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ADVANCE Perspective: Nurses

Pretty in Pink
March 18, 2015 9:49 AM by Pam Tarapchak

Walking to an early morning breakfast event at the Association of periOperative Registered Nurses (AORN) conference, held March 7-11, I kept thinking of my friend, Lisa. Still recovering from a double mastectomy and reconstructive surgery during her fight with breast cancer, she would often attend shows with me in the past to cover events for our magazines. On March 9, I was attending the launch of the Medline Pink Glove Dance Video Competition. As I walked into the large gala room, it was flooded with pink lights and nearly 1,000 nurses were getting ready to kick off the competition. I sat down at a table with nurses from Boston, Kansas and Nebraska to eat my food, but we were soon all jumping to our feet as we began to honor breast cancer survivors through the joy of dancing.

The Medline Pink Glove Dance is the only campaign to unite nearly 200,000 healthcare professionals, patients, survivors and communities to share hope for a cure and honor those affected by the disease. Breast Cancer survivor and former “Dancing With the Stars” host Samantha Harris danced side-by-side with the nurses and shared her personal cancer journey.

“I knew I was in the right place when I walked into the Breast Center at St. John’s Hospital in Santa Monica, Calif. Nurses held my hand, listened to me and I never felt alone,” Harris said at the event. “Cancer had a chance to break me down but I was determined to fight back with strength and positivity.”

ADVANCE for Nurses will be highlighting the very first Pink Glove Dance video, as well as last year’s winner and other ones at www.advanceweb.com/nurses to inspire you to challenge your colleagues to enter your dance moves. The competition is running in its fifth year and includes the U.S., Canada and Panama. To register, go to http://www.pinkglovedance.com/.

According to the American Cancer Society, 1 out of 8 women in the U.S. will develop breast cancer in their lifetime. I’m thankful every day my friend, Lisa, is cancer free. With support from Medline, which has donated more than $1.6 million to the National Breast Cancer Foundation, more awareness of the disease will be able to be spread throughout the community to help those numbers finally reach zero.

NICHE: Innovation Through Leadership
February 17, 2015 1:44 PM by Guest Blogger

By Eileen Sullivan-Marx, PhD, RN, FAAN

Mark Twain famously said: “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.” There is a good amount of truth to his words but – try though we might – we cannot think away the aging process. As we get older, there will come a time when we will find ourselves in the care of healthcare professionals. When that time comes, I want to know that my well-being is in the hands of dedicated individuals who know how to not only care for me in ways that are sensitive to my unique needs, but are also solidly based in the latest evidence and carefully established protocols.

Those are important criteria. That is why when it comes to my health I, like many others, know to put my trust in nurses. Nursing interventions have long proven to have a substantive and positive impact on patient care and outcomes. When identifying the best and most appropriate interventions for older adults, a growing number of healthcare facilities look to NICHE (Nurses Improving Care for Healthsystem Elders). NICHE is an internationally recognized leader in nurse-led interventions that address critical health issues older adults face every day. The NICHE program aims to improve how older adults receive care by affecting change at the healthsystem level. To date, this approach has been highly effective, with the NICHE program successfully implemented in more than 620 facilities.

This spring, nurses and healthcare providers will meet in Lake Buena Vista, Fla., for the 2015 Annual NICHE Conference “Innovation Through Leadership.”  Join us from April 14-17 as we celebrate the numerous successes at our NICHE facilities. Then be part of our ongoing discussion about what we – as nurses and healthcare leaders – can do to ensure that our older patients receive the quality care they need and deserve.

Whether you have been involved with NICHE for years, or are just now beginning to explore this innovative program, the 2015 Annual NICHE Conference is a must-attend event. Where else can you hear about the latest innovations and initiatives being developed by NICHE sites and leading experts in geriatric care? When you leave, you will take with you a wealth of information and innovative ideas that you can adapt for your facility.

We are privileged to have two very interesting and knowledgeable keynote speakers at the conference this year. Our first is Eric A. Coleman, MD, MPH. Dr. Coleman is professor of medicine and head of the division of Health Care Policy and Research at the University of Colorado Anschutz Medical Campus, where he leads The Care Transitions Program. Our second keynote speaker is Patricia Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP. Dr. Quigley is associate director of the VISN 8 Patient Safety Center of Inquiry, where she is nationally recognized for her work in patient safety, nursing, and rehabilitation.

What else does NICHE have in store for you over the four-day event?

·       57 panel presentations during which speakers will present evidence-based approaches to promote positive outcomes.

·       Over 110 poster presentations that will dive into key topics like transitions, cognitive impairment, medication, and patient safety.

·       Our new roundtable sessions with 27 presenters who will facilitate discussions on cognitive behavior, patient safety, and transitions.

As for me, I will kick-off the conference with opening remarks on Tuesday, April 14. After that, I look forward to spending the rest of my time learning about the remarkable accomplishments being made by all of you. I anticipate getting a lot of useful ideas from you – ideas that NICHE can use to further build on its already outstanding program, ensuring you continue to make a positive impact in the lives of your patients through your relationship with us.

I hope you will be able to attend this important event. For a complete list of conference information and to register, please visit:  http://conference2015.nicheprogram.org/.

Eileen Sullivan-Marx is dean of New York University College of Nursing. NICHE is based at the college and has over 620 hospitals and healthcare facilities from the US, Canada, Bermuda, and Singapore in its network.

