DiversityNursing Blog

By Debra Anscombe Wood, RN

While credentials may seem like an alphabet soup after one’s name, the letters tell the world much about a nurse’s qualifications, including licensure, certifications and fellowships.  

“Credentials are not only a source of pride for the nurse, but communicate to patients, colleagues and hospital leaders the nurse’s commitment to standards of excellence,” said Mary Frances Pate, PhD, RN, CNS, associate professor at the University of Portland School of Nursing in Oregon and chairwoman of the board of directors for AACN Certification Corporation, the certification organization for the American Association of Critical-Care Nurses.

Other academic nurses agree. “Credentials matter to the public,” said Rebecca M. Patton, MSN, RN, CNOR, FAAN, Lucy Jo Atkinson Scholar in Perioperative Nursing at Case Western Reserve University in Cleveland, adding that they also demonstrate growth and lifelong learning valuable to the nurse and to nurse managers and administrators.

Depending on the position, “some nursing positions require certification demonstrating expertise, and some do not,” said Robert Hanks, PhD, FNP-C, RNC, assistant professor and clinical/FNP track director at the University of Texas Health Science Center at Houston School of Nursing. 

Marianne Horahan, MBA, MPH, RN, CPHQ, director of certification services at the American Nurses Credentialing Center, reported an increase in certification applications this year, in part because of employers’ promotion of certification. A new “Success Pays” program allows the hospital to directly pay for successful exam completion. 

Employers also seek nurses with degrees, as evidence suggests organizations with a higher percentage of BSN- or MSN-prepared nurses have greater patient outcomes, said Paulette Heitmeyer, MSN/ED, RN, CNO at Marina Del Rey Hospital in California. 

Pate said nurses whose clinical skills and judgment have been validated through certification often make patient care decisions with greater confidence, recognize problems and intervene appropriately.

While many believe credentials lead to better care and patient outcomes, research is limited. The Institute of Medicine recently released a research agenda to help fill this gap. 

Nurses should list the highest degree first, immediately after their name, then licensure, any state designations, national certifications, awards, honors and other recognitions, according to the ANCC. 

“Certification provides a foundation for lifelong learning and professional development,” Horahan said. “The purpose of certification is to assure the public that this individual has mastered the body of knowledge and acquired skills in the specialty.”

Source: http://news.nurse.com

By Eun Kyung Kim

Even before she had a groom in mind, Katie Breland Hughes knew she wanted to walk down the aisle at her wedding on her own two feet.

It became one of her initial goals after a horrific car accident left her paralyzed from the waist down. But first, she needed to survive her injuries.

“Honestly, I had so many skin graft surgeries and so many burns, my first goal was just to sit up in the bed," said Hughes, now 27. "I was literally at rock bottom."

In October 2011, the Louisiana personal trainer and physical therapy assistant missed a stop sign while driving home from an appointment with a client. A truck hit her vehicle broadside, and Hughes went flying through her windshield. She landed in a ditch and, seconds later, her burning car landed on top of her, searing her back.

Conscious throughout the ordeal, Hughes knew she was either paralyzed or that her legs were amputated because she couldn’t feel either one.

“Immediately, I started asking myself all the physical therapy questions. Is my spinal cord severed? What kind of injury is this? How far up? How low down?” she recalled for TODAY.com. 

At the hospital, doctors told Hughes that she would never walk again. But during a nine-hour surgery to insert rods and plates along her spine to stabilize it, they learned that Hughes' spinal cord wasn’t severed as they originally thought. 

“That was all I needed to hear to keep pushing forward,” she said. “That was kind of my prayer.”

After her 100-day hospital stay, Hughes went home and immediately started training. An athlete all her life —she was supposed to run a marathon the week after her crash — exercise had always given Hughes an emotional outlet. After the accident, her love of exercise proved critical to her recovery, and to attaining the new goal she had created for herself.

“I told my sister from the beginning, I will not get married — whoever it be to, or whenever it happens — I will not do it until I can walk down the aisle. I just won’t be in a wheelchair,” she said. “So that was always a goal. I didn’t know the next year it would actually happen.”

Hughes heard about a Michigan trainer who had worked with other paraplegics. She reached out to him and flew to Michigan to begin training.

“The first time I talked to her on the telephone, she was like, ‘Look, I don’t want to be in this chair forever. I understand what happened to me, but I want to work hard and see where I can get,’” said Mike Barwis, a strength and conditioning coach who frequently works with Olympic and professional athletes. 

