Archive for the ‘Uncategorized’ Category


Workplace Discrimination: A Survey among Newly Arrived Foreign-Educated Nurses

January 27, 2014

By Sylvia Foley, AJN senior editor

Table 2. Outcome Metrics by Recruitment Model

Table 2. Outcome Metrics by Recruitment Model

This country has often relied on foreign-educated nurses (FENs) to ease nursing shortages—and  with more shortages predicted for as early as next year, it’s likely we’ll do so again. A positive workplace environment is a known predictor of staff retention; yet little is known about how FENs experience their jobs. To learn more, Patricia Pittman and colleagues surveyed more than 500 FENs. This month’s original research CE, “Perceptions of Employment-Based Discrimination Among Newly Arrived FENs,” reports on their findings. This abstract offers a brief overview.

Objective: To determine whether foreign-educated nurses (FENs) perceived they were treated equitably in the U.S. workplace during the last period of high international recruitment from 2003 to 2007.
Background: With experts predicting that isolated nursing shortages could return as soon as 2015, it is important to examine the lessons learned during the last period of high international recruitment in order to anticipate and address problems that may be endemic to such periods. In this baseline study, we asked FENs who were recruited to work in the United States between 2003 and 2007 about their hourly wages; clinical and cultural orientation to the United States; wages, benefits, and shift or unit assignments; and job satisfaction.
Methods. In 2008, we administered a survey to FENs who were issued VisaScreen certificates by the Commission on Graduates of Foreign Nursing Schools International between 2003 and 2007. We measured four outcomes of interest (hourly wages, job satisfaction, adequacy of orientation, and perceived discrimination) and conducted descriptive and regression analyses to determine if country of education and recruitment model were correlated with the outcomes.
Results: We found that 51% of respondents reported receiving insufficient orientation and 40% reported at least one discriminatory practice with regard to wages, benefits, or shift or unit assignments. Read the rest of this entry ?


AJN’s Top 15 Most Viewed Articles in 2013

January 24, 2014
by rosmary/via Flickr

by rosmary/via Flickr

We thought readers might be interested in seeing which articles and topics got the most page views in 2013. Many of these articles are open access, including a number of CE articles as well as the articles from our Evidence-Based Practice: Step by Step series. Some articles require an AJN subscription or individual article purchase. Several of the articles in this list were from recent years other than 2013; a couple were much older, but are evidently still relevant, since not every idea in nursing is ephemeral or subject to improvement by the next generation.—Jacob Molyneux, senior editor

1. “Asking the Clinical Question: A Key Step in Evidence-Based Practice” – (March, 2010) – part of AJN‘s EBP series

2. “Improving Communication Among Nurses, Patients, and Physicians” – (November, 2009)

3. “The Seven Steps of Evidence-Based Practice” – (January, 2010) – part of our EBP series

4. “Nurses and the Affordable Care Act” – (September, 2010)

5. “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” – (December, 1984; not HTML version; readers must click through to PDF version)

6. “COPD Exacerbations” – (CE article; February, 2013)

7. “Therapeutic Hypothermia After Cardiac Arrest” – (CE; July, 2012)

8. “From Novice to Expert” – (March, 1982; article looks at stages to mastery; no html version, so click the PDF link on the landing page)

9. “Men in Nursing” – (CE; January, 2013)

10. “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections” – (June, 2013) – part of EBP series Read the rest of this entry ?


Health Technology Hazards: ECRI’s Top 10 for 2014

January 15, 2014
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s that time of year again—the ECRI Institute has released its Top 10 Health Technology Hazards for 2014 report, and with it come new (and old) hazards to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the third year running. Other repeat hazards included medication administration errors while using smart pumps (in at number two), inadequate reprocessing of endoscopic devices and surgical instruments (number six), and, at number eight, risks to pediatric patients associated with technologies that may have been designed for use in adults (such as radiology, oxygen concentrators, computerized provider order–entry systems, and electronic medical records). For an overview on these, see our posts from 2012 and 2013.

And here’s a snapshot of new hazards that made the cut, along with some of the report’s suggestions on how to prevent them.

Radiation exposures in pediatric patients (#3)

The risk: Although computed tomography (CT) scans are valuable diagnostic tools, they are not without risk, and children, who are more sensitive to the effects of radiation than adults, are more susceptible to its potential negative effects. According to the report, new empirical studies suggest that “diagnostic imaging at a young age can increase a person’s risk of cancer later in life.”

Some suggestions: The report suggests that health care providers take the following actions: use safer diagnostic options, when possible, such as X-rays, MRIs, or ultrasounds; avoid repeat scanning; and use a dose that is “as low as reasonably achievable.”

