DiversityNursing Blog

From Nurse.com News

Contrary to what many trauma teams believe, the presence of family members does not impede the care of injured children in the ED, according to a study.

Professional medical societies, including the American Academy of Pediatrics and the American College of Emergency Physicians, support family presence during resuscitations and invasive procedures. The degree of family member involvement ranges from observation to participation, depending on the comfort level of families and healthcare providers.

"Despite the many documented family and patient benefits and previous studies that highlight the safe practice of family presence, trauma providers remain hesitant to adopt this practice," lead author Karen O’Connell, MD, FAAP, a pediatric emergency medicine attending physician at Children’s National Medical Center in Washington, D.C., said in a news release.

"A common concern among medical providers is that this practice may hinder patient care, either because parents will actually interfere with treatment or their presence will increase staff stress and thus decrease procedure performance."

The aim of the study was to evaluate the effect of family presence on the trauma teams’ ability to identify and treat injured children during the initial phase of care using the Advanced Trauma Life Support protocol. ATLS is a standard protocol for trauma resuscitation shown to limit human error and improve survival.

Over a four-month period, researchers reviewed recordings of 145 trauma evaluations of patients younger than 16. Of the patients, 86 had family members present.

Investigators compared how long it took the trauma team to perform important components of the medical evaluation (such as assessing the child’s airway, breath sounds, pulse and neurologic disability, and looking for less obvious injuries) when families were present and when they were not. Investigators also compared how frequently elements of a thorough head-to-toe examination were completed.

Results showed no differences in the time it took to complete the initial assessment with and without family members present. For example, the median time to assessing the airway was 0.9 minutes in both groups. In addition, the researchers found no difference in how often components of the head-to-toe exam were completed. The abdomen was examined in 97% of all patients when families were present, for example, and 98% of patients when families were not present.

"Parents are increasingly asking and expecting to be present during their child’s medical treatment, even if it involves invasive procedures," said O’Connell, who also is an assistant professor of pediatrics and emergency medicine at George Washington University School of Medicine and Health Sciences.

"We found that medical teams were able to successfully perform needed evaluation and treatments of injured children both with and without family members present. Our study supports the practice of allowing parents to be present during the treatment of their children, even during potentially painful or invasive procedures."

From Advance for Nurses

Findings from the NLN's Annual Survey of Schools of Nursing Academic Year 2010-2011 attest to the continued need for more nurse faculty to meet the needs of the U.S. healthcare system.

Conducted October-November of last year, the NLN survey reveals demand for pre-licensure program entry continues high despite a shifting student demographic, while competition for entry into post-licensure is increasing.

Unfortunately, notes NLN CEO Beverly Malone, PhD, RN, FAAN, the percentage of post-licensure programs that turned away qualified applicants also rose between 2009 and 2011.

Most strikingly, the percentage of MSN programs turning away qualified applicants jumped by 15 percent over the past 2 years, from just one in three programs to almost half in 2011.

The survey also shows the percentage of racial-ethnic minority students enrolled in pre-licensure RN programs fell from a high of 29 percent in 2009 to 24 percent in 2011.

The majority of that decline stems from a steep reduction in African American students enrolled in associate degree nursing programs, which dropped by almost 5 percent to 8.6 percent in just 2 years.

Hispanics remain dramatically underrepresented among nursing students as well, according to NLN, representing only 6 percent of baccalaureate and associate degree nursing students.

But while educational capacity is still insufficient to keep up with demand, some promising trends were uncovered by the survey, says NLN president Judith Halstead, PhD, RN, FAAN,

"For example, the percentage of male pre-licensure graduates in 2011 was up to 15 percent after inching up only a percentage point a year since 2009," she notes. "In addition, the percentage of pre-licensure RN students over age 30 has declined in recent years."

From WorkingNurse.com By Christine Contillo

It’s clear that we’ve not just entered the Information Age — we’ve exploded into it. Information exchange is critical to both the advancement of science and patient care, and the impact of the Internet in the medical field has been enormous. Practitioners are now able to jump the barrier of time and access research findings worldwide; and in nursing it’s caused the creation of an entire subspecialty (nursing informatics) meant to manage the amount of information available.

But nurses studying informatics aren’t he only ones finding ways to improve their skills by surfing the web. According to a survey of the American Academy of Nurse Practitioners, more than 98 percent of nurses responded that they use the Internet or email. The survey continued to ask in what way the Internet was used, and the answers may surprise you.

No More Pencils, No More Books

Beginning with nursing education, students everywhere have access to virtual classrooms and degree programs. Online education means that the limits previously imposed by location and time become less important. Busy students with a computer, or those in the workforce trying to fit school into their already packed schedule, should be able to find a few hours at home for study.

