Ongoing Neurological Assessments Reveal Subtle Changes

Ongoing Neurological Assessments Reveal Subtle Changes

Patients with alterations in level of consciousness are among the most difficult to assess and may have subtle neurological changes that can occur suddenly and become life-threatening if they go unnoticed.

Nurses who care for these patients must have the knowledge, skill, and time to confidently perform comprehensive neurological assessments to identify changes that require quick diagnosis and intervention by the multidisciplinary team, according to a new article in Critical Care Nurse .

Assessing Patients With Altered Level of Consciousnessdiscusses methods to assess these patients and describes the neurological assessment and potential causes for altered levels of consciousness.

Co-author Melissa Moreda, MSN, APRN, ACCNS-AG, CDCES, CNRN, SCRN, is an inpatient diabetes clinical nurse specialist at Duke Raleigh Hospital in North Carolina.

“Neurologically impaired patients are among the most vulnerable, often unable to communicate, advocate for, or defend themselves,” she says. “Direct care nurses are at the forefront of care, and it’s imperative to understand key components of an assessment and be able to evaluate trends rather than isolated events.”

The article provides guidance for conducting a thorough neurological assessment, including:

  • General behavior and body position
  • Vital signs
  • Level of consciousness
  • Mental status
  • Motor control and sensory function
  • Cranial nerve function
  • Pupillary response
  • Language and speech
  • Reflexes
  • Cerebellar function

Many of the components of a neurological assessment are subjective, and changes in status may be subtle, requiring ongoing and astute monitoring. When minute changes are identified quickly, interventions critical for brain preservation can be implemented rapidly to prevent long-term complications and provide quality care for patients with altered levels of consciousness.

ANA Underscores Urgency for Safe Staffing Solutions, Minimum Nurse-to-Patient Ratios

ANA Underscores Urgency for Safe Staffing Solutions, Minimum Nurse-to-Patient Ratios

The American Nurses Association  (ANA) underscores the urgency for Congressional leaders, the Centers for Medicare & Medicaid Services (CMS), and other key stakeholders to advance efforts in implementing safe staffing standards, including minimum nurse-to-patient ratios.

The nurse staffing crisis demands a national dialogue with nurse-led approaches to help ease longstanding work environment challenges that nurses face across numerous specialties and healthcare settings. ANA supports minimum nurse-to-patient ratios enacted by nurse-centered committees dependent upon key factors such as patient acuity, intensity of the unit practice setting, and nurses’ competency, among other variables.

“ANA’s goal is to empower nurses and position them for success. Embracing setting specific ratios for nurses should be viewed as only one piece of a much larger solution. We’re still working to address other longstanding workforce challenges that have dramatically worsened the nurse’s staffing crisis, such as burnout, workplace violence, mandatory overtime, and barriers to full practice authority, says ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN.

“Studies have shown unsafe staffing negatively affects patient care outcomes and the well-being of nurses. According to the American Nurses Foundation’s national workplace survey of nurses, 31% of nurses are required on a weekly basis to work beyond their scheduled shifts to provide adequate care to patients. And the National Council of State Boards of Nursing says a quarter to half of the nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) “a few times a week” or “every day.”

“We urge health care leaders and policymakers at all levels to effect the necessary change, but we must not underestimate the power of nurse advocacy. Direct care nurses have special relationships with their patients, imparting unique insights into patient care and the dynamics of the practice setting. That is knowledge that can’t be matched. Nurses are the most trusted professionals in the U.S., especially among healthcare consumers, so we should both trust and empower them to be the decision-makers on how to improve their work environment and deliver the best patient care,” says ANA Enterprise CEO Loressa Cole, DNP, MBA, RN, NEA-BC, FAAN.

