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Nurses On the Move: Paula Roe

clock September 19, 2014 04:55 by author Cara Gavin, Digital Editor

As fall gets underway and nurses head back to school, it’s important to look at how academic and professional education can shape a nurse in different ways.

September’s Nurse On the Move, Paula Roe BSN, MBA/HCM, FACHE, has a unique experience with nursing. She currently serves Simpler Consulting as a senior advisor - where she helps clients achieve sustainable breakthrough improvements in care quality, productivity, and cost reduction by applying process improvement techniques to daily operations – and operational excellence practice leader, responsible for Simpler’s internal process improvement.

She previously spent six years as the vice president of operations for St. Elizabeth Healthcare, a regional hospital system located in northern Kentucky. Before that, Roe spent 13 years with the Toyota Motor Engineering and Manufacturing American, where she learned the tools of the Lean management trade.Roe’s experiences have shaped her perspective as a nurse and operations leader. Through our interview, I discovered how these different settings impacted her thoughts on nursing and patient care. 

Q: Why did you choose to receive your BSN and start your nursing career?
A: A career in nursing was not my original plan. When I enrolled at Ohio State University, I was on course for a degree in engineering. By my sophomore year…I was forced to take the pre-medical school-level anatomy class to fulfill an undergraduate requirement. As soon as the class was underway, I knew I was hooked. I soon met with my advisor and found that nursing was the best match for me.

Q: You went on to manage a CTU/SICU department of a hospital. How did this shape your decision to earn your MBA in health care management?
A: Early in my nursing career, I was involved in staff nurse counsel and had the opportunity to present to hospital administration on a regular basis. I really enjoyed this interaction and pursued hospital administration as department manager of the CTU/SICU. When I went to work for Toyota as a safety, health and environmental administrator, I never lost that dream of working in healthcare administration. Lucky for me, Toyota offered MBA programs on campus, and I was able to earn my master’s degree specifically for healthcare management. 

Q: Please describe what Lean management means to you and why you believe it’s an important tool for nurses to use?
A: Lean is all about delivering value to the customer. From a nursing perspective, the customer is the patient and the patient’s family. When you think about nursing and the tenants of Lean – striving for zero defects, the relentless pursuit of value, and the delivery of service in the least wasteful way – the two are necessarily harmonious…The delivery of care is spending time with the patient and delivering care value. We need to relentlessly pursue the elimination of wasteful steps, challenging our day-to-day activities to spend more time with patients and deliver the best care in the least wasteful way. 

Q: In your role at Toyota, how did Lean management practices and role process improvement techniques shape your perspective as a nurse and operations leader?
A: When you start a career with Toyota, you start a lifelong journey of hands-on learning. The training advances as you practice and apply these Lean skills. Lean is also a team-based model; it allows teams to bring their ideas and thoughts together so the whole group is focused on what matters most. But with Lean, the team makes decisions together on execution and output as well. And action is immediate, meaning you are able to achieve breakthrough results within a very short time. I very quickly saw how Lean’s team-based approach could be applied to the nursing world.

Q: How do you define a nurse leader?
A: I came across not long ago a quote from renowned leadership expert Dr. Stephen Covey: “Leaders do what’s right and managers do the right thing.” To me, a nursing leader is one who does what’s right for his or her staff, the patient, the organization, and the population served.. 

Q: What do you see for the future of nursing?
A: I believe that nursing will continue to be developed from within the profession and innovative ways to deliver care and patient treatment models will emerge. But, nurses will have to also look outside of nursing for solution approaches. I foresee Lean and other management techniques more widely accessed. I believe the pace of change in the industry is going to require new and breakthrough ways of looking at things, and traditional improvement approaches are going to be challenged. As Einstein said, “Insanity is doing the same thing over and over again and expecting different results.” In nursing, we’ll need to think outside of the traditional nursing box to eliminate waste and to ultimately spend more by the patient bedside.

Do you know a great candidate to be featured for Nurses On the Move? We want to know about the nurses who are advancing the profession and inspiring others to do the same. We will feature a new nurse every month. Email your submissions to ClinicalEditor@NursingCenter.com.



