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Contents
MARCH 2015 • Vol 1 • Issue 3
ON THE WEB
www.advanceweb.com/Nurses
Visit www.advanceweb.com/Nurses
anytime for national and regional news,
timely articles, forums, blogs and more.
Take Our Salary
Survey
▶ Learn more about your
colleagues’ salaries and
working environments
from across the country in
the final results revealed in late summer.
Cover Story
8
2015 Conferences
Patient-Centered Environment
Nurses give a certain cachet to an increasingly common role - chief patient experience officer.
(Cover image THINKSTOCK/Getty Images)
Regional Focus
Features
12 Cultivating Nurse Leaders
16 Certification in the OR
One hospital gives its nurses a leg up on
mangement skills.
14 Moving Patients
Teamwork helps the creation of new
facilities in one hospital.
15 Deep Brain Stimulation
Nurse coordinator helps Parinson’s patients manage their disease.
Research links nursing care and education.
21 Diet Desperation
Let evidence be your
▶ This patient had a lot to
say before his death. Read
this poignant story about
how to celebrate each
moment in life instead of
waiting until you die.
Departments
Editorial: Pretty in Pink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
News & Happenings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CE Article: Rapid Trauma Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Caregiver Handout: Infection Control Out of the Hospital. . . . . . . . . . . . . . . . Education Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Career Opportunities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RxUpdate: Droxidopa (Northera). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postmaster: Send address changes to ADVANCE for Nurses, Merion Publications Inc., Circulation, 2900 Horizon
Drive, King of Prussia, PA 19406.
ADVANCE Focus
on Education
Celebration of Life
guide when
recommending weight
loss strategies.
ADVANCE for Nurses is published by Merion Publications Inc., 2900 Horizon Drive, King of Prussia, PA 19406.
Periodicals postage paid at Norristown, PA, and additional mailing offices. ADVANCE for Nurses is free to all
licensed RNs and senior nursing students. Contents are not to be reproduced or reprinted without permission
of publisher. © 2015 Merion Publications Inc.
conferences will help
you plan continuing
education and networking
opportunities for nurses in
all specialties for the year ahead.
▶ This guide is a resource
to help improve your
career through education,
plus event, course and
degree offerings across the country.
19 Acuity-Based Staffing
Learning to pair nurses with patients.
▶ This schedule of
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Career Opportunities
Editorial
Job search by facility below, or use the key on page 32 to target your job search by your region.
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How to Contact Us: Merion Matters, ADVANCE for Nurses, 2900 Horizon Drive, King of Prussia, PA 194062651 On the Web: www.advanceweb.com ▶ E-mail: [email protected] ▶ Editorial: 800-355-5627 ▶
Pamela Tarapchak, Editor, [email protected], ext. 1360 ▶ Danielle Bullen, Senior Associate Editor,
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­4 ADVANCE FOR NURSES MARCH 2015
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The Pink Glove Dance is back; start practicing
your dance moves!
By Pamela Tarapchak, Editor
40
36
www.grmc.org
Pretty in Pink
WALKING TO an early morning event at the
Association of periOperative Registered Nurses
conference, held March 7-11, I kept thinking
of my friend, Lisa. Now still recovering from a
double mastectomy and reconstructive surgery
during her fight with breast cancer, she would
often attend shows with me in the past to cover
events for our magazines. On March 9, I was attending the launch
of the Medline Pink Glove Dance Video Competition. As I walked
into the large gala room, it was flooded with pink lights and nearly
1,000 nurses were getting ready to kick off the competition. I sat
down at a table with nurses from Boston, Kansas and Nebraska to
eat my food, but we were soon all jumping to our feet as we began
to honor breast cancer survivors through the joy of dancing.
The Medline Pink Glove Dance is the only campaign to unite
nearly 200,000 healthcare professionals, patients, survivors and
communities to share hope for a cure and honor those affected by
the disease. Breast Cancer survivor and former “Dancing With the
Stars” host Samantha Harris danced side-by-side with the nurses
and shared her personal cancer journey.
“I knew I was in the right place when I walked into the Breast
Center at St. John’s Hospital in Santa Monica, Calif. Nurses held my
hand, listened to me and I never felt alone,” Harris said at the event.
ADVANCE for Nurses will be highlighting the very first Pink Glove
Dance video, as well as last year’s winner and other ones at www.
advanceweb.com/nurses to inspire you to challenge your colleagues
to enter videos. To register, go to www.pinkglovedance.com.
According to the American Cancer Society, 1 out of 8 women in the
U.S. will develop breast cancer in their lifetime. I’m thankful every
day my friend, Lisa, is cancer free. With support from Medline, which
has donated more than $1.6 million to the National Breast Cancer
Foundation, more awareness of the disease can spread throughout
the community to help those numbers finally reach zero. n
is produced by Merion Matters, celebrating 30 years of excellence in healthcare publishing
PRESIDENT Ann Wiest Kielinski • GENERAL MANAGER W.M. “Woody” Kielinski • PUBLISHER Lynn Nace EDITORIAL Editor: Pamela Tarapchak Lead Nurse Planner: Jennifer Oakley, FNP, MSN, RN Senior Associate Editor: Danielle Bullen Web Director: Jennifer Montone • DESIGN Design Director: Walt Saylor • Mac Tech Manager & Production: Michael Galban Production Manager: Cheryl A. Drotar Art Director: Doris Mohr • MARKETING Marketing
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News&Happenings
APIC Develops New ED
Ebola Training
▶ WASHINGTON, D.C. The Association
for Professionals in Infection Control and
Epidemiology (APIC) assisted the Johns
Hopkins Armstrong Institute for Patient Safety and Quality to create four
new interactive, web-based training modules for emergency department personnel
who treat patients with infectious diseases,
which are now available on CDC website.
The training program, titled “Ebola
Preparedness: Emergency Department
Guidelines,” helps prepare healthcare personnel to quickly and efficiently identify,
triage and manage the care of patients with
suspected Ebola virus disease.
APIC was among a team of experts
who contributed to the development
of the CDC-funded training modules.
Additional partners included Johns
Hopkins University, Society for Healthcare
Epidemiology of America, Emergency
Nurses Association, American College of
Emergency Physicians, and others.
“This innovative program will assist
emergency department personnel in managing the care of patients who might have
a highly virulent infectious disease such as
Ebola or other emerging pathogens,” said
Michael Anne Preas, BSN, RN, CIC.
“The new modules — which consist
of short, step-by-step video clips and vignettes — provide infection preventionists with a valuable tool to expand and
reinforce their education efforts to better
protect patients and ensure healthcare
worker safety,” Preas noted.
72 Hospital Units Earn AACN
Beacon Awards in 2014
▶ ALISO VIEJO, CALIF. The American Association of Critical-Care Nurses
(AACN) has recognized 72 units from
60 hospitals nationwide that earned
the Beacon Award for Excellence between Jan. 1, 2014, and Dec. 31, 2014.
▶ SEALING THE DEAL: Anne McGinley, dean of Nursing, Camden County College, Lisa Easterby, dean
of Our Lady of Lourdes School of Nursing, and Filomena Marshall, dean of W. Cary Edwards School
of Nursing, pose with students at the signing ceremony.
The Beacon Award for Excellence lauds
hospital units that employ evidence-based
practices to improve patient and family
outcomes.
Beacon-designated units meet criteria
in five categories consistent with criteria
for national awards, including Magnet
Recognition, the Malcolm Baldrige National
Quality Award, and National Quality
Healthcare Award. Units that receive the
award demonstrate practices that align
with AACN’s Healthy Work Environment
Standards for optimal care.
In 2014, VCU Medical Center, Richmond,
Va., had three units that received Gold-level
recognition, the Beacon Award’s highest
distinction.
With the addition of these units, VCU
becomes the first hospital with eight Beaconrecognized units.
In all, 20 units received Gold Beacon
Awards in 2014, including two units at
Sharp Grossmont Hospital, La Mesa, Calif.
Hospital units at the St. Mary’s campus of
Mayo Clinic Hospital, Rochester, Minn.,
received two Gold Beacon Awards and one
Silver Beacon Award.
Five additional hospitals had multiple
units honored with an award, demonstrating excellence in caring for high acuity and
critically ill patients and their families.
New Four-Year Pathway to
BSN Degree
▶ CAMDEN, N.J. Camden County Col-
lege and Our Lady of Lourdes School
of Nursing are collaborating with the
W. Cary Edwards School of Nursing at
Thomas Edison State College to create a
dual admission nursing program that enables students to complete a BSN degree
in four years.
The “Finish in Four” program will allow
graduates of the nursing cooperative program offered by Camden County College
and Our Lady of Lourdes School of Nursing
to transfer and apply up to 80 credits to the
online RN-BSN program at the W. Cary
Edwards School of Nursing. The program
provides a pipeline of baccalaureate-prepared
nurses.
Eligible students enrolled in the cohortbased program will be granted conditional
acceptance to the RN-BSN program at
Thomas Edison State College and full
acceptance once they complete the nursing
diploma and associate in science degree
and pass the National Council Licensure
Examination for Registered Nurses
(NCLEX-RN).
Students enrolled in the RN-BSN collaboration program will receive discounted
tuition and a deferred payment option.
www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES
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News&Happenings
NYU College of Nursing to Survey
Newly Licensed RNs
▶ NEW YORK, N.Y. New York University College of Nursing’s
Christine Kovner, PhD, RN, FAAN, has been awarded a $338,807
grant by the Robert Wood Johnson Foundation (RWJF) to conduct
a national study of newly licensed registered nurses (NLRNs) to
assess the impact of a number of initiatives sponsored by RWJF on
the educational status, leadership capacity, and knowledge of quality improvement and patient safety of these NLRNs.
The study will investigate changes in trends across four cohorts
of those RNs who have graduated since 2004-05.
“We think the data generated from this new survey will add
additional data about new nurses to inform decisions of health care
managers, policy makers and foundations,” said Kovner.
New Parkland Hospital Burn Center
Quadruples in Size
▶ DALLAS – The Burn Center at Parkland Memorial Hospital
is one of the largest civilian burn units in the nation.
More than 1,200 burn victims are cared for annually at Parkland
and more than 790 pediatric and adult burn patients were admitted to
the hospital in 2014 for inpatient care. When the new Parkland opens
in August, patients will receive care in a centralized 32,000 square-foot
center; nearly quadruple in size from the current 8,500 square feet.
Having all the services located in one area will enhance patients’
continuum of care and make it easier as they transition from
intensive care to acute care and then outpatient, said Christine
Lane, RN, Burn Unit Manager.
Parkland’s Burn Center maintains Burn Center Verification
status by meeting the criteria of the American Burn Association’s
Burn Center Verification/Consultation Program. Doctorate for Family Nurse Practitioners at SIUE
▶ EDWARDSVILLE, ILL. The Southern Illinois University Edwardsville School of Nursing has announced that the family
nurse practitioner master’s program will transition to a doctor of
nursing practice with a family nurse practitioner specialization
(FNP DNP) beginning in August 2015.
The doctoral program will consist of eight semesters of full-time
coursework, with an addition of only 12 credits more than the
master’s degree. Individualized progressions will also be considered.
Students who graduate from the FNP DNP will be eligible to
take the same certification exams, either the American Nurses
Credentialing Center or the American Association of Nurse
Practitioners, as the previous master’s students.
To enroll in the FNP DNP specialization for Fall 2015, visit siue.
edu/nursing. The SIUE School of Nursing will accept applications
for this new program until April 1, 2015.
Nursing Program Has Earned 10-Year CCNE
Accreditation
▶ IRVINE, CALIF. Concordia University Irvine announced the
Accelerated Bachelor of Science in Nursing (ABSN) and the Associate Degree Registered Nurse (RN) to Bachelor of Science in Nursing Degree (BSN) programs have earned a 10-year accreditation
from the Commission of Collegiate Nursing Education (CCNE).
“This year-long, rigorous accreditation process has demonstrated
to the medical community and our academic peers that we offer
a high-quality nursing education that provides great opportunities for our students,” said Mary Hobus, PhD, MS, RN, director
of the Department of Nursing at Concordia University Irvine.
The CCNE accreditation process included a thorough examination of Concordia’s curriculum and a formal on-site visit, which
occurred in the spring of 2014. n
™
More Nursing News
READ MORE about your colleague’s accomplishments and news around
the country online at www.advanceweb.com/NurseNews.
­6 ADVANCE FOR NURSES MARCH 2015
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News&Happenings
Names&Faces
Margaret (Peg)
O’Donnell, DNPs, FNP,
ANP, B-C, FAANP
Vicki Mihalek, RN
LIBN Names Senior Nurse Practitioner
A Health Care Hero
Chief Nursing Officer Wins State
Leadership Award
OCEANSIDE, N.Y. The Long Island Business News
(LIBN) recently awarded its “Health Care Heroes”
Nurse Hero Award to Margaret (Peg) O’Donnell,
DNPs, FNP, ANP, B-C, FAANP, senior nurse practitioner at South Nassau Communities Hospital.
The award honors individuals and organizations in
the healthcare industry in Nassau and Suffolk counties for outstanding leadership and commitment.
A Fellow of the American Association of Nurse
Practitioners, O’Donnell is a primary care provider
and preceptor, providing comprehensive healthcare at
South Nassau. One of the first NPs named to its medical staff, O’Donnell organized the hospital’s Advanced
Practice Nurses Innovative Care Committee, which
engages in peer review, case presentations, strategic
planning, and coordinating efforts between inpatient
and outpatient services.
AUSTIN, TEXAS Jane McCurley, DNP, MBA, RN,
NEA-BC, FACHE, chief nursing officer at St. David’s North Austin Medical Center, was awarded
the 2014 Texas Organization of Nurse Executive
(TONE) Excellence in Leadership Award. It is granted on an annual basis to an active TONE member
who provides a mechanism for the interchange of
ideas and dissemination of information regarding
nursing practice and legislative issues; promotes
education and other professional activities through
serving as a role model and mentor; and shares his or
her knowledge through presentations, seminars, and
publications.
Emerson Clinician Honored With
Compassionate Caregiver Award
Anthony Diorio, FNP,
MSN, BSN, BA
Jane McCurley, DNP,
MBA, RN, NEA-BC,
FACHE
CONCORD, MASS. Vicki Mihalek, RN, from the
interventional radiology department was chosen
by colleagues to receive Emerson Hospital’s highest honor for patient care. Mihalek’s daughter, Kelly
Flynn, herself a nurse at Emerson, spoke about her
mother’s “empathetic, selfless and determined” approach with her patients. “Every decision, thought
and task is for her patients.”
