DiversityNursing Blog

By Christina Orlovsky Page 

If necessity is the mother of invention and Florence Nightingale is the mother of modern nursing, it’s only fitting that during National Nurses Week--culminating in Nightingale’s birthday, May 12--we take the time to recognize nurses’ inventions and the talented professionals who used their creative energy to improve patient care. Ever hear of the crash cart, for instance? It is just one of the many innovations that nurses have helped devise. 

So here is a salute to just a few nurse inventors, from past and present, who realized a need and turned their ideas into reality.

A Nurse-Turned-Physical Therapist’s Feeding Apparatus for Amputees 

For Bessie Blount, nursing was just one step on her long career path, but it was a step that led to several technological advances in assistive devices for amputees. Working with veterans disabled in World War II, Blount, who trained in nursing and then physical therapy, created an electronic device in the early 1950s that allowed amputees to eat on their own. When Blount didn’t receive support for her invention from the American Veteran’s Association, she donated the rights to the French government, and the rights to another invention--a disposable hospital basin--to Belgium. Blount, who became a pioneer among African American women in the mid-century, ended her career path in forensic science, which she practiced until her death in 2009. 

An ER Nurse Leader’s Profession-Changing Invention and Association  

In the 1960s, emergency department nurse Anita Dorr, RN, recognized the length of time it took to gather the supplies the unit needed in a critical situation. Together with her staff, who created a list of necessities, and her husband, who built a wood prototype, Dorr envisioned a wheeled “crisis cart” in 1968 that has since evolved into the crash cart of today. Dorr’s dedication to emergency nursing eventually led to the establishment of the Emergency Room Nurses Organization in 1970--a group that would later become the Emergency Nurses Association, today a 40,000-member-strong organization devoted to strengthening and supporting the professional specialty. 

A Mother-Daughter Duo’s IV Catheter Shield 

In the early 1990s, mother-daughter duo Betty M. Rozier, an entrepreneur, and Lisa M. Vallino, RN, BSN, a pediatric emergency nurse, teamed up to establish I.V. House, Inc., an intravenous therapy organization based in Chesterfield, Mo. With products designed out of a need Vallino had seen in her clinical years for site protectors that eased patient anxiety and reduced reinsertions, the original I.V. House device was patented in 1993; today, millions of I.V. House site protectors have been provided to hospitals worldwide. 

A Sister Act for IV Safety  

Inventive IV lines took a colorful turn for nurse sisters Terri Barton-Salinas, RN, and Gail Barton-Hay, RN, whose half-century-plus of combined nursing experience provided helped them see the need for increased patient safety surrounding IV lines. Acknowledging the hazards of using clear, indistinguishable lines, the pair assisted with the product development of ColorSafe IV Lines, lines available in red, green, orange, blue and purple, with corresponding colored labels for the IV bags.  

A College’s Nursing-Engineering EHR Collaboration 

Perhaps no place is better for innovation than a university campus, which affords bright minds the opportunity to brainstorm, collaborate and experiment with creativity. One such innovative collaboration came out of the University of Tennessee at Knoxville, where the colleges of nursing and engineering partnered to create the DocuCare EHR, which integrates electronic health records into a simulated learning tool for students, changing the way nursing students learn and preparing them for the increasingly EHR-heavy hospital workforce. Developed by Tami Wyatt, PhD, RN, associate professor of nursing, and Xueping Li, PhD, associate professor of industrial and information engineering--co-directors of the university’s Health Information Technology and Simulation Laboratory--the product was purchased by health care publishing giant Lippincott Williams & Wilkins (LWW) in 2010 and is being utilized in nursing school curricula across the country.

© 2013. AMN Healthcare, Inc. All Rights Reserved. 

Source: Nursezone.com

by Crystal Owens

Years ago, nursing students would practice on each other to learn to provide care to patients.

They would inject each other with IVs and give shots to oranges.

But technology has provided training in the way of computerized manikins, designed to simulate almost any situation a student would encounter once they enter the workforce.

At The George Washington University campus in Loudoun, nursing students are provided training that goes far beyond the textbook.

