Reducing RN Vacancy Rate: A Nursing Recruitment Office Process Improvement Project.

OBJECTIVE: The aim of this study was to reduce the RN vacancy rate at an academic medical center by improving the hiring process in the Nursing Recruitment Office. BACKGROUND: Inability to fill RN positions can lead to higher vacancy rates and negatively impact staff and patient satisfaction, quality outcomes, and the organization's bottom line. METHODS: The Model for Improvement was used to design and implement a process improvement project to improve the hiring process from time of interview through the position being filled. RESULTS: Number of days to interview and check references decreased significantly, but no change in overall time to hire and time to fill positions was noted. RN vacancy rate also decreased significantly. Nurse manager satisfaction with the hiring process increased significantly. CONCLUSION: Redesigning the recruitment process supported operational efficiencies of the organization related to RN recruitment.

Adverse effects of steroid therapy in children with pharyngitis with unsuspected malignancy.

Pharyngitis is a common clinical complaint for children and accounts for 3.1% of all visits to selected ambulatory care settings. Most children with pharyngitis have benign, self-limited disease with infrequent complications such as peritonsillar abscess, mastoiditis, or lymphadenitis. Recent studies have touted the benefits of steroids in the treatment of children with pharyngitis for pain control. These studies do not address the potential life-threatening complication of steroids in patients with pharyngitis or lymphadenopathy in the setting of undiagnosed acute lymphocytic leukemia (ALL) or lymphoma. We report 4 cases of children treated with steroids for pharyngitis or adenitis that subsequently were diagnosed with ALL or lymphoma. If steroids are to be used in children with pharyngitis or adenitis, the following recommendations should be strongly considered: Careful history and physical examination should be obtained. Presence of hepatosplenomegaly or lymphadenopathy outside the cervical region should raise suspicions regarding an underlying malignancy. Normal results of complete blood cell count in the setting of clear cut pharyngitis with exudates and a lack of significant adenopathy essentially rules out the diagnosis of ALL. Because traditional analgesics are available, which do not affect the curability of ALL or lymphoma, the routine use of steroids in pharyngitis in children should be considered only in rare circumstances.

Cyclic vomiting syndrome: a disease in disguise.

Cyclic vomiting syndrome (CVS) is a childhood disorder characterized by bouts of vomiting that last from a few hours to several days. The current prevalence in the pediatric population is estimated at 2% (Li & Balint, 2000). The vomiting episodes occur in a regular cycle: some children have them every few days, others every few months. Currently, researchers have been unable to determine what causes CVS. Many of the patients and families, however, can identify particular events that seem to trigger the vomiting. Diagnosis can be difficult because CVS does not leave clues that can be found by any current diagnostic test. Lack of knowledge about CVS by physicians, nurses, and the lay public contribute to the helplessness families feel when coping with this disease in disguise. Nursing's primary actions in the care of children and their families affected by CVS should be one of advocacy for diagnosis and support for the family and child through treatment and long term management of this chronic illness.

Responding to nursing's agenda for the future. Where do we stand on recruitment and retention?

How can the nursing profession address the escalating shortage of registered professional nurses? A multifaceted approach is important to ensure success. One domain of Nursing's Agenda for the Future (American Nurses Association [ANA], 2002) is recruitment and retention. Through the Agenda, creative strategies are being sought to attract and retain qualified nurses. This article describes one institution's response to addressing this critical shortage. Strategies were developed to present a continuum of learning and advancement opportunities across the career span of the professional nurse. They include recruiting student nurses, increasing NCLEXRN pass rates, providing financial support for further education or specialty certification, and using shared governance to increase retention. Institutions must look to their own resources as well as federal and state resources to offer these opportunities to nursing staff. The goal is to build an environment that both attracts nurses and supports them in their career and life goals.