Chapter 4: - Nurse practice act: State legislation regulate practice; protect public; define scope of practice; nurse accountability; create state boards of nursing. - **First state = New York; had lots of opposition from MDs and untrained nurses. - FloNight created first registry of nurses certifying student nurses passing her program. - Permissive license = allows less trained and cheaper workforce; can practice in nursing pool; cannot use RN title; not allowed anymore. - Mandatory license = Protect title of RN; Nurse practice act; required by all state boards; must pass NCLEX; Illegal to call yourself a nurse w/o licensure. - Certification vs Licensure = Cert shows required studies completed; License is legal designation of right to work in profession. - ANA’s power = Large group w/ one voice; quality; restructured in 2012; grant, revoke, or deny license; can suspend license; standards for renewal; fee for licensure; approves nursing programs; write regulations for practice; legislative authority. - Laws about delegation = included in nurse practice act. Chapter 13 – Workforce advocacy - Areas nurses can advocate for improvement = Job assignments; volume of work assigned; prof. skills req. for job assigns; duration of experience in a particular job category; work schedules - 2017 job satis. Survey = 83% nurses satisfied w/ career; less optimistic about current jobs (only 60%); 55% worry about job affecting health; 38% feel like resigning. - Why appl. Being turned away from bachelor and grad. Nursing programs? Not enough faculty. - AACN recommend at least 80% nurses be BSN by 2020. - Faculty shortage issues = budget cuts; no ability for salary benefits; less teachers due to more money in hospitals. - Predictors of nurse turnover = Job strain; role tension; work-family conflict; job control; job complexity; rewards/recognition; team cohesion. - Impact of aging workforce r/t staffing = over 50yoa nurses represent 50% of workforce; older nurses leaving the field creating shortage; no research about effectiveness of recruit/retent strategies for older nurses so they are leaving due to stress, frustration, physical limits. - Approaches to promote sufficient nurse staffing = Nurse-driven staffing commitees; disclose staffing levels to public and/or regulatory body; enact legislation to mandate specific nurse/patient ratios (California only one) - Floating issues = mandate last minute overtime instead of finding safer appropriate staffing; errors caused due to overtime. - Mandatory overtime issues = no law in SC, follows fed regs of standard 40 hr workweek and hourly employees qual for OT pay, salaried do not. - Whistleblowing = nurses are protected; reserve judgement; seek council; legal counsel; put complaint in writing; document all interactions; keep objective; remain calm; have facts straight. - Violence = 2002 to 2013 health care had 4x risk experiencing violence. - Incivility/bullying/violence = 81.8% report verbal abuse; 49.8% report physical abuse; advocate for interventions and safety. - Inadequate sleep negative affect performance and mood; increase risk taking; impairment communication; memory deficits. - Shift work/Long work hours = diabetes; cardiovascular disease; depression; sleep disturbance; physical injuries. - Magnet programs = design provide best practice standards to improve nurse satis. And encironment to reduce turnover; transformational leadership; structural empowerment; exemplary profess. Pract.; new knowl. And innov.; empirical outcomes; magnet nurses have higher autonomy, more cont. over pract., better relationships w/ MDs, lower mortality rates. - Shared governance = intro in 1970s, id’d by RNs as cornerstone of excel. Nurse pract.; provides org. framework for nurses in direct care to engage in create and sust. Optimal practice and work envir. Ensuring active particip. In decisions and accountability. Chapter 10 - Ageism = stereotype or discrim. Based on age; assuming health issues or cognition is same for every senior adult. - 2 factors that will double population 65+ in next 25 yrs = longer lifespan & aging baby boomers. - Issues r/t aging population = Longer life increase risk for chronic illnesses; PCP’s faced w/ IDing risks to independence and health; mental health providers faced with pt’s who are socially isolated and depressed in older pops. - 7 defined minority groups = Asian; Black/African; Hisp/Latino; Hawaiian; Pacific islander; AmerIndian; Alaska native. - Melting pot = assimilation. Chapter 10 Cont’d - Salad bowl = no assimilation, retain culture and add to society. - diversity = differences b/t cultures - Primary diversity = race; skin color; gender; age; religion. - secondary diversity = socio-economic; education; occupation; time away from country origin; residential status; sexual orientation. - Workforce diversity = processes to drive diversity (hiring process); be inclusive; welcoming and attractive to all kinds; workplace needs to care, act, and support diversity. - 4 steps to cultural competence = cultural awareness; cultural knowledge; cultural sensitivity; cultural competence. - Cultural synergy = bring two or more cultures together to form combined strengths. - Cultural assessment = open