NursingCenter’s In the Round

A dialog by nurses, for nurses

Directing nurses back to patient care

clock July 25, 2014 03:09 by author Cara Gavin, Digital Editor

What made you decide to become a nurse? Was it the thrill of directly impacting a patient’s life? Or, was it because you really love tracking down medications and filling out paperwork? I’m going to guess it wasn’t the latter, and the people at the Institute for Healthcare Improvement agree.

In a recent article this week in the Wall Street Journal, Laura Landro explored the institute’s new partnership with the Robert Wood Johnson Foundation to develop Transforming Care at the Bedside, a program “to help hospitals increase to 70% the amount of time nurses spend in direct patient care while improving the work environment for nurses.”

This initiative attempts to answer the increasing need to streamline the work nurses are doing, while improving nurses’ delegation practices, “shifting more routine tasks to certified nurse assistants and other less high skilled staffers.” In an interview between Landro and Patricia Rutherford, a nurse and vice president at the institute, Rutherford explained, “We shouldn’t be using expensive professional nursing time doing unnecessary and inefficient things when that time could be reinvested in direct patient care.”

The institute isn’t the first to notice the lack of time nurses are spending with patients. In 2008, the American Journal of Nursing published a series of studies that found direct patient care “accounts for less than 50% of working hours.”

NursingCenter’s own clinical editor, Lisa Bonsall, MSN, RN, CRNP, remembers her frustrations at the bedside. “Patient care is what nursing is all about. I can remember clearly being pulled away from the bedside searching for supplies or medications, or even fixing or calibrating equipment. One time, I was caring for a patient admitted with DKA (diabetic ketoacidosis), who needed finger stick blood glucose checks every hour for titration of his insulin drip. We had two machines on our unit and one was broken. At about my third hour of the shift, the machine that was working needed to be calibrated…[which] took quite some time. This event not only took me away from the bedside, but put him at risk as I was unable to check his blood sugar for about two hours. Fortunately, no untoward events occurred, but I remember thinking at the time, ‘There’s got to be a better way!’”

Studies show the more time a nurse is at the bedside, the better the outcomes. Bonsall explains, “The relationship between patient safety and nursing care is documented in the research, including direct impacts on healthcare-associated infection, readmission rates, and mortality. We are the ones noticing the subtle changes in a patient’s status. If we are repeatedly pulled away from the bedside, those changes can go unnoticed.”

In a 2010 internal audit conducted by Presbyterian Medical Center, it was discovered that “nurses were involved in direct patient care at the bedside for only 2.5 hours every 12-hour shift.” Nurses were spending too much time searching for missing test results and supplies and not enough time monitoring their patients. After implementing the Transforming Care at the Bedside program, the center was hitting “6.5 hours per shift at the end of 2013 with a goal to hit 8.5 hours by the end of 2015.”

Time will tell if the center is able to hit their goal. But, as more hospitals begin to take a robust approach at managing their nurses’ time and delegation strategies, the hope is to return nurses back to why they began their work in the first place – to care for the patients.

Nurses who led the way: Clara Barton

clock May 6, 2014 03:04 by author Cara Gavin, Digital Editor

To kick off Nurses Week, we are starting with Clara Barton, “one of the most honored women in American history.” Known as the “Angel of the Battlefield,” Barton served as a nurse during the Civil War at the battles of Chantilly, Fairfax Station, Fredericksburg, Harpers Ferry, Antietam, South Mountain, Petersburg , Charleston, and Cold Harbor, often at the front line. Not only did she nurse the wounded, she comforted, cooked, read, wrote letters, and prayed for them. Barton also helped establish a national cemetery and identify the graves of 13,000 men at the Andersonville prison in Georgia.

In 1870, in the outbreak of the Franco-Prussian War, Barton was introduced to the International Red Cross. Her time with the organization during the war led her to work with Red Cross officials in Switzerland in an effort to establish a charter in America in 1900. Barton left the organization in 1904 to start the National First Aid Association of America, which emphasized basic first aid instruction, emergency preparedness, and the development of first aid kits. She served as its honorary president for five years.

