DiversityNursing Blog

Heather Stringer

In 2010, the Institute of Medicine issued eight recommendations that dared to transform the nursing profession by 2020. This year marks the midway point for reaching the goals outlined in the report “The Future of Nursing: Leading Change, Advancing Health,” and statistics at halftime offer a glimpse into nursing’s progress so far.

Although the numbers in some areas have altered little in the first few years, infrastructure changes have been set in motion that will lead to more noticeable improvements in the data in the next several years, said Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. The RWJF partnered with the IOM to produce the report. 

“I am a very impatient person and would like things to move faster, but we have to remember that we are changing social norms with these goals,” Hassmiller said. “We are trying, for example, to convince hospital leaders, nursing students and educational institutions that it is important for nurses to have a baccalaureate degree, and that takes time.”

Hassmiller is referring to Recommendation 4 of the report, which calls academic nurse leaders across all schools of nursing to work together to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. The most recent data collected from the American Community Survey by the Future of Nursing: Campaign for Action found that the percentage of employed nurses with a bachelor’s degree or higher only climbed 2% between 2010 and 2013. However, Hassmiller suggested the percentage is likely to increase rapidly in coming years because nursing schools have increased capacity to accommodate more students. As a result, the number of nurses enrolled in RN-to-BSN programs skyrocketed between 2010 and 2014, from about 77,000 nurses in 2010 to 130,300 students in 2014, according to the American Association of Colleges of Nursing — a 69% increase. 

New education models

Campaign for Action leaders also are optimistic about the profession’s ability to approach the 80% goal because nursing schools are beginning to experiment with new models of education, such as bringing BSN programs to community colleges. 

Traditionally, students spend at least three years in a community college earning an associate’s degree to become an RN — at least a year for prerequisites and another two to complete the nursing program, Hassmiller said. These RNs may work for a few years before returning to school to earn a BSN — and some may not return at all, said Jenny Landen, MSN, RN, FNP-BC, dean of the School of Health, Math and Sciences at Santa Fe Community College in New Mexico. To avoid losing potential BSN students, leaders from New Mexico’s university and community colleges began meeting to discuss a new paradigm: students who were dually enrolled in a community college and a university BSN program. 

The educators started by forming a common statewide baccalaureate curriculum that would be used by all community colleges and universities, Landen said. The educators also discussed how to pool resources, such as offering university courses online at local community colleges. “This opens the opportunity of earning a BSN to people who need to stay in their communities during school,” she said. “They may have family commitments locally, and they can take the baccalaureate degree courses at the community college tuition fee, which is much less expensive.”

Four community colleges in New Mexico have launched dual enrollment programs within the last year. At Santa Fe Community College, there are far more applicants than the program can hold, Landen said. Community colleges and universities in other parts of the country also are working together to create programs in which nursing students can be dually enrolled. In addition to nursing schools buying into the need for more BSN-prepared nurses, there also is evidence that employers are moving toward this new standard as well. According to a study released in February in the Journal of Nursing Administration, the percentage of institutions requiring a BSN when hiring new RNs jumped from 9% to 19% between 2011 and 2013. 

Beyond the BSN

So far, the national data related to Recommendation 5 — double the number of nurses with a doctorate by 2020 — suggests there have been minimal changes in the number of employed nurses with a doctorate, yet there has been a significant increase in the number of students pursuing this level of education. According to the JONA article, on average about 3.1% of employed nurses in all institutions had a doctorate in 2011. This rose to 3.6% in 2013. This percentage likely will increase in the coming years because of the proliferation of doctor of nursing practice programs since 2010. These programs are geared for advanced practice RNs who are interested in returning to the clinical setting after earning a doctoral degree. Between 2010 and 2013, the number of students enrolled in DNP programs doubled from just over 7,000 students to more than 14,600. There was a lesser increase in the number of students enrolled in PhD programs, up 12% from 4,600 to 5,100, according to the AACN. 

“When the DNP degree became an option, it opened the opportunity of a higher level of education to the working nurse, not the researcher, and that was attractive to many nurses,” said Pat Polansky, MS, RN, director of program development and implementation at the Center to Champion Nursing in America. “Getting a research-based PhD takes longer and not every nurse can do that, so the DNP has become a wonderful option.”

Leaders at the Campaign for Action, however, acknowledge that it is important to find strategies to boost the number of PhD-prepared nurses because the profession needs those nurses in academia and other administrative, research or entrepreneurial roles where they are contributing to the solutions of a transformed healthcare system, Hassmiller said. To encourage more nurses to pursue the path of a PhD, in 2014 the RWJF launched the Future of Nursing Scholars Program, which awards $75,000 per scholar pursuing a PhD. This is matched with $50,000 by the student’s school, and the funds can be used over the course of three years. 

Forging ahead

In December, the nursing profession will have another opportunity to assess progress on the recommendations when the IOM releases findings from a study that is under way to assess the national impact of the Future of Nursing report. The changes happening in areas such as education are remarkable, Hassmiller said, and she is eagerly anticipating the results from the current IOM study. 

“I would never modify the goals because you need something to strive for in order to affect change,” Hassmiller said. “I am extremely encouraged because we have never seen anything like this. For the first time in history, more than half of nurses have a bachelor’s degree, and it is going to keep climbing. The most challenging part has been the number of people that need to be influenced to make the business case as to why it is important, and it is finally happening.” 

Key recommendations from “The Future of Nursing: Leading Change, Advancing Health”

1) Remove scope-of-practice barriers.
2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 
3) Implement nurse residency programs.
4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020. 
5) Double the number of nurses with a doctorate by 2020.
6) Ensure that nurses engage in lifelong learning.
7) Prepare and enable nurses to lead change to advance health. 
8) Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.

Source: http://news.nurse.com

JENNIFER SCHMIDT

There are many reasons women need cesareans. Sometimes the situation is truly life-threatening. But often the problem is that labor simply isn't progressing. That was the case for Valerie Echo Duckett, 35, who lives in Columbus, Ohio. After receiving an epidural for pain, Duckett's contractions stopped. By late evening she was told she'd need a C-section to deliver her son, Avery. Duckett says she has vague memories of being wheeled into the operating room, strapped down and shaking from cold.

