http://forums.nurse.com/blog.php?678823-terri_g This is a Nursing discussion forum. en Wed, 22 May 2013 15:50:45 GMT vBulletin 60 http://forums.nurse.com/images/misc/rss.jpg http://forums.nurse.com/blog.php?678823-terri_g http://forums.nurse.com/entry.php?1151-Passing-on-School-Truly-a-Failure Wed, 23 Mar 2011 15:11:24 GMT The call for a highly educated nursing workforce has been delivered by nurse experts, supported by studies conducted by the Institute of Medicine... The call for a highly educated nursing workforce has been delivered by nurse experts, supported by studies conducted by the Institute of Medicine and Carnegie Foundation, and endorsed by professional nursing organizations. Yet, we still drag our feet when it comes to returning to school.

One of the most common excuses I hear from nurses about returning to school is that it is too expensive. Over the past year, more attention has been devoted to whether a college education is a wise investment. Several economics experts have considered the issue of rising tuition rates as compared to the return on financial investment.

Specifically, they claim that some majors, such as social work and education, produce a low rate of return.

In 1964, the National League for Nursing estimated the annual cost of a diploma nursing education as $1,100 a year. By 1981, tuition and fees for a baccalaureate education were averaging about $3,000 a year. Today, the College Board — a nonprofit group that focuses on expanding access to higher education — estimates in-state tuition and fees for full-time students enrolled in public four-year colleges averages $7,605 and can run as much as $35,000 a year for private colleges.

Even with rising tuition rates, enrollment in schools of nursing continues to rise. According to the American Association of Colleges of Nursing, between 2009 and 2010, enrollment in baccalaureate programs increased by 6.1%. Similarly, enrollment in master’s programs grew by 9.8%. Research-focused doctoral programs saw an increase of 4.5% as compared to a 25.6% growth in DNP programs. These numbers reinforce the notion that a nursing education remains a valuable commodity.

I have been thinking about returning to school for several years but have been hampered by my own personal list of reasons as to why it was not feasible.

My excuses included the usual litany. I was too busy. My family needed me. And, of course, school was too expensive. After all, I already was paying tuition for one child. How could I possibly afford a second tuition?

In reality, the lack of time and money were not the true reasons preventing me from going back to school. I was paralyzed by my fear of failure. Would a school accept me? Could I successfully navigate a formal education program? What if I didn’t have what it took to pass the classes?

I finally bit the bullet and am proud to say I am eagerly pursing a doctoral degree in nursing. I enjoy being exposed to the world of higher education and comparing notes with my daughter, who is a college sophomore. But more importantly, I love the intellectual stimulation and being able to expand my knowledge of nursing and healthcare. Finally, given the high cost of a college degree, I am definitely getting my money’s worth.

As our practice becomes more complex, we must accept the role of lifelong learners if we expect to improve patient-care outcomes. So when asked if going back to school is a good investment, my reply is, “I can’t afford not to.” ]]> terri_g http://forums.nurse.com/entry.php?1151-Passing-on-School-Truly-a-Failure http://forums.nurse.com/entry.php?1146-Nurse-Managed-Clinics-Provide-Critical-Services Thu, 10 Mar 2011 18:20:07 GMT Last week I found myself in Annapolis, MD standing before the Senate Executive Nominations ... Last week I found myself in Annapolis, MD standing before the Senate Executive Nominations committee discussing my recent appointment to the Governor’s Wellmobile Advisory Board. I am extremely proud to be affiliated with this nurse-led care initiative, managed by the University of Maryland School of Nursing, that brings health care to underserved communities throughout Maryland. Using mobile vans, hypertension, diabetes, and cancer screenings, health education, medication assistance, and other services are delivered to vulnerable populations in Maryland’s Western, Central, and Eastern Shore regions.

Mobile nurse-managed centers are not unique to Maryland. For example, Samford University's mobile vans deliver healthcare services to children and adults with developmental disabilities throughout Birmingham, AL, the Senior HealthMobile project in Idaho focuses on keeping older adults in rural areas healthy, and UMDNJ’s mobile vans address the healthcare needs of at-risk residents in Newark, NJ.

In each case, these mobile centers are nurse-managed entities staffed with faculty and students from local nursing schools. Not only do these mobile clinics bring needed care to underserved areas, they also offer unique practice experiences. In addition, mobile clinics have proven to be effective delivery models in times of disaster.

