2012 MAGNET HIGHLIGHTS Recognizing Nursing Excellence Special Section
MAGNET HIGHLIGHTS Inside ANA From Your ANA President Magnet : Good for nurses, good for patients THE AMERICAN NURSES ASSOCIATION (ANA) and its subsidiary, the American Nurses Credentialing Center (ANCC), formed the Magnet Recognition Program as a way to recognize with an earned credential the efforts of select healthcare organizations that practice policies that maintain nursing excellence. After more than 20 years of experience with the program, we know that the Magnet designation really does make a difference in the lives of nurses and patients in Magnet facilities. A recent study by Linda Aiken, PhD, RN, FAAN, Lesly Kelly, PhD, RN, and Matthew McHugh, PhD, JD, MPH, RN, CRNP, found that Magnet hospitals fared better than non-magnet facilities in terms of positive nurse work environment and outcomes. The study included more than 26,000 direct patient care RNs in 567 hospitals, including 47 Magnet hospitals. Among the study s findings were that Magnet hospitals were more likely to have nurses that were specialty certified and that Magnet facilities employ more nurses with a bachelor of science in nursing (BSN). Most striking, however, is the determination that the nurses work environment in Magnet hospitals is significantly better than at non-magnet hospitals. Nurses in Magnet hospitals are 18% less likely to be dissatisfied with their work and 13% less likely to suffer burnout. Likewise, Magnet facility nurses were found to be less likely to want to leave their current position than their non- Magnet counterparts. In turn, patients benefit greatly from the steps needed to obtain Magnet designation.we know from previous studies that patient mortality in Magnet hospitals is 4.6% lower than in non-magnet hospitals, and that Magnet hospitals had the lowest levels of mortality for AIDS patients (in facilities without specialized AIDS units). The newest data suggest that the better work environment found in Magnet hospitals is a boon to patient outcomes: In a best work environment, the decrease in nurse workload by one patient lowers mortality by 9%. In contrast, poor nurse work environments show no positive effect on mortality. Without a better work environment, mortality rates do not improve. What s more, as the percentage of nurses with a BSN increases, so do patient outcomes. In fact, every 10% increase in hospital staff nurses with a BSN results in a 5% reduction in mortality and failure to rescue. It is clear that patients in Magnet facilities, which offer better work environments and a higher rate of BSN nurses, benefit from these characteristics. Magnet designation ongoing It is not easy to get and maintain Magnet status, and for good reason. Ensuring Magnet-level nursing excellence is an ongoing process in which the successful organization will continually review and revise its programs. Once a hospital has attained Magnet status, it must continue to provide ongoing work to assure that it maintains nursing excellence. While Magnet certification covers a 4-year period, the process includes interim steps to show that the facility remains in compliance with the necessary requirements of Magnet status. The first of these steps is the yearly submission of the demographic information form, which is a collection tool for nurse and unit-type data that covers a wide range of information, including patient encounters, average daily census, average length of stay, a case mix index (to serve as a global indicator of patient acuity), number of RNs by unit, turnover and vacancy rates, and nursing care hours, among others. Additionally, at 2 years after Magnet designation, the hospital must submit an Interim Monitoring Report. This comprehensive report includes a nursing satisfaction engagement survey, a summary of patient satisfaction survey data, nursing-sensitive indicator data for the most recent eight quarters (including data on patient falls and incidents of pressure ulcers), a summary of any report deficiencies, and updates on any unit openings or closings or changes in personnel. At the end of the 4-year designation period, the organization can reapply for Magnet status and, if successful, repeat this process. Through this methodical, continual monitoring, facilities remain on an upward trajectory in terms of improving nursing outcomes. In short, the Magnet designation ensures that nurses are in a work environment that allows them to work at their peak performance. ANA and ANCC are proud that Magnet promotes this goal and will continue to improve the lives of nurses and patients. Karen Daley, PhD, MPH, RN, FAAN President, American Nurses Association 44 American Nurse Today Volume 7, Number 1 www.americannursetoday.com
