The reality of unreality Nurses weigh in about their portrayal in popular media

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1 July/August 2009 The Official Publicatio of the America Nurses Associatio ANA jois Presidet Obama at White House i call for health care reform By Joe Vallia ANA Presidet Rebecca M. Patto, MSN, RN, CNOR, ad two ANA urse members joied Presidet Barack Obama, Health Resources ad Services Admiistratio Admiistrator Mary Wakefield, PhD, RN, FAAN, ad select lawmakers July 15 at a evet i the White House Rose Garde to ecourage Cogress to pass meaigful health care reform this year. ANA was ivited by the admiistratio to show that America s urses, who are cosistetly raked as America s most trusted professioals i the aual Gallup poll, stad together with the presidet i his call for log-awaited chages to the coutry s health care system, chages that must iclude a public pla optio ad guarateed health care as a huma right for all. I am very pleased to be joied today by the represetatives of the America Nurses Associatio o behalf of 2.9 millio registered urses i America me ad wome who kow as well as ayoe the urget eed for health reform, Obama said i his opeig remarks. I a private meetig with the presidet before his address, ANA uderscored urses cocers that may America families are curretly fallig through the gaps i the system ad have limited access to health care, if they have ay access at all. The choice of a public health isurace pla optio would provide millios of idividuals ad families what they wat most access to affordable health care whe they eed it, Patto said. As a atio, we caot cotiue i good cosciece to allow families to go bakrupt or people to suffer with health problems ANA ad Marylad Nurses Associatio members Rebecca Wisema ad Keisha Walker (i blue scrubs, left to right), alog with ANA Presidet Rebecca M. Patto (behid Walker) supported Obama s efforts to eact health care reform at a White House Rose Garde evet July 15. uecessarily because they ca t afford treatmet, are deied health care, ad lack basic coverage or private isurace. A public pla optio must fill the large holes left by our curret health care system. I his speech, the presidet oted that he holds a log-stadig bias toward urses, which was formed through persoal iteractios durig the birth of his childre ad his daughter Sasha s treatmet for meigitis. I kow how importat urses are, ad the atio does too, Obama said. Nurses are t i health care to get rich; they re i it to care for all of us from the time they brig ew life ito this world to the momet they ease the pai of those who pass from it, he said. If it were t for urses, may Americas i uderserved ad rural areas would have o access to health care at all. That s why it s safe to say few uderstad why we have to pass reform as itimately as our atio s urses. ANA ad Marylad Nurses Associatio (MNA) member Keisha Walker, MSN, RN, who stood by the presidet as he made his remarks, oted the importace of havig urses be a part of the health care reform process. As patiet advocates, it is importat for urses to commuicate to Presidet Obama, Cogress, ad the public about our everyday patiet ecouters as health care legislatio is drafted, Walker said. Ultimately, urses seek to permaetly improve the health care eviromet so that all patiets have access to affordable, high quality See White House o page 16 * The reality of ureality Nurses weigh i about their portrayal i popular media By Susa Trossma, RN Most urses have a sese of humor ad uderstad the cocept of dramatic effect. That said, whe it comes to portrayig urses i televisio, films, ad commercials, the popular media ofte just get it plai wrog. Sometimes it s the little thigs, like how urses typically dress. Other times it s big, as i promotig commo stereotypes, most otably that urses are simply there to follow physicias orders or that they egage i sexual liaisos at work. So whe two ew cable televisio shows featurig urses as lead characters premiered this Jue, it got urses talkig about stereotypes, ethics, cliical skills, ad the potetial impact these programs could have o ursig s public image. The first to broadcast was Showtime s dark comedy, Nurse Jackie. It stars actress Edie Falco, formerly of The Sopraos, portrayig a paikiller-addicted ER urse with seemigly strog cliical skills ad her ow set of ethics. The secod was TNT s HawthoRNe, i which actress Jada Pikett Smith portrays the title character as a multi-taskig chief ursig officer who, at least i the first episode, works with staff urses who breach ethical stadards ad commo ursig protocols. I respose to these shows ad members subsequet outrage, ANA posted a call to actio protestig the egative portrayals of urses ad asked RNs to sed i letters of complait to the producers of both shows. ANA s cocer is that egative images, such as those i Nurse Jackie, erode the highly See Ureality o page 12 * Creatig healthy workplaces p.8 Staffig shortages permeate workplace p.13 ANA participates i health care rally p.16 For all the latest ursig ews, go to

2 Beefits ANA ad Help Protect Your Best Iterests Offers up to $2M/$4M idividual limits Covers voluteer ad part-time work Provides you with your ow attorey if you are amed i a malpractice lawsuit Employer-Sposored Pla 1 YES NO YES NO YES NO Reimbursemet for lost earigs while attedig a trial, hearig or arbitratio proceedig at the request of Chicago Isurace Compay Licesig Board Reimbursemet up to $5,000 for attorey fees ad other costs, expeses or fees, resultig from the ivestigatio or defese of proceedig before the etity that regulates your licese. YES YES NO NO Pays covered court costs ad settlemets i additio to liability limits Allows you to take your coverage with you if you leave your employer (Portability) Gives you four ways to save 10% o premiums YES YES YES If you were amed i a medical malpractice lawsuit today, would your employer-sposored liability coverage protect your best iterests? Probably ot. I fact, it s likely that your workplace pla is meat to serve as a group policy that covers all employees metioed i a lawsuit with limits that put your best iterests at risk. Here s why: Policy limits may ot be high eough to protect you ad all of your coworkers amed i a lawsuit. You may ot be provided coverage or reimbursemet for lost wage reimbursemet, costs associated with licesig board issues ad/or defese costs. You may ot be covered for services provided outside of the workplace, such as voluteer ad part-time work. Admiistered by Marsh Affiity Group Services, a service of Seabury & Smith, Ic., Isurace Program Maagemet. Uderwritte by Chicago Isurace Compay, a member compay of the Firema s Fud Isurace Compaies. NO NO NO The America Nurses Associatio gives you access to outstadig idividual coverage. Marsh is the oly Professioal Liability Program edorsed by the America Nurses Associatio (ANA). As the chart shows the Chicago Isurace Compay s coverage, it helps to esure that your best iterests are protected with limits up to $2,000,000 per icidet ad up to $4,000,000 per aual aggregate. That s twice as much coverage as offered by competitors without twice the cost! Receive a 10% Premium Credit Four Ways to Save You may be eligible to receive a 10% premium credit if you complete or participate i oe of the followig: 1. Atted four hours of approved loss prevetio/losscotrol/risk maagemet semiars 2. Hold a approved certificatio 3. Employmet at a Maget Hospital 4. Employmet i a uit that has received the AACN Beaco Award for Critical Care Excellece Get a o-obligatio quote ad apply for istat proof of coverage. 2 Visit or call to speak with a professioal liability represetative today. Limits ad rates may vary by state. 1 Based o compariso with radomly selected employer pla CA# Pedig uderwritig approval d/b/a i CA Seabury & Smith Isurace Program Maagemet (5/09) Seabury & Smith, Ic. 2009

3 Nurses are leaders ad deserve to be recogized As ANA presidet, oe of the most ejoyable activities that I get to do is participate i programs wherei we hoor the outstadig idividuals i our professio. As you kow, beig a urse is oe of the most challegig jobs ayoe ca fulfill. At ANA, we are tremedously proud of all urses, but there are certai idividuals amog us whose actios truly go above ad beyod the call of duty. Their iovatio, determied commitmet to make thigs better, ad edless effort to make a differece serve as a ispirig example to us all. ANA takes pride i idetifyig the special achievemets of these urse leaders through its Natioal Awards program. The program highlights the accomplishmets of these idividuals ad, by extesio, focuses attetio o ursig s vital work. The award process culmiates i recogizig these accomplishmets at a special receptio held i their hoor at the 2010 House of Delegates. The ANA awards program is a importat part of our orgaizatioal life ot oly because it recogizes the accomplishmets of idividuals, but also because it says much about ANA itself. It speaks to our values. There are 14 atioal awards that cover a wide rage of ursig activities. The awards reflect may of the roles ad practice settigs i which urses are ivolved. Awards like those that carry the ames of ursig lumiaries such as Pearl McIver ad Luther Christma, show that we care deeply about areas ragig from public health to me i ursig. Oe award, i particular, is especially recogized: the ANA Hall of Fame award. Located i a hallowed hallway at ANA headquarters i Silver Sprig, MD, the Hall of Fame features idividual photographs of each recipiet of ANA s top award. It is a powerful ad ispiratioal experiece to see the photos of these idividuals, all of whom have made a life-log commitmet to the field of ursig. The award, established i 1976, recogizes their impact o the health ad social history of the Uited States, ad represets the piacle of ursig achievemet. Save the Date Upcomig evets September 30, 2009 ANCC Research Symposium Louisville, KY October 1-3, ANCC Natioal Maget Coferece Louisville, KY Jauary 20-22, th Aual NDNQI Coferece New Orleas, LA Jue 16-19, ANA House of Delegates Washigto, DC Presidet s Perspective Now is the time for you to cosider which of your deservig colleagues to omiate for oe or more of these prestigious awards. The omiatio process is simple, ad omiatios ca be made by ay ANA member. To make a omiatio fill out a omiatio packet, which ca be foud at ad forward it to your costituet member associatio (CMA) for cosideratio. The CMA official submitter will the forward the omiatio to ANA. All omiatios will be reviewed by members of the Committee o Hoorary Awards ad its subcommittees. Recommeded cadidates are the set to the ANA board of directors for fial approval. The ANA Hall of Fame features idividual photographs of each recipiet of ANA s top award. If you are a presidet or desigee of ANA s CMAs, orgaizatioal affiliates, or structural uits, you have bee amed as the official submitters for omiatios ad, as such, play a most importat role i the awards program. Keep i mid that this year we are ecouragig official submitters (CMA/ANA/Idividual Member Divisio (IMD) presidets or desigees, Cogress o Nursig Practice ad Ecoomics, labor, ad workforce advocacy affiliates presidets or desigees) to submit omiatio packets electroically. Nomiatio forms ad supportig documets ca be set via . The Call for Natioal Award Nomiatios cotais specific iformatio about the process ad importat deadlies for the submissio of omiatios. It ca be foud at Program.aspx. If you have ay additioal questios, cotact Debra Evas, seior goverace specialist, at (301) or Our ethusiastic, collective support for the atioal awards program will tell others what we as ANA members value. Hoorig a idividual with a ANA award is the best way to show appreciatio ad recogitio for their cotributios, so please joi us i recogizig our most deservig urse leaders. DEPARTMENTS Presidet s Perspective... 3 I Brief... 4 Shift Report... 8 As the Web Turs CE Corer Doatios at Work Media Briefs Political Nurse Volume 41, No. 4 (ISSN ) Published bimothy: Jauary/February, March/April, May/Jue, July/August, September/October, ad November/December. Copyright 2009 by the America Nurses Associatio, 8515 Georgia Aveue, Suite 400, Silver Sprig, MD , (301) Views expressed herei are ot ecessarily those of ANA. The publisher reserves the right to accept or reject advertisemets for The America Nurse. All advertisers i this publicatio must employ without regard for age, color, creed, disability, geder, health status, race, religio, lifestyle, atioality, ad sexual orietatios. Chief Executive Officer Marla J. Westo, PhD, RN Director of Commuicatios Laura Diamod Asst. Director, Periodicals Joe Vallia Seior Reporter Susa Trossma, RN Productio/Graphic Desig Christy Carmody Circulatio/Subscriptios America Nurses Publicatio Ceter, (800) Director of Marketig Betty Whitaker Advertisig Sales Toy Ward, (301) Presidet Rebecca M. Patto, MSN, RN, CNOR 1st Vice Presidet Debbie Hatmaker, PhD, RN, SANE-A 2d Vice Presidet Coleee Kim Armstrog, BSN, RNC Secretary Susa Foley Pierce, PhD, RN Treasurer Marily Sulliva, DSN, RN, LNC, CPE Directors Cythia Balkstra, MS, APRN, BC Barbara Crae, RN, CCRN Kare A. Daley, MS, MPH, RN, FAAN Jacquelie Edwards, BSN, RN Lida Gobis, JD, RN, FNP Lida M. Gural, RN, CCRN Carrie Houser James, MSN, RN, CNA, BC, CCE Florece Joes-Clarke, MS, RN Mary A. Marylad, PhD, APRN,BC, ANP Julie Shuff, RN, CCRN Margarete L. Zalo, PhD, RN, ACNS-BC Editorial Advisory Board Cythia Balkstra, MS, APRN, BC Julia Rose Barcott, RN Nia Boardma, BSN, RN Diae Daddario, MSN, ACNS-BC, RN, BC, CMSRN Teresa Hollad, MSN, RN, PMHCNS-BC Jacquely Reid, MSN, RN, CNM Julie Staik-Hutt, PhD, ANCP, CCNS, FAAN David Whitehor, BSN, RN, CCRN Address editorial commet ad iquiries to Editor, The America Nurse, 8515 Georgia Aveue, Suite 400, Silver Sprig, MD or, via , Postmaster: Sed address chages to The America Nurse, Cetral Billig, America Nurses Associatio, 8515 Georgia Aveue, Suite 400, Silver Sprig, MD Subscriptio to The America Nurse is icluded with membership i a state urses associatio ad ANA direct membership. Subscriptio rate for omembers, $20 per year; for full-time ursig studets, $10 per year. Subscriptios begi approximately six to eight weeks after receipt of paymet. Idexed by: Iteratioal Nursig Idex; Cumulative Idex to Nursig ad Allied Health Literature; Hospital Literature Idex of the America Hospital Associatio. Circulatio: 130,000 The America Nurse is available i microform from Uiversity Microfilms Iteratioal, 300 North Zeeb Road, A Arbor, Mich Periodicals postage paid at Silver Sprig, MD, ad additioal mailig offices. ANA is a equal opportuity employer. The publicatio of ay advertisemet i The America Nurse is either a edorsemet of the advertiser or of the products or services advertised. July/August 2009 The America Nurse 3

