Archive for the ‘Shawn Kennedy, AJN editor-in-chief’ Category

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AJN’s January Issue: Perceptions of Employment-Based Discrimination Among FENs, Self-Management of Incontinence, Book of the Year Awards, More

December 26, 2013

AJNJANAJN’s January issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Experts say that nursing shortages could reappear as soon as 2015. Historically, foreign-educated nurses (FENs) have been essential in filling those spaces. This month’s original research article, “Perceptions of Employment-Based Discrimination Among Newly Arrived Foreign-Educated Nurses,” surveyed FENs to determine whether they perceived they were being treated equitably in the U.S. workplace.

Earn 2.5 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page. The podcast is also available on our Web site.

Incontinence can have many distressing physical and social outcomes, and many sufferers try to deal with the condition on their own. “Self-Management of Urinary and Fecal Incontinence” provides nurses with strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence. Earn 2.3 CE credits by reading this article and taking the test that follows.

Violence is a recognized public health problem in the Unites States, and the media’s focus on recent tragic stories has likely reinforced the common perception that mental illness causes violence. “Mental Health and Violence,” an article in our Mental Health Matters column, reviews the relevant research and describes how all nurses can identify the signs and symptoms of potential violence in their patients. Listen to a podcast interview with the author on your iPad by clicking on the podcast icon on the first page of the article or download the podcast from our Web site.

Last year, a new and severe acute respiratory infection was discovered in Saudi Arabia. “Middle East Respiratory Syndrome (MERS-CoV),” an article in our Emerging Infections column, describes the rapid identification of the causative organism and the story of how this often deadly infection was tracked.

Looking for a good read? The votes are in, and the winners of AJN’s annual Book of the Year Awards are listed in this issue. A supplemental online-only companion to the article provides the judges’ reviews for each book.

There’s plenty more in this issue, including an update to an article on resources for leadership development that we originally published in 2006 and AJN‘s special “Annual Year in Review 2013” in In The News. And don’t forget to check out our January cover. AJN’s take on Norman Rockwell’s Before the Shot, painted by Jerry Miller, shows a primary care provider we’re increasingly likely to see in today’s changing health care landscape: an NP. For more on the growing role of the NP, see this month’s editorial, “The New Paradigm: The Nurse as Family Doctor.”

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Worsening Global Health Workforce Shortage: What’s Being Done?

December 9, 2013
JM: photo emailed to you. Photo is of Frances Day-Stirk, president of the International Confederation of Midwives, and David Benton, CEO of the International Council of Nurses. Photo courtesy of Marilyn DeLuca, consultant, Global Health - Health Systems  and adjunct associate professor, College of Nursing, New York University.

Frances Day-Stirk, president, International Confederation of Midwives, and David Benton, CEO of International Council of Nurses. Photo courtesy of Marilyn DeLuca.

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

While it might seem—based on what we see in our own country—that there is no shortage of health care workers, there is indeed a global shortage and it’s only going to get worse. We reported on the global health workforce last year; new reports are revealing just how much worse things may get. According to the World Health Organization (WHO), by 2035 there will be a shortage of 12.9 million health care workers; currently, there is a shortage of 7.2 million.*

The shortage is being exacerbated by a confluence of occurrences:

  • the aging population is living longer and with more illness
  • noncommunicable chronic illnesses like cancer, cardiovascular disease, and diabetes are increasing worldwide
  • many undeveloped countries lack educational facilities for training new professionals
  • experienced health care workers migrate to developed countries for better working conditions and pay

Discussions focused on how nations individually and together can develop and strengthen the workforce to meet Millenium Development Goals and attain the goal of universal health coverage. The result was the Recife Declaration, a call to action detailing what needed to be done to address the problem, asking nations and organizations to commit to a goal of universal health coverage for all, and committing resources to develop the workforce to provide it.

