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

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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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White Uniforms for Nurses? The ‘Nays’ Have It…

October 26, 2012

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

Nurses and patients aboard U.S.S. Relief, 1921/via Wikipedia

Well, if sheer numbers rule, then the image of nurses in white uniforms has gone the way of the nurse’s cap.

Earlier this week, on AJN’s Facebook page, I asked whether RNs should go back to white uniforms as a professional standard. Within a few hours there were 20 comments; by the next day there were about 200 comments (we had to delete the post with the first 100 or so, since we were unsure about the copyright status of the image used—very sorry if that included your comment!).

Clearly, nurses care about what they wear. Comments ranged from one word (“No,” with multiple exclamation points), to thoughtful reasoning around stains and keeping the uniforms clean, to advocating for an individual’s right to choice (about colors, that is).

There were only a few comments that were pro-white, with arguments that they were more professional than colors and “wild prints” and helped patients identify RNs from other staff more easily.

Here’s a sampling of comments (a few minor typos corrected):

Yes—but no hats.

No—but I do think it makes a lot of sense to be able to clearly identify who is an RN when you are a patient in a hospital. Clear identification is definitely a problem.

I support white uniforms. This is the required color at the Cleveland Clinic. Patients tend to appreciate the crisp, clean look of white. Also, white scrubs may be safer because they can be washed with chlorine-based bleach. Some studies suggest that this simple action decreases the risk of HAI. Some people are arguing that white will show body fluids and soil that we may be exposed to. Seriously? No matter what color you wear, it is NEVER acceptable to wear a contaminated uniform!

White is cold , sterile, institutional and hard to keep clean. A study of people with impaired sensory and cognition indicated that often nurses in all white garb blend into the background and walls and appear as “floating heads.” Who does an all white uniform benefit?

NO!!! We like color, too! Freedom of choice!!

I think so—and the hat, too? When I’m at work, you can’t tell a nurse from environmental services.  I’ve been a patient and I like KNOWING who is the nurse.

My view: whether it’s a white uniform or colored scrubs, we need to be sure patients can recognize who is providing their care. We often claim that we’re “invisible” and aren’t given credit for what we do, yet we make it hard for our patients to recognize that it’s a nurse who is providing their care. Also, if we don’t differentiate among staff, patients may assume that there are more RNs than there really are.

Here’s another issue: some RNs cover their name tags with tape or hide their names, so patients can only identify them as “Mary” or “Steve.” What do you think of that practice?

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Where Do You Get Your News?

September 10, 2012

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

I’ve watched the recent political conventions and have been listening to the sound bites one hears on the radio and television news shows. The speakers and newscasters all sound intelligent and righteous and in command of “facts.” However, as we’ve learned from the widespread public misunderstanding of many aspects of the Affordable Care Act, it takes some deeper digging to know what’s “spin” versus what’s fact. (Indeed, fact-checking has become its own political issue, as it seems both parties have been playing a bit loose when it suits their messaging.)

I wonder how many people actually take the time to validate what they hear on the radio or television. Do most people take what they hear at face value? Will many people vote based only on what they heard from the convention coverage or in 30-second news clips (or worse, in the barrage of advertising paid for by the PACs, many of which are quietly funded by industries or wealthy individuals with a stake in who gets elected)?

It occurred to me that I’ve never seen my youngest son or nieces and nephews read a newspaper, yet they seem well-informed about the political issues. I asked my son where he gets his information. He said, “Well, there’s something called RSS feeds . . . .” (He was surprised that I not only knew what they were, but that I use them!) (RSS stands for really simple syndication.  For information on how to use RSS feeds, see our article. The illustration on the right is from it.)

He says most of his friends use these feeds—managed through such simple tools as Google Reader—to track content they want. The feeds are automatically updated, delivering new content right to his email or to the type of RSS feed reader he prefers. When he wants more information, he turns to Google and YouTube. All one needs to be smart is a smart phone.

