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Groundbreaking study seeks to uncover truth about new grad nurses

As new generations of nurses enter the workforce, questions abound. What influences a new graduate’s job choice? How long do they expect to stay? Why do some of them want to leave? Professors Christine T. Kovner, PhD, RN, FAAN, and Carol S. Brewer, PhD, RN, are spearheading an in-depth study to find answers to some of these critical questions. And thanks to a recent $4.1 million grant, in addition to $1.9 million in earlier funding, from the Robert Wood Johnson Foundation, the research is now funded into 2015.

“There is a lot of information floating around about new graduates,” says Kovner, who has been at New York University since 1985. “But, in my opinion, there is no solid, systematic research.”

Already, that is changing.

The study, which tracks more than 3,000 nurses from 35 states, touches on a variety of topics including workplace experience, relationships with managers, and violence against nurses. Some early highlights from the first few years of the study include:

  • About 66% of newly licensed registered nurses (NLRNs) worked a 12-hour shift
  • Poor management was cited as the top professional reason for leaving a first job
  • About 62% of NLRNs reported at least one incidence of verbal abuse
  • 27.2% of NLRNs who had worked at least 13 months in nursing had already left their first job
  • Nearly 60% of NLRNs reported they were satisfied or very satisfied with their jobs
  • 41% of NLRNs planned to stay in their first jobs for less than three years
  • The median income for NLRNs was $45,000
  • The most important work characteristics to new RNs are “the ability to do the job well” and “being rewarded fairly for the work”

What are your impressions of these early study findings?

For more information on the study, visit http://www.rnworkproject.org or for more of this article, click here.

Frequently asked questions about blogs

What is a blog? A blog (short for Weblog) is a Web site where you post thoughts, articles, and ideas on an ongoing basis. New posts show up at the top, so visitors can read what’s new. Then they comment on it. The posts can be broken down into categories and topics for easier navigation.

For more information, watch this video.

What is a blogger? A blogger is someone who posts an article on a blog. (Email the blog editor at mbriddon@hcpro.com for more information on how to become a blogger on this site.)

What is the benefit of a blog? You can network with peers, gather new insight, and share stories and successes. More specifically, on our blog, you can learn about new ideas, programs, and best practices at facilities across the country, get some tips to help you in your daily life, or share some advice or an opinion with others in the nursing industry.

How can a blog help you, specifically, in your job? Our blog is filled with valuable articles, insight from others in the nursing industry, and links to other items of interest. Because your time is tight, we try keep posts short and to the point. Feel free to share any of the information you find with peers or employees or post your comments on a particular topic with others who visit the blog.

What is the difference between a blog and a discussion board? The idea is basically the same: People can read what has been written and add their own comments. However, a discussion board usually begins with a single idea or question. A blog begins with a longer post, something that typically portrays a certain idea or opinion. Then, people can comment on that particular topic.

How do I comment on the blog? It’s easy. Click on the headline of a post to go to that particular post. Scroll down and click on “Add comment.” Then, simply fill out the fields and click “post.”

How do I comment on a comment? The same way that you’d comment on the blog.

Can anyone comment on a blog? Yes. The blog is open for anyone to comment on any topic they wish.

Getting another chance . . . thanks to robots

By Charlene Gordon, RN, Emergency Preparedness Manager at Huntsville (TX) Memorial Hospital

Ever have a patient go bad and just wish at the end of the day you could get a chance to replay it and fix what went wrong?

I just got done with a three-day WMD (weapons of mass destruction) course that had a robot for a victim. And this guy was so real, it was scary.

“The guy” was a manikin that blinked, had pupils that were reactive to light, and emitted pulses from every place a real person would. He made different heart sounds and different lung sounds (from rales to wheezing to rhonchi) while his chest rose and fell. He had an IV site that takes into account which drug you are pushing, how much you are giving, and how fast you are giving it! He responds by computer to all your interventions, including reading an exact Oxygen saturation to see if you are bagging correctly. (Don’t push the versed too fast!)

Crashing him is okay . . . just re-boot and start all over again. With this one, you can play it again. And, what a learning experience it was!

It would have been awesome for just basic assessments or regular ACLS (advanced cardiac life support), but this guy put ER nurses, ICU nurses, floor nurses, respiratory techs, and paramedics through their paces for a WMD treatment roundtable. We treated chemical emergencies, including viral and biological illnesses that were bad and getting worse.

The real beauty of the course was that several of the nurses have been around the emergency/ICU block a few times and were pretty sure this class was going to be a dud. They were one wound up bunch of nurses after three days. They loved it! This guy is spooky real and it really feels like he is dying, but unlike ACLS, where you alone have to answer, the group cooperates just like a real crashing patient.

