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DiversityNursing Blog

Top CE courses that build confidence

Posted by Alycia Sullivan

Tue, Feb 05, 2013 @ 01:58 PM

BY JESSICA ELLIS

describe the imageConfidence is a key factor in successful healthcare practice. Not only will you give better patient care when you’re more confident, but you’ll also enjoy giving care that is not hindered by second-guessing yourself. Knowledge is power! Here are a few CE courses essential for improving your basic knowledge and confidence:

1. Conflict Management

Face it: Conflict is impossible to avoid, especially in healthcare settings where tension runs high and patient outcomes may involve death. Do you know how to effectively address conflict among your peers, management and support staff? Hint: Avoidance doesn’t work. Learn how to manage conflict in a professional manner and your confidence will soar!

2. Time Management Strategies

Ever been so busy during a shift that you drive home with the nagging feeling you forgot something? Time management is essential to decreasing feelings of being overwhelmed and sloppy. This course will outline various time management methods and help you identify your own barriers to effective time management.

3. Team Building

As much as we sometimes hate to admit it, we need the assistance of our coworkers. Think about it. Are you more confident when you feel left alone to handle everything? Or are you more confident when you know your peers will jump in and help when needed? Do you know how to improve the team mentality on your unit? Having team building skills will not only improve productivity and patient safety, but also you’ll be in a better position to enjoy showing up for shift with a positive and calm attitude.

4. Medical Terminology 101

Did you ever read through doctors’ or radiologists’ notes and say to yourself, “Sounds like Greek to me!” Well, it just may be. While medical words rely heavily on Latin origins, the terminology also uses “pieces” from the Greek language. Taking a terminology course will help you memorize medical terms by body system. At the end of the day, patient chart comprehension will definitely improve your confidence!

5. Phlebotomy Basics

If you’re a seasoned nurse or provider, you may or may not be 100% up to speed in your phlebotomy or intravenous access skills. This course helps practitioners at all levels of experience review the principles of safe and appropriate venipuncture, including identifying patients and reporting critical levels of laboratory results.

Topics: learning, knowledge, nurse, CE course, confidence, top, best

How to Succeed in the Current Job Market

Posted by Alycia Sullivan

Tue, Feb 05, 2013 @ 01:55 PM

By Jennifer Larson

If you’re looking for a nursing job in 2013, you could be in luck--especially if you have pursued your education and have some experience in the field. While the recovering job market is looking strong for the most part, it holds even more potential in future years. The important thing for nurses is to understand how to position themselves for success, both now and in the coming months.

The U.S. Bureau of Labor Statistics’ most recent report on registered nurses predicted a 26 percent growth rate in employment for registered nurses during the 2010-2020 period. That’s considered “faster than average” when compared to all other populations.

A number of factors are expected to contribute to growth in particular areas. For instance, the aging of the baby boomer population and increasing pressure on hospitals to discharge patients as soon as possible is expected to spur job growth in outpatient care centers, as well as in home health and long-term care facilities.

For the coming year, however, it’s unlikely that the overall employment situation will be significantly different from last year.

“I haven’t seen a lot of change,” said Geraldine “Polly” Bednash, PhD, RN, FAAN, chief executive officer and executive director of the American Association of Colleges of Nursing (AACN), which surveys nursing schools to gauge the experiences of new graduates in finding employment.

Do your homework

If you plan to look for a new nursing job in 2013, it’s important to prepare yourself. Check out the job market in the area where you wish to live, or, if you’re open to different locations, find out where nurses with your specialty have the most opportunities. Know which employers are hiring, and what types of positions are in most demand.

For example, in the field of school nursing, some areas of the country are eagerly looking for qualified candidates to fill vacant positions in schools, while other regions can barely afford the nursing staff they already have, due to funding issues.

“It’s all over the map, depending on the state,” said Linda Davis-Alldritt, RN, president of the National Association of School Nurses. “Some states are seeing not so much a shortage of school nurses but a shortage of funded positions. The further west you go, that’s the situation, especially in California.”

Be flexible

Although the overall job market for nurses is predicted to be good, nurses in certain pockets of the country--particularly the ones with the least amount of experience--may have trouble landing their dream job right away. But that’s been true for the last few years in high-demand areas like the Bay Area in California and a few other places, and experts typically recommend that job seekers show flexibility in those situations.

If you’re willing to move or work the night shift or try other types of nursing jobs, you’ll be in a better position to get hired; this flexibility can also help new graduates acquire the basic experience that so many employers are seeking.

Take advantage of advanced education

What is most likely to help you land a new job in the current health care environment? More education and training. That might mean attaining a certification in your specialty area, or it could mean returning to school for another degree.

A baccalaureate degree could be especially useful. The Institute of Medicine’s landmark Future of Nursing report, released in 2010, called for increasing the percentage of the nursing workforce with a BSN to 80 percent by 2020, and a growing number of hospitals are prioritizing candidates with the degree.

According to information gathered from nursing schools in August 2012 by the AACN, 88 percent of new graduates with a BSN degree received job offers within four to six months of graduation.

“We’re always very pleased to see the baccalaureate graduates are getting hired,” said Bednash, adding that employers “understand they can make a choice, and they are going straight to the best-educated clinicians and hiring them.”

Graduates with master’s degrees fared even better; within four to six months after graduation, 92 percent of them were fielding job offers, according to the AACN’s survey.

“The hottest commodity on the market today is a graduate-prepared nurse practitioner,” said Bednash.

Expect more jobs on the horizon, thanks to ACA

When the Supreme Court upheld the Affordable Care Act (ACA) in June 2012, many noted that the law will likely expand the possibilities for nurses in the future.

As the law continues to undergo implementation, more than 30 million additional people could be added to the insurance rolls. Those people will need primary care--and primary care providers. Advanced practice nurses will be called upon to fill those spots in many places, especially in light of the ongoing shortage of primary physicians. In fact, the January 2013 issue of Health Affairs even noted that the use of “non-physicians” could help improve access to care for many people and avert a physician shortage in the future.