Emerson Hospital’s annual Compassionate Caregiver
Award was established in 2004 and recognizes compassionate care as exemplified by the late Terry Croteau,
a social worker at Emerson who made an exceptional
difference in the lives of her patients and co-workers.
Our Lady of Lourdes Medical Center
Welcomes New Nurse Manager
CAMDEN, N.J. Our Lady of Lourdes Medical Center recently appointed Anthony Diorio, FNP, MSN,
BSN, BA, as its nurse manager for the OR, Pre-Admission Testing, and Post-Anesthetic Surgery Unit.
Diorio comes to Lourdes from Wilmington VA
Medical Center, where he was the nurse manager of
Surgical Services. He currently serves as a Lieutenant
in the United States Navy Reserve, where he holds the
positions of clinic director and nursing leader.
USI Graduate to Receive National
Neuroscience Nursing Award
EVANSVILLE, IND. Lauren Perrey, BSN, RN, has
been selected as the recipient of the 2015 Rising Star
in Clinical Practice Award from the American Association of Neuroscience Nurses (AANN). Perrey, of
Indianapolis, is a registered nurse in a 33-bed Neuroscience Critical Care Unit at IU Health Methodist
Hospital, which is a comprehensive stroke and level
1 trauma venter.
In her job, Perrey cares for patients who have had
strokes, traumatic brain injuries, spinal cord injuries,
brain and spinal tumors, and vascular abnormalities,
such as aneurysms and arterial venous malformations.
SFGH Nurse Honored by San Francisco
General Hospital Foundation
SAN FRANCISCO Maya Vasquez, RN, with the
San Francisco General Hospital and Trauma Center (SFGH) has received the 2015 Heroes & Hearts
Award bestowed by the San Francisco General Hospital Foundation.
Vasquez is the program manager for SFGH’s BabyFriendly Hospital Initiative. She was instrumental in
the hospital receiving its Baby-Friendly certification in
2007, and is dedicated to offering nurturing support
to new moms and their newborns.
As a board-certified lactation consultant, Vasquez
continues to promote breast-feeding and trains health
providers in supporting lactation practices for their
patients. n
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Cover Story
Patient-Centered
Environment
by Danielle Bullen
Nurses give a certain cachet to an increasingly common
role — chief patient experience officer
O
“
rganizations around the country are working to create
a patient-centered environment.” So said Sandy
Myerson, MBA, MS, BSN, RN. Myerson is one of
a growing number of executives who occupy the role
of chief patient experience officer, a position she
has held at the seven- hospital Mount Sinai
Health System in New York, N.Y. since
November 2014.
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Cover Story
This role “ensures a seat at the table for the voice
of the customer to be heard and acted on when
senior leaders gather and make decisions.”1
Larger, more forward-thinking organizations see the value in the position. The Cleveland
Clinic was the frontrunner, becoming the first
academic medical center to appoint a chief
experience officer and make patient experience
a strategic goal.2
With the Affordable Care Act now linking
part of Medicare’s payments to how patients
rate hospitals, having a point person to oversee
patient experience is becoming more crucial for
both a facility’s reputation and its bottom line.
Filling a Niche
Before her career at Mount Sinai began, Myerson
was a managing consultant for Press Ganey, the
company that processes the majority of patient
satisfaction surveys in the U.S., working with
hospitals all over the country to improve the
patient experience. The Mount Sinai Health
System leadership asked her to assess three
of its hospitals to see where they could
improve. One of Myerson’s recommendations included the appointment of
a chief patient experience officer
to orchestrate all the improvement initiatives around the patient experience.
The road to hiring a chief patient experience officer is a fairly typical one.
Organizations first realize something is lacking when it comes to their patients’
experiences and then prioritize improving the experience of care. A chief patient
experience officer is brought on board, and he or she builds a team and begins to
implement changes.
Since most organizations are still in the early stages of having a chief patient experience officer on staff, comprehensive feedback on the effects of this new model of
leadership — both financially and on patient perspectives — remain a few years out.1
Kenneth L. Davis, MD, president and CEO of the Mount Sinai Health System, and
“I think it’s helpful for someone with a clinical
background to be in this role because it brings a level
of credibility. I’m not just saying ‘do this.’”
— Sandy Myerson, MBA, MS, BSN, RN
Jeremy Boal, MD, chief medical officer, agreed with the need for this new C-suite
executive. The individual hospital leaders were focused on the day-to-day running
of their institutions. A system-level person could provide support and implement
change drivers.
When they had difficulty filling the role, Myerson presented herself as a candidate, a win for all sides. She explained, “What excited me about this organization is
the passion and drive that exist here to make the experience for patients and their
families better; they had a vision of where healthcare needs to go to be successful.”
Connecting With the Nurses
Reporting to Boal, Myerson describes her role as an internal consultant. Being an
executive-level position brings a certain clout to the role. “Our CEO, Dr. Ken Davis,
and CMO, Dr. Jeremy Boal, speak highly of me and promote my knowledge and
expertise,” she said. She interfaces regularly with the board of directors and articulates the value of patient experience, calling to it the level of attention it deserves.
Myerson has strong working relationships with the chief nursing officers,
chief medical officers and the chief operating officers of each hospital, and
meets frequently with other leadership team members, including the individual
nurse managers at each facility. She works to uncover both the challenges and
the opportunities at each hospital and figure out which changes will bring the
greatest improvement.
Besides dealing with the higher ups, she noted, “I’m in the weeds, rounding with
the front-line staff.” Her background as both an ED and a critical care nurse means
she has walked in their shoes and can bring her own experiences.
“Nurses often have the most one-on-one contact with patients of any care provider,
so CNOs and other nurse with executive experience have made successful CXOs,”
noted an article in Becker’s Hospital Review. “Nurses have seen the good, bad and
the ugly of patient care and are behind the drive to improve it.”3
Myerson concurred. “I think it’s helpful for someone with a clinical background
to be in this role because it brings a level of credibility. I’m not just another suit
walking around saying ‘do this.’” Knowing how hospitals operate makes it easier
for her to know what changes are the most feasible. Her forward thinking can help
predict the operational and financial impact of changes and to figure out how new
www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES
9
Treating you better…for life.
Cover Story
Saint Peter’s University Hospital was founded in 1907 and is part of
the Saint Peter’s Healthcare System formed in 2007, which reflects
the expansive scope of health and wellness services we offer to our
community. The system also includes the Saint Peter’s Foundation and
Saint Peter’s Health and Management Services Corporation, which
oversees various initiatives (the Margaret McLaughlin McCarrick Care
Center, CARES Surgicenter, and Adult Day Center in Monroe). Saint
Peter’s University Hospital is a state-designated children’s hospital
and regional perinatal center, an affiliate of The Children’s Hospital of
Philadelphia, and is sponsored by the Diocese of Metuchen.
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Change at the Unit Level
Many of the initiatives Mount Sinai Health System has undertaken
under her watch involve the individual nurses, those employees
who have the most contact with the patients.
One focus is daily nurse manager rounding. They look at issues
from the patients’ perspective and figure out what patients need
and want. When patients see the care team members working well
together, it adds to their overall experience.
‘Nurses often have the most one-on-one
contact with patients of any care
provider, so CNOs and other nurse
executives have made successful CXOs.
Nurses have seen the good, the bad,
and the ugly of patient care and are
behind the drive to improve it.’
—Becker’s Hospital Review
Nurse Manager – Pediatrics and PICU, Full Time
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Certification required. Must have minimum 3 – 5 years progressive leadership
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Healthcare providers required, PALS needed for PICU, ACLS and EKG needed for ICU.
Successful communication, both with patients and among clinicians, is a big factor on positive patient experiences. Myerson
explained, “We expect people to know how to communicate with
patients but haven’t taught them. We need to coach people on
communication best practices.”
Mount Sinai is focusing resources on that goal, including improved
physician communication skills and making physician satisfaction
scores transparent and more accessible. Executive leader rounding builds employee engagement and buy-in. Taking a page from
Lean Six Sigma, the system is reducing waste and implementing
processes that reduce variability.
For a chief patient experience office like Myerson to be impactful,
the support of both peers and higher-ups is instrumental.
Myerson acknowledged, “I am at a huge advantage,” due to an
endowment created by the Joseph F. Cullman, Jr. Institute for
Please email your resume to [email protected], or apply
online at www.saintpetershcs.com/CareerCenter.
254 Easton Avenue, New Brunswick, NJ 08901
www.saintpetershcs.com
EOE
­10 ADVANCE FOR NURSES MARCH 2015
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Cover Story
Patient Experience to fund patient experience initiatives across the healthcare system.
Listening and building relationships help
her to better understand the barriers to
improved experience of care. She says it
is helpful to have sufficient resources to
provide support, and those resources can
vary for different teams.
The goal is for all hospitals in the system
to be ranked in the top 10% nationally with
their HCAHPS scores within the next four
years. That is an ambitious undertaking,
but with Myerson’s vision at the helm, it’s
entirely feasible. n
Resources for this article can be accessed
online at www.advanceweb.com/nurses.
Click on Resources, then References.
Danielle Bullen is on staff at ADVANCE. Contact
[email protected]
Measuring the Impact
One of those resources is a team for data
reporting and analysis, so she can assess the
impact of changes. Outcome measures are
a critical component of patient experience.
The healthcare system analyzes its success
by way of its HCAHPS score, which are the
national, standardized surveys of patient
perspectives of care.
The surveys are sent to a random sampling
of patients after discharge. They contain 18
core questions about particular aspects of
the hospital experience, focusing on clinician communication, response time, pain
management, discharge instructions and
whether they would recommend the hospital. Sample questions include “Does the
nurse always communicate well?” and “Did
you receive help as soon as you needed it?”4
When compared to other New York hospitals, Mount Sinai Hospital, the flagship
hospital of the system, got higher than
average scores on its most recent survey of
patient experiences. The hospital received
its highest marks for the question, “Were
patients given information about what to
do during their recovery at home?”5
Myerson observed, “There’s a lot of positive energy and many people working to
make things happen.” Along with other
leaders, she is striving to create a “Mount
Sinai experience,” a patient-centered culture
that will provide a similar, positive experience across all parts of the system.
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www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES
11
Regional Focus
Cultivating Nurse
Leaders
George Washington University Hospital
gives its nurses a leg up on management
skills
By Danielle Bullen
WHETHER THEY are in the C-Suite or the intensive care unit,
professional development is critical to all nurses. Recognizing
nurse leaders might not have the same learning opportunities as
staff nurses, last year, the George Washington University Hospital
in Washington, D.C., launched a front-line leadership course for
nurse managers.
The eight-part course was developed by the corporate education office of the hospital’s parent company, Universal Health
System, which saw a need to develop nursing leaders. Under the
guidance of Rose Labriola, EdD, MSN, RN, chief nursing officer
and Eugenia Powell, Phd, RN, NEA-BC, director of professional
development, George Washington University Hospital modified
it to meet their needs. Each session was offered twice per month
to maximize attendance potential and nurse managers, clinical
supervisors and charge nurses attended.
Management Topics
Powell explained, “How to hone in on transformational leadership
skills was main theme.” Topics for discussion included the front-line
nurse leader as chief retention officer, where nurses learned how
trust and active listening can retain staff; effective delegation or
how to hold staff accountable; motivating and coaching staff, and
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Stronger Relationships
Going into the program, according to Powell, the
goal was to “enhance and improve nurse leadership
competencies.” The participants assessed their
own management styles throughout the eight
months. Rhodes-Vivour explained, “You can easily
get wrapped up in stuff and make an emotional
decision that could be detrimental.” Instead, the
nurse managers learned about emotional intelligence and best practices for decision making.
One key part of nurse leadership is developing
critical relationships with staff. Powell said, “If
you’re a leader, it is important how you connect
with your staff. It’s how you move to another level.”
Connection means hearing them and letting them
be involved in decision making.
The nurses who went through the program
shared positive feedback. Rhodes-Vivour, for one,
thinks it is an excellent opportunity for those
nurses who are new to leadership roles, as it gives
them a new foundation from which to grow.
Overall, the nurse managers enjoyed it
immensely and were grateful the hospital offered
the training. George Washington University
Hospital is looking to repeat the course again this
year for newly-hired managers and supervisors. n
Danielle Bullen is on staff at ADVANCE. Contact dbullen@
advanceweb.com
KYLE KIELINSKI /thanks to The George Washington University Hospital, Washington, D.C.
LEARNING OPPORTUNITY:
Meedie Bardonille and Sarita
Rhodes-Vivour, two nurse
managers at the George
Washington University
Hospital, took the leadership
course.
on the flip-side, disciplining staff; best practices
for using data to drive outcomes in the unit;
evidence-based practice and nursing research
for quality improvement; financial guidelines
for reconciling productivity; patient experience
and patient culture, where nurses learned communication tools that hard-wired safety into the
work day; and stress management and succession
planning for nurse leaders.
Sarita Rhodes-Vivour, MSN, RN, CCRN, nurse
manager of an internal medicine unit, appreciated
that the teachers were fellow nurse leaders from
the hospital. “They understand our day-to-day so
we could be more candid,” she noted.
Classes, held in the hospital auditorium, consisted of a variety of teaching styles, including
dialogue, small groups, role-playing, videos and
self-assessments. “The content was applicable
and not just conceptual. We drilled it down to
the day-to-day operations,” said Powell. Classes
included examples of real cases to evaluate.
“It was a good opportunity for us to talk about
what we’re doing in real time,” Rhodes-Vivour
explained.
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GW Hospital: Currently accepting applicants in
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To Apply, visit www.gwhospital.com/careers
or call 202-715-4406
Regional Focus
Moving Patients
Teamwork helps in the creation of new
facilities in one hospital
By Marybeth McManus, MPA, BSN, RN-BC
THE TEAM: Gerald Ajayi, RN, (left, front) Susan Fitzgerald, RN, Kristy Loewenstein, RN, Marie Horowitz, RN, Joseph Whelan, RN, Craig Washington, patient
support manager (back, left) Linda Minlionica, RN, Barbara Russo, RN, Paul
Panakal, RN, Alicia Yorke, RN, Kathryn Nash, Fairfield University student, Marybeth McManus, RN, and Mary Ann Haran, RN. photo courtesy Zucker Hillside Hospital
A NEW PSYCHIATRIC FACILITY with six inpatient units, an
electroconvulsive therapy suite and a pharmacy was to open at
Zucker Hillside Hospital-NSLIJ Health System, Glen Oaks, N.Y.
