Special Nursing Task Force Appointed
The Joint Commission on Accreditation of Healthcare Organizations has appointed a special Nursing Standards Task Force to address shortterm and long-range nursing standards issues. The Task Force is predominantly made up of experienced registered nurses from diverse hospital settings; many have also had management responsibilities. Also included on the Task Force are licensed practical nurses, a hospital executive, a physician, and a patient advocate.
The Task Force, which will meet periodically over the next two years, will concentrate its initial efforts on updating Joint Commission nursing standards which were last revised in 1979. "The practice of nursing has changed significantly over the past decade. We must assume that nursing standards reflect practical but stateof-the-art expectations that foster the clinical skills and caring behaviors that patients have always associated with nurses," said Dennis S. O'Leary, MD, Joint Commission president.
The Task Force will then turn its attention to establishing a standards framework that will accommodate the application of clinical indicators that are being developed as a major component of the Joint Commission's Agenda for Change initiatives. These initiatives are intended to stimulate continuous improvement in organizational and clinical performance through the application of indicators throughout all hospital clinical areas.
Commission on Nursing Releases Report
The Commission on Nursing of the U.S. Department of Health and Human Services issued its final report on December 12, 1988, recommending a wide variety of actions to overcome the nation's shortage of registered nurses and to prevent recurrence of the problem.
Concluding that no single action alone could address the shortage, the commission made 16 recommendations within 81 action-oriented "strategies" for achieving the goals. Among the recommendations were:
* Increased salaries and expanded opportunity for pay advancement throughout a nursing career.
* Increased involvement by nurses in client care decisions.
* More efficient use of registered nurses and other hospital staff in carrying out nursing and nonnursing duties.
* Improved nursing education and expanded financial support for education including more "service-payback" loans.
* Enhanced public image of registered nurses and the nursing profession.
The commission found that a significant and persistent shortage is being experienced by hospitals, nursing homes, and other health-care settings across the nation. The shortage is caused by increased demand for registered nurses due to changes in the health-care delivery system, while sources of supply have not been able to keep pace, the commission said.
"The country is demanding more nurses to supply increasingly technical, complex, and cost-effective patient care while fewer potential entrants to the profession are viewing nursing as an attractive career alternative," the report says.
The report projects that a variety of trends "including an aging population, new technologies and treatment possibilities, legislative changes, and the emergence of new diseases" will further increase the demand for registered nurses in all health-care sectors.
The commission also urges policy and law makers and those who set the standards for health-care practices to give nurses more say in decisions that affect their work and the quality of client care. It recommends that nurses be included on governing boards and in the decision-making process at administrative and management levels in the institutions where they work. And, the commission maintains, it is critical to the quality of care that greater collaboration be fostered among the medical and nursing members of the health care team.
For more information, contact Paula Kuzmich, U.S. Department of Health and Human Services, Washington, DC; 202-245-9286.
War is Hell on the Homefront, Too
Counseling the Vietnam Veteran is a 28-minute video designed to alert nurses to the specific needs of Vietnam veterans and to give them the nursing know-how to meet these needs. Just released by the American Journal of Nursing Company, this program presents the experience of two psychiatric nurses who work with the Veterans Administration. These nurses have identified important differences between Vietnam veterans and veterans of World War II. They detail treatment modalities that will help Vietnam vets understand and integrate their particular war experience, rather than let it obstruct their lives.
Special emphasis is placed on the most common diagnosis, post traumatic stress disorder (PTSD), and scenes from actual counseling sessions round out this unique video.
Counseling the Vietnam. Veteran can be purchased for $275. or rented for $60. For more information, contact American Journal of Nursing Company, Educational Services Division, 555 West 57th Street, New York, NY 10019-2961; 800-223-2282.
He Said It!
In a recent journal article discussing "What the Nursing Shortage Means to Doctors," surgeon Raymond J. Dieter, Jr., an AMA delegate, had this suggestion for physicians who want to help alleviate the nursing shortage: "We have to raise the professional status - and the pay - of nurses. We have to treat them with more respect, especially in front of patients. And while only doctors should make medical decisions, we have to allow nurses the autonomy to make nursing decisions. If we doctors don't work at making nursing a more rewarding and desirable profession, we're going to make medicine a miserable one." Sounds like a good start to us (Med Ec(Surg) Dec 88:76).
