Nursing News

UC-Davis Graduating First Class of Nurses

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

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Five years ago, philanthropist Betty Irene Moore donated $100 million to the University of California – Davis, moving the School of Nursing from dream to reality. This week, the first group of nurses will graduate from the program.

25 students who were recruited for their talent and whose education was fully funded by scholarships will be graduating. The hope is that they represent a new breed of well-educated nurses who will transform the health care system.

In this article in the Sacramento Bee, the School of Nursing Dean Heather Young said, “Our goals and priorities are to improve the health care system and advance the health of our communities. We realize that nurses can, and should be, the catalysts of change.”

Young called this year’s class of graduating nurses “just a beginning.” Already another 25 students are queued up for the next two years, with more than 30 percent of them coming from underrepresented ethnic communities. The school also enrolls doctoral students in a four-year program.

In a seminal 2010 report on the future of nursing, the Institute of Medicine concluded that health care reform meant “nursing education must be fundamentally improved both before and after nurses receive their licenses.”

With the population growing older and chronic diseases taking center stage, the IOM report, which Young endorses, determined that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.”

Young said she was drawn to the position of dean because she, too, was inspired by the vision of Betty Moore.

The story of how Moore decided to commit $100 million over 11 years to a new school of nursing is a tale of personal belief in change.

Moore had been in a hospital and experienced a medication error. A nurse had insisted she take a shot, but Moore objected. The nurse gave her the shot anyway.

It turned out the shot of insulin was meant for a neighboring patient and potentially put the health of both patients at risk.

Says nurse Johnston, “What impresses me most is that Betty Irene Moore, a person with a lot of money, didn’t go blaming the individual or the system, she did the opposite. She decided she could do something positive about the problem of medical errors, make change for the better and build a better nurse.”

Specifically, Johnston’s job, which he says is a project of the Gordon and Betty Moore Foundation, is to be an educator, a monitor and a resource to prevent patients from getting hospital-acquired infections from improper use of ventilators, intravenous tubes, catheters and the like.

In the status-quo health care system, such infections have come to be seen as somewhat of a statistical inevitability – even to the point where patients’ rights groups routinely tracked and reported their occurrence in various hospitals.

“The culture and belief that infections are a part of a hospital stay needs to change,” Johnston said.

In an interview at the UC Medical Center where he works, Johnston said his job is called “nurse champion.”

He works as part of a collaborative system for higher quality by advising and teaching medical staff on ways to curb hospital infections.

It’s a challenging and new role for Johnston, who’s worked as a nurse for 5 1/2 years.

“We are colleagues with physicians and nurses and aides,” he said. “We are change agents in the system.”

To be sure, Johnston’s gotten some push back already in his new job in the UC Davis Medical Center’s burn unit. But he’s prepared to tap into the communication and leadership skills he’s learned to overcome the skepticism.

“I was seen as an outsider, someone to audit them and get them in trouble,” Johnston said of his colleagues. “There was some question of my credibility and credentials both from nurses and the physician side. It’s a challenge. It takes time to get that buy-in.”

School Nurse Visits Up

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

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Visits to school nurses have significantly increased, likely because of the difficult economy. People often lose health care when they lose their jobs, meaning that they will sometimes send their kids to the school nurse before their primary care doctor.

In Rhode Island, increases in the last five years total in the thousands, according to this article on in the Valley Breeze.

Linda Newbury, a school nurse, provided figures that indicated that visits doubled at one school (3,800 visits to 7,554 visits) and increased significantly at almost all schools. Only one school had a decrease, from 11,000 to 10,930.

Newbury acknowledged that an increase in population is a contributing factor, but not the only one. Parents will ask school nurses, “Before I spend money, what do you see?”

School nurses also are expected to address a much wider range of medical issues, from standard sore throats and fevers to allergies and diabetes.

Cumberland school nurse Margaret Wharton said while the district had not compiled specific figures, she has also noted a similar increase in visits as the neighboring town.

“All I can say is that student visits to the nursing offices appear to continue to increase each year as many families have lost health coverage due to economic issues,” she told The Breeze.

“School nurse teachers, in many cases, have become the first person to see a child for a health issue because they provide free interim nursing care until they are able to refer the child for appropriate medical care.”

Wharton said she is “very concerned” for the next school year, when there will be one fewer nurse in the schools due to budget cuts.

