Delegate Specifically

Delegate specific tasks to specific people using appropriate supervision.

So this can't be simply, "keep an eye on Mr. Smith in Room 12." Delegation has to be specific. So we have to define parameters that we're assessing for. We have to define accountability and measurement of those parameters to a specific person who is able to manage that task. In other words, if you have an aide that is going to be taking vital signs you don't want to tell them, "can you please take vital signs on Mr. Smith every 15 minutes because I need to know if she has a transfusion reaction?" Instead you need to say to her, "please take vital signs on Mr. Smith every 15 minutes, I'm looking for a transfusion reaction and I will check the vital signs that you get every 15 minutes to make sure that they remain in the normal range".

You don't want to give a specific parameter to somebody who doesn't know how to interpret that information. So for example, you couldn't tell the aide, "come back and tell me if her temperature goes up." Okay, well her temperature didn't go up but she's hypotensive and tachycardic; you see, that wasn't a good delegation. We need to define specific accountability and specific parameters. By doing so you will decrease your chance of liability, you'll increase accountability for the things that happen with your patients, and you will improve outcomes.

Best wishes,

David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

Reading Emergency Medical Services Literature

Reading Emergency Medical Services Literature

By Jim Upchurch

It is important to have a basic understanding of research study prior to interpreting research articles and abstracts. Dr. Jim Upchurch and Jeri D. Pullum illustrate the significance of scrutinizing EMS research articles.

Introduction
Emergency Medical Services (EMS) literature is the printed word concerning EMS. This includes articles, books, computer software and WebPages. The literature can be divided into two broad categories: research literature and non-research literature. Both serve an important purpose. Research literature helps to direct the practice of EMS by showing us what works and what doesn’t. The non-research literature may also change our EMS practice through the spread of information concerning various topics in EMS. These topics can be educational, personal opinion, survey data, etc. The article you are currently reading is non-research literature with the intent to describe two categories of EMS literature and offer an approach to effective reading.

EMS is a broad field dealing with the medical care provided for patients who become suddenly ill or injured. The field includes both out-of-hospital and in-hospital emergency healthcare providers. There are publications devoted entirely to EMS, such as JEMS and Prehospital Emergency Care, and there are general medical journals that regularly print articles about EMS. Until the past decade, virtually everything that was considered literature was in print form: books, magazines, journals and newspapers. A growing source for literature is the Internet. Readers must apply the same critical reading skills to Internet sources as they do to print sources.

Those who know the literature gain a better understanding of the field and can use that information to continually improve their out-of-hospital medical practice.

Research Literature
According to Webster, research is the careful, systematic study and investigation in some field of knowledge, undertaken to discover or establish facts or principles. Our interest is in the field of medicine. Articles published on medical research can be thought of as a snapshot of the medical topic being investigated. This snapshot gives us one view of a problem. Sometimes that single view is so powerful as to change our patient approach through just one study. One example is the investigation of penetrating chest trauma and treatment with the Military Anti-Shock Trousers (MAST), now often referred to as the Pneumatic Anti-Shock Garment (PASG). This study was done in Houston, Texas, several years ago, and clearly demonstrated that patients who were shot or stabbed in the chest died more often when MAST were applied than when they were not. This one study has changed the way we treat penetrating chest trauma in the field. However, the benefit of MAST or PASG in other situations remains unanswered due to a lack of research. It often takes several research projects or snapshots to give us a good picture of the subject under investigation.

What is EMS research literature? Research articles are generally published in medical journals that are issued several times a year. This helps to distribute the results of medical research faster than waiting for textbooks to be released or updated. Prehospital Emergency Care is currently the only medical journal dedicated to out-of-hospital medicine. EMS research articles are also found in the Annals of Emergency Medicine and occasionally in other medical journals. EMS research occupies a very small space in the overall field of medical research. Other research not specifically EMS also can impact out-of-hospital practice. The ongoing research in the treatment of heart disease is one major example.

So, what is a ‘good’ research article? It is one that gives us a true snapshot of the subject studied. The first step toward finding these articles is to look in a refereed medical journal. The author(s) published in these journals must work their way into the journal by passing one or more in-depth reviews of their article. The reviews are performed by one or more experts on the research subject contained in the article. It can take a year or longer before the article is accepted for publication. Journals that require a review process will identify this fact inside their journal. Prehospital Emergency Care and Annals of Emergency Medicine are two examples of refereed medical journals. After obtaining an article to read (or perhaps, one provided by your medical director), how do you get the most from your reading? First, you will need access to a dictionary (English and medical). It is important to look up words that are unfamiliar; otherwise, an important message from the article may be lost. A terminology gap can exist between what the author writes and the reader’s word memory bank. Dictionaries help close the gap. Other useful tools may include medical texts, drug references, etc. Next, it is helpful to understand how a research article is put together. In general, research articles are divided in to the Study Objective or Introduction, Methods, Results, Discussion and Conclusion. All but the Discussion is briefly covered at the beginning of an article. This is called the Abstract. The remainder of the research article discusses all divisions in detail.

The Study Objective or Introduction contains the research question. This part of the article should clearly describe what is being studied. Background information and a discussion of related studies (literature review) may also be provided here.

Methods is a description of how the study was conducted. Retrospective and prospective methods are frequently used. Retrospective studies use previous patient contacts to look for answers to the study objective. This is accomplished by reviewing medical records from a hospital or ambulance or from a database like the trauma registry. A prospective study is set up before patient contact. An example is the MAST study mentioned earlier. MAST was applied on one day but not the next. Patient response to treatment with and without MAST was documented in a prospective manner.

The Results section describes the data collected by the researchers and whether it meant anything. By time you get to this point in the article, you should have a fair understanding of what the researchers are looking for. Statistics help determine if the results of the study were real or due to outside influences. This is called statistical significance. There are different statistical tests used to calculate statistical significance. The selected test method should be identified along with the results. Statistical significance is important but does not guarantee clinical significance. Clinical significance is whether the study shows an impact on patients. The authors should identify the clinical significance they found.

The Discussion should be straightforward and review the study up to this point. Look for a description of the limitations of the study. This is a clue that the author(s) are trying to present a true picture of their findings.

Finally, the Conclusion should contain the author(s) response to the Study Objective based on the research. This may be included in the Discussion.

Non-research Literature
Non-research literature can take many forms: reporting on practices in the field, product reviews, announcements of new procedures, or feature stories on unusual or noteworthy people, agencies or events.

A critical reader can gain much valuable information from these articles. Product reviews help readers make informed decisions about purchases. Reporting on practices in the field helps readers stay up-to-date and helps determine whether practices in their own areas need updating. Feature stories can provide motivational material or can spawn ideas of how to adapt innovations to improve local EMS services.

As with the research article, critical reading is important to gain the most from the non-research article. Although there is nothing wrong with reading for entertainment, the critical reader can improve comprehension through guided reading. You can perform a self-review of the information you read by answering the following questions.

Who wrote the article? The critical reader should check the writer’s credentials. The credentials should support the notion that he or she has some knowledge of the topic under discussion. For example, an article on surgical airways written by a social worker probably should not carry much weight (unless the social worker is also a paramedic, R.N. or M.D.). However, that same social worker writing an article on critical incident stress is more likely to be useful. Also, the critical reader will pay attention to the credentials of other sources the writer is using for information. All this helps the reader shape an opinion about the article. Many feature stories are project reports and are often submitted by someone involved in the project. There is nothing inherently wrong with this practice, but without the strict scientific standards that are required of research articles, some writers involved in the project may paint a biased “rosy” picture. The critical reader should be suspicious if the writer fails to acknowledge any adverse circumstances, results or features.

What is the writer’s perspective? A physician may have a different view of the subject than an emergency medical technician, nurse or non-medical author. Medical professionals are not the only people who can write about EMS; people with many different backgrounds can offer great insight into various EMS topics. But their perspective is bound to be different.

What is the article’s perspective? Does the writer presents various points of view? Obviously, an article about a controversy in the field should include all viewpoints. This consideration applies to other topics as well. A product review should note poor features of the product, as well as the good features, indicating an unbiased evaluation. Critical readers can gain valuable insight from weighing opposing viewpoints for themselves or from understanding what does or does not work.

What are the credentials of the source: the journal, magazine, newspaper or Web site? The critical reader should find out how long the source has been operating and who publishes it. A critical reader can get a good sense of the tone of the source by evaluating its contents over time. Web sites, in particular, can come and go in the blink of an eye. That does not mean that a new magazine or web site is automatically suspect, but the critical reader realizes that such sources have not had time to establish a reputation. Publishers can range from professional organizations, industry groups with specific special interests, educational institutions, or communications organizations. The publisher’s philosophy influences the types of information published and exerts at least some editorial control.

