DiversityNursing Blog

By KAYLEIGH SOMMER

Wherever health care is provided, a nurse is likely to be there.

Tuesday marks the start of National Nurses Week, an annual opportunity for communities to recognize the full range of nurses’ contributions. This year’s theme, “Nurses: Leading the Way,” recognizes nurses as leaders in the field.

Nurses are being honored as leaders who improve the quality of health care. Nurses practice in diverse roles, such as clinicians, administrators, researchers, educators and policymakers.

Lizeth Martinez, a registered nurse at Valley Baptist Medical Center in Harlingen, said every nurse is different.

“We each have our scope of practice and me, personally, I always try to be there for my patients,” Martinez said. “From what I have seen I am very fortunate to work with the people that I do.”

Martinez, who was born and raised in Brownsville, is currently working on a graduate degree in nursing at the University of Texas at Brownsville and should be finished by next year.

She said that in the two and half years that she’s been a nurse she has gained a lot of experience.

“I love being a nurse,” Martinez said. “As nurses we care in a different way, in a compassionate and holistic manner promoting health and healing.”

However, being a nurse is not without its challenges, said Martinez, who mainly works with wound care and diabetes patients.

“I think the most challenging thing about being a nurse is the emotional aspect because we see a lot of patients that are chronically ill,” Martinez said.

Garett Byrd, a pediatric registered nurse at Harlingen Medical Center, has worked in the nursing field for nine years.

Byrd, whose parents were nurses, said the profession has changed a lot during that time.

“Over the years I’ve noticed an increase in accountability and technology,” Byrd said. “The nursing profession has moved towards a more evidenced based practice. Were not doing things just to do them, were researching and going by the research.”

He said the community should keep one thing in mind.

“The community needs to remember that we’re human beings too, and we’re here because we care,” Byrd said.

Both Martinez and Byrd said nurses are leaders in the health profession.

“I think we are leaders. The profession is so amazing because there are so many things you can do, so many fields you can go into,” Martinez said.

“As nurses were able to provide and coordinate care and think those aspects of leadership position.”

Karen A. Daley, president of the American Nurses Association, agrees.

“All nurses are leaders, whether they are in direct patient care, administrative roles or meeting consumers’ needs in new roles such as care coordinators or wellness coaches,” Daley said.

“This week, we acknowledge nurses’ vast contributions and how they are leading the way in improving health care and ultimately, the health of the nation.”

Nurses are leading initiatives to increase access to care and improve outcomes by focusing on primary care, prevention, wellness, chronic disease management and the coordination of care among health care providers and settings.

These are areas in which nurses excel given their education and experience, the ANA said.

According to the ANA, nursing is the nation’s largest health care profession, with nearly 3 million employed professionals and is projected to grow faster than all other occupations.

The federal government projects that more than 1 million new registered nurses will be needed by 2022 to fill new jobs and replace nurses who leave the profession.

Demand for nursing care will grow rapidly as Baby Boomers swell Medicare enrollment by 50 percent by 2025 and millions of individuals obtain new or better access to care under the health care reform law, the ANA said.

Source: Valley Morning Star 

By Janice Petrella Lynch, RN, MSN, and Tracey Boyd

My network of team leaders helped me transition into nursing after 16 years as a paramedic. I didn’t get to be part of patients’ follow-up care or journey back to independence while working as a paramedic. 

As part of MJHS Home Care, I see patients one-on-one, but with the support I get from my special colleagues, I’ve never felt alone. Most important, my team leaders have taught me that at the end of the day, it’s all about our patients. 

When I was a high school volunteer in the ICU of a community hospital in Brooklyn, I watched the nurses care for patients and knew I wanted to be a nurse. As a nurse for more than three decades, I continue to be inspired by nurses every day, individually and collectively. 

Individually, I see nurses work tirelessly to provide excellent care during difficult financial times, and I am determined to make sure they have the resources they need to provide safe care. I am inspired when I see younger nurses become leaders on their units and I know I have made a difference. 

Several nurses have mentored and provided a springboard for me to elevate my practice and expand my scope of influence. They did so by recognizing potential in me that was hidden from myself. They helped me gain entry into higher levels of practice and a peer group that role-modeled leadership. 

When I am having one of those days when I ask myself, “Why do I do this?,” I think of those nurses and the patients we care for and remember that I am privileged to be touched by others and to touch others’ lives every day. 

