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    Trends in Nursing, Part 3: What nurses should do to prepare for the future

    May 12th, 2014

     

    Nursing is a growing profession. In the United States, there are 2.7 million registered nursing jobs today, and experts predict an increase of 19% by 2022. Both Australia and the United Kingdom are working to address workforce shortages.

    As the industry continues to change, nurses can prepare today to make the most of tomorrow’s opportunities.

    To help honor the profession during Nurses Week (May 6 – 12), we interviewed nursing leaders around the world. Here are some of the highlights of what they shared on this subject:

    What should nurses do today to help them prepare for changes coming over the next 2-3 years?

    “I believe nurses have to position themselves to be there very best. What does that mean? Nurses need to have advanced degrees — at minimum a Bachelor’s degree perhaps even a Master’s degree and looking in the future towards a doctorate !   I believe nurses need to be certified in their respective areas. I think that nurses need to be savvy with technology. I think that nurses need to be compensated in many different ways.  Nurses also need to learn to be business people; They need to understand that their profession requires them to be savvy and articulate in many other areas such as finance, healthcare updates, trends of the future and a clinical expert in their own area of expertise.  

    “I believe nurses are not as involved in politics and or specifically policy development and they should be. Because any policy that is established through our government to CMS who establish regulations for health care affects the hands-on registered nurses. Finally I think that Nursing needs to understand the value of working with elderly nursing colleagues.

    “Nursing is complex and dynamic at the same time. What a great profession.”

    Jeanine Frumenti, DNP, RN, Chief Nursing Executive

    Bronx-Lebanon Hospital Center

    Bronx, New York, U.S.A.

     

    “Nurses need to be open minded…and managers need to provide strong leadership and help staff realize the benefits of electronic patient records. Realize that a lot of planning, research, clinician input and ongoing work goes into these systems.”

    Helen Carter, Corporate Matron

    Salford Royal NHS Foundation Trust

    Salford, United Kingdom

     

    “Nurses need to understand the continuing importance of their role. By that I mean we’re the only healthcare providers who are trained to keep the whole patient in perspective. We care for the psychosocial, physical and emotional aspects of patients’ well-being. Nurses serve as advocates for patients by helping them navigate the complexities of an illness or a hospitalization.  And sometimes, the nurse is that voice that offers support to patients making critical healthcare decisions or finding peace at end of life.

    “With the changes in health care, there is an even bigger role for nurses. They’ll have a whole new series of opportunities with population and community-based health care. I’m excited that nurses get to do something new again.”

    Karen A. Grimley, Chief Nursing Officer

    University of California, Irvine Medical Center

    Orange, Calif., U.S.A.

     

    “We are in the era of smart technology and medical innovations. I believe nurses should be “tech” savvy. To be relevant and well informed, nurses should step up to the Allscripts celebrates Nurses Week with wisdom from nursing leaders on blog.allscripts.comchallenges and be more proactive in acquiring new knowledge and skills to better equip them. One of the ways to be updated is to read up on medical and nursing informatics journals and also to be updated in basic/intermediate level of computing skills.

    “Also we have to keep in mind with the advancement in technology, it will not only streamline and speed up the process on information retrieval, there is also a raising concern on IT security. Such fraudulent acts as stealing identities and bank records are quite common nowadays, soon it could happen to the hospitals too.  So I think more education needs to be given for nurses on IT security, this will help to safeguard the nursing practice and protect the best interest of our patients that we take care daily.”

    Khairunnisa Ahmad, Senior Staff Nurse

    Singapore General Hospital – SingHealth

    Singapore

     

    “As to how to prepare for changes, the nurses just need to remain flexible and open to what is coming forward. They need to keep educated on the trends coming forward, work with their professional organizations, work with nursing leadership to help with changes needed and just have an open mind as to what the future holds. Obtaining additional education and certification is also needed.”

     Jill Mason, RN, MS, Chief Nursing Officer

    Blessing Hospital

    Quincy, IL, U.S.A.

     What do you think nurses should do to prepare for the next 2-3 years? Please add your thoughts in the comments below.

    Editor’s Note – “Save one life, you’re a hero. Save 100 lives, you’re a nurse.” To share this idea and wisdom from nursing leaders, click here to tweet.

