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The 2018 Marguerite Rodgers Kinney Award for a Distinguished Career was awarded to Beth Tamplet Ulrich, EdD, RN, FACHE, FAAN at the 2018 American Association of Critical Care - National Teaching Institute annual conference. While at the NTI conference, Mary Watts, BSN, RN, allnurses.com Community Director interviewed Dr. Ulrich and discussed her career and some of her accomplishments. Dr. Ulrich received her bachelor’s degree from the Medical University of South Carolina, her master’s degree from the University of Texas Health Science Center at Houston, and her doctorate from the University of Houston in a collaborative program with Baylor College of Medicine. When she moved to El Paso, Texas; due to her husband’s job, she started in dialysis and learned from the ground up as dialysis was in infancy. She worked to set standards of care and is a past president of the American Nephrology Nurses Association (ANNA). While earning her doctorate, she worked in hospital administration developing nursing simulations and nurse residency programs. She became interested in the healthy work environment and began her work with the American Association of Critical Care Nurses (AACN). She assisted with development of the first Healthy Work Standards survey in 2005. Dr. Ulrich stated that AACN brought together “an expert panel to create the standards.” In 2006, it was decided to “obtain opinions from those nurses with boots on the ground; the staff nurses who do the doing every day.” She further explained that AACN is “absolutely committed” to obtaining information to help the bedside nurse work in the safest environment possible. The 2005 survey was a snapshot. By the 2008 survey, AACN began to assemble comparisons of data which expanded when the 2013 survey data was added and AACN was able to took at trends. Now in 2018, AACN has received over 8000 responses to their current survey. Every time the survey is done, there are more and more nurses responding. Mary stated, “nurses see the value in these surveys because they want changes” via the published results. Dr. Ulrich continued, “When we first looked at this, we were looking for a baseline. In 2013, we saw the down turn of the economy: nurses were returning to work, they were changing from part time to full time, or for those who were working full time, they were looking for overtime.” In this scenario where the economy dictated how much you needed to work, there were not a lot of changes in the work environment regarding safety as income was the number one reason to work. Mary asked, “What contributes to an unhealthy work environment?” Dr. Ulrich answered that inappropriate staffing - results showed that 39% of the respondents reported they had appropriate staffing. Another more concerning result was that 32% stated that <50% of the time, they had adequate staffing. “This is pretty scary for the patients and the nurses". Dr. Ulrich pointed out that "staffing isn't just about the patients; it's about the nurses too, because when staffing isn't adequate, nurses don’t practice at the top of their license. They get done what they have to get done. They don't get to do the things only nurses can do - the critical thinking things, the discharge planning, comforting, teaching patients and families. They have to do tasks and then nurses aren’t satisfied with their jobs.” This results in decreased job satisfaction. Staffing is more than just about enough nurses to take care of the patients. It reflects on everything in the work environment. “I was surprised at the high number of incidents of discrimination with the 2018 survey.” This included verbal and physical abuse experiences. “We capped it at 200 incidents in the survey.” Nurses aren’t leaving nursing, they are leaving the hospitals - they have many options. They aren’t limited to work in the hospitals. “Once a nurse, always a nurse,” stated both Mary and Dr. Ulrich in unison. Data for these surveys are available in Journal of Critical Care Nursing. Allnurses.com extends their gratitude to Dr. Ulrich and AACN for continued support in disseminating vital information for nurses.

As nurses move into new positions, there are many choices and aspects to consider before saying yes to the job. Mary Watts, BSN, RN and Maureen Bishop, MSN, CNS discussed ICU orientation and how to be a successful ICU nurse. They met at the 2018 NTI Conference in Boston, Massachusetts. They talked about the changing face of nursing employment. Nurses on the Move A recent study found that millennials will change jobs an average of four times in their first decade out of college, compared to about two job changes by Gen Xers their first ten years out of college. Ms. Bishop explained that the expectation of employment at her institution is two years. Essentials of Critical Care Orientation (ECCO) Ms. Bishop has been hiring new grads into the ICU for the past 10 years. "Mostly we look for passion. We do what is called a blended orientation concept. They do online modules, classroom time where they learn basic critical thinking skills and they take an 8-week arrhythmia course." In addition, they are required to take and pass ACLS and "of course the most important part is to spend time bedside." Ms. Bishop attributes her facility's orientation success to utilizing AACN's ICU Essentials of Critical Care Orientation (ECCO). According to the AACN, "ECCO's up-to-date, interactive evidence-based education easily blends into your existing orientation plans. AACN's 24/7 customer support, comprehensive reports, and progress tracking tools make implementation straightforward." The ECCO program has earned accolades for its content: "American Association of Critical-Care Nurses (AACN), a leader in providing standard-setting education and expertise that nurses and healthcare organizations can trust, recently won two prestigious Brandon Hall Group silver awards for excellence in the Best Learning Team and Best Advance in Custom Content categories." Even after the 4-6 month official orientation, there is a mentorship program too; where new grads and seasoned have added support for an extended period of time. They also have follow up with Ms. Bishop as well as the unit manager. Mary asked about whether orientation is customized for the experienced nurse and Ms. Bishop assured her that the orientation must be flexible in order to meet the needs of everyone. Customized orientation is also important to AACN and their ECCO program. Ms. Bishop also emphasized that they welcome nurses who apply from out of state, both new grads and experienced nurses. Evaluation Evaluating the end product of orientation is extremely important. Ms. Bishop states that the criteria she uses to evaluate orientees consists of their ability to grasp the concepts of ECCO and put them into practice. She also emphasizes the need to utilize solid critical thinking skills when confronting complex patient care. Other important aspects of a successful new ICU nurse are that they are able to coordinate all the aspects of care including physical assessment into a solid plan of care. This includes understanding lab results, medications and how they affect the overall care of the patient. She concludes, "so for me, it's really how they are doing on the job. Are they putting that knowledge into practice?" Nurses want to be successful in their chosen career. There are many barriers to a successful orientation but using a known product to facilitate this process will increase the odds of retaining ICU nurses.

