Nurse Mentor

The American Association of Colleges of Nursing is the organization that accredits baccalaureate nursing programs in the United States.  They do a really great job of ensuring that nursing education programs in the US produce the best possible graduates. They also track hiring patterns among new graduates.  Here are some key results from their most recent survey of May 2013 graduates: 59% of new BSN graduates had job offers at the time of graduation. At four to six months after graduation, the survey found that 89% of new BSN graduates had secured employment in nursing. The percentage of BSN graduates with job offers at graduation varied by region of the country, from 68% in the South, to 59% in the Midwest, to 50% in the Northeast, to 47% in the West. The job offer rate for new nurses at the 4-6 month mark also varied by region from 93% in the South, to 90% in the Midwest, to 82% in the Northeast and West. So what does this mean for you, December 2013 or May 2014 grad

OK nurse friends and colleagues, can you find your passion and have a greater impact than you already do? Go for it!   See this story for an example of how to get started.   Passionate nurses at every level, from the front lines everywhere to management and academia are what attracts people to our profession and taking advantage of the many career options available to nurses in the United States and many other countries.

NY Times 10/15/2013 October is Breast Cancer Awareness month.  Over the last few years, I have too many friends diagnosed with breast cancer under the age of 50.  I'm sure you've seen all the ads on TV, heard them on the radio, gotten hits from internet ads about breast cancer awareness in the United States. What you probably don't hear too much about is the global burden of the disease.  The New York Times highlighted the issue with an excellent report about the challenges low and middle income countries face when trying to treat the disease and its after effects.  The infographic above  comes from the article and shows the scope of the disease. You'll need to scroll down a bit in the article to get to this graphic and the others that further explain its pattern.  Cancer's impact goes just beyond the individual.  Much like the cellular mutations that generate the disease, it touches the individual, family, community, and national health system.  Wh

Every so often a news story linked to a research study comes out with health care statistics that blow my mind.  I read a lot of research so when that happens, it's pretty rare. Kaiser Health News released this story about "super utilizers" in the US healthcare system.  A "super utilizer" is an economic term for a patient who is constantly using healthcare services.  This happens because they do not have good care coordination, lack health insurance, and often have multiple chronic disease conditions that are costly to treat.  Key quote from the article: "These patients are among the 1 percent whose ranks no one wants to join: the costly cohort battling multiple chronic illnesses who consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person. Five percent of patients accounted for 50 percent of all health-care expenditures. By contrast, the bottom 50 percent of patients accounted for j

My favorite shift, evening shift that ran from 3-11:30pm or 4p-12:30am, is disappearing from US hospitals. Evening shift was great.  If morning is not your best time of day, you can be assured that evening shift is your friend.  It gave you time to sleep and refresh from the evening before and attend to life's needs before going to work.  If the shift was crazy, you had time to calm down and still get sleep during normal sleeping hours.  During the shift, it might be admission or post-op care central as patients came in from the ED or back from the OR.  Nurses who worked evening shifts liked them, so you often had a steadier group of co-workers.  Working only 8 hours also meant you had more opportunities to get the same assignment of patients, get to know them, and improve continuity of care. Evening shifts have gone by the wayside because most nurses seem to prefer working 12 hour shifts and management likes them because there is a 4 hour window for extra time worked that doesn&

Greetings All! I didn't intend to take a summer hiatus but it just kind of happened.  Nonetheless, I'm back with an invitation for you to get on the phone with VP Biden and learn about what the Affordable Care Act (a.k.a. Obamacare) means for US nurses.  Info located below. Friends, You and fellow members of the nursing community are invited to join Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius for a conference call on September 26 at 4:30 PM EDT to discuss the October launch of the new Health Insurance Marketplace. Vice President Biden wanted to personally reach out and thank all of the nurses across the country who are gearing up to help millions of Americans access affordable, high quality health coverage. This is your opportunity to hear from him directly about the work ahead. We hope you will be able to join us. WHEN: Date: Thursday, September 26, 2013 Time: 4:30PM ED