The state-of-the-art nursing lab is filled with every computerized manikin a student might encounter, from pediatrics to obstetrics to general health care.

“The trend in nursing education and health care is safety of patients. We play into that in multiple levels in the nursing education field. Simulation has become an even greater part of that in order to be able to provide contextual learning for nursing students,” said Christine Seaton, clinical educator-instructor at GWU’s Loudoun campus.

The current class learning in the lab has 48 students. A new class of 44 began this week. In all, the school has graduated three classes, including the last one of 65 students. 
Students spend two semesters at the school before going on to their clinical settings.

The growth of health care simulation

Simulation has been around for health care students in a variety of fields for years, Seaton said, but it was usually for those looking to become certified as doctors. For nurses, simulation has been going strong for about 10 years, but the manikins were not nearly as complex as they are today.

“It depends on [the school’s] resources, how much they are able to provide … and the hospital because hospitals are able to train their staff using simulation,” Seaton said. 
Students start the program with the basics – how to provide outpatient assessments such as blood pressure, body temperatures and heart rates –  and progress to more complex situations, Seaton said.

Once they’ve mastered the basics, it’s on to the high-fidelity manikins – those that have computerized functions that can express pain, the sounds of lungs, bowels and the heart and simulate everything from vomiting to a seizure to childbirth and childbirth complications. The manikins have IVs in them complete with drains to provide realistic assessment details needed in a learning situation.

“We have a diversity. We like them to see the diversity not only culturally, gender, age and in the fidelity – the complexity of what the manikin can do,” Seaton said.

One manikin is named for Minnie Paxton, the supervisor for GWU’s nursing school in the 1920s. The school had to close during the Great Depression during her tenure.

Paxton is one of the manikins students see from the beginning, Seaton said, with the fundamentals all the way through their capstone experience before they go on to preceptorship – where students chose a nursing specialty and have one-on-one training with staff members in a real hospital setting.

Instructors sit in a control room and throw simulations at the students. For example, one student might believe their patient is taken care of, but instructors want to see how they act under stress. So they make the manikin’s blood pressure spike or simulate a heart attack.

“We’ll embed errors for them to find and to know that they should paying attention,” Seaton said.

Seaton, to check her students’ skills, will even sneak around and saturate a patient’s wound with fake blood to teach them to check dressings often.

The control rooms allow instructors to video tape the students in action and later replay the scenarios, pointing out mistakes that can be corrected.

Instructors will also live-stream to the classrooms so other students can see their peers’ performance.

Even at a simulated nursing station within the classrooms, students are watched from behind glass windows. Instructors want to see how students are utilizing their time, Seaton said.

The school runs a virtual hospital, where eight to nine students take care of their own manikin patients at a time.

Communication and home health care skills

Training goes beyond just knowing how to properly use medical equipment.

“A lot of it is also knowing how to communicate because communication is key in nursing as well. We’ll have them communicate with each other. We’ll have them phone as if they’re talking to physicians and learning how to provide essential details for effective care,” Seaton said.

Students also are exposed to community health settings where they evaluate a patient in a home setting.

“A lot of the trends in health care is to provide care in the home,” Seaton said. “It’s a very definite of the future.”

Health care professionals are seeing more patients in home settings because hospital stays are become shorter as medical expenses increase, said Billinda Tebbenhoff, assistant professor at GWU’s School of Nursing. Patients simply can’t afford to stay as long as they need to get complete care.

Mental health is also become more home-based, Tebbenhoff said, because many hospitals have shut down or provide only forensic beds.

“It’s amazing what people go home with … drains and IVs and medications and families are overwhelmed. I think nursing will see a huge push to community-based care,” she said. 
The school is looking also to begin a bridge program for military veterans that specialized in health care in the fall, Seaton said.

“Many of graduates are either EMTs, paramedics and they’re coming back. They may have a degree already, but they’re coming back for the BSN and to go forward even more for bachelor’s or doctorate degrees,” she said.

The biggest goal for the school, Seaton said, is to make sure students comfortable and ready for the workforce.

