CampusRN Job Blog
What makes a great nurse?
Monday, April 30, 2012
To better understand why nurses command our trust and respect, we asked some metro Atlanta health care professionals to tell us what they think makes a great nurse
Nurses aren’t angels, but they may be the closest thing we have in the workplace.
For 12 of past 13 years, nurses have topped the Gallup Poll of the most trustworthy professionals. Patients and their families know why.
While doctors diagnose illnesses and prescribe medication, surgery or other treatment, it’s often nurses who explain medical procedures, help manage symptoms, respond to emergencies, listen to family concerns, allay patient fears, soothe worries and find ways to make difficult situations bearable.
A nurse’s mission is not only to save lives, but to promote and preserve quality of life.
“The basis of great nursing is caring, but it’s bigger than that,” said Deborah Almauhy, chief nursing officer at Rockdale Medical Center in Conyers. “It’s a commitment to a lifestyle, not just a 12-hour job at a hospital.
“I’m a nurse at every family picnic, neighborhood gathering and kids’ ballgame. I’m a nurse when friends are sick and [when] parents get older and turn to you for help. Nursing is a part of my protoplasm.”
While caring is an integral component of nursing, today’s focus on evidence-based practice, ongoing research and continuous technological advances make a passionate commitment to learning just as essential, Almauhy said.
Almauhy’s career plans were set when she was in preschool, as a poster in her office confirms. It shows the face of a young girl with the words, “When I grow up I’m gonna be a nurse.”
For more than 20 years, Almauhy has worked in urban emergency, trauma and burn centers, as well as serving as a nurse in the U.S. Navy Reserve.
“I can’t even begin to put into words how much I have loved being a nurse,” Almauhy said. “It has been an indescribable career.”
Elaina S. Hall, director, Grady Burn Center, Grady Health System
“Every great nurse I know has the following characteristics: caring nature, detail-oriented, emotionally stable, great judgment, physical endurance and extraordinary communication skills.
“In today’s health care environment, nurses must be ready to complete a comprehensive physical and mental assessment of a patient. He or she must have a comprehensive knowledge of infection control, body mechanics, genitourinary issues and an endless list of quantitative and qualitative measures of a patient’s well-being.
“She must do all this and, of course, smile and help achieve organizational patient-satisfaction metrics. A great nurse can do all these things and still love her job!”
Carol Danielson, senior vice president and chief nurse executive, Gwinnett Health System
“What makes a great nurse? Two words come to mind: competent and compassionate. A competent nurse is a skilled and knowledgeable expert for the patient [and] who is trusted to always do the right thing. A compassionate nurse is sympathetic to another’s misfortune.
“A great nurse empathizes with the patient and family and is able to consistently convey a complete understanding and knowledge of what they are experiencing, along with a strong conviction of wanting to help. These qualities combined result in the ultimate bond between patient and nurse — one of trust, understanding and advocacy.”
Susan Grant, chief nurse executive, Emory Healthcare
“I spent a summer in college working as a nursing assistant and discovered that I loved connecting and being present with my geriatric patients. I thought, ‘This is me, this is who I am.’
“I felt compassion for them and that they needed an advocate. I think it’s critical for a nurse to really know herself. Nursing requires a lot of self-awareness. It’s not a job; it’s about who you are and how you relate to other people.
“A great nurse is someone who is a good partner. She partners with her patients and families, not with the goal of making them dependent, but of fostering empowerment. Her role isn’t to do things to them or for them, but to strengthen them through the healing process.
“It takes skill, a sharp intellect, self-knowledgeempathy and compassion to be a great nurse.
“I have the privilege of leading other nurses. People think of a chief nurse executive as a big job, but the big job is taking care of patients at the bedside. Seeing what our nurses do inspires me every day.”
Victoria Alberti, manager, Kaiser Permanente of Georgia Breast Center
“Great nurses are born, not made. They have an innate gift of unconditional compassion and a relentless determination to alleviate suffering.
“Providing strength in a patient’s time of weakness and going beyond the call of duty to bring a smile to his face — that is the role of a great nurse.
