Archive for the ‘nursing innovations’ Category

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Staff Nurses at the Center: Joyce C. Clifford’s Still Radical Notion

November 4, 2011

By Katheren Koehn, MA, RN, who is a member of the AJN editorial board

It was with great regret that I read of the passing of Joyce C. Clifford last week. She was a nurse whose career as a nurse administrator and leader was spent empowering nurses, from the bedside to the boardroom. Much has been written since her passing about her nursing leadership at the administrative level. I would like to take some time to recognize her as a nurse leader who empowered nurses at the bedside.

I first learned of the work of Joyce C. Clifford from a staff nurse who’d moved from Boston to Minneapolis in the late 1980s. The entire time this nurse and I worked together she was in mourning for the hospital and job she’d left behind in Boston. Almost every day she talked about how wonderful Beth Israel was and how great it had been to be a staff nurse there. She talked about primary nursing, nurse autonomy, and interdisciplinary respect. At the time, none of these terms were familiar to me, but I knew she was telling me that “my” hospital, where she now worked, could never measure up to the fabulous BI.

I next learned of the work of Dr. Clifford through the book Code Green: Money-Driven Hospitals and the Dismantling of Nursing by Dana Beth Weinberg. In this book, Ms. Weinberg described the nursing environment that had been created under Dr. Clifford’s leadership:

When Beth Israel Hospital adopted primary nursing on its inpatient floors in the 1970s, the hospital also adopted a host of new organizational arrangements. The architects of Beth Israel’s professional nursing practice argued that by meeting nurses’ needs, the hospital simultaneously met those of patients. Beth Israel organized itself around nurses’ work, supporting and encouraging the work that nurses did with patients.

Organizing a hospital around nurses’ work, encouraging the work that nurses did with patients! Those are sweet words to a staff nurse’s ears. No wonder my nurse colleague was mourning the job she’d left when she moved to Minneapolis! Read the rest of this entry ?

Posted in nursing innovations, nursing perspective, patient perspective, professional identity | Tagged , , , , | 6 Comments »

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So What? An Invitation to Nurses To Tell Us How They’re Translating Research into Practice

June 17, 2011

By Inge B. Corless, PhD, RN, FAAN, professor at the MGH Institute of Health Professions, Boston, and Brian Goodroad, DNP, RN, AACRN, nurse practitioner and associate professor at Metropolitan State University in Minneapolis–St. Paul, Minnesota

by centralasian/via Flickr

Crossing the Quality Chasm, an Institute of Medicine report from 2001, bemoans the chasm between our current research knowledge and the current state of care. Back in 2003, Don Berwick, now the Administrator of the Centers for Medicare and Medicaid Services, provided the following pithy codification of the problem in a JAMA article called “Disseminating Innovations in Health Care” (subscription required; click here for the abstract): “Failing to use available science is costly and harmful; it leads to overuse of unhelpful care, underuse of effective care, and errors in execution.” Berwick pondered the slow pace of innovation adoption and attributed it to three factors:

  • the characteristics of the innovation
  • the characteristics of the potential adopters
  • contextual factors

Berwick also made this observation about innovations that do get adopted: “Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all.”

Given these obstacles, what can be done to facilitate the integration of research findings into practice? What can be done to change this situation, and what would this entail?

One step is to share our knowledge and our successes in making changes, along with the obstacles to doing so. We invite nurses to identify research that has changed or somehow influenced their practice and to share their experiences with us for potential publication on this blog. We’re not asking for formal academic work here; what’s we’d like is simple, brief (one to five paragraphs) summary description in your own voice. Briefly describe the study and its findings, as you understand them—and then describe how the findings were integrated into practice and any outcomes (whether they were formally measured or anecdotally reported). Read the rest of this entry ?

