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Showing posts with label CNA SCHOOLS UTAH. Show all posts
Showing posts with label CNA SCHOOLS UTAH. Show all posts
Wednesday, November 28, 2012
Tuesday, September 25, 2012
Why Hospital Workers Should Be Forced to Get Flu Shots
Author
Arthur L. Caplan, PhD
Director, Division of Medical Ethics, New York University Langone Medical Center and School of Medicine, New York, New YorkDisclosure: Arthur L. Caplan, PhD, has disclosed no relevant financial relationships.
Why Hospital Workers Should Be Forced to Get Flu Shots
Posted: 09/13/2012
It is about to be flu season, and we are starting to see the signs go up at pharmacies, drugstores, and other retail outlets: They have the flu shot, so come get one. I think that doctors responsibly tell their patients to get a flu shot. The problem is that we don't get our flu shots, and I am talking about doctors, nurses, nurses' aides, pharmacists, and other people who work in healthcare settings.
The average rate of flu shots among the workforce in American hospitals varies from about 80% in physicians down to 60% in nurses. In nursing homes, you are often looking at rates that are 30% or lower. Who is likely to get harmed by the flu? Who is at great risk? It is not the healthy 30-year-old. They may get sick and they may have some time in which they cannot go to work. It's not a good thing and I think they should get a flu shot, but they are not going to die.
The elderly are at high risk, babies are at high risk, and people who are immune-comprised due to HIV or transplants are at high risk too. Where are they going to be? In nursing homes, hospitals, and healthcare settings.
Therefore, it is of crucial importance that doctors, nurses, nurses' aides, and people who work in healthcare settings get their shots. I know that a lot of people have said that it ought to be voluntary, that it ought to be something that I choose to do. I do not lose my right as a doctor or a nurse to say that I don't want to do that.
Well, I think you do. Ethically, your first obligation is to do no harm. If you are there to do no harm and that is your primary obligation, then you cannot put your personal choice or your personal reluctance to get that shot above doing harm. And you are likely to do harm to others if you do not get that shot.
Also, every code of ethics that I have seen -- medical, nursing, and others -- says that we put patient interests first. It is not in the patient's interest for you to not get a flu shot. If we are putting patient interests first, if that rhetoric is what we believe in our codes of ethics, what we teach in our medical and nursing schools, there is no excuse for not getting a flu shot.
I think the obligation is there to do it, and I will go further. I think that every hospital and every nursing home should require as a condition of employment that you show that you got a flu shot every year. I think it is also important, if you are talking with families or patients who might have a relative in a high-risk category, that you remind them to ask their healthcare providers whether they have had a flu shot. When you go to visit Grandmom in the nursing home or if you are going to see the newborn baby, is everybody vaccinated there? That is a question that they need to be asking, and you need to remind them.
At the end of the day, it's flu season and we can do something about this. We can protect the weakest and most vulnerable that are among us, but we have to set the right example. Our moral duty is to get our flu shots and prevent harm to others who can't protect themselves or who are especially at risk for the flu. It's the time of the year to do it. I think it is important that we set the right example.
I am Art Caplan at the Division of Medical Ethics at NYU Langone Medical Center. Thanks for listening.
Medscape Business of Medicine © 2012 WebMD, LLC
Wednesday, August 1, 2012
Certified Nursing Assistant Examination
Certified Nursing Assistant Examination
Cheating Policy*
1. Purpose.
To define the ZERO TOLERANCE policy for cheating on the Utah State Competency Exam for Certified Nursing Assistants.
2. Policy.
Cheating by an applicant on any examination required as a condition of obtaining a certificate shall be considered unprofessional conduct and shall result in dismissal from the current test and denial of any further certification.
No personal items at computer
No cell phones or pagers
No talking or any other type of communication
No books, dictionaries or notebooks
No cheating of any kind
Any infraction of the above regulations will invalidate your test
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*For the UNAR cheating policy in its entirety, please ask testing personnel.
7-12
Utah nurse aide registry
UNAR Cheating Policy
Effective Date: August 29, 2005
|
Revised: September 18, 2008
April 22, 2010
July 15, 2010
August 29, 2011
1. Purpose.
To define the ZERO TOLERANCE policy for cheating on the Utah State Competency Exams for Certified Nursing Assistants.