The HackensackUMC Difference Making History in 1995 as the first official Magnet Hospital in New Jersey, Hackensack University Medical Center is the only hospital in NJ with four designations from the American Nurses Credentialing Center. Your C ommitment Never Ceases and Neither Does Our Gratitude. Hackensack University Medical Center salutes our nurses for being honored with four prestigious Magnet designations. You set the standard for nursing excellence each and every day. And it s because of your commitment to our patients and their loved ones that they put their trust in Hackensack University Medical Center during their times of need. HackensackUMC.org 2011 Hackensack University Medical Center
MAGNET HIGHLIGHTS Highlights from the 2011 ANCC National Magnet Conference The 2011 American Nurses Credentialing Center (ANCC) National Magnet Conference was held October 4 to 6, 2011 in Baltimore, Maryland. Here we highlight some of the activities. Education programs Attendees attended a wealth of education programs. Karen Drenkard, PhD, RN, NEA-BC, FAAN, executive director of ANCC, welcomes attendees to the conference. Michael L. Evans, PhD, RN, NEA-BC, FAAN, ANCC president, speaks at the conference. Linda Aiken, PhD, RN, FAAN, FRCN, Claire M. Fagin Leadership Professor in Nursing, professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, presents research on the positive effects of attaining Magnet status. Some Magnet teams self-identified with color-coordinated clothing. Participants had learning opportunities at the many posters presented both on site and virtually. Networking and fun The conference provided networking opportunities and more. Participants sent a message of excellence. The Time Machine Welcome Party offered lots of fun, plenty of food, and great memories for participants, who dressed in clothing from their favorite decade. 46 American Nurse Today Volume 7, Number 1 www.americannursetoday.com
Art of Magnet Nursing Gallery & Film Festival The festival gave attendees the opportunity to view the results of nurses sharing their talent and passion for nursing practice. Quilt, submitted by GrantMedical Center MAGNET HIGHLIGHTS Celebrating the Profession of Nursing; photos submitted by Baptist Hospital of Miami AtlantiCare Garden of Healing: The Past Nourishing the Future, submitted by AtlantiCare Regional Medical Center Acknowledging Our Past, Living the Present, Weaving Our Future. Fabric art submitted by OSF Saint Anthony Medical Center. Participants contributed to the sewing of the 2011 ANCC National Magnet Conference quilt (left); finished quilt (right). Attendees visit the Career Center for advice. Two nurses enjoy the conference. Karen Drenkard, PhD, RN, NEA-BC, FAAN, executive director of ANCC, visits with attendees. www.americannursetoday.com January 2012 American Nurse Today 47
MAGNET HIGHLIGHTS Schwartz Center Rounds and Magnet : Enhancing patientand family-centered care This favorable combination provides a safe setting for caregivers to discuss difficult issues. By Bridget Mudge, MS, RN, CNS, BC, and Marjorie Stanzler, BA The healthcare team determines a 13-year-old girl with medically complex needs is ready for discharge but her mother demands that she stay. As part of the team, what should you do? A 2-month-old girl is admitted to the pediatric intensive care unit with multiple injuries; the diagnosis is nonaccidental trauma. The mother s boyfriend had been babysitting and brought the infant to the emergency department because she wouldn t wake up. She is intubated and has no spontaneous movement. How should you and your team work with this family to provide patientand family-centered care? A unique multidisciplinary forum, Schwartz Center Rounds (SCR) provide a safe, comfortable setting in which caregivers can discuss difficult emotional and social issues, such as those described above. Unlike traditional rounds, which focus on the patient, diagnosis, and plan of care, SCR focus on the human dimension of health care. They give caregivers the chance to share their experiences, thoughts, and feelings on thought-provoking topics based on actual patient cases. The premise of SCR is that caregivers are better able to make personal connections with patients and colleagues when they have insight into their own feelings and responses. To sustain compassion and prevent burnout, clinicians need a chance to reflect, share their challenges and successes, and support each other in ways not otherwise possible in their fast-paced work environment. The Schwartz Center for Compassionate Healthcare, housed at Massachusetts General Hospital in Boston, developed the SCR format in 1997. Currently, SCR are held in 245 sites, including 34 organizations with Magnet designation in 35 states. These rounds are expanding to new sites each month. Caregivers sharing their perspectives A hallmark of SCR is dialogue with the participation of professionals from diverse disciplines. The casebased format stimulates discussion on a given topic with a skilled facilitator who encourages interaction and highlights salient