Unfortunately, as healthcare providers, we must be prepared to intervene during emergencies that we would never imagine.  The bombings at the Boston Marathon have left me with a heavy heart, yet I am inspired by the stories of heroism that have resulted. My thoughts and prayers go out to all those impacted by this tragedy.

When a traumatic event occurs, I tend to immerse myself in information – not so much the media details surrounding the event, but in the human stories, especially about the “helpers” that I’ve been reading so much about over the last few days. We have several articles related to emergency preparedness that may give you some insight and confidence that you are the nurse that would be using your skills to care for the injured with expertise and compassion.

 Dealing with Disaster
Nursing Management, July 2007

 Disaster preparedness: Are you ready?
Men in Nursing, June 2007

 Emergency Department Response to Terrorism
Topics in Emergency Medicine, March 2005

Sending heartfelt wishes to those affected by the events of this week. Many thanks to the first responders for their swift action and to those who continue to care for the injured. 

As I write this, I’m on my return flight from Nursing2013 Symposium in Las Vegas, Nevada. With each conference I attend, a highlight for me is developing new relationships and strengthening older ones with nursing colleagues from around the country and world. As nurses, we have an incredible amount of knowledge and experiences to share and getting away from our workplaces and joining together to talk and learn is exhilarating! By the nature of my work, so many of my relationships are “virtual” ones – communication via email, text, and social media is more the norm for me than face-to-face conversations, so it thrills me to connect in person with nurses that I’ve only “met” online.

I have quite a bit to share from this conference, but let me start with quotes that inspired & educated me during this event!

“Many times, a patient’s history leads to a diagnosis; the physical examination supports that diagnosis.”
Anne Dabrow Woods, MSN, RN, CRNP
Physical Assessment Skills for Adult Patients

“The most accurate way to take a blood pressure is by using the bell of the stethoscope.”
Anne Dabrow Woods, MSN, RN, CRNP
Physical Assessment Skills for Adult Patients

“It doesn’t take a title to be a leader.”
Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC
Leading From Where You Are: Creating a Culture That Inspires

“Staff nurses are front-line leaders and often hold the key to resolving turnover drivers.”
Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC
Leading From Where You Are: Creating a Culture That Inspires

“The best leaders are personal leaders.”
Charles Denham, MD
A Lifesaver for Lifesavers: How to Survive the Rough Seas of Patient Safety and Value-Based Purchasing Demands

“Human factors that contribute to the complexities of patient handoffs include too few nurses, fatigue, rushed report, memory, nursing turnover, emotion, and information/sensory overload.”
JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS
Effective Handoff Communication: A Key to Patient Safety

“Every time lactate increases by 2, the risk of death [from sepsis] increases by 20%.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“The mortality for sepsis equals that of an acute MI in 1960.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“For every organ system that fails, mortality [from sepsis] increases by 22%.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“Falls are an adverse drug reaction.”
Anne Dabrow Woods, MSN, RN, CRNP
Recognizing and Treating Adverse Drug Reactions

“Angioedema from ACE inhibitors is not dose dependent.”
Anne Dabrow Woods, MSN, RN, CRNP
Recognizing and Treating Adverse Drug Reactions

“Start with what you know best, maybe a case study, and start writing.”
Denise Drummond Hayes, MSN, RN, CRNP
Bylines and Deadlines: Writing for Professional Publication

“Our work is based on science and evidence, but we are best known for our caring side.”
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Finding Your Nursing Voice

“The person with a strong nursing voice is an expert problem solver who is more proactive than reactive.”
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Finding Your Nursing Voice

As many of the sessions were happening concurrently, I know there is so much that I missed and I look forward to listening to several of the presentations when they are available online. For those of you who attended this conference, please share what you learned and what inspired you too! 

Also, you can view some photos from the conference on our Facebook page!

“Learning is one of life’s most essential activities.” — Annie Murphy Paul

Enrollment in all types of professional nursing programs increased from 2011 to 2012, according to new survey data from the American Association of Colleges of Nursing. These findings are based on data reported from 664 of the 856 nursing schools in the U.S. with baccalaureate and/or graduate programs.

The survey also saw a 3.5% increase in entry level Bachelor of Science in Nursing programs. The number of students enrolled in RN-to-BSN programs increased by 22.2% from 2011 to 2012, which, according to the AACN, signals a growing interest for baccalaureate-prepared nurses from both nurses and employers.