While the advantages of such programs have been well documented, funding remains challenging. In many cases, public-private partnerships have sustained these services. However, without a financial investment from the state, it is difficult for such programs to attract matching private support. Last year, due to a lack of funding Maryland’s Wellmobile Program was only able to circulate one of its four vans. Even so, the program saved the state more than $957,600 in averted emergency department visits.

Program staff continues to explore innovative funding opportunities to allow them to serve their constituents. However, the question remains, where do these programs fit in the emerging medical home model? The Nursing Alliance for Quality Care is hosting a symposium on April 5, 2011 to discuss the role of APRNs in the medical home model and to identify ways in which nurses and APRNs can assume leadership roles in the future. Nurses and nurse-led programs have a critical role in the changing healthcare landscape. ]]> terri_g http://forums.nurse.com/entry.php?1146-Nurse-Managed-Clinics-Provide-Critical-Services http://forums.nurse.com/entry.php?1110-Three-Strategies-for-Dealing-with-Compassion-Fatigue Thu, 24 Feb 2011 12:35:17 GMT As a member of the nurse leader team at Gannett Healthcare Group (http://www.nurse.com/), I have an opportunity to talk with nurses across the... As a member of the nurse leader team at Gannett Healthcare Group, I have an opportunity to talk with nurses across the country. Recently, I have noticed our conversations turning to the issue of compassion fatigue.

I find that nurses are anxious to share their feelings, frustrations, and fears as it relates to this topic. However, one important concept that I have learned is that burnout is often confused with compassion fatigue.

Although the symptoms can be similar, such as anger, sadness, despair, and hopelessness, there are clear differences. Burnout is generally related to organizational situations and is believed to occur as a result of an individual not being correctly matched to the right job position. In comparison, compassion fatigue, according to Deborah Boyle, an oncology clinical nurse specialist and consultant in Phoenix, who has explored this notion among oncology nurses, occurs when nurses are not able to find a balance between empathy and objectivity. Left unaddressed, it can lead to physical and psychological consequences.

However, more research is being done in this area and new strategies to manage compassion fatigue are being discussed. In a recent blog post, Dr. Nikore raised the idea of a 3-month sabbatical as a unique way to refocus the turmoil of this emotional stress.

Short of obtaining a paid sabbatical, there are other steps nurses can take to manage compassion fatigue. For example, many facilities offer employee assistance programs and counseling services that are available to help nurses address compassion fatigue. In addition, nurse support groups provide an opportunity to share feelings. Finally, nurses must ensure they replenish their physical, emotional, and spiritual needs.

Finally, a key to successfully coping with compassion fatigue is to remember that you are not alone. ]]> terri_g http://forums.nurse.com/entry.php?1110-Three-Strategies-for-Dealing-with-Compassion-Fatigue http://forums.nurse.com/entry.php?1085-Honor-Your-Nursing-Colleagues-Today Fri, 28 Jan 2011 14:40:08 GMT Celebrating nursing excellence is near and dear to our hearts at Nurse.com (http://www.nurse.com)and once again we are seeking nominations of nurses... Celebrating nursing excellence is near and dear to our hearts at Nurse.com and once again we are seeking nominations of nurses who deserve to be honored at the 2011 Nursing Excellence Awards Galas.

I am certain that you know nurses who exemplify all that nursing should be — nurses you would want to care for you or your loved ones, who have advanced the profession, taught or mentored you as you progressed along your career path, or gone beyond the call of duty to improve the lives of people in their communities. Those are the nurses Nurse.com wants to recognize.

We're seeking nominations for Nursing Excellence Awards in six categories:

• Advancing and Leading the Profession: RNs who have led, advanced, or strengthened nursing, either as a profession or in the delivery of patient care.

• Clinical Care: RNs who demonstrate excellence in direct care delivery in any clinical setting.

• Community Service: RNs who have made significant professional or voluntary contributions that have improved patient care.

• Management: RNs who have demonstrated exceptional management of nursing or patient care services in any setting.

• Mentoring: RNs who provide a positive professional influence, guidance, and support for other nurses in any setting.

• Teaching: RNs who have made significant contributions in the education, professional development, or long-term learning of nursing professionals.

Recognition for going above and beyond what is expected is important to everyone. However, for nurses, peer recognition is most meaningful. Being acknowledged by respected colleagues who understand the challenges and opportunities of the job speaks volumes. So please take a few moments and submit the names of your colleagues who have made unique contributions to the profession.

