You entered the field of psychiatric nursing because you wanted to make a difference in the lives of patients. As a psychiatric nurse with VHA, you’ll do that and more. Not only will you play a critical role in changing the lives of Veterans, often in the most challenging stage of their life, but you’ll work with their network of family and friends to provide whole healing and a successful outcome. Learn more about the specific Veteran populations you’ll be working with and the opportunities for making an impact.
1. The families of Veterans
VA offers a range of family services for Veterans and their family members, including family education, brief problem-focused consultation, family psychoeducation, and marriage and family counseling. Our psychiatric nurses play an integral part in facilitating these services, working with all members of the family to provide holistic solutions.
2. Homeless Veterans
VA is the only Federal agency that provides substantial hands-on assistance directly to homeless Veterans. As a VHA psychiatric nurse, you’ll have the unique opportunity to step outside the hospital walls and treat Veterans who would not otherwise seek help. Additional VA assistance programs where you can make an impact include:
- Drop-in centers where Veterans who are homeless can shower, get a meal, and get help with a job or getting back into society
- Transitional housing in community-based programs
- Long-term assistance, case management and rehabilitation
3. Veterans with Serious Mental Illness
Veterans diagnosed with Schizophrenia, Schizoaffective Disorder and Bipolar Disorder work with VHA psychiatric nurses on a variety of treatment plans, including psychosocial rehabilitation and recovery services to optimize functioning. In addition, you’ll be a part of our Mental Health Intensive Case Management team. The team of mental health physicians, nurses, psychologists and social workers helps Veterans experiencing symptoms of severe mental illness cope with their symptoms and live more successfully at home and in the community.
4. Veterans adjusting to civilian life
The transition process from military to civilian life is a challenging one, and our psychiatric nurses are there from the beginning to provide crucial support. At our 300 community-based Vet Centers, our staff provides adjustment counseling and outreach services to all Veterans who served in any combat zone. Services are also available for family members for military-related issues, and bereavement counseling is offered for parents, spouses and children of Armed Forces, National Guard and Reserve personnel who died in the service of their country.
5. Older Veterans
To provide specialized care for our older Veterans, we’ve developed VA Community Living Centers (CLCs). Here, you will treat older Veterans needing temporary assisted care until they can return home or find placement in a nursing home. Our staff also works on ensuring that Veterans can safely live independently by screening for dementia and general assessments that help us decide whether the Veteran can make informed medical decisions.
As a psychiatric nurse at VHA, the work you do will deeply affect the Veteran, their family and generations of families to come. View our Nursing positions or, Join VA in making a difference in one of the many other health care fields available.
This story was originally posted on VAntage Point.
But low-ranking hospitals had nearly double the risk
The estimated number of avoidable deaths in U.S. hospitals each year has dropped, according to updated analysis prepared for The Leapfrog Group by Johns Hopkins University School of Medicine researchers.
Matt Austin, PhD, an assistant professor in the school’s Armstrong Institute for Patient Safety and Quality, and Jordan Derk, MPH, used the latest data from Leapfrog’s semiannual hospital safety grades to estimate that there are 161,250 such deaths each year, down from the 206,000 deaths they estimated three years prior, according to their report.
Austin and Derk said they used 16 measures from Leapfrog’s 2019 data to identify deaths that could clearly be attributed to a patient safety event or closely related prevention process. The reduction is the result of two main factors, they wrote: One, hospitals have made some improvement on the performance measures included in Leapfrog’s safety grades. And, two, some of the measures “have been re-defined and rebaselined” in the past three years, they wrote.
Furthermore, these data likely represent an undercount, Austin and Derk wrote, noting that other studies have estimated anywhere from 44,000 to 440,000 deaths due to medical errors.
“The measures included in this analysis reflect a subset of all potential harms that patients may encounter in U.S. hospitals, and as such, these results likely reflect an underestimation of the avoidable deaths in U.S. hospitals,” they wrote.
“Also, we have only estimated the deaths from patient safety events and have not captured other morbidities that may be equally important,” they added.
The updated analysis was released to coincide with the latest release of Leapfrog’s controversial scores, which assessed quality data from more than 2,600 hospitals and assigned each an “A” through “F” letter grade.
“The good news is that tens of thousands of lives have been saved because of progress on patient safety. The bad news is that there’s still a lot of needless death and harm in American hospitals,” Leapfrog Group President and CEO Leah Binder said in a statement.
Less than one-third (32%) of hospitals secured an “A” grade. More than a quarter (26%) earned a “B.” The group gave a “C” to another 36%, a “D” to 6%, and an “F” to less than 1% of hospitals.
The analysis from Austin and Derk found that the rate of avoidable deaths per 1,000 admissions was 3.24 at “A” hospitals, 4.37 at “B” hospitals, 6.08 at “C” hospitals, and 6.21 and “D” and “F” hospitals combined. That means patients admitted to a “D” or “F” hospital face nearly double the risk of those admitted to an “A” hospital, the Leapfrog group said.
