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ADVANCE Perspective: Nurses

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.
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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.

Statistics

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.

Population

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.

Challenge

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.

Conclusion

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. 

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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?

 

References

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.

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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).

 

 

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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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Why Are New Nurses Leaving?
September 29, 2014 10:47 AM by Pam Tarapchak

One in five. That's how many new nurses choose to change their job within their first year of nursing. One in three leave within two years. Given that new grads often struggle to find their first positions, one study shines a light on this interesting trend -- and why it might not be a bad thing.

These statistics were based on a study in the current issue of Policy, Politics & Nursing Practice, that was conducted by the RN Work Project, funded by the Robert Wood Johnson Foundation.

The data comes from surveys of three cohorts of newly-licensed RNs conducted since 2006.

RNs leaving their jobs (RN turnover) is costly for hospitals and also affects quality of care. Organizational costs associated with RN turnover can be as much as $6.4 million for a large acute care hospital, and studies have associated turnover among health providers with an increase in the use of physical restraints, pressure ulcers and patient falls.

The authors point out many of the problems with existing turnover numbers in the literature.

"One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there's not a single, agreed-upon definition of turnover," said Kovner. "In order to make comparisons across organizations and geographical areas, researchers, policy makers and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover."

The RN Work Project is directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University (NYU); and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo. Other investigators for this study were Farida Fatehi, MS, BDS, data analyst at New York University; and Jin Jun, MSN, APRN, CCRN, research assistant at also at the College of Nursing at NYU.

The research team noted that there are different kinds of turnover, and that in some cases, RN turnover can actually be helpful. In cases of functional turnover, a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave. Authors recommend that organizations pay attention to the kind of turnover occurring, and point that their data indicate that when most RNs leave their jobs, they go to another health care job.

"Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions' turnover rates," said Brewer. "A high rate of turnover at a hospital, if it's voluntary, could be problematic, but if it's involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story."

The RN Work Project's data include all organizational turnover (voluntary and involuntary), but do not include position turnover if the RN stayed at the same health care organization.

The RN Work Project is a 10-year study of NLRNs that began in 2006. It is the only multi-state, longitudinal study of new nurses' turnover rates, intentions and attitudes-including intent, satisfaction, organizational commitment, and preferences about work. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

What are your thoughts on nursing turnover standards? How does your facility handle the trends?

 

 

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Mandatory Flu Vaccines for Nurses: The Wrong Choice
September 8, 2014 2:22 PM by Guest Blogger

By Priscilla Ngo, BSN, RN, a staff nurse on critical care staff unit in Philadelphia and Family Nurse Practitioner student at the University of Pennsylvania School of Nursing.

For many years, the flu vaccine has been recommended for healthcare workers, especially nurses who have direct patient contact, to prevent the spread of the influenza virus from healthcare workers to their patients.

Recognizing the importance of vaccination, Healthy People 2020 has created a goal to increase the percentage of healthcare personnel who are vaccinated annually against seasonal influenza to 90%.1

Unfortunately, there has been difficulty with getting healthcare workers vaccinated, as vaccination rates have been as low as 45.5% in 2008.1

Getting desperate, hospitals and other healthcare facilities have started implementing policies mandating vaccination of their healthcare workers as a condition of employment. Many research studies do show that having mandatory vaccination policies are very effective in raising vaccination rates to above the 90% goal.

 However, instituting a mandatory vaccination policy is a drastic measure that is unnecessary.

Getting vaccinated is indeed a good way to protect yourself and your patients and should be encouraged for everyone, especially healthcare workers – but there is a big difference between encouragement and mandating.

Flu vaccination should be heavily encouraged, not mandated.

Freedom of Choice

Mandating flu vaccination violates freedom of choice for healthcare workers. Healthcare workers should have the autonomy to make their own informed decisions regarding their own health.

We as nurses are constantly advocating for our patients’ autonomy to make their own informed healthcare decisions, so why are we not advocating for ourselves?

Even the American Nurses Association came out with a statement saying that they do not support mandatory vaccination and that we “need to protect the rights of nurses to ensure that they are treated fairly and have the necessary workplace protections”.2

Voluntary Programs

Mandatory vaccination policies are not necessary because voluntary vaccination programs can be successful on their own.

Research studies have shown a significant increase in healthcare worker vaccination rates in voluntary programs over time. In one study, vaccination rates jumped from 61% in 2010 to 85% the next year in 2011.3

Research studies have also been conducted exploring the specific components of a vaccination program that are most effective in increasing rates of vaccination.  Some of the most effective components include emphasizing accountability to the highest levels of the organization, weekend access to the vaccine, and train-the-trainer programs.4

Using this information, we can strengthen voluntary programs. We can also strengthen voluntary programs by using research conducted on why healthcare workers decline vaccination. One study found that the most common reason was concern about side effects.5 If we provide better education regarding the side effects of the flu vaccine (which are not serious), then perhaps more healthcare workers’ fears would be allayed and vaccination rates would increase.