It was during a session with Barwis that Hughes moved her legs for the first time since the accident. 

Meanwhile, Hughes had reconnected with a former acquaintance, Odie Hughes. She initially worried about meeting him again now that she was in a wheelchair.

“I didn’t know how he would accept that, or how he would feel about that,” she recalled. “But it was like he never even saw the chair, he just saw me. He believed everything with me. If I told him, ‘I think I can do this. I want to try this,’ then he would be my biggest cheerleader.”

Within three months, they were engaged. Hughes started the clock: She had nine months to get on her feet. Barwis said he had no doubts they could make it happen.

“Katie is a vibrant person. She has an amazing personality and she’s very driven,” he said. “Her mentality has been one of absolute determination.”

But while working to build up the strength in her legs, Hughes also had to plan a wedding. She also opened a gym she started in her community of Bogalusa, about 70 miles north of New Orleans. 

There was also the issue of finding a wedding gown. 

“I actually bought three dresses. I didn’t like any of them,” she said. After getting ready to settle on one of them, she received a call from the cable network TLC, asking if she wanted to be featured on the show, “Say Yes to the Dress.” Hughes flew to the Atlanta bridal store featured on show (the episode airs Jan. 2) and finally found a gown she was happy with.

“Everything about it was perfect,” she said.

Except she never practiced walking in it until the day of her wedding. "I didn’t want anybody to see the real one," she explained. So instead, she practiced using one of the other gowns. She started in a full-body brace, then with a walker before moving on to two canes. Finally, she used two leg braces that went up from her feet to just above the knees, all while holding on to a person on each side of her.

On her wedding day, Sept. 20, Hughes walked down the aisle, on her own two feet, holding the hands of the two men giving her away: Her dad, who stood to her right, and Barwis, on her left. 

As excited as she was, Hughes said she never anticipated the nerves she experienced as she stared down the aisle at her guests.

“I felt like this was everybody’s fairytale ending. This was the story they had been following for so long and this was the ending they were waiting to see,” she said. “So I felt like there was a lot of pressure but there was no greater reward than getting to the end of that aisle, for sure.”

Waiting for her there with a huge smile was her fiance.

"When her foot caught that slip my heart stopped. But she just held it together like a champ," said Odie Hughes. "I had complete faith in her."

He said he never for a second doubted the woman he considers "the most stubborn person I know" 

"When she said she was gonna do it, it was a done deal," he said. "Never one doubt in my mind she'd not only make it down the aisle but she'd do it in dramatic fashion. That's my Katie." 

Months later, Katie is back at work, keeping busy with her physical therapy patients and running her gym, Katie's Shed, where she teaches various cardio and full-body workout classes.

She enjoys newlywed life and said it helps to have a partner who is familiar with life-altering injuries: Her husband once broke his neck during a car accident that left him with metal rods in his legs.

“Me and him both just really understand how quick this life is and how short it can be made,” she said. “We really value each other and the time we have together and with our family. We know first hand how quickly it can be taken from you, so we try to make the best of that.”

Hughes still uses her braces, alternating between them and her wheelchair, depending on the circumstances.

She speaks at local and regional events about her accident and hopes her story will inspire others to reach beyond traditional expectations.

“A lot of people would say, ‘Okay, I did it and now I’m going to be content with my progress right now.’ But I think contentment is our worst enemy a lot of times, just being content with where you are,” she said. “You should always try to excel forward and move forward and continue to reach goals and set new ones.”

Source: www.today.com

By LINDSAY CROUSE

When Paula Radcliffe won the New York City Marathon in 2007, nine months after giving birth to a daughter, Isla, Radcliffe was considered an anomaly. Her intense training through her pregnancy, which included twice-a-day sessions and grueling hill workouts, was scrutinized and criticized.

Seven years later, maintaining a top running career and a family has become relatively common. About a third of the women in the professional field of 31 for the New York City Marathon next Sunday have children.

“I watched Paula win New York, basically leading from the starting gun to the finish tape, and afterward she picked up her baby,” said Kara Goucher, a top American marathoner. “I realized I can do both. And I want to do both.”

Goucher, 36, finished third in the 2008 New York City Marathon, and this year she will run the New York race for the first time with her 4-year-old son, Colt, cheering her on.

