DiversityNursing Blog

By Diane Sparacino via rn.com

Imagine a world where hospitals have become so noisy that the annoyance has topped hospital complaints, -- even more than for the tasteless, Jell-O-laden hospital food (Deardorff, 2011). If you’re a nurse, you know that we’re already there -- with noise levels reaching nearly that of a chainsaw (Garcia, 2012). In fact, for more than five decades, hospital noise has seen a steady rise (ScienceDaily, 2005).

But it wasn’t always that way. At one time, hospitals were virtually noise-free like libraries -- respected spaces, preserved as quiet zones. The culture was such that a loud visitor might be silenced by a nurse’s purposeful glare or sharply delivered “Shhh!” As early as 1859, the importance of maintaining a quiet environment for patients was a topic for discussion. In Florence Nightingale’s book, “Notes on Nursing,” she described needless noise as "the most cruel absence of care" (Deardorff, 2011).
 
Fast forward to 1995, when the World Health Organization (WHO) outlined its hospital noise guidelines, suggesting that  patient room sound levels not exceed 35 decibels (dB). Yet since 1960, the average daytime hospital noise levels around the world have steadily risen to more than double the acceptable level (from 57 to 72 dB), with nighttime levels increasing from 42 to 60 dB. WHO found that the issue was not only pervasive, but high noise levels remained fairly consistent across the board, despite the type of hospital (ScienceDaily, 2005).

Researchers at Johns Hopkins University began to look into the noise problem in 2003. They maintained that excessive noise not only hindered the ability for patients to rest, but raised the risk for medical errors. Other studies blamed hospital noise for a possible increase in healing time and a contributing factor in stress-related burnout among healthcare workers (ScienceDaily, 2005).

Technology is, of course, partly to blame. State-of-the-art machines, banks of useful alarms, respirators, generators, powerful ventilation systems and intercoms all add up to a lot of unwanted racket. When human voices are added to the mix, (i.e.  staff members being forced to speak loudly over the steady din of medical equipment), it’s anything but a restful environment. For the recovering patient in need of sleep, that can be a real issue (Deardorff, 2011).

Contributing to the problem, experts say, are the materials used in hospitals. Because they must be easily sanitized, surfaces cannot be porous where they could harbor disease-causing organisms. Rather than using noise-muffling materials like carpet, acoustic tiles and other soft surfaces, hospitals have traditionally been outfitted using smooth, hard surfaces – especially in patient rooms. Good for cleanliness – not so great for dampening sounds, which tend to bounce around the typical hospital (Deardorff, 2011).

Which brings us to the most recent research, published January 2012 in the Archives of Internal Medicine. In the report, Jordan Yoder, BSE, from the Pritzker School of Medicine, University of Chicago, and his colleagues associated elevated noise levels with “clinically significant sleep loss among hospitalized patients,” perhaps causing a delay in their recovery time (Garcia, 2012). During the 155-day study period, researchers examined hospital sound levels. The numbers far exceeded (WHO) recommendations  for average hospital-room noise levels, with the peak noise at an average 80.3 dB – nearly as loud as a chainsaw or electric sander (85 dB), and well over the recommended maximum of 40 dB. And while nights tended to be quieter, they were still noisier than recommended allowances, with “a mean maximum sound level of 69.7 dB” (Garcia, 2012).

Perhaps most interestingly, the researchers broke down the sources of noise into categories: “Staff conversation (65%), roommates (54%), alarms (42%), intercoms (39%), and pagers (38%) were the most common sources of noise disruption reported by patients” (Garcia, 2012). "Despite the importance of sleep for recovery, hospital noise may put patients at risk for sleep loss and its associated negative effects," they wrote. In addition, researchers found that the intensive care and surgical wards had some work to do in dampening noise levels, with ICU peaking at 67 dB and 42 dB for surgical areas. Both far exceeded WHO’s 30 dB patient room recommendation (Garcia, 2012).

Besides patient sleep deprivation, which itself can lead to a multitude of health problems including high blood sugar, high blood pressure and fatigue, studies have reported that elevated noise levels can increase heart and respiratory rates, blood pressure and cortisol levels. Recovery room noise causes patients to request more pain medication, and preterm infants “are at increased risk for hearing loss, abnormal brain and sensory development, and speech and language problems when exposed to prolonged and excessive noise” (Deardorff, 2011).

There is still more research to be done, of course, but Yoder and his colleagues had good news, as well; much of the hospital noise they identified is modifiable, suggesting that hospitals can take steps to successfully create a quieter environment for both patients and healthcare providers (Garcia, 2012).

Around the country, “quiet campaigns” have been launched by hospitals in an attempt to dampen nighttime noise. Besides dimming lights and asking staff to keep their voices down at night, they are working to eliminate overhead paging systems, replace wall and/or floor coverings – even the clang of metal trashcans. Northwestern's Prentice Women's Hospital in Chicago was built with noise reduction in mind, replacing the idea of centralized nursing stations with the advent of smaller, multiple stations (Deardorff, 2011)

Billed as “one of the nation’s largest hospital construction projects,” Palomar Medical Center in North San Diego County is a state-of-the-art facility that has been designed “to encourage quietness,” according to Tina Pope, Palomar Health  Service Excellence Manager. Slated to open its doors this August, the hospital will feature a new nursing call system to route calls directly to staff and help eliminate the need for overhead paging, de-centralized nursing stations and clear sight lines, allowing staff to check on patients without having to leave unit doors open. With measures already in place including “Quiet Hospital” badges on staff and posters at the entrance of every unit, a “Quiet at Night” campaign (9 p.m. – 6 a.m.), and a “Quiet Champions” program that encourages staff to report noise problems, Palomar is one of a growing number of hospitals working toward a new era of quiet.

