Linda Lindsay, RN

Do you know Certified Nurses Day is on March 19?

Many still ask, “What are the differences between licensure and certification?” Some use the terms interchangeably, but they both are quite different. Licensure is mandatory and signifies that the licensee has met the minimum standards to practice nursing in a particular state.  In contrast, certification is voluntary. By taking and passing a specialty examination offered by a nongovernmental professional nursing or other interprofessional agency, the nurse or other healthcare professional has now validated his knowledge, skills and abilities in a defined role and clinical area of practice, based on predetermined standards.

According to an article published by the American Nurses Credentialing Center (ANCC) Certification is a ”profession’s official recognition of achievement, expertise and clinical judgment. It is a mark of excellence that requires continued learning and skill development to maintain.”

So I guess you must be asking yourself, “How does certification benefit me?” Benefits include: professional recognition and achievement, credibility, career advancement and higher pay, just to name a few. Certification also benefits patients and hospitals as a quality indicator that attracts patients to a certain facility. Certification also has shown to have positive effects on patient care and safety by attesting to a nurse’s knowledge, techniques and judgment.

Now that the benefits are clear, how does one get started?  First you need to find out which credentialing body you must apply to and understand the eligibility requirements. Then you have to apply, pay and prepare.

Nurse.com offers one method of preparation. PearlsReview, our online certification review, features more than 60 specialty certification reviews for nurses. PearlsReview gives you unlimited access to all of the certification reviews for an annual fee. These review courses are written and reviewed by nurses certified in the particular specialty areas and are written with the test content outline as a guide to help you pinpoint the areas on which to focus your study. You can earn as many as 42 CE hours for one certification review. I would like to call your attention to some of the most recently updated additions to our certification library: critical care/progressive care, neuroscience nurse, medical surgical nursing,nursing professional development, informatics and oncology.

Lastly, as we celebrate Certified Nurses Day on March 19, I would like to congratulate all certified nurses on their achievements and contribution to nursing and patient care. Continue to strive for excellence; I am honored to be among you!

If you would like to learn more about nursing certification, check out this free white paper by Nicholas Lorenzo, MD:

Nursing Certification: Impact and Benefits on Nurses, Healthcare Employers, and the Patients they Serve

Originally posted on nurse.com

Home health care is allowing the patient and their family to maintain dignity and independence. According to the National Association for Home Care, there are more than 7 million individuals in the United States in need of home health care nurse services because of acute illness, long term health problems, permanent disability or terminal illness.

Home Health Care Basics

Nurses practice in a number of venues: Hospital settings, nursing homes, assisted living centers, and home health care. Home health care nursing is a growing phenomenon as more patients and their families desire to receive care in their homes. The history of home health care stems from Public Health Nursing where public health nurses made home visits to promote health education and provide treatment as part of community outreach programs. Today academic programs train nurses in home care and agencies place home health care nurses with ailing individuals and their families depending on the nurse’s experience and qualifications. In many cases there is a shared relationship between the agency and the academic institution.

Many changes have taken place in the area of home health care. These include Medicare and Medicaid, and Long Term Care insurance reimbursement and documentation. It is important for the nurse and nursing agency to be aware of the many factors involved for these rules and regulations resulting from these organizations. Population and demographic changes are taking place as well. Baby boomers approaching retirement and will present new challenges for the home health care industry. Technology and medical care in hospitals has lead to shorter inpatient stay and more at-home rehabilitation. Increases in medical outpatient procedures are also taking place with follow-up home care. This has resulted in the decrease of mortality rate from these technologies and medical care has lead to increases in morbidity and chronic illness that makes the need for home health care nursing a greater priority.

Home Health Care Nurse Job Description

Through an array of skills and experience, home health care nurses specialize in a wide range of treatments; emotional support, education of patients who are recovering from illnesses and injury for young children and adults, to women who have experienced recent childbirth, to the elderly who need palliative care for chronic illness.

