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ADVANCE for Nurses • South
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Contents
ADVANCE for NURSES •
8
[10] ADVANCE Extra!
September 2012 • Volume 14 • Number 8
10
ED/Trauma
Despite the mainstream
nature of body piercing, the
associated risks, while most
often minor, can have rare and
life-threatening complications.
Healthcare providers must
be aware of the anatomical
location of body jewelry and
how to remove it in emergency situations. “Body Jewels in the ED,” the ED/
Trauma Extra, examines popular jewelry types.
Features
Extra! Body Jewels in the ED ....................................................................... 10
[8] In the Cardiac OR
Florida Hospital Waterman in Tavares, FL, launched its openheart surgery program last fall, with a goal of reaching
100 cases by the end of its first year. That the hospital met
that milestone just a little more than 8 months in is first
a testament to the need in the community, more than 30
percent of which is older than 65 — an age when there’s a
high risk for cardiovascular-related issues. It also speaks to the
quality of care delivered by nurses and physicians who staff the
program. They shared their successful approaches and lessons
learned for this issue’s cover story.
On the Web
Learning Scope: Nursing Quality Initiatives ............................................... 16
Departments
Editorial: Take the Pledge ............................................................................... 6
News Southeast ............................................................................................... 7
Education Opportunities .............................................................................. 20
Career Opportunities .................................................................................... 23
ADVANCE Healthcare Shop .......................................................................... 26
Where We Work: Florida Hospital DeLand ................................................. 30
www.advanceweb.com/Nurses
Visit www.advanceweb.com/Nurses anytime for national and regional news, timely articles, forums, blogs and more.
Laser Neurosurgery
Saving Shooting Victims
Getting to Know You
Head Lice
Miami Children’s
Hospital offers
an MRI-guided,
minimally invasive
procedure for
epilepsy in children that lowers
surgical risk and speeds recovery.
Visit www.advanceweb.com/
Nurses, search keywords “Laser
Neurosurgery.”
Level I trauma staff
immediately began
preparing for a
patient surge after
the shooting at a
Sikh temple in Wisconsin. Read
more about their efforts at www.
advanceweb.com/Nurses, search
keywords “Saving Shooting
Victims.”
Take our reader
survey, which will
take less than 10
minutes and could
result in hours of
informative and entertaining
reading from ADVANCE. Go to
www.advanceweb.com/Nurses
and look for the Contests and
Surveys area.
Although head
lice pose no
public health
threat or
transmission of disease, they are
an expensive nuisance. Find out
if “no-nit” policies are worth the
price at www.advanceweb.com/
Nurses, search keywords “Head
Lice.”
ADVANCE reaches RNs with editions of ADVANCE for Nurses in five zones: • Northeast • Mid-Atlantic & Lower Great Lakes • South • Midwest • West
ADVANCE is a member of the National Association for Health Care Recruitment (NAHCR), NCHCR, AAHCR, NSCSF, SFONE, FHA,
Postmaster: Send address changes to ADVANCE for Nurses, South, Merion Publications Inc., Circulation, 2900 Horizon Drive, SFAHR, TAHCR, DFWHHRA, HSHHRA and TONE.
King of Prussia, PA 19406.
Advertising Policy: All advertisements sent to Merion Matters for publication must comply with all applicable laws and regulations. Recruitment ads that discriminate against applicants based on sex, age, race, religion, marital
status or any other protected class will not be accepted for publication. The appearance of advertisements in ADVANCE Newsmagazines is not an endorsement of the advertiser or its products or services. Merion Matters does not
investigate the claims made by advertisers and is not responsible for their claims.
e This M
cycl
Re
e
azin
ag
ADVANCE for Nurses South (USPS #020683) is published 10 times per year on a monthly basis with the exception of July
and December by Merion Publications Inc., 2900 Horizon Drive, King of Prussia, PA 19406. Periodicals postage paid at Norristown, PA, and additional mailing offices. ADVANCE for Nurses South was established September 1999 and is free to all
licensed RNs and senior nursing students in areas of the Carolinas, Georgia, Tennessee, Alabama, Florida, Mississippi, Arkansas,
Louisiana, Oklahoma, and Texas. Contents are not to be reproduced or reprinted without permission of publisher. © 2012
Merion Publications Inc.
Our company serves the informational and career needs of doctors, nurses and allied healthcare professionals through a wide range
of products and services, including magazines, e-newsletters and websites for health information professionals, healthcare executives,
hearing healthcare professionals, imaging and radiation oncology professionals, laboratory administrators, long-term care managers and
professionals, medical laboratory professionals, nurse practitioners and physician assistants, nurses, occupational therapy practitioners,
physical therapy and rehabilitation professionals, respiratory care and sleep medicine professionals,
and speech-language pathologists and audiologists.
Pleas
e
ADVANCE for Nurses, South
®
5
Career Opportunities
Editorial
Job search by facility below, or use the Specialty Key on page 23 to target your job search by your
area of expertise.
Facility
All Children’s Hospital
BayCare Health System
Phone or web address
www.allkids.org
Pg. #
32
10
www.baycarejobs.com
Bethesda Healthcare System
Dekalb Medical
15
12
www.dekalbmedical.org
Denton State Supported Living Center
23
Florida Hospital - Deland
Florida Hospital of Zephyrhills, Inc
10
14
www.fhzeph.org
Florida Hospital Waterman
9
Ft. Duncan Regional Medical Ctr.
23
Georgia Health Sciences Health System
www.georgiahealth.org/career
23
Gulf Coast Healthcare
www.gchc.com
23
James Haley Veterans Hospital
Memorial Hermann Healthcare System
25
13
www.memorialhermann.org/careers
Munroe Regional Medical Center
25
Palms of Pasadena Hospital
www.palmspasadena.com
24
Parkland Health and Hospital System
jobs.parklandcareers.com
12
Piedmont Mountainside Hospital
24
Rowan Cabarrus Community College
23
Self Regional Healthcare
24
South Texas Health System
23
Surgical Center of Greensboro –
Orthopaedic Surgical Center
25
Texas Health Resources
www.texashealth.org
11
Venice Regional Medical Center
www.veniceregional.com
24
Products, Services, Education
Support the Companies That Support Your Profession. The companies listed support nurses by placing
advertisements in ADVANCE for Nurses. Their support keeps this publication coming to you free of charge. For
more information on these advertisers, go to www.advanceweb.com/nursesdirectory or visit their Web sites.
ADVERTISER
Phone or web address
Pg. #
ADVANCE Custom Promotions
www.advancecustompromotions.com
4
ADVANCE Healthcare Shop
www.advancehealthcareshop.
com
26
ADVANCE Virtual Education Fair
www.advanceweb.com/events
13
American Career CollegeWest Coast University
www.studyWCU.com
20
American Public University
www.studyatAPU.com/advance
21
inside front
cover
Dansko
www.dansko.com
Florida Nurses Association
www.floridanurse.org
20
www.fsaohn.org
20
Florida State Association of
Occupational Health Nurses
17
Keiser University
21
Keiser University
20
Take the Pledge
Nurses can help patients access information and
better manage their own healthcare
By Richard Krisher
A
s she prepared the manuscript for this issue’s
Learning Scope continuing education offering,
“Consumer-Driven Healthcare,” author Kay
Bensing, MA, RN, and I had spirited discussions about
the content. Her article focuses on how nurses can help
consumers use data on quality to empower themselves to
navigate the healthcare system.
While we agreed on the need for more reliable and accessible quality information, we diverged when it came to money. She believes
healthcare consumers are interested in the cost of their care and want
to use information about cost and quality to seek out the best options.
I contend the vast majority of those covered by public or private
healthcare plans might shake their heads when they see how much the
third-party payer spent on their care, but aren’t positioned or inclined
to do comparative shopping.
The American Nurses Association is moving the conversation in the
right direction. The rise of information technology in healthcare holds
promise to promote enhanced quality and efficiency. The association
is asking nurses to sign a four-point pledge to access their own health
information to verify its accuracy and completeness, use that information
to “share in the decision-making process for both clinical and financial
decisions about my health,” educate others about how to access their
health information, and support the IT movement in healthcare.
The idea is nurses will be better able to help patients take the same steps
and better manage their own healthcare. Getting hands-on exposure to
your own healthcare information is a terrific first step to help patients
make their way through the coming changes in our healthcare system,
which are sure to demand greater knowledge and participation from
all involved.
Lawrence Center for Hypnotherapy
Origin Food Group, LLC
www.getconcentric.com
14
Prepared Childbirth Educators
www.childbirtheducation.org
20
University of Wisconsin - Green Bay
www.uwgb.edu
22
USF HPCC - USF School of Aging
www.cme.hsc.usf.edu/hcrm
21
Venoscope
www.venoscope.com
30
Serving RNs in areas of the South is published by Merion Matters, publishers of leading healthcare magazines since 1985
Publisher Ann Wiest Kielinski • General manager W.M. “Woody” Kielinski • REGIONAL STAFF Editorial Director: Linda Jones Editor: Richard Krisher Senior Nurse Consultant: Kay Bensing, MA, RN Senior Graphic
Designer: Christian Adams Web Manager: Jennifer Montone • design Vice President, Director of Creative
Services: Susan Basile Design Director: Walt Saylor Multimedia Director: Todd Gerber Art Director: Doris Mohr
• advertising Director of Marketing Services: Christina Allmer Art Director: Chris Wofford • events
Public Relations Director: Maria Senior Job Fair Manager: Laura Smith Events Product Manager: Mike Connor
• administration Vice President, Director of Human Resources: Jaci Nicely Vice President of Business Technology Operations: Joe Romello Information & Business Systems Director: Ken Nicely Digital
Media Sales Director: Kim Noble Circulation Manager: Maryann Kurkowski Billing Manager: Christine Marvel
Subscriber Services Manager: Vikram Khambatta • Media & marketing opportunities: DISPLAY
Advertising Sales Director: Amy Turnquist Manager of Custom Communications and Marketing Services: Shannon Reiss Corporate Sales Manager: Kevin Miller Display Sales: Shannon Ferguson, Ashley Hackett •
healthcare facility Advertising Sales Director: Kim Noble Group Manager: Robert Murray Account
Executive: Bridget Gardner Sales Associates: Steve Benner, Mandy Dunfee, Meghan Simmons • education
advertising Sales Manager: Ed Zeto Sales Associate: Sarah Rucinski • Custom Promotions Sales
Manager: Mike Kerr Senior Account Executives: Noel Lopez, Sue Borjeson-Romano Sales Associates: Kristen
Erskine, Desirae Slaugh, Leah Stashko, Gina Willett
6
Sound Off!
