Transition Quiz 2
Face to face interview
critical first 5 minutes! - show up at least 10-15 mins early - be aware of body language: eye contact, try to avoid distracting nervous manneurisms - dont shake your foot - dont have a beverage with you - dont chew gum -smile - demonstrate interest in what they have to say - wait to answer questions about salary and benefits until all other aspects are done - ask if they mind if you take notes -can bring a list of questions if you need
End of life decision making
decisions to withdraw or withhold nutrition and hydration from patients are the subject of ongoing debate by ethicitis, health care personell, and the legal system - the ethics committee of the ANA developedguidelines that state that there are instances when withholding or withdrawing are morally permissable - although intended only as a guideline, this document provides direction for nurses who face such issues - its wording has been praised - the primary exception to the withdrawal of hydration and nutrition is when harm from these measures can be demonstrated
BSN for entry: against
- Many hospital employees do not have the time to commit to school as a full time student due to financial needs and family needs BSN Programs typically do not allow for full time work along with school, ASN programs hae more flexibility - By utilizing LPNs to work within their full scope of practice, there is a substantial decrease in workload for the RN. RN's will have more time to provide quality patient care with LPN assistance
Assessing an organization
- Talk to people in the organization - Read and analyze the recruitment materials - Mission or philosophy statement - Reputation of the leadership - Do they use a nursing theory or philosophy
Spirituality
- a universal concept relevant to all iondividuals - uniqueness of an indiviudal is paramount - formal religious affiliation is not a prereq for sprituality - may be more spritually aware during a time of need
Extrinsic cost factors
- availability of technology, prescription drug costs, and workforce costs - prescription drug spending
Cultural competence
- competent nurses have an enhanced ability to provide high quality care which fosters better patient understanding and invovement in plan of care - ensuring that written instructions are appropriate and given -use translators - learn how to use cultural assessment tools - continuing education and trianing for nurses, - important to have diversity in the profession -
Informed consent
- doctor needs to explain the information, and witness the signature - must be signed when a patient is considered capable to make informed decisions - informed consent is not required if the procedure is necessary to save a life and is done during an emergency - as advanced practice nurses perform more invasive procedures, the process of informing the patient of what is to occur is the advanced practice nurse's responsibility
Suggested strategies for self care base on the hollistic self assesment tool: factors in people with healthy self esteem
- face, manner and way of talking and moving that project the pleasure one takes in being alive - ease in talking of accomplismentsor shortcomings with directness and honesty - an attitude of openness to and curiosity about new ideas, experiences, possibilities of life - openness to criticism and being comfortable about acknowledging mistakes because one's self esteem is not tied to an image of perfection - an ability to enjoy the humerous aspects of life in oneself and others - key to growing self esteem is become aware of the areas that need to most work and work on them
The mentor: characteristics
- high expectations - good listener - empathy -encouragement - generous - takes a long term personal interest in your career - role model, counselor, advises, guides, and promotes you in your career - can be there for you for years - trust and caring are hallmarks of the bonding that occurs between the two - a wise and trusted advisor that can serve you well as you experienced both professional and personal growth
Role of the mentee
- learning and absorbing the useful information that the mentor provides -make sure you communicate clearly - welcome input - take initiative to maintain relationship with them - actively explore options with mentor - share results with them - listen for the whole message - be alert for mentors nonverbal communication and use it as data -accept constructive feedback
Mentoring through reality shock
- mentors encourage them to discuss their feelings of disillusionment and frustration and share their own personal transition process through this phase - asking mentees to write down their feelings or sharing ideas for a possible resolution can be helpful in mitigating feelings associated with this phase
Floating to another unit
- sometimes pt volumes are lower on units so you are floated -not on your assigned unit, dont know where things are and certain policies - the more patients a nurse has the more room for error - it is unethical for a nurse to refuse an assignment if it is reasonable, could cause unreasonable workloads on other floor - on the other hand, organization owes its nurses, and patients an orientation session on all the units to which they are assigned - talk with advisor about experience and make sure you are oriented to the unit before being asked to float there - ask to be assigned to less complex patients if you are not comfortable - report any bad experiences
Workplace violence
