Saturday, July 10, 2010

PARADIGM BYTES

PARADIGM BYTES
Newsletter for Paradigm 97
July 10, 2010



PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.

MISSION STATEMENT

We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPETS
International Year of the Nurse....2010


Florence Nightingale

Nurse.com asks noted Nightingale scholars to predict what the nursing pioneer would think of the complicated environment in which nurses practice today. http://topics.nurse.com/nightingale

Like other pioneers who helped to shape their professions’ destinies, Florence Nightingale (1820-1910) created an indelible legacy for her profession—modern nursing.

A pioneer in the nursing field, she established herself as a competent nursing administrator during the Crimean War, where her insistence on sanitary conditions cut the death rate considerably. She continued to advance the field in her later years, providing better health service and opportunities for women at the same time.

As we mark the centennial year of her death, we look back for guidance from her works to confront a plethora of social and healthcare-related issues. In recognition of this historic year, the 2010 International Year of the Nurse was established to involve the world’s nurses. The organizations behind the effort are Sigma Theta Tau International, the Nightingale Initiative for Global Health and the Florence Nightingale Museum in London. Gannett Healthcare Group, publisher of Nursing Spectrum, NurseWeek and Nurse.com, is a gold sponsor.

An estimated 15 million nurses practice around the world, 2.9 million in the United States. Nurses are the universal caregivers, respected the world over. They are responsible for fully 80% of healthcare and are grassroots catalysts for health development worldwide.

During the International Year of the Nurse and beyond, we can all be informed and inspired by her legacy. As a nurse, Nightingale challenged other nurses and leaders on every continent to raise their concerns for human health. For Nightingale, nursing was both an individual and a worldwide service of caring for humanity and of communicating her knowledge and commitment. She created a wider understanding of the importance of health and the many determinants of health—for individuals and communities and nations.

For her letters: http://topics.nurse.com/nightingale

As an aside, if you would like to read a fictional account about Florence Nightingales' nurses: Read Anne Perry's books with the characters of William Monk and Hester. Her character, Hester, is a depiction of a typical nurse who worked w' Florence Nightingale in the Crimean War.

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FROM THE MEMBERS

COMBATVET@aol.com (Robert) wrote: " I completed the LPN to ASN and graduated 15 May. I began the RN-BSN program in June." Robert Congratulations, Robert!!

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Jenxl@AOL.com (Linda) writes in response to the article: Women should be allowed to eat and drink what they want during labour, say Cochrane Researchers. The researchers carried out a systematic review of studies examining the traditional practice of restricting food and fluid intake during labour and found no evidence for any risk or benefit for women at low risk of complications. Linda writes:" Couldn't agree more. I've said for years one wouldn't expect to run an engine without fuel."

I did send you my article entitled "Born in Borneo' didn't I? I certainly wouldn't think it would be worth publishing in yuor magazine ....takes up too much room for a very select group that might be interested....but I'd happily send it to anyone that might be interested if they'd send me an email requesting it. Thanks. Linda Jenxl@AOL.com
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I am looking for someone in health care who is from Uganda, Columbia, Native America, El Salvador or Cuba. This is for reviewers for chapters in my book on culture and healthcare. It's really just lists of ideas of how to be more aware of the customs/beliefs of our patients from these cultures, such as: Don't touch the baby's head, Husband will/will not be likely to want to go into the delivery room, and may have consulted a shaman before we see them.
.....stuff like that. Each chapter is about 2 pages long, and should not take more than 20 minutes to review. FA Davis, the publisher will pay you $25 and you get your name on the chapter. There are many other chapters, but we need reviewers for these cultures. (Please help her out !!!) Thank you,
Barbara Stuart 541-505-9275 bstuart598@comcast.net

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MEDICAL NEWS

Rookie docs may get more oversight, shorter shifts AP Health News
Patients will be told when they're being treated by rookie doctors, who would get shorter shifts and better supervision under proposed work changes for medical residents.
http://hosted.ap.org/dynamic/stories/U/US_MED_DOCTORS_WORK_HOURS?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2010-06-23-17-18-00
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Reuters (6/25) OraSure Technologies announced that it secured FDA approval for OraQuick, a test that can spot antibodies to the hepatitis C virus (HCV) using a patient's blood sample. OraSure already has one FDA approved HIV test, OraQuick Advance Rapid, in the U.S. market for detecting antibodies to HIV-1 and HIV-2.
The approval of the device to detect HCV antibodies in unmodified blood specimen raises hopes of the test getting the nod for multiple specimen types such as oral fluid and fingerstick whole blood sample types. An analyst for Needham & Co. said the FDA could approve an oral fluid test version of the company's OraQuick this year. http://www.reuters.com/article/idUSTRE65O4AR20100625
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Storm over J&J's child drug recall only grows Johnson & Johnson was blasted by lawmakers on Thursday for its massive recall of children's medicines, as regulators said a string of recent manufacturing lapses could lead to civil or criminal charges. Late last month, J&J recalled 40 widely used nonprescription products for children and infants, such as Tylenol and Motrin, after Food and Drug Administration inspectors found filthy equipment and contaminated ingredients at a Pennsylvania factory. "This is an issue of trust," House Oversight and Government Reform Committee Chairman Edolphus Towns told a hearing held to investigate the recall.... http://www.reuters.com/article/idUSTRE64P3UD20100527?feedType=nl&feedName=ushealth1100