ANA’s call for staffing solutions that include ratios was voted on and approved at its 2022 Membership Assembly, the official voting and governing body of the association, which led to nearly 400 members of ANA convening on the U.S. Capitol to petition Congress to address the national nurse staffing crisis last month. ANA is not only advocating but seeking solutions, launching the Nurse Staffing Think Tank in 2022 in partnership with other leading organizations, which produced a series of actionable strategies that healthcare organizations could implement within 12 – 18 months. In May 2023, the Nurse Staffing Task Force identified another 65 proposed long-term recommendations to spur innovation, policy, and regulatory action, encourage new care models, and effectively support direct care nurses and nurse leaders.

ANA continues to advocate for nurses, remain a collaborative partner, and call on Congress to enact meaningful legislation and policies that improve nurse staffing and work environments. ANA provides nurses at all levels key resources to help inform advocacy and approaches to address the nurse staffing crisis.

AANP Applauds Senate Introduction of ICAN Act

AANP Applauds Senate Introduction of ICAN Act

The American Association of Nurse Practitioners (AANP) commends Sens. Merkley (D-OR) and Lummis (R-WY) for introducing the Improving Care and Access to Nurses (ICAN) Act in the U.S. Senate.

This legislation would strengthen healthcare access for Medicare and Medicaid beneficiaries by removing federal barriers to practice for nurse practitioners (NPs) and other advanced practice registered nurses (APRNs).

“Every day, nurse practitioners are striving to meet our country’s growing need for high-quality healthcare in all practice settings yet outdated federal barriers limit patient access to NP-provided care,” says AANP President Stephen Ferrara, DNP. “This important legislation will move our nation’s healthcare system toward one that more accurately reflects the modern healthcare workforce. It is vital that the millions of Medicare and Medicaid patients who choose NPs receive timely access to high-quality healthcare. AANP applauds the introduction of the ICAN Act by Senators Merkley and Lummis in the U.S. Senate, and we urge its swift passage by Congress.”

NPs are the fastest-growing Medicare provider group, and approximately 40% of Medicare beneficiaries receive NP-delivered care. The ICAN Act would improve timely access to care by authorizing NPs to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities, and more.

AANP strongly supports the ICAN Act and efforts to modernize policies to ensure every American has timely access to high-quality healthcare from their chosen healthcare provider. Earlier this year, the House of Representatives introduced companion legislation that has garnered the support of more than 235 national, state, and local organizations.

National League for Nursing to Induct 2023 Class of Fellows into the Academy of Nursing Education

National League for Nursing to Induct 2023 Class of Fellows into the Academy of Nursing Education

Twenty-three distinguished nurse educators, including a former National League for Nursing president, have been selected for induction as the 17th class of fellows in the prestigious Academy of Nursing Education . Dr. Elaine Tagliareni, who joined the Academy with this class, served as League president from 2007 to 2009. The Academy was launched in March 2007 while Dr. Tagliareni served as president-elect.

With the addition of the 17th class, academy membership totals 379 leading nurse educators who teach in various programs across the spectrum of higher education. They are affiliated with top-ranked teaching hospitals, academic institutions, and other organizations committed to advancing healthcare quality in the U.S. and globally.

Following tradition, the induction ceremony takes place at the Honors Convocation before the closing Gala at this year’s NLN Education Summit on Saturday, September 30.

In a competitive application process, the Academy of Nursing Education Review Panel has a great deal to consider before recommending fellowship candidates to the NLN Board of Governors, the oversight body for the Academy. Evaluations consider applicants’ contributions to innovative teaching and learning strategies; nursing education research; faculty development activities; academic leadership; promotion of public policy initiatives that advance nursing education; and collaborative educational, practice, or community partnerships.

NLN Chair Kathleen Poindexter, PhD, RN, CNE, ANEF, assistant dean of undergraduate programs at Michigan State University in Lansing, congratulated the 2023 fellows on behalf of the Board, saying, “This cohort of Academy of Nursing Education fellows, like the classes before them, reflect the extraordinary leadership, fortitude, creativity, and compassion required to tackle the enormous challenges facing today’s health care and higher educational environments. They have demonstrated important success in preparing and motivating students to increase access and inclusion in delivering outstanding, culturally humble health care.”