- the act or threat of violence, ranging from verbal abuse to physical assaults directed towards persons at work or on duty - impact can range from physical injury to psychological damage - nurses often fail to report because of lack of understanding of rerporting guidelines by their employers or a belief that reporting will not change -failure to report can contribute to escalation of the situation until physical violence occurs - very real - risen since covid - most frequently reported causes include staffing shortages, visitor restrictions, and changes in patient populations - Workplace Violence Protection for Health care and social service workers act requires violence prevention programs in both health care and social service sectors
RN as team leader
- the team leader determines work assignments for the team on the basis of the acuity level of the group of patients and the ability of the individual team members - success of the team depends on good communication among team members - team leader needs to continuously evaluate and communicate changes in the patients condition to the team members -team conference allows access to assess the needs of their patients and reverse their own individual plans of care - team model helps with patient assignments
Common problems for new grads
- time management skills - increasing acuity of patients - feeling powerless, depressed and insecure
symptoms of compassion fatigue
- triggered by prolonged exposure to traumatic experiences of patients - sudden and acute onset - mirror ptsd symptoms - insomnia, difficulty falling asleep, nightmares - irritability or outburst of anger - exaggerated startle response - depression, sadness, grief - witness guilt -addiction detachment, diminished intimacy
Mentoring
- trusted advisor, friend, teacher, guide, wise person - mentoring requires a primary focus on needs of the mentee and an effort to fulfill the most critial of these needs - requires going the extra mile for someone else, the rewards are huge, a sense of personal achievement, mentee appreciation, and a sense of building a better organization - partnership created between two people, the mentor possesses the education degree to which the mentee aspires
Malpractice
- when they make a mistake or decision while being aware of the potentially harmful consequences - medication administration failures, botched treatment, failure to provide treatment, failure to monitor or failure to accurately update patient records. - Any time a nurse provides substandard care, that is an example of nursing malpractice. -
Self care strategies importance
- you are caring for others, need to care for yourself first to do so - compassion fatigue from dealing with emotional situations - engage in activities that promote a healthy lifestyle - this takes time, knowledge, motivation, effort but its essential to manage stress - physical illnesses can lead to cardiovascular problems, stress, migraines, IBS, depression, muscle and joint pain, insomnoa, anxiety
Managing tasks
- you should prevent procrastination cause it will just end in multi-tasking which you do not want to have to juggle - consider the consequences (if something will happen if you dont do it just do it) - the earlier the better -study hard concepts first -chunks of 50 min study sessions - 10 min break after - keep a calendar, to do lists - before starting a project know your goals and what you are doing - reward yourself -avoid the myth of perfection
Agents of bioterrorism
-Anthrax (Bacillus anthracis) -Plague (Yersinia pestis) -Smallpox (variola major) -Botulism (Clostridium botulinum) -Tularemia (Francisella tularensis) -Viral hemmorhagic fevers (Marburg virus, Ebola, Lassa fever)
Recovery phase of reality shock
-Beginning to have sense of humor (first sign). -Decrease in tension -Increase in ability to be objective
Shock and rejection phase of reality shock
-Has excessive mistrust -Experiences increased concern over minor pains and illness -Experiences decrease in energy and feels excessive fatigue. -Feels like a failure and blames self for every mistake -Bands together and depends on people who hold same values -Has hypercritical attitude -Feels moral outrage
How to prepare yourself for the transition process
-begin increasing independence - more realistic patient care assignments - clinical hours that represent realistic shift hours - perform nursing procedures instead of observing - more truth about the real work setting experience - look for opportunities to problem solve and practice critical thinking -request constructive feedback from staff and instructors - request clinical experience in an area or hospital of interest
Spiritual competence
-impt for nurses to refrain from imposing their spiritual beliefs on patients because spiritality is subjective experience and differs from one person to another - essential to include the subjective spiritual assessment of pts spiritual needs to make sure there is a plan for providing ongoing interventions and evaluation of effectiveness - prayer, being present and active listening, providing guided imagery, support activities like music, art, reading and being outdoors, journaling, therapeutic message or touch, meditation, visits with spiritual or religious advisors -
Nurse Practice Act- scope of practice
-perhaps the most important guideline for nurses will be the Nurse practice act in the state where you are practicing - most acts describe what a nurse may or may not do - prohibitions or things that are unprofessional conduct are usually more specific - Nurse practice act violation usually means you have fallen below a standard of care set by the state for nurses - also may mean you risk an action against your license - need to know these prohibitions - range of permissable activity that is defined by the law, in essence it defines what nurses can and sometimes more important cannot do - great variation from state to state - some states are more broad than others