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INTERESTING READING


Please remember that the REUTERS articles usually good for only 30 days

Are Copy Machines a Security Risk? HIPAA?
http://www.cbsnews.com/video/watch/?id=6412572n&tag=related;photovideo
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Watkins AL et al. – Breastfeeding education can be effective in increasing the knowledge and confidence of nurses. Duration and exclusivity rates for breastfeeding may also be improved. Improving nurses' knowledge of breastfeeding is a modifiable factor that is important in supporting a mother in her decision to breastfeed. ...
http://www3.interscience.wiley.com/journal/123439672/abstract?CRETRY=1&SRETRY=0
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RANDOM FACT: Windmills always turn counter-clockwise. Except for the windmills in Ireland.
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Combo vaccine increases seizure risk in children A Kaiser Permanente study found that toddlers who were given the combination measles, mumps, rubella and chickenpox vaccine were at greater risk of having a febrile seizure a week to 10 days after vaccination than those who got the MMR and the chickenpox vaccines separately. "Unless parents have a strong preference for the combination vaccine, providers should use a separate vaccine," the lead author said. The New York Times (about time "they" wonder about combination vaccines!)
(free registration
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The Nutritional Management of COPD Shepherd A – Active smoking remains the main risk factor, but other factors are becoming better known, such as occupational factors, infections and the role of air pollution. Prevalence of COPD varies according to country, age and sex. Nutritional depletion in patients with COPD is common and has a negative impact on respiratory and peripheral muscle function. Therefore assisting patients with COPD to attain and maintain optimal nutritional status is crucial to enhancing their physical wellbeing and function. In COPD, achieving an optimal nutritional status can delay the progression of this disease and may also reduce the risks of morbidity and early mortality. http://www.britishjournalofnursing.com/cgi-bin/go.pl/library/article.html?uid=48054;article=BJN_19_9_559

*********************** Sandy Summers book, SAVING LIVES, demonstrates very succinctly "...why the Media's Portrayal of Nurses puts all of us at risk" Please support her very important efforts by purchasing the paperback for only $12.00 : Saving Lives now in paperback! Expanded edition with foreword by Echo Heron!

July 2010 -- Recently MysticArt Pictures issued a casting call for a new "sexy docu-series" called Cali Nurse, to be produced by the prominent production company Studio Lambert. The show is seeking real nurses and nursing students, but the casting material makes clear that it is going to focus on damaging stereotypes. The show wants "gorgeous" young females (ages 21-30 only) who will experience "comedy, romance, and fun" and are all about "big hearts" and "dates with McDreamy." We didn't notice anything in the casting call about being bright, articulate, tough, or skilled, qualities that real nurses need to improve patient outcomes, though the casting call did suggest that the show would "capture the lives of those learning to save lives." ... http://www.truthaboutnursing.org/news/2010/jul/calinurse.html
********************* BBC News: "Is the media image of nursing damaging the profession?" June 9, 2010 - Today the BBC News web site published an op-ed by the Truth About Nursing's executive director Sandy Summers and senior advisor Harry Jacobs Summers. The "Viewpoint" piece ran as an installment in the site's regular Scrubbing Up column, which features "provocative thoughts from experts in the worlds of health and medicine." Using examples from media ranging from Hollywood shows to a recent "naughty nurse" ad for an English bus company, the op-ed argues that media stereotypes of nurses as brainless bimbos and physician lackeys contribute to a global undervaluation of the profession. As a result, the piece notes, nurses face a critical lack of respect, including frequent abuse, and they often lack the staffing and other resources they need to save lives. See the op-ed...
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S'More about Sandy Summers ( ssummers@truthaboutnursing.org) More nurses, less death Ten to 13 percent fewer surgical patients in New Jersey and Pennsylvania would die if hospitals in those states had as many nurses as California law requires, according to a University of Pennsylvania study published Tuesday.

The study of 1.1 million patients in 2005 and 2006 found that the nurse-to-patient ratios mandated in California could have saved the lives of 468 patients in New Jersey and Pennsylvania over a two-year period.

Linda Aiken, who led the study and directs the Center for Health Outcomes and Policy Research at Penn, said improved nurse staffing likely could save "many thousands a year" nationally.

The study was based on reports to states of deaths within 30 days of surgery and surveys completed by 22,336 nurses. It was published in the journal Health Services Research. Aiken said 18 states, including Pennsylvania, were considering legislation on nurse-staffing levels. ... See University of Pennsylvania's press release:
http://www.nursing.upenn.edu/sia/Pages/Californianurseratioscouldpreventthousandsofdeaths,studyfinds.aspx
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Maarsingh OR et al. – Contrary to most previous studies, cardiovascular disease was found to be the most common major cause of dizziness in elderly patients in primary care. In one–quarter of all patients an adverse drug effect was considered to be a contributory cause of dizziness, which is much higher than reported in previous studies. http://www.mdlinx.com/NurseLinx/newsl-article.cfm/3148422/ZZ5603146585149290157159/?news_id=1188&subspec_id=51
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RANDOM FACT: Lemons ripen after you pick them, but oranges do not.
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Nurse-led postpartum discharge education programme including information on postnatal depression reduces risk of high depression scores at 3-month follow-up
(Evidence based nursing article) Morrell CJ et al. – It is difficult to predict who will suffer depressive symptoms postnatally, and many of these symptoms can remain unidentified by healthcare professionals. Special training for health visitors can reduce the symptoms of depression among postnatal women, and antidepressants may help. The Edinburgh Postnatal Depression Scale is the instrument most frequently used to identify postnatal depression in primary care. ... http://ebn.bmj.com/content/13/2/48.short?rss=1
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RANDOM FACT: The human heart beats over 100,000 times a day.
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Whether you're noshing on a lean turkey with tomato or a veggie delight, add these to your sandwich to reduce your risk of stroke: onions. Onions are brimming with flavonols, and new research suggests that these nutritional goodies could downsize the risk of stroke by as much as 20 percent.... http://www.realage.com/tips/add-these-to-your-sandwich-to-stop-strokes?eid=5739&memberid=4687812#

