Archive for February, 2012

New Guidelines for Blood Glucose Testing

Posted in Nursing, Nursing News

Image ©

Nurses may soon have to learn a new set of practice guidelines when it comes to all their patients. The Endocrine Society has issued new clinical practice guidelines concerning inpatient monitoring of blood glucose levels. Whether or not patients have been diagnosed as diabetics, patients admitted to a facility should receive blood glucose monitoring as long as they are not receiving intensive nursing care. The January 2012 issues of Journal of Clinical Endocrinology & Metabolism published the new standards.

Citing observational studies which found that hyperglycemia affects 32 to 38 percent of inpatients in community hospitals regardless of a pre-existing diagnosis of diabetes, the eight-person task force – all experts in the field of endocrinology – developed new evidence-based guidelines and designed protocols, system improvements and glycemic targets in order to facilitate better blood glycemic control. Dr. Guillermo Umpierrez of Emory University, the task force chair, stated that long hospital stays, higher infection rates and death in non-critical patients were all linked to hyperglycemia.

The new guidelines for acute care facilities include:

– Blood glucose testing upon admission for all patients admitted to the hospital whether they are a known diabetic or not. Diabetic patients will automatically receive A1c level testing if none has been done in the last two to three months.

– For the majority of hospitalized patients, the target premeal glucose level should not exceed 140 mg/dl; random testing should not reveal more than a 180 mg/dl level. If glucose levels fall under 100 mg/dl or 70 mg/dl, treatment should be reevaluated or modified.

– Closer monitoring should be implemented for patients not at risk for hypoglycemia, and for terminally ill or end-of-life patients and patients who are more likely to develop hypoglycemia.

– Diabetics on injectable insulin should continue to receive insulin as long as they are inpatients.

– As a preventive measure to perioperative complications, all type 1 diabetics and the majority of type 2 diabetics should receive a continuous IV insulin infusion or “sub-q” insulin with bolus insulin used as needed.

– Patients admitted with a higher than 140 mg/dl glucose level and patients receiving enteral or parenteral nutrition should be monitored with bedside glucose testing, whether the patient is diabetic or not. Patients on corticosteroids or octreotide should also receive bedside glucose testing.

– One to two hours after completion of continuous IV insulin, patients should be transitioned to “sub-q” insulin.

The new guidelines were reviewed by Endocrine Society members, the American Diabetes Association, the American Heart Association, the American Association of Diabetes Educators, the European Society of Endocrinology and the Society of Hospital Medicine.

While the new guidelines will likely increase the workload of nurses, better guidelines may decrease the risk of infection and save patients’ lives.

Nurse Practitioners: Health Care Reform’s Missing Link

Posted in California, Nursing, Nursing Jobs, Nursing News, Nursing Specialties

© Jose Manuel

Patricia Dennehy RN NP has written an Op-Ed for the Los Angeles Times explaining the role that Nurse Practitioners have as millions of people find new health care providers as part of expected Health Care reforms.

She says that about 30 million people in America will be looking for new health care providers, about 6.9 million of them in California, where she lives and works.

Unfortunately it won’t be very easy, as primary care physicians are increasingly moving to other types of practices, especially higher-paid specialties.

Dennehy argues that Nurse Practitioners, with their training and experience, are perfectly poised to fill that gap. “We’re fully prepared to provide excellent primary care,” she says.

Clinics like the one I direct in the heart of San Francisco’s Tenderloin district — GLIDE Health Services — offer a hopeful glimpse into California’s healthcare future. We are a federally funded, affordable clinic, run almost entirely by nurse practitioners. At our clinic, we nurses and talented specialists provide high-quality, comprehensive primary care to more than 3,200 patients each year.

Despite the special hardships of our clientele, who daily cope with the negative effects on health caused by poverty, unemployment and substance abuse, our results routinely compare favorably with those of mainstream physicians. Our patients with diabetes, for example, report regularly for checkups, take their meds as directed and maintain relatively low average blood-sugar levels.