NLN President and CEO Beverly Malone, PhD, RN, FAAN says, “With threats to global health ever-present, not least the existential effects of climate change, and social determinants of health creating greater obstacles to health care equity, we applaud these leading nurse educator-scholars for their role in supporting and facilitating excellence in nursing education and serving as role models to their students and peers alike.”

2023 Academy of Nursing Education Fellows

  • Lora Claywell, PhD, MSN, RN, CNE
  • Jennifer Coleman, PhD, RN, CNE, COI
  • Kelley Connor, PhD, RN, CHSE
  • Audria Denker, DNP, RN, FAADN
  • Michael Joseph Dino, PhD, MAN, RN, LPT, FAAN, FFNMRCSI
  • Selena Gilles, DNP ANP-BC, CNEcl, FNYAM
  • Susan Hendricks, EdD, MSN, RN, CNE
  • Desiree Hensel, PhD, RN, PCSN-BC, CNE, CHSE
  • Mary Ann Jessee, PhD, RN
  • Brandon “Kyle” Johnson, PhD, RN, CHSE
  • Megan Lippe, PhD, RN
  • Rachel Onello, PhD, RN, CHSE, CNE, CNL
  • Steven Palazzo, PhD, MN, RN, CNE
  • Elizabeth Richards, PhD, RN, CHES
  • Leland Rockstraw, PhD, RN, FNAP
  • Jennifer Ross, PhD, RN, CNE
  • Zepure Samawi, PhD, MSN, BSN, RN
  • Elizabeth Seldomridge, PhD, RN, CNE
  • Linda Silvestri, PhD, RN, FAAN
  • Beth Ann Swan, PhD, RN, FAAN
  • M. Elaine Tagliareni, EdD, RN, CNE, FAAN
  • Beth Vottero, PhD, RN, CNE
  • Penni Watts, PhD, RN, CHSE-A, FSSH, FAAN

Application for admission to the Academy in 2024 opens this November. Eligibility criteria and other details may be found online at NLN.org. For more information about the 2023 NLN Education Summit, including online registration, visit Summit.NLN.org.

AACN Recognizes Beacon Award for Excellence Winners in 2022

AACN Recognizes Beacon Award for Excellence Winners in 2022

The American Association of Critical-Care Nurses (AACN ) recognized 185 units from 134 hospitals that earned the Beacon Award for Excellence in 2022. (View recipient list.)

The Beacon Award for Excellence lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver, and bronze recognition to hospital units that exemplify excellence in professional practice, patient care, and outcomes. Recognition is for a three-year term.

AACN President Amanda Bettencourt, PhD, APRN, CCRN-K, ACCNS-P, praises the exemplary efforts of the unit teams who achieved the Beacon Award for Excellence.

“During the height of the COVID-19 pandemic, Beacon units were truly a light showing the way forward, as these teams demonstrated an ongoing and steadfast commitment to providing safe, patient-centered, and evidence-based care to patients and families,” she says. “This achievement is not only a tremendous honor, but it also provides meaningful recognition of their efforts to achieve excellence in patient care and create a healthy work environment.”

Units that receive the Beacon Award demonstrate practices that align with AACN’s Healthy Work Environment standards. Beacon-designated units meet the criteria in five categories, all of which are consistent with other national awards, including the ANCC Magnet Recognition Program®, the Malcolm Baldrige National Quality Award, and the National Quality Forum’s Eisenberg Patient Safety and Quality awards.

Results from AACN’s most recent national nurse work environment study indicate that nurses who work in Beacon units and units obtaining Beacon recognition report healthier work environments and higher quality of patient care than nurses who don’t work in Beacon units.

