allnurses BSN, RN

This article was written by someone who wishes to remain anonymous. Due to the topic and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system. COVID-19 is here and it is terrifying. People are scared. People are panicking. I have seen posts that criticize nurses who choose not to work right now because they are afraid. “This is what YOU signed up for!” people say. That is not true. This is NOT what we signed up for. NOBODY has signed up for this. Unlike what you might have seen on TV, there are many different types of nurses and we all have different skills. We specialize in our own fields. The Renal nurse knows how to educate patients who are in renal failure about fluid and dietary restrictions, so they do no overload their systems. She understands shunts and dialysis equipment. For the patient in renal failure, she is an expert. The Cardiac nurse knows how to take care of patients who have just had open-heart surgery. She can read an EKG expertly. She may not know how to connect a patient to a dialysis machine, but for cardiac patients, she is an expert. The Labor and Delivery nurse can check your cervix to tell when it’s time to push. She can read fetal monitoring strips to make sure your baby is not in distress during labor. She may not be an expert at reading EKGs, but for a laboring mom, she is an expert. The ICU nurse takes care of the most fragile patients. She understands ventilator settings, arterial pressure readings, blood gas readings. Drugs that most wards will never see – like Levophed are used here. She cannot check your cervix, but for a critical patient, she is a lifesaver. Each of these nurses (and oh so many more different types of nurses!) are experts in their fields. They “signed up” to care for those patients. They have trained and educated themselves to care for their specific patients. That is why if you are in labor, you want a labor nurse, not a renal nurse, at your bedside. Right now, ALL NURSES, regardless of specialty, are being called to care for COVID patients. Please bear in mind that not ALL nurses have been trained to deal with highly infectious patients who have the potential to go into acute respiratory distress quickly. We are NOT being offered additional training. This is part of the reason nurses are terrified. This is why some nurses are leaving nursing right now. This is definitely NOT what they “signed up for.” For the most part, nurses take care of people who are ill or injured with non-communicable illnesses or injuries like cancer, heart disease, strokes, car accidents, etc. This means we can help without the risk of catching our patient’s illness or injury. We do take care of patients with infectious illnesses as well – the flu, pneumonia, etc. Because these patients do not take up a large part of our hospital normally, we have the appropriate respirators, reverse-air flow rooms, and PPE we need to take care of these patients. These patients are usually on appropriate wards with nurses who have been trained to care for them. Although there is a risk when we take care of these patients, there are also vaccines and known treatments to help us fight if we get infected. COVID-19 IS DIFFERENT. IT IS A HIGHLY INFECTIOUS, POTENTIALLY FATAL VIRUS WITH NO KNOWN CURE OR TREATMENT. Because it is a PANDEMIC, many people are sick at the same time. Hospitals are overwhelmed. Patients are being sent to wards where nurses do not have the correct expertise to care for them. Hospitals do not have the appropriate equipment to help keep their nurses SAFE while we are caring for patients. There are not enough masks. Nurses are being asked to wear bandanas or sew their own masks at home! Would YOU walk into a potentially infected person’s room and care for them with a bandana? So please. STOP. STOP saying “Nurses signed up for this.” We did not. We did not sign up to sacrifice ourselves because hospitals won’t provide us with the proper equipment and training we need. We did not sign up to die of an infectious disease just because “it’s your job!” Do you want a labor nurse trying her best to ‘figure out’ how to operate a ventilator for your child? Do you want a cardiac nurse delivering your daughter’s baby? Do you want a wound care nurse to try and figure out your dialysis settings? No. I promise - you don’t. We understand you need us, but our families need us too. If we are scared right now, it’s because we have every damned reason to be terrified. If some nurses choose to stay home and protect their families, that is their priority. They have a right to protect their own life. No JOB is worth anyone’s life

COVID-19 is here and it is not going away anytime soon. As this story continues to unfold, the media coverage is permeating our lives. As nurses who are on the front line, we need to take care of ourselves. But the buck doesn’t stop with nurses and healthcare providers. Everyone has an obligation to do their part to help flatten the curve of what is yet to come. There has been much information out there, but as this is constantly evolving, you need to keep up to date with information, recommendations, and mandates from reputable sources. We have created this simple visual to answer the question: WHAT CAN I DO? allnurses.com covid-19 health and safety tips.pdf

Ahuh. Yeah. Ugh. What do you think?