Championing the Capstone Experience
January 7, 2015 2:37 PM by Guest Blogger

By Agnes Gutowski, MSNc, BSN, and Ryann Nocereto, MSNc, BSN

In recent years, hospital administrators and staff nurses have reported dissatisfaction with the level of preparedness of new graduate nurses. Despite decreased availability of clinical sites, a shortage of faculty members and an increase in student volume, schools of nursing have been given the task of improving the quality of graduating nursing students. 

Schools of nursing have partnered with healthcare organizations to create an immersion program for senior nursing students, coined the “Capstone Experience.”

At our community hospital in Connecticut, Capstone students are accepted from in-state baccalaureate programs. Students choose their top areas of interest and are placed on units with staff nurses who possess a desire to mentor. This provides students with the opportunity to explore various specialties in a structured environment. As experienced nurses, we have noticed that this initiative is innovative and effective in preparing student nurses to enter the workforce. 

The Capstone program pairs students one-on-one with a selected preceptor on any hospital unit. Students become immersed in the role of staff nurse and are coached through performing full assessments, applying ordered interventions, taking part in interdisciplinary collaboration, and communicating using the SBAR technique. Students follow their preceptor once a week for eight hours during the last semester of their senior year. This program serves as preparation for their upcoming graduation and transition into the nursing profession.

At the completion of their Capstone experience, students report feeling an increased level of confidence, improved assessment skills, and a positive career outlook. In addition, hired nurses with Capstone experience have displayed a solid knowledge base and ability to adapt in their role as a patient's primary nurse. In turn, this creates improved retention rates and increased job satisfaction among new hires. Preceptors report a sense of satisfaction watching the student evolve from novice to advanced beginner at the completion of the program.  

Staff members at our hospital have responded positively to graduate nurses with Capstone experience. The program has shown to produce quality nurses who possess an understanding and increased level of comfort related to patient care. 

Fellow nurses should champion Capstone projects in their facilities to bridge the gap between academia and clinicals. With continued use of this immersion program, hospitals can expect to see competent new graduates with a true understanding of the nursing profession.

Agnes Gutowski is staff nurse, PACU, and Capstone preceptor; and Ryann Nocereto is staff nurse, surgical unit and Capstone Clinical Nurse Educator, both at Middlesex Hospital, Middletown, Conn.

Give Back — to Yourself
December 23, 2014 10:37 AM by Pam Tarapchak
For nurses, 2014 has been challenging. Just saying the word Ebola stirs up a host of images in our minds. What once was only found across the ocean made its way to the United States, and nurses were heavily involved in the care of patients - as well as becoming patients themselves. Day after day, headlines updated the world on the well-being of those who were sick, as well as the controversial decisions of one nurse being quarantined after caring for patients in Africa. Infection control practices throughout hospitals across the country were under scrutiny, as were nursing ethics.

Ebola was a large issue this year, but other nursing topics that have been in the spotlight include bullying, the ADN versus BSN controversy, and the challenges new grads face entering the profession.

Looking beyond these issues, ADVANCE highlighted hundreds of nurses working long hours doing what they do best  - tirelessly caring for their patients.

As we look forward to 2015, it's important that you recognize all that you contribute to your job and the importance of giving back some of your passion to yourself. There are always challenges around the next corner, which makes it imperative to take care of who you are first, so you can continue to care for others.

But how can you keep your well-being intact as you head into 2015? Throughout this holiday season, take the time to relax, have fun, and be yourself - spend time with your kids, visit family members, find quiet time to do what makes you happy.

I have the greatest respect for nurses and what they do, and I don't think many are recognized for the dedication they give to their patients and the healthcare profession in general. The most important thing is to be proud of what you do. One way ADVANCE wants to recognize nurses and their hard work is through the 2015 Best Nursing Team contest. Beginning Dec. 15, you can enter your team and showcase all the great work you do.

Visit http://nursing.advanceweb.com/Web-Extras/Online-Extras/Best-Nursing-Team-2015.aspx to tell us all the great work you've done over the past year. All you need to do is write a short essay highlighting the programs you've worked on to improve patient care and healthcare initiatives. Take some time to share your successes. We want to hear from you.

The Season of Giving: Cardinal Health Recognizes Nurses
December 1, 2014 2:39 PM by Guest Blogger
By Maureen Girard, RN, BSN, MBA, vice president, Marketing Management, Medical Products

Healthcare in the U.S. has experienced a dramatic shift throughout the past decade. From an increase in chronic illness and a growing aging population to the changing models in coordinated care, employees in the healthcare field, most notably nurses, are facing increasing demands. To help celebrate and bring renewed appreciation to the men and women who are at patients' bedsides day in and day out, Cardinal Health created a campaign to inform and inspire the nursing community.

RNspire, a largely digital program hosted through Facebook, is a community dedicated to recognizing nurses for their countless contributions to the healthcare industry. In the spirit of Thanksgiving, we launched a campaign encouraging fans to share ‘Thank You Notes' to showcase their appreciation to family, friends and colleagues.

The campaign was a success with more than 500 shares and further encouraging dialogue with nurses from across the country. All three campaigns have collected stories and shared special experiences from nurses stretching from New York to California. AmeriCares will receive a $5,000 donation from the Cardinal Health Foundation as a result of these shares.

