NurseAndStuff

Home Healthcare Market (2009-2014)

2010-02-11T05:16:00.000-08:00

Home healthcare, also referred to as formal or skilled care, is the support and care service that healthcare professionals provide at the patient’s own home. These care services include respiratory therapy, home infusion therapy, home medication, skilled nursing or medical care. The global home care and self care market is the aggregate of the markets for home healthcare equipment and home healthcare services.

The most important trend in healthcare witnessed in the recent times has been a shift of patient’s focus from hospitals to home care. The move from treatment to proactive monitoring has opened up new opportunities in the home healthcare market. Patients prefer home healthcare over hospitals mainly for the latter’s cost and convenience benefits; and are thus increasingly opting for third-party medical professionals and care-givers.

The home healthcare market generates approximately 70% of revenues from the people aged 65 years and above; mainly because of the declining ‘elderly support ratio’, or the ratio of the number of people caring for the elderly, to the number of older people above 65 years. This factor highlights the growth potential of the market for third-party care in the coming years.

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10 Healthcare IT Trends To Watch In 2010

2010-02-11T05:14:00.000-08:00

With a major push toward healthcare reform and the appropriation of nearly $20 billion in federal stimulus funds as part of ARRA (The American Reinvestment and Recovery Act), 2009 was an action-packed year for the healthcare industry, particularly healthcare IT. 2010 promises to be even more dynamic as healthcare organizations prepare for upcoming industry changes and position themselves to take advantage of government incentives. The following are 10 trends I feel will drive the healthcare IT market this year:

1. EMR Adoption Gains Momentum — According to the latest statistics from HIMSS (Healthcare Information and Management Systems Society), only 0.5% of U.S. hospitals currently have a complete EMR (electronic medical record) system that provides data continuity throughout the institution. Hospitals and healthcare systems will install, integrate, and enhance EMR systems at an accelerated pace in an effort to demonstrate "meaningful use" and capitalize on ARRA incentives.

2. PHRs Earn Legitimacy — PHRs (personal health records), once rejected by providers and academics, will become recognized as a viable method in which to transport patient data and will complement EMRs and EHRs (electronic health records). Advances in secure personal storage, smart card, and software technology will help drive this trend.

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14 Biggest Trends and Events for Hospitals and Health Systems in 2009

2010-02-11T05:10:00.000-08:00

by Leigh Page

1. Recession. Though conditions have improved in some areas, hospitals are still feeling the lasting effects of the recession.

"This recession seems to be a two-step process that we are only halfway through," says Michael Rowan, COO and executive vice president of Catholic Health Initiatives in Denver. "The markets are improving but there are still a large number of unemployed out there, and that will affect hospitals' bottom lines." The recession has revealed itself in a variety of ways that are mapped out in numbers 2-7 below.

2. More non-paying patients. "Growth in unemployment has translated into growth of the uninsured," says Nancy M. Schlichting, president & CEO of Henry Ford Health System in Detroit. Michigan has had a longer and deeper drop in unemployment than any other state, with the jobless rate at 15 percent for the state and at 30 percent for Detroit alone. Ms. Schlichting says Henry Ford has seen a 20 percent growth in uncompensated care each year for the past two years.

Ms. Schlichting has been trying to find ways to cope with the influx of non-paying patients. Henry Ford is partnering with a federally qualified health center in Detroit to direct patients needing primary care from its EDs to the center. Even as the economy improves, Ms. Schlichting says the challenge of non-paying patients won't go away because unemployment will remain high. Washington has been trying to soften the blow. Dick Clarke, president of the Healthcare Financial Management Association, hopes that Congress' extension of COBRA eligibility for group insurance coverage for laid-off workers could markedly raise the number of paying patients.

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Medical crisis in Haiti: Q&A with nursing faculty members

2010-02-11T05:05:00.000-08:00

by Marjorie Simoens

Marilyn Pattillo, RN, Ph.D., is an associate professor of clinical nursing and co-chair of the Disaster Nursing Committee, and Trish O’Day, MSN, RN, CNS, is an instructor in clinical nursing in the School of Nursing.
      What was your initial reaction when you heard about the earthquake in Haiti?

      MP: Sadness…. Sadness for those whose lives have been disrupted. Sadness because I know that many groups from countries all over the world are sending help. Unfortunately there is probably no command and control in Haiti to organize the response efforts. As usual, politics, influence and power will come into play.

      TO: My initial reaction was how different this disaster is from a disaster in the United States. Even with the many challenges of Katrina in our country, the aftereffects of this earthquake in Haiti will not be remedied in five or 10 years. After Katrina, there was housing (imperfect, perhaps) for evacuees to transition to. That is not the case in Haiti, with no resources to rebuild. Where will survivors live?
      How important is it for nurses to be mobilized into Haiti to help with triage and providing care?

      MP: There are trauma and emergency room nurses who are trained to work in triage teams and assist in search and rescue efforts. Most nurses, however, will be needed to stabilize injured patients and to keep epidemics from happening. In addition, nurses can also help by:
          o Mobilizing and keeping the families resourceful and intact to help with caring for injured family members.
          o Preventing a “second disaster” by conducting good health assessment and disease surveillance.
          o Organizing immunization and vaccination efforts.
          o Identifying people at high risk for malnutrition and sickness.
          o Identifying areas that need immediate assistance because of poor sanitation, lack of water, lack of good food, grief and psychological trauma.
          o Setting up shelters that are safe and can provide respite.
          o Training local nurses and physicians.
          o Collecting data so resources can be appropriately allocated.

PS. This is a good article because we can use it not only in Haiti but also wherever disaster strikes

PS2. The whole article is on this site

Elderly to Outnumber Children for First Time in 2045, UN Says

2010-02-11T04:59:00.000-08:00

By Jason Gale

The elderly will outnumber children for the first time in 2045, ratcheting demand on nursing homes and increasing the burden on working-age people to support retirees, a United Nations report found.

The proportion of the world’s population older than 60 years will reach 22 percent over the next four decades from 11 percent in 2009 and 8 percent in 1950, the UN’s Department of Economic and Social Affairs said in the report, titled World Population Ageing 2009.

The ranks of the elderly are expanding 2.6 percent a year, three times faster than humanity as a whole, mostly because people are living longer and having fewer children. The trend will affect economic growth, savings, investment, consumption, labor markets, pensions and taxation, the UN found. It will also influence living arrangements, housing demand, migration trends and the need for health-care services.

“As children account for a declining proportion of the population, there may be a reduction in the number of schools just as the increasing share of the older population begins to require more long-term care facilities,” the authors said. “In the political arena, population aging may shape voting patterns and political representation.”

The number of people older than 60 surpassed 700 million worldwide last year and is projected to swell to 2 billion by 2050, or triple the level in 2000. In most countries, the population over 80 is growing faster than any other age group and will continue growing rapidly until at least 2050, indicating “a growing demand for long-term care,” the authors said.

Today, the median age for the world is 28 years. The north central African nation of Niger has the youngest population with a median age of 15; Japan has the oldest, with a median age of 44, according to the report. Worldwide, the median age will likely increase by 10 years over the next four decades.

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3 Chicago babies born seconds after midnight

2010-02-11T04:56:00.000-08:00

By Lewis Lazare

As revelers celebrated the start of a new year and a new decade, little Miya Tanni was welcomed into the world as Chicago's first baby born in 2010 -- arriving 10 seconds after midnight, according to St. Joseph Hospital on the North Side.

Weighing in at 7 pounds, 6 ounces, Miya was born to West Rogers Park residents Linda and Azin Tanni, both registered nurses. Azin Tanni also is an Iraqi war veteran, having done two tours of duty over four years.

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Four P’s Initiative Reduces Patient Falls at Northern Westchester

2009-11-07T09:07:00.000-08:00

By Robin Huiras

Patients at risk for falls at Northern Westchester Hospital Center in Mount Kisco, N.Y., are easily identifiable. They wear yellow socks. It is part of a new way of doing things at the facility, an innovative falls prevention initiative designed and carried out largely by nurses.

Unofficially called the Four P’s, the evidence-based practice model incorporates pain, position, potty, and placement markers into two-hour rounding. Because the program is only 3 months old, official falls data isn’t available. But the nurses, who round in the units where falls traditionally occur, report fewer occurrences.

“Within the last month and half, at least on this unit, I don’t remember hearing of a fall taking place,” says Cristina Fata, RN, BSN, staff nurse on the mixed medical unit. “That rates really well with a year ago. Obviously our goal is to have no falls, but realistically sometimes something happens we can’t account for. This has definitely reduced the number of falls and call bells.”

The idea behind the Four P’s arose from Northern Westchester’s evidence-based practice council, says Chief Nursing Officer Lauraine Szekely, RN, MBA, who also is the senior vice president for patient care services at the 235-bed facility.

“The nurses who are involved in the evidence-based practice council through our shared governance model were interested in looking at falls and pressure ulcers to see what evidence was out there to ensure our practice was the best and meeting industry standards,” Szekely says.

To that end, the evidence-based practice team reviewed existing literature on falls prevention and examined internal data on when and where falls occurred in the facility, says nurse educator Fay Wright, RN, MS, SPRN-BC, coordinator of evidence-based practice and clinical instructor at Northern Westchester.

“Most of the falls at Northern Westchester were because people needed to go to the bathroom, and if you think about it, that makes sense because you wake up in the morning and you have to go,” Wright says. “So we looked at the evidence, and people were looking at toileting every one to two hours as a way to prevent falls. It’s almost like taking tiny steps — called small tests of change — in the change process.

The next step in creating the program was developing a fall risk assessment tool that not only incorporated toileting with falls-prevention strategies done during rounding, but also continually measured a patient’s fall risk.

“This is the beauty of the small tests of change,” Wright adds. “We identified procedural issues. For example, someone goes in and turns a patient, but they don’t potty before turning and a few minutes later the patient needs to go to the bathroom, so it’s almost double the work and uncomfortable for the patient because they’re getting moved a couple of times. [We’ve] developed a system that helps people work together.”

Four P’s Primer

Nursing professionals saw how the elements of the tool fit together in April during a comprehensive training. Close to 150 RNs, LPNs, technicians, chart coordinators, and respiratory therapists received education designed and administered by Wright on the new program.

“We had a bed set up with a mannequin, and everyone role played what they needed to do during rounding and used the key words to assess pain, potty, position, and placement,” Wright says. “At first people were like, ‘We can’t do this,’ but once they started doing it they got really engaged and played with it.”