Nominations can be submitted online at www.Nurse.com/nursingexcellence. The deadline for submissions in specific regions is February 1st. ]]> terri_g http://forums.nurse.com/entry.php?1085-Honor-Your-Nursing-Colleagues-Today http://forums.nurse.com/entry.php?1081-Opportunities-Abound-with-Healthcare-Reform Wed, 26 Jan 2011 16:42:11 GMT Among the new members of 112th Congress sworn in on January 4, 2011 were four nurses – Renee Elmers, R-NC (http://ellmers.house.gov/), Diane Black,... Among the new members of 112th Congress sworn in on January 4, 2011 were four nurses – Renee Elmers, R-NC, Diane Black, R-Tenn, Ann Marie Buerkle, R-NY, and Karen Bass, D-Calif – bringing the total number of nurses currently serving in Congress to seven. In addition, many nurses serve in elected and appointed positions in state legislatures and local governments across the nation.

Yet, nurses remain largely invisible in policy making circles.

For years nurses quietly have fought to be seen as full partners in the healthcare system. We established nurse managed clinics to provide care to underserved populations and demonstrated creative ways to coordinate care for medically complex patients while improving outcomes.

However, a 2010 Gallop poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perception” indicated nurses are not viewed as important decision makers. In fact, leaders in this study, commissioned by the Robert Wood Johnson Foundation, ranked nurses behind six other stakeholders when it comes to those expected to influence healthcare reform.

The recently released Institute of Medicine / Robert Wood Johnson Foundation report on the Future of Nursing marks the beginning of a new era for nursing. The report, which highlights nurse’s wisdom and expertise, recommends numerous strategies to transform the healthcare system.

Although some of these changes in care delivery, practice, and education can be addressed at the federal level, many will require state legislative or regulatory action.

While healthcare reform debates are resuming at the federal level, the states have been busy addressing reforms. According to the National Council of State Legislatures, 33 states have established an entity to implement the new federal law.

At the national, state, and local level there is much work to be done if nursing is to shape our healthcare future.

So, while we celebrate the seven nurses serving in Congress we must recognize that more nurses must become engaged in shaping legislation, regulations and health policy to improve our nation’s health.

Opportunities are bountiful – from serving on state boards to hospital boards or even being groomed to step into elected office. ]]> terri_g http://forums.nurse.com/entry.php?1081-Opportunities-Abound-with-Healthcare-Reform http://forums.nurse.com/entry.php?1072-New-Year-Healthier-Habits Thu, 06 Jan 2011 14:09:45 GMT Have you noticed that every January we are bombarded with advertisements for exercise equipment and diet aids? As a nation, we engage in many... Have you noticed that every January we are bombarded with advertisements for exercise equipment and diet aids? As a nation, we engage in many unhealthy behaviors and struggle to modify our lifetstyle choices. Personallly, I find it alarming that obesity is expected to be our next major health battle. But as a nation, we are trying to improve. According to a Consumer Reports phone survey, 90% of American adults believe that they ate healthfully, despite data that suggests otherwise.

As health care costs continue to rise both employers and communities are taking more active steps in helping folks adopt healthier behaviors. Smoke free workplaces are not a new concept but recent trends indicate that employers are not only banning smoking on their grounds but declining to hire smokers. According to a Massachusetts Department of Public Health study, smoking costs the Commonwealth $6 billion each year in health care costs and lost productivity. The Cleveland Clinic in Ohio adopted this policy years ago while Memorial Hospitalin Tennessee and Anna Jaques Hospital in Massachusetts implemented their policies in 2010. The policy at ProMedica Health System in Ohio, will go into effect this month.

Taking this theme a step further, the community of Alberta Lea in Minnesota launched an initiative to improve the health of its residents. Incorporating innovate walking programs, healthy cooking courses, and seminars, residents were able to modify their behaviors and increase their lifespan by an average of 3.1 years. Now communities such as Hermosa and Redondo in California are adopting similar programs.

