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Fostering a smooth transition into the faculty role

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Fostering a smooth transition into the faculty role

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A Technology-Driven Nursing Faculty Resource Center

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A Technology-Driven Nursing Faculty Resource Center

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Dr Cornelius

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The Office of Disease Prevention and Health Promotion (ODPHP) partners with the Centers for Disease Control and Prevention (CDC) to offer free continuing education for Healthy People eLearning offerings. You will need to complete a brief post-test and evaluation to receive your continuing education or certificate of completion.
To obtain continuing education for a Healthy People eLearning lesson or event, please find your activity below and follow these instructions:
Continuing education is available through the CDC Training and Continuing Education Online system only. You must complete the online evaluation within two years of the lesson or event launch date to receive your continuing education or your certificate of completion.

1. Go to the CDC Training and Continuing Education Online at http://www.cdc.gov/tceonline/. If you have not registered as a participant, click on New Participant to create a user ID and password; otherwise click on Participant Login and login.

2. Once logged in to the CDC Training and Continuing Education Online website, you will be on the Participant Services page. Click on Search and Register. Search by date, keyword, or course ID to locate the course and click on View.

3. Click on the course. The course information page will come up. Scroll down to Register Here. Click on the type of continuing education that you would like to receive and then click Submit. Three demographic questions will come up. Complete the questions and then click Submit.

If you have already completed the course, you may choose to go right to the evaluation. Complete the evaluation and click Submit. A record of your course completion and your continuing education certificate will be located in the Transcript and Certificate.

Healthy People eLearning Lessons:

Webinar: "Measuring Policy and Environmental Change in Obesity Prevention: Comparing and Contrasting Opportunities and Challenges from Local Communities."
Course ID: WD2281
Course Date: 7/24/2013
Keywords: Policy, Environmental Change, Childhood Obesity

Once you have watched this webinar, the following continuing education is available, free of charge, through the Centers for Disease Control and Prevention's (CDC) Training and Continuing Education Online system.

Continuing Medical Education (CME) activities with Joint Sponsors: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Centers for Disease Control and Prevention and the Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services. The Centers for Disease Control and Prevention is accredited by the (ACCME®) to provide medical education for physicians.

The Centers for Disease Control and Prevention designates this enduring educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™.

Continuing Education Contact Hours in Health Education (CECH): Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designed for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.5 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 0. CDC provider number GA0082.

IACET Continuing Education Units (CEU): The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. The CDC is authorized by IACET to offer 0.2 ANSI/IACET CEUs for this program.

Lesson: "Defining Success in a Systems Approach: The San Diego County Childhood Obesity Initiative"
Course ID: WB2059
Launch Date: 3/22/2013
Keywords: Systems Approach, Childhood Obesity

Once you have completed this lesson, the following continuing education is available, free of charge, through the Centers for Disease Control and Prevention's (CDC) Training and Continuing Education Online system:

Continuing Education Contact Hours in Health Education (CECH): Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designed for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 0. CDC provider number GA0082.

IACET Continuing Education Units (CEU): The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. The CDC is authorized by IACET to offer 0.1 ANSI/IACET CEUs for this program.

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The Office of Disease Prevention and Health Promotion (ODPHP) partners with the Centers for Disease Control and Prevention (CDC) to offer free continuing education for Healthy People eLearning offerings. You will need to complete a brief post-test and evaluation to receive your continuing education or certificate of completion.

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Essentials for New Clinical Nursing Instructors, Especially Adjuncts
There are many things it's helpful to know when you start work as a clinical instructor-and you might not get a lot of orientation first. By Maureen Shawn Kennedy, AJN editor-in-chief

"So you've accepted the contract for your first part-time clinical teaching assignment and you're wondering where to start in preparing for this new role. Perhaps you've been working in an administrative role, away from direct caregiving. Maybe you've been active in bedside nursing but have no formal preparation in clinical teaching. If you take the time to prepare for your teaching assignment, you can confidently lead your students through a meaningful clinical experience."

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

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Jacob Molyneux, senior editor/blog editor

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Essentials for New Clinical Nursing Instructors, Especially Adjuncts

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There are many things it's helpful to know when you start work as a clinical instructor-and you might not get a lot of orientation first. By Maureen Shawn Kennedy, AJN editor-in-chief "So you've accepted the contract for your first part-time clinical teaching assignment and you're wondering where to start in preparing for this new role.

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Transitioning from staff nurse to undergraduate nursing instructor

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Transitioning from staff nurse to undergraduate nursing instructor

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May 2013 Vol. 8 No. 5

Author: Kathleen A. Ahonen, MSN, RN, NP, and Colleen M. Quinlan, MS, RN, CNP, PhD, WHCNP

The staff nurse plays an integral role in clinical nursing education, helping to prepare undergraduate nursing students for professional practice. A positive and enriched learning environment can influence a student's perception of the healthcare facility as a possible future employment site. As healthcare reform continues to alter the healthcare workforce, providing positive clinical learning experiences can aid recruitment of future nursing staff.

But while many staff nurses find the teaching role satisfying, others don't see it as their responsibility. Greater patient acuity, high nurse-to-patient ratios, and increased workloads stop some nurses from participating in students' education.