While the enhanced rounding intrinsic to the Four P’s initially seemed like more work for bedside nurses, that perception quickly was dismissed.

“It’s less work in a way because when you’re frequently checking on patients you’re anticipating their needs and decreasing the call bells,” says Katerina Langer, RN, staff nurse in the orthopedic and neurology units. “But safety is the biggest concern, so whether it’s more or less work we’ll do whatever’s necessary to improve safety and prevent falls.”

The assessment component of the Four P’s provides another layer of prevention. Upon admittance and each ensuing day, patients are evaluated for risk. Not only do high-risk individuals receive yellow socks, they are charted with yellow stars and identified as fall risks to the call-bell intercom operators.

“One day a patient may be OK, but the next day have a procedure and become a risk, and this encourages us to assess our patients’ fall risks on a daily basis,” says Annmarie Tietjan, RN, BA, PCCN, staff nurse in psychology and cardiopulmonary units. “This is a tool that is more specific to each patient — it’s in tune to their individual needs.”

Patient Acceptance

High-risk patients generally have been receptive to the new tool, Tietjan says.

“The funniest thing happened. The first day it went live I went into a patient’s room — it was an elderly man — and told him about the new rounding, and he said, ‘That’s the best damn thing I heard all week. That makes so much sense,’ and I told him he was absolutely right,” Tietjan says. “It really gives us an opportunity to talk to the patients and see what they need.”

The additional time with patients is a boon to nurses stretched by the fast-paced hospital environment, Fata adds.

“Even if it’s just a few minutes to toilet and turn the patient, it gives you that time and allows you to assess and pick up on cues if the patient is in distress,” Fata says. “I don’t think it makes you a better nurse, but it brings out top-notch nursing; it’s more about personal nursing. With turning and positioning and being about the patient more, it makes it more personal and patients see the difference.”

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High-Tech Patient Teaches US Nurses Critical Skills

2009-11-04T08:18:00.000-08:00

By Daniel Ryntjes

Students from a medical school in the United States are learning emergency medical techniques from advanced simulator patients. Georgetown University has spent hundreds of thousands of dollars buying the latest simulators, which combine mechanical body systems, chemical sensors and cutting-edge computer programming to simulate major body functions. There are about 1,000 such simulators around the world. The use and popularity of these systems has recently increased among nursing students in the United States.

His name is Gus. He is not breathing very well and his heart rate is high.

Megan Stevens is a postgraduate student nurse who has worked at a family general practice clinic. She is learning techniques to react to different situations when Gus needs emergency care. "You know the assessments are done quickly, trying to work out what's going on with the patient and trying to fix [it], in giving him some medication, cardioverting him, like we did today, and seeing if that works and if not, keep going, trying to work out what will make him better," she explains.

"I can't seem to catch my breath," Gus said.

The team interacts with the patient, whose voice comes from Stephen Hurst, the University's Director of Medical Technologies.

Gus responds, "I tried sitting up or lying down, nothing makes it better."

Hurst also manages the computer and monitoring systems in the control room. "The simulators we possess are high-fidelity simulators," he says. "They allow our students to interact with a physical mannequin and get the associated response, whether it is feeling pulses, or hearing lung sounds or breath sounds."

This simulator is one of a family of three mannequin patients at Georgetown university - a man, a woman and a child.

Hurst changes the symptoms as students work on the mannequin patients. He says the simulator is the most advanced teaching aid in medical history. "Every time it takes a breath in, the computer samples a little bit of that gas, and figures out how much oxygen is in it, how much anesthetic gas in it. and then calculates with mathematical models for the appropriate response," Hurst said.

Program Director Dr. Karen Kesten sets up particular scenarios before the class begins. Watching from another room, she can assess the nurses' ability to respond to unpredictable situations.

"It gives me the opportunity to evaluate my students' assessment skills and their intervention skills, their recognition of a problem with a patient and how quickly they respond and intervene appropriately or inappropriately," Dr. Kesten said.

Student nurse Alexis Walter says the simulator enables her to experience situations she might never have come across before. "We get nervous because our instructors are watching us. It is the place to make mistakes, but when you are in school you feel the need to not make mistakes, but it is honestly the best place to do it," Walter said.

After the patient is stabilized, the students are given feedback on their performance, enabling them to take those lessons back to the clinics and hospitals where they work.

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Type of breast cancer determines outlook :Pathology basics to help you navigate diagnosis, treatment

2009-11-01T08:15:00.000-08:00

By Marcia Frellick

Most breast cancers begin in the breast's ducts or glands (lobules). Some begin in the cells that line the lobules (lobular cancers), while a small number start in other tissues, according to the American Cancer Society. Where it starts is determined by how the cells appear under a microscope.

Here are the most common types, according to mayoclinic.com:

Invasive: This type of breast cancer has spread into the tissues surrounding the membrane of the duct or lobule. From there it can spread to other parts of the body. Most common among invasive breast cancers are invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC).

About 70 percent of all breast cancers are the IDC type, the Mayo Clinic reports. The cancer cells form in the lining of the milk duct, then break through and invade surrounding tissue. They may remain in that area or spread into other regions via blood circulation or lymph nodes.

ILC is less common than IDC, but invades in a similar way. It starts in the lobules, breaks into the surrounding tissue and can spread to other parts of the body. With ILC, you may feel more of a thickness than a lump in the breast.

In situ: Here the cancer cells have remained within their place of origin. Most common among these non-invasive cancers is ductal carcinoma in situ (DCIS) which is contained in the milk duct lining. With treatment, this has an excellent prognosis.

Breast cancer occurs primarily in women, but men can get it too. Men make up less than 1 percent of the cases because their breast duct cells are less developed than women's and their breast cells aren't hit with the same growth-inducing effects.

Understanding your pathology report

After breast cancer surgery, the pathology report will help doctors determine the stage (from 0 to 4) of your cancer. This is based on the size of your tumor and whether cancer is in your lymph nodes or has spread beyond the breast. The pathologist determines whether cells are cancerous, precancerous (at high risk of becoming cancerous) or benign (harmless). This information is key for your medical team to develop a treatment plan. Before you read the report:

--Go to breastcancer.org and find the celebrity talking dictionary. You can hear words that you may see on your report pronounced and then defined by the likes of Celine Dion, Regis Philbin or Tom Brokaw.

--When it's time to go over the results, first check the top of the report to make sure the name and procedure are yours.

--Be sure you have all the information. Sometimes tests lead to more tests, so wait to get all the results. You will need the whole picture to help make decisions about your treatment.

Breastcancer.org describes the parts of the report. They include:

Clinical diagnosis: This is the diagnosis doctors were expecting before your tissue was tested.

Gross description: This talks about the size, weight and color of each sample.

Microscopic description: This describes the way the cells look under the microscope.

Special tests or markers: This section reports the results of tests for proteins, genes, and how fast cells are growing.

--Schedule time with your doctor just to go over the report. The language can be intimidating. Don't be afraid to ask questions. And don't be afraid to ask for a second opinion. It is a common request and most doctors are comfortable with it, says the American Cancer Society. In fact, some insurance companies require you to get one before you start treatment.

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Workplace Shaman: Diagnosing the nursing crunch

2009-10-30T07:18:00.000-07:00

By Mary Pearson

Planning for workforce requirements sometimes goes beyond the bounds of a single organization. A good case in point is the need to address human resource requirements in Canada's health care system.

Q: A recent report by the Canadian Nurses Association (CNA) predicts that Canada will experience a shortfall of 60,000 registered nurses by 2022 unless something is done to address the situation. How can human resources planning help to address this?

The Problem:

Nursing is the backbone of our medical system and critical to the success of almost all aspects of medicine. As with doctors, (though perhaps not to the same degree), nurses specialize in specific areas of medicine.

Demographic factors influence the demand for specific nursing services. For example, if retirees flock to Victoria, B.C., the need for OR and palliative care nurses will likely increase in that region due to the number of older patients who require hip or knee replacements or other long-term care, whereas the need for pediatric nurses may remain the same or decline. Thus, solving the shortfall issue isn't just a simple case of finding 60,000 more nurses.

To successfully address a potential shortfall, it is critical to appreciate the evolving needs within the Canadian healthcare system.

Remedies:

Understanding complex long-term trends and then taking appropriate coordinated action at a number of levels including governments, healthcare organizations and academic institutions is the challenge ahead.

Although mapping out when, where and how nurses will be needed is a complicated process, there are tools available through predictive analytics technology.

SAS Institute Canada has teamed up with healthcare strategist, Brian Shorter, to examine the effects of the aging population on Canada's healthcare system. Shorter says analyzing healthcare and census data can help assess where needs will arise and what sorts of specialties will be needed to map staffing and skill requirements against future needs. This is done by analyzing healthcare and census data on disease types and treatment times to spot subtle trends in demographics that might point to an increase or decrease in the need for certain medical treatments.

"There is no quick fix for the country's healthcare ills," said Pat Finerty, a vice president at SAS Canada. "However, analyzing some of the current data available is a great way to plan for the future and truly understand the implications of our aging and shifting population. It is this type of information that will help governments and the healthcare systems devise appropriate strategies to ensure all Canadians receive top-level and quality healthcare."

Finding ways to interest young people and providing them with information on potential career opportunities in the field is an important component of addressing the issue. Academic institutions also need do their own program and course planning based on identified predicted specialty requirements.

According to the Canadian Nurses Association, increasing enrollment in registered nursing programs by 1,000 per year between 2009 and 2011 would reduce the gap by 15,000 nurses over 15 years.

There is much work that needs to be done, from promoting the profession to Canadian youth to understanding future needs. But given the complex and multi-jurisdictional nature of the issue, the biggest challenge may be leadership. With so many players at so many levels, progress requires consultation across sectors and a high level of communication, planning and coordination.

Getting all stakeholders to the table requires a very deliberate and concentrated effort and skilful facilitation. Multi-organizational initiatives can stumble because of the silo mentality that is so prevalent in organizations and institutions.

Michael Decter, chairman of Saint Elizabeth Health Care and former chairman of the Health Council of Canada noted recently: "Decisions taken to implement the baccalaureate as the basis for entry to Registered Nursing practice led to an unintended consequence. As training courses transferred from hospitals and community colleges to universities the total number of training slots nationally dropped dramatically. This was an outcome no one had sought or planned."

