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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

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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. ADVERTISER

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Atlantic Health System Bala Nursing & Rehab Center BayCare Health System Bayfront Health St. Petersburg Beck Field and Associates Berkshire Community College Camp Chipinaw CFG Health Network Chandler Hall Health Services Community Hospital Concorde Career College CritiCare Diamond HealthCare - Behavioral Health Pavilion Florida Hospital of Zephyrhills George Washington University Hospital George Washington University Medical Faculty Associates Gila Regional Medical Center Holy Redeemer Hospice of New York Indian Head Camp Indian Hills Community College Inglemoor Care Center Inspira Health Network Inc. Lower Bucks Hospital Lower Keys Medical Center Main Line Health System Maris Grove - An Erickson Living Community MJHS New England Center for Children Norton Sound Health Corp. Raquette Lake Camp Richmond University Medical Center Saint Peters University Hospital Shepherd Center Summit Oaks Hospital The Watershed Addiction Treatment Programs US Army AMEDD National Online Media Venice Regional Bayfront Health WakeMed White Glove Agency Youth Consultation Service

www.balanursingandrehab.com www.beck-field.com

www.yourcommunityhospital.com

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34 32 37 39 40 40 40 34 34 38 38 35

www.indianhead.com www.orthonet-online.com www.lowerbuckshosp.com

www.ericksonliving.com

www.nortonsoundhealth.org www.raquettelake.com

36 13 40 35 32 34 38 32 33 34 38 35 35 33 32 38 34 32 10 36 34 38

www.veniceregional.com www.whiteglovecare.com www.ycs.org

41 37 37 33 34

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www.advanceweb.com/nursece www.advanceweb.com www.advancehealthcareshop.com www.advanceweb.com/jobs/healthcare/index.html www.advanceweb.com StudyatAPU.com/advance www.calmoseptineointment.com www.championchair.com http://klogs.com www.mskcc.org rasmussen.edu/RNtoBSN salemstate.edu/graduate

PG #

22 2 43 20 18 29 22 6 17 30, 31 29 11 30 30

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, [email protected], ext. 1649 ▶ Article Reprints: 800-355-5627, ext. 1484 ▶ Subscriptions: 800-3551088 ▶ To place an ad, call our Sales Department: 800-355-JOBS (5627)

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www.advanceweb.com/Nurses

The Pink Glove Dance is back; start practicing your dance moves! By Pamela Tarapchak, Editor

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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 Director: Maria Senior Marketing Manager: Kate McNally Events Manager: Laura Smith • ADMINISTRATION Vice President, Director of Human Resources: Jaci Nicely Billing Manager: Christine Marvel Administration Manager: Mike Connor • MEDIA & MARKETING OPPORTUNITIES Media Operations Manager: Sofia Goller HEALTHCARE FACILITY SALES Group Sales Managers: Amy Sherlock, Ken Burd • EDUCATION ADVERTISING SALES Senior Account Executive: Sarah Rucinski • CUSTOM PROMOTIONS Sales Manager: Mike Kerr

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.


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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.


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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 www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES

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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

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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.

Seasonal Employment Opportunities: ICU, PICU, NICU, LDR, Pediatrics and Mother/Baby Receive premium pay when you make a commitment to work a minimum of 2 twelve hour shifts per week including weekends and holidays. Days and Night shifts available, Minimum of 1 year experience needed in the specialty. Must have your BSN and BLS for Healthcare providers. t t t t

ACLS required for ICU. PALS required for PICU and Pediatrics. ACLS, NRP and EFM required for LDR. NRP required for NICU and Mother/Baby.

Night Supervisor, Full Time NJ RN license, Minimum of a BSN required, BLS for Healthcare providers and ACLS, Certification required. Must have minimum of 5 years nursing experience with evidence of progressive leadership experience.

programs can be implemented both efficiently and effectively.

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 BSN required, Masters preferred, BLS for Healthcare providers and PALS, Certification required. Must have minimum 3 – 5 years progressive leadership experience in an acute care setting, National certification or nursing admin certification within 1 year of hire.

