Effects of sleep loss linger longer than you think

from LA Times Booster Shots 7/31/10

It can take several days to recover after experiencing a few nights of little sleep, according to a new study. Researchers found that even a catch-up night of 10 hours of sleep may not be enough to restore many people after they have a few nights of bad sleep.

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

Why bullies are so awful.

Why bullies are so awful. from Thisisindexed.com

Survey: Older nurses sticking around

By Amy Jeter The Virginian-Pilot © February 21, 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, amy.jeter@pilotonline.com

Whistle-blowing, is it worth it? Is it protected?

Texas Nurse Acquitted: Only the Beginning

Posted on February 12, 2010 by Great Blue

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.

Sheriff Robert L. Roberts, Jr., who instigated the prosecution, was unrepentant:

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.

from http://vagreatblueheron.wordpress.com/2010/02/12/texas-nurse-acquitted-only-the-beginning/

Nearly three of 10 nurses plan to change career path ... soon!

Nearly three of 10 nurses plan to change career path ... soon!

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. These are among key findings from the 2010 Survey of Registered Nurses: Job Satisfaction and Career Plans, conducted by AMN Healthcare, provider of health care staffing and management services. The survey, which collected data from 1,399 respondents, was conducted during a period of economic recession and in the course of an ongoing national debate over health care reform. The survey shows how RNs may have altered their career plans due to the recession, how they might respond to an economic recovery and whether they believe health care reform will address the nurse shortage. 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 the survey highlights dissatisfaction of nurses with their current jobs, most nurses are satisfied with their careers overall. Fifty-nine percent would select nursing as a career if they had it to do it all over, and 64 percent would recommend nursing as a career to young people. “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

The Complex Work of RNs: Implications for Healthy Work Environments

The Complex Work of RNs: Implications for Healthy Work Environments

Nursing a Dirty Job

There is a powerful message here about the value of work.

Nursing Shortage Will Return

New survey finds nursing shortage likely to increase

February 03, 2010 | Diana Manos, Senior Editor

SAN DIEGO – Nearly one-third of registered nurses surveyed in January say they will not be working in their current job a year from now, and close to half say they plan to alter their career path in one to three years.

The 2010 survey of registered nurses released Wednesday by AMN Healthcare, a San Diego-based provider of healthcare staffing and management services, found 28 percent of nurses surveyed plan to leave the nursing field entirely or cut back on hours because the job is affecting their health.

Researchers said they polled 1,399 RNs for the study, asking questions related to job satisfaction and nursing opinions on how the recession and potential healthcare reform may affect their jobs.

On the healthcare reform issue, only 6 percent of the respondents are "very confident" that reform will provide a mechanism for ensuring an adequate supply of nurses.

Industry data indicates the nation will face a shortage of 260,000 RNs by 2025.

"Our survey clearly indicates significant job dissatisfaction and that is concerning in terms of quality healthcare delivery," said Ralph Henderson, AMN Healthcare's nursing and allied division president. "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."

According to the survey, 55 percent believe that the quality of care that nurses provide has declined compared to five years ago.

Researchers said that while the survey highlights nurse dissatisfaction with their current job, most are satisfied with their careersl, with 59 percent saying they would select nursing as a career if they had it to do it again. Sixty-four percent said they would recommend nursing as a career to young people.

"While nursing has made tremendous strides as a profession, in terms of pay and prestige, staffing shortages remain the profession's greatest challenge," Henderson said.

Six percent of nurses permanently employed in a hospital setting plan to retire in the next one to three years. This action would reduce the hospital nursing workforce by more than 70,000, according to researchers.

"It is critical that we find ways to keep experienced nurses engaged in patient care and attract new nurses to the workforce," Henderson said. "These two things combined will help mitigate the impact of the nation's growing nurse shortage."

From Healthcare Finance News http://www.healthcarefinancenews.com/news/new-survey-finds-nursing-shortage-likely-increase

Too kind? Maybe it’s codependency.