Lack of long-term high-level planning, decisions taken at the local level or from a singular perspective, and taken without regard for future trends, can inadvertently lead to unintended circumstances.

Thus leaders need to seek ways to break down organizational and institutional silos and start to set priorities with common assumptions and a collaborative mind-set with an eye to long-term outcomes. Multi-organizational initiatives are very difficult to achieve, yet absolutely essential in today's complex world.

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Nurses offer tips for surviving a hospital stay

2009-10-27T06:41:00.000-07:00

By Elizabeth Cohen

Imagine you're about to travel to a foreign land. You've heard it can be a mighty dangerous place, but you have to go there -- you have no choice. You don't know exactly where the threats lurk, and you don't speak the language. Wouldn't it be nice to have a guide?

In many ways, a hospital is like that foreign land, and the guides that know the terrain are the nurses.

As many as 98,000 people die in U.S. hospitals each year as a result of medical errors, according to an Institute of Medicine report. Some 99,000 people die each year from infections acquired in the hospital, according to data from the Centers for Disease Control and Prevention.

Vigilance is key, says Cindy Sellers O'Brien, president of the mid-Maryland chapter of the Emergency Nurses Association. "The patients that do better are the ones that take an active role in their health care. They have the better outcomes [because] they take more ownership."

The American Hospital Association agrees that patients play a crucial role. "While we are striving for perfection in the way we deliver care, we know we fall short of that mark -- but patients can help us get better," says Nancy Foster, AHA's vice president for quality and patient safety policy. "They can -- and should -- ask questions when something does not seem quite right."

The consequences of medical errors are especially devastating for children, according to the Joint Commission, which accredits hospitals nationwide. This week the commission released tips for keeping your child safe in the hospital, noting that according to its figures, one in 15 hospitalized children is harmed by medication errors. A study out last week from the University of Michigan found that nearly two-thirds of parents reported they felt the need to watch over their child's hospital care to make sure no one made any mistakes.

Given the dangers lurking in hospitals, we asked several nurses to give us their suggestions about what steps to take to protect yourself and your family.

1. Bring in a list of the medications you're taking

This is one of the most important things you can do to ensure your safety, according to a survey of 731 nurses by Consumer Reports. It's best to have the list in your wallet in case you're taken to the emergency room.

Rita Kobert, a nurse in Fredericksburg, Virginia, who has a seizure disorder, told Consumer Reports she learned this lesson long ago. "If I fall from a seizure ... and have to go to the hospital, I already have a printout of medications," she said.

2. Make sure the hospital gets your name right

Last year, Michelle Waddy, a freelance pediatric nurse practitioner in Roanoke, Virginia, suffered a drop in hemoglobin and needed four units of blood immediately. "The emergency room nurse entered my name on the computer wrong. I was given blood under another patient's name," she wrote to us.

Waddy says she caught the error, but the hospital continued to use the wrong name. "Luckily they had to get my blood type before I was given blood, or I wouldn't be telling this story."

3. Ask about every medication they give you

Nurses say to double-check the name, dosage, and timing of every medicine you receive in the hospital.

Susan Gonzalez, a nurse in Austell, Georgia, caught a medication error just in time. She was visiting her father in the hospital when a nurse came to give him an intravenous medicine. "I asked them, 'What are you hanging?' " she said. The nurse answered it was ampicillin, an antibiotic. "I was like, 'My dad is allergic,' and they said, 'Oh, you're right.' That could have been a fatal outcome."

4. Make sure everyone washes hands

In the Consumer Reports survey, 26 percent of the nurses reported observing hand-washing lapses.

"It seems like a simple little thing, but doctors and nurses pick up a lot of nasty germs and then transmit them to other patients," Dr. Howard Blumstein told Consumer Reports. Blumstein is a vice president of the American Academy of Emergency Medicine and practices in North Carolina.

Since it can be an uncomfortable conversation, Consumer Reports has a list of ways to ask a doctor or nurse to wash up.

5. If you think something's wrong, don't back down

O'Brien, the nurse from Maryland, said she had to fight to stop her mother from receiving a dangerous medication during an emergency visit to the hospital.

She says her mother, who had breast cancer, was supposed to receive a dose of a steroid called Decadron before her chemotherapy sessions. She said someone in the hospital made a mistake and wrote in her mother's chart that she was supposed to receive Decadron every twelve hours.
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O'Brien begged the nurses to take her mother off the 12-hour schedule of Decadron, explaining that she was a diabetic and it could hurt her heart. Within 10 minutes of talking to the nurse, her mother experienced chest pain and had a heart attack, O'Brien recalls, adding that her mother survived.

O'Brien says don't give up if you think something's wrong. "You don't need to be aggressive, nasty, and mean. Be convincing and confident," she said.

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Widget

2009-10-26T21:22:00.001-07:00

Top 7 Mistakes to Avoid in Your Nursing Career

2009-10-24T06:32:00.000-07:00

By NursingLink

When you first become a nurse, it’s easy to believe that you’ll always love your job. But there will come a time where burnout, frustration and boredom take their toll. While you can’t avoid every pitfall, there are some mistakes that you can veer around.

Make the most of your career as a nurse by avoiding these seven mistakes.

1. Rushing Into Becoming a Nurse

If you’re thinking of becoming a nurse, take the time to talk to seasoned veterans and get the inside scoop. Visit nursing schools to learn about pre-requisites. Volunteer at a hospital or clinic to see if you really have a passion for medicine. Nursing is one of the most rewarding jobs out there, but it’s best to be prepared before you dive in.

Sure, some of us are really impulsive and can pull off a career switch or educational 180 with ease. Most of us, though, need a little more preparation. Deciding on a career path is a big decision – whether you’re 17 or 47 – but it’s particularly important to think through your choice to become a nurse because there is so much involved. Pre-reqs. Nursing school. NCLEX. New grad programs. A lot goes into becoming a nurse –which is why not everyone can be one!

2. Changing Specialties Too Many Times

You started in med/surg but soon got bored and moved to L&D. A few months later you got tired of your boss and jumped to same day surgery. A year later you were on to pediatrics. Switching nursing specialties can be a great way to learn what you really have a passion for, but changing areas too quickly or too many times can cause burnout or hurt your career. You might begin to feel like you don’t have a place in nursing and potential employers might wonder why you haven’t committed to one area for very long.

Give each specialty you enter a chance before you take off for something more enticing. Talk to nurses who are currently working in the area you are considering as well as nurses who have left that specialty. They can give you the nitty gritty details on what that area is really like.

3. Not Changing Specialties Enough

On the other side of the coin, you could damage your career by not trying out enough different specialties. Of course, if you love the NICU, don’t leave just to try something else. But if you’re staying in the OR because it’s safe and familiar (but you’re bored out of your mind!), take the risk and apply to another area. You never know what you might be destined to do!

4. Letting Your Job Control Your Life

With late-night shifts and long hours, it’s easy to let your nursing career take over the rest of your life. Maintaining work-life balance is a key element in being stress-free and loving your job. Sure, there will be times when your 12-hour shift seems to stretch into a 24-hour shift, but leave that pressure at home. Remember to take time for yourself, your friends and your family – even if it’s just 1 night a week.

5. Ignoring Compassion Fatigue

Compassion fatigue (otherwise known as “burnout”) can hit even the most conscientious nurse from time to time. The key is recognizing burnout and making a concentrated effort to eradicate it. Of course, there will always be those patients, families, and colleagues that make you want to tear your hair out, but that doesn’t have to ruin your nursing career.

Feeling burned out? Take a step back and think to yourself “What am I worried about? Is something outside work stressing me out?” Look into changing shifts if working in the middle of the night isn’t your cup of tea. Have some vacation time saved up? Take some time off – alone or with family and friends. Lastly, think back to all the reasons you wanted to become a nurse. Make a list of these reasons and look at it every once in a while to remind yourself of all the great things about your job.

6. Believing You’re “Just a Nurse”

As featured author Donna Cardillo said, “Just a nurse? No such thing!” Don’t let anyone beat you down and make you feel inferior. You care for the sick. You inspire the down-trodden. And you save lives! There really is no such thing as “just a nurse.” Be proud of what you do and why you do it.

7. Not Gathering Nurse Allies

We’ve all heard the phrase “Nurses eat their young” and many NursingLink members have said that is definitely true. But even with the drama that may occur, there is always room for friendship. Connecting with other nurses is a great way to avoid burnout, re-ignite your passion for nursing, and expand your knowledge. Whether it’s nurse friends at work or nurses from another facility, they will understand you like your non-nursing friends never will.

Nurse allies can benefit more than your mental health. They can help you advance your career by writing recommendations and finding job openings. It’s always good to have someone who’s looking out for you – and who better to do it than someone who can literally save your life!

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Top Ten Highest Paying Nursing Specialties

2009-10-24T06:13:00.000-07:00

By NursingLink

After you finish nursing school, choosing the right nursing specialty becomes your chief focus. With so many specialties to choose from, many prospective nurses find it difficult to just pick one, but with nearly every specialty requiring candidates to pass a series of exams and fulfill a period of on-the-job training, time is of the essence!

Pay should not be your only consideration when deciding on a specialty, but the list below of the highest paying nursing specialties, provided by our friends at NursingLink, is a good primer on which types of nurses have the greatest earning potential.

You worked hard to get where you are. Now you want to make the most of your career by obtaining the highest salary possible!

#10: Neonatal Nurse, Average Salary: $74,000

Neonatal Nurses care for sick and/or premature newborn babies. They also provide consultation to the newborn’s family during what can be an emotionally draining period.

#9: Gerontological Nurse Practitioner, Average Annual Salary: $75,000

Gerontological Nurse Practitioners (GNPs) hold advanced degrees specializing in geriatrics. They are able to diagnose and manage their patients’ often long-term and debilitating conditions and provide regular assessments to patients’ family members. Similar to all geriatrics nurses, GNPs must approach nursing holistically and pay special attention to maintaining a comforting bedside manner for their elderly patients.

#8: Clinical Nurse Specialist, Average Salary: $76,000

Clinical Nurse Specialists develop uniform standards for quality care and work with staff nurses to ensure that those standards are being met. They are required to possess strong managerial skills and an ability to anticipate potential staff/patient conflicts.

#7: Nurse Practitioner, Average Salary: $78,000

Nurse practitioners provide basic preventive health care to patients, and increasingly serve as primary and specialty care providers in mainly medically underserved areas. The most common areas of specialty for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and gerontology; however, there are many other specialties. In most States, advanced practice nurses can prescribe medications.