Similarly, many states now require continuing education (CE) for licensing. Nursing needing those hours can get them without leaving home, which in many cases removes important constraints such as child care. Sites such as WorldWideLearn.com allow the student 24/7 access to courses and technical support. Employers can select educational seminars and show them in real time in a conference room or select courses that have been archived for their nurses to watch later.

Nurses were instrumental in developing accredited online continuing education for Wild Iris Medical Education. The company established the site Nursing Continuing Education to help nurses (and other health professionals) across all 50 states fulfill CE requirements. Prices range from free to $65 depending on the individual requirement and number of contact hours offered. Fees can be paid with a credit card — how else? — online.

Podcasts

For those nurses who are pretty comfortable with technology, podcasts are another avenue to investigate. Similar to audio versions of magazines, they can be heard on MP3 players for up-to-date information. Check out PodFeed.net and searching “nursing” or listen to “Nursing Education on the Go” at Podcast Alley.

Streaming Radio

Somewhat similar to podcasts is streaming radio, or radio shows that are available worldwide. AM/FM radio is usually limited by geographical distance, but streaming radio listeners only need access to the web, some free software to download, and a set of speakers.

Barbara Ficarra, RN, BSN, MPA, is a nurse educator in the metro-NYC area and host of “Health in 30,” which airs live at 5:30pm on Fridays on WRCR-AM 1300. Ms. Ficarra lines up expert guests for her weekly show, announces the topic ahead of time, and fields questions as they are phoned in. Without the Internet her show could only be heard locally, but the vast audience afforded by online listeners has enabled her to win wider recognition. In fact, in 2007, she won the Excellence in Journalism award given by the American College of Emergency Physicians.

Blogs

Nursing blogs are web logs and can range from silly to academic. Just as journals are intimate thoughts, blogs can detail nursing practice issues, patient stories, fears, triumphs or even family and leisure activity. Blogs allow nurses to vent their frustrations to their peers and share valuable resources for patient care. Following a few favorites allows you to peer into the mind of the writer. The ability to comment allows you to enter into an electronic relationship that nurses in remote areas may treasure. Certainly information about individual patients must protect their identity, but sharing the means of resolving practice issues helps to improve practice standards everywhere.

Information Sites

According to Family Nurse Practitioner Roseann Neuberg, the impact brought by the Internet to her clinical nursing practice is “huge,” and she identifies it as a valuable source of patient education material. “There are just so many things I can do in terms of patient education,” she says. “I can look up issues or treatments while my patient is sitting right next to me. I can print it up, hand it out, and be sure that they understand what I’m saying before they leave. When I prescribe a medication I can check the price and look for alternatives. I can even use a program to check for drug interactions.”

Tracy Plaskett, a staff nurse at Beth Israel Hospital in New York City, says, “When I get my patient assignment, I’m able to look up any unfamiliar terms in the notes instantly. I can check spellings and make sure that medication orders are correct.”

Ms. Neuberg is quick to point out that she sticks with sites she knows are accurate and updated frequently in order to feel confident that the advice she is giving is sound. Two such sites are UpToDateOnline.com and Epocrates.com, which provide current information about clinical management and treatment of disease. Both require a subscription and password.

Mobile Medicine

Lynda O’Grady, RN, has found another important use of the Internet. Ms. O’Grady is part of a large travel medicine clinic, assessing international travelers who participate in academic programs, sometimes to remote and disease-infested areas. Using special software she’s able to assess their individual medical risks. If she has questions she can access advice from organizations like the Center for Disease Control and the World Health Organization. But what she finds most helpful is her membership in the International Society of Travel Medicine. Through a listserv available only to members she’s able to gain up-to-the-minute answers to questions posed, such as, “Where is the nearest medical clinic to Daar es Salaam?” or, “What do you recommend for altitude sickness for a patient allergic to sulfa?” Thousands of members pose and answer questions for each other, some providing clinical advice that only a person actually living in that area might be able to give.

Support Groups for Patients

Nurses may want to suggest online communities to patients experiencing chronic illness or going through debilitating treatments. Immune-compromised patients may be unable to attend in-person meetings, but staying in touch with a virtual group may allow them to feel less isolated. CancerCare is one professional association that helps organize free groups for patients as well as their caregivers. Virtual communities and forums have been vital to patients sharing treatment experience and offering support to each other.

Consults

The Internet can be used in a novel way for clinical consults. One home care nurse described how she and her colleagues became discouraged trying to evaluate decubiti. When described in the paper chart by different clinicians using different languages or terms it was often difficult to determine if progress was being made. Solution? They used a digital camera to capture an image that could be sent daily via the web to the practitioner. In this case a picture really was worth a thousand words.