Meet Theresa Puckett If you do a Google search for "nurse fired for being sick" you will be inundated with articles about Theresa Puckett, PhD, RN, CRCP, CNE, a nurse from Northeast Ohio who found herself terminated after a legitimate bout of the Flu during one of the worst Flu seasons our country has seen. According to an article in Becker's Hospital Review, Theresa worked as a PRN Nurse at University Hospitals, based in Cleveland. She called in sick one day at the end of December 2017 with flu symptoms. Theresa visited a physician and tested positive for the flu virus. She was treated with Tamiflu and ended up missing two days of work. Her physician provided a note excusing her from work for these days. She returned to work a few days later and was instructed by a supervisor to leave early due to continued illness. The next day, she saw a Nurse Practitioner who diagnosed her with a sinus infection and provided her with another note stating she should not return to work for a few more days. However, returning to work was never an option for Nurse Puckett because she was terminated. You may be thinking - How does that happen? According to the University Hospitals statement to Becker's Hospital Review, they allow six unscheduled absences for full and part-time staff within a 12 month period, and nine absences may result in termination. For "as needed" or PRN staff, two occurrences of unscheduled absences within a 60-day period may result in termination. Because Theresa returned to work for one shift in between her two absences, this counted as two occurrences and qualified her for termination. Presentism versus Absenteeism If you have ever gone to work sick, raise your hand. As hands of nurses around the world are raised high, let's discuss the reasons we've all done it. To really understand both sides of the issue, you need to understand the difference between absenteeism and presenteeism. Absenteeism is the practice of staying home from work or school when you are ill. Of course, there are other reasons people call off, but for this article, we are only exploring this issue concerning illness. So, what's the opposite of absenteeism? Presenteeism - the act of going to work when you are ill. Nurses have high standards for themselves and the care they provide to patients, even when they are ill. A 2000 study by Aronsson, et al. reported that rates of presenteeism were highest among nurses and teachers. But, we know that presenteeism may result in adverse patient outcomes, poor nurse health, and cost consequences. So, why is it so difficult to take a sick day? Let's consider a few of the most important factors when deciding which side of the issue you support. The Team Needs You Your throat is on fire, your head feels like a giant elephant is jumping on it and crawling back into bed sounds like the best possible plan - but, you know your teammates need you. You don't want to let others down. Staffing on many units is kept to a minimum so even one call off could cause your co-workers to take on larger assignments, be in unsafe situations, or be upset with you for calling off. A February 2018 article by News 5 Cleveland quoted one nurse as saying "Nurses are often commended for coming into work sick, so they don't put their comrades at a disservice for being understaffed." It seems the issues of teamwork, loyalty, and service is a double-edged sword on nursing units. Patients Need You Nurses spend more time with patients than any other healthcare professional. You recognize minor changes in assessments and notify physicians. Yes, the doctors diagnose and order new treatments, but it's the nurses who carry out these orders that are often life-saving treatments. A 2015 study published in JAMA Pediatrics explored the reasons physicians and advanced practice nurses work while ill. While 95% of the respondents believed working while sick put patients at risk, 83% reported working at least one time in the prior year while sick, and 9% reported working while ill at least 5 times. Symptoms reported in this study included fever, diarrhea and acute onset of respiratory symptoms. 92.5% of these clinicians cited not wanting to let patients down as one of the reasons they headed to work with these signs of illness. So, as you lie in bed contemplating calling in - that's what runs through your mind, right? Without you - who will care for your patients? And, what if you are not the only one with this dreaded illness? So, off to work you go. Sick Time Policies Are sick time policies created to protect or punish you? This is a hard question to answer. And, it often leaves nurses faced with difficult decisions that end in absenteeism or presenteeism. Let's explore a few sick time policy practices. Forfeiting Pay Some call-off policies will withhold pay from nurses if you call off at specific times. This might mean that calling off the day before a holiday will result in forfeiture of holiday pay. Or, if you call off on your last scheduled day before a planned vacation or on your first scheduled day after a planned vacation - you forfeit vacation pay. In a world where many people live paycheck to paycheck, this policy might result in nurses putting themselves and their patients at risk to keep pay that many would argue is rightfully yours. You can't plan illness, so if you are sick around these specific time points, what are you to do? Unexcused Absences Most policies give a number of 'unexcused" absences allowed over a period of time, such as 12 months. Typically after missing this number of days, you will be reprimanded. You may also be given a specific amount of time, such as the remainder of the year or 90 days, in which you must not miss any more work. Of course, if you end up legitimately ill during this time, you are probably going to go to work or risk disciplinary action. No Sick Pay Nurses who work a limited number of hours per week or prn often have no sick time. This leaves you making financial decisions in the face of illness. Or, your policy may require you to use vacation time before using sick pay. This may seem counterintuitive given the fact that nurse burnout and fatigue runs rampant on many nursing units and days off are necessary. Physician Notes Some sick policies require a physician's note for any unplanned absences. Others might state that no MD note is necessary because all unscheduled absences are unapproved. Or, you may also find policies that require a doctor's note after a certain number of days, which may be due to the Family Medical Leave Act. No matter what your policy reads in regards to doctors notes, you need to understand it before you need to use it. Be sure to get notes when they are required to remain compliant with your facilities policies. Termination Almost all sick policies will lead to termination as an end result. And, when such procedures are executed the same across the board, most nurses find these policies to be acceptable. However, when these policies are not carried out consistently, you may feel that they are being used against you or other staff on your unit to force your hand at finding a new job. Some of the allnurses team met Theresa at the NursesTakeDC rally earlier this year. Nurse Beth was able to interview Theresa and learn more about her ordeal. Thank you for sharing with us, Theresa. What are Your Thoughts? So, where does all of this leave you? Do you stay home when ill or head to work in an attempt to avoid discipline, even when you know it is not best for you or your patients? Now it's time for you to decide. Tell us your thoughts and experiences with nurse absenteeism, presenteeism, and termination.

This article was written by a member of allnurses. Due to the delicate and emotionally charged nature of the article as well as details, the member wanted the topic posted anonymously. If other readers have articles they would like published anonymously, please contact me by private message. Let's start out with my first encounter with a parent. I was a paramedic (a newbie..a rookie..an innocent.,,) called to a home of a 4 month old that rolled off of a couch. The baby is seizing and the father is talking about how he was making the baby a bottle. He was alone with the kid and the mom was at work. He claimed to put the baby on the couch and the baby rolled off the couch. A short couch...onto carpet. The story didn't add up. The baby seized the entire 30 minutes it took us to get to the nearest hospital, and then later died from massive head trauma. Shaken baby syndrome. That was some fall. This was my induction into real life. I was out of my protective cocoon and my rose colored glasses cracked in the truth of real life. I have scraped children off of the highway who were unrestrained; I have whisked children out of homes that were besieged with fighting under the protection of cops; and I have taken children to the ED scared to be touched by anyone. The pressure of being a paramedic became too much, so I chose a new profession...pediatric nursing! (insert snarkiness here). I was working in the ED when a mom brought in her 13 year old. Both were afraid and the mom said the dad would be there soon. Mom did not have custody, and the dad was not happy the kid was in the ED. Dad, I am sure after meeting him, is in a gang. The cops were brought in, the mom asked to leave, the dad was cursing up a storm and I confronted him. "We will absolutely not tolerate that type of behavior in the hospital, in a CHILDREN'S HOSPITAL. If you don't sit down and be quiet, you will be escorted out." Nicer than a punch, and I kept my job. I myself was escorted by security to my car after work....fearing what may await me. A 15 year old on life support who OD'd to see if her mom loved her. She did not want to die, she wrote me in a note when she was intubated, she just wanted to see if her mom cared. The child took a turn for the worst with multi-system organ failure. As we strived to make her comfortable and keep her body in a hypothermic state, the mom was mad at ME because the room was too cold. She tried to fire me from being her daughters nurse. This after she so nonchalantly said, "pull the plug". I stayed at the bedside and held her hand as she passed away, mom went to go eat. A 13 year old dying from HIV/AIDS. The dad wanting to be at her side, the step-mom wanting to go do stuff. The dad confided in me once, when he was irritated with his wife, that his daughter was never treated fairly by his wife. He wanted to bring his daughter home to hospice and wanted to redo her room - a makeover - just how she would have loved it. The wife would not hear of it, since the girl was 'gonna die anyway'. And she did, in the hospital room with nursing staff at her side. The mother of an 18 month old who was beaten by the mom's boyfriend. The grandmother had unofficial custody since the day the child was born. She had unofficial custody of 3 of the children because the mom was always partying and never had time for the kids. When the family decided to remove the child from life support after the baby was declared to have brain death, the mother banned the grandmother from the room. That was the only time I did not let a parent help me bathe a patient after the patient died....and I gave them a time limit for grieving as well. The fact that the mother was holding her dead child and talking about going to Chili's and a movie later in the day sort of made up my mind, along with her acting like this was a party and yelling at her brother to "go get me a coke, hey, my baby just died and you need to be nice to me", and "hey, you know that ************ was going to go get a new car today?" Absolutely no feeling at all about the loss of a child, but enough bitterness in her to block the one true person who cared for the baby from being at his side. The four year old who was NPO for surgery. As usual, the patient did not go to OR before lunch and she became fussy and..hungry...I walked past her room to hear her father yell at her to "Shut up!" as she was crying. I went in right away and she was reaching for his lunch. His McDonald's fries and burger he was munching down on. I absolutely kicked him out of the room (sans roundhouse kick to the face). I know that people deal with grief in unusual ways. I have seen grief, I have seen the absolute absence of grief, and I have seen those who pretend to have grief. For me, the people who have not one ounce of compassion for the child who most needs their love are the ones who I cannot and will not ever understand. I know that people don't think beyond their own needs, even when a child is crying and does not understand what is happening. But it doesn't mean I agree with it, or have to like it. As a nurse, the hardest part of my job is to not say and do what I really think and feel. Or I would have been in jail a LONG time ago. What have you seen that makes you want to commit an assault? I-Should-Be-in-Jail.pdf