When she contemplated having a child, Goucher engaged in the careful strategizing common to elite female athletes, who consider precisely when to become pregnant so as not to risk missing out on an Olympic medal or sacrificing a corporate sponsorship.

Elite female distance runners now run competitive times well into their late 30s. The average age of a top female marathoner is 30, and 19 women in next Sunday’s professional field are that age or older.

As athletic peaks for these top runners have overtaken fertility peaks, the decision to combine motherhood and training has become increasingly unavoidable. Competitive careers are stretching: The American Deena Kastor, expected to be another top finisher next Sunday, is 41.

“I always wanted to have a child,” Goucher said, “and I didn’t want to wait until I was done, because I don’t really see an end date on my career. I wanted more in my life than just running. But the details of how you do that can get incredibly complicated.”

Elite runners often try to squeeze in a pregnancy and recovery in the 16-month window between world track championships in years with no Summer Olympics. This is one such year, and pregnancies abound.

Maternity leave in professional running is rare. A pregnancy is still frequently treated as if it were an injury, and women can experience a pay cut or not be paid at all if they do not compete for six months. During that period, they often remain bound to sponsors in exclusive contracts that can last upward of six years. Because the athletes are independent contractors, they are not covered by laws that protect employed women in pregnancy.

Lauren Fleshman, an N.C.A.A. 5,000-meter champion and a professional runner, switched to a women’s-oriented sponsor, the running apparel company Oiselle, before having a son in June 2013.

Referring to Goucher and Radcliffe, Fleshman said: “Kara and Paula showed that pregnancy doesn’t necessarily need to be an impediment to the athletic part of our careers, and blew up the vestiges of the myth of the ‘fragile woman’ who can’t be both a top athlete and a mother. But in terms of your career, there’s still the feeling that if you say you want to have a kid, you’re saying you don’t want to be an athlete.”

It does not help that so many people seem to have an opinion on the matter. After Alysia Montaño, a 2012 Olympian, ran an 800-meter race in June during her eighth month of pregnancy, her decision became the subject of intense public scrutiny.

“I wanted to help clear up the stigma around women exercising during pregnancy, which baffled me,” Montaño said. “People sometimes act like being pregnant is a nine-month death sentence, like you should lie in bed all day. I wanted to be an example for women starting a family while continuing a career, whatever that might be. I was still surprised by how many people paid attention.”

Montaño’s daughter was born in August.

“Giving birth is a very athletic activity, like going through intervals on the track,” Montaño said. “Like contractions, intervals can start out easy and progress as they get harder. There’s sometimes a point where you wonder, ‘Can I do one more set?’ But you know you’re going to make it. And then you kick to the finish.”

Other women have chosen different paths.

Clara Horowitz Peterson, a former top runner at Duke, focused on starting a family in her mid-20s, aiming for a racing peak afterward. Now 30, she is pregnant with her fourth child.

“I think if I’d chosen to train at altitude and log 120-mile weeks, I could have made it to the Olympics,” said Peterson, who typically runs 80 to 90 miles a week when not pregnant. “But that comes with sacrifices; you put your career first, and before you know it, you’re 28, maybe confronting fertility issues. I always felt like having children was more important to me than a running career.”

Still, Peterson ran right up until the births of her first three children. She qualified for the 2012 United States Olympic marathon trials just four months after delivering her second child, and she logged a 2-hour-35-minute time at the race four months later.

“I trained hard through that pregnancy,” Peterson said. “You can tell when you’re pushing it. You get twingy, or feel tendons pulling, so I backed off when that happened.”

To bounce back for the trials, Peterson said, she breast-fed her second child for only five weeks — finding that the hormones related to breast-feeding made her feel sluggish — and dropped the 20 pounds she typically gained during pregnancy in eight weeks without dieting. (She breast-fed her third child for six months.)

The understanding of women’s physical resilience during and after pregnancy has also developed in recent years.

“We still don’t have good science to guide us,” said Dr. Aaron Baggish, associate director of the cardiovascular performance program at Massachusetts General Hospital in Boston, which counsels elite athletes through pregnancy. “But unequivocally I think women should exercise through pregnancy, both for their baby and their own health. The body has evolved that way. Your baseline fitness level is the best guideline: Elite athletes start out with a higher threshold, so they can do more.”

After athletes give birth, efforts to get back into shape are consuming, coupled with the usual adjustments to caring for an infant. Breast-feeding interrupts the sleep that heals spent muscles and restores energy to a tired body. Babies are often kept out of group day care to prevent them from bringing home illnesses that could compromise rigid training plans.

