Nursingmatters January 2015
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Volume 26, Number 1
www.nursingmattersonline.com
InsIde: Future of nursing report: A Wisconsin profile
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Climb for a cause results in near-death
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nurse Anesthetists important to healthcare future
PAID
MADISON WI PERMIT NO. 1723
PRST STD US POSTAGE
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Lecture showcases nurse-designed models Kathleen Corbett Freimuth
The 15th 2014 Littlefield Leadership Lecture was the first to be held in the University of Wisconsin-Madison School of Nursing’s Signe Skott Cooper Hall. The lecture, presented Nov.14, was entitled “Transforming Health Care through Nursing Innovations: Lessons Learned.” Diana J. Mason, Ph.D., RN, FAAN, DHL (Hon.), American Academy of Nursing president and the Rudin Professor of Nursing at Hunter College-Bellevue School of Nursing of the City University of New York, gave the lecture. As chair of the Academy of Nursing’s “Raise the Voice” campaign for eight years, Mason has sought to make visible the innovative models of care and interventions developed by nurses – models that can help to transform U.S. healthcare. Accordingly, Mason’s lecture message was clear: Nurses are guarantors of quality care; healthcare must resolve to embrace them as innovators. According to the Commonwealth Fund’s comparative analysis of health systems (Davis et al., 2010) involving seven peer countries, Mason noted, the United States ranks sixth or seventh on healthcare quality, efficiency, access and ability for citizens to lead long, healthy lives. But it ranks first in healthcare spending. However, solutions to a costly, poor-performing system are in the offing. A reformed healthcare system, Mason said, must use nursedesigned innovations to improve patient outcomes. She gave numer-
Dean Katharyn May, UW SON greets speaker, Diana J. Mason, Ph.D., RN, FAAN, DHL (Hon.)
ous examples of models of care by nurse innovators already in play that respond to what patients and families need and want. Among them are Centering Pregnancy and Transitional Care models, the Eleventh Street Family Health Service, and the Nurse-Family Partnership initiative. These edge-runner models of care serve a triple aim: to improve patient experiences, to improve health outcomes and to reduce costs. Health, Mason proposed, must be defined holistically; must be individual-, family-, and community-centric; and must be built on strong relationships that are key to patient/family/community engagement. Healthcare’s future must move beyond a disease-based view of health to one of health promotion, wellness and public health buoyed by care models demonstrating significant clinical outcomes that are cost-effective. Nurse edgerunners are prepared to do this.
Following Mason’s lecture, Susan Zahner, DrPH, RN, FAAN, associate dean for academic affairs and Vilas Distinguished Achievement Professor, moderated a responder panel of health-policy experts. The panel was comprised of Jonathan Jaffery, MD, a board-certified nephrologist and associate professor of medicine at the University of Wisconsin–Madison; Nancy Kaufman, MS, RN, founding president of the Strategic Vision Group, a health-consulting firm based in Milwaukee; and Kim E. Whitmore, MSN, RN, CPN, policy section chief and state health plan officer at the Office of Policy and Practice Alignment/Division of Public Health in Madison. The lecture audience, largely composed of nursing students from UW–Madison as well as Edgewood and Madison Area Technical College, appeared to leave the event inspired.n
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Nursingmatters Nursingmatters is published monthly by Capital Newspapers. Editorial and business offices are located at 1901 Fish Hatchery Road, Madison, WI 53713 FAX 608-250-4155 Send change of address information to: Nursingmatters 1901 Fish Hatchery Rd. Madison, WI 53713
Editor ......................................... Kaye Lillesand, MSN 608-222-4774 • kayelillesand@gmail.com Managing Editor .................................Julie Belschner 608-250-4320 • jbelschner@madison.com Advertising Representative ...............Andrew Butzine 608-252-6263 • abutzine@madison.com Recruitment Sales Manager .................... Sheryl Barry 608-252-6379 • sbarry@madison.com Art Director ....................................... Wendy McClure 608-252-6267 • wmcclure@madison.com Publications Division Manager............... Matt Meyers 608-252-6235 • mmeyers@madison.com Nursingmatters is dedicated to supporting and fostering the growth of professional nursing. Your comments are encouraged and appreciated. Email editorial submissions to klillesand@sbcglobal.net. Call 608-252-6264 for advertising rates. Every precaution is taken to ensure accuracy, but the publisher cannot accept responsibility for the correctness or accuracy of information herein or for any opinion expressed. The publisher will return material submitted when requested; however, we cannot guarantee the safety of artwork, photographs or manuscripts while in transit or while in our possession.
EDITORIAL BOARD Vivien DeBack, RN, Ph.D., Emeritus Nurse Consultant Empowering Change, Greenfield, WI Bonnie Allbaugh, RN, MSN Madison, WI Cathy Andrews, Ph.D., RN Associate Professor (Retired) Edgewood College, Madison, WI Kristin Baird, RN, BSN, MSH President Baird Consulting, Inc., Fort Atkinson, WI Joyce Berning, BSN Mineral Point, WI Mary Greeneway, BSN, RN-BC Clinical Education Coordinator Aurora Medical Center, Manitowoc County Mary LaBelle, RN Staff Nurse Froedtert Memorial Lutheran Hospital Milwaukee, WI Cynthia Wheeler Retired NuRSINGmatters Advertising Executive, Madison, WI Deanna Blanchard, MSN Nursing Education Specialist at uW Health Oregon, WI Claire Meisenheimer, RN, Ph.D. Professor, UW-Oshkosh College of Nursing Oshkosh, WI Steve Ohly, ANP Community Health Program Manager St. Lukes Madison Street Outreach Clinic Milwaukee, WI Joyce Smith, RN, CFNP Family Nurse Practitioner Marshfield Clinic, Riverview Center Eau Claire, WI Karen Witt, RN, MSN Associate Professor uW-Eau Claire School of Nursing, Eau Claire, WI © 2015 Capital Newspapers
January • 2015
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Nursingmatters
explore what it means to be an American nurse By Kaye Lillesand, MSN
Exciting news! Instead of a keynote speaker at our Career EXPO this year we will be showing “The American Nurse” Kaye Lillesand film. In addition, both Carolyn Jones, the photographer, and Sister Stephen Bloesl, a Wisconsin nurse, will be speaking. In addition we are creating a Network Cafe where attendees can have a cup of coffee and network with nurses about practices or issues they are working with such as workplace violence. Visit www.nursingmattersonline. com to register for the lunch; be sure to bring the printed registration to the EXPO. The day is free for all registered nurses. In our April edition, Mary Jo Borden wrote the following about the film. “The American Nurse invites us to think about nurses in a way that many may never have before, unless you are a nurse or
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edITORIAL have been under a nurse’s care. This body of work will inspire audiences to focus their attention on the nurses who serve as healers in their community, and whose wealth of knowledge needs to be tapped in order to solve today’s pressing healthcare issues. The challenge of creating a rich portrait of nursing in America began with a map of the United States and a red pen. Jones wanted to cover as much territory as possible with the hope that along the way she would capture stories touching on the kinds of issues nurses are dealing with in every corner of the country. The issues might be specific to a particular area, like the nurses who were charged with evacuating patients in the aftermath of Hurricane Katrina. Others would be universal no matter where Jones visited, such as nurses providing emotional sup-
port to patients and families to help them through the toughest times in their lives. Five nurses are featured in the film, one of whom is Bloesl. Visit http://americannurseproject.com/ interviews to watch a short video about Bloesl’s work as a nurse and learn more about the other 75 nurses featured in “The American Nurse” book. The American Nurse Project is an endeavor launched by Fresenius Kabi, a worldwide leader in infusion therapy, IV generic drugs and clinical nutrition. Enlisting the talents of Jones and her producer, Lisa Frank, the project set out to capture and share the images and stories of nurses from all across America and to celebrate the role of the nurse in this country’s healthcare system.” Visit http://americannurseproject. com for more information. Come and renew your commitment to nursing.
