Nurse-Recruiter.com Monthly Articles

How Nurses Are Portrayed on TV

Mon, 29 Jun 2009 23:24:36 GMT

How Nurses Are Portrayed on TV:

One New Show Has Some Nurses Asking to Pull the Plug

By Sue Antinoro Nurse-Recruiter.com

One of my all-time favorite shows recently had their final episode: ER. I was always a big fan of Nurse Hathaway (and Dr. Ross too) then later Sam Taggart. I always thought, if I ever end up in the ER, please let me be attended by a nurse like them (and a doctor like Dr. Ross, or at least Dr. Gates).

Of course not all nurses portrayed on television are fan favorites. Most recently, the nurse role as portrayed by Edie Falco on Showtime's new show, Nurse Jackie, has met with a lot of criticism. In the show, her character forges an organ donor card, pops vicadon pills that she received from a pharmacist (with whom she is also having an affair), flushes a patient's ear down the toilet, and then steals his wallet to give to a pregnant women. She is no Florence Nightingale. The New York State Nurses Association has requested that a disclaimer be added to the show, that says Falco's "Jackie" is an aberration.

"We believe that the public's view of nurses is influenced by TV dramas, and we have yet to see an accurate portrayal of what nurses really do," wrote NYSNA Chief Executive Officer Tina Gerardi in a letter to Showtime. Showtime officials have denied the request.

The NYSNA describes "Nurse Jackie" as someone who has "no qualms about repeatedly violating the nursing Code of Ethics" and hoped a disclaimer will distance the show from the real world. Gerardi said she's worried that a negative character would discourage people from joining the profession.

Of course any negative feedback from nurses regarding the show will probably create an even bigger buzz about it, which makes the Showtime executives very happy. This show is in contrast to the other new show premiering on TNT, HawthoRNe, which stars Jada Pinkett Smith as Nurse Christina Hawthorne. As a chief nursing officer, she is depicted as a hero who "prides herself on standing up for her patients and preventing them from falling through the cracks of hospital bureaucracy," according to TNT's web site

Should these two shows survive, they'll be joined in early 2010 by Mercy, an NBC drama centered on three nurses at a hospital, one of four new medical dramas planned for the 2009-10 TV schedule.

Not all nurses are unanimously against the series. Showtime screened "Nurse Jackie" for a group of emergency room nurses at New York's Roosevelt Hospital and more than four in five said they enjoyed it and would recommend it to a friend according to Showtime executives.

Registered nurse Sandy Summers has co-written a book entitled Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk. The book details how the media's portrayal of nurses may endanger public health.

"When you have physician characters on most hospital dramas, they spend most of their time doing nursing work," said Summers, 47, whose book cites ABC's Grey's Anatomy and Fox's House as particular offenders. "They make people think that nursing doesn't take much skill, and that nursing is mostly about getting stuff for physicians. And when nurses are portrayed as unskilled, we can't get the funding we need to hire them."

Summers, details many ways in which TV has tarnished the nursing image. For example, showing nurses who have more interest in becoming doctors, showing nurses as sex objects, shows where nurses are portrayed as mostly unskilled assistants to physicians and showing doctors doing things nurses typically do (i.e. giving intravenous medication, spending hours with one patient). She maintain that these contribute to students becoming less interested in studying to be nurses and medical professionals convinced nursing is menial work.

Nurses On The Go Jun09 - Why I Became a Nurse

Mon, 29 Jun 2009 23:23:29 GMT

Why I Became a Nurse

by Ann Mathiews MSN, RN, CEN, TNCC

The sun was shining. The blinding light reflected off the apartment pool surface as Lori and I sat sipping frozen margaritas and watching our four children splash in the shallow baby pool. Laughing as freckles emerged on our skin instead of the even tan we were seeking, we joked about the customers that frequented the diner where we both worked. The customers confused us because we were both blonde and thin. Lulled into a false sense of security, Lori said, "I'm going to close my eyes a minute, watch the kids".

"Sure", I replied, sipping the icy margarita and starting a head count. One, my Jessica; two, my Alex; three, Lori's Jimmy, and wait a minute...where is Lori's Joey? I sat up spilling the margarita. The children were here a minute ago. Where was Lori's Joey? I scanned the area around the pool. He had a ball earlier. I looked across the lawn and into the cabana. Where was Joey?

As I stood up to call for Joey, I saw a teenage girl waist high in the adult pool. She held up a limp rag and say "does this child belong to someone?"

I walked swiftly over to the girl taking Joey's limp body and laying him down on the lawn. I had only seen infant CPR once in my life. Joey was three years old. I didn't know if it would work. I shook his foot, looked, listened and felt for breath. I breathed into his tiny body watching the chest rise. I could feel a pulse, so I started five compressions, then I held him up to give him five back blows, then again from the beginning. Was I doing it right? I didn't know. Keep it up, my self dialog cheered me on. My hands were shaking as I struggled to overcome the adrenaline rush.

A crowd gathered. My husband arrived and petrified he grabbed both our children and stood watching me. A lady with a ridiculous hat said "My husband knows CPR". She tried to pull Joey from my arms.

"Go get him" I said shaking her off. And breathed into Joey's mouth again. Someone woke Lori and she screamed as she realized it was her child. Standing frozen and watching me work to save her son, I saw her holding her breath.

Chest compressions. Five. Back blows. Five. Breath again. Better seal. Breath again. Chest rise. He coughed. I sat back. He coughed again. The paramedics arrived and swarmed Joey. I rose from my knees and took two steps back. Holding my breath, as equipment emerged and hid Joey from view. A stretcher appeared and in a blur Joey disappeared into the ambulance. The teenage girl said "I didn�t realize he was dead".

Dead. Neither did I. I only saw a child not breathing. Joey went into cardiac arrest three more times in the ambulance. Each time the ambulance stopped, the paramedics resuscitated him. Following in our car, we prayed silently with tears streaming from our eyes. All the fears unspoken fermenting just below the surface. Arriving at the hospital we streamed into the waiting room as the stretcher rushed past us with a blur of firemen, paramedics, white coats, and green scrubs.

I stared at the clock. Each minute passing was an eternity. Did I do it right? I had only seen CPR once. Did I do it right? My husband silently holding my four year old and my two year old. Fear pasted on their faces. Even my two year old son understood the enormity of what was happening. I couldn't comfort them, we just didn't know yet.

A white coat came into the room. "Are you the mom?" He asked Lori.

"Yes," Lori whispered and looked at me. I stood and put my hands on her shoulders willing her strength and hope.

The white coat had a big smile. "He is fine. Come see." Relief washed over us. We ran to see the smiling face of the pale boy with the crooked grin.

"Why did you do that?" asked Lori mad and happy as she reached to hug her son.

"There was a penny. I wanted the penny." said Joey unaffected by the near-tragedy.

Today Joey is a Pentecostal minister and I am a nurse and I teach CPR. The best part of being a nurse is not just knowing what to do in a crisis but learning each day to help people transcend their crisis, their pain, their tragedy. Hospice nursing, for me, is an honor. The honor is found in sharing very intense and memorable moments that shape the essence of people's lives. Each day I try to be the change I wish to see in the world.

My favorite instructor was that visiting nurse who came to the home of an eighteen year old mother to teach her CPR because it was part of a high risk program out of the Valley Settlement House in West Orange, New Jersey. I wish I had learned her name but I will never forget the way she made me feel and the life she saved.

What Is It Like To Be A Forensic Nurse?

Tue, 26 May 2009 23:05:34 GMT

What Is It Like To Be A Forensic Nurse?

By Sue Antinoro Nurse-Recruiter.com

I must admit I had never heard of this specialty and my first thought was, this must be a profession where you are dealing with dead bodies, a la C.S.I. But apparently those in this field do not spend their entire day hanging around corpses. Forensic nursing does combine the job aspects of clinical nursing with those of law enforcement. They are trained to deal with victims of trauma, accidental death, or other acts of violence. A forensic nurse must also be trained to promptly and properly collect evidence considered necessary in the court of law. They may be asked to examine a victim of sexual assault or treat a patient who has been violently injured. Forensic nurses may also handling cases such as elderly abuse or child neglect.

Forensic nurses can work in a variety of settings such as with crime scene units, private or public crime labs, law enforcement agencies, private investigators, and detective agencies as well as healthcare facilities, medical examiners and insurance companies. They may be asked to testify as a witness for a trial, whether as a fact witness, stating what they witnessed or perhaps as an expert witness. Forensic nurses may identify injuries and/or death and their causes, preserve and document the chain of custody, and refer victims for appropriate follow-up care.

Training as a Sexual Assault Nurse Examiner (SANE) is the entry-level position you need to obtain in order to break into forensic nursing. The nurse should be a Registered Nurse (RN) before being able to complete the specialized training needed to meet the standards as required by the IAFN or International Association of Forensic Nurses. Nurses should be trained in handling and collecting evidence such as hairs and fibers for DNA testing. A lot of forensic nurses work as examiners in emergency rooms collecting evidence such as bullets and victim's clothing which would be pertinent to a criminal case.

It can be a remarkably exciting and rewarding career choice and there is an ever growing demand of nurses who specialize in this field. The industry is growing more and more attractive to the nurses who want to take an initiative for their community.

Nurses On The Go May09

Tue, 26 May 2009 23:06:47 GMT

Nurses On The Go

by Bernadette M. Bailey, R.N.

I was working in Labor and Delivery about 2 years into my nursing career, when I was assigned to a young patient who was in labor. This young girl had a hard life, was poverty-stricken and surrounded by friends and family who abused drugs on a regular basis, and she had given in to this temptation.

I happened to go in to check on her when she began to cry. When I inquired as to her cause for tears, she explained that the Nursery nurse had just informed her that they had called the state agency and were going to remove her new baby from her care as soon as she was discharged from the hospital. She explained that her new daughter, her first child would be going to a Foster Care family.

I asked her what her thoughts were on this and she said she was upset, that she loved her baby and wanted nothing more than to take her home with her. She said she loved her more than anything else on earth. I told her if she loved her baby then her battle against drugs was already fifty-percent won. I told her that the Foster Family could be like a babysitter while she recuperated, and that it didn't have to be a negative thing at all, but that she had a very tough choice to make. She would have to leave behind all those people who use drugs, in order to live a clean and sober life, and to provide a good home for her and her baby.

She said she was ready to make that choice. I asked her if she wanted to have me call the Social Worker to get her into a free program so she could begin right away, so the time separated from her baby would not be wasted. She agreed to this plan and the Social Worker came to see her. I helped her through her labor and delivery, and wiped her tears after the birth, and encouraged her to press on. Even though they were taking her baby � I reminded her that it was temporary and that the tiny child would not remember this time but would remember later in life, after she was clean and sober, offering her a good life.

The young girl had her baby, was discharged, promising to me to change her life, and vowed to get custody of her baby. I reassured her that she could do it and off she went. Months passed and I sometimes thought of her. The other nurses didn't think she could break away and told me my efforts, while appreciated, were of no use. I said that if I only ever reached one single new mother in this condition, that at least I would have changed one child's life by trying, during my career. One day she walked off the elevator. She looked so good I didn't recognize her! She presented me with a photo of her baby and hugged me, telling me that she was clean and sober, and was getting her baby back. She was happy and all my nurse friends were surprised and happy. It was a day I will never forget.

Always remember that no matter who doesn't believe, just one person who really does can change a life!

Thanks to Bernadette for her wonderful submission to this month's Nurses On The Go segment. If you would like to have the chance to get published in our monthly newsletter and be eligible to win a $50 VISA gift card, we would welcome your submission. All submittals should be between 500 and 800 words. To submit a story, send an email with the subject line Nurses On The Go story submission to info@nurse-recruiter.com.

Ethical Dilemma in Nursing and Moral Distress

Mon, 27 Apr 2009 23:31:49 GMT

Ethical Dilemma in Nursing and Moral Distress

By Sue Antinoro Nurse-Recruiter.com

There has never been a time where there exists so many advances in medicine and technology which allow healthcare professionals including nurse RNs and travel nurses the ability to offer a wide range of treatment options. At the same time insurance and administrative restraints, rising healthcare costs, and scarce resources can lead to ethical issues and conflicts. As cultures become more diverse, a difference in beliefs about treatments may exist between providers and patients which in turn leads to ethical dilemmas.

Moral distress occurs when a provider struggles between what is an ethically appropriate treatment for a patient and the inability to discuss their views. Many healthcare facilities have ethical committees and consultants to address this issue. Even nursing and medical schools are addressing ethics in their programs, recognizing the need to provide professionals with the skills to address these conflicts.

Yet many nursing professionals still feel this is a reoccurring issue. Many responded to a nytimes.com article about moral distress agreeing that is was a big concern and that the threat of malpractice and insurance requirements are contributing factors. Some suggested having patients fill out a treatment directive would help in alleviating this problem. Clearly many professionals had left or were thinking about leaving the nursing profession due to the strain of dealing with moral distress. Several critical care nurses had witnessed family members, who were facing a family crises and, desperate not to lose a loved one, would make decisions in the family's interest and not necessarily the patient's. The occurrence of a situation where the patients best interests or wishes are not always respected during end-of-life care due to families insistence on prolonging the inevitable only grows each day with advances in medicine coupled with an increasing rise in an older population. In addition, many voiced the opinion that today's medicine is not about prolonging life but rather about improving quality of life and some even agreed that euthanasia should be legalized.

In regards to this issue, the Hospice Foundation of America will be presenting a program live via satellite and webcast on "Diversity and End-of-Life Care". The program aims to discuss challenges faced by healthcare professionals whose cultural values may differ with those of patients and families and how we can respect and support each other even though our beliefs and preferences may differ. "Our goal in hosting this teleconference is to increase sensitivity by helping professionals in our community acknowledge how their own cultural values and assumptions influence the delivery of care. There are many times when cultural considerations may cause ethical concerns or moral distress and this program will discuss those challenges," Community Relations Director for Heart To Heart Hospice Tiwana O'Rear said. The teleconference will be broadcast Wednesday, April 29. More information can be found at http://www.hospicefoundation.org/teleconference .

Nurses On The Go

Mon, 27 Apr 2009 23:33:56 GMT

Nurses On The Go

By Donna Rich, R.N.

Seven months ago my husband announced that he was just laid off from his marine construction job. I looked around our dream home, one block from our beloved ocean...the Olympic-sized pool in the backyard and an upstairs deck for our teenagers to hang with their friends. There was, I admit, in a brief moment of panic, but then the reality set in.

"I can go back to nursing," I reminded Dave. We smiled at each other. I'd had a couple of years off, to work on my writing, but both of us had always known that someday I'd go back. "Someday just came a little sooner, honey," I added, giving his arm a squeeze as I Googled nursing jobs in our area.