Sylvie Jacobs, RN, BSN, CPAN, postanesthesia care unit, Mount Sinai Hospital, New York City

The nurse who remains with me as the most inspiring is Patricia Liang. We worked side by side in the postanesthesia care unit for decades. 

She was the go-to resource because she seemed to know what to do in every situation and could impart the information to staff in a kind and supportive way. 

Liang was tiny in stature but relayed an enormous, quiet power, always in a respectful way. The new residents got away with nothing when Liang was around. She not only had a seemingly bottomless wealth of knowledge, but she also had an unfailing moral compass. When there was an ethical issue that needed to be resolved, we knew to ask Liang. 

She was not a talkative person — she was usually focused on coordinating care — but you somehow felt her support and appreciation for your efforts. I always will remember her for not just being an outstanding nurse, but for also being an outstanding person. 

Nearly every morning for the past 10 years, I have been fortunate to have a chat with Marilyn Liota, RN, as we start our day around 7 a.m. Nearly every conversation begins with Liota saying: “Tell me what is good.” From there, we have gone off in many directions. What a way to open a conversation, and what a way to start the day. 

I consider myself fortunate to have known Liota, worked under her leadership and guidance, and been a part of the special and historic “Marilyn Liota” years at VNSNY. Liota recently retired and I’m truly happy for her, yet underneath it all, I feel a touch of sadness, too. I will miss her so much. 

So typical of a giving soul like hers, Liota’s next steps involve giving generously of herself to help others as a volunteer working with new immigrants for a nonprofit organization called “Literacy Nassau.” 

I was 21 years old when I was a new RN on a med/surg floor. On that unit there was no such thing as being alone as a nurse — we worked together as a team. It was scary, overwhelming and exciting at the same time. 

Lisa Williams, my first nurse manager, did more than just her job. If there was a sick call, she would take a section of patients. If we needed some extra hands, she would give bed baths. Williams exemplified confidence, leadership and teamwork with a touch of color and a twist of enthusiasm that would radiate to her staff. 

The quality that amazed me most was her compassion for people. It wasn’t just about your abilities as a nurse; it was about tapping into the kind of person you were and helping you grow. She could sense if something was wrong, take you to the side and support you through the challenge. 

Williams’ specialty was to identify a nurse’s potential and mentor her to be a better nurse and a better person. She encouraged me to be the charge nurse and join committees when I didn’t think I was ready, but she assured me I was. Now I am a critical care RN and even host a CCRN review class. I volunteer for many committees. I am a better person and nurse because of Williams, my first nurse manager, mentor and friend. 

Erica Zippo, RNC-OB, BSN, C-EFM, staff nurse, labor and delivery, White Plains (N.Y.) Hospital

I was a new graduate nurse when I started working on the labor and delivery unit at White Plains Hospital. In nursing school, we heard that nurses eat their young, so the support, camaraderie and familylike atmosphere I felt on the unit was something I never expected. 

My colleagues took me under their wings and enthusiastically shared their knowledge and individual experiences, most of which were things I had not learned in school. When observing my colleagues in action, I learned how to make a patient and his or her family feel comfortable, calm and welcome; how to complete an efficient history and physical while admitting a woman in labor; and how to make the delivery of every baby special despite the paperwork and nursing tasks. 

This shared knowledge from my colleagues continues to enrich my professional life and has shaped me into the nurse I am today. My colleagues also have supported me in my personal life through many important moments, such as relationships, break-ups, moves, graduate school, marriage and the birth of my daughter. I am thankful for the positive influences of my strong, intelligent and caring colleagues.

For more responses, visit www.Nurse.com/Article/NJThankYou. 

Source: Nurse.com

When it comes to the cost and quality of hospital care, nurse tenure and teamwork matters. Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study from researchers at Columbia University School of Nursing and Columbia Business School. The study was published in the current issue of the American Economics Journal: Applied Economics.

The review of more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System is the largest study of its kind to link nurse staffing to patient outcomes. The researchers analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing impacted the length of stay for patients. Because length of stay is increased by delays in delivery of appropriate care and errors in care delivery, a shorter length of stay indicates that the hospital provided better treatment. At the same time, a shorter length of stay also makes care more cost-effective. The study found that a one-year increase in the average tenure of RNs on a hospital unit was associated with a 1.3 percent decrease in length of stay.

"Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care," says senior study author Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at Columbia Nursing. "When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions – disrupting the balance of a team can make quality go down and costs go up."