Zahner honored: Ruth B. Freeman award held the positions of chair-elect, Susan Zahner, DrPH, RN, chair and immediate past-chair for FAAN, associate dean for acathe American Public Health Asdemic affairs and the Vilas Distinsociation Public Health Nursing guished Achievement Section from 2011 to Professor at the Univer2014. She served as a sity of Wisconsin-Madmember of the Wisison School of Nursing, consin Public Health received the Ruth B. Association Board of Freeman Award from the Directors as well as Public Health Nursing the association presiSection of the American dent, and she chaired Public Health Associathe Board of Health tion at its 142nd Annual for Madison and Dane Meeting and Exposition County. She is a curSusan Zahner held November 15-19 in rent member of the New Orleans. The award executive committee for the Unirecognizes Zahner’s distinguished versity of Wisconsin Population career in the field of public health. Health Institute. Among her many leadership Zahner was a driving force roles in public health, Zahner has behind the Linking Education and Kathleen Corbett Freimuth
Practice for Excellence in Public Health Nursing Project, aimed at improving preparation for publichealth nursing practice, and in the development of the Wisconsin Public Health Research Network, which supports and advances public-health systems and services research driven by the needs and interests of health departments in Wisconsin and beyond. Zahner’s achievements in public health were aptly summarized in her Ruth B. Freeman Award nomination letter: “Few have had the kind of impact that Dr. Zahner has had in truly bringing together the critical ingredients of leadership, lifelong learning, and deep and meaningful collaboration.”n
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January • 2015
Program offers school-nurse help Kathleen Corbett Freimuth
A web-based system called eSchoolCare helps school nurses manage the care of children with chronic health conditions. It has gained the support of a University of Wisconsin–Madison initiative that helps move UW-inspired technology and innovation to market. Guided by UW’s Discovery to Product program, eSchoolCare’s creator Lori Anderson, Ph.D., RN, hopes her product gains nationwide success among school nurses in order to benefit thousands of school children. “Our challenge is getting eSchoolCare into school nurses’ hands in a way that is efficient Lori Anderson and sustainable,” Anderson said. “How do we get the word out about eSchoolCare? How can we improve it? What is a price that is affordable? After all, the main goal is to get eSchoolCare out to nurses who need it, but we also need to make it a sustainable enterprise. (Discovery to Product) will provide us with expertise, support, and funding to answer these questions.” Anderson, a clinical assistant professor at the
University of Wisconsin–Madison School of Nursing, was chosen as one of 17 entrepreneurs awarded “igniter” grants as part of the Discovery to Product’s inaugural class of projects. Discovery to Product, a partnership between UW–Madison and the Wisconsin Alumni Research Foundation, will advise awardees in steering their research toward marketable products. “Dr. Anderson’s award will provide valuable advice,” Dean Katharyn May said, “that will help us move ahead on other School of Nursing initiatives that can and should be distributed to a wider audience, using technology of the day to deliver nursing expertise wherever and whenever it’s needed.” Anderson’s project, eSchoolCare, is designed to support school nurses in caring for children with five chronic pediatric conditions: asthma, diabetes, severe allergy, cancer and mental-health disorders. Via an iPad, the online resource delivers step-by-step assistance on how nurses can provide care in schools on an immediate basis. The program has already shown that its technology works. “It has been tested at least initially in the
marketplace,” Anderson said. “We have paying customers; about 500 nurses are currently using eSchoolCare. That makes us somewhat unusual among the (Discovery to Product) grantees in that many of the projects are at earlier stages of development.” Market success, however, will look different for each entrepreneur’s project. In Anderson’s case, she said she hopes to take the next step toward commercialization of her product, which is sustainability. Award grantees will participate in a 10-week business-accelerator program. Each team will receive a portion of Discovery to Product’s $2.4 million from the state of Wisconsin’s Economic Development Incentive Grant based on achievement of these milestones. Along with Anderson, eSchoolCare team members include Kate Fletemeyer, eSchoolCare project manager, and Erik Burns, special projects manager at the UW–Madison Division of Continuing Studies. “(Discovery to Product’s) support is a great opportunity,” Anderson said. “Through the support of eSchoolCare, other outreach endeavors at the School of Nursing, both current and future, may benefit as well.”n
Josie Veal recipient of national award Washington, D.C. – A Wisconsin nurse who has made extraordinary efforts to improve the diversity of the nursing workforce will be recognized as one of 10 recipients of the new Breakthrough Leaders in Nursing award created by the Future of Nursing: Campaign for Action, a joint initiative of AARP and the Robert Wood Johnson Foundation. Josie L. Veal, Ph.D., RN, APNP, FNP-BC, has worked as a sexual-assault examiner, an advanced-practice nurse in a correctional setting, a surgical nurse, and an operating-room nurse in the U.S. Army Reserve. “Working as a sexual-assault examiner was my most challenging nursing position,” said Veal, who is helping to improve workforce diversity as a member of the Wisconsin Action Coalition. “When someone has suffered a sexual assault, the nurse is not just dealing with health issues, but must consider problems that may surface years later as a result.” Veal said the common thread that has linked her varied career is her efforts to give a voice to the underrepresented, such as minority nurses, underserved patients or people who are incarcerated. As a member of the nursing faculty at Milwaukee Area Technical College, Veal wants her students to know that achieving a doctoral degree and assuming a leadership role is not
Photo Left to right: Susan Hassmiller, PhD, RN, FAAN, Robert Wood Johnson Foundation Senior Adviser for Nursing and Director of the Campaign for Action, Josie Veal, PhD, RN and Susan Reinhard, Ph.D., RN, FAAN, Senior Vice President of the AARP Public Policy Institute and Chief Strategist at the Center to Champion Nursing in America.