This article was written by a member on allnurses. Due to the controversial and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system. An Open Letter to Hospital Administrators I am an experienced nurse that has watched many of my very talented colleagues leave the bedside due to the changes that have taken place in healthcare as of late. I have seen staff cut to the minimum, while patient acuity and nurse to patient ratios increase. I have seen support staff break down in tears because they have not been able to do their jobs properly. I have seen staff pushed to their breaking point, all the while administration stays in their offices, or in the meetings, determining yet more ways they can cut our resources. I see your salaries raised to ridiculous amounts, while we are denied cost of living increases, housekeeping is cut at night, and our benefits cost more, while the services are decreased. I see our retirement cut while at the same time, the amount matched continues to be diminished or non-existent. I see ways in which we are constantly blamed for declining patient satisfaction, increased patient falls, late medication administration, all the while we are asked to do more with less. I have seen you fire experienced staff and hire less experienced, cheaper, staff. I have seen that new staff break down because they have no resources, no experience to draw from and I have seen patients suffer from that inexperience. I have seen codes increase, inappropriate admissions to floors, transfers to higher levels of care, all because no one was there initially to advocate for a higher level of care for the patient, to begin with. I still see you in your office. I do not see you on the floor. I see you with your graphs, your pie charts, your questions about readmission rates when I had already advocated for that patient to stay longer but was simply laughed off by doctors and not supported by you. Yet, somehow, I need to be on a committee to fix the problem. I am now required to work extra shifts, because staff are getting sick due to stress, or leaving completely because they are tired of dealing with things. I see you develop a culture of fear, where our jobs are at stake and threatened at every turn. Yet, you still look to me for solutions. "How can we do more with what we have?" I am asked. My answer: There is no way to do more. We are at our limit. You are losing nurses as fast as you are gaining them, at a time when we need to be building up our profession when the baby boomers are just starting to become a factor in our healthcare environment. My answer to this is simple. It is time to get real and start valuing your employees. If you want to be reimbursed for patient satisfaction, increase your services. Staff departments with what they need - enough nurses, enough aids, monitor techs, secretaries, ED techs, whatever. Then you will see positive results. Falls will decrease. Medication errors will decrease and medications will be given on time. Patients will get the treatment they deserve and patient satisfaction scores will improve. Your reimbursement will improve and you will stop losing money. Everyone wins: most importantly, the patients. We need to stop the assembly-line mentality of medicine and return to the service mentality. Yes, we are a business. But any business that has ever done well has not done well by decreasing the services to people or by mistreating its staff. Otherwise, healthcare facilities are going to see more of the same and suffer more financial penalties, less high-quality staff, and patients will suffer. I was talking with several of my colleagues just the other day. All of us had many years of experience. Many had been at the bedside for over 20+ years. Many are leaving the bedside due to the unsafe conditions they are seeing. They just don't want to be a part of it. Perhaps this does not scare you, but it should. You must not be a patient yet. For a follow-up article, please go to Nurses Fight Back! Why Some Hospitals are Despicable Hospitals Firing Seasoned Nurses_ Nurses FIGHT Back! _ allnurses.pdf

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. 2015 allnurses Salary Survey Results

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. The survey results are published in Critical Care Nurse, AACN's clinical practice journal. Link to study 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.

The opioid epidemic is a hot topic in today's headlines affecting more than 1 million people across the United States. As part of the multidisciplinary healthcare team, the nurse plays an important role in providing safe pain management using a multimodal approach. Catherine Ewing, BSN, RN shares strategies for optimal outcomes for pain control including safe prescribing and follow-ups as needed. At NTI 2018, allnurses.com's Community Director Mary Watts interviewed Catherine Ewing, BSN, RN who addressed the nurses' role in the opioid epidemic. She discussed the recent changes to the Centers for Disease Control and Prevention's recommendations. She stated, "The purpose of these guidelines is not to deny people pain medications but to prescribe safely and have prescribers practice follow-up." Catherine Ewing holds a BSN from the College of Saint Teresa in Winona, Minnesota. She works in the Department of Anesthesia Inpatient Pain Service at the Mayo Clinic, Rochester. As a member of this consult service, she triages and manages epidural and peripheral nerve catheters for both inpatient and outpatient populations. Catherine and Mary discussed the importance of individual pain assessment relative to several factors: Type of pain Reason for pain - is it due to recent surgery or trauma? Patient's previous experience with narcotics Does the patient have a history of addiction? Patients who have addiction issues need pain control also. The American Pain Society has guidelines to help clinicians provide adequate pain relief for those patients who have opioid addiction issues. Some of the points include: Use of methadone, dosing, initiation and titration Conduct a thorough pre-op pain medication assessment in a non-judgemental manner Use a validated pain management tool Provide close monitoring of respiratory status Surgeons should consider local blocks during surgery utilizing long-acting analgesia Catherine went on to state, Consistent nursing assessment and documentation is key to successful pain management. Nurses should also consider nonpharmacological means of pain management too, for instance, ice, elevation, guided imagery, and massage. This is a national problem and one many nurses face each shift they work. Pain Management and the Opioid Crisis - Conversation with Catherine Ewing Catherine's session was very popular and widely attended. One of the comments from the audience, "this is such an important topic given the current state of our healthcare system! I find this particularly relevant to the Cardiothoracic Surgery patients I typically encounter - in the facility in which I work a major issue is that generalized "pain management" policies do not take in to account the nature of the operation itself and the importance of pain control in preventing complications and improving outcomes. Pulmonary hygiene and early mobilization are paramount, however often difficult to achieve without adequate pain control. Unfortunately, it seems the corporate-minded aspect of many healthcare institutions is becoming a barrier to optimizing patient outcomes. I believe wholeheartedly that bedside critical-care nurses should be included by administrators in the development of methods to manage pain in postoperative recovery given the concerns of the opioid crisis. Great topic, glad to see it being discussed!" Pain control is an important element of patient care and one that deserves all nurses' attention. What is your hospital doing to ensure patients have adequate pain control? Reference: American Pain Society, Guidelines on the Management of Post-Op Pain