Another study found that a common reason among nurses for declining the vaccine was that they objected to being coerced or pressured into vaccination.6 If nurses do not like being coerced or pressured into vaccination, then clearly they would disapprove of mandatory vaccination policies.

Instead of enforcing a mandate that would create resentment among nurses and staff, a comprehensive voluntary vaccination program can be created using all of the research gathered regarding most effective components and reasons for declination.

With time, vaccination rates can reach the proposed goal of 90% with these strengthened voluntary programs.

Effectiveness of Flu Vaccine Questioned

After all this discussion on the flu vaccine, you have to wonder – exactly how effective is the vaccine?

We all know that the flu vaccine only protects against certain strains of the influenza virus. The Center for Disease Control and Prevention (CDC) takes an educated guess on what strains will be most prevalent during any given year, and creates a vaccine based on that information.

But really, how protected are we?

According to a recent large meta-analysis study, the flu vaccine was only 59% effective for adults aged 18-65 years old.7 This means that vaccinated healthcare workers can still potentially get the flu and transmit it to their patients. Instead, emphasis should be placed on encouraging healthcare workers to stay home when experiencing flu-like symptoms without any repercussions.

Too often, healthcare workers encounter problems when wanting to call out sick – for example, not having enough sick time or strict policies against calling out sick more than a certain number of times a year. These policies regarding calling out sick are ridiculous – if a staff member is feeling sick, there should not be any roadblocks to allowing them to stay home. Keeping sick healthcare workers at home is truly the best way to prevent the spread of the flu virus to patients.

Drastic Measures

Mandatory flu vaccination for healthcare workers is a drastic measure that is unnecessary and should not be implemented. It violates the rights of healthcare workers.

A comprehensive voluntary program using all the research that has been done in the past several years can be used instead to effectively increase vaccination rates. In addition, the flu vaccine isn’t guaranteed to be effective – more emphasis should be placed on allowing healthcare workers to stay home when feeling sick.

Certainly, mandating flu vaccination as a condition of employment can be the fastest and easiest way to increase vaccination rates to goal. But, after giving it some thought, is it really the right choice?

References 
1.  Healthy People 2020. Immunization and Infectious Diseases. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=23.  Accessed September 15, 2013.
2.  American Nurses Association. ANA Urges Registered Nurses to Get the Seasonal Influenza Vaccine: Supports Comprehensive Prevention Plan. http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2010-PR/ANA-Urges-RNs-Get-Seasonal-Influenza-Vaccine.pdf.  Accessed September 15, 2013.
3.  Modak RM, et al. Increasing Influenza Vaccination Rates among Hospital Employees without a Mandatory Policy. Infect Control Hosp Epidemiol. 2012;33(12):1288-1289. doi: 10.1086/667384
4.  Talbot TR, et al. Factors Associated with Increased Healthcare Worker Influenza Vaccination Rates: Results from a National Survey of University Hospitals and Medical Centers. Infect Control Hosp Epidemiol. 2010;31(5):456-462. doi: 10.1086/651666
5.  Palmore TN, et al. A Successful Mandatory Influenza Vaccination Campaign Using an Innovative Electronic Tracking System. Infect Control Hosp Epidemiol. 2009;30(12):1137-1142. doi: 10.1086/648084 
6.  Ribner BS, et al. Use of a Mandatory Declination Form in a Program for Influenza Vaccination of Healthcare Workers. Infect Control Hosp Epidemiol. 2008;29(4):302-308. doi: 10.1086/529586
7.  Osterholm MT, et al. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:36-44. doi:10.1016/S1473- 3099(11)70295-X. 

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Nurses: Leadership, Is it Nature or Nurture?
August 22, 2014 3:09 PM by Guest Blogger
By Sandra Ann Evans, DNP, MSN, RN, CNS-BC, CCM, patient care services, Detroit Receiving Hospital.

Nurses, let us critically think about nursing leadership. Leadership, is it nature or nurture? While most would agree that a person's charisma plays a role, I suggest that leadership skills are developed over time through learning. Those of us who are educated in the area of science readily accept that science is a learned process.

While there are known leadership traits that help a leader to lead, much of leadership is a learned process according to Quinn (1996), Goleman (2002) and Kouzes & Posner (2002).

So the good news is, for those of us who are not gifted with inherent leadership charisma, leadership abilities can certainly be learned. Leadership behavior is dynamic. In fact, today, most collegiate nursing educational programs make leadership principles a part of their curricula. Certainly programs at the graduate and doctoral level for nurses contain a significant focus on teaching leadership principles.

