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  • Apr 26

    In 2015 The Journal of American Medicine released a study on the pay gap between male and female nurses. That survey revealed that male nurses earn about $5100 per year more than women. This survey sparked much interest and dialog as to the reasons for this disparity.

    The new analysis, which included data on more than 290,000 registered nurses, also found that the pay gap had not narrowed within workplace settings and specialties from 1988 to 2013. The new study is the first to have measured gender disparities in pay among nurses over time.
    Published in 2016, an allnurses.com survey yielded results also showing the wage gap with men making more per hour than their female coworkers. Is it just about gender or are there other variables that factor into the results?

    Women make up 92% of the nursing workforce while men hold only 7.74%, as noted in the allnurses. com 2015 survey. The majority of nurses at the time were paid hourly, 80%, in fact. Men tended toward specialty areas like anesthesiology (with 41% of nurse anesthetists being men), cardiac care, critical care and Emergency room care. The AMA study found that approximately 40 percent of nurse anesthetist are men and were paid on the average $17,290 more annually than female nurse anesthetists.

    It seems that one of the main factors that may influence the gender wage gap is that woman take time off to care for family and children. When they return to the workforce they often come back at generally the same pay grade while men have continued working and have received hourly wage increases along the way.

    Women are also more apt to regulate their work hours. They seek out opportunities for a more traditional 9-5 nursing job or a shorter work week, again to meet the needs of work/family balance. Men are more likely to take “off hour” opportunities for higher pay and have more overtime on a regular basis.

    In the 2017 allnurses Salary Survey nurses were asked to provide the number of regular hours they work per week as well as how many hours of paid overtime they average per week. This data, as well as a breakdown by gender, could shed some additional light on the gender gap in salary.


    Men are also known to negotiate salary increases and higher pay rates than women. This accounts for some of the higher wage per hour values noted.

    As we are nearing the release of the current (2017) allnurses.com salary results, it will be interesting to see if the gender gap has narrowed over the past year and what the variables will look like! What are some of your thoughts on this finding?

    Resources:

    Pay Gap Between Male and Female RNs Has Not Narrowed

    Although women dominate the nursing profession, do men make more money?

    2015 allnurses Salary Survey Results

  • Apr 26

    Becoming a stress-savvy nurse goes far beyond having an intellectual awareness that stress exists in our professional and personal lives. Being stress-savvy requires thinking about stress in productive ways, staying open to new approaches for coping with stress, and sharing what you’ve learned with others. This article discusses a rationale, a study, and three basic tips you can use every day, at work and at home, to improve your life by reducing stress.

    Stress Management vs Stress Reduction

    There’s a big difference between managing stress and actually reducing it or, better yet, eliminating it from your life, according to Morton C. Orman, MD, founder of Stress Awareness Month. According to Dr. Orman, merely managing stress is not enough improve your health, because management fails to resolve the root cause of the stress. Orman bases his ideas on the notion that the concept of stress is an all-encompassing way of collectively labeling life’s events or problems. From that standpoint, he concludes that successfully resolving the causative problems will effectively eliminate the stress.

    Whether it is addressed via management or reduction, stress is a constant topic of conversation in the healthcare workplace, and for good reason: The healthcare professions, including nursing, have long been recognized as highly stressful occupations. While stress may sometimes seem like an over-hyped topic, it remains on corporate agendas because it has such serious health and economic consequences. According to research findings in the growing field of psychoneuroimmunology, chronic stress causes overexposure to cortisol and other stress hormones, which ultimately depletes the immune system and sets the stage for increased risk for a numerous other health problems. This in turn, leads to high staff turnover in organizations.

    Study Shows Online Stress Reduction Program Works

    High rates of nursing staff turnover are not only an expensive problem for healthcare organizations, but staff turnover can diminish the quality of care for patients as well. While employers recognize the need for supporting staff in the name of stress reduction, in-person trainings can sometimes be seen by employees as an additional source of stress.

    A randomized controlled trial published in November 2016 by Applied Nursing Research evaluated the efficacy of a web-based stress reduction program developed by ISA Associates, Inc. called BREATHE: Stress Management Program for Nurses. The 104 nurses and nurse managers from 6 eastern U.S. hospitals who participated in the 3-month trial were divided in to control and program groups. Those in the program group experienced greater reductions in stress, as measured by the Nursing Stress Scale, than those in the control group.

