Monday, August 2, 2010
Effects of sleep loss linger longer than you think
The study involved 159 adults who were assigned to sleep a certain number of hours a night. The participants underwent computerized neurobehavioral tests during the day to assess their cognitive function. Their results were compared to see how well they recovered after various amounts of sleep deprivation. The results showed that, after a few nights of little sleep, the participants were able to recover substantially after one 10-hour night of sleep. However, they still showed lapses of attention, sleepiness, slowed reaction times and fatigue that lasted for several days.
Previous research suggests that one 10-hour night of sleep is likely to restore people to normal alertness, but circadian rhythms make it difficult to recover fully after just one night, the authors said. Although a "recovery" sleep of 10 hours or more helps people function better, it may take several nights of sleeping eight to 10 hours to regain peak alertness during the day. However, if sleep restriction was less severe -- for example, suffering one four-hour night of bad sleep, it may be possible to recover fully after a single long night of sleep, the authors said.
The study, published Friday in the journal Sleep, has implications for people who work in jobs in which they have several nights of restricted sleep, the lead author of study, David F. Dinges of theUniversity of Pennsylvania School of Medicine, said in a news release.
"Lifestyles that involve chronic sleep restriction during the workweek and during days off work may result in continuing buildup of sleep pressure and in an increased likelihood of loss of alertness and increased errors," he said.
-- Shari Roan
Tuesday, April 20, 2010
Monday, February 22, 2010
Marjorie J. Shibler has a mortgage.
Juliette Crichton wants to continue a lifestyle of monthly pedicures and workouts with a personal trainer.
Luzviminda Jusayan hopes to avoid the boredom and weight gain of staying at home.
They’re all registered nurses who are old enough to be on Medicare but have no plans to retire.
“There’s always going to be a need – forever – because there’s always going to be ill patients,” said Shibler, 73, a medical-surgical nurse at Chesapeake General Hospital . “My future plan is to work at the hospital until I can’t work anymore.”
Though older nurses are hardly a staple in Virginia health care, a surprising number of those still around intend to stay.
About 30 percent of the state’s registered nurses between ages 66 and 70 said they planned to work at least another five years, according to a recent survey by the Virginia Department of Health Professions. More than 40 percent of the state’s licensed practical nurses in that age group said they would stay on the job another 10 years or more.
The trend is helping to temporarily relieve the state’s nursing shortage.
Those results also mirror other polls showing that older workers are delaying retirement to bolster financial security during tough economic times.
Elaine Griffiths, Chesapeake Regional Medical Center’s chief nursing officer, thinks there’s more to it than that. As life expectancy increases, she said, people are accomplishing more in later years.
“Our whole notion of older people’s capabilities and wisdom in their profession is being modified,” she said.
On Chesapeake General’s fifth floor, Shibler tends to five or six patients a day.
She assesses them from head to toe, administers medication and fulfills doctors’ orders. When needed, she starts IVs and performs a particular type of dialysis through the abdomen. She also is trained to handle skin wounds sustained by patients during long hours in bed.
Shibler became a nurse in 1981 after a divorce forced her to find an income.
“I thought, 'What could I do forever?’” said the grandmother of two.
She keeps working to pay the bills – and because she likes the experiences and autonomy that go along with a full-time job.
Her colleagues see her as “old school” because of the time she devotes to talking with patients – and perhaps for her occasional struggles with computers.
Shibler is not afraid to ask for help with “texting, computer stuff, hi-fi and hi-wi and all the crap that I don’t know anything about.”
Years of experience in a profession that demands problem solving sets Shibler apart, said Margaret Summers, a nurse manager at Chesapeake General.
“The new ones,” she said, “they just don’t have that yet.”
Patients who find out how old these nurses are often respond the same way: “Wow.”
Some older patients prefer talking to a caregiver closer to their own age.
