The goal of breast reconstruction after a mastectomy is to restore the appearance of the breast and to improve women’s psychological health after cancer treatment. But how successful is it? Recent studies on the health and wellbeing of women who undergo breast reconstruction have generated mixed findings.

To provide a clearer picture of women’s mental and physical health following two advanced forms of breast reconstruction, Toni Zhong, MD, MHS, of the University Health Network Breast Restoration Program at the University of Toronto in collaboration with her colleagues at Memorial Sloan Kettering Cancer Center in New York City surveyed 51 women undergoing free MS-TRAM or DIEP flap reconstruction between June 2009 and November 2010. During these procedures, which are gaining popularity in North America and Europe, surgeons take tissue from the patient’s abdomen and use it to reconstruct the breast. The women in the study completed questionnaires prior to surgery and following surgery at three weeks and three months.

Women who underwent the breast reconstruction procedures reported significant improvements in psychological, social, and sexual wellbeing just three weeks after surgery. Unfortunately, however, they continued to experienced decreased physical wellbeing at the abdominal location where tissue was removed at three months following surgery.

The results may be helpful to breast cancer survivors who are considering breast reconstruction. “In the current healthcare environment where patients and providers increasingly seek evidence-based data to guide clinical decisions, discussing satisfaction outcomes with patients will help them make educated decisions about breast reconstruction,” said Dr. Zhong. “Our study can serve as an important source of evidence to guide the decision-making process for both surgeons and patients,” she added.

The first PIN grant the Tufts Health Plan Foundation received helped create a collaborative program to develop a regional approach to nursing education in Massachusetts, New Hampshire, and Rhode Island. The new inter-professional program will focus on shared learning, resources, curriculum components and an evaluation methodology.

“In Massachusetts, we are seeing excellent overall quality and patient safety results from the use of inter-professional care teams — both within hospital units and across the continuum of care,” said MHA’s Vice President for Clinical Affairs Pat Noga, PhD, RN. “We report and validate these findings through our PatientCareLink transparency website and Strategic Performance Improvement Agenda to lower patient mortality, readmissions and healthcare acquired infections. Expanding such collaboration and cooperation efforts to caregiving teams across New England through the new PIN funding will have a tremendous, positive impact on patient safety and care coordination in the region.”

The three-state collaboration is building upon the recommendations of the recent Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, which seeks to prepare the nursing workforce to meet the needs of America’s healthcare system and patients, and to ensure an adequate supply of nurses for a growing, aging population. The IOM report focuses on the fact that patients receive safer, higher-quality care when health professionals work in inter-professional teams, communicate effectively and clearly understand each others’ roles.

The lead partners in the grant for Massachusetts are the University of Massachusetts Worcester, Graduate School of Nursing, the University of Massachusetts School of Medicine and the Family Health Center of Worcester. Medical and academic centers in N.H. and R.I. are also involved.

TAMPA, Fla. — In every profession there are those who pursue advanced education and training to achieve top-level expertise. Nurse practitioner (NP) is the title given to nurses who attain such proficiency in their field. Recent studies by PayScale.com show that the top-end salary for NPs can exceed $93,000 annually, and demand for healthcare professionals is growing faster than that ofany other career. Join U.S. News University Directory as they explore how NP licensure helps nurses position themselves for a lifetime of lucrative, rewarding and stable employment.

To begin a nurse practitioner education, the first step is to earn a registered nurse (RN) license. There are several ways to do this – including diploma and associate’s degree programs – but for those who want to someday become an NP, a Bachelor of Science in Nursing (BSN) followed by successful completion of the National Council Licensure Examination-Registered Nurse (NCLEX-RN) is the preferred path. This is because BSN programs generally better prepare nurses for the rigorous education required of NPs, and also leave graduates at least two years closer to completing their master’s or doctoral degree than other RN programs.

After earning a registered nurse license, gaining acceptance to a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) program is the next step to becoming a nurse practitioner. Nurses pursuing either degree typically specialize in a particular area of nursing; psychiatric nurse practitioner (PHMNP), family nurse practitioner (FNP), pediatric nurse practitioner (PNP) and neonatal nurse practitioner (NNP) are the most popular concentrations, but there are many others. Specializing in this way allows nurses to concentrate on the aspect of their field that they find most rewarding and become true experts in its practice.

Which nursing schools to apply to is also a critical decision. Those offering MSN and/or DNP programs in a desired specialty are the obvious choice, but there areother factors to consider as well. Generally, nursing students should attend the most prestigious nursing school that they can get accepted to and afford. Graduating from a well-known and highly respected program expands theiremployment options once they enter the job market, and also increases their likelihood of landing the positions they really want. In this, nursing is like any other field: having a prestigious alma mater doesn’t mean everything, butit can put a candidate ahead of the pack when competition for jobs is fierce.