Pregnancy can be hard to combine with any job. As in other fields, partners are generally a key component of elite athletes’ ability to continue their careers after having children.

Edna Kiplagat, a 35-year-old Kenyan who is among the favorites in next Sunday’s race, had two children before becoming a two-time marathon world champion and the 2010 winner in New York.

Her husband and coach, Gilbert Koech, gave up his running career to focus on hers and manage their family, making breakfast for their five children, three of whom are adopted, and taking them to school while Kiplagat trains.

Goucher’s husband, Adam, retired from professional racing a year after their son’s birth and started a running-related business. He tries to balance supporting her racing career with managing his new one, saying that he and Kara work to share equally in caring for Colt.

“Kara’s putting her body through a lot right now,” her husband said, “and we need to do everything possible to alleviate the stress of training. When she needs to go out and run, or needs to rest and recover, that’s my first priority.”

Goucher said she was taking the trade-offs in stride.

“It’s scary because the fact is for all women when you have a child, you do need to drop out for a long time, and you don’t know how you’ll come back,” she said. “It’s a huge risk. Of course, I’m serious about my job, but in life I needed to be more than that. So I think it was worth it.”

Source: www.nytimes.com

By Stacey Burling

The nurses' emotional response to George's impending loss was a sign of the emotional power of narrative, which the National League for Nursing is harnessing to improve education about late-life medical problems. The group also is embracing a multimedia approach that includes the written word, audio recordings of the "patients" voiced by actors, simulations that include mannequins and live actors, and the latest addition: virtual animations of the patients and nurse avatars who make treatment decisions.

"Traditional-based teaching is really over for most of us," Elaine Tagliareni, the league's chief program officer, told the crowd of about 175 who had gathered for her group's Advancing Care Excellence for Seniors conference. The Independence Blue Cross Foundation is a sponsor. Using technology to improve care was a theme this year.

The nursing group wants to reach a new generation of students who are already accustomed to multimedia learning, may be taking classes online, and will work in a world where technology increasingly connects patients, doctors, and nurses who are not in the same room.

Medical and nursing schools have long used standardized patients: actors who portray certain medical conditions. Increasingly sophisticated mannequins have been playing a bigger role in medical education in recent years.

Drexel University's College of Nursing and Health Professions began using a virtual-patient program produced by Shadow Health last year. It is meant to reinforce classroom training. The University of Pennsylvania School of Nursing also is using a Shadow Health program to teach nurses how to take a health history and perform a physical exam.

Gregg Lipschik, director of life-support training and undergraduate curriculum at the Penn Medicine Clinical Simulation Center, said Penn sometimes uses a virtual program to review resuscitation techniques. It pairs computer simulation and mannequins to teach procedures such as bronchoscopies.

Lipschik said use of simulation had been growing since 1999, when an Institute of Medicine report recommended it to reduce medical errors and improve teamwork. "It's really boomed in the last few years," he said.

The nursing league began its Advancing Care program in 2009, Tagliareni said, because "care of older adults is not well integrated into nursing programs" even though 75 percent of the care nurses give is to people over 65. It's adding the new dementia cases to expand education on another neglected topic.

The patient profiles are purposely complicated - like real people - and they unfold over time in unpredictable ways. The death of George Palo's golden retriever is a calamity not only because George's grief adds to his thinking problems but because walking Max was a key way the man exercised and interacted with the outside world. The profiles are accompanied by teacher information.

Tagliareni said that the dementia patients may not end up in the virtual world but that other fictitious elderly characters like Millie Larsen and Red Yoder may be available this fall in the gamelike "vSim for Nursing" program developed by Wolters Kluwer Health of Philadelphia and Laerdal Medical.

An audience member said her students easily identified with the league's patients. "That's my Pop-Pop," one of them told her.

The group at the meeting saw a younger virtual patient named Stan and his virtual nurse, Dan. Stan had gone to the emergency room with stomach pain from a bowel obstruction. The student, who had access to test information and doctor's orders, had to use a menu of options to decide what Dan should say and do. The animation was primitive, but the decisions were complex. At the end of their 30-minute encounter, the student received a number score and a report on what had been done and should have been done.

Barbara McLaughlin, head of nursing at Community College of Philadelphia, did a pilot test of vSim, which costs $100 per student for two years of access, with her students last year. "They liked them [the scenarios] a lot because it gave them the opportunity to do the same experience over and over and correct their mistakes," she said.

