like, 'Well I'll show you, I'm going to run in college and not only that I'm going to run for a D1 school.' And I am! 

"Lipscomb is one of the best, it's really awesome to achieve that once really far-fetched dream."

Montgomery was actively recruited by Lipscomb, the first school to contact her -- others also rang "but a lot of them never called back" after she explained her condition.

"They made me feel so welcome," she says of her first visit to Lipscomb's campus. "They all knew my situation and it didn't bother them, and they didn't acknowledge it or ignore it either. It was exactly what I was looking for."

Her debut collegiate cross-country season was a steep learning curve, but Montgomery helped Lipscomb win a fourth successive conference championship in November, placing 13th overall and seventh in her team in the 5 km race.

On the track, she was sixth in the 10,000 meters last weekend as Lipscomb's women's team finished third at the Atlantic Sun championships in Florida, its best result at the event -- and a continuation of its rapid improvement since Bill Taylor, who recruited Montgomery, took over the athletics program in 2007.

She says the coach has given her the confidence to keep pushing herself, having taken a chance on her even though he realizes she may not be able to fulfill the four years of her scholarship if her condition gets worse.

"I keep running because it makes me happy," Montgomery says. "It makes me feel whole and safe, just because I know as long as I am running and still moving, I am still OK."