Occupational radiation hazards in hybrid ORs (#5)

The risk: Hybrid ORs, which bring advanced imaging capabilities into the surgical environment, are a growing trend. However, with these angiography systems comes exposure to radiation—a risk to both patients and OR staff.

Some suggestions: According to the report, a radiation protection program is a must. The program should include training for staff, who may not have experience with imaging technology; the use of shielding with lead aprons or other lead barriers; and monitoring of radiation levels. Read the rest of this entry ?


Happy Holidays!

December 23, 2013


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Congress Could Learn from Global Nursing Unions

October 7, 2013

By Shawn Kennedy, AJN editor-in-chief

New South Wales Nurses and Midwives' Association rally

New South Wales Nurses and Midwives’ Association rally

In this month’s issue of AJN, we report on the formation of a new international organization of nurses and health care workers in June—Global Nurses United (GNU). Under the auspices of the California-based National Nurses United, unions from 14 countries agreed to work together to “stop the harmful effects of austerity measures, privatization, and cuts in health care services.” The organization also is actively involved in advocating for other issues supported by labor unions, such as a tax on certain financial firms (called the Robin Hood tax) that would raise revenues to help provide needed services. Saving jobs and making workplaces safer unite all unions.

On September 17, the group held an international day of action. Member unions in Africa, Asia, Australia, and Europe held marches to protest cuts in health services and advocate for better working conditions for nurses, better staffing ratios and the Robin Hood tax. Unions in some countries had additional agendas—in South Korea, it was to save the Jin Ju Medical Center; in Australia, mandatory minimum nurse–patient ratios was a demand; in Costa Rica, the member union called for nurses’ right to participate in collective bargaining.

Will these marches and protests yield any results? Will policy makers take note at the discontent of so many people or will they just nod and carry on, business as usual?  Read the rest of this entry ?


Where Medicine Leaves Off

May 17, 2013

Long before we see the face, we hear the crying. Mournful, broken, it expresses general discomfort more than acute pain. In it lies the anxiety of all those children brought here against their will, made to submit to the probing of pale strangers who speak an alien tongue.

AftertheScienceIllustrationThat’s the start of the May Reflections essay, “After the Science,” by Charlie Geer, about working as a medical translator on an Episcopal church–sponsored team in the Dominican Republic. Geer, who published a comic novel in 2005, writes with sensitivity about the limits of medicine and the way the “nurses gather round, the compassion that brought them to medicine picking up where medicine leaves off.”—JM, senior editor


Winding Down Nurses Week 2013

May 10, 2013

By Shawn Kennedy, AJN editor-in-chief

We’d be remiss not to mention Florence Nightingale during Nurses Week, especially since her birthday marks the end of the celebration. (She was born on May 12, 1820.) I often wonder what this visionary would be like if she were a nurse today—my bet is she would be a PhD and FAAN, and conducting multinational outcomes research related to nursing-sensitive indicators with grants from the Royal College of Nursing and the AARP/Robert Wood Johnson Foundation’s Campaign for Nursing!

Nightingale never wrote for AJN, but there are some 200 stories and mentions of her in our archives. We thought we’d mark the close of Nurses Week with a comment from AJN’s founding editor, Sophia Palmer, on the occasion of Nightingale’s death in 1910. Here’s an excerpt, or read the original piece in our archives (free until next week on AJN‘s Web site).


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Nurse ‘Edge Runners’ from the AJN Archives

May 7, 2013

By Shawn Kennedy, AJN editor-in-chief

In her message to nurses for Nurses Week, ANA president Karen Daley notes, “This year’s National Nurses Week theme, ‘Delivering Quality and Innovation in Patient Care,’ emphasizes our role and influence in making the health care system work better for patients. Think about the many ways you innovate and improve care.”

The Frontier Nursing Service evolved from the Kentucky Committee for Mothers and Babies initiated by Mary Breckenridge in 1925.

The Frontier Nursing Service evolved from the Kentucky Committee for Mothers and Babies initiated by Mary Breckenridge in 1925.

We’ve been publishing our series on “Edge Runners”—those nurses designated by the American Academy of Nursing (AAN) as creative, out-of-the box innovators. In January, we profiled Marilyn Rantz for her innovative program to assist seniors to age in place; in March, we highlighted Deborah Gross for her Chicago Parent Program; for May, we have a profile of Donna Torrisi, founder of a nurse-managed family health center in Philadelpia. (The AJN articles linked to in this post will be free for the next week, until May 13, in honor of Nurses Week.)

But of course, there were ‘edge runners’ well before the AAN starting naming them. Nurses have a time-worn tradition of using their creativity and problem solving to provide care to those who need it, and AJN has chronicled many of these movers and shakers over the years.