    The authors of the study concluded that web-based programs hold promise as a resource for providing nurses with the necessary tools for addressing work-related stress. The finding is significant because it suggests that employers can provide tools that are convenient for employees in their ultimate efforts to reduce staff turnover. By extension, reductions in staff turnover may contribute to enhanced quality of care for patients as well. This study draws attention to the continuing need for employers to support stress reduction in the workplace, and points to the myriad benefits this support can bring to individual nurses and patients, as well as to healthcare organizations as a whole.

    Three Tips for Taking Action

    Beyond the opinions of thought leaders, the findings of researchers, and the actions of employers, there are some practical tips individual nurses can use every day to upgrade stress awareness to stress-savviness.

    1. Recognize stress and keep it in perspective.

    When we unwittingly accept constant stress as normal, we set ourselves up for failure because the human body was never designed to thrive under the constant engagement of fight-or-flight physiology. By first admitting or recognizing that stress exists, and then by keeping it in perspective-- by acknowledging that it is neither good nor bad, but simply is-- we can take clear steps toward reducing its effects and its existence. It may be helpful to remember here Dr. Orman’s idea that stress is just a code word for the collective accumulation of life’s problems, which can make it easier to address and resolve each individual problem one at a time.

    2. Distinguish appropriate from inappropriate tools.

    Whether your approach to stress emphasizes management or reduction, it likely focuses on the use of tools such as assessments, tracking applications, information products, or online programs, among others. While substances such as alcohol, nicotine, sugar, and alcohol may also be classified as tools, it is important to distinguish between which tools are appropriate and which are not. Attitudes of denial, hedonistic escapism, and self-medication with addictive substances or risky behaviors not only fail to address the underlying sources of stress, but may actually create new sources of stress, and are therefore inappropriate tools.

    3. Develop, refine, and practice your preferred skills.

    What is your own, go-to, personal skillset for reducing stress? Every nurse should have his or her own personal set of preferred coping skills for resilience, mindset shifting, and problem-solving. While your choice of skills is guided by your personal preference, the important thing to remember is to stay aware what works for you—not every technique works for, or is enjoyable for, every individual. Once you’ve discovered what works for you, committing to practicing your preferred skills is key. Failure to practice equals failure to reduce the stress. While time-tested relaxation techniques such as yoga, meditation, massage, and exercise require the development and refinement of skill over time and can be extremely effective for managing the symptoms of stress if they work for you, it is important to remember that the longest lasting and most satisfying health benefits come from addressing the actual root cause of the stress. Depending on your individual needs, this is where counseling, coaching, or other means of coping and support can be infinitely useful if you determine that you do not currently have the skills to address the root cause yourself.

    In conclusion, nurses who approach stress with a problem-solving mindset are stress-savvy, and as such, can enjoy improved health and quality of life.


    Questions for comment:

    What is your favorite way to reduce stress? Does your institution have a stress reduction program? How has it helped you?


    Sources and resources:

    Chronic stress puts your health at risk - Mayo Clinic

    Hospital Nurses Can Reduce Stress With Online Program, Study Suggests
    Medscape: Medscape Access

    Nurse Turnover: The Revolving Door in Nursing
    Medscape: Medscape Access

    Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses

    Stress, Illness and the Immune System | Simply Psychology

    Stress Awareness Month — Official Site

    The Immune System and Stress

  • Apr 25

    I don't see the program I am attending listed (via search) University of Nevada Reno, Orvis School of Nursing. Orvis School of Nursing
    I can provide more info and details that are not listed via the website if needed such as the total estimated cost breakdown, prerequisites, application process etc. This is the oldest nursing program in NV now in its 60th year. The BSN program runs through summer so it is 17 months instead of 2 years but only Starting classes in fall and spring semesters.

  • Apr 25
  • Apr 25

    Thank you!

  • Apr 25

    Quote from ksisemo
    Serious question, because I think you are right - do you know if there have been any studies done on the safety and/or efficacy of NPs both with RN experience and without?

    I am certain these types of things are studied or tracked when compared with MDs/DOs. Of course, insurance companies watch "evidence-based medicine" practice like a hawk and will reimburse based upon those practices, which are supposed to be founded in safety and efficacy. But I am wondering if there are any real, controlled, peer-reviewed studies published on the track records of NPs based upon level of experience.