Does the author describe reading objectives and resources used in their work? You should be informed early on what it is you will gain by spending the time to read the author’s creation. Resources utilized by the author should be recorded in the offering.

Does the information apply to you? The reader should consider both how well the information applies to his or her particular situation and the age of the information. The reader should look carefully at how the reported situation is both similar to and different from his or her own experience. Further, the reader must evaluate whether the information is dated or if it still applies.

Does the author use correct grammar and spelling (yes grammar!)? If the text does not flow well it may be the result of poor sentence structure and/or spelling. A writer who does not take the time to use correct grammar and spelling may not have taken the time to develop good content. And speaking of content, the ideas presented should flow in a logical manner.

Now, where do we find these articles? JEMS and EMS Magazine are major contributors to the written word on EMS. The articles are generally well written by experienced writers and provide useful information. Other sources include various web sites, Fire based journals, Search and Rescue journals, and occasionally medical journals other than Prehospital Emergency Care or Annals of Emergency Medicine.

Summary
With the information overload provided by the Internet and the many publications that address EMS, it is important to develop a sense of what is worth your valuable reading time and to get the most from what you do read. The reader who can keep an open mind but remain skeptical has the most to gain from regular and studied reading of the EMS literature. Hopefully this introduction will point you in the right direction. So read!

References
Rowntree D. Statistics Without Tears: A Primer for Non-Mathematicians. New York: Charles Scribner’s Sons; 1981.

Cuddy PG, Elenbaas RM, Elenbaas JK: Evaluating the medical literature. Part I: abstract, introduction, methods. Ann Emerg Med. 1983; 12:549-555.

Elenbaas JK Cuddy PG, Elenbaas RM: Evaluating the medical literature. Part III: results and discussion. Ann Emerg Med. 1983; 12:679-686.

Huck SW. Reading Statistics and Research, 2nd ed. New York: Addison Wesley Longman; 2000.

Merriam-Webster’s Collegiate Dictionary. Springfield, MA: Merriam-Webster, Inc. 1999; 995.

CO-AUTHOR
Jeri D. Pullum. Jeri has spent the past 15 years working with rural EMS providers, primarily on training projects for the Critical Illness and Trauma Foundation. She has designed, produced and authored numerous interactive computer-based training programs and contributes substantially to both the development of grant projects and in overseeing their completion. Using her background in print journalism and bachelor’s degree in journalism from the University of Montana, Jeri writes and edits scripts, training materials, proposals, reports and newsletters. She was an editor for a daily newspaper and worked for several years for a video production company. Jeri has a master’s degree in distance education and instructional technology. You can contact her at jpullum@bresnan.net.

Jim Upchurch MD, MA, NREMT practices in Montana and is board certified in Family Practice with added qualification in Geriatrics. He has a master’s degree in education and human development and is licensed as a paramedic. Dr. Upchurch is a ‘Legacy’ member of the American College of Emergency Physicians. Since 1985 his practice has focused on emergency medicine and EMS while providing the full spectrum of care required in a rural/frontier environment. He provides medical direction for BLS and ALS EMS systems, including critical care interfacility transport; and for the Incident Medical Specialist Program, USDA Forest Service, Northern Region. Dr. Upchurch has served as American Heart Association ACLS Regional and National faculty for Montana and currently represents Montana on the Council of State EMS Medical Directors of the National Association of State EMS Officials. Contact him via e-mail at upchurch@mcn.net.

Criminalizing Medical Errors

Criminalizing Medical Errors

By Mike McEvoy

Example scenario: While treating a 31-year-old heart failure patient, a paramedic mistakenly pushes 4 milligrams of intravenous norepinephrine instead of the intended lookalike vial of 1 milligram of bumetanide (Bumex®). The patient immediately develops a supraventricular tachycardia, becomes hypertensive, and deteriorates into ventricular fibrillation. Resuscitative efforts are unsuccessful; the patient is pronounced dead on arrival at the ED. After learning of the error from local media accounts, the district attorney launches a criminal investigation. A grand jury returns a felony indictment against the paramedic involved in the error.

Every medical provider fears making an error that harms a patient. The possibility of criminal prosecution adds to those fears — loss of personal freedom, property, certification or licensure, and potential loss of livelihood. Today, with increasing frequency, human errors in health care are being criminalized. The results may have far reaching consequences on the practice of medicine, nursing and EMS.

While the public and our legal system seek to blame and punish people who make fatal mistakes, health care experts and advocates believe that criminal prosecution of medical providers ultimately does far more harm than good. Such actions, they argue, will ultimately drive practitioners to stop reporting errors, and discourage recruitment and retention of a profession already in short supply.

The fact of the matter is that a fatal medication or procedural error could happen to any nurse, paramedic, EMT or physician. How then, should these tragic circumstances be dealt with? What leads society to criminalize medical mistakes? What role can you and I play in affecting how medical errors are managed?

Medicine is not the only profession susceptible to criminal indictments for mistakes. In September 2006, two U.S. pilots flying an executive jet clipped the wings of a commercial airplane over Brazil. The resulting crash was the worst aviation accident in the history of Brazil and killed all 154 people aboard the 737 airliner.
Criminal charges were later filed against the U.S. pilots involved(1). Like health care authorities, aviation safety experts commented that the charges would have a "chilling effect … on getting people to come forward and admit mistakes. We need to focus not on putting people behind bars, but rather on finding out what went wrong and why, and then to prevent its reoccurrence." (Kenneth Quinn, Flight Safety Foundation).

'Criminal human error'
History illuminates when and how safety experts and the criminal justice system arrived at their present day impasse. Attorney David Marx, writing in The Just Culture Community News and Views newsletter(2), calls this juncture the "birth of criminal human error." Marx traces the birth in the U.S. to a 1952 Supreme Court decision in the case of Morissette v. United States, 342 U.S. 246.

In December 1948, while deer hunting on an abandoned air force bombing range, Morissette salvaged 3 tons of abandoned bomb scrap metal. He did this in full view during broad daylight believing it was abandoned, and did not think he was stealing.

When the government charged him with theft, his attorneys argued for dismissal on the grounds that there was no evil or criminal intent, which they believed the law required(3). Justice Jackson, writing for the court, described a paradigm shift in defining the word "criminal," which until that time typically conjured up images of evil intent or intent to cause harm.
Jackson described how the industrial revolution had introduced powerful, complex machines with potential to cause significant harm not previously possible except by the hands of man or animal. He pointed out that automobiles became an instrument by which human behavior could inflict major damage. With the industrial revolution, vast harm became able to be caused from great distances. In response, legislatures started criminalizing acts where "evil intent" was no longer a necessary element. Criminal negligence was born.

Since the industrial revolution, many types of human error have been criminalized, especially where public health or welfare is at stake. Marx points out that today's convicted criminals are not all folks with "evil intent," but include those who breach a duty to others that our government labels "criminal." The Clean Water Act makes polluting waterways criminal. People who leave a child or pet in an unattended vehicle during hot summer months are likely to face criminal charges.

Unavoidable events
Considering the potential scope of actions that could expose any one of us to prosecution, statistics demonstrate a predictable randomness that would pronounce such events unavoidable. The only question is which one of us it will happen to next. And when egregious harm befalls an innocent victim, human nature is to react to the seriousness of the outcome. What firefighter is not happy to see criminal charges brought against an arsonist? What medic is not pleased to see a drunk driver marched off to jail?

Yet to effectively deal with errors, particularly medical errors, we need to suppress our natural reactions and try to ignore outcomes during the time it takes to analyze the circumstances that led to the error.

The greater question, as it pertains to medical providers, is why human error has become not only a violation of rules and regulations, but a criminal act when it threatens the safety of citizens. Are prosecutors becoming overzealous? Are lawyers running out of control? Are our elected officials so frustrated that they’ve turned to criminal law to protect society? Or is it perhaps the systems we designed and manage that are heading us in this direction? Probably no single one of these explanations accounts entirely for where we are today, but several will determine where we go in the future.

No one of us is perfect. As human beings, we are destined to make mistakes. The Just Culture Organization, working to improve patient safety, believes that medical systems often fail to recognize human beings have not one, but two "intentions" related to anything we do. But while we acknowledge human intention toward the outcome, we frequently overlook human intention toward the action or behavior that leads to the outcome.