Many of us know skilled leadership when we see it, especially when we look at nursing leaders in our organizations. In fact, for many of us, this is the way we learn best. By witnessing effective nursing leadership in action, we too can learn the art and science of leadership. "Titles are granted, but it's your behavior that wins you respect" (Kouzes & Posner, 2007). Kouzes & Posner continue, "Leadership is not about personality; it's about behavior (p.23)."

Leadership opportunities for nurses are abounding in today's healthcare. There are leadership characteristics demonstrated in various ways all around us every single day (Kouzes & Posner). The reality is that nurses, while pursuing advancement in their careers, often inherit leadership responsibilities. In other cases, leadership roles are simply thrust upon us.

In order to advance the leadership skills that you admire most, go out of your way to fulfill these roles by becoming a member of a nursing committee/council, orientate a new nurse or obtain certification in a specialty. If you have the leadership skills that others lack, then lead others by actively passing along what you have learned to those who are willing to follow in your footsteps.

Quinn (1996) states that "change" can only begin with one individual. We can change the world only by changing ourselves (Quinn, 1996). In the course of my career, I have been in the role of both mentor, and mentee and have chosen to learn about leadership. Every nurse can choose to be a nurse leader by learning leadership behavior beginning with self exactly where they are.

References

Goleman D, Boyatzis R & McKee A. Primal Leadership: Learning to Lead With Emotional Intelligence. Boston: Harvard Business Review, 2002.

Konuzes J M & Posner BZ. The Leadership Challenge (3rd ed.). San Francisco: Jossey-Bass, 2002.

Quinn R. Deep Change: Discovering the Leader Within. San Francisco: Josey-Bass, 1996.

 

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Two Nursing Worlds that SHOULD Collide
August 19, 2014 9:54 AM by Guest Blogger

By Casey Hill, MSN, RN-BC, CEN, who is a nurse educator in Connecticut.

Recently I attended a nursing orientation at a hospital, composed of both new graduates and experienced nurses. As a nurse educator, I enjoy being in this type of setting, seeing former students grow into their new role as a registered nurse.  Yet, like my former students and everyone else in the room, I was there to get credentialed on a skill for hospital protocol purposes.

The nurse educator leading the presentation was informative, humorous and kept the tone light. When it came time for skill practice she said something that would really challenge my thought process over the next several days. She stated, “You’re not in nursing school anymore; let’s practice the real way.” 

My former students looked back at me and I laughed. I knew the instructor meant no harm in the statement and every experienced nurse knows about the two worlds that exist; Nursing school and professional practice settings. I thought nothing of at the time.

But over the next several days those nurse educators’ words couldn’t escape me. Why are there two worlds? Isn’t my purpose and everyone’s purpose as a nurse educator to be teaching best practice, to develop a competent, compassionate and safe future nurse? Moreover, after graduation and licensure, shouldn’t that nurse be empowered to take those practices learned in school and continue them when caring for patients?

It seems we have a major disconnect here in our profession. Two worlds existing at the same time does seem counterintuitive.  I have lived both aspects, I understand both perspectives. You go through school as a student; things are taken at a slower pace, every procedure dissected. Sterility held to its highest regard and every medication researched. Then as a professional nurse, conditions are altered in an instant, patient nurse ratio’s climb and both time management and prioritization must be perfected to survive.

But, now as a nurse educator, instructing the nurses of tomorrow, I feel we simply cannot have mentality of the “nursing school way” versus “real world, professional nurse way.”

Medications need to be researched whether someone is studying to be a nurse or practicing it every day. Sterility should always be maintained and time management needs to be practiced as a student, so it can be perfected as a professional nurse.

The method of caring for patients in nursing school and caring for patients as a professional nurse should be uniform. Yes, the experienced nurse is able to be more efficient and proactive.  But, being experienced does not mean that now corners should be cut and procedures should be streamlined. This is not to imply that every experienced nurse practices this way, but, I do believe this has become a sub-culture of our profession.

At the end of the day, it is all about the patient. That is something every nurse seems to agree upon. But, I believe the student nurse who learns to develop a solid foundation in nursing school, maintains it and builds upon it as a professional nurse, will be able to deliver the best nursing care possible for their patient.

So, if it really is all about the patient then, it’s about time these “two worlds” collide and experienced nurses stop forgetting about the “nursing school way” but rather embrace all that they have learned during their career. It will only make them a stronger and safer nurse.

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Response to “Trust in Us”: The Art of Nursing
August 12, 2014 6:27 PM by Guest Blogger
By Marietta J. de la Rosa, BSN, RN, who works at Lourdes Specialty Hospital of Southern New Jersey in Willingboro, N.J., and Deborah Heart & Lung Center, Browns Mills, N.J.

We go to work, we get paid, we repeat the process. It is easy for many of us to fall into the habit of just "doing our jobs" that we forget what is truly at the core of the very thing we do: patient satisfaction.