    Check out other posts in this Trends in Nursing series: 

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    Trends in Nursing, Part 2: What healthcare IT improvements would most help nurses

    May 7th, 2014

     

    Nurses are on the front lines of all aspects of health care. Their many responsibilities include adopting and making the most of new technologies and electronic systems.

    To help honor the profession during Nurses Week (May 6 – 12), we interviewed nursing leaders around the world. Here are some of the highlights of what they shared on this subject:

     

    What healthcare IT improvement(s) would be most helpful to nurses? Or how can IT help nurses?

     

    “Machine device interfacing to online records and documentations would be most helpful to nurses as this would truly provide the much touted seamless transition of patient data from point to point and free the nurses to focus on patient education and bedside care.

    “Not only that, with the creation of a single source of medical records which is accessible by all healthcare provider, allows the nurses to understand the extent of care for their patients as well as provide the basis for more evidence based nursing care.”

    Annabelle Neo, Nursing Informatics

    Singapore General Hospital – SingHealth

    Singapore

     

    “This is certainly a challenging question and it is very specific to the age group of the workers. I would say that the electronic medical record (EMR) — utilizing decision-support with its alerts, reminders, sharing of information among providers, the ability to auto populate information — is certainly most helpful to clinicians as they are operating in a highly stressed and busy environment.

    “I also believe that having the technology available to review the literature online on protocols practices diagnoses to allow that the clinician to working in evidence-based environment is of utmost importance. In addition I think that smart pumps and other technology that can interface with an EMR certainly is helpful to the clinicians should have redundancy is reduced. Finally I think that technology such as voters and tablets allow clinicians to conduct their work without running to the nursing station and tracking people or information down; It’s at their fingertips. 

    “I believe technologies are beneficial when used properly and we educate our teams effectively to maximize their usage. When we do not rollout or educate them and re-educate them on changes and easier methods to obtain the information they need, that’s what I think technologies become a drawback and hindrance to them.”

    Jeanine Frumenti, DNP, RN, Chief Nursing Executive

    Bronx-Lebanon Hospital Center

    Bronx, New York, U.S.A.

     

     

    “I believe that having more hand held IT tools will be essential for the nurse to have. I see iPhones being used more in order for the nurses to communicate verbally or by text. These devices should be connected to the call system, to bed alarms, monitors and IV pumps. This should save the nurses time and provide a safer environment for the patients, which in turn should improve the patient experience.”

    Jill Mason, RN, MS, Chief Nursing Officer

    Blessing Hospital

    Quincy, IL, U.S.A.

     

    “The saddest thing about automation is that we sometimes lose the story of the patient. Even the most engaged, enlightened groups who design these systems – it’s such a process – we create a very cumbersome tool with a lot of exceptions. We’re not charting to normal; we’re charting exceptions. We may be capturing a lot of data elements, but we don’t have a good picture of who Mr. Jones really is. We’re working with our IT department to re-establish our vision for nursing and what documenting should capture.”

    Karen A. Grimley, Chief Nursing Officer

    University of California, Irvine Medical Center

    Orange, Calif., U.S.A.

     

    “No one wants to harm patients; we come to work every day to help them. IT needs to support that mission, not hinder it…The electronic system needs to become completely second nature. Whereas you would have had a piece of paper that seemed very accessible, the IT system needs to replicate that and make documentation legible and clear.”

    “It’s crucial that staff can see what the real benefits are to patients…The health care in England is currently so high-pressured and busy. If nurses perceive it will be extra work, they will not be supportive.”

    Helen Carter, Corporate Matron

    Salford Royal NHS Foundation Trust

    Salford, United Kingdom

     

    What improvements in healthcare IT do you think would most help nurses? Please add your thoughts in the comments below.

    Editor’s Note – “Save one life, you’re a hero. Save 100 lives, you’re a nurse.” To share this idea and wisdom from nursing leaders, click here to tweet.

    Check out other posts in this Trends in Nursing series: 

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    Trends in Nursing, Part 1: How the shift to new care models affects nurses

    May 5th, 2014

     

    Nursing is the world’s largest healthcare profession. As the industry evolves to new models (such as value-based care*), it significantly affects nurses in acute settings, home care, case management, clinics and all venues of care.

    To help honor the profession during Nurses Week (May 6 – 12), we interviewed nursing leaders around the world. Here are some of the highlights of what they shared on this subject:

    How is health care’s shift to value-based models affecting nurses in your organization?