As leaders and active contributors to multidisciplinary teams, nurses continue to play an important role within the ever-changing healthcare system, and constantly rise to the challenges to ensure quality and safety, care and compassion. It's because of nurses like Marvin Delfin, staff nurse at Trinity Mother Francis, and Leanne Jewell, nurse in the mother-baby unit at South Miami Hospital - both recent winners of RNspire competitions - that we created and maintained this program. It has been so inspiring to read the comments and stories that have been collected since the launch in early May.

So, tell me, what inspires you as a nurse?

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Sustainable Corporate Social Responsibility
December 1, 2014 8:54 AM by Guest Blogger

By Susan Salka, President and CEO, AMN Healthcare

Most public companies dedicate some resources to good corporate citizenship. They choose to spend these resources - time, money or both -- on endeavors aligned with the company's mission and goals in win-win situations. It's all part of a company's social responsibility. But I believe we need to take it one important step further and create sustainable CSR programs.

There are times when it is absolutely appropriate and necessary to provide support to alleviate a short-term situation. When natural disasters or personal tragedies hit, people need immediate assistance to survive and rebuild their lives. And who can argue the benefit of brightening the day of a child enduring cancer treatment at a local hospital? But in addition to these endeavors, a significant amount of time, energy and resources expended by a company and its team members should be focused on activities that result in an enduring, tangible benefit, one that builds upon its own past achievements.

The most meaningful and lasting CSR initiatives are built around the active participation of company team members. I personally encourage our team to be active at work, active in their lives and active in the community. And they've responded. We have very committed [and] purposeful people who avidly take part in our many CSR projects. So, to honor that high level of engagement, it behooves company leadership -- and me personally -- to make sure that the causes we support make meaningful and, ideally, lasting change out there.

Last year, AMN Healthcare developed a partnership with a charitable institution on the mission of a lifetime, one that effectively aligns with our business strengths, provides powerful opportunities for team engagement and results in vital and sustainable improvement in the lives of people who really need help.

The organization is HELPS International, a Dallas-based nonprofit founded by a former investment banker, whose mission is to provide integrated, long-range solutions for Central American communities in need. HELPS sends several mission trips each year to the same regions of Guatemala, with carefully designed programs that build upon successes from the prior year. As a healthcare staffing and workforce solutions company, AMN sponsored 10 clinicians for the week-long medical mission and 10 nonclinical volunteers from our staff to take part in a correlated community development project. 

As background, the highlands of Guatemala are an impoverished area with incredibly scarce medical resources. People often live in dirt-floor shacks and cook over open fires with no ventilation. The HELPS medical mission included an acute-care mobile hospital where medical professionals saw about 500 patients, many with chronic respiratory and eye diseases and/or burns from the open fires, and hernias due to carrying large amounts of wood. The community development team installed safety stoves that vent toxic smoke out of homes, use 70% less wood and reduce the incidence of burns from children falling into open cook fires. For more information visit https://helpsintl.org/.

For AMN, sustainability must be more than a buzzword; it has to be a palpable achievement. For example, the HELPS hospital and clinic created a portable health records system so that families have accurate medical charts covering many years of treatment. Continuity in treatment improves long-term patient outcomes. The stoves program reduces diseases; prevents burns; helps alleviate the heavy burdens people must carry and provides families more time to create wealth. In addition, HELPS integrates an education program for indigenous children and an economic development program to help small-hold farmers increase corn yield so they can feed their families and sell extra production for cash.

This sustainable CSR opportunity enhances the quality of our company and our entire team by fostering meaningful engagement in the world around us. Every team member who volunteered for the Guatemala mission told me it was a life-changing opportunity. Those who went came back and told colleagues amazing stories -- and showed them even more amazing pictures - of how they made worthwhile, lasting improvements in people's lives. The team engagement success of this mission is itself sustainable, its long-term value transcending the company outlay to sponsor the volunteers. The mission spreads pride throughout the company for the achievement of this year's volunteers and, looking forward, is building team enthusiasm to take part in what will become an annual mission. In addition, we were recognized by our industry association with its top award for corporate social responsibility.

The HELPS mission has quickly become the centerpiece of our CSR activities. We still support many other very important causes locally and nationwide, particularly those that involve health and wellness. But by embracing true sustainability as our principal CSR objective, we have created a partnership that manifests the character of our company and our team and ensures that our investment of resources results in meaningful achievement. I challenge every company to examine their CSR efforts to ensure they have appropriate focus on the sustainability of their activities. 

My Journey With Depression
November 26, 2014 9:41 AM by Pam Tarapchak
Late this summer, lots of people were talking about Robin Williams, discussing what he must have been going through, what would bring a person to the end thought of suicide. I was quite sad at this news, but it's a shame it takes a top celebrity's death to bring up the topic of depression and mental illness. In reality, you probably interact with someone who has the same disease/condition every day. Like me.

From experience, I know that depression brings with it much stigma. It's much different than saying you have cancer or heart disease; those conditions have solid treatments. Depression does not. So, it's not something I've shared with many people. A handful, at most. And to be honest, I'm hesitant in writing this now. I've fought a battle for almost 2 years. Very few people knew I had depression because I couldn't see past the darkness and stigma. I'm quite saddened by what Robin Williams must have been going through to have reached the point of suicide. I am one of the lucky ones who is starting to win the battle and see the light. I agree knowledge of this disease is power. But it's not an easy battle to win.