An interdisciplinary Transition and Occupancy (T & O) Steering
Committee Team, led by nursing administration, convened more
than a year before the move to lead the staff through changes.
A formal Plan of Concept was developed to secure executive
sponsorship, outline a comprehensive education program, discuss
the design of the units, create a schedule to move 131 patients in
one day, and make decisions on the care model, equipment and
clinical programming. In addition to new team structures and
new environments of care, staff needed to be deemed competent
in Pyxis medication administration, revised dietary services, life
safety policies and procedures for a new building, and new staff
safety alarm and nurse call systems.
In one day, the hospital would go from providing services on
nine units in six buildings to 10 units in two buildings. Such a
significant organizational change required the T & O team to work
closely together to assure quality and safety in all aspects of care
delivery throughout the process. The strongly bonded teams on
the existing units had worked together for numerous years with a
turnover and vacancy rate well below the national average. The T
& O team quickly identified a widespread reluctance to any change
in structure during initial focus groups.
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John Kotter’s theory of change management
was chosen to organize the cultural change for
staff adaptation. Initial efforts to create a sense of
urgency included a logo competition; the winner
– “10 units, 2 Buildings, 1 Team” under a graphic
of the new building, was printed on notepads and
mouse pads and all communications from the
team. Newsletters included articles on change and
consistent reinforcement of the team’s mission,
goals and strategies. Ongoing focus groups provided motivation and strengthening of the shared
mental model. Minutes of clinical sub-committees
encouraged staff members to participate in T &
O team activities, including biweekly interactive
exercises to establish credibility, assure communication with all levels of staff, build confidence
in the course of action, constantly analyze the
process, and reinforce urgency.
The vision and strategy defining the culture
change, along with the transition and occupancy
of the new building, required the team to be adaptable, flexible and strongly committed to patient
and family-centered care. As the transition became
imminent, interdisciplinary staff participation
in the T & O meetings increased to make shared
decisions about equipment, clinical programming and the logistics of moving 131 patients in
one day, empowering staff to participate in the
change process. The T & O team worked closely
with physicians to identify which patients would
be reassigned to a new unit and care delivery team.
Several sub-committees reported to the T & O
committee, which then consolidated individual
committee efforts into the overall plan to transform the culture. An education sub-committee
of the T & O committee was formed to create a
comprehensive training program for education
of the 500 nursing staff.
Transition to the new facility was successful.
131 patients were moved in 7 hours with customized transport plans, no disruptions in treatment
or appointments, no occurrences, and no misplacement of property. Team members spread
confidence and enthusiasm and assured safety.
Staff members were all compliant with training,
and 100% of the nursing staff attended their 8
hour training day, demonstrating a truly engaged
workforce. Allowing staff members a full shift to
train in the new site allayed anxietyand led to a
safer transition. n
Marybeth McManus is associate executive director and
chief nurse, Zucker Hillside Hospital-NSLIJ Health System,
Glen Oaks, N.Y.
Regional Focus
different elements and decide if the patient is a
candidate,” he explained.
The team considers the patient’s goals and
assesses if they are cognitively stable, determining
if the procedure could cause any cognitive deficits
SYSTEM CHECK: Carlos
Rodriguez, RN, CCRN, tests
the equipment used in
the Stanford Movement
Disorders Center.
Brain Waves
Deep Brain Stimulation
Nurse coordinator at Stanford Healthcare
helps Parkinson’s patients manage their
disease
NORBERT VON DE GROEBEN/Stanford Health Care
By Danielle Bullen
FOR PATIENTS with Parkinson’s disease, tremors, rigidity and
bradykinesia are often an expected part of life. Yet, it does not have
to be that way. Technology, in the form of deep brain stimulation
(DBS), a sort of pacemaker for the brain, can help with the motor
symptoms of those with Parkinson’s and a few other movement
disorders. Stanford Healthcare in Stanford, Calif. is one such
facility that offers DBS.
Carlos Rodriguez, RN, CNRN, works as the deep brain stimulator program and Stanford balance center nurse coordinator. He
brings a long-standing interest in neuroscience to the role, dating
back to his days in nursing school at Washington State University.
Choosing Candidates
The DBS program at Stanford Healthcare is under the umbrella
of the Stanford Movement Disorders Center, which sees patients
with many diagnoses. However, Parkinson’s, essential tremor and
a very specific type of dystonia with a genetic component are the
primary diagnoses for the surgery.
Rodriguez is responsible to guide the patient through the presurgery phase, making sure they are evaluated by the neurologist
and neuropsychologist. Evaluations take place over two days, one
while the patient is on medication and one while they are not. “All
the staff gets together and discusses the patient. We look at the
DBS consists of two phases. During surgeries,
the leads are implanted in the subthalmic region
of the brain. In a separate procedure, the neurostimulator, which delivers electronic signals to
the brain, is implanted under the collarbone. The
two components are connected via the extension,
an insulated wire.
“We give patients time to heal and recover
from the stress the surgery causes the body,”
explained Rodriguez. This is especially important
as stress can increase Parkinson’s symptoms. A few
weeks after the operation, the device is turned on.
DBS sends out electrical pulses that change how
Parkinson’s impacts movement. Rodriguez is in
charge of the methodical programming needed
to find the most therapeutic settings.
He uses the United Parkinson’s Disease Rating
Scale III to assess the patient’s motor control
before the DBS, and then again after implantation,
assessing the effectiveness of therapy, pre- and postimplantation. The essential tremor patients write
and do other fine motor tasks with their hands.
If the tremor goes away without side effects,
the procedure is considered a success. According
to Stanford researchers, DBS allows for a 60-80%
improvement in symptoms and a 50%-60% reduction in medication.
Nursing Knowledge
As a nurse, Rodriguez brings a specialized knowledge
to the proceedings. He uses his past work experience at an inpatient neuroscience unit at as a point
of reference. He explained, “I did not see the rest of
the story with the inpatient neurological patients.”
He is able to connect everything together and
have a broader view of what the patient goes
through. He looks at the whole patient and helps
them manage their entire disease.
The DBS patients will return to the clinic for
adjustments, so Rodriguez can follow their progress
more so than with other patients.
“That interaction with patients is what we nurses
do all the time. We are the frontlines no matter
where we are.” n
Danielle Bullen is on staff at ADVANCE. Contact dbullen@
advanceweb.com
www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES
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Perioperative Certification
Research links nursing care and education
By Jim Stobinski, PhD, MSN, RN
IN NOVEMBER of 2014, the AORN Journal published the results
of a research study, The Relationship Between Direct-Care RN
Specialty Certification and Surgical Patient Outcomes.1 This was a
study initiated and directed by nurses with funding from a diverse
group of nursing certification organizations. The article detailed
the results of a large multi-hospital study that looked at complications experienced by surgical patients. I was one of the authors of
the study and I would like to share my thoughts on how this work
fits into the larger picture of nursing and our healthcare system.
Our study examined the relationship between the care delivered
by certified nurses to surgical patients and the occurrence of nursing sensitive patient outcomes. Using the National Database of
Nursing Quality Indicators (NDNQI), we examined care given in
surgical intensive care units (SICU) and med/surg units. Some of
the results were encouraging and came out as we had anticipated.
For example, we found that in the SICU setting that lower central
line-associated bloodstream infections rates were significantly associated with higher rates of nursing certification in two specialties.
But, we also unexpectedly found that under some conditions higher
rates of certification in perioperative nurses were associated with
adverse events like higher rates of pressure ulcers following surgery.
These are not the results we had anticipated, but we believe the study
still has value for the nursing profession. Let me explain further.
Significance for Nursing & American Healthcare
I urge you to thoughtfully read the article as I believe that this
type of research will have increasing importance in the evolving
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American healthcare system. I wish I could report
clear and convincing research-based evidence
from this study that clearly supports my long held
views — but I cannot. That fact does not, however,
detract from the importance of the study. As we
explore the effectiveness of our healthcare delivery
system, research such as this will become more
prevalent and we will come to examine more of
our current assumptions.
For example, one long-held assumption is that
higher levels of nursing education and increased
professional development will yield better patient
outcomes. That is an assumption underlying
mandatory continuing education, the push to
BSN-level education, certification and other
professional development activities. Nursing, as a
profession within the larger system of American
healthcare, will be challenged to strengthen the
evidence underlying these assumptions. Changes
in healthcare financing will force us to become
even more efficient and also to investigate the
causes of complications that result in non-reimbursable care. Examples of these complications
include events like pressure ulcers, urinary tract
infections and central line infections following
surgery that we studied.
Value-Based Purchasing
American healthcare is in the midst of tremendous
change with some of the biggest changes coming in
the area of healthcare financing. In general terms,
we are shifting from a system of care based mainly
on the volume of care and services provided to one
in which the value of care is also rewarded. The
Value-Based Purchasing (VBP) initiative from the
KYLE KIELINSKI
Certification in the OR
Perioperative Certification
Centers for Medicare & Medicaid Services
(CMS) is a prime driver in this transition. The
VBP program, “…rewards acute-care hospitals with incentive payments for the quality of
care they provide to people with Medicare.”2
The program aims to reward facilities for
adherence to best clinical practices and for
enhancing the patient care experience. The
net result of changes in reimbursement is
that high rates of complications and avoidable events will have a negative impact on
hospital reimbursement.
Complications such as those that we
studied are common examples that may
be traced to care delivered in the operating
room and in the units that care for postsurgery patients. Closer examination of these
events may reveal factors such as education
and training methods, orientation processes
and professional development practices
that can be modified to yield better patient
outcomes. Non-reimbursed care secondary
to complications and never events will have
increasingly significant budget implications
for healthcare facilities. This will in turn open
the door to a fresh look at factors that affect
these outcomes. One method to examine
factors such as the effect of professional
development activities will be research.
Examining Quality in Healthcare
Donabedian spoke to the necessity of examining three components of healthcare, structure,
process, and outcomes, if we are to make
meaningful change in healthcare quality.3 Our
research begins to point out the complexity
of all the influences which are in play in this
relationship between the characteristics of
the nursing workforce, the care nurses deliver
and nursing sensitive patient outcomes. From
our work we now know more of the factors
which can influence patient outcomes both
from the structure and also the process aspect.
These findings present further opportunities
for study but also reveal layers of complexity
in this picture.
A summary regarding priorities on credentialing research in nursing, which was
just recently released by the Institute of
Medicine, points out just how complex
this relationship will be to study.4 In this
summary, Jack Needleman, a professor of
Health Policy and Management at UCLA,
refers to the term Invisible Architecture.
Invisible Architecture being, “…the structures of culture, leadership, and climate
within an organization; by catalyzing the
synergies between physicians and nurses,
these structures can lead to organizational
excellence.” [Appendix B, p. 103]. This overarching term encompasses a multitude of
factors such as the quality of nurse/physician relationships that could be studied to
more fully understand the influences on
nursing-sensitive patient outcomes.
Reinforcement for the need to fully examine the complex processes affecting patient
outcomes also comes from earlier scholarly
work by nurse researchers. Armstrong and
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Perioperative Certification
Laschinger5 also point out that nurse leaders have an important role in assuring that
all the necessary components are in place
to facilitate improved patient outcomes.
They stress patient outcomes result from
processes enabled by both administrative structure and the work and leadership
of nurses. These findings are congruent
with the statements by Needleman and are
also framed within the familiar lexicon of
Donabedian’s influential work.
(CCI) which is my employer, was one of the
funders of this research. CCI is continuing their support of nursing research and
is working with the NDNQI staff and the
authors of this study on further research.
The next step in our research agenda will
be a large, multi-site study that will examine
the relationship between nursing care and
the incidence of surgical site infections, the
most common complication of surgery. This
is but one example of the opportunities now
open to perioperative nurse researchers. n
Future Research Opportunities
References
1. Boyle, D. K., Cramer, E. Potter, C. Gatua, M. W. &
Stobinski, J. X. (2014). The relationship between direct-care
RN specialty certification and surgical patient outcomes.
AORN Journal, Vol. 100, Issue 5, p 511–528.
2. Centers for Medicare & Medicaid Services. (2012).
Frequently Asked Questions Hospital Value-Based
Purchasing Program. [On-Line]. Accessed 4 March 2015
The NDNQI database is a rich opportunity
to support further research. This database
continues to grow in both size and depth
offering a rich, diverse source of nursing
data for which researchers are just now
beginning to realize the full potential.
This study demonstrates what is possible in terms of research. Our findings
are one small building block upon which
others can expand the knowledge base. The
Competency and Credentialing Institute
at: http://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/hospital-value-basedpurchasing/Downloads/FY-2013-Program-FrequentlyAsked-Questions-about-Hospital-VBP-3-9-12.pdf
3. Donabedian, A. (2005). Evaluating the quality of
medical care. Milbank Quarterly. Volume 83, Issue 4,
pages 691–729,
4. IOM (Institute of Medicine). 2015. Future directions
of credentialing research in nursing: Workshop summary.
Washington, DC: The National Academies Press.
5. Armstrong, K. J. & Laschinger, H. (2006). Structural
Empowerment, Magnet Hospital Characteristics, and
Patient Safety Culture: Making the Link. Journal of
Nursing Care Quality: April/June 2006 - Volume 21 Issue 2 - p 124–132.
Jim Stobinski has in excess of 25 years of experience in the OR with roles that have included janitor, orderly, staff nurse and supervisory positions.
He is the director of credentialing and education
at the Competency and Credentialing Institute in
Denver and also works as adjunct faculty at Nova
Southeastern University in Ft. Lauderdale, Fla.
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BE SURE to “like” the ADVANCE for Nurses Facebook page to see updates, special offers and events. Find us
at www.facebook.com/ADVANCEforNurses.
FREE IN-PERSON JOB FAIR
New York, NY
Tuesday, April 28
Exhibit Hall: 10:00am-2:00pm
Sessions: 10:00am-1:00pm
Wyndham New Yorker Hotel
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­18 ADVANCE FOR NURSES n MARCH 12015
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3/9/15 2:58 PM
Med/Surg
Acuity-Based Staffing
AS THE HEALTHCARE INDUSTRY continues a shift toward
an accountable care model, hospital decision-makers will need to
become more forward thinking in how they deliver personalized,
high-quality care, while keeping costs down.