Do you agree nurses should take the lead
in accessing and analyzing their own health
information? Will doing so eventually help patients
share in clinical and financial decisions regarding
their healthcare? Join the discussion at www.
advanceweb.com/NurseBlogs.
How to Contact Us
Merion Matters, ADVANCE for Nurses, South, 3100 Horizon Drive, King of Prussia, PA 19406-0956
On the Web: www.advanceweb.com ▶ E-mail: [email protected]
Editorial: 800-355-5627 ▶ Richard Krisher, Editor, [email protected], ext. 1391 ▶
Catlin Nalley, Editorial Assistant, [email protected], ext. 1459 ▶ Linda Jones, Editorial
Director, [email protected], ext. 1229
Article Reprints: 800-355-5627, ext. 1446 ▶ Subscriptions: 800-355-1088 ▶ To place an ad, call
our Sales Department: 800-355-JOBS (5627)
Compiled by Tom Kerr & Kathleen A. Waton
south*News
CONFERENCES EXPANSION PROMOTIONS HONORS LEGISLATION GRANTS APPOINTMENTS CERTIFICATION WORKSHOPS
Magazine Recognizes
‘Most Wired’ Hospitals
▶ More than 200 hospitals have been recognized
as one of the Most Wired Hospitals and Health
Systems of 2012, according to the results of the
2012 Most Wired Survey released in the July
issue of Hospitals & Health Networks magazine.
The recognition highlights organizations that
utilize health information technology to improve
performance in patient safety, flow and communication. Acknowledged hospitals include:
Alabama
St. Vincent's – Birmingham
University of Alabama at Birmingham
Hospital
Florida
Baptist Health South Florida, Coral Gables
Florida Hospital, Orlando
Memorial Healthcare System, Hollywood
Martin Health System, Stuart
NCH Healthcare System, Naples
Georgia
Emory Healthcare, Atlanta
Grady Memorial Hospital, Atlanta
Northeast Georgia Medical Center, Gainesville
Piedmont Fayette Hospital, Fayetteville
Piedmont Hospital, Atlanta
Louisiana
Lafayette General Medical Center, Lafayette
Mississippi
North Mississippi Health Services, Tupelo
North Carolina
Alamance Regional Medical Center,
Burlington
Carolinas HealthCare System, Charlotte
Charles George VA Medical Center,
Asheville
FirstHealth of the Carolinas, Pinehurst
Mission Hospital, Asheville
Vidant Health, Greenville
Womack Army Medical Center, Fort Bragg
Oklahoma
Oklahoma Heart Hospital, Oklahoma City
Unity Health Center, Shawnee
Oklahoma Heart Hospital South Campus,
Oklahoma City
South Carolina
AnMed Health, Anderson
Beaufort Memorial Hospital, Beaufort
Greenville Hospital System University
Medical Center, Greenville
M edical University of South Carolina,
Charleston
Palmetto Health, Columbia
Tennessee
HCA, Nashville
Mountain States Health Alliance, Johnson
City
Vanderbilt University Medical Center,
Nashville
Texas
Brooke Army Medical Center, Fort Sam Houston
Children's Medical Center, Dallas
Harris County Hospital District, Houston
Memorial Hermann, Houston
Methodist Health System, Dallas
Texas Health Resources, Arlington
University Health System, San Antonio
UT Southwestern Medical Center, Dallas. n
Names & Faces
Holy Cross RN Receives DAISY Award
▶ Fort Lauderdale, FL Deborah
Napoli, RN, has been honored with the
DAISY Award at Holy Cross Hospital,
where she is manager of the cardiac
rehabilitation program.
“Debbie began her career in Holy Cross in
1988 and has served tirelessly in a number of
areas," said Meg Scheaffel, MBA-MHA,
BSN, RN, vice president/CNO at Holy Cross.
In addition to assisting patients improve
Meg Scheaffel, MBA-MHA, BSN, RN,
vice president/CNO at Holy Cross their cardiac health, Napoli serves as
presents Deborah Napoli, RN, with secretary for the Holy Cross Mended
the DAISY Award recognizing her
Hearts Program, which is affiliated with the
outstanding direct care of patients.
American Heart Association and provides
support, health information, workshops, and outreach programs to patients
and their families.
RWJF 2012 Executive Nurse
Fellows Selected
▶ The Robert Wood Johnson Foundation (RWJF) recently announced the 20
nurses from across the country who have been selected as RWJF Executive
Nurse Fellows for 2012.
This group will participate in a 3-year, leadership development program that
is enhancing nurse leaders’ effectiveness in improving the nation’s healthcare
system. They join more than 200 nurse leaders who have participated in
the RWJF Executive Nurse Fellows program since it began in 1998.
Executive Nurse Fellows hold senior leadership positions in health services,
scientific and academic organizations, public health and community-based
organizations or systems, and national professional, governmental and policy
organizations. They continue in their current positions during their fellowships,
during which each Fellow develops, plans and implements a new initiative to
improve healthcare delivery in her or his community.
The fellowship is supported through a grant from the Robert Wood Johnson
Foundation. Nurses in the region selected include:
• Richard Cuming, EdD, MSN, RN, NEA-BC, senior vice president/CNE,
Jackson Health System, Miami
• Cole Edmonson, DNP, MSN, BSN, FACHE, NEA-BC, vice president
of patient care services/CNO, Texas Health Presbyterian Hospital Dallas
• Linda Lawson, DNP, RN, NEA-BC, administrative director of nursing
operations, Del Sol Medical Center, El Paso, TX
• Shawanda Poree, MBA, BS, BSN, deputy director for the healthcare
placement service, Veterans Health Administration Healthcare Retention
and Recruitment Office, New Orleans
• Lisa Sgarlata, MSFM, MSN, RN, chief administrative officer, Lee
Memorial Hospital, Lee Memorial Health System, Fort Myers, FL
• Suzan Ulrich, DrPH, CNM, FACNM, associate dean of midwifery and
women’s health, Frontier Nursing University, Deerfield Beach, FL. n
7
Cover Story
In the
That activity helped build a united culture
that was dedicated to its mission of serving heart
patients and focused on solutions.
“The OR can be stressful,” Phelps-Keaton said.
“You need a dedicated team that’s really supportive
of one another … not thinking, ‘That’s not my
job,’ but doing what’s needed to take care of that
patient at that time.”
“Everybody moved here to start this program
… and we want this program to work,” Gallion
said. “Because we had so many nurses with great
experience from other units who had never
themselves opened up an open-heart program,
we were so excited and we put in 110 percent.”
Cardiac
OR
When Florida Hospital Waterman launched an open-heart
program last year, experienced nursing staff got the program
up and running By Danielle Wong Moores
W
hen Ontoinette Hanks, BSN, RN,
charge nurse of the cardiovascular
ICU at Florida Hospital Waterman
(FHW), Tavares, FL, checked her email one day
in early June, she was surprised to learn the heart
center had reached a milestone: its 100th case.
“I said, ‘We didn’t do 100 cases already?’” Hanks
recalled. “It’s gone by so fast.”
FHW only recently launched its open-heart
surgery program, with a goal of reaching 100
cases by the end of its first year. That the hospital met that milestone just a little more than
8 months in is first a testament to the need in
the community, more than 30 percent of which
is older than 65 — an age when there’s high risk
for cardiovascular-related issues.
But it’s also a testament to the quality of the
program. The open-heart service is helmed by
Gary Allen, MD, a fellowship-trained cardiothoracic surgeon who specializes in coronary
bypass surgery — both traditional and “beating
heart” — as well as traditional and minimally
invasive valve surgery, laser surgery, and surgery
for aneurysms and rhythm disorders.
Months before the launch, the hospital also
began actively recruiting nurses and other staff
experienced in open-heart surgery and care, or
with extensive ICU experience, who were will-
ing and interested in building a new open-heart
program.
Building a New Culture
When the hospital sent out its call, nurses and
staff from near and far responded.
Recruited in February 2011 night shift charge
nurse Sandy Gallion, BSN, RN, left a 5-year stint
in pediatrics to return to her first love — adult
heart care.
“When I was approached by the recruiter, I
said, ‘Absolutely, I’m on board, when do I start?’”
she said. “The thought of starting a brand-new
program from the ground up was enticing. I
couldn’t pass it up.”
“It was a wonderful opportunity,” agreed
cardiovascular OR coordinator Tuwana PhelpsKeaton, BSN, RN, CNOR, CRNFA, who relocated
from Ohio and brought open-heart surgery
experience from the Cleveland Clinic. “It was a
good opportunity for me to grow by starting up
a program and bringing it all together.”
Nursing staff, including Gallion, PhelpsKeaton and Hanks, were all hands-on in building the program, including hiring, developing
policies and procedures, ordering equipment,
organizing rooms, choosing uniforms, even
selecting paint colors.