"They were covering me up with warm blankets,"she says. "I kind of slept in and out of it." Her only memory of meeting her newborn son for the first time was from some pictures her husband took.

This is the experience many women have. The cesarean section is the most common surgery in America — about 1 in 3 babies is delivered this way. But for many women, being told they need a C-section is unpleasant news. Duckett says she felt like she missed out on a pivotal moment in her pregnancy.

"It took me a long time even to be able to say that I gave birth to Avery," she says. "I felt like I didn't earn the right to say I gave birth to him, like it was taken from me somehow, like I hadn't done what I was supposed to do."

Duckett's reaction to her C-section is unfortunately a common one, says Betsey Snow, head of Family and Child Services at Anne Arundel Medical Center, a community hospital in Annapolis, Md.

"I hear a lot of moms say, 'I'm disappointed I had to have a C-section.' A lot of women felt like they failed because they couldn't do a vaginal delivery," says Snow.

Now some hospitals are offering small but significant changes to the procedure to make it seem more like a birth than major surgery.

In a typical C-section, a closed curtain shields the sterile operating field. Mothers don't see the procedure and their babies are immediately whisked away for pediatric care — a separation that can last for close to half an hour. Kristen Caminiti, of Crofton, Md., knows this routine well. Her first two sons were born by traditional cesarean. She was happy with their births because, she says, it was all she knew. Then, just a few weeks into her third pregnancy, Caminiti, who is 33, saw a post on Facebook about family-centered cesarean techniques catching on in England.

"I clicked on the link and thought, 'I want that,' " she says.

The techniques are relatively easy and the main goals simple: Let moms see their babies being born if they want and put newborns immediately on the mother's chest for skin-to-skin contact. This helps stimulate bonding and breast feeding. Caminiti asked her obstetrician, Dr. Marcus Penn, if he'd allow her to have this kind of birth. He said yes.

When Caminiti told Penn what she wanted, his first thought was it wouldn't be that difficult to do. "I didn't see anything that would be terribly out of the norm," he says. "It would be different from the way we usually do it, but nothing terrible that anyone would say we shouldn't try that."

Family-centered cesareans are a relatively new idea in the U.S., and many doctors and hospitals have no experience with them. Penn and the staff at Anne Arundel Medical Center quickly realized the procedure would require some changes, including adding a nurse and bringing the neonatal team into the operating room.

And there were a bunch of little adjustments, such as moving the EKG monitors from their usual location on top of the mother's chest to her side. This allows the delivery team to place the newborn baby immediately on the mother's chest. In addition, Penn says, the mother's hands were not strapped down and the intravenous line was put in her nondominant hand so she could hold the baby.

At the beginning of October, Caminiti underwent her C-section. She was alert, her head was up and the drape lowered so she could watch the delivery of her son, Connor. Caminiti's husband, Matt, recorded the event. After Connor was out, with umbilical cord still attached, he was placed right on Caminiti's chest.

"It was the most amazing and grace-filled experience to finally have that moment of having my baby be placed on my chest," Caminiti says. "He was screaming and then I remember that when I started to talk to him he stopped. It was awesome."

And the baby stayed with her for the rest of the procedure.

Changes like this can make a big difference, says Dr. William Camann, the director of obstetric anesthesiology at Brigham and Women's Hospital in Boston and one of the pioneers of the procedure in the U.S. At Brigham and Women's, their version of the family-centered cesarean is called the gentle cesarean. Moms who opt for it can view the birth through a clear plastic drape, and immediate skin-to-skin contact follows.

Camann says the gentle C-section is not a replacement for a vaginal birth; it's just a way to improve the surgical experience. "No one is trying to advocate for C-sections. We really don't want to increase the cesarean rate, we just want to make it better for those who have to have it," he says.

So why has the procedure been slow to catch on? Hospitals aren't charging more for it — so cost doesn't seem to be a major factor. What's lacking are clinical studies. Without hard scientific data on outcomes and other concerns like infection control, many hospitals may be wary of changing their routines. Betsey Snow of Anne Arundel Medical Center says the family-centered C-section represents a cultural shift, and her hospital is helping break new ground by adopting it.

"It is the first time we have really done anything innovative or creative with changing the C-section procedure in years," she says.

Kristen Caminiti says her hope is that these innovations become routine. She says she'd like nothing more than to know that other women having C-sections are able to have the same amazing experience she had.

Source: www.npr.org

SABRINA TAVERNISE

When it came time to have the baby, Shirita Corley was alone. Her mother was at the casino, her sister was not answering her cellphone, her boyfriend had disappeared months earlier, and her father she had not seen in years.

So she got in her green Chevy TrailBlazer and drove herself to the hospital.

“I feel so down,” she texted from her hospital bed. “I’m sick of these deadbeats. I’m sick of having to be so strong.”

The message went not to a friend or family member, but to a nurse, Beth Pletz. Ms. Pletz has counseled Ms. Corley at her home through the Nurse-Family Partnership, which helps poor, first-time mothers learn to be parents.

Such home visiting programs, paid for through the Affordable Care Act, are at the heart of a sweeping federal effort aimed at one of the nation’s most entrenched social problems: the persistently high rates of infant mortality. The programs have spread to some 800 cities and towns in recent years, and are testing whether successful small-scale efforts to improve children’s health by educating mothers can work on a broad national canvas.

Home visiting is an attempt to counter the damaging effects of poverty by changing habits and behaviors that have developed over generations. It gained popularity in the United States in the late 1800s when health workers like Dr. S. Josephine Baker and Lillian Wald helped poor mothers and their babies on the teeming, impoverished Lower East Side of Manhattan. At its best, the program gives poor women the confidence to take charge of their lives, a tall order that Ms. Pletz says can be achieved only if the visits are sustained. In her program, operated here by Le Bonheur Children’s Hospital, the visits continue for two years.

It is Ms. Pletz’s knack for listening and talking to women — about misbehaving men, broken cars, unreliable families — that forms the bones of her bond with them.