Assistant Nurse Manager Opportunities t Adult Medicine Unit, Full Time Nights t Metabolic Unit, Full Time Days BSN required, current NJ RN License, BLS for Healthcare providers and EKG certification needed. Supervisory experience desired, may include charge nurse, committee leadership etc. Med/Surg certification needed.

Per Diem Opportunities: PICU, ICU, Med/Surg float, Adult Communities (float between Wound Care Center in Monroe, Adult Day Care Center and the Adult Communities), Cardiac Cath Lab and OR BSN required. Must have a minimum of 2 years experience in specialty, BLS for 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


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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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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 12 ADVANCE FOR NURSES MARCH 2015 n

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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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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. 14 ADVANCE FOR NURSES MARCH 2015 n

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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


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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 16 ADVANCE FOR NURSES MARCH 2015 n

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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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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 www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR NURSES

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Med/Surg 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.

WE MAKE IT EASY TO: Refine your search criteria. Use our handy navigation bar to customize your results by employer, city, state and search radius. Explore your options instantly. Make changes to your criteria and the results will refresh automatically on the same page. Track your search history. Refer back to your past searches and click on any of one them to run it again.

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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Lifestyle

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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.


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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 ABC for hemorrhage control. The 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


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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

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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.

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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).


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).


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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. 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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Evaluation Please respond to the following statements. You must complete this evaluation to receive your certificate. A = strongly agree B = agree C = neutral D = disagree E = strongly disagree 1. I can describe the requirements of providing effective trauma care. 2. I can describe the rationale for utilizing a standardized Primary and Secondary manner of head-to-toe assessment on trauma patients. 3. I can identify reasons that trauma nurses may experience moral/emotional distress. 4. The objectives relate to the overall goal of the article. 5. The article is well-written and logically organized, and defines terms adequately. 6. Please offer any comments or suggestions for future CEs. __________________ ___________________________________________________________________

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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


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SALEM STATE UNIVERSITY OFFERS MSN IN NURSING EDUCATION, NURSING ADMINISTRATION AND ADULT GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER Our students specialize in nursing education, nursing administration or adult gerontology primary care nursing with a focus on developing the skills and expertise to excel in the advanced nursing practice roles of nurse educator, nurse administrator or nurse practitioner. Graduates are educationally equipped to make significant contributions and meet the many challenges of tomorrow’s demanding health care environment.

s a l e m s t a t e . e d u / g r a d u a t e 30 ADVANCE FOR NURSES MARCH 2015 n

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TREATMENT AND MANAGEMENT STRATEGIES

Sponsored by: Memorial Sloan Kettering Cancer Center Department of Nursing

TIME

TO RENEW YOUR FREE SUBSCRIPTION

ADVANCED CRITICAL CARE SYMPOSIUM FOR NURSES

Date: Time: Fee:

April 29, 2015 7:30 am - 4:15 pm $250

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Contact hours awarded to nurses who attend the entire event and complete a program evaluation

Date: April 10, 2015

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CALL TODAY 800-355-1088

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www.advanceweb.com/Nurses n MARCH 2015 n ADVANCE FOR2/20/15 NURSES5:27 31PM

Massachusetts, New York, Pennsylvania, New Jersey CAREER OPPORTUNITIES

Career Opportunities Sign up or renew your FREE subscription at the website or by calling (800) 355-1088.

To place an ad in this section, call ADVANCE at (800) 355-JOBS (5627). www.advancehealthcarejobs.com.

MAKING A DIFFERENCE IN OUR COMMUNITY!

Operating Room RN – Open House Wednesday, April 15 • 2-4pm Human Resources Dept, 355 Bard Ave. Staten Island, NY 10310 2nd floor Villa Building, Between Kissel and Hoyt Ave

We are seeking NYS licensed OR nurses with 2-3 years of experience in both scrubbing and circulating in major surgical cases. BSN preferred.

LEADERSHIP OPPORTUNITIES: NYS licensed RNs • Administrative Director of Clinical Services – Behavioral Health, FT Master’s degree and 5+ years of inpatient behavioral health experience required. Leadership experience also required. • Nurse Manager – Inpatient Behavioral Health, FT BSN required. Five years of recent clinical inpatient psychiatric and leadership experience are preferred.

