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Byline: Caroline Hudson Providers are relying on out-of-the-box thinking to navigate historically high labor costs that show no sign of easing. Hospitals, health systems and other providers are investing billions [...]

The American Academy of Ambulatory Care Nursing (AAACN) recognizes a paradigm shift represented by the volume of health care delivery flowing from episodic acute care encounters to long-term relationships. This shift presents opportunities to further recognize and prepare nurse graduates for the complex and expanded role of the ambulatory care registered nurse (RN). This position paper discusses the current state of the RN role in ambulatory care and provides a vision for the future. The paper further identifies challenges, poses possible solutions, and highlights the AAACN position on the role of the ambulatory care RN., Ambulatory care nursing is a broad specialty that extends across diverse care settings providing care coordination and management to prevent gaps in health, avoid injury, promote disease prevention, restore health, [...]

The current study investigated factors that influence the intention to stay (ITS) of RNs working in South Korean nursing homes (NHs). Thirty-six questionnaire responses from organizational NHs and 101 from individual RNs were analyzed using multilevel regression analysis. At the individual level, RNs' ITS increased with years of work at their current NH, and that of RNs who received emergency calls to work at night was lower than that of RNs with fixed night shifts. At the organizational level, ITS was higher when the ratios of RNs to residents and RNs to nursing staff were higher. To improve ITS, NHs should consider adopting mandatory deployment of RNs, increasing their RN to resident ratios, and implementing a fixed night shift RN system, wherein night shift working hours count as twice the daytime hours, and night shift is voluntary. [Journal of Gerontological Nursing, 49(7), 40–48.], Nursing homes (NHs) are health care institutions where older adults reside and receive 24-hour assistance for activities of daily living (ADL) from nursing staff (Estrada et al., 2021). According to [...]

The opioid crisis continues to impact the United States despite efforts to reduce or remove barriers to expanding access to opioid use disorder (OUD) care and treatment. There is significant work still to be done. Given the overall financial impact to health care, the criminal justice system, and general lost productivity in the United States that continues to grow each year, it is imperative that interventions supportive approaches be implemented. As licensed clinicians, ambulatory care registered nurses have the potential to make a significant impact to the expansion of OUD services. However, overcoming the barrier of billing for their services is a hurdle that must be tackled., From 2019 to 2020, deaths by overdose increased by roughly 30% (Spencer et al., 2022). Although the rate of overdose deaths was less from 2020 to 2021, it still increased [...]

RNs lead care planning in long-term-care (LTC), yet there are knowledge gaps regarding their communication with residents and families about end-of-life (EOL) care preferences. A sample of 10 LTC RNs were virtually interviewed to describe their EOL care communication experience. Using an interpretative phenomenological framework, narrative analysis within an interpretive constructivism paradigm yielded four concepts—Being Together, Becoming Clear to Become Comfortable, Advocacy to Honor Residents, and Unique Impact on Nurses—which are all part of RNs' commitment to a continuous, dynamic EOL care communication process. Nurses commit to ongoing whole-person assessment and education, becoming proactive advocates for resident-centered, goal-concordant care. Their knowledge was experientially derived, as their nursing education did not adequately prepare them for EOL care communication or complex, multidimensional relationships with residents and families. Further research is needed to evaluate the nature and interaction and relative contribution of the components of EOL care communication in LTC. [Journal of Gerontological Nursing, 48(11), 29–36.], RNs in long-term care (LTC) settings lead resident care management, planning, and education rather than physicians, and play a crucial role in facilitating resident and family comprehension and communication about [...]

The economic burden of community acquired pneumonia in the United States is well documented, and the elderly population is at greater risk for infection, hospitalization, and death. There are innovative methods that can be implemented in the primary care setting that can lead to improved health maintenance, preventative services, and patient outcomes for Medicare beneficiaries. RNled models are an effective method for improving preventative care and addressing health maintenance gaps., Pneumonia is a well-documented cause of morbidity and mortality in the United States. In 2017, 1.3 million people were diagnosed with pneumonia in an emergency department setting (Centers for Disease [...]