She zips around Memphis in her aging Toyota S.U.V. with a stethoscope dangling from the rearview mirror. Her cracked iPhone perpetually pings with texts from her 25 clients. Most of them are young, black, poor and single. Few had fathers in their lives as children, and their children are often repeating the same broken pattern.

“I was lost, going from house to house,” recalled Onie Hayslett, 22, who was homeless and pregnant when she first met Ms. Pletz two years ago. Her only shoes were slippers. “She brought me food. That’s not her job description, but she did it anyway. She really cares about what’s going on. I don’t have many people in my life like that.”

Infant mortality rates in the United States are about the same as those in Europe in the first month of life, a recent study found, but then become higher in the months after babies come home from the hospital — a period when abuse and neglect can set in. (The study adjusted for premature births, which are also higher in the United States partly because of poverty. They were kept out of the study, researchers said, because the policies to reduce them are different.)

In Memphis, where close to half of children live in poverty, according to census data, the infant mortality rate has long been among the country’s highest. Sleep deaths — in which babies suffocate because of too much soft bedding or because an adult rolls over onto them — accounted for a fifth of infant deaths in the state, according to a 2013 analysis of death certificates by the Tennessee Department of Health.

When Ms. Pletz recently visited Darrisha Onry, 21, she saw Ms. Onry’s week-old child, Cedveon, lying beside her on a dark blue couch. The room was warm, small and crowded with a large living room set, a glass table, porcelain statues of dogs and an oversize cage holding two tiny, napping puppies.

“Where is he sleeping?” Ms. Pletz asked.

Cedveon started to cry, and Ms. Onry walked out of the room to make his bottle.

“The safest place for him is alone by himself on his back in his crib,” Ms. Pletz said, scooping up Cedveon, who had launched into a full-throated squall.

A little later, Ms. Pletz said, "You know never to shake the baby, right?”

Ms. Onry nodded.

Ms. Pletz continued: “Nerves get shot and sometimes people lose their cool. If that happens, just put him on his back on a bed and close the door, and take a little rest away from him.”

The program is unusual because it is based on a series of clinical trials much like those used to test drugs. In the 1970s, a child development expert, Dr. David Olds, began sending nurses into the homes of poor mothers in Elmira, N.Y., and later into Memphis and Denver. The nurses taught mothers not to fall asleep on the couch with their infants, not to give them Coca-Cola, to pick them up when they cried and to praise them when they behaved. The outcomes were compared with those from a similar group of women who did not get the help.

The results were startling. Death rates in the visited families dropped not just for children, but for mothers, too, when compared with families who did not get the services. Child abuse and neglect declined by half. Mothers stayed in the work force longer, and their use of welfare, food stamps and Medicaid declined. Children of the most vulnerable mothers had higher grade-point averages and were less likely to be arrested than their counterparts.

The program caught the attention of President Obama, who cited it in his first presidential campaign. His administration funded the program on a national scale in 2010. So far, the home visits have reached more than 115,000 mothers and children. States apply for grants and are required to collect data on how the families fare on measures of health, education and economic self-sufficiency. Early results are expected this year.

“The big question is, can the principle of evidence be implemented in a large federal program?” said Jon Baron, president of the Coalition for Evidence-Based Policy, a nonprofit group in Washington whose aim is to increase government effectiveness in areas including education, poverty reduction and crime prevention. “And if so, will it actually improve health?”

Experts say federal standards are too loose and have allowed some groups with weak home visiting programs to participate, even if they show effects on only trivial outcomes that have no practical importance for a child’s life. Congress should fix the problem, Mr. Baron said, warning that the program in its current state is “a leaky bucket.”

“If left unchanged, essentially anyone will figure out how to qualify,” he said.

Its future is not assured. Funding for the home visiting initiative runs out as early as September for some states, and if Congress does not reauthorize it this month, programs may stop enrolling families and the $500 million the Obama administration has requested for 2016 will not be granted. Last week, its supporters urged Congress to extend it.

In Tennessee, where home visiting programs have bipartisan support, infant mortality is down by 14 percent since 2010, and sleep deaths dipped by 10 percent from 2012 to 2013. State officials credit a multitude of policies, including the home visits.

Ms. Pletz worries that she has helped only a handful of her clients truly improve their lives. But Ms. Corley, 28, the mother who drove herself to the hospital, said Ms. Pletz, who has been visiting her for two years, had made a difference. She “has been my counselor, my girlfriend, my nurse,” Ms. Corley said. Ms. Pletz helped her cope with the disappearances of her children’s fathers, taught her to recognize whooping cough and pushed her to set career goals, she said.

“She knows more about me than my own family does,” Ms. Corley said. “I feel like I’ve grown more wise. I feel stronger for sure.”

The morning after Ms. Corley gave birth, Ms. Pletz brought her breakfast: eggs, flapjacks and bacon. The new baby, Daniel, lay in a clear plastic crib next to Ms. Corley’s hospital bed, and the two women talked over his head like old friends.

“Can I pick him up?” Ms. Pletz asked.

Ms. Corley replied: “I think he’s waiting on it.”

Source: www.nytimes.com

  PAULA SPAN

What she wanted, the patient told the geriatricians evaluating her, was to be able to return to her condominium in Boston. She had long lived there on her own, lifting weights to keep fit and doing her own grocery shopping, until a heart condition worsened and she could barely manage the stairs.

So at 94, she consented to valve replacement surgery at a Boston medical center. “She never wanted to go to a nursing home,” said Dr. Perla Macip, one of the patient’s geriatricians. “That was her worst fear.”

Dr. Macip presented the case on Saturday to a meeting of the American Academy of Hospice and Palliative Medicine. The presentation’s dispiriting title: “The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?”

Like Dr. Macip, a growing number of physicians and researchers have grown critical of 30-day mortality as a measure of surgical success. That seemingly innocuous metric, they argue, may actually undermine appropriate care, especially for older adults.

The experience of Dr. Macip’s patient — whom she calls Ms. S. — shows why.