My nursing career of two-plus decades has provided a steady and certain ability to support my family, regardless of economic well-being or instability. Wherever we've lived, when I was married, when I was a single mom, I have been able to find work. People get sick wherever you live, and no matter how tough times are, patients always need their nurses.

So here I am, sitting at my desk, writing. From time to time, I gaze out my window at waves crashing and seagulls diving in the ocean, and I smile, content in my life, and the lessons I have learned along the way. I am a nurse, and after 26 years of giving of myself and my talents to those for whom I care, I realize more and more what nursing has meant to me.

Nursing has benefited me in more ways than one. Inherently restless, never one to sit still or in one place for long, I have taken full advantage of the varied opportunities to do wildly different kinds of nursing jobs. I've happily traded pediatric scrubs for street clothes and a lab coat when I went from pediatric med-surgery to psychiatric nursing, and just as easily transitioned back into scrubs when I tried out home healthcare in a rural area. I fed my lust for travel as a missionary nurse in the Philippines, as I learned Tagalog, the local dialect and struggled to adjust to a culture that was so much more grateful and so much less materialistic than my own.

When I had a temporary burn-out in my early 40's, I went to work as a health reporter at a newspaper. I stayed there for two years, and garnered that year's Georgia Nurses Association's Media Award, reminding me that I was truly, a nurse at heart and I returned to the field.

The variety of my experiences, as myriad in color and shape as the pieces of a complicated puzzle, somehow fit together in one exciting, adventurous whole. I believe true, real nursing encompasses so much more than the physical realm. Caring for patients requires attention to three other, just as important, if less obvious, areas: the mental, the emotional and the spiritual arenas.

This was brought home to me early on, in my first year as an R.N. A pediatric nurse at a large teaching facility, I had a patient with priapism. Only 12 years old, he was in fairly constant discomfort and rang his call bell often. One evening, less than 15 minutes before it was time for me to give my report to the night nurse, I stopped by to answer his call. He was lying there, pain contorting his face, with big tears rolling down his cheeks. I realized that it wasn't all about the physical pain. A few minutes talking to him revealed that he missed his mother terribly and wanted to call her, but he didn't know how to use the phone card she'd left for him. "She can't come see me because there's nobody to take care of my little brothers and sisters," he explained, sobbing by this point. "And we don't have a car." I glanced down at my watch. I had just enough time to sign out his Demerol and give it to him. I would be late with my report, no matter what the night nurse said. I showed him how to access an outside line and how to use the card. By the time he took his pill, he was talking to his mother, tears dried and a little smile on his face.

That moment has stayed with me, crystal clear. From the pediatric floor to the psych unit, from my stint as an occupational nurse to my most recent job as a school nurse, in all my "faces" as a nurse, holistic care remains my trademark, my unofficial calling card.

Thanks to Donna for her wonderful submission to this month's Nurses On The Go segment. If you would like to have the chance to get published in our monthly newsletter and be eligible to win a $50 VISA gift card, we would welcome your submission. All submittals should be between 500 and 800 words. To submit a story, send an email with the subject line Nurses On The Go story submission to info@nurse-recruiter.com.

Tax Delinquencies May Put Your License in Jeopardy

Tue, 24 Mar 2009 21:35:33 GMT

By Sue Antinoro Nurse-Recruiter.com

You've worked hard to obtain your healthcare license and are therefore, very protective of it. Certain actions such as drug use, negligence or criminal actions can cause it to be suspended or revoked. But what does the government have to say about it when it comes to filing your taxes? According to an article published in this month's Healthcare Traveler Magazine, there are some states which pursue action against healthcare providers for failure to file state tax returns or which continue to have a delinquent status in payment of a tax liability. If you file your taxes and/or pay any money owed on a timely basis then you will not be affected. But if you have not filed last year's return or are considered delinquent with a tax owed to the state your license may be at risk. If you have an outstanding liability to which you have not contacted the state to set up a payment plan you are considered to be in delinquent status. The article states that currently the states of Louisiana, Oklahoma and Kansas were found to aggressively review tax filing delinquencies and payments not entered into a repayment plan and cross reference that information with healthcare licenses. All other states have this ability as well. The article brought up one last concern which addresses whether state licensing boards have the ability to cross reference information such as license renewals with tax filings? Since this information is easily accessible to state agencies, the answer is yes, they do and may do so at their discretion. Obviously no one likes the government's ability to intrude on our lives, yet filing and paying taxes are a necessary evil and we all must do our part to keep up with this responsibility.

If you are new to travel nursing or even if you've been traveling for a few years, the following are some tax tips geared towards you:

Its never too late to start keeping organized records for filing next year's return. First and foremost, keep good records. There is nothing more frustrating that having to sift through piles of misshapen receipts.

Good record keeping will be to your benefit not only at tax time but if you are ever audited. A travel file system which will store paperwork, receipts, etc. is also extremely helpful. Its also a good idea to keep a separate folder for each travel assignment.

Keep a log tracking your vehicle mileage as well a log tracking all of your travel expenses. You should record the mileage on your vehicle on December 31 so that you have an ending point for the year (and a starting point for the following tax year) as you will need to know the total mileage put on your vehicle. Record the mileage for all business trips from starting to end point.

When maintaining a log, its best to record the place, time and purpose of each assignment. Keep all receipts in regards to lodging, tolls, air fares, parking, etc. Also be sure to record any travel between your assignment and home and from temporary residences to your work site. As for vehicle expenses, most people benefit by using the standard mileage deduction rate as stated by the IRS regulations.

Keep receipts for general business expenses such as uniforms, licensing fees, dues, seminar expenses, etc. Communications services such as cell phones, internet, and/or pagers are deductible to the extent of which you use it towards your business. Also keep track of expenses related to the upkeep of your home while away on assignment that you would otherwise not pay for (i.e. lawn maintenance).

More tips on deducting travel expenses can be found by clicking here.

The above tips are not intended as legal advice and it is always recommended to consult a certified tax professional when filing your taxes.

Nurse On The Go

Tue, 24 Feb 2009 15:23:29 GMT

Nurse On The Go

By Lori OKeefe RN, BSN, CDE

I have been a nurse and a certified diabetes educator for the past 11 years. I would like to share a experience I had with one of my patients.

We know that we can prevent or at least delay complications related to diabetes by keeping the blood sugar as close to normal as possible without risking low blood sugar. I provide diabetes education to individuals in individual or group classes. Many patients are very frightened when they come to see me as they don't know what to expect. Mr. Thomas came to see me with his wife last year. The first thing he said to me was, "I don't want you to take away all the foods I like. My wife has told me I can't eat ice cream and drink soda anymore. Please help me!"

Mrs. Thomas immediately stated, "I have to watch him all the time. He eats too much".

After doing a quick assessment, I explained what happens in the body when diabetes develops. I explained that we approach eating differently now. There is no "Diabetic Diet" anymore. Many myths and misconceptions still continue to exist about how people with diabetes should eat. Most foods are not forbidden to people with diabetes. The emphasis should be on portion control. I explained that Mr. Thomas could still eat ice cream and I talked about reading food labels and the importance at looking at the serving size, carbohydrate content, calorie content, and fat content. I also explained that Mr. Thomas should be the one making decisions about the foods he wants to eat. If his wife is constantly watching his food intake, he will sneak food when she is not looking. Patients need to know they can still have small portions of the food they really enjoy. I did explain that regular soda has a large amount of calories and carbohydrates. Mr. Thomas agreed to try seltzer mixed with lemon instead of regular soda. When he left our session, he seemed relieved. He knew he had to lower the portions of food he ate, but he was so happy to know that he could still eat his favorite foods. Can you imagine someone telling you to never eat your favorite foods again?

I don't believe patients suffer diabetes related complications because they eat cookies or ice cream. I believe they are at greater risk for complications, if their blood sugars remain above recommended levels. There are several ways to keep blood sugars as close to normal as possible. Healthy eating is just one way. Exercise, monitoring blood sugars, taking medications, healthy coping, problem solving, and risk reduction are also just as important to review with patients. These behaviors are also called the American Association of Diabetes Educator's 7 self-care behaviors. They summarize the information we share with patients. I am happy to report that Mr. Thomas's blood sugars are within recommended levels. His fasting blood sugars are between 90 and 110. His 2 hour post meal blood sugars are less than 180. He is exercising regularly by walking with his wife at the mall at least 4 days per week. He tests his blood sugars once to twice daily. He takes Glucophage XR 2ooo mg with his dinner meal. He now drinks seltzer instead of regular soda. He lost 10 pounds. And most of all, he is happy.

Sincerely,
Lori OKeefe RN, BSN, CDE

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Patient Simulators Gaining Popularity Among Teachers & Students

Tue, 24 Feb 2009 15:25:35 GMT

Patient Simulators Gaining Popularity Among Teachers & Students

By Sue Antinoro Nurse-Recruiter.com

Today's complex health care environment demands that nurses are able to make quick assessments and clinical decisions. More and more nursing schools are using high tech mannequins which offer an extraordinary tool for nursing education. The Human Patient Simulator is capable of realistically exhibiting the symptoms of medical crises such as: respiratory arrest, heart attacks, tachycardia, anaphylactic reactions, asthma, chronic heat failure, gastrointestinal bleeding and many more. Often referred to as "SimMan", this patient simulator is so advanced, it’s actually easy to operate. Other simulators include "SimBaby" and "PediaSim", and SimMan can also be turned into a woman and be pregnant. Sim-Man can have multiple computerized symptoms and diagnoses, and will respond to treatment. Different protocols will yield different outcomes and help nursing students learn proper techniques.

The pediatric human patient simulator, PediaSim is approximately the size of a 7-year-old child weighing 20 kilograms. PediaSim is especially helpful since only about 10 percent of calls to EMS providers involve a child. Nurses and physicians also have limited exposure to certain pediatric emergency situations. Infrequently used skills can be practiced and reinforced in HPS education to achieve a higher level of proficiency. As a result, students can learn and practice without risk of harming a real child. They can practice a procedure over and over until it's perfect.

The simulator affords residents an incredibly realistic training experience. But experts said that what really makes the patient simulator ideal for training is that it instantly reacts physiologically to the treatment it's given even if it's the wrong one. The simulator system registers the dosage and drug type, and the patient simulator reacts as a human patient would. Key features include pupils that automatically dilate and constrict, a drug-recognition system with bar code reader, realistic respiratory gas exchange and anesthesia delivery capabilities, and variable lung compliance and airways resistance. Another advantage of the patient simulator is that students can run through a situation repeatedly and that patient simulators allow students the opportunity to practice things they might not encounter except in rare circumstances, such as emergency situations.

A computer system allows the instructor to operate the HPS while working up close with students. Instructors can easily increase or decrease event severity and duration, overlay scenarios or interrupt the event. The scenarios allow students to respond as they would in the course of daily care. For instance, they can request a chest film or CT, or draw lab for blood gases, and will receive realistic values.

Caregivers can assess vital functions such as blood pressure, temperature, differential pulses, heart sounds, including murmurs and gallops, breath sounds including wheezing, and respiratory efforts. Caregivers can also perform procedures in a realistic fashion such as intubation with difficult airway and laryngospasm, IV lines, central line monitoring, EKG interpretation and defibrillation. The simulator can recognize appropriate CPR technique and what drugs are being administered at what amount and will react accordingly. The simulator will start to breathe once his airway receives adequate oxygenation and ventilation.

Since patients do not have as extended stays in they did years ago, its not as easy to observe patient progress over a period of time. In addition, simulation helps new nursing students get over their initial fear of encountering their first real patient. While many students claim they feel funny talking to a mannequin at first, they also recognize the benefits in using the patient simulator. Instructors also appreciate the fact that they standardize scenarios for the students and observe what each student does in a given situation and then follow up with comments and advice.

Nurses On The Go

Thu, 29 Jan 2009 20:20:55 GMT

By Nurse-Recruiter.com We'd like to congratulate Susan Hancz, RN a School Nurse from The Colony, TX for her winning submission to our "Nurses On The Go" feature. Her story about her life working with the students at the Morningside Elementary School was chosen as last quarter's winner and Susan will be receiving a $50 Visa gift check. If you would like to share an amusing or heartfelt story or just give our readers some insight into your life as a nurse, we would like to here from you. Its always nice for those who may work in a completely different nursing capacity to hear from others what their job entails. Who knows, you may entice someone to finally make that job switch into a different area of nursing expertise because they read your story. All submittals should be between 500 and 800 words. To submit a story, send an email with the subject line Nurses On The Go story submission to info@nurse-recruiter.com

Violence Against Nurses An Increasing Issue

Thu, 29 Jan 2009 20:21:55 GMT

Violence Against Nurses An Increasing Issue

By Sue Antinoro Nurse-Recruiter.com

Among all the other difficulties nurses deal with in their day to day work, violence against nursing staff is becoming an increasing concern. In fact, nationally crimes against nurses and health care workers are as common as assaults on correctional and police officers.

One Massachusetts nurse was confronted by an angry patient who not only dug her nails into her but threatened her children. Another time the same nurse was assaulted by an H.I.V. infected patient and ended up with the patients blood on her. Violence against nursing staff is seen often in the ER, where many patients are either intoxicated, frustrated with long wait times or both. Nurses maintain that an increase in violence in today's society and the fact that handguns are easier to obtain, along with a decrease in treatment options to psychiatric patients due to budget cuts are more factors which have led to the increase in violence against the staff. Nurses have reported dealing with with verbal abuse, being kicked, spit upon and assaulted.

Many of these assaults on nursing staff go unreported. In addition, some hospital administrators seem to be reluctant to acknowledge unruly incidents. Nursing advocates maintain that, in the past, nurses were encouraged to just deal with violence against them as if it were part of the job. Some nurses may be afraid to report an incident, fearing it will show up as a negative comment on their performance evaluation as not being able to handle a patient.

Some hospitals have made security guards less obvious by having them wear suits and ties instead of uniforms. While this is done in an effort to make hospitals appear more friendly, some say it has helped with the increase in patient violence.

Nurses maintain a more active presence of security officials, along with violence protection training which would include recognizing a potentially violent situation, are among efforts to help curtail this increasing problem. Other hospitals have gone a step further. For example, the University of Utah Medical Center has an armed police officer in the ER 24 hours a days along with security personnel. In addition, when a crime victim is brought into the ER and the perpetrator has not been apprehended, the ER is put into a lockdown.

With more attention being given to this issue in recent years, more nurses are being encouraged to report any incidents and more hospitals are implementing or increasing training to combat workplace violence and enhance employee and patient safety.