A practicing nurse must have the skills to provide care in a unique setting such as someone’s home. The nurse is working with the patient and the family and must understand the communication skills for such dynamics. Rapport is evident in all nursing positions, but working in a patient’s own living space needs a different level of skill and understanding. There is autonomous decision making as the nurse is no longer working as a team with other nurses in a structured environment, but is now as a member of the “family” team. The host family has cultural values that are important and are different for every patient and must be treated with extreme sensitivity. Other skills include critical thinking, coordination, assessment, communication, and documentation.

Home health care nurses also specialize in the care of children with disabilities that requires additional skills such as patience and understanding of the needs of the family. Children are living with disabilities today that would have resulted in mortality just twenty years ago. Genetic disorders, congenital physical impairments, and injury are just a few. Many families are familiar with managing the needs of the child, but still need expert care that only a home health care nurse can provide. It is important that a home health care nurse is aware of the expertise of the family about the child’s condition for proper care of the child. There are many complexities involved, but most important, a positive attitude and positive reinforcement is of utmost importance for the development of the child.

Medication coordination between the home health care nurse, doctor, and pharmacist, ensures proper management of the exact science behind giving the patient the correct dose, time of administration, and combinations. Home health care nurses should be familiar with pharmacology and taught in training about different medications used by patients in the clinical setting.

Many advanced practicing nurses are familiar with medication regiments. They have completed graduate level programs. Home health care agencies believe that a nurse should have at least one year of clinical experience before entering home health care. Advanced practicing nurses can expedite that training by helping new nurses understand the home health care market and teaching.

Employment and Salary

According to the United States Department of Labor, there were 2.4 million nurses in America, the largest healthcare occupation, yet many academic and hospital organizations believe there is a gross shortage in nursing staff. The shortage of nurses was 6% in 2000 and is expected to be 10% in 2010. The average salary for hospital nursing is $53,450 with 3 out of 5 nursing jobs are in the hospital. For home health care, the salary is $49,000. For nursing care facilities, they were the lowest at $48,200.

Training and continuing education

Most home health care nurses gain their education through accredited nursing schools throughout the country with an associate degree in nursing (ADN), a Bachelor of Science degree in nursing (BSN), or a master’s degree in nursing (MSN). According to the United States Department of Labor, in 2004 there were 674 BSN nursing programs, 846 ADN programs. Also, in 2004, there were 417 master’s degree programs, 93 doctoral programs, and 46 joint BSN-doctoral programs. The associate degree program takes 2 to 3 years to complete, while bachelors degrees take 4 years to complete. Nurses can also earn specialized professional certificates online in Geriatric Care or Life Care Planning.

In addition, for those nurses who choose to pursue advancement into administrative positions or research, consulting, and teaching, a bachelor’s degree is often essential. A bachelor’s degree is also important for becoming a clinical nurse specialist, nurse anesthetists, nurse midwives, and nurse practitioners (U.S. Department of Labor, 2004).

All home health care nurses have supervised clinical experience during their training, but as stated earlier advanced practicing nurses hold master’s degrees and unlike bachelor and associate degrees, they have a minimum of two years of post clinical experience. Course work includes anatomy, physiology, chemistry, microbiology, nutrition, psychology, and behavioral sciences and liberal arts. Many of these programs have training in nursing homes, public health departments, home health agencies, and ambulatory clinics. (U.S. Dep. of Labor, 2004).

Whether a nurse is training in a hospital, nursing facility, or home care, continuing education is necessary. Health care is changing rapidly and staying abreast with the latest developments enhances patient care and health procedures. Universities, continuing education programs, and internet sites, all offer continuing education. One such organization that provides continuing education is the American Nurses Association (ANA) or through the American Nurses Credentialing Center (ANCC).

Conclusion

There are many rewards to becoming a home health care nurse. Some rewards include the relationship with a patient and their family, autonomy, independence, and engaging in critical thinking. The 21st Century brings with it many opportunities and challenges. We must meet these challenges head on – there is an aging baby boomer population, a growing morbidity factor due to increased medical technology and patient care, and the growing shortage in nursing care.