Ms. S. sustained cardiopulmonary arrest during the operation and needed resuscitation. A series of complications followed: irregular heartbeat, fluid in her lungs, kidney damage, pneumonia. She had a stroke and moved in and out of the intensive care unit, off and on a ventilator.

After two weeks, “she was depressed and stopped eating,” Dr. Macip said. The geriatricians recommended a “goals of care” discussion to clarify whether Ms. S., who remained mentally clear, wanted to continue such aggressive treatment.

But “the surgeons were optimistic that she would recover” and declined, Dr. Macip said.

So a discussion of palliative care options was deferred until Day 30 after her operation, by which time Ms. S. had developed sepsis and multiple-organ failure. She died on Day 31, after life support was discontinued.

The key number here, surgeons and other medical professionals will recognize, is 30.

Thirty-day mortality serves as a traditional yardstick for surgical quality. Several states, including Massachusetts, require public reporting of 30-day mortality after cardiac procedures. Medicare has also begun to use certain risk-adjusted 30-day mortality measures, like deaths after pneumonia and heart attacks, to penalize hospitals with poor performance and reward those with better outcomes.

However laudable the intent, reliance on 30-day mortality as a surgical report card has also generated growing controversy. Some experts believe pressures for superior 30-day statistics can cause unacknowledged harm, discouraging surgery for patients who could benefit and sentencing others to long stays in I.C.U.s and nursing homes.

“Thirty days is a game-able number,” said Dr. Gretchen Schwarze, a vascular surgeon at the University of Wisconsin-Madison and co-author of an editorial on the metric in JAMA Surgery. Last fall, she led a session about the ethics of 30-day mortality reporting at an American College of Surgeons conference.

“Surgeons in the audience stood up and said, ‘I can’t operate on some people because it’s going to hurt our 30-day mortality statistics,’” she recalled. The debate is particularly urgent for older adults, who are more likely to undergo surgery and to have complications.

Those questioning the 30-day metric point to potential dilemmas at both ends of the surgical spectrum. Surgeons may decline to operate on high-risk patients, even those who understand and accept the trade-offs, because of fears (conscious or not) that deaths could hurt their 30-day results.

At a hospital in Pennsylvania, for instance, a cardiothoracic surgeon declined to operate on a man who urgently needed a mitral valve replacement. He wasn’t elderly, at 53, but he was an alcoholic whose liver damage increased his risk of dying.

Dr. Douglas White, the director of ethics and decision-making in critical illness at the University of Pittsburgh School of Medicine, was asked to consult. According to Dr. White, the surgeon explained that “we have been told that our publicly reported numbers are bad, and we have to take fewer high-risk patients.”

Other surgeons at the hospital, under similar pressure, also refused. A helicopter flew the patient to another hospital for surgery.

An outlier case? A study in JAMA in 2012 compared three states that require public reporting of coronary stenting results to seven nearby states that didn’t report. Older-adult patients having acute heart attacks had substantially lower rates of the stenting in the reporting states. Doctors’ concerns about disclosure of poor outcomes might have led them to perform fewer procedures, the authors speculated; they might also have weeded out poorer candidates for surgery.

Perhaps as important for older people, when things go wrong, surgical teams concerned about their 30-day metrics may delay important conversations about palliative care or hospice, or even override advance directives.

“There are no good published studies on this, but it’s something we see,” Dr. White said. “Surgeons are reluctant to withdraw life support before 30 days, and less reluctant after 30 days.”

That may have been what happened to Ms. S. Or perhaps her aggressive treatment resulted from a surgical ethos that has little to do with mortality reports.

“We want to cure patients and help them live, and we consider it a failure if they don’t,” said Dr. Anne Mosenthal, who heads the American College of Surgeons committee on surgical palliative care.

With surgeons already prone to optimism and disinclined to withdraw life support, the effect of reporting failures, if there is one, is subtle. Surgeons tell themselves, “Maybe if we wait a little longer, he’ll improve; there’s always a chance,” Dr. Mosenthal said.

But many older patients, and their families, have different ideas about what makes life worth sustaining and might welcome a frank discussion before a month passes.

“The 30-day mortality statistic creates a conflict of interests,” said Dr. Lisa Lehmann, an associate professor of medical ethics at Harvard Medical School. “It can lead to the violation of a physician’s duty to put patients’ interests first.”

Leaders at the nonprofit National Quality Forum, which just endorsed 30-day mortality as a measure for coronary bypass surgery, find such fears overblown. The forum evaluates quality measures for Medicare and other insurers, and went ahead with its endorsement despite some physicians’ objections.

“There is some concern,” said Dr. Helen Burstin, the chief scientific officer of the forum, but “certainly no evidence” that the metric is unduly influencing patient care.

“Is it better not to measure and compare, just because we can’t get it perfect?” added Dr. Lee Fleisher, a co-chairman of the forum’s surgery standing committee.

But critics think other quality measures might serve better. Perhaps the benchmark should be 60- or 90-day mortality. Perhaps patients having palliative surgery to relieve symptoms should be tracked separately, because comfort is their goal, not survival.

Maybe quality should include days spent in an I.C.U. or on a ventilator, Dr. Schwarze said.

“Medicine isn’t just about keeping people alive,” she said. “Some of it is about relieving suffering. Some of it is about helping people die.”

Source: www.nytimes.com

A University of Missouri nurse researcher is working to ensure people who use hearing aids for the first time are not bombarded by sounds that could be overwhelming and potentially painful. 

Individuals who wear hearing aids for the first time can potentially hear sounds they have not heard in months of even years, according to a University of Missouri news release on the research. The study, published online Dec. 17, in the journal Clinical Nursing Research, looked at the feasibility and initial effect of Hearing Aid Reintroduction to assist people 70 to 85 years old to adjust to hearing aids.

Some of the noises hearing aids enable their users to hear are not always easy to embrace, researchers found. These include air conditioners, wind and background conversations which can be annoying, painful and tough to ignore, the release said.