I have been on more than 15 medications that have brought on anxiety and sickness. I've attended more than 50 therapy sessions, and struggled day in and day out to get out of my bed and live my life. Anxiety greeted me every day as I turned my alarm off and I cried every morning while driving to work; I took medications that made me have poor perception, resulting in bumping into cars in front of me; I've made dates with friends only to change them once, then twice, then cancelling them; I've hidden in closets so my kids couldn't see me lose it. I was constantly looking within, and blind to everything outside of me.

Looking back, I have to say I definitely reached the very bottom of depression and saw no way of climbing out. I was at the bottom of that hole for a long time, through celebrations like birthdays and Christmas, through meetings at work and trips to conferences. Every doctor or therapy appointment I attended, I was asked if I considered suicide. And each time I always hesitated and said no, simply for two reasons - Ava and Harrison. So, sitting at the bottom, I had to find a way to climb out. I switched doctors, went religiously to therapy sessions, and literally just kept getting up each day and doing what I needed to do. I leaned on my faith and kept asking God if he could make it a little bit easier every day. There were days when I didn't think He was listening. When was He going to help me? 

Slowly, over several months, I have worked with my new doctor to titrate my medication from 6-8 pills a day down to 2. I've stretched my wings, sometimes to the point of great unease, meeting a friend for dinner, or taking my kids for a day out. I've found that I look at others quite differently because they too could be battling hidden demons. So I reach out with kind words: hello, have a great day, thanks for your help. 

My battle is not over but my climb out of depression has come a long way. I could have depression for the rest of my life, but I've learned there's strength in adversity and there are others in worse pain than I myself have felt. I'm just an ordinary person who is a mother, daughter, sister and friend. My life has been average with normal ups and downs. Depression came to rest on my shoulders and this journey has been given to me for some reason. But today I laugh more, and reach out more and feel empathy more. Moving forward, I ask you to show kindness to others and know that people may not be the person they appear on the outside. 

I'm a 45-year-old woman who is beating depression. And I'm proud of that.
An Attitude of Gratitude
November 10, 2014 10:11 AM by Pam Tarapchak

There's a lot going on in the world today that's scary. Words like Ebola, ISIS, shootings, bullying, cancer, depression and death are just the tip of the iceberg when it comes to things that probably keep us awake at night. While these thoughts can become all-consuming given the technology-driven world we live in where our phones, tablets and TVs provide us with uncomfortable images 24/7, perhaps we should start spending more time trying to find the positives in life.

Thanksgiving is coming up soon, and for many reasons we always make time to be grateful on that day when we're sitting around the dining room table. But I think it might help us deal with the reality of life if we try and practice gratitude every day of the year. In the car. At your desk. Before you go to sleep at night.

It only takes one thought. I'm thankful for my kids, and my house, and my health. I'm thankful that I have friends and my co-workers and my job. And if you take just that one minute, then perhaps that one minute will spread throughout your day and into tomorrow and perhaps next month. And if you show gratitude toward others, it becomes contagious.

Another way to show gratitude is to reach out to others in your life, to your patients and even to strangers. Smile. Listen to someone's troubles. Hold the door for the next person. Sit at the bedside of a patient and share stories. Send a card for no reason. Appreciate all the people in your life and goodness will come back to you.

I'm not trying to make you believe that if you're thankful, nothing bad will ever happen to you. We face challenges every day, lives filled to the brim with trials: financial troubles, health issues, loneliness. As nurses, you work long hours, handle difficult cases and face hard decisions every day to ensure your patients receive the best care. But if you can recognize the good things in life and be grateful for them, then perhaps the bad times might seem more manageable.

With all the negativity that has been swamping the healthcare sector recently, including nurses with Ebola, quarantines and stressors on healthcare professionals addressing infection control measures, maybe it's time we start to share our gratitude with others. We should all be thankful we live in a country where healthcare advances save lives every day. And I'm thankful for all the nurses who tirelessly care for their patients, those who teach the next generation and the individuals who handle the management of nursing initiatives throughout healthcare failities.

What are you thankful for? I'd like to encourage you to share your gratitude with ADVANCE and then we'll compile a "gratitude wall" online later this month. Through sharing, we can all start focusing on the positive things in our lives and, by doing so, can face the challenges with a stronger point of view.

Share your gratitude with me at ptarapchak@advaneweb.com.

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Men in Nursing: A Diversity Solution
November 10, 2014 10:04 AM by Guest Blogger

By Sam Osei, RN

In my opinion, I do not think the body of nursing has done enough to acknowledge the presence of males in the nursing profession in this 21st century. Low interest in nursing for men contributes to the lack of gender diversity in the profession. As a result, stereotype of nursing as a “female profession” persists. Men make up fifty % of the general population, therefore, developing strategies to encourage men to choose nursing will not only help to diversify the profession but will also help to fill the gap for the anticipated nursing shortage and eliminate the stereotype of nursing as a female profession.

Nursing Shortage

The anticipated next nursing shortage is not all about the fact that the nation’s schools of nursing are not producing enough nurses to meet the demand for healthcareservices. Neither is the shortage of nurses only about the lack of nursing educators or not enough schools available. It is also about the possible number of baby boomers retiring in the next few years. According to the American Association of Colleges of Nursing (AACN), the average age of nursing professionals is about 44.5 years as of 2012, ("AACN," 2010) and this group will be retiring in the next few years. Also, a specific elderly population in our society is living longer. Therefore, it is certain to project a cause for national crisis with too few nurses to care for such a large human population.

