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Showing posts from 2015

Job Security

This is a great comprehensive report about current US nursing workforce issues. It gets a lot right and few things wrong. Yes, 1/3 of US RNs will retire by 2020 but many of them are concentrated in selected states.  The million nurse shortage coming our way by 2030 will be concentrated in 16 states and most of those are in the South, South West, and Midwest. Most coastal locations will actually have surpluses of nurses.

Job hunting advice: If you want your first choice job right out of school, be prepared to move. You can do anything for two years and get solid experience. Have a friend go with you and start a new adventure somewhere you wouldn't have thought to live before.  You never know what might happen!  With solid work experience, you can always move to your preferred location down the road.

Dear View: The Stethoscope is a Tool for ALL Healthcare Providers

In light of the member's of The View's ignorant statements about nurses, how we dress, and the tools we use to do our jobs, let's review a few things.  We can discuss how their behavior denigrates women in general by engaging in catty, superficial commentary focused on nothing substantive at another time.

Stethoscopes are used by the following healthcare providers in addition to physicians:

NursesRespiratory therapistsNurse PractitionersPhysician Assistants They all use the stethoscope as a tool to double check the findings of other professionals. It helps prevent mistakes and catches problems that could be life threatening. Clearly The View thinks only doctors save lives when it is a team effort.

Nurses using stethoscopes in the United States and other countries was a hard fought battle. Physicians did not feel nurses and other healthcare professionals were qualified to use stethoscopes for many years.  Nurses fought long and hard to use them.  Now it is a tool that helps…

Please, Let Sleeping Patients Lie

A recent Kaiser Health News article highlights one of my personal pet peeves about hospital care: Unnecessarily interrupted sleep during hospitalization. It is bad for the patient and certainly impacts their satisfaction with your care.

You know how you feel when you haven't slept well, right? Add illness to that and for some, aging changes and you end up with a cranky patient and often family to boot.  Sleep is important for all when ill, no matter what age the patient.

Sleep helps you heal.  It allows your body to work on fixing the problem while the mind switches to different activity levels that allow for physiologic healing to occur.

Sick kids need it so they have the energy to cope with their illness during the day and all those grown ups doing stuff to them.

The elderly need sleep because it will take them longer to recover.  Lack of sleep also puts them at higher risk for delirium, confusion, and wandering. (Oh, does that explain a few things?!)

So if you are working night …

How to Choose the Right PhD Program for You - Part III: Finances

Money issues stop a lot of nurses from going back to do their PhD, sometimes for good reason. Let's dispel some common concerns first.
When Enrolled Full Time in a PhD Program, Your Student Loans Go Into Payment Deferral
That's right. When you're studying full time you don't have to pay your loans. You're allowed to defer payments until you finish. You can pay the interest so the amount doesn't accumulate too much.  It is a good idea to pay the interest while in school.
Many Full Time PhD Programs Offer Full Tuition Funding and a Living Stipend
Funded PhD study is a great thing. It allows you to focus on your studies and develop your ideas. You can take the time you need to think, because you'll never have it again.
So how much is a living stipend? It varies by school and program but reports from the field suggest that it ranges from $1,500 to $2,300 per month. It is usually enough to cover rent, food, and your internet/phone connection. It is not meant to be…

A Better Way to Get Rid of Your Nursing Student Loans OTHER Than Working Another Job

Social media recently tuned me into a great resource every nurse with loans should know about: Student loan repayment through volunteer work. SponsorChange is a non-profit committed to helping people repay their student loans.

Here's why it is a better option for you than working a second job to repay those loans.  And yes, I know many of you do.

1) Working more than three 12 hour shifts a week is bad for your health and your patients.

More and more research shows that 12 hour shifts are bad for you.  How come?  Let's think about it. The shift starts at 7am.  You're up at 5:30 or 6 so you can commute and get there on time unless you live within a short walk to your job, which most people do not in the US.  So your day really starts at 5:30am.

