If you’re a nurse who specializes in caring for patients suffering from neurological problems, check out these top five reasons why VHA would be the perfect fit for you:
VHA is the largest health care system in the U.S., as well as the largest employer of nurses in the Nation, meaning the career opportunities at VA are endless. With five Polytrauma Rehabilitation Centers, 19 Polytrauma Network Sites and a wide variety of nursing careers, finding work in your desired interdisciplinary team in an area near you is simple.
Continuous learning is a key element in keeping our employees at the forefront of clinical practice. That’s why we offer VHA nurses a multitude of opportunities for learning and career advancement through programs such as RN Transition to Practice, TMS Genomics Education and VA Nursing Academic Partnerships.
Every day, there is a steady stream of Veterans and military service members returning to our communities. As a neuro nurse at VHA, your contributions will be essential to improving the health of our Nation’s heroes and preparing them for a life in the civilian world.
The variety and scope of work at VHA allows neuro nurses to work with cases and patients outside the typical assignments of the private sector. At VA, you’ll mainly serve Veterans with war-related illnesses and injuries, including spinal cord injuries and disorders, Traumatic Brain Injury (TBI) and various psychiatric conditions such as substance abuse, dementia and personality disorders.
At VHA, you won’t be just a nurse. You’ll invent a new model of health care. While working at one of the largest research organizations in the U.S. you’ll play an integral role in developing patient safety initiatives, conducting research to evaluate and improve care delivery and taking on leadership roles to help guide the next generation of nurses.
Are you ready to learn, grow and launch your career in an environment with a wealth of opportunity? Join VA.
Some nurses charge the program has strayed from its original mission
Like many nurses, Alene Nitzky, PhD, RN, went into nursing because she wanted to help people. She had moved through the U.S. healthcare system as both a patient and an advocate, and wanted to draw from her experience to deliver quality, compassionate care to others.
She joined a Magnet hospital in her hometown that was recognized for “nursing excellence” and high-quality patient care.
But the longer she worked there, the more she felt that Magnet status was less about supporting nurses and providing the best care, and more about hospital marketing and profits.
Nitzky acknowledged clashing with management and eventually leaving the hospital, but her concerns about Magnet status were shared by several nurses contacted by MedPage Today. Many similarly acknowledged a lack of autonomy, excessive documentation, and understaffing issues that detracted from the original intentions of Magnet. But some also felt that the program’s value depended on its execution by management — thus varying widely from hospital to hospital.
Principles of Magnetism
Magnet status is awarded to hospitals that meet a set of criteria designed to measure nursing quality by the American Nurses’ Credentialing Center (ANCC), a part of the American Nurses Association (ANA).
It was developed in the early 90s to help hospitals attract and retain nurses during a nursing shortage spurred by poor working conditions, partially due to the introduction of managed care organizations. In response to increasing pressure about the cost of care, hospitals reduced staffing and implemented mandatory overtime. For bedside nurses, this meant an increased workload and less control over scheduling, without a bump in pay.
To combat those challenges and boost the nursing profession’s image, ANCC developed the Magnet designation program, based on a 1983 ANA survey of 163 hospitals, deriving its key principles from the hospitals that had the best nursing performance. The prime intention was to help hospitals and healthcare facilities attract and retain top nursing talent, foster a collaborative culture, and empower nurses to deliver better patient care — ultimately improving clinical outcomes.
Pursuing Magnet status varies from hospital to hospital, but on average it takes a little more than 4 years to achieve, and it needs to be renewed every 4 years.
As of 2016, a total of 445 hospitals had achieved Magnet status, an increase from 387 five years earlier. Notably, U.S. News & World Report‘s top five hospitals of 2017 — the Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, and UCLA Medical Center — have all pursued Magnet designation.
Repulsed by Magnet
But several nurses told MedPage Today that the program has strayed from its original mission.
Chief among their concerns was that Magnet limited nurses’ independence and flexibility in practice. Nitzky said bedside nurses at Magnet hospitals often don’t have time to think; instead they go through the motions, doing the minimum in hands-on care.
Koeller agreed that nurse happiness and critical thinking skills aren’t paramount. She said her hospital often focuses less on patient-centered care and more on technology.