Kari Lane, PhD, RN, MOT, assistant professor of nursing at MU Sinclair School of Nursing, studied a group of elderly adults’ satisfaction with hearing aids after participating in HEAR, according to the release. Study participants recorded the total time they wore hearing aids for 30 days. Participants gradually increased the amount of time they wore the hearing aids and the variety and complexity of sounds they experienced, including household appliances or sounds from crowded areas, the release said. 

“Hearing loss is a common health problem facing many aging adults that can have serious effects on their quality of life, including heightened chances of depression and dementia,” Lane said in the release. “Hearing aids are not an easy fix to hearing loss. Unlike glasses, which provide instant results, it takes more time for the brains of hearing-aid users to fully adjust to the aids and new sounds they could not hear before.”

All participants at the start of the research reported being unsatisfied with their hearing aids, Lane said. At the end of the study, more than half of participants reported being able to increase their hearing aid use and 60% of them said they were satisfied with their hearing aids, the release stated. 

“It is common practice for audiologists to have their patients wear hearing aids all day when they first buy them, but not all persons are able to do this comfortably,” Lane said in the release. “Prior research shows there is a need for alternative ways to teach people how to use hearing aids like the HEAR intervention, which allows hearing-aid users to gradually adjust to using the aids while receiving support and coaching from health professionals and family members.”

Healthcare providers should give patients guidance on conditions they might experience during the aging process, such as hearing loss, according to the release. Such proaction could help to reduce the stigma surrounding hearing aids, Lane said. 

“If healthcare professionals begin discussing hearing loss with their patients sooner, before problems arise, the use of hearing aids could be normalized, and individuals would be better prepared for the transition when it is time for them to begin use,” Lane said in the release. 

Source: http://news.nurse.com

EMILY SHAPIRO

A nurse who contracted Ebola at the Dallas hospital where she worked plans to sue the hospital's parent company, Texas Health Resources, hoping to be a "voice for other nurses," her lawyer said today.

In the suit, which Nina Pham plans to file Monday, the 26-year-old nurse alleges that Texas Health Presbyterian Hospital didn't train the staff to treat Ebola and didn't give them proper protective gear, which left parts of their skin exposed, her lawyer Charla Aldous said.

"One of the most concerning things about the way [the hospital] handled this entire process is you've got a young lady who has this disease which she should not have. And if they properly trained her and given her the proper personal protective equipment to wear, she would not have gotten the disease," Aldous said.

Aldous said Pham hopes the suit will "help make sure that hospitals and big corporations properly train their nurses and healthcare providers."

"This is not something that Nina chose," Aldous said, but "She's hoping that through this lawsuit she can make it a change for the better for all nurses."

Pham is still coping with Ebola's after-effects, including nightmares and body aches, her lawyer said.

"She has not gone back to work yet and she is working on recovering," Aldous said. "I don't know if she'll ever be a nurse again."

Texas Health Resources spokesperson Wendell Watson said in a statement: "Nina Pham bravely served Texas Health Dallas during a most difficult time. We continue to support and wish the best for her, and we remain optimistic that constructive dialogue can resolve this matter."

Last fall, Pham cared for Liberian native Thomas Eric Duncan, who flew to the U.S. and was diagnosed with Ebola at Texas Health Presbyterian Hospital.

Pham took care of Duncan when he was especially contagious, and on Oct. 8, Duncan died from the virus.

Pham tested positive for Ebola on Oct. 11, marking the first Ebola transmission on U.S. soil.

On Oct. 16, Pham was transferred to the National Institutes of Health's hospital in Bethesda, Maryland. She was discharged on Oct. 24.

At the news conference announcing Pham's discharge, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH, said she tested negative for Ebola five times, and that it wasn't clear which treatment saved her because they were all experimental.

"I want to first tell you what a great pleasure and in many respects, a privilege ... to have the opportunity to treat and care for and get to know such an extremely courageous and lovely person," Fauci said, adding that she represents the health care workers who "put themselves on the line."

Pham's dog, Bentley, was also quarantined for several weeks, over fears that he, too, would develop Ebola.

Source: http://abcnews.go.com

By DIONNE SEARCEY, EDUARDO PORTER and ROBERT GEBELOFF

For Tabitha Waugh, it was another typical day of chaos on the sixth-floor cancer ward.

The fire alarm was blaring for the second time that afternoon, prompting patients to stumble out of their rooms. One confused elderly man approached Ms. Waugh, a registered nurse at St. Mary’s Medical Center here, but she had no time to console him. An aide was shouting from another room, where a patient sat dazed on the edge of his bed, blood pooling on the floor from the IV he had yanked from his vein.

“Hey, big guy, can you lay back in bed?” she asked, as she cleaned the patient before inserting a new line. He winced. “Hold my hand, O.K.?” she said.

Ms. Waugh, who is 30 and the main breadwinner in her family of four, still had three hours to go before the end of a 12-hour shift. But despite the stresses and constant demands, all the hard work was paying off.

Her wage of nearly $27 an hour provides for a comfortable life that includes a three-bedroom home, a pickup truck and a new sport utility vehicle, tumbling classes for her 3-year-old, Piper, and dozens of brightly colored Thomas the Tank Engine cars heaped under the double bed of her 6-year-old, Collin.

The daughter of a teacher’s aide and a gas station manager, Ms. Waugh, like many other hard-working and often overlooked Americans, has secured a spot in a profoundly transformed middle class. While the group continues to include large numbers of people sitting at desks, far fewer middle-income workers of the 21st century are donning overalls. Instead, reflecting the biggest change in recent years, millions more are in scrubs.

“We used to think about the men going out with their lunch bucket to their factory, and those were good jobs,” said Jane Waldfogel, a professor at Columbia University who studies work and family issues. “What’s the corresponding job today? It’s in the health care sector.”

In 1980, 1.4 million jobs in health care paid a middle-class wage: $40,000 to $80,000 a year in today’s money. Now, the figure is 4.5 million.

The pay of registered nurses — now the third-largest middle-income occupation and one that continues to be overwhelmingly female — has risen strongly along with the increasing demands of the job. The median salary of $61,000 a year in 2012 was 55 percent greater, adjusted for inflation, than it was three decades earlier.