Becoming a home health care nurse today is exciting and an opportunity to make a difference one life at a time. With clinical experience and proper education, a home health care nurse will lead the future of medical care.By Michael V. Gruber, MPH is a contributing author to My Nursing Degree Online, providing articles and resources for nurses looking for continuing education online. With a Masters of Public Health and two years of medical school, Michael provides a unique perspective on the current nursing shortage crisis on the Nursing Career Blog as well as comprehensive articles about nurse education and advancement.

Linda Lindsay, RN

Do you know Certified Nurses Day is on March 19?

Many still ask, “What are the differences between licensure and certification?” Some use the terms interchangeably, but they both are quite different. Licensure is mandatory and signifies that the licensee has met the minimum standards to practice nursing in a particular state.  In contrast, certification is voluntary. By taking and passing a specialty examination offered by a nongovernmental professional nursing or other interprofessional agency, the nurse or other healthcare professional has now validated his knowledge, skills and abilities in a defined role and clinical area of practice, based on predetermined standards.

According to an article published by the American Nurses Credentialing Center (ANCC) Certification is a ”profession’s official recognition of achievement, expertise and clinical judgment. It is a mark of excellence that requires continued learning and skill development to maintain.”

So I guess you must be asking yourself, “How does certification benefit me?” Benefits include: professional recognition and achievement, credibility, career advancement and higher pay, just to name a few. Certification also benefits patients and hospitals as a quality indicator that attracts patients to a certain facility. Certification also has shown to have positive effects on patient care and safety by attesting to a nurse’s knowledge, techniques and judgment.

Now that the benefits are clear, how does one get started?  First you need to find out which credentialing body you must apply to and understand the eligibility requirements. Then you have to apply, pay and prepare.

Nurse.com offers one method of preparation. PearlsReview, our online certification review, features more than 60 specialty certification reviews for nurses. PearlsReview gives you unlimited access to all of the certification reviews for an annual fee. These review courses are written and reviewed by nurses certified in the particular specialty areas and are written with the test content outline as a guide to help you pinpoint the areas on which to focus your study. You can earn as many as 42 CE hours for one certification review. I would like to call your attention to some of the most recently updated additions to our certification library: critical care/progressive care, neuroscience nurse, medical surgical nursing, nursing professional development, informatics and oncology.

Lastly, as we celebrate Certified Nurses Day on March 19, I would like to congratulate all certified nurses on their achievements and contribution to nursing and patient care. Continue to strive for excellence; I am honored to be among you!

If you would like to learn more about nursing certification, check out this free white paper by Nicholas Lorenzo, MD:

Nursing Certification: Impact and Benefits on Nurses, Healthcare Employers, and the Patients they Serve

Each year, the ANCC selects recipients for outstanding contributions in clinical nursing in five Magnet Model components, including: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations and Improvements; and Empirical Outcomes.

An emergency department nurse at St. Elizabeth Healthcare and a student in the Master of Science in Nursing (Nurse Executive Leadership track) program, Linda received recognition during the ANCC National Magnet Conference in Los Angeles in the category of Structural Empowerment.

“Linda has been a valued member and contributed much during her tenure as a bedside nurse and as a certified emergency and forensic nurse,” said Kim Boyer, system director of emergency services. “It is her passionate mission against workplace violence that has set her apart and endeared her to emergency nurses within the organization, region and state.”

Robinson has been an associate of St. Elizabeth Healthcare for 28 years and is currently a charge nurse in the Covington Emergency Department. She has been a major advocate for ending workplace violence, initiating the emergency department workplace violence program at St. Elizabeth Healthcare. She also participated in the Emergency Nurses Association Workplace Violence Work Team as a co-investigator on a study of “Violence against Nurses Working in U.S. Emergency Departments” published in the Journal of Nursing Administration in 2009. This eventually led to her appointment as an expert advisor for an interventional workplace violence study with the University of Cincinnati that was funded by the National Institute for Occupational Safety and Health.

She has presented on workplace violence at numerous national conventions, and was largely responsible for the passing of Senate Bill 58 in February 2012, which helped make emergency departments safer by allowing local police to remove and arrest anyone who assaults an emergency department healthcare worker. She testified before the Kentucky State Judiciary Committee and the Kentucky House of Representatives. The bill passed unanimously.

