Scientists are reporting in a new study that mammography is not an effective screening tool for women in their 40s because a tumor and the patient's tissue appear to be the same color.
Stanford University researchers reporting in the Journal of the National Cancer Institute said while the screening technique works best for women older than 50, the denser tissue of younger women tends to obscure tumors.
For years, doctors have known that tumors and dense tissue tend to appear white on a mammogram. In women who have undergone menopause, breast tissue often appears gray on a mammogram, so the sharp color contrast of the tumor is not as difficult to miss.
The State Board of Health rejected a petition Wednesday to add Tourette's syndrome to the list of conditions for which patients can obtain medical marijuana.
It was the first time in the 10-year history of Colorado's medical-marijuana law that a petition to add a new condition had made it through the state health department's review process and come before the board. The decision suggested that the board will require a high standard of proof before allowing new conditions to go on the list.
Board members expressed concerns over the health impacts of smoking marijuana, noted that there are other medications that could be used to treat Tourette's and concluded that the research wasn't evolved enough to show that marijuana would be useful in treating Tourette's.
"I don't see what we add to the mix by actually adding Tourette's under these circumstances," said Glenn Schlabs, the board's president.
Nine workers at the Northwoods Rehabilitation and Extended Care Facility have been named in a 175-count indictment charging them with not properly caring for an incapacitated patient and falsifying records to make it appear they did.
Authorities allege the resident was often left in the same position throughout an entire shift.
Nursing staff members are accused of failing to administer medications, as well not treating the resident's bedsores and failing to check the resident for incontinence or change undergarments for long periods of time.
The following people were named in the 173-page state attorney general's indictment handed up in Rensselaer County Court:
The continuing debate over healthcare reform legislation has focused national attention on complex issues such as high cost, overuse of technology, significant gaps in quality, access to services, and consumer satisfaction. Although the future system of healthcare remains unclear, the solutions to these issues will undoubtedly need to be both innovative and comprehensive in order to address the needs of an aging population and the millions of previously uninsured Americans who will be entering the system. In this new horizon, nurses will continue to play a key role in providing efficiently orchestrated care, reducing length of stay, achieving desired quality outcomes, and managing costs.
These challenges will require what Health Affairs terms a high-value workforce—one with the ability to quickly assess patient needs, develop comprehensive plans of care, and work within the health system to marshal the resources needed to attain necessary outcomes.
Key to maintaining and building a high-valued workforce is the retention of experienced nursing staff with advanced problem-solving skills and an understanding of the healthcare environment developed over years of service. Typically these attributes can be found and cultivated in nurses within the age range of 40 to 60 years, who have, during their career, witnessed an evolution in the healthcare system, including significant changes to the system of care delivery, third party payment, technology, internal and external organizational structures, and focus on public reporting of quality data and care outcomes. The 2004 HRSA National Sample Survey of Registered Nurses indicated that 59% of currently licensed RNs are between the ages of 40 and 59 years of age, indicating a substantial resource.
In an effort to retain a high-value nursing workforce, nurse leaders tend to initially focus on salaries. Although in most studies salaries continue to be an important work satisfier for nurses, this alone will not retain the talented nursing staff necessary to meet current and future demands. One critical factor is for leadership to be committed to creating a culture that values the depth of knowledge and skill that a seasoned nurse brings to the workplace, provides a sense of job satisfaction, and inspires organizational commitment. This is only attained through an atmosphere of mutual trust, collaborative decision-making, and meaningful recognition for clinical excellence.
Strategies to create this culture begin with an understanding of the individual and collective staff values and needs. This type of understanding will develop a workplace where individuals have a sense of organizational fit and belonging which leads to retention. Providing forums for collaborative decision-making on schedule development, policies, and individual responsibilities is key. Encouraging staff to participate in the decision-making process will help unite them as a unit and develop a strong sense of ownership.
Another culture building strategy is to assign seasoned staff to mentor less experienced nurses. Typically, mentoring occurs only during orientation or with new graduates. However, these experienced high-value nurses are repositories for professional knowledge and skills that have yet to develop in other staff members. Designating mentors allows the rest of the staff to seek guidance in a safe environment and properly recognizes seasoned nurses as invaluable experts while creating closer bonds with the staff and organization.
Creating meaningful rewards for the tenured staff has long been overlooked as a strategy to retain high-value nurses. Salary compression has been common with salary dollars focused on competitive wage rates to attract new recruits, especially new graduates. Other ways of recognition and reward for high-valued nurses may be to decrease the holiday commitment for nurses with 20 or more years of tenure, provide a bonus structure based on contribution, and/or assigning unlicensed personnel to work under their direction to lower the physical stress.
Although the solutions to the complex problems related to healthcare reform will not be easy, every bit of talent is needed to fashion successful new systems. A high-value nursing workforce with members who can use their individual and collective knowledge to structure new avenues to meet patient needs is an essential component. Retaining the current resources present now will serve as the key to future success.
Bonnie L. Barndt-Maglio, PhD, RN, is a vice president at the Camden Group, where she specializes in incentive management and other ways organizations can substantially improve current operations while successfully navigating likely healthcare reform initiatives.
