DiversityNursing Blog

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

Nursing schools have major funding gaps. Foundations and charity groups can't make those ends meet. Another source of income may come from Nurse entrepeneurs. Some nursing schools and business communities are teaming up to develop healthcare technology, which in turn will help fill the funding gaps needed to acquire more nurses for our future.

Americans are applying to nursing school in record numbers. Unfortunately, the only thing many of the applicants end up nursing is a bruised ego.

In 2012, U.S. nursing schools rejected more than 80,000 qualified applicants. It's not as if the schools didn't want to admit them. Rather, they don't have enough faculty -- especially nurses with doctorates -- to teach more students.

That's a problem, as the United States will need 1 million new nurses by 2020.

At many nursing schools, tuition and grants are insufficient to cover the costs of hiring additional nurses with doctorates. To generate the cash they need to solve that problem -- and narrow the looming shortage of nurses -- schools should consider expanding beyond teaching and into entrepreneurship.

Nurses with doctorates are possibly the most versatile cogs in the U.S. health care system. They conduct research, do clinical work, and teach aspiring nurses. As researchers, these nurses examine the science and practice of nursing. Their work often combines the scientific elements of health care research with the more practical side of patient care.

This research can lead to new methods of pain management or medical devices such as the StethoClean, a self-cleaning stethoscope that prevents germs from being transferred among patients. It was invented by a nurse.

Because they understand the science and the practice of the profession, nurses with doctorates are invaluable resources for students. That's why the American Association of Colleges of Nursing recommends that all teaching faculty at nursing schools hold doctoral degrees.

Unfortunately, only about 1 percent of nurses in the United States have a doctorate, and that's not enough. More often, though, it's because of the significantly higher salaries they stand to earn outside academia.

Philanthropic groups are trying to help fill this funding gap. The Robert Wood Johnson Foundation, for example, has invested $20 million to help pay for nurses seeking doctorates across the country. But charitable gifts alone won't cut it. Nursing schools need another source of income. They just might find it by deputizing their faculty as health care entrepreneurs.

Nurses with doctorates are uniquely positioned to develop new health care technology. Whether they're administering medicines, utilizing medical devices or inputting data into the latest computer program adopted by hospitals, they have more hands-on experience with health care technology than anyone else in the system. To turn that technological aptitude into revenue, though, nursing schools have to partner with the business community.

Some schools are doing so. At the University of Utah, for instance, our Center for Medical Innovation provides seed funding for faculty members developing health care technology. It then links the innovators with business experts who can help them produce and market their technology.

In exchange, the university receives a share of the profits from intellectual property that is developed. It can then use the revenues to hire more nurses.

Other schools have adopted similar strategies. In March, the Midwest University HealthTech Showcase brought investors and industry professionals together to check out 50 early-stage health care start-ups at nine Midwestern colleges.

The young tech firms showed inventions ranging from gesture recognition software for smartphones to small-molecule drugs for post-traumatic stress disorder.

That's the sort of platform where inventions from nurses with doctorates can shine. 

To solve our nation's impending shortage of nurses, universities will need to get creative. Empowering nursing faculty members to become entrepreneurs can give schools the funding they need to educate the next generation of nurses.

Contributor: Patricia Morton

www.newsday.com 

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 Pat Magrath – DiversityNursing.com

When you think of the nurses in your life – family, friends and coworkers – are they all female? For many years, this has been the reality. But these days, more men are getting into the field of nursing. A friend of mine, Esteban, and I were chatting about his 18-year career as a nurse.

Esteban grew up in Puerto Rico. His family came to the U.S. when he was a child. His father and brother are policemen, a field primarily dominated by men. When he talked to his mother about becoming a nurse, she wasn’t excited about it because “if you’re Hispanic and interested in becoming a nurse, it is assumed you’re gay.” When she realized his passion for nursing, she was supportive and advised him respectfully.

Esteban explained that, in his culture, there is “machismo.” The Urban Dictionary defines machismo as “having an unusually high or exaggerated sense of masculinity. Including an attitude that aggression, strength, sexual prowess, power and control is the measure of someone’s manliness.” With the nursing profession being predominately female, Esteban’s mother feared he’d be teased and not seen as a strong “man.”

In Esteban’s Hispanic culture, he explained, “female nurses are completely accepted with pride, but for a male nurse it is expected you’re gay. Machismo is very strong in the Mexican, Dominican and Puerto Rican cultures. More straight guys are getting into nursing now. It is changing because of the nursing shortage and shortage of jobs. For many, this is a second career choice when men couldn’t find work in their first career choice.”

