Family planning counseling, by Dick Schmidt / Sacramento Bee / Zuma Press
Unintended pregnancy can, in some circumstances, be detrimental to the health of both the women who become pregnant and the children born as a result. And such pregnancies happen far more often than you might think, accounting for nearly half of all pregnancies in this country, with even higher rates among women ages 18 to 24 and low-income women. Yet we have had the means to safely prevent such pregnancies for decades, through emergency contraception. Why isn’t emergency contraception used more often?
That’s a question author Kit Devine explores in “The Underutilization of Emergency Contraception,” one of April’s CE features. First, Devine describes the four methods currently available: conventional oral contraceptives and the copper intrauterine device (IUD)—both are used for birth control and can also be used to prevent pregnancy after intercourse has occurred—and the agents levonorgestrel and ulipristal acetate, which are FDA-approved for emergency contraception. Effectiveness ranges from 51% to 62% (for conventional oral contraceptives) to as high as 99% (for IUDs).
It’s no surprise that the recent economic recession caused many older nurses to return to the workforce or to delay retirement and work longer hours, thus easing the projected nursing shortage—at least for the time being. But nurse researcher Carol S. Brewer and colleagues wanted to understand how the recession affected new nurses’ work attitudes and behaviors, in particular those related to turnover. What they found has many implications, both now—although the recession is reportedly over, we’re still in an economic slump—and as the economy recovers.
To learn more, Brewer and colleagues compared data for two cohorts of newly licensed RNs. The first cohort consisted of 983 new nurses licensed between August 2004 and July 2005 who were surveyed before the economic downturn; the second cohort consisted of 1,765 new nurses licensed between August 2007 and July 2008. The survey tool included questions on attitudinal variables in four areas: personal characteristics, work attributes, work attitudes, and job opportunities. The researchers report the results in this month’s CE–Original Research feature, “New Nurses: Has the Recession Increased Their Commitment to Their Jobs?”
Among the key findings:
Commitment to the profession was high in both cohorts. Most (82%) of the RNs in each cohort strongly agreed with the statement that within one year they planned “to have a job that requires an RN license.”
Income and job satisfaction levels were about the same in both cohorts.
Nurses in the 2007–2008 cohort were significantly more likely to be searching for a new job, although they also reported a significantly greater intent to stay with their current employers than the 2004–2005 cohort did.
The 2007–2008 cohort perceived significantly fewer job opportunities, both locally and nonlocally, than did the 2004–2005 cohort.
The researchers concluded that
despite some improvements in working conditions, newly licensed RNs may just be waiting for the recession to end before changing jobs. Health care organizations’ efforts to improve RNs’ working conditions and wages, and to implement or support existing programs aimed at increasing retention, should be continued.
For more study results and an intriguing discussion about what it all means, read the article (for easier reading, open the PDF). And if you’re a newly licensed RN (or if you’re not, but this topic resonates for you), please weigh in here—how has the continuing economic slump affected your job satisfaction and intent to stay?
In January 2009 an independent community hospital in Massachusetts switched from using older, outmoded IV pumps to using “smart” pumps—pumps that have built-in computers with libraries of information on selected drugs and fluids, including predetermined concentrations and volumes with relevant administration limits. Library subsets (called profiles) contain information specific to certain patient populations or care areas. When properly implemented, these devices can be invaluable tools in reducing the risk of medication errors and improving patient safety.
Photo courtesy of Alaris
But when the hospital conducted a review, it found that smart pump libraries had been used in only 37% of all smart pump infusions done between January and June. One reason was that no “owner” had been assigned to oversee the implementation process. So the hospital’s nursing quality team (NQT) and pharmacy quality team began collaborating to find ways to increase nurses’ use of the pump libraries.
Medicare is confusing for providers who aren’t yet familiar with it. Here’s a Nursetopia post that draws attention to its complexity and notes the useful video above (it’s one of a series of videos on different aspects of Medicare). Those of you who know all about it already: Drop by her thoughtful (and consistently updated!) blog and let her know your own tips on handling the ins and outs of Medicare and Medicaid.
