Archive for August, 2008

Retention of Staff is One of the Biggest Challenges for Nurses

Posted in Nursing, Nursing Jobs, Uncategorized

Retention of Staff is One of the Biggest Challenges for Nurses

Nursing is one of the most versatile professions, and yet if you ask a disgruntled nurse why s/he is thinking about leaving nursing instead of changing specialties, the answer will more than likely be that s/he feels stuck.

In the midst of a severe nursing shortage, retention is one of the biggest challenges the nursing profession faces. In 2000, for example, it is estimated that 500,000 nurses in the U.S. were not working as nurses. They were either staying home raising children or working in other fields such as real estate, retail sales and education. If all of those nurses had been working as nurses, there would have been no shortage of nurses.

The advent of managed care in the nineties brought about so many drastic cuts and changes that resulted in some of the worst working conditions for nurses in the history of the profession.

Studies proving high nurse-to-patient ratios negatively impact patient safety and outcomes also helped convince insurance companies and facility administrators that work conditions had to improve. The unionization of the nursing workforce, helped to improve many of these situations, but much more has yet to be done.

Now Medicare has implemented stringent rules for not paying for additional patient expenses related to specific medical errors. This should be driving the point home even further that nurses need better working conditions if the quality of patient care is to improve.

The financial downturn in the past couple of years has brought many nurses back into the field, but with a shortage of over 800,000 nurses in the U.S. being predicted by 2020, retention of nurses is more important than ever.

Helping nurses to transition to new fields when they are burned out or no longer physically or emotionally capable of working in a particular area is one of the ways we can and must work to help to solve the nursing shortage.

Using older, retiring nurses as mentors for new nurses for example will keep the masses of Baby Boomers ready to retire from leaving the profession all together. The valuable resources from the wealth of knowledge and experience these nurses have to share should not be lost.

Most new grad nurses are encouraged to spend a year in basic med/surg nursing before seeking out a specialty. This helps to provide them with a broad background of experience and confidence in their skills.

However, in recent years, many more nurses have chosen (and been allowed) to go straight into a specialty. This can be very stressful for the new grad, but many times they would prefer the stress to being “bored” with a more mundane experience. A few years down the road they may live to regret this decision. More often than not, these nurses seem to be the ones who feel stuck because they are too specialized.

Some specialties naturally lend themselves to others better than others, but if you want out of the high stress of the ICU, moving into the ER isn’t necessarily going to reduce your stress. The hospital may only allow this transition however because of the skill levels involved. They may frown on losing such a technically skilled nurse to the Labor and Delivery team. And so instead of retaining the nurse, s/he decides to move on or leave nursing all together in order to reduce the amount of job related stress.

Stress is relevant, and each field of nursing has varying levels of stress. Being able to transition to another department, or to move into another field such as public health, home health or forensic nursing can afford nurses the opportunity to remain a nurse, while making the lifestyle changes necessary for their own physical and emotional health.

The nursing profession has to learn not only to think, but to live, outside the box in order to retain the nursing workforce we have as well as to attract new nurses to the profession.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and is the author/owner of

Nursing School Admission Requirements

Posted in Nursing, Uncategorized

Nursing School Admission Requirements

Many nursing programs require an essay on why you want to become a nurse as part of their admission requirements. Each of the requirements is scored or carries a weight which, when combined with the other requirements, will determine whether or not you get into the program, get put on the waiting list, or rejected all together. You will want your essay to stand out. Don’t just say “because I want to help people.”

Altruism is an inherent characteristic for nurses. Everyone wants to help people, and there are thousands of other jobs where you can “help people.” Don’t state the obvious.

Be creative. Was there a nurse who influenced your decision? What about that person impressed you and why? Did you learn how to give your father insulin shots? Were you a primary caregiver for your grandmother? Are you interested in research? Would you like to become a nurse educator? Do you have a desire to learn about juvenile diabetes and teach children how to control their disease? Do you have experience in the health field and are looking to expand your role?

Your essay should reflect your desire to become a nurse and to meet the challenges of the profession. Nursing is not an easy job. It is physically and emotionally exhausting. Are you sure you can do this? Tell them why you are sure. Your essay may mean the difference between getting in or being rejected.
The nursing shortage has impacted nursing schools. There is a shortage of nurse educators which means that nursing schools have a finite number of spaces for students. This often means nursing schools have long waiting lists and many qualified students are turned away each term.

The nursing shortage creates a sort of Catch-22 situation for nurse educators. Simple economics means that to meet demands, hospitals and other employers have increased salaries and benefits for nurses far above what most schools are able to pay nurse educators. Consequently, nurse educators are hard to find and to retain and schools have to turn away students.