“We can talk about things the younger nurses wouldn’t know anything about,” said John Horn, 74, who works as a licensed practical nurse at Sentara Heart Hospital. Like the Korean War, he said. Like “what it was like before we had television all the time.”
Juliette Crichton , who turned 71 on Saturday , is often mistaken for someone years younger. Despite a hip replacement a little more than year ago, she works out twice a week with a trainer who is a former Olympian in handball.
Like Shibler, Crichton specializes in preventing and treating skin wounds. She has worked at Sentara Virginia Beach General Hospital since 1981.
“They’ll say to me, 'Honey, when you’re my age …’” Crichton said. “I’ll think, 'I’m not going to tell them.’”
She trained in the 1960s when nurses were taught to help patients look pretty and give them back rubs.
Today, people who are hospitalized typically suffer from numerous and more serious ailments and nurses don’t have time for such niceties, she said.
“Nursing was always hard, but the patients are so much more complicated,” Crichton said.
Her colleague Linda Neely points to advances that have made the job easier and medical care better, such as magnetic resonance imaging.
Even the fax machine helped, she said, remembering occasions in the past when she would go to doctor’s offices to retrieve records. Neely, who turned 67 on Friday , is the lone nurse in the radiation oncology department of Virginia Beach General. She prepares cancer patients for treatment and makes sure they fully understand the procedures.
Colleagues covet her job for its regular weekday shifts and its specialized focus. Some keep tabs on her retirement plans, but Neely brushes them off.
“I’m looking at 75, but I’m not committing to anything,” she said.
That might have been different if she’d kept her position in a medical-surgical unit, where nurses are responsible for several patients in different rooms and are on their feet all day. After back surgery two years ago, Neely stopped doing heavy lifting.
Most problems that come with aging – such as diminished eyesight – can be easily corrected in the nursing workplace, said Griffiths, the chief nursing officer with Chesapeake Regional.
Nurses, like other hospital employees, must be able to demonstrate competence in their field every year for the organization to maintain accreditation from The Joint Commission, a nationally recognized group.
If older caregivers meet those requirements, Griffiths said, she does n’t worry about their capabilities.
Equipment and co-workers can help with some of the physical issues, such as lifting. At Children’s Hospital of The King’s Daughters, managers have considered scheduling older nurses differently, so their three 12-hour shifts are not on consecutive days, said Penny Hatfield, a nurse manager.
Luzviminda Jusayan started tending to babies after she injured her back lifting adult patients. Now, she works in CHKD’s neonatal intensive care unit with infants sometimes smaller than 1 pound.
At 66, she’s one of the oldest of 150 registered nurses in her unit, and she knows tricks to keep her body from tiring too easily. She wears support panty hose and Easy Spirit slip-on shoes and sits down to do paperwork when she can, twirling her ankles to restore circulation.
Friends who retired advised her against it, saying there was nothing to do but watch television and eat.
Jusayan’s job gives her purpose. The babies she cares for inhabit her thoughts and dreams, even when she’s away from the hospital. “It’s in your head,” she said. “Maybe you can say it’s in your blood.”
Amy Jeter, (757) 446-2730, firstname.lastname@example.org
Saturday, February 20, 2010
Late yesterday, a jury acquitted a Texas registered nurseof a felony charge of “misuse of information” for reporting an unqualified doctor who practiced unsafe medicine. The nurse, who served as compliance officer for a small rural hospital, was abruptly terminated from her job of twenty-five years after she sent in an anonymous complaint to the Texas Medical Board about the unsafe practices of Dr. Rolando G. Arafiles.
Although Dr. Arafiles had a prior disciplinary record and a restricted license to practice medicine, hospital administrators failed to heed the warnings of Ms. Mitchell and other nurse professionals about Dr. Arafiles’ poor standard of care.
The jury took just one vote to unanimously acquit the nurse:
The jury foreman said the panel of six men and six women voted unanimously on the first ballot, and questioned why Mrs. Mitchell had ever been arrested.
