Two nurse anesthetists from Minnesota sacrificed their careers to pursue lawsuits against Allina Health Care, which ended with a settlement and changes to Medicare rules that helped save the profession, the Minneapolis Star Tribune reports. But despite the victory they helped bring about, Ladonna Schweer and Gayle McKay had to sue their own organization, the Minnesota Association of Nurse Anesthetists, in order to make the group honor its long-standing vow to compensate them for putting their ideals ahead of their jobs, the Star-Tribune reports.
Nurses often try to find ways to do more for the profession that they love. In many facilities, nurses make note of how they can help and lend a hand to those in need.
One nurse who is lending a hand to others is psychiatric nurse, Trisha Pearce. Pearce witnessed firsthand what the war can do to returning soldiers and their families when her brothers returned from Vietnam and the Gulf War.
Pearce, with more than three decades worth of experience in mental health and chemical dependency, did not want to see returning soldiers suffer without help, so she founded the Soldiers Project Northwest in 2007.
The project reaches out to veterans of the wars in Iraq and Afghanistan, along with active-duty personnel and military families. The project provides free, confidential, therapeutic counseling, and aims to educate communities on the psychological effects of the war. Volunteers also benefit from the project, and are able to receive training to better aid these soldiers and their families.
There are currently 57 volunteers involved with the project that is now an affiliate of the Los Angeles-based national Soldiers Project. Pearce volunteers more than 20 hours a week to ensure military families can receive the support they need. Named the Outstanding Female Non-Veteran of the Year by the Washington state Department of Veterans Affairs, Pearce rode in the Auburn Veterans Day parade alongside groups of veterans.
Another nurse who has been practicing for more than three decades is also leaving her mark and helping those hospitals in third-world countries.
After her first medical mission trip to the Amazon in South America, Mary McMahon, a nurse from Georgia, returned home and founded the nonprofit organization, Nurses for the Nations. The organization is gearing up for an 11-day trip to Liberia in January, where nurses will test for malaria, provide mosquito nets, and teach sanitation and proper use of the nets in six remote villages.
The philosophy of Nurses for Nations is to focus on one small region of the world at a time, which McMahon believes can inspire long-term change. McMahon plans to turn the organization's focus on another medically desperate part of the world during the next three to five years.
In March 2008, a task force was formed to review and revise the American Nurses Association's (ANA) Professional Development Scope and Standards of Practice. This document establishes the range of practice and the principles by which nursing staff development professionals conduct our professional lives.
It is no easy task to revise such an important document. Why undertake such a critical venture? To begin with, says task force member Dora Bradley, PhD, RN-BC, vice president of nursing professional development at Baylor Health Care System in Dallas, "it has been 10 years since the last version was created. There have been so many changes in healthcare as well as our profession, so we must look at the Scope and Standards in terms of how our roles have evolved." Bradley notes that, for example, technology was not even addressed in the most recent Scope and Standards.
"The new version of the Scope and Standards must also consider the fact that the continuing education target audience is now worldwide," she says. "We must think in terms of a globalization concept and how education needs can be assessed across the world. Simulation and virtual reality must also be incorporated as these teaching modalities grow in scope and importance. I remember someone saying that 98% of the change in the world has occurred in the last 100 years, and 90% of that change has occurred in the last 10."
The task force started by conducting an intensive literature review of training and continuing education in and out of the healthcare arena. The ANA mandated that the group create something "that would represent not only current practice, but a future trajectory to guide practice for the next five years," says Bradley. "We must create a 30,000-ft. view because our specialty has so many different arms where we practice, our roles, and practice setting, etc."