2. Policy.
Cheating by an applicant on any examination required as a condition of obtaining a certificate shall be considered unprofessional conduct and shall result in dismissal from the current test and denial of any further testing or certification.
A. Cheating is defined as:
The use of any means of instrumentality for the benefit of an examinee to alter the results of the certification examination in any way to cause the examination results to inaccurately represent the competency of an examinee with respect to the knowledge or skills about which they are examined. Cheating includes but is not limited to:
1. Communication between examinees inside of the examination room or facility during the course of the examination;
2. Communication about the examination with anyone outside of the examination room or facility during the course of the examination;
3. Copying another examinee’s answers or looking at another examinee’s answers while an examination is in progress;
4. Permitting anyone to copy answers to the examination;
5. Substitution by an applicant or by others for the benefit of an applicant as the examinee in place of the applicant;
6. Use by an applicant of any written, audio, or video material or any other mechanism not specifically authorized during the examination for the purpose of assisting an examinee in the examination;
7. Obtaining, using, buying, selling, possession of or having access to a copy of the examination prior to administration of the examination.
3. Procedure:
A. The UNAR shall notify all proctors, test administrators, and test centers of the rules concerning cheating.
B. All applicants will be required to review and sign the test center’s policy acknowledging that they understand the definition of cheating and the penalties that will be imposed.
C. Upon determination that an applicant has cheated on an examination, the following steps will be taken:
i. The person making the cheating allegation will investigate and document the allegations in writing and forward to the UNAR along with the voucher.
ii. Upon the allegation being reported and investigated by the Utah Nursing Assistant Registry (UNAR), the UNAR will notify the applicant in writing that he/she is being denied of any future opportunity to test or to receive a certificate.
iii. The applicant may appeal the allegation through the UNAR, in writing.
Superbug
As it relates to CNA
What is antimicrobial resistance, commonly known as drug resistance? What is the
difference between antibiotic, antimicrobial and antiretroviral resistance or so called “superbugs”?
Antimicrobial resistance – also known as drug resistance – occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. When the microorganisms become resistant to most antimicrobials they are often referred to as “superbugs”. This is a major concern because a resistant infection may kill, can spread to others, and imposes huge costs to individuals and society.
Clostridium Difficile
Clostridium difficile (klos-TRID-e-uhm dif-uh-SEEL), often called C. diff, is a spore forming bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. C.diff transmission is through the fecal-oral route. Sadly, the hands of health care workers are probably the main cause. Illness from C. diff most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications. C diff has surpassed MRSA to become the most prevalent hospital-acquired infection. More importantly hand hygiene products (hand sanitizers) are often not effective at killing C. diff.
How does this relate to CNA?
The most effective means for preventing the spread of C. diff is hand washing with soap and water. Contact precautions: properly putting on and removing PPE.
Cryptosporidium
Cryptosporidium (krip-toe-spo-RID-ee-um) is a parasite which is found in the digestive tracts of domestic animals and are transferred by contact. It is water (drinking water and recreational water) that is the most common method of transmission. Cryptosporidium begins its life cycle inside your body — burrowing into the walls of your intestines and then later being shed in your feces. This is a gastrointestinal disease whose primary symptom is severe diarrhea, and in an immunosuppressed person could be fatal. Cryptosporidium also has a spore form and hand sanitizers are not effective.
How does relate to CNA?
Wash hands with soap and water for at least 20 seconds, rubbing hands together vigorously and scrubbing all surfaces: Contact Precautions: properly putting on and removing PPE.
http://www.cdc.gov/handhygiene/training/interactiveEducation/
Why New Nurses Don't Stay and What the Evidence Says We Can Do About It
From American Nurse Today
Tripping Over the Welcome Mat
Why New Nurses Don't Stay and What the Evidence Says We Can Do About It
Posted: 07/10/2012; Am Nurs Today. 2012;7(6) © 2012 HealthCom Media
Abstract and Introduction
Introduction
In a recently conducted survey regarding newly graduated nurses' readiness to practice in the hospital setting, only 10% of nurse executives believed that new graduate nurses (NGNs) were fully prepared to practice safely and effectively. NGNs agreed with nurse executives that they lack confidence and adequate skills for up to a year after graduation. The perceptions of nurse executives and NGNs seem to be borne out by NGN turnover rates of roughly 30% in the first year of practice and as much as 57% in the second year. At a cost of $82,000 or more per nurse, NGN attrition is costly in economic and professional terms—and can negatively impact patient-care quality.While the current economic downturn in the United States has reduced nurse turnover, the looming retirement of Baby Boomer nurses will leave a shortfall of 260,000 nurses by 2025. Thus, hospitals continue to seek best practices for retaining NGNs and easing the transition into practice. A quick check of the evidence reveals some contributing factors to NGN turnover and highlights effective retention strategies.
