greatly distressed to have received a written warning about my conduct at work. I am sending this letter to more fully detail my side of the story.
When I first secured my position 18 months ago, I was given the task of enacting a number of necessary changes as the clinical research coordinator for the cardiac surgery service. I was instructed to implement new processes for patient care and to improve the skill levels of the staff. I have over twenty years of experience in my field and am currently enrolled in a master's program for health care management to further hone my abilities.

I was well aware of the phenomenon of change resistance when I embarked upon my task and given the fact that the needed changes were so intimately related to standard operating procedures at the hospital, some anger and resentment was only natural, despite the fact that the…...

Nurse-headed telephone triage has increasingly been employed for managing physician consultation demands in British general practice. Prior research works are vague when it comes to delineating the association between nurse triage call results and practical clinical experience. A majority of studies are restricted to scrutinizing out-of-hours nurse phone triage. This particular study has been performed within the framework of current knowledge, thereby contributing a solution angle highly relevant to the nursing profession. This study's key purpose was investigating whether or not primary care nursing staff's (who undertake digital decision-backed software phone triage) professional traits are associated with call disposition (Varley, et al., 2016).
Literature eview

Telephone Triage

Telephone triage application is an approach utilized for tackling increasing nurse workloads. Nursing staff offer an effective and safe triage service within various settings such as primary care, in which they may prove efficient in terms of managing doctors' workload in out-of-hours and day-of-contact primary healthcare…...

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References

Campbell, J., Fletcher, L., Britten, E., Green, N., Holt, C., & Lattimer, V. (2015). . The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with care. Health Technology Access.

Varley, A., Warren, F., Richards, S., Calitri, R., Chaplin, K., Fletcher, E., . . . Campbell, J. (2016). The effect of nurses' preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial. International Journal of Nursing Studies, 12 - 20.

Evidence of this can be corroborated with a study conducted by the California Nurses Association, which found similar positive effects. At the same time, researchers found that reducing these ratios in various specialty environments inside the hospital (such as the ICU), improves the underlying amounts of care being provided dramatically. This is important, because it is verifying the positive effects that nurse to patient ratios are having on the industry. ("Does Mandating Nurse Patient Ratios Improve Care," 2010)
Clearly, the study that was conducted by article titled, Nursing Staff and Patient Mortality, highlights how various nurse to patient ratios, improves the quality of care being provided. The study is useful, because it examines the underlying affects of having various nurse to patient ratios at a facility or the lack of these regulations. As a result, the information that was collected and analyzed helps to highlight how hospitals can avoid the…...

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Bibliography

Does Mandating Nurse Patient Ratios Improve Care. (2010). Health Leaders Media. Retrieved from:http://www.healthleadersmedia.com/content/NRS-245408/Does-Mandating-NursePatient-Ratios-Improve-Care

Aiken, L. (2002).Hospital Nursing Staff and Patient Mortality. Journal of American Medial Association, 288 (16), 240 -- 247.

Clarke, S. (2003). Failure to Rescue. American Journal of Nursing, 103 (1), 42 -- 47.

Nursing Shortage
eview On Nurses Shortage

The supply of professional nurses relative to the increase in demand for their services has been on a general decline over the years. As a career choice, nursing has been facing perennial shortage of professionals. Most healthcare organizations will affirm that their daunting tasks were recruiting fresh nurses and retaining the ones already in practice. The 2008 projections from the Bureau of Labor Statistics showed that the demand for professional nurses would increase from the then two million to three million, which represents sixty percent increment. In ideal situations, the number of those who have enrolled in nursing will be sufficient to supply the rise in their number. Nevertheless, this would not be the case if nothing were done to salvage the worrying trend of most students not graduating or resorting to other careers. According to Benjamin Isgur of PWHC Health and esearch Institute, of the…...

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References

American Association of Colleges of Nursing. (2009, September, 28). Nursing Shortage Fact Sheet. USA: AACN.

Buerhaus, P.I., Staiger, D., & Auerbach, D.I. (2009). The future of the nursing workforce in the United States: Data, trends, and implications. Boston: Jones and Bartlett Publishers.

Blakeley, J., & Ribeiro, V. (2008). Early Retirement among Registered Nurses: Contributing Factors. Journal of Nursing Management, 16(1), 29 -- 37

Cummings, G., et al. (2008). The Relationship between Nursing Leadership and Nurses' Job Satisfaction in Canadian Oncology Work Environments. Journal of Nursing Management, 16(5), 508 -- 518.