In order to improve the process of selecting students, many schools have instituted various additional entrance requirements such as an essay. Other requirements may include specific nursing entrance exams, and previous health care experience.

Schools have found that the success rate for nursing students is enhanced when they have some previous health care experience such as becoming a CNA, working as a medical assistant or volunteering in a hospital or clinic setting.

Entrance exams which test reading and language skills as well as math and science preparation are also good indicators as to which students will stick it out, graduate and successfully pass the NCLEX.
The entrance essay gives nursing students the opportunity to seriously consider why they want to become nurses and to express this desire.

Gaining entrance into a nursing program can prove to be a competitive experience. Understanding why you want to become a nurse and being able to express that reason may be one of the most important steps you will take.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the author/owner of

Joint Commission Certification and The Partnership of Two Industry Leaders

Posted in Travel Nursing

Welcome to the first edition of truNews, an online column dedicated to keeping you in the know about one of the most competitive firms in the healthcare staffing industry, trustaff! As one of top 500 fastest growing companies in the country today, trustaff is constantly improving to offer the best service and positions to our clients.

In April of this year, trustaff was awarded the Gold Seal for Healthcare Staffing Service from the Joint Commission ( This prestigious accolade is currently held by only twelve staffing companies in Ohio, a total of 176 companies nationwide, and shows that trustaff complies with the standards and guidelines set by the Joint Commission that ensure the healthcare staffing industry provides the best service possible. Recertification will be completed every two years via unannounced visits to ensure our continuing compliance with the Joint Commission.

We have recently moved! Our new facilities are located at 4270 Glendale Milford Road in Blue Ash, Ohio and feature the latest technological amenities helping us to better serve our clients. This facility places all of our divisions and departments together with much more room to continue expanding as one of the fastest growing companies in the country.

As a new part of the move into the new facilities, trustaff would like to extend a warm welcome to FirstCall who will be joining us at our new Glendale Milford location! FirstCall is a well established firm with more than twelve years in the industry and several large local clients. We are all looking forward to continuing the excellence of both FirstCall and trustaff as we serve all of our local and national clients.

Are You Ready for an Online Course?

Posted in Nursing, Uncategorized

Are you ready for an online course?

Online education is a popular alternative to traditional learning. In some instances, a few on-campus sessions are required for various reasons such as an orientation, exams, or labs. For the most part, however, online programs are conducted strictly online. This affords students from all over the country or world to take a particular class in the same time period.

Not all classes or subjects lend themselves easily to an online opportunity. Much of the basic nursing education process does not. Theoretically you can learn how to give an injection, insert a Foley catheter, start an IV line, and perform a head to toe assessment from written and audiovisual materials. Would you want that nurse to start your IV?

In some instances, a video which can be played over and over may indeed be one of the best learning opportunities. However, the boards of nursing have established rules to protect the public which state that to become a nurse, the student must participate in a set number of hours of hands-on learning under the direct supervision of a qualified nurse educator.

In the future, perhaps more of the nursing theory classes will be available online and afford schools to accept more students into their programs by using their nurse educators to conduct more clinical education opportunities. Currently, online nursing programs are reserved for those advancing their education. Non-nurses must take on-campus nursing classes to become nurses.

Are you ready for online learning? Do you meet the criteria to make a good student? Here are a few things you need to consider. You may find you need to work on some in order to better prepare yourself.

  • Are you a self-starter?
  • Can you organize your life and use your time wisely?
  • Can you work independently?
  • Do you often complete tasks before they are due?
  • Are you able to figure out instructions on your own or with a little help?
  • When reading something, are you a quick reader and able to grasp concepts and meaning easily?
  • Can you work with others you have never met or don’t ever see in person?

If you require a great deal of motivation from others to get you started you may not be ready to successfully complete an online class. If you need multiple reminders or are one to procrastinate until the last minute, an online class may not be good for you either.

If you’re a social butterfly and need interactions with others to flourish, the isolation of an online class may not work well for you.

For those who are slow readers and need help to understand the concepts, an online class may not be well suited for you. And if you have to interact with others face to face, then an online learning environment will not work well either.

Online education offers students the opportunity to study at their own pace and “attend” classes in their own time frame. You can sit at you computer at 1 AM in your pajamas and take an exam, or watch or listen to a lecture. You can email your study group or group project members who may scattered all over the world and not awaken anyone.

But you do have to be motivated to sit down and focus for a set period of time. It can be easy to get distracted by friends and family, television, phone calls, etc. It isn’t like going off to class and sitting there until the bell rings.

