California Hospital Association Vice President Denies Increased Nurse Staffing Improves Quality of Care

Yesterday, while perusing my guilty-pleasure, Facebook, I noticed this cartoon. Funny, because it sure has a ring of truth to it, doesn't it?! Auspiciously, this morning, I read a comment from B.J. Bartleson, vice president of Nursing and Clinical Services at the California Hospital Association denying that increased nurse presence in the hospitals improves quality of care. Wow! The comment was in response to a study which, according to its own authors, requires more research follow-up in order to draw conclusions about the efficacy of the California nurse:patient ratio law. I think it's fair to say there are many, many variables to study when looking at quality of care. One factor that influenced my own workload when the ratio law was implemented was the cost-cutting measure of eliminating many ancillary positions. This RN rarely has a nurse aide, has to strip rooms and do many housekeeping tasks, lift and transport her own patients, etc. In this instance, the ratio law may not have lead to improved quality as some studies do suggest. BUT, to state that increased nurses do not lead to improved quality of care is, in my mind, so obviously financially self-serving as to be ludicrous. So, when Bartleson is a patient and his nurse has 10 other patients to care for, we should ask again if he believes staffing doesn't affect quality.

 http://www.californiahealthline.org/features/2012/study-nurse-ratio-law-has-mixed-results-on-quality-of-care.aspx

California Leads Other States in Implementation of the "Future of Nursing"

Last spring I had the privilege of convening with approximately 100 other nurses in Humboldt County, CA, to brainstorm obstacles and opportunities to implementation of the IOM's white paper report, "Future of Nursing: Leading Change, Advancing Health." I was thrilled to read the following interview and learn that California is leading the way towards healthcare change. I hope other states will jump aboard because it is exciting news for nurses and healthcare consumers alike. I am particularly interested, being a nurse educator myself, in the transitioning towards BSN degrees through articulated agreements between community colleges and state universities. How exciting to think that getting a BSN will be all the more convenient. http://news.nurse.com/article/20121203/CA02/112030017

Free CEUs from the National Institute of Nursing Research

Previously, nurses interested in becoming researchers could travel all the way to Bethesda, MD to attend a four day course called "Developing Nurse Scientists." Now, the NINR has turned that class into a free online program worth four CEUs. It really did take me about that much time because the information was so new to me, but I feel I have a much better understanding of how the research which has advanced nursing so much was conducted. The free class is available at this link: www.ninr.nih.gov/Training/OnlineDevelopingNurseScientists/

Saturday Night and I'm Officially a Nerd (with a thanks to Orrin Hatch)

Okay, okay, I admit it: I am a nursey nerd. But I have to share with you this great opportunity for a free book! I am only partly into it but already learning so much about our history of nursing and research in the National Institute of Nursing Research's History Book.

Apparently, despite a presidential veto (Reagan!), the Center for Nursing Research, a part of the National Institute for Health, was created in 1985. It was Senator Orrin Hatch who helped our profession so much when he championed others to override President Reagan, "The notion that the $5 million for nursing research within NIH’s $5.5 billion budget was “too much,” Hatch said, was “preposterous. A proposal for nursing research to have one one-thousandth of the NIH budget is too much? My fellow Senators, don’t you believe it,” he admonished. “It is high time that nursing research took its rightful place in those NIH halls of ivy.” Most senators agreed. They voted to override the veto, 89 to 7"(NINR, 2012).

 This NINR (as it is now an Institute and not a Center) has continued to support nursing research and has trained more scientists, as a percentage of its budget, than any other Institute (NINR, 2012). Its history book is now available for FREE download here:  http://www.ninr.nih.gov/NewsAndInformation/NINRPublications/HistoryBook

New Study Indicates Benefit of IV Inotropics for Hospice Patients at Home

Just yesterday I discharged a CHF patient from the hospital to home with hospice. He had an ejection fraction of only 10% and all of his meds, except the usual oxygen and morphine drops, had been discontinued. I worried for his comfort at home, despite knowing that hospice was involved. This morning I awoke to find reference to a new study which indicates that IV inotropics given to the heart failure (HF) hospice  patient in the home setting can be safely administered. 64.5% of HF patients receiving this therapy were able to remain at home compared to 35.9% not receiving it. Inotropics for palliative care of the HF patient is no new topic, but this study really seems to support the financial and psychosocial benefits of the treatment as well. The following links to a summary of the findings:

Patients at home benefit from inotropic infusion

Teachers Teach More By What They Are Than By What They Say

"Ask not what your students can learn, but what you can learn from your students." Corny, I know, but I like to pose this to myself at the beginning of each semester as I hurry to make sure the classroom environment is set for learning, syllabus thorough and student learning objectives clearly identified.  I strongly believe in the newer approach to adult learning whereby I am not the "sage on a stage" but, rather, the "guide by the side,"  so I do not believe learning should flow only in one direction. Truly, today's nurse educator must blend the art and science of nursing with enthusiasm, caring and scientific pedagogy to help our students develop into the critical-thinking patient advocates necessary in today's complex healthcare delivery environment and this necessitates coming out from behind the podium. Nurse faculty face a daunting task as resources are increasingly limited while expectations and higher level learning outcomes are expected of the new graduates so old approaches must be abandoned.