Job Searches

Work-related issues can be shared via the Internet. Nurses interested in relocating can do a web search to conduct virtual tours of hospitals they might be interested in, file an application online, get driving directions, or book travel plans through a travel site such as Velocity. When looking to change jobs they can post their resume online. Even low-cost phone communication can be run through Vonage or Skype — both require an Internet connection and headset instead of a phone line or cell phone.

Creating Community

The Internet facilitates a feeling of community and can create the ability to investigate job issues easily. Union members can use online forums to discuss contract negotiation issues, salary, benefits and legal information. New healthcare legislation and practice agreements, as well as regulatory mandates, can be tracked through blog sites. There is just no excuse now for remaining uninformed.

Brian Short, RN, discovered the importance of a nursing community over a decade ago. When Mr. Short was still a nursing student, he created AllNurses.com for the purpose of online support and education. Two years ago the site claimed to cover 400 nursing topics every day and a total of 1.5 million posts. In an interview given at the time of its 10th anniversary, Teresa Burgess, RN, pointed out the importance of the online nursing community for its ability to be used for mentoring and creating a sense of shared purpose.

Let’s end with a word of warning, however, when it comes to using the Internet. While the examples given prove that use of the Internet can be beneficial to nursing practice, we must all bear in mind that much of what we find there remains anonymous and subject to scrutiny.
Our own critical thinking must be used to determine when and how best to use the available information, and to evaluate the value and truth of what we read. Certainly if what we find can nudge us toward being better health professionals, then the monthly cost of Internet service and the time spent in connection with others is well worth it.

by Jennifer Etienne and Anna Diane
Boston College William F. Connell School of Nursing

Our names are Jennifer Etienne and Anna Diane, and we are currently senior nursing students at Boston College. This past January, Boston College’s Connell School of Nursing sponsored a nursing service trip to Leogane, Haiti as a part of the community health clinical requirement. This service trip included Boston College (BC) nursing students, nurse practitioners and registered nurses. We held mobile clinics for ten days and saw over 1100 patients. Over the course of our trip, we encountered many patients who we will never forget.

We were amazed by the beauty and kindness of the Haitian people despite all the myriad challenges of their daily lives. We saw many of the common medical conditions that we see in the U.S., such as hypertension, GERD, and diabetes. Due to the area’s extreme poverty, most of our patients had not received health care in years- if at all. A typical day consisted of waking up at 6 a.m., eating breakfast, and packing up a truck with all of the medications and supplies that we had restocked and repacked the night before. We worked with the resources that were available in the community. We set up the clinic with a triage station, consultation, and pharmacy that were situated in the home of one of the individuals within the community. We were fortunate to have a Haitian dentist participate in our clinic as well. Generous neighbors were kind enough to donate chairs and tables for use in our clinics. The women’s privacy room for pelvic exams was constructed from two sheets and a cement wall on a slab of pavement, and the dentist did his work in a reclining lawn chair. In spite of these challenging conditions, our clinics were very successful with the individuals within the community, as exemplified by their gratitude.

The truth is that the people in Haiti receive little healthcare and basic problems often become major health concerns, which is very frustrating to us as future health care providers. This experience illustrated the importance of preventative health care measures. Preventative health care measures, such as providing health education, not only empowered the people, but also gave us a chance to interact with our patients. For example, we crafted and brought cycle beads, which we handed out to the women who we saw in our clinics. These beads help women with family planning as an alternative to birth control contraceptives because many Haitian women do not have the choice to take birth control or access to contraceptives.
It was clear that education was the most important aspect of health promotion and health prevention in Haiti, because it gave the Haitian people a sense of autonomy. For example, simple measures such as demonstrating to Haitians how to properly carry a bucket of water by evenly distributing their weight could help prevent future back problems. We realized, however, that in order to educate the Haitian people on preventative measures, we had to consider what resources were available to them. For instance, teaching a group of Haitian families how to reduce their risk of hypertension would be difficult since measuring cups and nutritional labels are not always available to them. However we could overcome the issue by demonstrating the healthy amount of salt used to prepare meals by using the tip of one’s pinky as an alternative measuring device. Such measures could help to reduce the risk of hypertension in Haitian families and significantly improve overall health. We believe that the use of primary prevention can help to prevent illness in Haiti and empower the people to make their own healthy choices.
Even though we treated more than eleven hundred patients, the realization that the majority of Haitians still lack access to basic health resources was overwhelming. Despite this sad reality, the people we met and the patients we treated assured us that our work was appreciated and worthwhile. Treating this population was an extremely moving experience. We were able to immediately see the difference that we were making, whether it be through treating a baby with scabies or rehydrating a child, the patients were enormously appreciative. This trip has forever changed how we view the care that we will provide as future nurses. We are more aware of the issues that affect Haitians, such as a pervasive lack of health education and the need for more culturally sensitive health care providers. This experience has further motivated us, because as minorities, we recognize our important role in communicating, advocating, and initiating preventative programs to help improve the care and quality of health of minorities. We hope to apply our nursing skills, education, and experiences to help decrease health disparities both within the U.S. and other countries.

