Archive for the ‘nursing perspective’ Category

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What to Do If the Nursing Board Takes Action Against You: A Lawyer and Former RN Advises

June 1, 2012

At 7 AM, when RN Michelle Flacco took over the care of 66-year-old Lester Scanlon, who had dementia and type 1 diabetes, she was notified that his blood glucose level was significantly elevated, at greater than 550 mg/dL. Ms. Flacco performed blood glucose tests three times during her shift, each time after Mr. Scanlon had eaten a meal, and each time his blood glucose level was elevated. However, Ms. Flacco didn’t notify Mr. Scanlon’s physician, nor did she administer insulin to the patient. The next shift, Mr. Scanlon was found unresponsive, with a very elevated blood glucose level. He was diagnosed with diabetic coma. The incident was reported to Ms. Flacco’s state board of nursing, and she was accused of professional incompetence. The board is seeking revocation of her RN license.

That’s the opening of “You’re Being Investigated by Your State Nursing Board” in the June issue of AJN. The case described is a composite, but it illustrates a situation that a nurse can find herself or himself in. The article, currently open access, is by Margaret E. Mangin, who practiced nursing for 12 years before becoming an attorney. For the past 26 years, she has practiced law in San Diego, primarily defending hospitals, nurses, and other health care providers. This is the latest installment of our Legal Clinic column. You might want to check it out. The table below gives the most frequent licensing violations, 1996 to 2006.

Table 1. Most Frequent Licensing Violations, 1996 to 2006 (click image for larger version)

(Please do note: We hope you’ll find the article helpful, and we welcome comments, which we now moderate. But this isn’t the best place for advocacy or extensive outward linking related to recent controversial cases that have been exhaustively treated elsewhere as well as in previous posts on this blog; we reserve in advance the right to not approve them for posting, or to remove similar repetitive linking from our Facebook page, if need be. Thank you in advance!)—Jacob Molyneux, senior editor

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Staffing: Hot Topic as Usual for Nurses

May 31, 2012

Karen Roush, MS, RN, FNP-C, clinical managing editor

Our Facebook post yesterday on an article on nurse staffing at the NPR Shots blog (“Need a Nurse? You May Have to Wait”) got a lot of responses. Staffing is a hot topic for nurses—from both a personal  and a patient care perspective. And I say “hot” because it never fails to raise emotions.

Everyone agrees that adequate nurse staffing is essential for safe, high quality patient care and nursing job satisfaction. Research has shown that it significantly improves patient outcomes.

Yet we—nurses, as well as the larger health care community—continue to debate how to determine what “adequate staffing” is and how to best achieve it. Acuity-of-care measures? Unit-by-unit mandated staffing plans? State-mandated staffing ratios? What do you think?

We’ve published numerous articles and news pieces on this topic in recent years; here are a few examples:

News, reports, and analysis (open access articles)

“Nurse Staffing Matters—Again”

“California Mandated Nurse–Patient Ratios Deemed Successful”

“Nursing Shortage—or Not”

Feature. Requires subsciption or purchase; abstract only

“Nurse Staffing and Patient, Nurse, and Financial Outcomes”

And here are some blog posts that deal either directly or indirectly with issues related to nurse staffing.

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Critical Care 2012: An Educational Extravaganza

May 29, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

So, for the 12th or 13th time (I’ve lost count), I attended the National Teaching Institute of the American Association of Critical-Care Nurses (the “other” AACN organization, not to be confused with the American Association of Colleges of Nursing) in Orlando last week. And as usual it was impressive—approximately 6,000 attendees, and rows and rows of exhibitors. There were two helicopters, a bus, and an ambulance in the exhibit hall, as well as two-story booths and classrooms. While there were some recruiters looking for staff, they were overshadowed by monitoring companies, bed and equipment manufacturers, and pharmaceutical companies.

Some highlights:

Left to right: Outgoing AACN president Mary Stahl and incoming president for 2013, Kathryn Roberts.

Kudos to the AACN for its creativity in making general sessions lively and interesting. This year, the organization held open auditions for a member to assist as “MC” for the general sessions (or “super sessions”). It was a tie, and attendees were treated to two of their own in action, hamming it up and enjoying the spotlight.