Undoubtedly, few medical providers intend to hurt their patients — the outcomes. But what about their intentions toward their actions? Did the paramedic in our opening scenario consciously disregard what he knew to be a significant and unjustifiable risk to his patient? If he did, the Just Culture model would call that behavior "reckless" and that is precisely the question they believe should be applied when considering criminal charges in medical errors.

The belief that punishment or criminal charges are unjustified merely because a health care provider did not intend to cause harm flies in the face of accountability, our legal system and good patient safety.

Provider's intentions
When investigating medical errors, our systems must carefully weigh the provider's intentions toward their behavior for recklessness. Regularly, we need to look for risky behavior and coach providers to straighten up and fly right.

Reckless behavior, on the other hand, should be punished. Yes, you read that correctly: some behaviors need to be punished. Perhaps our failure to consistently address reckless practices has prompted attorneys, prosecutors and legislators to take up our slack themselves.

A highly intoxicated partygoer who chooses to drive themselves home does not intend to strike and kill a pedestrian. But when such an incident happens, the courts will likely find the behavior — driving drunk — was intended, and consciously disregarded a significant risk to others.
Recklessness that harms others is criminal, and society sends the guilty to jail. Health care providers should not enjoy special exemption from the rules that govern the rest of society.
Our regulatory systems need to do a better job of dealing with providers who aren't living up to professional standards. Using the criminal justice system to accomplish this should rarely be necessary.

Speaking at the Society of Critical Care Medicine's 2007 Congress in Orlando, Lucian Leape, a Harvard physician and founder of the National Patient Safety Foundation, told the audience that problem health care providers are not bad people but, "our friends and colleagues whose performance poses a potential threat to patient safety.

Our failure to insure that all of our colleagues are competent and safe is ethically indefensible, and we have to do something about it." Dr. Leape continued, "We are the only ones capable of judging and taking action with our peers. We have to take the responsibility."

Equally important are our safety systems. Many error investigation models, the Just Cause model included, see two inputs for every adverse outcome: the system we design around the provider and the behavioral choices they make within that system.

Some systems facilitate risky behaviors; others fail to implement safeguards to reduce risks. In 1998, a Denver nurse was indicted for criminally negligent homicide in the death of a newborn from a dose of penicillin. The Institute for Safe Medication Practices (ISMP) investigating the case found more than 50 deficiencies in the hospital medication-use system contributed to the error(4). Had any one of them been corrected, the error would not have reached the infant.

Protecting patients, providers
Safety systems are critical to protect patients and providers. Too often, safety nets are lacking or non-existent. Human beings will continue to make mistakes. System operators, administrators, manufacturers and regulators own responsibility for the environment of care.

When two drugs are packaged in lookalike vials, the department has an obligation to prevent potential errors. While we often focus on individuals involved in errors, the fire service and EMS community collectively are responsible to gather and analyze near miss reports and feedback from the streets to improve patient safety. Without strides in meeting that obligation, future criminal focus may well take aim at chiefs, administrators, medical directors and system operators.

The increasing trend toward criminalizing medical errors is very likely to discourage health care providers from reporting errors, hurt recruitment and retention, and bring important patient safety initiatives to a screeching halt. EMS providers, like our physician and nursing colleagues, need to step forward and take a more proactive role in how medical errors are managed.
We need to look for risky behavior before they result in errors, and consider whether recklessness contributed to errors that do occur. We must begin to hold our systems accountable for their contributions to errors in the environment of care.

Until we manage to convince the public, our legal system and legislators that we take mistakes seriously, they will continue attempts to fix our problems themselves with legislation, regulations and criminal charges.

Far better outcomes could be had if we, the people who know health care, lead change from within. It's time to begin — we owe it to our patients and each other.

References:
1. ISMP Medication Safety Alert! Criminal prosecution of human error will likely have dangerous long-term consequences. 2007; 12(5):1-2.
2. The Just Culture Community News and Views. The Criminal Edition. Marx, D, Cassidy, KM. Eds. January/February 2007.
3. Morissette v United States, 342 U.S. 246 (1952)
4. ISMP Medication Safety Alert! Since when is it a crime to be human? 2006; 11(23):2.
________________________________________
Mike McEvoy is the EMS Coordinator for Saratoga County and the EMS Director on the Board of the New York State Association of Fire Chiefs. Formerly a forensic psychologist, he is a clinical specialist in Cardiac Surgery and teaches Critical Care Medicine at Albany Medical College. Mike is a paramedic for Clifton Park-Halfmoon Ambulance, chief medical officer for West Crescent Fire Department, past chair and current member of the New York State EMS Council. He is the fireEMS editor for Fire Engineering magazine and recently published a book titled "Straight Talk About Stress for Emergency Responders." Mike is a popular speaker at fire, EMS, and medical conferences and in his free time, is an avid hiker and winter mountain climber

Nurses, Social Responsibility, Human Rights, and Activism

Nurses, Social Responsibility, Human Rights, and Activism

Written by NurseKeith
Monday, 26 May 2008

While nursing is seen by many as an inherently political act in and of itself, and while nurses have advocated for the poor for centuries, this article explores how nurses have organized for the betterment of society, and whether nurse-centric organizations exist---or have existed---akin to Doctors Without Borders or Physicians for Social Responsibility.

For decades, Physicians for Social Responsibility (PSR), Physicians for Human Rights (PHR), Doctors of the World , Partners in Health (PIH), and Medicins Sans Frontieres/Doctors Without Borders (MSF) have played crucial roles as advocates for human rights worldwide. With cultural clout, economic power, name recognition, and the admiration of millions, several of these organizations---especially MSF---frequently deliver reports and news conferences which garner enormous global media attention. MSF is also an incredibly effective front-line organization which well deserves the praise lavished upon it.

Since the politically-charged 1960’s and 1970’s---when many medical students and young doctors were radicalized---a small but mighty cadre of progressive, politically savvy doctors with an interest in human rights have spear-headed many important and memorable movements in the interest of serving those most in need, from refugees to inner-city American children. I admire these groups, and actually long to eventually count myself among their rank and file, serving refugees or other vulnerable groups worldwide.

As for nurses, many volunteer with MSF, PIH, and PSR to do their part in making the world safer for those vulnerable individuals most in need of medical care and advocacy. That said, the purpose of this article is to explore if, when, and how nurses have themselves organized into nurse-centric organizations to address similar concerns of human rights and social responsibility, and/or whether nurses need to create their own organizations vis-a-vis these vital human issues.

Over the years, I have noticed that nurses are quick to organize around a specific legislative agenda centered in the US, whether it be universal healthcare, safe staffing ratios for hospitals, or recruitment of nursing students during the all-too-familiar nursing shortage. This legislative agenda is indeed country-specific, and does indeed benefit patients as much---or more---than it benefits nurses on the front line. However, what I am seeking is evidence of nurses organizing within the nursing community itself in response to injustice, inhumane treatment, war, genocide, famine, widespread disease, or other global crises. Thus, for the purpose of this article, I set about searching the Internet for information on nurses and their work for human rights and social justice.

As for web searches, Googling “nurses without borders” brings one to a site offering several links to articles on the jailing of nurses in Bulgaria, as well as a very interesting article about a nurse who works for Doctors Without Borders . Still, it seems “Nurses Without Borders” simply exists as a dead-end web address and has never appeared to exist as an actual entity or organization in an of itself, as opposed to Engineers Without Borders , Reporters Without Borders , among others.

Moving on, a Google search of “nurses and human rights” brings the earnest surfer to Nurses for Human Rights , an excellent site specifically dedicated to the health and well-being of children and adults as they interface with the medical and psychiatric systems. While the site is narrow in focus, it addresses very important issues of human rights, especially in terms of children’s health.

In terms of searching on the Internet for articles on “nurses and activism”, a NurseWeek article highlights nurses who have pioneered Sexual Assault Response Teams (SART) in Texas, championed the improvement of low immunization rates for children, and worked to prevent Shaken Baby Syndrome.

According to the same NurseWeek article, “nurses have been activists since medieval times, when members of religious and secular nursing orders looked after lepers, orphaned children, and poor men and women whose families couldn’t or wouldn’t care for them. Nurse activists of previous centuries, including Florence Nightingale, Dorothea Dix, and Margaret Sanger, pushed for and achieved tremendous health care improvements in their lifetimes.” Nursing history is filled with individuals such as Lillian Wald and her Henry Street Settlement , which addressed issues of inner city poverty in radical and effective ways.

However, NurseWeek is also quick to point out that “in these days of heavy workloads, increasingly sicker patients and the demands of balancing work and family lives, many nurses find it hard to get through a work week, much less push for change or look for ways to give back to their communities.”

