ND Nurses Voice

Check us out on facebook! Update from January Meeting.

2012-01-23T07:15:00.000-08:00

NDNA's board of directors met Jan. 12 in Bismarck. Along with the BOD, several NDNA members as well as several young non-member nurses were invited to join the group for their input on several issues. Membership and Technology.

The day was very thought-filled and several changes will be forth coming.

NDNA's mission was updated based on member input from a survey done in 2011. Members were asked first if they knew NDNA's mission, then if they said yes, to write it out without looking. No one got it right.

The new mission is: Promote the Profession of Nursing.

The organizational model was updated to reflect the closing of CNE-Net/ANCC accreditation unit. As well as to simplify the elected positions to just 3. Four additional board positions will be added to better represent the 4 districts in ND. All the changes will occur AFTER the 100 year anniversary celebration in September 2012.

The non-members present assisted those present in discussing membership issues. They also addressed the issue of technology and highly encouraged us to "advertise" our facebook page. Members received an invitation to check us out last week. You do not need a facebook page to read our page. If you want to leave a comment or to "like" us you will need to create a facebook account. We are happy to report we have the tools many of you are looking for, we just need to share and spread the word that we have these great resources for communication. Click on the facebook badge at the right and you will be at our facebook page.

Don't forget to 'like" us on facebook... stay warm!

Our History Informs Our Future

2011-12-27T14:13:00.000-08:00

“Certainly she was heroic . . . It was not by gentle sweetness and womanly self-abnegation that she brought order out of chaos . . . it was by strict method, by stern discipline, by rigid attention to detail, by ceaseless labor, by the fixed determination of an indomitable will . . . Changing a system means changing attitudes, expectations, and behaviors. It means overcoming disbelief, prejudice, and fear. Old systems do not readily embrace new ideas or information; defenders of the status quo can be stubbornly impervious to common sense…. ” (From Chapter 4 “The Fixed Determination of an Indomitable Will- Florence Nightingale” in How to Change the World: Social Entrepreneurs and the Power of New Ideas by David Bornstein).

As we head into 2012, conditions are such that our system(s) have never been more ready for a change maker, a leader. The Future of Nursing initiative supports work toward preparing and enabling nurses to lead change to advance health. How will this be accomplished?

õ Nurses take responsibility for their personal and professional growth by continuing their education and seeking opportunities to develop and exercise their leadership skills.

õ Nursing education programs integrate leadership theory and business practices across the curriculum including clinical practice.

õ Nurse representation on boards, executive management teams, and other key leadership positions.

Four characteristics of leaders are those who exhibit competency, honesty, those who are inspiring, and those who possess a vision for the future. The key word is exhibit. To possess these qualities but fail to demonstrate or show evidence of these behaviors does not reveal the leader within.

To clearly and wholly take on the role of leadership one requires courage and action.

The world in which we live is in need of a few million nurses who possess “fixed determination of an indomitable will” . . . after all it is our work to care for the human response. Human responses occur everywhere…so nursing happens everywhere as well…to recognize and embrace the full dimension and potential of nursing is a matter of changing attitudes, expectations, and behaviors. . . of overcoming disbelief, prejudice, and fear… welcome to 2012.

The future of NDNA

2011-10-25T07:41:00.000-07:00

NDNA will turn 100 years old in 2012.

When you are 100, you have seen a lot of change.

In the 2011 Journal of Public Health Management and Practice, Edward Baker MD, MPH, the column editor of the Management Moment wrote about the Evolution of a Leader. He briefly describes the emerging leader, the early leader, the established leader, and the emeritus leader. As an organization NDNA has passed through these stages. As the established leader NDNA dealt with ambiguity, conflicting demands, and many challenges that were of a complex nature.

Today, NDNA is transitioning to the role of emeritus leader. This leader leads through thoughts, rather than running the marathon race and being the doer of all the deeds. This role is one where the leader is conceptually skilled and wisdom oriented. It is the role of coach or guide.

For example this is an organization that leads by influence and the purpose for being is to grow new leaders, more specifically to promote the professional development of nurses.

ANA has championed these initiatives:

1. Professional Practice Excellence

ANA successfully champions professional nursing excellence through standards, code of ethics and professional development, such as credentialing and lifelong learning.

2. Health Care and Public Policy

ANA is an acknowledged leader in the formulation of effective health care and public policy as they affect the profession and the public.

3. Knowledge and Research

ANA is the recognized source for accurate, comprehensive health policy information from evidence-based research.

4. Unification

ANA facilitates unification and advancement of the profession.

5. Advocacy for Work Force and Workplace

ANA with its partners and through its organizational relationships is the leader in promoting improved work environments and the value of nurses as professionals, essential providers and decision makers in all practice settings.

6. Organizational Effectiveness

ANA improve its structural units and resources to pursue its vision, achieve its mission and fully satisfy the needs of its constituents, structural units, subsidiaries, associate organizational members and organizational affiliates.

As an organization that has reached the stage of emeritus leader NDNA adapts these initiatives to shift the role of the organization from being the doer to being the supporter/coach for the new emerging and early leader, to be the guide and sounding board for the established leader.

NDNA is still here, the role and purpose has shifted.

The role is now to help grow the next 100 years through sharing wisdom and influencing the professional development of nurses. The boots on the ground are the next generation of nurses, NDNA is the safe place to come home to.

NDNA proposal for our role as emeritius leader adapted from the ANA initiatives.

1. Professional Practice Excellence

NDNA successfully champions professional nursing excellence through standards, code of ethics and professional development, such as credentialing and lifelong learning.

2. Health Care and Public Policy

NDNA assists the individual nurse to become an acknowledged leader in the formulation of effective health care and public policy as they affect the profession and the public.

3. Knowledge and Research

NDNA assists the individual nurse to become a recognized source for accurate, comprehensive health policy information from evidence-based research.

4. Unification

NDNA assists the individual nurse to facilitate unification and advancement of the profession.