The task force identified specific future trends to be addressed. These include (Bradley et al., 2009):
Increased use of technology
Global target audience
Teaching/learning modalities
Evidence-based practice
Increased accountability
Increased interdisciplinary involvement
Fiscal management
Need for complex implementation expertise
Professional development metrics
Decreasing time to achieve competency
Generational differences, including the emerging adult (Tanner, Arnett, and Leis, 2009)
Escalating competing priorities
Knowledge management and succession planning
Increased need for clinical affiliations and academic partnerships
Move toward learning as an investment in human capital
Cost avoidance versus expenditure
Focus on transition into practice
Bradley says the "influence of the work environment became very apparent, which was not addressed in previous editions. Learning and practice environments have tremendous influence on how much of this role [as identified in the Scope and Standards] can be operationalized by the individual specialist. For example, a one-person staff development department can't do orientation, continuing education, research, etc., not when there is only one person doing everything. We must be respectful of the practitioner's practice environment."
There was a significant struggle as the task force altered the practice model. The former model was a triangle with three intersecting circles (continuing education, staff development, and academic education), which appeared to reflect the professional development aspects of the nurse.
The proposed new model is a systems model focusing on the practice of nursing professional development (NPD). The system includes inputs (environment, learner, NPD specialist), system throughputs (evidence-based practice, practice-based evidence, orientation, competency program, inservice education, continuing education, career development, research-systematic inquiry, scholarship, academic partnerships, pole of NPD specialist), and system outputs (outcomes, change, learning, professional role competence and growth). Note that academic education is now addressed via partnerships. Nurses in academia have their own set of competencies and a certification model separate from the Professional Development Scope and Standards. The proposed model is also more fluid, documenting inputs, throughputs, and outputs (Bradley et al., 2009).
The suggested changes were posted on various professional association Web sites, including the ANA and the National Nursing Staff Development Organization (NNSDO), for public comment. Education requirements generated the most buzz: The task force proposed that educational preparation for NPD specialists be a master's degree in nursing. This is controversial because many NPD specialists have a master's degree in education. Due to public comment, the proposal has been changed to a master's degree in nursing or appropriate related discipline such as education.
However, if the master's degree is in such a related discipline, the NPD specialist must hold a baccalaureate in nursing. Additionally, the task force recommends that executive leaders for NPD be RNs prepared at the doctoral level in nursing or education. At a minimum, department administrators are strongly encouraged to have a master's degree in nursing or related field.
When will the revisions be published? At presstime, the task force was working to approve the final revisions and submit them to the ANA. The ANA must guide the proposed document through its approval process, and hopefully, the new version of the Scope and Standards will be ready to print in the first quarter of 2010.
Bradley points out that the task force received about 30 pages of public comment pertaining to the proposed document. She notes that this is comparable to feedback received from other specialties, which have more practitioners, when their Scope and Standards undergo revision. Professional development specialists are obviously deeply committed to their specialty and the way they practice.
Those of us involved in this specialty would be wise to incorporate the future trends identified by the task force into our practice settings. The effect and the rapidity of change greatly influence how we incorporate these trends. The new Professional Development Scope and Standards should be used to enhance our professional growth and development as well as our practice initiatives.
References
Bradley, D., et al. (2009). "The Past, Present, and Future: The Evolution of the ANA Nursing Professional Development Scope and Standards." General session at the 2009 NNSDO convention, Philadelphia.
Tanner, J.L., Arnett, J.J., and Leis, J.A. (2009). "Emerging Adulthood: Learning and Development During the First Stage of Adulthood." In M. C. Smith & N. Defrates-Densch (Eds.), Handbook of Research on Adult Learning and Development, 34–67. New York: Routledge.
This article was adapted from one that originally appeared in the December issue of The Staff Educator, an HCPro publication.
Students, state legislators, journalists, and nurse advocates held a press conference at the Connecticut Legislative Office Building to protest the cut of a state-subsidized nurse-training program. Gov. M. Jodi Rell recently decided to suspend the heavily subsidized program to save $1.7 million to help close a $600 million deficit in the state budget. Advocates said suspending the program is short-sighted, not only because a nursing shortage looms in the future, but because jobs are so scarce. The press conference was organized by District 1199, New England Health Care Employees Union.
Peer Assistance Services, a Colorado nonprofit organization that provides guidance, support, and rehabilitation services for healthcare professionals, has seen an increase in nursing clients this year—a majority of whom needed help for alcohol and drug abuse.