What are all those letters and how can I get them?

clock September 14, 2014 09:07 by author Lisa Bonsall, MSN, RN, CRNP

BSN, RN-C, APHN-BC, PPCNP-BC, DNP… There are so many opportunities for furthering your nursing education. Whether it’s achieving a new academic degree or getting certified in your specialty, we’ve got resources to share with you! Take some time to explore these FREE resources on Lippincott’s NursingCenter!

Focus On: Achieving Your BSN
Learn why now is the time to return to school, and gain advice on overcoming barriers that are in your way. 

Focus On: Achieving Your Advanced Nursing Degree
With options such as online programs and employer-based incentives, achieving an advanced degree in nursing is within reach. 

Nursing Certification Boards By Specialty
Certification in a nursing specialty demonstrates a commitment to advancing one’s knowledge and skillset. 

Good luck to you in your future educational endeavors!



Enterovirus-D68

clock September 8, 2014 08:34 by author Lisa Bonsall, MSN, RN, CRNP

In the Midwest,  an enterovirus, known as EV-D68, is causing concern. While not a new virus, EV-D68 has recently caused severe respiratory symptoms in affected children in Missouri, and several other states have contacted the CDC for assistance with a possible regional outbreak as well. These are Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma, and Kentucky. Symptoms of a common cold are typical at the onset of EV-D68, however the development of fever, rash, or dyspnea – particularly in children with asthma – is occurring and necessitating hospitalization, and in some instances, ICU admission. 

While details continue to be released, please remember your role in patient education and infection control. Tell parents and caregivers about these symptoms of EV-D68 and advise them to seek care for their child if fever, rash, or breathing difficulties develop. Also, share these basics of infection control:

  • avoiding close contact with people who have respiratory symptoms, such as coughing or sneezing
  • staying home when sick
  • washing hands often with soap and water for 15 to 20 seconds or using alcohol-based hand cleansers 
  • not touching eyes, nose, or mouth 
  • keeping surfaces and objects (especially tables, counters, doorknobs, and toys) that can be exposed to a virus clean
  • practicing other good health habits, including getting plenty of sleep, staying active, drinking plenty of fluids, and eating healthy foods

As more details are released, we’ll be sure to keep you informed! 

Update 9/16/14 - More states have reported EV-D68 infections. Please visit our page on this topic for more information and resources!

Reference:

Bonsall, L. (2009). Be prepared for H1N1 flu. Nursing Made Incredibly Easy!, 7(6).




Are you ready to go back to school?

clock August 25, 2014 03:55 by author Cara Gavin, Digital Editor

Deciding whether to go back to school for your advanced degree can be a difficult decision. Whether you are a registered nurse with an associate’s degree looking at bachelor’s degree programs, or an advanced practice nurse thinking about a doctorate, there’s so many factors that go into making the decision, including timing, money, availability, and program options, it can be hard figuring out if you are really ready for that next step.

For further insight into this issue, I spoke with Wolters Kluwer Medical Research Division and NursingCenter’s chief nurse, Anne Dabrow Woods DNP, MSN, RN, CRNP, ANP-BC, who received her doctorate in nursing practice this May from Texas Christian University. Dr. Woods has been a nurse for more than 30 years and a nurse practitioner for 16 years. Currently, she serves as our chief nurse, as well as the publisher of the American Journal of Nursing and the Joanna Briggs Resources. She also works as a critical care nurse practitioner every weekend, while also serving as adjunct faculty for Drexel University.

Although Dr. Woods certainly has enough on her plate, she still chose to go back and get her doctorate. “The way healthcare is evolving,” says Dr.Woods, “I needed to go back for my doctorate to learn the skills, resources, and tools I need to really be effective in the market.” She sees the pursuit of higher education as a major trend across the profession. “Transitioning nurses who have their associate’s degree or diploma to a bachelor’s degree is really important. There are skillsets they haven’t learned before, and a bachelor’s degree will really help them in their practice. The other big push I see is advanced practice nurses going back for their DNP. It’s really only been in the last 10 years that we’ve had the ability to have a practice doctorate. The Future of Nursing initiative and the LACE model of nursing is that by 2015, all of these advance practice programs should be DNP.”

