innovative five-part program to enhance and expand the development of senior
nurse executive leaders has announced that it will be welcoming its first
incoming class of nurse executives in August 2020. The program, titled the Coldiron
Senior Nurse Executive Fellowship Program, was developed by the Marian K.
Shaughnessy Nurse Leadership Academy of the Frances Payne Bolton School of
Nursing at Case Western Reserve University in partnership with the American
Nurses Association (ANA), the American Organization for Nursing
Leadership (AONL), and the Healthcare Financial Management
The new program will empower
nurse leaders to make healthcare more patient-centered, cost effective, accessible,
and quality-driven. The curriculum will cover quality and safety competencies,
care coordination, wellness, public communication, executive presence,
financial acumen, and understanding and leading change.
ANA President Ernest J. Grant, PhD, RN, FAAN, tells globenewswire.com, “The American Nurses Association is proud to partner with the Marian K. Shaughnessy Nurse Leadership Academy, AONL and HFMA on this important initiative. Nurse leaders are integral players in not only the delivery of quality patient care, but also operational excellence across diverse health care settings. The Coldiron Senior Nurse Executive Fellowship Program is a testament to the power of nursing and nurses’ role as change agents in health care. ANA looks forward to welcoming the first incoming class of nurse executives.”
Applications for the
fellowship program are available online for nurse executives with at least five
years of experience at the most senior level in health services, public health,
and community-based organizations or systems, as well as professional,
governmental, and policy organizations. The inaugural session in Cleveland will
be three days long, followed by sessions to be held in Atlanta, Washington, DC,
and Cleveland over a 15-month period.
HFMA President and CEO Joseph J. Fifer, FHFMA, CPA, stated in a press release: “We are pleased to partner with our nursing colleagues to leverage the strengths each organization brings to professional development. Interprofessional collaboration promotes better leadership, and better leadership is the key to delivering safe, effective high-quality care.”
To learn more about Coldiron Senior Nurse Executive Fellowship
Program, an innovative five-part program to enhance and expand the development
of senior nurse executive leaders, visit here.
As the caseload of patients with the new coronavirus grows, masks and other personal protective equipment are in short supply — and nurses in Washington state are resorting to workarounds to try to stay safe.
Wendy Shaw, a charge nurse for an emergency room in Seattle, said her hospital and others have locked up critical equipment like masks and respirators to ensure they don’t run out.
Shaw is the de facto gatekeeper, and is now required to run through a list of questions when anyone comes to get a mask: “What are you using it for? What patient? What’s the procedure?”
“I have become a ‘jailer’ in a sense of these masks,” she said.
“We now have to learn how to work with less, and how to be good stewards of the resources that we have,” Shaw said.
For Shaw, there’s a very personal stress driving her to be careful. She has Type 1 diabetes, and so does her young son, which puts her at high risk for complications if she were to be infected.
“I am cleaning like I have never cleaned before. I am hyperaware of what I touch, who has brushed up against me,” said Shaw. “We think about this all the time. Every day I wake up without a fever or a cough is a win for me.”
At some hospitals, nurses and doctors said they are being told that, contrary to standard protocol of disposal after a single use, they should try to clean and reuse their N95 masks, a respirator that protects the face from airborne particles and contaminated liquid.
Ad Hoc “Mask Workshops” and Mask Crowdsourcing
Meanwhile, office staff at the corporate headquarters of Providence St. Joseph Health in Renton, Washington, have opened an ad hoc workshop where they are assembling masks and face shields on their own, to bolster resources.
“At any given time, we are days away from running out of personal protective equipment,” said Melissa Tizon, with Providence St. Joseph Health.
Tizon said the health system has already delivered 500 face shields to Providence-affiliated hospitals in Seattle and Everett, Washington, and plans to start sewing masks in the coming days.
Some nurses are even crowdsourcing masks.
Bobbie Habdas, an ICU nurse at Swedish Medical Center, took to Facebook asking for help from her community.
“I never thought that we’d necessarily be doing this,” said Habdas.
Her post gained lots of attention, and she collected more than a hundred masks to share with co-workers.
“Honestly, it shocked me and it really touched me — it’s extremely appreciated,” she said.
The outpouring was a bright spot, but Habdas wonders why nurses have to scrounge for supplies, in addition to their regular duties.