Removing Barriers to VAD Therapy
Patients with ventricular assist devices face healthcare barriers as
outpatients when trying to seek medical care and/or coverage for
routine supplies, cardiac rehab and more. Find out how nurses can
help at www.advanceweb.com/Nurses, search keywords
“Removing Barriers to VAD Therapy.”
8
Growing Pains
But any program developing from infancy is
bound to have a few growing pains, and FHW’s
was no different.
One challenge, Hanks said, came from the
fact the hospital had never had an open-heart
surgery program before, and departments such
as the blood bank and lab needed to understand
why the CVICU was more like a PACU than a
traditional ICU, and why nurses needed a little
more autonomy to rapidly care for patients.
For example, patients recovering in the CVICU
might require certain medications or begin bleeding and need a blood transfusion, and earlier policies didn’t allow for a blood bank refrigerator on
the unit or a set of standard medications a nurse
could readily access during the patients’ recovery
phase. Instead, a nurse would have to physically
go to the blood bank to pick up a unit, or have
specific orders for each medication, which could
cause critical delays in patient care.
“We’ve worked with and met with pharmacy
and the lab to look at protocols and policies and
to make them suitable for us also,” Hanks said.
“I can say we’ve done a 180 since we started the
program.” For example, the unit and blood bank
now have a rapid infusion policy that allows the
unit to get massive quantities of blood quickly
during situations where this is necessary.
In another example, a state-of-the-art table was
perfect for the OR, but didn’t work so well when
the OR proposed bringing patients down to the
unit on it, requiring extra staff and time. The unit
offered another option: Why don’t we come to you
instead? “It was a great compromise on both sides,”
Gallion said. “Everyone was willing to talk about
it and come up with a better solution.”
Innovative Care
It’s estimated that around 80 percent of all heart
bypass surgeries in the U.S. are performed on a
Cover Story
heart and lung machine, which takes over the
work of those organs during procedures.
FHW is among that other 20 percent, which
includes leading institutions such as Vanderbilt
and Johns Hopkins, offering “beating heart” or
off-pump cardiac bypass surgery, in which the
heart continues to beat throughout the procedure.
According to Allen, the procedure is more
challenging, but offers greater benefits to the
patient, including shorter operating times, fewer
postoperative complications, reduced risk of
stroke and shorter length of stay.
Being involved in off-pump recovery was a
new experience for many of the nurses, which
is why nursing orientation includes observing
an OR case. “It helps you understand the whole
anatomy, the physiology and why we’re doing what
we’re doing to recover the patient,” Hanks said.
The nursing team also took an online critical
care course, and spent 4 weeks in the CVICU at
Florida Hospital Orlando.
Coupled with cutting-edge procedures is cutting-edge care. The CVICU was the first at FHW
to launch collaborative rounds, which include the
surgeon, PA, dietitian, case manager, intensivist,
nursing, pharmacy, respiratory, physical therapy,
cardiac rehabilitation, and the patient and family.
Starting on postop day one through discharge, the
group gathers at the patient’s door daily at 7:30
a.m. to review the plan of care.
“Everyone is there to know what the plan is
so everyone is always on the same page on the
patient,” Hanks said. “It’s the greatest thing we
could offer.”
Visitation on the unit is also 24/7, Hanks said,
giving families important peace of mind and providing patients with needed family support. That
patient- and family-centered focus is also why
the unit strives not to use restraints as patients
are recovering and waking prior to extubation.
One-on-one staffing for the first 6 hours of a
patient’s recovery and the use of all-disposable
products are other innovative practices that
FHW employs for high-quality care and infection prevention.
is already looking forward to growth: opening
an adjacent cardiac medical ICU, which would
double the unit from eight to 16 beds, and hiring more staff.
Service-wise, FHW has already begun caring
for heart transplant candidates, preparing them
for transfer to Florida Hospital Orlando’s heart
transplant program. More minimally invasive
procedures and possibly robotic surgery are also
in the program’s future.
The program’s success is based on several
factors, according to nursing staff. It’s about
dedication, communication and hospital support,
Phelps-Keaton said. It’s the great team, Gallion
said, and the autonomy.
For Hanks, it’s all about the innovative care,
plus community support.
“I’m excited about how much progress we’ve
made,” she said. “We’ve far exceeded the quality
outcomes, numbers and expectations. I’m really
excited to keep moving forward.” n
Future of Heart Care
With the program off to a running start, FHW
Danielle Wong Moores is a frequent contributor
to ADVANCE.
Florida Hospital Waterman has been named #4
of the “25 Most Beautiful Hospitals in the World”
(HealthExecNews.com) and one of the Orlando
Sentinel’s 2012 “Top 10 Companies For Working
Families.” Join us here, in a place unlike any other.
UPCOMING JOB FAIRS FOR EXPERIENCED RNs:
UP TO 60 NEW BEDS OPENING IN 2013!
At least 2+ years of experience in Med/Surg, CVOR, CVICU
or other major specialty required.
September 6th, 9:00 - 11:00AM
September 11th, 5:00 - 7:00PM
Florida Hospital Waterman
Human Resources Department
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You can achieve professional, personal, emotional and
spiritual well-being at Florida Hospital Waterman, in a
faith-based setting that promises always the best patient
care experience. Come ¿nd beauty in caring with us.
Beautiful careers
grow here.
RSVP to [email protected].
Please attach your resume.
www.fhwat.org/Careers.aspx
We are an Equal Opportunity Employer, Tobacco-Free Campus and Nicotine-Free Workplace.
9
ADVANCE EXTRA! ▶ ED/TRAUMA
I’m a friend.
I’m an optimist.
I’m a nurse…
ST. JOSEPH’S HOSPITALS & BAYCARE MOBILE POOL
RN JOB FAIRS
Thursday, September 27, 2012 • 11am-6pm
Locations:
St. Joseph’s Hospital – Main
Team Resources
4th Floor Medical Arts Building
3001 W. Dr. Martin Luther King Jr. Blvd.
Tampa, FL 33607
St. Joseph’s Hospital – North
Garden Classroom
4211 Van Dyke Rd.
Lutz, FL 33558
Mease Dunedin Hospital
Education Conference Room
601 Main Street
Dunedin, FL 34698
• RNs: All Specialties
• Mobile Pool RNs: Now Booking Current & Winter
Contracts - Housing Option for Out-of-Area.
For Baycare Mobile Pool, RNs must possess at least
18 months of recent acute care experience.
If unable to attend any event, apply online at:
BayCareJobs.com
For Mobile Pool questions, please contact: Kerry Holt
at 727-519-1403
ENJOYING LIFE. LOVING WORK. BEING BAYCARE.
Serving Clearwater, St. Petersburg & Tampa, Florida Equal Opportunity Employer • Drug-Free & Tobacco-Free Workplaces
10
Body Jewels in the ED
Weighing the risks of body piercing in the
healthcare setting.
By Sue Durkin, MSN, RN, CCRN, CCNS
D
espite the fact body piercings are associated with a complication rate
as high as 35 percent, this popular self-expression mode is becoming
a cultural norm. Body piercing is the practice of creating a puncture
into the skin to create an opening for devices such as jewelry, an apparatus or
implanted item. Microdermal implants, the newest form of body modification, appear as surface piercings that look like jewelry stuck onto the skin.1
Body piercing has been accepted as a common practice among older adolescents and young adults with some estimates that up to 56 percent of those
ages 17-25 have one or more devices in place.2 Despite the mainstream nature
of these body modification practices, however, associated risks, while most
often minor, can have rare and life-threatening complications. Healthcare
providers must be aware of the anatomical location of body jewelry and how
to remove it in emergency situations.
Where It All Began
As an art form, piercing has been present for centuries throughout the world
and a significant part of cultures and rituals in many civilizations. A practice
for more than 5,000 years, it was often used to denote status, nobility, virility
John Cuipa
at BayCare Health System, and I enjoy living life to the
fullest while caring for others along the way. Join us at our
upcoming job fairs and find new reasons to love where
you work and who you are.
Our benefits package
includes loving your job.
Recruiting ED RNs.
Are you one of us? Stepping into the Emergency Department takes courage, instincts, and skill. The
challenges come from every direction, with no time for second-guessing. Not everyone can do it. But
those who can will join an elite group of caregivers dedicated to making a real difference. We are now
hiring experienced RNs for Emergency Services in select Texas Health Resources hospitals. If you’re
looking for the chance to gain real experience and feel immediate lifesaving satisfaction, let’s talk.
TexasHealth.org/Careers
[email protected]
EOE/AA/M/F/D/V
11
Make the right choice
for a rewarding career.
As a ED RN, you’re looking for a clinical
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it’s the perfect time to join us.
Choose Parkland.
and strength. Body piercing has been noted in the Mayan culture of 700 AD,
where it was a common religious practice. Female nipple and male genital
piercings were common practices centuries ago in Egyptian dynasties and
among Roman soldiers.3
In modern society, the profile of a person with body piercings has often
been associated with gangs, artists or cults. But, when examined, one research
study found the majority of males with genital piercings were well-educated,
with a middle-class income, in a heterosexual relationship and an average
age of 36 years old.4 However, data on females with genital piercings found
a large percentage have experienced depression and physical or emotional
abuse in their lives.5 Whatever the reasons, worldwide, body piercing professionals find their crafts in demand by people of any age, race, religion, sex
and socioeconomic level.3
Jewelry Types & Removal
The popularity of body piercing has led to an increased need for education
within the general population and healthcare profession. Knowledge of
bonus
$3,000 sign on incentive bo
various types of jewelry, proper removal, anatomical locations and associated
Please visit us online at
complications such as infections, allergic reactions and interference with diagjobs.parklandcareers.com
jobs
jo
bs.par
parkl
klan
a dcareers.com
nostic testing or surgery are important areas for the healthcare professional
to understand. Encouraging the patient to remove devices before diagnostic
FIND IT HERE
testing should be a standard practice in hospitals and emergent care areas.