insurmountable, no matter their background. The Campaign for Action created the 2014 Breakthrough Leaders in Nursing award to celebrate nurse leadership and the importance of efforts by nurses to improve health and healthcare. The award recipients have worked to help victims of sexual assault, medically fragile
children and neurologically impaired individuals, among others. Their work is helping to improve the quality of medical care in Vermont, prevent bedsores and reduce Medicaid costs in Texas and provide healthcare to women in rural Utah, to name a few. “Josie has worked tirelessly to improve access to healthcare, especially for those people who are too often marginalized,” said Judith Hansen, executive director, Wisconsin Center for Nursing Inc., the state’s nursing workforce center and co-lead for the Wisconsin Action Coalition. “As a member of the Wisconsin Center for Nursing Board of Directors, Josie contributes scholarship and research excellence in addition to her strengths as a practicing professional. This award recognizes the incredible progress Josie’s leadership has made for the people of Wisconsin.” The Future of Nursing: Campaign for Action is a joint initiative of AARP and the Robert Wood Johnson Foundation, working to implement the Institute of Medicine’s evidence-based recommendations on the future of nursing. The Campaign includes Action Coalitions in 50 states and the District of Columbia and a wide range of healthcare professionals, consumer advocates, policy-makers, and the business, academic, and philanthropic communities. Visit www.campaignforaction.org for more information.n
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Nursingmatters
Future of nursing report: A Wisconsin profile Judith Hansen, Wisconsin Center for Nursing Executive Director
The Wisconsin Center for Nursing recently published a landmark report on progress being made in Wisconsin on recommendations from the Institute of Medicine Future of Nursing Report of 2011. The report was published on behalf of the Wisconsin Action Coalition, which is co-led by the Wisconsin Center for Nursing, the state’s nursing workforce center and the Rural Wisconsin Health Cooperative, a collaborative network of 39 rural, acute, general medical-surgical hospitals. Implementation of the institute’s Future of Nursing Report: A Wisconsin Profile is based on responses to a unique inventory to assess the implementation of the report in the state. The report’s recommendations provided the framework for the survey questions. In addition to the report, the Wisconsin Nursing Workforce: Status and Recommendations 2013 was also used in the analysis of the survey results. The Workforce Report is used by educators, health systems, governmental agencies, workforce planners and policymakers to inform and implement strategies to mitigate emerging nursing workforce challenges in Wisconsin. The report provides judicious information on the status of the nursing workforce and recommendations to address projected nursing shortages impacting future healthcare delivery. Members of the Action Coalition Advisory Council who served on a subcommittee for the inventory project were Tim Size, Rural Wisconsin Health Cooperative executive director; Silvana Richardson, dean and professor at Viterbo University School of Nursing; and Mary Gulbrandsen, executive director of Fund for Wisconsin Scholars. The Rural Wisconsin Health Cooperative also provided the survey link to conduct the survey and assisted in compiling the results. The inventory was accomplished with participation by many indi-
Key Findings -‐ Implementation of the IOM Future of Nursing Report: A Wisconsin Profile Hospitals/ Clinics
Nursing Education
Other Organizations
Is your organization taking action to:
n=51
n=43
n=27
n=121
Remove scope-‐of-‐practice barriers?
63%
70%
41%
60%
Expand opportunities for nurses to lead & diffuse collaborative improvement efforts?
80%
56%
52%
65%
Implement nurse residency programs?
76%
30%
11%
45%
Increase proportion of nurses with a BSN to 80% by 2020?
80%
88%
48%
76%
Double number of nurses with a doctorate by 2020?
31%
56%
19%
37%
Ensure that nurses engage in lifelong learning?
78%
88%
78%
82%
Prepare & enable nurses to lead change to advance health?
76%
70%
59%
70%
Build infrastructure for collection & analysis of inter-‐professional health care workforce data?
47%
74%
30%
53%
Enhance models of inter-‐professional education & practice?
39%
70%
19%
45%
Increase nursing diversity?