But, the growing number of nurses seeking treatment for substance abuse doesn't necessarily reflect a growing problem, according to Rebecca Heck, BSN, RN, MPH, program director of the Nursing Peer Health Assistance program at Peer Assistance Services in Denver.
"We are seeing more nurses come forward, but the problem of substance abuse among healthcare professionals mirrors that of the general public," she says. "I don't know if there is an actual increase in the problem or if nurses are becoming more comfortable coming to us for help."
Heck attributes recent media attention surrounding drug thefts by Colorado healthcare professionals as influencing more nurses to seek treatment. The most recent being the case of a former Rose Medical Center surgical technician, Kristen Diane Parker, who admitted to stealing fentanyl-filled syringes and occasionally swapping them with her used syringes filled with saline. The Denver Post reports that 20 patients appear to have contracted hepatitis-C from Parker as a result.
"I think the stigma is still there and is powerful," Heck says. "But this is making the front page and people are getting scared and realizing they need help."
Treatment plans through the Nursing Peer Health Assistance program are individualized depending on nurses' needs and range from one to five years. Rehabilitation requirements can include therapy treatment, psychiatry, pain management, urinary analysis testing for drugs and alcohol, 12-step groups, sponsorship with a 12-step participant, and peer support groups. Any deviation from the rehabilitation may result in a referral to Colorado's Board of Nursing, in which a nurse may deal with consequences, such as a suspended license to practice or a public discipline in the form of stipulation.
"We want to lead nurses to treatment and monitor them to hold them accountable for that treatment," says Heck.
Literature shows that anywhere between 8%-12 % of nurses have substance abuse disorders that affect their ability to practice, says Heck. Studies have found prescription medication use to be higher among nurses than in the general population, while marijuana and cocaine use has been found lower among nurses than in the general population.
Aside from the easy access of prescription drugs on the job, a number of factors make nurses and other healthcare workers at high risk for substance abuse.
"The culture amongst all healthcare professionals is that we know how the drugs work, so therefore we think we can control them," says Heck. "But they control us like they do everyone else."
Nurses' often stress-filled and lengthy work shifts and nature to "take care of others—not ourselves" are other risk factors, says Heck.
Clients receiving Nursing Peer Health Assistance services complete intensive portions of treatment before returning to work. However, some practice while receiving less serious forms of support with approval from Peer Assistance Services, a therapist, a psychiatrist, or other treatment provider.
Nurses' identities are kept confidential, but they are required to disclose of their participation in the program to their nurse managers.
"Our number one goal is public safety," says Heck. "If a nurse relapses, whether through behavioral symptoms or positive drug tests, we remove them from work within 24 hours and we inform the nurse manager. But then we also make sure the nurse gets treatment."
Heck believes increased education about the causes of and prevention of substance abuse in nursing school and in the profession is needed to minimize the problem and push more nurses to get help.
"Nurses, risk management, and nurse educators do all of this work to make hospitals safer for patients, but we are all missing this huge element; to make nurses safer to provide patient care," says Heck.
When people in healthcare hear the word simulation, they generally think of a computerized mannequin that talks, breathes, and has other human physiological characteristics. Though the development of this human patient simulator, or HPS, has been able to serve as a breakthrough in the teaching/learning environment, there is more than meets the eye with the whole field of simulation.
Human patient simulation
HPS technology has been in use for about the last 10 years in some fashion. Implementation of HPS technology originally gained the most attention in nursing and medical schools, where its use continues to proliferate as new users encounter this technology for the first time.
More recently, such technology has made its way to the clinical practice arena and is used for orientation of new graduate nurses, ongoing staff development, staff competency assessments, required courses such as ACLS and PALS, and team training exercises for interprofessional education.
HPS technology is considered high fidelity, meaning that it is more lifelike than the older mannequins that did not respond via voice or change in physiological parameters when an intervention occurs. For example, high fidelity HPS technology can make a palpable pulse go away when there is ventricular fibrillation or asystole on the cardiac monitor, raise and lower the blood pressure in response to a drug being given, etc.