Esteban’s family has been extremely supportive of his chosen career, particularly while he was pursuing his master’s degree online. He explained how important family support is. His family provided some meals, continually asked what he needed and attended his graduation. They are very proud of him.

English is not Esteban’s first language, so classes and homework were very difficult. If you’re Hispanic and thinking about becoming a nurse, he advises, “don’t procrastinate.” He explains, “you need time to research and support your articles.” With English as his second language, “it took more time to check my sources, read it, read it again, and… read it again. Then… write and re-write my papers. English-speaking people can take about a half hour. It took me three times longer.” He offers great advice about the support of family and the expectation that assignments will take longer to complete.

Think about taking classes online as an option in pursuing your nursing career while juggling a busy life.

Esteban’s proficiency in Spanish comes in very handy while working at the VA in Harlem as an RN Care Manager. He is often asked to translate for patients, and most of Esteban’s patients are male veterans and Hispanic. He said, “they like a Hispanic male nurse taking care of them.”

He has plans to continue his education in the fall of 2016 and work toward attaining his doctorate. While achieving his master’s through an online program, which served him well, he envisions taking his PhD classes in a classroom to consult with instructors and collaborate with others.

Whenever Esteban talks to people about becoming a nurse, he loves to point out that “as a nurse, you can work in any setting – hospitals, schools, insurance companies, etc. If you don’t want to be a bedside nurse, there are different places to work.”

Gracias for your insights, Esteban! We appreciate all your hard work and dedication.

And if you’re thinking about getting into this field, this is a great time to do so.

I’m compensated by University of Phoenix for this blog. As always, all thoughts and opinions are my own.

We found this interesting article about the growth of smartphone use and apps available to Nurses while at work. These apps are being used to research drugs, gather information about home care as well as diseases and disorders. This is an area that will continue to grow and hopefully provide much needed assistance to our hard-working Nurses.

A new survey indicates nurses are relying more than ever on their smartphone for clinical care – to the detriment of the so-called "doctor on call."

Conducted by InCrowd, a Boston-based market intelligence firm, the survey found that 95 percent of the 241 responding nurses own a smartphone and 88 percent use smartphone apps at work. More intriguing, 52 percent said they use an app instead of asking a colleague, and 32 percent said they consult their smartphone instead of a physician.

"The hospital gets very busy and there isn't always someone available to bounce ideas off of," one respondent said. Said another: "It's often easier to get the information needed using my smartphone – I don't have to wait for a response from a coworker."

Nurses have long been seen as an under-appreciated market for mHealth technology, and one that differs significantly from doctors, but that seems to be changing. Companies like Voalte are marketing communications platforms targeted at nurses, and even IBM has come out with a line of nurse-specific apps.

"There's a lot of untapped potential in the use of mobile apps for nursing," Judy Murphy, IBM's chief nursing officer, told mHealth News.

Unlike physicians, who are looking for apps that can retrieve information, enter orders and push notifications, nurses need apps that assist their workflow, offer quick information and coordinate multiple activities.

"It's all about care coordination," Murphy said. "Nurses want apps that can help them organize their day."

The ideal app will be simple in nature, so that it can be used quickly, and will help nurses organize several functions, from taking care of multiple patients to addressing orders from doctors, according to Murphy. Some tasks, like entering complex data into the EMR, actually clutter the form factor of the smartphone and are best handled at a workstation.

According to the InCrowd survey, nurses are quick to point out that their smartphones "enhance but don't substitute" for the physician, but when they're running around and need a quick question answered about medications, illnesses or symptoms, sometimes the app does the job more effectively – such as "in patient homecare situations when I need quick answers without making a bunch of phone calls," or "so I can make an educated suggestion to the doctor."

According to the survey, 73 percent of the nurses surveyed use their smartphones to look up drug information at the bedside, while 72 percent use it to look up various diseases or disorders. And befitting the various roles of the smartphone in the healthcare setting, 69 percent of nurses said they use their smartphones to stay in touch with colleagues. Other uses include viewing images and setting timers for medication administration.

Finally, the survey found that nurses are using smartphones in the workplace no matter who's paying for them. Some 87 percent of those surveyed said their employer isn't covering any costs related to the smartphone, while 9 percent are reimbursed for the cost of the monthly bill, 1 percent receive some reimbursement for the cost of the smartphone, and 3 percent are reimbursed for both the phone and the phone bill. Less than 1 percent, meanwhile, said their institution bans the use of personal smartphones while on duty.