“But more importantly, great nurses are medical advocates for their patients.”
Sheyla Desir, nurse manager, acute care services, Atlanta VA Medical Center
“The technology has changed and our patients have more complex illnesses, but the one thing that hasn’t changed since Florence Nightingale started the profession is caring. A great nurse sees the patient, not the tubes. She sees someone who could be her mother, her father or her child, and she cares for them as if it were so.
“I’ve been fortunate to have some great nurses teach me, nurture me and take me under their wings to guide me into the profession. I’ve learned that a great nurse takes care of her patients, her fellow nurses and her whole organization.”
Susan Sweat Gunby, professor, Mercer University’s Georgia Baptist College of Nursing
“Great nurses, regardless of whether they work in clinical practice, education, administration, research or other areas, all possess three qualities or essences. These are:
“1. Passion: Their passion for excellence in all they do can be seen and felt by others.
“2. Pride: They take immense pride in being a nurse and in honoring the heritage and legacy of a caring profession.
“3. Presence: Great nurses communicate with — and from — a profound depth and quality of presence. They are committed to ‘being with’ and ‘being there’ with patients and clients.”
posted in: National, news, Employer News
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Elder care enters the digital age
Monday, April 30, 2012
The growing business of taking care of aging seniors at home is getting help from a powerful, but unlikely suspect: the mobile phone industry.
With rising health care costs, the soaring baby boomer population and an increased emphasis on keeping people out of hospitals for conditions that can be monitored and treated at home, Atlanta-based AT&T Mobility and other major wireless phone companies have found a sweet spot for new growth.
Marrying technology with medicine may be part of the solution to better health care and lead to more business opportunities, but there have been challenges. Concerns about privacy, how doctors get paid and whether traditional geriatric facilities — such as nursing homes — will go away as more people choose to remain in their homes, are among them.
“In the private industry, there’s a whole group of people looking at how to solve this problem,” Ralph de la Vega, chief executive officer of Atlanta-based AT&T Mobility, said in an interview with The Atlanta Journal-Constitution. “Obviously, we’re not alone in this, but we think the technology we have will allow people to be able to do that.”
Analysts say what’s known as the home health care industry — adding technology, telecommunications, smartphone applications and other equipment to make it easier for seniors to stay in their homes — could swell to between $1.5 billion and $2.5 billion because of the number of involved partners: wireless companies, technology developers, hospitals, doctors, insurers and home builders. The growth will come at the right time. Nearly 75 percent of AARP’s surveyed members say they’d prefer to stay in their current home as long as possible, and much of the baby boomer generation is more comfortable with using technology and mobile devices compared with their parents.
They also have the most equity in their homes, have more long-term savings and are willing to spend money on gadgets.
“It’s helping the wireless industry transform itself. It can become more competitive and better for the customers. That’s a big job,” said telecommunications analyst Jeff Kagan.
The business opportunities have led AT&T Mobility to develop what’s becoming a separate division called Digital Life Services that will be run out of Atlanta. The organization will be housed under the AT&T Mobility’s whiz-bang “Emerging Devices” division, which started three years ago.
For its part, Verizon Wireless has formed its own team of account managers, executives and others to focus solely on the health care industry.
“The biggest piece is that Verizon wants to play in this space,” said Rachael Nagrowski, Verizon Wireless’ associate director of strategic sales. “We no longer want to be seen as a cellphone provider.”
AT&T Mobility talked up its new suite of home monitoring services including cameras, lighting, thermostats and motion detectors, part of its Digital Life efforts, at an international mobile technology conference in Barcelona in February. The business model is for overseas only; the company has not made any announcements in the United States. Here, the company broke into the digital health care industry by selling pill bottle tops called GlowCaps, which flash and send out ringtones to remind people to take their medicine. Every time the cap is opened, the person’s doctor or family member gets notified electronically.
