NursingCenter’s In the Round

A dialog by nurses, for nurses

Nurses Increase Vigilance for Fungal Meningitis

Nurses must increase vigilance for identifying patients at risk for fungal meningitis following the September 26, 2012 recall of injectable methylprednisolone acetate that was packaged by New England Compounding Facility in Framingham, MA. According to the Centers for Disease Control and Prevention's website, there have been 185 cases and 14 deaths among 12 states and continues to grow (CDC, 2012). The impact is potentially greater because healthcare facilities in 21 states have received the recalled lots of the affected drug. 

Patients who received contaminated injections presented with symptoms from one week to 4 weeks after the injection. It is important for nurses to report patients who are symptomatic of meningitis through the month of October to a physician or licensed advanced practiced nurse. To further assist in the evaluation or referral for meningitis work-up, all health care professionals including those in primary care offices, emergency departments, or retail clinics should go to the CDC website ( for a current list of health care providers who administered the recalled lots. The CDC website also provides continually updated information on the meningitis outbreak and educational information for providers and patients.


Centers for Disease Control & Prevention. (2012). Multistate Meningitis Outbreat Investigation. Retrieved from Last accessed 10/12/2012.

ANA Publishes Social Networking Guidelines

   In October the American Nurses Association published ANA's Principles for Social Networking and the Nurse.  This document provides nurses with much needed authoritative guidance on professional and ethical conduct on social media. The boundaries between some nurses' personal lives and careers have become blurred, and some nurses have been disciplined for inappropriate posts and photos of unprofessional behavior or those that identify patients. ANA's Principles for Social Networking and the Nurse and accompanying materials bring clarity to the using social networking sites for personal and professional use. Along with the principles, ANA provides online resources including a poster, a tip card, and fact sheet about social media. All of these documents are available for download at ANA's website by clicking the following link:

Building Skills and Celebrating the NP of the Year at NCNP

The National Conference for Nurse Practitioners (NCNP), sponsored by Lippincott Williams & Wilkins, the publisher of The Nurse Practitioner Journal, is well under way at the Las Vegas Hilton. NCNP began on Wednesday, May 11 with a keynote address on The Implication of Health Care Reform for Nurse Practitioners by Eileen T. O'Grady, PhD, RN. Dr. O'Grady is a visiting professor at Pace University's Graduate School of Nursing in New York City where she teaches health policy. Her energizing presentation outlined the many opportunities that nurse practitioners have in the Patient Protection and Affordable Care Act of 2010 including funding for education and nurse managed clinics.

Also at NCNP, the conference chairperson, Margaret A. Fitzgerald, DNP, FNP-BC, FAANP presented the Nurse Practitioner of theYear Award to Margaret L. Campbell, PhD, RN, FAAN, Assistant Professor at Wayne State University. Dr. Campbell is noteworthy for her contributions, not only to nursing, but to health care for her pioneering work in the palliative care specialty.

Through Saturday, May 14 nurse practitioners will engage in hands-on workshops to build skills in common office procedures, orthopedic procedures, dermatology procedures, and suturing. Participants will also update their practice at numerous sessions on the latest evidence-based diagnostic and treatment recommendations for acute and chronic care for patient populations from children through older adults. For more information about the National Conference for Nurse Practitioners, visit

Knowledge, A Power Source for Nurses

In relation to patient care delivery, knowledge can give nurses greater power to take action and lack of knowledge can leave nurses powerless to provide safe or effective care. Evidence of knowledge as a source of power is that many employers during this difficult economic time prefer to recruit experienced RNs rather than incurring the expense of training new graduates.

Anderson and Willson (2009) offer a conceptual framework for nursing knowledge management that supports using technology to offer health care providers many tools to effectively use data to transform it into knowledge. Clinical decision support software such as those integrated with electronic medical records or those that clinicians access through mobile applications (apps) are examples of using data effectively to support knowledgeable clinical interventions. An example of how powerful this can be is that two nurses sharing a clinical rotation have access to texts for purchase in the books store and mobile apps that they can use on a Smartphone. One nurse feels more comfortable using the text and the other is very adept at navigating information technology including mobile apps. The nurse with the mobile product completes medication administration quicker because he finds all the drugs in his reference while the nurse with a book misses out on recent drug releases requiring an extra step to call the pharmacy or to look up drugs online.

There are many other examples and some that may have life-threatening consequences such as drug to drug interactions that information systems recognize that health professionals frequently overlook. In a time when health care quality is a mandate, organizations and professionals who use knowledge effectively will have the power to take control over costs and attain a higher rate of insurance reimbursement due to fewer complications. 