Once she decided to pursue a doctorate, Dr. Woods knew it was going to be costly, which is a major concern for most nurses contemplating higher learning. She explains, “It’s really expensive to go to school. Nurses need to do their homework and find out where they can obtain funding – scholarships, grant money, student loans.” Earning an advance degree is pricey, but Dr. Woods knows the value of an education. She says, “Even though it’s really expensive, and I probably won’t make any more money from having it, I feel that I am a better nurse and nurse practitioner by having it. [Nursing] is about being able to provide better care for the patients, the community, and people on a global perspective…It’s never about the money. It’s about practicing to the fullest potential that you can practice and providing the best care to our patients.”

Money isn’t the only issue for nurses looking for more education. Many nurses continue to work fulltime, while balancing families, friends, and other responsibilities. This was no different for Dr. Woods, who says, “The biggest challenge for me was time management. I work fulltime, and, I practice every weekend as a critical care nurse practitioner. Trying to fit in school work, even though it was a part-time online program, was challenging. The course work wasn’t hard; it’s the amount of work and the time it takes to do that work that is hard.” Being prepared for the commitment in cost and time is crucial to earning an advanced degree.

After the sacrifices she made to earn her doctorate, Dr. Woods already sees the benefit of her choice, only three months after graduation. She says, “As a DNP now working every weekend with nurses, they have really embraced my new degree and will ask me how they can think differently about this situation or what they are missing. I find myself doing a lot more teaching about things related to patient care or ethics of care. Now, I can help the nurse look differently at these issues.” And she doesn’t plan to stop learning any time soon. Dr. Woods explains, “I’m going forward to get some additional certifications to be the best healthcare professional, the best nurse practitioner, the best nurse I can be.”

Choosing the path of higher learning isn’t for everyone. Those who do take on this challenge, however, understand the immense benefit to not only themselves, but to the nursing community as a whole. Now, are you ready to go back to school?



Suicide assessment – an important nursing responsibility

clock August 20, 2014 09:09 by author Lisa Bonsall, MSN, RN, CRNP

As we continue to mourn the loss of Robin Williams, an iconic entertainer and comedian, it’s important for us to take a step toward learning from his death. As nurses, our responsibilities to our patients are numerous, but we know that safety is a number one priority. Even if we don’t routinely care for patients with mental illness, patients that we encounter may have a mental illness of which we are unaware. Some patients may have an undiagnosed or newly diagnosed disorder that may increase their suicide risk, whether due to its pathophysiology or its impact on quality of life. In nursing school, we learned about suicidal ideation and how to do a suicide assessment. I’d like to share some resources from our journals with you to revisit this important topic.

 

Assessing patients for suicide risk
Nursing2010 

Suicide Prevention in Neurology Patients: Evidence to Guide Practice
Journal of Neuroscience Nursing

All along the watchtower: Suicide risk screening, a pilot study 
Nursing Management

As If the Cancer Wasn't Enough... A Case Study of Depression in Terminal Illness
Journal of Hospice and Palliative Nursing

Additional Resources
American Foundation for Suicide Prevention
National Alliance on Mental Illness
U.S. Department of Health and Human Services – Directory of support groups



Nurses On the Move: Lorry Schoenly

clock July 31, 2014 03:29 by author Cara Gavin, Digital Editor

Nurses work in all types of environments. Whether it is an ER, university, military, consulting firm, or even a prison, the role of the nurse goes far beyond the typical hospital setting.

July’s Nurse On the Move, Lorry Schoenly PhD, RN, CCHP-RN, is a correctional healthcare risk consultant for jail and prison clients. She also currently serves as part of the faculty at the Chamberlain College of Nursing and writes a monthly column on correctional healthcare issues, along with podcasts.

Schoenly previously served as the director of education of the National Association of Orthopaedic Nurses and assistant vice president of Rancocas Hospital, among other titles. She started her career as a staff nurse. She received her bachelor’s of nursing from Excelsior College and earned both her master’s in burns, emergency, and trauma, and doctorate in nursing from Widener University.

Through our interview, I learned why Schoenly went into correctional nursing and what daily reminder she has for nurses.

Q: Why did you decide to become a nurse?
A:  I never imagined being a nurse while growing up. I come from a family of educators. While in critical care after the difficult delivery of our son, I looked around at the nurses scurrying about and thought, "These folks are doing meaningful work.” I was hooked.