This high standard of care provided by nurse practitioners has been confirmed in several studies, including a 2009 Rand Corp. report, which found that “nurse practitioners provide care of equivalent quality to physicians at a lower cost, while achieving high levels of patient satisfaction and providing more disease prevention counseling, health education and health promotion activities than physicians.”

At last count, there were more than 250 nurse-run clinics nationwide similar to GLIDE Health Services. We and about 20 others are funded by a special federal program for affordable care. In all of these projects, nurse practitioners offer both primary and preventive care, including mental health services and screening for HIV and diabetes.

Researchers have confirmed that such clinics not only improve local health but also save taxpayers money. Nurse practitioners’ salaries are generally lower than those of physicians. At the same time, the comprehensive care we provide can significantly reduce the costly emergency room visits used by all too many low-income Americans as their default healthcare.

Unfortunately, some major obstacles stand in the way of expanding our money-saving model. One big hurdle is the reluctance of leading private health plans to contract with nurse practitioners as primary care providers. Even as Medicare, Medi-Cal and pioneering local programs for the uninsured, such as “Healthy San Francisco,” now contract with nurse practitioners to provide such care, a 2009 study by the National Nursing Centers Consortium found that nearly half of the country’s major managed care organizations don’t.

Some of the holdout companies require nurses to bill for their services under a physician’s supervision. California’s insurance code only requires insurance companies to contract with nurse practitioners for primary care when it involves Medicare or Medi-Cal. If the code were expanded to include all coverage, access in the state would be greatly improved. There is room for reform on these fronts and others, and we should get started now to enact change.

In October 2010, the Institute of Medicine, an arm of the National Academy of Sciences, issued a landmark report called “The Future of Nursing,” in which it urged that nurses be “full partners, with physicians and other health care professionals, in redesigning health care in the United States.” At clinics such as GLIDE Health Services, we’re showing that we’re more than ready to answer this challenge, and take our places on the front lines of healthcare reform in America.

Retired Nurse Shares Experience of Integration

Posted in Nursing, Nursing News

Vintage blood pressure cuff ©

The Jackson Sun has a story about a retired African-American nurse who was one of the very first people to desegregate the Jackson General Hospital in Jackson, Tennessee.

Vernice Dixon, 93, was in her 30’s when she decided to quit her job as a dishwasher and try to become a nurse.

In 1952, she became part of a small group of minority nurses — patients were still segregated at that time, and some of the white patients didn’t want anyone but white nurses helping them. (An issue that unfortunately still persists today.)

“I remember one man, who was white, who spoke real bad to me,” Dixon said. “I came into his room and I said, ‘Hello’ and told him that I was there to take his temperature. He cussed so bad and used words that no one around me had used before.”

Dixon told a white colleague who came to her defense.

“I had to learn how to get over things like that,” Dixon said. “As a nurse, whether you’re black or white, you have to deal with patients. Sometimes you just have to grin and bear it.”

One of the most challenging examples of integrating a once-segregated hospital, Dixon said, was the separation of rooms for white and black people.

“There were times when the first floor, where they kept all of the black patients, was overcrowded when the rooms on the third floor were empty,” Dixon said. “There were empty beds, but they were not for black people.”

As a nurse, Dixon earned $300 every two weeks, which was a large pay increase from $1.10 she made cleaning houses.

“I always knew how to stretch a dollar,” Dixon said.

Her ability to make her money last helped improve the lives of her parents and her only daughter Clementine, who she hoped would follow in her footsteps as a nurse.

“She became a teacher instead,” Dixon said.

“Mama loved nursing with a passion; it’s her calling,” said Clementine Spencer, Dixon’s daughter.

Dixon worked in the hospital for 28 years before she retired.

“I saw a lot of changes,” she said. “We (black nurses) broke up a lot of segregation that was going on.”

In one of Dixon’s stories, she asked nursing supervisors about why black nurses didn’t know about training inservice opportunities.

“After that, they posted the inservice trainings,” Dixon said.