4 I Brief ANA, TNA, speak out agaist wrogful prosecutio of Texas urses ANA ad the Texas Nurses Associatio (TNA) are speakig out agaist the recet idictmet ad prosecutio of two RNs i Wikler Couty, TX, for reportig to the state medical board their cocers about a physicia s stadard of practice at a west Texas hospital. ANA ad TNA are gravely cocered about the chillig effect the couty s actios could have o future urse whistle blowers who advocate for their patiets i the atio s hospitals. A iitial hearig o the urses motios to dismiss the case was held July 15 i the Wikler Couty Courthouse, but o ruligs were made. TNA aouced that it has established the TNA Legal Defese Fud for the Wikler Couty urses, with a goal of raisig at least $10,000 for their defese. TNA plas to match every dollar cotributed by idividual urses up to $5,000. TNA ad ANA call o all urses to cotribute to the fud. To make a doatio, please visit ANA wats Wikler Couty to kow the world is watchig we will be moitorig this case closely i the hope that the apparet abuse of prosecutorial discretio will be corrected, said ANA Presidet Rebecca M. Patto, MSN, RN, CNOR. It is outrageous to file crimial feloy charges agaist these urses based o allegatios that they raised cocers over a physicia s actios. This udermies oe of the basic teets of the Code of Ethics for Nurses RNs have a duty to advocate for the health ad safety of their patiets, ad that is what these urses were doig. Wikler Couty Memorial Hospital urses Ae Mitchell, RN ad Vicki Galle, RN, were charged with violatig the law by sedig a aoymous letter to the Texas Medical Board that expressed cocer about a physicia at the hospital i Kermit, TX. After receivig a complait of harassmet from the physicia, the Wikler Couty Sheriff s Departmet iitiated a ivestigatio that resulted i crimial charges agaist both urses. Because the two urses worked for a couty hospital, the Couty Attorey s office idicted them o misuse of official iformatio a third-degree feloy that carries potetial pealties of two- to 10-years imprisomet ad a maximum fie of $10,000. The urses report to the board icluded oly medical record umbers of the patiets. Mitchell ad Galle, both log-time urses at the hospital, were fired from their positios. ANA ad TNA believe the law is beig misiterpreted to wrogly prosecute Mitchell ad Galle as puishmet for filig a complait agaist a physicia. No urse should be pealized because he or she is advocatig for patiet safety, said TNA Executive Director Clair B. Jorda, MSN, RN. The ursig professio is stadig behid these two urses right ow. The state medical board has writte a letter to the Wikler couty ad district attoreys statig that it is improper to crimially prosecute people for raisig complaits with the board; that the complaits were cofidetial ad ot subject to subpoea; ad that uder federal law the board is exempt from Health Isurace Portability ad Accoutability Act (HIPAA) requiremets. Therefore there was o violatio of ay HIPAA laws. ANA provides testimoy o health care reform Doa Policastro, RNP, executive director of the Rhode Islad State Nurses Associatio (RISNA), testified o behalf of ANA Jue 24 before the House Ways ad Meas Committee o health care reform. I her testimoy, Policastro stressed urses willigess to work with policy makers, idustry leaders, providers, ad cosumers to support ad advace meaigful health care reform. She thaked the committee for recogizig the eed for a itegrated ad well-resourced atioal health care workforce policy, a system that focuses o welless ad prevetio, ad a high-quality public health isurace optio that complemets ad competes fairly with optios offered by private isurers. She also remarked o the valuable role advaced practice registered urses play i primary care, ad the importace of recogizig urse practitioers as providers i medical homes. I additio to her leadership role at RISNA, Policastro is a member of the ANA-PAC Board of Trustees. To read Doa Policastro, RNP, testifyig o Capitol Hill. Policastro s complete testimoy, go to aspx. New Jersey urse receives Nightigale medal New Jersey State Nurses Associatio member Susa B. Hassmiller, PhD, RN, FAAN, is oe of three U.S. urses selected as the 2009 wiers of the 42d aual Florece Nightigale Medal, a distiguished award that represets the highest iteratioal hoor bestowed by the Iteratioal Committee of the Red Cross (ICRC) i ursig. Preseted every two years sice 1920 by the ICRC, the Florece Nightigale Medal is awarded to urses ad voluteer aides who have demostrated extraordiary courage to help the wouded, sick, or disabled, as well as civilia victims of armed coflict or disaster i times of war or peace. Dr. Susa Hassmiller is a log-time ANA member ad exceptioal urse who truly exemplifies the Susa Hassmiller best of the ursig professio, said ANA Chief Programs Officer Mary Jea Schuma, MSN, MBA, RN, CPNP. ANA commeds Dr. Hassmiller for her uwaverig dedicatio, compassio, ad cotributios o behalf of people i eed. She is a true humaitaria ad a atioal urse leader i disaster preparedess. Hassmiller recetly served a six-year term as a member of the Natioal Board of Goverors for the America Red Cross, servig i the role of chair of the Disaster ad Chapter Services Committee. As a voluteer for the orgaizatio sice college, Hassmiller has bee ivolved i Red Cross disaster relief efforts i the Uited States ad abroad, icludig toradoes i the Midwest, Hurricae Adrew, September 11th, the 2004 Florida hurricaes, Hurricae Katria, ad the tsuami i Idoesia. She also serves as seior adviser to the orgaizatio o ursig ad disaster programmig, is the chair of the 9/11 Recovery Program ad serves o the board of the Cetral New Jersey Red Cross. Hassmiller is curretly a seior adviser for ursig with the Robert Wood Foudatio, where she leads the foudatio s strategies to address the urse ad urse faculty shortages i a effort to create a higher quality of patiet care i the Uited States. Global survey: Patiets pay price for isufficiet staff, high urse workloads Nurses believe that heavy workloads ad isufficiet staff are impactig patiet care ad health outcomes aroud the world, accordig to research preseted July 1 at the Iteratioal Coucil of Nurses (ICN) 24th Quadreial Cogress i Durba, South Africa. The results are part of a extesive global attitudial survey, which asked more tha 2,000 urses about the challeges ad opportuities that urses face. ANA applauds ICN s efforts to collect comprehesive, represetative data from aroud the world i a attempt to better uderstad how urses view their professio ad work eviromets, as well as the opportuities ad challeges that face urses ad their professio, said Alice Bodley, ANA geeral cousel. These global umbers ad, i particular, the fidig for urses i the U.S., make clear that ow is the time to esure that urses perspectives ad cotributios to health care are uderstood ad fully valued by all. ICN Chief Executive Officer David Beto said, Nurses represet the largest group of health care providers i the world. We are kee to better uderstad urses views of their work ad the eviromets i which they practice across the world. These results will iform the Positive Practice Eviromet campaig ICN ad parters are implemetig to improve the practice eviromet ad with it the quality of care. ICN ad Pfizer Ic. Exteral Medical Affairs collaborated o a global represetative survey of 2,203 urses i 11 coutries, icludig Brazil, Caada, Colombia, Japa, Keya, Portugal, South Africa, Taiwa, Ugada, the Uited Kigdom, ad the Uited States. The survey was coducted by APCO Isight. The survey fids that ie i 10 urses (92 percet) face time costraits that prevet them from spedig eough time with idividual patiets as they thik ecessary. Nearly all urses surveyed (96 percet) say that spedig more time with idividual patiets would have a sigificat impact o patiet health. Nurses are key patiet advocates ad have always bee patiet-focused, said Paula DeCola, MSc, RN, from the office of the Chief Medical Officer at Pfizer, Ic. Exteral Medical Affairs. The research shows that for urses, the most favorable aspect of their professio is ideed patiet cotact. This survey supports the research of Dr. Lida Aike at the Uiversity of Pesylvaia urses perceive that iadequate staffig ad high workloads are havig a egative impact o the quality of care patiets receive. Other key fidigs from the research provide a glimpse ito the challeges urses face, ad opportuities for improvemet: See I Brief o page 5 * 4 July/August 2009 The America Nurse

5 Nearly half of urses (46 percet) say their workload is worse today compared to five years ago, potetially impactig the quality of patiet care. Nurses are most cocered with heavy workloads (42 percet), isufficiet pay ad beefits (22 percet), a lack of recogitio for their work (15 percet) ad too much bureaucracy (13 percet). The best part of their professio is helpig patiets; urses are most likely to say that patiet cotact (37 percet) is the most favorable aspect of their work experiece. Nursig as a career is viewed as worse today tha it was five years ago i Caada (52 percet), the U.S. (46 percet), Taiwa (45 percet), ad the UK (39 percet); however urses i Keya (71 percet), Brazil (64 percet), ad South Africa (63 percet) are more likely to see their roles improvig over this time. More iformatio about the survey ad the methodology ca be foud at: www. Strategies to boost vacciatio amog health care workers I Brief Cotiued from page 4 To help health care orgaizatios improve the rate of health care worker iflueza vacciatios, The Joit Commissio is releasig a moograph Providig a Safer Eviromet for Health Care Persoel ad Patiets Through Iflueza Vacciatio: Strategies from Research ad Practice. The moograph, which was supported by a educatioal grat from Saofi Pasteur, is the result of the project Strategies for Implemetig Successful Iflueza Immuizatio Programs for Health Care Persoel, a 10-moth collaboratio amog The Joit Commissio, the Associatio for Professioals i Ifectio Cotrol ad Epidemiology, Ic., the Ceters for Disease Cotrol ad Prevetio (CDC), the Society for Healthcare Epidemiology of America, ad the Natioal Foudatio for Ifectious Diseases. The moograph icludes iformatio about seasoal iflueza ad the iflueza vaccie, barriers to successful programs ad strategies for overcomig them, ad examples of successful iitiatives orgaizatios have used to improve their iflueza vacciatio rates. Health care worker flu vacciatio rates have bee less tha optimal for years, ad the vacciatio rate is still below 50 percet, said Jerod M. Loeb, PhD, executive vice presidet, Divisio of Quality Measuremet ad Research, The Joit Commissio. Orgaizatios are eager to fid ways to ecourage their employees to get vacciated. Ad accordig to the CDC, vacciatio coverage of health care persoel remais low despite the documeted beefits o patiet outcomes, staff abseteeism, ad reductio of ifectios amog staff. I additio, icreased vacciatio rates ca reduce costs withi health care orgaizatios. I 2007, The Joit Commissio implemeted a ew stadard i hospitals ad log term care facilities requirig that iflueza vacciatios be offered to staff ad practitioers. Electroic copies of the moograph are available free of charge o The Joit Commissio s Web site at Ad for more iformatio o H1N1, go to ANA s Web site, for up-to-date iformatio o curret outbreaks, vaccie productio, cliical guidace for H1N1 care ad treatmet, as well as resources for urses iterested i respodig as voluteer health providers. Recessio temporarily easig ursig shortage The recessio may temporarily ed a 11-year-log ursig shortage i may areas of the coutry, accordig to a ew study released by the health policy joural, Health Affairs. However, this is oly a respite for the atio s health care system, as the study also projected a ursig shortage of 260,000 RNs developig by 2025 a shortage twice as large as ay ursig shortage experieced sice the itroductio of Medicare ad Medicaid i the mid-1960s. The study was authored by Peter Buerhaus, PhD, of Vaderbilt Uiversity Medical Ceter ad Vaderbilt s School of Nursig; David Auerbach, PhD, of the Cogressioal Budget Office; ad Dartmouth Ecoomics Professor Douglas Staiger, PhD. It focused o assessig the impact of the recessio o curret urse employmet, ad o projectios of the future age ad supply of RNs i the Uited States. Accordig to the study, durig the curret recessio, hospital employmet of full-time equivalet RNs icreased by 8.6 percet, well above the 5.3 percet average icrease durig the previous four ecoomic bust periods startig with the 1981 recessio. From 2007 to 2008, RN employmet i hospitals icreased by a estimated 243,000 full-time positios. The icrease i hospital employmet of early 250,000 RNs i such a short period of time is stuig, said Buerhaus, a Teessee Nurses Associatio member. While we expected a icrease i employmet, we were surprised by the magitude ad by the shift from o-hospital settigs ito the hospitals. This surge i employmet will ease, if ot ed, the hospital ursig shortage. Cosequetly, we aticipate it will be temptig for employers ad policymakers to focus o other issues. However, relief is likely to be temporary ad we eed to focus o how the curret workforce is chagig ad the implicatios for future imbalaces i the urse labor market i the years ahead. To back up this claim, the study foud that the recessio had iduced older urses to delay retiremet ad others to re-eter the workforce. Sice 70 percet of RNs are married, may had little choice as spouses lost their jobs or feared that they might. However, betwee 2001 ad 2008, 77 percet of the icrease i total RN employmet was accouted for by RNs over the age of 50, the age group that is growig the fastest amog professioal ursig. I the log-term, the study poits to the developmet of aother ursig shortage, oe that will be larger tha ay experieced i the past. Because RNs over age 50 will soo be the largest age group i the ursig workforce, their retiremet over the ext decade will lead to a projected shortfall developig by 2018 ad growig to approximately 260,000 RNs by The authors urge employers ad policymakers to look closely at several issues they believe will lesse the severity of a future ursig shortage, specifically: Improvig the ergoomic eviromet of the cliical workplace to keep older urses from beig ijured o the job ad icrease retetio. Coductig research o patiet outcomes ad safety to determie if policies are eeded to improve commuicatio skills amog U.S. ad iteratioally-educated RNs. Ecouragig the Istitute of Medicie to coduct a aalysis to determie the structural barriers that restrict ursig educatio capacity. Assess private ad public sector optios that will be most effective ad iexpesive i expadig capacity quickly. Promotig ursig careers to me ad Latios, who are curretly uderrepreseted i the ursig workforce. The study, The Recet Surge i Nurse Employmet: Causes ad Implicatios, ca be reviewed i its etirety i the Jue 12 olie issue of Health Affairs at www. Program aims at metorig ew urse faculty Sigma Theta Tau Iteratioal Foudatio for Nursig has bee awarded a $200,000 grat by The Elsevier Foudatio to support a ew Nurse Faculty Metored Leadership Developmet (NFMLD) pilot program focused o retaiig ad buildig the ext geeratio of urse faculty. The program, which will be admiistered by Sigma Theta Tau Iteratioal s (STTI) Iteratioal Leadership Istitute, will help alleviate the urse faculty crisis See I Brief o page 11 * Sig up for disaster respose ow ANA supports Presidet Obama s Uited We Serve campaig, lauched Jue 22, ad urges the atio s 2.9 millio RNs to be disaster ready by takig actio ow ad sigig up with oe of the may disaster registries ad respose orgaizatios that already exist. Created as part of the Serve America Act, siged ito law April 21, the Uited We Serve campaig calls o all Americas to make a focused effort to voluteer i their commuities over the ext three moths, culmiatig i a Natioal Day of Service ad Remembrace o Sept. 11, The Uited We Serve iitiative ecourages Americas to play a active role i the atio s ecoomic recovery by steppig up to voluteer i service projects at this critical time i our atio s history, whe help is eeded ad resources are stretched thi. I the aftermath of Hurricae Katria ad the icrease i the level of the pademic alert of the H1N1 flu virus, ow more tha ever it is critical that urses heed the call to serve by sigig up o atioal disaster registries, said ANA Presidet Rebecca M. Patto, MSN, RN, CNOR. ANA strogly believes that i order to respod effectively, ow is the time for urses to get prepared ot whe the disaster occurs, but before it strikes. By joiig a disaster respose registry, RNs licesure ca be pre-verified ad validated; they will have access to disaster traiig ad drillig; ad durig a disaster, they will be deployed through a recogized system that has bee icorporated ito the local, state, ad atioal respose plas. For more iformatio o the Uited We Serve effort, go to July/August 2009 The America Nurse 5

