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Newsletters from 3/9/05, 11/9/04, 7/9/04, 5/29/04
© Critical Difference Inc. 2007
Newsletters from 12/21/07, 4/10/08, 6/1/08
CRITICAL DIFFERENCE INC.
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
9/9/09   Issue LX  850-477-1234
Newsletters from 6/29/09, 3/9/09,12/29/08,
Home
Making a Difference
The words “We are from the government, we are here
to help” sends chills down my spine.  Though, one
name from the government has filled my soul with
hope… CAHPS (Consumer Assessment of Healthcare
Providers and Systems)…if you haven’t heard these
letters whispered in the halls, you will soon.  CAHPS is
a patient survey tool that will measure how the hospital
is doing from a patient prospective.  The results will be
tallied and publicly reported.  The areas covered in the
survey:
– Communication with nurses         (Questions 1, 2, and
3)
– Communication with doctors         (Questions 5, 6,
and 7)
– Responsiveness of hospital staff         (Questions 4
and 11)
─Pain management
(Questions 13 and 14)
– Communication about medicines         (Questions 16
and 17)
– Discharge information
(Questions 19 and 20)
– Cleanliness of hospital environment
(Question 8)
– Quietness of hospital environment         (Question 9)
– Overall rating of hospital                 (Question 21)
Data from 2006-2007 trial time frames showed that
“…appropriate staffing levels may be one of the most
important factors to assure overall cost management
and financial performance”. Curtin and  Shaffer,
Concerro WebCast 7/09
One of the changes that you will see is hourly rounds.  
Long proven to be in the patient’s best interest and to
decrease the use of patient call lights, hourly rounds
actually decrease nursing care interruptions.
These patient surveys will allow hospital to hospital
comparisons, with questions that are not crafted by the
hospital themselves. Want to see how your local
hospitals are doing? www.hospitalcompare.hhs.gov   
Sometimes, even the government can make a
difference.
SIDS Deaths On The Rise
In fact, the number has quadrupled in the last 20 years!  
Noteworthy was the number of deaths due to be co- sleeping
53.3%.  Shapiro-Mendoza CK, et al.  Pediatrics 2009: 123(2):
533-9
Also noteworthy, in one study 72% of newborn nursery nurses
were aware that the supine position reduced SIDS deaths… yet,
only 30% said they most often placed the infants supine!
Stastny P et al. Nurs Res 2004
Get Control
In patients with atrial fibrillation and CHF, mortality rates were
no different with rhythm control or rate control. Don’t rush for
the paddles, get control of the rate first.  Roy D, et al. N Engl J
Med 2008: 358(25): 2667-77
Information About Available Services
Listed as number one need by family members trying to care
for a sick relative.  If your discharge instructions didn’t include
available resources,  you let them down.   Yedidia and
Tiedemann AJN 9/08 VOL 108, No 9
How to get up with us:
From anywhere on earth www.CDIstaffing.com
From anywhere in the area M-F 9-5:
850-477-1234
From anywhere in the states
M-F 9-5:
866-CDI- NURSE (866-234-6877)
Fax:  850-434-1515
Toll free fax:  866-473-3238
Past newsletter links bottom of page
CRITICAL DIFFERENCE INC.
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
12/09/09   Issue LXI  850-477-1234
Making a Difference
Call it a midlife crisis ... without the affair.  At fifty-four I
have started
to swim, run and bike. This morning’s routine is my
toughest yet.  Swam a third of a mile, ran two miles, walked
2, hope to run all 4 someday.  The good news is the 42
pounds of wt. loss.  The bad news is I ache all over, and
am not sure that my lateral tuberosity hasn't ripped off this
morning.  Haven’t had this many aches and pains since
working med/
surg 3 decades ago. The bike ride is up next.  It leaves you
alone with your thoughts and breathlessness for an hour,
so don't come empty minded.  Today it brought thoughts of
the panel discussion at the local junior college recently,  
where the incoming Jan. 2010 class had a chance to ask
me and 2 other nursing administrative types some
questions.  In answer to a question on how to get a job on
graduation in a specialty unit, we all urged them as in a
single voice to start in Med/Surg.