Nursing School Enrollments Down Again, but Upswing Is Approaching
Preliminary results from the 1988 annual survey of state-approved schools of nursing show a drop of 0.7% in the number of students studying to be registered nurses. But in contrast to this enrollment figure, the number of first-time admissions (new students beginning nursing school in 1988) is up about 4%, which observers say may signal that a turnaround is imminent in the nursing profession's recruitment crisis.
The RN program enrollment figure is good news and bad news," explains NLN Vice President for Research Peri Rosenfeld, PhD. "The bad news is obvious - we're still seeing fewer instead of more students in nursing schools; but the good news is that the five-year trend of declining enrollments appears to be leveling off - the 1988 decline of 0.7% is far smaller than the 1987 decrease of 5.6% and the 1986 decrease of 11.1%. The admissions figure is more optimistic, and suggests that next year's enrollment figure may break the downward trend and actually show an increase in the number of students studying to be RNs."
But Rosenfeld says that until enrollments rise substantially and those larger classes of students graduate and enter the field, the nursing supply crisis will continue - the graduating class of '88 is almost 8% smaller than the class of '87, the result of previous drops in nursing school enrollments.
The RN enrollment and admissions figures describe percentage changes for the current academic year compared with the previous academic year.
Three types of education programs prepare students to become RNs - two-year associate degree programs, three-year hospital-based diploma programs, and four-year bachelor's degree programs. Licensed practical/ vocational nurses (LPNs/LVNs), who are supervised by RNs, graduate from programs that take about one year to complete.
To date, more than 90% of the nation's RN education programs - some 1,300 schools - have responded to the 1988 National League for Nursing (NLN) survey. NLN has conducted these surveys since 1958. In a separate study, NLN also surveys LPN/LVN schools; 1988 results for that survey will be announced in the spring of this year. NLN is the recognized accrediting agency for master's degree, bachelor's degree, associate degree, diploma, and practical nursing programs in the United States.
Analysis of the 1988 data shows the sharpest RN enrollment decline (5%) in four-year bachelor's degree nursing programs, which provide students with the credentials that many health care employers prefer for nurses in specialized practice. According to the 1988 federal Commission on Nursing, the nursing shortage is most critical in areas that require specialized training, such as critical-care nursing and medical-surgical nursing.
The only category of RN education programs showing an upswing in enrollments was the associate degree program category, with a gain of 3,1% over the previous academic year. Hospital-based diploma programs (which have been dwindling in number for more than two decades and now account for less than 20% of all nursing education programs) experienced an enrollment decline of 1.5%.
The most recent data available for licensed practical nursing programs stem from the '86-'87 academic year, when enrollments increased slightly - up about 4% over the previous academic year.
NLN maintains the most comprehensive database in existence for nursing education statistics - data reports compiled from the annual surveys are based on a 100% response rate. This is important, explains Rosenfeld, because the severity of the current nursing shortage "has spawned an abundance of research on nursing. Unfortunately, much of this research is poorly designed and executed, resulting in misinformation about a serious crisis that is compromising the quality of health-care delivery."
In summary, Rosenfeld says that although interest in the nursing profession seems to be reviving, "we have a long way to go."
MD Says Boycott Threatens South African Health Care
Health care in South Africa is a twosided coin burnished by affluence on one side, bearing the mark of malnutrition on the other.
White South Africans suffer from "the three B's - beer, barbecue, and beef," said Dr. Mary Roberts, a physician whose work took her from Groote Schuur, a high-tech hospital in Cape Town, to a settlement teeming with impoverished blacks on the city's outskirts.
Speaking recently at The University of Texas at Austin School of Nursing, she said her contemporaries among white South Africans share ailments with their U.S. counterparts, the diseases of stress, fat-laden diets, and lack of exercise. In stark contrast, patients at clinics she helped establish in the black settlement suffer from starvation, overcrowding, and poverty.
"Most common among blacks are two diseases of malnutrition," Roberts explained. "Kwashiorkor, caused from lack of protein, bloats the body, while marasmus shrinks its host into a living skeleton."