Nursing
There are several pros and cons to requiring a nurse to have a BSN to enter nursing practice. The most obvious advantage is that it would standardize practice and ensure excellence. Today, healthcare has been under the spotlight for potential pitfalls and difficulties in areas of care and excellence. If nurses have the same or similar qualifications before entering practice, there is less potential for error (Santina, 2012).

Furthermore, the course requires three years of not only theory, but also of hands-on practice, both in the classroom and in real-time environments such as clinics and hospitals. There are few teaching methods that offer as much in terms of personal and educational development as practical experience. This is particularly true of nursing and other healthcare practice arenas. Hence, more years of hands-on experience is a major advantage of requiring this kind of qualification before allowing nurses to enter practice (Santina, 2012). Indeed,…...

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References

Miller, C.D. (2007). A Comparison of Skill Perofrmance of the and BSN Prepared Nurse at Three and Four-Year Post-Graduate Level. Retrieved from: http://gradworks.umi.com/1446281.pdf

MomMD (2012). How to become an advanced practice nurse. Retrieved from:  http://www.mommd.com/advanced-practice-nursing.shtml 

Orsolini-Hain, L. (2008). What's all the Fuss? Working Towards a Baccalaureate or Graduate Degree in Nursing. NSNA. Retrieved from:  http://www.nsna.org/careercenter/fuss.aspx 

Santina, J. (2012). The BSN: A Higher Degree of Nursing Care. Health Care Career. Retrieved from:  http://www.worldwidelearn.com/healthcare/healthcare/the-bsn-a-higher-degree-of-nursing-care.php

Short-Range Goal: Appoint persons who are responsible for retrieving and providing information.

One challenge that night personnel in a hospital face is the fact that technical and information personnel, along with the resources that they provide, are only available during daytime hours. In order to handle the issue, the first step will be to determine the extent of the problem.

During the first three days of the two-week period, interviews will therefore be conducted with night staff to determine their information and resource needs. he findings will then be compared with the availability of resources to the day staff to determine what can realistically be accomplished to reach the long-range goal.

On the first day, applications will be invited from the night staff for the position of information assistant at each particular floor. Such persons will have to have a proven record of reliability and ethics, as well as at least 5 consistent…...

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Through interviews and regular monitoring and testing, the educator can also identify problems in the quality of nursing work, which will lead to the further identification and implementation of the staff's educational needs. By filling these needs, the role of the educator is to ensure excellence of care for patients and excellent knowledge for nurses.

Source

Nurses for a Healthier Tomorrow. (2010). Nurse Educator.  http://www.nursesource.org/nurse_educator.html

Nursing
One need only read the newspaper "Classified" ads to realize that employers are trying many clever marketing tactics to attract prospective nurses into their organizations. Many are offering sign-on bonuses, extra benefits and other amenities to attract a limited supply of nurses. As both the general population and the elderly population grow, the number of nurses needed to care for them increases proportionally as well. The number of people choosing to pursue nursing as a career has been on the decline, mainly due to long working hours, low pay, high job stress and other factors. These factors will not resolve themselves if the nursing deficit continues to increase. In addition, graduate nurses find it difficult to enter the workforce due to their lack of experience and a shortage of mentors to teach them. The solution is simple, more nurses are needed, and soon. Novice nurses are fresh graduates who usually…...

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Works Cited

Durkin, Barbara.(2002) Reliving Hospital Mistake: Mom recalls overdose case February

24, 2002. Newsday, Inc.

Lang, Susan. (1996) Lack of nursing assistants is an impending crisis, says Cornell gerontologist. Cornell University. Cornell University.   Accessed June, 2002.http://www.news.cornell.edu/releases/May96/nursingassistants.ssl.html .

National League for Nursing (NLN). (2000). Unpublished Data. New York, NY. Accessed June, 2002.http://nursing.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.nln.org%2Faboutnln%2Fnews_tricouncil2.htm.