“The essences of where nursing education is is combining what they learn in the classroom, how they do in the experiential, the kind of learning they can’t necessarily get as frequently as they used to get in the hospitals many years ago,” Seaton said.

by Veronica Combs

There are about eight halls of exhibitors at the 2013 Consumer Electronics Show and I swear at least one of them was full of iPhone cases and nothing else. I just bought a Droid Razr and I hate the Otter Box that I bought with it, so I was quite disgusted that I couldn’t find an alternative in this sea of cases.

Anyway, there were several practical iPhone and iPad accessories at the show, mixed in with the Spider-Man and jeweled options. Here are three that would keep your Apple device safe no matter what job you have in healthcare:

LifeProof

This booth had several small stages with a chef, a firefighter, and a doctor — each one explaining the merits of this protector. It is a thin, polycarbonate frame that goes around the device.

It’s waterproof up to 6.6-feet deep for 30 minutes and keeps out dust. The nice part about the waterproof seal is that it goes around the edge of the screen, so you can still touch it directly. Water can touch the screen but not get inside the device or touch any of the plugs.

LifeProof also has two straps that seem perfect for a nurse or doctor. One fits diagonally across the back of the iPad and the other is a shoulder strap.

The Joy Factory

C-clamp Mount from The Joy Factory

This company also had a great case and an awesome accessory. To illustrate how strong the case is, people were shooting bean bags at it. If a dangling device suffered a direct hit, it splashed down into the tank beneath. Cool factor? The aXtion pro case floats. The case goes on sale in April.

The company also makes BubbleShield bags with a big ring at the top. They’re like stylish Ziploc bags for your iPhone — perfect for those days when you are canoeing down the river.

The accessory is a wheelchair mount for iPads and other tablets. The arm attaches with a C-clamp designed to fit around a tube or other curved surface. The tablet snaps into the protective hard-shell tray, which in turn screws to the mounting brackets. A magnet connects the tablet to the arm of the mount.

Barry Lieberman of Joy Factory said the company donated some of the mounts to soldiers at a VA hospital in Texas and that scientists in the spinal research lab at the University of California Irvine were using the mounts as well.

Joy Factory was recognized at the show as a 2013 Design and Engineering Awards honoree.

Nanotech protection

If you want an invisible cloak of protection, I found two options: one is available now, the other is still coming to America. For readers everywhere else in the world, you’re in luck.

Liquipel is the one you can get now. You can buy a device treated with this self-sealing
nanocoating that protects your phone if it falls into water. The entire phone — guts and all — is coated, so no more rice treatments if your phone falls into the toilet. Currently, you can buy Asus, Samsung, Motorola and HTC products as well as Apples.

DryWired is also a nanocoating, but it protects against bacteria and corrosion as well as water. The treatment has been applied to printed circuit boards, cellphones, tablets, medical electronics, aircraft foam, plastics and cloth without changing the look or feel of the product. That was the “oooo” demonstration at the booth: “Here, touch this tissue, feels normal, right? But look, it doesn’t disintegrate in water.”

DryWired licenses the technology from EuroPlamsa, a Belgian company. The Los Angeles company is working with manufacturers to get electronics and other components treated with the coating right in the factory.

By Dr. Sapna Parikh 

Video

NEW YORK (WABC) -- New technology is helping medical professionals learn from each other, even though they're 1,500 miles apart.

A patient has chills and a fever. Students at Columbia University School of Nursing discuss the diagnosis with their classmates. But they also talk to people in a little box--the medical team at a clinic in La Romana in the Dominican Republic.

Norma Hannigan said she got the idea while she was at the clinic last April. Why not discuss medical cases and learn from each other?

"We're a little stronger on the primary care chronic illness end of the spectrum, and they're much stronger on the infectious disease," Hannigan, an assistant professor of clinical nursing.

The students were presented a patient with diabetes and everyone had to figure out how they'd solve it together.

"The way we manage the case here versus the way they would manage the case in the Dominican Republic is very different," Stephanie Paine, a nurse practitioner student, explained.