After publishing several books about founding the American Red Cross, Barton died in 1912 at her home in Glen Echo, Maryland. Her service to the profession of nursing is remembered today through the continued work of the organization. 

Healthcare Policy – An interview with Dr. Carole Eldridge

clock August 30, 2012 16:36 by author Lisa Bonsall, MSN, RN, CRNP

Last week I had the privilege of speaking with Carole Eldridge, RN, DNP, CNE, NEA-BC, Director of Graduate Programs at Chamberlain College of Nursing. This fall, Chamberlain is launching a new Masters of Science in Nursing Healthcare Policy Track and I was particularly interested in learning more about Dr. Eldridge, as I’ve been following her on twitter for years (@Nerdnurse), and about this new MSN track.

I was more than impressed when I asked Dr. Eldridge to share her nursing background with me. In a nutshell, after about 15 years in acute care (including critical care, post-surgical care, hemodialysis, and transplant), Dr. Eldridge and her husband moved to Africa for about a year to run a health clinic. When she returned to the U.S., she started a Home Health and Hospice Agency which grew into about 50 agencies in 4 states! After selling this business, Dr. Eldridge became interested in education and saw a need for training nurse aides. She started her own publishing company which developed training packets. After selling this company, Dr. Eldridge returned to school herself for her MSN in Leadership and Healthcare Business, and later her DNP. She taught for about 3 years, and since then has held various titles including Director of a Master’s program, Dean, and Campus President. Wow!

In her current role, Dr. Eldridge oversees all of the graduate programs at Chamberlain College of Nursing. As previously stated, this fall, a new Healthcare Policy track is available for MSN students. The development of this track is timely in the wake of the report from the Institute of Medicine – The Future of Nursing: Leading Change, Advancing Health – and as we approach a Presidential election here in the United States. An MSN in Healthcare Policy will prepare nurses to be active in bill and policy writing, foundations, education and training, academia and research, disease investigations, health services, and other positions where one can “Impart the voice of nursing to direct the path of healthcare policies that benefit patients, the community, our nation and the world.”

This particular program involves 6 core courses (foundational concepts, theory, informatics, leadership, research, and basic healthcare policy) and 6 specialty courses (healthcare systems, economics, global health, nurse leadership and healthcare policy, healthcare policy practicum, and a capstone project).  When asked for more details about the capstone project, Dr. Eldridge gave me several examples that students from similar programs have done, such as global health projects, legislative proposals, and oral testimony collaboration. The coursework is flexible, can be completed in 2 years, and is completely online.

My favorite part of our conversation had to be discussing the upcoming election. Dr. Eldridge reminds us that as nurses, we have a responsibility to be politically engaged in order to best advocate for our patients. In particular, we need to be alert to the following:

  • Economics – how will healthcare be funded? 
  • Affordable Care Act
  • The aging population, including funding their care & medical devices
  • “Equitable access”
  • Epidemiology
  • Vaccines
  • Global Healthcare 

Remember, Florence Nightingale was our first political activist. As nurses, let’s remain educated about the issues and share our voice. We are more than 3 million strong – it’s important that we are heard!


The Future of Nursing: Leading Change, Advancing Health 

Keeping Health Care Reform Healthy, Patients Informed (American Nurses Association) 

ANA’s Policy and Advocacy page 

ANA's Nurses Strategic Action Team (N-STAT)

The Future Has Begun

clock July 29, 2012 03:38 by author Lisa Bonsall, MSN, RN, CRNP

It’s been almost 2 years since the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) released Future of Nursing: Leading Change, Advancing Health and this landmark report is still being discussed and written about. This thrills me! People are hearing and learning about nursing. Other disciplines in healthcare have responded to the report. Nurses are making changes based on the report and sharing their plans and outcomes. Good things are happening!