And it was about $9,000 more than the shriveled wages of, say, a phone company repairman, who would have been more likely to head a middle-class family in the 1980s. Back then, more than a quarter of middle-income jobs were in manufacturing, a sector long dominated by men. Today, it is just 13 percent.

As the job market has shifted, women, in general, have more skillfully negotiated the twists and turns of the new economy, rushing to secure jobs in health care and other industries that demand more education and training. Men, by contrast, have been less successful at keeping up.

In many working- and middle-class households, women now earn the bigger paycheck, work longer hours and have greater opportunities for career advancement. As a result, millions of American families are being reconfigured along with the economy.

“The culture still has traditional attitudes about who does what, who brings home the bacon and who scrambles the eggs,” said Isabel Sawhill, co-director of the Center on Children and Families at the Brookings Institution. “The economy is now out of sync with the culture, and I think that’s creating tensions within marriage.”

A New Springboard

At the Waughs’ house, it is T.J. Waugh, 33, who picks up the couple’s two children from the babysitter when he leaves his afternoon shift at a small plant in Huntington.

By the time Ms. Waugh arrives home in rural Salt Rock from her shift, often far later than her 7 p.m. quitting time, the children have been bathed and fed.

The house is usually messy. The bathroom walls are covered with scribbles from bath crayons; dirty clothes pile up. Ms. Waugh often jams six 12-hour shifts into one week, leaving little time for cleaning and laundry. Mr. Waugh mows the lawn and will run the vacuum cleaner now and then, and if there are no clean towels, Ms. Waugh will do a load of laundry. Otherwise, housework waits until she has a stretch of days off.

“I’m just really tired when I get home,” Ms. Waugh said.

Ms. Waugh is the keeper of the family’s books. That she out-earns her husband — a pipe fitter who hunts deer and plays men’s softball on the weekends — is an unspoken given.

“She doesn’t rub that in,” he said.

Without missing a beat, Ms. Waugh adds, “It doesn’t matter where it comes from.”

Most of the new jobs produced by America’s sprawling economy — especially since the turn of the century — are either in highly paid occupations that often require an advanced degree, or, more predominantly, in lower-paid positions providing direct services that cannot be sent overseas and, at least for now, are difficult to automate.

But even with a hollowing out of the job market and a broad stagnation in wages, an analysis by The New York Times has found, a set of occupations has emerged that holds promise as the base of a more robust middle class.

Many are in health care, which has grown sharply over the last few decades.

Economists at the Labor Department project that by 2022, as baby boomers age, health care and social assistance will absorb nearly 20 percent of consumer spending, double the share of manufactured goods. The sector is expected to support over 21 million jobs, five million more than today. This includes half a million more registered nurses.

A Rare Green Shoot

The reordering of the economic landscape can be seen all over West Virginia’s old coal country, where billboards along the highways that run through the region advertise a new cardiac center and an orthopedic clinic; and where a strip mall houses Scrubs Unlimited, a medical outfitter, its retail floor crammed with nursing uniforms in 38 colors and Peter Pan prints.

Hugging the Ohio River as it bends around the Appalachian foothills, Cabell County, which includes Huntington, has often found itself on the wrong side of economic change. The population — about 97,000 today — has shrunk 10 percent over the last three decades, as the old have died and many of the young have left.

The railroad that helps shuttle coal to Huntington, one of the nation’s busiest inland ports, is still a source of jobs. But manufacturing employment — once clustered at the long-gone glassmaking plants and furniture makers — has dwindled to fewer than 5,000 jobs. Recently, a 1920s-era nickel alloy plant laid off dozens of workers after a bankruptcy, a corporate acquisition and weak sales.

In real terms, wages in Cabell County now are lower than in the 1970s, stumbling along well below the national average. One in five residents lives in poverty.

The health care industry — which added 3,000 jobs here over the last 10 years — is one of the few green shoots in a struggling economy.

West Virginia has been battered by the same forces that have reshaped the nation since the late 1970s, when global competition, an overvalued dollar, declining unions and advanced technology began to undercut the jobs created during America’s industrial heyday, deepening income inequality. And since 2000, the share of middle-income workers has been squeezed and wages have stagnated.

Yet many of the jobs added in medical services here and across the nation have turned out to be surprisingly good ones.

That was what motivated the only male registered nurse colleague of Ms. Waugh’s on the sixth-floor cancer unit, Johnny Dial, a former highway construction worker and heavy equipment mechanic. More men are joining nursing, but they still make up only 10 percent of the ranks, compared with 4 percent in 1980.

As Mr. Dial contemplated supporting a family, it came down to health care or the railroad if he wanted job security and benefits. He chose what he thought would be a more fulfilling career, and the same one as his wife, who is also a nurse.

“You get to help people,” Mr. Dial said.

Women Stepped Up

Similar thinking was behind the career choices of Ms. Waugh’s fellow female R.N.s. They include a former waitress, a former journalist, an ex-administrator in a metals factory and a former store clerk at Bath & Body Works. In addition to the satisfaction of the work, they all said, the wages are generally better in health care than they could find in other fields.

Ms. Waugh has urged her husband to try to move up at his company, where he earns about $40,000 in regular wages, plus pay for occasional extra shifts, or to switch to a more lucrative career, maybe even in health care as a radiology technician.

But for Mr. Waugh, the only way up at the plant is to go into sales, a promotion he already turned down because he said he did not want to “deal with people.” He could earn more in the coal mines, but that work is dirty and dangerous.

Mr. Waugh has talked about trying college again; he dropped out twice in the past. At one point, his wife even filled out application papers for him to jump-start his re-enrollment, but he did not pursue class work.

“My philosophy is he is lazy,” Ms. Waugh said, standing in the hospital’s white hallway. “That’s what makes me so mad.”

For all the troubles associated with traditionally male jobs, women have not had an easy ride through the economic turmoil, either.

“The occupational structure has not somehow become more women-friendly,” said David Autor, an economist at M.I.T. who has studied the changing American job market. In fact, he added, “the hollowing out of middle-skill jobs was larger for women than for men.” The process intensified sharply during the financial crisis and the ensuing economic downturn.

