DiversityNursing Blog

By PATTY WIGHT

Some of us are lucky enough to stumble into a job that we love. That was the case for Gabrielle Nuki. The 16-year-old had never heard of standardized patients until her advisor at school told her she should check it out.

"I was kind of shocked, and I was kind of like, 'Oh, is there actually something like this in the world?' "

Since Nuki wants to be a doctor, the chance to earn $15 to $20 an hour training medical students as a pretend patient was kind of a dream come true. Every six weeks or so, Nuki comes to Maine Medical Center in her home town of Portland, Maine, slips on a johnny, sits in an exam room and takes on a new persona.

Third-year medical student Allie Tetreault knows Nuki by her fictional patient name, Emma. A lot of teens avoid the doctor, so it's important for Tetreault to learn how to make them feel comfortable.

"What kinds of things do you like to do outside of school?" Tetreault asks.

"Um, I play soccer, so preseason is coming up soon."

Nuki preps weeks ahead of time for her patient roles. She memorizes a case history of family details, lifestyle habits and the tone she should present. "I've had one case where I was concerned about being pregnant. That was kind of like the most harsh one, I guess."

As Emma, Nuki's playing just a shy, healthy teen.

"How did school finish up for you this year?" Tetreault asks.

"Um, it was good. Yeah, school's been good. Um, yeah."

Emma's an easy role, Nuki says, but she ups the shyness factor because it poses a classic challenge to the medical student: how to get a teen to open up?

"Each case kind of has what's on paper, but then you can come in and kind of add another level," Nuki says. "Depending on how complex it is, you can add your own twist to it."

After asking Emma about her personal history, Tetreault moves on to the physical exam and listens as Emma takes deep breaths.

Tetreault gives Emma a clean bill of health and the practice appointment is over. But the most important part of Gabrielle Nuki's job is about to begin.

The 16-year old now has to evaluate the adult professional. She's smooth and tactful after lots of training on how to deliver feedback. Nuki tells Tetreault she did a good job making her feel comfortable.

"I also liked how you mentioned confidentiality, because for my age group, that's important to touch on," Nuki says. "And I think that maybe you could have had a couple more times where you asked me if I had any questions, but other than that I think you did a really great job."

It's communication skills versus acting skills that really qualify someone to be a standardized patient, says Dr. Pat Patterson, the director of pediatric training at Maine Medical Center.

"A lot of patients want to please their physician," Patterson says. "It's not easy for a patient to say 'That didn't feel right', or 'The way you asked that made me feel bad.' "

Gabrielle Nuki says working with medical students and being forthright about their performance has given her more confidence. In the future, she hopes to take on more complex roles — maybe someone with depression.

But she knows no matter what kind of patient she portrays, this job will prepare her well for when she reverses roles and one day becomes a doctor.

Source: http://www.npr.org

By Michelle Healy

Let them sleep!

That's the message from the nation's largest pediatrician group, which, in a new policy statement, says delaying the start of high school and middle school classes to 8:30 a.m. or later is "an effective countermeasure to chronic sleep loss" and the "epidemic" of delayed, insufficient, and erratic sleep patterns among the nation's teens.

Multiple factors, "including biological changes in sleep associated with puberty, lifestyle choices, and academic demands," negatively impact teens' ability to get enough sleep, and pushing back school start times is key to helping them achieve optimal levels of sleep – 8½ to 9½ hours a night, says the American Academy of Pediatrics statement, released Monday and published online in Pediatrics.

Just 1 in 5 adolescents get nine hours of sleep on school nights, and 45% sleep less than eight hours, according to a 2006 poll by the National Sleep Foundation (NSF).

"As adolescents go up in grade, they're less likely with each passing year to get anything resembling sufficient sleep," says Judith Owens, director of sleep medicine at Children's National Medical Center in Washington, D.C., and lead author of the AAP statement. "By the time they're high school seniors, the NSF data showed they were getting less than seven hours of sleep on average."

Chronic sleep loss in children and adolescents "can, without hyperbole, really be called a public health crisis," Owens says.

Among the consequences of insufficient sleep for teens, according to the statement:

Napping, extending sleep on weekends and caffeine consumption can temporarily counteract sleepiness, but they do not restore optimal alertness and are not a substitute for regular, sufficient sleep, the AAP says.