Rochester Mayo Clinic is a complex primary care clinic with several valuable care management programs. A gap was noted in the communication between the inpatient and primary care practices when [...]

The growing demand for mental health services, together with current and increasing shortages of mental health professionals and increasing adoption of integrated models of care delivery, suggest nurses will become [...]

As the demand on time and resources of licensed health care professionals increases and costcontainment measures challenge organizations, the use of unlicensed assistive personnel for patient care activities increases. Emphasis on safe and effective care delivery remains crucial when registered nurses (RNs) delegate certain tasks and aspects of patient care. The principles of delegation from the American Nurses Association and the National Council of State Boards of Nursing include the responsibility and accountability of the RN for patient care outcomes. Authority for delegation of clinical tasks in the chronic hemodialysis setting varies significantly by state. The responsibility remains with the RN to oversee complex tasks despite the staff skill mix. Knowing individual state Nurse Practice Acts remains the responsibility of the individual. This article discusses the results of a review of the available information on state positions on delegation of clinical tasks in hemodialysis. Key Words: Delegation, patient care technician (PCT), hemodialysis, licensed practical nurse (LPN) Licensed vocational nurse (LVN), unlicensed assistive personnel, scope of practice., 1.3 contact hours Direct patient care in chronic hemodialysis centers is provided by registered nurses (RNs), licensed practical nurses/licensed vocational nurses (LPNs/LVNs), and patient care technicians/nephrology clinical technicians (PCTs). The [...]

Airway mucus is essential to immune function. Changes in the amount and characteristics have clinical significance. Understanding mucus physiology, causes of change, beneficial diagnostic studies, and use of descriptive terminology may help nurses determine continued patient care needs., Medical-surgical nurses quickly become familiar with the wet, slimy, sticky, and colorful characteristics of mucus. Mucus is one of several familiar names for respiratory secretions; others include phlegm, sputum, post-nasal [...]

Registered nurses (RNs) across nursing specialties require expert skill sets to address acute and emergent healthcare needs for every patient. RNs experienced with patient-engaged video surveillance expertly repurposed the system as a rapid response intervention for 24-hour observation of patients suspected to have or diagnosed with COVID-19. This study provided insight into RNs' rapid action to meet patient and healthcare workforce needs when experiencing the unknown., On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic (Executive Office of the President, 2020). The fastest transformation of health care was witnessed worldwide [...]

2022 AUG 20 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on telemedicine have been published. According to news reporting [...]

Students chronicle their good and bad experiences with preceptors and give their view on how to perform the role well, to educate and inspire the next generation of nurses. RNs [...]

RNs should be setting an example to student nurses on how to perform hand hygiene to the highest standards. Registered nurses (RNs) and student nurses have the most contact with [...]

Payment reform in health care is impacting care delivery models, with the shift in payment focused on efficiency, safety, and quality care outcomes. The overarching goal is to provide cost-effective [...]

In this retrospective, nonexperimental, comparative descriptive design using convenience sampling, the timeliness of care delivered by 11 Stroke Certified Registered Nurses (SCRNs) to 95 hyperacute stroke patients (last known well of 4.5 hours or less) on the acute stroke protocol set by Target: Stroke Phase II Campaign Manual was compared with that of 13 non-SCRNs in a small, rural, level III stroke facility in the southwestern region of the United States. There was statistical significance in the total timeliness of care delivered by SCRNs to hyperacute stroke patients as compared with the non-SCRNs (t = -4.109, P = .001) and acute stroke protocol goal times for door to stroke team activation (t = -3.291, P = .001), door to computed tomography (t = -4.020, PKeywords: acute stroke patient, certified nurse, door to alteplase administration, nursing, stroke certified registered nurse, stroke nursing care delivery process, Target Stroke goals, Background and SignificanceIn the United States, stroke is the fifth leading cause of death and the leading cause of long-term disability and costs more than $34 billion annually. (1) According [...]

