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The Nurse
In a recent press release, the California Nurses Association announced that nearly 5000 of its members will hold a one day strike at nine Sutter Health Bay Area hospitals on Christmas Eve to protest what they characterize as major cuts in nurse benefits and staffing levels that impact patient safety.

“Sutter has forced us to strike again by immorally proposing to strip us of our sick leave, healthcare, and much of what we have worked hard for over the years,” said Alta Bates Summit Oakland RN Paula Lynn. “Sutter must stop its unfair treatment of nurses and negotiate a fair contract.”
 
Sutter corporate officials, taking an especially hard line in the Sutter East Bay Region, continue to demand some 100 sweeping cuts in patient care protections and nurses’ contract standards – despite being one of the wealthiest hospital chains in the United States. In contrast, Sutter hospitals in San Mateo, Sonoma, and Lake counties have broken the pattern and called off their war on nurses and patients by withdrawing their unwarranted concession demands, which led to quick contract settlements at those facilities.
 
But at Alta Bates Summit Medical Center hospitals in Berkeley and Oakland, for example, management continues to insist on elimination of paid sick leave, effectively forcing nurses to work when ill, exposing already frail and vulnerable patients to further infection.

Naturally, Sutter Health has a different perspective and has created a web site to present its side of the story on its negotiations with the California nurses union.     The negotiations appear to have been dragging on for months without any resolution in sight.  Indeed, a July 6, 2012 story in the San Francisco Business Times  reported that a July 3rd strike by California nurses was the "fifth such action since September [2011]."  

A key concern for many is the impact of nurse strikes on patient care and safety.  In September 2011, a replacement nurse working during a strike at a Sutter Health hospital in Oakland made an error that resulted in the death of a patient.  Fortunately, such incidents are relatively rare but they do illustrate how important it is that hospitals hire the best possible replacement nurses during a strike or transfer patients to other hospitals if they are unable to do so.  

During a nurse strike, most hospitals hire temporary replacement nurses though nurse staffing agencies that specialize in per diem and travel nursing assignments.   Hiring these replacement nurses is very expensive and thus provides the employer with a major financial incentive to reach an agreement with the nurses' union.  Hospitals that hire replacement nurses often have to commit to a minimum contract period and thus a one-day strike often becomes a multi-day lockout period as the hospital waits until the contract period of the replacement nurses has expired.

While crossing a picket line may be regarded as shameful in other industries, in healthcare it is understood that someone has to care for the patient. Nurses who cross the picket to care for sick patients during a nurse strike should not feel any shame but simply do their best to protect patient safety and wellbeing.    

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In today's nursing industry, hospitals and healthcare facilities have had to rely on hiring and looking for new blood by recruiting in foreign countries to meet the demand for nurses.

In some places, this has led to hospitals having to make sure that the foreign nurse was not only fluent in english but as well understands euphemism of the country in question.  One such example according to the UK Guardian took place at the Queen Elizabeth Hospital in Norfolk, Uk where the english euphemisms can be confusing to a foreigner even if they speak perfect english.

Since many nurse job boards like NursingJobs.us have a percentage of their travel nurses come from countries where English is not spoken, this could become an issue down the road as the nursing shortage increases and a higher percentage of nurses must be brought in from abroad.

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I can't believe I havent written a nurse blog post in 2 years!  But my posting vacation is over and now Im back on track.

My last assignment was actually in the state of Washington and it was very invigorating.  I had never realized that Washington was such a  beautiful state.  Its a perfect place for those that love the outdoors and hiking.

I'm not sure if any of my readers follow other nurse blogs but I actually follow quite a few of them as they help me keep a fresh perspective on the nurse and the travel nursing industry.

One nurse blog that is quite interesting is the Ultimate Nurse Blog

I think that everyone should take the time to read a  nurse blog or two every once in a while as it will give you a fresh perspective on the nursing industry.