We’ve developed an upgraded career site that’s
completely designed around the user experience.
The most common types of jewelry are studs, screws, hoops, captive rings,
And coming soon, the search engine–friendly site
will be viewable on your mobile device.
barbells, open circular barbells and nostril screws. Studs and screws can be
removed by disconnecting the back with a straight pulling motion or by
Equal Opportunity Employer
unscrewing the head of the stud. Remove hoops by
unsnapping the latch or pulling it apart.
Devices slightly more difficult to remove are captive rings and barbells. Barbells can be unscrewed and
separated into two pieces for removal. Captive rings
consist of a circular ring with a ball and usually requires
a special type of small pliers for removal. Hence the
term “captive,” which defines the name of the device.
The ball is first removed and then the ring is opened
with special pliers. Equipment to remove piercings,
such as ring opening pliers and bolt cutters, should
be available for use in diagnostic areas as well as the
ED by trained individuals so risks can be minimized.
Commonly pierced body parts include earlobes and
cartilage, tragus, nose, septum, edge and distal portion,
Be part of a great healthcare employer, dedicated to pushing beyond ordinary jobs...
to extraordinary careers. DeKalb Medical is proud to be an environment teeming with
eyebrow, tongue, lips, navel, nipples and genitalia.3,6
opportunities for you to learn, grow and advance in your field.
Because piercings can be found almost anywhere on
the body, it is important for healthcare professionals
$10,000 Sign-on Bonus
to do a thorough health history and physical assessEmergency Nursing Opportunities
ment during a patient’s admission to determine if any
permanent jewelry or devices are in place.
• Staff RNs – FT and PRN
• Nurse Manager of ED
Implanted devices, which alter the shape or form
• CNS – Nurse Educator
• Executive Director of Emergency
of the body, are popular in some circles and it should
be noted they may interfere with diagnostic images
Take your career all the way to extraordinary! For more details and to apply, please visit
or radiologic films. The popularity of magnetic body
www.dekalbmedical.org/careers. EOE
jewelry is increasing. While not permanent, these
devices should also be considered in the physical
Check out DeKalb Medical
assessment. If the patient is unable to respond or if
on Facebook and Twitter.
concerns are aroused after completing an explanation
of risks associated with specific imaging, examining
for any hidden objects not mentioned during the initial
ordinary jobs to extraordinary careers
12
Attend for FREE from anywhere
you
y can access the internet!
Houston, Texas
LEARNING
OPPORTUNITIES
THAT FIT YOUR SCHEDULE
Online Education Fair
for Healthcare Professionals
OCTOBER 17 • 12:00 PM – 6:00 PM ET
Education can push you to the next level in your
career, and this FREE online event can help you find
the CE and advanced degrees you need to get there.
• Chat with admissions personnel
• Sign in and out as many times as you please
• Learn about CE and higher education providers
• Get info on CE courses and
healthcare degree programs
Reach your highest goals
at Memorial Hermann.
Memorial Hermann is a world-class health system with locations
throughout Houston and the surrounding areas. With benefits
eligibility that begins the first day of employment, this is a great
time to become part of our award-winning organization. Our
team of more than 20,000 consistently votes us among
Houston’s Best Places to Work. Find out why—
and take your career to a higher level.
• Enjoy career enhancement sessions
• Enter to win prizes
Visit us at Booth
#1345 at the
ENA Conference
to learn about
our exciting ER
nursing careers!
CONTACT US
Toll-free
1-866-441-4567
email
[email protected]
or online
jobs.MemorialHermann.org
Register now at www.advanceweb.com/events
We offer
world-class
opportunities
in nine Emergency
Departments
throughout Houston:
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EOE, M/F/D/V. No agencies, please.
Questions? Call 800-546-4987 or email [email protected]
13
history may be indicated. Healthcare personnel must remember to remain
professional in all aspects of assessment and care.
FREE Educational Opportunity for ED Nurses
CURRENT ISSUES IN
EMERGENCY NURSING
Shelly Cohen, RN, MSN, CEN
Earn 3.5 CEU’s and join us for a dynamic ½ day seminar
covering the current issues in emergency nursing:
ǩ Do’s and Don’ts of ER Documentation
ǩ The image of ED nurses
ǩ Risky business for triage
Florida Hospital Zephyrhills
November 8, 2012
8:00 am to 12:00 pm
Job Fair and ED Tours immediately follow
Continental breakfast and refreshments will be provided.
Register Now – Seating is Limited!
Seating is limited; please register by October 31, 2012 to
secure your space.
Email: Your name, address, and phone number to
[email protected]
Call: (813) 788-0411, extension 1921
7050 Gall Blvd. Zephyrhills, FL 33541
When to Remove
Most body jewelry is specifically designed to stay in place, making it more
difficult to remove rather than inadvertently fall out during a procedure or
surgery. However, jewelry left in place may cause difficulty with placement of
devices such as a cervical collar or urinary catheter. Jewelry or devices left in
place can interfere with an MRI, creating artifact and/or distortion, or even
injuring the patient. Piercings left in place during surgery can interfere with
electrocautery, causing burns or disruption of the procedure.3
Proactively removing jewelry prior to diagnostic procedures or surgery
saves the patient from a potential adverse event and encourages safe practice.
A practice recommended by the American Academy of Dermatology is to use
nonmetallic retainers or catheters to keep the pierced tract open during surgery,
or to cover with a clear occlusive dressing before a procedure.7,8
Clinicians may be concerned about possible aspiration of jewelry during
intubation or airway management. However, some practitioners believe if
the patient can walk, talk and sleep with tongue jewelry in place, they can
probably be intubated with it.9
Tongue piercings bring their own set of complications to the patient from
poor healing to excessive bleeding due to the high vascularity of the region. A
frequent challenge to dentists and oral surgeons, tongue piercings are associated
with chipped or fractured teeth, eating problems, speech impediments, ageusia
Continued on page 22
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14
h
LIVE VIVIDLY
Opening An Additional Hospital
To Serve Our Growing Community
Bethesda West Hospital - Opening January 8, 2013
Apply online at:
www.BethesdaWeb.com/Careers
A not-for-profit, 401-bed hospital, Bethesda Memorial Hospital in Boynton Beach, FL has provided quality health
services in a caring manner since 1959. Today, we’re more committed than ever to improving the well-being of our
patients and our professionals. Now is the perfect time to join our health system. Let’s work together to strengthen
our community—starting with your career.
In addition, our state-of-the art facility was designed to provide efficient and effective treatment for all levels of
emergencies. Divided into separate sections, 43-private treatment rooms are used to deliver specialized care, including
cardiac emergencies, pediatric emergencies and even an “express care” area for less serious illnesses and injuries.
Immediate Opportunities Available for
Emergency Room RNs
Intensive Care Unit RNs
Critical Care RNs
Cardiovascular Intensive Care Unit RNs
Our Many Accolades Include:
Commitment Bonuses for ER, ICU & CVICU RNs
• 2011 Kids’ Crown Award for the Best Maternity Hospital in
Palm Beach County - South Florida Parenting Magazine
• 2011 American Heart Association Fit-Friendly Hospital
• 2011 American Heart Association Gold Award for Stroke Care
• Recognized in U.S. News & World Report’s “America’s
Best Hospitals”
For information on all of our available opportunities, please
visit our web site, www.BethesdaWeb.com/Careers.
For any additional questions, contact Duarte Mendonca,
Nurse Recruiter at [email protected]
or call 561.737.7733, ext. 84371.
Bethesda Memorial Hospital is a fully-accredited, not-for-profit community
hospital and equal opportunity employer. Smoke-free, drug-free workplace.
15
THE LEARNING SCOPE ▶ CE Offering • 1 Contact Hour
Consumer-Driven Healthcare
Patient engagement is critical to meeting quality initiatives
By Kay Bensing, MA, RN
T
he Affordable Care Act (ACA) became law
with the professed goal of providing Americans the right to access quality healthcare.
What is quality care? Who has the responsibility to
define quality in healthcare? Who evaluates quality,
and how will consumers know if they are getting the
same quality as their neighbors or friends?
For at least 2 decades, healthcare analysts and
policymakers have debated what quality healthcare
is. However, consumers rarely questioned if the
healthcare they were receiving was top quality. This
changed in 1999 when the Institute of Medicine
published its seminal report, “To Err Is Human:
Building a Safe Health System.” The public was
shocked to learn medical errors were the eighth
leading cause of death in the U.S.
This article focuses on how consumers can
receive and interpret quality data, how they can
share decision-making with their providers, and
The Learning Scope
CE Offering • 1 Contact Hour
This offering expires in 2 years:
August 27, 2014
The goal of this continuing education
offering is to provide current and relevant
information about the importance of patient
involvement in healthcare quality for all
consumers. After reading this article, you
will be able to:
1. Compare and contrast how the
American public has viewed healthcare
quality over the past 2 decades.
2. Discuss consumer engagement as it
relates to healthcare quality.
3. Identify two reasons why patient
navigator programs are successful.
Online CEs
Earn contact hours with just a click of the
mouse, www.advanceweb.com/nurseCE
16
learn how to navigate the sometimes-confusing
healthcare system.
Experts Debate
In April 2002, healthcare leaders, experts and
policymakers met in Philadelphia to share their
views about how to keep public attention focused
on quality in healthcare. Their panel discussion
preceded a 2-day conference, “Keeping Health
Care Quality on the Policy Agenda.”