We have a collection of articles and editorials all about the Future of Nursing Report and in the past few months several good reads have been published. Take a look:

Learn how the nursing staff at one New Jersey health system embraced the report and made changes to improve patient outcomes and satisfaction by reading Responding to Health Care Reform by Addressing the Institute of Medicine Report on the Future of Nursing (Nursing Administration Quarterly, September 2012).

In Nursing's future: What's the message? (Nursing Management, July 2012), the authors share the response of the Robert Wood Johnson University Hospital Division of Nursing, including “…creating opportunities within our hospital and our professional networks for honest conversation about the report and its implications, and then using strategic planning to design our action strategies.”

Read Wellness Promotion and the Institute of Medicine's Future of Nursing Report: Are Nurses Ready? (Holistic Nursing Practice, June 2012) and discover how the role of disease prevention and health promotion, or wellness, is a critical component for nurses in implementing the changes recommended in the IOM report. 

In the NACNS Position Paper: The National Association of Clinical Nurse Specialists Response to the Institute of Medicine’s The Future of Nursing Report (Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, August 2012), the NACNS addresses several of the IOM recommendations with strategies and recommendations specific to clinical nurse specialists. 

The American Association of Neuroscience Nurses has also developed specific recommendations based on the report which were published in the Journal of Neuroscience Nursing (June 2012) – Integrating the Institute of Medicine Future of Nursing Report Into the American Association of Neuroscience Nurses Strategic Plan. 

There are over 35 editorials and articles that have been published in our journals since the release of the IOM report. All can be read online FREE --- be sure to check out Focus On: The Future of Nursing.  

What changes have you implemented in your practice or career plans? Have there been initiatives at your workplace since the release of the IOM report?

Nurse to lead CMS

clock November 30, 2011 18:16 by author Lisa Bonsall, MSN, RN, CRNP

On December 2nd, Dr. Donald M. Berwick will step down as administrator for the Centers for Medicare and Medicaid Services (CMS). Replacing Dr. Berwick will be Marilyn Tavenner, who served as Berwick’s deputy principal administrator since April 2010. The first article I read about this development was last week on Toward the end of the article, I read “Tavenner is a former Virginia health secretary and hospital chief executive. A nurse by training, she has been with CMS since February 2010, first as acting administrator and currently as principal deputy administrator." A nurse to head CMS? Yes!

Since last week, I’ve read more about the sequence of events leading to Dr. Berwick’s resignation as well as more about Marilyn Tavenner’s background and experience. In this blog post from the Washington Post, Tavenner’s path from ICU nurse to this nomination is chronicled in detail with comments from former colleagues describing her as respectful, quick-thinking, decisive, and hard-working. In an article on HealthLeaders Media, more former colleagues share their thoughts and feelings of Tavenner’s pragmatism, leadership experience, and decision-making skills. 

The American Nurses Association (ANA) has released a statement commending the White House for its decision to nominate Marilyn Tavenner, MHA, BSN, RN, to head CMS.  I’d like to join in on the commendation. Seeing a nurse take on such a prominent leadership role makes me feel proud – how about you?

Thank you from one nurse to another

Another Nurses Week has made its way to us. It's amazing how fast time goes by as we get older. Nurses Week this year is a little different that previous years for me. My mom was diagnosed with small cell lung cancer  2 months ago. She tried chemo but unfortunately it didn't work,  so 2 weeks ago we placed her on hospice and I moved in with her so she could stay at home and die surrounded by her family and friends.

What has struck me about this entire experience is the importance of nursing throughout the entire process. When my mom was a patient in the hospital where I work on the weekends, I was in awe by the way nurses of all ages and experience delivered care. I always thought our hospital delivered great care, but until I saw it in action with one of my own family members, I have a renewed appreciation for the nurses at the facility.

My mom has quite a few friends who are retired nurses. They  have stepped up to the plate to care for her, and to give me and the rest of our family a break when we need it. The care they deliver is exceptional. They know the importance of "just being" with her,  when to just hold her hand, when to medicate her, and when to talk her through episodes of respiratory distress. Obviously the art of nursing doesn't stop when you retire.