The illnesses seen are cyclical, Villeneuve reported at the meeting. While strep was prevalent several years ago, this year saw more cases of pneumonia, she said.

The nurses all spoke about the increase in number and types of food-related allergies.

Wharton said when she started in the schools 21 years ago, she had about five EpiPens for children with allergies. Now she said she has “a wall full” with about 35.

Newbury said food restrictions, like not allowing peanut butter in the cafeteria, “change the climate of the classroom.”

Newbury said more “medically fragile” students are enrolled in school with more cases of autoimmune diseases and diabetes in children as young as 3.

K-9 Team Puts Nurses at Ease

Posted in Maryland, Nurse Safety, Nursing, Nursing News

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The emergency department in a hospital can be a very tense place. Injured people want to be tended to immediately, their family members get upset on their behalf, two people from an altercation can both wind up at the same hospital — there are many reasons why emotions can spill over and difficult situations can develop. And such situations can be stressful and dangerous for nurses as well as patients and their families.

At a hospital in Baltimore, a two-member security team is called when things start to get heated. One member of the team is human, but the other is a German Shepherd. Often just the dog’s presence can serve as a calming influence, according to this article on Nurse.com. The dogs add “another level of authority,” according to the hospital’s clinical director for the ED, and “They have a nice presence.”

The hospital is in a high-risk crime area, and started using a K-9 unit in 1994 to help curb violence on the campus. Administrators think that the dogs’ presence has had a profound effect.

“Our director goes to downtown meetings in Baltimore [with other hospital administrators] and they share crime statistics,” said Mark Ross, captain of Mercy’s K-9 Unit. “It’s well-known within the city that Mercy has dogs and it’s not a place to go for crime.”

Ross and four other handlers have their dogs with them at work and at home. The dogs are imported from Europe and trained for protection and to hunt human and explosive odors. Ross, who has partnered for two years with Iko, said the dogs can track someone on the campus, find explosive devices and protect hospital personnel. Working in a hospital requires the dogs to be more sociable than other police dogs. The Mercy dogs must have the ability to be friendly one minute and ready for business the next. “It makes it a little more tricky when it comes to selecting a dog for this environment,” Ross said. “The dogs are tempered because they have to be sociable. They also have to have the ability to work or apprehend on command.”

The dogs at Mercy develop friendships with nurses and patients and are able to enjoy some attention.

“The staff loves them,” said Janet Norman, RN, MS, PCCN, nurse manager, progressive care unit. “When they are training a younger dog, a guard may say, ‘You can’t come close to this one.’ The older dogs, you can talk to them and pet them.”

There is time for pleasure, but during most of the 10-hour shifts, the handlers’ and dogs’ time is for work.

“There is an added sense of protection here,” Norman said. “We had a disturbance once and a family had become so angry. I’m not sure it was directed at us, but it was very frightening. Security came up with the dog and everyone quieted down. There was no feeling that there would be any harm to anyone.”

Handlers and dogs also may walk nurses to their cars in the parking lot. “It gives us peace of mind,” Disney said. “It’s interesting the effect when you have a really busy waiting room. The dogs have a tendency to calm everybody down. It’s a distraction as much as anything, (to) watch the dog for a minute. We joke and call them our favorite security officers.”

And like any smart dog, the Mercy K-9 dogs remember where their friends are when making the rounds. “We have a couple nurses who sneak biscuits for them,” Disney said. “They know where those nurses work and go right to them.”

On Discouraging Unnecessary Medical Tests

Posted in Nursing, Nursing Jobs, Nursing News

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Recently, the American Board of Internal Medicine (ABIM) Foundation, working in conjunction with numerous medical specialty boards and Consumer Reports, instituted an initiative to decrease the number of medical tests ordered unnecessarily by physicians. It also has contributed to new recommendations for annual exams. The initiative is called “Choosing Wisely.” The following are some of the pros and cons of this initiative.

Pros:
Reduction in healthcare spending
: An article appearing in Kaiser Health News reported that $6.8 billion dollars were spent in 2009 on twelve unnecessary tests and treatments, such as ordering routine blood work during yearly physicals on healthy patients, performing Pap smears on teens who were unlikely to have cervical cancer, and ordering drugs for children with sore throats that were caused by viruses. Some experts estimate that up to 1/3 of every health care dollar spent in the U.S. is wasted on unnecessary tests, treatments and medications. A McKinsey report states that “health care spending reached record levels in 2009, both in absolute terms and as a share of GDP” . Few people will disagree that we need to spend less money on healthcare and reduce waste where possible; therefore, cutting out unnecessary tests and treatments may be a good place to start.