Thank you for allowing us to share about our experience in Haiti. We strongly encourage others to consider doing nursing work abroad. In addition to helping those in need of care, such trips endow nurses with truly invaluable perspective into the issues that face the world of health care. With hope, the insights that nurses gain through these types of trips will benefit their patients for years to come.

From Advance for Nurses

When a patient enters a hospital, she enters an alien environment. 

Her personal things, even her clothes, are set aside. She is given to wear a billowy gown that is not merely unflattering but starkly revealing if one's free hand isn't vigilant about keeping it cinched.

Inside this linoleum landscape of wheelchairs and rolling beds, where strangers in scrubs politely jab and weigh and probe her, the only haven that offers her a modicum of quiet in which to gather her thoughts and to reclaim herself, to semi-relax, to take stock, or just to escape into the beams of an innocuous sitcom floating overhead - the only personal space in this impersonal world is that humble but all-important retreat, the patient room.

Respecting the sanctity of the patient room is the first lesson Pam White, RN, gives when teaching the basics of relationship-based care (RBC).

"When I talk to nurses, I tell them 'We all have busy lives taking care of many patients, but before you walk across the threshold of a patient's room, pause, take a deep breath, let other things go and prepare to focus on that patient's needs,'" said White, director of nursing administration at Mayo Clinic Health System in Eau Claire, WI. "I always reinforce the need for them to reintroduce themselves to each patient every time they enter the room."

RBC - a philosophy based on honoring and respecting your relationship with your patients, your co-workers and yourself - is fast emerging as the care delivery model of necessity.

Experts say respecting patients will become more and more important as healthcare adopts its new culture of accountability. Reimbursement will hinge, in part, on patient satisfaction.

A Way of Being

RBC as a concept appeared in 2000 and coalesced in 2004 with the publication of Relationship-Based Care: A Model for Transforming Practice by Creative Health Care Management Inc., Minneapolis.

"It's a model, a philosophy, a framework and a way of being," said Mary Koloroutis, RN, who co-authored and edited that text. "RBC creates a methodology for aligning values and operations within a healthcare system so clinicians can establish relationships with patients," Koloroutis explained. 

Finding time to develop relationships with patients isn't easy for nurses, though. 

"Time is a nurse's greatest challenge," Koloroutis acknowledged. 

"You are dealing with large volumes of patients with highly complex medical needs," she said. "We don't have a long time to spend with a patient. It could be just 5 minutes at the bedside to learn about the person and plan their care."

However short, interpersonal time with patients is crucial for a successful outcome. 

"The role of the primary nurse is to understand who this patient is, and what it will take to prepare her and her loved ones to take ownership for her own care after discharge," Koloroutis said.

Family members "will be the village surrounding the patient, so they need to be every bit as supported as the patient is," she added. 

"The likelihood that a plan of care will be followed increases with their learning and understanding."

HCAHPS Survey

Communicating with patients is becoming as vital as vital signs. Officials from the Center for Medicare & Medicaid Services care so much what patients think they instituted the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

HCAHPS asks patients to rate their hospital stays on a scale of one to five through a series of questions such as: How well did doctors and nurses communicate with you? How well was your pain managed? How clean was the hospital? How quiet?

"As of 2013, there will be reimbursement attached to HCAPS scores, so this is a strong push right now and part of why the patient experience is so potent and important," Koloroutis said.

ThedaCare, an integrated care delivery system in northeastern Wisconsin, increased its patient satisfaction scores by working with a firm called Simpler Consulting to adopt Toyota-inspired "lean" initiatives to streamline its processes and allow nurses to spend more time with patients.

For example, it implemented a variation of a Toyota production strategy called "kanban," so nurses have all the supplies they need at their fingertips.

"We have designed patient rooms so that 90 percent of all nursing supplies are stocked by a central stocking person, using the kanban system," said ThedaCare CEO Emeritus John Toussaint, MD. "Nurses are at the bedside nearly all the time. Medications are delivered directly to rooms in portable supply cabinets called nurse servers. There are no central nursing stations. They've all been eliminated."