59%
86%
41%
64%
viduals and partners throughout the state, from a wide variety of settings. In order to assure input from all the sectors where nurses are educated or work, organizations were invited to have their members complete the survey. These organizations included the Wisconsin Hospital Association, Administrators of Nursing Education in Wisconsin, Wisconsin Nurses Coalition, Wisconsin Association of Local Health Departments and Boards, Wisconsin Association of School Nurses, Wisconsin Health & Homecare Association, Wisconsin Long-term Care Association, Rural Wisconsin Health Cooperative, Wisconsin Medical Society, Wisconsin Medical Group Management Association and Wisconsin Minority Nurses Associations, as well as numerous other partners and key stakeholders. The survey was released to the field in late summer 2013; participants
were invited to describe how their organizations supported each of the individual key recommendations. A writing team from the Wisconsin Center for Nursing Board of Directors compiled the findings into a final report. The team was comprised of Yvonne Eide, Patricia Keller, Brent MacWilliams, Barbara Pinekenstein, Josie Veal and Executive Director Judith Hansen. There were 121 surveys returned, which included 500 qualitative comments. Respondents represented all five geographical phone area codes of the state, and included responses from hospital and clinic systems, residential long-term care, public health, schools, nursing education and nursing associations. The level of interest and dedication to implementing both the Institute of Medicine Report of 2011 and the Workforce Report of 2013 recommendations is readily apparent and demonstrates that
All Responses
the movement is well underway in Wisconsin. This report is a clear indication of what is already occurring in the state to implement the recommendations, and there are likely to be many more such programs than are shown in the report. The inventory is unique to Wisconsin, and represents a pioneering effort to assess the impact of implementation. It serves as an exemplar to other state Action Coalitions, and has already received recognition at the national level. The Implementation of the Institute of Medicine Future of Nursing Report: A Wisconsin Profile provides a snapshot of work taking place in Wisconsin, and is intended to be used by educators, health systems and other key stakeholders to inform, assess and implement strategies to address the recommendations. Visit www.wisconsincenterfornursing.org to view and download the report.n
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January • 2015
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Giving a new meaning to “guinea pig” Kathy Bruning, MS, RN
I am a human subject. I am one of those nameless people that one reads about in news articles, in nursing or Kathy Bruning medical journals, or that encounter in the course of research projects at a facility or institution. And I have been a human subject for 25 years. No, I am not part of a clinical trial for medical devices, medications or procedures. I am not part of a study on nurse education, recruitment or retention. I am simply a part of a long study of nurses on the effects of lifestyle on many aspects of health for women. What is this mysterious study, and how important is it? And what is it like to be a human subject for so many years? Since 1989, I have been a part of the Nurses’ Health Study II. I was recruited while living in Kentucky – one of a limited number of states targeted for recruitment for that cohort. It sounded interesting and I was intrigued with the idea of contributing to a knowledge base about how lifestyle might affect health. In fact, this was the second cohort of the study run out of Harvard School of Public Health. The first Nurses’ Health Study began in 1976 with more than 120,000 nurses; 78,000 continue with that study. NHS II enrolled 116,000 nurses; 110,000 of us remain. As you can see, we are a persevering bunch! I recall the first questionnaire as quite long and intimidating – pages and pages of items about intake of specific foods I had eaten over the course of a year – all food groups!; specific exercise and activity I engaged in and how many minutes/ hours of each, again over a long time span; my health history and that of my family; medication use; OB/Gyn status and practices; and on and on. And the questions were completed on paper, like old-style standardized tests. Whew! I thought; that should give them enough to analyze for several
years. Sort of. There were news updates after the first year; and the second year brought… another questionnaire. While this one was shorter, it was still detailed and taxed my memory quite a bit. And so it has gone since then: every two years brings a questionnaire with news updates now every year due to the many results that regularly are gathered from the data. There have also been periodic requests for other “samples,” such as blood and urine. While it might sound bizarre, there are always sensible provisions given for collecting and shipping. Sometimes specific groups are asked to provide other kinds of samples related to their health status. And what is the big deal with these studies? What have they accomplished? Here is a sampling of headlines and capsule conclusions detailing results attributable to the study over recent years: • PTSD Linked to Obesity Risk in Women – by affecting parts of the brain controlling reactions to stress and regulating body processes, including digestion; • Breast Cancer Risks – heightened in premenopausal women by high blood levels of endogenous hormones – estradiol and androgens; postmenopausal use of estrogen plus testosterone; and consumption of red meat several times a week, possibly related to hormones in red meat; • Nuts for Health – one daily serving of nuts was associated with a 20 percent lower mortality rate; • Adolescent Milk Consumption and Hip Fracture – risk of hip fracture was not lower in those who drank milk four or more times per day during teenage years; in men, hip fracture risk was higher, possibly related to increased height. • Preventing or Delaying Memory Loss – positive effects include physical activity, such as walking 90 minutes a week or more, regular consumption of cruciferous or green leafy vegetables, and moderate alcohol consumption; negative effects include inadequate sleep and uncontrolled diabetes – higher-than-normal levels of insulin.
These Harvard folks started a third cohort a few years back – NHS 3 – recruiting on an ongoing basis RNs, LPNs and nursing students. Now they’ve done the truly unthinkable, by inviting men to enroll as well! It will be interesting to see how men’s lifestyle influences relate to their health. The other longstanding study involving men, the Physicians Health Study, had a particular clinical agenda and
enrolled a much smaller number – 22,000 – over a shorter time period. Would you like – would you dare – to become a human subject? If you are male or female and between 19 and 46 years of age, you, too, can contribute to groundbreaking research on lifestyle, environment, nurses’ work life and wellness. The time commitment is minimal – an hour of time online a year – and the continued on page 10
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January • 2015
Nursingmatters
Climb for a cause results in near-death Karen Klemp RN, BSN MA with Lisa Quintana
In most challenges in life, it’s not all about climbing to the top of a mountain, but the lessons learned during the climb. This was never more real than during a recent reallife climb led by the non-profit organization Hope-2-Others. A team headed up Mount Kilimanjaro to raise awareness for the organization’s cause. “Climb for a Cause” took place July 1 through July 7, 2014, with a group of seven members – six from the United States and one Tanzanian. They were determined to make it up more than 19,340 feet. All members raised money for the mission trip to build awareness for a planned medical center in Kisongo. Currently, the entire country has limited access to medical care and resources, especially in rural Tanzania. The center will serve as a birthing, medical and nutritional facility for over 20,000 people in the area.
Hope-2-Others crew in their Mount Kilimanjaro climb.