    “I think in a positive way. We focus on communication and on setting and sharing expectations, using value-based equations to explain why these are the right things to do. We work hard to make sure our goals tie together – from the University of California, to the department, to the individual.

    “For example, about 18 months ago we held a 4-hour training for all nursing staff and leadership in the inpatient environment, focused on communication, compassion and comfort at the bedside. It was a reminder of our overall care delivery model and we re-committed to doing these things every day in our jobs. Our outcomes have improved, because we’re strengthening the infrastructure. These are the right processes for patient care.

    “Through value-based models, we can tie our daily actions to goals that make sense. People here are connected to our progress.”

    Karen A. Grimley, Chief Nursing Officer

    University of California, Irvine Medical Center

    Orange, Calif., U.S.A.

     

    “As the Singapore government moves towards measuring patient outcomes as part of the key indicators for the industry, the impact of value-based model of healthcare will be most keenly felt when the nurses have to rely more on technology to meet these outcomes.

    “Quality care has always been a part of bedside nursing but with the reliance on technology to provide efficacy, majority of nurses have felt that the value of nursing has changed from quality to quantity. Thus, this has begun to pose a challenge to them in accepting changes in the way nursing care is carried out and documented.

    “However, there are the minority few nurses within the organization who shares the same goals of a value-based model to provide affordable care to patients. These are the nurses who will be able to fully appreciate the shift in healthcare model and be able to benefit both their patients and themselves.”

    Annabelle Neo, Nursing Informatics

    Singapore General Hospital – SingHealth

    Singapore

     

    “Value-based models are causing us to look at providing care in different ways. We now have an outpatient care management team that works with the patients in our physician office practice to try and keep them out of the hospital by case managing them there in place of just the hospital. Our staff has to be more in tune to assuring we have things properly documented as well as assuring that the quality measures are met 100% of the time. We have been able to utilize the EHR to assist with this by providing care maps, discharge education forms, tracking of measures, etc.”

    Jill Mason, RN, MS, Chief Nursing Officer

    Blessing Hospital

    Quincy, IL, U.S.A.

     

    “About 85% of Salford Royal NHS Foundation Trust’s nursing records are now electronic, and I think staff recognize the advantages of using this system. For example standardized and structured documents. The system ensures we can standardize care and improve patient safety…More than anything it has changed our culture. With electronic documentation there is a really clear audit trail, which increases accountability and quality of care.

    “You can measure outcomes much easier than you could before. As a Ward Manager, you look at those things on a regular basis. You have your objectives and can tell the electronic system what to audit — things such as drug doses, patient evaluations — at the click of a button. It definitely has improved patient safety.”

    Helen Carter, Corporate Matron

    Salford Royal NHS Foundation Trust

    Salford, United Kingdom

     

    “Value-based models have created an interesting phenomenon among nurses in an organization. As nurses are educated to manage the art and science of nursing — which is compassion, kindness, communication and the actual science of medicine — the art has become a greater focus than the science of nursing.  

    “Senior leaders have been focusing on the science of nursing using evidence-based methodologies.  Magnet status encourages the science of nursing becoming a certified, strong evidence-based leader in the field.  

    “I believe that value-based purchasing is creating an increased workload for the nurses and even decreasing the performance outcomes.   As nurses diligently work their shift they deal with factors of staffing, such as a poor working environment, operational failures, and high turnover of patients during the day. This increased workload also enhances the decrease in nursing satisfaction. In addition there is a huge burden in documentation related to the increased number Admission Assessments that the nurse has to conduct based on the volume as well as the requirements of our regulatory bodies.

    “The final piece of this which is probably the most significant is that with a lower, value-based reimbursements can create budget cuts, which in turn will decrease the number of nursing and other staff. Those who remain will be required to do the same or a greater job to manage patient care. I do believe we should see nurses as customers although they are non-billing customers. They are essential to the operation of the organization, sustaining the life of the organization, and the financial reimbursement. We need to be sensitive that their words and voices must be heard.”

    Jeanine Frumenti, DNP, RN, Chief Nursing Executive

    Bronx-Lebanon Hospital Center

    Bronx, New York, U.S.A.

     

    How do you think the shift to new care models affects nurses? Please add your thoughts in the comments below.