6 The proof is i the data Fidigs bolster urses stace that RN care makes a differece By Susa Trossma, RN Years ago whe battlig staffig cuts, just about all RNs had were aecdotes about why their ursig care mattered. But times have chaged, ad ow there is a solid foudatio of data showig that factors like the umber of RNs, skill mix, ad experiece level of staff o a hospital uit play a sigificat role i patiet outcomes. Ad that evidece keeps buildig, as revealed at the Natioal Database of Nursig Quality Idicators (NDNQI ) coferece ad through other research efforts. Held earlier this year, the ANAhosted atioal coferece icluded two presetatios spotlightig ew fidigs o RN ad LPN staffig levels ad patiet falls. I this ecoomic climate, it s icreasigly importat to demostrate with data the value we brig as RNs, said Isis Motalvo, MS, MBA, RN, director of ANA s Natioal Ceter for Nursig Quality (NCNQ ). Through these presetatios we re fidig oce agai that havig more RNs o a uit has a positive impact o patiet outcomes. NDNQI is a system developed by ANA that eables hospitals to collect ad evaluate ursig-sesitive idicators icludig urse turover, skill mix, pressure ulcers, ad osocomial ifectios all with a eye toward improvig patiet care. Makig the case for RNs Eilee Lake, PhD, RN, FAAN, associate director at the Uiversity of Pesylvaia School of Nursig s Ceter for Health Outcomes ad Policy Research ad Pesylvaia State Nurses Associatio member, has bee iterested i how staffig iflueces patiet outcomes for some time. Ad she credits ANA for developig the ursig sesitive idicators i the mid- 1990s to aid i research o staffig ad quality. As a urse, I kow that ursig practice our presece ca have a direct effect o prevetig adverse outcomes, such as falls ad pressure ulcers, Lake said. Those adverse evets are the focus of two ew studies she s leadig. I oe study beig published later this year, Lake ad her team have foud that addig a additioal hour of RN care reduced the likelihood of patiet falls by a small percetage. I cotrast, slightly icreasig LPN hours resulted i a small rise i patiet falls. Historically, hospital executives have looked at reducig the umber of RNs ad substitutig them with lesser skilled staff as a way to cut costs, accordig to Lake. Without presetig evidece that shows RN care matters, we give maagemet free rei to make those chages, she said. These prelimiary fidigs, however, show that it s ot about bodies, but rather the type of care provider, Lake said. RNs have the capacity to perform iitial assessmets o patiets, idetify risks for patiet falls, ad iitiate fall prevetio protocols. Ad if there are eough RNs o staff, they ca sped more time with each patiet, as well as carry out their importat surveillace role, gai a accurate ad more complete cliical picture of the patiet, ad fie-tue plas of care. Lake s study also has revealed that Maget hospitals experiece fewer patiets falls tha o-maget hospitals. This data ca help urses build their case for pursuig Maget status. Further, it gives urse executives more evidece that ca allow them to marshal more hospital resources to improve RN staffig ad quality care. Lake emphasized that hospitals participatig i NDNQI already are qualityorieted, so the effects of RN care o patiet falls are most likely uderestimated. As for her ogoig projects, Lake ext plas o examiig cost savigs associated with fall prevetio to see if they offset the cost of icreased staffig. Ad she is just begiig to look at the effect of RN staffig o the icidece of pressure ulcers. Aalyzig the pressure ulcer data is more complex because of the magitude ad richess of iformatio collected through NDNQI, she said. Balacig skill mix, improvig outcomes RNs at St. Athoy Medical Ceter i Rockford, IL, have always valued their LPN colleagues, may of whom have substatial expertise ad years o staff, accordig to Ae Hammes, RN, MS, RN, NEA-BC, director of ursig operatios at St. Athoy ad a Illiois Nurses Associatio member who helped craft ANA s Priciples for Nurse Staffig. However, give the icreasig complexity of ipatiet care, potetial legislatio requirig specific RN-to-patiet ratios, ad passage of a staffig by acuity law, hospital maagemet decided i 2006 to reexamie its staffig patters. Hammes shared those fidigs i her NDNQI coferece presetatio, LPNs ad the Nursig Workforce: Preparig for Legislative Madates, as well as chages i staffig patters the hospital subsequetly implemeted. What we foud is that we had a umber of LPNs o surgical uits, ad that we were ot meetig the skill mix stadards of other commuity hospitals, Hammes recetly said. Of particular cocer was the orthopedic surgical uit, where six LPNs, each with betwee 25 to 32 years of teure, were employed. O that uit, the umber of RN hours per patiet day i 2006 was 4.41, below the atioal mea of 5.47 reported by NDNQI hospitals for uits of similar type ad size. Coversely, the umber of LPN hours per patiet day o the ortho uit was 1.23, more tha double the 0.6 atioal compariso. Give that staffig mix, the hospital would ot have met the madated ratio of 1 RN to 4 patiets o med-surg uits as proposed i Illiois legislatio at that time. So Hammes recommeded that St. Athoy use oly RNs to fill the core uit positios ad shift LPNs ito the float pool, where they d be deployed equitably i a supplemetal staff role to all the uits. Oce the ew staffig patter was implemeted i 2007, Hammes agai examied how her facility ad the ortho uit i particular compared with other facilities atiowide usig NDNQI data from 2006 ad She foud that the total RN hours were ow 5.75 o the ortho uit, slightly above the atioal mea. Ad the icreased RN staffig revealed a uexpected fidig: The umber of total patiet falls had decreased from 5.13 per 1,000 days i 2006 to 1.16 i O a ortho uit, we expect a certai umber of falls eve with prevetio iitiatives i place, Hammes said. But seeig that decrease was a real aha momet for me. It showed that RNs astuteess ad assessmet skills allow them to pick up o ay sigs or chages that could put a patiet at icreased risk for falls. (The fall rate is moitored as part of the staffig effectiveess data to assure that the improvemet cotiues.) Beyod that study, Hammes reported that RNs also are more likely to act o subtle chages i patiet coditios much sooer tha LPNs, icludig callig the hospital s rapid respose team. As for RNs ad LPNs view of the staffig pla chage, both have viewed it geerally as positive. The LPNs feel good because they are still cotributig ad workig withi their scope of practice, Hammes said. We also gave them additioal traiig, which they liked, ad a 10 percet salary icrease, which was the differetial for all supplemetal staff. RNs also feel their patiet assigmets have improved, which was supported by the NDNQI RN Satisfactio Survey data from sprig We used to thik that the post-surgical populatio was pretty routie ad predictable. But care is more complicated ow, so the critical thikig ad decisio-makig skills of RNs are eeded. We really wated the right care-givers to match patiets eeds, ad I believe we ow have a better staffig aligmet. As for madated ratios, Hammes expects legislatio to be re-itroduced this year. Stretchig RN staff thi Christie Kover, PhD, RN, FAAN, is a professor ad log-time ursig workforce researcher at New York Uiversity ad a New York State Nurses Associatio member who also helped develop ANA s staffig priciples. Oe of her early studies, Nurse Staffig Levels ad Adverse Evets Followig Surgery i U.S. Hospitals, published i 1998, revealed that icreasig RN care by oe hour per patiet day resulted i early 10 percet fewer post-op patiets cotractig uriary tract ifectios ad 8 percet fewer patiets with peumoia. But RNs cotiue to be taxed whe it comes to their patiet-load ad ability to See RN care o page 13 * 6 July/August 2009 The America Nurse