Registered nurses at an academic medical center reported lack of knowledge of how to make appropriate changes to clinical practice. After implementation of a quality improvement project, they reported a significant increase in their confidence to change clinical practice based on current evidence., Evidence-based practice (EBP) is a systematic problem-solving strategy that integrates high-quality, current evidence in conjunction with clinicians' expertise and patients' preferences for determining patient care (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, [...]

The Centers for Medicare & Medicaid Services (CMS) metric for reporting ultrafiltration (UF) recommends limiting UF at a range of 10 to 13 mL/Kg/Hr to avoid organ stunning. All organ stunning has an impact on patient quality of life (QoL). As this new standard of UF is implemented, the interdisciplinary team (IDT) and the patient must work together toward achieving a less than 13 mL/Kg/Hr UF buy-in. Understanding the CMS goals and target date of January 1,2018, for data collection purposes was key to early initiation of staff and patient education. Dialysis treatment centers must rise to implement mandated fluid removal objectives. Education and knowledge are the best facilitators of success when implementing change. The IDT must work together to continually reinforce the standards set by CMS. Key Words: Hemodialysis, interdialytic weight gain, quality of life, interdisciplinary team, ultrafiltration., Patients on hemodialysis endure diet and fluid intake restrictions impacting their quality of life (QoL). Limiting net daily fluid gain to no more than one to two liters is required. [...]

* Nurses have the potential to positively impact patient outcomes and make changes in care delivery models to improve care and decrease cost. * Registered nurses are the ideal team members to expand the capacity in primary care; however, their true impact and utilization has been underutilized. * To show the impact nurses can have, nurse leaders and researchers must leverage nursing-sensitive indicators (NSIs) and make comparisons with demographic and role information. * To make these comparisons and provide the most cost-effective, efficient, and high-quality care to patients in the ambulatory care setting, nurse leaders and healthcare leaders need to gather data on the various NSIs for benchmarking. * The more data that can be gathered, the better comparisons can be made and staffing models can be modified., The chaotic and ever-changing nature of health care is reflective of a well-documented under-performance of quality along with a lack of efficiency throughout the continuum (Schneider, Sarnak, Squires, Shah, & [...]

* The nursing faculty shortage worsens the nursing shortage. * The Nurse Educator Doctoral Grants for Practice and Dissertation Research (NEDG) program was launched in 2012 to expedite doctoral degree completion and reduce personal debt for full-time nurse faculty in Maryland. * The program provided financial incentives to retain and develop a cadre of nursing faculty with terminal degrees. * The NEDG program met its goals of increasing the number of doctorally prepared faculty in Maryland and retaining them in teaching positions. * It is highly regarded by awardees and clearly influential in facilitating degree completion., Nearly 1 million registered nurses in the United States will reach retirement age within the next 10-15 years (Keele & Alpert, 2015). Moreover, one-third of current faculty will retire by [...]

Executive Summary * Care planning and care coordination are quality metrics for Medicare Access and CHIP Reauthorization Act (MACRA). * Registered nurses in ambulatory care were surveyed to assess current care coordination practices and identify opportunities for RNs to promote quality under the law. * Findings can assist in understanding the ways nurses in ambulatory care currently contribute to quality outcomes and identify additional opportunities for registered nurses to lead efforts to continue to improve quality under MACRA., HEALTH EXPENDITURES in the United States exceed those of other high-income countries, yet health disparities persist (Squires & Anderson, 2015). The demand for health care is burgeoning, yet healthcare needs [...]