“AT&T’s concern in this space is really around the fact that when you look at the stats — 10,000 people a day retiring — you look at the current infrastructure in the U.S. for people that are aging, there is no way with the baby boomers and how fast they are retiring. We don’t have the infrastructure to keep up,” said Glenn Lurie, head of AT&T Mobility’s emerging devices unit. “We need to understand that people are living longer, and we need to do a better job of asking those people what they want.”
It’s rare that the phone companies will develop these mobile health care technology devices themselves. Rather, they will partner with a company that’s developed new technology for the health care industry. That device typically contains the same type of software and network elements that are in a smartphone, so it can communicate with a caregiver, doctor or nurse using the mobile phone provider’s wireless network.
The development of these devices now helps people take their blood pressure, heart rate and weight at home, for example, and upload the information to a database for a doctor to read it. Any changes in vital signs or warnings of trouble can be spotted early, and the doctor can call to change medication, ask the person to come in for an appointment or send an ambulance for emergency care.
“The focus of all of health care now is really to reduce in-patient hospital care, nursing home care, facility kind of care,” said Mark Oshnock, chief executive officer of Atlanta-based Visiting Nurse Health System.
As much as $25 billion a year is spent on hospital readmissions. Medicare estimates that 75 percent of those readmissions could be prevented with better outpatient care, Oshnock said.
Oshnock said there was initial resistance from the visiting nurses when they first started using remote monitoring equipment five years ago.
“There were a lot of implementation issues, one of which was, ‘How can I be replaced by this little piece of equipment?’”
Not long after, Oshnock said the nurses said it was worth taking an extra 10 to 15 minutes to show someone who had just been discharged from the hospital how to use the remote monitoring equipment to check vital signs. It’s prevented people from returning to the hospital, allows nurses to check more patients and saves everyone money.
“It’s been a working solution for us,” Oshnock said.
In many cases, it’s eased the mental, emotional and often physical stress families or a spouse experience when caring for an ailing family member.
Suffering from dementia and emphysema, Jim Connelly wasn’t getting out of bed or interacting with his wife, Cackie. That all changed when his daughter, Mary McKenzie of Sandy Springs, bought a multimedia device called SimpleC. Similar to a small TV screen, the device uses photos, music and voice recordings to tap into a person’s long-term memory, helping to motivate someone who is suffering from memory loss.
McKenzie installed old family photos, 1950s music and voice recordings of herself reading prayers and psalms to help trigger memories of the family growing up.
“Dad would perk up,” when he would hear the music and see the photos, McKenzie said. Hearing the psalms would calm him at night, she said. What’s more, McKenzie said her mother felt less overwhelmed.
“This gave her a little bit of confidence, and afterward she started taking steps to get Dad more help,” McKenzie said. “I felt like it was a catalyst to get her going.”
The makers of SimpleC, which contracts with Verizon Wireless to run on its 4G LTE network, started testing it in homes last summer after installing it in 29 assisted-living centers. SimpleC directly markets SimpleC to assisted-living centers and is working with Verizon to market it to families and seniors who are remaining in their own homes.
posted in: National, news, Employer News
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5 Steps for Finding the Perfect Part-Time Gig
Wednesday, April 25, 2012
Whether you need a second job for extra income or you’re unemployed and open to working part-time to bring in cash flow, part-time work is available if you know where to look for it. And before you assume that your only options are outside your field, you should know that most part-time jobs aren’t advertised. What you see on job boards isn’t all that you could get.
Why Work Part Time
There are different reasons for needing or wanting to work part-time. Maybe you’re interested in working as a contractor to ramp up a new freelance business. Or maybe you want to spend more time with your kids. Maybe you feel like you’ve exhausted all the full-time opportunities in this market, or perhaps you just want some extra cash. (According to SnagaJob.com, 8.3 million Americans take part-time jobs because they can’t find full-time roles.)
Whatever the reason, a part-time role (temporary or otherwise) will do the trick. Take these 5 steps to land part-time work:
1. Figure out your schedule. Because part-time roles vary in the number of hours worked, you’ll need to begin by determining how many hours you can work a week, and what hours you are available. Part of determining your availability is looking at the amount of money you want to bring in. Do a rough estimate of what you think you could make hourly, and decide how many hours you would have to work to bring that amount home. Take your availability schedule with you when starting the job search.