There was lively discourse among the panelists
about why consumers pay so little attention to
the quality of care they receive. For example, the
group agreed there was ample data available for
consumers to access information about quality
from varied resources. However, the panelists could
only speculate the public didn’t know how to access
this information or interpret the quality findings.
There was consensus the priority of consumers is
to be able to access care at the time they need it;
quality of care is secondary concern.1
“Many people don’t think there is any problem
related to quality in healthcare,” said Trudy Lieberman, a healthcare consumer journalist for more than
40 years who at that time was senior health policy
editor at Consumer Reports. “There is a cultural bias
in this country about this issue. Americans believe
more [in healthcare] is always better; the doctor
is always right and we [Americans] have the best
[healthcare] system in the world.”2
Lieberman reported that when media report
stories related to the poor quality of care, consumers believe the press is transmitting negative messages. Consumers believe if there is a problem, the
government will take care of it, and consumers will
be protected.
In 2004, Lois Butcher of the Kansas City Business
Journal wrote an article comparing information
given to consumers about stroke programs in local
hospitals. After reading data from various sources
about the programs, the hospitals and the physiThis continuing education offering is
sponsored by an educational grant from
Innovative Senior Care
cians, Butcher concluded this information, meant
to educate the public, seemed flawed.3
The writer reviewed reports from insurers, government agencies, employer groups and independent
companies. She expected to find some similarities
related to quality indicators. Instead, it seemed the
reports confused instead of clarified this information
for consumers. No one facility, program or physician
involved in stroke treatment programs received
good grades consistently, or were even noted in the
comparative data, according to Butcher.
Fast Forward to 2011
Enacted into federal law in March 2010, the ACA
“seeks to increase access to high-quality, affordable
healthcare for all Americans.”4 The law calls for the
secretary of the Department of Health and Human
Services (HHS) to establish a “national strategy for
quality improvement in healthcare.”4 In March 2011,
the first blueprint for this requirement, the “National
Strategy for Quality Improvement in Health Care”
report, was presented to Congress by HHS. This
report will be published annually.
Included in the 2011 report to Congress are six
priorities related to quality that were initially implemented. For example, one priority is to “ensure that
each person and family is engaged as partners in
their care.”4 Specific quantifiable goals and measures
for each of these priorities are to be a joint effort
with stakeholders and the HHS. For each of the
ADVANCE
The author has completed a disclosure form and
reports no relationships relevant to the content of
this article.
CE Offering • 1 Contact Hour ▶ THE LEARNING SCOPE
six priorities related to healthcare quality, several
research projects, in varied locations in the country,
are discussed in the report.
These initiatives should be reviewed by nurses
and all healthcare professionals annually to gain an
understanding of how these priorities translate into
practice interventions. Collaboration with patients/
families, other professions, healthcare agencies,
providers and payers is critical if the identified
outcomes are to be reached.
The 2012 report to Congress includes discussion regarding the progress in each of the priority
areas listed.5
‘Wakeup Call’
In April 2011, a month after the unveiling of the
“National Strategy for Quality Improvement in
Health Care” report, a poll about how Americans
grade the quality of care was presented at the annual
membership meeting of the American Hospital
Association.6
Commissioned by the Robert Wood Johnson
Foundation (RWJF), the poll was conducted by
researchers at the Harvard School of Public Health.
The poll showed more than half of the 1,034 people
surveyed (55 percent) gave the quality of healthcare
in the country as a whole grades of C or D. Eleven
percent answered with a failing grade of F.6
“This poll is a wakeup call for the healthcare
industry, both of which have been working steadily
to improve the quality of care, but need to kick
their efforts into overdrive to accountability,” said
Risa Lavizzo-Mourey, MD, MBA, president/CEO
of RWJF.6
The researchers noted significant differences in
specific areas. For example, across the board, those
polled ranked the quality of care they receive as better than what they think other Americans receive.
Only 13 percent gave their own care a D or an F.6
Fifty-seven percent of those surveyed said they
chose a hospital they have used for years, as opposed
Health Education & Promotion
Each nurse-patient interaction provides
patient education and nurses should take
advantage
of every
opportunity to
teach patients
good health
habits. Learn
successful strategies, and earn 1 contact
hour, by reading “Health Education &
Promotion” at www.advanceweb.com/
NurseCE. Look for CE #368.
to hospitals in their communities that have higher
quality scores (38 percent). Also, a response worth
noting was that despite studies showing racial and
ethnic disparities in healthcare, 60 percent of poll
respondents think blacks and Hispanics receive the
same or better care than whites.6
Using the results of the 2011 RWJF poll as a
springboard to place quality accountability on
consumers, Lavizzo-Mourey urged the public to
step up to the plate. Consumers need to be more
engaged in their healthcare, she emphasized, which
means taking responsibility for learning about their
care, understanding whether it as good as it could
be, and then acting on that knowledge.
family never sued the hospital, and 3 years after
his daughter’s death, Michelle’s father became a
contributing member of the hospital’s safety team.8
At the Table
Long before the ACA became law, there was consensus among healthcare quality experts that if patients
and their families were educated with the “right’
information, they could be activated to:
• demand high-quality services from their
providers;
• share decision making with their clinicians; and
• self-manage their own healthcare.
Consumer engagement encompasses a wide
range of health responsibilities healthcare experts
and government agencies hope patients, with the
help of family or professional advocates and effective tools, will want to improve the quality of care.
Even though there is resistance by some providers
and payers to partner with patients, noted quality
expert and former commissioner of the Centers for
Medicare and Medicaid (CMS), Donald Berwick,
MD, and his colleagues believe “the guiding principle
is if health is on the table, then the patient and family
must be at the table, every table now.”7
Studying the Gaps
In 2007, consumer engagement in healthcare was
gaining momentum. Research articles attempted
to address topics such as consumer activation,
decision making (health plan, provider and treatment choices) and how to navigate the healthcare
system. However, there were substantial gaps in
the research.9
To study these research gaps, RWJF partnered
with Academy Health, a Washington, DC-based
professional society of healthy policy analysts and
health service researchers. From this project came
five white papers on various aspects of consumer
engagement. When the experts presented their
papers and discussed the details of the complex
issues, they kept coming back and asking, “Why are
we talking about consumer engagement?” However,
they were able to summarize their work and beliefs
into three statements affirming consumer engagement is essential the delivery of cost-effective, quality
care. These statements are:
• Consumer engagement holds great potential
to spur health quality improvements, particularly in improving patient safety and treatment
decision-making.
• Consumer engagement must not be viewed as
a silver bullet; consumers have neither the power
nor the skills to transform healthcare systems on
their own.
• Change will require a joint effort on the part
of consumers, providers, payers, insurers and
policymakers.
Obstacles Remain
Despite the evidence of the effectiveness of patient
involvement, implementation has been modest for
a number of reasons, according to quality analysts.
For starters, some clinicians are reluctant to share
knowledge and care plans with patients; consumer
advocacy groups have often not been invited to the
table, and many clinicians are not convinced sharing
information about adverse events with the public
can result in positive outcomes.
However, several adverse incidents have resulted
in transparency between the hospital and patients/
families that have led to positive outcomes.7 In 2008,
Michelle Malizzo Ballog, 39, died in the operating
room at the University of Illinois Medical Center
in Chicago due to anesthesia not being properly
monitored. The hospital was forthcoming to Ballog’s
family about the incident and quickly implemented
interventions to correct the error. As a result, the
Promising Strategies
In January 2012, a RWJF issue brief described four
examples to indicate patient engagement is moving
forward. These are:
• Website data comparing the performance of
different providers. Surveys now show the use of
performance data to help patients make informed
decisions about their care is not widespread, but is
increasing. Most patients still choose their physicians
based on previous experience or word of mouth.
Under ACA, HHS will set standards for collecting
and reporting this data to the public.
• Decision-making aids to help patients make
informed choices about healthcare. In one study of
men considering prostate surgery, those who used
decision-making aids scored highest on a prostate
cancer knowledge test and were less uncertain when
comparing clinical options.
• Patient-centered medical homes, an alterna-
17
THE LEARNING SCOPE ▶ CE Offering • 1 Contact Hour
tive healthcare delivery model under ACA, require
primary care physicians to coordinate a patient’s
care. The expectation is there will be shared decisionmaking between the physician and the patient. It is
recommended that electronic technology be adopted
by the practice to track patients and help patients to
stay involved in their care.
• Care transitioning programs will help patients
move seamlessly from one health setting to another.
The Community-Based Care Transitions Program,
a pilot under the direction of CMS, will educate
Medicare and Medicaid patients to manage their
own health and hopefully decrease the current trend
of frequent readmissions to hospitals for those with
chronic diseases.
Navigating Healthcare
One of the five white papers on consumer engagement sponsored by RWJF and Academy Health is
titled “Navigating Health Care: Why It’s So Hard
and What Can Be Done to Make it Easier for the
Average Consumer.”10
Alison Rein, director of Academy Health and
author of the paper, said, “Patient navigation has
emerged as a way of characterizing the experiences
of consumers in healthcare.”10
The challenges consumers face when trying to get
the care they need in the current healthcare system,
Rein said, is best expressed by Jesse Gruman, PhD,
president of the Center for Advancing Care, whose
experiences of treatment for four cancer diagnoses
have promoted her advocacy for patient engagement since 1992.
“Being a patient in the United States is like being
drop-kicked into a foreign country,” Gruman said.
“You don’t know the language; you don’t have a
map; you can’t tell who’s in charge and all you want
to do is go home.”10
Eliminating Barriers
Patient navigation is defined as a process in which
patients and/or families move through a complex
healthcare continuum to seek healthcare services
that will result in positive outcomes. The core function of patient navigation is to eliminate barriers to
timely care across for all segments of the population.