The student-staff nurse relationship profoundly affects learning. Not all staff nurses have formal preparation for the role of mentor or are responsible for evaluating a student's clinical performance. Staff nurses are meant to be resources for students when faculty members are unavailable. They also serve as nursing role models and educational facilitators of practical nursing skills. This socialization into the profession is a crucial component of the student's education.

Practice makes perfect

Applying classroom concepts to actual practice is an exciting and anticipated part of the curriculum for young, eager nursing students. They arrive with theory, knowledge, and simulated laboratory experience, ready to practice nursing skills on real patients.

Nursing students are partnered with staff nurses as an extension of the learning model and are supervised by a faculty member. A positive experience in the clinical site with a dedicated, kind, nurturing role model can promote learning. A negative experience with an overburdened, unpleasant, uninterested mentor can impede learning.

Clinical preparation is crucial. Hospital surveys have shown new nurses have high expectations. Many staff nurses, on the other hand, believe nursing education programs don't adequately prepare new staff for increased patient acuity and blame a lack of clinical-skills preparation. Yet some of these same nurses dislike teaching nursing students.

Students' attitudes and expectations also affect clinical learning. How strong is the student's desire to learn? Is the student self-directed? New learners lack experience, which contributes to increased stress. They're also less self-directed and need more nurturing and structure in their learning environment. Undergraduates tend to focus narrowly on basic tasks and skills; experienced nurses see the broader picture.

Clinical settings place a high priority on clinical competency. Yet new learners may be awkward and slow, which can frustrate a hurried clinician. Effective mentors have such characteristic behaviors as guiding, cooperating, supporting, and listening actively. (See Effective mentoring behaviors by clicking the PDF icon above.) When staff nurses lack these characteristics, nursing students may be afraid to ask questions and may lose their confidence. If these mentoring deficiencies persist throughout the student's clinical experience, it creates a poor learning environment for everyone. On the other hand, if a mentor interjects simple praise or suggestions, such as "Take your time, you're doing fine" or "Try positioning the lead farther over here," this may calm the student-and reassure the patient that the clinical situation is under professional supervision.

Clinical teaching challenges

Many challenges exist in clinical teaching. Some challenges, such as lack of clinical sites and poor attitudes from patients, are outside educators' control. Students and faculty also face obstacles from within. Although staff nurses work closely with students, few are adequately prepared or formally recognized for their role as clinical facilitators.

The learning experience is richer when administrators believe the staff nurse plays a critical role in improving the quality of nursing education. Hospitals and other healthcare employers must be held accountable for providing these educational experiences.

Partnerships between staff nurses and clinical faculty should be cultivated so both groups can foster a culture of learning and support. To bridge the gap between education and practice, educational institutions should implement some form of educational preparation for staff nurses who are acting as preceptors for students.

Students need to be respectful and courteous to teachers. Sometimes, a hospital unit has as many nursing students as clinicians. Even small niceties, such as students offering staff their seats in crowded places or recognizing the need for quiet conversations in areas reserved for charting, show a respectful attitude toward their nurse-teachers.
Also, students should refrain from challenging mentors by saying, for example, "My teacher says it should be done this way." The student's role is that of learner, not critic. Students should appreciate that they're guests of the facility and make sure their behavior shows they understand this concept.

Recognizing staff nurses' contribution

Observing all aspects of professional nursing is educational for students. This includes observing interactions among staff nurses and colleagues, physicians and other healthcare providers, support staff, patients, and visitors. Discussing these observations in postconference debriefings held with faculty and students immediately after clinical experiences provides important learning opportunities, whether perceived as positive or negative.

Students and faculty should recognize all clinical experiences by acknowledging the staff nurses' efforts to mentor students. Whether it's a small gesture (such as a written thank-you note or a home-baked or store-bought treat from students) or something more formal (such as a staff nurse-appreciation luncheon hosted by the educational institution), all thoughtful actions go a long way toward recognizing staff nurses' contributions to clinical nursing education.

Educating future caregivers

Staff nurses are educators by definition. They educate patients, families, the community, and each other. We need to help them realize they have a vested interest in their vital teaching role, because today's nursing students are tomorrow's caregivers.

Transitioning from nursing as a collection of skills learned from a textbook to nursing as a profession in a peopled work setting is difficult, at best. How can we foster professional growth in nursing students? Staff nurses and clinical faculty strive to balance academic and clinical knowledge in daily nursing practice. Giving students learning opportunities to find this balance is a key component of clinical education‚Äîand the staff nurse plays a critical role.

Staff nurses should value and recognize their role in ongoing development of future nurses. Of course, staff nurses vary in terms of educational personalities. Some are more productive educationally to students than others; those who've received little or no formal training in teaching and mentoring students may be ill prepared for this role. With even minor improvements in the educational atmosphere-including positive attitudes from staff, students, and administrators-staff nurses will be able to more fully appreciate and enjoy their important contribution.

Click here for a complete list of references.
Kathleen A. Ahonen is an assistant professor at the University of Toledo College of Nursing in Toledo, Ohio, and maintains a part-time practice as a women's health nurse practitioner (NP). Colleen M. Quinlan is an assistant professor at the University of Toledo College of Nursing and a certified women's health care NP.