While many hospitals rely on temporary staffing agencies at least some of the time to fill RN vacancies, the study found that it's more cost-effective for hospitals to pay staff RNs overtime to work more hours on their unit. RNs working overtime resulted in shorter lengths of stay than hours worked by nurses hired from staffing agencies, the study found.

Nursing skill also mattered, the study found. Length of stay decreased more in response to staffing by RNs than by unlicensed assistive personnel. Furthermore, the study showed that length of stay increased when a team of RNs was disrupted by the absence of an experienced member or the addition of a new member.

"This rigorous econometric analysis of nurse staffing shows that hospital chief executives should be considering policies to retain the most experienced nurses and create a work environment that encourages nurses to remain on their current units," says the senior economist on the study team, Ann Bartel, PhD, Merrill Lynch Professor of Workforce Transformation at Columbia Business School.

The researchers used the VA's Personnel and Accounting Integrated Data for information on each nurse's age, education, prior experience, VA hire date, start date at the current VA facility, and start date for the current unit at that facility. To assess patient outcomes, the researchers used the VA's Patient Treatment File for information on each patient including dates of admission and discharge for each unit and for the overall hospitalization, as well as age and diagnoses. The final sample accounts for 90 percent of all acute care stays in the VA system for the fiscal years 2003 to 2006.

More information: The paper is titled: "Human Capital and Productivity in a Team Environment: Evidence from the Healthcare Sector," and it was published in April 2014.

For nearly a year, the Boston Marathon bombings and their aftermath have haunted Chelsey McGinn, RN, of the Blake 12 Intensive Care Unit (ICU). In December the MGH gave McGinn an opportunity to honor the victims – and begin her own healing process – by running this year’s marathon as part of its Emergency Response Fund team.

“I feel like it’s been almost a year now, and I haven’t really done anything therapeutic since it happened,” McGinn says. “I felt like other people who I worked with found ways to kind of cope with it, but I hadn’t really found that. When this came up, I thought this was a perfect way to celebrate how far the victims have come and recognize my co-workers.” 

McGinn is one of six nurses on her unit who are planning to run the 2014 Boston Marathon – five for charity teams and one as a qualified runner. Most are first-time runners, and all say they are running in honor of the three bombing victims who were treated on the unit.

“I had a really hard time afterward, and it lasted longer than I expected,” says Laura Lux, RN, who is running for the American Red Cross. “I’m running because I don’t want to be defeated. I know if he could, my patient would be running just to prove a point. Because he can’t, I feel like I need to do this for him. After watching what he and his family went through, I feel like it’s the least I could do for them.”

Lux says she felt an immediate connection with her patient and his family. “Despite everything they were just so determined and so strong,” she says. “Everyone was angry, but there was good coming from it too. We got to know each other because of it. I felt like he was a family member. It’s the most personal experience of my career.”

Lux’s experience is similar to that of the other nurses who are running, including Emily Erhardt, RN, a trauma ICU nurse and member of the MGH Emergency Response Fund Team, who has stayed in touch with her patient and his family since they left the hospital. “This event affected everyone, so it was one of the few times in my career that I felt like all I could do with the family was cry with them. It’s such a terrible thing that happened that there aren’t words to comfort them. You just have to be there for them,” she says. “A year ago they were strangers to me, but now they’re the most inspiring people in my life. I’m not much of an athlete, but I was really affected by the whole thing, and I wanted to do something more.”

Blake 12 runners receive a boost of support from the Harvard University Employees Credit Union. Included in the photo with members of the ICU are Paul Conners, MGH branch manager; Eugene Foley, president and CEO; and Guillermo Banchiere, MGH director of Environmental Services, who serves as a member of the credit union's board of directors.

Allyson Mendonza, RN, who is running for the Mass General Marathon Team “Fighting Kids Cancer … One Step At a Time,” recalls the moment she knew she too wanted to do something more. Mendonza says her patient had just returned from surgery when she was told President Barack Obama was coming to visit. The woman was excited but was distraught about her appearance, so Mendonza and her colleague soaked her nails and helped shampoo and condition her hair to wash out the cement and clumps of dried blood.

“We just tried our best to make her feel better about herself and feel good for the day ahead. She actually fell asleep. When she awoke, she said, ‘This is the most relaxed I have felt in days.’ It was just so emotional for us and for her,” Mendonza says.

Caring for the marathon victims brought the unit closer together, and staff once again have come together to support and encourage their fellow colleagues.