The following editorial from The Journal of Nursing Education is a refreshing perspective on what it means to be a nurse educator and the importance of defining the teacher before defining the student.
The Scholarship of Teaching as Science and as Art

Clarifying The Roles of the DNP and PhD

http://www.nursingcenter.com/lnc/journalarticle?Article_ID=942589

A nice article (free from this link) about the history of the nursing PhD (who knew there was a program way back in 1924?) and the importance, relevance and nature of the DNP as the hot new terminal degree for clinicians. I believe the argument from the medical establishment that Doctors of Nursing will confuse patients is a smokescreen. Business professors, art professors, dentists, and literally ANYONE with a doctoral degree in ANY field is rightfully titled "Dr." Nursing is a very unique profession, that special blending of art and science, and thus it necessitates two terminal degrees: that of the clinical doctor of nursing and the research doctor of nursing. The linked article helps differentiate the courses of study and typical career paths of the DNP versus PhD.

Nurse Educators---Facilitating that unique blend of science and art that is nursing

Click here for a A Nice Synopsis of Why The Nursing Faculty Shortage Exists

I love teaching, I really do. Students report that I am like a "breath of fresh air" and I believe nursing education to be my calling as it truly brings out my best. But I have to question myself when I consider going into another $40,000 of student loan debt for a doctorate (on top of my $30,000 MSN) in order to gain full-time employment in this career that only pays me $46,000 in some states up to around a maximum of $65,000 in others. Why are schools allowing such manufactured faculty shortages when there are numerous excellent MSN prepared faculty who want full time employment? Does one truly need a PhD to teach basic nursing courses? I would argue against a PhD teaching basic nursing as the preparation for that degree involves statistics, business management concepts, research design and application, curriculum review, and other decidedly non-bedside nursing topics. The PhD and DNP are important for advancing the profession of nursing, but if there is such a shortage of faculty and the PhD is far removed from the bedside, I have to wonder at the motives of those search committees who only want PhDs to teach full-time. And further, if the PhD is the best faculty member, then why are colleges hiring so many MSNs and BSNs to teach as adjuncts? Typically my students receive at least half of their instruction from part-timers with BSN and MSN preparation. Seems like a very double standard. What do you think? What's the solution?

Dog-associated house dust protects against respiratory infection linked to asthma

As a dog lover, pediatric RN in a home with a kid and furry German Shepherd this is fascinating to me!!

Dog-associated house dust protects against respiratory infection linked to asthma

Beauty and Competence

Such serious, caring eyes...

The Balancing Act

 Helping My Patient Die Loved

Ruth, with the left side of her face hanging slack like an empty pillow case, weakly nods she wants a drop of water on her cracked and useless tongue. Carefully, just a dropper-full, but I worry she can’t swallow. Seeing my fear, she finds some humor to mock her end and mumbles “It must be hot where I’m going!”

I doubt there’s space in hell for her; can’t my tears squelch its licking flames?

She’s had a stroke, come to me to die. I have only been an RN a few months and have never seen the dead; my nursing knowledge came from books.

I clasp her hand and nervously try to smooth wrinkled, papery skin. I want to hold her more securely on her tightrope, not let her drop into the deep. In my discomfort I say “My grandmother’s name is Ruth, too.”

“I always hated it,” she barely manages to reply.

My gramma felt the same and she'd ask “Why couldn’t I be a Marie?” Marie is a tender glissando across the tongue, a curling treble cleff, unlike the spitball that is Ruth.

With droppers-full to measure out the cooling water and long, lonely night, I tried to hold tautly onto her fraying ends; but, by morning the balancing-act was over for this Ruth so like my grandmother.

Kissing

Yesterday I kissed my patient. I have been a nurse for almost 18 years and it was a first for me. I do believe in the power of touch and I have held many a hand and wiped both dead and feverish brows, but never had I kissed a patient. I am not a touchy-feely kind of girl and I strongly believe in the "professional presentation" of nursing. But yesterday, I kissed an 87 year old man on the forehead. It wasn't his birthday and he wasn't dying, but he had been asking me to kiss him every day for a week and giving me the most beautiful smile whenever I would bathe him, turn him to prevent pressure ulcers, or give him his sickly pink paste of medicines crushed into applesauce. Then, after a week of his not being able to safely eat from dysphagia that would promptly deposit most foods into his lungs, I assisted a surgeon in bridling him with red robinson catheters.  Through each nare we twisted those large tubes that then were pulled out his mouth, sutured together, clipped short, and turned around to form a red rubber ring. To this a Keofeed tube could be tied that he would never be able to pull out. He cried and coughed, turned blue and batted at us, but there was no family to help us decide what to do and he had been SO hungry all week. I had been the one to passionately tell the doctors that we must somehow feed this man and, so, a surgeon who wasn't even on the case heard me from his dictation desk and volunteered to bridle my patient.

After the procedure, after I had put away the unused sutures and kelly clamps, the patient looked at me and managed to smile again. At me, the nurse who had initiated this procedure that turned a lovely gentleman into a bull. All I could do WAS kiss him.