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Role of the staff nurse in undergraduate nursing education - American Nurse Today

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May 2013 Vol. 8 No. 5 Author: Kathleen A. Ahonen, MSN, RN, NP, and Colleen M. Quinlan, MS, RN, CNP, PhD, WHCNP The staff nurse plays an integral role in clinical nursing education, helping to prepare undergraduate nursing students for professional practice.

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Tips for publishing in a nursing journal

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Tips for publishing in a nursing journal

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These tips from RN editors and writers will help you transform your ideas into published nursing journal articles.

Megan Malugani, Monster contributor

Getting an article published in a nursing journal may seem daunting to novice writers, but the rewards far outweigh the challenges. RN editors and authors offer these pointers to help aspiring authors convert good ideas into published work.

Recognize the Opportunity

Most nursing journal articles are written by nurse educators required to conduct and publish research. However, staff nurses, nurse managers and nurse administrators have ample opportunity to write about their cases or workplace innovations.

"There are close to 200 nursing journals," says Elizabeth Poster, PhD, RN, FAAN, editor of theJournal of Child and Adolescent Psychiatric Nursing and dean of the University of Texas at Arlington School of Nursing. "Think about the volume of articles needed to fill those journals."

Choose a Compelling Topic

During her six years as a nurse manager, nurse recruitment and retention captivated novice writer Kristina Ibitayo, MSN, RN. Her article on the subject, "Understand Health Care's True Cost," has been accepted for publication byNursing Management. "You have to write about a topic you're passionate about and intensely interested in," says Ibitayo, a certified ambulatory perianesthesia nurse at Good Shepherd Medical Center in Longview, Texas.

Beware the Common Pitfalls

You can overcome writer's block as well as warm up your writing skills by penning a few smaller pieces, like short columns or book reviews. When you're ready to tackle a longer journal article, pay attention to organization, Poster says. "Outline your article before you write it, and don't jump from one topic to another and back again," she says. "Clarity is very important."

Before submitting your article, always have a trusted friend or colleague critique it, says Jeanette Daly, PhD, RN, a geriatric nurse researcher in the Department of Family Medicine at the University of Iowa. "If you don't get much feedback from the people proofing it, you don't have the right people doing the job," says Daly, who has authored dozens of articles about elder abuse.

Research Potential Publishers

Each nursing publication has its own purpose and audience, so make sure your desired topic lines up with the journal you're targeting. Also, look at how that journal's articles are formatted. Paying close attention to issues like headings and subheadings will help you structure your article to the journal's style.

Study the Writers' Guidelines

You'll find the journal's purpose, article layout guidelines and other information for authors here. "If the writers' guidelines say to write in a certain style, your chances of getting published will improve if you do it," Ibitayo says.

The guidelines will also tell you how a journal wants articles submitted. Some prefer that you first pitch your idea via query letter, but you can just send several copies of your manuscript to others.

You can find authors' guidelines and editors' email addresses for many nursing journals at Online Nursing Editors.

Be Patient

If you don't hear anything a few months after submitting your manuscript, call the publication, Poster advises. You're professionally obligated to submit your article to only one journal at a time -- another reason to take such care in targeting the right publication.

Prepare Yourself for the Process

Once a journal expresses interest in your article, there's more work to do. You may be asked to revise or even rewrite it, tackling issues as small as consistency in terminology or as large as incorporating more references or additional statistics. The process of initial submission to publication may take as long as three years and several rounds of revisions, Poster says, since both the author and the nurse reviewers who recommend changes have other full-time jobs. "In my 10 years as an editor, I think there have been fewer than half a dozen articles that have required no revision whatsoever," Poster says.

Try Again

If one journal rejects your article, consider reworking it and submitting it elsewhere. "You can only improve if you keep trying," Daly says.

Ibitayo found the process of converting her ideas into an article gratifying. "Getting my article accepted was exciting, because I know my thoughts are valid and have a place in the wide world of nursing," she says. "And anyone who says it's not exciting to see your name in print is lying."

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writing an article for a professional journal

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Tips For Getting Published In A Nursing Journal

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These tips from RN editors and writers will help you transform your ideas into published nursing journal articles. Megan Malugani, Monster contributor Getting an article published in a nursing journal may seem daunting to novice writers, but the rewards far outweigh the challenges.

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Our resource materials have been designed to help nurse educators inspire the next generation of health care professionals

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Eight traits for great nursing instructors

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Eight traits for great nursing instructors

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Eight traits make great nursing instructors.

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Now's the perfect time to move into nursing education to teach the next generation of nursing students.

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Characteristics of the best and worst nursing instructors

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Characteristics of the best and worst nursing instructors

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Abstract

Background

Nursing budgets constitute a major part of a hospital's operating costs, accounting for some 25% of the total operating budget and 44% of direct care costs. Recent studies have demonstrated that higher staffing ratios of registered nurses are associated with fewer hospital-related deaths, failures to rescue, cardiac arrests, hospital-acquired pneumonia and other adverse events, as well as having positive effects on patients' safety in intensive care units and in surgical patients. Increased registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay. In the course of providing direct patient care, nurses assess each patient by physiological system and record those assessments in the electronic medical record (EMR). Once recorded however, nursing notes are not often read by attendants or residents.