Despite South Africa's turmoil over racial segregation, Roberts noted progress toward improved health care for blacks. In 1980, city officials in Cape Town launched "GOBI- FFF," a campaign aimed at "health for all by 2000." The acronym stands for "growth monitoring, oral rehydration, breast feeding, immunization, family spacing, female education and food supplements."
Death from gastroenteritis and measles is on the decrease for blacks, referred to in their country as "Africans," Roberts added. "But tuberculosis is widespread and gastroenteritis from contaminated drinking water in rural areas still causes many deaths."
But Roberts says the biggest health problem in South Africa is spawned from socioeconomic conditions rather than disease. Addressing graduate students in UT Austin's nursing program, she painted a picture of hardship and suffering among blacks in her homeland mitigated in part by a handful of dedicated white activists who oppose the South African government's racial policies.
"In Cape Town, there has been an influx of about one million Africans from rural areas over the past decade," the physician said. 'Africans had been forcibly sent to rural areas where the land became overcrowded and unproductive."
Roberts said migrant labor, often the only work offered to Africans, forces men to leave their families behind in villages with virtually no resources. Most rural areas have poor roads, substandard schools, a few small stores and no basis for industry, she added.
An informal economic sector has sprung up in some townships where residents provide taxi and other services to each other, but urban areas also are hit with high unemployment. Lures for industry - transit, capital, and training - are in short supply. Since unemployment and other forms of public assistance are virtually unavailable to blacks, most are chronically underfed and vulnerable to disease.
AIDS, just now beginning to spread, will find ideal conditions for an epidemic in the settlements, Roberts warned. Added to the situation, many U.S. firms pulled out of South Africa under pressure to divest or boycott the country and eliminated for many blacks the only training or jobs previously open to them. Unemployment rates are 70% in areas where vanished American companies once were the main employers of blacks. "Divestment, although well intentioned, has been counterproductive in education and employment," Roberts said. "The effect has been devastating on education. No longer do these firms offer scholarships or train African workers."
African health care professionals fare somewhat better mostly due to a nursing shortage, Roberts said. Black "nursing sisters" operate clinics in both rural and urban areas. Nurses who have completed sufficient course work are allowed to diagnose cases and prescribe some medicines, she noted.
"What we need, short of an end to the boycott, is for more nurses to come to South Africa and join in our work," Roberts said. She also called for an international effort to educate South Africans who are in exile because of their anti-Apartheid views.
"It is a complicated matter to run a modern country of 30 million people," Roberts said. "We need experts in agriculture, industry, government, and all areas. I think America and Europe should take the lead in offering this kind of help to exiles."
Roberts also worked for 15 years with another woman physician who headed a rural hospital where food supplements were administered to 3,000 malnourished children. As the Cape Town settlement grew, Roberts and a Swedish doctor recruited nutrition layworkers and, with the help of a University of Cape Town medical students organization, established the three Philani Nutrition Centres.
The centers also feature employment strategies so African mothers can "learn a skill, earn some money and make the journey to self-confidence and self-sufficiency," she said.
Roberts' address was part of a seminar titled "Leadership Strategies for Success in the Service Professions" conducted by J.B. Matkowski of Austin and sponsored by the UT Austin dean of nursing, Dr. Billye Brown. Roberts participated as one of the mentors for the 55 School of Nursing students, faculty and staff enrolled in the seminar.
"Breakthrough" Educational Software Game Prepares Nursing Students for Tough Licensure Exam
As part of its commitment to solving the nationwide nursing shortage, the National League for Nursing (NLN) has announced the release of THE RN COMPUTER CHALLENGE. Developed by NLN's Division of Test Service, THE RN COMPUTER CHALLENGE has been specifically designed for nursing students and graduate nurses who need to take or retake the NCLEX-RN, the licensure examination for registered nurses.
THE RN COMPUTER CHALLENGE can be played individually or in groups of up to four, maximizing the use of the computer as a cost-effective learning tool. The fun of playing with peers and vying for the highest score makes THE RN COMPUTER CHALLENGE a radical departure from the standard choices of NCLEX-RN review books, tests, and courses.