A recent column by MedPage Today contributor Milton Packer, MD, echoed those frustrations with the Magnet system, which Packer experienced first-hand during a relative’s 5-day stay in a Magnet hospital. He said nurses did everything by the book, regardless of whether it made sense.
From taking vital signs to responding to personal needs, he noted that “every movement had been dictated in advance. Every word used in communications had been pre-approved. Forms needed to be checked, whether or not they had relevance. But the really important questions were never asked.”
“Instead of spending time with patients, nurses sit in front of computers,” Packer wrote. “Instead of interacting with patients according to their needs, nurses simply ask formulaic questions that are dictated by the Magnet program. The process takes up all of their time. And their compliance with the process is the only thing that matters.”
While Magnet status is supposed to symbolize better working conditions, nurses still work 12-hour shifts and are expected to take on a huge burden of electronic documentation for the program, Nitzky said. And since hospitals frequently understaff their nursing, the extra burden often leads to not having enough time for real lunch breaks or regrouping during hectic rounds, she said.
Gerard Brogan, lead nursing practice representative for National Nurses United (NNU), the nation’s largest union and professional association of registered nurses, called Magnet designation a “commercial product,” and argued that it’s part of a strategic effort to deregulate the profession.
“The ANA has decided to back the healthcare industry over the bedside nurse,” Brogan told MedPage Today, adding that Magnet promotes short-term financial incentives that drive hospitals to cut costs and skimp on nursing requirements.
Many nurses contacted by MedPage Today complained that hospitals viewed Magnet merely as a marketing tool. Though they went through the certification process, they ultimately did little to support a thriving nursing culture.
“They hire a team of people to go through the program and make the changes in the hospital, to check a box and please the Magnet people, but as soon as they get it, the chief nursing officer is fired,” said Sandy Summers, RN, MSN, MPH, founder and executive director of the Truth About Nursing, a nonprofit organization that raises awareness about the role of nurses in modern healthcare.
“All the changes that the hospital went through to increase professionalism, performance, and vision are reduced and it becomes clear that it was all window dressing and they weren’t interested in changes,” she said.
Nitzky said when Magnet inspectors left her hospital, it would go “back to business as usual, finding workarounds for any promises of nurse/patient staffing ratios, gutting committees where direct-care nurses had a voice.”
Hospitals shell out about $2 million for initial Magnet certification, and pay nearly the same amount for re-certification every 4 years — an obvious money-maker for the ANCC and the ANA. The organizations did not respond to a MedPage Today query about total annual revenue from Magnet.
Magnet status is also a good return-on-investment for hospitals. A study by the Robert Wood Johnson Foundation found that achieving Magnet status not only pays for itself, but actually increases hospital revenue down the line. On average, Magnet hospitals received an adjusted net increase in inpatient income of about $104 to $127 per discharge after earning Magnet status, amounting to about $1.2 million in revenue each year.
Jeff Doucette, DNP, RN, vice president of the Magnet Recognition Program at ANCC, spoke with MedPage Today about the Magnet program, but declined to comment about nurses’ aforementioned complaints.
He had previously sent Packer an email in response to his column noting that patients and nurses should “share these concerns directly with executive leaders at the organization and allow them to investigate. Then they will be given the opportunity to make the necessary changes to ensure the service breakdowns can be corrected.”
Still an Attractor
Doucette’s comments parallel the sentiments of other nurses who said the program’s execution varies widely by hospital.
Susan O’Brien, MS, RN, PCCN, has 41 years of hospital experience and has worked at both Magnet and non-Magnet hospitals. One Magnet hospital where she worked was keenly focused on exceptional patient care and had been recognized with national awards.
“The employees and leadership lived the mission,” O’Brien told MedPage Today. “The leadership in the hospital was committed to staffing ratios that allowed the patient to receive the care that the patient should and the [nurse] wanted to deliver.”
Data about quality were prominently displayed in the hospital for all to see, including patients, their families, and staff, O’Brien said. And the hospital was committed to ensuring staff had the education and equipment to do their job well.
Summers agreed that delivering on the mission of Magnet depends on the institution.