points. A clinician leader and planning committee choose a case and a panel of two or three caregivers to briefly share personal perspectives on the social and emotional issues involved. The rest of the hour is devoted to a give-andtake discussion, with caregivers in the audience sharing their perspectives and experiences. The facilitator (typically a social worker or psychologist) helps direct the discussion. Patient identifiers are omitted to protect confidentiality; all participants are expected to maintain caregivers confidentiality. Typically, caregivers are trained to problem-solve and develop action plans, but that s not the purpose of SCR, which encourage open discussion of emotions. A skilled facilitator can divert discussion from problem solving by framing issues from a different perspective. For example, at a rounds about an angry parent, the facilitator reminded participants that anger comes from fear. Recognizing this helped caregivers realize the anger wasn t directed at them personally. Rounds are a place to come together and share support and validation for one another. They meet a deep need and fulfill a hole in the clinical community. Rounds participant SCR at Children s Hospital at Dartmouth In 2002, Children s Hospital at Dartmouth (CHaD), part of Dartmouth-Hitchcock Medical Center in New Hampshire, introduced SCR after observing them in Boston. Although CHaD already had case conferences and ethics rounds, SCR offered a forum for a facilitated discussion and participation of a broad spectrum of pediatric providers and staff from both inpatient and outpatient locations. Participants in monthly SCR at CHaD include physicians, nurses, social workers, psychologists, physical therapists, care managers, hospital administrators, and clergy. Average attendance is about 40. CHaD s multidisciplinary SCR planning committee includes a chaplain, a physician, two nurses, a social worker, a child life specialist, and a facilitator. 48 American Nurse Today Volume 7, Number 1 www.americannursetoday.com
Carilion Clinic 1906 Belleview Avenue Roanoke, VA 24014 800-599-2537 Dana Johnson dejohnson@carilionclinic.org www.carilionclinic.org Level 1 trauma center. Aspire to be among the best. Carilion nurses are Committed to finding better ways to improve the health of the communities we serve. Thriving in an empowered practice environment that is guided by transformational leaders. Dedicated to the professional development and advancement of nurses as expert practitioners, researchers, teachers, and mentors. Respected and rewarded for the work they do within the hospital and among many communities in southwest Virginia. Actively engaged in interdisciplinary evidence-based initiatives that improve patient care and safety using the most advanced technologies and innovative strategies. Carilion Clinic is an Equal Employment Opportunity/Affirmative Action Employer. Cleveland Clinic: Main Campus & Fairview Hospital 9500 Euclid Ave. Cleveland, OH 44195 216.448.0305 Susie Vrabel vrabels@ccf.org clevelandclinic.jobs Cleveland Clinic is ranked as one of the nation s top four hospitals by U.S.News & World Report. Both our Main Campus and Fairview Hospital have achieved Magnet Status. Visit clevelandclinic.org for more information. Children s National Medical Center 111 Michigan Ave, NW Washington, DC 20010 202-476-5397 Sharon Livingston, MA, BSN, RN slivings@cnmc.org www.childrensnational.org 283 Beds Level IIIC NICU; Level I pediatric trauma center; Critical Care Transport Teams; Magnet recognized facility; CICU & PICU received Beacon Award for Critical Care Excellence; Regional referral center for cancer, cardiac, orthopaedic surgery, neurology, and neurosurgery. Children s National Medical Center, located in Washington, D.C., is a proven leader in the development of innovative new treatments for childhood illness and injury. For more information about Children s National Medical Center, visit www.childrensnational.org. South Shore Hospital 55 Fogg Road South Weymouth, MA 02190 (781) 624-8796 Jeanne Waller Jeanne_Waller@sshosp.org southshorehospital.org 318 Beds Initial Magnet designation in 2010, Level II Trauma Center, designated Stroke Center, Level III Maternity, regional Cancer Center, third busiest emergency department in Massachusetts. More than 20 clinical nurse specialists with robust Shared Governance model. Magnet facilities outperform other hospitals in both recruiting and retaining nursing professionals, resulting in higher employee satisfaction and lower staff turnover. Hackensack University Medical Center 30 Prospect Ave., Hackensack, NJ 07601 551-996-2000 Karen Hanson KHanson@HackensackUMC.org www.hackensackumc.org 775 Beds John Theurer Cancer Center Heart & Vascular Hospital Joseph M. Sanzari Children s Hospital DON IMUS/WFAN Pediatric Center for Tomorrows Children Donna A. Sanzari Women s Hospital Jeffrey M. Creamer Emergency Trauma Center