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to begin construction of the building. Karen Klemp, RN, founder and president of Hope-2-Others, said the recent journey forever changed her outlook on the desperate need for good medical treatment in Tanzania. “We trained for months with the Prairie Athletic Club before embarking on this climb,” she said. She said she is deeply grateful for the trainers who wanted them to succeed, training for 16 weeks prior to the exhausting climb. But only God, she said, could prepare her soul for the trial she was about to endure. Karen is 60 years old. Even though she was the so-called “weakest link,” she led the team up the mountain with local guides. The slowest hiker sets the pace on a climb like this, and the strongest member is placed at the end. That strongest player was Drew, a strapping, healthy young man standing more than 6 feet tall. He comes from Colorado, where he was accustomed to heights and had climbed many mountain peaks. There were a total of 31 guides helping the Hope-2-Others crew during the climb; local Tanzanians have many tourists wanting to make
the famous ascent. Guides carry one small oxygen tank and a stretcher with them in case of emergencies. The oxygen levels become thinner as climbers go higher, and sometimes hikers suffer from “mountain sickness,” where a person’s oxygen levels deplete to dangerous levels. Mount Kilimanjaro is the highest freestanding mountain in the world. When the team climbed to about 16,000 feet high, on the fourth day of the climb, Karen and her friend, Amy Martin, both RNs, noticed Drew’s expression began to change. He was normally full of smiles, but his demeanor became different as his countenance fell. They kept an eye on him and noticed he was starting to cough, complaining of headaches. He lost his appetite. Those are all signs of oxygen deprivation, or mountain sickness. Being a trained athlete, Drew stayed quiet, trying to tough it out, but he knew something was wrong. Despite this, he didn’t fully recognize the danger he was facing. “My whole body was so weak,” Drew explained. “I became really nauseous. I could barely walk. Now I know that oxygen wasn’t getting to my muscles, and I didn’t feel like I could breathe enough – like I couldn’t catch my breath. My heart began beating faster than I could breathe.” He felt his heart pulsating wildly, knocking against the walls of the artery in his throat. That wasn’t supposed to happen to the strongest team member. Karen and Amy began to become seriously concerned when they realized Drew was beginning to cough blood. That was bad – very bad. The guides began to carry Drew’s pack for him; they continued to climb because there was no place on the trail for the group to stop. As they reached a peak, they saw the base camp – down a rocky, steep ravine and across a stream. Drew pressed forward. There was no other choice but to walk another couple of hours to make it to base camp, but it was slow-going. Eventually too weak to even walk, Drew needed to rely on porters holding him up continued on page 9
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January • 2015
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nurse Anesthetists important to healthcare future Luke R. Hattenhauer DNP, CRNA
For anyone who has had surgery or a procedure requiring anesthesia, there’s a good chance a Certified Registered Nurse Anesthetist was involved in administering the anesthesia. Nurse Anesthetists became the first recognized nursing specialty in the late 1800s, long before anesthesiology was a medical subspecialty. Today, Nurse Anesthetists are involved in the administration of 60 percent of anesthetics in the United States. They are the primary providers of anesthesia in many rural locations and for U.S. military personnel. About 44,000 Nurse Anesthetists live and work in the United States. In Wisconsin, there are more than 650 Nurse Anesthetists, practicing in 85 percent of the state’s hospitals. As Advanced Practice Registered Nurses, Nurse Anesthetists are licensed as independent practitioners, and practice within a variety of care models. A prevalent model in many urban and suburban hospitals is that of Nurse Anesthetists practicing as part of an anesthesia care team. In this model, multiple Nurse Anesthetists might be simultaneously supervised or medically directed by an anesthesiologist. In another model, Nurse Anesthetists practice independently. This model is prevalent in many rural areas. In fact, in Wisconsin, Nurse Anesthetists are employed in 52 of the 53 Critical Access Hospitals, and are the sole providers of anesthesia in 77 percent of these facilities. Critical Access Hospitals generally are smaller hospitals, located in rural areas that receive special reimbursement from Medicare such that they may provide services to an underserved population. The educational path of a Nurse Anesthetists begins with a bachelor’s degree in nursing. This is followed by a required minimum of one year of critical care nursing experience in an Intensive Care Unit, a Pediatric Intensive Care Unit, a Surgical Intensive Care Unit, etc. There are 113 accredited nurse anesthesia schools in the United States, including one school in Puerto Rico. Franciscan Healthcare School of Anesthesia, affiliated with the University of Wisconsin – La Crosse, is Wisconsin’s
only nurse anesthesia school, and has been in operation for more than 70 years. The surrounding states of Minnesota, Illinois and Iowa collectively have 10 accredited schools of nurse anesthesia. Currently, nurse anesthesia schools are between 27 and 36 months in length, and grant either a Master’s or Doctorate degree. By 2025, all nurse anesthesia schools will grant a Doctorate degree upon graduation. Currently, many schools are in the process of transitioning from a Master’s degree curriculum to Doctorate. The National Board of Certification and Recertification for Nurse Anesthetists requires that Nurse Anesthetists complete 40 hours of continuing education credits every two years. Continuing education credits may be completed through anesthesia seminars or meetings, hands-on workshops or self-study programs. The administration of anesthesia is considered both a nursing and medical specialty. Nurse Anesthetists practice in every setting in which anesthesia is delivered, including hospital surgical suites, obstetrical units, physician offices, ambulatory surgical centers, pain clinics, U.S. military and veterans facilities, and Critical Access Hospitals. The scope of practice of Nurse Anesthetists is broad and centered around the safe, effective administration of general, regional, sedation or local anesthesia
to patients of all ages. Prior to the administration of any anesthetic, Nurse Anesthetists perform a comprehensive history and physical, and develop a patient-specific plan of anesthesia. Nurse Anes-
thetists administer anesthetic drugs, insert invasive lines and/or monitors, and appropriately emerge patients from anesthesia. They may also order and interpret appropriate diagnostic tests, and obtain consultations from other specialists. Within this broad scope of practice, Nurse Anesthetists enjoy collegial relationships with surgeons, anesthesiologists and many other healthcare professionals. Nurse Anesthetists will continue to play a major role in the delivery of anesthesia in the future. With changes looming in the structure and administration of healthcare, Nurse Anesthetists are well positioned to embrace models of care centered around safe, effective and cost-conscious delivery of anesthesia. It will be important for them to be able to practice to the full extent of their education and training as the healthcare system continues to evolve. In this way, Nurse Anesthetists will have maximal benefit on anesthesia practice models, both collaboratively and independently.n
Assistant Professor of Nursing The Henry Predolin School of Nursing at Edgewood College announces the opening for two full-time tenure track faculty positions beginning with the academic year 2014-2015. Responsibilities include teaching at the undergraduate and graduate (MSN and DNP) levels. Graduate concentrations include Nursing Administration and Leadership. Qualifications: • Earned PhD in Nursing (preferred), or doctorate in related field with a Master’s degree in Nursing; DNP may be considered • Eligible for RN licensure in the State of Wisconsin • Evidence of teaching, scholarly and community services potential • Knowledge and skills in contemporary practice issues related to the AACN Essentials • Demonstrated commitment to promoting diversity, inclusion, and multicultural competence To Apply: Send a letter of application, resume, and references to: Edgewood College Human Resources – APN1 1000 Edgewood College Drive Madison, WI 53711 www.edgewood.edu E-mail: humanresources@edgewood.edu Equal Opportunity Employer
Nursingmatters
FREE FOR NURSES & NURSING STUDENTS!
EXPO 2015
Nurses: K Keeping eeping Amer America ica Health Healthy y THURSDAY, FEB. 19 • 8:30 a.m.-3:30 p.m. EXHIBITION HALL AT THE
ALLIANT ENERGY CENTER
MADISON, WI
BREAKOUT SESSIONS - 2:15 p.m.
SPECIAL SCREENING “The American Nurse” 10 a.m.