7 Pre-coferece Report: ANCC s Upcomig Natioal Maget Coferece By Mary Golway, MS, BSN RN-BC The Maget Recogitio Program of the America Nurses Credetialig Ceter (ANCC) showcases health care orgaizatios for their excellece i ursig practice. There are more tha 300 Maget-recogized orgaizatios i the Uited States ad three iteratioally. Whe U.S. News & World Report showcases America s Best Hospitals aually, Maget recogitio cotributes to the total score for quality of ipatiet care. Of the hospitals listed o the exclusive 2008 Hoor Roll rakigs (July 10, 2008), seve of the top 10 were Maget hospitals. The oly official Natioal Maget Coferece is sposored by ANCC, ad takes place from Oct. 1 to 3 i Louisville, KY. There will be more tha 5,000 attedees gathered i celebratio of ursig excellece. These health care professioals from aroud the world share ad lear the latest treds i cliical practice, leadership, ad research. Pre-coferece, pleary, cocurret, ad poster sessios will be icluded. The heart ad soul of ursig are also explored through art, film, ad a variety of exhibits. Creatig a future of excellece Attedees at this year s coferece will hear the latest iformatio o the prestigious Maget Recogitio Program directly from those who admiister it. Maget Director Kare Drekard, PhD, RN, NEA-BC, CPHQ, Commissio o Maget members, ad members of the ANCC staff will host a iteractive sessio about this recogitio program, ad about the quest for ursig excellece. Participats will be able to have their questios aswered firsthad by Maget program experts. Pre-coferece research symposium ANCC is excited to lauch its first research symposium Sept. 30. Offered the day before the Maget coferece opeig, it will feature Margaret McClure, EdD, RN, FAAN as a speaker. McClure was oe of four pioeers i the area of research to support Maget. The ANCC Research Symposium is aimed at advacig research topics that help uderstad the impact of professioal ursig practice eviromets i health care orgaizatios. The ifluece of these eviromets o patiet, workforce, ad orgaizatioal outcomes will be explored. This symposium will provide a veue for researchers to share ad discuss their latest fidigs. Researchers, as well as urse executives, iterdiscipliary health team members, ad other cliicias are ecouraged to atted. Pre-coferece leadership sessio Also ew i 2009, ANCC will offer a precoferece sessio to help ursig leaders develop a professioal practice model for their orgaizatio. This is a challegig, yet critical aspect of becomig a Maget orgaizatio. Oce itegrated ito the culture of a health care orgaizatio, the professioal practice model provides a framework for decisio makig ad creates a guide for practice. Participats will lear the compoets of a professioal practice model, ad how it differs from a care delivery model, ad will explore various applicatios of implemetig a professioal practice model withi a orgaizatio. Maget coferece geeral sessios Opeig Pleary - Maagig Iovatio: Tom Kelly, geeral maager, IDEO Kelly is atioally recogized as a iovator ad will discuss his experieces maagig iovatio. IDEO is a award-wiig firm, which developed the Apple mouse, the Palm V, ad hudreds of other cuttig-edge products ad services. Curret ad Future Treds i the Nursig Workforce: Peter Buerhaus, PhD, RN, FAAN Buerhaus is a iteratioally reowed leader, health care ecoomist, ad distiguished professor of ursig at Vaderbilt Uiversity Medical Ceter. Usig the latest data, Buerhaus will discuss how the recessio impacts the employmet ad earigs of RNs. He will also provide updated key demographic iformatio about the chagig ursig workforce. Curret ad relevat Iformatio about the impact of the recessio o the RN workforce also will be discussed. Participats will lear recommedatios for policy makers ad health care orgaizatios o stregtheig the curret ad future RN workforce. ANCC will offer, for the first time i 2009, olie access to coferece recordigs for all attedees. Through the Maget Coferece Live Learig Ceter, sessios will be captured as multimedia recreatios with sychroized slides, hadouts, ad more. Free olie access to geeral sessio recordigs, posters, ad sessios uder the research track will be icluded with Maget coferece registratio. Olie access to sessios uder the cliical practice ad leadership tracks may be added to registratios for a omial fee. For more iformatio ad to register for the 2009 Natioal Maget Coferece, visit Mary Golway is the maager of the ANCC Istitute for Credetialig Iovatio. Stregth. Rewards. Support. The NEW ANA Platium MasterCard Ear 1 poit for every $1 spet Redeem your poits for cash, gift cards, travel, ursig-specific rewards ad more Holdig Hads Low itroductory rate, plus o aual fee Powerful Platium MasterCard beefits Support the ursig professio Heart Three uique card desigs Visit or call to apply today! ANA Logo Rewards apply oly to et card Purchases o the Card. Balace Trasfers, Cash Advaces ad Fiace Charges are ot eligible for Reward Poits. A miimum of 2,500 poits is eeded i order to redeem. Poits expire 60 moths after applied to your accout. See your Rewards Program terms for more details. These beefits are provided by MasterCard, ot GE Moey Bak. For details, see your MasterCard Guide to Beefits which will be eclosed with your ew card. Credit issued by GE Moey Bak. July/August 2009 The America Nurse 7

8 Creatig healthy workplaces ad gettig recogized for it Shift Report By Susa Trossma, RN Teamwork is a cocept log held dear by urses, but oe that is ot always put ito practice i today s rapid-paced health care facilities. But there are workplaces i North Carolia where it s alive ad well ad literally celebrated. To recogize idividual uits ad hospitals that promote positive workplace attributes, the North Carolia Nurses Associatio (NCNA) bega its Hallmarks of Healthy Workplaces Program i Durham Regioal Hospital s Edoscopy Services uit is oe of the 17 curret recipiets to have garered this recogitio. Of all the places I ve worked, this is the most team-orieted uit, said Gary O Briat, RN, a staff urse i Edoscopy Services. Everyoe pitches i ad supports each other whe we are busy. Our urse maager helps ad always kows what is goig o i the uit. Ad I really ejoy comig to work, which is ot somethig all urses ca say. So what does it take to get what NCNA calls its seal of approval? The hallmarks of the program With the ursig shortage i full swig, NCNA brought together a statewide, multi-orgaizatioal work group to determie what could be doe to recruit ad retai urses. The work group looked at the various factors that lead to a positive workplace, said Ashley Tratham, director of Hallmarks Admiistratio ad Developmet. Based o their fidigs, NCNA created the Hallmarks program, which brigs attetio to those factors ad highlights workplaces that are goig a good job. To be cosidered a Hallmarks healthy workplace, cadidates must show they meet certai criteria. They iclude: Actively respodig to employee cocers ad promotig a culture that views employees as powerful, skillful, kowledgeable, competet, ad solutio-orieted. Providig opportuities for urses to expad kowledge, skills, ad competecies. Maitaiig employee skill mix appropriate for patiet eeds. Promotig employee health ad well-beig. Iitiatig iovatios to improve service ad the work eviromet. Providig orietatio for ew employees, supportig metors ad preceptors, ad skill-buildig for maagers to esure they are effective. Hallmarks recogitio is ope to hospitals, idividual uits, schools of ursig, home health agecies, ad ay site where three or more RNs work or voluteer throughout the state. Its focus is o the frotlie staff s workplace experiece. (For more program details, go to Several of the curret Hallmarks desigees, icludig Durham Regioal ad Duke Raleigh hospitals, also are Maget facilities, which meas the America Nurses Credetialig Ceter has determied they ve demostrated excellece i ursig practice. The sushie uit Marya Petrosky, RN, is the urse maager of oe of Durham Regioal s two Hallmarks-desigated uits, Edoscopy Services, which is kow throughout the hospital as the sushie uit. Whe asked why her uit works, Petrosky poited to the staff. We have a lot of good idividuals, Petrosky said. We are a very fast-paced uit that would t fuctio well if we did t have teamwork. Everyoe realizes that, so they work really well together to make the workload maageable. Ad people like each other. I terms of her uit s demographics, the ewest urse has bee there about five years, ad the most seasoed 25. Or as Petrosky put it, We have gradmas ad the ewly egaged. Ad teamwork exteds beyod the tasks at had. Everyoe ca express their ideas, ad all decisios are made as a group, Petrosky said. We re all ope to chage ad icredibly flexible. If someoe has a idea to improve work flow, for example, the we ll try it out. Ad if we fid out it s ot workig by the ed of the day or i two weeks, we move o. Staff urse-geerated chages have icluded assemblig charts prior to geerally axious patiets arrivig for their procedures; removig problematic cabiet doors to stop physicias ad staff from costatly bumpig their heads; ad placig lamiated patiet educatio posters o uit walls to give patiets health ews they ca use while waitig. Our uit is kow to be very friedly, professioal, ad to have high stadards, Petrosky cocluded. Ad I kow there will be those who are auseated by me sayig it, but we come to work happy ad leave happy. Here you have people askig oe aother if they eed help ad thakig each other. There s just a lot of commo courtesy. Staff urse Christi McKellar, RN, added that the uit ot oly embraces teamwork, but also urse autoomy. Our maager rewards us for our hard work, supports educatioal advacemet, ad ecourages us to get ivolved i hospital committees, she said. McKellar said eve patiets are aware of the good workig relatioships staff have with each other ad with physicias. Patiets ofte will say, It looks like you guys really get alog, McKellar said. Ad that helps puts them at ease. Promotig creative ideas NCNA member ad urse maager Moette Mabolo, MSN, MBA, RN, CPAN, also credits staff urses o her geeral surgery uit at Duke Raleigh Hospital with makig it a iovative ad positive workplace. The etire hospital eared the Hallmarks recogitio, ad her uit also was recetly recogized regioally for its teamwork. From left, Duke Raleigh Hospital urses Ja Adams, RN, CNIV, who created the Walk the Dog program, ad Moette Mabolo shared the beefits of this iitiative at a atioal coferece. Oe of its most iovative programs is called Walk the Dog, which was created after a staff urse surveyed surgeos about what they thought were the most importat post-op itervetios. Walkig was No. 1, Mabolo said. So the urses decided to do somethig that would ecourage people to walk to prevet peumoia ad DVTs ad promote a earlier recovery. They developed a motivatioal tool comprised of a layard aroud a lamiated picture of a dog, which patiets are the asked to walk. The program has become so popular that patiets have asked for a copy of the picture to take home, ad some patiets have eve brought photos of their ow dogs to walk, Mabolo said. Aother staff urse took o a project to improve the layout of the uit. She worked with physicias ad pharmacists to switch the physicias dictatio room with the medicatio room, which was at the far ed of the uit, to promote better urse access. Mabolo said she routiely expresses her appreciatio to staff urses, urse s aides, ad travelers with cards ad other rewards programs, ad moreover, she tries to give them the resources ad support they eed to succeed. We have a lot of fu, but it is hard work, Mabolo said. I believe it s importat to empower urses. So charge urses ru the uit, ad they determie staffig ad trouble shoot. Staff urses also created their ow bylaws o how the uit should operate regardig workplace processes, behaviors, ad values. Agreed-upo values iclude teamwork, respect, commuity, ad achievemet, Mabolo said. Aother Duke Raleigh uit that accetuates the positive is the same-day surgery post-up recovery uit. We have very limited space i our uit ad see 60 to 100 patiets a day, so teamwork is really importat, said Yvette Meggs, RN, a cliical urse IV ad postop team leader. No oe ever has to ask for help, because everyoe is very i tue to what s goig o i the uit. Ad that s eve with a wide rage of experiece levels from ew graduates to veteras with 25-plus years, which ca ofte be the source of workplace coflict. We like to joke that the ew urses lear our old tricks, said Meggs, ad ew urses teach us the ew tricks. We all keep a ope mid ad respect each other. Like the other Hallmarks recipiet, Meggs said patiets otice urses camaraderie. We get letters practically o a daily basis about our teamwork, she said. Meggs also said that she gets 100 percet back-up from her maager, admiistrators, ad physicias alike, which also cotributes to a healthy workplace. They liste to us, respect what we say, ad do whatever they ca to help, she said. To keep the uit ruig smoothly, staff urses participate i a briefig i the morig ad a debriefig i the afteroo. There also are regularly-held uit meetigs where staff ca vet, express cocers, lear about what co-workers are doig, ad offer ideas. Oe importat chage came after Meggs observed family members, who had just bee give some bad ews, cryig o the uit. Staff urses lobbied for the costructio of a cosult room, where patiets ad families members ow ca talk with physicias ad digest iformatio privately. We picked out a area ad talked it over with admiistratio ad egieers, Meggs said. We also asked the Ladies Guild to help furish it. Added Meggs, Nurses kow they are beig paid attetio to, ad that they are see as people who ca help improve the uit, the hospital, ad patiet care. It s really a good place to work. Susa Trossma is the seior reporter for The America Nurse. 8 July/August 2009 The America Nurse

9 New editio of Teachig IOM emphasizes quality Sice its first release by ANA i 2007, Teachig IOM: Implicatios for Istitute of Medicie Reports for Nursig Educatio has bee well received by leaders i the ursig professio ad at top U.S. ursig schools. Cliical urse leaders have also used materials from the book ad CD-ROM for i-service traiig programs, ad urse educators have icorporated its cotets ito classroom teachig, learig strategies, ad materials. The secod editio of the book cotiues the discussio begu i the first editio. The ew editio provides more cotet, examples, ad teachig-learig strategies, ad it describes additioal Istitute of Medicie (IOM) reports relevat to ursig. The cotet o cliical implicatios, geeral ursig educatio issues, ad five health care core competecies has bee expaded with more examples of teachig-learig strategies. A list of abbreviatios ad a glossary has bee added, also useful as ew features for the classroom. ANA ad the America Academy of Nursig (AAN) have both bee ivolved i work o quality, ad have provided ursig represetatio to the Natioal Quality Forum (NQF). ANA has take the lead i desigig quality idicators used i ursig s report card for bechmarkig health care delivery systems quality of care through the Natioal Database of Nursig Quality Idicators (NDNQI ), which is discussed i Part 2 of the text. I late 2008, AAN set out a press release about its commitmet to trasform the health care system ad support the Natioal Priorities Partership, which is a diverse coalitio of 29 orgaizatios led by NQF. The Agecy for Healthcare Research ad Quality (AHRQ) has bee ivolved i health care quality for some time withi the Departmet of Health ad Huma Services (HHS). It has issued several requests for proposals aimed at cliical reductio of errors, or policies that promote patiet safety ad quality of care. AHRQ plays a critical role i promotig the IOM Quality Chasm series: it admiisters the Natioal Healthcare Quality report ad the Natioal Healthcare Disparities report, which are discussed i the book. Despite this edorsemet of the IOM reports by ANA, AAN, the Natioal Istitute of Nursig Research (NINR), ad AHRQ, may health professioals cotiue to questio the eed for IOM iformatio to be icluded i curricula. But the IOM reports (Quality Chasm series ad other related reports) are chagig every aspect of health care delivery ad patiet care. To that ed, this book presets strategies for itegratig the IOM material ito the ursig curriculum, ad this secod editio updates ad expads this critical iformatio. This itegratio at the poit of educatio is the core purpose of this text, which follows this structure: Part 1 sets the cotext for the book with a overview of the critical IOM reports. Part 2 examies some of the cliical implicatios of the IOM reports. Part 3 provides a overview of ursig s geeral educatioal strategic resposes ad critical issues. Part 4 presets specific strategies for itegratig safety ad quality ito ursig educatio, framed o the five core competecies amed i the 2003 report, Health Professios Educatio. Part 5 presets additioal teachiglearig strategies ad tools that may be used to further guide studets as they lear about the IOM reports ad how to apply this iformatio to their practice (icludig applicatio to staff educatio). Part 6 icludes the refereces used throughout parts 1 to 5, a list of abbreviatios ad acroyms, a glossary ad several appedices. I additio to the recommedatios of several of the key reports, there are appedices that provide: Examples of how the five IOM core competecies could form the basis for both a urse residecy pla ad a udergraduate curriculum, ad A discussio of Suzae Gordo s 2005 Nursig Agaist the Odds, a critical portrait of moder ursig. The compaio CD-ROM offers additioal teachig-learig strategies ad materials, readigs, questios for quizzes ad exams, aotated liks, ad PowerPoit presetatios. For more iformatio about Teachig IOM: Implicatios for Istitute of Medicie Reports for Nursig Educatio, go to www. or call (800) This fall, the authors are givig a free olie preview of the book, icludig practical tips o how to use the IOM reports i the classroom ad to reshape ursig curricula. To receive further iformatio about this preview, please respod by Aug. 30 with your ame, title, work address, phoe ad address to ANA Foudatio of Nursig Package Upgraded The upgraded package cotais the March 2008 release of the Guide to the Code of Ethics for Nurses: Iterpretatio ad Applicatio. This ew 200-page book cotais the full text of the Code of Ethics for Nurses with Iterpretive Statemets. It guides urses i uderstadig the specific implicatios of the ANA Code of Ethics. These books are the basis of cotemporary ursig practice. Each book may be purchased separately or as a set. Get free shippig ad save 20% off list price for orders of 20 or more packages. Expires 09/07/09. Must use promo code 09FNDNFLY. Special Offer Now Through Labor Day Cotais full text of the ANA Code of Ethics with Iterpretive Statemets. The keystoe of the ANA Nursig Stadards. Defies ursig ad describes the basis of practice. Upgraded Foudatio Package Pub #08FNDN List $59.95 / Member $49.95 (Cotais Code of Ethics with Iterpretive Statemets) For more iformatio or to order go to or call July/August 2009 The America Nurse 9