“Linda exemplifies the true meaning of being a Magnet Nurse. She is passionate about nursing, committed to the issue of workplace violence prevention, and makes us all realize that one nurse really can make a difference,” said Jane Swaim, senior vice president and chief nursing officer at St. Elizabeth Healthcare. “Because of her unique abilities and talent, and the fact that she is one of our Magnet shining stars … she is very deserving to be Magnet Nurse of the Year.”

St. Elizabeth Healthcare operates six facilities throughout Northern Kentucky – St. Elizabeth Covington, St. Elizabeth Edgewood, St. Elizabeth Falmouth, St. Elizabeth Florence, St. Elizabeth Fort Thomas and St. Elizabeth Grant.

Born in Massachusetts, LaRosa grew up in Shelburne. She went on to major in environmental studies and conservation biology at Middlebury College, but heart surgery her freshman year had her changing career choices.

LaRosa had a congenital heart defect that wasn’t discovered until college. “I was inspired by the nurses who cared for me,” said LaRosa, who graduated from Middlebury and immediately joined the master’s entry nursing program at the University of Vermont.
She completed the one-year program, earning her registered nurse licensure, and went on to complete her master’s degree at the University of Vermont to become a family nurse practitioner.

She previously worked as a registered nurse in a variety of fields, including as a pediatric and family nurse with the Visiting Nurse Association of Chittenden and Grand Isle Counties and as an operating room nurse at Northwestern Medical Center in St. Albans.

Her experiences in orthopedic surgery coupled with her own athletic interests led her to the new position at the Sharon Health Center.

“This was the ideal, dream job,” LaRosa says, noting she is excited to practice high-quality medicine in a rural setting.

“Even when I lived in Burlington, I was familiar with Gifford. Gifford has a reputation as a place with really high-quality care and as a small hospital that does a lot of big things,” LaRosa says.

She also praises the Sharon Health Center’s staff, facility and interdisciplinary team. The Sharon Health Center has two podiatric surgeons, a sports medicine physician, a sports medicine chiropractor, an athletic trainer and physical therapists. It is also home to X-ray and MRI diagnostic imaging.

LaRosa is board-certified by the American Nurses Credentialing Center and a member of the Vermont Nurse Practitioners Association. Her clinical interests include sports medicine, especially for adolescents, and surgery.

In her free time, she is a cyclist, runner, and skier. She currently mountain bikes with the 1K2GO-Onion River Sports cycling team and is a former youth Nordic ski coach. She now lives in Washington.

Call her or another member of the Sharon Health Center sports medicine team at (802) 763-8000.

Intended for certified adult and family nurse practitioners, the program prepares students to provide mental health promotion and mental health diagnosis and treatment across the lifespan. This program is also targeted for Psychiatric Clinical Nurse Specialists who wish to sit for the certification exam as a Psychiatric and Mental Health Family Nurse Practitioner.

The curriculum aligns with the new Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, & Education (APRN Consensus Model). Upon completion students are eligible to sit for Family Psychiatric & Mental Health Nurse Practitioner certification exam offered through the American Nurses Credentialing Center (ANCC).

The program is offered entirely on-line making it attractive to rural and working students. The program consists of 23 credit hours and includes courses in psychopharmacology, counseling, and psychotherapy, and is designed to be completed in 4 semesters or 15 months. Students are required to complete 500 clinical hours to obtain the post-masters certificate.

For further information on the Family Psychiatric & Mental Health Nurse Practitioner (PMHNP) program email nkuonline@nku.edu.

Nurse Practitioner Amanda Flyckt

RANDOLPH – Acute care nurse practitioner Amanda Flyckt has joined the hospitalist team at Gifford Medical Center in Randolph. Hospitalists are providers who care for hospitalized patients, or inpatients.

A native of Washington state, Flyckt earned her undergraduate degree in microbiology at Washington State University in Pullman, and then her master’s in acute care nursing from Vanderbilt University in Nashville.

