Friday, April 11, 2014

Isn't Collaboration in Nursing Something We Do Everyday?

This post is part of a collaboration with other nurse bloggers through The Nurse Blog Carnival.  Keith and Kevin from RNFM Radio are hosting this months enlightening round which will be posted on 4/15/14.

Collaboration in nursing is a term that can sound overwhelming and off-putting to many. In truth it's probably something that you do everyday without even thinking about it. It's not necessary for every situation, but when it is needed, the outcomes can be compromised if nurses are unwilling or unable to participate.

If you stop and think about it, physicians have been collaborating for forever. When the generalist needs advice about a specific problem he calls in the specialist. If that specialist needs more help she calls in another specialist and so on. Collaboration is a journey as well as a process and outcome (you need to register - free- to read) to help patients achieve common goals and optimum outcomes in a cost-effective manner.

Collaboration and Teamwork
Collaboration and teamwork are often used interchangeably. Some nurses are not well suited for this process and resist it with all their might. There is professional jealousy or a need to be in control that doesn't let that nurse accept help and capitalize on the process of working with others to achieve a common goal. This brings to mind the idea that nurses eat their young.

In patient-centered care, nurses have to leave their egos outside and work with others to provide the best quality and evidence-based care possible. Collaboration easily uses the nursing process to define the problem, brainstorm using critical thinking skills to problem solve, establish a plan and set goals and then evaluate the process. Sometimes collaboration is just a part of our everyday routine and we don't necessarily realize it.

Shared Decision Making
Collaboration is about shared decision making and bringing together the best minds to assess and evaluate the situation. As a single individual, the nurse is not often able to provide for all of the needs of the patient. A simple collaboration example would be to call in the WOCN nurse to consult on a wound that is not responding to the current treatment.

Other examples include meeting interdisciplinary needs such as bringing a physical therapist in to teach safe transfers to the family before discharge, an occupational therapist to explore energy conservation techniques, or social services to assist with community resources and financial issues involving the patent's care.Interdisciplinary communication allows the team to collaborate to problem solve, set goals, and achieve optimum outcomes for the patient 

Promoting Wellness and Preventative Care
In a wellness model of health care delivery, collaboration becomes even more important. Our jobs are no longer all about just treating the current problem and discharge. We have to educate patients so they can take responsibility for their own health status and outcomes. If we help them learn how to prevent illness in the first place and prevent or control complications for chronic diseases already present, we will significantly reduce the costs of health care and promote wellness.

This post was written as part of the Nurse Blog Carnival. If you are interested in participating find out more details and sign up here.

Monday, April 7, 2014

Focus on Quality by Focusing on Evidence Based Nursing Practice in the Onboarding Process

Health care has gone through many paradigm shifts in the past few years with focus on quality and containing the skyrocketing costs. As many more citizens find access to health care and insurance (7.1 million signed up under the Affordable Care Act) and the Baby Boom generation moves into the later stages of life, many more challenges will be felt by the industry.

The focus has changed from a sick care delivery system to a wellness system. Patients are charged with the responsibility for their own health status and to do this they need education. That education has to include not only disease management and medication reconciliation, but specific instructions in how to access and maneuver through the healthcare system. Nurses have found themselves at the helm of this process and the backbone of the healthcare system. Success lies in the hands of the nurses; both in ensuring patients are able to control their health status and prevent complications, and in ensuring patient satisfaction through evidence based quality patient care. The measurable outcome means reimbursement is maximized.

Quality is quickly becoming the standard by which healthcare providers are being reimbursed. One of the primary measures of quality is patient satisfaction. Satisfaction is tied to the quality of care received and the outcomes achieved. Reimbursement is and will be driven by the quality of care. In 2009, Medicare began to institute Do-Not-Pay penalties for specific errors such as wrong site surgeries, vascular catheter infections, other hospital acquired infections, bed sores, falls, air embolisms, and UTIs from Foley catheters.

Many of these items very much involve nursing care and it’s now more important than ever to ensure that nurses are using evidence based practice when providing care.  This can be a challenge when nurses come to organizations with different ideas and approaches to patent care from their past education and experience.