As a nurse, you speak with the public daily. You educate patients, support families, and provide information to community resources to get your patients the care they need. When our country experiences disasters, nurses are at the bedsides, providing care, and advocating for their patients. But, when a journalist covers a story about the latest flu epidemic, acute flaccid myelitis, or another violent attack, who do they interview? Do they look for the nurse at the bedside who cared for these patients, or the doctor overseeing the care? We're quite sure you just said "doctor" in your head, right? But, do you know why? A recent study conducted by Diana Mason and Barbara Glickstein replicated the original Woodhull Study that was done in 1997 to explore how often nurses were identified or interviewed in the media for general healthcare stories. The study was reproduced to determine if there have been any advancements of nurses in the media. At a recent AACN-NTI Conference, we sat down with Diana, who is the Senior Policy Service Professor for the Center for Health Policy and Media Engagement at George Washington University School of Nursing during the American Association of Critical Care Nurses meeting. She provided an overview of the original findings, new data, and the future of nurses in the media. You can watch/listen to the full interview below. The Original Woodhull Study In 1997, the "Woodhull Study on Nursing and Media" was published, and was the first of it's kind to explore the representation of nurses in the media as sources of health-related stories. Dianna explained that the original study found that nurses were sources in quotes less than 4% of the time in newspapers, and about 1% of the time in newsweeklies. During the interview, she explored the notion that even when nurses were at the heart of the story, such as with HIV/AIDS care in the mid-90's, they were nowhere to be found in print publications. Even rarer was to find nurses being interviewed about nursing policy or actually photographed for news stories. Following the release of the original findings, Sigma Theta Tau raised awareness of the need for nurses in the news. Then in 2010, the Institute of Medicine (IOM) released the Future of Nursing Report in which the Robert Wood Johnson Foundation and the IOM conducted a two-year initiative to assess and transform the profession of nursing. The study concluded that nurses played a vital role in the advancements of the healthcare industry, but that barriers existed that prevented them from being well-positioned to lead change and advance health. Have We Progressed? According to the preliminary results released by The George Washington University, the new study examined 365 randomly sampled health news stories published in September 2017. They looked at the type and subject of the article, the profession, and gender of the speakers, and how many times nurses were references without being quoted. The researchers found that nurses were identified as sources in just 2% of the health news coverage and mentioned in 13% of health news coverage overall. While this is a decrease in the representation, Dianna explained that it's not statistically significant, so the conclusion has been made that nothing has changed. She acknowledged that this might not be accurate because nurses might be cited in stories, but not recognized for their role. It's normal to see stories where Dr. Smith is quoted, even if he or she isn't in a hands-on provider. However, when a nurse holds an executive level position, their credentials aren't always given. Other findings included that females are less represented that males in the media, even though the profession is predominately made up of women. There were also preconceptions in the news media about positions of authority and journalists admitted that they weren't sure what nurses do and when nurses would add to a story unless it was explicitly about nursing. How Do We Make Change? Nurses provide more hands-on care than any other healthcare professional. Yet, they aren't equally represented in the media. Is this because nurses are not comfortable with being in the spotlight? Could it be that when journalists request an interview for a story nurses are not the ones provided by healthcare systems? Or, maybe journalists aren't even sure how to access nurses for stories. Actually, all of these were found to be true. So, how do we ensure that this won't be the same 20 years from today? Here are a few things you can do to help progress nursing representation in the media: Support movements like Show Me Your Stethoscope (SMYS) that advocate for positive cultural changes within the nursing profession and the healthcare community. They strive to provide a united voice for nurses on issues facing our communities. SMYS was founded in response to a public attack on the nursing profession and has ultimately led to the #NursesUnite concept. Talk about your credentials. Diana points out that you don't need to include all 7 of the certifications you hold, but identifying yourself as a nurse with a hard-earned degree and license is paramount to the required changes in media. Improve media competence by training journalists and offering media training to nurses. If you want to be a presence in your local community, seek out the media relations department at your facility and request to be trained on how to speak to the media. This training can teach you how to talk with journalists, stay on your message, and just be yourself. Anticipate healthcare happenings and identify nurses who should be at the forefront of stories. This should be accomplished on a local, state, and national level by healthcare facilities, organizations, universities, and government agencies. Our time with Diana was eye-opening and empowering. Have you been in the media as a nurse? Were you well-represented in print? Or, maybe you have ideas on how to empower nurses to be in the press? Whatever your thoughts are about this study, we want to know. Comment below and get the conversation started.

AllNurses.com's Content and Community Director, Mary Watts recently interviewed Karen Kesten, DNP, APRN at NTI 2018 on the subject of nursing certification. Dr. Kesten is the past chair of the national board of directors for the AACN Certification Corporation, as well as an associate professor George Washington University School of Nursing. Many nursing certifications are available from AACN Certification Corp. for both RNs and APRNs. Dr. Kesten recommends certification for all nurses as a "mark of excellence and distinction." She went on to state that this proves credibility of knowledge and leads to higher patient and nurse satisfaction. New Certifications Two new certifications; CCRN-K and PCCN-K are now available. These certifications are for nurses who do not currently deliver direct bedside care but who indirectly affect patient care thru management, instruction or staff development. The "K" stands for "knowledge." This is a way for nurses to continue to use their knowledge even though they are no longer bedside. Other new certifications include palliative care, and forensics nursing. These specialties show patients and colleagues that the nurse has attained a level of expertise in their specialty. Dr Kesten foresees possible future certifications for nurse navigators and nurses who are involved in transitions of care. APRNs and the Consensus Model Advanced Practice Registered Nurses (APRNs) also need to consider the Consensus Model when choosing their educational pathway. The APRN roles are: Nurse Practitioner Clinical Nurse Specialist Certified Nurse Midwife Certified Registered Nurse Anesthetist "To help take APRN practice to the next level, AACN collaborated with over 40 nursing organizations to address the inconsistency in APRN regulatory requirements throughout the United States. The result was the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (LACE)." The Consensus Model sought to improve patient access to APRNs, support nurses to work more easily across different states, and enhance the certification process by preserving the highest standards of nursing excellence. Through consistency and clarity of APRN Consensus Model criteria, APRNs were empowered to work together to improve health care for all." LACE also determines what patient population and focus the APRN certifications cover. This is an effort to delineate out each APRN specialty and to develop more consistency. Dr. Kesten encourages nurses to consider a primary care APRN role as nurse practitioners are in great demand especially in underserved and more rural communities. With the current physician shortage, nurse practitioners are filling many provider roles. More and more nurse practitioners are seeking roles in specialty care, which extends the availability of providers. Why Certification is Needed Dr. Kesten encourages nurses to obtain certifications. She emphasized that nurses are in a life-long learning pattern and with certification, they have more options. There are many faces of nurses so there are many certifications and she expects that nurses will have many more opportunities in the future. Dr. Kesten advocates for nurses having a louder voice in order to advocate for their patients. Overall there are many more opportunities available for certified nurses. Consider certification! References: AACN Certification Corporation APRN Consensus Model

