Archive for January, 2012

Hand-off Communication Practice

Posted in Nursing, Nursing Jobs, Nursing News

For the last 15 years, the Joint Commission (formerly JCAHO) has been evaluating medical errors and their causes and using this data to improve patient safety standards. What it has found is that hand-off communication has played a role in approximately 80 percent of “serious preventable adverse events,” also known as sentinel events, in healthcare.

In 2006 the Joint Commission initiated National Patient Safety Goals, which changes emphasized goals on a yearly basis. These standards grew out of the recommendations of the Sentinel Event Advisory Group and target issues that most commonly lead to sentinel events. For 2011, Goal 2 focused on improving communication among caregivers since communication errors and breakdowns remain a leading cause of sentinel events.

Hand-off communication can be especially problematic, for several reasons such as one person is often at the end of their shift and wanting to go home, or a patient is being bumped up to a higher level of care and the care provider has already been under stress and strain from the patient’s more serious needs. Important details that are vital to the patient’s current state and treatments may be missed or misunderstood due to the stress of the situation and fatigue of the caregiver.

Image courtesy of Kathryn Weigel via Flickr

One method of improving the odds of giving and receiving a more thorough report has been for the oncoming nurse to perform an immediate baseline assessment to confirm the hand-off report. This method can take time and hold up an outgoing nurse from leaving the facility, which means that she must remain on the clock until the assessment is finished. Most facilities have strict time limits on end-of-shift overage minutes.

Another method that has been gaining ground is the hand-off sheet used in many facilities when transferring patients between units. Although a seasoned nurse knows if she’s is likely to have all the information she needs, a newer nurse may want the security of a completed hand-off sheet. Although nurses offer mixed reviews of the extra paperwork, a benefit is that the communication is documented.

Some nurses prefer the “walking report” where the off- and on-going nurses walk from room to room and give a hallway report outside the patient’s room. This allows a quick review of the nurses’ notes and the chart, and a quick visit with the patient. Other nurses feel this invites interruptions from family members, and patient requests that cannot be handled until after hand-off has been completed.

In school, nurses learn the quick 30-second head to toe assessment. While this method is a goal, in school most students only have one or two patients for their ‘shift.’ In the real world of nursing what works best is often found only through evidence-based practice and a lot of talking to other nurses to find out what works best for them.

Maternity Nurse Remembers a 51-year Career

Posted in Nursing, Nursing Jobs, Nursing Specialties

The Tucson Citizen has an interview with Guadelupe Montez, a maternity nurse who just retired after 51 years. She specialized in labor and delivery and antepartum testing.

CC image courtesy of Sweet Carolina Design & Photo via Flickr

“To be carrying a baby and to have the baby out, it’s beautiful. It’s like a miracle to me,” Montez, 77, said. “I’ve always really loved babies, except they grow up too fast.”

A lot has changed at Maricopa Medical Center over the past five decades, particularly the growing use of technology. It took Montez a while to catch on. She always preferred paperwork, writing patients’ information on their hospital charts.

But through it all, the county hospital has remained Montez’s second home.

After Montez graduated from high school in Morenci, she rode a Greyhound bus to the Valley to attend a nursing school at what is now St. Joseph’s Hospital and Medical Center. She had only the exact tuition with her — $350 for a three-year program that included housing and meals.

“When I came down, the sisters knew I had exactly $350. So they said, ‘Why don’t you set this aside?’ and gave me a scholarship. Where can you do that now?” Montez said.

“I didn’t have to pay it back until I graduated, and with no interest,” she said.

Montez began working as a labor and delivery nurse in January 1961 at the old county hospital, then located at 35th Avenue and Durango Street.

Back then, there was one doctor delivering babies in two delivery rooms and three labor rooms. Patients stayed at least a week after getting their Caesarean sections to receive postpartum care.

The hospital in 1971 moved to 24th and Roosevelt streets. Now, there is a whole crew of doctors, midwives, nurse practitioners and rotating interns and residents. Patients leave the next day.

After about 20 years in the delivery ward, Montez felt that the hectic and high-stress environment was too much. She meant to retire, but then decided to work part time as an antepartum testing nurse instead.

In that role, Montez saw high-risk expectant mothers several times a week throughout their pregnancies to make sure there were no serious complications.

The schedule was much more relaxed, and Montez was able to build relationships with patients.