Reference: Anderson, J. A., & Willson, P. (2009). Knowledge Management Organizing Nursing Care Knowledge. Critical Care Nursing Quarterly , 32 (1), 1 - 9.


Misconceptions about pressure ulcers

The 25th Annual Clinical Symposium on Advances in Skin & Wound Care was held from September 30, to October 2, 2010 in Orlando Florida. This gathering of top wound care clinicians and presents clinical skill-building sessions for beginners in wound care as well as advanced sessions for expert clinicians and researchers. Some presentations addressed issues including inadequate education of general practitioners and misconceptions that have detrimental effects on patients and possible costly consequences including reduced reimbursement and malpractice claims. Reflect on your own practice setting to examine if these problems or misconceptions exist regarding pressure ulcers.

o   Pressure ulcers cannot be staged in the reverse.

o   Not all pressure ulcers form from the outside and become deeper. Pressure ulcers can be caused by deep tissue injury and form from the inside out.

o   Pressure ulcers are not considered “never events” by the Center for Medicare and Medicaid Services because not all pressure ulcers are avoidable.

o   Pressure ulcer staging cannot be used for other types of wounds

Take action to improve awareness by discussing these issues in journal clubs, inviting the wound care specialist in your organization to provide education, and implementing appropriate clinical practice guidelines. For more information on this subject and educational materials, go to the National Pressure Ulcer Advisory Panel website at

Leaders Energized and Network at Nursing Management Congress

clock September 25, 2010 03:25 by author Karen Innocent, MS, RN, CRNP, ANP-BC, CMSRN

    On  Wednesday, September 22 to Sunday September 26, nurse managers and nurse executives are gathering at Nursing Management Congress at the Gaylord Texan Resort & Convention Center in Grapevine, Texas near Dallas. While the Congress is still underway, I wanted to post about how great the conference is going. Preconferences on September 22 and 23rd provided essential skills for new nurse managers and those seeking certification as nurse executive or nurse executive advanced. Plus some attendees explored the Anatomy of a Malpractice Trial.    

    The evening of September 23rd, Nancy McKinstry CEO and Chairman of Wolters Kluwer, (Lippincott's parent company), delivered the opening address. Nancy McKinstry set the stage for the entire Nursing Management Congress by discussing national and international trends in nursing and the demands on nurses' need for information. She demonstrated how advances in technology and information solutions can be integrated into nurses' workflow to help them focus on what is relevant and credible among the enormous volumes of new information available to them.  Nancy McKinstry emphasized the critical importance of nurse managers and nurse executives of placing access to evidence based information at the bedside or clinical area to improve quality, efficiency, and effectiveness of nursing care.

     While the planners of Nursing Management Congresss are serious about providing education, they also like to infuse energetic, motivational, and entertaining presentations in to the program.   The keynote address on Friday, September 24th "performed" by Robin Crow delivered on all three points. His riveting guitar music captivated the nursing audience while he drove home a leadership message of personal accountability for ensuring the success and survice quality in our organizations.

     With a day and a half to go, the participants are enthusiastice about the sessions, new products and opportunities in the exhibital hall, and they are networking and sharing ideas about new practice and management models at the poster sessions.

Warning of vaccine administration errors

   Recent news about pertussis outbreaks that have resulted in infant deaths is causing serious concern in the healthcare community. Back in August 2006 and again in July 2010 the Institute for Safe Medication Practices (ISMP) issued a warning about confusion of Adacel and Daptacel which are vaccines for the prevention of tetanus, pertusis, and diptheria. ISMP explained how administering the incorrect vaccine to infants can result in ineffective immunization leaving babies vulnerable to infection. The IMSP Medication Safety Alert from July 1 2010 reported that "Part of the problem is that the official names of the products are very similar although stated in different order on the labels. One of them, diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), is sold under the brand names DAPTACEL and TRIPEDIA (Sanofi Pasteur), and INFANRIX (GlaxoSmithKline). This formulation is for active immunization of pediatric patients 6 weeks through 6 years of age. The other vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap), is sold under the names BOOSTRIX (GlaxoSmithKline) and ADACEL (Sanofi Pasteur), and is meant to be used as booster shots for older children, adolescents, and adults."