“They ought to be thinking carefully about going on to get a graduate degree,” Bednash said of nurses who are interested in the new possibilities opening up.

The Affordable Care Act also encourages the patient-centered medical home model, which utilizes care coordinators.

“And that’s a nursing role,” said Bednash.

Copyright © 2013. AMN Healthcare, Inc. All Rights Reserved

Topics: 2013, growth, education, nurse, succeed, job market

One Hundred and One Interesting Facts, Quotes (and Even a Couple of Jokes) About Nursing:

Posted by Hannah McCaffrey

Mon, Feb 04, 2013 @ 07:39 PM

1. January 27th is School Nurse Day. Planning on flowers? Chocolates? Didn’t think so.

2. The most visits to emergency rooms occur during the warmer months of the year.

3. According to the latest data available to the World Health Organization, Finland, Norway, Monaco, Ireland and Belarus have, in that order, the highest ratios of nurses per capita of all nations, ranging from 2162 to 1182 nurses per 100,000 people.
nurse laughing
4. The National Association of Colored Graduate Nurses was formed in 1908.

5. According to a 2001 World Health Organization report, the number of psychiatric nurses in poor countries is about 0.1 per 100,000 persons.

6. In 1783 a black slave named James Derham worked as a nurse in New Orleans, eventually earning enough money to buy his freedom and move to Philadelphia, where he studied medicine and became a doctor.

7. Men and women between the ages of 25 and 44 account for 33 percent of all people in the U. S. who come to emergency rooms with injury-related wounds.

8. Linda Richards became the first nurse to earn a nursing diploma in the United States in 1873.

9. In 1846 the first hospital training school for nurses, the Institute for Protestant Deaconesses, was established in the town of Kaiserwerth, Germany.

10. The National Association of School Nurses recommends nurse-to-student ratios should be one to 750 for general populations, one to 250 in mainstreamed populations and 1 to 125 in severely handicapped populations.

11. According to a recent World Health Organization report, the United States spends more money, as a ratio of GNP, on health care than any country, followed closely by Lebanon and Zimbabwe.

12. “When we are well, we all have good advice for those who are ill.” Terence, from The Woman of Andros (166 B.C.)

13. In a 2001 survey done by the ANA/NursingWorld.com, 45% of nurses expressed fear of getting a potentially deadly disease as one of their top three occupational health concerns.

14. Nursing is one of the fastest growing occupations in the U.S.

15. According to the latest data available to the World Health Organization, Nepal, Liberia, Central African Republic, Haiti and Bangladesh have, in that order, the lowest ratios of nurses per capita of all nations, ranging from 5 to 11 nurses per 100,000 people.

16. One out of every four registered nurses works part time.

17. The American Nurses Association, first known as the Nurses Associated Alumnae, was started in 1898.

18. The New England Hospital for Women and Children, established in 1862, was the first school for nursing in the U.S.

19. The order of the Brothers of Mercy was founded in 1538 by Juan Ciudad. (b. 1495. d. 1550.)

20. One out of every five licensed practical nurses works part time.

21. During the months that school is out, emergency room visits from children under 14 years old rise by 18 percent.

22. The demand for registered nurses is expected to rise 21 to 35 percent through the first decade of the 21st century.

23. “The charity that is a trifle to us can be precious to others.” Homer, from The Odyssey (9th Century, B.C.).

24. There were 358 existing master’s of nursing programs in the U.S. in 2002, comprising 9% of all registered nurses.

25. In a 2001 survey done by the ANA/NursingWorld.com, 59% of nurses expressed fear of getting a severe back injury as one of their top three occupational health concerns.

26. Around 500 A. D. the Benedictine nursing order was founded by Saint Benedict.

27. There were 75 existing doctorate of nursing programs in the U.S. in 2002, comprising 0.6% of all registered nurses.

28. There were 1,100 existing practical nursing programs in the U.S. in 2002.

29. The average annual earnings for registered nurses was $44,840 in 2000.

30. In 1996, the National Institute of Occupational Safety and Health (NIOSH) reported that one million workers are assaulted every year in the workplace and that “Most of these assaults occur in service settings such as hospitals, nursing homes, and social service agencies.”

31. In 1898 the British Army formed the Royal Army Medical Corp.

32. According to the latest data available to the World Health Organization, Ireland, Seychelles, Maldives, Philippines and Azerbaijan have, in that order, the highest ratios of midwives per capita of all nations, ranging from 411.0 to 137.0 midwives per 100,000 people.

33. In 1947, Florence Blanchfield, a nurse, became the first female regular commissioned officer in the United States Army, assigned as the superintendent of the Army Nurse Corp. (b. 1882. d. 1971).

34. There are approximately 567,000 bicycle-related injuries each year that require emergency room attention.

35. 29 Victoria Crosses have been awarded to British medical personnel.

36. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) has been the main regulatory institution of nursing training and standards in the British since 1983.

37. “It is one of the beautiful compensations of this life that no one can sincerely try to help another without helping himself.” Charles Dudley Warner, from “Fifth Study,” Backlog Studies (1873).

38. You know you are a nurse when you baste your Thanksgiving turkey with a Toomey syringe.

39. According to a 2001 World Health Organization report, nurses and midwives can comprise between 50% to 90% of the number of health practitioners in many countries.

40. The American College of Nurse-Midwives was formed in 1955.

41. The National League for Nursing Accrediting Commission (NLNAC), recognized by the U.S. Department of Education as the national accrediting body of nursing education programs of all types, oversees over 1,900 different programs.

42. “If you would live in health, be old early.” – a Spanish proverb.

43. Walt Whitman’s service as a nurse during the American Civil War inspired many of his poems, including Memoranda During the War (b. 1819 d. 1892).

44. According to the latest data available to the World Health Organization, the country of Nepal has the lowest ratio of nurses per capita in the world, with 5.0 per 100,000 people.

45. The first nursing school in history dates back to 250 B.C. and was located in India.

46. An associate’s degree in nursing (ADN) takes about 2 to 3 years to earn.

47. Clara Louise Maass is famous for serving as a contract nurse during the Spanish American War. (b. 1876 d. 1901).

48. The largest demand for licensed practical nurses through 2110 will be in nursing homes.

49. 17th century shipwreck survivor Juan de Mena is considered the first nurse in the New World.