The class really helped to prepare us to understand these complicated patients during a critical time where hesitation or a wrong choice could mean life or death for them. I just wish every nurse and all healthcare professionals could take this course every year. This was a great experience!

Don’t you wish you could get another chance sometimes?

Merging competency validation and performance evaluation

A new way to look at competencies, from the pages of our Briefings on Long-Term Care newsletter:

Making sure nurses are competent in their skill sets is one of the most important responsibilities of a director of nursing. But as the need for validation goes beyond technical skills and focuses on professional development as a whole, the traditional methods of assessing competencies need to be examined in a new light.

“It has always been important to validate competencies, but how some institutions are choosing to look at it is taking a different spin,” says Sheila St. Cyr, MS, RN-BC, OCN, performance-based development system coordinator at the University of Oklahoma (OU) Medical Center in Oklahoma City. “Now we’re not just looking at technical skills, we’re validating interpersonal skills as well. It used to be more about the technical skills checklist. And that’s just not how it should be.”

With the recent shift in focus, directors of nursing must arm themselves with the necessary tools and information to think beyond simply validating skill sets.
St. Cyr says there are two main areas of assessment on which to focus: competency validation and performance evaluation. Recently, the shift has been to combine the two efforts rather than have an instructor simply check off that a nurse is able to complete a particular skill.

Developing a definition of competency validation for your facility must take place prior to any assessments, says Diana Swihart, PhD, DMin, MSN, CS, APRNBC, clinical nurse specialist in nursing education at the Bay Pines (FL) VA Healthcare System.

When you begin working with staff members to validate competencies, St. Cyr says one of the best strategies toward education is to play the what-if game. “Use a questioning technique with staff members,” she says. Give your nurses a scenario, then ask the following questions:

  • What complications can happen?
  • What are the signs or symptoms?
  • Would you need to call the doctor?
  • What assessments would you need to make?

Other methods for validation, adds Swihart, can include:

  • Case studies, which can help measure critical thinking
  • Quality improvement monitors, which are a strong determinant of competency because they reflect an individual’s overall performance
  • Mock events, which are useful in measuring cognitive knowledge

What methods are used at your organization?

Learning Management Systems: Their place in healthcare

By Diane M. Billings, EdD, RN, FAAN

Following our discussion during today’s audioconference, we realized that one big component of implementing new classroom technology includes bringing in a Learning Management System (LMS). Basically, an LMS includes software tools designed to manage learning. Many LMSs are Web-based and are able to facilitate “anytime, any place, any pace” access to administration and learning content. LMSs are especially relevant in healthcare as compliance training remains essential. Characteristics of LMSs often include:

  • The ability to manage users, courses, and instructors
  • The inclusion of a course calendar
  • Access to messaging learners
  • The chance to display scores and transcripts

There are many different types of LMSs that are available, including Blackboard Inc., Saba Software, and ATutor. What have your experiences been with using LMSs, and which ones have you found to be most effective (or ineffective) in your educational endeavors?

A great idea for teambuilding!

Purchase a puzzle large enough for each staff member to have a piece. Give each one a piece of the puzzle (during a staff meeting, in their mailbox, etc.). Explain that you need everyone’s participation to make the team fit together. Have a designated place for staff to begin working the puzzle until it’s completed.

Kick It Up A Notch: Leave a few pieces out, but give them to ancillary staff (RT, PT, CM, etc.). After a time of having “holes” in the finished picture, ask the other disciplines to fit their pieces into the picture. You could even have someone glue the puzzle and ask engineering to hang it–as a reminder that we cannot work together without everyone’s input.

2 GREAT QUOTES:
“Whoever does not love his work cannot hope that it will please others.” (unknown)

“Leaders must be close enough to relate to others, but far enough ahead to motivate them.” (John Maxwell)

Lessons learned from my first class

When the Leader’s Lounge was born, I started the blog with my decision to return to school in my mid-50s. What was I thinking? It is hard to believe that my first course has already ended, and that I am preparing for the next one. Wondering how it went?

Better than I expected.

I took the one course that was only for two credits, as I knew the load would be less and I could plan from that for the other three- and four-credit course loads. I found out today I received an “A” (I never read so much in such a short time period; eat lots of carrots!) and found the overall experience was good. Getting a good grade certainly helped with that perception. I would prefer to be in a live classroom as I thrive on that interaction, but “life” gets in the way of that. Online courses can be interactive in their own way, but I miss the voices, tones, and facial expressions. Call me a product of my generation compared to the younger ones who don’t use the phone much (they text message).

I learned a great deal from my first course on Issues in Health Care Informatics. Along with the acquired knowledge of real substantial material that I can use, I learned how to study at an airport with people around you talking (shouting) into their blackberry’s, I learned how to scan articles for what I have to read, and mostly, I learned that my nursing experience, every bit of it, is relevant.

