Lillee Gelinas Appointed Editor-in-Chief

antlogoSILVER SPRING,MDAmerican Nurse Today, the official journal of the American Nurses Association (ANA), has announced Lillee Gelinas, MSN, RN, FAAN, has been appointed editor-in-chief effective June 1, 2014. Gelinas, a member of ANA and the Texas Nurses Association, has served on the journal’s editorial board since its inception in 2006. American Nurse Today is a peer-reviewed journal owned and published by HealthCom Media.

Gelinas succeeds Pamela Cipriano, PhD,RN, NEA-BC, FAAN, who served as American Nurse Today editor-in-chief since its founding in 2006.

lillee“We are excited to see Lillee assume this new role. She has demonstrated dedication and enthusiasm in her long service on the editorial board, and we are confident she will shape its future as editor-in-chief,” said ANA President Karen A. Daley, PhD, RN, FAAN. “We also gratefully acknowledge Pam Cipriano for her leadership in helping to launch and establish American Nurse Today as a respected and valued journal.”

ANA members receive a subscription to the award-winning journal as a benefit of membership.

“Lillee’s amazing passion for nursing and her in-depth understanding of the profession will be a valuable asset as American Nurse Today continues its focus on delivering information that nurses can use in their practice,” said Greg Osborne, HealthCom Media President. “Since her appointment to the editorial board in 2006, Lillee has contributed to shaping our award-winning editorial content. It is also very important to acknowledge Pam Cipriano, whose invaluable editorial leadership skills have helped establish American Nurse Today as the leading source of clinical and practical content in the nursing market.”

“I am humbled and honored to accept this appointment with American Nurse Today,” said Gelinas. “Pam Cipriano’s shoes will be very hard to fill, but with a talented editorial board and an engaged audience, I’m very confident of a successful future. I firmly believe in the journal’s role, which supports nursing practice through evidence-based, practical information, and the platform it provides to reinforce the fundamental role we as nurses play in transforming the health care system.”

Gelinas continued, “Nurses are vital to the care provided today, are well-positioned to help patients navigate the shifts occurring in care delivery, and serve as the hearts and hands of our health care system.  With such an important role, it is essential that we stay in conversation and connected as together we design the paths to our future. American Nurse Today provides an important outlet where the dialogue can occur.”

A nurse leader with more than 30 years of experience, Gelinas currently serves as system vice president and chief nursing officer of CHRISTUS Health, a system comprising more than 350 hospitals, services, and facilities in the U.S., Mexico and Chile. She is a well-respected thought leader and speaker on health care management, clinical issues, and patient safety and quality issues. She has served in various nursing leadership roles, including member of the Center for Medicare & Medicaid Services Nursing Steering Committee; member of the board of directors for the National Patient Safety Foundation; member of the Nursing Advisory Council of The Joint Commission; and many others. She is a fellow of the American Academy of Nursing and a member of the Academy’s Nursing Informatics and Technology Expert Panel.

Lawrie Elliott Appointed as Editor for JPMHN

Lawrie Elliott has been appointed Editor for the Journal of Psychiatric and Mental Health Nursing, succeeding outgoing editor, Dawn Freshwater.

Lawrie shares some of his background and expertise:

Career History

image001I trained as a mental health nurse in Glasgow (UK) in 1977 and qualified in 1980.  I moved into public health research in the 1990s, became a senior lecturer (and Director of Research) at the University of Dundee (UK) in 1997 and then reader in 2003.   I took up my present post as professor at Edinburgh Napier University (UK) in 2005.  I am an active researcher and have contributed to the strategic development of nursing research throughout my career, including research lead for a cross NHS/University ‘Centre for Integrated Healthcare Research’ (2005-2010) and more recently led the Research Excellence Framework 2014 submission for Nursing at Edinburgh Napier University.  