10 RNs hope urses float at Rose Parade By Susa Trossma, RN Every year, millios of people aroud the world witess souther Califoria s Rose Parade replete with spectacular floats, marchig bads, ad equestria pageatry. But i 2013, a group of urses are hopig for more: to see a float hoorig urses make its way dow the traditioal parade route ad ito the iteratioal spotlight. Our missio for the float is to hoor urses worldwide ad remid everyoe how importat urses are to idividual patiets ad to the health of their commuities, said Suzae Ward, MN, MA, RN, CNOR, a America Nurses Associatio-Califoria (ANA\C) member ad treasurer of the o-profit orgaizatio Bare Root, Ic., which is plaig the float. We also see the float as a way to recruit people ito the professio by highlightig what we do. Sally is a excellet role model ad someoe who s had a woderful career i ursig. Sally Bixby That s Sally as i Sally Bixby, MS, RN, CNOR, a ANA\C member, director of surgical services at the City of Hope Natioal Medical Ceter i Duarte, CA, ad a future presidet of the Touramet of Roses. Bixby is the first urse ad oly the secod woma amed to this top role. Her term will ru from Ja. 19, 2012 through the fial evets of the Touramet of Roses o Ja. 17, Havig a float is such a fabulous opportuity to get worldwide exposure for ursig, ad to get urses ad other people excited about the professio, Bixby said. I m totally thrilled ad hoored that my colleagues are promotig ursig durig my teure as touramet presidet. Roses ad Bare Root Traditioally held o New Year s Day, the Touramet of Roses has two major televised evets. The Rose Parade, which debuted i 1890, highlights floats made of flowers ad other atural materials, such as seeds, leaves, or bark, accordig to the touramet Web site. The Rose Bowl Game pits the wiers of the Pac-10 college football coferece agaist the wiers of the Big Te coferece. Sice 1895, the festivities have bee ru by the Touramet of Roses Associatio, which ow comprises 935 voluteer members. Ad Bixby has bee active i the evet plaig ad operatios for more tha 20 years. I ve kow Sally professioally sice the 1970s, ad I always kew about her touramet ivolvemet, said Ward, whose 38-year career as a urse icluded the roles of staff urse, educator, urse maager, ad director of surgical services. But we usually talked about ursig thigs. I 2006, however, Ward ad four other Califoria urses who ow serve as the Bare Root board of directors leared that Bixby had bee amed touramet presidet for the term. We felt it s a historic evet for wome ad for ursig, Ward said. So the group decided a float was i order. They formed Bare Root, a 501(c) 3 o-profit orgaizatio, ad lauched their Flowers 4 the Float campaig to raise fuds to desig, build, ad decorate the float; maitai the orgaizatio s Web site; ad cover other related costs. (The ame Bare Root refers to the root of a rosebush or tree before it is plated ad leafs out.) We re ot experieced fud-raisers, but our goal is to make this happe, Ward said. Ad as urses, we re used to public speakig, teamwork, ad workig o committees to get thigs doe. So she, her board colleagues, ad ow a growig umber of urses have rolled up their sleeves to do just that. Their first goal is to raise $500,000 by December 2011, oe of several deadlies for potetial float participats. There are millios of people whose lives have bee touched i a positive way by urses, said Moica Weisbrich, RN, presidet of Bare Root ad a member of the ANA\C board of directors. We ecourage urses ad those who have bee helped by urses to go to our Web site ad cotribute to help us meet our goal. Rose Parade floats are extremely complicated structures to build, ad atural materials ca be quite expesive. However, Ward added that ay moey remaiig after the float is built will go toward scholarships ad grats to qualifyig orgaizatios. The group also is tryig to promote its campaig through other veues. They ve already had several articles published i ursig publicatios, ad they speak at every ursig evet possible. Their costat effort thus far has yielded the cooperatio of several orgaizatios, icludig the Associatio of Califoria Nurse Leaders, the Califoria Studet Nurses Associatio, ANA\C, ad idividual urses. ANA has promoted the effort through listservs ad its publicatios. To illustrate the differece oe urse ca make, Ward poited to Sylvia Estrada, RN, WHCNP, who works at a Los Ageles hospital ad is actively ivolved i three separate urse orgaizatios Greater Los Ageles Chapter of the Ocology Nursig Society, Califoria Associatio of Nurse Practitioers Chapter 17, ad the Natioal Associatio of Hispaic Nurses-Los Ageles Chapter. She has ecouraged all three groups to have a mothly raffle to support the urses float. Ad the urse practitioers group has created a rose pi to sell ad will share the profits with the float project. Ad the there is the work aroud the float itself. The group has to develop a solid theme ad hire a float desiger who ca brig the urses visio to life. We really wat to celebrate ursig ad show its diversity i both the roles urses ca have ad where we come from, said Ward, who was ecouraged to go ito ursig by her mother ad a ursig home charge urse with whom she worked as a youg girl. A urse ad evet-plaer Bixby was bor ad raised i Pasadea ad started goig to the Rose Parade as a small child. Whe she was i high school, her family moved to a house that was at the ed of the parade route. Whe we started to hear the (marchig) bads, we put up a couple of ladders with a plak i betwee ad watched the etire parade, Bixby said. The parades always were woderfully etertaiig. I 1988, Bixby became officially ivolved i the touramet associatio by voluteerig ad beig assiged to oe of the big three committees. Her first role was o the formatio committee, i which she helped secure the area aroud the floats, bads, ad equestrias prior to ad durig the parade. After that two-year stit, she was assiged to parade operatios, which stages the evet, ad the the post-parade committee, which oversees geerally two days of public viewig of the floats. Other voluteer work had her pitchig i o activities ivolvig decoratig sites, quee ad court, ad hostig touramet guests. She curretly is touramet secretary. Whe she assumes the touramet presidecy, Bixby will oversee the etire parade, icludig such duties as selectig the theme ad appoitig the grad marshal. (Previous grad marshals have icluded Shirley T emple i 1939, Presidet Dwight D. Eisehower i 1964, ad Tom Brokaw i 2001.) She ad her touramet officers also will make fial decisios o marchig bads, float etrats, ad other key compoets. Additioally, she will travel aroud the coutry to hoor selected marchig bads (13 selected from roughly 50 etrats each year) ad for promotioal egagemets. Bixby said her ursig career defiitely has prepared her for the role of touramet presidet. As a surgical urse all my life, I have worked with may surgeos, urses, ad staff i other departmets, she said. Those iteractios have allowed me to build strog iterpersoal ad commuicatios skills. As a maager, I ve leared other importat busiess skills, icludig beig able to hadle a very large budget. Bixby added that she started as a scrub urse more tha 30 years ago ad has always bee happy with her career choice. Said Bixby, Nursig has really bee a perfect fit for me, ad havig a urses float is just a great way to highlight the differet opportuities available i ursig. For more iformatio, go to www. Susa Trossma is the seior reporter for The America Nurse. 10 July/August 2009 The America Nurse

11 I Brief Cotiued from page 5 by providig kowledge, skill developmet opportuities, ad support to retai ew urse educators who have trasitioed ito the role. Early career urse educators with a advaced degree will be professioally metored for 18 moths by established urse faculty leaders (metor-metee pairs must be from differet istitutios). A separate group of expert urse program faculty will desig the NFMLD curriculum that will iclude: A three-day, face-to-face workshop at STTI headquarters, utilizig experietial methods of teachig ad learig. Participatio i olie discussio forums with faculty. Developmet of a idividualized leadership progressio pla. Metor-metee collaboratio to create a iovative educatioal project. Dissemiatio of project results through the world-reow Virgiia Hederso Iteratioal Nursig Library. We are extremely pleased to have support from The Elsevier Foudatio for this ew pilot program, said STTI CEO Patricia E. Thompso, EdD, RN, FAAN, a Idiaa State Nurses Associatio member. The urse faculty program is modeled after our highly successful Iteratioal Leadership Istitute programs ad has great potetial to impact the retetio of urse educators. Research shows that ew faculty who have worked successfully with a metor have higher job satisfactio, with icreased promotios ad mobility tha those without metors. They are also more productive i obtaiig competitive grats, leadig professioal orgaizatios, ad publishig i scholarly books ad jourals articles. Detailed program iformatio is available olie at Applicatios will be accepted begiig i October. IOM report o 100 iitial priorities for research A ew report from the Istitute of Medicie (IOM) recommeds 100 health topics that should get priority attetio ad fudig from a ew atioal research effort to idetify which health care services work best. It also spells out actios ad resources eeded to esure that this comparative effectiveess research iitiative will be a sustaied effort with a cotiuous process for updatig priorities as eeded ad that the results are put ito cliical practice. A committee coveed by the IOM developed the list of priority topics at the request of Cogress as part of a $1.1 billio effort to improve the quality ad efficiecy of health care through comparative effectiveess research outlied i the America Recovery ad Reivestmet Act of The committee s report provides idepedet guidace iformed by extesive public iput to Cogress ad the secretary of the U.S. Departmet of Health ad Huma Services o how to sped $400 millio o research to compare health services ad approaches to care. Health care decisios too ofte area matter of guesswork, because we lack good evidece to iform them, said committee co-chair Harold C. Sox, editor, Aals of Iteral Medicie, America College of Physicias of Iteral Medicie, Philadelphia. For example, we sped a great deal o diagostic tests for coroary heart disease i this coutry, but we lack sufficiet evidece to determie which test is best. The 100 priority areas reflect the isights of health professioals, cosumer advocates, policy aalysts, ad others who submitted omiatios through a olie form that was ope to ay idividual or orgaizatio ad through presetatios at public meetigs. The committee America Nurse Today frequecy chage As you may kow, the iteratioal ecoomic dowtur that bega i 2007 ad cotiues today has severely impacted the magazie ad joural publishig idustry s ability to geerate advertisig reveue. HealthCom Media, the publisher of ANA s official joural, America Nurse Today, is o exceptio. Due to the dowtur i the advertisig market, HealthCom Media will o loger be able to publish America Nurse Today as it has doe to date. Effective with the July/Aug 2009 issue, America Nurse Today will be issued o a bimothly basis. Rest assured that this chage i frequecy will ot affect the cotet of the joural i ay way. America Nurse Today will cotiue to brig ANA members the comprehesive, reliable, ad up-to-date cliical ursig iformatio that you have come to rely o to ehace patiet outcomes, develop your professioal careers, ad build your educatioal foudatio of best practices. ANA appreciates your uderstadig durig this trasitio ad remais fully committed to brigig you the best i ursig cliical ews. If you have ay questios, please cotact ANA Assistat Director, Periodicals Joe Vallia at ANT_ received 1,268 uique topic suggestios, which it arrowed to 100 based o a set of criteria that icluded its charge to develop a balaced portfolio. The list reflects a rage of cliical categories, populatios to be studied, categories of itervetios, ad research methodologies. The committee developed its list of priorities idepedet from the comparative effectiveess research activities that other orgaizatios have bee charged to do through the America Recovery ad Reivestmet Act. The report also recommeds actios ecessary to establish a ogoig comparative effectiveess research effort that would ot oly carry out studies o the 100 recommeded iitial topics, but also develop priorities for future research ad traslate the kowledge gaied ito improvemets i cliical care. Pre-publicatio copies of Iitial Natioal Priorities for Comparative Effectiveess Research are available from the Natioal Academies Press at edu. Correctio I the May/Jue 2009 issue of The America Nurse, we mistakely idetified Lt. Florece B. Choe as a urse. Our sources for the article, icludig the L.A. Times, had misidetified Lt. Choe i the iitial reports of her death. I actuality, she was a Medical Service Corps (MSC) member. We regret the error, but stad by our salute to Lt. Choe for the sacrifice she made for our atio. NYSNA coferece to address staffig, political advocacy Safe staffig, health care reform, ad evirometal health are three of the pressig issues o tap for discussio at a coferece for urses hosted by the New York State Nurses Associatio (NYSNA). Fidig Our Voice: Legislative Advocacy for Nurses will be held Nov. 9 to 11 at the Disey Boardwalk I, i Orlado, FL. The coferece is ope to all urses who are iterested i learig how their colleagues aroud the coutry are tacklig these issues, as well as those who wat to gai or sharpe their political advocacy skills. The coferece differs from ANA s aual CMA lobbyist meetig, which allows CMAs to dialog o specific state legislative strategies. NYSNA has developed the program i collaboratio with ANA, the Washigto State Nurses Associatio, the Orego Nurses Associatio, the Ohio Nurses Associatio, ad others. Not all urses feel the same about the best way to approach ursig ad health care issues, said NYSNA Deputy Executive Officer Deborah Elliott, MBA, RN. This coferece is iteded to give urses the opportuity to share their perspectives ad broade their advocacy skills beyod their idividual patiets. Added NYSNA Director of Govermetal Affairs Shau Fly, We re ot tryig to promote ay particular issue, but to discuss ad educate each other about strategies that ca be very useful ad good for the professio as a whole. The coferece specifically was desiged to take place separate from urses associatios traditioal lobby days, so participats have more time to uderstad the legislative process ad lear skills they ca take back to their home states to build their political power. The coferece format icludes formal speakers, pael discussios, ad etworkig opportuities. Providig the keyote address is atioally kow jouralist, lecturer, ad patiet advocate Suzae Gordo. Her most recet book is Safety i Numbers: Nurse-to-Patiet Ratios ad the Future of Health Care. Jaet Haebler, MSN, RN, associate director of State Govermet Affairs for ANA, is amog the paelists who will discuss staffig issues. She specifically will provide a atioal overview o staffig iitiatives, as well as discuss ANA s Priciples for Nurse Staffig. Barbara Crae, RN, ANA board of directors member ad presidet of the Natioal Federatio of Nurses (NFN), will deliver the edote address. The NFN is the ew atioal uio created by six state urses associatios. Coferece participats ca ear a total of 10 cotiuig educatio cotact hours. The New York State Nurses Associatio is accredited as a provider of cotiuig ursig educatio by the America Nurses Credetialig Ceter s Commissio o Accreditatio. For more iformatio ad olie oly registratio, go to July/August 2009 The America Nurse 11