Additionally, because this was a two-credit course, it did not take nearly the time away from my home life as I thought it would. Being able to do a great deal of the work while on the road, left little time taken away once I was home.

Are you still on the edge about going back to school? What’s holding you back?

Shhh! We’re preventing medication errors here!

A creative way to prevent medication errors from the pages of our Briefings on Patient Safety newsletter:

Citizens Medical Center in Victoria, TX, took a creative approach to cut down on medication errors when it created a “no-talk zone.”

“Distractions were definitely becoming an issue with medication errors,” says Gail Martin, MBA, RN, quality analyst at Citizens Medical Center. The main problem was that two of the facility’s busiest and most critical floors had Pyxis medication dispensing machines located out in the open-next to the coffee pot and across from the nurses’ station, says Martin.

Though the obvious solution was to relocate the Pyxis machines, it was not feasible at that time, says Martin.

“That costs money. And we’re a county hospital, so it wasn’t happening,” she says. “It is in our future plans, but for the immediate future, we needed to do something.”

So, Martin’s team brainstormed different signage asking staff and hospital visitors not to disturb anyone using a Pyxis machine, especially in a busy area. They eventually settled on a simple “no-talk zone” sign much like a “no smoking” sign. The lettering is black, and the symbol is red. The sign is displayed on the floor in front of the Pyxis machine, kind of like a mat slicked on the floor, says Martin.

The “no-talk zone” has been in place for a year and has paid dividends. Since the start of 2007, five medication errors have been attributed to frequent interruptions, lighting, or noise level; this is a decrease from the entire year of 2006, in which 23 medication errors were attributed to the same causes, according to Martin.

What does your organization do to prevent medication errors? Do you think something like this “no-talk zone” would work where you are?

Quick nurse retention ideas!


In my position as Nurse Retention Coordinator, I am always on the lookout for innovative ideas I can adapt as a retention strategy. I then share these ideas with our Nurse Managers.
Employee of the Month contests tend to become popularity events; try this instead: At monthly staff meetings, draw one name out of the hat and that person becomes Employee of the Month for that month. This gives everyone an opportunity to be recognized!
Encourage your staff to write down their KUDOS about that person. Who is your creative staff member who just loves crafts, design or scrapbooking? Ask that person to compile the peer comments in any way they think is appropirate: typed on a sheet, a collage, a scrapbook page, a certificate. Be creative (or allow them to be!). No one can win twice until all staff have had one opportunity to shine!

Kick It Up A Notch: Give your creative staff a bulletin board in your unit, but not in the staff lounge. You want patients and visitors to see it too. Encourage your creative person(s) to design the board each month highlighting the Employee of the Month. This is an awesome way to provide peer recognition!
One of my staff nurses also earned a degree in Recreation Therapy – she LOVES taking time each month to design a THEME board. If you have to pay an hour or so of OT, is the recognition factor worth it?

Show your colors on National Wear Red Day

Think men are more prone to heart disease? Try again. More women than men die of heart disease each year. In fact:

  • Nearly 39% of all female deaths in the United States occur from cardiovascular disease (American Heart Association).
  • Heart attack, stroke, and related cardiovascular diseases are responsible for almost twice as many deaths among women as all forms of cancer combined (American Heart Association).
  • Coronary heart disease is the leading cause of death among U.S. women. It affects 1 in 10 women over the age of 18 (National Institute on Health).

While awareness of heart disease as the leading cause of death has increased from 30% in 1997 to 46% in 2003, only 20% of women consider it to be their own greatest health risk. National Wear Red Day, celebrated on Friday, February 1, is a day when Americans nationwide will wear red to show their support for women’s heart disease awareness and bring well-needed attention to this killer.

“Women need to realize that making even one lifestyle change reduces their risk for heart disease,” says August Stieber of Bensinger, DuPont & Associates (BDA), a national EAP firm. In fact, the risk of heart disease can be lowered by as much as 82% just by leading a healthy lifestyle, according to The National Heart, Lung and Blood Institute.

Stieber offers these lifestyle suggestions:

  • Exercise: Regular physical activity–even as simple as walking 30 minutes a day–can lead to improved blood pressure, cholesterol levels, and cardiovascular fitness.
  • Nutrition: A diet low in fat and high in fiber can help reduce the risk for heart attack by lowering cholesterol levels and blood pressure.
  • Stress Reduction: Stress management reduces heart rate, blood pressure, and cholesterol–all of which improve heart health.

National Wear Red Day was launched in partnership with The Heart Truth, a national awareness campaign for women about heart disease sponsored by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, U.S. Department of Health and Human Services. For more information on National Wear Red Day, click here.

Editor’s note: For additional information, Stieber can be reached at 1-800-227-8620. Courtesy of Bensinger, DuPont & Associates. Reprinted with permission.