USAID recently published this infographic from their work through the " Deliver Project ".  Their research and program development work adopts a variety of approaches to help people in low and middle-income countries have planned pregnancies. What happens when mothers survive childbirth and can space their pregnancies appropriately? * Children are more likely to live to adulthood and create a sustainable workforce. * Children are more likely to go to school, develop literacy and numeracy skills, and become contributing members to society and economic development. * Children are less likely to grow up with one parent or become orphans because their mothers survive child birth. What's more amazing is we know how to solve these problems.  We have the science and the technology available.  The research-based has captured what we need to do to create behavior change that promotes mother and child survival. Yes, it is complicated and each effort needs to be count

From the latest  US nursing workforce report from the Health Research Services Administration in the US, this striking graph should get more attention.  The plunging pass rates of internationally educated nurses (IEN) on the NCLEX-RN exam have big implications for global health workforce policy. The first thing you need to know is that the National Council of State Boards of Nursing (NCSBN) changed the format and content of the NCLEX-RN exam in 2008.  The test designers added new testing methods that better validate the actual knowledge, skills, and abilities of internationally educated candidates.  This also occurred during growing global outcry of high income countries contributing to "brain drain" in low and middle-income countries.  The impact of the change on internationally educated nurses is clear and has reduced the number of viable candidates who would be eligible for practice in the US. At the same time, NCSBN data also show that the overall numbers of IENs

A new study by my colleague Heather Tubbs-Cooley, PhD, RN out of Cincinnati Children's Hospital demonstrated that better RN to patient ratios mean reduced readmission rates between 15 and 30 days after hospital discharge.   From the study published in the British Medical Journal of Quality & Safety : " Each one patient increase in a hospital's average paediatric staffing ratio increased a medical child's odds of readmission within 15–30 days by a factor of 1.11, or by 11% (95% CI 1.02 to 1.20) and a surgical child's likelihood of readmission within 15–30 days by a factor of 1.48, or by 48% (95% CI 1.27 to 1.73). Children treated in hospitals with paediatric staffing ratios of 1 : 4 or less were significantly less likely to be readmitted within 15–30 days. There were no significant effects of nurse staffing ratios on readmissions within 14 days."   Weaknesses of the study include that it does draw from a dataset of nurse survey responses from four US s

I've succumbed to Twitter.  You can follow my tweets @nursementornyc.   The blog will continue for more in-depth critiques, stories from the field, and other resources to help keep you moving forward in your career.

It's our week to be recognized, so enjoy it. Take some time to remember your best patient care moments of the past year. Hold on to those and remember them when you're having not so good moments. The good moments will keep you going, always.

With more absurd stories of bad management coming in from the field, it seems only appropriate to talk about the great need for good nurse managers. According to the 2008 US national sample survey of nurses, less than 25% of nurses in management roles have a masters degree in general, nevermind a specialized one with the necessary leadership, finance, and operations management skills and knowledge required for the role. In fact, 40% of nurse managers only have an associate's degree. Managers continue to impact patient outcomes with how they choose to staff their units, handle patient complaints, and navigate workplace relationships. The quality of their management is reflected in unit turnover rates of staff. Unit level turnover is very costly to the healthcare system. If you interview for a job and you find out there has been a lot of turnover, be wary of bad management practices. As your career evolves, test out your leadership skills as a charge nurse. Get involved with projec

I wish I didn't have to keep highlighting nurses who are the embodiment of what our profession should be at all times, never mind during disasters, but that seems to be the way the media highlights nurses these days. CNN highlighted a story about the nurse who was with a Boston Marathon bombing victim during her last minutes of life.  Read the story here and remember these are moments that remind us why we do what we do.

This week seemed to produce a flurry of stories* from former students about management absurdities they have experienced in their first year on the job, from managers with associates degrees through masters. Here are the best gems of the bunch.  When reading the stories, think about how much these management decisions could cost a healthcare system. __________________________________________ "I was written up for calling a doctor by his first name." Last I checked, doctors have called nurses by their first names --without the "Nurse" prefix-- for at least the last thirty years.  As long as the other person is OK with that kind of informality, does this really merit disciplinary action on the part of management?  How far behind twenty-first social norms does healthcare have to be?  We are not practicing in a 1970s soap opera any more. Managers who use these petty power plays, get over yourselves and focus on something that actually improves patient outcomes.