"AACN is pleased to see across-the-board increases in nursing school enrollments this year, given our commitment to encouraging all nurses to advance their education as a catalyst for improving patient care," said AACN President Jane Kirschling in a press release. "As the national voice for professional nursing education, AACN is committed to working with the education and health care community to create a highly qualified nursing workforce able to meet the expectations and challenges of contemporary nursing practice."

A few other interesting survey findings:

• Enrollment in master’s and doctoral degree programs increased “significantly.”
• Survey data indicated an 8.2% jump in enrollments for nursing schools with master’s programs (432 institutions reported data).
• Doctor of Nursing Practice programs saw a 19.6% enrollment increase (166 schools reported data).
• Baccalaureate nursing graduates are more than twice as likely to have jobs at the time of graduation than those entering the workforce in other fields.
• Graduates from master’s degree programs (MSNs) were most likely to have secured jobs at graduation (73%).

"Momentum is clearly building for advancing nursing education at all levels,” Kirschling said in a press release. “Given the calls for more baccalaureate- and graduate-prepared nurses, federal and private funding for nursing education should be targeted directly to the schools and programs that prepare students at these levels."

"Further, achieving the Institute of Medicine’s recommendations related to education will require strong academic-practice partnerships and a solid commitment among our practice colleagues to encourage and reward registered nurses committed to moving ahead with their education."

This post was written by Erica Moss, who is the community manager for the online masters in nursing programs at Georgetown University.

As I write this, I’m on my flight home from the Clinical Symposium on Advances in Skin & Wound Care 2012 which was held at Caesars Palace in Las Vegas, Nevada. Thank you to the conference chairpersons, Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN and Richard Salcido, MD. It was an informative, well-organized, and fun conference!

I was particularly drawn to the sessions which addressed skin care and pressure ulcer management at the end of life. Even in the keynote address, Legally Defensible Wound Care, presented by Caroline E. Fife, MD, CWS and Kevin W. Yankowsky, JD, this was a theme. An interactive case presentation was the format and we, the audience, got to share our opinions/votes by holding up a red or green card to questions such as “Was this pressure ulcer a result of negligence?”, “Would you take the case?”, and “Should the hospital be sued?”, among many others. During the presentation, an interesting observation was shared. When a cause of death is identified as ‘heart failure’ or ‘renal failure,’ a response of sympathy often results; however, a cause of death of ‘skin failure’ often leads to more negative responses, such as “that never should have happened” or even a search for somewhere or someone on which to place blame. 

The lesson that I learned, both from this keynote address and from a session titled Skin & Wound Care at Life’s End: Clinical Considerations, presented by Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN, is that the skin is an organ and at the end of life, it will fail just as the heart and kidneys and other organs do. Despite optimal care and evidence-based interventions for skin and wound care, skin failure and pressure ulcers often are unavoidable at the end of life. 

Here are some more highlights from the conference:

• Book signing! Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN and Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN were on hand to sign their book Wound Care Essentials, Third Edition. 

• Exhibit Hall! The exhibitors shared their products in dynamic ways, including wound care karaoke & dressing change races.

• Resources! Here’s a list of resources shared by the presenters – be sure to check them out!
  • Advances in Skin & Wound Care
  • The National Pressure Ulcer Advisory Panel 
  • SCALE Final Consensus Statement
  • Screening for the High Risk Diabetic Foot: A 60-Second Tool
  • Braden Scale for Predicting Pressure Sore Risk

• Quotes! Looking back on my notes, I just have to share these wise words that were shared.
  • “The keys to preventive legal care and effective communication are managing expectations beforehand and answering questions afterward.” Kevin W. Yankowsky, JD
  • “Edema is the real enemy.” Sandra Wainwright, MD (discussing chronic venous hypertension ulcers)
  • “Anytime cartilage is present, you have a stage IV pressure ulcer.” Diane K. Langemo, PhD, RN, FAAN
  • “If there is stable eschar on a heel, leave it alone!” Diane K. Langemo, PhD, RN, FAAN
  • “We all own pressure ulcers, not just nurses.” Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN
  • “The Braden scale accounts for most risk factors for pressure ulcers, but we also need to think about perfusion, age, comorbidities, and if the patient has a history of pressure ulcers.” Dr. Janet Cuddigan

You can see some pictures from the conference on our Facebook page. Next year, this conference will be held in Orlando, FL on October 24-27, 2013. It would be great to see you there!

