Career planning and development for nurses: the time has come.

Developments in how the nursing profession is perceived by nurses and by society, along with unparalleled changes in health care systems, have created an environment in which individual nurses must take control of their careers and futures. Educators, employers and professional organizations also have a key role to play in fostering the career planning and development of nurses, usually the largest employee group in most health care organizations. This article provides an overview of what career planning and development is and why it is important for nurses. A career planning and development model is described that provides nurses with a focused strategy to take greater responsibility for engaging in the ongoing planning process that is crucial throughout the major stages of their career. Finally, educators, employers and professional organizations are challenged to collaborate with individual nurses on career-development activities that will enable nurses to continue to provide high-quality care in ever-changing health care systems.

Forecasting models for human resources in health care.

This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models--needs based, utilization based, and effective demand based--provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long-term forecasting or for estimating needs for large geographical areas or populations.

Discovery Path: a retention strategy for mid-career nurses.

As health care administrators, policymakers, nursing organizations, and nurses begin to deal with the reality of a looming (and to an increasing extent, existing) serious shortage of nurses both in Canada and globally, recruitment and retention issues are again in the news. Much attention has been directed towards two responses: (a) attracting young people into the profession and helping them integrate into and identify with nursing as a lifelong career, and (b) developing sustainable retention strategies to ensure that nurses remain in nursing. One population that requires particular attention is the mid-career group of nurses. Those nurses, in their late 30s and 40s with 15 and more years of experience, have the professional memory that employers count on, the expertise that patients and clients require, and the experience and wisdom that young nurses depend on for coaching, mentoring, and support. Retention strategies targeted to these mid-career nurses require a diverse set of activities that are focused on those nurses' specific stage of personal and professional development and that recognize their unique needs. The purpose of this article is to describe a program that targets mid-career nurses, predominantly women who, having spent much of their careers and lives caring for others-children, parents, patients-are beginning to question their own futures. The goals of the program and the experiences of one group of nurses in the program, as well as the results of a two-year follow up with them, will be discussed. Recommendations for future retention strategies will also be offered.

Primary amenorrhea caused by crushing trauma of the pelvis.

An 18-year-old woman sought treatment for primary amenorrhea. Crushing trauma of the pelvis in her childhood had caused separation between the uterine corpus and the cervix. Through a combined abdominal and vaginal approach the continuity of the uterine outflow tract was restored. Years later, after in vitro fertilization, the patient was delivered of a healthy term baby in an elective cesarean procedure.

Dinoflagellates from marine algal blooms produce neurotoxic compounds: effects on free calcium levels in neuronal cells and synaptosomes.

In this report, evidence is presented that the marine unicellular eukaryotic dinoflagellates can cause neurotoxicity very likely by an increase in intracellular free calcium ions ([Ca(2+)](i)). Determinations of the effects of culture supernatants from different clones of the dinoflagellate Alexandrium sp. isolated from algal blooms on the viability of rat primary neuronal cells revealed that all clones tested were toxic for these cells. In addition, all Alexandrium clones tested, except for A. ostenfeldii BAH ME-141, were found to be toxic for rat pheochromocytoma PC12 cells. No toxicity was observed for culture supernatants from Gonyaulax and Coolia monotis. Calcium ions are important in the process of apoptotic cell death; our studies revealed that the dinoflagellate supernatants from A. lusitanicum K2, A. lusitanicum BAH ME-091, and A. tamarense 1M caused an increase in [Ca(2+)](i) levels in both PC12 cells and primary neuronal cells. These dinoflagellate supernatants, as well as the A. tamarense ccmp 115 supernatant, were found to cause also an increase in free calcium concentration in isolated synaptosomes. Our results suggest that the neurotoxic effects of certain dinoflagellate supernatants may be associated with disturbances in [Ca(2+)](i) levels.

Potent inhibitors of protein farnesyltransferase: heteroarenes as cysteine replacements.

Synthesis and biological evaluation of heteroarenes as reduced cysteine replacements are described. Of the heteroaryl groups examined with respect to FT inhibitor FTI-276 (1), pyridyl was the replacement found to be most effective. Substitutions at C4 of the pyridyl moiety did not affect the in vitro activity. Compound 9a was found to have moderate in vivo bioavailability.

Planning for complex change: insights from the Metro Toronto District Health Council Hospital restructuring project.

