New Medical Residents and Patient Mortality – Does the ‘Nurse Effect’ Lessen the ‘July Effect’?

Last week, a post on the New York Times Well blog discussed whether mortality rates in hospitals are worse during July when new interns and residents begin their clinical training. It described findings from three studies, with the final conclusion, “Though the debate continues, most studies have not found a spike in hospital mortality rates in July.”

It was common thinking in hospitals when I worked clinically—“Never be sick enough to have to go to a hospital the first two weeks of July, and NEVER, EVER need surgery during that time”—and I’d venture that many people still believe it, despite what studies may report. (And, as I write, I see that ABC News is reporting on a new review of 39 studies, published in the Annals of Internal Medicine, that does support the existence of the July Effect. Click the image below for the ABC article and videos.)

I remember working in the ED when the new residents on call would come to see patients, their “whites” impeccably spotless and starched, with new blank index cards in their pockets, looking eager and anxious to finally be getting to the real work of their profession. By mid-August, they all seemed a bit haggard, the whites rumpled and the pockets torn a bit, bulging […]

2018-04-26T10:16:40-04:00July 12th, 2011|nursing perspective|2 Comments
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Giving Noise a Red Light

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

This stoplight noise meter showed up at the nurse’s station last week.

I have to admit—we didn’t take it too seriously, at first.

It looks like something you could buy in a novelty shop, shelved next to lava lamps and strobe lights. And it’s modifiable; buttons and dials on the back of the gadget allow not only for sensitivity adjustments, but also give the option of changing the type of alarm that sounds when a noise infraction is detected. The default alarm warning is a soft-spoken, female “quiet, please!” that can be translated into Spanish, French, or German—but there’s also an option for a shrill siren, which seems ridiculous, considering that much of the cacophony of critical care is owed to noisy alarms and ringing phones.

We even discovered how to record our own admonishments (which opened the door to countless mischievous possibilities . . . not that we’d indulge in that sort of thing, of course).

In seriousness, noise reduction is vital to promoting a healing environment. In a recent article in Critical Care Nurse, the links between sleep deprivation and altered physiologic processes specific to the critical care population are reviewed. Noise reduction guidelines and recommendations from both […]

2016-11-21T13:12:28-05:00July 8th, 2011|Nursing, nursing perspective, patient experience|2 Comments
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Feel the Power (What Nursing Can Learn from the Dancing Man)

By Shawn Kennedy, AJN editor-in-chief—Writing in a recent blog post on NursingTimes.net (a UK-based site), Mark Radcliffe poses this question:

“Do you, as a nurse, feel you have any collective power to influence policy? Are we as well versed as other professional groups in articulating loudly and clearly why nursing needs to be the foundation stone of any health service?”

I thought it was a good question for us here in the United States. Most U.S. nursing associations, nurse executives, and deans are invested in politics. The recent Institute of Medicine Report on the Future of Nursing is the most recent example of how nursing is collectively trying to influence health policy.

But I still wonder how many nurses involved in direct care feel that the politics of health is something they need to pay attention to. It seems that it’s only when it becomes part of the job, directly affects one’s ability to perform a job, or has an impact on one’s financial well-being that many people get involved.

When I was a young nurse, I and many in my cohort didn’t pay attention to things like politics or getting involved in associations. We were new and intent on acquiring skills and becoming competent in our jobs, and politics seemed esoteric and something we needn’t be concerned about.

But within two years, I found myself in court on a workmen’s compensation claim for an illness I’d contracted from a patient. I was going to be out of work for four to six […]

2016-11-21T13:12:29-05:00July 5th, 2011|career, nursing perspective|1 Comment
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Sexual Predators Online: Where Do They Intersect With Adolescents and Young Adults?

Here are some of the results described in “Online Social Networking Patterns Among Adolescents, Young Adults, and Sexual Offenders,” an original research article published in the July issue of AJN:

nearly two-thirds of Internet offenders said they’d initiated the topic of sex in their first chat session; more than half . . . disguised their identity when online; most . . . preferred communicating with teenage girls rather than teenage boys; high school students’ experience with “sexting” . . . differed significantly according to their sex; a small number of students are being threatened and assaulted by people they meet online; avatar sites such as Second Life were used both by students and offenders . .  . .

What’s your own experience? Have a look at the article, and pass along the link if you find it useful, as a parent or nurse. Have you heard any concerns about Internet safety from parents or adolescents you encounter in your own practice or community? What’s your own take on Facebook and privacy, or any other issue raised in this article?—JM, senior editor

2016-11-21T13:12:30-05:00June 30th, 2011|healthcare social media, nursing research|0 Comments
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If the Patient Doesn’t Understand the Treatment: New Essay by Theresa Brown

Ben’s inability to understand even the basics of his situation, combined with his lack of family support, made it seem that we were in effect imprisoning him and torturing him.

That’s an excerpt from the Reflections essay in the June issue of AJN. By Theresa Brown, a nurse who regularly writes for the New York Times “Well” blog, “Right Treatment, Right Patient?” explores the ethics and emotions involved in providing an unpleasant but potentially life-saving treatment to a patient who can’t understand what’s being done to him (click through to the PDF for the best version).

We hope you’ll read it through and let us know if you’ve ever faced a similar ethical quandary as a health care professional (or, for that matter, as a family member or patient).—JM, senior editor

2016-11-21T13:12:31-05:00June 27th, 2011|nursing perspective|0 Comments
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