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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



Celebrate Nursing 2014: Part 2

clock May 30, 2014 07:44 by author Lisa Bonsall, MSN, RN, CRNP

I hope that 2014 has been a good year so far! It’s hard to believe we are heading into June soon and it's time to look ahead to nursing recognition days, weeks, and months for the second half of the year. (You can see what we’ve already celebrated this year in Celebrate Nursing 2014 Part 1).  

Vascular Nursing Week
June 8-14 

National Time Out Day
June 11  

37th Annual National Nursing Assistants Week
June 12-19  

Healthcare Risk Management Week
June 16-20  

National Nurses in Staff Development Week
July 15-19

National Pediatric Hematology/Oncology Nurses Day
September 8  

Nephrology Nurses Week
September 14-20 

National Neonatal Nurses Day
September 15  

Gerontological Nursing Week
September 28-October 4  

National Midwifery Week
October 5-11 

Emergency Nurses Week
October 5-11 (Emergency Nurses Day is October 8) 

National Pediatric Nursing Week
October 6-12 

National Case Management Week
October 12-18  

National Hospice/Palliative Care Month
November 

Urology Nurses and Associates Week
November 1-7  

Medical-Surgical Nurses Week
November 2-8 

Emerging Nurse Leaders Week
November 2-8 

Perioperative Nurses Week
November 9-15 

National Nurse Practitioner Week
November 9-15 

Forensic Nurses Week
November 10-14 

Remember to celebrate yourselves and your colleagues! 



Nurses On the Move: Karlene Kerfoot

clock May 19, 2014 09:22 by author Cara Gavin, Digital Editor

National Nurses Week ended May 12th. It was a great opportunity to reflect on the important nurses who changed the course of the profession.

Today, nurses are still serving as role models to those around them. In recognition, we honor a NursingCenter member, Karlene Kerfoot PhD, RN, NEA-BC, FAAN, as this month’s Nurse On the Move. Currently the Chief Clinical Integration Officer at API, Kerfoot also worked in patient care administration, clinical practice, and healthcare consulting. She served in adjunct academic positions and was the Corporate Chief Nursing and Patient Care Officer at three of the largest healthcare systems in the U.S. She earned a doctorate in nursing from the University of Illinois and a master’s and BSN from the University of Iowa.

I spoke with her to learn a little more about her outstanding work and to discover what she sees for the future of nursing.

Q: Why did you choose nursing as a profession?
A: Well, it wasn’t my first choice. I wanted to go into political science, but there were limited jobs there. I know I wanted to make a difference. With nursing, it’s a great opportunity. You can travel and do different things. I forgot about political science and never looked back.

Q: What encouraged you to continue your education as a nurse?
A: I wanted to be able to have a choice of options as I got older. With a master’s or a PhD, you have more choices. I know I wanted to work in a complex setting where I could combine research and so on. I thought, “20 years from now, what will people want? They’ll want advanced degrees. I better get busy!”

Q: In your current role, what is the biggest challenge you face?
A: My biggest challenge is that many technology firms have technology people developing applications, but on the client side, the applications lack client input. I need to make sure they fit and that they are what’s needed out there and are relevant to the frontline clinical person.

Q: Nurses Week was celebrated May 6-12th. Why do you believe this week is important?
A: It’s important to understand your history and future. There are so many people who have changed the course of history, for instance Florence Nightingale. They are fabulous role models for people to look at and think, “I can change history too.”

Q: What are the top four ways nurses can avoid holding back their careers?
A: The first way to avoid holding back your career is to learn positive discontentment. Florence Nightingale said, “If you’re not moving forward, you’re moving backward.” We need to value innovative people, especially those who take a positive outlook on things and who can offer solutions, not just complaints.

Second, practice “No Excuse” career development. Florence Nightingale was discontent, and it pushed her to make changes [not just give up].

Third, talk about your work in measurable outcomes. Saying “I did good work” isn’t good enough anymore. In the last 10-15 years, there’s been a push for measurement. Give examples that show things happened because of you.

Fourth, become agile with technology. Technology is everywhere. Look for what’s coming in the future and what it will mean to patients. It’s like a language you need to understand.

Q: For a nurse starting out, what would be your number one piece of advice?
A: Look ahead and think about what people will need in the future and how you can provide it. You are your own company, so you need to prepare for the future. Every three to five months, practice strategic thinking, “What have I learned and what do I need to learn?”

Q: Finally, what do you envision for the future of nursing?
A: I wish, as time goes on, nurses will be more empowered. The public says nurses are the most trusted workers and they should be involved in healthcare policy and reform. I would hope nurses become more prepared to sit at those tables and to a make a difference because nurses are the spokesperson for the patient.

Do you know the perfect nurse to be featured for Nurses On the Move? Email your submissions to ClinicalEditor@NursingCenter.com.