The solution lies in moving from opinion-based systems to
acuity-based staffing models, which allow hospitals to pair nurse
talents, skills and experience with specific patient needs.
Another process involves estimating the
time needed for tasks and procedures based
on actual measurements of how long it takes
nurses to complete certain tasks. To arrive at
time standards, observers measure the actual
time needed for nursing tasks such as medication
administration. Generalized time standards are
then based on these timed observations. The
challenge with this method is that generalized
task/time measurement cannot account for
patient variations, such as emotional distress
and family support systems. With this method,
it’s also challenging to measure the intellectual
work of the nurse, such as patient engagement,
emotional support, assessment, planning and
other professional activities.
Previous Solutions to Nurse Staffing
Taking Advantage of EHR
There have been many attempts to validate the needs of the patient
with appropriate care delivery systems. One such approach classifies
patients into categories based on the number of direct nursing and
technical support needed. The most common is a system where
the nurse uses an informed opinion to categorize patients into
groups based on the hours needed for care. The problem with this
method lies in the subjectivity of the analysis and the reliability
between nurses.
The electronic health record (EHR) provides
an abundance of info about the patient that
should be considered when assigning patients
to nurses, however, without the right staff in
place to care for that particular patient’s specific
needs, the valuable information in the EHR just
goes to waste.
Nurse assignments should never be one size
fits all. Some patients may have a condition that
requires a high number of patient care hours.
Some patients may have a unique set of personal
and environmental factors that require a certain
skillset to manage. The “source of truth” about
a patient’s condition lies in the medical record.
This type of information in the EHR is too complex to be stored in the heads of staffing managers
or the staffing office personnel. Now that EHRs
are documenting the patient condition, we have
information available to better classify patients
and create acuity-based nursing assignments,
ensuring the needs of the patient are captured
with each assignment. Using this data, nursing
time can be based on the actual acuity of the
patient, not an average or estimate.
The technology collects the information electronically and provides an analysis, which quickly
develops a data-driven profile of the patient.
Variations between patients with similar diagnoses such as age, mobility, level of consciousness,
etc., can be determined from the documentation and incorporated into the analysis of the
patient needs.
Striking the perfect match when pairing
nurses with patients
JEFFREY LEESER/thanks to Capital Health Regional Medical Center, Trenton N.J.
By Karlene Kerfoot, PhD, RN, NEA-BC, FAAN
Key Benefits of Acuity-Based Nurse Staffing
Nurse satisfaction and retention
Acuity-based assignment methods are beneficial
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for maintaining high employee satisfaction. Just as each patient is
different, each nurse brings different experiences and strengths
to the job. Matching nurses with patients that complement their
skills and preferences can help improve nurse retention by avoiding
the situations that increase unwanted employee turnover, due to
burnout, fatigue or general dissatisfaction. Conscientious employers recognize continuous recognition and utilization of individual
nurse qualities increases productivity and keeps nurses satisfied
with their role on a daily basis.
Reduced costs
Nurse burnout, retention, and satisfaction also have a direct impact
on a hospital’s bottom line. Nurses want to treat all of their patients
safely, effectively, and compassionately. However, when their
workload is not balanced and nurse assignments prohibit them
from providing adequate care, dissatisfaction begins to take over
and turnover rates increase. Replacing a healthcare employee can
cost as much as 250% of their salary.
Improved patient outcomes
In a value-based market, where outcome metrics are tied to financial performance of the organization, acuity-based staffing can
help achieve a higher likelihood for positive outcomes. Accurately
balancing patient care needs with nurse workload and skill mix
can help maximize potential revenue and minimize harm. Having
nurses with the right skill sets and the necessary competencies
readily available to take care of the right patient at the right time is
essential to achieving quality of care, patient safety, and financial
health goals in this new era of value-based purchasing.
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Continuity of care
The best acuity systems integrate with staffing and scheduling
systems to automatically assign the same clinicians to care for
the same patients on a regular basis. Patients benefit from this
consistency, and nurses are able to take advantage of the opportunity to learn more about their patients through regular, ongoing
interaction and direct patient care.
Thanks to EHRs that give us a more accurate picture of patient
needs, we now have the opportunity to transition from opinionbased to evidence- and data-driven staffing decisions. We can
better match nursing skills and the amount and type of nursing
time needed based on actual data, not estimates or subjectivity. n
Karlene Kerfoot is chief clinical integration officer, API Healthcare, a GE
Healthcare Co.
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Lifestyle
TV Diets: Bust or Boon?
Diet Desperation
Let evidence be your guide when
recommending weight loss strategies
JEFFREY LEESER
By Valerie Neff Newitt
WHEN PATIENTS see extra pounds on the scale, even the worst
diet may seem a reasonable option. Imagine the level of desperation required to ingest cotton balls (a practice commonly called
the Cotton Ball Diet) for calorie-free satiety — and unanticipated
intestinal blockages. Then there is the Tapeworm Diet: Dieters eat
tapeworm eggs to reap weight-loss “benefits” as developing worms
“gobble up” excess calories.
Sometimes eyebrow-raising approaches can have medical benefit.
The KE Diet (so named for the ketosis it achieves) can produce a
weight loss of 1 to 2 pounds per day over a 10-day cycle. Creator
Oliver Di Pietro, MD, has been featured on CBS’ “The Doctors”
and ABC News Report to talk about his innovation, alternatively
called the Feeding Tube Diet. This medically supervised diet is
administered through a feeding tube, eliminates carbs completely,
supplies 800 calories a day, and puts dieters into fat-burning nutritional ketosis. Proponents say it is a viable option for very obese
patients and patients with type 2 diabetes.
Di Pietro told ABC News that patients are “… not hospitalized
... Instead, they carry the food solution with them, in a bag, like
a purse, keeping the tube in their noses for 10 days straight. The
main side effects are bad breath; and there is some constipation
because there is no fiber in the food.”
Patients often take dieting cues from television
shows like “The Biggest Loser” and “Extreme
Weight Loss,” which combine supervised diet and
exercise to guide morbidly obese participants to
the Valhalla of fitness. These shows suggest that
massive poundage can be lost quickly and safely.
While a 1- to 2-pound loss per week has long
been considered a safe pace, some practitioners
believe more rapid loss has benefits.
Holly Wyatt, MD, is director of the University
of Colorado’s Anschutz Health and Wellness
Center in Denver. She is medical director for
ABC’s “Extreme Weight Loss,” filmed in part at
the center. “The notion of safe loss rates is changing,” she explained. “The accepted 1 to 2 pounds
per week was supported by data that said losing
more rapidly wasn’t any better — not that it was
any worse.” The guidelines emerged because
slower losses reduce the risk of gall stones or gout
flareups associated with rapid loss.
Wyatt said newer data suggest that quicker loss
followed by a maintenance period may be a better
approach. “Patients need to get weight off quickly to
fuel future success. Our strategy here [at Anschutz]
is to get as much weight off a patient as is possible
in a finite period of time. We maximize the effort
while patients are still able to adhere to a diet —
usually a maximum of 6 months — then move
them to maintaining their losses.” Wyatt said the
rapid loss-to-maintenance process can eventually
start all over again, if more weight must be lost.
She explained that the most rapid loss is produced via a very low calorie diet (VLCD; about
800 calories) delivered under medical supervision
to ensure nutritional needs are met, electrolytes
are normal, medications are adjusted, side effects
are minimal, hydration is adequate, and supplements are administered (such as adding fish or
olive oil to avoid gall stone formation). She said
800 calories produces optimum losses; there is
no advantage to cutting to 600 calories.
So Many Diets, So Little Time
Aside from VLCDs, other diet regimes are trending
for 2015. Katie Ferraro, MPH, RD, CDE, is author
of “Diet Therapy in Advanced Practice Nursing”
and is an assistant clinical professor who teaches
NP students at the University of California San
Francisco and the University of San Diego.
“There will be questions about blending and
fasting diets,” she predicted. “It’s important for
NPs to know that not all cleansing patterns are
harmful, as long as they are limited to 1 or 2 days.
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Some patients use a cleanse to start significant changes in eating;
it represents a psychological break from bad habits.”
She noted that juicing and blending are not interchangeable terms.
“Juicing extracts juice and removes pulp, whereas blending
retains valuable fiber, phytochemicals — the whole food.” In short,
blending is a better option.
Gluten-free diets have become uber-trendy as well. “There’s a
gluten-free obsession, yet we should remember that only 1% of the
population needs a gluten-free diet,” Ferraro said.
“Certainly there’s nothing wrong with a patient removing refined
white breads from the diet; they will benefit whether they have celiac
disease or not,” she said.
But Ferraro warned that patients should be wary of the spate of
gluten-free products flooding the consumer marketplace.
“These are primarily highly-processed, gluten-free versions of
junk food — foods patients shouldn’t be eating in the first place.
NPs need to educate around foods that are naturally gluten-free,
whole grains like buckwheat, quinoa, millet, oats.”
Ferraro gave a thumbs up to sugar detoxes, such as a now-popular
10-day “sugar challenge” to eat only foods without added sugar. “I
believe these will become more popular as people recognize there
is high fructose corn syrup in everything,” she said. “Just look at
yogurt labels — some have sugar as the first ingredient.”
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The list of prevailing diets is extensive — from South Beach to Paleo
to Atkins to Weight Watchers to Jenny Craig to Mediterranean and
beyond. Wyatt said there really is no “best” diet when it comes to
weight loss. “When we’ve done head-to-head comparisons of The
Zone Diet to the Ornish Diet to Weight Watchers, none came out
the clear winner. The best diet is the one a patient will adhere to
and tolerate the longest.”
The point is that any patient can lose weight with calorie restriction and exercise. Wyatt stressed that maintenance, not weight
loss, is the toughest part of transformation.
“Physical activity is the key driver to maintenance success,” she
said. “Data show that 70 minutes of moderate intensity exercise 6
days a week is, on average, necessary.”
Ferraro summed up the best way to dispel diet desperation. “There
is so much noise about diet, food and nutrition online, patients
are bound to be confused about what they should eat,” she said.
“NPs must guard against adding to that confusion by supporting
evidence-based diet therapies only. We have clear evidence about
carbohydrate-controlled diets, low-fat diets, calorie-controlled
diets. ” ■
Valerie Neff Newitt is a staff writer. Contact: [email protected].
Your Source for Lifestyle Advice
THE ADVANCE FOR NURSES website is proud to bring you expert advice
on lifestyles issues such as healthy eating, work-life balance and personal
time. Visit the Lifestyles Resource Center at www.advanceweb.com/
NurseLifestyle for the latest features, columns and blogs.
­22 ADVANCE FOR NURSES MARCH 2015
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CE Offering: Trauma
Rapid Trauma
Assessment
What nurses need to know
JEFFREY LEESER
By Helene Harris, MSN, RN
TRAUMA CARE occurs wherever nurses care for injured patients,
from prehospital assistance through emergency department resuscitation to surgery and recuperation and return to the community.1
Though we generally think of trauma assessment in association
with emergency department nursing, rapid and thorough physical
assessment is a skill set all nurses can use when they need to act
quickly to care for patients in acute distress. This article reviews
the steps performed in a primary and secondary trauma assessment and discusses the emotional impact of trauma on the patient,
family and nurse.
Trauma care requires a systematic process of identifying, treating,
and stabilizing patients with potentially life-threatening injuries
in an organized and timely manner. Time is a critical factor, so
having a process that is methodical, easy to learn and perform,
and consistent for all the members of the trauma team is the most
effective way to provide care.1
To provide clarity and ease of flow, the initial trauma assessment is divided into a primary and secondary assessment format
by linking letters with associated care. Starting with the letter A
and moving through the letter I, the primary and secondary survey
assessment format provides a logical sequencing of assessment and
treatment. The primary assessment provides a quick check of vital
oxygenation, perfusion and neurologic function with appropriate
interventions if life-threatening deficits are noted in these areas.
The secondary assessment follows up with a more comprehensive
look at the person’s physical status and provides further interventions for continued patient care.1
Primary Assessment
The primary assessment survey begins the moment the patient
arrives at the emergency department. Observing the patient across
the room provides for rapid determination of his
or her overall physiologic status and the presence of any uncontrolled external hemorrhage.
If identified, the usual ABC assessment format
may be reprioritized to <C>ABC for hemorrhage
control. The <C> stands for catastrophic hemorrhage. Then the nurse follows the primary survey,
which consists of the following areas: A (alertness/
airway), B (breathing), C (circulation), D (neurologic disability), E (exposure and environment),
and F (focused adjuncts and family presence).1
A = Alertness & Airway
A quick assessment of the patient’s level of consciousness is obtained by assessing the patient
with the “AVPU” mnemonic, which indicates
whether the patient is alert, responsive to verbal
commands, responsive to painful stimuli, or
unresponsive. The alertness level of the patient
can be an important determinant for selecting
appropriate airway intervention.
The airway is then assessed for patency, while
maintaining cervical spinal immobilization.
Always assume a neck injury is present in any
patient with multisystem trauma, especially if
injury is suspected above the collarbone. If the
patient does not have a cervical immobilization
brace, the nurse should apply one or ensure the
neck is stabilized manually.
If the patient is awake with a patent airway, he
or she may assume a position to allow for sufficient
www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES
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CE Offering: Trauma
air exchange. If the airway is not patent, the
nurse should use a jaw thrust maneuver
to open the airway. Inspect the mouth for
tongue obstruction, loose or missing teeth,
foreign objects, blood/vomitus/secretions,
and swelling. Also assess for snoring, gurgling, and stridor. Intervene as needed to
maintain airway patency. This may require
suctioning vomit, blood or secretions to
prevent aspiration, and removal of foreign
objects.
In addition, airway adjuncts, such as a
nasopharyngeal airway or an oropharyngeal
airway, can be used to facilitate the airway’s
patency. If the interventions do not clear
the airway, or if the patient’s condition and
injuries cause concern for the ability to
maintain a patent airway, the patient should
be prepared for immediate intubation with
a definitive airway.1-4
B = Breathing
The nurse should assess the patient for spontaneous breathing. If breathing is absent,
rescue breathing should be initiated using
a bag-valve mask device, ventilating the
patient every 5 to 6 seconds (10 to 12 breaths
per minute) for adults, with faster rates
for children (every 4 seconds) and infants
CE OFFERING
This offering is worth 1 contact hour.