Self care strategies
-take up hobbies - go on walks listen to podcasts -mindfullness -yoga - work at a place that aligns with your goals
How to prepare yourself for the transition process
-think positively - be flexible - get organized -stay healthy - find a mentor - find other new grads -have some fun - know what to expect
What influences transition
-transition does not take place automatically - having the optimal experience during transition takes a lot of attention, planning and determination -how you handle it will determine how you will progress through the process - keep a positive attitude - expected to have various emotions, will affect your physical and emotional well being but you will be ok
Transitions
-transitioning into being a nurse from being a student - new grads need a period of time to develop skills in a supportive environment - hospitals need to take into account the well being of the nurse to care for patients during transition -need to be able to critically think, decision make and clinical judgement
signs of burnout
-triggered by work related issues and dissatisfaction - occurs gradually - irritability, anger, frustration - negative reactions toward others - weight changes, headaches, gi distuburbances, chronic fatigue - feeling of personal inadequacy - negativity, cynicism, and decreased engagement and productivity at work
NCSBN's transition to practice model (TTP model)
0-6 months - preceptor to nurse relationship - transition modules - patient centered care - commiuncatoopn and teamwork - ebp - quality improvement and informatics 6-12 months - ongoing institutional support
Phases of reality shock
1. Honeymoon phase 2. Shock and rejection phase 3. Recovery phase
Characteristics of successful mentors
1. Make a personal commitment to be involved with mentee for an extended period of time 2. Be trustworthy and sincere 3. Show mutual respect 4. Do not be in a position of authority over the mentee 5. Promote an easy give-and-take relationship, and be flexible and open 6. Listen and accept different points of view 7. Be experienced 8. Have values and goals compatible with those of the mentee 9. Be able to empathize with mentee's struggles 10. Be nurturing 11. Have a good sense of humor, and enjoy nursing
What info is necessary for a resume
demographic data: who are you? - name, mailing address, number, email, employer and name and number summary of qualifications (professional objective) for what position are you applying - summary of qualifications has become more common td than professional objective -skills you have Education: where did you receieve Professional experience - easy to read is the goal - list most recent at top Licensure: what can you do and where can you do it Professional Organizations:to which do you belong Honors and rewards: for what did you receive recognition References: Who knows about you -cover letter: brief introduction
Universal patient records: For
A Universal Patient Patient Record is a comprehensive digital record of an individual's health and medical history. It is designed to be accessible nationwide across various healthcare providers and settings. - Streamline health information: Provide access to information across healthcare venues Improve continuity of care: Aggregate patient data and will create cost savings by streamlining administrative systems Decrease in medical waste: less over-utilization of healthcare resources, decrease duplicate testing, reduction in printing & faxing supplies and machinery, and paper usage. Error Reduction: Decrease medical errors by having access to accurate and current medical information.
ANA code of ethics
ANA: organization that provides support to advance the nursing profession, advocates in Congress, and sets the standards for nursing worldwide ethics: rules or principles that determine which human actions are right or wrong - this code is a statement to society that outlines the values, concerns, and goals of the profession - should be capatible with the individual nurse's personal values and goals - the code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse-patient relationship entails
BSN required for entry: For
According to reports by the NCLEX, [in 2020] "Roughly 90 percent of candidates with a BSN passed theexam compared to roughly 82 percent of candidates with an ADN. The education that a BSN provides canbetter prepare you for this exam." (Post University) -New York recently passed a law that requires all new nurses that obtain a license in the state ofNew York have to get their BSN in the next 10 years if they do not have it already- They expect that many other states will follow with their own legislature because the Institute ofMedicine's Future of Nursing Report called for at least 80% of RNs to obtain their BSN In the May 2013 issue of Medical Care, researchers from the University of Pennsylvania, led by Dr.Matthew McHugh, found that surgical patients in Magnet hospitals had 14% lower odds of inpatientdeath within 30 days and 12% lower odds of failure-to-rescue compared with patients cared for innon-Magnet hospitals" (American Association of Colleges of Nurses
Universal patient records: against
Adopting a Universal Patient Record introduces unethical privacy and security concerns, has large-scale implementation challenges, and completely upends the core of patient care; in person patient-provider interaction.