12 Ureality Cotiued from page 1 valued trust of patiets who rely o the expertise of urses i health care situatios, said ANA Presidet Rebecca M. Patto, MSN, RN, CNOR. These harmful images also play a role i shapig the values, impressios, ad ultimately, the career choices of youg people, ad may very well cotribute to the ursig shortage that is reachig crisis proportios i our atio. ANA oted that while HawthoRNe attempts to depict ursig i a positive light, it also resorts to the offesive ad demeaig stereotype of sexual iteractio betwee a urse ad a patiet, ad i so doig, isults the itelligece ad professioalism of urses ad wome. ANA wats cosumers to clearly uderstad that urses practice uder priciples detailed i ANA s Code of Ethics for Nurse with Iterpretive Statemets, ad is publicizig that poit olie ad through the media. Based o their members iput, the New York State Nurses Associatio (NYSNA) requested that the producers of Nurse Jackie iclude a disclaimer at the begiig of the show emphasizig the Code s impact o urses iteractios with patiets ad colleagues. However, this request was deied. Laurie Badzek, JD, MS, RN, LLM, director of ANA s Ceter for Ethics ad Huma Rights ad a professor of ursig at West Virgiia Uiversity, wats people just to stop watchig these shows. Nursig teds to draw i people with high itegrity ad good character, ad we must have those qualities to get licesed ad remai i the professio, she said. The public also expects us to be good people who will keep them safe ad take care of them i a professioal maer. She oted that there was a time whe health care professioals were show i a positive light, such as i the 70s show, Marcus Welby, M.D. Today producers take the worst possible qualities a perso ca have ad mold them aroud the persoa of a urse or a physicia. They show urses stealig, lyig, takig drugs, ad actig amorally, Badzek said. I defiitely thik those images hurt us professioally ad i terms of recruitig. Ad although a sigificat umber of people kow ursig has a Code of Ethics, this may be a very appropriate time to reiforce that message. The good, the bad & the ugly Eve though urses have cosistetly raked at the top of Gallup s public opiio poll o the most trusted ad ethical professios, their fictioal represetatios frequetly have told a differet tale. There is the scary, sadistic urse: Nurse Ratched from Oe Flew Over the Cuckoo s Nest. There is the sexy, ad ofte brailess, urse: the Clairol Herbal Esseces commercial that aired i 2003, i which a urse igores her patiet while she washes her hair ad praces aroud i apparet ecstasy. (The ad was pulled followig complaits from ANA, the Ceter for Nursig Advocacy, ad others.) NYSNA CEO Tia Gerardi, RN, said that eve a show like ER, which she ad other urses reported likig, sometimes fell short of portrayig urses accurately. Jada Pikett Smith starrig i TNT s HawthoRNe. The physicias ofte were show doig thigs that urses would ormally do, from providig post-mortem care to helpig families with the grievig process, Gerardi said. But Nurse Hathaway was a strog advocate who certaily was oe of the team i the ER ad made patiet care decisios. ER writers also had Nurse Hathaway mometarily o the stereotypical brik by havig her cotemplate medical school. Ultimately they showed her as someoe who is a bright, itelliget caregiver who ca be proud ad satisfied practicig as a urse, Gerardi said. Ad while adult ad geriatric urse practitioer Kevi Hook, MA, CRNP, a member of ANA s ethics advisory board, does ot agree with Nurse Jackie s methods, he believes her character does go agaist type. (This setimet was echoed by other urses i several blogs, alog with commets remidig people that it s oly TV.) I foud her to be compellig i that she is three dimesioal, Hook said. She has some major problems, but she was ot show stadig aroud waitig for doctors to tell her what to do. She wet about her busiess like ay real urse would do performig a impeccable head-to-toe assessmet. Hook also believes that urses, ad particularly me i ursig, ofte are ivisible whe it comes to health care dramas. Whe other TV programs iclude urses, they ted to be better at depictig the carig part of ursig ad ot so good at showig urses cliical care ad kowledge, he said. Hook poited to two more well-rouded fictioal images of urses: Carla, who s bee show to have solid skills ad judgmet, o the TV show Scrubs, ad the AIDS urse i the Toy Kusher play ad movie, Agels i America. For critical care urse ad Washigto State Nurses Associatio member Julia Barcott, RN, ER ad Chia Beach, a TV drama set i a evacuatio hospital i Vietam that aired from 1988 to 1991, were two of the better portrayals of urses ad the health care team. Chia Beach was a huge hit, ad it addressed chemical depedecy ad had some quirky characters, Barcott said. It was a drama, yet it showed the reality of people pullig together for the best iterests of their patiets. More critiques & ethics Barcott said she was excited at the prospect of seeig urses as lead characters o televisio. But after viewig Nurse Jackie ad HawthoRNe, she believed the egative depictios outweighed the positives. I liked the idea that they showed a urse i a positio of authority (the CNO of HawthoRNe ), but it looked like staff urses could t solve ay problems o their ow, Barcott said. Ad I was isulted by Nurse Jackie. I kow it s supposed to be a dark comedy, ad it was very fuy i parts. But it still portrays urses as less tha professioal. She also said the show missed a real opportuity to highlight the fact that, like Nurse Jackie, urses ofte work with back ijuries. Istead they decided to focus o the way she eases her pai by usig drugs at work. Edie Falco portrays Showtime s Nurse Jackie. I do t thik that this show will impact the way the public thiks about us, Barcott added. But do we really eed to worry our patiets by showig a urse who crushes pills ad puts them i a packet of sweeteer? Gerardi expressed a similar cocer whe Nurse Jackie is show forgig a sigature o a orga doatio card. Nurses would t do that, Gerardi said. But it might plat a seed of doubt i a perso who watched the show, ad patiets ad their families are already so vulerable. Motaa Nurses Associatio ad ANA ethics advisory board member Sharo Sweeey Fee, PhD, RN, foud may breaches of ethics ad reality whe it came to the ewest shows o ursig. The way I looked at them is, this is TV, ot reality, Sweeey Fee said. Ad I also thought that at least they are showig urses ad the chaos that is our health care system. However, Sweeey Fee said she still did ot like the egative imagery. For example, i oe scee i HawthoRNe, a urse kowigly gives too high a dose of isuli to a patiet after beig ordered by the physicia to do so. It was the typical, I m just a urse, ad all I do is follow orders, Sweeey Fee said. But i reality, urses do t give somethig to patiets that they kow ca harm them. Ad urses would be guilty of a ethical ad professioal breach if they performed a sexual act o a patiet, which was implied i aother scee. That is really about exercisig udue ifluece or power or cotrol over a patiet who a urse is supposed to protect, added Badzek. That s crossig a professioal ad ethical boudary that also could permaetly cost the urse his or her licese. Aother irksome scee ivolved the CNO tellig urses to do somethig or she will have to yell at them, Sweeey Fee said. Ethically, we have a duty to our patiets, ourselves ad each other, Sweeey Fee said. That meas that urses are obligated to be kid to each other, ad as i the case of Nurse Jackie, itervee whe there is a colleague who is chemically depedet. What could make these shows more realistic while keepig the drama ad the laughs is to have urses iput while they are beig coceived ad taped, oted several iterviewed urses. ANA ecourages media productio firms to cosult with it before shows go ito productio, whe there is still time i the process to address iaccuracies ad potetial problems from a ursig perspective. I d really like (popular media) to show what urses really do, ad that we re compassioate, highly educated ad critical thikers, Gerardi said. I d like them to show that we are some of the best ad brightest. To view the Code of Ethics, go to www. ANA also recetly published three books that will provide a framework for ethical decisio makig i all areas of ursig practice: Guide to the Code of Ethics for Nurses: Iterpretatio ad Applicatio; Nursig ad Health Care Ethics: A Legacy ad A Visio; ad Geetics ad Ethics i Health Care: New Questios i the Age of Geomic Health (available at www. Susa Trossma is the seior reporter for The America Nurse. 12 July/August 2009 The America Nurse