Furthermore, the current trend of hospitals acquiring magnet status has resulted in the hiring of Bachelor of Science in Nursing (BSN) prepared nurses and the elimination of Licensed Practical Nurse (LPN) positions. This has increased the pressure of associate degree nurses (ADN’s) to acquire Bachelor of Science in nursing degree within a set amount of time, or lose their job and there by adding more fuel to the anticipatory nursing shortage.

The nursing shortage needs to be addressed head on and I will be pleased to read first hand from your prestigious journal my suggestions for an alternative solution to combat the shortage crisis.


The nursing shortage threatens patient care, affordability, and safety. Studies have corroborated the intuitive idea that when nurses are understaffed, patient safety suffers and medical error increase (AACN, 2010). The supply of nurses in this country is made up of licensed practical nurses (LPN’s), registered nurses (RN’s) and advanced practice registered nurses (APRN’s). The profession is predominantly females and according to the National League for Nursing (NLN), male enrollment in undergraduate nursing education has increased to 16% in 2011 ("NLN," 2013). However, according to the Department of Professional Employees (DPE), only 9% of registered nurses of the national workforce is composed of men ("DPE, 2013"). It is time that the “gurus” in the profession refrain from using derogatory words in discouraging the few accepted males in nursing.

The Basics

The nursing profession is not just pushing pills and taking orders as some may think, instead, providing care beyond and above expectation. Providing physiological and psychosocial needs of our patients sometimes require using personal resources that have gone unnoticed. Kudos to most nurses who exceed expectation in care, providing basic needs such as clothing, powder, combs, and shoes to name just a few that contribute to “Holistic Care”.

On the same token, just as physical needs are not only part of the holistic care, emotional needs are also taken into consideration. What is considered “woman talk” in patient care, where by a woman nurse to woman patient is requested to resolve pertinent issue related to their care; it is likewise in “man to man talk”, male patients may feel more comfortable in discussing issues with their male nurses. The female patient also do ask for the male perspective in issues that is also pertinent to their care. It is time to look beyond the past and encourage men to pursue the nursing profession as a career.


The need for healthcare is growing. The fact still remain that people are living longer. The population aged 65 and older will double from 2000 to 2030 and the nation’s nursing care is expected to balloon over the next 20 years ("BLS," 2010). According to the Bureau of Labor statistics, the future demand for nurses is expected to increase dramatically when the baby boomers reach their 60’s and beyond (BLS, 2010). Also, the population aged 85 and older is the fastest growing age group in the U.S.

 Men make up 50% of the population, and they remain the largest source to plan for the future nursing profession. By 2020 the number of nurses will fall nearly 20% below requirement; therefore, using all resources available to attract men into the profession will not only diversify the nursing profession but also provide competent and increase choices available to the patient population in offering care. The Institute of Medicine reported that, “Men’s unique perspective and skills are important to the profession and will help contribute additional diversity to the workforce” ("IOM," 2010). We need men in nursing to enhance diversity (Vicki, 2012) and to close the gap for nursing shortage.


For these reasons mentioned, I call on the nursing profession to step up and recognize that there is only “A Nurse,” and not a male or female nurse. Every effort should be made to recognize that men are an additional resource to the profession in contributing to the “Holistic Care” teachings. This idea is worth encouraging males to pursue the profession and not to discourage them into nursing. After all, nursing still remain second to none because of the vast amount of knowledge we bring to healthcare.

I challenge all nurses, professors of nursing and the nursing profession to consider men in nursing as a viable solution to the nursing shortage and a viable resource in this great profession.


I am a registered nurse who specializes in spinal cord and brain injuries, working in a specialty healthcare facility in Connecticut. I am proposing an extensive recruitment campaign geared towards men to tap into the 50% male population. Part of the campaign effort will be geared towards eliminating the stereotype of nursing as a female only profession, and the successes of male nurses in the different nursing environments. This effort in campaigning will help open the door to accept more males in this non-traditional field of practice hence contribute to the diversity in nursing and confront head on the predicted nursing shortage.

Sam Osei is a registered nurse at the Hospital for Special Care, University of Hartford, Hartford, Conn. 

Patient GPS
November 5, 2014 11:57 AM by Guest Blogger
By Ebun Ebunlomo, PhD, faculty member of public health at American Public University

I don't know about you, but I can't imagine driving without my GPS in the glove box of my car. Even when I know my trip route, I still have an extra sense of security that if my phone dies, or I take the wrong turn accidentally, I can always turn on my GPS and get re-routed. I got my Garmin Nuvi 1490T as a birthday gift after several years of pent-up frustration from getting lost on the seemingly convoluted roads of Houston. Now, I don't leave home without making sure my little electronic friend - Hank - is intact, charged and ready to go in my car.

Navigating the healthcare system can be similar to driving on the complicated streets of Houston, if one is not familiar with the territory. In essence, people often get lost on the complex "roads" to healthcare services in this country. In light of this, several studies have shown the positive impact of patient navigators, those I refer to as Patient GPS. A Patient GPS in the area of women's health can guide women from the side streets of preventive services like mammograms to the complicated highways of understanding and selecting treatment options if or when diagnosed with breast cancer. This short video clip gives a good overview of a Patient GPS's characteristics in the breast cancer healthcare service area.1

The American Cancer Society recommends the following for women to prevent breast cancer:2

  • Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
  • Clinical breast exam about every three years for women in their 20s and 30s and every year for women 40 and over.
  • Women should know how their breasts normally look and feel and report any breast change promptly to their healthcare provider. Breast self-exam is an option for women starting in their 20s.