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RANDOM FACT: North Dakota is the only state in the US that has never had an earthquake.
************** Try this cheap and tasty wrinkle fighter For younger looking skin, skip the high-priced wrinkle creams and invest in a 50-cent can of this: tomato paste.

Eating a little tomato paste every day not only may help your wallet, but a new study suggests that it may give you deep-down 24/7 protection against wrinkles and skin cancer, too.... http://www.realage.com/tips/try-this-cheap-and-tasty-wrinkle-fighter?eid=7034&memberid=4687812

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RANDOM FACT: Just one in three consumers pays off his or her credit card bill every month.
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A nurse's Identity theft nightmare: It all started 8 months ago when I took my son to the pediatric allergist. The allergist advised we get a chest X-ray because there was a question of pneumonia. So, for convenience and because they accept my health insurance, we popped across the parking lot to the adjacent hospital. ... http://nursing.advanceweb.com/Features/Articles/Nurses-Nightmare.aspx *************************
peRx: Prescribing Evidence Based Therapies
Free CE program available for nurse practitioners and other APN prescribers at www.perxinfo.org. Earn up to 4 free CE credits (non-industry funded). Topics include: FDA drug approval process, promotional factors involved in prescribing, ethical implications of prescribing and sources of evidence based information on drugs. **************

Luppa M et al. –Predictors of nursing home admission of individulas without a dementia diagnosis before admission Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use. Conclusions: Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia–free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. ... http://www.biomedcentral.com/1472-6963/10/186/abstract free full text

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RANDOM FACT: Electric eels can generate an electrical charge of 600 volts or more in order to stun prey or zap predators.
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Stay Ahead of Arthritis AOL Health spoke with Dr. Dale Snead, an orthopedic surgeon at Methodist Sports Medicine in Indianapolis, to get his expert advice on avoiding arthritis. There are a few ways you can help yourself avoid the joint pain that comes with osteoarthritis, says Snead.

"Maintaining motion is the main thing," he says. In other words, keep exercising. Or if you aren't, start. Don't be fooled into thinking you can "preserve" your joints by not using them. This is a situation where the phrase "use it or lose it" is apt. When your joints are functioning well, they're more likely to keep functioning. And once they lose that functionality, it's very hard to get it back". ...
http://www.aolhealth.com/condition-center/arthritis/prevent-arthritis?icid=main|htmlws-main-n|dl3|link3|http%3A%2F%2Fwww.aolhealth.com%2Fcondition-center%2Farthritis%2Fprevent-arthritis

Symptom Checker http://www.aolhealth.com/symptom-checker/
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RANDOM FACT: Armadillos have four babies at a time and they are always all the same sex.
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(Reuters 6/21) - Automated blood pressure measuring devices are replacing old-fashioned mercury manometers in doctor's offices and clinics around the world. But a new head-to-head comparison of the two techniques suggests that the newer version isn't necessarily better -- and could even be missing some people with high blood pressure who are in need of blood pressure-lowering treatment.... http://www.reuters.com/article/idUSTRE65K0WS20100621?feedType=nl&feedName=ushealth1100
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Doctor of nursing degree could help NPs promote the profession Pursuing the doctor of nursing practice degree could allow nurse practitioners to promote the nursing profession and effectively manage the complex problems in today's health care system. The DNP degree also can help NPs learn and apply nursing and non-nursing theories to further evidence-based clinical research and practice. ...
http://nurse-practitioners.advanceweb.com/Features/Articles/NPs-Making-a-Difference.aspx
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Milk, wheat-free diet may not help autism: U.S. study A popular diet that eliminates wheat and milk protein does not appear to help children with autism, but early behavioral treatments do, researchers reported on Wednesday.... http://www.reuters.com/article/idUSTRE64I6EZ20100519
See also: autism-society.org
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New approach to old test may detect ovarian cancer- Researchers have found a new way to use an existing blood test that may provide a way to screen women for ovarian cancer, perhaps in time to cure more women of the deadly disease.
They said combining a test that measures levels of a certain protein along with a way of measuring risk of the disease helped spot early stage cancers in otherwise healthy women. ...
http://www.reuters.com/article/idUSTRE64J73R20100520?feedType=nl&feedName=ushealth1100
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Random Fact: Red wine will spoil if exposed to light; hence tinted bottles. (also, Olive oil needs to be in dark bottles-- choose First Cold pressed, Extra Virgin Olive Oil)
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The Effects of Low-frequency Ultrasound (35 kHz) on Methicillin-resistant Staphylococcus aureus (MRSA) in vitro Scanning electron microscopy study results support an in vitro bactericidal effect of low-frequency ultrasound (LFU) delivered at 40 kHz on bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this in vitro study was to determine the effects of LFU delivered at 35 kHz on bacterial viability, cell wall structure, and colony characteristics, including antibiotic resistance on vegetative forms of MRSA.