It was surprising to learn, for example, they almost never do a test called Hemoglobin A1C. It's too expensive, but in the U.S., that test is done for diabetics all the time.

Students can also learn about cultural differences. In Washington Heights, many of the residents are from the Dominican Republic.

"It's a way to improve the way we treat patients," said Dr. Leonel Lerebours, the medical director of La Clinica de Familia in La Romana, Dominican Republic.

Lerebours says they have learned to work with fewer resources.

"We rely more on clinical features than lab," he said.

This is the first long distance webinar, but they say it won't be the last.

"Maybe incorporate more people from the school of public health from the school of medicine," Hannigan suggested.

"It's really good," Martha Yepes said. "We're able to have this exchange, especially with the technology that we have now."

There were, of course, some technical challenges; the connection was slow at times, and it's hard to capture excitement or enthusiasm when you're doing it over the web.

But there were also funny moments. Where what we consider a problem here, La Romana's medical team thinks it's normal.

By PAM BELLUCK

Published: October 8, 2012

“I thought I was going to see a regular doctor,” she said, but instead she saw “this giant screen.”

Suddenly, two doctors appeared on the video screen: dermatologists in Boston. A nurse in the room with Ms. Cohen held a magnifying camera to her face, and suggested she close her eyes.

Why? she wondered — then understood. The camera transmitted images of her face on screen, so the doctors could eyeball every bump and crater. “Oh my God, I thought I was going to cry,” Ms. Cohen recalled. “Even if you’ve never seen that pimple before, it’s there.”

That, she realized, was the point. Technology, like these cameras and screens, is making it affordable and effective for doctors to examine patients without actually being there.

More hospitals and medical practices are adopting these techniques, finding they save money and for some patients work as well as flesh-and-blood visits.

“There has been a shift in the belief that telemedicine can only be used for rural areas to a belief that it can be used anywhere,” said Dr. Peter Yellowlees, director of the health informatics program at the University of California, Davis, and a board member of the American Telemedicine Association. “Before, you had to make do with poor quality, or buy a very expensive system. Now, you can buy a $100 webcam and do high-quality videoconferencing.”

The technology is especially being embraced in professions like ophthalmology, psychiatry and dermatology, which face shortages of physicians. At Kaiser Permanente, dermatologists “sit in a suite in San Francisco” and tele-treat patients throughout Northern California, Dr. Yellowlees said. “It’s much more efficient than having 20 hospitals, each with a dermatologist.”

On Nantucket, an island 30 miles from the nearest spit of mainland, “telemedicine just makes a lot of sense,” said Dr. Margot Hartmann, chief executive officer of Nantucket Cottage Hospital. “It allows us to meet the mission of the hospital better because we’re offering more locally,” and saves patients the cost and time of flying or ferrying off-island, then driving to Cape Cod or Boston hospitals.

The island may be small, but it has strikingly diverse medical needs. Its year-round population of about 10,000 balloons to 50,000 in the summer. And while it is famous for wealthy visitors, its year-rounders are much less affluent. They include immigrants from many countries, and range from businesspeople to scallopers.

Nantucket has all the ailments one would find anywhere, plus some exacerbated by island life: skin cancer, tick diseases, water accidents.

“Most people are within an hour of some major hospital,” said Joanne Bushong, the hospital’s outpatient clinical coordinator. Not Nantucket. “We’re not practicing rural medicine; we’re practicing island medicine.”

Nantucket’s hospital has a handful of year-round doctors. While mainland specialists do visit, fog or storms can keep them from getting there. And specialists cost money. The hospital, millions in the red in recent years and now needing $60 million to replace its outmoded 1957 building, must pay for the specialists’ travel and lodging.

Telemedicine, done by doctors at Massachusetts General Hospital, saves some of those costs, and generates revenue because it means more tests are done on Nantucket. “If someone was going off-island to see a dermatologist, they would probably have their labs and X-rays done where that dermatologist was,” Dr. Hartmann said.

