Careers in Health Nursing Resources

     I have learned earlier on in my nursing career that, in order to lead my patient toward wellness, I have to apply the nursing process as a method of problem solving which enables a nurse to organize and deliver nursing care.  It is an element of critical thinking that allows nurses to make decisions and intervene based on reason.  The nursing process is used to diagnose and treat human responses to health and illness by utilizing five steps:  assessment, diagnosis, planning, implementation, and evaluation (ADPIE).  ADPIE provides a blueprint for critical thinking which allows the nurse to individualize care and respond to a client’s need in a timely and reasonable manner therefore improving or maintaining the client’s level of health. The purpose of the nursing process is to identify the client’s health care needs (assessment), determine priorities (diagnosis), establish goals and expected outcomes of care, establish and communicate a client-centered plan of care (planning), provide nursing interventions designed to meet client needs (implementation), and appraise the effectiveness of nursing care in achieving expected client outcomes and goals (evaluation).  As laid out, these principles can easily be applied in parallel to project management.

     Project Management according to Lewis (2007, Chapter 1) is, “a temporary endeavor undertaken to produce a unique product, service, or result.” Similarly, project management follows the same basic tenets as the nursing process of ADPIE.  Every project manager needs to define the project (assessment), develop solution options (diagnosis), plan the project (planning), execute the plan (implementation) and finally monitor, control progress and close out the project accordingly (evaluation).  Just as a nurse ensures that the patients transitions from health to wellness, Lewis (2007, Chapter 2) quips, “the primary responsibility of the project manger is to ensure that all work is completed on time, within budget and scope, and the correct performance level.”  A project manager will develop a work breakdown structure, (WBS) to pictorial represent to team members and stakeholders all the components that are necessary to deliver the project.  The nurse in return has a similar tool the equivalent of a WBS called the Care Plan, which is the documentation of a plan identified by a nurse as all the necessities required to assist a patient (a nurses project), move from illness to wellness. Just as every project team member utilizes the WBS to gain a big picture perspective, all nurses involved in patients treatment regimen will look to the care plan.

     With healthcare reform currently at the center of our nation’s political debate, what has been overshadowed is The Health Information Technology for Economic and Clinical Health Act (HITECH) enacted into law by President Obama in February of 2009 with the basic premise of providing healthcare organizations with stimulus dollars and emphasizing on quality and efficiency and utilizing information technology to affect changes the healthcare industry desperately needs.  In a struggling economy it was only natural for the organization I work for then, a not for profit, faith based community hospital, to strategically align itself to realize the full profit potential the stimulus funding can provide.  In our usual annual fashion my Chief Nursing Officer (CNO) provided me with a report on projects approved by the organization’s Executive Team.  In reviewing these approved projects, it became apparent to me that the strategic plan for the year will be without complications.  Utilizing the process of ADPIE I quickly realized that my organization was asking me to do the equivalent of building a roof without the basic structure a home needs to support it.   In order for our organization to sustain the yearly requirements for stimulus funding, certain prerequisite projects were needed to scale our system to the desired end point.  Furthermore, I knew building the system without the prerequisite architecture would fragment data and therefore ultimately affect how the clinicians provide patient care and, subsequently affect patient outcomes.  As a health care provider I became quickly cognizant of the demands that have been overlooked, but I also knew I could not merely respond by saying it cannot be done.  I then embarked on a process of analysis, using ADPIE as my basic framework, to foresee how I could continue with the approved projects and at the same time reinstate the previously dismissed projects and build a business case that still aligned itself with the organization’s strategic plan for the year.  Apparently, I was organically utilizing project management principles in the process as well.  With a business plan the equivalent of a work breakdown structure (WBS) and risk analysis in place, I then engaged my CNO in a crucial conversation in which I asked her to re consider reinstating the previously dismissed projects.  Following a principle provided by Verzuh (2008, Chapter 11), “the best way to communicate difficulties to customers and managers is simply to present them the facts.”  I went on to articulate crucial components of a plan, in essence the critical path, which included reallocation of funding and resources to support the end goal.  The plan had a slight caveat, the need for additional funding with an amount that I felt was reasonable and minimal in quantity considering the funding and returns on investment that would be realized.   Clear and transparent communication being the key, my CNO was in agreement that certain items may have been overlooked by the Executive Team, and felt I had equipped her with enough information to confidently go back to the leadership team and request additional funding.   Approval was ultimately obtained and I came to the realization that in the process I had learned to advocate for the needs of the healthcare consumer as well as our healthcare providers.