Ensuring that patients get the quality nursing care they deserve involves training nurses in the best evidence based practice standards from day one. This requires a thorough onboarding process to ensure nurses have strong clinical competencies and skills and continue to be educated on the most up to date best practices. Many find that the onboarding process and continuing staff education can be cumbersome and difficult to track on paper, however, talent management software like those provided by Halogen can simply this process. Providing the best quality patient care and achieving optimum patient satisfaction are key to reimbursement and need to begin from day one.

Disclosure: This content has been brought to you by Halogen Software, the market leader in talent management software. Bringing value to nurses is at the forefront of Halogen Software’s goals so they are partnering with nurse leaders online to bring attention to important issues that healthcare organizations face every day. To find out more Halogen Software and the support they can provide to your nursing staff check out their healthcare page.

Friday, April 4, 2014

Why Nurses Aren't Being Hired from New Grad to Experienced Nurse

There is an excellent article today on Scrubs Magazine Weekly Best. It's a frank discussion with HR about why they didn't hire nurses and provides a great checklist of the top reasons for not hiring candidates.

Anyone looking for that new or next job should take a long hard look. Just a few years back nurses were writing their own ticket to almost any job they wanted because employers were desperate to hire nurses and sometimes just a warm body would do. Today the scene has changed radically and employers can be and are being very choosy.

Year after year nurses have been voted by the Gallup Poll to be the most trusted honest and ethical professionals. And nurses are being held to a very high bar. Nurses have much more responsibility now for patient's health care and need to come to job prepared to provide the best care possible. If you can't show up to an interview with all of your paperwork in hand, you probably won't get the highest points for being hired. If you come dressed for exercising or lounging on your day off, you're not going to make your best impression. And if you have been careless with your own life in the past, you're going to be very hard pressed to prove that you can value the lives of others.

These are hard cold facts and not always easy to swallow,  but nursing is serious business. It can be great fun and very rewarding, but it's long hours and hard work.

One great point they made in this article is that it costs $40,000 to train a new grad nurse. It is also quite expensive to hire experienced nurses, and if they don't work out, the financial losses can be overwhelming. If you really want that job, make them know you are the best fit and you'll do your part to make it work out.

Thursday, April 3, 2014

Another Great Recognition

It is always an honor to be recognized by ones peers. The Nursing Site Blog has once again been recognized. This time by as one of their Top 10 Nursing Blogs for 2014.
Thanks so much.


Thursday, March 20, 2014

Sites You Need to Check Out

Playing catch up today. I have made many promises to mention or post links and this is going to be a grouping of those promises. There should be some very good information here so bear with me....

Scrubs are such a wonderful invention. And Uniform Advantage has published a great infographic about the Best Scrubs for your Body.  There are some very interesting points to help you looks your best. Thanks for sharing UA!

We were once again honored to be recognized by peers from as one of the Top 50 Nursing Blogs for Students. Scroll down to the bottom fo the Home Page to find the list. (We're #11). Thanks for the mention!!! 

A fellow nurse writer has written Nurse Your Wallet Ebook available on in their Kindle store. Janine Kelbach, RNC-OB helps you think outside the box about how to use your nursing education to find ways to make extra income. It's $2.99.

Working the night shift is something most nurses have or will have to do at some point in their career. On the blog is a great post entitled Nursing Night Shift Tips. They have a nice collection of interesting blog posts! Check out their ceu options too.  

And finally, I found a great post by fellow nurse write, Brittney Wilson, about hw to handle the problem with nurse wannabees. It can be very frustrating to follow a medical assistant or nurses aide when the patient thinks they are the nurse and who the heck are you?! Many great nurses bridge from these careers and others continue to be great bedside assistants, but Calling Yourself a Nurse is Criminal No Less helps the licensed nurse set clear boundaries and explain the issues.