5. Advocacy for Work Force and Workplace

NDNA assists the individual nurse to partner through its organizational relationships to become the leader in promoting improved work environments and the value of nurses as professionals, essential providers and decision makers in all practice settings.

6. Organizational Effectiveness

NDNA seeks to improve its structural units and resources to pursue its vision, achieve its mission and meet the needs of its constituents, structural units, subsidiaries, associate organizational members and organizational affiliates.

Come join us! www.ndna.org

Magnet Recognition Program

2011-09-24T08:41:00.000-07:00

As of this writing there are two (2) Magnet designated facilities in North Dakota. Others may or may not be in the process of either making a commitment to become a Magnet facility or others may have already decided and are in the process of a self study to determine how they measure up to the Magnet criteria.
So what does being designated "Magnet" mean?
There are 5 components to the Magnet model:
Transformation Leadership
Structural Empowerment
Exemplary Professional Practice
New Knowledge, Innovation, and Improvements
Empirical Quality Results

New Knowledge, Innovation, and Improvements is briefly described as "organizations have an ethical and professional responsibility to contribute to healthcare delivery, the organization, and the profession." [emphasis added].
Empirical Quality Results is described as "Organizations are in a unique position to become pioneers of the future and to demonstrate solutions to numerous problems inherent in today's healthcare systems" (notice it does not say just in your OWN system).
NDNA is a professional organization for nurses. We are a constituent member organization of the American Nurses Association (ANA) of which ANCC -the American Nurses Credentialing Center is part of. ANCC is the organization facilities apply to to achieve Magnet status.
Membership in NDNA provides an opportunity for nurses in this state to achieve portions of the Magnet criteria. Active membership provides opportunities to serve on national boards, you could be appointed to serve on ANA or ANCC committees! Membership and communication with nurses across the state assists and influences the practice of nursing everywhere. Discussions, problem solving, and sharing innovations benefits everyone in the health care system.
Many nurses continue to choose to NOT join any professional organization. (Some national estimates are as high as 80%). In ND we have over 10,000 RNs licensed to practice. Some choose to join their specialty organization, some NDNA, but sadly the vast majority are not a member of ANY professional organization.
With the number of present and potential Magnet facilities in this state, the ratio of nurses who participate in professional activities should be far higher.
NDNA participates with the ND Center for Nursing, the Partners Investing in Nursing's Future (Geriatric Nursing/ FLAG), and maintains the ND Online Journal Club where EBP is showcased. Every other year NDNA is active in monitoring and testifying if needed at the ND legislature.
NDNA champions the Scope and Standards of Nursing Practie. Aspiring authors are supported through the publishing process to help disseminate information to a wider audience.
Membership in a professional organization provides the opportunity for nurses to step outside their workplace and contemplate the bigger picture of health care in North Dakota. NDNA's mission is to promote the professional development of nurses and enhance health care for all through practice, education, research and development of public policy.
Come join us, fulfill your professional responsibility to contribute to your profession.

Necessary Conversations

2011-08-24T08:32:00.000-07:00

The July-August 2011 edition of Nursing Economics features a conversation with Peter I. Buerhaus PhD, RN, FAAN (one of the co-authors of the Needleman article published in the New England Journal of Medicine in 2011 that addressed the issue of hospital mortality and nurse staffing).

The PDF file for the Nursing Economics interview of Dr. Buerhaus can be found at http://www.nursingeconomics.net/necfiles/CrucialConversations/cc_JA11.pdf

On page 170 Dr. Buerhaus makes the following statment:

"I am somewhat frustrated in that studies we and others have published that show relationships of staffing and adverse patient outcomes have not led to nurses taking more responsibility for these outcomes. Instead, they are blaming hospitals, saying in essence, “Our hospital doesn’t treat us well; therefore, adverse outcomes continue to be experienced. If they would just listen to us and improve our life, we could do better to decrease adverse outcomes.” Many RNs are not stepping up and taking responsibility and saying, “These outcomes are occurring, and they are associated with nurse staffing. What can we do as nurses to improve and assure they are not occurring in our institution, and on my nursing unit?”

This fundamental issue of professional responsibility is clearly outlined in the ANA foundation documents. Nurses are expected to behave and act according to the standards of professional performance.

Two books have recently been added to my recommended reading list. Carrots and Sticks don't work by Paul Marciano (2010) and The Knowing-Doing Gap by Pfeffer & Sutton (2000).

An epidemic of failure to act plagues the human race. In nursing failure to act is unforgivable and it is also a failure to meet the nursing standards of practice and performance.

In a perfect world, the knowing-doing gap should not occur within the nursing practice arena. Unfortunately, it does. Education is just the beginning, to make changes one needs to take action. Action partnered with self responsibility and accountability. Too often blame for less than ideal practice situations is assigned to someone else. "if only they"...

Watch for further discussion regarding the concepts of commitment, engagment and action in future Prairie Rose editions. If you have ideas, thoughts let us know..let's start a robust and necessary conversation.

NDNA October 5 & 6, Conference Topics

2011-07-30T09:48:00.000-07:00

The registration for the fall conference is now open, you can click here to go to the website where you will find the overview, the schedule, the conference flyer, registration, and hotel accommodation information.

Where: Ramkota Hotel, Bismarck, ND

When: Oct 5 & 6 2011 (Wed. & Thurs.)

Full day on the 5th, 1/2 day on the 6th.

Topics:

Oct 5-- Bullying - Dr. Strauss will lead us through a discussion and facilitate group activity to develop strategies and policies that the participants can take back to their workplace.

Oct 6-- Leading Virtual Teams. Explore the use of technology and ways of working together when we are now meeting and working together via the electronic world.

Questions? Call 701-223-1385 or email becky@ndna.org

Health Care Jobs

2011-07-11T08:46:00.001-07:00

The Wall Street Journal (online version) had an article titled: Slow Recovery Curbs New Health-Care Jobs. As many states struggle with budgets that must take deep cuts to remain fiscally sound, healthcare provided by state agencies is on the chopping block. Health care systems that rely on federal monies (Medicare and Medicaid and in some cases grant money) are preparing themselves for cuts or in some cases reductions in expected reimbursements.