Shift length: 12 hours
Benefits of 12s: - Fewer Patient Handoffs More Meaningful Nurse-Patient Relationship Better Work Life Balance Flexible Schedules More Days Off Lower Stress Levels Improved Durations and Quality of Off Duty Sleep Improvement in Family Relations Added Financial Benefit Lower child care costs Less Schedule Conflict
Shift length: 12 hours
Cons of 8s: Fewer Days Off Per Week Lower Inter-Shift Recovery Less Choice in Scheduling Increased Commuting Time Associated with higher levels of stress, poor cardiovascular health and reduced sleep More Patient Hand Offs can Negatively Impact Patient Care/ Safety
Madatory overtime: For
Continuity of Care - Allows for a comprehensive understanding of a patient's specific needs and consistent care of that patient Improved Working Conditions - More people working = more hands to help, fostering a more supportive working environment. Solution to staffing shortages - A set number of hours required eliminates the risk of unsafe staffing. Improved Patient Outcomes -Having fewer patients will give nurses more time to follow detailed individual care plans Overtime Pay - Nurses are compensated for extra hours with time and a half pay
Mandatory staffing ratios: for
Cost - Paying for adequate staffing The cost of adequate staffing for ratios dependent on the unit outweighs the cost that the hospitals have to pay for preventable hospitals deaths essentially saving the hospital money Promotion of Nursing - Main reasons why nurses leave the profession: Burnout Inadequate staffing Frustration with leadership feeling under appreciated Feeling unsafe at work Staffing ratios facilitate healthy work environments and patient safety regulations enhancing the care of nurses, keeping retention rates high and giving nurses the help they deserve
Ergonomic hazards
Ergonomic risk factors are workplace situations that cause wear and tear on the body and can cause injury. These include repetition, awkward posture, forceful motion, stationary position, direct pressure, vibration, extreme temperature, noise, and work stress. - puts them at risk for musculoskeletal injuries - most prevalent injuries are resulting in sprains, strains, or tears - many affect the back which are most debilitating -
Ethical principles: cont
Fidelity: duty to be faithful to commitments - keeping info confidential and maintaining privacy and trust - who has right to patient medical records, etc Justice: duty to treat all patients fairly, without regard to age, socioeconomic statys, immigration states or other variables - involves the allocation of scarce and expensive health care resources - should uninsured patients be allowed to the the ED for nonemergency care, the costliest route for delivering this care - who should be paying for their care Veracity: the duty to tell the truth - may become an issue when a patient who suspects that her diagnosis is cancer asks you: nurse, do I have cancer? - her family has request that she not be told the truth because their culture believes bad news takes away all hope for the patient
Types of mentoring relationships
Formal: Mentor/Mentoree assigned to one another by mgmt. of organization for a specific purpose (productivity, job success, satisfaction) May be time limited and less intense relationship building Informal: Situational: Mentoree seeks out a mentor for/ to meet an acute need (specific intervention technique, statistical analysis of research) Long-term interpersonal relationship to meet long-term needs Situational - brief contact, often casual - a one time event - results assessed later
BSN for entry: against
Healthcare companies need staff quickly due to the present shortage ASN Programs allow nurses to practice within two years, so they are able to begin working sooner They can also bridge to BSN while working - BSN costs on average 40,000-100,000 per year ASN Programs on average only cost $2,500-15,000 per year Many individuals cannot afford to be in BSN programs that also will not allow for full time work furing school - Both degrees give the nurse what is expected of them in order to succeed in the clinical field ASN and BSNs take the same NCLEX-meaning they are held to the same standard of nursing practice and ethics
Shift length: 8 hours
Higher quality of safety- Decreased risk of patient care errors Decreased risk of burnout and job dissatisfaction Decreased risk of the development of physical and cognitive disorders There is greater patient satisfaction when nurses work 8 hour shifts Lesser chance of on the job injuries
Use of travel nurses: against
Job insecurity and unreliable finances - Each contract that you undertake with an institution will have varying pay rates. ➢ Travel nurses face a lack of job insecurity as their nursing contracts may be terminated at any time, for any cause. The hospital may find they don't have the patient numbers to sustain employment or the staff numbers have returned to normal levels. ➢ If agencies do not offer benefits, the travel nurse will have to individually account for their own benefits. Compact License - Popular destinations such as NY, HI, CA do not accept compact licenses which may leave travel nurses scrambling for a new license before their contact begins, and out a few hundred dollars. Bait and Switch Contract - Often companies will bait and switch travel nurse contracts. You can be contracted for a preferred speciality and then floated permanently to a less desirable floor.
Fiscal responsibility
Knowing what to do with your money - includes having insurance, maintaining a budget, saving and investing for the future, etc.