Something else to remember: Financial aid is available, even at the graduate level. All nursing students should fill out the Free Application for Federal Student Aid (FAFSA) to see if there are any grants or loans that they qualify for. Obviously, grants are preferred – free money is better than money that must be paid back – but they are rare in the world of post-baccalaureate education. Most graduate students have more luck finding cheap, federally subsidized student loans. Careful research of scholarship opportunities is also recommended; nurses studying at the graduate level are encouraged to apply for any they think they have a chance of getting. Landing just one or two scholarships can render a prohibitively expensive nursing program suddenly affordable.

After completing an MSN or DNP degree, nurses can apply for licensure as a nurse practitioner. Every state has a board of nursing that regulates NP licenses, and each has its own particular credentialing standards. Most states require, at
minimum, an MSN and certification by the American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC). Licensing periods also vary from state to state: some require relicensing every two years, while others require it every three.

Finally, certification from additional organizations might be required to enter certain specialties. For example, the American Psychiatric Nursing Association sets credentialing standards for nurse practitioners who want to work in the
psychiatric field.

Healthcare employment is growing by leaps and bounds, so finding nurse practitioner jobs after licensure shouldn’t be too difficult. The U.S. Bureau of Labor Statistics expects the nursing field to grow by 22% through 2018, a pace that is much faster than the average for all professions. This means there should be almost 600,000 new nursing jobs created over the next eight years, in addition to hundreds of thousands of job openings that will result from nurses who retire or leave for other reasons. Licensed NPs have the advanced education and training that qualifies them for many of the most sought-after and best-paying positions.

Nurse practitioner salaries are among the highest in the nursing field. According to PayScale.com, NPs with one to four years of experience earn between $65,000 and $80,000 annually. Those who have been in the field for five to nine
years bring in anywhere from $70,000 to $88,000 per year, while NPs who have been practicing for over ten years can increase that to more than $93,000. Location and the type of facility an NP works in also play a role in determining how much they earn – those who work in large cities, and those employed by surgery centers or the military, tend to have the highest top-end salaries.

When choosing a career path, it is wise to consider many factors: growth potential, salary, educational requirements, fringe benefits and more. The entire healthcare field is expanding rapidly, and nurse practitioners are positioned to
land some of the best jobs in it, so this is an excellent career to consider for those who are willing and able to earn the necessary credentials. Few other professions offer such an advantageous mix of flexibility, opportunity and job
security.

Nationwide statistics show that one in five new graduate nurses leave their first job within the first year. This is for a variety of reasons; lack of support, lack of confidence, feeling unwelcomed and overwhelmed. It is not only costly to train a new graduate nurse, but also reflects poorly on both nursing unit and facility retention statistics for further recruitment.  How do we as administrators/managers keep new staff?

Most every nurse when they enter the workforce is paired up with a senior nurse on their unit known as a preceptor. The role of the preceptor is to teach policies and procedures, oversee skills, and act as a teacher.  The new nurse relies on their preceptor for guidance and instruction and comes to them with questions or concerns.  While this is a great asset for this new nurse, it isn’t necessarily all they may need.  It is difficult to complain to your preceptor about something specific to the unit or about another co-worker. Often those little things can lead to frustration and undue stress, and the new nurse will leave.

In 2008, Brattleboro Memorial Hospital in Southern Vermont began a Nurse Mentoring Program.  The goal of the program was to maintain our new graduate nurses for many years and to offer them the support they needed to achieve that goal.  The first thing the committee, which was integral in instituting the program, did was to come up with their definition of a mentor as a basis for the program.  The definition; ” A mentor is a collaborative partner who is a role model and motivator providing support, help, enthusiasm, inspiration, and nurturing in a non-structured learning environment.  A mentor is an active listener who will provide a safe, non-judgmental, friendly, and creative atmosphere for the mentee.” A survey was sent out to all nurses, and from those surveys that were returned a group of nurses was selected to become mentors. Those who responded rated themselves on the qualities they felt they possessed which were direct reflections of our mentor definition. The committee then spoke with the individual’s manager as to whether or not the candidate would be a good mentor.

Each nurse mentor goes through a 10 hour training program which covers skills such as active listening, goal setting, emotional intelligence, learning styles, job stress, and difficult behaviors. This gives the mentor a variety of skills and ideas to become a dedicated mentor and to be instrumental in the retention of our new nurses.  At the end of this intense course the new mentors are asked to sign a contract that outlines the expectations and commitment that are expected from each one of them.

To date, 20 trained nurse mentors have been trained. When new nurses are hired they are paired up with a mentor. One thing that is vital to the success of the program is that the mentor and mentee not work on the same unit. It is the intent of the committee that the mentor/mentee work the same shift. During orientation week the mentor and mentee are introduced and a future meeting is set up at that time. The expectation of the program is that the mentor and mentee will meet at least every two weeks for the first three months, and then at least once a month for the first year. The overall hope of the program is that the mentor/mentee relationship will continue for  many years beyond that first year.

We have one mentor/mentee team who are well into their second year of their relationship and have built a solid foundation. This team was paired up at the very beginning of our program, even before our first mentor training. Without this relationship we would have lost the new nurse within the first three months of hire for a variety of reasons. Because of the commitment and dedication of the mentor, this nurse is still a vital part of our organization and has grown in both confidence and skill. This is just a reflection of how vital the nurse mentoring program can be to an organization.