Judith Hansen, MS, BSN, RN
Executive Director Wisconsin Center for Nursing The Wisconsin Workforce: Pathway, Progress, and Potential This presentation will provide participants with results from the 2014 Wisconsin RN Survey, updates on implementing the IOM Future of Nursing Report in our state, and plans for the future.
We are fortunate to be able to screen this important documentary which gives voice to nurses on the front lines of some of the biggest issues facing America. The film has received nationwide accolades, from the White House to the American Journal of Nursing, and raves in the national media. When you watch the film you are eligible for continuing education credits.
Karen Klemp, MA, BSN, RN
NICU nurse Hope 2 Others Learn what drove Karen to the other side of the world, bringing Hope 2 Others, mothers desperate for their babies’ lives.
12:15 p.m. Complimentary Luncheon
Margaret Schmelzer, MS, RN
Guest speaker, Carolyn Jones, author and filmmaker of The American Nurse. Known internationally for her socially proactive photography, Carolyn is also an award winning filmmaker. She personally interviewed and photographed dozens of nurses for The American Nurse Project. PHOTO: LEO SOREL
Although the luncheon is free, you must register at
Complimentary luncheon sponsored by
www.nursingmattersonline.com. Luncheon sponsored by UW Health.
Chair, Prescription Drug Abuse Task Force Wisconsin Nurses Association
Louis Oppor, Section Chief
Substance Abuse Services Section Bureau of Prevention Treatment and Recovery Division of Mental Health and Substance Abuse Services Department of Health Services Addressing the Problem of Prescription Drug Abuse
While at Expo, be sure to visit the Exhibit Hall! Employers – Shopping – Holistic Health – Education – Uniforms – Books – Chair Massage
EXHIBITORS
Arbonne Blue River Chiropractic Cardinal Stritch University Coalition of Wisconsin Aging Groups College of St. Scholastica Easter Seals of Wisconsin East-West Healing Arts Institute Edgewood College Froedert Health Gideon’s International
Gilda’s Club Grand Canyon University Group Health Cooperative of South Central WI Heartland Home Care & Hospice Herzing University Home Health United Kaplan Health L’BRI Pure ‘n Natural Long Term Care Insurance Solutions LLC Marian University
Milwaukee School of Engineering National Registered Nurse Case Manager Training Center Rainbow Hospice Care Select Specialty Hospital Madison Stoughton Hospital Uniforms Direct LLC UW Health UW-Madison School of Nursing UW-Milwaukee College of Nursing Viterbo University
Walden University Waukesha County Technical College Wildtree William S. Middleton Memorial Veterans Hospital Wisconsin Center for Nursing Wisconsin Department of Corrections Wisconsin Nurses Association And MORE . . .
For information about exhibit space, contact Andrew Butzine, 608-252-6263, abutzine@madison.com
Endorsed by
www.nursingmattersonline.com
Climb continued from page 6
underneath his arms, carrying him to the camp. They arrived at 5 p.m. “The strongest became the weakest,” Karen said. And Karen, the supposed “weakest,” proved later to become one of the strongest team players on the dangerous adventure. Karen had fortunately brought an oxygen-saturation monitor and other assessment equipment the tour guides didn’t have. They measured Drew’s oxygen levels. Drew had only a 45 percent oxygen level, compared to the desired 90-to100-percent level. At only 45 percent, vital organs will begin to deteriorate, leading to cerebral edema and death. It was a critical medical situation. Raphael, the lead tour porter, pulled Karen aside and told her, “This is the worst case of mountain sickness I’ve ever seen. If we don’t get him down soon, he’ll die.” Oxygen was started on Drew at 10 liters per minute, much higher than the porters normally ran on trips, 1 to 2 liters per minute. Karen also had homeopathic oils that helped Drew breathe, and she administered some steroids to reduce inflammation. But as Drew stabilized, they realized at the rate he was using oxygen in the available tanks, he’d run out. They needed more oxygen stat. The decision was made to rush him back down the mountain. They gathered and prayed, and Karen’s daughter, Kaity, believed she saw angels around the group, which gave everyone faith to embark on the unexpected journey. Karen knew she needed to go with Drew to attend to his care; that meant leaving her daughter behind with the remaining team members. Karen said it was all so surreal she couldn’t believe it was happening. “I just climbed over nine hours straight that day, and now I had to climb back down another 9 hours,” she said. At 6:40 p.m. they off down the mountain, knowing sunset would come at 7:00 p.m. A team of eight porters carried Drew on a stretcher, with a ninth porter to help by rotating with the eight carrying Drew over the cliffs and mountains. When they reached the half-way point, they switched to a stretcher that had a
January • 2015 bicycle wheel underneath that could go faster. It was something like a big wheelbarrow, useful as they went down the bumpy mountain trail. The porters all had head-lamps and 40-pound backpacks. Karen watched in awe as she saw the porters trotting down the hill with Drew. A thought kept surfacing in Karen’s mind as she prayed for supernatural strength to continue down, needing divine intervention as her legs began to feel weak. She realized that many people in Tanzania die on the way to find medical help. Two people had died on Mount Kilimanjaro the week prior to the Hope-2-Others tour. Now another concern surfaced. Would the batteries on the oxygen analyzer and the oxygen tanks hold out? They had borrowed oxygen tanks from other teams at base camp four; oxygen tanks were being taken back up the mountain to replace those they borrowed. They couldn’t risk the batteries dying, so another hard decision was made. The porters needed to run ahead of Karen, leaving her to continue the descent with just one porter. She encouraged Drew to stay awake and believe God had a plan for him. She told him to just whisper, “Jesus,” because by this time, he could no longer talk without his oxygen dropping. Karen watched the porters wind their way down, smoothly carrying Drew. It looked like a ribbon of light flowing downhill. “The entire night sky was lit up with millions of stars that night,” she said. “I could see them clearly as they descended. It was just like a caravan with their head-lamps glowing in the distance.” The porters soon saw bars on their cell phones, and communicated with the teams at the bottom who were waiting to assist. Plans were being made to take Drew to the closest medical hospital in Moshi. With every step down, more oxygen was in the air, helping Drew’s situation improve. Karen prayed continuously that they wouldn’t drop him. She felt the desperation for the life of another person that others must feel who live in that area, and began to weep as she thought about Drew’s parents, who had no idea how critical their son was. “This is bigger than this mountain,”
Karen said she thought silently. “I had the realization of walking in their shoes, desperate for medical help, having to trek mile upon mile with a sick loved one to receive medical care.” She said she had the impression God was with her as she walked down the hill, showing her this is how His people feel. Karen went far beyond “walking a mile” in their shoes. The porters reached safety with Drew two hours before Karen arrived. He managed to stay awake the whole bumpy ride. When Karen finally reached the bottom, she looked for Drew – and there he was looking great, eating and drinking. He was fine and no need to seek advanced medical care. Through his ordeal, God showed Drew something that changed his life. “God showed me a selfless love through these porters,” Drew said. The porters really had no incentive to help Drew. They received no extra money and walked or trotted through the entire night carrying him. They simply carried Drew because it was the right thing to do – he was helpless without them. Drew said he was humbled and honored at the same time. It took several days for Drew to return to normal. His chest was incredibly sore from breathing so hard, but he said he never feared he’d die. He said he’s thankful for the experience because it taught him something he’ll never forget. He learned to trust God for his future. “God is the best adventure!” he said. Drew now has plans to pursue medical missions, and plans to go back someday to make it to the top of Mount Kilimanjaro. This situation could have turned out much worse, and they all knew it. The tour guide, Raphael, and owner of the Tembea Africa Tour Company, Meleck Lemomo, wanted Karen and Amy to teach their porters more about monitoring oxygen levels because they knew it was increasing the oxygen levels that kept Drew alive – besides prayer, of course! Karen and Amy spent the next day educating the tour guides about altitude mountain sickness, and realized the porters were in dire need of more equipment. Karen gave them her oxygen moni-