7 Steps to a Job Winning Resume

Sat, 03 Jan 2009 19:34:06 GMT

7 Steps to a Job Winning Resume

By Neca Rocco SelectNursingResumes.com

An effective resume is an important self-marketing tool for all nursing professionals. Whether you are just out of nursing school or a seasoned professional, and no matter what area of nursing you choose, a well-written resume will open doors of opportunity for you.

The main purpose of a resume is to help you get a job interview. A resume is more than a list of your jobs and the facts of your employment history. A good resume is about YOU and how you act and perform in your jobs.

Without a great resume, how will employers and recruiters know your unique skills and accomplishments? How will they know that you are the right candidate for the job they need to fill? And since you will probably have competition for that job, how can your resume help you stand out from the others?

Give your resume this quick check up and see for yourself how it will improve your chances of getting the nursing job you want.

1. Choose your job target. Because of the great variety of nursing specialties, it's important to focus your resume. Targeting your resume to a specific job objective will give you faster results.

2. Match your skills and experience. Use the job posting to look for the basic qualifications, and when writing your resume, highlight your training and history that match.

3. Summarize your key points. Put this "Professional Summary" section at or near the top of the resume, and then support it with your job history. The summary can be written as a paragraph or a list.

4. List your achievements. In addition to basic job descriptions, show ways you were able to increase production, streamline a process, increase efficiency, etc. Show how you solved problems, and give specific numbers if you can (i.e. dollar amounts, percentages, etc.). Remember to include promotions and awards.

5. Include keywords. Since many resumes are scanned into databases, career-specific keywords will help employers and recruiters searching for specific skills and experience to find your resume. Some people even include a special "Keyword" section in their resume.

6. List training and certifications related to the new job you want, and other skills that would be an asset, such as a second language.

7. Make your resume easy to read. Your resume will be read very quickly by hiring professionals, and long paragraphs of job descriptions may hide important information about you. Make that information easy to find, with bulleted highlights below each job listing.

Follow these steps and you'll see an increase in the response to your resume, more interviews, and you'll soon be on the way to that great new job!

Nurse-Recruiter.com Store Is Officially Open

Sat, 03 Jan 2009 19:33:06 GMT

Nurse-Recruiter.com Store Is Officially Open Our new store is now open and is filled with a wonderful assortment of merchandise that you can order for yourself or that special nurse in your life. Some of the items you will find are t-shirts, mugs, hoodies, track suits, tote bags, tank tops and even maternity wear. Our merchandise includes some of our more popular nurse sayings such as: * love a nurse * nurses are patient people * nurses can take the pressure * my mommy is a nurse * nurses call the shots * Thanks to all who contributed their favorite nurse sayings. These items make a wonderful gift, whether it be to help celebrate a co-worker's work anniversary, a special birthday or an amusing retirement gift for your favorite boss. You can find all the great products by clicking here. Lastly, we'd like to remind you that we are still looking for submissions to our Nurses On The Go feature. Do you have a heartfelt, amusing, or memorable work experience that you'd like to share? Your story could put you in the running to win a $50 Visa gift card. To submit a story, send an email with the subject line "Nurses On The Go story submission" to info@nurse-recruiter.com. All submittals should be between 500 and 800 words. We look forward to hearing from you! Thanks for reading and we wish a new year filled with peace, good health and prosperity!

Labor and Delivery

Sat, 03 Jan 2009 19:32:06 GMT

Labor and Delivery

By Belinda Mileur BSN RN

I remember it was my first month on the Labor and Deliver Deck of a small New England Naval Hospital as a Naval Nurse Corps officer. I had never worked Labor and Delivery in my 7 years prior while in civilian service and was intentionally trying to do everything by the book. My patient was a Gravida 1 Para 0 mother who had started her labor about 90 minutes before she came in to be admitted. She was 50 percent and 4 cm. Dilated.

No sooner than I had removed my exam gloves when, the mother started screaming "it's coming...it's coming". I reassured her that she was no where near delivering but her face, and uncontrolled body language told me otherwise. She pleaded with me to once again check her only 2-3 minutes after I had removed my hand. I reluctantly pulled back the sheet only to view a thick layer of dark black hair crowning. No where in my books or lectures had I remembered that it was possible for a first time mom to go from 4 cm and 50 percent effaced to complete and crowning in less than 3 minutes. That is the moment I decided that reading my patients took priority over reading my books.

Coming Soon...Gifts For Yourself or Your Favorite Nurse

Sat, 03 Jan 2009 19:31:06 GMT

Coming Soon...Gifts For Yourself or Your Favorite Nurse

Did you enjoy our section in last month's newsletter about nurse slogans? Perhaps you would like to show the world how proud you are to be a nurse. Or maybe you are looking for the perfect gift to honor a fellow nurse who is retiring or just a little something to say thanks to a colleague.

NurseRecruiter.com will soon have a merchandise link on the website and give nurses an opportunity to order their favorite item with a choice of several nurse sayings/slogans. Do you have a favorite one that you think would be great on a shirt or mug? Let us know and we may offer it on the merchandise. Here are some more sayings about nurses:

You know you are a nurse when you baste your Thanksgiving turkey with a Toomey syringe.

When you're a nurse you know that every day you will touch a life or a life will touch yours.

Nurses don't wait until October to celebrate Make a Difference Day - they make a difference every day!

Nurses are the hospitality of the hospital.

LPN: means Loving Person Near.

Nurses are the cure-all!

Nurses call the SHOTS!

Nurses give Intensive Care.

Nursing is the gentle art of caring.

Nurses are Angels in comfortable shoes.

RN means Real Nice!

Nurses can really take the pressure!

If love can't cure it, nurses can.

Being a nurse is not just a job, it's an adventure.

On a scale of 1-100, nurses are a 98.6!

Behind every good doctor is a great nurse!

From Emergency to Elementary

Sat, 03 Jan 2009 19:30:43 GMT

From Emergency to Elementary

By Susan Hancz

After working in a state-of-the-art pediatric emergency department for thirteen years, my career took a different path...sort of. I had triplet daughters that were starting Kindergarten and with no extended family anywhere near our city, I felt that I needed a career that would allow me to be on their schedule. That's when I began to search for a school nurse position. Initially I was concerned that I would be 'bored'. The thought of leaving an exciting emergency department to work in an elementary school setting seemed worlds apart. What I soon realized was that even though the settings are drastically different, in many ways, the job responsibilities are strikingly identical.

I have over 670 students in my school. I triage twenty-five to sixty students a day in my clinic. The complaints range from simple, non-urgent illnesses or injuries to more serious, emergent illnesses or injuries. I quickly found that making a triage decision or developing a plan of care in the school setting is far different than that in the hospital setting. In the hospital setting, there are Physicians, Registered Nurses, or Respiratory Therapists to confer with; however, in the school setting, I am the sole decision maker for these students. While I can not diagnose the problem, I must evaluate the student and make the most effective decision that I can for the best outcome and well-being for each student. Just as in the hospital setting, I rely heavily on my critical-thinking and problem-solving skills to make these decisions for each student.

Patient care in the school setting involves assessment, evaluation, observation, medication administration, screenings, and teaching. I have physician orders for daily and "as needed" care of students with Asthma, Diabetes, Sickle Cell Anemia, severe food allergies, and various other syndromes. Staying on top of health care is imperative for me as the school nurse. Just as in the hospital setting, if there is a problem with the physician order, I am responsible for notifying the physician before carrying out the order. Also, just as many people use their local emergency department for their primary healthcare needs; many others use the school nurse as their primary access to healthcare. Unfortunately, many families cannot afford healthcare for their children, so sending their child "to see the school nurse" has become a very common entity. Astute assessment skills and student/family teaching often go hand-in-hand. Additionally, the state mandates that all students in Kindergarten, First, Third, and Fifth Grades undergo screenings. I screen approximately 400 students annually for vision, hearing, and Acanthosis Nigricans. Referrals, family teaching, and financial assistance are provided if indicated.

The adrenaline rush of the "bat phone" reporting that a child is being transported to the ER with head and neck pain after a fall is now replaced with a call to the clinic to come to the playground because a child has fallen from the monkey bars and is complaining of head and neck pain: same adrenaline rush...different setting. As I perform my trauma assessment, I secretly miss having my colleagues around and the state-of-the-art equipment to assist with the plan of care for this student. The "what to do" is left up to my professional judgment.

School nursing may not be as "glamorous" as emergency nursing, but it definitely requires the same ability to problem solve, utilize critical thinking skills, and practice autonomously. I may not get the opportunity to "start the I.V. on the first stick" or "start 2 units of PRBC's for the trauma patient", but there is a subtle sense of pride when a parent approaches me with a "Thank You for taking care of my son yesterday. He did break his arm." or "I never realized that she was sitting so close to the T.V. because she needed glasses. Thanks for the referral!" While the parts of my career that used to bring me job satisfaction are different now, I can definitely find joy in the difference I make at my school.

Susan Hancz, RN
Morningside Elementary
The Colony, TX

As you can see, today's school nurse is more than just a person who bandages scraped knees and hands out lolly pops. To work as a School Nurse, one must be prepared for a wide variety of medical conditions, ranging from the standards flu like illnesses to students who have chronic conditions and need the assistance of the nurse to help administer prescription medications such as Ritalin or to monitor a child's asthma or diabetes. If you are considering a job as a School Nurse, you can access our extensive database at www.nurse-recruiter.com or fill out our Rapid Apply Form to submit your profile to healthcare employers who fit your requirements.

What Do People Really Think Of Nurses

Sat, 03 Jan 2009 19:29:06 GMT

What Do People Really Think Of Nurses

These are sayings by people or unknown authors about nurses.
Interested in seeing these on a T-shirt, sweatshirt, travel mug or a baby's bib?
Nurse Recruiter will soon have a merchandise link on the website and give nurses an
opportunity to order their favorite item with a choice of several nurse sayings/slogans.
Have a favorite one not listed below? Let us know and we may offer it on the merchandise.

Nurses are angels in comfortable shoes

Nurses can take the pressure

Nurses dispense comfort, compassion, and caring without a prescription

A nurse is compassion in scrubs

Nurses are I.V. leaguers

After two days in the hospital, I took a turn for the nurse

Nurses are patient people

Nurses - one of the few blessings of being ill

If love can't cure it, nurses can

Confucius say: "Man who want pretty nurse, must be patient."

We'd all be worse without a nurse

Nurse Anesthetists: the Often-Overlooked CRNA

Sat, 03 Jan 2009 19:28:06 GMT

Nurse Anesthetists: the Often-Overlooked CRNA

By Norma Walsh

Most people outside the medical field - and a good deal of those within it - are not sure exactly what a nurse anesthetist does; some may have never even heard of it, or think of them as "assistants" to anesthesiologists. Nurse anesthetists have a long and storied history spanning over 150 years, and today perform an important and increasing role in patient care.

The first nurse to provide anesthesia was Catherine S. Lawrence, who administered anesthesia for Civil War surgeons circa 1861 to 1865. However, anesthesia was used infrequently, because it was considered too dangerous.The first "official" nurse recognized as a nurse anesthetist was Sister Mary Bernard, a Catholic nun who practiced in the 1870s at St. Vincent's Hospital in Erie, Pennsylvania. The first school of nurse anesthesia formed in 1909 at St. Vincent Hospital, Portland, Oregon. The course of study was 6 months long, and included classes on anatomy and physiology, pharmacology, and administration of common anesthetic agents. Soon, many schools offering similar programs were formed. Between 1912 and 1920, approximately 19 schools opened in the United States. All consisted of post-graduate anesthesia training for nurses, and were about 6 months in length. These included programs at Mayo Clinic, Johns Hopkins Hospital, Barnes Hospital, New York Post-Graduate Hospital and Presbyterian Hospital in Chicago.

At the time, physician residences in anesthesia did not exist, so doctors attended these programs to learn anesthesia. The nurse anesthesia specialty was formally organized on June 17, 1931, when the American Association of Nurse Anesthetists (AANA) held its first meeting. The new organization had two main objectives: establish a national qualifying exam, and establish an accreditation program for nurse anesthesia schools. The first national certification exam was held on June 4, 1945, with 92 candidates sitting for the exam.

Prior to World War II, anesthesia was considered more a nursing specialty. In 1942, there were 17 nurse anesthetists for every one anesthesiologist. Even as late as 1971, 48.5% of anesthesia was given by certified registered nurse anesthetists (CRNAs), while 38.34% was provided by American Society of Anesthesiology members. The numbers of physicians in this specialty did not greatly expand until the late 1960s and 1970s, which parallels a time in surgical history when operations became much more complex.

After many years of preparation, on January 19, 1952, a program for the accreditation of nurse anesthesia schools went into effect. The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer approximately 30 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists' (AANA) 2007 Practice Profile Survey.

Nurse anesthetist programs are offered by 109 educational institutions in the United States today. The programs are between 24 to 36 months in length (average 28) and provided on a Masters degree level. All programs include clinical training in university-based or large community hospitals. In addition, there are Doctorate programs (Nursing Doctorate or Doctor of Nursing Practice) at several universities in the United States. All programs require you to be a registered nurse, and have a four year college degree in science or nursing (BSN), and at least one year of acute care nursing experience before entry. Acute care is usually defined as intensive care, coronary care, emergency/trauma, etc. In addition, applicants must meet the qualifications of the graduate school (GRE, GPA, required course work). Because most programs have far more qualified applicants than available spaces, successful candidates usually have several years of experience in nursing in addition to specialized education in nursing or other health disciplines. Graduate college requirements may include a minimum score on GRE exams (e.g. 1000+), and possibly a 400 or graduate level statistics course. Anesthesia school requirements usually include recent college level math, physics, chemistry and anatomy.

There is a varied scope of practice for nurse anesthetists. They can work for a hospital, outpatient surgery center (surgery, dental, podiatrist), in a group practice or they can practice independently. CRNAs will work in collaboration with surgeons, dentists or podiatrists, or on an anesthesia team with an anesthesiologist, to provide anesthesia care. Laws governing the degree of physician collaboration or supervision will vary state to state. Most often, the patient can expect to receive their anesthetic from an anesthesia care team, with the CRNA and anesthesiologist working together. CRNAs can administer anesthesia in all types of surgical cases, applying all the accepted anesthetic techniques - general, regional, local, or sedation. The exception is "pain medicine," which is usually practiced by anesthesiologists. Others become clinical instructors, school directors, or department supervisors. Working hours vary according to practice, but in many cases, exceed 40 hours per week. Salaries exceed most nursing specialties, depending on location and experience.