Universal patient records: For
Makes care further transparent: - Providers can see previous interventions done, patients' can access record in one streamlined place Improve quality of care: - Increase time spent by the healthcare team on interventions and less on history taking. Better management of chronic conditions with streamlined team communication. Cost reduction: - Reduces administration cost by removing decentralized IT systems, decrease cost spent on medical waste, Patient identifier to ensure security: - Patient's will have a unique identification code that changes often to ensure privacy. Improved emergency management: - Providers can learn a patient's medical history that is essential in an emergency when the patient is unable to communicate
Neuman
Neuman systems model - focuses on wellness and mitigating stress within 3 levels of prevention - primary, secondary and tertiary primary: before illness: exercising, sleep, 8 hours, balanced diet secondary: when illness hits, when person with MI comes to hospital tertiary: what is done to rehabilitate a person after an illness: stroke rehab -flexible lines of defense, normal lines of defense and lines of resistence - flexible: outermost boundary initial response to stressors: lack of sleep, eating well -normal: what protect us from stressors: physical health, genetic, spiritual belief, gender - when equillibrium is affected: lines of resistence take over: to restore balance, similar to immune system - diagnosis, nursing goals and outcomes - internal, external and created environments
BSN required for entry: For
Nurses with a BSN are more educated in their practice and have more clinical experience, which has provedto lead to lower mortality rates and safer, more ecient patient care.. as stated in the evidence previouslypresented.● Having a bachelor's degree in nursing gives you a strong educational foundation that prepares you forpassing the NCLEX, and gives you a broader variety of career options.● Having a BSN can lead you to, and sometimes be essential for, leadership opportunities as well as being astepping stone to higher education. A BSN is required for some specialties in nursing, including beinginvolved in nursing informatics and becoming a nurse manager.
Madatory overtime: For
Nursing shortages across the nation are impacting patient care outcomes, timely interventions by nursing staff, job satisfaction, and various other aspects. Mandatory overtime plays a crucial role in addressing these unsafe staffing ratios, resulting in reduced burnout among nurses, fewer mistakes, increased support, and ultimately, improved patient care outcomes. - Mandatory overtime contributes to many factors that benefit all parties involved. Besides contributing to improving staffing ratios, continuity of patient care is a leading factor in improving working conditions for the nurse as well as improving the quality of patient care. Additionally, implementing mandatory staffing will be the solution to emergency situations, eliminating the fear of not enough staff during unexpected times of need. Mandatory overtime has a negative connotation associated with it that leads to many benefits being overlooked.
Use of travel nurses: against
Patient safety - Each hospital has different units, equipment, electronic medical records, protocols, and policies. A shortened orientation can present as a safety concern for patients when travel nurses are given one or two days to fully orient to an entirely new environment. ➢ Travel nursing creates a lack of stability in the workplace for both travelers and regular staff on a unit. It is impossible to build rapport and a sense of comradery when new coworkers are constantly starting up. This can affect the focus of nursing staff, as well as their ability to trust and ask for help when necessary to ensure patients are getting the care they deserve. ➢ Frequent staffing turnover can lead to miscommunication and major inconsistencies in care for patients when it comes to report, resulting in an unsafe environment and difficulty building trust with patients and other members of the healthcare team.
Rogers
Science of Unitary Human Beings addresses the complexity of unitary human being. Which allows for the examination of phenomena (energy fields, paranormal), that other theorists do not describe, as nurses promote suncrhonitcity between human beings and their environment or universe - what you think is healthy of yourself may be different for the patient - complementary practices, other forms of therapy, believed diseases wouldn't be a thing in space cause of gravity - wave patterns and vibes? lol
Orem
Self care nursing theory 3 layers 1) self care 2) self care deficit 3) the nursing system that helps the nurse identify strategies to help meet the patient's self care needs - a nurse may need to do everything for the patient, or some, or educate the patient nurse would ask " what can the patient do for themselves, and what do i as the nurse need to do for the patient
Use of travel nurses: against