“When going through the program with good intentions, it is a way to transform the hospital to one where nurses are stronger and more included in decision making,” she said. “Those nurses are much happier and confident, and the care they deliver is better. When people feel like respected professionals, they act like respected professionals.”
What Do the Data Say?
There’s no consensus in the literature as to whether Magnet status has an impact on nurse retention or on clinical outcomes.
Last month, a study of a single hospital found that nurses who worked there 2 years after it lost its Magnet designation reported significantly lower work engagement than those who worked there under Magnet status. Similarly, a 6-year-old study found that Magnet hospitals provide better work environments and a more highly educated nursing workforce than non-Magnet hospitals.
A 2010 study, however, found no significant difference in working conditions between Magnet and non-Magnet hospitals.
The clinical outcomes literature is similarly equivocal: one study from 2013 found that Magnet hospitals have 14% lower mortality and 12% lower failure-to-rescue rates than non-Magnet hospitals. But a 2011 study showed that non-Magnet hospitals generally had better patient outcomes than Magnet hospitals.
Regardless of whether they work at a Magnet hospital or not, nurses are likely to face continued pressure as hospital administrators focus on keeping costs down, Summers said.
But Nitzky still channeled the blame on Magnet: “What we really need is a massive sit-down strike of all physicians and nurses who work under these oppressive conditions to band together and say, enough. This is not healthcare. This is a profit-generating scheme that preys on direct caregivers and the uninformed public.”
The term “midwife” literally means “with woman.” Although nurse-midwives are best known for their work during pregnancy and specifically labor and delivery, nurse midwives care for women’s health in a comprehensive way. Certified nurse midwives (CNM) are advanced practice nurses specializing in prenatal care, labor and delivery, postpartum care, gynecology, well women’s health care, and family planning. They work anywhere other advanced practitioners do: in the hospital, at the clinic, and at home.
In the past, many people thought of midwives as only assisting women in home births, water births, and labor without anesthesia. Although some women may choose to deliver their babies in this way, midwives actually oversee all types of births, including those that are more conventional in the hospital. Nurse midwives have the credentials and authority to empower patients, so the kind of care given is according to their preferences and in their best interest.
Despite common misunderstandings, nurse midwives are qualified
to care for women during various stages of life. Furthermore, as prescribers
and independent providers, they are able to manage all types of pregnancies,
whether straightforward or complicated. Like other advanced practice nurses,
many midwives have years of experiences as registered nurses in labor and
delivery and other areas of women’s health. Many contend that the unique
experience of working as a registered nurse before advancing is what sets nurse
practitioners, including midwives, apart from their physician counterparts.
Within midwifery, there are stratified scopes of practice and levels of education; this is both location and training-dependent. Just like other advanced practice nurses, midwives work with varying degrees of independence from physician oversight in an ever-changing climate of advanced practice patient care. The majority of midwives hold a master’s or doctorate nursing degree (CNM); there are also certified midwives (CM) who have passed their advanced practice boards while maintaining a bachelor-level degree of education. For those who don’t have a bachelor’s, master’s, or doctorate degree can qualify to be a certified professional midwife (CPM). They are either trained through apprenticeship and/or formal education, and their scope of practice is narrower than CNMs.
As standards of health care providers evolve, the accreditation process for nurse midwives has increasing standards. The good news is that nurse midwives are learning through rigorous training and experience to provide high-quality patient care independently. Nurse midwives are more than the overseers of alternative birthing methods. They are fully licensed and independent women’s health providers.
This second edition of a groundbreaking book is substantially revised to deliver the foundation for an evidence-based model for best practices in midwifery, a model critical to raising the United States' current standing as the bottom-ranking country for maternity mortality among developed nations.With a focus on updated scientific evidence as the framework for midwifery practice, the book includes 21 completely new chapters that address both continuing and new areas of practice, the impact of institutional and national policies, and the effects of diversity and globalization.
Sharing personal information with patients sometimes is
just natural for nurses. Working closely with patients while caring for them
and giving them compassion warrants it.
The adage says that you don’t discuss some things with
other people: religion, money, and politics. But is this really true, though?