2. Start with the job boards. You might be surprised to find a variety of part-time opportunities on job boards, especially in nursing and sales. Not all companies list part-time jobs on these boards, but they are the places to start. Sometimes a company may list a full-time role that could be a part-time position for the right person, so don’t disregard full-time positions that look good.
3. Do a little handshaking. Because so many companies don’t publicly announce part-time positions, it’s important to network with people who work at different companies. Sometimes positions are created based on a company’s needs and an individual’s skill set, so you might find yourself in a unique position to pitch a company on a part-time role if you network with the right people (Think: part-time social media manager). Spend some time on LinkedIn to reconnect with your contacts. Put your feelers out for any opportunities that may fit.
4. Look in the right places. Part-time jobs aren’t just found in retail and restaurants. Customer service roles, for example, may be offered as telecommute positions that allow you to customize your schedule.
Government agencies and schools are another good place to look for part-time jobs. Unfortunately, many federally funded entities have had their budgets cut and are looking for ways to reduce expenses. While they still need staff, these entities work to reduce their full-time positions so they don’t have to pay benefits, which means there may be part-time opportunities. Since not everyone can afford to take a part-time job, you may have a little less competition than you would with a full-time role.
posted in: Career, National, news, Employer News
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Colleges with nursing jobs programs offer task possibilities
Friday, April 20, 2012
Colleges using nursing programs are in high demand these days. With a lot of anticipating a shortage of healthcare professionals, programs have opened doors wider to accommodate the influx of students applying to nursing packages. A few people have criticized this action, some praoclaiming that these programs have finally flooded the industry using too many graduates and never enough jobs. Even so, those colleges using nursing programs claim that with the right leverage of the degree, individuals can and perform find jobs.
“I tell new grads all the time that there’s still the nursing shortage. It is simply in a bit of a lull at this time,” Susan Battaglia, nursing jobs recruitment director at AtlantiCare Regional Medical Center, stated. “We also tell individuals not to put all of the eggs in one gift basket. I think people consider the only nursing tasks are in a hospital, however there are clinics, nursing homes, schools and physicians’ offices as well.”
Having said that, colleges with nursing programs should stress to their students there are many more places to work than in a hospital. Not only that, but many hospitals prefer candidates using experience over those that do not have much, hence the competition for the a lesser number of jobs is fiercer.
Nursing Homes
As the population gets older, nursing homes may see a blast at the in new people and will, or already have, been hiring pertaining to nursing assistants, LPN’s and RN’s.
In addition to providing medical to residents, RN’s as well as their counterparts strive to preserve residents as cozy and happy as you possibly can.
Home Care
RN’s will travel to home-bound patients and still provide care to them when needed. It could be on call or scheduled, depending on every single patient or company they work for.
This kind of work allows nurses to be more one-on-one with a patient and because of the of the job, nursing staff are always on the move and therefore are not confined to a single place all day.
Medical professional Office
RN’s working in doctor offices generally take pleasure in regular hours.
These people work as a staff with the physician, though they are usually the first person who a patient sees before the physician comes in to initially assess these people.
Schools
School nurse practitioners see children and teens on a daily basis, managing them for more typical illnesses. They also layout health programs on the school to raise attention about health issues.
RN’s in schools may also learn the signs of abuse or neglect, and other concerns like an eating disorder, and also help the student find the proper kind of help.
posted in: National, news, Employer News
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Would you want a male midwife to deliver your baby? Or trust a man to do your nails?
Wednesday, April 18, 2012
These days we often hear of career girls making their way in a man’s world — but what of the men doing ‘women’s work’?
Gary Slevin, 51, is a midwife from London. He has five children, aged 19 to 33, and has been married three times. He says:
Since I qualified, I’ve delivered more than 2,000 babies. Some women are very surprised when they’re told I’m going to be their midwife — but they get over it pretty quickly when they realise I’m there to help them.