However, if consumers can’t navigate this maze
themselves or find a family member or professional
or layperson to guide them through this process, they
delay or don’t get the care they need. Often when
consumers can’t navigate their care, they become
frustrated and seek care in overcrowded emergency
departments, which then adds an additional burden
to the healthcare system.
Rein said efforts to improve patient navigation
have not challenged the current healthcare delivery
system to come up with solutions that are workable,
and they only seem to create more barriers.
Structural Innovations
Rein said structural innovations might facilitate
patient navigation. For example, if integrated
delivery systems that provide multiple health services could be managed by the same organization,
it might be easier to coordinate the care. Rein said
this is probably even more feasible for organizations
like Kaiser Permanente and Group Health of Puget
Sound where healthcare coverage is integrated with
delivery of services.11
Another proposal to cut down on the navigation
maze, according to Rein, is referred to as the “focused
factory.” This calls for reimbursement and treatment
to be provided as one-stop shopping, for diseases like
diabetes and cancer. However, with both of these
examples, they are not one disease, but rather include
multiple conditions or comorbidities. In this type of
situation, the solution defeats it purpose, so to speak.
Professional & Lay Navigators
Since there have been no research-based solutions
to date to resolve consumer navigation problems,
the use of professional and lay patient navigator
programs began to emerge within the past 10 years.
Initially launched as a value-added service for
cancer patients, navigation programs are seen in
many different settings. The primary functions of a
patient navigator are to provide access to care and
assist the patient to comply with treatment.
Navigators also provide emotional support as
needed during a specified time period. With most
This CE offering expires August 27, 2014.
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate, go to www.
advanceweb.com/nurseCE. Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or
a photocopy) with payment to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406.
3) Fax the answer sheet with payment informaton to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice
of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association
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Publications is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board
of Nursing (No. 3298).
18
navigator programs, the role of the navigator is
defined and does not overlap with the role of other
staff. Response from patients, healthcare providers
and insurers has been largely positive. However,
there is minimal research related to care outcomes,
according to Rein.
Nurses Can Lead
Nurses have a responsibility to help patients engage
in their health and their healthcare. Nurses are still
rated by the public as those professionals they trust
the most. As the ACA is implemented in coming
years, nurses also have a responsibility to educate
themselves about the changes they will help explain
to their patients. n
References
1. Keeping health care quality on the policy agenda. (2002).
Retrieved July 7, 2012 from the World Wide Web: http://www.
upenn.edu/ldi/panel.html
2. Bensing, K. (2002). Advocating quality care. Retrieved July
5, 2012 from the World Wide Web: http://nursing.advanceweb.
com/article/advocating-quality-care-3.aspx
3. Butcher, L. (2004). Differing definitions of ‘quality’ lead
to disparate health rankings. Retrieved July 1, 2012 from the
World Wide Web: http://www.bizjournals.com/kansascity/stories/2004/11/01/story8.html
4. Report to Congress: National strategy for quality in improvement in health care. (2011). Retrieved July 2, 2012 from the World
Wide Web: http://www.healthcare.gov/law/resources/reports/
nationalqualitystrategy032011.pdf
5. National quality strategy: 2012 annual progress report.
(2012). Retrieved Aug. 13, 2012 from the World Wide Web:
http://www.healthcare.gov/news/factsheets/2012/04/nationalquality-strategy04302012a.html
6. When it comes to quality, new poll shows Americans give U.S.
health care low grades. (2011, April 12). Retrieved July 10, 2012
from the World Wide Web: http://www.hsph.harvard.edu/news/
press-releases/2011-releases/poll-us-health-care-quality.html
7. Leape, L., Berwick, D., Clancy, C., et al. (2009). Transforming healthcare: A safety imperative. Quality and Safety in Health
Care, 18(6), 424-428.
8. Shelton, D. (2011). Family of woman who died after a medical error joins hospital’s safety panel. Retrieved from the World
Wide Web July 26, 2012: http://articles.chicagotribune.com/201110-07/health/ct-met-medical-errors-20111007_1_medicalerrors-safety-panel-patient-advocates
9. Arnold, S. (2007). Improving quality health care: The role
of consumer engagement. Retrieved March 28, 2012 from the
World Wide Web: http://www.academyhealth.org/files/issues/
ConsumerEngagement.pdf
10. Robert Wood Johnson Foundation. (2012). Which
approaches encourage patients to become more engaged in
their own health care? Retrieved July 31, 2012 from the World
Wide Web: http://www.rwjf.org/healthpolicy/quality/product.
jsp?id=73835
11. Rein, A. (2007). Navigating health care: Why it’s so hard
and what can be done to make it easier for the average consumer.
Retrieved July 8, 2011 from the World Wide Web: http://www.
academyhealth.org/files/issues/NavigatingHealthCare.pdf
Kay Bensing is a frequent contributor to ADVANCE.
Sponsored by Innovative Senior Care
CE Offering • 1 Contact Hour ▶ THE LEARNING SCOPE
1. At the 2002 panel discussion, “Keeping
Health Care Quality on the Policy
Agenda,” the panelists agreed:
a. c onsumers were well-informed about the
quality of care in the U.S.
b. t here was a scarcity of information about
healthcare quality for consumers to access
c. c onsumers believe too much emphasis on
healthcare quality is directed to seniors
d. c onsumers want to know they can access
care at the time they need it; quality is not
a priority
2. At the same 2002 panel discussion,
Trudy Lieberman said the perception of
Americans about healthcare was all of
the following EXCEPT:
a. h ealthcare in the U.S. is the best in the
world
b. u niversal healthcare might be a way to cut
healthcare costs
c. physicians are almost always right
d. m
ore is always better when it comes to
healthcare
3. The poll about healthcare quality in
America released in 2011 by the Robert
Wood Johnson Foundation revealed:
a. M
ost Americans rated healthcare quality
above average.
b. C
onsumers said the quality of care they
received was better than what they think
other Americans received.
c. M
ore and more consumers were selecting
their clinicians from Internet data.
d. C
onsumers believe there are widespread
healthcare disparities among those with
ethnic and racial differences.
4. The primary function of patient
navigators is to:
a. h elp patients eliminate the barriers for
patients in accessing healthcare
b. v alidate the patient’s insurance and assist
with completing admission procedures
c. assist the patient’s assigned case managers
in hospitals/clinics
d. b e available for clinician appointments to
clarify information for all patients
5. Which of the following statements is
accurate about how clinicians view
consumer engagement?
a. M
ost clinicians do not welcome sharing
treatment plans with their patients.
b. C
onsumer advocacy groups are usually
welcome by clinicians.
c. C
linicians are convinced transparency
about adverse events is positive.
d. M
ost clinicians are comfortable sharing
knowledge with patients/families.
6. The Affordable Care Act (ACA):
a. w
as enacted into federal law in March
2010 and will be implemented through
2014
b. w
as struck down as unconstitutional by
the Supreme Court in June 2012
c. d oes not include states that have already
implemented healthcare reform legislation
d. d oes not include Medicare and Medicaid
recipients
7. The proposed outcome of the CMS pilot
program, the Community-Based Care
Transitions Program, under the ACA is to:
a. b etter educate patients with chronic
diseases
b. c ut down on hospital readmissions for
those with chronic diseases
c. r educe the number of patients admitted to
LTCs
d. r educe hospital morbidity and mortality
rates for the elderly
8. Most consumers choose their primary
physician/clinician based on:
a. previous experience or word of mouth
b. a hospital’s online referral service
c. comparative quality data
d. c hecking data to make sure the clinician
has never been sued for malpractice
9. In patient-centered medical homes, an ACA
alternative healthcare delivery model:
a. e lectronic technology is expected to
promote consumer engagement
b. t he primary care physician directs the care
and there are no referrals to other physicians
c. p hysicians are required to use
complementary and holistic therapies
d. t he primary care physician will make house
calls
10. The most important role for nurses in
consumer engagement is to:
a. become a patient navigator
b. t each patients how to compare quality data
c. a ssess patients about their self-managed
care and proceed accordingly
d. p rovide educational resources for patients,
according to their disease or condition
Evaluation
1. I can compare and contrast how the
American public has viewed healthcare
quality over the past 2 decades.
a. strongly agree
b. agree
c. neutral
d. disagree
e. strongly disagree
2. I can discuss consumer engagement as it
relates to healthcare quality.
a. strongly agree
b. agree
c. neutral
d. disagree
3. I can identify two reasons why patient
navigator programs are successful.
a. strongly agree
b. agree
c. neutral
d. disagree
4. The objectives relate to the overall goal
of the article.
a. strongly agree
b. agree
c. neutral
d. disagree
5. The article is well-written and logically
organized, and defines terms adequately.
a. strongly agree
b. agree
c. neutral
d. disagree
Consumer-Driven Healthcare
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19
EDUCATION OPPORTUNITIES
MASTER
Your
SEPT. 13-15, 2012
ORLANDO, FL
Florida Occupational
Health 2012 Conference
Health Care Career
Keiser University now offers a
Master’s Degree in:
NURSING
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employer for potential career
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nursing practice
Join us for the Florida Occupational Health Conference
-”Journey through the Constellations of Occupational Health,
2012” at the Marriott World Center - two pre-conference sessions will be offered. One will focus on a variety of Occupational
Health topics and the second will focus on Occupational Health
Nursing Certification preparation. The conference speakers are
experts in their fields. The conference is open to anyone with
an interest in occupational health or WC case management.