Still other articles argue that nursing is innately a political act in and of itself, elucidating the role that nursing has played vis-a-vis labor activism , or calling strongly for increased education of nursing students regarding how to influence public policy through civic participation.

My cursory searches have revealed that no organizations exist which exactly mirror PSR and MSF. Groups of nurses have seemingly not coalesced around issues forcefully enough to form independent non-profit organizations with progressive political or social agendas apart from regional, national or provincial professional nursing organizations.

As nurses, do we need organizations beyond the ANA and its regional counterparts through which nurses can make their collective voices heard? Is it enough for nurses to join MSF or PSR and be, as it were, participants in well-funded and progressive organizations founded and run by doctors? Are nurses less politically progressive than doctors? Do nurses simply work too hard? Do nurses have the will and desire to belong to groups that take strong stands for or against various issues and causes? Does the world need organizations such as “Nurses Without Borders”, “Nurses of the World”, or “Nurses for Human Rights”? Is there funding, political will, organizational will, and time and energy for such endeavors? And if there is the will, who will make it happen?

For myself, I have wondered if I personally have the energy to be the founder of such an organization. Do I have the resources, the skills, the desire, the time to undertake the quest? I also ask myself if nurses are ready for such a leap, if such organizations are truly necessary, or if they would simply be redundant? Could I truly garner enough support, funding, and membership to make such an organization viable?

Perusing the websites of MSF, PSR, and PHR, it would be a daunting effort to equal such solid organizational and global presence. Is my nurse’s ego bruised that it takes physicians---with their economic and cultural clout---to coalesce such efforts? Or am I happy enough to simply ride on the coattails of physicians and join in their well-organized and well-funded efforts?

As a hard-working nurse, stretched in many areas of my life, I conclude from my present vantage point and research that I would not choose to form an organization that would simply weakly echo the stances of PSR and MSF. While I lament the fact that nurses generally join physician-run progressive organizations rather than found their own, I admit that I too simply do not have the time or will to do what it takes to enjoin nurses across the country and around the world to join together under yet another banner. I also honestly wonder if there are enough politically progressive activist nurses willing to take up arms (so to speak) against the vast inequities and pervasive violence facing the world.

I can safely conclude that nurses are indeed activists, but nurse activism is operationalized in daily life, both at home and at work. In the course of their work, nurses advocate, educate, support and care for individuals across the lifespan. Under the auspices of the American Nurses Association and the various regional nurse organizations, nurses do indeed use their collective voice to push legislative agendas which are deemed germane and timely. Still, the ANA and AMA are limited in scope as professional organizations, taking no apparent position on issues such as genocide, famine, refugees, political strife, torture, or the war in Iraq.

As for nurse-run organizations akin to MSF or PSR, I have found no conclusive evidence that such organizations exist. Thus, I believe that nurses such as myself who have interest in such work will continue to join physician-led organizations in order to satisfy the desire for politically progressive work with a bias towards global justice and humanitarianism, or at least until some enterprising and well-meaning nurse---or group of nurses---decides that a nurse-run humanitarian organization is the key to fulfilling our ambitions of a more global activism for nurses.

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NurseKeith is a blogger, nurse, writer, and consultant. Please feel free to visit his blog, Digital Doorway .

PROGRAM PENEMPATAN PERAWAT INDONESIA KE JEPANG

PROGRAM PENEMPATAN PERAWAT INDONESIA KE JEPANG

Bppsdmk, Jakarta -

PENGUMUMAN

Nomor : KM.01.03.6.2.1884/2008

PROGRAM PENEMPATAN PERAWAT INDONESIA KE JEPANG

Sebagai realisasi dari kesepakatan G to G antara Pemerintah Indonesia dan Jepang dalam kerangka IJEPA (Indonesia-Japan Economic Partnership Agreement) yang telah ditandatangani di Jakarta pada tanggal 19 Mei 2008, maka Pemerintah Indonesia melalui Departemen Kesehatan RI membuka kesempatan bagi perawat Indonesia untuk bekerja sebagai Perawat (Kangoshi) di Jepang. Bagi perawat yang lulus seleksi (diharapkan 240 orang perawat) akan diberangkatkan ke Jepang pada bulan Agustus 2008 dengan masa kontrak kerja selama 3 tahun dengan starting salary sekitar 200.000-250.000 yen atau Rp 17,9 juta.

Persyaratan dan prosedur pendaftaran :
1. Perawat Indonesia, laki-laki dan wanita, usia 21 – 35 tahun, lulusan D-3 /S-1 Keperawatan tahun 2005 atau sebelumnya dengan pengalaman kerja di klinik/RS sebagai perawat min 2 tahun.
2. Berkas yang diperlukan (masukkan dalam 1 map berwarna merah) :
a. Fotocopy Ijazah dan transkrip nilai akademik yang sudah dilegalisir (bahasa Indonesia) dan yang sudah diterjemahkan dalam bahasa Inggris (dari institusi pendidikannya atau penterjemah resmi)
b. Fotocopy surat keterangan pengalaman kerja minimal 2 tahun dalam bahasa Indonesia dan terjemahan dalam bahasa Inggris.
c. Fotocopy KTP, Surat Keterangan Catatan Kepolisian/SKCK (asli), Kartu tanda pencari kerja/Kartu kuning (asli dan fotocopy yang dilegalisir oleh Disnakertrans).
d. Surat Ijin dari suami/istri/orangtua/wali yang diketahui oleh Ketua RW/Lurah/Kepala Desa.
e. Pasfoto terbaru latar belakang biru ukuran 3x4 cm = 4 lembar.
f. Good performance (bagi wanita tidak dalam keadaan hamil, bagi pria tidak bertindik, dan baik pria maupun wanita tidak boleh bertato).
g. Mengisi formulir 5 di tempat pendaftaran.

3. Waktu dan tempat pendaftaran : 27 Mei s/d 3 Juni 2008 di Puspronakes LN Depkes RI, Jln.Wijaya Kusuma Raya 48, Cilandak Jakarta Selatan, tlp 021 75914747 pswt 115 dan 021 7691531
4. Uji kompetensi tanggal : 5 Juni 2008 di Puspronakes LN Depkes RI Jakarta, (bebas biaya/Gratis).
5. Pengumuman kelulusan uji kompetensi : 6 Juni 2008 dan akan diterbitkan Surat Tanda Registrasi (STR) Keperawatan dalam bahasa Indonesia dan Inggris oleh Depkes RI.
6. Bagi yang lulus akan mengikuti test kesehatan / Medical Check Up tanggal 6-7 Juni 2008
7. Finalisasi nama peserta yang lulus seleksi Depkes RI : 8 Juni 2008, penyerahan berkas ke BNP2TKI tanggal 9 Juni 2008.
8. Prosedur seleksi selanjutnya akan dilaksanakan oleh BNP2TKI dan JICWELS (Japan International Corporation of Welfare Services) meliputi :
a. Tanggal 9-11 Juni 2008 :kelengkapan berkas administrasi meliputi persyaratan, keaslian dokumen, dan pemberitahuan jadual psiko test dan wawancara.
b. Tanggal 16-20 Juni 2008 : psikotest dan wawancara
c. Dilanjutkan dengan penyelesaian proses administrasi selanjutnya dan direncanakan dapat berangkat ke Jepang antara tanggal 3-9 Agustus 2008.

Sosialisasi program ini akan dilaksanakan oleh Depkes pada :
Tanggal 2 Juni 2008 jam 10.00 WIB di Puspronakes LN Depkes RI Jakarta, tlp 021-75914747 pswt 115.

Jakarta, 23 Mei 2008
Kepala,

Dr.Asjikin Iman H. Dachlan,MHA
NIP 140 174 584

(article copied from http://www.bppsdmk.depkes.go.id)

Being new

Being new

Caryn Salito, RN, MSN, MBA 1

In an article entitled The Challenges of Being New, Catherine Robinson-Walker, MBA, MCC 1 brings attention to the challenges a new nurse manager faces. Ms. Robinson-Walker identified that the biggest challenge of a new nurse manager is lack of support.

Most would probably consider me a new nurse with a mere 7 years of nursing experience. I am currently completing my MSN/MBA and have always had the desire to run a nursing unit in my area of expertise. Approximately 8 months ago I was given this exact opportunity. I was given the opportunity to manage a 27-bed inpatient nursing unit along with its coinciding outpatient clinic.