CRNAs are the primary anesthesia providers in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals. Nurse anesthetists have been the main providers of anesthesia care to U.S. military men and women on the front lines since WWI, including the current conflicts in Iraq and Afghanistan.

Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. Approximately 44 percent of the nation's 39,000 nurse anesthetists and student nurse anesthetists are men, compared with less than 10 percent in the nursing profession as a whole. More than 90 percent of U.S. nurse anesthetists are members of the AANA.

As advanced practice nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly. There is also a stringent recertification/continuing education requirement, as CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

They Might be Angels

Sat, 03 Jan 2009 19:27:06 GMT

They Might be Angels

By Norma Walsh

In the last few years of my mother's life, when she was suffering from myriad chronic conditions that had greatly decreased her mobility, my entire family - but especially my mother, the patient - was thankful for the convenience and reassurance of having a weekly visit from an Registered Nurse, Annie. After my father passed away and my mother was home alone all day, it was especially nice to know that someone whose company she truly enjoyed and appreciated, who had knowledge of her "ailments," as she called them, would be evaluating her regularly for those small changes that can signal major problems in the elderly. It was, in fact, Annie who called my brother at work in alarm one frigid February morning, quite concerned that she had arrived at my mother's house to find the door locked and no one answering the phone. Annie offered to call 911 and wait at the house until emergency services and my brother arrived. Sadly, my mother had passed away in her sleep a few hours earlier. But it seemed fitting and comforting to my brother and me that Annie, whom she trusted and, I'm certain, loved, had been there to cushion the fall for us.

Visiting nurses have been providing home health care and more to patients for over 100 years through various agencies and organizations. The Visiting Nurse Associations of America (VNAA) was established in 1983 as the official national association for non-profit, community-based Visiting Nurse Agencies, who care for and treat approximately four million patients each year. The nation's network of more than 400 Visiting Nurse Associations share a nonprofit mission to provide cost-effective and compassionate home healthcare to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. The VNAA offers a wide range of resources about home healthcare and questions to ask when considering home healthcare.

Visiting Nurse Associations (VNAs) care for patients of all ages, from infants to the elderly, offering comprehensive services such as post-partum and infant wellness programs to hospice care. Patients can receive skilled nursing care, rehabilitation therapy, social services/counseling and other professional attention as needed. Many VNAs also offer help with housekeeping, transportation, personal care and delivery and set-up of medical equipment. And in addition to individualized, at-home care, VNAs play an important role in the community, organizing immunization clinics and support groups and running wellness programs in schools and senior centers.

Both in their involvement with patients at home and their work with the public, Visiting Nurses play a role in improving quality of life for everyone with whom they interact. Annie told me about the bond she felt not only with my mother, but with all the patients she works with and cares for, short-term or long-term, recovering from minor surgery or terminally ill. She truly made a difference to my family and visiting nurses make a difference in society.

What's it Like to be a Travel Nurse?

Sat, 03 Jan 2009 19:26:06 GMT

If you are a nurse who enjoys the challenge of working in new environments, meeting new people and gaining experience in different areas of nursing, you may be suited for Travel Nursing.

Travel Nurses are, generally, assigned to positions in a location for a period of 13 weeks. Often, they are asked to stay on longer and have the option to extend their contracts with the healthcare facility. Travel Nurses enjoy top pay, free housing and gain valuable experience that can result in career advancement or permanent positions. As a Travel Nurse, you can work in home health care, hospitals, long-term care facilities, clinics or medical offices in any of the dozens of nursing specialties.

As a Travel Nurse, you indicate to your employer your location preferences and specific skills or interests, in addition to salary and schedule requirements. You'll then be told of the Travel Nurse positions that meet your criteria, and your employer will supply you with information regarding the healthcare facilities, housing arrangements and particulars of each job, enabling you to choose the one that suits you best.

The most satisfied Travel Nurses are those who fully understand and accept the terms of their contracts. With each position you are offered, you will have a contract that states your duties and rewards. A Travel Nursing contract will describe the nature of the Travel Nurse's professional responsibility, list offenses that may result in premature termination and detail the standards to be followed; e.g. JCAHO. Your contract will state the length of the assignment, how many hours you will be working, your pay rate and the method and schedule of payment, information about overtime and any bonuses that may be earned. Travel Nursing contracts will explain employee benefits such as liability and health insurance and any allowances, as well as information about provided housing, payment of utility bills during the assignment and any other costs that may be reimbursed. There will be a section that indicates what, specifically, is expected of you and states policies and procedures of the healthcare facility where you will be working. Read your contract carefully, read it again, and address any concerns or questions immediately before signing. You will walk in prepared to excel on your first day with a clear understanding of what the next three months will entail.

An important thing to consider when thinking about Travel Nursing is transportation. Most Travel Nurses use their own cars to travel from one assignment to the next and for their daily commutes to work, so it's important to have a reliable vehicle. Some Travel Nurses' employers fly them to their destinations and provide a rental car; some do not. Make sure you know before you sign the contract. Also determine what the parking situation at your housing and work location will be ahead of time. If you're assigned to a big city, you may have the option to use public transportation.

Travel Nursing is a very non-traditional lifestyle and you must accept or even thrive in atypical circumstances. If you're married and your spouse cannot join you on your assignment, you need to be prepared to withstand that type of separation. If you're hesitant about spending time alone or having to re-build your social life every few months, you might want to consider more long-term or permanent nursing jobs rather than Travel Nursing. Lots of resources exist, like message boards and chat boards, where Travel Nurses can talk to and support each other, and some hospitals will have programs to acclimate their Travel Nurses to the local area. Travel Nursing is a big change from a "regular" nursing job, but if you don't mind a semi-nomadic existence, like the idea of taking time off in between assignments when you want a break and are happiest when trying new things, the potential financial, personal and professional rewards of Travel Nursing can't be beat.

RN Jobs

Sat, 03 Jan 2009 19:25:06 GMT

Whether you are a newly-minted R.N. or a veteran nurse, it is well-known that there are currently more Registered Nurse jobs than there are qualified professionals to fill them. If youre on the hunt for your first nursing job or a new position, opportunities abound. But it's important to find the right job. How does a Registered Nurse find the job that's best for him or her?

Registered Nurse positions exist in various types of facilities, the most obvious being hospitals, of course, which comprise nearly 60% of all R.N. jobs. If you're interested in working in a hospital, again, there are many different things to consider: for example, do you prefer a smaller, community hospital or a university-affiliated teaching hospital in a big city? Do you have a nursing specialty, such as emergency medicine or telemetry, and do you want to continue practicing in that area or try something new, like critical care or post-anesthesia/recovery? Along the same lines, but with more regular and traditional schedules, are R.N. jobs in doctor's offices or walk-in clinics where you may see a couple dozen patients a day who are seeking routine or urgent care. If the personal touch is your forte, R.N.s provide home health care to housebound patients through social service agencies or hospital programs. Nursing homes and rehabilitation facilities afford nurses the chance to work with patients needing long- or short-term medical care for all kinds of injuries, illnesses and chronic conditions. If your lifestyle is suited to it, travel nursing is an exciting (and potentially very profitable) way to apply your skills, live and work in new places every few months and try out different kinds of R.N. jobs. And jobs for Registered Nurses are plentiful in settings that are often overlooked, such as schools and colleges, camps, correctional facilities, substance abuse treatment centers, state and municipal governments, shelters, the forensic and legal fields, and insurance companies. Some of these jobs are entirely administrative and involve no direct patient care; others are just as hands-on as an R.N. position on a busy surgical floor.

So, once you've narrowed down what kind of Registered Nurse job you want, in what kind of facility and in what locale, how do you find those jobs? Registered Nurses are in agreement that going it alone is not the best approach. You will get the job you want and get to work faster when you use the up-to-the minute database at www.nurse-recruiter.com. Here, you can not only search for R.N. positions, but also post your resume and be found by employers who want you; a process that saves you time and energy and gets you working at the R.N. job you want, where you want, at the salary you want, faster and easier. With just a few clicks, you can explore Registered Nurse jobs at all kinds of healthcare facilities in cities and towns all over the country. And when you complete the Rapid Apply Form on www.nurse-recruiter.com/members/rapidapply.php, hundreds of employers looking for Registered Nurses with your background and skills will be able to access your information and contact you to express their interest and give you a chance to ask questions. Maybe the perfect Registered Nurse job is one you never even thought of, but it could find you when your resume appears on an employer's search for Registered Nurses on www.nurse-recruiter.com.

Trying Telephone Triage

Sat, 03 Jan 2009 19:24:06 GMT

Trying Telephone Triage

By Norma Walsh

Any nurse who�s worked in an urgent care setting will tell you that it is invariably the most severely ill/injured patients who say, �I wasn�t even sure I should come in for this,� (and �this� could be anything from kidney stones to an MI to a deep puncture wound) and are the most apologetic about �taking up your time� and �being a nuisance,� while those who present with hangnails and cold sores are the most apt to complain, loudly and vehemently, about long wait times and not getting the brand-name antibiotic they are sure they need. What if you, as a nurse, could help ensure that people who need emergency care seek it, and help those not requiring immediate treatment understand their conditions and find appropriate care in the near future? Perhaps telephone triage nursing is a career option for you.

Telephone triage nurses are employed by health insurers, HMOs, physician�s offices and hospitals as a front line resource for patients who have questions about changes in their health and what kind of treatment they should pursue. Telephone triage nursing is different than health advice lines offered by insurance companies, health care facilities and municipalities, which exist to provide answers to general medical questions. Telephone triage aims to advise patients regarding appropriate treatments for their current symptoms and decrease the number of unnecessary office and emergency room visits.

Telephone triage services rose to prominence in the U.S. during the mid-1990s in response to the overwhelming numbers of non-urgent cases presenting at emergency departments. The idea was adopted by physician�s offices as a way of advising patients who called with concerns during or outside of office hours where, when or if to seek medical attention. Because of the special challenges involved in telephone triage nursing, it takes a certain kind of nurse to enjoy the job and meet its goals.

Obviously, evaluating a patient over the phone is a different experience than triaging a patient in the ED. With no physical assessment and lacking the non-verbal cues and diagnostic equipment that help a nurse understand a patient�s complaint, the telephone triage nurse must rely on excellent communication and interpersonal skills. It requires an in-depth knowledge of disease processes applied in conjunction with critical thinking and judgment, although the telephone triage nurse does not provide a diagnosis. The phone triage nurse assesses the information given by the patient, asks questions and guides the patient to the appropriate care.

Telephone triage is provided by RNs, generally those with extensive hands-on triage experience or who have taken classes that specifically teach pone triage skills and protocol. Ongoing education is usually part of the job. Performing telephone triage nursing has unique pros and cons. On the plus side, nurses deal with a varied caseload, work regular hours, may even be able to work from home rather than at a call center or medical facility and the job itself is not physically demanding � there is no heavy lifting or clean-up. Negative aspects of telephone triage include the lack of personal contact with patients, no follow-up with patients, no real interaction with colleagues, heavy computer/paperwork load and a sense of isolation or disconnect. One must have the proper skills, mindset and personality to succeed and thrive as a telephone triage nurse.

Certification is not usually required for working as a telephone triage nurse.� However, many employers see this as a reflection of competency and professionalism that then increases the appeal of a job candidate.� The National Certification Corporation now offers certification in Telephone Triage.� As with most other certifications, there are certain eligibility requirements, such as current licensure, 2000 hours of specialty experience and recent employment in the specialty if applicable

The Emergency Nurses� Association (ENA) notes in their Position on Telephone Advice that �as health care changes in this country, the demand for telephone assistance is climbing.� It advises, however, against nurses performing such functions without an established telephone triage program and without appropriate education, asserting that the consequences of nurses� giving phone advice can be �devastating� in the absence of polices, protocols and documentation. There can be negative outcome for patients as well as risk to the facility and violation of state nurse practice acts if telephone triage services are improvised. ENA recognizes that �sophisticated telephone triage programs provide quality health care assessment opportunities that enhance and promote quality health care within the community,� but caution that proper expertise, training, documentation, continuing education and clearly defined policies and quality control standards are �essential in assuring that telephone triage does more good than harm.�

If you�re looking for a non-traditional way to use your nursing skills, telephone triage is an ideal example of a way nurses assist the community in a setting other than direct patient care or administration. Don�t be fooled into thinking that triage nursing is an undemanding job.� On the contrary, a shift at the phone on a triage line can be more demanding than a day running up and down the medical/surgical floors.� The major difference is that the delivery of top-notch nursing care must come without the advantage of seeing or touching the patient.�

Nursing as a Second Career

Sat, 03 Jan 2009 19:23:06 GMT

Nursing as a Second Career

By Norma Walsh

About five years ago, when she was in her early fifties, my friend Nancy made a decision that surprised her family and friends. She was going back to school. And she was going to become a nurse.

�A nurse?� more than a few people responded. �Why would you want to go through all that schooling? Start a whole new career at this age? Nursing�s not easy, you know.�

�I had been the primary caregiver for both my aunt and one of my very close friends during their final months,� Nancy told me. �And I found that I was a natural at it. Being able to do what I did for them showed me that I had a calling for nursing, even though I�d been doing something else for almost 30 years.�

That �something else� was working as a top-level executive assistant. Nancy had been the right-hand-woman to some of the most prominent corporate leaders at some of the largest firms in her city, in fields ranging from commercial real estate to publishing. Could she walk away from the world of designer suits and catered lunch meetings into the completely different world of scrubs and sandwiches from the cafeteria? She could, she did, and she�s never been happier. Nancy found that she was in good company, and plenty of it, as someone who chose a nursing career later in life.

Nancy, and others like her, knew going into it that beginning a nursing career is no small undertaking. As with any profession, good education, training and preparation for the realities of the job are essential to a candidate�s success, as is the support of one�s family and the ability to withstand the rigors of, perhaps, both attending school and working full time. Nurses, however, are in high demand � a situation that is expected to continue for decades � so colleges and employers are finding ways to make classes and clinical assignments a viable option for those coming to nursing as working adults. If you already have a Bachelor�s degree, many schools have accelerated nursing (BSN) programs that allow you to earn your degree more quickly. There are also part-time nursing programs that let you continue to work full time in your current position while studying. And many schools offer some of their courses online so you can work from home, a valued convenience for many older nursing students.

What does it take to become a nurse, at any age? Of course, the love of working with people is paramount. An aptitude for math and science, excellent communication skills and thriving on intensity and a fast-paced environment are critical as well. Older nursing students, however, are especially valued by nursing schools and prospective employers, because they bring energy and focus to their studies and work. This may stem from their having arrived in the field after years of considering it and finally having the chance to bring all that�s inside them out and applied to the real world, or, like Nancy, finding their way to nursing after a life-changing experience.

