The future of nursing; overcoming obstacles today for a better tomorrow


ANAHEIM, CALIFORNIA A recent Press Ganey survey conducted at Fox Chase Cancer Center in Philadelphia, Pa. reported that patients rated their overall care in the 99th percentile. "Fox Chase continues to be recognized for demonstrating clinical competency and providing excellent care to patients," said director of nursing, Anne Jadwin, RN, MSN, AOCN, CNA. "Our challenge now is maintaining very high standards while managing the changes created by an aging nursing population coupled with the shortage. All across the county, nurses are growing older and the supply of new nurses is not enough to fill positions left by retirees and the increasing demand for professional nurses." At the 29th Annual Oncology Nursing Society, Jadwin shares first hand struggles and successes of implementing a certified nursing assistant (CNA) program and why the process is worth the bumpy ride for the future of nursing.

"The average age of a hospital nurse is 45," explains Jadwin. "After years of providing care, this age group is starting to feel the physical stresses of the job. Adding the certified nursing assistant position is not a means of replacing current experienced nurses, but aiding them and further introducing the profession of oncology nursing."

At Fox Chase, newly hired CNAs are required to complete a three-day oncology course with curriculum designed by clinical nurse specialists. Topics covered include patients' rights, communication, end-of-life and restorative care, reporting of signs and symptoms, and behavioral expectations. Certified nursing assistants are also required to obtain CPR certification and complete competency-based skills checklists.

"We wrongly assumed that just because our nurses provide outstanding care to patients, that they would also be great teachers for CNAs. It wasn't until we went through this process that we figured out that we needed to help re-educate our experienced nurses," said Jadwin. Delegation in-services for RNs and behavioral interviewing skills workshops for clinical managers were established, as well as a review of job descriptions and department care delivery model philosophy.

Fox Chase is not the only institution that underestimated the difficulty of implementing CNA positions in a primary nursing model," said Jadwin. "Through constant modification, the CNA turnover rate has decreased by over 20 percent since its implementation in 2001," continued Jadwin. In addition to the three-day oncology course, certified nursing assistants are offered career development assistance, on-site conferences, tuition reimbursement and recognition in the departmental newslette

In the future, Jadwin plans to continue to monitor Press Ganey patient satisfaction surveys and RN and CNA turnover and vacancy statistics, evaluate trends in staff satisfaction data, and support diversity leadership programs.

"When properly utilized, unlicensed competent personnel can enhance unit efficiency and patient care outcomes," concluded Jadwin.

Jadwin is among the staff of Fox Chase nurses who, in 2000, were recognized for excellence with the Magnet Award. At Fox Chase, nurses not only specialize in oncology, but further concentrate within a particular field allowing them to provide the most up-to-date treatment.

Co-presenting with Jadwin is JoAnn Mick, RN, MSN, MBA, AOCN, CNAA, of MD Anderson Cancer Center at the University of Texas.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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