Source: philly.com

By Madison Lozano

Sgt. Angela Hughes was always interested in nursing, but wasn’t up to the role right out of high school.

Instead, she entered the Army as a supply soldier. Though she loved her job, after 15 years, Hughes developed carpal tunnel syndrome and was moved to Fort Hood’s Warrior Transition Brigade to prepare to leave military service.

Hughes is one of several soldiers taking part in a new brigade program to earn nurse’s aide certifications before they transition out of the Army.

The Gateway program runs in coordination with Skillpoint Alliance, an Austin-based nonprofit that provides training and education to job seekers. This is the first time Skillpoint has worked in the Fort Hood area.

On Monday, four brigade soldiers trained at the Hill Country Nursing and Rehab facility in Copperas Cove. The center is where they spent 40 hands-on clinical hours, in addition to the 60 classroom hours needed to earn the certification. The group will graduate from the program on Friday.

“It’s a great opportunity for soldiers who are transitioning ... at no cost to them,” said Anthony Thomas, the brigade transition coordinator. He was contacted by Skillpoint and served as a liaison between the brigade and the nonprofit.

“We try to accommodate soldiers’ career goals through job fairs and workshops,” he said, but this program is the first of its kind for the brigade.

Bethany Paul, Skillpoint’s Gateway program coordinator, worked directly with the students during the four-week training period.

“My job is to get them graduated and employed,” she said. Her organization has an 80 percent employment rate within the first 30 days after students graduate from the program.

Paul’s role required her to select the students and track them throughout the program to ensure successful completion.

“We love being able to serve this population,” she said. “I’m excited to be able to give back.”

Skillpoint also offers mock interviews, resume support and networking opportunities, Paul said.

The brigade soldiers have been pleased with the outcome of the program.

“At the beginning, I was disappointed,” Hughes said of leaving the Army. But now that she’s had time to accept the idea, she is excited to move on and work in nursing.

The patients have been her biggest joy of working at the rehab center.

“The residents are great to be with,” she said. “It’s always something new every day.”

Hughes will exit the Army in May 2014 and is looking forward to spending more time with her three children. “Things slow down a bit when you get out,” she said. She’s glad her post-military life will still require interaction with people on a daily basis.

Resident Eva Xindaris loved working with the brigade soldiers.

“They’re very thorough,” she said. “They’re not rushing.” Though Xindaris is sad to see them go, she knows there will be more in the future.

For Staff Sgt. Jennifer Adams-Ward, working in the facility has been a pleasure.

“It’s a joy to see me put a smile on someone’s face,” she said. She loves to help people, and the residents at the Hill Country Rehab Center have treated her well. “I enjoy learning the story of them and what they’re done in their lives,” she said.

Adams-Ward’s path differs from her fellow classmates. She will not be transitioning out of the Army. She is a medic, currently serving as the medical noncommissioned officer of the brigade’s 1st Battalion. Earning her nurse’s aide certification is one step towards becoming a registered nurse and an Army officer.

At this time, the brigade and Skillpoint are offering an electrician apprenticeship program too. Thomas hopes to add more options in the coming year. The Gateway program is also open to spouses and dependents.

“It’s been very successful,” Thomas said. “I appreciate the fact that they’re giving soldiers this (chance).”

Source: Fort Hood Herald

by Mark Downey

One of the questions that I frequently ask my students is, “Do you need to care to be a great nurse?” It’s always interesting to read the expressions on their faces and imagine what they must be thinking, because for the majority of my students it is the wanting to be a nurse and all that it entails that is a motivating factor in studying for their nursing degree.

From “Is he trying to trick me?” to “My teacher is an idiot!”, I can see the cogs and wheels ticking over in their brains. More often than not, I don’t give them an opportunity to answer. Instead, I tell them, “You don’t have to care about people to be a nurse. I consider myself an excellent nurse, but I’m not paid to care”.

Reactions to this vary. The two most common being dumbstruck, tongue tied and not knowing quite what to say or alternatively the hairs on the back of the neck bristle and I am challenged (often quite vigorously). Rarely, if ever, does anyone agree with me.

Let me explain with an example. If you’re a patient in an Accident and Emergency Room or perhaps lying unconscious in an Intensive care bed or on an operating table, is it really going to matter if the nurse gives two hoots about caring for you? Of course not! What is important is that the nurse is clinically competent and understands your health requirements so that every opportunity is afforded in generating a positive health outcome.

