As melanoma rates and diagnosis continue to rise, early detection (before the disease spreads to the lymph nodes) is critical for survival. In the January-February 2009 issue of Dermatology Nursing, Arlene Vickers describes how dermatology nurses can use evidence-based practice (EBP) to develop their own skin cancer screening guidelines.

Vickers recommends obtaining best practices by using several resources:

- Conducting systematic reviews through journal databases to answer specific clinical questions
- Evaluating existing skin cancer screening guidelines (many are posted on the National Guideline Clearinghouse Web site, http://www.guideline.gov)
- Keeping up with current research studies
- Looking to professional organizations for information and guidelines

In her article, Vickers used the above resources to determine what the evidence reveals about skin cancer screening. According to Vickers, even though the research evidence does not recommend for or against skin cancer screenings in the general population, clinical expertise has shown that early detection saves lives. She says dermatology nurses must use evidence and clinical practice to determine best practices for their patients.

“Evidence-Based Practice Guidelines for Skin Cancer Screening”
Arlene Vickers, FNP-C, DN-C, WOCN
Dermatology Nursing; January-February 2009
http://www.dermatologynursing.net

Main Category: Melanoma / Skin Cancer
Also Included In: Cancer / Oncology; Dermatology; Nursing / Midwifery

The Board of Directors of the American Association of Colleges of Nursing (AACN) has moved to establish the Commission on Nurse Certification (CNC), a new credentialing body to oversee the certification of Clinical Nurse Leaders (CNLs). Composed of representatives from practice and academia, this new authority will lead the effort to certify graduates of master’s level nursing programs that prepare advanced generalists for practice across a variety of health care settings.

“Certifying CNL program graduates is an effective way to ensure that nurses are expertly prepared to provide clinical leadership at the point of care,” said AACN President Jeanette Lancaster, PhD, RN, FAAN. “CNL certification serves as a mark of excellence which promotes safe, quality practice through its ongoing requirements for personal and professional growth.”

The Clinical Nurse Leader or CNL® is a fast emerging nursing role being developed by AACN in collaboration with leaders from the education and practice arenas. AACN is advancing the CNL to improve the quality of patient care and to better prepare nurses to thrive in the health care system. The CNL role was developed following research and discussion with stakeholder groups as a way to engage highly skilled clinicians in outcomes-based practice and quality improvement. The CNL is a master’s prepared advanced generalist who oversees the care coordination for patients, provides risk assessment and quality improvement strategies, and implements evidence-based practice.

To date, more than 90 education-practice partnerships in 35 states and Puerto Rico are working together to advance the CNL role. Partners are working to develop master’s programs to educate CNLs, integrate this clinician into the health care system, and evaluate outcomes. The Veterans Health Administration, the largest employer of Registered Nurses in the world, has made a commitment to integrating the Clinical Nurse Leader role throughout its health care system. For a current list of CNL programs offered at nursing schools across the country, see here.

CNL Certification Commences

CNL Certification provides a unique credential for graduates of master’s and post-master’s CNL programs or similar graduate programs that prepare advanced generalists and meet the outcome competencies and program requirements delineated in the AACN white paper on The Education and Role of the Clinical Nurse Leader. The certification exam was piloted in November/December 2006 at 10 academic institutions offering the CNL degree. The computer-based test has two separate components, multiple choice and simulation/case-based items, and is administered at individual schools of nursing. Since the first regular administration of the CNL Certification Examination in Spring 2007, more than 250 CNLs have been formally certified with many others applicants currently being assessed for certification. For more details including eligibility requirements and upcoming testing windows, see here.

To oversee certification activities, the AACN Board of Directors created the Commission on Nurse Certification (CNC) which met for the first time during AACN’s recent Fall Semiannual Meeting. The CNC oversees all aspects of its certification functions including the establishment of bylaws, policies, operating rules and procedures, and examinations; implementation of its rules and procedures; and allocation of budget and expenditures. Members of the CNC Board of Commissioners include:

Jeri A. Milstead, PhD, RN, FAAN – Chair
Dean and Professor, University of Toledo

Terry Beach, MS, RN, CNL – Vice Chair
Regional Clinical Nurse Leader, Providence Health Systems, Portland, OR