By Debra Wood via NurseZone.com

July 12, 2012 - Who says that mentorships are only useful for new, fresh-out-of-school nurses?  Health care facilities, schools of nursing and professional associations are trying new approaches to reach out and support nurses throughout their careers, resulting in benefits for all parties involved.

Mentors can guide a nurse’s career and help the mentee weigh alternatives and avoid pitfalls; at the same time, mentors enhance their own skills and the profession as they pass along knowledge and intangibles necessary for success. And employers can realize a double bonus--by improving retention rates at both levels within their workforce.

“Mentors are critical to our profession,” said Lois L. Salmeron, Ed.D, RN, MS, CNE, ANEF, associate dean for academic affairs and professor at the Kramer School of Nursing at Oklahoma City University in Oklahoma. “This is one way to nurture our own and retain nurses.”

The Kramer School offers a formal mentoring program, assigning a seasoned faculty member to someone new to the program, ideally team teaching. Most remain close after the one-year formal program ends.

“We view [mentoring] as key to a positive transition,” said Salmeron, who adds that mentors also are important when a nurse wants to change specialties.

Cynthia Nowicki Hnatiuk, EdD, RN, CAE, executive director of the Academy of Medical-Surgical Nurses, called mentors the single most effective way to help nurses learn a new role and increase their confidence.

“It provides a one-on-one opportunity for two individuals to teach and learn together,” Hnatiuk said.

“Mentorship is something that never really stops, and something each person has to take responsibility for themselves,” added Ora Strickland, Ph.D., RN, FAAN, dean of the Florida International University (FIU) College of Nursing and Health Sciences in Miami. “You will have many mentors through your career, and more than one mentor at one time, depending on what you are trying to gain skills in.”

Strickland has found most mentors enjoy the experience.

FIU offers a research mentorship program to increase the research productivity of its faculty and help them learn how to network, seek funding, conduct studies and publish their findings. The mentorships cross disciplines to encourage collaboration.

Formal mentoring programs

Many nursing employers provide formal mentoring programs.

UnitedHealth Group Center for Nursing Advancement built its own nurse mentoring initiative, leveraging best practices. It facilitates monthly in-person and virtual mentor/mentee interactions. Mentees submit profiles about development needs and potential mentors’ strengths, and the center electronically matches them. After the one-year mentorship ends, mentees can continue attending special events.

Dawn Bazarko, DNP, MPH, RN, senior vice president of the Center for Nursing Advancement, reports 100 percent of the first cohort of nurse mentees has continued working at UnitedHealth and 21 percent have received a promotion. The center is now building a new mentoring program for more seasoned nurses within the organization to take on broader leadership roles.

“We’re taking our experience to inspire and evolving that to address the needs of our senior nurses,” Bazarko said. “Nurses are critical to the people we serve, modernized health care and our business success. It’s a deliberate investment in their personal and professional enrichment.”

MedStar Good Samaritan Hospital in Baltimore also offers a formal mentoring program and has found it reduces turnover and increases productivity, reported Joy Burke, RN, MSN, CCRN, a clinical specialist at Good Samaritan. The hospital offers mentoring classes to prospective mentors, who must have at least two years of experience. Approximately 130 nurses have taken the course and are currently mentoring 67 novice nurses.

“The nurse has a friend, a buddy, someone they can call on,” Burke said. “They get critical feedback from the mentor.”

Huntington Hospital in Pasadena, Calif., pairs new hires with a mentor, said Lynette Dahlman, MSN, RN-BC, director of clinical education and academic partnerships. Serving as a mentor earns credit toward a nurse’s career ladder.

Nurses do everything they can to help a nurse grow, so they are proud to work alongside [of them],” Dahlman said.

Texas Children’s Hospital in Houston also offers a formal mentoring program. The hospital matches mentors and mentees with like backgrounds and with the skills the mentee needs. Formalized classes provide resources and an objective look at internal resources.

Kara Boakye, RN, BSN, CPN, nurse manager of the progressive care unit at Texas Children’s, said she has gotten to know herself better and become a better leader after being mentored by Emily Weber, RN, NEA-BC, nursing director for newborns at the hospital.

“I feel I gain just as much from the relationship, because it makes me pause and think about why I would make that decision,” Weber said. “Both parties gain a lot from it.”

South Nassau Community Hospital in Oceanside, N.Y., takes a slightly different approach with its mentoring program, designed to help nurses advance to the expert level. It matches nurses with potential to move up with outstanding stars who can mentor and coach them in communication skills, working within the organization and understanding the health care industry.

“Mentoring isn’t about clinical skills,” said Sue Penque, Ph.D, RN, CNP, chief nursing officer at South Nassau. “A mentor is above and beyond what you get in didactic training.”

South Nassau conducts annual assessments of nurses’ strengths and performance to evaluate the effectiveness of the program. It also identifies experiences where people can grow and take on new responsibilities while the mentor is present and able to coach.

Finding a mentor

While a formal program might make it easier to connect with a mentor, nurses often can find one independently. Nurses should observe others who practice as they aspire to and approach that person, advises Hnatiuk.

Penque has asked a nursing leader in academia whom she admired to mentor her.