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Preventing Violence Against Nurses

August 29, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

shawnkennedyWhen I graduated from nursing school, my first job was as an ED nurse at Bellevue Hospital in New York City. We’re talking about the 1970s, when drugs were plentiful and plenty of young people used them, especially hallucinogenic drugs like LSD and mescaline. Many times these patients were violent because of “bad trips” or because as the drugs wore off, they “crashed.” Sometimes these patients were accompanied by friends who were just as stoned as they were. I often experienced situations in which patients or visitors became disruptive and sometimes violent, usually because they didn’t understand what was happening to them or because they were scared and paranoid. We had no strategy or guidelines for proceeding—it was pretty much trial and error. Sometimes reasoning worked, but often it didn’t, and then we called security.

Dan Hartley.

Violence in the ED and hospital setting hasn’t gone away. In fact, I just learned from Dan Hartley, an epidemiologist with the National Institute for Occupational Safety and Health (NIOSH), that according to data from the Bureau of Labor Statistics, between 2003 and 2010 the health care and social assistance industry accounted for almost two-thirds of nonfatal occupational injuries and illnesses. I spoke with Dan (you can listen to the podcast here) about workplace violence and about a new educational program from NIOSH to help nurses deal with violence (physical as well as verbal and emotional abuse) in their work settings.

Hartley and Marilyn Ridenour, a nurse epidemiologist at NIOSH, led a team that developed an online CE course, Workplace Violence Prevention for Nurses, which is available for free. The course covers “the key elements of a comprehensive workplace violence prevention program, how organizational systems impact workplace violence, how to apply individual strategies, and develop skills for preventing and responding to workplace violence.” Read the rest of this entry ?

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Future Nurses—No Shrinking Violets

June 24, 2013
Thelma Schorr and Kathryn Brownfield.

Thelma Schorr and Kathryn Brownfield

By Maureen Shawn Kennedy, AJN editor-in-chief

Last week I had the opportunity to meet several members of the National Student Nurses Association (NSNA) board of directors when they were here in New York for a board meeting. As is custom, NSNA chief executive officer Diane Mancino invites many of the NSNA sponsors and supporters to dinner to meet the new board.

I had the pleasure of meeting Kathryn Brownfield, the nursing student editor of Imprint, the NSNA’s official publication. She’s a nursing student at Nash Community College in North Carolina. We sat with Thelma Schorr, AJN’s former editor and publisher (and a consulting editor at Imprint) and Florence Huey, a former editor of AJN and of Geriatric Nursing (and a former president of the NSNA). It was like homecoming!

I was impressed—as I always seem to be—with these aspiring nurses. Many of them are second-degree students and come into nursing with work experience, a family, and a maturity that was lacking in my cohort, which was largely younger, right out of high school, with little work experience.

I wonder how these nursing students will fare in their first nursing jobs. One hears a lot about bullying and lateral violence and how it’s driving some new nurses away. I can’t imagine any of the students I met being cowed by overbearing coworkers.

In November, NSNA will host its mid-year conference, which typically draws 1,500 attendees; this year, it will be held in Louisville, Kentucky.

We’ve been able to publish some very engaging blog posts by NSNA members in the past. These two posts by Medora McGinnis, a former editor of Imprint, were particularly popular:

“Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect”

“Practically a Nurse: Life as a New Graduate RN”

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At Least Once in Every Nursing Career: Final ICN Congress Recap

June 4, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

from Great Ocean Road in Australia

from Great Ocean Road in Australia

Here’s a final recap of my trip last week to the 25th quadrennial congress of the International Council of Nurses (ICN). (My previous posts on this year’s ICN events are here and here; there’s also a podcast of my interview with outgoing ICN president Rosemary Bryant.)

