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OSTEOPOROSIS
As a nurse diagnosed with severe
osteoporosis more than 10 years
ago, I found your comprehensive
coverage of this diagnosis most
helpful ("Prevention and Treat
ment of Osteoporosis in Postmen
opausal Women," August).
In spite of having a very well-
known and knowledgeable endo
crinologist caring for me, somehow
many of the particulars of living
with osteoporosis remained un
clear. The thorough discussions of
the pathophysiology of bone loss
and of pharmacotherapy were im
mensely helpful.
Beryl Skog, MA, RN,
AHN-BC, SANE-A
Cresskill, NJ
RURAL HEALTH
Gail M. Pfeifer's "Finding So
lutions to Advance Rural Health"
(In the News, September) con
cludes by mentioning a key com
ponent: collaboration. Indisputably,
one of the major hardships of ru
ral nursing is a lack of resources.
Building collaborative relation
ships is imperative if we are to
improve patient care and have
better patient outcomes.
The importance of collabo
ration became clear during my
recent work as a consultant and
project process owner with a ru
ral facility's program to improve
inpatient hyperglycemia care. The
chief nursing officer collaborated
with a pharmaceutical company
sponsoring a glycemic health ini
tiative, which gave the hospital
the free assistance it needed to get
the project off the ground. An in
terdepartmental and interdisciplin
ary methodology required the
involvement of those in the phar
macy, laboratory services, admis
sions, dietary, and information
technology departments, among
others. Realizing there were in
sufficient resources for long-term
sustainability of the initiative at the
hospital, the chief nursing officer
reached out to community-based
diabetes educators and home
health nurses. A new, evidence-
based protocol was created, an
education plan was developed,
and compliance parameters were
fixed.
Ultimately, by using an innova
tive approach and collaborative
relationship building, this rural fa
cility has changed the face of hy
perglycemia care in its community.
Laura Mosca, BSN, RN, CEN
Oklahoma City, OK
SPECIALIZED TRANSPORT
As a flight nurse and paramedic,
I read with interest "The Case
for Specialized Transport Teams"
(Viewpoint, September).
Critically ill and injured chil
dren and neonates who require
transport between facilities need
a different level of care than hos
pital or emergency field patients
do. The basic paramedic and
nursing curricula don't include
training in specialized interhospi
tal critical care transport or how
to care for critically ill children
and neonates in transit.
When making decisions about
transferring these patients, refer
ring providers should be aware of
the level of education and train
ing of the transport team. Teams
must, at a minimum, have train
ing and experience in the manage
ment of these patients in critical
care settings and must be capable
of functioning autonomously in
a variety of settings if immediate
communication with a physician
isn't possible, or if immediate
lifesaving actions are required.
Kellene H. Sauls, BSN, RN, EMT-P
Yulee, FL
RESOURCE NURSE PROGRAMS
I'm a nurse manager at a busy
rural medical-surgical unit and
always looking for innovative
ways to improve quality patient
care. After reading "Creating a
Unit-Based Resource Nurse Pro
gram" (Cultivating Quality, Sep
tember), I wondered about the
potential of this type of program
on my unit. It could improve RN
to-RN interaction, help to build
critical thinking skills, and lead to
the mentoring of novice nurses and
improvements in clinical judgment.
Each of these concepts is delicate:
without one, the others will suf
fer, especially in an environment
with complex patient populations
and relatively novice nurses.
The implications for quality pa
tient care outcomes and a healthy
work environment are significant,
and using current staff members to
fill the resource nurse role is a crea
tive way to do more with less. In
rural settings, resources and qual
ity mentoring potential may be
limited due to natural attrition. A
quality resource nurse program
could supplement the mentorship
process and provide greater lead
ership throughout an organization.
Shelley Simmons, BSN, RN
Altus, OK
I was impressed with the docu
mented improvement in skin care,
pain management, and diabetes
education outcomes after the im
plementation of the resource
nurse program. It's a benefit to
the program that the resource
nurse isn't removed from direct
patient care. Contact with patients
can clearly show which areas or
processes need improvement.
This model of education, the
process of peer mentoring, and
support for the staff will help to
improve employees' practice and
enhance the organization overall
by reducing staff turnover due to
job dissatisfaction.
Andrea Wright-Mattis, BSN, RN
Lake Worth, FL W
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AJN  December 2011  Vol. 111, No. 12
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