     Project Management however goes beyond the day to day managing of task and deliverables.  If projects were that easy, then we would not see a failure rate of 83%, which basically suggest that a project is bound for failure the minute it is started (Lewis, 2007).  There is a crucial component to project management which I like to call the people management. These include the managing of the project team and the crucial conversations that must take place between the project team and the project stakeholders.  As a project manager, assumptions can be a dangerous thing, even detrimental.  As a people manager, a project manager has the difficult job of ensuring all parties are moving towards the ultimate goal, which is the successful implementation and completion of a project.  It is not just completing the project that determines success.  It is doing so in such a way that meets your stakeholder’s original intent, along with being on time and on budget.  Clearly there are three major moving parts; people, timeline and budget that ultimately will define if a project is indeed a success.  Lewis (2007, Chapter 10) explained the difficult task of a project manager the best when he stated, “a manager should try to satisfy the needs of the organization, while simultaneously helping individuals satisfy their own needs through participation in the project.” 

     In my years working in Healthcare Information Technology I have leveraged the use of the nursing process not realizing I have also been utilizing project management concepts.  Both of these principles have been an objective tool that has been so ingrained in me that I have used it often.  In the almost seven years that I have been in a managerial role, managing the electronic medical record implementation for hospitals, what has enabled me to thrive and manage such a complex implementation with multiple moving parts and sometimes conflicting priorities, is my very own knowledge and utilization of the project management process which has allowed me to achieve, and has been instrumental in, realizing my managerial potential.  Clearly whether it is patient care, or project oversight, structure and proper methodology is needed in order to be successful.  The process of ADPIE is such a universal concept that it can be an instrumental tool versatile enough that it can be used in business practices as well as in life decision making processes.  By using this blue print one can prioritize and approach critical situations with ease and confidence.

References

Lewis J P 2007 Fundamentals of project managementLewis, J. P. (2007). Fundamentals of project management (3rd ed.). New York, NY: AMACOM.

Verzuh, E. (2008). The fast forward mba in project managment (3rd ed.). Hoboken, NJ: John Wiley & Sons, Inc. 

The Care Extender Program provides opportunities for volunteers to experience health care from a clinical perspective through patient contact and volunteer involvement. CareExtenders are trained to assist Medical Center staff, who, in turn, are able to share their personal experiences with their volunteers.

Time spent in the program proves invaluable because it provides each Care Extender with "in-the-trenches" experience in a real hospital setting. Care Extenders are respected as professional members of a patient care team. As a result, they gain an insiders’ understanding of the operations of the hospital- an experience which helps them determine their specific course for future studies.

Below are the steps to becoming a Care Extender:

-To qualify, you must be 18 years or older, currently attend college or already have a degree.

-Attend a mandatory orientation/application session (by reservation only) and submit the complete application at the end of that session

-If selected, attend an interview session.

-Upon acceptance into the program (requires one year commitment), you must attend a mandatory training session.  You will also need to get CPR certified by the American Heart Association, complete a 2-step TB test, and have proof of MMR vaccination and Varicella vaccination (or proof of history of chicken pox).

Spring 2011 ORIENTATIONS ARE ON THE FOLLWING DATES:

Tuesday, March 29^th: 7-9pm

Wednesday, March 30^th: 7-9pm

Saturday, April 2^nd: 10am-12pm

To sign up for one of the sessions, please click and follow directions on this link:

http://sites.google.com/site/careextendersprogram/Home/staff/faq/how-to-apply

You should bring a pen to the orientation so that you may complete the application, and you may use your resume for as a reference – resumes will not be collected. Dress is casual.  Orientations will be held in Ronald Reagan Hospital.

Please email questions to:

Cheryl Yashar: cyashar@ucla.edu

Blame it on Hollywood: thanks to an endless stream of TV series and movies set in hospitals, most of us probably have the wrong idea about what nurses do and just how important they are to the medical field. They’re usually depicted as smart but somehow inferior to doctors, as if they didn’t have their own medical knowledge or years of experience to guide them through the days. But this, like a lot of other popular portrayals of nurses, is almost moronically lazy and misinformed. Nurses are integral members of a health care team. If you’ve ever come across any of the myths below, or even if you’ve perpetrated them, know that the truth is a lot more interesting than the fictions.