Nurses being the labor force that “costs” facilities a great deal of money is being eyed as well, as an area where staff reductions may occur. (Never mind that without nursing staff, you would NOT have a health care facility!)

A national nursing Blog had a conversation thread regarding what is the salary of RNs across the country. A nurse from New York said she made $48/ hour as her base salary. According to the 2011 Wages for ND Jobs (Job Service ND), RNs in North Dakota can expect to make $19.24-33.21/ hour depending on experience, job title, and location. LPNs are listed at $14.13-20.24.

The trend in ND has been the rural facilities that employ nurses find it difficult to recruit and retain not only nurses but supportive staff as well. Nurse aides/ orderlies/ home health aides can expect to make from $9 to $14/ hour.

As solutions are sought to balance the budget(s), is nursing involved in knowing what it costs to run an organization or do you just pick up your check and are unconcerned at the dilemma most organizations face to recruit, retain, make decisions for a lay off, and balance the limited sources of income all the while meeting the federal and state regulations.

What does all this mean? It is an opportunity for creative solutions!

What do you think?

We have a Blog on ANA nurse space ...check us out.

2011-06-16T09:59:00.001-07:00

Click here to join the discussion.

NDNA Fall Conference

2011-06-10T14:22:00.000-07:00

Planning continues for the 2011 Fall Conference and Business Meeting scheduled for October 5&6 in Bismarck, ND. Discussions with our speaker Susan Strauss RN, EdD have netted some great ideas for the conference. Dr. Strauss will help us analyze the concept of workplace bullying and develop an action plan to minimize bullying behavior in the workplace. Dr. Strauss will speak and lead group activities the full day on Wednesday Oct. 5 and will also present on Thursday, Oct 6 for an hour on the topic of Leading Virtual Teams. A topic particularly useful for NDNA members as NDNA has been virtual for well over a year now.
The Nightingale Tribute will close the business meeting on Oct 6th. Nurses are reminded to forward names of nurses who have passed away over the last year to be included in the tribute.
Mark your calendars, come join us in Bismarck. See the NDNA website for the link to the conference website that has been set up for this event.

It’s Nurses Week. Get It?

2011-05-04T07:32:00.000-07:00

It’s Nurses Week. Get It?

Work Related Stress

2011-04-16T07:38:00.000-07:00

McKinney (2011) writes in "Withstanding the Pressure of the Profession" (Published in the March/April 2011 Journal for Nurses in Staff Development) that the nursing profession is a particularly stressful occupation. The author goes on to write "It is evident that nurses cannot wait for administrators, middle managers, or other others to address their stress levels" (p. 71). The proverbial "they" will not fix this problem either. There are a multitude of self help books out there, all listing great resources and actions one can take to reduce stress. YOU have to read them. YOU have to take action. No one else will or can fix your stress level.

Nurses could be accused of "analysis paralysis", in that the situation is defined, analyzed, identified, recognized, named, listed, related to death. It is the action portion of the equation, that is often lacking or missing entirely. We know that stress ruins our health, burns us out, makes us bullies, and tarnishes our reputation. How many studies do we need before we take action to reduce the stress our work adds to our lives? The solutions are there. The evidence is there. Are we in a cycle of using excuses rather than mustering a change?

As an example, the literature is full of evidence that 8 hour shifts are better for us than the 12 hour shifts. They are also better for patients as less mistakes are made when nurses are NOT tired.

The literature identifies poor communication as a stressor, yet, how many of us take the time to learn and practice effective communication techniques and USE them at work. What excuse do you use to just "shut up" and get through the shift?

McKinney (2011) searched the literature and found criticism, elevated responsibility, low levels of support, and sense of security at work as common stressors among physicians, nurses, and laboratory workers. As a profession, nurses, have a level of responsibility that equates to high vigilance. Meaning, you are always on alert for subtle cues, adverse events, because patient care situations are extremely complex. However, you can NOT stay on high alert for hours and hours without a break to re-charge.

To build a healthy work environment takes commitment and ACTION. Necessary skills include reviewing the Nursing Standards of Practice and Professional Performance. Your work environment needs to be a place where nurses can practice ethically, with support from all for having moral courage. It needs to be a place where there is ongoing collective, commitment to ongoing education, use of evidence based practice and research to inform practice, that practice must be of quality. Nurses need to communicate with all persons effectively. Nurses, no matter the title, must be leaders. Leadership is what is needed to initiate and sustain healing an unhealthy work environment. All persons on the workforce must collaborate to ensure patients receive the best possible care. Nurses need to regularly evaluate their own practice, measuring themselves against standards of practice, identifying gaps in knowledge, skills, and ability...then formulate an ACTION that fills in those gaps. Nurses need to use resources responsibly and be aware of the impact on the work environment ... the fiscal health of the work environment is everyone's concern.
Do not be satisfied with the old saying...this is always how it has been...nothing we can do about it...you can make a difference...and the outcome will be a healthier YOU!

Academic progression: BSN in 10?

2011-02-15T07:43:00.000-08:00

The Future of Nursing (IOM, 2010) http://thefutureofnursing.org/IOM-Report has as one of its KEY messages: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

So, when do we start? How do we start?

Statistics show in 2008 just 13.2% of all RNs in the United States held an advanced degree. This low number is a sobering predictor of future shortages for faculty and advanced practice nurses who provide direct care to patients.

Factor in rising dissatisfaction in nurses at the bedside (some studies report as high as 37% of nurses at the bedside are feeling "burned out"), we have a recipe for shortages in nursing looming that will need new strategies to solve. No longer will the same old behavior achieve better results.

It is very difficult to convince the nurse who is burned out at the bedside to invest in his/her education to remain in an environment that does not support professional progression, let alone academic progression. We need to do some really tough evaluation of what is needed at the bedside, in management, as leaders, what can the system support financially, and most important of all, what does the public need from nursing.

