Sunday, October 9, 2011

Trendsetters: Specialty Nursing Preview 2011

Top nurses are not only tuned into their patients’ vital signs, but they also have their fingers on the pulse of the profession. To get a feel for some of the up-and-coming trends in nursing, spoke with five nursing specialty organization presidents about what the future holds for RNs.

(Pediatrics) School Offers Tools

Pediatric nurses are embracing the importance of education and weaving it into all areas of their nursing practice, says Debbie Arnow, RN, MSN, NE-BC, president of the Society of Pediatric Nurses.

SPN has created guidelines for nurses who care for children and families during disasters. “We think it’s important to give guidance to our members and other healthcare professionals on how to help families deal with some of those issues,” Arnow says.

Promoting quality pediatric nursing education in the nation’s nursing schools is another way pediatric nurses are championing the importance of education to their nursing faculty colleagues. “There’s a lot of things that are important in the curriculum in schools, like public policy or research,” Arnow says, “but we want to make sure that schools continue to include [pediatric nursing] in their curriculum so that when these nurses graduate from nursing school and they are working in a community hospital and a pediatric patient comes in they have some basis to provide the right care to that patient.”

The need for education doesn’t stop after students have passed the NCLEX and are sporting RN credentials. “We’d like to see more [pediatric nurses] become prepared with their bachelor’s degree, master’s degree and doctoral preparation,” Arnow says. To help RNs attain this goal, SPN will launch a scholarship program this year.

(Oncology) Side Effects May Vary

When patients receive a cancer diagnosis and learn they’ll undergo chemotherapy, they often assume they’ll lose their hair and experience extreme fatigue and nausea as a result of the treatments. Depending on their courses of treatment they could be right, but, with the advent of new types of chemotherapy agents, they might just bypass those side effects altogether, says Oncology Nursing Society President Carlton Brown, RN, PhD, AOCN.

“The idea that everyone will get chemotherapy or radiation in liquid form is not always the case,” Brown says. “A trend for us right now is more oral chemotherapy administration. Over the last couple of years, we’ve had some really good chemotherapy agents that patients take orally.”

But with new medications and new delivery methods come new side effects. “For instance, epidermal growth factor receptor inhibitors, these drugs are not like the chemotherapy drugs that you thought about in the past that were IV,” Brown says. “They’re really inhibitors, so patients are taking these at home, but they also have their own strange types of side effects.” Nail and skin issues such as rashes are common side effects that indicate the EGFR inhibitors are working.

“Now we’ve got to educate nurses about new and different side effects,” Brown says. “No longer are we having side effects that are nausea and hair loss, so now we have to change the way we’re educating nurses and patients.”
(Medical/Surgical) What’s Old Is New

The trials and tribulations of caring for high-acuity patients with multiple comorbidities and fewer staff isn’t new to med/surg nurses, but according to Academy of Medical-Surgical Nurses President Sandra Fights, RN, MS, CNE, CMSRN, these are still the major issues facing med/surg nurses today.

“The patients are so complex and have so many comorbidities going on that it makes it difficult to spend the amount of time that you need to spend with a patient because you’re short-staffed,” says Fights, who also is the freshman division coordinator at St. Elizabeth School of Nursing in Lafayette, Ind.

The aging nurse workforce compounds the difficulties faced by med/surg nurses. “As a nurse, continuing to be able have the energy you need to have to care for the patients who are sicker and require more effort, time and energy to take care of — that’s becoming a bigger issue for us,” Fights says.

While these challenges might sound daunting, Fights actually finds them invigorating. “The med/surg nurse really has the challenge of keeping all the different disciplines working together for the benefit of the patient,” Fights says.

Fights says the struggles are not without their benefits. “The reward comes from being with the patient and knowing that you’ve made all the connections with the patient and the family but you’ve also connected all the dots with the other disciplines,” she says.

(Perioperative) Be Blunt About It

With its embrace of minimally invasive procedures and robotic surgery, perioperative nursing is known as a leader in adopting new technology in the clinical arena. But according to Association of periOperative Registered Nurses President Charlotte Guglielmi, RN, BSN, MA, CNOR, there is one area where perioperative nursing has lagged behind the rest of the profession — sharps safety.