The decision I was faced with was not simple. I asked myself several times “Do I accept this opportunity or should I gain more experience and wait for the next opportunity to come along?”
Many factors would contribute to my decision. My commute would change from nonexistent to a 1-hour drive each way. My days would increase from 8 hours to whenever the job was done. I continuously questioned whether I am the right person to fill this position. Would I be able to maintain such a large inpatient unit and high volume clinic with no management experience? Would the staff accept me? Would the institution be a good fit for me? Most importantly, would I have the support and mentorship that would be necessary to allow me to succeed?

My thoughts kept racing, and the only question answered was “would I have the support and mentorship that would be necessary for me to succeed?” The answer I received time and time again was “Yes.”

From day one I knew I was in for the challenge of a lifetime. I felt as though the entire hospital was awaiting me, the new nurse manager. I knew no one, yet the whole hospital knew me. My eyes were overwhelmed with their stares. My mind was overwhelmed with what I assumed were their thoughts. My stomach was overwhelmed with nerves. My ears were overwhelmed with the abundance of names being sent through them. I was overwhelmed.

I continuously had to remind myself of the support I was guaranteed. Knowing that when it all became too much I would have someone to turn to and know she would give me the support I needed to get through. My support was my boss and a fellow nurse manager. The nurse manager assigned as my mentor was wonderful, but she, too, was a new nurse manager with less then a year of management experience on her resume. When I questioned how effective one new nurse manager could be as a mentor to another new nurse manager I was reminded that she had years of nursing experience to speak about at this very same institution.

In From Novice to Expert, Patricia Benner, RN, PhD 2 teaches nurses that a nurse will be successful personally and professionally when she is nurtured from novice to expert. To develop from novice to expert it is crucial that the novice have direction from others with more experience. In the profession of nursing, experience has traditionally been defined as the total years an individual has practiced as a nurse. Commonly, experience in a particular role within nursing is not considered. To assure nurse managers are successful it is pertinent they model after nurses with an abundance of management experience rather then many nursing years of experience. A nurse with 20 years of clinical nursing experience and 1 year of management experience is as novice as a nurse with 7 years of clinical experience and 8 months of management experience. A novice manager mentoring a novice manager will not allow for professional growth and success. What it will allow for is dissatisfaction, as well as mental and physical exhaustion.

With each day that passes I have been expected to do more and more. My mentoring sessions have dwindled from every week to “Hello, how are you doing?” while arriving at a meeting. My meetings with my boss take place on a biweekly basis with the expectation that I call when I am uncertain or I hit a bump in the road. If this were the case, I would never hang up the phone.
As a new nurse manager I would define support as a solid foundation composed of resources and individuals that allow a nurse manager the opportunity to grow both personally and professionally. Support is receiving proper and thorough training. It is knowing that as a manager you are being heard, it is knowing that others are being held accountable so yet another task does not fall into your lap as the manager, it is knowing that when you throw your hands in the air someone will come and help you through.

After reality set in and I realized that I was now a nurse manager, I did feel a sense of excitement in the midst of my nerves. I was excited about entering an institution at the brink of tremendous change. I was excited to add my thoughts and previous experience to their change process. I would be helping to make a difference, or at least I thought.

In an article entitled “The Change-Dazed Manager,” Katherine Vestal 3 nicely states that “today's nurse managers are experiencing the most intense, change laden roles that ever functioned in healthcare.” Vestal 3 goes on to state that “Nurse Managers manage healthcare organizations that are larger by revenue then most small businesses in America.”
I have found that running a multi-million dollar business alone is difficult. It is very difficult to lift my head out of my daily tasks. The needs of my staff take precedence, the schedule and payroll need to be completed and e-mails and phone calls need to be returned. On top of my day-to-day tasks, I find myself holding members of other departments accountable for completing their tasks. When their work is not complete and it affects my unit, I find myself completing their work.

Nursing management positions now require a minimum of an MSN. In 5 weeks I will have my MSN/MBA. Currently, I do not find myself using my degree. I do not have the time to work on projects that would require me to use the knowledge I have gained from my graduate course work.

It is now that the profession of nursing needs to conform to allow its new nurse managers the opportunity to be successful. It is the successful new nurse managers who will bring nursing to the next level of practice.

Footnotes1. Caryn Salito, RN, MSN, MBA, is a recent graduate of the MSN/MBA program at the Johns Hopkins University School of Nursing in Baltimore, Md.

References
1 Robinson-Walker C, The challenges of being new, Nurs Leader, Volume: 5, Issue: 1 (2007), pp. 8--9 Bibliographic Page Full text
2 Benner P, From novice to expert, (1985), Prentice Hall, New York.
3 Vestal K, The changed-dazed manager, Nurs Leader, Volume: 1, Issue: 5 (2003), pp. 6--7 Bibliographic Page Full text

Look up: Could that new leader be you?

Look up: Could that new leader be you?

Katherine Vestal, RN, PhD, FAAN, FACHE 1,

Have you ever watched a leader that you admire and wondered if you could ever be successful in that job? Or conversely, have you watched someone and said to yourself that you could never, or would never, do that job? Or have you assessed a leader and determined that you think you could do a better job than they do? Probably all of us have experienced these moments more than once and found that they either motivate us to explore opportunities or confirm that we should just stay the course with our present role.

Given the current and increasing leadership shortage in nursing, these thoughts will inevitably lead to a lot of soul searching as pressures mount to have talented nurses in leadership roles. Nursing leadership roles are naturally evolving to meet myriad organizational challenges, so there will be ample opportunities for those who aspire to fill them. While all leadership roles do not necessarily involve upward promotion, at some point in a career that will likely be the case. So look up. What do you see in the hierarchy in the way of leadership roles? Do any of them look challenging or attractive to you? Do you aspire to fill a specific role?

Many of us are reluctant to have discussions about our leadership career aspirations or potential pathways. Are we afraid to offend the people currently in the roles? Or are we afraid to commit to a pathway and do the work to make it happen for fear of failure or disappointment? Often, we assume that because we are doing a good job in our current role that that will be recognized and we will be sought out for new opportunities. So there is usually some mix of fear of the unknown, reluctance to clarify our career intents, and belief that if we work hard enough the opportunities will come to us.

While this may work for some, more than likely it will slow advancement or in some cases derail upward mobility. Both of these are antithetical to what we need in nursing. So how can we begin to look up, clarify what we want, and set a course to achieve career goals?

Assess the changes that are underway in your organization
Many of these changes will create opportunities that you might pursue. For instance, if there are leadership changes underway and new leaders are coming into the organization or internal leaders moving around in the organization, vacancies will be created that will probably need to be filled. Give a lot of thought to pursing selected opportunities by assessing your interest in the work of that role, determining how selection will be made, and doing a self assessment of what you would bring to the role. If you can then envision yourself in the role it is helpful to talk with others to get information and feedback.

Make it known that you are interested in the job or a job with increased responsibility
In busy complex healthcare organizations it is easy to be overlooked, so have a conversation with other leaders and express your interest in advancing your career. Make it clear that you are ready to tackle assignments where you can learn and grow, that you are actively pursuing knowledge and skill building, and that you have the energy to invest in new initiatives. Whether this leads to a new role, a committee leadership assignment, or a special project is less important than the fact that you are now in a more visible position and can continue to pursue your goals.

Gather information on your experiences and accomplishments into a portfolio that you can review and also share with others
Over the years we tend to forget a lot of the detail of what we have accomplished, so it is important to periodically take stock of our careers to date. In objectively reviewing your accomplishments and holding them up to the career plan that you design, it will become clear where your strengths are and the areas that you will need to develop. In discussing your career portfolio with leaders who can advise you, you will get valuable insight into how the organization views your preparation for advancement.

Getting up to speed quickly will fast track your advancement
None of us ever has a full portfolio of skills and knowledge needed by the organization. But some have more than others. Establish a plan to enable you to gain expertise quickly so you are ready for the opportunities as they arise. For instance, if you determine that you need more expertise in fi-nance, or human resources, or patient safety, look around you and find people who can teach or mentor you and implement a plan to learn what you need to know. These resources can be inside or outside of the organization and in many cases can be learned through continuing education programs or the internet.

Demonstrate that you are flexible, focused, and dependable in meeting goals and metrics
With the increased pressure to meet targets and goals in healthcare organizations, it will not go unnoticed that you are able to deliver results. In the process you show that you are creative, innovative and able to find new and better ways of doing things. It is important that you share your findings with others, not only to better the organization, but also to create a platform for your own career pursuits. It is easy to think that the things you ac-complish will be highly visible and credited to you, but in reality that does not happen by chance.