Why New Nurses Leave
New nurses report that low job satisfaction is primarily related to heavy workloads and an inability to ensure patient safety. In addition, new nurses express disillusionment about scheduling, lack of autonomous practice, and the lack of intrinsic and extrinsic workplace rewards. Lastly, new nurses report dissatisfying relationships with peers, managers, and interprofessional colleagues and insufficient time with patients. Discontent peaks between 4 and 6 months and again near the end of the second year. Low salaries can contribute to a weak commitment to stay in a job but are less important if the work is rewarding, staffing is adequate, and scheduling is satisfactory. Men are twice as likely as women to leave a nursing position for higher pay.Starting off on the Right Foot
Retention begins with hiring the right NGN. The hiring process can focus on assessing new nurses' values and attitudes and how they fit with the organization. Skills can be taught, while attitudes, values, and general behavior patterns are much more difficult, if not impossible, to change.Two effective strategies to ensure a good fit between a new nurse and a work unit are prehire job shadowing and behavior-based interviews by both peers and managers. When new nurses job shadow on a unit, they can evaluate workload, role expectations, and cultural norms. Based on the principle that past behavior is the best predictor of future behavior, behavior-based interviewing allows managers and peers to assess communication and relational skills through exemplars the candidate shares. During the peer interview, NGNs can gain insight into potential coworkers to estimate an ability to fit in. When unit nurses help select NGNs, they have a greater interest in retaining them and engage more fully in the on-boarding process.
Smoothing the Way
Research evidence strongly supports nurse residency programs as a key strategy to retain NGNs. The Institute of Medicine, National Council of State Boards of Nursing, and Commission on Collegiate Nursing Education all advocate for nurse residency programs. Retention rates of NGNs in residency programs range from 88% to 96%. For example, in a prospective study of 111 NGNs from six academic centers across the United States, a 1-year residency program positively impacted job satisfaction, with a retention rate of 87%. Likewise, a residency program involving 679 NGNs at 12 sites across the United States showed reductions in stress for NGNs, improved clinical and communication skills, and a 1-year termination rate of 12%.Residencies are longer than traditional orientation programs, ranging from 6 to 12 months. Residencies promote strong connections with workplace colleagues and support job embeddedness (a close fit between the nurse's new position and other aspects of the nurse's life).
Key evidence-based elements of residency programs include:
- clinical coaching by a preceptor matched for compatibility with the NGN
- preceptors and NGNs on the same schedules as much as possible.
- evidence-based classroom curriculum with case studies and direct linkage to clinical experiences
- hands-on learning of skills in a clinical setting or simulations
- time spent in areas outside the NGN's home unit to understand overall system issues
- participation in a support group of NGN peers
- high visibility of nurse leaders
- professional socialization and opportunities for development.
Forming a Team
Evidence indicates that preceptors are vital support persons when NGNs enter the workplace, both in residencies and traditional orientation programs. The preceptor is the first nurse who intensely invests in the NGN, planning patient assignments on a daily basis, nurturing confidence and competence, and overseeing the development of skills and clinical judgment. Preceptors socialize NGNs into new roles, unit processes, and workplace norms. The preceptor and NGN may work together for a variable length of time from weeks to months.Mentoring programs also improve NGN retention. Mentors differ from preceptors in that mentors invest in NGNs for years, rather than weeks or months. Some mentoring programs do not begin until the residency or orientation ends to avoid overlap between mentors and preceptors. Mentors provide professional development advice and serve as consultants for complex cases and workplace issues.
Research suggests that preceptors and mentors not only should be experienced clinicians but should have skilled communication, relational abilities, and a positive attitude toward nursing and the organization. NGNs report high anxiety in the first weeks of employment; preceptors who consistently convey caring behaviors can reduce anxiety for NGNs and facilitate learning. Some studies suggest increased NGN satisfaction when NGNs choose their own preceptors and mentors.