Nurses who led the way: Florence Nightingale

clock May 12, 2014 04:23 by author Cara Gavin, Digital Editor

The founder of modern nursing, Florence Nightingale, was born on May 12, 1820, so it is only fitting that we end Nurses Week on her birthday. Despite her wealthy parents’ wishes to live a conventional upper class life, Nightingale desired to serve others and entered into nursing by studying in Germany in 1851. By 1853, she became the superintendent at a hospital for gentlewomen. 

In 1854, the Crimean War started and Nightingale traveled to Turkey to head a team of nurses in the British military hospitals. During the war, she witnessed the horrible sanitary conditions while overseeing 38 nurses at Scutari. Using statistical data analysis, she was able to lower medical facilities’ mortality rates, and she pushed for reform in all British military hospitals. 

She founded the Nightingale Training School for nurses at St. Thomas' Hospital in London in 1860. Using her Environment Theory, otherwise called the "Nightingale Model," she trained nurses and then sent them to work in facilities all over Britain. Her nursing theories were published in Notes on Nursing in 1860. 

Nightingale received the title of Lady of Grace of the Order of St. John of Jerusalem and became the first woman to receive the Order of Merit. After her death in 1910, her family declined a state funeral and burial in Westminster Abbey and buried her in the family plot in St. Margaret’s Church in East Wellow, Hampshire.



Nurses who led the way: Loretta C. Ford

clock May 12, 2014 03:52 by author Cara Gavin, Digital Editor

Dr. Loretta C. Ford is an internationally recognized leader in nursing and the founder of the nurse practitioner movement, which is celebrating its 50th anniversary this year. She received her diploma in nursing in 1942 from Middlesex General Hospital in New Jersey and started her nursing career as a staff nurse for the Visiting Nurses’ Association. After serving as first lieutenant in the U.S. Army Air Force for three years, Ford earned her bachelor’s and master’s degrees from the University of Colorado School of Nursing. In 1961, she earned her doctorate of education from the University of Colorado School of Education.

Ford, along with pediatrician Henry K. Silver, was offered a grant from the University of Colorado in 1965 to create a demonstration project to expand the role of nurses in healthcare. After publishing their findings, they created a curriculum to educate nurse practitioners. The program gained national success, and Ford became the founding dean of the University of Rochester School of Nursing in 1972. 

She wrote more than 100 publications, earned six honorary doctorates, and received numerous awards, including the Gustav Lienhard Medal from the Institute of Medicine, the Living Legend Award from the American Academy of Nursing, and the American College of Nurse Practitioner’s Crystal Trailblazer Award.

Today, Ford continues to lecture on the nurse practitioner movement. 



Nurses who led the way: Virginia Avenel Henderson

clock May 11, 2014 00:26 by author Cara Gavin, Digital Editor

Regarded as one of the most famous nurses in history, Virginia Avenel Henderson is credited with developing a nursing theory, in which she defined the role of nurses in healthcare. Henderson was trained at the Army School of Nursing in 1921, and she earned her bachelor’s and master’s degrees at the Teachers College in Columbia University. She started as a public health nurse at the Henry Street Settlement in New York City and soon became the first full-time nursing instructor at the Norfolk Protestant School of Nursing. 

In 1953, Henderson began teaching at the Yale School of Nursing and continued to teach there with emeritus status until 1996. She wrote and published numerous textbooks throughout her career, as well as The Nursing Studies Index, a 12-year project in which she covered the first 60 years of nursing research. Her nursing theory, the “Henderson Model,” is used internationally as a standard for nursing practice. 

Henderson received 13 honorary degrees, was inducted into the American Nurses Association Hall of Fame, and was awarded the most prestigious honor in nursing, the Christiane Reimann Prize, by the International Council of Nurses. 

She died in 1996 at the age of 98 in Connecticut. She is still known today as “the first lady of nursing.”



Nurses who led the way: Mary Eliza Mahoney

clock May 10, 2014 00:54 by author Cara Gavin, Digital Editor

Mary Eliza Mahoney was the first African-American professional nurse in the United States. She dedicated her life to the profession, starting by working for 15 years in the New England Hospital for Women and Children before enrolling in its nursing program. She was one out of only four nurses to graduate out of a program of 42 students. 

After graduation, Mahoney became a member of the American Nurses Association (ANA) and helped establish the National Association of Colored Graduate Nurses in 1908. She was elected the chaplain of the association in 1909 and received lifetime membership status. 

Mahoney also fought for women’s rights. At the age of 74, she became one of the first women to register to vote in Boston. Later, she continued her work as a nurse at the Howard Orphan Asylum before she retired.

Mahoney passed away from breast cancer at 80-years-old. Today, ANA offers an award in her name every year to members who strive to ease racial obstacles. She has been inducted into the Nursing Hall of Fame and the National Women’s Hall of Fame. 



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