Posted in nursing innovations, nursing perspective, nursing research | Tagged , , , , , , | 2 Comments »

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Confused About the Charge Nurse Role? You’re Not Alone

February 3, 2011

Charge nurses—as is often the case, there’s the ideal and the reality. Consider a recent blog post at the nursing blog At Your Cervix, which expresses some honest reservations about acting as a charge nurse—both about the challenges involved, and the lack of compensation for the added duties. Here’s an excerpt:

I’m really not so sure about this charge nurse thing. I was told when I arrived on a recent shift that I was to be in charge. I think I’ve done charge (maybe?) three times. Those times were only because there was no one available who did charge, and I was the most likely choice to do it. I haven’t been trained or oriented to do charge. It was kind of a “toss her in there and do it” situation.

If you read the entire post, you’ll learn that this blogger isn’t so sure she wants to take this role on again anytime soon. As it happens, AJN published a CE article back in September of last year (our clinical editor, Christine Moffa, wrote this post about it at the time) on an initiative which took place at the highly respected New York-Presbyterian Hospital/Weill Cornell Medical Center. Its goal was to figure out this charge nurse thing in a more systematic and sensible way.

Like so many roles in so many professions, there may be multiple versions of the same job, depending on where you work. This can be a good thing, since complex work within a complex system is difficult to reproduce by formula (hence the limitations of certain uses of “workflow mapping” done by outside consultants), but it can also be a huge problem, as the facts noted by this blogger suggest.

Our September 2010 article, “An Evidence-Based Approach to Taking Charge,” is part of our Cultivating Quality series, which looks at specific evidence-based initiatives and sees how they worked. The article about charge nurses describes the role confusion and other issues the medical center hoped to address by the initiative; gives a research overview; and addresses, in particular, the selection, preparation, and duties of charge nurses. Here’s a brief excerpt:

Our medical center doesn’t have a permanent charge nurse model; rather, charge nurses are assigned on a rotating basis. Until this initiative, the role wasn’t voluntary; all staff nurses were expected to assume the position if the need arose. The majority of staff new to the charge nurse position said they didn’t have a clear understanding of the expectations for the role. Some units had their own charge nurse descriptions; other units had none. Orientation to the role was inconsistent and unstructured. The vice president of patient care services responded to these concerns and identified a project leader who coordinated a task force to determine issues and develop strategies to address them. The goals, as established by the task force, were to

* provide role clarity.

* clearly define responsibilities and core competencies.

* provide a formalized orientation.

* develop a standardized hand-off report.

Is it possible to anticipate every problem? No, probably not. But there’s a lot more that can be done to make everyone’s life easier, and the role far more helpful—and less stressful. We hope you’ll read the article, and let us know your own experiences in this role.—JM, senior editor/blog editor

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Posted in nursing innovations, nursing research | Tagged , , , | 1 Comment »

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Neither Dragons nor Angels — Just Imperfect, Like Everybody Else

January 21, 2011

By Gail Pfeifer, MA, RN, AJN news director

I’m not a history buff, but my husband is. So I nicely went along on a recent trip with him to Virginia, visiting historic sites like Montpelier, Jamestown, Yorktown, and Appomattox. It was more fun than I’d anticipated and it really did open a door for me, showing me how much, and how little, has changed, especially in political behavior: When Cornwallis had to surrender to Washington, for example, he feigned illness and sent his second in command, General O’Hara, to do so. Washington, in return, would not accept the sword from O’Hara, directing him to his own second in command. Tit for tat.

Interior doorways, Clover Hill Tavern, Appomattox Court House

One of the things I least expected from the National Park Service was a specific acknowledgment of nurses or nursing (except for maybe Clara Barton, who established the American branch of the International Red Cross). Yet there it was at one of our Civil War site stops: a note that Dorothea Dix had visited to review care of the Union soldiers.

Although she is best known for her work improving care for the mentally ill, Dix became Superintendent of Female Nurses for the Union during the Civil War, serving for the entire duration without pay. At that time, biographers say (variably) that she was 59 or 60 years old, a strong, unmarried woman of her times. Dix was a social reformer and far from politically correct for her day. They called her “Dragon Dix” because of her outspoken opinions and her “autocratic” approach to choosing nurses who could serve under her aegis—no hoop skirts, no jewelry, and preferably plain looking and over 30. Despite her nickname, and perhaps (depending on how you view appropriate behavior in women) her flaws, you can find her described online, along with Barton, as an “Angel of the Battlefield.”