I used to be the manger of a restaurant and pub, then, when I was 28, my wife and I split up and I took charge of our four children. The youngest was three and the oldest 11. I gave up work to bring them up.
When my youngest started school, I looked around for a job, and my sister — who was a nurse — said: ‘Why don’t you go into nursing?’
I thought: ‘Well, it’s quite apt because I’ve been doing all this caring at home.’ So I went to train at the Coventry and Warwickshire College of Nursing and Midwifery.
One of my early placements was with a community midwife, who could recall every single baby and woman she’d looked after. I thought that was amazing. It meant the service was personal — she was involved in their lives.
I wanted to be part of that, so soon after qualifying as a nurse I started my midwifery training at the Warwick Hospital in Leamington Spa. I qualified as a midwife when I was 36.
Some of the other midwives were very anti me at first. They said ‘We’ll have to chaperone him everywhere’ and ‘He can’t possibly know what it’s like to have a baby’.
I would reply: ‘Well, a lot of you haven’t got babies, so you don’t know that either. It’s not about having babies, it’s about having empathy.’
They would also say: ‘There’s no way women are going to let him look after them.’
I’d tell them: ‘Well, if a woman doesn’t want me to look after her, that’s absolutely fine. It’s her choice, and that’s not a problem because there will be plenty of women who do want me to look after them.’
Within three or four months, even the most resistant person was friendly and supportive. They could see I really cared for the patients.
I’ve worked in six or seven hospitals across the country, and am now at University College Hospital, London, where I’ve been for two years.
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Nursing career prepared woman for volunteer work at hospice
Monday, April 16, 2012
For nearly 17 years, retired nurse Mary C. Fello has administered comfort and kindness to dying patients as a volunteer in the Forbes Hospice unit of West Penn Hospital.
But it wasn’t always that way. She began her nursing career in the nursery and delivery unit of the former St. Francis Hospital.
“I was a St. Francis graduate nurse and worked there for about 35 years,” recalled Mrs. Fello, 88. While her children were young, she took the night shift, and later she switched to short stay surgery. “I loved that,” she noted, adding, “but I knew I wanted to volunteer here when I retired from that job.”
She has been volunteering more than 30 hours a month ever since. For that contribution, she is a finalist for Most Outstanding Volunteer Award from among 48 winners of the Jefferson Awards for Public Service of 2011.
The outstanding volunteer will be announced Thursday at a 7 p.m. ceremony in the Music Hall of the Carnegie Museums of Art and Natural History. The winner will represent Western Pennsylvania at the national Jefferson Awards ceremony in Washington, D.C., this summer.
The Snavely Foundation will donate $1,000 to Forbes Hospice on Mrs. Fello’s behalf.
The program is administered locally by the Pittsburgh Post-Gazette with sponsorship by Highmark, BNY Mellon, The Pittsburgh Foundation and The Heinz Endowments.
“It makes you feel good to help,” she acknowledged recently.
A woman of few words, Mrs. Fello of Point Breeze is more comfortable doing than talking about doing. When asked if it takes a special kind of person to work with the dying, she replied, laughing, “I’d like to think it takes a special person.”
Her daughter, Maryanne Fello, the medical director of Forbes Hospice, agreed. “The nurses who do this are kind of a special breed. They come in and are not afraid and like to help.”
She said her mother “is a purpose-driven person. She is always involved and takes up causes and advocates for her grandchildren. She goes after things that really make her get up in the morning.”
The hospice serves an average of 125 patients a day. “The people who come to the hospice are very, very sick, and one of our goals is to keep people free of pain,” Mrs. Fello said.
All the volunteers, whether they are nurses or not, go through special training with Shelby Anderson, hospice volunteer coordinator who nominated Mrs. Fello for a Jefferson Award.
“It kind of comes naturally, but we have special instructions on spiritual care and bathing patients and things like that,” Mrs. Fello explained.
Because of her extensive experience and her natural aptitude for making people feel better, she also helps train new hospice volunteers, giving them the confidence to care for the terminally ill.