There have been several studies of the relationship between registered nurse staffing and in-hospital mortality. However, no previous studies have demonstrated a direct connection between nursing assessments and patient risk of mortality. Furthermore, while the nursing literature is replete with studies of nursing diagnostic terminology and its standardisation, there is a paucity of quantitative studies of the validity and clinical implications of nurses' head-to-toe clinical assessments. In this article we investigate clinical associations of 12 simplified nursing assessments, one for each physiological systems, with both in-hospital and postdischarge mortality data. Our hypotheses are that nursing assessments performed at entry of in-patients are predictors of in-hospital mortality, and nursing assessments performed just before in-patient discharges are predictors of postdischarge mortality.

Methods

This research was initiated in an attempt to understand issues of continuity of care in hospitals. What piqued our interest in nursing assessments is the fact that other than laboratory tests and vital signs, they are the only clinical variables in the EMR that are reflective of patient condition that are not static, and their values are updated regularly. The results of this research are incorporated in the 'Rothman Index', which is a new measure of patient condition. This is the first foundational paper in a series of studies related to the scientific basis of the Rothman Index. Approval for the work was granted by the Sarasota Memorial Hospital Institutional Review Board.

Nursing assessment data for the periods 1/2004-12/2004 and 7/2005-6/2006 were extracted from the Electronic Hospital Record at Sarasota Memorial Hospital, an 805-bed community hospital. Our cohort for this study were all patients admitted for any reason during these periods, excluding obstetrics, paediatric and psychiatric patients, which determined the study size of 42 302 inpatient visits. For the discharge study, we had complete data for 39 964 inpatient visits in which the patient was discharged alive. Demographic data and diagnostic data have not been collected for this population; however, our subject community hospital serves a population skewed older than the US average.

In general, nurses' assessments are entered into the Electronic Medical Record in one of two ways: either the nurse answers a series of detailed questions to document each assessment, such as for respiratory, 'What are the breath sounds?', 'What colour are the nail beds', etc; or, the 'charting by exception' method is used, where the nurse records a simple overall answer of 'met' or 'not met' for each physiological system, such as 'Does the patient's respiratory function meet a minimum standard?' (if the answer is 'not met', only then are detailed follow-on questions considered). In this study the binary charting by exception method was used, and the assessments were characterised as either having 'met' the standard or having 'not met' the standard in each of the following 12 areas: food, neurological, safety, skin, genitourinary, musculoskeletal, respiratory, cardiac, peripheral vascular, gastrointestinal, psychosocial and pain. Definitions of the relevant standards are shown in the appendix. Nursing assessments were generally performed at least once per shift. For each area of nursing assessment, the all-cause in-hospital death rates and mortality OR's, associated with patients' entry nursing assessments, were computed and the all-cause death rates and mortality OR's, associated with patients' last assessments prior to discharge, were computed for patients living at the time of discharge with deaths within the time periods 2 days, 30 days and 1 year from discharge. Mortality was established by comparison with the Social Security Administration Death File. The reproducibility of outcome measures between the 2004 data and the 2005-2006 data was assessed using an intraclass correlation coefficient. The data analysis was carried out utilising SAS V.9.2 (SAS Institute, Cary, North Carolina, USA) and Systat V.13 (Systat Corp., Chicago, Illinois, USA).

Results

The population studied had a mean of 4.7 days and median 3.1 days length of stay, with an SD of 5.1 days. An example of the data and associated results for 30-days postdischarge mortality is given in , illustrating our calculations. Results for in-hospital mortality OR's associated with failing an entry nursing assessment are given in for 42 302 patients of whom 1086 died in the hospital. OR's for deaths within postdischarge periods of 2 days, 30 days and 1 year for 39 964 patients for whom we had data and who were living at the time of discharge are given in . There were less than 0.3% missing data for any result. Although generally, about 90% of patients passed the assessments, in all categories and for both in-hospital and postdischarge deaths, not meeting standards for an assessment resulted in significantly higher death rates than meeting standards and very large mortality OR's, with the single exception of the pain assessment. Except for the pain assessments, all results are statistically significant (p<0.001) and none of the 95% CI's overlap one. The implications of pain assessments are examined in the discussion section below.

Table 1

Table 2

Table 3

To evaluate the agreement between 2004 and 2005-2006 values, first we calculated all the OR's for the 2004 and 2005-2006 subsets of data, and then an intraclass correlation coefficient was calculated comparing all OR's for 2004 to their counterparts from 2005 to 2006 across all categories and all time points (ie, in-hospital and 2, 30, and 365 days postdischarge) and found to be 0.85; values greater than 0.75 indicate excellent reproducibility. Thus, there is excellent reproducibility between the results for 2004 and those for 2005-2006 across all our measures of interest.

Discussion

There is a growing body of evidence that suggests that nurses have a separate and identifiable effect on patient hospital outcomes, irrespective of other medical care (cfKane et al and references cited therein). An important subject area in the literature is whether nursing data collected during the hospital stay can be used to explain commonly studied variables such as costs/charges, lengths of stay and mortality. However, until now, nursing assessments have not been shown to have clinical predictive validity. Our study combines over 40 000 cases, encompassing all admissions for any reason except for paediatrics, psychiatric and rehab, and we have shown that patients failing to meet minimum standards for any nursing assessment had significantly higher in-hospital and postdischarge death rates than patients who did meet these standards, regardless of medical history and diagnosis. This is evidence of the clinical validity of nursing assessments. In fact, the medical literature is replete with studies of critically ill patients for whom variables with mortality OR in the range 2-4 are considered sensitive and important predictors of mortality. The OR's we report demonstrate that these measures of a patient's functionality are significant and sensitive indicators of a patient's condition. Thus, nursing assessments may aid in physician care and possibly reduce hospital patient mortality, and future risk-related health research ought to consider incorporation of nursing assessments. Further study is clearly warranted.