If you are reading this article, then likely you have come to the same decision or are thinking about it. We each have a story or background as to how we came to make this life-altering leap into the sexy and emotionally fulfilling field of nursing right? (Teehee, that's a whole nother article!) Books, television shows, and movies like to portray nurses as being born knowing that this was our lifelong goal. While this may be true for some of us, how did the rest of us come to choose a career in nursing? In late August 2017, allnurses.com released a survey that ran through September to determine what factors students consider when selecting a school. One of the questions asked nurses and student nurses, "Why did you choose nursing?". The survey, which is set to release soon, had over 1500 participants. The responses varied greatly; some were light-hearted answers (like the "sexy" comment, wearing scrubs, or liking all things gruesome); some practical, "it's what my parents would pay for"; some well thought out, "hours, schedule and pay", and some people were just plain "born to do this". There were a number of similar and common threads woven through the survey responses. Nursing has ranked #1 as the most trusted profession for at least 15 years in a row in Gallup Polls. Job security, flexibility, and pay were a deciding factor for many choosing nursing as a career. No matter sick or well, people will always be in need of healthcare. Nursing was a popular second career choice as reported in the survey results, either from a non-healthcare profession or from many who were non-nursing healthcare professionals. They reported wanting to have more direct contact and connection with patients, many stating that they feel drawn to care for those in need, not to "sit behind a desk". The career opened up possibilities to work schedules so they could care for aging loved ones or children. For many it was a better, more stable paycheck offering sick and vacation time and better healthcare for themselves and their loved ones. Nursing also offered the ability to advance within the career itself and further their education toward ultimate life goals. The "calling", or desire to care for people in a time of crisis or at their weakest, seems to be a strong pull toward nursing as a career. Several answers reflected "always having known that nursing was a calling", or that their "personality and heart guided them" toward this career. There were many replies that the "science" that nursing encompasses was the appeal. Anatomy, physiology, how the body responds to pharmacologic interventions, the technology of caring for the body systems was another popular response. The ability to think critically and quickly and to work with a team of like-minded professionals was a draw. Some answered that they loved the rush of emergent care, or on the flip side, the pace and attention to dying hospice patients and their loved ones. A large number of participants were inspired by a family member (s). Some had family members that were in the healthcare profession and through watching, listening, or living with someone who is a nurse, they felt compelled to go on to nursing school themselves. Experiencing healthcare from the opposite side of the bed was another influence that a family had on many. For some being the patient and "living through" the healthcare continuum was the guide toward wanting to make a difference in the life of others. As we all have come into the "wonderful world of nursing" for our various reasons, decisions, or life events it is clear that the survey has captured the uniqueness that each of us brings to the care of our patients and the advancement of our profession. Our passions, skills, and differences will ultimately keep nursing innovative and cutting edge while maintaining the very core of our career of care and compassion for others. Keep your eyes open and watch for the complete results from the 2017 Student Survey to be posted soon. You will find out what students think are the most important factors to consider when searching for a nursing school. The interactive images will allow you to customize your view and discover how variables such as age, location, current level of educational standing, and degree program enrolled in can affect one's priorities. More 2017 Student Survey Articles... 2017 Student Survey: Demographics 2017 Student Survey: School Profiles 2017 Student Survey: What Students Really Want From Nursing School [tableauchart=width=728 height=700]allnursesNursingSchoolSurvey-2017/8?:embed=y&:display_count=yes&:showVizHome=no[/tableauchart]

It is interesting to see the demographics of nursing changing, including average age, gender, ethnicity etc., and there are several reasons for that. In looking at some of the results from the allnurses 2017 Interactive Salary Survey, we can see a change, but do the results leave us with more questions than answers??? The 2017 allnurses Salary Survey asked questions about nurse's age, years as a nurse, and years of experience. It is interesting to compare the current data provided by more than 18,000 respondents to data from the past. Looking back in time, we are able to see from a study conducted in 1980 that 25% of registered nurses were over 50 years old. By 2000 33% were over age 50, and in 2007 the numbers rose to 41% of RNs were over 50 years of age. In the allnurses 2017 interactive study, results show that 30% of nurse respondents are over 50 years old. Why the drop? Are aging Baby Boomers leaving the workforce? Are nurses retiring early? Are they leaving the nursing workforce for other careers? Leaving to care for aging parents? Now, let's look at the opposite end of the spectrum. In 1980 25% of nurses were under age 25, but by 2007 that number drastically dropped to only 8% under 30 years old. Our 2017 survey shows that approximately 16% or our respondents were under the age of 30 with 4% under the age of 25. This presents an interesting question? In 2007 there are the least number of nurses under 30 and the greatest number over 50. The largest percentage, 54%, of respondents in the 2017 allnurses survey fall in the 30 - 50 age range. Does the shift have to do with age entering into nursing as a career? In other words, were there more nurses choosing nursing as a second career or career change? What factors may be playing into the drop in nurses entering nursing under the age of 30? Part of the equation seems to be the age of nurses when they graduate nursing school as their INITIAL education. We have some statistics showing that in 1985 the average age of the registered nursing school graduate was 24 years old. By 2004 that number jumps to 31 years