Mindy B Zeitzer, PhD, MBE, RN, Visiting Assistant Professor of Nursing at the Linfield College, School of Nursing, has worked a lot with self-disclosure—when it’s okay to share information and when it’s not. She took time to answer our questions.
Nurses who work
with patients may practice a particular religious faith or have none at all.
When is it appropriate to share their faith with patients? When is it not
Self-disclosure of any type including religious beliefs and religious practices should or can be done when the purpose benefits the patient. Meaning religion beliefs or practices can/should be shared when its purpose is to either help with patient goals or help develop a better nurse-patient relationship, a therapeutic relationship. For example, if the patient had particular religious beliefs and perhaps felt alone in those beliefs or was struggling with a certain aspect of health and religious beliefs and the nurse shared similar beliefs, the nurse might connect with the patient by discussing those beliefs and expressing empathy through understanding.
It would be inappropriate to share religious beliefs or
practices if the purpose or intent was to serve the nurse’s goals rather than
the patient’s. It also would be inappropriate if the nurse does not feel
comfortable with sharing or divulging such information. When it comes to self-disclosure
of any kind, the nurse should only share information and as much information as
they feel comfortable sharing.
When can talking
about their faith actually help patients?
Many patients turn to faith in difficult times with health. For some patients, turning to faith may be “new” to them, and they may not feel totally comfortable with it. As nurses, we are often at the bedside at those vulnerable times. Expressing empathy and understanding through shared beliefs—or even if they are not shared—can help a patient feel understood and talk about their current feelings, emotions, and experience. It can also help “normalize” the experience of thinking about faith at these difficult times, if that is what the patient needs.
Are there instances
in which expressing their faith can get nurses in trouble?
Anytime a nurse discusses information pertaining to themselves (self-disclosure) to fulfill the nurse’s own goals such as trying to convince a patient to receive a certain treatment or refuse a certain treatment—based on the nurse’s beliefs—could be considered coercive. The nurse, rather, should try to help the patient understand/recognize their own beliefs and values so the patient can make an informed, well thought-through decision based on their own values and beliefs in order to make the best decision for the patient—rather than what is best for the nurse.
What advice would you give to nurses about sharing their faith in general—whether it’s with patients, families, or coworkers?
First, only share information about your beliefs if you
feel comfortable doing so.
Second, before discussing your own beliefs, think about
what will be accomplished by doing so. Does it help meet patient goals or personal
Should they ask
patients about their beliefs in a way to be cross-cultural?
An important aspect of being culturally sensitive is to make sure we meet [the] patient’s need related to cultural and religious beliefs. In order to do this, it’s important to ask if patients have a particular belief system, particular beliefs, or religious or cultural practices. Perhaps they would like to see a particular clergy member or have various care aspects modified—in particular: diet, modesty, the way we approach medical treatments, aspects pertaining to death and dying, pain control, etc. If we don’t ask about these needs, we likely will miss an important aspect of the patient and won’t be able to help the patient holistically.
I am a cardiac acute care nurse in a large Northeast suburban trauma hospital. I arrive at work twenty minutes early so that I can get to know my patients. I then check the chart for admitting diagnosis, pending labs, exams, point-of-care testing needs, etc. I do this because no matter how much I trust the nurse giving me the report, I recognize that any human is more liable to make mistakes and oversights after working at this level of intensity for thirteen hours.
After receiving the report, I introduce myself to my patients. The nursing ratio on my unit is 3:1 and at times up to 5:1. If the patient is awake, I assess them right away after introductions. I bring a computer-on-wheels (COW) in the room with me to document everything. The COW minimizes distractions and allows me to assess anything I forgot if needed. Next, I administer scheduled medications.
I find it most effective to complete tasks while in the room with the patient. The hallway is an obstacle course of distractions. For example, it may seem reasonable to step out while your patient is on a nebulizer treatment knowing the treatment takes five to eight minutes to complete. In a high-acuity unit, eight minutes is an eternity. Therefore, no matter how much I plan, I can almost guarantee I will be sidetracked by a new task in that short time. On good days, my charting is done by 10 a.m., which happens about 60% of the time. This allows me to have my afternoons free to address anything that comes up. Afternoons are less predictable because usually the night shift has set up and stabilized the patient for the mornings.
