Letters – December 2011


Critical Access Hospitals

I take issue with the headline “Rural Hospital Care May Need Improvement,” (October) because you cannot make the statement without examining the causes for different outcomes and considering the likely outcomes if critical access hospitals were unavailable to initially treat and stabilize patients with life-threatening conditions. The three-bed ICU in our western Colorado 25-bed critical access hospital will soon expand to four.

We can transport by air, but half the time we have weather delays. In good weather, we’re two hours by ground from a tertiary facility and more than three hours from highly specialized care.

To ensure care consistent with accepted standards in larger urban ICUs, we employ very experienced nurses who are committed to excellent care. Half are CCRN certified.

Twice a year we validate nurse competency in high-risk, low-volume procedures. Evidence-based order sets reviewed against care standards address the VAP bundle, sepsis, pneumonia and acute myocardial infarction, with specialized order sets for STEMI and stroke.

We also have invested in telemedicine technology.

Joseph Dunn
Aspen, Colo.


I’m proud to work at a critical access hospital in west central Illinois. We have electronic patient records and order entry. Our specialized care unit — we don’t have an ICU — has 24-hour monitoring and staff who verify their competencies at least once a year.

All inpatient and emergency department nurses are BLS and ACLS certified. Most are PALS certified and TNCC prepared. All three shifts do safety huddles at the start of the shift, bedside reporting and hourly rounds.

We don’t have a cardiac cath lab, because we can’t economically support one. But our door-to-cath-lab time is 118 minutes or less, including flight time.

Mary Johnson
Monmouth, Ill.


Recognition for Certification

September’s article says “Nurses Earn More With Specialty Certification.” My employer pays for the exam.

As an individual, I continue to advocate for certification to be rewarded in other ways, such as making it part of the clinical ladder program so it qualifies for a pay increase. That has not happened.

But it has not stopped me from pursuing specialty, and now subspecialty, certification for personal growth. It would be even more motivating if we received additional recognition.

Dino Crisostom V. Bueno, Jr.
Clayton, Ohio


Certification in itself does not result in higher pay but is a prerequisite for the highest level of our clinical advancement program (CAP). Program members receive a financial incentive that applies to all hours worked. Staff nurses apply to be accepted.

An assigned sponsor helps each applicant compile for committee review a portfolio showing how she or he meets the level standards. Our organization encourages and supports certification by reimbursing for the initial certification exam.

Our progressive care unit manager orchestrates an on-site PCCN review course presented by certified nurses.

Claire Reed
Rutland, Vt.


In the hospital where I work there is no increase in pay rate after certification or recertification.

Ella Chiang
Baltimore, Md.


Roper St. Francis Healthcare, Charleston, S.C., promotes specialty certification by reimbursing review course and test expenses. Further academic education is promoted with scholarships and tuition reimbursement.

Both of these are recognized with announcements posted throughout the hospital. Further education does not result in an increased salary, but (nurses receive) a small compensation during their performance evaluation the year education is completed.

Grace Rankin
Charleston, S.C.


Our institution has an approved list of recognized certifications. Not all national nursing certifications are accepted or rewarded.

For certifications on the list, we receive a 4 percent bonus when we become certified and a 2 percent bonus for renewal.

About 75 certified nurses attend an annual recognition luncheon. Nurses are not paid to attend.

Renae Dougal
Boise, Idaho


We Can't Stand Alone

In “We Can’t Stand Alone” (October) Mary Stahl shows her knack for connecting with others and bringing us all in. Keep up the great work.

Teresa M. Brown
Columbus, Ga.



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