I am all for creating healthier communities and finding unique ways to engage restaurants, business, and government to support healthy habits ranging from easily accessible walking paths to healthy menu choices. As my first step, I resolve to walk more by parking at the back of the parking lot at the shopping mall and grocery store. After all, it is a new year and like everyone else, I am trying to adopt healthier habits. ]]> terri_g http://forums.nurse.com/entry.php?1072-New-Year-Healthier-Habits http://forums.nurse.com/entry.php?1048-From-Good-to-Great Thu, 02 Dec 2010 12:30:39 GMT Just before the Thanksgiving holiday, my mother was hospitalized. Her surgery went well and she is recuperating as expected. However, the event... Just before the Thanksgiving holiday, my mother was hospitalized. Her surgery went well and she is recuperating as expected. However, the event occurred at a time when I was deep in thought about the future of nursing and creating an exemplary healthcare experience.

As I sat at my mother’s bedside in the ICU and later in the step-down unit, I observed the nurses and other members of the healthcare team and contemplated the experience through the lens of a family member instead of that as a nurse.

My mother received excellent care during her hospitalization, although my brothers and I found ourselves wanting to be included as trustworthy partners of the care team. The doctors, nurses, and therapists entering the room, routinely introduced themselves, and asked if there was anything my mother needed. They were professional, knowledgeable, and competent. However the only information we received about my mother’s care goals were what we read on the whiteboard posted in her room. My mother didn’t understand many aspects of her care such as why she was receiving heparin or having her finger stuck to test her blood sugar. It would have been helpful for our family to understand the plan for pain management, and ambulation, as well as hospital protocol bundles. Had we been treated more as partners, we could have avoided the constant barrage of questions we had each time a provider entered the room. In short, we could have supported the plan of care more effectively.

This week during the keynote session of the National Summit on Advancing Health through Nursing, Dr. Don Berwick, Administrator, Centers for Medicare and Medicaid Services, shared his view that healthcare providers are “guests” in our patient’s lives rather than hosts to patients who enter our facilities. Adopting this point of view would have changed our recent experience from good to great. ]]> terri_g http://forums.nurse.com/entry.php?1048-From-Good-to-Great http://forums.nurse.com/entry.php?959-Excellence-Is-it-a-Meaningful-Pursuit Fri, 08 Oct 2010 13:22:19 GMT In the midst of the 1980s nursing shortage, the American Academy of Nursing (http://www.aannet.org/i4a/pages/index.cfm?pageid=1) embarked on a study... In the midst of the 1980s nursing shortage, the American Academy of Nursing embarked on a study to examine why some hospitals acted as magnets that attracted and retained RNs. This seminal work became the foundation for the creation of the Magnet Recognition Program and was based on the premise that better nursing work environments produced better patient outcomes.

Today, the term Magnet is synonymous with excellence.

Over the course of the past 20 years, the number of programs recognizing excellence has grown. The American Association of Critical-Care Nurses’ Beacon Award for Excellence recognizes excellence in nursing care provided to critical-care patients. The Emergency Nurses Association’s Lantern Award symbolizes a commitment to quality of care delivered within positive work environments. And the National League of Nursing has established programs to promote and recognize excellence in nursing education.

At its inception, this movement toward excellence was process oriented, focusing on how organizational culture supported the delivery of patient care. Today, we are moving away from the “how” and exploring the “what.” Programs examining excellence are looking at the “intensity of the relationship between process and outcome,” healthcare consultant Tim Porter-O’Grady, DM, EdD, ScD(h), FAAN says.

This natural evolution is driving us to raise the bar on our expectations and standards. Further, it is encouraging the nursing community to engage in a dialogue around the notion of excellence.

There are many examples of excellence, as demonstrated by the 370 Magnet hospitals as well as the growing number of Beacon and Lantern honorees and educational centers of excellence. But the question to consider is whether these are meaningful designations.

According to Beth Ulrich, RN, EdD, FAAN, who has done extensive research about nurses’ perceptions of the work environment, nurses working in organizations striving for excellence are more satisfied and report healthier work environments.

The work of Linda Aiken, RN, PhD, FAAN, FRCN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, informs us that improvements in the nursing work environment and efforts to establish a professional practice model result in higher quality of care, both at home and abroad.