Reducing the risk to patients: First, do no harm. Performing unnecessary medical tests or prescribing unnecessary treatments to patients could be potentially harmful. For example, performing an unnecessary x-ray exposes the patient to harmful radiation. Prescribing antibiotics that aren’t clearly indicated (i.e. for viral infections) could result in an unforeseen drug reaction or antibiotic resistance. In addition, ordering unnecessary tests and procedures may result in increased patient anxiety.

Cons:
Missing a diagnosis: One concern about discouraging tests is it might result in missing a diagnosis that otherwise may have been caught through routine testing. Some physicians may feel uncomfortable about the new initiative for this reason. A big part of the reason that physicians order multiple tests is due to the fact that doctors are vulnerable to being sued when they miss a diagnosis. Fear of litigation is a driving force behind physicians’ ordering practices. Until this fact changes (or the laws do) some doctors may be reluctant to Choose Wisely.

Removing autonomy: Some might argue that physicians go to school for many years and should be able to practice as they see fit. If insurers and payers determine that certain tests and treatments will not be reimbursable, this can be seen as a challenge to physicians’ autonomy and decision-making ability. Many doctors will be less than appreciative of this kind of oversight. On the patient side, such an initiative might not be met with favor by patients who have become used to certain treatments and test. These patients may also feel that money is being given a higher priority than their health.

As nurses, it will be our job to explain to patients why tests and treatments that they have grown accustomed to receiving are no longer being offered. Rather than confronting their physician, patients may choose to confront nurses instead. Researching “Choosing Wisely” can help us prepare for these questions.

Helping New Moms Achieve Success

Posted in Nursing, Nursing Jobs, Nursing News

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The Nurse-Family Partnership in Virginia assigns a nurse to visit low-income, first-time mothers at home every week, starting early in pregnancy and not ending until the child’s second birthday.

This article in the Virginian-Pilot followed nurse Glenda Asterilla-White as she visited a pregnant 24-year-old named Crystal Stewart in her home.

They discuss things like nutrition, what to expect from each doctor’s appointment, and the need to decrease caffeine intake.

The nurses in the program offer information about how to achieve a healthy pregnancy and also help the mothers prepare for the child. Then after the baby is born, they help offer guidance and information for successful parenting strategies.

Nurse-Family Partnerships have been shown to be extremely successful, when done right. (Especially, the more skilled the nurses, the better the outcomes.)

“This technique that they have really focused on in the Nurse-Family Partnership is intended to help the family be empowered rather than simply supplying them the information,” said Dr. Nancy Welch, acting director of the Western Tidewater Health District.

More than a dozen studies have documented the Nurse-Family Partnership’s impact over three decades.

Researchers say the program improves prenatal health, reduces the number of subsequent pregnancies for the mother, and increases the number of months she is employed. The children experience fewer injuries and are better prepared for starting school.

The program’s success comes from the trust that nurses inspire and the long-term bonding between the nurses and the mothers, said Lauren Baker, chief marketing and communication officer for the partnership.

The results impressed Welch, who also is the director of the Chesapeake Health District. In that capacity, she had evaluated a similar nurse home visiting program in Chesapeake.

Her conclusion: Over a five-year period, families supported by the Baby Care program had lower infant mortality rates, a smaller percentage of low-birth-weight babies and fewer premature births than families in a control group. If the program was expanded to cover all of the city’s premature births, it could save $1.34 million in hospital costs annually, a 129 percent return on the original investment, according to her estimates.

That analysis, along with the Nurse-Family Partnership studies, reinforced Welch’s conviction that home visiting programs work.

Some already existed in Western Tidewater, including one that focuses on parenting education and one for teens who are pregnant or parents.

When the national health law provided more money to the state for such programs, Welch applied for a grant. Relatively high poverty, dropout rates, unemployment rates and pre-term deliveries put Suffolk and Southampton County families at higher risk for unhealthy children, she wrote. Both localities could benefit from another home visiting program.

The health district was awarded a combined $450,000 from the government and Obici Healthcare Foundation. The grant allows five nurses to serve a total of 100 families for four years in Isle of Wight, Franklin, Suffolk and Southampton.