“Every year, I kept saying, ‘This is my last year.’ My kids would say, ‘Are you sure?’ ” Montez said. “I guess I didn’t want to give it up. I was happy there, getting out of the house, with friends who you work with.”

Montez has come to know all the nurses and secretaries at the clinic, as well as their children and grandchildren. She has crocheted afghans for all of them.

The article goes on to say that when she’s out and about in the Phoenix area, she’s often stopped by former patients who recognize her. (The moms who delivered the babies, not the babies themselves!) She’s looking forward to spending time with her grandchildren but is sad about leaving her job. “I miss it,” she says.

Nursing is Still a Growing Field in Florida

Posted in Nursing, Nursing Jobs, Nursing News, Nursing School, Nursing Specialties

Is the nursing shortage over? Not in Florida, anyway. There are about 14,000 available nursing jobs in that state according to online job postings in November, and this article in the Bradenton Herald says that state projections made earlier this month forecast a 2.4 percent annual growth in registered nurse job openings.

There are a few catches, though.

For one, it can be hard to get into the state’s nursing schools due to lack of spaces and caps on enrollment. Also, cuts to Medicaid are coming which could mean layoffs as hospital budgets are stretched further.

The article notes that demand is growing as experienced nurses who may have delayed retirement during the economic are expected to leave the profession in coming years.

CC image of Florida Coast used courtesy of USFWS/Southeast via Flickr

“We’ve had an artificial bubble. But nurses are not going to continue to work four and five 12-hour shifts a week,” said Ralph Egües, executive director of the Nursing Consortium of South Florida.

To recruit nurses, hospitals, including some run by Broward Health, have formed training partnerships with colleges and universities.

Boca Raton Regional Hospital offers scholarships in return for a two-year work commitment to students who work at the hospital while attending Florida Atlantic University’s nursing college.

“I don’t mind. I like it,” said Cassandre Exantus, 21, who has a $10,000 scholarship from the hospital toward her bachelor’s of nursing degree at FAU. After graduating, she hopes to become a nursing teacher.

The hospital also partners with FAU in an accelerated nursing program for those who already have a bachelor’s degree and want to change careers.

Timothy Parker, a teacher for 12 years, is thrilled to be in the special one-year nursing program. “I’ve always thought about working in a medical career,” said Parker, who said a scholarship and a supportive working spouse made that career transition possible.

Not everyone who wants to be a nurse can find a spot in nursing school, where teacher shortages limit enrollment. But Florida’s nursing schools don’t have the capacity to meet the demand for students wanting to enter the field, according to the state’s workforce agency.

FAU’s College of Nursing said it usually has about 80 slots open a year for new nursing students, but it has at least 700 applicants.

Nursing and other health care jobs could be affected by Gov. Rick Scott’s proposal to cut $1.9 billion from the $21 billion Medicaid program for treating the poor. Most of the money pays for care at hospitals in South and Central Florida.

Still, nursing students are likely to find new career opportunities in the future, many the result of health care reform.

Nurses are being hired in medical technology, transitional care from hospital to home, as case managers for insurance companies and for research trial coordination, according to Broward General’s Sprada.

“You can wear many hats,” he said.

While there seem to be an especially large number of nursing jobs available in Florida right now, many of the other factors mirror national trends.

New Grads, New Jobs

Posted in Nursing, Nursing Jobs, Nursing News, Nursing School

Some new graduate nurses are finding that there aren’t a plethora of nursing jobs, as they had expected. Instead, many discover after months of searching and applying that the nursing shortage so touted by the Department of Health and Human Services is more of a local problem in some parts of the country. There are new grads who eventually become disenchanted with the search and leave the profession in favor of finding another job that can pay their bills.

As health systems have eliminated nursing positions through redistribution of their current staff, the number of positions for new graduates nurses may no longer exist or be drastically cut. (more…)

Dealing With Compassion Fatigue

Posted in Nursing, Nursing Jobs, Nursing News

Nursing is an incredibly important profession, but also an incredibly exhausting one. Few other jobs have such a large emotional component; nurses must deal with literally life-and-death situations on a daily basis.

The term “compassion fatigue” was coined about twenty years ago to describe the emotional state that some nurses reach when the emotional toll has become just too much.

An article in St. Louis Today outlines a program called which provides a curriculum for nurses wishing to become more emotionally resilient. You can’t control the stresses of nursing, but you can control how you respond to them.