Traci Hoiting, MS, RN, CNL – Secretary
Chief Nursing Officer, Swedish Health System, Seattle, WA

Susan M. Schmidt, PhD, RN, CNS, COHN-S, CNL – Treasurer
Chair and Professor/Epidemiologist, Xavier University

Jim Begun, PhD
Professor, School of Public Health, University of Minnesota

Susan R. Hartranft, MS, ARNP, CNL
Manager, Research & Development, Morton Plant Mease Health Care, Clearwater, FL

Phyllis Healy, PhD, RN, BC-FNP
Associate Professor, University of Southern Maine

Janis C. Holiwell, MN, RN, CNL, CNS Geriatrics, WOCN
Clinical Nurse Specialist-Long Term Care, Eastern Kansas Health Care, Topeka, KS

Melissa Vandeveer, PhD, RN, PNP, CNL
Director, Direct Entry CNL Program, Sonoma State University

“I am honored to have been selected to lead the CNC and be a part of this organization during its formative stage,” said CNC Board Chair Jeri Milstead. “The CNC Board of Commissioners is committed to advancing the CNL role and ensuring competency and ongoing development of those nurses practicing in this capacity.”

The CNL Trademark

AACN and the CNC are pleased to announce that “CNL®” is now a registered trademark following a recent decision by the Federal Trademark Office to grant the AACN title protection for the CNL title and credential. AACN also holds service marks for both “Clinical Nurse Leader” and “Clinical Nurse Leader Certification Examination.” The registered trademark and service marks will appear in marketing materials. Only certified CNLs may use this trademark in their credentials. Also, the CNL acronym may only be used to describe programs that reflect the AACN white paper on The Education and Practice of Clinical Nurse Leaders. This paper is posted online here.

For more information on the CNL role, certification, or related information, visit the Clinical Nurse Leader resource section on the AACN Web site found at http://www.aacn.nche.edu/CNL.

The American Association of Colleges of Nursing (AACN) is the national voice for university and four-year college education programs in nursing. Representing more than 600 member schools of nursing at public and private institutions nationwide, AACN’s educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor’s- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.

American Association of Colleges of Nursing

The New York State Nurses Association (NYSNA) has announced that it is disaffiliating from the United American Nurses (UAN), the national union formed by state nurses’ associations in 1999.

“We made our concerns known to the UAN, identifying what we viewed as problems with its structure and how it functions,” said Barbara Crane, RN, president of the NYSNA Delegate Assembly. “We asked the UAN to undertake needed reforms so we could preserve the national organization. We offered a series of specific recommendations that would have ensured participation in decision-making by the state associations. Unfortunately, these proposals were dismissed by the UAN leadership.” The Delegate Assembly is a NYSNA organizational unit of elected representatives from local bargaining units.

NYSNA President Linda O’Brien, RN, said there would be no disruption in services to NYSNA local bargaining unit members in New York and New Jersey. “We will continue to focus on providing excellent service to our members,” she said.

With more than 35,000 members, the New York State Nurses Association is the nation’s oldest and largest state nurses’ association. NYSNA fosters high standards of nursing education, research, and practice; engages in legislative activity; and provides collective bargaining services to registered nurses. Its mission is to advance the profession of nursing and protect the public’s health.

New York State Nurses Association

http://www.nysna.org

A 54 year-old nurse from Liverpool received a five-year caution after lying about being at work and claiming payment for days she did not work.

An independent panel of the Nursing & Midwifery Council heard last week that while working at Zoe’s Place in West Derby – a hospice for terminally ill babies – Helen Edge permitted a colleague to clock in and clock out for her but was in fact absent from work.

The incident took place in May 2005 and again three months later in August.

The panel heard that not only did Edge fail to disclose the absence when questioned by the general manager, but went on to intimidate a colleague who gave information about the unauthorised leave.

The independent panel found Edge’s fitness to practise impaired by reason of misconduct and imposed a caution which will remain on her record for five years.

Commenting on the panel’s decision, Stephanie Guyett, NMC spokesperson said,

“All nurses and midwives have a duty and personal accountability to conduct themselves in a way that justifies public confidence in the profession of nursing. The actions taken by this nurse reveal a pattern of dishonesty and represent a serious departure from the code of conduct.”