#6: Orthopedic Nurse, Average Salary: $81,000

Orthopedic Nurses provide care for patients suffering for musculoskeletal ailments, such as arthritis, joint replacement, and diabetes. They are responsible for educating patients on these disorders and on available self care and support systems.

#5: Pediatric Endocrinology Nurse, Average Salary: $81,000

Pediatric Endocrinology Nurses provide care to young children who are suffering from diseases and disorders of the endocrine system. This often involves educating both parents and children on the the physical and sexual development issues that arise from these disorders.

#4: Certified Nurse Midwife, Average Salary $84,000

Nurse midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. CNMs work in hospitals, clinics, health departments, homes and private practices. Midwives will often have to work unpredictable hours (due to the unpredictable nature of childbirth). They should have good communications skills should be willing to commit to a holistic approach to patient care.

#3: Psychiatric Nurse Practitioner, Average Salary: $95,000

Psychiatric Nurse Practitioners are advanced practice nurses who provide care and consultation to patients suffering from psychiatric and mental health disorders.

#2: Nurse Researcher, Average Salary: $95,000

Nurse Researchers work as analysts for private companies or health policy nonprofits. They publish research studies based on data collected on specific pharmaceutical/medical/nursing product and practices.

#1: Certified Registered Nurse Anesthetist, Average Salary: $135,000

A Certified Registered Nurse Anesthetist administers anesthesia to patients. They collaborate with surgeons, anesthesiologists, dentists and podiatrists to safely administer anesthesia medications.

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Dr. Talitha Sannes-Venhuizen answers questions on breastfeeding

2009-10-21T05:47:00.000-07:00

by Erin Leigh Jepson

Talitha Sannes-Venhuizen is a family practice doctor with St. Mary's Innovis Health, practicing both in Detroit Lakes and Frazee. She lives between Frazee and Vergas on a farm with her husband Jason and their four children. Talitha grew up on Rose Lake and graduated from Perham High School. This week she answers some questions about breastfeeding.

Q. As a doctor, what are some of the benefits breastfeeding provides to mothers and children and what are some of the risks of not breastfeeding?

A. • Formula fed babies have lower IQs than breastfed babies up to 10 months of age with this lower IQ being sustained all the way out to 5 years of age (that's the length of time they studied the children).

• More infant deaths per year in formula fed babies due to all causes. About 6,000 deaths possibly could be prevented per year in the U.S. if all women who were capable of breastfeeding did.

• More ear infections, colds, hospitalizations in formula fed babies (passive immunity to every illness mom has had is passed in the breast milk to protect breastfed babies).

• Formula fed babies are more likely to be obese as children and as adults.

• Formula fed babies are more colicky and more likely to have spitting up problems than breastfed babies. Some babies are so intolerant to cow's milk proteins that they are unable to gain weight or develop without breast milk.

• For every year a woman breastfeeds, she lowers her risk of breast cancer by 4 percent.

Q. Some people may ask, "Is there really a difference between formula and breast milk?" How would you reply to that?

A. A huge difference! If there was a pill that we could give all babies to get the benefits of breast milk it would be malpractice not to prescribe it.

Q. As a mother of four, why did you choose to breastfeed? What is one of your best or worst experiences?

A. My husband was very pro-breastfeeding and actually wasn't willing to have children unless I was willing to breastfeed. My worst breastfeeding experience was being a first-year resident and pumping every two hours to try to get enough milk for my husband to feed the baby while working 120 hours a week. Sometimes he would even have to come in at 5 a.m. when I was on call to pick up the milk I had pumped because it was so hard to get enough since I wasn't home much. The first two months of residency I didn't have more than two hours of sleep consecutively at home or at work. I still can't believe I survived it looking back on it.

Q. The World Health Organization (W.H.O., www.who.int) "strongly recommends exclusive

breastfeeding for the first 6 months of life. At 6 months, other foods should complement breastfeeding for up to two years or more."

What are your personal feelings on that recommendation?

A.I agree very strongly with this, although any breastfeeding is better than no breastfeeding, women who breastfeed for a year or longer get the most benefit.

Q.Can you share some information about breast milk banks and how they are used for babies in Neonatal Intensive Care Units (NICU)? Even mothers of premature babies are encouraged to breastfeed, why?

A. Because preterm babies are high-risk babies, these babies show even more significant benefit from breastfeeding when followed out on outcomes than healthy babies born at term. In California, preterm babies are now all required to be fed breast milk. If moms aren't able or willing to pump, then the milk is acquired from the breast milk bank. I would guess in time as we continue to get the word out more states will follow suit.

Q. This year's theme for World Breastfeeding Week (Aug. 1-7) is "Breastfeeding, a Vital Emergency Response. Are You Ready?" (www.worldbreastfeedingweek.org) How can you foresee breastfeeding being vital in our area if a disaster were to occur?

A. (Breastfeeding) is guaranteed safe feeding for infants if there is no clean water to use or no access to formula, hard to clean bottles, etc. We actually saw that in the Fargo flood. Women who were breastfeeding were much better off than those trying to figure out how to safely feed their babies with bottles.

Q. In closing, what would you like to tell mothers out there that are trying to make the choice between breast and bottle?

A. Feeding your baby formula is not what is best for baby. Although there are some women who are unable to nurse because of dangerous medications they take or because of HIV positive status, most women are capable of nursing if they get the right assistance. I would encourage women to contact their local breastfeeding support group or Becker County Public Health for more information on how to successfully nurse. For women who have trouble knowing how to get a good latch or struggle with wondering if they make enough milk, there are lots of resources for support in our community.

Community health nurses can help

Although breastfeeding is natural, problems can still develop, especially in the first two weeks of nursing. Many new moms may struggle alone or quit breastfeeding altogether. But, there are free resources available that can help moms through this difficult period.

Stacey Heitkamp is a public health nurse with Becker County Community Health and she, along with several other nurses; work with Maternal Child Health clients. At-home visits offer mothers and babies support, education and reassurance.

"During the newborn/postpartum visit we weigh and measure the baby, answer parents' questions, give feeding support, provide information on safety and connect them with community resources that they may not be aware of. We also offer ongoing visits for parenting support and education," explained Heitkamp.

There are a variety of issues a mother can face when beginning to nurse and Heitkamp commented on one of the most common ones, "One common issue that breastfeeding moms often discuss is whether or not they have enough milk supply. A large portion of the time this is due to the mother's perception of lack of milk supply. One of our nurses can assess if there are issues, or if there are some interventions that would improve baby's latch, positioning, or feeding in general. Another problem is nipple damage due to improper latch. Support from a nurse can help improve the baby's latch, help breastfeeding and help the mother heal."

In conclusion Heitkamp offers these words of encouragement to anyone out there who may be struggling, "I would like to encourage moms to breastfeed because it is the best choice for their health and their baby's, and if they are struggling, to reach out for help by either calling us, talking to other mothers that breastfeed, or to family members that have breastfed. A lot of moms give up because they are overwhelmed and have not been able to access help, or they are not sure what to do to improve their breastfeeding experience. There can be a learning curve for mom and baby and our goal is to provide support and help to all new mothers."

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NY Catholic Nurse Sues Hospital

2009-10-18T05:34:00.000-07:00

By Kathleen Gilbert

- A Catholic nurse is suing a New York hospital for forcing her to participate in the abortion of a late-term unborn child under the threat of possible termination and loss of license, and penalizing her after she filed a grievance and continued to refuse performing abortions.

Alliance Defense Fund (ADF) attorneys filed a lawsuit against the Mount Sinai Medical Center on behalf of senior nurse Cathy Cenzon-DeCarlo, who says she was denied an opportunity to find a nurse to replace her after resisting a last-minute summons to assist in the scheduled abortion. While hospital administrators told the nurse that the scheduled abortion was an "emergency,"

However, Cenzon-DeCarlo says that she saw no indications that the abortion was a medical emergency while in the operating room.

Despite repeated and emotional objections, Cenzon-DeCarlo was ultimately forced to participate in the child's death, and was later pressured to sign an agreement that she would assist in all abortions doctors deemed an "emergency."

Mount Sinai, argue the lawyers, should not be allowed to continue receiving millions of dollars of federal funds while in violation of federal law protecting the conscience rights of medical workers.

"Pro-life nurses shouldn't be forced to assist in abortions against their beliefs," said ADF Legal Counsel Matt Bowman. "Requiring a devout, Catholic nurse to participate in a late-term abortion in order to remain employed is illegal, unethical, and violates her rights of conscience.

"Federal law requires that employers who receive funding from tax dollars must not compel employees to violate their sincerely held religious beliefs, but this nurse's objections fell on deaf ears."

Cathy Cenzon-DeCarlo is described in court papers as having a reputation for "a high level of expertise" and competency in various medical disciplines. The hospital, they say, has known of her religious objections to abortion since her declaration of that fact in a job interview in 2004.

The complaint states that Cenzon-DeCarlo was scheduled to perform an abortion on May 24 of this year, and grew concerned when she discovered that the child in the womb was alive. Cenzon-DeCarlo was accustomed to assisting at similar procedures that followed a miscarriage.

The nurse reportedly then sought her nursing supervisor, who warned that if Cenzon-DeCarlo did not participate, she "would be brought up on charges of 'insubordination and patient abandonment.'" Such charges, says the lawyers, "would severely jeopardize Mrs. Cenzon-DeCarlo's employment and her nursing license and consequently her career and her and her family's livelihood."

While hospital officials insisted to DeCarlo that the woman's life would be in danger without the abortion, Cenzon-DeCarlo believed that the situation did not require her immediate involvement, as she says the mother's preeclampsia had not reached a critical stage. Preeclampsia is a medical condition arising as a complication from pregnancy, which can be resolved in severe cases by removing the unborn child - although the child need not be killed.

The complaint states Cenzon-DeCarlo was reduced to tears, and offered to have her priest explain why she could not assist in the death of the child, but her supervisors would not yield. Cenzon-DeCarlo ultimately submitted.

"Mount Sinai callously imposed this harm on Mrs. Cenzon-DeCarlo over and against her tears and urgings and known religious beliefs," says the ADF lawyers.

Participating in the death of the child (duties included transporting and treating the baby's dismembered parts with saline) reportedly caused Cenzon-DeCarlo "extreme emotional, psychological, and spiritual suffering." Cenzon-DeCarlo says she sought therapy after she began suffering from nightmares of children in distress, as well as insomnia and a breakdown in personal and religious relationships.