This offering expires in 2 years:
MARCH 16, 2017
Learning Objectives
After reading this article, the learner
should be able to:
1. Describe the requirements of providing
effective trauma care.
2. Describe the rationale for utilizing a
standardized Primary and Secondary
manner of head-to-toe assessment on
trauma patients.
3. Identify reasons that trauma nurses
may experience moral/emotional distress.
To take this test, go to www.advanceweb.
com/NurseCE and look for #520. You may
take the test online, or download the answer
sheet and send it in.
Online CEs
Earn contact hours with just a click of the
mouse, www.advanceweb.com/nurseCE
­24 ADVANCE FOR NURSES MARCH 2015
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(every 3 seconds). If the patient is breathing, the nurse should look at the rise and
fall of the chest, assessing for symmetry,
depth/rate/pattern of breathing, and signs
of respiratory difficulty, such as accessory
muscle use, diaphragmatic breathing, paradoxical breathing (flail chest) retractions
in children, etc.
The nurse should assess for skin color,
contusions, abrasions, deformities and open
wounds, along with tracheal deviation or
jugular venous distension (JVD). Bilateral
breath sounds should be auscultated to
determine whether they are absent or present, as well as for any adventitious sounds
(crackles, wheezes, rhonchi). Palpate bony
structures for possible rib fractures and
soft tissue for subcutaneous emphysema. In
addition, assess for signs of inhalation injury,
such as singed nasal hairs or carbonaceous
sputum, especially if the trauma included
explosions or flames.1-4
Supplemental oxygen should be administered at 15 L/min preferably via a nonrebreather mask with an oxygen reservoir. If
the patient has ineffective breathing or any
signs of respiratory distress, the nurse should
assist ventilation with a bag-valve mask
and anticipate the insertion of a definitive
airway. Penetrating objects should be left in
place. Life-threatening injuries, such as flail
chest, hemothorax, open pneumothorax,
and tension pneumothorax require rapid
identification and immediate intervention.
For example, if the patient has a tension
pneumothorax, the nurse may assess absent
or significantly diminished breath sounds to
one lung, with anxiety/restlessness, severe
respiratory distress, jugular vein distension, cyanosis and a deviated trachea. This
patient needs immediate decompression
via needle thoracentesis and insertion of
a chest tube.1,2,4-6
C = Circulation
The circulation evaluation focuses on assessment of bleeding, pulses and skin. Assess
the patient for any obvious signs of external
bleeding. If noted, the nurse should take
appropriate measures to control it, such as
applying direct pressure to the site, elevating
a bleeding extremity, applying pressure to
arterial sites, and considering tourniquet
use (life over limb situations only).
www.advanceweb.com/Nurses
Check central pulses (carotid, femoral)
for rate, regularity and amplitude (weak,
thready, bounding). Strong, regular pulses
at a normal rate for the patient’s age may
indicate normovolemia, while rapid, thready
pulses could identify hypovolemia and even
shock. Irregular pulses could mean potential
cardiac dysfunction.
Pediatric patients also require peripheral
pulse and capillary refill assessment as part
of the primary survey, since these are good
measures of tissue perfusion in younger
patients. If the pulse is absent, cardiopulmonary resuscitation should be initiated. Skin
should be assessed for color, temperature
and moisture; cold, clammy, pale patients
increase the suspicion of potential blood
volume and perfusion issues.
The nurse should insert two large-bore
intravenous catheters and obtain blood
samples (type and crossmatch is priority, other labs as able). Administer fluids,
including isotonic crystalloid solutions like
0.9% saline (warmed), and blood/blood
products as ordered. If unable to obtain
venous access rapidly, intraosseous or central
venous access options should be considered.
Life-threatening situations, such as cardiac
tamponade, require immediate intervention.
The nurse should be prepared for rapid
transfer to an operating suite if patient
condition requires immediate surgery.1,2,4
D = Disability
Primary assessment of the patient’s neurologic status involves identifying level of
consciousness (LOC). The Glasgow Coma
Scale (GCS) monitors LOC by reviewing
the patient’s “best” response in three areas:
eye opening, verbal response, and motor
response. Although it is not accurate for
intubated or aphasic patients who are unable
to respond verbally, the GCS scale offers
a standardized format for evaluation of
patient’s LOC and an objective tool for communicating among healthcare professionals. Interventions for altered LOC include
preparation for computed tomography scan
of the head.
In addition, arterial blood gasses and
glucose levels should be drawn to determine
if hypoventilation, acid-base balance issues
or hypoglycemia is contributing to an alteration in neurologic function.1,2,4
CE Offering: Trauma
E = Exposure
Secondary Assessment
Clothing should be carefully and completely
removed to facilitate a full assessment of
the patient. The nurse then assesses again
for any uncontrolled bleeding and obvious
injuries. Following the quick viewing, the
patient should be kept warm (e.g., warm
blankets, warmed IV fluids, radiant warming lights, etc.) to prevent any heat loss.1
It is important that the nurse monitors for hypothermia in trauma patients.
Hypothermia can precipitate the development of acidosis, as well as coagulopathy,
which can negatively impact microvascular
blood flow.2,4,6
The secondary assessment begins after the
completion of the primary survey assessment, initiation of resuscitation efforts
and application of appropriate adjuncts. It
completes the overall trauma assessment
letter mnemonic with the letters H and I.
H refers to both history and head-to-toe
assessment. I represents Inspection of the
patient’s posterior surfaces.1
F = Facilitate Adjuncts & Family
A complete set of vital signs, including blood
pressure, pulse, respirations and temperature, should be obtained, with trending of
the vital signs at regular intervals to assess
the patient’s status and the effectiveness of
interventions. In addition, family should
be encouraged to be present during the
resuscitation and for invasive procedures,
in accordance with the patient’s and family’s wishes.1
G = Get Resuscitation Adjuncts
At this time, any additional adjunct equipment that would be beneficial for monitoring
the patient’s condition should be placed,
if it has not been completed already. The
pneumonic “LMNOP” is used to remember
these resuscitation aids.
L is for Laboratory blood samples, including arterial blood gases, lactate, blood
type and cross match, complete blood
count, metabolic panel, coagulation studies,
etc. M refers to Monitoring the patient’s
cardiac rate and rhythm. N is for insertion of a Nasogastric or orogastric tube,
as long as the patient’s injuries do not
contraindicate insertion. O addresses
Oxygenation and ventilation assessment.
Pulse oximetry provides a measurement
of oxygen saturation, and end tidal carbon
dioxide monitoring (capnography) provides
information for ventilation, perfusion
and CO2 metabolism. Finally, P refers to
Pain assessment and management, which
includes the use of both pharmacologic
and nonpharmacologic measures to treat
the trauma patient’s pain.1,5
metry, open wounds, or impaled objects,
and palpating for tenderness, crepitus, bony
deformities (step-offs) and asymmetry.
Auscultation provides information on lung
sounds (presence, symmetry, adventitious),
heart sounds (rate/rhythm, murmurs, friction rub, muffled) and abdominal sounds
(presence/absence).
Some areas of the body have specific
assessment features in addition to the
A thorough head-to-toe assessment is performed using
inspection, palpation and auscultation to identify all potential injuries.
H = History & Head-To-Toe Assessment
History information should include details
about the traumatic event, which is often
obtained through the emergency medical
services prehospital report. This includes the
mode of injury, manifestations at the accident
scene and any treatments initiated prior to
arrival at the hospital. In addition, pertinent
medical history should be obtained. The
mnemonic SAMPLE helps illustrate the significant aspects of patient history: Symptoms
associated with the injury; Allergies, along
with tetanus status; Medications currently
taking, including anticoagulants; Past medical
history, both medical conditions and hospitalizations/surgeries; Last oral intake: and
Events and Environmental aspects associated
with the injury. The patient and/or family
members may also be asked to provide this
information, depending on condition and
availability.1,2,4
A thorough head-to-toe assessment is
performed using inspection, palpation and
auscultation to identify all potential injuries.
Nurses need to be cognizant during the
assessment that movement of the patient
can exacerbate any injuries, especially if a
spinal injury is suspected. Initial observation of the patient’s general appearance will
reveal any guarding, stiffness, rigidity, or
flaccidity of the extremities. Then, starting with the head and working downward
toward the extremities, each portion of the
body should be examined in detail.
Examination includes inspecting for lacerations, puncture wounds, abrasions, contusions, ecchymosis, bleeding, edema, asym-
common assessment just discussed. For
example, eyes should be checked for Pupil
Equality, Round shape and Reaction to Light
(PERRL). The nurse should examine the
ears and nose for drainage such as blood
and cerebral spinal fluid, assess the neck
for jugular venous distension and tracheal
deviation, and the chest for subcutaneous
emphysema and flail chest. Apply gentle
pressure on the pelvis and symphysis pubis
to determine pelvic instability.
Skin temperature, color and moisture
should be checked, along with pulses (central
and peripheral) capillary refill, sensation
and motor function of extremities.1 Urinary
output is considered an important indicator
of end-organ perfusion and overall volume
status in trauma patients. Intake and output
should be closely monitored, as well as urine
color and character. In the elderly patient, in
whom glomerular filtration rate is already
decreased, it is especially important to
monitor urine output.1-4
I = Inspect Posterior Surfaces
While maintaining cervical spinal immobilization, the patient is turned to the side via a
log-rolling technique. The same inspection
and palpation techniques are used to determine any injuries to the patient’s neck, back,
and buttock area. In addition, the posterior
surfaces of the head and extremities are
assessed. In a male patient, an involuntary
penis erection (priapism) may indicate a
spinal injury. While turned, the backboard
(if used) is removed to prevent skin and tissue breakdown.1,2,4
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CE Offering: Trauma
In addition to assessment, the nurse will
anticipate the need for diagnostic tests and
interventions for identification of specific
injuries. Examples include X-rays, computerized tomography scans, magnetic
resonance imaging, splint/traction application, medications (tetanus, antibiotics,
analgesics, sedation, neuromuscular blocking agents), ultrasound (focused assessment
with sonography, or FAST), angiography,
and bronchoscopy/esophagoscopy. The
nurse should also prepare the patient for
surgery, admission or transfer to a trauma
center if further care is required.1,2,4
Psychosocial Considerations
Emotional Impact on Family Members.
When a loved one is injured, family members may experience high levels of stress,
often feeling overwhelmed and out of control. This can escalate emotional outpourings, such as agitation, disbelief, crying,
wailing, screaming, anger, and physical
violence. De-escalation techniques may be
helpful for controlling difficult situations.
It is important to include the family in
the decision-making process, if appropriate, and to keep them informed of their
loved one’s progress. If staff levels permit,
assigning a dedicated staff support person
to family members during resuscitation
measures and invasive procedures is helpful for providing emotional support and
answering family questions.1,7
Emotional Impact on Healthcare Workers.
Trauma nurses are often exposed to difficult and even violent behaviors in the
performance of their duties. Patients and/
or their families may be under the influence of drugs or alcohol, be affected by
psychiatric disorders, or display ineffective
communication patterns.1 It is important
to realize that nurses do experience stress
and face psychological, moral and ethical
dilemmas while caring for trauma patients.
Caring is at the heart of nursing practice.
The very nature of trauma exposes the nurse
to distress and suffering. When a trauma
patient arrives in the ED, nurses may have
to perform or assist in procedures, deal
with the patient’s possibly life-threatening
personal crisis, as well as manage distraught
family members. Nurses must handle all this
with a professional demeanor, no matter
what they are feeling. They must suppress
their emotions while managing sometimes
horrific conditions or situations, such as
participating in sometimes futile resuscitation efforts, watching a patient in extreme
pain, or dealing with complex and possibly
volatile family situations. This is a daily
challenge for all trauma nurses, and it can
negatively impact the trauma nurse’s ability to provide quality, empathetic care.1,8,9
Nurses can experience compassion
fatigue or secondary traumatic stress from
repeated exposure to suffering. Some trauma nurses may experience post-traumatic
stress disorder symptomatology during
and after exposure to certain traumatic
situations.8,9 Decisions for patient care that
conflict with the nurse’s personal views can
lead to moral distress. For example, if a
patient with a Do-Not-Resuscitate advanced
directive is being coded to appease family
members, the nurse may feel depressed
or angry after the code has ended. Other
similar scenarios can take a toll emotionally on the nurse.9
Often these emotions are curtailed at
work, but they can manifest themselves in
the nurse’s personal life. Some nurses maintain emotional stability during the crisis,
but afterward have trouble controlling their
feelings. This may lead to unprofessional
behavior toward co-workers and/or friends
and family, or displaying emotional liability
(crying, anger, anxiety) at work, home or in
THIS CE OFFERING EXPIRES MARCH 16, 2017
You can earn 1 contact hour of continuing education credit in three ways: 1) Grade and certificate are available
immediately after taking the online test. 2) Download the answer sheet from the website and send it to ADVANCE
for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406, with a self-addressed, stamped envelope.
3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure.
A certificate of credit will be awarded to participants who achieve a passing grade of 70% or better.
Merion Matters is accredited as a provider of continuing nursing education by the American Nurses Credentialing
Center’s Commission on Accreditation.
Merion Matters is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the
Florida Board of Nursing (No. 3298).
­26 ADVANCE FOR NURSES MARCH 2015
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www.advanceweb.com/Nurses
public. The nurse may even decide to leave
the ED for another area of nursing or quit
the nursing profession entirely.8,9
It is important for trauma nurses to have
a venue to deal with their emotions without
repercussions. Helping nurses recognize
this moral distress and its impact on their
professional as well as personal lives will
help them manage their jobs in a healthier
manner. It is important for leadership to
become involved in this process. Once a
trauma nurse is able to identify traumarelated health worker disorders and learn
how to manage them, he or she will be
better prepared deal with emotional and
ethical issues that arise.9
A Coordinated Effort
When patients sustain traumatic injuries,
they require immediate assessment and
appropriate care. Caring for the trauma
patient entails much more than managing
the specific trauma-affected area; it requires
a coordinated and thorough assessment in
an organized manner, and ongoing treatment to ensure that patients are provided
with comprehensive care for their injuries.
Utilizing the primary and secondary assessment survey is an effective way to identify
and treat life-threatening problems and
to promote optimal outcomes for trauma
patients and their families. n
Helene Harris is a retired clinical educator, Central
Texas Veterans Health Care System in Temple, Texas.
