Nursing Management:
doi: 10.1097/01.NUMA.0000409928.92460.84
Department: Letters

Letters

Olsen, Jeanette M. MSN, RN; Baker, Jean BSN, RN; Cabibbo, Tiffany RN, OCN; Ford, Patricia BSN, RN, ONC

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Nursing Instructor WITC-Rice Lake Rice Lake, Wis.

Director of Rehab and Skilled Services Tomball Regional Medical Center Tomball, Tex.

Director of Oncology Martin Memorial Medical Center Stuart, Fla.

Director of Quality Houston Physicians' Hospital Webster, Tex.

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Is personality greater than education?

Should attitude be more important than education level when hiring nurses in today's quality-driven and increasingly complex healthcare system? Thank-you for initiating this dialogue by publishing “The Gap Between Education Preferences and Hiring Practices” by Dana Beth Weinberg, PhD; Dianne Cooney-Miner, PhD, RN; Jennifer N. Perloff, PhD, MPA; and Michael Bourgoin, MA, in the September 2011 issue.

In this article, two primary reasons presented for bachelor's of science in nursing (BSN) preference when hiring are improved patient mortality and shorter hospital stays. As the authors note, several studies have suggested a connection between facilities with higher numbers of BSN-prepared nurses and better patient outcomes. However, the Institute of Medicine indicates that research surrounding this issue is currently inconclusive. If clear evidence can be presented confirming the value of a BSN to patient outcomes over the associate's degree in nursing, it would behoove the discipline of nursing to finally require a BSN degree as the minimal level of entry to the profession, rather than risk continued reliance on subjective characteristics in hiring.

The preference for good attitudes in hiring present in the literature calls attention to the need for further research in this area. It's quite possible that measurable benefits to hiring employees with positive attitudes, including benefits to patient outcomes, may be found. Clearly, this is an issue in need of further exploration, and I believe the authors have opened the door for that inquiry to begin.

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Safety first

It's the responsibility of nurse leaders to inspire nurses to strive for excellence and cultivate an environment of safety for both the staff and patients. Your October 2011 article “10 Ways to Practice Evidence-Based Staffing and Scheduling” by Susan M. Reese, MBA, RN, CPHIMS, raised many questions for me as to my current practice of staffing and scheduling for patient and staff safety.

Reviewing the staff mix is critical for a safe environm ent. It's necessary to have the correct support staff, as well as the licensed staff, to give safe quality care. Balancing new graduate nurses and experienced nurses is essential for the safety of patients. Fatigue is a large component of safety with respect to the delivery of nursing care.

Literature continues to debate the positives and negatives of shift hours in relationship to creating a safe environment. Fatigue affects performance, which trickles down to patient safety. Long hours reduce the nurse's ability to recognize subtle changes in a patient's condition and intervene quickly, and increase medication errors. Yet studies have shown that 12-hour shifts are preferred and add to job satisfaction. Additional studies are needed that relate staffing and scheduling to patient and staff safety. As leaders, it's our ethical obligati on to study evidence and make decisions that will promote a healthy climate and create a safe environment for both the patient and the employe e.

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Meaningful use?

I'm writing in response to the article “Meaningful Use 101” published in the August 2011 issue by Yvette Bolla, MSN, RN. As a nurse manager, I found this article very informative. I work at an organization that's less than 90 days from a complete transformation to electronic medical records (EMRs), and it has been a whirlwind journey thus far. I've been fortunate to be involved in many meetings and focus groups regarding the development of the workflow for the new system, and “meaningful use” comes up at every meeting. However, I can honestly say that I didn't fully understand what meaningful use actually meant, therefore, this article attracted my attention. With the aid of this article, I feel that I have a better understanding of meaningful use and will be able to bring back to the staff two key educational points.

The first bullet point suggests explaining the reasons related to converting to an EMR. Many associates don't understand the reasons why their organization is making such an expensive investment at this time in this economy. I feel if they understood the financial incentives related to such an investment, it would clarify the rationale. With the cuts to Medicaid and Medicare payments, healthcare organizations need to be able to attain full reimbursement without percentage deductions.

Second, the government isn't just creating more “red tape,” and it isn't all about money. Patient safety, efficiency, evidence-based improvements, and quality are the actual goals of EMR meaningful use. No one in healthcare should feel that EMRs are a bad thing; the changeover should be welcomed. Nurses should advocate and participate in these changes. I fully agree that now is the time for nurses to be vocal, ensuring that the contributions this profession makes to positively impact patient care are properly reflected.

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Hold on...to your jobs

I read, with interest, “Investing in the Future Nursing Workforce” by Juanita S. Parry, MS, BSN, RN, et al., in the July 2011 issue. As a nurse with 40 years of experience in hospital settings, I feel encouraged knowing that so many are pursuing a career in nursing and I applaud the University of Michigan Health System (UMHS) in their efforts to address the nursing shortage and nursing retention through their proactive Career Launch program for senior nursing students. Learning how to assess an organization's vision and mission, dress appropriately, prepare a resume, and interview successfully are positive first steps to launching a rewarding career. However, high turnover rates (30% in the first year and 57% in the second year) of new graduate nurses indicate that working in hospital settings causes these graduates to experience frustration and stress when their perception of nursing and the reality of nursing collide.

I believe that the UHMS model should be incorporated into a comprehensive, collaborative framework that bridges the gap between the end of students' academic learning experience and their ability to function independently, even if it takes a year or longer. In light of the current nursing shortage and the high turnover rate for new graduates, it would behoove nurse leaders in the fields of education and administration to focus on the retention of new nurses by building bridges between academia and practice through internships, extended orientation, and nurse residency programs. As the authors concluded, the Career Launch program is about engaging students and building lasting relationships.

Jeanette M. Olsen, MSN, RN

Nursing Instructor WITC-Rice Lake

Rice Lake, Wis.

Safety first

Jean Baker, BSN, RN

Director of Rehab and Skilled Services

Tomball Regional Medical Center

Tomball, Tex.

Tiffany Cabibbo, RN, OCN

Director of Oncology

Martin Memorial Medical Center

Stuart, Fla.

Patricia Ford, BSN, RN, ONC

Director of Quality

Houston Physicians' Hospital

Webster, Tex.

© 2012 by Lippincott Williams & Wilkins, Inc.

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