A nurse for more than 30 years, Asterilla-White decided to join the program for a new challenge and because she had been a teen mother herself.

“I’m getting a kick out of being able to make sure that the resources are known by the mothers and that I’m making a contribution,” she said.

Stuart signed up because she wanted as much support as she could get.

“It’s not like a business coming to you,” Stuart said. “It’s more like family.”

Effective Communication and Patient Safety

Posted in Nursing, Nursing Jobs, Nursing News

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Communication has a direct impact on patient safety, according to a new report which found that hospitals where physicians and nurses scored highest on communication also had fewer patient safety events.

The report from HealthGrades is summarized in this article on Nurse.com. The report analyzed patient safety data for hospitalizations between 2008 and 2010.

They found that during that time period, 254,000 patient safety events among Medicare patients could have been prevented, and that 56,367 Medicare patients who died experienced one or more of these events. Data was also taken from Medicare patients’ satisfaction scores. The better the communication, the better the care.

Among the report’s key findings:

• 27% more overall patient safety events occurred in hospitals performing in the bottom 10% for nursing communication, compared to the top 10;

• 15% more overall patient safety events occurred in hospitals performing in the bottom 10% for physician communication, compared to those in the top 10%;

• 13% more patients at hospitals performing in the top 10% for patient satisfaction reported they received instructions on what to do when they left the hospital, compared to the bottom 10% — key guidance that underscores the importance of communication, according to the report.

HealthGrades conducted the analysis as part of its process for identifying the HealthGrades Patient Safety Excellence Award and HealthGrades Outstanding Patient Experience Award recipients. This year, 263 hospitals received the Patient Safety Excellence Award (http://bit.ly/JDRf3e) and 332 received the Outstanding Patient Experience Award (http://bit.ly/JIHBly), with 47 receiving both.

“We have reached a point where Americans must acknowledge the connection between communicating with their healthcare provider and their own safety and satisfaction as patients,” Kristin Reed, MPH, the author of the study and vice president of clinical quality programs for HealthGrades, said in a news release. “Our research revealed some shocking disconnects.”

For example, Reed said, catheter-related bloodstream infections were about 56% more common in hospitals with poor nursing or physician communication.

Waiting for Nurses

Posted in Nurse Safety, Nursing, Nursing News

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A new poll has found that 34% of patients who were hospitalized for at least one night in the past year said that “nurses weren’t available when needed or didn’t respond quickly to requests for help.”

The poll was conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

NPR was surprised at the findings and decided to find out more, so they put a request on Facebook for nurses to respond to the poll and provide their own stories. They received hundreds of responses, with stories about nurses feeling overworked, not getting enough breaks or even no breaks at all, and even barely enough time to go to the bathroom.

Most of the nurses who responded did not want to be interviewed for a broadcast, because they were worried about their employers’ reaction. Many were willing to be interviewed anonymously, though.

They conveyed a picture of being understaffed and overworked — even though the nursing shortage is considered to be over in most places, each individual nurse still has a whole lot on his or her plate.

“We’re always afraid that something will happen to our patients during the time we’re off the floor,” one nurse says, “and I personally don’t feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I’m off the floor.”

This nurse says she rarely stops. Not for 12 hours. She’s an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more — often eight, if she’s covering for a colleague taking a lunch break. She says there are times when she can’t leave patients’ bedsides.

“Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn’t harm them,” she says, “and I can see the call bell going off in the hallway, and there’s no way I could respond to that.”

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she “missed something.”

Another nurse likens her job to “spinning plates,” just “praying,” she says, that one doesn’t fall. “And these are human beings,” she says, “not products on conveyor belts.”

Stories like this suggest there’s a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that’s not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can’t find jobs.

“There’s not an actual nursing shortage,” Aiken says. “There’s a shortage of nursing care in hospitals and other health care facilities.”

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

“In part, it’s because our patients are sicker — coming to us with more intense diseases and disorders than they did 25 years ago,” she says. “In part, it’s because there’s so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health.”

That is terrific, of course, but it’s not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

“Nurses are the surveillance system in hospitals for early detection and intervention [to save patients’ lives],” she says.

According to one nurse, little clues from patients are critical.

“I mean, you might walk into a room, and they are breathing and answering your questions,” the nurse says, “but if you look at their neck and the jugular vein is slightly distended … taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast.”