References
1. Emergency Nurses Association. Initial Assessment.
In: TNCC Trauma Nursing Core Course Provider Manual.
7th ed. Des Plaines, IL: Emergency Nurses Association;
2014: 39-54.
2. Ignatavicius D, Workman M. Concepts of emergency and trauma nursing. Medical-Surgical Nursing:
Patient-Centered Collaborative Care. 7th ed. St Louis,
MO: Elsevier; 2013: 121-135.
3. Ruppert SD. Recognizing and managing acute
anaphylaxis. Nurse Pract. 2013;38(9):10-13.
4. Urden L, et al. Trauma. In: Critical Care Nursing:
Diagnosis and Management. 7th ed. Mosby Elsevier: St.
Louis, MO; 2014: 849-885.
5. Kim H, Fischer D. Anaphylaxis. Allergy, Asthma
Clin Immunol. 2011;7(Suppl 1):S6.
6. Ray JM, Cestero R. Initial management of the trauma patient. Atlas Oral Maxillofac Surg Clin N Amer.
2013;21(1):1-7.
7. Hasse GL. Patient-centered care in adult trauma intensive care unit. Journal Trauma Nurs. 2013;20(3):163-165.
8. Gillespie G, Gates D. Using proactive coping to
manage the stress of trauma patient care. J Trauma Nurs.
2013;20(1):44-50.
9. Hamilton Houghtaling D. Moral distress: an
invisible challenge for trauma nurses. J Trauma Nurs.
2012;19(4):232-237.
CE Offering: Trauma
Rapid Trauma Assessment
Questions
1. In the primary assessment
phase of trauma care, what does
the “C” stands for?
a. Chest
b. Cardiac
c. Circulation
d. Calcification
2. The usual ABC assessment may
be changed during the rapid
trauma assessment. Which of
the following is the appropriate
change in the assessment
sequence?
a. DABC (neurologic disability,
airway, breathing, circulation)
b. <C> ABC (hemorrhage, airway,
breathing, circulation)
c. EABC (exposure, airway, breathing,
circulation)
d. FABC (focused adjuncts, airway,
breathing, circulation)
3. Which of the following is NOT
assessed during the primary quick
check of vital functions?
a. Oxygenation
b. Neurologic status
c. Perfusion
d. Past medical history
4. Diminished or absent breath
sounds to one lung may indicate
which of the following:
a. COPD
b. Asthma
c. Tension pneumothorax
d. Cardiac tamponade
5. A patient who is hemorrhaging
is brought into the emergency
department. The patient is
hypovolemic. One of the nurse’s
first responses would be to do
which of the following?
a. Insert two large bore intravenous
catheters
b. Prepare to take the patient to
radiology for a CT scan
c. Get a thoracotomy tray set up
d. Talk to the family
6. The Glasgow Coma Scale is used
to monitor which of the following?
a. Ventilation status
b. Level of consciousness
c. Vital signs
d. Dysrhythmias
7. A full set of vital signs, including
blood pressure, pulse, respiration
rate and temperature should be
obtained and is part of which
phase of the primary assessment?
a. A = airway
b. B = breathing
c. C = circulation
d. F = focused adjuncts
8. The mnemonic, SAMPLE,
includes all but which one of the
following?
a. Symptoms associated with the
injury
b. Allergies
c. Medical insurance
d. Past medical history
9. During the head-to-toe
assessment, which part of the
body is assessed for spinal fluid
drainage?
a. The back
b. The anus
c. The mouth
d. The nose and ears
10. In the assessment phase of
trauma care, the “I” stands for:
a. Insurance
b. Intubation
c. Pupil response
d. Inspect posterior surfaces
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1. I can describe the requirements of providing effective trauma care.
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manner of head-to-toe assessment on trauma patients.
3. I can identify reasons that trauma nurses may experience moral/emotional distress.
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CAREGIVERHANDOUT
By Leah Frederick, MS, RN, CIC
Infection Control Out of the Hospital
HOSPITAL-ACQUIRED INFECTIONS (HAIs)
continue to make headlines and affect dayto-day operations in the medical office. As
healthcare providers, we are responsible for
safeguarding patients against potential sources
of cross-contamination. A key part of this effort is
ensuring that the instruments we use for patient
exams and procedures are clean.
1
Make Staff Education an
Ongoing and Dynamic Process
In order to prevent cross contamination, medical personnel must precisely follow
published guidelines to remove all organic
materials from instruments and ensure that
reprocessed devices are truly ready for reuse.
Multiple studies, however, have documented a
lack of compliance with established guidelines
for disinfection and sterilization. This failure
has led to numerous outbreaks.
In most cases, the lack of compliance is the
unintentional result of inadequate education
of front-line staff.
What’s needed in every medical office is con-
sistent on-site supervision of the sterilization and
disinfection processes, return demonstration of
correct practices by all staff and documentation
of practice competency. It’s critical that office
staff are kept informed and up-to-date on new
strategies and best practices.
2
Move to Disposable Wherever
Possible
There is a growing body of evidence
— and countless real-world examples —that
demonstrate how so-called “disinfected” medical devices are not as clean as we think. The
reprocessing of devices is an imperfect science.
In fact, contaminants can still exist deep in the
equipment because cleaning protocols aren’t
always sufficient, devices aren’t cleaned in a
timely fashion or they simply weren’t designed
with optimal cleaning in mind.
As an example, let’s take a look at the reusable metal speculum. These devices have moving, hinged parts where lubricant embedded
with bacteria can become stuck. Unless the
speculum is disassembled and washed prior
to reprocessing, pathogens can survive the
sterilization process.
In addition, some reusable specula cannot
be disassembled, making them impossible to
adequately clean and leaving open the possibility of bacteria passing from one patient
to the next.
To address this issue, offices should consider
using disposable devices whenever possible.
Disposable instruments are also convenient for
medical staff and can be more cost-effective in
the long term.
3
Take into Account Peripheral
Equipment, Consider Single-Use
While making the move to disposable
devices is an important step, it may not be sufficient on its own.
Going back to the example of the vaginal
speculum, many offices have made the move
from reusable metal to disposable plastic versions. But even disposable speculums require the
use of plug-in or rechargeable light sources that
themselves become vehicles for cross contamination if not properly cleaned. The problem is that
these lights are not designed for easy cleaning
and cannot withstand rigorous disinfection or
sterilization. The lack of proper cleaning makes
items like lights potential vehicles for pathogen
transmission.
The good news is that new single-use options
for the vaginal speculum — along with devices
like the laryngoscope and anoscope — now
come with built-in light sources that are, themselves, disposable. This means that everything,
including the light, comes out of the package
ready to use and is thrown away after a single
procedure, significantly reducing the risk of
cross contamination from either the device
or the light.
When considering infection control in the
medical office, approach the problem from
multiple angles. Ensuring that staff are educated
on current best practices — and updating
policies and procedures on a regular basis — is
critical. As healthcare professionals, nothing
less should be expected. n
Leah Frederick owns the consulting firm, Infection Prevention Consultants, LLC.
The purpose of this Caregiver Handout is to further explain or remind you about a medical condition or process. This handout
is a general guide only. It may be reproduced for distribution. View and print this and other caregiver handouts on our web
site, www.advanceweb.com/NurseHandouts. ©2015 MERION MATTERS
­28 ADVANCE FOR NURSES MARCH 2015
n
n
www.advanceweb.com/Nurses
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RED BANK, NJ
CHICAGO, IL
RAPID CITY, SD
EDUCATION OPPORTUNITIES
APRIL 9-10, 2015
APRIL 21-22, 2015
MAY 6-7, 2015
Lactation Counselor
Prep Course and/or Certification Exam
All of PCE’s certifications are on the American Nurses
Credentialing Center (ANCC) Magnet recognition list. Evidencebased course designed for nurses that follows the baby friendly hospital initiative and offers 16 nursing contact hrs/cerps.
Topics include anatomy of the breast, latch on /suck assessment, guidelines for the first week, nutritional needs, identifying, evaluating and managing common problems, the premature
infant, medications, lactation gadgets, and hospital /community support. Independent study available. Group, PCE member
and multiple course discounts available. Contact: Prepared
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Childbirth Educator
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AAll PCE's certifications are on the American Nurses
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Course is evidence-based following nursing standards and
offers 16 contact hrs. Topics include pain management,
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massage instructors, breastfeeding counselors, labor
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www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES
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EDUCATION OPPORTUNITIES
END OF LIFE NURSING EDUCATION
CONSORTIUM (ELNEC) PROGRAM
WITH A FOCUS ON ONCOLOGY
Sponsored by:
Memorial Sloan Kettering Cancer Center
Department of Nursing
Date:
May 21-22, 2015
Fee:
$350.00
Location:
Memorial Sloan Kettering Cancer Center
New York City
Credit: 14.25 contact hours will be awarded
For online registration visit:
www.mskcc.org/education/cne
For additional information contact:
Nursing Education @ 212-639-6884
E-mail: [email protected]
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SALEM STATE UNIVERSITY OFFERS MSN
IN NURSING EDUCATION, NURSING ADMINISTRATION AND
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Our students specialize in nursing education, nursing administration or adult
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­30 ADVANCE FOR NURSES MARCH 2015
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›› MIDDLE ATLANTIC
REGISTERED NURSES
$2,000 Bonus
Inglemoor Rehabilita�on and Care Center
of Livingston, NJ, is seeking highly skilled
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preferred. FT/PT/PD & Wknd Sup/Charge
Nurse for all shi�s. Compe��ve salary
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your resume to: [email protected]
visit our website: www.inglemoor.com
Please, no phone calls. EOE.
PRIMARY CARE RNS
2 positons available;
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Provides primary health care/case
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The New England Center for Children
33 Turnpike Road, Southboro, MA 01772
Email: [email protected] EOE/M/F
Bala Nursing & Rehabilitation Center
“A Tradition of Care”
2 Key Nursing Leadership
Positions Currently Available:
• PT RN to work in the Admissions
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• Unit Manager - Full Time
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• Clinical Resource Manager – Care Coordination, PT
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www.rumcsi.org
$3,000 Sign-On-Bonus!!!!
STAFF DEVELOPMENT COORDINATOR
Seeking a strong hospice nurse and advocate for end-of- life care, with excellent communication skills and a desire to share knowledge and experiences with other healthcare professionals.
Responsibilities: Coordinate and present training and development programs for all employees. Also
responsible to plan and coordinate training and development activities for our contracted facilities and
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• 3 + years in hospice or palliative care nursing • 2+ years in Training & Development or leadership
experience • Exceptional written and oral communication skills • Proficiency in Microsoft applications;
Word, Excel, PowerPoint presentations and electronic medical records applications • CHPN certification
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PATIENT CARE COORDINATOR
Seeking an experienced clinical professional with clinical management experience and hospice RN experience
to manage one of our growing teams. Responsibilities: Coordinate all aspects of daily patient care and
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Requirements: • Current NYS RN license • 5 years experience as a clinical supervisor/manager
• BSN required, MSN a plus • Hospice RN experience required • Proficiency in Microsoft computer
applications required • Proficiency with Allscripts or other electronic medical records applications required.
Competitive Salaries + Benefits
To apply send cover letter & resume:
Attn: Human Resource Dept.
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Fax: 718-784-1413
Website: www.hospiceny.com
HONY is an equal opportunity employer
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WHITE GLOVE
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85 Bartlett St., Brooklyn, NY 11206
866.387.8100
Experienced RNs – Home Care and Hospice
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• $2,500 sign-on bonus for part-time
Inspira Health Network is seeking experienced RNs to join our Home
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management skills. Apply online at:
inspirahealthnetwork.org/careers
Apply Online: www.whiteglovecare.com
EOE
Contributing
g to the ongoing
g g success of MJHS.
J
New
Salar y
Structure
B o nu s e s
and Sign on ositions
for select p
Imagine a career with a perfect balance of stability and opportunity? At MJHS
we understand that better care for our patients begins with better care for our
employees. That’s why we’ve introduced a new salary structure and sign-on
bonuses for select positions, underscoring our dedication to our colleagues as
well as those we serve.
We currently have openings available in the following areas:
Home Care, Hospice & Palliative Care, and Health Plans
Open House
Wednesday, April 15th
For more information, please visit mjhs.jobs
and search for job number 11114
Language Differential • Bilingual (Chinese or Spanish) a plus
For more information or to view current opportunities,
visit
[ mjhs.jobs ]
mjhs.jobs or scan our QR code.
We are an equal opportunity employer, dedicated to promoting a drug-free workplace.
www.advanceweb.com/Nurses ■ MARCH 2015 ■ ADVANCE FOR NURSES
33
New York, Pennsylvania, New Jersey
CAREER OPPORTUNITIES
Behavioral Health Opportunities at
Summit Oaks Hospital
We are a private provider of comprehensive acute behavioral health and addictions
treatment services serving a child, adolescent and adult population.
Cohesive teamwork with
a new slant
to your day.
We are seeking: A Full Time NURSING SUPERVISOR (Night Shift)
Requirements: Registered Nurse, with a BSN (MSN preferred) and hospital
supervisory experience.
STAFF REGISTERED NURSE positions are also available in all specialty
services. Requirements: Must have prior nursing experience.
Full-time benefits include medical, Rx, dental and vision coverage,
life insurance, tuition reimbursement and a 401(k) plan.
Please complete our on-line application at:
www.summitoakshospital.com
(click the "About" tab on website)
Where you work matters.
Open House for Experienced RNs
Summit Oaks Hospital
19 Prospect St., Summit, NJ 07902 (908) 522-7000
Friday, March 20th and March 27th
Morristown Medical Center and Overlook Medical Center
RSVP Online to Req. #15311
Positions are available systemwide for RNs with 2+ years experience:
ED, OR, PACU, Cardiac Cath, NICU, Mother/Baby, L&D, CVICU,
Home Care & Hospice, Oncology, Critical Care, Nurse Coordinators,
Nurse Managers as well as other specialty areas.
Chandler Hall, a Kendal afƒliate, and Quaker
long term care facility, has opportunities
for caring and compassionate RNs in our
skilled nursing home.
To learn more, please visit jobs.atlantichealth.org
• Staff RNS- Pool positions all shifts
• Resident Care Coordinator - responsibility
and accountability for resident care in our
skilled nursing home.