Where will these 150 fresh faces fit in? We have yet to
establish in hospital career days where med/surg nurses
can attend presentations by specialty dept. supervisors.
Those interested in transferring would be put on a wish
list.  Nurses on this list would be given a skills/course
requirement packet.  Complete this and move to the top of
the list, opening a formal pipeline to align prepared talent
to need.  This would also vastly increase skill sets at all
levels.
Where?  Med/Surg said we all.  Yet none of us at that table
could physically do that job now, and I am now 1.5 hours
into this exercise routine.  Thirty years ago and working
only 8 hour shifts I would go home and lay on the floor to
get the spasms out of my back.
Where are the over bed lifts?  On a recent visit to the floor
the nurse  couldn’t even find the pt. transfer board.  The
board has hand holds for 6 people, 6x35lbs. means the
max. pt transfer wt. was 210, much less than the patients
actual wt.  The nurse laughed at my figures, there wasn't
that many people working... even on days.
Where are the nurses?  With 1800 employees working for
the hospital, why are less than 200 of these employees
RNs?  There are over 8,000 nurses in the Panhandle.  If we
could change some of our shifts to 8 hour shifts, it would
allow more of the nurses over 35 yrs. old to come back to
nursing.   We need to seriously talk to HR about getting
part time nurses in every nursing division; the savings in
overtime would spin the CFO’s head.  The hospital with the
most nurses, the least over time and the best opinion polls
wins.
Where is my foot pedal?  I am going to have to break down
and buy some bike shoes...and maybe a real seat, every
bump puts me in doubt of ever walking again.  Ah the joys
of aging.
CRITICAL DIFFERENCE INC.
PROFESIONAL FREEDOM THROUGH INDEPENDENC
E
3/09/10   Issue LXII  850-477-1234
Jump Your Kids SAT Scores
Children that had skills in delayed gratification had SAT scores an   average 210 points over kids with average gratification
tolerance.  The difference?  
The parents.  A large number of the parents had delayed payment, gratification, etc. so that the kids would receive more if
they elected to delay getting the “payment” so they would get more for having waited.  Mom might offer, “Your allowance
plus a dollar bonus, if you wait to get it until after we come back from the mall.” Look for ways to improve your child’s ability
to wait for gratification and you change their lives forever.  The difference another 210 points on the SAT will make in their
lives…well these kids also went on to achieve far more in life as well.  Give it a try.   May 18 2009 New Yorker
FDA Warning on Rocephin
The FDA has determined that Rocephin precipitating in solution could be harmful to human life.  When the medication is
mixed with IV fluids containing Calcium (like Lactated Ringers), it precipitates.
Making a Difference
Administration’s outer office is quiet. A bit nervous,
you are sitting waiting for an interview for a job you
have done for years.  Maybe not at this facility, but
this interview comes with a twist.  There are 8 others
sitting next to you waiting their turn for a staff
position!  What happened?  The worst recession in
70 years has kept folks in the work force, down
staffed others and brought part timers into full time
slots.  Behind the door something stirs and a very
competent but very pale face heads for the exit.  
Another’s name is called and the wait begins anew.  
What could have drained the blood from her face like
that?  In your last interview it was more a review of
your resume, a look at the list of places you have
worked; maybe some polite talk about shared
experiences, colleagues, or previous cities lived in.  
But that kind of an interview wasn’t what drained that
interviewee’s face. Your job in this style interview is to
be the kind of person the interviewee would like to
work with.  You had done some homework, it showed
a shift to a style called a behavioral interview.  You
read that you might be asked a question like “Tell me
about a time you had to go above and beyond to
help a patient.”  You knew that the scores would
depend on doing a good job on covering… Situation-
where you describe a specific situation.   Hindrances-
where you would identify hindrances to a resolution.  
Action- where you would explain the action you took.  
Results – here you discuss the results of your
actions.  And finally Evaluate- where you summarize
what you did or learned.  SHARE
Strasser PB Improving applicant interviewing- using
as behavioral-based questioning approach AAOHN J.