Both preceptors and peers can encourage nurses to stay. (See What you can do in the sidebar.)
Creating a Welcoming Work Environment
Job satisfaction for NGNs is heavily influenced by workplace culture. The American Association of Critical-Care Nurses calls for the advancement of healthy work environments, which can promote nurse retention through teamwork, meaningful recognition, collaboration, skilled communication, authentic relationships with leaders, and adequate staffing. NGNs can experience a sense of acceptance and safety on units where trust is intentionally built. On a healthy unit, gossip and humiliation of employees constitute workplace maltreatment and are as serious as errors in patient care. Respectful collegial relationships modeled by all staff help the newest nurse feel safe and able to admit shortcomings.Healthy work cultures encourage new nurses to practice good self-care, such as taking breaks away from the bedside, limiting overtime hours, and achieving life-work balance. NGNs can experience burnout when they do not feel competent to care for patients safely, especially if the NGN is experiencing other life stress outside of the workplace. Strategies to address compassion fatigue can be implemented in a timely manner and may include debriefing after difficult shifts, team-building events, celebration of meaningful work, and rotating difficult patient assignments. Peers, managers, or a counseling center can provide emotional support when NGNs experience moral distress or the recurring painful memories of high-impact events, known as secondary trauma. NGNs need encouragement when they make errors, since errors may shame and weaken one's confidence and sense of belonging. NGNs may withdraw from relationships, call in sick, or begin to think about terminating their job. A manager, preceptor, or any nurse peer can reach out to express acceptance and understanding.
Nurse-physician rounding on patients not only improves patient-care outcomes but allows new nurses to build relationships with physician partners. Nurse-physician relationships are a key component to nurses' job satisfaction and perceived competence. A zero-tolerance policy regarding uncivil actions or words among professionals is particularly important for a healthy work environment.
Using Simulated Learning for New Nurses
Simulation laboratories are another way to support NGNs' transition into practice. Simulations can bridge the gap between knowledge already gained in academic curricula and skills needed to care for multiple, complex patients. Simulations allow a wide range of clinical scenarios to be analyzed in the safety of a lab where patients cannot be harmed. Simulations can be via high-tech, robotic dummies that display real-life physiological symptoms or via live persons from nearby communities who have medical conditions and are willing to role play and be assessed by NGNs in a laboratory setting. While simulation labs can be costly to start up if advanced technology is desired, grants may be available. Multiple facilities can share labs or partner with academic centers that have labs.Becoming an Owner
A professional development program such as a clinical ladder can give NGNs a way to objectively confirm their abilities and worth. Furthermore, after initial job anxiety eases, NGNs can be encouraged to pursue new professional roles on unit councils and work groups. Being part of process improvement teams and collaborative interprofessional work groups helps the new nurse develop communication skills and a system-level perspective. When new nurses believe they have influence and are empowered, they feel more engaged in work and more committed to the organization. Organizations that value autonomous nursing and empower nurses to shape and own their practices have higher nurse retention.Providing Support
Nurse managers and senior administrators play a pivotal role in new nurse retention, beginning on the first day of orientation. Administrators can welcome new nurses by name and begin fostering a warm relationship. Early in the orientation, administrators can outline the mission, vision, values, and strategic direction of the organization, making it clear to all new staff the vital role they play in achieving excellence in care.During residencies or traditional orientations, staff development personnel can make frequent contact with NGNs and schedule structured interviews at 30, 60, and 90 days and at 6 months. The interviews provide opportunities for individualized feedback and identification of nurses at risk for terminating. Feedback from NGNs can be solicited and incorporated into the design of future orientation and residency programs.
Managers can commit to rounding on NGNs each week to ensure new employees have the tools, equipment, and support they need. Senior administrators can schedule follow-up meetings with new nurses at predetermined times, such as 60 days and 6 months after beginning work. The administrator can seek feedback for program improvement and explore the fit between what NGNs expected and what they are experiencing. If a reported problem can be addressed, act quickly and let the NGN know the resolution.
Administrators can ask NGNs to recognize individuals who have been an instrumental, positive influence in their orientation. The administrator can write thank-you notes or thank these role models face to face for their positive impact on the on-boarding of the newest staff members. This culture of gratitude and recognition can encourage peers and preceptors that their contribution to the NGNs' transition is valued.