Q: You started as a staff nurse and remained in that role for a little over three years. What motivated you to continue your education and become a staff instructor and, eventually, a director of education?
A:  I guess I have always been an educator at heart. As a staff nurse…I was like a sponge soaking up information from any inservice or continuing education course I could find. I was thrilled to apply and be accepted [to a staff development position]…where I was able to continue in patient care, while managing the orientation of new staff and creating inservices for new treatment and equipment. For me, it was an ideal combination.

Q: As a nurse educator, what advice do you have to inspire others to further their education?
A:  You can almost never go wrong with education. One of the joys of nursing is the wide array of opportunities. If you are unhappy in your current position, research other options and determine what is needed for an entry-level position. Enjoy the journey and seek to apply everything you learn in the classroom into your current work experiences.

Q: How did you become interested in correctional nursing?
A:  Like many in our specialty, I am an accidental correctional nurse. I don't know anyone who announced as a child that they wanted to be a jail nurse when they grew up. In fact, it had never occurred to me that nurses worked in jails and prisons until I answered an advertisement for a nurse educator position in the NJ prison system. However, once I saw the great need for nursing care and nursing caring behind bars, I saw an opportunity to bring my skills and abilities to bear both locally and nationally. Correctional nurses care for a vulnerable, marginalized, and very needy patient population. And, it takes grit and determination to work in that environment day after day. I see firsthand the struggles correctional nurses have in the low resourced and ethically challenging criminal justice system. I do what I can to support their efforts.

Q: As a correctional healthcare consultant, what is your biggest challenge related to patient care?
A: The greatest challenge I face when helping improve patient care is organizational culture. Pervasive attitudes among team members are hard to eradicate. We want quick fixes, whether it be losing weight, getting dinner on the table, or improving a relationship. It is the same in healthcare. Leaders want to write a policy, inservice staff, and then move on to the next thing on the list. It doesn't work like that in organizations, even though we wish it would!

Q: If you could give nurses a daily reminder, what would it be?
A: The encouragement I use at the end of each of my Correctional Nursing Today podcasts is to "Make today count for good.”  As nurses, we always have an opportunity to make a difference in someone's life, and I try to remind myself of that regularly. A quotation on the whiteboard of my office that encourages me is from Goethe, "Knowing is not enough; we must apply. Willing is not enough; we must do,” As an educator, I try to continually encourage others to apply what they are learning, otherwise it is for naught.

Q: What do you see for the future of nursing?
A:  The future of nursing is bright as we move forward. There are many opportunities for nurses to make a difference, no matter the position or location. Correctional nursing, in particular, is advancing as a specialty, and I am delighted to be a part of it!



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.



Read these award-winners!

clock July 3, 2014 01:33 by author Lisa Bonsall, MSN, RN, CRNP

Last month, 21 Apex Awards were presented to journals published by Lippincott Williams & Wilkins. These awards are based on “excellence in graphic design, editorial content and the ability to achieve overall communications excellence.” The award-winning articles from our nursing journals are listed below. We are very proud to share them with you!

Shining a Light on Hoarding Disorder
Nursing2013

Responding To an Active Shooter and Other Threats of Violence 
Nursing2013

25th Annual Legislative Update: Evidence-Based Practice Reforms Improve Access to APRN Care 
The Nurse Practitioner: The American Journal of Primary Health Care 

The Hard Truth about Human Trafficking 
Nursing Management

IT Extra: Technology Management Strategies for Nurse Leaders  
Nursing Management

Smart Management: Recruitment And Retention: How To Get Them And How To Keep Them
OR Nurse 2013

Smart Management: High reliability Organizations: An Idea Worth Pursuing 
OR Nurse 2013

Smart Management: Build Your Staff's Leadership Skills 
OR Nurse 2013

Managing Patients with Severe Traumatic Brain Injury
OR Nurse 2013

Editorial: A Grassroots Movement Sounds the Call 
American Journal of Nursing



Cover Image from January 2014 issue of American Journal of Nursing


January 2013 issue of Nursing2013 Critical Care



Nurses On the Move: Helene Bowen-Brady

clock June 24, 2014 04:33 by author Cara Gavin, Digital Editor

As summer heats up, so do the incredible nurses who focus on the hottest professional topics.

This month’s
Nurse On the Move is Helene Bowen-Brady, M.Ed, BSN, RN-BC, the program manager for professional development at Brigham and Women's Faulkner Hospital. Not only does she focus on guiding the Department of Nursing on a Magnet Journey, but she also sits on the Steering Committee for the CLCDN (Clinical Leadership Collaborative for Diversity in Nursing), and recently served as the site coordinator for an international nursing research project.