Instead, tele-dermatology saves nearly $29,000 a year because two dermatologists now visit only four times a year, but appear on screen six times a month and see 1,100 patients a year. Previously, dermatologists visited monthly, and always had “100 people on the waiting list,” Ms. Bushong said.

Nantucket also uses tele-radiology, having Boston radiologists, some specializing in certain body areas, read X-rays and scans. It has used tele-pediatrics twice, for a child in a car accident and one in diabetic crisis. Tele-stroke uses video neurologists to quickly determine if a patient’s stroke type warrants a clot-busting drug, tPA, or if tPA could harm the patient.

Tele-endocrinology, for thyroid problems and diabetes, is starting. And Nantucket hopes to have video sessions for autistic children “so parents would not have to take kids with autism off-island, since it’s hard to travel with them and it upsets them,” Ms. Bushong said.

Dr. Hartmann envisions tele-rheumatology and tele-psychiatry, among other teles. Instead of screens in one exam room and the emergency room, “I would love to see every room telemedicine-capable,” she said.

But there are limitations, nationally and on Nantucket. Dr. Yellowlees said interstate telemedicine was hindered by rules requiring that doctors be licensed in the state where patients are treated.

Insurance coverage varies, with Medicare and some policies covering telemedicine services only in rural areas. “If you’re in a city, Medicare will only reimburse if you’re in the same room as the doctor,” Dr. Yellowlees said.

And some telemedicine is not cost-saving or accepted by doctors on the receiving end. Memorial Hermann Hospital-Texas Medical Center in Houston ended a tele-I.C.U. program in which intensive care specialists monitored and assisted intensive care units at five other hospitals. It was expensive and not demonstrably better, and some doctors and nurses disliked being watched from afar, said Dr. Eric J. Thomas, associate dean for health care quality at University of Texas Medical School at Houston.

On Nantucket, Dr. Timothy J. Lepore, 67, a surgeon and the hospital’s medical director, sees value in some long-distance doctoring, but has some concerns. He especially prefers having a radiologist on-site because he believes that conferring in person helps prevent mistaken readings and gets quicker results.

Dr. Lepore said that one tele-radiologist misread a chest X-ray, missing that the patient had pulmonary edema, fluid in the lungs. And when Dr. Lepore injured a hamstring while running, a tele-radiologist said an M.R.I. showed Dr. Lepore had pulmonary edema of the hip, which was bizarre and impossible. His actual diagnosis: a torn hamstring.

Occasionally, Dr. Lepore said, “it just goes completely off the trolley.”

Dr. Efren Flores, a radiologist who divides time between Boston and Nantucket, said he has learned to heed Dr. Lepore’s insistence on fast, accurate tele-radiology readings because on Nantucket it is important to determine if patients can be treated there or must be flown to Boston.

Many patients appreciate that telemedicine saves them trips off-island, but not everyone likes it.

“There are some people who just flatly refuse, and I see them in person,” said Dr. Peter Schalock, one of the two Mass General dermatologists who treat Nantucketers remotely. He said he has had to get used to diagnosing without feeling a patient’s skin, relying on the nurse, Ms. Bushong, for that. “Somebody with 100 strange-looking moles, I can probably do in 10 or 15 minutes myself, when it might take half an hour with the camera. Definitely people with more interesting moles, I like to see myself.”

Still, “we’re pretty good at picking up what looks funky, to use a technical term,” Dr. Schalock said. “I really feel like we’re providing essentially the same quality care.”

So, in August Dr. Schalock remotely diagnosed eczema in Aaron Balazs, 35, but saw him in person in September and increased his medication dosage and switched him from a cream to pills.

Mr. Balazs, stationed on Nantucket with the Coast Guard, was not expecting video doctoring, and said initially “it was sort of awkward.” But he concluded “it’s definitely beneficial for both parties.”

By the time Ms. Cohen had her second session in August, this time with Dr. Schalock, she said, “I feel like it’s the same thing” as an in-person visit. She had accepted the mega-magnifying camera by then.

“It kind of freaks out some people,” Dr. Schalock said. “They say, ‘Oh my God, I should have shaved my legs!’ I’m not looking at the hair. I’m looking at the mole.”