The #1 digital stethoscope for nurses. 40x sound amplification Reduced ambient noise 7 volume levels for listening comfort Adult & pediatric diaphragms Rechargeable battery with 9 hour life with continuous use Bluetooth connectivity to free mobile app Connecting the CORE to the free Eko App gives clinicians the ability to visualize, record, save, and share heart sounds. These functions are useful for hearing low grade heart murmurs, getting a second opinion on irregular sounds, education, and telemedicine. The Eko CORE is available in two models. $299, the Eko CORE Digital Stethoscope is a complete stethoscope $199, the Eko CORE Digital Attachment can digitize a traditional stethoscope from manufacturers such as 3M Littman, ADC, and Medline Who uses Eko Stethoscopes? The Eko CORE is used by over 10,000 clinicians at 1,000 institutions around the world. The sound amplification and bluetooth connectivity are helpful for clinicians with hearing loss or patients that are difficult to auscultate. Medical and nursing schools are adopting Eko as an intuitive learning tool. Finally, Eko is expanding telemedicine programs with cardiology-grade live streaming of heart and lung sounds. FLASH SALE This special 30% off offer - only available to allnurses.com readers - expires September 30th, 2018. Use the promo code allnurses to get 30% off your order today! Click Here to Purchase

Disposable gloves have long been a mainstay of required equipment for the protection of healthcare workers and patients. In many perioperative areas, surgical tasks require the use of double-gloving. Ansell developed the GAMMEX® PI Glove-in-Glove System™, the world's first pre-donned double-gloving system featuring pre-donned outer and inner gloves allowing quick and easy double gloving with a single don. Features and benefits include: Semi-transparent outer glove over a green under glove allows quick and easy breach detection Ability to don 2 pairs of gloves with one don in half the time of the traditional double gloving with 2 dons Non-latex Saves time Cuts down on waste For more information see the GAMMEX® PI Glove-in-Glove System™ Product Overview in the allnurses Product Directory. If you have used this product, please leave a review in the Directory.

Julie Godby Murray, RN has over 40 years in healthcare and is currently an OR nurse in Michigan. She has been instrumental in developing the Nurse Honor Guard. This is a ceremony that takes place to honor a nurse's service to her patients, community, family and friends. As Ms Murray states, "It's so healing for the families. Families know what we go through. The families are very touched." She further explains that the Honor Guard wears a white dress, cap, cape, and they carry a white rose that is placed on the casket to symbolize the caring that a nurse does during her lifetime. This is a ceremony that takes place to honor a nurse's service to her patients, community, family and friends. As Ms Murray states, " Its so healing for the families. Families know what we go through. The families are very touched." She further explains that the Honor Guard wears a white dress, cap, cape, and they carry a white rose that is placed on the casket to symbolize the caring that a nurse does during her lifetime. Here is an example of a Nurse Honor Guard ceremony. Taking their cue from military honor guards with a tradition of honoring fallen military comrades via a ceremonial tribute, the Nursing Honor Guard provides this tribute for nurses who have died. Julie, who is also the union steward for over 500 nurses in a Michigan hospital system provided some more information about what a Nurse Honor Guard does: Attend all services wearing the traditional white uniforms with cap and cape Stand guard at the nurse's casket or simply provide a presence at the visitation. Recite "A Nurse's Prayer" at the funeral or during a special service Present the Florence Nightingale lamp to the family. Place a white rose on the nurse's casket at the end of the service, which signifies the nurse's devotion to his or her profession. Julie has been a driving force in the further development and spread of the Nurse Honor Guard. From the east coast all the way to the Kenai Peninsula in Alaska, you will find Nurse Honor Guards ready and willing to pay tribute to their fellow nurses. Julie is willing to help and has assembled many tips on her organization's FaceBook page; OPEIU Nurses Honor Guard. Julie was also one of the invited speakers at the 2018 Nurses Take DC. She encourages nurses to legislate for adequate nurse-patient ratios. She stated, "Our hospital has the same staffing ratios that California has and our ancillary personnel are figured into this. We need them too!" She went on, "We have the power, lets do this together." She closed her discussion with this quote from Alice Walker, "The most common way people give up their power is by believing they don't have any." [video=youtube_share;22nbfekuGCE] References: Alice Walker, Author of the Color Purple

NursesTakeDC had one purpose: to support the Federal Legislation for National Nurse-to-Patient Ratios S.1063 & H.R.2392 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. These bills support mandated nurse to patient ratios. Doris Carroll, BSN, RN-BC, CCRC is one of the faces and organizers of NursesTakeDC. She is also the Vice President of the Illinois Nurses Association and she is an administrative nurse at the University of Illinois Hospital and Health Sciences System. At the recent NursesTakeDC rally in April, where nurses gathered in the Nations' Capitol to advocate for safe nurse-patient ratios, Nurse Beth from allnurses. com talked with Doris Carroll who stated, "It's time we do something. We need to take charge of our profession. Some of our nurses have 3 and 4 patients in the ICU... Nurses need to understand that we are so powerful at almost 4 million strong across the country, yet we can't seem to unify around the most dangerous part of our jobs which is unsafe staffing. What we want to do is empower nurses. This movement is comprised of both non-union and union nurses. It doesn't matter where you come from or what kind of nurse you are. What matters is that you do and say something to change things. is not just about nurses, it's about our patients. We must let the public and legislators know that patient acuity ratios affect patient outcomes." Nurse Beth, who is from California stated, "Some of these ICU nurses have 3-4 patients. This is unheard of in California where we've had nurse ratios for 14 years. What would you advise nurses to do?" Doris responded, "Find out who your senators are - talk to them about acuity-based nursing ratios in language they can understand. Relate it to their family - I might not be able to get to their Mother or Father in a timely manner when they need help; when they cry out for pain medication or if they fall on the floor. Encourage your legislators to co-sponsor nurse ratios laws." She went on, "It doesn't matter whether you are union or non-union, we want our patients to be safe. Educate other nurses that acuity-based ratio staffing will help the nurses to remain at the bedside caring for patients." Currently 14 states have staffing ratios: 7 states require hospitals to have staffing committees responsible for plans (nurse-driven ratios) and staffing policy - CT, IL, NV, OH, OR, TX, WA. CA is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. MA passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient. MN requires a CNO or designee develop a core staffing plan with input from others. The requirements are similar to Joint Commission standards. 5 states require some form of disclosure and / or public reporting - IL, NJ, NY, RI, VT Nurse-patient ratios are an extremely important issue for nurses as well as patients. Improving safety and reducing errors as well as improving job satisfaction are all tenets of nurse-patient ratios. In 2014, the Robert Wood Johnson Foundation cited a statistic that almost one out of five new nurses leave their first job within the first year of gaining licensure as a nurse. If that is not worrisome enough, one out of three leaves the profession within two years of beginning their nursing career. Medical errors are the third leading cause of death in the US. Patient safety is the most important reason to improve and mandate nurse-patient ratios. In order to reduce patient errors, there needs to be more nurses at the bedside. One study found that for every one additional patient added to a hospital staff nurse's workload is associated with a seven percent increase in hospital mortality. A study published in 2014 in the Lancet showed, "An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%." Doris Carroll concluded, "We are educated and professional and we care about our patients." Thanks to Doris Carroll and Nurse Beth for their informative interview. Now...we all are being tasked to talk to the public and our legislators. [video=youtube_share;5H2LCDSuEPY] References: ANA - Nurse Staffing Nearly One in Five New Nurses Leaves First Job in One Year Nurses Take DC Position Paper Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study Third Leading Cause of Death Doctors