After Cenzon-DeCarlo filed a grievance over the incident, Mount Sinai allegedly began to retaliate against her by cutting her hours and pressuring her to sign an agreement that she would assist in performing abortions in the case of an "emergency." Cenzon-DeCarlo refused to sign the agreement.

Mount Sinai declined LifeSiteNews.com's request for comment on the litigation.

ADF attorneys filed the complaint in Cenzon-DeCarlo v. The Mount Sinai Hospital with the U.S. District Court for the Eastern District of New York. They are also requesting a preliminary injunction that would order the hospital to honor Cenzon-DeCarlo's religious objection against assisting in abortion and refrain from retaliation against her while the case moves forward.

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From Starched Aprons to Surgical Scrubs

2009-10-15T05:29:00.000-07:00

by Terry Goodrich

WACO, Texas -- A century ago, nurses wore blue-and-white striped dresses and starched aprons. Their duties often included cooking for patients as well as caring for them -- and nurses gave up nursing if they married.

These days, nurses wear scrubs, train on simulator "patients" and have careers which may include military duty. Their ranks -- unlike in the early days -- include men. And marriage doesn't come between nurses and their desire to serve.

Through all those changes, Baylor University Louise Herrington School of Nursing in Dallas has helped prepare students to serve. Its history is captured in a new exhibit at Baylor University's Mayborn Museum Complex in Waco.

Celebrating a Century of Service, a 1,000-square-foot exhibit, will open with a 2 p.m. ribbon-cutting Aug. 17 and will run through April 18, 2010, in the History of Baylor University Exhibit at the Mayborn. The Baylor exhibit hall was made possible through a donation by Marie and John Houser Chiles during the capital campaign for the Mayborn Museum. They are members of the nursing school's Dean's Board.

More than 200 items, from yesteryear's wool nursing capes and apothecary bottles to modern scrubs and a hospital bed, will be on display, said Ann Garrett, coordinator of exhibits at the Mayborn.

"One of the things that is so exciting is that we've collected these items from alums or the families of alums," said Dr. Judy Wright Lott, the nursing school's dean.

"They don't just say, 'Here. You can have this uniform.' They tell you either about their own experience or those of the family members," Lott said. "They're so proud, either of their careers or those of the family members."

The school's contributions to the military and missions are highlighted in the exhibit.

One individual who helped obtain items for the exhibit is Jac Harding of San Antonio, whose mother, the late Earlyn Marie "Blackie" Black Harding, was a 1938 graduate. She enlisted in the Army Nurse Corps and volunteered for duty in the Philippines before the attack on Pearl Harbor. When the Japanese began bombing the Philippines, the nurses set a hospital in the Malinta Tunnel.

Harding's mother was one of 66 nurses who were held as prisoners of war for three years after Corregidor, an island in the Philippines, surrendered to the Japanese.

"It's important the word gets out to the younger generation," said Harding, who arranged the loan of wartime nurse uniforms from the So Proudly We Hailed Museum in Kerrville, Texas.

"My mother would have approved of this exhibit."

The school's Christian mission is reflected in well-worn Bibles and mementos from mission stints, among them woven baskets and wooden drums.

Today, the school has more than 300 students and more than 70 full- and part-time faculty members and staff. More than 4,000 students have graduated, many of whom have participated in mission work, school officials said.

Through photographs, news articles and videos, the exhibit traces the nursing school's origins, growth and future.

The school, which began as a nurses' training school for the Texas Baptist Memorial Sanitarium, opened in 1909. It provided students as the sole nursing staff for the sanitarium, which was chartered in 1903 and is now the Baylor University Medical Center at Dallas.

The school was renamed the Baylor Hospital School of Nursing in 1921 and became the Baylor University School of Nursing in 1936, shifting in 1950 from hospital-based training to university-based instruction.

In 2000, its named was changed to the Louise Herrington School of Nursing in honor of Louise Herrington Ornelas of Tyler, who gave a $13 million endowment to the school. All faculty members are registered nurses.

In the early days, students' classes and hospital work often made for 12-hour days, said Dr. Linda F. Garner, professor of nursing at Louise Herrington School of Nursing. After graduation, they went on to private duty. But that changed with the Depression, when many people could no longer afford to hire them. Nurses found jobs in hospitals in return for room and board, she said. During World War II, many went off to war.

The changing times are reflected in the exhibit, from striped uniforms to World War II uniforms to modern scrubs -- including camouflage ones such as those worn by nurses in Iraq and Afghanistan, museum staffers said.

Vintage nursing tools include glass syringes, ceramic oil lamps, medicine spoons, mercury thermometers and a red-letter sign warning, "SCARLET FEVER. CONTAGIOUS. KEEP OUT."

Items reflecting modern nursing education include mock-ups of hospital settings. A visual display will show simulator "patients" are used to train students. Software allows instructors to control realistic functions as pulse and breathing to prepare students for real-life situations.

"We want to honor and celebrate the alumni of the first 100 years, but we also want people to get excited about what the school will be doing for the next 100 years," Lott said.

Admission to the Mayborn Museum is $6 for adults; $5 for senior citizens; and $4 for children. The Celebrating a Century of Service exhibit is included at no additional cost. Other museum exhibits include forest and cave dioramas and a replica of the Waco excavation site of skeletons of Columbian mammoths.

Hours are 10 a.m. to 5 p.m. Mondays, Tuesdays, Wednesdays, Fridays and Saturdays; 10 am to 8 p.m. Thursdays; and 1 to 5 p.m. Sundays. The museum is at 1300 S. University Parks Drive in Waco.
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Medical drama - No politics, we're doctors

2009-10-12T19:51:00.000-07:00

In the post-'ER' world of American TV medical dramas, a raft of new shows is shifting the focus from the doctors to the nurses. But, says Gerard Gilbert, while they offer gore, adultery and drug abuse aplenty, one subject remains stubbornly out-of-bounds

Given how miserable is the experience of being a hospital patient – let alone the business of being cut open, stitched back together again, irradiated and generally poisoned for our health's sake – we seem to have an inordinate appetite for watching it happen to other people. Hospital dramas and melodramas have been a staple of US television since Richard Chamberlain started checking pulses as Dr Kildare back in the Kennedy era, Grey's Anatomy being just the latest show to lather up this well-formulated medicated- soap mixture of accident, illness and romance.

For many aficionados of the genre, ABC's Seattle-based Grey's Anatomy has almost seamlessly supplanted arguably the greatest medical saga of them all, ER, the NBC series that gave us George Clooney and which ended this April after 15 award-laden years. The last few seasons may have become a bit fagged-out and on the sudsier side, but at its zenith Michael Crichton's saga of a Chicago emergency room was a miracle of intelligence and adrenaline. "The great thing that ER taught us about medical dramas is that they provide a great, high-pressure backdrop to play out the usual personal dramas", says Laura Fries of the Hollywood industry magazine Variety.

But while Grey's Anatomy may provide much of the same – albeit with less surgical excitement and greater emphasis on the personal relationships of the doctors – for many people there is still an ER-shaped hole in the weekly TV schedules. And it's a void that TV producers have rushed to fill, with a glut of new medical dramas this summer and autumn. In fact, never before have the networks sought so much medical help – and if you were looking for trends, you might say that there has been a shift of emphasis from the doctors to the nurses.

Edie Falco – Carmela from The Sopranos – takes the title role in Nurse Jackie, a blackly comic drama about an adulterous, pill-popping New York nurse which has already fallen foul of both Christian groups and nursing bodies. It's been a big hit however for its makers, Showtime, the subscription channel that also brings us those other morally screwed shows Dexter, Californication and Weeds. Indeed New York magazine reckoned Nurse Jackie was "the best series yet in the cable channel's ongoing meditation on the nature of addiction... and the setting for a truly breakthrough female character."

Nursing bodies presumably approve wholeheartedly of Christina Hawthorne, the eponymous protagonist of Hawthorne – a paragon of a head nurse: a beautiful widow who sticks up for her patients and staff, even championing the janitor when he complains that the hospital bean-counters have made him switch to a cheaper brand of disinfectant (you can perhaps already guess where Edie Falco's Nurse Jackie would tell him to stick his disinfectant).

Hawthorne is played by Jada Pinkett Smith – Mrs Will Smith – and her saintly health-care worker stuck in the throat of the New York Times, who reckoned: "Hawthorne is mostly it seems intent on promoting the self-regard of its star, who also happens to be an executive producer on the show."

The heroine of NBC's Mercy is also a nurse, although American viewers will have to wait until mid-season to catch Taylor Schilling as a nurse returning from a tour of duty in Iraq. NBC also have Trauma, starring Derek Luke (Antwone Fisher) and Cliff Curtis as San Franciso paramedics, while the British actor Jeremy Northam (Sir Thomas More in The Tudors) has the starring role in CBS's similar-sounding Miami Trauma.

But it's CBS's other new medical drama of the autumn, Three Rivers, that is the most eagerly anticipated. This one's about transplant doctors – and it is apparently earnest and contemplative, posing ethical questions as it considers the viewpoints of donors and those receiving their organs. CBS has given it the prime-time Sunday-night slot.

You wonder how realistic the transplant scenes in Three Rivers are going to be. ER broke the mould of TV medical dramas when it came to the gory details of emergency health-care. "We wanted to show what it was really like to be a doctor in an emergency room, the explicit surgeries, successful and botched", recalls Dr Fred Einesman, ER's former medical adviser. "In the beginning we said 'that's too bloody to show', or 'we can't use technical medical jargon'. But not for long."

Adds Laura Fries from Variety: "In a way, shows like House up the stakes because with seemingly daily advancements in medicine and outrageous real-life medical stories – think of things like 'Octomom' [the Californian woman who gave birth to octuplets in January] – shows have to rely less on the technical health aspects and more on the extreme measures taken by the doctors."

But if the blood and guts, as well as technical realism, are reaching ever greater extremes, there is arguably one form of realism, the socio-political realism of the US health-care system, that is still not being addressed. As President Obama struggles to turn his health-care reforms into law, there is one ambitious new TV medical drama you won't find in the autumn schedules – so let me pitch it here.

It seems to me that there is a gap in the market for a medical version of The Wire or perhaps The West Wing. The former could focus on one city hospital and include those who don't have health-care insurance, the middle-class patients who don't have quite as much coverage as they think they do, as well as form-filling doctors and litigation-averse administrators. David Simon, I await your call.