The patient experience is what ultimately drives our hospital's name forward, and what nurtures our hospital's relationship with the public at large. As mentioned in the article, "Trust in Us," a hospital's financial stability is a direct consequence of the nurse-patient relationship that is formed immediately upon admission. "Trust in Us" outlines the importance of this relationship and how it has become the forefront of hospital culture, with facilities inducting changes to various factor such as reimbursement equations, all in the name of patient satisfaction.

I believe a job done right is a job done well. Different nurses may have different mindsets as to how to gauge a job well done. Some may view a larger paycheck or a big raise as a sort of "pat on their backs," for having successfully completed two weeks' worth of seemingly endless shifts. For others, it is the approval of their superiors. Perhaps the approval from a third party - a thumbs-up from friends or the smiling faces of their children?

How about the satisfaction of patients? Hospital reviews that rave about the care, as well as the competency of its nurses is the grand scheme of patient experience. We often overlook these two important gauges in a job well done and "Trust in Us" reminds us that how a patient feels emotionally as well as physically before, during and after care can be extremely crucial to a nurse's growth, as well as the growth of the entire hospital facility.

As cleverly stated by the brilliant Maya Angelou, "People will forget what you said. People will forget what you did. But people will never forget how you made them feel."

It is easy to overlook how many people a patient will come in contact with before being admitted to our floor. It is easy for us to forget the anxiety a patient must be feeling, not knowing what to expect, being transported floor after floor.

Often, we find ourselves so pressed for time throughout a night or day of work at the hospital that empathy gives way to stress. Rather than seeing a patient as a human being to be cared for as well as treated, we begin to see them merely as jobs that need to get done - another burden on our to-do list and another admission.

It is important to keep in mind, however, that upon discharge when a patient goes out into the world, that it is not the name of the man who transported her, nor the face of the nurse that aided her that she will remember, but how she was treated and how her overall experience was.

The empathy and care of one healthcare provider can stimulate the growth of an entire facility.

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CMS Policy Hurting Hospice Patients & Families
July 29, 2014 8:40 AM by Guest Blogger

A hospice patient in Oklahoma City is being denied his medications to treat his COPD, while coping with a diagnosis and treatment for tongue cancer.  In Cadillac, Michigan a patient struggling with colon cancer is being denied insulin to treat his diabetes and is in danger of diabetic shock.  

Due to a recent and poorly thought out Medicare Part D Prescription Drug policy, dying patients are revoking hospice services to maintain access to other necessary prescriptions for diseases unrelated to their terminal illness that Part D paid for until recently.  

Patients’ families are left at the pharmacy counter with no refill of medications, after the pharmacist announces that because the patient is on hospice, the pharmacy is no longer allowed to fill their prescriptions – which in not accurate. 

Or, they are going days and sometimes weeks without the necessary medication to manage symptoms that were present before they elected the hospice benefit due to unnecessary complications in approving prescriptions under Part D. 

The intention of the new Medicare Part D policy implemented by the Centers for Medicare and Medicaid Services is to prevent the federal government from incurring duplicate costs for medications of hospice patients.  

NHPCO agrees that hospice providers should be held responsible for all drugs that are related to the terminal diagnoses and those drugs that are unrelated should be billed to Medicare Part D.   

NHPCO acknowledges that there have been instances of Part D payment for drugs that should have been covered by the hospice provider under the Medicare hospice benefit.  

“The hospice community understands there is a need to address the issue. NHPCO has worked with CMS on Part D implementation for months now with limited success,” said Schumacher.  “We requested that CMS convene several different stakeholder groups to determine the best way to carry out this process so that it would be uniform and effective and we have been denied that opportunity.”

The National Hospice and Palliative Care Organization has strongly opposed the inadequate and haphazard implementation of this guidance.   

“The guidance set forth by CMS requiring a claim to be rejected by Part D before a prior authorization process can begin  has created numerous and unnecessary challenges for terminally ill patients and their families,” says J. Donald Schumacher, NHPCO president and CEO.

“Hospice providers are being tasked with sorting out a process that is difficult, lacks standardization and is incredibly time-consuming, keeping the hospice clinician in the office when they could be in the field providing care to patients and families.”

NHPCO continues to encourage CMS to halt the implementation of the Part D guidance and convene key stakeholder groups to collaborate and create a strategic and uniform process. 

An effective solution can be reached so that Part D providers, pharmacists, hospice providers and beneficiaries have developed a coherent process together and hospice patients are not denied the medications they need at the end of life.     

With a workable system, hospice patients and their loved ones can receive the care they need without suffering, confusion and hassle of an ill-conceived process.

The preceding is the collective opinion of the National Hospice and Palliative Care Organization released June 9 in a statement to the press.

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