A steam train driver doesn’t have to care about his train to drive it, but he does need to understand how it works. As long as the gauges stay within the safe zones and coal is regularly fed to help generate steam to drive the engine, it doesn’t matter if he cares about the train or not. In fact, regardless of his care factor, the end result will never vary as long as he is good at his job. To be a good and great nurse is to know how to do your job right. I know everyone will agree.

Isn’t a nurse just like the train driver? Health outcomes will always be the same regardless of how much caring the nurse gives. It all boils down to the nurse trainings and the skills they have developed and how they are implemented. Nothing more, nothing less. A Cardiac Nurse needs to know about your heart, how it works, what the ECG squiggles mean and what the drugs that have been prescribed for you are going to do, but they don’t need to know your hearts desires or what’s in your heart. Isn’t that the job of the Chaplain?

Another important point is not to confuse advocating for the patient with caring. Advocacy is mandatory if the nurse’s training and experience lead them to believe that an alternative option may deliver a better health outcome for the patient. But really you don’t have to care to advocate as it’s just part of being a good nurse.

My argument is further proven when you consider the nursing process. Although it comes in many forms and guises, it is essentially:

• Assess the situation.
   
• Planning a course of action.
   
• Implement that action plan.
   
• Review the effectiveness of the plan and when necessary returning to step 1 and repeating. 

Nowhere, I repeat, nowhere, in any of the literature I have read, have I ever seen or mentioned that caring was required as part of the nursing process.

So do nurses care about their patients? Of course they do! Don’t be a goose! For the vast majority it’s an integral part of what makes them who they are. Nurses are looking after people, not machines. So, do I care for the people that I look after? I do and with a passion, but I don’t have to and, if couldn’t care for people, I couldn’t do my job.

Earlier on in this post I made the comment “I consider myself to be a great nurse, but I’m not paid to care.” This, I hold, as an absolute truth. When I am nursing, I am not paid to care.  You cannot pay me to care. I will not accept money to care! I choose to care because I want to care and you get that for free.

Source: NurseTogether

Dozens of teachers and health care providers went back to the classroom recently. They attended the I-pad Institute at the University of Cincinnati. 

Local 12's Liz Bonis got to sit in and learn a few things too. From the letter you get by email when you are accepted to nursing school, to no more paper in the classroom. The first thing I learned at the I-pad Institute is that going I- Tech, is likely a heartbeat away from a health care setting near you!

For health care providers or in this case, nurses in training. "We are helping them learn how to use the technology to deliver safe patient care," says Robin Wagner, assistant professor.

Robin Wagner, a nursing instructor, says for example, even if you are sitting here, with the help of iPad learning, you can virtually go inside the doctors office and when it comes to giving hands on care, such as taking a blood pressure, not only can you see how in here, you can see what's happening in the body on this virtual organ because, believe it or not, there's an app for that! "They can actually see what the hearts doing and in the past we would have just described that, this valve opens this one closes. Now, they can actually see that," says Wagner. 

The really exciting part of all this however, is not just what happens here in the teaching and learning environment, it is what happens when you take that to the next level. Perhaps with robotics? In this I-Tech learning lab for students and staff, I got to observe just a few weeks ago, I met Flo-Bot. "They are going to be using the iPad to control Flo-Bot, our robot, so it has an app that will allow the students to drive the interaction with patients," says Chris Edwards. 

As Chris Edwards explains, Flo-Bot is designed for health care providers to be able to better diagnose and assist patients, even at a distance if needed.  

Please view the video in the below link.

Source: Local 12 Cincinnati (Video Available Here)

By Karren L. Johnson

After a nearly 15-year journey — which included raising three children and working full time as a registered nurse -- Terra Brown of Susquehanna Township is just months away from completing her bachelor’s of science degree in nursing.

“It took a lot of hard work but it was worth it,” said the 42-year-old Brown, who works at Penn State Hershey Heart and Vascular Institute in Lower Paxton Township and entered the nursing field with an associate’s degree. “It feels good to know I improved both my knowledge and myself.”

Brown said she wants to teach other nurses and plans to go on to earn a master’s in nursing.

According to a recent survey by the American Association of Colleges of Nursing, Brown isn't alone in her pursuit to further her nursing education. The number of students enrolled in baccalaureate degree completion programs — also known as RN to BSN programs — increased by 13.4 percent from 2010 to 2011, the study found. Master’s programs reported a 7.6 percent jump in enrollments in 2011.