"THE RN COMPUTER CHALLENGE is a breakthrough in our NCLEX-RN review repertoire," notes Sr. Rosemary Donley, NLN's President and Executive Vice President of The Catholic University of America in Washington, D.C. "It offers our students a review program for NCLEXRN that provides both the excitement and peer feedback of group learning with the fast response of a colorful computer game. The timing couldn't be better . . . better prepared students are the best response nurse educators can give to the public's increasing demand for quality health-care services."
The National Council Licensure Examination for Registered Nurses, or NCLEX-RN, was completely revised last year to reflect changes in nursing practice. These changes were widely held to be the cause of a decline in passing rates, considered a contributing factor to the nation's nursing shortage. "Nurse educators are particularly sensitive to any hint that their students could have been better prepared for last year's NCLEX-RN," reports Dr. Patricia Moccia, NLN's Vice President for Education and Accreditation Services. "We are fielding many requests from schools of nursing looking for new and innovative NCLEX-RN review materials. We think THE RN COMPUTER CHALLENGE will relieve some of the external pressure on the curriculum."
To play THE RN COMPUTER CHALLENGE, each player chooses a preferred game speed, ranging from novice to genius. Correct responses are recorded on the color monitor gameboard, and points are accumulated. If a question is missed, players are given the correct answer and its rationale. Participants get their own individualized printout providing immediate feedback in each test category. Players can then select any category for intensive drill and practice, considered key to building test-taking confidence.
THE RN COMPUTKR CHALLENGE can be used on any IBM-compatible PC, with 64OK memory, color monitor, and hard disk. It has been designed with the beginner in mind; with easy-to-follow, menu-driven instruction, a user's manual, and a toll-free number for software support.
Information is available from NLN Test Service, National League for Nursing, 10 Columbus Circle, New York 10019; toll-free 1-800-847-8480 (in New York State, 1-800-442-4546), also 1-212-582-1022.
Grant Awarded to University of Pennsylvania School of Nursing for New Master's Program
The University of Pennsylvania School of Nursing is developing a master's level educational program to prepare nurse managers for positions in community-based health-care agencies. The effort is funded by a $162,466 grant from the W.K. Kellogg Foundation of Battle Creek Michigan. It is managed by Cynthia Scalzi, PhD, RN, director of Penn's Nursing Administration Program.
The program will be designed with the assistance of a community/faculty task force. The task force, comprised of faculty and community leaders, will provide a broad base of community support for the program. Task force members will also assist in the development of a needs assessment survey, which will provide the basis for the development of the curriculum and the marketing plan.
Because nursing is expanding from hospitals to community settings, the School of Nursing recognizes that nurse administrators today need superior planning and administrative expertise to handle the legal, regulatory, marketing, quality assurance, and finance issues that are unique to community-based healthcare programs, according to Scalzi.
"The grant makes it possible to respond to current and future community health-care needs," Scalzi said. "Through the program, administrators will gain skills in such areas as budget development, career planning, objective setting, and personnel forecasting."
Research Grant Program Available
The National Association of Orthopaedic Nurses (NAON) is pleased to announce the availability of a research grant program to provide financial assistance to nurses who are actively engaged in research projects in orthopaedics.
Grants will be awarded annually through a competitive application process based on criteria established by NAON. For additional information and a grant application, submit a brief abstract of the research project to be conducted along with a curriculum vitae to NAON Research Grant Project, c/o National Association of Orthopaedic Nurses, North Woodbury Road/ Box 56, Pitman, NJ 08071. Deadline for the 1989-90 year is December 1, 1989.
The Pew Charitable Trusts Grants $800,000 for Nursing Project
The nation's nursing shortage continues to worsen, despite health-care employers' and nursing educators' best recruitment efforts, and healthcare consumers stand to be the biggest losers. Something is still wrong in the nursing recruitment picture, and the Nursing Tri-Council is convinced that the problem lies in the picture of nursing itself.
The average American probably sees a nurse on television five to ten times a week, say media analysts, and with few exceptions these health-care professionals are portrayed in an outdated, unrealistic fashion - as submissive hospital servants lacking professional status and responsibilities. Now the forces that generate such portrayals and the misconceptions that result are the target of the Nursing Tri-Council.