* A systematic review of the methodologies was employed in six published cost analyses of increasing scope of practice for advanced practice registered nurses (APRNs). * Despite differences in how the costs analyses were calculated, all six studies suggest expanding APRNs' scope of practice could decrease healthcare costs, especially for the state as pertinent stakeholder. * However, these studies did not examine cost savings for the patient. * There is a need for future studies to employ more rigorous methodology and focus on the cost benefits to patients., The U.S. Health Resources and Services Administration (HRSA, 2013) reported a nationwide shortage of primary care physicians (PCPs). HRSA projected the PCP shortage to be 20,400 by 2020. Advanced practice [...]

Advances in nursing regulations alongside strained access to primary care for an aging population present entrepreneurial opportunity for nurse practitioners (NPs), especially NPs in states with full practice authority. Twenty-two [...]

* Operational costs and length of stay of patients who fall in hospitals are greater than those who do not fall. * The purpose of this study was to identify highly effective interventions to prevent fall injuries as perceived by registered nurse (RN) staff for adult inpatients in acute hospital settings. * A multihospital, cross-sectional design explored the underlying grouping structure of the nurse-perceived effectiveness items of preventive interventions in acute hospital settings. * Twenty-one highly effective interventions to prevent fall injuries were identified. * Ten interventions were related to improving patients' surrounding environment and 11 were related to increasing RN vigilance., IN A STUDY OF THREE U.S. hospitals, the operational costs for patients who fell with serious injury were $13,316 higher and length of stay 6.3 days longer than patients who [...]

* Forecast models can help policymakers, educators, and others to anticipate and take action to forestall or mitigate, surpluses or shortages of key healthcare providers. * Confusion and uncertainty over forecasts of registered nurse (RN) supply, demand, and shortages is particularly unsettling to organizations, educators, and public policymakers. * Two of the leading forecasters of the RN workforce jointly convened a meeting of the nation's experts on modeling the supply and demand for nurses to better understand and reconcile underlying model differences, and discuss communication, messaging, and other strategies around workforce forecasts. * Key details of two supply forecasting models--the Cohort supply model and the Health Workforce Simulation Model--are discussed. * A comparative analysis, key factors that workforce analysts should monitor to anticipate changes in the future size of the nation's RN workforce, and recommendations for how the two forecast models can be modified are presented., BALANCING THE SUPPLY and demand of healthcare professionals is critical to a well-functioning healthcare delivery system. Shortages of providers can have severe consequences for patients who need care, and can [...]

Telehealth development and implementation within the military has continued to grow at a rapid pace. As part of the Army Campaign 2020, the US Army Medical Command (MEDCOM) has committed [...]

Patients receiving hemodialysis are challenged with maintaining adequate vascular access. Nephrology nurses are on the forefront of daily care, assessment, and monitoring of patients' vascular accesses for hemodialysis. This article discusses the literature and manufacturer information to support best nursing practices. Key Words: Biological, biologic arteriovenous grafts, bovine, allograft, cannulation., In the 1930s, Dr. Wilhelm Kolff developed the basics of hemodialysis therapy. The challenge for healthcare workers then became finding a suitable method for repeated access to the vascular system [...]

To improve oral hygiene practice for patients on medical-surgical units, authors examined knowledge, practice, documentation, and delegation of oral hygiene among registered nurses and certified nursing assistants., Oral care is a primary component in the prevention of hospital-acquired infection (Hanne, Ingelise, Linda, & Ulrich, 2012). Evidence-based protocols have been established for the management of patients in the [...]

This educational project describes telemetry RN-patient caring pain communications both before and after an intensive, peer-delivered educational intervention. Outcomes suggest research and adopting/ adapting the intervention with outcome monitoring are [...]

> Globally, an estimated 25% of individuals suffer from mental disorders. > Approximately 50% of Americans will experience mental disorders in their lifetime. > The cost of this U.S. mental health crisis is estimated at $444 billion per year when lost economic productivity is included, with only about one-third of the total dollars going to care itself. > The generalist RN workforce is an untapped resource and invaluable health provider choice, uniquely suited to make an economic difference to the U.S. healthcare system by improving access, lowering costs, and improving quality of behavioral health care., BEHAVIORAL HEALTH (BH) disorders significantly affect overall health of each community as well as the economic health of the country. Solutions are difficult to implement due to multiple factors including [...]