    I wonder, though, if this might be hard to nail down, because NPs with RN experience might have obtained that experience in an area entirely different to their NP specialty.

    ??
    Excellent question and there are a couple of articles out there indicating there isn't an issue, "nursing research" of course, however I believe it is too early in this new initiative to have enough data. Unfortunately the trend is now to admit anyone who can fog up a mirror held under their nose and pay the tuition so my guess is the next 5-10 years is where we will see the problems although I consider negative outcomes, short of death or extreme disability, difficult to quantify. And patients LOVE their NPs because they hold their hands, and mop their brows with little concern of their actual skill set.

    I've posted about this in the past but how would one discern if a patient saw NP with c/o ear pain, received antibiotics and actually didn't have an ear infection? Or a patient who comes in with a rash that gets treated for eczema without effect, then tinea corpus, then finally scabies which they had from the onset. The patient didn't die or likely suffer disabling harm so would this even be documented or monitored? Would the insurance companies pick up on this eventually? In psych I frequently see egregious regimens for people with substance use disorder and bipolar disorder. Bipolar is a common train wreck that inexperienced clinicians seem to favor for people with SUD, personality disorders and most concerning children who have trauma hx and horrible home lives NOT bipolar disorder. Do your first intake on a NP's patient who is 9yo with a bipolar disorder diagnosis on a stimulant, alpha blocker and lithium, which has blown out their thyroid, minimal therapy and living in an unsafe home and get back to me on how dangerous inexperienced prescribers can be.

    My opinion and one that clearly isn't shared by the universities who are interested in retaining students and therefore tuition is overall the odds of being a better clinician would be more favorable if the person actually had nursing experience which if anyone cares to remember is why our short nurse practitioner education was originally approved. PAs and of course physicians have significantly more clinical hours.

    Overall I think its too early in the new trend of everyone and their poodle becoming a NP for us to tell exactly how things will go but one thing is certain, our wages are going to continue to tank as the supply exceeds the demand and those with zero business sense accept lame offers. Like you and others have said there are certainly outliers however I would disagree that NP clinical requirements of 500-1000 hours is sufficient to take a person from zero medication knowledge to competently diagnosing and prescribing regardless of how well regarded the university is so imvho you will need to be the exception rather than the rule.

  • Apr 25
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  • Apr 25

    Boston College-Private
    University of Massachusetts (Boston, Worcester, Dartmouth, Amherst)-Public
    Curry College-Private
    Simmons College-Private
    Mass General Institute of Health-Private

  • Apr 25

    Lakeview College Nursing
    Danville IL
    Private accelerated BSN program that has wonderful competent instructors, hospital close by and small enough that you are getting a great nursing education. The college is looking into obtaining approval for possible masters in nursing as well in the future. The college is accredited. Has different tracks such as BSN for non-nursing, LPN to BSN, ADN to BSN.

  • Apr 24

    I went to update my years of experience, but it won't let me save any changes because I don't have my gender set. Can the form be changed so that I can leave that blank?

  • Apr 24

    P - Purpose

    What does this medication do? What ailment or disorder is it meant for? Knowing the purpose of the drug you're about to give is the most basic yet vital piece of information. It holds the key to how you will proceed with administration and assessment going forward. It can also provide your first red flag. Your patient is here for an asthma flare but this is a potent diuretic. Wait, huh? Hold on…

    Many drugs can sound and look alike, despite efforts like capitalizing part of the drug name. To give you an idea of just how many medications are reported as being confused with one another, see the complete list by The Institute for Safe Medication Practices here.

    Was it a DTap or TDap immunization you were supposed to give? Did he say alprazolam or lorazepam? Take a moment to stop, clarify & reassess. You will never regret it.
    A - Action

    How does this drug work? If you can identify the mechanism of action you can predict many of the potential side effects and reactions that could occur. For example: If you’re treating hypertension with a loop diuretic it’s helpful to know where & how these drugs work in the body - leading you to further monitor the patient for dehydration, hyponatremia, hypokalemia & hypomagnesemia.