Areas of Expertise

1064_LargeI have a substantial track record in applied research in Public Health and published numerous high quality papers including a report with colleagues for the World Health Organisation on health inequalities (2006). My methodological expertise centres on the evaluation of public health interventions which range from needle exchange, methadone and sexual health programmes to community nursing. I served on the Editorial Board of the Journal of Psychiatric and Mental Health Nursing between 2005 and 2012 and became an Associate Editor in 2013. I have also reviewed for a number of international health journals and grant awarding organisations. I have worked on a number of public health nursing research studies commissioned by government including, The Public Health Contribution of Nursing: a Review of the Evidence (2001), and the Review of Nursing in the Community (2009-2012). I also led on the evaluation of Healthy Respect; a national health demonstration project designed to improve the sexual health of young people including vulnerable groups (2012).  I have obtained over £3 million of funding in collaboration with my colleagues including new studies on young people and families funded by the National Institute for Health Research and the Scottish Government which will run to 2017. I am currently collaborating with researchers from the USA, Australia, Ireland and Sweden and internationally recognised researchers from UK countries.

Contact information: Professor Lawrie Elliott
School of Nursing, Midwifery, and Social Care
Edinburgh Napier University, Sighthill Campus
Edinburgh, Scotland. UK
EH11 4BN
Tel: +44 (0) 131 455 5304
Email: l.elliott@napier.ac.uk

Seen in the New York Times…

GIRLS-02-popupA new campaign has been launched in New York City called the New York City Girls Project. It is designed to tell girls they are beautiful the way they are. An article in the New York Times on Monday, September 30 profiled the project which was noted to be the first campaign aimed at female body image to be carried out by a major city.

Margaret Comerford Freda, editor of MCN: The American Journal of Maternal Child Nursing brought the article to my attention because of this paragraph:

City officials cited evidence in The American Journal of Maternal/Child Nursing and elsewhere that more than 80 percent of 10-year-old girls are afraid of being fat, that girls’ self-esteem drops at age 12 and does not improve until 20, and that that is tied to negative body image.

Margaret told me that the research they were referring to was done by Dr. Linda Andrist and published in MCN. Her study on Media Images, Body Dissatisfaction, and Disordered Eating in Adolescent Women found that more than 80% of girls over 10 were afraid of becoming fat, and that self esteem dropped at age 12.

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In Memory of Rheba de Tornyay, EdD, RN, FAAN

rheba-tornyay-bwIt is with sadness that I report our nursing editor community has lost another visionary leader. Rheba de Tornyay, Editor of the Journal of Nursing Education  from 1983-1990, and Editor Emeritus in the years since, died in Seattle, Washington on September 27, 2013. She was 87.

Dean Emeritus at the University of Washington, Rheba is described in their memorial as:

Dean, educator, innovator, trailblazer, mentor, collaborative colleague, friend, inspirational leader…all these were facets of a career whose focal point and touchstone was the University of Washington School of Nursing, where she served as dean from 1975 to 1986 and as a faculty member until 1996.

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Marilyn Oermann to Receive Award for Excellence in Nursing Education

Duke University School of Nursing Scholar Dr. Marilyn Oermann to be Honored with

the Elizabeth Russell Belford Award for Excellence in Education

from Sigma Theta Tau International

Durham, NC…Dr. Marilyn Oermann, director of evaluation and education research at Duke University School of Nursing is the recipient of the Elizabeth Russell Belford Award for Excellence in Education by the Sigma Theta Tau International (STTI), the honor society of nursing. The award, named in honor of one of the five founding members of STTI, is awarded every two years and pays tribute to excellence in teaching, significant contributions toward advancing the science of nursing and influencing the professional practice and public image of nursing.

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More Men Trading Overalls for Nursing Scrubs

More Men Trading Overalls for Nursing Scrubs

By TESS VIGELAND

Detroit

IN 2007, Kurt Edwards figured he would be stacking and racking 80-pound boxes of dog food and celery in the back of a grocery store for the rest of his working life. And he was fine with that.

But that June, after nine years on the job, layoff notices arrived on the warehouse floor at the Farmer Jack store in Detroit where he worked. His employer, Great Atlantic and Pacific Tea Company, closed the Farmer Jack chain. Today he still does a lot of lifting, but of people, not boxes. Mr. Edwards joined the ranks of former warehouse, factory and autoworkers trading in their coveralls and job uncertainty for nurses’ scrubs.

At 49, divorced with no children, he now tends to patients on the graveyard shift at Sheffield Manor Nursing and Rehab Center, a two-story, gray brick building in a ramshackle neighborhood on Detroit’s west side. Interviewed last month, he says he is making about $70,000 annually, $20,000 more than he did at the warehouse.