Staffing - Over reliance on travel nurses can indicate deeper issues within the healthcare system such as chronic understaffing or retention problems. Instead of addressing the root cause, hospitals may opt for a quick fix and hire travel nurses ➢ They also come at a higher cost due to higher hourly rates, housing stipends, and recruitment fees and the use of travel nurses is sometimes associated with worse patient outcomes based on limited research ➢ Building nursing teams comprised of full time nurses can solve this inequity Nursing burnout - Animosity developed between permanent staff and travel nurses, particularly surrounding pay differences, can complicate the travel nurses' transition to a new unit and lead to faster burnout. ➢ Navigating a new organizational culture and attempting to access unknown networks for support can also create additional stress for travel nurses. ➢ If assigned to break a strike, the travel nurse might have to face further emotional conflict from both the moral dilemma and hostile situation
Reality shock
Term often used to describe the reaction experienced when one move after several years of educational preparation, which occurs in a familiar, idealistic educational environment, into a new role in the work force where the expectations are not clearly defined or may not even be realistic ex) as a student taught to consider the patient holistically, but in practice you often do not have time to consider the psychosocial or teaching needs of the patient even though they must be documented and attended to
Watson
Theory of Human Caring - identifies 10 carative factors focusing on the interactions between the one who is caring and the one who is being cared for 1) formation of humanistic-altruistic system of values 2) instillation. of faith and hope 3) cultivation of sensitvity to ones self and others 4) develop of helping trust relationship 5) promotion and acceptance pof expression of positive and negative feelings 6) systematic use of. scientific problem solving methods for decision making 7) promotion of interpersonal teaching learning 8) provision of supportive, protective, and corrective mental, physical, sociocultural, and spiritual environment 9) assistance with the gratification of human needs 10) this allowance for existential forces
Universal patient records: against
Top Threats Against Electronic and Health Record ★ Phishing attacks ★ Fraud ★ Data breaches and vulnerabilities ★ Malware and ransomware attacks ★ Encryption blind spots ★ Cloud threats/Third-party risks ★ Employees/Insider threats How Does this affect you? ★ Loss of control ★ Discrimination ★ Inaccurate/outdated information ★ Consent issues ★ misuse/improper treatment/medical errors
Use of travel nurses: For
Travel nursing has gained recognition over the past couple of years because it is a great way for nurses to advance their careers and have more flexibility over their schedules (Hansen, 2022). It is also incredibly beneficial for organizations to hire travel nurses because they can provide safer staffing ratios (Odom-Forren, 2022). Overall, travel nursing is an important step in the future of nursing.
Use of travel nurses: For
Travel nursing offers a number of benefits such as increased patient safety, staffing flexibility, reduced nurse burnout, skill development and increased learning (Ford, 2023). Organizational benefits include emergency preparedness because travel nurses can provide immediate medical care in times of need (Theraex Staffing Services, 2024) - Travel nurse salaries may seem higher initially, however, hospitals can save money in the long run. Travel nurses are employees of their agency, therefore the administration is spared the nursing labor costs of employee benefits such as health insurance, paid time off (PTO), and retirement (Heath Carousel Nursing & Allied Health, 2023).
Universal patient records: For
Up to $935 billion in savings 30% of healthcare spending may be considered waste 1000+ unidentified patients Hospital in LA sees average of 3 unidentified individuals a day in emergency department 19 different doctors per patient Average number of doctors people 18 years and older see, leads to miscommunication & information loss 200,000 deaths a year from errors Preventable medical errors cause deaths due to lack of information
Mandatory Overtime: Against
We are against mandatory overtime because we believe that it presents multiple challenges and drawbacks for nurses and the quality of patient care. When hospital policy requires extended shifts, nurses are stretched thin and become mentally and physically fatigued, which could potentially lead to decreased alertness at work. Although mandatory overtime is necessary in emergency situations, such as the COVID-19 pandemic, it has proven to have negative consequences on the well being of nurses. Without implementation of hospital policy protecting nurse's rights regarding overtime, the safety of both nurses and patients is neglected.
BSN required for entry: For
We believe that a BSN should be required in order for nurses to qualify for entry into practice. Overall nursing as a healthcare especially has become more complex in all areas of care. As the world adjusts to new advances so must the nursing world. Requiring a higher level of education for nursing practices that are getting more complex and involved. The NCLEX is another aspect of the nursing world that is changing as it advances to the NGN style which requires more critical thinking and education to answer questions to the best of a nurse's ability.