If the patient asks about dying, the volunteers are taught how to discuss it. “A volunteer will sit with the patient and hold her hand and talk or pray with her or read, whatever is appropriate,” she said. The volunteers also help family members feel comfortable around the patient by having them do simple things for their loved one, including holding a hand or rubbing a back or combing hair.
“I get a real personal satisfaction from the work at the hospice. You don’t really realize what has happened until you come home and think about the day,” she said. “If you have helped anybody, it gives you a certain satisfaction.”
As for the families, the volunteers are glad to have them there at the time of death. “Sometimes they choose not to be, and other times it just happens when they are not there,” she said. Knowing that a volunteer was there and can tell them how peaceful it was makes a difference for the families.
posted in: Career, National, Employer News
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New York pushes nurse staffing ratios bill for hospitals, nursing homes
Wednesday, April 11, 2012
New York legislators are considering the Safe Staffing for Quality Care Act, a nurse staffing ratios bill for hospitals and nursing homes that is supported by the New York State Nurses Association and the New York State Public Employees Federation and opposed by the New York State Organization of Nurse Executives and the Greater New York Hospital Association.
The bill (A00921 and S4553) would require one-nurse-to-one-patient staffing in the operating room, trauma emergency unit, intensive care and maternal/child care units during the second and third stages of labor. It would set a minimum of one nurse to two patients during the first stage of labor and in postanesthesia units; one nurse to three patients in antepartum, ED, pediatrics, telemetry and newborn and intermediate care nursery units; one nurse to four patients on med/surg units and acute care psychiatric units; one nurse to five patients on rehabilitation units; and one nurse to six patients on well-baby nursery units. The minimum requirements shall be adjusted to reflect the need for additional direct-care nurses in accordance with an approved acuity system.
The proposed ratios are more stringent for some units compared with California’s safe staffing ratios law, which went into effect in 2004 and mandates one nurse to two critical care patients, one nurse to four patients on telemetry units and EDs, and one nurse to five patients on med/surg floors.
California experience
Linda H. Aiken, RN, PhD, FAAN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia, and colleagues reported April 2010 in the journal Health Services Research that California hospital med/surg nurses cared for one fewer patient per shift, on average, than nurses in the other states studied. The lower rates were associated with lower mortality, and nurse outcomes were predictive of better nurse retention in California than in other states studied.
“It validates our experience in reducing harm and death,” said DeAnn McEwen, RN, MSN, president of the California Nurses Association/National Nurses Organizing Committee and vice president of National Nurses United in Oakland, Calif., which is supporting a national staffing ratios bill (H2187 and S992) pending in Congress.
Proposed staffing regulations
Bill A00921 and S4553 propose the following staffing ratios:
• OR — 1 nurse to 1 patient
• Trauma emergency — 1 nurse to 1 patient
• ICU — 1 nurse to 1 patient
• Maternal/child — 1 nurse to 1 patient (during second and third stages of labor)
• Maternal/child — 1 nurse to 2 patients (during first stage of labor)
• Postanesthesia — 1 nurse to 2 patients
• Antepartum — 1 nurse to 3 patients
• ED — 1 nurse to 3 patients
• Pediatrics — 1 nurse to 3 patients
• Telemetry — 1 nurse to 3 patients
• Newborn/intermediate care nursery — 1 nurse to 3 patients
• Med/surg — 1 nurse to 4 patients
• Acute care psychiatric — 1 nurse to 4 patients
• Rehabilitation — 1 nurse to 5 patients
• Well-baby nursery — 1 nurse to 6 patients
Note: The minimum requirements shall be adjusted to reflect the need for additional direct-care nurses in accordance with an approved acuity system.
posted in: Career, news, Employer News, New York
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‘Be proud of your profession and enjoy your working life’
Monday, April 09, 2012
We talk to Alison While, professor of community nursing at King’s College London who registered as a nurse in 1975, before becoming a health visitor.
Why did you decide to become a nurse?
I always wanted to be a nurse throughout my childhood and it never really occurred to me to pursue other career options.
Where did you train?
I trained at St Thomas’ Hospital, London and had the most inspirational nurse tutors. Sadly one of my nurse tutors died two winters ago. I’m still in correspondence with my other nurse tutor.