Putting Patients First

Posted in Nursing, Nursing Home, Nursing News

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Going to the hospital is just plain not fun.

But there are some hospitals who are trying new ways to make their patients’ stays as pleasant as possible. They are working with an organization called Planetree, founded by a former patient named Angelica Theiriot.

In the 1970’s, she was very ill and had to be hospitalized. The actual care she got was pretty good, she said, according to this article on the NPR website, “but she was really horrified by the human experience that she had.” She founded Planetree with the goal of changing the health care system to be more patient- and family-centered.

After more than three decades of pursuing this goal, Planetree has “designated” 30 hospitals and nursing homes in the U.S. and four other countries as meeting their criteria as someplace that provides truly patient-centered care.

One such hospital is Fauquier Hospital in Warrenton, Virginia. Its CEO, Rodger Baker, says that while he made the decision to get Planetree certification partly for business reasons, he agrees with the organizations goals and that was a primary motivation. He decries practices such as gowns with no backs on them as “stripping patients of their dignity.”

Fauquier offers services such as making all of its patient rooms private; food is cooked and delivered to order; the walls are decorated with local art; and the hallways are carpeted. They also offer massage therapy onsite, and even bake cookies!

The hospital’s concierge (it has a concierge) says that Fauquier has a “different energy about it” since it adopted the Planetree model.

Doctors and patients seem to agree.

Interventional radiologist Adam Winick admits he was a skeptic at first.

Winick says he was particularly concerned about doing away with set visiting hours, which among other things gave patients’ families open access to the intensive care unit.

“My own little area that I was most worried about was in a code setting when the patient’s heart stops. And having the family members standing there watching I felt would traumatize the patients’ families, because they don’t understand what’s going on,” he says.

But that hasn’t turned out to be a problem after all: The hospital always makes sure a staff member is on hand to explain to the family what’s going on in those situations.

Winick also says that communication has improved between patients and staff, and between doctors and nurses as a result of the changes. Poor communication in the hospital was a key complaint in the poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

“It puts everybody in the mindset that I’m doing this for the patient,” he says. “A doctor doesn’t mistreat a nurse out of anger because he’s doing it or she’s doing it — asking a question for the patient’s benefit.”

Patients also seem to appreciate what they see as more personal care.

“It’s friendly, it’s more like home,” says Marianna Traczuk, who’s been in and out of Fauquier several times being treated for ovarian cancer. She says she prefers Fauquier to the hospital where she used to get care in Maryland. “It’s nice to have someone walk in and say, ‘Hi, how are you today?’ instead of walking by and acting as if you’re invisible.”

And how much more does all this pampering cost?

Actually, unlike many hospitals, Fauquier doesn’t charge extra for private rooms or fancy food.

And Planetree President Susan Frampton says that providing the kind of care that involves patients and their families, and that patients actually want, can cut costs. She says that one hospital system that has some hospitals in the Planetree system and some that aren’t compared its orthopedic patients.

“And they found that the length of stay was actually shorter” in the Planetree hospitals, she says. “People healed quicker, they were discharged more quickly, and so the cost of care came down. So [it was] interesting to counter that misbelief that care has to be more expensive if it’s done in a patient-centered context, or in a place that’s more pleasant to be in.”

But health quality experts like Don Berwick, the former head of Medicare, warn that the most important part of places that are designated by Planetree aren’t the fancy extras like alternative therapies or fancy food — it’s the actual involvement of patients and families in their own care.

“The amenities are nice, of course,” he says. “But what really counts in patient-centered care is that the more patients and families and their loved ones participate in their own care, really play an active role in the care itself, the better the care gets. Outcomes get better, costs fall, and satisfaction increases. So this isn’t about the amenities; this is about the core of health care.”

Berwick and other quality experts also warn that being a patient-centered facility doesn’t itself guarantee high-quality care. Patients still have to make sure the medical staff is following proper guidelines for care and getting those good outcomes. But they say that keeping the patient and family highly involved in their care is one important indicator of a good hospital.

Horizontal Violence in Nursing

Posted in Nurse Safety, Nursing, Nursing News

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Nurses can expect the occasional outburst from a patient whether verbally or physically, but when violence or bullying comes from their co-workers, nurses may find themselves unsure of how to react. Horizontal violence is when some sort of violence comes from a peer, rather than a consumer or a supervisor. Victims of horizontal violence can experience psychological distress, and their workplaces can suffer decreased morale and a higher turnover rate. But why and how does the violence start? It is a mere dislike for a co-worker or a culturally imbedded phenomenon?