Nursing
Bar code medication administration (BCMA) is one of the keys to minimizing medical errors in a manner consistent with evidence-based practice (Poon et al., 2010). However, universal embrace and utilization of BCMA remains stagnant. easons for resisting the transition to BCMA include nurse perceptions. Holden, Brown, Scanlon, & Tzion-Karsh (2012), for instance, found nurses reporting low perceived usefulness of BCMA in spite of the wealth of evidence supporting the technology. Perceived ease of use of BCMA was moderate, suggesting that it is mainly attitude factors preventing nurses from implementing BCMA in their institutions. When perceptions of the usefulness of BCMA increase, then compliance with BCMA standards can become more widespread. Any program that attempts to increase the utilization of BCMA must focus first on human factors including attitudes. This requires that all nurse leaders, as well as nurse educators, prepare advance practice nurses for using BCMA as a matter of…...

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References

Duffield, C.M., Roche, M.A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20(1-2), 23-33.

Roberts, B.R. (2013). Doctor of nursing practice: Integrating theory, research, and evidence-based practice. Clinical Scholars Review, 6(1), 4-8. doi:  http://dx.doi.org/10.1891/1939-2095.6.1.4

It is critical that NHAs are first qualified nurses, as their ability to relate to other nurses is essential to the organizational success of the nursing home ("Nursing home administrator jobs," 2011). Career paths for an NHA are rooted with education background and nursing experience. Although experience is necessary for being a successful NHA, a career path at minimum requires clinical licensing (Decker, & Castle, 2009).
The NHA is the management body over the facility, and their positions are in high demand. In the U.S. In 2008, approximately 17,000 nursing home administrators were responsible for the oversight of care for 1 million elderly adults and 1.3 million employees (Leister, 2009). Overseeing a large nursing staff, as well as vulnerable residents, are the daily demands of the NHA. The future of NHA field is concerning to researchers and professionals, as the number of licensed NHAs is on the decline. In Maryland,…...

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References

Decker, F, and Castle, N. (2009). The relationship of education level to the job tenure of nursing home administrators and directors of nursing. Health Care Management, 34(2), 152-160.

Leister, D. (2009). The vanishing nursing home administrator: stress and intent to leave.

Informally published manuscript, Capella University, Minneapolis, MI. Retrieved from http://gradworks.umi.com/3359575.pdf

Nursing home administrator jobs. (2011). Retrieved from http://www.nursinghomesjobs.org/nursing-home-administrator-jobs/

It is thus possible for the institution to retain nurses by strengthening the interpersonal leadership and management skills that lead to empowerment within the healthcare environment. This is especially supported by studies that found that despite the fact that a nurses' pay is important, it is not as critical in enhancing retention as a positive work place or an empowered environment that promotes teamwork and encourages ongoing learning, trust, and respect. (Chan, 2001).
It must always be remembered that nursing retention is the result of a combination of factors. There is no easy solution, and managers and leaders need to choose the combination of approaches that will be effective in their specific organization, since there is no one range or combination of strategies that will fit all.

eferences

Buerhaus, P., Staiger, D.O. & Auerbach, D.I. (2003) Is the Current Shortage of Hospital Nurses Ending? Health Affairs 22: 191-198.

Chan, C.C.A. (2001). Implications of…...

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References

Buerhaus, P., Staiger, D.O. & Auerbach, D.I. (2003) Is the Current Shortage of Hospital Nurses Ending? Health Affairs 22: 191-198.

Chan, C.C.A. (2001). Implications of organizational learning for nursing managers from the cultural, interpersonal and systems thinking perspectives. Nursing Inquiry, 8(3), 196-199.

Faulkner, J., & Laschinger, H. (2008). The effects of structural and psychological empowerment on perceived respect in acute care nurses. Journal of Nursing Management. 16(2): 214-221.

Kanter, R.M. (1979). Power failure in management circuits. Harvard Business Review, 65-75.

Nursing Educator and the AED
Personal Experience of Teaching and Helping Other Nurses to be More Ready in the Use of a Phillips Heart Start Defibrillator (AED)

Children and young adults as well as other adults can and do have cardiac arrest. Estimations state that undiagnosed heart conditions cause the deaths of one individual every three days in organized youth sports in the United States. (AED Universe, 2012, paraphrased) The Survivor's Foundation states that 460,000 deaths occur each year in the U.S. from sudden cardiac arrest. Sudden cardiac arrest (SCA) is reported to occur "when the lower chambers of the heart (the ventricles) suddenly stop beating normally and develop what is called ventricular fibrillation (VF). VF is a chaotic heart rhythm that is similar where the heart muscle begins quivering which prevents the heart from effectively pumping blood. If this condition is not corrected immediately, death will follow within ten minutes.