   This is back to school season and vaccines are on the minds of parents, schools nurses, pediatric nurses and NPs. This is a perfect time to review our procedures for prescribing and administering childhood vaccines to ensure that the correct vaccine is ordered and administered each time. For more details on the recommended vaccine schedule, go to the Center for Disease Control and Prevention website at

Two Texas Nurses Vindicated...ANA Code for Nurses Prevails

Two nurses, Anne Mitchell and Vickilyn Galle, settled with Winkler County, Texas and will share $750,000 in restitution following being fired and criminally prosecuted for upholding their duty to protect the public by sending an anonymous note detailing incompetent physician practice. The settlement is symbolic of both the personal vindication of these nurses and acknowledgement that the ANA Code for Nurses has prevailed.

This closes the book on this horrific experience that Mitchell and Galle endured. What's more is that there is a clear precedent which may discourage retaliation of this sort from happening to other nurses who attempt to blow the whistle whenever they observe substandard care.  

PhD or DNP, what's right for you?

I'm very excited now that I am less than two weeks away from starting a doctor of nursing practice (DNP) program at George Washington University. In reflecting on my decisoin to pursue this practice-focused degree, I thought it would be helpful to share my journey through the decision-making process with you.

It is 15 years since I completed a master's degree and became certified as adult NP. When I started, I was sure I would continue my education to the doctoral level, but I was struggling, to decide on what degree I should pursue. I really didn't think I wanted to go into the academic role, nor did I think I would fully take advantage of the years of research training, not to mention the blood sweat and tears of a dissertation. Therefore, I never applied to any PhD programs. Until the recent emergence of DNP programs, I did not find any doctoral program that were going to help me in my practice and professional development roles. "Finally..they created a doctoral degree for me!" 

Boland, and others in the April 2010 issue of The Nurse Practitioner journal did an excellent job in providing the background on the history and process of developing DNP programs. In summary, the doctor of nursing practice is intended to provide advanced education to clinical leaders and advanced practice nurses. Don't worry if you are not a nurse practitioner. DNP's can be in varying roles including: nurse executive, clinical nurse specialist, or nurse informaticist. In contrast, the PhD prepares prepares nurses for a research-focused role. In addition to clincial roles, the authors expect that DNPs will also be an essential part of the nursing faculty in BSN, master's, and doctoral programs.

What some master's prepared NPs are concerned about is whether they should go back to school. With the expectation that new NP graduates have DNPs by 2015, it is a job security issue. I recall, when I was beginning my master's program, there were several NPs and nurse midwives who had certificates who were grand-fathered and allowed to practice. But they were challenged by the employment market or pressured by employers to return to school. Therefore, if you have a career of 10 years or more left, it might be the logical conclusion. Nursing may not have come to terms on entry into practice; however, it is clear that a doctoral degree is where we are going.

New grads challenged by job market

  Back in 1991, I received a job offer from each of the five hospitals to which I applied long before graduation. Just one year later, my sister also graduated from the same school of nursing and did not receive a single job offer until much later.  My sister was not alone. There were many nursing graduates who were shocked that they were having difficulty finding work in their chosen profession. Once again, new nurses around the U.S. are experiencing this phenomenon because of the recession. Yet many are wondering how could this happen to the profession that they were told was recession-proof? 

  KYW News 1060 AM in Philadelphia, PA reported on July 13, 2010 that none of the 54 graduates of the Abington Memorial Hospital's Dixon School of Nursing were hired as RNs. However, what I want to know is how wide a net did they cast in terms of practice setting and location?

   Back in 1992, my sister and several friends had to use creativity to land jobs. They applied for positions in home care, long term care, and other settings where new nurses are less likely to look. One friend took a less desirable position and then moved into travel nursing. One factor about our expectations of nursing is that most nurses think the hospital must be the place to start, but that is not where the job growth will be. With shorter lengths of stay and minimally invasive procedures, there are fewer patients requiring an overnight stay. Therefore, when the economy recovers, there will likely be more growth in ambulatory care, rehabilitation, skilled nursing, and home care than in acute and critical care.

   If you are unattached and still want to work in acute care, you might want to consider relocating. There are still areas, such as Texas, where there are many nursing jobs available. Some hospitals are very interested in new nurses' development and have extended orientations, internships and residency programs. Also, if you are facing obstacles such as organizations that prefer BSNs, go back to school! It might help to defer the loans once again while you build upon your education and earn a more marketable degree in acute care. Whatever you do, don't give up. You chose nursing for many good reasons and your career is worth using creativity and courage to step out of your comfort zone to explore other nursing practice settings and perhaps new regions of the country. 

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Views expressed on this blog are solely those of the authors or persons quoted. They do not necessarily reflect Lippincott's's views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.

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