You work all day long and give report, which ideally means you finish report at 7:30pm and then you leave.  But that never happens right?  So, you stay to finish up everything and maybe get paid overtime for documenting on your patient…

How to Choose the Right PhD Program for You - Part II: Family Factors

In 2011, some colleagues and I wanted to see what factors might influence someone's choices for going back for a PhD. Our pilot study found some interesting results and you can read about them in our 2014 published study here.

Among our findings, family and financial factors were major concerns. This is a pretty common concern among most women returning for graduate study, and increasingly for men.

Let's take a look at common questions and concerns around family issues that come up among potential PhD applicants.  Most responses are geared toward individuals returning for full time study and modified for part-time study as needed. These responses also apply to the US context. They may not be relevant outside the US.
My family can't afford for me to quit my job for full time study.

Full time PhD study is at least a 4 year commitment and most Ph…

What's This Big Data Stuff Anyway? (Besides increased documentation for frontline nurses)

There's a lot of potential to make a real difference for our patients.

How to Choose the Right Nursing PhD Program for You - Part 1: The Right Program

Congratulations! You've decided to take your career to another level and pursue a research degree. I can assure you that you've not lost your mind (however, you can email me during years 1 and 2 when you're sure you've lost your mind and I'll give you a pep talk), you've just probably come up with more questions that you cannot find answers for in the existing evidence. Even though your undergraduate self that probably did not like your introduction to research course is in shock at the moment, you've made a good choice.

So at this moment you're trying to figure out where to go to study. Here's how you should choose.  This is the first post in a series getting published in the Fall of 2015.

Do you see yourself doing research just about all the time or maybe part of the time?

Just about all of the time = You need to choose a top 25 graduate school that is designated as a Research I university. Most of your time will be spent doing research and less t…

Developing a Patient-Centered Career Path

Every month I spend a few hours talking to students, both graduate and undergraduate, about what to do next in their careers. I have these conversations enough that I've started to think that the half-life of a bedside nurse in any clinical setting is about 15 years, though there is no research to support this (yet).  Colleagues at the RN Work Project just might figure it out as they study new graduate career patterns.

Anyway, the central theme of most of these discussion is the patients that care for or finding that patient population that makes them happy in their jobs. Sometimes its about creating the conditions that make for happy nurses caring for satisfied patients.
The central question is: How can you create a patient-centered career path?
Let's walk through a few questions to ask yourself. I'll use examples from my own career to illustrate.
Q: Who are the patients you love to work with and in which clinical setting?
A: I started off my career in med-surg and then se…

Amazing Data Generation Graphic

A zetabyte generated between 2012-2014!

Think about what this might mean for our work.

The Quality of Your E-documentation May Actually Affect Your Salary

You've probably noticed an uptick in the blog posts this past week. That's because I'm spending the week at the National Institute for Nursing Research learning all about Big Data and it's quite inspiring. One topic that consistently comes up in how to better integrate nursing documentation data into large datasets so we can figure out how to improve patient outcomes using real bedside data.

By now you should know you're always learning something new as a nurse. This is even more true once you have a PhD when you learn about how little you really know about anything. As we've listened to really interesting speakers this past week, a few things have come up that relate directly to you, the frontline nurse.

Here's probably the most important.

That electronic health record (EHR) where you document your work may actually affect your paycheck. No, not because you have to spend so much time filling everything in that you're staying late and getting overtime (…

Do all those medicines you give actually work well? Maybe not.

This graphic from Nature gives nurses lots to think about.

The blue people are the ones for whom the medication actually works well for while the red represents the ones that have bad side effects.

How can we encourage adherence to medication regimens with these kinds of facts?

The Frustrating Thing(s) About the US Health Insurance Marketplace - Part 3

This is part 3 of a 3 part series. Click to read Part 1 and Part 2 for background on the story.

In parts 1 and 2, my friend Eva tries and eventually succeeds in getting an appointment so she can get treated for what turns out to be severe laryngitis and walking pneumonia, and how the market-based insurance system foils her attempts.