ended questions; language (services available); clothing; touch acceptance; eye contact; diet; family roles; religion; pain interpretation. Chapter 11 - Natural products = herbs, vitamins, minerals, probiotics. - Mind-body practices = acupuncture (energy channels); biofeedback; chiropractic (misalignments); hypnotherapy; healing touch/massage; tai chi (flow of chi); relaxation techniques. - Education/precautions with alternative medicine = always talk to MD; lack of validation; lack of regulation; lack of information/sources; herbal remedies have side effects; nurses lack of knowledge. - Popularity of alternatives = consumer driven; dissatis. With health care system; increased consumer empowerment; shrinking world; “evidence” of effectiveness. - Alternative healing = body can heal itself; harmony of mind body and spirit; basic positive health practices; approaches are individualized; responsible for own healing. - St John’s Wort = depression; side effects photosense, anxiety, dry mouth, dizziness, GI, fatigue, headache, ED; contra with antidepressants, birth control, cyclosporine, digoxin, indinavir, irinotecan, seizure control meds, warfarin, other antigoags. - Ginseng = stress, immune stim, general stim, lower blood sugar; side effect beast tender, sleep or GI issue; contra with diabetics and medications. - Feverfew = migraines; side effects headaches, diff sleeping, nervousness, joint/muscle stiff after discontinue. - Gingko = increase circ to brain for cognition/demetia; side effect headache, nausea, GI, diarrhea, dizziness, allergic skin reactions; contra can prolong bleeding, reduce anticonvulses. - Best resource for alternative meds = international college of integrative medicine; not for profit dedicated to educating health care workers about latest research and clinical trials. Chapter 15 - EHR recommendations = health info and data capture; results/data mgmt.; provide order entry mgmt.; clinical decision support; electronic comm and connectivity b/t providers etc; patient support; administrative process support; reporting and population health mgmt.. - Advantages of telecommunication = Extending care to home; delivery of care to underserved; benefits include quality of care, enhanced continuity, availability, access, decision making, time savings, higher quality of records. Chapter 16 - Triage priority = large # of vics do the greatest good for most num of people; care given to greatest chance of survival. - Terrorism acronyms = C – Chem; B – Bio; R – radiologic; N – nuke; E – explosive - Phases of disaster = Preparedness; Relief response (first emerg resp); recovery (72 hrs after disaster and up to 2-3 yrs). - Strategic national stockpile (SNS) – CDC stockpile w/ medicine, supplies in case of depletion; antibiotics, chem antidotes, antitoxins, IV admins, airway supplies, other med-surg items. - Active shooter = Evacuate; Hide if evac not poss; Take action (fight) is last resort in imminent danger, attempt to disrupt or incapacitate shooter. Chapter 7 - Why involved in healthcare reform = Waste and workload; where can practice; what allowed to do; ability to be reimbursed for services they provide. - Affordable care act = 32 million new pt’s w/ insurance; 80% of care can be provided by NP instead of PCPs; shortage of NP and family MD predicted. - Issues with more insured = w/o preventative or early recognition increased cost due to eneeding expensive hospitals or office; costs shifted to hospitals, HCPs, and those insured; children w/o insurance 7x more likely to have no regular care provider. - ANA & healthcare reform = support for restructured healthcare system for universal access to a standard package of services; devel and impl of policies that reflect six IOM policies; system must be reshaped and redirected away from overuse of expensive, tech driven, acute, hospital based services; ANA supports single payer mech as most desirable financing for reform; moves from illness care to preventative; Health care is human right. Chapter 28 - Computer adaptive testing = adapt to taker by difficulty level, harder Q’s based on previous correct answers; projects zone of knowledge, if above minimal level it is pass. - 3 types of RN progs = Nursing diploma and associate degree (ADN); Bachelor of science in nursing (BSN); Master of science in nursing (MSN). - NCLEX-RN purpose = demonstrate minimal knowledge and competency; protect public from unlicensed and unsafe nurses - how often NCSBN analysis of entry level practices = every 3 years - NCLEX company = pearson vue - How long official results = online 72 hrs; mail 7-10 days - Number of Q’s = 75-180 - Goal for NCLEX-RN confidence interval rule = 95% - 4 main categories of the test plan = safe and effective care envir; health promotion and maint; psycho integrity; physio integrity. - Safe and effective is 26 – 38 % (mgmt. of care = 7-23%; safety and inf control 9-15%); - Health promotion and maint 6-12 %; - Psycho integrity 6-12 %; - Physio integrity = basic care and comf 6-12%; reduction of risk 9-15%; physio adaptation 11-15%; - Pharmacologic and parenteral therapies is 12-18% - Five fundamental processes in test plan = assessment, analysis, planning, implementation, evaluation.