ScienceDaily (Oct. 22, 2012) — Like cleaning the lenses of a foggy pair of glasses, scientists are now able to use a technique developed by UCLA researchers and their European colleagues to produce three-dimensional images of breast tissue that are two to three times sharper than those made using current CT scanners at hospitals. The technique also uses a lower dose of X-ray radiation than a mammogram.

Anyone who has been in the nursing field for an extended period of time will tell you that a lot has changed. In fact, the twentieth century brought – literally – a technological “invasion” to nursing. 

According to Kaplan Nursing, from small advances, like digital thermometers, to sophisticated strides, like laser surgery, health care as a whole has been on quite a rollercoaster - and nurses have been along for the ride.

Medical advancements and information technologies of the twentieth century have not only changed the face of the nursing – they have become part of the intricate fabric of the field. 

But what are the technologies responsible for this monumental transformation?

One nursing professional – and author of a site called The Nurse Lady- offers these 19 technologies that changed nursing forever.

1.Electronic IV monitors

There was a time when IVs had to be administered with a nurse’s constant attention to ensure a steady flow. Manual IVs were highly sensitive to a patient’s movement and the flow of the IV could be sped up or slowed to a crawl by a subtle movement. To prevent this, nurses had to directly administer an IV from beginning to start. With the advent of IV pump infusion and electronic monitoring, nurses are freed up to initiate an IV and allow a machine to monitor and regulate the process. If there is an error, the system tries to correct it, and otherwise contacts the nurse via remote monitoring.

2.The Sphygmomanometer

The sphygmomanometer is simply a fancy term for electronic blood pressure cuffs that also measure heart beat rate automatically. Gone are the days when a nurse had to measure blood pressure manually. According to one nurse, this is the technological change that makes the biggest daily difference.

3.Information management

As computer technologies become the primary means of managing patient information, nurses have had to adapt their record-keeping practices and increase their computer skills. Nursing informatics is a specialty that has emerged, combining IT skills and nursing science.

4.The portable defibrillator

Manual CPR can only do so much and for the longest time this was the only method available to many nurses for reviving someone’s heart. Now, even school nurses stand a fighting chance to save the life of a person whose heart has failed. The few minutes after heart failure are critical, and the portable defibrillator allows for immediate resuscitative action.

Sturdy, portable IT devices

Tablet computers and mobile wireless computer stations are now a standard part of the day-to-day methods of delivering care to patients. Charts are updated continuously, in real time, providing nurses with immediate access to essential patient information.

6.Readily accessible base of information

Wireless Internet connections quickly make reference materials available. This can prove very helpful for diagnosis, especially when using a resource like WebMD.

7.The sonogram/ultrasound

Ultrasound devices provide nurses working with pregnant patients the ability to see inside the womb. Ultrasound has been nothing short of revolutionary in the field of Women’s Health and pregnancy, allowing nurses and doctors to noninvasively identify the health of the baby throughout pregnancy. Now, with the advent of 4-D ultrasound, unprecedented detail is available for diagnosing fetal well-being. In addition to pregnancy monitoring, sonogram technology also offers many other new diagnostic advances such as the ability to easily identify cancer tumors in the bladder, and to tell whether the liver is enlarged.

8.Local wireless telephone networks

These systems significantly reduce communication delays. Not only is this type of communication technology being utilized between nursing staff, but also between patients and staff, changing the dynamics of the relationship between patients and their nurses.

9.Hands-free communication devices

Hands-free devices such as Vocera’s Call Badge provide the ultimate in communication while a nurse is engaged in active patient care or associated tasks.

10.Communications options

It is not uncommon for patients and nurses (and doctors) to communicate via e-mail or even web cam; a practice that is becoming common for parents of children in neo-natal intensive care units.

11.Patient remote monitoring

In addition to high-tech and ultra-sensitive vital signs monitoring equipment, web cams and other technologies make the close monitoring of multiple patients much easier, changing how environments are staffed and operated.