Strickland has approached subject-matter experts whose abilities and skills she respected and asked them for mentoring and has never been turned down.

Finding the right mentor “can be just as hard as finding a good husband or wife--and well worth the search,” said author and relationship expert April Masini of Naples, Fla. She recommended being persistent and trying until you connect with the right person; when you succeed, be careful not to seek more time than agreed upon and to respect professional boundaries.

The Academy of Medical-Surgical Nurses recently launched a free, self-directed mentoring program with online validated tools, including mentor and mentee guides, for nurses new to the specialty and those who are changing settings.

“We would love for people to use the resources,” Hnatiuk said.

Mentoring across the profession

In addition to mentors in clinical and academic settings, nurses also mentor each other in professional associations.

The Association of Pediatric Hematology/Oncology Nurses recently introduced a members-only, two-year mentoring program, which matches experienced mentors with mentees. The goal is to facilitate member’s career growth and leadership development.

Ramón Lavandero, RN, MA, MSN, FAAN, senior director of communications and strategic alliances for the American Association of Critical-Care Nurses and a clinical associate professor at Yale University School of Nursing in New Haven, Conn., said mentoring is embedded in the fabric of the association’s community of nurses. The organization has a formal process for newly elected board members, and chapter advisors offer mentorship to local leaders.

“Mentorship ranges from coaching on leadership development and succession planning to problem solving challenging situations,” Lavandero said. “A newer chapter known for its innovative activities may mentor an experienced chapter that wants to explore new direction.”

By Rose O. Sherman via American Nurse Today

Editor’s note: At American Nurse Today, we believe every nurse can be a leader. This article is the first in what will be occasional guest blogs by Rose O. Sherman, founder of the Emerging RN Leader blog (www.emergingrnleader.com). In addition to her guest blogs, Rose will contribute articles on a regular basis to help nurses achieve their leadership potential.

 You may know that you want to be a nurse leader but are unsure about your next career step. It is important to recognize that you don't have to be a chief nursing officer or a nurse manager to "lead." You can begin leading from wherever you are in the organization. If you manage your career around this concept, you will focus less on your linear progression up the career ladder and more on your own personal mastery and impact.

An important question to ask yourself as you begin your leadership journey is whether you have the qualities that nurses look for in their leaders. Successful leaders are unable to achieve goals without inspired and motivated followers. We have all probably observed nurses who have been placed into leadership positions and had the formal title of leader but are not successful in capturing the heart and soul of those they lead. John Maxwell, in his book The 21 Irrefutable Laws of Leadership, makes the important point that leadership is above all the ability to influence others. We know from research some key qualities that nurses look for in their leaders include:

• ·       A commitment to excellence
• ·       Passion about their work
• ·       A clear vision and strategic focus
• ·       Trustworthiness
• ·       Respectfulness
• ·       Accessibility
• ·       Empathy and caring
• ·       A commitment to developing others

Honest feedback about whether or not you demonstrate these qualities is important at the beginning of a leadership career. A good mentor can help you grow as an emerging nurse leader and open doors to new learning. Unlike the preceptor relationship, which you may be familiar with in the clinical setting, a mentor provides career guidance and helps you become more aware of your strengths and areas where you need development. An ideal mentor for an emerging nurse leader is someone who is knowledgeable, has leadership experience, and is interested in helping you to grow.

For some nurses, just getting noticed in their organization can be a challenge, especially if it is very large or if you work a night tour. When opportunities become available for advancement, you want to be someone that the nurse leaders in your organization think about as a great candidate, so consider these tips:

 1. Look professional

First impressions do count if you want to get noticed. Professional dress and being well groomed matter in creating a good image. When nurse leaders see nurses with wrinkled scrubs and dirty shoes, the impression is generally not favorable. You want to be remembered as someone who will be a good candidate to represent the organization.

2. Stay updated

It is important to stay updated by reading professional journals and attending educational programs. Be a "go-to person" for new information in your specialty area. In addition to staying updated clinically, pay attention to the news and what is happening with health policy. Think about how proposed changes in health reform could impact your organization and share your knowledge with other staff. Recognize that health care is also a business and become knowledgeable about the business of caring.

3. Take leadership roles

Take leadership roles at the unit level. They can be small but it is a great way to get started. Volunteer to take a leadership role on a unit shared-governance committee. Take charge when you have the opportunity. This is an excellent way to connect with other staff and leaders in your organization.

4. Volunteer for task forces and committees

Volunteer for organizational committees and task forces, even if it does mean coming in on your day off to participate. Leaders do notice when staff members are committed enough to an organization that they are willing to give back some of their personal time to be involved in activities.

5. Participate in organization-sponsored community activities

Join the heart walk team, the breast cancer walk, the March of Dimes, or other teams your organization may put together to support the community. Get others on your unit to join you. You will find that organizational leaders participate in these activities, and it can be a great way to introduce yourself in an informal setting and meet many new people.

6. Be professionally involved

Join a professional nursing association and attend the local meeting. You will probably meet staff and leaders from your organization that you might not interact with in other forums. Local professional associations are always looking for members who are willing to assume some leadership responsibilities. Holding office in a local association can be a good way to gain recognition.

7. Serve as a preceptor and cheerleader to other staff

Be ready to share your skills and knowledge with others. Sharing and volunteering to be a preceptor can be a great way to get noticed. Your manager will appreciate your willingness to be a strong team player. Be the first to congratulate others for their achievements and be the person who helps create a healthy work environment on your unit.