> Multiple national reports identify actionable recommendations to transform education and practice to meet the needs of health care and healthcare delivery beyond the hospital walls. > The Josiah Macy Jr. Conference (2016) focused on transforming primary care and changing healthcare culture to support expansion of roles for registered nurses (RNs). > Partnerships between academia and clinical practice are critical to expanding learning opportunities beyond traditional acute care settings. > Development of primary care expertise in nursing faculty and adjunct faculty, in collaboration with primary care and ambulatory care nursing leaders, is essential. > Academic-practice partnerships must advocate for removing regulatory and practice barriers to allow RNs to practice to the full scope of education and training. > Recommendations from national reports extend beyond enhanced roles in primary care practice and have global implications for all RNs practicing in ambulatory care., AS HEALTHCARE REFORM continues to be debated and the future of the Patient Protection and Affordable Care Act (ACA, 2010) remains uncertain, some truths endure as foundational to the future [...]

In 2011, the American Academy of Ambulatory Care Nursing (AAACN) published the first-ever position statement regarding the role of the registered nurse (RN) in ambulatory care. Since that time, tremendous [...]

Depression, anxiety, delirium, addictions, distress ... these are just some of the mental health issues registered nurses (RNs) are likely to come across, wherever they work in the health sector. [...]

Ambulatory care registered nurses (RNs) have a pivotal role in educating, encouraging, motivating, and supporting patients to be engaged in their care and achieve their health care goals. To improve health outcomes, patients need to be engaged in attaining these goals. RNs are instrumental in this process and well-controlled studies will demonstrate their impact on helping patient's engage in their care., The American Academy of Ambulatory Care Nursing (AAACN) convened a task force to research, recommend, and/or develop ambulatory care nurse-sensitive indicators (NSI). A group was assembled to examine and develop [...]

This descriptive study used mock codes and a written education intervention to address RN under-performance during patient emergencies. Units with shorter lengths of stay, more experienced RNs, and a greater percentage of RNs had higher mock code scores., Although survival rates for in-hospital cardiopulmonary arrest in adults have improved during the past decade, these emergent events are sporadic and unpredictable. Assuring increased survival rates requires staff to maintain [...]

* Research has shown male registered nurses (RNs) outearn their female colleagues by approximately $5,000 annually. * The aim of this study was to explore differences in characteristics of female and male fulltime employed RNs, and to examine whether these differences help account for the female-male earnings gap in nursing. * Specifically, the researchers tested whether the gender earnings gap could be explained by differences in career aspiration, workplace experience, time taken out of the labor force for child-rearing, and physical strength. * While some evidence suggested motivational differences in career aspirations between female and male RNs exist, evidence supporting other hypotheses was not found. * Given the expansion of nurses' roles in health care delivery, serious deliberations of how to respond to the earnings gap in nursing is warranted., IN A RECENT STUDY, the authors examined the female-male earnings difference for registered nurses (RNs), documenting a mean annual salary difference of approximately $10,000 (Muench, Sindelar, Busch, & Buerhaus, 2015). [...]

* Interest in care transitions has intensified in light of emphasis placed on hospital readmissions. * This study provides a comparative analysis of the costs of providing transitional care through a program for cardiac patients against hospital readmission costs. * The advanced practice registered nurse-managed BRIDGE model reduced health care costs associated with readmissions that were in excess of program costs. * On average, there was a per-patient savings of $4,944 in avoided readmissions within 30 days of hospital discharge. * Over the duration of the program, this equates to a $306,537 savings in patients with acute coronary syndrome. * Nurse practitioners have a unique, holistic, and supportive approach to providing care that may make them ideal for the transitional care setting., WITH MORE THAN 83 million Americans affected, cardiovascular disease (CVD) is the most costly disease in the United States (Go et al., 2014; Hoyert & Xu, 2012). Of the $315.4 [...]