Page 9 tor and two stethoscopes as a start, but they need more oxygen tanks, monitors and medications to treat the sickness. The remaining team members, once hearing Drew was safe, continued to climb. But ultimately only one member, Tom Kiphizi who is Tanzanian, reached the very top of Mount Kilimanjaro. Kaity, Karen’s daughter, came the next closest at only 400 meters from the top. But she started to experience headaches and coughing, so, being extra cautious, she decided to stop. Even at that, it was a huge victory for Kaity because doctors predicted she would never be able to walk or talk following a near-drowning accident when she was 2 1⁄2 years old. The rest of the team came down after an exhausting week of hiking – all to raise awareness and support of the need for medical centers. Everyone was champion for the cause, taking the challenge and stepping out in faith and courage, working together to make a difference in the lives of others. Safari, owner Meleck Lemomo, and his tour-guided company, Tembea Africa Tours, the Prairie Athletic Club were critical to the success of the mission, the organizers said. Dr. David Ende, Karen and Rick’s cardiologist, who instructed them in what to do in case of an emergency, and all who contributed to the mission of raising awareness to improve medical assistance in Tanzania were also important. Donations of 18 parcels of land ranging from 1 to 50 acres of land, totaling more than 250 acres all over Tanzania, have been given to Hope-2-Others so they can build medical facilities. During this season of Thanksgiving and Christmas, the organizers say they ultimately give all thankfulness, praise and glory to the Great Physician, our God and Creator, who brings us all hope, healing and health in our lives. They thank the Lord for using these men and women, and working through them to bring the healing and hope they needed during the team’s challenging time, and for rescuing Drew and the team in their time of need. Visit www.bringinghope2others. com or e-mail hope2others.info@ gmail.com or call 608-825-9557 for more information.n
January • 2015
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Nursingmatters
Reprint in a series written by Signe Cooper and introduced by Laurie Glass in Nursingmatters
Reflections of our Heritage Signe Skott Cooper’s legacy Josephine Balaty
nurse saves early nursing history Signe Cooper, RN, MEd, FAAN
Josephine Balaty served as assistant administrator of the Wisconsin Department of Nurses for 25 years. In this position, she assisted in the establishment of new schools of nursing in the state, as well as evaluating existing schools and encouraging their improvement. But her unique contribution was the location and preservation of items relating to the history of nursing in Wisconsin. Her outstanding contribution to the preservation of nursing history of Wisconsin occurred at a time when few nurses were concerned with or interested in the history of nursing. She chaired the Committee on Nursing History of the Wisconsin Nurses Association from 1956 until 1975. Many of her efforts were related to the work of the committee, but much was on her own initiative. Her deep interest and unwavering belief in the importance of preservation of Wisconsin history led her to devote an inordinate amount of time and effort to this cause. She actively sought books, artifacts and other memorabilia significant to the history of nursing in the state. She located historically significant books in hospitals where their schools of nursing had closed, and had them placed in the historical collection of the University of Wisconsin Health Sciences library and other nursing libraries in the state. Many of these books were out of print and very scarce indeed. It was her idea that a collection of pins from schools of nursing be started. The collection, located in the Wisconsin Nurses Association headquarters in Madison, consists of pins of many schools no longer in existence. Replicating the collection would now be impossible, because
many of the early schools had only Active in several nursing orgaa small number of graduates nizations, Balaty was a who wore the pins. member of and chaired the As chairman of the WisAmerican Nurses Associaconsin Nurses Association’s tion’s Blueprint Committee Committee on History, she for the development of the encouraged and assisted state board test pool examiwith the development of disnation. She was president of plays, including “Tubercuthe Wisconsin Association losis Nursing” from 1970 to of License Practical Nurses 1974. These interpretations Josephine Balaty from its founding in 1949 of nursing’s contribution to through the next 15 years. the public’s health were viewed by An avid traveler, Balaty visited Euthousands of visitors. rope several times, as well as the Far
J
osephine Balaty was born April 22, 1915, in Brookfield, Illinois. Her parents were Vincent and Josephine Kapella Balaty, both born in Czechoslovakia, and she herself spoke Czech. Josephine Balaty graduated from Lyons Township High School in La Grange, Illinois, in 1932. She then attended Lyons Township Junior College for two years before enrolling in the Evanston Hospital School of Nursing, associated with Northwestern University. She received her Bachelor of Science degree in 1937, and the next year she enrolled in the year-long postgraduate course in psychiatric nursing at the Neuropsychiatric Institute of the Hartford Retreat, Hartford, Connecticut. She later was awarded a Master’s Degree from the University of Chicago. Balaty began her nursing career as a staff nurse at Evanston Hospital, followed by private-duty nursing at the same institution. In 1940 she was appointed an instructor and assistant director of nurses at the
Guinea pig continued from page 5
process is easy: visit www.nhs3. org for more information. There you will find information about the study and how to enroll. Over the years of being a human subject, I have felt pride knowing my responses to those questionnaires have been incorporated into leading-edge research on women’s
East, Canada and Mexico. She was a member of Altrusa International and the Madison Civics Club. She retired in 1974 to live in Hatfield in Jackson County to care for her aging parents. After their deaths, she moved to Lake Charles, Louisiana, where she now lives. Much of the Wisconsin’s early nursing history was saved through the efforts of Josephine Balaty. She wanted future generations of nurses to appreciate and understand their professional heritage.n
Lakeview Hospital School of Nursing in Danville, Illinois. For a short time she was the nursing-arts instructor at the Hartford, Connecticut, Hospital School of Nursing, but in 1946 she returned to Lakeview Hospital in Danville where she served as director of its school of nursing and nursing service. Two years later she was appointed assistant coordinator of nursing education for the Illinois Department of Registration and Education in Springfield, Illinois. In 1949 Balaty came to Wisconsin as assistant director and educational consultant for the Wisconsin Department of Nurses – now the Bureau of Nursing, Wisconsin Department of Regulation and Licensing. There she worked with Adele Stahl. (see NURSINGmatters, May 1992.) Balaty’s work as a state employee in the Department of Nursing was exemplary. Always helpful and supportive to faculty members, she was untiring in her efforts to improve the schools of nursing in the state.n
– and men’s – health. It is a way of giving back to nursing, as well as supporting a broader emphasis on research. As a side note, I have provided NHS II with addresses of family who can reach me in case I fall out of touch. I also have a signed form authorizing release of medical records to the study in case of my illness or death. Is that commitment?