The annual Emergency Nurses Association conference is dedicated to the emergency nursing profession and it will be held in the City of Bridges at the David L. Lawrence Convention Center (Pittsburgh, Pa.), Sept. 26 - 29, 2018. "Emergency Nursing 2018" will bring attendees unique opportunities for hands-on education, access to cutting-edge research and renowned experts in emergency medicine as well as opportunities to network with nurses from around the world. There are numerous ways to take advantage of the education and networking opportunities at the conference this year. Attendees can earn over 29 contact hours and choose from more than 160 sessions ranging from pediatrics and geriatrics, to leadership, trauma, advanced practice and forensics. All attendees have the opportunity to build their own personal agenda by pre-registering for their desired sessions, including hands on cadaver and ultrasound labs. This year, there will be more advanced practice content available too. In partnership with the American Academy of Emergency Nurse Practitioners (AAENP),ENA has created a full day Advanced Practice Procedural Skills Lab that allows attendees to participate in hands-on practice elements, two interactive simulations to promote clinical reasoning skills, a basic suturing workshop and more. This experience can be further enhanced by an advanced practice ten-course track designed to dive deep into common advanced practice emergency nursing skills and address the risks, benefits and possible complications that become considerations practitioners should be versed in. The conference offers several interactive experiences in the Exhibit Hall including: ENA Learning Lab: Discover clinical education sessions on the exhibit floor and earn CERPs - topics include IV infiltration, intubation, obstetrics in the ED and more. Career Wellness Center: Access professional services like headshots, make use of private interview spaces and unwind in the ENA sponsored relaxation station. DisastER: Visit the flight medical helicopter and tent to learn more about transport nursing. Presentation topics will focus on how to become a transport nurse, how to transport intubated patients and more: SIM Wars: 16 teams of four will compete in a two-day emergency simulation competition on two separate stages complete with bracket style playoffs, ending in a championship round. AdvancED: Step into the future of emergency nursing. This fully-equipped, mock, four- bed ED provides nurses at any stage of their career with progressive clinical information allowing groups of six to eight to participate in hands-on clinical simulations. EDTalks/SMACC Talks: Listen while colleagues, ENA representatives and valued partners share short presentations focused on successful ideas, trends, equipment, supplies, services, research studies, practical problem-solving efforts and expertise that are optimizingEDs around the country. Early bird rates are available through July 31, 2018. For more information or to register for the conference, visit Emergency Nursing 2018. Register When: September 26 - 29, 2018 Where: David L. Lawrence Convention Center in Pittsburgh, PA Primary Spokesperson: ENA President Jeff Solheim, MSN, RN, CEN, TCRN, CFRN, FAEN, FAAN Conference Website For additional information regarding ENA, please contact Tim Mucha at tim.mucha@ena.org, 847.460.4022 Rates Registration Type Early Bird Deadline July 31, 2018 Advanced Registration After July 31, 2018 Member - Full Conference $520 $750 Member - Two Day $350 $500 Member - One Day $185 $285 Non-Member - Full Conference $620 $850 Non-member - Two Day $450 $600 Non-member - One Day $285 $385 General Assembly - Full Conference $520 $520 General Assembly - Two Day $350 $350 General Assembly - Thursday Only $185 $185 Student Nurses* - Full Conference $250 $250 Student Nurses* - One Day $100 $100 Faculty Discounted Rate** $250 $250 *Student rate applies to both member and non-member students, based on ENA Student Membership requirements. **Must be approved for discounted rate. Please contact education@ena.org for details. Hotel Information: ENA has negotiated travel discounts and secured a limited number of reduced-rate hotel rooms to make your trip to Pittsburgh affordable. Through the travel experts at onPeak, rooms at the group rate are limited and available on a first come, first served basis. Please login into the registration dashboard to book your hotel. You must have an active Emergency Nursing 2018 registration in order to reserve a hotel room in the official hotel block. Reservations without active registration records will be canceled and a cancellation confirmation will be sent. Please note: You may book up to 3 rooms per registrant. If you require more than three rooms, please email your request to ena@onpeak.com. Official ENA Hotels The Westin Convention Center Pittsburgh - Headquarter Hotel Starting at $209/night Courtyard by Marriott Pittsburgh Downtown Starting at $199/night Doubletree by Hilton & Suites Pittsburgh Downtown Starting at $199/night Embassy Suites by Hilton Pittsburgh Downtown Starting at $189/night Hampton Inn & Suites Pittsburgh Downtown Starting at $184/night Kimpton Hotel Monaco Pittsburgh Starting at $234/night Omni William Penn Hotel Starting at $205/night Renaissance Pittsburgh Hotel Starting at $189/night