Being scared can be a good thing as it will motivate you to quickly find an answer
Most leaders will tell you that they had a fair amount of fear when they began new jobs and that they felt that they had a lot at stake to succeed. From the outside, they exuded confidence so it was hard to see that they were scared, but they were. Often it is that same fear that keeps capable people from pursuing new jobs and the opportunity to grow and advance is lost. For all nurse leaders, there will be so many opportunities to advance that we must understand that the fear we feel should be the driver for learning and advancement. It is not necessary when considering a new role, to overemphasize your needs. Just acknowledge that there are things to be learned and you will have a plan to accomplish that.

Look for opportunities to try a role on an interim basis
With all of the organizational challenges there are always opportunities to fill a function or role on a short-term basis. That might be just the chance to try out a role and see if it interests you while also getting visibility from other leaders. Interim roles always have unique challenges so you will need a sense of adventure as you assume the responsibilities. Be sure when agreeing to assume an interim leadership role that you have clarity about what must be accomplished within a defined time frame. This will help you determine how you can pace change and meet expectations. Be prepared to track your results closely and stay in close touch with the leader the role reports to.

In many ways advancing in leadership and moving to the top is as much of an art as a science. Of course, you will need to have substantial knowledge and skills as you assume increasing responsibility, but you will also have to keep looking up and determine what you will need to learn next. Perhaps the greatest challenge is to be able to visualize yourself in that role and make a personal career commitment to get there.
So be sure and look around at the leaders you admire, look up at the leaders you aspire to be, and then look inside yourself and instill the drive to get there. We need so many new leaders, and you can make sure you are one of them.

Footnotes1. Katherine Vestal, RN, PhD, FAAN, FACHE, is president of Work Innovations, Inc., in Lake Leelanau, Mich.

Upaya Meningkatkan Profesionalisme Perawat

Upaya Meningkatkan Profesionalisme Perawat

(Dari Simposium Keperawatan RS Husada)

JAKARTA – Sebut satu saja pekerjaan yang sangat mulia, jawaban yang mungkin paling banyak muncul adalah perawat. Betapa tidak, merawat pasien yang sedang sakit adalah pekerjaan yang sangat sulit. Tak semua orang bisa memiliki kesabaran dalam melayani orang yang tengah menderita penyakit.

Namun, perawat sebagai profesi dan bagian integral dari pelayanan kesehatan tidak saja membutuhkan kesabaran. Kemampuannya untuk ikut mengatasi masalah-masalah kesehatan tentu harus juga bisa diandalkan.
Demikian dikemukakan pakar Keperawatan Murni Suliantoro dalam simposium bertema "Upaya Memajukan Profesionalisme dan Praktik Keperawatan" yang berlangsung di Rumah Sakit Husada, pekan lalu.
Untuk mewujudkan keperawatan sebagai profesi yang utuh, menurut Murni, ada beberapa syarat yang harus dipenuhi. Setiap perawat harus mempunyai "body of knowledge" yang spesifik, memberikan pelayanan kepada masyarakat melalui praktik keprofesian yang didasari motivasi altruistik, mempunyai standar kompetensi dan kode etik profesi. Para praktisi dipersiapkan melalui pendidikan khusus pada jenjang pendidikan tinggi.

Simposium yang menampilkan para pakar di bidang keperawatan dan kesehatan ini membahas juga pelaksanaan keperawatan profesional terkini, isu etik dan spiritual dalam asuhan keperawatan, pemahaman profesionalisme dalam keperawatan dan pemeliharaan kualitas rekam medis dalam menunjang peningkatan mutu pelayanan kesehatan.

Kerangka Kerja
International Council of Nurses (ICN) mengeluarkan kerangka kerja kompetensi bagi perawat yang mencakup tiga bidang, yaitu bidang Professional, Ethical and Legal Practice, bidang Care Provision and Management dan bidang Professional Development. Kerangka kerja ini menurut Murni kini menjadi acuan dalam menyusun standar kompetensi perawat di Indonesia.
Budi Sampurna, Pakar Hukum Kesehatan dari Universitas di Indonesia, mengemukakan bahwa setiap profesi pada dasarnya memiliki tiga syarat utama, yaitu kompetensi yang diperoleh melalui pelatihan yang ekstensif, komponen intelektual yang bermakna dalam melakukan tugasnya, dan memberikan pelayanan yang penting kepada masyarakat.

Sikap yang terlihat pada profesionalisme adalah profesional yang bertanggung jawab dalam arti sikap dan pelaku yang akuntabel kepada masyarakat, baik masyarakat profesi maupun masyarakat luas. Beberapa ciri profesionalisme tersebut merupakan ciri profesi itu sendiri, seperti kompetensi dan kewenangan yang selalu sesuai dengan tempat dan waktu, sikap yang etis sesuai dengan standar yang ditetapkan oleh profesinya dan khusus untuk profesi kesehatan ditambah dengan sikap altruis (rela berkorban).
Kemampuan atau kompetensi, menurut Budi, diperoleh seorang profesional dari pendidikan atau pelatihannya, sedangkan kewenangan diperoleh dari penguasa atau pemegang otoritas di bidang tersebut melalui pemberian izin.
Kewenangan itu, ungkap Budi, memang hanya diberikan kepada mereka yang memiliki kemampuan. Namun, memiliki kemampuan tidak berarti memiliki kewenangan. Seperti juga kemampuan yang didapat secara berjenjang, kewenangan yang diberikan juga berjenjang.

Dalam profesi kesehatan hanya kewenangan yang bersifat umum saja yang diatur oleh Departemen Kesehatan sebagai penguasa segala keprofesian di bidang kesehatan dan kedokteran. Sementara itu, kewenangan yang bersifat khusus dalam arti tindakan kedokteran atau kesehatan tertentu diserahkan kepada profesi masing-masing.

Dijelaskan Budi, kompetensi dalam keperawatan berarti kemampuan khusus perawat dalam bidang tertentu yang memiliki tingkat minimal yang harus dilampaui.

Kewenangan berkaitan dengan izin melaksanakan praktik profesi. Kewenangan memiliki dua aspek, yakni kewenangan material dan kewenangan formal. Kewenangan material diperoleh sejak seseorang memiliki kompetensi dan kemudian teregistrasi (registered nurse) yang disebut Surat Ijin Perawat atau SIP.
Sedangkan kewenangan formal adalah izin yang memberikan kewenangan kepada penerimanya untuk melakukan praktik profesi perawat yaitu Surat Ijin Kerja (SIK) bila bekerja di dalam suatu institusi dan Surat Ijin Praktik Perawat (SIPP) bila bekerja secara perorangan atau berkelompok.

Murni mengatakan profesi keperawatan di Indonesia mempunyai peluang sekaligus tantangan dalam menunjukkan profesionalismenya. Cepat atau lamban pengakuan dan penghargaan terhadap profesi keperawatan tergantung pada kemampuan dan kemampuan setiap perawat dalam menghadapi masalah-masalah keperawatan baik dalam skala mikro maupun makro.
Hal yang tidak kalah penting, kata Murni, adalah penyelenggaraan pendidikan yang bertanggung jawab. Dalam pengabdiannya, perawat dituntut bekerja secara profesional, memiliki sifat "caring", bertanggung jawab dan bertanggung gugat. Setiap perawat harus berusaha selalu meningkatkan kemampuannya baik dari segi keterampilan di mana era globalisasi diharapkan kemampuan profesionalisme perawat dengan basis kompetensi seiring dengan perkembangan ilmu pengetahuan. (tom)

HEALTH-CARE WORKERS, THE 'TRUE LIFESAVERS,' MUST BE SUPPORTED - BAN KI-MOON

HEALTH-CARE WORKERS, THE 'TRUE LIFESAVERS,' MUST BE SUPPORTED – BAN KI-MOON

New York, Mar 4 2008 10:02AM
The time has come to focus on supporting and retaining health workers – "the true lifesavers in the society of every nation"– Secretary-General Ban Ki-moon told the first-ever world forum on the topic, which convened in Kampala, Uganda, today.

"Almost 60 countries – most of them in Africa – face such critical shortages of health workers that they cannot provide basic health care to all their people," Mr. Ban said at the Global Forum for Human Resources in Health, which expects over 1,000 government leaders and experts to meet under the auspices of the World Health Organization (<"http://www.who.int/mediacentre/en/">WHO).

In his statement to the gathering, Mr. Ban emphasized the crucial part that health care plays in economic development and in reaching the Millennium Development Goals (MDGs), which aim to reduce extreme poverty and other global ills by 2015.