Although annual mammography screening is recognized as effective in reducing breast cancer-related deaths, immigrant and refugee women are still less likely to have mammography screenings due to the fact that they are less familiar with the U.S. healthcare system.3-5 Immigrant women, racial/ethnic minorities and women from low-income backgrounds are most affected by breast cancer.6-11 A recent study about Bosnian refugee women in Massachusetts found that patient navigation worked to significantly increase mammogram rates among this group of women.12 Just like my friend, Hank, a Patient GPS can keep women (especially immigrant and refugee women) from getting lost on the busy roads and various detours of the U.S. healthcare system.

What ways do you think a patient GPS can support breast cancer survivors in staying healthy? What other areas of our lives do you think a human GPS can help us?



1. Flager Hospital Cancer Institute. (2010). Role of a cancer patient navigator. Retrieved from http://www.youtube.com/watch?v=RbUkwzTj_mg&feature=related

2. American Cancer Society. (2014). American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. Retrieved from http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs

3. Norman, S.A., et al. (2006). Benefit of screening mammography in reducing the rate of late-stage breast cancer diagnoses (United States). Cancer Causes and Control, 17(7), 921-929.

4. Norman, S.A., et al. (2007). Protection of Mammography Screening against Death from Breast Cancer in Women Aged 40-64 years. Cancer Causes and Control, 18(9), 909-918.

5. Sabatino, S.A., Coates, R.J., Uhler, R.J., Breen, N., Tangka, F., & Shaw, K.M. (2008). Disparities in mammography use among US women aged 40-64 years, by race, ethnicity, income, and health insurance status, 1993 and 2005. Medical Care, 46(7), 692-700.

6. Andreeva, V.A., Unger, J.B., & Pentz, M.A. (2007). Breast cancer among Immigrants: A systematic review and new research directions. Journal of Immigrant and Minority Health, 9(4), 307-322.

7. Echeverria, S.E., & Carrasquillo, O. (2006). The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women. Medical Care, 44(8), 788-792.

8. Israel De Alba, F., McMullin, J.M., Sweningson, J.M., & Saitz, R. (2005). Impact of US citizenship status on cancer screening among immigrant women. Journal of General Internal Medicine, 20(3), 290-296.

9. Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., & Thun, M.J. (2009). Cancer statistics. CA: A Cancer Journal for Clinicians, 59(4), 225-249.

10. Pasick, R.J., & Burke, N.J. (2008). A critical review of theory in breast cancer screening promotion across cultures. Annual Review of Public Health 29, 351-368.

11. Sheppard, V.B., Christopher, J., & Nwabukwu, I. (2010). Breaking the silence barrier: Opportunities to address breast cancer in African-born women. Journal of National Medical Association, 102(6), 461-468.

12. Percac-Lima, S., Milosavljevic, B., Oo SA, Marable, D., & Bond, B. (2012). Patient navigation to improve  breast cancer screening in Bosnian refugees and immigrants. Journal of Immigrant and Minority Health, 14(4), 727-30.

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Prioritizing Communications to Improve Care Coordination
October 27, 2014 10:38 AM by Guest Blogger
By Terry Edwards is the CEO of PerfectServe.

Clinicians constantly receive texts, calls, voicemails, emails, tweets, etc., all flowing right to their fingertips. Everything can seem urgent, and it can be difficult to determine what actually requires immediate attention, what can wait and what can be handled by someone else. This can be especially problematic for nursing staff who communicate with multiple clinicians across multiple care teams and facilities. It's enough to drive anyone nuts.

In an effort to improve care coordination, many healthcare organizations are adopting solutions that would give clinicians access to all of the information they could possibly need, as soon as it's available. And while these notifications and messages are well-intentioned, receiving a high volume of incoming notifications and messages can actually backfire. Receiving too many messages can result in "alarm fatigue," driving a tendency for clinicians to simply tune out.

Instead of shuffling every piece of information to clinicians when information becomes available, we need to provide them with opportunities to appropriately filter that information so they receive what is actually pertinent to them at a given point in time and context. The Memorial City Practice of the IPC Hospitalist Group is one example of a provider that's cutting down on this unnecessary static. They've recently implemented a program that enables physicians to create a personal algorithm to drive communications to them based upon how, where and when they work.

In addition to taking steps to reduce the noise, Memorial City is also giving nurses a way to reach those physicians quickly when time is of the essence. They have developed an escalation process that first delivers an unobtrusive notification "ping" to the physician when a new message is available. Without an immediate response, a follow-up notification is delivered at the one-minute mark, and then another at 15 minutes. If the physician still hasn't responded after 15 minutes, she or he receives a phone call. By establishing this type of protocol, Memorial City is balancing the need to cut down on white noise while still giving nurses the ability to sound the alarm when necessary.

Healthcare organizations of all shapes and sizes need to support clinicians by helping them improve their personal efficiency and develop best practices for communicating with one another, and offering guidelines for how they can identify the communication events that are relevant. Doing so creates more effective communications among providers and helps better coordinate care.