“The teamwork and the camaraderie were amazing,” saysKatherine Pyrek, RN, who was the charge nurse during the week of the bombing. “Every one of the nurses was affected by what was going on, but they stayed strong and carried on. The bonds the nurses made with the patients and their families were incredible and really went above and beyond.”

Pyrek, who is running for the Mass General Marathon Team, says the Blake 12 runners offer each other advice and encouragement to help in the training process. “We remind why we’re doing this – for our patients and their families,” she says. “I think about the patients when they were in pain and how scared they were. I think that if they get through it then I can get through however many miles I need to run.”

The runners all say they look to Meredith Salony, RN, a veteran marathoner who qualified for the marathon, for guidance. “I’m so proud to be in this unit where there’s so much enthusiasm. Even the people who aren’t running are trying to help out and organize events and find ways for people to contribute,” Salony says.

Each of the nurses says they are overwhelmed when they imagine how they will feel on Marathon Monday.

“I think it’ll be really therapeutic and empowering,” McGinn says. “I’m honored to be a part of it. If I’m ever going to run a marathon, this is the one I want to run. I’ll always remember the way I felt at work that night, and it’s going to be a really nice thing to be able to remember this feeling for the rest of my life too.”

For more information or to support the teams visit www.runformgh.org.

This is the first in a series of articles that MGH Hotline will publish about staff running in this year’s Boston Marathon.

Source: Massachusetts General Hospital

By Donna Cardillo 

It is imperative that every nurse – new and experienced – realize the healthcare landscape has completely changed. There will be plenty of opportunities for RNs and APNs who stay current with trends in education, technology, care and personal and professional development. Nurses must be willing to step outside their comfort zone and learn new ways — and places — of working and thinking about their profession. Cynthia Nowicki Hnatiuk, RN, EdD, CAE, FAAN, executive director of the American Academy of Ambulatory Care Nurses and the Academy of Medical Surgical Nurses. stresses that, to stay competitive, nurses also will have to be able to articulate the value that they bring to outcomes, beyond tasks, in any setting. So what does every nurse need to do? Here are four key areas:

1| Skill building

Clinical skills alone won’t see us through in this new paradigm. Self-marketing, computer skills, oral and written communication, conflict management, negotiation, leadership and networking skills must be learned and practiced. Hnatiuk said nurses also need to be more business savvy, with an understanding of finances, staffing, acuity and productivity.

2| Education

Higher education is no longer optional. It is a foundation for practice in any setting and fundamental to professional and personal growth and development. Hnatiuk advises that formal and continuing education, along with clinical certification, will help nurses take their practice and careers to the
next level.

For those considering advanced practice, particularly becoming nurse practitioners, the NNCC’s Hansen-Turton advises: “Don’t think too long; jump in. Opportunities will be increasing for NPs over the next 5-10 years. NPs are and will continue to be a hot commodity.” Certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists also will see expanded opportunities.

3| Professional association involvement

Our professional associations are where we connect with one another, form communities, share best practices (local and national), stay current with trends and issues, and find support. Hnatiuk added that through association involvement, you learn more than you could by yourself and progressively learn leadership skills

4| Mentoring

Hnatiuk encourages nurses to take advantage of opportunities to be mentored and to mentor others. “We have so much to share. Mentoring will allow us to achieve all we’re capable of doing.”

For personalized career advice

If you have specific career-related questions, send them to Dear Donna at www.Nurse.com/AsktheExperts/DearDonna for a personalized response.

Source: Nurse.com

Question:

Dear Donna,

I'm a recent new graduate and I'm trying to figure out how to setup and update my resume to be more attractive to employers. Are there certain topics or headlines that should be included and what are the rules for putting my clinical experience on
my resume?

Wants a More Attractive Resume 

By Sophie Quinton

Isabel Barradas, 48, has been a doctor for 25 years. In her native Venezuela, she was an orthopedic surgeon and head of a hospital department, with expertise in physical rehabilitation. She speaks three languages and—since marrying an American and moving to South Florida more than a decade ago—is a U.S. citizen.

Barradas passed her U.S. medical licensing exams with flying colors. But she didn't get a residency position in the specialty she loves. "Orthopedic surgery? Forget it. In this country, that is so elite," Barradas says. Competition for the training positions required for medical licensure is fierce, and most go to seniors at U.S. medical schools. Barradas decided that the position she did get—internal medicine in Buffalo, N.Y.—wasn't worth leaving her family in Miami for.