13 Staffig shortages permeate workplace: ANA poll More tha seve i 10 urses said that staffig o their uit ad shift is isufficiet, ad more tha half said they are curretly cosiderig leavig their positio, accordig to a ANA olie poll that drew more tha 15,000 resposes. The poll, which has bee posted o ANA s Safe Staffig Saves Lives Campaig Web site (www.safestaffigsaveslives. org) sice March 2008, showed that about 7,900 of the 15,000 respodets said they are cosiderig leavig their positio. About 42 percet, or 6,300 of the 15,000 respodets, said the reaso they would leave is associated with iadequate staffig. Also, more tha oe i three urses reported that they kew a urse o their uit who left direct care ursig due to cocers about usafe staffig. These results cofirm what we have log bee hearig from registered urses: that usafe staffig o their uits is their top cocer, said ANA Presidet Rebecca M. Patto, MSN, RN, CNOR. Nurses take our professio s Code of Ethics very seriously. Whe obligatios to our patiets are compromised because there are ot eough urses o hospital uits to provide the highest quality of care, registered urses are uderstadably frustrated. ANA has a log track record of advocatig for safe staffig coditios for the atio s 2.9 millio RNs. I 2007, ANA lauched its Safe Staffig Saves Lives grassroots campaig callig for sufficiet urse staffig levels i health care facilities ad supportig staffig legislatio ANA crafted with members of Cogress. Kow as The Registered Nurse Safe Staffig Act, the legislatio is expected to be re-itroduced i Cogress later i The legislatio would require hospitals to develop urse staffig plas, with iput from direct-care urses, for each care uit ad work shift. The plas would be based o factors such as patiet acuity, umber of patiets, urse skill mix, ad experiece ad available resources, such as support staff ad techology. Seve states have passed urse safe staffig legislatio that closely resembles ANA s model, icludig five states sice These results cofirm what we have log bee hearig from registered urses: that usafe staffig o their uits is their top cocer. Rebecca M. Patto, MSN, RN, CNOR, ANA Presidet The olie poll also revealed that urses are i a severe time cruch durig their work hours. Nearly oequarter said their work schedule rarely allows them to take a full meal break which traslates ito a full meal break less tha oe time per moth. Nearly two-thirds said they must perform o-ursig activities daily, such as deliverig meals, trasportig patiets, ad makig pharmacy rus, i additio to ursig duties for which they are educated. The staffig issue is ot oly about esurig there are eough urses to properly care for patiets, but about employig sufficiet support staff so urses ca do the vital work with patiets that they are traied to do, Patto said. Aythig that takes away from that potetially ca result i declies i the quality of care ad safety for patiets. The survey also showed the followig: More tha half (51.6 percet) of respodets said the quality of care o their uit had declied i the past year. Nearly half (49.5 percet) of respodets would ot feel cofidet havig someoe close to them receive care i the facility i which they work. Nearly oe-quarter (23.9 percet) of respodets said they were cosiderig leavig ursig altogether. Of those takig the survey, 83.6 percet said they work at a hospital, ad 75.8 percet said they work full time. Nearly 75 percet idetified themselves as a staff urse. Experiece levels were broadly distributed, with about 55 percet reportig less tha 15 years experiece ad 45 percet more tha 15 years. Results to some of the poll questios ca be foud at www. Doig/PollResults.aspx. RN care Cotiued from page 6 sped crucial time with patiets. Clearly RNs are the oes who cotiuously moitor patiets for ay potetial problems, but you eed to have a adequate umber of them to prevet those complicatios, Kover said. She oted that it s ot uusual for urses to take care of six patiets over a 12-hour shift. If urses pass meds at least three times ad chart them, that leaves oly about 1.5 hours to sped with each patiet durig a give shift to assess coditios, chage dressigs, perform other procedures, ad complete required patiet teachig. Ad that does t iclude may other factors, such as participatig i chage-of-shift report, time away from the uit to accompay a patiet to a procedure ad ay formal breaks. Beyod RN umbers, Kover also believes it s importat to look at other critical factors, such as skill mix ad RNs experiece levels, whe determiig staffig o each uit for each shift. Those factors are part of ANA s staffig priciples, which ca be foud at ANA s olie urse staffig campaig site, %%%%%%%%%%%%%%%%%%!"#$%!&'$()"%*)+ The Dedicated Network for Nurses. Itroducig RN/LPN Coect, the ursig idustry s premier Web site for searchig, fidig, ad postig job positios, as well as procurig the tools you eed to make your veture succeed ad prosper. Coceived ad created by a urse who uderstads the specific eeds ad demads of our dyamic field, is the oly professioal urse etworkig site that effectively liks qualified urses ad studet urses throughout the atio with their potetial employers. For every ursig specialty, shift, ad detail, RN/LPN Coect offers robust, up-to-date opportuities ad resources that you ca cosistetly trust. Log o today ad see the possibilities for yourself.,,,-./01/()**$(&-()2 RNs have more educatio ad cliical experiece tha LPNs, Kover said. Ad a RN who is out of school two years geerally eeds more support tha a urse with eight years of experiece. Yet i fidig after fidig, ewly licesed RNs report havig to do their jobs without adequate resources, icludig eough supplies, said Kover, who is trackig their careers as part of a 10- year atioal study fuded by The Robert Wood Johso Foudatio. She ad her team already discovered the professioal reasos behid ewly licesed RNs leavig their first job: iadequate urse maagemet ad stressful, resource-poor workplaces. Both are fixable problems, Kover said. We ca t keep holdig urses accoutable for quality patiet care, if they do t have the resources ad support to provide that care. She also kows RNs fear losig their jobs, because of the dowtur i the ecoomy. But this time aroud, the hard evidece is there for RNs to show their value to patiet care ad to their employers. For more iformatio o ANA s quality iitiatives, go to Susa Trossma is the seior reporter for The America Nurse.,)-$)"$!"#$+."&$." Free registratio through August 2009!"#$%"#&'(()*+#,-./+)/#012345(66###7 8979:;###;<7=#>? July/August 2009 The America Nurse 13

14 Comparative effectiveess research (CER) Comparative effectiveess research (CER), is a hot topic i health care reform discussios these days, ad i February 2009 Cogress made a sigificat dow paymet o health care reform i the America Recovery ad Reivestmet Act, or the stimulus bill, by committig $1.1billio to CER. But what exactly is CER? Simply put, CER aims to determie how various health care itervetios compare to oe aother i their ability to address a particular health care problem. The goal is to improve quality ad cotrol costs of health care by esurig that health care decisios are based o the best evidece available. CER is ot a ew cocept. The Agecy for Healthcare Research ad Quality (AHRQ) work o CER origiated with the Medicare Prescriptio Drug, Improvemet, ad Moderizatio Act (MMA) of Accordig to AHRQ, its Effective Health Care Program is dedicated to facilitatig decisio-makig by providig fidigs from high quality research i formats for differet audieces. But efforts to utilize CER are ot limited to the federal govermet. May health plas look to CER to help make coverage decisios. For example, the Blue Cross ad Blue Shield Associatios Techology Evaluatio Ceter was fouded i 1985 ad serves ot oly BCBS cliets, but Kaiser Permaete ad the Ceters for Medicare ad Medicaid Services (CMS). To date, most CER has bee about drug therapy lookig at how oe drug stacks up agaist aother, or lookig at the effectiveess of a drug versus a placebo. But today there is geeral agreemet federally ad amog various health professioal groups that CER eeds to aalyze a variety of approaches to care, ad should look at delivery systems, as well. ANA o ursig s uique perspective ad role ANA preseted testimoy before the Istitute of Medicie s Comparative Effectiveess Research Priorities Committee Public meetig o March 20, ad has provided iput to the Federal Coordiatig Coucil for CER. ANA believes that CER holds great promise, if it is doe well. It is importat that ursig s uique perspective be a part of decisio-makig about CER. A CER program must be developed with objectivity, trasparecy, ad accoutability. Patiets are justifiably cocered that decisio-makig about treatmet optios ot be affected by those who may profit from such decisios. Public opiio polls repeatedly idetify urses as highly trusted professioals, ad as a result, urses will play a importat role i the acceptace of CER. Nursig ad priorities for CER ANA s testimoy, available at www., outlies priorities i greater detail, ad icludes the followig cocepts: The scope of CER must be broad ad must embrace a wide rage of methodologies. The Natioal Quality Forum Natioal Priorities ad Goals ad ANA s Natioal Database of Nursig Quality Idicators ca help frame CER priorities. Deliverig more ad better primary care is a priority. Federal coordiatig coucil o CER To provide iput o priorities for the $400 millio fud i the recovery act, the Departmet of Health ad Huma Services (HHS) amed a 15-member Federal Coordiatig Coucil for CER i March The Coucil will ot recommed cliical guidelies for paymet, coverage, or treatmet, but will cosider the eeds of populatios served by federal programs ad opportuities to build o curret priorities. Coucil members were chose to represet a diverse set of idividuals ad agecies, ad amog its members is Rear Admiral Deborah Parham Hopso, PhD, RN, FAAN, associate admiistrator for HIV/AIDS i HHS, Health Resources ad Services Admiistratio (HRSA). The oly urse o the federal coucil, she was amed after represetig HRSA o aother govermet committee, which examied CER activity withi HHS ad idetified research gaps, such as a lack of studies focusig o the care of racial ad ethic miorities ad uderserved populatios. Nurses are a critical part of the health care system, ad subsequetly crucial to addressig ad implemetig health care reform ad comparative effectiveess research, Hopso said. Ad it is a opportuity ad resposibility of urses to lear what CER is, what it is ot, ad how it ca be used to improve our practice. Patiet educatio, oe of urses mai resposibilities, is oe example of how CER ca be used o the frotlies of care, accordig to Hopso. Patiets ofte ask us what they should do whe we are takig care of them at the bedside, a doctor s office, or commuity cliic, Hopso said. If that patiet has adult oset diabetes, for example, we eed to be able to explai the types of medicatios that are available, the beefits of exercise ad losig weight, ad other optios. It s up to us to explai those differet itervetios, ad kow what research says about the beefits ad risks of those differet optios. ANA urges urses, particularly urse researchers, to keep abreast of developmets regardig CER. Updates will be icluded i future ANA commuicatios. Visit to see what s ew o ursig s most popular Web site. Get up-tothe-miute ursig ews, by urses for urses, by sigig up to receive the ANA e-ewsletter, NursigIsider, at Letter/SigupforANAeNewsletters.aspx. OJIN: The Olie Joural of Issues i Nursig New Colums: The Iformatics colum by Lida Thede, Iformatics: Electroic Records ad Orgaizatioal Culture cotributes to the Curret Topic, Nursig Techologies: Iovatio ad Implemetatio. Go to: Colum. I their Legislative colum, The America Recovery ad Reivestmet Act of 2009: What s i it for Nursig? Charles Alexadre ad Greer Glazer give a update of the recovery act, which was siged ito law Feb. 17. Go to OJIN/LegislativeColum. New CE articles i America Nurse Today: May 2009 Avoid the Dagers of Opioid Therapy Whe opioids keep patiets free from pai, RNs must keep them free from harm. Opioids provide superb pai relief ad are amog the least expesive drugs prescribed. Plus, i low doses, they re usually safe. But these potet aalgesics do pose dagers. The risks of abuse ad serious adverse effects have always come with the beefits of opioids. Now, there s a growig awareess of safety cocers. Read this article ad lear about the cliical guidelies for use, beefits versus risks, ad ursig strategies to improve opioid safety. This CE article ca be accessed at: opioidfull.htm. Accreditatio: Expiratio Dec. 31, cotact hours, icludig 2.0 pharmacology cotact hours, will be awarded to urses who successfully complete this CNE activity. The America Nurses Associatio Ceter for Cotiuig Educatio ad Professioal Developmet is accredited as a provider of cotiuig ursig educatio by the America Nurses Credetialig Ceter s Commissio o Accreditatio. ANA is approved by the Califoria Board of Registered Nursig, provider umber CEP6178. As the Web Turs ANA ow o Facebook, LikedI groups ANA aouced the lauch of its ew Facebook ad LikedI olie commuity groups, providig urses with access to two popular social etworkig sites that offer fast, free, ad coveiet ew ways to share iformatio ad make professioal coectios olie. By sigig up to become a fa of ANA at org/facebook, users will be able to post ews, share photos, dowload ANA video clips, ad joi i o discussio boards o timely ursig issues. By joiig LikedI, users will be able to coect with a vast etwork of professioal cotacts withi the ursig field. CE Corer Are We Makig Progress Agaist Autism? Scietists are learig more about this bafflig disorder, but a cure is a log way off. Autism is oe of the most challegig disabilities ecoutered amog pediatric patiets. A major developmetal disorder of ukow cause, it requires itesive multidiscipliary itervetio ad lasts a lifetime. No cure exists, but health care professioals ad families of autistic persos are workig hard to forge effective itervetios. Lear about diagosis, itervetios, ad ursig care for autism. This CE article ca be accessed at: Accreditatio: Expiratio Dec. 31, cotact hours will be awarded to urses who successfully complete this CNE activity. The America Nurses Associatio Ceter for Cotiuig Educatio ad Professioal Developmet is accredited as a provider of cotiuig ursig educatio by the America Nurses Credetialig Ceter s Commissio o Accreditatio. ANA is approved by the Califoria Board of Registered Nursig, provider umber CEP July/August 2009 The America Nurse