1. All nurses are women: Not true. Admittedly, women outnumber men in the nursing field by a large margin — in the United States and Canada, only about 5-6% of nurses are men — but still, it’s wrong to say that there aren’t any men in the field. As a result of the gender imbalance, the profession is often perceived as an exclusively female one, which in America makes it a feminized one and therefore a less powerful or worthwhile one. Accordingly, portrayals of male nurses perpetuate the stereotype; a few years ago, on Scrubs, Rick Schroder played a nurse with the surname Flowers. Come on.
2. Being a nurse isn’t as challenging as being a doctor: Are you serious? Being a nurse requires education, critical thinking skills, and serious amounts of medical training. Nurses perform research, participate in surgeries, administer medicine and treatments, and act as the glue that keeps the hospital running. The hours can be long, but the work can be extremely rewarding on personal and professional levels. What part of that doesn’t sound challenging?
3. Nurses function as gofers for doctors: Again, a common misconception but a horribly wrong-headed one. Nurses often work in a capacity that sees them assisting doctors, but they’re anything but errand-runners. Nurses diagnose and treat patients, provide health care strategies for the infirm, and work to ensure people know how to take care of themselves. Nurses save lives, period. They apply medical knowledge in a host of areas to a steady stream of patients, and they do it every day. Helping out a doctor, even when it means retrieving something, doesn’t turn them into dull physical laborers in scrubs.
4. Nursing is a dead-end job: The Bureau of Labor Statistics pegs nursing as a hot field, with prospects for RNs listed as "excellent." Why? Well, baby boomers are getting old, and we’re also living longer in general, which means there’s going to be a glut of Americans putting a strain on the health care system. If you’ve got the training, you can likely find work, especially if you’re willing to relocate. What’s more, nurses with the right kind of training can further their careers in specialized fields (midwifery, elderly care), which opens doors to even more jobs and opportunities. In short, a smart nurse will succeed.
5. Nurses are all the same: Even patients in hospitals are rarely aware of what nurses do. They see people in scrubs walk in and out, but that’s about it. It’s easy to start thinking that all nurses have the same duties, training, goals, and career paths. But think for a second about the fact that you see nurses in all parts of the hospital, no matter what department or specialty you’re visiting. That’s not an accident. Nurses working for ear, nose, and throat doctors have otolaryngological training; pediatric nurses have knowledge of and training with children; etc., etc. Being a nurse means committing to any one of dozens of specialties, and more if you change tracks.
6. Nurses are people who couldn’t hack it in med school: One of the ugliest myths out there. It’s not unique in assigning weakness to a particular medical job that’s misunderstood; dentists deal with the same stuff. (Thanks, Jerry.) But nursing isn’t a fallback. It’s not an also-ran for people who wanted to be doctors. It’s not a consolation prize. It’s a conscious career choice made by people who want to work in health care, and it’s one that requires some real education. Many nurses hold bachelor’s degrees in their field, and some nurses even go on to attain higher medical degrees but remain devoted to nursing or working a nurse-like relationship. Nurses provide top-flight medical care for patients. They know what they’re doing.
7. Nursing is grunt work: It’s true that nurses are often called upon to perform physically demanding tasks in the course of providing medical care to patients of all ages and shapes, but it’s incorrect to assume that all nursing boils down to a willingness to lift people, boxes, and bedpans. What’s more, nurses work in a variety of fields, whether in hospitals or other areas, and such tasks are only usually a fraction of what they deal with in a given day. This myth is related to the one that says nurses are merely hired hands or assistants meant to run errands, but it’s insidious enough to count as its own separate untruth because of how badly it misrepresents the scope of what nurses do.
8. Nurses don’t get paid well: The federal government reports that median income for RNs in 2008 was $62,450, with earnings ranging from $43,000 to $92,000. That’s nothing to sneeze at, considering that some studies show that anyone earning more than $70k a year has already hit peak happiness in terms of salary. What’s more, many hospitals provide tuition reimbursement for classes designed to advance your degree, which helps save cash. Plus there’s access to entire fleets of medical professionals who know you personally. The medical benefits of being a nurse are definitely not to be overlooked. Between the perks and the salary, it’s a smart job choice.

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Masters in Healthcare  is your source for finding the best online Master’s in Health Care Degrees

Specialty Nurses You Can Follow and Learn From on Twitter

These Twitter feeds come from nurses who work in a specialty area of medicine.

24. Joe Weaver, RN: He is an RN and author of “The Tao of Quitting Smoking.” His nursing specialties are psych, OMRDD, and Med/Surgery. He tweets on medical and current event topics.