Results Bacterial reduction study. MRSA numbers dropped from 106/mL pre-treatment to 6 CFUs after 30 seconds of treatment, a >99.99% reduction (P <.001). A similar reduction was obtained for 60 seconds with bacterial numbers decreasing to 4 CFUs from 106/mL. After 180 seconds, no MRSA were detected on the SBA at 24 hours post 35-kHz LFU treatment. Results at each time point were similar whether treatment was conducted in or out of an ice bath. ... http://www.o-wm.com/content/effects-low-frequency-ultrasound-35-khz-methicillin-resistant-staphylococcus-aureus-mrsa-vit
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The FDA on Tuesday issued a warning to parents about the potential risk of overdosing infants with fluid vitamin D. The agency also called on manufacturers to mark droppers in their supplement containers more clearly and to make droppers that hold only the recommended dose of 400 international units of vitamin D. ... Los Angeles Times/Booster Shots blog
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RANDOM FACT: Roosters have to extend their necks in order to crow.
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Shift work noticeably affects sleep and creeps into relationships Barbara Hobbs, an associate professor of nursing at South Dakota State University who has researched shift work, says working nights is like flying to Germany every night, working and flying back -- the adjustments the body has to make are that drastic.
Typically, night workers get fewer hours of sleep than day workers, in large part because their bodies' circadian rhythms are out of whack, Hobbs said.

But even shift workers who get a full eight hours of sleep sometimes still feel fatigued, because their bodies don't get good, quality sleep, she said ... http://www.delawareonline.com/article/20100628/BUSINESS/6280314/1003

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Mastectomy Rates Down Overall, New Study Finds The number of women undergoing mastectomy for unilateral breast cancer declined from 41% in 2000 to 37% in 2006, according to a study based on data representative of the entire U.S. population. However, the study also showed that more women are choosing preventive mastectomy, with the rate increasing from 2.5% to 5.7% for the same period. HealthDay News (6/15) http://consumer.healthday.com/Article.asp?AID=640132

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HUMOR SECTION

Kids Are Quick
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TEACHER: Maria, go to the map and find North America .
MARIA: Here it is.
TEACHER: Correct. Now class, who discovered America ?
CLASS: Maria.
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TEACHER: John, why are you doing your math multiplication on the floor?
JOHN: You told me to do it without using tables.
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TEACHER: Glenn, how do you spell 'crocodile?'
GLENN: K-R-O-K-O-D-I-A-L'
TEACHER: No, that's wrong
GLENN: Maybe it is wrong, but you asked me how I spell it.
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TEACHER: Donald, what is the chemical formula for water?
DONALD: H I J K L M N O.
TEACHER: What are you talking about?
DONALD: Yesterday you said it's H to O.
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TEACHER: Winnie, name one important thing we have today that we didn't have ten years ago.
WINNIE: Me!
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TEACHER: Glen, why do you always get so dirty?
GLEN: Well, I'm a lot closer to the ground than you are.
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TEACHER: Millie, give me a sentence starting with 'I.'
MILLIE: I is..
TEACHER: No, Millie..... Always say, 'I am.'
MILLIE: All right... 'I am the ninth letter of the alphabet.'
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TEACHER: George Washington not only chopped down his father's cherry tree, but also admitted it
Now, Louie, do you know why his father didn't punish him?

LOUIS: Because George still had the axe in his hand.
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TEACHER: Now, Simon, tell me frankly, do you say prayers before eating?
SIMON: No sir, I don't have to, my Mom is a good cook.
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TEACHER: Clyde , your composition on 'My Dog' is exactly the same as your brother's. Did you copy his?
CLYDE: No, sir. It's the same dog.
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TEACHER: Harold, what do you call a person who keeps on talking when people are no longer interested?
HAROLD: A teacher
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Contact me for a full page of CEU offerings........!

Walk the walk to reduce catheter-related bloodstream infections CEU 2 hr http://www.americannursetoday.com/Article.aspx?id=6174&fid=6116

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !


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WEBSITES/ LINKS
Always on the lookout for interesting websites / links.
Please send them to:RNFrankie@AOL.com.

http://ow.ly/1S2O5 Fixing the noisy hospital

Back issues of the ISMP . org newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.

Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)
Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org

Decubqueen's website: www.accu-ruler.com

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

http://www.nationalnurse3.blogspot.com/

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

The Nursing Site http://thenursingsite.com .

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website

http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

National Do Not Call Registry

If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Critical Thinking is More Than Problem Solving Critical Thinking: Not Usually Rapid Fire Should Clinical Courses Get a Letter Grade?

Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/

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MEDICAL RECALLS
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Thanks to JANNARN@AOL.com for the following: Chicken of the Sea canned tuna recalled A limited number of 12-ounce cans of Chicken of the Sea solid white tuna in water have been recalled because of faulty seals.
Tri-Union Seafoods LLC issued the recall for tuna distributed in Feb. And May at King Soopers and City Markets in Colorado.