Too kind? Maybe it’s codependency.By Barbara Oakley
Your best friend—let’s call her Sarah—is a hopeless do-gooder. She rescues stray animals and is always lending what little money she has. (Payback is rare.) “Friends” take her good nature and willingness to help for granted—Sarah often finds herself babysitting or running their errands—and it’s beginning to take its toll. Even church, which has given so much meaning to Sarah’s life, has come to feel like a chore. She is often asked to take care of the tedious responsibilities that no one else has the time or inclination to do. Worst of all, Sarah is married to an alcoholic. It’s not her fault, really. Even youwere charmed when you first met Ken. Sarah’s so loyal that she would never dream of a divorce. It’s become more difficult recently, though. Ken’s job has been to look after the baby, since he doesn’t have a regular job because of his bad back. But Sarah came home last week to find Ken passed out on the couch. The baby obviously hadn’t been fed or changed since she’d left, 12 hours before. Ken blamed Sarah for working so many hours. But what else could she do? The bills had to be paid. You may have wondered about Sarah and why her life is so troubled. Something seems very wrong with her, even though she’s a wonderful human being. You’re correct. There is something wrong. Sarah is a codependent, a person whose emotions are strongly affected by other people’s emotions. As recovering codependent Melody Beattie writes in her classic bestseller,Codependent No More, people such as Sarah don’t behave codependently just with spouses. It’s everyone—parents, children, guests, friends and acquaintances. Somehow, codependents just seem to lose themselves in other people. They get enmeshed in them (Beattie, 1986). There are millions of Sarahs in the world. Because of their compassionate nature, many of them become nurses. But, sadly, there is no straightforward psychological diagnosis for codependency. The Diagnostic and Statistical Manual of Mental Disorders—the bible for mental health professionals who attempt to understand personality disorders—has no category for the condition. But new insights from neuroscience and genetics are beginning to provide clues about how codependency arises and what can be done to help. I feel your pain! As it turns out, some unusual cells known as “mirror neurons” help us feel what others are feeling. When we watch another person catch a finger in a slammed door, for example, we unconsciously recoil because the neurons that signal “Ouch!” in the other person’s brain are also signaling in our own brain. This may be one reason we generally try to help one another, especially when a person is truly in need. There’s more. Mirror neurons, along with many other aspects of our neurological makeup, are formed by our genes and our interactions with the environment. Some genes appear to predispose us to more ruthless behavior, others to kinder, more empathetic and altruistic actions (Anckarsäter & Cloninger 2007; Cesarini et al., 2008; Israel et al., 2008; Knafo et al., 2008). What happens when someone gets an overdose of the genes that relate to empathy and altruism? And what happens if environment fans the flames—as can occur with gender roles that emphasize nurturing above all else, or with spiritual counselors who specialize in guilt? Just as we can reprogram a computer away from default settings, codependents can ... overcome their original biological “settings.” What can happen then is codependence. Codependents help others feel better because they are trying to make themselves feel better. In a sense, then, codependents are trying to control other people’s emotions in an attempt to control their own emotions. Controlling others is an iffy proposition at best; the only person you can truly control is yourself. So codependents are locked in a losing spiral of “helping” that doesn’t really help and, in fact, may simply enable others to take advantage. But hold on a minute! If genes are responsible, even in part, for codependency, doesn’t that imply that codependents have a “hardwired” predisposition that can’t be changed? Of course not! There’s hope! A predisposition is just that—a natural tendency, but not a certainty. As we now know, the brain is capable of extraordinary plasticity. Just as we can reprogram a computer away from default settings, codependents can, with focused attention and determination, overcome their original biological “settings.” The nice thing about realizing that being too kind can arise from natural tendencies is that it explains not only why codependents are the way theyare, but also why many recommendations commonly given to codependents work. For example, the first step taught to recovering codependents—realizing that people can’t change others, only themselves—now makes sense. (Of course, you can’t change other people’s brains; you can only change your own brain!) Codependents are often told that their disease is progressive, that it worsens with time. That makes sense, too. The dysfunction gets worse because the same neural pathways involved in the emotional response to other people’s emotions keep getting reinforced—that is, unless active, conscious steps are taken to change one’s thinking patterns. Understanding why changing your thinking can change your life can be the first, vital step toward recovering from codependent behavior that can cripple our lives and ultimately hurt those we hold most dear. If you know a “Sarah,” encourage her—or him—to read this article and seek out an organization such as Codependents Anonymous. They’ll be glad you did.RNL Barbara Oakley Barbara Oakley, PhD, PE, is a fellow of the American Institute of Medical and Biological Engineers and associate professor of engineering in the School of Engineering and Computer Science at Oakland University in Rochester, Michigan, USA, where her research centers on neuroscience and society. Her tongue-in-check book titled Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed, and My Sister Stole My Mother’s Boyfriend, has received critical acclaim for its sympathetic, scientifically based explanation of why people do the nasty things they do. She is principal co-editor of the forthcoming books Pathological Altruism (Oxford University Press) andKilling Kindness (Prometheus Books). Oakley also blogs as “Scalliwag” forPsychology Today. References: Anckarsäter, H., & Cloninger, R.C. (2007). The genetics of empathy and its disorders. In T.F.D. Farrow & P.W.R. Woodruff (Eds.), Empathy in mental illness, pp. 261-288. New York: Cambridge University Press. Beattie, M. (1986). Codependent no more: How to stop controlling others and start caring for yourself. Center City, MN: Hazeldon. Cesarini, D., Dawes, C.T., Fowler, J.H., Johannesson, M., Lichtenstein, P., & Wallace, B. (2008). Heritability of cooperative behavior in the trust game.Proceedings of the National Academy of Sciences, 105(10), 3721. Retrieved 28 January 2010 from http://www.pnas.org/content/105/10/3721.full Israel, S., Lerer, E., Shalev, I., Uzefovsky, F., Reibold, M., Bachner-Melman, R., et al. (2008). Molecular genetic studies of the arginine vasopressin 1a receptor (AVPR1a) and the oxytocin receptor (OXTR) in human behaviour: From autism to altruism with some notes in between. Progress in brain research, 170, 435. Knafo, A., Israel, S., Darvasi, A., Bachner-Melman, R., Uzefovsky, F., Cohen, L., et al. (2008). Individual differences in allocation of funds in the dictator game associated with length of the arginine vasopressin 1a receptor RS3 promoter region and correlation between RS3 length and hippocampal mRNA. Genes, Brain and Behavior, 7(3), 266-275. Published 1/29/2010 , Vol. 36, No. 1