One theory suggests that in order to assimilate into a group, an individual first observes the behavior, attitudes and emotional reactions that the members of the group display, and the individual then mimics that behavior in order to be accepted. This pattern is also known as reciprocal determinism. In theory then, if the group engages in bullying a co-worker, the individual who wants to join the group will engage in the same behavior. It is not surprising then that at a 15-member meeting on nursing retention, all but one member could relate a first-hand experience of workplace bullying.

In a study led by Nancy Walrafen, MS, RN, OCN, respondents scored the top five behaviors considered bullying or workplace violence, and as witnessed as being done to others, as follows:

– Backstabbing – complaining to others about one individual (77.0%)
– Failure to respect the privacy of others – gossip or talking about others without their permission (76.0%)
– Nonverbal negative innuendo – raising eyebrows or face-making (72.2%)
– Bickering among peers (72.1%)
– Covert or overt verbal affront – snide remarks, withholding information, abrupt response (66.7%)

The most egregious behavior, undermining clinical activities (not available to help, turning away when asked for help), was witnessed by 50% of the respondents. If half of all nurses witness this behavior, how is it affecting patient outcomes or satisfaction scores?

One-third of the respondents reported that they had engaged in negative behavior because they had gotten caught up in the moment or the culture surrounding them. Some did not realize that the displayed behavior was considered bullying or workplace violence.

Nurse victims of workplace bullying often do not report the incidents. Reasons for this vary, from a desire to avoid making waves on a team that needs to maintain cohesion, to feeling that one more report won’t make a difference to supervisors or administrators who have been actively ignoring a problem.

In the study, respondents were also asked to contribute positive suggestions on possible methods for dealing with workplace violence and bullying in the nursing profession. Cultural awareness and appreciation for the differences and similarities was viewed as a possible solution, especially if hospital-sponsored continuing education credits on cultural awareness could be given. One respondent suggested practicing the golden rule of “do unto others” as no one wants to be treated negatively. One nurse offered that adequate staffing could reduce much of the stress on co-workers, giving them the opportunity to focus more on their own needs. All of the respondents agreed that all levels of management should work to address and solve the problem of horizontal violence in their workplace.

Nurses Play a Crucial Role in American Health Care

Posted in Nursing, Nursing Jobs, Nursing News, Pennsylvania

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In an editorial, the Reading Eagle says that the community should take a moment to salute its nurses.

Noting that pretty much everyone has been cared for by a nurse, a nurse practitioner, or a licensed practical nurse, the editorial recognizes “all in the nursing profession who have come so far since Florence Nightingale founded the modern nursing movement.”

Nurses have always been important but are becoming even more important for a variety of reasons, including changes in the law and industry trends. Nurses are an integral part of a patient’s medical team and are consulted along with the primary care doctor, physical and occupational therapists, pharmacists, and more. Nurses are also increasingly taking on an advocacy role, studying patient histories and catching mistakes in medications.

They’re also doing more in-home care, due to health insurance trends towards shorter hospital stays.

And nurse practitioners can write prescriptions and do some of the more routine tasks that doctors usually do, thereby easing some of the pressures on the system and filling the gap left by the decreasing number of family doctors and general practitioners.

Nurses aren’t just generalists anymore. All require continuing education, and many require certification in a specialty, such as surgery, pediatrics or trauma. As was recently reported in the Reading Eagle, some nurses even are trained in the specialty of collecting forensic evidence from rape victims to be used by law enforcement in court cases.

Along with all the other changes in the profession, technology has changed nursing in ways that still are being measured.

As The New York Times reported in January: “In just a few years, technology has revolutionized what it means to go to nursing school, in ways more basic – and less obvious to the patient – than learning how to use the latest medical equipment.

“Nursing schools use increasingly sophisticated mannequins to provide realistic but risk-free experience; in the online world Second Life, students’ avatars visit digital clinics to assess digital patients.

“But the most profound recent change is a move away from the profession’s dependence on committing vast amounts of information to memory. It is not that nurses need to know less, educators say, but that the amount of essential data has exploded.”

We hope that the use of technology doesn’t replace the personal care members of the nursing profession are known for and that attracts men and women to the profession.

It is that personal care that we and other members of the health care profession depend on.