"I appreciate that the issues are complex," he said, maintaining that the crisis in the world's health workforce requires different stakeholders to take action in a range of areas – migration, development, education, finance and more.

However, he pointed to renewed momentum throughout the international community to tackle large challenges in health care, as well as advances in knowledge.

"We have the resources and the know-how," he concluded: "Let us work together, with coherent and coordinated action, to translate commitments into protected livelihoods and saved lives."

The first Global Forum for Human Resources in Health will run through 7 March.
2008-03-03 00:00:00.000


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NCLEX - RN Examination

NCLEX - RN Examination

Preparation Guide
Discuss about NCLEX - RN Exam in our discussion forums. Click here to go to the NCLEX - RN Exam discussion forum.

Books for NCLEX - RN Exam
NCLEX-RN Review by Alice M. Stein
Saunders Comprehensive Review for the NCLEX-RN(r) Examination
Lippincott's Review for NCLEX-RN (Book with CD-Rom for Windows)
Kaplan NCLEX-RN Exam 2005-2006 with CD-ROM (Kaplan Nclex-Rn)
Mosby's Comprehensive Review of Nursing for NCLEX-RN (Book with CD-ROM for Windows & Macintosh)

Useful Links for Preparation
If you would like a website to be added to this list please click here

http://caring4you.net/tests.html - List of Links to sites that have free practice exams

http://nursing.drexel.edu/excel/index.cfm?action=nursing_resources - Favorite websites of the faculty of the Drexel College of Nursing and Health Professions.

http://www4.utsouthwestern.edu/library/guides/nursing/nursing.cfm - Southwestern Medical Center Library Nursing Resources.

http://nursingjourney.com/links.html - Nursingjourney.com links page.

http://www.nclexinfo.com/ - Site with some practice exams.

Process for FNGs

Process for FNGs

In order to work as a nurse in the USA you have to obtain a license to practice nursing and then apply for a US Visa/Green Card. In the USA nurses are licensed by each state. Due to this you have to decide which state you are interested in and then meet the requirements put forth by that state's professional licensing organisation inorder to obtain a license to practice in that state.

The National Council of State Boards of Nursing (NCSBN) website has contact information for the individual State Boards of Nursing(BONs): http://www.ncsbn.org/regulation/boardsofnursing_boards_of_nursing_board.asp. Contact the state board for requirements for licensure. In general the licensing requirements involve the following:
- Complete Credentials Verification
- Pass the NCLEX-RN Exam
- Apply to and obtain License from State BON (Board of Nursing)

Once you have the license you are ready to apply for a US Visa/Green Card:
- Pass one of the English Language Exams
- Apply and obtain a Visa Screen Certificate

The Visa Screen certificate can then be attached to your US Visa/Green Card application. Although the obtaining the Visa Screen is the last step in this process you might want to consider starting the process first even before you obtain the license as it takes a long time for the Visa Screen from CGFNS and usually there is enough time to obtain the license before CGFNS has had the time to start looking at your licensing credentials.

Credentials Verification
Each state typically requires a Credentials Verification process to be completed. This involves an independent verification authority that would verify all the educational credentials supplied by the candidate and then certify whether or not those credentials are valid. The Commission on Graduates of Foreign Nursing Schools (CGFNS) is one of the independent verification authority that is used. However, some states use other independent verification authorities to do the Credentials Verification process.

NCLEX - RN
The NCLEX-RN exam is conducted by the National Council of State Boards of Nursing (NCSBN). In the U.S. one has to obtain the license from the individual states to practice nursing. The NCLEX-RN exam is the licensure exam that is recognized by the states.

After the Credentials Verification process is completed you are eligible to appear for the NCLEX-RN exam. Pearson VUE conducts the NCLEX-RN exam on behalf of NCSBN.

The following link has more information from NCSBN about the NCLEX-RN exam: http://www.ncsbn.org/pdfs/Web_Bulletin_05.pdf

Obtain License from the State BON
Once one passes the NCLEX-RN and have completed the Credential Verifications process through the recommended agency by the State Board of Nursing then that state will issue a license.

English Language Exam
The most popular English language exam that is used to certify English Language Proficieny is TOEFL, Test of English as a Foreign Language. Some states use other Exams like IELTS (International English Language Testing System ) or TOEIC (Test of English for International Communications).

Visa Screen Certificate
The VisaScreen Certificate is issued by the International Commission on Healthcare Professions (ICHP) – a division of CGFNS. The VisaScreen program is comprised of an educational analysis, licensure validation, English language proficiency assessment, and passing the NCLEX-RN exam. The VisaScreen Certificate needs to be attached to any application to the US Embassy to immigrate to the USA.

Covering up for a colleague

Covering up for a colleague

Covering for a careless colleague endangers patients and jeopardizes the quality of your own work.

Jan 1, 2008
By:Amy Haddad, RN, PhD
RN

I work with a nurse who knows how to do her job but doesn't always do it. If she is reprimanded, she improves for a while, but it doesn't last. I can't stand seeing patients get less than quality care. How responsible am I to cover her carelessness?

In this time of a severe nursing shortage, it might be tempting to overlook the actions of a marginally competent colleague rather than report her actions and risk having no colleague at all. However, slowly allowing the erosion of quality nursing care not only puts patients at risk of harm but the profession as a whole, as well.

Your personal responsibility for the incompetent conduct of others is limited by the duty to protect patients' interests. Covering for a careless colleague only enables the process to continue and jeopardizes the quality of your own work.

That said, the answer to a question like yours is not always clear. One problem is the ethical conflict between the obligation to serve the patient's best interest and loyalty to a colleague whose interests would be jeopardized if you reported her to a supervisor or took other action to get her to clean up her act.
Before deciding if an intervention is in order and what kind it would be, you'd also have to determine whether you have any duty to your colleague to serve her interests. Loyalty to those with whom we work is an important principle. It establishes a foundation of trust among members of a working team. So as colleagues we have a collegial duty to protect the reputations of those with whom we work—but only to a point. We also have a duty to future patients who could be injured by a careless colleague.

One issue to consider is whether the nurse should be viewed as responsible for her behavior. Is she in a position where she should clearly realize that she's failing to meet the standard of professional conduct? Has she been properly oriented to her position? The answers to these questions may determine whether you and others hold her responsible.

AMY HADDAD, RN, PhD, a member of the RN editorial board and a widely recognized ethicist, is a professor at the Center for Health Policy and Ethics at Creighton University in Omaha. She is the co-author of Ethical Dilemmas in Perioperative Nursing, Ethical and Legal Issues in Home Health Care, and The Arduous Touch: Voices of Women in Health Care.

Enrollment growth slows in U.S. nursing schools

Enrollment growth slows in U.S. nursing schools

Jan 1, 2008
RN

Enrollment in entry-level baccalaureate nursing programs increased by 4.98% from 2006 to 2007, the seventh consecutive year of enrollment growth, according to the American Association of Colleges of Nursing. However, the rate at which nursing schools have been able to increase student capacity has declined sharply since 2003, when enrollment was up by 16.6%. Also, more than 30,000 qualified applicants were turned away from baccalaureate nursing programs last year due primarily to an intensifying shortage of nurse faculty.

In a related development, the Robert Wood Johnson Foundation announced it would provide a $10 million grant to the AARP Foundation to help create the Center to Champion Nurses in America, which will address the nursing shortage and lobby for more state and federal funding to help expand nursing education programs.

The 15 Percent Solution

The 15 Percent Solution

You've heard it before and so have I: the average person only uses 10 percent of their brain. This means as you go through your daily activities on average you only use 10 percent of your mental capacities. Can you imagine how much more you could accomplish if you could use more of your brain?

I'm not asking you to use 90 percent, but how about 15 percent?

How much more could you accomplish if you were using 15 percent of your brain on a consistent and persistent basis? Could you do better assessments? Could you provide better care? Would you be better equipped to evaluate your treatments and avoid complications in your patients? I think most of us would.

But how do you squeak out another 5 percent if you are using only 10 percent of your brain and you feel like you’re using a lot. You’re stressed and at times you go home mentally exhausted. How can you squeeze that extra 5 percent out?

I believe the key lies in your knowledge base. The greater your knowledge base, the more information you have to go back to. The greater your knowledge base, the more connections you find between concepts. And the greater your knowledge base, the more creativity you can use in finding solutions to complex problems. So read, observe, pay attention, keep an open mind and be receptive to learning. Remember that there's plenty of room for extra potential and strive for a little more, just 15 percent.