50. The average starting wage for a certified registered nurse anesthetist is over $50,000.

Would you believe how many babies this 18th century midwife delivered successfully?  –>

51. According to a recent World Health Organization report, 93 member countries of the United Nations annually spend less than $100 per capita on health care, 56 member countries spend less than $500 per capita and 26 member countries spend over $1000 per capita.

52. The Teutonic Knights, the Knights of Lazarus and the Knights Hospitalers were all orders that organized male nurses to tend to sick and wounded.

53. Second Lieutenant Edward Lynn, in 1955, was the first male to be commissioned in the United States Army Nurse Corp.

54. Around nine million children visit emergency rooms in the U.S. each year due to injuries.

55. “To preserve a man alive in the midst of so many chances and hostilities, is as great a miracle as to create him.” Jeremy Taylor, from The Rule and Exercise of Holy Dying (1651).

56. In October of 1902, Lina Rogers Struthers became the first school nurse in the United States.

57. The second week of May is National Nursing Home Week.

58. A bachelor of science degree in nursing (BSN) takes about 4 to 5 years.

59. Lucretia Lester was a midwife for 34 years, between 1745 and 1779, and is reputed to have helped deliver 1,300 children, of which only two were lost.

60. The Knights Hospitalers was founded in 1119 to protect a hospital build in Jerusalem and also provided nursing care.

61. Clara Barton founded the American Red Cross in 1881. (b. 1821 d. 1912).

62. A 1996 survey done by the Department of Health and Human Services found that 95% of all working nurses are female.

63. The U.S. Army Nurse Corp was started in 1901.

64. According to the U.S. Centers for Disease Control, open wounds are the leading diagnosis for injury-related visits to emergency rooms.

65. Why did the nurse keep the bedpan in the refrigerator? Because when she kept it in the freezer it took too much skin off.

66. There were about 700,000 jobs for licensed practical nurses in the year 2000.

67. According to a recent World Health Organization report, the United States, Switzerland, Norway, Denmark and Germany, respectively, annually spend the most money per capita on health care.

68. About three out of every five registered nurses work in hospitals.

69. The fourth week of May is National Nurses Week.

70. There are more nurses than any other workers in the health profession.

71. “When a man is ill his very goodness is sickly.” Nietzsche, The Will to Power (1888).

72. A 1996 survey done by the Department of Health and Human Services found that only 10% of working nurses represent minorities.

73. There were 86 existing diploma for nursing programs in the U.S. in 2002, comprising 27% of all registered nurses.

74. You know you are a nurse when you think giving your patients TLC means giving them Thorazine, Lorazepam and Compazine.

75. The training time it takes to become a licensed practical nurse is about one year.

76. Traumatic wounds account for around 11 million visits to the emergency room each year.

77. The Canadian Victorian Order of Nurses was founded in 1897 in honor of Queen Victoria of England’s Diamond Jubilee.

78. Mary Todd Lincoln, the wife of Abraham Lincoln, was a volunteer nurse during the American Civil War (b. 1818 d. 1882).

79. There were about 2,200,000 jobs for registered nurses in the year 2000.

80. If you see a nurse smiling when things go wrong, she is probably going off duty.

81. May 8th is National Student Nurses’ Day.

82. According to a 2001 World Health Organization report, the number of psychiatric nurses in developed countries is about 33.5 per 100,000 persons.

83. The first week of May is National Hospital Week and Health Care Administrators’ Week.

84. In the various U.S. Military branches, approximately one-third of all nurses are male.

85. In 2000, there were 57,954 school nurses looking out for the health of 52 million students.

86. The Nurses Registration Act of 1919 established the first oversight of nursing training and standards in Great Britain.

87. There were 885 existing associate’s degrees for nursing programs in the U.S. in 2002, comprising 32.0% of all registered nurses.

88. According to the latest data available to the World Health Organization, the United States has a ratio of 972 nurses per 100,000 people, or about the same as Germany and Uzbekistan.

89. In a 2001 survey done by the ANA/NursingWorld.com, 51% of nurses said they worked an average of 41 to 60 hours per week.

90. Mary Seacole, a self-taught nurse, was famous for establishing a hotel for invalids close to the front during the Crimean War.

91. In a 2001 survey done by the ANA/NursingWorld.com, nurses said they spent 62% of their time in direct patient care.

92. Anne L. Austin was a famous historian of nursing (b. 1891 d. 1986).

93. Florence Nightingale, the most famous nurse in modern history, was only a nurse for three years of her life (b. 1820 d. 1910).

94. Saint Camillus de Lellis established a Catholic order called the Fathers of a Good Death in 1584 to tend to the terminally ill, and is also reputed to have designed the red cross on a white background symbol and to have developed the first ambulance (b. 1550 d. 1614).

95. The average annual earnings for licensed practical nurses was $29,440 in 2000.

96. Mary Eliza Mahoney became the first African American nurse in 1879 (b. 1845 d. 1926).

97. There were 695 existing baccalaureate of nursing programs in the U.S. in 2002, comprising 31% of all registered nurses.

98. You know you are a nurse when you find yourself complimenting a complete stranger on his veins.

99. The demand for licensed practical nurses is expected to rise 10 to 20 percent through the first decade of the 21st century.

100. In a 2001 survey done by the ANA/NursingWorld.com, 71% of nurses selected ‘acute/chronic effects of stress and overwork’ as one of their top three occupational health concerns.

101. You know you are in trouble when it’s your first night shift in three years and there’s a full moon.

Topics: jobs, scholarship, diversity, nursing, nurse, nurses, nurse assisant training

Nurse Workforce Growth from 1988 to 2012

Posted by Alycia Sullivan

Fri, Jan 18, 2013 @ 01:46 PM

Experts weigh in on how the nursing workforce has changed in last 25 years. Download, read the full PDF article -> http://bit.ly/VvUIdy

timeline

Topics: growth, 2012, 1988, progress, charts, statistics, Workforce, nurse

Nurse busts top 5 flu myths

Posted by Alycia Sullivan

Fri, Jan 11, 2013 @ 12:33 PM

by 

Video

The flu season is the meanest it has been in a decade. 