Provided by ANCC American Nurses Credentialing Center This year's event in Denver will mark the 16th year ANCC has hosted the Magnet Conference. Join over 10,000 other talented nurses and nursing executives that represent more than 20 countries for the National Magnet Conference. The prestigious Magnet Recognition Program celebrates accomplishments for newly designated Magnet organizations. Attendees return to their hospitals energized to improve their practice and equipped with proven solutions. Over 250 exhibitors will be sharing their expertise so make sure to stop by and pick their brains. The Magnet Conference was organized to recognize healthcare organizations that provide exceptional nursing care and uphold the tenets of professional nursing practice. Lunch and refreshments are provided along with prize drawings and giveaways. Make sure to take time to see the more than 150 posters that fellow nurses have made showing their evidence-based practice. Choose from the 70+ new and innovative concurrent sessions and enjoy the inspirational general sessions with dynamic speakers ... and don't forget to come to the welcome party! Who Attends Magnet? Magnet is the leading source of successful nursing practices and strategies worldwide. A breakdown of the attendees is below. 65% have a BSN - 2% are under age 25 44% have a RN - 22% are age 25-34 33% have a MSN - 26% are age 35-44 7% have a MS - 27% are age 45-64 8% have a BS - 21% are age 55-64 4% have a PhD 42% are staff nurses 9% are CNO 9% are Directors 6% are Hospital Administrators Attendee to Exhibitor is 32 to 1 Conference Dates Wednesday - October 24, 2018, 12:00 p.m. to 4:00 p.m. Thursday - October 25, 2018, 8:30 a.m. to 12:30 p.m. Friday - October 26, 2018, 8:30 a.m. to 12:30 p.m. Conference Location Colorado Convention Center 700 14 Street Denver, Colorado 80202 Sessions The Year of Rapid Improvement Events Inpatient Flow A Behavioral Emergency Support Team (BEST) on Medicine Developing Future Nurse Manager Empowering Nurses With an Online Roadmap for Evidence Based Practice From Paper to Practice: Getting Your Team on the Same Page Building a Nurse-Led Patient Care Logistics Reducing Unrecognized Clinical Deterioration and MANY MORE. For a full list, go to Concurrent Sessions Poster Subjects Fostering Systems Thinking to Improve Golden Hour Efficiency Elevating Practice with an Electronic Peer Review Tool Contrast Induced Acute Kidney Injury in the Cath Lab Decreasing Staff Injury with Innovative Protective Equipment Rates Early-Bird Registration Ends June 22, 11:59 p.M. EDT Individual rate: $889 before deadline June 22, 2018 - save $490 Group Rate: $879 before deadline June 22, 2018 - save $1050 Retired Nurse, Faculty: $629 before deadline June 22, 2018 - save $240 PreConference Options Research Symposium: October 22, 2018 9am-5pm - $359 Practice Transition Accreditation Program (PTAP) Workshop: October 23, 2018 8am-5pm - $325 Nurse Executive Certification Interactive Review Course: October 23, 2018 8am-12:30 p.m. - $399 Advanced Nurse Executive Certification Interactive Review Course - Workshop: October 23, 2018 1:00 p.m.-5:30 p.m. - $399 International Forum: October 23, 2018 5:30pm-7:30pm - $125 Getting Started Magnet Program: October 22, 2018 8am-4pm - $999 Additional Guest to Welcome Party - $125 The Welcome Party is on October 24, 2018 from 7pm to 9pm. Journey through the seasons and snack on locally grown food and enjoy the beer garden from the Colorado microbrewery. Registration Register online only and pay by check or credit card. Pay by check is only to September 7, 2018. After that date, the only payment accepted is by credit card. Refunds up until September 7 minus $200 administration fee. Contact information ANCC Conference Services, P.O. box 207, Lincoln, RI 02865-0207 ancc@confex.com Hotel/Travel Information Use Connection Housing (the official provider) for special rates and features Email: ANCCHousing@ConnectionsHousing.com Phone: 404-842-0000 Toll free: 1-800-262-9974 Fax: 678-228-1930 Information regarding hotels and prices is available at conference site Airline discounts starting on January 22, 2018, 3-10% discounts available Delta - delta.com/meetings: Code NMRT3 1-800-328-1111 United Airlines - www.united.com: Code ZCODE=ZEZC Agreement code: 119159 (1-800-426-1122) Check out the excitement from the 2017 event [video=youtube;0OI-O-Ml6F4] Conclusion Bring your family or a best friend with you to enjoy the Mile High City. There is a large variety of restaurants, museums, nightlife, and natural wonders for you to explore. While you learn and network, you know that you are with an organization that gives back. They partner with Metro Caring that has been in the Denver community since 1974. Here they have a free Fresh Foods Market in which their aim is to end hunger through access to food and break the cycle of poverty.

Meet and network with fellow Students, Nursing leaders, and Faculty members at the National Student Nurses' Association: Get Hooked! Insight, Inspiration, Ingenuity 66th Annual Conference in Nashville, Tennessee. Glean nuggets of knowledge from the 35th president of ANA, keynote speaker, Dr. Pamela Cipriano on Wednesday, April 4th. Gain insight from her and the other speakers that will help you in your journey as a student or faculty member. Be inspired by your fellow students, nursing leaders, and faculty. Connecting with fellow nurses helps create a network of friends that can lead to a study group, future jobs, or having a support group. Show your ingenuity, branch out and try something new... You never know where it will lead. When April 4th through April 8th, 2018 Gaylord Opryland Hotel 2800 Opryland Drive Nashville, TN 37214 Sessions and Special Events A few of the sessions offered are a mini NCLEX review, career counseling, poster sessions, and focus sessions. Don't forget the party on the first night: Lights, Camera, Action - From Movies to music. Come dressed as your favorite star! Grab your bestie and participate in the fun run. Run the 5k or walk the 1k taking place on April 7th at 7 am. Have fun whether you walk or run while raising funds to support the Foundation of NSNA undergraduate scholarship program. Sign Up Now! Another special event is the Poster Session and Project Showcase. The NSNA Chapters are invited to share school or state projects for research projects. These are great ways to expand your knowledge whether you are a poster presenter or an observer. Registration Information Register Online March 19 is the deadline for registration. Mail registration by March 12, 2018; if it is postmarked past that it will be returned. One form per registrant and it may be photocopied. Onsite Registration opens 4/3/18 at noon. Registration confirmation is sent via email only, one week prior to the convention. Students must show valid student ID and current membership card (if a member) when picking up registration materials onsite. National Student Nurses Association, Inc., Meeting Registration Dept. P.O. Box 798 Wilmington, OH 45177 Refunds and Returned Checks 80% refund if a written request is emailed to nsna@nsna.org or postmarked by 3/21/18 Administrative fee is $10 for returned checks Non-member students may join NSNA and register as a member NSNA Membership Onsite Registration Available 4/3/18 Convention only Members/sustaining Members: $120; $70 Daily Non-Member Students/Visitors: $175; $85 Daily Faculty Advisors.State Consultants: $120; $75 Daily NCLEX Review only Members/sustaining Members: 90 Non-Member Students/Visitors: $125 Convention and NCLEX Review Members/sustaining Members: $145 Non-Member Students/Visitors: $220 Faculty Workshop only - How to Teach with Technology Faculty Advisors/State Consultants: $300 Non-Member Students/Visitors: $350 Convention and Faculty Workshop Faculty Advisors/State Consultants: $400 Early Bird Registration Convention only Members/sustaining Members: $110 Non-Member Students/Visitors: $170 Faculty Advisors/State Consultants: $115 NCLEX Review only Members/sustaining Members: $ 85 Non-Member Students/Visitors: $120 Convention and NCLEX Review Members/sustaining Members: $130 Non-Member Students/Visitors: $200 Faculty Workshop How to Teach with Technology Faculty Advisors/State Consultants: $275 Non-Member Students/Visitors: $350 Convention and Faculty Workshop Faculty Advisors/State Consultants: $375 Hotel Information Gaylord Opryland Hotel 2800 Opryland Drive Nashville, TN 37214 877-382-7299 Room rate is $199 per night for a single, double, or quad Debit cards are not recommended because the hotel immediately deducts the first-night deposit and will freeze a set amount per day, per room for incidentals upon check-in. You will not have access to these frozen funds for up to 2 weeks after checkout. Parking Valet Hotel parking is $38 daily, or self-park for $23.20. Attendance Expected attendance is 3,000 from 2,000 Nursing Programs. Get exposure to over 60,000 NSNA members. Join Us! Make sure you take time to enjoy all that Nashville has to offer. Check out the museums, music tours, and the zoo which are just a couple of highlights. There are plenty of good restaurants, so try something you've never had before. But most of all, know that going to a conference at any stage of your career can give you invaluable information. Gain knowledge, friends, and confidence by attending this conference.