If you think you’re ready to engage in an online learning experience to further your nursing education and career, there are many opportunities available ranging from continuing education courses, certificate programs to advanced degrees.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book, and owner/author of

Patient Safety Threatened by Unprofessional Behavior

Posted in Nursing, Uncategorized

Patient Safety Threatened by Unprofessional Behavior

JCAHO (Joint Commission) has issued a Sentinel Alert based on findings that rude behavior undermines patient safety. The alert is an effort to change attitudes and promote safety by educating all health care professionals about the consequences and effects of their behavior with other health care professionals and with patients.

As of January 1, 2009, all JCAHO accredited facilities will be required to take action to create a code of conduct and establish a process for educating staff as well as identifying and managing unacceptable behaviors with a “zero tolerance” policy.

Accredited organizations will need to establish an education process to help health care professionals understand that although historically there has been a culture of tolerance of intimidating and disruptive behavior that this can no longer be.

According to JCAHO, these “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”

Intimidation and disruptive behaviors includes:

  • Verbal outbursts and physical threats
  • Passive/aggressive behaviors such as refusing to perform assigned tasks or subtly exhibiting an uncooperative attitude during routine tasks
  • Refusal or reluctance to answer questions, return phone calls or pages
  • Using a condescending tone or verbiage
  • Showing an impatience with questions

Research conducted with physicians and nurses has revealed that this behavior is not rare and that administrators, pharmacists, support staff and therapists are also widely involved in demonstrating such behaviors. Furthermore, the problem is not limited to a small number who habitually exhibit such behavior. The fact that the behavior has not been stopped has eroded the professionalism across the board. This is a big factor in why nurses leave nursing.

Other factors such as fatigue, pressures from cost containment requirements and the need for improved productivity, fear of litigation, as well as highly emotional situations often contribute to these behaviors.

A survey conducted by the Institute for Safe Medication Practices found that 40% of clinicians admitted having remained quiet about or during an intimidating or disruptive episode rather than confront the offender.

All too often the offender is in a position of power. The behavior is never reported and therefore never addressed because of a fear of reprisal or of the stigma of being a “whistle blower.”

Most nurses, physicians, therapists and other health care professionals entered the field for altruistic reasons. They have a strong desire to care for and help others. Most conduct themselves in a professional manner. Those who don’t, are eroding the professionalism and creating an unhealthy and often hostile environment.

According to the JCAHO alert, individuals who exhibit immaturity, self-centeredness or defensiveness are most often guilty of these intimidating or disruptive behaviors. They often lack coping, interpersonal and conflict management skills. Staff education can help set the standards and improve these skills.

The alert further states that it is the behavior which threatens patient safety and not the person engaging in the behavior. This is an important point for all to remember. Behavior and skills can be modified.

In the interest of patient safety, JCAHO has issued the new requirements for January, 2009. These new mandates for educating staff, and reporting and addressing behaviors should help to remove the stigma and improve working conditions.

For further information see:

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book, and is the owner/author of

Writing For Ultimate Nurse

Posted in Uncategorized

Thank you for your interest in writing for UltimateNurse.Com!

I have to be honest I am a bit overwhelmed by the number of responses we have received so far.  We have had over 750 responses to date.  We are accepting submissions on just about any topic relative to the field of nursing however due to the sheer volume of responses to our inquiry we must limit the number of contributors.  Do not let this deter you however, and if you are not approved by our editor you are more than welcome to showcase your writing skills on our posting forums and reference them for future consideration.  Additionally, we will be looking to add more forum moderators in the next 30 days if you would be interested in one of those positions.

I have hired an editor to assist with the application process.  If your application is accepted we will be in contact with you as soon as possible, however please allow up to 4 weeks for us to process your submission.  It shouldn’t take that long, but there are only two of us to go through all of these submissions.

We aren’t looking for technical writers, in depth nursing theory, or blog type stories.  We are looking for simple, well written nursing content that is easy to read.  Experience and story type submissions may be accepted however stories that are more suited for message board posts than articles will be declined.  Please view this list of recent articles to get an idea of what we are looking for:

Negotiating a Travel Nursing Contract

Nurses don’t need to feel stuck

Is organization in your skills list?

The Nurse Practice Act

To qualify for payment for submitted articles you need to meet the following criteria.