Restructuring and large-scale organizational change have become facts of life in Ontario's health care sector in recent years. Nearly every jurisdiction in Ontario has undergone systemwide hospital restructuring studies, and individual hospitals have increasingly turned to large scale re-engineering processes to improve efficiency and effectiveness. One example of planning for significant change was a hospital restructuring study undertaken by the Metropolitan Toronto District Health Council between 1993 and 1995. This article provides an overview of key insights gleaned from the project, including an analysis of the effectiveness and utility of some of the major planning strategies and tactics employed to realize project objectives. Given the organizational, process and communications issues faced by the study, many of the insights provide will be relevant to other groups engaged in planning for large-scale change processes, who face tough decision making in similarly complex environments.

The changing role of hospital nurse managers: a literature review.

Hospitals in Canada and indeed throughout the world are in the midst of significant and even dramatic change. The impact of these changes on the role of the nurse manager is just beginning to be identified and research in this area is limited. As hospitals' structures and functions change, so must the roles of their managers and providers. The nurse manager is key in both facilitating patient care and in ensuring the quality of worklife of staff nurses. If the nurse manager role is to be maintained and more importantly, if the role is to develop as a significant one in the hospital infrastructure, more understanding, more study, and clear directions for the future are required. This article provides an overview of the literature on nurse managers, examines the roles, perspectives and needs of those managers and discusses the implications for future research in this area.

The nurse manager as career coach.

The conventional wisdom has been that career coaching is an important part of the nurse manager's role. In the current stressful healthcare environment, nurse managers seem more than ever in need of direction in this area. This paper examines the nurse manager's traditional role as a career coach, identifies the problems the current environment poses for implementation of that role and, considers options for achieving the goal of supporting staff with career development.

Downsizing in the hospital system: a restructuring process.

In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.

Transcultural nursing in Canada.

By the year 2000, approximately one in every five Canadians will represent an ethnic minority. Even today, Canada is home to over a hundred different linguistic and cultural groups. Yet between these Canadians and the health care system there exists a large cultural gap. At the crux of the matter is the lack of recognition by health care professionals of the cultural differences and related health beliefs of various groups. A further impediment is the lack of formal educational programs, theory and research in multicultural nursing care in Canada.

Neoadjuvant chemotherapy (MVAC) in locally invasive bladder cancer.

In order to evaluate the efficacy of neoadjuvant chemotherapy in invasive urothelial carcinoma of the bladder a retrospective analysis was performed. 54 patients without distant metastases (T2-T3b, N0-X, M0) received 3 cycles of neoadjuvant chemotherapy according to the MVAC protocol (methotrexate, vinblastine, doxorubicin and cisplatin) after transurethral resection (TUR) followed by cystectomy. 52 patients had previously undergone cystectomy immediately after TUR. Complete histopathological remission was observed in 9 patients (17.3%) after TUR and in 17 patients (31.5%) after TUR+MVAC. Neoadjuvant MVAC resulted, therefore, in a 14% higher rate of complete remissions. The overall response to TUR was significantly improved by MVAC therapy. Downstaging by neoadjuvant chemotherapy was more readily achieved in initially low-stage tumours (T2: 44.4% and 30.8%, T3a: 47.1% and 19%, T3b: 5.3% and 5.5% in patients receiving TUR+MVAC and TUR alone, respectively). Overall survival did not differ significantly between both groups. Patients who were successfully downstaged to pT0 had a significantly better prognosis, and patients resistant to chemotherapy had the poorest prognosis, showing the shortest survival. In conclusion, histopathological response at cystectomy was improved by neoadjuvant MVAC chemotherapy after TUR and can be expected to be prognostically relevant in those patients who can be downstaged to T0, although overall survival failed to be significantly increased in this relatively small patient sample.

Maximal androgen blockade in combination with methotrexate for treatment of metastatic prostate cancer.