old. Additionally, many students obtaining an RN license have initially earned a different academic degree before deciding to enter the nursing field. During the years from 2000 to 2008, the percentage of RN candidates having earned previous degrees rose from 13.3 percent to 21.7 percent. The increase in the number of second-career students entering the nursing profession would help account for the increase in age of nurses with fewer years' experience. When we compare the years of experience as a nurse from our allnurses 2015 study to the 2017 study we see age does not seem to correlate directly to number of years of experience. In the 2015 results, 62% of nurses had less than 10 years of experience as compared to the 2017 results showing the number has dropped to 56% having less than 10 years experience. As one would expect the numbers have increased in years of experience between 11-20 years (a 3 point increase), 21-35 (2 point increase), and 35+(up 1 point) since the 2015 survey. There are so many variables to factor into these statistics, and it will be interesting to see if the entire 2017 allnurses survey answers or leaves more questions. As we can see, the average age of registered nurses is increasing yet the number of years as a nurse or years of experience does not reflect the age increase. When a younger friend of mine graduated nursing school with her BSN in 1993 their graduating class had a greater number of second career, or mothers that raised children prior to attending nursing school, than those of us coming straight out of high school into college. What have you newer grads been seeing? This year's survey did not ask how many of you entered nursing as a second career or how old you were when you graduated, but we would love to get your input on that, and any other variables you think contribute to the statistics. The results of the 2017 allnurses Salary Survey will be posted soon. Resources: 2015 National Nursing Workforce Study NCSBN.org 2015 allnurses Salary Survey Results NLN Biennial Survey of Schools of Nursing, 2014 Nursing: Tradition Gives Way to Non-Traditional Non-Traditional Nursing Students Take Non-Traditional Pathways

AllNurses staff recently interviewed Dan Nadworny, MSN, RN, Clinical Director for Operations at Beth Israel Deaconess Medical Center in Boston, MA. He was the point person during the Boston Marathon Bombing in April 2013. He will also be one of the featured speakers at the Emergency Nursing 2017 conference to be held September 13-16 in St Louis, MO where he will conduct a mock disaster drill, emphasizing hands-on teaching. In the interview we discussed training for Mass Casualty Incidents (MCI) as a means to prepare for the unknown. Dan stated, "disasters are local." When an MCI occurs the resources that you have immediately on hand are the ones you will immediately use. As time goes on, more resources might be available but it is important to be able to rely on immediate staff to make the most impact on survivability. As the basics get dealt with, you continue to move forward to the more complex tasks. A cohesive staff is a must for any emergency department and it is of paramount importance during an MCI. "Disasters will occur," Dan said and relying on your training will enable you and your team to come through with the best patient outcomes. He went on to discuss what training involves. Although slide presentations have their place in training situations for routine matters, nothing beats hands-on and "real life" training. We discussed off-site training for ED staff incorporating local fire departments. Dan emphasized that it's important to spend time working with other agencies because in an MCI, other agencies will be involved and having a working relationship allows all stakeholders to conquer a disaster. Some of the important details to discuss with other agencies include: Communication - operating on same radio frequency, what to do if no cell service or no landlines Organization and leadership structure - who is going to be the "Captain of the Ship?" Does it make sense for the ED Attending MD who is not "on the streets" or should the police take the lead or the fire department? Where is equipment stored? Does everyone know how and when to don it? This was brought home vividly during the Ebola crisis. Dan had several suggestions: Hands on demonstrations of equipment, personal protective equipment (PPE) Working for a prolonged period of time in a hazmat suit - how do you start an IV, obtain an EKG, even talk to the patient Training with other agencies on their turf. Getting out of your comfort zone. With all the training modalities available, it is hoped that you won't experience an MCI. However, if you find yourself in the middle of a disaster, your training will be what saves you and your patient. During a disaster, many people report time stands still. As the adrenaline kicks in, you respond as your training dictates. Once the MCI resolves though, an even longer period of time occurs - recovery. Peer discussions are often a focal point for emergency workers who have been thru a traumatic event. Sharing details and retelling them allows for shared grief and shared healing. Dan stated that there is no one "right" way to recover. While some workers internalize their emotions, others seek relief from a support group, either formal or informal, a professional counselor or a member of the clergy. Anniversaries of MCI's are a cause for strong emotions also. From sadness, grief, fear to anxiety and dread people involved in an MCI run the gamut. Dan also commented on this aspect of the MCI during an interview in 2014 with WGBH in Boston, "I think I have a greater respect for how a hospital works together than I ever did," he said. "And I think that did change me - for the better. And I think it will always be a little bit different, but in my mind, the differences need to be looked at as a positive. We now know what we can accomplish together and this hospital knows what it can accomplish together." Dan authored an article in the Emergency Nurses Association Journal of Emergency Nursing in 2014 and commented, "The importance of community and individual hospital preparedness for mass casualty events has become increasingly apparent as the magnitude and frequency of natural and humanmade disasters has escalated in recent years. Beyond the formal after-action reports, sharing experiences and lessons learned with others after an event allows for learning through a whole new perspective." Come to Emergency Nursing 2017 for hands-on training from an expert in mass casualty incidents! Early Bird Registration ends July 13th. Non-ENA members who register by July 13 can use the promo code: STLOUIS for $100 off conference registration. And for more details.....here you go.... References: Beth Israel, One Year Ago Boston Strong - One Hospital's Response to the 2013 Boston Marathon Bombing Emergency Nursing 2017