The latter show would concentrate on the Washington end of the equation – the reformers, the conservatives, Big Pharma. Fries however argues that the changing face of US medical care is gradually being addressed.

"I've enjoyed USA Network's new show Royal Pains, because it looks more closely at the failings of the American health system. The lead character [played by Mark Feuerstein] is a doctor kicked out of a prestigious hospital because he helped an uninsured patient over a wealthy hospital-board member. His new practice works outside of the usual medical norms – almost going back to the days of home visits and personal care.

"In fact, I would wager that we'll see more medical shows that will work outside the traditional ER-format, sort of reinventing the rules as the rules for health care (especially in the US) seem to keep changing."

Reviewing the latest crop of medical dramas, Fries's colleague Brian Lowry sounds a more caustic note about the way TV medical dramas soft-sell the realities of the US health-care system. "Thankfully, patients [on TV] seldom have to worry about filling out tedious medical forms, being grilled about insurance coverage or suffering from a prior condition", he says. "Getting their doctors to see them on a moment's notice is never an issue. And their insurance companies are presumably more than willing to pay for any and all medical care.

"Come to think of it, perhaps the Obama administration should enlist TV writers and the medical consultants that they employ to take the lead in revamping the health-care industry. After all, who could possibly object to a system that functions as smoothly, humanely and efficiently as all that?"

BLOOD SIMPLE: FIVE NEW MEDICAL DRAMAS

Three Rivers
Every ethical angle about organ transplants is explored, as Alex O'Loughlin ('Moonlighting') leads the dedicated team of transplant doctors at Three Rivers hospital in Pittsburgh. Each story is told from the point of view of the organ donors, the recipients and the medics who look after them.

Hawthorne
Jada Pinkett Smith – aka Mrs Will Smith – stars in this new drama about a saintly head nurse who cares too much (yes, it's possible). Christina Hawthorne is beautiful, widowed and dedicated... did you already guess that Pinkett Smith is also the show's executive producer?

Royal Pains
Mark Feuerstein plays a fast-rising ER doctor who loses his job after he favours an uninsured patient over a hospital-board member, winding up in the Hamptons as a "concierge doctor" to the rich and famous. Breezy escapism for those who thought that 'Burn Notice' put some fun back into the spy genre.

Trauma
The lives and loves of a team of San Francisco paramedics, marking 'Antwone Fisher' star Derek Luke's return to the small screen. Cliff Curtis ('Live Free or Die Hard') co-stars as a genius surgeon who likes to travel by helicopter.

Nurse Jackie
Edie Falco from 'The Sopranos' plays a ballsy New York healthcare worker who pops pills for a bad back and isn't beyond giving the hospital pharmacist a quick one in return for a fresh supply of tablets. Pitch-black humour is the edge here, as you'd expect from the cable channel behind 'Dexter' and 'Weeds'.

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A dedicated nurse at home and away

2009-10-12T17:08:00.000-07:00

By Bonnie Henry

If you want Gussie Graham to tell you about her remarkable life, you've got to ignore the whining, licking and barking of the dozen or so dogs she "baby-sits" each day.
Well worth it.
Lean and healthy at 89, Graham is at the moment going through a patch of dandelions she's picked from her backyard for a salad.
"I'm studying herbs and food right now," says Graham, pausing just long enough to deliver a well-aimed squirt of water toward a barking miniature poodle.
It works. Now where were we?
A former nurse, Graham has tended to the sick and wounded everywhere from war-torn London and Korea to Tucson, where she retired in 1988.
Tucson is also where she got her nurse's training at St. Mary's Hospital back in the early '40s. "There were about 18 or 19 in the class, including two boys who stayed here and worked at the VA Hospital."
Not her. In January of 1943, she flew to a military hospital outside London. "The plane was jammed with soldiers, nurses and WACs," says Graham, who wore starched uniforms at the hospital, fatigues out in the field.
"After the bombing raids, we would go into London looking for survivors. We found a few — and a few we wish we hadn't."
Then again, she'd seen just as bad and bloody in the ER at St. Mary's. "They shoot each other here too," she says with a shrug.
Still, when asked to recount the worst case she ever encountered during wartime, she grows still and shakes her head. No. She cannot answer.
She was born in Mexico to Cherokee parents who had fled the poverty of the Oklahoma reservation by working on the railroad — her father shoveling coal into the firebox of a belching locomotive, her mother working in the cook car.
"I was born in Magdalena. I just happened to delay them," Graham says.
Before long, she, her parents and an older brother and sister were homesteading 640 acres in New Mexico, about 30 miles or so from Socorro.
"Our first home was a dug-out hole, what most would call a storm cellar," says Graham. By the time she was in the third grade, her parents had built an adobe house and barn. "Part of it is still there," she says.
Her parents raised cattle, horses, sheep and pigs. Her mother had a garden and an orchard groaning with apples, peaches and pears.
Chores were of the usual egg-gathering, cow-milking, butter-churning variety.
Transportation came in the form of an old Dodge pickup. "Our fuel was moonshine," says Graham. "We made our own from a little corn."
And no, she is not pulling my leg. You can indeed run a car on 190-proof hooch.
In the summer of '39, her parents lost the farm. "The government took it, shot all the cows," she says.
That fall, she came west to Tucson to attend nurse's training at St. Mary's Hospital. "My mother bought my ticket and put me on a bus. When I got to Tucson, I was met by this colored lady. She fed me. She clothed me. We lived on South Park Avenue. There was nothing out there."
Once here, however, Graham learned, "My education was not good enough. I had to go to Tucson High for a year."
In the summer of 1940, she did enroll at St. Mary's, living and taking her training there.
A year or so later, her parents moved to Tucson, where they took over a private-home-turned-rooming-house on the southern edge of the UA campus.
The rooms were filled with women following the troops soon pouring into Tucson. "The women went out with the men, but my mother told them, 'You don't bring them home here.' "
While still in nursing school, Graham married a young man she had known back in New Mexico. He, too, was stationed in England, though their paths never crossed there.
By war's end, both were back in the states and living in Phoenix, where Graham found work in the labor room at Good Samaritan Hospital.
In 1950, both were called up for the Korean War. "I was there almost 10 years," says Graham, who treated wounded soldiers at M.A.S.H. units near the front lines.
Ironically, hostilities had long ceased by 1958, when her husband was killed in a cannon explosion in Korea. "They were loading up the cannons to bring them back here," says Graham.
She returned to the states, delivering a baby girl at Fort Sam Houston in early 1959. "My husband was killed eight months earlier. He never knew I was pregnant."
Not long after giving birth, she returned to Tucson, went back to nursing at St. Mary's, and enrolled in pre-med at the University of Arizona. But the rigors of motherhood, work, and school were too much and after about a year and a half, she gave up her classes.
When St. Joseph's Hospital opened in 1961, she was one of its first nurses. Later on, she nursed at University Medical Center and finally the VA. "I was an operating-room nurse in all of them," she says.
And always, a nurse to the core.
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Lifespan Approach to Substance Abuse Added to HealthForumOnline's Continuing Education (CE) Library for Mental Health Professionals & Nurses

2009-10-12T16:58:00.000-07:00

HealthForumOnline (HFO), a nationally-approved (APA, ASWB, NBCC, PSNA, CA-BBS) online provider of continuing education (CE) for psychologists, social workers, counselors, nurses and other allied healthcare professionals announces the addition of a new online CE/CEU course, Biopsychosocial Effects of Substances: A Lifespan Approach, to the Chemical Dependency category of their extensive online CE/CEU resource library.

substance abuse issues are reflected across the entire range of development and, as such, one must not just understand the variety of substances that are abused and their short- and long-term impact, but also be aware of how different developmental variables increase risk for use, abuse, and addiction…known within the field as a lifespan approach.
An estimated 30 million Americans currently suffer from drug dependency and addictions, placing an enormous fiscal and personal burden on society. Many more are on the verge of becoming drug abusers. As a first step in prevention and treatment, it is essential that health professionals understand substance abuse from various perspectives as it is a multi-faceted and complex problem. In particular, the biopsychosocial effects of substance use and abuse is an area of scientific study that examines the immediate and long-term impacts of abused chemicals on biological, psychological, and sociological systems. The biopsychosocial model is a fully integrative approach to the growing substance abuse problem. Dr. Brian Kelly, the author of this online CE course and Department Chair, Neuroscience Program Advisor, and Associate Professor of Psychology at Bridgewater College notes that "substance abuse issues are reflected across the entire range of development and, as such, one must not just understand the variety of substances that are abused and their short- and long-term impact, but also be aware of how different developmental variables increase risk for use, abuse, and addiction…known within the field as a lifespan approach." A lifespan approach is critical when working within the area of substance use and abuse and allows for an analysis of behavior across the entire range of human development encompassing a variety of biological, psychological, and sociological changes that occur starting prior to conception through prenatal development, birth, and early childhood all the way through middle age, geriatric development, and eventually death.

Anchored in the biopsychosocial approach, this online CE course for mental health professionals extends beyond this model to present a lifespan approach to the prevention and treatment of substance abuse. Specifically, a theory- and evidence-based overview of the concept of addiction, the history of addiction treatment, basic types of drugs and their distinct effects, and implications for treatment planning and delivery are presented emphasizing important risk factors and substance abuse problems prevalent at each stage of development.

Psychologists, social workers, counselors, nurses and other allied health professionals can now chose from HFO's 19 categories of topics related to health psychology and behavioral medicine (i.e., ethics, cancer adaptation, women's health, cultural diversity, eating disorders, reproduction/sexuality, aging/gerontology, pediatric behavioral medicine, assessment, chemical dependency, chronic/acute illness, clinical intervention, group therapy, infectious disease, long-term care, neuropsychology, pain management, spirituality, LGBT issues) containing over 67 courses available online or as downloadable, transportable PDFs. Health professionals can log on and complete CE courses at their own pace, on their own schedule, anywhere they have Internet access. CE certificates can be downloaded, printed and reprinted at any time to meet licensure renewal needs. Lastly, since HFO understands that busy health professionals need to have fast, convenient and cost-effective resources for state-of the-science education, we notify customers when their purchased CE course has been updated and enable customers to review these updates for free online even after they have completed the CE activity and generated their CE certificate.