What was your first job in nursing?
I worked as a health visitor in north Kensington, London. My geographical patch comprised a housing clearance/improvement area and some streets with mansions.
What is the trait you least like in yourself and why?
A constant desire to aspire to the highest standards in everything; it is exhausting.
From whom have you learnt most in your nursing career and why?
At different times I have been lucky to learn from lots of different people. My nurse tutors taught me the importance of personal and professional integrity, which I have carried with me over the years. But they were also tremendous fun. I was fortunate to work alongside Jenifer Wilson-Barnett for many years; she was committed to high quality nursing and believed you should never settle for second best when it came to patient care.
What advice would you give someone starting out in the profession?
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Students prepare for careers in nursing
Wednesday, April 04, 2012
Scurrying through the hallways of the Gracie Lee Haught Education Center, dark blue smock clad students from Debbie Eldredge’s Gila Community College (GCC) nursing assistant class prepare for their weekly clinical training.
“This room is completely set up for test tubes,” says one student.
A group sits in a corner analyzing their notes and preparing for their hands-on clinical class, part of one of GCC’s most important, best attended vocational programs.
Two girls rush out of the supply room carrying linens, bowls and dishes.
“This room will be for peri-care, this for feeding, and this for bed baths and conditioning,” said Eldredge focusing the energy of her students.
As they settle into their different rooms, Eldredge takes a moment to explain the purpose of the day.
“I have my students practice on each other so they know what it feels like when they give care,” said Eldredge, “By the end of their time with me, I tell them they have good enough training to take care of my family.”
The state requires students to know 21 different skills on a written exam, explained Eldredge. The students today practice peri-care, learning to wash a patient who must use a bed pan or diapers; feeding and mouth care, practicing how to brush teeth and feed; and bed baths and conditioning, caring for a patient who cannot get out of bed and must be cleaned and moved to remain healthy.
Eldredge listed off further tasks nursing assistants do for incapacitated patients: hair and nail care, non-sterile dressings, shaving, vitals, bed pans, monitor fluid and food intake, foley bags, mouth care, and taking measurements and weight, plus a long list of other tasks healthy people take for granted.
Her class also teaches the students the theories, foundations, and legalities of health care. Students learn didactics and the 10 bodily systems they will work with on patients.
“I tell my students the best way to learn is repetition, repetition, repetition and to practice, practice, practice,” said Eldredge showing check-off lists the nursing assistant patients have filled in with their hours of practice.
“Knock, knock, knock!” is heard through the hallway.
In the next room, Mary Lambken starts her practice by knocking on the door of the room her mannequin patient sits in.
“Hello Mr. Jones, I’m here to brush your teeth,” said Lambken, “I hope that is alright,” she explains as if she were in the middle of an actual patient visit.
She pulls out a side table covered with a toothbrush, towel and cup.
“First what I’m going to do is brush your teeth side to side,” she takes the tooth brush and does this to the mannequin, “Now I’m going to get your biting surface,” she brushes that area, “and now the top teeth,” she finishes the job.
“OK, I’m going to have you rinse and spit a couple of times ... here’s a glass with a straw,” she said as she handed the materials to Mr. Jones.
When she believes the patient has finished, she pulls out a towel to wipe off any wet spots.
“I’m done Mr. Jones. If you need anything, please give me a call.”
Tori McDaniels sits next to the wall with the list of activities watching everything Lambken does. McDaniels makes sure every task is done in the proper order to complete the tooth-brushing task.
“You did good, just don’t forget to do this step before that one,” said McDaniels pointing to the towel and cup.
“The students check each other before I come in to check them off,” said Eldredge.
Nursing is a growing business.
“Three out of the nine students who graduated in December from the program just called me,” said Eldredge, “They all got jobs in Payson.”
In fact, the U.S. Department of Labor lists nursing as one of the hot job fields of the future. In the next decade, nursing jobs will grow by an estimated 20 percent. Already, more than 100,000 nursing jobs remain vacant nationwide.