Allnurses staff recently attended AACN's National Teaching Institute 2017 in Houston, Texas. One of the interesting presentations was Mastering the Art of Professional Networking, presented by Alvin Jeffery, MSN, CCNR, RN-BC and Anna Dermenchyan, RN, BSN, CCRN-CSC. Networking is one of the best ways to make connections that will lead to success in your nursing career. Getting to know other nurses on a professional basis often leads to a tip on a new job, insider information about a prospective facility or unit and can expand your circle of friends. Develop a Goal for Your Network Adventure Are you looking for a new job? Do you want to expand your knowledge of your present specialty? Are you returning to school? Do you want to expand your social media network? What is your goal when you talk about networking? Before you go to a networking event, determine your goal and decide what you would consider success? Is it getting an insider view of a particular hospital or unit? Getting the name of a unit manager or recruiter? Making new contacts in general? Benefits of Networking Potential employment and consulting opportunities Identity for oneself Be more effective in your current job Engagement with others Build a support system Networking at a Nursing Conference That said, few of us can walk into a room of strangers and start instantly networking. Here are some tips for your networking success: Be interesting If you want to have interesting conversations you must be an interesting person. You can do this by staying up-to-date on current events, both in and out of nursing, and doing some homework before the occasion. Check the agenda in advance and research the guest speaker, host, sponsor, or award recipients. Knowing these details will empower you to initiate discussions. Step outside your comfort zone Most of us are more at ease conversing with people we know, which means we often end up not meeting anyone new. Summon the confidence to independently work your way around the room. While you're at it, introduce yourself to someone you've never met before and start a dialogue. If you're unsure whom to approach, simply look for a person who is alone. Invite others to join you People naturally gravitate toward those who are warm and welcoming. Display open body language, wear a smile, make eye contact, and always be ready to shake hands and introduce yourself and the others in your group to newcomers. Make every effort to be inclusive of everyone. Refer to people by name When you meet someone new, use his or her name as soon as you can in conversation. If you forget the name of a person you've met before, ask for clarification. A gracious way to do this is to say, "I remember meeting you, but somehow I've forgotten your name. Can you please tell me what it is again?" Have an escape plan Knowing how to exit a conversational cul-de-sac can be your saving grace. If you need to leave a group discussion, simply excuse yourself at an appropriate moment. When someone has you cornered in a one-on-one situation, however, acknowledge that you were listening before you leave. Wait for a natural break, comment on a point they made, say their name, and move on. Try something like this, "It sounds like your research project is fascinating, Jeremy. Best of luck. Enjoy the rest of the conference." And here are some additional networking questions for national conferences: What's your name? Where are you from? What do you do? Is this your first time at NTI? If not, which other ones have you been to? What's been your favorite thing so far? Who inspires you? Which workshops/tracks are you attending at the conference? Social Networking The rules for social networking vary depending on the goal of your networking. Some of the more common tips are: Create a professional networking profile. No matter what social media platform you choose, it is imperative that you develop a professional profile. Include a professional headshot of you. Do not use a selfie or a picture that could be misinterpreted as less than professional. Join professional groups or discussion boards. You already have a common ground and this makes it easier to talk about your commonalities. Volunteer with your professional organization - this is a great way to network and develop relationships. Volunteering doesn't necessarily have to involve a lot of time and effort but volunteers are noticed and that's one of the goals of networking. Pitfalls of Networking As with anything positive, there are also negatives. Avoid the following issues: Always go to a networking event prepared: find out the dress code in advance, bring plenty of business cards and understand your goals. Do your research on the organizer: what is their goal for this event? Don't arrive late. When you arrive with others, it automatically opens up a conversation. If you arrive late, the conversations will have already started and you have missed out on valuable networking time. References: Networking for Medical Professionals Networking Tips for Every Healthcare Professional Can Use 3 Business Networking Pitfalls to Avoid

Hospitalized patients often experience pain. In the ICU, most patient experience pain to some degree. As more invasive and painful procedures are performed, pain escalates. Add in intubation, multiple lines and your patient experience a wide variety of painful sensations. How to manage this pain? What is the best pain regimen for the opioid naive and opioid-dependent patient? Principles of Pain Assessment Pain is a subjective complaint based on many factors: Procedures being performed Patient past medical history History of opioid use Perception of care received Just to name a few. Assessing pain can also involve many avenues - for the verbal patient: Wong-Baker Pain Scale Faces Pain Scale Verbalization from the patient It becomes more difficult to assess pain in the unresponsive patient. Patients can be unresponsive for various reasons: intubation, sedation, paralysis, dementia, psychiatric disease. However, here are some tips: Grimacing Tachycardia Irritability Decreased interaction with the environment Opioid-Tolerant Patients There is no exact formula to follow to ensure adequate pain management for your patients that already take opioids. The first task is to obtain information regarding the patient's past/current opioid use. Do they have cancer and take escalating doses? Are they on maintenance suboxone for past opioid addiction? Do they use street drugs? Not always easy