     

    Editor’s Note – “Save one life, you’re a hero. Save 100 lives, you’re a nurse.” To share this idea and wisdom from nursing leaders, click here to tweet.

    Check out other posts in this Trends in Nursing series: 

    *Value-based care – A healthcare payment model focused on improving quality of care and results, while reducing costs. It is different from models where providers receive payment for each service, known as “fee-for-service.”

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    Trends in Nursing: Q&A with Healthcare Leaders

    May 6th, 2013

    The founder of modern nursing, Florence Nightingale, earned the nickname “The Lady with the Lamp” from this report in The Times:

    She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds. (Cited in Cook, E. T. The Life of Florence Nightingale)

    Reading this account, I instantly recognize the nobility of nursing. The tireless efforts and commitment to patient care remain the same.

    But beyond its focus on patients, nursing is a dynamic profession – always innovating.

    In honor of National Nurses Week  (May 6-12), I talked about trends in the field with Marcia Ferrero, vice president and CNO at Heritage Valley Health System, and Patricia P. Sengstack , deputy CIO and chief of clinical informatics at NIH Clinical Center. Here are some of the highlights:

    Q. How is nursing today different than it was two years ago?

    Marcia Ferrero: The rapid influx of various types of technology — not only bedside direct patient care equipment, but also for medical record documentation — has impacted former nursing work flows immensely.  Although the patient must remain the focus of safe nursing practice, the application of the various technologies has forced work flow analysis and revisions to occur often resulting in process improvements along the way.

    Patricia Sengstack: Over the last two years and certainly over the last 5 years, the pervasiveness of technology would constitute one of the greatest changes to nursing and patient care. It’s now difficult to find any segment of healthcare that hasn’t implemented several types of new technology, whether it’s a clinical information system, bedside diagnostic testing device, electronic patient bed, or a new method to communicate with co-workers or patients. The list goes on …

    Another significant change is a trend we’ve seen taking place over the last 5 – 10 years, and that’s the shift toward ambulatory care leaving only the very sickest and most complex patients in hospitals. And then of course there’s the pharmaceutical industry that continues to develop new drugs and treatments for various illnesses to the point that it’s almost impossible to keep up. Add these together and you’ll understand why nurses must continue their education to keep up to date on new treatment modalities, medications, and the latest technologies – including access to the latest evidence in online knowledge bases.

    Q. How do you expect nursing to change over the next two years, and how can nurses prepare for those changes?

    Marcia Ferrero: Less acute care focus and more towards population management – the hospital will take the back seat to the outpatient world of healthcare delivery. Maintain flexibility and never lose sight of the patient!

    Q. What aspects of healthcare technology are the most challenging for nurses?

    Patricia Sengstack: Even with the pervasiveness of technology within an organization, a major challenge remains:  many of the electronic systems that are implemented do not talk to one another. I’d be willing to bet that if we asked healthcare organizations to provide a list of every clinical system in use and then ask how many of them are truly interoperable with one another, that we’d find a very small percentage. And those that are actually talking to one another may share very limited information.

    This is challenging to the nurse as he/she is required to log in to multiple systems and often enter duplicate data. I’d also be willing to bet that the average nurse will log-on to at least 5 -6 different systems multiple times throughout the course of the day in order to provide and manage patient care. Additionally, I’ve observed technology implemented at a rate that outpaces the ability to develop strong processes, policies and procedures to support efficient patient care and can lead to frustration. It’s sometimes hard to keep up.

    Q. What aspects of healthcare technology are the most beneficial to nurses?

    Marcia Ferrero: The interdisciplinary flow of information to multiple caregivers AND that it is all legible!

    Q. What can nurses do to help lead technology efforts and build a more Connected Community of Health?                                                                      

    Marcia Ferrero: Constantly ask yourself if this is meeting the goal to provide the safest and most efficient story of a patient’s stay or experience.  Think positive and offer suggestions to improve processes for all involved.

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    We’ve come a long way since Florence Nightingale. In what other ways do you see nurses delivering quality and innovation in patient care through healthcare technology? Please share in the comments below.

    Editor’s Note – “Save one life, you’re a hero. Save 100 lives, you’re a nurse.” If you’d like to thank a nurse who made a difference in your life, join us on Twitter and share your example. (Click to tweet this idea

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