Last month I blogged about budget cuts preventing nurses from attending conferences. However, that was before seeing signs improving conference enrollment.  Nursing2010 Symposium (Las Vegas, NV at the Hilton Las Vegas from April 6 to 9) is experiencing a significant surge in registration. Maybe the hotel room discounts are attracting larger numbers or employers are reconsidering the decision to cut education budgets. Whatever the reason, nurses are once again taking advantage of the opportunity to attend conferences. I'm glad to know that nurses can return to conferences in their specialties to renew their energy and continue to develop their skills. 

I just returned from the National Association of Clinical Nurse Specialist's Conference in Portland, Oregon.  I applaud the efforts of the NACNS for focusing on the importance of clinical nurse specialists and their role in bringing evidence-based practice to the bedside.  The speakers were not afraid to share their triumphs and their lessons learned with the attendees.  In this economic climate, sometimes the CNS role is the first one to be cut.  What came through loud and clear was the impact the CNS has in improving nursing practice and improving patient outcomes.  Speakers Beverly Malone, PhD, RN, FAAN, Linda Burnes Bolton, DrPH, RN, FAAN, and Melanie Duffy, MSN, RN, CCRN, CCNS spoke about clinical nurse specialists and their roles as consultants and leaders as we shape the healthcare system.

For all you CNS's out there, and for that matter, all nurses who didn't have a chance to attend this conference, I urge you to think twice next year.  As an NP attending this conference, I found it refreshing to hear real life experiences of nurses and advanced practice nurses pushing limits to benefit their patients.  This forward thinking is what healthcare should be all about.

When I hear the words “patient safety”, the first thing that comes to my mind is medication errors. Of course, there are plenty more factors to consider with regard to patient safety – infections, surgical errors, and pressure ulcers, just to name a few. In fact, a search for the keywords “patient safety” on nursingcenter.com yields a result of 3,309 articles!

This week is Patient Safety Awareness Week. The theme, "Let's Talk: Healthy Conversations for Safer Healthcare" got me thinking about how conversation can minimize or prevent medication errors. Here are some of my ideas – please add to this list! Let’s learn from each other and help one another to improve patient safety!

Questions to ask patients:
1. What medications do you take regularly? How do you take them? When do you take them? With meals or on an empty stomach? Why do you take these medications? Do you ever not take them?
2. Do you take any medications “as needed”? What medications? Why do you take them?
3. Do you take any over-the-counter medications? What are they? Why do you take them? When do you take them?
4. Do you take and herbs or vitamins? When? How? Why?
5. Do you have any questions about your medication regimen?
6. Is there anything I can do to help you manage your medication routine?

Before administering a medication, ask him if he’s had this drug before, if he knows why it’s been prescribed for him, if the dose is his usual dose, and if he has any questions.

For discussion with our colleagues:
1. Let’s review his medication list.
2. How often did you give his pain medication (or any p.r.n. medication)? What were the results?

Also, if any questions arise at any time – talk about it! Confer with your nurse colleagues, pharmacist, and the prescriber. The patient and his family members or other caregivers can also be valuable sources of information.

Lastly, be sure to take a look at the website of the Institute for Safe Medication Practices (ISMP). Here you’ll find several must-have tools for nurses, including a ISMP’s list of high-alert medications, ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations, Oral Dosage Forms that should not be crushed, and more. 

Thanks for “listening” to me. What do you want to talk about?

   In the summer of 2009, Dr. Murray Kopelow, Chief Executive of the Accreditation Council for Continuing Medical Education had to address the U.S. Senate Committee on Aging to defend his organization's policies and procedures regarding protection of continuing medical education from influences of commercial interests, particularly pharmaceutical companies. With so much attention given to this issue at the federal level, there are many learners and faculty who are unaware of the reasons for strict procedures and documentation required for continuing education. 

   As as nurse, you may be wondering what this has to do with you. For one thing, the ACCME Standards of Commercial Support were adopted by the American Nurses Credentialing Center's Commission on Accreditation to ensure that continuing nursing education activities are free from bias related to medical products. Also organizations that provide interprofessional education e.g. activities for both physicians and nurses,  must follow all of the ACCME standards in order to maintain accreditation. The issue at hand is that continuing education providers and accrediting bodies have to protect the independence and scientific integrity of continuing education. While these concerns were directed at physicians because of their prescriptive authority, there are some categories of nurses who are involved in making decisions on purchasing products, making recommendations, and prescribing treatments. Some examples are nurse executives, wound ostomy and continence nurses, and nurse practitioners.