Organizational leaders can arrange for formal and informal support groups for NGNs in which they can meet with other NGNs and share experiences. Conversation with peers who understand the transition can bring new insight, reduce isolation, and build a sense of community.
Feeling Like Home
In environments where NGNs move smoothly across the threshold into practice, nurses at all levels of the organization accept responsibility for job retention. Ideally, nurses know the retention rates on their unit and have retention plans in place based on local data and feedback from recently hired nurses. Nurses know the evidence-based strategies, including residency programs, strong preceptor and mentor support, a healthy work environment, simulations, visible leadership, and trusting relationships with peers.New nurses start to feel at home and committed to stay in an organization when they are empowered in practice, have a sense of belonging in a work group, and perceive that resources balance job stress. Before long, NGNs who commit to stay become the peer group for the next wave of new nurses, smoothing out wrinkles in the welcome mat and opening wide the door to a successful professional transition.
Sidebar
What You Can Do
- Arrange time away from the patient to review clinical judgments and decisions.
- Offer emotional support, especially during highly stressful times (errors, angry patients, shame from colleagues).
- Shape expectations for workload and scheduling.
- Introduce new nurses to key personnel and "manage up" the new nurse.
- Socialize informally and build caring relationships.
- Monitor the NGN for compassion fatigue and strategize for work-life balance.
- Be alert to how generational differences may influence work attitudes and relationships.
- Share your stories and lessons learned to shape clinical judgment.
[ CLOSE WINDOW ]
References
- American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Aliso Viejo, CA: 2005. http://www.aacn.org/WD/HWE/Docs/HWEStandards.pdf. Accessed May 17, 2012.
- Benner P, Stephen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass; 2010.
- Berkow S, Virkstis K, Stewart J, Conway L. Assessing new graduate nurse performance. J Nurs Adm. 2008;38(11):468–474.
- Bratt MM. Retaining the next generation of nurses: the Wisconsin nurse residency program provides a continuum of support. J Contin Educ Nurs. 2009;40(9):416–425.
- Brewer CS, Kovner CT, Greene W, Cheng Y. Predictors of RNs intent to work and work decisions 1 year later in U.S. national sample. Int J Nurs Stud. 2009;46:940–956.
- Buerhaus P. The shape of the recovery: economic implications for the nursing workforce. Nurs Econ. 2009;27(5):338–340, 336.
- Coomber B, Barriball KL. Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature. Int J Nurs Stud. 2007;44(2):297–314.
- Eaton-Spiva L, Buitrago P, Trotter L, Macy A, Lariscy M, Johnson D. Assessing and redesigning the nursing practice environment. J Nurs Adm. 2010;40(1):36–42.
- Halfer D. Job embeddedness factors and retention of nurses with 1 to 3 years of experience. J Contin Educ Nurs. 2011;42(10):468–476.
- Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx. Accessed May 17, 2012.
- Jones CB. Revisiting nurse turnover costs: adjusting for inflation. J Nurs Adm. 2008; 38(1):11–18.
- Kovner C, Brewer C, Greene W, Fairchild S. Understanding new registered nurses' intent to stay at their jobs. Nurs Econ. 2009;27(2):81–98.
- Kramer M, Maguire P, Halfner D, al. The organizational transformative power of nurse residency programs. Nurs Adm Q. 2012:36(2):155–68.
- Myers S, Reidy P, French B, McHale J, Chisholm M, Griffin M. Safety concerns of hospital-based new-to-practice registered nurses and their preceptors. J Contin Educ Nurs. 2010;41(4):163–171.
- Pellico LH, Brewer CS, Kovner CT. What newly licensed registered nurses have to say about their first experiences. Nurs Outlook. 2009;57(4):194–203.
- Ulrich B, Krozek C, Early S, Ashlock CH, Africa LM, Carman ML. Improving retention, confidence, and competence of graduate nurses: results from a 10-year longitudinal database. Nurs Econ. 2010;28(6):363–375.
- Williams CA, Goode CJ, Krsek C, Bednash GD, Lynn MR. Postbaccalaureate nurse residency 1-year outcomes. J Nurs Adm. 2007;37(7/8):357–365.
Am Nurs Today. 2012;7(6) © 2012 HealthCom Media
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