My final few days were busy with sessions as well as a meeting with some members of AJN’s International Advisory Board. Here are some highlights:

  • Nurses and the Nazis. A session on ethics led by Australian nurse Linda Shields examined nursing in Nazi Germany and discussed how nurses might have rationalized participation in Nazi euthanasia and killing programs. She noted that aside from the usual “just following orders” mantra, obedience was tied to housing and livelihood, as well as to the belief that “the health of the volk (community) was more important than the health of the individual.” (The topic brings to mind our 2009 article, “The Third Reich, Nursing, and AJN [abstract only], which made the case that “in the interest of promoting international cooperation and an image of nursing unity, AJN shirked its duty to hold German nurses accountable” for complicity in the Holocaust.)
  • Nursing visibility. Presentations by Canadian nurse union leaders reminded me of home: they talked about campaigns to make what nurses do more visible, noting that if RNs were invisible and their work not valued, they would be at high risk for job cuts. Debbie Forward, president of the Newfoundland–Labrador Nurses Union, talked about “role clutter” and the loss of an RN identity when one couldn’t distinguish RNs from other health care providers, and she described a union campaign—the Clarity Project—to protect and promote the RN role. Sandi Mowatt from the Manitoba Nurses Association, which represents all levels of nurses, talked about initiatives to protect and support all nurses. Ten years ago, she said, only 26% of their members would recommend nursing as a career because of dissatisfaction with workplace policies and wages; today, 72% of nurses in the union would recommend nursing as a good career. Read the rest of this entry ?
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Dispatch #2 from Melbourne: Dues, Election Results, Nursing at the WHO

May 21, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

There’s lots happening at the International Council of Nurses (ICN) meeting and I’ve logged more walking miles here in Melbourne in the last two days than I do in a week at home.

Judith Shamian

Judith Shamian

On Monday, the Council of National Representatives (CNR), the ICN’s governing body, announced election results. Judith Shamian, a well-known Canadian nursing leader, was elected the 27th president of the ICN. (For more information about Judith and other election results, read this press release.)

The CNR also agreed to address issues related to membership models and will move forward with a plan designed to support inclusiveness and membership growth in national associations. The plan also includes a tiered voting model that takes membership and percentage of membership into account. (The final vote will take place at the 2015 Congress).

Bryant

Rosemary Bryant

New dues scheme: will RCN return? The CNR approved a new scheme for dues that should address the issue that led the Royal College of Nursing (RCN) to withhold dues, resulting in its suspension from the ICN and its recent vote to withdraw from the ICN. According to ICN president Rosemary Bryant, Norway and Japan, who were also unhappy with their dues payments, were pleased with the new model. She is hopeful that the RCN will be as well. (A podcast interview with Bryant can be listened to at our podcast conversations page here.)

I spoke with David Benton, chief executive officer of the ICN, about the RCN’s two-year suspension. According to Benton, the ICN had no choice. “The RCN made a unilateral decision in 2010 with no attempt to negotiate another resolution,” he said. He added that as a long-time member and a fellow of the RCN, he’s personally saddened by its decision to withdraw from the ICN. He noted that only a small portion of RCN’s dues goes to ICN membership and that other countries with far less resources continue to support the ICN’s work. He, too, is hopeful that the changes recently approved by the CNR will prompt the RCN to reconsider its position.

Meanwhile, two new associations were admitted to the ICN: the Chinese Nurses Association and the Palestinian Nursing and Midwifery Association (read more here).

Invisible nurses at the WHO. Another issue, not new but perhaps one that is coming to a head, is the “eradication of nursing expertise at the WHO.” Nursing positions, especially leadership posts, have been disappearing from the WHO headquarters and regional offices and are now at an all-time low of 0.6% (down from 2.6% in 2000).  (See AJN‘s July 2011 editorial and July 2012 report on this.) According to a document issued Monday, the CNR “calls upon the WHO Director General to urgently reinstate the vacant positions of WHO Chief Nursing Scientist  at WHO headquarters and urges regional directors to retain and strengthen senior nursing advisor positions in their regions.”

I also attended several interesting sessions: Read the rest of this entry ?

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Dispatch from Melbourne: A Significant Loss for International Council of Nurses?