But in general women have reacted much better, climbing the educational ladder to capture more of the better jobs. Today, 38 percent of women in their late 20s and early 30s have a college degree, compared with 15 percent 40 years ago. The completion rate for young men is now 7 percentage points lower than for women — back then it was 7 points higher.

This has given women an edge in the new job market: Today, almost 58 percent of registered nurses have a bachelor’s degree or more, compared with about a third in 1980.

This is true across the range of occupations capable of supporting a middle-class life. In 1980, 55 percent of workers who earned the equivalent of $40,000 to $80,000 in today’s dollars had at most a high school diploma, according to the analysis by The Times, which reviewed census returns for employed people ages 25 to 64. Only a quarter had a college degree. Today, the share of college graduates has risen to about 41 percent, while just under 31 percent have completed no more than high school.

“The days when a very, very substantial share of the work force would be able to make good middle-class incomes from jobs that did not require post-high school training are just not the case anymore,” said Francine D. Blau, an economics professor at Cornell University.

Men still hold most of the top jobs in the economy, including seven out of 10 jobs that pay over $80,000 a year. But women are rapidly moving up the ranks. Women hold 44 percent of middle-income jobs, compared with about a quarter 30 years ago.

These trends may not hold forever. Though educational attainment continues to rise for women, their progress in the workplace — in terms of both wages and jobs — has slowed significantly. Tighter controls on the cost of health care could weaken the job growth and pay raises helping support the new American middle. And while the industry is largely immune to foreign competition, it may be affected by advances in labor-saving technology.

Even as more women get ahead, many men are struggling to grab a handhold into higher-paying jobs. After her husband was laid off from a string of auto mechanic jobs, Donna Colbey, 53, urged him to switch careers and become a radiology technician.

It was a job Ms. Colbey knew would offer a good salary and require only two years of training. She had taken the same route, which eventually led her to a nursing career at a Washington hospital.

He enrolled in the courses but dropped out after a few months.

“He got tripped up over the math and didn’t go back,” said Ms. Colbey, who regularly picks up extra shifts to support her family.

A Relentless Pursuit

Far more is expected of nurses now than even two decades ago. Medical advances have kept patients alive longer, meaning many are sicker with more complex illnesses than in the past. Nurses must master technology that helps both treat and track patients, and they are called on to coordinate not just with doctors but also social workers and physical therapists.

At St. Mary’s Medical Center, Ms. Waugh, in her navy scrubs, fed potassium on a recent day into the vein of one woman with a broken hip who was on the cancer floor because of a lack of beds. She gave anti-nausea medicine to a moaning young man with liver cancer in the midst of chemotherapy and prepared pills for a half-dozen other patients, documenting it all on a computer.

An outpatient arrived for his regular blood-drawing and, squatting alongside him in a waiting room, Ms. Waugh unbuttoned his shirt and collected blood from an access port in his chest.

Ms. Waugh’s pursuit of learning to advance her career has been relentless. By her own count, she has been out of school for no longer than two years since kindergarten.

All that education has come with a cost. The couple has amassed about $50,000 in student debt. Ms. Waugh would like to send her children to a better school, but the $10,000 annual tuition that would require is out of reach. “I can’t save for their college and send them to private school,” she said.

To her husband’s co-workers who are raising families on pipe fitters’ salaries, the Waugh family is rich. Ms. Waugh’s purchase of a new Toyota S.U.V. raised eyebrows around the plant.

“We’re not wealthy,” Mr. Waugh said, “but we’re not poor.”

It hasn’t been easy getting to this point. As she made the rounds at the hospital, Ms. Waugh explained how her family was set back in 2008 after Collin was born. She stayed home for one year with the boy, who had digestive problems and required expensive formula. Living on just Mr. Waugh’s salary, they ran through their savings and they accumulated credit card debt that they are still paying off.

“That was a horrible financial situation,” Ms. Waugh said.

But later this year, when her classes and other course work are finished, Ms. Waugh will qualify as a nurse practitioner, a job that she expects will allow her to earn at least 50 percent more than her current salary. And she will be prepared, she believes, for almost anything to come.

“I knew if I was a nurse I could be self-sufficient,” she said, “and wouldn’t have to rely on anyone to take care of me.”

Source: www.nytimes.com

It’s something each of the nation’s 3.1 million RNs understands intimately: Being a nurse is intense. The hospitals and clinics where they work are often stressful. And patient care and healthcare systems have never been more complex.

Nationally, nurse turnover stands at 20 percent, but nearly 40 percent of nurses are ready to leave their job after a single year. About 14 percent leave the field altogether, and the ‘working wounded’ that remain are at best demoralized and at worst error-prone. And dealing with RN turnover is among the biggest, costliest burdens in healthcare today.

It’s why University of Virginia School of Nursing’s Compassionate Care Initiative has sponsored a new Public Radio documentary series – Resilient Nurses, now available online – which will be heard on many public radio stations starting this month and also on Sunday Feb. 22 on the NPR Channel (#122) of SiriusXM satellite radio at 4pm ET / 1pm PT.  

Hosted by award-winning documentary producer David Freudberg of Humankind, the program takes a no-holds-barred look at what ails American RNs: the stress, the exhaustion, and the pressured environments that often lead to their burnout. 

But beyond sourcing RNs’ biggest challenges, Freudberg offers a promising glimpse into the growing number of nurses hoping to improve their lot by harnessing well-being through resilience. Freudberg also chronicles the growing movement of resilience at a handful of American clinics and hospitals where administrators realize the very real financial and personal stake they have in helping their nurses effectively handle stress. 

And the stories are inspiring. Sharing the voices of these powerful, real nurses may be an important step in healing the profession’s broken hearts, strengthening American RNs’ care and practice through a practitioner-centered approach to well-being. 

The Resilient Nurses audio podcast is now available online. Editors and bloggers may download and publish graphics and a brief program description from http://www.humanmedia.org/nurse/resources.php.

We hope the program will inspire nurses, nursing professors, nursing students and others in healthcare to begin their own resilient practices.