Thanks to such changes, 95 percent of ThedaCare patients in 2011 gave top approval ratings when asked to assess their stay.

Eye-to-Eye Care

More time spent at the bedside "brings you to the heart of nursing," declared White, who instructs her nurses to sit down when interacting with patients.

"We typically stand up and over a patient," she said. "But research shows if you sit down and speak with them eye-to-eye, patients feel you spend more time with them - even if the amount of time you spend is the same."

She continued: "As a nurse, my needs for the patient are important, but they may differ from the patient's needs. For example, patients need to walk so many times a day, take so many pills. But those are not necessarily the goals of patients. We determine those goals simply by asking them. They could say 'I would like my hair washed,' or 'I would like to call my granddaughter.' Those things are important to them."

For hospitals thinking about instituting RBC, Koloroutis had this advice:

"Recognize that transformation is not a quick fix. It is a cultural evolution. Some aspects of RBC are already alive and well in every organization. Use them and build on that success. Commit to a 3-5 year process."

Healthcare workers, she concluded, "can grow weary of hearing about new programs. They'll ask, 'Is this another flavor of the month?' I say no. This is a way to get back to the basics, back to the care and service of patients."

From nursetogether

Everybody deals with fear and anxiety, however sometimes our anxieties can get the best of us.  Here are 6 tips on stress management and anxiety management in nursing to help you manage your daily challenges easily.

1.    Find a diversion  Often times, nurses get stressed when there is a lot going on all at once, particularly in the workplace. When this happens, take a deep breath and try to find something to do for a few minutes to get your mind off of the problem. You could take a walk, listen to some music, read the newspaper or do an activity that will give you a fresh perspective on things – when time permits.

2.    Positive affirmations work  Another technique that is very helpful is to have a small notebook of positive statements that make us feel good. Whenever you come across an affirmation that makes you feel good, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel anxious, open up your small notebook and read those statements.

3.    Take it one day at a time  In dealing with your anxieties, learn to take it one day at a time. While the consequences of a particular fear may seem real, there are usually other factors that cannot be anticipated and can affect the results of any situation. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

4.    Find gratitude   Sometimes, we can get depressed over a stressful situation. When this happens, take a few minutes to write down all of the things that you are thankful for in your life. This list could include past accomplishments and all the things that you have taken for granted. The next time you feel depressed, review your list and think about the good things that you have in your life.

5.    Think positive  Challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make you fearful or anxious, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense.

6.    Divide and conquer  When facing a current or upcoming task that overwhelms you, divide the task into a series of smaller steps and then complete each of the smaller tasks one at a time. Completing these smaller tasks will make the stress more manageable and increases your chances of success.I know that anxieties and stresses can be difficult to manage, particularly for nurses; however, there are many helpful resources available. Managing stress and anxiety in nursing does take some practice but eventually you will improve in time.

From RNCentral.com

I love my computer. I drag it and my iPhone almost everywhere, including to the NANDA-I Conference I attended last week. I take notes while listening to speakers, I use my phone or my digital camera to record the slides the experts use in their presentations, I post conference updates on Twitter and Facebook, and I bring it all together for this blog. I live an e-life it seems.

This is important because it has a direct bearing on healthcare, nursing, and as it would seem, nursing language (what NANDA-I uses to define “the knowledge of nursing”). My vocabulary enlarged last week as I learned a new word, some new phrases, and some new perils to look out for when I am working at the hospital.

E-Iatrogenic

We should all know that “iatrogenic” means “of or relating to illness caused by medical examination or treatment.” One of the terms we see a lot these days is “HAI” or “hospital acquired infection.” This, along with other illnesses and injuries, which happen as a result of other medical care, are no longer being paid for by the Center for Medicare and Medicaid Services (CMS) or by most insurance companies. And, there is new area of concern of which we must be aware: E-iatrogenic issues.

In the simplest way I can explain it, all the computers we’ve come to rely on in healthcare have their own perils and we are really starting to see evidence of that.

Elizabeth Borycki, RN, PhD, is an assistant professor of health information science the University of Victoria, in British Columbia, Canada. While attending NANDA-I she presented a paper on identifying and reducing “technology-induced errors” (one of those new phrases) or e-iatrogenic.

Technology-induced errors are errors that arise from the design and development of technology and the implementation and customization of that technology. In 1995 the U.S. Institute of Medicine endorsed the use of electronic health records (EHRs) as an intervention that could reduce errors. Healthcare organizations around the world ran with it and some follow-up studies reported the systems could replace the number of errors happening each year.