15 percent of your mental capability is 50 percent more than you've been using. Your assessments would be 50 percent better. Your interventions would be 50 percent better. Your ability to respond in a crisis would be 50 percent better. That's a big jump for a little bump in brain power.

So how do you go about achieving this lofty 15 percent? The first step is to learn something new today. Learn something new every week. I use what I call the idea quota; I require myself to come up with one new idea every week. It maintains my creativity and it keeps me looking for unique and innovative solutions all the time. You could do the same thing with your care by making a creativity quotient or an idea quota for every week. Require yourself to learn something new every week. Come up with a new idea every week and you'll find that your brain power is expanding and before you know it you'll be up to your 15 percent which would dramatically improve your outcomes.

Best wishes,
David W. Woodruff, MSN, RN, CNS
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Opportunity is all around us

Opportunity is all around us

For me the ground is too close, the walls are too close, but the sky is endless. I think this is also true of opportunity. Opportunity is all around us if we can only see it; but many times we spend too much time looking at the walls and the ground and not enough time looking up to the open sky.

As this pertains to goal setting, you might find that you are hesitant to make large goals because of the limitations that are right around you. When you look up, you can see that the possibilities are endless and that the goals that you achieve in your life can be endless as well. To go up, you must look up.

If you want better health, more opportunities and greater prosperity in your life, stop looking around at the limitations next to you, and below you, and start looking up at the endless opportunities that really exist. You are an incredible being born into a time of limitless opportunity. Look up to see the vastness of opportunity and abundance that really surrounds you.

To your success,
David W. Woodruff, MSN, RN
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Empowerment for Nurses

Empowerment for Nurses

October 27, 2007

Nurses have incredible power; but few realize it and even fewer use it to improve care and to help their patients. Empowerment is not a gift that someone gives you. Rather it is a gift you give yourself by realizing the excellence you already have, embracing it, and developing it further.

Your clinical practice will improve. By recognizing the excellence that others have, it will help patient care in general improve. Nurses are the only caregiver that is at the bedside 24 hours a day, 7 days a week. Nurses are also the largest body of employees in any hospital system. For these two reasons alone nurses have incredible power. For six of the last seven years the Gallup Poll has listed nurses as being the most ethical and trusted profession. Nurses are respected by their patients and by society.

So why is it that so many nurses feel disempowered?

I believe it is because most nurses do not embrace, develop, or use the incredible power they have for the good of the healthcare system. Empowerment comes from recognizing those things you do well, embracing them and wanting to validate and do them better. To “Embrace your Excellence” means to recognize what you do well and what your peers do well and to encourage your peers to embrace and develop those things that they excel at. Imagine what healthcare would be like if nurses embraced their excellence, developed it further and used their incredible power to change the healthcare system for the better. Could we solve the problems that we face in healthcare today? I think we could.

Nurses are an incredibly intelligent, creative and empathetic group of people who could come up with unique and powerful solutions to the problems we face today.

Embrace your excellence!

“Get out there and give real help!
Get out there and love!
Get out there and testify!
Get out there and create whatever you can to inspire people to claim their divine being and origin.
This is what has to be done now.
There is no time, there has never been any time for dallying and being depressed."
-Mother Teresa

Best wishes,
David W. Woodruff, MSN, RN, CNS
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Are Nurses With a Doctor of Nursing Practice Degree Called "Doctor"?

Are Nurses With a Doctor of Nursing Practice Degree Called "Doctor"?

Question:

I am thinking of going back to school to earn a DNP. If I earn this degree, can I be called "Doctor" when I practice? How must I identify myself to the public as a nurse practitioner?

The Clinical Doctorate

Practitioners, employers, credentialers, and the public may soon notice that the title "Doctor" applies to many health practitioners who are not physicians or dentists. The clinical doctorate (doctor of nursing practice [DNP]) signifies completion of a clinically focused, rather than research-focused, advanced degree program. Beginning in 2015, the DNP has been targeted as the accreditation standard for advanced practice nursing in accordance with the American Association of Colleges of Nursing (AACN) guidelines.[1] Whether schools and colleges of nursing will revise their program offerings in time to meet this deadline remains to be seen, but clearly the tide is turning toward doctoral preparation for allied health professions at the advanced practice level.

In this regard, nursing follows other professions, such as medicine, physical therapy, pharmacy, clinical psychology, and naturopathy. The call for interdisciplinary practice and education, envisioned by the Institute of Medicine in its report Health Professions Education: A Bridge to Quality, predicts that more professionals with the title "Doctor" will be working together in the same settings.[2] Many of these professionals will not be physicians.

Current Law

According to the 2007 Pearson Report, only 7 states (Georgia, Illinois, Maine, Missouri, Ohio, Oklahoma, and Oregon) have statutes or regulations prohibiting a nurse practitioner (NP) or other doctorally prepared health professional from using the title "Doctor.[3]" Several other states have provisions in law allowing nonphysician healthcare professionals to use the title "Doctor" as long as they also include their title of licensure or specialty (NP, physical therapist, etc) in patient communication. The American Medical Association (AMA) has identified use of the professional title of "Doctor" as a topic for legislative initiative on behalf of its membership. Resolution 211, passed by the AMA House of Delegates, accused nurses and other "nonphysicians" with doctoral degrees of misleading patients "to believe that they are receiving care from a doctor.[4]" The resolution states further that the AMA resolves to work with individual states to "identify and prosecute those individuals who misrepresent themselves as physicians to their patients.[4]"

Although the AMA resolution has no binding effect on individual state law, it does indicate intent to mount a campaign that challenges the abilities of nurses and other health professionals to claim the title "Doctor," even if a degree is earned and recognized by the public.

How Can I Approach This Question in My Professional Setting?

The first recommendation is to clearly understand what your state titling law, generally found in your state's Nurse Practice Act, requires that you must call yourself. Although all NPs are required to meet registered nurse (RN) licensing requirements, in Utah, the RN license is expired when the NP is granted. Check with your state Board of Nursing to determine whether the practice title in your state is "ARNP," "CRNP," or whether you should use a specialty title, such as "FNP." Professionally, this is the title that you must use on all materials that you present or hold out to the public. There may also be a requirement that "RN" is used for any nursing practice.

National certification titles, such as APRN-BC, CNM, or RNC, designate that a certification exam was passed, but these titles do not tell the public whether you currently hold a state professional license. Similarly, professional degrees, such as MSN or PhD, are earned titles that may be legally used in any setting, but do not by themselves tell the public clearly in what capacity you are licensed to practice. Using these titles in addition to your legal title of licensure may or may not be required when practicing in a clinical or academic setting.

The second recommendation is to begin working with other health professionals in your employment setting to implement nurse-positive language as advised by the Center for Nurse Advocacy. They rightly note that the way nurses refer to other professionals models language that is then adopted by patients and by the media. As the Center for Nurse Advocacy observes, "media, like most people, often use the term doctor to mean physician. Although this usage is deeply ingrained, it gives many people the impression that physicians are the only health care workers who can earn doctoral degrees.[5]"

Clearly, this is not the case, as more advanced practice nurses seek doctoral degrees for professional or clinical goals. Be ready for the discussion where you practice; understand and use your licensure title appropriately and assertively; and initiate nurse-positive language where you practice. The AACN has a document that reviews talking points in response to the AMA Resolution 211 that could be used in the workplace, or by your professional organization, to introduce the concept that doctorally prepared nurses are likely to be a strong presence in healthcare for many years to come.

In summary, you must always use your legal title of licensure in the state that you practice in your communications with the public. You may use your academic degree credentials in all settings, to indicate educational credentials. You can legally use the title "Doctor" in conjunction with the appropriate licensure title in the majority of states. In states where the legal statutory language is unclear, your professional organization on a state or national level should be contacted to initiate appropriate legislative or interpretive action, so that you may confidently use the title you worked diligently to earn.

References
1. American Association of Colleges of Nursing. Commission on collegiate education moves to consider for accreditation only practice doctorates with the DNP degree title. 2005. Available at: http://www.aacn.nche.edu/Media/NewsReleases/2005/CCNEDNP.htm Accessed July 22, 2007
2. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003. Available at: http://www.nap.edu/catalog/10681.html Accessed July 22, 2007.
3. Pearson L. The Pearson Report. Am J Nurs Pract. 2007;11:2.
4. American Medical Association House of Delegates. Resolution 211 (A-06). June 13, 2006. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/471/211a06.doc Accessed July 22, 2007.
5. Center for Nurse Advocacy. Should we refer to physicians as "doctors"? Available at: http://www.nursingadvocacy.org/faq/nf/physician_vs_doctor.html Accessed July 22, 2007.