Earn Nursing CEs on the wide variety of stellar topics. Contact:
www.fsaohn.org
SEPT. 13-OCT. 14, 2012
NOV. 8-DEC. 9, 2012
CHARLOTTE, NC
MYRTLE BEACH, SC
Hypnosis Certification Program
1.877.916.2503
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7-day program offered 9/13-16 & 10/12-14 in Charlotte,
NC & 11/8-11 & 12/7-9 in Myrtle Beach area. Freedom to
work with clients on your schedule! You will be certified by
the national Guild of Hypnotist, Inc., largest hypnosis group
in the country (www.ngh.net). Use hypnosis to help patients
stop smoking, reduce anxiety before medical procedures,
lose weight, manage pain, reduce stress symptoms and
effectively deal with many more issues. Course is limited
to 10 students. Dr. Lawrence is a college faculty member
and author of two cozy murder mysteries (A Hypnotic
Suggestion & Why Kill a Parapsychologist?) with a forensic
hypnotherapist as the primary crime solver. One copy of
her book is free with the course. Contact: Dr. Madelaine
Lawrence, 803-367-3156; [email protected] or
www.hypnosisinfo.org
Call for a complete list of career choices U Programs vary by campus
www.KeiserSuccess.com
*Online only
SEPT. 14-15, 2012
ORLANDO, FL
FNA 2012 Membership Assembly
Over 500 students and experienced nurses will meet in
beautiful Altamonte Springs for Florida Nurses Association’s
2012 Membership Assembly. Join nurses from around the
state as we make important association decisions, network,
and earn continuing education credit hours. Be sure that our
voice is heard and that you continue to play a vital role in the
shaping of the future of nursing in Florida. Early bird registration specials offer a significant discount. Keep an eye on your
inbox for registration opening dates. A special rate of $99.00
per night has been arranged for us at the Hilton Orlando/
Altamonte. This rate is available until September 1st or until
it sells out, so be sure to make your reservation ASAP to get
the rate locked in. Make your reservation online at tinyurl.
com/FNAMembershipAssemblyHotel or call 407-830-1985
and be sure to tell them you are with FNA. Contact: www.
floridanurse.org and click on “Conferences”.
OCT. 3-4, 2012
NOV. 29-30, 2012
FEB. 8-9, 2013
CHICAGO, IL
SAN ANTONIO, TX
MONTGOMERY, AL
Childbirth Education
Certification Course
All of PCE’s certifications are on the American Nurses
Credentialing Center (ANCC) Magnet recognition list. Course
is evidence-based following nursing standards and offers
16 contact hrs. Topics include pain management theories,
relaxation, breathing patterns, comfort measures, prenatal
exercises, pushing techniques, support person, teaching
strategies, curriculum development, childbirth education as
a business. PCE offers programs to become infant massage
instructors, breastfeeding counselors, labor doulas & pre/
postnatal fitness instructors. Independent study courses
available. Group, PCE member and multiple course discounts
available. Contact: Prepared Childbirth Educators, Inc., 888344-9972; www.childbirtheducation.org for details, dates
and locations nationwide.
20
Certificate Program
MASTER
Nursing Career
Your
Prepare for a leadership role with
the online Master of Science in
Revised and Reapproved in 2011 to Comply with
the Risk Management Handbook for Health Care
Organizations, 6 th Edition
This online certification course is designed to
prepare health care professionals, including
physicians and nurses, and others for positions as
risk managers in health care settings. A special
unit is included to meet the risk management
needs of long-term care facilities.
NURSING
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KEISER UNIVERSITY
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For more information, please call at (813) 974-2161
or email [email protected]
S C H O O L
Training Academy on Aging at the Florida Policy Exchange Center on
Aging in the School of Aging Studies
Sponsored by
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We want you to make an informed decision about the university that’s right for you. For more about our graduation rates, the
median debt of students who completed each program, and other important information, visit www.apus.edu/disclosure.
21
Body Jewels
EXPLORE
PROFESSIONAL INFORMATION
JOB FAIRS
HEALTHCARE CAREERS
ONLINE CE CREDITS
BUYERS GUIDES
SHOPPING
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COURSES
AND MORE!
22
Continued from page 14
and occasional ingestion. Swollen tongues can
lead to airway occlusion and respiratory distress.
Improper removal of a tongue piercing appliance can lead to problems with airway management or accidental aspiration of the jewelry.
One study noted that, between 2002 and 2008,
nearly 25,000 oral piercing injuries presented
to EDs throughout the U.S. The predominant
age group was 14-22 years old. Injuries to lips,
tongue and teeth were the most prevalent, with
infections accounting for 42 percent of complications. Thirty-nine percent of complications
were associated with inability to remove oral
piercing.10 Patients with oral piercings are also at
risk for receding gums and should be counseled
to make regular dental screening visits.10
Body jewelry may interfere with diagnostic
imaging, especially if it is in direct view of the
area to be scanned, so removal or repositioning
the patient to decrease artifact should be considered.11 Generally, if not in the direct area being
examined, an X-ray or CT scan should not be
affected (see Figure). But for MRI procedures,
follow the policies of the institution, which
should mimic the guidelines of the American
College of Radiology. Most institutions recommend removal of jewelry or any metal device
before an MRI to prevent complications. Using
a synthetic catheter to substitute in place for
jewelry to keep the pierced tract open may be
a satisfactory alternative for the patient. Documenting in the medical record the site where
jewelry has been removed and the condition of
the surrounding skin is important for trending
of any changes that occur.
Complications
Piercings bring a host of complications such as
pain, persistent bleeding, delayed healing, infection, keloid formation, granulomas, hypertrophic
scarring, rejection or migration of jewelry,
structural body tissue defects, superficial nerve
involvement, allergic reactions, dermatitis, tooth
injuries, perichondritis of the ear pinna, endocarditis, acute glomerulonephritis, angioedema,
and pelvic inflammatory disease.2 Skin tears
developing during transfer activities from carts to
bed can become problematic.3 Changes in urine
flow as a result of genital piercing through the
penis and urethra may also occur.4
Ranging from local to severe systemic infections such as osteomyelitis, toxic shock syndrome
and bacteremia, specific infectious organisms
have been associated with various piercing
sites. Streptococcus and Staphylococcus aureus
are common organisms that infect piercings.12
Pseudomonas aeruginosa, S. Aureus and group
A beta-hemolytic strep infections are associated
with ear piercings. Tongue and mouth infections are linked to Haemophilus aphrophilus or
S. aureus, while genital piercings are associated
with Escherichia coli or Klebsiella pneumoniae.12
Signs and symptoms of infections may include
tenderness or pain, excessive swelling, odor,
erythema and purulent discharge. Additional
systemic symptoms include fever, fatigue, mental
status changes, shortness of breath and tachycardia. Rare but life-threatening complications such
as endocarditis, viral hepatitis, septic shock and
cerebral abscess can occur.12,13
Allergic reactions to metals can cause dermatitis, rashes and more dangerous pulmonary
complications such as inflammation and wheezing. Infectious bloodborne pathogens such as
HIV or hepatitis can occur if patients are exposed
to contaminated blood or improperly sterilized
body piercing equipment. Healthcare providers
should practice safe care by adhering to universal
precautions when caring for any patient, with or
without piercings. Patient education can be as
simple as explaining proper hand hygiene techniques. Referring the patient to the pamphlets
provided by professional piercing organizations
that encourage safe practices can reinforce additional education. Examples of these can be found
at www.safepiercing.org.
Body piercings are not without associated
complications. An educated consumer and
healthcare provider is the best option for safe
patient care. Following practice guidelines from
professional organizations for infection control
and diagnostic imaging safety should be standard
at healthcare facilities. A thorough patient history, preprocedure screening and assessment can
minimize safety risks. An awareness of trends
and practices in skin and body modification can
assist in anticipating care needs for patients who
present with this popular art form. n
References for this article can be accessed at www.advanceweb.
com/Nurses. Click on Resources, then References.
Sue Durkin is an advanced practice nurse, clinical nurse specialist, at Advocate Good Samaritan
Hospital, Downers Grove, IL.
Self-Expression
Through Body Art
Nurses can educate young
patients on safe practices
for piercing and tattooing
before they make a decision. Learn
more at www.advanceweb.com/
Nurses, search keywords “SelfExpression Through Body Art.”
MULTIPLE OPPORTUNITIES
Denton State Supported
Living Center
Career
Opportunities
Want to make a career move, or interested to see what’s out there? Use this
section to check out the latest nursing
career opportunities in the South.
Specialties are listed conveniently under
categories so it’s easy to find the openings that are right for you.
Multiple Opportunities . . . . . . 23
Acute Care . . . . . . . . . . . . . . . . .
Alternative Settings . . . . . . . . . .
Community Health . . . . . . . . . . .
Management/Administration . . .
Mental Health. . . . . . . . . . . . . . .
Post Acute. . . . . . . . . . . . . . . . . .
Surgical. . . . . . . . . . . . . . . . . . 25
Women’s & Children’s Health . . .
Out of Region Opportunities. . . . .
NOW HIRING
Committed to
Service
Excellence
You Can Make a Difference in
People’s Lives!
Positions Open:
RNs and LVNs
Join an excellent team of medical specialists
to further our vision of providing superior
services to a special population of individuals with intellectual and developmental
disabilities.
Plus:
• Defined Benefits Retirement System
• Paid Medical Insurance
• 14-16 Paid Holidays Annually
• Paid Vacation and Sick Leave
• Conveniently located only minutes from
Dallas and Ft. Worth
• The charm of small town warmth, coupled
with the unique diversity of housing two major
Universities in the city
Apply online today:
www.careersatdads.com
Denton State Supported
Living Center
3980 State School RD
Denton, TX 76202
(940) 591-3364
COME JOIN US FOR SAND, SUN AND FUN
IN SUNNY SOUTH TEXAS!