May 20, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

So this week I’ve traveled halfway across the world to Melbourne, Australia, where the International Council of Nurses (ICN) is holding its 25th quadrennial meeting. Nearly 4,000 nurses from 134 countries are expected to attend. There’s a mind-boggling number of concurrent sessions—there must be about 60 sessions each hour, offering glimpses into various  international  health problems and solutions from nurses.

Chinese Nursing Association at ICN 2013

Chinese Nursing Association at ICN 2013

A river of nurses. Sunday morning was the opening plenary. I left my hotel at 8:30 am to walk to the convention center along the Yarra River, which runs through this very metropolitan city. I began as a fairly solitary walker, but was soon joined by other walkers, mostly women, all carrying the same ICN2013 conference bag, all walking purposefully in the same direction. We were mostly middle-aged and dressed in sensible walking shoes and “business casual” clothes, and must have looked like a well-dressed walking club to those biking and strolling past. I was quickly reminded that, for all our differences in language and customs, we’re all pretty much alike.

Missing this year from the Congress of Nursing Representatives, however, is the Royal College of Nursing (RCN), which represents nurses from the United Kingdom. The RCN was suspended for failing to pay all of its dues and now is expected to withdraw membership from the ICN. In April, over 91% of members attending (539 of 588 present) an “extraordinary general meeting” voted for withdrawal. The precipitating issue for the RCN was the breakdown of negotiations to reduce its annual dues payment, which is currently about 600,000 pounds (about 1.8 pounds per member). Though a number of RCN members forcefully dissented from this decision, this dues payment was, according to the RCN, “unsustainable.” The question that no one is asking is, “Will any other members follow suit?”

More to come . . .

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Misplacing Our Focus on Quality Improvement

April 24, 2013

Gold_StarBy Maureen Shawn Kennedy, AJN editor-in-chief

I welcome manuscripts written by nurses in clinical practice, especially comprehensive updates on managing a clinical syndrome or a common problem that readers would find informative and interesting. I call these the “meat and potato” papers—the ones that provide substantial content, the need-to-know information that will help nurses provide quality, evidence-based care. The best ones discuss the physiology and pathology underlying clinical symptoms, practice implications for ongoing monitoring and management, and patient and family teaching and concerns.

The other papers I value are those that describe quality improvement initiatives or processes that improve outcomes and, by following the SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines, are sufficiently detailed so that others can replicate them. (For information on what we seek to publish, see a recent blog post.)

Lately, though, I’m seeing more and more submissions that are not so much focused on how to use best practices to improve care, but rather on ways to improve scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The authors typically describe the impetus for the improvement as low scores, get administrative support to set benchmarks for improving scores, and define success as improved scores. Often the changes are clinically insignificant but scores increase, so everyone is happy.

While the HCAHPS is a national measure that has been adopted as a measure of quality, it’s important to keep in mind that it measures the patient’s experience and satisfaction with only a few selected aspects of care, such as, according to the official HCAHPS Web site, “communication with nurses, communication with doctors, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.” And because these measures  are tied to reimbursement, they receive a lot of attention.

There are many more aspects of care—treatment based on evidence, thwarting complications, early mobility to prevent pressure ulcers, adequate patient and caregiver teaching to prevent readmissions, to name a few—that are not measured in such a direct way and that may not be visible to patients and families, but may be more critical to a successful hospital experience.

We need to take a balanced approach to assessing quality and to be sure we’re placing emphasis on the right things. And while patients and their families are—or should be—at the center of what we do, our improvement initiatives shouldn’t be focused on getting a “gold star” for customer service.

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In Memory of the Victims in Newtown

December 17, 2012

shawnkennedyBy Shawn Kennedy, AJN editor-in-chief

I could scarcely watch the news coverage of the horrific shooting that occurred in the small Connecticut town of Newton on Friday. It was just too awful. Children no older than seven, all shot, along with several teachers, by a young man who had already killed his mother and who later took his own life after causing unimaginable carnage. When the first reports emerged and newscasters were speculating on the number of people killed, I recalled then-mayor Rudy Giuliani’s reported response to a journalist who asked him how many were killed in the 9/11 attack on the World Trade Center: “More than we can bear.”