1. 2. 3. 4. 7.

New England . . . . . . . . . . . . . . 32 Middle Atlantic . . . . . . . . . . . . 32 Upper South Atlantic . . . . . . 36 Lower South Atlantic . . . . . . 36 West North Central . . . . . . . . 38

8. West South Central . . . . . . . . 38 9. Southwest . . . . . . . . . . . . . . . . 38 11. Pacific . . . . . . . . . . . . . . . . . . . . 38 National . . . . . . . . . . . . . . . . . . 39

›› MIDDLE ATLANTIC

REGISTERED NURSES $2,000 Bonus

Inglemoor Rehabilita�on and Care Center of Livingston, NJ, is seeking highly skilled RN’s to join our team. SAR/LTC experience preferred. FT/PT/PD & Wknd Sup/Charge Nurse for all shi�s. Compe��ve salary and benefits including: up to 35 days PTO (available for pay out), Health Ins. & 401k. High Staffing Levels. Please email your resume to: [email protected] visit our website: www.inglemoor.com Please, no phone calls. EOE.

PRIMARY CARE RNS 2 positons available; 1 Day hours and 1 Evening hours. Provides primary health care/case management for assigned teams of students; collaborates with the NP as appropriate. Requires a BSN; experience with a pediatric special needs population preferred; must be licensed in MA. The ideal candidate will be able to work in a fast paced environment, be able to multi-task and prioritize needs efficiently, work independently, provide health education to teaching staff, and have strong written and verbal communication skills. Basic computer skills required. Forward letter of interest and resume to: Human Resources - RN 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 Office and the RNAC Office. Experience preferred, but willing to train. • Unit Manager - Full Time All positions require current PA RN licensure, CPR and IV certifications and at least 2 years of relevant experience in long-term care.

www.NECC.org

4001 Ford Road, Philadelphia, PA 19131 Phone: (215) 877-5400 Fax: (215) 871-3110 Email: [email protected]

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32 ADVANCE FOR NURSES MARCH 2015 www.advanceweb.com/Nurses ■

• Clinical Resource Manager – Care Coordination, PT BSN and PRI certification required. We are also seeking experienced Per Diem RNs in Cath Lab, Emergency Room, Critical Care & Operating Room. Requires NYS RN licensure and 1-2 years of relevant experience. BSN preferred.

›› NEW ENGLAND

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• Nurse Practitioner – Cath Lab, FT Flexible shifts Requires an MSN with 3+ years of critical care experience.

■

We offer a competitive salary and benefits package. For immediate consideration, please apply online at www.rumcsi.org or fax resume indicating position of interest, to 718-818-2789. Richmond University Medical Center is an EOE/AA employer.

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 contracted vendor staff. Requirements: • BSN minimum, MSN preferred • NYS RN License required • 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 required within 6 months of hire • Must have a reliable automobile, valid driver’s license and the minimum state required liability auto insurance.

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 serve as a team leader, providing directions and supervision to the Hospice interdisciplinary care team. 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. [email protected] Fax: 718-784-1413 Website: www.hospiceny.com HONY is an equal opportunity employer

Id8db[dgi6alVnh###

VISIT NURSES POV: A collection of BLOGS for Nurses advanceweb.com/community

New York, New Jersey

gives you the

CAREER OPPORTUNITIES

MY INSPIRATION:

White Glove

providing compassionate care while growing as a nurse

Freedom to choose...

Nursing Assignments in All Major Hospitals, Nursing Homes, Correctional Facilities & Group Homes

Part-time | Full-Time Per Diem | Contracts | Travel

NY – Always New Openings! UÊAmb Surg UÊClinic UÊCorrections UÊEndoscopy UÊER UÊGer/LTC

UÊHemo/Dialysis UÊICU/CCU UÊL&D UÊMB/PP UÊMed/Surg UÊNICU

UÊOncology UÊOR UÊPACU UÊPediatrics UÊPeds ER UÊPICU

UÊPsych UÊRadiology UÊSchool UÊTelemetry UÊUAS Assessments

Extraordinary benefits and pay: UÊ}Ê,>ÌiÃÊUÊ ÀiVÌÊ i«ÃÌÊUÊÃÌ>ÌÊ >ÞÊ*>ÞÊ UÊHealth & Dental UÊ ÕÃiÃÊ>`ÊÀit

WHITE GLOVE W PLACEMENT, INC.