These polar-opposite labels tweaked my interest in nursing history and made me wonder: How far have we come as nurses in the eyes of those we serve, and how do these labels end up persisting over decades? Are we either dragons or angels, or will we finally be acknowledged as professionals with individual, imperfect personalities who work to improve health care? When new nurses look at nursing history 150 years from now, what doors will they see opened, by us, in 2011?

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Posted in combat nursing, media depictions of nursing, nursing innovations, nursing perspective, public health nursing | Tagged , , , , | 1 Comment »

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‘The Birthplace’: Showcasing a Collaborative Practice Model

December 21, 2010

By Sylvia Foley, AJN senior editor

Megan Tudryn, RN and expectant mother, undergoes a contraction. Photo by Alice E. Proujansky; all rights reserved.

Photojournalist Alice E. Proujansky reports in AJN this month on The Birthplace, a collaborative care practice model at Baystate Franklin Medical Center in Greenfield, Massachusetts, where a team of five nurse midwives, three obstetricians, and 35 nurses attend some 400 to 500 births annually. Except for preterm and other higher-risk deliveries, the nurse midwives manage all deliveries and monitor fetal and maternal health. Patients complete detailed birth plans that afford them various care options. Physicians are called in only when necessary; as one nurse midwife told the author, “There’s an awful lot that we can do on our own.”

How well does the model work? The Birthplace has lower-than-usual rates of medical interventions such as episiotomy, epidoral anesthesia, and cesarean section. The patients have greater autonomy and decision-making capabilities. And the practitioners “relish the collaborative approach,” says Proujansky, who interviewed several clinicians and patients for the article; her photographs appear alongside the text and on the December cover. Proujansky’s last piece for AJN, a photo essay on a Dominican maternity ward, appeared in our December 2008 issue; read it here.


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Posted in children's health, nurse practitioners, nurses, nursing innovations, patient perspective | Tagged , , , , | Leave a Comment »

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Harm Reduction or Stigmatization: What’s Your Approach to Drug-Addicted Patients?

November 1, 2010

By Alison Bulman, senior editorial coordinator

How much of your nursing education focused on how to handle drug addicts and substance abuse? Probably not much, according to speakers at a recent event I attended with my colleague Christine Moffa, AJN’s clinical editor, at the Center for Health, Media, and Policy at Hunter College.

The event was focused around a clip (longer than the one above) from “Bevel Up: Drugs, Users and Outreach Nursing,” an award-winning film by Canadian documentary filmmaker Nettie Wild. (A photo of a street nurse from the program appeared on AJN’s cover in July 2009, along with an article about the program.) Fiona Gold, BA, RN, and Juanita Maginley, MA, BSN, RN, whose work in Vancouver is the subject of the film, spoke on the panel about the value of harm reduction and about the systemic flaws and tendency to stigmatize drug addicts that prevent health care from reaching this population.

The powerful clip showed street nurses searching the city’s alleys and housing complexes for drug addicts, dealers, and sex workers. They carry bags full of syringes, condoms, and crack pipe mouthpieces which they deliver to those willing to take them. They ask street patients whether they might be pregnant, have unsafe sex, may have a disease, and if they want to have the nurses draw blood for testing.

The outreach project started in response to Vancouver’s alarming increase in HIV infections. Medical services were not reaching the most vulnerable people, so nurses devised a plan to go to them, a strategy they referred to as “meeting the client where they are.”

The nurses in the film show an amazing ability to balance gentle persistence and respect for the autonomy of their patients. We all know that some health care workers, including nurses, can be contemptuous of drug addicts, and may perceive addiction as self-indulgent and little more than a burden to the system. And far more money is spent on criminalizing drug use than on treating drug addiction as a disease.

My colleague Christine’s reaction to the clip reflected her experience as a nurse: ED nurses’ job “is difficult, and patients who are using drugs are not always easy to deal with.” But she also stressed that nurses don’t have a choice who they work with, and that the best approach we can take is to make sure they get enough training, both at school and at work, to meet the needs of this population.