South Texas Health System is currently seeking RNs
in the following specialties:
• ICU • CCU
• PICU • PCCU
• ER
We offer:
• Competitive Pay • Specialty Area Incentive
• $10,000 Sign-On Bonus (restrictions apply)
• Excellent Benefits and Incentives
• Internship Program
EEO/ADA Employer
RNs!! F
ULL-TIME
Med-Surg, ER, ICU, L&D, Pediatrics
Excellent Sign-On Bonus
• $24,000 Night Shift
• $20,000 Day Shift • Relocation
• Shift Differentials
• Excellent Benefits and More!
Join Us Now at our 104-Private Bed Hospital!
For more information on your future
at FDRMC contact:
[email protected]
Visit us on our web at: www.fortduncanmedicalcenter.com
Fort Duncan Regional Medical Center
3333 N. Foster Maldonado Blvd., Eagle Pass, Texas 78852
P: (830) 872-2620 F: (830) 872-2629
Want to drive the Bus?
Please contact our Nurse Recruiter
Terri Villarreal
Phone: (800) 633-3658
E-mail: [email protected]
To apply for these positions or to
learn more about STHS, our facilities
and our Critical Care services, visit
www.southtexashealthsystem.com
EOE
Rowan-Cabarrus
Community College
Seeks applications for full-time
Nursing Instructor
Required: A current, unrestricted license
to practice as a registered nurse in North
Carolina; a masters degree in nursing from an
accredited institution; work experience to include
two calendar years or the equivalent of full-time
clinical experience as a registered nurse; have
preparation in teaching and learning principles for
adult education, including curriculum development
and implementation.
EOE
For further information and to apply,
visit our website at
https://rcccjobs.com
Take charge of Risk Management!
We have 2 career
opportunities in Florida:
• North Miami • Deland
Must be people-oriented, organized and
possess strong clinical skills as well as
knowledge of federal & state regulations.
Contact Kim to apply:
[email protected]
www.gulfcoasthealthcare.com
ADVANCE MESSENGER
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Soda & Stroke
Researchers from Cleveland
Clinic's Wellness Institute
and Harvard University have
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of sugar-sweetened and lowcalorie sodas is associated
with a higher risk of stroke.
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of caffeinated or decaffeinated coffee was associated
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■
SEPTEMBER 3, 2012
■
SOUTH
■
ADVANCE FOR NURSES
23
23
MULTIPLE OPPORTUNITIES
SOUTH CAROLINA
NOW HIRING REGISTERED NURSES!
Great Nursing Opportunities
RN, BSN, MSN-FNPs
PIEDMONT MOUNTAINSIDE HOSPITAL
Jasper, GA
Whatever your specialty, new graduate or experienced nurse, Self Regional Healthcare may be the best opportunity you’ll ever have to fulÄll your potential and truly
enjoy all that life has to offer. What is your calling- the ward, a clinic, critical care,
OR, administrative, ICU-CCU, ER, leadership or case management?
Our Continued Growth Has Created Exciting
New Opportunities!
REGISTERED STAFF NURSE
(Full-time, Part-time and PRN)
The ideal candidate will have their current Georgia licensure
as a Registered Nurse, a minimum of two years of experience
in Nursing, current certification in BCLS and ACLS, and other
applicable nursing skills.
These are exciting times here at Self Regional in Greenwood, South Carolina.
We have been selected as a Gallup Great Workplace for the
last four years! We proudly set the example for being a
great place to work every day compared to 18,000
other companies world wide! We’ve been here
60 years, we’re Änancial healthy with a very
positive operating margin and we have
never frozen salaries or reduced beneÄts.
Please email your cover letter and resume to our onsite Recruiter,
Diane Pelzek, [email protected] or contact her to
discuss positions: 706.299.5103. You may also visit us online at
piedmontcareers.org, then click Mountainside.
Self Regional Healthcare is a 420 bed
hospital with 2300 staff and a number
of family practice ofÄces located in the
surrounding counties. Our footprint is
growing with recent remodeling of the
main facility, growth of our physician
ofÄces, a highly specialized neurosurgical
program and a 40,000 sq ft Cancer Center
that opened in March 2011.
Check us out and see what we have to
offer. Take the time to review our web site at
www.selfregional.org. Greenwood is just a short
day trip to Charlotte or Atlanta. We are an EEO
employer, cost of living is very reasonable
and we are an “at will” work state.
1266 Highway 515 South
Jasper, Georgia 30143
Only qualiÄed and complete applications
submitted through the Self Regional Healthcare
web site shall be considered.
© 2012 Piedmont Healthcare,
Equal Opportunity Employer
SEASONAL
NURSES:
Come Get It All in
Sun-and-fun-filled Florida!
MONTHLY RECREATION ALLOWANCE!
COMPLETION BONUS!
Join us at Palms of Pasadena Hospital, a 307-bed facility providing
healthcare with a personal touch, and enjoy all the fun our area has
to offer! World famous entertainment attractions! Gourmet dining!
World-class beaches! Outdoor and indoor activities to suit every
lifestyle! We make it a memorable pleasure for our seasonal nurses
with a generous Recreation Allowance, 16-week contracts and a
Completion Bonus!
Our convenient location just one block from the sparkling,
sun washed beaches of Florida’s West Coast in
St. Petersburg, FL, combined with myriad specialty
services and flexible scheduling, provides our team
members with the perfect work/life balance.
REGISTERED NURSES – ALL AREAS!
Must possess Florida licensure or the
ability to obtain same. Candidates with
a minimum of two (2) years experience
may apply online at:
www.PalmsPasadena.com
Or contact our
Florida Regional Recruiter:
Don Madock
Ph. 727-341-7876
[email protected]
eoe
Join us on the
West Coast of Florida
Venice Regional Medical Center a 312-bed
regional healthcare system has been providing
compassionate healthcare since 1951. Today
Venice Regional Medical Center’s healthcare system
focuses on providing health care that is cost effective,
high quality and convenient for the many patients
throughout the region.
Now Hiring Full-Time &
Upcoming Seasonal Registered Nurses
RN Seasonal Rates for 2012-2013
• Day shift $42 per hour
• Night shift $47per hour
• $2,000 end of season bonus
• $3,500 end of season bonus
for OR, CVOR, CVICU and CCU
18-week contracts beginning on
December 10th or January 14th Venice, Florida
Apply online at www.veniceregional.com
or E-mail Tracy Pelletier
[email protected] • EOE/drug free workplace
SIGN UP FOR YOUR FREE E-NEWSLETTER AT WWW.ADVANCEWEB.COM
24
24
ADVANCE FOR NURSES
■
SOUTH
■
SEPTEMBER 3, 2012
■
MULTIPLE OPPORTUNITIES, SURGICAL
IMMEDIATE OPENINGS
FOR
ICU
Cardiac Cath Lab
Emergency Room
Ambulatory Care – Gastroenterology
Ambulatory Care – Interventional Radiology
REGISTERED NURSES
Spinal Cord Injury – Vent
Spinal Cord Injury – Rehab
Polytrauma
Med/Surg
Call Mary Seaman, Nurse Recruiter
TEL: (813)
979-3672
FAX: (813)
910-3033
James A. Haley Veterans’ Hospital
#SVDF#%PXOT#MWEt5BNQB'-
The New AIDS of
the Americas
Travel a
new path
in your
career
and life.
All the lifestyle advantages of a unique Florida location and all the
career satisfaction of a key role—you’ll find both at Munroe Regional
Medical Center. A leader in cutting-edge medical care and designated
a Top 50 Hospital for 6 years in a row (2007-2012) by HealthGrades,
we currently seek:
Registered Nurses
• CVICU - Days and Nights
• Pediatric Emergency Room - Nights
• Observation - Days and Nights
Must Possess Current FL RN Licensure
We offer a very competitive salary and comprehensive benefits.
Apply online at: www.MunroeRegional.com
2012
EOE
Chagas disease is spread by
bloodsucking insects and is
hard or impossible to cure
according to an editorial
published in PLoS Neglected
Tropical Diseases. The insects
carry a single cell parasite
called trypanosome and can
be transmitted from mother
to child. About a quarter of its
victims can suddenly die from
the development of enlarged
hearts or intestines that can
fail or burst. It infects up to
eight million people, more than
300,000 in the U.S., many of
which are immigrants.
}} SURGICAL
Surgical Center of Greensboro/Orthopaedic Surgery Center
1211 Virginia Street/1101 Carolina Street
Greensboro, NC 27401
Busy outpatient surgery center looking for:
RNs: Operating Room: FT and Pool
positions available, 1-2 yrs OR experience
required, outpatient orthopaedic surgery or
multi-specialty experience preferred. M-F schedule,
no nights, no weekends, no holiday, no call schedule.
Excellent benefits package for full-time schedule.
Please return resumes via fax to (336) 272-4063
or by e-mail to [email protected]
EOE
ADVANCE
MESSENGER
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FOR ARE EMAILED DIRECTLY
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LOOKING FOR
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■
SEPTEMBER 3, 2012
■
SOUTH
■
ADVANCE FOR NURSES
25
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▶ DeLand, FL – Nestled in a historic town, Florida
Hospital DeLand is a 156-bed, not-for-profit community hospital guided by its mission to extend the healing ministry of Christ through skill and compassion.
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Hospital DeLand aims to “provide exceptional care
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“We are a small community hospital, which allows
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The same principles that shape patient care also
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Build Yourself A Great Career
In Pediatric Nursing
Our Jobs Are Even Better Than Our Beaches
R.N. Opportunities in CVICU, PICU, CVOR,
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32

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