Why does nursing appeal to people who may have spent 20 or more years in non-medical fields? In addition to the feeling of personal satisfaction, people in their forties or fifties may be thinking about that not-as-far-away-as-it-seems retirement age, and are looking for a career with excellent earning potential and job security to carry them through the next 20 years or more. Nursing certainly fits the bill. With nursing salaries on the rise and many different opportunities for employment (visiting nurse, hospice, administration, phone triage, as well as traditional patient care roles in hospitals and offices), new nurses in their fifties will have options far beyond what would be open to them in other professions.

Women aren�t alone in finding their way to nursing careers after spending decades doing �something else.� Men are turning to nursing as a second career in ever-increasing (though still small) numbers. The often say they desired to pursue nursing as college students, but concerns about societal perceptions led them down other paths of study. Later in life, with more perspective and confidence and years of other kinds of experience under their belts, often seeking more meaningful work, they�re able to return to school and become nurses. Many men who come to nursing as a second career gravitate to intense specialties, like ICU and ER, while others apply their �old life� business skills to hospital administration or management.

A Vanderbilt University School of Nursing study cites concerns that the average age of working RNs increased by 4.5 years between 1983 and 1998. At present, the average age of working RNs is approximately 45.4 years, a number which has increased by more than 3.5 years since 2000. And the nursing shortage of the last ten years is expected to continue if less young students choose the field while large cohorts of RNs retire. Nancy, for one, is looking forward to spending the next fifteen years � �at least fifteen years,� she says � at the job she began after completing her degree and passing her boards: working in the post-anesthesia unit at the VA hospital in her city, where she did her first clinical rotation. �I love it here; I love the hospital, my patients and my co-workers,� she beams. �If I�d only known then what I know now.�

Why NurseRecruiter.com for Nurses

Sat, 03 Jan 2009 19:22:06 GMT

Why NurseRecruiter.com for Nurses

By Norma Walsh

Nursing can be an extremely rewarding and enriching career path. It can also be exhausting and overwhelming.

What if you could start fresh every thirteen weeks, gaining new and valuable experiences, meeting new people in new places, earning excellent pay and benefits?

You can. By taking a few minutes to fill out the Rapid Apply Form on Nurse-Recruiter.com, you become known to thousands of health care employers and staffing agencies who need qualified nurses NOW.

Travel nurses enjoy top pay, free housing and exploring different kinds of health care environments and fields that can result in career advancement or permanent positions. As a travel nurse, you can work in home health care, hospitals, long-term care facilities, clinics or medical offices in specialties like:

1. ICU/CCU
2. ER
3. Pediatrics
4. Psych
5. Telemetry
6. Med/Surg
7. OR
8. Post-Anesthesia/Recovery
9. Oncology
10. Labor & Delivery

You can work full-time, part-time and may have the opportunity to pick up per diem shifts tax-free. Health care employers� nursing needs vary seasonally � you can follow the sun and work in warm climates over the winter.

Fill out one form, tell Nurse-Recruiter.com where you want it go, and we make you accessible to thousands of health care employers who need your skills. With over 30,000 jobs listed at any given time, you can browse through permanent and temporary positions, chat live online with potential employers to ask questions about their organizations and change your profile preferences as you wish. Why limit yourself to a limited pool of local health care employers when your skills are in demand everywhere? Search the term �nursing jobs� on Google, Yahoo or MSN, and Nurse-Recruiter.com will be in the top five results, attracting hospital and health care recruiters, staffing agencies from across the country.

Nurse-Recruiter.com was the first online job portal dedicated to nursing positions and remains the top-rated web source for nursing jobs today. For nine years, we�ve been connecting health care employers with dedicated professionals who excel in their chosen fields. Visit our site today, fill out Rapid Apply and see where you can be working tomorrow.

The Changing Role of School Nurses

Sat, 03 Jan 2009 19:21:05 GMT

The Changing Role of School Nurses

By Norma Walsh

In a recent edition of the monthly newsletter I receive in the mail from my family's HMO, a letter from a reader asked, "Do we even have school nurses anymore? And, what do they do?"

School nursing has evolved from the temperature-taking, bandage-applying friendly face we remember from our childhoods, and not all for the positive. While the responsibilities of school nurses have expanded to include things like nutrition counseling, crisis intervention and developing special education programs, nurses are now often very limited, due to liability, on how much hands-on care they can provide to injured or ill students. School nurses are pressed for time as the nursing shortage combines with dwindling education budgets to affect staffing. Schools may have only part-time coverage as one nurse rotates among many schools in a district, leaving office staff or paraprofessionals to handle routine and emergency care.

Most states have Nurse Practice Acts which govern the scope of nursing practice and spell out the services school nurses can provide. These may be basic, such as applying ice packs and administering prescribed medications to students, or they may include training school staff in CPR, developing and implementing Individualized Health Plans (IHPs) for students who require them and working with the city or town Board of Health to address health issues such as communicable diseases.

School nurses can be RNs or LPNs, but the most important qualities in a school nurse � besides the obvious love of working with children and teens � are time-management skills and the ability to set priorities. School nurses mainly work alone (or with a very small staff) and are responsible to not only the students, but to parents, school staff and the community at large. School nurses are a liaison between home and school regarding health concerns, and often interpret medical data from a student's parent to his or her pediatrician and vice versa. The increasing numbers of children who require medication or assistance with devices during the school day, and ever-growing concerns about food allergies and childhood obesity add to the realm of situations under the school nurse's umbrella. They often work with teachers, contributing to the health and science curriculum; may have input into the physical education program and are the first line of defense in addressing issues ranging from head lice to child abuse. It's important that a school nurse is well-organized and able to wear many different hats while switching from patient care provider to administrator to consultant often in the course of several minutes.

Much like the teachers with whom they work, school nurses are not in the job for the money. Unfortunately, school nurses salaries are lower than their hospital counterparts. The job of a school nurse presents unique challenges but also the reward of knowing that every day is an opportunity to better the quality of children's health care directly. Qualified school nurses are a necessity, not an option; and school nurses do make a difference.

Nursing shortage prompts creative efforts to fill nursing jobs

Sat, 03 Jan 2009 19:20:06 GMT

Nursing shortage prompts creative efforts to fill nursing jobs

By Katy Schiel

Plentiful nursing jobs in the Canadian province of Saskatchewan are soon going to be filled by unlikely candidates if local health care professionals get their way. In March, a delegation of health care professionals and hospital administrators are traveling to the Philippines in hopes of recruiting up to 300 nurses to fill the gap in local nursing jobs and to relieve the nurses who are currently working many hours of overtime.

Saskatchewan, like much of North America, is facing a huge nursing shortage. The Saskatchewan Union of Nurses estimates that there are between 800 and 1,000 open nursing jobs in the province. And the problem is only going to get worse, with more than 1,400 practicing nurses eligible for retirement in 2010.

The Philippines is an attractive destination for recruiting nurses because it trains more nurses than it needs. According to James Winkel, the spokesperson for the Saskatoon Health Region, the province would not be "poaching" nurses to fill their nursing jobs, since there are over 400 nursing schools there. "They have a huge surplus of nurses graduating and not enough openings," Winkel said. "There's just too many nursing grads." Despite the frigid temperatures in Saskatchewan, finding Filipino recruits to fill open nursing jobs is relatively easy since the pay is substantially higher. Nursing jobs in the Philippines only pay between $125 and $150 per month.

All candidates are required to take an English test, and officials will check their credentials to ensure that they meet all the requirements of the specific nursing jobs they are being recruited for.

Travel nursing: an increasingly popular option for in-home care

Sat, 03 Jan 2009 19:19:15 GMT

Travel nursing: an increasingly popular option for in-home care

By Katy Schiel

Travel nursing is becoming extremely popular not only because nurses love the freedom, flexibility, and higher pay that travel nursing offers, but also because it's a convenient choice for anyone needing in-home care. Once thought of only as an option for the ultra rich, private, or travel nurses are a viable heath care option for anyone, including retirees who would otherwise have to enter a nursing facility, and those recovering from major surgery or disease such as cancer.

Interested in becoming a travel nurse specializing in private in-home care? Now might be the best possible time to start a career in travel nursing. Patients are quickly becoming wise to the availability of travel nurses, and are seeing them as a more convenient and cost-effective option for either short-term or long-term care.

Patients 65 and over will get help paying for travel nurses through Medicare, which will pay for up to eight hours a day or 24 hours of care within a 60-day period. While in-home health aids are more affordable for long-term care, travel nurses are able to provide the skilled care that could make the difference between a speedy recovery and a less palpable outcome.

Have You ever Thought About Becoming a Flight Nurse?

Sat, 03 Jan 2009 19:18:46 GMT

Have You ever Thought About Becoming a Flight Nurse?

By Katy Schiel

What is it about flight nursing that makes seemingly sane nurses who are already under mountains of stress at their "routine" hospital jobs want to take on the added challenges of this all-encompassing job? Flight nurses care for the most critically ill or injured patients across all specialties of medicine and disease. Flight nursing is, according to those who do it, the ultimate test of your skills, education, and experience as a nurse. There's no routine day for a flight nurse. You could be on a mountainside rescuing an injured climber one day and transporting a burn victim in an urban area the next. When you're called, you have to have the skills and the wherewithal to deal with whatever comes your way. With just you, your partner, and the pilot aboard, you will be faced with challenging decisions that you might never have to make in a hospital setting.

For some nurses, the opportunity to fly, be a part of a highly trained team, receive specialized training, and also to help give critically injured trauma patients the chance to live makes the flight nursing profession highly appealing - a true "higher" calling.

How does one train to be a flight nurse?

Once you finish your nursing education, you will need to gain as much experience as possible in as many areas as you can. While some argue that ER nurses make the best flight nurses, there are others who say that ICU nurses are best prepared for the role. Whatever you do, try to gain experience with as many types of patients as possible.

Flight nursing requirements vary from state to state, but on a national level, all flight nursing programs require RNs to have two to three years of critical care experience, advanced cardiac life support, and pediatric advanced life support certificates. Some states require that nurses be trained paramedics or EMTs, and might require certification in neonatal resuscitation, critical care, and as a certified flight RN.

Nurses at High Risk for Chemical Exposure

Sat, 03 Jan 2009 19:17:35 GMT

By Katy Schiel

Are the very people who we depend on the most to keep us healthy putting their own health at risk through workplace exposure? A new study released in December by Environmental Working Group and Health Care Without Harm found that nurses are exposed to a shocking number of toxic chemicals in their daily work routines.

The survey of over 1500 nurses asked about exposure to 11 common chemicals, including hand sanitizers, latex, chemotherapy and antiretroviral drugs, medical devices containing mercury, gases for anesthesia, and even personal care products such as shampoo and soap. The results of the survey showed that nurses exposed at least once a week to the chemicals had increased rates of cancer, asthma, and miscarriages. There was also some evidence that nurses who were pregnant when exposed to the chemicals had children with higher rates of musculoskeletal defects.

The study found that there are few regulations that limit nurses' exposure to harmful chemicals, and that most nurses are not aware of the dangers they face. "As much as we rely on nurses to protect us when we're sick, we're not protecting nurses in return," said Jane Houlihan, the vice president of research for the Environmental Group and one of the study's authors.

Despite the study's findings, there are improvements being made in hospitals across the country. Latex glove use is being limited due to allergic reactions, and vinyl (PVC) is being phased out in some hospitals as awareness about its hazards expands.

The authors of the study hope that the survey's results will persuade national health officials to study the issue further and pass regulation to limit chemical exposure among nurses.

Read the full press release.

Stringent Nurse-to-Patient Ratios Increased Demand for Nurses in California

Sat, 03 Jan 2009 19:16:20 GMT

California is one of those states which has passed legislation in 1999 demanding lower nurse-to-patient ratios in its hospitals. The last phase of the legislation went into effect on January 1, 2008.

In many CA hospitals the ratio is down to as low as five nurses per patient, especially in the cardiac and special care units. It can go even lower if only there were enough qualified nurses available.

The intended positive impact of the law is obvious. When nurses work with a smaller number of patients and are not required to put in inhumanly long working hours, there is less burnout. And less burnout means both lower turnover rates for the nurses and a higher level of medical care for the patients.

The 1999 law triggered a boom in nurse recruitment which still continues in California today, as documented by Melissa Evans in her excellent Daily Breeze story.

Little Company of Mary, for example, has spent $10 million since 2004 to hire new nurses.

Torrance Memorial Hospital hired 340 nurses since 2003, 140 of them in 2006 and 2007.

County Harbor-UCLA Medical Center near Torrance, California, hired 350 nurses since 2005.

Kaiser Permanente South Bay Medical Center in Harbor City also recruited hundreds of nurses since the legislation.

But all that effort has only jacked up the demand for new nurses. The shortage became more acute with the retirement of a whole cohort of experienced RNs. The average age of a nurse in the United States went up from 44 to 47 within the last few years. By the year 2030, in the State of California alone, there will be need for 89,000 nurses.

Currently CA hospitals are 11,000 nurses short of the levels mandated by the law. The hospitals on the average run at a 10 to 15% nurse vacancy rate.

This of course creates an excellent opportunity for travel nurses. A recent report found that California hospitals hired 4,000 traveling nurses in 2006 alone.

"Crew Resource Management" Benefits Doctors, Nurses, and Patients Alike

Sat, 03 Jan 2009 19:15:41 GMT

"Crew Resource Management" Benefits Doctors, Nurses, and Patients Alike

Ugur Akinci, Ph.D.

A surgery is much like a commercial flight in many ways.

Both are delicate operations in which human lives are at stake.

Both rely on high-skilled services delivered by a highly-trained professional "crew."

And study after study has shown that both in operating rooms and aviation, a majority of accidents are directly attributable to human error.

Furthermore, in both aviation and medicine, the research has shown that the unquestioned authority of the pilot/surgeon, and the resultant lack of communication among the crew members for fear of getting rebuked by the "chief" in charge, turned out to be the main component of "human error."

It became clear about 20 years ago that in order to reduce human error in aviation there had to be better communication between a pilot and all his other crew members, including co-pilot, navigator, and flight attendants.

Thus the airline industry years ago started what it called a "Crew Resource Management" (CRM) program which turned out to be a resounding success in terms of reducing the human-error-related accidents and fatalities.

The same idea is borrowed these days by the medical industry in order to reduce surgery room fatalities traced back to human error.

A nationwide study conducted in 2006 by The Joint Commission estimated that 65 percent of the medical errors that caused injury to a patient could be attributed to a communication breakdown among members of the medical team.