questions to ask. If the patient is unresponsive, asking the family in a non-judgemental manner is essential. Emphasize that you want to provide optimal pain relief and in order to do so, you need to know if the patient takes opioid medication/drugs frequently. From the Society of Hospital Medicine: "Patients with chronic pain present a special challenge. When they have pre-existing pain and undergo an operative procedure, it becomes important to differentiate pre-existing chronic pain from new acute postoperative pain. Additionally, patients already on chronic opioid therapy may require a 200 to 400 percent increase in preoperative opioid requirements.24 Thus, it is important to establish preoperative analgesic requirements to create a postoperative pain management plan, not to mention a keen awareness of comorbidities that may preclude the escalation of regimens due to patient safety concerns." The Stepwise Approach is recommended - this involves the use of non-opioid medications such as NSAIDs, Cox-2 Inhibitors and non-pharmacological options also. However, in opioid-tolerant patients, "always start off with an immediate release medication. Long-acting opioids are not appropriate to be used to treat acute pain and for initial dose titration. The route of pain medications also makes a difference in the frequency of administering pain medications. Short-acting oral opioids peak in 45-60 minutes. Intravenous dosing will peak in 10-15 minutes. Knowing these parameters makes it easier to dose medications sooner to achieve adequate pain relief in acute pain. When dosing medications for acute pain, it is appropriate to give an additional dose if the pain is not relieved by the expected peak time. As an example, if a patient in acute pain is given an intravenous dose, then it is appropriate to give the same dose again or double the dose (depending on the clinical situation) if there is no relief in 15 minutes once peak onset of action has been reached." (Society of Hospital Medicine) Opioid Naive Patients Patients that do not take opioids merit consideration also. "When using a patient-controlled analgesic (PCA) in opioid-naïve patients, only patient-controlled dosing should be used initially. Starting a continuous basal dose on an opioid-naïve patient is generally not appropriate. Once steady state is achieved with patient-controlled bolus dosing in 24 hours, then starting a continuous basal rate can be considered if the clinical judgment deems it necessary to use opioids for a longer time period." (Society of Hospital Medicine) Other Considerations Always be mindful of renal function as this can adversely affect pain control. Also, due to many factors, renal function can deteriorate while hospitalized. Dose adjustment must be considered. NSAIDs and Cox-2 Inhibitors are usually precluded for the patient who has decreased renal function. Patients on dialysis or CRRT also pose special pain management issues and it will be important to bring on the care of the nephrologist. References: Getting Out of Your Comfort Zone With Opioid Tolerant Patients Multi-Modal Pain Strategies for the Post-Op Patient - Society of Hospital Medicine

Staff of allnurses recently attended the AACN National Teaching Institute (NTI) in Houston, Texas. One of the sessions was "Owning Your Future: Building Personal Resiliency in Times of Burnout and Challenging Environments", presented by Vicki Good, DNP, RN, CENP, CPPS. "I'm fried!" "I just can't do this anymore!" "I'm burnt out!" How many times have we heard our colleagues or even ourselves say or think these thoughts? Nursing is a high-stress environment. Burnout is a state of stress that many high achievers experience. Some of the symptoms are: physical and emotional exhaustion cynicism and detachment feelings of ineffectiveness and lack of accomplishment Exhaustion is generalized fatigue that can be related to devoting excessive time and effort to a task or project that is not perceived to be beneficial. Depersonalization is a distant or indifferent attitude toward work. It manifests as negative, callous, and cynical behaviors or interaction with colleagues or patients in an impersonal manner. Reduced personal accomplishment is the tendency to negatively evaluate the worth of one's work, feeling insufficient regarding the ability to perform one's job, and a generalized poor professional self-esteem. Experts estimate that one out of three critical care nurses is experiencing severe burnout syndrome, which is often referred to as a "silent epidemic" in healthcare. Organizational and individual factors lead to the presence of burnout syndrome and both must be addressed to prevent the negative consequences of the syndrome. Critical care nurses are at high risk for burnout due to the complexity of care as well as the high mortality and morbidity of the patients they care for. Over the years, as patient acuity has increased, so has the immense responsibility of the critical care nurse. The ethical journey that we take also takes it toll. The question is no longer "what can be done?" but rather, "should we do it?" Should we continue full court press for all patients regardless of their quality of life? Should we offer all modalities and treatment options even knowing they come with a high potential for a limited quality of life? These questions and much more lead to stress which in turn leads to burnout. We constantly care for others, yet sometimes we are not kind to ourselves. How many times have we put off going to lunch, break, bathroom because "our patient needs us?" How many times have we said "yes" to overtime that we didn't really want to do just so our co-workers wouldn't work short? Again, all circumstances that lead to added stress and burnout. So...how do we combat burnout? Based on a report from the American Association of Critical-Care Nurses, 6 standards are needed to establish and sustain a healthy work environment: Skilled communication True collaboration Effective decision-making Appropriate staffing Meaningful recognition Authentic leadership. Additional commonly recognized tenets of a healthy ICU environment include "avoiding or managing conflicts" and "improving end-of-life care." Communication, collaboration, and effective decision-making during times when emotions are elevated are critical in engaging the team to decrease stress and BOS. A healthy work environment may be enhanced by utilizing team debriefings, structured communication, and collaborating with team members on critical decisions. From Dr. Good's presentation, here are some environmental or organizational solutions: Acknowledgment of stress and burnout Established wellness program Palliative care consultations Active Ethics Committee As individuals there are steps we can also take to reduce or relieve burnout: Stress reduction training Meditations Work-life balance Ensuring adequate rest, breaks, time with family and outside activities We all realize that we work in a stressful environment. To continue to care for our patients and ourselves we need to recognize ways to minimize and cope with stress. It is important that both our organization and nurses work together to focus attention on this increasingly common issue and work jointly to combat it. In the end, this will provide improved care for both patients and nurses. References: American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2016. Burnout Syndrome in Critical Care Healthcare Professionals Owning Your Future: Building Personal Resiliency in Times of Burnout and Challenging Environments Tell-tale Symptoms of Burn-Out