Should many of the nurses today take a good hard look at future employment, self-employment opportunities? Will the majority of nurses become public health officers in the future, leaving only a few to supervise technicians in acute care?

Hospital employment has been the mainstay of work for many nurses, is it time to move upstream and become the primary care givers in prevention/ condition management?

We will never be able to take that advanced role and own it without a well rounded education.

What scope of practice do you see for the future of nursing?

Are you fit to serve?

2010-12-29T14:25:00.000-08:00

I am too tired to think, too tired to give meds, too tired to admit one more patient, and if I ever get to leave I am too tired to drive!

Many occupations have strict rules regarding "fit to serve" meaning there is a body of evidence that concludes after -X- amount of hours the person becomes a hazard behind the wheel, flying, or making life and death decisions. Truck drivers, airline pilots have rules regarding the number of hours they can work and the number of hours they need to "recover". It is well known nurses must remain alert while at work, the concept of vigilance is described in this article. It is also known that being on high vigilance cannot be sustained for a prolonged period without a recovery period.

There has been a steady rise in the number of phone calls to NDNA regarding staffing conditions. Nurses are tired. Nurses are frustrated. Nurses are telling their employers they are at risk for making mistakes. Nurses are telling us they are NOT being heard.

ANA has a campaign called Safe Staffing Saves Lives.

ANA has statements regarding nurse fatigue and the employers role and responsibilities. Nurses are also responsible to monitor their level of fatigue to keep patients safe.

The IOM has compiled a large body of evidence that supports a fatigued nurse is a dangerous nurse.

Cole Edmonson, vice president and chief nursing officer at Texas Health Presbyterian Dallas Hospital writes "Professional, caring, competent, compassionate, and courageous nurses are what the public expects and the patients and families who entrust us with their care deserve. As nurses and nurse leaders, we have an obligation to be "fit for duty" when reporting to work, and a duty to construct and support healthy work environments for optimizing professional practice." Complete story here.

There is a nation wide initiative to put into place legislation that compels employers to follow a set of rules regarding staffing. Some legislation is very restrictive, leaving little room for those crisis events. It could tie the hands of employers and nurses alike in keeping patients safe and cared for. On the other hand, do employers become guilty of failure to act when staff documents and provides evidence that they are over tired and need time off? And what kind of evidence do you need to determine staffing changes are in order? If the criteria remains "well nothing has happened", you are left with a very unhappy staff...staff that will have a higher likelihood of leaving.

Nurses need to take responsibility as well for allowing the inadequate staffing to continue. Sadly, most of the time the solution is to voice with your feet and leave.

Nursing as the most trusted profession needs to find a solution to the unsatisfactory staffing problems. Employers need to heed the call for help, tired nurses are NOT fit to serve.

Future of Nursing

2010-12-08T10:09:00.000-08:00

The IOM and RWJF recently published the Future of Nursing Report. I have provided a quick overview here:

KEY MESSAGES

from IOM Report on the Future of Nursing

As a result of its deliberations, the IOM committee formulated four key messages that structure the discussion and recommendations presented in this report:
1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

RECOMMENDATIONS

From IOM Report on the Future of Nursing

IOM Recommendation 1: Remove scope-of-practice barriers.
Advanced practice registered nurses should be able to practice to the full extent of their education and training.

NDNA fully supports removal of need for physician signature on a collaborative agreement for prescriptive privileges requirement for APRNs in ND. Legislation will be brought forth in 2011 to change the nurse practices act.

IOM Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
Private and public funders, health care organizations, nursing education programs, and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices.

IOM Recommendation 3: Implement nurse residency programs.
State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.

IOM Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020.

These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan.

IOM Recommendation 5: Double the number of nurses with a doctorate by 2020.
Schools of nursing, with support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity.

IOM Recommendation 6: Ensure that nurses engage in lifelong learning.
Accrediting bodies, schools of nursing, health care organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.

NDNA is committed to continuing profession development. The Mission of the North Dakota Nurses Association is to promote the professional development of nurses and enhance health care for all through practice, education, research and development of public policy. Every activity NDNA engages in is based on the Mission statement, with attention to type and quality of content before development and during dissemination.

IOM Recommendation 7: Prepare and enable nurses to lead change to advance health.
Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses.

IOM Recommendation 8: Build an infrastructure for the collection and analysis of

interprofessional health care workforce data.
The National Health Care Workforce

Commission, with oversight from the Government Accountability Office and the Health

Resources and Services Administration, should lead a collaborative effort to improve research and the collection and analysis of data on health care workforce requirements. The Workforce

Commission and the Health Resources and Services Administration should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible.

Nurses in ND need to engage in a robust discussion regarding embracing and implementing these Key messages and recommendations.

The Future of Nursing recommendations are being taken seriously at all levels of health care ... this is your chance to help craft what they will look like and how our professional will be changed when full implementation occurs.