At the end of the last post, I asked the question "What would have happened to Eva if I (or someone else with health system insider knowledge) hadn't been there to help her get connected to people who could see her that day?

Scenario 1: She gets frustrated with not being able to find a primary care practice who can see her that day and so decides to go to the local public hospital emergency department (ED) --because they will take her insurance.  She goes to the ED and spends hours waiting to be seen because her case is considered non-urgent.  Eventually she is seen in the overcrowded ED and gets sent home in the middle of the night (or next mornin…

The Frustrating Thing(s) About the US Health Insurance Marketplace - Part 2

This post continues from Part 1.  Click here to read it.

This is the story of my friend Eva trying to get seen in primary care and how the insurance system foils multiple attempts and delays care. We left off with Eva's first attempt to getting an appointment failing.  Eva is a friend of mine from graduate school with a PhD and a good job she was able to take because it was easier for her to buy private insurance after the Affordable Care Act and work as a consultant.

Eva still needs to be seen. She's traveling for consulting work three days later --kind of important when you need to pay your bills while waiting to hear about full time work.  She doesn't travel, she doesn't get paid.

I dive into the bag of tricks most nurses develop when they've dealt with their health system after about a year.  I email a colleague I know who runs a nurse managed clinic (staffed by nurse practitioners) to see if she can get her in.  In 5 minutes, she gets back to me and connects he…

The Frustrating Thing(s) About the US Health Insurance Marketplace - Part 1

Let's be clear: I'm all for people having insurance.  I spent enough time working in the US healthcare system to see what a lack of health insurance does to patients.  It adds to the stress of their illness and sends many into medically driven bankruptcy because of their medical bill debt --something no one should ever have to endure.  I was thrilled when the Affordable Care Act [ACA] (a.k.a Obamacare) passed. With my policy training, I knew the bill was far from perfect but what was important in the US context was to get it through and then embed it in the bureaucracy, as happened prior to and continues since implementation.

But there are flaws nonetheless.  These are driven by the business of medicine and how it is funded in the US.

This is the story of my friend Eva.

Eva and I did our PhDs together. Instead of going into academia, she ended up in the corporate world with a good paying job and excellent benefits.  After putting in her time in that sector, she decided she wan…

Neglected Non-Communicable Diseases

These diseases are already widely affecting health care and nursing practice in high income countries. The implications for low and middle income countries are scary.  They already do not not have enough health workers to care for their country's infectious disease burden (i.e. pneumonia, HIV, gastrointestinal diseases, etc.) and these diseases will increase costs because they require longer term and more treatments.  Thanks to BioMed Central for the powerful infographic.

Should you have work experience before getting your PhD in nursing?

This is a hot topic these days: Should someone be admitted to a PhD program in nursing without ever having worked as a nurse, straight from their bachelor's degree?

Good question.

A common reaction from most people is that well, of course they should! How can you know what healthcare is like from a nursing perspective if you don't have experience?

Of course, one could make the same argument about a PhD in public health where it is also common to go straight from an undergraduate bachelor's degree right into a PhD program. How can you understand the context of public health without any experience? Do we assume that bright people will be able to make reductionistic arguments about their research findings based purely on what trends in numbers show?  In many cases, it happens all the time.

Kind of like management consultants with no life or healthcare experience that make recommendations for hospitals and how they should operate. Happens more than you think it does.


Professional Conferences: Get Re-Energized About Your Nursing Career

I was reminded this morning of the value of going to travel for conferences.  Someone I had met 18 months ago at a conference in Brazil emailed me about a really interesting project with multiple benefits to my organization and career.  It's the second project to come out of that conference and a valuable network connection.

So there are lots of conferences out there for nurses and health care professionals.  Some are specific to your specialty, some are great places for general practice resources.

Most of all, what conferences can provide you is moral support for the work we do.

When you find other nurses who understand the challenges of the patients you care for and are trying to help, you realize you are not alone in the clinical practice world.

When you find other nurses who also happen to have an unsupportive manager, toxic personalities on their units, and other relationship challenges that affect the work environment, you know other people understand what you do at a deep…