In fact, an updated map from the CDC shows the Commonwealth presently in the red zone, which is the highest category for flu cases reported in states.

Nurses at the CVS Minute Clinic said there are some myths about the flu and its vaccine.

  • #1: It is too late to get the seasonal flu shot.
  • #2: The flu shot can give you the flu.
  • #3: If you got the flu vaccine last year, you don’t have to get it again this year.
  • #4: There are serious side effects caused by the flu vaccine.
  • #5: Natural immunity or living a healthy lifestyle is better than getting immunity from the flu shot.

Watch the video above to hear why Nurse Practitioner Anne Pohnert said these are false. 

Topics: flu, myths, nurse, CDC

Social Media Guidelines

Posted by Alycia Sullivan

Fri, Jan 11, 2013 @ 12:18 PM

describe the image

From NCSBN

The use of social media and other electronic communication is expanding exponentially as the number social media outlets, platforms and applications available continue to increase. Individuals use blogs, social networking sites, video sites, online chat rooms and forums to communicate both personally and professionally with others. Social media is an exciting and valuable tool when used wisely. The very nature of this medium however can pose a risk as it offers instantaneous posting opportunities that allow little time for reflective thought and carries the added burden that what is posted on the Internet is discoverable by law even when it is long deleted.

Because of inappropriate use of social media, some nurses have lost their jobs, been disciplined by the Board of Nursing, been highlighted in national media, been a target of lawsuits, and been criminally charged. What do nurses need to know so that they can use social media, both personally and professionally, without worrying about repercussions? NCSBN has developed some guidelines for using social media responsibly.

NCSBN is thrilled to announce that they have collaborated with the American Nurse’s Association (ANA) on the professional use of social media. NCSBN has endorsed ANA’s principles of using social media, and ANA has endorsed NCSBN’s guidelines. ANA and NCSBN recently hosted a collaborative Webinar and they are planning further collaborative efforts to get the word out about using social media appropriately without harming patients. These are the social media guidelines from the National Student Nurse Association. NSNA Social Media Guidelines.


Topics: inappropriate, job loss, NCSBN, nurse, ANA, social media

For Mothers at Risk, Someone to Lean On: N.Y.C. Nurses Aid Low-Income First-Time Mothers

Posted by Alycia Sullivan

Thu, Jan 10, 2013 @ 04:46 PM

mason

By 

The tattoo below Joanne Schmidt’s right ear says “Jesus” in Hebrew. On the back of her neck, under a short crop of dyed red hair, is a second tattoo that says “Bad Girl” in Chinese.

“That was from my earlier period,” she said.

On a drizzly December afternoon, Ms. Schmidt was in the Throgs Neck section of the Bronx to visit Elizabeth De la Rosa, who is 19 years old, single and was about as pregnant as a person can be. On this day, which happened to be the date her baby was due, Ms. De la Rosa was living in her mother’s apartment, a surprise to Ms. Schmidt, 37, who had been visiting her since early in the pregnancy — sometimes at a homeless shelter, sometimes at Ms. De la Rosa’s aunt’s. Ms. De la Rosa and her mother had a history of bitter arguments, which had landed the daughter in counseling at age 14.

“I must say,” Ms. Schmidt said mildly, “I’m glad that you and your mom are getting along.”

“We don’t fight when I’m at my aunt’s,” Ms. De la Rosa said.

“Did your mother ask you to move back?” Ms. Schmidt asked.

“My sister did.”

As the two talked, Ms. De la Rosa’s mother watched television in her bedroom. There were many things to discuss:

How was Ms. De la Rosa feeling? (Impatient.) Did she have headaches or blurry vision? (Headaches.) Did she tell her doctor? (Yes.) Was she still planning to get a job and find her own place? (First she wanted to get her high school equivalency diploma.) Did she need a referral? Did she have a day care plan? Was she considering any schooling beyond the G.E.D.? How long did she plan to breast-feed?

Discussion circled back to her relationship with her mother. Ms. Schmidt, who did not get along with her own mother, nodded sympathetically and recorded Ms. De la Rosa’s answers on printed sheets that she kept in a thick folder.

Afterward, in her government-owned Prius, Ms. Schmidt confided that she was worried. “What happens when this baby’s born and her mom tells her she’s doing something wrong? Elizabeth says she doesn’t want it to get physical, but that it can get physical. She’s very strong-willed. I’m going to ride it out.”

Her face showed her further concern: In a home with physical violence, little money or resources, with a nonsupportive father, what sort of life prospects would Ms. De la Rosa’s baby have?

“I know these girls because I come from the same background as they do,” Ms. Schmidt said, adding that of the young women she visited, Ms. De la Rosa had one of the more stable home situations. “There were a few times when I found myself on the streets,” Ms. Schmidt said — “no apartment, I was cut off of welfare, living from place to place. I lived out of my car for a while. With my son.

“So my story is very much these girls’ story. And it just takes one person, one person, to just say, ‘You are worth it. You’re not a terrible person for the mistakes and the things you’ve done in the past. You may have gone through whatever, but there’s a way out.’ ”

She did not need to say that for her clients, 15 at any time, she intended to be that one person.

Joanne Schmidt is a nurse for the New York City Department of Health and Mental Hygiene, in a program called the Nurse-Family Partnership, which matches specially trained nurses with low-income first-time mothers, starting during pregnancy; they meet at the mother’s home every week or two until the child’s second birthday. She is also a daughter of the soul singer Sam Moore, of Sam and Dave — a quick-eyed woman with freckles and a Rochester accent that adds a Midwestern flavor to mild oaths like “jeez Louise” or “shut the front door.”

Raised mostly by her maternal grandmother and aunt, she was not told until age 8 who her father was, or why she looked different from her German relatives.