For current nurses and those looking to enter the field, the future looks bright. A 26 percent increase in the demand for new nurses is expected between 2010 and 2020, equating to 711,900 new jobs, according to the U.S. Bureau of Labor Statistics.

“A driving force behind this increase in BSN enrollment is the Institute of Medicine’s “The Future of Nursing” report that calls for the number of nurses who hold BSNs to increase to 80 percent by 2020,” said Betsy Snook, a registered nurse and the CEO of the Pennsylvania State Nursing Association.

“To meet this goal, which will help meet the needs of our growing population and more complex health care environment, there has been a trend among hospitals to require nurses to complete a BSN degree or higher,” Snook said.

While this goal does take a certain amount of initiative from nurses, it isn’t on them alone to achieve, Snook said. It also requires the support from employers and organizations such as PSNA, as well as education institutions, to help nurses achieve a higher level of education and training.

A choice to advance

Armed with a BSN from York College of Pennsylvania, Patricia Himes was excited to begin providing care to people. She joined the staff of a local hospital where she worked as a charge nurse for about six years. While she loved her job, she found herself curious about opportunities for growth.

“I’ve always had an urge to learn more and do more,” said Himes, who had heard there was a growing need for certified nurse practitioners.

As a result, she went back to school while working full time, receiving a master’s degree and her nurse practitioner training from Widener University’s Harrisburg campus.

“We are seeing a very large growth in nurses seeking advanced degrees, particularly as nurse practitioners,” said Geraldine M. Budd, assistant dean in Widener University School of Nursing’s Harrisburg campus. Budd said nurse practitioners provide most of the same services as physicians, making them especially important for practices and hospitals in disadvantaged areas without many physicians.

For now, Himes wants to just continue her overall growth and development while working for PinnacleHealth FamilyCare in Lower Paxton Township. But she said she definitely sees herself getting a doctor of nursing practice down in the future.

Nurses who do get additional training will find themselves in demand.

“With many of the highest trained nurses in the teaching arena reaching retirement age, there is also going to be a real need for qualified nurses to step into roles as nurse educators,” Budd adds.

Enhanced educational programs

Among the BSN to RN programs seeing a surge in enrollment is the one offered by Penn State Harrisburg. The school has seen enrollment increase by 25 percent between 2011 and 2012, said Melissa Snyder, coordinator for the nursing bachelor’s program.

“To best meet the needs of our students, we offer an evening format, a hybrid format, which is a combination of online and face-to-face classes and periodic all-day formats,” Snyder said. “We also ensure that nurses are graduating with solid skills in leadership, critical thinking and research, all things that employers are looking for.”

While enrollment in its BSN programs has increased, Penn State recently announced that it is phasing out all of its associate nursing programs and transitioning them to four-year baccalaureate programs, Snyder said.

Some community colleges are finding other ways to appeal to students who want more than an associate degree. For example, Harrisburg Area Community Collegerecently created a dual admission partnership with Millersville University to keep their graduates competitive and to provide a seamless transition into a bachelor’s program.

“We have always been very clear with our students that an associate degree is not an end point and we encourage they should seek further education,” said Ron Rebuck, director of nursing at HACC’s Harrisburg Campus. “The trend that I’m seeing is that by the time our nursing students graduate, a majority of them are already enrolled in a BSN program.”

Ever since Jeremy Whitmer graduated from high school just over 10 years ago, he has made it his personal mission to advance his nursing career. Despite being deployed to Iraq with the National Guard, he was still able to earn an associate’s degree, as well as a BSN degree thanks to HACC’s dual admission program.

“It was the perfect route for me because it provided a lot of flexibility,” said Whitmer, who is now working in Holy Spirit Hospital’s cardiovascular operating room. “I feel that having a BSN degree has given me many more leadership opportunities, as well as critical thinking and time management skills that I apply to my job every day.”

Support from employers

Having recently applied for magnet status, a designation awarded by the American Nurses Association that denotes nursing excellence, Holy Spirit Health System takes pride in being in full support of helping its nurses reach a higher level of education, said Brenda Brown, director of human resources.

“We know there are a lot of great nurses coming out of associate programs,” Brown said. “When we see such a nurse who exemplifies our values, we will support them in completing their BSN within four years of their hire.”