The tuna cans have UPC Code 4800000262 printed on the side of the can and "Best By Date 2/10/2014" on the bottom. Product codes include 7OA1E ASWAB, 7OA2E ASWAB, 7OA3E ASWAB, 7OA4E ASWAB, 7OA5E ASWAB, 7OAEE ASWAB or 7OAFE ASWAB.

In addition to being distributed in Colorado, the product also was distributed in limited supplies in California, Indiana, Maine, Nebraska, New York, Oregon, Pennsylvania, Utah and Wisconsin. No illnesses have been reported.
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Blacksmith Brands and FDA notified healthcare professionals and patients about a nationwide recall of all lots of four PediaCare children's products. These products are sold exclusively in the United States and were manufactured by McNeil Consumer Healthcare at McNeil's Fort Washington, PA plant. Blacksmith Brands initiated the recall as a precautionary step because the products were manufactued at a McNeil plant in which a recent FDA inspection found serious problems in meeting FDA's current good manufacturing practice requirements. The company advises consumers who have purchased these recalled products to discontinue use. The four PediaCare items involved in the recall are: PediaCare Multi-Symptom Cold 4oz. UPC # 3 0045-0556-05 9
PediaCare Long Acting Cough 4oz. UPC# 3 0045-0465-04 7
PediaCare Decongestant 4oz. UPC# 3 0045-0554-04 8
PediaCare Allergy and Cold 4oz. UPC# 3 0045-0552-04 4
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts
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FDA notified healthcare professionals not to use the intravenous medications, metronidazole, ciprofloxacin and ondansetron manufactured by Claris Lifesciences due to contamination. These products were all manufactured on the same manufacturing line and sold under the Claris, Sagent Pharmaceuticals, Pfizer, and West-Ward Pharmaceuticals labels. The FDA received reports of floating matter in intravenous bags of metronidazole and ondansetron. Foreign matter should not be present in a sterile injectable product. Healthcare professionals should not use these products and should immediately remove them from their pharmacy inventories. Claris is initiating a recall of all lots of these products. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm214034.htm
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Vita Breath Dietary Supplement FDA notified healthcare professionals, their patients, and consumers not to consume Vita Breath, a dietary supplement manufactured by American Herbal Lab and marketed at health fairs and on the Internet, because the product may contain hazardous levels of lead. The New York City Department of Health and Mental Hygiene analyzed a sample of Vita Breath and reported it contained 1,100 parts per million of lead. This level is more than 10,000 times higher than FDA’s maximum recommended level for lead in candy.

People with high blood levels of lead may show no symptoms, but the condition may cause damage to the nervous system and internal organs. Acute lead poisoning may cause a wide range of symptoms, including abdominal pain, muscle weakness, nausea, vomiting, diarrhea, weight loss, and bloody or decreased urinary output. Children are particularly vulnerable to lead poisoning. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm210514.htm

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GnRH Agonists: Safety Review of Drug Class Used to Treat Prostate Cancer (sold under the brand names Lupron, Zoladex, Trelstar, Viadur, Vantas, Eligard, Synarel, and generics) FDA notified healthcare professionals and patients of FDA's preliminary and ongoing review which suggests an increase in the risk of diabetes and certain cardiovascular diseases in men treated with GnRH agonists, drugs that suppress the production of testosterone, a hormone that is involved in the growth of prostate cancer.
Most of the studies reviewed by FDA reported small, but statistically significant increased risks of diabetes and/or cardiovascular events in patients receiving GnRH agonists. FDA's review is ongoing...
Healthcare professionals and patients should be aware of these potential safety issues and carefully weigh the benefits and risks of GnRH agonists when determining treatment choices. FDA recommends that patients receiving GnRH agonists should be monitored for development of diabetes and cardiovascular disease. Patients should not stop their treatment with GnRH agonists unless told to do so by their healthcare professional. Some GnRH agonists are also used in women and in children for other indications than those above. There are no known comparable studies that have evaluated the risk of diabetes and heart disease in women and children taking GnRH agonists. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm210576.htm

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Magic Power Coffee: Undeclared Drug Ingredient Magic Power Coffee, an instant coffee product marketed as a dietary supplement for sexual enhancement, contains the drug ingredient hydroxythiohomosildenafil, a chemical similar to sildenafil, the active ingredient in Viagra. Hydroxythiohomosildenafil, like sildenafil, may interact with prescription drugs known as nitrates, including nitroglycerin, and cause dangerously low blood pressure. FDA is warning consumers not to use this product. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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NURSING HINTS CORNER

Inaccurate dosing if insulin withdrawn from a pen cartridge. A nurse called a pharmacist to express concern that a patient’s insulin pen was not delivering the correct dose of insulin. To demonstrate the problem, the nurse took a standard insulin syringe, dialed the pen to 10 units, and injected the insulin into the syringe to measure how much would reach the patient. She found that the insulin syringe into which she injected 10 units of insulin really only contained 5 units of insulin. This was repeated twice with the same results.
The pharmacist went to the nursing unit, repeated the experiment, and also got just 5 units. When laying the pen down on the table, the pharmacist noticed that an air bubble was visible in the pen cartridge. Knowing how that could affect insulin delivery from the pen, he obtained a new pen from stock and repeated the previous experiment. This time, when 10 units were injected from the pen into the syringe, it now measured 10 units of insulin. The problem was traced to nurses using the pen cartridges as “mini” insulin vials by drawing doses out of the pen cartridge with an insulin syringe. It’s a practice we’ve warned against because it’s known to lead to inaccurate dose measurement as well as infection control concerns. When nurses are not sure how to use a pen, or encounter problems when using it, they may be tempted to remove the pen cartridge and use it as a vial. This can accidentally introduce air into the cartridge. Once any amount of insulin is withdrawn from the cartridge, it may no longer deliver the exact amount of insulin listed on the dispensing dial (and may also risk contamination of the remaining medication). In this instance, the patient was subjected to several injections and less effective blood glucose control because the pen was used in an untintended manner.
ISMP Nurse Advise-ERR May 2010