However, 10 years later, journal articles started publishing findings that described how EHRs and component software systems could, in themselves, lead to errors. Some of the types of errors Borycki highlighted included automatic defaults, incorrect medication dosages, and incorrect patient data. She cited some of the factors involved in these technology-induced mistakes:

• Human factors including usability and workflow.
• Organizational behavior such as socio-technical issues and system/organizational fit.
• Software engineering including testing approaches.

While chatting with Borycki, after her presentation, we noted several ways these errors happen to all of us. For example, you put in some data but forget to hit return and “oops,” the patient’s last set of vital signs don’t actually get recorded. Or the drop down box you have to pick from auto-populates an answer if you don’t pick one, or something unusual happens and there is no free-text box to record the event—all of these are situations I’ve actually dealt with as hospital’s I’ve worked in become more automated. These are all potential patient safety issues.

And this brings us to why Borycki presented at NANDA-I. Borycki and her fellow researchers believe that we need to extend the NANDA-I taxonomy to include the emergence of these new patient safety issues. That is, technology-induced errors arising from the widespread implementation of health information systems. We need some new nursing diagnoses.

According to Borycki, examples of potential interventions include:

• Reporting if computer system is not working or is malfunctioning.
• Reporting if computer system causes hazards due to inefficiencies or negatively affects workflow.
• Awareness of limitations of computer systems in nursing.
• Questioning computer generated results that may not appear to match the right patient.
• Recognizing problems in dangerous “work-arounds” due to technology.
• Training on how to proceed in situations where a computer system goes down or is not available.

Nurses I have worked with come from many camps. Some like charting electronically, some miss paper charting (although there are error problems there too) and some want EMRs to work but don’t trust the systems. The reality is EMRs and electronic charting are here to stay. It is our job as nurses to get involved, to point out where entries could be more efficient or easier to use, to learn more about the systems we are given and use every day and to be proactive in finding the best possible means for using them. For that, we need a language because it all comes back to standardized communication techniques are the best ways to keep our patients safe—our primary concern as RNs. NANDA-I has a new challenge, defining the e-knowledge of nursing.

From Nurse.com

Alisa Glaister, RN, credits her opportunity to ascend from new grad to nurse manager to a few key colleagues, including a director from a different unit who advised her as she led a project to treat angioplasty patients on the telemetry floor. “He helped me get my foot in the door for this project, which I believe has led to my current management position,” said Glaister, a nurse manager at St. Mary’s Medical Center in San Francisco.

Glaister met with her mentor weekly to discuss techniques of effective leadership. “He was a tremendous help and guide,” she said. 

Mentoring has gained considerable respect as an essential element for training new nurses, whether they’re fresh out of school or recently transferred from another unit. “The first year [out of school] you have those vulnerable moments all the time, and you forget what you have accomplished,” said Hazel Curtis, RN, BSN, MPH, an education specialist for staff development at Loma Linda (Calif.) University Medical Center. “A great mentor picks you up, dusts you off, gives you a pat on the back and says, ‘You can do it.’” 

Going one on one

Formal mentoring programs hatched in professional associations and hospitals are popping up around the country as researchers and managers find the practice boosts a nurse’s job satisfaction and confidence. 

Cecelia Gatson Grindel, RN, PhD, CMSRN, FAAN, studied the outcomes of Nurses Nurturing Nurses (N3), a mentoring program designed by the Academy of Medical-Surgical Nurses. The year-long program was rolled out to 40 medical institutions across the country in 2002. Grindel, a professor and interim dean at Georgia State University in Atlanta, said data she could gather indicated more than 90% of mentored nurses stayed on the job, compared to attrition rates as high as 30%. Feedback collected throughout the pilot year of the program suggested mentored nurses had more job satisfaction and confidence. 

Yvonne Brookes, RN, director of clinical learning at Baptist Health South Florida in Miami, found similar results after implementing a residency program that included a mentorship component. Previously, turnover among the system’s 4,000 nurses averaged 22%, often because new graduates left the profession or pursued an advanced degree after their first year. Since implementing the program in 2007, the new graduate turnover rate dropped to 6%, she said.

“We realized it wasn’t about the science, it was all that other stuff that goes to the head of a new grad,” she said. 

“Other stuff” can range from implementing unit procedure to dealing with difficult managers or unhelpful preceptors. It can be conflict with patients or their families dealing with the shock of witnessing a death for the first time. “Sometimes you just need to vent,” Brookes said.

A mentor also can help a nurse recover from making a medical error — a potentially traumatic experience — by offering emotional support and emphasizing that one mistake doesn’t make a bad nurse. 