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Nothing beats travel nursing! I have been a travel nurse for 6 years, going on 7 and I love the excitement of starting over. I have always loved change and I look forward to working in a new facility, making new friends and moving into a fresh home before every assignment. Although I have had a bit of experience with change involved in travel nursing, I continue to find new ways over the years to keep the feeling of being right at home even though my lifestyle is constantly changing. Due to continuous travel, coziness in my own home is extremely important. Below I have listed a few tips on how to turn your new home into a Cozy and most importantly, an enjoyable environment for every assignment.

  • Be sure that you have memorabilia displayed in your apartment. This could be pictures of you and your family, posters of your favorite band or an item that you have inherited. Whatever is meaningful to you, make sure you bring it with you on every assignment. These items add character and make you feel right at home.
  • Bring your own pillows and blankets. Nothing is more comforting then your own pillows and blankets. You will feel relaxed and you will get better rest at night.
  • Keep it fresh. Light candles, keep your place breezy or simply keep it neat. There are many ways to keep your home feeling fresh.
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Healthy Active Nurses

Nurses have a demanding career that involves long hours, stressful shifts and never ending schedules.  It is especially easy for nurses to fall into some unhealthy habits, but a healthy lifestyle is an important and often overlooked aspect to being able to provide good healthcare for patients! 

 
It’s so easy for nurses to become unhealthy with all the stressful demands that come with being in the medical profession.  Travel nurses have a unique opportunity to choose environments that enable a healthy lifestyle.  Travel nursing to such areas like California, Arizona, and Florida offer warm weather so being active outside is especially easy.

 
Here are some tips for happier and healthier nurses!

 
Tip 1: Be Active.  Being an active nurse who walks, runs or does some form of exercise daily is an essential part of being healthy.  Your body will feel so much better if nurses incorporate exercise into their routine. 

 
Tip 2: Choose foods that make you feel good.  California is a great place to travel because the culture embraces a healthy lifestyle.  There are an abundance of farmer markets and healthy organic stores like Whole Foods, Trader Joes and Henry’s which offer fresh produce and specialty items to keep you a healthy happy travel nurse.

 
Tip 3: Find a travel nursing location that offers fun activities.  Travel nursing is a great career because it allows for nurses to enjoy a schedule that gives them lots of free time.  As a travel nurse you are working 3-12 hour shifts, so on those four days off plan activities like kayaking, hiking, swimming or surfing.  You will enjoy your travel nursing experience so much more if you get outside and try something new and physically challenging.

 
Links for Active Travel Nurses:

WebMD - Your Exercise Routine: How Much Is Enough? 

New York Times: Do We Really Know What Makes Us Healthy?

California Travel Nursing Jobs

Arizona Travel Nursing Jobs

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In a national online survey conducted by the American Society of Registered Travel Nurses (ASRN.org), 56% of the 761 Registered Nurses surveyed on March 26 that worked under nurse-to-patient ratios said that due to the implementation of the ratios, they had more time for breaks. In a separate survey, 69% said they had more time for personal care of their patients.

California's historic staffing law for registered nurse staffing ratios, achieved through years of advocacy by California's Registered Nurses, completed its phase-in period this year.

Over the five-year course of the phase-in, these ratios have revolutionized hospital care and improved patient safety by mandating hospitals maintain minimum, specific nurse-to-patient staffing ratios for all hospital units at all times.

Ratios differ by hospital area, such as a minimum of no less than 1 RN for every 5 patients in general medical or post-surgical care units, 1:4 in pediatrics, and 1:4 in emergency rooms. The ratios are a floor, not a ceiling, with hospitals also required to increase registered nurse staffing as needed based on individual patient illness or acuity.

As of January 1, 2008, new ratios went in effect for three units. They improve to 1:3 in Step Down (transitional units between intensive care and general medical-surgical floors, reduced from 1:4), 1:4 in Telemetry (where patients are on monitors, improved from 1:5) and 1:4 in Other Specialty Care units such as cancer care (upgraded from 1:5).