Reflections on Nursing Leadership A Sigma Theta Tau International Publication

You are such a Tool

Top 16 Reasons that Nurses are Tools.

1. Tools are forgotten until needed or they can't be found.
2. A tool’s value is its ability to do the bidding of others.
3. A craftsman cures and tools are merely extensions of his hands.
4. Break a tool and you can always go to Sears and buy another.
5. New tools are broken in.
6. Old tools are replaced with shiny new ones.
7. Tools don’t have to eat or go to the bathroom.
8. Something goes wrong, and it’s the tool that gets thrown in anger.
9. In a pinch a screwdriver can be used as a pry bar. Of course, the screwdriver might break, so see Reason 4.
10. The craftsman is given all the credit even though a good tool can make even the least skilled craftsman look good.
11. A toolbox is just another tool the craftsman uses to keep the other tools organized, but it is still a tool even though it does no actual work.
12. Everyone thinks they know how to use a tool.
13. Duct tape works temporarily but a better solution is buying a good set of tools, caring for them and using them properly.
14. Tools don’t know any better. Tools are used by one thing to act on another.
15. The idea of tools has many connotations, some good, some bad, but all involve the tool being used.
16. Like servants, man created tools to make their life easier. God didn’t make tools, to do good works, He doesn’t need them.

What nursing leaders know: Seven truths from top health care professionals

What nursing leaders know: Seven truths from top health care professionals