At the end of the day, we can have all the gadgets in the world with information coming at us from multiple directions, modalities and apps - but it's knowing how to effectively optimize the flow of those interactions that is the key to meaningful improvement in care coordination.


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The Ebola Outbreak
October 27, 2014 8:28 AM by Pam Tarapchak

I knew I wanted to address Ebola in this editorial. How could I not? If you ask my colleagues, they'll tell you I have strong opinions about all of this. But when I think about writing a strong, clear message about the topic, it seems impossible. There is so much information, right and wrong, being manufactured on an hourly basis. On the day I wrote this editorial Oct. 18, these were some headlines I found: "Texas Hospital Employee Quarantined in Belize," "Ebola in America: Who Is Being Watched Most Closely," and "Without a Vacccine I'm Not Sure We Can Stop Ebola." What does all this mean?

As an editor, I'm a member of the media; but in this case, I believe there are too many stories coming from various media sources that foster the hysteria of the situation or give half the story. Don't get me wrong, this is a serious situation that needs to be covered, but as nurses, you have to know the best sources to find the information that will be help you protect yourselves and your patients in the coming months.

ADVANCE for Nurses has been busily creating an Ebola resource Center that includes original content written by nurses, as well as information from the CDC, including infographics and handouts on personal protective equipment and important ways to stop the spread of disease in your facility. I encourage you to take a look and find important materials you can use in your own patient and healthcare worker education: http://nursing.advanceweb.com/Web-Extras/Online-Extras/Ebola-Resource-Center.aspx

In one story, Eileen Thomas is a nursing professor at American Sentinel University in Aurora, Colo., offers her advice: "Encourage nurses to make a commitment to educating themselves rather than responding in fear. Seek information from reliable sources such as the CDC and WHO, rather than relying on information portrayed by the media alone.

"As nurses, we have a professional responsibility to become knowledgeable regarding Ebola transmission, symptoms, and prevention. If we educate ourselves first, can then educate our patients and the public to prevent history repeating itself in regards to stigma that is often associated with an infectious disease, particularly when it reaches epidemic proportion. 

Follow ADVANCE's Ebola Resource Center in the coming weeks as we continue to provide you with the resources you need to keep fighting this disease.  

Other sources you can research include the CDC (www.cdc.gov/), World Health Organization (www.who.int/en/) and the American Nurses Association (www.nursingworld.org/Ebola-Information).

As nurses, I know you have one thing in mind: the safety of your patients. This scary situation finds everyone in a place of not knowing where to turn. But as one nurse commented to one of ADVANCE's writers: "Caring for patients in what the World Health Organization acknowledged as the 'most severe, acute health emergency in modern times' may be part of her nurses' wiring. "Nurses were drawn to this role because of their capability for new knowledge and their passion for patients," she said. "They're doing what needs to be done even when there aren't others who would step forward."

Keep stepping forward, and keep learning more each day.

Email me at ptarapchak@advanceweb.com to share your thoughts on the Ebola story.

Hand Washing: Painful or Protective
October 13, 2014 9:11 AM by Pam Tarapchak

By Martie Moore, RN, MAOM, CPHQ, chief nursing officer, Medline Industries Inc.

Who would have thought that the tools you count on every day to do so much for you would become the center of incredible tension within the care delivery system? 

In many ways, these tools are a perfect example of Polarity. Polarity Management teaches us that it is not black and white, nor is it gray. It is black and it is white. When using Polarity Management theory, you consider the polar points within an issue. In hand hygiene, the polar points I am speaking about are simple and yet very complex: They are the hands of caregivers. 

Hand hygiene has become a focal point of care settings in the U.S. Many hand washing programs have an "either/or" focus to them:  Either you wash or gel your hands, or you don't. I had one infection control practitioner say to me that she did not understand why this was such a difficult issue. You just wash your hands, period, end of story. "Enough said about the subject!" 

Given that conversation, I started to research the tension around hand hygiene. I would not argue with the IP that hand hygiene is critical. I agree on that point. But I do not agree that it is as simple as just washing your hands. 

I asked caregivers across the nation how they would describe their hands at the end of a shift. More than 70 percent of the respondents said dry, itchy, cracked, sweaty or red. The majority were in the dry and itchy category. Many expressed concern about their ability to maintain care at the bedside with the condition of their hands.

When asked if they would be more compliant with hand hygiene if their hands felt better, the vast majority of respondents said yes. They also acknowledged that they use a variety of products and solutions - rom homemade to commercial - to try to address the discomfort of the condition of their skin. 

Here lies the polarity: The very action that we are asking people to do this is causing them discomfort and pain.   

When we as leaders take the approach of an "either/or" to hand washing, we miss a very important component to being successful in protecting our patients and those who provide care. We miss the simple element of pain and discomfort and the influence that has on the brain and subsequent actions of the care providers.   

Understanding how to protect and heal the skin of the care providers is a critical first step. Look at what is available to them throughout their workday. If key steps are taken on a preventive measure to preserve the integrity of the skin and hands of the care providers, they will respond to what they know is so important: hand washing. 


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More Important Than Reimbursement
October 3, 2014 9:56 AM by Chuck Holt

U.S. Rep. Earl Blumenauer (D-OR) and 33 other members of the House of Representatives recently sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner asking her "to adopt recommendations that would adequately reimburse Medicare providers for having voluntary discussions about end-of-life care and planning with patients.”