After high school, she said, “that’s kind of when my life went — ” she made a screeching sound like a rocket veering out of control. “I didn’t realize I was following my mother.” For years she was by her description a “groupie” on the hip-hop scene; now she is a Christian, a PTA president, a mother to a 16-year-old and a partner with his father. And a nurse.

Her unit takes the hard cases: mothers in foster care, homeless shelters or Rikers Island.

babyThe program, which was started in upstate New York in the 1970s and has been adopted in 42 states, is one of the rare public initiatives that have shown consistent and rigorously tested benefits for the mothers and children, as well as significant savings for taxpayers.

In different studies on different demographic groups, women in the program have had fewer premature deliveries, smoked less during pregnancy, spent less time on public assistance, waited longer to have subsequent children, had fewer arrests and convictions, and maintained longer contact with their baby’s fathers. Their children have had fewer language delays and reported less abuse and neglect, slightly higher I.Q. scores, fewer arrests and convictions by age 19, and less depression and anxiety.

A 2011 study of New York City’s Nurse-Family Partnership program, which currently has 91 nurses serving 1,940 families, projected that by the time a child in the program turns 12, the city, state and federal governments will have saved a combined $27,895, with additional savings thereafter — more than twice the program’s cost per child. The study was conducted by the Pacific Institute for Research and Evaluation using data from the Nurse-Family Partnership’s research at three locations, then extrapolated to New York.

This fall, I attended a dozen home visits, all in the Bronx, with five nurses — three from the Visiting Nurse Service of New York, which contracts with the city to provide service in the Bronx, and two, including Ms. Schmidt, with the health department’s Targeted Citywide Initiative, which tackles the most at-risk cases. The nurses’ styles and backgrounds varied; the families’ needs and challenges even more so. Each mother participated voluntarily and at no cost.

The problems were many: violence on the street, abuse in the women’s past, illness, anger, obesity, insecure housing or financial circumstances. Most of the women had the poor luck to have been born in poverty. Like their middle-class counterparts, none came into the world knowing how to raise a baby.

At the Andrew Jackson Houses in the South Bronx, Rose Mendoza and her nurse, Susan Spadafora, were discussing Ms. Mendoza’s plans for the next week. She had a doctor’s appointment for her son, Mason, who is about 17 months old, and an appointment to get an assessment from her psychiatrist, so she could receive counseling for her longstanding temper problems. Previous attempts to get this assessment had failed, often ending with Ms. Mendoza in a tantrum.

“If she’s not there,” Ms. Mendoza said of the psychiatrist, “I’m going to be mean.”

“You don’t have to be mean,” Ms. Spadafora said. She commended Ms. Mendoza, 26, for her progress in controlling her temper since the baby’s birth.

“She’s always late,” Ms. Mendoza said. “And I get frustrated to have to wait.”

Patiently, Ms. Spadafora, 52, who works for the Visiting Nurse Service of New York, walked her client through steps they had discussed for dealing with unresponsive clinic staff members without blowing up. Several times, the nurse has gone along on appointments to demonstrate ways to ask questions and elicit better treatment. Part of her work, she said, lies in modeling good habits.

“Susan’s changed a lot for me,” said Ms. Mendoza, who dyes her hair flaming red and has a gold stud by the corner of her mouth. “A lot. Like how to deal with things, how to think before you speak. Don’t just blurt it out.”

Most of Ms. Mendoza’s friends had children as teenagers, but she did not become pregnant until she was 24, with her long-term boyfriend, David. They both left high school in their senior years.

Hers was not an easy pregnancy. Ms. Mendoza weighed as much as 380 pounds and had diabetes and dangerously high blood pressure. Early tests showed that she was pregnant with triplets. One died in the womb, then a second. The third fetus and Ms. Mendoza were both in danger of not surviving.

On a late-November morning, Mason stared alertly at the action around him and babbled. He ambled from one part of the apartment to another.

Ms. Mendoza’s goal is to move out. Two people have been killed in the building since Ms. Spadafora started visiting, including one man who was shot in the daytime; Ms. Mendoza heard him screaming on the sidewalk at the pain, waiting for an ambulance that arrived too late.

During two visits I attended, Ms. Mendoza was adamant that she was going to get her G.E.D., study to become a pastry chef, apply for housing, get an apartment with David — “he’s a great father,” she said — and begin a new life with her new family. But she has been making such plans since pregnancy, Ms. Spadafora said.

“She seems to put roadblocks in front of herself,” the nurse said. “She’s registered for six or seven G.E.D. review courses. Always the obstacles seem real, but she can exaggerate them. Success can be as scary as failure. There’ll be more expectations if she gets a degree.”

Like other nurses I talked to, Ms. Spadafora finds herself trying to counteract certain practices of the babies’ grandmothers — like putting cereal in a baby bottle, which can lead to overfeeding. “Everybody wants a fat baby,” Debra Rivera-Oquendo, who works for the Visiting Nurse Service of New York, told me.

Though childhood obesity is not high on the national Nurse-Family Partnership agenda, it is a major concern in New York and especially in the Mendoza household, where obesity and diabetes are rampant. At 295 pounds, Ms. Mendoza was greatly slimmed down but still no waif. Her mother, who is also obese and diabetic, pushed back against the nurse.

“We’re trying to make tiny breakthroughs with the baby,” Ms. Spadafora said. “I’ll ask, ‘What things did your mother do that might have contributed to your obesity?’ She knows what her mother did wrong, and doesn’t want to do that with the baby. Rose is doing better with the baby than with herself.”

The visiting nurse program, though, is not for everyone. It makes demands on both nurses and clients, not least the demand for data, which means constant reporting and paperwork.

More than half of the mothers drop out before their child turns 2 — some because they successfully move into work or school, but others because they lose interest. In the original trials, 60 percent of mothers finished the program, but the rate fell to 42 percent as the program expanded — another impetus for more data-gathering.

For Joanne Schmidt, whose team has a far lower graduation rate because of the mothers’ challenges going in, each patient who drops out becomes an unsolved mystery.

“I wonder what happens to some of them,” she said. “I wonder if they went to school. I wonder if they’re out of jail. I try hard not to take it personal. They have their own life to live, and I made it through on my own with no help. A lot of these girls are tough. They know how to use their resources.