  • You must be fluent in the English language.  I know this seems like a no brainer, but if you can’t use proper grammar we will not be able to accept your submissions.
  • Articles must be pre approved.  You will have the freedom to write on just about any nursing related topic that you choose however all articles must be approved before they are published.
  • Articles must be a minimum of 400 words and a maximum of  800, however there can be exceptions, especially for articles of more than 800 words.
  • Articles must be original content written by you and never before published.
  • All accepted articles become property of UltimateNurse.Com unless otherwise determined prior to submission.  If you want to retain the rights to your work I am sure that we can work something out but it will likely reflect in the payment per submission.
  • Articles with misspelled words or improper grammar will not be approved or payment will be adjusted accordingly.
  • Author must be willing to accept payment via paypal for individual article submissions.  Otherwise, payment can be sent via other method once the writer has written a minimum of 5 accepted and published articles.  It only takes about two minutes to setup a paypal account and the account can be verified and connected to your bank account if you so choose.  If you do not have a paypal account and would rather not get one payment by check is not a problem however you will have to agree to withold payment until you have accrued more than the minimum amount of compensation of 150 dollars by check.  That’s simply because it’s a pain in the rear to send a check out after every individual article submission we receive.
  • No more than one submissions per week will be accepted from any one author unless agreed to prior to the submission process.
  • You must be willing to submit the proper form if required for tax and payment purposes.

We’re looking for people who enjoy writing and contributing to an online nursing community.  Your articles will be published on UltimateNurse.Com and visible to thousands of daily visitors.  If you’ve made it this far and are still interested in contributing or hearing more you simply need to fill out the form below:

You be added as a contributor and will receive a response with a login url, a username, and a password.   This will get you into the software and allow you to add your contribution.  It will be reviewed, and the article will be approved and payment of 30 dollars will be sent, or you will be contacted regarding the length, or quality of the article submission.

That’s it!

If you have any questions please feel free to email me and title your email: Article Writing Questions.

Thanks for your time and I look forward to working with you!


How Medicare Reimbursement Changes Affect Nurses

Posted in Nursing, Uncategorized

How Medicare Reimbursement Changes Affect Nurses

In August, 2007, CMS, the Centers for Medicare and Medicaid Services, instituted reimbursement rules known as a “do-not-pay list” for which they will no longer pay hospitals for extra care fees involving several preventable conditions. On October 1, 2008, that list will expand to include two additional conditions.

The original set of preventable conditions includes:

  • Falls
  • Mediastinitis (an infection which can occur after heart surgery)
  • Urinary tract infections from improper use of catheters
  • Pressure ulcers
  • Vascular infections from improper use of vascular catheters

The list also includes three items better known now as “never events.” These are:

  • Objects left in the body during surgery
  • Air embolisms
  • Blood incompatibility (transfusing the wrong blood type)

The conditions being added to this list of preventable conditions are:

  • Blood clots in the leg after knee or hip-replacement surgery
  • Complications resulting from inadequate control of blood sugar levels

Along with these new conditions, CMS is expected to expand the “never events” list to include surgical site infection resulting from certain elective procedures.

CMS had been considering seven new items, but reduced the list to only two after careful consideration of concerns raised by the AMA and hospitals that quality of patient care could be reduced significantly at a time when concerted efforts are being made to preserve and improve quality of care.

CMS has recommended to the states that they adopt similar do-not-pay categories for Medicaid reimbursement. Many private health insurance companies have implemented similar rules for reimbursement and are expected to expand them to coincide with the changes Medicare is making now.

How does all this affect nurses?

One might expect that the hospitals would “wake up” and realize that they need to have better staffing ratios and working conditions, along with staff education so that nurses can ensure patients have the quality of care needed to prevent these complications. Studies have proven that nurse to patient ratios directly affect quality of care.

Continuing education is also important. For example, there has been much said in nursing literature recently about patients in the ICU developing pressure ulcers. With all the tubes and wires, it can be difficult to rotate positions. The problem however is that many nurses believe that the patient won’t be in that state long enough to develop a decub. But pressure ulcers can develop very quickly and especially in the very debilitated.

While it may be true that a patient doesn’t stay in the ICU long enough for the ICU nurses to have to treat a pressure ulcer, that time lying on their back 24/7 has set in motion an ulcer that will need to be treated on the medical floor and probably even at home after discharge. It’s only when risk management carefully tracks the data and provides feedback and education that the ICU nurses would even know that their patients developed the decubs from their ICU care.

More staff and better staff education would seem a natural order of progression in preventing the complications that result in reimbursement losses. In reality, more often than not hospital administrators have, and will likely continue to pressure nursing administration to put the responsibility on the staff nurses to improve the care and not offer much in the way of support.

How has your facility dealt with these changes in reimbursement?

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the owner/author of