Choosing teams

Matching the mentor who responds to help with complaints, concerns, self-doubts and errors with the nurse who needs to share them is somewhat hit and miss in formal mentorship programs. Both parties have to accept the relationship takes time — not an easy pill to swallow in today’s intense work environment.

N3 guidelines advised managers to look for someone with three- to five-years of experience in the same field who worked outside the nurse’s unit. In a new mentoring program at St. Mary’s, nurse managers help match personalities and proximity, among other factors, Glaister said. “We really take into consideration who we’re matching with whom,” she said.

At Baptist Health, the process was more intuitive, Brookes said. Mentors and mentees gathered in one room to talk one on one and then rotated until every mentee had met every mentor. “It’s sort of a speed-dating situation to find a mentor that will work for you,” she said. 

Programs across institutions vary, but the time commitment can range from trading a text message or two per month to having biweekly meetings for one year. Since many new nurses are assigned to the night shift, a good deal of these conversations happen in the evening. But meetings also can be irregular or precipitated by emergent situations, said Abigail Mitchell, RN, DHEd, MSN, a professor at D’Youville College, Buffalo, N.Y., and a nursing supervisor at Kaleida Health, Buffalo, N.Y. “If they’re in crisis, you have to handle it,” said Mitchell, who runs a private mentoring firm. “You can’t just say, ‘It’s not our date to meet.’”

Generation gaps can present challenges in mentor-mentee relationships. For instance, younger nurses are often more comfortable communicating through texting and email. Nurses from the baby-boomer generation are sometimes reluctant to mentor the next generation. “The work ethic is different,” Mitchell said. Boomers will pick up extra time or stay over their shift to help coworkers, while some younger-generation nurses rather go home and pick up extra hours when it works for them, around holidays, for example, she said.

Sometimes the mentor-mentee relationship just doesn’t work out, but that doesn’t necessarily mean mentoring didn’t work. Anecdotal evidence from the N3 program indicated nurses who’d been assigned a mentor were likely to seek out another if the first relationship wasn’t helpful. Managers also have noticed that mentored nurses go on to mentor their junior colleagues. “The process has fed on itself,” Brookes said. “The more professional their approach, the more they want to contribute to the next group coming in.”

The program’s success has inspired Brookes to extend the model to other levels of the profession. A med/surg nurse with 15 years experience still needs guidance when transferring to a different unit, like critical care, she said. She is mentoring four managers to help them ease into their new roles. “They’re degreed up to the caboozle, but that doesn’t mean they know whom to reach out to,” Brookes said.

At this level, mentoring is more about handling people and situations than about patients and skills. Healthcare management involves evaluating staffing ratios, managing human and fiscal resources and strategic planning. Sometimes advice is just practical: a nurse manager would do well to keep a pressed blazer in the office closet, for example. 

Recently, Curtis convened a small mentor circle for managers. The new managers come together about once a week to ask questions and hear presentations on broad topics of interest, such as the hospital culture. The program has boosted their confidence, she said. 

Educating educators

Academia, too, reaps benefits from mentoring. Shellie Bumgarner, RN, MSN, CEN, EMT, a clinical educator at Lenoir-Rhyne University School of Nursing in Hickory, N.C., sought help to implement an education day for nurses at a small rural hospital. 

She found a mentor at the 2010 national convention of the Emergency Nurses Association, which had started EMINENCE (Establishing Mentors InterNationally for Emergency Nurses Creating Excellence) in 2008. The pair worked together for one year, talking about once a month and trading emails frequently. 

Her mentor helped her with the substance of her topic, which focused on pediatric care in smaller, rural facilities. She also contributed creative ideas to help Bumgarner find a way to cover the shifts of nurses who attended her training. “She advised how to tweak my ideas to better fit the smaller hospital,” she said. 

Retention of nursing faculty is as urgent as the need for unit staff, as professors leave academia for higher paying jobs. The National League for Nursing, which focuses on nursing education, released “The Mentoring of Nursing Faculty Tool Kit” to promote recruitment and retention of nurse faculty (available online at NLN.org/facultydevelopment/mentoringToolkit/index.htm). 

Beyond orientation, mentoring faculty includes the development of teaching and research skills. 

Mitchell has started her own mentoring program targeting faculty. Managing workload and outlining governance procedures are primary topics, she said.

The idea may be slow to grow, but more nurses at all levels are realizing the importance of mentoring, said Brookes. Is it a widespread practice? “No,” she said. “But it should be.”

From SouthtownStar via Chicago Sun-Times

Ray Mendez’s first year of medical school at Loyola University has ended, but there’s no slacking off on his “to-do” list.