For a number of years, due to the power disparity between the physicians and the other members of the operation room staff (including the nurses), communication surveys yielded a skewed data when only the physicians were interviewed.

For example in one study conducted by J.B. Sexton and colleagues in 1033 operating rooms in the USA, 73% of surgical residents and 64% of the surgeons reported "high levels of teamwork."

But when the same question was put to other members of the surgery team, the perception of teamwork evaporated. Only 39% of attending anesthesiologists, 28% of surgical nurses, 25% of anesthesia nurses, and 10% of anesthesia residents reported "high levels of teamwork."

The study underlined the need for a serious program like the one adopted by the aviation industry to eliminate that discrepancy and minimize human errors due to lack of communication.

All that is now changing thanks to various CRM programs rapidly adopted in many hospitals across the United States.

Nebraska is one state where CRM programs are in effect in a number of hospitals like Nebraska Medical Center . NMC hired a CRM consultant company to train hundreds of doctors and nurses for better communication skills and procedures.

Creighton University Medical Center is another facility that has adopted TeamStepps, a CRM program designed specifically for medical institutions.

Thanks to such training, the Nebraska Medical Center team members who did not hesitate to speak up their minds when they detected something wrong went up from 76% to 86% . Nurses who go through CRM training appear to be much less intimidated by the surgeon leading the operation compared to those who don’t get the training.

One crucial aspect of CRM is the formal protocol it introduces to make sure the communication is acknowledged and followed up. For example, if a nurse detects something wrong during an operation, she or he is supposed to express that concern in exact terms rather than with a general observation that "something does not feel right."

For example, one reference article (link provided below) describes the process this way:

"Team members are trained to say, for example: "Dr. Jones, I’m uncomfortable because the blood looks too dark." If the surgeon does not respond, the team member repeats the observation. If the surgeon continues to ignore the observation, the team member may call for help outside the operating room."

Another innovation ushered in by CRM is the concept of a Checklist, just like the kind that pilots go through before a take-off. The checklist is constantly revised and improved through post-operation debriefings, again similar to the post-flight debriefings that flight crews go through regularly.

LifeWings, a company specializing in CRM training has trained 70 hospitals last year and already has contracts to train 15 more. Other companies are expected to fill the gap in this newly emerging training market. The training is not cheap and can run as much as $125,000 per hospital. But since the end result is reducing fatal mistakes and saving lives, most observers (and especially the patient families) think that’s a fair price to pay.

Here are some additional sources you can use to learn more about CRM programs in medicine:

Connecticut Nurse Shortage Incentives Nursing Faculty Norwich L&M Hospital Harbor School

Sat, 03 Jan 2009 19:14:28 GMT

Connecticut Innovates to Ease the Pain of Nurse Shortage

Featured Employer
Connecticut's struggle to find multiple solutions to its crippling nurse shortage is worth keeping an eye on

It's official - after Alaska, Connecticut has the worse nurse shortage problem in the nation, according to a study released by Connecticut Hospital Association back in April.

Currently there are 23,500 nurses in the state, 6,000 short of the ideal number. In 13 years the gap will mushroom to 22,400 nurses as the number of working nurses shrink to 15,000.

The reasons are obvious - the U.S. population is getting older. As the baby boomers retire they need more medical care. Yet, the nurse population is getting older too, with an average age of 44 across the nation. But new students cannot graduate fast enough to replace the retiring nurses.

Why there is a difficulty to replace the retiring generation of nurses?

Two reasons.

First off, nursing is not promoted as an attractive and exciting career alternative to those students who are still in the secondary education system.

Secondly, even though at the college level there is adequate interest, the applicants are turned down due to lack of adequate faculty, classroom, lab space and funds to train the new nursing students.

Since there is a legal obligation to stick to a minimum student-faculty ratio, 130,000 applicants were turned away in 2006 from nursing schools, according to a report by the National League of Nursing.

And going one level deeper, one can also ask why do qualified nurses not want to earn graduate degrees and enjoy a new career as nursing school faculty?

One answer: working registered nurses hardly have the time and energy to squeeze in a demanding degree program to their daily schedules.

Here is another -- when a RN with a bachelor's or associate's degree can earn $50,000 to $60,000 year as a full-time hospital employee, the monetary incentives are not there for her to make the extra effort to become an academician since the chances are she will probably be paid less. The "equation of transition" still does not make economic sense for most nurses.

So what did the State of Connecticut do to remedy the situation?

Connecticut newspaper The Day (www.theday.com) ran an excellent story detailing the particulars of the CT program. Here are some highlights:

Hospitals like The William W. Backus Hospital in Norwich launched "job shadowing" programs for high school juniors and seniors. The program allows the teenagers to visit the hospital for a day and listen to a panel of nurses about the various attractive career alternatives nursing provides.

L&M Hospital, which employs 500 registered nurses, launched a similar outreach program for elementary school children. At the Harbor Elementary School, for example, L&M nurses answer the students' question in a relaxed atmosphere and distribute latex gloves and face masks for them to try on.

Harbor School elementary students are also involved in another health career pilot program for the fourth and fifth graders, administered by UConn Avery Point.

Community colleges like Three Rivers are adding new nursing faculty positions thanks to donations from institutions like L&M. Average nursing class size was increased from 72 to 80. There is a wide-spread awareness in Connecticut that unless faculty numbers are improved, there won't be anyone to train the next generation of registered nurses.

Another measure implemented is the generous sign-up bonuses for CT nurses who volunteer for night shifts and for those who refer other nurses for the job.

Connecticut's struggle to find multiple solutions to its crippling nurse shortage is worth keeping an eye on.

Nurses Need More User-Friendly Technology Solutions

Sat, 03 Jan 2009 19:13:51 GMT

Study: Nurses Need More User-Friendly Technology

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Technology Drill Down (TD2) Methodology Identifies New Solutions to Persistent Problems

By Ugur Akinci, Ph.D.

Nurses work hard yet most of the time they are also painfully aware that working hard in itself is not enough to communicate well with other actors within the healthcare system plus patients and their families, to avoid errors, administer the right medication and save lives.

A major obstacle to providing better care is the complexity of procedures and workflows, and the inability to access the right technological solutions at the right time and place. For example, even if a computer is loaded up with a wonderful program that a nurses can use, it's not of much help if it cannot be accessed from right next to a patient's bed.

According to the extensive "Technology Drill Down" (TD2) study conducted in 2007, an average nurse spends only 30% of her or his time for patient care and the rest on documentation, bureaucratic chores, tracking down information, etc.

A case in point: sometimes half of the patient data is kept as paper-based documentation and the other half would be saved electronically in computer databases. The mismatch and lack of integration between these two different types of data storage would eventually give rise to communication bottlenecks and errors.

The study "Technology Targets: A Synthesized Approach for Identifying and Fostering Technological Solutions to Workflow Inefficiencies on Medical/Surgical Units" was funded by Robert Wood Johnson Foundation and carried out by the American Academy of Nursing (AAN) during March-May 2007.

TD2 selected 25 pilot hospitals and health care institutions to implement the new brainstorming methodology to identify solutions to such technological bottlenecks.

The pilot study consisted of gathering 20 to 30 multidisciplinary health care specialists from a wide range of areas for a two-day brainstorming session. Each team had at least four staff nurses and included other providers like "pharmacists, social workers, respiratory and occupation therapists, facilities management, and IT [information technology] experts" as well.

During day one, the specialists would identify four top areas that need improvement after examining "14 to 24 major categories of daily work" such as communicating with families, direct patient care, documentation, transporting patients, patient scheduling and medication administration.

On the second day, the participants would separate into smaller work groups drill down further to find out of the box solutions to the problems identified the previous day.

Here are some of the findings of the study which was presented at AAN's November 2007 conference.

The following were identified in most of hospitals as problem areas in dire need of new technological solutions:

* Documentation
* Communication among patients, families, physicians and across departments
* Streamlining equipment and supplies
* Medication administration

And here are some of the concrete technological solutions that the interdisciplinary teams came up with:

* Computerized Provider Order Entry (CPOE) systems would make documentation more efficient, consistent, and timely. Touch-screen, voice-activated, portable computers available to nurses in patients' rooms and their offices
* A centralized, computerized patient-scheduling system for all departments
* Wireless, hands-free devices to perform many of the documentation processes performed by hand
* Portable devices designed specifically to take measurements and administer medication
* A robotic medication delivery and a bar-coded medication-tracking system
* Radio Frequency Identification Devices (RFID) to improve the accessibility and tracking of medical equipment, patients, caregivers and supplies

Some hospitals have already taken such technological innovations to heart. The George Washington University Hospital in Washington, for example, now boasts "state-of-the art monitors, portable computers, a wireless system that operates only within hospital walls and bigger operating rooms."

Just five years ago, GWU Hospital could provide only four computers for 12 nurses. Now, in its new modern facility, every nurse has his or her own computer.

Hopefully 2008 will be the year in which more recommendations of the TD2 study would be adopted by more hospitals to help our hard-working nurses get the support they deserve in their daily struggle against steep odds.

Nursing Titles

Sat, 03 Jan 2009 19:12:24 GMT

Nursing Titles

by Ugur Akinci, Ph.D., Nurse-Recruiter.com

Here are some of the main titles in nursing, each reflecting a different set of educational requirements:

* Nurse Practitioner (NP)
* Director of Nursing (DON)
* Registered Nurse (RN)
* Licensed Practical Nurse (LPN)
* Licensed Vocational Nurse (LVN)
* Nursing Assistant. (NA)
* Registered Medical Assistant (RMA)

*** NPs are RNs with advanced academic degrees; usually a Master's. They are licensed either through American Nurses Credentialing Center (ANCC) or National Certification Corporation (NCC). They provide a wide variety of advanced health services in clinical settings.

*** Director of Nursing (DON) is the title awarded to an experienced RN who moves into a senior administrative position after serving for years in a clinical setting. DONs participate in policy formation and enforce the regulations for nurses in an institutional setting.

*** RNs are nurses with Associate of Science in Nursing degree (ADN) which is usually a two-year college degree. There are Bachelor's and Master's programs for RNs as well. They lead and supervise the work of LPNs and LVNs and keep in daily contact with the patients.

Even though they do not always work one-on-one with the patients, RNs are the ones responsible for their health, recovery and safety. They act as the patience's advocate and are the lynchpin of American health care system.

*** LPNs and LVNs (also called Registered Practical Nurses (RPNs) in Ontario, Enrolled Nurses (ENs) in Australia and State Enrolled Nurses (SENs) in the United Kingdom) go through a12 to 24 month training in "in anatomy and physiology, pathophysiology, pharmacology, and practical patient care." They work one-on-one with patients under the supervision of RNs for a variety of crucial medical tasks that require operational accuracy, sound medical knowledge, and logical decision making.

There are 700,000 LPNs and LVNs in the United States according to U.S. Department of Labor.

*** NAs work under the supervision of an RN and perform such daily tasks as taking a patient's temperature, drawing blood, measuring blood pressure, etc. They assist the RNs, LPNs and LVNs in all kinds of diagnostic tests. They must be high school graduates and go through at least 120 hours of state-certified training in the United States; including 16 hours of supervised clinical training.

*** RMAs assist the physicians and nurses mainly in an administrative capacity. The tasks they perform include keeping the patient files in order, preparing the medical examination rooms and making sure all supplies are in place.

Different Types of Nursing Careers

Sat, 03 Jan 2009 19:11:50 GMT

Different Types of Nursing Careers

by Ugur Akinci, Ph.D., Nurse-Recruiter.com

Nursing is one of the most exciting and in-demand jobs in America today. In terms of the variety of career options it offers, it's second to no other profession. Here are some of the subject areas in which a nurse can specialize today: JOB AGENCY NURSES sign up with a nurse staffing agency and work at assignments offered by the organization, in line with the nurse's specialization and preferences. These temporary assignments in some cases roll over into permanent positions as well. TRAVEL NURSES take up positions in different parts of the country, usually for 13-week assignments. It is ideal for nurses who'd like to travel and see different parts of the country while working. There are quite a few staffing agencies that specialize in travel nursing. It provides not only a good income but also a generous benefits package that usually includes full medical coverage, free housing, full reimbursement of all licensing fees, etc. AMBULATORY CARE NURSES are needed to help outpatients who typically stay for less than 24 hours in a hospital. They provide a wide variety of diagnostic and other medical services, sometimes under time pressure. NURSE ANESTHETISTS work in critical surgery settings as an important part of the surgery team, administering anesthesia to the patients. This type of work requires special training due to the high-liabilities involved.

EMERGENCY NURSES work in a high-pressure emergency setting where the patients need be diagnosed quickly, racing against time. That's why people skills are paramount for an emergency nurse. In the United States, RNs earn the Certified Emergency Nurse (CEN) certification after they pass a written test.

ONCOLOGY NURSES take care of cancer patients. Certification is not necessary but interested RNs can get oncology certified by Oncology Nursing Certification Corporation (ONCC).

PEDIATRIC NURSES take care of infants, children and teenagers. This is a family-centered nursing specialization in which the nurse stays in close contact with the family members and becomes an active partner in the proper care of the child.

GERIATRIC NURSES take care of old adults either in hospital, home or nursing home settings. A nurse specializing in geriatrics must have a lot of patience and endurance since most of the time he or she will be dealing with very sick and frail individuals with complicated ailments.

MIDWIFE NURSES are trained in helping deliver babies in a home or hospital setting. They are knowledgeable in pre- and post-natal complications and care. Since post-natal mortality represents a significant portion of all infant mortality cases, the important role of the midwife nurses cannot be overstated.

MILITARY NURSES sometimes work in probably the most challenging of all environments � the combat zone. They need to be not only well trained in all kinds of emergency procedures but also be team players who can remain cool under pressure. But not all military nurses work at the combat zone. There are many who provide medical services at home bases as well.

There are dozens of other career specialization choices that a nurse can make, including Critical Care, Gastroenterology, HIV/AIDS, Psychiatry, Clinical Research, Trauma, Urology, etc.

For a fairly comprehensive list of different nursing careers please visit the following Wikipedia page:

Nursing Specialties

American Nurses Travel Abroad on Medical Missions of Mercy

Sat, 03 Jan 2009 19:10:33 GMT

American Nurses Travel Abroad on Medical Missions of Mercy

by Ugur Akinci, Ph.D., Nurse-Recruiter.com

Jossie Gomez has been a registered nurse at Wayland Baptist University of Wayland, Texas for the last nine years. Although she had traveled to Latin America in the past, this time she was captivated by a strictly humanitarian kind of travel idea - to visit Brazil on a boat to dispense medical help to those who needed it badly.