Friday, March 14, 2014

Salary Data for Registered Nurses

By Brendon Barnett
Registered Nurse Salary at a Glance
The registered nurse (RN) is one of the most diverse nursing occupations, with wide ranging skills and qualifications. RNs are used in various health care environments. They provide direct patient care, deliver health-related education, and offer advice to patients and families. “To do what nobody else will do, a way that nobody else can do, in spite of all we go through; is to be a nurse,” said Rawsi Williams. It’s for this type of dedication that nurses are compensated, and rightly so.

Becoming a Registered Nurse
In the United States RNs are required to be licensed. To become licensed, nurses must graduate from an approved program and pass the National Council Licensure Examination for Registered Nurse (NCLEX-RN). There are three common types of RN programs that nurses take: a bachelor’s of science degree in nursing (BSN), an associate’s degree in nursing (ASN) or a diploma from an approved nursing program. Any of these three paths can qualify a nurse for an entry-level staff nurse position, but some employers may require a bachelor’s degree.

Industries with Highest Levels of Employment for Registered Nurses
In 2012 there were approximately 2.7 million RNs employed in the United States. Most RNs work in private, public, and state hospitals, followed by physician offices and nursing and residential care facilities. RNs are found in many other work settings, including correctional facilities, schools, community centers, and the military.

Median RN Salary
On average, RNs earn 25% more than the median salary of all workers. In 2012 the U.S. Bureau of Labor Statistics (BLS) identified the median RN salary at $67,390 per year, or about $33 per hour. While the lowest 10% of RNs earned about $45k per year, the top 10% of RNs earned more than $94k annually on average. Of course there are different areas across the country where RNs have a much higher earning potential.

Top Paying States for Registered Nurse Salary
For the last 10 years California has topped the charts as the state with the highest RN salary. But there are other states that also compensate RNs well. As you can see from the map to the right, most of the highest paying states are located on the west coast and in the north east regions of the country. In 2012 the top 5 highest paying states by annual mean RN salary were:
1. California – $94,120
2. Hawaii – $84,750
3. Massachusetts – $83,370
4. Alaska – $80,970
5. Oregon – $78,530

Some people argue that California continuously tops the list for highest salary because the cost of living is much higher there. Just like any state, California has pockets of higher than average income levels. But when you compare RN salary with median salary from the same state, you realize something: California simply pays nurses better. California has the highest margin of difference between RN salary and the salary of the average worker (64%).

Top Paying Metropolitan Areas for Registered Nurse Salary
In 2012 all of the top 10 highest paying metropolitan areas for RN salary were in California. Most of the highest paying jobs are located in and around the San Francisco Bay Area. The top paying metro areas for RN salary are:
1. San Jose, CA – $122,990
2. Vallejo-Fairfield, CA – $119,310
3. Oakland, CA – $113,520
4. San Francisco, CA – $110,630
5. Sacramento, CA – $107,710

RN Jobs and the Nursing Shortage
The United States is currently facing a nursing and physician shortage. This is due to a combination of expanding affordable health care, lack of nurse educators, and the fact that many current nursing professionals are moving into retirement age. The need for RNs has never been greater. The BLS projects that RN jobs will grow by 19% over the next decade, a rate much faster than usual. BLS estimates are that 526,800 new RN jobs will be created between 2010 and 2020.

Bureau of Labor Statistics, Occupational Employment Statistics Survey, (2012). Retrieved from
Median Wage by Occupation Across States, (2012). Retrieved from
RN Salary Comparison by State (2012), (2014). Retrieved from

Monday, March 10, 2014

Core Competencies and the Continuum of Care

The high cost of health care has to be managed. This requires patients to learn about their own health conditions, and how to manage them appropriately so as to avoid setbacks and complications. Patients must take responsibility for their health status and practice wellness. In order to do this, patients have to be well educated about their medical status.

Across the continuum of health care, patient education begins in the physician's office and carries through to the after hours care, the urgent care and emergency room, the hospitalists and the home health care team. Each professional and team builds on the education and assessment of the patient's status and how to best assist him in attaining management of his health care status. Nurses are at the forefront of the process to ensure quality care across the continuum. Strong leadership skills and professionalism are essential for the success of this process.

