Seizing the initiative

Article Abstract:

If action is not taken soon, great effects will be felt from the long-term critical nursing care shortage. Enrollment in nursing schools has declined and many training programs do not emphasize critical care nursing. Nurses are turning away from the profession because of low job satisfaction and because of a lack of respect given to them as health professionals. There is little financial reward and the workload is great. As the number of critically ill patients increases, more critical care units will need critical care nursing specialists. Although nurses' salaries have increased, they still do not correspond to the level of expertise required for the job. A new era of professionalism is needed to improve the practice of critical care nursing. Nurses and physicians should work together to implement a new system of bedside care that is more efficient. The critical care nurse can manage the workflow and oversee the new tasks generated by technological advances. It should be a part of the critical care nurse's job to delegate these tasks to a nurse or a 'nurse extender'. This management role will enhance comprehensive care and enable the nurse to maintain more personal contact with each patient. The American Medical Association proposes that registered care technicians help perform selected tasks. The utilization of the nursing care extender is part of the nursing shortage solution. Improvements in the critical care crisis will begin if nursing leaders and physicians work together. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Nurse and physician, Nurse-physician relationship, Intensive care nursing, Critical care medicine, editorial

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A standard of care for the nursing diagnosis of ineffective airway clearance

Article Abstract:

In an effort to assure quality patient care, criteria for the nursing care of patients with breathing complications are provided. The airway may be compromised by an ineffective breathing pattern, poor gas exchange (oxygen and carbon dioxide), poor heart functioning, altered body fluids, physical impairments and poor nutrition. Signs and symptoms include abnormal breathing sounds, difficulty breathing, altered breathing rate, blue skin coloring, and abnormal blood gases. Some factors that put patients at risk for ineffective airway clearance are thick mucous, swelling or obstructions in breathing structures, infection, and the use of artificial breathing devices. Nurses can teach patients to cough up secretions, avoid infection, and provide information regarding potential drug reactions. Nurses can perform postural drainage, a technique using cupping and clapping on the chest to loosen secretions, and vacuum suctioning to remove secretions. Humidified air, oxygen, and breathing exercises may also be useful. Other methods of treatment include intubation (inserting a tube down the airway passage), monitoring blood gases for adequate ventilation, examining X-ray films, and administering antibiotics when an infection is noted. The goal is to maintain an open, unblocked airway and to provide the patient with adequate ventilation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Respiration, Airway (Medicine), Airway

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Shortage of professional nursing practice: a reframing of the shortage problem

Article Abstract:

It is commonly believed that the nursing care shortage will be resolved by producing more nurses. However, it is argued that relying on the supply and demand theory may make matters worse. Labor markets become balanced when the supply available at a given wage is equal to the employers demand. The number of employed registered nurses has increased by 36 percent between 1978 and 1985. Nursing salaries have increased, but not at the same rate as other professions. There are four types of nursing shortages; those produced by vacancies, transience, scheduling problems, and position shortages. A restructuring of nursing roles is the solution to the problems in nursing; the shortage is not due to the number of workers available. Administrators do not acknowledge that nurses are an important professional resource with specialized knowledge. The primary reason that patients are hospitalized is to receive nursing care. However, administrators regard nursing as an expense, rather than a billable service having potential revenue. Removing these barriers to nursing practice will help improve the profession and reframe the nursing shortage problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

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