HackensackUMC is a 775-bed teaching and research hospital and is the fourth largest hospital in the nation based on admissions. Founded in 1888 with 12 beds and as Bergen County s first hospital, HackensackUMC has demonstrated more than a century of growth and pro - gress. Today, this not-for-profit, tertiarycare, teaching and research hospital serves as the hub of healthcare for northern New Jersey and the New York metropolitan area. UNC Health Care 101 Manning Drive Chapel Hill, NC 27514 919-966-2012 or 1-800-852-NURSE (toll-free) Nurse Employment Office www.unchealthcare.org 803 Beds Beacon Award for Critical Care Excellence American Association of Critical Care Nurses. Our Cardiothoracic Intensive Care Unit was a recipient in 2008, 2010 and our Cardiac Intensive Care Unit received the award in 2010. ANCC s Magnet Recognition is not an award; it is a credential that is earned by the designated hospitals. MAGNET HIGHLIGHTS www.americannursetoday.com January 2012 American Nurse Today 49
MAGNET HIGHLIGHTS The committee publicizes SCR, schedules presenters from rotating departments, monitors evaluations, and plans the budget. SCR topics Cases and topics are chosen because they are particularly poignant or difficult and raise issues relevant to a wide range of caregivers. Some topics are selected for their timeliness. For example, during the H1N1 flu outbreak, one topic was titled When you want the H1N1 flu shot and can t get it, and when you can get a H1N1 flu shot and don t want it. Challenges While attendees find SCR an overwhelmingly positive experience, a few challenges have arisen. For one, getting staff nurses to attend can be difficult. Rounds are at noon, and covering nursing staff for 1 hour isn t always easy. Choosing a case in which a bedside nurse was very involved is a way to encourage other nurses and nursing leaders to attend. Maintaining patient and staff confidentiality can be difficult, too. CHaD staff have learned how to set firm ground rules on confidentiality. They are encouraged to continue to discuss the topic on their floors or units without identifying the case or attributing specific statements to specific caregivers who attended rounds. Benefits of SCR A few years ago, the Schwartz Center hired an independent evaluation and research firm to conduct a comprehensive evaluation of SCR using a mixedmethod approach and quantitative and qualitative data. It showed SCR have a unique and profound impact on caregivers as well as host institutions. Caregivers who participated in multiple rounds sessions reported: increased insight into the social and emotional aspects of patient care, greater compassion toward patients, and increased readiness to respond to patients and families needs improved teamwork, interdisciplinary communication, and appreciation for the roles and contributions of colleagues from different disciplines decreased feelings of stress and isolation, and more openness to giving and receiving support. (See SCR evaluation results.) Rounds are a place where people are willing to share their vulnerability, to question themselves. They are an opportunity for dialogue that does not happen anywhere else in the hospital. Rounds participant SCR counter hospitals hierarchical structure by humanizing caregivers and creating an equal playing field. Many evaluation respondents said SCR make a unique and profound contribution, helping SCR evaluation results Results of a recent evaluation of Schwartz Center Rounds (SCR) found the rounds had a positive impact on patient care and teamwork. 87% of respondents reported that SCR led to new ideas and strategies for challenging patient situations. 84% said SCR increased their compassion for patients and families. 93% reported a greater appreciation for the roles and contributions of colleagues from other disciplines. 88% gained a sense of belonging to a caregiver team. 76% said they felt less alone in working with patients. If you re interested in starting SCR at your facility, visit www.theschwartzcenter.org. to change the culture of their organization and setting a new standard of care. Participants have reported that insights gained at SCR have led to implementation of specific changes in departmental or hospital-wide practices or policies that benefit both patients and providers. The study found that the more rounds caregivers attended, the more benefits they experienced. Rounds and the Magnet environment Incorporating SCR into the culture of CHaD supports a Magnet environment by providing a forum that encourages reflection on patient care. SCR foster an open dialogue, increased interdisciplinary collaboration, mutual respect, better conflict management, and collegial relationships. They allow staff to gain new knowledge and understand both the independent and dependent role of nursing as part of the care team. SCR promote the model of patient- and familycentered care a goal at Dartmouth-Hitchcock. Principles of patient- and family-centered care include respect and dignity, information sharing, participation, and collaboration. Respecting patient and family choices and developing a meaningful relationship can be difficult when the family s choices differ from what caregivers may consider right. This dilemma is often at the heart of discussions in SCR, which offer a way to recognize and work through such conflict. Selected references Fowler M, ed. Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: American Nurses Association; 2008. Lown BA, Manning CF. The Schwartz Center Rounds: an evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Acad Med. 2010 June;85(6):1073-81. Wolf G, Triolo P, Ponte PR. Magnet Recognition Program: the next generation. J Nurs Adm. 2008 April;38(4);200-4. For a list of sample SCR topics, visit www.americannursetoday.com/ Archives.aspx. Bridget Mudge is a pediatric clinical nurse specialist at Children s Hospital at Dartmouth (part of Dartmouth-Hitchcock Medical Center) in Lebanon, New Hampshire. Marjorie Stanzler is Senior Director of Programs at the Schwartz Center for Compassionate Healthcare in Boston, Massachusetts. 50 American Nurse Today Volume 7, Number 1 www.americannursetoday.com
A hospital s Magnet redesignation drive spurs efforts to improve patient safety Magnet appraisers questions increase the author s determination to reduce patient falls. By Brenda Wolles, RN, OCN MAGNET HIGHLIGHTS ANT July Ads:Layout 1 10/27/11 7:48 PM Page 42 Brenda Wolles My first exposure to a Magnet redesignation initiative occurred in 2008 when I served as a member of our hospital s house-wide falls committee. The medical/oncology floor had a higher-than-average number of patient falls, and one of the Magnet appraisers challenged me with two questions: What s unique about your med/onc patient population? What interventions are you using specific to this population? After the appraisers visit, I approached my role on the falls committee with renewed energy, determined to answer these questions and decrease falls on the med/onc floor. While reviewing patient fall data for one calendar year (2008), I discovered several interesting facts about patients on that floor: They were younger (mean age 59) than those typically studied in falls research (age 65); about 30% of oncology patients who fell on our med/onc Subscribe Ways! 1 Now you can subscribe 2 2 different ways! There are two convenient ways for you to stay current with evidence-based, peer-reviewed clinical, practical nursing information that can impact your practice right away! Only American Nurse Today, the dynamic voice of nursing, offers you a choice of the way you receive your subscription! 1 Print Plus 12 issues 6 print issues PLUS access to all digital products including 6 electronic issues of American Nurse Today, e-edition, and archives. $29.90 2 Digital Only 12 issues all issues delivered electronically to the email address you provide during the subscription process as well as access to the e-edition and archives. $9.99 The choice is yours. It s as easy as 1-2! Go to www.americannursetoday.com/subscribe.aspx to order now! Or call 215.489.7000 ext. 119 to order by telephone. just another way we go well beyond. At Cleveland Clinic, we offer an excellent benefits package and a wellness program with an abundance of resources to promote your best health. Join us and discover how collectively we can pave the path to a promising future. Be a world class caregiver. clevelandclinic.org/ant We are proud to be an equal opportunity employer. Smoke-free/drug-free environment. www.americannursetoday.com January 2012 American Nurse Today 51
MAGNET HIGHLIGHTS floor were age 55 or younger, and 49.6% were younger than age 65. Also, more than half the total falls occurred among patients in or on their way to the bathroom. A nurse researcher and unit director supported a retrospective study to explore characteristics of fallers among oncology patients on the med/onc floor. Study results showed oncology patients who fell had a higher use of therapy services and were twice as likely to be discharged to somewhere other than the home. These data were shared in a poster presentation at a local research- and evidence-based practice conference. Combined with the knowledge that most falls were bathroom-related, they led to the first intervention for our adult oncology population: A commode was placed in each patient room on the floor. Subsequently, the fall rate decreased from 67 falls in 2008 to 39 in 2009. As the unit champion, I took on the task of tracking and evaluating each patient fall on the med/onc floor and educating staff through lunch and learns, morning huddles, and yearly skills validations. Focused fall-prevention activities include ongoing fall risk and intervention education, close monitoring of each fall event, and review of all variances. I initiated a