Mandatory staffing ratios: against
With that being said, mandating staffing ratios limits the approaches hospitals can take on staffing their floors. This is only the surface of the problems that come a long with mandating staffing ratios. Here are some other issues associated with this mandate: NOT THE ANSWER Mandatory Staffing Ratios are... Let's learn about why! A lower nurse to patient ratio does not automatically mean an improvement in the working conditions for patient outcomes to be positively impacted- there is more to consider than a ratio Longer wait times because there will be a large influx of patients who might not receive immediate treatment since the hospital is required to keep nurse-to-patient ratios at a certain level The acuity of the patients on the floor is unknown when staffing is scheduled. If the staff ratio is locked in, you might not have the correct amount of nursing support based on your patient's presentation
Informed consent
a process whereby a patient is informed of - the nature of their condition, proposed care, services, meds, interventions or procedures - the potential benefits, risks, or side effects, including potential problems including death, related to recuperation - the likelihood of achieving care, treatment and service goals - reasonable alternatives and their retrospective risks and benefits, including the alternative of not receiving the treatment or procedure
What mentoring Is
a professional relationship in which an experienced person assists another typically less experienced person or nurse in developing specific skills and knowledge that will enhance the less experienced persons professional and personal growth - mentors are chosen rather than assigned, whereas preceptors are assigned -mentors develop a professionally based, nurturing relationship, which generally occurs outside of the work environment
health care economics definition
a simple definition of economics its the allocation of scarce resources - the paycheck is a limited finite amount of money and choices must be made about how to spend, or allocate the money - individuals may not be able to pay for all of the goods or services that they wish to have, so decisions must be made and priorities established - similary, health care is a limited resource and choices must be made - choices about health care that concern economists are made at the national level
Roy
adaptation model -involves an individual seeking equillibrium through the process of adaptation: she identified 6 psysiological needs - excercise and rest, nutrition, elimination, fluid and electrolytes, oxygenation and circulation, regulation of temperature, senses and endocrine system) - adapting to stimuli
Intrinsic cost factors
characteristics of the population, the demand for health care, and health insurance coverage,
Ethical principles
commonc principles or rules that should be taken into account when an ethical decision is being examined Autonomy: a patients right to self determination without outside control - freedom to make choices about ones healthcare without interference even if the decision are not in agreement with the health care team Beneficence: duty to actively do good for patients - when deciding what nursing interventions should be providing to those that are duing when some of those interventions could cause pain Nonmaleficence: Duty to prevent doing harm, whether intentional or unintentional - is it harmful to accept an assignment to an unfamiliar area that requires the administration of unfamiliar meds - is it acceptable to refuse an assignment, when does an assignment become unsafe
START system of triage
divides injured personell into 4 separate groups 1) Deceased (black): injured people whoi aree beyond the scope of medical assistance. People tagged deceased only if they are not breathing and attempts to resuscitate have not been successful 2) Immediate (red): injured persons who can be assisted or their health aided by advanced medical care immediately or within 1 hour of onset 3) Delayed (yellow): Injured persons who can be assisted after immediate persons are medically cared for first. Delayed persons are medically stable but require medical assistance 4) Minor (green): injured personsn who can be assisted after immediate and delayed have been attended to medically. Persons tagged minor will not need medical care for at least several hours and can usually walk with assistance (usually bandages and first aid)
Bullying
early warning signs of bullying: - coworkers might become quiet or leave the room when you walk in, or they might simply ignore you - you might be left out of office culture such as chit chat, parties - your supervisor might check on you often to ask you to meet multiple times a week without a clear reason - it may seem like work is constantly monitored, to the point when yoi being to doubt yourself and have difficulty with your regular tasks - you might bne asked to do difficult or seemingly pointless tasks and be ridiculed or criticized when you cant get them done - you may notice a pattern of your documents, files, other work related items or personal belongings going missing -you may be asked to do new tasks or tasks outside your typical duties without training or help even when u request it
Spiritual areas to assess
faith and belief importance community address/action of care - how would you like us to address these issues in your health care?
Nightingale
first nursing theorist - did not have a specific name - how a person is influenced by the environment - nursing was a calling to help the patient in a reparative process by directly working with the patient or indirectly by affecting the environment to facilitate health and recovery from illness
Incident reporting
generate many legal concerns because in most states they must be produced in a lawsuit and can be used as evidence against individuals and the institution - caution should be used when completing an incidence report, and only the person directly involved should objectively document the facts - conclusions, opinions, defensiveness and judgement or blame of others have absolutely no place here - in addition, the form should never be used for punitive reasons because this will almost certainly increase the possibility that the report will not be completed honestly -would not mention in medical record that you filed an incidence report, but info put in should match - lack of documentation will always be considered a cover up and will be detrimental to any subsequent legal action -
What mentoring is not