8. Keep your commitments

I once asked a great nursing leader what he attributed his success to. He told me that he did what he said he was going to do when he said he was going to do it. This will get you noticed, he assured me, because so few people actually keep their commitments. This is really great advice. If you volunteer, be sure to follow through.

There has never been a better time to choose nursing leadership as a career goal. The retirement of a large number of baby boomer nurse leaders will result in great career opportunities by the end of the decade. Oprah Winfrey often says that “luck is preparation meeting opportunity.” The time to start preparing for these opportunities is now. 

By Lea Rae Keyes via Nurse Entrepreneur Network

There are a few things any nurse entrepreneurs can do to increase their likelihood of being successful. One of the easiest and most powerful is to blog or write articles. This is also a very low cost way to promote your business. If you are wondering what blogging or writing articles has to do with the success of your business, read on....

1.  Develops your brand - Your brand tells your potential customers what you stand for, what you deliver, and portrays an overall experience. It tells your potential customers why they should buy from you.

2.  Helps people get to know you - Blogging is a way for you to share your personality and brand so your potential customers have a feeling that they know you or are at least getting to know you.

3.  Establishes you as an expert -- Blogging gives you the chance to share your expertise and knowledge with a larger audience.

4.  Helps to create community -- As you blog your audience will begin to add comments. Next they will start commenting on each other's postings and ultimately a community will begin to be form in a space you created.

5.  Aids your 'know, like, and trust' factor -- The more people read with you have written the more they feel as though they know you. As this continues they begin to like and trust you. People are far more likely to buy from someone they know, like, and trust.

6.  Enhances readability -- When you blog or write short articles it is easy for your audience to scan or quickly read what you have written. If your target audience can quickly read what you have written they are more likely to do this than if you are writing a long, complex newsletter or white paper.

7.  Increases you chances of being invited to write for others -- Blogging helps others notice you and then ask you to be a guest blogger for them. When you guest blog for someone else it broadens the number of people exposed to your writing.

If you want a low cost, effective way to become better known you need to add blogging to your marketing plan mix.

Via MedicalNewsToday

University of Stirling researchers have secured funding to investigate the effectiveness of training student nurses in mindfulness to reduce stress levels.

The study, which begins next month, will involve student nurses undergoing a stress test and then carrying out four weeks of mindfulness training. The participants will then undergo another stress test to find out if the mindfulness has helped reduce stress levels and increase their ability to cope with stress.

The student nurses will have guided meditation sessions and keep a journal about their own practice sessions at home as part of the research.

Mindfulness, or meditation, is a technique which can be learned and helps individuals to relax and cope better with stressful situations.

PhD research student Jenny Jones and Research Fellow Mariyana Schoultz, based at the Highland Campus in Inverness, are carrying out the study with Professor Stephen Leslie, a cardiologist consultant at Raigmore Hospital and Professor Angus Watson.

Researcher Jenny Jones said: "Hospitals can be a very stressful environment to work in. In my nursing training there was no mention of how to cope with stress but this is something that nurses face on a daily basis. Student nurses are not prepared for the very emotional and sometimes traumatic events they may witness at work, or equipped with the tools to cope and carry on with their job effectively. This study hopes to change that.

"We want to find out if mindfulness will impact on how nursing students cope with stress. If the results are positive, we want it to be introduced as part of nursing training. The ultimate hope is that this will make the nurses of the future more resilient to work related stress."

Nurses experience high levels of work related stress and are at risk of stress related illness. At any one time up to four per cent of trained nurses and up to six per cent of health care assistants are off work with stress or stress-related illness.

By Suvarna Sheth, Hcareers.com

There's been a lot of contentious chatter lately on the state of job boards as social media moves in. Some say job boards are waning in popularity, while others say they're not going anywhere. The fact is the number of job boards are still proliferating and they are widely used by advertisement agencies and HR departments for many professions from retail to research. We speak to some industry insiders for their views on the importance of job boards in implementing an integrative recruitment strategy.

Bruce Dorskind, president of the Dorskind Group, a strategic consulting firm specializing in marketing communications, global recruitment, and business has seen the advertising recruitment industry evolve over decades, from one that relied 90% on print media to one that is dominated by digital media today. Dorskind claims there are over 10,000 job boards in the United States and probably 100,000 around the world, and growing.
"The big general job boards, Monster, Hotjobs and Career Builder were very important early on," says Dorskind," because they educated the public about the concept of a job board." They were basically a game changer says the industry veteran. "What the big job boards did was it sold the American public the idea that a job board is a viable way to find a job."

But today, 20 years into the concept of a job board, the market has changed, according to Dorskind. "Like every nascent market, it starts out in a very general way, and migrates to the specific," he says.

In the beginning, Dorskind explains everyone from the person working behind the retail counter at Wal-Mart to the person developing next generation pharmaceuticals for Genentech went to the same job board. "Now, the market has moved from general to segmented and you have the opportunity to only deliver your message to the specific group of people you are interested in through a targeted job board.

The niche job board has managed to be a very successful model for many reasons. One is that it has allowed employers to get resumes or responses from people that are relevant. "And it allows you to pay for the candidates you are getting, while with a general job board, you're paying for the entire audience, 95% of who aren't qualified," says Dorskind.

Still, not all niche job boards are successful. The ones that are, according to Dorskind are the ones that get their visitors involved, constantly produce fresh material, have current and real jobs and promote potential advertisers.