Querying Google about an issue (say, “Romney Medicare cuts”) will yield far more information than I will get from my usual two daily newspapers. Up will pop articles from multiple newspapers, news outlets, and opinion sources: in addition to Mr. Romney’s Web site, Bloomberg News,  the Washington Post, New York Times, ABC and CBS news, Huffington Post, LA Times, and many more bona fide sites. (Of course, as with newspapers, some sites are more reliable than others and vet their content more closely or present a more balanced picture.)

From scanning the various articles (and blogs and other Web sites), one can sometimes get a better view of all the “angles” of a story than just by reading one or two sources. And then, you can often go to YouTube to view a newscast or a taped video of the actual event. Not too bad—and here I’d thought these “young’uns” weren’t plugged in.

But a caveat: this method of keeping up with the news only delivers what each person has already marked as areas of interest—it’s easy to miss out on the broader news pieces that may be truly important, or on perspectives that might cast your beliefs into a new light. When I read the newspaper (whether print or online), I’ll read interesting articles that I might never find in a targeted Web search. Because it’s right there in front of me, I may read it—and it will give me a broader view of the world.

How do you get your news?  Do you read only what’s on your “like” list, or do you cast a wider net?

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Health information Technology, EHRs, Meaningful Use, and Nursing

August 15, 2012

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

If you’re like most nurses working in a health care organization, you’ve been involved in a migration to electronic health records, computerized physician order entry (CPOE), or bar code medication administration.

If you’re lucky, nursing input was considered during the planning stages of all this health information technology (HIT). We’ve heard from many nurses (and have had a few submissions from nurses about their experiences—see for example the Reflections essay “Paper Chart Nurse”) who have had “issues” with the systems or who wonder, why the big push?

In the August issue of AJN, which is available online and on the iPad (download the app here), Susan McBride and colleagues John Delaney and Mari Tietze debut their three-part series on HIT. The first article, “Health Information Technology and Nursing,” examines the federal policies behind efforts to expand the use of this technology, the importance of meaningful use, and the implications for nurses. Subsequent articles upcoming in the fall will take a closer look at the use of HIT to improve patient safety and quality of care, and the important role nurses are playing—and could play—in this system-wide initiative.

It’s crucial for nurses to understand HIT. As the authors note,

“If HIT systems are going to truly improve care, nurses need a voice in their planning and development to ensure patient safety and system usability. The success of this technology depends on nurses informing the industry—at all levels, from influencing federal policy to providing feedback to their department and facility leaders—about what works best for the patient and the clinician. If wisely implemented, HIT may eventually free up more time for nurses to spend at the bedside . . . ”

We’d love to hear your experiences: Were nurses consulted and included in planning the implementation of HIT at your facility? Was there a thoughtful plan to “roll out” adoption? Do you see computerized health records as a help or hindrance? What would you change? Let us know how it is in your practice area.

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Making a Case for Therapeutic Hypothermia

July 23, 2012

Photo © Rick Davis 2011.

One of the articles published in AJN’s July issue that’s proving popular is “Therapeutic Hypothermia After Cardiac Arrest,” by Jessica L. Erb, an acute care NP at the University of Pittsburgh Medical Center Presbyterian Shadyside Hospital, and colleagues Marilyn Hravnak and Jon C. Rittenberger. The article points out that, despite evidence supporting its effectiveness, therapeutic hypothermia is not widely used.

According to the article’s overview, “Irreversible brain damage and death are common outcomes after cardiac arrest, even when resuscitation is initially successful. Chances for both survival and a good neurologic outcome are improved when mild hypothermia is induced shortly after reperfusion. Unfortunately, this treatment is often omitted from advanced cardiac life support protocols.”

The article discusses the efficacy of therapeutic hypothermia, indications and contraindications for its use, various induction methods, associated complications and adverse effects, and nursing care specific to patients undergoing this procedure.

Read the article (it’s open access)—you can earn 2.3 hours of CE credit.—Shawn Kennedy, AJN editor-in-chief

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