Monday, July 19, 2010

DNP Series: The Search

I recently wrote about my pursuit of the DNP and my rationale for it. As promised, here is the first brief installment of posts chronicling my final year of school (I actually have 10 months left now but who's counting!)

Part of the final project is writing a systematic review. Since one of the principles of our program is evidence-based practice (EBP), our final project must be framed in the form of a PICO question. That is, Population, Intervention, Comparison, and Outcome. My group and I are still tweaking our question but it is centered on adults with type II diabetes. (Plus, I do need to maintain some level of suspense throughout these posts!) In order to gather the evidence, a comprehensive, systematic, and exhaustive search of the literature must be performed using key words and MeSH terms to narrow down the number of hits we get on our search. This is a critical part of any systematic review since the evidence gleaned will lay the groundwork for the review.

We are searching health/medical databases including Medline, CINHAL, & Cochrane. I grossly underestimated the amount of time this would take as we refined our key words and MeSH terms a few times - it's been about 4 weeks or so that we've been working on it. This process has been much more involved than say going to Google and typing in some search words. We were fortunate to have a group member very adept at searching and have taken advantage of the university librarian for additional tips. We are now confident that we are on the right track and are capturing the abstracts to read to determine if the article is applicable for inclusion in our review.

This searching resulted in 400+ abstracts to review. We have each individually read the abstracts and are meeting to discuss the ones we disagree on to determine whether we retrieve the actual article or not. We also need to search the "gray literature" for additional articles that weren't published in peer-reviewed journals to see if any other evidence exists. We will then enter them into the Joanna Briggs Institute software for tracking and as a way to get started on the actual write up. Next, we will critically review the article to see if it makes the cut for inclusion into our systematic review. (Note: this is a lot of reading - so much for being off the summer!)

I am excited to see what the evidence suggests regarding our focused topic. While all this is going on, in the Fall, we hope to implement the intervention at the clinical agency we are partnered with and are calling that "a small test of change" (STOC). Lots of work ahead but there is definitely a small light at the end of the tunnel (did I mention that I will be done in 10 months?)

Tuesday, July 6, 2010

Passé or is it?

I started to write this post and then said to myself, I'm not going there...its so passé. I saved it as a draft with little intention of completing it. Then I come across this "media kit" posted on the American Academy of Family Physician's (AAFP) website and just can't believe my eyes with their approach. They have set out to point out the obvious: NP education and training is different than that of physicians! Who knew?!?!

I am so disappointed in the AAFP. Perhaps no other specialty works as closely together as NPs and family practice physicians. Up until now, I've generally come across very supportive family practice physicians of nurse practitioner practice. This is a slap in the face of sorts.

And now the original post: Another day, another article about nurse practitioner's filling roles traditionally held by physicians, and another physician-centric theme by organized medicine. It's nice to read an article with some NP input and perspective. However, here we see the proposal of a pyramid with a physician sitting atop to "supervise" and develop protocols. Does that even deserve any further comment?

I am not completely without despair though. I found a blog by Dr. Lin, Common Sense Family Doctor, and his recent post about Primary Care Dream Teams. Without specifically mentioning NPs, he captures the essence of collaboration and working together in the best interest of the patient, not the profession - I don't think that should ever become passé.

Guest Post: How Hospitals Can Better Retain Their Nurses

How Hospitals Can Better Retain Their Nurses

America is in the middle of a nursing shortage that is only expected to worsen as baby boomer nurses reach retirement age and a burgeoning population requires more healthcare. Here are just a few statistics that highlight the serious problems facing the healthcare industry:

· More than 581,000 new nursing positions are expected to be created by 2018. This growth is much faster than any other industry, and there just aren’t enough nurses to fill the positions.

· U.S. nursing shortage is projected to grow to between 260,000-500,000 by 2025.

· Over the next 20 years, the average age of the RN will increase and the size of the workforce will plateau as large numbers of RNs retire. Because demand for RNs is expected to increase during this time, a large and prolonged shortage of nurses is expected to hit the US in the latter half of the next decade.

· There are more than 100,000 vacant RN positions.

· 55% of surveyed nurses plan to retire during this decade.

· 1 in 5 new nurses quit within a year

You get the point.

With so many nurses leaving, hospitals are put in a position where they have to do everything they can to increase nurse retention. Simply put, they can’t afford for any more nurses to quit.

But how can they achieve this? What can hospitals do to keep nurses happy and interested in their careers? Here are some of the most effective nurse retention strategies.

· Offer longer orientation periods for new nurses—Starting a new career as a nurse can be overwhelming. Nursing is a hectic job, and lives are on the line. With about 20 percent of new nurses quitting within a year, that’s a strong indication that new nurses just aren’t prepared for the job. By having a longer orientation period for new nurses, hospitals can help them adjust at a comfortable pace to the job, increasing the chances that they’ll stick around.

· Have rapid response support teams for new nurses—New nurses often find themselves in tough situations where they don’t know what to do. These situations can be very stressful, and if handled improperly, it could break the nurse. By having rapid response teams available for nurses who find themselves in a pinch, you can help guide them through these tough situations.

· Reduce nurse to patient ratios—One of the most common complaints nurses have is that they’re responsible for too many patients. Keeping up with too many patients can place extra stress on the nurse, and it could even cause the quality of patient care to decline. Whenever possible, hospitals should strive to reduce the nurse to patient ratio so everyone will benefit.

· Conduct exit surveys for nurses who quit—An exit interview with nurses who quit should be a standard procedure. This is a great opportunity for hospitals to gain insight into the factors that lead to a nurse moving on from their job. By identifying the things that are causing nurses to quit, the hospital can hopefully take steps to correct these issues and improve nurse retention.

· Get feedback from nurses on a regular basis—Don’t just wait until a nurse quits to talk to them; hospitals should also get feedback from current nurses on a regular basis. They should set aside time to talk to the nurses to hear what they have to say about the job. This can be helpful for identifying problems early on and correcting them before a nurse decides it’s time to quit.

· Offer opportunities for nurses to further their careers—If nurses feel like they have a chance to grow in their career, they’ll be likelier to stick around and keep moving forward. The best hospitals offer professional development programs for nurses to help them improve their careers and stay interested in their jobs.

· Be flexible—Nursing jobs carry a lot of stress with them. They can be very harsh on the personal lives of nurses. That’s why hospitals should strive to be more flexible and accommodating to nurses. By offering flexible scheduling and assistance with various personal issues, hospitals can keep their nurses happy.

What are some other things hospitals can do to retain more nurses?

Guest post submitted by John Smith. John manages the Nursing Scrubs store located at

Submit a guest post to anpview at gmail dot com.