The story of how he made the transition is one that men like him appear to be telling with increasing frequency, and the demand for their services is what is setting so many of them on similar paths.

Hard figures are elusive, but the Michigan Department of Energy, Labor and Economic Growth estimates a shortage of 18,000 nurses in the state by 2015 — and the labor force is adapting.

Oakland University in nearby Rochester, Mich., has established a program specifically to retrain autoworkers in nursing — about 50 a year since 2009. And the College of Nursing at Wayne State University in Detroit is enrolling a wide range of people switching to health careers, including former manufacturing workers, said Barbara Redman, its dean. “They bring age, experience and discipline,” she said.

David Pomerville brings a few more years than Mr. Edwards. A 57-year-old nursing student, he spent most of his career as an automotive vibration engineer, including almost 10 years at General Motors. His pink slip arrived in April 2009.

At the time, Mr. Pomerville was earning almost $110,000 a year at the General Motors Milford Proving Ground in Milford Township, Mich.

But having watched another round of bloodletting at G.M. three years earlier, he had already decided on nursing as his Plan B. “I thought, ‘Well, I worked on cars for this long, now I’m going to work on people for a while,’ ” he said.

A married father of two and grandfather of two, Mr. Pomerville had almost no money saved when he was laid off. But the federal Trade Readjustment Act, which aids workers who lose their jobs as a result of foreign competition, paid for nursing school tuition. His wife is a teacher, and he receives unemployment benefits. He hopes to graduate at the end of this year, and he expects his salary will be about half what he used to make.

Timothy Henk ultimately decided not to try to stick it out as long as Mr. Pomerville did. Mr. Henk, 32, worked for eight years at the Ford Sterling Axle Plant in Sterling Heights, Mich., installing drive shafts in the F-150 truck, and was making about $25 an hour by 2007. With overtime, he earned $70,000 a year.

But as he and his wife contemplated having children, he worried that income would not last. So in 2007, he took a buyout, which included $15,000 a year for four years to put toward education. Two friends in nursing — both women — had suggested he look into joining their profession. He researched the demand for nurses in Michigan and used the buyout money to pay his tuition at Wayne State.

The amount of schooling required to be a nurse depends on the level of nursing a student chooses to pursue. Mr. Henk went through Wayne State’s four-year program to obtain a bachelor of science in nursing and then took a licensing exam to become a registered nurse, or R.N. Other levels of nursing include the C.N.A., or certified nurse’s aide, which can require as little as eight weeks of training plus a certification exam, and L.P.N., or licensed practical nurse, which requires one or two years of schooling and a licensing exam.

All of that assumes acceptance in a nursing program. The American Association of Colleges of Nursing said more than 67,000 applicants were turned away in 2010 for lack of faculty or classroom space — not a good sign with a national nursing shortage projected to be as high as 500,000 by 2025.

Mr. Henk now works in the critical care unit at Beaumont Hospital in Royal Oak, Mich. He makes about $50,000 annually for a 36-hour workweek, though Ford’s health insurance was better.

The choice to make this switch was probably least likely for Mr. Edwards, the former grocery worker. He dropped out of college and spent four years in the Army as a paratrooper with the 82nd Airborne Division. He found his unionized warehouse job after a stint working for his father, an accountant.

“You have this plan, this goal,” he said. “I was going to be at this warehouse; all the guys were retiring with great benefits. I was part of the middle class, and I was going to make it.”

When it became clear that he would not make it to retirement there, someone he was dating suggested nursing.

Though he wrote it off as woman’s work at first, he realized he was getting a bit old for manual labor. So he returned to school, living on unemployment checks and occasional groceries from by his mother. He spent the last four months of his L.P.N. training with no electricity because he could not afford to pay any bills except rent.

Once he finished, the Sheffield Manor administrator, LaKeshia Bell, pretty much hired him on the spot. “They are like a hot commodity,” she said. “A male presence actually helps us in the facility.” At 5 feet 9 inches tall and 220 pounds, Mr. Edwards lifts patients as easily as he stacked boxes.

But he still appears to be a rarity. Just 7 percent of employed registered nurses are men, according to a 2008 Department of Health and Human Services survey. It did not count licensed practical nurses. Still, the percentage of people certified in nursing in some way who are men has risen to 9.6 percent since 2000 from 6.2 percent before, according to the department.