This story was originally posted on MedPage Today.
A medical review specialist is a unique role where nurses help to ensure that health care services are delivered in a manner that balances high-quality, efficient care that is also fairly priced and compliant. Nurses in this role will review patient charts, billing, and documentation to ensure a variety of different things important to health care organizations.
In order to be competent in this role, a different set of skills will be crucial for success and can be a great option, especially in certain states and areas. Let’s discuss three important skills that are paramount for the medical review specialist role.
A medical review specialist will have numerous tasks and projects they are working on at one time. In this role, you could expect to be working with numerous different individuals and multiple different deadlines. Given these realities, the ability to stay organized and manage workload will be of vital importance. The ability to manage a significant amount of work at the same time will be a daily task that you must be proficient in to succeed in the role.
In this role, a period in the wrong place or a missing sentence could mean the organization doesn’t get reimbursed for the care they provided. A medical review specialist will be expected to review doctor’s notes, coding, billing, and other data within a patient’s chart. This requires a strong attention to detail because seemingly insignificant things can cause serious consequences. Without this skill, you will struggle to be effective in this role.
Medical review specialists must think in a way that is unusual for most nurses. While bedside nurses tend to have a broad focus on the care of the patient, a medical review specialist is focused on small but significant behind-the-scenes factors such as coding and regulations. This role requires a new set of knowledge not needed by other nursing roles. In essence, a medical review specialist completes the work for the care given by other nurses, doctors, and practitioners by ensuring the charting was proper and accurately encapsulates all the care given. If elements are missing, individuals in this role will reach out to members of the care team to have them correct their charting.
To be successful as a medical review specialist, one must be competent in workload management, pay attention to the details, and have in-depth knowledge of coding and other regulations.
I recently visited a friend while they were in the hospital and during my visit, I stopped by the coffee shop. As I sipped my coffee, I listened to the calls the nurses were receiving on their unit-specific mobile phones. While I can appreciate that a phone makes for better communication between the nurses and hospital staff, I can also appreciate that the same staff are unaware that the phones are inadvertently putting patients at risk.
During the hours I spent with my friend, I was inadvertently present for phone conversations, all on speaker, regarding what patients required pain medication and their room numbers, whose test results were received and their result, what patient was being combative and needed sedation, and who required pain medication. I heard patient names, room numbers, physician names, and patient conditions. And I learned that the wife of the gallbladder in 100B called. Needless to say, it was an interesting and enlightening time. Let me just say that when HIPAA became de rigueur, nurses would have been fired for less illicitly passed information than I learned that afternoon. You weren’t allowed to utter a patient name or room number anywhere where other patients or family members or the public in general were located. If overheard or reported by fellow staff, you were terminated.
The nurses carrying on these conversations were on a break from their units, attending a Nurses Week event, but I’m sure these conversations occur all day long, no matter where the nurse is… in report, at the bedside, at lunch, even in the bathroom. While I’m sure the latter is at most inconvenient and intrusive, the prior is downright dangerous. I’m sure if they even get a break off the unit, the phone goes with them and so does the stress.
We teach students and new nurses to prepare medications where they are not distracted, to check everything multiple times. We never tell them “OK, let’s see if you can titrate this medication while a disembodied voice is telling you about another patient who urgently needs you.” We also don’t teach them that while they are attempting to complete complex therapy requiring their undivided attention while keeping a field clean or sterile, that they will be called multiple times about multiple patients. Several studies have noted that these distracted nurses are at higher risk of committing a medication error or an error of omission.
Do they change gloves and wash their hands after handling the phone? Do they ignore the calls when they are in the middle of changing a dressing or toileting a patient? A 2009 study in Turkey found that 94.5% of health care workers’ cell phones tested positive for bacteria including the MRSA. Further, it was found that mobile phones were only cleaned per policy 10.5%. That leaves a staggering 89.5% that were NEVER cleaned! You don’t need to be an infection control nurse to figure out that the mobile phones carried by nurses and other staff are contaminated with nosocomial pathogens that place both the staff and their patients at risk. So along with the importance of hospital staff washing their hands after patient care, they must also be mindful of hand hygiene between patient care and handling of their mobile phones.
Although many hospital systems have implemented policies with regards to mobile phone use, hopefully to increase patient safety and confidentiality, they need to be reviewed and reinforced periodically. It is easy to become desensitized to our actions and those of others in the health care field and it is pretty glaring when violated. Policies should include when the phone should be in silent mode, when and how phones should be cleaned, and how calls to nurses should “roll over” to the nurse’s station—especially when staff are involved in patient care activities. The policy should also include enforcement and the consequences of policy violation.