25. Erica Coyle: Her specialty is on med-surgery oncology. She is also a devout Catholic and conservative patriot. In addition to tweets on what’s going on in her life, she also gives recommendations on other Twitter users to follow.

26. Bev Wallace: Beverly also authors a blog entitled Sassy Nurse Says. She recently had to give up her career due to fibromyalgia and is seeking certification for medical transcription.

27. Nurse for Health: Sue has been a registered nurse for over 29 years specializing in pediatric orthopedics, cardiac-thoracic-neuro surgery, neonatal ICU, and hemodialysis. Her philosophy is to bring back the “do no harm” principle of medicine. A regular stream of tweets is on health, daily life, and anything that interests her.

28. InterOpNurse: This nurse specializes in the field of healthcare information technology. The blog is full of tips for software, implementation, and more. Tweets are often both health and technology related.

29. Kristy: An RN from Arizona, she is also a community health nurse. Kristy’s special interest is in preventing suicides. You can get tweets on her daily life, as well as responses to her followers.

30. HowHotareWe: This nurse is also a yoga instructor and counselor. From San Diego, Roseanna keeps a positive and healthy attitude. See what she is up to by following her tweets.

31. Brent Northouse: He is a BSN, RN, and recruiter for DaVita, Inc. Brent also specializes in ESRD, renal failure, kidney disease, and top places to work. Get tweets on nursing, his job, and more.

32. MommyKennedy: Marcy has been a transplant nurse for fifteen years. She is also a frugal lover of deals and mother of three. Posts are on freebies, deals, and nursing.

For the full post, click here… 

Do you have employees who “rent” their jobs? You know the ones: They do competent work but that’s as far as it goes. They lack passion and commitment. They watch the clock. They never stray outside their assigned tasks, even when they see a need. And they do nothing to move the organization forward or to make patients feel that your hospital is the dynamic, welcoming place they need to go to get great service.

Now I am open to any topic.  You can be a nurse from a different specialty looking to for advise on how to get in this highly completive industry.  You may be a nurse who by default have been asked by your administration to help launch and implement an Electronic Medical Record (EMR) project.  You might be in sales and want advice on how to market a product.  You may be the CIO of an organization wanting to find other ways to get better end-user adoption.  I want to be open to any topic…

Now let me give you a little bit of my background.  I am a Registered Nurse, and my nursing background has provided me a myriad of experiences.  From my humble beginnings as a Critical Care Nurse, I have done Public Health Nursing (more specifically Parish Nursing), Travel Nursing, Critical Care Transport Nursing and now Nursing informatics.  I have been working in the HIT industry for 5 years now starting in the vendor side and now on the provider side.  My implementation experience is in the inpatient arena.  I am open to discussions related to other disciplines (i.e. ambulatory, financial, ancillary, etc…) because I feel the process is the same.  I am not PMP certified, nor do I hold prestigious letters after my name from HIMSS.  I am not even Board Certified in Nursing Informatics.  All my experiences have been OJT (on the job training).  Depending on your opinion, I personally feel I am gaining the experiences based on real life situations, just like I felt I learned more during my nursing new grad program, than I did in nursing school.  Nursing School definitely gave me the fundamentals, but the critical thinking skills were developed while on the job. 

So, just as I have learned from great people on the job, together we can broaden this experiences through this great medium – The Internet. 

Looking forward to your questions…

The internet has extended its tentacles all over the nursing industry.  While information technology is one of the best ways nurses’ jobs are made easier, the internet has made it possible for hiring managers to find the best available nurses for their staff.  There are thousands of websites that claim to be the best out there for finding nurses, if you’re going to be in the recruiting business for your facility you need to be honest and up front.  Aside from that most crucial piece of recruiting advice, here are six more things you need to know about recruiting on the internet:

1. Explicitly define your benefits package.  Nowadays, your benefits that you offer your workers are often deal breakers or deal makers.  Explain your salary structure, retirement savings plan, health insurance plan, time off procedures, etc.  This will be one of, if not the, first things that prospective nurses will look at.
2. Let nurses know who you serve.  Identifying your demographic base will give nurses an honest description of where they may be working.  This goes hand-in-hand with our cardinal rule of being up front with your prospective employment base.
3. What kind of environment can nurses expect?  Explain the resources you have available for your nurses.  Let them know what kind of experience your staff has.  Who makes the decisions for nursing care?  Is personal and professional growth a priority?  These are all things you should be advertising and questions you should be answering.
4. Introduce key personnel.  On your main page, introduce the people that your new nurses will be reporting to on the administration and nursing levels.  This will foster a more personal attitude for the prospective nurses.  Don’t be afraid to put faces to the people that your nurses will be working with and if this is a problem then that’s something that could be a major issue down the road.
5. Be current with the times.  Most reputable organizations welcome online resume submissions.  It’s not enough just to accept resumes in this fashion but you need to take ownership and provide initial feedback within a day.  This practice will make you come off as an organization that is responsive to the technological demands of the incoming crop of nurses.
6. Make your mission known.  We recommend that you put your mission statement somewhere prominent on your main page.  Let visitors to your site know your methods and what you expect from all levels of personnel.