You ccare re for your patients.We care for YOU. 85 Bartlett St., Brooklyn, NY 11206

866.387.8100

Experienced RNs – Home Care and Hospice • $5,000 sign-on bonus for full-time • $2,500 sign-on bonus for part-time Inspira Health Network is seeking experienced RNs to join our Home Care and Hospice divisions. As a leader on our team, you will deliver direct patient care, coordinate home health services and supervise home health aides. BSN, valid New Jersey RN license and CPR/IV certification are essential. We require 1+ years of recent experience as a home care case manager, with excellent clinical, assessment, teaching and case 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 tr dition tra oon nal a ccocoo ed edd,, ed, res re res eside id ddeenti nttiaal nt al,l,l summ su um mm mme m r cam me aamp mpp in m in beeeaaut bea uttiful uti ful fu ul Nort Nort No rrth tth h Ea Easstt Pe Pen P een nnsy nnsy nssylva ns llvvvaania ani niaa. Wee are W arre re hi hiring rriinng Patient rin atttiient aati ent, Fun en uun, nn, Energ EEn nerg rg rgeti geeti etti tc aand nd nd FFllex e bble exi blle le R RN Ns for sum sum umm mer me er e 20015 155. 15. Wee oof W off ffeerr a be ff ffer beeau eaaauuttif iffuull se settin set tin tin ng, g, ggre reaatt re sta sst taff ta ff com om ommun mmu mun m unit un nity itty ty aan nd an 8 we week ek experience of a lilifet fet etiim et ime mee. m To inquire about joining the IHC team,, pple please lease conta conta co ntact: ct: La Laure uren@i ure n@indi n@i ndianh anhead headd.co coom 914-345-2155 • www.indianhead.com om m

IHC – Cel C lebr ebrati b ating ng 75 yea years! rs!

www.cfghealthsystems.com EOE


■

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.


35


Erickson Living

helps people live better lives


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


■

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


37


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 ȏΖ&8 ȏΖ0& ȏ0HG6XUJ ȏ/ '

ȏ25 ȏ(5 ȏ3V\FK ȏ4XDOLW\&RRUGLQDWRU

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 ■

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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


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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 Clinical Adjuncts - A.D.N. & P.N.

FIND IT AT ADVANCEHEALTHCAREJOBS.COM

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Executive Directors Director of Nursing Compliance Managers Psychiatric RNs

Berkshire Community College 1350 West Street Pittsfield, MA 01201 413-499-4660

WWW.DIAMONDHEALTH.COM

www.berkshirecc.edu Employment Opportunities

Northern, Louisiana A Vibrant Community!

Get More from Advance

Up to $9,000 Relo/Sign-on

COME AND HELP US BUILD THE BEST RURAL HOSPITAL IN THE COUNTRY!

Hospital RN F/T Openings...NOW Limited New Grad Openings Safe Patient Ratios / Caring Managers Shift/Diff to $6 hr / Comp Pay & benefits

Job Openings:

Call: Jim Cox 800-304-3095 Email: jcox@beck-field.com Cell: 210-885-5483 eves/text ok

Registered Nurses Eligible for up to • $10K sign-on and • $5K relocation

Camp Chipinaw in New York’s Catskill Mountains seeks RNs for 4 or 8 weeks from June 24th thru August 16th. Receive room, board, and salary. Camper tuition included. Come join our family!

email resume to: [email protected] or apply online: www.chipinaw.com

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Located in Silver City, New Mexico, near the Gila National Forest

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Employment is contingent upon successful completion of pre-employment drug and alcohol testing. GRMC is an Equal Opportunity Employer.

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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