The hospital I work in is not unionized, so taking breaks is not enforced. We are entitled to one 30-minute and one one-hour break during a twelve-hour shift. Some nurses follow that timing fastidiously on each shift, while some nurses don’t take a break at all. I strongly discourage that. I perform better when I take a few 15-20 minute breaks throughout the day when my patients are settled. Otherwise, I use the extra time to prepare for later tasks, such as setting up and labeling IV medications. This ensures I leave on time, and I always do.
I have the opportunity today to precept new nurses and I always encourage them to find their own rhythm. In the beginning, I used to follow my preceptor and make an index card with a table of all the medications and point-of-care testing for each patient. Once I found my stride, I realized this card was actually wasting more time than it was saving, and I relied on the EMR instead anyway. Who knows? That may change again.
Evolving and learning are constant features of acute care nursing. A day in the life of an acute care nurse may be a misnomer as, lucky for me, no two patients are the same and no two days are the same.
To learn more about a career in acute care nursing, visit here.
Only one group of Americans has more than doubled in size over the past twenty years: the elderly. They’ve experienced more than most in their lifetimes, from world wars to the first man on the moon. Thanks to lengthening life spans, they have much more to experience; over 41.4 million Americans are 65 and older – that’s more than 13.3 percent of the total U.S. population.1
As this golden group ages, how can we serve and love the elders that hold such a special place in our communities and families?
The role of geriatric social workers includes:
Helping senior citizens cope with common problems experienced by the elderly
Ensuring the needs of their clients are met from day-to-day
Providing aid with financial issues, medical care, mental disorders and social problems
Geriatric care manager
Care managers help the elderly and their loved ones develop a long-term care plan and connect with necessary services.
Healthcare business manager
These managers make sure healthcare facilities provide the most effective patient care. This includes planning and coordinating services in hospitals and clinics.
Art therapy uses the visual and auditory arts to help restore function and general wellbeing. Benefits can include:
Increased cognitive skills
Improved motor skills
78 percent of art therapists report working with older adults on a regular basis.2
Grief counselors help seniors process bereavement and loss, as well as cope with thoughts of their own death.
Assisted living administrator
Administrators manage assisted living facilities or services, which provide care to adults who need help with daily tasks like bathing, eating and dressing.
These educators provide the elderly with lessons that inform them about health concerns.
Physical therapists help aging adults strengthen their muscles, increase mobility and improve endurance. They also help with recovery from an injury or illness.
HELPING AND HEALING
The elderly are likely to face hardships, but with our help, they don’t have to go through them alone.
Bereavement and loss
A natural part of the aging process is experiencing the loss of loved ones as well as coping with one’s own progressing age. Seniors often experience bereavement and loss differently than younger adults, which puts them at risk for depression, anxiety and PTSD. Grieving seniors can benefit from the support others as they work through difficult times.
75 percent of adults 50 and older reported finding humor and laughter in their daily lives.3
Family caregivers play a crucial role in keeping the elderly comfortable at home by providing support like:
Loving relationships and companionship
Minimal health and wellness assistance
Support with day-to-day needs
More than 10 percent of the U.S. population have served as unpaid caregivers for older adults.4
Health promotion and self-care
Age can prevent seniors from properly taking care of their bodies, but we can help our loved ones stay beautiful and healthy. Helping the elderly groom themselves, receive regular medical attention and stay active can go a long way in promoting general wellbeing.
In more extreme cases, seniors may experience disabilities or other chronic health conditions. You can support older adults by ensuring they can access the healthcare professionals and resources they need. This might involve assistance with transportation and attending to business, legal and medical concerns.
75 percent of seniors have at least one chronic health condition, and most have two or more.5
End-of-life and palliative care
As our loved ones enter their final days, specialized care can help provide relief from the symptoms and stress. End-of-life and palliative care makes their last days as pain-free and comfortable as possible.
Quality of long-term care
Fortunately, there are a number of geriatric professionals trained to provide excellent care for aging adults in all of these areas. A growing population of the elderly means the demand for these practitioners is greater than ever – and there are more opportunities for you to bring wellness and care into the lives of the elderly than ever.