Each week we select 3 articles to feature on our Recommended Reading list. We rotate the items on this list so there are always 10 articles available – and they are all free to read! It’s fun for me to choose these articles for several reasons – first, I get to do a lot of reading, but most of all, because I do think about what I’m “hearing” here on our blog, out there on our social media pages, and in real-life discussions with my nursing friends, when I select the articles to include each week. We also select 3 continuing education articles to include on our Recommended CE list, and remember, all of our CE articles can be read online free!

A hot topic lately, and one that is dear to me, is communication. Interactions with both patients and our colleagues are so important for outcomes and patient and staff satisfaction. We know that patients trust us, we know that we know our patients well, and we know that we are important members of the healthcare team. One of our current featured articles, Facilitating Goals-of-Care Discussions for Patients With Life-Limiting Disease—Communication Strategies for Nurses, has a great section with the heading Nurses' Special Relationship With Patients: 

“For those with a life-limiting illness, nurses are the "constant" in their journey through a frequently fragmented healthcare system. The nurse becomes familiar with the patient's medical history, health status changes, "behind the scenes" discussions of the team, family dynamics, and expressions of thoughts, concerns, and values. Thoughtful communication is essential throughout the trajectory. As the nurse builds a relationship based on trust and consistency, he/she may be viewed as "more approachable" than others in the healthcare team and, as a consequence, be part of informal discussions with patients and families. Therefore, the nurse is well positioned to facilitate discussions focused on goals of care and treatment choices in the setting of a progressive debilitating illness.”

We do have special relationships with our patients. They are relationships that allow us into patients' lives during critical times, they are relationships that allow us to advocate for our patients, and they are relationships that allow us to provide the best possible nursing care to our patients. I hope you enjoy this article and the others on our Recommended Reading lists! 

Happy Reading 

Reference

Peereboom, K., & Coyle, N. (2012). Facilitating Goals-of-Care Discussions for Patients With Life-Limiting Disease—Communication Strategies for Nurses. Journal of Hospice and Palliative Nursing, 14(4). 

March 19th is Certified Nurses Day. A large number of nursing certification programs exist (I count 92!). This number alone tells me that this is something important that all nurses should consider. I was proud to use the credential CCRN during my days working in a medical ICU. The exam was tough and maintaining the necessary continuing education requirements was challenging, but my own sense of pride and the respect I received from patients, my colleagues, and my employer made it worth it.   

So what is specialty certification exactly? The American Nurses Credentialing Center (ANCC) defines certification as “a process by which a nongovernmental agency validates, based upon predetermined standards, an individual nurse’s qualifications for practice in a defined functional or clinical area of nursing." Many other definitions exist, depending on where you look or from which organization you are seeking certification. In general, being certified demonstrates that you have advanced knowledge and competence in a given specialty. 

Barriers to certification have been identified as time, cost of preparation and examinations, test anxiety, lack of support from supervisors, and continuing education requirements (Valente, 2010). Overcoming these barriers, both on personal and professional levels, is important because of the value and benefits associated with specialty certification. Kaplow (2011) categorized this value associated with certification into three realms: value to patients, value to employer, and value to self. 

With regard to value to patients, certified nurses demonstrate greater confidence in decision making, increased patient safety (including less falls and decreased pressure ulcers), and higher patient satisfaction. Also, certified nurses have been shown to be more likely to provide care based on evidence-based guidelines (Kaplow, 2011). 

Specialty certification sends a message of commitment to a current or potential employer. Nurses who are certified demonstrate a personal responsibility to their education, and in turn, patient care and outcomes. Some studies have even shown an association between certification and turnover, vacancy, staffing, nurse retention, job satisfaction, higher nurse performance, and patient satisfaction (Watts, 2010). 

Finally, the personal benefits that come with certification are numerous. The sense of accomplishment, feeling of empowerment, and validation of knowledge had a great impact on my confidence. Other benefits can include an impact on salary and career advancement, as well as improved marketability (Kaplow, 2011).

If you’re interested in learning more about certification, take a moment to read Your guide to certification. This handy table of specialty certification boards and contact information along with the associated credential and requirements is a good place to start your journey to certification. Good luck!