The AED

The…...

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Bibliography

Automated External Defibrillators Reviewed (2003) Survivor's Foundation. Retrieved from:  http://firstaidcoach.com/AED_comparison.pdf 

Deakin C. et al. (2010) European Resuscitation Council Guidelines for Resuscitation 2010. Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation; 81: 1293-1304.

Jevon, Phil (2011) Defibrillation 1: Using an AED Outside Hospital. Nursing Times. 23 Sept 2011. Retrieved from:  http://www.nursingtimes.net/5035495.article 

Philips Announces 8-year warranty on Heartstart Onsite and FRx AED's (2012) AED Universe. Retrieved from:  http://aeduniverse.blogspot.com/

Nursing
Fatigue and Compassion as Functions of Ethical Nursing

The American Nursing Association's Scope and Standards of Practice are designed to provide a blueprint for preempting and addressing the various challenges, pitfalls and procedurals norms of the profession. These help to draw a professional, ethical and practical connection that offers a basic outline for that which is expected of the registered nurse. Indeed, it is of critical benefit to the nursing professional and to the patient community that there exist some clearly elaborated set of ethical standards that pertains directly to sometimes difficult to identify challenges such as bedside manner and fatigue. The American Nursing Association (ANA) provides just such standards, and these function to significantly aid in the decision-making, workplace culture and treatment processes undertaken by nurse professionals.

Ethical orientation is an important feature of a nursing team, particularly as it impacts the morale of nurses and the treatment experience for patients.…...

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Works Cited:

AIPPG. (2010). Betty Neuman's System Model. Nursing Theories.

American Nursing Association (ANA). (2004). Nursing: Scope and Standards of Practice. Nursingbooks.

Nurse Lit eview
TYPE OF ESEACH STUDY - Quantitative or qualitative

Descriptive, correlational, experimental, quasi-experimental, phenomenological, grounded theory ethnographic, historical

SAMPLE METHOD & SAMPLE SIZE

Knoll, Lautenschlager & Lipp (2009). British Journal of Nursing.

Impact of workload on hygiene practices.

Quantitative.

Experimental.

trials of nursing staff.

Statistical.

Enforcing hygiene practices has practical healing benefits for nurses.

Souweine, B. et al. (2009). Intensive Care Medical Journal.

Compared hygiene practices. Hand rubbing vs. hand washing.

Quantitative.

Experimental.

person nursing staff.

Workers completed self report questionnaires.

Hand rubbing with alcohol is preferred to handwashing in some instances.

Creedon, S. (2006). International Journal of Nursing Technologies and Classifications.

Observe health worker compliance in handwashing guidelines.

Quantitative.

Quasi-experimental.

73 doctors and nurses in an Irish ICU.

Questionnaire responses.

Knowledge of handwashing guidelines can lead to positive outcomes.

Allen, L. et al. (2014). Nevada Nformation.

Compared hand washing with hand sanitizer.

Quantitative.

Descriptive.

Literature review.

Statistical.

Hand washing was prescribed for killing certain bacteria.

Evans & Breshears, (2007).

How hand washing affects chiropractic practices.

Quantitative.

Correlation.

150 students randomly selected took survey

Survey results.

easonable control measures regarding hand washing need to be implemented…...

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References

Allen, L., & et al. . (2014). Professionalism in Nursing. Nevada RNFormation, 18(1).

Creedon, S.A. (2005). Healthcare workers' hand decontamination practices: compliance with recommended guidelines. Journal of advanced nursing, 51(3), 208-216.

Evans, M.W., Breshears, J., Campbell, A., Husbands, C., & Rupert, R. (2007). Assessment and risk reduction of infectious pathogens on chiropractic treatment tables. Chiropractic & osteopathy, 15(1), 8.

Knoll, M., Lautenschlaeger, C., & Borneff-Lipp, M. (2010). The impact of workload on hygiene compliance in nursing. British Journal of Nursing, 19(16), S18-S22.

Nurse Assessment
The overall health care profession is undergoing fundamental change due in part to new laws and regulations. These laws and regulations, although well intended may result in unintended consequences for the nursing profession overall. Turnover, in particular is a critical aspect of the health care profession. Turnover creates added costs to the firm, while also sacrificing both care and service. In the future, the role of a nurse will be fundamentally altered. For one, regulation such as the Affordable Care Act will result in an entire population of insured patients needing care. As such, the role of a nurse will ultimately be predicated on a more individualized basis with specialization in certain aspects. Reducing turnover therefore will now become paramount to overall viability of the healthcare firm. The population at risk, due in part to regulation, is now society as a whole. Nurses due in part to this shift…...