California's ratios are a spectacular success story. Under California's ratio law, lives are being saved, the ability to be effective advocates for patients is stronger, and more RNs are entering the work force and staying at the bedside longer mitigating the nursing shortage.

Since the law was signed, 80,000 more licensed RNs have come into the state's workforce. In contrast to the years before the law was signed in 1999, more RNs are entering the state than leaving, and more are staying at the bedside.

Because of their achievements, the ratios have sparked a brush fire around the country by nurses demanding similar laws in 13 other states including: Arizona, Florida, Illinois, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania and Texas.

In many other workplace settings like for instance, day-care centers, public school classrooms, local fire stations and on commercial aircraft, minimum staffing levels are well established and clearly work for the benefit of the public. Why not in hospitals?

Today, it's still perfectly legal for nurses in 49 states to be assigned to 10 or even 15 patients at a time, far more than can be safely handled. It is hoped that by Nurses' Week next year, more states will have joined California in regulating hospital workloads, so nurses can properly meet their professional responsibilities.

-- Journal of Nursing

-- Journals belonging to the American Society of Registered Nurses

The American Society of Registered Nurses (ASRN) was founded in May 2003 for the purpose of bringing together professional nurses interested in creating a nursing "society" which is defined as "A group of humans broadly distinguished from other groups by mutual interests, participation in characteristic relationships, shared institutions, and a common culture".

This new Society brings together nurses from all fields of inquiry, regions, and specializations both inside and outside academe in order to expand the study and practice of nursing, and offer support, resources, education, and distinction to its members. The Society serves nurses in all 50 states as well as across the globe. ASRN represents a community for all nursing voices. We invite registered nurses, international professionals, and new graduates to discover ASRN. Our goal is to advance nursing as a science and profession.

http://www.asrn.org (ASRN)
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The National League for Nursing, for more than 60 years a recognized leader in assessment and evaluation in nursing education, announced increased benefits to faculty and students who use the comprehensive Total Assessment Program (TAP) for NCLEX-RN Success across the curriculum. TAP, the most complete package now available, enables nursing programs and faculty to improve student retention and better prepare students for success on the national licensure exam.

"NLN test developers take their responsibility to nursing education very seriously," observed NLN CEO Beverly Malone, RN, PhD, FAAN. "Our aim is to support our colleagues in academia to produce the best and brightest nursing workforce, prepared to enter a diverse, challenging, and ever-changing health care environment." Dr. Malone continued, "The NLN testing services team conducts on-going validation and reliability studies ensuring that we continue our tradition as the gold standard in NCLEX preparation."

TAP, with vital input from nurse educators clinicians, reflects the skills and knowledge nursing graduates need for entry into practice, and features:

- Computer-based and paper-based test formats

- Pre-admission exam (PAX) online registration that enables academic testing centers to better manage test administration, including seat availability, scheduling, special accommodations, student inquiries and technical support

- Achievement tests in 16 discrete clinical practice areas, with corresponding practice exams that offer comprehensive rationales and online remediation

- Pre-NCLEX readiness testing to identify student weaknesses for more focused study

- NLN Live Review for NCLEX-RN Success© with exemplar nurse educators as facilitators, incorporating evidence-based nursing practice scenarios, to improve student critical thinking and clinical judgment skills

- Online 4200-plus-item Question Review Bank with comprehensive rationales and customized practice exams

New this year is the unique TAP Rewards rebate offer. Depending upon the size of its Total Assessment Program contract, schools of nursing may qualify for up to a 5 percent rebate that may be credited to other NLN programs and services, such as the Annual Education Summit, faculty development activities, the Academy of Nursing Education, the Certified Nurse Educator examination and membership dues.

In addition, the College Network has established a National League for Nursing Scholarship Program. With a history of supporting excellence in nursing education, TCN is an associate member of the NLN.