The Nursing and Midwifery Council (NMC) is the UK regulator for two professions, nursing and midwifery. The primary purpose of the NMC is protection of the public. It does this through maintaining a register of all nurses, midwives and specialist community public health nurses eligible to practise within the UK and by setting standards for their education, training and conduct. Currently the number of registrants exceeds 682,000. The Nursing and Midwifery Order 2001 (The Order), sets out the NMC’s role and responsibilities.

The independent panel is selected from a pool of individuals appointed by the Appointments Board. They come from a variety of backgrounds and are not NMC Council members, nor do they sit on any committee of the Council.

Nursing and Midwifery Council

Registered nurses at Alta Bates Summit Medical Center facilities in Berkeley and Oakland are following in their University of California medical centers’ colleagues’ footsteps by emphatically rejecting a Sutter Health proposal for an invasive wellness program. The program is fraught with problems of confidentiality and carries financial penalties for non-participations. This is one of the issues that drove RNs at several of the 13 Sutter health hospitals to overwhelmingly vote for a second two-day strike, which will begin at 7:00 a.m., on Thursday, Dec. 13.

UC was forced into giving its many unions the option of opting out of their health assessment questionnaire program after CNA/NNOC-represented RNs refused to agree to the university’s 2008 health insurance plans if it included the questionnaire. “UC insists on its right to forward your questionnaire to your insurance carrier without telling you and without your permission,” said James Darby, RN, who works at UCSF, and is a member of the CNA/NNOC RN bargaining team. “This shows a complete lack of respect for employee privacy.”

Alta Bates Summit Medical Center RNs expressed similar concerns of confidentiality, especially in light of the fact that the questionnaire will be administered by a Sutter Health affiliate in a record number of large corporate computer breaches have occurred throughout the world.

“These are eight pages of some of the most personal and intimate questions imaginable that could play havoc with a nurse’s ability to be insured,” said Efren Garza, RN, who works at the Herrick campus of ABSMC in Berkeley and is a member of the RN negotiating team. “RNs, who suffer the highest rate of back injuries of any profession, do not need to also live in fear of being denied healthcare coverage.”

The program would also classify nurses as low, medium, or high risk based on the results of the questionnaire. “Sutter has refused to provide the RN negotiating team with the information we need to assess whether the classifications are even reasonable or valid, said Bonnie Castillo, RN, CNA/NNOC Sutter director. ” We also take issue with RNs in select risk groups being sent to non-medically trained health educators for counseling.”

UC’s version is marketing the questionnaire as “confidential,” then insisting that once the employee fills out the questionnaire UC has the right to send the results to the employee’s health plan. They are still in “Phase 1″ of the questionnaire program, where the incentive to participate is a $75 gift certificate, not a $100-200 increase in monthly premiums as is the case of Sutter’s Phase 2.

“This punitive program is another example of what appears to be a pattern of disrespect and harassment that this corporation has adopted towards its nurses, in contrast to the RNs who are taking an emphatic stance for improved patient care standards,” said Castillo.

Last week, a memo circulated by Alta Bates Summit Medical Center’s Chief Nursing Officer Viki Ardito directed managers to single out RN staff who have the “worst attitudes” for discipline, up to termination. Ardito’s memo coincides with the targeting of RNs at other Sutter facilities, especially Sutter Novato and California Pacific Medical Center in San Francisco.

Registered nurses at 13 Bay Area Sutter Health hospitals will hold their second two-day strike Thursday, Dec. 13 and, Dec. 14. Sutter has notified RNs of a four to five-day lockout at all of the hospitals except CPMC, St. Luke’s, and Sutter Santa Rosa. The RNs will also continue to protest Sutter’s plans to close St. Luke’s hospital in San Francisco, San Leandro Hospital, and Sutter Santa Rosa.

The only negotiations scheduled are for ABSMC, which was called by the federal mediator for today. No additional negotiations are scheduled for any of the other facilities.

Among the many problems in Sutter facilities are the hospital chain’s refusal to:

- Assure adherence with safe RN staffing ratios during RN meals and breaks, forcing RNs to jeopardize patients if they take breaks.