Plus a brief note on reader comments: we’ve been getting a lot of great comments lately on this blog, and we’re grateful for that. So thank you. A fair number of the comments were on posts from previous months, such as this post comparing U.S. and Australian health care systems. Is somebody by chance teaching a nursing course that requires students to leave thoughtful, respectful, engaged comments in the blogosphere? If so, bless you!—JM, senior editor/blog editor
Frank Jones, age 83, arrives at a local trauma center after falling down a flight of stairs in his home. Initially diagnosed with two fractured ribs, a fractured ulna, and a fractured tibia, he’s admitted to the ICU. At first, things seem to go well—his electrolytes and bloodwork appear to be within normal limits, and his vital signs are stable. But the next day he becomes increasingly unstable. What’s going on?
Stairs by spivvo, via Flickr
Trauma is currently the seventh leading cause of death in older adults—and older adults are more likely to suffer complications and die than are younger ones. But as author Christine Cutugno points out in this month’s CE, “The ‘Graying’ of Trauma Care: Addressing Traumatic Injury in Older Adults,”advanced age isn’t a predictor of trauma outcome. Many trauma-related complications are preventable.
What guides current care? While standards of care for geriatric patients and for trauma patients exist, as yet none have been specifically developed for and tested in geriatric trauma patients. Until that happens, Cutugno writes, “nurses will need to be guided by measures known to prevent iatrogenic complications in other patient populations.”
To that end, Cutugno first reviews common mechanisms of traumatic injury in older adults and discusses the effects of aging and comorbidities. She points out that older adults usually have poorer physiologic reserves and are less able to maintain homeostasis. Their compensatory responses may be inadequate. The drugs taken to manage many comorbidities can mask warning signs. In short, it can be challenging for nurses to recognize when a geriatric trauma patient is in trouble. Read the rest of this entry ?
A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.
ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So it’s essential for providers and patients to talk about the possibility of deactivation, well in advance of such crises.
Russo, the coordinator of the pacemaker clinic at the Department of Veterans Affairs Medical Center in New York City, wanted to better understand why providers and patients weren’t discussing this possibility and to find ways to promote more timely discussions. Read the rest of this entry ?
Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,
On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”
By Medora McGinnis. Medora is a student at Bon Secours Memorial College of Nursing in Richmond, Virginia, and the 2011-2012 Imprint Editor of the National Student Nurses’ Association (NSNA). This is her first post for this blog.
There was a time when the majority of all nursing programs were diploma programs, emphasizing practice over theory. They were largely based out of hospitals and proved very well suited for this training. Popular among students, they provided the majority of the nursing workforce well into the 1950s. But these programs began to lose popularity as they were supplanted by other forms of training. At the same time, patient care was shifting and hospital care costs were exploding. By the late 1970s, 40 diploma programs were closing their doors every year.
The year is now 2011, and there are less than 40 diploma programs nationwide. I am a senior nursing student in one of these programs, and have been a part of their transition from the diploma to the four-year BSN. My graduating class will be the last of the diploma graduates, and many of us plan to continue our education and quickly complete an RN-to-BSN program. Why? Certainly to maintain our momentum, and to be competitive in today’s workforce. But the undertone in the nursing community, especially among young and new nurses, is that the BSN is required in order to earn respect. Read the rest of this entry ?
By Sylvia Foley, AJN senior editor In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.
Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?
There is strong evidence that a hospital’s use of a medical emergency team (MET) helps to decrease the rates of in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality. (A MET is similar to a rapid response team, but is typically led by a physician rather than by a nurse.)
But our understanding of such teams is incomplete. Nurse researcher Margaret Pusateri and colleagues set out to explore, in particular, the role of non-ICU staff nurses during a MET call. They wanted to better understand such nurses’ familiarity with and perceptions of the MET, and possibly, to increase the team’s effectiveness. So they sent a survey to 388 non-ICU staff nurses at a large urban teaching hospital; 131 nurses (34%) responded.
The authors report on the results in May’s CE feature (for optimum reading, open the PDF version). Among their findings:
Nearly three-quarters of the respondents had participated in a MET call.
The most common actions they reported taking during the call included relaying patient history, initiating the call, and documenting MET data.
But fewer than half of the respondents agreed or strongly agreed with the statements “I feel comfortable with my role as a member of the MET” and “I know what my role as a member of the MET is.” Read the rest of this entry ?
Names and identifying details of all patients mentioned have been changed to protect their privacy.
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