“It sounds cold, but I have to remember that this is my role. I can’t save the world. If someone drops, you wrestle with that for a second, then it’s, ‘all right, got to pick up the next client.’ That’s part of being a nurse, knowing you’re going to have clients that die on you. You have babies that die, you have clients that die. It’s sad to see, but it’s part of why you do what you do, and part of the reason everyone can’t be a nurse.”

The Monday after Ms. Schmidt’s visit to Ms. De la Rosa, the baby had still not arrived. The nurse was hoping the birth would fall on her own birthday, Dec. 12. She needed some good news. One of her patients, a 5-month-old boy born a month early, was in the hospital with respiratory syncytial virus, or RSV, an illness that can be fatal to premature infants. Another patient, who was born two months prematurely, was sick and not receiving treatment.

The two families were lined up back-to-back on her Monday morning schedule, along with a mother and her 3-month-old son who were living at Inwood House, transitional housing for homeless youths who are pregnant or have children. The mother, Nicola Brown, 19, said she had been physically and emotionally abused as a child, and verbally abused by the baby’s father.

Ms. Brown was the day’s first appointment, and she had good news: in part thanks to Ms. Schmidt, she had finished her training to become a home health aide. This after getting her G.E.D. in August.

Ms. Schmidt beamed at her. “Do you feel proud of yourself?” she said. “You should.”

Ms. Brown said she wanted to work for a while, then go to nursing school. She was seeing a mental health clinician because of lingering effects of her past abuse, she said.

 Ms. Schmidt was her second nurse in the program. She had not gotten along with the first, whom she described as loud and obnoxious. “Joanne has an upbeat personality, and it’s easy to trust her,” she said, adding that she did not easily trust people.

The meeting was the easiest part of Ms. Schmidt’s day. At the next appointment, in the Eastchester neighborhood, Natasha Pennant and her boyfriend, Aaron Pelzer, had a sick child, a new apartment, problems with Medicaid and stress from Ms. Pennant’s mother, who recently had shoulder surgery, and who relied on her daughter for help raising four foster children. Their daughter, Azalea, was born at 30 weeks, weighing one pound, 14 ounces.

“I feel everything is on me,” Ms. Pennant said. “With my mom and Azalea, and trying to find a steady job.” She was too busy with her mother to reapply for Medicaid, she said. Without the coverage, she did not have money to take her daughter to the pediatrician.

Ms. Schmidt asked how she was coping with the stress.

“Honestly, I’m going back to smoking,” Ms. Pennant said. Mr. Pelzer, who is trying to start a mobile app business, sat nervously by her side.

“When you smoke, where do you smoke?” Ms. Schmidt asked.

Ms. Pennant told a story about Ms. Schmidt’s visiting her in the hospital just after Azalea was born. For two days, Ms. Pennant was unable to go to her daughter in the neonatal intensive care unit because of a pounding headache, which the floor doctors were not treating. Ms. Schmidt pushed the nurses on the floor to have a doctor look into it. Finally, a doctor said that the pain was a side effect of spinal anesthesia and prescribed treatment. Ms. Pennant was able to see and hold her child.

“It was all because of Joanne,” she said.

Now Ms. Schmidt urged the couple to take Azalea to the pediatrician or the emergency room ASAP. “They cannot refuse to see you based on your inability to pay.” Because Azalea had been premature, Ms. Schmidt feared RSV, and was especially worried about delaying treatment. “I just went through this with someone, and the outcome is not going well,” she said.

The last visit of the day was the hardest: At Montefiore Medical Center’s Wakefield campus, a weary Stephanie Velez-Rivera, 23, lay with her son, Elisha, on her chest, trying to ease his weak cough. After eight days in the hospital and a week of illness before, he had lost half a pound and wasn’t eating or sleeping. The night before, he had rolled off his mother while she slept and onto the floor; in the morning, she said, the medical staff had interrogated her as if she had dropped her baby.

Now she worried that when her husband learned of the baby’s fall, he would be upset with her. During Ms. Schmidt’s last visit, Ms. Velez-Rivera’s husband had rejected a suggestion of couples counseling.

Ms. Schmidt did not criticize the husband. “His personality isn’t able to handle some of the things you can,” she said.

“He gets stressed out,” Ms. Velez-Rivera said.

Ms. Velez-Rivera, who has sickle-cell anemia, said that she had been raised in an abusive home, “physically, emotionally, verbally,” and that she was determined to make a better home for Elisha; the boy’s needs, she said, came before hers or her husband’s.

Ms. Schmidt had no easy answers. The child was very sick, the marriage was fraught, the mother was pushed beyond exhaustion — and still it was not too early to discuss birth control, so Ms. Velez-Rivera would not become pregnant again right away. The nurse promised to bring information at their next visit, and to check back in a few days.

Ms. Schmidt’s birthday came and went without Ms. De la Rosa delivering her baby. Instead of celebrating, the nurse went to a holiday party for the mothers and babies in the program. She asked her clients not to mention her birthday, saying the party was for them, not her.

By week’s end everything was still up in the air. Ms. De la Rosa’s doctor said he would wait until Dec. 18 before inducing labor. Ms. Velez-Rivera was fighting to keep Elisha in the hospital, saying he was still not eating well enough to be safely discharged.

Ms. Schmidt put away her work cellphone for the weekend, then picked up a message anyway.

“All my girls have a lot going on,” she said. “That’s their everyday life. I know that they’ll be O.K., and that the decisions they make will become the road they have to take.”

She took a deep breath. “I have to hang up my cape at some point,” she said. “You let it go, then you pick it back up.”

Topics: low income, support, NYC, first-time mother, baby, nurse

Nursing education enrollment keeps rising in 2012

Posted by Alycia Sullivan

Thu, Jan 03, 2013 @ 01:41 PM

Nurse.com News

The American Association of Colleges of Nursing has released preliminary survey data showing that enrollment in all types of professional nursing programs increased from 2011 to 2012, including a 3.5% increase in entry-level BSN programs. 