To learn more about Chandler Hall and employment opportunities we offer, apply at our
website www.ch.kendal.org
We offer a pleasant working environment, and
excellent beneƒts including medical, onsite
daycare, cafeteria, ƒtness center and much
more! EOE
We are an Equal Opportunity Employer. All quali¿ed applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.
Magnet® is a registered trademark of the American Nurses Credentialing Center.
FORTUNE and FORTUNE 100 Best Companies to Work For are registered trademarks of Time
Inc. and are used under license. From FORTUNE Magazine, February 3, 2014 ©2014 Time Inc.
FORTUNE and Time Inc. are not af¿liated with, and do not endorse products or services of, Licensee.
jobs.atlantichealth.org
YCS is a private, not-for-proÚt, nonsectarian social services organization; offers hope to the states most vulnerable children and adults in this special education and
autism programs, foster care, residential safe havens,
programs for developmentally disabled consumers and
community based programs. We are currently seeking a
highly motivated, responsible, dedicated:
Make A Difference.
Make It Happen.
CFG Health Network is a broad-based healthcare provider dedicated to
increasing access to care through its own clinics, residential treatment
services, healthcare services for correctional facilities, and hospital-based,
school-based, partial hospitalization programs.
SRT STAFF NURSE
Must have valid drivers license and vehicle. One (1) year
of psychiatric nursing required. Work schedule: varies,
must be Ûexible, and willing to commute throughout
the northern region. Psych, Pediatric and/or DDD
experience a plus. Current NJ License, RN and CPR
certiÚcation required.
EOE M/F/D/V
Lower Bucks Hospital has
an immediate opening
for a Full Time, day shift,
RNFA in the Perioperative
Services Department.
A current PA RN license, CNOR and
BLS are required. Minimum 2 years
experience in perioperative services
required. Lower Bucks Hospital offers competitive salary, free parking
and a convenient suburban location
in Bristol, PA, within easy access
from the PA Turnpike, I-95 and the
Burlington Bristol Bridge.
We are an Equal Opportunity / Affirmative Action Employer and do not
discriminate against applicants due to
veteran status, disability, race, gender
or other protected characteristics.
Interested candidates please send resume
to [email protected]
Apply Online www.ycs.org
RNs and LPNs
at Correctional Facilities in these New Jersey counties:
Atlantic, Burlington, Camden, Cumberland, Essex, Hudson,
Mercer, Middlesex & Warren Counties.
Youth Consultation Service
Current NJ license required. Experience in corrections a plus. We
offer excellent compensation. Full-Time employees enjoy a generous
benefits package. Send resume:
Elite boys and girls residential
summer camp in the beautiful Adirondack
Mountains of NY seeks camp nurses to
work June-August. Looking for energetic
and fun people who want to spend their
summers with children. Need both males and
females. Top Salary, room and board provided.
Licensing fees and travel paid.
Vandette Anderson,
Executive Director Recruiting
[email protected]
(Cell) 856-797-4844; (Fax) 856-797-4824
Call 800-786-8373 or
www.raquettelake.com
We are a traditional
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years!
rs!
www.cfghealthsystems.com
EOE
34 ADVANCE FOR NURSES MARCH 2015 www.advanceweb.com/Nurses
■
■
NEED ADVANCE REPRINTS? CALL 800-355-5627
Pennsylvania
®
MARIS GROVE IS HIRING
RN Supervisor
Full & Part Time - Evening
Rose Court, the skilled nursing and
personal care facility of Maris Grove
is seeking strong candidates for
2 RN Supervisor positions. The right
candidate must be clinically sound with
the ability to demonstrate leadership
and management skills. Must be able
to delegate duties, organize multiple
responsibilities and contribute to building a positive team spirit. Must have
strong communication skills to be able
to interact with residents and their families. To be considered, candidates must
have a current RN License in PA and at
least 3 years supervisory experience.
Maris Grove is also hiring RNs for Flex
Private Duty Home Care positions.
Experienced RNs & LPNs
CritiCare Home Health & Nursing Services,
a Medicare certified skilled agency in
Chadds Ford, PA (a suburb of Philadelphia)
has an immediate need for the following:
1. RNs & LPNs experienced in working
with children for assignments in
Delaware and Chester County schools.
2. RNs for post hospital in-home
follow up care. Experience in wound
care, wound vac, trachs, vents and
infusion services a plus.
3. CNAs / Teachers’ Aides for
in-home and school assignments.
careers that
re lect
your
passion.
Holy Redeemer is unique among the area’s health systems. We offer patients multiple points of access to
some of the best care in the area. Opportunities for growth and development are available for those who
are passionate about their careers. If you’re ambitious, motivated and dedicated to your patients, you’ve
come to the right place. Holy Redeemer is a reflection of all you value in a career.
HOLY REDEEMER HOSPITAL - Meadowbrook, PA
Excellent hourly rates.
Flexible hourly schedules.
* RNs $28-$38/hr
* LPNs $22-$28/hr
* CNAs $11-$13/hr
*Nursing Director opportunity available in Emergency Department*
Operating Room RNs:
PT & FT opportunities for experienced O.R. RNs and those with Peri-operative training
Oncology Nurse Navigator (FT)
Cancer Center
Depending on experience
Staff Development department
Call Nursing Line:
FT & PT:
610-675-1111, Ext. 127
www.criticareplus.com
• Emergency Department • Neonatal ICU • Quality Assurance Nursing Coordinator
• Continuous Quality Clinical Documentation Improvement Specialist
• Nurse Practitioner (Days)- Hospitalist Program
learn more and apply @
PRN & Supplemental:
www.elmjobs.com
200 Maris Grove Way, Glen Mills PA 19342
Clinical Nurse Educator (PRN)
• Cardiology • Emergency Department • ICCU • Labor & Delivery • Transitional Care Unit
eoe
EOE
HOMECARE & HOSPICE
Enriching
quality of life
for patients
As a member of Main Line Health System, HomeCare & Hospice is one
of the most highly regarded providers of home health and hospice
services in southeastern Pennsylvania. We are a not-for-profit home
health and hospice agency that provides care to residents of Bucks,
Chester, Delaware, Montgomery and Philadelphia counties. Our specially trained
Home Care & Hospice team members ensure the highest level of expertise when
working with our patients and their physicians in developing an individualized
plan of care. Staff members undergo extensive and ongoing training that is
specially designed to address specific needs.
Main Line Health Home Care and Hospice
OPEN HOUSE
240 North Radnor Chester Road, Radnor, PA 19087
Time: 10 am – 6 pm
Date: Thursday, March 19th
Call Hope Shafer at 215-214-0682
HOLY REDEEMER ST. JOSEPH MANOR - Meadowbrook, PA
HOLY REDEEMER D’YOUVILLE MANOR - Yardley, PA
HOLY REDEEMER LAFAYETTE - Philadelphia, PA
• Team Leader RNs (Skilled and Short Stay Rehab) – PT nights & PRN
• LPNs (Skilled and Personal Care) - PT evenings or nights & PRN
• House Supervisor- PRN
Call Alisa Cohen at 215-214-0681
HOLY REDEEMER HOME CARE
AND
HOSPICE - Philadelphia, PA
• Home Care RNs – FT, PT & PRN • Central Intake RN’s – PT & supplemental w/wknds.
• Nurse Manager, Hospice IPU – FT • Nurse, Hospice IPU – FT nights 36/12 7pm-730am & PRN
• Clinical Resource RN – FT, PT & PRN • Staff Development Coordinator – FT • Palliative RN - FT
For more information on the above Home Care and Hospice
positions, please call Lilly Cortez at 856-312-1398
Cape May, NJ:
• Hospice Admission RN – FT • Homecare RN – PRN
Atlantic County, NJ:
• Hospice RN – PRN • Homecare RN – PRN • Weekend Admission RN – PT
Ocean County, NJ:
• Homecare Admission RN – FT, PT & Weekends • Hospice RN – PT & PRN
• Homecare RN – PRN • Homecare RN – FT temporary
Cumberland County:
• Homecare RN – FT
Positions available for RNs and Case Managers
Refreshments will be served
Please RSVP to Jenn Lennon at 484.580.1568
or email: [email protected].
Applicants must certify that they have not used tobacco
products or nicotine in any form in the 90-days prior to
submitting an application to Main Line Health. This will be
verified during pre-employment testing. We are an Equal
Opportunity Employer.
mainlinehealth.org/careers
Runnemede:
• Homecare Coordinator – PRN • Hospice Admission RN – FT
• Hospice Nurse Practitioner – PRN or PT • On Call RN – FT, 7 on-7 off
• Triage RN – Supplemental & PRN, Weekends • Homecare RN – PRN & FT
For more information on the positions in New Jersey,
please call Susan Burns at 609-761-0296
To learn more about how we care for our community
and to apply, visit
www.holyredeemer.com
EOE
SIGN UP TO RECEIVE FREE DIGITAL EDITIONS
advanceweb.com/subscribe
www.holyredeemer.com
HEALTH CARE. HOME CARE. LIFE CARE.
www.advanceweb.com/Nurses ■ MARCH 2015 ■ ADVANCE FOR NURSES
35
CAREER OPPORTUNITIES
Erickson Living
helps people live better lives
CAREER OPPORTUNITIES
Washington DC, Georgia, Florida
›› UPPER SOUTH ATLANTIC
CHAT LIVE WITH
RECRUITERS
CLINICAL NURSE MANAGER
Orthopedics Department job # 15-0190
QualiÚed applicant will have three years relevant clinical
experience, Bachelors degree & current DC License as an RN.
Responsibilities include the following
Provide proÚcient nursing care for an individual or group
of patients. Provide leadership in the implementation of
high quality nursing care. Ensures patient care area is in
compliance with regulatory requirements including CLIA
and OSHA. Assist doctors with procedures, give injections,
triage and other nursing duties. Manages and oversees
the materials management function of the patient care.
Maintains stafÚng requirements during peak periods,
vacations and other absences.
EOE
GREAT OPPORTUNIES
ARE WAITING
FOR YOU AT OUR
ONLINE JOB FAIRS
Apply: www.gwdocs.com
advanceweb.com/events
advanceweb.com/events
›› LOWER SOUTH ATLANTIC
Find Your
Purpose
MORE THAN A JOB
A CALLING
Welcome to the Shepherd Center, the country’s largest catastrophic care
hospital. Located in Atlanta, Shepherd Center is a world renowned, non-profit
hospital specializing in medical treatment, research and
rehabilitation for people with spinal cord or brain injury.
A 152-bed facility, Shepherd Center is ranked among the top 10
rehabilitation hospitals in the nation.
ACQUIRED BRAIN INJURY PROGRAM
• Staff RN; Weeknights; 7pm-7am x3
• Staff RN; Weekend Option Days*; 7am-7pm Saturday/Sunday only
INTENSIVE CARE UNIT (Offering Higher Base Rate!)
• Staff RN; Weeknights 7pm-7am; Wednesday/Thursday/Friday
• Staff RN; Weekend Option Nights*; 7pm-7am Friday/Saturday/Sunday
MEDICAL/SURGICAL UNIT
Florida Hospital Zephyrhills has been nationally
recognized by the American Heart Association, the
American Stroke Association, The Joint Commission,
The Leapfrog Group, and HealthGrades for
excellence in providing top quality patient car.
We now have open positions in the following areas:
• Cardiac Services
• Critical Care
• Emergency Services
• Womens Health Center
• Medical-Surgical
• Surgical Services
• Seasonal Positions
Full-time RNs receive:
• Sign-on-Bonus or Relocation Assistance
• Seasonal Completion Bonus
• First Day BeneÚts
• Tuition Assistance
• Wellness Incentive
• Tobacco-free Campus
• Free parking
To Find out more about our exciting opportunities,
visit our Careers page on our website at
www.FloridaHospital.com/zephyrhills/careers
Contact us: 1-855-JOBS-FHZ (562-7349) or
[email protected]
• Staff RN; Weeknights; 7pm-7am Wednesday/Thursday/Friday
TIME
TO RENEW
YOUR FREE
SUBSCRIPTION
CALL TODAY
800-355-1088
*WEEKEND OPTION
Saturday & Sunday - 7am-7pm = $10/hr Differential
Saturday & Sunday - 7pm-7am = $13/hr Differential
Be part of improving the lives of teens and adults who have experienced traumatic spinal
cord injuries, brain injuries and other neuromuscular conditions. At Shepherd,
you’ll find competitive compensation, a diverse workplace culture, enlightened
leadership and professional growth opportunities. Visit our website and apply
on-line at Shepherd.org
EOE
FIND TOP CAREER ENHANCEMENTS AT ADVANCEWEB . COM
36 ADVANCE FOR NURSES MARCH 2015 www.advanceweb.com/Nurses
■
■
YOUR
ONE-STOP
CAREER CENTER
ADVANCEHEALTHCAREJOBS.COM
Healthcare POV BLOGS
advanceweb.com/community
North Carolina, Florida
CAREER OPPORTUNITIES
Wish
You H ere
Were
Extraordinary People, An Extraordinary Workplace
Nursing jobs in paradise.
Since 1976, BayCare HomeCare has been providing high-quality, compassionate care
right at home to Florida residents. Join us for our upcoming Job Fairs and learn more
about our exciting home health opportunities!
HOME HEALTH RN JOB FAIRS
Live and work where you play!
Wednesday, April 29 • 11am-6pm
Venice Regional Bayfront Health is an award-winning,
nationally recognized 312-bed hospital situated on a
coastal island in sunny Southwest Florida.
Hiring experienced Registered Nurses in Critical
Care, Emergency Services, OR, Medical/Surgical and
Cardiac Telemetry.
Benefits include competitive pay, 401(k), generous
vacation, sick and holiday time, and walking distance to
the beach!
Apply online at
VeniceRegional.com
Two Locations:
Mease Dunedin Physician Office Building
Board Room - 8th Floor
646 Virginia St., Dunedin, FL 34698
BayCare HomeCare
8452 118th Ave. N.
Largo, FL 33773
Opportunities are available for RNs, LPNs & Physical Therapists. Open positions
available in Hillsborough, Pinellas, Polk, Sarasota and other surrounding counties.
Be sure to bring your resume!
If unable to attend, apply at
BayCareJobs.com | 866-221-3222
Serving The Tampa Bay Area. EOE M/F/D/V • Drug & Tobacco-Free Workplaces
Exceptional People.
Exceptional Care.