- Maintain safe lift practices to reduce serious RN back injuries and patient falls and accidents. In the November Journal of the American Association of Occupational Health Nurses, a Seattle safety consultant noted that “protecting the health and safety of nurses” is a critical contribution “to protecting patients.”

- Respond to CNA/NNOC proposals for enhanced staffing in emergency rooms and establishment of hospital rapid response teams for increased response time for life-threatening patient emergencies.

- Guarantee that patients will only be assigned to an RN

In addition to Alta Bates Summit, the strike will affect Sutter Novato, California Pacific, and Mills-Peninsula Health Services in Burlingame and San Mateo, San Leandro Hospital, Eden Medical Center in Castro Valley, Sutter Delta in Antioch, Sutter Solano in Vallejo, St. Luke’s Hospital in San Francisco, Sutter Santa Rosa, and Sutter Marin General Hospital in Greenbrae, as well as members of the CNA/NNOC-affiliated Caregivers and Healthcare Employees Union, representing respiratory, X-ray, and other technical workers at Alta Bates Summit.

California Nurses Association

The Minister for Health and Children, Mary Harney, T.D. today, Friday 30 November 2007, announce a public consultation on proposed new legislation for the regulation of nurses and midwives.

The Minister wishes to obtain the views of the public and key stakeholders on the draft new legislation. The views expressed in this consultation process will be taken on board when finalising the legislation.

“The main objectives of this new legislation are to protect the public in its dealings with the professions of nursing and midwifery, and to ensure the integrity of these professions through the promotion of high standards of professional education, training and practice and professional conduct” the Minister said.

The draft new legislation for nurses and midwives will become part of a suite of legislative instruments to ensure greater accountability of all professions in healthcare. The Health & Social Care Professionals Act 2005, Medical Practitioners Act 2007 and Pharmacy Act 2007, as well as forthcoming legislation regulating dentists, have a common thread of ensuring robust governance, clarity of procedures and formal systems of accountability. They are aimed at the protection of the patient while at the same time recognising the need for due process in relation to the processing of allegations and complaints against healthcare professionals.

The Minister for Health and Children, Mary Harney TD, today, 30th November, 2007 congratulated the first group of nurses and midwives to successfully complete the Certificate in Nursing (Nurse/Midwife Prescribing) Programme at the Royal College of Surgeons in Ireland.

“Improving patient care is at the heart of the nurse and midwife prescribing initiative and I believe that patients will receive earlier interventions and therefore a better service” the Minister said.

In May of this year the Minister put in place legislative provisions to allow for nurse/midwife prescribing. Patient safety is paramount and will be protected by the combination of the specific requirements to be met under the Regulations, i.e. the nurse must be employed by a health service provider and may only prescribe the drugs relevant to the setting in which they are employed, together with the requirements introduced by the nursing board (An Bord Altranais).

The Minister congratulated the 22 new nurse and midwife prescribers. “This is a very significant development for the nursing and midwifery professions. The introduction of nurse/midwife prescribing represents a real and important change in nursing practice in Ireland which will deliver, over time, better and timelier access to medications by patients”she said.

The new prescribers will be working in the clinical areas of cardiology, coagulation, respiratory, dermatology, wound care, breast care, diabetes, A&E, midwifery, sexual health, occupational health.

The Minister especially thanked the Consultants whose participation in the project as mentors to the nurses and midwives was vital to its successful outcome. The Minister also acknowledged the significant contribution of the Health Service Executive and An Bord Altranais in developing the mechanisms and safeguards required to facilitate the safe introduction of this new initiative.

A Resource and Implementation Group which was established by the Minister in 2006 is continuing its work in overseeing the roll-out of nurse/midwife prescribing on a national basis.

A further 20 nurse and midwife prescribers are due to graduate from UCC in December with up to 100 expected to graduate nationally in 2008.

Over the four-year span between 1998 and 2002, community health centers not only improved their processes for managing diabetes, such as testing for blood glucose and cholesterol, but also saw gains in their patients’ health, a new study finds.

Researchers found “a statistically and clinically significant” reduction in hemoglobin A1c (a measure of long-term “blood sugar” control) and low-density lipoprotein (“bad” cholesterol) levels in center patients.