We have studied deaths without regard to diagnosis, age, gender or severity of illness that occur in-hospital as well as within short (2 and 30 days) and long (1-year) periods of time for two reasons: (1) in order to learn whether there might be similar or different short and long-term relationships of assessments to mortality and (2) as a way to test validity and reliability. We have found that failing a nurse's assessment has both short-term and long-term correlations with mortality. The fact that our results are consistent over short and long periods, over all assessments, and from a medically diverse patient population, demonstrates that nursing assessments have valid and significant clinical implications irrespective of medical histories and diagnoses. While we have not compared survivor demographics with those who died, it is unlikely that such large OR's would be explained by underlying demographic factors like age or race or gender.

One might ask whether the high OR's associated with these assessments may simply represent high-risk diagnoses. We have not built a multiple linear regression model to determine the added predictive power of nursing assessments to other indicators of mortality. However, this is an area of current investigation. Preliminary results, which we shall publish in subsequent studies, show that among patients who were admitted with a diagnosis of congestive heart failure, those who failed any of the food, neurological, musculoskeletal or skin nursing assessments at admission had a mortality OR of 6-9, versus those who passed. Further, failing multiple nursing assessments had a greater implication in terms of in-hospital mortality than failing just one. Generally, patients who fail nursing assessments may well be those who also have serious or even terminal diagnoses. Nonetheless, here we have demonstrated that nursing assessments at both entry and discharge capture the seriousness of the patient's condition irrespective of diagnosis. Given the size of the study, it is clear that these variables are meaningful indicators of both in-hospital and postdischarge mortality.

The highest in-hospital mortality OR's, 7 or greater, are associated with those patients not passing the food, neurological, psychosocial or musculoskeletal assessments. It is important to comprehend the simple clarity of these findings. For example, if a newly admitted patient is not able to move independently in his/her bed, or behaves inappropriately, or cannot chew and swallow food-that patient is almost seven times more likely to die in the hospital than patients who have none of these problems. If a patient is incoherent or is not oriented, that the patient is almost 10 times more likely to die in the hospital than those who are coherent and alert, no matter what the diagnosis may be. In contradistinction, pain is not a significant indicator of mortality. This may be because pain, unlike the other problems indicated by nursing assessments, can often be controlled independent of the patient's general condition, so one does not expect it to have similar clinical implications. Further studies may clarify this issue.

Since we have shown that initial and final nursing assessments contain clinical information, it is reasonable to infer that all nursing assessments (other than pain) gathered throughout the patient's stay in the hospital contain significant clinical information. Nursing assessments are generally recorded every 12 h, and sometimes more frequently, throughout the patient's stay. Therefore, these data represent a changing indicator of patient condition. Thus, the importance of this work is in alerting physicians to a source of longitudinal clinical information about the patient's condition that no static measurement, such as demographics or principal diagnosis, can provide and which is not currently being routinely utilised.

Although our results show excellent reproducibility across two 1-year time periods, we are aware of questions about the reliability of nursing data, specifically intra-rater and inter-rater reliability. However, reproducible and consistent results such as shown here are only possible with reproducible and consistent nursing assessments. One has to conclude that by and large, the nurses get it right, and that they provide an important and valuable tool for assessing patient condition, irrespective of medical diagnosis and history. Thus, it is suggested that hospital physicians make special effort to ascertain whether patients have passed or failed their nursing assessments, a practice not widely followed currently by attendants or residents.

We have established that simplified nursing assessments, gathered throughout a patient's stay and which are now essentially unused by physicians, have clinical validity. If physicians were to utilise these data, they then would be adding an important and largely 'new' source of clinical information to their evaluations. For example, when a physician sees a patient in the hospital, he or she often consults with the bedside nurse. However, this consultation is not always possible or practical. In many cases, consulting with the nurse from the previous shift, or the previous day, or even the day before that, to understand changes in the patient's condition, is not feasible. And even if it were, getting a verbal report on a patient's condition about the previous several days would likely be incomplete. These circumstances make use of nursing assessments, recorded in the EMR, the only effective way to gain access to this clinically relevant information. And though immediate observations are the most important in determining care, the prior observations provide an important and meaningful context, allowing the physician to assess the changes in patient condition. It must be noted however, that current EMR technology does not facilitate quick and easy physician access to nurses' observations and assessments. Either changes in current record-keeping software or adjuncts to it would make access to this information more accessible.