"We're hitting the tip of the iceberg here with apps that a nurse will want and will use," Murphy said.

www.mhealthnews.com

Contributor: Eric Wicklund

We wholeheartedly agree with this article that Nurse Practitioners across the country should be allowed to practice without a doctor’s consent in a variety of medical areas.

What are your thoughts about this important issue? Do you strongly agree or disagree?

In March, Nebraska became the 20th state to allow nurses with the most advanced degrees to practice without a doctor’s oversight in a variety of medical fields. Maryland recently followed suit and eight more states are considering similar legislation.

What does all this mean? Nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to order and interpret diagnostic tests, prescribe medications and administer treatments.

These changes are long overdue.

The preponderance of empirical evidence indicates that, compared to physicians, nurse practitioners provide as good — if not better — quality of care. As I’ve written previously, patients are often more satisfied with nurse practitioner care — and sometimes even prefer it.

The Institute of Medicine is unambiguously clear about this: 

No studies suggest that APRNs [Advanced Practice Registered Nurse] are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs.

In addition, see this review of the literature in Health Affairs.

In general, nurse practitioners have the skills to prescribe, treat and do most things a primary care physician can do. They generally must have completed a Registered Nurse and a Nurse Practitioner Program and have a Masters or PhD degree. In addition, there are physician assistants, registered nurses, licensed vocational nurses, emergency medical technicians, paramedics and army medics. In most states, each of these categories has its own set of restrictions and regulations, delineating what the practitioners can and can’t do.

What should each of these professionals be allowed to do? Whatever they’ve been trained to do.

The doctors counter that someone who hasn’t trained to be a doctor might miss important symptoms or clues that a physician might catch. This observation is true but trivial. Every professional might miss something that someone who is better trained might catch. A specialist might catch something a primary care physician might miss. A specialist in one field (say, oncology) might catch something a specialist in some other field (say ENT) might miss.

Perhaps more relevant to common experience, Emergency Medical Technicians riding in ambulances are treating victims of accidents and emergencies every day. Would the care be slightly less risky if we put doctors in all those ambulances? Maybe. Is anyone seriously suggesting that we do that? Of course not.

Think of health care as a large market in which everyone has to make decisions about whether the patient-provider nexus is the right fit. It’s not just the providers who have to decide whether the problem lies within their area of competence. Patients must make those decisions too. In Britain (under socialized medicine), patients make such decisions all the time. For routine problems, most Britons see a National Health Service physician. But “if it’s serious, go private” is a common bit of advice in that country.

How do professionals handle these decisions? From the most part quite well. Walk-in clinics (where nurses deliver care following computerized protocols) have been around for at least a decade. Studies show that the nurses follow best practices as well or better than traditional primary care physicians. And I am not aware of any serious, reported cases of nurses failing to distinguish between cases they are competent to handle and those they are not.

But even if a nurse did make a serious mistake, doctors make mistakes too. There is no such thing as a risk free world. We encounter tradeoffs between cost and risk every day. There is no reason for politicians (beholden to special interests) to make these decision for us.

In Texas, which has some of the most stringent regulations in the country, however, a nurse practitioner can’t do much of anything without being supervised by a doctor who must:

•Not oversee more than four nurses at one time.

•Not oversee nurses located outside of a 75 mile radius.

•Conduct a random review of 10 percent of the nurses’ patient charts every 10 days.

•Be on the premises 20 percent of the time.

These restrictions make it virtually impossible for Texas’ 8,600 nurse practitioners to practice outside the office of a primary care physician. The Texas requirement that a doctor supervising nurse practitioners be physically present and spend at least 20 percent of her time overseeing them creates an incentive for the physician to require nurses to be employees, rather than self-employed professionals. When practitioners are employed by a doctor, the physician meets state supervision requirements simply by showing up. This allows the doctor to see her own patients while generating additional revenue from patients seen by the practitioners.

These regulations have the greatest impact on the poor, especially the rural poor. The farther a nurse is located from a doctor’s office, the less likely the physician will be willing to make the drive to supervise the nurse. This means that people living in poverty-stricken Texas counties must drive long distances, miss work and take their kids out of school in order to get simple prescriptions and uncomplicated diagnoses. This problem might be alleviated if nurse practitioners were allowed to practice independently in rural areas. But, under Texas law, these practices must be located within 75 miles of a supervising physician. A physician with four nurses located in rural areas could drive hundreds of miles a week to review the nurses’ patient charts. The result is that doctors in Texas don’t receive a return on investment sufficient to induce them to supervise nurse practitioners.