The hospice nurses are some of the most gifted nurses I have ever seen. They have so much to teach the rest of us on managing symptoms of end of life and have no problem with getting what they need for their patients from physicians.

My mom is pain-free and comfortable right now due to all of your efforts. I know she will experience a "good death" based on her terms.

So for all you nurses out there, I would like to say thank you for your dedication to the profession and your ability to make a difference in a person's life. You have certainly made a difference in mine and my mom's.  Happy Nurses's Week!



The Future of Nursing Roundtable

clock March 28, 2011 03:30 by author Lisa Bonsall, MSN, RN, CRNP

On March 22, 2011, the Editors-in-Chief of the top LWW nursing journals got together for a roundtable discussion about the Institute of Medicine and the Robert Wood Johnson Foundation Report on the Future of Nursing. For those of you who listened in, I hope you enjoyed the conversation about how these nurse leaders interpret and understand the key messages and recommendations from the report. For me, the task at hand is now clearer. It is now up to us nurses to bring our profession and our own careers to the level we deserve. I’d like to share some of what I took away from this discussion.

Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC, Chief Nurse of Wolters Kluwer Health/ Lippincott Williams & Wilkins and Ovid Technologies, moderated the discussion and reminded me that there are 3.1 million nurses (which is the largest group of health care providers) in the United States and we “need a seat at the table” to “make changes happen.” Anne then went on to explain in detail the key messages and recommendations in the report.

Maureen "Shawn" Kennedy, MA, RN, Editor-in-Chief of the American Journal of Nursing, spoke next about what the Report means to “nurses at the point of care” - which includes staff nurses, nurses practicing in home care, nursing homes, and other areas where direct patient care is occurring. She speaks about professional practice and having a voice when it comes to priorities of care.  Later in the webcast, Shawn talks about the education of nurses being for the public good and she includes good points about responsibility for funding.

Rich Hader, PhD, NE-BC, RN, CHE, CPHQ, FAAN, Editor-in-Chief of Nursing Management and Senior Vice-President and Chief Nursing Office of Meridian Health System gave his take on the report and what it means for managers and other nurse leaders. Some of his great words included “forge partnerships with academic colleagues” and “produce lifelong learning.” He commented on the timeliness of the report and brought up the idea of economic incentive for nurses going back to school. Rich also lists some key ideas for leaders and managers.

Jamesetta Newland, PhD, FNP-BC, FAANP, DPNAP, Editor-in-Chief of The Nurse Practitioner and Clinical Associate Professor at New York University shared her views on the report with regards to advanced practice nurses (APNs). She commented about APNs being trained holistically and the push to move the healthcare system to one of wellness, instead of illness.

Janet Fulton, PhD, RN, Editor-in-Chief of Clinical Nurse Specialist and Associate Professor at Indiana University spoke about clinical nurse specialists in acute care. Her comments about all APNs collaborating with each other to provide inpatient and outpatient care were eye-opening, especially her quote “nursing collaborating with itself.” Another good one…for all APNs to “push the boundaries to meet the public’s need.”

Suzanne Smith, EdD, RN, FAAN, Editor-in-Chief of the Journal of Nursing Administration and Nurse Educator spoke about the meaning of the report for educators and students. She suggested that we refer to guiding reports from organizations such as the NLN and the AACN. Specifically, Suzanne refers to the AACN’s “call for imagination” and the need for “dramatic change in Master’s education.” This discussion proceeds to the issue of cost.

The entire webcast has been archived and will be available until March 22, 2012. Take some time to listen in to the words of these nursing leaders!

Getting ready for the future of nursing

clock January 13, 2011 18:15 by author Lisa Bonsall, MSN, RN, CRNP

Have you made any adjustments in your career goals or education plans based on the RWJF and IOM Report , The Future of Nursing: Leading Change, Advancing Health, released last October?

I have been away from clinical nursing since 2001. I can’t believe that it has been 10 years. I’ve always believed that someday I would go “back to the bedside” and I really do miss taking care of patients. It’s been a little more noticeable to me lately just how much I miss the clinical side of nursing. I’m not sure if it’s because the fact that it’s been 10 years overwhelms me or because I am excited about the direction in which our profession is headed. Perhaps it’s a little of both.