Delaying school start time is a necessary step, but not the only step needed to help adolescents get enough sleep, Owens says. "Other competing priorities in most teenagers' lives are also components of this problem," she says, including homework, after-school jobs, extracurricular activities and electronic media use. Computers and television screens, she adds, "produce enough light to suppress melatonin levels and make it more difficult to fall asleep."

"The bottom line is if school starts at 7:20 there is no way for the average adolescent to get the 8½ to 9½ hours of sleep they need," Owens says

Research on student performance in schools that have reset the start clock, including Minneapolis Public Schools, "shows benefits across the board," says Kyla Wahlstrom, director of the Center for Applied Research and Education Improvement at the University of Minnesota.

"We've found statistically significant evidence that attendance is improved, tardiness is decreased and academic performance on core subjects, English, math, social studies and science, is improved. And now we have evidence that on national standardized tests such as the ACT, there's improvement there, too," Wahlstrom says.

Obstacles commonly cited to changing school start schedules, include curtailed time for athletic practices and games, reduced after-school employment hours for students and significant impact on bus scheduling and other transportation arrangements, she says, adding, "This is a major policy change that schools have to grapple with if they want to embrace the research about what we know about teens."

According to U.S. Department of Education statistics approximately 43% of the more than 18,000 public high schools in the U.S. have a start time before 8 a.m.; just 15% started at 8:30 a.m. or later.

In some school districts that transport students great distances, buses are picking up students as early as 5:45 a.m., "so there's also a safety element" to early start times, says Terra Ziporyn Snider, executive director of the advocacy group Start School Later.

Other major health organizations, including the American Medical Association and the Centers for Disease Control and Prevention, have all highlighted insufficient sleep in adolescents as a serious health risk, as has U.S. Education Secretary Arne Duncan, Snider says.

"What's unique about the American Academy of Pediatrics' statement is that it's very specific," she says. "It says very clearly that high school and middle schools should not start before 8:30 a.m. for the sake of the health and sleep of our children. They draw the red line."

Source: http://www.usatoday.com

By: American Profile

School nursing started out as a practical solution for Beth Mattey: The mom of three liked the hours. Now, 27 years later, she says it was the perfect career choice—creative, independent and full of meaning. “As Maya Angelou said, ‘People never forget how you made them feel,’” Mattey says. “That’s the connection that school nurses make.” We asked Mattey what parents might be surprised to know about her job—and their kids.

1. Sadness is one of the most common illnesses she sees in students. “Kids are anxious and want to do well,” she says, noting a 2012 National Association of School Nurses report that the top five health conditions of U. S. children are mental health- related, issues that school nurses spend about a third of their time helping students cope with.

2. Every kid should carry a water bottle. Dehydration is often the cause of headaches, another common complaint among kids, Mattey says. Also a culprit? Lack of sleep.

3. School nurses need to know your secrets. In addition to any chronic conditions your student is coping with, update your school’s nurse on any big family news like an illness, death or divorce. Your instinct might be to keep such facts private, but the nurse can offer your child valuable support.

4. Your kids aren’t eating the lunch you pack. “I often ask teens what they had for lunch, and they say, ‘Chips.’ We need to help them understand the value of nutrition and to make good choices,” Mattey says.

5. A “mental health day” is not a stress solution. Allowing your anxious teen a day off won’t get to the root of the cause. “If a kid is too stressed to go school, find out why,” Mattey says. “Is she being bullied? Did she not do her homework?”

6. Teens need vaccines. Make sure yours is up to date on the Tdap or tetanus, diphtheria, pertussis; meningitis—one at age 11, the second at age 16; and the HPV (human papilloma virus).

7. A school nurse can be a teen’s— and parent’s—best friend. Mattey sees herself as supporting students, physically and emotionally. After all, she’s there day after day, year after year. “School nurses provide a safety net,” she says.

Source: www.tauntongazette.com

By MICHELLE ANDREWS

School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student's seizure or asthma attack, among many other things.