Christine Phelan Kueter, writer

Source: U.Va. School of Nursing

Alana Massey

We asked the BuzzFeed Community to tell us what the most common misconceptions about nurses are. They had a lot to say.

1. First of all, “Why didn’t you just become a doctor? You’re too smart to be a nurse” is a rude thing to say.

Wall Street Journal Live

Submitted by SadiaK.

2. And no, people can’t just apply for nursing licenses before being educated and rigorously trained.

20th Century Fox

Submitted by jennah4377addc7.

3. Because nursing is not about wiping butts all day.

Shironosov / Getty Images/iStockphoto

Submitted by MariliseB

4. And nurses are not just there for their ability to “nurture” and “mother” patients; they’re there to use science and critical thinking to save lives.

PBS

Submitted by hellokitty914 and edwyer94.

5. Which is why it’s annoying when people think you’re always just following a doctor’s orders.

Getty Images/iStockphoto Dana Bartekoske

Submitted by oneloveyogi.

6. But you’d never know that from TV and movies, which almost never portray nurses accurately.

NBC / Getty Images

Submitted by angry penguin.

7. The reality is that doctors rely heavily on the knowledge and observations of nurses to make decisions about patient care.

NBC

Submitted by lexia49c9c42e3.

8. And it is often the nurses who make life and death decisions.

Via domice.deviantart.com

Submitted by andreae41060b2b6.

9. Nurses are actually more like a doctor-social worker-respiratory therapist-pharmacist-phlebotomist-physiotherapist-receptionist-X-ray technician-transporter-housekeeper-caregiver hybrid.

ThinkStock

Submitted by oneloveyogi.

10. Which is probably why they’re not actually wearing sexy nurse outfits over lingerie with stilettos on their feet.

s3.amazonaws.com

Submitted by sandrafromparis.

11. That might also be because a huge number of nurses are men.

s3.amazonaws.com

Submitted by preciouskittenn.

12. Who, by the way, are not all gay.

ABC

Submitted by richardd31.

13. When nurses are “just taking blood pressure” they are simultaneously assessing a dozen things about a patient’s condition.

BBC / Via bbcsherlockgifs.tumblr.com

Submitted by shannooney.

14. It doesn’t help anyone to say that all nurses do is put on Band-Aids when they’re actually catching potentially fatal mistakes made by doctors who don’t know the patient as well.

Fox

Submitted by betty.swiecka.

15. And when people assume a home health care nurse is there to give sponge baths and clean the house, it makes it harder for them to provide care.

ThinkStock

Submitted by kimberly.riggs.18.

16. Saying nurses are so lucky to work three days a week ignores how much recovery time and rest is needed after long shifts and demanding work.

1492 Pictures

Submitted by lydia.maria.94.

17. Patients with the “I write your check” mentality that feel justified using nurses as servants make it harder for nurses to do their jobs.

Columbia Records / Via tumblr.com

Submitted by kelly.hilker.

18. That job is not being a personal drug dealer who is totally OK with going to jail just so a patient can get some OxyContin.

United Artists

Submitted by nic0lie0lie and cheries4218b4a82.

19. So if you come in and say you’re allergic to every drug except Dilaudid and that you needs lots and lotsof Dilaudid, the nurse is onto you, buddy.

Warner Bros.

Submitted by cheries4218b4a82.

20. And when a nurse clearly knows the answer to your question and you say, “Can you ask the doctor?” you’re undermining their expertise and their profession.

United Artists

Submitted by lalroma.

21. But the great thing about nurses is that they don’t actually care all that much about all these misconceptions.

ThinkStock

Submitted by jonathanr49e5c50fe.

22. Because the thing they care more about than anything is saving your life.

ThinkStock

Submitted by jonathanr49e5c50fe.

23. But for those of us who are annoyed on their behalves, we are just going to leave this here.

BuzzFeed

Submitted by ashleym45a8b720b.

Source: www.buzzfeed.com

Nurses’ Health Study recruits “next generation”

Boston, MA - From the dangers of tobacco and trans fats to the benefits of physical activity and whole grains, much of what we know about health today is thanks to the Nurses’ Health Study.

Researchers are recruiting 100,000 nurses and nursing students to join the long-running Nurses’ Health Study and expand its landmark research on health and well-being. And for the very first time, male nurses and students are being invited to join. 

RNs, LPNs, and nursing students between the ages of 19 and 46 who live in the US or Canada are eligible to join the study. More than 38,000 have signed up already, and recruitment will stay open until the goal of 100,000 participants is reached.

Researchers hope to engage a highly diverse group of nurses in the “next generation” of the study. For the first time, nursing students are eligible to enroll.

In order to make participation as convenient as possible for busy nurses, participants can join online and complete the study’s surveys through a secure website, http://www.nhs3.org/.

More than 250,000 nurses have participated in the study since the 1970s. By completing confidential lifestyle surveys, they have helped advance medical knowledge about nutrition, exercise, cancer, heart disease, and many other conditions.

“Nurses were originally recruited for their expertise in accurately reporting health data,” explains Dr. Walter Willett, the study’s lead researcher and Chair of the Nutrition Department at Harvard School of Public Health in Boston, Mass. “Their involvement has been invaluable, and their dedication is remarkable—an astounding 90% of them are still enrolled, decades later! The new group, NHS3, will allow us understand how today’s lifestyle and environment affect a person’s health in the future.”

Nurses enrolled in the earlier studies are encouraging their children and younger colleagues to join. “My mom started filling out surveys when the study began,” one nurse recently commented on the NHS3 Facebook page (www.facebook.com/NHS3.org). “I am so proud to be part of this study and see what it has done.”

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NURSES’ HEALTH STUDIES
Started in 1976 and expanded in 1989, the Nurses’ Health Studies have led to many important insights on health and well-being, including cancer prevention, cardiovascular disease, and diabetes. Most importantly, these studies showed that diet, physical activity, and other lifestyle factors can powerfully promote better health.

Contact: Michael Keating
617-432-7078

 nhs3@channing.harvard.edu

SOURCE Nurses Health Study 3    www.nhs3.org