Does your organization have a process for clinical advancement? Do many nurses pursue advancement, or do they feel there are barriers?
At Yale-New Haven (CT) Hospital, Pina Violano, MSPH, RN-BC, CCRN, PhD(c), was concerned that too few nurses took advantage of the clinical advancement program offered by her organization. Violano is now the injury prevention coordinator for the trauma department, but at the time she was a clinical nurse educator in the Center for Professional Practice. She says only 50% of nurses participated in the program and less than 0.2% achieved Clinical Nurse IV, the highest level of practice (Pellico & Violano, 2010). As a result, she felt there was a serious problem.
“As an educator, I was concerned that so few nurses were completing the application process to advance clinically,” says Violano. “I believed that nurses needed a voice to prepare themselves to attempt clinical advancement.”
She realized that nurses needed help preparing their application portfolios for advancement, which consist of a letter of intent, clinical narrative or exemplars, curriculum vitae (CV), a self-evaluation, and clinical practice goals. A completed portfolio is submitted to a formal committee that meets four times per year to review applications.
For nurses to begin the advancement process, the first step is to inform their manager of their plan to apply by submitting a letter of intent. After the manager gives the okay, nurses prepare the portfolio.
“I found that many nurses were intimidated by the process,” says Violano. So she developed a formal, daylong class where nurses could gather and work on the application process.
Class content
The class size was limited to 12, allowing for individualized attention and small group discussions. It was also the maximum number of people who could be accommodated in the computer lab.
“It is important that all participants have computer access since they actually work on writing letters, CVs, etc., in the classroom setting,” says Violano. “The goal is to have as much of the application portfolio completed by the end of the class as possible. In fact, about one-third of the class is generally able to complete their entire portfolios by the end of the day.”
Before the nurses could work on writing their portfolios, though, they needed help with computer and writing skills. “I found that even though we are extremely electronic in our organization, nurses still lacked typing and writing skills,” says Violano.
The class also had in-depth discussions on written and verbal communication skills. They reviewed tips for communicating with managers as well as how to compose a letter of intent. Several templates were presented to help participants formulate their letters.
CV development
During the class, Violano likened writing a CV to writing a storybook of participants’ professional careers. A template was developed so that nurses simply had to fill in critical information, individualizing the template to their own careers.
Nurses needed a lot of help with identifying activities and accomplishments to include in their CVs. “They tend to underestimate the skills and knowledge they possess,” Violano says.
Clinical narratives and self-evaluations
Although templates were useful for some aspects of portfolio development, they were not suitable for clinical narratives (exemplars) or self-evaluations. Exemplars require nurses to tell a story about their clinical decision-making and collaboration and how they positively affected a patient.
Nurses, in general, are not accustomed to praising themselves. Violano used the book Women’s Ways of Knowing: The Development of Self, Voice, and Mind to help participants find their professional voices and express themselves in writing. The concept of finding one’s voice includes learning to express oneself, taking credit for successes, exploring areas for improvement, and identifying future goals and ambitions. The classroom setting provided a safe, supportive environment in which nurses could create their exemplars and reflect on their nursing practice.
In the next segment of the application, the self-evaluation, nurses must reflect on the current state of their practice and areas where they can improve. The candor and thoughtfulness of these reflections allows the clinical advancement committee members to gain insight into applicants’ attributes and self-awareness.
Identifying professional goals
An important step in assembling a portfolio, is to identify measurable professional goals. Violano did not simply help write these goals; she also provided resources to assist nurses in meeting them.
“If someone says she wants to go back to school, I make it a point to have college catalogs available for them to look at,” she says. “Some may say they want to become more involved in professional associations, so I make sure that I have information about associations available.”
About 87% of the nurses who attended the classes have advanced on the clinical ladder. They report that having a nurturing environment to work on their portfolios was a great benefit.
Clinical advancement is an important retention tool. But, Violano points out, the real impetus of this program is the professional development of staff.
References
Belenky, et al. (1986). Women’s Way of Knowing: The Development of Self, Voice, and Mind. New York: Basic Books, Inc.
Pellico, L.H., & Violano, P. (2010). “Creating a Room of Our Own.” Journal for NursesinStaff Development 26(3): 104?107.
________________________________________________________________________ This article was adapted from one that originally appeared in the September 2010 issue of Briefings on Evidence-Based Staff Development[http://www.hcmarketplace.com/prod-2771/Briefings-on-EvidenceBased-Staff-Development-formerly-The-Staff-Educator.html], an HCPro publication.
An infectious-disease nightmare is unfolding: Bacteria that have been made resistant to nearly all antibiotics by an alarming new gene have sickened people in three states and are popping up all over the world, health officials reported Monday.
The U.S. cases and two others in Canada all involve people who had recently received medical care in India, where the problem is widespread. A British medical journal revealed the risk last month in an article describing dozens of cases in Britain in people who had gone to India for medical procedures.
How many deaths the gene may have caused is unknown; there is no central tracking of such cases. So far, the gene has mostly been found in bacteria that cause gut or urinary infections.
Scientists have long feared this — a very adaptable gene that hitches onto many types of common germs and confers broad drug resistance, creating dangerous "superbugs."