Next up is “effect social change.”

Mendez, 26, of Palos Heights, recently was selected for an Albert Schweitzer Fellowship, a program in which fellows design community health initiatives. Mendez was one of just 31 Chicago-area candidates selected.

“This may be one of the most important things I’ve ever done,” Mendez said. “As important as medical school.”

The fellowship, a yearlong program, is designed to develop leaders in community health and give students in health-related fields a unique social and economic perspective on issues they may face as professionals. Recipients can be from a variety of fields, but they have a common goal to improve some aspect of health care in the Chicago area.

“Every fellow creates his own program, and we have to put in 200 hours of work toward it over the next year,” Mendez said.

The projects are varied, ranging from putting together a music therapy program for refugee and immigrant children to one that will provide preventative health care for the homeless.

Mendez’s goal is to increase the presence of minorities in the health care profession.

“There’s an acute (lack of) representation of minorities in the health care field. Less than 9 percent of all physicians are black or Latino, and less than 7 percent for nurses, while they make up 28 percent of the U.S. population,” Mendez said.

He said this is significant because there’s a direct link between low minority representation and a lack of health care support for those minorities.

“One of the most important aspects of the program is making sure students stay in touch afterward so that when they succeed and get out of their communities, they can come back and uplift those same communities,” Mendez said.

He hopes to achieve his goal by expanding on an existing Loyola program that works closely with some Chicago-area high schools. He plans to use motivational speeches, activities and an immersion program with the Loyola School of Medicine to introduce students to the field and to encourage them to pursue careers in health care.

A visit to Cristo Rey Jesuit High School in Chicago as part of a social justice class he took convinced him that putting the idea into action is necessary.

“When I went to Cristo Rey and saw how enthusiastic the students and teachers are about going to school, I thought, ‘Wow, this is what needs to be done,’ ” Mendez said.

As a Latino student, he has realized the difficulty a minority can face pursuing a career in health care.

“I definitely didn’t have a lack of educational opportunities in Palos, but when I was applying to medical schools, it was still really hard. I didn’t have a mentor to look up to and to guide me through the process,” he said.

He said he didn’t understand why more minorities were not applying to medical school, and he feels like it is his responsibility to help change that. So after some reflection and research, he applied for the Schweitzer Fellowship.

“I feel I have the power and time to do it,” Mendez said.

He said he’s prepared for the challenge of balancing medical school and his fellowship work. He said he’s dropped a few extracurricular activities.

“It’s gonna be tough definitely, but I’ve created a pretty good support network of friends who are really interested in this project,” he said. “So I think I can handle it.”

From PRNewswire

Academic Program is First of Its Kind

ATLANTA, May 30, 2012 /PRNewswire/ -- Morehouse School of Medicine today announced the creation of an endowed academic chair devoted to issues related to sexuality and religion.  The Marta S. Weeks and David E. Richards Endowed Chair in Sexuality and Religion will develop innovative health and pastoral services as well as teaching, research and public leadership related to issues that bridge the topics of sexuality, religion and medicine.

"Through this unique chair, Morehouse School of Medicine will provide national and international leadership addressing the challenges of sexuality and sexual health in the worlds of medicine and religion," said David Satcher, M.D. Ph.D., 16th Surgeon General of the United States and founder of Morehouse School of Medicine's Satcher Health Leadership Instituteand its Center of Excellence for Sexual Health.

The Marta S. Weeks and David E. Richards Endowed Chair in Sexuality and Religion is a major accomplishment of more than a decade of work by Satcher, who in 2001 released the Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. That document outlined a framework of initiatives to strengthen the national dialogue on sexual health. It recognized that sexuality and religion are deeply connected in the United States and that public health would benefit from coordinated efforts of leaders in public health and religion as well as other major constituencies with deeply held beliefs relating to sexuality.

"While the chair will address sexual health issues in all communities, it will place a particular emphasis on underserved populations which is integral to Morehouse School of Medicine's mission," added Satcher. "The continuing disparities in access to quality health care services for minorities, poor people, and other disadvantaged groups results in a weakened public health infrastructure, which ultimately affects everyone."

The endowed chair will focus its efforts on:

• Teaching sexuality and sexual health topics to current theological and medical students;
• Training the next generation of religious and healthcare leaders to meet the sexual health challenges of  both disciplines;
• Bringing together leaders of constituency organizations that have diverse viewpoints for consultations and consensus-building;
• Research directed toward documenting and suggesting ways to overcome disparities in sexual health with a special focus on underserved communities.

For more information on Morehouse School of Medicine and the institution's latest endowed chair in sexuality and religion, please visit www.msm.edu.