The AACN’s annual survey findings are based on data reported from 664 of the 856 nursing schools in the U.S. with baccalaureate and/or graduate programs (a 77.6% response rate). In a separate survey, the AACN found a strong hiring preference for new nurses prepared at the baccalaureate level, and a comparatively high job-placement rate for new BSN graduates.

"AACN is pleased to see across-the-board increases in nursing school enrollments this year given our commitment to encouraging all nurses to advance their education as a catalyst for improving patient care," AACN President Jane Kirschling, RN, PhD, FAAN, said in a news release.

Baccalaureate nursing education

The AACN said its annual survey is the most reliable source for actual — as opposed to projected — data on enrollment and graduations reported by the nation’s baccalaureate- and graduate-degree programs in nursing. This year’s 3.5% enrollment increase for entry-level baccalaureate programs is based on data supplied by the same 539 schools reporting in both 2011 and 2012 (see www.aacn.nche.edu/Media-Relations/EnrollChanges.pdf for year-by-year enrollment changes in baccalaureate nursing education from 1994 to 2012).

Among the most noteworthy findings, the number of students enrolled in RN-to-BSN programs increased by 22.2% from 2011 to 2012 (471 schools reporting). This year marks the 10th year of enrollment increases in these programs, signaling a growing interest among nurses and employers for baccalaureate-prepared nurses, the AACN noted. 

Stakeholders inside and outside the nursing profession — including the Institute of Medicine, Tri-Council for Nursing, National Advisory Council for Nursing Education and Practice, Carnegie Foundation for the Advancement of Teaching and many others — are calling for higher levels of academic progression in nursing.

Graduate nursing programs

Preliminary data from the AACN’s 2012 survey show that enrollment in master’s and doctoral degree nursing programs increased significantly this year. Nursing schools with master’s programs reported an 8.2% jump in enrollment, with 432 institutions reporting data. In doctoral nursing programs, the greatest growth was seen in DNP programs, where enrollment increased by 19.6% (166 schools reporting) from 2011 to 2012. 

During this same time period, enrollment in research-focused doctoral programs (PhD, DNS) edged up by 1.3% (96 schools reporting), even though 195 qualified applicants were turned away from these programs, based on preliminary findings.

"Momentum is clearly building for advancing nursing education at all levels," Kirschling said. "Given the calls for more baccalaureate- and graduate-prepared nurses, federal and private funding for nursing education should be targeted directly to the schools and programs that prepare students at these levels.

"Further, achieving the Institute of Medicine’s recommendations related to education [calling for 80% of nurses to have BSNs by 2020] will require strong academic-practice partnerships and a solid commitment among our practice colleagues to encouraging and rewarding registered nurses committed to moving ahead with their education."

Turned away

Although interest in nursing careers remains strong, many individuals seeking to enter the profession cannot be accommodated in nursing programs, despite meeting all program entrance requirements. Preliminary AACN data show that 52,212 qualified applications were turned away from 566 entry-level baccalaureate nursing programs in 2012. The AACN expects this number to increase when final data on qualified applications turned away in the fall of 2012 are available next March. 

The primary barriers to accepting all qualified students at nursing colleges and universities continue to be a shortage of clinical placement sites, faculty and funding, according to the AACN (see www.aacn.nche.edu/Media-Relations/TurnedAway.pdf for information about the number of qualified applicants turned away from entry-level baccalaureate nursing programs over the past 10 years).

Hiring preferences

In addition to its annual survey, the AACN has collected data on the employment of new graduates from entry-level baccalaureate and master’s programs to assess how these RNs fare in securing their first jobs in nursing. 

Conducted for the third consecutive year, survey findings show baccalaureate nursing graduates remain more than twice as likely to have jobs at the time of graduation as those entering the workforce in other fields. While the employment rate at graduation increased slightly, from 56% in 2011 to 57% in 2012 for BSN students, the employment rate at four to six months after graduation was identical over the two-year period (88%). By comparison, the National Association of Colleges and Employers conducted a national survey of 50,000 new college graduates across disciplines and found that only 25.5% of new graduates in 2011 had a job offer at the time of graduation.

The AACN also collected data on entry-level MSN programs, which remain a popular pathway into nursing for those transitioning into nursing with degrees in other fields. Graduates from these programs were most likely to have secured jobs at graduation (73% for MSNs vs. 57% for BSNs) and at four to six months after graduation (92% for MSNs vs. 88% for BSNs). These data further illustrate a renewed employer preference for hiring the best educated entry-level nurse possible. 

Once again this year, the AACN queried nursing schools about whether hospitals and other employers express a preference for hiring new nurses with a bachelor’s degree. A significant body of research shows that nurses with baccalaureate level preparation are linked to better patient outcomes, including lower mortality and failure-to-rescue rates, according to the news release. With the Institute of Medicine calling for 80% of the nursing workforce to hold at least a bachelor’s degree by 2020, moving to prepare nurses at this level has become a national priority. 

In terms of this year’s survey, schools of nursing were asked whether employers in their area were requiring or strongly preferring new hires with baccalaureate degrees, with the findings showing that 39.1% of employers require the BSN for new hires while 77.4% strongly prefer BSN-prepared nurses.

Resources

To download the complete research brief on the "Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses," visit www.aacn.nche.edu/leading_initiatives_news/news/2012/employment12.

The AACN works on several fronts to enhance the number of baccalaureate-prepared nurses in the workforce, including:

• Working collaboratively with leaders from associate degree programs and the community college arena to encourage academic progression in nursing (see www.aacn.nche.edu/news/articles/2012/academic-progression).

• Partnering with the National Organization for Associate Degree Nurses to disseminate a new brochure titled "Taking the Next Step in Your Nursing Education" (see www.aacn.nche.edu/students/your-nursing-career/Academic-Progression-Brochure.pdf).

• Advancing the Robert Wood Johnson Foundation’s "Academic Progression in Nursing" initiative as part of the Tri-Council for Nursing, which is focused on implementing state and regional strategies to create a more highly educated nursing workforce (see www.aacn.nche.edu/news/articles/2012/rwjf).