Conclusions

Entry nursing assessments of in-hospital patients are strongly associated with in-hospital mortality, and predischarge nursing assessments of in-hospital patients are associated with postdischarge mortality. No multivariate analysis has yet been performed, and will be the subject of a future study, and thus there may be confounding factors. However, it is difficult to hypothesise any alternative factors that might confound our results, given the high OR's and the variety, multiple time intervals, and extent of data considered. We infer that these nursing assessments have valid and significant clinical meaning irrespective of medical histories and diagnoses. It is reasonable to infer further that nursing assessments taken throughout a patient's stay are also clinically meaningful. These assessments, which are part of what is termed as the 'head-to-toe' patient assessment, and which are a standard part of nursing school curricula, are collected and recorded at all hospitals, and simplified summaries of assessments, as we have analysed, can be constructed. Since nursing assessments are recorded at least every 12 h throughout the patient's stay, they represent a changing indicator of patient condition. Thus, they make available real-time longitudinal sensitivity that no static measurement, such as demographics or principal diagnosis, can provide.

The large OR's suggest that nursing assessments are sensitive indicators of clinical problems during the course of a patient's hospital stay. This compact clinical data source in the EMR is a natural longitudinal source of information, providing physicians access to the insights of nurses as recorded throughout the patient's entire stay. Such dynamic information should allow physicians to improve patient care. While these conclusions must remain tentative, pending detailed multivariate analyses, we believe nursing assessment data ought to be incorporated along with standard diagnoses in future risk-related health research. Current EMR technology does not allow quick and easy access to nurses' observations and assessments, so changes in current record-keeping software or adjuncts to it will be necessary to make this information more accessible.

Acknowledgments

The authors thank Sarasota Memorial Hospital for making available the data upon which this investigation is based, and for the cooperation of the staff, especially Steven Goodman, Donna Jackson, Patti Reynolds and Denis Baker. Alex Kiss is thanked for checking calculations, a critical reading of the manuscript, and general statistical advice. Peter Herbert, Chief Medical Officer, Yale New Haven Hospital, is thanked for discussions regarding doctors' current utilisation of nursing assessments. We also thank Susan Horn and Professor Robert Kane for their insights in reviewing the study, which resulted in significant improvements.

Appendix

Nursing assessments

The nursing assessments are generally performed at least once per shift. When documented as described above, they consist of binary data, characterised either as having 'met' the standard or having 'not met' the standard. For each physiological system, definitions for the relevant standards at Sarasota Memorial Hospital are shown below. Although standards vary across hospitals, basically the same data are being collected at every hospital. It is generally possible to construct similar binary variables from any hospital's nursing data.

Cardiac standard: Pulse regular, rate 60-100 bpm, skin warm and dry. Blood Pressure less than 140/90 and no symptoms of hypotension.

Food/nutrition standard: No difficulty with chewing, swallowing or manual dexterity. Patient consuming >50% of daily diet ordered as observed or stated.

Gastrointestinal standard: Abdomen soft and non-tender. Bowel sounds present. No nausea or vomiting. Continent. Bowel pattern normal as observed or stated.

Genitourinary standard: Voids without difficulty. Continent. Urine clear, yellow to amber as observed or stated. Urinary catheter patent if present.

Musculoskeletal standard: Independently able to move all extremities and perform functional activities as observed or stated (includes assistive devices).

Pain standard: Without pain or visual analogue scale<4 or experiencing chronic pain that is managed effectively.

Neurological standard: Alert, oriented to person, place, time and situation. Speech is coherent.

Peripheral/vascular standard: Extremities are normal or pink and warm. Peripheral pulses palpable. Capillary refill <3 s. No oedema, numbness or tingling.

Psychosocial standard: Behaviour appropriate to situation. Expressed concerns and fears being addressed. Adequate support system.

Respiratory standard: Respiration 12-24/min at rest quiet and regular. Bilateral breath sounds clear. Nail beds and mucous membranes pink. Sputum clear if present.

Safety/fall risk standard: Safety/fall risk factors not present. Patient is not a risk to self or others.

Skin/tissue standard: Skin clean, dry and intact with no reddened areas. Patient is alert, cooperative and able to reposition self independently. Braden scale>15.

Footnotes

Contributors: MJR, SIR and GDF conceived this research issue, and performed the preliminary investigations. MJR performed the data extraction. ABS extended the scope of the investigation, analysed the extended dataset, searched the literature and wrote the first draft of the manuscript. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. MJR is the guarantor.

Funding: This research was funded by Rothman Healthcare Corporation, of which Michael and Steven Rothman are cofounders, in an attempt to find ways to improve communication between caregivers in the hospital, following the avoidable hospital death of Florence Rothman in 2003 (which led to the creation of the company). This research was also funded by the Sarasota Memorial Health Care System, and by grants from the Sarasota Memorial Healthcare Foundation and the Goldsmith Fund of the Greenfield Foundation.

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and submitted herewith, and declare: we have received support from Rothman Healthcare Corporation (RHC) for the submitted work; and we all have financial relationships with RHC, which has an interest in the submitted work, but no other relationships or activities that could appear to have influenced the submitted work. All the authors performed this work as employees of RHC, except ABS, who worked on this project as an independent contractor. RHC utilises the results of this research in the Rothman Index, which is used in commercial products, and thereby has an interest in having the research reviewed by an impartial peer journal.

Ethics approval: Sarasota Memorial Hospital IRB.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data sharing statement: Data will be made available to qualified researchers upon request to the corresponding author.