Dorskind says ad agencies and individual employers have five benefits to using niche job boards: you have a targeted audience, you can build a brand among the people you're trying to reach, they tend to be far more cost efficient, they tend to be where you're competitors are advertising, and they tend to do a better job reaching the passive job seeker than the general job boards.

Whether a particular recruitment strategy involves using large or niche job boards, Dorskind recommends ad agencies to use the strategy that meets their client's needs most efficiently.

"Certainly if they're looking for hundreds of people working in thousands of different locations for a retail store, then a strategy of being on a large job boards makes sense," he notes.

The problem for ad agencies, according to Dorskind is that there are too many job boards, and there is too much noise in the marketplace and within given industries. "In healthcare, there are over 500 job boards and it's impossible to keep up with all the new job boards unless it's a dominant player in its market," he adds.
Dorskind says niche job boards are a way to go for recruitment advertising. "I think in a world where technology is changing as quickly as ours and the options are as great as ours, there is no one solution," he remarks.

Like Dorskind, Sean Quigley, senior director of digital media at Bernard HODES Group says it's the obligation of the ad agency to do what's best for the client.
Quigley, who works on building strategies for clients and formulating digital media plans based on a given budget and set of targets, says there's definitely a shift going on in the recruitment world because of digital media.

And that's why he says it's not only about job postings at Hodes. "E-mail campaigns, banners, videos, as well as traditional job boards and niche job boards are all usually considered as part of a recruitment strategy," he says, "It's different for every client and there are more options on the table now so we're looking to take advantage of everything we can," he says.

According to Quigley, it's also important to have strategy on some of the more generic boards because that's where a lot of the target is ending up anyway. "On the other hand, we do see awesome results on more targeted job boards, which preform extremely well and rise to the top, delivering great results for certain accounts," he states.

For example, for a large pharmaceutical client who was more engaged in science oriented candidates, Quiqley and his team did extremely well on BioSpace.com, using large posting packages and creating a very strong branding presence throughout the site including e-mail sponsorships and a continual presence on the BioSpace pages. "BioSpace was an extremely beneficial option for us to have; it really helped us reach our client goals," he says.
Adele Mirabelli, a field sales representative within the healthcare division of onTargetjobs works with ad agencies to create media plans and posting packages for their healthcare clients.

She says the benefits to using a niche job board is quality vs. quantity. "Clients may not get as many candidates but the few that they do will be better qualified candidates," she states.

Also, she says clients can get lost within a general job board. "They have so many more jobs and unqualified candidates and at times healthcare employers can get lost in the mix of all the other industries out there."

Since niche job boards are focused and targeted to one industry, it makes it a lot easier for job seekers to find the jobs that they are looking for.
Mirabelli can't say without a doubt that niche boards are more successful than larger boards because it depends on the client and the job advertisement. "A lot of factors come into play when it comes to measuring success for our clients and the job boards they use," she says. However, with the economy picking up and recruitment opportunities on the rise, there is a need for better qualified candidates.

And when it comes to finding quality, Mirabelli is hearing that her clients are not finding it on general job boards like Monster. She finds that specifically healthcare employers are using niche job boards more because they are finding that the quality of the candidates is better.
Mirabelli says a lot of ad agencies use niche job boards for some of their client's hard to fill vacancies because they find they can reach a higher caliber of job seekers through them.

"At the end of the day, it's all about ROI and the quality of the candidates that they bring on board," she says. Like Dorskind and Quiqley, she notes that ad agencies need to recommend the best solutions out there to ensure that their clients are performing as well as possible.

This is true today, especially when everyone is tightening their belts and spending less. "When budgets are being cut, ad agencies really need to focus on what is the best solution for their clients and how they can help their clients achieve the best ROI," Mirabelli comments.

As for whether niche job boards are going to survive the rampant changes going on in digital media, Quiqley has no doubt. "Any site that's able to attract a high value audience that is engaged in looking for jobs-that's always going to be something that's going to be valuable," he notes.

"I don't see any evidence for job boards becoming extinct," Quiqley states, "While social media is powerful and is going to get more and more important, it's a different function in terms of actually being a destination where someone in a given career can look for job openings," he says.

The digital media expert says the business model for job placement on social media sites hasn't really developed yet, and while the potential may be there, nothing compares to achieving goals in a measurable way than job boards, SEO, smart placement of advertising and e-mails to targeted candidates.
"None of them are going to be replaced," he says, "there are different stages and audiences you're simultaneously reaching with these tools, so none of the individual tactics are going to be completely ruled out because of social media," he comments.

From Management-Issues.com

Many tribal cultures don't have a word for "boredom". Sitting under a tree for hours at a time, waiting in line to get water from the well, or walking four days to a nearby village for medical help is just a way of life. But as technological advances penetrate societies all over the globe, impatience is mounting everywhere.

Google slowed down the speed of search results by four tenths of a second to see what impact it would have. The result was eight million fewer searches a day! A quarter of us abandon a webpage if it doesn't load within four seconds. An email that doesn't get a response within 24 hours is considered unresponsive. And one USA Today study found that most North Americans won't wait in line for more than 15 minutes.

But "impatience" + "cross-cultural" don't work well together. Cross-cultural relationships and projects inevitably take more time, more effort, and more patience. Slowing down often goes against the grain of what we're trying to accomplish.