Ms. Bell noted that new nurses coming from manufacturing had unusual adjustments to make. When dealing with parts on the factory floor, she said, repetition is a major part of the job. “These are not parts. They’re people, so you can’t just have a set regimen like in a plant setting,” she said.

That cultural shift goes both ways. Mr. Edwards’s supervisor, Yvonne Gipson, provided an example. “I mean Kurt is not an ugly man, O.K.?” she said. “You got all these female workers, and they’re all looking at him like, ‘Oh! Potential husband!’ So, yes, it does change.” Her voice trailed off, erupting into peals of laughter as Mr. Edwards slipped a $20 bill into her pocket.

While these success stories point to opportunity, Michigan’s unemployment rate is still 9 percent. And Nelson Lichtenstein, director of the Center for the Study of Work, Labor and Democracy at the University of California, Santa Barbara, says history is a cruel taskmaster when it comes to struggling industries.

“When one industry goes in decline and another comes to the fore, you don’t have a one-to-one employment replacement at all,” he said. “It takes a decade, two decades. In the meantime, some people find their careers are ended, ruined, and they never get them back.”

For these new nurses, the advantage is the demand in Michigan. Mr. Edwards knows he is lucky. “You know I wake up every day and I’m very proud,” he said. “I’m looking in the mirror. I’m happy. I’m proud. I’m saying, you know, this turned out great. The lights are on!”

Devin Maverick Robins contributed reporting.

Source: New York Times

An Interesting Study from the University of Pennsylvania

I love when nurses do interesting and creative research and to me, this study fits that description to a “T.” This was a press release I received from Penn entitled “Science in Action.”

Food Stamps and Farmers’ Markets

Current food stamp programs at urban farmers’ markets attempting to bring fresh produce to economically stressed city dwellers are so complicated for the shopper and expensive for the farmer that fewer people are taking advantage of the federal program designed to help them, according to research at the University of Pennsylvania School of Nursing.

Record numbers of Americans are receiving Supplemental Nutrition Assistance Program (SNAP) benefits, as food stamps are now known, and many SNAP participants live in neighborhoods with little or no access to healthy food. A study conducted at the Clark Park Farmers’ Market in Philadelphia, Pa., found that making it easier for vendors to collect SNAP payments with electronic point-of-sale systems increased fresh produce sales to SNAP recipients by 38 percent.

However, the costs associated with such systems may put them out of reach for farmers. The study, by Penn Nursing professor Alison M. Buttenheim, PhD, MBA, and colleagues, appears in the Journal of the Academy of Nutrition and Dietetics.

“Our study highlights the need for an equitable approach to subsidizing Electronic Benefits Transfer (EBT) fees at farmers’ markets,” Dr. Buttenheim reported. “Vendors told us, and we confirmed with a cost-benefit analysis, that they would not be able to break even on sales after paying the associated costs.”

SNAP participants access their benefits through EBT cards. To accept the cards at farmers’ markets, vendors must rent wireless POS terminals, pay for wireless service, and cover transaction fees. Because of the associated costs, many market managers operate a single wireless POS terminal for the entire market. SNAP beneficiaries may buy a token that they can exchange for produce, but they can’t receive change. Alternatively, customers can make their selections with a vendor, get a paper receipt for the total amount of the purchase, and present the receipt to the central terminal, where the customer’s EBT card is swiped for the exact amount of purchase. This must be repeated for each vendor the customer wants to visit.

Dr. Alison M. Buttenheim

Instead, Dr. Buttenheim and colleagues provided each vendor at the Clark Park Farmers’ Market with a wireless POS terminal for EBT and credit/debit card transactions. A grant covered all associated wireless charges, transaction fees, and processing fees during a pilot program which ran from June 2008 through February 2009. After the pilot period, the market returned to a single market-operated terminal and receipt system.

Researchers analyzed sales data at the market for four years, beginning 17 months before the pilot project and ending 22 months afterward. There was a 38 percent increase in SNAP/EBT sales during the months with multiple vendor-operated terminals. However, after the pilot project ended, sales to SNAP participants returned to pre-pilot levels, controlling for increases in SNAP participation in Philadelphia.