Gastroenterology nurses use their skills and experience specifically in the areas related to gastrointestinal issues. They address the care for any illness, condition, or dysfunction occurring anywhere in the digestive tract; the body’s system which takes in, processes for absorption, and eliminates the food we consume for the nutrition of our bodies. But they also do so much more on a daily basis so make sure you are prepared if you’re considering transitioning into this specialty.
One of their most commonly known responsibilities is preparing patients for endoscopies—diagnostic procedures for detecting illnesses within the upper and lower digestive tracts—and caring for patients as they recover. They educate patients about the procedure, any preparation required, and what to expect afterward. But they also care for their patients through whatever condition may be diagnosed as a result of those endoscopies.
They also assist with more specialized procedures, such as those that measure things like transit time (the time it takes the food we eat to make the trip through the digestive system), pH levels in the digestive tract to evaluate for reflux, or esophageal motility studies to evaluate the function of the esophageal sphincter (the dysfunction of which also contributes to reflux).
Often, patients are struggling with a diagnosis that has altered the way they’re able to live their lives. Gastroenterology specialty nurses help to educate them about how to manage their condition, prevent symptom flare-ups, and provide alternative solutions while managing their condition. These nurses educate patients about specific diets that may alleviate symptoms and prevent further complications.
Gastrointestinal nurses also work with patients who have
ostomies. They educate patients regarding their necessity and how to manage and
care for them; and when appropriate, prepare and educate them regarding the
reversal of the ostomy.
One of the most important roles a nurse plays in gastroenterology nursing—and all nursing—is assisting patients in setting and managing expectations for their care. This is a critical task whether the nurse is working with a healthy individual or one who has received chronic or even catastrophic diagnoses. An experienced, skillful nurse is able to help their patients maintain realistic expectations while working toward optimum health.
Be sure to check out more information here if you’re curious about gastroenterology nursing.
Work-life balance is a hot concept in the nursing profession. We hear we need it. We want to achieve it. But does it really exist?
That question has piqued the interest of Adele A. Webb, PhD, RN, FNAP, FAAN, senior academic director of workforce solutions at Capella University in Minneapolis.
“People think they need it,” she said. “But do they? Can you ever have it? Or are people chronically dissatisfied because it’s like a unicorn … they’re chasing something that doesn’t exist.”
Balance Vs Satisfaction
Webb plans to study and delve into the concept of work-life balance and nurses. She said recent conversations with nurse executives, including those at HealthLeaders Media 2017 CNO Exchange, left her realizing that the idea needs to be better defined.
“Years ago, I read an article called Balance is Bunk!, and [the point] was you never have 50% this and 50% that. Sometimes work takes more, sometimes family takes more,” she recalled.
For example, if a nurse must take off from work to stay home with a sick child, on that day, family needs more focus than work. And there are times, especially for those who work weekends or holidays, where work will eclipse family.
Still, Webb said she understands the desire behind the idea of work-life balance.
“What does work-life balance really mean? It means you’re happy. Well, what does happy mean? Happy means you’re satisfied with what you’re doing,” she said. “I think what people really want is life satisfaction. They can be satisfied at home and satisfied at work even if it’s not balanced.”
Another question Webb said she is pondering is, “How then do we address or encourage satisfaction and what does that mean?”
She said she has noticed, even among her own family, that different generations of nurses crave different things.
“I have a daughter and a granddaughter who are nurses. My granddaughter is definitely a Millennial. She’s 24, new in her career, and what she wants is opportunity,” Webb said. “She’s always reading, trying to better her skills, and to learn something new.”
This drive to further their skills and their careers is a trait often tied to the Millennial generation. However, it can also be a factor that contributes to their workplace turnover. According to the RN Work Project, almost 18% of newly licensed RNs leave their first employer within the first year.
“We have the job to educate these younger nurses on opportunities to find satisfaction in the job they’re in. So when you want more, you can sign up for a committee. You can look at policy in your community or state. There are opportunities outside of leaving your unit that can meet your needs,” Webb said.
“How exciting it would be for a young nurse to have the opportunity to be on the quality committee at a hospital. Or to have the opportunity to contribute to care algorithms or standards or care or policies?” she added. “They would learn [so much] from it [and] they could contribute so much.”
While baby boomers are more likely to stay in their positions, they, too, have a need for life satisfaction and often value time and self-fulfillment, said Webb.
For example, offering tuition assistance to pursue a master’s degree may give this generation a sense of satisfaction. Or they may find fulfillment in sharing the knowledge they’ve garnered over their years of experience.
“[Give them] the opportunity to be involved, and be on a budget committee at the hospital and understand the finances and the contributions they make,” Webb suggested. “Train them to be preceptors. Let them share that knowledge with the younger generation.”
Webb is in the early stages of reviewing published literature for existing information on work-life balance and satisfaction, and plans to interview nurses about their insights. Once she has a working thesis, she plans to connect with nursing professionals through presentations and conferences to see whether her definition and evaluation of work-life balance or work-life satisfaction rings true.
This story was originally posted on MedPage Today.