Core Competencies
Roles for nurses are expanding rapidly to provide the necessary evidence-based education to patients so they can take control of their destinies. Nurses need to constantly improve their knowledge base and become the best patient educators they can be. Skills and competencies have to be top notch. It is no secret that lower patient mortality rates have long been linked to having BSN prepared nurses in charge of their care. Nurses who are best prepared to deliver health care also provide patients with the best possible options and outcomes. Advance practice nurses such as Clinical Nurse Specialists and  Nurse Practitioners have taken lead roles in driving the need for all nurses to obtain higher education. With the emphasis on wellness and not sick care now, this becomes essential.

Today's nurses must have strong critical thinking skills and know how to actually practice nursing theories as well as employ the tools and core competencies they learned in school and have experienced on the job. They must utilize the continuum of care and understand their position in it with each patient. No one professional will see the process through from start to finish so it's important for nurses to focus on the tasks at hand and provide the next level of care and then provide a thorough hand-off report for the education process to continue and patient outcomes maximized. Nurse educators in facilities are charged with the job of evaluating their staff's skills and improving them through continuing education.

Avoiding Readmission Using Continuum of Care
Hospitals are charged with avoiding readmissions and this is best achieved through a strong continuum of care both in-house and with post acute care options. Teamwork and collaboration is vital as each team member builds on the previous information and reviews the patient's understanding to plan for the next step. Quality patient-centered care and education includes hand-off reporting that ensures the wheel is not being reinvented from scratch with each subsequent patient encounter.

Home health care is proving to be a very effective choice after, or even in lieu of, acute care in providing quality patient education and achieving optimum outcomes. Hospital readmissions have been reduced, proving this continuum of care is effective. As this becomes more the norm, health care costs will be contained and patient outcomes improved.

Disclosure: This content has been brought to you by Halogen Software, the market leader in talent management software. Bringing value to nurses is at the forefront of Halogen Software’s goals so they are partnering with nurse leaders online to bring attention to important issues that healthcare organizations face every day. To find out more Halogen Software and the support they can provide to your nursing staff check out their healthcare page.

Further Resources:
Quality and Nursing: Moving from a Concept to a Core Competency

Friday, March 7, 2014

ANA Overlooks Dallas Buyer's Club in Honoring Latest Oscar Movies

Several friends belong to the American Nurses Association (ANA) and one forwards their emails to me in hopes I would change my mind and join. Well the latest posting from the Government Affairs Team caught my eye with a cute little play on words using the recently honored Oscar-nominated movies. They found a cute connection to nurses for all but one....

Then they totally dissed The Dallas Buyers Club stating, "P.S. Dallas Buyers Club. That one simply didn’t fit in." Perhaps no one would have noticed if they simply ended without this post scrip. But the fact that they had to say it simply didn't fit in leaves one to wonder why and how?

HIV and AIDS have been a huge part of the health care world for decades now. How can you not find a way to include this title? With better options and medication cocktails it's definitely not the death sentence it once was. Many nurses today fear contracting MRSA more than seemingly ever feared HIV or AIDS. Safe sex and needle precautions have almost become a thing of the past and this non-challant attitude can really come back to bite us all if we are not careful. Yes, precautionary measures exist today to protect us, but if we forget why for example, we have sharps precautions and needleless systems we become complacent and dangerous!

The fact that desperate people had to turn to such underground means as a "buyer's club" to obtain the education, information and medications to help them live even a few more days or weeks is not something we should shut our eyes and ears to. This need for subculture continues to a smaller extent today as patients seek care and treatment that isn't approved and available for multiple rare diseases.

For a simple example: there is evidence that IV vitamin C can help prevent the side effects and promote the effectiveness of many chemo therapies. There simply isn't the money to support the research because it's not an expensive new drug to discover and patent. Big pharmacy denies these benefits to cancer sufferers all over the world.

How can the ANA diss such an important movie? Because it's about the subculture of health care in the 1980's?  Is it because the story also encompassed LGBT ( lesbian, gay, bisexual, and transgender) lifestyles as well? The very possibility that they are in violation of their own ethics code is mind blowing. What direction is the ANA trying to take the nursing profession now?  There are so many valuable lessons to remember and learn from this era to help us continue to move forward in providing quality care without judgment and discrimination. Are we moving backwards here?