The Story of Gloves

2010-11-08T16:26:00.000-08:00

If any of you have read any of my past articles you may notice a theme has started to emerge about gloves!
You know how it is, buy a red car, everywhere you look you see a red car. In this case have an issue with "gloves" and everywhere I look there is an issue with gloves...I will start with the food service folks at the grocery stores. Whether behind the deli counter or stocking fresh lettuce, everyone has gloves..and it would seem they all need a HUGE lesson in the purpose for wearing gloves. As the young man briskly yanked the lettuce out of the packing box and stuffed it into the display bins...peeling off some of the wilted leaves (dropping them on the floor) I shuddered first at the bruised vegetables, then decided never to buy open bin lettuce ever again as he used his gloved hand to scratch a posterior portion of his body, then brush his hair out of his eyes, then pick up the lettuce leaves from the floor....toss the leaves in the empty box, then turn without a pause and pat the leaves of ALL the lettuce in such a vigorous manner as to make sure all the protruding leaves were even. I stood with my mouth open, then decided being a nurse I needed to say SOMETHING...I asked him "did you know you have now contaminated all that lettuce by using your dirty gloves to pat them all?" He looked at me as if I were an alien, shrugged his shoulders and pushed his now empty boxes through some doors marked "employees only".
The deli counter and the nice ladies handing out food are no better. Those gloves hold a days worth of sweat inside them. Food is touched after their gloved hands have opened packaging, touched knives, scissors. Ink pens are picked up that fall on the floor or from behind their ears...labels are marked, I could go on and on.
Now, for the most part, we can excuse some of this, they just don't know any better. But what about nurses who fail to recognize when they should have gloves on, should change gloves, should recognize when they have entered territory that requires that the gloves they have on, should now come off before they pick up a pen or touch the panel on the IV pump, or heavens come back to touch the patient.
Do you known how to guard a sterile field, do you speak up? Do you wear gloves every time you should? Do you take those same gloves off and wash your hands every time you should? Did you know every time you reach into the glove box, without cleaning your hands FIRST you contaminate the box...have you ever seen anyone drag out more gloves than is needed and stuff them back in the box? How about stuff them in their pocket, then drop, keys, pens, scissors, tape in the same pocket?
We have much to remember about gloves, put them on when you should, take them off when you should. And no patting the lettuce after touching the floor!!

Work Environment

2010-10-19T19:23:00.000-07:00

Several years ago NDNA received a grant to study work environments that were positive and promoted health for the staff. Key areas that promoted these "ideal" environments were found to be: nursing practice control, nurses accountable for their own practice, the work environment was safe (both for patients and staff), nurses embraced the code of ethics, nurses engaged in methods to reduce errors, and patient care was continually improved. All new staff were provided orientation and a mentor. There were abundant opportunities for professional growth. The leadership not only knew how to manage but encouraged leadership at the bedside. Management was prepared for their position. All staff were encouraged to grow and to continue learning. Wages were fair with performance reviews based on principles of professional development. Staff was recognized for accomplishments and coached rather than punished when they fell short. Staff felt that work and home life was balanced, issues related to workplace stress were addressed, staff had opportunities for debriefing after adverse events. Bullying was not tolerated, in fact there was zero tolerance for violence at the workplace. Management was trustworthy, created an environment of respect, open communication. Leadership training was available for all staff. The facility was committed to evidence based practices, both for patient care and how the facility was operated.

Growing and sustaining the ideal environment was accomplished by communication, teamwork, critical thinking skills, an appropriate staff to patient ratio, recognition for contributions and leadership growth.

As you examine your workplace, is this the type of environment in which you find yourself? If not, what can you do to grow a better work place?

The measure of nursing. . .

2010-10-11T12:32:00.000-07:00

Your past achievements have often been measured in terms of a “grade point average”, a measurement that you have come to know as having some value and worth in academic culture.

For most for our lives we have had our “intelligence” measured in one way or another. We have had a never ending number of grades and evaluations. However, grades, IQ scores, SATs cannot predict who will succeed in life. We all know those really smart people who just seem to be out of touch with everyone else.

The brightest among us can be poor pilots of our private lives, especially when another type of intelligence is missing.

(David Goleman describes Emotional Intelligence as:

Being able to motivate oneself and persist in the face of frustrations

Being able to control one’s impulses and delay gratification

Being able to regulate and monitor ones moods and keep distress from swamping the ability to think. (Nursing provides many opportunities to be swamped!)

Possessing the skill of empathy and the ability to hope for better things.

Studies over the last 10 years have confirmed being able to make the grade is not enough, especially when we don’t possess the ability to measure our own and others emotions.

We have to know how to relate, and nursing demands we have a highly developed sense of how we affect/ impact others.

Stories told by patients speak of the need to connect with their nurses. For healing to occur a therapeutic relationship must be established. It is not enough to know what to do, to be successful, you must be emotionally smart. You need to develop the ability to know what is knowledge, to do things with that knowledge and know how your knowing and doing affect others.

The very first step in cultivating emotional intelligence is to be self aware. You must recognize your feelings and build a vocabulary for those feelings. You need to know there is a difference in the definition of emotions, feelings and reactions.

Next you must examine your actions and know their consequences. You need to know if feelings are ruling your decision making process, you need to learn to monitor and manage feelings.

You need to learn to handle stress.

Handling stress is all about choices.

Making good choices is all about perceptions, self awareness, and feelings. Do you see the connection?

You must cultivate empathy.

Understand others’ feelings and concerns.

It is about being aware of other people’s perspectives.

You must become a good listener and learn to ask good questions to be a good communicator—it is not just about talking.

You need to monitor your judgments and reactions.

You need to value self disclosure, AND you need to balance and be insightful when it is appropriate and trustworthy to share private feelings.

You need to build the skill of pattern recognition; it will build your ability to be insightful.

You need to be self accepting, see your strengths and weaknesses, don’t forget to laugh at yourself once and awhile.

You need to be responsible, and assertive. The patients you serve are counting on you to be their advocates. In learning these behaviors, you will be able to take care of yourself as well.

There is yet another type of intelligence.

It is called: Spiritual intelligence.

Spiritual intelligence is about why we do what we do.

What calls us and guides us in our career.

It is the development of our self.

It is the ability to be awake and aware every moment.

David Foster Wallace told this short story in his commencement speech at Kenyon College in Ohio.

There are these 2 young fish swimming along…they happen to meet an older fish swimming the other way, . . .. . . .who graciously nods at them and says, “Good morning…how’s the water?

And the 2 young fish swim on for a bit, and then eventually one of them looks at the other and says,

“What the hell is water?”

It is my fervent hope that as you swim along in your nursing career, you are always awake enough to be aware of your life. Your discover your reason for being here.

That you get the opportunity to become who you are meant to be.

Ee cummings wrote it takes courage to grow up and become who you really are.