proactive fall-risk assessment now performed on all patients quarterly; the resulting data are disseminated to staff in daily staff huddles and have been shared via a poster presentation at a regional conference. Through webinars, I continue to engage in learning about patient falls. Since the last Magnet appraisers visit, the fall rate on the med/onc floor has decreased significantly; for seven of the last eight quarters, it has been at or below the national benchmark. On implementation of the proactive fall-risk assessment, that floor went 54 days without a fall. Staff took pride in this success and celebrated a fall-free February on March 2, 2011. The med/onc floor is now a safer place for patients. On a personal level, I ve grown since the last Magnet appraisers visit. Currently, I m enrolled in an RN-to-master s degree bridge program. Also, I m a co-principal investigator in a research project that will study the role of fatigue and fall risk in hospitalized oncology patients. Recently, my facility received a J. Patrick Barnes Grant for Nursing Research and Evidence-Based Practice to study the relationship of cancer-related fatigue to falls and fall risk in a hospitalized oncology population. I am grateful to the Magnet Recognition Program for challenging my colleagues and me to advance our nursing skills and provide safer patient care. Brenda Wolles is a clinical care coordinator at Sanford USD Medical Center in Sioux Falls, South Dakota. Connecting To What Really Matters: Patients and Families Children s National Medical Center is designated as a Magnet * Hospital. Our dedicated Professional Registered Nurses have earned this designation because of their exemplary care and outcomes. Our nurses acknowledge that their practice allows the special gift to enter sacred spaces between children and their families. This relationship is part of a precious circle where trust is implicit and where professional nurses are part of the patient and family s joys and challenges. We are proud to be a Magnet Hospital: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, and Improvements; and Empirical Outcomes. For additional information, please visit: www.childrensnational.org eoe, m/f/d/v *Magnet status is granted by the American Nurses Credentialing Center, the world s largest nurse credentialing organization and a subsidiary of the American Nurses Association (ANA). The Magnet Recognition Program, ANCC Magnet Recognition, Magnet, National Magnet Conference names and logos are registered trademarks of the American Nurses Credentialing Center. Journey to Magnet Excellence TM is a trademark of the American Nurses Credentialing Center. All rights reserved. 52 American Nurse Today Volume 7, Number 1 www.americannursetoday.com
VCU Health System 1250 E. Marshall Street Richmond, VA 23298 804-628-0918 www.vcuhs.jobs Gale Rose grose@mcvh-vcu.edu 779 Beds Level 1 Trauma Center; over 200 Specialty areas, to include Hume-Lee Trans plant Center, Stroke Center, Massey Cancer Center, Harold F. Young Neurosurgical Center, Evans-Haynes Burn Center, Pauley Heart Center and the Children s Hospital of Richmond. VCU Medical Center is an internationally-recognized, Magnet-designated regional referral center on the forefront of health care, providing the most progressive treatments and medical technology available. Ranked among the top centers nationwide by U.S.News & World Report, VCU Medical Center is a seventime Working Mother magazine 100 Best Company, a recipient of the Alfred P. Sloan Award for Workplace Flexibility and one of only eight hospitals nationally with five or more unique AACN Beacon Award for Excellence recipients. MAGNET HIGHLIGHTS Index Carilion Clinic... 49 Children s National Medical Center... 49, 52 Cleveland Clinic... 49, 51 Hackensack University Medical Center... 45, 49 South Shore Hospital... 49 UNC Health Care... 49, 53 VCU Health System... 53 MAGNET HIGHLIGHTS KEVIN Registered Nurse WE VE BUILT OUR REPUTATION AS AN EXCELLENT EMPLOYER, ONE PERSON AT A TIME. The benefits of working as a nurse at VCU Health System are clear. We re a Magnet hospital the first in Richmond to achieve this prestigious designation and the first to gain re-designation, a seven-time Working Mother magazine 100 Best Company, a 2011 Richmond Employer of Choice and a recipient of the 2011 Alfred P. Sloan Award for Workplace Flexibility. As a great place for work/life balance, we provide child and elder care, flexible work options, extensive medical benefits, competitive pay and pre-paid tuition. Everything you need for a wonderful nursing career can be found here at VCUHS. Discover all that VCU Health System has to offer at www.vcuhs.jobs. at UNC Health Care Find Career Opportunities in Chapel Hill, NC www.unchealthcareers.org EOE/AA. Women, minorities, veterans and persons with disabilities are encouraged to apply. www.americannursetoday.com January 2012 American Nurse Today 53