Recipients of a gold-level Beacon Award demonstrate staff-driven excellence in sustained unit performance and improved patient outcomes that exceed national benchmarks. Silver-level recipients demonstrate continual learning and effective systems to achieve optimal patient care. Bronze-level awardees successfully develop, deploy and integrate unit-based performance criteria for optimal outcomes.

Sixty-six units received gold-level Beacon awards, the program’s highest distinction. Among the 2022 recipients, Arnold Palmer Hospital for Children in Orlando, Florida, had five units recognized with gold-level awards. Morristown Medical Center, New Jersey, had three units earning gold-level honors, with another two earning silver-level awards. University Hospital in San Antonio, Texas, also had five units receive Beacon awards in 2022 – three silver and two gold. Eight other hospitals had two units recognized with gold-level awards.

The only international hospital recognized in 2022 was Fundación Santa Fe de Bogotá, in Colombia, a first for the country. Three units at the hospital received silver-level Beacon awards, and a fourth unit earned a bronze-level award.

A total of 34 hospitals had multiple units honored with an award in 2022, demonstrating a system-wide approach to caring for acutely and critically ill patients and their families.

Twenty-nine units at 18 Texas hospitals attained Beacon status in 2022, the most for any state.

Amanda Bettencourt Begins Term as President of AACN Board

Amanda Bettencourt Begins Term as President of AACN Board

Amanda Bettencourt, PhD, APRN, CCRN-K, ACCNS-P , is the new president of the American Association of Critical-Care Nurses (AACN) board of directors. She began her one-year term on July 1, 2022.

“The future of nursing and health care is unknown, and the COVID-19 pandemic has brought a newfound urgency for us to work together to find solutions to both long-standing issues and new challenges,” said Bettencourt. “Starting now, we step forward with a renewed sense of purpose, a commitment to action and a focus on a better tomorrow.” Amanda Bettencourt, PhD, APRN, CCRN-K, ACCNS-P.

Bettencourt is an assistant professor in Penn Nursing’s Department of Family and Community Health. As an educator, researcher and pediatric clinical nurse specialist, her focus is on achieving the best possible outcomes for acutely and critically ill children. Her current research involves evaluating factors influencing the research-to-practice gap in critical care settings and testing implementation strategies targeting the interprofessional team to improve evidence-based care. She was recently a postdoctoral fellow at the University of Michigan, where she was appointed to the National Clinician Scholars Program and received advanced training in implementation science. Previously, she was responsible for ensuring high-quality nursing care and optimal outcomes for burn, trauma and pediatric patients as a clinical nurse specialist at Regions Hospital in St. Paul, Minnesota, and at UF Health Shands Children’s Hospital in Gainesville, Florida.

Bettencourt’s extensive volunteer service with AACN includes board liaison, NTI Program Planning Committee (2021), AACN – AACN Certification Corporation Nominating Committee, (2020-2021), community moderator, online AACN Peer Support Community Development Team (2020) and board liaison, Chapter Advisory Team (2019-2020).

Her additional affiliations include the American Burn Association and Sigma. In addition to presenting at the National Teaching Institute & Critical Care Exposition (NTI), she has led sessions at several other conferences, including the American Burn Association’s annual meeting. Bettencourt’s publications are in the areas of implementation science, nursing and patient safety, nurse staffing and work environments, burn critical care and pediatric delirium.

Bettencourt earned a Bachelor of Science in exercise science from the University of Florida, an accelerated Bachelor of Science in Nursing from the University of North Carolina at Chapel Hill, and a Master of Science in Nursing from Johns Hopkins University, Baltimore. She earned a PhD from the University of Pennsylvania and a Master of Science in health care research at the University of Michigan.

Before she assumed the role as president, Bettencourt served a one-year term as president-elect. Before that, she completed a three-year term as a director from July 1, 2018, through June 30, 2021, and a one-year term as treasurer from July 1, 2019, through June 30, 2020.

For more than 50 years, the AACN has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.