There from the Start: A Hospice Nurse Looks Back

A painting of Dianne Puzycki, RN, hangs in Connecticut Hospice in New Haven.

At age 82, Dianne Puzycki has yet to retire from nursing—she still works the night shift once a week at Connecticut Hospice in Branford, where she’s been employed since the organization’s inception in the 1970s. Founded by Florence Wald, it was the first hospice in the United States.

Puzycki started her career in 1955 at Memorial Hospital in New York City, caring for patients with cancer at a time when death and dying wasn’t openly discussed. “We weren’t allowed to talk about that. It really haunted me for years,” she told AJN in a July profile. Several years later, she encountered two influential women: Dame Cicely Saunders, who founded the first modern hospice, and Elisabeth Kübler-Ross, who introduced the concept of the five stages of grief in her groundbreaking 1969 book On Death and Dying. Seeing them speak piqued her interest in the hospice movement, and she began volunteering for Connecticut Hospice, which eventually led to a full-time job.

Throughout the decades, says Puzycki, she’s witnessed hospice care constantly change and improve. She recalls that in the past, more patients used to stay up at night, afraid, spending time in a family room near the nurses’ station—but now, “most people sleep […]

2017-07-26T09:35:44+00:00 July 26th, 2017|Nursing, nursing career|1 Comment

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