    Drugs only work as intended when given correctly. The action of the medication relies on proper route of administration. So make sure that painful IM injection you’re about to give was ordered correctly and shouldn’t be subcutaneous instead!

    A - Adverse Effects


    Knowing the possible side effects can ensure you are prepared to treat them. Does administration of this particular drug have a potential for anaphylaxis? If so, you can be prepared by having a corticosteroid, antihistamine, H2 blocker and epinephrine available at bedside before you start. Adverse effects can vary ranging anywhere from nausea and headache to edema and changes in cardiac rhythms.

    S - Safe Dosage Range

    Is the dose ordered within the appropriate range? Dosages can come in many forms: milliliters, drops, grams, milligrams, micrograms, etc. Some are based on weight: mg/kg, ml/kg, or even based on body surface area. Being comfortable with unit conversions and drug calculations are crucial. Don’t just assume the math is correct because the pharmacy label says so. Check it yourself. Utilize available resources such as the drug pamphlet insert (provided with the medication, ask your pharmacist), an in-print/online medication handbook or your hospital's online medication database (if available).

    S - Special Nursing Considerations

    Does this drug require frequent monitoring of vital signs? For example, some drugs may cause a sudden drop in blood pressure so taking a set of vitals at the fifteen minute mark is necessary. This is also a great time to think about what patient/family education you’ll provide. For example, your patient was prescribed Pyridium for a UTI - let them know their urine might turn reddish orange! Or maybe the medication you’re giving can cause delayed excessive hiccups, bruising or even hives. Do they need to increase fluids or avoid alcohol, avoid direct sunlight? The list goes on and obviously differs with each drug, but whatever the follow up - be sure your patient is educated and leaves prepared to monitor themselves accordingly.


    Truth be told, I once came quite close to making a potentially fatal medication error. Our hospital did not have a policy on double checking insulin, however being an outpatient adult oncology unit, administration of insulin was rare. So we all double checked with each other, just in case. Our open box of TB syringes were located directly next to our insulin syringes. I had a few years of experience under my belt.

    I grabbed what I thought was an insulin syringe out of the correctly marked box, drew up the ordered amount and asked a seasoned nurse to double check me. I told her the ordered dose. She quickly eyeballed the vial & syringe and gave her blessing. I walked less than twenty feet, over to the patient's chair. Something in my gut didn’t feel right. I opened the alcohol swab, prepped the site for administration. Still a pang resonated in my gut. I stopped, excused myself. Exited the room and tried to find another nurse to double check. It was a first year nurse that caught my mistake. “That looks like a lot. Is that an insulin syringe?”. It wasn’t. Always double check, even triple check... especially when something doesn’t feel quite right.



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  • Apr 24

    Driving to get her MRI under fluoroscopy, Susan kept reflecting on the fact that she was told that her first one didn’t show any damage to her left shoulder. Being claustrophobic added to her anxiety as she pulled into the parking lot. However, she did feel an inkling of hope as she stepped up to check in.

    Susan told the tech what had happened at the first MRI, and he knew exactly what she was talking about.


    “That is what we call shadowing. When a patient is small statured, then the machine sometimes has difficulty focusing on the area of interest. Positioning is very important for patients like you, we will position you with your left shoulder closest to the center of the machine rather your whole body being in the center. Don’t worry, we will get some good pictures.” the tech reassured her.

    Sitting once again in front of a doctor for her results, the doctor who failed to listen, investigate, or even care made Susan’s stomach twist and turn.

    “The test shows bone marrow edema in the area that the injection was given,” he began, “But I want you to have a full body scan, Susan. There must be something else wrong. I want to see if something else shows up.”

    There it was, in black and white, the flu shot had hit the bone and the trauma had caused the edema... Finally! She had proof! Leaving his office, Susan now realized that the doctor wanted to find something else wrong so that he could say it wasn’t the flu shot. Susan could only say, “bring it on.”

    The full body scan required more needles and an extra bonus of a nuclear medicine chaser. It would show any fractures, dysplasia, arthritis, or cancer in Susan’s bones. She knew what they would find, exactly what she had been telling them for months.

    Once again, back in the doctor’s office for another test result, Susan was handed a piece of paper, “Have you seen this?” Looking at it, she realized it was an addendum to her first MRI. After her full body bone scan, the radiologist had looked back at the first MRI and wrote an additional note stating that there was damage there three months ago along with specific image numbers for reference. The full body scan showed one hot spot - her left shoulder, exactly where the flu shot was given. Not only that, the radiologist wrote in the report that the damage was due to the flu shot.