“Many stakeholders want to increase SNAP redemptions at farmers’ markets,” said Dr. Buttenheim. “We hope this study can inform policymakers about the specific mechanisms driving SNAP redemptions and about the need for subsidies for wireless POS technology at farmers’ markets.”

In an accompanying podcast, Dr. Buttenheim and co-author Allison Karpyn of The Food Trust, a Philadelphia nonprofit working with communities on lasting and stable sources of affordable food, discuss the impact of wireless POS terminals at farmers’ markets on sales to SNAP beneficiaries, and the policy implications of their research. The podcast is available at http://andjrnl.org/content/podcast.

Reference:

Buttenheim AM, Havassy J, Fang M, Glyn J, Karpyn AE. Increasing Supplemental Nutrition Assistance Program/Electronic Benefits Transfer Sales at Farmers’Markets with Vendor-Operated Wireless Point-of-Sale Terminals. J Acad Nutr Diet. 2012 Mar 15. [Epub ahead of print] PubMed PMID: 22425028.

AAN and IOM Partnership

American Academy of Nursing Joins the IOM Global Forum on Innovation in Health Professional Education as Founding Member-Sponsor

IOM collaborative to incubate and evaluate new solutions to today’s health professional education challenges.

WASHINGTON, Feb. 23, 2012 /PRNewswire-USNewswire/ – The American Academy of Nursing reaffirms its commitment to the future of health care and the dissemination of innovative nursing knowledge by joining the Institute of Medicine’s Global Forum that brings together interdisciplinary leaders to address challenges in health professional education and support the incubation and evaluation of new solutions.

Set to launch in March 2012, the Institute of Medicine’s Global Forum on Innovation in Health Professional Education will further investigate the Lancet Commission’s Report Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World as well as the Institute of Medicine’s and Robert Wood Johnson Foundation’s 2010 report The Future of Nursing: Leading Change, Advancing Health.

Academy Fellow Afaf Meleis, PhD, and Jordan Bohen, MD, two Lancet report Commissioners, will serve as co-chairs for the new forum — a forum whose visible work will manifest through several workshops held yearly in addition to video-conferencing with international partners.

“The Academy is honored to join this Global Forum,” said Joanne Disch, PhD, RN, FAAN, President of the Academy. “We look forward to collaborating with esteemed education and health care organizations and ensuring that nurse innovations are on the table as part of the solutions to our professional health education needs.”

Academy Fellow Madeline Schmitt, PhD, RN, FAAN, Professor Emeritus, University of Rochester School of Nursing, who encompasses both a vast experience with health professional education and keen sense of innovation, will represent the Academy. Dr. Schmitt is a nurse-sociologist who has conducted extensive research on interprofessional collaborative practices. In addition to her research and teaching agenda, Dr. Schmitt serves as a national and international consultant and chairs the Expert Panel commissioned by the AACN, AACOM, AACP, ADEA, AAMC, ASPH to develop core competencies for interprofessional collaborative practices.

The American Academy of Nursing anticipates and tracks national and international trends in health care, while addressing resulting issues of health care knowledge and policy. The Academy’s mission is to serve the public and nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge.

In Memory of Joyce C. Clifford, 1935-2011

I didn’t realize that Joyce Clifford died in October. When I was a student, we practiced primary nursing while the actual staff nurses were all still doing team nursing. It was a tumultuous time. Joyce was truly a visionary and deserves the honor of being a nursing legend.

The following obituary is from The New York Times.

~~

Joyce C. Clifford, a nurse who advocated a partnership of equals between doctors and nurses in the treatment of patients, and whose ideas were adopted in some of the nation’s best hospitals because they reduced medical errors and improved survival rates, died on Oct. 21 in Boston. She was 76.

The cause was heart disease and kidney failure, said her husband, Lawrence.

Dr. Clifford, who received a Ph.D. in health planning from Brandeis University, was part of the first generation of registered nurses who sought to make bachelor’s degrees a minimum requirement in a field where most held associate degrees. It was a requirement she set for all the nurses she hired at Beth Israel Hospital in Boston, a Harvard teaching hospital, where she worked from 1974 until 1999 as the nursing administrator and later vice president.

Under the “primary nursing” model she introduced in 1975 at Beth Israel, nurses were assigned primary responsibility for four or five patients — caring for each while on duty, being on call when off duty, and acting as an advocate and intermediary with each patient’s doctors.