Recently attention has been focused on the optimal timing of chemotherapy within the treatment regimen for patients with metastatic prostate cancer, i.e., hormonal manipulation, preferably maximal androgen blockage (MAB) consisting of chemical/surgical castration followed by treatment with antiandrogens. We have conducted a randomized prospective clinical trial, investigating the efficacy and toxicity of MAB (orchiectomy followed by flutamide therapy) alone as compared to MAB combined with methotrexate (MTX, 50 mg/m2/week) in 53 patients with newly diagnosed stage IV(M1) prostatic cancer (UICC TNM Classification 1987). The observed remission rates (complete + partial) of 42.3% in the MAB + MTX arm and 29.6% in the MAB arm did not differ significantly. The response rates (complete + partial + stable disease) of 73.1% and 66.7% for MAB + MTX and MAB respectively, also showed no significant difference. Neither progression-free survival (median 18/5 and 23.8 months for MAB + MTX and MAB, respectively) nor overall survival (median: 37.4 and 36.1) months in the MAB + MTX and MAB arm, respectively) could be improved by the addition of MTX to MAB Only the extent of metastatic pain reported by the patients was consistently less under MAB + MTX than under MAB alone (P<0.1). Both treatment regimens were well- tolerated with slightly more undesirable effects in the MAB + MTX arm. Our results do not provide evidence for the achievement of marked gains by combining chemotherapy with endocrine therapy in newly diagnosed patients with stage IV (M1) prostate cancer.

Supporting staff in times of change: career development strategies.

Today's nurse managers face an environment where change is the only constant. Managers and staff are feeling threatened, overworked, and stressed. Career development strategies provide managers with an opportunity to assist staff to cope with change and to grow and develop professionally. The strategies described also assist managers to feel a sense of accomplishment and satisfaction--something hard to achieve.

Adjuvant intravesical mitoxantrone after transurethral resection of primary superficial transitional cell carcinoma of the bladder. A prospective randomised study.

A prospective randomised controlled clinical trial began in 1989 on 126 patients with superficial transitional cell carcinoma of the bladder (pTa-pT1, grades 1-3) to compare the efficacy of adjuvant topical mitoxantrone after transurethral resection versus no further treatment. 62 patients received no further treatment, 64 patients received weekly 20 mg mitoxantrone intravesically for 6 weeks after differentiated TUR of all visible tumours. The endpoint of the study was any progression of stage or grade or further recurrences. The median follow up was 29 months--the minimum follow up was 24 months. The percentage of recurrences (25.8 versus 23.4), the recurrence rate (1.2 versus 0.9), the overall disease free interval and the tumour progression rate showed no statistically significant differences (P > 0.05 Mantel-Cox test). Only the comparison of time to recurrence in tumours with recurrences showed a statistically significant difference, with a longer disease free interval for the TUR plus mitoxantrone group (P = 0.016 Mantel-Cox test).

[Topical immunotherapy (KLH) vs. chemotherapy (Ethoglucid) in prevention of recurrence of superficial bladder cancer. A prospective randomized study]. / Topische Immuntherapie (KLH) vs. Chemotherapie (Ethoglucid) in der Rezidivprophylaxe oberflächlicher Harnblasenkarzinome. Eine prospektiv randomisierte Studie.

A prospective randomized controlled study on the effect of KLH (keyhole limpet hemocyanin) versus etoglucid in the prevention of recurrences in primary and recurrent superficial transitional cell carcinoma of the bladder (stage pTa-pT1, grades 1-3 according to the recommendations of UICC and WHO) after complete transurethral resection of the tumor started in 198. Patients in group 1 (n = 76) were immunized with 1 mg KLH intracutaneously, after which they received bladder instillations of 30 mg (30 ml) KLH weekly for 6 weeks and then monthly for 1 year. Patients in group 2 (n = 85) received weekly bladder instillations of 0.565 g etoglucid (50 ml 1% solution) for 6 weeks and then monthly for 1 year. The percentage of recurrences, recurrence rate, disease-free interval and tumor progression rate were evaluated for both treatment groups. The end-point of the study was progression in stage or grade or more than two recurrences during the observation period. The shortest follow-up was 12 months, the mean follow-up, 27.5 months. No statistically significant differences were found between the two groups in percentage of recurrences (43.4% KLH-53.9% etoglucid), recurrence rate (4.4 KLH-3.9 etoglucid), mean disease-free interval (12.1 months KLH-13.6 months etoglucid) or progression rate (6.5% KLH-9.4% etoglucid).

Epidermoid cysts of the testis: organ-preserving surgery following diagnosis by ultrasonography.

Epidermoid cysts of the testes are rare, benign tumours that can be visualised by high frequency ultrasonographic transducers. Their echo patterns are characteristic but not pathognomonic, so that inguinal exposure of the testis is required to confirm the diagnosis. However, sonography facilitates the planning of surgery, since excision of the tumour can be performed in an organ-preserving manner. In 6 patients with epidermoid cysts treated in this way between 1986 and 1989, no recurrence was seen during a mean follow-up period of 37 months.