Striving for excellence in nursing education, nursing practice or nursing leadership is not just another task, but a meaningful endeavor that ultimately improves the end product — patient care. ]]> terri_g http://forums.nurse.com/entry.php?959-Excellence-Is-it-a-Meaningful-Pursuit http://forums.nurse.com/entry.php?905-Indicators-of-Workplace-Violence Mon, 20 Sep 2010 17:07:45 GMT I was on my way to a meeting of Maryland nurse executives when I learned of the shooting at Johns Hopkins Medical Center ... I was on my way to a meeting of Maryland nurse executives when I learned of the shooting at Johns Hopkins Medical Center in Baltimore. Just a few weeks earlier a Franklin Hospital nurse suffered facial injuries when she was beaten by a patient. In August, a nurse was punched, kicked and choked by a psychiatric patient at the Erie County Medical Center. We expect to feel safe in our workplace but it seems as though violence is erupting around us. Given the increased stress people are experiencing, due to the recession, home foreclosures, job loss and uncertainty; we are likely to see an increase in workplace violence.

While violence can occur in any healthcare setting, emergency departments are especially susceptible. According to a study conducted by the Emergency Nurses Association, nurses working nights and weekend are more likely to experience physical violence. The ENA is currently involved in a Violence Surveillance Study and developing best practices to reduce violence against nurses.

In the meantime, it is wise to be alert to potential clues that an environment or situation may be turning violent. Here are warning indicators of potential workplace violence outlined in theUSDA Handbook on Workplace Violence Prevention and Response.

1. Intimidating, harassing, bullying, belligerent, or other inappropriate and aggressive behavior.
2. Numerous conflicts with customers, co-workers, or supervisors.
3.Bringing a weapon to the workplace (unless necessary for the job), making inappropriate references to guns, or making idle threats about using a weapon to harm someone.
4. Statements showing fascination with incidents of workplace violence, statements indicating approval of the use of violence to resolve a problem, or statements indicating identification with perpetrators of workplace homicides.
5. Statements indicating desperation (over family, financial, and other personal problems) to the point of contemplating suicide.
6. Direct or veiled threats of harm.
7. Substance abuse.
8. Extreme changes in normal behaviors. ]]> terri_g http://forums.nurse.com/entry.php?905-Indicators-of-Workplace-Violence http://forums.nurse.com/entry.php?869-7-Interesting-Facts-about-Blood-Transfusions Thu, 26 Aug 2010 17:25:52 GMT At NurseWeek (http://www.Nurse.com)’s Career Fair in Houston, Texas, Susan Baimbridge (http://nurseweek-houston-careerfair.eventbrite.com/), RN,... At NurseWeek’s Career Fair in Houston, Texas, Susan Baimbridge, RN, CCRN-CSC, ADCNS-BD, from St. Luke’s Episcopal Hospital, spoke about blood conservation during cardiac surgery. Here are some interesting facts she noted during her presentation.

1. Blood transfusions date back to the 17th century when they were used to change the humor of patients.
2. It was not until the Civil War that hemorrhage was recognized as a cause of death.
3. Transfusion medicine began during World War II.
4. It costs $9,000 to give one unit of blood to a soldier in Afghanistan.
5. Blood is an organ; thus when administering blood transfusions you are actually giving an organ transplant.
6. Transfused patients have an increased risk of mortality and morbidity. Even receiving one unit of blood can increase morbidity and significantly decrease the long term rate of survival.
7. It takes 10 units of blood to change the blood throughout the body.

She closed her session with highlighting the need for practice guidelines in blood management. To develop effective guidelines Baimbridge recommends looking at current practice, identifying opportunities for improvement, and establishing a transfusion trigger. St. Luke’s has decreased the need for blood transfusions in 80% of their coronary artery bypass graft (CABG) patients by implementing such a program. This has resulted in cost savings for the hospital and decreased length of stay for patients. ]]> terri_g http://forums.nurse.com/entry.php?869-7-Interesting-Facts-about-Blood-Transfusions http://forums.nurse.com/entry.php?851-Respect-An-Essential-Component-for-Successful-Teams Fri, 20 Aug 2010 19:31:50 GMT I recently had the privilege of spending a day with a group of nurses at Kennedy Krieger (http://www.kennedykrieger.org/) Institute ... I recently had the privilege of spending a day with a group of nurses at Kennedy Krieger
Institute in Baltimore, MD. Known for its groundbreaking work in treating children and adolescents with brain disorders, these nurses shared some amazing success stories. One particular story involved a young girl who had sustained life threatening injuries resulting from a traumatic fall. She arrived at Kennedy Krieger in a coma. Six months later the young patient had recovered to the point where she was able to walk and was discharged to her parent’s care. When asked the key to their success, the nurses responded “teamwork.”