The question that really gets to me is where do I want to be? Critical care was my home for most of my clinical career.  I loved the thrill of caring for acutely ill patients and their families. Titrating vasoactive drugs, assisting with invasive procedures, using the latest technologies - all so cool! Admissions from the ER, “road trips” to diagnostic tests, end-of-life discussions, and the list goes on…

However, my “other list” is quite impressive to me also. As a women’s health NP, it was so fulfilling to be in the community and make a difference educating women about preventive care. Also, contraceptive counseling, prenatal care and teaching, helping someone find some relief from her symptoms of menopause, and so on…. Primary care practitioners have so much to offer and the need is so great.

The very first key message from the IOM report states “Nurses should practice to the full extent of their education and training.” Does this mean that it is my duty to practice as an NP because I have the degree and license? Would I be disregarding this message by returning to staff nursing in the ICU? I sure hope not. Then again, I could always pursue another degree…critical care NP might be the answer. Now there’s something for me to think about!

Perhaps as we prepare for the future of our profession, we should all take this time to look at our individual goals as well. What is your future in nursing?

Drug shortages...putting people at risk

clock October 27, 2010 05:33 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

I was made aware of a serious problem with drug availability to consumers and health care institutions recently. My youngest daughter is allergic to milk and cheese which requires her to have an epipen available at all times and have an epipen available at school.  When I recently went to refill her perscription from the pharmacy, I was only permitted to get 1 pack of epipens. Each pack has 2 pens in it so we need two, one to carry and one to leave at school.  I was told by the pharmacist that there was a shortage of epinephrine emergency syringes so we were only able to get one at a time.

Today I was reading the health section of and found an article that really peaked my interest, "When vital drugs run out, patients pay the price". The article discussed the drug shortages that exist today and how these shortages are putting the health and welfare of the U.S. population at risk. According to the Food and Drug Administration, the majority of drug shortages are caused by manufacturing issues, safety concerns, and production delays. The article stated that there are 150 drugs currently on the shortage list by the American Society of Health-System Pharmacists. I went to their site,, and found that in fact there are 150 drugs on the list, and the issue is so prevalent that there is an article titled, "ASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems," posted on their site. 

Over the last year, I've noticed a shortages of drugs that are essential to my practice and now the shortage has affected me at home.  Unfortunately, the FDA does not have the authority to ensure that pharmaceutical companies produce adequate supplies of drugs. There has to be a change in the pharmaceutical drug supply chain to fix the drug shortage issue.    

The First Lady Talks to Nurses

clock October 4, 2010 17:07 by author Lisa Bonsall, MSN, RN, CRNP

Last week, more than 5,000 nurses participated in a conference call with First Lady Michelle Obama and Mary Wakefield, PhD, RN, FAAN, the administrator of the Health Resources and Services Administration. The call focused on the role of nurses in educating the public about the Affordable Care Act. After sharing the personal experience of her daughter’s meningitis and the impact of the nurses who provided her care, Mrs. Obama went on to describe details of the Affordable Care Act:

“…insurance companies can no longer discriminate against kids because they have a preexisting condition.  Patients can no longer be dropped by their insurance companies because they get sick.  People suffering from a serious illness like breast cancer can focus on their treatment because they no longer have to worry about hitting their lifetime limit on coverage.  And college kids and young adults just starting out on their own can now get coverage through their parents’ plan.”

“And some of the biggest new changes and benefits are the reforms that deal with preventative care…Things like mammograms, cervical screenings, colonoscopies, childhood immunizations, prenatal and new baby care, high blood pressure treatment, all of these are included in new insurance plans with no deductable, no copay, no coinsurance, nothing.”

Mrs. Obama is calling upon nurses to “spread the word” of these changes and educate our patients and the public. You can read the transcript of the teleconference as well as the American Nurses Association's highlights of the newly enacted provisions of the Affordable Care Act for more information.

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