In conclusion, we have had the Brattleboro Memorial Hospital Nurse Mentoring Program up and running for a year. The program began with eight new graduate nurses and to date seven are still employed at BMH. This ratio of 1 in 8 far outweighs the nationwide statistic of 1 in 5. I feel this retention is solely based on the nurse mentoring  program and the dedication that all participants have put into its success!

When patients make a request, the answer is often a resounding “No” even when the request is appropriate, not harmful, illegal, or wrong. Patients are often denied requests because their needs don’t fit into rigid policies. Although health care policies and procedures are very important for patient safety and quality, policies are black and white, but patient needs come in shades of gray. What makes policies and procedures most effective is to empower nurses with good critical thinking skills to apply those policies and procedures to patient situations in a thoughtful way.

Why don’t nurses say yes to patient requests more often? Nurses feel safe when they can say, “I followed the policy to the letter,” even when patient needs remain unmet. The reason for this is that, many times, nurses have been criticized for making patient-centered decisions so they have learned that it is probably safer to hedge, not make a decision, and follow policies and procedures to the letter.

• Instead of saying no, find a way to say yes. When patients ask for something, listen fully, and give them what they want if at all possible.
• Use your creativity. Innovate and start new patient-satisfaction trends.

Rigidity Is Expensive

• Rigidity wastes nursing time, because rigid protocols are hurdles for nurses to clear before they can focus on patient needs. Autonomous nurses who satisfy patients’ needs with flexibility save time and raise patient satisfaction. Multiply these small segments of time saved by the number of nurses in your facility and then by their salary. The financial savings add up quickly.
• Rigidity interferes with patient satisfaction because patients dislike waiting to have their needs met unless there is a good reason for the delay.
• Rigidity blocks patient safety because it prevents nurses from quickly sizing up the situation and taking action to solve urgent problems.

Bureaucracy

• Bureaucracy sabotages individual effort. Many health care systems merged during the last 10 years in order to survive, forming integrated networks composed of hospitals, physician practices, medical specialty groups, home care companies, and satellite hospitals.
• This strategy has been the opposite of what others have done: become smaller, decentralized, and leaner; be more flexible and able to respond quickly to shifting market demand.
• It is more important than ever for nurses to be autonomous and able to make patient care decisions at the patient level.
• Consider the following two scenarios and decide which staff member you would prefer if you were Mr. Jones.

First Scenario

• Mr. Jones, a patient who is 100 pounds overweight, has been put on a 1,000 calorie weight-reduction diet during his stay at a long-term-care facility until his leg ulcers heal. He receives one half of a hamburger, a few vegetables and pieces of fruit, and black coffee for lunch. Mr. Jones’s resentment about his dietary restrictions and lack of dietary control builds every day. Will this dietary regime provide any long-term benefit for Mr. J ones? Hardly. Mr. Jones will probably eat even more when his stay in the long-term facility is over.

Second Scenario

• Nurse Smith understands how to make a real difference with Mr. Jones. She asks his doctor to order a regular diet, enabling him to make his own food choices. She, along with the dietician, works with Mr. Jones to learn how to make better food choices. She asks the food service to provide Mr. Jones with high-bulk, low-calorie foods such as stir-fries and vegetable soups. She reminds him how weight reduction can improve his quality of life an d enable him to return to his hobby of fly-fishing. Motivation, flexibility, and patient involvement make a big difference to Mr. Jones, who continues to gradually lose weight after discharge.
• In the first scenario, the staff required Mr. Jones to follow a rigid, senseless plan. In the second, nurse Smith thought critically and used a flexible approach. Although Mr. Jones was not able to lose a dramatic amount of weight immediately, nurse Smith’s thoughtful intervention started him on the road to healthier living.

Flexibility Strengthens Medical Ethics

• Organizations often think that their rigidity is the best way to provide ethical care, but that is not so. Read what Marvin T. Brown says in his book, Working Ethics (1990):

People, interested in ethics will understand the differences between an ethics of rules, which attempts to control behavior, and an ethics of decision making, which empowers people and organizations.

Our diverse patient population has diverse needs, making it more important than ever to support critically thinking nurses as they respond to patients in a patient-centered way.

Massachusetts

November 5
Ocology for Nurses
This program will increase knowledge in oncology nursing. The content will include an overview of cancer management, tumor physiology and staging, relevant laboratory testing and treatment strategies and safe handling of neoplastic agents. Chemotherapy administration, classification of chemotherapeutic agents, management of toxicities and adverse effects of treatments and oncological emergencies will be discussed. The program will conclude with pain and symptom management, palliative care and an overview of Hospice care. (Class size limited to 25 participants).
Location: Massachusetts Nurses Association Headquarters in Canton, MA; Contact hours: 6 contact hours for nurses; Time: Registration 8

New Hampshire

October 1
New Hampshire Nurses Association Annual Meeting And Fall Conference
Join the New Hampshire Nurses Association at their annual meeting and Fall Conference in October this year. Keynote speaker for this year