A volunteer construction team from the U.S. traveled to Liberia to put a roof on a Monrovian school. The Liberians were extremely grateful for the N. Americans' generosity but the first day into the project, the Liberians expressed concern about whether the new roof would be well-suited to the Monrovian climate and environment.

When they voiced their concern, the volunteers replied, "Look. You have to trust us. We've worked on buildings like this all over the world. We're only here for six days. So the only way we'll get this done is if we stick with our plan."

Three months later, a monsoon came in off the Atlantic coast and the new roof came crashing down. A couple Liberian students died and several others were injured. Sometimes our "efficient"(impatient!) approach is not so great after all.

Just about everything takes longer when working and relating cross-culturally. Communication, trust-building, and just getting things done requires more effort and perseverance. Whether it's dealing with long queues when traveling, merging different technology systems, or trying to get to the bottom of a conflict, understanding and effectiveness come more slowly when different cultures are involved.

Patience needs to be factored in from the very beginning of any cross-cultural project. Long before the U.S. construction team ever arrived in Liberia, a more thorough process of determining what the need was and how to best meet it would have been valuable.

For a fraction of the cost of shipping a team to Africa, the volunteers could have sent money to have local builders put on a new roof. Or with a deeper level of analysis, they may have concluded that the roof wasn't really the problem but instead, was a symptom of deeper problems of poverty and conflict that could be better addressed by partnering with development experts.

Full disclosure. I'm terribly impatient. I hate waiting in lines, I calculate which driving lane is moving fastest, and I want things to happen quickly and according to plan. But on the rare occasion when I exercise patience, the end result is almost always better: the partnership is richer, the project gains wider acceptance, and the money invested goes further.

In a world of instant information and feedback, it's counterintuitive to step back and move more slowly. But slow is the new fast when you're working across cultures. Take a deep breath and trust that something far bigger and better can be accomplished when you patiently persevere through the hard work of listening, understanding, and discovering the possibilities that may otherwise go unnoticed when rushing to the finish line.

From USA Today

WASHINGTON – A narrowly divided Supreme Court upheld President Obama's health care law Thursday in a complex opinion that gives the president a major election-year victory.

The historic 5-4 decision will affect the way Americans receive and pay for their personal medical care in the future. It upholds the individual mandate that most Americans get health insurance or pay a penalty — and it was the penalty, or tax, that ultimately saved the law.

Chief Justice John Roberts announced the decision that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. He argued that the mandate is constitutional only because the penalty "functions like a tax" and is therefore allowed under Congress' taxing power.

"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts wrote.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the majority vote. They argued for a more sweeping approval based on the commerce clause, but the end result was the same.

Conservative Justices Samuel Alito, Anthony Kennedy,Antonin Scalia and Clarence Thomas dissented. Kennedy, who was thought to be the most likely swing vote, delivered a scathing denunciation from the bench.

"The majority rewrites the statute Congress wrote. … What Congress called a penalty, the court calls a tax," Kennedy said. "The Affordable Care Act now must operate as the court has revised it, not as Congress designed it."

President Obama, speaking from the White House after the decision, said, "Whatever the politics, today was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it.

"It should be pretty clear by now that I didn't do this because it's good politics," Obama said. "I did it because I believed it was good for the country."

Roberts — a conservative appointed by President George W. Bush— provided the key vote to preserve the landmark health care law, which figures to be a major issue in Obama's re-election bid against Republican opponent Mitt Romney.

From Advance for Nurses By Beth Puliti

The Institute of Medicine recently appealed for a change in nurses' roles, responsibilities and education, proposing to implement nurse residency programs to assist in the clinical practice transition (Advancing Health, October 2010).

The Hospital of the University of Pennsylvania, Philadelphia, identified the need for support much earlier.

Its Gateway to Critical Care Program started 10 years ago and offers new nurses and registered nurses with less than 1 year of critical care experience the opportunity to work alongside experienced ICU nurse preceptors to become safe and competent critical care nurses.

"The competency-based orientation program helps foster the knowledge and skills necessary to care for patients within the different critical care units in our hospital," said Lisa Fidyk, MSN, MS, RN, coordinator of the Gateway to Critical Care Program.

Catering to the Adult Learner

Participants enrolled in the program adhere to an educational plan that defines competency expectation, patient assignment and preceptor/learner responsibilities.

"We base our program on Patricia Benner's From Novice to Expert model. We work to assist the graduate nurse's progress from advanced beginner to competent nurse utilizing her framework," explained Fidyk, who is also a professional development specialist in the Department of Nursing Education, Innovation and Professional Development.

As Fidyk mentioned, Benner's framework of skill acquisition and development of the essence of critical thinking is utilized in the Gateway to Critical Care Program. Goals are reached through segmented learning, faculty guidance, a supportive environment and preceptor/orientee relationships.

The 16- to 20-week program consists of 4-5 weeks of classroom/clinical and 11-16 weeks of full-time clinical. It enrolls new-to-practice surgical, cardiac, neuroscience, cardiothoracic and medical ICU nurses, as well as nurses from the emergency department. Fidyk noted the nurses learn from various teaching strategies, including classroom instruction, clinician-supervised skill labs and clinical experiences.

"The program caters to the adult learner and provides different ways for these nurses to learn about the critical care arena. We incorporate case studies, lectures, discussions and simulation to help them develop the skills they would need to care for critically ill patients," she said.

Throughout the program, nurses learn the following core competencies: airway and ventilator management; cardiac monitoring; critical care pharmacology; hemodynamic monitoring; arterial blood gases analysis; acid-based balance; pain, sedation, neuromuscular blockade; and end-of-life care.