15 ANF door exemplifies a profile i carig Doatios at Work Rose Costatio, PhD, JD, RN, FAAN, FACFE, typifies the spirit of givig that the America Nurses Foudatio (ANF) embodies. ANF the charitable ad philathropic arm of ANA is pricipally kow for providig seed moey to begiig urse researchers, thus eablig them to start their research careers ad go o to receive atioal fudig. The ANF Legacy Wall, located at ANA headquarters i Silver Sprig, MD, recogizes those who have made a doatio of at least $10,000 to ANF s urestricted fud, which allows ANF the maximum flexibility i fulfillig its missio. Costatio, who recetly completed eight years of service as a ANF trustee, jumped at the chace to cotribute whe the ANF Legacy Wall was aouced. It is importat to provide seed moey, to help people who do ot have resources to get a start, Costatio said. Studets ad ew researchers rely o our research orgaizatios to help them get started. While it may be a sacrifice for me, it provides support for what I believe i, ad I hope it will ispire others to give, as well. Costatio is dedicated to improvig the lives of studets, urses, ad her cliets, so a commitmet to the ANF is a atural extesio of her commitmet to service to others, ad it is a commitmet that has made a lastig impact o the professio by supportig the advacemet of its sciece. Her story is remarkable, ad represets oly oe of the may examples of voluteers ad doors who work hard to make sure that ANF has a robust, vital grats program. Costatio received her basic ursig educatio i the Philippies before comig to the Uited States. She wet o to ear her master s ad doctoral degrees i ursig from the Uiversity of Pittsburgh, ad completed her law degree at Duquese Uiversity, Pittsburgh. I additio to servig o the faculty at the Uiversity of Pittsburgh, where she teaches courses i psychiatric ad foresic ursig ad leadership, Costatio has a pro boo law practice for wome recoverig from sexual assault, rape, ad abuse (SARA). More recetly, her work has focused o creatig a global partership for survivors of SARA. I this edeavor, Costatio is parterig with urses i Jorda ad the Philippies usig a Iteret- Rose Costatio eabled support etwork to provide health, educatio, legal, ad postvetio (HELP) services to survivors of SARA. Costatio s ow research examies the health outcomes of abused wome who experiece domestic violece, demostratig that there is a differece i the psychological, physical, ad behavioral health outcomes betwee abused wome who receive itervetio ad abused wome who do ot. She also examies specific factors i loss ad abusive experieces, ad the itervetio accoutig for those differeces. As is true of may of our voluteers, Costatio has devoted herself to servig others i may ways. She is the presidet of the Nursig Foudatio of Pesylvaia ad the presidet of the board of Pittsburgh Actio Agaist Rape. Recetly, she has begu the Dr. Rose Eva Baa Costatio Nursig Research Partership through the Beta Delta Nu Society i the Philippies. This effort is desiged to tap the resources of the global Filipio ursig commuity to build a research ifrastructure i the Philippies that is made possible through grats ad metorig. ANF was established i 1955 as the philathropic ad charitable arm of ANA, supportig ANA ad its work to promote the welfare ad well-beig of urses, ad advace the ursig professio, thereby ehacig the health of the public. Nearly 1,000 urses have received research grats from the ANF. I 2008, ANF awarded 30 research grats to urse researchers for a total of $190,106, with the awards ragig from $3,500 to $20,000. I the past 54 years, the ANF has awarded early $4 millio i grats to begiig ad experieced urse researchers. May of the ANF Scholars have goe o to be leaders i ursig research, advacig the scietific foudatio for practice, as well as leaders i ursig ad i their commuities. For more iformatio o ANF, visit ANF is a ot-forprofit, 501(c)3, orgaizatio. Doatios are tax-deductible to the fullest extet allowed by law. Doatios support the work of ANF, icludig its premier Nursig Research Grats Program. By Mary McNamara Nurses headig back to the workforce The New York Times examied which careers are strugglig, ad which provide opportuities i the curret job market. For urses, it seems the ecoomic ews is mixed. The shortage is ot as great as it was before the recessio, particularly i battered states like Michiga ad Ohio, said Cheryl Peterso, director of ursig practice ad policy at ANA. Util the dowtur, it was easy for experieced registered urses to fid employmet right i their commuities, i whatever positios they wated, Peterso cotiued. Now it is a little more difficult because the umber of job opeigs has falle ad we have more retired urses, i eed of icome, comig back. But there are opportuities, accordig to Dr. Robert Pearl, chief executive ad chairma of the Permaete Medical Group. There are probably more urses recetly traied tha there are jobs for them, he said, but for those with the highest level of skill ad experiece, there are always opeigs. Ad those opeigs pay $100,000, accordig to Pearl. I a mothly cout of olie job opeigs listed o ad more tha 1,200 similar Web sites, i oly four of the categories: architecture ad egieerig, the physical scieces, computer ad mathematical sciece, ad health care, were the uemployed equal to or fewer tha the listed job opeigs. There were, i sum, 1.09 millio listed opeigs ad oly 582,700 uemployed people presumably available to fill them. Safe staffig: Examiig ANA s model for legislatio With a ew admiistratio i the White House, health care idustry groups ad labor orgaizatios are reewig their push for safe staffig legislatio. Moder Healthcare took a i depth look at the differig perspectives o the issue. ANA differs from some groups i that it does t support legislatio that prescribes miimum staffig ratios. It s more importat that the hospitals have the flexibility, says Jaet Haebler, the ANA s associate director of state govermet affairs. ANA is a major voice represetig the professio i public policy debates i cocert with its costituet associatios, ad has charted a alterate, more fruitful course o urse staffig. It has doe this by seekig laws that require hospitals to adhere to staffig plas geerated by committees at idividual hospitals with commet from direct-care urses. While efforts to brig miimum staffig ratios to states beyod Califoria have failed, ANA has gotte its model adopted i seve states, ofte workig cooperatively with state hospital associatios, most recetly i Ohio i Jue I Texas ad Florida this year, bills that would employ ANA s staffig model competed directly with bills modeled o the CNA/NNOC s ratios. The ratio bills died i committee i both states. The Texas staffig-pla bill, which builds o similar requiremets for staffig plas already i effect uder state regulatio, has the support of the Texas Hospital Associatio ad is movig forward, while the Florida staffig-pla bill died i committee. A bill i Nevada itroduced with miimum ratios was ameded to istead require staffig committees i the couties that iclude Las Vegas ad Reo. Propoets of the Califoria-style staffig ratios, pricipally CNA/NNOC, have failed to duplicate the model i other states. There were at least 12 itroduced i curret legislative sessios, several of them packaged with bas o madatory overtime ad other measures. May died i committee ad few, if ay, appear likely to advace. The case o ratios as they ve played out i Califoria is mixed, accordig to the Moder Healthcare article. A study released i February by the idepedet Califoria HealthCare Foudatio cocluded that o sigificat impact o the quality of patiet care has bee measured. Nor could it be said that the regulatio was draggig dow hospital fiaces, the authors cocluded, fidig that chages i Medicaid paymet policy aroud the same time were primarily to blame for decliig margis. For more iformatio o ANA s efforts o safe staffig, see Staffig shortages permeate workplace: ANA poll, o page 13. Media Briefs Health care reform heats up Capitol Hill As the debate over health care reform heats up o Capitol Hill, ANA is makig sure that ursig s perspective is heard. I Roll Call, ANA s chief associate director for govermet affairs Michelle Artz was quoted as sayig, I our ideal world a sigle-payer system is the way to go. However, we really recogize that s ot where the dialogue is ow. We ve bee really tryig to focus our efforts o the pieces that are movig. We just feel the realities of how this is ufoldig right ow are takig a differet path, ad we wat to make sure that urses are o that path, recogized ad heard. But as health care is poised for ceter stage i the comig moths, the article states urses clearly wat to be part of the actio. Nurse lobbyig groups are all jockeyig for a more promiet role for their members. Nurses ofte make the argumet that urses help reduce costs ad, accordig to some cliical studies, eve make for better patiet outcomes, especially whe treatig chroic ailmets. Mary McNamara is the seior public relatios specialist at ANA. July/August 2009 The America Nurse 15

16 ANA participates i health care reform rally Political Nurse By Hilary Hase ANA members joied a estimated 10,000 people to call o Cogress to pass health care reform this year at a health care rally Jue 25. As part of the Health Care for America NOW (HCAN) coalitio, ANA took part i the rally i Washigto, DC, at which hudreds of orgaizatios set represetatives with oe commo goal quality, affordable health care for America ow. Joiig i the call for reform with a strog public optio were Ses. Charles Schumer (D-NY) ad Sherrod Brow (D-OH), Reps. Athoy Weier (D-NY), Xavier Becerra (D-CA), Sheila Jackso Lee (D-TX), ad others. Followig the rally, ANA participated i a Nurse/Physicia Provider Tow Hall moderated by Gov. Howard Dea, MD, ad Elle-Marie Whela, PhD, NP, from the Ceter for America Progress. The evet focused o four mai messages of health care reform: guarateed, quality coverage; a public health isurace optio; affordability ad cost cotaimet; ad elimiatio of health disparities ad improved quality for all. At the tow hall, more tha 300 urses ad physicias shared their stories o how the curret health care system has made their jobs harder ad, more importatly, how it has egatively impacted their patiets. Marylad Nurses Associatio member Keisha Walker shared her story o how lack of isurace causes health disparities amog wome with irregular pap smears ad the struggles for follow-up amog those without isurace. Se. Debbie Stabeow (D-MI) ad Cogresswoma Ja Schakowsky (D-IL) came to the tow hall to aswer questios ad speak to the eergized crowd. ANA plas to participate i future HCAN-orgaized evets. ANA-PAC olie House of Delegates fudraiser a success The ANA Political Actio Committee (ANA-PAC) cotiued i its quest to Race for the Millio, by hostig a evet Jue 15 to 20 for members of the ANA House of Delegates (HOD). ANA-PAC is reow for hostig past evets i previous years to thak doors, such as sposorig a luxury massage hospitality suite, ivitig political commetators to speak, ad presetig the comedy troupe Capitol Steps, ad this evet was just as groudbreakig. Because the House will ot covee i perso util Jue 2010, ANA-PAC hosted a first-ever virtual fudraisig evet, i which delegates were ot ivited to atted i perso ad istead were able to kick up their feet, relax with family, ad doate olie. I the fu spirit of competitio that marks ANA-PAC evets, delegates were challeged to wi a gold medal for their costituet member associatoios by havig all delegates doate a average of $50. I additio, all doors who cotributed more tha $10 were etered ito a drawig for a collectable, sculptured jewelry box with a raised image of the U.S. Capitol. Deb Fischer-Clemes of Sioux Falls, SD, wo the prize. ANA-PAC would like to thak all the delegates who participated, ad looks forward to seeig everyoe at the HOD meetig i For more iformatio about the ANA-PAC 2009 House of Delegates Challege or ANA-PAC, go to or cotact Agela Sog at White House Cotiued from page 1 health care that they eed ad deserve. The other ANA ad MNA member at the evet, Rebecca Wisema, PhD, RN, also oted the importace of havig ANA ad the urses it represets speak out i the legislative process. Nurses face the realities of a dysfuctioal health care system every day, Wisema said. Whe people with prevetable diseases die from lack of access to a health care provider, how ca we tur our heads ad ot see the problem? Oe of our core values is to advocate for our patiets. Advocacy icludes political actio to affect positive health outcomes for all citizes. Advocatig for reform o Capitol Hill A ANA-led group of RNs joied the House Democratic Caucus July 21 at the U.S. Capitol to demostrate support for a health care reform bill (HR 3200) ad share persoal stories of a broke system i which health care is too ofte deied or delayed. The measure, America s Affordable Health Choices Act of 2009, would establish a public health isurace pla optio to broade access ad choices for patiets; address the ursig shortage through a icreased commitmet to workforce ivestmet; ad recogize urse practitioers as primary care providers. ANA board member ad critical care urse Lida M. Gural, RN, CCRN, described how a uisured patiet s health problem is exacerbated because she caot afford to pay for eeded follow-up care or a prescriptio, ad subsequetly must retur to the ER for care yet agai. This patiet should ot have to suffer because of a lack of isurace or a primary care provider, Gural told reporters. Our urses should o loger bear witess ad share the eedless sufferig of the patiets we serve due to the cost of iactio. Said ANA Presidet Rebecca M. Patto, MSN, RN, CNOR, All too ofte, registered urses ecouter patiets who have t had timely access to health care services or could t pay for treatmet, ad the suffer the cosequeces. At press time, the bill is beig cosidered by the House Eergy ad Commerce Committee. The presidet remarked o the skyrocketig costs of deductibles ad out-of-pocket expeses for patiets ad stressed that thousads of Americas lose isurace coverage each day that the govermet fails to act. [Nurses] see firsthad the heartbreakig cost of our health care crisis, Obama said. They hear the same stories I ve heard across this coutry of treatmet deferred or coverage deied by isurace compaies; of isurace premiums ad prescriptios that are so expesive they cosume a family s etire budget; of Americas forced to use the emergecy room for somethig as simple as a sore throat just because they ca t afford to see a doctor. Ad they uderstad that this is a effort we ca o loger defer. Deferrig reform is othig more tha defedig the status quo. Ad those who would oppose our efforts should take a hard look at just what it is they are defedig. The status quo o health care is ot a optio for the Uited States of America. The presidet said that he recogized the eed to improve aspects of the health care system that ihibit urses ability to perform their duties, icludig may issues that ANA has bee talkig about for may years. America s urses eed us to succeed, Obama said. If we ivest i prevetio, urses wo t have to treat diseases or complicatios that could have bee avoided. If we moderize health records, we ll streamlie the paperwork that ca take up more tha oe third of the average urse s day, freeig them to sped more time with their patiets. If we make their jobs a little bit easier, we ca attract ad trai the youg urses we eed to make up [for] a ursig shortage that s oly gettig worse. Nurses do their part every time they check aother healthy patiet out of the hospital. It s ow time for us to do our part. Obama the recalled a bit of iformal advice Patto had give him momets before. Becky ad I were talkig i the Oval Office ad [she] poited out that we eed to buck up people a little bit here, related Obama. Ad that s what urses do all the time. They buck up patiets. Sometimes they buck up some residet who does t quite kow what he s doig. You look at Becky ad you ca tell she kows what she s doig. Ad what she s sayig is that it s time for us to buck up Cogress, this admiistratio, the etire federal govermet; to be clear that we ve got to get this doe. ANA ecourages its members to cotact their represetatives i Cogress to urge actio o health care reform this year ad support for the public health isurace pla optio. For more iformatio o ANA s positio o health care reform, go to reform. Joe Vallia is the assistat director, periodicals at ANA. 16 July/August 2009 The America Nurse

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