With an $800,000 grant from The Pew Charitable Trusts in Philadelphia, the Nursing Tri-Council will launch a two-year, comprehensive public relations campaign aimed at both the broadcast and print media in an effort to bring the public's image of nursing up to date. By doing so, project planners say that the profession's undeserved "image problem" will fall away as a stumbling block for the profession.
The Tri-Council includes the American Nurses' Association, the American Association of Colleges of Nursing, the American Organizations of Nurse Executives, and the National League for Nursing (NLN). NLN will administer the grant, and an executive committee made up of TriCouncil organization representatives will be responsible for policy decisions regarding the project.
"The Pew Charitable Trusts has had the foresight to recognize that if organized nursing can't correct the public's image of nurses' roles and responsibilities, our best efforts to battle the nursing supply crisis will fall short," explains Claire Fagin, PhD, RN, FAAN, the dean of the School of Nursing at the University of Pennsylvania in Philadelphia, and a driving force behind the project. "While we've made significant progress to improve reward systems for nurses and to encourage better, more appropriate use of nursing resources, nurses still suffer from an outdated, inaccurate image. We've got a public relations problem and it calls for a public relations solution," says Fagin.
Project administrators will make use of a variety of media vehicles to get their messages across, including nonpaid and paid broadcast and print media placements in public service campaigns, news stories, feature stories, and entertainment programs. A key aspect of the program will involve media training for a select group of nursing spokespersons who will then be able to make the most effective use of media coverage to address national and regional nursing issues. Public speaking tours are also part of this media strategy.
"We have three major goals to accomplish here," explains NLN Chief Executive Officer Pamela J. Maraldo, PhD, RN, FAAN. "We have to make visible the many changes that have shaped contemporary nursing roles, place the issue of nursing's image on the publics agenda, and provide visibility for models that exemplify these contemporary roles and images."
Fagin says the project will emphasize three key images of nurses: as health information specialists who can explain to consumers in lay terms the mysteries of the health-care system; as case managers able to guide patients through the maze of healthcare providers and settings for the duration of their illnesses while ensuring high quality care; and as clinically expert bedside caregivers in hospitals, caring for patients 24 hours a day and dealing with complex technology, life and death situations, and sensitive ethical and emotional issues.
"In short, we're going to project nurses as the heroines they are," says Fagin.
The media program will involve four phases: information gathering, developing key messages, disseminating messages, and evaluating project outcomes and followup strategies. Target groups for these messages include the business community and third party payers, because of their key roles in deciding how health-care dollars are spent; the elderly population, because of its increasing need for nursing care to alleviate chronic illnesses; and women between the ages of 25 and 40, who tend to be the health-care decisionmakers in families.
An advisory committee made up of public relations and media professionals and influential members of target media markets will lend their expertise throughout the project. Fagin and Maraldo will also serve as advisors.
The Pew Charitable Trusts comprises seven charitable funds established between 1948 and 1979 by the sons and daughters of Joseph N. Pew, the founder of the Sun Oil Company. The Trusts support nonprofit organizations dedicated to improving the quality of life for people and communities and encouraging personal growth and self-sufficiency. Grants are awarded in the areas of conservation and the environment, culture, education, health and human services, public policy, and religion.
Health Connection Launched by Hospitals
Schools and hospitals are forming partnerships for the first time in Ohio through a program called The Health Connection, sponsored by the Hospital Association of Central Ohio (HACO).
This program matches the 49 HACO-member hospitals with over 350 private and public junior, middle, and senior high schools and vocational schools located in central Ohio. The partnership provides the first step in developing a working relationship between the health-care and education community. It is designed to encourage schools and hospitals to develop working relationships.
The Health Connection also allows students to learn about the newest opportunities in health careers from hospital professionals. In turn, hospitals will showcase health-care professions to potential candidates.
Initially, the program will concentrate on the opportunities available in nursing due to the critical need for nursing professionals. Two years ago, the Ohio Department of Health projected that over five thousand more registered nurses would be required in Ohio hospitals. Furthermore, the number of students enrolled in Ohio nursing schools has dropped 27% in the last four years.
The Health Connection was launched at a reception hosted by HACO and its members for the guidance counselors and principals of Central Ohio schools.