Lead investigator Marshall Chin, M.D., associate professor of medicine at the University of Chicago, said that earlier measures of community health center efforts had shown improvement in actions taken, but the studies were not long lasting enough to gauge patient outcomes resulting from the programs.

The study of 34 community health centers in 17 states appears in the December issue of the journal Medical Care and focuses on disadvantaged and underserved populations.

The community health centers took cues from several initiatives, foremost among them the decade old federal Health Disparities Collaborative, which lays down guidelines and oversight for chronic disease management. They incorporated the rapid quality improvement approach, dubbed “Plan, Do, Study, Act,” created by Associates in Learning.

This model adapts elements of improvement into practice as soon as they show results, raising quality of care at an accelerated pace. “If you try something on a few patients and it works, you implement it,” Chin said.

Also woven into the study was the MacColl Chronic Care Model, created by Group Health’s MacColl Institute for Healthcare Innovations, which is aimed at helping primary care doctors proactively manage people with long term conditions and creating informed, activated patients who cooperate in their own care.

“The idea,” said Katie Coleman, a research associate at the MacColl Institute, “is that people all over the country are trying to find ways of improving care. In this intervention, not only did physicians deliver better care, but patients’ health improved, likely because they changed their behavior, ate better, exercised and checked their sugar more often.”

Earlier one-year studies did not show this improvement. “It takes time to make a dent,” Chin said. Improved glucose and cholesterol control can reduce blindness and cardiovascular events, he added.

Chin MH, et al. Improving and sustaining diabetes care in community health centers with the health disparities collaboratives.” Med Care 45(12), 2007. 17(4), 2007

The Nursing and Midwifery Council (NMC) has issued an advice sheet for nurses and midwives who administer Botulinum toxin. The advice, available on the NMC website is to be read in conjunction with the Standards for Medicine Management (2007) and clarifies the NMC’s position regarding the administration of Botulinum toxin from a remote prescription.

The NMC does not consider it to be best practice to administer Botulinum toxin that has been prescribed remotely by a medical practitioner or by an independent prescriber who has not assessed the patient as this is contrary to the guidance issued within the NMC Standards for Medicine Management (2007).

NMC professional advisor, Liz Plastow said: “Botulinum toxin like all medicines has the potential to give rise to side effects and adverse reactions. If a nurse or midwife administers this from a remote prescription they are jointly accountable for this action. If a reaction occurs, although the prescriber would be liable for prescribing the drug the nurse or midwife would be accountable for their assessment of the patient and the administration of the drug.”

The Nursing and Midwifery Council (NMC) is the UK regulator for two professions, nursing and midwifery. The primary purpose of the NMC is protection of the public. It does this through maintaining a register of all nurses, midwives and specialist community public health nurses eligible to practise within the UK and by setting standards for their education, training and conduct. Currently the number of registrants exceeds 682,000. The Nursing and Midwifery Order 2001 (The Order), sets out the NMC’s role and responsibilities.

The 150,000 strong Australian Nursing Federation (ANF) welcomed the election of the Rudd Labor Government with optimism for the future for health care, nurses and nursing. We congratulate Kevin Rudd on becoming Prime Minister.

Ged Kearney, ANF Acting Federal Secretary said; “The Labor victory is a defining moment for Australia, a moment when voters decided on new leadership and rejected the harsh WorkChoices legislation overwhelmingly. Australians not only rejected AWAs but saw through the Liberal Party’s piecemeal approach to health policy, best demonstrated by the Mersey Hospital debacle.

“The ANF looks forward to working with the new government to implement the pre-election policies on health reform, primary health care and revitalising the health workforce. But other outstanding areas require immediate attention. For example, a significant wages gap exists between nurses working in aged care and other sectors that make it impossible for aged care providers to attract and retain qualified staff and to ensure quality care. Indigenous and rural and remote health also require fundamental and thoughtful change.

“There are 250,000 nurses in Australia and our members will hold the ALP to account. We expect Mr Rudd to fulfill his promises to address major systemic problems through health reform, increased public hospital funding and better aged care solutions.” Ms Kearney said.

“The election of the ALP is a positive first step toward better health outcomes for all Australians and fairer working conditions for our members.”

The ANF, representing 150,000 members, is the professional and industrial voice for nurses and midwives in Australia.