With so many competing holds on your life, be it your parents wishes, your partner’s wishes, your friends, your colleagues, it can be very tough to first evaluate your beliefs and to embrace your values.

Spiritual intelligence is an ability to access higher meanings, values, abiding purposes, and to wake up the unconscious aspects of the self.

It is the ability to take this self discovery of meaning, values and purpose to live a richer and more creative, happy, successful, confident life.

Nursing will give you the opportunity to develop spiritual intelligence.

It will give you a sense of vocation or calling.

It provides an avenue through which you will be given the opportunity to inspire others to be fulfilled.

Your patients need not only intelligent nurses, they need emotionally mature, spiritually gifted nurses.

Ones who sense and act on their needs, from a place inside that is holistic, open, positive, aware, and present.

Spiritual intelligence is the ability to be aware of others, have a sense of wonder, awe, to cherish the wisdom passed through the ages, to have perspective, to be at comfort with chaos and paradox, and to be committed and dedicated to the tenets of your chosen profession.

I ask you to consciously choose to be a nurse, it will take courage and dedication to be successful, and being a nurse will give you the opportunity to be fulfilled,to be the full measure of who you really are.

Nursing's Social Policy Statement (2010)

2010-07-14T06:45:00.000-07:00

ANA has just published the newest edition of Nursing's Social Policy Statement: The Essence of the Profession. As I contemplate how important it is that all nurses actually READ this work, I first was going to use the words "urge you to read", but instead I have decided to write I DEMAND you read this work. On page 5, a quote from Donabedian (1976), ends with these sentences, "Self-regulation to assure quality and performance is at the heart of this [the nurse-society] relationship. It is the authentic hallmark of the mature profession. "
Do you require "oversight" or do you perform to the best of your knowledge, skills and ability based on self-regulation? Self-regulation is based on embracing the standards and ethics of nursing practice.
Nurses need to wrap our brains around the fact the reason we exist is not because we have spent $20-40,000 for an education (and now feel entitled to have a good paying job), rather because the PUBLIC/ society in which we provide care needs nurses. We would not nor should we exist if we don't fulfill the "contract" with society in providing the care needed.
Care that not only includes the ability to remember 10,000 drug names/dosages/ effects, how to complete technically complex tasks, or how to traverse a health care system to secure necessary items and services for patients, but also to always remember to be aware of the patient's response to their "diagnosis/condition/situation/experience" and to treat the human response. It is far easier to just do the physical care, get the tasks done...move on to the next list of things to do...it is far more difficult to engage in the mental/emotional/ESSENCE of what patients and families need. We use excuses that we are over worked, too many patients, etc. I challenge you to take control of your practice ...yes yours...and embrace the relationship that created the need for nursing to exist in the first place.

Do nurses need to be involved in politics?

2010-07-02T07:14:00.000-07:00

The overwhelming answer is YES!!
As we breeze through the day there are many disturbing ...really life changing issues about to become central critical problems that MUST be addressed by the American people.
If you want a look at what these issues are check out the Congressional Budget Office website. As health care workers... nearly every looming problem is related to health care in this country. http://www.cbo.gov/
If nothing else we should be alarmed at the real source of our paycheck as most health care institutions rely heavily on funding from Medicare...and that program is in deep trouble.
And if you are counting on Social Security as part of your retirement, annual spending on Social Security payments will regularly exceed the program's tax revenues starting in 2016, if current laws remain in place.
The national debt will reach 62 percent of gross domestic product by the end of this year ― its highest percentage of GDP since the end of World War II (from CBO).
It is of deep concern that nursing continues to recruit students to the profession by using the line that nursing is recession proof...not so. And in many parts of the country nurses are not finding jobs or are being laid off.
What happens when most of the upcoming nursing workforce who are seeking to join nursing for the money or supposed job security nursing offers find out the pay is frozen or cut...? What happens when facilities have huge cuts in federal dollars that typically come through programs such as Medicare? What about the patients?
Nursing education systems also tend to rely heavily on government support. Once the government runs out of funds for nursing education then what??
We need a new income source and a new way for funding health care and health care education...education for XX years of service...with a stipend for day to day living...we'll see how many "nursing is a good secure job" folks are recruited then...complicated issue, one that needs attention and some bright minds to find a far outside the box solution...up to the challenge?
Most will admit our economy is in really deep trouble...some might equate it to be being on a ventilator, but the electricity is about to go off.
Will there be a nurse there to manually ventilate? Not sure as dangling the money carrot usually doesn't sustain dedication during a crisis..especially when the carrot is gone.

Continuing Professional Development

2010-06-21T18:10:00.000-07:00

Continuing education for nurses is about to change. Redesigning continuing education for health professionals outlines a shift that is sure to catch, changing the expectations society will have about how you the nurse engage in life long learning.
You can read all about it in the online PDF version of the book at http://www.nap.edu/catalog.php?record_id=12704
ANCC identifies this source as one of the foundation resources for the changes about to be implemented in the new 2010 accreditation manual that will impact the way contact hours are reviewed.
Frankly, it is about time the bar is raised for professional development expectations. I nearly cry every time I hear a nurse say their employer provides all the continuing education they need...meaning the number of contact hours needed to renew their license. Professional development? Isn't it by the virtue that my name tag says RN I am deemed a professional? Hardly.
Continuing Professional Development (CPD) is a far more comprehensive look at life long learning. It quite possibly will be the push we need to finally tip over into being a true profession.