"As with all NLN testing products, TAP has been developed in accordance with the League's longstanding philosophy of consultation with nurse educators and clinicians," asserted NLN president, Dr. Elaine Tagliareni. "This approach assures the highest level of student achievement on exams, as well as predictability of student success in nursing programs of all types."

Dedicated to excellence in nursing, the National League for Nursing is the premier organization for nurse faculty and leaders in nursing education offering faculty development, networking opportunities, testing and assessment, nursing research grants, and public policy initiatives to its 25,000 individual and 1,200 institutional members.

National League for Nursing
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Research Indicates Women in Military Conflicted About Domestic Violence Screening, Reporting A study published this month in Military Medicine (Vol. 171, August 2006) shows that while women on active duty in the military supported the now revised policy requiring healthcare providers to offer abused persons services and to report the abuse, concerns remain about the consequences of that policy. In "Domestic Violence in the Military: Women's Policy Preferences and Beliefs Concerning Routine Screening and Mandatory Reporting," Johns Hopkins University School of Nursing (JHUSON) researchers Jacquelyn Campbell, RN, PhD and Joan Kub, RN, PhD, and co-authors found in interviews with active duty military women-25% of whom had experienced domestic violence (DV) during their military service-that despite support of the previous policies by a majority of respondents, less than half thought abuse should be reported to the commanding officer. Those who had been abused were significantly less likely to agree with informing commanding officers. The interviews also revealed that more than 75% of the women agreed that routine screening would make it easier for abused women to get help, but about the same number felt by doing so, many would be at more risk for being hurt. Additional findings included concerns about the negative effect on their military careers and those of their partners if abuse was disclosed and fears that routine screening and mandatory reporting would make it less likely that military women would disclose abuse. Recent revisions in the policies now allow health care providers to keep the DV information confidential if victims so desire.

Graduate Student is First NCIS Forensic Nurse

Shadonna Hawkins, a master's student in the JHUSON Forensic Nursing Specialist Program, is the first nurse to join the U.S. Navy's nationally recognized Naval Criminal Investigative Service (NCIS) as part of a summer internship. Hawkins, who has been assigned to the elite NCIS Death Investigations Unit, was recently asked to continue her tenure with the unit until she completes her degree in December. The service investigates the deaths of Navy and Marine Corps personnel, their family or dependents, whose demise was the result of homicide, suicide, natural causes, or accident, as well as the deaths of dependent youth under the age of 18. In her position, Hawkins analyzes such information as investigator's reports, autopsy reports and photographs, data gathered from interviews and past history information from family services in order to prepare case summaries that will be presented to the Death Review Board. Action, including criminal investigation, may be taken by that Board. Hawkins has been told the addition of a forensic nursing perspective provides a significant contribution to the CSI analytical process, and she noted that her previous experience as an intern for two summers at the Baltimore Attorney General's Office has been extremely helpful in her new position.

Positive Role of Spiritual Well-Being Seen Among African Americans Treated for Breast Cancer Previous studies have found that spirituality and religiosity play a prominent part in African American culture and that they influence health practices, beliefs and outcomes. Now a study appearing in the ABNF Journal (Spring 2006), "Spiritual Well-Being, Religious Coping, and Quality of Life of African American Breast Cancer Treatment: A Pilot Study," by JHUSON faculty members Phyllis D. Morgan, PhD, APRN, BC; Fannie Gaston-Johansson, PhD, FAAN, and Victoria Mock, DNSc, FAAN, and co-authors, shows significant positive correlations between spiritual well-being and a cancer patient's physical, emotional, and functional well-being. Conversely, the study indicated that as negative-or lack of-religious coping increased, physical well-being decreased. The women in the study, all of whom were in treatment for breast cancer, described their spirituality as having a significant role in coping with their illness. The study also suggests culturally competent nurses recognize the coping strategies used by women from diverse ethnic and racial backgrounds undergoing cancer treatment and work with them to incorporate spiritual well-being and religious coping strategies as part of comprehensive cancer care treatment.