Joined by 12 other missionaries from the Evangelistic Mission Assistance to Fishermen project, RN Gomez treated more than her own share of intestinal worms, anemia and scabies on a trek that extended from Isla Grande off the coast of central Brazil to remote villages of the interior. Since most of the villagers had no dental hygiene to speak of, the groups dentist was also very busy, pulling a lot of rotten teeth along the way.

In line with the tradition of the project, the team never left their boat for four days straight except when the weather conditions made it impossible to use their boat as a mobile hospital.

"The biggest blessing for me came from giving a shot to one lady who could barely walk from painful arthritis and had been that way for eight months," Gomez was quoted as saying. "She said through the interpreter that it was the first shot she'd had that didn't hurt, and the next day she came up to me and was saying, 'Thank you' and hugging me and telling me how she didn't hurt anymore."

Gomez is not alone to donate her medical knowledge and expertise generously in the service of the truly needy.

Gilbert Irwin and Medical Missionaries, a medical charity group based in the Prince William County close to Washington D.C., has recently delivered precious medical supplies to the poor in Haiti as they did for the last 11 years. Since the group has no budget of its own it relies on generous patron angels for all kinds of donations.

This year help arrived in the form of $4,000 worth of donations from Roberts Home Medical and Devilbiss, a major leader in oxygen concentrator technology. An oxygen concentrator is an electric-operated device that separates the oxygen in the room air from its hydrogen atoms and feeds it to the patient through a tube.

Another group of selfless doctors and nurses headed by Dr. Jay Grosse from the Medical Clinic in Jackson, TN traveled to a village in Guyana to take care of the medical needs of poor villagers down there. Back in 2004 Dr. Grosse again took 20 volunteers from his Church of Christ congregation to Guyana, followed by another trip in 2005 with a group of volunteers from the All Saints Anglican Church.

The Tennessee group included Mary Haynes, a registered nurse at Jackson-Madison County General Hospital. "One cannot imagine what it is like until you've been there," she is quoted as saying. "From a nursing perspective, it was like being back in the '30s or '40s in the States, as far as the poverty level. We saw malnourished children with hernias and women with goiters."

Among the ailments the group took care of were broken bones, early diabetes, diarrhea, a lot of malnutrition cases and parasites. No doctor visited the village for the last three years and the closest hospital was half-a-day's trip away. The visit of the Tennesseans was an act of pure compassion well appreciated by the locals.

Nurses Asked to Wash Hands to Help Control Deadly MRSA Bacteria

Sat, 03 Jan 2009 19:09:25 GMT

Nurses Asked to Wash Hands to Help Control Deadly MRSA Bacteria

Ugur Akinci, Ph.D., Nurse-Recruiter.com

A surprisingly deadly drug-resistant bacteria has claimed more lives than AIDS in 2005. That's the bad news.

The good news is, its spread can be slowed down by strict adherence to hygiene rules in hospitals and health care facilities, according to a new study published in The Journal of the American Medical Association.

The killer bacteria's scientific name is methicillin-resistant Staphylococcus aureus, or MRSA.

The authors of the study, who work for the Centers for Disease Control and Prevention (CDCP), recommended strict adherence to basic personal hygiene practices by nurses, doctors and other health care workers like washing hands frequently throughout the day.

Other suggestion that has already been put to practice with considerable success is to screen the incoming patients and treat those with MRSA in quarantine. Evanston Northwestern Healthcare in Chicago reported 60 percent reduction in invasive MRSA infections after it began screening all patients in 2005.

The study examined nine metropolitan areas and then extrapolated their data nationwide.

The number of MRSA deaths the researchers came up with (18,650 out of 94,360 MRSA patients) is greater than the total number of patients who die in the USA each year due to H.I.V.-AIDS, Parkinson's disease, emphysema and homicide combined.

MRSA affects "46 out of every 1,000 U.S. hospital and nursing home patients � or as many as 5 percent," the study has found.

Dr. Elizabeth A. Bancroft, an epidemiologist with the Los Angeles County Department of Public Health, said the finding was "astounding."

Dr. John A. Jernigan, the deputy chief of prevention and response at CDCP, said "this confirms in a very rigorous way that this is a huge health problem."

In Virginia 21 schools were closed recently after a teenager died due to MRSA infection.

MRSA is not especially deadly when it stays on the skin surface. But the invasive MRSA that enters the bloodstream through cuts and open wounds exacts its toll quickly. The study concluded that "85 percent of invasive MRSA infections are associated with health care treatment."

The antibiotic-resistant bacteria "can be transmitted by contact as casual as the brush of a doctor's lab coat." MRSA can be fought only with medication delivered intravenously which creates its own complications in patients whose immune systems have already been weakened.

For more information please visit:

JAMA
CDC

Nursing Education for a Wonderful Career - 4 Online Options

Sat, 03 Jan 2009 19:08:12 GMT

Nursing Education for a Wonderful Career - 4 Online Options

Ugur Akinci, Ph.D., Nurse-Recruiter.com

Nursing must be the only profession in the United States right now where you can pack up your bags, jump on a plane, and move out with confidence to pretty much any city you like across the nation. The chances are, not only your well-paying job, but even your well-decorated (and free!) house or apartment will be waiting for you.

Given the incessant demand for nurses of all specialties in the foreseeable future, it is one of the best career advices one can give today to those looking for a secure job with good pay.

The only precondition to nursing is training - a good education covering the basics of health care is a must for certification. But it does not stop there. The field is deep and wide, and the terrain is changed frequently by the new technologies. That's why a nurse's education never ends.

Online education is an attractive alternative for those nurses too busy to take the time off to acquire a college degree.

Here are four alternative schools to get your nursing degree online, with a study schedule flexible enough to accommodate your full-time job commitments.

University of Phoenix (UP)

UP allows you to earn a B.S. in Nursing or an M.S. while specializing in Health Care Education, Integrative Health Care, Health Care Management or Health Care Administration.

According to the University, the graduates of the B.S. or M.S. programs find employment as "registered nurses, emergency medical technicians, paramedics, occupational therapists, physical therapists, physician assistants, respiratory therapists, and social workers as well as a variety of other specializations."

Click here for more information and registration

Kaplan University (KU)

KU offers an "RN to BSN degree completion program" for the Registered Nurses to get their Bachelor's degrees. Although most of the classes are available online, the program has a prerequisite clinical course. KU emphasizes the leadership dimension of professional nursing and provides career planning for job placement as well.

The curriculum covers "health promotion, risk reduction, disease prevention, information and health care technologies, ethics, human diversity, management theory, and health care system and policies."

Click here for more information and registration

Jacksonville University School of Nursing (JU)

JU, the main campus of which is located in Jacksonville, Florida , offers a similar online "RN to BSN" program for Registered Nurses. The students are provided 30 credits for their active U.S. RN licenses. They can transfer "approved credits from other degree and diploma programs," which helps.

The best part is, you can "complete your labs and practice projects without setting foot on campus." JU's Bachelor of Science in Nursing degree is CCNE-accredited.

Click here for more information and registration

South University (SU)

SU also has an "RN to BSN" online program with no campus residency requirements.

The only prerequisite for the incoming students is that they should be a Registered Nurse with either an associate's degree from a school of nursing accredited by the National League of Nursing Accrediting Commission (NLNAC) or hold a diploma from a school of nursing accredited by the NLNAC.

The curriculum covers "innovative health care concepts, palliative care, gerontological nursing, and complementary and alternative nursing methods."

Click here for more information and registration

Nurse Shortage Continues...

Sat, 03 Jan 2009 19:07:54 GMT

Nurse Shortage Continues...

Ugur Akinci, Ph.D., Nurse-Recruiter.com

But some states move forward to lessen the burden

It is not exactly a stop-the-presses kind of news story because it's not exactly new.

But it continues to be a serious enough issue to warrant frequent coverage: the nurse shortage continues, threatening safe and effective delivery of health services to a steadily aging population.

And what makes things worse than they need to be is the continuing lack of classroom space and faculty to graduate more nurses. The demand for nurse training far outstrips the supply of college-level facilities to accommodate it.

In Michigan, for example, 53 nursing schools had to turn away about 50% of their prospective nursing students because they did not have the budget and faculty. If there's anything that goes smack against the logic of market supply-and-demand theory, it's the continuing crisis in nurse education.

The applications to Michigan's nursing schools went up to 16,000 since 2004, according to a recent press report. But the state seems to have capacity to admit only 8,000 of them. This is all happening while the observers expect a shortage of 18,000 nurses in Michigan by 2015.

A United Press International story has quoted Jeanette Klemczak, the state's first chief nurse executive, as follows: "If you're short 18,000, that's an absolute crisis. If we don't have those nurses, we're going be in a dire situation. We'll find ourselves with closed operating rooms and less hospital beds available to patients. It will slow down the whole delivery of the health care process."

In Pennsylvania the situation is no different. The gap is expected to widen to 4,100 licensed practical nurses and 16,100 registered nurses by 2010, according to the official figures of the Governor's Office.

Counter-measures taken

Some states are already busy developing programs to remedy the situation, at least partially.

In Wyoming, for example, the state's Health Resources and Services Administration awarded an $850,000 grant for a three-year period to the University of Wyoming's Fay W. Whitney School of Nursing to expand its online registered nurse/bachelor of science in nursing degree program.

The program is expected to accelerate the awarding of bachelor's degrees and to address the specific health issues that Wyoming faces like high incidents of Alzheimer's, occupational fatalities, and high mortality rates for teenagers and young children.

Pennsylvania has also stepped up to the plate by budgeting an additional $2.5 million for nurse education.

"Pennsylvania, like many other states, is facing a long-standing health care workforce crisis that must be addressed," Gov. Ed Rendell is quoted saying. "That is why we are investing an additional $2.5 million into our nurse education initiatives through the Pennsylvania Higher Education Assistance Agency to expand our ability to educate new nurses as a way to ensure that residents have access to quality health care now and in the future."

The silver lining

One bright note in all this is the excellent job prospects that still await almost all nurse graduates. This is obviously still a field in which unemployment is not a daily issue in contrast to, let's say, steel workers or newspaper reporters.

For example, all 100% of the graduates of Allegany College of Maryland's nursing program found jobs, according to Fran Liebfried, the director of the school's nursing education. The demand remains very high both in private sector and in the armed services.

We here at Nurse Recruiter also do offer a rich menu of alternatives for excellent travel and regular nurse assignments. Thousands of nurses have already taken advantage of our great programs. Call us today toll free at 877-562-7966 to see what we can do for you.

Nurse Organization Issues White Paper for International Traveler Health Safeguards

Sat, 03 Jan 2009 19:06:35 GMT

Nurse Organization Issues White Paper for International Traveler Health Safeguards

Ugur Akinci, Ph.D., Nurse-Recruiter.com

808 million people traveled internationally in 2005. Americans made almost 62 million trips abroad in 2004, which translates to about 1 in every 5 U.S. residents.

With the increasing number of people traveling internationally, the risk of diseases carried across national boundaries also increases. The global society brings with itself global health risks as well.

Among the travel-related diseases most frequently mentioned in the press stories are malaria, travelers' diarrhea, hepatitis A, HIV, various STDs, typhoid, and meningitis.

That issue was addressed in a new white paper released by Nurse Practitioner Healthcare Foundation (NPHF), written by Nancy Rudner Lugo, DrPH, NP.

The NPHF paper warned that most travelers do not know anything about such risks and when they do become aware of the danger, it usually proves to be too late.

Only a handful of travelers made sure they received any shots before they flew abroad: 11% for tetanus, 14% for hepatitis A, 13% for hepatitis B, and 5% for yellow fever. 58.4% and 68.7% of travelers reported that they did not receive protection against hepatitis A or hepatitis B, respectively.

This is where NPFH says the nurses have an important role to play both in terms of making the American public aware of the various health dangers lurking out there and also in terms of providing practical and effective means of protection against them.

Consistent with that approach, the Center of Disease Control in Atlanta also recommends that "international travelers contact a healthcare provider for pre-travel advice at least 4 to 6 weeks before travel in order to obtain current health information, vaccinations, and prophylactic medications ( e.g., for malaria, traveler's diarrhea)."

Here are the NPFH recommendations to all the nurses and healthcare professionals:

Raise awareness of the need for travel health care before, during, and after travel.
Initiate a comprehensive, multi-tiered approach to travel health education, targeting consumers, healthcare professionals, health information systems, and policy formulation.
Incorporate travel health education and assessment into routine primary care.
Encourage patients to self-identify their travel needs.
Create an environment of travel health reminders in the practice.
Increase primary care providers' knowledge of travel health and safety.
Include travel immunization content, use of over-the-counter products, and resources for travel health and safety in core curricula for primary care professionals.
Increase access to travel health services.
Encourage primary care practices to offer travel health services.
Engage in research on travel health.

Visit http://www.nphealthcarefoundation.org/news/ for the full text of the white paper.

Saluting Army Nurses

Sat, 03 Jan 2009 19:05:20 GMT

Saluting Army Nurses

Ugur Akinci, Ph.D., Nurse-Recruiter.com

All nurses are precious and they work hard to save lives. Yet, some perhaps work even harder because they work not within the safe confines of a hospital in urban America but out there in the battlefield, braving not only fatigue and despair but bombs and bullets as well. We are talking about the Army Nurses of course.

Capt. Maria I. Ortiz of New Jersey, 40, was one such resourceful and brave army nurse who lost her life during a mortar attack in Baghdad, July 2007. Ortiz has served as a nurse since 1991 when she enlisted at the age of 24.

Ortiz was taking care of the wounded Iraqis inside the "Green Zone" since last September. According to a Pentagon source, Ortiz became "the first Army nurse to die from combat-related injuries in the Iraq war."

Others will certainly take Ortiz's place like Kristi Jo Newland of Grand Forks, N.D. who enlisted at age 41 to become an army nurse and is on her way to Fort Jackson, S.C. for the Army Reserve basic training.

Newland is currently a nurse's aide at Altru Health Systems . She can't wait to go through two more years of intense training to become a Registered Nurse.

"For 23 years, I've been chasing that elusive nursing degree," she said. "I put that mostly on hold to raise my kids. I want it so bad that I can taste it."

The Army has already paid her $9,000 as enlistment bonus. Another $24,000 will cover the cost of Newland's RN program.

"I felt it's pointless at my age to take out loans to get it done. I'd waste another 10 years to pay off the loans" she said.

Ortiz and Newland have followed that blazing trail of service set by the early pioneers of army nursing in World War Two.

Recently one such brave army nurse was honored with two WW2 medals.

Marie Serafinowicz, 88, of Poughkeepsie, NY was honored with American Campaign Medal and WWII Victory Medal presented to her by Dutchess County Executive William Steinhaus and Veterans Services Agency Director Nelson Rivera.