The “TED-talk” presentation style used by both AACN president  Mary Stahl and president-elect Kathryn Roberts was refreshing—and unique for nursing meetings.

I interviewed both presidents—click the link to listen to the podcast (it may take a minute to load). The 2013 president, Kathryn Roberts, MSN, RN, CNS, CCRN, CCNS, is a clinical nurse specialist in the pediatric ICU at The Children’s Hospital of Philadelphia; she chose “dare to” as her theme for the year.

My favorite session, hands down, was Elizabeth Bridges’ “Critical Care Studies You Should Know About,” in which she pulled apart recent research and evaluated it in the context of other studies. She is the only person I know who can have 500+ people laughing and learning statistical analysis. (After hearing her speak last year, I approached her to do a column for AJN. Her column, Critical Analysis: Critical Care, debuted earlier this year with “Central Venous Pressure Monitoring: What’s the Evidence?”—free until June 12. And she’s working on two more.)

The engaging super session featuring Robyn Benincasa—a firefighter, world class adventure racer (think Survivor and The Amazing Race combined), and motivational speaker—illustrated what one could achieve with team support, leadership, and perseverance. (Of course, being in superb shape for firefighting, endurance biking, and mountain climbing doesn’t hurt either.)

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The Evolution of Nursing: Always a Mirror for Cultural Attitudes, But With Some Constants

May 14, 2012

Of hygiene practices at one public institution, Hobson wrote, “The visitor found a woman with a broken leg twelve days after she had been brought to the hospital in the same miserable garments in which she fell.” In describing an almshouse (poorhouse) hospital, she said, “The condition of the patients was unspeakable; the one [untrained] nurse slept in the bathroom, and the tub was filled with filthy rubbish.”

. . . On the subject of nutrition, Hobson recounted a Friday meal in the same hospital, wherein “the dinner of salt fish was brought in a bag to the ward and emptied on to the table; the convalescents helped themselves, and carried to the others their portions on a tin plate with a spoon.”

Pediatric NP, circa 1965. Courtesy of Barbara Bates Center for the Study of the History of Nursing, Univ. of Penn. School of Nursing

These are quotes from “Key Ideas in Nursing’s First Century,” an article in the May issue of AJN by historian Ellen Davidson Baer. Baer draws on vivid primary sources  from the 19th century, such as the one quoted above, to depict stages in the evolution of nursing into a respected and regulated profession with standards and essential skills and knowledge.

Though nursing has changed a great deal since its early days, Baer sees theory and compassion as intertwined constants throughout the history of nursing, both of them very much present from the start.

She’s also attuned to ways in which the evolution of nursing reveals a great deal about cultural attitudes toward gender (specifically, the roles of women), class, race, scientific knowledge, and professionalism. As you read, it’s easy to see how far nursing has come—but also how much such matters continue to play a role in the ways nurses see themselves and in how the public views nurses.—Jacob Molyneux, senior editor  


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Nurses Week: Comparing Notes on Matters of the Heart

May 9, 2012

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

Image courtesy of Wikemedia Commons

Earlier this week I took care of a man who nearly coded, rather unexpectedly. I was standing next to his bed when his heart rate slowed suddenly and significantly, with one extraordinarily long pause between beats.

A pause doesn’t have to be extraordinarily long to feel like it is, especially when you’re standing next to someone, palpating their pulse while watching the monitor. In this case, in this five-second pause that felt like minutes, I’d dropped the bed rail, shouted out to my team, and was ready to start chest compressions when his heart beat again. His symptomatic bradycardia was treated accordingly; there were no chest compressions, and it was no code.

I had lunch with a good nurse-friend of mine who works in a nearby hospital. I was telling her how “bradycardia with a five-second pause” feels a lot like asystole, when you’re standing next to your patient, and she was telling me that her hospital had sort of cancelled Nurses Week this year. Instead of the traditional week of silly games, superlative awards, and physician-sponsored lunches, and then a later “Hospital Week,” her facility was having a combined “Team Member Week.”

“It feels like we’ve lost recognition,” my friend said. “We don’t feel appreciated, and we’re angry.”