“Since President Clinton signed the sharps safety legislation [in 2000], non-surgical injury rates around sharps have decreased by 31.6%,” Guglielmi says. However, “in the surgical suite, they increased by 6.5%.” (These statistics were reported in the April 2010 issue of the Journal of the American College of Surgeons.)

Early blunt needles were not acceptable to surgeons, who reported they were difficult to use, she says. Technology has caught up and new blunt sharps move through tissue more effectively, comparable to traditional sharps. Beth Israel Deaconess Medical Center in Boston, where Guglielmi works as a perioperative nurse specialist, launched its transition to blunt-needle sutures in November.

AORN is making a marked effort to put together more tools and strategies to promote sharps safety, such as the Sharps Safety Took Kit, which wil be ready for the AORN Congress in March. It will be available free to members and for a fee to non-members. “As we move forward into 2011, we’re going to be working with partners to help to reverse this trend,” Guglielmi says. “My dream would be in 10 more years that the problem would be eradicated.”

(Emergency) Safe and Sound

As goes emergency nursing, so goes the nation — of nurses that is. At least that’s how Emergency Nurses Association President AnnMarie Papa, RN, DNP, CEN, NE-BC, FAEN, describes the significance of trends occurring in emergency nursing. “The ED is the microcosm of the community,” Papa says. “So you see something first in the ED before it makes its way up to the floor.”

One unfortunate phenomenon creeping out of the trauma bay and onto acute care units is violence against staff. “In the ED, we see patients on what they often describe as the worst day of their life,” Papa says. “You have a lot of people in a small space, in high-crisis mode, and this causes a lot of stress and anxiety for patients.”

Often, this leads patients or family members to take out their fear and frustration on the nursing staff. In September, the ENA reported that more than half of 3,211 ED nurses surveyed experienced physical or verbal abuse at work during the previous seven-day time frame.

Although some might think dealing with violence is just part of a high-intensity job, Papa sees it differently. “[In the past] we were very accepting of the fact that someone lashed out and hit us because we recognized it’s a tough place and people are upset,” she says. “It’s there, but that doesn’t mean that we shouldn’t have things in place to mitigate it.”

Papa says EDs should take a page from the emergency medical services field when it comes to dealing with workplace violence. “Years ago, the EMS community got it right because whenever they go to a scene, the first thing they say is, ‘We have to ensure that the scene is safe because if we’re not safe, we’re not doing anybody any good,’” Papa says. “We need to start looking at violence through those lenses in the emergency nursing world.”

Papa stresses that while every step needs to be taken to prevent violence against staff, when it does happen, an RN needs support recovering so he or she can feel safe returning to work.

(Critical Care) Beyond the ICU

Gone will be the days when critically ill patients are exclusively relegated to care in critical care units. “It’s impossible to deny that hospitals have become critical care facilities regardless of how units are named,” says Kristine Peterson, RN, MS, CCRN, CCNS, president of the American Association of Critical-Care Nurses. ”Hospital nursing and critical care nursing will become one and the same as the specifics of healthcare reform play out. Hospital care represents one of the most expensive forms of healthcare. When one moves as much care delivery as possible to other locations, critical care is what will remain in the hospital.”

With an increase in critically ill patients, new modes to deliver high-quality care will become a necessity. Peterson cites eICUs, centralized groups of critical care nurses who can monitor patients from remote locations. “Tele-ICUs will make it easier for the knowledge and skills of an interdisciplinary team outside a clinical unit to match a patient’s needs by using state-of-the-art clinical monitoring, audiovisual and electronic record links,” Peterson says.

For example, there can be an eICU hub at one hospital in Chicago monitoring patients in other facilities and even other states. “Tele-health refers to health professionals monitoring from a central location patients in other locations, such as hospital units or even home,” she says.

These new care delivery methods will allow critical care nurses to take their expertise outside the ICU and share it with other RNs, not just in their own hospital but those miles away.

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