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Christian Nurse Forced to Assist in Late-Term Abortion

2009-09-25T11:26:00.000-07:00

A Catholic nurse who was forced against her will to assist in a late-term abortion procedure has filed a lawsuit against New York’s Mount Sinai Hospital.

With the legal help of Alliance Defense Fund, Cathy Cenzon-DeCarlo filed the complaint with the U.S. District Court for the Eastern District of New York on Tuesday.

Federal law states that hospitals that receive tax dollars cannot under any circumstances force employees to participate in abortion procedures.

“Pro-life nurses shouldn’t be forced to assist in abortions against their beliefs,” said ADF legal counsel Matt Bowman, in a statement Wednesday. “Requiring a devout, Catholic nurse to participate in a late-term abortion in order to remain employed is illegal, unethical, and violates her rights of conscience.”

He added, “[T]his nurse’s objections fell on deaf ears.”

A late term abortion occurs in the 7th, 8th, and 9th months of pregnancy when the preborn baby is nearly fully formed.

According to ADF, hospital administrators told Cenzon-DeCarlo that there was an “emergency” late-term abortion procedure that she must assist with or else face disciplinary action. She had repeatedly objected to being a part of the abortion process and the hospital reportedly has known of her religious objections to abortions for many years.

Moreover, documents indicate that the procedure was not an “emergency” and was not classified as such either.

Emergencies would be classified as “Category I” for “patients requiring immediate surgical intervention for life or limb threatening conditions.” This abortion procedure was classified as “Category II,” which needed to take place within six hours, providing enough time to find a different nurse to assist.

Cenzon-DeCarlo said based on her observations there was no indication that the abortion was a medical emergency, and that the patient’s condition did not even rise to a Category II.

The ADF legal team has requested a preliminary injunction that would order the hospital to respect Cenzon-DeCarlo’s religious objection against assisting in abortions and refrain from retaliation against her as the case moves forward.

Founded in 1994, ADF is a legal alliance of Christian attorneys who defend the rights of people to live according to their faith.
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Muslim women workers allowed to wear veils in hospitals

2009-09-21T11:19:00.000-07:00

The bishops' commission on interreligious dialogue has lauded the health department's move to allow Muslim women health workers to wear veils while on hospital duty.

On June 30, the Islamic Medical Association of the Philippines (IMAP) started distributing a Department of Health memorandum which states that female workers "should be allowed to use their veil (hijab) and wear their prescribed mode of dressing inside the premises of all healthcare institutions."

"In special areas where sterility must be maintained, veils must be treated equal to the hair," the document states. "They must be freshly laundered, covered by a surgical cap or worn neatly and changed when going out of the assigned area."

Father Carlos Reyes, executive secretary of the Episcopal Commission on Interreligious Dialogue considers the memorandum a "positive" development. He told UCA News that Muslim women wearing veils is "an expression of their religiosity and religious sentiment." He added that people have the "right" to practice their religious beliefs as long as public health and safety are safeguarded.

Even if the hospital is run by Christians, Muslim women should be allowed to wear their veil and traditional attire in less critical areas of the health facility, provided these do not constrict their movements, he added.

IMAP board secretary Doctor Naheeda Dimacisil told UCA News that Health Secretary Francisco Duque signed the memorandum on April 29 in response to the association's appeal for the protection of the rights of Muslim workers, students and trainees in hospitals. She said students reported restrictions in one hospital in Pasig City.

Dimacisil noted that in her six years of medical practice in Metro Manila, wearing the hijab (veil) "has never been a problem for me or other Muslim women doctors."

Even if not all Philippine Muslim women wear veils, she is "happy" that the Department of Health has given them the option to do so. Modesty as expressed in properly covering one's self is an Islamic value, she said.

Dimacisil said IMAP is circulating the memorandum and encouraging nursing students to demand a respect for their religious rights and to follow the directive on how to dress in critical areas of a hospital.

The IMAP was established in 2007 by a group of Muslim physicians to address issues related to health care for Philippine Muslims.

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Interactive learning delivered asynchronously on demand is a paradigm shift in the way patients are educated.

2009-09-18T10:50:00.000-07:00

For years, the nursing industry has reported high levels of job dissatisfaction due to poor scheduling, unrealistic workloads and hours, mandatory overtime and the lack of responsiveness to nurses' concerns.

These issues have lead to historically high turnover rates and an earlier retirement age among registered nurses.

In 2007, Pricewaterhouse Coopers' Health Research Institute reported in a study addressing nursing performance and quality of care that the average nurse turnover rate in hospitals is 8.4 percent, with the average voluntary turnover rate for first-year nurses reaching an astounding 27.1 percent.1

There are steps hospitals can take in-house to ensure a lower turnover rate, such as increasing their education services and nurse satisfaction levels with the implementation of an interactive patient care system. The implementation of emerging interactive technologies can empower staff, while increasing job satisfaction and decreasing stress.

Finding a Solution

With the baby boomer generation requiring more healthcare services, the declining number of nursing staff is responsible for more patients, resulting in an overloaded work force. In fact, according to a report from the National Center for Health Workforce Analysis, a high rate of nursing turnover has been linked to a prevalence of non-nursing tasks and a decrease in the time allotted for actual patient care.2 Not only does this trend negatively affect the morale of nursing staff, it also equates to inefficient nonclinical workloads.

Clear Lake Regional Medical Center in Webster, TX, installed an interactive patient care system to maximize the shifts of nursing staff. Clear Lake, a 595-bed medical center, has experienced an increase in the quality of care nurses are providing to patients.

The survey/questionnaire and automated service recovery functions of interactive patient education systems allow nonclinical workflow to be directly routed to the proper department. Hospitals are able to customize surveys and questionnaires for their patients to gauge different aspects of the patient experience. Part of the implementation process of the survey involves setting up reporting functionality so that, when a patient answers a question, the answer is e-mailed to the appropriate department, allowing for proactive action on the facility's part.

Whether used for discharge management or a meal order delivered directly to the dietitian, workflow efficiencies are streamlined, leading to increased nurse satisfaction and energy levels. In many cases, the on-demand education systems become so ingrained from an operational standpoint that it becomes a part of standard of care.

Jayne Schaffer, BSN, RN, discharge nurse of surgical units, has experienced first-hand the benefits of Clear Lake's interactive system.

"I discharge between six and 10 patients in an 8-hour time frame. I can show the programs to one set of patients as I am discharging and verbally instructing another," Schaffer said. "I find I have much more time to provide specific discharge instructions with the video on-demand films giving a comprehensive overview of the topics I need to instruct the patient or family with. It is a tool I use each and every day.

Staff Education

A rapidly changing healthcare industry and mandatory continuing education for nurses heightens the need for nurses to continuously expand their knowledge and skills. Even if staffing levels are sufficient to provide care, many nurses have not received enough on-the-job training to provide high-quality care. Research has associated formally educated nurses and positive work environments with significantly improved patient outcomes.

Additional development and training addresses the broader issue of self-worth for nurses as it pertains to the profession. Through continuing education courses provided via Clear Lake's on-demand education system, nurses can become more professionally competent, increase their knowledge base and meet state and other licensing/certification criteria.

The system's ease of use, as well as its full facility access, removes the burden of traveling to receive CE credits and makes the experience much more accommodating to a busy schedule. Using an education system decreases the challenge nurses face when trying to stay up-to-date on trends and treatments, broadening their outlook and ensuring patients see a benefit reflected in their treatment.

Patient Education

Interactive learning delivered asynchronously on demand is a paradigm shift in the way patients are educated. Information is transferred through a television or monitor, a move away from traditional educational methods and presentations. Television has become an effective tool in expressing abstract concepts or ideas.

By providing video education in synchrony in dual-sensory information, the stimulation achieves more optimal outcomes and aids in providing a more efficient means of the nursing staff's valuable time.

Susie Sonnier, MSN, RN, patient education coordinator, has a responsibility to ensure patients are receiving and retaining the proper information necessary to care for their condition.

"The on-demand education system has launched patient education to a new level since the incorporation in March of this past year. There are two buildings in our complex that have diverse services that create countless patient and family educational needs on a daily basis. As a patient education coordinator, I needed a time efficient and effective tool to place in the staff's hands to help me cover the enormity of needs and topics," Sonnier said.

"Our system augments my education canvassing of these services and units so each patient has an opportunity for education and information regarding their condition. The staff utilizes this tool at the point of contact with patients, thus making them a more caring and efficient caregiver. Many patients and their families have expressed much satisfaction with this tool and the positive outcomes it provides."

An interactive patient education system has the ability to interface with an electronic medical record system, supplying the patients with educational programming directly related to their condition. This focused educational content empowers the patient and family to take an active role in the recovery process.

With nurses as the ultimate point-of-care professional within the hospital setting, educating and informing patients with an on-demand education system can greatly reduce the amount of time nurses spend answering questions concerning the patient's stay in the hospital. It also delivers the education at a time convenient for the patient, equating to several hourssaved per work week and an environment for optimal patient care

Start Making a Difference Today

There are many ways hospitals can make a difference in their facilities. Take a close look at the educational system your hospital has in place. Is it applied efficiently? Does it have a positive impact on both the nurses' work environment and the patient's experience?

Begin researching the different types of educational systems available within the market place. Survey the nurses in the facility and find out what is needed to better serve patients, as well as increase their industry knowledge. By addressing workflow management, patient education and staff education proactively, the facility will see environmental improvements both now and in the future.

References

1. PricewaterhouseCoopers. (2007). What works: Healing the healthcare staffing shortage. Retrieved April 15, 2009 from the World Wide Web: http://www.pwc.com/extweb/pwcpublications.nsf/docid/674d1e79a678a0428525730d006b74a9
2. Department of Veterans' Affairs, Veteran's Health Administration. (2001, November). VA's response to the national nursing shortage. Washington, DC: Author.

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Why Nurse Stereotypes Are Bad for Health

2009-09-14T10:07:00.000-07:00

My husband was working recently on a New York Times crossword puzzle when he called me over. “Hey, look at this one.”

The clue was “White-cap wearer” and the answer was . . . Nurse.

What?! There may be nurses in the hinterlands who still wear white caps, but no nurse I trained with or work
with would be caught on the floor in a “nurse’s cap.” The outdated suggestion of wearing a cap raises the
hackles of every nurse I know.

In the new book “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” co-authors Sandy
Summers and Harry Jacobs Summers explore the dated and false images of nursing that still persist in the
media, ranging from popular television shows to the crossword puzzle. They cited a February 2007 Times puzzle that listed “I.C.U. helpers” as a clue. (The answer was RNs.)