(2008). The study measures public opinion concerning two scenarios: one in which the kidney donor is given a fixed financial compensation; and one in which the donor is provided with health insurance coverage for life. According to the findings of the study, "although almost half of the respondents (46%) were reluctant towards introducing a system with fixed compensation to increase the number of living kidney donors, still 25% of the general public reacted positively." (Kranenburg, 1039) This study would conduct a similar comparative discussion, but would expand the number of available options discussed and would use a different sample population, as discussed in the subsequent section.
Subjects and Sampling Technique:

The subjects will be drawn from amongst nursing professionals working in randomly selected renal specialty facilities and wards. Initial contact will be made by phone with a Director of Nursing at selected facilities requesting participation. Those that agree will receive surveys…...

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Works Cited:

Conesa, C.; Rios, a.; Ramirez, P.; Sanchez, J.; Sanchez, E.; Rodriguez, M.; Martinez, L.; Ramos, F. & Parrilla, P. (2009). Attitude of Primary Care Nurses Toward Living Kidney Donation. Transplantation Proceedings, 37(9), 3626-3630.

Kranenburg, L.; Schram, a.; Zuidema, W.; Weimar, W.; Hilhorst, M.; Hessing, J. & Busschbach, J. (2008). Public Survey of Financial Incentives for Kidney Donation. Nephrology Dialysis Transplantation, 23(3), 1039-1042.

Neyhart, C. & Colaneri, J. (2004). Living Anonymous kidney donation: A solution to the organ donor shortage? Nephrology Nursing Journal. Online at  http://findarticles.com/p/articles/mi_m0ICF/is_3_31/ai_n17207253/ 

Watson, J. (2007). Theory of Human Caring: Theory Evolution. University of Colorado at Denver. Online at  http://www.nursing.ucdenver.edu/faculty/jw_evolution.htm

Research-Based Essay: Impact of Nurse-to-Patient Ratios on Patient Outcomes

Introduction

The nurse-to-patient ratio is a key factor that influences patient care quality and outcomes. Extensive research has demonstrated a strong correlation between lower nurse-to-patient ratios and improved patient outcomes, highlighting the critical role that nurses play in providing safe and effective care.

Evidence

Reduced mortality: Studies have shown that patients cared for by nurses with lower caseloads experience lower mortality rates. A study published in the Journal of the American Medical Association found that for every additional patient assigned to a nurse, the risk of in-hospital mortality increased by 7%.
Shorter hospital stays:....

Nurse Burnout: A Critical Issue in Healthcare

In the fast-paced and high-pressure environment of healthcare, nurses play a vital role in providing quality care to patients. However, the demanding nature of the job, coupled with long hours and a high level of emotional strain, often leads to burnout among nurses. Nurse burnout is a pervasive issue that not only affects the well-being of healthcare professionals but also has a significant impact on patient outcomes and the overall functioning of healthcare organizations. In this essay, we will explore the causes and consequences of nurse burnout, as well as potential strategies for prevention....

1. Medical facilities promote self-care among nursing staff in hospitals through the implementation of wellness programs that focus on stress management, mental health support, and physical well-being.

2. Self-care among nursing staff is promoted in hospitals through the provision of resources such as counseling services, mindfulness training, and access to fitness facilities to help employees prioritize their health and wellness.

3. By creating a culture that values self-care, medical facilities can encourage nursing staff to prioritize their well-being, leading to increased job satisfaction, reduced burnout, and improved patient outcomes.

4. The promotion of self-care among nursing staff in hospitals can....

1. Medical facilities actively promote self-care among nursing staff through comprehensive programs and resources that address the physical, emotional, and mental well-being of nurses, recognizing the vital role they play in healthcare delivery.

2. Hospitals implement proactive strategies to encourage self-care practices among nursing staff by fostering a supportive work environment, providing flexible scheduling options, and offering access to health and wellness programs tailored to their specific needs.

3. Medical facilities prioritize the education and training of nurses on self-care techniques, equipping them with the knowledge and skills to effectively manage their own health and well-being while providing exceptional patient care.

4. Hospitals....