About Shawn Kennedy, MA, RN

Editor-in-chief, AJN

Establishing the Evidence for Clinical Ladder Programs

Nursing Advancement Before the Clinical Ladder

When I took my first job as a hospital staff nurse, pretty much the only path to advancement in the clinical setting was moving into an administrative position. Nurses moved up by becoming nurse managers, then supervisors, and eventually nursing directors. It was considered unusual for someone to stay at the bedside for many years.

Benner’s Novice-to-Expert Model

Then along came the clinical ladder—a way for nurses to advance clinically. Patricia Benner’s landmark work on identifying the hallmarks of novice-to-expert practice laid the foundation for identifying the different stages of acquisition of skills (see her article on the topic published in AJN in 1982; free until May 22).

Evolving Competencies Require New Paths to Advancement

But while the competencies nurses need to practice effectively are vastly different today, many hospitals haven’t updated their clinical advancement programs to reflect the knowledge, skills, and attitudes (KSAs) that nurses need to practice effectively in today’s complex health systems. Moreover, there’s been little research to provide the evidence for identifying the various competencies and the associated KSAs. Our original research article in the May issue provides that evidence.

Creating an Evidence-Based Progression

The authors of “Creating an Evidence-Based Progression for Clinical Advancement Programs” used the […]

2017-05-12T10:50:46+00:00 May 12th, 2017|Nursing, nursing career|0 Comments

Nurses, What’s Your ‘Elevator Speech’?

“We need to value ourselves—what we do, all that we know, how we change lives. If we don’t own and value our worth, no one else will.”

It’s always nice to write about some good things happening, and this week there are two that gave me a lift.

First, an award: The American Society of Healthcare Publication Editors (ASHPE) recently named this blog the winner of the 2017 gold ASHPE award for best blog. I’m pleased that the hard work by blog editor Jacob Molyneux and the AJN editors and authors who contribute to the blog was recognized. AJN also received a gold award for best cover illustration for our October 2016 political cartoon cover, a silver award for best peer-reviewed journal, and a bronze award for best news coverage. I’m thankful every day that I work with such talented people. They’re committed to upholding AJN’s reputation and mission:

to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.

Second, it’s time for Nurses Week: This Saturday begins Nurses Week (May 6-12), the last day of which always marks the anniversary of […]

2017-05-05T10:13:36+00:00 May 5th, 2017|Nursing|2 Comments

Nurses vs. Computers: Predicting Risk of Patient Harm

Not All Signs of Potential Harm Are Quantifiable

From chego101, via Flickr

Hospital nurses have many, many responsibilities and tasks, but one of the most important is to ensure patient safety by assessing patients for changes that can signal worsening of a condition or a new potential harm. Creating special units like ICUs, recovery rooms, and step-down units; flags on charts; various alarmed monitors; and safety huddles are a few of the ways hospitals have tried to identify potential problems. Now we have computerized tools to do this—or do we?

The complaint I have heard most from nurses about the electronic health record (EHR) is its inability to capture all the nuances of patient care or various patient problems, especially those that don’t involve easily quantifiable measures like heart rate or lab values. (For more detail, read our November 2016 report on nurses’ concerns with EHRs.)

One cannot accurately use a check mark to convey certain patient behavioral parameters or the “can’t put my finger on it but something’s going on with this patient” assessment that experienced nurses often make. In the April issue of AJN, we published an important study that investigates just this issue: “Identifying Hospitalized Patients at Risk for Harm: A Comparison of Nurse Perceptions vs. Electronic Risk Assessment Tool Scores

Deciding Whether to Implement an Electronic Risk Tool

Researchers […]

Managing Your Patients’ Pain: It’s Not Just about the Opioids

Before Pain Assessment Was the Norm

Some of the most difficult times I experienced as a nurse involved patients in pain. This was before the days of patient-controlled analgesia, when patients in acute pain were mostly managed with “Demerol IM q4h.”

I recall many incidents of paging and telephoning and beeping physicians and residents to get orders for pain medications and trying whatever non-pharma methods I could think of to allay pain. It was awful to see patients suffer needlessly.

Progress, But with a Cost

Then pain became a key part of assessment, as well as of patient satisfaction scoring, and clinicians heeded the need for managing pain. However, there has been too much reliance on the quick fix of strong opioids. A friend who recently had surgery was asked by a nurse to rate his pain. When he replied “eight,” she asked him if he wanted one or two oxycodone pills. His reply, “Well, what do people usually take?”

Revising the Approach to Pain Management

Thankfully, pain management is being revisited, and along with a renewed focus on not prescribing by the numbers (a patient’s pain rating should only be one factor in deciding the intervention), there is a greater understanding of pain and how it can become chronic, and there are more modalities at our disposal to manage it.

To prevent acute pain from […]

2017-04-05T10:34:01+00:00 April 5th, 2017|Nursing, pain management|0 Comments

The Buzz at Nursing Conferences about Quality and Healthy Work Environments

“I was struck by the preponderance of sessions dealing specifically with incivility and bullying (in both academia and practice settings).”

Recent back-to-back nursing meetings gave me a lot of food for thought. After attending conferences, I like to find the overall theme—not just from the scheduled topics, but from the posters and the exhibits and the general “buzz” from conversations. Here’s my take on the two meetings I attended this month.

ANA’s 2017 Translating Quality into Practice Conference

This conference started with an opening session focused on quality from a consumer point of view. Keynote speaker Harry Greenspun asserted that today “it’s the patient or family’s responsibility that the right thing happens at the right time by the right person.” Nurses, he said, are the group that needs to engage and empower consumers (who, he said, should only be called patients when they are receiving care) in improving care.

ANA president Pam Cipriano added that “nurses are the ones doing the work on quality—all the projects and quality improvement is being done on the backs of nurses.”

While some sessions focused on specific clinical practices (reducing hospital-acquired infections or falls, for example), many focused on broader aspects of quality improvement—how systems can support QI change and integrate new technology (mobile apps, simulation).

There was also discussion relating to staffing strategies and teams […]

2017-03-29T13:31:16+00:00 March 29th, 2017|Nursing|0 Comments