“Helpers?” the writers asked with exasperated italics. That one word encapsulates their critique of how nurses
are typically portrayed on entertainment television, in movies and in most journalism.

Nurses are not “helpers,” the authors argue. Nurses work with medical doctors, but not for them. Hospital
nurses are hired and fired by other nurses, answer to a unit manager who is a nurse, and follow the protocols
set by more senior nursing officers. Health care works best when doctors and nurses communicate, but the
authors note that nursing is an autonomous profession and the formal management structure of most hospitals
keeps M.D.’s and R.N.’s separate and independent.

Maintaining a nurse’s independent status is about saving lives, note the authors. “One of nurses’ most
important professional roles is to act as an independent check on physician care plans to protect patients and
ensure good care,” they write.

In nursing school, we hear over and over that keeping patients safe is a crucial part of the job, but we
rarely see that role of nurses portrayed in the media. It’s not that doctors constantly make mistakes — they
don’t. But in the ordered chaos of the modern hospital it’s good to have the person who spends the most time
with the patient — the nurse — keeping a watchful eye on his or her patient’s care, and nurses feel that
obligation heavily.

Sandy Summers was an emergency department and intensive care nurse herself for many years and now runs a nonprofit advocacy organization called The Truth About Nursing. Her co-author, Harry Jacobs Summers, is a lawyer and senior adviser for the group.

“Saving Lives” is an important book because it so clearly delineates how ubiquitous negative portrayals of
nursing are in today’s media, particularly three common stereotypes of nurses — the “Naughty Nurse,” the
“Angel” and the “Battle Axe.” They argue that these images of nursing degrade the profession by portraying
nurses as either vixens, saints or harridans, not college-educated health care workers with life and death
responsibilities.

The popular medical television shows “ER,” “House,” “Grey’s Anatomy,” “Private Practice” and “Scrubs” receive the bulk of the authors complaints. They list numerous examples of nurses acting as “helpers” in these TV programs rather than autonomous and knowledgeable professionals. The writers also contend that these shows go out of their way to denigrate nurses and insult nursing as a profession. In one episode of “Grey’s Anatomy,"for instance, a male doctor insults a female doctor by calling her a nurse.

Another problem is that popular television shows often show doctors doing nurse’s jobs: giving medications,
checking I.V.’s, educating patients about treatment, and providing ongoing emotional support from shift to
shift. Of course, the focus of the storyline is often on the physician, so it may simply be easier to write
and follow if the doctors do all the work. A notable, but still controversial, exception is the new Showtime
program “Nurse Jackie,” which features Edie Falco as a capable and assertive nurse, although she’s also highly troubled and hardly a role model.

The problem with how nurses are portrayed in the media is that it has the potential to devalue the way we view nurses in the real world. The result is less support for important policy issues like short staffing and nurse
burnout.

I certainly never expected my beloved New York Times crossword to reinforce an outdated nursing stereotype.White-cap wearer, indeed! Nurses don’t need headgear to show the world what we do. It’s what’s inside of our heads that counts.

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Help desperately wanted

2009-09-11T06:59:00.000-07:00

Here's a suggestion for people with a death wish. Stroll through Windsor, Ont., or a Newfoundland outport, and chat up the older residents about their employment prospects. After you've listened to their tales about massive layoffs in the automotive sector and dried-up opportunities in natural resources, tell them that Canada is facing a labour shortage. Then start running.

Along with sticks and stones, your pursuers will hurl statistics at you. In May, the country hit its highest level of joblessness since 1998 - 8.4% - and staffing firm Manpower Canada reports that a mere 16% of companies are planning to hire new workers in the third quarter of 2009. Canada's GDP shrank by an annual rate of 5.4% in the first quarter of this year, its worst contraction since 1991. Those are dramatic numbers. But they're merely snapshots of the recent past, not a trailer for the feature film. What's coming soon to a city near you are workplaces that will be desperate for young, highly skilled workers. Unlikely as it sounds, Canada is actually in the midst of an ongoing labour shortage.

It's a shortage that will have a substantial impact across wide sectors of the economy as we pull out of the recession, and will grow over the years to follow. According to predictions from the Conference Board of Canada, Ontario may face a shortfall of 190,000 workers by 2020, while Quebec may be short 363,000 workers by 2030. The think tank predicts that British Columbia may be in need of 160,000 employees by 2015, while Alberta may have 332,000 unfilled positions by 2025.

The apparent contradiction between the unemployment rate, which is at an 11-year high, and a labour shortage can be explained by separating the current economic woes from the people in the workforce. The economy can turn around - for better or worse - in mere months, but overall skill levels and demographic patterns take years or decades to change, and it's these long-term trends that are behind the coming crunch. "Right now, with unemployment where it is, labour shortages are the furthest thing from people's minds," says Jim Milway, executive director of the Martin Prosperity Institute, a Toronto-based economic think tank. "But mark my words, this recession will end - whether in six, or nine, or 12 months - and those ‘Help Wanted' signs will be going back up."

To understand why, it helps to point out that the current overall employment situation is not nearly as bleak as the headlines suggest. The numbers are highly skewed by the carnage in manufacturing and construction. Since the spring of 2008, Canada has shed more than 200,000 manufacturing jobs, a staggering decline of about 10%, and lost an additional 100,000 jobs in construction. "Manufacturing of both durable and non-durable goods is the weakest we have seen in our surveys since the first quarter of 1978," says Lori Rogers, vice-president of staffing services for Manpower Canada. It's a rotten time to be a middle-aged auto worker, but routine-oriented physical jobs have been in decline for decades. These occupations have unemployment rates approaching 13%, with little hope for improvement.

The big picture looks quite different, however. Statistics Canada divides the Canadian workforce into two broad categories: the goods-producing sector (manufacturing, construction, agriculture, natural resources and utilities) and the service-producing sector, which lumps together everything else. This latter sector - which employs three and a half times more people than the goods-producing sector - has seen a net increase of 24,000 jobs in the last year. So while the demise of manufacturing jobs has meant hardship for thousands, the service economy is providing livelihoods for more than 13 million Canadians, and that number is growing.

True, recent job gains in the service sector have been modest, well off the growth we saw from 2006 through 2008. But that was during an economic boom and was unsustainable: We had three straight years of unemployment under 7%, a streak we've not seen since the 1960s, before women entered the labour force in significant numbers. In fact, the average annual jobless rate over the past 33 years has been 8.5% - a tick higher than it was in May. We've merely come down from Mount Everest and settled at sea level.

The current hiring freeze at many companies is not going to change the long-term trend. "The recession is actually masking a talent shortage, not only in Canada, but globally," says Manpower's Rogers. There's already a dearth of skilled workers in a wide variety of occupations. Many economists would classify a level of unemployment under 3% as an acute labour shortage, and creativity-oriented workers - a diverse group including scientists and technologists, managers and analysts, lawyers and accountants - now have a jobless rate of just 2.7%. "Unemployment among this creative class is up a bit because of the recession, but it's nothing compared with what you see among blue-collar workers," says Milway.

For example, in high-tech fields such as IT, demand for highly skilled workers remains strong. "I don't think it's ever easy to find good people," says Sarah Weiss, manager of campus programs for IBM Canada. Another sector where worker demand is strong is public administration - local, provincial and federal government departments and agencies, as well as courts and correctional institutions. In nursing, meanwhile, unemployment levels are a minuscule 0.6%, far lower than in any other profession. "There is a well recognized global nursing shortage," says Dr. Sally Thorne, director of the School of Nursing at the University of British Columbia.

And despite the fact that many Canadians seem eager to run their investment advisers out of town, the labour market for business and finance professionals is also tight. A 2009 Manpower survey ranks financial jobs number eight among hard-to-fill positions. Statistics Canada confirms that unemployment in the sector is a mere 2.7% - up from 1.9% in 2008, but still very low. "When it comes to business and finance, contrary to the general perception, in Canada it seems there is still a shortage," says Roger Sauvé of People Patterns Consulting, which specializes in the labour market.

It's worth stressing that creativity-oriented jobs like these are not a lone bright spot in an otherwise dark economic future. On the contrary, they are Canada's economic future, and will be the engine of growth in the years to come. As the number of creative jobs grows, Milway says, they create other opportunities in the service industries. More high-tech workers means more office cleaners to vacuum the cubicles; more accountants working overtime means more take-out restaurant visits on the way home. The Martin Prosperity Institute estimates that creativity-oriented jobs and the services they spawn will make up almost 90% of new positions by 2016. According to Milway, it will be difficult to fill all these new jobs, and while immigration will help, it won't be enough to prevent worker shortages.

Another major factor driving the shortage is our aging population. According to Sauvé, the number of workers aged 55 to 64 has doubled since 1989, while the number over 65 has increased by an astonishing 129%. When the Baby Boomers finally retire, they will leave enormous career opportunities in their wake.

The recession has merely slowed down this demographic inevitability. In many jobs, workers with seniority are the least likely to be laid off, and some workers have delayed retirement so they can rebuild their savings. All of which is creating obstacles for younger people getting jobs - but only temporarily.

The labour shortage will create winners and losers. On one hand, a tight labour market can create big problems for businesses. As companies are forced to raise wages to compete for fewer skilled employees, their costs go up. At the same time, however, a backlog of unfilled positions leads to a drop in production levels. This double whammy of rising costs and lower production is what economists call "wage-push inflation." It can slow economic growth, contribute to a lower overall standard of living, and make the country less competitive in the global marketplace.

The real casualties in Canada's evolving labour force will continue to be those who work in the goods-producing sector, especially manufacturing. Some will successfully complete retraining programs and find work in new fields. Many more, unfortunately, face years of hardship as they compete for a shrinking number of jobs in industries that continue their steady decline.

The winners, of course, will be those with the schooling and skills suited to the new economy. As companies demand more creative, highly skilled workers - a trend already well underway - young, well-educated Canadians can look forward to a fertile job market in the months and years ahead. In the sectors with the greatest needs, the small number of qualified workers should be able to demand higher wages and better working conditions. When the economy improves and these young guns are in high demand, look for them to push back against their employers, lobbying for more flexible hours and family-friendly policies.

The cloud of recession is still hovering above us, and there may be more rain in the coming months. But young Canadians and people in skilled fields can look forward to their day in the sun. "It sounds heartless to say this now," Milway says, "but high unemployment is not a long-term problem."

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