Bowen-Brady previously served as a nurse educator, lactation consultant, and school nurse, all while raising her four children. She received her BSN from Boston College. She also earned a master’s degree and is currently exploring doctoral programs.

I interviewed Bowen-Brady to discover what drew her to such different roles in nursing and what she sees for the profession in the future.

Q: Why did you choose nursing as a profession?

A: Honestly, I wasn’t sure when I was 16 what I wanted to do. In the early 70’s, the career advice I received was to become either a teacher or a nurse. In the end, the motivation was simply that nurses who went to diploma schools got to live away at school, and if I became a teacher, I would have to commute to college. At 16, it was a very easy decision – I wanted to live away.  In retrospect, it was the best decision for me. As a nurse, I have had an incredible career.

Q: You worked with Canton public schools as a school nurse. How was that working environment and why did you choose to pursue a different venue for nursing?

A: I started working as a substitute nurse because the hours worked for my family. Little did I know what a great career move that would turn out to be and what wonderful clinical and leadership experiences school nursing would provide. In all of the nursing roles that I have had, I think that school nursing was probably the most challenging. School nurses work independently in most settings to manage a variety of complex acute and chronic healthcare needs for students of all ages.

Q: You were previously a lactation consultant. What drew you to that role?

A: Personal need – when my first son was born there was limited, if any, support for breastfeeding mothers in my community. When I worked as a VNA nurse, I was fortunate to work with an innovative nurse director who supported me to expand the services we provided for families with newborns.

Q: What encouraged you to continue your education as a nurse?

A: I believe that lifelong learning is essential for every nurse. The knowledge I gain from reading journal articles, attending classes, listening to webinars, or taking an online class absolutely helps me to be a better practitioner.

Q: You’ve spent a good amount of your career working in staff development and education. How has professional development changed over the years, if at all?

A: The biggest change is the technology. When I first became an educator in 1980, I had to handwrite every lecture, which was then typed by the department secretary since she was the only person with a typewriter. Finding relevant journal articles meant a trip to a hospital library or a local college. Today, I have countless electronic folders stored on my computer. Search engines make it easy to find reliable and current information about any topic. There are so many new and innovative technological strategies and tools that educators can use to engage adult learners in order to positively enhance learning activities to make them more meaningful for staff.

Q: What do you envision for the future of nursing?

A: When I entered nursing school in the early 70’s, healthcare was primarily provided in the acute care hospital. Over the past 40 years, healthcare has changed dramatically. Nurses have an opportunity to play key roles in the future of healthcare and most of these expanded roles will be outside of the inpatient setting. I truly believe that the changes ahead will prove to be in the best interest of our patients and families.

Q: For a nurse starting out, what would be your number one piece of advice?

A: It would be to encourage nurses to get involved. Step outside the comfort zone of the unit or area you work in – join a committee at work or the professional organization that represents your practice area’s local chapter. There are so many incredibly talented and innovative nurses within the profession that each one of us can learn from. 



Technology and Global Health: A Nurse Presents For the U.N.

clock June 19, 2014 10:22 by author Lisa Bonsall, MSN, RN, CRNP

On May 16th, Dr. Anne Dabrow Woods, Chief Nurse of Wolters Kluwer Medical Research and the publisher of American Journal of Nursing and Joanna Briggs Institute (JBI) at Wolters Kluwer, was a special guest speaker for the United Nations and the World Health Organization on “E-health: Using Technology to Improve Global Public Health” during the Global Classrooms® International Model United Nations 2014. In attendance at the three-day conference were 2,300 students from more than 20 nations. The event was held at United Nations Headquarters and the Grand Hyatt Hotel in New York City.

During her presentation, Anne discussed the importance of access to evidence-based practice resources from global collaborations such as JBI and exposed future policymakers to the principles of evidence-based practice. Anne fielded over 20 delegate questions, including the impact of "Big Pharma"  policies on global health, ensuring clean water, food and sanitation as foundations for health in developing nations, and how new technologies, such as apps and robots, are changing healthcare practice today. 

Submitted by:
Janet Feeney
Senior Marketing Manager
Medical Research
Wolters Kluwer



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