“We just didn’t see the wrongdoing of sending the file numbers in, since she’s a nurse,” said the foreman, Harley D. Tyler, a high school custodian.
The defense had to spin this as a reporting issue, that nurses were not going to be able to report bad medical care, and it’s never been that,” he said. “We encourage people to report bad medical care. But I encourage public servants to report it properly.
Sheriff Roberts did not explain what was “improper” about a nurse reporting a bad doctor to the state medical board, which investigates such complaints, particularly after the hospital had failed to act to protect patients.
Speaking of “improper,” it turns out that Sheriff Roberts was a personal friend and admiring patient of Dr. Arafiles, whom he credited with saving his life after a heart attack. The Sheriff was also allegedly involved in the doctor’s side business peddling herbal remedies. And the prosecuting attorney, Scott M. Tidwell, was a political ally of the sheriff and, according to testimony, Dr. Arafiles’ personal lawyer.
It’s good to know that, even in Texas, free speech rocks. However, serious questions remain.
Two ethical, professional nurses with a combined 47 years of experience at the hospital lost their jobs and their livelihoods for doing the right thing. A sheriff abused the authority of his office. A prosecuting attorney with blatant conflicts of interest conducted a patently malicious prosecution. A magistrate and judge inexplicably found probable cause where none existed, and failed to exercise their sworn responsibility to dismiss this groundless case before it ever reached a jury.
A small rural hospital needs a thorough investigation and top-to-bottom house-cleaning. Not to mention that an unqualified doctor is still out there, practicing bad medicine, and endangering innocent patients.
It would be tempting to say that justice has been done. In reality, however, justice hasn’t even begun.
|Nearly three of 10 nurses plan to change career path ... soon!|
Nearly one-third of registered nurses surveyed in January 2010 say they will not be working in their current job a year from now, and nearly 50 percent say they plan to alter their career path in the next one to three years in a way that will take them out of the nursing field entirely or reduce their contribution to direct patient care, either by working fewer hours or choosing a less demanding role. What’s driving their decision to change career paths? Nearly half of those surveyed say their job is affecting their health.
On the health care reform issue, only 6 percent of respondents were very confident that reform will provide a mechanism for ensuring an adequate supply of nurses, this at a time when industry data indicates the nation will face a shortage of 260,000 RNs by 2025. Estimates of the pending shortage provided by the Bureau of Labor Statistics come in even higher.
“Our survey clearly indicates significant job dissatisfaction, and that is concerning in terms of quality health care delivery,” says Ralph Henderson, president of AMN Healthcare’s Nursing and Allied Division. “Nurses are at the core of quality care in our nation’s delivery system and, if we see large numbers of nurses leaving the profession, it could negatively impact patient care outcomes.”
A majority of nurses (55 percent) believe that the quality of care nurses provide today has declined compared to five years ago, according to the survey. The survey also notes that 29 percent of nurses plan to take steps in the next one to three years to reduce their role in nursing or take them out of the profession altogether. An additional 15 percent say they will make a change in their career path, such as becoming a travel nurse or nurse practitioner.
“While nursing has made tremendous strides as a profession, in terms of pay and prestige, staffing shortages remain the profession’s greatest challenge,” notes Henderson.
Of immediate concern, he says, is that 6 percent of nurses permanently employed in a hospital setting indicate they plan to retire in the next one to three years. This action would reduce the hospital nurse workforce by more than 70,000. This is of particular concern, since the number of new candidates taking the National Council Licensure Examination (NCLEX) to become a registered nurse has flattened over the last year, suggesting no growth in the supply of new nurses entering the profession.
“It is critical that we find ways to keep experienced nurses engaged in patient care and attract new nurses to the workforce,” Henderson says. These two things combined will help mitigate the impact of the nation’s growing nurse shortage, he observes.
A complete breakdown of AMN’s 2010 Survey of Registered Nurses: Job Satisfaction and Career Plans is available at www.amnhealthcare.com. RNL