References: 

American Nurses Credentialing Center. (2012). What is Nurse Certification. Retrieved March 15, 2012, from ANCC website: http://www.aacn.org/wd/certifications/content/consumer-whatiscert.pcms?menu=certification  

Kaplow, R. (2011). The Value of Certification. AACN Advanced Critical Care, 22(1). 

Valente, S.M. (2010). Improving Professional Practice Through Certification. Journal for Nurses in Staff Development, 26 (5). 

Watts, M.D. (2010). Certification and Clinical Ladder as the Impetus for Professional Development. Critical Care Nursing Quarterly , 33(1).

It amazes me the amount of content that is available in our nursing journals on the subject of technology and social media. From simulation mannequins and electronic health records (EHRs) to handheld devices and mobile apps to blogs and twitter, the way we learn and communicate is forever changed. For some of us, these changes are overwhelming – there is so much to learn. For others, maintaining confidentiality and professionalism is most concerning. Some of us welcome new technology; even thrive on it, believing that easy access to reliable information will increase productivity and lead to better patient outcomes.  And some of us, myself included, are experiencing all of those feelings – it is overwhelming, we do have a big responsibility to protect our patients and act professionally, and the benefits are numerous. 

So what is a nurse to do? Learn about what's out there! When a new technology is presented, take advantage of the inservices or staff educators on the unit who are there to teach you. If you use a smartphone, search for apps that will help you in your practice and try them out. If you blog or use social media, make sure you're familiar with the American Nurses Association's Principles for Social Networking and the Nurse: Guidance for the Registered Nurse. Also, grow your online network with other nurses, whether on Facebook, twitter, LinkedIn, WordPress, or another platform. I have learned so much about healthcare, nursing, and social media from my fellow nurses all around the world.

I am very excited to introduce our new microsite, the Skin Care Network! This site was developed by the clinical and editorial team of Lippincott's NursingCenter.com in collaboration with the Dermatology Nurses' Association and the American Society of Plastic Surgical Nurses. Our goal is to share with you all the dermatology and skin care content from Lippincott's vast collection of nursing journals and keep you up-to-date with the latest research, news, and information your patients may be reading or hearing about in the media.

Here are some highlights of the Skin Care Network that I don't want you to miss:

• In News, you'll discover the latest research findings and evidence-based practice recommendations, as well as links to related mainstream media items that your patients may ask about.
• In Tools & Resources, we've organized content by clinical topic, created a page with all our dermatology and skin care continuing education opportunities, and compiled patient education tools for you to share with your patients.
• In Multimedia, find podcasts of presentations from Lippincott's nursing conferences. More resources will be coming soon to this section!
• Also learn more about the Dermatology Nurses' Association and the American Society of Plastic Surgical Nurses on our Society Partners page and the Journal of the Dermatology Nurses Association (JDNA), Plastic Surgical Nursing (PSN), and The Nurse Practitioner by visiting the Journals page.

Take some time to explore the site ~ I hope you find the Skin Care Network to be a valuable resource to meet your professionals needs!

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 www.ncnpconference.com.

National Nurses Week starts tomorrow and continues until May 12th, the birthday of Florence Nightingale. This year we are celebrating all that you do by opening up some of our journals for you to read free and offering coupon codes for free articles and continuing education credits. I hope that you'll check back to our National Nurses Week page each day to access our content and use your coupon codes. Here's what we have in store:

Friday, May 6th ~ Read the current issue of Nursing2011 free!
Saturday, May 7th ~ Take any CE test up to a $21.95 value for free!
Sunday, May 8th ~ Get your coupon code to purchase any non-CE article (up to $9.99)!
Monday, May 9th ~ Read the current issue of Nursing Made Incredibly Easy! free!
Tuesday, May 10th ~ Get your coupon code to purchase any non-CE article (up to $9.99)!
Wednesday, May 11th ~ Read the current issue of AJN, American Journal of Nursing free!
Thursday, May 12th ~ Take any CE test up to a $27.95 value for free!

I hope that you'll take advantage of these exciting offers. You must be a NursingCenter member and logged in to access the free journals, take the CE tests, and use the coupon codes. Not yet a member? Click "register" at the top right of this page. Membership is free and has many benefits! Have a great week everyone!