Managing your career as a nurse educator: considering an academic appointment

This column discusses academic appointments, requirements for appointments, and the appointment process.     

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential diagnosis of delirium

Abstract

Background. Medical toxicologists are frequently consulted when young patients present with delirium attributed to suspected poisoning. Medical toxicologists should be aware of non-toxicological mimics of delirium. We describe two patients ultimately diagnosed with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis for which a toxicological consultation was requested to evaluate for neuroleptic malignant syndrome (NMS). Case 1. A 21 year old male was sent from a psychiatric facility for new, worsening psychotic symptoms. He had autonomic instability, confusion, and hyper-reflexia. He was treated for NMS without improvement, and after an extensive workup was unrevealing, he was discharged home with significant cognitive dysfunction. Stored CSF later tested positive for anti-NMDAR antibodies. Case 2. A 27 year old female was sent from a psychiatric facility for a seizure and new psychiatric symptoms. She was agitated and had violent, alternating extremity flexion and extension along with autonomic instability. She was treated for NMS, rhabdomyolysis, and rabies before analysis of CSF demonstrated anti-NMDAR antibodies. Treatment included surgical resection of a suspicious ovarian cyst, steroids and IVIG, with moderate improvement. Discussion. Autoimmune syndromes of the central nervous system result from receptor dysfunction after an antibody response to extracellular or intracellular antigens, such as subunits of the NMDA receptor. The NMDA subunits NR2b and NR2a, in addition to the N-terminal region of the glycine binding NR1 subunit, have been implicated. Typical features such as memory loss, movement disorders, and hallucinations reflect the density and distribution of neuronal NDMA receptors. As young people, particularly young women, are predominantly affected, initial symptoms may be attributed to encephalopathy from drug abuse or schizophrenia. Toxicologists may be consulted as many features mimic NMS. Serum and cerebrospinal fluid can be checked for anti-NMDAR antibodies as part of a paraneoplastic or meningioencephalitis panel. Effective treatments have been described and include surgical resection and immunosuppressive medications.     

Medical career choice: Current status of research literature

This article examines the research evidence supporting relationships between both personal and social factors and the career choices of physicians in training. Although the research literature in this area is limited by a lack of longitudinal studies, a dependence on cross‐sectional designs, and a lack of multivariate investigations, data support relationships in each of the following areas: sociodemographic characteristics of student, student personality and attitudinal variables, institutional characteristics of the medical school, characteristics of the specialty training programs, and information available to students about the various careers. Additionally, this review investigates the stability of career preferences and career choices over time.     

Nurse managers in Australia: mentoring,leadership and career progression

Identification of those leadership qualities which nurses believe led to their successful attainment of a nursing management position may help in understanding how to identify and foster leadership potential amongst nursing staff. This study asked nurse managers to indicate the important factors which influenced and facilitated their entry to management positions with a particular reference to the development of leadership characteristics. The results suggest that the leadership qualities we expect nurse managers to display evolve in a largely random way. Additionally, there is evidence that the development of leadership skills and attainment of management positions remains fragmented and random in nature. Because of this, individual nurse managers develop leadership skills almost by default using informal strategies to learn and develop. These findings should provide direction to educational providers and senior managers who seek to develop future leaders and managers.     

Nurse prescribing in practice: patient choice in stoma care

In the first of a new series, Janice Lee examines the choices facing nurse prescribers when selecting items for stoma management. Studies have estimated that there are up to 100,000 people with a stoma in England and Wales, and stoma care therefore forms a significant part of community nursing caseloads. The enormous range of available items means that both patient and prescriber are likely to have difficulty selecting the correct device. Patient preferences, comfort and pricing all play a part in stoma appliance selection.     

Reflections on nursing as a career choice

Aim The study sought to explore (1) reasons for choosing nursing as a career; (2) expectations, if any, of nursing; (3) whether those expectations had been realized; (4) how such expectations had been met or could be met.
Background Nursing recruitment and retention are of central concern to health care. The Audit Commission have highlighted the costs of 'preventable' staff attrition and suggested that staff turnover may be minimized if staff policies reflected an understanding of the views and aspirations of staff.
Method A semi-structured interview survey was conducted with a quota sample of undergraduates attending one university ( n =40). Different course groups were represented.
Findings Satisfaction of caring for people together with long-term desire to nurse emerged as important factors influencing career choice. Expectations included working in a caring team and having a satisfying career. Conflict experienced in the clinical setting, disappointment over the treatment of nurses and changes within the NHS and nursing were considered among the factors detracting from nursing as a career.
Conclusion Health care management must recognize issues of concern to nurses and develop policies which make nurses feel valued.     

Choosing nursing as a career: a narrative analysis of millennial nurses' career choice of virtue

The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences and professional expectations of Millennial nurses (born 1980 or after) is a critical component of recruitment and retention strategies. This study utilized Polkinghorne's interpretive, narrative approach to understand how Millennial nurses explain, account for and make sense of their choice of nursing as a career. The positioning of nursing as a virtuous choice was both temporally and contextually influenced. The decision to enter the profession was initially emplotted around a traditional understanding of nursing as a virtuous profession: altruistic, noble, caring and compassionate. The centricity of virtues depicts one‐dimensional understanding of the nursing profession that alone could prove dissatisfying to a generation of professionals who have many career choices available to them. The narratives reveal how participants' perceptions and expectations remain influenced by a stereotypical understanding of nursing, an image that remains prevalent in society and which holds implications for the future recruitment, socialization and retention strategies for upcoming and future generations of nurses.     

Career in mental health still an unlikely career choice for nursing graduates: A replicated longitudinal study

The lack of qualified mental health nurses is at critical level with the problem likely to worsen as the aging mental health nursing workforce retires. This study investigates the career preferences of undergraduate nursing students by comparing preferences at the start, middle, and end of the Bachelor of Nursing program. The comparison of the cohorts gave an indication of the change in preferences over the intervening years. It replicates research completed in 1992, 1997, and 2001, and develops a profile of nursing career preferences and the rationale underpinning those preferences in a cohort of students (n = 150) who began their Bachelor of Nursing studies in 2007 and completed in 2009. The main findings included that, like the previous studies, mental health nursing is one of the least desirable career choices for most nurses at the start of their course and remains so as they approach graduation. The reasons change but the outcome remains the same. The current system of using the Bachelor of Nursing award to produce mental health nurses in Australia does not encourage nurses to consider a career in mental health nursing. Which begs the question: where will mental health nurses in the future come from?     

The similarities and differences between nurses with different career choice profiles: findings of an interview survey

This paper explores differences and similarities between participants who had selected nursing as an occupational choice from childhood and those for whom nursing was not a childhood occupational choice The implications of the findings are discussed