I definitely see her point. Although Nurses Week festivities can seem campy sometimes, it’s the sentiment behind them that matters, and merging Nurses Week into an “everybody” celebration seems like a poor administrative move. I’m not sure I’d want to work for a hospital that didn’t specifically honor and recognize its nurses.

My friend and I agreed—whether in the case of marked bradycardia with a long pause, or in the exchange of Nurses Week for “Team Member Week,” the rhetoric doesn’t mitigate the reality, nor does it soften the reaction.

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‘How Can You Bear to Be a Nurse?’ – Nurses Week Begins

May 7, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

Photo from otisarchives4, via Flickr.

Many people, myself included, have mixed feelings about Nurses Week. But since many institutions have finally gotten the message that “I love nurses” shoelaces and bumper stickers are not appreciated, I’m fine with using the week to highlight nurses’ accomplishments or provide special educational programs—we should use all opportunities available to increase awareness of the value nurses bring to health care.

Former AJN editor Mary Mallison wrote an editorial for Nurses Week in 1987 that’s been deemed a classic. We’ve reprinted it in the journal, but it’s timeless in how it captures what nurses do, so here it is again (either click the above link to the article on our Web site, or just click the PDF below) for Nurses Week.

  PDF version: HowCanYouBearToBeANurse?

Posted in nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 8 Comments »

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At the Terminus of Romantic Dreams, an ICU

April 26, 2012

It was early. The sun had yet to rise, but already the ICU was filled with stark fluorescence and beeping alarms. My patient sat alone and aphasic, helpless amidst the bustle of the unit. The day stretched long ahead of us.

The circumstances of Frank’s admission were unusual. The nursing report (conveyed with a snicker) was that, while vacationing in our coastal city with his mistress, he’d slipped away and visited yet another lady friend. While engaged in an “intimate” act, he’d hit his head on the coffee table and been knocked unconscious.

The paramedic’s report backed up that version of events, but Frank’s admission CT scans of the brain weren’t consistent with head trauma. Instead, a vascular abnormality was found. He’d suffered two seizures since admission to the hospital.

by utahwildflowers/via Flickr

That’s the start of “The Love Song of Frank,” the Reflections essay in the May issue of AJN. Click on its title to read the entire essay (and, once there, perhaps click through to the PDF version for the best read). 

Those of you who know the T. S. Eliot poem “The Love Song of J. Alfred Prufrock” (beautifully spun, and a favorite of bookish adolescents for its highly quotable and world-weary take on conventional society) will recognize the irony in the title.

But the essay, by ICU nurse and regular AJN blogger Marcy Phipps, stands on its own in its sympathetic but unsentimental description of a nurse’s encounter with a man who’s reached the limits of his own brand of romanticism. Some readers may have less compassion for this man and his apparent fate than others. Either way, it’s well worth a read, and not our typical Reflections essay either, if such a thing exists.—JM, senior editor/blog editor 

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Early Spring Web Roundup: Insomnia, Early Delivery, Persistence, Painkillers, Overtesting

April 6, 2012

Cherry Blossoms, Washington, DC/by cliff1066, via Flickr

We’ve been a little quiet here on the blog this week. Maybe it has to do with the opening of baseball season or signals a hangover from media coverage of the Supreme Court give-and-take about the Affordable Care Act last week and the endless guesses about how the court is likely to vote come June. Or maybe all our nurse bloggers are using spare time to clean out closets, sweep the cherry blossoms and sale inserts from the sidewalk, purge the inbox, box up the humidifier, watch Mad Men, or whatever. But here are a few things we’d like to draw your attention to:

If the windy spring nights wake you (or your patients) to the sound of a trash can lid flying away, maybe this will help: As described in the Drug Watch column in AJN‘s April issue, a sublingual form of the drug zolpidem (think Ambien) has now been approved, with the fancy name Intermezzo, for people who wake in the middle of the night and start hearing the same song over and over in their heads or thinking of the perfect comeback to that snippy waiter.

Also in the April issue, an AJN Reports looks at efforts to get people not to opt for potentially risky early delivery of their babies, and a Reflections essay called “Giving Up—Or Not” details one nurse’s patience and persistence in trying to get a patient to start wanting to live again after major surgery. Here’s an excerpt:

We encourage, beg, cajole, and nag him—to feed himself, to sit in the chair, to roll over. Healing is work, we tell him.