The title of this news reporting "When Nurses Talk, Washington Listens" sends shivers down my spine to think that bias and discrimination appear to be being given a voice by the ANA. We are here to provide care to every living soul that crosses into our care pathway and not to pass judgement and discriminate. We fought hard to make sure HIV and AIDS patients had access to the same care and nurses who were scared and biased had the education to help them understand how to give care safely or find other avenues to pursue.

There are so many possible "fits" for a relevant play on words in infection control, hematology nursing, forensic nursing,  informatics, just for starters. How did they not find a way to honor this movie in their salute? Instead they choose to make a point of leaving it out.

Thursday, February 20, 2014

Thanks for the Recognition!!!

I am very honored to have The Everything New Nurse Book recently listed # 17 among 105 books on's Ultimate Reading List for Nurses. There are 2 editions available now.

Today I heard TheNursingSiteBlog was listed by as one of the Top 14 Nursing Blogs of 2014. WOW!

I was also featured on a recent posting from Terpening Insurance with several other top nurse writers discussing Don’t Let Winter Drag You Down: 5 Tips to Stay Healthy

These are terrific honors, and coming from peer groups they really mean a lot!!! Thanks so much for the recognition.

Thursday, February 6, 2014

Highway Hypodermics a Premier Guide for Travel Nurses

When nurse authors meet, they swap autographed copies of their books. Epstein LaRue (Epi also known as Kay in the real world)  and I recently met for lunch to celebrate our half birthday. We share July 27 as our real birthday. Epi is now working in So CA as a travel nurse and we just had to find time to meet face to face finally and celebrate! And to swap books and have a photo op.
photo (c)Tim Quan : nurse authors Epstein LaRue and Kathy Quan

The Highway Hypodermics series is the premier guide for travel nurses in my mind, and Epi is the guru. I never had a need or reason to travel professionally, but in writing about the many aspects of nursing for and now my own sites, I had to reach beyond my comfort zone of home health and hospice and discover all I could about other options and roles. Travel nursing really caught my interest.

In 2007, Epi sent me a copy of Highway Hypodermics Travel Nursing 2007 to review for the now defunct nursing site at and I fell in love with the field all the while knowing I would probably never try it myself. Based on what I learned, I've written many travel articles for my sites as well as others such as (when it was still owned by Aaron Cooper).

The book she gave me recently is Highway Hypodermics: Travel Nursing 2012 which enjoys the distinction for 2012 as #1 book on Amazon in Nursing Issues, Trends, and Roles for the kindle version. She's working on a new edition for 2014. Epi's writing style is conversational and she covers everything you might possibly need to know about how to be a happy and successful travel nurse. Epi clearly enjoys the adventures herself and shares her secrets!

There are many options for travel nurses from housing to transportation to traveling with a family and pets. What does it take to become a travel nurse? It's clearly not an option for everyone.
Then you need to figure out other issues. Where do you want to live? What type of accommodations do you need? How do you manage to travel with school aged children? What happens if the assignment is a disaster? How do you decide which travel company/recruiter to use?How to deal with the politics.

Epstein LaRue takes you through the process step-by-step and prepares you for your next life as a travel nurse. You'll step into the role with ease and comfort because you know what to expect and how to handle almost every conceivable situation and then some. For anyone considering travel nursing, or even a seasoned traveler, this book is a must have!

There are profiles of travel companies written by the companies themselves and blurbs from a number of travelers about their own experiences on the road. As the world of travel nursing changes due to things such as new laws, regs, and demands from employers, Epi is right on top of them to bring you the latest information.

There's also a lot of information in her book that can be helpful to visiting nurses and health professionals who make home health and hospice visits to patient's home.  Any tips that can make it easy to handle being on the road all day and facing obstacles such as the Polar Vortex of a winter we've had across the country are always welcome!

Epi is active on social media sites so follow her on Facebook, Twitter and Pinterest. Find her blog and website online. Stay up to date with travel nursing.