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from the members
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO: Our Newest members:

jeluciano@gmail.com (Jacquie) June 12, 2010

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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com

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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.

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THOUGHT FOR THE DAY


It may seem a strange principle to enunciate as the very first requirement
in a Hospital that it should do the sick no harm. [1859]


Florence Nightingale


Hope to see you online..... Frankie
RNFrankie@AOL.com

Saturday, July 3, 2010

The Nurse-Patient ratio five years later

The Nurse-Patient ratio: Five years Later In the late ’90s, the California Nurses Association sponsored a bill that would ensure safe staffing for patients in California. Known as AB394, the bill was the third attempt made to obtain mandated ratios in the state. The first was in 1993, but the bill died in committee. A second bill came around in 1997 and was passed through the legislature, but eventually vetoed by Gov. Pete Wilson. Things changed in the fall of 1999, however, and then-Gov. Gray Davis signed AB394 into law, the nation’s first directive mandating nurse staffing ratios for acute-care hospitals.

The California Department of Health Services (DHS) was given the task of determining and implementing the staffing ratios over a period of several years. During that time, nurses, legislators, media and the public at large were bombarded by a variety of messages from both proponents and opponents of the law. Some said hospitals will close; other said patients should be afraid to go to the hospitals where it wasn’t yet implemented; many hoped nurse satisfaction would increase, thus keeping more nurses at the bedside.

The Ratio Effect


To date only two studies have been conducted that specifically focused on the outcomes and/or results of this law, and both were published in the nursing journal Policy, Politics & Nursing Practice. The first was in 2005 and its primary focus was on the impact of the nurse-patient ratio on incidence of patient falls and prevalence of pressure ulcers. The results revealed no significant changes and they were not able to find compliance with the ratio per shift or unit, but they seemed to show an overall compliance with the law.

The second study was published earlier this year and focused more specifically on nurse satisfaction, which was revealed to have improved between 2004 and 2006. The authors stipulated that the improvements were not associated with the degree to which the hospitals were expected to increase staffing.

Massachusetts and the Nurse-Patient Ratio

Even though the studies concluded that more studies are needed to fully determine the effect of mandating staff ratios, both sides of the nurse-patient ratio debate have latched onto them. Each side has used the effect and efficacy of nurse-patient ratios to argue the case for and against legislation brought before state houses throughout the country.

Earlier this summer, the Massachusetts House of Representatives passed a bill very similar to California’s law. Meanwhile the Massachusetts Senate proposed and passed a bill that would allow individual hospitals, in conjunction with nurse input, to develop a nurse-patient staffing plan specific to that hospital. The customized plan would then be publicly posted and would allow the state’s Department of Health (DPH) to monitor and audit and, where appropriate, penalize hospitals for failure to comply with their own staffing plan.

Both plans have a deep attachment to either the passage or defeat of their legislation. They each built coalitions to help them press their cause and argument.

Ultimately neither bill passed since both houses failed to agree upon a compromise prior July 31, 2008, the end of the legislative session. As with California, emotions and rhetoric surrounding the Massachusetts legislation ran high, and dire predictions were announced should either bill pass.

Acuity-Based vs. “Cookie Cutter” Systems

As a nurse who is very outspoken (imagine that) on all things nursing, my readers may remember my earlier column on the nurse-patient ratio that was published in 2004. [Editor's Note: This article can be found below.] My position on the mandated ratio law hasn’t changed. I am a firm believer in the acuity-based patient assignment system. Though many nurses and their supporters seem to prefer the more cookie-cutter approach of the ratio, my experience has taught me that it can and is subject to manipulation. I use the term “cookie cutter” to describe the mandate because even though it has been based on outcomes from nursing research, in my opinion, it ultimately removes the individual nursing judgment from the patient assessment system.

Advocates of the nurse-patient ratio laws will often argue that the law is simply a “floor,” not a “ceiling,” and that the ratio can be adjusted based on patient acuity. However, I have rarely seen this put into practice. Perhaps it is believed that the “law is being met” even when the patient acuity might demand a different assignment.

For example, not that long ago a RN working in ICU at a hospital in the Los Angeles area shared how she had started her shift with one patient and, as the shift progressed, the charge nurse assigned her an additional newly admitted patient. The RN, who had many years of experience under her belt, informed the charge nurse that the patient assignment was inappropriate since both patients were highly unstable and a 1:1 ratio was more appropriate for each. The charge nurse disagreed with the RN’s assessment and said that the law’s requirements had been met. So the RN had to assume the care of the two patients and, sadly, one died on her watch.