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

allnurses.com staff recently had the opportunity to interview Lisa Wolf, PhD, RN, CEN, FAEN, Director of ENA's Institute for Emergency Nursing Research. She has published research about bullying and how it affects nurses patient care. How does bullying in the ED manifest itself? Bullying can manifest as the dynamics of aggression, which includes overt hostility, denigrating comments, giving inappropriate assignments for the nurses' experience and expertise, and selective reporting. More difficult to identify and call out, however, are the dynamics of exclusion, which is marked by a withdrawal of help, support, and information. These types of behaviors often result in a nurse being "set up to fail", which has consequences for patient care. How does this differ from bullying in other departments? I don't know that it is very different in other departments, but the constant flow of patients, the short turnaround times, and the initial lack of knowledge about patient conditions make the emergency department a particularly high-risk area for this dynamic to manifest. What kind of collateral damage results from bullying in the ED? Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs What methods did you find to be the most effective in addressing/decreasing bullying? Our respondents report that a "calling it out" strategy by both staff and management is the most effective way to reduce bullying and its consequences. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying As a result of your research, what type of training do you recommend? Given that management is the key role in mitigating bullying behaviors, education in the identification of bullying behaviors (especially those marked by the dynamic of exclusion) and in addressing them with staff is probably the most effective way to reduce workplace bullying. Bullying is becoming more pervasive in our culture as a whole. However, as nurses on the forefront of life and death decisions, it is imperative that nurses have a toolkit to deal with bullying at work. The American Nurses Association published a position paper on this in 2015 with a goal; "to create and sustain a culture of respect, free of incivility, bullying and workplace violence." ENA has also published guidelines to deal with and curb lateral violence which is defined as; "violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse, etc.)." "According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported, due in part to the perception that assaults are "part of the job"." ENA offers a toolkit with six distinct steps to address workplace violence. The first step is acknowledging that it exists and that nurses have the capability to decrease the incidence. There are many shareholders in this initiative including the front line staff but managers and administrators also have a key role in this. JCAHO, OSHA and other governmental agencies require documentation of a safe workplace and offer recommendations as well. Violence should never be tolerated. Do you feel safe from lateral violence in your emergency department? What has your ED done to combat lateral violence?

Urology nurses function in multiple environments including hospitals, same-day surgi-centers, private practices and home health. They may care for patients with multiple co-morbidities in addition to urologic needs. The urologic nursing specialty requires its professionals to have a comprehensive knowledge of developmental and aging changes that are essential to understanding acute and chronic urological diseases. Here is an article about urologic nurses. There are several sub-specialties for urologic nurses too: Office nurses that assist with cystoscopies and sedation Nurse Practitioners in urology practices Nurses that administer intravesicular meds for bladder cancer Pediatric urologic nurses Many opportunities exist for urologic nurses and associates. Urologic associates are often unlicensed assistive personnel who help with procedures, assist with patient education and otherwise contribute to overall patient care. Often the nurse will delegate tasks to a urologic associate in order to focus on a nursing-related skillset. Here is a description of a day in a urologist's office. You will see patients with appointments for recurrent UTIs, renal stones, and post-op follow ups. You might also see patients with the complaint of sexual dysfunction related to erectile dysfunction. Urologic nursing can also encompass some aspects of transplant nursing. Renal transplants occur frequently and often are done in coordination with a transplant surgeon as well as urologist. Nurse navigators help to coordinate care and ensures patients are kept up to date regarding their cares, assists with appointments, and facilitates communication. They work with physicians and other medical personnel to help with transitions and follow-up. Nurse navigators bridge the gap between hospital and out-patient care and work as an integral part of the care of the urological patient.

The Academy of Medical-Surgical Nurses wants to recognize and identify the contributions of med-surg nurses all year round but especially this week. Med-surge nurses form the basis of almost all nursing care. It is the fundamental practice of nursing encompassing many different diagnoses and levels of care. Even though med-surg nurses have existed for many years it wasn't until 1990 that the AMSN was formed with an objectives to: Improve the image of the medical-surgical nursing Develop standards for medical-surgical nursing practice Create a Core Curriculum for establishing the essence of the medical-surgical nursing practice As med-surg nursing has grown, developed and become even more complex, the Academy works to keep up by developing position papers on patient literacy, certification, political awareness, staffing standards and practice environment. Gone are the days of med-surg nurses just providing back rubs, routine bed baths, supervising patients' smoking, and giving the occasional medication. Nowadays, med-surg nurses are caring for central lines, stable inotrope drips, post-op patients with open wounds, patients with cardiac monitoring, and complex medication regimens. Today, more than ever, patients are not hospitalized for long periods of time. Therefore, it is imperative that nurses from admission to discharge work to provide education to the patient and family members to decrease the chance of readmission. Medical-surgical nurses care for patients with a wide variety of diagnoses such as: Gastrointestinal hemorrhages COPD/Asthma Cellulitis Endocarditis Pnuemonia Other infections requiring hospitalization GYN disorders Documentation is always paramount for all nurses. An article published in 2016 on AN focuses on documentation: Nurses Charting. Another popular article, A Push for the Return of Team Nursing explores staffing on med-surge units and the needs of an increasingly complex medical-surgical patient. Many nurses have traditionally started in med-surg in order to get an introduction to the nursing workplace and also develop time management and critical thinking skills. Med-surg nurses are the generalists of nursing. They care for several patients with multiple medical and/or surgical needs. Thank you to all the Med-Surg Nurses on AN. Here is your forum.

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? 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

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 new 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 Non-Traditional Nursing Students Take Non-Traditional Pathways