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. 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? Edited to add: The complete results including interactive graphs are posted now in these 2 articles: 2017 allnurses Salary Survey Results Part 1: Demographics and Compensation 30% of Nurses Leaving the Workforce - 2017 Salary Survey Results Part 2 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

I was talking about this topic with one of my younger nurse friends. She shared the following comments with me. I want to start by saying that quality bedside nursing care can be provided no matter the advanced degree or not. As a new graduate, I survived and so did my patients thanks to the care and support and knowledge of many many LPN's and ADN's. There are also plenty of not so great nurses out there with various degrees. That being said, there has been much discussion, surveys and studies done regarding the differences in the career of a BSN prepared nurse, LPN, and an ADN prepared nurse. The results of the 2015 allnurses salary survey presented that 39% of respondents held an ADN and 39% held a BSN. As we are about to release the comprehensive 2017 allnurses nursing salary results, we will see where the trends have gone. So what's the big deal...as long as you are an RN? The title of RN whether earned through a Degree or Diploma program will allow you to provide the same level of basic nursing care as we see in hospitals, clinics and doctors offices. The BSN prepared nurse, however, has many more options that require higher responsibilities, therefore higher pay. This is due to the more in-depth coursework in physical and social sciences including public health, nursing research and nursing management. An RN with a BSN can choose a career in nursing education, public health, or clinically focus in specific diseases or adult, pediatric, geriatric care. A BSN is required to be considered for many positions or to further one's education to focus on speciality care. In 2010, the Institute of Medicine introduced new demands on the nursing field when it set a target goal for 80% of all nurses to hold bachelor's degrees by 2020. This goal was derived from academic research indicating that patients receive better care in hospitals when the majority of nurses hold a BSN or higher. The American Nurses Credentialing Center (ANCC) devised the Magnet Recognition Program to draw attention to top healthcare facilities. This recognition means that 100% of the organization's nurse managers have a BSN or graduate degree. "Achieving Magnet status also means that there are generally a higher number of nurses holding a BSN degree for jobs in direct patient care. Approximately 50% of all nurses associated with direct patient care in a Magnet-recognized hospital currently have a BSN." The 2017 allnurses survey results have shown some slight shifts. In 2017 the percentage of BSN prepared nurses has remained steady at 39% while ADN's have dropped by 2 percentage points. The number of MSN's have increased by 1%. Why might this be? Is there a greater demand for advanced practice nurses? Are employers encouraging and/ or supporting advancing degrees? Is retirement a factor in the decrease in ADN's? As our final results are revealed, new light might be shed on factors influencing the slight shift from last year to this year. Will the trend continue? Are you thinking of furthering your education? We want to hear from you! We as nurses should support each other in furthering education, as well as respecting those who have years of bedside experience but might not have higher education degrees. As the field of nursing continues to grow our knowledge base will be required to change to keep up with the technology and level of care. The 2017 allnurses salary survey results will be released soon. It will be interesting to see if the interactive survey results show pay differences based on degree as well as location, speciality and gender. Hospitals Require Nurses to Have a BSN Degree 2015 allnurses Salary Survey Results BSN Degree vs RN Differences

Premature birth is categorized as an infant born prior to 37 weeks gestation. This is a world-wide issue. Statistics from the World Health Organization: Key facts Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for nearly 1 million deaths in 2015. Three-quarters of them could be saved with current, cost-effective interventions. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. There sub-categories of prematurity based on gestational age: extremely preterm (<28 weeks) very preterm (28 to <32 weeks) moderate to late preterm (32 to <37 weeks) Globally, prematurity is the leading cause of death in children under the age of 5. And in almost all countries with reliable data, preterm birth rates are increasing. Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive. Infants born prior to 37 weeks can experience a host of difficulties. Premature infants often require care in the Neonatal Intensive Care Unit (NICU) and can remain in-patient for many weeks and often months. In the NICU, ICU nurses and providers care for these tiny children. Much specialized equipment is utilized to care for these patients. Prematurity can result in death and many life-long complications including: Anemia Apnea Chronic lung disease Infections Intraventricular hemorrhage (IVH) Jaundice Necrotizing enterocolitis (NEC) Patent ductus arteriosus (PDA) Respiratory distress syndrome (RDS) Retinopathy of prematurity (ROP) The March of Dimes has extensive research into premature birth, prevention as well as post-birth interventions. They have developed five research centers in the US to help combat this devastating complication: The first Center was launched in 2011 at Stanford University School of Medicine, followed by the March of Dimes Prematurity