Multitalented Nurse Seeks to Inspire Women

Posted in Nursing, Nursing Jobs, Nursing News

Via iStockphoto

Vicki Milazzo is a nurse, but she’s also a legal nurse consultant and an author and CEO of the Vicki Milazzo Institute. She’s a registered nurse (RN) and also has a master’s degree in nursing (MSN) and then also has a doctorate in law (JD).

She put all of these diverse interests and talents together to pioneer the nurse consultant field. In an interview with Laura Raines of the Atlanta Journal-Constitution, Milazzo says that she was working overtime to pay off her mortgage but was no longer feeling fulfilled in a hospital setting.

“I didn’t want to change professions, but I wanted to practice nursing in my own way,” she said.

If she started her own business, Milazzo decided, she could be her own boss. Interested in the relationship between nursing and the law, Milazzo set out to pitch the value of her nursing expertise to medical malpractice attorneys. Although the term “legal nurse consultant” didn’t exist yet, Milazzo became one and went on to start an educational company that trained other nurses in the specialty.

“I had no business skills, so I followed the nursing process I’d learned — assess, diagnose, plan, perform appropriate action, evaluate and start over. I still use that process every day,” she said.

Milazzo also made herself five promises when she realized that having dreams wasn’t enough to change her life and that it would take commitment to realize them.

1. “I will live and work a passionate life.” She wanted to wake up every day feeling excited and energetic.

2. “I will go for it or reject it outright.” You can’t wait for the right time to start living your dreams.

3. “I will take one action step a day toward my passionate vision.” That’s how she created her business.

4. “I commit to being a success student for life.” The quickest way to learn is through the experience of others.

5. “I believe, as a woman, I really can do anything.” If she could save a life in the middle of the night, she could certainly start a business.

“I still live those five promises every day,” Milazzo said.

She encourages nurses to commit to their own promises and reach for their goals. “Nurses today have an incredible knowledge base that can take them in any direction.”

Returning to Nursing

Posted in Nursing, Nursing Jobs, Nursing News

Image © Alexander Raths via Fotolia

One of the biggest challenges for women seeking to build a career and also have a family is to figure out how to find a balance. Many professions require a level of commitment that is incompatible with raising a family, and it is rare to find a profession that allows you to take a long break and then return to work. Nursing is one of those rare professions.

The story of how one nurse took a long break from nursing, but then was able to return to the profession (and excel) is told in this article on

Some nurses break from the bedside and return to their patients with fresh eyes.

“My scope is bigger this time,” said Nan Whalen, RN, MSN.

Whalen stopped nursing for five years to focus on her family. She gradually added PRN shifts and as her children grew older, then flew from the nest, Whalen re-entered the work force full time. She said few professionals can re-enter their field of choice.

“That’s one of the unique benefits of nursing overall,” she said. “There are not a lot of professions that allow you to do that.”

To keep her options open, Whalen never let her nursing license lapse while she stayed home full time to raise children. She also fulfilled 45 hours of continuing education credits every three years required by the state of Iowa, where she lived at the time.

Whalen said it is important to do what is right for you and for your family. Nurses can take a break or scale down their hours, she said if that is what they choose. There is a need for nurses working in a variety of shifts and hours, Whalen said.

“Nurses work everywhere in the community,” she said. “There are so many ways to contribute. I am a firm believer in life balance. It was important to take care of my family and kids.”

Whalen encourages anyone struggling to maintain family and work to take a break or ot scale back, but to keep your eyes on the future.

“You have to be purposeful about it,” she said. “ I need to keep current in it. You‘ve got to take professional accountability.”

Whalen is administrative director of Inpatient Nursing Services at St. Joseph Medical Center, a position she never dreamed she would pursue. As a younger adult in her twenties, she viewed nursing as a means to support herself and her family and did not consider moving into leadership roles, she said. That changed after several decades of motherhood and patient experiences when delivering her children in a hospital. She came back to nursing wanting to make a better experience for patients.

“It was a completely different feeling,” she said. “I definitely viewed patients differently.”

It was tougher than she liked, taking those initial steps back into nursing, Whalen said. Having moved from Iowa, she quickly learned it would be wise to certify on both sides of the state line, she said. There were changes in medications and technology she knew she would face. She spent extra hours in orientation becoming comfortable with electronic record keeping.”