In addition, Holy Spirit offers a tuition reimbursement and an RN scholarship program, as well as an education loan repayment program. It also pays for all certifications. Currently, 42 percent of the hospital’s nurses either have bachelor’s or master’s degrees in nursing, she said. There are currently 88 nurses enrolled in bachelor’s programs and 27 are working toward their master’s in nursing, she said.

Sherry Kwater, chief nursing officer for the Penn State Milton S. Hershey Medical Center, said 57 percent of the center’s more than 1,800 nurses have a BSN. She said many have advanced their education while working at the center, which is a magnet facility.

“At Penn State Hershey Medical Center, we have so many specialty patients who require nurses with a body of knowledge around that patient population,” Kwater said. “Education is our mission here, so we migrate towards hiring nurses who are educators or specialists with a focus in a specific area. This also helps raise the skill of the bedside nurse.”

 Himes, the nurse with PinnacleHealth, credits the support from her coworkers for enabling her to grow and gain increased confidence in her field.

“The physicians are very supportive and very willing to teach me how to do things that I’ve never done before or that I’m insecure about,” she said. “I couldn’t be happier about my career path. It’s been a great testament of how the field of nursing is growing and that the opportunities are endless."

Source: The Patriot News

By Georgann Yara

Clad in pajamas and a Diamondbacks cap, the “patient” lay still in the bed as Banner Health registered nurse Stacey Fuller looked on and answered questions from an inquisitive mother worried about her son’s asthma attack.

Fuller determined her “patient” displayed good vital signs — even without a heart, brain and other functioning organs.

A recent nursing school graduate, Fuller was interacting with one of 80 high-tech mannequins at the Banner Simulation Medical Center in Mesa, where some 1,500 registered nurses train a few days annually.

The mannequins give nurses the chance to practice their skills in a real-time setting before working at one of Banner’s medical centers because they simulate breathing, bleeding, giving birth and even speaking.

“At first, it’s odd having these pretend conversations. But you get used to it and you get to practice conversations that you would actually have with patients and their parents,” said Fuller, whose specialty is pediatrics. “I like to talk to people and explain things, so I think it’s a lot of fun.”

The 55,000-square-foot facility is among the largest in the world and gives new hires an opportunity to work out the kinks and adjust to any policies and procedures specific to Banner. The Mesa location is one of Banner’s two simulation centers in the Valley. The other is in central Phoenix.

The center has many of the same departments found in an actual hospital, such as an intensive-care unit, operating room, emergency department and pediatrics.

Recently, the simulation program received accreditation from the Society for Simulation in Healthcare in five areas of expertise, becoming one of three organizations in the world to achieve this status. Last year, the program was accredited by the American College of Surgeons.

Being placed in real scenarios has given Fuller a better idea of her strengths, like patient interaction, and areas she needs to work on, like time management.

“I’m practicing getting the timing down,” Fuller said. “What I like is that Banner hones their nurses’ education and is supportive of that. Other places don’t do that.”

As Fuller made her rounds, registered nurse and simulation specialist Vickie Hawkins sat in a control room in the pediatrics department. Here, she can watch nurses interact with patients and evaluate their performance. Nurses have the opportunity to see themselves at work by viewing the videos.

Hawkins also plays multiple roles, depending on the scenario. With Fuller’s asthma patient, she was the voice of the mother. In other situations she can play the patient or physician.

The simulation center gives new graduates the chance to function independently — a luxury that they typically don’t get to experience in training, Hawkins said. It also gives veteran nurses new to Banner exposure to situations that they may not have experienced despite their years in the field.

“We allow them to make decisions and mistakes because, unfortunately, mistakes are how we learn,” said Hawkins, who has worked at the center since it opened in 2009.

However, nurses aren’t the only ones gaining knowledge. Simulation director Karen Josey described a scenario that simulated post-labor hemorrhaging. It required taking a mannequin to Banner Gateway Medical Center in Gilbert and putting everyone involved, including representatives from the local blood bank, through the paces.

A few days later, doctors at Gateway repeated that scenario. But this time, it was for real.

“Everyone knew exactly what they had to do and they could do it quickly because they had just gone through it,” Josey said.

The training center is a far cry from when Josey, as a registered nurse in training years ago, practiced inserting IV’s by using oranges.

“We immerse them in a clinical environment so they get that complexity,” Josey said. “It’s about how realistic we can make it.”

Source: AZ Central

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.