By-line:

This article is contributed by Heather Johnson, who regularly writes on top nursing school. She invites your questions and writing job opportunities at her personal email address: heatherjohnson2323 at gmail dot com.

32% of RNs Say They Shouldn’t Be Driving After Work  

Thought everyone might be interested in this article from the Congressional Budget Office on the Evidence on the costs and benefits of health information technology. It might help with those trying to determine metrics for the implementation of an EHR.

Telehealth Promise…Better Health Care and Cost Savings for the 21st Century – report from AT&T Center for Telehealth research and Policy, U of Texas…

Telecare made easy…A very strong case can be made that the UK is way ahead of the US in Telecare.

Advances in electronic medical records have led to the need for standardization of nursing language and "finding a place for nursing’s voice to be heard," says a Florida Atlantic University professor of nursing. She is working on an e-records model that will allow nurses to enter not only medical data but also their notes on relationships with patients

A great website concept for connecting cancer survivors.

Has anyone seen the new device from Amazon called the "Kindle."  If they actually start having nursing and medical textbooks be available, this might actually have a place in the health care sector.

Here are some EMR/EHR company spoof sites.  This is too funny.  If you do not read teh fine prints, you can be fooled to thinking it is a legitimate company.  Great website design at least.  Here you go:

• Extormity = “At the confluence of extortion and conformity lies Extormity, the electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize and prohibitively expensive healthcare IT solutions.”
• Seedie = “SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s”

Nurses aren’t trained to be managers. They’re trained to be clinicians. So how can your hospital ensure that it is providing the additional training and leadership development needed to create the next generation of chief nursing officers…

Doctors using Virtual Approach.  Rush University Medical Center‘s new study reports that elederly patients suffering from chronic illnesses receiving virtual care from a team of medical experts linked together via phone, fax, and email make fewer emergency room visits. Also download a presentation on the Virtual Integrated Practice approach.

CMS’ proposed rule to allow physicians to be reimbursed for telehealth follow-up inpatient consultations could encourage insurers to provide similar reimbursements, Modern Healthcare reports (Vesely, Modern Healthcare, 7/2).

Details of Proposed Rule

The proposed CMS rule for 2009 Medicare payments, released this week, would allow physicians to bill for electronic consultations following inpatient visits. It also would add new codes specifically for telemedicine consultations for health care providers who are consulted by a patient’s physician but are not available for in-person consultations (iHealthBeat, 6/30). The telehealth consultations would include monitoring a patient’s progress, recommending care-management changes or providing a new plan of care. The e-visits would be performed in real time with interactive communications systems in all states except for Alaska and Hawaii, where store and forward technology is being used in federal telemedicine demonstration projects, according to CMS. The three new billing codes would reflect the complexity of each different e-visit and the amount of time spent by the physician.

Private Insurers

Jonah Frolich, senior program officer for the California HealthCare Foundation, said that while e-visits are still new, some insurers already have begun reimbursing health care providers for the service. Five California insurers are paying $40 per e-visit, and some national plans have launched telemedicine reimbursement pilot projects, Frolich said. He added that insurers tend to adopt billing practices used by CMS (Modern Healthcare, 7/2).

Considering telecare for someone with dementia.  In this social worker’s blog he/she describes going to assess a client for the first time. It’s heartening to see that some form of telecare is automatically considered as part of that process

Read more…

“Technology, demographic shifts, new legislation, and consumer preference changes have effectively eliminated many jobs. (Met any dodo trainers lately? Or FORTRAN pros, for that matter?) However, there’s an upside to obsolescence: the creation of jobs that, until recently, no one had ever heard of–and perhaps you still haven’t.”

Guess which one is at #1?

Read more…

One-on-One with Methodist Hospital CIO Kara Marx, Part I

One-on-One with Methodist Hospital CIO Kara Marx, Part II

One-on-One with Methodist Hospital CIO Kara Marx, Part III