“It’s very scary to leave the field and come back,” she said. “Things change so rapidly in health care.”

Whalen said you cannot take the nurse out of nursing, however. A colleague told her that nurses are hard-wired to do what they need to do and Whalen has come to believe that. In the five years she was gone from the field, she saw equipment like drains, ventilators and computers had changed and grown in hospital settings, but the respiratory and cardiovascular systems remained the same, she said.

“The tools changed but the pathophysiology didn’t change,” she said. “It still provided the same benefit to the patient.”

Helping Patients Maintain Successful Weight Loss

Posted in Nursing, Nursing News

Patients who have lost significant amounts of weight, especially for health reasons, need a stronger support system than someone who simply lost five pounds for swimsuit season. Often a little cheating or relaxation of the new diet habits causes a quick backslide to old habits, which can lead patients back to their starting point with a few extra pounds tacked onto their middle. By helping patients identify possible weight gain triggers, nurses can provide a strong foundation of support to mitigate the chances of a substantial weight regain in their patients.

The Journal of the American Academy of Nurse Practitioners recently reported eight categories of potential factors leading to a weight regain in patients after a successful weight loss, which may provide talking points to a nurse counseling a patient who is struggling to maintain the loss: (more…)

Study Finds Disparities in Pain Treatment

Posted in Nursing, Nursing News

Image used courtesy of Ben via Flickr

A study from nurse researchers at the University of Pennsylvania school of nursing has found that while pain is undertreated in general in the United States, low-income and minority patients are even less likely to receive adequate pain treatment. This result holds up across virtually all healthcare settings.

Minority patients are more likely to have dangerous jobs and often suffer more severe pain and physical impairments than non-minority patients, according to this article on

Poor and minority patients often experience pain for many years before being seen by a specialist in pain treatment, possibly because health providers are more likely to underassess pain in minorities, the reviewers said. Minority and low-income patients also are more likely to live in geographic areas that restrict their access to healthcare, while pharmacies in minority zip codes are significantly less likely to have sufficient supplies of pain medications than pharmacies in predominantly white zip codes.

“There is no question that pain treatment disparities matter in many significant ways,” Penn Nursing professor and lead study author Salimah Meghani, RN, PhD, said in a news release. “The most important are the tremendous burdens placed on patients, health systems and society when the most effective pain care is not accessible, affordable and delivered to those in need.

“Until the prevailing issues of inequitable healthcare are realized and confronted through focused and systematic strategies for education, research and healthcare reform, it is unlikely that progress will occur in reducing and ultimately eliminating pain disparities.”

According to recent estimates, chronic pain affects 116 million American adults and remains the most common reason people seek medical care. The burden of pain on Americans in direct and indirect costs can reach $635 billion annually. This expenditure includes disability, poor quality of life, relational problems, lost income and productivity, and higher healthcare utilization including longer hospital stays, ED visits and unplanned clinic visits.

Meghani and colleagues, including Penn Nursing professor Rosemary Polomano, RN, PhD, FAAN, also proposed broad advocacy initiatives such as “Look at the Data Campaigns,” especially targeted at providers to sensitize them to their blind spots that contribute to inequitable pain care — emphasizing the need for targeted education in pain disparities as part of graduate and continuing medical education, and in licensure, accreditation and certification programs for medicine, nursing and allied health professionals.

Although the Patient Protection and Affordable Care Act mandates federally funded programs to consistently collect data to track trends in healthcare disparities, the authors urged the creation of public-private partnerships in promoting standardized reporting of race and ethnicity data to allow researchers to track disparities, monitor efforts to reduce them and compare findings across studies regardless of the source of funding.

Nurse Brings Fun Where It’s Needed

Posted in Nursing, Nursing Jobs, Nursing News

Image courtesy of serch via Flickr

The Daily Iowan has an article about a nurse practitioner named Mary Shlapkohl, who has worked at the University of Iowa Children’s Hospital for many years. She managed to find a way to bring some much-needed cheer to the kids who are her patients.