I later learned that she was fired, and when asked if she had filed an incident report about the unsafe patient assignment, she replied, “Why bother?” The charge nurse who made the initial assignment had defended her decision; therefore she felt her complaint would fall on deaf ears.

I was somewhat surprised by her response since I know that there had been an extensive educational campaign to educate nurses on the nurse-patient ratio laws, and several hospitals had even developed a reporting mechanism for their nurses to report violations of the law.

Then again, this could be another example of the “human factor” — just as one can easily point the finger at the healthcare industry for ignoring reasonable patient assignments, one can never underestimate the impact that one nurse can have on another — people sometimes just do unwise things, regardless of what common sense, training or laws suggest they should do.

Between the Battle Lines

Presently, the movement to regulate patient assignment is making its way across our country. My research revealed 12 states that have or are considering legislation that would mandate a minimum nurse-patient ratio in hospitals. 14 states are considering legislation that attempts to address nurses’ concerns about staffing. Oregon (the only state so far) has enacted legislation that requires an acuity-based staffing plan, and I look forward to reading the research on the state’s experience.

I foresee a heated battle in the states with a mandated nurse-patient ratio, especially in light of the two studies that have been published on the subject matter. I read a letter to the editor of the Salem News (a local paper in Massachusetts) claiming that the 2002 had been “academically discredited,” and when I learned of this accusation I asked another University of California at San Francisco (UCSF) professor to shed light on this accusation.

The person I chose to contact, since I know her, was Joanne Spetz, the author of the 2008 study mentioned earlier in this column. She expressed a common conundrum often faced by researchers. She said the study had not been “academically discredited,” but questions had been raised about its methodology.

Just because an organization disagrees with the results of a study, the funding source, or even the researchers themselves does not mean that the results of said research should be discarded. It is imperative that we — especially those of us who advocate so passionately for nursing, don’t engage in such destructive behavior. That’s for the spin doctors, lobbyists and politicians. Labeling research done by hospitals, clinics or fellow nurses with whom we may not agree as being tainted or discredited does not move the nursing profession forward.

Fact or Fiction?

That said, we still must consider the bias of sponsored research, which is why researchers often make a habit of disclosing both their affiliations, possible conflicts of interests, and the sources of funding. So long as this information is clearly disclosed, we should be cautious about making accusations and assumptions.

For example, when I read the 2008 study authored by Ms. Spetz, I thought it odd that Bay Area RNs had been oversampled (this was disclosed in the study) since the Bay Area has a more unionized RN workforce than elsewhere in our state. So I emailed her and asked about it, to which she explained that it had been done at the request of and with funding from a specific foundation.

No doubt the oversampling was weighted statistically to not have an effect on the overall outcome, and it’s not uncommon for studies to use such a process to balance studies when such “side tracks” are taken. This serves as a good example of the slippery slope we can go down if we choose to accept such practices.

It is critical as the nurse-patient ratio debate continues that we seek out all research related to the effects of California’s law and separate fact from fiction. However, to do so we must be willing to allow both sides to present their concerns and their studies. For example, one of the big selling points currently being promoted by supporters of mandated ratio laws is that nurses have flocked back to the bedside.

If truth be told, there has been a documented 90,000 new RN licenses issued since AB394 was signed into law. However, a nearly equal number of RNs have left the state during this same period. Of even greater concern is a recent revelation that a large number of RNs have not renewed their license at the first renewal opportunity.

I learned of this unsettling statistic from Ms. Spetz, who led me to understand that California’s Board of Registered Nursing (BRN) has asked her to study this development. I, for one, look forward to learning the results of this study because our state can ill-afford nurses flocking into California to get their licenses if an equal number are going to flock out.

It is equally important that we study the assertion made by the hospital industry (which occurred early in the implementation) that the law would cause hospital closures. Proponents of the nurse-patient ratio law have dismissed such claims as alarmist talk, but I know that in the Los Angeles County area we’ve had 11 hospitals close during this period. Some have claimed they closed because they could not meet the mandated ratios while others intimated that the ratios were a contributing factor.

I’m no naïf when it comes to healthcare and its politics, so I know that there are many reasons why hospitals face closure. Though I’m not sure how much AB394 impacted these decisions, I for one would like to know whether AB394 was a contributing factor or not. This could have wide-ranging impacts if similar models are adopted nationwide.

The Future of Nursing

Why nurses stay or leave the bedside is not a simple answer and goes beyond a mandated nurse-patient ratio. It is easy for nurses to latch onto this as the answer to all our woes, just as we often hear the phrase, “If nurses were only compensated more fairly there would be no nursing shortage.”

The nursing shortage is a spectrum of challenges that need to be addressed if we ever hope to solve it. Some feel that the cookie-cutter approach is part of the answer. I’m convinced that such decisions are best left to the bedside nurse and not legislators and bean counters. We are taught the skills needed to do patient assessments and we should be in a position to put our education, training and skills into action.