Working Alongside Experienced Nurses

Clinical support comes in the way of clinical preceptors, Gateway to Critical Care faculty and critical care advanced practice nurses/clinical nurse specialists/clinical nurse IV staff nurses.

While enrolled in the program, nurses work beside experienced ICU nurse preceptors.

"A preceptor is a mentor," Fidyk said. "They work with that person when they are on the unit taking care of patients. Preceptors are experienced nurses who know what it's like to go through the Gateway Program, how to collaborate and how to make it a great experience."

When the nurses return to their floor, they practice and hone their skills with a preceptor for the duration of the program.

"My nurse preceptor was a nurse on the unit for 5 years," recalled Lauren Mang, BSN, RN, clinical nurse I in the neuro ICU at the Hospital of the University of Pennsylvania. "She was fabulous. She really gave me the confidence and courage I needed to become a better nurse."

Mang noted preceptors help new nurses become more at ease because, as an experienced nurse who knows the ins and outs, they are able to impart their knowledge at a comfortable level.

"She was there side by side with me until toward the end when she started to hide from me so I would learn how to answer questions on my own. She gave me the confidence to be able to do that," she said.

New Graduate Nurse Retention

After the Gateway to Critical Care program, nurses are enrolled in the Nurse Residency Program, a yearlong series of learning and work experiences designed to support nurses as they transition into professional nursing practice.

The Hospital of the University of Pennsylvania participates in the United HealthSystem Consortium (UHC)/American Association of Colleges of Nursing (AACN) National Nurse Residency Program and was actually the first Philadelphia hospital to participate in the National Nurse Residency Program.

The UHC/AACN Nurse Residency Program consists of an evidence-based curriculum developed by academic and nursing experts across the country. It boasts a reduction in voluntary turnover rate for first-year nurses to well below the median of 27.1 percent. Programs that have implemented this residency program model have attained retention rates of more than 94 percent.

Fidyk commented that both the Gateway to Critical Care Program and the Residency Program at the Hospital of the University of Pennsylvania act as a great support system, and with that support she's seen a "huge" increase in retention. A 98 percent retention rate to be exact.

A higher nurse retention rate delivers better patient outcomes by increasing the nursing staff's experience and competency. Retention also helps preserve new graduate nurses' knowledge, experience and competence gained during the first year of professional practice.

"I know a lot of hospitals don't have these programs, and when I was in a leadership class in nursing school, we actually talked about Penn's Gateway program. That really opened my eyes to research this program more," Mang said. "I needed just a little bit of extra help one-on-one and it really helps you with that. Right now, I'm only 11 months into this and I feel very confident and have learned a lot from this program."

Fidyk noted that, for most of the nurses who come into the program, it's their first job - and it's an intense arena.

"You're saving people's lives, you're dealing with emotional aspects of your job, you're coming in contact with many different healthcare providers - it's all very overwhelming. The Gateway to Critical Care Program is a great way to help new nurses figure everything out and have someone to talk to who will listen," she concluded.

From WorkingNurse.com By Elizabeth Hanink

Work-life balance is more than good time management. It means having a professional life and personal life that are integrated so well that each part enhances the other. That takes self-knowledge and self-discipline—two traits that we need to cultivate if we ever hope to achieve the balance that brings enjoyment along with achievement. It is a life-long process that requires daily fine-tuning.

All sorts of people have trouble with work-life balance. What makes nurses especially vulnerable is that so much of our professional life is beyond our control. We can’t change the fact that most nursing jobs involve tricky schedules, heavy work-loads, and tons of variables that can shift by the hour, yes, even by the minute.­ Most of us are additionally burdened by wanting to give good care.

But not having the power to manage many aspects of our jobs doesn’t mean we have no control. Nurses can be like the sleeping elephant, unaware of its strength. If you want to make your dreams come true, wake up to your own power, to the role you play in your own life. Taking control is the key. If you live in a constant state of reaction, you give control to someone else. Time management only enters the equation when you use it as your tool to gain control: over a day, a month, a life-time.

Remember Nursing 101

Where to start? You don’t need a new system of thought. What you learned in nursing 101 about nursing process will serve quite well here. Remember how assess, diagnose, plan, implement, and evaluate worked for all nursing problems. It works for the big picture of your life, too and helps you get the minute by minute obstacles out of the way so the bigger pieces fall into place. It does you no good to manage a perfect work day, every day even, if there is nothing left for family or fun or personal growth.

Let’s start with assessment. What do you want—what is important to you? Knowing that, and it can take some time to figure it out, makes all the difference. Do you want, in the next hour, to have all your charting completed or do you want to be sure that all your patients have a clean, neat room with trash picked up and tray tables cleared? Do you want in five years to have an advanced practice degree or do you want weekends free for hobbies? Do you want to own a home or vacation every year in a different country? All of these are commendable goals but which are yours? Only you really know.

The second step is diagnosis. What is keeping you from achieving your ambitions? Are you stuck in the land of “after this happens?” as in I’ll get to my charting after I have rechecked all the rooms. Or I’ll start school after I feel more settled at work? Or could you be like the man in the Chinese proverb waiting for roasted duck to fly into his mouth? You will wait a very, very long time. The important ingredient is taking responsibility for what is lacking. This step does not allow placing blame anywhere but on you.