“There is a huge feeling of panic, not only externally, but also internally within the hospital,” said Habdas.
She said spending time looking for supplies during her shift doesn’t help with the stress of responding to the coronavirus pandemic. Patients have died from the disease in Washington, with at least 74 COVID-19 deaths recorded across the state as of Thursday afternoon.
Sally Watkins, executive director of the Washington State Nurses Association, said nurses are being forced to make do with less.
“They are not being protected at the level that they should be,” said Watkins. She hopes the region will get more supplies from the federal stockpile soon.
After 39 years as an intensive care nurse, Mary Mills has dealt with other infectious disease crises, but her hospital’s response to the coronavirus outbreak feels different. She remembers helping to intubate HIV patients in the early days of the AIDS crisis, when there was still a lot of fear and unknowns about that illness.
“Everybody was on the same page,” Mills said. “There was clear communication.”
Mills works at one of the five hospitals run by Swedish Medical Center in the Seattle area. “I hate to say I don’t feel particularly supported now,” she said.
Like many health care workers, Mills feels frustrated because the guidance on when to use personal protective equipment, or PPE, keeps shifting, sometimes daily.
“What they decide I need, in terms of my safety, is being changed based on availability of product, rather than the science,” Mills said.
“This is super contagious. We can spread it to our kids, our parents and grandparents,” she added.
This story is part of a partnership that includes NPR and Kaiser Health News.
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
Our Nurse of the Week is Marcela Hanson, a senior nursing student at the University of Wisconsin–Madison (UW-Madison) who used her time during the COVID-19 pandemic to help others. After being barred from all in-person healthcare settings, Hanson and other UW-Madison nursing students found a way to help their local healthcare professionals through crowdsourcing.
UW Health decided to bar students from going into rooms at the hospital that require personal protective equipment back in February, during what was already a heavy flu season. Fast-spreading COVID-19 only made things worse, forcing the nursing school to move all learning to an online format, and ending students’ interactions with real patients, despite hospitals needing more help than ever.
Hanson works as a University Hospital nursing assistant while taking classes. She learned through a colleague that many health care workers were struggling to balance work and childcare after schools were shuttered to slow the outbreak of COVID-19. This sparked an idea for Hanson: she and her fellow nursing students could watch the children, since they would remain in Madison for their nursing classes.
Hanson shared the idea on her class’s Facebook page and received an unexpectedly strong response. She created a spreadsheet with the name and contact information for the nursing students willing to help and sent it to every nurse and physician she knows.
To learn more about the UW-Madison nursing students who crowdsourced childcare help for local healthcare workers during the COVID-19 pandemic, visit here.
After years of opposition from the Florida Medical Association and seven years of passing in the state House but not in the Senate, the bill to allow Floridian Nurse Practitioners full practice authority has finally been passed. Starting in July 2020, advanced NPs who have accumulated at least 3,000 hours of experience under physician supervision will have the right to independently operate primary care practices in Florida without an attending doctor. To qualify, they will also have to complete minimum graduate level course work in differential diagnosis and pharmacology.
Under the new law, signed on March 11 by Florida Governor Ron
DeSantis, qualified NPs will be able to independently practice family medicine,
general pediatrics and general internal medicine. House Speaker Jose Oliva, who
made the bill a priority, praised the bill’s passage, saying, “Freeing
(advanced practice registered nurses) of the red tape that has historically
stopped them from working to the full extent of their education and training
will immediately improve access to quality care for all.”
In a compromise between the Florida House and Senate, while the bill grants full practice authority to advanced NPs, it does not cover physician assistants or certified registered nurse anesthetists. Calling the bill “a good first step,” the Florida Association of Nurse Anesthetists commented, “Although we are disappointed that the legislation did not include certified registered nurse anesthetists … we are pleased that some of Florida’s (advanced practice nurses) will be able to practice autonomously.” The group added, “Passage of this bill demonstrates Florida’s commitment to modernizing the way health care is being delivered in our state by ensuring that Floridians have full access to health care, particularly in rural areas that are often underserved.”
Florida Republican Representative Cary Pigman, a physician who has filed the bill multiple times in the state House, noted, “Beyond the classroom, the data from statewide experiments across the nation demonstrate without a doubt that nurse practitioners are highly skilled, highly trained, and highly eager to care for patients independently.” Pigman added, “Advance practice professionals achieve higher marks in patient outcomes, patient satisfaction, and they spend more time actually talking to patients.” For more details, visit here.