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Case management nurses coordinate care
Wednesday, April 04, 2012
Like many nurses, Stacy Szucs and Kim Farr came to work in case management after long and varied careers. They have found it to be a dynamic and growing role that is changing them and their nursing practice.
Case managers offer ongoing support, expertise and coordinated care for patients with complicated health needs. Once a narrowly applied function, case management has become a fully developed area of practice in which professionals manage the social, medical, financial and behavioral issues associated with complex cases, according to the Commission for Case Manager Certification.
“When Pulse first started publishing in 1992, utilization review nurses often served the role of reviewing requested clinical services for coverage to determine if the care [of a patient] was the right care, at the right time and in the right setting,” said Szucs, RN, CCM, case management supervisor at Cigna, a global health service company.
“Case management nurses still have that role to some extent, but today we are moving much more into health advocacy. We play a much larger role in teaching customers about their care, emphasizing prevention and how to avoid illness. We’re using innovative techniques to empower people to take better care of their own health. It’s a fresh approach and one that people value.”
Szucs, who previously worked in critical care, cardiothoracic and rehabilitation nursing, has worked for Cigna for 16 years. As a case manager and a supervisor, Szucs can take a step back and look at things from a different perspective.
“I can ask how we can make changes to make our services better,” she said.
Seeing the big picture
When Farr started her nursing career, she remembers having diagnosis and nursing goals for her patients.
“We were adept at telling them what to do. Our goal was to get them well,” said Farr, RN, CCM, case manager on Cigna’s complex case team.
Today, Farr uses her assessment skills to listen, encourage and help patients get the right treatment, accept difficult diagnoses and find solutions for a better quality of life.
Farr spends her days on the phone performing a multitude of tasks. She helps patients transition from hospital care to home care and explains diagnoses or treatment plans. She also obtains access to doctors, coordinates health benefits and helps patients better manage chronic conditions.
“Maybe it’s my critical care background, but I love coming into mass confusion and bringing order out of chaos,” Farr said.
It’s not unusual for a routine case to become more complicated.
“I had an elderly woman who was sent home from the hospital after a diagnosis of pneumonia,” Farr said. “No home health [care] had been prescribed but in following up with her, I learned she was uncomfortable with her doctor’s diagnosis. She thought something else was wrong.”
Farr encouraged the woman to seek a second opinion and a doctor found permanent lung damage from a 15-year-old chemical injury. Despite oxygen treatment, she ended up back in the hospital and faced a lung biopsy.
“I talked to her frequently. She was extremely ill and scared, but ultimately came to the decision to have the biopsy,” Farr said.
Unfortunately, the patient died soon after.
“Coaching her through that process was very emotional, but I considered it successful, because the last time I talked to her, she was at peace that she had done what she needed to do and was glad that someone had helped her,” she said.
While Farr is not a therapist, she has learned to be an expert listener, thanks to Cigna Care Coaching, a training program the company launched in 2007.
“It’s an intense 15-week course with readings, case studies and role-playing to try out different methods and techniques,” Szucs said. “Our case managers and health coaches go through it to learn better communication skills. They learn how to actively listen for what is said and not said, how to ask reflective, open-ended questions and to use motivational interviewing techniques to help clients make better decisions for their health.”
Farr said the course helps nurses and coaches identify their own belief systems.
“That self-awareness is very important in working with a multicultural population,” she said. “It helps case managers get past the ‘righting reflex’ — of wanting to fix things their way — and allows them to let the customer come to his own conclusions.
“We used to choose the best treatment for patients or list their options. Now I give them resources and encourage them to go on their own fact-finding missions in order to find the solutions that meet their needs. I’ll ask if they’d like more information and wait to be invited into the decision-making process.”
Importance of relationships
Szucs and Farr have learned that listening and offering information — rather than telling patients what to do — is a better way to convince people to change poor lifestyle choices such as smoking, eating fatty foods or not exercising.
“I’ve had people tell me that they weren’t going to do something, then turn around and change their minds because we kept calling and listening. We didn’t give up on them,” Farr said.
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