And though school nurses see many students regularly, they don't always have the most up-to-date information about the students' health. School nurses must get permission from parents to communicate with a child's doctor. Once the doctor gives them a care plan for the child, they generally rely on the doctor and/or parents for updates and changes.

"When things change, we don't always get told in a timely manner," says Nina Fekaris, a school nurse in the Beaverton, Ore., school district. "It works, but it takes a lot of coordination."

At the same time, school-based health care is unfamiliar territory to many medical professionals, who operate in a health care universe largely separate from school clinics and other community-based medical services.

In Delaware, "lots of nurses expressed that they had difficulty communicating with providers" at Nemours Health System, which serves children around the state, according to Claudia Kane, program manager of the Student Health Collaboration at Nemours.

In 2011, Nemours got together with the Delaware School Nurses Association and the state Department of Education to develop a program that, with parental approval, gives school nurses read-only access to the electronic health records of more than 1,500 students who have complex medical conditions or special needs. That includes conditions such as diabetes, asthma, attention deficit hyperactivity disorder, seizure disorders or gastrointestinal problems.

Beth Mattey, a school nurse in Wilmington, says that now that she has access to the Nemours system, she can check the recent lab test results of a student who has diabetes. "It's helpful for me to monitor his [blood sugar levels] and work with him to make sure he's in better control," says Mattey, who is president-elect of the National Association of School Nurses.

When a student put a staple through his finger, Mattey was able to check to make sure he went to the doctor and got treatment. "Checking with him directly involves calling him out of class," she says.

Eventually, school nurses will be able to put information into the Nemours electronic records system as well, says Kane.

In the meantime, Nemours doctors, some of whom were initially skeptical about allowing school nurses access to health system medical records, are warming up to the arrangement. Kane says it encourages communication between physicians and school nurses, and eases the burden of routine tasks because Nemours doctors no longer have to fax over care plans or instructions to the school nurse every few months for students who are part of the program.

The Nemours Student Health Collaboration project is operating in all Delaware public school districts as well as half of charter schools and about one-third of private schools. Kane says Nemours plans to extend the program to school-based health centers next.

Source: npr.org

Do you think they should have access to medical records?

By RICHARD PÉREZ-PEÑA

Published: June 23, 2012

Ms. Matton, a nurse, works at Abington Memorial Hospital, one of hundreds around the country that have started to require that their nurses have at least a bachelor’s degree in nursing. Many more hospitals prefer to hire those with such degrees.

That shift has contributed to a surge in enrollment in nursing courses at four-year colleges, particularly at the more than 600 schools that have opened “R.N. to B.S.N.” programs, for people who are already registered nurses to earn bachelor’s degrees. Fueled by the growth in online courses, enrollment in such programs is almost 90,000, up from fewer than 30,000 a decade ago, according to the American Association of Colleges of Nursing.

The need is so great that nurses without bachelor’s degrees are still in demand. But experts say that may change in years to come, particularly at hospitals, the largest segment of the profession and one of the best paid.

Enrollment in community college programs, the typical path to becoming a nurse, remains strong, but many of those schools are looking for new arrangements, like partnerships with four-year schools, to keep their graduates competitive.

Ms. Matton, 37, first went to college for an associate degree in radio and television broadcasting. By the time she returned to school for an associate’s in nursing, she was a wife and mother — she gave birth to her youngest a few days before taking an exam. Now she is weeks away from her third degree, a bachelor’s in nursing from Drexel University in Philadelphia, with most of the work done online.

“I wanted to get the bachelor’s at the start, but I needed to start earning some money,” said Ms. Matton, whose husband, Joel, is a computer programmer. “Now I need to do this for job security, to have opportunities down the road.”

Schools like Drexel have seized the opportunity. Its online R.N. to B.S.N. program began in the late 1990s with a few dozen students and today has 650. Over all, its College of Nursing and Health Professions has doubled over the last decade, to about 2,400 students, making it one of the nation’s largest.

“There are several hospitals in our region, like Abington, that will hire nonbaccalaureate nurses but give you a certain number of years to finish the baccalaureate, and some that won’t even interview you without it,” said Gloria Donnelly, dean of the nursing college.