"We owe a debt of gratitude to all of those veterans who have served our country," Steinhaus said. "It is a privilege to be able to honor Mrs. Serafinowicz for her service and present her with the medals she has earned, but that she had never received."

Army nurses... we salute them all.

National Survey Reveals Nurses' Concern About Injectable Medication Errors

Sat, 03 Jan 2009 19:04:33 GMT

National Survey Reveals Nurses' Concern About Injectable Medication Errors

Ugur Akinci, Ph.D., Nurse-Recruiter.com

The results of a new national study should come as no surprise to any seasoned nurse or healthcare worker. The study found out that a great majority of the medication errors arise from mislabeling of the safety syringes used in hospitals and medical facilities.

The study which surveyed 1,039 nurses across the nation was conducted by The American Nurses Association (ANA) and sponsored by ANA and Inviro Medical Devices, a company that caters to the $1.6 billion safety syringe market.

This insider's look at the safety syringe practices is crucial given the fact that 44% of the U.S. nurses use injectable medication more than five times per shift. That's a lot of opportunities for error on a daily basis.

One overall result of the study stands above all others:

97 % of the nurses surveyed said they "worry" about medication errors, and more than two-thirds (68 %) said they believe medication errors can be reduced with more consistent syringe labeling.

So the question arises: what is preventing the healthcare professionals from applying "more consistent syringe labeling"?

To understand that question, we need to look at the existing syringe labeling practices.

An alarming 28% of nurses said they do not label the syringes at all.

Of the remaining 72% who do, this is how they said they do it:

* Writing on self-adhesive labels then applying to syringe (54 %).
* Writing on pieces of tape and adhering to syringe (31 %).
* Using a Sharpie pen and writing directly on syringe (11 %).
* Writing on paper or sticky note and taping to syringe (4 %).

More Nurses in Decision Making Roles - Prospects and Challenges

Sat, 03 Jan 2009 19:03:03 GMT

More Nurses in Decision Making Roles - Prospects and Challenges

Ugur Akinci, Ph.D., Nurse-Recruiter.com

Nurses have always been at the front lines of the "healthcare battle field" more so than anybody else. They are the ones in close touch with patients and their families. They are the ones who are holding the pulse of the healthcare system on a day to day basis.

Thus it is also natural that there is an increasing demand in the nursing community to have a more say in the formulation of healthcare policies as well as in the way the system itself is run and governed.

In theory, this is a good thing too since no doubt it will bring much needed invaluable input from the trenches and make sure the best possible solutions reach those in direst need through the most efficient channels possible.

Compared to the situation ten or twenty years ago, nurses today do participate in healthcare decision making in increasing number of course. There is no doubt about that. But, despite all the qualified undergraduate and master's nursing programs across the nation and many professional development programs, there is still long ways to go.

The chief challenge and issue with the expanded participation of the nurses in decision making is that it involves nothing less than the very same leadership and management skills that the movers and shakers in any industry must possess.

That is, when it comes to decision making, strategic planning and policy formulation, it is not enough just to be a highly qualified nurse well versed in medical technology and skills.

One must also be, for example, an excellent coalition-builder in order to build common fronts with other governmental and non-governmental organizations in society in order to influence the decision making process. Basically, it is a political as much as a technical role.

Among other things, our nurses must also master advanced mass communication skills in order to "work" the media and get the appropriate messages across as wide a cross section as possible. In this day and age of hourly news cycles and instant Internet communication, nurses in such leadership roles must have the skills to understand and manipulate the way the news is created, distributed and consumed. They need to plan their strategies by leveraging such comprehensive media expertise.

Again related to that is the necessity for the nursing community as a whole to get involved in better public relations and explain at a higher level the crucial role they play in the national health system.

A case in point -- go to Google News for example on any given day and make a news story search with the key word "nurse" and you would be surprised at the number of stories returned about nurses "taking advantage" of their patients or getting involved in one or other type of vice and character weakness that none of us associates with our dignified profession.

That goes to show that image building and maintenance is a public process that should be tended to with the same care that goes towards our patients and our own professional development. A solid positive image, a "market brand" if you will, that clearly communicates the precious "value added" that nursing profession represents is an invaluable ingredient for all nurses climbing up the proverbial ladder of decision making. It's the "water" that raises all the "boats" effortlessly.

In a recent paper, the International Council of Nurses (ICN) headquartered in Geneva, Switzerland has summarized the various dimensions of increased decision making by nurses as follows: strategic planning, budgeting, efficient resource planning and utilization, and the planning, management and evaluation of programs and services.

The ICN has again stressed that the position of the nurses as the "point guards" of the whole health care system who are in close touch with what's really happening out there uniquely qualifies them for coordination of health services and "strategic planning and the efficient utilization of resources." Who can argue with that?

One hopes that through such expanded participation in the decision making process at all levels, the trend for "moral and ethical stress" among nurses that has been covered by the recent literature might be countered as well, at least to a certain extent.

The recent research by Mary C. Corley, PhD, RN., Associate Professor at Virginia Commonwealth University found that a large percent of nurses interviewed would not want family members treated in their own hospitals.

The same study also showed a larger percent (25%) of nurses had left a position in the past due to "moral distress" compared to 13% in 1995 -- that is, the "distress" of disillusionment with the various "managed care systems." Increased political participation in decision making should be expected to work in the other direction and increase job satisfaction among nurses at large. It would help not only the patients, their families and public at large but the nurses themselves too.

The most systematic framework of nurses' participation in decision making process has been developed by the American Nurses Credentialing Center (ANCC), the same organization that confers on US hospitals the prestigious designation of "magnet hospital." To earn the distinction, hospitals usually invest two to five years of work to change their structure to one that complies with the ANCC criteria.

Some of the "magnet hospital" criteria directly address increased decision making participation for nurses like "decentralized, shared decision-making processes prevail throughout the nursing operations of the organization," or " the rehabilitation nurse participates in decision-making regarding allocation of resources used by or for the patient."

Clearly, such expansion of nurses' administrative, leadership and political roles is here to stay thanks to the wide-spread consensus that it would only increase the efficiency, rationality and fairness of our existing healthcare system.

Now it's up to us to run through this portal of opportunity and make the best of it. The decades ahead will be an exciting one for our nursing community, full of fascinating professional challenges and growth opportunities. It's a good time to serve as nurses again.

Should Nurses be Paid by Pharmaceutical Companies to Visit Patients?

Sat, 03 Jan 2009 19:02:08 GMT

Should Nurses be Paid by Pharmaceutical Companies to Visit Patients?

Ugur Akinci, Ph.D., Nurse-Recruiter.com

It is an intricate situation... Most states or local administrative regions do not have enough funds to check up and monitor all those who need medical treatment, especially those suffering from chronic diseases like diabetes and asthma.

So what if a pharmaceutical companies puts up the funds to have qualified nurses visit doctors' offices to review the charts of the patients and to assess their progress? They sometimes also provide much needed professional development training for the office staff as well.

The practice, generally referred to as "disease-management programs," started in U.K. but is spreading to Ireland, Germany and Belgium as well. The French drug maker Sanofi-Aventis SA, for example, is funding programs in Britain to provide training materials and classes for the staff nurses working in doctors' offices. However, the company officially claims that no attempt is made to push any proprietary drugs.

Critics of the practice charge that such pharmaceutical company programs are nothing but a thinly veiled attempt to push more highly-priced pills that the company manufactures. Dr. Jim Kennedy, the spokesman for the Royal College of General Practitioners, is reported in American press as saying that there is a "perceived or real risk of the pharmaceutical companies' interests taking precedence over the patients' interests."

The conflict of interest perhaps cannot be proven with 100% certainty but it's there and everyone knows it, the critics claim.

As proof, the point at what happened to Merck last year in Britain where such paid-nurse visits are very prevalent. The Prescription Medicines Code of Practice Authority, a British watchdog group, has examined the complaint filed by a former Merck sales representative and decided that the program was indeed a "reward program" for those doctors prescribing "Cozaar," a Merck product.

After being suspended for three months, Merck wrote a letter to all doctors involved and said it was taking the issue "very seriously," and that it "is working hard on corrective actions."

Another issue that the critics of the program like Royal College of Nursing bring up is the alleged violation of the patients' privacy when these "contract nurses" examine the patient charts usually without the knowledge or the consent of the patients involved. In a recent $80,000 program sponsored by several big drug companies, for example, the nurses contracted from outside examined patient records for six months to find out instances of heart disease. The defenders of the program insist that the nurses are prohibited from sharing such patient information with the pharmaceuticals and the abide by that rule.

The practice is not totally unknown in the United States. Pfizer Health Solutions have sponsored similar "disease-management programs" in Florida, especially for Medicaid and Medicare patients. Between 2001 and 2005, a group of Pfizer-paid nurses visited tens of thousands of Florida patients with asthma, diabetes and heart disease or talked to them over the phone. The "contract nurses" encouraged these patients with chronic illness to eat well, consulted with them on how to exercise properly and take their medications regularly.

As in all other cases, Pfizer claimed it was rendering the State of Florida an important public health service by diagnosing chronic problems before they evolved into much more serious and costly cases. Florida saved money by allowing Pfizer to carry out such programs, the company officials claimed.

The Sunshine State, in return, seems to have agreed with that assessment since it gave a "preferred status" to Pfizer drugs for its Medicaid patients.

So it's a delicate symbiotic situation in which the states and governments, on the one hand, and the pharmaceutical companies, on the other, are trying to come up with a middle-path solution in which one side would manage to stem the ever-increasing cost of treating chronic diseases while the other side is guaranteed an inelastic demand for its prescription drugs. Caught in between are our professional nurses who have to rely more on their innate sense of right and wrong and their oath "not to do any harm" than anything else.

Given the trend in rising medical care costs and tight state budgets, I think we will see more cases of similar "disease-management programs" in the United States and more opportunities for RNs to offer their services through quality professional agencies like those found on Nurse-Recruiter.

NURSE STAFFING RATIOS

Sat, 03 Jan 2009 19:01:06 GMT

NURSE STAFFING RATIOS
A Cookie Cutter Won't Fix The Problem

by Pat Mahan

Staffing ratio debates have been going on for a number of years now. States like California have already ratified such ratios but without adding any real teeth to the law. Massachusetts has been battling for more than a year trying to get legislation passed. So what are the issues, how does it impact nurses and nursing? Whose counted, whose left out and why.

It's a cinch that this problem is going to worsen as the shortage of nurses in the U.S. continues to rise compounded by the increased need for care (as the baby boomers reach later years and require more care). A research study done a few years back showed that the vast majority of health care dollars are spent in the last year of life. Included in that cost is obviously the cost of nursing care.

On one side we have some nursing organizations saying we must have laws that protect patients by requiring a certain number of nurses for every patient in the hospital (mind you they don't seem to care about nursing homes, or other types of inpatient settings). As a nurse, who no doubt has had an overloaded assignment, one might tend to quickly agree. But there is a problem with this "simple solution", it does not take in to consideration many factors including but certainly not limited to: patient mix, patient acuity, patient education levels, and many more. Now before you start writing me, let me say that even the ANA opposes some of the pending legislation for these same reasons.

Here's an example of two different hospitals, but in the same state. One is a large teaching hospital. It's filled with Interns and Residents, lots of new graduates and lots of students. The hospital performs "cutting edge" care and has a very high acuity rating. Its patients mix is comprised mostly of transfers and referrals too acute for other facilities. Add to this they have patients from all over the world that go to this facility for care. The other hospital is a small rural facility, it handles the fairly routine needs of the community. All of the doctors are experienced, most of the nurses have been on the job for many years. How do you come up with one solution that meets the needs of both of these hospitals? The simple solution will not do. You'll end up with too few nurses in the teaching facility and too many in the small rural hospital.

That leads to another important consideration, the nurse's level of training, experience and support. Let's say we have a fairly new grad, been on the job six months. S/he is off orientation and expected to take a "full" assignment. Does any nurse manager really think that new grad can handle the same load, as competently as the nurse whose been working on that unit for the past five years? We must consider the staff as individuals, nurses are not equal in their capabilities.

Furthermore, to date, none of the legislation aims to solve the underlying problem ...there is a nursing shortage and its going to get worse! We need more educators, we need more seats in the schools of nursing. Students need more clinical hours in more diverse settings. So far, the numbers just are not adding up.

As healthcare professionals, nurses must also be aware of how this impacts the cost of care and the subsequent access to care for the general public. Let's take our example hospitals above. If we add a simple nurse-patient ratio law, it is unlikely to impact the teaching hospital but is likely to have a very detrimental effect on the smaller rural hospital. It will drive up costs, these costs are passed on to insurance companies, states, and individuals. When the cost of health care is inaccessible, we know people avoid it even if they've identified they need care...they wait. So when we advocate a simple staffing ratio, we may indirectly be doing harm to those we are here to protect.

Okay, we do need legislation that is going to prevent for profit companies from understaffing, but the solution is not a simple staffing ratio, one size fits all. Nursing is too complex a science and service to be handled by cookie cutter legislation. Any legislation that does not put staffing in the hands of the nursing staff at a facility is going to miss the mark. That's right, nurses must be in charge of saying how many patients are assigned to a particular nurse.

Let's also consider, as I have written many times in the past the old model of team nursing. Some hospitals are trending back that way again. But there is a preference to use unlicensed assistive personnel (UAP). These are individuals that the hospital, at its sole and unreviewable discretion has determined competent to help provide nursing care. In many cases, "skilled" nursing care. It is high time we recognize the nearly 1,000,000 LP/VNs in the U.S. and their history. Since World War II, the LPNs in this country have stepped up to the plate during every nursing crisis and helped to provide the much needed skilled nursing care our citizens need and deserve. Registered nurses should be demanding that if they work in a team environment, it should be with licensed nurses that have been through accredited programs and been licensed by the state to meet a minimum competency level. This is a no brainer and the CA legislation on nurse patient ratios includes the LVN in the mix. The California Nurses Association fought hard to prevent the inclusion of LVNs in the mix, but the fact is that LP/VNs are far better suited to help alleviate the nursing shortage than are UAPs. See the research article above by Dr. Jean Ann Seago for more on this subject.

So what's the answer? The nursing professional organizations in conjunction with healthcare providers should immediately seek funding and research the best way to address this issue. We have been moving towards evidence based practice for many years. We should not make staffing an exception to this rule. There has been one minimal study done on the subject RN staffing ratios and it is quoted often during these staffing battles. The authors sited many limitations in this study and it only showed nursing had an impact on four areas of inpatient care and the biggest result of the study was areas where additional research needed to be conducted.
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