The idea was to restore the continuity and accountability that were considered casualties of the nursing system then widely in use, known as team nursing. In the team system each nurse had a specialized task, like dressing wounds or managing medication, but no single nurse had a glimpse of the big picture.

“Doctors see a patient for a couple of minutes a day, but nurses are there 24/7,” Margaret Grey, dean of the Yale School of Nursing, said in an interview after Dr. Clifford’s death. “Joyce Clifford put together a system that gave the primary nurse the benefit” of that accumulated round-the-clock nursing information, she said.

Dr. Clifford was not the creator of the primary nursing model, but she was probably the first to put it into practice in a large teaching hospital, said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, who published research about the work of Dr. Clifford.

Studies showed that the system was good for patients and for hospitals, Professor Aiken added. The increased accountability and higher level of education it demanded were linked to a decline in patient mortality and a lower turnover of nurse staff.

“Beth Israel had a waiting list of applicants,” Professor Aiken said, “even when there were nurse shortages everywhere else.”

Primary nursing has never become the norm. Only about 10 percent of the nation’s hospitals use it in one form or other. In the face of corporate mergers and cost-cutting, some hospitals where it was once in practice — including Beth Israel, now known as theBeth Israel Deaconess Medical Center — have since modified or eliminated it in favor of more decentralized systems.

Dr. Clifford’s achievement was in showing how primary nursing could work, said Dana Beth Weinberg, an assistant sociology professor at Queens College. Professor Weinberg’s Harvard dissertation, published in 2003 as the book “Code Green: Money-Driven Hospitals and the Dismantling of Nursing,” chronicled the dismantling of primary nursing at Beth Israel after its merger with Deaconess Medical Center in 1999 and Dr. Clifford’s departure.

Dr. Clifford went on to found and lead the Institute for Nursing Healthcare Leadership, which promotes research and advanced education in nursing and the primary nurse system.

She was born Joyce Catherine Hoyt in New Haven on Sept. 12, 1935, one of four daughters of Raymond Hoyt, an ironworker, and his wife, Helen. She received a nursing diploma from St. Raphael Hospital in New Haven and a bachelor of science degree in 1959 from St. Anselm College in New Hampshire.

She joined the Air Force in the early 1960s and received a master’s degree in nursing administration in 1968 from the University of Alabama in Birmingham, where she was stationed.

She and her husband met at the university. Besides Mr. Clifford, she is survived by a sister, Rita Brown, of West Haven, Conn.

Dr. Clifford was hired as Beth Israel’s chief nurse by its president and chief executive, Dr. Mitchell T. Rabkin, a member of the Harvard Medical School faculty.

Dr. Rabkin said Monday in an interview that he had had an insight when he was a young intern. “On my very first day of internship,” he said, “I realized that nurses knew a hell of a lot more than I did.”

Dr. Rabkin gave Dr. Clifford carte blanche to put together a nursing staff that would work collaboratively with doctors. There was some resistance at first. Medical doctors complained that instead of talking to one nurse about the patients in a section of a ward, say, they had to contact each patient’s primary nurse, which meant making a number of separate contacts.

“The resistance did not last long,” Dr. Rabkin said. “Because the doctors soon realized that they were getting far better information, and the patients were getting better care.”

Creating New Solutions from Caring Ideas

Sanofi announces nursing recognition program to help turn caring ideas into new solutions

Nurses worldwide are encouraged to enter an exciting recognition program showcasing nursing innovations and care solutions

DEADLINE EXTENDED TO March 31, 2012

Paris, France, 9 November, 2011…  Sanofi and its partnering organizations, the International Council of Nurses (ICN); the Nurse Practitioner Healthcare Foundation (NPHF); le Secrétariat International Des Infirmières et Infirmiers de l’Espace Francophone (SIDIIEF); and l’Association Française pour le Développement de l’Education Thérapeutique (AFDET) are delighted to announce the CARE CHALLENGE  recognition programme (www.care-challenge.com), inviting nurses to submit their innovative patient care ideas and projects. Nurses from anywhere around the world can share, exchange, and nominate projects and ideas for the CARE CHALLENGE initiative and be eligible to receive an award. To accommodate the international scope of this programme, the deadline for submissions online at www.care-challenge.com has been extended to March 31, 2012.

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