2005:53(4); 149-151
Your job here is to be a good story teller.  Practice doing several of
these questions with a coworker and anyone can sound like a
Cracker Jack Nurse.
 This isn’t that hard.  A shuffle at the door
and the nurse you saw stroll in comes out even paler than the last,
and her hands are quivering as she reaches for the door knob.  
What is going on?  It is a third method of interviewing, and the most
effective.  Before you arrived, they had researched your resume
and folks were actually called and an effort made to find out how
good a nurse you are.  When the nurse is interviewed for an area
she is not asked to tell stories but to answer questions about
nursing care specific to that area.  Tell me about DKA?   What
symptoms will a hypoxic patient display?  Tell me what you know
about low molecular weight Heparin?  Today, the interview is going
to truly reflect the best candidate for the job. Would it have been
you?   
An Asprin Every Other Day
Keeps strokes and first heart attacks away…unless you are
female!  Researchers found that in women it managed only to
decrease strokes.  Ridker, P.M., Cook, N.R., et al. (2005) A
randomized trial of low-dose aspirin in the primary prevention of
cardiovascular disease in women. N Engl J Med,352(13), 1293
Third Leading Cause of Death
In kids between 15 and 19 depression is the 3rd leading cause
of death.  That represents a decline in adolescent suicide rate!  
Brent DA. Antidepressants and pediatric depression-the risk of
doing nothing. N Engl J Med 2004:351 (16):1598-601.  Think
you have seen someone who has a problem?  They probably
do.  Get them help.
Post Abdominal Surgery Hypoxia
Think CPAP with O2.  Researchers found that patients moved to
CPAP were less likely to need intubation, 1 vs 10 (in a study of
104), less likely to get pneumonia, 2 vs 10, less likely to get
septic, 2 vs 11, less likely to die, 0 vs 3.  O2 good, CPAP with O2
better.  Squadrone
V, et al. JAMA 2005:293(5): 589-95
Newsletters from 9/09, 12/09,
and 3/10
Newsletters from 10/1/07, 6/24/07, 3/19/07
Newsletters from 12/19/06, 7/9/06, 3/9/06
Newsletters from 12/9/05, 9/9/05, 6/9/05
Newsletters from 3/9/05, 11/9/04, 7/9/04, 5/29/04
© Critical Difference Inc. 2007
Newsletters from 12/21/07, 4/10/08, 6/1/08
CRITICAL DIFFERENCE INC.
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
9/9/09   Issue LX  850-477-1234
Newsletters from 6/29/09, 3/9/09,12/29/08,
Home
Making a Difference
The words “We are from the government, we are here
to help” sends chills down my spine.  Though, one
name from the government has filled my soul with
hope… CAHPS (Consumer Assessment of Healthcare
Providers and Systems)…if you haven’t heard these
letters whispered in the halls, you will soon.  CAHPS is
a patient survey tool that will measure how the hospital
is doing from a patient prospective.  The results will be
tallied and publicly reported.  The areas covered in the
survey:
– Communication with nurses         (Questions 1, 2, and
3)
– Communication with doctors         (Questions 5, 6,
and 7)
– Responsiveness of hospital staff         (Questions 4
and 11)
─Pain management
(Questions 13 and 14)
– Communication about medicines         (Questions 16
and 17)
– Discharge information
(Questions 19 and 20)
– Cleanliness of hospital environment
(Question 8)
– Quietness of hospital environment         (Question 9)
– Overall rating of hospital                 (Question 21)
Data from 2006-2007 trial time frames showed that
“…appropriate staffing levels may be one of the most
important factors to assure overall cost management
and financial performance”. Curtin and  Shaffer,
Concerro WebCast 7/09
One of the changes that you will see is hourly rounds.  
Long proven to be in the patient’s best interest and to
decrease the use of patient call lights, hourly rounds
actually decrease nursing care interruptions.
These patient surveys will allow hospital to hospital
comparisons, with questions that are not crafted by the
hospital themselves. Want to see how your local
hospitals are doing? www.hospitalcompare.hhs.gov   
Sometimes, even the government can make a
difference.