If all this sounds like the reinvention of the Medieval Guild system, that’s exactly what it is. In Capitalism and Freedom, Milton Friedman argued that these labor market restrictions are no more justified today than they were several centuries ago. The proper role of government, said Friedman, is to certify the skills of various practitioners; then let consumers decide what services to buy from them.

Contributer: John C. Goodman

www.forbes.com

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.

Phil Galewitz

www.usatoday.com 

With her children grown and husband nearing retirement, Amy Reynolds was ready to leave behind snowy Flagstaff, Ariz., to travel but she wasn't ready to give up her nursing career.

She didn't have to.

For the past three years, Reynolds, 55, has been a travel nurse – working for about three months at a time at hospitals in California, Washington, Texas and Idaho, among other states. Her husband accompanies her on the assignments. "It's been wonderful," she said in May after starting a stint in Sacramento. "It's given us a chance to try out other parts of the country."

Reynolds is one of thousands of registered nurses who travel the country helping hospitals and other health care facilities in need of experienced, temporary staff.

With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses such as Reynolds is at a 20-year high, industry analysts say. That's meant Reynolds has her pick of hospitals and cities when it's time for her next assignment. And it's driven up stock prices of the largest publicly traded travel-nurse companies, including San Diego-based AMN Healthcare Services and Cross Country Healthcare of Boca Raton, Fla.

"We've seen a broad uptick in health care employment, which the staffing agencies are riding," said Randle Reece, an analyst with investment firm Avondale Partners. He estimates the demand for nurses and other health care personnel is at its highest level since the mid-1990s.

Demand for travel nursing is expected to increase by 10% this year "due to declining unemployment, which raises demand by increasing commercial admissions to hospitals," according to Staffing Industry Analysts, a research firm. That trend is expected to accelerate, the report said, because of higher hospital admissions propelled by the health law. 

Improved profits — particularly in states that expanded Medicaid — have also made hospitals more amenable to hire travel nurses to help them keep up with rising admissions, analysts say.

At AMN Healthcare, the nation's largest travel-nurse company, demand for nurses is up significantly in the past year: CEO Susan Salka said orders from many hospitals have doubled or tripled in recent years. Much of the demand is for nurses with experience in intensive care, emergency departments and other specialty areas. "We can't fill all the jobs that are out there," she said.

Northside Hospital in Atlanta is among hospitals that have recently increased demand for travel nurses, said David Votta, manager of human resources. "It's a love-hate relationship," he said. From a financial viewpoint, the travel nurses can cost significantly more per hour than regular nurses. But the travel nurses provide a vital role to help the hospital fills gaps in staffing so they can serve more patients. 

Northside is using 40 travel nurses at its three hospitals, an increase of about 52% since last year. The system employs about 4,000 nurses overall. 

Historically, the most common reason why hospitals turn to traveling nurses is seasonal demand, according to a 2011 study by accounting firm KPMG. Nearly half of hospitals surveyed said seasonal influxes in places such as Arizona or Florida, where large numbers of retirees flock every winter, led them to hire traveling nurses. 

Though there have been rare reports of travel nurses involved in patient safety problems, a 2012 study by researchers at the University of Pennsylvania published in the Journal of Health Services Research found no link between travel nurses and patient mortality rates. The study examined more than 1.3 million patients and 40,000 nurses in more than 600 hospitals. "Our study showed these nurses could be lifesavers. Hiring temporary nurses can alleviate shortages that could produce higher patient mortality," said Linda Aiken, director of the university's Center for Health Outcomes and Policy Research. The study was funded by the National Institutes of Health and the American Staffing Association Foundation.

The staffing companies screen and interview nurses to make sure they are qualified, and some hospitals, such as Northside, also make their own checks. Nurses usually spend a couple days getting orientated to a hospital and its operations before beginning work. They have to be licensed in each state they practice in, although about 20 states have reciprocity laws that expedite the process.

Cherisse Dillard, a labor and delivery room nurse, has been a traveler for nearly a decade. In the past few years, she's worked at hospitals in Chicago, Dallas, Houston, Pensacola and the San Francisco area.

While delivering a baby is relatively standard practice, she said she makes it a practice at each new hospital to talk to doctors and other staff to learn what their preferences are with drugs and other procedures. Dillard, 46, often can negotiate to be off on weekends and be paid a high hourly rate. "When the economy crashed in 2008, hospitals became tight with their budget and it was tough to find jobs, but now it's back to full swing and there are abundant jobs for travel nurses," she said.

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."