The healthcare team at Kennedy Krieger is interdisciplinary. They evaluate every aspect of their patient’s life (medical, physical, psychosocial, and nursing) and a team of specialists work collaboratively to help these children reach their full potential. I believe their success is a result of team members, with clearly defined roles, respecting and trusting each other and communicating openly.

It’s no surprise that healthcare professionals are not good team players. After all, we are educated in silos, work within a hierarchical system, and are trained to be autonomous. We have struggled to become more team focused over the past few years and have made progress however; there is still room for improvement.

A 2008 survey of registered nurses by Buerhaus, Donelan, Desroches, and Hess asked nurses to rate the quality of their relationships with other healthcare personnel. Although nurses rated the quality of their relationships slightly lower in 2008 than in 2006, they again indicated they had better relationships with nurse colleagues than with physicians and others. When asked about their perceptions of respect, nurses indicated they felt more respected by other nurses than physicians.

Great groups, as Warren Bennis says, are able to accomplish so much more than talented people working individually. The healthcare workforce consists of many talented nurses, physicians, pharmacists, social workers, technicians, and others. Whether working with colleagues on a nursing care team or participating in an interdisciplinary group, we must understand and respect the unique contribution everyone contributes to the success of our mission. Working together toward a common vision we can improve patient outcomes. ]]> terri_g http://forums.nurse.com/entry.php?851-Respect-An-Essential-Component-for-Successful-Teams http://forums.nurse.com/entry.php?817-Have-You-Read-The-Checklist-Manifesto Thu, 05 Aug 2010 20:28:35 GMT A colleague gave me a copy of Atul Gawande’s The Checklist Manifesto for my birthday. While I had heard about the book, little did I know what I was... A colleague gave me a copy of Atul Gawande’s The Checklist Manifesto for my birthday. While I had heard about the book, little did I know what I was in for when I opened the cover.

The book grabbed me from the start. Gawande quickly makes the case that knowledge is both a blessing and a curse. However, he advocates that in order to create safer healthcare environments and reduce medical errors, we must develop strategies that build on the knowledge we have.

Throughout the book, Gawande makes his points using stories we can easily relate to. One of my favorite passages is the story of Captain “Sully” Sullenberger landing the US Airways flight on the Hudson. Although I was familiar with the media coverage of the event, I was interested to see what lessons could be applied to healthcare. Gawande discusses the strict discipline that pilots adhere to, particularly as it applies to the use of checklists. He writes, “The checklist gets the dumb stuff out of the way, the routines your brain shouldn’t have to occupy itself with.”

What I found more interesting was the notion of the team that develops among the flight crew. In the case of the US Airways flight, when disaster struck, the pilot, copilot, and flight attendants worked as a team flawlessly following the protocols that had been rehearsed in training. Teamwork was the key to everyone surviving the disaster.

For me, the take away message from Gawande’s book is that humans are fallible. We cannot remember everything thus reliance on checklists should not be viewed as a weakness but an essential tool. Further, the importance of team work cannot be ignored. The aviation industry has learned to quickly establish cohesive teams in which each member plays a critical role and is respected for the knowledge they bring. These are lessons that we in healthcare must adopt in order to improve patient outcomes. ]]> terri_g http://forums.nurse.com/entry.php?817-Have-You-Read-The-Checklist-Manifesto http://forums.nurse.com/entry.php?775-5-Tips-to-Consider-When-Planning-a-Hospital-Stay Thu, 15 Jul 2010 21:07:26 GMT I am helping my mother prepare for an elective surgical procedure and as I look at the experience through her eyes, I am reminded that hospitals can... I am helping my mother prepare for an elective surgical procedure and as I look at the experience through her eyes, I am reminded that hospitals can be intimidating places.

We realize that the more consumers know about what to expect during a hospital stay, the more effectively they will be able to participate in their care. But in this age of information, where advice is easily accessible, what resources really help prepare patients for what to expect during hospitalization? Here are a few resources I have found to be helpful.

1. WebMD advises consumers to plan for a hospital stay before an acute crisis occurs. This site offers sound advice such as having meaningful conversations with healthcare providers about treatment options and choices before an acute episode. Planning care in this manner helps everyone know what to expect.

2. Recently I found myself re-reading a particular article titled, “Be Patient With Your Nurse to Get the Best Care.” I am drawn to this article not only because it acknowledges that nurses (not doctors) provide care in hospitals; it also recognizes the multiple competing demands nurses face during each shift. Although this is not earth shattering information to nurses, it is an important point for patients to understand as they enter the unique environment of the hospital.