As nurses, we are no strangers to what happens when violence occurs. We see the results of it every day in our workplaces. Individuals, families, and communities are changed forever, and often we as caregivers are, too. What begins as an ordinary day becomes a tragic milestone: future events are remembered as “before” or “after” the event.

I’m tired of hearing “Guns don’t kill people, people kill people.” Yes, but some guns make it a heck of a lot easier to do so, and in large numbers. We’ve had Columbine, Virginia Tech, the Aurora movie theater, a Portland mall, Congresswoman Gabby Giffords and others on an Arizona street, and now Newtown.  And as I was writing this, the Chicago Tribune reported that a 60-year-old man in Indiana was arrested after threatening to set his wife on fire and kill people at a nearby elementary school. He had 47 guns in his house.

What are we waiting for?  Automatic weapons are too readily available; we need sensible restrictions on the purchase of automatic weapons. These are not hunting or sport shooting guns; they are rapid-fire machines designed to kill multiple targets in a short period of time. Some question whether anyone other than law enforcement and the military should be in possession of these guns. What does it say about us as a nation that we allow the greed of special interest groups and the politicians who cater to them to continue to block what is clearly for the common good?

In a Sunday column, Nicholas Kristof points out that, in the 18 years before Australia enacted gun control legislation limiting the sale of rapid-fire rifles, there were 14 mass shootings. There have been none since the law was passed.

There are more than 3.1 million nurses in this country. Although we are largely fragmented, choosing affiliations with many different organizations, this violence should bring us together with other health care colleagues to support changes in legislation around ownership of automatic weapons.


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Veterans, Nurses, and PTSD

November 12, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

Vietnam Women’s Memorial, Washington, DC. Courtesy of Kay Schwebke.

Veteran’s Day was officially yesterday, November 11, but many will mark it today with a day off from work and school and for some reason, shopping. I’m not sure when or why Veterans Day became associated with bargains, but it seems especially out of place this year, as we hear more and more about the issues being faced by the thousands of new veterans. As I note in my November editorial, an Institute of Medicine report estimates that 13% to 20% of returning veterans from Iraq and Afghanistan “have or may develop PTSD.”

Last month, I had the opportunity to spend some time with Brigadier General (Ret.) Bill Bester, former chief of the Army Nurse Corps. I interviewed General Bester about his career and veterans’ health issues. The general was engaging and candid about the difficulties returning veterans face and he spoke about the post-deployment transition period that can be difficult for returning veterans.

He also spoke about his current activities as a senior advisor for the Jonas Foundation’s Veterans Healthcare Program, which supports scholarships for nurses pursuing doctoral degrees related to veteran-specific health issues. The program supports nurses pursuing both PhD as well as DNP degrees and hopes to focus on researching the issues as well as implementing best practices.

With many veterans accessing care outside the VA system, it’s important for nurses in all settings to be knowledgeable about issues many returning veterans may have. General Bester noted that nurses are often the ones that pick up clues, from a veteran accessing care or from a family member, that something is not right. We asked contributing editor Donna Sabella to address PTSD in her November column, Mental Health Matters, and she offers some information on recognizing PTSD and resources to help veterans get the help they need.

And we must also recognize and support our nurse colleagues who were subject to many of the same stressors as combat soldiers as well as the stress of seeing a continual parade of severely injured young men and women. On our Web site, we have a collection of audio interviews and poems being read aloud by nurses who served in Vietnam. There’s one poem by Penny Kettlewell that I think is especially poignant in describing a nurse’s wartime experience. It’s worth taking a few minutes to listen to it in remembrance and to honor the service of our colleagues.

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