According to the letter sent to CMS on Sept. 24, the time doctors currently spend having discussions with their patients about end-of-life care and planning is not reimbursed under Medicaid and Medicare.

Unfortunately, without this incentive, these conversations are not happening.

"Patients who wish to make clear their goals, values, and wishes through discussions with their trusted providers should have the opportunity to do so,” Blumenauer notes in a press release about the letter. “In order to have these conversations, providers must have the adequate time, space and reimbursement to conduct the complex and time-consuming discussions necessary to learn about the goals and values held by their patients and plan appropriately for their care.

“Every organization that has seriously considered this issue, from the American Medical Association to the Institutes of Medicine, knows we have to start respecting people’s choices about how they face the end of life,” continues Blumenauer. “Making this simple change will have a profound effect on the way patients and their families spend their final days, and everyone deserves that dignity.”

While I fully support the recommendations in the letter from the representatives to CMS, and although I understand healthcare is a business and also recognize that the culture in the U.S. rewards those who make the most money they can by charging as much as they can for their services at every turn, I have to ask how any physician can justify on moral and ethical grounds refusing to speak to a dying patient about their wishes at the end-of-life just because they may not get paid for having the conversation.

Is there really nothing left that is more important than money?  

The other signers of the letter, all of whom are Democrats, were:

Henry A. Waxman (CA-33), Suzanne Bonamici (OR-01), Peter DeFazio (OR-04), Ted Deutch (FL-19), Sander Levin (MI-09), Jim McDermott (WA-07), Lois Capps (CA-24), Rosa DeLauro (CT-03), Keith Ellison (MN-05), Sam Farr (CA-17), Rush Holt (NJ-12), Rick Larsen (WA-02), Barbara Lee (CA-09), Betty McCollum (MN-04), James P. Moran (VA-08), Chellie Pingree (ME-01), Alcee Hastings (FL-20), Jared Huffman (CA-02), Ron Kind (WI-03), John Larson (CT-01), John Lewis (GA-05), James P. McGovern (MA-02), William Owens (NY-21), Mark Pocan (WI-02), David Price (NC-04), Linda Sanchez (CA-38), Allyson Schwartz (PA-13), Mike Thompson (CA-05), Peter Welch (VT-At large), Bobby Rush (IL-01), Janice Schakowsky (IL-09), David Scott (GA-13), and Chris Van Hollen (MD-08).



Breast Cancer Up Close
October 2, 2014 3:25 PM by Pam Tarapchak

My friend and I were supposed to meet for a walk one night. But a text popped up on my phone that she had an extended doctor's appointment that included an emergency ultrasound after an annual mammogram. The word "emergency" always makes me feel uncomfortable, but I'd been through a series of breast cysts and knew that mammograms sometimes take longer when they find those types of things.

Later that night, my friend called me to relay a story that left me speechless. After reviewing her images, her radiologist recommended she visit her physician in the same building - that day. So she made her way to the next appointment. Her doctor examined her and the images and then revealed he had taken the liberty of making an appointment with a breast surgeon - that day. Confused, she made her way across the hall to surgeon's office. During that meeting, she heard the words no woman wants to hear - I'm pretty confident you have breast cancer.

This began a journey she's still traveling.

My friend was the first person I knew personally who had breast cancer, which is pretty surprising given about 1 in 8 (12%) women in the U.S. will develop invasive breast cancer during their lifetime. There are about 232,670 new cases of invasive breast cancer diagnosed in women each year, according to the American Cancer Society.About 62,570 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer). And about 40,000 women will die from breast cancer.

As nurses, you no doubt have either cared for patients or know your own personal family and friends who are fighting a breast cancer battle. And as a nurse, you can provide a valuable resource for patients and families who must face questions, fear and the unknown. While October is Breast Cancer Awareness Month, I ask that you spread the word about this disease throughout the entire year. Below are some ideas from the U.S. Department of Health & Human Services you can incorporate into your healthcare facility's education program. Find the toolkit here: http://healthfinder.gov/NHO/PDFs/OctoberNHOToolkit.pdf

  • Send out tweets to your patients or friends. For example: Nervous about getting a mammogram? Watch this short video about mammograms and what to expect: http://1.usa.gov/fKtUB
  • Send out mammogram reminder e-cards: http://healthfinder.gov/StayConnected/ecards/DisplayCard.aspx?CardID=48
  • Partner with your community's women's organizations, community groups and senior centers to reach women ages 40 and older with important information on breast cancer screening.

And when caring for patients with breast cancer, share as many resources as you can to help them make difficult decisions about treatment, surgery and healing. Remember, you may understand radiation, lumpectomies and chemotherapy, but a patient with a new diagnosis does not. And perhaps, the most important thing you can do when encountering a patient with breast cancer is to show compassion.

After much research and soul-searching, my friend chose a double mastectomy. Two weeks post surgery, she continues the fight to get better. She received the wonderful news that no more cancer was found during the surgery and all had been removed. Now she can heal without the worry of continued treatments or cancer. Each day she gets a little stronger, and I'm thankful every day she's made it through. She's a survivor.

Let's work to spread the word on breast cancer awareness and early diagnosis and treatment - this month and throughout the year. Because there are thousands of people like me who have a friend who must hear the words "I'm pretty confident you have breast cancer." Let's get that number to zero.

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