No time to linger. Now that you know what you want and why you don’t have it, move onto the third step, planning. This involves setting priorities. Out of all the things you want, what is most important? It might be different every day, it might vary by what age you are at a given time, or it might vary by what is realistically possible given your circumstances. If you already have three young children, then the Peace Corps is not feasible.

Your self-knowledge that came through assessment is critical in this step. And because you are employed as a nurse, again, you might not have total control minute by minute. But taking your theoretical goal for today as wanting to get all the charting done on time, how are you going to achieve that with a last minute admission? Take the time to assess where you are and plan. Write it down, even if jotting down will delay you, what 15 seconds. Maybe the new goal will have to be leaving only 15 minutes late instead of the usual hour that a last minute admission would ordinarily require.

Now it’s time to implement and here is where some time management skills can play a part. If you are lacking these, get some. Study the nurses around you who do manage to get it all to happen, because some tricks do not come naturally. Not every experienced nurse is savvy in these skills but most who last in a hectic hospital environment have a clue, and you can learn from them.
There’s a ton of specific information out there.

Role Models

Kathy Quan, RN, has written a book on time management just for nurses, Tips and Strategies for Effective Time Management for Nurses. You can download it as an ebook. If you are a new graduate, try The Everything New Nurse Book also by Kathy Quan(www. kathyquan.com). Her website and those of others are full of suggestions. If you can get work under control, you will have much more energy left for the rest of life. And don’t wait to get started on that. Life doesn’t wait.

Don’t forget, there are nurses who manage to have long careers meeting interesting challenges and still live interesting lives outside of work. What is the secret, you might ask.

It isn’t a secret says Tilda Shaloff, RN. You have to set priorities (remember planning?). She uses a daily written list (no Blackberry for her) that she often formulates while walking her dog. It contains, every day, day in and day out, 17 items. The number 17 has private significance for her. Your number could be different. The act of writing the list helps her organize what has priority and what can wait.

She also delegates. Her children have always been paid to help around the house and her husband has always been willing to participate fully in chores. She also, and this is key, arranges her clinical work schedule to suit the other important things in her life—her writing and public speaking. Being the author of several books and a very popular motivational speaker, Shaloff says, takes tremendous energy. But these activities are important to her and so she makes the effort to have the time and strength. It is a conscious choice. She can do speaking and writing and work in an ICU but not other things. You need to make the same choices. It might mean saying no to being room mother or working the polls on election day. Or it might mean having a clean as opposed to an immaculate house. Make your life and your job work for you.

Kathleen Singleton, RN, MSN, also makes choices. As the president of the American Association of Medical Surgical Nurses she has a serious obligation on a national stage plus the obligations of her “day job.” For her the secret is, of course, organization, and she is very dependent, she says, on any electronic help she can get. But the real key for her is negotiation and flexibility. Singleton makes her day job work for her.

She has had scads of practice at this; she worked over the years from nursing attendant to MSN all while working full-time. She thinks any nurse can do it. Instead of moaning about them, make the weekend and shift obligations work for you, she says. Take advantage of your ability to trade shifts. Work with your fellow employees and supervisors to have everyone gain. Negotiate your holiday obligations in such a way that the schedule then allows you to do what is vital to your happiness. In Singleton’s case, her employer, an affiliate of the Cleveland Clinics, allows her maximum flexibility in scheduling in exchange for her willingness to be quite flexible in what is required of her.

Keep in mind: achievement without enjoyment is not the way to balance. Taking control is. Plan, choose, and readjust. Balance is achieved both daily and over the long haul and can be different for each of us each day. Adjust as needed, both the goal, and the implementation because there is more than one way to success.

A Jar Full of Rocks

Here’s a strategy to visualize how, without planning and taking control, you can work very hard all day or even all your life and still have no accomplishments and no satisfaction. Picture a large jar like one that old-fashioned delis kept pickles in. Or the type that holds pretzels from Costco. Fill it as full as you can with large rocks. Now fill in the other spaces with small pebbles. Next add sand. Isn’t it amazing how much sand fits into all the nooks and crannies between the rocks and pebbles? Last fill with water. Quite a bit goes in, doesn’t it, despite all those rocks.

But stop. What if you had poured the water in first? It would be impossible to get even one large rock in without spilling everywhere. Now think of all the things you want to do, today and in life. Make sure the large goals, the large rocks, are what you really want from life — to have more education, to write a book, to own a house, to run a business. You choose. Then fill in with the small pebbles. Do they support the rocks? If you took away three pebbles---a ho-hum hobby, a favorite TV show, or say time on Facebook, would you have room for another large rock? And what about the sand in your life? Is it helping you toward your goal or is it just getting between your toes? Are you drowning in all the water that fills up your life? Is the water keeping you from getting any large rocks into the jar?

As for those nurses like Singleton or Shaloff who work, have a rich personal life, and still have time to pursue advanced degrees or run side businesses? Look at what they don’t do. You will probably find they have eliminated those things that don’t move them toward their goals. They don’t know about the latest episode of American Idol. Maybe they don’t have the latest French tips from the manicurist. They dare to bring store-bought to the potluck. They have made the choice that these things matter less than achieving their goals.

You need to do the same. Just remember. To avoid the pickle jar trap or the “as soon as” trap or any other trap that is robbing you of a good work-life balance, you need to take time now to decide what is important (assess),what is keeping me from it (diagnose) how do I get it from here (plan) and execute. Reassess frequently and adjust as needed. Now you have balance.