Serving the community since 1961, WakeMed Health & Hospitals is a nationally recognized, private, not-for-profit health care
organization based in Raleigh, N.C. The largest health system in Wake County, WakeMed exists to improve the health and well-being of
our community by providing outstanding, compassionate, patient- and family-centered care to all. The multi-facility health system
includes a Level I Trauma Center, the area’s premier Heart Center, Wake County’s only Children’s Hospital, and a Certified Primary
Stroke Program. With more than a dozen inpatient and outpatient facilities throughout the Triangle, WakeMed offers a wide range of
unique employment opportunities. WakeMed’s team of more than 8,200 employees, 1,500 volunteers, 1,200 affiliated physicians and
more than 255 physicians employed by WakeMed Physician Practices represent the best minds and the biggest hearts in the business.
Staff Nurse opportunities in Women Services
• Labor & Delivery
• Mother/Baby
• Neonatal ICU
• Newborn Nursery
WakeMed proudly offers family-friendly benefits, flexible shifts, continuing education opportunities and competitive salaries reflecting background, experience and special skills.
www.wakemed.org
850+ beds
8,000 employees
2 full-service hospitals
Outpatient & Physician Practices
4 healthplexes
7 full-service 24-7 emergency departments
Outpatient facilities across the region
Diversity celebrated
Differences valued
www.advanceweb.com/Nurses ■ MARCH 2015 ■ ADVANCE FOR NURSES
37
CAREER OPPORTUNITIES
Florida, Iowa, Texas, Colorado, California, Alaska
›› LOWER SOUTH ATLANTIC
›› PACIFIC
We’re all about
commitment
CONGRATULATIONS NSHC!
to our patients, community,
and professionals.
Norton Sound Regional Hospital is a
Joint Commission accredited facility.
We are a healthcare system serving
the people of the Seward Peninsula
and Bering Straits Region of Northwest
Alaska. NSHC is an IHS eligible loan
repayment site. We welcome new graduates to apply to help provide services
to an under-served population.
At Lower Keys Medical Center, the
community we proudly serve, we are
dedicated to making life better for
patients and families. We’re committed
to our talented professionals as well,
ZKLFKLVZK\ZHR΍HUDVXSSRUWLYHWHDP
environment and advancement potential.
Located in Key West, our 167-bed
DFXWHFDUHKRVSLWDOR΍HUVVXSHULRUFDUH
throughout a wide range of medical
procedures. If you’re as committed as
we are, join our friendly team of:
Contact
Rhonda Schneider, Human Resources
[email protected] • 907-443-4525
Registered Nurses
Clinical Nurse Lead
Competitive Benefit
Package
Relocation Assistance
Hiring Bonus
NSHC is an equal opportunity employer affording
Native preference under PL 93-638. AA/M/D/F. We
are a Drug Free Workplace and background checks
required for all positions.
www.nortonsoundhealth.org
RNs
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Director of Nursing - $2,500 SIGN-ON BONUS
APPLY ONLINE:
www.lkmc.com/about/careers
We Are Concorde
“Committed to improving futures by preparing students for success”
Resumes may also be
emailed or faxed:
E-mail: [email protected]
Fax: 305.296.2520
Locations: Garden Grove, CA and
San Diego, CA
Job Code: 6265
Number of Openings: 1
Lower Keys Medical Center is an
equal opportunity employer.
›› WEST NORTH CENTRAL
›› WEST SOUTH CENTRAL
Nurses-RNs
Department Chair, Nursing Program
Indian Hills Community College
has an opening for someone who will lead
the nursing program administration.
This position is located in Ottumwa, Iowa
Candidates must be a graduate of an
approved school of nursing with licensure
as an RN in Iowa or a compact state; MSN;
3 yrs FT clinical nursing as an RN; 2 yrs FT
experience in nursing education required.
Supervisory experience and knowledge of
Curriculum Development preferred.
NEEDED AT THE WATERSHED IN WEBSTER, TX
Psych. experience pref.; TX RN Lic. Req.;
FT/PT and Day/Nights shifts available;
www.thewatershed.jobs
EOE/DFWP
›› SOUTHWEST
• Starting salary range: $68,283 - $74,949 plus
• Competitive fringe beneÚt package & 4-day
workweek (184 days annually).
NEW HOSPITAL WITH RN
POSITIONS AVAILABLE!
OB/Med-Surg/OR/PACU/Infusion/Oncology
$24.48 - $34.27/Hour with Competitive Benefits
Fast facts about Grand Junction, Colorado:
* Largest city between Denver & Salt Lake City
* High desert climate offers warm days, cool
nights and over 300 days of sun a year!
* One of the few growing cities in the west.
* More outdoor recreation within a 100 mile
radius than any other city in the western USA.
A complete job description can be found at www.indianhills.edu
Office: 641-683-5200
Fax: 641-683-5184
Human Resources
Email: hr @indianhills.edu
Indian Hills Community College
AA/EOE
Send letter of application
and resume to:
Subscribe to our
FREE E-newsletter
at advanceweb.com
38 ADVANCE FOR NURSES MARCH 2015 www.advanceweb.com/Nurses
■
■
Description: Concorde Career Colleges, Inc.
is a nationally recognized for-profit, post-secondary
education company providing career training in the field
of allied health, and we have an opening for a full-time
Director of Nursing. $2,500 Sign-on Bonus!!
Responsibilities Include: Recruit and develop qualified
Nursing Instructors ensuring continuous and consistent
delivery of coursework throughout the program. Manage the Nursing Instructors and the education activities
of the Nursing Department and all classes. Ensure compliance with applicable
accreditation commission standards, agency regulations and the Campus Policy and Procedure Department’s curricula. Monitor student progress, conduct
student orientations, and advise students throughout the applicable program.
Minimum Qualifications: Current license to practice as a registered nurse
in California. BSN required, MSN preferred. Board Vocational Nursing and
Psychiatric Technicians (BVNPT) Director’s level certificate or eligibility. Minimum
3 years RN experience with one year in teaching or clinical supervision or minimum of 3 years RN experience in nursing administration or teaching in the last 5
years. Must have completed a course or courses offered by an accredited school
with instruction and administration, teaching, curriculum development and counseling. Management experience required or acceptable equivalency in CCC
experience. Must be capable of teaching both the Clinical and Didactic aspects
of the programs. Must meet approval of regulatory board in order to hold the
position. Teaching experience preferred. DON Education experience preferred.
We Offer: Medical/dental/vision, 401K retirement plan, paid holidays, vacation,
and education reimbursement for full-time and part-time employees.
To apply please email resumes to [email protected] or go to our website
http://jobs.concorde.edu
TO ORDER ARTICLE REPRINTS,
CALL 800-355-5627.
National
CAREER OPPORTUNITIES
Check out the HOT
opportunities in Florida!
Bayfront Health St. Petersburg is a 480-bed private teaching hospital located in beautiful downtown
St. Petersburg, FL. Bayfront is our communities only level II Trauma center, a state approved level III
regional perinatal intensive care center, chest pain center and comprehensive and primary stroke
center. By investing in the latest technology, Bayfront has created many areas of expertise, and
become one of Florida’s most respected hospitals.
Nurse Resource Team – General Practice and Critical Care
These rewarding opportunities allow RNs to work within a variety of Bayfront’s specialty service lines
such as Trauma/Emergency, Cardiovascular, Neuroscience, Orthopedics, Rehab, Critical Care, and
General Surgery.
Critical Care Nurse Fellowship
This is an opportunity for experienced acute care RNs to train for the critical care setting and gives the
valuable skills necessary to build a rewarding career in the specialty of interest.
Experienced RNs with at least 1 year acute care experience:
Cardiac Cath Lab • Case Management • CCU • CVICU • CVOR • Emergency
Department • Labor and Delivery • Medical Surgical • Medical Telemetry
Neuro ICU • Neuroprogressive • Ortho Surgical • PACU • Progressive Care
Unit • Rehab • Same Day Surgery • Trauma ICU
RN Transition Program
The program allows experienced RNs to train and transition to work
in General Practice within the acute care setting.
Surrounded by America’s top ranked beaches, vacation
destinations, theme parks, museums and more… our area
offers something for everyone! Our affordable cost of living
and no state income tax combined with our ideal climate
makes Florida one of the most sought after states for
relocation. If you have a minimum of one year acute care
hospital experience with current RN license, and are ready to
be part of a team that is always striving to make medical
history, improve patient care and truly make a difference... we
encourage you to apply online today at:
www.bayfrontstpete.com
www.advanceweb.com/Nurses ■ MARCH 2015 ■ ADVANCE FOR NURSES
39
CAREER OPPORTUNITIES
National
›› NATIONAL
Diamond Healthcare,
a national behavioral health
management company, is recruiting
experienced professionals.
Opportunities in
Nursing Education
WE MAKE IT EASIER
TO WRITE YOUR
RESUME WITH
RESUME BUILDER
NEW OPENINGS
Program Director / RN
- Poteau, OK
Director of Nursing
- Dorchester, MA
Director of Nursing
Assistant Professor - Practical Nursing
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RxUpdate
By Grace Earl, PharmD, BCPS
Droxidopa (Northera)
Medication to treat neurogenic orthostatic hypotension
INDICATIONS
Neurogenic orthostatic hypotension
CONTRAINDICATIONS
None
DROXIDOPA (NORTHERA) is a firstin-class treatment to raise blood pressure
in patients with neurogenic orthostatic
hypotension.1 Symptoms are dizziness and
fainting caused by impaired autonomic
reflexes.2 Normally, reflexes stabilize blood
pressure during positional changes. A serious complication is supine hypertension
affecting about half of the patients.2
A robust study was conducted to evaluate adult patients with neurogenic orthostatic hypotension (experiencing a drop
in systolic blood pressure > 20 mm Hg or
diastolic blood pressure > 10 mm Hg while
standing for 3 minutes). 3 Subjects were
included with neurogenic causes as well
as primary causes (Parkinson’s disease,
multiple system atrophy). Droxidopa was
titrated from 100-600 mg by mouth three
times a day over a 14-day open label period
A total of 263 patients entered the openlabel period, and 162 responders continued in the study phase.3 Responders were
randomized in double-blind fashion to
droxidopa or placebo. The mean age was 42
years for men and 39 years for women, and
the majority of subjects were Caucasian.
Most subjects had Parkinson’s disease.
The mean baseline supine systolic blood
pressure was 127.6 mm Hg and standing
systolic blood pressure was 90.8 mm Hg.
The study outcomes were improved blood
pressure (BP > 10 mm Hg) and symptom
questionnaire results (change > 1 unit).3
Hemodynamic changes improved significantly in the droxidopa group with a mean
increase in systolic blood pressure of 11.2 mm
Hg versus 3.9 mm Hg for placebo (difference
of 7.3 mm Hg (95% CI 1.1-13.5)(p<0.001).3
Symptoms improved significantly based
on a 10-point Likert scale (p = 0.010).
Headache, dizziness and nausea were
reported frequently. Serious effects included
palpitations, urinary obstruction and hypertension. Syncope was reported in 2.5% of
droxidopa patients and 1.2% on placebo.
­42 ADVANCE FOR NURSES MARCH 2015
n
n
Droxidopa was effective in improving
blood pressure, symptoms and daily activities when used for short periods.3 However,
no differences in symptoms were observed
in a similar placebo-controlled study.4 The
prescribing instructions should be followed
closely regarding dosing and monitoring. The FDA approved the medication
supporting short-term use for 2 weeks.1
Treatment approaches also include prescribing fludrocortisone tablets or using
a vasoconstrictor medication.2
Mechanism of Action
Droxidopa is a prodrug and is converted by
enzymes to norepinephrine.5 The mechanism involves stimulation of alpha- and
beta-receptors on blood vessels resulting
from norepinephrine-induced vasoconstriction of arterial and venous blood vessels.
Dosage, Costs, Pharmacokinetics
The initial dose of droxidopa is 100 mg
by mouth three times a day.1 The dose is
titrated upward by increments of 100 mg
three times daily. Capsules can be taken
with or without food. Do not open or crush
capsules. Timing of the dose should be 3
hours prior to bedtime to avoid nighttime
supine hypertension.4 Advise patients to
elevate the head of the bed while sleeping.1
A two-week supply of the medication will
cost approximately $800 at the low dose.6
The maximum concentration (Cmax) is
achieved in 2 hours and is associated with
increased systolic & diastolic blood pressure.5
Norepinephrine concentrations in plasma
increased significantly at 2 hours after an
oral administration of 400 mg droxidopa,
and the drug crosses the blood-brain barrier. Droxidopa is metabolized by DOPA
decarboxylase, an enzyme involved with
the catecholamine system.5 It is eliminated
predominantly by the kidneys, and studies
conducted in patients with mild-moderate
kidney impairment did not need dose adjust-
www.advanceweb.com/Nurses
WARNINGS
allergic reactions, supine hypertension,
hyperpyrexia, worsening heart disease
ments.1 The mean half-life is 2.5 hours.
Drug Interactions & Side Effects
Increases in blood pressure may stem from
interactions with sympathetic stimulants
used for congestion (epinephrine, ephedrine) or migraines (triptans-rizatriptan).5
Midodrine should be discontinued to avoid
additive effects. Dopa decarboxylase inhibitors (carbidopa) used for Parkinson’s disease may interact by preventing conversion
of droxidopa to active norepinephrine.1,5
The most frequently reported unwanted
effects occurred in studies were hypertension,
dizziness, headache, fatigue and nausea.1,3
Supine hypertension can occur on or off
treatment and carries an increase in cardiovascular risk. Syncope was reported in 13%
of subjects in one study.1 Falls were reported
in patients taking both drug or placebo in
long-term open label studies underscoring
the importance of careful patient selection.1,5
Allergic reactions can occur.1 Monitor
standing and supine blood pressure. Heart
rate is not affected. Monitor for chest
pressure, palpitations and pulmonary
congestion. Monitor for signs of confusion
and elevated temperature that may indicate hyperpyrexia or signs of neuroleptic
malignant syndrome. There is a boxed
warning for supine hypertension.1 This
drug is listed as Pregnancy Category C.
Don’t use with nursing mothers. n
References for this article can be accessed
online at www.advance web.com/nurses.
Click on Resources, then References.
Grace Earl is an ambulatory care pharmacist at
the University of the Sciences and her practice site
is at Hahnemann University Hospital, Philadelphia.
She is Guest Editor for the Rx & OTC update column.
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