Research Center - Ohio Collaborative in 2013. In 2014, two more centers were launched. On November 10, the March of Dimes Prematurity Research Center at Washington University was established in St. Louis, Mo. The next Research Center was opened at the University of Pennsylvania in Philadelphia, Pa. The final center, March of Dimes Prematurity Research Center University of Chicago-Northwestern-Duke was launched in 2015. Together, this network of five research centers leverage specific and complementary strengths to accelerate productivity. Collective progress will translate into diagnostics and treatments to prevent premature birth. Most poignant are the personal stories of parents and their infants. GE Healthcare provides the following: Thru these parents' words of wisdom and daily interactions with the Neonatal Intensive Care Unit (NICU) staff, they tell their stories. Prematurity is one of the main foci of the National March of Dimes. Their campaign, Healthy Babies are Worth the Wait, emphasizes the need for solid and continuous prenatal care as well as access to the NICU if premature birth or other birth complications occur. AN and GE Healthcare bring this hot topic to focus via the following stories about prematurity. NICU nurses and parents who have experienced prematurity are sharing their words of inspiration on this Pinterest board for parents who may be experiencing the NICU journey today. The impact on the family as a whole and the care required for these infants is phenomenal. The stories of the following NICU patients and families will give you a glimpse of the prematurity experience. Mae Davis and her Twins - Born 15 weeks early, weighing 1 lb 9 oz and 1 lb 10 oz. Multiples have a higher risk of being born prematurely due to a host of maternal and fetal complications. Another set of twins born at 26 weeks: Ashley Piche Prematurity is a worldwide epidemic. Here is a story of Baby Yohannes. Closer to home is a story from Indiana: For This Mother, the Third Time was Golden As research continues to reduce the number of premature births in the US and worldwide, the personal stories will always be in the forefront of researchers and companies that develop equipment to care for our most fragile infants. References: Baby Center GE Healthcare March of Dimes World Health Organization

Update on Achieve Test Prep Litigation Pursuant to the posted notice, several of the anonymous posters have taken the opportunity to address the Court to correct misinformation and defend their right to speak anonymously. It is beneficial for the Court to hear from those affected by this litigation and allnurses greatly appreciates the time and effort required to engage in this process. While the deadline for responding has passed, allnurses will continue to defend the rights of all posters to engage in protected anonymous speech, regardless of whether a response has been presented to the Court. For any of the John Does that have not responded, or those who wish to supplement any previous filings, several questions have arisen that may impact the decision as to whether to file anything further with the Court. First, will additional submissions be accepted past the deadline? The Court has not rendered an opinion on this and it will be addressed on a case by case basis. allnurses urges any potential John Doe defendants to carefully read and follow the Court's "LEGAL NOTICE TO THE FOLLOWING ALLNURSES SUBSCRIBERS" page in order to remain anonymous. Second, the notice states that I may attend the hearing. May I attend in person or appear via telephone in an anonymous capacity? All questions relating to appearing before the Court anonymously or by any means other than in person should be directed to Magistrate Judge Janie Mayeron (not the Clerk of Court) at the contact information posted on the "LEGAL NOTICE TO THE FOLLOWING ALLNURSES SUBSCRIBERS" page. She will determine what options are available to any John Doe defendant and work with the named parties to address any issues that arise. Third, if I want to raise counterclaims or cross claims against one of the current parties (e.g., ATP, Allnurses, or the Estate of Brian Short) will I be able to maintain my anonymity as allowed under the notice if I raise those counterclaims or cross claims? The Court has not rendered an opinion on whether anonymity will be available to any party that raises claims against any of the known parties to the litigation. If you believe you have a claim against one of the parties, allnurses urges any potential John Doe defendants to seek competent legal advice about the risks of identification if alternative claims or counterclaims are pursued as a plaintiff. Neither allnurses nor the Court can provide this legal guidance and the provisions in the notice regarding remaining anonymous may not apply to outside or additional claims and counterclaims. allnurses With over 4 million visitors each month, allnurses.com is the largest online community for nurses and nursing students. Join over 983,000 nurses, educators, and students sharing, learning, and networking. People from all over the world come to allnurses.com to communicate and discuss nursing, jobs, schools, NCLEX, careers, and so much more. allnurses.com - Helping you become a better nurse. More information about allnurses is available at https://allnurses.com/aboutus-info.html

The Survey In January 2015, allnurses.com invited members and readers holding an active nursing license via the allnurses site as well as newsletters, emails and facebook to participate in a 10-minute online survey about nursing salaries. Respondents were asked 20 questions to characterize their educational background (degree, license), main roles as nurses, employer type, experience level, geographic location, etc....... After just 2 weeks from January 22 through February 3, more than 18,800 responses were received. After reviewing the results, feel free to post your questions and comments. We can all learn from each other's input. Respondent Profile As shown in Figure 1, the majority of the respondents have a Bachelor's or Associate's Degree in Nursing(39.23% and 38.89% respectively), followed by Diploma (14.81%), Master's Degree in Nursing (6.38%), PhD (0.29%), Doctor of Nursing Practice(0.29%), and Doctor of Nursing Science(0.10%). With the difference in the number of BSN (6,891) and Associate (6,831) respondents so slim, it will be interesting to see what effect the mandates of some health systems requiring BSN or higher will have on these numbers in future surveys. To see what allnurses readers are already saying about this, go to BSN and Associate Nurses are Neck and Neck. Will this change? FIGURE 1 Figure 2 shows that the majority of respondents were overwhelmingly RNs (82.39%). A couple of questions this brings to mind: are fewer nurses beginning their career as LPNs/LVNs (14.84%), and will the number of APRNs (2.09%) increase fast enough to help meet the needs of a rapidly growing population in need of more autonomous healthcare providers. FIGURE 2 When asked, "Are you a manager or supervisor?" 