Geneviève M. Clavreul, RN, Ph.D, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management. gmc@solutionsoutsidethebox.net

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The Nurse/Patient Ratio, originally published January 26, 2004, Working Nurse issue 2
by Genevieve M. Clavruel, RN, PhD

The New Year heralds many things, and this year brings legislation mandating a nurse/patient ratio in California. But after the confetti stops falling, did we get what we want? We now have a panacea for thousands of nurses in California, however the ratio really can’t be enforced. (At the writing of this article the companion bill for enforcement is stalled in the legislature, having been defeated at least once already)

As my children are fond of saying, “Why am I not surprised?” Having been a nurse for almost 30 years, most of those years spent in the NICU/PICU, I am used to working with a strict nurse/patient ratio. ICUs and a few other areas of nursing have always been under the control of an “acuity” system. Actually, all nursing is supposed to be, but we know this isn’t always the case. For this reason, I knew in my heart that legislating a nurse/patient ratio was probably an exercise in futility.

Why this attitude, you may ask? First, hospitals and The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) already require the development of an acuity tool to assess the patient and assign nurse/patient ratios. Second, I hate to see laws passed for the sake of passing laws. Do California nurses need reliable nurse/patient ratios? Yes. Do these ratios need to be enforceable? Yes. Do we need legislation? Probably not.

Let’s dissect the problem. How is the nurse/patient ratio determined? In theory, each hospital has in place an acuity procedure. It can be as simple as if the patient has x, they are a 1; if the patient has x and y, they are a 2; and so forth. The more complicated the care required for the patient, usually the higher the number assigned. Then, depending on the number, the nurse has an allotment of patients. For example, a nurse can have a total of two, three, four or even 10 patients that are ranked 1, but a nurse can only have a total of one patient if that patient is ranked 6 or 7.

The system is simple, until the human factor is taken into account. That factor is the charge nurse, who usually makes the assignments. In most cases, a floor nurse is assigned the duty of being charge nurse during a shift. She is usually not trained as a manager and is often unwilling to take the risk of rocking the boat. Tomorrow she will be a floor nurse again and someone else will be the charge nurse.

Any management expert will tell you that this is a formula for disaster. A recent incident at a local area hospital serves as a good example of this problem.

I showed up for work one night at a “Not Quite Out in the Sticks” hospital (which was listed as one of the top 100 hospitals in the nation). As usual, the NICU was short-staffed—nothing new there, especially since this unit suffers from nurses consistently calling in sick. A recent survey found that nurses were as likely to call in sick because they were just “plain sick and tired” as they were due to actual illness.

The charge nurse for the night gave me my assignment. Three neonates, one is ranked a 5 and two are ranked at 4. By visually assessing the number of IVs they each had, the order for lipids and TPN, and the nasal cannulas, I knew that I was being assigned three patients that were all 5’s. This was before I discovered that two of the neonates ranked 4 were also having severe Brady’s and apnea. This was an unsafe patient assignment. So much so that one of the infant’s IVs infiltrated and he was burned from the medication being delivered.

The nurse assigned his care, who I had relieved, was not only devastated, but frustrated as well. The injury under normal circumstances was probably avoidable, but with the patient load assigned, it was an accident waiting to happen.

As I stated earlier, I have been a nurse for 30 years. It was my RN license that kept a roof over the heads of my four children, mother and dog when my husband and I divorced — so I place a high value on it. Unwilling to risk my license, I alerted the charge nurse of the unsafe patient load. Her response to me was, “Well this is the ranking that has been in place for several days.” My response to her was, “Just because it was ranked wrong in the first place doesn’t mean we have to perpetuate the error.”

A charge nurse who had been trained in management, and who was assigned solely as a charge nurse, would have been better prepared to deal with the problem, or may have had at her disposal a wider array of “management tools” to help solve the problem. For example, she may have prefaced the unusually heavy assignment with words of encouragement and support, such as, “We are really short-staffed this evening, and with your many years of experience I thought that you would be up to this challenge,” or “I know that this is a heavy assignment, but I am here to help when you need it.”

She did, however, send the transport RN to change the ranking of one of my patients from a 5 to a 4. The nurse in the bay next to me leaned over, winked and whispered, “Now don’t you feel better?”

The above is a good example of how, even with an acuity system in place, the nurse/patient ratio is ignored. To believe it could be legislated was a pipe dream. Nurses, hospital administration and unions would better serve the patients and nurses if we took different, more effective action.

Here is a quick and dirty solution to part of the problem:

Step One: Make charge nurse a middle management position. This is a good way to reward competent and interested nurses who are ready to begin moving from the bedside, but who might not be ready to tackle the head nurse position.

Step Two: The charge nurse does not get assigned a patient load. Instead, like the head nurse, she would take on the care of patients when and where necessary. Her primary focus, however, would be to come to the aid of the nurses on the floor and do admitting when necessary. With this method a floor nurse on occasion could be assigned a slightly higher than normal patient load. For example, caring for three patients ranked 5, because the charge nurse would be there to help when needed.

Step Three: Train the charge nurse in management techniques. The charge nurse position needs to be a stable position, not a position that is rotated among floor nurses. By assigning the charge nurse position a stable “rank” it is more likely there will be a constant continuum of care and fairness of assignment.

Step Four: Compensate the charge nurse, not necessarily with money, although a pay increase is always appreciated. Compensation could also come as a benefit package, designated parking, extra paid time off, paid CEU classes or additional university-level classes.

Is this the solution to the nursing shortage? No. However, I feel it is one step in the direction of mitigating the problem. One of the biggest reasons why nurses leave the field is that they feel poorly treated, such as when they are asked to work an unfair assignment.

Geneviève M. Clavreul is a healthcare management consultant. She is an RN and has experience as a director of nursing and as a teacher of nursing management.