SIDS Deaths On The Rise
In fact, the number has quadrupled in the last 20 years!  
Noteworthy was the number of deaths due to be co- sleeping
53.3%.  Shapiro-Mendoza CK, et al.  Pediatrics 2009: 123(2):
533-9
Also noteworthy, in one study 72% of newborn nursery nurses
were aware that the supine position reduced SIDS deaths… yet,
only 30% said they most often placed the infants supine!
Stastny P et al. Nurs Res 2004
Get Control
In patients with atrial fibrillation and CHF, mortality rates were
no different with rhythm control or rate control. Don’t rush for
the paddles, get control of the rate first.  Roy D, et al. N Engl J
Med 2008: 358(25): 2667-77
Information About Available Services
Listed as number one need by family members trying to care
for a sick relative.  If your discharge instructions didn’t include
available resources,  you let them down.   Yedidia and
Tiedemann AJN 9/08 VOL 108, No 9
How to get up with us:
From anywhere on earth www.CDIstaffing.com
From anywhere in the area M-F 9-5:
850-477-1234
From anywhere in the states
M-F 9-5:
866-CDI- NURSE (866-234-6877)
Fax:  850-434-1515
Toll free fax:  866-473-3238
Past newsletter links bottom of page
CRITICAL DIFFERENCE INC.
PROFESIONAL FREEDOM THROUGH INDEPENDENCE
12/09/09   Issue LXI  850-477-1234
Making a Difference
Call it a midlife crisis ... without the affair.  At fifty-four I
have started
to swim, run and bike. This morning’s routine is my
toughest yet.  Swam a third of a mile, ran two miles, walked
2, hope to run all 4 someday.  The good news is the 42
pounds of wt. loss.  The bad news is I ache all over, and
am not sure that my lateral tuberosity hasn't ripped off this
morning.  Haven’t had this many aches and pains since
working med/
surg 3 decades ago. The bike ride is up next.  It leaves you
alone with your thoughts and breathlessness for an hour,
so don't come empty minded.  Today it brought thoughts of
the panel discussion at the local junior college recently,  
where the incoming Jan. 2010 class had a chance to ask
me and 2 other nursing administrative types some
questions.  In answer to a question on how to get a job on
graduation in a specialty unit, we all urged them as in a
single voice to start in Med/Surg.
Where will these 150 fresh faces fit in? We have yet to
establish in hospital career days where med/surg nurses
can attend presentations by specialty dept. supervisors.
Those interested in transferring would be put on a wish
list.  Nurses on this list would be given a skills/course
requirement packet.  Complete this and move to the top of
the list, opening a formal pipeline to align prepared talent
to need.  This would also vastly increase skill sets at all
levels.
Where?  Med/Surg said we all.  Yet none of us at that table
could physically do that job now, and I am now 1.5 hours
into this exercise routine.  Thirty years ago and working
only 8 hour shifts I would go home and lay on the floor to
get the spasms out of my back.
Where are the over bed lifts?  On a recent visit to the floor
the nurse  couldn’t even find the pt. transfer board.  The
board has hand holds for 6 people, 6x35lbs. means the
max. pt transfer wt. was 210, much less than the patients
actual wt.  The nurse laughed at my figures, there wasn't
that many people working... even on days.
Where are the nurses?  With 1800 employees working for
the hospital, why are less than 200 of these employees
RNs?  There are over 8,000 nurses in the Panhandle.  If we
could change some of our shifts to 8 hour shifts, it would
allow more of the nurses over 35 yrs. old to come back to
nursing.   We need to seriously talk to HR about getting
part time nurses in every nursing division; the savings in
overtime would spin the CFO’s head.  The hospital with the
most nurses, the least over time and the best opinion polls
wins.
Where is my foot pedal?  I am going to have to break down
and buy some bike shoes...and maybe a real seat, every
bump puts me in doubt of ever walking again.  Ah the joys
of aging.
CRITICAL DIFFERENCE INC.
PROFESIONAL FREEDOM THROUGH INDEPENDENC
E
3/09/10   Issue LXII  850-477-1234
Jump Your Kids SAT Scores
Children that had skills in delayed gratification had SAT scores an   average 210 points over kids with average gratification
tolerance.  The difference?  