Strong Case Made for Evidence-based Nursing Practice

"The awareness that evidence-based medicine results in better care drives the education of healthcare administrators," states JHUSON researcher Robin P. Newhouse, PhD, RN, in "Evidence and the Executive: Examining the Support for Evidence-based Nursing Practice," published in this month's Journal of Nursing Administration (Volume 36, Number 7/8, July/August 2006). Newhouse adds," The benefit of evidence-based practice (EPB), however, not only applies to medicine but to nursing as well." In her examination, she notes that the EBP approach is more than reviewing and incorporating research results during a policy review; it is an active process in which nurses ask an important question, search both research and non-research evidence, review, and rate the design, quality and consistency of evidence, and implement and evaluate practice changes. Among the benefits of implementing processes supported by evidence is the reduction of practice variations and improvement of patient outcomes. The author includes The Johns Hopkins Nursing Evidence-based Practice Rating Scale to aid users in gauging the strength and quality of evidence being examined.

Interdisciplinary Education Improves Quality Patient Care: The Johns Hopkins Experience In a study published in the August issue of Academic Medicine (Volume 81, Number 8, August 2006), JHUSON Assistant Professor Jo Walrath, RN, PhD, and co-authors describe how in ten months during 2004 and 2005, the JHU schools of nursing and medicine, and an administrative residency program implemented and evaluated a structured, interdisciplinary approach to learning health care quality improvement (QI). The importance of interdisciplinary participation in planning QI projects, the value of the patient's perspective on systems issues, and the value of a system's perspective in crafting solutions to issues, all proved to be valuable lessons learned through the Achieving Competency Today II Program.

Abbott to Study How Health Information Technology Influences Human Behaviors JHUSON Assistant Professor Patricia Abbott, PhD, RN, has been awarded a Post-Doctoral Fellowship by the National Library of Medicine. The two-year full-time Medical Informatics Research Fellowship will focus on Human-Computer Interaction, specifically on understanding how human behaviors are influenced by health information technology interfaces. Abbott will explore the growing problem of "unintended consequences" of health information technology (HIT) and will focus on instances where HIT is inappropriately designed and employed without systemic considerations of user characteristics, and results in an increase in medical errors rather than the reduction envisioned.

The Johns Hopkins University School of Nursing is a global leader in nursing research, education and scholarship and is ranked among the top 10 nursing higher education institutions in the country. The School's community health program is second in the nation and the nursing research program now holds eighth position among the top nursing schools for securing federal research grants. The School continues to maintain its reputation for excellence and educates nurses who set the highest standards for patient care, exemplify scholarship, and become innovative national and international leaders in the evolution of the nursing profession and the health care system. For more information, visit http://www.son.jhmi.edu/

525 North Wolfe St, Rm 525

MD 21205

http://www.son.jhmi.edu/
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JHPIEGO, an international health affiliate of The Johns Hopkins University, has enlisted the Hopkins School of Nursing (JHUSON) in spearheading efforts to improve the curriculum for midwifery education in Afghanistan, a country that has suffered from the highest infant and child mortality rate and second highest maternal mortality rate in the world. Few midwives, who deliver many of the nation's infants, were trained during the civil war. And, because of restrictions on education during the political unrest, many students did not receive basic science, math and pre-clinical skills needed to provide basic maternal and newborn care. JHUSON will help in the creation of visual teaching tools and learning activities in general science and math, anatomy and physiology, microbiology and pharmacology to create a more comprehensive program. Assistant Professor Dr. Nancy Woods pointed out that the new curricula is an interdisciplinary collaboration, noting, "It is crucial that we take full advantage of the multi-disciplinary expertise available to us to create the best possible programs and products to save lives beyond our borders." The updated curriculum will be translated into Dari and used in more than 20 midwifery schools in Afghanistan. For more information, go to http://www.jhpiego.org.