Standardized patients
There are other simulation teaching/learning modalities that can be used in concert with HPS technology or by themselves. Standardized patients, or trained medical actors, have been used in medical schools for the past 40 years to help medical students interact with real human beings. The use of SPs, as they are referred to, is gradually started to grow in nursing schools. SPs can act not only as a patient but as a family member or a disruptive colleague. This is particularly important, say, when staff development educators are trying to teach clinicians about teamwork and how to assertively speak up if they see something wrong.
For example, a "confederate," (also referred to as a disrupter), SP can act as an overbearing physician who adamantly insists that a nurse give a drug, even though it is not appropriate in that particular clinical situation and giving that drug could cause extreme harm or death to the patient. During the simulation activity, the nurse can learn how to effectively confront this confederate with good communication skills, which are an essential part of teamwork and patient safety.
Serious games and computer interactive devices
Other simulation modalities include serious games, which are essentially video games that are designed to teach concepts in an immersive computerized environment. The same game development technology that is used to build entertainment-focused virtual game worlds where "players" interact online using avatars (onscreen representatives of themselves), can be used to build learning games. Since the average age of video game players is now almost 40 years old, many in the workforce are very comfortable with this technology and would naturally be adept at learning this way.
Medical and surgical simulators, including devices that teach bronchoscopies, endoscopies, surgical procedures, coronary angiography, and many other skills, are proliferating in use. Computer interactive devices that teach IV insertion and IV therapy skills can be used for many different levels of providers, including paramedics, nurses, physicians, physician assistants, etc. Investment in these simulator devices, particularly for high-risk skills, can truly pay off in the long run.
Teaching teamwork
With patient safety being paramount, many institutions are using simulation modalities to teach and enhance interprofessional team training. One model that is commonly used is the Agency for Healthcare Research and Quality and the Department of Defense's TeamSTEPPS system, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety. Since healthcare teams are often contingency teams where the individuals do not necessarily work together on a regular basis (unlike a football team), there is even more need to make sure that all staff are trained in good teamwork and communication skills as they are not likely to know each other's capabilities and weaknesses.
Using simulation techniques can provide a safe and effective environment for all levels of staff to learn and interact with others on the healthcare team. More information on TeamSTEPPS can be found at http://teamstepps.ahrq.gov.
Competitive advantage of simulation
One of the major challenges that permeates simulation methodologies is cost. HPS can run tens of thousands of dollars for the initial investment alone. SPs are generally paid hourly not only for their simulation time, but for their rehearsal and training time for each character that they portray.
Serious games can be expensive for an initial startup, but once built, that technological platform can be used to produce different immersive learning scenarios very efficiently and effectively. Medical and surgical simulators, though costly, can be used extensively and with many learners over a long period of time. Even with the cost issue, these methodologies are extremely important to implement if institutions wish to remain competitive.
For example, students who are graduating from nursing and medical school have now been generally exposed to some type of simulation teaching/learning during their educational program. They naturally expect the institutions at which they will work will also have the same technology and employ the same teaching/learning strategies. Having a solid simulation program at an institution where the equipment and infrastructure are in place, along with well-trained and enthusiastic staff development personnel, can only be a plus for recruitment and retention of staff. In addition, simulation has been shown to increase learner retention and engagement. As noted previously, it provides a safe alternative to learning and practicing difficult skills since no real patients are involved.
One way to control costs is to partner with the healthcare professional schools in the local region. Regional simulation centers are growing around the country, and sharing of resources can help control costs for all involved. In addition, it can have the added benefit of bringing together diverse learners who might not otherwise interact. Multi-environment simulations can also be done in these centers, such as an EMS transport to the emergency department, then a transfer to the ICU, and then a transfer to the operating room.
The technology for simulation modalities is continually improving as companies respond to user requests for more and more capability. Institutions need to jump on the bandwagon or will eventually get left behind as this progression occurs.
For more information on the many uses of simulation, go to the Society for Simulation in Healthcare Web site at www.ssih.org.
Mary Holtschneider, RN, BSN, BC, MPA, NREMT-P, is the director of nursing practice and education for the North Carolina Nurses Association in Raleigh.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.