• Joining with the Robert Wood Johnson Foundation to enhance diversity in the nursing workforce through the "New Careers in Nursing" program, which provides financial support and guidance to students from under-represented groups enrolled in accelerated nursing programs (http://www.newcareersinnursing.org). 

Topics: 2012, enrollment, rise, education, nurse, college

Telephone calls from nurses reduce readmissions

Posted by Alycia Sullivan

Fri, Dec 21, 2012 @ 03:11 PM

By 

describe the imageA series of simple phone calls from a nurse can reduce readmissions and cut $1,225 in costs per patient, according to a study in this month's Health Affairs.

Researchers from the University of Wisconsin School of Medicine and Public Health looked at more than 600 patients enrolled in the Coordinated Transitional Care (C-TraC), a low-resource Madison (Wis.) VA program that uses registered nurses for quality transitional care, according to the C-TraC website.

Patients discharged from the William S. Middleton Memorial Veterans Hospital and considered high risk received weekly phone calls from a nurse case manager for four weeks or until the patient transitioned to a primary care provider, according to last week's research announcement. High-risk patients had dementia, were over 65 years old and living alone or had a previous hospitalization in the past year.

In an open-ended discussion, the nurse talks about medication adherence--most often the biggest issue--symptoms and other follow-up.

The program has been popular with almost full patient participation, according to lead investigator Amy Kind, assistant professor of medicine (geriatrics) at the UW School of Medicine and Public Health.

"Patients don't mind a phone call," Kind said. "Our role is not to complicate the process but to more seamlessly bridge the patient's journey from the hospital to the home and to primary care," she added.

Such nurse-led contact has saved the hospital nearly three-quarters of a million dollars ($741,125) in healthcare costs over 18 months, according to the program.

Patients in the program had 11 percent fewer 30-day readmissions at 23 percent, compared to 34 percent of the those not enrolled.

Because the nurses don't spend a lot of time traveling, they can therefore reach out to more patients by phone, Kind noted. Most of the patients live in remote areas where a home visit is easily accessible.

"Simple, protocol-driven, telephone-based programs like C-TraC may be able to reach larger patient populations, including patients living a greater distance from hospitals and could be used in a wider variety of care settings than traditional in-home transitional care programs can," study authors wrote.

Researchers said resource-strained hospitals, such as safety nets, that can't afford home visits can implement similar telephone protocols. However, they also recognized that the VA is unique from other hospitals in that the VA has a single electronic health record system, shared among all VA-affiliated inpatient and outpatient providers.

Topics: phone calls, less readmission, nurse, patients

Future nurses learn with smart dummies

Posted by Alycia Sullivan

Mon, Dec 10, 2012 @ 03:41 PM

November 24, 2012|By Kevin Duffy, Special to The Morning Call

"I need a nurse. I can't breathe! Send a nurse!"

Maria Gonzales is in distress, and her caregivers need to figure out what to do.

She is sitting upright in her hospital bed, knees bent toward her chest. Beside her, a team of nurses and technicians scan the bar-coded bracelet on her wrist, and Gonzales' patient history flashes across the computer screen beside the bed. They quickly assess its contents — she was admitted two days ago with an inflamed pancreas — and check to see if she is flagged from receiving any medications.

A nurse applies a pulse oximeter to Gonzales' index finger to monitor oxygen saturation. Her levels are low. They place an oxygen mask over her nose and mouth. They check the screen again.

She has a history of high cholesterol. The medical team notes the clinical signs: alert and responsive, but expressing pain. What to do?

Complicating matters, her heart rate is low.

From an adjacent monitoring room, an instructor observes the scene through one-way glass but makes no move to help. The nurses, actually students, are on their own. The scene isn't playing out at St. Luke's or Lehigh Valley Hospital, but in a nursing simulator on the campus of Northampton Community College.

And Maria Gonzales is really in no danger. This "46 year-old wife and mother of two" is a mannequin.

This mannequin, however, is a smart dummy. "Maria Gonzales," one of six mannequins recently purchased by NCC at a cost of $75,000, has a full personal profile and medical history available to the students online. Instructor Marie Everhart in this class provided Maria's voice by speaking into a microphone from the observation room, where she also can alter the mannequin's health status.

Maria also has speakers in her ears and a camera installed in her head. This allows the instructors to video the exercise and then debrief the students afterward, said Mary Jean Osborne, program director for the nursing lab.

Gonzales is equipped to simulate 30 scenarios, such as pancreatic inflammation, sickle cell anemia, fractures and allergic reactions to blood transfusions. Instructors can alter the sex of each smart dummy to practice gender-specific exercises.

The technology, which began in the aviation industry with dummy test pilots measuring G-force, goes back about a decade in nursing applications. Neighboring centers of learning such as Lehigh Valley Health Network have been using simulators for some time, but they are new to NCC.

Using a high-tech mannequin "allows us to standardize experiences we'd like each student to have so they have an opportunity to practice what their responses should be," said Mali Bartges, director of nursing practice at the college.

"And to use their reasoning skills — what should I do first?"

As the exercise continues, Maria says she is in extreme pain and her oxygen levels drop.

Everhart leans into the microphone again and coughs for Maria. She presses another button, and Gonzales begins to blink.

"They better call for help," Everhart says.

Ultimately the students do, and the exercise reaches its conclusion. Afterward, the students realize that a rapid response team should have been summoned once the patient's heart rate dropped.

Worrying about administering pain medication, they agreed, is secondary.

There's an obvious benefit to using mannequins for learning.

"When you're using a mannequin you never have to worry about anyone dying or getting hurt," said Joan Yankalunas, education specialist for the Division of Education at Lehigh Valley Health Network.

"You can't do CPR on a live person, but you can certainly do that on a mannequin," she said. "So in those situations, getting the practice helps the student know how they're going to react and what they need to do in an emergency situation. And it's a safe way to learn it."

Student Jennifer Lamont, one of Gonzales' nurses, said the exercise with the mannequin provided a valuable learning experience.

"We are the nurses," she said. "Their lives are in our hands."

Topics: mannequin, nursing student, technology, nurse

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