Patient safety is compromised when nurses have underdeveloped critical-thinking skills, knowledge, and awareness. Incorporating critical thinking into hospital orientation and ongoing educational offerings for all registered nurses is essential., Critical thinking in nursing has been discussed widely and generally is accepted as fundamental knowledge in current, complex nursing practice (Perez et al., 2015). Facione (1990) published a consensus definition [...]

A functional assessment is a key part of any occupational health consultation, yet effective history-taking is something many coming into the profession have to learn from scratch. Helena Brady looks [...]

2019 MAY 18 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Oncology - Breast Cancer have been published. According [...]

Professional values form the basis for nurse attitudes and behavior, and are cornerstones to guiding nurses' clinical practice decisions. The purpose of this descriptive study of nurses at a large children's hospital is to describe the professional values of employed registered nurses and describe differences based on demographic characteristics, such as generation, years of experience, education, and professional role. This study is based on Benner's (1984) theoretical framework of novice to expert. The Nurses Professional Values Scale: Revised (NPVS-R) (Weis & Schank, 2004) was administered to working RNs at the children's hospital. The results of this descriptive study indicate that nurses' professional values differed based on characteristics, such as education, generation, job classification, and years of experience., Nursing's professional values are clearly articulated in several key documents, including the Code of Ethics for Nurses (American Nurses Association [ANA], 2008), Nursing's Social Policy Statement (ANA, 2010b), Nursing: Scope [...]

* Nursing home care is expensive; second only to acute hospital care for inpatient Medicare costs. * The increased focus on costs of care accrued by Medicare beneficiaries in nursing homes presents a valuable opportunity for registered nurses (RNs) to further demonstrate quantitatively the value they add to the capacity of the nursing home nursing skill mix to provide cost-effective and efficient quality care. * Most of the studies included in this review consistently reported that higher RN staffing and higher ratios of RNs in the nursing skill mix are related to better NH quality. * Concerns about the costs of employing more highly skilled RNs and directors of nursing that have the potential to positively influence members of the nursing skill mix will continue to influence nursing home industry hiring practices. * For both the advancement of nursing as an applied science and the benefit of society at large, nursing researchers are challenged to better demonstrate how the increased presence of a RN on each shift has the potential to enhance the cost effectiveness, efficiency, and quality of nursing homes., IMPLEMENTATION OF THE Affordable Care Act has generated renewed interest in the quality and costs of health care provided to Medicare and Medicaid beneficiaries in skilled nursing facilities (SNFs), commonly [...]

The Medical-Surgical Nursing Certification Board (MSNCB) is a professional organization whose mission is to validate excellence in medical-surgical nursing. MSNCB administers the Certified Medical-Surgical Registered Nurse (CMSRN[R]) and Certified in [...]

Newly licensed registered nurses (NLRNs) are an important health care resource and represent the future nursing workforce. Yet studies show many of them feel stressed at their jobs and would [...]

Management of metabolic syndrome (MetS), a group of disease processes that involves numerous body systems, is a complex combination of pharmacologic and nonpharmacologic modalities using current evidence-based guidelines. A case of an Asian-American adult with MetS is presented to highlight the increasing prevalence of this syndrome in Asian Americans compared to other racial groups., Metabolic syndrome (MetS) is a complex cluster of conditions involving a combination of metabolic risk factors that predispose individuals to the development of cardiovascular disease (CVD) and type 2 diabetes [...]

EXECUTIVE SUMMARY * Traditional chronic disease management that focuses on single conditions does not meet the needs of patients with multimorbidities. * The transformation of primary care in the United [...]

The idea that all registered nurses (RNs) should give so-called 'basic care' is a non-negotiable part of every RN's role. However some concerning comments about how this is not so, [...]