Flamed Out

2010-04-27T08:04:00.000-07:00

In the latest "Directions in Nursing" nurses respond to a previous article on nursing burn-out written by Jean Williams. The writer of the first response is grief stricken at the present state she finds herself in. She describes what the literature would identify as compassion fatigue, caring too much. A post traumatic syndrome of sorts. Kubler-Ross would call this the "death of unmet expectations"...the resulting coping would be the classic denial, anger, bargaining, depression, and acceptance.
What is all this? The colliding of the epic mismatch of what we expect to be able to do in our practice and the environment in which we practice.
Clearly it is time to examine the work nurses do, it is afterall part of our contract with society to provide the services society needs. What are those services? Yes, technically competent nurses are necessary. The ability to start IVs, insert catherters, give "good" shots...all the hands on skills continue to be a measuring stick we are judged by, mostly by our peers, not the patients. Patients, however, tend to measure us by whether we are "nice or not". All nurses who are technically competent do not necessarily embrace the concept of caring.
The generational differences expose different reasons for becoming and remaining a nurse. There are a whole range of issues associated with how we became a nurse in the first place. What brought you to nursing? How did you learn to BE a nurse? Personal perceptions of what it means to be a nurse heavily influence how you behave as a nurse. Do you believe nursing's purpose is to care for the HUMAN RESPONSE to all the possible conditions that touch health and illness? Do you alleviate suffering in all encounters? Is all this suffering just too much?
Or do you pass meds, check IV sites, do wound care, assess tube insertion sites, measure output, etc. because this is the "distance or separation" mechanism you are using to cope with your own fatigue?
In a recent conversation about "nursing eating their young", I flippantly said well, "if you don't want to be eaten, don't be the food". The response was laughter, but in reality research has been done that identifies the type of behaviors that mentors identify as "very difficult" to deal with in a preceptor relationship. Top 2: "know it all" & "pretend to know".
Is the fresh, eager nurse a relic of the burned out nurse's past, a reminder of how it used to be? Is it just too painful to see the past and realize our own many episodes of the "death of unmet expectations"?

BSN in 10

2010-03-18T06:50:00.000-07:00

In the mid 80's ND became the first state to require a BSN as entry into practice, in 2003 that law was overturned.
ANA has long held the BSN should be the entry into practice requirement for all nurses.
ANA has proposed the "BSN in 10" as a way to move all nurses to the BSN level. As in the past, nurses who are already licensed will not be affected but the proposal seeks to implement from initiation date forward as the time frame for the new requirement. Nurses will be expected to achieve a BSN in that 10 year time frame. This proposal is sure to bring to the surface many of the old for and against arguments. Along with concerns about how fully employed nurses will return to school, how the present system will adapt to a whole new set of "students" who are different from anything in the past, and how nurses will be able to take courses to meet this requirment there remains the conflicting views about basic issues related to entry nursing education. What are your thoughts?

Does “practice” make the Nurse competent?

2010-02-12T12:48:00.000-08:00

Most of you have heard the cliché “practice makes perfect”. But Sheffield (2009), challenges that assumption with a new twist on an old saying. “Practice does not make perfect; practice makes permanent.” He goes on to remind us that flawed practice ultimately leads to a flawed outcome. It is not enough to merely practice, one needs to engage in reflective practice as to discern areas of strength and areas of weakness. Nursing has long held the individual accountable for one’s practice. While not all of us practice in the same setting, core accountabilities apply. The definition of nursing is universal:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in the care of individuals, families, communities, and populations. (Nursing’s Social Policy Statement 2nd ed., 2003).

The Standards of Professional Performance (ANA, 2004) clearly outline the expectations related to quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, and research. Nurses sometimes place less emphasis on these standards, focusing instead on the Standards of Practice; assessment, diagnosis, outcome identification, planning, implementation, and evaluation. In reality these Standards run consecutively and are meant to be considered in totality. Nurses are expected to meet both the Standards of Practice and the Standards of Professional Performance.
Every two years nurses in North Dakota must accumulate twelve (12) contact hours and provide evidence of “400 practice hours” over the course of the previous 4 years.
These requirements are attempts to ensure that nurses licensed here are at a minimum safe to continue to practice. These requirements are in place in an attempt to ensure competency. If the adage “practice makes perfect” is challenged, what happens when the saying “practice makes permanent” occurs, especially in practice that is flawed? Is this where we see nurses who forget to follow the obligations to keep patients safe by not following hand washing guidelines, not always wearing gloves, or not following other standard precautions? Is this where it becomes part of the practice to recap needles, pick up dropped items off the floor, or not worry about medication administration rules of right patient, right medication, right time, right dose, right route, and right reason? Is this the practice where nurses expect all education needs to be met by the employer, where mistakes are covered up, or where collegiality and civility are replaced by “lateral violence” and bullying? Is this the practice that finds nurses talking on the phone to family members to iron out babysitting issues, or directing family members on the grocery list needs for the week rather than attending to patient needs? Is this the nurse running errands off the unit and out of the facility without a formal report/ patient hand off to colleagues? Is this the nurse telling patients about his/her own personal life? These nurses all “practice” far more than 400 hours every four years. But what kind of nurse does this practice make? Are they really competent as measured against the standards of practice and professional performance? And what about all their colleagues who let them get away with such bad behavior? Many of these behaviors are grounds for disciplinary action, not only by your employer but by the licensing board.
So the case can be made; practice does not always ensure competency and it certainly does not ensure perfection.
A recent review of all 50 states’ requirements for renewal of the nursing license found a variety of methods to document competency. Some, have no renewal requirements, others provide a variety of methods that range from contact hour accumulation (many require specific educational topics), to certifications, and or the maintenance of a portfolio as a way to foster reflective practice.
How can nurses prove they are competent? It will take a shift in behavior and an acceptance of personal responsibility for one’s practice. It requires learning the art of self assessment, gaining honest feedback from co-workers and supervisors. It requires the ability to develop and maintain one’s own record of learning needs, plans to fill those needs, goals, progress toward goals, interventions, re-evaluations, and acceptance of the fact that each registered nurse is individually responsible and accountable for first knowing the professional standards and then maintaining them. It takes operationalizing reflective practice.
What is reflective practice? It is a way to continuously examine your assumptions and practices. It provides the means by which we compare our present state with the standards by which we are measured. It assists in identifying through critical reflection areas of our professional development that need strengthening or developing more fully.
The generally accepted standards for competency are as follows:
Ø The ability to apply knowledge and skills at the level required for a particular situation.
Ø The ability to demonstrate responsibility and accountability for practice and decisions.
Ø The ability to restrict and/or accommodate practice if one cannot safely perform essential functions of the nursing role due to mental or physical disabilities (NCSBN, 1996 in Huston, 2006).