Such policies are limited to a small fraction of the nation’s more than 5,000 hospitals — while no definitive count exists, they tend to be teaching hospitals in major metropolitan areas — but the number is rising fast. Hospital and nursing school officials say most hospitals insisting on bachelor’s degrees began doing so in the last five years, like Abington, a suburban hospital north of Philadelphia, which adopted its policy in 2010.

Surveys show that most hospitals prefer to hire nurses with bachelor’s degrees, though they often cannot find enough. Lawmakers in several states, including New York, have introduced bills that would require at least some hospital staff nurses to have bachelor’s degrees within 10 years, though none have become law.

No matter the type of nursing school, a graduate who passes a national licensing exam becomes an R.N., and for decades, that was the only credential that mattered to hospitals. (Licensed practical nurses, or L.P.N.’s, who take a different version of the exam, can perform fewer functions and are being phased out of hospitals.)

Not long ago, most nurses did not go to college at all, but to nursing schools run by hospitals — including one still run by Abington — that do not confer degrees. As recently as the mid-1980s, half of the country’s registered nurses had started that way. But by then, hospital-based schools were closing in droves, and community college education was becoming the norm.

Still, professional groups and employers continue to push for more education, citing studies linking better-educated nurses to better patient care. Where traditional nursing education focuses on practical skills, students in four-year programs learn more about theory, public health and research.

An added incentive for hospitals is the coveted “magnet” designation, awarded by the American Nurses Association to about 400 hospitals and sometimes featured in their advertising. Among the association’s criteria for magnet status is the nursing staff’s level of education.

A 2008 federal government survey showed that among newly minted nurses, only 3 percent had graduated from nondegree programs, 58 percent from community colleges, and 39 percent from four-year colleges. With more of them returning to school, half of the nation’s 3 million registered nurses had a bachelor’s or master’s degree in nursing.

In 2010, the Institute of Medicine called for raising that figure to 80 percent by 2020, but that is a tall order.

“The baccalaureate programs can’t find enough qualified instructors, so they turn away tens of thousands of qualified applicants every year,” said Geraldine Bednash, chief executive of the American Association of Colleges of Nursing. “There’s going to be a big need for community-college-educated nurses for a long time, but they may be increasingly limited to nonhospital settings.”

But many community colleges are finding ways to appeal to students who want more than an associate degree. A handful of community colleges have won permission to offer bachelor’s degrees in nursing — notably Miami Dade College, one of the nation’s largest, which started its bachelor’s program in 2008 — and other schools have petitioned state regulators and accreditation agencies to do the same.

Many more junior colleges have made arrangements with four-year colleges to help nursing students move more readily from one to the other. In Oregon, eight community colleges and the state’s Health and Science University have shared a nursing curriculum since 2006, an approach since adopted by others around the country.

“I really don’t foresee a day when the nursing pipeline can continue without community colleges, but we have to take steps to ensure our graduates remain marketable, and some programs may not survive in the long run,” said Nell Ard, director of nursing at Collin College, a community college outside Dallas. Each Collin nursing student is enrolled simultaneously in one of two four-year state schools, allowing for a seamless transfer.

But a bachelor’s program sets a high a bar for many would-be nurses and working nurses, who are older than their counterparts of a generation ago and are more likely to have family obligations. It is, increasingly, a second career; the typical starting age is around 30.

“My school puts more pressure on us, no question, and more household stuff falls to the wayside,” said Ms. Matton, 37, sitting in her kitchen and eating a hamburger her husband had waiting when she got home. She shifted a few years ago to working part time.

Yet she endorses the bachelor’s requirement, pointing to the high stakes of her job, working in the emergency room. On a recent day that she described as slow, she had treated, among others, a middle-aged man who fainted in the heat and needed a cardiac work-up, a young woman in withdrawal from an opiate addiction, a pregnant woman with abdominal pain who spoke no English, an elderly woman with a badly infected thumbnail, an elderly man with gastrointestinal bleeding who had an adverse reaction to a plasma transfusion, and a young man whose tingling hands, head pain and elevated blood pressure persuaded a doctor to order a CT scan.

“It blows me away how much influence nurses have on serious treatment decisions,” Ms. Matton said. “After going back to school, I think more critically about what we’re doing, and I have a better understanding of why we’re doing it.”