Every day, Mary Schlapkohl wears a red I AM LOVED button pinned to the straps of her ID-card, dangling around her neck.

“A teenage girl gave this to me,” the 50-year-old said, clutching it in her hand.

The nurse-practitioner said when she asked the young patient handing them out for one, the child replied, “Ugh, you’re never going to wear it.”

“And so I’ve never not worn it, just to spite her,” Schlapkohl said and smiled.

Working at the University of Iowa Children’s Hospital for the last two decades has allowed her to meet numerous children and families facing cancer.

“I’ve worked here a long time, so everybody knows me, and I’m up here on the floor a lot,” she said.

A UI nursing alumna, Schlapkohl worked for two years as a bone-marrow transplant specialist before becoming an assistant head nurse for the inpatient unit at UIHC. In 1992, she became a nurse-practitioner — beginning her work in the UI’s second-level pediatric hematology oncology unit.

A few years after, Schlapkohl was invited to the first planning meeting for Dance Marathon. From there, she has witnessed its continued growth.

“I think of how [Dance Marathon] has evolved to where it is now, and I can’t believe it,” she said. “It’s not just the amount of money it has raised, but what this has grown to mean to our families has been just incredible and how much the students just embrace our families and become so involved with them.”

For Schlapkohl, Dance Marathon is like a partnership. The volunteers bring joy to distract patients, she said, and the hospital staff members help children get better and provide information to the families.

“So I think it’s a great parallel way of treating our patients and working with them together,” she said.

Children’s Hospital nurse Kristie Febus, who has worked with Schlapkohl for the last seven years, said she has a knack for working with children.

“I can honestly say that I have not seen a kid who doesn’t love Mary,” the 31-year-old said.

Febus said Schlapkohl always maintains a lot of energy around staff and patients.

“She figures out a way to put fun into the hospital,” Febus said. “This isn’t a very fun place, and somehow she is able to make the kids feel comfortable and make them feel like they’re at home. It’s always jokes and laughing with them, and she makes them feel like there’s a little bit of fun to be had here.”

Study: 55% of Nurses Are Overweight or Obese

Posted in Nursing, Nursing News

Image courtesy of -Paul H- via Flickr

Job stress and long, irregular hours are two of the reasons that 55% of all nurses are obese, according to a study at the University of Maryland School of Nursing.

Over two thousand nurses were surveyed in the study.

An article on quotes medical professionals who say that nurses are just as susceptible to health problems as the rest of society, and that “Nurses need to understand the importance of taking care of themselves before patients or their families.”

To combat the high obesity rate among nurses, Kihye Han, the author of the study, proposed more education on good sleep habits, and better strategies for adapting work schedules. She also called for napping at work to curb sleep deprivation, reduce fatigue and increase energy.

The 2004 National Sample Survey of Registered Nurses found that more than 40 percent of nurses who left nursing said they did so because of irregular and long hours, indicating that better scheduling could help nurse retention.

Han also proposed increasing making healthy food more available, and allowing enough time to consume it.

For instance, Han recommends on-site farmer’s markets to serve health care workers who work nonstandard hours, healthier vending machine choices or having food delivered to the work unit.

“There’s an awful lot conspiring against weight control in nurses. The solutions are … giving the nurses the knowledge and skills they need to manage their weight, and environmental reforms, like having opportunities for physical activity breaks in hospitals, and having nutritious food options readily available 24 hours a day,” Katz said.

“Nurses, who dedicate themselves to helping others,” said Katz, “deserve that support from us.”

The Stress of Dealing with Violent Patients

Posted in Nursing, Nursing News

Image courtesy of aturkus via Flickr

A registered nurse named Theresa Brown has written an article for The New York Times’ “Cases” feature about the strain of taking care of a patient who is violent.

She had to deal with a tall, muscular 300-pound man who would act in a threatening way and then say things like “Look at you, standing there with that stupid look on your face.”

He was scary, and it turned out that he had threatened to kill a nurse on another floor. (more…)