    Susan now knew that the first radiologist had not read her MRI correctly, not only that the doctor had told her he had looked at the MRI disc which he most likely didn’t or he would have seen the damage.

    “I’m beginning to think your problems are related to the flu shot. Since I’ve never treated anyone with your problem, I don’t know how to treat it. You could probably google it,” he said with a chuckle, scratching his head. (Pause and let that sink in)

    “I have googled stuff about this, but all it did was scare me to death!” Susan responded, her eyes wide, cheeks flushed.

    Trying to process all she had learned and heard in the past ten minutes made her heart beat fast. They discussed sending her to another doctor, which was something Susan wanted to do anyway.

    When he left the room, the nurse leaned over and whispered,”He is just very conservative.”

    Oh, so what exactly does that mean? It’s ok to waste four months of my life calling me a liar, ignoring my pleas, or the fact that he would resort to googling my problem because he didn’t know what to do.

    Several weeks later, Susan got word that she had a new doctor, and it was the one she wanted in the beginning. This made her the happiest she had been in months. A case worker was also assigned to her case and would attend the doctor visits with her.

    Seeing the new doctor walk in the room made Susan want to cry with relief. Gulping, she shook his hand.

    “Hello, Susan, nice to meet you. I have reviewed your scans, and I can see the exact trail that the needle took, and all the cartilage, tendons, rotator cuff, and bone it affected. I also wanted to let you know that I have at least 15 other patients that have the same problem as you. Why in the world did someone give a shot there? I just don’t understand.” He paused and looked up from his paperwork, “Let me tell you, Susan, this will not be an easy, or quick recovery. It will take over a year, but you will get better.”

    Susan let out her breath, not realizing she had been holding it. She smiled and tears came to her eyes. Having validation meant the world to her after all she had been through. He had other patients like her, and he had a plan! The tension in her shoulders loosened, the sudden blood flow made her dizzy.

    Before she left his office, he gave her a steroid injection in her left shoulder joint, and put her back in physical therapy, telling her she should have been in therapy the entire time. He also told her that surgery would not help at this point, but instructed her to be patient.

    Susan went back to work with restrictions, but at least she was on a path to recovery.
    Even though the steroid shot helped, Susan still had limited range of motion, and continued to have pain. Sleeping on her left side still hurt, and the OTC anti-inflammatories she was taking kept her stomach upset. About a month later, she had another injection which again gave limited relief. The doctor concluded that surgery may be exactly what she needed so he could see exactly what was going on.

    Susan had the shoulder arthroscopy that showed inflammation on the rotator cuff that had spread into and throughout her muscle, tendon, cartilage, joint and joint bursa. He showed Susan’s husband the pictures from the surgery and they showed what looked like red spider veins that was the actual inflammation. He told her husband that he had washed out the inflammation, and shaved part of her rotator cuff as well as had done a decompression because she had not been able to use her shoulder for so long it had become compressed. Because he had to shave so much bone, Susan continues to have pain and popping of the shoulder joint.

    Back to work and life, Susan continues to have pain daily, limited range of motion, and still can’t sleep on her left side. Repetitive movements using her left arm causes pain in her shoulder. She can’t lift her arms above her head or lift anything. Susan had to change the way she dresses, and how she blow dries her hair. Now she has chronic tendonitis and bursitis in her left shoulder from the injections that cause her continued pain.

    Almost two years after she received a shot that has forever changed her life, Susan continues to fight to get better. She has since found out that the person giving the flu shots were medical assistants contracted by the hospital, and when she searched online, she could not find any certifications for that person. She wants you to know that she is changed forever. This event has affected her not only physically, but emotionally and financially as well.

    An injection of any kind given in the wrong place by an untrained person can result in severe injury. We are advocates for our patients and we must be advocates for each other as well. The telling of this story is part of being an advocate for one of our own.

    Her story is far from over, and I have been honored to share it. I hope and pray for her full recovery, physically and financially.

    For the first 2 parts of this story, please read:

    Injection Gone Wrong - Part 1

    Injection Gone Wrong: Part Two


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