Here’s a couple of my favorites from AJN’s archives (click through to the pdf versions to see the entire articles):

  • Lillian Wald writing about the beginning of the Henry Street Settlement in May 1902.
  • A profile of Mary Breckenridge, founder of the Frontier Nursing Service, from 1930.

We’ll bring you a few more later in the week.

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Kasandra Perkins, Domestic Violence, and the Senseless Search for a Reasonable Explanation

December 6, 2012
photo via Facebook

photo via Facebook

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

Let’s call it what it was. Kasandra Perkins was murdered in a domestic violence attack. This was not about a football player who took one too many hits to the head. This was not about a good, loving family man who was driven to take this terrible action. This was not about someone who snapped from stress (would he get enough playing time? would he make enough money to pay for his expensive new car?).

This was about what domestic violence is always about: control, rage, and power. There is no mystery here—we don’t need to search for reasons why a good, loving family man would shoot someone he loved. Because they don’t. Violent men commit acts of violence.

This searching for a reasonable explanation distracts us from the truth. It bolsters myths and misconceptions. It creates the illusion that each domestic violence attack is a special case, not part of the fabric of our society. One in four women experience domestic violence. Over a thousand die every year. Do the math—Kasandra was one of at least three women we could expect to have been murdered in a domestic violence attack on Saturday. We didn’t read about the other two. We wouldn’t have read about Kasandra either if her murder weren’t at the hands of a professional football player.

Not that the coverage has had a great deal to do with Kasandra. Most news stories tell us little about her—not who she was, what she hoped to become, if she worked, went to school. Because she really doesn’t matter—the attention to this case has nothing to do with her. It’s all about Belcher. And what do we hear about Belcher? We hear about what a good man he was, his perfect teammate persona, his hard work to earn a place on the football team. We also hear a lot about the team. How will the Kansas City Chiefs navigate this public relations disaster? How will they help their players grieve while not seeming disrespectful? How will they win football games under such circumstances? Frankly—who cares? Yes, they have suffered a loss and each individual will have to deal with it in their own way. But where is the outrage for Kasandra?

It’s time to stop being shocked and incredulous that this could happen. Again and again and again. Domestic violence is senseless.  It is time to be angry. It is time to act. It is time to demand change in the societal and cultural norms that propagate it.

Nurses, there are things you can do. Screen everyone for domestic violence. Examine your beliefs about culpability, responsibility. Know what your community resources are. Treat abused women with respect and dignity. Speak up. Model behavior for your sons and daughters that empower them to be loving, strong, confident adults. Teach them to abhor violence in all its forms.

Many nurses have experienced domestic violence. I am one of them. We need to speak up. We need to end the stigma. I call on all survivors—when you are ready and it is safe to do so—speak up. The shame doesn’t belong to us. It belongs to the perpetrators and to society; give it back to them.

It is up to us to keep talking about Kasandra and all the women lost to domestic violence. Others may be talking about it this week, but they’ll move on too soon. Until the next time. Because women will continue to die. How many more before we finally say, “Enough”? And mean it.

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AJN’s December Issue: Staffing Issues, Wandering in Dementia, Type 2 Diabetes Meds, More

November 30, 2012

AJN’s December 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.

Data from the Military Nursing Outcomes Database project demonstrate that inadequately staffed shifts can increase the likelihood of adverse events. But what does this mean for the average nurse on a shift? In “Staffing Matters—Every Shift,” the authors present common dilemmas hospitals face in nurse staffing, illustrating the potential hazards for patients and nurses alike. This CE article is open access and can earn you 2.1 CE credits.

People with dementia are at risk for both missing incidents and wandering. In “Missing Incidents in Community-Dwelling People with Dementia,” the authors differentiate between these two risks, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents. This CE article is open access and can earn you 2.1 CE credits. For more information, listen to a podcast with the authors.

There is a growing consensus that primary care providers can better address patients’ needs by using different models of care, such as the patient-centered medical home. “The Patient-Centered Medical Home” discusses the guiding principles of this model, nurse care coordination, reimbursement and implementation, cost-effectiveness and quality improvement, and the need for greater nurse advocacy.

Being unaware of the realities of licensure can damage a nurse’s career, even permanently. “Professional License Protection Strategies,” the third and final article in a three-part series on nursing boards’ disciplinary actions, discusses strategies for protecting one’s nursing license.

Nearly 26 million people in the United States have diabetes and over a quarter of these are unaware of their condition. “Recent Safety Updates on Type 2 Diabetes Medications” offers providers an overview of current treatments, as well as their risks and benefits to help when deciding on drug therapy for specific patients.

And for an exploration of how bias in health care affects transgender patients, read “The Ethical Nursing Care of Transgender Patients.”

There is plenty more in this issue, so stop by and have a look. Feel free to tell us what you think on Facebook or our blog.

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