The parents.  A large number of the parents had delayed payment, gratification, etc. so that the kids would receive more if
they elected to delay getting the “payment” so they would get more for having waited.  Mom might offer, “Your allowance
plus a dollar bonus, if you wait to get it until after we come back from the mall.” Look for ways to improve your child’s ability
to wait for gratification and you change their lives forever.  The difference another 210 points on the SAT will make in their
lives…well these kids also went on to achieve far more in life as well.  Give it a try.   May 18 2009 New Yorker
FDA Warning on Rocephin
The FDA has determined that Rocephin precipitating in solution could be harmful to human life.  When the medication is
mixed with IV fluids containing Calcium (like Lactated Ringers), it precipitates.
Making a Difference
Administration’s outer office is quiet. A bit nervous,
you are sitting waiting for an interview for a job you
have done for years.  Maybe not at this facility, but
this interview comes with a twist.  There are 8 others
sitting next to you waiting their turn for a staff
position!  What happened?  The worst recession in
70 years has kept folks in the work force, down
staffed others and brought part timers into full time
slots.  Behind the door something stirs and a very
competent but very pale face heads for the exit.  
Another’s name is called and the wait begins anew.  
What could have drained the blood from her face like
that?  In your last interview it was more a review of
your resume, a look at the list of places you have
worked; maybe some polite talk about shared
experiences, colleagues, or previous cities lived in.  
But that kind of an interview wasn’t what drained that
interviewee’s face. Your job in this style interview is to
be the kind of person the interviewee would like to
work with.  You had done some homework, it showed
a shift to a style called a behavioral interview.  You
read that you might be asked a question like “Tell me
about a time you had to go above and beyond to
help a patient.”  You knew that the scores would
depend on doing a good job on covering… Situation-
where you describe a specific situation.   Hindrances-
where you would identify hindrances to a resolution.  
Action- where you would explain the action you took.  
Results – here you discuss the results of your
actions.  And finally Evaluate- where you summarize
what you did or learned.  SHARE
Strasser PB Improving applicant interviewing- using
as behavioral-based questioning approach AAOHN J.
2005:53(4); 149-151
Your job here is to be a good story teller.  Practice doing several of
these questions with a coworker and anyone can sound like a
Cracker Jack Nurse.
 This isn’t that hard.  A shuffle at the door
and the nurse you saw stroll in comes out even paler than the last,
and her hands are quivering as she reaches for the door knob.  
What is going on?  It is a third method of interviewing, and the most
effective.  Before you arrived, they had researched your resume
and folks were actually called and an effort made to find out how
good a nurse you are.  When the nurse is interviewed for an area
she is not asked to tell stories but to answer questions about
nursing care specific to that area.  Tell me about DKA?   What
symptoms will a hypoxic patient display?  Tell me what you know
about low molecular weight Heparin?  Today, the interview is going
to truly reflect the best candidate for the job. Would it have been
you?   
An Asprin Every Other Day
Keeps strokes and first heart attacks away…unless you are
female!  Researchers found that in women it managed only to
decrease strokes.  Ridker, P.M., Cook, N.R., et al. (2005) A
randomized trial of low-dose aspirin in the primary prevention of
cardiovascular disease in women. N Engl J Med,352(13), 1293
Third Leading Cause of Death
In kids between 15 and 19 depression is the 3rd leading cause
of death.  That represents a decline in adolescent suicide rate!  
Brent DA. Antidepressants and pediatric depression-the risk of
doing nothing. N Engl J Med 2004:351 (16):1598-601.  Think
you have seen someone who has a problem?  They probably
do.  Get them help.
Post Abdominal Surgery Hypoxia
Think CPAP with O2.  Researchers found that patients moved to
CPAP were less likely to need intubation, 1 vs 10 (in a study of
104), less likely to get pneumonia, 2 vs 10, less likely to get
septic, 2 vs 11, less likely to die, 0 vs 3.  O2 good, CPAP with O2
better.  Squadrone
V, et al. JAMA 2005:293(5): 589-95