The program’s curriculum taught the nurses five steps to resiliency:

• Self-regulation, which involves learning exercises to reduce stress when they perceive a threat. (more…)

NY Bill Would Require Registered Nurses to Have 4-Year Degrees

Posted in Nursing, Nursing Jobs, Nursing News, Nursing School, Nursing Specialties

New York State lawmakers are considering a bill that would require registered nurses to earn bachelor’s degrees within 10 years in order to continue to work as a nurse in the state.

It’s called the “BSN in 10” and is being backed by nursing associations and major healthcare associations, with the goal creating a better-trained nursing workforce to care for an aging population. The aging of the baby boomers also means that many experienced and knowledgeable nurses will be retiring, creating a double whammy for healthcare providers.

Right now no other states have a law like this on the books. It looks like New York’s law has a pretty good chance of passing, though.

New York’s legislation died in committee last session, but it has bipartisan support in both chambers this year and could be debated as early as January. (more…)

The History of School Nurses

Posted in Nursing, Nursing Jobs, Nursing Specialties, School Nurses

An interesting article on Philadelphia’s answers a question I hadn’t really thought about: Why we have school nurses in the first place.

Up until the very beginning of the 20th century if students were sick, they were sent home with a note. Caring for the sick child and getting medical attention if necessary was the responsibility of the child’s family.

The nurse and social reformer Lillian Wald had a better idea — why not treat the children in school?
In 1902, she started to provide four New York City public schools (serving about 10,000 students) with nurses from her Henry Street Settlement. Her experiment was so successful that New York officials expanded it citywide.

By hiring 25 nurses, the public schools reduced the number of students sent home from roughly 10,000 in 1902 to a little more than 1,000 in 1903 – an astounding decrease of 90 percent. School nurses also made home visits to children who were removed from school, treating their illnesses and instructing their families in hygiene and prevention.

Other cities quickly followed New York’s example. Los Angeles put nurses in its schools in 1904, Boston did so the following year, and Philadelphia hired its first school nurses three years after that, in 1908.

Over the ensuing century, school nurses provided a variety of crucial health services. As public vaccination expanded, nurses helped ensure that children were protected against polio, diphtheria, and other diseases. And when the federal government required schools to accommodate handicapped children, including those who needed catheterizations and feeding tubes, their care often fell to – you guessed it – school nurses.

Today we’re told that nurses are too expensive for cash-strapped school districts. But the same objection was raised back in Wald’s time, at the dawn of school nursing. “There are still many people, even kindly souls, who cry out about this ‘fad’ because of the cost,” wrote Lina Rogers, New York’s first full-time school nurse. “What willful, heartless blindness.”

She was right. A hundred years later, let’s hope kindly Americans will open their hearts – and their wallets – to school nursing. The alternative is to close our eyes, like little children, and pretend nobody can see.

This recent post examines the issue of school nurses, budgets and the many services school nurses now provide in more detail.

School Nurses Spread Thin

Posted in Nursing Jobs, Nursing News, Nursing Specialties, School Nurses

Somehow I’ve made it to adulthood without ever breaking a bone, but I was either a very clumsy or a very active kid (perhaps both?) and throughout my elementary school years I was forever heading to the school nurse to have a cut attended to or a bruise soothed. In my memory, she was always there when needed.

I don’t know if she actually was on duty all of the time or if it just seemed that way, but school nurses these days usually have to serve several schools at once, even as the medical needs of their patients only become more complex and time-consuming.

The Whidbey News of Washington spoke to Robbin White, a school nurse, and Rick Shulte, the Superintendent of the district she works in, about the unique challenges that school nurses face now.

“The students’ needs for nurses has risen to more than it used to be,” (more…)

The Importance of Good Documentation Practices

Posted in Nursing, Nursing Jobs, Uncategorized

Few things can save your job and reputation like your documentation. In instances where another clinician may question your judgment or activities, your documentation can indicate the date, time and other details necessary to prove that you acted in an appropriate manner.

Although nursing instructors attempt to teach proper and thorough documentation in nursing school, frequently new grads include either too much or not enough detail. A key to learning best documentation practices is to read other nurses’ notes. Although most facilities now use computerized charting due to new laws regarding the electronic medical record (EMR), you can check other nurses’ notes within your system. Additionally, some facilities (mostly nursing homes) still use paper charts.

Typically, all charting involves a lot of check-off boxes. In areas that require handwriting, remember that someone other than yourself may have to read your notes and that one day you may be called to testify as a witness. (more…)