The University of Wisconsin Health (UW Health)
recently announced it will be expanding
its nurse residency program due to a state and national shortage of nurses.
UW Health will increase its recruiting efforts to cope with the rising demand.
UW Health’s nurse residency program
takes one year to complete and is comprised of groups of 20-40 nurse residents
who have graduated from an accredited nursing program. Residents are used to
fill vacant spots left by retired nurses as well as to fill new positions.
Program Manager Kim McPhee tells uwhealth.org, “We’ve really tried to be proactive, so that we don’t feel the shortages as much as some other sites have felt…Before we had this nurse residency program, we were experiencing what everyone experienced around the country, where up to 60 percent of new graduate nurses left the profession in the first year. That’s a huge concern.”
The UW Health nurse residency program
is one of 29 programs recognized by the Certified Commission on Collegiate
Nursing Education. The residency program has hired over 2,000 nurses in the
past 13 years, accounting for two-thirds of the current UW Health staff.
According to the Bureau
of Labor Statistics, job growth for registered nurses will increase 15
percent from 2016 to 2026, from 2.9 million registered nurses in the workforce to
3.4 million nurses. They also project that 203,700 registered nurses will be
needed annually to carry out new positions and replace retiring ones.
The UW Health nurse residency program currently holds
3,152 nurses and added 572 nurses in 2019. The most recent class of resident
nurses graduated in February.
To learn more about UW Health’s announcement to expand
its nurse residency program to meet increased demand in the state and
nationwide, visit here.
Coping With COVID-19
On Tuesday, Dr. Jeanne Noble devoted time between patient visits to hanging clear 2-gallon plastic bags at each of her colleagues’ workstations. Noble is a professor of emergency medicine and director of the UC-San Francisco medical center response to the novel coronavirus that has permeated California and reached into every U.S. state.
bags were there to hold personal protective equipment — the masks, face
shields, gowns and other items that health care providers rely on every day to
protect themselves from the viruses shed by patients, largely through coughs
and sneezes. In normal times, safety protocols would require these items be
disposed of after one use. But just weeks into the COVID-19 pandemic, supplies
of protective gear at UCSF are already so low that doctors and nurses are
wiping down and reusing almost everything except gloves.
is not a foolproof strategy at all; we all realize the risk we are taking,”
Noble said. But as supplies dwindle, she increasingly finds herself asking the
folks in charge of infection control at the hospital if they can make changes
to protocols. “As days go by, one regulation after the other goes out,” she
Noble is among the Bay Area physicians applauding the decision
this week by seven Bay Area counties and multiple others across California to
order residents to shelter
in place for the foreseeable future, directives that are
upending life for millions of people and shuttering schools and businesses
across the state. Without swift and dramatic changes to curb transmission of
the virus, hospital officials say, it is just a matter of time before their
health systems are overwhelmed.
with California physicians on the front lines of COVID-19 offer a sobering
portrait of a health care system preparing for the worst of a pandemic that
could be months from peaking. In the Bay Area, the battle is being waged
hospital by hospital, with wide variations in resources.
Waging the Battle, Hospital By Hospital
tent where Noble tended to patients this week was set up to deal with a recent
rise in people showing up with respiratory illness. Even without the
coronavirus threat, UCSF’s emergency room is a busy one, and doctors frequently
see patients in hallways and other spaces. But the current outbreak makes that
close contact unsafe. So instead, everyone who comes to the hospital is being
triaged. Most people with fever, cough or shortness of breath are diverted to
the tent, which is heated and has negative air pressure to prevent the spread
of infection. For now, the pace is manageable, but Noble fears what’s ahead.
south, in Palo Alto, Stanford Medical Center was testing patients with
respiratory problems in its parking garage. The private university hospital has
more protective gear than the public one in San Francisco; a global scavenger
hunt several weeks ago bolstered supplies, though Stanford, too, has adapted
protocols to be more sparing with some items.
don’t have an unlimited supply,” said Dr. Andra Blomkalns, professor and chair
of the Stanford School of Medicine’s Department of Emergency Medicine. “But at
least we’re not looking at our last box.”