As an undergraduate, Flyckt thought her career in medicine would be in research. But after spending time working in a laboratory setting, she knew, “I really wanted to work with patients” – specifically inpatients.

After moving to Vermont, she looked for a hospital that effectively utilized “midlevel” providers well, and found Gifford.

“Everyone is really friendly to me. I really like the organization,” says Flyckt, who calls Gifford’s hospitalist program “innovative.”

Gifford was among the first small hospitals in the region to utilize hospitalist providers and has been included in multiple national hospitalist publications for its successful use of midlevels – physician assistants and nurse practitioners – as part of the hospitalist team.

Flyckt was also drawn to the Gifford for the diverse patient needs and health conditions that are managed locally.

She is board certified by the American Nurses Credentialing Center and a member of both the American College of Nurse Practitioners and Vermont Nurse Practitioners Association.
She lives in Burlington and enjoys snowboarding and outdoor activities in her free time.

Magnet® and Magnet Recognition Program® are registered trademarks of the American Nurses Credentialing Center. All rights reserved.

Image via Wikipedia

Image via Wikipedia

Fast Track Total Hip Replacement Surgery Is Effective and Safe

Source: click here, Date:7/1/2011

NEW YORK, July 1, 2011 /PRNewswire/ — Generally healthy patients who undergo total hip replacement (THR) can be fast tracked to be discharged in two days compared with the standard three to six days, according to a new study by researchers at Hospital for Special Surgery (HSS) in New York City. The study could help cut down on hospital-acquired infections, reduce hospital costs and improve patient satisfaction.

“Before this study, we were uncertain how safe it would be to discharge patients within two days after a total hip replacement, but based on this study, we now know that it is safe. This is evidenced by the fact that the patients who were discharged within two days did not have an increase in complications, readmissions or reoperations,” said Lawrence Gulotta, M.D., an orthopedic surgeon at HSS and first author of the study. “This is something that can help improve health care costs and provide better care for our patients by keeping them out of the hospital.” Bryan Nestor, M.D., an orthopedic surgeon in Adult Reconstruction and Joint Replacement Service at HSS, was principal investigator of the study.

The prospective study that will be reported in an upcoming issue of  Springer’s HSS Journal compared outcomes of patients undergoing THR at HSS between 2004 and 2008. One cohort of 149 patients underwent THR with a fast track protocol. The other cohort of 134 patients underwent THR followed by the hospital’s traditional clinical pathway, which aimed to discharge patients at four days at that time.

Patients in the two cohorts were matched for age, sex, body mass index, and comorbidities. Patients were excluded if they had inflammatory arthritis, complex THR, and medical comorbidities such as a history of a myocardial infarction, pulmonary embolism or deep vein thrombosis. Blood clots can be a complication of THR, and patients with a history of these comorbidities cannot be treated with simple aspirin consumption. All patients in the  study were discharged with aspirin.

Patients on the fast track protocol had a physical therapy session on the day of their surgery. The main difference was that a patient’s pain medication was discontinued in the fast track cohort postoperative day one (as long as pain was deemed to be under control), whereas in the traditional cohort, pain medication is usually discontinued on day two.

Patients in both cohorts were sent home with aspirin, an arrangement for work with a physical therapist, a patient management plan including a list of daily goals, and nausea and pain control plans. A study coordinator screened for complications one day and one week after discharge.

The investigators found that 58 percent of the fast track cohort was discharged within two days of a THR and 73 percent were discharged within three days. The average discharge time was 2.6 days in the fast track cohort and 4.1 in the traditional cohort. Patients were less likely to be discharged rapidly in the fast track cohort, if they had significant post-operative pain, nausea, or dizziness. At one year, there were no differences in complications, readmissions or reoperation in the two cohorts.

“For a select group of patients, we have shown that a two day discharge is safe and feasible for patients undergoing a total hip replacement,” Dr. Nestor said. He pointed out that the two day fast track is not for higher risk patients, the ones who were excluded from the study. While the authors did not measure if the fast track protocol saves money, since it involves shortened hospital stays, the researchers expect it to.