it is not coaching, coaching is guiding the persons growth and goal attainment through dialogue - coaches help others disover and appreciate their own unique and internal quality they may not recognize otherwise - partnershgip tat anables and motivates the individual receiving coaching to attain this or her highest achievement in all areas of life - coaches help people find new ways to solve problems, reach goals and design plans of action to motivate people in activities that will advance and fufill all aspects of their lives -coaches dont need to have experience
Cultural competence
neccessary component of excellence in nursing care - need to understand the difference between themselves and others - a set of congruent behaviors, attitudes, policties that come together in a sustem or agency or among professionals that enables effective interactions in a cross-cultural framework - it is essential for nurses to first gain awareness of the need to develop cultural sensitivity - can be achieved through exploring one's own personal views, beliefs, stereotypes, and assumptions about other cultures - addressing and overcoming language barriers if they exist - establishes trust and builds rapport between pt and nurse - culturally competent nurses are accountable for assessing and recognizing not only the differences but also the variation of being the same
Self care activities
physical exercise laughter mental exercise motivating yourself alternating physical and mental tasks schedule idle time- disconnect from technology to think and reflect having a relationship with a greater power feeling good about the future believing there is a real purpose in life
NCSBN's transition to practice model (TTP model)
recommends a 9-12 month internship so that new grads get continued support during the vulnerable period from 6-9 months - for transition process to be successful it shoild occur across all settings and all education levels - supporting the new nurse in their transition to safe practice
Code of ethics for nurses
the provisions for this allude to the ethical prinicples mentioned earlier and imply that fidelity to the patient is most important - a copy of the code with interpretive statements is available from the ANA
Staff turnover
the rate at which employees leave a company and are replaced by other people
Leinenger
theory of culture care and universality- grand theory that considers the impact of culture on the person's health and caring practices
Empowerment
to empower means to enable self and others to reach their greatest potential for health and well being - with this comes with a feeling of well being and effectiveness - assess your life and your role in other relationships - know yourself - emotional wholeness is about our ability to feel -ability to express a wide range of emotions is indicative of good mental health
Negligence
when they accidentally cause harm during medical treatment - a nurse must legitimately make an error in judgement - important for the nurse to know the basic elements that must be proved before negligence can occur, then the nurse can evaluate incidents realistically
Burnout
work overload and job stress that can leave nurses vulnerable to depression, physical illness, decreased efficiency, absenteeism, and self doubt - starts gradually and worsens overtime - goes through 5 stages - loss of enthusiasm, continuous deterioration., crisis and finally devastation and the inability to work efficiently - caring for yourself helps you better care for others, work at a place with your morals and goals in mind
Honeymoon phase of reality shock
- excited about completing school and getting a job - no more hard schoolwork -everyone knows school is harder - short lived as they realize the difference between what they were taught and reality - may cope by withdrawing or rejecting the values learned during school
Role of case manager
(1) Provide referral info Facilitates movement of client through health care system (2) Negotiation (3) Collaboration
Mandatory staffing ratios: against
Overly simplistic One Size does not fit all Mandated nurse staffing ratios without mechanisms to help achieve ratios may force hospitals, especially safety net hospitals to make tradeoffs in other services or investments with unintended negative consequences for patients
Shift length: 8 hours
Poor sleep quality occurs among nurses worldwide. 61% of nursing staff experiences sleep problems. Researchers found that insufficient sleep caused by shift work increases injuries, chronic diseases, compromised healthcare quality, and medical errors. All of these issues detrimentally impact nurses and threaten patients' safety" (BMC 2024)
Stages of disaster management
Prevention Mitigation Preparedness Response Recovery
Universal patient records: against
Risks Database Information Breaches ★ Cybersecurity threat Implementation Concerns ★ Staff resistant to change ★ Cost ★ Technical disadvantages Undermined patient-provider Interaction ★ Burnout related to EMR use ★ Chat features can lead to miscommunication
Mandatory staffing ratios: for
Safety: -Mandating staffing ratios has improved patient safety by allowing nurses more time to: Monitor their patients conditions Provide elaborate assessments and evaluations Form a therapeutic and supportive bond with patients Prevent avoidable hospital acquired infections, medication errors, and death Acuity level - Many states with mandatory staffing ratio laws have put into place an 'Acuity Tool' for measuring patient condition and choosing adequate ratios per unit. Massachusetts ICU 1:1 Illinois Medical Surgical 4:1
The interview process
Set up your schedule - prepare to show your best side -rehearse the interview - dress the part -find a friend to practice with you - ask for feedback - prepare to ask questions to them - make sure you are on time - know where to go -know who you will be talking to
Use of travel nurses: For
The COVID-19 pandemic placed a huge stress on the nursing population. A nursing shortage was announced because many nurses were experiencing burnout, feeling underpaid and underappreciated, and left the profession for mental health reasons (Ford, 2023). Travel nurses were hired for less nurse burnout and an overall shift of allowing nurses to focus on their wellbeing - Jealousy and poor workplace culture is usually brought up with travel nursing mostly because of the compensation travel nurses receive. However, permanent staff must be educated on the expectations of travel nurses and why they are being compensated. The pay corresponds with the challenges they face and the skills they bring to the job (Hansen, 2022).