3. “A Painless Guide to Navigating Your Hospital Stay” discusses simple points such as why everyone keeps asking your name and suggests patients keep a notebook at hand to record important information.

4. CNN offers tips for surviving a hospital stay. Their suggestions include bringing a list of your medications with you to the hospital and making sure everyone washes their hands. These are 2 critical steps in preventing errors and infection.

5. Finally, REAL SIMPLE offers a quick checklist of items to bring to the hospital. My personal favorite is ear plugs!

What resources would you recommend for family and friends preparing for a hospital visit? ]]> terri_g http://forums.nurse.com/entry.php?775-5-Tips-to-Consider-When-Planning-a-Hospital-Stay http://forums.nurse.com/entry.php?730-Hearing-a-Buzz-at-the-World-Cup Wed, 23 Jun 2010 02:01:39 GMT There has been a lot of “buzz” about the vuvuzelas... There has been a lot of “buzz” about the vuvuzelas at soccer’s 2010 World Cup. You know what I am referring to – those 3-foot long plastic horns creating the sound of a million buzzing bees.

Along with cheering on their teams, my family loudly complains about the annoying sound these horns make. They rant that it is difficult to hear the calls and enjoy the play. As a health care professional I am more concerned with the affects of such loud and constant noise. As usual, when I voice my concerns the family raises their eyebrows giving me that “there she goes again” look.

But noise induced hearing loss (NIHL) is no joke. While we are constantly surrounded by sound, there is such a thing as too much noise. Audible sounds are measured in decibels. A normal conversation is clocked around 60 decibels and diesel trucks and lawnmowers can range up to 85 decibels. According to the National Institutes of Health, repeated exposure to sounds louder than 85 decibels can lead to hearing loss. Sounds measured around 120 decibels (boom boxes) can cause our ears to hurt and at 150 decibels can even rupture our eardrums. The din from a stadium filled with vuvuzelas at the World Cup has been measured at 127 decibels.

Given this, we need not worry too much about the fans watching a couple of games. Although it is important to note the South African Medical Journal has noted "significant hearing changes in participant’s hearing following matches and recommends haring protection for football match spectators." Instead we should focus our attention on those being exposed to this cacophony day after day including volunteers, event staff, broadcasters, and referees.

NIHL is preventable. Watching the World Cup on television, I am able to regulate the drone of the vuvuzelas. But now they are making their way to sporting events in the US. The Miami New Times reports that 15,000 vuvuzelas transformed the Florida Marlin’s stadium into an "echo chamber."

Vuvuzelas may be considered a happy sound in South Africa; however I am not certain the “buzz” is as welcome here. ]]> terri_g http://forums.nurse.com/entry.php?730-Hearing-a-Buzz-at-the-World-Cup http://forums.nurse.com/entry.php?714-Nursing-Retirements-Have-Critical-Implications Mon, 14 Jun 2010 20:37:48 GMT An article (http://www.washingtonpost.com/wp-dyn/content/article/2010/06/13/AR2010061304096.html) in the today’s Washington Post... An article in the today’s Washington Post, written by Darryl Fears, states, “Health-care economists and other experts say retirements in that group [nurses] over the next 10 to 15 years will greatly weaken the health-care workforce...” I am glad to see more attention being paid to the implications of losing our most experienced nurses.

Several years ago, I heard David DeLong, an expert on the aging workforce; speak about the notion of lost knowledge. He remarked that as highly experienced workers retire, companies lose critical information that resides deep within their minds. This concept resonated with me and I set out to learn how it applied to the aging nursing workforce.

Dr. Patricia Benner’s work informs us that experiential learning is a requisite for the development of expert nurses. As nurses transition from novice to expert they develop clinical judgment, which can only be acquired through experiential learning. When the nursing workforce experiences massive retirements, we will lose years of wisdom that is critical to reducing medical errors and preventing catastrophic events. The key to success lies in being able to capture and transfer experiential knowledge from our seasoned workforce to novice nurses.

I have spent the last several years talking with healthcare groups about this looming problem and identifying tools that will help us address this issue and improve workforce practices. In addition to complex knowledge management programs, there are simple tools we can incorporate such as developing a storytelling program or clinical narratives to pass on critical knowledge or incorporating critical knowledge into pre-retirement mentoring programs. But the point is – we have to start now.
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