17.58% (3,316) responded YES, while 82.42% (15,542) answered NO. In response to the question, "What percentage of time is spent in direct patient care?", half of the respondents(51.85%) spend 75-100% of their time in direct patient care while 8.79% spend less than 5% in direct patient care. (Figure 3) FIGURE 3 It's not any surprise that the survey revealed that 92.26% of respondents are female and 7.74% are male. FIGURE 4 FIGURE 5 Experience: Figure 6 show that 62% of the respondents have 10 years or less experience. FIGURE 6 Additional demographic of our respondents: 82% work full-time; 11% part time; 7% other 55% work at a Not-for-Profit facility Facility Size: 25.47% less than 100; 21.45% = 100-300; 15.93% = 300-800; 11.94% = 800 - 1500; 11.54% = 1500 - 3000; 13.67% = more than 3000 Population Setting: 45.38% Urban; 32.15% Suburban; 22.47% Rural 56% of nurses work in a hospital. To see the other places that top the list, read Where Do Most Nurses Work? FIGURE 7 FIGURE 8 FIGURE 9 - Total Number of Respondents by Primary Specialty Compensation The interactive charts below will allow you to customize your view to include various filters that will affect the range of figures shown. You can do this by selecting items in the drop down menus at the top of the charts. Be sure to hover your cursor over the chart for more details. These salary figures do account for cost of living indexes, which can greatly affect the value of salaries. Generally, the cost of living is highest on the West Coast and in the Northeast. The states in the South, Midwest, and sections of the Mountain West have the lowest cost of living. For more discussion about this, please read What States Pay the Highest and Lowest Nursing Salaries? Although women dominate the nursing profession, do men make more money? - Read what our readers have said. Look at interactive graphs below and see what you think. FIGURE 10 - Annual Salary Base Pay by Gender [tableauchart=width=330 height=995]allnurses05-10-2016/DASHBOARDSalaryannualbasepaybygender[/tableauchart] FIGURE 11 - HourlyBase Pay by Gender [tableauchart=width=330 height=795]allnurses05-10-2016/DASHBOARDHourlyannualbasepaybygender[/tableauchart] FIGURE 12 [tableauchart=width=330 height=615]allnurses05-10-2016/DASHBOARD-totalno_ofrespondentsbyState[/tableauchart] FIGURE 13 [tableauchart=width=330 height=1415]allnurses05-10-2016/DASHBOARDavghourlypaybydegreeandstate[/tableauchart] FIGURE 14 [tableauchart=width=330 height=915]allnurses05-10-2016/Dashboardavghourlybydegree[/tableauchart] FIGURE 15 - Avg Salary by Degree/State [tableauchart=width=330 height=915]allnurses05-10-2016/DASHBOARD-avgsalarypaybydegreeandstate[/tableauchart] FIGURE 16 - Annual Salary by Degree/State [tableauchart=width=330 height=3215]allnurses05-10-2016/DASHBOARD-avgsalarypaybydegreeandstate_1[/tableauchart] FIGURE 17 - Avg Annual Salary + Hourly Pay by Degree/State [tableauchart=width=330 height=3215]allnurses05-10-2016/DASHBOARD-salaryhourlypaybydegreeandstate[/tableauchart] FIGURE 18 - Annual Salary + Hourly Pay by Degree/State [tableauchart=width=330 height=715]allnurses05-10-2016/DASHBOARDsalaryhourlypaybydegreeandstate1[/tableauchart]

As with any job, salaries for nurses vary greatly from state to state and even city to city within the same state. Below are listed average high and low state salaries by degree based on the results of the allnurses salary survey. In order to find the "best" state to work in, more than just the numbers below have to be considered. These figures represent nurses of all levels of experience, age, position, specialty area, work setting, etc. The figures also do not account for the cost of living indexes. Cost of Living We all know that the cost of living index greatly affects the value of the salary and what that salary will buy. Generally, the cost of living is highest on the West Coast and in the Northeast. The states in the South, Midwest, and sections of the Mountain West have the lowest cost of living. Based on cost of living data provided by research conducted by the Council for Community and Economic Research, the cost of living indexes for the highest and lowest states are as follows. States with the Highest Cost of Living: HAWAII: 167.1 WASHINGTON DC: 144.8 CONNECTICUT: 132.7 ALASKA: 134.5 NEW YORK: 130.4 States with the Lowest Cost of Living: TENNESSEE: 90.6 KENTUCKY: 91 ARKANSAS: 91.5 INDIANA: 91.7 KANSAS: 91.9 How does your salary stack up to the ones listed? Are you thinking about moving in search of a higher salary? Remember......it's more than the numbers that count. what-states-pay-the-highest-and-lowest-nursing-salaries.pdf

One of the questions we queried our audience about was what type of facility do you work at? For-Profit or Not-For-Profit? Slightly more than half of our 18,600 respondents work at a not-for-profit institution. Then we coupled this with another question: What type of environment do you work in? Again, not too surprising 56% of the nurses that answered our survey say they work at a hospital. The second highest group works for long term care facilities. I guess it shouldn't be a big surprise since the baby boomers are reaching the senior adult status in mass numbers and are requiring care provided by LTCs. According to the Bureau of Labor Statistics, 61% of US nurses are employed by hospitals. This is quite similar to our survey where 56% of the respondents said they worked in a hospital. A tandem question on our survey asked: Do you work full time or part time? The responses were as follows: 82% work full-time 11% work part time 7% work another schedule This somewhat mirrored Dept of Labor stats: 76% work full-time 16% work part time which includes all schedules except full time Both surveys show that most nurses work full-time. Do you work full-time by choice or necessity? Doing a search on allnurses provided many topics on the subject. And while there are many schedules to accommodate many situations, most of us agree that flexibility is one reason to be a nurse. What is your ideal schedule? What is your ideal work-place? Don't miss the nursing salary survey infographic and related articles. How much are nurses making? 2015 Salary Survey results available soon. Although women dominate the nursing profession, do men make more money? BSN and Associate Nurses are Neck and Neck. Will this change?