   Lippincott Williams & Wilkins Continuing Education Group goes through great lengths to sanitize our CE activities by prohibiting employees of medical product industries from presenting or authoring continuing education activities. We obtain and publish financial disclosure of faculty, authors, and planners, and we conduct peer reviews of learning materials. Sometimes speakers are offended by being rejected on the grounds that they are employed by the medical product industry, and some feel that our disclosures are an invasion of privacy. However, LWW must comply with these policies and respond to those who feel they are not treated fairly by educating them about the standards. We will stand firm on these policies and will not compromise.

   When you read our journals or attend our conferences, you probably have noticed these disclosure statements, but what do they represent to you?  I'm curious to know if continuing education participants would know if the author or presenter has a conflict of interest or recognize bias in the learning materials. The following is a short list of violations of the standards of commercial support. You be the judge on whether your next CE is biased.

1. A product vendor gives you the CE materials.
2. There is only one product mentioned as treatment of a disorder without specific reference to a research study, practice standard, or mention that it is the only FDA approved treatment for the condition.
3. There are no statements of financial disclosure included in the learning materials.
4. Name brands of pharmaceuticals are listed instead of generic names.
     

I am at the HIMSS Conference in Atlanta, Georgia right now.  For those of you who don't know what HIMSS stands for, it is the Healthcare Information and  Management Systems Society.  This conference is one of the most cutting-edge conferences I have ever attended.  According to the HIMSS representative I spoke to, their attendance is 25,000 this year.  For those of you interested in how technology can improve practice, this conference is for you.  Nurses involved in informatics, clinical leaders, and nurse leaders presented how information management systems, electronic health care records, computerized prescriber order entry, and different types of monitoring systems can fit into workflow and give nurses the clinical support they need to deliver the highest quality, evidence-based care. What I was most impressed with was their Interoperability Showcase which used patient case studies to demonstrate how different systems can exchange information and seamlessly work together.  Many of the sessions stressed the importance of having nurses part of the decision making process when new technology is being evaluated.

It was refreshing to see healthcare institutions sending their nurse leaders, clinical leaders, and nurse informatics specialists to this conference to find ways to use technology to improve patient care.  If you're interested in how technology can improve nursing practice and improve patient outcomes, or your facility is looking at new technology, then I would highly recommend you attend this conference.

An article about end-of-life care received front page billing in The Philadelphia Inquirer this past Sunday. The article A look at the new field of palliative care describes the case of a previously active 74-year old woman who became seriously ill. When a meeting was set up with the palliative care team, family members expressed concerns about “death panels” and “pulling the plug.” They did not anticipate that the goals of this first family meeting were to talk about managing their loved one’s pain, answer questions, and provide information to help them make decisions about her care.

The article goes on to describe the role and goals of a palliative care team. With quotes from both the team members and the patient’s family members, this well-written article really serves to educate the public about making end-of-life decisions. It shows us that making decisions about care are not always a matter of live or die, but more an ongoing process about providing appropriate care.  The article also discusses the importance of living wills and having discussions with one’s family before critical illness occurs. 

As a former critical care nurse, I know how satisfying it was when we had what we called a “save” – when a patient near-death turned the corner and got better. I also know how satisfying it was for a patient to have a “good death.” At that time we didn’t have a palliative care team, but we did have plenty of family meetings.  Helping a patient and family have a positive experience and make the right decisions for their family member was an important part of my job. Is there a palliative care team where you work? How are you involved in discussions about end-of-life care?

   Lisa Bonsall's blog post from earlier this week inspired me to write about my orientation into acute care nursing. I hope that my story will provide some encouragement to novices in the profession.

   I was certain that I would be a nurse at a young age because my mother and six of her siblings were also nurses. I believe it was a family calling. While my family members often shared the benefits of the profession, I wish that someone had told me that I may feel anxious after the honeymoon of orientation passes. I recall asking myself, "What am I doing here?" and  "Why did I go into nursing?" I have even wondered how I could have an RN license and not be able to start I.V.s, not know how to read ECGs, and be afraid of doing some procedures. I would also stay awake at night replaying my assignments to be certain that I didn't forget to do anything. Fortunately, I had the experience of going through orientation with eleven other new graduates. This was a very supportive group because we shared our frustrations and successes. During our many discussions, I learned that others also had similar fears and a few experienced sleepless nights.