References

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Clinical implications and validity of nursing assessments: a longitudinal measure of patient condition from analysis of the Electronic Medical Record

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Nursing budgets constitute a major part of a hospital's operating costs, accounting for some 25% of the total operating budget and 44% of direct care costs. Recent studies have demonstrated that higher staffing ratios of registered nurses are associated with fewer hospital-related deaths, failures to rescue, cardiac arrests, hospital-acquired pneumonia and other adverse events, as well as having positive effects on patients' safety in intensive care units and in surgical patients.

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Transitioning into the role of novice nursing instructor

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Transitioning into the role of novice nursing instructor

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Module #1 Transition to the Role of Clinical Nursing Instructor

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Teaching students with English as a second language

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Teaching students with English as a second language

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Providing effective feedback during  clinical

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Providing effective feedback during  clinical

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Medication administration

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Clinical Teacher Effectiveness | Five Principles of Positive Feedback

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In a clinical practicum course, providing feedback to a student is crucial to their success. This video supports Clinical Teaching Effectiveness using the Five Principles of Positive Feedback: 1. Provide Specific and Precise Feedback 2. Provide Differing Amounts of Feedback and Positive Reinforcement 3. Provide Verbal and Visual Feedback 4.

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Brunner and Suddarth's Medical-Surgical Nursing Text

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Brunner and Suddarth's Medical-Surgical Nursing Text

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I probably learned from the 1st edition :)

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Brunner & Suddarth's Medical-Surgical Nursing, 14th Edition

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Brunner & Suddarth's Medical-Surgical Nursing, 14th Edition

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Effective pedagogies for teaching math to nursing students: A literature review

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Effective pedagogies for teaching math to nursing students: A literature review

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teaching drug math

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Effective pedagogies for teaching math to nursing students: A literature review

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Nursing Faculty Preparedness for Clinical Teaching

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Nursing Faculty Preparedness for Clinical Teaching

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Teaching drug calculations to nursing students

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Teaching drug calculations to nursing students

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When it comes to doing nursing math, which is essentially figuring out dosage amounts, the absolute best, easiest and most foolproof way to do it is by using dimensional analysis. You may remember it from your chemistry class and loved it even then ;-). In this post I will show you how to use dimensional analysis to solve any dosage calculation, even the tricky weight-based ones.

Level 1 Dimensional Analysis: Piece of Cake
We'll start at level 1....super easy ones to give you a feel for the technique. Ready? Your order reads:
In dimensional analysis, you always start with what's ordered. In this case it's 650 mg of acetaminophen. You will write this as a fraction, with 650 on top and 1 on the bottom like so:

Next, you need to know what dosage amounts your medication comes in. This is known as the conversion factor. In the case of good ol' Tylenol, we check our blister pack and see that it's 325 mg per tablet. The next step is to add the conversion factor also as a fraction. Since mg is at the top of our first fraction, it will go on the bottom of our next one so that they cancel each other out. Like so:
As we move forward into more complicated calculations, it will become more evident that you know when to stop conversions when you are left only with the information needed to give the dose. In this case, we want to know how many tablets to give the patient. Everything except for tablets is crossed out, so we know we are ready to do some math.

1) Multiply across the top: 650 x 1
2) Then divide across the bottom: ÷ 325.
What answer did you get?

Let's do one more easy one, then move on to something a little more difficult.
For this calculation, let's assume midazolam comes in 5 mg tablets. I have no idea if it does, but we're just practicing so it's all good. Hopefully, you've set up your calculation like this:
Next, cross out the units that are the same...in this case it's mg.

We are no weft with X # of tablets to give our 1 patient. Voila! Now, do your calculation!

OK...you have the hang of that now? That's a simple calculation with one conversion. What if you have multiple conversions?

Level 2 Dimensional Analysis: Multiple Conversions
Rather than deal with actual drugs, I'm just going to make them up from here on out...easier and more fun that way! So, your order reads:
You go to the med room and see that Smartella comes in vials that have 4 mg of drug per ml. How much Smartella do you need to draw up? Start with the order:
Next, look at your vial...you know you need to ultimately get to mg, so let's convert mcg to mg in our next step:
Notice how mcg are set up to cancel each other out...let's continue as we add the amounts our medication comes in (4mg/ml)
Let's get to canceling our units:
Now we do the math:
1) Multiply across the top: 2000 x 1 x 1
2) Divide across the bottom: ÷ 1000 ÷ 4
3) Press "=" on the calculator...what did you get?

Way to go! Let's do one more...your order reads:
You check the vials of Awesome-Sauce and see they contain 1gm of drug in 10ml of solution. Because you yourself are taking Awesome-Sauce regularly, you know how to do the calculation:
Next you get to crossing things off that cancel each other out:
You're just left with ml, which is exactly what you need to know. Now it's time to do some math!
1) Multiply across the top: 60 x 1 x 10
2) Divide across the bottom: ÷ by 1000 ÷ by 1
OK! You've got this! Let's move on to something a little more difficult.

Level 3 Dimensional Analysis: Weight-based Calculations
You will do a LOT of weight-based calculations in pediatrics and a fair amount in the adult population. For this first calculation, let's assume your patient is 4 kg....awwwww a little baby!
You will start with the dose as always, which is:
Notice what we did differently here? We didn't put the 1.4 mg over a 1...we put it over KILOGRAMS, because your dose is 1.4 mg per kilogram. By the way, Brainzy comes in a 10ml vial that contains 100mg of the good stuff, so you'll write out your calculation like this:
As you write out your conversions, notice that we have 4kg over 1baby...that's because your particular patient is a 4kg baby. Next we cancel things out:
We are left with X number of ml for 1 baby...which is exactly what you need to know. No Brainzy for you...you're already super smart!