Accepted definitions of competence are as follows:
Ø Continuing competence is ongoing professional nursing competence according to level of expertise, responsibility, and domains of practice.
Ø Professional nursing competence is behavior based on beliefs, attitudes, and knowledge matched to and in the context of a set of expected outcomes as defined by nursing scope of practice, policy, Code of Ethics for Nurses, standards, guidelines, and benchmarks that assure safe performance of professional activities.
Ø Continuing professional nursing competence is ongoing professional nursing competence according to level of expertise, responsibility, and domains of practice as evidenced by behavior based on beliefs, attitudes, and knowledge matched to and in the context of a set of expected outcomes as defined by nursing scope of practice, policy, Code of Ethics, standards, guidelines, and benchmarks that assure safe performance of professional activities (ANA, 2000 in Huston, 2006).

In the May 28, 2008 “Professional Role Competence Position Statement” ANA clearly states, “The public has the right to expect registered nurses to demonstrate professional competence throughout their careers”, they further write; “the registered nurse is individually responsible and accountable for maintaining professional competence”. Key stakeholders are the profession as a whole, the individual professional organizations, credentialing and certification bodies, regulatory agencies, and employers. In addition educational institutions strive to achieve entry level benchmarks at the doorway of professional practice/ performance. Regulatory agencies determine minimum competency requirements. The expected level of performance through out the nurse’s career depends upon context and the selected competence framework used as a benchmark. Frameworks evolve and become more complex as expertise is gained. Is it acceptable to remain “minimally competent” in the present work environment? An integrated approach to assessing competency that achieves the definition of continuing professional nursing competence requires the nurse to fulfill the professional tenet of life long learning; a true measure of competency considers far more than hours worked or the practice of a skill set. A true measure considers the Standards of Practice and the Standards of Professional Performance, the Code of Ethics for Nurses, and Nursing’s Social Policy Statement as the bedrock of performance. You must ensure your practice fulfills the principle that the public has the right to expect registered nurses to demonstrate professional competence throughout their careers. We answer to this relationship as it defines the meaning and purpose of nursing.
NDNA would like to engage all nurses in North Dakota in robust discussion regarding the issues surrounding competency. We would like input regarding your thoughts about the present requirements for accumulating 400 hours of practice every 4 years. We would like to learn how nurses themselves ensure they are competent.
Anyone wishing to send a private comment may email us at info@ndna.org ANA Sources:
Code of Ethics for Nurses with Interpretive Statements (2001)
Nursing’s Social Policy Statement 2nd Ed. (2003)
Nursing Scope and Standards of Practice (2004)
Position Statement: Professional Role Competency (May 28, 2008). http://www.nursingworld.org/NursingPractice You must be a member to view the complete document.
Redesigning Expectations for Initial and Continuing Competence for Contemporary Nursing Practice (1999) retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/RedesigningExpectationsforInitialandContinuingCompetence.aspx
North Dakota Board of Nursing web pages:
Nurse Practice Act
http://www.ndbon.org/nurse_practices_act.asp
Administrative Rules and Regulations http://www.ndbon.org/links_admin%20rules.asp
Continuing Education Requirements
http://www.ndbon.org/education/continuing%20education/continuing%20education.asp
Patient Abandonment http://www.ndbon.org/opinions/patient%20abandonment.asp
ND license renewal requirements
http://www.ndbon.org/licensure/renewal_requirements.asp
Other Sources for further exploration:
Huston, C. (2006). Professional Issues in Nursing: Challenges & Opportunities. New York: Lippincott, Williams, & Wilkins.
State by state guide for RN license renewal requirements. (Nursing 2006 Career Directory) retrieved from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=636579 Sheffield, D. (2009). Practice Makes Perfect- Not! Online Bookstore: Dorrance Publishing Co., Inc. Retrieved at http://dorrance.stores.yahoo.net/prmape.html?jmid=12021&j=238693609&m=B17F0EA43CDC48269A46D356274AFF92&g=194704459

Welcome to the ND Nurses Voice

2010-02-10T16:37:00.000-08:00

The launch of the new ND Nurses Journal Club has generated lots of discussion...and suggestions. One tool that needs to be available is a way for all of us to talk to each other..a message board of sorts. When PICO questions are generated it is not always a straight line to the best question..sometimes we need to talk about it and sometimes we find we actually have many questions.
We are offering several different ways for you to talk to each other and to us...by using the guest book, by using the chat room and now having access to this blog.
Let us know what you think!
Let's get talking!

ND Nurses Voice

Check us out on facebook! Update from January Meeting.

Our History Informs Our Future

The future of NDNA

Magnet Recognition Program

Necessary Conversations

NDNA October 5 & 6, Conference Topics

Health Care Jobs

Nurses being the labor force that “costs” facilities a great deal of money is being eyed as well, as an area where staff reductions may occur. (Never mind that without nursing staff, you would NOT have a health care facility!)

The trend in ND has been the rural facilities that employ nurses find it difficult to recruit and retain not only nurses but supportive staff as well. Nurse aides/ orderlies/ home health aides can expect to make from $9 to $14/ hour.

What does all this mean? It is an opportunity for creative solutions!

What do you think?

We have a Blog on ANA nurse space ...check us out.

NDNA Fall Conference

It’s Nurses Week. Get It?

Work Related Stress

Academic progression: BSN in 10?

Are you fit to serve?

Future of Nursing

The Story of Gloves

Recommended Read

Work Environment

The measure of nursing. . .

Nursing's Social Policy Statement (2010)

Do nurses need to be involved in politics?

Continuing Professional Development

Flamed Out

BSN in 10

Does “practice” make the Nurse competent?

Welcome to the ND Nurses Voice