Melanie* is a former student who took a job in a rural hospital, deciding she would rather have a job sooner than later so her career could begin moving forward after graduation.  In a recent letter, she reflected on her first year's experiences. "The hospital has its pluses and minuses - I always, quite often, remember what you said to me about how accepting this job would be wise in my long-term plan, because it would give me an understanding of how different systems work in different areas. It really has done so. It has been an eye-opening journey into the difficulties rural health systems face. Rural hospitals have unique challenges that come from both their revenue sources and the locally available talent pool.  They can be great places to get experience with a wide range of patients.       "The good: The step down unit is 24 beds, with a ratio of 4:1. Because of the hospital's small size and inability to specialize, it's a kitchen sink as to what

A former student shares her story of trial and triumph as she fought her way through a nursing school program that doubted her nursing skills because she had only one arm. She's a wonderful example of perseverance and how nurse managers can really make a difference with developing and retaining young nurses.

It strikes me that many students and nurses do not seem to know about the "other" masters degree options for nurses.  Everyone seems to want to be a nurse practitioner these days.  Now, that's great news for the primary care provider shortage, but we need nurses with masters degrees who can work in other positions and have other skill sets. Let's review the other masters degrees in nursing.  Nearest and dearest to my own heart is Nursing Education.  Remember that really cool clinical instructor you had in your entry-level nursing program --that could be you!  Do you like precepting new hires?  Are you the person on your unit who unofficially keeps everyone up-to-date on the latest evidence?  Do you really enjoy patient teaching, whether in the hospital or community setting?  Do you just like to teach?  Nursing education is the right masters for you.  Skills learned in a nursing education masters cannot be learned on the job.  Curriculum writing and program developm

Nurses, regardless of your views about gun ownership, by the very nature of your career choice you are now on the National Rifle Association's enemies list .  Not to worry, you are in good company with our physician colleagues.  That's right, the American Medical Association made the list too along with the Pediatricians.  The complete list also has teachers, cops, and religious groups on there.  Yes, your religious affiliation could make you an NRA enemy, even if you own a gun. Suffice it to say, it's pretty easy to understand why health professions associations made those lists.  When you keep seeing teenagers and young adults hospitalized due to gun violence in their communities, take care of a critically ill child that was shot by a gun in their own home because they were playing with it, or when an angry human being walks into the emergency room where you work with a loaded rifle threatening everyone, that kind of waste of human potential is a gross injustice on man

When people live longer, societies have to figure out how to ensure they do not end up in poverty and that they can remain active citizens.  Elders in poverty mean higher health system costs because poor people have more health problems.  Nonetheless, health issues with aging are inevitable regardless of income level. The Washington Post highlights the graph from the US Department of Health and Human Services below. What the graph shows is not a surprise: More people growing older means increased Medicare costs.  See the graph below (courtesy of Flowing Data ) illustrating the average age of members of congress. When you wonder why policy choices are made about Medicare, look at those in Congress who are close to receiving it.

The New York Times published a wonderful piece about a nurse who was diagnosed with pancreatic cancer and offered herself as a teaching case study.  You can read the story in the Times here . Photo review here . From the article: "Spending time with the dying is not fundamental to nurse training, partly because there are not enough clinical settings to provide the experience. The End-of-Life Nursing Education Consortium , a project of the American Association of Colleges of Nursing, has provided training in palliative care to some 15,000 nurses and nursing instructors around the nation since 2000, focusing not just on pain management but also on how to help terminally ill patients and their families prepare for death.  In addition, some students do rotations with hospice nurses, said Pam Malloy, the project’s director. But Ms. Malloy said that nursing schools still do not focus on end-of-life care nearly as much as they should. “We live in a death-denying society, a

Remember your research or evidence-based practice class?  Here is a great example of how nurses can help create evidence to shape workforce policy. The American Nurses Association is moving in a new direction and conducting it first national nursing survey in cooperation with the National Council of State Boards of Nursing (NCSBN) and the Forum of State Nursing Workforce Centers. The survey will be conducted via a mailing through the U.S. Postal Service and via the web. It should reach potential respondents between Jan. 7 and Jan. 14 .  All RNs in the U.S. with active RN licenses are eligible candidates for survey participation. A random sample of this population will be chosen to participate. (Quiz: Why is random sampling important for this type of survey?  Write your responses in the comments!) Nurses who receive the survey are strongly encouraged to provide information such as basic demographic and professional data (e.g., age, year licensed, etc.) even if they ar