Sometimes your nursing professors will try to get all tricky on you and give you your patient's weight in pounds, with the dosage in kilograms. No problem!

Your patient weighs 283 pounds and just had a BKA...you do NOT want him trying to get out of bed! You mosey on in to the med room and see that CalmDown (the greatest invention EVER) comes in a dosage of 1 mg per 10 ml bag. You diligently set up your equation, including all the conversion factors you need to end up with X number of ml per patient:
Notice how we start with the order (2 mcg/kg) then convert the kg to pounds, then input our patient's weight in pounds, then convert the mcg to mg, then add in the number of mg in a 10ml bag. Easy!

Now you cross things off...cancel out those matching units!
And you are left with X number of ml per angry patient...exactly what you need!

Now get to calculating!
1) Multiply across the top: 2 x 1 x 283 x 10
2) Divide across the bottom: ÷ 2.2 ÷ 1 ÷ 1000 ÷ 1
3) = ??
The next level of dimensional analysis is a bit more tricky...but you are amazing, so I'm not worried at all!

Level 4 Dimensional Analysis: Weight Based Meds by Time
If you precept or do clinicals in critical care, you will notice that meds are often dosed mcg/kg/min...woah! That's a lot of conversions! But with dimensional analysis it's a walk in the ol' park. Your order is:
You start with the order...which is to start your med at 2mcg/kg/minute. So let's start there!
Next, think about what you want to get out of this calculation. Your pumps run on mls/hr so that's what we want! You check out the bag of Squeezalot and see that it delivers 250 mg of drug in 250 ml. Ready? Let' do this.
You've started with your order, then added your patient's weight, then converted mcg to mg (since that's what unit measurement our med comes in). Next we converted minutes to hours (since our pumps are configured to run on mls per hour) and lastly we have 250 mg of Squeezalot in one 250 ml bag. If you're sure you've got yourself covered, let's cancel out!
As you can see, we are left with ml/hr/patient...which is what we want! Now let's do the mathulations:
1) Multiply across the top: 2 x 45 x 60 x 250
2) Divide across the bottom: ÷ 1 ÷ 1000 ÷ 1 ÷ 250
3) = ??

One more tricky one and then you'll be good to go! Your order is for a continuous infusion meant to keep intubated patients calm: You check the Copacetik IV bag and see that it provides 1000 mg in a 25o ml IV bag. Your patient weighs 180 kg and now you are ready to set up your equation. Hopefully it looks like this:
We've started with our dose of 3mcg/kg/min, then added in our patient's weight, then converted mcg to mg, then converted minutes to hours, then added the information specific to Copacetik. What's next? Cancel out those units!
Then it's time to get down with yo bad self and math it out!
1) Multiply across the top: 3 x 180 x 1 x 60 x 250
2) Divide across the bottom: ÷ 1 ÷ 1000 ÷ 1 ÷ 1000
3) = ??

See how wonderful, versatile and ultimately easy this method is? It works for any kind of calculation, any time, anywhere, on any patient. In these examples, I had you multiply and divide all numbers, including the numeral 1. Obviously, you don't have to do include the 1's, but if it helps you to remember every step, then it doesn't hurt to include them.

Coming soon...a dosage calc quiz to test your brainy-ness!

Be safe out there!

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Dosage calculations the easy way! - Straight A Nursing

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When it comes to doing nursing math, which is essentially figuring out dosage amounts, the absolute best, easiest and most foolproof way to do it is by using dimensional analysis. You may remember it from your chemistry class and loved it even then ;-).

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Interpersonal communication

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Building resources for nursing simulations: Challenges and opportunities

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Classroom and clinical teaching in nursing: Delineating differences

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https://learn.dcollege.net/bbcswebdav/pid-6009555-dt-content-rid-32086671_1/courses/23206.201725/Mrs.%20Chase%20-%20A%20Noble%20and%20Enduring%20Figure.pdf

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Healthy people 2020 health communication and health technology

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Healthy people 2020 health communication and health technology

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https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology

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Virtual meetings from the comfort of your home

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http://tinyurl.com/yau9rl8q

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Information on how to deal with students that are failing

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http://stopbullyingtoolkit.org/Difficult-Conversations.pdf

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https://www.nursebuff.com/apps-for-nursing-students/

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Top Ten Educational nursing games on Pinterest

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https://www.nursebuff.com/best-educational-board-games-for-nurses/

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An article supporting the flipped classroom

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Canva App

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This is a program that is free for health care professions to participate in research

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A way to meet virtually

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Canva app

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Kahoot is an interactive game to promote learning

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Get Certified

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Some learners are visual learners

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Become a member and receive peer reviewed journals

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Help with the NCLEX Review

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ACLS algorithm

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The is a great resource teaching procedures and physical exams

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Prezi presentation

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operating room responsibilities of the labor and delivery nurse Part I

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Be a part of your institution's Magnet journey

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This theorist is great for teaching tasks

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Postoperative of chlorhexidine vs Povidine Iodine PICO paper

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study groups improve test scores

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