Or insanity?? I even involved my son. GUTS – Growing Up Today Study – began in 1996, for children of NHS II subjects. Since then, nearly 100 articles about its findings have been published, including a recent correlation showing that girls regularly consuming vegetable protein, peanut butter or nuts may have lower risk of developing benign breast disease.n
REGISTERED NURSES
Contact Kaye Lillesand, editor of
Nursingmatters with news or events you would like to submit at
Mile Bluff Medical Center currently has the following Registered Nurse positions available. These positions include our benefit package. Part time position available in our OB department. This position is for 12 hour night shifts. Experience in labor and delivery preferred. Full time position available in the Med/ Surg department. This position is for 12 hour Night shifts. Experience preferred. Part time position available at Crest View Nursing Home. Full time and part time positions available in our Emergency department for PM and Night shifts. Current RN licensure and BLS required. Emergency Room nursing experience preferred. Mile Bluff Medical Center is a rural facility located in South Central Wisconsin on I90/94, 70 miles from Madison and LaCrosse. For more information on our facility, please visit our website at www.milebluff.com. Interested candidates may send resume to: Mile Bluff Medical Center Attn: Human Resources 1050 Division St. Mauston, WI 53948 (608) 847-1461
608-222-4774 or
An Equal Opportunity Employer
email klillesand@sbcglobal.net
Got a Position You Need Filled?
House Supervisor, RN
POSITION SUMMARY: The House Supervisor has the overall responsibility for oversight during the assigned shift as well as coordinating as necessary with the Administrator on Call for all hospital operations. The House Supervisor is responsible for ensuring the department is staffed in accordance with established guidelines, with quality, patient safety and fiduciary expectations in mind. The House Supervisor manages, organizes and provides direct patient care, incorporating clinical decision-making and prioritization of activities by floating to the area of greatest patient need. The House Supervisor is responsible for implementing the Emergency Preparedness Plans for the corporation. HOURS: 0.5FTE. PM and Night shifts, rotating weekends and holidays. REQUIREMENTS: Current Wisconsin license as a registered nurse. Graduate of an accredited school of nursing. Bachelor of Science in Nursing is desirable. CPR certification. ACLS certification. NRP certification. PALS preferred. Computer knowledge is preferred. Prior supervisory experience preferred. TNCC preferred.
Applications can be completed online at www.cch-inc.com.
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January • 2015
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Nursingmatters
Wolters Kluwer Health: nurses are key Wolters Kluwer Health added a new component earlier this fall to Lippincott Advisor. The addition addresses sentinel events and is designed to help nurses increse their role in helping to reduce incidence of these adverse patient outcomes in hospitals and other institutions. The new feature provides a comprehensive decision-support resource that details what nurses and clinicians caring for patients at the bedside can do when a sentinel event occurs. Defined by the Joint Commission as “an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof ” that occurs in a hospital or other healthcare facility, a sentinel event “signals the need for immediate investigation.” Since 2004, the Joint Commission reports it has investigated nearly 8,000 sentinel events, including 887 in 2013 alone. In addition,
other key industry organizations and programs require tracking and trending of sentinel events. Patient safety is of paramount concern to hospitals and other healthcare facilities, and to the Joint Commission, which considers reduction of sentinel events one of its highest priorities. To this end, Wolters Kluwer Health saw an opportunity to help nurses address this issue by utilizing Lippincott Advisor as a way to deliver easy, online access to a comprehensive set of information devoted to sentinel events. Lippincott Advisor is a clinical decision-support solution designed for point-of-care usage by nurses and other clinicians. “We are committed to the idea that nurses can play a key role in mitigating sentinel events if they
They are the ones WHO
have more information about what they should do when an event occurs,” said Judith McCann, MSN, RN, chief murse, Wolters Kluwer Health, Professional and Education. “Not all sentinel events are preventable, but nurses who know the warning signs are able to better manage risk for the patient and, if an event occurs, know the actions they need to take to ensure the patient receives evidence-based, quality care.” The new section provides links to 16 sentinel-event categories as defined by the Joint Commission, including fall-related events, infection-related events, operative/ postoperative events, medication errors and delayed treatments. Each category provides a definition of the sentinel event, a list of
common causes and risk factors, and a section called “What the Nurse Should Do,” which provides detailed analysis of steps and actions a nurse can take for a variety of different conditions and scenarios. The product also has a detailed reference section for each category. Lippincott Advisor includes more than 10,000 collective entries of critical, evidence-based information spanning diseases and treatments, diagnostic tests, drugs, signs and symptoms, nursingcare plans, patient education, core measures, hospital-acquired conditions, national guidelines and sentinel events. Using a proprietary synoptic search, Lippincott Advisor provides immediate, evidencebased answers to clinicians’ most pressing health-information questions. Visit LippincottSolutions.com for more information.n
RAISE THE BAR They are the world-class nurses of UW Health. And yes, they set the bar high. Nurses will find remarkable opportunities at one of the nation’s leading academic health centers. Visit uwhealth.org/careers to learn more.
HN-41536-14
UW Health. Remarkable Careers.