entire country is short on protective gear, a result of both the surging demand
for such equipment as the virus spreads and the implosion of supply chains from
China, where much of the equipment is manufactured.
believes some equipment will need to be made locally. “If the [federal]
government doesn’t step in and force manufacturing of these products here now,
we are going to run out,” she said.
supply closets affect everyone who needs care, including heart attack victims
and people in need of emergency surgery, said Dr. Vivian Reyes, president of
the California chapter of the American College of Emergency Physicians and a
practicing emergency physician in the Bay Area.
know it’s really hard for us Americans because we’re never told no,” she said
of the shortfall of supplies. “But we’re not in normal times right now.”
protective equipment isn’t the only thing in short supply.
a few days ago, UCSF had to rely on the San Francisco Department of Public
Health for coronavirus testing, and a shortage of test kits meant clinicians
could test only the most critically ill. The situation improved March 9, when
the university started running tests created in its own lab. First, there were
40 tests a day. By Tuesday, there were 60 to 80. But a new shortage looms: The
hospital has just 500 testing swabs left.
pathologist Benjamin Pinsky built an in-house test that has been approved for
use by the federal Food and Drug Administration. Since March 3, Stanford has
used it to test more than 500 patients, 12% of whom had tested positive as of
Tuesday. The university has been running tests for other hospitals as well,
including UCSF. It’s a dramatic improvement from a few weeks ago, when Stanford
relied on its county lab.
saw a sick patient in mid-February, before the hospital had its own test kits,
who had symptoms of COVID-19 but didn’t qualify for testing under the narrow
federal guidelines in place at the time. He went home, only to return to the
hospital after his condition deteriorated. This time, he was tested and it came
Santa Clara County, home to Stanford, 175 people have tested positive for
COVID-19 and six have died. Late last week, the medical center’s emergency
department saw the highest number of patients in one day in its history.
Blomkalns doubts it’s because there are more cases in her area. “If you don’t
test, you don’t have any cases,” she said.
worries about staffing shortages as health care workers are inevitably exposed
to the virus. As of Tuesday, one doctor in the Stanford ER had tested positive.
At UCSF, six health care providers had.
all Bay Area hospitals are seeing a flood of patients. In fact, some have fewer
patients than usual, as they have canceled elective surgeries in anticipation
of a COVID-19 surge.
doctors treating COVID-19 patients say nearly all who test positive have a
cough. They complain of fatigue, body aches, headaches, runny noses and sore
throats. While most people are well enough to recover at home, those who get
critically ill tend to do so in their second week of symptoms, and can
deteriorate very quickly, several doctors noted. “We are recommending that
patients get intubated a little earlier than they might otherwise,” said Reyes.
COVID-19 in CA: The Symptoms They’re Seeing
general, officials are asking people who have mild cases of COVID-19 to treat
their symptoms at home, as they would a cold or flu, and refrain from seeking
care at hospitals. People experiencing shortness of breath, however, should
definitely go to the emergency room, said Blomkalns.
children, the criteria may be a bit different. Shortness of breath should
trigger a visit, as should altered mental state, excessive irritability, or an
inability to eat or drink, said Dr. Nicolaus Glomb, a pediatric emergency care
physician at UCSF Benioff Children’s Hospital.
Gavin Newsom said Tuesday that rough projections suggest the state could need
anywhere from 4,000 to 20,000 additional beds to treat patients with serious
cases of COVID-19.
testing problems worry Noble, as do the equipment shortages, but not nearly as
much as the potential for a lot of sick people. “I’m mostly worried about a
tsunami of very ill patients that we’re not equipped to take care of,” said
isn’t sure whether or when Stanford might exceed capacity, saying the caseload
trajectory may hinge on how aggressively state and national authorities move to
cut off routes of community transmission. “It all depends on what happens in
the coming weeks and days,” she said. “We know what we need to do, and we’re
doing the job.”
KHN Senior Correspondents JoNel
Aleccia and Jenny Gold contributed to this report.
This KHN story
first published on California
Healthline, a service of the California
Health Care Foundation.
Reposted courtesy of Kaiser Health
News, a nonprofit news service covering health issues. It is an
editorially independent program of the Kaiser Family Foundation, which is not
affiliated with Kaiser Permanente.