to the Editor


I was very moved and touched by “Am I Going to Be Okay?” by Danielle Allen, RN (Reflections, March). The whole time I was reading it, my mind was zooming through all of the things I wanted the nurse to say to her patient . . . and then she said them! More importantly, she did them. She gave the most important gift she could—she stayed with the patient. This article should be required reading for all nurses. It is beautifully written (I was engaged and couldn’t wait to hear how the story ended), it is concise (but skillfully conveys the nurse’s rapid thought processes), and it is educational (demonstrating for others how the nurse’s critical thinking in a difficult moment benefits both the patient and the nurse). Congratulations to Allen on such a masterful piece of work. I plan to share it widely. Connie Barden, MSN, RN, CCRN-E, CCNS Aliso Viejo, CA

Editor’s note: Barden is a member of AJN’s editorial board.


We know that the presence of more nurses with bachelor’s degrees results in significant improvements in patients’ health outcomes (“Bachelor’s Degrees Not Only Save Lives, They Save Hospitals Money,” In the News, February). However, nurses are poorly compensated for their level of education and contribution to the health care system. I am an associate’s degree nurse pursuing a bachelor of science in nursing. On a daily basis I see the value of higher education as it relates to patient care. Unfortunately, incentives to continue on this academic path are insufficient. Tuition reimbursement provided by the institution for which I work is barely enough to pay for a parttime semester at a city university. [email protected]

Even worse, nurses who work at my institution and complete a bachelor’s degree only receive a $1,200 increase in annual salary. Nyonoweh Marwieh, RN Jamaica, NY


As a collector of nursing history items, I have always been awed by the accomplishments of our nursing foremothers (“Securing Our Place in History,” Editorial, March). It was wonderful to see their faces on the cover of this issue. Thank you for the succinct reminder of the story of nursing and its great legacy. On tough days I remind myself of the battles our ancestors faced and regain the courage to keep moving forward. Marcia K. Flesner, PhD, RN Columbia, MO


As manager of a pediatric ICU and chair of our facility’s code committee, I implemented the rapid response program in our facility (“Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis,” February). One thing that helped to eliminate the barriers and stigma of calling for help was the implementation of an early warning assessment, PEWS (Pediatric Early Warning System). Objective data from an early detection intervention such as PEWS or MEWS (Modified Early Warning Score) can be more reliable than clinical judgment alone in the detection of subtle changes in a patient’s condition.1 Nurses, however, tend to frown upon additional documentation requirements. One alternative worth exploring is the use of automated, computerized data collection software that can analyze electronic medical records (EMR) and help predict clinical deterioration. The numeric computations and early warning score provided

by the Rothman Index, for example, is based on changes documented in the patient’s EMR and can thereby eliminate subjectivity and stigma.2 It’s possible that the incorporation of new evidence-based tools can make the decision to call a rapid response team an easy one. Emma J. Sandhu, BSN, RN, CCRN Mission Viejo, CA

REFERENCES 1. Fullerton JN, et al. Is the modified early warning score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation 2012;83(5): 557-62. 2. Finlay GD, et al. Measuring the modified early warning score and the Rothman index: advantages of utilizing the electronic medical record in an early warning system. J Hosp Med 2014; 9(2):116-9.


As a student nurse working toward a bachelor’s degree, I completely agree that a highly educated, skilled, diverse nursing workforce is necessary if we are to create a high-quality health care system that can meet current and emerging needs (“A Bold New Vision for America’s Health Care System,” February). Amir Ziyamov, RN Corona, NY ▼

AJN welcomes letters to the editor regarding recently published articles, although critiques of original research may be submitted at any time. Submissions must be typed, contain fewer than 300 words, and must include the correspondent’s name, city and state, phone number, and e-mail address. Please include no more than three references for any statistics or studies cited. Letters will be edited for length, clarity, and accuracy. Submission of a letter will constitute the author’s permission to publish it, although it doesn’t guarantee publication. Letters become the property of AJN and may be published in all media. Send letters to [email protected] com, or AJN Letters, Lippincott Williams & Wilkins, 333 Seventh Avenue, 19th Floor, New York, NY 10001, or (212) 886-1206 (fax). AJN ▼ June 2015

Vol. 115, No. 6


New health care vision.

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