But his body has turned on itself as a substitute for food. His long series of complications has left him discouraged and depressed. If staying comfortable impedes his progress, he’s willing to live with the trade-off.

Sam opens his eyes when I walk into his room, then closes them again. While I assess him, I tell him the plans for the day.

He puts a finger over his trach. “Do I have to have a bath? I feel so tired.” His voice is soft and slightly rasping.

You might have noticed recent headlines about prescription painkiller abuse in the U.S. Read the rest of this entry ?

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April Apps and Other Good Things

April 4, 2012

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

April is one of those months most people like, I think—the weather becomes consistently warmer and flowers appear. And this month, we at AJN are especially delighted because we launch our very own iPad app! As a temporary introductory offer, you can download the app for free (click here, or search under American Journal of Nursing in the iTunes app store) and get the full April issue. (Eventual pricing is still being determined.)

It’s another way AJN is providing you with accurate, evidence-based information in formats that allow you to access it when and where and how you want it. Don’t forget to subscribe to our always free audio podcasts, too—there are monthly highlights and interviews with authors.

And April is a stellar issue. This month we focus on examining how we treat people with disabilities. The cover, the editorial, and two features all deal with how we need to do better in this area. In the original research article, Suzanne Smeltzer and colleagues report on their survey of people with disabilities, querying them on interactions with nurses during hospitalizations. Their findings are sobering and should serve as a wake-up call when providing care to people with disabilities when they are hospitalized.

There’s also a poignant piece, “Hard Lessons from a Long Hospital Stay,” describing the experience of one of the authors of the research article, Michael Ogg, who despite being severely disabled from multiple sclerosis, lives independently. Yet during his four hospitalizations, he was mostly bedridden, unshaven, and often left unfed because the system is not geared towards people with disabilities nor are nurses familiar with providing care for them.

I hope these articles will increase awareness and spur some changes in how hospital-based nurses view and interact with people with disabilities (and also among faculty who are developing curricula). There’s also an interview with the authors of these pieces—just click on the podcast icon when reading the article on our Web page (or tap the icon when on the iPad).

‘Course, there’s also another CE article in the issue, articles dealing with latent tuberculosis in health care workers, managing cancer fatigue, a QI report on early post-op ambulation, news, Drug Watch, the Reflections essay, Art of Nursing, and more. You can go right to the issue on our Web site, or download the app and check it out on your iPad (the graphics are awesome!), or  of course read it in print—your choice on how you want to keep up to date.

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iPad Apps, the Future of Nursing, More: Notes from the Nurse Execs Meeting in Boston

March 26, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

AJN iPad app exhibit

Last week, the city of Boston hosted the annual meeting of the American Organization of Nurse Executives (AONE). For those unfamiliar with this group, it’s a subsidiary of the American Hospital Association and its mission is, according to the Web site, “to shape health care through innovative and expert nursing leadership.” It’s been a few years since I last attended this conference, and I was amazed at increase in both sophistication of exhibits and number and variety of sessions. There was even an iPad app for the meeting!

Best-selling authors abounded: Dan Pink, author of Drive: The Surprising Truth of What Motivates Us, opened the conference and Thomas Goetz, executive editor of Wired magazine and author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, closed the meeting. Dee Dee Myers, former press secretary to President Bill Clinton, also talked about her new book, Why Women Should Rule the World.

As at many meetings this past year, the Institute of Medicine’s Future of Nursing report figured prominently, with a track focused on interpretations and implementation of its recommendations.

I asked Linda Burnes Bolton, chief nurse officer of Cedars Sinai Medical Center in Los Angeles and co-chair of the report, if she thought nurses in hospitals felt left out of the report because of the emphasis on NPs and community health. She acknowledged that many did, saying that chief nurse executives need to do a better job in communicating recommendations to staff and in building the recommendations into strategic plans. “Every nurse in my facility received a copy of the report, and we look at our policies and practices against the report. It can help hospitals help RNs to practice better.” Read the rest of this entry ?

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