The nursing shortage: solutions for the short and long term.

With predictions that this nursing shortage will be more severe and have a longer duration than has been previously experienced, traditional strategies implemented by employers will have limited success. The aging nursing workforce, low unemployment, and the global nature of this shortage compound the usual factors that contribute to nursing shortages. For sustained change and assurance of an adequate supply of nurses, solutions must be developed in several areas: education, healthcare deliver systems, policy and regulations, and image. This shortage is not solely nursing's issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media. This paper poses several ideas of solutions, some already underway in the United States, as a catalyst for readers to initiate local programs.

Creating the executive team to lead team-based organizations.

In team-based organizations, senior executives are often the last group to be truly a team. Many factors contribute to the individualism that is characteristic of the leadership of an organization. Factors that produce the success of an executive may be contradictory to the skills needed to be an effective team member. Team-based organizations continue to demonstrate their success in managing the changing and challenging work environments. Health care executive leadership groups must realize the impact they can have on the organization if they become a team. This article reviews how executives can become a team.

Build or remodel? Preparing facilities for today's and tomorrow's needs.

As the site for the patient care moves from inpatient settings, hospitals face major decisions about the future of their facilities. Those build in the 1970's and early 1980's do not necessarily accommodate today's technology and patient care equipment, not convert readily to outpatient space. Thus administrators face the challenge of deciding what and how much to remodel in a facility, and what should be new construction. Duke University Medical Center, which includes 1124 licensed inpatient beds, on campus clinics, and off-site primary care practices, has faced such a challenge. In the past five years, administrators, clinicians, and facility designers have systematically reviewed current facility status, and planned renovations and new construction. All inpatient units were renovated in less than two years. During this time, clinical services were maintained and occupancy issues were managed. Space utilization, design and new technology resulted in units better suited to the needs of patients, families and staff.

Vinorelbine tartrate (Navelbine): drug profile and nursing implications of a new vinca alkaloid.

PURPOSE/OBJECTIVES: To review the drug profile and nursing implications of a new vinca alkaloid, vinorelbine tartrate (Navelbine, Burroughs Wellcome Co., Research Triangle Park, NC). DATA SOURCES: Published articles, abstracts, professional communications, drug manufacturer, and personal experience with vinorelbine clinical studies. DATA SYNTHESIS: The U.S. Food and Drug Administration approved vinorelbine for the treatment of advanced non-small cell lung cancer (NSCLC) in December 1994. Vinorelbine has shown significant activity in a variety of malignancies, including NSCLC and breast cancer. Studies of vinorelbine used as a single agent in treating patients with NSCLC have achieved results comparable to combination therapies but with less toxicity. Like other vinca alkaloids, vinorelbine is a microtuble-inhibiting agent. The recommended dose for a single-agent IV dose is 30 mg/m2 administered weekly. Vinorelbine is a moderate vesicant and venous irritant. The most common side effects are leukopenia and granulocytopenia; others include fatigue, injection site pain or irritation, nausea, vomiting, constipation, paresthesias, and diminished reflexes. CONCLUSIONS: Vinorelbine is a well-tolerated treatment with mostly mild to moderate side effects that are reversible following treatment discontinuation. IMPLICATIONS FOR NURSING PRACTICE: Nurses in diverse settings will focus on teaching and identifying and managing side effects of vinorelbine. Patient care concerns include risk for infection, potential for impaired skin integrity at injection site, altered comfort, constipation, and sensory/perceptual alterations.

Fundamentals for oncology nurse/data managers--preparing for a new role.

The nurse's role as a clinical trial data manager is a vital component of the success of the trial. Physicians rely on the nurse's expertise as a skilled observer to gather clinical data; act as a liaison to the many agencies involved in the study; instruct patients, families, and colleagues; and assess the information gathered. However, information about the nurse/data manager role is scarce. This article reviews information useful for the nurse assuming a clinical trial data manager position and for the nurse caring for patients on a research protocol.