Research Shows Sharp Rise in Coronary Heart Disease in Korea

According to a study published in the International Journal of Cardiology (110 - [2006]), Assessing Risk Factors of Coronary Heart Disease and its Risk Prediction Among Korean Adults: The 2001 Korea National Health and Nutrition Examination Survey, JHUSON Associate Professor Miyong T. Kim, RN, PhD, FAAN, and co-authors note there has been a steeply increasing incidence of coronary heart disease (CHD) in developing countries undergoing rapid westernization, including Korea. The in-depth assessment of CHD based on the 2001 Korea National Health and Examination Survey concludes: "...contrary to the popular notion of relatively better coronary heart health status in Asian countries, the results of this analysis indicate that the overall coronary health of the adult Korean population is comparable to that of other developed countries." Cited as factors contributing to the problem were poor management of high blood pressure, fairly high low high-density lipoprotein cholesterol, and a strikingly high smoking rate among men (61.6%). Diabetes mellitus was also implicated.

Should Oncology Nurses Provide Spiritual Care?

Anne E. Belcher, PhD, RN, AOCN, CNE, FAAN, JHUSON Senior Associate Dean for Academic Affairs, points out in ONS News (Vol 21, No.5) that many oncology nurses report a reluctance to assess patients' spiritual needs or intervene when spiritual distress is diagnosed. She states that nurses should feel empowered to provide the spiritual care that people with cancer need and want. In the article, Dr. Belcher addresses significant issues related to spirituality and nursing including defining the differences between spirituality and religion, characteristics of spiritual well-being and the conduct of a spiritual assessment, how a nurses' spiritual perspective impacts practice, barriers to spiritual care as identified by nurses in general and oncology nurses in particular, and how nurses develop expertise in spirituality and incorporate it into their practice.

Rushton Named Robert Wood Johnson Executive Nurse Fellow Cynda H. Rushton, DNSc, RN, FAAN, JHUSON Associate Professor, has been named one of 20 nurses nationwide selected as a "2006 Robert Wood Johnson Executive Nurse Fellow." The three-year fellowship program is designed to strategically position the voice of nursing across key sectors of the economy in a health care system undergoing unprecedented change and challenges. Dr. Ruston said: "Nurses must play a pivotal role in leading the redesign and success of health care now and in the future." She added she was honored to have the intensive opportunity to develop critical leadership skills and work with a nationally recognized team of coaches and instructors drawn from the health care industry and other sectors of the economy.

For more information, go to

http://www.son.jhmi.edu/aboutus/directory/faculty/faculty_detail.asp?ID=599

The Emergence of Personal Health Records Will Change Health Care

According to lead author and JHUSON professor Marion J. Ball, EdD, FHIMSS. CHIME, consumer and patient demand for Personal Health Records (PHRs) will change health care just as automatic teller machines changed banking. Writing in the Journal of Healthcare Information Management (Vol. 20 No. 2), she states PHRs are made possible through the development of Electronic Health Records. But unlike electronic health records, which are typically maintained by physicians or other health care provider organizations, PHRs will be directed by consumers/patients and maintained by independent Regional Health Information Organizations. Various models are described in the article but all offer the consumer the benefits of encompassing both the basic health information contained in electronic health records as well as information needed to help the consumer manage a broad array of health-related personal data that can be immediately accessed when needed.

http://www.himss.org/ASP/publications_jhim_issue.asp?issue=3/1/2006

The Johns Hopkins University School of Nursing is a global leader in nursing research, education and scholarship and is ranked among the top 10 nursing higher education institutions in the country. The School's community health program is second in the nation and the nursing research program now holds eighth position among the top nursing schools for securing federal research grants. The School continues to maintain its reputation for excellence and educates nurses who set the highest standards for patient care, exemplify scholarship, and become innovative national and international leaders in the evolution of the nursing profession and the health care system.

For more information, visit

http://www.son.jhmi.edu/

Johns Hopkins University School of Nursing

http://www.son.jhmi.edu
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