Thousands of foreign-educated doctors living in the U.S. would like to practice medicine here but don't have the time, money or language skills to compete for and complete a residency. Miami's Florida International University offers other options: accelerated programs leading to a bachelor's and master's of science in nursing which train foreign-educated doctors to be nurse practitioners. FIU's programs both give internationally educated professionals an outlet for their skills and helps add much-needed diversity to the health care workforce.

The U.S. faces a dearth of 20,400 primary care physicians by 2025, according to federal statistics. The Association of American Medical Colleges projects a shortage of thousands of surgeons and other specialists too. While an aging population and health insurance expansion increase demand for health care services, medical schools and residency programs aren't producing enough doctors to meet demand.

There are thousands of foreign-educated doctors living in the U.S. who have the expertise needed to address some of this growing need. Every year for the past decade, between 5,000 and 12,000 foreign-educated physicians who have passed their licensing exams apply for a residency position. Typically, about half get one, compared with more than 90 percent of U.S. medical school seniors who apply, according to data from the National Resident Matching Program.

International medical school graduates, like minority doctors, often go on to serve medically underserved populations. Graduates of international medical schools make up a quarter of U.S. office-based physicians, and are more likely than their U.S.-educated peers to treat minority patients, foreign-born patients, patients who speak little English and patients who qualify for Medicaid, according to a 2009 study from the Centers for Disease Control and Prevention.

Demand for highly trained nurses is also growing, particularly for nurses who speak more than one language and reflect the growing diversity of the U.S. population. If highly trained professionals like nurse practitioners and physician assistants were to take on more primary care responsibilities, the shortage of primary care doctors could be cut by more than two-thirds, according to the Health Resources and Services administration.

FIU introduced its accelerated nursing degree program in 2000, in response to pressure from underemployed Cuban doctors living in the area. The FEP-BSN/MSN program began as a bachelor's degree program that prepared students to become registered nurses. In 2010, FIU added a master's degree, and graduates of the full program can now find work as nurse practitioners—an advanced role that can include prescribing medicine and diagnosing patients. In Florida, nurse practitioners earn about $86,800 per year. Barradas hopes to find work with an orthopedic surgeon.

Isabel Barradas (left) and Mariana Luque, trained and credentialed as physicians in their native Venezuela and Colombia respectively, are nursing students at Florida International University. (Sophie Quinton)The program compresses six years of education into four, mostly by moving quickly through undergraduate-level material. English language learners get help with reading and writing academic papers, and courses are scheduled in the evenings or compressed into one day a week to fit the needs of working adults. For the past few years, the graduation rate has been close to 100 percent.

Despite its South Florida roots, the program has begun to attract students from all over the U.S. "I ask them, why don't you just go to the accelerated program where you live? And it's not the same for them," says Maria Olenick, program director. "They choose to come here because they know that there are other people in the same situation."

Most of the 200 doctors enrolled in FIU's program this year are bilingual. About 39 percent are from Cuba, 28 percent are from Haiti, and 6 percent are from Colombia, with the rest hailing from Nigeria to Lithuania. Students are evenly split between men and women, and the average age is about 40. Applicants must be U.S. citizens or permanent residents.

Some doctors are initially reluctant to enter a nursing program, Olenick says, fearing loss of prestige, but usually the negative feelings don't last. "What we're hearing from them is that they're actually really, really enjoy the role of nurse practitioner in the United States, because it's more like the way they practiced in their home countries," she says. American physicians tend to spend less time with patients and more time processing paperwork than their counterparts overseas. Barradas' patients in Venezuela used to come by just to chat.

It's not always easy for graduates of the accelerated degree program to find the kind of work they want, says Carlos Arias, chief operating officer of Access Healthcare. Although they're armed with an advanced nursing degree and have medical training, graduates are often offered entry-level positions with low salaries. Arias, a Cuban-educated doctor himself, now heads a Florida independent practice association that has hired two graduates of FIU's program to date.

Not all graduates choose to enter the workforce right away. The first class of nurse practitioners graduated last summer, and of 55 graduates 12 returned to FIU to enroll in a doctoral program. "We're looking now at making the program a BSN to DNP program, because we have so many that are interested," Olenick says of the doctoral program. "The way that nursing is moving, eventually a DNP will be required to practice as a nurse practitioner."

For the foreign-educated physicians in the program, the doctorate offers another perk. As a graduate, you get to be titled Dr. again.

CORRECTION: An earlier version of this article misspelled the name of Carlos Arias. It also omitted the number of graduates who returned to FIU to enroll in a doctoral program. Twelve did.

Source: NationalJournal