12.RFID technologies

RFID-enabled devices make monitoring hospital assets easier, ranging from drugs and equipment to records and patients. They also enhance safety and security with less effort and lower long-term cost.

13.Compact, portable medical devices

Combined with portable IT and communication equipment, these small, high-tech types of devices allow well-equipped nurses to take their skills on the road. They can travel to patients’ homes and treat conditions that once had to be treated on an in-patient basis.

Neo-natal nursing advancements

New, more affordable portable devices for the care of tinier and more health-compromised babies.

15.Drug management technologies

High-tech systems of medication retrieval and delivery, such as bar coding and verification, have greatly reduced the potential for dangerous error. Infusion equipment advances have made the delivery of slow-administer drugs much easier, with computerized machines able to control dosages and rates.

16.Configurable nursing environments

Configurable work spaces increases efficiency and safety, reduces stress, and prevents accidents and injuries.

17.Learning technologies

The availability of individual and off-site learning opportunities and degree programs, via specialized software and online classes, allows for more rapid career advancement.

18.Video conferencing

The ability to interact with nursing professionals throughout the world, through such means as video conferencing, offers advantages and opportunities like never before, both in terms of the further development of the nursing profession and the continued improvement in patient care outcomes.

19.The blogosphere 

Medical technologies have brought changes to the process of life and death and the role of the nurse. The Internet allows nurses to share their experiences and feelings. As technology transforms the profession, nurses adapt and change as well. The big question is: What will the rest of the twenty-first century bring?

By RICHARD PÉREZ-PEÑA

In just a few years, technology has revolutionized what it means to go to nursing school, in ways more basic — and less obvious to the patient — than learning how to use the latest medical equipment. Nursing schools use increasingly sophisticated mannequins to provide realistic but risk-free experience; in the online world Second Life, students’ avatars visit digital clinics to assess digital patients. But the most profound recent change is a move away from the profession’s dependence on committing vast amounts of information to memory. It is not that nurses need to know less, educators say, but that the amount of essential data has exploded.

“There are too many drugs now, too many interactions, too many tests, to memorize everything you would need to memorize,” says Ms. Eland, a specialist in uses of technology. “We can’t rely nearly as much as we used to on the staff knowing the right dose or the right timing.”

Five years ago, most American hospital wards still did not have electronic patient records, or Internet connections. Now, many provide that access with computers not just at a central nurse’s station but also at the patient’s bedside. The latest transition is to smartphones and tablet computers, which have become mandatory at some nursing schools.

“We have a certain set of apps that we want nursing students to have on their handheld devices — a book of lab tests, a database of drugs, even nursing textbooks,” says Helen R. Connors, executive director of the Kansas University Center for Health Informatics. Visiting alumni, she says, are shocked to see students not carrying physical textbooks to class.

But technology carries risks as well. So much data is available that students can get overwhelmed, and educators say that a growing part of their work is teaching how to retrieve information quickly and separate what is credible, relevant and up-to-date from what is not. (Hint: look for the seal of approval of Health on the Net.)

They also worry that students rely too much on digital tools at the expense of patient interaction and learning.“There’s a danger that having that technology at the point of care at the bedside creates a misperception that students don’t need to know their stuff,” says Jennifer Elison, chairwoman of the nursing department at Carroll College in Helena, Mont.

“I get worried when I hear about nursing programs that want to replace the person-to-person clinical experience with increased hours with simulation,” she says. “We hear sometimes that it feels to patients that the computers are more important than they are.”

Then there’s the patient privacy issue in the era of blogging, Facebook and Twitter. How to properly use social media has become standard in the curriculum, thanks in part to what is known in nursing circles as “the placenta incident.” Four nursing students at a community college in Kansas posted Facebook photos of themselves with a human placenta. The students were expelled in 2010, and later reinstated, but the episode showed how murky the boundaries of privacy and professionalism can be. The National Council of State Boards of Nursing recently published guidelines on social media.

“That is the new hot issue now,” Ms. Elison says. “That’s been hard, because this is a generation that immediately hits that send button.”

By Suvarna Sheth, Hcareers.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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