To order the DVD of this film, which includes  a teaching module, go here. It’s sure to start some lively conversations among health care workers.

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Posted in advocacy/political action, HIV/AIDS, international nursing, media depictions of nursing, nursing innovations, nursing perspective, patient perspective, public health nursing, videos | Tagged , , , , , , , | 21 Comments »

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IOM Report: The Evidence Shows the Future of Health Care Rests on the Backs of Nurses

October 8, 2010

By Shawn Kennedy, AJN interim editor-in-chief

This past Tuesday, I attended the release of the highly anticipated (at least by nursing) report by the Institute of Medicine (IOM) on the future of nursing. Spearheaded and supported by the Robert Wood Johnson Foundation (RWJF), the report provides a review of nursing’s role in health care and details what changes need to occur for the future—not just of nursing, but for the future health of the health care system.

While the findings support what nursing has been claiming all along—that nurses have a critical role in health care and the health care system needs nurses to practice to the full extent of their capability—what is especially important about this report is that it is backed by the IOM’s multidisciplinary panel and an “objective evaluation of evidence according to the robust evaluation processes of the National Academy of Sciences,” said John Rowe, a committee member and professor at Mailman School of Public Health at Columbia University.

The panel at the public briefing for the release of the report included some health care heavyweights who voiced strong support for the findings:

Harvey V. Fineburg, president of the IOM: “One thing shouts out—nurses are critical to the nation’s health and central to the goals of high quality care.”

Risa Lavizzo-Mourey, president and CEO of the RWJF: “This is not a report about nursing but a report about a key missing piece to fixing health care; it establishes the centrality of nursing in providing safe, high quality, patient-centered care.”

Donna Shalala, president, University of Miami: “This report will usher in the golden age of nursing. Nursing has to be allowed to practice to the full extent of its scope of practice and to be a full partner with other professions in redesigning the U.S. health care system. It’s not about one profession substituting for another but about true collaboration.”

Later, in an interview I conducted with ANA CEO Marla Weston, she made a point of saying that allowing nurses to fully practice “isn’t just about NPs—nurses in all settings need to be allowed to practice according to their education and professional scope.  Nurses in institutional settings are often limited by bureaucratic policies and procedures.”

Prior reports by the IOM have spurred transformation of health care delivery—think of the 1999 report on medical errors, To Err is Human: Building a Safer Health System, and how that initiated a focus on creating a culture of safety and brought about new standards for hospital safety. I’m hoping the same will happen now with this report.

What the MDs say. And I hope our professional colleagues will be open to the report’s findings, though I have some doubts. The American Medical Association issued a statement that, after initially noting that “health care professionals will need to continue to work together,” goes on to reveal that the AMA believes in  “a physician-led team approach to care—with each member of the team playing the role they are educated and trained to play.” Further, it says, “increasing the responsibility of nurses is not the answer to the physician shortage.”

In that they are correct—the report is not about nurses taking on the functions of physicians; it’s about nurses doing nursing and yes, some nursing and medical tasks and procedures are the same. Physicians need to change their entrenched way of thinking that they and only they know what’s best for patients (case in point: see “No Country for Old Women,” a recent blog post by AJN associate editor Amy Collins about her grandmother) and for health care. Otherwise, we will all fail those we purport to serve.

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Posted in advocacy/political action, audio interviews, health care reform, media depictions of nursing, nursing innovations, nursing perspective, nursing research, nursing shortage, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 6 Comments »

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Promoting Awareness of Patient-Centered Care

October 7, 2010

By Shawn Kennedy, AJN interim editor-in-chief

October is, among other things, patient-centered care awareness month. At AJN, we’ve been focusing on patient-centered care for some time, most recently by virtue of our collaboration on a series of articles with Planetree, a nonprofit that “facilitates patient-centered care in healing environments.” The first article, Creating a Patient-Centered System, appeared in March 2009; the final article (from which we took the image above) was published in September 2010, and they’re all available in a collection on our Web site. Articles focus on such topics as creating quieter hospital environments and promoting patient access to medical records. We’re excited that this collaboration evolved into a four-part free webinar series supported by the Picker Institute. The final webinar, A Patient-Centered Approach to Visitation, presented by Planetree vice president Jeanette Michalak, MSN, RN, along with Wendy Tennis, BA, and Nancy Jane Schreiner, BSN, RN, will be on October 19 at 1 pm EST. We hope you will register and learn how to facilitate family visitation that meets patient needs. (The Planetree Web site also offers a downloadable toolkit and suggestions to focus attention on patient-centered care.)