Roughly half a million THRs are conducted every year in the United States, and this number is expected to grow. Many in the baby boomer generation are not willing to be sedentary and as their joints age, they are demanding joint replacement surgeries to keep active.

Other HSS authors involved in the study are Douglas Padgett, M.D., Thomas Sculco, M.D ., Michael Urban, M.D., Ph.D., and Stephen Lyman, Ph.D. No author received financial support related to the study.

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology, No. 16 in neurology and No. 18 in geriatrics by U.S. News & World Report (2011-12), has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center, and has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www.hss.edu.

This news release was issued on behalf of Newswise(TM). For more information, visit http://www.newswise.com.

Related articles

• Fast Track Discharge Following Hip Replacement (earlsview.com)
• Minimally Invasive Total Hip Arthroplasty (earlsview.com)
• Advances in Knee Replacement Surgery for Active Baby Boomers (earlsview.com)
• How Long Do Hip Replacements Last? (earlsview.com)

This is seriously significant for several reasons:

1)  As you might know, Magnet Recognition Program designation is the gold standard for nursing excellence and is given by the ANCC to  hospitals which demonstrate exceptional commitment to nursing quality and dedication to patient care.  Only 6 percent of hospitals in the country have the designation.

2)  As far as I know, no other hospital in the U.S. has ever been designated so soon after it opened. Hospitals can’t apply for Magnet status until they have two full years of quality data to submit.  MCR opened in February 2007 and submitted its application as soon as it could. The  results came back just today.

Congratulations to Kay Miller, MCR chief nursing officer, and the entire staff who lead this charge! This obviously could not have happened without nurses, staff, physicians, volunteers…everyone demonstrating superior outcomes from the minute MCR was opened.

3) You will remember that in 2000 Poudre Valley Hospital was only 17th hospital in the country to be designated a Magnet facility, and the first between Minnesota and California. PVH became only the 11th hospital to be designated twice, and just last spring only the 7th hospital EVER to receive magnet designation a third time!  This shows a systemwide commitment to quality over more than a decade, which is honestly inspirational!

We’ll be updating the the blog through the day with pictures and video, so stay tuned.

Congratulations to the entire MCR and PVHS team for continuing the decade long commitment to quality!

Rulon

Our employees are very excited for this three-day site visit, which I wrote about earlier this summer, and gave them a warm MCR welcome. I know our fantastic nurses and employees will show Magnet why people rave about the care at MCR.

You can also watch a slideshow of the morning here.

Debbie D. Hatmaker, PhD, RN, SANE-A, President of ANCC, indicated that the nominating process was very competitive and that the Executive Committee of the Board of Directors was pleased to hear that Havens was selected.

That program won the 2009 Magnet Prize, and PVH was honored to have national and state nursing leaders attend its Magnet Nursing celebration last week. 

More than 130 people attended the event, which recognized 29 Magnet Nurse nominees, and the crowd included Dr. Jeanne Floyd, executive director, American Nurses Credentialing Center; Dr. Debbie Hatmaker, president, American Nurses Credentialing Center, board of directors and vice president of the American Nurses Association; Roy Simpson, vice president of nursing, Cerner Corporation; and Lola Fehr, president, Colorado Nurses Association board of directors. 

ANCC visits Poudre Valley Hospital

Dr. Floyd, Dr. Hatmaker and Mr. Simpson were visiting PVH as result of the PVH Community Case Management program receiving the 2009 Magnet Prize. In his remarks to those in attendance, Mr. Simpson said that “By winning the Magnet Prize, PVH has set the platinum standard for excellence in nursing practice and innovation and differentiated itself from other organizations.” 

Mr. Simpson, representing the Cerner Corporation, is the sponsor of the Magnet Prize. In addition to the recognition PVH received $25,000, which is being used to enhance the Community Case Management Program and support the development of a “tool kit” which will help other organizations create a program similar to the one at PVH. 

Dr. Floyd, Dr. Hatmaker, and Mr. Simpson also met with community case managers and went with case managers to client visits to get a first-hand experience of the program’s impact those clients’ lives. 

Rulon