   I have to give a lot of credit to my employer because we received good mentorship, education, hands-on assistance from our nurse manager, staff development instructors, and preceptors. In addition, we had an informal support team among ourselves. After nearly twenty years, I'm still friends with a few of them. As we progressed through orientation and gradually built up our skill level to management of a full assignments and practicing independently, we all decided to stick it out the first year. By the second year in nursing, we found that it got better. We would exchange anecdotes about how scared, naive, and slow we were as "new nurses". I recall the situations when nurses would avoid code blues; spend 30 minutes administering medications...to one patient; and completing A.M. care at 2 o'clock in the afternoon. One of the best examples of adjusting to the "real world" was that we occasionally struggled to interpret the alphabet soup of medical acronyms, but in a few months we used the terminology quite fluently. By then we realized that all the knowledge that we acquired in school was just the beginning.

   My advice to new nurses is to keep in mind that your classess and clinical rotations are merely establishing a minimum level of competence and safety. You will eventually emerge as proficient nurses if you demonstrate a commitment to the nursing professions by truly caring for your patients, practicing the standards of care, and building upon your knowledge through inservices and continuing education. What's most important is that you find a supportive team either at work, professional organizations, or the internet that will help you through those difficult phases of developing your nursing career.

Recently the Archives of Internal Medicine published a study that demonstrated the economic and mortality impact of hospital-acquired infections, specifically sepsis and hospital-acquired pneumonia (HAP). These infections affect 1.7 million patients each year. Researchers studied 69 million discharge records of patients in 40 states in the U.S. from 1998 to 2008. Patients who acquired sepsis after surgery stayed an extra 11 days at a cost of $32,000 per patient and patients who acquired HAP after surgery stayed an extra 14 days at a cost of $46,000 per patient. Almost 20% of the patients who had sepsis post surgery died and almost 11% of the patients with HAP post surgery died. 

When you add up the number of patients and the cost per patient, these statistics are alarming.  So what are we doing wrong? We wash our hands, wear gloves and make sure we aren't exposing patients to contaminants from respiratory equipment along with all of the other interventions in our guidelines. Some days when I walk onto my unit, it seems like every other patient is in some form of isolation.  I have a confession to make - I hate wearing the protective equipment. I wear it but, the entire time I feel like I'm overheating and I can't breathe.  Anyone who's worn the "gear" for more than 15 minutes knows exactly what I'm talking about. There has got to be a better way! We need to find better ways of preventing infection so our patients don't end up contracting infections and worse, dying. What are you doing to prevent hospital-acquired infections?

I wanted to be a nurse for as long as I can remember. I started volunteering at a local hospital as soon as I was old enough and when college application time care around I was certain that nursing school was where I wanted to be. After a 4 year program and with my BSN under my belt, I began working as an RN in the medical intensive care unit of a university hospital.

After a few years, I decided to return to school and further my education. While I remember considering a critical care nurse practitioner program, I ultimately decided to study women’s health. It took me about 4 years to get my Master’s Degree – working weekends while attending classes and clinicals during the week. Caring for women (mostly healthy and many pregnant!) in an outpatient setting was a very different experience than caring for critically ill patients in the hospital.

The next stop in my career was as a clinical editor. I just happened to see an ad for a position in a local nursing publication, and although I wasn’t entirely sure what “clinical editor” even meant, I decided to apply for the job and find out. What a change I was in for! I was in an office setting and wearing real clothes. I spent my first 6 months in a film studio helping to produce nursing videos. If anyone had ever said that as a nurse, I could someday be writing scripts on ECGs and I.V. insertion, recruiting talent, and spending time in an edit suite, I never would have believed them!

Of course, there were bumps in this road…financing my education, reality shock, balancing family responsibilities, just to name a few. I’ll have to save those for another post! Well – that’s my story, what’s yours?

  As the recession is causing declining hospital admissions due to fewer elective surgeries, hospital revenues have decreased to a point where executives need to make budget cuts. Some are struggling to keep their doors open and have made the difficult decision to lay off employees and to close beds. If you are more fortunate, continuing education and staff training may be budget cuts that you will experience.

   Whether you are an employed or unemployed nurse, you are accountable for maintaining your own continued competence. If you having trouble with the out of pocket costs for conference registration or travel, you may want to consider some affordable options for continuing education including online articles, webinars, and virtual conferences.

   Most nurses are aware of continuing nursing education articles that are published in journals and magazines; however, many nurses prefer going to conferences because they are auditory or visual learners. Webinars and virtual conferences are good alternatives because they provide either recordings or live broadcasts of educational sessions. These presentions allow participants to hear the speaker and see the slides. In some cases there are videos of the speakers. Virtual conferences provide additional benefits of allowing interaction with other participants and experts. The next Lippincott's Online Expo will be held on March 3, 2010.  It is a great example of a virtual conference, and you can participate for free. I suggest you try it out. For more information click this link: http://www.nursingcenter.com//upload/static/950972/CCExpo_index.html.