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Posted in healing/holistic, nursing innovations, nursing perspective, patient perspective, Shawn Kennedy, AJN editor-in-chief, spirituality and nursing | Tagged , , , , , | Leave a Comment »

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Taking Charge Seriously

October 6, 2010

By Christine Moffa, MS, RN clinical editor      

Most hospitals have charge nurses, although how they’re selected and what they do varies not only between hospitals but often between units in the same hospital. For instance, the first time I was in the role of charge nurse it was because none of the usual suspects were working that day! And my manager’s parting words were, “Looks like you’re getting baptized with fire. Good luck.” Thanks to the work of a quality improvement team, the nurses at New York-Presbyterian/Weill Cornell Medical Center in New York City won’t have to go through what I did.

This month’s Cultivating Quality column, An Evidence-Based Approach to  Taking Charge, “describes the planning, implementation, and evaluation of a charge nurse initiative in a large academic medical center.” After reviewing the literature and identifying issues through the use of focus groups, members signed up for different quality improvement teams to develop solutions and action plans.

            The following are some of the changes implemented by the teams:

  • The development of charge nurse core competencies and a definition of the role to be used hospital wide.
  • A standardized hand-off report to be used between charge nurses going off and on shift.
  • An orientation workshop using interactive case scenarios.

See the full article for a list of the charge nurse core competencies as well as an example of a case study used during the interactive workshop. Here’s a breakdown of the charge nurse role and its responsibilities:


Let us know your experience. How are charge nurses selected at your facility? Is there consistency in the responsibilities given to charge nurses between units or shifts—for example, do they take a patient assignment or not? And are they given any special training or support from management?

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Posted in nursing innovations, nursing perspective, nursing research, professional identity | Tagged , | 3 Comments »

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Entering the Mainstream? Nursing Research at 25 Years

October 4, 2010
Logo of the United States National Institute o...

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By Shawn Kennedy, AJN interim editor-in-chief

Last Thursday the National Institute of Nursing Research (NINR) held its kick-off event to celebrate its 25th anniversary—and what could be more appropriate than holding a research symposium at the National Institutes of Health (NIH)? Scientists and researchers (nurses as well as others) whose work is supported by the NINR presented highlights of their research. (See here for synopses.)

Why it matters to all nurses. All nurses, researchers or not, should celebrate the growth and accomplishments of the NINR—its establishment provided tangible recognition of the value of the substantial body of research conducted by and/or about the nursing profession. As practitioners, where would we be without research to provide the evidence underlying care interventions or the processes of delivering that care? With the October issue, AJN highlights the NINR’s silver anniversary: on the cover, with a guest editorial by NINR director Patricia Grady, and with a timeline highlighting key milestones and landmark research supported by the NINR (click through to the PDF version to read this article). To give you an idea why nursing research matters, here’s just one entry on the timeline, from 1998:

Nancy Bergstrom, PhD, RN, FAAN, in a multisite study, tests the Braden Scale for Predicting Pressure Sore Risk and finds its predictive capability accurate. The scale is now widely used in nursing homes and hospitals.

AJN’s role in dissemination. What’s critical, though is that the outcomes of research get disseminated to those at the point of care. Researchers tend to publish in research journals, but how many nurses in clinical practice read those journals? As a general nursing journal with a wide readership, AJN covers the “broad view” of what’s important for most nurses regardless of practice setting or role. It’s our mission “to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research . . . .”

So on this 25th anniversary of the NINR, my hope for the next decade (we can’t wait another 25 years) is that nursing research will move more and more into mainstream clinical journals.

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Posted in nursing innovations, nursing perspective, nursing research, professional identity, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 1 Comment »

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